NC Medicaid Physician Services Fee Schedule (See Affordable Care Act (ACA) Tab for Applicable ACA Defined Taxonomy Rates) Provider Specialty 001 Fee Schedule Updated on: 6/26/2020

***The Agency's fee schedule rates below were set as of January 1, 2014 unless otherwise noted*** Rate changes after January 1, 2014 are based on the January 1st RVU of the year in which the service was initally established.

The inclusion of a rate on this table does not guarantee that a service is covered. Please refer to the Medicaid Billing Guide and the Medicaid and Health Choice Clinical Policies on the DHB Web Site.

Providers should always bill their usual and customary charges. Please use the monthly NC Medicaid Bulletins for additions, changes and deletion to this schedule.

Medicaid Maximum Allowable

NON-FACILITY Effective FEE END DATE PROCEDURE CODE MODIFIER PROCEDURE DESCRIPTION FACILITY RATE RATE Date of Rate 01967 ANESTH/ANALG VAG DELIVERY $ 220.11 $ 220.11 3/1/2020 12/31/9999 01996 HOSP MANAGE CONT DRUG ADMIN $ 40.88 $ 40.88 3/1/2020 12/31/9999 10004 FNA BX W/O IMG GDN EA ADDL $ 38.83 $ 46.10 3/1/2020 12/31/9999 10005 FNA BX W/US GDN 1ST LES $ 65.75 $ 110.89 3/1/2020 12/31/9999 10006 FNA BX W/US GDN EA ADDL $ 44.80 $ 53.29 3/1/2020 12/31/9999 10007 FNA BX W/FLUOR GDN 1ST LES $ 84.41 $ 247.72 3/1/2020 12/31/9999 10008 FNA BX W/FLUOR GDN EA ADDL $ 55.05 $ 139.88 3/1/2020 12/31/9999 10009 FNA BX W/CT GDN 1ST LES $ 102.46 $ 404.53 3/1/2020 12/31/9999 10010 FNA BX W/CT GDN EA ADDL $ 74.89 $ 244.25 3/1/2020 12/31/9999 10011 FNA BX W/MR GDN 1ST LES $ 54.57 $ 108.33 3/1/2020 12/31/9999 10012 FNA BX W/MR GDN EA ADDL $ 54.57 $ 108.33 3/1/2020 12/31/9999 10021 FNA BX W/O IMG GDN 1ST LES $ 54.98 $ 105.50 3/1/2020 12/31/9999 10030 GUIDE CATHET FLUID DRAINAGE $ 132.37 $ 645.99 3/1/2020 12/31/9999 10035 PERQ DEV SOFT TISS 1ST IMAG $ 78.18 $ 459.69 3/1/2020 12/31/9999 10036 PERQ DEV SOFT TISS ADD IMAG $ 39.36 $ 398.32 3/1/2020 12/31/9999 10040 ACNE SURGERY $ 66.71 $ 75.81 3/1/2020 12/31/9999 10060 DRAINAGE OF SKIN ABSCESS $ 70.76 $ 81.63 3/1/2020 12/31/9999 10061 DRAINAGE OF SKIN ABSCESS $ 126.15 $ 140.54 3/1/2020 12/31/9999 10080 DRAINAGE OF PILONIDAL CYST $ 72.31 $ 120.49 3/1/2020 12/31/9999 10081 DRAINAGE OF PILONIDAL CYST $ 126.75 $ 190.20 3/1/2020 12/31/9999 10120 REMOVE FOREIGN BODY $ 69.38 $ 99.65 3/1/2020 12/31/9999 10121 REMOVE FOREIGN BODY $ 142.05 $ 194.34 3/1/2020 12/31/9999 10140 DRAINAGE OF HEMATOMA/FLUID $ 90.65 $ 114.73 3/1/2020 12/31/9999 10160 PUNCTURE DRAINAGE OF LESION $ 73.00 $ 93.25 3/1/2020 12/31/9999 10180 COMPLEX DRAINAGE WOUND $ 133.77 $ 172.25 3/1/2020 12/31/9999 11000 DEBRIDE INFECTED SKIN $ 25.75 $ 40.44 3/1/2020 12/31/9999 11001 DEBRIDE INFECTED SKIN ADD-ON $ 12.98 $ 17.09 3/1/2020 12/31/9999 11004 DEBRIDE GENITALIA & PERINEUM $ 461.03 $ 461.03 3/1/2020 12/31/9999 11005 DEBRIDE ABDOM WALL $ 601.67 $ 601.67 3/1/2020 12/31/9999 11006 DEBRIDE GENIT/PER/ABDOM WALL $ 569.27 $ 569.27 3/1/2020 12/31/9999 11008 REMOVE MESH FROM ABD WALL $ 216.89 $ 216.89 3/1/2020 12/31/9999 11010 DEBRIDE SKIN AT FX SITE $ 219.49 $ 347.56 3/1/2020 12/31/9999 11011 DEBRIDE SKIN MUSC AT FX SITE $ 236.70 $ 387.67 3/1/2020 12/31/9999 11012 DEB SKIN BONE AT FX SITE $ 342.57 $ 529.69 3/1/2020 12/31/9999 11042 DEB SUBQ TISSUE 20 SQ CM/< $ 36.83 $ 55.92 3/1/2020 12/31/9999 11043 DEB MUSC/FASCIA 20 SQ CM/< $ 179.07 $ 204.04 3/1/2020 12/31/9999 11044 DEB BONE 20 SQ CM/< $ 246.38 $ 278.71 3/1/2020 12/31/9999 11045 DEB SUBQ TISSUE ADD-ON $ 14.92 $ 25.78 3/1/2020 12/31/9999 11046 DEB MUSC/FASCIA ADD-ON $ 31.77 $ 44.92 3/1/2020 12/31/9999 11047 DEB BONE ADD-ON $ 55.20 $ 73.77 3/1/2020 12/31/9999 11055 TRIM SKIN LESION $ 18.49 $ 36.11 3/1/2020 12/31/9999 11056 TRIM SKIN LESIONS 2 TO 4 $ 26.07 $ 44.29 3/1/2020 12/31/9999 11057 TRIM SKIN LESIONS OVER 4 $ 33.85 $ 53.53 3/1/2020 12/31/9999 11102 TANGNTL BX SKIN SINGLE LES $ 35.33 $ 85.63 3/1/2020 12/31/9999 11103 TANGNTL BX SKIN EA SEP/ADDL $ 20.46 $ 46.22 3/1/2020 12/31/9999 11104 PUNCH BX SKIN SINGLE LESION $ 44.34 $ 107.67 3/1/2020 12/31/9999 11105 PUNCH BX SKIN EA SEP/ADDL $ 24.18 $ 52.96 3/1/2020 12/31/9999 11106 INCAL BX SKN SINGLE LES $ 53.91 $ 130.26 3/1/2020 12/31/9999 11107 INCAL BX SKN EA SEP/ADDL $ 28.85 $ 62.49 3/1/2020 12/31/9999 11200 REMOVAL OF SKIN TAGS 2.0 CM $ 57.53 $ 96.89 3/1/2020 12/31/9999 11305 SHAVE SKIN LESION 0.5 CM/< $ 29.44 $ 51.77 3/1/2020 12/31/9999 11306 SHAVE SKIN LESION 0.6-1.0 CM $ 44.60 $ 71.62 3/1/2020 12/31/9999 11307 SHAVE SKIN LESION 1.1-2.0 CM $ 52.58 $ 84.61 3/1/2020 12/31/9999 11308 SHAVE SKIN LESION >2.0 CM $ 63.26 $ 95.28 3/1/2020 12/31/9999 11310 SHAVE SKIN LESION 0.5 CM/< $ 33.68 $ 62.46 3/1/2020 12/31/9999 11311 SHAVE SKIN LESION 0.6-1.0 CM $ 49.34 $ 79.59 3/1/2020 12/31/9999 11312 SHAVE SKIN LESION 1.1-2.0 CM $ 56.65 $ 91.90 3/1/2020 12/31/9999 11313 SHAVE SKIN LESION >2.0 CM $ 75.79 $ 115.15 3/1/2020 12/31/9999 11400 EXC TR-EXT B9+MARG 0.5 CM< $ 56.16 $ 84.95 3/1/2020 12/31/9999 11401 EXC TR-EXT B9+MARG 0.6-1 CM $ 74.90 $ 104.86 3/1/2020 12/31/9999 11402 EXC TR-EXT B9+MARG 1.1-2 CM $ 82.96 $ 117.03 3/1/2020 12/31/9999 11403 EXC TR-EXT B9+MARG 2.1-3CM $ 105.55 $ 134.94 3/1/2020 12/31/9999 11404 EXC TR-EXT B9+MARG 3.1-4 CM $ 117.58 $ 153.70 3/1/2020 12/31/9999 11406 EXC TR-EXT B9+MARG >4.0 CM $ 176.27 $ 217.69 3/1/2020 12/31/9999 11420 EXC H-F-NK-SP B9+MARG 0.5/< $ 60.89 $ 86.14 3/1/2020 12/31/9999 11421 EXC H-F-NK-SP B9+MARG 0.6-1 $ 82.41 $ 112.10 3/1/2020 12/31/9999 11422 EXC H-F-NK-SP B9+MARG 1.1-2 $ 99.38 $ 125.23 3/1/2020 12/31/9999 11423 EXC H-F-NK-SP B9+MARG 2.1-3 $ 116.08 $ 146.04 3/1/2020 12/31/9999 11424 EXC H-F-NK-SP B9+MARG 3.1-4 $ 133.94 $ 168.61 3/1/2020 12/31/9999 11426 EXC H-F-NK-SP B9+MARG >4 CM $ 205.00 $ 242.60 3/1/2020 12/31/9999 11440 EXC FACE-MM B9+MARG 0.5 CM/< $ 72.78 $ 94.22 3/1/2020 12/31/9999 11441 EXC FACE-MM B9+MARG 0.6-1 CM $ 95.78 $ 119.87 3/1/2020 12/31/9999 11442 EXC FACE-MM B9+MARG 1.1-2 CM $ 106.94 $ 135.15 3/1/2020 12/31/9999 11443 EXC FACE-MM B9+MARG 2.1-3 CM $ 132.43 $ 162.68 3/1/2020 12/31/9999 11444 EXC FACE-MM B9+MARG 3.1-4 CM $ 170.13 $ 205.67 3/1/2020 12/31/9999 11446 EXC FACE-MM B9+MARG >4 CM $ 241.16 $ 280.82 3/1/2020 12/31/9999 11450 REMOVAL SWEAT GLAND LESION $ 175.30 $ 256.07 3/1/2020 12/31/9999 11451 REMOVAL SWEAT GLAND LESION $ 231.95 $ 335.34 3/1/2020 12/31/9999 11462 REMOVAL SWEAT GLAND LESION $ 168.50 $ 252.50 3/1/2020 12/31/9999 11463 REMOVAL SWEAT GLAND LESION $ 236.54 $ 344.65 3/1/2020 12/31/9999 11470 REMOVAL SWEAT GLAND LESION $ 199.78 $ 281.43 3/1/2020 12/31/9999 11471 REMOVAL SWEAT GLAND LESION $ 251.67 $ 354.20 3/1/2020 12/31/9999 11600 EXC TR-EXT MAL+MARG 0.5 CM/< $ 84.80 $ 131.21 3/1/2020 12/31/9999 11601 EXC TR-EXT MAL+MARG 0.6-1 CM $ 109.75 $ 162.33 3/1/2020 12/31/9999 11602 EXC TR-EXT MAL+MARG 1.1-2 CM $ 120.79 $ 178.37 3/1/2020 12/31/9999 11603 EXC TR-EXT MAL+MARG 2.1-3 CM $ 143.78 $ 203.11 3/1/2020 12/31/9999 11604 EXC TR-EXT MAL+MARG 3.1-4 CM $ 158.04 $ 224.43 3/1/2020 12/31/9999 11606 EXC TR-EXT MAL+MARG >4 CM $ 234.70 $ 316.93 3/1/2020 12/31/9999 11620 EXC H-F-NK-SP MAL+MARG 0.5/< $ 86.08 $ 133.96 3/1/2020 12/31/9999 11621 EXC S/N/H/F/G MAL+MRG 0.6-1 $ 110.94 $ 163.81 3/1/2020 12/31/9999 11622 EXC S/N/H/F/G MAL+MRG 1.1-2 $ 128.00 $ 185.57 3/1/2020 12/31/9999 11623 EXC S/N/H/F/G MAL+MRG 2.1-3 $ 157.90 $ 217.23 3/1/2020 12/31/9999 11624 EXC S/N/H/F/G MAL+MRG 3.1-4 $ 179.61 $ 244.53 3/1/2020 12/31/9999 11626 EXC S/N/H/F/G MAL+MRG >4 CM $ 224.95 $ 298.10 3/1/2020 12/31/9999 11640 EXC F/E/E/N/L MAL+MRG 0.5CM< $ 90.68 $ 140.03 3/1/2020 12/31/9999 11641 EXC F/E/E/N/L MAL+MRG 0.6-1 $ 118.42 $ 172.47 3/1/2020 12/31/9999 11642 EXC F/E/E/N/L MAL+MRG 1.1-2 $ 139.79 $ 199.12 3/1/2020 12/31/9999 11643 EXC F/E/E/N/L MAL+MRG 2.1-3 $ 174.81 $ 234.75 3/1/2020 12/31/9999 11644 EXC F/E/E/N/L MAL+MRG 3.1-4 $ 218.00 $ 289.97 3/1/2020 12/31/9999 11646 EXC F/E/E/N/L MAL+MRG >4 CM $ 307.02 $ 383.10 3/1/2020 12/31/9999 11719 TRIM NAIL(S) ANY NUMBER $ 7.27 $ 15.79 3/1/2020 12/31/9999 11720 DEBRIDE NAIL 1-5 $ 13.61 $ 23.30 3/1/2020 12/31/9999 11721 DEBRIDE NAIL 6 OR MORE $ 23.26 $ 33.54 3/1/2020 12/31/9999 11730 REMOVAL OF NAIL PLATE $ 47.15 $ 73.88 3/1/2020 12/31/9999 11732 REMOVE NAIL PLATE ADD-ON $ 24.51 $ 34.48 3/1/2020 12/31/9999 11740 DRAIN BLOOD FROM UNDER NAIL $ 24.30 $ 33.42 3/1/2020 12/31/9999 11750 REMOVAL OF NAIL BED $ 134.11 $ 159.96 3/1/2020 12/31/9999 11755 BIOPSY NAIL UNIT $ 66.74 $ 99.34 3/1/2020 12/31/9999 11760 REPAIR OF NAIL BED $ 99.69 $ 148.45 3/1/2020 12/31/9999 11762 RECONSTRUCTION OF NAIL BED $ 154.00 $ 200.71 3/1/2020 12/31/9999 11765 EXCISION OF NAIL FOLD TOE $ 51.18 $ 94.08 3/1/2020 12/31/9999 11770 REMOVE PILONIDAL CYST SIMPLE $ 135.10 $ 191.50 3/1/2020 12/31/9999 11771 REMOVE PILONIDAL CYST EXTEN $ 312.90 $ 393.98 3/1/2020 12/31/9999 11772 REMOVE PILONIDAL CYST COMPL $ 407.61 $ 478.11 3/1/2020 12/31/9999 11900 INJECT SKIN LESIONS 7 $ 37.76 $ 53.33 3/1/2020 12/31/9999 11920 CORRECT SKIN COLOR 6.0 CM/< $ 94.99 $ 160.65 3/1/2020 12/31/9999 11921 CORRECT SKN COLOR 6.1-20.0CM $ 104.74 $ 154.08 3/1/2020 12/31/9999 11950 TX CONTOUR DEFECTS 1 CC/< $ 39.63 $ 56.67 3/1/2020 12/31/9999 11951 TX CONTOUR DEFECTS 1.1-5.0CC $ 55.27 $ 75.85 3/1/2020 12/31/9999 11952 TX CONTOUR DEFECTS 5.1-10CC $ 79.80 $ 106.83 3/1/2020 12/31/9999 11954 TX CONTOUR DEFECTS >10.0 CC $ 89.64 $ 121.95 3/1/2020 12/31/9999 11960 INSERT TISSUE EXPANDER(S) $ 689.15 $ 689.15 3/1/2020 12/31/9999 11970 REPLACE TISSUE EXPANDER $ 453.45 $ 453.45 3/1/2020 12/31/9999 11971 REMOVE TISSUE EXPANDER(S) $ 223.53 $ 334.27 3/1/2020 12/31/9999 11976 REMOVE CONTRACEPTIVE CAPSULE $ 76.90 $ 113.33 3/1/2020 12/31/9999 11980 IMPLANT HORMONE PELLET(S) $ 64.61 $ 80.76 3/1/2020 12/31/9999 11981 INSERT DRUG IMPLANT DEVICE $ 67.91 $ 103.75 3/1/2020 12/31/9999 11982 REMOVE DRUG IMPLANT DEVICE $ 82.86 $ 119.58 3/1/2020 12/31/9999 11983 REMOVE/INSERT DRUG IMPLANT $ 151.73 $ 186.10 3/1/2020 12/31/9999 12001 RPR S/N/AX/GEN/TRNK 2.5CM/< $ 79.38 $ 109.63 3/1/2020 12/31/9999 12002 RPR S/N/AX/GEN/TRNK2.6-7.5CM $ 88.10 $ 116.89 3/1/2020 12/31/9999 12004 RPR S/N/AX/GEN/TRK7.6-12.5CM $ 103.61 $ 137.98 3/1/2020 12/31/9999 12005 RPR S/N/A/GEN/TRK12.6-20.0CM $ 129.20 $ 172.10 3/1/2020 12/31/9999 12006 RPR S/N/A/GEN/TRK20.1-30.0CM $ 163.28 $ 213.79 3/1/2020 12/31/9999 12007 RPR S/N/AX/GEN/TRNK >30.0 CM $ 186.63 $ 242.15 3/1/2020 12/31/9999 12011 RPR F/E/E/N/L/M 2.5 CM/< $ 82.07 $ 116.43 3/1/2020 12/31/9999 12013 RPR F/E/E/N/L/M 2.6-5.0 CM $ 93.60 $ 128.55 3/1/2020 12/31/9999 12014 RPR F/E/E/N/L/M 5.1-7.5 CM $ 112.76 $ 151.84 3/1/2020 12/31/9999 12015 RPR F/E/E/N/L/M 7.6-12.5 CM $ 141.55 $ 190.91 3/1/2020 12/31/9999 12016 RPR FE/E/EN/L/M 12.6-20.0 CM $ 172.82 $ 228.33 3/1/2020 12/31/9999 12017 RPR FE/E/EN/L/M 20.1-30.0 CM $ 205.77 $ 205.77 3/1/2020 12/31/9999 12018 RPR F/E/E/N/L/M >30.0 CM $ 254.32 $ 254.32 3/1/2020 12/31/9999 12020 CLOSURE OF SPLIT WOUND $ 142.76 $ 197.98 3/1/2020 12/31/9999 12021 CLOSURE OF SPLIT WOUND $ 103.55 $ 117.96 3/1/2020 12/31/9999 12031 INTMD RPR S/A/T/EXT 2.5 CM/< $ 119.63 $ 174.85 3/1/2020 12/31/9999 12032 INTMD RPR S/A/T/EXT 2.6-7.5 $ 146.92 $ 224.76 3/1/2020 12/31/9999 12034 INTMD RPR S/TR/EXT 7.6-12.5 $ 153.92 $ 222.36 3/1/2020 12/31/9999 12035 INTMD RPR S/A/T/EXT 12.6-20 $ 180.55 $ 271.02 3/1/2020 12/31/9999 12036 INTMD RPR S/A/T/EXT 20.1-30 $ 208.45 $ 297.75 3/1/2020 12/31/9999 12037 INTMD RPR S/TR/EXT >30.0 CM $ 242.69 $ 336.09 3/1/2020 12/31/9999 12041 INTMD RPR N-HF/GENIT 2.5CM/< $ 128.18 $ 183.42 3/1/2020 12/31/9999 12042 INTMD RPR N-HF/GENIT2.6-7.5 $ 149.82 $ 213.85 3/1/2020 12/31/9999 12044 INTMD RPR N-HF/GENIT7.6-12.5 $ 161.61 $ 246.79 3/1/2020 12/31/9999 12045 INTMD RPR N-HF/GENIT12.6-20 $ 187.61 $ 273.68 3/1/2020 12/31/9999 12046 INTMD RPR N-HF/GENIT20.1-30 $ 221.06 $ 324.17 3/1/2020 12/31/9999 12047 INTMD RPR N-HF/GENIT >30.0CM $ 241.91 $ 347.95 3/1/2020 12/31/9999 12051 INTMD RPR FACE/MM 2.5 CM/< $ 137.15 $ 197.07 3/1/2020 12/31/9999 12052 INTMD RPR FACE/MM 2.6-5.0 CM $ 160.81 $ 223.38 3/1/2020 12/31/9999 12053 INTMD RPR FACE/MM 5.1-7.5 CM $ 163.68 $ 245.64 3/1/2020 12/31/9999 12054 INTMD RPR FACE/MM 7.6-12.5CM $ 174.10 $ 260.18 3/1/2020 12/31/9999 12055 INTMD RPR FACE/MM 12.6-20 CM $ 212.63 $ 313.96 3/1/2020 12/31/9999 12056 INTMD RPR FACE/MM 20.1-30.0 $ 259.38 $ 370.71 3/1/2020 12/31/9999 12057 INTMD RPR FACE/MM >30.0 CM $ 296.91 $ 414.41 3/1/2020 12/31/9999 13100 CMPLX RPR TRUNK 1.1-2.5 CM $ 178.97 $ 234.20 3/1/2020 12/31/9999 13101 CMPLX RPR TRUNK 2.6-7.5 CM $ 217.57 $ 295.71 3/1/2020 12/31/9999 13102 CMPLX RPR TRUNK ADDL 5CM/< $ 58.44 $ 80.48 3/1/2020 12/31/9999 13120 CMPLX RPR S/A/L 1.1-2.5 CM $ 187.05 $ 243.44 3/1/2020 12/31/9999 13121 CMPLX RPR S/A/L 2.6-7.5 CM $ 246.59 $ 327.38 3/1/2020 12/31/9999 13122 CMPLX RPR S/A/L ADDL 5 CM/> $ 66.97 $ 90.16 3/1/2020 12/31/9999 13131 CMPLX RPR F/C/C/M/N/AX/G/H/F $ 211.09 $ 268.97 3/1/2020 12/31/9999 13132 CMPLX RPR F/C/C/M/N/AX/G/H/F $ 355.87 $ 431.35 3/1/2020 12/31/9999 13133 CMPLX RPR F/C/C/M/N/AX/G/H/F $ 104.02 $ 127.82 3/1/2020 12/31/9999 13151 CMPLX RPR E/N/E/L 1.1-2.5 CM $ 244.52 $ 305.61 3/1/2020 12/31/9999 13152 CMPLX RPR E/N/E/L 2.6-7.5 CM $ 329.53 $ 421.48 3/1/2020 12/31/9999 13153 CMPLX RPR E/N/E/L ADDL 5CM/< $ 112.72 $ 140.34 3/1/2020 12/31/9999 13160 LATE CLOSURE OF WOUND $ 618.21 $ 618.21 3/1/2020 12/31/9999 14000 TIS TRNFR TRUNK 10 SQ CM/< $ 377.07 $ 456.08 3/1/2020 12/31/9999 14001 TIS TRNFR TRUNK 10.1-30SQCM $ 501.06 $ 593.89 3/1/2020 12/31/9999 14020 TIS TRNFR S/A/L 10 SQ CM/< $ 431.45 $ 513.70 3/1/2020 12/31/9999 14021 TIS TRNFR S/A/L 10.1-30 SQCM $ 558.32 $ 652.03 3/1/2020 12/31/9999 14040 TIS TRNFR F/C/C/M/N/A/G/H/F $ 491.42 $ 571.90 3/1/2020 12/31/9999 14041 TIS TRNFR F/C/C/M/N/A/G/H/F $ 607.24 $ 711.82 3/1/2020 12/31/9999 14060 TIS TRNFR E/N/E/L 10 SQ CM/< $ 519.09 $ 582.54 3/1/2020 12/31/9999 14061 TIS TRNFR E/N/E/L10.1-30SQCM $ 647.50 $ 762.36 3/1/2020 12/31/9999 14301 TIS TRNFR ANY 30.1-60 SQ CM $ 558.98 $ 659.73 3/1/2020 12/31/9999 14302 TIS TRNFR ADDL 30 SQ CM $ 145.10 $ 145.10 3/1/2020 12/31/9999 14350 FILLETED FINGER/TOE FLAP $ 574.15 $ 574.15 3/1/2020 12/31/9999 15002 WOUND PREP TRK/ARM/LEG $ 176.60 $ 248.56 3/1/2020 12/31/9999 15003 WOUND PREP ADDL 100 CM $ 35.84 $ 54.05 3/1/2020 12/31/9999 15004 WOUND PREP F/N/HF/G $ 220.79 $ 301.86 3/1/2020 12/31/9999 15005 WND PREP F/N/HF/G ADDL CM $ 71.11 $ 91.37 3/1/2020 12/31/9999 15040 HARVEST CULTURED SKIN GRAFT $ 99.19 $ 187.31 3/1/2020 12/31/9999 15050 SKIN PINCH GRAFT $ 330.35 $ 399.39 3/1/2020 12/31/9999 15100 SKIN SPLT GRFT TRNK/ARM/LEG $ 542.76 $ 643.81 3/1/2020 12/31/9999 15101 SKIN SPLT GRFT T/A/L ADD-ON $ 87.37 $ 140.83 3/1/2020 12/31/9999 15110 EPIDRM AUTOGRFT TRNK/ARM/LEG $ 560.18 $ 638.02 3/1/2020 12/31/9999 15111 EPIDRM AUTOGRFT T/A/L ADD-ON $ 84.55 $ 93.66 3/1/2020 12/31/9999 15115 EPIDRM A-GRFT FACE/NCK/HF/G $ 580.03 $ 646.12 3/1/2020 12/31/9999 15116 EPIDRM A-GRFT F/N/HF/G ADDL $ 116.59 $ 127.16 3/1/2020 12/31/9999 15120 SKN SPLT A-GRFT FAC/NCK/HF/G $ 595.54 $ 700.12 3/1/2020 12/31/9999 15121 SKN SPLT A-GRFT F/N/HF/G ADD $ 133.75 $ 199.25 3/1/2020 12/31/9999 15130 DERM AUTOGRAFT TRNK/ARM/LEG $ 424.04 $ 500.42 3/1/2020 12/31/9999 15131 DERM AUTOGRAFT T/A/L ADD-ON $ 69.20 $ 76.24 3/1/2020 12/31/9999 15135 DERM AUTOGRAFT FACE/NCK/HF/G $ 583.89 $ 647.64 3/1/2020 12/31/9999 15136 DERM AUTOGRAFT F/N/HF/G ADD $ 65.75 $ 70.46 3/1/2020 12/31/9999 15150 CULT SKIN GRFT T/ARM/LEG $ 486.01 $ 526.55 3/1/2020 12/31/9999 15151 CULT SKIN GRFT T/A/L ADDL $ 91.49 $ 98.82 3/1/2020 12/31/9999 15152 CULT SKIN GRAFT T/A/L +% $ 120.23 $ 128.45 3/1/2020 12/31/9999 15155 CULT SKIN GRAFT F/N/HF/G $ 520.95 $ 554.73 3/1/2020 12/31/9999 15156 CULT SKIN GRFT F/N/HFG ADD $ 130.42 $ 137.17 3/1/2020 12/31/9999 15157 CULT EPIDERM GRFT F/N/HFG +% $ 141.60 $ 151.29 3/1/2020 12/31/9999 15200 SKIN FULL GRAFT TRUNK $ 496.99 $ 597.74 3/1/2020 12/31/9999 15201 SKIN FULL GRAFT TRUNK ADD-ON $ 62.49 $ 109.79 3/1/2020 12/31/9999 15220 SKIN FULL GRAFT SCLP/ARM/LEG $ 469.13 $ 567.82 3/1/2020 12/31/9999 15221 SKIN FULL GRAFT ADD-ON $ 57.17 $ 102.10 3/1/2020 12/31/9999 15240 SKIN FULL GRFT FACE/GENIT/HF $ 599.35 $ 682.77 3/1/2020 12/31/9999 15241 SKIN FULL GRAFT ADD-ON $ 89.25 $ 137.13 3/1/2020 12/31/9999 15260 SKIN FULL GRAFT EEN & LIPS $ 650.25 $ 741.02 3/1/2020 12/31/9999 15261 SKIN FULL GRAFT ADD-ON $ 112.06 $ 159.94 3/1/2020 12/31/9999 15271 SKIN SUB GRAFT TRNK/ARM/LEG $ 51.86 $ 85.11 3/1/2020 12/31/9999 15272 SKIN SUB GRAFT T/A/L ADD-ON $ 10.33 $ 16.14 3/1/2020 12/31/9999 15273 SKIN SUB GRFT T/ARM/LG CHILD $ 123.42 $ 174.70 3/1/2020 12/31/9999 15274 SKN SUB GRFT T/A/L CHILD ADD $ 26.30 $ 41.33 3/1/2020 12/31/9999 15275 SKIN SUB GRAFT FACE/NK/HF/G $ 60.08 $ 91.33 3/1/2020 12/31/9999 15276 SKIN SUB GRAFT F/N/HF/G ADDL $ 14.79 $ 20.00 3/1/2020 12/31/9999 15277 SKN SUB GRFT F/N/HF/G CHILD $ 128.05 $ 176.33 3/1/2020 12/31/9999 15278 SKN SUB GRFT F/N/HF/G CH ADD $ 32.55 $ 48.77 3/1/2020 12/31/9999 15570 SKIN PEDICLE FLAP TRUNK $ 543.11 $ 657.38 3/1/2020 12/31/9999 15572 SKIN PEDICLE FLAP ARMS/LEGS $ 549.56 $ 638.26 3/1/2020 12/31/9999 15574 PEDCLE FH/CH/CH/M/N/AX/G/H/F $ 580.61 $ 673.43 3/1/2020 12/31/9999 15576 PEDICLE E/N/E/L/NTRORAL $ 509.81 $ 598.24 3/1/2020 12/31/9999 15600 DELAY FLAP TRUNK $ 150.20 $ 238.61 3/1/2020 12/31/9999 15610 DELAY FLAP ARMS/LEGS $ 178.00 $ 240.86 3/1/2020 12/31/9999 15620 DELAY FLAP F/C/C/N/AX/G/H/F $ 236.57 $ 320.29 3/1/2020 12/31/9999 15630 DELAY FLAP EYE/NOS/EAR/LIP $ 258.59 $ 338.78 3/1/2020 12/31/9999 15650 TRANSFER SKIN PEDICLE FLAP $ 291.81 $ 378.46 3/1/2020 12/31/9999 15730 MDFC FLAP W/PRSRV VASC PEDCL $ 804.94 $ 1,344.25 3/1/2020 12/31/9999 15731 FOREHEAD FLAP W/VASC PEDICLE $ 772.92 $ 849.87 3/1/2020 12/31/9999 15733 MUSC MYOQ/FSCQ FLP H&N PEDCL $ 919.09 $ 919.09 3/1/2020 12/31/9999 15734 MUSCLE-SKIN GRAFT TRUNK $ 1,033.29 $ 1,157.26 3/1/2020 12/31/9999 15736 MUSCLE-SKIN GRAFT ARM $ 892.35 $ 1,024.53 3/1/2020 12/31/9999 15738 MUSCLE-SKIN GRAFT LEG $ 973.11 $ 1,095.01 3/1/2020 12/31/9999 15740 ISLAND PEDICLE FLAP GRAFT $ 655.05 $ 757.87 3/1/2020 12/31/9999 15750 NEUROVASCULAR PEDICLE FLAP $ 695.16 $ 695.16 3/1/2020 12/31/9999 15756 FREE MYO/SKIN FLAP MICROVASC $ 1,837.55 $ 1,837.55 3/1/2020 12/31/9999 15757 FREE SKIN FLAP MICROVASC $ 1,820.03 $ 1,820.03 3/1/2020 12/31/9999 15758 FREE FASCIAL FLAP MICROVASC $ 1,820.98 $ 1,820.98 3/1/2020 12/31/9999 15760 COMPOSITE SKIN GRAFT $ 537.20 $ 629.42 3/1/2020 12/31/9999 15769 GRFG AUTOL SOFT TISS DIR EXC $ 426.48 $ 426.48 3/1/2020 12/31/9999 15770 DERMA-FAT-FASCIA GRAFT $ 497.24 $ 497.24 3/1/2020 12/31/9999 15777 ACELLULAR DERM MATRIX IMPLT $ 125.61 $ 125.61 3/1/2020 12/31/9999 15780 DERMABRASION TOTAL FACE $ 490.51 $ 617.72 3/1/2020 12/31/9999 15781 DERMABRASION SEGMENTAL FACE $ 321.68 $ 395.12 3/1/2020 12/31/9999 15782 DERMABRASION OTHER THAN FACE $ 308.33 $ 416.43 3/1/2020 12/31/9999 15783 DERMABRASION SUPRFL ANY SITE $ 278.86 $ 359.35 3/1/2020 12/31/9999 15786 ABRASION LESION SINGLE $ 105.50 $ 176.01 3/1/2020 12/31/9999 15787 ABRASION LESIONS ADD-ON $ 14.81 $ 35.96 3/1/2020 12/31/9999 15788 CHEMICAL PEEL FACE EPIDERM $ 176.10 $ 310.04 3/1/2020 12/31/9999 15789 CHEMICAL PEEL FACE DERMAL $ 320.64 $ 418.75 3/1/2020 12/31/9999 15792 CHEMICAL PEEL NONFACIAL $ 192.70 $ 304.62 3/1/2020 12/31/9999 15793 CHEMICAL PEEL NONFACIAL $ 265.55 $ 347.80 3/1/2020 12/31/9999 15819 PLASTIC SURGERY NECK $ 560.24 $ 560.24 3/1/2020 12/31/9999 15820 REVISION OF LOWER EYELID $ 360.96 $ 397.38 3/1/2020 12/31/9999 15821 REVISION OF LOWER EYELID $ 383.00 $ 422.95 3/1/2020 12/31/9999 15822 REVISION OF UPPER EYELID $ 276.11 $ 310.77 3/1/2020 12/31/9999 15823 REVISION OF UPPER EYELID $ 455.05 $ 492.93 3/1/2020 12/31/9999 15830 EXC SKIN ABD $ 893.24 $ 893.24 3/1/2020 12/31/9999 15832 EXCISE EXCESSIVE SKIN THIGH $ 678.08 $ 678.08 3/1/2020 12/31/9999 15833 EXCISE EXCESSIVE SKIN LEG $ 639.19 $ 639.19 3/1/2020 12/31/9999 15834 EXCISE EXCESSIVE SKIN HIP $ 636.96 $ 636.96 3/1/2020 12/31/9999 15835 EXCISE EXCESSIVE SKIN BUTTCK $ 673.67 $ 673.67 3/1/2020 12/31/9999 15836 EXCISE EXCESSIVE SKIN ARM $ 561.13 $ 561.13 3/1/2020 12/31/9999 15837 EXCISE EXCESS SKIN ARM/HAND $ 507.84 $ 578.05 3/1/2020 12/31/9999 15838 EXCISE EXCESS SKIN FAT PAD $ 437.45 $ 437.45 3/1/2020 12/31/9999 15839 EXCISE EXCESS SKIN & TISSUE $ 550.27 $ 639.28 3/1/2020 12/31/9999 15840 NERVE PALSY FASCIAL GRAFT $ 772.31 $ 772.31 3/1/2020 12/31/9999 15841 NERVE PALSY MUSCLE GRAFT $ 1,293.99 $ 1,293.99 3/1/2020 12/31/9999 15842 NERVE PALSY MICROSURG GRAFT $ 2,044.31 $ 2,044.31 3/1/2020 12/31/9999 15845 SKIN AND MUSCLE REPAIR FACE $ 724.49 $ 724.49 3/1/2020 12/31/9999 15847 EXC SKIN ABD ADD-ON $ 289.68 $ 289.68 3/1/2020 12/31/9999 15851 REMOVE SUTURES DIFF SURGEON $ 36.16 $ 69.35 3/1/2020 12/31/9999 15852 DRESSING CHANGE NOT FOR BURN $ 37.64 $ 37.64 3/1/2020 12/31/9999 15860 TEST FOR BLOOD FLOW IN GRAFT $ 88.52 $ 88.52 3/1/2020 12/31/9999 15920 REMOVAL OF TAIL BONE ULCER $ 444.55 $ 444.55 3/1/2020 12/31/9999 15922 REMOVAL OF TAIL BONE ULCER $ 564.67 $ 564.67 3/1/2020 12/31/9999 15931 REMOVE SACRUM PRESSURE SORE $ 507.43 $ 507.43 3/1/2020 12/31/9999 15933 REMOVE SACRUM PRESSURE SORE $ 623.70 $ 623.70 3/1/2020 12/31/9999 15934 REMOVE SACRUM PRESSURE SORE $ 696.32 $ 696.32 3/1/2020 12/31/9999 15935 REMOVE SACRUM PRESSURE SORE $ 827.86 $ 827.86 3/1/2020 12/31/9999 15936 REMOVE SACRUM PRESSURE SORE $ 675.05 $ 675.05 3/1/2020 12/31/9999 15937 REMOVE SACRUM PRESSURE SORE $ 788.85 $ 788.85 3/1/2020 12/31/9999 15940 REMOVE HIP PRESSURE SORE $ 521.63 $ 521.63 3/1/2020 12/31/9999 15941 REMOVE HIP PRESSURE SORE $ 676.21 $ 676.21 3/1/2020 12/31/9999 15944 REMOVE HIP PRESSURE SORE $ 666.38 $ 666.38 3/1/2020 12/31/9999 15945 REMOVE HIP PRESSURE SORE $ 740.19 $ 740.19 3/1/2020 12/31/9999 15946 REMOVE HIP PRESSURE SORE $ 1,239.68 $ 1,239.68 3/1/2020 12/31/9999 15950 REMOVE THIGH PRESSURE SORE $ 431.34 $ 431.34 3/1/2020 12/31/9999 15951 REMOVE THIGH PRESSURE SORE $ 615.30 $ 615.30 3/1/2020 12/31/9999 15952 REMOVE THIGH PRESSURE SORE $ 647.16 $ 647.16 3/1/2020 12/31/9999 15953 REMOVE THIGH PRESSURE SORE $ 720.54 $ 720.54 3/1/2020 12/31/9999 15956 REMOVE THIGH PRESSURE SORE $ 868.22 $ 868.22 3/1/2020 12/31/9999 15958 REMOVE THIGH PRESSURE SORE $ 885.38 $ 885.38 3/1/2020 12/31/9999 16000 INITIAL TREATMENT OF BURN(S) $ 36.92 $ 51.90 3/1/2020 12/31/9999 16020 DRESS/DEBRID P-THICK BURN S $ 43.47 $ 60.50 3/1/2020 12/31/9999 16025 DRESS/DEBRID P-THICK BURN M $ 89.31 $ 110.46 3/1/2020 12/31/9999 16030 DRESS/DEBRID P-THICK BURN L $ 101.43 $ 131.97 3/1/2020 12/31/9999 16035 INCISION OF BURN SCAB INITI $ 167.98 $ 167.98 3/1/2020 12/31/9999 16036 ESCHAROTOMY ADDL INCISION $ 66.94 $ 66.94 3/1/2020 12/31/9999 17000 DESTRUCT PREMALG LESION $ 40.86 $ 58.19 3/1/2020 12/31/9999 17003 DESTRUCT PREMALG LES 2-14 $ 3.59 $ 5.65 3/1/2020 12/31/9999 17004 DESTROY PREMAL LESIONS 15/> $ 103.19 $ 131.10 3/1/2020 12/31/9999 17106 DESTRUCTION OF SKIN LESIONS $ 213.03 $ 257.69 3/1/2020 12/31/9999 17107 DESTRUCTION OF SKIN LESIONS $ 281.74 $ 341.37 3/1/2020 12/31/9999 17108 DESTRUCTION OF SKIN LESIONS $ 367.68 $ 436.71 3/1/2020 12/31/9999 17110 DESTRUCT B9 LESION 1-14 $ 50.77 $ 80.45 3/1/2020 12/31/9999 17111 DESTRUCT LESION 15 OR MORE $ 63.46 $ 95.78 3/1/2020 12/31/9999 17250 CHEM CAUT OF GRANLTJ TISSUE $ 27.96 $ 54.68 3/1/2020 12/31/9999 17260 DESTRUCTION OF SKIN LESIONS $ 51.20 $ 70.58 3/1/2020 12/31/9999 17261 DESTRUCTION OF SKIN LESIONS $ 69.06 $ 104.88 3/1/2020 12/31/9999 17262 DESTRUCTION OF SKIN LESIONS $ 88.44 $ 128.10 3/1/2020 12/31/9999 17263 DESTRUCTION OF SKIN LESIONS $ 97.95 $ 141.44 3/1/2020 12/31/9999 17264 DESTRUCTION OF SKIN LESIONS $ 104.69 $ 151.39 3/1/2020 12/31/9999 17266 DESTRUCTION OF SKIN LESIONS $ 121.99 $ 172.23 3/1/2020 12/31/9999 17270 DESTRUCTION OF SKIN LESIONS $ 74.70 $ 109.07 3/1/2020 12/31/9999 17271 DESTRUCTION OF SKIN LESIONS $ 84.12 $ 120.54 3/1/2020 12/31/9999 17272 DESTRUCTION OF SKIN LESIONS $ 97.61 $ 138.15 3/1/2020 12/31/9999 17273 DESTRUCTION OF SKIN LESIONS $ 110.24 $ 154.31 3/1/2020 12/31/9999 17274 DESTRUCTION OF SKIN LESIONS $ 135.42 $ 183.02 3/1/2020 12/31/9999 17276 DESTRUCTION OF SKIN LESIONS $ 163.05 $ 212.39 3/1/2020 12/31/9999 17280 DESTRUCTION OF SKIN LESIONS $ 67.88 $ 102.25 3/1/2020 12/31/9999 17281 DESTRUCTION OF SKIN LESIONS $ 94.86 $ 130.98 3/1/2020 12/31/9999 17282 DESTRUCTION OF SKIN LESIONS $ 110.21 $ 151.92 3/1/2020 12/31/9999 17283 DESTRUCTION OF SKIN LESIONS $ 138.09 $ 183.92 3/1/2020 12/31/9999 17284 DESTRUCTION OF SKIN LESIONS $ 164.83 $ 214.17 3/1/2020 12/31/9999 17286 DESTRUCTION OF SKIN LESIONS $ 221.74 $ 271.68 3/1/2020 12/31/9999 17311 MOHS 1 STAGE H/N/HF/G $ 297.49 $ 514.55 3/1/2020 12/31/9999 17312 MOHS ADDL STAGE $ 158.24 $ 307.45 3/1/2020 12/31/9999 17313 MOHS 1 STAGE T/A/L $ 267.07 $ 469.44 3/1/2020 12/31/9999 17314 MOHS ADDL STAGE T/A/L $ 146.88 $ 284.95 3/1/2020 12/31/9999 17315 MOHS SURG ADDL BLOCK $ 41.75 $ 61.72 3/1/2020 12/31/9999 17340 CRYOTHERAPY OF SKIN $ 36.00 $ 37.18 3/1/2020 12/31/9999 17360 SKIN PEEL THERAPY $ 76.60 $ 98.63 3/1/2020 12/31/9999 19000 DRAINAGE OF BREAST LESION $ 37.11 $ 84.99 3/1/2020 12/31/9999 19001 DRAIN BREAST LESION ADD-ON $ 18.54 $ 21.79 3/1/2020 12/31/9999 19020 INCISION OF BREAST LESION $ 214.77 $ 319.06 3/1/2020 12/31/9999 19030 INJECTION FOR BREAST X-RAY $ 67.14 $ 130.88 3/1/2020 12/31/9999 19081 BX BREAST 1ST LESION STRTCTC $ 152.69 $ 555.25 3/1/2020 12/31/9999 19082 BX BREAST ADD LESION STRTCTC $ 73.49 $ 449.22 3/1/2020 12/31/9999 19083 BX BREAST 1ST LESION US IMAG $ 143.23 $ 551.62 3/1/2020 12/31/9999 19084 BX BREAST ADD LESION US IMAG $ 69.09 $ 443.08 3/1/2020 12/31/9999 19085 BX BREAST 1ST LESION MR IMAG $ 167.35 $ 834.89 3/1/2020 12/31/9999 19086 BX BREAST ADD LESION MR IMAG $ 76.59 $ 667.16 3/1/2020 12/31/9999 19100 BX BREAST PERCUT W/O IMAGE $ 54.43 $ 104.37 3/1/2020 12/31/9999 19101 BIOPSY OF BREAST OPEN $ 163.52 $ 238.43 3/1/2020 12/31/9999 19110 NIPPLE EXPLORATION $ 242.74 $ 331.75 3/1/2020 12/31/9999 19112 EXCISE BREAST DUCT FISTULA $ 217.69 $ 309.62 3/1/2020 12/31/9999 19120 REMOVAL OF BREAST LESION $ 298.57 $ 346.14 3/1/2020 12/31/9999 19125 EXCISION BREAST LESION $ 331.43 $ 383.43 3/1/2020 12/31/9999 19126 EXCISION ADDL BREAST LESION $ 125.67 $ 125.67 3/1/2020 12/31/9999 19281 PERQ DEVICE BREAST 1ST IMAG $ 87.12 $ 201.68 3/1/2020 12/31/9999 19282 PERQ DEVICE BREAST EA IMAG $ 42.06 $ 140.02 3/1/2020 12/31/9999 19283 PERQ DEV BREAST 1ST STRTCTC $ 88.00 $ 228.78 3/1/2020 12/31/9999 19284 PERQ DEV BREAST ADD STRTCTC $ 42.36 $ 167.71 3/1/2020 12/31/9999 19285 PERQ DEV BREAST 1ST US IMAG $ 74.62 $ 385.65 3/1/2020 12/31/9999 19286 PERQ DEV BREAST ADD US IMAG $ 36.31 $ 323.15 3/1/2020 12/31/9999 19287 PERQ DEV BREAST 1ST MR GUIDE $ 119.22 $ 712.11 3/1/2020 12/31/9999 19288 PERQ DEV BREAST ADD MR GUIDE $ 54.36 $ 568.27 3/1/2020 12/31/9999 19294 PREP TUM CAV IORT PRTL MAST $ 142.85 $ 142.85 3/1/2020 12/31/9999 19296 PLACE PO BREAST CATH FOR RAD $ 161.30 $ 2,898.15 3/1/2020 12/31/9999 19297 PLACE BREAST CATH FOR RAD $ 73.03 $ 73.03 3/1/2020 12/31/9999 19298 PLACE BREAST RAD TUBE/CATHS $ 265.88 $ 995.25 3/1/2020 12/31/9999 19300 REMOVAL OF BREAST TISSUE $ 289.18 $ 367.31 3/1/2020 12/31/9999 19301 PARTIAL MASTECTOMY $ 463.60 $ 463.60 3/1/2020 12/31/9999 19302 P-MASTECTOMY W/LN REMOVAL $ 663.56 $ 663.56 3/1/2020 12/31/9999 19303 MAST SIMPLE COMPLETE $ 717.32 $ 717.32 3/1/2020 12/31/9999 19305 MAST RADICAL $ 827.19 $ 827.19 3/1/2020 12/31/9999 19306 MAST RAD URBAN TYPE $ 866.64 $ 866.64 3/1/2020 12/31/9999 19307 MAST MOD RAD $ 871.70 $ 871.70 3/1/2020 12/31/9999 19316 SUSPENSION OF BREAST $ 591.15 $ 591.15 3/1/2020 12/31/9999 19318 REDUCTION OF LARGE BREAST $ 870.31 $ 870.31 3/1/2020 12/31/9999 19325 ENLARGE BREAST WITH IMPLANT $ 488.87 $ 488.87 3/1/2020 12/31/9999 19328 REMOVAL OF BREAST IMPLANT $ 368.61 $ 368.61 3/1/2020 12/31/9999 19330 REMOVAL OF IMPLANT MATERIAL $ 474.51 $ 474.51 3/1/2020 12/31/9999 19340 IMMEDIATE BREAST PROSTHESIS $ 309.87 $ 309.87 3/1/2020 12/31/9999 19342 DELAYED BREAST PROSTHESIS $ 697.84 $ 697.84 3/1/2020 12/31/9999 19350 BREAST RECONSTRUCTION $ 513.92 $ 632.89 3/1/2020 12/31/9999 19357 BREAST RECONSTRUCTION $ 1,171.84 $ 1,171.84 3/1/2020 12/31/9999 19361 BREAST RECONSTR W/LAT FLAP $ 1,260.67 $ 1,260.67 3/1/2020 12/31/9999 19364 BREAST RECONSTRUCTION $ 2,158.31 $ 2,158.31 3/1/2020 12/31/9999 19366 BREAST RECONSTRUCTION $ 1,066.52 $ 1,066.52 3/1/2020 12/31/9999 19367 BREAST RECONSTRUCTION $ 1,394.56 $ 1,394.56 3/1/2020 12/31/9999 19368 BREAST RECONSTRUCTION $ 1,729.94 $ 1,729.94 3/1/2020 12/31/9999 19369 BREAST RECONSTRUCTION $ 1,577.32 $ 1,577.32 3/1/2020 12/31/9999 19370 SURGERY OF BREAST CAPSULE $ 514.15 $ 514.15 3/1/2020 12/31/9999 19371 REMOVAL OF BREAST CAPSULE $ 593.23 $ 593.23 3/1/2020 12/31/9999 19380 REVISE BREAST RECONSTRUCTION $ 580.29 $ 580.29 3/1/2020 12/31/9999 20100 EXPLORE WOUND NECK $ 460.51 $ 460.51 3/1/2020 12/31/9999 20101 EXPLORE WOUND CHEST $ 156.94 $ 291.77 3/1/2020 12/31/9999 20102 EXPLORE WOUND ABDOMEN $ 191.40 $ 341.81 3/1/2020 12/31/9999 20103 EXPLORE WOUND EXTREMITY $ 272.14 $ 417.54 3/1/2020 12/31/9999 20150 EXCISE EPIPHYSEAL BAR $ 743.24 $ 743.24 3/1/2020 12/31/9999 20200 MUSCLE BIOPSY $ 72.45 $ 141.47 3/1/2020 12/31/9999 20205 DEEP MUSCLE BIOPSY $ 115.34 $ 193.77 3/1/2020 12/31/9999 20206 NEEDLE BIOPSY MUSCLE $ 50.76 $ 195.00 3/1/2020 12/31/9999 20220 BONE BIOPSY TROCAR/NEEDLE $ 63.38 $ 135.36 3/1/2020 12/31/9999 20225 BONE BIOPSY TROCAR/NEEDLE $ 96.13 $ 506.78 3/1/2020 12/31/9999 20240 BONE BIOPSY OPEN SUPERFICIAL $ 176.39 $ 176.39 3/1/2020 12/31/9999 20245 BONE BIOPSY OPEN DEEP $ 481.41 $ 481.41 3/1/2020 12/31/9999 20250 OPEN BONE BIOPSY $ 289.56 $ 289.56 3/1/2020 12/31/9999 20251 OPEN BONE BIOPSY $ 321.05 $ 321.05 3/1/2020 12/31/9999 20500 INJECTION OF SINUS TRACT $ 73.25 $ 88.52 3/1/2020 12/31/9999 20501 INJECT SINUS TRACT FOR X-RAY $ 33.45 $ 98.67 3/1/2020 12/31/9999 20520 REMOVAL OF FOREIGN BODY $ 108.56 $ 141.75 3/1/2020 12/31/9999 20525 REMOVAL OF FOREIGN BODY $ 190.76 $ 344.10 3/1/2020 12/31/9999 20526 THER INJECTION CARP TUNNEL $ 45.68 $ 57.73 3/1/2020 12/31/9999 20527 INJ DUPUYTREN CORD W/ENZYME $ 35.26 $ 44.87 3/1/2020 12/31/9999 20550 INJ TENDON SHEATH/LIGAMENT $ 33.56 $ 44.72 3/1/2020 12/31/9999 20551 INJ TENDON ORIGIN/INSERTION $ 34.24 $ 44.24 3/1/2020 12/31/9999 20552 INJ TRIGGER POINT 1/2 MUSCL $ 29.02 $ 40.18 3/1/2020 12/31/9999 20553 INJECT TRIGGER POINTS 3/> $ 32.27 $ 44.89 3/1/2020 12/31/9999 20555 PLACE NDL MUSC/TIS FOR RT $ 267.65 $ 267.65 3/1/2020 12/31/9999 20600 DRAIN/INJ JOINT/BURSA W/O US $ 31.97 $ 41.96 3/1/2020 12/31/9999 20604 DRAIN/INJ JOINT/BURSA W/US $ 40.44 $ 62.38 3/1/2020 12/31/9999 20605 DRAIN/INJ JOINT/BURSA W/O US $ 33.19 $ 44.95 3/1/2020 12/31/9999 20606 DRAIN/INJ JOINT/BURSA W/US $ 45.79 $ 68.65 3/1/2020 12/31/9999 20610 DRAIN/INJ JOINT/BURSA W/O US $ 39.64 $ 57.86 3/1/2020 12/31/9999 20611 DRAIN/INJ JOINT/BURSA W/US $ 53.63 $ 78.58 3/1/2020 12/31/9999 20612 ASPIRATE/INJ GANGLION CYST $ 34.23 $ 44.80 3/1/2020 12/31/9999 20615 TREATMENT OF BONE CYST $ 122.89 $ 163.13 3/1/2020 12/31/9999 20650 INSERT AND REMOVE BONE PIN $ 121.16 $ 148.79 3/1/2020 12/31/9999 20660 APPLY REM FIXATION DEVICE $ 185.90 $ 196.48 3/1/2020 12/31/9999 20661 APPLICATION OF HEAD BRACE $ 352.15 $ 352.15 3/1/2020 12/31/9999 20662 APPLICATION OF PELVIS BRACE $ 366.05 $ 366.05 3/1/2020 12/31/9999 20663 APPLICATION OF THIGH BRACE $ 338.69 $ 338.69 3/1/2020 12/31/9999 20664 APPLICATION OF HALO $ 579.53 $ 579.53 3/1/2020 12/31/9999 20665 REMOVAL OF FIXATION DEVICE $ 77.79 $ 92.18 3/1/2020 12/31/9999 20670 REMOVAL OF SUPPORT IMPLANT $ 113.82 $ 288.89 3/1/2020 12/31/9999 20680 REMOVAL OF SUPPORT IMPLANT $ 317.31 $ 441.56 3/1/2020 12/31/9999 20690 APPLY BONE FIXATION DEVICE $ 418.77 $ 418.77 3/1/2020 12/31/9999 20692 APPLY BONE FIXATION DEVICE $ 783.04 $ 783.04 3/1/2020 12/31/9999 20693 ADJUST BONE FIXATION DEVICE $ 351.20 $ 351.20 3/1/2020 12/31/9999 20694 REMOVE BONE FIXATION DEVICE $ 256.37 $ 317.46 3/1/2020 12/31/9999 20696 COMP MULTIPLANE EXT FIXATION $ 841.43 $ 841.43 3/1/2020 12/31/9999 20697 COMP EXT FIXATE STRUT CHANGE $ 971.91 $ 971.91 3/1/2020 12/31/9999 20700 MNL PREP&INSJ DP RX DLVR DEV $ 75.32 $ 75.32 3/1/2020 12/31/9999 20701 RMVL DEEP RX DELIVERY DEVICE $ 56.26 $ 56.26 3/1/2020 12/31/9999 20702 MNL PREP&INSJ IMED RX DEV $ 125.27 $ 125.27 3/1/2020 12/31/9999 20703 RMVL IMED RX DELIVERY DEVICE $ 89.91 $ 89.91 3/1/2020 12/31/9999 20704 MNL PREP&INSJ I-ARTIC RX DEV $ 130.49 $ 130.49 3/1/2020 12/31/9999 20705 RMVL I-ARTIC RX DELIVERY DEV $ 107.47 $ 107.47 3/1/2020 12/31/9999 20802 REPLANTATION ARM COMPLETE $ 1,925.15 $ 1,925.15 3/1/2020 12/31/9999 20805 REPLANT FOREARM COMPLETE $ 2,357.93 $ 2,357.93 3/1/2020 12/31/9999 20808 REPLANTATION HAND COMPLETE $ 3,184.07 $ 3,184.07 3/1/2020 12/31/9999 20816 REPLANTATION DIGIT COMPLETE $ 1,756.85 $ 1,756.85 3/1/2020 12/31/9999 20822 REPLANTATION DIGIT COMPLETE $ 1,489.41 $ 1,489.41 3/1/2020 12/31/9999 20824 REPLANTATION THUMB COMPLETE $ 1,750.15 $ 1,750.15 3/1/2020 12/31/9999 20827 REPLANTATION THUMB COMPLETE $ 1,547.58 $ 1,547.58 3/1/2020 12/31/9999 20838 REPLANTATION FOOT COMPLETE $ 1,943.39 $ 1,943.39 3/1/2020 12/31/9999 20900 REMOVAL OF BONE FOR GRAFT $ 203.50 $ 314.23 3/1/2020 12/31/9999 20902 REMOVAL OF BONE FOR GRAFT $ 281.78 $ 281.78 3/1/2020 12/31/9999 20910 REMOVE CARTILAGE FOR GRAFT $ 329.74 $ 329.74 3/1/2020 12/31/9999 20912 REMOVE CARTILAGE FOR GRAFT $ 370.52 $ 370.52 3/1/2020 12/31/9999 20920 REMOVAL OF FASCIA FOR GRAFT $ 312.30 $ 312.30 3/1/2020 12/31/9999 20922 REMOVAL OF FASCIA FOR GRAFT $ 382.88 $ 459.85 3/1/2020 12/31/9999 20924 REMOVAL OF TENDON FOR GRAFT $ 386.49 $ 386.49 3/1/2020 12/31/9999 20931 SP BONE ALGRFT STRUCT ADD-ON $ 89.05 $ 89.05 3/1/2020 12/31/9999 20932 OSTEOART ALGRFT W/SURF & B1 $ 635.79 $ 635.79 3/1/2020 12/31/9999 20933 HEMICRT INTRCLRY ALGRFT PRTL $ 583.26 $ 583.26 3/1/2020 12/31/9999 20934 INTERCALARY ALGRFT COMPL $ 635.46 $ 635.46 3/1/2020 12/31/9999 20937 SP BONE AGRFT MORSEL ADD-ON $ 135.61 $ 135.61 3/1/2020 12/31/9999 20938 SP BONE AGRFT STRUCT ADD-ON $ 147.27 $ 147.27 3/1/2020 12/31/9999 20939 BONE MARROW ASPIR BONE GRFG $ 58.91 $ 58.91 3/1/2020 12/31/9999 20950 FLUID PRESSURE MUSCLE $ 70.48 $ 181.50 3/1/2020 12/31/9999 20955 FIBULA BONE GRAFT MICROVASC $ 1,993.76 $ 1,993.76 3/1/2020 12/31/9999 20956 ILIAC BONE GRAFT MICROVASC $ 2,080.52 $ 2,080.52 3/1/2020 12/31/9999 20957 MT BONE GRAFT MICROVASC $ 1,990.97 $ 1,990.97 3/1/2020 12/31/9999 20962 OTHER BONE GRAFT MICROVASC $ 2,036.92 $ 2,036.92 3/1/2020 12/31/9999 20969 BONE/SKIN GRAFT MICROVASC $ 2,209.21 $ 2,209.21 3/1/2020 12/31/9999 20970 BONE/SKIN GRAFT ILIAC CREST $ 2,219.44 $ 2,219.44 3/1/2020 12/31/9999 20972 BONE/SKIN GRAFT METATARSAL $ 2,031.25 $ 2,031.25 3/1/2020 12/31/9999 20973 BONE/SKIN GRAFT GREAT TOE $ 2,132.54 $ 2,132.54 3/1/2020 12/31/9999 20974 ELECTRICAL BONE STIMULATION $ 36.89 $ 49.22 3/1/2020 12/31/9999 20975 ELECTRICAL BONE STIMULATION $ 138.96 $ 138.96 3/1/2020 12/31/9999 20979 US BONE STIMULATION $ 28.55 $ 40.59 3/1/2020 12/31/9999 20982 ABLATE BONE TUMOR(S) PERQ $ 330.24 $ 2,786.85 3/1/2020 12/31/9999 20983 ABLATE BONE TUMOR(S) PERQ $ 354.65 $ 5,916.16 3/1/2020 12/31/9999 21010 INCISION OF JAW JOINT $ 560.31 $ 560.31 3/1/2020 12/31/9999 21011 EXC FACE LES SC <2 CM $ 153.91 $ 196.46 3/1/2020 12/31/9999 21012 EXC FACE LES SBQ 2 CM/> $ 210.53 $ 210.53 3/1/2020 12/31/9999 21013 EXC FACE TUM DEEP < 2 CM $ 248.18 $ 305.46 3/1/2020 12/31/9999 21014 EXC FACE TUM DEEP 2 CM/> $ 325.34 $ 325.34 3/1/2020 12/31/9999 21015 RESECT FACE/SCALP TUM < 2 CM $ 325.56 $ 325.56 3/1/2020 12/31/9999 21016 RESECT FACE/SCALP TUM 2 CM/> $ 652.20 $ 652.20 3/1/2020 12/31/9999 21025 EXCISION OF BONE LOWER JAW $ 571.49 $ 666.36 3/1/2020 12/31/9999 21026 EXCISION OF FACIAL BONE(S) $ 365.74 $ 438.87 3/1/2020 12/31/9999 21029 CONTOUR OF FACE BONE LESION $ 478.63 $ 561.47 3/1/2020 12/31/9999 21030 EXCISE MAX/ZYGOMA B9 TUMOR $ 304.30 $ 367.46 3/1/2020 12/31/9999 21031 REMOVE EXOSTOSIS MANDIBLE $ 217.76 $ 282.09 3/1/2020 12/31/9999 21032 REMOVE EXOSTOSIS MAXILLA $ 214.67 $ 285.76 3/1/2020 12/31/9999 21034 EXCISE MAX/ZYGOMA MAL TUMOR $ 903.00 $ 1,009.06 3/1/2020 12/31/9999 21040 EXCISE MANDIBLE LESION $ 302.54 $ 370.39 3/1/2020 12/31/9999 21044 REMOVAL OF JAW BONE LESION $ 675.03 $ 675.03 3/1/2020 12/31/9999 21045 EXTENSIVE JAW SURGERY $ 942.10 $ 942.10 3/1/2020 12/31/9999 21046 REMOVE MANDIBLE CYST COMPLEX $ 830.06 $ 830.06 3/1/2020 12/31/9999 21047 EXCISE LWR JAW CYST W/REPAIR $ 1,008.07 $ 1,008.07 3/1/2020 12/31/9999 21048 REMOVE MAXILLA CYST COMPLEX $ 841.48 $ 841.48 3/1/2020 12/31/9999 21049 EXCIS UPPR JAW CYST W/REPAIR $ 974.56 $ 974.56 3/1/2020 12/31/9999 21050 REMOVAL OF JAW JOINT $ 661.61 $ 661.61 3/1/2020 12/31/9999 21060 REMOVE JAW JOINT CARTILAGE $ 604.84 $ 604.84 3/1/2020 12/31/9999 21070 REMOVE CORONOID PROCESS $ 491.14 $ 491.14 3/1/2020 12/31/9999 21073 MNPJ OF TMJ W/ANESTH $ 182.84 $ 273.03 3/1/2020 12/31/9999 21100 MAXILLOFACIAL FIXATION $ 301.17 $ 523.82 3/1/2020 12/31/9999 21110 INTERDENTAL FIXATION $ 473.05 $ 553.23 3/1/2020 12/31/9999 21116 INJECTION JAW JOINT X-RAY $ 34.57 $ 110.94 3/1/2020 12/31/9999 21120 RECONSTRUCTION OF CHIN $ 372.06 $ 459.88 3/1/2020 12/31/9999 21121 RECONSTRUCTION OF CHIN $ 494.99 $ 576.37 3/1/2020 12/31/9999 21122 RECONSTRUCTION OF CHIN $ 545.77 $ 545.77 3/1/2020 12/31/9999 21123 RECONSTRUCTION OF CHIN $ 654.74 $ 654.74 3/1/2020 12/31/9999 21125 AUGMENTATION LOWER JAW BONE $ 573.32 $ 2,224.47 3/1/2020 12/31/9999 21127 AUGMENTATION LOWER JAW BONE $ 669.87 $ 2,647.38 3/1/2020 12/31/9999 21137 REDUCTION OF FOREHEAD $ 552.41 $ 552.41 3/1/2020 12/31/9999 21138 REDUCTION OF FOREHEAD $ 690.05 $ 690.05 3/1/2020 12/31/9999 21139 REDUCTION OF FOREHEAD $ 774.82 $ 774.82 3/1/2020 12/31/9999 21141 LEFORT I-1 PIECE W/O GRAFT $ 1,038.69 $ 1,038.69 3/1/2020 12/31/9999 21142 LEFORT I-2 PIECE W/O GRAFT $ 1,027.48 $ 1,027.48 3/1/2020 12/31/9999 21143 LEFORT I-3/> PIECE W/O GRAFT $ 1,066.01 $ 1,066.01 3/1/2020 12/31/9999 21145 LEFORT I-1 PIECE W/ GRAFT $ 1,195.26 $ 1,195.26 3/1/2020 12/31/9999 21146 LEFORT I-2 PIECE W/ GRAFT $ 1,275.58 $ 1,275.58 3/1/2020 12/31/9999 21147 LEFORT I-3/> PIECE W/ GRAFT $ 1,313.57 $ 1,313.57 3/1/2020 12/31/9999 21150 LEFORT II ANTERIOR INTRUSION $ 1,304.09 $ 1,304.09 3/1/2020 12/31/9999 21151 LEFORT II W/BONE GRAFTS $ 1,574.54 $ 1,574.54 3/1/2020 12/31/9999 21154 LEFORT III W/O LEFORT I $ 1,592.24 $ 1,592.24 3/1/2020 12/31/9999 21155 LEFORT III W/ LEFORT I $ 1,806.87 $ 1,806.87 3/1/2020 12/31/9999 21159 LEFORT III W/FHDW/O LEFORT I $ 2,186.03 $ 2,186.03 3/1/2020 12/31/9999 21160 LEFORT III W/FHD W/ LEFORT I $ 2,251.12 $ 2,251.12 3/1/2020 12/31/9999 21172 RECONSTRUCT ORBIT/FOREHEAD $ 1,383.72 $ 1,383.72 3/1/2020 12/31/9999 21175 RECONSTRUCT ORBIT/FOREHEAD $ 1,670.77 $ 1,670.77 3/1/2020 12/31/9999 21179 RECONSTRUCT ENTIRE FOREHEAD $ 1,144.23 $ 1,144.23 3/1/2020 12/31/9999 21180 RECONSTRUCT ENTIRE FOREHEAD $ 1,304.43 $ 1,304.43 3/1/2020 12/31/9999 21181 CONTOUR CRANIAL BONE LESION $ 544.61 $ 544.61 3/1/2020 12/31/9999 21182 RECONSTRUCT CRANIAL BONE $ 1,587.62 $ 1,587.62 3/1/2020 12/31/9999 21183 RECONSTRUCT CRANIAL BONE $ 1,775.55 $ 1,775.55 3/1/2020 12/31/9999 21184 RECONSTRUCT CRANIAL BONE $ 1,899.11 $ 1,899.11 3/1/2020 12/31/9999 21188 RECONSTRUCTION OF MIDFACE $ 1,255.40 $ 1,255.40 3/1/2020 12/31/9999 21193 RECONST LWR JAW W/O GRAFT $ 960.18 $ 960.18 3/1/2020 12/31/9999 21194 RECONST LWR JAW W/GRAFT $ 1,096.49 $ 1,096.49 3/1/2020 12/31/9999 21195 RECONST LWR JAW W/O FIXATION $ 1,028.84 $ 1,028.84 3/1/2020 12/31/9999 21196 RECONST LWR JAW W/FIXATION $ 1,121.28 $ 1,121.28 3/1/2020 12/31/9999 21198 RECONSTR LWR JAW SEGMENT $ 881.01 $ 881.01 3/1/2020 12/31/9999 21199 RECONSTR LWR JAW W/ADVANCE $ 800.47 $ 800.47 3/1/2020 12/31/9999 21206 RECONSTRUCT UPPER JAW BONE $ 867.93 $ 867.93 3/1/2020 12/31/9999 21208 AUGMENTATION OF FACIAL BONES $ 631.60 $ 1,272.84 3/1/2020 12/31/9999 21209 REDUCTION OF FACIAL BONES $ 484.14 $ 607.81 3/1/2020 12/31/9999 21210 FACE BONE GRAFT $ 631.42 $ 1,520.01 3/1/2020 12/31/9999 21215 LOWER JAW BONE GRAFT $ 658.49 $ 2,574.30 3/1/2020 12/31/9999 21230 RIB CARTILAGE GRAFT $ 589.58 $ 589.58 3/1/2020 12/31/9999 21235 EAR CARTILAGE GRAFT $ 430.66 $ 540.52 3/1/2020 12/31/9999 21240 RECONSTRUCTION OF JAW JOINT $ 852.47 $ 852.47 3/1/2020 12/31/9999 21242 RECONSTRUCTION OF JAW JOINT $ 780.72 $ 780.72 3/1/2020 12/31/9999 21243 RECONSTRUCTION OF JAW JOINT $ 1,282.59 $ 1,282.59 3/1/2020 12/31/9999 21244 RECONSTRUCTION OF LOWER JAW $ 796.32 $ 796.32 3/1/2020 12/31/9999 21247 RECONSTRUCT LOWER JAW BONE $ 1,248.32 $ 1,248.32 3/1/2020 12/31/9999 21255 RECONSTRUCT LOWER JAW BONE $ 1,100.93 $ 1,100.93 3/1/2020 12/31/9999 21256 RECONSTRUCTION OF ORBIT $ 901.53 $ 901.53 3/1/2020 12/31/9999 21260 REVISE EYE SOCKETS $ 1,013.82 $ 1,013.82 3/1/2020 12/31/9999 21261 REVISE EYE SOCKETS $ 1,738.70 $ 1,738.70 3/1/2020 12/31/9999 21263 REVISE EYE SOCKETS $ 1,564.90 $ 1,564.90 3/1/2020 12/31/9999 21267 REVISE EYE SOCKETS $ 1,183.21 $ 1,183.21 3/1/2020 12/31/9999 21268 REVISE EYE SOCKETS $ 1,471.96 $ 1,471.96 3/1/2020 12/31/9999 21270 AUGMENTATION CHEEK BONE $ 538.03 $ 684.33 3/1/2020 12/31/9999 21275 REVISION ORBITOFACIAL BONES $ 619.77 $ 619.77 3/1/2020 12/31/9999 21280 REVISION OF EYELID $ 398.88 $ 398.88 3/1/2020 12/31/9999 21282 REVISION OF EYELID $ 262.94 $ 262.94 3/1/2020 12/31/9999 21295 REVISION OF JAW MUSCLE/BONE $ 131.22 $ 131.22 3/1/2020 12/31/9999 21296 REVISION OF JAW MUSCLE/BONE $ 319.35 $ 319.35 3/1/2020 12/31/9999 21310 CLOSED TX NOSE FX W/O MANJ $ 22.94 $ 78.18 3/1/2020 12/31/9999 21315 CLOSED TX NOSE FX W/O STABLJ $ 111.92 $ 191.82 3/1/2020 12/31/9999 21320 CLOSED TX NOSE FX W/ STABLJ $ 104.99 $ 184.89 3/1/2020 12/31/9999 21325 OPEN TX NOSE FX UNCOMPLICATD $ 349.63 $ 349.63 3/1/2020 12/31/9999 21330 OPEN TX NOSE FX W/SKELE FIXJ $ 430.17 $ 430.17 3/1/2020 12/31/9999 21335 OPEN TX NOSE & SEPTAL FX $ 558.40 $ 558.40 3/1/2020 12/31/9999 21336 OPEN TX SEPTAL FX W/WO STABJ $ 480.54 $ 480.54 3/1/2020 12/31/9999 21337 CLOSED TX SEPTAL&NOSE FX $ 214.33 $ 288.35 3/1/2020 12/31/9999 21338 OPEN NASOETHMOID FX W/O FIXJ $ 549.31 $ 549.31 3/1/2020 12/31/9999 21339 OPEN NASOETHMOID FX W/ FIXJ $ 613.59 $ 613.59 3/1/2020 12/31/9999 21340 PERQ TX NASOETHMOID FX $ 617.06 $ 617.06 3/1/2020 12/31/9999 21343 OPEN TX DPRSD FRONT SINUS FX $ 873.05 $ 873.05 3/1/2020 12/31/9999 21344 OPEN TX COMPL FRONT SINUS FX $ 1,151.90 $ 1,151.90 3/1/2020 12/31/9999 21345 CLOSED TX NOSE/JAW FX $ 500.24 $ 601.87 3/1/2020 12/31/9999 21346 OPN TX NASOMAX FX W/FIXJ $ 722.47 $ 722.47 3/1/2020 12/31/9999 21347 OPN TX NASOMAX FX MULTPLE $ 838.11 $ 838.11 3/1/2020 12/31/9999 21348 OPN TX NASOMAX FX W/GRAFT $ 894.58 $ 894.58 3/1/2020 12/31/9999 21355 PERQ TX MALAR FRACTURE $ 246.55 $ 325.27 3/1/2020 12/31/9999 21356 OPN TX DPRSD ZYGOMATIC ARCH $ 282.77 $ 364.14 3/1/2020 12/31/9999 21360 OPN TX DPRSD MALAR FRACTURE $ 402.94 $ 402.94 3/1/2020 12/31/9999 21365 OPN TX COMPLX MALAR FX $ 847.59 $ 847.59 3/1/2020 12/31/9999 21366 OPN TX COMPLX MALAR W/GRFT $ 942.30 $ 942.30 3/1/2020 12/31/9999 21385 OPN TX ORBIT FX TRANSANTRAL $ 543.78 $ 543.78 3/1/2020 12/31/9999 21386 OPN TX ORBIT FX PERIORBITAL $ 508.54 $ 508.54 3/1/2020 12/31/9999 21387 OPN TX ORBIT FX COMBINED $ 567.55 $ 567.55 3/1/2020 12/31/9999 21390 OPN TX ORBIT PERIORBTL IMPLT $ 588.50 $ 588.50 3/1/2020 12/31/9999 21395 OPN TX ORBIT PERIORBT W/GRFT $ 743.55 $ 743.55 3/1/2020 12/31/9999 21400 CLOSED TX ORBIT W/O MANIPULJ $ 107.79 $ 130.42 3/1/2020 12/31/9999 21401 CLOSED TX ORBIT W/MANIPULJ $ 222.37 $ 347.20 3/1/2020 12/31/9999 21406 OPN TX ORBIT FX W/O IMPLANT $ 411.34 $ 411.34 3/1/2020 12/31/9999 21407 OPN TX ORBIT FX W/IMPLANT $ 487.53 $ 487.53 3/1/2020 12/31/9999 21408 OPN TX ORBIT FX W/BONE GRFT $ 671.34 $ 671.34 3/1/2020 12/31/9999 21421 TREAT MOUTH ROOF FRACTURE $ 460.90 $ 536.99 3/1/2020 12/31/9999 21422 TREAT MOUTH ROOF FRACTURE $ 509.29 $ 509.29 3/1/2020 12/31/9999 21423 TREAT MOUTH ROOF FRACTURE $ 605.97 $ 605.97 3/1/2020 12/31/9999 21431 TREAT CRANIOFACIAL FRACTURE $ 553.34 $ 553.34 3/1/2020 12/31/9999 21432 TREAT CRANIOFACIAL FRACTURE $ 508.05 $ 508.05 3/1/2020 12/31/9999 21433 TREAT CRANIOFACIAL FRACTURE $ 1,311.62 $ 1,311.62 3/1/2020 12/31/9999 21435 TREAT CRANIOFACIAL FRACTURE $ 1,033.32 $ 1,033.32 3/1/2020 12/31/9999 21436 TREAT CRANIOFACIAL FRACTURE $ 1,521.54 $ 1,521.54 3/1/2020 12/31/9999 21440 TREAT DENTAL RIDGE FRACTURE $ 324.19 $ 388.52 3/1/2020 12/31/9999 21445 TREAT DENTAL RIDGE FRACTURE $ 460.72 $ 554.43 3/1/2020 12/31/9999 21450 TREAT LOWER JAW FRACTURE $ 339.99 $ 404.89 3/1/2020 12/31/9999 21451 TREAT LOWER JAW FRACTURE $ 458.67 $ 536.22 3/1/2020 12/31/9999 21452 TREAT LOWER JAW FRACTURE $ 245.01 $ 436.53 3/1/2020 12/31/9999 21453 TREAT LOWER JAW FRACTURE $ 553.01 $ 620.87 3/1/2020 12/31/9999 21454 TREAT LOWER JAW FRACTURE $ 419.57 $ 419.57 3/1/2020 12/31/9999 21461 TREAT LOWER JAW FRACTURE $ 685.52 $ 1,395.81 3/1/2020 12/31/9999 21462 TREAT LOWER JAW FRACTURE $ 760.91 $ 1,510.56 3/1/2020 12/31/9999 21465 TREAT LOWER JAW FRACTURE $ 697.43 $ 697.43 3/1/2020 12/31/9999 21470 TREAT LOWER JAW FRACTURE $ 910.85 $ 910.85 3/1/2020 12/31/9999 21480 RESET DISLOCATED JAW $ 25.87 $ 66.70 3/1/2020 12/31/9999 21485 RESET DISLOCATED JAW $ 410.68 $ 478.83 3/1/2020 12/31/9999 21490 REPAIR DISLOCATED JAW $ 706.49 $ 706.49 3/1/2020 12/31/9999 21497 INTERDENTAL WIRING $ 414.87 $ 483.32 3/1/2020 12/31/9999 21501 DRAIN NECK/CHEST LESION $ 237.89 $ 322.49 3/1/2020 12/31/9999 21502 DRAIN CHEST LESION $ 399.42 $ 399.42 3/1/2020 12/31/9999 21510 DRAINAGE OF BONE LESION $ 352.20 $ 352.20 3/1/2020 12/31/9999 21550 BIOPSY OF NECK/CHEST $ 121.26 $ 189.13 3/1/2020 12/31/9999 21552 EXC NECK LES SC 3 CM/> $ 280.25 $ 280.25 3/1/2020 12/31/9999 21554 EXC NECK TUM DEEP 5 CM/> $ 460.81 $ 460.81 3/1/2020 12/31/9999 21555 EXC NECK LES SC < 3 CM $ 251.46 $ 319.32 3/1/2020 12/31/9999 21556 EXC NECK TUM DEEP < 5 CM $ 314.66 $ 314.66 3/1/2020 12/31/9999 21557 RESECT NECK THORAX TUMOR<5CM $ 447.16 $ 447.16 3/1/2020 12/31/9999 21558 RESECT NECK TUMOR 5 CM/> $ 864.97 $ 864.97 3/1/2020 12/31/9999 21600 PARTIAL REMOVAL OF RIB $ 420.57 $ 420.57 3/1/2020 12/31/9999 21601 EXC CHEST WALL TUMOR W/RIBS $ 1,046.40 $ 1,046.40 3/1/2020 12/31/9999 21602 EXC CH WAL TUM W/O LYMPHADEC $ 1,403.25 $ 1,403.25 3/1/2020 12/31/9999 21603 EXC CH WAL TUM W/LYMPHADEC $ 1,552.68 $ 1,552.68 3/1/2020 12/31/9999 21610 PARTIAL REMOVAL OF RIB $ 821.87 $ 821.87 3/1/2020 12/31/9999 21615 REMOVAL OF RIB $ 519.62 $ 519.62 3/1/2020 12/31/9999 21616 REMOVAL OF RIB AND NERVES $ 662.35 $ 662.35 3/1/2020 12/31/9999 21620 PARTIAL REMOVAL OF STERNUM $ 400.44 $ 400.44 3/1/2020 12/31/9999 21627 STERNAL DEBRIDEMENT $ 420.11 $ 420.11 3/1/2020 12/31/9999 21630 EXTENSIVE STERNUM SURGERY $ 982.19 $ 982.19 3/1/2020 12/31/9999 21632 EXTENSIVE STERNUM SURGERY $ 972.75 $ 972.75 3/1/2020 12/31/9999 21685 HYOID MYOTOMY & SUSPENSION $ 766.21 $ 766.21 3/1/2020 12/31/9999 21700 REVISION OF NECK MUSCLE $ 325.31 $ 325.31 3/1/2020 12/31/9999 21705 REVISION OF NECK MUSCLE/RIB $ 500.76 $ 500.76 3/1/2020 12/31/9999 21720 REVISION OF NECK MUSCLE $ 313.65 $ 313.65 3/1/2020 12/31/9999 21725 REVISION OF NECK MUSCLE $ 406.70 $ 406.70 3/1/2020 12/31/9999 21740 RECONSTRUCTION OF STERNUM $ 847.79 $ 847.79 3/1/2020 12/31/9999 21742 REPAIR STERN/NUSS W/O SCOPE $ 847.79 $ 847.79 3/1/2020 12/31/9999 21743 REPAIR STERNUM/NUSS W/SCOPE $ 983.16 $ 983.16 3/1/2020 12/31/9999 21750 REPAIR OF STERNUM SEPARATION $ 561.87 $ 561.87 3/1/2020 12/31/9999 21812 TREATMENT OF RIB FRACTURE $ 590.96 $ 574.73 3/1/2020 12/31/9999 21813 TREATMENT OF RIB FRACTURE $ 798.92 $ 786.29 3/1/2020 12/31/9999 21820 TREAT STERNUM FRACTURE $ 97.69 $ 96.53 3/1/2020 12/31/9999 21825 TREAT STERNUM FRACTURE $ 434.19 $ 434.19 3/1/2020 12/31/9999 21920 BIOPSY SOFT TISSUE OF BACK $ 121.16 $ 188.72 3/1/2020 12/31/9999 21925 BIOPSY SOFT TISSUE OF BACK $ 255.54 $ 312.83 3/1/2020 12/31/9999 21930 EXC BACK LES SC < 3 CM $ 283.25 $ 349.05 3/1/2020 12/31/9999 21931 EXC BACK LES SC 3 CM/> $ 293.09 $ 293.09 3/1/2020 12/31/9999 21932 EXC BACK TUM DEEP < 5 CM $ 420.86 $ 420.86 3/1/2020 12/31/9999 21933 EXC BACK TUM DEEP 5 CM/> $ 464.12 $ 464.12 3/1/2020 12/31/9999 21935 RESECT BACK TUM < 5 CM $ 898.57 $ 898.57 3/1/2020 12/31/9999 21936 RESECT BACK TUM 5 CM/> $ 899.30 $ 899.30 3/1/2020 12/31/9999 22010 I&D P-SPINE C/T/CERV-THOR $ 689.48 $ 689.48 3/1/2020 12/31/9999 22015 I&D ABSCESS P-SPINE L/S/LS $ 685.59 $ 685.59 3/1/2020 12/31/9999 22100 REMOVE PART OF NECK VERTEBRA $ 621.94 $ 621.94 3/1/2020 12/31/9999 22101 REMOVE PART THORAX VERTEBRA $ 620.43 $ 620.43 3/1/2020 12/31/9999 22102 REMOVE PART LUMBAR VERTEBRA $ 618.06 $ 618.06 3/1/2020 12/31/9999 22103 REMOVE EXTRA SPINE SEGMENT $ 113.43 $ 113.43 3/1/2020 12/31/9999 22110 REMOVE PART OF NECK VERTEBRA $ 773.36 $ 773.36 3/1/2020 12/31/9999 22112 REMOVE PART THORAX VERTEBRA $ 749.61 $ 749.61 3/1/2020 12/31/9999 22114 REMOVE PART LUMBAR VERTEBRA $ 768.56 $ 768.56 3/1/2020 12/31/9999 22116 REMOVE EXTRA SPINE SEGMENT $ 112.82 $ 112.82 3/1/2020 12/31/9999 22206 INCIS SPINE 3 COLUMN THORAC $ 1,847.97 $ 1,847.97 3/1/2020 12/31/9999 22207 INCIS SPINE 3 COLUMN LUMBAR $ 1,823.87 $ 1,823.87 3/1/2020 12/31/9999 22208 INCIS SPINE 3 COLUMN ADL SEG $ 465.64 $ 465.64 3/1/2020 12/31/9999 22210 INCIS 1 VERTEBRAL SEG CERV $ 1,354.46 $ 1,354.46 3/1/2020 12/31/9999 22212 INCIS 1 VERTEBRAL SEG THORAC $ 1,120.11 $ 1,120.11 3/1/2020 12/31/9999 22214 INCIS 1 VERTEBRAL SEG LUMBAR $ 1,126.84 $ 1,126.84 3/1/2020 12/31/9999 22216 INCIS ADDL SPINE SEGMENT $ 295.61 $ 295.61 3/1/2020 12/31/9999 22220 INCIS W/DISCECTOMY CERVICAL $ 1,219.68 $ 1,219.68 3/1/2020 12/31/9999 22222 INCIS W/DISCECTOMY THORACIC $ 1,116.02 $ 1,116.02 3/1/2020 12/31/9999 22224 INCIS W/DISCECTOMY LUMBAR $ 1,207.71 $ 1,207.71 3/1/2020 12/31/9999 22226 REVISE EXTRA SPINE SEGMENT $ 294.43 $ 294.43 3/1/2020 12/31/9999 22310 CLOSED TX VERT FX W/O MANJ $ 201.27 $ 215.07 3/1/2020 12/31/9999 22315 CLOSED TX VERT FX W/MANJ $ 571.59 $ 639.73 3/1/2020 12/31/9999 22318 TREAT ODONTOID FX W/O GRAFT $ 1,218.18 $ 1,218.18 3/1/2020 12/31/9999 22319 TREAT ODONTOID FX W/GRAFT $ 1,339.37 $ 1,339.37 3/1/2020 12/31/9999 22325 TREAT SPINE FRACTURE $ 1,066.60 $ 1,066.60 3/1/2020 12/31/9999 22326 TREAT NECK SPINE FRACTURE $ 1,112.12 $ 1,112.12 3/1/2020 12/31/9999 22327 TREAT THORAX SPINE FRACTURE $ 1,103.56 $ 1,103.56 3/1/2020 12/31/9999 22328 TREAT EACH ADD SPINE FX $ 222.88 $ 222.88 3/1/2020 12/31/9999 22505 MANIPULATION OF SPINE $ 94.84 $ 94.84 3/1/2020 12/31/9999 22510 PERQ CERVICOTHORACIC INJECT $ 397.38 $ 1,487.26 3/1/2020 12/31/9999 22511 PERQ LUMBOSACRAL INJECTION $ 372.26 $ 1,472.35 3/1/2020 12/31/9999 22512 VERTEBROPLASTY ADDL INJECT $ 181.61 $ 822.61 3/1/2020 12/31/9999 22513 PERQ VERTEBRAL AUGMENTATION $ 452.95 $ 6,227.05 3/1/2020 12/31/9999 22514 PERQ VERTEBRAL AUGMENTATION $ 423.05 $ 6,202.55 3/1/2020 12/31/9999 22515 PERQ VERTEBRAL AUGMENTATION $ 189.38 $ 3,761.77 3/1/2020 12/31/9999 22532 LAT THORAX SPINE FUSION $ 1,330.51 $ 1,330.51 3/1/2020 12/31/9999 22533 LAT LUMBAR SPINE FUSION $ 1,254.05 $ 1,254.05 3/1/2020 12/31/9999 22534 LAT THOR/LUMB ADDL SEG $ 291.76 $ 291.76 3/1/2020 12/31/9999 22548 NECK SPINE FUSION $ 1,415.65 $ 1,415.65 3/1/2020 12/31/9999 22551 NECK SPINE FUSE&REMOV BEL C2 $ 1,424.14 $ 1,424.14 3/1/2020 12/31/9999 22552 ADDL NECK SPINE FUSION $ 332.61 $ 332.61 3/1/2020 12/31/9999 22554 NECK SPINE FUSION $ 977.56 $ 977.56 3/1/2020 12/31/9999 22556 THORAX SPINE FUSION $ 1,268.93 $ 1,268.93 3/1/2020 12/31/9999 22558 LUMBAR SPINE FUSION $ 1,167.57 $ 1,167.57 3/1/2020 12/31/9999 22585 ADDITIONAL SPINAL FUSION $ 269.49 $ 269.49 3/1/2020 12/31/9999 22586 PRESCRL FUSE W/ INSTR L5-S1 $ 1,264.49 $ 1,264.49 3/1/2020 12/31/9999 22590 SPINE & SKULL SPINAL FUSION $ 1,174.73 $ 1,174.73 3/1/2020 12/31/9999 22595 NECK SPINAL FUSION $ 1,115.35 $ 1,115.35 3/1/2020 12/31/9999 22600 NECK SPINE FUSION $ 955.59 $ 955.59 3/1/2020 12/31/9999 22610 THORAX SPINE FUSION $ 943.35 $ 943.35 3/1/2020 12/31/9999 22612 LUMBAR SPINE FUSION $ 1,223.73 $ 1,223.73 3/1/2020 12/31/9999 22614 SPINE FUSION EXTRA SEGMENT $ 314.53 $ 314.53 3/1/2020 12/31/9999 22630 LUMBAR SPINE FUSION $ 1,175.78 $ 1,175.78 3/1/2020 12/31/9999 22632 SPINE FUSION EXTRA SEGMENT $ 255.51 $ 255.51 3/1/2020 12/31/9999 22633 LUMBAR SPINE FUSION COMBINED $ 1,086.50 $ 1,086.50 3/1/2020 12/31/9999 22634 SPINE FUSION EXTRA SEGMENT $ 292.35 $ 292.35 3/1/2020 12/31/9999 22800 POST FUSION VERT SEG $ 1,911.48 $ 1,911.48 3/1/2020 12/31/9999 22808 ANT FUSION 2-3 VERT SEG $ 1,407.44 $ 1,407.44 3/1/2020 12/31/9999 22810 ANT FUSION 4-7 VERT SEG $ 1,571.19 $ 1,571.19 3/1/2020 12/31/9999 22812 ANT FUSION 8/> VERT SEG $ 1,719.00 $ 1,719.00 3/1/2020 12/31/9999 22818 KYPHECTOMY 1-2 SEGMENTS $ 1,732.69 $ 1,732.69 3/1/2020 12/31/9999 22819 KYPHECTOMY 3 OR MORE $ 1,995.83 $ 1,995.83 3/1/2020 12/31/9999 22830 EXPLORATION OF SPINAL FUSION $ 618.60 $ 618.60 3/1/2020 12/31/9999 22840 INSERT SPINE FIXATION DEVICE $ 613.85 $ 613.85 3/1/2020 12/31/9999 22841 INSERT SPINE FIXATION DEVICE $ 618.60 $ 618.60 3/1/2020 12/31/9999 22842 INSERT SPINE FIXATION DEVICE $ 615.21 $ 615.21 3/1/2020 12/31/9999 22843 INSERT SPINE FIXATION DEVICE $ 655.06 $ 655.06 3/1/2020 12/31/9999 22844 INSERT SPINE FIXATION DEVICE $ 802.45 $ 802.45 3/1/2020 12/31/9999 22845 INSERT SPINE FIXATION DEVICE $ 587.16 $ 587.16 3/1/2020 12/31/9999 22846 INSERT SPINE FIXATION DEVICE $ 609.65 $ 609.65 3/1/2020 12/31/9999 22847 INSERT SPINE FIXATION DEVICE $ 672.78 $ 672.78 3/1/2020 12/31/9999 22848 INSERT PELV FIXATION DEVICE $ 292.39 $ 292.39 3/1/2020 12/31/9999 22849 REINSERT SPINAL FIXATION $ 1,005.21 $ 1,005.21 3/1/2020 12/31/9999 22850 REMOVE SPINE FIXATION DEVICE $ 547.10 $ 547.10 3/1/2020 12/31/9999 22852 REMOVE SPINE FIXATION DEVICE $ 523.03 $ 523.03 3/1/2020 12/31/9999 22853 INSJ BIOMECHANICAL DEVICE $ 231.24 $ 231.24 3/1/2020 12/31/9999 22854 INSJ BIOMECHANICAL DEVICE $ 299.34 $ 299.34 3/1/2020 12/31/9999 22855 REMOVE SPINE FIXATION DEVICE $ 850.44 $ 850.44 3/1/2020 12/31/9999 22856 CERV ARTIFIC DISKECTOMY $ 1,417.62 $ 1,417.62 3/1/2020 12/31/9999 22859 INSJ BIOMECHANICAL DEVICE $ 299.34 $ 299.34 3/1/2020 12/31/9999 22864 REMOVE CERV ARTIF DISC $ 1,429.58 $ 1,429.58 3/1/2020 12/31/9999 22865 REMOVE LUMB ARTIF DISC $ 1,641.41 $ 1,641.41 3/1/2020 12/31/9999 22900 EXC ABDL TUM DEEP < 5 CM $ 313.69 $ 313.69 3/1/2020 12/31/9999 22901 EXC ABDL TUM DEEP 5 CM/> $ 414.46 $ 414.46 3/1/2020 12/31/9999 22902 EXC ABD LES SC < 3 CM $ 210.09 $ 262.31 3/1/2020 12/31/9999 22903 EXC ABD LES SC 3 CM/> $ 274.50 $ 274.50 3/1/2020 12/31/9999 22904 RADICAL RESECT ABD TUMOR<5CM $ 648.70 $ 648.70 3/1/2020 12/31/9999 22905 RAD RESECT ABD TUMOR 5 CM/> $ 840.90 $ 840.90 3/1/2020 12/31/9999 23000 REMOVAL OF CALCIUM DEPOSITS $ 270.63 $ 391.06 3/1/2020 12/31/9999 23020 RELEASE SHOULDER JOINT $ 527.11 $ 527.11 3/1/2020 12/31/9999 23030 DRAIN SHOULDER LESION $ 195.92 $ 311.94 3/1/2020 12/31/9999 23031 DRAIN SHOULDER BURSA $ 162.12 $ 284.03 3/1/2020 12/31/9999 23035 DRAIN SHOULDER BONE LESION $ 522.60 $ 522.60 3/1/2020 12/31/9999 23040 EXPLORATORY SHOULDER SURGERY $ 548.94 $ 548.94 3/1/2020 12/31/9999 23044 EXPLORATORY SHOULDER SURGERY $ 434.94 $ 434.94 3/1/2020 12/31/9999 23065 BIOPSY SHOULDER TISSUES $ 126.96 $ 159.26 3/1/2020 12/31/9999 23066 BIOPSY SHOULDER TISSUES $ 255.95 $ 371.97 3/1/2020 12/31/9999 23071 EXC SHOULDER LES SC 3 CM/> $ 260.37 $ 260.37 3/1/2020 12/31/9999 23073 EXC SHOULDER TUM DEEP 5 CM/> $ 431.72 $ 431.72 3/1/2020 12/31/9999 23075 EXC SHOULDER LES SC < 3 CM $ 135.07 $ 191.18 3/1/2020 12/31/9999 23076 EXC SHOULDER TUM DEEP < 5 CM $ 429.00 $ 429.00 3/1/2020 12/31/9999 23077 RESECT SHOULDER TUMOR < 5 CM $ 914.13 $ 914.13 3/1/2020 12/31/9999 23078 RESECT SHOULDER TUMOR 5 CM/> $ 875.00 $ 875.00 3/1/2020 12/31/9999 23100 BIOPSY OF SHOULDER JOINT $ 369.44 $ 369.44 3/1/2020 12/31/9999 23101 SHOULDER JOINT SURGERY $ 339.70 $ 339.70 3/1/2020 12/31/9999 23105 REMOVE SHOULDER JOINT LINING $ 485.01 $ 485.01 3/1/2020 12/31/9999 23106 INCISION OF COLLARBONE JOINT $ 360.62 $ 360.62 3/1/2020 12/31/9999 23107 EXPLORE TREAT SHOULDER JOINT $ 504.08 $ 504.08 3/1/2020 12/31/9999 23120 PARTIAL REMOVAL COLLAR BONE $ 435.32 $ 435.32 3/1/2020 12/31/9999 23125 REMOVAL OF COLLAR BONE $ 536.74 $ 536.74 3/1/2020 12/31/9999 23130 REMOVE SHOULDER BONE PART $ 457.94 $ 457.94 3/1/2020 12/31/9999 23140 REMOVAL OF BONE LESION $ 390.94 $ 390.94 3/1/2020 12/31/9999 23145 REMOVAL OF BONE LESION $ 526.80 $ 526.80 3/1/2020 12/31/9999 23146 REMOVAL OF BONE LESION $ 457.39 $ 457.39 3/1/2020 12/31/9999 23150 REMOVAL OF HUMERUS LESION $ 498.41 $ 498.41 3/1/2020 12/31/9999 23155 REMOVAL OF HUMERUS LESION $ 604.23 $ 604.23 3/1/2020 12/31/9999 23156 REMOVAL OF HUMERUS LESION $ 513.09 $ 513.09 3/1/2020 12/31/9999 23170 REMOVE COLLAR BONE LESION $ 403.13 $ 403.13 3/1/2020 12/31/9999 23172 REMOVE SHOULDER BLADE LESION $ 413.19 $ 413.19 3/1/2020 12/31/9999 23174 REMOVE HUMERUS LESION $ 573.50 $ 573.50 3/1/2020 12/31/9999 23180 REMOVE COLLAR BONE LESION $ 521.56 $ 521.56 3/1/2020 12/31/9999 23182 REMOVE SHOULDER BLADE LESION $ 503.07 $ 503.07 3/1/2020 12/31/9999 23184 REMOVE HUMERUS LESION $ 568.37 $ 568.37 3/1/2020 12/31/9999 23190 PARTIAL REMOVAL OF SCAPULA $ 423.24 $ 423.24 3/1/2020 12/31/9999 23195 REMOVAL OF HEAD OF HUMERUS $ 574.94 $ 574.94 3/1/2020 12/31/9999 23200 RESECT CLAVICLE TUMOR $ 679.70 $ 679.70 3/1/2020 12/31/9999 23210 RESECT SCAPULA TUMOR $ 710.82 $ 710.82 3/1/2020 12/31/9999 23220 RESECT PROX HUMERUS TUMOR $ 823.73 $ 823.73 3/1/2020 12/31/9999 23330 REMOVE SHOULDER FOREIGN BODY $ 112.39 $ 164.68 3/1/2020 12/31/9999 23333 REMOVE SHOULDER FB DEEP $ 380.98 $ 380.98 3/1/2020 12/31/9999 23334 SHOULDER PROSTHESIS REMOVAL $ 899.63 $ 899.63 3/1/2020 12/31/9999 23335 SHOULDER PROSTHESIS REMOVAL $ 1,072.94 $ 1,072.94 3/1/2020 12/31/9999 23350 INJECTION FOR SHOULDER X-RAY $ 43.83 $ 118.45 3/1/2020 12/31/9999 23395 MUSCLE TRANSFER SHOULDER/ARM $ 991.04 $ 991.04 3/1/2020 12/31/9999 23397 MUSCLE TRANSFERS $ 888.16 $ 888.16 3/1/2020 12/31/9999 23400 FIXATION OF SHOULDER BLADE $ 751.99 $ 751.99 3/1/2020 12/31/9999 23405 INCISION OF TENDON & MUSCLE $ 482.55 $ 482.55 3/1/2020 12/31/9999 23406 INCISE TENDON(S) & MUSCLE(S) $ 604.01 $ 604.01 3/1/2020 12/31/9999 23410 REPAIR ROTATOR CUFF ACUTE $ 640.30 $ 640.30 3/1/2020 12/31/9999 23412 REPAIR ROTATOR CUFF CHRONIC $ 669.29 $ 669.29 3/1/2020 12/31/9999 23415 RELEASE OF SHOULDER LIGAMENT $ 532.51 $ 532.51 3/1/2020 12/31/9999 23420 REPAIR OF SHOULDER $ 750.31 $ 750.31 3/1/2020 12/31/9999 23430 REPAIR BICEPS TENDON $ 567.75 $ 567.75 3/1/2020 12/31/9999 23440 REMOVE/TRANSPLANT TENDON $ 585.97 $ 585.97 3/1/2020 12/31/9999 23450 REPAIR SHOULDER CAPSULE $ 736.07 $ 736.07 3/1/2020 12/31/9999 23455 REPAIR SHOULDER CAPSULE $ 785.28 $ 785.28 3/1/2020 12/31/9999 23460 REPAIR SHOULDER CAPSULE $ 849.86 $ 849.86 3/1/2020 12/31/9999 23462 REPAIR SHOULDER CAPSULE $ 834.15 $ 834.15 3/1/2020 12/31/9999 23465 REPAIR SHOULDER CAPSULE $ 870.04 $ 870.04 3/1/2020 12/31/9999 23466 REPAIR SHOULDER CAPSULE $ 856.67 $ 856.67 3/1/2020 12/31/9999 23470 RECONSTRUCT SHOULDER JOINT $ 947.01 $ 947.01 3/1/2020 12/31/9999 23472 RECONSTRUCT SHOULDER JOINT $ 1,173.73 $ 1,173.73 3/1/2020 12/31/9999 23473 REVIS RECONST SHOULDER JOINT $ 1,354.13 $ 1,354.13 3/1/2020 12/31/9999 23474 REVIS RECONST SHOULDER JOINT $ 1,462.81 $ 1,462.81 3/1/2020 12/31/9999 23480 REVISION OF COLLAR BONE $ 631.93 $ 631.93 3/1/2020 12/31/9999 23485 REVISION OF COLLAR BONE $ 747.36 $ 747.36 3/1/2020 12/31/9999 23490 REINFORCE CLAVICLE $ 645.48 $ 645.48 3/1/2020 12/31/9999 23491 REINFORCE SHOULDER BONES $ 786.67 $ 786.67 3/1/2020 12/31/9999 23500 TREAT CLAVICLE FRACTURE $ 151.82 $ 152.69 3/1/2020 12/31/9999 23505 TREAT CLAVICLE FRACTURE $ 239.74 $ 252.37 3/1/2020 12/31/9999 23515 TREAT CLAVICLE FRACTURE $ 535.79 $ 535.79 3/1/2020 12/31/9999 23520 TREAT CLAVICLE DISLOCATION $ 159.27 $ 158.39 3/1/2020 12/31/9999 23525 TREAT CLAVICLE DISLOCATION $ 231.56 $ 246.83 3/1/2020 12/31/9999 23530 TREAT CLAVICLE DISLOCATION $ 410.66 $ 410.66 3/1/2020 12/31/9999 23532 TREAT CLAVICLE DISLOCATION $ 471.79 $ 471.79 3/1/2020 12/31/9999 23540 TREAT CLAVICLE DISLOCATION $ 154.62 $ 156.68 3/1/2020 12/31/9999 23545 TREAT CLAVICLE DISLOCATION $ 209.41 $ 226.45 3/1/2020 12/31/9999 23550 TREAT CLAVICLE DISLOCATION $ 435.13 $ 435.13 3/1/2020 12/31/9999 23552 TREAT CLAVICLE DISLOCATION $ 501.31 $ 501.31 3/1/2020 12/31/9999 23570 TREAT SHOULDER BLADE FX $ 165.44 $ 163.38 3/1/2020 12/31/9999 23575 TREAT SHOULDER BLADE FX $ 264.32 $ 279.59 3/1/2020 12/31/9999 23585 TREAT SCAPULA FRACTURE $ 729.27 $ 729.27 3/1/2020 12/31/9999 23600 TREAT HUMERUS FRACTURE $ 211.56 $ 228.01 3/1/2020 12/31/9999 23605 TREAT HUMERUS FRACTURE $ 313.61 $ 338.29 3/1/2020 12/31/9999 23615 TREAT HUMERUS FRACTURE $ 666.31 $ 666.31 3/1/2020 12/31/9999 23616 TREAT HUMERUS FRACTURE $ 996.41 $ 996.41 3/1/2020 12/31/9999 23620 TREAT HUMERUS FRACTURE $ 177.52 $ 187.81 3/1/2020 12/31/9999 23625 TREAT HUMERUS FRACTURE $ 258.28 $ 274.14 3/1/2020 12/31/9999 23630 TREAT HUMERUS FRACTURE $ 572.01 $ 572.01 3/1/2020 12/31/9999 23650 TREAT SHOULDER DISLOCATION $ 196.36 $ 213.70 3/1/2020 12/31/9999 23655 TREAT SHOULDER DISLOCATION $ 284.61 $ 284.61 3/1/2020 12/31/9999 23660 TREAT SHOULDER DISLOCATION $ 441.11 $ 441.11 3/1/2020 12/31/9999 23665 TREAT DISLOCATION/FRACTURE $ 288.30 $ 305.35 3/1/2020 12/31/9999 23670 TREAT DISLOCATION/FRACTURE $ 643.45 $ 643.45 3/1/2020 12/31/9999 23675 TREAT DISLOCATION/FRACTURE $ 371.27 $ 399.47 3/1/2020 12/31/9999 23680 TREAT DISLOCATION/FRACTURE $ 696.76 $ 696.76 3/1/2020 12/31/9999 23700 FIXATION OF SHOULDER $ 148.26 $ 148.26 3/1/2020 12/31/9999 23800 FUSION OF SHOULDER JOINT $ 791.67 $ 791.67 3/1/2020 12/31/9999 23802 FUSION OF SHOULDER JOINT $ 962.33 $ 962.33 3/1/2020 12/31/9999 23900 AMPUTATION OF ARM & GIRDLE $ 1,030.00 $ 1,030.00 3/1/2020 12/31/9999 23920 AMPUTATION AT SHOULDER JOINT $ 832.86 $ 832.86 3/1/2020 12/31/9999 23921 AMPUTATION FOLLOW-UP SURGERY $ 301.07 $ 301.07 3/1/2020 12/31/9999 23930 DRAINAGE OF ARM LESION $ 164.63 $ 259.22 3/1/2020 12/31/9999 23931 DRAINAGE OF ARM BURSA $ 118.05 $ 201.17 3/1/2020 12/31/9999 23935 DRAIN ARM/ELBOW BONE LESION $ 375.65 $ 375.65 3/1/2020 12/31/9999 24000 EXPLORATORY ELBOW SURGERY $ 357.21 $ 357.21 3/1/2020 12/31/9999 24006 RELEASE ELBOW JOINT $ 542.20 $ 542.20 3/1/2020 12/31/9999 24065 BIOPSY ARM/ELBOW SOFT TISSUE $ 125.92 $ 184.97 3/1/2020 12/31/9999 24066 BIOPSY ARM/ELBOW SOFT TISSUE $ 301.23 $ 430.48 3/1/2020 12/31/9999 24071 EXC ARM/ELBOW LES SC 3 CM/> $ 252.82 $ 252.82 3/1/2020 12/31/9999 24073 EX ARM/ELBOW TUM DEEP 5 CM/> $ 434.01 $ 434.01 3/1/2020 12/31/9999 24075 EXC ARM/ELBOW LES SC < 3 CM $ 235.14 $ 348.23 3/1/2020 12/31/9999 24076 EX ARM/ELBOW TUM DEEP < 5 CM $ 359.75 $ 359.75 3/1/2020 12/31/9999 24077 RESECT ARM/ELBOW TUM < 5 CM $ 624.94 $ 624.94 3/1/2020 12/31/9999 24079 RESECT ARM/ELBOW TUM 5 CM/> $ 806.82 $ 806.82 3/1/2020 12/31/9999 24100 BIOPSY ELBOW JOINT LINING $ 304.51 $ 304.51 3/1/2020 12/31/9999 24101 EXPLORE/TREAT ELBOW JOINT $ 375.34 $ 375.34 3/1/2020 12/31/9999 24102 REMOVE ELBOW JOINT LINING $ 467.12 $ 467.12 3/1/2020 12/31/9999 24105 REMOVAL OF ELBOW BURSA $ 250.73 $ 250.73 3/1/2020 12/31/9999 24110 REMOVE HUMERUS LESION $ 441.27 $ 441.27 3/1/2020 12/31/9999 24115 REMOVE/GRAFT BONE LESION $ 558.77 $ 558.77 3/1/2020 12/31/9999 24116 REMOVE/GRAFT BONE LESION $ 664.27 $ 664.27 3/1/2020 12/31/9999 24120 REMOVE ELBOW LESION $ 395.03 $ 395.03 3/1/2020 12/31/9999 24125 REMOVE/GRAFT BONE LESION $ 456.98 $ 456.98 3/1/2020 12/31/9999 24126 REMOVE/GRAFT BONE LESION $ 485.10 $ 485.10 3/1/2020 12/31/9999 24130 REMOVAL OF HEAD OF RADIUS $ 381.12 $ 381.12 3/1/2020 12/31/9999 24134 REMOVAL OF ARM BONE LESION $ 574.65 $ 574.65 3/1/2020 12/31/9999 24136 REMOVE RADIUS BONE LESION $ 454.95 $ 454.95 3/1/2020 12/31/9999 24138 REMOVE ELBOW BONE LESION $ 500.96 $ 500.96 3/1/2020 12/31/9999 24140 PARTIAL REMOVAL OF ARM BONE $ 546.95 $ 546.95 3/1/2020 12/31/9999 24145 PARTIAL REMOVAL OF RADIUS $ 457.99 $ 457.99 3/1/2020 12/31/9999 24147 PARTIAL REMOVAL OF ELBOW $ 475.13 $ 475.13 3/1/2020 12/31/9999 24149 RADICAL RESECTION OF ELBOW $ 883.33 $ 883.33 3/1/2020 12/31/9999 24150 RESECT DISTAL HUMERUS TUMOR $ 749.28 $ 749.28 3/1/2020 12/31/9999 24152 RESECT RADIUS TUMOR $ 562.96 $ 562.96 3/1/2020 12/31/9999 24155 REMOVAL OF ELBOW JOINT $ 652.22 $ 652.22 3/1/2020 12/31/9999 24160 REMOVE ELBOW JOINT IMPLANT $ 459.45 $ 459.45 3/1/2020 12/31/9999 24164 REMOVE RADIUS HEAD IMPLANT $ 375.11 $ 375.11 3/1/2020 12/31/9999 24200 REMOVAL OF ARM FOREIGN BODY $ 102.27 $ 144.56 3/1/2020 12/31/9999 24201 REMOVAL OF ARM FOREIGN BODY $ 274.28 $ 403.23 3/1/2020 12/31/9999 24220 INJECTION FOR ELBOW X-RAY $ 57.90 $ 130.45 3/1/2020 12/31/9999 24300 MANIPULATE ELBOW W/ANESTH $ 290.78 $ 290.78 3/1/2020 12/31/9999 24301 MUSCLE/TENDON TRANSFER $ 576.03 $ 576.03 3/1/2020 12/31/9999 24305 ARM TENDON LENGTHENING $ 438.77 $ 438.77 3/1/2020 12/31/9999 24310 REVISION OF ARM TENDON $ 358.87 $ 358.87 3/1/2020 12/31/9999 24320 REPAIR OF ARM TENDON $ 593.76 $ 593.76 3/1/2020 12/31/9999 24330 REVISION OF ARM MUSCLES $ 547.27 $ 547.27 3/1/2020 12/31/9999 24331 REVISION OF ARM MUSCLES $ 605.65 $ 605.65 3/1/2020 12/31/9999 24332 TENOLYSIS TRICEPS $ 457.75 $ 457.75 3/1/2020 12/31/9999 24340 REPAIR OF BICEPS TENDON $ 465.81 $ 465.81 3/1/2020 12/31/9999 24341 REPAIR ARM TENDON/MUSCLE $ 547.88 $ 547.88 3/1/2020 12/31/9999 24342 REPAIR OF RUPTURED TENDON $ 602.06 $ 602.06 3/1/2020 12/31/9999 24343 REPR ELBOW LAT LIGMNT W/TISS $ 532.53 $ 532.53 3/1/2020 12/31/9999 24344 RECONSTRUCT ELBOW LAT LIGMNT $ 833.30 $ 833.30 3/1/2020 12/31/9999 24345 REPR ELBW MED LIGMNT W/TISSU $ 529.21 $ 529.21 3/1/2020 12/31/9999 24346 RECONSTRUCT ELBOW MED LIGMNT $ 835.04 $ 835.04 3/1/2020 12/31/9999 24350 REVISION OF TENNIS ELBOW $ 378.28 $ 378.28 3/1/2020 12/31/9999 24351 REVISION OF TENNIS ELBOW $ 413.19 $ 413.19 3/1/2020 12/31/9999 24352 REVISION OF TENNIS ELBOW $ 440.72 $ 440.72 3/1/2020 12/31/9999 24354 REVISION OF TENNIS ELBOW $ 440.82 $ 440.82 3/1/2020 12/31/9999 24357 REPAIR ELBOW PERC $ 332.75 $ 332.75 3/1/2020 12/31/9999 24358 REPAIR ELBOW W/DEB OPEN $ 393.44 $ 393.44 3/1/2020 12/31/9999 24359 REPAIR ELBOW DEB/ATTCH OPEN $ 496.86 $ 496.86 3/1/2020 12/31/9999 24360 RECONSTRUCT ELBOW JOINT $ 692.60 $ 692.60 3/1/2020 12/31/9999 24361 RECONSTRUCT ELBOW JOINT $ 777.20 $ 777.20 3/1/2020 12/31/9999 24362 RECONSTRUCT ELBOW JOINT $ 822.48 $ 822.48 3/1/2020 12/31/9999 24363 REPLACE ELBOW JOINT $ 1,155.95 $ 1,155.95 3/1/2020 12/31/9999 24365 RECONSTRUCT HEAD OF RADIUS $ 487.81 $ 487.81 3/1/2020 12/31/9999 24366 RECONSTRUCT HEAD OF RADIUS $ 522.92 $ 522.92 3/1/2020 12/31/9999 24370 REVISE RECONST ELBOW JOINT $ 1,281.23 $ 1,281.23 3/1/2020 12/31/9999 24371 REVISE RECONST ELBOW JOINT $ 1,476.50 $ 1,476.50 3/1/2020 12/31/9999 24400 REVISION OF HUMERUS $ 631.56 $ 631.56 3/1/2020 12/31/9999 24410 REVISION OF HUMERUS $ 808.73 $ 808.73 3/1/2020 12/31/9999 24420 REVISION OF HUMERUS $ 758.31 $ 758.31 3/1/2020 12/31/9999 24430 REPAIR OF HUMERUS $ 806.74 $ 806.74 3/1/2020 12/31/9999 24435 REPAIR HUMERUS WITH GRAFT $ 817.43 $ 817.43 3/1/2020 12/31/9999 24470 REVISION OF ELBOW JOINT $ 481.70 $ 481.70 3/1/2020 12/31/9999 24495 DECOMPRESSION OF FOREARM $ 499.42 $ 499.42 3/1/2020 12/31/9999 24498 REINFORCE HUMERUS $ 671.65 $ 671.65 3/1/2020 12/31/9999 24500 TREAT HUMERUS FRACTURE $ 225.89 $ 248.20 3/1/2020 12/31/9999 24505 TREAT HUMERUS FRACTURE $ 332.68 $ 362.07 3/1/2020 12/31/9999 24515 TREAT HUMERUS FRACTURE $ 672.72 $ 672.72 3/1/2020 12/31/9999 24516 TREAT HUMERUS FRACTURE $ 665.93 $ 665.93 3/1/2020 12/31/9999 24530 TREAT HUMERUS FRACTURE $ 243.23 $ 267.32 3/1/2020 12/31/9999 24535 TREAT HUMERUS FRACTURE $ 424.55 $ 454.22 3/1/2020 12/31/9999 24538 TREAT HUMERUS FRACTURE $ 566.19 $ 566.19 3/1/2020 12/31/9999 24545 TREAT HUMERUS FRACTURE $ 700.81 $ 700.81 3/1/2020 12/31/9999 24546 TREAT HUMERUS FRACTURE $ 814.33 $ 814.33 3/1/2020 12/31/9999 24560 TREAT HUMERUS FRACTURE $ 198.70 $ 222.79 3/1/2020 12/31/9999 24565 TREAT HUMERUS FRACTURE $ 346.76 $ 373.20 3/1/2020 12/31/9999 24566 TREAT HUMERUS FRACTURE $ 529.61 $ 529.61 3/1/2020 12/31/9999 24575 TREAT HUMERUS FRACTURE $ 562.07 $ 562.07 3/1/2020 12/31/9999 24576 TREAT HUMERUS FRACTURE $ 211.31 $ 234.22 3/1/2020 12/31/9999 24577 TREAT HUMERUS FRACTURE $ 359.75 $ 388.25 3/1/2020 12/31/9999 24579 TREAT HUMERUS FRACTURE $ 639.62 $ 639.62 3/1/2020 12/31/9999 24582 TREAT HUMERUS FRACTURE $ 590.91 $ 590.91 3/1/2020 12/31/9999 24586 TREAT ELBOW FRACTURE $ 847.29 $ 847.29 3/1/2020 12/31/9999 24587 TREAT ELBOW FRACTURE $ 843.73 $ 843.73 3/1/2020 12/31/9999 24600 TREAT ELBOW DISLOCATION $ 241.45 $ 263.78 3/1/2020 12/31/9999 24605 TREAT ELBOW DISLOCATION $ 342.09 $ 342.09 3/1/2020 12/31/9999 24615 TREAT ELBOW DISLOCATION $ 547.69 $ 547.69 3/1/2020 12/31/9999 24620 TREAT ELBOW FRACTURE $ 414.37 $ 414.37 3/1/2020 12/31/9999 24635 TREAT ELBOW FRACTURE $ 572.52 $ 572.52 3/1/2020 12/31/9999 24640 TREAT ELBOW DISLOCATION $ 64.37 $ 86.69 3/1/2020 12/31/9999 24650 TREAT RADIUS FRACTURE $ 163.91 $ 180.65 3/1/2020 12/31/9999 24655 TREAT RADIUS FRACTURE $ 288.83 $ 313.81 3/1/2020 12/31/9999 24665 TREAT RADIUS FRACTURE $ 491.53 $ 491.53 3/1/2020 12/31/9999 24666 TREAT RADIUS FRACTURE $ 559.30 $ 559.30 3/1/2020 12/31/9999 24670 TREAT ULNAR FRACTURE $ 183.36 $ 203.33 3/1/2020 12/31/9999 24675 TREAT ULNAR FRACTURE $ 306.77 $ 331.75 3/1/2020 12/31/9999 24685 TREAT ULNAR FRACTURE $ 493.72 $ 493.72 3/1/2020 12/31/9999 24800 FUSION OF ELBOW JOINT $ 608.67 $ 608.67 3/1/2020 12/31/9999 24802 FUSION/GRAFT OF ELBOW JOINT $ 771.40 $ 771.40 3/1/2020 12/31/9999 24900 AMPUTATION OF UPPER ARM $ 549.68 $ 549.68 3/1/2020 12/31/9999 24920 AMPUTATION OF UPPER ARM $ 546.25 $ 546.25 3/1/2020 12/31/9999 24925 AMPUTATION FOLLOW-UP SURGERY $ 422.53 $ 422.53 3/1/2020 12/31/9999 24930 AMPUTATION FOLLOW-UP SURGERY $ 579.59 $ 579.59 3/1/2020 12/31/9999 24931 AMPUTATE UPPER ARM & IMPLANT $ 650.71 $ 650.71 3/1/2020 12/31/9999 24935 REVISION OF AMPUTATION $ 789.84 $ 789.84 3/1/2020 12/31/9999 24940 REVISION OF UPPER ARM $ 907.18 $ 907.18 3/1/2020 12/31/9999 25000 INCISION OF TENDON SHEATH $ 259.55 $ 259.55 3/1/2020 12/31/9999 25001 INCISE FLEXOR CARPI RADIALIS $ 246.61 $ 246.61 3/1/2020 12/31/9999 25020 DECOMPRESS FOREARM 1 SPACE $ 430.67 $ 430.67 3/1/2020 12/31/9999 25023 DECOMPRESS FOREARM 1 SPACE $ 833.90 $ 833.90 3/1/2020 12/31/9999 25024 DECOMPRESS FOREARM 2 SPACES $ 585.24 $ 585.24 3/1/2020 12/31/9999 25025 DECOMPRESS FOREARM 2 SPACES $ 905.48 $ 905.48 3/1/2020 12/31/9999 25028 DRAINAGE OF FOREARM LESION $ 383.48 $ 383.48 3/1/2020 12/31/9999 25031 DRAINAGE OF FOREARM BURSA $ 282.62 $ 282.62 3/1/2020 12/31/9999 25035 TREAT FOREARM BONE LESION $ 489.72 $ 489.72 3/1/2020 12/31/9999 25040 EXPLORE/TREAT WRIST JOINT $ 434.72 $ 434.72 3/1/2020 12/31/9999 25065 BIOPSY FOREARM SOFT TISSUES $ 124.13 $ 183.47 3/1/2020 12/31/9999 25066 BIOPSY FOREARM SOFT TISSUES $ 283.10 $ 283.10 3/1/2020 12/31/9999 25071 EXC FOREARM LES SC 3 CM/> $ 264.97 $ 264.97 3/1/2020 12/31/9999 25073 EXC FOREARM TUM DEEP 3 CM/> $ 330.08 $ 330.08 3/1/2020 12/31/9999 25075 EXC FOREARM LES SC < 3 CM $ 248.02 $ 248.02 3/1/2020 12/31/9999 25076 EXC FOREARM TUM DEEP < 3 CM $ 334.88 $ 334.88 3/1/2020 12/31/9999 25077 RESECT FOREARM/WRIST TUM<3CM $ 570.93 $ 570.93 3/1/2020 12/31/9999 25078 RESECT FORARM/WRIST TUM 3CM> $ 704.46 $ 704.46 3/1/2020 12/31/9999 25085 INCISION OF WRIST CAPSULE $ 349.35 $ 349.35 3/1/2020 12/31/9999 25100 BIOPSY OF WRIST JOINT $ 258.90 $ 258.90 3/1/2020 12/31/9999 25101 EXPLORE/TREAT WRIST JOINT $ 305.45 $ 305.45 3/1/2020 12/31/9999 25105 REMOVE WRIST JOINT LINING $ 371.58 $ 371.58 3/1/2020 12/31/9999 25107 REMOVE WRIST JOINT CARTILAGE $ 462.25 $ 462.25 3/1/2020 12/31/9999 25109 EXCISE TENDON FOREARM/WRIST $ 395.69 $ 395.69 3/1/2020 12/31/9999 25110 REMOVE WRIST TENDON LESION $ 271.02 $ 271.02 3/1/2020 12/31/9999 25111 REMOVE WRIST TENDON LESION $ 235.06 $ 235.06 3/1/2020 12/31/9999 25112 REREMOVE WRIST TENDON LESION $ 288.19 $ 288.19 3/1/2020 12/31/9999 25115 REMOVE WRIST/FOREARM LESION $ 609.51 $ 609.51 3/1/2020 12/31/9999 25116 REMOVE WRIST/FOREARM LESION $ 491.70 $ 491.70 3/1/2020 12/31/9999 25118 EXCISE WRIST TENDON SHEATH $ 288.59 $ 288.59 3/1/2020 12/31/9999 25119 PARTIAL REMOVAL OF ULNA $ 382.83 $ 382.83 3/1/2020 12/31/9999 25120 REMOVAL OF FOREARM LESION $ 419.32 $ 419.32 3/1/2020 12/31/9999 25125 REMOVE/GRAFT FOREARM LESION $ 488.75 $ 488.75 3/1/2020 12/31/9999 25126 REMOVE/GRAFT FOREARM LESION $ 493.75 $ 493.75 3/1/2020 12/31/9999 25130 REMOVAL OF WRIST LESION $ 338.97 $ 338.97 3/1/2020 12/31/9999 25135 REMOVE & GRAFT WRIST LESION $ 423.98 $ 423.98 3/1/2020 12/31/9999 25136 REMOVE & GRAFT WRIST LESION $ 374.67 $ 374.67 3/1/2020 12/31/9999 25145 REMOVE FOREARM BONE LESION $ 430.73 $ 430.73 3/1/2020 12/31/9999 25150 PARTIAL REMOVAL OF ULNA $ 439.77 $ 439.77 3/1/2020 12/31/9999 25151 PARTIAL REMOVAL OF RADIUS $ 485.65 $ 485.65 3/1/2020 12/31/9999 25170 RESECT RADIUS/ULNAR TUMOR $ 677.66 $ 677.66 3/1/2020 12/31/9999 25210 REMOVAL OF WRIST BONE $ 371.91 $ 371.91 3/1/2020 12/31/9999 25215 REMOVAL OF WRIST BONES $ 479.86 $ 479.86 3/1/2020 12/31/9999 25230 PARTIAL REMOVAL OF RADIUS $ 329.28 $ 329.28 3/1/2020 12/31/9999 25240 PARTIAL REMOVAL OF ULNA $ 333.65 $ 333.65 3/1/2020 12/31/9999 25246 INJECTION FOR WRIST X-RAY $ 63.71 $ 132.75 3/1/2020 12/31/9999 25248 REMOVE FOREARM FOREIGN BODY $ 332.08 $ 332.08 3/1/2020 12/31/9999 25250 REMOVAL OF WRIST PROSTHESIS $ 396.03 $ 396.03 3/1/2020 12/31/9999 25251 REMOVAL OF WRIST PROSTHESIS $ 542.26 $ 542.26 3/1/2020 12/31/9999 25259 MANIPULATE WRIST W/ANESTHES $ 291.63 $ 291.63 3/1/2020 12/31/9999 25260 REPAIR FOREARM TENDON/MUSCLE $ 514.80 $ 514.80 3/1/2020 12/31/9999 25263 REPAIR FOREARM TENDON/MUSCLE $ 514.04 $ 514.04 3/1/2020 12/31/9999 25265 REPAIR FOREARM TENDON/MUSCLE $ 611.45 $ 611.45 3/1/2020 12/31/9999 25270 REPAIR FOREARM TENDON/MUSCLE $ 412.79 $ 412.79 3/1/2020 12/31/9999 25272 REPAIR FOREARM TENDON/MUSCLE $ 465.19 $ 465.19 3/1/2020 12/31/9999 25274 REPAIR FOREARM TENDON/MUSCLE $ 552.16 $ 552.16 3/1/2020 12/31/9999 25275 REPAIR FOREARM TENDON SHEATH $ 510.04 $ 510.04 3/1/2020 12/31/9999 25280 REVISE WRIST/FOREARM TENDON $ 471.48 $ 471.48 3/1/2020 12/31/9999 25290 INCISE WRIST/FOREARM TENDON $ 397.88 $ 397.88 3/1/2020 12/31/9999 25295 RELEASE WRIST/FOREARM TENDON $ 438.61 $ 438.61 3/1/2020 12/31/9999 25300 FUSION OF TENDONS AT WRIST $ 519.46 $ 519.46 3/1/2020 12/31/9999 25301 FUSION OF TENDONS AT WRIST $ 494.70 $ 494.70 3/1/2020 12/31/9999 25310 TRANSPLANT FOREARM TENDON $ 510.63 $ 510.63 3/1/2020 12/31/9999 25312 TRANSPLANT FOREARM TENDON $ 592.27 $ 592.27 3/1/2020 12/31/9999 25315 REVISE PALSY HAND TENDON(S) $ 635.36 $ 635.36 3/1/2020 12/31/9999 25316 REVISE PALSY HAND TENDON(S) $ 735.96 $ 735.96 3/1/2020 12/31/9999 25320 REPAIR/REVISE WRIST JOINT $ 731.06 $ 731.06 3/1/2020 12/31/9999 25332 REVISE WRIST JOINT $ 647.18 $ 647.18 3/1/2020 12/31/9999 25335 REALIGNMENT OF HAND $ 734.86 $ 734.86 3/1/2020 12/31/9999 25337 RECONSTRUCT ULNA/RADIOULNAR $ 673.01 $ 673.01 3/1/2020 12/31/9999 25350 REVISION OF RADIUS $ 562.76 $ 562.76 3/1/2020 12/31/9999 25355 REVISION OF RADIUS $ 633.51 $ 633.51 3/1/2020 12/31/9999 25360 REVISION OF ULNA $ 545.95 $ 545.95 3/1/2020 12/31/9999 25365 REVISE RADIUS & ULNA $ 745.41 $ 745.41 3/1/2020 12/31/9999 25370 REVISE RADIUS OR ULNA $ 812.48 $ 812.48 3/1/2020 12/31/9999 25375 REVISE RADIUS & ULNA $ 784.10 $ 784.10 3/1/2020 12/31/9999 25390 SHORTEN RADIUS OR ULNA $ 637.40 $ 637.40 3/1/2020 12/31/9999 25391 LENGTHEN RADIUS OR ULNA $ 811.57 $ 811.57 3/1/2020 12/31/9999 25392 SHORTEN RADIUS & ULNA $ 823.87 $ 823.87 3/1/2020 12/31/9999 25393 LENGTHEN RADIUS & ULNA $ 926.48 $ 926.48 3/1/2020 12/31/9999 25394 REPAIR CARPAL BONE SHORTEN $ 594.49 $ 594.49 3/1/2020 12/31/9999 25400 REPAIR RADIUS OR ULNA $ 668.84 $ 668.84 3/1/2020 12/31/9999 25405 REPAIR/GRAFT RADIUS OR ULNA $ 851.64 $ 851.64 3/1/2020 12/31/9999 25415 REPAIR RADIUS & ULNA $ 799.63 $ 799.63 3/1/2020 12/31/9999 25420 REPAIR/GRAFT RADIUS & ULNA $ 953.07 $ 953.07 3/1/2020 12/31/9999 25425 REPAIR/GRAFT RADIUS OR ULNA $ 822.01 $ 822.01 3/1/2020 12/31/9999 25426 REPAIR/GRAFT RADIUS & ULNA $ 864.80 $ 864.80 3/1/2020 12/31/9999 25430 VASC GRAFT INTO CARPAL BONE $ 541.57 $ 541.57 3/1/2020 12/31/9999 25431 REPAIR NONUNION CARPAL BONE $ 600.43 $ 600.43 3/1/2020 12/31/9999 25440 REPAIR/GRAFT WRIST BONE $ 596.41 $ 596.41 3/1/2020 12/31/9999 25441 RECONSTRUCT WRIST JOINT $ 723.56 $ 723.56 3/1/2020 12/31/9999 25442 RECONSTRUCT WRIST JOINT $ 615.96 $ 615.96 3/1/2020 12/31/9999 25443 RECONSTRUCT WRIST JOINT $ 590.78 $ 590.78 3/1/2020 12/31/9999 25444 RECONSTRUCT WRIST JOINT $ 630.48 $ 630.48 3/1/2020 12/31/9999 25445 RECONSTRUCT WRIST JOINT $ 551.76 $ 551.76 3/1/2020 12/31/9999 25446 WRIST REPLACEMENT $ 910.94 $ 910.94 3/1/2020 12/31/9999 25447 REPAIR WRIST JOINTS $ 622.48 $ 622.48 3/1/2020 12/31/9999 25449 REMOVE WRIST JOINT IMPLANT $ 797.57 $ 797.57 3/1/2020 12/31/9999 25450 REVISION OF WRIST JOINT $ 461.94 $ 461.94 3/1/2020 12/31/9999 25455 REVISION OF WRIST JOINT $ 527.10 $ 527.10 3/1/2020 12/31/9999 25490 REINFORCE RADIUS $ 579.84 $ 579.84 3/1/2020 12/31/9999 25491 REINFORCE ULNA $ 611.87 $ 611.87 3/1/2020 12/31/9999 25492 REINFORCE RADIUS AND ULNA $ 738.44 $ 738.44 3/1/2020 12/31/9999 25500 TREAT FRACTURE OF RADIUS $ 169.89 $ 185.75 3/1/2020 12/31/9999 25505 TREAT FRACTURE OF RADIUS $ 337.42 $ 363.86 3/1/2020 12/31/9999 25515 TREAT FRACTURE OF RADIUS $ 508.19 $ 508.19 3/1/2020 12/31/9999 25520 TREAT FRACTURE OF RADIUS $ 384.67 $ 402.58 3/1/2020 12/31/9999 25525 TREAT FRACTURE OF RADIUS $ 614.25 $ 614.25 3/1/2020 12/31/9999 25526 TREAT FRACTURE OF RADIUS $ 754.30 $ 754.30 3/1/2020 12/31/9999 25530 TREAT FRACTURE OF ULNA $ 161.77 $ 179.40 3/1/2020 12/31/9999 25535 TREAT FRACTURE OF ULNA $ 331.74 $ 352.88 3/1/2020 12/31/9999 25545 TREAT FRACTURE OF ULNA $ 474.98 $ 474.98 3/1/2020 12/31/9999 25560 TREAT FRACTURE RADIUS & ULNA $ 168.98 $ 188.08 3/1/2020 12/31/9999 25565 TREAT FRACTURE RADIUS & ULNA $ 350.74 $ 381.30 3/1/2020 12/31/9999 25574 TREAT FRACTURE RADIUS & ULNA $ 499.95 $ 499.95 3/1/2020 12/31/9999 25575 TREAT FRACTURE RADIUS/ULNA $ 681.17 $ 681.17 3/1/2020 12/31/9999 25600 TREAT FRACTURE RADIUS/ULNA $ 185.83 $ 204.91 3/1/2020 12/31/9999 25605 TREAT FRACTURE RADIUS/ULNA $ 425.78 $ 448.69 3/1/2020 12/31/9999 25606 TREAT FX DISTAL RADIAL $ 499.38 $ 499.38 3/1/2020 12/31/9999 25607 TREAT FX RAD EXTRA-ARTICUL $ 540.80 $ 540.80 3/1/2020 12/31/9999 25608 TREAT FX RAD INTRA-ARTICUL $ 617.51 $ 617.51 3/1/2020 12/31/9999 25609 TREAT FX RADIAL 3+ FRAG $ 788.89 $ 788.89 3/1/2020 12/31/9999 25622 TREAT WRIST BONE FRACTURE $ 189.71 $ 209.98 3/1/2020 12/31/9999 25624 TREAT WRIST BONE FRACTURE $ 305.67 $ 333.27 3/1/2020 12/31/9999 25628 TREAT WRIST BONE FRACTURE $ 543.43 $ 543.43 3/1/2020 12/31/9999 25630 TREAT WRIST BONE FRACTURE $ 195.54 $ 215.51 3/1/2020 12/31/9999 25635 TREAT WRIST BONE FRACTURE $ 283.15 $ 315.48 3/1/2020 12/31/9999 25645 TREAT WRIST BONE FRACTURE $ 428.44 $ 428.44 3/1/2020 12/31/9999 25650 TREAT WRIST BONE FRACTURE $ 207.72 $ 224.76 3/1/2020 12/31/9999 25651 PIN ULNAR STYLOID FRACTURE $ 353.67 $ 353.67 3/1/2020 12/31/9999 25652 TREAT FRACTURE ULNAR STYLOID $ 466.81 $ 466.81 3/1/2020 12/31/9999 25660 TREAT WRIST DISLOCATION $ 295.51 $ 295.51 3/1/2020 12/31/9999 25670 TREAT WRIST DISLOCATION $ 462.48 $ 462.48 3/1/2020 12/31/9999 25671 PIN RADIOULNAR DISLOCATION $ 389.45 $ 389.45 3/1/2020 12/31/9999 25675 TREAT WRIST DISLOCATION $ 288.17 $ 311.37 3/1/2020 12/31/9999 25676 TREAT WRIST DISLOCATION $ 478.83 $ 478.83 3/1/2020 12/31/9999 25680 TREAT WRIST FRACTURE $ 342.44 $ 342.44 3/1/2020 12/31/9999 25685 TREAT WRIST FRACTURE $ 557.97 $ 557.97 3/1/2020 12/31/9999 25690 TREAT WRIST DISLOCATION $ 345.03 $ 345.03 3/1/2020 12/31/9999 25695 TREAT WRIST DISLOCATION $ 480.74 $ 480.74 3/1/2020 12/31/9999 25800 FUSION OF WRIST JOINT $ 568.79 $ 568.79 3/1/2020 12/31/9999 25805 FUSION/GRAFT OF WRIST JOINT $ 655.95 $ 655.95 3/1/2020 12/31/9999 25810 FUSION/GRAFT OF WRIST JOINT $ 662.22 $ 662.22 3/1/2020 12/31/9999 25820 FUSION OF HAND BONES $ 463.70 $ 463.70 3/1/2020 12/31/9999 25825 FUSE HAND BONES WITH GRAFT $ 571.91 $ 571.91 3/1/2020 12/31/9999 25830 FUSION RADIOULNAR JNT/ULNA $ 712.31 $ 712.31 3/1/2020 12/31/9999 25900 AMPUTATION OF FOREARM $ 569.81 $ 569.81 3/1/2020 12/31/9999 25905 AMPUTATION OF FOREARM $ 563.65 $ 563.65 3/1/2020 12/31/9999 25907 AMPUTATION FOLLOW-UP SURGERY $ 491.46 $ 491.46 3/1/2020 12/31/9999 25909 AMPUTATION FOLLOW-UP SURGERY $ 554.10 $ 554.10 3/1/2020 12/31/9999 25915 AMPUTATION OF FOREARM $ 972.43 $ 972.43 3/1/2020 12/31/9999 25920 AMPUTATE HAND AT WRIST $ 521.35 $ 521.35 3/1/2020 12/31/9999 25922 AMPUTATE HAND AT WRIST $ 440.59 $ 440.59 3/1/2020 12/31/9999 25924 AMPUTATION FOLLOW-UP SURGERY $ 509.07 $ 509.07 3/1/2020 12/31/9999 25927 AMPUTATION OF HAND $ 589.51 $ 589.51 3/1/2020 12/31/9999 25929 AMPUTATION FOLLOW-UP SURGERY $ 427.00 $ 427.00 3/1/2020 12/31/9999 25931 AMPUTATION FOLLOW-UP SURGERY $ 536.71 $ 536.71 3/1/2020 12/31/9999 26010 DRAINAGE OF FINGER ABSCESS $ 98.69 $ 182.42 3/1/2020 12/31/9999 26011 DRAINAGE OF FINGER ABSCESS $ 137.93 $ 278.04 3/1/2020 12/31/9999 26020 DRAIN HAND TENDON SHEATH $ 317.94 $ 317.94 3/1/2020 12/31/9999 26025 DRAINAGE OF PALM BURSA $ 310.95 $ 310.95 3/1/2020 12/31/9999 26030 DRAINAGE OF PALM BURSAS $ 368.07 $ 368.07 3/1/2020 12/31/9999 26034 TREAT HAND BONE LESION $ 398.57 $ 398.57 3/1/2020 12/31/9999 26035 DECOMPRESS FINGERS/HAND $ 623.07 $ 623.07 3/1/2020 12/31/9999 26037 DECOMPRESS FINGERS/HAND $ 430.36 $ 430.36 3/1/2020 12/31/9999 26040 RELEASE PALM CONTRACTURE $ 227.58 $ 227.58 3/1/2020 12/31/9999 26045 RELEASE PALM CONTRACTURE $ 348.18 $ 348.18 3/1/2020 12/31/9999 26055 INCISE FINGER TENDON SHEATH $ 217.60 $ 405.90 3/1/2020 12/31/9999 26060 INCISION OF FINGER TENDON $ 194.73 $ 194.73 3/1/2020 12/31/9999 26070 EXPLORE/TREAT HAND JOINT $ 222.71 $ 222.71 3/1/2020 12/31/9999 26075 EXPLORE/TREAT FINGER JOINT $ 235.69 $ 235.69 3/1/2020 12/31/9999 26080 EXPLORE/TREAT FINGER JOINT $ 283.94 $ 283.94 3/1/2020 12/31/9999 26100 BIOPSY HAND JOINT LINING $ 238.55 $ 238.55 3/1/2020 12/31/9999 26105 BIOPSY FINGER JOINT LINING $ 244.05 $ 244.05 3/1/2020 12/31/9999 26110 BIOPSY FINGER JOINT LINING $ 234.19 $ 234.19 3/1/2020 12/31/9999 26111 EXC HAND LES SC 1.5 CM/> $ 257.12 $ 257.12 3/1/2020 12/31/9999 26113 EXC HAND TUM DEEP 1.5 CM/> $ 338.40 $ 338.40 3/1/2020 12/31/9999 26115 EXC HAND LES SC < 1.5 CM $ 265.32 $ 446.86 3/1/2020 12/31/9999 26116 EXC HAND TUM DEEP < 1.5 CM $ 357.81 $ 357.81 3/1/2020 12/31/9999 26117 RAD RESECT HAND TUMOR < 3 CM $ 490.63 $ 490.63 3/1/2020 12/31/9999 26118 RAD RESECT HAND TUMOR 3 CM/> $ 663.02 $ 663.02 3/1/2020 12/31/9999 26121 RELEASE PALM CONTRACTURE $ 450.29 $ 450.29 3/1/2020 12/31/9999 26123 RELEASE PALM CONTRACTURE $ 616.63 $ 616.63 3/1/2020 12/31/9999 26125 RELEASE PALM CONTRACTURE $ 222.45 $ 222.45 3/1/2020 12/31/9999 26130 REMOVE WRIST JOINT LINING $ 340.40 $ 340.40 3/1/2020 12/31/9999 26135 REVISE FINGER JOINT EACH $ 415.14 $ 415.14 3/1/2020 12/31/9999 26140 REVISE FINGER JOINT EACH $ 377.04 $ 377.04 3/1/2020 12/31/9999 26145 TENDON EXCISION PALM/FINGER $ 383.41 $ 383.41 3/1/2020 12/31/9999 26160 REMOVE TENDON SHEATH LESION $ 237.53 $ 407.33 3/1/2020 12/31/9999 26170 REMOVAL OF PALM TENDON EACH $ 300.91 $ 300.91 3/1/2020 12/31/9999 26180 REMOVAL OF FINGER TENDON $ 328.98 $ 328.98 3/1/2020 12/31/9999 26185 REMOVE FINGER BONE $ 393.26 $ 393.26 3/1/2020 12/31/9999 26200 REMOVE HAND BONE LESION $ 338.23 $ 338.23 3/1/2020 12/31/9999 26205 REMOVE/GRAFT BONE LESION $ 455.21 $ 455.21 3/1/2020 12/31/9999 26210 REMOVAL OF FINGER LESION $ 327.35 $ 327.35 3/1/2020 12/31/9999 26215 REMOVE/GRAFT FINGER LESION $ 417.19 $ 417.19 3/1/2020 12/31/9999 26230 PARTIAL REMOVAL OF HAND BONE $ 378.92 $ 378.92 3/1/2020 12/31/9999 26235 PARTIAL REMOVAL FINGER BONE $ 372.10 $ 372.10 3/1/2020 12/31/9999 26236 PARTIAL REMOVAL FINGER BONE $ 329.30 $ 329.30 3/1/2020 12/31/9999 26250 EXTENSIVE HAND SURGERY $ 440.04 $ 440.04 3/1/2020 12/31/9999 26260 RESECT PROX FINGER TUMOR $ 412.04 $ 412.04 3/1/2020 12/31/9999 26262 RESECT DISTAL FINGER TUMOR $ 343.60 $ 343.60 3/1/2020 12/31/9999 26320 REMOVAL OF IMPLANT FROM HAND $ 255.85 $ 255.85 3/1/2020 12/31/9999 26340 MANIPULATE FINGER W/ANESTH $ 227.64 $ 227.64 3/1/2020 12/31/9999 26341 MANIPULAT PALM CORD POST INJ $ 44.04 $ 58.25 3/1/2020 12/31/9999 26350 REPAIR FINGER/HAND TENDON $ 527.55 $ 527.55 3/1/2020 12/31/9999 26352 REPAIR/GRAFT HAND TENDON $ 601.68 $ 601.68 3/1/2020 12/31/9999 26356 REPAIR FINGER/HAND TENDON $ 786.30 $ 786.30 3/1/2020 12/31/9999 26357 REPAIR FINGER/HAND TENDON $ 646.92 $ 646.92 3/1/2020 12/31/9999 26358 REPAIR/GRAFT HAND TENDON $ 684.24 $ 684.24 3/1/2020 12/31/9999 26370 REPAIR FINGER/HAND TENDON $ 572.49 $ 572.49 3/1/2020 12/31/9999 26372 REPAIR/GRAFT HAND TENDON $ 665.05 $ 665.05 3/1/2020 12/31/9999 26373 REPAIR FINGER/HAND TENDON $ 631.71 $ 631.71 3/1/2020 12/31/9999 26390 REVISE HAND/FINGER TENDON $ 622.58 $ 622.58 3/1/2020 12/31/9999 26392 REPAIR/GRAFT HAND TENDON $ 726.96 $ 726.96 3/1/2020 12/31/9999 26410 REPAIR HAND TENDON $ 419.17 $ 419.17 3/1/2020 12/31/9999 26412 REPAIR/GRAFT HAND TENDON $ 510.57 $ 510.57 3/1/2020 12/31/9999 26415 EXCISION HAND/FINGER TENDON $ 540.58 $ 540.58 3/1/2020 12/31/9999 26416 GRAFT HAND OR FINGER TENDON $ 579.76 $ 579.76 3/1/2020 12/31/9999 26418 REPAIR FINGER TENDON $ 420.07 $ 420.07 3/1/2020 12/31/9999 26420 REPAIR/GRAFT FINGER TENDON $ 531.02 $ 531.02 3/1/2020 12/31/9999 26426 REPAIR FINGER/HAND TENDON $ 429.00 $ 429.00 3/1/2020 12/31/9999 26428 REPAIR/GRAFT FINGER TENDON $ 558.33 $ 558.33 3/1/2020 12/31/9999 26432 REPAIR FINGER TENDON $ 366.56 $ 366.56 3/1/2020 12/31/9999 26433 REPAIR FINGER TENDON $ 393.83 $ 393.83 3/1/2020 12/31/9999 26434 REPAIR/GRAFT FINGER TENDON $ 473.99 $ 473.99 3/1/2020 12/31/9999 26437 REALIGNMENT OF TENDONS $ 461.67 $ 461.67 3/1/2020 12/31/9999 26440 RELEASE PALM/FINGER TENDON $ 461.92 $ 461.92 3/1/2020 12/31/9999 26442 RELEASE PALM & FINGER TENDON $ 703.62 $ 703.62 3/1/2020 12/31/9999 26445 RELEASE HAND/FINGER TENDON $ 427.95 $ 427.95 3/1/2020 12/31/9999 26449 RELEASE FOREARM/HAND TENDON $ 566.43 $ 566.43 3/1/2020 12/31/9999 26450 INCISION OF PALM TENDON $ 297.72 $ 297.72 3/1/2020 12/31/9999 26455 INCISION OF FINGER TENDON $ 295.68 $ 295.68 3/1/2020 12/31/9999 26460 INCISE HAND/FINGER TENDON $ 287.31 $ 287.31 3/1/2020 12/31/9999 26471 FUSION OF FINGER TENDONS $ 454.80 $ 454.80 3/1/2020 12/31/9999 26474 FUSION OF FINGER TENDONS $ 435.83 $ 435.83 3/1/2020 12/31/9999 26476 TENDON LENGTHENING $ 424.36 $ 424.36 3/1/2020 12/31/9999 26477 TENDON SHORTENING $ 427.93 $ 427.93 3/1/2020 12/31/9999 26478 LENGTHENING OF HAND TENDON $ 465.06 $ 465.06 3/1/2020 12/31/9999 26479 SHORTENING OF HAND TENDON $ 460.04 $ 460.04 3/1/2020 12/31/9999 26480 TRANSPLANT HAND TENDON $ 558.93 $ 558.93 3/1/2020 12/31/9999 26483 TRANSPLANT/GRAFT HAND TENDON $ 632.77 $ 632.77 3/1/2020 12/31/9999 26485 TRANSPLANT PALM TENDON $ 605.66 $ 605.66 3/1/2020 12/31/9999 26489 TRANSPLANT/GRAFT PALM TENDON $ 657.79 $ 657.79 3/1/2020 12/31/9999 26490 REVISE THUMB TENDON $ 587.40 $ 587.40 3/1/2020 12/31/9999 26492 TENDON TRANSFER WITH GRAFT $ 655.23 $ 655.23 3/1/2020 12/31/9999 26494 HAND TENDON/MUSCLE TRANSFER $ 594.54 $ 594.54 3/1/2020 12/31/9999 26496 REVISE THUMB TENDON $ 645.87 $ 645.87 3/1/2020 12/31/9999 26497 FINGER TENDON TRANSFER $ 646.19 $ 646.19 3/1/2020 12/31/9999 26498 FINGER TENDON TRANSFER $ 866.18 $ 866.18 3/1/2020 12/31/9999 26499 REVISION OF FINGER $ 617.13 $ 617.13 3/1/2020 12/31/9999 26500 HAND TENDON RECONSTRUCTION $ 464.56 $ 464.56 3/1/2020 12/31/9999 26502 HAND TENDON RECONSTRUCTION $ 525.46 $ 525.46 3/1/2020 12/31/9999 26508 RELEASE THUMB CONTRACTURE $ 467.18 $ 467.18 3/1/2020 12/31/9999 26510 THUMB TENDON TRANSFER $ 442.28 $ 442.28 3/1/2020 12/31/9999 26516 FUSION OF KNUCKLE JOINT $ 524.01 $ 524.01 3/1/2020 12/31/9999 26517 FUSION OF KNUCKLE JOINTS $ 618.14 $ 618.14 3/1/2020 12/31/9999 26518 FUSION OF KNUCKLE JOINTS $ 624.13 $ 624.13 3/1/2020 12/31/9999 26520 RELEASE KNUCKLE CONTRACTURE $ 483.00 $ 483.00 3/1/2020 12/31/9999 26525 RELEASE FINGER CONTRACTURE $ 485.04 $ 485.04 3/1/2020 12/31/9999 26530 REVISE KNUCKLE JOINT $ 402.47 $ 402.47 3/1/2020 12/31/9999 26531 REVISE KNUCKLE WITH IMPLANT $ 468.81 $ 468.81 3/1/2020 12/31/9999 26535 REVISE FINGER JOINT $ 302.16 $ 302.16 3/1/2020 12/31/9999 26536 REVISE/IMPLANT FINGER JOINT $ 498.49 $ 498.49 3/1/2020 12/31/9999 26540 REPAIR HAND JOINT $ 491.28 $ 491.28 3/1/2020 12/31/9999 26541 REPAIR HAND JOINT WITH GRAFT $ 602.24 $ 602.24 3/1/2020 12/31/9999 26542 REPAIR HAND JOINT WITH GRAFT $ 508.29 $ 508.29 3/1/2020 12/31/9999 26545 RECONSTRUCT FINGER JOINT $ 517.48 $ 517.48 3/1/2020 12/31/9999 26546 REPAIR NONUNION HAND $ 728.23 $ 728.23 3/1/2020 12/31/9999 26548 RECONSTRUCT FINGER JOINT $ 570.73 $ 570.73 3/1/2020 12/31/9999 26550 CONSTRUCT THUMB REPLACEMENT $ 1,136.29 $ 1,136.29 3/1/2020 12/31/9999 26551 GREAT TOE-HAND TRANSFER $ 2,479.53 $ 2,479.53 3/1/2020 12/31/9999 26553 SINGLE TRANSFER TOE-HAND $ 2,178.55 $ 2,178.55 3/1/2020 12/31/9999 26554 DOUBLE TRANSFER TOE-HAND $ 2,840.53 $ 2,840.53 3/1/2020 12/31/9999 26555 POSITIONAL CHANGE OF FINGER $ 1,038.10 $ 1,038.10 3/1/2020 12/31/9999 26556 TOE JOINT TRANSFER $ 2,250.58 $ 2,250.58 3/1/2020 12/31/9999 26560 REPAIR OF WEB FINGER $ 422.79 $ 422.79 3/1/2020 12/31/9999 26561 REPAIR OF WEB FINGER $ 683.09 $ 683.09 3/1/2020 12/31/9999 26562 REPAIR OF WEB FINGER $ 995.37 $ 995.37 3/1/2020 12/31/9999 26565 CORRECT METACARPAL FLAW $ 503.67 $ 503.67 3/1/2020 12/31/9999 26567 CORRECT FINGER DEFORMITY $ 508.78 $ 508.78 3/1/2020 12/31/9999 26568 LENGTHEN METACARPAL/FINGER $ 670.13 $ 670.13 3/1/2020 12/31/9999 26580 REPAIR HAND DEFORMITY $ 1,061.91 $ 1,061.91 3/1/2020 12/31/9999 26587 RECONSTRUCT EXTRA FINGER $ 729.16 $ 729.16 3/1/2020 12/31/9999 26590 REPAIR FINGER DEFORMITY $ 968.67 $ 968.67 3/1/2020 12/31/9999 26591 REPAIR MUSCLES OF HAND $ 321.56 $ 321.56 3/1/2020 12/31/9999 26593 RELEASE MUSCLES OF HAND $ 440.94 $ 440.94 3/1/2020 12/31/9999 26596 EXCISION CONSTRICTING TISSUE $ 552.29 $ 552.29 3/1/2020 12/31/9999 26600 TREAT METACARPAL FRACTURE $ 181.14 $ 195.53 3/1/2020 12/31/9999 26605 TREAT METACARPAL FRACTURE $ 206.88 $ 225.97 3/1/2020 12/31/9999 26607 TREAT METACARPAL FRACTURE $ 327.06 $ 327.06 3/1/2020 12/31/9999 26608 TREAT METACARPAL FRACTURE $ 353.19 $ 353.19 3/1/2020 12/31/9999 26615 TREAT METACARPAL FRACTURE $ 410.95 $ 410.95 3/1/2020 12/31/9999 26641 TREAT THUMB DISLOCATION $ 239.48 $ 260.91 3/1/2020 12/31/9999 26645 TREAT THUMB FRACTURE $ 275.88 $ 297.92 3/1/2020 12/31/9999 26650 TREAT THUMB FRACTURE $ 352.94 $ 352.94 3/1/2020 12/31/9999 26665 TREAT THUMB FRACTURE $ 456.41 $ 456.41 3/1/2020 12/31/9999 26670 TREAT HAND DISLOCATION $ 213.86 $ 235.89 3/1/2020 12/31/9999 26675 TREAT HAND DISLOCATION $ 294.90 $ 317.82 3/1/2020 12/31/9999 26676 PIN HAND DISLOCATION $ 370.06 $ 370.06 3/1/2020 12/31/9999 26685 TREAT HAND DISLOCATION $ 421.46 $ 421.46 3/1/2020 12/31/9999 26686 TREAT HAND DISLOCATION $ 468.04 $ 468.04 3/1/2020 12/31/9999 26700 TREAT KNUCKLE DISLOCATION $ 210.70 $ 225.39 3/1/2020 12/31/9999 26705 TREAT KNUCKLE DISLOCATION $ 268.72 $ 291.33 3/1/2020 12/31/9999 26706 PIN KNUCKLE DISLOCATION $ 321.54 $ 321.54 3/1/2020 12/31/9999 26715 TREAT KNUCKLE DISLOCATION $ 411.57 $ 411.57 3/1/2020 12/31/9999 26720 TREAT FINGER FRACTURE EACH $ 124.33 $ 135.48 3/1/2020 12/31/9999 26725 TREAT FINGER FRACTURE EACH $ 219.38 $ 243.17 3/1/2020 12/31/9999 26727 TREAT FINGER FRACTURE EACH $ 347.08 $ 347.08 3/1/2020 12/31/9999 26735 TREAT FINGER FRACTURE EACH $ 428.87 $ 428.87 3/1/2020 12/31/9999 26740 TREAT FINGER FRACTURE EACH $ 148.45 $ 157.86 3/1/2020 12/31/9999 26742 TREAT FINGER FRACTURE EACH $ 243.62 $ 266.84 3/1/2020 12/31/9999 26746 TREAT FINGER FRACTURE EACH $ 526.43 $ 526.43 3/1/2020 12/31/9999 26750 TREAT FINGER FRACTURE EACH $ 123.73 $ 126.96 3/1/2020 12/31/9999 26755 TREAT FINGER FRACTURE EACH $ 195.72 $ 223.35 3/1/2020 12/31/9999 26756 PIN FINGER FRACTURE EACH $ 305.45 $ 305.45 3/1/2020 12/31/9999 26765 TREAT FINGER FRACTURE EACH $ 348.22 $ 348.22 3/1/2020 12/31/9999 26770 TREAT FINGER DISLOCATION $ 175.49 $ 191.05 3/1/2020 12/31/9999 26775 TREAT FINGER DISLOCATION $ 244.89 $ 271.32 3/1/2020 12/31/9999 26776 PIN FINGER DISLOCATION $ 325.26 $ 325.26 3/1/2020 12/31/9999 26785 TREAT FINGER DISLOCATION $ 380.36 $ 380.36 3/1/2020 12/31/9999 26820 THUMB FUSION WITH GRAFT $ 588.27 $ 588.27 3/1/2020 12/31/9999 26841 FUSION OF THUMB $ 543.53 $ 543.53 3/1/2020 12/31/9999 26842 THUMB FUSION WITH GRAFT $ 591.71 $ 591.71 3/1/2020 12/31/9999 26843 FUSION OF HAND JOINT $ 547.54 $ 547.54 3/1/2020 12/31/9999 26844 FUSION/GRAFT OF HAND JOINT $ 611.58 $ 611.58 3/1/2020 12/31/9999 26850 FUSION OF KNUCKLE $ 518.35 $ 518.35 3/1/2020 12/31/9999 26852 FUSION OF KNUCKLE WITH GRAFT $ 595.50 $ 595.50 3/1/2020 12/31/9999 26860 FUSION OF FINGER JOINT $ 413.77 $ 413.77 3/1/2020 12/31/9999 26861 FUSION OF FINGER JNT ADD-ON $ 83.90 $ 83.90 3/1/2020 12/31/9999 26862 FUSION/GRAFT OF FINGER JOINT $ 540.70 $ 540.70 3/1/2020 12/31/9999 26863 FUSE/GRAFT ADDED JOINT $ 187.09 $ 187.09 3/1/2020 12/31/9999 26910 AMPUTATE METACARPAL BONE $ 533.06 $ 533.06 3/1/2020 12/31/9999 26951 AMPUTATION OF FINGER/THUMB $ 458.85 $ 458.85 3/1/2020 12/31/9999 26952 AMPUTATION OF FINGER/THUMB $ 481.68 $ 481.68 3/1/2020 12/31/9999 26990 DRAINAGE OF PELVIS LESION $ 466.82 $ 466.82 3/1/2020 12/31/9999 26991 DRAINAGE OF PELVIS BURSA $ 394.98 $ 517.76 3/1/2020 12/31/9999 26992 DRAINAGE OF BONE LESION $ 738.23 $ 738.23 3/1/2020 12/31/9999 27000 INCISION OF HIP TENDON $ 338.99 $ 338.99 3/1/2020 12/31/9999 27001 INCISION OF HIP TENDON $ 411.59 $ 411.59 3/1/2020 12/31/9999 27003 INCISION OF HIP TENDON $ 442.16 $ 442.16 3/1/2020 12/31/9999 27005 INCISION OF HIP TENDON $ 559.09 $ 559.09 3/1/2020 12/31/9999 27006 INCISION OF HIP TENDONS $ 564.74 $ 564.74 3/1/2020 12/31/9999 27025 INCISION OF HIP/THIGH FASCIA $ 685.16 $ 685.16 3/1/2020 12/31/9999 27027 BUTTOCK FASCIOTOMY $ 670.07 $ 670.07 3/1/2020 12/31/9999 27030 DRAINAGE OF HIP JOINT $ 731.24 $ 731.24 3/1/2020 12/31/9999 27033 EXPLORATION OF HIP JOINT $ 757.03 $ 757.03 3/1/2020 12/31/9999 27035 DENERVATION OF HIP JOINT $ 850.32 $ 850.32 3/1/2020 12/31/9999 27036 EXCISION OF HIP JOINT/MUSCLE $ 773.60 $ 773.60 3/1/2020 12/31/9999 27040 BIOPSY OF SOFT TISSUES $ 155.37 $ 251.42 3/1/2020 12/31/9999 27041 BIOPSY OF SOFT TISSUES $ 529.38 $ 529.38 3/1/2020 12/31/9999 27043 EXC HIP PELVIS LES SC 3 CM/> $ 292.62 $ 292.62 3/1/2020 12/31/9999 27045 EXC HIP/PELV TUM DEEP 5 CM/> $ 465.38 $ 465.38 3/1/2020 12/31/9999 27047 EXC HIP/PELVIS LES SC < 3 CM $ 394.95 $ 466.32 3/1/2020 12/31/9999 27048 EXC HIP/PELV TUM DEEP < 5 CM $ 361.98 $ 361.98 3/1/2020 12/31/9999 27049 RESECT HIP/PELV TUM < 5 CM $ 771.13 $ 771.13 3/1/2020 12/31/9999 27050 BIOPSY OF SACROILIAC JOINT $ 264.62 $ 264.62 3/1/2020 12/31/9999 27052 BIOPSY OF HIP JOINT $ 422.11 $ 422.11 3/1/2020 12/31/9999 27054 REMOVAL OF HIP JOINT LINING $ 518.89 $ 518.89 3/1/2020 12/31/9999 27057 BUTTOCK FASCIOTOMY W/DBRDMT $ 744.04 $ 744.04 3/1/2020 12/31/9999 27059 RESECT HIP/PELV TUM 5 CM/> $ 1,142.02 $ 1,142.02 3/1/2020 12/31/9999 27060 REMOVAL OF ISCHIAL BURSA $ 326.56 $ 326.56 3/1/2020 12/31/9999 27062 REMOVE FEMUR LESION/BURSA $ 340.35 $ 340.35 3/1/2020 12/31/9999 27065 REMOVE HIP BONE LES SUPER $ 379.95 $ 379.95 3/1/2020 12/31/9999 27066 REMOVE HIP BONE LES DEEP $ 619.24 $ 619.24 3/1/2020 12/31/9999 27067 REMOVE/GRAFT HIP BONE LESION $ 786.63 $ 786.63 3/1/2020 12/31/9999 27070 PART REMOVE HIP BONE SUPER $ 648.22 $ 648.22 3/1/2020 12/31/9999 27071 PART REMOVAL HIP BONE DEEP $ 695.78 $ 695.78 3/1/2020 12/31/9999 27075 RESECT HIP TUMOR $ 1,804.80 $ 1,804.80 3/1/2020 12/31/9999 27076 RESECT HIP TUM INCL ACETABUL $ 1,242.53 $ 1,242.53 3/1/2020 12/31/9999 27077 RESECT HIP TUM W/INNOM BONE $ 2,085.83 $ 2,085.83 3/1/2020 12/31/9999 27078 RSECT HIP TUM INCL FEMUR $ 783.34 $ 783.34 3/1/2020 12/31/9999 27080 REMOVAL OF TAIL BONE $ 375.66 $ 375.66 3/1/2020 12/31/9999 27086 REMOVE HIP FOREIGN BODY $ 112.35 $ 179.91 3/1/2020 12/31/9999 27087 REMOVE HIP FOREIGN BODY $ 483.58 $ 483.58 3/1/2020 12/31/9999 27090 REMOVAL OF HIP PROSTHESIS $ 640.50 $ 640.50 3/1/2020 12/31/9999 27091 REMOVAL OF HIP PROSTHESIS $ 1,245.10 $ 1,245.10 3/1/2020 12/31/9999 27093 INJECTION FOR HIP X-RAY $ 58.58 $ 145.82 3/1/2020 12/31/9999 27095 INJECTION FOR HIP X-RAY $ 66.90 $ 175.89 3/1/2020 12/31/9999 27096 INJECT SACROILIAC JOINT $ 56.35 $ 134.20 3/1/2020 12/31/9999 27097 REVISION OF HIP TENDON $ 510.50 $ 510.50 3/1/2020 12/31/9999 27098 TRANSFER TENDON TO PELVIS $ 477.55 $ 477.55 3/1/2020 12/31/9999 27100 TRANSFER OF ABDOMINAL MUSCLE $ 629.32 $ 629.32 3/1/2020 12/31/9999 27105 TRANSFER OF SPINAL MUSCLE $ 659.18 $ 659.18 3/1/2020 12/31/9999 27110 TRANSFER OF ILIOPSOAS MUSCLE $ 737.19 $ 737.19 3/1/2020 12/31/9999 27111 TRANSFER OF ILIOPSOAS MUSCLE $ 658.19 $ 658.19 3/1/2020 12/31/9999 27120 RECONSTRUCTION OF HIP SOCKET $ 1,001.28 $ 1,001.28 3/1/2020 12/31/9999 27122 RECONSTRUCTION OF HIP SOCKET $ 856.54 $ 856.54 3/1/2020 12/31/9999 27125 PARTIAL HIP REPLACEMENT $ 872.50 $ 872.50 3/1/2020 12/31/9999 27130 TOTAL HIP ARTHROPLASTY $ 1,126.46 $ 1,126.46 3/1/2020 12/31/9999 27132 TOTAL HIP ARTHROPLASTY $ 1,316.95 $ 1,316.95 3/1/2020 12/31/9999 27134 REVISE HIP JOINT REPLACEMENT $ 1,529.42 $ 1,529.42 3/1/2020 12/31/9999 27137 REVISE HIP JOINT REPLACEMENT $ 1,164.43 $ 1,164.43 3/1/2020 12/31/9999 27138 REVISE HIP JOINT REPLACEMENT $ 1,212.25 $ 1,212.25 3/1/2020 12/31/9999 27140 TRANSPLANT FEMUR RIDGE $ 694.41 $ 694.41 3/1/2020 12/31/9999 27146 INCISION OF HIP BONE $ 981.51 $ 981.51 3/1/2020 12/31/9999 27147 REVISION OF HIP BONE $ 1,144.06 $ 1,144.06 3/1/2020 12/31/9999 27151 INCISION OF HIP BONES $ 1,194.55 $ 1,194.55 3/1/2020 12/31/9999 27156 REVISION OF HIP BONES $ 1,336.05 $ 1,336.05 3/1/2020 12/31/9999 27158 REVISION OF PELVIS $ 1,073.54 $ 1,073.54 3/1/2020 12/31/9999 27161 INCISION OF NECK OF FEMUR $ 948.52 $ 948.52 3/1/2020 12/31/9999 27165 INCISION/FIXATION OF FEMUR $ 1,060.08 $ 1,060.08 3/1/2020 12/31/9999 27170 REPAIR/GRAFT FEMUR HEAD/NECK $ 918.51 $ 918.51 3/1/2020 12/31/9999 27175 TREAT SLIPPED EPIPHYSIS $ 509.47 $ 509.47 3/1/2020 12/31/9999 27176 TREAT SLIPPED EPIPHYSIS $ 704.25 $ 704.25 3/1/2020 12/31/9999 27177 TREAT SLIPPED EPIPHYSIS $ 860.04 $ 860.04 3/1/2020 12/31/9999 27178 TREAT SLIPPED EPIPHYSIS $ 697.03 $ 697.03 3/1/2020 12/31/9999 27179 REVISE HEAD/NECK OF FEMUR $ 751.13 $ 751.13 3/1/2020 12/31/9999 27181 TREAT SLIPPED EPIPHYSIS $ 837.23 $ 837.23 3/1/2020 12/31/9999 27185 REVISION OF FEMUR EPIPHYSIS $ 531.07 $ 531.07 3/1/2020 12/31/9999 27187 REINFORCE HIP BONES $ 770.03 $ 770.03 3/1/2020 12/31/9999 27197 CLSD TX PELVIC RING FX $ 103.14 $ 103.14 3/1/2020 12/31/9999 27198 CLSD TX PELVIC RING FX $ 263.51 $ 263.51 3/1/2020 12/31/9999 27200 TREAT TAIL BONE FRACTURE $ 129.35 $ 126.71 3/1/2020 12/31/9999 27202 TREAT TAIL BONE FRACTURE $ 484.52 $ 484.52 3/1/2020 12/31/9999 27215 TREAT PELVIC FRACTURE(S) $ 568.83 $ 568.83 3/1/2020 12/31/9999 27217 TREAT PELVIC RING FRACTURE $ 787.44 $ 787.44 3/1/2020 12/31/9999 27218 TREAT PELVIC RING FRACTURE $ 1,078.04 $ 1,078.04 3/1/2020 12/31/9999 27220 TREAT HIP SOCKET FRACTURE $ 392.97 $ 395.63 3/1/2020 12/31/9999 27222 TREAT HIP SOCKET FRACTURE $ 754.94 $ 754.94 3/1/2020 12/31/9999 27226 TREAT HIP WALL FRACTURE $ 804.85 $ 804.85 3/1/2020 12/31/9999 27227 TREAT HIP FRACTURE(S) $ 1,304.44 $ 1,304.44 3/1/2020 12/31/9999 27228 TREAT HIP FRACTURE(S) $ 1,494.66 $ 1,494.66 3/1/2020 12/31/9999 27230 TREAT THIGH FRACTURE $ 346.99 $ 351.39 3/1/2020 12/31/9999 27232 TREAT THIGH FRACTURE $ 601.02 $ 601.02 3/1/2020 12/31/9999 27235 TREAT THIGH FRACTURE $ 704.04 $ 704.04 3/1/2020 12/31/9999 27236 TREAT THIGH FRACTURE $ 922.59 $ 922.59 3/1/2020 12/31/9999 27238 TREAT THIGH FRACTURE $ 340.08 $ 340.08 3/1/2020 12/31/9999 27240 TREAT THIGH FRACTURE $ 736.87 $ 736.87 3/1/2020 12/31/9999 27244 TREAT THIGH FRACTURE $ 949.23 $ 949.23 3/1/2020 12/31/9999 27245 TREAT THIGH FRACTURE $ 982.84 $ 982.84 3/1/2020 12/31/9999 27246 TREAT THIGH FRACTURE $ 288.47 $ 287.89 3/1/2020 12/31/9999 27248 TREAT THIGH FRACTURE $ 581.63 $ 581.63 3/1/2020 12/31/9999 27250 TREAT HIP DISLOCATION $ 184.32 $ 184.32 3/1/2020 12/31/9999 27252 TREAT HIP DISLOCATION $ 582.31 $ 582.31 3/1/2020 12/31/9999 27253 TREAT HIP DISLOCATION $ 731.83 $ 731.83 3/1/2020 12/31/9999 27254 TREAT HIP DISLOCATION $ 990.93 $ 990.93 3/1/2020 12/31/9999 27256 TREAT HIP DISLOCATION $ 190.64 $ 223.53 3/1/2020 12/31/9999 27257 TREAT HIP DISLOCATION $ 260.75 $ 260.75 3/1/2020 12/31/9999 27258 TREAT HIP DISLOCATION $ 858.82 $ 858.82 3/1/2020 12/31/9999 27259 TREAT HIP DISLOCATION $ 1,206.06 $ 1,206.06 3/1/2020 12/31/9999 27265 TREAT HIP DISLOCATION $ 295.12 $ 295.12 3/1/2020 12/31/9999 27266 TREAT HIP DISLOCATION $ 441.09 $ 441.09 3/1/2020 12/31/9999 27267 CLTX THIGH FX $ 314.50 $ 314.50 3/1/2020 12/31/9999 27268 CLTX THIGH FX W/MNPJ $ 390.46 $ 390.46 3/1/2020 12/31/9999 27269 OPTX THIGH FX $ 944.95 $ 944.95 3/1/2020 12/31/9999 27275 MANIPULATION OF HIP JOINT $ 136.68 $ 136.68 3/1/2020 12/31/9999 27279 ARTHRODESIS SACROILIAC JOINT $ 496.62 $ 496.62 3/1/2020 12/31/9999 27280 FUSION OF SACROILIAC JOINT $ 793.87 $ 793.87 3/1/2020 12/31/9999 27282 FUSION OF PUBIC BONES $ 622.79 $ 622.79 3/1/2020 12/31/9999 27284 FUSION OF HIP JOINT $ 1,214.75 $ 1,214.75 3/1/2020 12/31/9999 27286 FUSION OF HIP JOINT $ 1,279.86 $ 1,279.86 3/1/2020 12/31/9999 27290 AMPUTATION OF LEG AT HIP $ 1,223.59 $ 1,223.59 3/1/2020 12/31/9999 27295 AMPUTATION OF LEG AT HIP $ 987.96 $ 987.96 3/1/2020 12/31/9999 27301 DRAIN THIGH/KNEE LESION $ 376.10 $ 488.91 3/1/2020 12/31/9999 27303 DRAINAGE OF BONE LESION $ 487.05 $ 487.05 3/1/2020 12/31/9999 27305 INCISE THIGH TENDON & FASCIA $ 354.72 $ 354.72 3/1/2020 12/31/9999 27306 INCISION OF THIGH TENDON $ 286.42 $ 286.42 3/1/2020 12/31/9999 27307 INCISION OF THIGH TENDONS $ 353.27 $ 353.27 3/1/2020 12/31/9999 27310 EXPLORATION OF KNEE JOINT $ 555.91 $ 555.91 3/1/2020 12/31/9999 27323 BIOPSY THIGH SOFT TISSUES $ 135.16 $ 195.67 3/1/2020 12/31/9999 27324 BIOPSY THIGH SOFT TISSUES $ 288.92 $ 288.92 3/1/2020 12/31/9999 27325 NEURECTOMY HAMSTRING $ 401.03 $ 401.03 3/1/2020 12/31/9999 27326 NEURECTOMY POPLITEAL $ 369.60 $ 369.60 3/1/2020 12/31/9999 27327 EXC THIGH/KNEE LES SC < 3 CM $ 263.94 $ 333.26 3/1/2020 12/31/9999 27328 EXC THIGH/KNEE TUM DEEP <5CM $ 319.05 $ 319.05 3/1/2020 12/31/9999 27329 RESECT THIGH/KNEE TUM < 5 CM $ 800.90 $ 800.90 3/1/2020 12/31/9999 27330 BIOPSY KNEE JOINT LINING $ 302.45 $ 302.45 3/1/2020 12/31/9999 27331 EXPLORE/TREAT KNEE JOINT $ 357.49 $ 357.49 3/1/2020 12/31/9999 27332 REMOVAL OF KNEE CARTILAGE $ 486.03 $ 486.03 3/1/2020 12/31/9999 27333 REMOVAL OF KNEE CARTILAGE $ 439.91 $ 439.91 3/1/2020 12/31/9999 27334 REMOVE KNEE JOINT LINING $ 517.89 $ 517.89 3/1/2020 12/31/9999 27335 REMOVE KNEE JOINT LINING $ 586.48 $ 586.48 3/1/2020 12/31/9999 27337 EXC THIGH/KNEE LES SC 3 CM/> $ 261.06 $ 261.06 3/1/2020 12/31/9999 27339 EXC THIGH/KNEE TUM DEP 5CM/> $ 470.22 $ 470.22 3/1/2020 12/31/9999 27340 REMOVAL OF KNEECAP BURSA $ 272.79 $ 272.79 3/1/2020 12/31/9999 27345 REMOVAL OF KNEE CYST $ 361.90 $ 361.90 3/1/2020 12/31/9999 27347 REMOVE KNEE CYST $ 388.49 $ 388.49 3/1/2020 12/31/9999 27350 REMOVAL OF KNEECAP $ 494.63 $ 494.63 3/1/2020 12/31/9999 27355 REMOVE FEMUR LESION $ 458.38 $ 458.38 3/1/2020 12/31/9999 27356 REMOVE FEMUR LESION/GRAFT $ 563.08 $ 563.08 3/1/2020 12/31/9999 27357 REMOVE FEMUR LESION/GRAFT $ 624.42 $ 624.42 3/1/2020 12/31/9999 27358 REMOVE FEMUR LESION/FIXATION $ 229.58 $ 229.58 3/1/2020 12/31/9999 27360 PARTIAL REMOVAL LEG BONE(S) $ 649.49 $ 649.49 3/1/2020 12/31/9999 27364 RESECT THIGH/KNEE TUM 5 CM/> $ 982.51 $ 982.51 3/1/2020 12/31/9999 27365 RESECT FEMUR/KNEE TUMOR $ 950.37 $ 950.37 3/1/2020 12/31/9999 27369 NJX CNTRST KNE ARTHG/CT/MRI $ 36.49 $ 124.05 3/1/2020 12/31/9999 27372 REMOVAL OF FOREIGN BODY $ 305.22 $ 437.12 3/1/2020 12/31/9999 27380 REPAIR OF KNEECAP TENDON $ 447.81 $ 447.81 3/1/2020 12/31/9999 27381 REPAIR/GRAFT KNEECAP TENDON $ 612.64 $ 612.64 3/1/2020 12/31/9999 27385 REPAIR OF THIGH MUSCLE $ 480.01 $ 480.01 3/1/2020 12/31/9999 27386 REPAIR/GRAFT OF THIGH MUSCLE $ 635.25 $ 635.25 3/1/2020 12/31/9999 27390 INCISION OF THIGH TENDON $ 331.98 $ 331.98 3/1/2020 12/31/9999 27391 INCISION OF THIGH TENDONS $ 433.61 $ 433.61 3/1/2020 12/31/9999 27392 INCISION OF THIGH TENDONS $ 535.71 $ 535.71 3/1/2020 12/31/9999 27393 LENGTHENING OF THIGH TENDON $ 384.25 $ 384.25 3/1/2020 12/31/9999 27394 LENGTHENING OF THIGH TENDONS $ 497.65 $ 497.65 3/1/2020 12/31/9999 27395 LENGTHENING OF THIGH TENDONS $ 675.20 $ 675.20 3/1/2020 12/31/9999 27396 TRANSPLANT OF THIGH TENDON $ 467.37 $ 467.37 3/1/2020 12/31/9999 27397 TRANSPLANTS OF THIGH TENDONS $ 690.14 $ 690.14 3/1/2020 12/31/9999 27400 REVISE THIGH MUSCLES/TENDONS $ 521.24 $ 521.24 3/1/2020 12/31/9999 27403 REPAIR OF KNEE CARTILAGE $ 489.59 $ 489.59 3/1/2020 12/31/9999 27405 REPAIR OF KNEE LIGAMENT $ 515.88 $ 515.88 3/1/2020 12/31/9999 27407 REPAIR OF KNEE LIGAMENT $ 590.58 $ 590.58 3/1/2020 12/31/9999 27409 REPAIR OF KNEE LIGAMENTS $ 743.25 $ 743.25 3/1/2020 12/31/9999 27415 OSTEOCHONDRAL KNEE ALLOGRAFT $ 1,079.02 $ 1,079.02 3/1/2020 12/31/9999 27416 OSTEOCHONDRAL KNEE AUTOGRAFT $ 745.98 $ 745.98 3/1/2020 12/31/9999 27418 REPAIR DEGENERATED KNEECAP $ 640.50 $ 640.50 3/1/2020 12/31/9999 27420 REVISION OF UNSTABLE KNEECAP $ 573.14 $ 573.14 3/1/2020 12/31/9999 27422 REVISION OF UNSTABLE KNEECAP $ 570.76 $ 570.76 3/1/2020 12/31/9999 27424 REVISION/REMOVAL OF KNEECAP $ 572.29 $ 572.29 3/1/2020 12/31/9999 27425 LAT RETINACULAR RELEASE OPEN $ 331.79 $ 331.79 3/1/2020 12/31/9999 27427 RECONSTRUCTION KNEE $ 549.35 $ 549.35 3/1/2020 12/31/9999 27428 RECONSTRUCTION KNEE $ 847.41 $ 847.41 3/1/2020 12/31/9999 27429 RECONSTRUCTION KNEE $ 949.25 $ 949.25 3/1/2020 12/31/9999 27430 REVISION OF THIGH MUSCLES $ 567.20 $ 567.20 3/1/2020 12/31/9999 27435 INCISION OF KNEE JOINT $ 608.09 $ 608.09 3/1/2020 12/31/9999 27437 REVISE KNEECAP $ 503.97 $ 503.97 3/1/2020 12/31/9999 27438 REVISE KNEECAP WITH IMPLANT $ 647.35 $ 647.35 3/1/2020 12/31/9999 27440 REVISION OF KNEE JOINT $ 591.81 $ 591.81 3/1/2020 12/31/9999 27441 REVISION OF KNEE JOINT $ 611.33 $ 611.33 3/1/2020 12/31/9999 27442 REVISION OF KNEE JOINT $ 670.70 $ 670.70 3/1/2020 12/31/9999 27443 REVISION OF KNEE JOINT $ 627.57 $ 627.57 3/1/2020 12/31/9999 27445 REVISION OF KNEE JOINT $ 980.81 $ 980.81 3/1/2020 12/31/9999 27446 REVISION OF KNEE JOINT $ 869.32 $ 869.32 3/1/2020 12/31/9999 27447 TOTAL KNEE ARTHROPLASTY $ 1,205.91 $ 1,205.91 3/1/2020 12/31/9999 27448 INCISION OF THIGH $ 632.35 $ 632.35 3/1/2020 12/31/9999 27450 INCISION OF THIGH $ 788.68 $ 788.68 3/1/2020 12/31/9999 27454 REALIGNMENT OF THIGH BONE $ 997.08 $ 997.08 3/1/2020 12/31/9999 27455 REALIGNMENT OF KNEE $ 728.36 $ 728.36 3/1/2020 12/31/9999 27457 REALIGNMENT OF KNEE $ 751.10 $ 751.10 3/1/2020 12/31/9999 27465 SHORTENING OF THIGH BONE $ 948.07 $ 948.07 3/1/2020 12/31/9999 27466 LENGTHENING OF THIGH BONE $ 918.09 $ 918.09 3/1/2020 12/31/9999 27468 SHORTEN/LENGTHEN THIGHS $ 1,041.20 $ 1,041.20 3/1/2020 12/31/9999 27470 REPAIR OF THIGH $ 915.17 $ 915.17 3/1/2020 12/31/9999 27472 REPAIR/GRAFT OF THIGH $ 990.13 $ 990.13 3/1/2020 12/31/9999 27475 SURGERY TO STOP LEG GROWTH $ 501.34 $ 501.34 3/1/2020 12/31/9999 27477 SURGERY TO STOP LEG GROWTH $ 562.71 $ 562.71 3/1/2020 12/31/9999 27479 SURGERY TO STOP LEG GROWTH $ 725.55 $ 725.55 3/1/2020 12/31/9999 27485 SURGERY TO STOP LEG GROWTH $ 513.18 $ 513.18 3/1/2020 12/31/9999 27486 REVISE/REPLACE KNEE JOINT $ 1,099.68 $ 1,099.68 3/1/2020 12/31/9999 27487 REVISE/REPLACE KNEE JOINT $ 1,389.07 $ 1,389.07 3/1/2020 12/31/9999 27488 REMOVAL OF KNEE PROSTHESIS $ 929.29 $ 929.29 3/1/2020 12/31/9999 27495 REINFORCE THIGH $ 880.18 $ 880.18 3/1/2020 12/31/9999 27496 DECOMPRESSION OF THIGH/KNEE $ 382.12 $ 382.12 3/1/2020 12/31/9999 27497 DECOMPRESSION OF THIGH/KNEE $ 416.31 $ 416.31 3/1/2020 12/31/9999 27498 DECOMPRESSION OF THIGH/KNEE $ 454.20 $ 454.20 3/1/2020 12/31/9999 27499 DECOMPRESSION OF THIGH/KNEE $ 503.55 $ 503.55 3/1/2020 12/31/9999 27500 TREATMENT OF THIGH FRACTURE $ 358.44 $ 383.71 3/1/2020 12/31/9999 27501 TREATMENT OF THIGH FRACTURE $ 372.76 $ 377.76 3/1/2020 12/31/9999 27502 TREATMENT OF THIGH FRACTURE $ 606.24 $ 606.24 3/1/2020 12/31/9999 27503 TREATMENT OF THIGH FRACTURE $ 616.30 $ 616.30 3/1/2020 12/31/9999 27506 TREATMENT OF THIGH FRACTURE $ 1,033.06 $ 1,033.06 3/1/2020 12/31/9999 27507 TREATMENT OF THIGH FRACTURE $ 765.58 $ 765.58 3/1/2020 12/31/9999 27508 TREATMENT OF THIGH FRACTURE $ 365.95 $ 386.52 3/1/2020 12/31/9999 27509 TREATMENT OF THIGH FRACTURE $ 487.87 $ 487.87 3/1/2020 12/31/9999 27510 TREATMENT OF THIGH FRACTURE $ 535.02 $ 535.02 3/1/2020 12/31/9999 27511 TREATMENT OF THIGH FRACTURE $ 792.97 $ 792.97 3/1/2020 12/31/9999 27513 TREATMENT OF THIGH FRACTURE $ 998.30 $ 998.30 3/1/2020 12/31/9999 27514 TREATMENT OF THIGH FRACTURE $ 800.33 $ 800.33 3/1/2020 12/31/9999 27516 TREAT THIGH FX GROWTH PLATE $ 341.54 $ 360.93 3/1/2020 12/31/9999 27517 TREAT THIGH FX GROWTH PLATE $ 512.42 $ 512.42 3/1/2020 12/31/9999 27519 TREAT THIGH FX GROWTH PLATE $ 723.71 $ 723.71 3/1/2020 12/31/9999 27520 TREAT KNEECAP FRACTURE $ 205.61 $ 226.18 3/1/2020 12/31/9999 27524 TREAT KNEECAP FRACTURE $ 579.00 $ 579.00 3/1/2020 12/31/9999 27530 TREAT KNEE FRACTURE $ 266.05 $ 284.87 3/1/2020 12/31/9999 27532 TREAT KNEE FRACTURE $ 435.80 $ 459.02 3/1/2020 12/31/9999 27535 TREAT KNEE FRACTURE $ 707.45 $ 707.45 3/1/2020 12/31/9999 27536 TREAT KNEE FRACTURE $ 920.37 $ 920.37 3/1/2020 12/31/9999 27538 TREAT KNEE FRACTURE(S) $ 321.28 $ 341.54 3/1/2020 12/31/9999 27540 TREAT KNEE FRACTURE $ 640.01 $ 640.01 3/1/2020 12/31/9999 27550 TREAT KNEE DISLOCATION $ 339.11 $ 362.62 3/1/2020 12/31/9999 27552 TREAT KNEE DISLOCATION $ 471.29 $ 471.29 3/1/2020 12/31/9999 27556 TREAT KNEE DISLOCATION $ 711.55 $ 711.55 3/1/2020 12/31/9999 27557 TREAT KNEE DISLOCATION $ 852.46 $ 852.46 3/1/2020 12/31/9999 27558 TREAT KNEE DISLOCATION $ 957.84 $ 957.84 3/1/2020 12/31/9999 27560 TREAT KNEECAP DISLOCATION $ 240.84 $ 264.33 3/1/2020 12/31/9999 27562 TREAT KNEECAP DISLOCATION $ 347.49 $ 347.49 3/1/2020 12/31/9999 27566 TREAT KNEECAP DISLOCATION $ 690.63 $ 690.63 3/1/2020 12/31/9999 27570 FIXATION OF KNEE JOINT $ 111.28 $ 111.28 3/1/2020 12/31/9999 27580 FUSION OF KNEE $ 1,120.98 $ 1,120.98 3/1/2020 12/31/9999 27590 AMPUTATE LEG AT THIGH $ 644.83 $ 644.83 3/1/2020 12/31/9999 27591 AMPUTATE LEG AT THIGH $ 712.10 $ 712.10 3/1/2020 12/31/9999 27592 AMPUTATE LEG AT THIGH $ 545.92 $ 545.92 3/1/2020 12/31/9999 27594 AMPUTATION FOLLOW-UP SURGERY $ 393.04 $ 393.04 3/1/2020 12/31/9999 27596 AMPUTATION FOLLOW-UP SURGERY $ 571.34 $ 571.34 3/1/2020 12/31/9999 27598 AMPUTATE LOWER LEG AT KNEE $ 580.14 $ 580.14 3/1/2020 12/31/9999 27600 DECOMPRESSION OF LOWER LEG $ 326.39 $ 326.39 3/1/2020 12/31/9999 27601 DECOMPRESSION OF LOWER LEG $ 337.81 $ 337.81 3/1/2020 12/31/9999 27602 DECOMPRESSION OF LOWER LEG $ 401.24 $ 401.24 3/1/2020 12/31/9999 27603 DRAIN LOWER LEG LESION $ 294.99 $ 386.94 3/1/2020 12/31/9999 27604 DRAIN LOWER LEG BURSA $ 259.92 $ 339.53 3/1/2020 12/31/9999 27605 INCISION OF ACHILLES TENDON $ 156.14 $ 268.94 3/1/2020 12/31/9999 27606 INCISION OF ACHILLES TENDON $ 229.39 $ 229.39 3/1/2020 12/31/9999 27607 TREAT LOWER LEG BONE LESION $ 472.29 $ 472.29 3/1/2020 12/31/9999 27610 EXPLORE/TREAT ANKLE JOINT $ 504.07 $ 504.07 3/1/2020 12/31/9999 27612 EXPLORATION OF ANKLE JOINT $ 440.16 $ 440.16 3/1/2020 12/31/9999 27613 BIOPSY LOWER LEG SOFT TISSUE $ 127.03 $ 183.73 3/1/2020 12/31/9999 27614 BIOPSY LOWER LEG SOFT TISSUE $ 315.70 $ 416.17 3/1/2020 12/31/9999 27615 RESECT LEG/ANKLE TUM < 5 CM $ 680.60 $ 680.60 3/1/2020 12/31/9999 27616 RESECT LEG/ANKLE TUM 5 CM/> $ 802.15 $ 802.15 3/1/2020 12/31/9999 27618 EXC LEG/ANKLE TUM < 3 CM $ 292.29 $ 363.67 3/1/2020 12/31/9999 27619 EXC LEG/ANKLE TUM DEEP <5 CM $ 454.52 $ 580.84 3/1/2020 12/31/9999 27620 EXPLORE/TREAT ANKLE JOINT $ 353.81 $ 353.81 3/1/2020 12/31/9999 27625 REMOVE ANKLE JOINT LINING $ 459.30 $ 459.30 3/1/2020 12/31/9999 27626 REMOVE ANKLE JOINT LINING $ 495.92 $ 495.92 3/1/2020 12/31/9999 27630 REMOVAL OF TENDON LESION $ 284.66 $ 396.28 3/1/2020 12/31/9999 27632 EXC LEG/ANKLE LES SC 3 CM/> $ 258.28 $ 258.28 3/1/2020 12/31/9999 27634 EXC LEG/ANKLE TUM DEP 5 CM/> $ 421.67 $ 421.67 3/1/2020 12/31/9999 27635 REMOVE LOWER LEG BONE LESION $ 455.57 $ 455.57 3/1/2020 12/31/9999 27637 REMOVE/GRAFT LEG BONE LESION $ 578.16 $ 578.16 3/1/2020 12/31/9999 27638 REMOVE/GRAFT LEG BONE LESION $ 603.34 $ 603.34 3/1/2020 12/31/9999 27640 PARTIAL REMOVAL OF TIBIA $ 668.46 $ 668.46 3/1/2020 12/31/9999 27641 PARTIAL REMOVAL OF FIBULA $ 535.78 $ 535.78 3/1/2020 12/31/9999 27645 RESECT TIBIA TUMOR $ 811.24 $ 811.24 3/1/2020 12/31/9999 27646 RESECT FIBULA TUMOR $ 717.72 $ 717.72 3/1/2020 12/31/9999 27647 RESECT TALUS/CALCANEUS TUM $ 637.68 $ 637.68 3/1/2020 12/31/9999 27648 INJECTION FOR ANKLE X-RAY $ 42.38 $ 119.92 3/1/2020 12/31/9999 27650 REPAIR ACHILLES TENDON $ 520.52 $ 520.52 3/1/2020 12/31/9999 27652 REPAIR/GRAFT ACHILLES TENDON $ 574.91 $ 574.91 3/1/2020 12/31/9999 27654 REPAIR OF ACHILLES TENDON $ 561.05 $ 561.05 3/1/2020 12/31/9999 27656 REPAIR LEG FASCIA DEFECT $ 269.00 $ 397.96 3/1/2020 12/31/9999 27658 REPAIR OF LEG TENDON EACH $ 294.89 $ 294.89 3/1/2020 12/31/9999 27659 REPAIR OF LEG TENDON EACH $ 388.45 $ 388.45 3/1/2020 12/31/9999 27664 REPAIR OF LEG TENDON EACH $ 280.74 $ 280.74 3/1/2020 12/31/9999 27665 REPAIR OF LEG TENDON EACH $ 322.02 $ 322.02 3/1/2020 12/31/9999 27675 REPAIR LOWER LEG TENDONS $ 396.21 $ 396.21 3/1/2020 12/31/9999 27676 REPAIR LOWER LEG TENDONS $ 480.49 $ 480.49 3/1/2020 12/31/9999 27680 RELEASE OF LOWER LEG TENDON $ 334.49 $ 334.49 3/1/2020 12/31/9999 27681 RELEASE OF LOWER LEG TENDONS $ 398.64 $ 398.64 3/1/2020 12/31/9999 27685 REVISION OF LOWER LEG TENDON $ 369.46 $ 472.27 3/1/2020 12/31/9999 27686 REVISE LOWER LEG TENDONS $ 435.32 $ 435.32 3/1/2020 12/31/9999 27687 REVISION OF CALF TENDON $ 358.26 $ 358.26 3/1/2020 12/31/9999 27690 REVISE LOWER LEG TENDON $ 494.03 $ 494.03 3/1/2020 12/31/9999 27691 REVISE LOWER LEG TENDON $ 579.20 $ 579.20 3/1/2020 12/31/9999 27692 REVISE ADDITIONAL LEG TENDON $ 89.03 $ 89.03 3/1/2020 12/31/9999 27695 REPAIR OF ANKLE LIGAMENT $ 381.09 $ 381.09 3/1/2020 12/31/9999 27696 REPAIR OF ANKLE LIGAMENTS $ 456.57 $ 456.57 3/1/2020 12/31/9999 27698 REPAIR OF ANKLE LIGAMENT $ 512.80 $ 512.80 3/1/2020 12/31/9999 27700 REVISION OF ANKLE JOINT $ 486.29 $ 486.29 3/1/2020 12/31/9999 27702 RECONSTRUCT ANKLE JOINT $ 774.89 $ 774.89 3/1/2020 12/31/9999 27703 RECONSTRUCTION ANKLE JOINT $ 897.40 $ 897.40 3/1/2020 12/31/9999 27704 REMOVAL OF ANKLE IMPLANT $ 437.80 $ 437.80 3/1/2020 12/31/9999 27705 INCISION OF TIBIA $ 594.00 $ 594.00 3/1/2020 12/31/9999 27707 INCISION OF FIBULA $ 299.61 $ 299.61 3/1/2020 12/31/9999 27709 INCISION OF TIBIA & FIBULA $ 870.58 $ 870.58 3/1/2020 12/31/9999 27712 REALIGNMENT OF LOWER LEG $ 847.77 $ 847.77 3/1/2020 12/31/9999 27715 REVISION OF LOWER LEG $ 828.04 $ 828.04 3/1/2020 12/31/9999 27720 REPAIR OF TIBIA $ 679.61 $ 679.61 3/1/2020 12/31/9999 27722 REPAIR/GRAFT OF TIBIA $ 678.27 $ 678.27 3/1/2020 12/31/9999 27724 REPAIR/GRAFT OF TIBIA $ 1,001.62 $ 1,001.62 3/1/2020 12/31/9999 27725 REPAIR OF LOWER LEG $ 929.86 $ 929.86 3/1/2020 12/31/9999 27726 REPAIR FIBULA NONUNION $ 710.91 $ 710.91 3/1/2020 12/31/9999 27727 REPAIR OF LOWER LEG $ 756.80 $ 756.80 3/1/2020 12/31/9999 27730 REPAIR OF TIBIA EPIPHYSIS $ 451.23 $ 451.23 3/1/2020 12/31/9999 27732 REPAIR OF FIBULA EPIPHYSIS $ 306.76 $ 306.76 3/1/2020 12/31/9999 27734 REPAIR LOWER LEG EPIPHYSES $ 461.84 $ 461.84 3/1/2020 12/31/9999 27740 REPAIR OF LEG EPIPHYSES $ 512.28 $ 512.28 3/1/2020 12/31/9999 27742 REPAIR OF LEG EPIPHYSES $ 540.62 $ 540.62 3/1/2020 12/31/9999 27745 REINFORCE TIBIA $ 582.72 $ 582.72 3/1/2020 12/31/9999 27750 TREATMENT OF TIBIA FRACTURE $ 225.34 $ 244.73 3/1/2020 12/31/9999 27752 TREATMENT OF TIBIA FRACTURE $ 371.61 $ 396.88 3/1/2020 12/31/9999 27756 TREATMENT OF TIBIA FRACTURE $ 432.29 $ 432.29 3/1/2020 12/31/9999 27758 TREATMENT OF TIBIA FRACTURE $ 685.13 $ 685.13 3/1/2020 12/31/9999 27759 TREATMENT OF TIBIA FRACTURE $ 777.21 $ 777.21 3/1/2020 12/31/9999 27760 CLTX MEDIAL ANKLE FX $ 214.73 $ 235.57 3/1/2020 12/31/9999 27762 CLTX MED ANKLE FX W/MNPJ $ 329.14 $ 354.69 3/1/2020 12/31/9999 27766 OPTX MEDIAL ANKLE FX $ 465.12 $ 465.12 3/1/2020 12/31/9999 27767 CLTX POST ANKLE FX $ 187.95 $ 187.07 3/1/2020 12/31/9999 27768 CLTX POST ANKLE FX W/MNPJ $ 304.24 $ 304.24 3/1/2020 12/31/9999 27769 OPTX POST ANKLE FX $ 532.99 $ 532.99 3/1/2020 12/31/9999 27780 TREATMENT OF FIBULA FRACTURE $ 191.57 $ 210.66 3/1/2020 12/31/9999 27781 TREATMENT OF FIBULA FRACTURE $ 287.06 $ 306.75 3/1/2020 12/31/9999 27784 TREATMENT OF FIBULA FRACTURE $ 529.16 $ 529.16 3/1/2020 12/31/9999 27786 TREATMENT OF ANKLE FRACTURE $ 201.83 $ 223.28 3/1/2020 12/31/9999 27788 TREATMENT OF ANKLE FRACTURE $ 286.51 $ 309.42 3/1/2020 12/31/9999 27792 TREATMENT OF ANKLE FRACTURE $ 534.88 $ 534.88 3/1/2020 12/31/9999 27808 TREATMENT OF ANKLE FRACTURE $ 210.36 $ 233.28 3/1/2020 12/31/9999 27810 TREATMENT OF ANKLE FRACTURE $ 320.88 $ 347.03 3/1/2020 12/31/9999 27814 TREATMENT OF ANKLE FRACTURE $ 596.99 $ 596.99 3/1/2020 12/31/9999 27816 TREATMENT OF ANKLE FRACTURE $ 200.17 $ 221.33 3/1/2020 12/31/9999 27818 TREATMENT OF ANKLE FRACTURE $ 328.51 $ 358.19 3/1/2020 12/31/9999 27822 TREATMENT OF ANKLE FRACTURE $ 652.71 $ 652.71 3/1/2020 12/31/9999 27823 TREATMENT OF ANKLE FRACTURE $ 744.69 $ 744.69 3/1/2020 12/31/9999 27824 TREAT LOWER LEG FRACTURE $ 214.97 $ 222.89 3/1/2020 12/31/9999 27825 TREAT LOWER LEG FRACTURE $ 377.59 $ 408.72 3/1/2020 12/31/9999 27826 TREAT LOWER LEG FRACTURE $ 626.65 $ 626.65 3/1/2020 12/31/9999 27827 TREAT LOWER LEG FRACTURE $ 836.08 $ 836.08 3/1/2020 12/31/9999 27828 TREAT LOWER LEG FRACTURE $ 1,001.64 $ 1,001.64 3/1/2020 12/31/9999 27829 TREAT LOWER LEG JOINT $ 500.29 $ 500.29 3/1/2020 12/31/9999 27830 TREAT LOWER LEG DISLOCATION $ 243.88 $ 259.46 3/1/2020 12/31/9999 27831 TREAT LOWER LEG DISLOCATION $ 284.49 $ 284.49 3/1/2020 12/31/9999 27832 TREAT LOWER LEG DISLOCATION $ 540.13 $ 540.13 3/1/2020 12/31/9999 27840 TREAT ANKLE DISLOCATION $ 262.96 $ 262.96 3/1/2020 12/31/9999 27842 TREAT ANKLE DISLOCATION $ 368.05 $ 368.05 3/1/2020 12/31/9999 27846 TREAT ANKLE DISLOCATION $ 570.05 $ 570.05 3/1/2020 12/31/9999 27848 TREAT ANKLE DISLOCATION $ 645.48 $ 645.48 3/1/2020 12/31/9999 27860 FIXATION OF ANKLE JOINT $ 137.42 $ 137.42 3/1/2020 12/31/9999 27870 FUSION OF ANKLE JOINT OPEN $ 815.37 $ 815.37 3/1/2020 12/31/9999 27871 FUSION OF TIBIOFIBULAR JOINT $ 534.14 $ 534.14 3/1/2020 12/31/9999 27880 AMPUTATION OF LOWER LEG $ 724.44 $ 724.44 3/1/2020 12/31/9999 27881 AMPUTATION OF LOWER LEG $ 695.71 $ 695.71 3/1/2020 12/31/9999 27882 AMPUTATION OF LOWER LEG $ 490.79 $ 490.79 3/1/2020 12/31/9999 27884 AMPUTATION FOLLOW-UP SURGERY $ 455.50 $ 455.50 3/1/2020 12/31/9999 27886 AMPUTATION FOLLOW-UP SURGERY $ 519.66 $ 519.66 3/1/2020 12/31/9999 27888 AMPUTATION OF FOOT AT ANKLE $ 549.14 $ 549.14 3/1/2020 12/31/9999 27889 AMPUTATION OF FOOT AT ANKLE $ 537.85 $ 537.85 3/1/2020 12/31/9999 27892 DECOMPRESSION OF LEG $ 421.17 $ 421.17 3/1/2020 12/31/9999 27893 DECOMPRESSION OF LEG $ 426.08 $ 426.08 3/1/2020 12/31/9999 27894 DECOMPRESSION OF LEG $ 655.29 $ 655.29 3/1/2020 12/31/9999 28001 DRAINAGE OF BURSA OF FOOT $ 143.33 $ 201.48 3/1/2020 12/31/9999 28002 TREATMENT OF FOOT INFECTION $ 302.17 $ 377.07 3/1/2020 12/31/9999 28003 TREATMENT OF FOOT INFECTION $ 446.29 $ 522.08 3/1/2020 12/31/9999 28005 TREAT FOOT BONE LESION $ 485.25 $ 485.25 3/1/2020 12/31/9999 28008 INCISION OF FOOT FASCIA $ 242.21 $ 318.58 3/1/2020 12/31/9999 28010 INCISION OF TOE TENDON $ 167.18 $ 178.05 3/1/2020 12/31/9999 28011 INCISION OF TOE TENDONS $ 236.00 $ 252.45 3/1/2020 12/31/9999 28020 EXPLORATION OF FOOT JOINT $ 283.87 $ 377.58 3/1/2020 12/31/9999 28022 EXPLORATION OF FOOT JOINT $ 262.84 $ 348.61 3/1/2020 12/31/9999 28024 EXPLORATION OF TOE JOINT $ 249.01 $ 331.24 3/1/2020 12/31/9999 28035 DECOMPRESSION OF TIBIA NERVE $ 286.60 $ 380.02 3/1/2020 12/31/9999 28039 EXC FOOT/TOE TUM SC 1.5 CM/> $ 215.06 $ 299.01 3/1/2020 12/31/9999 28041 EXC FOOT/TOE TUM DEP 1.5CM/> $ 282.59 $ 282.59 3/1/2020 12/31/9999 28043 EXC FOOT/TOE TUM SC < 1.5 CM $ 205.50 $ 253.67 3/1/2020 12/31/9999 28045 EXC FOOT/TOE TUM DEEP <1.5CM $ 261.68 $ 355.10 3/1/2020 12/31/9999 28046 RESECT FOOT/TOE TUMOR < 3 CM $ 536.90 $ 650.87 3/1/2020 12/31/9999 28047 RESECT FOOT/TOE TUMOR 3 CM/> $ 599.14 $ 599.14 3/1/2020 12/31/9999 28050 BIOPSY OF FOOT JOINT LINING $ 246.74 $ 333.41 3/1/2020 12/31/9999 28052 BIOPSY OF FOOT JOINT LINING $ 224.60 $ 307.43 3/1/2020 12/31/9999 28054 BIOPSY OF TOE JOINT LINING $ 204.39 $ 288.11 3/1/2020 12/31/9999 28055 NEURECTOMY FOOT $ 315.48 $ 315.48 3/1/2020 12/31/9999 28060 PARTIAL REMOVAL FOOT FASCIA $ 288.12 $ 375.08 3/1/2020 12/31/9999 28062 REMOVAL OF FOOT FASCIA $ 338.76 $ 442.16 3/1/2020 12/31/9999 28070 REMOVAL OF FOOT JOINT LINING $ 281.94 $ 371.82 3/1/2020 12/31/9999 28072 REMOVAL OF FOOT JOINT LINING $ 272.06 $ 365.47 3/1/2020 12/31/9999 28080 REMOVAL OF FOOT LESION $ 274.63 $ 358.64 3/1/2020 12/31/9999 28086 EXCISE FOOT TENDON SHEATH $ 284.13 $ 391.93 3/1/2020 12/31/9999 28088 EXCISE FOOT TENDON SHEATH $ 236.29 $ 332.06 3/1/2020 12/31/9999 28090 REMOVAL OF FOOT LESION $ 248.09 $ 336.51 3/1/2020 12/31/9999 28092 REMOVAL OF TOE LESIONS $ 217.23 $ 303.01 3/1/2020 12/31/9999 28100 REMOVAL OF ANKLE/HEEL LESION $ 322.12 $ 434.04 3/1/2020 12/31/9999 28102 REMOVE/GRAFT FOOT LESION $ 439.56 $ 439.56 3/1/2020 12/31/9999 28103 REMOVE/GRAFT FOOT LESION $ 355.60 $ 355.60 3/1/2020 12/31/9999 28104 REMOVAL OF FOOT LESION $ 282.26 $ 373.03 3/1/2020 12/31/9999 28106 REMOVE/GRAFT FOOT LESION $ 376.33 $ 376.33 3/1/2020 12/31/9999 28107 REMOVE/GRAFT FOOT LESION $ 307.93 $ 413.68 3/1/2020 12/31/9999 28108 REMOVAL OF TOE LESIONS $ 232.79 $ 313.56 3/1/2020 12/31/9999 28110 PART REMOVAL OF METATARSAL $ 232.21 $ 328.56 3/1/2020 12/31/9999 28111 PART REMOVAL OF METATARSAL $ 272.00 $ 374.80 3/1/2020 12/31/9999 28112 PART REMOVAL OF METATARSAL $ 253.98 $ 354.14 3/1/2020 12/31/9999 28113 PART REMOVAL OF METATARSAL $ 331.59 $ 424.43 3/1/2020 12/31/9999 28114 REMOVAL OF METATARSAL HEADS $ 641.97 $ 773.87 3/1/2020 12/31/9999 28116 REVISION OF FOOT $ 457.10 $ 554.61 3/1/2020 12/31/9999 28118 REMOVAL OF HEEL BONE $ 329.99 $ 427.81 3/1/2020 12/31/9999 28119 REMOVAL OF HEEL SPUR $ 292.04 $ 381.34 3/1/2020 12/31/9999 28120 PART REMOVAL OF ANKLE/HEEL $ 313.87 $ 422.27 3/1/2020 12/31/9999 28122 PARTIAL REMOVAL OF FOOT BONE $ 403.45 $ 493.33 3/1/2020 12/31/9999 28124 PARTIAL REMOVAL OF TOE $ 268.99 $ 348.87 3/1/2020 12/31/9999 28126 PARTIAL REMOVAL OF TOE $ 202.01 $ 281.03 3/1/2020 12/31/9999 28130 REMOVAL OF ANKLE BONE $ 501.36 $ 501.36 3/1/2020 12/31/9999 28140 REMOVAL OF METATARSAL $ 367.50 $ 464.14 3/1/2020 12/31/9999 28150 REMOVAL OF TOE $ 230.85 $ 313.69 3/1/2020 12/31/9999 28153 PARTIAL REMOVAL OF TOE $ 209.82 $ 292.08 3/1/2020 12/31/9999 28160 PARTIAL REMOVAL OF TOE $ 218.64 $ 299.71 3/1/2020 12/31/9999 28171 RESECT TARSAL TUMOR $ 492.92 $ 492.92 3/1/2020 12/31/9999 28173 RESECT METATARSAL TUMOR $ 449.77 $ 554.63 3/1/2020 12/31/9999 28175 RESECT PHALANX OF TOE TUMOR $ 316.68 $ 405.69 3/1/2020 12/31/9999 28190 REMOVAL OF FOOT FOREIGN BODY $ 107.26 $ 178.34 3/1/2020 12/31/9999 28192 REMOVAL OF FOOT FOREIGN BODY $ 256.99 $ 344.81 3/1/2020 12/31/9999 28193 REMOVAL OF FOOT FOREIGN BODY $ 306.08 $ 396.55 3/1/2020 12/31/9999 28200 REPAIR OF FOOT TENDON $ 256.29 $ 344.73 3/1/2020 12/31/9999 28202 REPAIR/GRAFT OF FOOT TENDON $ 358.90 $ 460.25 3/1/2020 12/31/9999 28208 REPAIR OF FOOT TENDON $ 246.04 $ 331.82 3/1/2020 12/31/9999 28210 REPAIR/GRAFT OF FOOT TENDON $ 335.01 $ 428.72 3/1/2020 12/31/9999 28220 RELEASE OF FOOT TENDON $ 248.57 $ 328.17 3/1/2020 12/31/9999 28222 RELEASE OF FOOT TENDONS $ 296.47 $ 380.18 3/1/2020 12/31/9999 28225 RELEASE OF FOOT TENDON $ 205.78 $ 284.50 3/1/2020 12/31/9999 28226 RELEASE OF FOOT TENDONS $ 256.70 $ 342.17 3/1/2020 12/31/9999 28230 INCISION OF FOOT TENDON(S) $ 236.29 $ 315.01 3/1/2020 12/31/9999 28232 INCISION OF TOE TENDON $ 200.33 $ 278.47 3/1/2020 12/31/9999 28234 INCISION OF FOOT TENDON $ 209.43 $ 288.45 3/1/2020 12/31/9999 28238 REVISION OF FOOT TENDON $ 403.12 $ 505.34 3/1/2020 12/31/9999 28240 RELEASE OF BIG TOE $ 242.48 $ 324.14 3/1/2020 12/31/9999 28250 REVISION OF FOOT FASCIA $ 322.12 $ 413.19 3/1/2020 12/31/9999 28260 RELEASE OF MIDFOOT JOINT $ 416.72 $ 506.91 3/1/2020 12/31/9999 28261 REVISION OF FOOT TENDON $ 635.75 $ 737.69 3/1/2020 12/31/9999 28262 REVISION OF FOOT AND ANKLE $ 888.92 $ 1,029.33 3/1/2020 12/31/9999 28264 RELEASE OF MIDFOOT JOINT $ 558.39 $ 657.69 3/1/2020 12/31/9999 28270 RELEASE OF FOOT CONTRACTURE $ 268.36 $ 350.61 3/1/2020 12/31/9999 28272 RELEASE OF TOE JOINT EACH $ 209.34 $ 286.31 3/1/2020 12/31/9999 28280 FUSION OF TOES $ 291.84 $ 384.67 3/1/2020 12/31/9999 28285 REPAIR OF HAMMERTOE $ 257.66 $ 339.61 3/1/2020 12/31/9999 28286 REPAIR OF HAMMERTOE $ 247.76 $ 332.06 3/1/2020 12/31/9999 28288 PARTIAL REMOVAL OF FOOT BONE $ 335.07 $ 425.25 3/1/2020 12/31/9999 28289 CORRJ HALUX RIGDUS W/O IMPLT $ 437.01 $ 539.52 3/1/2020 12/31/9999 28291 CORRJ HALUX RIGDUS W/IMPLT $ 430.52 $ 650.77 3/1/2020 12/31/9999 28292 CORRECTION HALLUX VALGUS $ 470.32 $ 573.42 3/1/2020 12/31/9999 28295 CORRECTION HALLUX VALGUS $ 479.70 $ 832.10 3/1/2020 12/31/9999 28296 CORRECTION HALLUX VALGUS $ 432.32 $ 543.65 3/1/2020 12/31/9999 28297 CORRECTION HALLUX VALGUS $ 485.85 $ 614.22 3/1/2020 12/31/9999 28298 CORRECTION HALLUX VALGUS $ 413.87 $ 530.19 3/1/2020 12/31/9999 28299 CORRECTION HALLUX VALGUS $ 561.13 $ 683.62 3/1/2020 12/31/9999 28300 INCISION OF HEEL BONE $ 523.60 $ 523.60 3/1/2020 12/31/9999 28302 INCISION OF ANKLE BONE $ 518.86 $ 518.86 3/1/2020 12/31/9999 28304 INCISION OF MIDFOOT BONES $ 477.75 $ 589.94 3/1/2020 12/31/9999 28305 INCISE/GRAFT MIDFOOT BONES $ 549.09 $ 549.09 3/1/2020 12/31/9999 28306 INCISION OF METATARSAL $ 322.69 $ 439.58 3/1/2020 12/31/9999 28307 INCISION OF METATARSAL $ 363.22 $ 516.85 3/1/2020 12/31/9999 28308 INCISION OF METATARSAL $ 295.64 $ 398.16 3/1/2020 12/31/9999 28309 INCISION OF METATARSALS $ 708.72 $ 708.72 3/1/2020 12/31/9999 28310 REVISION OF BIG TOE $ 288.88 $ 392.57 3/1/2020 12/31/9999 28312 REVISION OF TOE $ 256.87 $ 358.51 3/1/2020 12/31/9999 28313 REPAIR DEFORMITY OF TOE $ 293.77 $ 377.19 3/1/2020 12/31/9999 28315 REMOVAL OF SESAMOID BONE $ 262.90 $ 346.91 3/1/2020 12/31/9999 28320 REPAIR OF FOOT BONES $ 495.55 $ 495.55 3/1/2020 12/31/9999 28322 REPAIR OF METATARSALS $ 457.14 $ 572.00 3/1/2020 12/31/9999 28340 RESECT ENLARGED TOE TISSUE $ 357.39 $ 456.38 3/1/2020 12/31/9999 28341 RESECT ENLARGED TOE $ 423.57 $ 526.97 3/1/2020 12/31/9999 28344 REPAIR EXTRA TOE(S) $ 249.36 $ 347.77 3/1/2020 12/31/9999 28345 REPAIR WEBBED TOE(S) $ 326.74 $ 421.62 3/1/2020 12/31/9999 28360 RECONSTRUCT CLEFT FOOT $ 763.71 $ 763.71 3/1/2020 12/31/9999 28400 TREATMENT OF HEEL FRACTURE $ 163.32 $ 177.12 3/1/2020 12/31/9999 28405 TREATMENT OF HEEL FRACTURE $ 274.52 $ 291.86 3/1/2020 12/31/9999 28406 TREATMENT OF HEEL FRACTURE $ 401.06 $ 401.06 3/1/2020 12/31/9999 28415 TREAT HEEL FRACTURE $ 886.35 $ 886.35 3/1/2020 12/31/9999 28420 TREAT/GRAFT HEEL FRACTURE $ 934.35 $ 934.35 3/1/2020 12/31/9999 28430 TREATMENT OF ANKLE FRACTURE $ 148.52 $ 165.85 3/1/2020 12/31/9999 28435 TREATMENT OF ANKLE FRACTURE $ 219.04 $ 235.48 3/1/2020 12/31/9999 28436 TREATMENT OF ANKLE FRACTURE $ 320.55 $ 320.55 3/1/2020 12/31/9999 28445 TREAT ANKLE FRACTURE $ 837.02 $ 837.02 3/1/2020 12/31/9999 28450 TREAT MIDFOOT FRACTURE EACH $ 138.05 $ 153.33 3/1/2020 12/31/9999 28455 TREAT MIDFOOT FRACTURE EACH $ 200.54 $ 214.05 3/1/2020 12/31/9999 28456 TREAT MIDFOOT FRACTURE $ 204.89 $ 204.89 3/1/2020 12/31/9999 28465 TREAT MIDFOOT FRACTURE EACH $ 475.42 $ 475.42 3/1/2020 12/31/9999 28470 TREAT METATARSAL FRACTURE $ 138.85 $ 153.25 3/1/2020 12/31/9999 28475 TREAT METATARSAL FRACTURE $ 181.61 $ 195.71 3/1/2020 12/31/9999 28476 TREAT METATARSAL FRACTURE $ 253.81 $ 253.81 3/1/2020 12/31/9999 28485 TREAT METATARSAL FRACTURE $ 409.75 $ 409.75 3/1/2020 12/31/9999 28490 TREAT BIG TOE FRACTURE $ 86.55 $ 98.30 3/1/2020 12/31/9999 28495 TREAT BIG TOE FRACTURE $ 111.28 $ 124.79 3/1/2020 12/31/9999 28496 TREAT BIG TOE FRACTURE $ 170.38 $ 299.33 3/1/2020 12/31/9999 28505 TREAT BIG TOE FRACTURE $ 377.58 $ 485.68 3/1/2020 12/31/9999 28510 TREATMENT OF TOE FRACTURE $ 84.21 $ 85.68 3/1/2020 12/31/9999 28515 TREATMENT OF TOE FRACTURE $ 104.42 $ 112.94 3/1/2020 12/31/9999 28525 TREAT TOE FRACTURE $ 299.59 $ 407.38 3/1/2020 12/31/9999 28530 TREAT SESAMOID BONE FRACTURE $ 76.78 $ 82.65 3/1/2020 12/31/9999 28531 TREAT SESAMOID BONE FRACTURE $ 148.24 $ 265.44 3/1/2020 12/31/9999 28540 TREAT FOOT DISLOCATION $ 138.01 $ 147.13 3/1/2020 12/31/9999 28545 TREAT FOOT DISLOCATION $ 167.35 $ 180.86 3/1/2020 12/31/9999 28546 TREAT FOOT DISLOCATION $ 225.67 $ 337.59 3/1/2020 12/31/9999 28555 REPAIR FOOT DISLOCATION $ 507.07 $ 635.44 3/1/2020 12/31/9999 28570 TREAT FOOT DISLOCATION $ 114.72 $ 126.77 3/1/2020 12/31/9999 28575 TREAT FOOT DISLOCATION $ 228.18 $ 243.17 3/1/2020 12/31/9999 28576 TREAT FOOT DISLOCATION $ 268.96 $ 268.96 3/1/2020 12/31/9999 28585 REPAIR FOOT DISLOCATION $ 570.81 $ 679.80 3/1/2020 12/31/9999 28600 TREAT FOOT DISLOCATION $ 138.13 $ 152.82 3/1/2020 12/31/9999 28605 TREAT FOOT DISLOCATION $ 185.93 $ 198.27 3/1/2020 12/31/9999 28606 TREAT FOOT DISLOCATION $ 297.71 $ 297.71 3/1/2020 12/31/9999 28615 REPAIR FOOT DISLOCATION $ 597.45 $ 597.45 3/1/2020 12/31/9999 28630 TREAT TOE DISLOCATION $ 85.96 $ 109.76 3/1/2020 12/31/9999 28635 TREAT TOE DISLOCATION $ 107.06 $ 130.86 3/1/2020 12/31/9999 28636 TREAT TOE DISLOCATION $ 158.60 $ 214.71 3/1/2020 12/31/9999 28645 REPAIR TOE DISLOCATION $ 368.97 $ 460.62 3/1/2020 12/31/9999 28660 TREAT TOE DISLOCATION $ 65.52 $ 79.92 3/1/2020 12/31/9999 28665 TREAT TOE DISLOCATION $ 106.50 $ 117.06 3/1/2020 12/31/9999 28666 TREAT TOE DISLOCATION $ 151.88 $ 151.88 3/1/2020 12/31/9999 28675 REPAIR OF TOE DISLOCATION $ 306.72 $ 416.57 3/1/2020 12/31/9999 28705 FUSION OF FOOT BONES $ 1,034.27 $ 1,034.27 3/1/2020 12/31/9999 28715 FUSION OF FOOT BONES $ 764.47 $ 764.47 3/1/2020 12/31/9999 28725 FUSION OF FOOT BONES $ 629.57 $ 629.57 3/1/2020 12/31/9999 28730 FUSION OF FOOT BONES $ 657.76 $ 657.76 3/1/2020 12/31/9999 28735 FUSION OF FOOT BONES $ 629.91 $ 629.91 3/1/2020 12/31/9999 28737 REVISION OF FOOT BONES $ 558.87 $ 558.87 3/1/2020 12/31/9999 28740 FUSION OF FOOT BONES $ 493.01 $ 628.71 3/1/2020 12/31/9999 28750 FUSION OF BIG TOE JOINT $ 468.63 $ 611.09 3/1/2020 12/31/9999 28755 FUSION OF BIG TOE JOINT $ 266.54 $ 367.29 3/1/2020 12/31/9999 28760 FUSION OF BIG TOE JOINT $ 463.37 $ 580.28 3/1/2020 12/31/9999 28800 AMPUTATION OF MIDFOOT $ 451.19 $ 451.19 3/1/2020 12/31/9999 28805 AMPUTATION THRU METATARSAL $ 596.20 $ 596.20 3/1/2020 12/31/9999 28810 AMPUTATION TOE & METATARSAL $ 347.15 $ 347.15 3/1/2020 12/31/9999 28820 AMPUTATION OF TOE $ 273.33 $ 388.19 3/1/2020 12/31/9999 28825 PARTIAL AMPUTATION OF TOE $ 311.87 $ 421.74 3/1/2020 12/31/9999 29000 APPLICATION OF BODY CAST $ 131.41 $ 196.62 3/1/2020 12/31/9999 29010 APPLICATION OF BODY CAST $ 121.18 $ 179.35 3/1/2020 12/31/9999 29015 APPLICATION OF BODY CAST $ 124.77 $ 175.00 3/1/2020 12/31/9999 29035 APPLICATION OF BODY CAST $ 107.37 $ 174.34 3/1/2020 12/31/9999 29040 APPLICATION OF BODY CAST $ 120.65 $ 169.69 3/1/2020 12/31/9999 29044 APPLICATION OF BODY CAST $ 125.18 $ 189.53 3/1/2020 12/31/9999 29046 APPLICATION OF BODY CAST $ 143.44 $ 207.19 3/1/2020 12/31/9999 29049 APPLICATION OF FIGURE EIGHT $ 47.03 $ 63.19 3/1/2020 12/31/9999 29055 APPLICATION OF SHOULDER CAST $ 103.39 $ 150.40 3/1/2020 12/31/9999 29058 APPLICATION OF SHOULDER CAST $ 64.42 $ 82.03 3/1/2020 12/31/9999 29065 APPLICATION OF LONG ARM CAST $ 51.80 $ 68.53 3/1/2020 12/31/9999 29075 APPLICATION OF FOREARM CAST $ 46.75 $ 63.49 3/1/2020 12/31/9999 29085 APPLY HAND/WRIST CAST $ 50.42 $ 67.75 3/1/2020 12/31/9999 29086 APPLY FINGER CAST $ 36.96 $ 51.65 3/1/2020 12/31/9999 29105 APPLY LONG ARM SPLINT $ 45.61 $ 62.95 3/1/2020 12/31/9999 29125 APPLY FOREARM SPLINT $ 32.49 $ 48.65 3/1/2020 12/31/9999 29126 APPLY FOREARM SPLINT $ 39.96 $ 56.12 3/1/2020 12/31/9999 29130 APPLICATION OF FINGER SPLINT $ 22.67 $ 30.02 3/1/2020 12/31/9999 29131 APPLICATION OF FINGER SPLINT $ 25.41 $ 36.87 3/1/2020 12/31/9999 29200 STRAPPING OF CHEST $ 31.44 $ 39.66 3/1/2020 12/31/9999 29240 STRAPPING OF SHOULDER $ 34.91 $ 44.32 3/1/2020 12/31/9999 29260 STRAPPING OF ELBOW OR WRIST $ 28.75 $ 38.16 3/1/2020 12/31/9999 29280 STRAPPING OF HAND OR FINGER $ 27.08 $ 36.78 3/1/2020 12/31/9999 29305 APPLICATION OF HIP CAST $ 120.57 $ 169.92 3/1/2020 12/31/9999 29325 APPLICATION OF HIP CASTS $ 136.36 $ 189.24 3/1/2020 12/31/9999 29345 APPLICATION OF LONG LEG CAST $ 78.37 $ 98.93 3/1/2020 12/31/9999 29355 APPLICATION OF LONG LEG CAST $ 83.49 $ 102.59 3/1/2020 12/31/9999 29358 APPLY LONG LEG CAST BRACE $ 79.82 $ 110.96 3/1/2020 12/31/9999 29365 APPLICATION OF LONG LEG CAST $ 67.94 $ 88.50 3/1/2020 12/31/9999 29405 APPLY SHORT LEG CAST $ 49.80 $ 65.08 3/1/2020 12/31/9999 29425 APPLY SHORT LEG CAST $ 55.07 $ 70.63 3/1/2020 12/31/9999 29435 APPLY SHORT LEG CAST $ 66.47 $ 86.45 3/1/2020 12/31/9999 29440 ADDITION OF WALKER TO CAST $ 27.34 $ 38.81 3/1/2020 12/31/9999 29445 APPLY RIGID LEG CAST $ 88.70 $ 109.25 3/1/2020 12/31/9999 29450 APPLICATION OF LEG CAST $ 98.82 $ 115.85 3/1/2020 12/31/9999 29505 APPLICATION LONG LEG SPLINT $ 36.74 $ 55.25 3/1/2020 12/31/9999 29515 APPLICATION LOWER LEG SPLINT $ 38.51 $ 52.03 3/1/2020 12/31/9999 29520 STRAPPING OF HIP $ 28.62 $ 37.14 3/1/2020 12/31/9999 29530 STRAPPING OF KNEE $ 29.39 $ 38.79 3/1/2020 12/31/9999 29540 STRAPPING OF ANKLE AND/OR FT $ 26.22 $ 32.09 3/1/2020 12/31/9999 29550 STRAPPING OF TOES $ 24.65 $ 31.11 3/1/2020 12/31/9999 29580 APPLICATION OF PASTE BOOT $ 28.86 $ 39.14 3/1/2020 12/31/9999 29581 APPLY MULTLAY COMPRS LWR LEG $ 20.74 $ 55.47 3/1/2020 12/31/9999 29584 APPL MULTLAY COMPRS ARM/HAND $ 9.29 $ 41.35 3/1/2020 12/31/9999 29700 REMOVAL/REVISION OF CAST $ 27.66 $ 47.02 3/1/2020 12/31/9999 29705 REMOVAL/REVISION OF CAST $ 37.92 $ 49.96 3/1/2020 12/31/9999 29710 REMOVAL/REVISION OF CAST $ 65.08 $ 87.41 3/1/2020 12/31/9999 29720 REPAIR OF BODY CAST $ 34.87 $ 58.09 3/1/2020 12/31/9999 29730 WINDOWING OF CAST $ 36.51 $ 48.55 3/1/2020 12/31/9999 29740 WEDGING OF CAST $ 53.30 $ 69.75 3/1/2020 12/31/9999 29750 WEDGING OF CLUBFOOT CAST $ 60.98 $ 76.25 3/1/2020 12/31/9999 29800 JAW ARTHROSCOPY/SURGERY $ 394.93 $ 394.93 3/1/2020 12/31/9999 29804 JAW ARTHROSCOPY/SURGERY $ 491.20 $ 491.20 3/1/2020 12/31/9999 29805 SHOULDER ARTHROSCOPY DX $ 357.22 $ 357.22 3/1/2020 12/31/9999 29806 SHOULDER ARTHROSCOPY/SURGERY $ 821.48 $ 821.48 3/1/2020 12/31/9999 29807 SHOULDER ARTHROSCOPY/SURGERY $ 799.95 $ 799.95 3/1/2020 12/31/9999 29819 SHOULDER ARTHROSCOPY/SURGERY $ 448.48 $ 448.48 3/1/2020 12/31/9999 29820 SHOULDER ARTHROSCOPY/SURGERY $ 413.99 $ 413.99 3/1/2020 12/31/9999 29821 SHOULDER ARTHROSCOPY/SURGERY $ 452.14 $ 452.14 3/1/2020 12/31/9999 29822 SHOULDER ARTHROSCOPY/SURGERY $ 438.99 $ 438.99 3/1/2020 12/31/9999 29823 SHOULDER ARTHROSCOPY/SURGERY $ 480.41 $ 480.41 3/1/2020 12/31/9999 29824 SHOULDER ARTHROSCOPY/SURGERY $ 511.96 $ 511.96 3/1/2020 12/31/9999 29825 SHOULDER ARTHROSCOPY/SURGERY $ 447.90 $ 447.90 3/1/2020 12/31/9999 29826 SHOULDER ARTHROSCOPY/SURGERY $ 514.53 $ 514.53 3/1/2020 12/31/9999 29827 ARTHROSCOP ROTATOR CUFF REPR $ 842.52 $ 842.52 3/1/2020 12/31/9999 29828 ARTHROSCOPY BICEPS TENODESIS $ 705.03 $ 705.03 3/1/2020 12/31/9999 29830 ELBOW ARTHROSCOPY $ 344.83 $ 344.83 3/1/2020 12/31/9999 29834 ELBOW ARTHROSCOPY/SURGERY $ 375.81 $ 375.81 3/1/2020 12/31/9999 29835 ELBOW ARTHROSCOPY/SURGERY $ 385.81 $ 385.81 3/1/2020 12/31/9999 29836 ELBOW ARTHROSCOPY/SURGERY $ 443.66 $ 443.66 3/1/2020 12/31/9999 29837 ELBOW ARTHROSCOPY/SURGERY $ 404.68 $ 404.68 3/1/2020 12/31/9999 29838 ELBOW ARTHROSCOPY/SURGERY $ 452.39 $ 452.39 3/1/2020 12/31/9999 29840 WRIST ARTHROSCOPY $ 337.77 $ 337.77 3/1/2020 12/31/9999 29843 WRIST ARTHROSCOPY/SURGERY $ 363.12 $ 363.12 3/1/2020 12/31/9999 29844 WRIST ARTHROSCOPY/SURGERY $ 377.57 $ 377.57 3/1/2020 12/31/9999 29845 WRIST ARTHROSCOPY/SURGERY $ 431.61 $ 431.61 3/1/2020 12/31/9999 29846 WRIST ARTHROSCOPY/SURGERY $ 397.29 $ 397.29 3/1/2020 12/31/9999 29847 WRIST ARTHROSCOPY/SURGERY $ 412.66 $ 412.66 3/1/2020 12/31/9999 29848 WRIST ENDOSCOPY/SURGERY $ 375.28 $ 375.28 3/1/2020 12/31/9999 29850 KNEE ARTHROSCOPY/SURGERY $ 438.86 $ 438.86 3/1/2020 12/31/9999 29851 KNEE ARTHROSCOPY/SURGERY $ 722.65 $ 722.65 3/1/2020 12/31/9999 29855 TIBIAL ARTHROSCOPY/SURGERY $ 604.16 $ 604.16 3/1/2020 12/31/9999 29856 TIBIAL ARTHROSCOPY/SURGERY $ 774.60 $ 774.60 3/1/2020 12/31/9999 29860 HIP ARTHROSCOPY DX $ 497.60 $ 497.60 3/1/2020 12/31/9999 29861 HIP ARTHRO W/FB REMOVAL $ 552.45 $ 552.45 3/1/2020 12/31/9999 29862 HIP ARTHR0 W/DEBRIDEMENT $ 616.57 $ 616.57 3/1/2020 12/31/9999 29863 HIP ARTHR0 W/SYNOVECTOMY $ 610.20 $ 610.20 3/1/2020 12/31/9999 29866 AUTGRFT IMPLNT KNEE W/SCOPE $ 804.84 $ 804.84 3/1/2020 12/31/9999 29867 ALLGRFT IMPLNT KNEE W/SCOPE $ 976.90 $ 976.90 3/1/2020 12/31/9999 29870 KNEE ARTHROSCOPY DX $ 309.81 $ 309.81 3/1/2020 12/31/9999 29871 KNEE ARTHROSCOPY/DRAINAGE $ 389.99 $ 389.99 3/1/2020 12/31/9999 29873 KNEE ARTHROSCOPY/SURGERY $ 388.23 $ 388.23 3/1/2020 12/31/9999 29874 KNEE ARTHROSCOPY/SURGERY $ 409.38 $ 409.38 3/1/2020 12/31/9999 29875 KNEE ARTHROSCOPY/SURGERY $ 377.25 $ 377.25 3/1/2020 12/31/9999 29876 KNEE ARTHROSCOPY/SURGERY $ 496.61 $ 496.61 3/1/2020 12/31/9999 29877 KNEE ARTHROSCOPY/SURGERY $ 469.65 $ 469.65 3/1/2020 12/31/9999 29879 KNEE ARTHROSCOPY/SURGERY $ 502.89 $ 502.89 3/1/2020 12/31/9999 29880 KNEE ARTHROSCOPY/SURGERY $ 525.26 $ 525.26 3/1/2020 12/31/9999 29881 KNEE ARTHROSCOPY/SURGERY $ 489.16 $ 489.16 3/1/2020 12/31/9999 29882 KNEE ARTHROSCOPY/SURGERY $ 530.34 $ 530.34 3/1/2020 12/31/9999 29883 KNEE ARTHROSCOPY/SURGERY $ 647.84 $ 647.84 3/1/2020 12/31/9999 29884 KNEE ARTHROSCOPY/SURGERY $ 468.22 $ 468.22 3/1/2020 12/31/9999 29885 KNEE ARTHROSCOPY/SURGERY $ 568.59 $ 568.59 3/1/2020 12/31/9999 29886 KNEE ARTHROSCOPY/SURGERY $ 479.02 $ 479.02 3/1/2020 12/31/9999 29887 KNEE ARTHROSCOPY/SURGERY $ 565.32 $ 565.32 3/1/2020 12/31/9999 29888 KNEE ARTHROSCOPY/SURGERY $ 768.88 $ 768.88 3/1/2020 12/31/9999 29889 KNEE ARTHROSCOPY/SURGERY $ 938.90 $ 938.90 3/1/2020 12/31/9999 29891 ANKLE ARTHROSCOPY/SURGERY $ 533.18 $ 533.18 3/1/2020 12/31/9999 29892 ANKLE ARTHROSCOPY/SURGERY $ 545.86 $ 545.86 3/1/2020 12/31/9999 29893 SCOPE PLANTAR FASCIOTOMY $ 335.31 $ 440.17 3/1/2020 12/31/9999 29894 ANKLE ARTHROSCOPY/SURGERY $ 400.58 $ 400.58 3/1/2020 12/31/9999 29895 ANKLE ARTHROSCOPY/SURGERY $ 387.50 $ 387.50 3/1/2020 12/31/9999 29897 ANKLE ARTHROSCOPY/SURGERY $ 405.60 $ 405.60 3/1/2020 12/31/9999 29898 ANKLE ARTHROSCOPY/SURGERY $ 454.04 $ 454.04 3/1/2020 12/31/9999 29899 ANKLE ARTHROSCOPY/SURGERY $ 817.06 $ 817.06 3/1/2020 12/31/9999 29900 MCP JOINT ARTHROSCOPY DX $ 347.20 $ 347.20 3/1/2020 12/31/9999 29901 MCP JOINT ARTHROSCOPY SURG $ 380.98 $ 380.98 3/1/2020 12/31/9999 29902 MCP JOINT ARTHROSCOPY SURG $ 407.63 $ 407.63 3/1/2020 12/31/9999 29904 SUBTALAR ARTHRO W/FB RMVL $ 473.70 $ 473.70 3/1/2020 12/31/9999 29905 SUBTALAR ARTHRO W/EXC $ 509.49 $ 509.49 3/1/2020 12/31/9999 29906 SUBTALAR ARTHRO W/DEB $ 536.69 $ 536.69 3/1/2020 12/31/9999 29907 SUBTALAR ARTHRO W/FUSION $ 658.74 $ 658.74 3/1/2020 12/31/9999 29914 HIP ARTHRO W/FEMOROPLASTY $ 858.07 $ 858.07 3/1/2020 12/31/9999 29915 HIP ARTHRO ACETABULOPLASTY $ 874.39 $ 874.39 3/1/2020 12/31/9999 29916 HIP ARTHRO W/LABRAL REPAIR $ 874.39 $ 874.39 3/1/2020 12/31/9999 30000 DRAINAGE OF NOSE LESION $ 89.01 $ 167.14 3/1/2020 12/31/9999 30020 DRAINAGE OF NOSE LESION $ 89.59 $ 161.85 3/1/2020 12/31/9999 30100 INTRANASAL BIOPSY $ 54.17 $ 101.76 3/1/2020 12/31/9999 30110 REMOVAL OF NOSE POLYP(S) $ 99.29 $ 164.20 3/1/2020 12/31/9999 30115 REMOVAL OF NOSE POLYP(S) $ 321.54 $ 321.54 3/1/2020 12/31/9999 30117 REMOVAL OF INTRANASAL LESION $ 248.73 $ 596.24 3/1/2020 12/31/9999 30118 REMOVAL OF INTRANASAL LESION $ 585.14 $ 585.14 3/1/2020 12/31/9999 30120 REVISION OF NOSE $ 339.78 $ 386.78 3/1/2020 12/31/9999 30124 REMOVAL OF NOSE LESION $ 204.33 $ 204.33 3/1/2020 12/31/9999 30125 REMOVAL OF NOSE LESION $ 465.19 $ 465.19 3/1/2020 12/31/9999 30130 EXCISE INFERIOR TURBINATE $ 279.62 $ 279.62 3/1/2020 12/31/9999 30140 RESECT INFERIOR TURBINATE $ 318.48 $ 318.48 3/1/2020 12/31/9999 30150 PARTIAL REMOVAL OF NOSE $ 597.86 $ 597.86 3/1/2020 12/31/9999 30160 REMOVAL OF NOSE $ 601.72 $ 601.72 3/1/2020 12/31/9999 30200 INJECTION TREATMENT OF NOSE $ 46.25 $ 81.50 3/1/2020 12/31/9999 30210 NASAL SINUS THERAPY $ 74.63 $ 107.25 3/1/2020 12/31/9999 30220 INSERT NASAL SEPTAL BUTTON $ 95.14 $ 209.70 3/1/2020 12/31/9999 30300 REMOVE NASAL FOREIGN BODY $ 90.20 $ 162.46 3/1/2020 12/31/9999 30310 REMOVE NASAL FOREIGN BODY $ 152.75 $ 152.75 3/1/2020 12/31/9999 30320 REMOVE NASAL FOREIGN BODY $ 337.43 $ 337.43 3/1/2020 12/31/9999 30400 RECONSTRUCTION OF NOSE $ 777.57 $ 777.57 3/1/2020 12/31/9999 30410 RECONSTRUCTION OF NOSE $ 924.60 $ 924.60 3/1/2020 12/31/9999 30420 RECONSTRUCTION OF NOSE $ 1,041.87 $ 1,041.87 3/1/2020 12/31/9999 30430 REVISION OF NOSE $ 676.88 $ 676.88 3/1/2020 12/31/9999 30435 REVISION OF NOSE $ 898.15 $ 898.15 3/1/2020 12/31/9999 30450 REVISION OF NOSE $ 1,199.71 $ 1,199.71 3/1/2020 12/31/9999 30460 REVISION OF NOSE $ 582.69 $ 582.69 3/1/2020 12/31/9999 30462 REVISION OF NOSE $ 1,171.24 $ 1,171.24 3/1/2020 12/31/9999 30465 REPAIR NASAL STENOSIS $ 743.94 $ 743.94 3/1/2020 12/31/9999 30520 REPAIR OF NASAL SEPTUM $ 453.57 $ 453.57 3/1/2020 12/31/9999 30540 REPAIR NASAL DEFECT $ 506.78 $ 506.78 3/1/2020 12/31/9999 30545 REPAIR NASAL DEFECT $ 733.91 $ 733.91 3/1/2020 12/31/9999 30560 RELEASE OF NASAL ADHESIONS $ 102.88 $ 192.48 3/1/2020 12/31/9999 30580 REPAIR UPPER JAW FISTULA $ 382.41 $ 471.71 3/1/2020 12/31/9999 30600 REPAIR MOUTH/NOSE FISTULA $ 339.33 $ 433.63 3/1/2020 12/31/9999 30620 INTRANASAL RECONSTRUCTION $ 460.60 $ 460.60 3/1/2020 12/31/9999 30630 REPAIR NASAL SEPTUM DEFECT $ 470.30 $ 470.30 3/1/2020 12/31/9999 30801 ABLATE INF TURBINATE SUPERF $ 98.16 $ 161.91 3/1/2020 12/31/9999 30802 ABLATE INF TURBINATE SUBMUC $ 141.17 $ 210.79 3/1/2020 12/31/9999 30901 CONTROL OF NOSEBLEED $ 50.04 $ 78.53 3/1/2020 12/31/9999 30903 CONTROL OF NOSEBLEED $ 65.03 $ 142.29 3/1/2020 12/31/9999 30905 CONTROL OF NOSEBLEED $ 83.61 $ 177.31 3/1/2020 12/31/9999 30906 REPEAT CONTROL OF NOSEBLEED $ 108.85 $ 204.32 3/1/2020 12/31/9999 30915 LIGATION NASAL SINUS ARTERY $ 438.40 $ 438.40 3/1/2020 12/31/9999 30920 LIGATION UPPER JAW ARTERY $ 632.23 $ 632.23 3/1/2020 12/31/9999 30930 THER FX NASAL INF TURBINATE $ 91.23 $ 91.23 3/1/2020 12/31/9999 31000 IRRIGATION MAXILLARY SINUS $ 78.93 $ 129.74 3/1/2020 12/31/9999 31002 IRRIGATION SPHENOID SINUS $ 150.09 $ 150.09 3/1/2020 12/31/9999 31020 EXPLORATION MAXILLARY SINUS $ 260.59 $ 351.07 3/1/2020 12/31/9999 31030 EXPLORATION MAXILLARY SINUS $ 394.02 $ 515.34 3/1/2020 12/31/9999 31032 EXPLORE SINUS REMOVE POLYPS $ 430.65 $ 430.65 3/1/2020 12/31/9999 31040 EXPLORATION BEHIND UPPER JAW $ 569.55 $ 569.55 3/1/2020 12/31/9999 31050 EXPLORATION SPHENOID SINUS $ 370.90 $ 370.90 3/1/2020 12/31/9999 31051 SPHENOID SINUS SURGERY $ 485.14 $ 485.14 3/1/2020 12/31/9999 31070 EXPLORATION OF FRONTAL SINUS $ 324.90 $ 324.90 3/1/2020 12/31/9999 31075 EXPLORATION OF FRONTAL SINUS $ 593.85 $ 593.85 3/1/2020 12/31/9999 31080 REMOVAL OF FRONTAL SINUS $ 768.14 $ 768.14 3/1/2020 12/31/9999 31081 REMOVAL OF FRONTAL SINUS $ 936.10 $ 936.10 3/1/2020 12/31/9999 31084 REMOVAL OF FRONTAL SINUS $ 897.14 $ 897.14 3/1/2020 12/31/9999 31085 REMOVAL OF FRONTAL SINUS $ 948.74 $ 948.74 3/1/2020 12/31/9999 31086 REMOVAL OF FRONTAL SINUS $ 849.57 $ 849.57 3/1/2020 12/31/9999 31087 REMOVAL OF FRONTAL SINUS $ 842.87 $ 842.87 3/1/2020 12/31/9999 31090 EXPLORATION OF SINUSES $ 752.48 $ 752.48 3/1/2020 12/31/9999 31200 REMOVAL OF ETHMOID SINUS $ 398.80 $ 398.80 3/1/2020 12/31/9999 31201 REMOVAL OF ETHMOID SINUS $ 552.86 $ 552.86 3/1/2020 12/31/9999 31205 REMOVAL OF ETHMOID SINUS $ 649.43 $ 649.43 3/1/2020 12/31/9999 31225 REMOVAL OF UPPER JAW $ 1,408.33 $ 1,408.33 3/1/2020 12/31/9999 31230 REMOVAL OF UPPER JAW $ 1,580.88 $ 1,580.88 3/1/2020 12/31/9999 31231 NASAL ENDOSCOPY DX $ 60.54 $ 139.56 3/1/2020 12/31/9999 31233 NSL/SINS NDSC DX MAX SINUSC $ 109.68 $ 198.10 3/1/2020 12/31/9999 31235 NSL/SINS NDSC DX SPHN SINUSC $ 131.07 $ 228.01 3/1/2020 12/31/9999 31237 NASAL/SINUS ENDOSCOPY SURG $ 146.10 $ 245.97 3/1/2020 12/31/9999 31238 NASAL/SINUS ENDOSCOPY SURG $ 158.61 $ 253.77 3/1/2020 12/31/9999 31239 NASAL/SINUS ENDOSCOPY SURG $ 511.21 $ 511.21 3/1/2020 12/31/9999 31240 NASAL/SINUS ENDOSCOPY SURG $ 129.72 $ 129.72 3/1/2020 12/31/9999 31241 NSL/SINS NDSC W/ARTERY LIG $ 390.38 $ 390.38 3/1/2020 12/31/9999 31253 NSL/SINS NDSC TOTAL $ 438.10 $ 438.10 3/1/2020 12/31/9999 31254 NSL/SINS NDSC W/PRTL ETHMDCT $ 222.51 $ 222.51 3/1/2020 12/31/9999 31255 NSL/SINS NDSC W/TOT ETHMDCT $ 328.81 $ 328.81 3/1/2020 12/31/9999 31256 EXPLORATION MAXILLARY SINUS $ 161.06 $ 161.06 3/1/2020 12/31/9999 31257 NSL/SINS NDSC TOT W/SPHENDT $ 390.09 $ 390.09 3/1/2020 12/31/9999 31259 NSL/SINS NDSC SPHN TISS RMVL $ 413.46 $ 413.46 3/1/2020 12/31/9999 31267 ENDOSCOPY MAXILLARY SINUS $ 259.64 $ 259.64 3/1/2020 12/31/9999 31276 NSL/SINS NDSC FRNT TISS RMVL $ 414.70 $ 414.70 3/1/2020 12/31/9999 31287 NASAL/SINUS ENDOSCOPY SURG $ 189.29 $ 189.29 3/1/2020 12/31/9999 31288 NASAL/SINUS ENDOSCOPY SURG $ 219.61 $ 219.61 3/1/2020 12/31/9999 31290 NASAL/SINUS ENDOSCOPY SURG $ 912.95 $ 912.95 3/1/2020 12/31/9999 31291 NASAL/SINUS ENDOSCOPY SURG $ 962.18 $ 962.18 3/1/2020 12/31/9999 31292 NSL/SINS NDSC MED/INF DCMPRN $ 789.58 $ 789.58 3/1/2020 12/31/9999 31293 NSL/SINS NDSC MED&INF DCMPRN $ 860.53 $ 860.53 3/1/2020 12/31/9999 31294 NSL/SINS NDSC SURG ON DCMPRN $ 988.66 $ 988.66 3/1/2020 12/31/9999 31295 NSL/SINS NDSC SURG MAX SINS $ 137.74 $ 1,728.15 3/1/2020 12/31/9999 31296 NSL/SINS NDSC SURG FRNT SINS $ 157.15 $ 1,750.28 3/1/2020 12/31/9999 31297 NSL/SINS NDSC SURG SPHN SINS $ 125.28 $ 1,715.98 3/1/2020 12/31/9999 31298 NSL/SINS NDSC SURG FRNT&SPHN $ 223.37 $ 3,325.79 3/1/2020 12/31/9999 31300 REMOVAL OF LARYNX LESION $ 959.85 $ 959.85 3/1/2020 12/31/9999 31360 REMOVAL OF LARYNX $ 1,542.57 $ 1,542.57 3/1/2020 12/31/9999 31365 REMOVAL OF LARYNX $ 1,934.22 $ 1,934.22 3/1/2020 12/31/9999 31367 PARTIAL REMOVAL OF LARYNX $ 1,663.42 $ 1,663.42 3/1/2020 12/31/9999 31368 PARTIAL REMOVAL OF LARYNX $ 1,858.82 $ 1,858.82 3/1/2020 12/31/9999 31370 PARTIAL REMOVAL OF LARYNX $ 1,562.07 $ 1,562.07 3/1/2020 12/31/9999 31375 PARTIAL REMOVAL OF LARYNX $ 1,477.35 $ 1,477.35 3/1/2020 12/31/9999 31380 PARTIAL REMOVAL OF LARYNX $ 1,455.74 $ 1,455.74 3/1/2020 12/31/9999 31382 PARTIAL REMOVAL OF LARYNX $ 1,595.65 $ 1,595.65 3/1/2020 12/31/9999 31390 REMOVAL OF LARYNX & PHARYNX $ 2,153.60 $ 2,153.60 3/1/2020 12/31/9999 31395 RECONSTRUCT LARYNX & PHARYNX $ 2,282.13 $ 2,282.13 3/1/2020 12/31/9999 31400 REVISION OF LARYNX $ 760.79 $ 760.79 3/1/2020 12/31/9999 31420 REMOVAL OF EPIGLOTTIS $ 642.04 $ 642.04 3/1/2020 12/31/9999 31500 INSERT EMERGENCY AIRWAY $ 90.93 $ 90.93 3/1/2020 12/31/9999 31502 CHANGE OF WINDPIPE AIRWAY $ 28.69 $ 28.69 3/1/2020 12/31/9999 31505 DIAGNOSTIC LARYNGOSCOPY $ 38.00 $ 62.09 3/1/2020 12/31/9999 31510 LARYNGOSCOPY WITH BIOPSY $ 96.51 $ 159.37 3/1/2020 12/31/9999 31511 REMOVE FOREIGN BODY LARYNX $ 103.86 $ 160.25 3/1/2020 12/31/9999 31512 REMOVAL OF LARYNX LESION $ 104.02 $ 158.07 3/1/2020 12/31/9999 31513 INJECTION INTO VOCAL CORD $ 105.95 $ 105.95 3/1/2020 12/31/9999 31515 LARYNGOSCOPY FOR ASPIRATION $ 88.18 $ 157.21 3/1/2020 12/31/9999 31520 DX LARYNGOSCOPY NEWBORN $ 123.51 $ 123.51 3/1/2020 12/31/9999 31525 DX LARYNGOSCOPY EXCL NB $ 128.28 $ 190.26 3/1/2020 12/31/9999 31526 DX LARYNGOSCOPY W/OPER SCOPE $ 127.26 $ 127.26 3/1/2020 12/31/9999 31527 LARYNGOSCOPY FOR TREATMENT $ 155.78 $ 155.78 3/1/2020 12/31/9999 31528 LARYNGOSCOPY AND DILATION $ 116.11 $ 116.11 3/1/2020 12/31/9999 31529 LARYNGOSCOPY AND DILATION $ 130.95 $ 130.95 3/1/2020 12/31/9999 31530 LARYNGOSCOPY W/FB REMOVAL $ 160.47 $ 160.47 3/1/2020 12/31/9999 31531 LARYNGOSCOPY W/FB & OP SCOPE $ 172.69 $ 172.69 3/1/2020 12/31/9999 31535 LARYNGOSCOPY W/BIOPSY $ 153.47 $ 153.47 3/1/2020 12/31/9999 31536 LARYNGOSCOPY W/BX & OP SCOPE $ 171.44 $ 171.44 3/1/2020 12/31/9999 31540 LARYNGOSCOPY W/EXC OF TUMOR $ 197.11 $ 197.11 3/1/2020 12/31/9999 31541 LARYNSCOP W/TUMR EXC + SCOPE $ 215.61 $ 215.61 3/1/2020 12/31/9999 31545 REMOVE VC LESION W/SCOPE $ 292.11 $ 292.11 3/1/2020 12/31/9999 31546 REMOVE VC LESION SCOPE/GRAFT $ 445.43 $ 445.43 3/1/2020 12/31/9999 31551 LARYNGOPLASTY LARYNGEAL STEN $ 1,258.62 $ 1,258.62 3/1/2020 12/31/9999 31552 LARYNGOPLASTY LARYNGEAL STEN $ 1,270.87 $ 1,270.87 3/1/2020 12/31/9999 31553 LARYNGOPLASTY LARYNGEAL STEN $ 1,385.10 $ 1,385.10 3/1/2020 12/31/9999 31554 LARYNGOPLASTY LARYNGEAL STEN $ 1,456.91 $ 1,456.91 3/1/2020 12/31/9999 31560 LARYNGOSCOP W/ARYTENOIDECTOM $ 255.47 $ 255.47 3/1/2020 12/31/9999 31561 LARYNSCOP REMVE CART + SCOP $ 279.98 $ 279.98 3/1/2020 12/31/9999 31570 LARYNGOSCOPE W/VC INJ $ 184.63 $ 265.42 3/1/2020 12/31/9999 31571 LARYNGOSCOP W/VC INJ + SCOPE $ 203.44 $ 203.44 3/1/2020 12/31/9999 31572 LARGSC W/LASER DSTRJ LES $ 161.15 $ 430.88 3/1/2020 12/31/9999 31573 LARGSC W/THER INJECTION $ 132.91 $ 230.37 3/1/2020 12/31/9999 31574 LARGSC W/NJX AUGMENTATION $ 132.91 $ 882.98 3/1/2020 12/31/9999 31575 DIAGNOSTIC LARYNGOSCOPY $ 60.54 $ 87.85 3/1/2020 12/31/9999 31576 LARYNGOSCOPY WITH BIOPSY $ 98.87 $ 170.26 3/1/2020 12/31/9999 31577 LARGSC W/RMVL FOREIGN BDY(S) $ 120.27 $ 184.59 3/1/2020 12/31/9999 31578 LARGSC W/REMOVAL LESION $ 136.83 $ 214.38 3/1/2020 12/31/9999 31579 LARYNGOSCOPY TELESCOPIC $ 112.71 $ 166.47 3/1/2020 12/31/9999 31580 LARYNGOPLASTY LARYNGEAL WEB $ 914.96 $ 914.96 3/1/2020 12/31/9999 31584 LARYNGOPLASTY FX RDCTJ FIXJ $ 1,168.79 $ 1,168.79 3/1/2020 12/31/9999 31587 LARYNGOPLASTY CRICOID SPLIT $ 767.58 $ 767.58 3/1/2020 12/31/9999 31590 REINNERVATE LARYNX $ 668.40 $ 668.40 3/1/2020 12/31/9999 31591 LARYNGOPLASTY MEDIALIZATION $ 919.00 $ 919.00 3/1/2020 12/31/9999 31592 CRICOTRACHEAL RESECTION $ 1,491.51 $ 1,491.51 3/1/2020 12/31/9999 31600 INCISION OF WINDPIPE $ 320.75 $ 320.75 3/1/2020 12/31/9999 31601 INCISION OF WINDPIPE $ 211.33 $ 211.33 3/1/2020 12/31/9999 31603 INCISION OF WINDPIPE $ 181.16 $ 181.16 3/1/2020 12/31/9999 31605 INCISION OF WINDPIPE $ 149.63 $ 149.63 3/1/2020 12/31/9999 31610 INCISION OF WINDPIPE $ 544.15 $ 544.15 3/1/2020 12/31/9999 31611 SURGERY/SPEECH PROSTHESIS $ 405.53 $ 405.53 3/1/2020 12/31/9999 31612 PUNCTURE/CLEAR WINDPIPE $ 39.03 $ 61.95 3/1/2020 12/31/9999 31613 REPAIR WINDPIPE OPENING $ 334.96 $ 334.96 3/1/2020 12/31/9999 31614 REPAIR WINDPIPE OPENING $ 557.36 $ 557.36 3/1/2020 12/31/9999 31615 VISUALIZATION OF WINDPIPE $ 102.21 $ 140.97 3/1/2020 12/31/9999 31622 DX BRONCHOSCOPE/WASH $ 120.11 $ 246.12 3/1/2020 12/31/9999 31623 DX BRONCHOSCOPE/BRUSH $ 121.70 $ 269.15 3/1/2020 12/31/9999 31624 DX BRONCHOSCOPE/LAVAGE $ 121.99 $ 250.65 3/1/2020 12/31/9999 31625 BRONCHOSCOPY W/BIOPSY(S) $ 142.05 $ 270.71 3/1/2020 12/31/9999 31628 BRONCHOSCOPY/LUNG BX EACH $ 158.67 $ 324.64 3/1/2020 12/31/9999 31629 BRONCHOSCOPY/NEEDLE BX EACH $ 169.83 $ 493.24 3/1/2020 12/31/9999 31630 BRONCHOSCOPY DILATE/FX REPR $ 169.16 $ 169.16 3/1/2020 12/31/9999 31631 BRONCHOSCOPY DILATE W/STENT $ 190.84 $ 190.84 3/1/2020 12/31/9999 31632 BRONCHOSCOPY/LUNG BX ADDL $ 43.96 $ 60.71 3/1/2020 12/31/9999 31633 BRONCHOSCOPY/NEEDLE BX ADDL $ 55.14 $ 73.34 3/1/2020 12/31/9999 31635 BRONCHOSCOPY W/FB REMOVAL $ 157.51 $ 278.53 3/1/2020 12/31/9999 31636 BRONCHOSCOPY BRONCH STENTS $ 186.55 $ 186.55 3/1/2020 12/31/9999 31637 BRONCHOSCOPY STENT ADD-ON $ 66.31 $ 66.31 3/1/2020 12/31/9999 31638 BRONCHOSCOPY REVISE STENT $ 209.33 $ 209.33 3/1/2020 12/31/9999 31640 BRONCHOSCOPY W/TUMOR EXCISE $ 216.64 $ 216.64 3/1/2020 12/31/9999 31641 BRONCHOSCOPY TREAT BLOCKAGE $ 214.36 $ 214.36 3/1/2020 12/31/9999 31643 DIAG BRONCHOSCOPE/CATHETER $ 147.18 $ 147.18 3/1/2020 12/31/9999 31645 BRNCHSC W/THER ASPIR 1ST $ 133.54 $ 242.81 3/1/2020 12/31/9999 31646 BRNCHSC W/THER ASPIR SBSQ $ 115.63 $ 220.21 3/1/2020 12/31/9999 31652 BRONCH EBUS SAMPLNG 1/2 NODE $ 211.50 $ 781.67 3/1/2020 12/31/9999 31653 BRONCH EBUS SAMPLNG 3/> NODE $ 233.44 $ 830.98 3/1/2020 12/31/9999 31654 BRONCH EBUS IVNTJ PERPH LES $ 61.16 $ 95.47 3/1/2020 12/31/9999 31717 BRONCHIAL BRUSH BIOPSY $ 91.88 $ 234.64 3/1/2020 12/31/9999 31720 CLEARANCE OF AIRWAYS $ 43.60 $ 43.60 3/1/2020 12/31/9999 31725 CLEARANCE OF AIRWAYS $ 78.58 $ 78.58 3/1/2020 12/31/9999 31730 INTRO WINDPIPE WIRE/TUBE $ 120.00 $ 660.49 3/1/2020 12/31/9999 31750 REPAIR OF WINDPIPE $ 1,019.35 $ 1,019.35 3/1/2020 12/31/9999 31755 REPAIR OF WINDPIPE $ 1,287.43 $ 1,287.43 3/1/2020 12/31/9999 31760 REPAIR OF WINDPIPE $ 1,117.31 $ 1,117.31 3/1/2020 12/31/9999 31766 RECONSTRUCTION OF WINDPIPE $ 1,461.26 $ 1,461.26 3/1/2020 12/31/9999 31770 REPAIR/GRAFT OF BRONCHUS $ 1,082.48 $ 1,082.48 3/1/2020 12/31/9999 31775 RECONSTRUCT BRONCHUS $ 1,119.68 $ 1,119.68 3/1/2020 12/31/9999 31780 RECONSTRUCT WINDPIPE $ 944.06 $ 944.06 3/1/2020 12/31/9999 31781 RECONSTRUCT WINDPIPE $ 1,146.52 $ 1,146.52 3/1/2020 12/31/9999 31785 REMOVE WINDPIPE LESION $ 864.87 $ 864.87 3/1/2020 12/31/9999 31786 REMOVE WINDPIPE LESION $ 1,203.68 $ 1,203.68 3/1/2020 12/31/9999 31800 REPAIR OF WINDPIPE INJURY $ 534.27 $ 534.27 3/1/2020 12/31/9999 31805 REPAIR OF WINDPIPE INJURY $ 661.98 $ 661.98 3/1/2020 12/31/9999 31820 CLOSURE OF WINDPIPE LESION $ 253.27 $ 324.05 3/1/2020 12/31/9999 31825 REPAIR OF WINDPIPE DEFECT $ 373.92 $ 454.70 3/1/2020 12/31/9999 31830 REVISE WINDPIPE SCAR $ 262.02 $ 326.35 3/1/2020 12/31/9999 32000 DRAINAGE OF CHEST $ 68.38 $ 149.51 3/1/2020 12/31/9999 32005 CHEMICAL PLEURODESIS $ 100.20 $ 283.78 3/1/2020 12/31/9999 32020 TUBE THORACOSTOMY W WATER SEAL PNEUMOTHO $ 160.73 $ 160.73 3/1/2020 12/31/9999 32035 THORACOSTOMY W/RIB RESECTION $ 563.16 $ 563.16 3/1/2020 12/31/9999 32036 THORACOSTOMY W/FLAP DRAINAGE $ 611.00 $ 611.00 3/1/2020 12/31/9999 32096 OPEN WEDGE/BX LUNG INFILTR $ 482.72 $ 482.72 3/1/2020 12/31/9999 32097 OPEN WEDGE/BX LUNG NODULE $ 482.72 $ 482.72 3/1/2020 12/31/9999 32098 OPEN BIOPSY OF LUNG PLEURA $ 453.72 $ 453.72 3/1/2020 12/31/9999 32100 EXPLORATION OF CHEST $ 776.34 $ 776.34 3/1/2020 12/31/9999 32110 EXPLORE/REPAIR CHEST $ 1,171.65 $ 1,171.65 3/1/2020 12/31/9999 32120 RE-EXPLORATION OF CHEST $ 695.43 $ 695.43 3/1/2020 12/31/9999 32124 EXPLORE CHEST FREE ADHESIONS $ 739.81 $ 739.81 3/1/2020 12/31/9999 32140 REMOVAL OF LUNG LESION(S) $ 791.68 $ 791.68 3/1/2020 12/31/9999 32141 REMOVE/TREAT LUNG LESIONS $ 1,199.52 $ 1,199.52 3/1/2020 12/31/9999 32150 REMOVAL OF LUNG LESION(S) $ 797.86 $ 797.86 3/1/2020 12/31/9999 32151 REMOVE LUNG FOREIGN BODY $ 815.50 $ 815.50 3/1/2020 12/31/9999 32160 OPEN CHEST HEART MASSAGE $ 612.86 $ 612.86 3/1/2020 12/31/9999 32200 DRAIN OPEN LUNG LESION $ 894.90 $ 894.90 3/1/2020 12/31/9999 32215 TREAT CHEST LINING $ 641.45 $ 641.45 3/1/2020 12/31/9999 32220 RELEASE OF LUNG $ 1,283.33 $ 1,283.33 3/1/2020 12/31/9999 32225 PARTIAL RELEASE OF LUNG $ 798.62 $ 798.62 3/1/2020 12/31/9999 32310 REMOVAL OF CHEST LINING $ 736.43 $ 736.43 3/1/2020 12/31/9999 32320 FREE/REMOVE CHEST LINING $ 1,287.06 $ 1,287.06 3/1/2020 12/31/9999 32400 NEEDLE BIOPSY CHEST LINING $ 75.54 $ 121.65 3/1/2020 12/31/9999 32405 PERCUT BX LUNG/MEDIASTINUM $ 84.95 $ 85.24 3/1/2020 12/31/9999 32420 PNEUMOCENTESIS, PUNCTURE OF LUNG FOR ASP $ 93.96 $ 93.96 3/1/2020 12/31/9999 32440 REMOVE LUNG PNEUMONECTOMY $ 1,287.26 $ 1,287.26 3/1/2020 12/31/9999 32442 SLEEVE PNEUMONECTOMY $ 2,401.95 $ 2,401.95 3/1/2020 12/31/9999 32445 REMOVAL OF LUNG EXTRAPLEURAL $ 2,728.23 $ 2,728.23 3/1/2020 12/31/9999 32480 PARTIAL REMOVAL OF LUNG $ 1,215.04 $ 1,215.04 3/1/2020 12/31/9999 32482 BILOBECTOMY $ 1,295.65 $ 1,295.65 3/1/2020 12/31/9999 32484 SEGMENTECTOMY $ 1,172.80 $ 1,172.80 3/1/2020 12/31/9999 32486 SLEEVE LOBECTOMY $ 1,875.07 $ 1,875.07 3/1/2020 12/31/9999 32488 COMPLETION PNEUMONECTOMY $ 1,898.90 $ 1,898.90 3/1/2020 12/31/9999 32491 LUNG VOLUME REDUCTION $ 1,205.36 $ 1,205.36 3/1/2020 12/31/9999 32501 REPAIR BRONCHUS ADD-ON $ 205.77 $ 205.77 3/1/2020 12/31/9999 32503 RESECT APICAL LUNG TUMOR $ 1,483.58 $ 1,483.58 3/1/2020 12/31/9999 32504 RESECT APICAL LUNG TUM/CHEST $ 1,704.35 $ 1,704.35 3/1/2020 12/31/9999 32505 WEDGE RESECT OF LUNG INITIAL $ 557.38 $ 557.38 3/1/2020 12/31/9999 32506 WEDGE RESECT OF LUNG ADD-ON $ 93.85 $ 93.85 3/1/2020 12/31/9999 32507 WEDGE RESECT OF LUNG DIAG $ 93.85 $ 93.85 3/1/2020 12/31/9999 32540 REMOVAL OF LUNG LESION $ 1,350.24 $ 1,350.24 3/1/2020 12/31/9999 32550 INSERT PLEURAL CATH $ 189.05 $ 615.00 3/1/2020 12/31/9999 32551 INSERTION OF CHEST TUBE $ 146.33 $ 146.33 3/1/2020 12/31/9999 32552 REMOVE LUNG CATHETER $ 102.04 $ 115.15 3/1/2020 12/31/9999 32554 ASPIRATE PLEURA W/O IMAGING $ 75.72 $ 462.75 3/1/2020 12/31/9999 32555 ASPIRATE PLEURA W/ IMAGING $ 94.52 $ 533.76 3/1/2020 12/31/9999 32556 INSERT CATH PLEURA W/O IMAGE $ 103.72 $ 488.54 3/1/2020 12/31/9999 32557 INSERT CATH PLEURA W/ IMAGE $ 136.83 $ 789.08 3/1/2020 12/31/9999 32560 TREAT PLEURODESIS W/AGENT $ 93.26 $ 231.63 3/1/2020 12/31/9999 32561 LYSE CHEST FIBRIN INIT DAY $ 46.33 $ 60.35 3/1/2020 12/31/9999 32562 LYSE CHEST FIBRIN SUBQ DAY $ 41.46 $ 53.66 3/1/2020 12/31/9999 32601 THORACOSCOPY DIAGNOSTIC $ 255.27 $ 255.27 3/1/2020 12/31/9999 32604 THORACOSCOPY WBX SAC $ 403.24 $ 403.24 3/1/2020 12/31/9999 32606 THORACOSCOPY W/BX MED SPACE $ 385.30 $ 385.30 3/1/2020 12/31/9999 32607 THORACOSCOPY W/BX INFILTRATE $ 184.92 $ 184.92 3/1/2020 12/31/9999 32608 THORACOSCOPY W/BX NODULE $ 227.05 $ 227.05 3/1/2020 12/31/9999 32609 THORACOSCOPY W/BX PLEURA $ 156.85 $ 156.85 3/1/2020 12/31/9999 32650 THORACOSCOPY W/PLEURODESIS $ 544.50 $ 544.50 3/1/2020 12/31/9999 32651 THORACOSCOPY REMOVE CORTEX $ 862.67 $ 862.67 3/1/2020 12/31/9999 32652 THORACOSCOPY REM TOTL CORTEX $ 1,311.06 $ 1,311.06 3/1/2020 12/31/9999 32653 THORACOSCOPY REMOV FB/FIBRIN $ 836.06 $ 836.06 3/1/2020 12/31/9999 32654 THORACOSCOPY CONTRL BLEEDING $ 924.56 $ 924.56 3/1/2020 12/31/9999 32655 THORACOSCOPY RESECT BULLAE $ 762.48 $ 762.48 3/1/2020 12/31/9999 32656 THORACOSCOPY W/PLEURECTOMY $ 652.44 $ 652.44 3/1/2020 12/31/9999 32658 THORACOSCOPY W/SAC FB REMOVE $ 587.78 $ 587.78 3/1/2020 12/31/9999 32659 THORACOSCOPY W/SAC DRAINAGE $ 597.24 $ 597.24 3/1/2020 12/31/9999 32661 THORACOSCOPY W/PERICARD EXC $ 657.08 $ 657.08 3/1/2020 12/31/9999 32662 THORACOSCOPY W/MEDIAST EXC $ 735.64 $ 735.64 3/1/2020 12/31/9999 32663 THORACOSCOPY W/LOBECTOMY $ 1,135.42 $ 1,135.42 3/1/2020 12/31/9999 32664 THORACOSCOPY W/ TH NRV EXC $ 699.12 $ 699.12 3/1/2020 12/31/9999 32665 THORACOSCOP W/ESOPH MUSC EXC $ 983.16 $ 983.16 3/1/2020 12/31/9999 32666 THORACOSCOPY W/WEDGE RESECT $ 521.03 $ 521.03 3/1/2020 12/31/9999 32667 THORACOSCOPY W/W RESECT ADDL $ 93.85 $ 93.85 3/1/2020 12/31/9999 32668 THORACOSCOPY W/W RESECT DIAG $ 94.34 $ 94.34 3/1/2020 12/31/9999 32669 THORACOSCOPY REMOVE SEGMENT $ 802.20 $ 802.20 3/1/2020 12/31/9999 32670 THORACOSCOPY BILOBECTOMY $ 957.48 $ 957.48 3/1/2020 12/31/9999 32671 THORACOSCOPY PNEUMONECTOMY $ 1,062.27 $ 1,062.27 3/1/2020 12/31/9999 32672 THORACOSCOPY FOR LVRS $ 908.66 $ 908.66 3/1/2020 12/31/9999 32673 THORACOSCOPY W/THYMUS RESECT $ 718.44 $ 718.44 3/1/2020 12/31/9999 32674 THORACOSCOPY LYMPH NODE EXC $ 128.71 $ 128.71 3/1/2020 12/31/9999 32701 THORAX STEREO RAD TARGETW/TX $ 182.78 $ 182.78 3/1/2020 12/31/9999 32800 REPAIR LUNG HERNIA $ 751.93 $ 751.93 3/1/2020 12/31/9999 32810 CLOSE CHEST AFTER DRAINAGE $ 727.08 $ 727.08 3/1/2020 12/31/9999 32815 CLOSE BRONCHIAL FISTULA $ 2,161.83 $ 2,161.83 3/1/2020 12/31/9999 32820 RECONSTRUCT INJURED CHEST $ 1,083.48 $ 1,083.48 3/1/2020 12/31/9999 32851 LUNG TRANSPLANT SINGLE $ 2,091.60 $ 2,091.60 3/1/2020 12/31/9999 32852 LUNG TRANSPLANT WITH BYPASS $ 2,314.04 $ 2,314.04 3/1/2020 12/31/9999 32853 LUNG TRANSPLANT DOUBLE $ 2,501.80 $ 2,501.80 3/1/2020 12/31/9999 32854 LUNG TRANSPLANT WITH BYPASS $ 2,722.97 $ 2,722.97 3/1/2020 12/31/9999 32900 REMOVAL OF RIB(S) $ 1,107.31 $ 1,107.31 3/1/2020 12/31/9999 32905 REVISE & REPAIR CHEST WALL $ 1,091.99 $ 1,091.99 3/1/2020 12/31/9999 32906 REVISE & REPAIR CHEST WALL $ 1,356.94 $ 1,356.94 3/1/2020 12/31/9999 32940 REVISION OF LUNG $ 1,000.55 $ 1,000.55 3/1/2020 12/31/9999 32960 THERAPEUTIC PNEUMOTHORAX $ 82.80 $ 111.58 3/1/2020 12/31/9999 32997 TOTAL LUNG LAVAGE $ 297.85 $ 297.85 3/1/2020 12/31/9999 33016 PERICARDIOCENTESIS W/IMAGING $ 210.88 $ 210.88 3/1/2020 12/31/9999 33017 PRCRD DRG 6YR+ W/O CGEN CAR $ 219.00 $ 219.00 3/1/2020 12/31/9999 33018 PRCRD DRG 0-5YR OR W/ANOMLY $ 250.38 $ 250.38 3/1/2020 12/31/9999 33019 PERQ PRCRD DRG INSJ CATH CT $ 202.81 $ 202.81 3/1/2020 12/31/9999 33020 INCISION OF HEART SAC $ 707.92 $ 707.92 3/1/2020 12/31/9999 33025 INCISION OF HEART SAC $ 653.51 $ 653.51 3/1/2020 12/31/9999 33030 PARTIAL REMOVAL OF HEART SAC $ 1,046.68 $ 1,046.68 3/1/2020 12/31/9999 33031 PARTIAL REMOVAL OF HEART SAC $ 1,169.51 $ 1,169.51 3/1/2020 12/31/9999 33050 RESECT HEART SAC LESION $ 808.38 $ 808.38 3/1/2020 12/31/9999 33120 REMOVAL OF HEART LESION $ 1,278.45 $ 1,278.45 3/1/2020 12/31/9999 33130 REMOVAL OF HEART LESION $ 1,125.74 $ 1,125.74 3/1/2020 12/31/9999 33140 HEART REVASCULARIZE (TMR) $ 1,285.78 $ 1,285.78 3/1/2020 12/31/9999 33141 HEART TMR W/OTHER PROCEDURE $ 124.80 $ 124.80 3/1/2020 12/31/9999 33202 INSERT EPICARD ELTRD OPEN $ 637.39 $ 637.39 3/1/2020 12/31/9999 33203 INSERT EPICARD ELTRD ENDO $ 671.84 $ 671.84 3/1/2020 12/31/9999 33206 INSERT HEART PM ATRIAL $ 388.59 $ 388.59 3/1/2020 12/31/9999 33207 INSERT HEART PM VENTRICULAR $ 416.33 $ 416.33 3/1/2020 12/31/9999 33208 INSRT HEART PM ATRIAL & VENT $ 448.86 $ 448.86 3/1/2020 12/31/9999 33210 INSERT ELECTRD/PM CATH SNGL $ 154.83 $ 154.83 3/1/2020 12/31/9999 33211 INSERT CARD ELECTRODES DUAL $ 155.66 $ 155.66 3/1/2020 12/31/9999 33212 INSERT PULSE GEN SNGL LEAD $ 290.57 $ 290.57 3/1/2020 12/31/9999 33213 INSERT PULSE GEN DUAL LEADS $ 331.76 $ 331.76 3/1/2020 12/31/9999 33214 UPGRADE OF PACEMAKER SYSTEM $ 411.20 $ 411.20 3/1/2020 12/31/9999 33215 REPOSITION PACING-DEFIB LEAD $ 262.61 $ 262.61 3/1/2020 12/31/9999 33216 INSERT 1 ELECTRODE PM-DEFIB $ 323.05 $ 323.05 3/1/2020 12/31/9999 33217 INSERT 2 ELECTRODE PM-DEFIB $ 320.36 $ 320.36 3/1/2020 12/31/9999 33218 REPAIR LEAD PACE-DEFIB ONE $ 333.91 $ 333.91 3/1/2020 12/31/9999 33220 REPAIR LEAD PACE-DEFIB DUAL $ 337.05 $ 337.05 3/1/2020 12/31/9999 33221 INSERT PULSE GEN MULT LEADS $ 209.79 $ 209.79 3/1/2020 12/31/9999 33222 RELOCATION POCKET PACEMAKER $ 293.57 $ 293.57 3/1/2020 12/31/9999 33223 RELOCATE POCKET FOR DEFIB $ 356.16 $ 356.16 3/1/2020 12/31/9999 33224 INSERT PACING LEAD & CONNECT $ 436.89 $ 436.89 3/1/2020 12/31/9999 33225 L VENTRIC PACING LEAD ADD-ON $ 394.33 $ 394.33 3/1/2020 12/31/9999 33226 REPOSITION L VENTRIC LEAD $ 422.07 $ 422.07 3/1/2020 12/31/9999 33227 REMOVE&REPLACE PM GEN SINGL $ 200.18 $ 200.18 3/1/2020 12/31/9999 33228 REMV&REPLC PM GEN DUAL LEAD $ 208.76 $ 208.76 3/1/2020 12/31/9999 33229 REMV&REPLC PM GEN MULT LEADS $ 217.33 $ 217.33 3/1/2020 12/31/9999 33230 INSRT PULSE GEN W/DUAL LEADS $ 225.71 $ 225.71 3/1/2020 12/31/9999 33231 INSRT PULSE GEN W/MULT LEADS $ 234.28 $ 234.28 3/1/2020 12/31/9999 33233 REMOVAL OF PM GENERATOR $ 205.07 $ 205.07 3/1/2020 12/31/9999 33234 REMOVAL OF PACEMAKER SYSTEM $ 417.43 $ 417.43 3/1/2020 12/31/9999 33235 REMOVAL PACEMAKER ELECTRODE $ 539.19 $ 539.19 3/1/2020 12/31/9999 33236 REMOVE ELECTRODE/THORACOTOMY $ 638.41 $ 638.41 3/1/2020 12/31/9999 33237 REMOVE ELECTRODE/THORACOTOMY $ 704.84 $ 704.84 3/1/2020 12/31/9999 33238 REMOVE ELECTRODE/THORACOTOMY $ 761.40 $ 761.40 3/1/2020 12/31/9999 33240 INSRT PULSE GEN W/SINGL LEAD $ 399.14 $ 399.14 3/1/2020 12/31/9999 33241 REMOVE PULSE GENERATOR $ 194.09 $ 194.09 3/1/2020 12/31/9999 33243 REMOVE ELTRD/THORACOTOMY $ 1,121.48 $ 1,121.48 3/1/2020 12/31/9999 33244 REMOVE ELCTRD TRANSVENOUSLY $ 733.50 $ 733.50 3/1/2020 12/31/9999 33249 INSJ/RPLCMT DEFIB W/LEAD(S) $ 776.84 $ 776.84 3/1/2020 12/31/9999 33250 ABLATE HEART DYSRHYTHM FOCUS $ 1,202.80 $ 1,202.80 3/1/2020 12/31/9999 33251 ABLATE HEART DYSRHYTHM FOCUS $ 1,333.38 $ 1,333.38 3/1/2020 12/31/9999 33254 ABLATE ATRIA LMTD $ 1,121.18 $ 1,121.18 3/1/2020 12/31/9999 33255 ABLATE ATRIA W/O BYPASS EXT $ 1,371.65 $ 1,371.65 3/1/2020 12/31/9999 33256 ABLATE ATRIA W/BYPASS EXTEN $ 1,636.53 $ 1,636.53 3/1/2020 12/31/9999 33257 ABLATE ATRIA LMTD ADD-ON $ 472.08 $ 472.08 3/1/2020 12/31/9999 33258 ABLATE ATRIA X10SV ADD-ON $ 533.41 $ 533.41 3/1/2020 12/31/9999 33259 ABLATE ATRIA W/BYPASS ADD-ON $ 695.79 $ 695.79 3/1/2020 12/31/9999 33261 ABLATE HEART DYSRHYTHM FOCUS $ 1,327.05 $ 1,327.05 3/1/2020 12/31/9999 33262 RMVL& REPLC PULSE GEN 1 LEAD $ 217.55 $ 217.55 3/1/2020 12/31/9999 33263 RMVL & RPLCMT DFB GEN 2 LEAD $ 226.12 $ 226.12 3/1/2020 12/31/9999 33264 RMVL & RPLCMT DFB GEN MLT LD $ 234.69 $ 234.69 3/1/2020 12/31/9999 33265 ABLATE ATRIA LMTD ENDO $ 1,118.83 $ 1,118.83 3/1/2020 12/31/9999 33266 ABLATE ATRIA X10SV ENDO $ 1,536.54 $ 1,536.54 3/1/2020 12/31/9999 33270 INS/REP SUBQ DEFIBRILLATOR $ 554.80 $ 554.80 3/1/2020 12/31/9999 33271 INSJ SUBQ IMPLTBL DFB ELCTRD $ 429.63 $ 429.63 3/1/2020 12/31/9999 33272 RMVL OF SUBQ DEFIBRILLATOR $ 369.75 $ 369.75 3/1/2020 12/31/9999 33273 REPOS PREV IMPLTBL SUBQ DFB $ 346.69 $ 346.69 3/1/2020 12/31/9999 33285 INSJ SUBQ CAR RHYTHM MNTR $ 79.14 $ 4,426.28 3/1/2020 12/31/9999 33286 RMVL SUBQ CAR RHYTHM MNTR $ 77.64 $ 115.82 3/1/2020 12/31/9999 33300 REPAIR OF HEART WOUND $ 1,907.68 $ 1,907.68 3/1/2020 12/31/9999 33305 REPAIR OF HEART WOUND $ 3,186.47 $ 3,186.47 3/1/2020 12/31/9999 33310 EXPLORATORY HEART SURGERY $ 958.63 $ 958.63 3/1/2020 12/31/9999 33315 EXPLORATORY HEART SURGERY $ 1,219.66 $ 1,219.66 3/1/2020 12/31/9999 33320 REPAIR MAJOR BLOOD VESSEL(S) $ 869.27 $ 869.27 3/1/2020 12/31/9999 33321 REPAIR MAJOR VESSEL $ 980.33 $ 980.33 3/1/2020 12/31/9999 33322 REPAIR MAJOR BLOOD VESSEL(S) $ 1,138.58 $ 1,138.58 3/1/2020 12/31/9999 33330 INSERT MAJOR VESSEL GRAFT $ 1,150.42 $ 1,150.42 3/1/2020 12/31/9999 33335 INSERT MAJOR VESSEL GRAFT $ 1,551.97 $ 1,551.97 3/1/2020 12/31/9999 33361 REPLACE AORTIC VALVE PERQ $ 1,114.01 $ 1,114.01 3/1/2020 12/31/9999 33362 REPLACE AORTIC VALVE OPEN $ 1,218.86 $ 1,218.86 3/1/2020 12/31/9999 33363 REPLACE AORTIC VALVE OPEN $ 1,262.02 $ 1,262.02 3/1/2020 12/31/9999 33364 REPLACE AORTIC VALVE OPEN $ 1,342.49 $ 1,342.49 3/1/2020 12/31/9999 33365 REPLACE AORTIC VALVE OPEN $ 1,468.68 $ 1,468.68 3/1/2020 12/31/9999 33366 TRCATH REPLACE AORTIC VALVE $ 1,624.38 $ 1,624.38 3/1/2020 12/31/9999 33367 REPLACE AORTIC VALVE W/BYP $ 515.90 $ 515.90 3/1/2020 12/31/9999 33368 REPLACE AORTIC VALVE W/BYP $ 625.17 $ 625.17 3/1/2020 12/31/9999 33369 REPLACE AORTIC VALVE W/BYP $ 825.38 $ 825.38 3/1/2020 12/31/9999 33390 VALVULOPLASTY AORTIC VALVE $ 1,701.71 $ 1,701.71 3/1/2020 12/31/9999 33391 VALVULOPLASTY AORTIC VALVE $ 2,016.49 $ 2,016.49 3/1/2020 12/31/9999 33404 PREPARE HEART-AORTA CONDUIT $ 1,470.55 $ 1,470.55 3/1/2020 12/31/9999 33405 REPLACEMENT AORTIC VALVE OPN $ 1,907.39 $ 1,907.39 3/1/2020 12/31/9999 33406 REPLACEMENT AORTIC VALVE OPN $ 2,356.63 $ 2,356.63 3/1/2020 12/31/9999 33410 REPLACEMENT AORTIC VALVE OPN $ 2,079.35 $ 2,079.35 3/1/2020 12/31/9999 33411 REPLACEMENT OF AORTIC VALVE $ 2,717.99 $ 2,717.99 3/1/2020 12/31/9999 33412 REPLACEMENT OF AORTIC VALVE $ 2,057.65 $ 2,057.65 3/1/2020 12/31/9999 33413 REPLACEMENT OF AORTIC VALVE $ 2,677.20 $ 2,677.20 3/1/2020 12/31/9999 33414 REPAIR OF AORTIC VALVE $ 1,788.28 $ 1,788.28 3/1/2020 12/31/9999 33415 REVISION SUBVALVULAR TISSUE $ 1,658.88 $ 1,658.88 3/1/2020 12/31/9999 33416 REVISE VENTRICLE MUSCLE $ 1,664.85 $ 1,664.85 3/1/2020 12/31/9999 33417 REPAIR OF AORTIC VALVE $ 1,386.05 $ 1,386.05 3/1/2020 12/31/9999 33420 REVISION OF MITRAL VALVE $ 1,127.96 $ 1,127.96 3/1/2020 12/31/9999 33422 REVISION OF MITRAL VALVE $ 1,392.11 $ 1,392.11 3/1/2020 12/31/9999 33425 REPAIR OF MITRAL VALVE $ 2,176.07 $ 2,176.07 3/1/2020 12/31/9999 33426 REPAIR OF MITRAL VALVE $ 1,971.23 $ 1,971.23 3/1/2020 12/31/9999 33427 REPAIR OF MITRAL VALVE $ 2,056.77 $ 2,056.77 3/1/2020 12/31/9999 33430 REPLACEMENT OF MITRAL VALVE $ 2,281.55 $ 2,281.55 3/1/2020 12/31/9999 33440 RPLCMT A-VALVE TLCJ AUTOL PV $ 3,007.79 $ 3,007.79 3/1/2020 12/31/9999 33460 REVISION OF TRICUSPID VALVE $ 1,936.75 $ 1,936.75 3/1/2020 12/31/9999 33463 VALVULOPLASTY TRICUSPID $ 2,448.10 $ 2,448.10 3/1/2020 12/31/9999 33464 VALVULOPLASTY TRICUSPID $ 1,969.93 $ 1,969.93 3/1/2020 12/31/9999 33465 REPLACE TRICUSPID VALVE $ 2,206.35 $ 2,206.35 3/1/2020 12/31/9999 33468 REVISION OF TRICUSPID VALVE $ 1,550.71 $ 1,550.71 3/1/2020 12/31/9999 33470 REVISION OF PULMONARY VALVE $ 979.79 $ 979.79 3/1/2020 12/31/9999 33471 VALVOTOMY PULMONARY VALVE $ 1,092.00 $ 1,092.00 3/1/2020 12/31/9999 33474 REVISION OF PULMONARY VALVE $ 1,699.06 $ 1,699.06 3/1/2020 12/31/9999 33475 REPLACEMENT PULMONARY VALVE $ 1,910.42 $ 1,910.42 3/1/2020 12/31/9999 33476 REVISION OF HEART CHAMBER $ 1,208.18 $ 1,208.18 3/1/2020 12/31/9999 33477 IMPLANT TCAT PULM VLV PERQ $ 1,167.60 $ 1,167.60 3/1/2020 12/31/9999 33478 REVISION OF HEART CHAMBER $ 1,297.96 $ 1,297.96 3/1/2020 12/31/9999 33496 REPAIR PROSTH VALVE CLOT $ 1,389.12 $ 1,389.12 3/1/2020 12/31/9999 33500 REPAIR HEART VESSEL FISTULA $ 1,303.30 $ 1,303.30 3/1/2020 12/31/9999 33501 REPAIR HEART VESSEL FISTULA $ 904.28 $ 904.28 3/1/2020 12/31/9999 33502 CORONARY ARTERY CORRECTION $ 1,043.83 $ 1,043.83 3/1/2020 12/31/9999 33503 CORONARY ARTERY GRAFT $ 1,116.16 $ 1,116.16 3/1/2020 12/31/9999 33504 CORONARY ARTERY GRAFT $ 1,192.75 $ 1,192.75 3/1/2020 12/31/9999 33505 REPAIR ARTERY W/TUNNEL $ 1,645.89 $ 1,645.89 3/1/2020 12/31/9999 33506 REPAIR ARTERY TRANSLOCATION $ 1,703.70 $ 1,703.70 3/1/2020 12/31/9999 33507 REPAIR ART INTRAMURAL $ 1,440.09 $ 1,440.09 3/1/2020 12/31/9999 33508 ENDOSCOPIC VEIN HARVEST $ 13.59 $ 13.59 3/1/2020 12/31/9999 33510 CABG VEIN SINGLE $ 1,621.78 $ 1,621.78 3/1/2020 12/31/9999 33511 CABG VEIN TWO $ 1,770.53 $ 1,770.53 3/1/2020 12/31/9999 33512 CABG VEIN THREE $ 1,995.07 $ 1,995.07 3/1/2020 12/31/9999 33513 CABG VEIN FOUR $ 2,038.74 $ 2,038.74 3/1/2020 12/31/9999 33514 CABG VEIN FIVE $ 2,160.48 $ 2,160.48 3/1/2020 12/31/9999 33516 CABG VEIN SIX OR MORE $ 2,246.04 $ 2,246.04 3/1/2020 12/31/9999 33517 CABG ARTERY-VEIN SINGLE $ 154.81 $ 154.81 3/1/2020 12/31/9999 33518 CABG ARTERY-VEIN TWO $ 335.25 $ 335.25 3/1/2020 12/31/9999 33519 CABG ARTERY-VEIN THREE $ 447.18 $ 447.18 3/1/2020 12/31/9999 33521 CABG ARTERY-VEIN FOUR $ 541.08 $ 541.08 3/1/2020 12/31/9999 33522 CABG ARTERY-VEIN FIVE $ 615.30 $ 615.30 3/1/2020 12/31/9999 33523 CABG ART-VEIN SIX OR MORE $ 702.17 $ 702.17 3/1/2020 12/31/9999 33530 CORONARY ARTERY BYPASS/REOP $ 426.36 $ 426.36 3/1/2020 12/31/9999 33533 CABG ARTERIAL SINGLE $ 1,578.98 $ 1,578.98 3/1/2020 12/31/9999 33534 CABG ARTERIAL TWO $ 1,836.68 $ 1,836.68 3/1/2020 12/31/9999 33535 CABG ARTERIAL THREE $ 2,039.99 $ 2,039.99 3/1/2020 12/31/9999 33536 CABG ARTERIAL FOUR OR MORE $ 2,186.55 $ 2,186.55 3/1/2020 12/31/9999 33542 REMOVAL OF HEART LESION $ 2,109.12 $ 2,109.12 3/1/2020 12/31/9999 33545 REPAIR OF HEART DAMAGE $ 2,488.83 $ 2,488.83 3/1/2020 12/31/9999 33572 OPEN CORONARY ENDARTERECTOMY $ 196.39 $ 196.39 3/1/2020 12/31/9999 33600 CLOSURE OF VALVE $ 1,413.63 $ 1,413.63 3/1/2020 12/31/9999 33602 CLOSURE OF VALVE $ 1,347.26 $ 1,347.26 3/1/2020 12/31/9999 33606 ANASTOMOSIS/ARTERY-AORTA $ 1,467.15 $ 1,467.15 3/1/2020 12/31/9999 33608 REPAIR ANOMALY W/CONDUIT $ 1,505.77 $ 1,505.77 3/1/2020 12/31/9999 33610 REPAIR BY ENLARGEMENT $ 1,469.57 $ 1,469.57 3/1/2020 12/31/9999 33611 REPAIR DOUBLE VENTRICLE $ 1,616.87 $ 1,616.87 3/1/2020 12/31/9999 33612 REPAIR DOUBLE VENTRICLE $ 1,669.70 $ 1,669.70 3/1/2020 12/31/9999 33615 REPAIR MODIFIED FONTAN $ 1,662.92 $ 1,662.92 3/1/2020 12/31/9999 33617 REPAIR SINGLE VENTRICLE $ 1,785.34 $ 1,785.34 3/1/2020 12/31/9999 33619 REPAIR SINGLE VENTRICLE $ 2,188.65 $ 2,188.65 3/1/2020 12/31/9999 33641 REPAIR HEART SEPTUM DEFECT $ 1,329.37 $ 1,329.37 3/1/2020 12/31/9999 33645 REVISION OF HEART VEINS $ 1,307.94 $ 1,307.94 3/1/2020 12/31/9999 33647 REPAIR HEART SEPTUM DEFECTS $ 1,390.50 $ 1,390.50 3/1/2020 12/31/9999 33660 REPAIR OF HEART DEFECTS $ 1,458.50 $ 1,458.50 3/1/2020 12/31/9999 33665 REPAIR OF HEART DEFECTS $ 1,578.62 $ 1,578.62 3/1/2020 12/31/9999 33670 REPAIR OF HEART CHAMBERS $ 1,642.43 $ 1,642.43 3/1/2020 12/31/9999 33675 CLOSE MULT VSD $ 1,638.26 $ 1,638.26 3/1/2020 12/31/9999 33676 CLOSE MULT VSD W/RESECTION $ 1,704.56 $ 1,704.56 3/1/2020 12/31/9999 33677 CL MULT VSD W/REM PUL BAND $ 1,771.71 $ 1,771.71 3/1/2020 12/31/9999 33681 REPAIR HEART SEPTUM DEFECT $ 1,513.61 $ 1,513.61 3/1/2020 12/31/9999 33684 REPAIR HEART SEPTUM DEFECT $ 1,546.69 $ 1,546.69 3/1/2020 12/31/9999 33688 REPAIR HEART SEPTUM DEFECT $ 1,554.02 $ 1,554.02 3/1/2020 12/31/9999 33690 REINFORCE PULMONARY ARTERY $ 953.15 $ 953.15 3/1/2020 12/31/9999 33692 REPAIR OF HEART DEFECTS $ 1,461.20 $ 1,461.20 3/1/2020 12/31/9999 33694 REPAIR OF HEART DEFECTS $ 1,646.06 $ 1,646.06 3/1/2020 12/31/9999 33697 REPAIR OF HEART DEFECTS $ 1,771.38 $ 1,771.38 3/1/2020 12/31/9999 33702 REPAIR OF HEART DEFECTS $ 1,267.23 $ 1,267.23 3/1/2020 12/31/9999 33710 REPAIR OF HEART DEFECTS $ 1,530.46 $ 1,530.46 3/1/2020 12/31/9999 33720 REPAIR OF HEART DEFECT $ 1,283.72 $ 1,283.72 3/1/2020 12/31/9999 33722 REPAIR OF HEART DEFECT $ 1,279.75 $ 1,279.75 3/1/2020 12/31/9999 33724 REPAIR VENOUS ANOMALY $ 1,302.92 $ 1,302.92 3/1/2020 12/31/9999 33726 REPAIR PUL VENOUS STENOSIS $ 1,703.47 $ 1,703.47 3/1/2020 12/31/9999 33730 REPAIR HEART-VEIN DEFECT(S) $ 1,624.34 $ 1,624.34 3/1/2020 12/31/9999 33732 REPAIR HEART-VEIN DEFECT $ 1,354.10 $ 1,354.10 3/1/2020 12/31/9999 33735 REVISION OF HEART CHAMBER $ 1,031.14 $ 1,031.14 3/1/2020 12/31/9999 33736 REVISION OF HEART CHAMBER $ 1,149.63 $ 1,149.63 3/1/2020 12/31/9999 33737 REVISION OF HEART CHAMBER $ 1,072.14 $ 1,072.14 3/1/2020 12/31/9999 33750 MAJOR VESSEL SHUNT $ 1,078.46 $ 1,078.46 3/1/2020 12/31/9999 33755 MAJOR VESSEL SHUNT $ 1,066.12 $ 1,066.12 3/1/2020 12/31/9999 33762 MAJOR VESSEL SHUNT $ 1,064.29 $ 1,064.29 3/1/2020 12/31/9999 33764 MAJOR VESSEL SHUNT & GRAFT $ 1,049.04 $ 1,049.04 3/1/2020 12/31/9999 33766 MAJOR VESSEL SHUNT $ 1,153.67 $ 1,153.67 3/1/2020 12/31/9999 33767 MAJOR VESSEL SHUNT $ 1,168.72 $ 1,168.72 3/1/2020 12/31/9999 33768 CAVOPULMONARY SHUNTING $ 356.74 $ 356.74 3/1/2020 12/31/9999 33770 REPAIR GREAT VESSELS DEFECT $ 1,778.00 $ 1,778.00 3/1/2020 12/31/9999 33771 REPAIR GREAT VESSELS DEFECT $ 1,823.09 $ 1,823.09 3/1/2020 12/31/9999 33774 REPAIR GREAT VESSELS DEFECT $ 1,497.35 $ 1,497.35 3/1/2020 12/31/9999 33775 REPAIR GREAT VESSELS DEFECT $ 1,557.80 $ 1,557.80 3/1/2020 12/31/9999 33776 REPAIR GREAT VESSELS DEFECT $ 1,639.06 $ 1,639.06 3/1/2020 12/31/9999 33777 REPAIR GREAT VESSELS DEFECT $ 1,605.79 $ 1,605.79 3/1/2020 12/31/9999 33778 REPAIR GREAT VESSELS DEFECT $ 1,973.84 $ 1,973.84 3/1/2020 12/31/9999 33779 REPAIR GREAT VESSELS DEFECT $ 1,895.55 $ 1,895.55 3/1/2020 12/31/9999 33780 REPAIR GREAT VESSELS DEFECT $ 1,969.51 $ 1,969.51 3/1/2020 12/31/9999 33781 REPAIR GREAT VESSELS DEFECT $ 1,937.02 $ 1,937.02 3/1/2020 12/31/9999 33782 NIKAIDOH PROC $ 2,087.79 $ 2,087.79 3/1/2020 12/31/9999 33783 NIKAIDOH PROC W/OSTIA IMPLT $ 2,256.78 $ 2,256.78 3/1/2020 12/31/9999 33786 REPAIR ARTERIAL TRUNK $ 1,903.72 $ 1,903.72 3/1/2020 12/31/9999 33788 REVISION OF PULMONARY ARTERY $ 1,284.03 $ 1,284.03 3/1/2020 12/31/9999 33800 AORTIC SUSPENSION $ 805.55 $ 805.55 3/1/2020 12/31/9999 33802 REPAIR VESSEL DEFECT $ 865.82 $ 865.82 3/1/2020 12/31/9999 33803 REPAIR VESSEL DEFECT $ 942.63 $ 942.63 3/1/2020 12/31/9999 33813 REPAIR SEPTAL DEFECT $ 1,066.80 $ 1,066.80 3/1/2020 12/31/9999 33814 REPAIR SEPTAL DEFECT $ 1,259.00 $ 1,259.00 3/1/2020 12/31/9999 33820 REVISE MAJOR VESSEL $ 805.68 $ 805.68 3/1/2020 12/31/9999 33822 REVISE MAJOR VESSEL $ 855.58 $ 855.58 3/1/2020 12/31/9999 33824 REVISE MAJOR VESSEL $ 967.62 $ 967.62 3/1/2020 12/31/9999 33840 REMOVE AORTA CONSTRICTION $ 979.06 $ 979.06 3/1/2020 12/31/9999 33845 REMOVE AORTA CONSTRICTION $ 1,127.79 $ 1,127.79 3/1/2020 12/31/9999 33851 REMOVE AORTA CONSTRICTION $ 1,038.14 $ 1,038.14 3/1/2020 12/31/9999 33852 REPAIR SEPTAL DEFECT $ 1,127.97 $ 1,127.97 3/1/2020 12/31/9999 33853 REPAIR SEPTAL DEFECT $ 1,554.90 $ 1,554.90 3/1/2020 12/31/9999 33858 AS-AORT GRF F/AORTIC DSJ $ 3,026.78 $ 3,026.78 3/1/2020 12/31/9999 33859 AS-AORT GRF F/DS OTH/THN DSJ $ 2,172.89 $ 2,172.89 3/1/2020 12/31/9999 33863 ASCENDING AORTIC GRAFT $ 2,600.75 $ 2,600.75 3/1/2020 12/31/9999 33864 ASCENDING AORTIC GRAFT $ 2,672.44 $ 2,672.44 3/1/2020 12/31/9999 33866 AORTIC HEMIARCH GRAFT $ 917.53 $ 917.53 3/1/2020 12/31/9999 33871 TRANSVRS A-ARCH GRF HYPTHRM $ 2,909.19 $ 2,909.19 3/1/2020 12/31/9999 33875 THORACIC AORTIC GRAFT $ 1,640.71 $ 1,640.71 3/1/2020 12/31/9999 33877 THORACOABDOMINAL GRAFT $ 2,925.25 $ 2,925.25 3/1/2020 12/31/9999 33880 ENDOVASC TAA REPR INCL SUBCL $ 1,730.13 $ 1,730.13 3/1/2020 12/31/9999 33881 ENDOVASC TAA REPR W/O SUBCL $ 1,485.66 $ 1,485.66 3/1/2020 12/31/9999 33883 INSERT ENDOVASC PROSTH TAA $ 1,093.37 $ 1,093.37 3/1/2020 12/31/9999 33884 ENDOVASC PROSTH TAA ADD-ON $ 407.90 $ 407.90 3/1/2020 12/31/9999 33886 ENDOVASC PROSTH DELAYED $ 943.68 $ 943.68 3/1/2020 12/31/9999 33889 ARTERY TRANSPOSE/ENDOVAS TAA $ 809.77 $ 809.77 3/1/2020 12/31/9999 33891 CAR-CAR BP GRFT/ENDOVAS TAA $ 1,032.68 $ 1,032.68 3/1/2020 12/31/9999 33910 REMOVE LUNG ARTERY EMBOLI $ 1,372.54 $ 1,372.54 3/1/2020 12/31/9999 33915 REMOVE LUNG ARTERY EMBOLI $ 1,098.63 $ 1,098.63 3/1/2020 12/31/9999 33916 SURGERY OF GREAT VESSEL $ 1,372.39 $ 1,372.39 3/1/2020 12/31/9999 33917 REPAIR PULMONARY ARTERY $ 1,241.50 $ 1,241.50 3/1/2020 12/31/9999 33920 REPAIR PULMONARY ATRESIA $ 1,502.62 $ 1,502.62 3/1/2020 12/31/9999 33922 TRANSECT PULMONARY ARTERY $ 1,135.56 $ 1,135.56 3/1/2020 12/31/9999 33924 REMOVE PULMONARY SHUNT $ 240.80 $ 240.80 3/1/2020 12/31/9999 33925 RPR PUL ART UNIFOCAL W/O CPB $ 1,461.78 $ 1,461.78 3/1/2020 12/31/9999 33926 REPR PUL ART UNIFOCAL W/CPB $ 1,950.07 $ 1,950.07 3/1/2020 12/31/9999 33935 TRANSPLANTATION HEART/LUNG $ 2,876.70 $ 2,876.70 3/1/2020 12/31/9999 33945 TRANSPLANTATION OF HEART $ 3,835.26 $ 3,835.26 3/1/2020 12/31/9999 33946 ECMO/ECLS INITIATION VENOUS $ 281.93 $ 281.93 3/1/2020 12/31/9999 33947 ECMO/ECLS INITIATION ARTERY $ 308.01 $ 308.01 3/1/2020 12/31/9999 33948 ECMO/ECLS DAILY MGMT-VENOUS $ 217.04 $ 217.04 3/1/2020 12/31/9999 33949 ECMO/ECLS DAILY MGMT ARTERY $ 211.64 $ 211.64 3/1/2020 12/31/9999 33951 ECMO/ECLS INSJ PRPH CANNULA $ 353.89 $ 356.00 3/1/2020 12/31/9999 33952 ECMO/ECLS INSJ PRPH CANNULA $ 344.58 $ 347.28 3/1/2020 12/31/9999 33953 ECMO/ECLS INSJ PRPH CANNULA $ 394.55 $ 396.65 3/1/2020 12/31/9999 33954 ECMO/ECLS INSJ PRPH CANNULA $ 384.03 $ 387.03 3/1/2020 12/31/9999 33955 ECMO/ECLS INSJ CTR CANNULA $ 792.62 $ 795.33 3/1/2020 12/31/9999 33956 ECMO/ECLS INSJ CTR CANNULA $ 749.93 $ 752.94 3/1/2020 12/31/9999 33957 ECMO/ECLS REPOS PERPH CNULA $ 245.13 $ 247.84 3/1/2020 12/31/9999 33958 ECMO/ECLS REPOS PERPH CNULA $ 240.02 $ 242.12 3/1/2020 12/31/9999 33959 ECMO/ECLS REPOS PERPH CNULA $ 287.29 $ 290.00 3/1/2020 12/31/9999 33962 ECMO/ECLS REPOS PERPH CNULA $ 273.45 $ 276.47 3/1/2020 12/31/9999 33963 ECMO/ECLS REPOS PERPH CNULA $ 485.75 $ 488.46 3/1/2020 12/31/9999 33964 ECMO/ECLS REPOS PERPH CNULA $ 493.50 $ 495.60 3/1/2020 12/31/9999 33965 ECMO/ECLS RMVL PERPH CANNULA $ 247.84 $ 245.13 3/1/2020 12/31/9999 33966 ECMO/ECLS RMVL PRPH CANNULA $ 277.74 $ 274.73 3/1/2020 12/31/9999 33967 INSERT I-AORT PERCUT DEVICE $ 228.61 $ 228.61 3/1/2020 12/31/9999 33968 REMOVE AORTIC ASSIST DEVICE $ 29.37 $ 29.37 3/1/2020 12/31/9999 33969 ECMO/ECLS RMVL PERPH CANNULA $ 294.19 $ 296.59 3/1/2020 12/31/9999 33970 AORTIC CIRCULATION ASSIST $ 307.50 $ 307.50 3/1/2020 12/31/9999 33971 AORTIC CIRCULATION ASSIST $ 588.75 $ 588.75 3/1/2020 12/31/9999 33973 INSERT BALLOON DEVICE $ 448.09 $ 448.09 3/1/2020 12/31/9999 33974 REMOVE INTRA-AORTIC BALLOON $ 749.74 $ 749.74 3/1/2020 12/31/9999 33975 IMPLANT VENTRICULAR DEVICE $ 928.67 $ 928.67 3/1/2020 12/31/9999 33976 IMPLANT VENTRICULAR DEVICE $ 1,031.25 $ 1,031.25 3/1/2020 12/31/9999 33977 REMOVE VENTRICULAR DEVICE $ 993.85 $ 993.85 3/1/2020 12/31/9999 33978 REMOVE VENTRICULAR DEVICE $ 1,095.20 $ 1,095.20 3/1/2020 12/31/9999 33979 INSERT INTRACORPOREAL DEVICE $ 2,036.59 $ 2,036.59 3/1/2020 12/31/9999 33980 REMOVE INTRACORPOREAL DEVICE $ 2,987.60 $ 2,987.60 3/1/2020 12/31/9999 33981 REPLACE VAD PUMP EXT $ 803.34 $ 803.34 3/1/2020 12/31/9999 33982 REPLACE VAD INTRA W/O BP $ 1,580.66 $ 1,580.66 3/1/2020 12/31/9999 33983 REPLACE VAD INTRA W/BP $ 1,580.66 $ 1,580.66 3/1/2020 12/31/9999 33984 ECMO/ECLS RMVL PRPH CANNULA $ 287.82 $ 290.82 3/1/2020 12/31/9999 33985 ECMO/ECLS RMVL CTR CANNULA $ 547.83 $ 550.54 3/1/2020 12/31/9999 33986 ECMO/ECLS RMVL CTR CANNULA $ 521.92 $ 524.94 3/1/2020 12/31/9999 33987 ARTERY EXPOS/GRAFT ARTERY $ 219.21 $ 219.21 3/1/2020 12/31/9999 33988 INSERTION OF LEFT HEART VENT $ 665.53 $ 668.83 3/1/2020 12/31/9999 33989 REMOVAL OF LEFT HEART VENT $ 439.24 $ 442.25 3/1/2020 12/31/9999 33990 INSERT VAD ARTERY ACCESS $ 362.34 $ 362.34 3/1/2020 12/31/9999 33991 INSERT VAD ART&VEIN ACCESS $ 527.99 $ 527.99 3/1/2020 12/31/9999 33992 REMOVE VAD DIFFERENT SESSION $ 172.44 $ 172.44 3/1/2020 12/31/9999 33993 REPOSITION VAD DIFF SESSION $ 151.42 $ 151.42 3/1/2020 12/31/9999 34001 REMOVAL OF ARTERY CLOT $ 802.79 $ 802.79 3/1/2020 12/31/9999 34051 REMOVAL OF ARTERY CLOT $ 803.57 $ 803.57 3/1/2020 12/31/9999 34101 REMOVAL OF ARTERY CLOT $ 510.43 $ 510.43 3/1/2020 12/31/9999 34111 REMOVAL OF ARM ARTERY CLOT $ 510.23 $ 510.23 3/1/2020 12/31/9999 34151 REMOVAL OF ARTERY CLOT $ 1,184.14 $ 1,184.14 3/1/2020 12/31/9999 34201 REMOVAL OF ARTERY CLOT $ 835.28 $ 835.28 3/1/2020 12/31/9999 34203 REMOVAL OF LEG ARTERY CLOT $ 817.06 $ 817.06 3/1/2020 12/31/9999 34401 REMOVAL OF VEIN CLOT $ 1,219.24 $ 1,219.24 3/1/2020 12/31/9999 34421 REMOVAL OF VEIN CLOT $ 618.64 $ 618.64 3/1/2020 12/31/9999 34451 REMOVAL OF VEIN CLOT $ 1,278.55 $ 1,278.55 3/1/2020 12/31/9999 34471 REMOVAL OF VEIN CLOT $ 896.55 $ 896.55 3/1/2020 12/31/9999 34490 REMOVAL OF VEIN CLOT $ 513.01 $ 513.01 3/1/2020 12/31/9999 34501 REPAIR VALVE FEMORAL VEIN $ 795.41 $ 795.41 3/1/2020 12/31/9999 34502 RECONSTRUCT VENA CAVA $ 1,288.88 $ 1,288.88 3/1/2020 12/31/9999 34510 TRANSPOSITION OF VEIN VALVE $ 904.52 $ 904.52 3/1/2020 12/31/9999 34520 CROSS-OVER VEIN GRAFT $ 868.73 $ 868.73 3/1/2020 12/31/9999 34530 LEG VEIN FUSION $ 816.13 $ 816.13 3/1/2020 12/31/9999 34701 EVASC RPR A-AO NDGFT $ 1,077.30 $ 1,077.30 3/1/2020 12/31/9999 34702 EVASC RPR A-AO NDGFT RPT $ 1,610.79 $ 1,610.79 3/1/2020 12/31/9999 34703 EVASC RPR A-UNILAC NDGFT $ 1,210.44 $ 1,210.44 3/1/2020 12/31/9999 34704 EVASC RPR A-UNILAC NDGFT RPT $ 2,016.01 $ 2,016.01 3/1/2020 12/31/9999 34705 EVAC RPR A-BIILIAC NDGFT $ 1,336.68 $ 1,336.68 3/1/2020 12/31/9999 34706 EVASC RPR A-BIILIAC RPT $ 2,012.11 $ 2,012.11 3/1/2020 12/31/9999 34707 EVASC RPR ILIO-ILIAC NDGFT $ 1,004.61 $ 1,004.61 3/1/2020 12/31/9999 34708 EVASC RPR ILIO-ILIAC RPT $ 1,617.77 $ 1,617.77 3/1/2020 12/31/9999 34709 PLMT XTN PROSTH EVASC RPR $ 282.51 $ 282.51 3/1/2020 12/31/9999 34710 DLYD PLMT XTN PROSTH 1ST VSL $ 700.79 $ 700.79 3/1/2020 12/31/9999 34711 DLYD PLMT XTN PROSTH EA ADDL $ 260.78 $ 260.78 3/1/2020 12/31/9999 34712 TCAT DLVR ENHNCD FIXJ DEV $ 600.26 $ 600.26 3/1/2020 12/31/9999 34713 PERQ ACCESS & CLSR FEM ART $ 112.86 $ 112.86 3/1/2020 12/31/9999 34714 OPN FEM ART EXPOS CNDT CRTJ $ 237.18 $ 237.18 3/1/2020 12/31/9999 34715 OPN AX/SUBCLA ART EXPOS $ 265.41 $ 265.41 3/1/2020 12/31/9999 34716 OPN AX/SUBCLA ART EXPOS CNDT $ 329.13 $ 329.13 3/1/2020 12/31/9999 34717 EVASC RPR A-ILIAC NDGFT $ 397.76 $ 397.76 3/1/2020 12/31/9999 34718 EVASC RPR N/A A-ILIAC NDGFT $ 1,108.24 $ 1,108.24 3/1/2020 12/31/9999 34808 ENDOVAS ILIAC A DEVICE ADDON $ 177.68 $ 177.68 3/1/2020 12/31/9999 34812 OPN FEM ART EXPOS $ 293.90 $ 293.90 3/1/2020 12/31/9999 34813 FEMORAL ENDOVAS GRAFT ADD-ON $ 204.37 $ 204.37 3/1/2020 12/31/9999 34820 OPN ILIAC ART EXPOS $ 422.06 $ 422.06 3/1/2020 12/31/9999 34830 OPEN AORTIC TUBE PROSTH REPR $ 1,554.93 $ 1,554.93 3/1/2020 12/31/9999 34831 OPEN AORTOILIAC PROSTH REPR $ 1,648.82 $ 1,648.82 3/1/2020 12/31/9999 34832 OPEN AORTOFEMOR PROSTH REPR $ 1,670.93 $ 1,670.93 3/1/2020 12/31/9999 34833 OPN ILAC ART EXPOS CNDT CRTJ $ 524.82 $ 524.82 3/1/2020 12/31/9999 34834 OPN BRACH ART EXPOS $ 237.75 $ 237.75 3/1/2020 12/31/9999 34841 ENDOVASC VISC AORTA 1 GRAFT $ 601.67 $ 601.67 3/1/2020 12/31/9999 34842 ENDOVASC VISC AORTA 2 GRAFT $ 601.67 $ 601.67 3/1/2020 12/31/9999 34843 ENDOVASC VISC AORTA 3 GRAFT $ 601.67 $ 601.67 3/1/2020 12/31/9999 34844 ENDOVASC VISC AORTA 4 GRAFT $ 601.67 $ 601.67 3/1/2020 12/31/9999 34845 VISC & INFRAREN ABD 1 PROSTH $ 601.67 $ 601.67 3/1/2020 12/31/9999 34846 VISC & INFRAREN ABD 2 PROSTH $ 601.67 $ 601.67 3/1/2020 12/31/9999 34847 VISC & INFRAREN ABD 3 PROSTH $ 601.67 $ 601.67 3/1/2020 12/31/9999 34848 VISC & INFRAREN ABD 4+ PROST $ 601.67 $ 601.67 3/1/2020 12/31/9999 35001 REPAIR DEFECT OF ARTERY $ 961.86 $ 961.86 3/1/2020 12/31/9999 35002 REPAIR ARTERY RUPTURE NECK $ 1,016.06 $ 1,016.06 3/1/2020 12/31/9999 35005 REPAIR DEFECT OF ARTERY $ 883.54 $ 883.54 3/1/2020 12/31/9999 35011 REPAIR DEFECT OF ARTERY $ 844.76 $ 844.76 3/1/2020 12/31/9999 35013 REPAIR ARTERY RUPTURE ARM $ 1,048.31 $ 1,048.31 3/1/2020 12/31/9999 35021 REPAIR DEFECT OF ARTERY $ 1,027.18 $ 1,027.18 3/1/2020 12/31/9999 35022 REPAIR ARTERY RUPTURE CHEST $ 1,162.36 $ 1,162.36 3/1/2020 12/31/9999 35045 REPAIR DEFECT OF ARM ARTERY $ 821.43 $ 821.43 3/1/2020 12/31/9999 35081 REPAIR DEFECT OF ARTERY $ 1,474.15 $ 1,474.15 3/1/2020 12/31/9999 35082 REPAIR ARTERY RUPTURE AORTA $ 1,851.74 $ 1,851.74 3/1/2020 12/31/9999 35091 REPAIR DEFECT OF ARTERY $ 1,560.07 $ 1,560.07 3/1/2020 12/31/9999 35092 REPAIR ARTERY RUPTURE AORTA $ 2,212.99 $ 2,212.99 3/1/2020 12/31/9999 35102 REPAIR DEFECT OF ARTERY $ 1,599.74 $ 1,599.74 3/1/2020 12/31/9999 35103 REPAIR ARTERY RUPTURE AORTA $ 1,913.89 $ 1,913.89 3/1/2020 12/31/9999 35111 REPAIR DEFECT OF ARTERY $ 1,177.93 $ 1,177.93 3/1/2020 12/31/9999 35112 REPAIR ARTERY RUPTURE SPLEEN $ 1,443.96 $ 1,443.96 3/1/2020 12/31/9999 35121 REPAIR DEFECT OF ARTERY $ 1,399.24 $ 1,399.24 3/1/2020 12/31/9999 35122 REPAIR ARTERY RUPTURE BELLY $ 1,675.16 $ 1,675.16 3/1/2020 12/31/9999 35131 REPAIR DEFECT OF ARTERY $ 1,192.50 $ 1,192.50 3/1/2020 12/31/9999 35132 REPAIR ARTERY RUPTURE GROIN $ 1,442.23 $ 1,442.23 3/1/2020 12/31/9999 35141 REPAIR DEFECT OF ARTERY $ 945.77 $ 945.77 3/1/2020 12/31/9999 35142 REPAIR ARTERY RUPTURE THIGH $ 1,131.59 $ 1,131.59 3/1/2020 12/31/9999 35151 REPAIR DEFECT OF ARTERY $ 1,066.74 $ 1,066.74 3/1/2020 12/31/9999 35152 REPAIR RUPTD POPLITEAL ART $ 1,238.93 $ 1,238.93 3/1/2020 12/31/9999 35180 REPAIR BLOOD VESSEL LESION $ 707.42 $ 707.42 3/1/2020 12/31/9999 35182 REPAIR BLOOD VESSEL LESION $ 1,455.20 $ 1,455.20 3/1/2020 12/31/9999 35184 REPAIR BLOOD VESSEL LESION $ 857.50 $ 857.50 3/1/2020 12/31/9999 35188 REPAIR BLOOD VESSEL LESION $ 717.94 $ 717.94 3/1/2020 12/31/9999 35189 REPAIR BLOOD VESSEL LESION $ 1,343.86 $ 1,343.86 3/1/2020 12/31/9999 35190 REPAIR BLOOD VESSEL LESION $ 627.28 $ 627.28 3/1/2020 12/31/9999 35201 REPAIR BLOOD VESSEL LESION $ 787.22 $ 787.22 3/1/2020 12/31/9999 35206 REPAIR BLOOD VESSEL LESION $ 643.23 $ 643.23 3/1/2020 12/31/9999 35207 REPAIR BLOOD VESSEL LESION $ 578.80 $ 578.80 3/1/2020 12/31/9999 35211 REPAIR BLOOD VESSEL LESION $ 1,142.96 $ 1,142.96 3/1/2020 12/31/9999 35216 REPAIR BLOOD VESSEL LESION $ 1,594.27 $ 1,594.27 3/1/2020 12/31/9999 35221 REPAIR BLOOD VESSEL LESION $ 1,179.44 $ 1,179.44 3/1/2020 12/31/9999 35226 REPAIR BLOOD VESSEL LESION $ 710.24 $ 710.24 3/1/2020 12/31/9999 35231 REPAIR BLOOD VESSEL LESION $ 986.99 $ 986.99 3/1/2020 12/31/9999 35236 REPAIR BLOOD VESSEL LESION $ 823.67 $ 823.67 3/1/2020 12/31/9999 35241 REPAIR BLOOD VESSEL LESION $ 1,193.70 $ 1,193.70 3/1/2020 12/31/9999 35246 REPAIR BLOOD VESSEL LESION $ 1,298.60 $ 1,298.60 3/1/2020 12/31/9999 35251 REPAIR BLOOD VESSEL LESION $ 1,402.98 $ 1,402.98 3/1/2020 12/31/9999 35256 REPAIR BLOOD VESSEL LESION $ 866.30 $ 866.30 3/1/2020 12/31/9999 35261 REPAIR BLOOD VESSEL LESION $ 875.06 $ 875.06 3/1/2020 12/31/9999 35266 REPAIR BLOOD VESSEL LESION $ 725.46 $ 725.46 3/1/2020 12/31/9999 35271 REPAIR BLOOD VESSEL LESION $ 1,141.28 $ 1,141.28 3/1/2020 12/31/9999 35276 REPAIR BLOOD VESSEL LESION $ 1,198.12 $ 1,198.12 3/1/2020 12/31/9999 35281 REPAIR BLOOD VESSEL LESION $ 1,339.72 $ 1,339.72 3/1/2020 12/31/9999 35286 REPAIR BLOOD VESSEL LESION $ 794.12 $ 794.12 3/1/2020 12/31/9999 35301 RECHANNELING OF ARTERY $ 891.53 $ 891.53 3/1/2020 12/31/9999 35302 RECHANNELING OF ARTERY $ 949.31 $ 949.31 3/1/2020 12/31/9999 35303 RECHANNELING OF ARTERY $ 1,044.90 $ 1,044.90 3/1/2020 12/31/9999 35304 RECHANNELING OF ARTERY $ 1,086.72 $ 1,086.72 3/1/2020 12/31/9999 35305 RECHANNELING OF ARTERY $ 1,043.73 $ 1,043.73 3/1/2020 12/31/9999 35306 RECHANNELING OF ARTERY $ 391.52 $ 391.52 3/1/2020 12/31/9999 35311 RECHANNELING OF ARTERY $ 1,278.88 $ 1,278.88 3/1/2020 12/31/9999 35321 RECHANNELING OF ARTERY $ 757.90 $ 757.90 3/1/2020 12/31/9999 35331 RECHANNELING OF ARTERY $ 1,252.06 $ 1,252.06 3/1/2020 12/31/9999 35341 RECHANNELING OF ARTERY $ 1,178.72 $ 1,178.72 3/1/2020 12/31/9999 35351 RECHANNELING OF ARTERY $ 1,096.12 $ 1,096.12 3/1/2020 12/31/9999 35355 RECHANNELING OF ARTERY $ 889.88 $ 889.88 3/1/2020 12/31/9999 35361 RECHANNELING OF ARTERY $ 1,349.05 $ 1,349.05 3/1/2020 12/31/9999 35363 RECHANNELING OF ARTERY $ 1,467.86 $ 1,467.86 3/1/2020 12/31/9999 35371 RECHANNELING OF ARTERY $ 700.63 $ 700.63 3/1/2020 12/31/9999 35372 RECHANNELING OF ARTERY $ 841.38 $ 841.38 3/1/2020 12/31/9999 35390 REOPERATION CAROTID ADD-ON $ 137.89 $ 137.89 3/1/2020 12/31/9999 35500 HARVEST VEIN FOR BYPASS $ 276.12 $ 276.12 3/1/2020 12/31/9999 35501 ART BYP GRFT IPSILAT CAROTID $ 1,328.05 $ 1,328.05 3/1/2020 12/31/9999 35506 ART BYP GRFT SUBCLAV-CAROTID $ 1,130.70 $ 1,130.70 3/1/2020 12/31/9999 35508 ART BYP GRFT CAROTID-VERTBRL $ 1,168.02 $ 1,168.02 3/1/2020 12/31/9999 35509 ART BYP GRFT CONTRAL CAROTID $ 1,276.81 $ 1,276.81 3/1/2020 12/31/9999 35510 ART BYP GRFT CAROTID-BRCHIAL $ 1,072.26 $ 1,072.26 3/1/2020 12/31/9999 35511 ART BYP GRFT SUBCLAV-SUBCLAV $ 1,007.79 $ 1,007.79 3/1/2020 12/31/9999 35512 ART BYP GRFT SUBCLAV-BRCHIAL $ 1,045.51 $ 1,045.51 3/1/2020 12/31/9999 35515 ART BYP GRFT SUBCLAV-VERTBRL $ 1,129.24 $ 1,129.24 3/1/2020 12/31/9999 35516 ART BYP GRFT SUBCLAV-AXILARY $ 1,034.54 $ 1,034.54 3/1/2020 12/31/9999 35518 ART BYP GRFT AXILLARY-AXILRY $ 1,025.96 $ 1,025.96 3/1/2020 12/31/9999 35521 ART BYP GRFT AXILL-FEMORAL $ 1,079.85 $ 1,079.85 3/1/2020 12/31/9999 35522 ART BYP GRFT AXILL-BRACHIAL $ 1,021.11 $ 1,021.11 3/1/2020 12/31/9999 35523 ART BYP GRFT BRCHL-ULNR-RDL $ 1,080.48 $ 1,080.48 3/1/2020 12/31/9999 35525 ART BYP GRFT BRACHIAL-BRCHL $ 958.30 $ 958.30 3/1/2020 12/31/9999 35526 ART BYP GRFT AOR/CAROT/INNOM $ 1,413.79 $ 1,413.79 3/1/2020 12/31/9999 35531 ART BYP GRFT AORCEL/AORMESEN $ 1,725.51 $ 1,725.51 3/1/2020 12/31/9999 35533 ART BYP GRFT AXILL/FEM/FEM $ 1,335.21 $ 1,335.21 3/1/2020 12/31/9999 35535 ART BYP GRFT HEPATORENAL $ 1,710.95 $ 1,710.95 3/1/2020 12/31/9999 35536 ART BYP GRFT SPLENORENAL $ 1,487.86 $ 1,487.86 3/1/2020 12/31/9999 35537 ART BYP GRFT AORTOILIAC $ 1,845.48 $ 1,845.48 3/1/2020 12/31/9999 35538 ART BYP GRFT AORTOBI-ILIAC $ 2,071.39 $ 2,071.39 3/1/2020 12/31/9999 35539 ART BYP GRFT AORTOFEMORAL $ 1,921.75 $ 1,921.75 3/1/2020 12/31/9999 35540 ART BYP GRFT AORTBIFEMORAL $ 2,152.66 $ 2,152.66 3/1/2020 12/31/9999 35556 ART BYP GRFT FEM-POPLITEAL $ 1,178.90 $ 1,178.90 3/1/2020 12/31/9999 35558 ART BYP GRFT FEM-FEMORAL $ 1,043.12 $ 1,043.12 3/1/2020 12/31/9999 35560 ART BYP GRFT AORTORENAL $ 1,518.51 $ 1,518.51 3/1/2020 12/31/9999 35563 ART BYP GRFT ILIOILIAC $ 1,163.83 $ 1,163.83 3/1/2020 12/31/9999 35565 ART BYP GRFT ILIOFEMORAL $ 1,127.08 $ 1,127.08 3/1/2020 12/31/9999 35566 ART BYP FEM-ANT-POST TIB/PRL $ 1,415.21 $ 1,415.21 3/1/2020 12/31/9999 35570 ART BYP TIBIAL-TIB/PERONEAL $ 1,321.31 $ 1,321.31 3/1/2020 12/31/9999 35571 ART BYP POP-TIBL-PRL-OTHER $ 1,143.56 $ 1,143.56 3/1/2020 12/31/9999 35572 HARVEST FEMOROPOPLITEAL VEIN $ 298.77 $ 298.77 3/1/2020 12/31/9999 35583 VEIN BYP GRFT FEM-POPLITEAL $ 1,217.64 $ 1,217.64 3/1/2020 12/31/9999 35585 VEIN BYP FEM-TIBIAL PERONEAL $ 1,425.78 $ 1,425.78 3/1/2020 12/31/9999 35587 VEIN BYP POP-TIBL PERONEAL $ 1,179.01 $ 1,179.01 3/1/2020 12/31/9999 35600 HARVEST ART FOR CABG ADD-ON $ 219.75 $ 219.75 3/1/2020 12/31/9999 35601 ART BYP COMMON IPSI CAROTID $ 1,227.81 $ 1,227.81 3/1/2020 12/31/9999 35606 ART BYP CAROTID-SUBCLAVIAN $ 1,000.01 $ 1,000.01 3/1/2020 12/31/9999 35612 ART BYP SUBCLAV-SUBCLAVIAN $ 781.29 $ 781.29 3/1/2020 12/31/9999 35616 ART BYP SUBCLAV-AXILLARY $ 957.63 $ 957.63 3/1/2020 12/31/9999 35621 ART BYP AXILLARY-FEMORAL $ 944.70 $ 944.70 3/1/2020 12/31/9999 35623 ART BYP AXILLARY-POP-TIBIAL $ 1,159.50 $ 1,159.50 3/1/2020 12/31/9999 35626 ART BYP AORSUBCL/CAROT/INNOM $ 1,330.47 $ 1,330.47 3/1/2020 12/31/9999 35631 ART BYP AOR-CELIAC-MSN-RENAL $ 1,587.72 $ 1,587.72 3/1/2020 12/31/9999 35632 ART BYP ILIO-CELIAC $ 1,624.29 $ 1,624.29 3/1/2020 12/31/9999 35633 ART BYP ILIO-MESENTERIC $ 1,754.11 $ 1,754.11 3/1/2020 12/31/9999 35634 ART BYP ILIORENAL $ 1,589.62 $ 1,589.62 3/1/2020 12/31/9999 35636 ART BYP SPENORENAL $ 1,408.93 $ 1,408.93 3/1/2020 12/31/9999 35637 ART BYP AORTOILIAC $ 1,457.95 $ 1,457.95 3/1/2020 12/31/9999 35638 ART BYP AORTOBI-ILIAC $ 1,489.35 $ 1,489.35 3/1/2020 12/31/9999 35642 ART BYP CAROTID-VERTEBRAL $ 880.69 $ 880.69 3/1/2020 12/31/9999 35645 ART BYP SUBCLAV-VERTEBRL $ 835.73 $ 835.73 3/1/2020 12/31/9999 35646 ART BYP AORTOBIFEMORAL $ 1,470.38 $ 1,470.38 3/1/2020 12/31/9999 35647 ART BYP AORTOFEMORAL $ 1,330.86 $ 1,330.86 3/1/2020 12/31/9999 35650 ART BYP AXILLARY-AXILLARY $ 909.80 $ 909.80 3/1/2020 12/31/9999 35654 ART BYP AXILL-FEM-FEMORAL $ 1,174.74 $ 1,174.74 3/1/2020 12/31/9999 35656 ART BYP FEMORAL-POPLITEAL $ 925.37 $ 925.37 3/1/2020 12/31/9999 35661 ART BYP FEMORAL-FEMORAL $ 926.00 $ 926.00 3/1/2020 12/31/9999 35663 ART BYP ILIOILIAC $ 1,074.28 $ 1,074.28 3/1/2020 12/31/9999 35665 ART BYP ILIOFEMORAL $ 1,006.22 $ 1,006.22 3/1/2020 12/31/9999 35666 ART BYP FEM-ANT-POST TIB/PRL $ 1,084.34 $ 1,084.34 3/1/2020 12/31/9999 35671 ART BYP POP-TIBL-PRL-OTHER $ 955.23 $ 955.23 3/1/2020 12/31/9999 35681 COMPOSITE BYP GRFT PROS&VEIN $ 68.95 $ 68.95 3/1/2020 12/31/9999 35682 COMPOSITE BYP GRFT 2 VEINS $ 307.82 $ 307.82 3/1/2020 12/31/9999 35683 COMPOSITE BYP GRFT 3/> SEGMT $ 363.10 $ 363.10 3/1/2020 12/31/9999 35685 BYPASS GRAFT PATENCY/PATCH $ 172.87 $ 172.87 3/1/2020 12/31/9999 35686 BYPASS GRAFT/AV FIST PATENCY $ 144.62 $ 144.62 3/1/2020 12/31/9999 35691 ART TRNSPOSJ VERTBRL CAROTID $ 842.18 $ 842.18 3/1/2020 12/31/9999 35693 ART TRNSPOSJ SUBCLAVIAN $ 745.82 $ 745.82 3/1/2020 12/31/9999 35694 ART TRNSPOSJ SUBCLAV CAROTID $ 871.15 $ 871.15 3/1/2020 12/31/9999 35695 ART TRNSPOSJ CAROTID SUBCLAV $ 907.32 $ 907.32 3/1/2020 12/31/9999 35697 REIMPLANT ARTERY EACH $ 128.78 $ 128.78 3/1/2020 12/31/9999 35700 REOPERATION BYPASS GRAFT $ 132.52 $ 132.52 3/1/2020 12/31/9999 35701 EXPL N/FLWD SURG NECK ART $ 449.91 $ 449.91 3/1/2020 12/31/9999 35702 EXPL N/FLWD SURG UXTR ART $ 365.61 $ 365.61 3/1/2020 12/31/9999 35703 EXPL N/FLWD SURG LXTR ART $ 370.95 $ 370.95 3/1/2020 12/31/9999 35800 EXPLORE NECK VESSELS $ 397.40 $ 397.40 3/1/2020 12/31/9999 35820 EXPLORE CHEST VESSELS $ 1,566.59 $ 1,566.59 3/1/2020 12/31/9999 35840 EXPLORE ABDOMINAL VESSELS $ 520.22 $ 520.22 3/1/2020 12/31/9999 35860 EXPLORE LIMB VESSELS $ 335.74 $ 335.74 3/1/2020 12/31/9999 35870 REPAIR VESSEL GRAFT DEFECT $ 1,091.58 $ 1,091.58 3/1/2020 12/31/9999 35875 REMOVAL OF CLOT IN GRAFT $ 501.98 $ 501.98 3/1/2020 12/31/9999 35876 REMOVAL OF CLOT IN GRAFT $ 805.27 $ 805.27 3/1/2020 12/31/9999 35879 REVISE GRAFT W/VEIN $ 787.94 $ 787.94 3/1/2020 12/31/9999 35881 REVISE GRAFT W/VEIN $ 876.05 $ 876.05 3/1/2020 12/31/9999 35883 REVISE GRAFT W/NONAUTO GRAFT $ 1,022.74 $ 1,022.74 3/1/2020 12/31/9999 35884 REVISE GRAFT W/VEIN $ 1,079.20 $ 1,079.20 3/1/2020 12/31/9999 35901 EXCISION GRAFT NECK $ 420.00 $ 420.00 3/1/2020 12/31/9999 35903 EXCISION GRAFT EXTREMITY $ 475.18 $ 475.18 3/1/2020 12/31/9999 35905 EXCISION GRAFT THORAX $ 1,485.49 $ 1,485.49 3/1/2020 12/31/9999 35907 EXCISION GRAFT ABDOMEN $ 1,637.16 $ 1,637.16 3/1/2020 12/31/9999 36000 PLACE NEEDLE IN VEIN $ 7.98 $ 20.02 3/1/2020 12/31/9999 36002 PSEUDOANEURYSM INJECTION TRT $ 92.98 $ 137.04 3/1/2020 12/31/9999 36005 INJECTION EXT VENOGRAPHY $ 42.04 $ 267.94 3/1/2020 12/31/9999 36010 PLACE CATHETER IN VEIN $ 105.87 $ 464.54 3/1/2020 12/31/9999 36011 PLACE CATHETER IN VEIN $ 136.88 $ 733.77 3/1/2020 12/31/9999 36012 PLACE CATHETER IN VEIN $ 154.29 $ 691.26 3/1/2020 12/31/9999 36013 PLACE CATHETER IN ARTERY $ 110.90 $ 637.01 3/1/2020 12/31/9999 36014 PLACE CATHETER IN ARTERY $ 134.10 $ 665.49 3/1/2020 12/31/9999 36015 PLACE CATHETER IN ARTERY $ 155.05 $ 730.21 3/1/2020 12/31/9999 36100 ESTABLISH ACCESS TO ARTERY $ 135.80 $ 425.73 3/1/2020 12/31/9999 36140 INTRO NDL ICATH UPR/LXTR ART $ 88.20 $ 387.23 3/1/2020 12/31/9999 36160 ESTABLISH ACCESS TO AORTA $ 114.64 $ 426.90 3/1/2020 12/31/9999 36200 PLACE CATHETER IN AORTA $ 131.87 $ 518.45 3/1/2020 12/31/9999 36215 PLACE CATHETER IN ARTERY $ 208.96 $ 911.61 3/1/2020 12/31/9999 36216 PLACE CATHETER IN ARTERY $ 235.58 $ 996.68 3/1/2020 12/31/9999 36217 PLACE CATHETER IN ARTERY $ 282.04 $ 1,618.60 3/1/2020 12/31/9999 36218 PLACE CATHETER IN ARTERY $ 44.95 $ 153.33 3/1/2020 12/31/9999 36221 PLACE CATH THORACIC AORTA $ 179.85 $ 950.07 3/1/2020 12/31/9999 36222 PLACE CATH CAROTID/INOM ART $ 243.94 $ 1,177.68 3/1/2020 12/31/9999 36223 PLACE CATH CAROTID/INOM ART $ 263.75 $ 1,288.38 3/1/2020 12/31/9999 36224 PLACE CATH CAROTD ART $ 287.49 $ 1,399.69 3/1/2020 12/31/9999 36225 PLACE CATH SUBCLAVIAN ART $ 262.71 $ 1,279.06 3/1/2020 12/31/9999 36226 PLACE CATH VERTEBRAL ART $ 288.05 $ 1,426.76 3/1/2020 12/31/9999 36227 PLACE CATH XTRNL CAROTID $ 91.21 $ 206.69 3/1/2020 12/31/9999 36228 PLACE CATH INTRACRANIAL ART $ 185.84 $ 979.52 3/1/2020 12/31/9999 36245 INS CATH ABD/L-EXT ART 1ST $ 215.06 $ 1,004.36 3/1/2020 12/31/9999 36246 INS CATH ABD/L-EXT ART 2ND $ 234.94 $ 988.40 3/1/2020 12/31/9999 36247 INS CATH ABD/L-EXT ART 3RD $ 279.71 $ 1,547.24 3/1/2020 12/31/9999 36248 INS CATH ABD/L-EXT ART ADDL $ 44.95 $ 132.18 3/1/2020 12/31/9999 36251 INS CATH REN ART 1ST UNILAT $ 166.34 $ 865.46 3/1/2020 12/31/9999 36252 INS CATH REN ART 1ST BILAT $ 216.68 $ 950.06 3/1/2020 12/31/9999 36253 INS CATH REN ART 2ND+ UNILAT $ 231.48 $ 1,324.04 3/1/2020 12/31/9999 36254 INS CATH REN ART 2ND+ BILAT $ 249.73 $ 1,377.55 3/1/2020 12/31/9999 36260 INSERTION OF INFUSION PUMP $ 478.22 $ 478.22 3/1/2020 12/31/9999 36261 REVISION OF INFUSION PUMP $ 290.50 $ 290.50 3/1/2020 12/31/9999 36262 REMOVAL OF INFUSION PUMP $ 220.85 $ 220.85 3/1/2020 12/31/9999 36400 BL DRAW < 3 YRS FEM/JUGULAR $ 15.03 $ 20.90 3/1/2020 12/31/9999 36405 BL DRAW <3 YRS SCALP VEIN $ 13.09 $ 18.96 3/1/2020 12/31/9999 36406 BL DRAW <3 YRS OTHER VEIN $ 7.68 $ 13.55 3/1/2020 12/31/9999 36410 NON-ROUTINE BL DRAW 3/> YRS $ 7.38 $ 15.03 3/1/2020 12/31/9999 36415 ROUTINE VENIPUNCTURE $ 2.84 $ 2.84 3/1/2020 12/31/9999 36420 VEIN ACCESS CUTDOWN < 1 YR $ 40.83 $ 40.83 3/1/2020 12/31/9999 36425 VEIN ACCESS CUTDOWN > 1 YR $ 32.09 $ 32.09 3/1/2020 12/31/9999 36430 BLOOD TRANSFUSION SERVICE $ 28.82 $ 28.82 3/1/2020 12/31/9999 36440 BL PUSH TRANSFUSE 2 YR/< $ 42.95 $ 42.95 3/1/2020 12/31/9999 36450 BL EXCHANGE/TRANSFUSE NB $ 98.54 $ 98.54 3/1/2020 12/31/9999 36455 BL EXCHANGE/TRANSFUSE NON-NB $ 107.50 $ 107.50 3/1/2020 12/31/9999 36456 PRTL EXCHANGE TRANSFUSE NB $ 96.02 $ 96.02 3/1/2020 12/31/9999 36460 TRANSFUSION SERVICE FETAL $ 281.27 $ 281.27 3/1/2020 12/31/9999 36465 NJX NONCMPND SCLRSNT 1 VEIN $ 104.40 $ 1,365.22 3/1/2020 12/31/9999 36466 NJX NONCMPND SCLRSNT MLT VN $ 132.86 $ 1,426.36 3/1/2020 12/31/9999 36470 NJX SCLRSNT 1 INCMPTNT VEIN $ 56.71 $ 108.41 3/1/2020 12/31/9999 36471 NJX SCLRSNT MLT INCMPTNT VN $ 79.91 $ 134.24 3/1/2020 12/31/9999 36473 ENDOVENOUS MCHNCHEM 1ST VEIN $ 155.37 $ 1,284.09 3/1/2020 12/31/9999 36474 ENDOVENOUS MCHNCHEM ADD-ON $ 77.84 $ 236.54 3/1/2020 12/31/9999 36475 ENDOVENOUS RF 1ST VEIN $ 285.47 $ 1,396.14 3/1/2020 12/31/9999 36476 ENDOVENOUS RF VEIN ADD-ON $ 139.74 $ 303.95 3/1/2020 12/31/9999 36478 ENDOVENOUS LASER 1ST VEIN $ 288.12 $ 1,153.20 3/1/2020 12/31/9999 36479 ENDOVENOUS LASER VEIN ADDON $ 140.63 $ 319.23 3/1/2020 12/31/9999 36481 INSERTION OF CATHETER VEIN $ 345.24 $ 345.24 3/1/2020 12/31/9999 36500 INSERTION OF CATHETER VEIN $ 154.27 $ 154.27 3/1/2020 12/31/9999 36510 INSERTION OF CATHETER VEIN $ 47.79 $ 87.44 3/1/2020 12/31/9999 36511 APHERESIS WBC $ 75.09 $ 75.09 3/1/2020 12/31/9999 36512 APHERESIS RBC $ 76.25 $ 76.25 3/1/2020 12/31/9999 36513 APHERESIS PLATELETS $ 78.65 $ 78.65 3/1/2020 12/31/9999 36514 APHERESIS PLASMA $ 74.50 $ 406.73 3/1/2020 12/31/9999 36516 APHERESIS IMMUNOADS SLCTV $ 52.40 $ 1,703.85 3/1/2020 12/31/9999 36522 PHOTOPHERESIS $ 84.15 $ 1,064.68 3/1/2020 12/31/9999 36550 DECLOTTING BY THROMBOLYTIC AGENT OF IMPL $ 19.03 $ 21.05 3/1/2020 12/31/9999 36555 INSERT NON-TUNNEL CV CATH $ 107.01 $ 219.21 3/1/2020 12/31/9999 36556 INSERT NON-TUNNEL CV CATH $ 101.43 $ 187.50 3/1/2020 12/31/9999 36557 INSERT TUNNELED CV CATH $ 248.96 $ 666.36 3/1/2020 12/31/9999 36558 INSERT TUNNELED CV CATH $ 237.95 $ 644.51 3/1/2020 12/31/9999 36560 INSERT TUNNELED CV CATH $ 294.87 $ 913.21 3/1/2020 12/31/9999 36561 INSERT TUNNELED CV CATH $ 285.17 $ 903.21 3/1/2020 12/31/9999 36563 INSERT TUNNELED CV CATH $ 296.08 $ 913.53 3/1/2020 12/31/9999 36565 INSERT TUNNELED CV CATH $ 281.05 $ 766.04 3/1/2020 12/31/9999 36566 INSERT TUNNELED CV CATH $ 301.05 $ 2,822.57 3/1/2020 12/31/9999 36568 INSJ PICC <5 YR W/O IMAGING $ 81.99 $ 246.49 3/1/2020 12/31/9999 36569 INSJ PICC 5 YR+ W/O IMAGING $ 81.89 $ 214.67 3/1/2020 12/31/9999 36570 INSERT PICVAD CATH $ 262.98 $ 926.27 3/1/2020 12/31/9999 36571 INSERT PICVAD CATH $ 255.89 $ 960.29 3/1/2020 12/31/9999 36572 INSJ PICC RS&I <5 YR $ 83.15 $ 363.41 3/1/2020 12/31/9999 36573 INSJ PICC RS&I 5 YR+ $ 76.66 $ 341.78 3/1/2020 12/31/9999 36575 REPAIR TUNNELED CV CATH $ 32.64 $ 126.93 3/1/2020 12/31/9999 36576 REPAIR TUNNELED CV CATH $ 155.12 $ 286.42 3/1/2020 12/31/9999 36578 REPLACE TUNNELED CV CATH $ 177.28 $ 398.46 3/1/2020 12/31/9999 36580 REPLACE CVAD CATH $ 58.94 $ 183.78 3/1/2020 12/31/9999 36581 REPLACE TUNNELED CV CATH $ 168.02 $ 597.48 3/1/2020 12/31/9999 36582 REPLACE TUNNELED CV CATH $ 246.82 $ 834.32 3/1/2020 12/31/9999 36583 REPLACE TUNNELED CV CATH $ 247.24 $ 834.73 3/1/2020 12/31/9999 36584 COMPL RPLCMT PICC RS&I $ 60.44 $ 180.87 3/1/2020 12/31/9999 36585 REPLACE PICVAD CATH $ 231.77 $ 855.70 3/1/2020 12/31/9999 36589 REMOVAL TUNNELED CV CATH $ 115.40 $ 135.37 3/1/2020 12/31/9999 36590 REMOVAL TUNNELED CV CATH $ 163.64 $ 219.46 3/1/2020 12/31/9999 36593 DECLOT VASCULAR DEVICE $ 28.31 $ 28.31 3/1/2020 12/31/9999 36595 MECH REMOV TUNNELED CV CATH $ 162.58 $ 483.96 3/1/2020 12/31/9999 36596 MECH REMOV TUNNELED CV CATH $ 38.34 $ 108.54 3/1/2020 12/31/9999 36597 REPOSITION VENOUS CATHETER $ 54.22 $ 102.99 3/1/2020 12/31/9999 36598 INJ W/FLUOR EVAL CV DEVICE $ 50.36 $ 91.78 3/1/2020 12/31/9999 36600 WITHDRAWAL OF ARTERIAL BLOOD $ 12.92 $ 24.66 3/1/2020 12/31/9999 36620 INSERTION CATHETER ARTERY $ 42.92 $ 42.92 3/1/2020 12/31/9999 36625 INSERTION CATHETER ARTERY $ 88.69 $ 88.69 3/1/2020 12/31/9999 36640 INSERTION CATHETER ARTERY $ 99.12 $ 99.12 3/1/2020 12/31/9999 36660 INSERTION CATHETER ARTERY $ 56.39 $ 56.39 3/1/2020 12/31/9999 36680 INSERT NEEDLE BONE CAVITY $ 49.73 $ 49.73 3/1/2020 12/31/9999 36800 INSERTION OF CANNULA $ 129.79 $ 129.79 3/1/2020 12/31/9999 36810 INSERTION OF CANNULA $ 175.06 $ 175.06 3/1/2020 12/31/9999 36815 INSERTION OF CANNULA $ 123.44 $ 123.44 3/1/2020 12/31/9999 36818 AV FUSE UPPR ARM CEPHALIC $ 561.35 $ 561.35 3/1/2020 12/31/9999 36819 AV FUSE UPPR ARM BASILIC $ 661.82 $ 661.82 3/1/2020 12/31/9999 36820 AV FUSION/FOREARM VEIN $ 663.97 $ 663.97 3/1/2020 12/31/9999 36821 AV FUSION DIRECT ANY SITE $ 551.53 $ 551.53 3/1/2020 12/31/9999 36823 INSERTION OF CANNULA(S) $ 1,056.35 $ 1,056.35 3/1/2020 12/31/9999 36825 ARTERY-VEIN AUTOGRAFT $ 478.70 $ 478.70 3/1/2020 12/31/9999 36830 ARTERY-VEIN NONAUTOGRAFT $ 548.45 $ 548.45 3/1/2020 12/31/9999 36831 OPEN THROMBECT AV FISTULA $ 378.24 $ 378.24 3/1/2020 12/31/9999 36832 AV FISTULA REVISION OPEN $ 483.45 $ 483.45 3/1/2020 12/31/9999 36833 AV FISTULA REVISION $ 546.38 $ 546.38 3/1/2020 12/31/9999 36835 ARTERY TO VEIN SHUNT $ 377.58 $ 377.58 3/1/2020 12/31/9999 36838 DIST REVAS LIGATION HEMO $ 976.73 $ 976.73 3/1/2020 12/31/9999 36860 EXTERNAL CANNULA DECLOTTING $ 86.03 $ 153.29 3/1/2020 12/31/9999 36861 CANNULA DECLOTTING $ 124.53 $ 124.53 3/1/2020 12/31/9999 36901 INTRO CATH DIALYSIS CIRCUIT $ 130.29 $ 491.45 3/1/2020 12/31/9999 36902 INTRO CATH DIALYSIS CIRCUIT $ 194.15 $ 1,043.16 3/1/2020 12/31/9999 36903 INTRO CATH DIALYSIS CIRCUIT $ 265.77 $ 4,767.93 3/1/2020 12/31/9999 36904 THRMBC/NFS DIALYSIS CIRCUIT $ 305.98 $ 1,521.59 3/1/2020 12/31/9999 36905 THRMBC/NFS DIALYSIS CIRCUIT $ 384.02 $ 1,946.89 3/1/2020 12/31/9999 36906 THRMBC/NFS DIALYSIS CIRCUIT $ 448.10 $ 5,784.81 3/1/2020 12/31/9999 36907 BALO ANGIOP CTR DIALYSIS SEG $ 111.83 $ 624.13 3/1/2020 12/31/9999 36908 STENT PLMT CTR DIALYSIS SEG $ 167.57 $ 2,292.54 3/1/2020 12/31/9999 36909 DIALYSIS CIRCUIT EMBOLJ $ 159.12 $ 1,673.12 3/1/2020 12/31/9999 37140 REVISION OF CIRCULATION $ 1,116.86 $ 1,116.86 3/1/2020 12/31/9999 37145 REVISION OF CIRCULATION $ 1,204.16 $ 1,204.16 3/1/2020 12/31/9999 37160 REVISION OF CIRCULATION $ 1,047.74 $ 1,047.74 3/1/2020 12/31/9999 37180 REVISION OF CIRCULATION $ 1,174.25 $ 1,174.25 3/1/2020 12/31/9999 37181 SPLICE SPLEEN/KIDNEY VEINS $ 1,269.23 $ 1,269.23 3/1/2020 12/31/9999 37182 INSERT HEPATIC SHUNT (TIPS) $ 759.08 $ 759.08 3/1/2020 12/31/9999 37183 REMOVE HEPATIC SHUNT (TIPS) $ 360.72 $ 360.72 3/1/2020 12/31/9999 37184 PRIM ART M-THRMBC 1ST VSL $ 388.30 $ 1,913.15 3/1/2020 12/31/9999 37185 PRIM ART M-THRMBC SBSQ VSL $ 143.05 $ 633.32 3/1/2020 12/31/9999 37186 SEC ART THROMBECTOMY ADD-ON $ 219.67 $ 1,287.73 3/1/2020 12/31/9999 37187 VENOUS MECH THROMBECTOMY $ 360.74 $ 1,832.71 3/1/2020 12/31/9999 37188 VEN MECHNL THRMBC REPEAT TX $ 261.04 $ 1,555.29 3/1/2020 12/31/9999 37191 INS ENDOVAS VENA CAVA FILTR $ 142.64 $ 1,573.75 3/1/2020 12/31/9999 37192 REDO ENDOVAS VENA CAVA FILTR $ 221.13 $ 1,056.67 3/1/2020 12/31/9999 37193 REM ENDOVAS VENA CAVA FILTER $ 220.93 $ 1,008.40 3/1/2020 12/31/9999 37195 THROMBOLYTIC THERAPY STROKE $ 255.66 $ 255.66 3/1/2020 12/31/9999 37197 REMOVE INTRVAS FOREIGN BODY $ 258.92 $ 1,296.27 3/1/2020 12/31/9999 37200 TRANSCATHETER BIOPSY $ 201.62 $ 201.62 3/1/2020 12/31/9999 37211 THROMBOLYTIC ART THERAPY $ 337.92 $ 337.92 3/1/2020 12/31/9999 37212 THROMBOLYTIC VENOUS THERAPY $ 298.31 $ 298.31 3/1/2020 12/31/9999 37213 THROMBLYTIC ART/VEN THERAPY $ 208.47 $ 208.47 3/1/2020 12/31/9999 37214 CESSJ THERAPY CATH REMOVAL $ 122.26 $ 122.26 3/1/2020 12/31/9999 37215 TRANSCATH STENT CCA W/EPS $ 933.67 $ 933.67 3/1/2020 12/31/9999 37216 TRANSCATH STENT CCA W/O EPS $ 858.08 $ 858.08 3/1/2020 12/31/9999 37217 STENT PLACEMT RETRO CAROTID $ 951.12 $ 951.12 3/1/2020 12/31/9999 37218 STENT PLACEMT ANTE CAROTID $ 765.18 $ 714.05 3/1/2020 12/31/9999 37220 ILIAC REVASC $ 361.83 $ 2,661.98 3/1/2020 12/31/9999 37221 ILIAC REVASC W/STENT $ 441.53 $ 3,935.89 3/1/2020 12/31/9999 37222 ILIAC REVASC ADD-ON $ 164.31 $ 766.84 3/1/2020 12/31/9999 37223 ILIAC REVASC W/STENT ADD-ON $ 186.80 $ 2,167.83 3/1/2020 12/31/9999 37224 FEM/POPL REVAS W/TLA $ 398.75 $ 3,198.88 3/1/2020 12/31/9999 37225 FEM/POPL REVAS W/ATHER $ 536.34 $ 9,037.59 3/1/2020 12/31/9999 37226 FEM/POPL REVASC W/STENT $ 449.38 $ 7,572.42 3/1/2020 12/31/9999 37227 FEM/POPL REVASC STNT & ATHER $ 647.79 $ 12,219.14 3/1/2020 12/31/9999 37228 TIB/PER REVASC W/TLA $ 486.87 $ 4,554.08 3/1/2020 12/31/9999 37229 TIB/PER REVASC W/ATHER $ 627.88 $ 8,958.84 3/1/2020 12/31/9999 37230 TIB/PER REVASC W/STENT $ 608.25 $ 7,039.62 3/1/2020 12/31/9999 37231 TIB/PER REVASC STENT & ATHER $ 661.09 $ 11,298.50 3/1/2020 12/31/9999 37232 TIB/PER REVASC ADD-ON $ 176.10 $ 1,022.06 3/1/2020 12/31/9999 37233 TIBPER REVASC W/ATHER ADD-ON $ 289.09 $ 1,247.88 3/1/2020 12/31/9999 37234 REVSC OPN/PRQ TIB/PERO STENT $ 241.51 $ 3,258.76 3/1/2020 12/31/9999 37235 TIB/PER REVASC STNT & ATHER $ 342.75 $ 3,480.58 3/1/2020 12/31/9999 37236 OPEN/PERQ PLACE STENT 1ST $ 395.34 $ 2,332.33 3/1/2020 12/31/9999 37237 OPEN/PERQ PLACE STENT EA ADD $ 184.54 $ 1,012.98 3/1/2020 12/31/9999 37238 OPEN/PERQ PLACE STENT SAME $ 276.97 $ 3,408.24 3/1/2020 12/31/9999 37239 OPEN/PERQ PLACE STENT EA ADD $ 128.79 $ 1,693.85 3/1/2020 12/31/9999 37241 VASC EMBOLIZE/OCCLUDE VENOUS $ 383.99 $ 3,777.31 3/1/2020 12/31/9999 37242 VASC EMBOLIZE/OCCLUDE ARTERY $ 428.72 $ 6,358.65 3/1/2020 12/31/9999 37243 VASC EMBOLIZE/OCCLUDE ORGAN $ 511.13 $ 8,026.53 3/1/2020 12/31/9999 37244 VASC EMBOLIZE/OCCLUDE BLEED $ 596.27 $ 5,624.01 3/1/2020 12/31/9999 37246 TRLUML BALO ANGIOP 1ST ART $ 318.38 $ 1,836.30 3/1/2020 12/31/9999 37247 TRLUML BALO ANGIOP ADDL ART $ 157.84 $ 743.76 3/1/2020 12/31/9999 37248 TRLUML BALO ANGIOP 1ST VEIN $ 273.79 $ 1,273.37 3/1/2020 12/31/9999 37249 TRLUML BALO ANGIOP ADDL VEIN $ 134.30 $ 546.14 3/1/2020 12/31/9999 37252 INTRVASC US NONCORONARY 1ST $ 83.21 $ 1,196.48 3/1/2020 12/31/9999 37253 INTRVASC US NONCORONARY ADDL $ 66.52 $ 187.17 3/1/2020 12/31/9999 37500 ENDOSCOPY LIGATE PERF VEINS $ 569.61 $ 569.61 3/1/2020 12/31/9999 37565 LIGATION OF NECK VEIN $ 566.71 $ 566.71 3/1/2020 12/31/9999 37600 LIGATION OF NECK ARTERY $ 579.76 $ 579.76 3/1/2020 12/31/9999 37605 LIGATION OF NECK ARTERY $ 663.74 $ 663.74 3/1/2020 12/31/9999 37606 LIGATION OF NECK ARTERY $ 431.81 $ 431.81 3/1/2020 12/31/9999 37607 LIGATION OF A-V FISTULA $ 308.28 $ 308.28 3/1/2020 12/31/9999 37609 TEMPORAL ARTERY PROCEDURE $ 158.68 $ 228.59 3/1/2020 12/31/9999 37615 LIGATION OF NECK ARTERY $ 381.93 $ 381.93 3/1/2020 12/31/9999 37616 LIGATION OF CHEST ARTERY $ 890.32 $ 890.32 3/1/2020 12/31/9999 37617 LIGATION OF ABDOMEN ARTERY $ 1,062.04 $ 1,062.04 3/1/2020 12/31/9999 37618 LIGATION OF EXTREMITY ARTERY $ 304.96 $ 304.96 3/1/2020 12/31/9999 37619 LIGATION OF INF VENA CAVA $ 971.16 $ 971.16 3/1/2020 12/31/9999 37650 REVISION OF MAJOR VEIN $ 416.94 $ 416.94 3/1/2020 12/31/9999 37660 REVISION OF MAJOR VEIN $ 994.23 $ 994.23 3/1/2020 12/31/9999 37700 REVISE LEG VEIN $ 204.10 $ 204.10 3/1/2020 12/31/9999 37718 LIGATE/STRIP SHORT LEG VEIN $ 337.16 $ 337.16 3/1/2020 12/31/9999 37722 LIGATE/STRIP LONG LEG VEIN $ 390.24 $ 390.24 3/1/2020 12/31/9999 37735 REMOVAL OF LEG VEINS/LESION $ 519.37 $ 519.37 3/1/2020 12/31/9999 37760 LIGATE LEG VEINS RADICAL $ 511.52 $ 511.52 3/1/2020 12/31/9999 37761 LIGATE LEG VEINS OPEN $ 366.43 $ 366.43 3/1/2020 12/31/9999 37765 STAB PHLEB VEINS XTR 10-20 $ 367.41 $ 367.41 3/1/2020 12/31/9999 37766 PHLEB VEINS - EXTREM 20+ $ 447.26 $ 447.26 3/1/2020 12/31/9999 37780 REVISION OF LEG VEIN $ 210.54 $ 210.54 3/1/2020 12/31/9999 37785 LIGATE/DIVIDE/EXCISE VEIN $ 211.02 $ 279.47 3/1/2020 12/31/9999 38100 REMOVAL OF SPLEEN TOTAL $ 860.52 $ 860.52 3/1/2020 12/31/9999 38101 REMOVAL OF SPLEEN PARTIAL $ 864.90 $ 864.90 3/1/2020 12/31/9999 38102 REMOVAL OF SPLEEN TOTAL $ 206.22 $ 206.22 3/1/2020 12/31/9999 38115 REPAIR OF RUPTURED SPLEEN $ 957.33 $ 957.33 3/1/2020 12/31/9999 38120 LAPAROSCOPY SPLENECTOMY $ 795.99 $ 795.99 3/1/2020 12/31/9999 38200 INJECTION FOR SPLEEN X-RAY $ 115.45 $ 115.45 3/1/2020 12/31/9999 38204 BL DONOR SEARCH MANAGEMENT $ 84.39 $ 84.39 3/1/2020 12/31/9999 38205 HARVEST ALLOGENEIC STEM CELL $ 66.68 $ 66.68 3/1/2020 12/31/9999 38206 HARVEST AUTO STEM CELLS $ 66.68 $ 66.68 3/1/2020 12/31/9999 38207 CRYOPRESERVE STEM CELLS $ 41.39 $ 41.39 3/1/2020 12/31/9999 38208 THAW PRESERVED STEM CELLS $ 26.42 $ 26.42 3/1/2020 12/31/9999 38209 WASH HARVEST STEM CELLS $ 11.35 $ 11.35 3/1/2020 12/31/9999 38220 DX BONE MARROW ASPIRATIONS $ 50.00 $ 121.97 3/1/2020 12/31/9999 38221 DX BONE MARROW BIOPSIES $ 63.42 $ 135.67 3/1/2020 12/31/9999 38222 DX BONE MARROW BX & ASPIR $ 69.09 $ 147.78 3/1/2020 12/31/9999 38230 BONE MARROW HARVEST ALLOGEN $ 254.63 $ 254.63 3/1/2020 12/31/9999 38232 BONE MARROW HARVEST AUTOLOG $ 108.60 $ 108.60 3/1/2020 12/31/9999 38240 TRANSPLT ALLO HCT/DONOR $ 103.03 $ 103.03 3/1/2020 12/31/9999 38241 TRANSPLT AUTOL HCT/DONOR $ 103.60 $ 103.60 3/1/2020 12/31/9999 38242 TRANSPLT ALLO LYMPHOCYTES $ 78.53 $ 78.53 3/1/2020 12/31/9999 38243 TRANSPLJ HEMATOPOIETIC BOOST $ 98.29 $ 98.29 3/1/2020 12/31/9999 38300 DRAINAGE LYMPH NODE LESION $ 137.95 $ 202.28 3/1/2020 12/31/9999 38305 DRAINAGE LYMPH NODE LESION $ 351.45 $ 351.45 3/1/2020 12/31/9999 38308 INCISION OF LYMPH CHANNELS $ 338.05 $ 338.05 3/1/2020 12/31/9999 38380 THORACIC DUCT PROCEDURE $ 434.84 $ 434.84 3/1/2020 12/31/9999 38381 THORACIC DUCT PROCEDURE $ 650.00 $ 650.00 3/1/2020 12/31/9999 38382 THORACIC DUCT PROCEDURE $ 524.66 $ 524.66 3/1/2020 12/31/9999 38500 BIOPSY/REMOVAL LYMPH NODES $ 190.37 $ 239.14 3/1/2020 12/31/9999 38505 NEEDLE BIOPSY LYMPH NODES $ 60.63 $ 99.70 3/1/2020 12/31/9999 38510 BIOPSY/REMOVAL LYMPH NODES $ 323.31 $ 387.91 3/1/2020 12/31/9999 38520 BIOPSY/REMOVAL LYMPH NODES $ 353.06 $ 353.06 3/1/2020 12/31/9999 38525 BIOPSY/REMOVAL LYMPH NODES $ 319.98 $ 319.98 3/1/2020 12/31/9999 38530 BIOPSY/REMOVAL LYMPH NODES $ 411.76 $ 411.76 3/1/2020 12/31/9999 38531 OPEN BX/EXC INGUINOFEM NODES $ 387.21 $ 387.21 3/1/2020 12/31/9999 38542 EXPLORE DEEP NODE(S) NECK $ 393.27 $ 393.27 3/1/2020 12/31/9999 38550 REMOVAL NECK/ARMPIT LESION $ 363.95 $ 363.95 3/1/2020 12/31/9999 38555 REMOVAL NECK/ARMPIT LESION $ 758.65 $ 758.65 3/1/2020 12/31/9999 38562 REMOVAL PELVIC LYMPH NODES $ 544.83 $ 544.83 3/1/2020 12/31/9999 38564 REMOVAL ABDOMEN LYMPH NODES $ 541.38 $ 541.38 3/1/2020 12/31/9999 38570 LAPAROSCOPY LYMPH NODE BIOP $ 441.70 $ 441.70 3/1/2020 12/31/9999 38571 LAPAROSCOPY LYMPHADENECTOMY $ 694.72 $ 694.72 3/1/2020 12/31/9999 38572 LAPAROSCOPY LYMPHADENECTOMY $ 764.51 $ 764.51 3/1/2020 12/31/9999 38573 LAPS PELVIC LYMPHADEC $ 1,018.57 $ 1,018.57 3/1/2020 12/31/9999 38700 REMOVAL OF LYMPH NODES NECK $ 611.93 $ 611.93 3/1/2020 12/31/9999 38720 REMOVAL OF LYMPH NODES NECK $ 1,017.35 $ 1,017.35 3/1/2020 12/31/9999 38724 REMOVAL OF LYMPH NODES NECK $ 1,103.62 $ 1,103.62 3/1/2020 12/31/9999 38740 REMOVE ARMPIT LYMPH NODES $ 512.64 $ 512.64 3/1/2020 12/31/9999 38745 REMOVE ARMPIT LYMPH NODES $ 652.84 $ 652.84 3/1/2020 12/31/9999 38746 REMOVE THORACIC LYMPH NODES $ 215.59 $ 215.59 3/1/2020 12/31/9999 38747 REMOVE ABDOMINAL LYMPH NODES $ 210.16 $ 210.16 3/1/2020 12/31/9999 38760 REMOVE GROIN LYMPH NODES $ 643.98 $ 643.98 3/1/2020 12/31/9999 38765 REMOVE GROIN LYMPH NODES $ 1,002.44 $ 1,002.44 3/1/2020 12/31/9999 38770 REMOVE PELVIS LYMPH NODES $ 671.31 $ 671.31 3/1/2020 12/31/9999 38780 REMOVE ABDOMEN LYMPH NODES $ 845.39 $ 845.39 3/1/2020 12/31/9999 38790 INJECT FOR LYMPHATIC X-RAY $ 65.91 $ 65.91 3/1/2020 12/31/9999 38792 RA TRACER ID OF SENTINL NODE $ 31.82 $ 31.82 3/1/2020 12/31/9999 38794 ACCESS THORACIC LYMPH DUCT $ 249.54 $ 249.54 3/1/2020 12/31/9999 38900 IO MAP OF SENT LYMPH NODE $ 113.73 $ 113.73 3/1/2020 12/31/9999 39000 EXPLORATION OF CHEST $ 389.42 $ 389.42 3/1/2020 12/31/9999 39010 EXPLORATION OF CHEST $ 646.81 $ 646.81 3/1/2020 12/31/9999 39200 RESECT MEDIASTINAL CYST $ 717.64 $ 717.64 3/1/2020 12/31/9999 39220 RESECT MEDIASTINAL TUMOR $ 924.27 $ 924.27 3/1/2020 12/31/9999 39401 MEDIASTINOSCPY W/MEDSTNL BX $ 279.26 $ 279.26 3/1/2020 12/31/9999 39402 MEDIASTINOSCPY W/LMPH NOD BX $ 364.44 $ 364.44 3/1/2020 12/31/9999 39501 REPAIR DIAPHRAGM LACERATION $ 657.89 $ 657.89 3/1/2020 12/31/9999 39503 REPAIR OF DIAPHRAGM HERNIA $ 4,618.49 $ 4,618.49 3/1/2020 12/31/9999 39540 REPAIR OF DIAPHRAGM HERNIA $ 672.69 $ 672.69 3/1/2020 12/31/9999 39541 REPAIR OF DIAPHRAGM HERNIA $ 725.67 $ 725.67 3/1/2020 12/31/9999 39545 REVISION OF DIAPHRAGM $ 713.61 $ 713.61 3/1/2020 12/31/9999 39560 RESECT DIAPHRAGM SIMPLE $ 616.92 $ 616.92 3/1/2020 12/31/9999 39561 RESECT DIAPHRAGM COMPLEX $ 958.82 $ 958.82 3/1/2020 12/31/9999 40490 BIOPSY OF LIP $ 57.96 $ 97.61 3/1/2020 12/31/9999 40500 PARTIAL EXCISION OF LIP $ 273.86 $ 368.46 3/1/2020 12/31/9999 40510 PARTIAL EXCISION OF LIP $ 272.02 $ 358.08 3/1/2020 12/31/9999 40520 PARTIAL EXCISION OF LIP $ 274.90 $ 367.72 3/1/2020 12/31/9999 40525 RECONSTRUCT LIP WITH FLAP $ 427.69 $ 427.69 3/1/2020 12/31/9999 40527 RECONSTRUCT LIP WITH FLAP $ 505.56 $ 505.56 3/1/2020 12/31/9999 40530 PARTIAL REMOVAL OF LIP $ 311.92 $ 406.21 3/1/2020 12/31/9999 40650 REPAIR LIP $ 218.83 $ 304.90 3/1/2020 12/31/9999 40652 REPAIR LIP $ 266.63 $ 358.86 3/1/2020 12/31/9999 40654 REPAIR LIP $ 323.90 $ 423.78 3/1/2020 12/31/9999 40700 REPAIR CLEFT LIP/NASAL $ 718.03 $ 718.03 3/1/2020 12/31/9999 40701 REPAIR CLEFT LIP/NASAL $ 890.99 $ 890.99 3/1/2020 12/31/9999 40702 REPAIR CLEFT LIP/NASAL $ 692.81 $ 692.81 3/1/2020 12/31/9999 40720 REPAIR CLEFT LIP/NASAL $ 762.65 $ 762.65 3/1/2020 12/31/9999 40761 REPAIR CLEFT LIP/NASAL $ 825.78 $ 825.78 3/1/2020 12/31/9999 40800 DRAINAGE OF MOUTH LESION $ 95.05 $ 146.16 3/1/2020 12/31/9999 40801 DRAINAGE OF MOUTH LESION $ 166.28 $ 225.92 3/1/2020 12/31/9999 40804 REMOVAL FOREIGN BODY MOUTH $ 96.27 $ 149.16 3/1/2020 12/31/9999 40805 REMOVAL FOREIGN BODY MOUTH $ 172.44 $ 236.79 3/1/2020 12/31/9999 40808 BIOPSY OF MOUTH LESION $ 79.84 $ 131.25 3/1/2020 12/31/9999 40810 EXCISION OF MOUTH LESION $ 95.09 $ 146.50 3/1/2020 12/31/9999 40812 EXCISE/REPAIR MOUTH LESION $ 148.37 $ 207.12 3/1/2020 12/31/9999 40814 EXCISE/REPAIR MOUTH LESION $ 228.86 $ 279.37 3/1/2020 12/31/9999 40816 EXCISION OF MOUTH LESION $ 239.52 $ 294.46 3/1/2020 12/31/9999 40818 EXCISE ORAL MUCOSA FOR GRAFT $ 203.99 $ 257.74 3/1/2020 12/31/9999 40820 TREATMENT OF MOUTH LESION $ 127.22 $ 190.07 3/1/2020 12/31/9999 40830 REPAIR MOUTH LACERATION $ 119.69 $ 176.38 3/1/2020 12/31/9999 40831 REPAIR MOUTH LACERATION $ 168.26 $ 234.36 3/1/2020 12/31/9999 40840 RECONSTRUCTION OF MOUTH $ 488.58 $ 606.07 3/1/2020 12/31/9999 40842 RECONSTRUCTION OF MOUTH $ 478.58 $ 596.97 3/1/2020 12/31/9999 40843 RECONSTRUCTION OF MOUTH $ 623.50 $ 780.66 3/1/2020 12/31/9999 40844 RECONSTRUCTION OF MOUTH $ 869.91 $ 1,035.30 3/1/2020 12/31/9999 40845 RECONSTRUCTION OF MOUTH $ 975.50 $ 1,128.54 3/1/2020 12/31/9999 41000 DRAINAGE OF MOUTH LESION $ 84.29 $ 117.18 3/1/2020 12/31/9999 41005 DRAINAGE OF MOUTH LESION $ 95.64 $ 163.20 3/1/2020 12/31/9999 41006 DRAINAGE OF MOUTH LESION $ 197.27 $ 264.83 3/1/2020 12/31/9999 41007 DRAINAGE OF MOUTH LESION $ 191.44 $ 265.17 3/1/2020 12/31/9999 41008 DRAINAGE OF MOUTH LESION $ 204.55 $ 273.28 3/1/2020 12/31/9999 41009 DRAINAGE OF MOUTH LESION $ 221.97 $ 290.42 3/1/2020 12/31/9999 41010 INCISION OF TONGUE FOLD $ 82.12 $ 146.45 3/1/2020 12/31/9999 41015 DRAINAGE OF MOUTH LESION $ 254.37 $ 312.53 3/1/2020 12/31/9999 41016 DRAINAGE OF MOUTH LESION $ 263.97 $ 320.96 3/1/2020 12/31/9999 41017 DRAINAGE OF MOUTH LESION $ 265.15 $ 323.32 3/1/2020 12/31/9999 41018 DRAINAGE OF MOUTH LESION $ 310.86 $ 371.39 3/1/2020 12/31/9999 41019 PLACE NEEDLES H&N FOR RT $ 396.30 $ 396.30 3/1/2020 12/31/9999 41100 BIOPSY OF TONGUE $ 83.88 $ 123.83 3/1/2020 12/31/9999 41105 BIOPSY OF TONGUE $ 85.06 $ 124.13 3/1/2020 12/31/9999 41108 BIOPSY OF FLOOR OF MOUTH $ 68.31 $ 106.20 3/1/2020 12/31/9999 41110 EXCISION OF TONGUE LESION $ 99.67 $ 152.85 3/1/2020 12/31/9999 41112 EXCISION OF TONGUE LESION $ 189.07 $ 241.94 3/1/2020 12/31/9999 41113 EXCISION OF TONGUE LESION $ 210.46 $ 265.69 3/1/2020 12/31/9999 41114 EXCISION OF TONGUE LESION $ 489.53 $ 489.53 3/1/2020 12/31/9999 41115 EXCISION OF TONGUE FOLD $ 112.69 $ 177.90 3/1/2020 12/31/9999 41116 EXCISION OF MOUTH LESION $ 165.62 $ 236.41 3/1/2020 12/31/9999 41120 PARTIAL REMOVAL OF TONGUE $ 793.00 $ 793.00 3/1/2020 12/31/9999 41130 PARTIAL REMOVAL OF TONGUE $ 983.02 $ 983.02 3/1/2020 12/31/9999 41135 TONGUE AND NECK SURGERY $ 1,647.75 $ 1,647.75 3/1/2020 12/31/9999 41140 REMOVAL OF TONGUE $ 1,690.87 $ 1,690.87 3/1/2020 12/31/9999 41145 TONGUE REMOVAL NECK SURGERY $ 2,120.43 $ 2,120.43 3/1/2020 12/31/9999 41150 TONGUE MOUTH JAW SURGERY $ 1,676.41 $ 1,676.41 3/1/2020 12/31/9999 41153 TONGUE MOUTH NECK SURGERY $ 1,820.53 $ 1,820.53 3/1/2020 12/31/9999 41155 TONGUE JAW & NECK SURGERY $ 2,268.84 $ 2,268.84 3/1/2020 12/31/9999 41250 REPAIR TONGUE LACERATION $ 108.10 $ 166.86 3/1/2020 12/31/9999 41251 REPAIR TONGUE LACERATION $ 125.91 $ 173.21 3/1/2020 12/31/9999 41252 REPAIR TONGUE LACERATION $ 163.08 $ 227.10 3/1/2020 12/31/9999 41510 TONGUE TO LIP SURGERY $ 306.58 $ 306.58 3/1/2020 12/31/9999 41520 RECONSTRUCTION TONGUE FOLD $ 191.51 $ 252.90 3/1/2020 12/31/9999 41800 DRAINAGE OF GUM LESION $ 96.36 $ 164.21 3/1/2020 12/31/9999 41805 REMOVAL FOREIGN BODY GUM $ 121.99 $ 169.58 3/1/2020 12/31/9999 41806 REMOVAL FOREIGN BODY JAWBONE $ 191.67 $ 249.83 3/1/2020 12/31/9999 41820 EXCISION GUM EACH QUADRANT $ 355.06 $ 355.06 3/1/2020 12/31/9999 41821 EXCISION OF GUM FLAP $ 295.90 $ 295.90 3/1/2020 12/31/9999 41822 EXCISION OF GUM LESION $ 134.03 $ 209.82 3/1/2020 12/31/9999 41823 EXCISION OF GUM LESION $ 240.78 $ 312.73 3/1/2020 12/31/9999 41825 EXCISION OF GUM LESION $ 95.24 $ 149.29 3/1/2020 12/31/9999 41826 EXCISION OF GUM LESION $ 153.80 $ 210.80 3/1/2020 12/31/9999 41827 EXCISION OF GUM LESION $ 228.57 $ 313.18 3/1/2020 12/31/9999 41830 REMOVAL OF GUM TISSUE $ 211.67 $ 283.04 3/1/2020 12/31/9999 41850 TREATMENT OF GUM LESION $ 35.50 $ 35.50 3/1/2020 12/31/9999 41870 GUM GRAFT $ 473.43 $ 473.43 3/1/2020 12/31/9999 41872 REPAIR GUM $ 196.25 $ 264.98 3/1/2020 12/31/9999 41874 REPAIR TOOTH SOCKET $ 193.35 $ 269.43 3/1/2020 12/31/9999 42000 DRAINAGE MOUTH ROOF LESION $ 78.25 $ 115.55 3/1/2020 12/31/9999 42100 BIOPSY ROOF OF MOUTH $ 83.04 $ 110.06 3/1/2020 12/31/9999 42104 EXCISION LESION MOUTH ROOF $ 104.40 $ 152.88 3/1/2020 12/31/9999 42106 EXCISION LESION MOUTH ROOF $ 136.69 $ 193.97 3/1/2020 12/31/9999 42107 EXCISION LESION MOUTH ROOF $ 263.93 $ 338.54 3/1/2020 12/31/9999 42120 REMOVE PALATE/LESION $ 740.39 $ 740.39 3/1/2020 12/31/9999 42140 EXCISION OF UVULA $ 116.99 $ 181.91 3/1/2020 12/31/9999 42145 REPAIR PALATE PHARYNX/UVULA $ 540.68 $ 540.68 3/1/2020 12/31/9999 42160 TREATMENT MOUTH ROOF LESION $ 116.45 $ 176.37 3/1/2020 12/31/9999 42180 REPAIR PALATE $ 141.82 $ 180.60 3/1/2020 12/31/9999 42182 REPAIR PALATE $ 207.26 $ 248.08 3/1/2020 12/31/9999 42200 RECONSTRUCT CLEFT PALATE $ 686.10 $ 686.10 3/1/2020 12/31/9999 42205 RECONSTRUCT CLEFT PALATE $ 732.12 $ 732.12 3/1/2020 12/31/9999 42210 RECONSTRUCT CLEFT PALATE $ 825.62 $ 825.62 3/1/2020 12/31/9999 42215 RECONSTRUCT CLEFT PALATE $ 539.85 $ 539.85 3/1/2020 12/31/9999 42220 RECONSTRUCT CLEFT PALATE $ 419.58 $ 419.58 3/1/2020 12/31/9999 42225 RECONSTRUCT CLEFT PALATE $ 716.23 $ 716.23 3/1/2020 12/31/9999 42226 LENGTHENING OF PALATE $ 712.71 $ 712.71 3/1/2020 12/31/9999 42227 LENGTHENING OF PALATE $ 692.57 $ 692.57 3/1/2020 12/31/9999 42235 REPAIR PALATE $ 565.33 $ 565.33 3/1/2020 12/31/9999 42260 REPAIR NOSE TO LIP FISTULA $ 530.87 $ 633.10 3/1/2020 12/31/9999 42300 DRAINAGE OF SALIVARY GLAND $ 116.84 $ 154.15 3/1/2020 12/31/9999 42305 DRAINAGE OF SALIVARY GLAND $ 334.72 $ 334.72 3/1/2020 12/31/9999 42310 DRAINAGE OF SALIVARY GLAND $ 95.39 $ 120.06 3/1/2020 12/31/9999 42320 DRAINAGE OF SALIVARY GLAND $ 137.07 $ 185.54 3/1/2020 12/31/9999 42330 REMOVAL OF SALIVARY STONE $ 127.23 $ 172.75 3/1/2020 12/31/9999 42335 REMOVAL OF SALIVARY STONE $ 199.16 $ 274.95 3/1/2020 12/31/9999 42340 REMOVAL OF SALIVARY STONE $ 262.44 $ 346.46 3/1/2020 12/31/9999 42400 BIOPSY OF SALIVARY GLAND $ 45.66 $ 81.21 3/1/2020 12/31/9999 42405 BIOPSY OF SALIVARY GLAND $ 177.73 $ 228.26 3/1/2020 12/31/9999 42408 EXCISION OF SALIVARY CYST $ 254.68 $ 339.28 3/1/2020 12/31/9999 42409 DRAINAGE OF SALIVARY CYST $ 172.32 $ 244.59 3/1/2020 12/31/9999 42410 EXCISE PAROTID GLAND/LESION $ 486.17 $ 486.17 3/1/2020 12/31/9999 42415 EXCISE PAROTID GLAND/LESION $ 879.14 $ 879.14 3/1/2020 12/31/9999 42420 EXCISE PAROTID GLAND/LESION $ 1,008.23 $ 1,008.23 3/1/2020 12/31/9999 42425 EXCISE PAROTID GLAND/LESION $ 662.95 $ 662.95 3/1/2020 12/31/9999 42426 EXCISE PAROTID GLAND/LESION $ 1,079.17 $ 1,079.17 3/1/2020 12/31/9999 42440 EXCISE SUBMAXILLARY GLAND $ 365.60 $ 365.60 3/1/2020 12/31/9999 42450 EXCISE SUBLINGUAL GLAND $ 276.86 $ 339.15 3/1/2020 12/31/9999 42500 REPAIR SALIVARY DUCT $ 263.29 $ 323.21 3/1/2020 12/31/9999 42505 REPAIR SALIVARY DUCT $ 353.15 $ 420.71 3/1/2020 12/31/9999 42507 PAROTID DUCT DIVERSION $ 395.25 $ 395.25 3/1/2020 12/31/9999 42509 PAROTID DUCT DIVERSION $ 647.19 $ 647.19 3/1/2020 12/31/9999 42510 PAROTID DUCT DIVERSION $ 488.27 $ 488.27 3/1/2020 12/31/9999 42550 INJECTION FOR SALIVARY X-RAY $ 54.92 $ 115.13 3/1/2020 12/31/9999 42600 CLOSURE OF SALIVARY FISTULA $ 274.91 $ 363.33 3/1/2020 12/31/9999 42650 DILATION OF SALIVARY DUCT $ 45.84 $ 61.99 3/1/2020 12/31/9999 42660 DILATION OF SALIVARY DUCT $ 61.20 $ 79.99 3/1/2020 12/31/9999 42665 LIGATION OF SALIVARY DUCT $ 159.39 $ 228.71 3/1/2020 12/31/9999 42700 DRAINAGE OF TONSIL ABSCESS $ 104.06 $ 139.29 3/1/2020 12/31/9999 42720 DRAINAGE OF THROAT ABSCESS $ 311.17 $ 351.71 3/1/2020 12/31/9999 42725 DRAINAGE OF THROAT ABSCESS $ 633.60 $ 633.60 3/1/2020 12/31/9999 42800 BIOPSY OF THROAT $ 86.06 $ 116.91 3/1/2020 12/31/9999 42804 BIOPSY OF UPPER NOSE/THROAT $ 88.14 $ 147.78 3/1/2020 12/31/9999 42806 BIOPSY OF UPPER NOSE/THROAT $ 103.66 $ 167.11 3/1/2020 12/31/9999 42808 EXCISE PHARYNX LESION $ 128.03 $ 171.21 3/1/2020 12/31/9999 42809 REMOVE PHARYNX FOREIGN BODY $ 100.40 $ 127.73 3/1/2020 12/31/9999 42810 EXCISION OF NECK CYST $ 218.15 $ 286.88 3/1/2020 12/31/9999 42815 EXCISION OF NECK CYST $ 428.70 $ 428.70 3/1/2020 12/31/9999 42820 REMOVE TONSILS AND ADENOIDS $ 227.08 $ 227.08 3/1/2020 12/31/9999 42821 REMOVE TONSILS AND ADENOIDS $ 237.04 $ 237.04 3/1/2020 12/31/9999 42825 REMOVAL OF TONSILS $ 202.72 $ 202.72 3/1/2020 12/31/9999 42826 REMOVAL OF TONSILS $ 195.95 $ 195.95 3/1/2020 12/31/9999 42830 REMOVAL OF ADENOIDS $ 159.44 $ 159.44 3/1/2020 12/31/9999 42831 REMOVAL OF ADENOIDS $ 171.96 $ 171.96 3/1/2020 12/31/9999 42835 REMOVAL OF ADENOIDS $ 143.72 $ 143.72 3/1/2020 12/31/9999 42836 REMOVAL OF ADENOIDS $ 187.95 $ 187.95 3/1/2020 12/31/9999 42842 EXTENSIVE SURGERY OF THROAT $ 744.39 $ 744.39 3/1/2020 12/31/9999 42844 EXTENSIVE SURGERY OF THROAT $ 1,047.80 $ 1,047.80 3/1/2020 12/31/9999 42845 EXTENSIVE SURGERY OF THROAT $ 1,720.98 $ 1,720.98 3/1/2020 12/31/9999 42860 EXCISION OF TONSIL TAGS $ 144.11 $ 144.11 3/1/2020 12/31/9999 42870 EXCISION OF LINGUAL TONSIL $ 436.29 $ 436.29 3/1/2020 12/31/9999 42890 PARTIAL REMOVAL OF PHARYNX $ 1,067.88 $ 1,067.88 3/1/2020 12/31/9999 42892 REVISION OF PHARYNGEAL WALLS $ 1,402.56 $ 1,402.56 3/1/2020 12/31/9999 42894 REVISION OF PHARYNGEAL WALLS $ 1,798.22 $ 1,798.22 3/1/2020 12/31/9999 42900 REPAIR THROAT WOUND $ 271.10 $ 271.10 3/1/2020 12/31/9999 42950 RECONSTRUCTION OF THROAT $ 604.97 $ 604.97 3/1/2020 12/31/9999 42953 REPAIR THROAT ESOPHAGUS $ 742.88 $ 742.88 3/1/2020 12/31/9999 42955 SURGICAL OPENING OF THROAT $ 570.18 $ 570.18 3/1/2020 12/31/9999 42960 CONTROL THROAT BLEEDING $ 131.62 $ 131.62 3/1/2020 12/31/9999 42961 CONTROL THROAT BLEEDING $ 326.35 $ 326.35 3/1/2020 12/31/9999 42962 CONTROL THROAT BLEEDING $ 404.80 $ 404.80 3/1/2020 12/31/9999 42970 CONTROL NOSE/THROAT BLEEDING $ 303.28 $ 303.28 3/1/2020 12/31/9999 42971 CONTROL NOSE/THROAT BLEEDING $ 356.90 $ 356.90 3/1/2020 12/31/9999 42972 CONTROL NOSE/THROAT BLEEDING $ 401.43 $ 401.43 3/1/2020 12/31/9999 43020 INCISION OF ESOPHAGUS $ 413.49 $ 413.49 3/1/2020 12/31/9999 43030 THROAT MUSCLE SURGERY $ 409.23 $ 409.23 3/1/2020 12/31/9999 43045 INCISION OF ESOPHAGUS $ 1,042.06 $ 1,042.06 3/1/2020 12/31/9999 43100 EXCISION OF ESOPHAGUS LESION $ 489.43 $ 489.43 3/1/2020 12/31/9999 43101 EXCISION OF ESOPHAGUS LESION $ 814.20 $ 814.20 3/1/2020 12/31/9999 43107 REMOVAL OF ESOPHAGUS $ 2,017.06 $ 2,017.06 3/1/2020 12/31/9999 43108 REMOVAL OF ESOPHAGUS $ 3,410.66 $ 3,410.66 3/1/2020 12/31/9999 43112 ESPHG TOT W/THRCM $ 2,156.54 $ 2,156.54 3/1/2020 12/31/9999 43113 REMOVAL OF ESOPHAGUS $ 3,403.08 $ 3,403.08 3/1/2020 12/31/9999 43116 PARTIAL REMOVAL OF ESOPHAGUS $ 3,873.64 $ 3,873.64 3/1/2020 12/31/9999 43117 PARTIAL REMOVAL OF ESOPHAGUS $ 1,972.98 $ 1,972.98 3/1/2020 12/31/9999 43118 PARTIAL REMOVAL OF ESOPHAGUS $ 2,805.81 $ 2,805.81 3/1/2020 12/31/9999 43121 PARTIAL REMOVAL OF ESOPHAGUS $ 2,225.80 $ 2,225.80 3/1/2020 12/31/9999 43122 PARTIAL REMOVAL OF ESOPHAGUS $ 1,995.13 $ 1,995.13 3/1/2020 12/31/9999 43123 PARTIAL REMOVAL OF ESOPHAGUS $ 3,428.44 $ 3,428.44 3/1/2020 12/31/9999 43124 REMOVAL OF ESOPHAGUS $ 2,926.73 $ 2,926.73 3/1/2020 12/31/9999 43130 REMOVAL OF ESOPHAGUS POUCH $ 620.43 $ 620.43 3/1/2020 12/31/9999 43135 REMOVAL OF ESOPHAGUS POUCH $ 1,165.57 $ 1,165.57 3/1/2020 12/31/9999 43180 ESOPHAGOSCOPY RIGID TRNSO $ 512.23 $ 466.24 3/1/2020 12/31/9999 43191 ESOPHAGOSCOPY RIGID TRNSO DX $ 107.70 $ 107.70 3/1/2020 12/31/9999 43192 ESOPHAGOSCP RIG TRNSO INJECT $ 128.45 $ 128.45 3/1/2020 12/31/9999 43193 ESOPHAGOSCP RIG TRNSO BIOPSY $ 153.06 $ 153.06 3/1/2020 12/31/9999 43194 ESOPHAGOSCP RIG TRNSO REM FB $ 139.06 $ 139.06 3/1/2020 12/31/9999 43195 ESOPHAGOSCOPY RIGID BALLOON $ 153.34 $ 153.34 3/1/2020 12/31/9999 43196 ESOPHAGOSCP GUIDE WIRE DILAT $ 167.74 $ 167.74 3/1/2020 12/31/9999 43197 ESOPHAGOSCOPY FLEX DX BRUSH $ 68.54 $ 153.96 3/1/2020 12/31/9999 43198 ESOPHAGOSC FLEX TRNSN BIOPSY $ 81.63 $ 171.98 3/1/2020 12/31/9999 43200 ESOPHAGOSCOPY FLEXIBLE BRUSH $ 83.07 $ 163.85 3/1/2020 12/31/9999 43201 ESOPH SCOPE W/SUBMUCOUS INJ $ 104.64 $ 225.07 3/1/2020 12/31/9999 43202 ESOPHAGOSCOPY FLEX BIOPSY $ 92.42 $ 214.90 3/1/2020 12/31/9999 43204 ESOPH SCOPE W/SCLEROSIS INJ $ 182.14 $ 182.14 3/1/2020 12/31/9999 43205 ESOPHAGUS ENDOSCOPY/LIGATION $ 182.66 $ 182.66 3/1/2020 12/31/9999 43210 EGD ESOPHAGOGASTRC FNDOPLSTY $ 386.25 $ 386.25 3/1/2020 12/31/9999 43211 ESOPHAGOSCOP MUCOSAL RESECT $ 208.35 $ 208.35 3/1/2020 12/31/9999 43212 ESOPHAGOSCOP STENT PLACEMENT $ 163.84 $ 163.84 3/1/2020 12/31/9999 43213 ESOPHAGOSCOPY RETRO BALLOON $ 231.51 $ 1,022.06 3/1/2020 12/31/9999 43214 ESOPHAGOSC DILATE BALLOON 30 $ 167.49 $ 167.49 3/1/2020 12/31/9999 43215 ESOPHAGOSCOPY FLEX REMOVE FB $ 124.89 $ 124.89 3/1/2020 12/31/9999 43216 ESOPHAGOSCOPY LESION REMOVAL $ 116.37 $ 154.56 3/1/2020 12/31/9999 43217 ESOPHAGOSCOPY SNARE LES REMV $ 137.28 $ 288.56 3/1/2020 12/31/9999 43220 ESOPHAGOSCOPY BALLOON <30MM $ 102.72 $ 102.72 3/1/2020 12/31/9999 43226 ESOPH ENDOSCOPY DILATION $ 114.57 $ 114.57 3/1/2020 12/31/9999 43227 ESOPHAGOSCOPY CONTROL BLEED $ 170.75 $ 170.75 3/1/2020 12/31/9999 43229 ESOPHAGOSCOPY LESION ABLATE $ 176.67 $ 602.84 3/1/2020 12/31/9999 43231 ESOPHAGOSCOP ULTRASOUND EXAM $ 154.98 $ 154.98 3/1/2020 12/31/9999 43232 ESOPHAGOSCOPY W/US NEEDLE BX $ 213.72 $ 213.72 3/1/2020 12/31/9999 43233 EGD BALLOON DIL ESOPH30 MM/> $ 198.79 $ 198.79 3/1/2020 12/31/9999 43235 EGD DIAGNOSTIC BRUSH WASH $ 117.92 $ 231.30 3/1/2020 12/31/9999 43236 UPPR GI SCOPE W/SUBMUC INJ $ 143.38 $ 287.89 3/1/2020 12/31/9999 43237 ENDOSCOPIC US EXAM ESOPH $ 195.27 $ 195.27 3/1/2020 12/31/9999 43238 EGD US FINE NEEDLE BX/ASPIR $ 242.10 $ 242.10 3/1/2020 12/31/9999 43239 EGD BIOPSY SINGLE/MULTIPLE $ 139.64 $ 268.01 3/1/2020 12/31/9999 43240 EGD W/TRANSMURAL DRAIN CYST $ 325.15 $ 325.15 3/1/2020 12/31/9999 43241 EGD TUBE/CATH INSERTION $ 126.72 $ 126.72 3/1/2020 12/31/9999 43242 EGD US FINE NEEDLE BX/ASPIR $ 346.78 $ 346.78 3/1/2020 12/31/9999 43243 EGD INJECTION VARICES $ 218.43 $ 218.43 3/1/2020 12/31/9999 43244 EGD VARICES LIGATION $ 242.12 $ 242.12 3/1/2020 12/31/9999 43245 EGD DILATE STRICTURE $ 152.63 $ 152.63 3/1/2020 12/31/9999 43246 EGD PLACE GASTROSTOMY TUBE $ 204.55 $ 204.55 3/1/2020 12/31/9999 43247 EGD REMOVE FOREIGN BODY $ 163.30 $ 163.30 3/1/2020 12/31/9999 43248 EGD GUIDE WIRE INSERTION $ 154.31 $ 154.31 3/1/2020 12/31/9999 43249 ESOPH EGD DILATION <30 MM $ 142.07 $ 142.07 3/1/2020 12/31/9999 43250 EGD CAUTERY TUMOR POLYP $ 152.67 $ 152.67 3/1/2020 12/31/9999 43251 EGD REMOVE LESION SNARE $ 177.66 $ 177.66 3/1/2020 12/31/9999 43253 EGD US TRANSMURAL INJXN/MARK $ 230.63 $ 230.63 3/1/2020 12/31/9999 43254 EGD ENDO MUCOSAL RESECTION $ 239.35 $ 239.35 3/1/2020 12/31/9999 43255 EGD CONTROL BLEEDING ANY $ 231.18 $ 231.18 3/1/2020 12/31/9999 43259 EGD US EXAM DUODENUM/JEJUNUM $ 248.24 $ 248.24 3/1/2020 12/31/9999 43260 ERCP W/SPECIMEN COLLECTION $ 284.27 $ 284.27 3/1/2020 12/31/9999 43261 ENDO CHOLANGIOPANCREATOGRAPH $ 298.82 $ 298.82 3/1/2020 12/31/9999 43262 ENDO CHOLANGIOPANCREATOGRAPH $ 350.98 $ 350.98 3/1/2020 12/31/9999 43263 ERCP SPHINCTER PRESSURE MEAS $ 347.21 $ 347.21 3/1/2020 12/31/9999 43264 ERCP REMOVE DUCT CALCULI $ 421.43 $ 421.43 3/1/2020 12/31/9999 43265 ERCP LITHOTRIPSY CALCULI $ 472.96 $ 472.96 3/1/2020 12/31/9999 43266 EGD ENDOSCOPIC STENT PLACE $ 198.03 $ 198.03 3/1/2020 12/31/9999 43270 EGD LESION ABLATION $ 208.16 $ 601.69 3/1/2020 12/31/9999 43273 ENDOSCOPIC PANCREATOSCOPY $ 106.08 $ 106.08 3/1/2020 12/31/9999 43274 ERCP DUCT STENT PLACEMENT $ 410.29 $ 410.29 3/1/2020 12/31/9999 43275 ERCP REMOVE FORGN BODY DUCT $ 338.28 $ 338.28 3/1/2020 12/31/9999 43276 ERCP STENT EXCHANGE W/DILATE $ 426.90 $ 426.90 3/1/2020 12/31/9999 43277 ERCP EA DUCT/AMPULLA DILATE $ 340.37 $ 340.37 3/1/2020 12/31/9999 43278 ERCP LESION ABLATE W/DILATE $ 386.99 $ 386.99 3/1/2020 12/31/9999 43279 LAP MYOTOMY HELLER $ 988.45 $ 988.45 3/1/2020 12/31/9999 43280 LAPAROSCOPY FUNDOPLASTY $ 824.31 $ 824.31 3/1/2020 12/31/9999 43281 LAP PARAESOPHAG HERN REPAIR $ 983.97 $ 983.97 3/1/2020 12/31/9999 43282 LAP PARAESOPH HER RPR W/MESH $ 1,106.74 $ 1,106.74 3/1/2020 12/31/9999 43283 LAP ESOPH LENGTHENING $ 136.23 $ 136.23 3/1/2020 12/31/9999 43286 ESPHG TOT W/LAPS MOBLJ $ 2,752.17 $ 2,752.17 3/1/2020 12/31/9999 43287 ESPHG DSTL 2/3 W/LAPS MOBLJ $ 3,139.04 $ 3,139.04 3/1/2020 12/31/9999 43288 ESPHG THRSC MOBLJ $ 3,281.36 $ 3,281.36 3/1/2020 12/31/9999 43300 REPAIR OF ESOPHAGUS $ 485.69 $ 485.69 3/1/2020 12/31/9999 43305 REPAIR ESOPHAGUS AND FISTULA $ 872.24 $ 872.24 3/1/2020 12/31/9999 43310 REPAIR OF ESOPHAGUS $ 1,219.26 $ 1,219.26 3/1/2020 12/31/9999 43312 REPAIR ESOPHAGUS AND FISTULA $ 1,346.78 $ 1,346.78 3/1/2020 12/31/9999 43313 ESOPHAGOPLASTY CONGENITAL $ 2,145.68 $ 2,145.68 3/1/2020 12/31/9999 43314 TRACHEO-ESOPHAGOPLASTY CONG $ 2,456.82 $ 2,456.82 3/1/2020 12/31/9999 43320 FUSE ESOPHAGUS & STOMACH $ 1,071.22 $ 1,071.22 3/1/2020 12/31/9999 43325 REVISE ESOPHAGUS & STOMACH $ 1,022.95 $ 1,022.95 3/1/2020 12/31/9999 43327 ESOPH FUNDOPLASTY LAP $ 685.41 $ 685.41 3/1/2020 12/31/9999 43328 ESOPH FUNDOPLASTY THOR $ 1,000.06 $ 1,000.06 3/1/2020 12/31/9999 43330 ESOPHAGOMYOTOMY ABDOMINAL $ 1,003.47 $ 1,003.47 3/1/2020 12/31/9999 43331 ESOPHAGOMYOTOMY THORACIC $ 1,086.40 $ 1,086.40 3/1/2020 12/31/9999 43332 TRANSAB ESOPH HIAT HERN RPR $ 981.33 $ 981.33 3/1/2020 12/31/9999 43333 TRANSAB ESOPH HIAT HERN RPR $ 1,065.70 $ 1,065.70 3/1/2020 12/31/9999 43334 TRANSTHOR DIAPHRAG HERN RPR $ 1,076.78 $ 1,076.78 3/1/2020 12/31/9999 43335 TRANSTHOR DIAPHRAG HERN RPR $ 1,160.29 $ 1,160.29 3/1/2020 12/31/9999 43336 THORABD DIAPHR HERN REPAIR $ 1,268.26 $ 1,268.26 3/1/2020 12/31/9999 43337 THORABD DIAPHR HERN REPAIR $ 1,384.74 $ 1,384.74 3/1/2020 12/31/9999 43338 ESOPH LENGTHENING $ 112.79 $ 112.79 3/1/2020 12/31/9999 43340 FUSE ESOPHAGUS & INTESTINE $ 1,041.61 $ 1,041.61 3/1/2020 12/31/9999 43341 FUSE ESOPHAGUS & INTESTINE $ 1,145.48 $ 1,145.48 3/1/2020 12/31/9999 43351 SURGICAL OPENING ESOPHAGUS $ 1,042.10 $ 1,042.10 3/1/2020 12/31/9999 43352 SURGICAL OPENING ESOPHAGUS $ 852.02 $ 852.02 3/1/2020 12/31/9999 43360 GASTROINTESTINAL REPAIR $ 1,827.75 $ 1,827.75 3/1/2020 12/31/9999 43361 GASTROINTESTINAL REPAIR $ 2,042.53 $ 2,042.53 3/1/2020 12/31/9999 43400 LIGATE ESOPHAGUS VEINS $ 1,253.95 $ 1,253.95 3/1/2020 12/31/9999 43405 LIGATE/STAPLE ESOPHAGUS $ 1,151.41 $ 1,151.41 3/1/2020 12/31/9999 43410 REPAIR ESOPHAGUS WOUND $ 787.21 $ 787.21 3/1/2020 12/31/9999 43415 REPAIR ESOPHAGUS WOUND $ 1,342.32 $ 1,342.32 3/1/2020 12/31/9999 43420 REPAIR ESOPHAGUS OPENING $ 788.13 $ 788.13 3/1/2020 12/31/9999 43425 REPAIR ESOPHAGUS OPENING $ 1,178.99 $ 1,178.99 3/1/2020 12/31/9999 43450 DILATE ESOPHAGUS 1/MULT PASS $ 71.88 $ 123.01 3/1/2020 12/31/9999 43453 DILATE ESOPHAGUS $ 78.08 $ 228.76 3/1/2020 12/31/9999 43460 PRESSURE TREATMENT ESOPHAGUS $ 179.17 $ 179.17 3/1/2020 12/31/9999 43500 SURGICAL OPENING OF STOMACH $ 589.09 $ 589.09 3/1/2020 12/31/9999 43501 SURGICAL REPAIR OF STOMACH $ 1,014.26 $ 1,014.26 3/1/2020 12/31/9999 43502 SURGICAL REPAIR OF STOMACH $ 1,148.76 $ 1,148.76 3/1/2020 12/31/9999 43510 SURGICAL OPENING OF STOMACH $ 727.06 $ 727.06 3/1/2020 12/31/9999 43520 INCISION OF PYLORIC MUSCLE $ 532.59 $ 532.59 3/1/2020 12/31/9999 43605 BIOPSY OF STOMACH $ 625.65 $ 625.65 3/1/2020 12/31/9999 43610 EXCISION OF STOMACH LESION $ 739.31 $ 739.31 3/1/2020 12/31/9999 43611 EXCISION OF STOMACH LESION $ 920.00 $ 920.00 3/1/2020 12/31/9999 43620 REMOVAL OF STOMACH $ 1,500.86 $ 1,500.86 3/1/2020 12/31/9999 43621 REMOVAL OF STOMACH $ 1,709.72 $ 1,709.72 3/1/2020 12/31/9999 43622 REMOVAL OF STOMACH $ 1,734.95 $ 1,734.95 3/1/2020 12/31/9999 43631 REMOVAL OF STOMACH PARTIAL $ 1,099.97 $ 1,099.97 3/1/2020 12/31/9999 43632 REMOVAL OF STOMACH PARTIAL $ 1,500.70 $ 1,500.70 3/1/2020 12/31/9999 43633 REMOVAL OF STOMACH PARTIAL $ 1,427.73 $ 1,427.73 3/1/2020 12/31/9999 43634 REMOVAL OF STOMACH PARTIAL $ 1,576.91 $ 1,576.91 3/1/2020 12/31/9999 43635 REMOVAL OF STOMACH PARTIAL $ 88.19 $ 88.19 3/1/2020 12/31/9999 43640 VAGOTOMY & PYLORUS REPAIR $ 884.02 $ 884.02 3/1/2020 12/31/9999 43641 VAGOTOMY & PYLORUS REPAIR $ 891.75 $ 891.75 3/1/2020 12/31/9999 43644 LAP GASTRIC BYPASS/ROUX-EN-Y $ 1,309.14 $ 1,309.14 3/1/2020 12/31/9999 43645 LAP GASTR BYPASS INCL SMLL I $ 1,400.88 $ 1,400.88 3/1/2020 12/31/9999 43651 LAPAROSCOPY VAGUS NERVE $ 490.06 $ 490.06 3/1/2020 12/31/9999 43652 LAPAROSCOPY VAGUS NERVE $ 574.16 $ 574.16 3/1/2020 12/31/9999 43653 LAPAROSCOPY GASTROSTOMY $ 417.75 $ 417.75 3/1/2020 12/31/9999 43752 NASAL/OROGASTRIC W/TUBE PLMT $ 34.10 $ 34.10 3/1/2020 12/31/9999 43753 TX GASTRO INTUB W/ASP $ 17.70 $ 17.70 3/1/2020 12/31/9999 43754 DX GASTR INTUB W/ASP SPEC $ 26.74 $ 66.47 3/1/2020 12/31/9999 43755 DX GASTR INTUB W/ASP SPECS $ 48.98 $ 101.56 3/1/2020 12/31/9999 43756 DX DUOD INTUB W/ASP SPEC $ 44.19 $ 183.90 3/1/2020 12/31/9999 43757 DX DUOD INTUB W/ASP SPECS $ 63.93 $ 236.79 3/1/2020 12/31/9999 43761 REPOSITION GASTROSTOMY TUBE $ 88.47 $ 99.65 3/1/2020 12/31/9999 43762 RPLC GTUBE NO REVJ TRC $ 33.86 $ 192.01 3/1/2020 12/31/9999 43763 RPLC GTUBE REVJ GSTRST TRC $ 74.64 $ 285.52 3/1/2020 12/31/9999 43770 LAP PLACE GASTR ADJ DEVICE $ 837.72 $ 837.72 3/1/2020 12/31/9999 43771 LAP REVISE GASTR ADJ DEVICE $ 955.89 $ 955.89 3/1/2020 12/31/9999 43772 LAP RMVL GASTR ADJ DEVICE $ 722.89 $ 722.89 3/1/2020 12/31/9999 43773 LAP REPLACE GASTR ADJ DEVICE $ 956.68 $ 956.68 3/1/2020 12/31/9999 43774 LAP RMVL GASTR ADJ ALL PARTS $ 723.72 $ 723.72 3/1/2020 12/31/9999 43775 LAP SLEEVE GASTRECTOMY $ 1,082.64 $ 1,082.64 3/1/2020 12/31/9999 43800 RECONSTRUCTION OF PYLORUS $ 701.54 $ 701.54 3/1/2020 12/31/9999 43810 FUSION OF STOMACH AND BOWEL $ 760.58 $ 760.58 3/1/2020 12/31/9999 43820 FUSION OF STOMACH AND BOWEL $ 985.95 $ 985.95 3/1/2020 12/31/9999 43825 FUSION OF STOMACH AND BOWEL $ 978.61 $ 978.61 3/1/2020 12/31/9999 43830 PLACE GASTROSTOMY TUBE $ 519.60 $ 519.60 3/1/2020 12/31/9999 43831 PLACE GASTROSTOMY TUBE $ 433.43 $ 433.43 3/1/2020 12/31/9999 43832 PLACE GASTROSTOMY TUBE $ 800.94 $ 800.94 3/1/2020 12/31/9999 43840 REPAIR OF STOMACH LESION $ 1,000.00 $ 1,000.00 3/1/2020 12/31/9999 43842 V-BAND GASTROPLASTY $ 971.83 $ 971.83 3/1/2020 12/31/9999 43843 GASTROPLASTY W/O V-BAND $ 953.96 $ 953.96 3/1/2020 12/31/9999 43845 GASTROPLASTY DUODENAL SWITCH $ 1,477.79 $ 1,477.79 3/1/2020 12/31/9999 43846 GASTRIC BYPASS FOR OBESITY $ 1,230.34 $ 1,230.34 3/1/2020 12/31/9999 43847 GASTRIC BYPASS INCL SMALL I $ 1,344.79 $ 1,344.79 3/1/2020 12/31/9999 43848 REVISION GASTROPLASTY $ 1,459.34 $ 1,459.34 3/1/2020 12/31/9999 43850 REVISE STOMACH-BOWEL FUSION $ 1,222.39 $ 1,222.39 3/1/2020 12/31/9999 43855 REVISE STOMACH-BOWEL FUSION $ 1,277.34 $ 1,277.34 3/1/2020 12/31/9999 43860 REVISE STOMACH-BOWEL FUSION $ 1,241.07 $ 1,241.07 3/1/2020 12/31/9999 43865 REVISE STOMACH-BOWEL FUSION $ 1,291.03 $ 1,291.03 3/1/2020 12/31/9999 43870 REPAIR STOMACH OPENING $ 530.84 $ 530.84 3/1/2020 12/31/9999 43880 REPAIR STOMACH-BOWEL FISTULA $ 1,212.44 $ 1,212.44 3/1/2020 12/31/9999 43886 REVISE GASTRIC PORT OPEN $ 318.47 $ 318.47 3/1/2020 12/31/9999 43887 REMOVE GASTRIC PORT OPEN $ 287.47 $ 287.47 3/1/2020 12/31/9999 43888 CHANGE GASTRIC PORT OPEN $ 405.10 $ 405.10 3/1/2020 12/31/9999 44005 FREEING OF BOWEL ADHESION $ 828.20 $ 828.20 3/1/2020 12/31/9999 44010 INCISION OF SMALL BOWEL $ 650.76 $ 650.76 3/1/2020 12/31/9999 44015 INSERT NEEDLE CATH BOWEL $ 113.16 $ 113.16 3/1/2020 12/31/9999 44020 EXPLORE SMALL INTESTINE $ 731.83 $ 731.83 3/1/2020 12/31/9999 44021 DECOMPRESS SMALL BOWEL $ 740.18 $ 740.18 3/1/2020 12/31/9999 44025 INCISION OF LARGE BOWEL $ 745.07 $ 745.07 3/1/2020 12/31/9999 44050 REDUCE BOWEL OBSTRUCTION $ 705.19 $ 705.19 3/1/2020 12/31/9999 44055 CORRECT MALROTATION OF BOWEL $ 1,130.77 $ 1,130.77 3/1/2020 12/31/9999 44100 BIOPSY OF BOWEL $ 93.69 $ 93.69 3/1/2020 12/31/9999 44110 EXCISE INTESTINE LESION(S) $ 638.14 $ 638.14 3/1/2020 12/31/9999 44111 EXCISION OF BOWEL LESION(S) $ 743.33 $ 743.33 3/1/2020 12/31/9999 44120 REMOVAL OF SMALL INTESTINE $ 921.30 $ 921.30 3/1/2020 12/31/9999 44121 REMOVAL OF SMALL INTESTINE $ 190.28 $ 190.28 3/1/2020 12/31/9999 44125 REMOVAL OF SMALL INTESTINE $ 894.22 $ 894.22 3/1/2020 12/31/9999 44126 ENTERECTOMY W/O TAPER CONG $ 1,848.01 $ 1,848.01 3/1/2020 12/31/9999 44127 ENTERECTOMY W/TAPER CONG $ 2,152.14 $ 2,152.14 3/1/2020 12/31/9999 44128 ENTERECTOMY CONG ADD-ON $ 191.17 $ 191.17 3/1/2020 12/31/9999 44130 BOWEL TO BOWEL FUSION $ 964.99 $ 964.99 3/1/2020 12/31/9999 44135 INTESTINE TRANSPLNT CADAVER $ 964.99 $ 964.99 3/1/2020 12/31/9999 44139 MOBILIZATION OF COLON $ 95.25 $ 95.25 3/1/2020 12/31/9999 44140 PARTIAL REMOVAL OF COLON $ 1,017.50 $ 1,017.50 3/1/2020 12/31/9999 44141 PARTIAL REMOVAL OF COLON $ 1,339.96 $ 1,339.96 3/1/2020 12/31/9999 44143 PARTIAL REMOVAL OF COLON $ 1,253.74 $ 1,253.74 3/1/2020 12/31/9999 44144 PARTIAL REMOVAL OF COLON $ 1,317.81 $ 1,317.81 3/1/2020 12/31/9999 44145 PARTIAL REMOVAL OF COLON $ 1,268.75 $ 1,268.75 3/1/2020 12/31/9999 44146 PARTIAL REMOVAL OF COLON $ 1,585.55 $ 1,585.55 3/1/2020 12/31/9999 44147 PARTIAL REMOVAL OF COLON $ 1,431.90 $ 1,431.90 3/1/2020 12/31/9999 44150 REMOVAL OF COLON $ 1,388.99 $ 1,388.99 3/1/2020 12/31/9999 44151 REMOVAL OF COLON/ILEOSTOMY $ 1,588.82 $ 1,588.82 3/1/2020 12/31/9999 44155 REMOVAL OF COLON/ILEOSTOMY $ 1,556.96 $ 1,556.96 3/1/2020 12/31/9999 44156 REMOVAL OF COLON/ILEOSTOMY $ 1,710.67 $ 1,710.67 3/1/2020 12/31/9999 44157 COLECTOMY W/ILEOANAL ANAST $ 1,625.04 $ 1,625.04 3/1/2020 12/31/9999 44158 COLECTOMY W/NEO-RECTUM POUCH $ 1,665.88 $ 1,665.88 3/1/2020 12/31/9999 44160 REMOVAL OF COLON $ 937.62 $ 937.62 3/1/2020 12/31/9999 44180 LAP ENTEROLYSIS $ 698.72 $ 698.72 3/1/2020 12/31/9999 44186 LAP JEJUNOSTOMY $ 492.19 $ 492.19 3/1/2020 12/31/9999 44187 LAP ILEO/JEJUNO-STOMY $ 829.36 $ 829.36 3/1/2020 12/31/9999 44188 LAP COLOSTOMY $ 917.72 $ 917.72 3/1/2020 12/31/9999 44202 LAP ENTERECTOMY $ 1,053.06 $ 1,053.06 3/1/2020 12/31/9999 44203 LAP RESECT S/INTESTINE ADDL $ 189.49 $ 189.49 3/1/2020 12/31/9999 44204 LAPARO PARTIAL COLECTOMY $ 1,176.25 $ 1,176.25 3/1/2020 12/31/9999 44205 LAP COLECTOMY PART W/ILEUM $ 1,026.89 $ 1,026.89 3/1/2020 12/31/9999 44206 LAP PART COLECTOMY W/STOMA $ 1,334.32 $ 1,334.32 3/1/2020 12/31/9999 44207 L COLECTOMY/COLOPROCTOSTOMY $ 1,402.73 $ 1,402.73 3/1/2020 12/31/9999 44208 L COLECTOMY/COLOPROCTOSTOMY $ 1,524.10 $ 1,524.10 3/1/2020 12/31/9999 44210 LAPARO TOTAL PROCTOCOLECTOMY $ 1,361.71 $ 1,361.71 3/1/2020 12/31/9999 44211 LAP COLECTOMY W/PROCTECTOMY $ 1,671.94 $ 1,671.94 3/1/2020 12/31/9999 44212 LAPARO TOTAL PROCTOCOLECTOMY $ 1,567.95 $ 1,567.95 3/1/2020 12/31/9999 44213 LAP MOBIL SPLENIC FL ADD-ON $ 149.37 $ 149.37 3/1/2020 12/31/9999 44227 LAP CLOSE ENTEROSTOMY $ 1,273.60 $ 1,273.60 3/1/2020 12/31/9999 44300 OPEN BOWEL TO SKIN $ 633.12 $ 633.12 3/1/2020 12/31/9999 44310 ILEOSTOMY/JEJUNOSTOMY $ 792.29 $ 792.29 3/1/2020 12/31/9999 44312 REVISION OF ILEOSTOMY $ 449.65 $ 449.65 3/1/2020 12/31/9999 44314 REVISION OF ILEOSTOMY $ 766.56 $ 766.56 3/1/2020 12/31/9999 44316 DEVISE BOWEL POUCH $ 1,050.55 $ 1,050.55 3/1/2020 12/31/9999 44320 COLOSTOMY $ 903.28 $ 903.28 3/1/2020 12/31/9999 44322 COLOSTOMY WITH BIOPSIES $ 713.85 $ 713.85 3/1/2020 12/31/9999 44340 REVISION OF COLOSTOMY $ 452.03 $ 452.03 3/1/2020 12/31/9999 44345 REVISION OF COLOSTOMY $ 790.28 $ 790.28 3/1/2020 12/31/9999 44346 REVISION OF COLOSTOMY $ 887.65 $ 887.65 3/1/2020 12/31/9999 44360 SMALL BOWEL ENDOSCOPY $ 128.37 $ 128.37 3/1/2020 12/31/9999 44361 SMALL BOWEL ENDOSCOPY/BIOPSY $ 141.49 $ 141.49 3/1/2020 12/31/9999 44363 SMALL BOWEL ENDOSCOPY $ 167.67 $ 167.67 3/1/2020 12/31/9999 44364 SMALL BOWEL ENDOSCOPY $ 180.58 $ 180.58 3/1/2020 12/31/9999 44365 SMALL BOWEL ENDOSCOPY $ 160.77 $ 160.77 3/1/2020 12/31/9999 44366 SMALL BOWEL ENDOSCOPY $ 212.85 $ 212.85 3/1/2020 12/31/9999 44369 SMALL BOWEL ENDOSCOPY $ 217.43 $ 217.43 3/1/2020 12/31/9999 44370 SMALL BOWEL ENDOSCOPY/STENT $ 234.17 $ 234.17 3/1/2020 12/31/9999 44372 SMALL BOWEL ENDOSCOPY $ 207.28 $ 207.28 3/1/2020 12/31/9999 44373 SMALL BOWEL ENDOSCOPY $ 167.67 $ 167.67 3/1/2020 12/31/9999 44376 SMALL BOWEL ENDOSCOPY $ 248.03 $ 248.03 3/1/2020 12/31/9999 44377 SMALL BOWEL ENDOSCOPY/BIOPSY $ 262.95 $ 262.95 3/1/2020 12/31/9999 44378 SMALL BOWEL ENDOSCOPY $ 337.32 $ 337.32 3/1/2020 12/31/9999 44379 S BOWEL ENDOSCOPE W/STENT $ 357.49 $ 357.49 3/1/2020 12/31/9999 44380 SMALL BOWEL ENDOSCOPY BR/WA $ 55.82 $ 55.82 3/1/2020 12/31/9999 44381 SMALL BOWEL ENDOSCOPY BR/WA $ 57.54 $ 57.54 3/1/2020 12/31/9999 44382 SMALL BOWEL ENDOSCOPY $ 67.13 $ 67.13 3/1/2020 12/31/9999 44384 SMALL BOWEL ENDOSCOPY $ 57.54 $ 57.54 3/1/2020 12/31/9999 44385 ENDOSCOPY OF BOWEL POUCH $ 86.07 $ 190.06 3/1/2020 12/31/9999 44386 ENDOSCOPY BOWEL POUCH/BIOP $ 101.01 $ 263.47 3/1/2020 12/31/9999 44388 COLONOSCOPY THRU STOMA SPX $ 134.15 $ 263.99 3/1/2020 12/31/9999 44389 COLONOSCOPY WITH BIOPSY $ 149.78 $ 306.35 3/1/2020 12/31/9999 44390 COLONOSCOPY FOR FOREIGN BODY $ 179.75 $ 354.23 3/1/2020 12/31/9999 44391 COLONOSCOPY FOR BLEEDING $ 204.81 $ 396.93 3/1/2020 12/31/9999 44392 COLONOSCOPY & POLYPECTOMY $ 176.89 $ 332.88 3/1/2020 12/31/9999 44394 COLONOSCOPY W/SNARE $ 208.53 $ 389.48 3/1/2020 12/31/9999 44401 COLONOSCOPY WITH ABLATION $ 138.30 $ 272.16 3/1/2020 12/31/9999 44402 COLONOSCOPY W/STENT PLCMT $ 138.30 $ 272.16 3/1/2020 12/31/9999 44403 COLONOSCOPY W/RESECTION $ 138.30 $ 272.16 3/1/2020 12/31/9999 44404 COLONOSCOPY W/INJECTION $ 138.30 $ 272.16 3/1/2020 12/31/9999 44405 COLONOSCOPY W/DILATION $ 138.30 $ 272.16 3/1/2020 12/31/9999 44406 COLONOSCOPY W/ULTRASOUND $ 138.30 $ 272.16 3/1/2020 12/31/9999 44407 COLONOSCOPY W/NDL ASPIR/BX $ 138.30 $ 272.16 3/1/2020 12/31/9999 44408 COLONOSCOPY W/DECOMPRESSION $ 138.30 $ 272.16 3/1/2020 12/31/9999 44500 INTRO GASTROINTESTINAL TUBE $ 21.46 $ 21.46 3/1/2020 12/31/9999 44602 SUTURE SMALL INTESTINE $ 1,047.23 $ 1,047.23 3/1/2020 12/31/9999 44603 SUTURE SMALL INTESTINE $ 1,199.99 $ 1,199.99 3/1/2020 12/31/9999 44604 SUTURE LARGE INTESTINE $ 803.91 $ 803.91 3/1/2020 12/31/9999 44605 REPAIR OF BOWEL LESION $ 990.83 $ 990.83 3/1/2020 12/31/9999 44615 INTESTINAL STRICTUROPLASTY $ 816.18 $ 816.18 3/1/2020 12/31/9999 44620 REPAIR BOWEL OPENING $ 651.49 $ 651.49 3/1/2020 12/31/9999 44625 REPAIR BOWEL OPENING $ 771.95 $ 771.95 3/1/2020 12/31/9999 44626 REPAIR BOWEL OPENING $ 1,228.36 $ 1,228.36 3/1/2020 12/31/9999 44640 REPAIR BOWEL-SKIN FISTULA $ 1,071.33 $ 1,071.33 3/1/2020 12/31/9999 44650 REPAIR BOWEL FISTULA $ 1,114.13 $ 1,114.13 3/1/2020 12/31/9999 44660 REPAIR BOWEL-BLADDER FISTULA $ 1,079.49 $ 1,079.49 3/1/2020 12/31/9999 44661 REPAIR BOWEL-BLADDER FISTULA $ 1,211.03 $ 1,211.03 3/1/2020 12/31/9999 44680 SURGICAL REVISION INTESTINE $ 806.06 $ 806.06 3/1/2020 12/31/9999 44700 SUSPEND BOWEL W/PROSTHESIS $ 780.55 $ 780.55 3/1/2020 12/31/9999 44701 INTRAOP COLON LAVAGE ADD-ON $ 131.74 $ 131.74 3/1/2020 12/31/9999 44800 EXCISION OF BOWEL POUCH $ 572.68 $ 572.68 3/1/2020 12/31/9999 44820 EXCISION OF MESENTERY LESION $ 633.17 $ 633.17 3/1/2020 12/31/9999 44850 REPAIR OF MESENTERY $ 558.65 $ 558.65 3/1/2020 12/31/9999 44900 DRAIN APPENDIX ABSCESS OPEN $ 572.53 $ 572.53 3/1/2020 12/31/9999 44950 APPENDECTOMY $ 485.00 $ 485.00 3/1/2020 12/31/9999 44955 APPENDECTOMY ADD-ON $ 66.13 $ 66.13 3/1/2020 12/31/9999 44960 APPENDECTOMY $ 653.40 $ 653.40 3/1/2020 12/31/9999 44970 LAPAROSCOPY APPENDECTOMY $ 445.31 $ 445.31 3/1/2020 12/31/9999 45000 DRAINAGE OF PELVIC ABSCESS $ 310.46 $ 310.46 3/1/2020 12/31/9999 45005 DRAINAGE OF RECTAL ABSCESS $ 114.95 $ 184.29 3/1/2020 12/31/9999 45020 DRAINAGE OF RECTAL ABSCESS $ 405.68 $ 405.68 3/1/2020 12/31/9999 45100 BIOPSY OF RECTUM $ 215.09 $ 215.09 3/1/2020 12/31/9999 45108 REMOVAL OF ANORECTAL LESION $ 262.11 $ 262.11 3/1/2020 12/31/9999 45110 REMOVAL OF RECTUM $ 1,400.93 $ 1,400.93 3/1/2020 12/31/9999 45111 PARTIAL REMOVAL OF RECTUM $ 822.78 $ 822.78 3/1/2020 12/31/9999 45112 REMOVAL OF RECTUM $ 1,446.73 $ 1,446.73 3/1/2020 12/31/9999 45113 PARTIAL PROCTECTOMY $ 1,482.10 $ 1,482.10 3/1/2020 12/31/9999 45114 PARTIAL REMOVAL OF RECTUM $ 1,354.36 $ 1,354.36 3/1/2020 12/31/9999 45116 PARTIAL REMOVAL OF RECTUM $ 1,216.95 $ 1,216.95 3/1/2020 12/31/9999 45119 REMOVE RECTUM W/RESERVOIR $ 1,484.51 $ 1,484.51 3/1/2020 12/31/9999 45120 REMOVAL OF RECTUM $ 1,185.73 $ 1,185.73 3/1/2020 12/31/9999 45121 REMOVAL OF RECTUM AND COLON $ 1,297.87 $ 1,297.87 3/1/2020 12/31/9999 45123 PARTIAL PROCTECTOMY $ 841.03 $ 841.03 3/1/2020 12/31/9999 45126 PELVIC EXENTERATION $ 2,192.87 $ 2,192.87 3/1/2020 12/31/9999 45130 EXCISION OF RECTAL PROLAPSE $ 822.58 $ 822.58 3/1/2020 12/31/9999 45135 EXCISION OF RECTAL PROLAPSE $ 1,006.78 $ 1,006.78 3/1/2020 12/31/9999 45136 EXCISE ILEOANAL RESERVIOR $ 1,393.72 $ 1,393.72 3/1/2020 12/31/9999 45150 EXCISION OF RECTAL STRICTURE $ 298.33 $ 298.33 3/1/2020 12/31/9999 45160 EXCISION OF RECTAL LESION $ 747.66 $ 747.66 3/1/2020 12/31/9999 45171 EXC RECT TUM TRANSANAL PART $ 371.92 $ 371.92 3/1/2020 12/31/9999 45172 EXC RECT TUM TRANSANAL FULL $ 511.10 $ 511.10 3/1/2020 12/31/9999 45190 DESTRUCTION RECTAL TUMOR $ 507.27 $ 507.27 3/1/2020 12/31/9999 45300 PROCTOSIGMOIDOSCOPY DX $ 38.55 $ 80.27 3/1/2020 12/31/9999 45303 PROCTOSIGMOIDOSCOPY DILATE $ 65.97 $ 613.22 3/1/2020 12/31/9999 45305 PROCTOSIGMOIDOSCOPY W/BX $ 59.24 $ 130.62 3/1/2020 12/31/9999 45307 PROCTOSIGMOIDOSCOPY FB $ 75.00 $ 146.09 3/1/2020 12/31/9999 45308 PROCTOSIGMOIDOSCOPY REMOVAL $ 63.60 $ 133.52 3/1/2020 12/31/9999 45309 PROCTOSIGMOIDOSCOPY REMOVAL $ 73.80 $ 150.18 3/1/2020 12/31/9999 45315 PROCTOSIGMOIDOSCOPY REMOVAL $ 83.98 $ 162.11 3/1/2020 12/31/9999 45317 PROCTOSIGMOIDOSCOPY BLEED $ 88.57 $ 157.31 3/1/2020 12/31/9999 45320 PROCTOSIGMOIDOSCOPY ABLATE $ 84.13 $ 157.86 3/1/2020 12/31/9999 45321 PROCTOSIGMOIDOSCOPY VOLVUL $ 81.40 $ 81.40 3/1/2020 12/31/9999 45327 PROCTOSIGMOIDOSCOPY W/STENT $ 94.93 $ 94.93 3/1/2020 12/31/9999 45330 DIAGNOSTIC SIGMOIDOSCOPY $ 49.73 $ 103.48 3/1/2020 12/31/9999 45331 SIGMOIDOSCOPY AND BIOPSY $ 60.36 $ 131.46 3/1/2020 12/31/9999 45332 SIGMOIDOSCOPY W/FB REMOVAL $ 88.56 $ 215.75 3/1/2020 12/31/9999 45333 SIGMOIDOSCOPY & POLYPECTOMY $ 88.07 $ 217.02 3/1/2020 12/31/9999 45334 SIGMOIDOSCOPY FOR BLEEDING $ 133.61 $ 133.61 3/1/2020 12/31/9999 45335 SIGMOIDOSCOPY W/SUBMUC INJ $ 73.54 $ 185.47 3/1/2020 12/31/9999 45337 SIGMOIDOSCOPY & DECOMPRESS $ 114.43 $ 114.43 3/1/2020 12/31/9999 45338 SIGMOIDOSCOPY W/TUMR REMOVE $ 114.57 $ 242.92 3/1/2020 12/31/9999 45340 SIG W/TNDSC BALLOON DILATION $ 92.72 $ 329.18 3/1/2020 12/31/9999 45341 SIGMOIDOSCOPY W/ULTRASOUND $ 127.51 $ 127.51 3/1/2020 12/31/9999 45342 SIGMOIDOSCOPY W/US GUIDE BX $ 195.16 $ 195.16 3/1/2020 12/31/9999 45346 SIGMOIDOSCOPY W/ABLATION $ 51.26 $ 106.68 3/1/2020 12/31/9999 45347 SIGMOIDOSCOPY W/PLCMT STENT $ 51.26 $ 106.68 3/1/2020 12/31/9999 45349 SIGMOIDOSCOPY W/RESECTION $ 51.26 $ 106.68 3/1/2020 12/31/9999 45350 SGMDSC W/BAND LIGATION $ 51.26 $ 106.68 3/1/2020 12/31/9999 45378 DIAGNOSTIC COLONOSCOPY $ 175.51 $ 306.53 3/1/2020 12/31/9999 45379 COLONOSCOPY W/FB REMOVAL $ 219.91 $ 389.12 3/1/2020 12/31/9999 45380 COLONOSCOPY AND BIOPSY $ 211.47 $ 368.04 3/1/2020 12/31/9999 45381 COLONOSCOPY SUBMUCOUS NJX $ 200.19 $ 357.95 3/1/2020 12/31/9999 45382 COLONOSCOPY W/CONTROL BLEED $ 270.29 $ 484.72 3/1/2020 12/31/9999 45384 COLONOSCOPY W/LESION REMOVAL $ 219.74 $ 362.21 3/1/2020 12/31/9999 45385 COLONOSCOPY W/LESION REMOVAL $ 251.08 $ 415.58 3/1/2020 12/31/9999 45386 COLONOSCOPY W/BALLOON DILAT $ 215.84 $ 508.70 3/1/2020 12/31/9999 45388 COLONOSCOPY W/ABLATION $ 180.94 $ 316.01 3/1/2020 12/31/9999 45389 COLONOSCOPY W/STENT PLCMT $ 180.94 $ 316.01 3/1/2020 12/31/9999 45390 COLONOSCOPY W/RESECTION $ 180.94 $ 316.01 3/1/2020 12/31/9999 45391 COLONOSCOPY W/ENDOSCOPE US $ 242.94 $ 242.94 3/1/2020 12/31/9999 45392 COLONOSCOPY W/ENDOSCOPIC FNB $ 307.49 $ 307.49 3/1/2020 12/31/9999 45393 COLONOSCOPY W/DECOMPRESSION $ 180.94 $ 316.01 3/1/2020 12/31/9999 45395 LAP REMOVAL OF RECTUM $ 1,513.88 $ 1,513.88 3/1/2020 12/31/9999 45397 LAP REMOVE RECTUM W/POUCH $ 1,641.10 $ 1,641.10 3/1/2020 12/31/9999 45398 COLONOSCOPY W/BAND LIGATION $ 180.94 $ 316.01 3/1/2020 12/31/9999 45400 LAPAROSCOPIC PROC $ 874.39 $ 874.39 3/1/2020 12/31/9999 45402 LAP PROCTOPEXY W/SIG RESECT $ 1,170.63 $ 1,170.63 3/1/2020 12/31/9999 45500 REPAIR OF RECTUM $ 383.15 $ 383.15 3/1/2020 12/31/9999 45505 REPAIR OF RECTUM $ 419.90 $ 419.90 3/1/2020 12/31/9999 45520 TREATMENT OF RECTAL PROLAPSE $ 29.63 $ 92.51 3/1/2020 12/31/9999 45540 CORRECT RECTAL PROLAPSE $ 807.19 $ 807.19 3/1/2020 12/31/9999 45541 CORRECT RECTAL PROLAPSE $ 692.24 $ 692.24 3/1/2020 12/31/9999 45550 REPAIR RECTUM/REMOVE SIGMOID $ 1,109.96 $ 1,109.96 3/1/2020 12/31/9999 45560 REPAIR OF RECTOCELE $ 547.55 $ 547.55 3/1/2020 12/31/9999 45562 EXPLORATION/REPAIR OF RECTUM $ 840.00 $ 840.00 3/1/2020 12/31/9999 45563 EXPLORATION/REPAIR OF RECTUM $ 1,217.51 $ 1,217.51 3/1/2020 12/31/9999 45800 REPAIR RECT/BLADDER FISTULA $ 943.55 $ 943.55 3/1/2020 12/31/9999 45805 REPAIR FISTULA W/COLOSTOMY $ 1,066.64 $ 1,066.64 3/1/2020 12/31/9999 45820 REPAIR RECTOURETHRAL FISTULA $ 937.18 $ 937.18 3/1/2020 12/31/9999 45825 REPAIR FISTULA W/COLOSTOMY $ 1,127.61 $ 1,127.61 3/1/2020 12/31/9999 45900 REDUCTION OF RECTAL PROLAPSE $ 148.21 $ 148.21 3/1/2020 12/31/9999 45905 DILATION OF ANAL SPHINCTER $ 125.52 $ 125.52 3/1/2020 12/31/9999 45910 DILATION OF RECTAL NARROWING $ 148.76 $ 148.76 3/1/2020 12/31/9999 45915 REMOVE RECTAL OBSTRUCTION $ 166.60 $ 229.76 3/1/2020 12/31/9999 45990 SURG DX EXAM ANORECTAL $ 83.20 $ 83.20 3/1/2020 12/31/9999 46020 PLACEMENT OF SETON $ 164.22 $ 186.55 3/1/2020 12/31/9999 46030 REMOVAL OF RECTAL MARKER $ 65.40 $ 93.30 3/1/2020 12/31/9999 46040 INCISION OF RECTAL ABSCESS $ 294.38 $ 363.11 3/1/2020 12/31/9999 46045 INCISION OF RECTAL ABSCESS $ 303.72 $ 303.72 3/1/2020 12/31/9999 46050 INCISION OF ANAL ABSCESS $ 68.85 $ 128.78 3/1/2020 12/31/9999 46060 INCISION OF RECTAL ABSCESS $ 334.14 $ 334.14 3/1/2020 12/31/9999 46070 INCISION OF ANAL SEPTUM $ 169.75 $ 169.75 3/1/2020 12/31/9999 46080 INCISION OF ANAL SPHINCTER $ 119.21 $ 170.03 3/1/2020 12/31/9999 46083 INCISE EXTERNAL HEMORRHOID $ 79.55 $ 127.72 3/1/2020 12/31/9999 46200 REMOVAL OF ANAL FISSURE $ 221.47 $ 283.74 3/1/2020 12/31/9999 46220 EXCISE ANAL EXT TAG/PAPILLA $ 85.32 $ 136.43 3/1/2020 12/31/9999 46221 LIGATION OF HEMORRHOID(S) $ 134.97 $ 179.04 3/1/2020 12/31/9999 46230 REMOVAL OF ANAL TAGS $ 127.95 $ 187.88 3/1/2020 12/31/9999 46250 REMOVE EXT HEM GROUPS 2+ $ 224.92 $ 312.47 3/1/2020 12/31/9999 46255 REMOVE INT/EXT HEM 1 GROUP $ 256.24 $ 349.06 3/1/2020 12/31/9999 46257 REMOVE IN/EX HEM GRP & FISS $ 299.61 $ 299.61 3/1/2020 12/31/9999 46258 REMOVE IN/EX HEM GRP W/FISTU $ 327.68 $ 327.68 3/1/2020 12/31/9999 46260 REMOVE IN/EX HEM GROUPS 2+ $ 340.75 $ 340.75 3/1/2020 12/31/9999 46261 REMOVE IN/EX HEM GRPS & FISS $ 381.29 $ 381.29 3/1/2020 12/31/9999 46262 REMOVE IN/EX HEM GRPS W/FIST $ 397.76 $ 397.76 3/1/2020 12/31/9999 46270 REMOVE ANAL FIST SUBQ $ 269.52 $ 338.26 3/1/2020 12/31/9999 46275 REMOVE ANAL FIST INTER $ 289.25 $ 358.58 3/1/2020 12/31/9999 46280 REMOVE ANAL FIST COMPLEX $ 331.68 $ 331.68 3/1/2020 12/31/9999 46285 REMOVE ANAL FIST 2 STAGE $ 285.59 $ 348.75 3/1/2020 12/31/9999 46288 REPAIR ANAL FISTULA $ 392.57 $ 392.57 3/1/2020 12/31/9999 46320 REMOVAL OF HEMORRHOID CLOT $ 81.21 $ 123.51 3/1/2020 12/31/9999 46500 INJECTION INTO HEMORRHOID(S) $ 91.73 $ 149.58 3/1/2020 12/31/9999 46505 CHEMODENERVATION ANAL MUSC $ 167.72 $ 197.10 3/1/2020 12/31/9999 46600 DIAGNOSTIC ANOSCOPY SPX $ 29.35 $ 59.89 3/1/2020 12/31/9999 46601 DIAGNOSTIC ANOSCOPY $ 30.25 $ 61.74 3/1/2020 12/31/9999 46604 ANOSCOPY AND DILATION $ 50.99 $ 367.94 3/1/2020 12/31/9999 46606 ANOSCOPY AND BIOPSY $ 56.37 $ 152.71 3/1/2020 12/31/9999 46607 DIAGNOSTIC ANOSCOPY & BIOPSY $ 30.25 $ 61.74 3/1/2020 12/31/9999 46608 ANOSCOPY REMOVE FOR BODY $ 62.13 $ 157.90 3/1/2020 12/31/9999 46610 ANOSCOPY REMOVE LESION $ 61.59 $ 156.18 3/1/2020 12/31/9999 46611 ANOSCOPY $ 63.62 $ 123.84 3/1/2020 12/31/9999 46612 ANOSCOPY REMOVE LESIONS $ 75.31 $ 187.23 3/1/2020 12/31/9999 46614 ANOSCOPY CONTROL BLEEDING $ 53.71 $ 95.12 3/1/2020 12/31/9999 46615 ANOSCOPY $ 76.60 $ 110.39 3/1/2020 12/31/9999 46700 REPAIR OF ANAL STRICTURE $ 473.49 $ 473.49 3/1/2020 12/31/9999 46705 REPAIR OF ANAL STRICTURE $ 389.42 $ 389.42 3/1/2020 12/31/9999 46706 REPR OF ANAL FISTULA W/GLUE $ 125.07 $ 125.07 3/1/2020 12/31/9999 46707 REPAIR ANORECTAL FIST W/PLUG $ 285.92 $ 285.92 3/1/2020 12/31/9999 46710 REPR PER/VAG POUCH SNGL PROC $ 807.07 $ 807.07 3/1/2020 12/31/9999 46712 REPR PER/VAG POUCH DBL PROC $ 1,650.27 $ 1,650.27 3/1/2020 12/31/9999 46715 REP PERF ANOPER FISTU $ 385.46 $ 385.46 3/1/2020 12/31/9999 46716 REP PERF ANOPER/VESTIB FISTU $ 940.37 $ 940.37 3/1/2020 12/31/9999 46730 CONSTRUCTION OF ABSENT ANUS $ 1,431.40 $ 1,431.40 3/1/2020 12/31/9999 46735 CONSTRUCTION OF ABSENT ANUS $ 1,672.64 $ 1,672.64 3/1/2020 12/31/9999 46740 CONSTRUCTION OF ABSENT ANUS $ 1,537.73 $ 1,537.73 3/1/2020 12/31/9999 46742 REPAIR OF IMPERFORATED ANUS $ 1,817.97 $ 1,817.97 3/1/2020 12/31/9999 46744 REPAIR OF CLOACAL ANOMALY $ 2,597.79 $ 2,597.79 3/1/2020 12/31/9999 46746 REPAIR OF CLOACAL ANOMALY $ 2,996.88 $ 2,996.88 3/1/2020 12/31/9999 46748 REPAIR OF CLOACAL ANOMALY $ 3,132.79 $ 3,132.79 3/1/2020 12/31/9999 46750 REPAIR OF ANAL SPHINCTER $ 573.06 $ 573.06 3/1/2020 12/31/9999 46751 REPAIR OF ANAL SPHINCTER $ 474.68 $ 474.68 3/1/2020 12/31/9999 46753 RECONSTRUCTION OF ANUS $ 432.36 $ 432.36 3/1/2020 12/31/9999 46754 REMOVAL OF SUTURE FROM ANUS $ 158.14 $ 203.68 3/1/2020 12/31/9999 46760 REPAIR OF ANAL SPHINCTER $ 811.19 $ 811.19 3/1/2020 12/31/9999 46761 REPAIR OF ANAL SPHINCTER $ 702.03 $ 702.03 3/1/2020 12/31/9999 46900 DESTRUCTION ANAL LESION(S) $ 103.14 $ 163.95 3/1/2020 12/31/9999 46910 DESTRUCTION ANAL LESION(S) $ 98.77 $ 170.74 3/1/2020 12/31/9999 46916 CRYOSURGERY ANAL LESION(S) $ 108.33 $ 169.14 3/1/2020 12/31/9999 46917 LASER SURGERY ANAL LESIONS $ 99.48 $ 322.13 3/1/2020 12/31/9999 46922 EXCISION OF ANAL LESION(S) $ 98.79 $ 177.81 3/1/2020 12/31/9999 46924 DESTRUCTION ANAL LESION(S) $ 138.16 $ 366.41 3/1/2020 12/31/9999 46930 DESTROY INTERNAL HEMORRHOIDS $ 114.16 $ 156.74 3/1/2020 12/31/9999 46940 TREATMENT OF ANAL FISSURE $ 110.34 $ 155.59 3/1/2020 12/31/9999 46942 TREATMENT OF ANAL FISSURE $ 98.00 $ 143.83 3/1/2020 12/31/9999 46945 INT HRHC LIG 1 HROID W/O IMG $ 154.31 $ 198.95 3/1/2020 12/31/9999 46946 INT HRHC LIG 2+HROID W/O IMG $ 163.80 $ 216.08 3/1/2020 12/31/9999 46947 HEMORRHOIDOPEXY BY STAPLING $ 279.33 $ 279.33 3/1/2020 12/31/9999 47000 NEEDLE BIOPSY OF LIVER $ 84.19 $ 253.10 3/1/2020 12/31/9999 47001 NEEDLE BIOPSY LIVER ADD-ON $ 81.52 $ 81.52 3/1/2020 12/31/9999 47010 OPEN DRAINAGE LIVER LESION $ 899.25 $ 899.25 3/1/2020 12/31/9999 47015 INJECT/ASPIRATE LIVER CYST $ 853.36 $ 853.36 3/1/2020 12/31/9999 47100 WEDGE BIOPSY OF LIVER $ 624.07 $ 624.07 3/1/2020 12/31/9999 47120 PARTIAL REMOVAL OF LIVER $ 1,761.94 $ 1,761.94 3/1/2020 12/31/9999 47122 EXTENSIVE REMOVAL OF LIVER $ 2,625.04 $ 2,625.04 3/1/2020 12/31/9999 47125 PARTIAL REMOVAL OF LIVER $ 2,350.71 $ 2,350.71 3/1/2020 12/31/9999 47130 PARTIAL REMOVAL OF LIVER $ 2,527.90 $ 2,527.90 3/1/2020 12/31/9999 47135 TRANSPLANTATION OF LIVER $ 3,719.13 $ 3,719.13 3/1/2020 12/31/9999 47140 PARTIAL REMOVAL DONOR LIVER $ 2,646.34 $ 2,646.34 3/1/2020 12/31/9999 47141 PARTIAL REMOVAL DONOR LIVER $ 3,150.03 $ 3,150.03 3/1/2020 12/31/9999 47142 PARTIAL REMOVAL DONOR LIVER $ 3,468.84 $ 3,468.84 3/1/2020 12/31/9999 47300 SURGERY FOR LIVER LESION $ 839.66 $ 839.66 3/1/2020 12/31/9999 47350 REPAIR LIVER WOUND $ 1,031.00 $ 1,031.00 3/1/2020 12/31/9999 47360 REPAIR LIVER WOUND $ 1,404.25 $ 1,404.25 3/1/2020 12/31/9999 47361 REPAIR LIVER WOUND $ 2,310.84 $ 2,310.84 3/1/2020 12/31/9999 47362 REPAIR LIVER WOUND $ 1,070.08 $ 1,070.08 3/1/2020 12/31/9999 47370 LAPARO ABLATE LIVER TUMOR RF $ 943.25 $ 943.25 3/1/2020 12/31/9999 47371 LAPARO ABLATE LIVER CRYOSURG $ 960.11 $ 960.11 3/1/2020 12/31/9999 47380 OPEN ABLATE LIVER TUMOR RF $ 1,103.25 $ 1,103.25 3/1/2020 12/31/9999 47381 OPEN ABLATE LIVER TUMOR CRYO $ 1,124.40 $ 1,124.40 3/1/2020 12/31/9999 47382 PERCUT ABLATE LIVER RF $ 696.76 $ 696.76 3/1/2020 12/31/9999 47383 PERQ ABLTJ LVR CRYOABLATION $ 446.91 $ 6,513.24 3/1/2020 12/31/9999 47400 INCISION OF LIVER DUCT $ 1,602.94 $ 1,602.94 3/1/2020 12/31/9999 47420 INCISION OF BILE DUCT $ 1,009.61 $ 1,009.61 3/1/2020 12/31/9999 47425 INCISION OF BILE DUCT $ 1,019.77 $ 1,019.77 3/1/2020 12/31/9999 47460 INCISE BILE DUCT SPHINCTER $ 961.72 $ 961.72 3/1/2020 12/31/9999 47480 INCISION OF GALLBLADDER $ 639.41 $ 639.41 3/1/2020 12/31/9999 47490 INCISION OF GALLBLADDER $ 428.51 $ 428.51 3/1/2020 12/31/9999 47531 INJECTION FOR CHOLANGIOGRAM $ 86.84 $ 320.91 3/1/2020 12/31/9999 47532 INJECTION FOR CHOLANGIOGRAM $ 195.67 $ 706.26 3/1/2020 12/31/9999 47533 PLMT BILIARY DRAINAGE CATH $ 276.99 $ 1,150.75 3/1/2020 12/31/9999 47534 PLMT BILIARY DRAINAGE CATH $ 367.29 $ 1,419.16 3/1/2020 12/31/9999 47535 CONVERSION EXT BIL DRG CATH $ 210.55 $ 950.10 3/1/2020 12/31/9999 47536 EXCHANGE BILIARY DRG CATH $ 133.94 $ 700.79 3/1/2020 12/31/9999 47537 REMOVAL BILIARY DRG CATH $ 89.84 $ 347.09 3/1/2020 12/31/9999 47538 PERQ PLMT BILE DUCT STENT $ 298.64 $ 3,849.92 3/1/2020 12/31/9999 47539 PERQ PLMT BILE DUCT STENT $ 404.02 $ 4,211.35 3/1/2020 12/31/9999 47540 PERQ PLMT BILE DUCT STENT $ 482.66 $ 4,381.76 3/1/2020 12/31/9999 47541 PLMT ACCESS BIL TREE SM BWL $ 256.39 $ 1,017.01 3/1/2020 12/31/9999 47542 DILATE BILIARY DUCT/AMPULLA $ 119.01 $ 443.36 3/1/2020 12/31/9999 47543 ENDOLUMINAL BX BILIARY TREE $ 150.20 $ 1,137.09 3/1/2020 12/31/9999 47544 REMOVAL DUCT GLBLDR CALCULI $ 191.60 $ 700.09 3/1/2020 12/31/9999 47550 BILE DUCT ENDOSCOPY ADD-ON $ 130.40 $ 130.40 3/1/2020 12/31/9999 47552 BILIARY ENDO PERQ DX W/SPECI $ 278.38 $ 278.38 3/1/2020 12/31/9999 47553 BILIARY ENDOSCOPY THRU SKIN $ 278.99 $ 278.99 3/1/2020 12/31/9999 47554 BILIARY ENDOSCOPY THRU SKIN $ 408.37 $ 408.37 3/1/2020 12/31/9999 47555 BILIARY ENDOSCOPY THRU SKIN $ 334.59 $ 334.59 3/1/2020 12/31/9999 47556 BILIARY ENDOSCOPY THRU SKIN $ 378.51 $ 378.51 3/1/2020 12/31/9999 47562 LAPAROSCOPIC CHOLECYSTECTOMY $ 555.00 $ 555.00 3/1/2020 12/31/9999 47563 LAPARO CHOLECYSTECTOMY/GRAPH $ 568.35 $ 568.35 3/1/2020 12/31/9999 47564 LAPARO CHOLECYSTECTOMY/EXPLR $ 657.34 $ 657.34 3/1/2020 12/31/9999 47570 LAPARO CHOLECYSTOENTEROSTOMY $ 586.59 $ 586.59 3/1/2020 12/31/9999 47600 REMOVAL OF GALLBLADDER $ 796.95 $ 796.95 3/1/2020 12/31/9999 47605 REMOVAL OF GALLBLADDER $ 737.48 $ 737.48 3/1/2020 12/31/9999 47610 REMOVAL OF GALLBLADDER $ 946.35 $ 946.35 3/1/2020 12/31/9999 47612 REMOVAL OF GALLBLADDER $ 956.24 $ 956.24 3/1/2020 12/31/9999 47620 REMOVAL OF GALLBLADDER $ 1,038.17 $ 1,038.17 3/1/2020 12/31/9999 47700 EXPLORATION OF BILE DUCTS $ 786.01 $ 786.01 3/1/2020 12/31/9999 47701 BILE DUCT REVISION $ 1,353.08 $ 1,353.08 3/1/2020 12/31/9999 47711 EXCISION OF BILE DUCT TUMOR $ 1,174.69 $ 1,174.69 3/1/2020 12/31/9999 47712 EXCISION OF BILE DUCT TUMOR $ 1,505.37 $ 1,505.37 3/1/2020 12/31/9999 47715 EXCISION OF BILE DUCT CYST $ 986.80 $ 986.80 3/1/2020 12/31/9999 47720 FUSE GALLBLADDER & BOWEL $ 851.95 $ 851.95 3/1/2020 12/31/9999 47721 FUSE UPPER GI STRUCTURES $ 1,005.97 $ 1,005.97 3/1/2020 12/31/9999 47740 FUSE GALLBLADDER & BOWEL $ 972.00 $ 972.00 3/1/2020 12/31/9999 47741 FUSE GALLBLADDER & BOWEL $ 1,101.62 $ 1,101.62 3/1/2020 12/31/9999 47760 FUSE BILE DUCTS AND BOWEL $ 1,661.64 $ 1,661.64 3/1/2020 12/31/9999 47765 FUSE LIVER DUCTS & BOWEL $ 2,195.42 $ 2,195.42 3/1/2020 12/31/9999 47780 FUSE BILE DUCTS AND BOWEL $ 1,817.57 $ 1,817.57 3/1/2020 12/31/9999 47785 FUSE BILE DUCTS AND BOWEL $ 2,371.17 $ 2,371.17 3/1/2020 12/31/9999 47800 RECONSTRUCTION OF BILE DUCTS $ 1,186.22 $ 1,186.22 3/1/2020 12/31/9999 47801 PLACEMENT BILE DUCT SUPPORT $ 836.64 $ 836.64 3/1/2020 12/31/9999 47802 FUSE LIVER DUCT & INTESTINE $ 1,138.31 $ 1,138.31 3/1/2020 12/31/9999 47900 SUTURE BILE DUCT INJURY $ 1,025.92 $ 1,025.92 3/1/2020 12/31/9999 48000 DRAINAGE OF ABDOMEN $ 1,423.66 $ 1,423.66 3/1/2020 12/31/9999 48001 PLACEMENT OF DRAIN PANCREAS $ 1,751.09 $ 1,751.09 3/1/2020 12/31/9999 48020 REMOVAL OF PANCREATIC STONE $ 876.75 $ 876.75 3/1/2020 12/31/9999 48100 BIOPSY OF PANCREAS OPEN $ 665.52 $ 665.52 3/1/2020 12/31/9999 48102 NEEDLE BIOPSY PANCREAS $ 214.77 $ 426.86 3/1/2020 12/31/9999 48105 RESECT/DEBRIDE PANCREAS $ 2,158.68 $ 2,158.68 3/1/2020 12/31/9999 48120 REMOVAL OF PANCREAS LESION $ 832.05 $ 832.05 3/1/2020 12/31/9999 48140 PARTIAL REMOVAL OF PANCREAS $ 1,178.53 $ 1,178.53 3/1/2020 12/31/9999 48145 PARTIAL REMOVAL OF PANCREAS $ 1,224.05 $ 1,224.05 3/1/2020 12/31/9999 48146 PANCREATECTOMY $ 1,395.46 $ 1,395.46 3/1/2020 12/31/9999 48148 REMOVAL OF PANCREATIC DUCT $ 926.74 $ 926.74 3/1/2020 12/31/9999 48150 PARTIAL REMOVAL OF PANCREAS $ 2,358.47 $ 2,358.47 3/1/2020 12/31/9999 48152 PANCREATECTOMY $ 2,180.36 $ 2,180.36 3/1/2020 12/31/9999 48153 PANCREATECTOMY $ 2,355.29 $ 2,355.29 3/1/2020 12/31/9999 48154 PANCREATECTOMY $ 2,186.11 $ 2,186.11 3/1/2020 12/31/9999 48155 REMOVAL OF PANCREAS $ 1,353.12 $ 1,353.12 3/1/2020 12/31/9999 48160 PANCREAS REMOVAL/TRANSPLANT $ 2,385.30 $ 2,385.30 3/1/2020 12/31/9999 48400 INJECTION INTRAOP ADD-ON $ 85.80 $ 85.80 3/1/2020 12/31/9999 48500 SURGERY OF PANCREATIC CYST $ 847.27 $ 847.27 3/1/2020 12/31/9999 48510 DRAIN PANCREATIC PSEUDOCYST $ 804.50 $ 804.50 3/1/2020 12/31/9999 48520 FUSE PANCREAS CYST AND BOWEL $ 822.41 $ 822.41 3/1/2020 12/31/9999 48540 FUSE PANCREAS CYST AND BOWEL $ 983.50 $ 983.50 3/1/2020 12/31/9999 48545 PANCREATORRHAPHY $ 995.60 $ 995.60 3/1/2020 12/31/9999 48547 DUODENAL EXCLUSION $ 1,343.80 $ 1,343.80 3/1/2020 12/31/9999 48548 FUSE PANCREAS AND BOWEL $ 1,257.97 $ 1,257.97 3/1/2020 12/31/9999 48550 DONOR PANCREATECTOMY $ 1,372.30 $ 1,372.30 3/1/2020 12/31/9999 48554 TRANSPL ALLOGRAFT PANCREAS $ 1,859.26 $ 1,859.26 3/1/2020 12/31/9999 48556 REMOVAL ALLOGRAFT PANCREAS $ 928.12 $ 928.12 3/1/2020 12/31/9999 49000 EXPLORATION OF ABDOMEN $ 584.58 $ 584.58 3/1/2020 12/31/9999 49002 REOPENING OF ABDOMEN $ 768.80 $ 768.80 3/1/2020 12/31/9999 49010 EXPLORATION BEHIND ABDOMEN $ 725.28 $ 725.28 3/1/2020 12/31/9999 49013 PRPERTL PEL PACK HEMRRG TRMA $ 393.20 $ 393.20 3/1/2020 12/31/9999 49014 REEXPLORATION PELVIC WOUND $ 324.93 $ 324.93 3/1/2020 12/31/9999 49020 DRAINAGE ABDOM ABSCESS OPEN $ 1,200.21 $ 1,200.21 3/1/2020 12/31/9999 49040 DRAIN OPEN ABDOM ABSCESS $ 751.86 $ 751.86 3/1/2020 12/31/9999 49060 DRAIN OPEN RETROPERI ABSCESS $ 841.68 $ 841.68 3/1/2020 12/31/9999 49062 DRAIN TO PERITONEAL CAVITY $ 571.50 $ 571.50 3/1/2020 12/31/9999 49082 ABD PARACENTESIS $ 41.70 $ 96.98 3/1/2020 12/31/9999 49083 ABD PARACENTESIS W/IMAGING $ 64.30 $ 183.09 3/1/2020 12/31/9999 49084 PERITONEAL LAVAGE $ 58.89 $ 58.89 3/1/2020 12/31/9999 49180 BIOPSY ABDOMINAL MASS $ 76.35 $ 135.38 3/1/2020 12/31/9999 49185 SCLEROTX FLUID COLLECTION $ 111.48 $ 853.45 3/1/2020 12/31/9999 49200 EXCISION INTRA-ABD RETROPERITONEAL TUMOR $ 557.83 $ 557.83 3/1/2020 12/31/9999 49203 EXC ABD TUM 5 CM OR LESS $ 916.71 $ 916.71 3/1/2020 12/31/9999 49204 EXC ABD TUM OVER 5 CM $ 1,171.56 $ 1,171.56 3/1/2020 12/31/9999 49205 EXC ABD TUM OVER 10 CM $ 1,341.91 $ 1,341.91 3/1/2020 12/31/9999 49215 EXCISE SACRAL SPINE TUMOR $ 1,682.75 $ 1,682.75 3/1/2020 12/31/9999 49220 MULTIPLE SURGERY ABDOMEN $ 730.80 $ 730.80 3/1/2020 12/31/9999 49250 EXCISION OF UMBILICUS $ 435.75 $ 435.75 3/1/2020 12/31/9999 49255 REMOVAL OF OMENTUM $ 592.10 $ 592.10 3/1/2020 12/31/9999 49320 DIAG LAPARO SEPARATE PROC $ 249.64 $ 249.64 3/1/2020 12/31/9999 49321 LAPAROSCOPY BIOPSY $ 262.82 $ 262.82 3/1/2020 12/31/9999 49322 LAPAROSCOPY ASPIRATION $ 285.81 $ 285.81 3/1/2020 12/31/9999 49323 LAPARO DRAIN LYMPHOCELE $ 485.38 $ 485.38 3/1/2020 12/31/9999 49324 LAP INSERT TUNNEL IP CATH $ 297.54 $ 297.54 3/1/2020 12/31/9999 49325 LAP REVISION PERM IP CATH $ 319.55 $ 319.55 3/1/2020 12/31/9999 49326 LAP W/OMENTOPEXY ADD-ON $ 147.91 $ 147.91 3/1/2020 12/31/9999 49400 AIR INJECTION INTO ABDOMEN $ 82.70 $ 141.15 3/1/2020 12/31/9999 49402 REMOVE FOREIGN BODY ADBOMEN $ 645.55 $ 645.55 3/1/2020 12/31/9999 49405 IMAGE CATH FLUID COLXN VISC $ 183.12 $ 725.00 3/1/2020 12/31/9999 49406 IMAGE CATH FLUID PERI/RETRO $ 183.41 $ 724.72 3/1/2020 12/31/9999 49407 IMAGE CATH FLUID TRNS/VGNL $ 195.25 $ 613.25 3/1/2020 12/31/9999 49418 INSERT TUN IP CATH PERC $ 196.88 $ 1,276.82 3/1/2020 12/31/9999 49419 INSERT TUN IP CATH W/PORT $ 344.73 $ 344.73 3/1/2020 12/31/9999 49421 INS TUN IP CATH FOR DIAL OPN $ 295.30 $ 295.30 3/1/2020 12/31/9999 49422 REMOVE TUNNELED IP CATH $ 296.88 $ 296.88 3/1/2020 12/31/9999 49423 EXCHANGE DRAINAGE CATHETER $ 65.80 $ 440.33 3/1/2020 12/31/9999 49424 ASSESS CYST CONTRAST INJECT $ 34.35 $ 120.40 3/1/2020 12/31/9999 49425 INSERT ABDOMEN-VENOUS DRAIN $ 579.53 $ 579.53 3/1/2020 12/31/9999 49426 REVISE ABDOMEN-VENOUS SHUNT $ 493.65 $ 493.65 3/1/2020 12/31/9999 49427 INJECTION ABDOMINAL SHUNT $ 39.66 $ 39.66 3/1/2020 12/31/9999 49428 LIGATION OF SHUNT $ 331.89 $ 331.89 3/1/2020 12/31/9999 49429 REMOVAL OF SHUNT $ 351.03 $ 351.03 3/1/2020 12/31/9999 49435 INSERT SUBQ EXTEN TO IP CATH $ 94.71 $ 94.71 3/1/2020 12/31/9999 49436 EMBEDDED IP CATH EXIT-SITE $ 138.35 $ 138.35 3/1/2020 12/31/9999 49440 PLACE GASTROSTOMY TUBE PERC $ 198.71 $ 859.94 3/1/2020 12/31/9999 49441 PLACE DUOD/JEJ TUBE PERC $ 219.60 $ 933.99 3/1/2020 12/31/9999 49442 PLACE CECOSTOMY TUBE PERC $ 181.50 $ 836.57 3/1/2020 12/31/9999 49446 CHANGE G-TUBE TO G-J PERC $ 146.34 $ 780.54 3/1/2020 12/31/9999 49450 REPLACE G/C TUBE PERC $ 58.60 $ 581.48 3/1/2020 12/31/9999 49451 REPLACE DUOD/JEJ TUBE PERC $ 81.51 $ 554.73 3/1/2020 12/31/9999 49452 REPLACE G-J TUBE PERC $ 127.05 $ 699.87 3/1/2020 12/31/9999 49460 FIX G/COLON TUBE W/DEVICE $ 41.77 $ 636.32 3/1/2020 12/31/9999 49465 FLUORO EXAM OF G/COLON TUBE $ 27.34 $ 133.97 3/1/2020 12/31/9999 49491 RPR HERN PREEMIE REDUC $ 582.99 $ 582.99 3/1/2020 12/31/9999 49492 RPR ING HERN PREMIE BLOCKED $ 712.43 $ 712.43 3/1/2020 12/31/9999 49495 RPR ING HERNIA BABY REDUC $ 296.27 $ 296.27 3/1/2020 12/31/9999 49496 RPR ING HERNIA BABY BLOCKED $ 449.40 $ 449.40 3/1/2020 12/31/9999 49500 RPR ING HERNIA INIT REDUCE $ 294.16 $ 294.16 3/1/2020 12/31/9999 49501 RPR ING HERNIA INIT BLOCKED $ 446.21 $ 446.21 3/1/2020 12/31/9999 49505 PRP I/HERN INIT REDUC >5 YR $ 386.43 $ 386.43 3/1/2020 12/31/9999 49507 PRP I/HERN INIT BLOCK >5 YR $ 476.14 $ 476.14 3/1/2020 12/31/9999 49520 REREPAIR ING HERNIA REDUCE $ 472.67 $ 472.67 3/1/2020 12/31/9999 49521 REREPAIR ING HERNIA BLOCKED $ 576.98 $ 576.98 3/1/2020 12/31/9999 49525 REPAIR ING HERNIA SLIDING $ 427.17 $ 427.17 3/1/2020 12/31/9999 49540 REPAIR LUMBAR HERNIA $ 505.64 $ 505.64 3/1/2020 12/31/9999 49550 RPR REM HERNIA INIT REDUCE $ 429.28 $ 429.28 3/1/2020 12/31/9999 49553 RPR FEM HERNIA INIT BLOCKED $ 469.94 $ 469.94 3/1/2020 12/31/9999 49555 REREPAIR FEM HERNIA REDUCE $ 447.00 $ 447.00 3/1/2020 12/31/9999 49557 REREPAIR FEM HERNIA BLOCKED $ 543.24 $ 543.24 3/1/2020 12/31/9999 49560 RPR VENTRAL HERN INIT REDUC $ 555.53 $ 555.53 3/1/2020 12/31/9999 49561 RPR VENTRAL HERN INIT BLOCK $ 701.35 $ 701.35 3/1/2020 12/31/9999 49565 REREPAIR VENTRL HERN REDUCE $ 575.99 $ 575.99 3/1/2020 12/31/9999 49566 REREPAIR VENTRL HERN BLOCK $ 708.57 $ 708.57 3/1/2020 12/31/9999 49568 HERNIA REPAIR W/MESH $ 209.57 $ 209.57 3/1/2020 12/31/9999 49570 RPR EPIGASTRIC HERN REDUCE $ 303.68 $ 303.68 3/1/2020 12/31/9999 49572 RPR EPIGASTRIC HERN BLOCKED $ 377.01 $ 377.01 3/1/2020 12/31/9999 49580 RPR UMBIL HERN REDUC < 5 YR $ 236.06 $ 236.06 3/1/2020 12/31/9999 49582 RPR UMBIL HERN BLOCK < 5 YR $ 351.47 $ 351.47 3/1/2020 12/31/9999 49585 RPR UMBIL HERN REDUC > 5 YR $ 326.64 $ 326.64 3/1/2020 12/31/9999 49587 RPR UMBIL HERN BLOCK > 5 YR $ 387.57 $ 387.57 3/1/2020 12/31/9999 49590 REPAIR SPIGELIAN HERNIA $ 425.63 $ 425.63 3/1/2020 12/31/9999 49600 REPAIR UMBILICAL LESION $ 549.45 $ 549.45 3/1/2020 12/31/9999 49605 REPAIR UMBILICAL LESION $ 3,808.67 $ 3,808.67 3/1/2020 12/31/9999 49606 REPAIR UMBILICAL LESION $ 861.27 $ 861.27 3/1/2020 12/31/9999 49610 REPAIR UMBILICAL LESION $ 511.16 $ 511.16 3/1/2020 12/31/9999 49611 REPAIR UMBILICAL LESION $ 459.57 $ 459.57 3/1/2020 12/31/9999 49650 LAP ING HERNIA REPAIR INIT $ 317.78 $ 317.78 3/1/2020 12/31/9999 49651 LAP ING HERNIA REPAIR RECUR $ 411.05 $ 411.05 3/1/2020 12/31/9999 49652 LAP VENT/ABD HERNIA REPAIR $ 599.00 $ 599.00 3/1/2020 12/31/9999 49653 LAP VENT/ABD HERN PROC COMP $ 748.44 $ 748.44 3/1/2020 12/31/9999 49654 LAP INC HERNIA REPAIR $ 688.44 $ 688.44 3/1/2020 12/31/9999 49655 LAP INC HERN REPAIR COMP $ 828.69 $ 828.69 3/1/2020 12/31/9999 49656 LAP INC HERNIA REPAIR RECUR $ 690.93 $ 690.93 3/1/2020 12/31/9999 49657 LAP INC HERN RECUR COMP $ 998.00 $ 998.00 3/1/2020 12/31/9999 49900 REPAIR OF ABDOMINAL WALL $ 610.25 $ 610.25 3/1/2020 12/31/9999 49904 OMENTAL FLAP EXTRA-ABDOM $ 1,136.14 $ 1,136.14 3/1/2020 12/31/9999 49905 OMENTAL FLAP INTRA-ABDOM $ 279.77 $ 279.77 3/1/2020 12/31/9999 50010 EXPLORATION OF KIDNEY $ 597.51 $ 597.51 3/1/2020 12/31/9999 50020 RENAL ABSCESS OPEN DRAIN $ 853.28 $ 853.28 3/1/2020 12/31/9999 50040 DRAINAGE OF KIDNEY $ 803.46 $ 803.46 3/1/2020 12/31/9999 50045 EXPLORATION OF KIDNEY $ 811.37 $ 811.37 3/1/2020 12/31/9999 50060 REMOVAL OF KIDNEY STONE $ 999.59 $ 999.59 3/1/2020 12/31/9999 50065 INCISION OF KIDNEY $ 1,051.25 $ 1,051.25 3/1/2020 12/31/9999 50070 INCISION OF KIDNEY $ 1,044.47 $ 1,044.47 3/1/2020 12/31/9999 50075 REMOVAL OF KIDNEY STONE $ 1,284.34 $ 1,284.34 3/1/2020 12/31/9999 50080 REMOVAL OF KIDNEY STONE $ 763.11 $ 763.11 3/1/2020 12/31/9999 50081 REMOVAL OF KIDNEY STONE $ 1,121.42 $ 1,121.42 3/1/2020 12/31/9999 50100 REVISE KIDNEY BLOOD VESSELS $ 817.83 $ 817.83 3/1/2020 12/31/9999 50120 EXPLORATION OF KIDNEY $ 827.26 $ 827.26 3/1/2020 12/31/9999 50125 EXPLORE AND DRAIN KIDNEY $ 855.48 $ 855.48 3/1/2020 12/31/9999 50130 REMOVAL OF KIDNEY STONE $ 905.33 $ 905.33 3/1/2020 12/31/9999 50135 EXPLORATION OF KIDNEY $ 980.78 $ 980.78 3/1/2020 12/31/9999 50200 RENAL BIOPSY PERQ $ 124.05 $ 124.05 3/1/2020 12/31/9999 50205 RENAL BIOPSY OPEN $ 576.02 $ 576.02 3/1/2020 12/31/9999 50220 REMOVE KIDNEY OPEN $ 891.46 $ 891.46 3/1/2020 12/31/9999 50225 REMOVAL KIDNEY OPEN COMPLEX $ 1,033.11 $ 1,033.11 3/1/2020 12/31/9999 50230 REMOVAL KIDNEY OPEN RADICAL $ 1,120.42 $ 1,120.42 3/1/2020 12/31/9999 50234 REMOVAL OF KIDNEY & URETER $ 1,137.32 $ 1,137.32 3/1/2020 12/31/9999 50236 REMOVAL OF KIDNEY & URETER $ 1,286.65 $ 1,286.65 3/1/2020 12/31/9999 50240 PARTIAL REMOVAL OF KIDNEY $ 1,155.58 $ 1,155.58 3/1/2020 12/31/9999 50250 CRYOABLATE RENAL MASS OPEN $ 1,071.92 $ 1,071.92 3/1/2020 12/31/9999 50280 REMOVAL OF KIDNEY LESION $ 823.64 $ 823.64 3/1/2020 12/31/9999 50290 REMOVAL OF KIDNEY LESION $ 760.62 $ 760.62 3/1/2020 12/31/9999 50300 REMOVE CADAVER DONOR KIDNEY $ 1,275.89 $ 1,275.89 3/1/2020 12/31/9999 50320 REMOVE KIDNEY LIVING DONOR $ 1,120.77 $ 1,120.77 3/1/2020 12/31/9999 50340 REMOVAL OF KIDNEY $ 691.33 $ 691.33 3/1/2020 12/31/9999 50360 TRANSPLANTATION OF KIDNEY $ 1,900.19 $ 1,900.19 3/1/2020 12/31/9999 50365 TRANSPLANTATION OF KIDNEY $ 2,140.83 $ 2,140.83 3/1/2020 12/31/9999 50370 REMOVE TRANSPLANTED KIDNEY $ 887.88 $ 887.88 3/1/2020 12/31/9999 50380 REIMPLANTATION OF KIDNEY $ 1,498.27 $ 1,498.27 3/1/2020 12/31/9999 50382 CHANGE URETER STENT PERCUT $ 245.84 $ 1,035.43 3/1/2020 12/31/9999 50384 REMOVE URETER STENT PERCUT $ 223.78 $ 891.17 3/1/2020 12/31/9999 50385 CHANGE STENT VIA TRANSURETH $ 209.60 $ 1,011.22 3/1/2020 12/31/9999 50386 REMOVE STENT VIA TRANSURETH $ 158.17 $ 656.37 3/1/2020 12/31/9999 50387 CHANGE NEPHROURETERAL CATH $ 89.12 $ 478.05 3/1/2020 12/31/9999 50389 REMOVE RENAL TUBE W/FLUORO $ 48.97 $ 277.21 3/1/2020 12/31/9999 50390 DRAINAGE OF KIDNEY LESION $ 86.69 $ 86.69 3/1/2020 12/31/9999 50391 INSTLL RX AGNT INTO RNAL TUB $ 88.27 $ 110.30 3/1/2020 12/31/9999 50396 MEASURE KIDNEY PRESSURE $ 103.06 $ 103.06 3/1/2020 12/31/9999 50400 REVISION OF KIDNEY/URETER $ 1,009.55 $ 1,009.55 3/1/2020 12/31/9999 50405 REVISION OF KIDNEY/URETER $ 1,224.90 $ 1,224.90 3/1/2020 12/31/9999 50430 NJX PX NFROSGRM &/URTRGRM $ 150.99 $ 450.37 3/1/2020 12/31/9999 50431 NJX PX NFROSGRM &/URTRGRM $ 59.73 $ 140.07 3/1/2020 12/31/9999 50432 PLMT NEPHROSTOMY CATHETER $ 199.65 $ 728.29 3/1/2020 12/31/9999 50433 PLMT NEPHROURETERAL CATHETER $ 246.63 $ 979.58 3/1/2020 12/31/9999 50434 CONVERT NEPHROSTOMY CATHETER $ 188.91 $ 775.02 3/1/2020 12/31/9999 50435 EXCHANGE NEPHROSTOMY CATH $ 91.44 $ 406.16 3/1/2020 12/31/9999 50436 DILAT XST TRC NDURLGC PX $ 136.57 $ 136.57 3/1/2020 12/31/9999 50437 DILAT XST TRC NEW ACCESS RCS $ 228.30 $ 228.30 3/1/2020 12/31/9999 50500 REPAIR OF KIDNEY WOUND $ 978.85 $ 978.85 3/1/2020 12/31/9999 50520 CLOSE KIDNEY-SKIN FISTULA $ 905.04 $ 905.04 3/1/2020 12/31/9999 50525 CLOSE NEPHROVISCERAL FISTULA $ 1,132.52 $ 1,132.52 3/1/2020 12/31/9999 50526 CLOSE NEPHROVISCERAL FISTULA $ 1,187.00 $ 1,187.00 3/1/2020 12/31/9999 50540 REVISION OF HORSESHOE KIDNEY $ 989.37 $ 989.37 3/1/2020 12/31/9999 50541 LAPARO ABLATE RENAL CYST $ 805.84 $ 805.84 3/1/2020 12/31/9999 50542 LAPARO ABLATE RENAL MASS $ 1,022.25 $ 1,022.25 3/1/2020 12/31/9999 50543 LAPARO PARTIAL NEPHRECTOMY $ 1,304.66 $ 1,304.66 3/1/2020 12/31/9999 50544 LAPAROSCOPY PYELOPLASTY $ 1,100.37 $ 1,100.37 3/1/2020 12/31/9999 50545 LAPARO RADICAL NEPHRECTOMY $ 1,180.96 $ 1,180.96 3/1/2020 12/31/9999 50546 LAPAROSCOPIC NEPHRECTOMY $ 1,046.47 $ 1,046.47 3/1/2020 12/31/9999 50547 LAPARO REMOVAL DONOR KIDNEY $ 1,257.12 $ 1,257.12 3/1/2020 12/31/9999 50548 LAPARO REMOVE W/URETER $ 1,190.96 $ 1,190.96 3/1/2020 12/31/9999 50551 KIDNEY ENDOSCOPY $ 262.54 $ 320.40 3/1/2020 12/31/9999 50553 KIDNEY ENDOSCOPY $ 277.37 $ 334.64 3/1/2020 12/31/9999 50555 KIDNEY ENDOSCOPY & BIOPSY $ 303.65 $ 365.04 3/1/2020 12/31/9999 50557 KIDNEY ENDOSCOPY & TREATMENT $ 308.39 $ 372.41 3/1/2020 12/31/9999 50561 KIDNEY ENDOSCOPY & TREATMENT $ 352.35 $ 422.54 3/1/2020 12/31/9999 50562 RENAL SCOPE W/TUMOR RESECT $ 518.29 $ 518.29 3/1/2020 12/31/9999 50570 KIDNEY ENDOSCOPY $ 439.99 $ 439.99 3/1/2020 12/31/9999 50572 KIDNEY ENDOSCOPY $ 478.82 $ 478.82 3/1/2020 12/31/9999 50574 KIDNEY ENDOSCOPY & BIOPSY $ 505.82 $ 505.82 3/1/2020 12/31/9999 50575 KIDNEY ENDOSCOPY $ 639.79 $ 639.79 3/1/2020 12/31/9999 50576 KIDNEY ENDOSCOPY & TREATMENT $ 505.07 $ 505.07 3/1/2020 12/31/9999 50580 KIDNEY ENDOSCOPY & TREATMENT $ 541.04 $ 541.04 3/1/2020 12/31/9999 50590 FRAGMENTING OF KIDNEY STONE $ 491.07 $ 788.62 3/1/2020 12/31/9999 50592 PERC RF ABLATE RENAL TUMOR $ 318.82 $ 2,920.84 3/1/2020 12/31/9999 50600 EXPLORATION OF URETER $ 817.97 $ 817.97 3/1/2020 12/31/9999 50605 INSERT URETERAL SUPPORT $ 788.55 $ 788.55 3/1/2020 12/31/9999 50606 ENDOLUMINAL BX URTR RNL PLVS $ 142.53 $ 456.34 3/1/2020 12/31/9999 50610 REMOVAL OF URETER STONE $ 834.49 $ 834.49 3/1/2020 12/31/9999 50620 REMOVAL OF URETER STONE $ 791.50 $ 791.50 3/1/2020 12/31/9999 50630 REMOVAL OF URETER STONE $ 771.99 $ 771.99 3/1/2020 12/31/9999 50650 REMOVAL OF URETER $ 902.58 $ 902.58 3/1/2020 12/31/9999 50660 REMOVAL OF URETER $ 998.38 $ 998.38 3/1/2020 12/31/9999 50684 INJECTION FOR URETER X-RAY $ 43.06 $ 148.22 3/1/2020 12/31/9999 50686 MEASURE URETER PRESSURE $ 78.95 $ 78.95 3/1/2020 12/31/9999 50688 CHANGE OF URETER TUBE/STENT $ 68.54 $ 68.54 3/1/2020 12/31/9999 50690 INJECTION FOR URETER X-RAY $ 60.87 $ 84.66 3/1/2020 12/31/9999 50693 PLMT URETERAL STENT PRQ $ 197.75 $ 910.53 3/1/2020 12/31/9999 50694 PLMT URETERAL STENT PRQ $ 255.71 $ 1,004.29 3/1/2020 12/31/9999 50695 PLMT URETERAL STENT PRQ $ 324.12 $ 1,225.26 3/1/2020 12/31/9999 50700 REVISION OF URETER $ 808.15 $ 808.15 3/1/2020 12/31/9999 50705 URETERAL EMBOLIZATION/OCCL $ 182.37 $ 1,461.72 3/1/2020 12/31/9999 50706 BALLOON DILATE URTRL STRIX $ 169.80 $ 659.33 3/1/2020 12/31/9999 50715 RELEASE OF URETER $ 956.38 $ 956.38 3/1/2020 12/31/9999 50722 RELEASE OF URETER $ 831.96 $ 831.96 3/1/2020 12/31/9999 50725 RELEASE/REVISE URETER $ 951.09 $ 951.09 3/1/2020 12/31/9999 50727 REVISE URETER $ 434.75 $ 434.75 3/1/2020 12/31/9999 50728 REVISE URETER $ 600.08 $ 600.08 3/1/2020 12/31/9999 50740 FUSION OF URETER & KIDNEY $ 936.33 $ 936.33 3/1/2020 12/31/9999 50750 FUSION OF URETER & KIDNEY $ 1,015.61 $ 1,015.61 3/1/2020 12/31/9999 50760 FUSION OF URETERS $ 947.85 $ 947.85 3/1/2020 12/31/9999 50770 SPLICING OF URETERS $ 984.41 $ 984.41 3/1/2020 12/31/9999 50780 REIMPLANT URETER IN BLADDER $ 950.28 $ 950.28 3/1/2020 12/31/9999 50782 REIMPLANT URETER IN BLADDER $ 933.10 $ 933.10 3/1/2020 12/31/9999 50783 REIMPLANT URETER IN BLADDER $ 968.43 $ 968.43 3/1/2020 12/31/9999 50785 REIMPLANT URETER IN BLADDER $ 1,054.67 $ 1,054.67 3/1/2020 12/31/9999 50800 IMPLANT URETER IN BOWEL $ 800.22 $ 800.22 3/1/2020 12/31/9999 50810 FUSION OF URETER & BOWEL $ 1,054.39 $ 1,054.39 3/1/2020 12/31/9999 50815 URINE SHUNT TO INTESTINE $ 1,067.89 $ 1,067.89 3/1/2020 12/31/9999 50820 CONSTRUCT BOWEL BLADDER $ 1,137.96 $ 1,137.96 3/1/2020 12/31/9999 50825 CONSTRUCT BOWEL BLADDER $ 1,444.26 $ 1,444.26 3/1/2020 12/31/9999 50830 REVISE URINE FLOW $ 1,568.70 $ 1,568.70 3/1/2020 12/31/9999 50840 REPLACE URETER BY BOWEL $ 1,074.72 $ 1,074.72 3/1/2020 12/31/9999 50845 APPENDICO-VESICOSTOMY $ 1,089.70 $ 1,089.70 3/1/2020 12/31/9999 50860 TRANSPLANT URETER TO SKIN $ 825.64 $ 825.64 3/1/2020 12/31/9999 50900 REPAIR OF URETER $ 726.39 $ 726.39 3/1/2020 12/31/9999 50920 CLOSURE URETER/SKIN FISTULA $ 767.91 $ 767.91 3/1/2020 12/31/9999 50930 CLOSURE URETER/BOWEL FISTULA $ 931.25 $ 931.25 3/1/2020 12/31/9999 50940 RELEASE OF URETER $ 772.64 $ 772.64 3/1/2020 12/31/9999 50945 LAPAROSCOPY URETEROLITHOTOMY $ 858.07 $ 858.07 3/1/2020 12/31/9999 50947 LAPARO NEW URETER/BLADDER $ 1,217.16 $ 1,217.16 3/1/2020 12/31/9999 50948 LAPARO NEW URETER/BLADDER $ 1,129.55 $ 1,129.55 3/1/2020 12/31/9999 50951 ENDOSCOPY OF URETER $ 273.88 $ 334.69 3/1/2020 12/31/9999 50953 ENDOSCOPY OF URETER $ 301.08 $ 353.38 3/1/2020 12/31/9999 50955 URETER ENDOSCOPY & BIOPSY $ 325.34 $ 390.56 3/1/2020 12/31/9999 50957 URETER ENDOSCOPY & TREATMENT $ 316.03 $ 380.36 3/1/2020 12/31/9999 50961 URETER ENDOSCOPY & TREATMENT $ 282.90 $ 343.11 3/1/2020 12/31/9999 50970 URETER ENDOSCOPY $ 331.77 $ 331.77 3/1/2020 12/31/9999 50972 URETER ENDOSCOPY & CATHETER $ 319.41 $ 319.41 3/1/2020 12/31/9999 50974 URETER ENDOSCOPY & BIOPSY $ 423.03 $ 423.03 3/1/2020 12/31/9999 50976 URETER ENDOSCOPY & TREATMENT $ 416.67 $ 416.67 3/1/2020 12/31/9999 50980 URETER ENDOSCOPY & TREATMENT $ 318.53 $ 318.53 3/1/2020 12/31/9999 51000 DRAINAGE OF BLADDER $ 35.27 $ 83.96 3/1/2020 12/31/9999 51005 DRAINAGE OF BLADDER $ 47.20 $ 175.68 3/1/2020 12/31/9999 51010 DRAINAGE OF BLADDER $ 214.89 $ 329.50 3/1/2020 12/31/9999 51020 INCISE & TREAT BLADDER $ 402.87 $ 402.87 3/1/2020 12/31/9999 51030 INCISE & TREAT BLADDER $ 399.50 $ 399.50 3/1/2020 12/31/9999 51040 INCISE & DRAIN BLADDER $ 251.20 $ 251.20 3/1/2020 12/31/9999 51045 INCISE BLADDER/DRAIN URETER $ 401.81 $ 401.81 3/1/2020 12/31/9999 51050 REMOVAL OF BLADDER STONE $ 409.30 $ 409.30 3/1/2020 12/31/9999 51060 REMOVAL OF URETER STONE $ 504.40 $ 504.40 3/1/2020 12/31/9999 51065 REMOVE URETER CALCULUS $ 501.07 $ 501.07 3/1/2020 12/31/9999 51080 DRAINAGE OF BLADDER ABSCESS $ 350.47 $ 350.47 3/1/2020 12/31/9999 51100 DRAIN BLADDER BY NEEDLE $ 34.01 $ 51.92 3/1/2020 12/31/9999 51101 DRAIN BLADDER BY TROCAR/CATH $ 45.57 $ 105.20 3/1/2020 12/31/9999 51102 DRAIN BL W/CATH INSERTION $ 131.91 $ 200.66 3/1/2020 12/31/9999 51500 REMOVAL OF BLADDER CYST $ 540.25 $ 540.25 3/1/2020 12/31/9999 51520 REMOVAL OF BLADDER LESION $ 508.47 $ 508.47 3/1/2020 12/31/9999 51525 REMOVAL OF BLADDER LESION $ 748.71 $ 748.71 3/1/2020 12/31/9999 51530 REMOVAL OF BLADDER LESION $ 667.13 $ 667.13 3/1/2020 12/31/9999 51535 REPAIR OF URETER LESION $ 677.67 $ 677.67 3/1/2020 12/31/9999 51550 PARTIAL REMOVAL OF BLADDER $ 823.80 $ 823.80 3/1/2020 12/31/9999 51555 PARTIAL REMOVAL OF BLADDER $ 1,096.05 $ 1,096.05 3/1/2020 12/31/9999 51565 REVISE BLADDER & URETER(S) $ 1,120.43 $ 1,120.43 3/1/2020 12/31/9999 51570 REMOVAL OF BLADDER $ 1,280.24 $ 1,280.24 3/1/2020 12/31/9999 51575 REMOVAL OF BLADDER & NODES $ 1,600.46 $ 1,600.46 3/1/2020 12/31/9999 51580 REMOVE BLADDER/REVISE TRACT $ 1,667.35 $ 1,667.35 3/1/2020 12/31/9999 51585 REMOVAL OF BLADDER & NODES $ 1,857.72 $ 1,857.72 3/1/2020 12/31/9999 51590 REMOVE BLADDER/REVISE TRACT $ 1,692.67 $ 1,692.67 3/1/2020 12/31/9999 51595 REMOVE BLADDER/REVISE TRACT $ 1,923.94 $ 1,923.94 3/1/2020 12/31/9999 51596 REMOVE BLADDER/CREATE POUCH $ 2,067.80 $ 2,067.80 3/1/2020 12/31/9999 51597 REMOVAL OF PELVIC STRUCTURES $ 1,994.48 $ 1,994.48 3/1/2020 12/31/9999 51600 INJECTION FOR BLADDER X-RAY $ 39.14 $ 159.57 3/1/2020 12/31/9999 51605 PREPARATION FOR BLADDER XRAY $ 33.46 $ 33.46 3/1/2020 12/31/9999 51610 INJECTION FOR BLADDER X-RAY $ 55.31 $ 93.80 3/1/2020 12/31/9999 51700 IRRIGATION OF BLADDER $ 39.14 $ 73.80 3/1/2020 12/31/9999 51701 INSERT BLADDER CATHETER $ 23.73 $ 51.05 3/1/2020 12/31/9999 51702 INSERT TEMP BLADDER CATH $ 26.08 $ 65.45 3/1/2020 12/31/9999 51703 INSERT BLADDER CATH COMPLEX $ 71.61 $ 119.20 3/1/2020 12/31/9999 51705 CHANGE OF BLADDER TUBE $ 57.91 $ 95.52 3/1/2020 12/31/9999 51710 CHANGE OF BLADDER TUBE $ 82.45 $ 134.75 3/1/2020 12/31/9999 51715 ENDOSCOPIC INJECTION/IMPLANT $ 174.81 $ 251.49 3/1/2020 12/31/9999 51720 TREATMENT OF BLADDER LESION $ 73.07 $ 99.80 3/1/2020 12/31/9999 51725 26 SIMPLE CYSTOMETROGRAM $ 67.11 $ 67.11 3/1/2020 12/31/9999 51725 TC SIMPLE CYSTOMETROGRAM $ 117.42 $ 117.42 3/1/2020 12/31/9999 51725 SIMPLE CYSTOMETROGRAM $ 184.53 $ 184.53 3/1/2020 12/31/9999 51726 26 COMPLEX CYSTOMETROGRAM $ 76.30 $ 76.30 3/1/2020 12/31/9999 51726 TC COMPLEX CYSTOMETROGRAM $ 191.06 $ 191.06 3/1/2020 12/31/9999 51726 COMPLEX CYSTOMETROGRAM $ 267.37 $ 267.37 3/1/2020 12/31/9999 51727 26 CYSTOMETROGRAM W/UP $ 70.46 $ 70.46 3/1/2020 12/31/9999 51727 TC CYSTOMETROGRAM W/UP $ 116.55 $ 116.55 3/1/2020 12/31/9999 51727 CYSTOMETROGRAM W/UP $ 187.01 $ 187.01 3/1/2020 12/31/9999 51728 26 CYSTOMETROGRAM W/VP $ 69.69 $ 69.69 3/1/2020 12/31/9999 51728 TC CYSTOMETROGRAM W/VP $ 117.24 $ 117.24 3/1/2020 12/31/9999 51728 CYSTOMETROGRAM W/VP $ 186.91 $ 186.91 3/1/2020 12/31/9999 51729 26 CYSTOMETROGRAM W/VP&UP $ 82.96 $ 82.96 3/1/2020 12/31/9999 51729 TC CYSTOMETROGRAM W/VP&UP $ 118.62 $ 118.62 3/1/2020 12/31/9999 51729 CYSTOMETROGRAM W/VP&UP $ 201.57 $ 201.57 3/1/2020 12/31/9999 51736 26 URINE FLOW MEASUREMENT $ 27.43 $ 27.43 3/1/2020 12/31/9999 51736 TC URINE FLOW MEASUREMENT $ 18.12 $ 18.12 3/1/2020 12/31/9999 51736 URINE FLOW MEASUREMENT $ 45.55 $ 45.55 3/1/2020 12/31/9999 51741 26 ELECTRO-UROFLOWMETRY FIRST $ 51.23 $ 51.23 3/1/2020 12/31/9999 51741 TC ELECTRO-UROFLOWMETRY FIRST $ 21.26 $ 21.26 3/1/2020 12/31/9999 51741 ELECTRO-UROFLOWMETRY FIRST $ 72.48 $ 72.48 3/1/2020 12/31/9999 51784 26 ANAL/URINARY MUSCLE STUDY $ 67.74 $ 67.74 3/1/2020 12/31/9999 51784 TC ANAL/URINARY MUSCLE STUDY $ 101.85 $ 101.85 3/1/2020 12/31/9999 51784 ANAL/URINARY MUSCLE STUDY $ 169.60 $ 169.60 3/1/2020 12/31/9999 51785 26 ANAL/URINARY MUSCLE STUDY $ 67.83 $ 67.83 3/1/2020 12/31/9999 51785 TC ANAL/URINARY MUSCLE STUDY $ 115.95 $ 115.95 3/1/2020 12/31/9999 51785 ANAL/URINARY MUSCLE STUDY $ 183.79 $ 183.79 3/1/2020 12/31/9999 51792 26 URINARY REFLEX STUDY $ 48.68 $ 48.68 3/1/2020 12/31/9999 51792 TC URINARY REFLEX STUDY $ 143.03 $ 143.03 3/1/2020 12/31/9999 51792 URINARY REFLEX STUDY $ 191.70 $ 191.70 3/1/2020 12/31/9999 51797 26 INTRAABDOMINAL PRESSURE TEST $ 38.68 $ 38.68 3/1/2020 12/31/9999 51797 TC INTRAABDOMINAL PRESSURE TEST $ 85.90 $ 85.90 3/1/2020 12/31/9999 51797 INTRAABDOMINAL PRESSURE TEST $ 124.58 $ 124.58 3/1/2020 12/31/9999 51798 US URINE CAPACITY MEASURE $ 16.88 $ 16.88 3/1/2020 12/31/9999 51800 REVISION OF BLADDER/URETHRA $ 910.15 $ 910.15 3/1/2020 12/31/9999 51820 REVISION OF URINARY TRACT $ 928.03 $ 928.03 3/1/2020 12/31/9999 51840 ATTACH BLADDER/URETHRA $ 553.75 $ 553.75 3/1/2020 12/31/9999 51841 ATTACH BLADDER/URETHRA $ 657.48 $ 657.48 3/1/2020 12/31/9999 51845 REPAIR BLADDER NECK $ 504.30 $ 504.30 3/1/2020 12/31/9999 51860 REPAIR OF BLADDER WOUND $ 616.80 $ 616.80 3/1/2020 12/31/9999 51865 REPAIR OF BLADDER WOUND $ 764.48 $ 764.48 3/1/2020 12/31/9999 51880 REPAIR OF BLADDER OPENING $ 399.70 $ 399.70 3/1/2020 12/31/9999 51900 REPAIR BLADDER/VAGINA LESION $ 708.91 $ 708.91 3/1/2020 12/31/9999 51920 CLOSE BLADDER-UTERUS FISTULA $ 655.17 $ 655.17 3/1/2020 12/31/9999 51925 HYSTERECTOMY/BLADDER REPAIR $ 854.36 $ 854.36 3/1/2020 12/31/9999 51940 CORRECTION OF BLADDER DEFECT $ 1,403.97 $ 1,403.97 3/1/2020 12/31/9999 51960 REVISION OF BLADDER & BOWEL $ 1,210.25 $ 1,210.25 3/1/2020 12/31/9999 51980 CONSTRUCT BLADDER OPENING $ 619.16 $ 619.16 3/1/2020 12/31/9999 51990 LAPARO URETHRAL SUSPENSION $ 637.37 $ 637.37 3/1/2020 12/31/9999 51992 LAPARO SLING OPERATION $ 695.71 $ 695.71 3/1/2020 12/31/9999 52000 CYSTOSCOPY $ 109.77 $ 179.09 3/1/2020 12/31/9999 52001 CYSTOSCOPY REMOVAL OF CLOTS $ 255.22 $ 332.48 3/1/2020 12/31/9999 52005 CYSTOSCOPY & URETER CATHETER $ 117.17 $ 245.54 3/1/2020 12/31/9999 52007 CYSTOSCOPY AND BIOPSY $ 146.75 $ 456.36 3/1/2020 12/31/9999 52010 CYSTOSCOPY & DUCT CATHETER $ 142.43 $ 341.60 3/1/2020 12/31/9999 52204 CYSTOSCOPY W/BIOPSY(S) $ 124.45 $ 374.14 3/1/2020 12/31/9999 52214 CYSTOSCOPY AND TREATMENT $ 192.06 $ 492.27 3/1/2020 12/31/9999 52224 CYSTOSCOPY AND TREATMENT $ 150.26 $ 698.10 3/1/2020 12/31/9999 52234 CYSTOSCOPY AND TREATMENT $ 219.16 $ 219.16 3/1/2020 12/31/9999 52235 CYSTOSCOPY AND TREATMENT $ 256.99 $ 256.99 3/1/2020 12/31/9999 52240 CYSTOSCOPY AND TREATMENT $ 449.74 $ 449.74 3/1/2020 12/31/9999 52250 CYSTOSCOPY AND RADIOTRACER $ 215.11 $ 215.11 3/1/2020 12/31/9999 52260 CYSTOSCOPY AND TREATMENT $ 185.62 $ 185.62 3/1/2020 12/31/9999 52265 CYSTOSCOPY AND TREATMENT $ 139.80 $ 358.94 3/1/2020 12/31/9999 52270 CYSTOSCOPY & REVISE URETHRA $ 161.47 $ 347.41 3/1/2020 12/31/9999 52275 CYSTOSCOPY & REVISE URETHRA $ 221.38 $ 475.47 3/1/2020 12/31/9999 52276 CYSTOSCOPY AND TREATMENT $ 236.30 $ 236.30 3/1/2020 12/31/9999 52277 CYSTOSCOPY AND TREATMENT $ 288.78 $ 288.78 3/1/2020 12/31/9999 52281 CYSTOSCOPY AND TREATMENT $ 136.71 $ 261.85 3/1/2020 12/31/9999 52282 CYSTOSCOPY IMPLANT STENT $ 298.05 $ 298.05 3/1/2020 12/31/9999 52283 CYSTOSCOPY AND TREATMENT $ 177.73 $ 244.11 3/1/2020 12/31/9999 52285 CYSTOSCOPY AND TREATMENT $ 172.14 $ 245.57 3/1/2020 12/31/9999 52287 CYSTOSCOPY CHEMODENERVATION $ 139.49 $ 255.80 3/1/2020 12/31/9999 52290 CYSTOSCOPY AND TREATMENT $ 217.39 $ 217.39 3/1/2020 12/31/9999 52300 CYSTOSCOPY AND TREATMENT $ 249.69 $ 249.69 3/1/2020 12/31/9999 52301 CYSTOSCOPY AND TREATMENT $ 262.34 $ 262.34 3/1/2020 12/31/9999 52305 CYSTOSCOPY AND TREATMENT $ 248.23 $ 248.23 3/1/2020 12/31/9999 52310 CYSTOSCOPY AND TREATMENT $ 134.39 $ 216.93 3/1/2020 12/31/9999 52315 CYSTOSCOPY AND TREATMENT $ 244.56 $ 384.38 3/1/2020 12/31/9999 52317 REMOVE BLADDER STONE $ 310.58 $ 810.83 3/1/2020 12/31/9999 52318 REMOVE BLADDER STONE $ 423.29 $ 423.29 3/1/2020 12/31/9999 52320 CYSTOSCOPY AND TREATMENT $ 219.62 $ 219.62 3/1/2020 12/31/9999 52325 CYSTOSCOPY STONE REMOVAL $ 285.82 $ 285.82 3/1/2020 12/31/9999 52327 CYSTOSCOPY INJECT MATERIAL $ 234.22 $ 455.12 3/1/2020 12/31/9999 52330 CYSTOSCOPY AND TREATMENT $ 235.13 $ 658.73 3/1/2020 12/31/9999 52332 CYSTOSCOPY AND TREATMENT $ 138.16 $ 406.93 3/1/2020 12/31/9999 52334 CREATE PASSAGE TO KIDNEY $ 228.26 $ 228.26 3/1/2020 12/31/9999 52341 CYSTO W/URETER STRICTURE TX $ 259.34 $ 259.34 3/1/2020 12/31/9999 52342 CYSTO W/UP STRICTURE TX $ 281.99 $ 281.99 3/1/2020 12/31/9999 52343 CYSTO W/RENAL STRICTURE TX $ 313.74 $ 313.74 3/1/2020 12/31/9999 52344 CYSTO/URETERO STRICTURE TX $ 340.12 $ 340.12 3/1/2020 12/31/9999 52345 CYSTO/URETERO W/UP STRICTURE $ 362.76 $ 362.76 3/1/2020 12/31/9999 52346 CYSTOURETERO W/RENAL STRICT $ 409.52 $ 409.52 3/1/2020 12/31/9999 52351 CYSTOURETERO & OR PYELOSCOPE $ 279.23 $ 279.23 3/1/2020 12/31/9999 52352 CYSTOURETERO W/STONE REMOVE $ 327.90 $ 327.90 3/1/2020 12/31/9999 52353 CYSTOURETERO W/LITHOTRIPSY $ 377.36 $ 377.36 3/1/2020 12/31/9999 52354 CYSTOURETERO W/BIOPSY $ 348.71 $ 348.71 3/1/2020 12/31/9999 52355 CYSTOURETERO W/EXCISE TUMOR $ 415.83 $ 415.83 3/1/2020 12/31/9999 52356 CYSTO/URETERO W/LITHOTRIPSY $ 351.81 $ 351.81 3/1/2020 12/31/9999 52400 CYSTOURETERO W/CONGEN REPR $ 426.47 $ 426.47 3/1/2020 12/31/9999 52450 INCISION OF PROSTATE $ 405.63 $ 405.63 3/1/2020 12/31/9999 52500 REVISION OF BLADDER NECK $ 423.85 $ 423.85 3/1/2020 12/31/9999 52601 PROSTATECTOMY (TURP) $ 722.13 $ 722.13 3/1/2020 12/31/9999 52630 REMOVE PROSTATE REGROWTH $ 385.98 $ 385.98 3/1/2020 12/31/9999 52640 RELIEVE BLADDER CONTRACTURE $ 262.77 $ 262.77 3/1/2020 12/31/9999 52647 LASER SURGERY OF PROSTATE $ 561.77 $ 1,829.30 3/1/2020 12/31/9999 52648 LASER SURGERY OF PROSTATE $ 599.68 $ 1,869.54 3/1/2020 12/31/9999 52649 PROSTATE LASER ENUCLEATION $ 857.22 $ 857.22 3/1/2020 12/31/9999 52700 DRAINAGE OF PROSTATE ABSCESS $ 376.82 $ 376.82 3/1/2020 12/31/9999 53000 INCISION OF URETHRA $ 128.55 $ 128.55 3/1/2020 12/31/9999 53010 INCISION OF URETHRA $ 251.66 $ 251.66 3/1/2020 12/31/9999 53020 INCISION OF URETHRA $ 85.85 $ 85.85 3/1/2020 12/31/9999 53025 INCISION OF URETHRA $ 56.29 $ 56.29 3/1/2020 12/31/9999 53040 DRAINAGE OF URETHRA ABSCESS $ 340.31 $ 340.31 3/1/2020 12/31/9999 53060 DRAINAGE OF URETHRA ABSCESS $ 132.97 $ 149.43 3/1/2020 12/31/9999 53080 DRAINAGE OF URINARY LEAKAGE $ 376.56 $ 376.56 3/1/2020 12/31/9999 53085 DRAINAGE OF URINARY LEAKAGE $ 535.98 $ 535.98 3/1/2020 12/31/9999 53200 BIOPSY OF URETHRA $ 123.59 $ 135.04 3/1/2020 12/31/9999 53210 REMOVAL OF URETHRA $ 670.68 $ 670.68 3/1/2020 12/31/9999 53215 REMOVAL OF URETHRA $ 815.14 $ 815.14 3/1/2020 12/31/9999 53220 TREATMENT OF URETHRA LESION $ 390.87 $ 390.87 3/1/2020 12/31/9999 53230 REMOVAL OF URETHRA LESION $ 521.59 $ 521.59 3/1/2020 12/31/9999 53235 REMOVAL OF URETHRA LESION $ 554.72 $ 554.72 3/1/2020 12/31/9999 53240 SURGERY FOR URETHRA POUCH $ 371.95 $ 371.95 3/1/2020 12/31/9999 53250 REMOVAL OF URETHRA GLAND $ 345.05 $ 345.05 3/1/2020 12/31/9999 53260 TREATMENT OF URETHRA LESION $ 152.29 $ 171.39 3/1/2020 12/31/9999 53265 TREATMENT OF URETHRA LESION $ 160.07 $ 190.03 3/1/2020 12/31/9999 53270 REMOVAL OF URETHRA GLAND $ 156.79 $ 174.71 3/1/2020 12/31/9999 53275 REPAIR OF URETHRA DEFECT $ 231.11 $ 231.11 3/1/2020 12/31/9999 53400 REVISE URETHRA STAGE 1 $ 697.21 $ 697.21 3/1/2020 12/31/9999 53405 REVISE URETHRA STAGE 2 $ 768.19 $ 768.19 3/1/2020 12/31/9999 53410 RECONSTRUCTION OF URETHRA $ 857.64 $ 857.64 3/1/2020 12/31/9999 53415 RECONSTRUCTION OF URETHRA $ 989.79 $ 989.79 3/1/2020 12/31/9999 53420 RECONSTRUCT URETHRA STAGE 1 $ 704.04 $ 704.04 3/1/2020 12/31/9999 53425 RECONSTRUCT URETHRA STAGE 2 $ 826.26 $ 826.26 3/1/2020 12/31/9999 53430 RECONSTRUCTION OF URETHRA $ 824.86 $ 824.86 3/1/2020 12/31/9999 53431 RECONSTRUCT URETHRA/BLADDER $ 1,011.72 $ 1,011.72 3/1/2020 12/31/9999 53440 MALE SLING PROCEDURE $ 764.68 $ 764.68 3/1/2020 12/31/9999 53442 REMOVE/REVISE MALE SLING $ 672.97 $ 672.97 3/1/2020 12/31/9999 53444 INSERT TANDEM CUFF $ 695.72 $ 695.72 3/1/2020 12/31/9999 53445 INSERT URO/VES NCK SPHINCTER $ 767.61 $ 767.61 3/1/2020 12/31/9999 53446 REMOVE URO SPHINCTER $ 560.67 $ 560.67 3/1/2020 12/31/9999 53447 REMOVE/REPLACE UR SPHINCTER $ 709.94 $ 709.94 3/1/2020 12/31/9999 53448 REMOV/REPLC UR SPHINCTR COMP $ 1,123.70 $ 1,123.70 3/1/2020 12/31/9999 53449 REPAIR URO SPHINCTER $ 533.19 $ 533.19 3/1/2020 12/31/9999 53450 REVISION OF URETHRA $ 354.12 $ 354.12 3/1/2020 12/31/9999 53460 REVISION OF URETHRA $ 398.11 $ 398.11 3/1/2020 12/31/9999 53500 URETHRLYS TRANSVAG W/ SCOPE $ 641.26 $ 641.26 3/1/2020 12/31/9999 53502 REPAIR OF URETHRA INJURY $ 421.14 $ 421.14 3/1/2020 12/31/9999 53505 REPAIR OF URETHRA INJURY $ 423.05 $ 423.05 3/1/2020 12/31/9999 53510 REPAIR OF URETHRA INJURY $ 550.92 $ 550.92 3/1/2020 12/31/9999 53515 REPAIR OF URETHRA INJURY $ 695.66 $ 695.66 3/1/2020 12/31/9999 53520 REPAIR OF URETHRA DEFECT $ 483.11 $ 483.11 3/1/2020 12/31/9999 53600 DILATE URETHRA STRICTURE $ 56.98 $ 74.61 3/1/2020 12/31/9999 53601 DILATE URETHRA STRICTURE $ 47.51 $ 72.18 3/1/2020 12/31/9999 53605 DILATE URETHRA STRICTURE $ 57.45 $ 57.45 3/1/2020 12/31/9999 53620 DILATE URETHRA STRICTURE $ 77.46 $ 106.53 3/1/2020 12/31/9999 53621 DILATE URETHRA STRICTURE $ 64.28 $ 100.40 3/1/2020 12/31/9999 53660 DILATION OF URETHRA $ 36.18 $ 62.33 3/1/2020 12/31/9999 53661 DILATION OF URETHRA $ 35.62 $ 62.06 3/1/2020 12/31/9999 53665 DILATION OF URETHRA $ 33.57 $ 33.57 3/1/2020 12/31/9999 53850 PROSTATIC MICROWAVE THERMOTX $ 495.81 $ 2,094.96 3/1/2020 12/31/9999 53852 PROSTATIC RF THERMOTX $ 539.49 $ 2,018.21 3/1/2020 12/31/9999 53855 INSERT PROST URETHRAL STENT $ 53.80 $ 416.52 3/1/2020 12/31/9999 54000 SLITTING OF PREPUCE $ 92.30 $ 133.41 3/1/2020 12/31/9999 54001 SLITTING OF PREPUCE $ 119.32 $ 164.56 3/1/2020 12/31/9999 54015 DRAIN PENIS LESION $ 270.04 $ 270.04 3/1/2020 12/31/9999 54050 DESTRUCTION PENIS LESION(S) $ 80.68 $ 100.66 3/1/2020 12/31/9999 54055 DESTRUCTION PENIS LESION(S) $ 74.46 $ 96.19 3/1/2020 12/31/9999 54056 CRYOSURGERY PENIS LESION(S) $ 83.23 $ 104.97 3/1/2020 12/31/9999 54057 LASER SURG PENIS LESION(S) $ 78.26 $ 115.26 3/1/2020 12/31/9999 54060 EXCISION OF PENIS LESION(S) $ 109.49 $ 156.19 3/1/2020 12/31/9999 54065 DESTRUCTION PENIS LESION(S) $ 133.86 $ 171.75 3/1/2020 12/31/9999 54100 BIOPSY OF PENIS $ 99.65 $ 156.94 3/1/2020 12/31/9999 54105 BIOPSY OF PENIS $ 186.99 $ 237.52 3/1/2020 12/31/9999 54110 TREATMENT OF PENIS LESION $ 543.08 $ 543.08 3/1/2020 12/31/9999 54111 TREAT PENIS LESION GRAFT $ 702.54 $ 702.54 3/1/2020 12/31/9999 54112 TREAT PENIS LESION GRAFT $ 824.71 $ 824.71 3/1/2020 12/31/9999 54115 TREATMENT OF PENIS LESION $ 364.47 $ 389.15 3/1/2020 12/31/9999 54120 PARTIAL REMOVAL OF PENIS $ 549.26 $ 549.26 3/1/2020 12/31/9999 54125 REMOVAL OF PENIS $ 708.84 $ 708.84 3/1/2020 12/31/9999 54130 REMOVE PENIS & NODES $ 1,049.80 $ 1,049.80 3/1/2020 12/31/9999 54135 REMOVE PENIS & NODES $ 1,333.56 $ 1,333.56 3/1/2020 12/31/9999 54150 CIRCUMCISION W/REGIONL BLOCK $ 85.60 $ 143.76 3/1/2020 12/31/9999 54160 CIRCUMCISION NEONATE $ 126.41 $ 198.95 3/1/2020 12/31/9999 54161 CIRCUM 28 DAYS OR OLDER $ 171.38 $ 171.38 3/1/2020 12/31/9999 54162 LYSIS PENIL CIRCUMIC LESION $ 170.34 $ 231.45 3/1/2020 12/31/9999 54163 REPAIR OF CIRCUMCISION $ 187.97 $ 187.97 3/1/2020 12/31/9999 54164 FRENULOTOMY OF PENIS $ 165.32 $ 165.32 3/1/2020 12/31/9999 54200 TREATMENT OF PENIS LESION $ 72.33 $ 93.78 3/1/2020 12/31/9999 54205 TREATMENT OF PENIS LESION $ 465.91 $ 465.91 3/1/2020 12/31/9999 54220 TREATMENT OF PENIS LESION $ 118.17 $ 182.21 3/1/2020 12/31/9999 54230 PREPARE PENIS STUDY $ 69.92 $ 84.32 3/1/2020 12/31/9999 54240 26 PENIS STUDY $ 59.09 $ 59.09 3/1/2020 12/31/9999 54240 TC PENIS STUDY $ 28.53 $ 28.53 3/1/2020 12/31/9999 54240 PENIS STUDY $ 87.61 $ 87.61 3/1/2020 12/31/9999 54300 REVISION OF PENIS $ 565.72 $ 565.72 3/1/2020 12/31/9999 54304 REVISION OF PENIS $ 662.96 $ 662.96 3/1/2020 12/31/9999 54308 RECONSTRUCTION OF URETHRA $ 631.23 $ 631.23 3/1/2020 12/31/9999 54312 RECONSTRUCTION OF URETHRA $ 729.50 $ 729.50 3/1/2020 12/31/9999 54316 RECONSTRUCTION OF URETHRA $ 883.32 $ 883.32 3/1/2020 12/31/9999 54318 RECONSTRUCTION OF URETHRA $ 635.91 $ 635.91 3/1/2020 12/31/9999 54322 RECONSTRUCTION OF URETHRA $ 690.71 $ 690.71 3/1/2020 12/31/9999 54324 RECONSTRUCTION OF URETHRA $ 858.69 $ 858.69 3/1/2020 12/31/9999 54326 RECONSTRUCTION OF URETHRA $ 807.77 $ 807.77 3/1/2020 12/31/9999 54328 REVISE PENIS/URETHRA $ 818.65 $ 818.65 3/1/2020 12/31/9999 54332 REVISE PENIS/URETHRA $ 894.96 $ 894.96 3/1/2020 12/31/9999 54336 REVISE PENIS/URETHRA $ 1,017.04 $ 1,017.04 3/1/2020 12/31/9999 54340 SECONDARY URETHRAL SURGERY $ 491.10 $ 491.10 3/1/2020 12/31/9999 54344 SECONDARY URETHRAL SURGERY $ 847.36 $ 847.36 3/1/2020 12/31/9999 54348 SECONDARY URETHRAL SURGERY $ 899.64 $ 899.64 3/1/2020 12/31/9999 54352 RECONSTRUCT URETHRA/PENIS $ 1,269.18 $ 1,269.18 3/1/2020 12/31/9999 54360 PENIS PLASTIC SURGERY $ 636.30 $ 636.30 3/1/2020 12/31/9999 54380 REPAIR PENIS $ 705.14 $ 705.14 3/1/2020 12/31/9999 54385 REPAIR PENIS $ 851.20 $ 851.20 3/1/2020 12/31/9999 54390 REPAIR PENIS AND BLADDER $ 1,038.31 $ 1,038.31 3/1/2020 12/31/9999 54406 REMOVE MUTI-COMP PENIS PROS $ 638.74 $ 638.74 3/1/2020 12/31/9999 54415 REMOVE SELF-CONTD PENIS PROS $ 458.16 $ 458.16 3/1/2020 12/31/9999 54420 REVISION OF PENIS $ 618.90 $ 618.90 3/1/2020 12/31/9999 54430 REVISION OF PENIS $ 560.46 $ 560.46 3/1/2020 12/31/9999 54435 REVISION OF PENIS $ 362.15 $ 362.15 3/1/2020 12/31/9999 54437 REPAIR CORPOREAL TEAR $ 607.87 $ 607.87 3/1/2020 12/31/9999 54438 REPLANTATION OF PENIS $ 1,226.79 $ 1,226.79 3/1/2020 12/31/9999 54440 REPAIR OF PENIS $ 765.78 $ 765.78 3/1/2020 12/31/9999 54450 PREPUTIAL STRETCHING $ 51.86 $ 63.62 3/1/2020 12/31/9999 54500 BIOPSY OF TESTIS $ 66.23 $ 66.23 3/1/2020 12/31/9999 54505 BIOPSY OF TESTIS $ 185.54 $ 185.54 3/1/2020 12/31/9999 54512 EXCISE LESION TESTIS $ 466.68 $ 466.68 3/1/2020 12/31/9999 54520 REMOVAL OF TESTIS $ 282.24 $ 282.24 3/1/2020 12/31/9999 54522 ORCHIECTOMY PARTIAL $ 506.80 $ 506.80 3/1/2020 12/31/9999 54530 REMOVAL OF TESTIS $ 440.60 $ 440.60 3/1/2020 12/31/9999 54535 EXTENSIVE TESTIS SURGERY $ 641.25 $ 641.25 3/1/2020 12/31/9999 54550 EXPLORATION FOR TESTIS $ 425.29 $ 425.29 3/1/2020 12/31/9999 54560 EXPLORATION FOR TESTIS $ 580.97 $ 580.97 3/1/2020 12/31/9999 54600 REDUCE TESTIS TORSION $ 393.06 $ 393.06 3/1/2020 12/31/9999 54620 SUSPENSION OF TESTIS $ 264.14 $ 264.14 3/1/2020 12/31/9999 54640 ORCHIOPEXY INGUN/SCROT APPR $ 403.57 $ 403.57 3/1/2020 12/31/9999 54650 ORCHIOPEXY (FOWLER-STEPHENS) $ 619.14 $ 619.14 3/1/2020 12/31/9999 54670 REPAIR TESTIS INJURY $ 350.88 $ 350.88 3/1/2020 12/31/9999 54680 RELOCATION OF TESTIS(ES) $ 684.23 $ 684.23 3/1/2020 12/31/9999 54690 LAPAROSCOPY ORCHIECTOMY $ 553.12 $ 553.12 3/1/2020 12/31/9999 54692 LAPAROSCOPY ORCHIOPEXY $ 675.81 $ 675.81 3/1/2020 12/31/9999 54700 DRAINAGE OF SCROTUM $ 183.04 $ 183.04 3/1/2020 12/31/9999 54800 BIOPSY OF EPIDIDYMIS $ 115.93 $ 115.93 3/1/2020 12/31/9999 54830 REMOVE EPIDIDYMIS LESION $ 319.31 $ 319.31 3/1/2020 12/31/9999 54840 REMOVE EPIDIDYMIS LESION $ 280.43 $ 280.43 3/1/2020 12/31/9999 54860 REMOVAL OF EPIDIDYMIS $ 362.30 $ 362.30 3/1/2020 12/31/9999 54861 REMOVAL OF EPIDIDYMIS $ 490.49 $ 490.49 3/1/2020 12/31/9999 54865 EXPLORE EPIDIDYMIS $ 308.26 $ 308.26 3/1/2020 12/31/9999 55000 DRAINAGE OF HYDROCELE $ 73.48 $ 104.03 3/1/2020 12/31/9999 55040 REMOVAL OF HYDROCELE $ 291.46 $ 291.46 3/1/2020 12/31/9999 55041 REMOVAL OF HYDROCELES $ 438.95 $ 438.95 3/1/2020 12/31/9999 55060 REPAIR OF HYDROCELE $ 325.94 $ 325.94 3/1/2020 12/31/9999 55100 DRAINAGE OF SCROTUM ABSCESS $ 138.10 $ 183.62 3/1/2020 12/31/9999 55110 EXPLORE SCROTUM $ 331.64 $ 331.64 3/1/2020 12/31/9999 55120 REMOVAL OF SCROTUM LESION $ 304.11 $ 304.11 3/1/2020 12/31/9999 55150 REMOVAL OF SCROTUM $ 420.45 $ 420.45 3/1/2020 12/31/9999 55175 REVISION OF SCROTUM $ 312.00 $ 312.00 3/1/2020 12/31/9999 55180 REVISION OF SCROTUM $ 594.54 $ 594.54 3/1/2020 12/31/9999 55200 INCISION OF SPERM DUCT $ 239.15 $ 416.27 3/1/2020 12/31/9999 55250 REMOVAL OF SPERM DUCT(S) $ 195.36 $ 366.03 3/1/2020 12/31/9999 55300 PREPARE SPERM DUCT X-RAY $ 158.77 $ 158.77 3/1/2020 12/31/9999 55500 REMOVAL OF HYDROCELE $ 323.52 $ 323.52 3/1/2020 12/31/9999 55520 REMOVAL OF SPERM CORD LESION $ 333.28 $ 333.28 3/1/2020 12/31/9999 55530 REVISE SPERMATIC CORD VEINS $ 305.78 $ 305.78 3/1/2020 12/31/9999 55535 REVISE SPERMATIC CORD VEINS $ 370.03 $ 370.03 3/1/2020 12/31/9999 55540 REVISE HERNIA & SPERM VEINS $ 404.46 $ 404.46 3/1/2020 12/31/9999 55550 LAPARO LIGATE SPERMATIC VEIN $ 366.49 $ 366.49 3/1/2020 12/31/9999 55600 INCISE SPERM DUCT POUCH $ 369.11 $ 369.11 3/1/2020 12/31/9999 55650 REMOVE SPERM DUCT POUCH $ 622.03 $ 622.03 3/1/2020 12/31/9999 55680 REMOVE SPERM POUCH LESION $ 293.91 $ 293.91 3/1/2020 12/31/9999 55700 BIOPSY OF PROSTATE $ 119.99 $ 197.54 3/1/2020 12/31/9999 55705 BIOPSY OF PROSTATE $ 235.02 $ 235.02 3/1/2020 12/31/9999 55706 PROSTATE SATURATION SAMPLING $ 332.12 $ 332.12 3/1/2020 12/31/9999 55720 DRAINAGE OF PROSTATE ABSCESS $ 402.22 $ 402.22 3/1/2020 12/31/9999 55725 DRAINAGE OF PROSTATE ABSCESS $ 510.60 $ 510.60 3/1/2020 12/31/9999 55801 REMOVAL OF PROSTATE $ 951.12 $ 951.12 3/1/2020 12/31/9999 55810 EXTENSIVE PROSTATE SURGERY $ 1,151.31 $ 1,151.31 3/1/2020 12/31/9999 55812 EXTENSIVE PROSTATE SURGERY $ 1,415.05 $ 1,415.05 3/1/2020 12/31/9999 55815 EXTENSIVE PROSTATE SURGERY $ 1,552.53 $ 1,552.53 3/1/2020 12/31/9999 55821 REMOVAL OF PROSTATE $ 764.90 $ 764.90 3/1/2020 12/31/9999 55831 REMOVAL OF PROSTATE $ 829.16 $ 829.16 3/1/2020 12/31/9999 55840 EXTENSIVE PROSTATE SURGERY $ 1,174.57 $ 1,174.57 3/1/2020 12/31/9999 55842 EXTENSIVE PROSTATE SURGERY $ 1,258.97 $ 1,258.97 3/1/2020 12/31/9999 55845 EXTENSIVE PROSTATE SURGERY $ 1,441.01 $ 1,441.01 3/1/2020 12/31/9999 55860 SURGICAL EXPOSURE PROSTATE $ 767.36 $ 767.36 3/1/2020 12/31/9999 55862 EXTENSIVE PROSTATE SURGERY $ 969.78 $ 969.78 3/1/2020 12/31/9999 55865 EXTENSIVE PROSTATE SURGERY $ 1,175.42 $ 1,175.42 3/1/2020 12/31/9999 55866 LAPARO RADICAL PROSTATECTOMY $ 1,530.77 $ 1,530.77 3/1/2020 12/31/9999 55873 CRYOABLATE PROSTATE $ 999.85 $ 999.85 3/1/2020 12/31/9999 55874 TPRNL PLMT BIODEGRDABL MATRL $ 146.92 $ 3,193.65 3/1/2020 12/31/9999 55875 TRANSPERI NEEDLE PLACE PROS $ 665.31 $ 665.31 3/1/2020 12/31/9999 55876 PLACE RT DEVICE/MARKER PROS $ 92.88 $ 121.98 3/1/2020 12/31/9999 55920 PLACE NEEDLES PELVIC FOR RT $ 376.04 $ 376.04 3/1/2020 12/31/9999 56405 I & D OF VULVA/PERINEUM $ 83.86 $ 85.63 3/1/2020 12/31/9999 56420 DRAINAGE OF GLAND ABSCESS $ 72.96 $ 98.23 3/1/2020 12/31/9999 56440 SURGERY FOR VULVA LESION $ 145.55 $ 145.55 3/1/2020 12/31/9999 56441 LYSIS OF LABIAL LESION(S) $ 112.47 $ 118.63 3/1/2020 12/31/9999 56442 HYMENOTOMY $ 38.78 $ 38.78 3/1/2020 12/31/9999 56501 DESTROY VULVA LESIONS SIM $ 89.27 $ 102.20 3/1/2020 12/31/9999 56515 DESTROY VULVA LESION/S COMPL $ 155.74 $ 175.12 3/1/2020 12/31/9999 56605 BIOPSY OF VULVA/PERINEUM $ 49.00 $ 66.05 3/1/2020 12/31/9999 56606 BIOPSY OF VULVA/PERINEUM $ 24.16 $ 30.63 3/1/2020 12/31/9999 56620 PARTIAL REMOVAL OF VULVA $ 390.77 $ 390.77 3/1/2020 12/31/9999 56625 COMPLETE REMOVAL OF VULVA $ 471.57 $ 471.57 3/1/2020 12/31/9999 56630 EXTENSIVE VULVA SURGERY $ 690.92 $ 690.92 3/1/2020 12/31/9999 56631 EXTENSIVE VULVA SURGERY $ 879.44 $ 879.44 3/1/2020 12/31/9999 56632 EXTENSIVE VULVA SURGERY $ 1,018.13 $ 1,018.13 3/1/2020 12/31/9999 56633 EXTENSIVE VULVA SURGERY $ 901.97 $ 901.97 3/1/2020 12/31/9999 56634 EXTENSIVE VULVA SURGERY $ 952.84 $ 952.84 3/1/2020 12/31/9999 56637 EXTENSIVE VULVA SURGERY $ 1,126.85 $ 1,126.85 3/1/2020 12/31/9999 56640 EXTENSIVE VULVA SURGERY $ 1,124.16 $ 1,124.16 3/1/2020 12/31/9999 56700 PARTIAL REMOVAL OF HYMEN $ 147.21 $ 147.21 3/1/2020 12/31/9999 56740 REMOVE VAGINA GLAND LESION $ 236.04 $ 236.04 3/1/2020 12/31/9999 56800 REPAIR OF VAGINA $ 194.09 $ 194.09 3/1/2020 12/31/9999 56805 REPAIR CLITORIS $ 916.92 $ 916.92 3/1/2020 12/31/9999 56810 REPAIR OF PERINEUM $ 208.59 $ 208.59 3/1/2020 12/31/9999 56820 EXAM OF VULVA W/SCOPE $ 68.30 $ 87.70 3/1/2020 12/31/9999 56821 EXAM/BIOPSY OF VULVA W/SCOPE $ 92.75 $ 117.43 3/1/2020 12/31/9999 57000 EXPLORATION OF VAGINA $ 151.71 $ 151.71 3/1/2020 12/31/9999 57010 DRAINAGE OF PELVIC ABSCESS $ 341.12 $ 341.12 3/1/2020 12/31/9999 57020 DRAINAGE OF PELVIC FLUID $ 65.95 $ 75.34 3/1/2020 12/31/9999 57022 I & D VAGINAL HEMATOMA PP $ 132.39 $ 132.39 3/1/2020 12/31/9999 57023 I & D VAG HEMATOMA NON-OB $ 248.33 $ 248.33 3/1/2020 12/31/9999 57061 DESTROY VAG LESIONS SIMPLE $ 76.25 $ 88.88 3/1/2020 12/31/9999 57065 DESTROY VAG LESIONS COMPLEX $ 135.59 $ 151.75 3/1/2020 12/31/9999 57100 BIOPSY OF VAGINA $ 52.97 $ 70.00 3/1/2020 12/31/9999 57105 BIOPSY OF VAGINA $ 98.58 $ 106.80 3/1/2020 12/31/9999 57106 REMOVE VAGINA WALL PARTIAL $ 375.89 $ 375.89 3/1/2020 12/31/9999 57107 REMOVE VAGINA TISSUE PART $ 1,118.45 $ 1,118.45 3/1/2020 12/31/9999 57109 VAGINECTOMY PARTIAL W/NODES $ 1,279.19 $ 1,279.19 3/1/2020 12/31/9999 57110 REMOVE VAGINA WALL COMPLETE $ 719.38 $ 719.38 3/1/2020 12/31/9999 57111 REMOVE VAGINA TISSUE COMPL $ 1,292.19 $ 1,292.19 3/1/2020 12/31/9999 57112 VAGINECTOMY W/NODES COMPL $ 1,372.49 $ 1,372.49 3/1/2020 12/31/9999 57120 CLOSURE OF VAGINA $ 406.93 $ 406.93 3/1/2020 12/31/9999 57130 REMOVE VAGINA LESION $ 127.97 $ 142.96 3/1/2020 12/31/9999 57135 REMOVE VAGINA LESION $ 138.04 $ 153.32 3/1/2020 12/31/9999 57150 TREAT VAGINA INFECTION $ 24.16 $ 40.02 3/1/2020 12/31/9999 57155 INSERT UTERI TANDEM/OVOIDS $ 337.08 $ 337.08 3/1/2020 12/31/9999 57156 INS VAG BRACHYTX DEVICE $ 87.10 $ 126.81 3/1/2020 12/31/9999 57160 INSERT PESSARY/OTHER DEVICE $ 38.80 $ 60.83 3/1/2020 12/31/9999 57170 FITTING OF DIAPHRAGM/CAP $ 39.33 $ 54.90 3/1/2020 12/31/9999 57180 TREAT VAGINAL BLEEDING $ 84.89 $ 111.62 3/1/2020 12/31/9999 57200 REPAIR OF VAGINA $ 234.62 $ 234.62 3/1/2020 12/31/9999 57210 REPAIR VAGINA/PERINEUM $ 291.45 $ 291.45 3/1/2020 12/31/9999 57220 REVISION OF URETHRA $ 253.10 $ 253.10 3/1/2020 12/31/9999 57230 REPAIR OF URETHRAL LESION $ 317.08 $ 317.08 3/1/2020 12/31/9999 57240 ANTERIOR COLPORRHAPHY $ 529.37 $ 529.37 3/1/2020 12/31/9999 57250 REPAIR RECTUM & VAGINA $ 518.22 $ 518.22 3/1/2020 12/31/9999 57260 CMBN ANT PST COLPRHY $ 646.22 $ 646.22 3/1/2020 12/31/9999 57265 CMBN AP COLPRHY W/NTRCL RPR $ 721.76 $ 721.76 3/1/2020 12/31/9999 57267 INSERT MESH/PELVIC FLR ADDON $ 218.10 $ 218.10 3/1/2020 12/31/9999 57268 REPAIR OF BOWEL BULGE $ 382.08 $ 382.08 3/1/2020 12/31/9999 57270 REPAIR OF BOWEL POUCH $ 636.95 $ 636.95 3/1/2020 12/31/9999 57280 SUSPENSION OF VAGINA $ 774.89 $ 774.89 3/1/2020 12/31/9999 57282 COLPOPEXY EXTRAPERITONEAL $ 405.22 $ 405.22 3/1/2020 12/31/9999 57283 COLPOPEXY INTRAPERITONEAL $ 548.95 $ 548.95 3/1/2020 12/31/9999 57284 REPAIR PARAVAG DEFECT OPEN $ 671.28 $ 671.28 3/1/2020 12/31/9999 57285 REPAIR PARAVAG DEFECT VAG $ 535.96 $ 535.96 3/1/2020 12/31/9999 57287 REVISE/REMOVE SLING REPAIR $ 562.13 $ 562.13 3/1/2020 12/31/9999 57288 REPAIR BLADDER DEFECT $ 591.92 $ 591.92 3/1/2020 12/31/9999 57289 REPAIR BLADDER & VAGINA $ 622.10 $ 622.10 3/1/2020 12/31/9999 57291 CONSTRUCTION OF VAGINA $ 431.51 $ 431.51 3/1/2020 12/31/9999 57292 CONSTRUCT VAGINA WITH GRAFT $ 662.42 $ 662.42 3/1/2020 12/31/9999 57295 REVISE VAG GRAFT VIA VAGINA $ 392.77 $ 392.77 3/1/2020 12/31/9999 57296 REVISE VAG GRAFT OPEN ABD $ 758.63 $ 758.63 3/1/2020 12/31/9999 57300 REPAIR RECTUM-VAGINA FISTULA $ 422.48 $ 422.48 3/1/2020 12/31/9999 57305 REPAIR RECTUM-VAGINA FISTULA $ 707.68 $ 707.68 3/1/2020 12/31/9999 57307 FISTULA REPAIR & COLOSTOMY $ 791.78 $ 791.78 3/1/2020 12/31/9999 57308 FISTULA REPAIR TRANSPERINE $ 504.68 $ 504.68 3/1/2020 12/31/9999 57310 REPAIR URETHROVAGINAL LESION $ 393.39 $ 393.39 3/1/2020 12/31/9999 57311 REPAIR URETHROVAGINAL LESION $ 449.43 $ 449.43 3/1/2020 12/31/9999 57320 REPAIR BLADDER-VAGINA LESION $ 447.81 $ 447.81 3/1/2020 12/31/9999 57330 REPAIR BLADDER-VAGINA LESION $ 637.12 $ 637.12 3/1/2020 12/31/9999 57335 REPAIR VAGINA $ 930.50 $ 930.50 3/1/2020 12/31/9999 57400 DILATION OF VAGINA $ 108.76 $ 108.76 3/1/2020 12/31/9999 57410 PELVIC EXAMINATION $ 85.34 $ 85.34 3/1/2020 12/31/9999 57415 REMOVE VAGINAL FOREIGN BODY $ 126.97 $ 126.97 3/1/2020 12/31/9999 57420 EXAM OF VAGINA W/SCOPE $ 72.56 $ 92.23 3/1/2020 12/31/9999 57421 EXAM/BIOPSY OF VAG W/SCOPE $ 99.10 $ 124.35 3/1/2020 12/31/9999 57423 REPAIR PARAVAG DEFECT LAP $ 741.36 $ 741.36 3/1/2020 12/31/9999 57425 LAPAROSCOPY SURG COLPOPEXY $ 781.92 $ 781.92 3/1/2020 12/31/9999 57426 REVISE PROSTH VAG GRAFT LAP $ 548.12 $ 548.12 3/1/2020 12/31/9999 57452 EXAM OF CERVIX W/SCOPE $ 73.58 $ 86.79 3/1/2020 12/31/9999 57454 BX/CURETT OF CERVIX W/SCOPE $ 109.88 $ 123.10 3/1/2020 12/31/9999 57455 BIOPSY OF CERVIX W/SCOPE $ 89.76 $ 114.16 3/1/2020 12/31/9999 57456 ENDOCERV CURETTAGE W/SCOPE $ 83.74 $ 107.82 3/1/2020 12/31/9999 57460 BX OF CERVIX W/SCOPE LEEP $ 131.96 $ 233.90 3/1/2020 12/31/9999 57461 CONZ OF CERVIX W/SCOPE LEEP $ 152.72 $ 262.88 3/1/2020 12/31/9999 57500 BIOPSY OF CERVIX $ 59.61 $ 103.38 3/1/2020 12/31/9999 57505 ENDOCERVICAL CURETTAGE $ 71.39 $ 79.61 3/1/2020 12/31/9999 57510 CAUTERIZATION OF CERVIX $ 92.87 $ 105.50 3/1/2020 12/31/9999 57511 CRYOCAUTERY OF CERVIX $ 104.08 $ 114.66 3/1/2020 12/31/9999 57513 LASER SURGERY OF CERVIX $ 104.67 $ 113.20 3/1/2020 12/31/9999 57520 CONIZATION OF CERVIX $ 216.34 $ 242.78 3/1/2020 12/31/9999 57522 CONIZATION OF CERVIX $ 191.95 $ 208.10 3/1/2020 12/31/9999 57530 REMOVAL OF CERVIX $ 272.25 $ 272.25 3/1/2020 12/31/9999 57531 REMOVAL OF CERVIX RADICAL $ 1,357.99 $ 1,357.99 3/1/2020 12/31/9999 57540 REMOVAL OF RESIDUAL CERVIX $ 621.00 $ 621.00 3/1/2020 12/31/9999 57545 REMOVE CERVIX/REPAIR PELVIS $ 655.26 $ 655.26 3/1/2020 12/31/9999 57550 REMOVAL OF RESIDUAL CERVIX $ 322.10 $ 322.10 3/1/2020 12/31/9999 57555 REMOVE CERVIX/REPAIR VAGINA $ 476.89 $ 476.89 3/1/2020 12/31/9999 57556 REMOVE CERVIX REPAIR BOWEL $ 455.06 $ 455.06 3/1/2020 12/31/9999 57558 D&C OF CERVICAL STUMP $ 89.72 $ 98.82 3/1/2020 12/31/9999 57700 REVISION OF CERVIX $ 241.26 $ 241.26 3/1/2020 12/31/9999 57720 REVISION OF CERVIX $ 242.14 $ 242.14 3/1/2020 12/31/9999 57800 DILATION OF CERVICAL CANAL $ 38.89 $ 47.70 3/1/2020 12/31/9999 58100 BIOPSY OF UTERUS LINING $ 70.72 $ 87.47 3/1/2020 12/31/9999 58110 BX DONE W/COLPOSCOPY ADD-ON $ 33.61 $ 39.19 3/1/2020 12/31/9999 58120 DILATION AND CURETTAGE $ 171.68 $ 197.53 3/1/2020 12/31/9999 58140 MYOMECTOMY ABDOM METHOD $ 728.48 $ 728.48 3/1/2020 12/31/9999 58145 MYOMECTOMY VAG METHOD $ 430.91 $ 430.91 3/1/2020 12/31/9999 58146 MYOMECTOMY ABDOM COMPLEX $ 928.47 $ 928.47 3/1/2020 12/31/9999 58150 TOTAL HYSTERECTOMY $ 789.69 $ 789.69 3/1/2020 12/31/9999 58152 TOTAL HYSTERECTOMY $ 997.02 $ 997.02 3/1/2020 12/31/9999 58180 PARTIAL HYSTERECTOMY $ 758.22 $ 758.22 3/1/2020 12/31/9999 58200 EXTENSIVE HYSTERECTOMY $ 1,044.65 $ 1,044.65 3/1/2020 12/31/9999 58210 EXTENSIVE HYSTERECTOMY $ 1,391.79 $ 1,391.79 3/1/2020 12/31/9999 58240 REMOVAL OF PELVIS CONTENTS $ 2,188.53 $ 2,188.53 3/1/2020 12/31/9999 58260 VAGINAL HYSTERECTOMY $ 658.96 $ 658.96 3/1/2020 12/31/9999 58262 VAG HYST INCLUDING T/O $ 736.59 $ 736.59 3/1/2020 12/31/9999 58263 VAG HYST W/T/O & VAG REPAIR $ 793.80 $ 793.80 3/1/2020 12/31/9999 58267 VAG HYST W/URINARY REPAIR $ 843.55 $ 843.55 3/1/2020 12/31/9999 58270 VAG HYST W/ENTEROCELE REPAIR $ 706.31 $ 706.31 3/1/2020 12/31/9999 58275 HYSTERECTOMY/REVISE VAGINA $ 785.96 $ 785.96 3/1/2020 12/31/9999 58280 HYSTERECTOMY/REVISE VAGINA $ 841.12 $ 841.12 3/1/2020 12/31/9999 58285 EXTENSIVE HYSTERECTOMY $ 1,056.22 $ 1,056.22 3/1/2020 12/31/9999 58290 VAG HYST COMPLEX $ 924.19 $ 924.19 3/1/2020 12/31/9999 58291 VAG HYST INCL T/O COMPLEX $ 1,004.45 $ 1,004.45 3/1/2020 12/31/9999 58292 VAG HYST T/O & REPAIR COMPL $ 1,058.73 $ 1,058.73 3/1/2020 12/31/9999 58293 VAG HYST W/URO REPAIR COMPL $ 1,099.40 $ 1,099.40 3/1/2020 12/31/9999 58294 VAG HYST W/ENTEROCELE COMPL $ 976.54 $ 976.54 3/1/2020 12/31/9999 58300 INSERT INTRAUTERINE DEVICE $ 44.77 $ 62.10 3/1/2020 12/31/9999 58301 REMOVE INTRAUTERINE DEVICE $ 55.10 $ 76.25 3/1/2020 12/31/9999 58346 INSERT HEYMAN UTERI CAPSULE $ 362.79 $ 362.79 3/1/2020 12/31/9999 58353 ENDOMETR ABLATE THERMAL $ 176.07 $ 878.43 3/1/2020 12/31/9999 58400 SUSPENSION OF UTERUS $ 355.92 $ 355.92 3/1/2020 12/31/9999 58410 SUSPENSION OF UTERUS $ 639.33 $ 639.33 3/1/2020 12/31/9999 58520 REPAIR OF RUPTURED UTERUS $ 624.28 $ 624.28 3/1/2020 12/31/9999 58540 REVISION OF UTERUS $ 725.04 $ 725.04 3/1/2020 12/31/9999 58541 LSH UTERUS 250 G OR LESS $ 683.63 $ 683.63 3/1/2020 12/31/9999 58542 LSH W/T/O UT 250 G OR LESS $ 759.64 $ 759.64 3/1/2020 12/31/9999 58543 LSH UTERUS ABOVE 250 G $ 772.35 $ 772.35 3/1/2020 12/31/9999 58544 LSH W/T/O UTERUS ABOVE 250 G $ 834.96 $ 834.96 3/1/2020 12/31/9999 58545 LAPAROSCOPIC MYOMECTOMY $ 714.18 $ 714.18 3/1/2020 12/31/9999 58546 LAPARO-MYOMECTOMY COMPLEX $ 905.67 $ 905.67 3/1/2020 12/31/9999 58548 LAP RADICAL HYST $ 1,413.29 $ 1,413.29 3/1/2020 12/31/9999 58550 LAPARO-ASST VAG HYSTERECTOMY $ 704.68 $ 704.68 3/1/2020 12/31/9999 58552 LAPARO-VAG HYST INCL T/O $ 778.03 $ 778.03 3/1/2020 12/31/9999 58553 LAPARO-VAG HYST COMPLEX $ 910.37 $ 910.37 3/1/2020 12/31/9999 58554 LAPARO-VAG HYST W/T/O COMPL $ 1,043.27 $ 1,043.27 3/1/2020 12/31/9999 58555 HYSTEROSCOPY DX SEP PROC $ 153.46 $ 191.06 3/1/2020 12/31/9999 58558 HYSTEROSCOPY BIOPSY $ 216.34 $ 258.64 3/1/2020 12/31/9999 58559 HYSTEROSCOPY LYSIS $ 278.38 $ 278.38 3/1/2020 12/31/9999 58560 HYSTEROSCOPY RESECT SEPTUM $ 314.67 $ 314.67 3/1/2020 12/31/9999 58561 HYSTEROSCOPY REMOVE MYOMA $ 445.60 $ 445.60 3/1/2020 12/31/9999 58562 HYSTEROSCOPY REMOVE FB $ 235.99 $ 273.87 3/1/2020 12/31/9999 58563 HYSTEROSCOPY ABLATION $ 278.38 $ 1,430.75 3/1/2020 12/31/9999 58570 TLH UTERUS 250 G OR LESS $ 734.20 $ 734.20 3/1/2020 12/31/9999 58571 TLH W/T/O 250 G OR LESS $ 807.05 $ 807.05 3/1/2020 12/31/9999 58572 TLH UTERUS OVER 250 G $ 913.61 $ 913.61 3/1/2020 12/31/9999 58573 TLH W/T/O UTERUS OVER 250 G $ 1,034.75 $ 1,034.75 3/1/2020 12/31/9999 58575 LAPS TOT HYST RESJ MAL $ 1,630.90 $ 1,630.90 3/1/2020 12/31/9999 58600 DIVISION OF FALLOPIAN TUBE $ 288.69 $ 288.69 3/1/2020 12/31/9999 58605 DIVISION OF FALLOPIAN TUBE $ 262.32 $ 262.32 3/1/2020 12/31/9999 58611 LIGATE OVIDUCT(S) ADD-ON $ 63.19 $ 63.18 3/1/2020 12/31/9999 58615 OCCLUDE FALLOPIAN TUBE(S) $ 198.26 $ 198.26 3/1/2020 12/31/9999 58660 LAPAROSCOPY LYSIS $ 536.83 $ 536.83 3/1/2020 12/31/9999 58661 LAPAROSCOPY REMOVE ADNEXA $ 516.24 $ 516.24 3/1/2020 12/31/9999 58662 LAPAROSCOPY EXCISE LESIONS $ 564.28 $ 564.28 3/1/2020 12/31/9999 58670 LAPAROSCOPY TUBAL CAUTERY $ 290.65 $ 290.65 3/1/2020 12/31/9999 58671 LAPAROSCOPY TUBAL BLOCK $ 290.55 $ 290.56 3/1/2020 12/31/9999 58700 REMOVAL OF FALLOPIAN TUBE $ 607.35 $ 607.35 3/1/2020 12/31/9999 58720 REMOVAL OF OVARY/TUBE(S) $ 570.82 $ 570.82 3/1/2020 12/31/9999 58800 DRAINAGE OF OVARIAN CYST(S) $ 235.97 $ 252.70 3/1/2020 12/31/9999 58805 DRAINAGE OF OVARIAN CYST(S) $ 320.99 $ 320.99 3/1/2020 12/31/9999 58820 DRAIN OVARY ABSCESS OPEN $ 247.36 $ 247.36 3/1/2020 12/31/9999 58822 DRAIN OVARY ABSCESS PERCUT $ 560.89 $ 560.89 3/1/2020 12/31/9999 58825 TRANSPOSITION OVARY(S) $ 554.69 $ 554.69 3/1/2020 12/31/9999 58900 BIOPSY OF OVARY(S) $ 327.55 $ 327.55 3/1/2020 12/31/9999 58920 PARTIAL REMOVAL OF OVARY(S) $ 558.78 $ 558.78 3/1/2020 12/31/9999 58925 REMOVAL OF OVARIAN CYST(S) $ 582.39 $ 582.39 3/1/2020 12/31/9999 58940 REMOVAL OF OVARY(S) $ 398.08 $ 398.08 3/1/2020 12/31/9999 58943 REMOVAL OF OVARY(S) $ 891.32 $ 891.32 3/1/2020 12/31/9999 58950 RESECT OVARIAN MALIGNANCY $ 849.33 $ 849.33 3/1/2020 12/31/9999 58951 RESECT OVARIAN MALIGNANCY $ 1,096.78 $ 1,096.78 3/1/2020 12/31/9999 58952 RESECT OVARIAN MALIGNANCY $ 1,236.92 $ 1,236.92 3/1/2020 12/31/9999 58953 TAH RAD DISSECT FOR DEBULK $ 1,535.02 $ 1,535.02 3/1/2020 12/31/9999 58954 TAH RAD DEBULK/LYMPH REMOVE $ 1,666.50 $ 1,666.50 3/1/2020 12/31/9999 58956 BSO OMENTECTOMY W/TAH $ 1,074.37 $ 1,074.37 3/1/2020 12/31/9999 58957 RESECT RECURRENT GYN MAL $ 1,181.29 $ 1,181.29 3/1/2020 12/31/9999 58958 RESECT RECUR GYN MAL W/LYM $ 1,313.08 $ 1,313.08 3/1/2020 12/31/9999 58960 EXPLORATION OF ABDOMEN $ 733.93 $ 733.93 3/1/2020 12/31/9999 59000 AMNIOCENTESIS DIAGNOSTIC $ 64.86 $ 101.28 3/1/2020 12/31/9999 59001 AMNIOCENTESIS THERAPEUTIC $ 148.34 $ 148.34 3/1/2020 12/31/9999 59012 FETAL CORD PUNCTURE PRENATAL $ 163.64 $ 163.64 3/1/2020 12/31/9999 59015 CHORION BIOPSY $ 106.47 $ 123.81 3/1/2020 12/31/9999 59020 26 FETAL CONTRACT STRESS TEST $ 30.36 $ 30.36 3/1/2020 12/31/9999 59020 TC FETAL CONTRACT STRESS TEST $ 24.93 $ 24.93 3/1/2020 12/31/9999 59020 FETAL CONTRACT STRESS TEST $ 55.27 $ 55.27 3/1/2020 12/31/9999 59025 26 FETAL NON-STRESS TEST $ 24.44 $ 24.44 3/1/2020 12/31/9999 59025 TC FETAL NON-STRESS TEST $ 12.44 $ 12.44 3/1/2020 12/31/9999 59025 FETAL NON-STRESS TEST $ 36.89 $ 36.89 3/1/2020 12/31/9999 59030 FETAL SCALP BLOOD SAMPLE $ 91.16 $ 91.16 3/1/2020 12/31/9999 59100 REMOVE UTERUS LESION $ 653.21 $ 653.21 3/1/2020 12/31/9999 59120 TREAT ECTOPIC PREGNANCY $ 623.91 $ 623.91 3/1/2020 12/31/9999 59121 TREAT ECTOPIC PREGNANCY $ 626.78 $ 626.78 3/1/2020 12/31/9999 59130 TREAT ECTOPIC PREGNANCY $ 731.96 $ 731.96 3/1/2020 12/31/9999 59135 TREAT ECTOPIC PREGNANCY $ 740.55 $ 740.55 3/1/2020 12/31/9999 59136 TREAT ECTOPIC PREGNANCY $ 692.35 $ 692.35 3/1/2020 12/31/9999 59140 TREAT ECTOPIC PREGNANCY $ 309.59 $ 309.59 3/1/2020 12/31/9999 59150 TREAT ECTOPIC PREGNANCY $ 606.61 $ 606.61 3/1/2020 12/31/9999 59151 TREAT ECTOPIC PREGNANCY $ 592.83 $ 592.83 3/1/2020 12/31/9999 59160 D & C AFTER DELIVERY $ 142.46 $ 168.32 3/1/2020 12/31/9999 59200 INSERT CERVICAL DILATOR $ 36.26 $ 58.29 3/1/2020 12/31/9999 59300 EPISIOTOMY OR VAGINAL REPAIR $ 117.09 $ 151.45 3/1/2020 12/31/9999 59320 REVISION OF CERVIX $ 122.66 $ 122.66 3/1/2020 12/31/9999 59325 REVISION OF CERVIX $ 193.66 $ 193.66 3/1/2020 12/31/9999 59350 REPAIR OF UTERUS $ 223.31 $ 223.31 3/1/2020 12/31/9999 59400 OBSTETRICAL CARE $ 1,393.91 $ 1,393.91 3/1/2020 12/31/9999 59409 OBSTETRICAL CARE $ 618.92 $ 618.92 3/1/2020 12/31/9999 59410 OBSTETRICAL CARE $ 717.70 $ 717.70 3/1/2020 12/31/9999 59412 ANTEPARTUM MANIPULATION $ 82.92 $ 82.92 3/1/2020 12/31/9999 59414 DELIVER PLACENTA $ 73.76 $ 73.76 3/1/2020 12/31/9999 59425 ANTEPARTUM CARE ONLY $ 273.93 $ 346.49 3/1/2020 12/31/9999 59426 ANTEPARTUM CARE ONLY $ 484.74 $ 619.88 3/1/2020 12/31/9999 59430 CARE AFTER DELIVERY $ 100.92 $ 111.18 3/1/2020 12/31/9999 59510 CESAREAN DELIVERY $ 1,578.42 $ 1,578.42 3/1/2020 12/31/9999 59514 CESAREAN DELIVERY ONLY $ 732.83 $ 732.83 3/1/2020 12/31/9999 59515 CESAREAN DELIVERY $ 863.95 $ 863.95 3/1/2020 12/31/9999 59525 REMOVE UTERUS AFTER CESAREAN $ 390.04 $ 390.04 3/1/2020 12/31/9999 59812 TREATMENT OF MISCARRIAGE $ 230.51 $ 246.66 3/1/2020 12/31/9999 59820 CARE OF MISCARRIAGE $ 271.14 $ 290.83 3/1/2020 12/31/9999 59821 TREATMENT OF MISCARRIAGE $ 275.52 $ 296.37 3/1/2020 12/31/9999 59830 TREAT UTERUS INFECTION $ 342.95 $ 342.95 3/1/2020 12/31/9999 59840 ABORTION $ 165.69 $ 170.98 3/1/2020 12/31/9999 59841 ABORTION $ 281.75 $ 297.91 3/1/2020 12/31/9999 59850 ABORTION $ 307.14 $ 307.14 3/1/2020 12/31/9999 59851 ABORTION $ 315.12 $ 315.12 3/1/2020 12/31/9999 59852 ABORTION $ 442.32 $ 442.32 3/1/2020 12/31/9999 59855 ABORTION $ 327.85 $ 327.85 3/1/2020 12/31/9999 59856 ABORTION $ 387.58 $ 387.58 3/1/2020 12/31/9999 59857 ABORTION $ 463.79 $ 463.79 3/1/2020 12/31/9999 59870 EVACUATE MOLE OF UTERUS $ 367.84 $ 367.84 3/1/2020 12/31/9999 59871 REMOVE CERCLAGE SUTURE $ 107.09 $ 107.09 3/1/2020 12/31/9999 60000 DRAIN THYROID/TONGUE CYST $ 111.84 $ 122.10 3/1/2020 12/31/9999 60100 BIOPSY OF THYROID $ 68.01 $ 91.80 3/1/2020 12/31/9999 60200 REMOVE THYROID LESION $ 503.95 $ 503.95 3/1/2020 12/31/9999 60210 PARTIAL THYROID EXCISION $ 540.11 $ 540.11 3/1/2020 12/31/9999 60212 PARTIAL THYROID EXCISION $ 776.36 $ 776.36 3/1/2020 12/31/9999 60220 PARTIAL REMOVAL OF THYROID $ 592.23 $ 592.23 3/1/2020 12/31/9999 60225 PARTIAL REMOVAL OF THYROID $ 711.55 $ 711.55 3/1/2020 12/31/9999 60240 REMOVAL OF THYROID $ 754.83 $ 754.83 3/1/2020 12/31/9999 60252 REMOVAL OF THYROID $ 1,019.32 $ 1,019.32 3/1/2020 12/31/9999 60254 EXTENSIVE THYROID SURGERY $ 1,313.71 $ 1,313.71 3/1/2020 12/31/9999 60260 REPEAT THYROID SURGERY $ 851.09 $ 851.09 3/1/2020 12/31/9999 60270 REMOVAL OF THYROID $ 1,072.69 $ 1,072.69 3/1/2020 12/31/9999 60271 REMOVAL OF THYROID $ 822.24 $ 822.24 3/1/2020 12/31/9999 60280 REMOVE THYROID DUCT LESION $ 337.84 $ 337.84 3/1/2020 12/31/9999 60281 REMOVE THYROID DUCT LESION $ 452.27 $ 452.27 3/1/2020 12/31/9999 60300 ASPIR/INJ THYROID CYST $ 41.91 $ 85.08 3/1/2020 12/31/9999 60500 EXPLORE PARATHYROID GLANDS $ 782.58 $ 782.58 3/1/2020 12/31/9999 60502 RE-EXPLORE PARATHYROIDS $ 982.41 $ 982.41 3/1/2020 12/31/9999 60505 EXPLORE PARATHYROID GLANDS $ 1,078.76 $ 1,078.76 3/1/2020 12/31/9999 60512 AUTOTRANSPLANT PARATHYROID $ 192.21 $ 192.21 3/1/2020 12/31/9999 60520 REMOVAL OF THYMUS GLAND $ 806.10 $ 806.10 3/1/2020 12/31/9999 60521 REMOVAL OF THYMUS GLAND $ 924.79 $ 924.79 3/1/2020 12/31/9999 60522 REMOVAL OF THYMUS GLAND $ 1,115.84 $ 1,115.84 3/1/2020 12/31/9999 60540 EXPLORE ADRENAL GLAND $ 849.86 $ 849.86 3/1/2020 12/31/9999 60545 EXPLORE ADRENAL GLAND $ 967.72 $ 967.72 3/1/2020 12/31/9999 60600 REMOVE CAROTID BODY LESION $ 1,125.76 $ 1,125.76 3/1/2020 12/31/9999 60605 REMOVE CAROTID BODY LESION $ 1,416.65 $ 1,416.65 3/1/2020 12/31/9999 60650 LAPAROSCOPY ADRENALECTOMY $ 947.99 $ 947.99 3/1/2020 12/31/9999 61000 REMOVE CRANIAL CAVITY FLUID $ 85.98 $ 85.98 3/1/2020 12/31/9999 61001 REMOVE CRANIAL CAVITY FLUID $ 84.03 $ 84.03 3/1/2020 12/31/9999 61020 REMOVE BRAIN CAVITY FLUID $ 99.74 $ 99.74 3/1/2020 12/31/9999 61026 INJECTION INTO BRAIN CANAL $ 99.97 $ 99.97 3/1/2020 12/31/9999 61050 REMOVE BRAIN CANAL FLUID $ 85.42 $ 85.42 3/1/2020 12/31/9999 61055 INJECTION INTO BRAIN CANAL $ 110.36 $ 110.36 3/1/2020 12/31/9999 61070 BRAIN CANAL SHUNT PROCEDURE $ 63.41 $ 63.41 3/1/2020 12/31/9999 61105 TWIST DRILL HOLE $ 328.78 $ 328.78 3/1/2020 12/31/9999 61107 DRILL SKULL FOR IMPLANTATION $ 245.84 $ 245.84 3/1/2020 12/31/9999 61108 DRILL SKULL FOR DRAINAGE $ 654.55 $ 654.55 3/1/2020 12/31/9999 61120 BURR HOLE FOR PUNCTURE $ 536.71 $ 536.71 3/1/2020 12/31/9999 61140 PIERCE SKULL FOR BIOPSY $ 932.37 $ 932.37 3/1/2020 12/31/9999 61150 PIERCE SKULL FOR DRAINAGE $ 998.60 $ 998.60 3/1/2020 12/31/9999 61151 PIERCE SKULL FOR DRAINAGE $ 722.63 $ 722.63 3/1/2020 12/31/9999 61154 PIERCE SKULL & REMOVE CLOT $ 933.75 $ 933.75 3/1/2020 12/31/9999 61156 PIERCE SKULL FOR DRAINAGE $ 931.71 $ 931.71 3/1/2020 12/31/9999 61210 PIERCE SKULL IMPLANT DEVICE $ 287.02 $ 287.02 3/1/2020 12/31/9999 61215 INSERT BRAIN-FLUID DEVICE $ 357.24 $ 357.24 3/1/2020 12/31/9999 61250 PIERCE SKULL & EXPLORE $ 628.73 $ 628.73 3/1/2020 12/31/9999 61253 PIERCE SKULL & EXPLORE $ 693.92 $ 693.92 3/1/2020 12/31/9999 61304 OPEN SKULL FOR EXPLORATION $ 1,230.48 $ 1,230.48 3/1/2020 12/31/9999 61305 OPEN SKULL FOR EXPLORATION $ 1,484.18 $ 1,484.18 3/1/2020 12/31/9999 61312 OPEN SKULL FOR DRAINAGE $ 1,540.62 $ 1,540.62 3/1/2020 12/31/9999 61313 OPEN SKULL FOR DRAINAGE $ 1,471.26 $ 1,471.26 3/1/2020 12/31/9999 61314 OPEN SKULL FOR DRAINAGE $ 1,361.63 $ 1,361.63 3/1/2020 12/31/9999 61315 OPEN SKULL FOR DRAINAGE $ 1,550.43 $ 1,550.43 3/1/2020 12/31/9999 61316 IMPLT CRAN BONE FLAP TO ABDO $ 67.64 $ 67.64 3/1/2020 12/31/9999 61320 OPEN SKULL FOR DRAINAGE $ 1,433.86 $ 1,433.86 3/1/2020 12/31/9999 61321 OPEN SKULL FOR DRAINAGE $ 1,572.39 $ 1,572.39 3/1/2020 12/31/9999 61322 DECOMPRESSIVE CRANIOTOMY $ 1,746.12 $ 1,746.12 3/1/2020 12/31/9999 61323 DECOMPRESSIVE LOBECTOMY $ 1,777.05 $ 1,777.05 3/1/2020 12/31/9999 61330 DECOMPRESS EYE SOCKET $ 1,219.66 $ 1,219.66 3/1/2020 12/31/9999 61333 EXPLORE ORBIT/REMOVE LESION $ 1,427.67 $ 1,427.67 3/1/2020 12/31/9999 61340 SUBTEMPORAL DECOMPRESSION $ 1,067.18 $ 1,067.18 3/1/2020 12/31/9999 61343 INCISE SKULL (PRESS RELIEF) $ 1,650.54 $ 1,650.54 3/1/2020 12/31/9999 61345 RELIEVE CRANIAL PRESSURE $ 1,527.04 $ 1,527.04 3/1/2020 12/31/9999 61450 INCISE SKULL FOR SURGERY $ 1,416.90 $ 1,416.90 3/1/2020 12/31/9999 61458 INCISE SKULL FOR BRAIN WOUND $ 1,509.75 $ 1,509.75 3/1/2020 12/31/9999 61460 INCISE SKULL FOR SURGERY $ 1,531.93 $ 1,531.93 3/1/2020 12/31/9999 61500 REMOVAL OF SKULL LESION $ 1,009.66 $ 1,009.66 3/1/2020 12/31/9999 61501 REMOVE INFECTED SKULL BONE $ 865.15 $ 865.15 3/1/2020 12/31/9999 61510 REMOVAL OF BRAIN LESION $ 1,627.69 $ 1,627.69 3/1/2020 12/31/9999 61512 REMOVE BRAIN LINING LESION $ 1,923.23 $ 1,923.23 3/1/2020 12/31/9999 61514 REMOVAL OF BRAIN ABSCESS $ 1,426.73 $ 1,426.73 3/1/2020 12/31/9999 61516 REMOVAL OF BRAIN LESION $ 1,391.97 $ 1,391.97 3/1/2020 12/31/9999 61517 IMPLT BRAIN CHEMOTX ADD-ON $ 67.61 $ 67.61 3/1/2020 12/31/9999 61518 REMOVAL OF BRAIN LESION $ 2,069.22 $ 2,069.22 3/1/2020 12/31/9999 61519 REMOVE BRAIN LINING LESION $ 2,229.39 $ 2,229.39 3/1/2020 12/31/9999 61520 REMOVAL OF BRAIN LESION $ 2,852.17 $ 2,852.17 3/1/2020 12/31/9999 61521 REMOVAL OF BRAIN LESION $ 2,396.23 $ 2,396.23 3/1/2020 12/31/9999 61522 REMOVAL OF BRAIN ABSCESS $ 1,642.33 $ 1,642.33 3/1/2020 12/31/9999 61524 REMOVAL OF BRAIN LESION $ 1,550.70 $ 1,550.70 3/1/2020 12/31/9999 61526 REMOVAL OF BRAIN LESION $ 2,593.08 $ 2,593.08 3/1/2020 12/31/9999 61530 REMOVAL OF BRAIN LESION $ 2,201.89 $ 2,201.89 3/1/2020 12/31/9999 61531 IMPLANT BRAIN ELECTRODES $ 896.74 $ 896.74 3/1/2020 12/31/9999 61533 IMPLANT BRAIN ELECTRODES $ 1,133.90 $ 1,133.90 3/1/2020 12/31/9999 61534 REMOVAL OF BRAIN LESION $ 1,221.21 $ 1,221.21 3/1/2020 12/31/9999 61535 REMOVE BRAIN ELECTRODES $ 729.61 $ 729.61 3/1/2020 12/31/9999 61536 REMOVAL OF BRAIN LESION $ 1,949.31 $ 1,949.31 3/1/2020 12/31/9999 61537 REMOVAL OF BRAIN TISSUE $ 1,798.15 $ 1,798.15 3/1/2020 12/31/9999 61538 REMOVAL OF BRAIN TISSUE $ 1,928.38 $ 1,928.38 3/1/2020 12/31/9999 61539 REMOVAL OF BRAIN TISSUE $ 1,764.88 $ 1,764.88 3/1/2020 12/31/9999 61540 REMOVAL OF BRAIN TISSUE $ 1,654.40 $ 1,654.40 3/1/2020 12/31/9999 61541 INCISION OF BRAIN TISSUE $ 1,589.23 $ 1,589.23 3/1/2020 12/31/9999 61543 REMOVAL OF BRAIN TISSUE $ 1,610.90 $ 1,610.90 3/1/2020 12/31/9999 61544 REMOVE & TREAT BRAIN LESION $ 1,332.21 $ 1,332.21 3/1/2020 12/31/9999 61545 EXCISION OF BRAIN TUMOR $ 2,373.61 $ 2,373.61 3/1/2020 12/31/9999 61546 REMOVAL OF PITUITARY GLAND $ 1,719.83 $ 1,719.83 3/1/2020 12/31/9999 61548 REMOVAL OF PITUITARY GLAND $ 1,167.58 $ 1,167.58 3/1/2020 12/31/9999 61550 RELEASE OF SKULL SEAMS $ 765.31 $ 765.31 3/1/2020 12/31/9999 61552 RELEASE OF SKULL SEAMS $ 1,005.21 $ 1,005.21 3/1/2020 12/31/9999 61556 INCISE SKULL/SUTURES $ 1,226.78 $ 1,226.78 3/1/2020 12/31/9999 61557 INCISE SKULL/SUTURES $ 1,259.69 $ 1,259.69 3/1/2020 12/31/9999 61558 EXCISION OF SKULL/SUTURES $ 1,300.68 $ 1,300.68 3/1/2020 12/31/9999 61559 EXCISION OF SKULL/SUTURES $ 1,803.75 $ 1,803.75 3/1/2020 12/31/9999 61563 EXCISION OF SKULL TUMOR $ 1,451.77 $ 1,451.77 3/1/2020 12/31/9999 61564 EXCISION OF SKULL TUMOR $ 1,816.90 $ 1,816.90 3/1/2020 12/31/9999 61566 REMOVAL OF BRAIN TISSUE $ 1,677.22 $ 1,677.22 3/1/2020 12/31/9999 61567 INCISION OF BRAIN TISSUE $ 1,887.31 $ 1,887.31 3/1/2020 12/31/9999 61570 REMOVE FOREIGN BODY BRAIN $ 1,372.08 $ 1,372.08 3/1/2020 12/31/9999 61571 INCISE SKULL FOR BRAIN WOUND $ 1,489.81 $ 1,489.81 3/1/2020 12/31/9999 61575 SKULL BASE/BRAINSTEM SURGERY $ 1,779.63 $ 1,779.63 3/1/2020 12/31/9999 61576 SKULL BASE/BRAINSTEM SURGERY $ 2,837.98 $ 2,837.98 3/1/2020 12/31/9999 61580 CRANIOFACIAL APPROACH SKULL $ 1,861.31 $ 1,861.31 3/1/2020 12/31/9999 61581 CRANIOFACIAL APPROACH SKULL $ 2,090.28 $ 2,090.28 3/1/2020 12/31/9999 61582 CRANIOFACIAL APPROACH SKULL $ 2,134.78 $ 2,134.78 3/1/2020 12/31/9999 61583 CRANIOFACIAL APPROACH SKULL $ 2,166.29 $ 2,166.29 3/1/2020 12/31/9999 61584 ORBITOCRANIAL APPROACH/SKULL $ 2,109.87 $ 2,109.87 3/1/2020 12/31/9999 61585 ORBITOCRANIAL APPROACH/SKULL $ 2,241.04 $ 2,241.04 3/1/2020 12/31/9999 61586 RESECT NASOPHARYNX SKULL $ 1,607.30 $ 1,607.30 3/1/2020 12/31/9999 61590 INFRATEMPORAL APPROACH/SKULL $ 2,376.40 $ 2,376.40 3/1/2020 12/31/9999 61591 INFRATEMPORAL APPROACH/SKULL $ 2,392.56 $ 2,392.56 3/1/2020 12/31/9999 61592 ORBITOCRANIAL APPROACH/SKULL $ 2,376.62 $ 2,376.62 3/1/2020 12/31/9999 61595 TRANSTEMPORAL APPROACH/SKULL $ 1,793.90 $ 1,793.90 3/1/2020 12/31/9999 61596 TRANSCOCHLEAR APPROACH/SKULL $ 1,976.85 $ 1,976.85 3/1/2020 12/31/9999 61597 TRANSCONDYLAR APPROACH/SKULL $ 2,158.50 $ 2,158.50 3/1/2020 12/31/9999 61598 TRANSPETROSAL APPROACH/SKULL $ 1,914.61 $ 1,914.61 3/1/2020 12/31/9999 61600 RESECT/EXCISE CRANIAL LESION $ 1,614.65 $ 1,614.65 3/1/2020 12/31/9999 61601 RESECT/EXCISE CRANIAL LESION $ 1,761.04 $ 1,761.04 3/1/2020 12/31/9999 61605 RESECT/EXCISE CRANIAL LESION $ 1,692.78 $ 1,692.78 3/1/2020 12/31/9999 61606 RESECT/EXCISE CRANIAL LESION $ 2,263.58 $ 2,263.58 3/1/2020 12/31/9999 61607 RESECT/EXCISE CRANIAL LESION $ 2,102.91 $ 2,102.91 3/1/2020 12/31/9999 61608 RESECT/EXCISE CRANIAL LESION $ 2,442.31 $ 2,442.31 3/1/2020 12/31/9999 61611 TRANSECT ARTERY SINUS $ 366.19 $ 366.19 3/1/2020 12/31/9999 61613 REMOVE ANEURYSM SINUS $ 2,375.11 $ 2,375.11 3/1/2020 12/31/9999 61615 RESECT/EXCISE LESION SKULL $ 1,878.25 $ 1,878.25 3/1/2020 12/31/9999 61616 RESECT/EXCISE LESION SKULL $ 2,466.00 $ 2,466.00 3/1/2020 12/31/9999 61618 REPAIR DURA $ 974.84 $ 974.84 3/1/2020 12/31/9999 61619 REPAIR DURA $ 1,125.12 $ 1,125.12 3/1/2020 12/31/9999 61623 ENDOVASC TEMPORY VESSEL OCCL $ 454.62 $ 454.62 3/1/2020 12/31/9999 61624 TRANSCATH OCCLUSION CNS $ 905.47 $ 905.47 3/1/2020 12/31/9999 61626 TRANSCATH OCCLUSION NON-CNS $ 738.07 $ 738.07 3/1/2020 12/31/9999 61645 PERQ ART M-THROMBECT &/NFS $ 697.52 $ 697.52 3/1/2020 12/31/9999 61650 EVASC PRLNG ADMN RX AGNT 1ST $ 476.42 $ 476.42 3/1/2020 12/31/9999 61651 EVASC PRLNG ADMN RX AGNT ADD $ 202.87 $ 202.87 3/1/2020 12/31/9999 61680 INTRACRANIAL VESSEL SURGERY $ 1,700.98 $ 1,700.98 3/1/2020 12/31/9999 61682 INTRACRANIAL VESSEL SURGERY $ 3,201.88 $ 3,201.88 3/1/2020 12/31/9999 61684 INTRACRANIAL VESSEL SURGERY $ 2,129.98 $ 2,129.98 3/1/2020 12/31/9999 61686 INTRACRANIAL VESSEL SURGERY $ 3,426.90 $ 3,426.90 3/1/2020 12/31/9999 61690 INTRACRANIAL VESSEL SURGERY $ 1,618.98 $ 1,618.98 3/1/2020 12/31/9999 61692 INTRACRANIAL VESSEL SURGERY $ 2,767.93 $ 2,767.93 3/1/2020 12/31/9999 61697 BRAIN ANEURYSM REPR COMPLX $ 3,132.92 $ 3,132.92 3/1/2020 12/31/9999 61698 BRAIN ANEURYSM REPR COMPLX $ 3,374.15 $ 3,374.15 3/1/2020 12/31/9999 61700 BRAIN ANEURYSM REPR SIMPLE $ 2,614.46 $ 2,614.46 3/1/2020 12/31/9999 61702 INNER SKULL VESSEL SURGERY $ 2,935.10 $ 2,935.10 3/1/2020 12/31/9999 61703 CLAMP NECK ARTERY $ 1,001.95 $ 1,001.95 3/1/2020 12/31/9999 61705 REVISE CIRCULATION TO HEAD $ 1,926.63 $ 1,926.63 3/1/2020 12/31/9999 61708 REVISE CIRCULATION TO HEAD $ 1,674.54 $ 1,674.54 3/1/2020 12/31/9999 61710 REVISE CIRCULATION TO HEAD $ 1,518.01 $ 1,518.01 3/1/2020 12/31/9999 61711 FUSION OF SKULL ARTERIES $ 1,962.10 $ 1,962.10 3/1/2020 12/31/9999 61720 INCISE SKULL/BRAIN SURGERY $ 876.63 $ 876.63 3/1/2020 12/31/9999 61735 INCISE SKULL/BRAIN SURGERY $ 1,077.85 $ 1,077.85 3/1/2020 12/31/9999 61750 INCISE SKULL/BRAIN BIOPSY $ 1,048.23 $ 1,048.23 3/1/2020 12/31/9999 61751 BRAIN BIOPSY W/CT/MR GUIDE $ 1,020.38 $ 1,020.38 3/1/2020 12/31/9999 61760 IMPLANT BRAIN ELECTRODES $ 1,154.67 $ 1,154.67 3/1/2020 12/31/9999 61770 INCISE SKULL FOR TREATMENT $ 1,141.65 $ 1,141.65 3/1/2020 12/31/9999 61781 SCAN PROC CRANIAL INTRA $ 197.16 $ 197.16 3/1/2020 12/31/9999 61782 SCAN PROC CRANIAL EXTRA $ 163.25 $ 163.25 3/1/2020 12/31/9999 61783 SCAN PROC SPINAL $ 197.16 $ 197.16 3/1/2020 12/31/9999 61790 TREAT TRIGEMINAL NERVE $ 633.77 $ 633.77 3/1/2020 12/31/9999 61791 TREAT TRIGEMINAL TRACT $ 821.37 $ 821.37 3/1/2020 12/31/9999 61796 SRS CRANIAL LESION SIMPLE $ 597.02 $ 597.02 3/1/2020 12/31/9999 61797 SRS CRAN LES SIMPLE ADDL $ 164.38 $ 164.38 3/1/2020 12/31/9999 61798 SRS CRANIAL LESION COMPLEX $ 597.02 $ 597.02 3/1/2020 12/31/9999 61799 SRS CRAN LES COMPLEX ADDL $ 227.23 $ 227.23 3/1/2020 12/31/9999 61800 APPLY SRS HEADFRAME ADD-ON $ 115.53 $ 115.53 3/1/2020 12/31/9999 61850 IMPLANT NEUROELECTRODES $ 728.55 $ 728.55 3/1/2020 12/31/9999 61860 IMPLANT NEUROELECTRODES $ 1,162.93 $ 1,162.93 3/1/2020 12/31/9999 61863 IMPLANT NEUROELECTRODE $ 1,126.78 $ 1,126.78 3/1/2020 12/31/9999 61864 IMPLANT NEUROELECTRDE ADDL $ 307.73 $ 307.73 3/1/2020 12/31/9999 61867 IMPLANT NEUROELECTRODE $ 1,665.47 $ 1,665.47 3/1/2020 12/31/9999 61868 IMPLANT NEUROELECTRDE ADDL $ 458.63 $ 458.63 3/1/2020 12/31/9999 61870 IMPLANT NEUROELECTRODES $ 882.99 $ 882.99 3/1/2020 12/31/9999 61880 REVISE/REMOVE NEUROELECTRODE $ 405.51 $ 405.51 3/1/2020 12/31/9999 61885 INSRT/REDO NEUROSTIM 1 ARRAY $ 467.87 $ 467.87 3/1/2020 12/31/9999 61886 IMPLANT NEUROSTIM ARRAYS $ 590.99 $ 590.99 3/1/2020 12/31/9999 61888 REVISE/REMOVE NEURORECEIVER $ 296.78 $ 296.78 3/1/2020 12/31/9999 62000 TREAT SKULL FRACTURE $ 659.12 $ 659.12 3/1/2020 12/31/9999 62005 TREAT SKULL FRACTURE $ 925.71 $ 925.71 3/1/2020 12/31/9999 62010 TREATMENT OF HEAD INJURY $ 1,130.64 $ 1,130.64 3/1/2020 12/31/9999 62100 REPAIR BRAIN FLUID LEAKAGE $ 1,205.09 $ 1,205.09 3/1/2020 12/31/9999 62115 REDUCTION OF SKULL DEFECT $ 1,075.94 $ 1,075.94 3/1/2020 12/31/9999 62117 REDUCTION OF SKULL DEFECT $ 1,433.38 $ 1,433.38 3/1/2020 12/31/9999 62120 REPAIR SKULL CAVITY LESION $ 1,358.10 $ 1,358.10 3/1/2020 12/31/9999 62121 INCISE SKULL REPAIR $ 1,241.59 $ 1,241.59 3/1/2020 12/31/9999 62140 REPAIR OF SKULL DEFECT $ 781.96 $ 781.96 3/1/2020 12/31/9999 62141 REPAIR OF SKULL DEFECT $ 858.97 $ 858.97 3/1/2020 12/31/9999 62142 REMOVE SKULL PLATE/FLAP $ 653.66 $ 653.66 3/1/2020 12/31/9999 62143 REPLACE SKULL PLATE/FLAP $ 766.35 $ 766.35 3/1/2020 12/31/9999 62145 REPAIR OF SKULL & BRAIN $ 1,051.76 $ 1,051.76 3/1/2020 12/31/9999 62146 REPAIR OF SKULL WITH GRAFT $ 902.52 $ 902.52 3/1/2020 12/31/9999 62147 REPAIR OF SKULL WITH GRAFT $ 1,072.14 $ 1,072.14 3/1/2020 12/31/9999 62148 RETR BONE FLAP TO FIX SKULL $ 96.67 $ 96.67 3/1/2020 12/31/9999 62160 NEUROENDOSCOPY ADD-ON $ 148.08 $ 148.08 3/1/2020 12/31/9999 62161 DISSECT BRAIN W/SCOPE $ 1,130.58 $ 1,130.58 3/1/2020 12/31/9999 62162 REMOVE COLLOID CYST W/SCOPE $ 1,406.56 $ 1,406.56 3/1/2020 12/31/9999 62163 ZNEUROENDOSCOPY W/FB REMOVAL $ 909.09 $ 909.09 3/1/2020 12/31/9999 62164 REMOVE BRAIN TUMOR W/SCOPE $ 1,501.07 $ 1,501.07 3/1/2020 12/31/9999 62165 REMOVE PITUIT TUMOR W/SCOPE $ 1,165.19 $ 1,165.19 3/1/2020 12/31/9999 62180 ESTABLISH BRAIN CAVITY SHUNT $ 1,185.07 $ 1,185.07 3/1/2020 12/31/9999 62190 ESTABLISH BRAIN CAVITY SHUNT $ 672.91 $ 672.91 3/1/2020 12/31/9999 62192 ESTABLISH BRAIN CAVITY SHUNT $ 718.04 $ 718.04 3/1/2020 12/31/9999 62194 REPLACE/IRRIGATE CATHETER $ 293.49 $ 293.49 3/1/2020 12/31/9999 62200 ESTABLISH BRAIN CAVITY SHUNT $ 1,024.68 $ 1,024.68 3/1/2020 12/31/9999 62201 BRAIN CAVITY SHUNT W/SCOPE $ 878.33 $ 878.33 3/1/2020 12/31/9999 62220 ESTABLISH BRAIN CAVITY SHUNT $ 754.68 $ 754.68 3/1/2020 12/31/9999 62223 ESTABLISH BRAIN CAVITY SHUNT $ 773.70 $ 773.70 3/1/2020 12/31/9999 62225 REPLACE/IRRIGATE CATHETER $ 368.00 $ 368.00 3/1/2020 12/31/9999 62230 REPLACE/REVISE BRAIN SHUNT $ 623.27 $ 623.27 3/1/2020 12/31/9999 62252 26 CSF SHUNT REPROGRAM $ 36.44 $ 36.44 3/1/2020 12/31/9999 62252 TC CSF SHUNT REPROGRAM $ 39.76 $ 39.76 3/1/2020 12/31/9999 62252 CSF SHUNT REPROGRAM $ 76.20 $ 76.20 3/1/2020 12/31/9999 62256 REMOVE BRAIN CAVITY SHUNT $ 431.54 $ 431.54 3/1/2020 12/31/9999 62258 REPLACE BRAIN CAVITY SHUNT $ 838.74 $ 838.74 3/1/2020 12/31/9999 62263 EPIDURAL LYSIS MULT SESSIONS $ 298.77 $ 497.92 3/1/2020 12/31/9999 62264 EPIDURAL LYSIS ON SINGLE DAY $ 183.69 $ 305.90 3/1/2020 12/31/9999 62267 INTERDISCAL PERQ ASPIR DX $ 133.68 $ 199.19 3/1/2020 12/31/9999 62268 DRAIN SPINAL CORD CYST $ 215.85 $ 361.55 3/1/2020 12/31/9999 62269 NEEDLE BIOPSY SPINAL CORD $ 220.02 $ 391.86 3/1/2020 12/31/9999 62270 DX LMBR SPI PNXR $ 62.44 $ 119.43 3/1/2020 12/31/9999 62272 THER SPI PNXR DRG CSF $ 65.88 $ 140.21 3/1/2020 12/31/9999 62273 INJECT EPIDURAL PATCH $ 89.41 $ 128.48 3/1/2020 12/31/9999 62280 TREAT SPINAL CORD LESION $ 121.87 $ 234.68 3/1/2020 12/31/9999 62281 TREAT SPINAL CORD LESION $ 117.66 $ 217.84 3/1/2020 12/31/9999 62282 TREAT SPINAL CANAL LESION $ 108.26 $ 224.88 3/1/2020 12/31/9999 62284 INJECTION FOR MYELOGRAM $ 73.26 $ 171.08 3/1/2020 12/31/9999 62287 PERCUTANEOUS DISKECTOMY $ 431.74 $ 431.74 3/1/2020 12/31/9999 62290 NJX PX DISCOGRAPHY LUMBAR $ 136.62 $ 251.18 3/1/2020 12/31/9999 62291 NJX PX DISCOGRAPHY CRV/THRC $ 132.02 $ 235.42 3/1/2020 12/31/9999 62292 NJX CHEMONUCLEOLYSIS LMBR $ 391.07 $ 391.07 3/1/2020 12/31/9999 62294 INJECTION INTO SPINAL ARTERY $ 624.08 $ 624.08 3/1/2020 12/31/9999 62302 MYELOGRAPHY LUMBAR INJECTION $ 110.07 $ 210.79 3/1/2020 12/31/9999 62303 MYELOGRAPHY LUMBAR INJECTION $ 111.57 $ 218.90 3/1/2020 12/31/9999 62304 MYELOGRAPHY LUMBAR INJECTION $ 108.18 $ 207.69 3/1/2020 12/31/9999 62305 MYELOGRAPHY LUMBAR INJECTION $ 112.91 $ 226.56 3/1/2020 12/31/9999 62320 NJX INTERLAMINAR CRV/THRC $ 91.31 $ 145.92 3/1/2020 12/31/9999 62321 NJX INTERLAMINAR CRV/THRC $ 98.46 $ 215.83 3/1/2020 12/31/9999 62322 NJX INTERLAMINAR LMBR/SAC $ 78.63 $ 135.96 3/1/2020 12/31/9999 62323 NJX INTERLAMINAR LMBR/SAC $ 89.93 $ 211.83 3/1/2020 12/31/9999 62324 NJX INTERLAMINAR CRV/THRC $ 83.54 $ 127.89 3/1/2020 12/31/9999 62325 NJX INTERLAMINAR CRV/THRC $ 96.04 $ 191.98 3/1/2020 12/31/9999 62326 NJX INTERLAMINAR LMBR/SAC $ 81.97 $ 134.17 3/1/2020 12/31/9999 62327 NJX INTERLAMINAR LMBR/SAC $ 87.24 $ 195.26 3/1/2020 12/31/9999 62328 DX LMBR SPI PNXR W/FLUOR/CT $ 80.47 $ 226.25 3/1/2020 12/31/9999 62329 THER SPI PNXR CSF FLUOR/CT $ 100.29 $ 280.00 3/1/2020 12/31/9999 62350 IMPLANT SPINAL CANAL CATH $ 301.84 $ 301.84 3/1/2020 12/31/9999 62351 IMPLANT SPINAL CANAL CATH $ 633.84 $ 633.84 3/1/2020 12/31/9999 62355 REMOVE SPINAL CANAL CATHETER $ 226.04 $ 226.04 3/1/2020 12/31/9999 62360 INSERT SPINE INFUSION DEVICE $ 217.67 $ 217.67 3/1/2020 12/31/9999 62361 IMPLANT SPINE INFUSION PUMP $ 299.69 $ 299.69 3/1/2020 12/31/9999 62362 IMPLANT SPINE INFUSION PUMP $ 316.64 $ 316.64 3/1/2020 12/31/9999 62365 REMOVE SPINE INFUSION DEVICE $ 249.75 $ 249.75 3/1/2020 12/31/9999 62367 26 ANALYZE SPINE INFUS PUMP $ 5.43 $ 9.74 3/1/2020 12/31/9999 62367 ANALYZE SPINE INFUS PUMP $ 19.37 $ 29.95 3/1/2020 12/31/9999 62368 26 ANALYZE SP INF PUMP W/REPROG $ 7.58 $ 10.73 3/1/2020 12/31/9999 62368 TC ANALYZE SP INF PUMP W/REPROG $ 22.73 $ 32.20 3/1/2020 12/31/9999 62368 ANALYZE SP INF PUMP W/REPROG $ 30.32 $ 42.95 3/1/2020 12/31/9999 62369 ANAL SP INF PMP W/REPRG&FILL $ 21.07 $ 73.75 3/1/2020 12/31/9999 62370 ANL SP INF PMP W/MDREPRG&FIL $ 28.20 $ 77.28 3/1/2020 12/31/9999 62380 NDSC DCMPRN 1 NTRSPC LUMBAR $ 431.74 $ 431.74 3/1/2020 12/31/9999 63001 REMOVE SPINE LAMINA 1/2 CRVL $ 923.36 $ 923.36 3/1/2020 12/31/9999 63003 REMOVE SPINE LAMINA 1/2 THRC $ 929.04 $ 929.04 3/1/2020 12/31/9999 63005 REMOVE SPINE LAMINA 1/2 LMBR $ 881.13 $ 881.13 3/1/2020 12/31/9999 63011 REMOVE SPINE LAMINA 1/2 SCRL $ 833.54 $ 833.54 3/1/2020 12/31/9999 63012 REMOVE LAMINA/FACETS LUMBAR $ 896.74 $ 896.74 3/1/2020 12/31/9999 63015 REMOVE SPINE LAMINA >2 CRVCL $ 1,108.63 $ 1,108.63 3/1/2020 12/31/9999 63016 REMOVE SPINE LAMINA >2 THRC $ 1,141.26 $ 1,141.26 3/1/2020 12/31/9999 63017 REMOVE SPINE LAMINA >2 LMBR $ 929.37 $ 929.37 3/1/2020 12/31/9999 63020 NECK SPINE DISK SURGERY $ 878.92 $ 878.92 3/1/2020 12/31/9999 63030 LOW BACK DISK SURGERY $ 729.66 $ 729.66 3/1/2020 12/31/9999 63035 SPINAL DISK SURGERY ADD-ON $ 155.88 $ 155.88 3/1/2020 12/31/9999 63040 LAMINOTOMY SINGLE CERVICAL $ 1,069.06 $ 1,069.06 3/1/2020 12/31/9999 63042 LAMINOTOMY SINGLE LUMBAR $ 1,000.46 $ 1,000.46 3/1/2020 12/31/9999 63043 LAMINOTOMY ADDL CERVICAL $ 239.80 $ 239.80 3/1/2020 12/31/9999 63044 LAMINOTOMY ADDL LUMBAR $ 226.11 $ 226.11 3/1/2020 12/31/9999 63045 REMOVE SPINE LAMINA 1 CRVL $ 955.54 $ 955.54 3/1/2020 12/31/9999 63046 REMOVE SPINE LAMINA 1 THRC $ 913.50 $ 913.50 3/1/2020 12/31/9999 63047 REMOVE SPINE LAMINA 1 LMBR $ 832.91 $ 832.91 3/1/2020 12/31/9999 63048 REMOVE SPINAL LAMINA ADD-ON $ 167.87 $ 167.87 3/1/2020 12/31/9999 63050 CERVICAL LAMINOPLSTY 2/> SEG $ 900.75 $ 900.75 3/1/2020 12/31/9999 63051 C-LAMINOPLASTY W/GRAFT/PLATE $ 1,002.59 $ 1,002.59 3/1/2020 12/31/9999 63055 DECOMPRESS SPINAL CORD THRC $ 1,230.64 $ 1,230.64 3/1/2020 12/31/9999 63056 DECOMPRESS SPINAL CORD LMBR $ 1,136.64 $ 1,136.64 3/1/2020 12/31/9999 63057 DECOMPRESS SPINE CORD ADD-ON $ 257.09 $ 257.09 3/1/2020 12/31/9999 63064 DECOMPRESS SPINAL CORD THRC $ 1,346.80 $ 1,346.80 3/1/2020 12/31/9999 63066 DECOMPRESS SPINE CORD ADD-ON $ 158.54 $ 158.54 3/1/2020 12/31/9999 63075 NECK SPINE DISK SURGERY $ 1,049.62 $ 1,049.62 3/1/2020 12/31/9999 63076 NECK SPINE DISK SURGERY $ 198.44 $ 198.44 3/1/2020 12/31/9999 63077 SPINE DISK SURGERY THORAX $ 1,153.53 $ 1,153.53 3/1/2020 12/31/9999 63078 SPINE DISK SURGERY THORAX $ 157.99 $ 157.99 3/1/2020 12/31/9999 63081 REMOVE VERT BODY DCMPRN CRVL $ 1,349.96 $ 1,349.96 3/1/2020 12/31/9999 63082 REMOVE VERTEBRAL BODY ADD-ON $ 214.22 $ 214.22 3/1/2020 12/31/9999 63085 REMOVE VERT BODY DCMPRN THRC $ 1,446.02 $ 1,446.02 3/1/2020 12/31/9999 63086 REMOVE VERTEBRAL BODY ADD-ON $ 152.26 $ 152.26 3/1/2020 12/31/9999 63087 REMOV VERTBR DCMPRN THRCLMBR $ 1,846.32 $ 1,846.32 3/1/2020 12/31/9999 63088 REMOVE VERTEBRAL BODY ADD-ON $ 208.33 $ 208.33 3/1/2020 12/31/9999 63090 REMOVE VERT BODY DCMPRN LMBR $ 1,511.28 $ 1,511.28 3/1/2020 12/31/9999 63091 REMOVE VERTEBRAL BODY ADD-ON $ 143.20 $ 143.20 3/1/2020 12/31/9999 63101 REMOVE VERT BODY DCMPRN THRC $ 1,728.23 $ 1,728.23 3/1/2020 12/31/9999 63102 REMOVE VERT BODY DCMPRN LMBR $ 1,721.18 $ 1,721.18 3/1/2020 12/31/9999 63103 REMOVE VERTEBRAL BODY ADD-ON $ 228.65 $ 228.65 3/1/2020 12/31/9999 63170 INCISE SPINAL CORD TRACT(S) $ 1,156.73 $ 1,156.73 3/1/2020 12/31/9999 63172 DRAINAGE OF SPINAL CYST $ 1,041.09 $ 1,041.09 3/1/2020 12/31/9999 63173 DRAINAGE OF SPINAL CYST $ 1,283.31 $ 1,283.31 3/1/2020 12/31/9999 63180 REVISE SPINAL CORD LIGAMENTS $ 1,047.17 $ 1,047.17 3/1/2020 12/31/9999 63182 REVISE SPINAL CORD LIGAMENTS $ 1,123.48 $ 1,123.48 3/1/2020 12/31/9999 63185 INCISE SPINE NRV HALF SEGMNT $ 851.73 $ 851.73 3/1/2020 12/31/9999 63190 INCISE SPINE NRV >2 SEGMNTS $ 979.01 $ 979.01 3/1/2020 12/31/9999 63191 INCISE SPINE ACCESSORY NERVE $ 936.25 $ 936.25 3/1/2020 12/31/9999 63194 INCISE SPINE & CORD CERVICAL $ 1,113.97 $ 1,113.97 3/1/2020 12/31/9999 63195 INCISE SPINE & CORD THORACIC $ 1,126.57 $ 1,126.57 3/1/2020 12/31/9999 63196 INCISE SPINE&CORD 2 TRX CRVL $ 1,325.10 $ 1,325.10 3/1/2020 12/31/9999 63197 INCISE SPINE&CORD 2 TRX THRC $ 1,263.10 $ 1,263.10 3/1/2020 12/31/9999 63198 INCISE SPIN&CORD 2 STGS CRVL $ 1,406.84 $ 1,406.84 3/1/2020 12/31/9999 63199 INCISE SPIN&CORD 2 STGS THRC $ 1,489.56 $ 1,489.56 3/1/2020 12/31/9999 63200 RELEASE SPINAL CORD LUMBAR $ 1,129.58 $ 1,129.58 3/1/2020 12/31/9999 63250 REVISE SPINAL CORD VSLS CRVL $ 2,195.52 $ 2,195.52 3/1/2020 12/31/9999 63251 REVISE SPINAL CORD VSLS THRC $ 2,277.21 $ 2,277.21 3/1/2020 12/31/9999 63252 REVISE SPINE CORD VSL THRLMB $ 2,278.89 $ 2,278.89 3/1/2020 12/31/9999 63265 EXCISE INTRASPINL LESION CRV $ 1,250.96 $ 1,250.96 3/1/2020 12/31/9999 63266 EXCISE INTRSPINL LESION THRC $ 1,286.37 $ 1,286.37 3/1/2020 12/31/9999 63267 EXCISE INTRSPINL LESION LMBR $ 1,035.42 $ 1,035.42 3/1/2020 12/31/9999 63268 EXCISE INTRSPINL LESION SCRL $ 1,040.12 $ 1,040.12 3/1/2020 12/31/9999 63270 EXCISE INTRSPINL LESION CRVL $ 1,540.52 $ 1,540.52 3/1/2020 12/31/9999 63271 EXCISE INTRSPINL LESION THRC $ 1,549.76 $ 1,549.76 3/1/2020 12/31/9999 63272 EXCISE INTRSPINL LESION LMBR $ 1,427.58 $ 1,427.58 3/1/2020 12/31/9999 63273 EXCISE INTRSPINL LESION SCRL $ 1,349.00 $ 1,349.00 3/1/2020 12/31/9999 63275 BX/EXC XDRL SPINE LESN CRVL $ 1,344.05 $ 1,344.05 3/1/2020 12/31/9999 63276 BX/EXC XDRL SPINE LESN THRC $ 1,338.96 $ 1,338.96 3/1/2020 12/31/9999 63277 BX/EXC XDRL SPINE LESN LMBR $ 1,175.07 $ 1,175.07 3/1/2020 12/31/9999 63278 BX/EXC XDRL SPINE LESN SCRL $ 1,150.56 $ 1,150.56 3/1/2020 12/31/9999 63280 BX/EXC IDRL SPINE LESN CRVL $ 1,588.89 $ 1,588.89 3/1/2020 12/31/9999 63281 BX/EXC IDRL SPINE LESN THRC $ 1,570.88 $ 1,570.88 3/1/2020 12/31/9999 63282 BX/EXC IDRL SPINE LESN LMBR $ 1,482.16 $ 1,482.16 3/1/2020 12/31/9999 63283 BX/EXC IDRL SPINE LESN SCRL $ 1,404.46 $ 1,404.46 3/1/2020 12/31/9999 63285 BX/EXC IDRL IMED LESN CERVL $ 1,951.82 $ 1,951.82 3/1/2020 12/31/9999 63286 BX/EXC IDRL IMED LESN THRC $ 1,944.64 $ 1,944.64 3/1/2020 12/31/9999 63287 BX/EXC IDRL IMED LESN THRLMB $ 2,052.24 $ 2,052.24 3/1/2020 12/31/9999 63290 BX/EXC XDRL/IDRL LSN ANY LVL $ 2,076.81 $ 2,076.81 3/1/2020 12/31/9999 63295 REPAIR LAMINECTOMY DEFECT $ 247.98 $ 247.98 3/1/2020 12/31/9999 63300 REMOVE VERT XDRL BODY CRVCL $ 1,386.14 $ 1,386.14 3/1/2020 12/31/9999 63301 REMOVE VERT XDRL BODY THRC $ 1,556.73 $ 1,556.73 3/1/2020 12/31/9999 63302 REMOVE VERT XDRL BODY THRLMB $ 1,546.80 $ 1,546.80 3/1/2020 12/31/9999 63303 REMOV VERT XDRL BDY LMBR/SAC $ 1,618.38 $ 1,618.38 3/1/2020 12/31/9999 63304 REMOVE VERT IDRL BODY CRVCL $ 1,715.47 $ 1,715.47 3/1/2020 12/31/9999 63305 REMOVE VERT IDRL BODY THRC $ 1,753.48 $ 1,753.48 3/1/2020 12/31/9999 63306 REMOV VERT IDRL BDY THRCLMBR $ 1,837.20 $ 1,837.20 3/1/2020 12/31/9999 63307 REMOV VERT IDRL BDY LMBR/SAC $ 1,705.10 $ 1,705.10 3/1/2020 12/31/9999 63308 REMOVE VERTEBRAL BODY ADD-ON $ 257.59 $ 257.59 3/1/2020 12/31/9999 63600 REMOVE SPINAL CORD LESION $ 647.70 $ 647.70 3/1/2020 12/31/9999 63610 STIMULATION OF SPINAL CORD $ 347.99 $ 1,019.20 3/1/2020 12/31/9999 63620 SRS SPINAL LESION $ 597.02 $ 597.02 3/1/2020 12/31/9999 63621 SRS SPINAL LESION ADDL $ 188.97 $ 188.97 3/1/2020 12/31/9999 63650 IMPLANT NEUROELECTRODES $ 320.86 $ 320.86 3/1/2020 12/31/9999 63655 IMPLANT NEUROELECTRODES $ 634.76 $ 634.76 3/1/2020 12/31/9999 63661 REMOVE SPINE ELTRD PERQ ARAY $ 196.32 $ 346.75 3/1/2020 12/31/9999 63662 REMOVE SPINE ELTRD PLATE $ 442.85 $ 442.85 3/1/2020 12/31/9999 63663 REVISE SPINE ELTRD PERQ ARAY $ 297.83 $ 508.53 3/1/2020 12/31/9999 63664 REVISE SPINE ELTRD PLATE $ 461.03 $ 461.03 3/1/2020 12/31/9999 63685 INSRT/REDO SPINE N GENERATOR $ 306.26 $ 306.26 3/1/2020 12/31/9999 63688 REVISE/REMOVE NEURORECEIVER $ 274.23 $ 274.23 3/1/2020 12/31/9999 63700 REPAIR OF SPINAL HERNIATION $ 923.36 $ 923.36 3/1/2020 12/31/9999 63702 REPAIR OF SPINAL HERNIATION $ 1,038.18 $ 1,038.18 3/1/2020 12/31/9999 63704 REPAIR OF SPINAL HERNIATION $ 1,157.99 $ 1,157.99 3/1/2020 12/31/9999 63706 REPAIR OF SPINAL HERNIATION $ 1,348.08 $ 1,348.08 3/1/2020 12/31/9999 63707 REPAIR SPINAL FLUID LEAKAGE $ 681.57 $ 681.57 3/1/2020 12/31/9999 63709 REPAIR SPINAL FLUID LEAKAGE $ 828.75 $ 828.75 3/1/2020 12/31/9999 63710 GRAFT REPAIR OF SPINE DEFECT $ 827.64 $ 827.64 3/1/2020 12/31/9999 63740 INSTALL SPINAL SHUNT $ 701.43 $ 701.43 3/1/2020 12/31/9999 63741 INSTALL SPINAL SHUNT $ 457.34 $ 457.34 3/1/2020 12/31/9999 63744 REVISION OF SPINAL SHUNT $ 479.13 $ 479.13 3/1/2020 12/31/9999 63746 REMOVAL OF SPINAL SHUNT $ 417.32 $ 417.32 3/1/2020 12/31/9999 64400 NJX AA&/STRD TRIGEMINAL NRV $ 49.89 $ 81.90 3/1/2020 12/31/9999 64405 NJX AA&/STRD GR OCPL NRV $ 58.22 $ 79.65 3/1/2020 12/31/9999 64408 NJX AA&/STRD VAGUS NRV $ 69.99 $ 91.73 3/1/2020 12/31/9999 64415 NJX AA&/STRD BRACH PLEXUS $ 59.09 $ 100.22 3/1/2020 12/31/9999 64416 NJX AA&/STRD BRACH PLEX NFS $ 74.30 $ 74.30 3/1/2020 12/31/9999 64417 NJX AA&/STRD AXILLARY NRV $ 58.53 $ 101.10 3/1/2020 12/31/9999 64418 NJX AA&/STRD SPRSCAP NRV $ 58.01 $ 102.67 3/1/2020 12/31/9999 64420 NJX AA&/STRD NTRCOST NRV 1 $ 52.30 $ 121.34 3/1/2020 12/31/9999 64421 NJX AA&/STRD NTRCOST NRV EA $ 71.73 $ 178.93 3/1/2020 12/31/9999 64425 NJX AA&/STRD II IH NERVES $ 74.35 $ 99.32 3/1/2020 12/31/9999 64430 NJX AA&/STRD PUDENDAL NERVE $ 70.11 $ 119.75 3/1/2020 12/31/9999 64435 NJX AA&/STRD PARACRV NRV $ 67.19 $ 111.25 3/1/2020 12/31/9999 64445 NJX AA&/STRD SCIATIC NERVE $ 64.00 $ 103.95 3/1/2020 12/31/9999 64446 NJX AA&/STRD SCIATIC NRV NFS $ 74.14 $ 74.14 3/1/2020 12/31/9999 64447 NJX AA&/STRD FEMORAL NERVE $ 56.50 $ 56.50 3/1/2020 12/31/9999 64448 NJX AA&/STRD FEM NERVE NFS $ 65.67 $ 65.67 3/1/2020 12/31/9999 64449 NJX AA&/STRD LMBR PLEX NFS $ 73.43 $ 73.43 3/1/2020 12/31/9999 64450 NJX AA&/STRD OTHER PN/BRANCH $ 57.34 $ 79.66 3/1/2020 12/31/9999 64451 NJX AA&/STRD NRV NRVTG SI JT $ 71.48 $ 183.62 3/1/2020 12/31/9999 64454 NJX AA&/STRD GNCLR NRV BRNCH $ 73.61 $ 185.44 3/1/2020 12/31/9999 64455 N BLOCK INJ PLANTAR DIGIT $ 32.69 $ 40.91 3/1/2020 12/31/9999 64479 INJ FORAMEN EPIDURAL C/T $ 97.55 $ 210.64 3/1/2020 12/31/9999 64480 INJ FORAMEN EPIDURAL ADD-ON $ 63.84 $ 106.74 3/1/2020 12/31/9999 64483 INJ FORAMEN EPIDURAL L/S $ 85.75 $ 204.44 3/1/2020 12/31/9999 64484 INJ FORAMEN EPIDURAL ADD-ON $ 54.43 $ 104.37 3/1/2020 12/31/9999 64490 INJ PARAVERT F JNT C/T 1 LEV $ 69.66 $ 105.32 3/1/2020 12/31/9999 64491 INJ PARAVERT F JNT C/T 2 LEV $ 40.04 $ 52.00 3/1/2020 12/31/9999 64492 INJ PARAVERT F JNT C/T 3 LEV $ 40.73 $ 52.69 3/1/2020 12/31/9999 64493 INJ PARAVERT F JNT L/S 1 LEV $ 59.18 $ 95.29 3/1/2020 12/31/9999 64494 INJ PARAVERT F JNT L/S 2 LEV $ 34.24 $ 46.67 3/1/2020 12/31/9999 64495 INJ PARAVERT F JNT L/S 3 LEV $ 34.93 $ 47.37 3/1/2020 12/31/9999 64505 N BLOCK SPENOPALATINE GANGL $ 66.36 $ 78.69 3/1/2020 12/31/9999 64510 N BLOCK STELLATE GANGLION $ 53.67 $ 107.72 3/1/2020 12/31/9999 64517 N BLOCK INJ HYPOGAS PLXS $ 94.41 $ 131.12 3/1/2020 12/31/9999 64520 N BLOCK LUMBAR/THORACIC $ 60.63 $ 140.53 3/1/2020 12/31/9999 64530 N BLOCK INJ CELIAC PELUS $ 71.58 $ 145.59 3/1/2020 12/31/9999 64555 IMPLANT NEUROELECTRODES $ 121.49 $ 164.97 3/1/2020 12/31/9999 64561 IMPLANT NEUROELECTRODES $ 341.71 $ 882.20 3/1/2020 12/31/9999 64568 INC FOR VAGUS N ELECT IMPL $ 539.39 $ 539.39 3/1/2020 12/31/9999 64569 REVISE/REPL VAGUS N ELTRD $ 518.08 $ 518.08 3/1/2020 12/31/9999 64570 REMOVE VAGUS N ELTRD $ 451.14 $ 451.14 3/1/2020 12/31/9999 64575 IMPLANT NEUROELECTRODES $ 220.96 $ 220.96 3/1/2020 12/31/9999 64581 IMPLANT NEUROELECTRODES $ 664.08 $ 664.08 3/1/2020 12/31/9999 64585 REVISE/REMOVE NEUROELECTRODE $ 125.31 $ 255.14 3/1/2020 12/31/9999 64590 INSRT/REDO PN/GASTR STIMUL $ 140.31 $ 240.48 3/1/2020 12/31/9999 64595 REVISE/RMV PN/GASTR STIMUL $ 110.51 $ 246.80 3/1/2020 12/31/9999 64600 INJECTION TREATMENT OF NERVE $ 166.95 $ 305.90 3/1/2020 12/31/9999 64605 INJECTION TREATMENT OF NERVE $ 266.05 $ 432.32 3/1/2020 12/31/9999 64610 INJECTION TREATMENT OF NERVE $ 372.60 $ 526.81 3/1/2020 12/31/9999 64611 CHEMODENERV SALIV GLANDS $ 74.95 $ 82.95 3/1/2020 12/31/9999 64612 DESTROY NERVE FACE MUSCLE $ 105.04 $ 118.85 3/1/2020 12/31/9999 64615 CHEMODENERV MUSC MIGRAINE $ 105.13 $ 116.73 3/1/2020 12/31/9999 64616 CHEMODENERV MUSC NECK DYSTON $ 89.04 $ 101.00 3/1/2020 12/31/9999 64617 CHEMODENER MUSCLE LARYNX EMG $ 96.35 $ 158.73 3/1/2020 12/31/9999 64620 INJECTION TREATMENT OF NERVE $ 130.68 $ 207.06 3/1/2020 12/31/9999 64624 DSTRJ NULYT AGT GNCLR NRV $ 131.66 $ 354.11 3/1/2020 12/31/9999 64630 INJECTION TREATMENT OF NERVE $ 151.44 $ 180.53 3/1/2020 12/31/9999 64632 N BLOCK INJ COMMON DIGIT $ 57.61 $ 67.02 3/1/2020 12/31/9999 64633 DESTROY CERV/THOR FACET JNT $ 140.62 $ 268.22 3/1/2020 12/31/9999 64634 DESTROY C/TH FACET JNT ADDL $ 42.17 $ 122.70 3/1/2020 12/31/9999 64635 DESTROY LUMB/SAC FACET JNT $ 137.81 $ 263.61 3/1/2020 12/31/9999 64636 DESTROY L/S FACET JNT ADDL $ 36.71 $ 110.43 3/1/2020 12/31/9999 64640 INJECTION TREATMENT OF NERVE $ 138.77 $ 177.25 3/1/2020 12/31/9999 64642 CHEMODENERV 1 EXTREMITY 1-4 $ 89.66 $ 115.61 3/1/2020 12/31/9999 64643 CHEMODENERV 1 EXTREM 1-4 EA $ 60.17 $ 76.20 3/1/2020 12/31/9999 64644 CHEMODENERV 1 EXTREM 5/> MUS $ 97.94 $ 132.05 3/1/2020 12/31/9999 64645 CHEMODENERV 1 EXTREM 5/> EA $ 68.90 $ 93.09 3/1/2020 12/31/9999 64646 CHEMODENERV TRUNK MUSC 1-5 $ 97.04 $ 124.44 3/1/2020 12/31/9999 64647 CHEMODENERV TRUNK MUSC 6/> $ 112.05 $ 144.12 3/1/2020 12/31/9999 64650 CHEMODENERV ECCRINE GLANDS $ 31.37 $ 51.33 3/1/2020 12/31/9999 64680 INJECTION TREATMENT OF NERVE $ 126.53 $ 233.16 3/1/2020 12/31/9999 64681 INJECTION TREATMENT OF NERVE $ 170.61 $ 301.93 3/1/2020 12/31/9999 64702 REVISE FINGER/TOE NERVE $ 350.22 $ 350.22 3/1/2020 12/31/9999 64704 REVISE HAND/FOOT NERVE $ 257.96 $ 257.96 3/1/2020 12/31/9999 64708 REVISE ARM/LEG NERVE $ 363.73 $ 363.73 3/1/2020 12/31/9999 64712 REVISION OF SCIATIC NERVE $ 419.71 $ 419.71 3/1/2020 12/31/9999 64713 REVISION OF ARM NERVE(S) $ 587.49 $ 587.49 3/1/2020 12/31/9999 64714 REVISE LOW BACK NERVE(S) $ 503.25 $ 503.25 3/1/2020 12/31/9999 64716 REVISION OF CRANIAL NERVE $ 397.68 $ 397.68 3/1/2020 12/31/9999 64718 REVISE ULNAR NERVE AT ELBOW $ 428.35 $ 428.35 3/1/2020 12/31/9999 64719 REVISE ULNAR NERVE AT WRIST $ 297.11 $ 297.11 3/1/2020 12/31/9999 64721 CARPAL TUNNEL SURGERY $ 311.75 $ 312.91 3/1/2020 12/31/9999 64722 RELIEVE PRESSURE ON NERVE(S) $ 255.36 $ 255.36 3/1/2020 12/31/9999 64726 RELEASE FOOT/TOE NERVE $ 225.06 $ 225.06 3/1/2020 12/31/9999 64727 INTERNAL NERVE REVISION $ 147.47 $ 147.47 3/1/2020 12/31/9999 64732 INCISION OF BROW NERVE $ 290.86 $ 290.86 3/1/2020 12/31/9999 64734 INCISION OF CHEEK NERVE $ 314.66 $ 314.66 3/1/2020 12/31/9999 64736 INCISION OF CHIN NERVE $ 297.06 $ 297.06 3/1/2020 12/31/9999 64738 INCISION OF JAW NERVE $ 351.55 $ 351.55 3/1/2020 12/31/9999 64740 INCISION OF TONGUE NERVE $ 350.42 $ 350.42 3/1/2020 12/31/9999 64742 INCISION OF FACIAL NERVE $ 359.47 $ 359.47 3/1/2020 12/31/9999 64744 INCISE NERVE BACK OF HEAD $ 315.26 $ 315.26 3/1/2020 12/31/9999 64746 INCISE DIAPHRAGM NERVE $ 340.62 $ 340.62 3/1/2020 12/31/9999 64755 INCISION OF STOMACH NERVES $ 689.57 $ 689.57 3/1/2020 12/31/9999 64760 INCISION OF VAGUS NERVE $ 365.20 $ 365.20 3/1/2020 12/31/9999 64763 INCISE HIP/THIGH NERVE $ 416.50 $ 416.50 3/1/2020 12/31/9999 64766 INCISE HIP/THIGH NERVE $ 481.27 $ 481.27 3/1/2020 12/31/9999 64771 SEVER CRANIAL NERVE $ 450.41 $ 450.41 3/1/2020 12/31/9999 64772 INCISION OF SPINAL NERVE $ 433.19 $ 433.19 3/1/2020 12/31/9999 64774 REMOVE SKIN NERVE LESION $ 312.83 $ 312.83 3/1/2020 12/31/9999 64776 REMOVE DIGIT NERVE LESION $ 300.75 $ 300.75 3/1/2020 12/31/9999 64778 DIGIT NERVE SURGERY ADD-ON $ 146.50 $ 146.50 3/1/2020 12/31/9999 64782 REMOVE LIMB NERVE LESION $ 354.77 $ 354.77 3/1/2020 12/31/9999 64783 LIMB NERVE SURGERY ADD-ON $ 175.09 $ 175.09 3/1/2020 12/31/9999 64784 REMOVE NERVE LESION $ 552.14 $ 552.14 3/1/2020 12/31/9999 64786 REMOVE SCIATIC NERVE LESION $ 829.71 $ 829.71 3/1/2020 12/31/9999 64787 IMPLANT NERVE END $ 201.08 $ 201.08 3/1/2020 12/31/9999 64788 REMOVE SKIN NERVE LESION $ 293.37 $ 293.37 3/1/2020 12/31/9999 64790 REMOVAL OF NERVE LESION $ 631.75 $ 631.75 3/1/2020 12/31/9999 64792 REMOVAL OF NERVE LESION $ 819.57 $ 819.57 3/1/2020 12/31/9999 64795 BIOPSY OF NERVE $ 150.12 $ 150.12 3/1/2020 12/31/9999 64802 SYMPATHECTOMY CERVICAL $ 467.48 $ 467.48 3/1/2020 12/31/9999 64804 REMOVE SYMPATHETIC NERVES $ 712.72 $ 712.72 3/1/2020 12/31/9999 64809 REMOVE SYMPATHETIC NERVES $ 668.65 $ 668.65 3/1/2020 12/31/9999 64818 REMOVE SYMPATHETIC NERVES $ 518.85 $ 518.85 3/1/2020 12/31/9999 64820 SYMPATHECTOMY DIGITAL ARTERY $ 577.63 $ 577.63 3/1/2020 12/31/9999 64821 REMOVE SYMPATHETIC NERVES $ 520.37 $ 520.37 3/1/2020 12/31/9999 64822 REMOVE SYMPATHETIC NERVES $ 514.24 $ 514.24 3/1/2020 12/31/9999 64823 SYMPATHECTOMY SUPFC PALMAR $ 584.89 $ 584.89 3/1/2020 12/31/9999 64831 REPAIR OF DIGIT NERVE $ 515.71 $ 515.71 3/1/2020 12/31/9999 64832 REPAIR NERVE ADD-ON $ 272.03 $ 272.03 3/1/2020 12/31/9999 64834 REPAIR OF HAND OR FOOT NERVE $ 571.75 $ 571.75 3/1/2020 12/31/9999 64835 REPAIR OF HAND OR FOOT NERVE $ 619.90 $ 619.90 3/1/2020 12/31/9999 64836 REPAIR OF HAND OR FOOT NERVE $ 619.57 $ 619.57 3/1/2020 12/31/9999 64837 REPAIR NERVE ADD-ON $ 302.01 $ 302.01 3/1/2020 12/31/9999 64840 REPAIR OF LEG NERVE $ 705.99 $ 705.99 3/1/2020 12/31/9999 64856 REPAIR/TRANSPOSE NERVE $ 780.23 $ 780.23 3/1/2020 12/31/9999 64857 REPAIR ARM/LEG NERVE $ 815.85 $ 815.85 3/1/2020 12/31/9999 64858 REPAIR SCIATIC NERVE $ 940.38 $ 940.38 3/1/2020 12/31/9999 64859 NERVE SURGERY $ 204.87 $ 204.87 3/1/2020 12/31/9999 64861 REPAIR OF ARM NERVES $ 1,062.34 $ 1,062.34 3/1/2020 12/31/9999 64862 REPAIR OF LOW BACK NERVES $ 1,041.88 $ 1,041.88 3/1/2020 12/31/9999 64864 REPAIR OF FACIAL NERVE $ 676.58 $ 676.58 3/1/2020 12/31/9999 64865 REPAIR OF FACIAL NERVE $ 891.88 $ 891.88 3/1/2020 12/31/9999 64866 FUSION OF FACIAL/OTHER NERVE $ 927.63 $ 927.63 3/1/2020 12/31/9999 64868 FUSION OF FACIAL/OTHER NERVE $ 811.63 $ 811.63 3/1/2020 12/31/9999 64872 SUBSEQUENT REPAIR OF NERVE $ 96.05 $ 96.05 3/1/2020 12/31/9999 64874 REPAIR & REVISE NERVE ADD-ON $ 141.28 $ 141.28 3/1/2020 12/31/9999 64876 REPAIR NERVE/SHORTEN BONE $ 154.37 $ 154.37 3/1/2020 12/31/9999 64885 NERVE GRAFT HEAD/NECK 4 CM $ 1,045.82 $ 1,045.82 3/1/2020 12/31/9999 64890 NERVE GRAFT HAND/FOOT 4 CM $ 868.12 $ 868.12 3/1/2020 12/31/9999 64892 NERVE GRAFT ARM/LEG <4 CM $ 817.67 $ 817.67 3/1/2020 12/31/9999 64893 NERVE GRAFT ARM/LEG >4 CM $ 861.36 $ 861.36 3/1/2020 12/31/9999 64895 NERVE GRAFT HAND/FOOT 4 CM $ 1,114.81 $ 1,114.81 3/1/2020 12/31/9999 64897 NERVE GRAFT ARM/LEG 4 CM $ 1,066.41 $ 1,066.41 3/1/2020 12/31/9999 64901 NERVE GRAFT ADD-ON $ 480.75 $ 480.75 3/1/2020 12/31/9999 64902 NERVE GRAFT ADD-ON $ 552.54 $ 552.54 3/1/2020 12/31/9999 64905 NERVE PEDICLE TRANSFER $ 781.73 $ 781.73 3/1/2020 12/31/9999 64907 NERVE PEDICLE TRANSFER $ 1,028.01 $ 1,028.01 3/1/2020 12/31/9999 65091 REVISE EYE $ 446.12 $ 446.12 3/1/2020 12/31/9999 65101 REMOVAL OF EYE $ 513.95 $ 513.95 3/1/2020 12/31/9999 65110 REMOVAL OF EYE $ 867.01 $ 867.01 3/1/2020 12/31/9999 65112 REMOVE EYE/REVISE SOCKET $ 1,021.22 $ 1,021.22 3/1/2020 12/31/9999 65114 REMOVE EYE/REVISE SOCKET $ 1,062.36 $ 1,062.36 3/1/2020 12/31/9999 65205 REMOVE FOREIGN BODY FROM EYE $ 32.55 $ 40.49 3/1/2020 12/31/9999 65210 REMOVE FOREIGN BODY FROM EYE $ 39.23 $ 49.51 3/1/2020 12/31/9999 65220 REMOVE FOREIGN BODY FROM EYE $ 32.08 $ 41.48 3/1/2020 12/31/9999 65222 REMOVE FOREIGN BODY FROM EYE $ 42.97 $ 54.43 3/1/2020 12/31/9999 65235 REMOVE FOREIGN BODY FROM EYE $ 490.73 $ 490.73 3/1/2020 12/31/9999 65260 REMOVE FOREIGN BODY FROM EYE $ 673.47 $ 673.47 3/1/2020 12/31/9999 65265 REMOVE FOREIGN BODY FROM EYE $ 758.61 $ 758.61 3/1/2020 12/31/9999 65270 REPAIR OF EYE WOUND $ 100.38 $ 185.57 3/1/2020 12/31/9999 65272 REPAIR OF EYE WOUND $ 243.64 $ 344.40 3/1/2020 12/31/9999 65273 REPAIR OF EYE WOUND $ 267.86 $ 267.86 3/1/2020 12/31/9999 65275 REPAIR OF EYE WOUND $ 318.90 $ 388.51 3/1/2020 12/31/9999 65280 REPAIR OF EYE WOUND $ 469.99 $ 469.99 3/1/2020 12/31/9999 65285 REPAIR OF EYE WOUND $ 734.33 $ 734.33 3/1/2020 12/31/9999 65286 REPAIR OF EYE WOUND $ 345.39 $ 487.57 3/1/2020 12/31/9999 65290 REPAIR OF EYE SOCKET WOUND $ 344.78 $ 344.78 3/1/2020 12/31/9999 65400 REMOVAL OF EYE LESION $ 415.51 $ 466.33 3/1/2020 12/31/9999 65410 BIOPSY OF CORNEA $ 75.13 $ 101.26 3/1/2020 12/31/9999 65420 REMOVAL OF EYE LESION $ 261.37 $ 356.83 3/1/2020 12/31/9999 65426 REMOVAL OF EYE LESION $ 334.05 $ 451.26 3/1/2020 12/31/9999 65430 CORNEAL SMEAR $ 75.13 $ 82.46 3/1/2020 12/31/9999 65435 CURETTE/TREAT CORNEA $ 50.00 $ 56.75 3/1/2020 12/31/9999 65436 CURETTE/TREAT CORNEA $ 259.88 $ 270.14 3/1/2020 12/31/9999 65450 TREATMENT OF CORNEAL LESION $ 219.77 $ 222.40 3/1/2020 12/31/9999 65600 REVISION OF CORNEA $ 234.90 $ 269.56 3/1/2020 12/31/9999 65710 CORNEAL TRANSPLANT $ 775.22 $ 775.22 3/1/2020 12/31/9999 65730 CORNEAL TRANSPLANT $ 862.92 $ 862.92 3/1/2020 12/31/9999 65750 CORNEAL TRANSPLANT $ 875.75 $ 875.75 3/1/2020 12/31/9999 65755 CORNEAL TRANSPLANT $ 870.59 $ 870.59 3/1/2020 12/31/9999 65756 CORNEAL TRNSPL ENDOTHELIAL $ 679.34 $ 679.34 3/1/2020 12/31/9999 65770 REVISE CORNEA WITH IMPLANT $ 1,001.97 $ 1,001.97 3/1/2020 12/31/9999 65772 CORRECTION OF ASTIGMATISM $ 281.60 $ 312.14 3/1/2020 12/31/9999 65775 CORRECTION OF ASTIGMATISM $ 384.74 $ 384.74 3/1/2020 12/31/9999 65800 DRAINAGE OF EYE $ 95.08 $ 107.71 3/1/2020 12/31/9999 65810 DRAINAGE OF EYE $ 326.18 $ 326.18 3/1/2020 12/31/9999 65815 DRAINAGE OF EYE $ 330.93 $ 441.66 3/1/2020 12/31/9999 65820 RELIEVE INNER EYE PRESSURE $ 524.37 $ 524.37 3/1/2020 12/31/9999 65850 INCISION OF EYE $ 598.89 $ 598.89 3/1/2020 12/31/9999 65855 TRABECULOPLASTY LASER SURG $ 211.09 $ 238.72 3/1/2020 12/31/9999 65860 INCISE INNER EYE ADHESIONS $ 183.36 $ 220.37 3/1/2020 12/31/9999 65865 INCISE INNER EYE ADHESIONS $ 333.72 $ 333.72 3/1/2020 12/31/9999 65870 INCISE INNER EYE ADHESIONS $ 412.63 $ 412.63 3/1/2020 12/31/9999 65875 INCISE INNER EYE ADHESIONS $ 438.15 $ 438.15 3/1/2020 12/31/9999 65880 INCISE INNER EYE ADHESIONS $ 462.12 $ 462.12 3/1/2020 12/31/9999 65900 REMOVE EYE LESION $ 678.68 $ 678.68 3/1/2020 12/31/9999 65920 REMOVE IMPLANT OF EYE $ 548.74 $ 548.74 3/1/2020 12/31/9999 65930 REMOVE BLOOD CLOT FROM EYE $ 452.13 $ 452.13 3/1/2020 12/31/9999 66020 INJECTION TREATMENT OF EYE $ 92.40 $ 129.71 3/1/2020 12/31/9999 66030 INJECTION TREATMENT OF EYE $ 77.08 $ 114.39 3/1/2020 12/31/9999 66130 REMOVE EYE LESION $ 407.65 $ 494.61 3/1/2020 12/31/9999 66150 GLAUCOMA SURGERY $ 602.49 $ 602.49 3/1/2020 12/31/9999 66155 GLAUCOMA SURGERY $ 600.58 $ 600.58 3/1/2020 12/31/9999 66160 GLAUCOMA SURGERY $ 684.40 $ 684.40 3/1/2020 12/31/9999 66170 GLAUCOMA SURGERY $ 828.74 $ 828.74 3/1/2020 12/31/9999 66172 INCISION OF EYE $ 1,041.27 $ 1,041.27 3/1/2020 12/31/9999 66179 AQUEOUS SHUNT EYE W/O GRAFT $ 945.28 $ 791.95 3/1/2020 12/31/9999 66180 AQUEOUS SHUNT EYE W/GRAFT $ 827.36 $ 827.36 3/1/2020 12/31/9999 66184 REVISION OF AQUEOUS SHUNT $ 687.92 $ 551.71 3/1/2020 12/31/9999 66185 REVISE AQUEOUS SHUNT EYE $ 520.88 $ 520.88 3/1/2020 12/31/9999 66225 REPAIR/GRAFT EYE LESION $ 655.96 $ 655.96 3/1/2020 12/31/9999 66250 FOLLOW-UP SURGERY OF EYE $ 386.47 $ 518.95 3/1/2020 12/31/9999 66500 INCISION OF IRIS $ 245.78 $ 245.78 3/1/2020 12/31/9999 66505 INCISION OF IRIS $ 269.13 $ 269.13 3/1/2020 12/31/9999 66600 REMOVE IRIS AND LESION $ 572.11 $ 572.11 3/1/2020 12/31/9999 66605 REMOVAL OF IRIS $ 745.89 $ 745.89 3/1/2020 12/31/9999 66625 REMOVAL OF IRIS $ 300.76 $ 300.76 3/1/2020 12/31/9999 66630 REMOVAL OF IRIS $ 396.22 $ 396.22 3/1/2020 12/31/9999 66635 REMOVAL OF IRIS $ 400.24 $ 400.24 3/1/2020 12/31/9999 66680 REPAIR IRIS & CILIARY BODY $ 357.81 $ 357.81 3/1/2020 12/31/9999 66682 REPAIR IRIS & CILIARY BODY $ 434.23 $ 434.23 3/1/2020 12/31/9999 66700 DESTRUCTION CILIARY BODY $ 277.15 $ 312.98 3/1/2020 12/31/9999 66710 CILIARY TRANSSLERAL THERAPY $ 276.35 $ 307.78 3/1/2020 12/31/9999 66711 ECP CILIARY BODY DESTRUCTION $ 442.09 $ 442.09 3/1/2020 12/31/9999 66720 DESTRUCTION CILIARY BODY $ 291.46 $ 322.01 3/1/2020 12/31/9999 66740 DESTRUCTION CILIARY BODY $ 277.54 $ 305.72 3/1/2020 12/31/9999 66761 REVISION OF IRIS $ 285.87 $ 313.19 3/1/2020 12/31/9999 66762 REVISION OF IRIS $ 295.90 $ 328.50 3/1/2020 12/31/9999 66770 REMOVAL OF INNER EYE LESION $ 335.56 $ 365.22 3/1/2020 12/31/9999 66820 INCISION SECONDARY CATARACT $ 275.51 $ 275.51 3/1/2020 12/31/9999 66821 AFTER CATARACT LASER SURGERY $ 211.64 $ 223.97 3/1/2020 12/31/9999 66825 REPOSITION INTRAOCULAR LENS $ 531.66 $ 531.66 3/1/2020 12/31/9999 66830 REMOVAL OF LENS LESION $ 499.61 $ 499.61 3/1/2020 12/31/9999 66840 REMOVAL OF LENS MATERIAL $ 486.90 $ 486.90 3/1/2020 12/31/9999 66850 REMOVAL OF LENS MATERIAL $ 555.93 $ 555.93 3/1/2020 12/31/9999 66852 REMOVAL OF LENS MATERIAL $ 595.20 $ 595.20 3/1/2020 12/31/9999 66920 EXTRACTION OF LENS $ 531.01 $ 531.01 3/1/2020 12/31/9999 66930 EXTRACTION OF LENS $ 603.61 $ 603.61 3/1/2020 12/31/9999 66940 EXTRACTION OF LENS $ 547.75 $ 547.75 3/1/2020 12/31/9999 66982 XCAPSL CTRC RMVL CPLX WO ECP $ 755.63 $ 755.63 3/1/2020 12/31/9999 66983 CATARACT SURG W/IOL 1 STAGE $ 520.91 $ 520.91 3/1/2020 12/31/9999 66984 XCAPSL CTRC RMVL W/O ECP $ 541.31 $ 541.31 3/1/2020 12/31/9999 66985 INSERT LENS PROSTHESIS $ 534.50 $ 534.50 3/1/2020 12/31/9999 66986 EXCHANGE LENS PROSTHESIS $ 654.92 $ 654.92 3/1/2020 12/31/9999 66987 XCAPSL CTRC RMVL CPLX W/ECP $ 755.63 $ 755.63 3/1/2020 12/31/9999 66988 XCAPSL CTRC RMVL W/ECP $ 541.31 $ 541.31 3/1/2020 12/31/9999 66990 OPHTHALMIC ENDOSCOPE ADD-ON $ 67.58 $ 67.58 3/1/2020 12/31/9999 67005 PARTIAL REMOVAL OF EYE FLUID $ 329.28 $ 329.28 3/1/2020 12/31/9999 67010 PARTIAL REMOVAL OF EYE FLUID $ 381.75 $ 381.75 3/1/2020 12/31/9999 67015 RELEASE OF EYE FLUID $ 406.56 $ 406.56 3/1/2020 12/31/9999 67025 REPLACE EYE FLUID $ 439.28 $ 503.91 3/1/2020 12/31/9999 67027 IMPLANT EYE DRUG SYSTEM $ 602.97 $ 602.97 3/1/2020 12/31/9999 67028 INJECTION EYE DRUG $ 122.39 $ 151.47 3/1/2020 12/31/9999 67030 INCISE INNER EYE STRANDS $ 362.60 $ 362.60 3/1/2020 12/31/9999 67031 LASER SURGERY EYE STRANDS $ 246.61 $ 268.04 3/1/2020 12/31/9999 67036 REMOVAL OF INNER EYE FLUID $ 681.47 $ 681.47 3/1/2020 12/31/9999 67039 LASER TREATMENT OF RETINA $ 872.00 $ 872.00 3/1/2020 12/31/9999 67040 LASER TREATMENT OF RETINA $ 1,006.73 $ 1,006.73 3/1/2020 12/31/9999 67041 VIT FOR MACULAR PUCKER $ 943.52 $ 943.52 3/1/2020 12/31/9999 67042 VIT FOR MACULAR HOLE $ 1,081.56 $ 1,081.56 3/1/2020 12/31/9999 67043 VIT FOR MEMBRANE DISSECT $ 1,134.24 $ 1,134.24 3/1/2020 12/31/9999 67101 REPAIR DETACHED RETINA CRTX $ 470.32 $ 539.94 3/1/2020 12/31/9999 67105 REPAIR DETACHED RETINA PC $ 451.22 $ 500.57 3/1/2020 12/31/9999 67107 REPAIR DETACHED RETINA $ 856.75 $ 856.75 3/1/2020 12/31/9999 67108 REPAIR DETACHED RETINA $ 1,142.17 $ 1,142.17 3/1/2020 12/31/9999 67110 REPAIR DETACHED RETINA $ 541.79 $ 605.52 3/1/2020 12/31/9999 67113 REPAIR RETINAL DETACH CPLX $ 1,241.72 $ 1,241.72 3/1/2020 12/31/9999 67115 RELEASE ENCIRCLING MATERIAL $ 343.46 $ 343.46 3/1/2020 12/31/9999 67120 REMOVE EYE IMPLANT MATERIAL $ 387.45 $ 454.72 3/1/2020 12/31/9999 67121 REMOVE EYE IMPLANT MATERIAL $ 638.20 $ 638.20 3/1/2020 12/31/9999 67141 TREATMENT OF RETINA $ 337.94 $ 361.74 3/1/2020 12/31/9999 67145 TREATMENT OF RETINA $ 345.61 $ 364.99 3/1/2020 12/31/9999 67208 TREATMENT OF RETINAL LESION $ 405.20 $ 419.30 3/1/2020 12/31/9999 67210 TREATMENT OF RETINAL LESION $ 475.57 $ 491.14 3/1/2020 12/31/9999 67218 TREATMENT OF RETINAL LESION $ 999.03 $ 999.03 3/1/2020 12/31/9999 67220 TREATMENT OF CHOROID LESION $ 720.15 $ 753.64 3/1/2020 12/31/9999 67221 OCULAR PHOTODYNAMIC THER $ 160.00 $ 212.00 3/1/2020 12/31/9999 67225 EYE PHOTODYNAMIC THER ADD-ON $ 20.91 $ 22.09 3/1/2020 12/31/9999 67227 DSTRJ EXTENSIVE RETINOPATHY $ 400.22 $ 426.36 3/1/2020 12/31/9999 67228 TREATMENT X10SV RETINOPATHY $ 743.47 $ 838.94 3/1/2020 12/31/9999 67229 TR RETINAL LES PRETERM INF $ 816.14 $ 816.14 3/1/2020 12/31/9999 67250 REINFORCE EYE WALL $ 552.52 $ 552.52 3/1/2020 12/31/9999 67255 REINFORCE/GRAFT EYE WALL $ 590.44 $ 590.44 3/1/2020 12/31/9999 67311 REVISE EYE MUSCLE $ 419.44 $ 419.44 3/1/2020 12/31/9999 67312 REVISE TWO EYE MUSCLES $ 502.40 $ 502.40 3/1/2020 12/31/9999 67314 REVISE EYE MUSCLE $ 470.39 $ 470.39 3/1/2020 12/31/9999 67316 REVISE TWO EYE MUSCLES $ 564.17 $ 564.17 3/1/2020 12/31/9999 67318 REVISE EYE MUSCLE(S) $ 492.15 $ 492.15 3/1/2020 12/31/9999 67320 REVISE EYE MUSCLE(S) ADD-ON $ 237.02 $ 237.02 3/1/2020 12/31/9999 67331 EYE SURGERY FOLLOW-UP ADD-ON $ 224.43 $ 224.43 3/1/2020 12/31/9999 67332 REREVISE EYE MUSCLES ADD-ON $ 244.05 $ 244.05 3/1/2020 12/31/9999 67334 REVISE EYE MUSCLE W/SUTURE $ 221.38 $ 221.38 3/1/2020 12/31/9999 67335 EYE SUTURE DURING SURGERY $ 111.36 $ 111.36 3/1/2020 12/31/9999 67340 REVISE EYE MUSCLE ADD-ON $ 263.72 $ 263.72 3/1/2020 12/31/9999 67343 RELEASE EYE TISSUE $ 456.95 $ 456.95 3/1/2020 12/31/9999 67345 DESTROY NERVE OF EYE MUSCLE $ 152.10 $ 166.50 3/1/2020 12/31/9999 67346 BIOPSY EYE MUSCLE $ 145.86 $ 145.86 3/1/2020 12/31/9999 67400 EXPLORE/BIOPSY EYE SOCKET $ 656.63 $ 656.63 3/1/2020 12/31/9999 67405 EXPLORE/DRAIN EYE SOCKET $ 558.16 $ 558.16 3/1/2020 12/31/9999 67412 EXPLORE/TREAT EYE SOCKET $ 607.87 $ 607.87 3/1/2020 12/31/9999 67413 EXPLORE/TREAT EYE SOCKET $ 608.08 $ 608.08 3/1/2020 12/31/9999 67414 EXPLR/DECOMPRESS EYE SOCKET $ 935.80 $ 935.80 3/1/2020 12/31/9999 67415 ASPIRATION ORBITAL CONTENTS $ 77.97 $ 77.97 3/1/2020 12/31/9999 67420 EXPLORE/TREAT EYE SOCKET $ 1,165.63 $ 1,165.63 3/1/2020 12/31/9999 67430 EXPLORE/TREAT EYE SOCKET $ 883.14 $ 883.14 3/1/2020 12/31/9999 67440 EXPLORE/DRAIN EYE SOCKET $ 851.59 $ 851.59 3/1/2020 12/31/9999 67445 EXPLR/DECOMPRESS EYE SOCKET $ 1,004.15 $ 1,004.15 3/1/2020 12/31/9999 67450 EXPLORE/BIOPSY EYE SOCKET $ 883.63 $ 883.63 3/1/2020 12/31/9999 67500 INJECT/TREAT EYE SOCKET $ 59.37 $ 65.24 3/1/2020 12/31/9999 67505 INJECT/TREAT EYE SOCKET $ 57.20 $ 63.37 3/1/2020 12/31/9999 67515 INJECT/TREAT EYE SOCKET $ 62.39 $ 67.39 3/1/2020 12/31/9999 67570 DECOMPRESS OPTIC NERVE $ 819.79 $ 819.79 3/1/2020 12/31/9999 67700 DRAINAGE OF EYELID ABSCESS $ 80.76 $ 184.16 3/1/2020 12/31/9999 67710 INCISION OF EYELID $ 67.22 $ 155.05 3/1/2020 12/31/9999 67715 INCISION OF EYELID FOLD $ 76.14 $ 163.67 3/1/2020 12/31/9999 67800 REMOVE EYELID LESION $ 74.05 $ 89.03 3/1/2020 12/31/9999 67801 REMOVE EYELID LESIONS $ 96.20 $ 114.41 3/1/2020 12/31/9999 67805 REMOVE EYELID LESIONS $ 117.99 $ 141.50 3/1/2020 12/31/9999 67808 REMOVE EYELID LESION(S) $ 255.35 $ 255.35 3/1/2020 12/31/9999 67810 BIOPSY EYELID & LID MARGIN $ 69.36 $ 158.96 3/1/2020 12/31/9999 67820 REVISE EYELASHES $ 38.91 $ 37.75 3/1/2020 12/31/9999 67825 REVISE EYELASHES $ 84.93 $ 90.23 3/1/2020 12/31/9999 67830 REVISE EYELASHES $ 97.36 $ 185.20 3/1/2020 12/31/9999 67835 REVISE EYELASHES $ 310.98 $ 310.98 3/1/2020 12/31/9999 67840 REMOVE EYELID LESION $ 112.96 $ 194.33 3/1/2020 12/31/9999 67850 TREAT EYELID LESION $ 100.96 $ 156.47 3/1/2020 12/31/9999 67875 CLOSURE OF EYELID BY SUTURE $ 70.42 $ 121.54 3/1/2020 12/31/9999 67880 REVISION OF EYELID $ 255.35 $ 316.44 3/1/2020 12/31/9999 67882 REVISION OF EYELID $ 329.21 $ 391.19 3/1/2020 12/31/9999 67901 REPAIR EYELID DEFECT $ 408.78 $ 488.96 3/1/2020 12/31/9999 67902 REPAIR EYELID DEFECT $ 506.90 $ 506.90 3/1/2020 12/31/9999 67903 REPAIR EYELID DEFECT $ 353.17 $ 432.47 3/1/2020 12/31/9999 67904 REPAIR EYELID DEFECT $ 419.07 $ 511.88 3/1/2020 12/31/9999 67906 REPAIR EYELID DEFECT $ 366.30 $ 366.30 3/1/2020 12/31/9999 67908 REPAIR EYELID DEFECT $ 304.10 $ 344.64 3/1/2020 12/31/9999 67909 REVISE EYELID DEFECT $ 311.52 $ 377.91 3/1/2020 12/31/9999 67911 REVISE EYELID DEFECT $ 391.89 $ 391.89 3/1/2020 12/31/9999 67912 CORRECTION EYELID W/IMPLANT $ 351.83 $ 632.35 3/1/2020 12/31/9999 67914 REPAIR EYELID DEFECT $ 205.34 $ 274.38 3/1/2020 12/31/9999 67915 REPAIR EYELID DEFECT $ 181.24 $ 245.57 3/1/2020 12/31/9999 67916 REPAIR EYELID DEFECT $ 306.01 $ 378.27 3/1/2020 12/31/9999 67917 REPAIR EYELID DEFECT $ 338.68 $ 413.88 3/1/2020 12/31/9999 67921 REPAIR EYELID DEFECT $ 191.93 $ 260.96 3/1/2020 12/31/9999 67922 REPAIR EYELID DEFECT $ 174.59 $ 237.74 3/1/2020 12/31/9999 67923 REPAIR EYELID DEFECT $ 330.39 $ 399.42 3/1/2020 12/31/9999 67924 REPAIR EYELID DEFECT $ 319.58 $ 412.69 3/1/2020 12/31/9999 67930 REPAIR EYELID WOUND $ 176.95 $ 259.20 3/1/2020 12/31/9999 67935 REPAIR EYELID WOUND $ 322.70 $ 421.69 3/1/2020 12/31/9999 67938 REMOVE EYELID FOREIGN BODY $ 81.09 $ 168.33 3/1/2020 12/31/9999 67950 REVISION OF EYELID $ 332.34 $ 406.94 3/1/2020 12/31/9999 67961 REVISION OF EYELID $ 324.66 $ 406.02 3/1/2020 12/31/9999 67966 REVISION OF EYELID $ 461.17 $ 537.55 3/1/2020 12/31/9999 67971 RECONSTRUCTION OF EYELID $ 520.62 $ 520.62 3/1/2020 12/31/9999 67973 RECONSTRUCTION OF EYELID $ 674.89 $ 674.89 3/1/2020 12/31/9999 67974 RECONSTRUCTION OF EYELID $ 672.17 $ 672.17 3/1/2020 12/31/9999 67975 RECONSTRUCTION OF EYELID $ 491.43 $ 491.43 3/1/2020 12/31/9999 68020 INCISE/DRAIN EYELID LINING $ 78.26 $ 83.83 3/1/2020 12/31/9999 68040 TREATMENT OF EYELID LESIONS $ 39.25 $ 46.89 3/1/2020 12/31/9999 68100 BIOPSY OF EYELID LINING $ 71.01 $ 120.66 3/1/2020 12/31/9999 68110 REMOVE EYELID LINING LESION $ 104.48 $ 157.06 3/1/2020 12/31/9999 68115 REMOVE EYELID LINING LESION $ 130.57 $ 217.81 3/1/2020 12/31/9999 68130 REMOVE EYELID LINING LESION $ 289.32 $ 376.55 3/1/2020 12/31/9999 68135 REMOVE EYELID LINING LESION $ 106.71 $ 110.23 3/1/2020 12/31/9999 68200 TREAT EYELID BY INJECTION $ 25.07 $ 30.06 3/1/2020 12/31/9999 68320 REVISE/GRAFT EYELID LINING $ 371.81 $ 498.12 3/1/2020 12/31/9999 68325 REVISE/GRAFT EYELID LINING $ 463.39 $ 463.39 3/1/2020 12/31/9999 68326 REVISE/GRAFT EYELID LINING $ 451.09 $ 451.09 3/1/2020 12/31/9999 68328 REVISE/GRAFT EYELID LINING $ 504.07 $ 504.07 3/1/2020 12/31/9999 68330 REVISE EYELID LINING $ 319.91 $ 418.91 3/1/2020 12/31/9999 68335 REVISE/GRAFT EYELID LINING $ 452.56 $ 452.56 3/1/2020 12/31/9999 68340 SEPARATE EYELID ADHESIONS $ 276.31 $ 376.76 3/1/2020 12/31/9999 68360 REVISE EYELID LINING $ 285.80 $ 368.05 3/1/2020 12/31/9999 68362 REVISE EYELID LINING $ 458.80 $ 458.80 3/1/2020 12/31/9999 68400 INCISE/DRAIN TEAR GLAND $ 96.75 $ 195.15 3/1/2020 12/31/9999 68420 INCISE/DRAIN TEAR SAC $ 124.35 $ 223.35 3/1/2020 12/31/9999 68440 INCISE TEAR DUCT OPENING $ 67.34 $ 74.68 3/1/2020 12/31/9999 68500 REMOVAL OF TEAR GLAND $ 683.55 $ 683.55 3/1/2020 12/31/9999 68505 PARTIAL REMOVAL TEAR GLAND $ 687.46 $ 687.46 3/1/2020 12/31/9999 68510 BIOPSY OF TEAR GLAND $ 214.16 $ 321.67 3/1/2020 12/31/9999 68520 REMOVAL OF TEAR SAC $ 483.48 $ 483.48 3/1/2020 12/31/9999 68525 BIOPSY OF TEAR SAC $ 197.37 $ 197.37 3/1/2020 12/31/9999 68530 CLEARANCE OF TEAR DUCT $ 188.02 $ 305.24 3/1/2020 12/31/9999 68540 REMOVE TEAR GLAND LESION $ 653.70 $ 653.70 3/1/2020 12/31/9999 68550 REMOVE TEAR GLAND LESION $ 804.08 $ 804.08 3/1/2020 12/31/9999 68700 REPAIR TEAR DUCTS $ 421.86 $ 421.86 3/1/2020 12/31/9999 68705 REVISE TEAR DUCT OPENING $ 117.42 $ 166.48 3/1/2020 12/31/9999 68720 CREATE TEAR SAC DRAIN $ 535.64 $ 535.64 3/1/2020 12/31/9999 68745 CREATE TEAR DUCT DRAIN $ 537.63 $ 537.63 3/1/2020 12/31/9999 68750 CREATE TEAR DUCT DRAIN $ 552.39 $ 552.39 3/1/2020 12/31/9999 68760 CLOSE TEAR DUCT OPENING $ 102.63 $ 141.10 3/1/2020 12/31/9999 68761 CLOSE TEAR DUCT OPENING $ 83.22 $ 102.90 3/1/2020 12/31/9999 68770 CLOSE TEAR SYSTEM FISTULA $ 418.16 $ 418.16 3/1/2020 12/31/9999 68801 DILATE TEAR DUCT OPENING $ 73.79 $ 84.96 3/1/2020 12/31/9999 68810 PROBE NASOLACRIMAL DUCT $ 133.00 $ 165.03 3/1/2020 12/31/9999 68811 PROBE NASOLACRIMAL DUCT $ 144.61 $ 144.61 3/1/2020 12/31/9999 68815 PROBE NASOLACRIMAL DUCT $ 182.69 $ 309.30 3/1/2020 12/31/9999 68816 PROBE NL DUCT W/BALLOON $ 174.87 $ 470.38 3/1/2020 12/31/9999 68840 EXPLORE/IRRIGATE TEAR DUCTS $ 78.55 $ 87.08 3/1/2020 12/31/9999 68850 INJECTION FOR TEAR SAC X-RAY $ 45.00 $ 49.12 3/1/2020 12/31/9999 69000 DRAIN EXTERNAL EAR LESION $ 88.76 $ 133.40 3/1/2020 12/31/9999 69005 DRAIN EXTERNAL EAR LESION $ 121.00 $ 158.90 3/1/2020 12/31/9999 69020 DRAIN OUTER EAR CANAL LESION $ 107.63 $ 169.31 3/1/2020 12/31/9999 69100 BIOPSY OF EXTERNAL EAR $ 38.37 $ 79.20 3/1/2020 12/31/9999 69105 BIOPSY OF EXTERNAL EAR CANAL $ 49.84 $ 103.31 3/1/2020 12/31/9999 69110 REMOVE EXTERNAL EAR PARTIAL $ 248.13 $ 338.02 3/1/2020 12/31/9999 69120 REMOVAL OF EXTERNAL EAR $ 301.42 $ 301.42 3/1/2020 12/31/9999 69140 REMOVE EAR CANAL LESION(S) $ 656.72 $ 656.72 3/1/2020 12/31/9999 69145 REMOVE EAR CANAL LESION(S) $ 187.08 $ 283.72 3/1/2020 12/31/9999 69150 EXTENSIVE EAR CANAL SURGERY $ 809.87 $ 809.87 3/1/2020 12/31/9999 69155 EXTENSIVE EAR/NECK SURGERY $ 1,302.84 $ 1,302.84 3/1/2020 12/31/9999 69200 CLEAR OUTER EAR CANAL $ 43.29 $ 90.00 3/1/2020 12/31/9999 69205 CLEAR OUTER EAR CANAL $ 77.43 $ 77.43 3/1/2020 12/31/9999 69210 REMOVE IMPACTED EAR WAX UNI $ 25.97 $ 37.72 3/1/2020 12/31/9999 69220 CLEAN OUT MASTOID CAVITY $ 48.33 $ 100.92 3/1/2020 12/31/9999 69222 CLEAN OUT MASTOID CAVITY $ 104.50 $ 162.08 3/1/2020 12/31/9999 69310 REBUILD OUTER EAR CANAL $ 821.68 $ 821.68 3/1/2020 12/31/9999 69320 REBUILD OUTER EAR CANAL $ 1,174.69 $ 1,174.69 3/1/2020 12/31/9999 69420 INCISION OF EARDRUM $ 91.19 $ 140.55 3/1/2020 12/31/9999 69421 INCISION OF EARDRUM $ 115.58 $ 115.58 3/1/2020 12/31/9999 69424 REMOVE VENTILATING TUBE $ 48.38 $ 95.38 3/1/2020 12/31/9999 69433 CREATE EARDRUM OPENING $ 98.82 $ 146.70 3/1/2020 12/31/9999 69436 CREATE EARDRUM OPENING $ 125.75 $ 125.75 3/1/2020 12/31/9999 69440 EXPLORATION OF MIDDLE EAR $ 519.81 $ 519.81 3/1/2020 12/31/9999 69450 EARDRUM REVISION $ 407.23 $ 407.23 3/1/2020 12/31/9999 69501 MASTOIDECTOMY $ 560.16 $ 560.16 3/1/2020 12/31/9999 69502 MASTOIDECTOMY $ 745.95 $ 745.95 3/1/2020 12/31/9999 69505 REMOVE MASTOID STRUCTURES $ 917.01 $ 917.01 3/1/2020 12/31/9999 69511 EXTENSIVE MASTOID SURGERY $ 943.16 $ 943.16 3/1/2020 12/31/9999 69530 EXTENSIVE MASTOID SURGERY $ 1,274.47 $ 1,274.47 3/1/2020 12/31/9999 69535 REMOVE PART OF TEMPORAL BONE $ 2,081.21 $ 2,081.21 3/1/2020 12/31/9999 69540 REMOVE EAR LESION $ 95.98 $ 152.67 3/1/2020 12/31/9999 69550 REMOVE EAR LESION $ 792.09 $ 792.09 3/1/2020 12/31/9999 69552 REMOVE EAR LESION $ 1,214.54 $ 1,214.54 3/1/2020 12/31/9999 69554 REMOVE EAR LESION $ 1,936.59 $ 1,936.59 3/1/2020 12/31/9999 69601 MASTOID SURGERY REVISION $ 804.06 $ 804.06 3/1/2020 12/31/9999 69602 MASTOID SURGERY REVISION $ 836.01 $ 836.01 3/1/2020 12/31/9999 69603 MASTOID SURGERY REVISION $ 970.34 $ 970.34 3/1/2020 12/31/9999 69604 MASTOID SURGERY REVISION $ 862.52 $ 862.52 3/1/2020 12/31/9999 69605 MASTOID SURGERY REVISION $ 1,201.78 $ 1,201.78 3/1/2020 12/31/9999 69610 REPAIR OF EARDRUM $ 231.37 $ 298.06 3/1/2020 12/31/9999 69620 REPAIR OF EARDRUM $ 374.26 $ 518.77 3/1/2020 12/31/9999 69631 REPAIR EARDRUM STRUCTURES $ 668.97 $ 668.97 3/1/2020 12/31/9999 69632 REBUILD EARDRUM STRUCTURES $ 822.95 $ 822.95 3/1/2020 12/31/9999 69633 REBUILD EARDRUM STRUCTURES $ 792.49 $ 792.49 3/1/2020 12/31/9999 69635 REPAIR EARDRUM STRUCTURES $ 930.47 $ 930.47 3/1/2020 12/31/9999 69636 REBUILD EARDRUM STRUCTURES $ 1,054.64 $ 1,054.64 3/1/2020 12/31/9999 69637 REBUILD EARDRUM STRUCTURES $ 1,049.76 $ 1,049.76 3/1/2020 12/31/9999 69641 REVISE MIDDLE EAR & MASTOID $ 797.85 $ 797.85 3/1/2020 12/31/9999 69642 REVISE MIDDLE EAR & MASTOID $ 1,029.97 $ 1,029.97 3/1/2020 12/31/9999 69643 REVISE MIDDLE EAR & MASTOID $ 940.65 $ 940.65 3/1/2020 12/31/9999 69644 REVISE MIDDLE EAR & MASTOID $ 1,136.35 $ 1,136.35 3/1/2020 12/31/9999 69645 REVISE MIDDLE EAR & MASTOID $ 1,112.86 $ 1,112.86 3/1/2020 12/31/9999 69646 REVISE MIDDLE EAR & MASTOID $ 1,184.35 $ 1,184.35 3/1/2020 12/31/9999 69650 RELEASE MIDDLE EAR BONE $ 607.53 $ 607.53 3/1/2020 12/31/9999 69660 REVISE MIDDLE EAR BONE $ 715.75 $ 715.75 3/1/2020 12/31/9999 69661 REVISE MIDDLE EAR BONE $ 936.52 $ 936.52 3/1/2020 12/31/9999 69662 REVISE MIDDLE EAR BONE $ 898.36 $ 898.36 3/1/2020 12/31/9999 69666 REPAIR MIDDLE EAR STRUCTURES $ 616.46 $ 616.46 3/1/2020 12/31/9999 69667 REPAIR MIDDLE EAR STRUCTURES $ 618.54 $ 618.54 3/1/2020 12/31/9999 69670 REMOVE MASTOID AIR CELLS $ 721.73 $ 721.73 3/1/2020 12/31/9999 69676 REMOVE MIDDLE EAR NERVE $ 634.84 $ 634.84 3/1/2020 12/31/9999 69700 CLOSE MASTOID FISTULA $ 529.94 $ 529.94 3/1/2020 12/31/9999 69714 IMPLANT TEMPLE BONE W/STIMUL $ 925.89 $ 925.89 3/1/2020 12/31/9999 69715 TEMPLE BNE IMPLNT W/STIMULAT $ 1,142.93 $ 1,142.93 3/1/2020 12/31/9999 69717 TEMPLE BONE IMPLANT REVISION $ 970.59 $ 970.59 3/1/2020 12/31/9999 69718 REVISE TEMPLE BONE IMPLANT $ 1,154.67 $ 1,154.67 3/1/2020 12/31/9999 69720 RELEASE FACIAL NERVE $ 901.12 $ 901.12 3/1/2020 12/31/9999 69725 RELEASE FACIAL NERVE $ 1,476.79 $ 1,476.79 3/1/2020 12/31/9999 69740 REPAIR FACIAL NERVE $ 910.70 $ 910.70 3/1/2020 12/31/9999 69745 REPAIR FACIAL NERVE $ 966.50 $ 966.50 3/1/2020 12/31/9999 69801 INCISE INNER EAR $ 569.90 $ 569.90 3/1/2020 12/31/9999 69805 EXPLORE INNER EAR $ 815.66 $ 815.66 3/1/2020 12/31/9999 69806 EXPLORE INNER EAR $ 731.45 $ 731.45 3/1/2020 12/31/9999 69905 REMOVE INNER EAR $ 705.01 $ 705.01 3/1/2020 12/31/9999 69910 REMOVE INNER EAR & MASTOID $ 791.43 $ 791.43 3/1/2020 12/31/9999 69915 INCISE INNER EAR NERVE $ 1,202.66 $ 1,202.66 3/1/2020 12/31/9999 69930 IMPLANT COCHLEAR DEVICE $ 965.22 $ 965.22 3/1/2020 12/31/9999 69950 INCISE INNER EAR NERVE $ 1,425.69 $ 1,425.69 3/1/2020 12/31/9999 69955 RELEASE FACIAL NERVE $ 1,557.62 $ 1,557.62 3/1/2020 12/31/9999 69960 RELEASE INNER EAR CANAL $ 1,511.72 $ 1,511.72 3/1/2020 12/31/9999 69970 REMOVE INNER EAR LESION $ 1,687.30 $ 1,687.30 3/1/2020 12/31/9999 69990 MICROSURGERY ADD-ON $ 170.69 $ 170.69 3/1/2020 12/31/9999 70010 26 CONTRAST X-RAY OF BRAIN $ 51.44 $ 51.44 3/1/2020 12/31/9999 70010 TC CONTRAST X-RAY OF BRAIN $ 88.15 $ 88.15 3/1/2020 12/31/9999 70010 CONTRAST X-RAY OF BRAIN $ 139.58 $ 139.58 3/1/2020 12/31/9999 70015 26 CONTRAST X-RAY OF BRAIN $ 52.62 $ 52.62 3/1/2020 12/31/9999 70015 TC CONTRAST X-RAY OF BRAIN $ 64.47 $ 64.47 3/1/2020 12/31/9999 70015 CONTRAST X-RAY OF BRAIN $ 117.10 $ 117.10 3/1/2020 12/31/9999 70030 26 X-RAY EYE FOR FOREIGN BODY $ 7.36 $ 7.36 3/1/2020 12/31/9999 70030 TC X-RAY EYE FOR FOREIGN BODY $ 15.39 $ 15.39 3/1/2020 12/31/9999 70030 X-RAY EYE FOR FOREIGN BODY $ 22.74 $ 22.74 3/1/2020 12/31/9999 70100 26 X-RAY EXAM OF JAW <4VIEWS $ 7.68 $ 7.68 3/1/2020 12/31/9999 70100 TC X-RAY EXAM OF JAW <4VIEWS $ 16.84 $ 16.84 3/1/2020 12/31/9999 70100 X-RAY EXAM OF JAW <4VIEWS $ 24.54 $ 24.54 3/1/2020 12/31/9999 70110 26 X-RAY EXAM OF JAW 4/> VIEWS $ 10.78 $ 10.78 3/1/2020 12/31/9999 70110 TC X-RAY EXAM OF JAW 4/> VIEWS $ 21.07 $ 21.07 3/1/2020 12/31/9999 70110 X-RAY EXAM OF JAW 4/> VIEWS $ 31.86 $ 31.86 3/1/2020 12/31/9999 70120 26 X-RAY EXAM OF MASTOIDS $ 7.68 $ 7.68 3/1/2020 12/31/9999 70120 TC X-RAY EXAM OF MASTOIDS $ 19.02 $ 19.02 3/1/2020 12/31/9999 70120 X-RAY EXAM OF MASTOIDS $ 26.70 $ 26.70 3/1/2020 12/31/9999 70130 26 X-RAY EXAM OF MASTOIDS $ 14.73 $ 14.73 3/1/2020 12/31/9999 70130 TC X-RAY EXAM OF MASTOIDS $ 29.51 $ 29.51 3/1/2020 12/31/9999 70130 X-RAY EXAM OF MASTOIDS $ 44.24 $ 44.24 3/1/2020 12/31/9999 70134 26 X-RAY EXAM OF MIDDLE EAR $ 14.73 $ 14.73 3/1/2020 12/31/9999 70134 TC X-RAY EXAM OF MIDDLE EAR $ 23.32 $ 23.32 3/1/2020 12/31/9999 70134 X-RAY EXAM OF MIDDLE EAR $ 38.05 $ 38.05 3/1/2020 12/31/9999 70140 26 X-RAY EXAM OF FACIAL BONES $ 7.99 $ 7.99 3/1/2020 12/31/9999 70140 TC X-RAY EXAM OF FACIAL BONES $ 16.09 $ 16.09 3/1/2020 12/31/9999 70140 X-RAY EXAM OF FACIAL BONES $ 24.08 $ 24.08 3/1/2020 12/31/9999 70150 26 X-RAY EXAM OF FACIAL BONES $ 11.10 $ 11.10 3/1/2020 12/31/9999 70150 TC X-RAY EXAM OF FACIAL BONES $ 23.32 $ 23.32 3/1/2020 12/31/9999 70150 X-RAY EXAM OF FACIAL BONES $ 34.44 $ 34.44 3/1/2020 12/31/9999 70160 26 X-RAY EXAM OF NASAL BONES $ 7.36 $ 7.36 3/1/2020 12/31/9999 70160 TC X-RAY EXAM OF NASAL BONES $ 18.32 $ 18.32 3/1/2020 12/31/9999 70160 X-RAY EXAM OF NASAL BONES $ 25.68 $ 25.68 3/1/2020 12/31/9999 70170 26 X-RAY EXAM OF TEAR DUCT $ 12.96 $ 12.96 3/1/2020 12/31/9999 70170 TC X-RAY EXAM OF TEAR DUCT $ 30.96 $ 30.96 3/1/2020 12/31/9999 70170 X-RAY EXAM OF TEAR DUCT $ 43.47 $ 43.47 3/1/2020 12/31/9999 70190 26 X-RAY EXAM OF EYE SOCKETS $ 8.93 $ 8.93 3/1/2020 12/31/9999 70190 TC X-RAY EXAM OF EYE SOCKETS $ 19.60 $ 19.60 3/1/2020 12/31/9999 70190 X-RAY EXAM OF EYE SOCKETS $ 28.53 $ 28.53 3/1/2020 12/31/9999 70200 26 X-RAY EXAM OF EYE SOCKETS $ 12.03 $ 12.03 3/1/2020 12/31/9999 70200 TC X-RAY EXAM OF EYE SOCKETS $ 23.63 $ 23.63 3/1/2020 12/31/9999 70200 X-RAY EXAM OF EYE SOCKETS $ 35.66 $ 35.66 3/1/2020 12/31/9999 70210 26 X-RAY EXAM OF SINUSES $ 7.36 $ 7.36 3/1/2020 12/31/9999 70210 TC X-RAY EXAM OF SINUSES $ 16.66 $ 16.66 3/1/2020 12/31/9999 70210 X-RAY EXAM OF SINUSES $ 24.03 $ 24.03 3/1/2020 12/31/9999 70220 26 X-RAY EXAM OF SINUSES $ 10.49 $ 10.49 3/1/2020 12/31/9999 70220 TC X-RAY EXAM OF SINUSES $ 20.98 $ 20.98 3/1/2020 12/31/9999 70220 X-RAY EXAM OF SINUSES $ 31.47 $ 31.47 3/1/2020 12/31/9999 70240 26 X-RAY EXAM PITUITARY SADDLE $ 8.30 $ 8.30 3/1/2020 12/31/9999 70240 TC X-RAY EXAM PITUITARY SADDLE $ 15.39 $ 15.39 3/1/2020 12/31/9999 70240 X-RAY EXAM PITUITARY SADDLE $ 23.67 $ 23.67 3/1/2020 12/31/9999 70250 26 X-RAY EXAM OF SKULL $ 10.17 $ 10.17 3/1/2020 12/31/9999 70250 TC X-RAY EXAM OF SKULL $ 19.02 $ 19.02 3/1/2020 12/31/9999 70250 X-RAY EXAM OF SKULL $ 29.19 $ 29.19 3/1/2020 12/31/9999 70260 26 X-RAY EXAM OF SKULL $ 14.43 $ 14.43 3/1/2020 12/31/9999 70260 TC X-RAY EXAM OF SKULL $ 24.41 $ 24.41 3/1/2020 12/31/9999 70260 X-RAY EXAM OF SKULL $ 38.85 $ 38.85 3/1/2020 12/31/9999 70300 26 X-RAY EXAM OF TEETH $ 4.56 $ 4.56 3/1/2020 12/31/9999 70300 TC X-RAY EXAM OF TEETH $ 6.87 $ 6.87 3/1/2020 12/31/9999 70300 X-RAY EXAM OF TEETH $ 11.41 $ 11.41 3/1/2020 12/31/9999 70310 26 X-RAY EXAM OF TEETH $ 7.05 $ 7.05 3/1/2020 12/31/9999 70310 TC X-RAY EXAM OF TEETH $ 20.09 $ 20.09 3/1/2020 12/31/9999 70310 X-RAY EXAM OF TEETH $ 27.13 $ 27.13 3/1/2020 12/31/9999 70320 26 FULL MOUTH X-RAY OF TEETH $ 9.53 $ 9.53 3/1/2020 12/31/9999 70320 TC FULL MOUTH X-RAY OF TEETH $ 28.62 $ 28.62 3/1/2020 12/31/9999 70320 FULL MOUTH X-RAY OF TEETH $ 38.16 $ 38.16 3/1/2020 12/31/9999 70328 26 X-RAY EXAM OF JAW JOINT $ 7.68 $ 7.68 3/1/2020 12/31/9999 70328 TC X-RAY EXAM OF JAW JOINT $ 16.26 $ 16.26 3/1/2020 12/31/9999 70328 X-RAY EXAM OF JAW JOINT $ 23.94 $ 23.94 3/1/2020 12/31/9999 70330 26 X-RAY EXAM OF JAW JOINTS $ 10.46 $ 10.46 3/1/2020 12/31/9999 70330 TC X-RAY EXAM OF JAW JOINTS $ 27.45 $ 27.45 3/1/2020 12/31/9999 70330 X-RAY EXAM OF JAW JOINTS $ 37.91 $ 37.91 3/1/2020 12/31/9999 70332 26 X-RAY EXAM OF JAW JOINT $ 22.84 $ 22.84 3/1/2020 12/31/9999 70332 TC X-RAY EXAM OF JAW JOINT $ 45.60 $ 45.60 3/1/2020 12/31/9999 70332 X-RAY EXAM OF JAW JOINT $ 68.43 $ 68.43 3/1/2020 12/31/9999 70336 26 MAGNETIC IMAGE JAW JOINT $ 64.27 $ 64.27 3/1/2020 12/31/9999 70336 TC MAGNETIC IMAGE JAW JOINT $ 348.51 $ 348.51 3/1/2020 12/31/9999 70336 MAGNETIC IMAGE JAW JOINT $ 412.79 $ 412.79 3/1/2020 12/31/9999 70350 26 X-RAY HEAD FOR ORTHODONTIA $ 7.36 $ 7.36 3/1/2020 12/31/9999 70350 TC X-RAY HEAD FOR ORTHODONTIA $ 9.22 $ 9.22 3/1/2020 12/31/9999 70350 X-RAY HEAD FOR ORTHODONTIA $ 16.58 $ 16.58 3/1/2020 12/31/9999 70355 26 PANORAMIC X-RAY OF JAWS $ 8.61 $ 8.61 3/1/2020 12/31/9999 70355 TC PANORAMIC X-RAY OF JAWS $ 9.91 $ 9.91 3/1/2020 12/31/9999 70355 PANORAMIC X-RAY OF JAWS $ 18.51 $ 18.51 3/1/2020 12/31/9999 70360 26 X-RAY EXAM OF NECK $ 7.36 $ 7.36 3/1/2020 12/31/9999 70360 TC X-RAY EXAM OF NECK $ 14.50 $ 14.50 3/1/2020 12/31/9999 70360 X-RAY EXAM OF NECK $ 21.87 $ 21.87 3/1/2020 12/31/9999 70370 26 THROAT X-RAY & FLUOROSCOPY $ 13.60 $ 13.60 3/1/2020 12/31/9999 70370 TC THROAT X-RAY & FLUOROSCOPY $ 46.05 $ 46.05 3/1/2020 12/31/9999 70370 THROAT X-RAY & FLUOROSCOPY $ 59.65 $ 59.65 3/1/2020 12/31/9999 70380 26 X-RAY EXAM OF SALIVARY GLAND $ 7.36 $ 7.36 3/1/2020 12/31/9999 70380 TC X-RAY EXAM OF SALIVARY GLAND $ 22.25 $ 22.25 3/1/2020 12/31/9999 70380 X-RAY EXAM OF SALIVARY GLAND $ 29.61 $ 29.61 3/1/2020 12/31/9999 70390 26 X-RAY EXAM OF SALIVARY DUCT $ 16.58 $ 16.58 3/1/2020 12/31/9999 70390 TC X-RAY EXAM OF SALIVARY DUCT $ 63.32 $ 63.32 3/1/2020 12/31/9999 70390 X-RAY EXAM OF SALIVARY DUCT $ 79.89 $ 79.89 3/1/2020 12/31/9999 70450 26 CT HEAD/BRAIN W/O DYE $ 37.19 $ 37.19 3/1/2020 12/31/9999 70450 TC CT HEAD/BRAIN W/O DYE $ 140.15 $ 140.15 3/1/2020 12/31/9999 70450 CT HEAD/BRAIN W/O DYE $ 177.37 $ 177.37 3/1/2020 12/31/9999 70460 26 CT HEAD/BRAIN W/DYE $ 49.23 $ 49.23 3/1/2020 12/31/9999 70460 TC CT HEAD/BRAIN W/DYE $ 180.23 $ 180.23 3/1/2020 12/31/9999 70460 CT HEAD/BRAIN W/DYE $ 229.46 $ 229.46 3/1/2020 12/31/9999 70470 26 CT HEAD/BRAIN W/O & W/DYE $ 55.35 $ 55.35 3/1/2020 12/31/9999 70470 TC CT HEAD/BRAIN W/O & W/DYE $ 222.19 $ 222.19 3/1/2020 12/31/9999 70470 CT HEAD/BRAIN W/O & W/DYE $ 277.53 $ 277.53 3/1/2020 12/31/9999 70480 26 CT ORBIT/EAR/FOSSA W/O DYE $ 55.66 $ 55.66 3/1/2020 12/31/9999 70480 TC CT ORBIT/EAR/FOSSA W/O DYE $ 214.47 $ 214.47 3/1/2020 12/31/9999 70480 CT ORBIT/EAR/FOSSA W/O DYE $ 270.13 $ 270.13 3/1/2020 12/31/9999 70481 26 CT ORBIT/EAR/FOSSA W/DYE $ 60.01 $ 60.01 3/1/2020 12/31/9999 70481 TC CT ORBIT/EAR/FOSSA W/DYE $ 253.96 $ 253.96 3/1/2020 12/31/9999 70481 CT ORBIT/EAR/FOSSA W/DYE $ 313.97 $ 313.97 3/1/2020 12/31/9999 70482 26 CT ORBIT/EAR/FOSSA W/O&W/DYE $ 62.82 $ 62.82 3/1/2020 12/31/9999 70482 TC CT ORBIT/EAR/FOSSA W/O&W/DYE $ 296.50 $ 296.50 3/1/2020 12/31/9999 70482 CT ORBIT/EAR/FOSSA W/O&W/DYE $ 359.33 $ 359.33 3/1/2020 12/31/9999 70486 26 CT MAXILLOFACIAL W/O DYE $ 49.55 $ 49.55 3/1/2020 12/31/9999 70486 TC CT MAXILLOFACIAL W/O DYE $ 178.93 $ 178.93 3/1/2020 12/31/9999 70486 CT MAXILLOFACIAL W/O DYE $ 228.47 $ 228.47 3/1/2020 12/31/9999 70487 26 CT MAXILLOFACIAL W/DYE $ 56.89 $ 56.89 3/1/2020 12/31/9999 70487 TC CT MAXILLOFACIAL W/DYE $ 219.30 $ 219.30 3/1/2020 12/31/9999 70487 CT MAXILLOFACIAL W/DYE $ 276.18 $ 276.18 3/1/2020 12/31/9999 70488 26 CT MAXILLOFACIAL W/O & W/DYE $ 61.58 $ 61.58 3/1/2020 12/31/9999 70488 TC CT MAXILLOFACIAL W/O & W/DYE $ 274.18 $ 274.18 3/1/2020 12/31/9999 70488 CT MAXILLOFACIAL W/O & W/DYE $ 335.75 $ 335.75 3/1/2020 12/31/9999 70490 26 CT SOFT TISSUE NECK W/O DYE $ 55.95 $ 55.95 3/1/2020 12/31/9999 70490 TC CT SOFT TISSUE NECK W/O DYE $ 170.70 $ 170.70 3/1/2020 12/31/9999 70490 CT SOFT TISSUE NECK W/O DYE $ 226.66 $ 226.66 3/1/2020 12/31/9999 70491 26 CT SOFT TISSUE NECK W/DYE $ 60.01 $ 60.01 3/1/2020 12/31/9999 70491 TC CT SOFT TISSUE NECK W/DYE $ 211.67 $ 211.67 3/1/2020 12/31/9999 70491 CT SOFT TISSUE NECK W/DYE $ 271.68 $ 271.68 3/1/2020 12/31/9999 70492 26 CT SFT TSUE NCK W/O & W/DYE $ 62.82 $ 62.82 3/1/2020 12/31/9999 70492 TC CT SFT TSUE NCK W/O & W/DYE $ 266.53 $ 266.53 3/1/2020 12/31/9999 70492 CT SFT TSUE NCK W/O & W/DYE $ 329.36 $ 329.36 3/1/2020 12/31/9999 70496 26 CT ANGIOGRAPHY HEAD $ 76.57 $ 76.57 3/1/2020 12/31/9999 70496 TC CT ANGIOGRAPHY HEAD $ 447.30 $ 447.30 3/1/2020 12/31/9999 70496 CT ANGIOGRAPHY HEAD $ 523.88 $ 523.88 3/1/2020 12/31/9999 70498 26 CT ANGIOGRAPHY NECK $ 76.87 $ 76.87 3/1/2020 12/31/9999 70498 TC CT ANGIOGRAPHY NECK $ 449.36 $ 449.36 3/1/2020 12/31/9999 70498 CT ANGIOGRAPHY NECK $ 526.23 $ 526.23 3/1/2020 12/31/9999 70540 26 MRI ORBIT/FACE/NECK W/O DYE $ 58.47 $ 58.47 3/1/2020 12/31/9999 70540 TC MRI ORBIT/FACE/NECK W/O DYE $ 388.25 $ 388.25 3/1/2020 12/31/9999 70540 MRI ORBIT/FACE/NECK W/O DYE $ 446.72 $ 446.72 3/1/2020 12/31/9999 70542 26 MRI ORBIT/FACE/NECK W/DYE $ 70.18 $ 70.18 3/1/2020 12/31/9999 70542 TC MRI ORBIT/FACE/NECK W/DYE $ 426.29 $ 426.29 3/1/2020 12/31/9999 70542 MRI ORBIT/FACE/NECK W/DYE $ 496.48 $ 496.48 3/1/2020 12/31/9999 70543 26 MRI ORBT/FAC/NCK W/O &W/DYE $ 93.20 $ 93.20 3/1/2020 12/31/9999 70543 TC MRI ORBT/FAC/NCK W/O &W/DYE $ 590.90 $ 590.90 3/1/2020 12/31/9999 70543 MRI ORBT/FAC/NCK W/O &W/DYE $ 684.10 $ 684.10 3/1/2020 12/31/9999 70544 26 MR ANGIOGRAPHY HEAD W/O DYE $ 52.05 $ 52.05 3/1/2020 12/31/9999 70544 TC MR ANGIOGRAPHY HEAD W/O DYE $ 429.29 $ 429.29 3/1/2020 12/31/9999 70544 MR ANGIOGRAPHY HEAD W/O DYE $ 481.33 $ 481.33 3/1/2020 12/31/9999 70545 26 MR ANGIOGRAPHY HEAD W/DYE $ 52.05 $ 52.05 3/1/2020 12/31/9999 70545 TC MR ANGIOGRAPHY HEAD W/DYE $ 427.23 $ 427.23 3/1/2020 12/31/9999 70545 MR ANGIOGRAPHY HEAD W/DYE $ 479.27 $ 479.27 3/1/2020 12/31/9999 70546 26 MR ANGIOGRAPH HEAD W/O&W/DYE $ 78.16 $ 78.16 3/1/2020 12/31/9999 70546 TC MR ANGIOGRAPH HEAD W/O&W/DYE $ 684.86 $ 684.86 3/1/2020 12/31/9999 70546 MR ANGIOGRAPH HEAD W/O&W/DYE $ 763.02 $ 763.02 3/1/2020 12/31/9999 70547 26 MR ANGIOGRAPHY NECK W/O DYE $ 52.05 $ 52.05 3/1/2020 12/31/9999 70547 TC MR ANGIOGRAPHY NECK W/O DYE $ 428.12 $ 428.12 3/1/2020 12/31/9999 70547 MR ANGIOGRAPHY NECK W/O DYE $ 480.15 $ 480.15 3/1/2020 12/31/9999 70548 26 MR ANGIOGRAPHY NECK W/DYE $ 52.05 $ 52.05 3/1/2020 12/31/9999 70548 TC MR ANGIOGRAPHY NECK W/DYE $ 446.92 $ 446.92 3/1/2020 12/31/9999 70548 MR ANGIOGRAPHY NECK W/DYE $ 498.96 $ 498.96 3/1/2020 12/31/9999 70549 26 MR ANGIOGRAPH NECK W/O&W/DYE $ 78.16 $ 78.16 3/1/2020 12/31/9999 70549 TC MR ANGIOGRAPH NECK W/O&W/DYE $ 685.44 $ 685.44 3/1/2020 12/31/9999 70549 MR ANGIOGRAPH NECK W/O&W/DYE $ 763.60 $ 763.60 3/1/2020 12/31/9999 70551 26 MRI BRAIN STEM W/O DYE $ 64.27 $ 64.27 3/1/2020 12/31/9999 70551 TC MRI BRAIN STEM W/O DYE $ 397.28 $ 397.28 3/1/2020 12/31/9999 70551 MRI BRAIN STEM W/O DYE $ 461.55 $ 461.55 3/1/2020 12/31/9999 70552 26 MRI BRAIN STEM W/DYE $ 77.52 $ 77.52 3/1/2020 12/31/9999 70552 TC MRI BRAIN STEM W/DYE $ 438.55 $ 438.55 3/1/2020 12/31/9999 70552 MRI BRAIN STEM W/DYE $ 516.09 $ 516.09 3/1/2020 12/31/9999 70553 26 MRI BRAIN STEM W/O & W/DYE $ 102.52 $ 102.52 3/1/2020 12/31/9999 70553 TC MRI BRAIN STEM W/O & W/DYE $ 584.49 $ 584.49 3/1/2020 12/31/9999 70553 MRI BRAIN STEM W/O & W/DYE $ 687.00 $ 687.00 3/1/2020 12/31/9999 70557 26 MRI BRAIN W/O DYE $ 126.90 $ 126.90 3/1/2020 12/31/9999 70557 TC MRI BRAIN W/O DYE $ 380.71 $ 380.71 3/1/2020 12/31/9999 70557 MRI BRAIN W/O DYE $ 507.60 $ 507.60 3/1/2020 12/31/9999 70558 26 MRI BRAIN W/DYE $ 138.59 $ 138.59 3/1/2020 12/31/9999 70558 TC MRI BRAIN W/DYE $ 415.77 $ 415.77 3/1/2020 12/31/9999 70558 MRI BRAIN W/DYE $ 554.36 $ 554.36 3/1/2020 12/31/9999 70559 26 MRI BRAIN W/O & W/DYE $ 140.75 $ 140.75 3/1/2020 12/31/9999 70559 TC MRI BRAIN W/O & W/DYE $ 422.26 $ 422.26 3/1/2020 12/31/9999 70559 MRI BRAIN W/O & W/DYE $ 563.01 $ 563.01 3/1/2020 12/31/9999 71045 26 X-RAY EXAM CHEST 1 VIEW $ 8.05 $ 8.05 3/1/2020 12/31/9999 71045 TC X-RAY EXAM CHEST 1 VIEW $ 9.00 $ 9.00 3/1/2020 12/31/9999 71045 X-RAY EXAM CHEST 1 VIEW $ 17.05 $ 17.05 3/1/2020 12/31/9999 71046 26 X-RAY EXAM CHEST 2 VIEWS $ 9.62 $ 9.62 3/1/2020 12/31/9999 71046 TC X-RAY EXAM CHEST 2 VIEWS $ 16.57 $ 16.57 3/1/2020 12/31/9999 71046 X-RAY EXAM CHEST 2 VIEWS $ 26.19 $ 26.19 3/1/2020 12/31/9999 71047 26 X-RAY EXAM CHEST 3 VIEWS $ 12.41 $ 12.41 3/1/2020 12/31/9999 71047 TC X-RAY EXAM CHEST 3 VIEWS $ 21.11 $ 21.11 3/1/2020 12/31/9999 71047 X-RAY EXAM CHEST 3 VIEWS $ 33.53 $ 33.53 3/1/2020 12/31/9999 71048 26 X-RAY EXAM CHEST 4+ VIEWS $ 14.29 $ 14.29 3/1/2020 12/31/9999 71048 TC X-RAY EXAM CHEST 4+ VIEWS $ 21.72 $ 21.72 3/1/2020 12/31/9999 71048 X-RAY EXAM CHEST 4+ VIEWS $ 36.00 $ 36.00 3/1/2020 12/31/9999 71100 26 X-RAY EXAM RIBS UNI 2 VIEWS $ 9.53 $ 9.53 3/1/2020 12/31/9999 71100 TC X-RAY EXAM RIBS UNI 2 VIEWS $ 16.96 $ 16.96 3/1/2020 12/31/9999 71100 X-RAY EXAM RIBS UNI 2 VIEWS $ 26.50 $ 26.50 3/1/2020 12/31/9999 71101 26 X-RAY EXAM UNILAT RIBS/CHEST $ 11.41 $ 11.41 3/1/2020 12/31/9999 71101 TC X-RAY EXAM UNILAT RIBS/CHEST $ 20.49 $ 20.49 3/1/2020 12/31/9999 71101 X-RAY EXAM UNILAT RIBS/CHEST $ 31.90 $ 31.90 3/1/2020 12/31/9999 71110 26 X-RAY EXAM RIBS BIL 3 VIEWS $ 11.41 $ 11.41 3/1/2020 12/31/9999 71110 TC X-RAY EXAM RIBS BIL 3 VIEWS $ 21.57 $ 21.57 3/1/2020 12/31/9999 71110 X-RAY EXAM RIBS BIL 3 VIEWS $ 32.99 $ 32.99 3/1/2020 12/31/9999 71111 26 X-RAY EXAM RIBS/CHEST4/> VWS $ 13.60 $ 13.60 3/1/2020 12/31/9999 71111 TC X-RAY EXAM RIBS/CHEST4/> VWS $ 28.53 $ 28.53 3/1/2020 12/31/9999 71111 X-RAY EXAM RIBS/CHEST4/> VWS $ 42.13 $ 42.13 3/1/2020 12/31/9999 71120 26 X-RAY EXAM BREASTBONE 2/>VWS $ 8.61 $ 8.61 3/1/2020 12/31/9999 71120 TC X-RAY EXAM BREASTBONE 2/>VWS $ 17.84 $ 17.84 3/1/2020 12/31/9999 71120 X-RAY EXAM BREASTBONE 2/>VWS $ 26.45 $ 26.45 3/1/2020 12/31/9999 71130 26 X-RAY STRENOCLAVIC JT 3/>VWS $ 9.53 $ 9.53 3/1/2020 12/31/9999 71130 TC X-RAY STRENOCLAVIC JT 3/>VWS $ 20.78 $ 20.78 3/1/2020 12/31/9999 71130 X-RAY STRENOCLAVIC JT 3/>VWS $ 30.32 $ 30.32 3/1/2020 12/31/9999 71250 26 CT THORAX W/O DYE $ 50.47 $ 50.47 3/1/2020 12/31/9999 71250 TC CT THORAX W/O DYE $ 181.02 $ 181.02 3/1/2020 12/31/9999 71250 CT THORAX W/O DYE $ 231.49 $ 231.49 3/1/2020 12/31/9999 71260 26 CT THORAX W/DYE $ 53.90 $ 53.90 3/1/2020 12/31/9999 71260 TC CT THORAX W/DYE $ 223.64 $ 223.64 3/1/2020 12/31/9999 71260 CT THORAX W/DYE $ 277.55 $ 277.55 3/1/2020 12/31/9999 71270 26 CT THORAX W/O & W/DYE $ 60.01 $ 60.01 3/1/2020 12/31/9999 71270 TC CT THORAX W/O & W/DYE $ 282.44 $ 282.44 3/1/2020 12/31/9999 71270 CT THORAX W/O & W/DYE $ 342.46 $ 342.46 3/1/2020 12/31/9999 71275 26 CT ANGIOGRAPHY CHEST $ 83.94 $ 83.94 3/1/2020 12/31/9999 71275 TC CT ANGIOGRAPHY CHEST $ 338.91 $ 338.91 3/1/2020 12/31/9999 71275 CT ANGIOGRAPHY CHEST $ 422.85 $ 422.85 3/1/2020 12/31/9999 71550 26 MRI CHEST W/O DYE $ 63.15 $ 63.15 3/1/2020 12/31/9999 71550 TC MRI CHEST W/O DYE $ 435.58 $ 435.58 3/1/2020 12/31/9999 71550 MRI CHEST W/O DYE $ 498.72 $ 498.72 3/1/2020 12/31/9999 71551 26 MRI CHEST W/DYE $ 74.76 $ 74.76 3/1/2020 12/31/9999 71551 TC MRI CHEST W/DYE $ 484.88 $ 484.88 3/1/2020 12/31/9999 71551 MRI CHEST W/DYE $ 559.64 $ 559.64 3/1/2020 12/31/9999 71552 26 MRI CHEST W/O & W/DYE $ 98.75 $ 98.75 3/1/2020 12/31/9999 71552 TC MRI CHEST W/O & W/DYE $ 668.75 $ 668.75 3/1/2020 12/31/9999 71552 MRI CHEST W/O & W/DYE $ 767.50 $ 767.50 3/1/2020 12/31/9999 71555 26 MRI ANGIO CHEST W OR W/O DYE $ 79.36 $ 79.36 3/1/2020 12/31/9999 71555 TC MRI ANGIO CHEST W OR W/O DYE $ 411.66 $ 411.66 3/1/2020 12/31/9999 71555 MRI ANGIO CHEST W OR W/O DYE $ 491.03 $ 491.03 3/1/2020 12/31/9999 72020 26 X-RAY EXAM OF SPINE 1 VIEW $ 6.73 $ 6.73 3/1/2020 12/31/9999 72020 TC X-RAY EXAM OF SPINE 1 VIEW $ 12.44 $ 12.44 3/1/2020 12/31/9999 72020 X-RAY EXAM OF SPINE 1 VIEW $ 19.18 $ 19.18 3/1/2020 12/31/9999 72040 26 X-RAY EXAM NECK SPINE 2-3 VW $ 9.53 $ 9.53 3/1/2020 12/31/9999 72040 TC X-RAY EXAM NECK SPINE 2-3 VW $ 20.20 $ 20.20 3/1/2020 12/31/9999 72040 X-RAY EXAM NECK SPINE 2-3 VW $ 29.73 $ 29.73 3/1/2020 12/31/9999 72050 26 X-RAY EXAM NECK SPINE 4/5VWS $ 13.28 $ 13.28 3/1/2020 12/31/9999 72050 TC X-RAY EXAM NECK SPINE 4/5VWS $ 28.82 $ 28.82 3/1/2020 12/31/9999 72050 X-RAY EXAM NECK SPINE 4/5VWS $ 42.09 $ 42.09 3/1/2020 12/31/9999 72052 26 X-RAY EXAM NECK SPINE 6/>VWS $ 15.66 $ 15.66 3/1/2020 12/31/9999 72052 TC X-RAY EXAM NECK SPINE 6/>VWS $ 37.04 $ 37.04 3/1/2020 12/31/9999 72052 X-RAY EXAM NECK SPINE 6/>VWS $ 52.70 $ 52.70 3/1/2020 12/31/9999 72070 26 X-RAY EXAM THORAC SPINE 2VWS $ 9.53 $ 9.53 3/1/2020 12/31/9999 72070 TC X-RAY EXAM THORAC SPINE 2VWS $ 17.84 $ 17.84 3/1/2020 12/31/9999 72070 X-RAY EXAM THORAC SPINE 2VWS $ 27.37 $ 27.37 3/1/2020 12/31/9999 72072 26 X-RAY EXAM THORAC SPINE 3VWS $ 9.53 $ 9.53 3/1/2020 12/31/9999 72072 TC X-RAY EXAM THORAC SPINE 3VWS $ 21.57 $ 21.57 3/1/2020 12/31/9999 72072 X-RAY EXAM THORAC SPINE 3VWS $ 31.10 $ 31.10 3/1/2020 12/31/9999 72074 26 X-RAY EXAM THORAC SPINE4/>VW $ 9.53 $ 9.53 3/1/2020 12/31/9999 72074 TC X-RAY EXAM THORAC SPINE4/>VW $ 26.76 $ 26.76 3/1/2020 12/31/9999 72074 X-RAY EXAM THORAC SPINE4/>VW $ 36.30 $ 36.30 3/1/2020 12/31/9999 72080 26 X-RAY EXAM THORACOLMB 2/> VW $ 9.53 $ 9.53 3/1/2020 12/31/9999 72080 TC X-RAY EXAM THORACOLMB 2/> VW $ 19.02 $ 19.02 3/1/2020 12/31/9999 72080 X-RAY EXAM THORACOLMB 2/> VW $ 28.56 $ 28.56 3/1/2020 12/31/9999 72081 26 X-RAY EXAM ENTIRE SPI 1 VW $ 11.92 $ 11.92 3/1/2020 12/31/9999 72081 TC X-RAY EXAM ENTIRE SPI 1 VW $ 21.32 $ 21.32 3/1/2020 12/31/9999 72081 X-RAY EXAM ENTIRE SPI 1 VW $ 33.23 $ 33.23 3/1/2020 12/31/9999 72082 26 X-RAY EXAM ENTIRE SPI 2/3 VW $ 14.44 $ 14.44 3/1/2020 12/31/9999 72082 TC X-RAY EXAM ENTIRE SPI 2/3 VW $ 38.77 $ 38.77 3/1/2020 12/31/9999 72082 X-RAY EXAM ENTIRE SPI 2/3 VW $ 53.20 $ 53.20 3/1/2020 12/31/9999 72083 26 X-RAY EXAM ENTIRE SPI 4/5 VW $ 15.73 $ 15.73 3/1/2020 12/31/9999 72083 TC X-RAY EXAM ENTIRE SPI 4/5 VW $ 42.07 $ 42.07 3/1/2020 12/31/9999 72083 X-RAY EXAM ENTIRE SPI 4/5 VW $ 57.80 $ 57.80 3/1/2020 12/31/9999 72084 26 X-RAY EXAM ENTIRE SPI 6/> VW $ 18.27 $ 18.27 3/1/2020 12/31/9999 72084 TC X-RAY EXAM ENTIRE SPI 6/> VW $ 50.49 $ 50.49 3/1/2020 12/31/9999 72084 X-RAY EXAM ENTIRE SPI 6/> VW $ 68.78 $ 68.78 3/1/2020 12/31/9999 72100 26 X-RAY EXAM L-S SPINE 2/3 VWS $ 9.53 $ 9.53 3/1/2020 12/31/9999 72100 TC X-RAY EXAM L-S SPINE 2/3 VWS $ 21.66 $ 21.66 3/1/2020 12/31/9999 72100 X-RAY EXAM L-S SPINE 2/3 VWS $ 31.20 $ 31.20 3/1/2020 12/31/9999 72110 26 X-RAY EXAM L-2 SPINE 4/>VWS $ 13.28 $ 13.28 3/1/2020 12/31/9999 72110 TC X-RAY EXAM L-2 SPINE 4/>VWS $ 30.29 $ 30.29 3/1/2020 12/31/9999 72110 X-RAY EXAM L-2 SPINE 4/>VWS $ 43.58 $ 43.58 3/1/2020 12/31/9999 72114 26 X-RAY EXAM L-S SPINE BENDING $ 15.66 $ 15.66 3/1/2020 12/31/9999 72114 TC X-RAY EXAM L-S SPINE BENDING $ 41.16 $ 41.16 3/1/2020 12/31/9999 72114 X-RAY EXAM L-S SPINE BENDING $ 56.82 $ 56.82 3/1/2020 12/31/9999 72120 26 X-RAY BEND ONLY L-S SPINE $ 9.53 $ 9.53 3/1/2020 12/31/9999 72120 TC X-RAY BEND ONLY L-S SPINE $ 29.40 $ 29.40 3/1/2020 12/31/9999 72120 X-RAY BEND ONLY L-S SPINE $ 38.94 $ 38.94 3/1/2020 12/31/9999 72125 26 CT NECK SPINE W/O DYE $ 50.47 $ 50.47 3/1/2020 12/31/9999 72125 TC CT NECK SPINE W/O DYE $ 181.61 $ 181.61 3/1/2020 12/31/9999 72125 CT NECK SPINE W/O DYE $ 232.07 $ 232.07 3/1/2020 12/31/9999 72126 26 CT NECK SPINE W/DYE $ 52.97 $ 52.97 3/1/2020 12/31/9999 72126 TC CT NECK SPINE W/DYE $ 223.93 $ 223.93 3/1/2020 12/31/9999 72126 CT NECK SPINE W/DYE $ 276.91 $ 276.91 3/1/2020 12/31/9999 72127 26 CT NECK SPINE W/O & W/DYE $ 55.05 $ 55.05 3/1/2020 12/31/9999 72127 TC CT NECK SPINE W/O & W/DYE $ 281.86 $ 281.86 3/1/2020 12/31/9999 72127 CT NECK SPINE W/O & W/DYE $ 336.91 $ 336.91 3/1/2020 12/31/9999 72128 26 CT CHEST SPINE W/O DYE $ 50.47 $ 50.47 3/1/2020 12/31/9999 72128 TC CT CHEST SPINE W/O DYE $ 181.02 $ 181.02 3/1/2020 12/31/9999 72128 CT CHEST SPINE W/O DYE $ 231.49 $ 231.49 3/1/2020 12/31/9999 72129 26 CT CHEST SPINE W/DYE $ 53.27 $ 53.27 3/1/2020 12/31/9999 72129 TC CT CHEST SPINE W/DYE $ 223.93 $ 223.93 3/1/2020 12/31/9999 72129 CT CHEST SPINE W/DYE $ 277.20 $ 277.20 3/1/2020 12/31/9999 72130 26 CT CHEST SPINE W/O & W/DYE $ 55.35 $ 55.35 3/1/2020 12/31/9999 72130 TC CT CHEST SPINE W/O & W/DYE $ 282.44 $ 282.44 3/1/2020 12/31/9999 72130 CT CHEST SPINE W/O & W/DYE $ 337.80 $ 337.80 3/1/2020 12/31/9999 72131 26 CT LUMBAR SPINE W/O DYE $ 50.47 $ 50.47 3/1/2020 12/31/9999 72131 TC CT LUMBAR SPINE W/O DYE $ 180.73 $ 180.73 3/1/2020 12/31/9999 72131 CT LUMBAR SPINE W/O DYE $ 231.20 $ 231.20 3/1/2020 12/31/9999 72132 26 CT LUMBAR SPINE W/DYE $ 53.27 $ 53.27 3/1/2020 12/31/9999 72132 TC CT LUMBAR SPINE W/DYE $ 223.64 $ 223.64 3/1/2020 12/31/9999 72132 CT LUMBAR SPINE W/DYE $ 276.91 $ 276.91 3/1/2020 12/31/9999 72133 26 CT LUMBAR SPINE W/O & W/DYE $ 55.35 $ 55.35 3/1/2020 12/31/9999 72133 TC CT LUMBAR SPINE W/O & W/DYE $ 282.16 $ 282.16 3/1/2020 12/31/9999 72133 CT LUMBAR SPINE W/O & W/DYE $ 337.50 $ 337.50 3/1/2020 12/31/9999 72141 26 MRI NECK SPINE W/O DYE $ 69.26 $ 69.26 3/1/2020 12/31/9999 72141 TC MRI NECK SPINE W/O DYE $ 353.22 $ 353.22 3/1/2020 12/31/9999 72141 MRI NECK SPINE W/O DYE $ 422.48 $ 422.48 3/1/2020 12/31/9999 72142 26 MRI NECK SPINE W/DYE $ 83.35 $ 83.35 3/1/2020 12/31/9999 72142 TC MRI NECK SPINE W/DYE $ 437.97 $ 437.97 3/1/2020 12/31/9999 72142 MRI NECK SPINE W/DYE $ 521.31 $ 521.31 3/1/2020 12/31/9999 72146 26 MRI CHEST SPINE W/O DYE $ 69.55 $ 69.55 3/1/2020 12/31/9999 72146 TC MRI CHEST SPINE W/O DYE $ 363.62 $ 363.62 3/1/2020 12/31/9999 72146 MRI CHEST SPINE W/O DYE $ 433.18 $ 433.18 3/1/2020 12/31/9999 72147 26 MRI CHEST SPINE W/DYE $ 83.64 $ 83.64 3/1/2020 12/31/9999 72147 TC MRI CHEST SPINE W/DYE $ 393.32 $ 393.32 3/1/2020 12/31/9999 72147 MRI CHEST SPINE W/DYE $ 476.96 $ 476.96 3/1/2020 12/31/9999 72148 26 MRI LUMBAR SPINE W/O DYE $ 64.27 $ 64.27 3/1/2020 12/31/9999 72148 TC MRI LUMBAR SPINE W/O DYE $ 363.33 $ 363.33 3/1/2020 12/31/9999 72148 MRI LUMBAR SPINE W/O DYE $ 427.60 $ 427.60 3/1/2020 12/31/9999 72149 26 MRI LUMBAR SPINE W/DYE $ 77.52 $ 77.52 3/1/2020 12/31/9999 72149 TC MRI LUMBAR SPINE W/DYE $ 437.68 $ 437.68 3/1/2020 12/31/9999 72149 MRI LUMBAR SPINE W/DYE $ 515.19 $ 515.19 3/1/2020 12/31/9999 72156 26 MRI NECK SPINE W/O & W/DYE $ 111.45 $ 111.45 3/1/2020 12/31/9999 72156 TC MRI NECK SPINE W/O & W/DYE $ 576.27 $ 576.27 3/1/2020 12/31/9999 72156 MRI NECK SPINE W/O & W/DYE $ 687.71 $ 687.71 3/1/2020 12/31/9999 72157 26 MRI CHEST SPINE W/O & W/DYE $ 111.74 $ 111.74 3/1/2020 12/31/9999 72157 TC MRI CHEST SPINE W/O & W/DYE $ 541.91 $ 541.91 3/1/2020 12/31/9999 72157 MRI CHEST SPINE W/O & W/DYE $ 653.64 $ 653.64 3/1/2020 12/31/9999 72158 26 MRI LUMBAR SPINE W/O & W/DYE $ 102.22 $ 102.22 3/1/2020 12/31/9999 72158 TC MRI LUMBAR SPINE W/O & W/DYE $ 575.97 $ 575.97 3/1/2020 12/31/9999 72158 MRI LUMBAR SPINE W/O & W/DYE $ 678.18 $ 678.18 3/1/2020 12/31/9999 72159 26 MR ANGIO SPINE W/O&W/DYE $ 77.68 $ 77.68 3/1/2020 12/31/9999 72159 TC MR ANGIO SPINE W/O&W/DYE $ 448.52 $ 448.52 3/1/2020 12/31/9999 72159 MR ANGIO SPINE W/O&W/DYE $ 526.20 $ 526.20 3/1/2020 12/31/9999 72170 26 X-RAY EXAM OF PELVIS $ 7.36 $ 7.36 3/1/2020 12/31/9999 72170 TC X-RAY EXAM OF PELVIS $ 13.63 $ 13.63 3/1/2020 12/31/9999 72170 X-RAY EXAM OF PELVIS $ 20.98 $ 20.98 3/1/2020 12/31/9999 72190 26 X-RAY EXAM OF PELVIS $ 9.22 $ 9.22 3/1/2020 12/31/9999 72190 TC X-RAY EXAM OF PELVIS $ 22.54 $ 22.54 3/1/2020 12/31/9999 72190 X-RAY EXAM OF PELVIS $ 31.76 $ 31.76 3/1/2020 12/31/9999 72191 26 CT ANGIOGRAPH PELV W/O&W/DYE $ 79.07 $ 79.07 3/1/2020 12/31/9999 72191 TC CT ANGIOGRAPH PELV W/O&W/DYE $ 328.34 $ 328.34 3/1/2020 12/31/9999 72191 CT ANGIOGRAPH PELV W/O&W/DYE $ 407.39 $ 407.39 3/1/2020 12/31/9999 72192 26 CT PELVIS W/O DYE $ 47.67 $ 47.67 3/1/2020 12/31/9999 72192 TC CT PELVIS W/O DYE $ 172.50 $ 172.50 3/1/2020 12/31/9999 72192 CT PELVIS W/O DYE $ 220.16 $ 220.16 3/1/2020 12/31/9999 72193 26 CT PELVIS W/DYE $ 50.47 $ 50.47 3/1/2020 12/31/9999 72193 TC CT PELVIS W/DYE $ 212.88 $ 212.88 3/1/2020 12/31/9999 72193 CT PELVIS W/DYE $ 263.35 $ 263.35 3/1/2020 12/31/9999 72194 26 CT PELVIS W/O & W/DYE $ 52.97 $ 52.97 3/1/2020 12/31/9999 72194 TC CT PELVIS W/O & W/DYE $ 282.43 $ 282.43 3/1/2020 12/31/9999 72194 CT PELVIS W/O & W/DYE $ 335.39 $ 335.39 3/1/2020 12/31/9999 72195 26 MRI PELVIS W/O DYE $ 63.15 $ 63.15 3/1/2020 12/31/9999 72195 TC MRI PELVIS W/O DYE $ 393.87 $ 393.87 3/1/2020 12/31/9999 72195 MRI PELVIS W/O DYE $ 457.01 $ 457.01 3/1/2020 12/31/9999 72196 26 MRI PELVIS W/DYE $ 75.35 $ 75.35 3/1/2020 12/31/9999 72196 TC MRI PELVIS W/DYE $ 431.40 $ 431.40 3/1/2020 12/31/9999 72196 MRI PELVIS W/DYE $ 506.75 $ 506.75 3/1/2020 12/31/9999 72197 26 MRI PELVIS W/O & W/DYE $ 98.16 $ 98.16 3/1/2020 12/31/9999 72197 TC MRI PELVIS W/O & W/DYE $ 596.02 $ 596.02 3/1/2020 12/31/9999 72197 MRI PELVIS W/O & W/DYE $ 694.19 $ 694.19 3/1/2020 12/31/9999 72198 26 MR ANGIO PELVIS W/O & W/DYE $ 78.46 $ 78.46 3/1/2020 12/31/9999 72198 TC MR ANGIO PELVIS W/O & W/DYE $ 409.61 $ 409.61 3/1/2020 12/31/9999 72198 MR ANGIO PELVIS W/O & W/DYE $ 488.06 $ 488.06 3/1/2020 12/31/9999 72200 26 X-RAY EXAM SI JOINTS $ 7.36 $ 7.36 3/1/2020 12/31/9999 72200 TC X-RAY EXAM SI JOINTS $ 15.97 $ 15.97 3/1/2020 12/31/9999 72200 X-RAY EXAM SI JOINTS $ 23.33 $ 23.33 3/1/2020 12/31/9999 72202 26 X-RAY EXAM SI JOINTS 3/> VWS $ 8.30 $ 8.30 3/1/2020 12/31/9999 72202 TC X-RAY EXAM SI JOINTS 3/> VWS $ 19.90 $ 19.90 3/1/2020 12/31/9999 72202 X-RAY EXAM SI JOINTS 3/> VWS $ 28.19 $ 28.19 3/1/2020 12/31/9999 72220 26 X-RAY EXAM SACRUM TAILBONE $ 7.36 $ 7.36 3/1/2020 12/31/9999 72220 TC X-RAY EXAM SACRUM TAILBONE $ 16.38 $ 16.38 3/1/2020 12/31/9999 72220 X-RAY EXAM SACRUM TAILBONE $ 23.74 $ 23.74 3/1/2020 12/31/9999 72240 26 MYELOGRAPHY NECK SPINE $ 39.40 $ 39.40 3/1/2020 12/31/9999 72240 TC MYELOGRAPHY NECK SPINE $ 89.04 $ 89.04 3/1/2020 12/31/9999 72240 MYELOGRAPHY NECK SPINE $ 128.45 $ 128.45 3/1/2020 12/31/9999 72255 26 MYELOGRAPHY THORACIC SPINE $ 38.52 $ 38.52 3/1/2020 12/31/9999 72255 TC MYELOGRAPHY THORACIC SPINE $ 79.03 $ 79.03 3/1/2020 12/31/9999 72255 MYELOGRAPHY THORACIC SPINE $ 117.56 $ 117.56 3/1/2020 12/31/9999 72265 26 MYELOGRAPHY L-S SPINE $ 35.98 $ 35.98 3/1/2020 12/31/9999 72265 TC MYELOGRAPHY L-S SPINE $ 83.44 $ 83.44 3/1/2020 12/31/9999 72265 MYELOGRAPHY L-S SPINE $ 119.42 $ 119.42 3/1/2020 12/31/9999 72270 26 MYELOGPHY 2/> SPINE REGIONS $ 57.83 $ 57.83 3/1/2020 12/31/9999 72270 TC MYELOGPHY 2/> SPINE REGIONS $ 128.55 $ 128.55 3/1/2020 12/31/9999 72270 MYELOGPHY 2/> SPINE REGIONS $ 186.39 $ 186.39 3/1/2020 12/31/9999 72275 26 EPIDUROGRAPHY $ 31.10 $ 31.10 3/1/2020 12/31/9999 72275 TC EPIDUROGRAPHY $ 53.49 $ 53.49 3/1/2020 12/31/9999 72275 EPIDUROGRAPHY $ 84.60 $ 84.60 3/1/2020 12/31/9999 72285 26 DISCOGRAPHY CERV/THOR SPINE $ 48.24 $ 48.24 3/1/2020 12/31/9999 72285 TC DISCOGRAPHY CERV/THOR SPINE $ 95.60 $ 95.60 3/1/2020 12/31/9999 72285 DISCOGRAPHY CERV/THOR SPINE $ 143.84 $ 143.84 3/1/2020 12/31/9999 72295 26 X-RAY OF LOWER SPINE DISK $ 35.20 $ 35.20 3/1/2020 12/31/9999 72295 TC X-RAY OF LOWER SPINE DISK $ 92.36 $ 92.36 3/1/2020 12/31/9999 72295 X-RAY OF LOWER SPINE DISK $ 127.55 $ 127.55 3/1/2020 12/31/9999 73000 26 X-RAY EXAM OF COLLAR BONE $ 7.05 $ 7.05 3/1/2020 12/31/9999 73000 TC X-RAY EXAM OF COLLAR BONE $ 15.09 $ 15.09 3/1/2020 12/31/9999 73000 X-RAY EXAM OF COLLAR BONE $ 22.13 $ 22.13 3/1/2020 12/31/9999 73010 26 X-RAY EXAM OF SHOULDER BLADE $ 7.36 $ 7.36 3/1/2020 12/31/9999 73010 TC X-RAY EXAM OF SHOULDER BLADE $ 15.39 $ 15.39 3/1/2020 12/31/9999 73010 X-RAY EXAM OF SHOULDER BLADE $ 22.74 $ 22.74 3/1/2020 12/31/9999 73020 26 X-RAY EXAM OF SHOULDER $ 6.44 $ 6.44 3/1/2020 12/31/9999 73020 TC X-RAY EXAM OF SHOULDER $ 12.44 $ 12.44 3/1/2020 12/31/9999 73020 X-RAY EXAM OF SHOULDER $ 18.88 $ 18.88 3/1/2020 12/31/9999 73030 26 X-RAY EXAM OF SHOULDER $ 7.98 $ 7.98 3/1/2020 12/31/9999 73030 TC X-RAY EXAM OF SHOULDER $ 16.09 $ 16.09 3/1/2020 12/31/9999 73030 X-RAY EXAM OF SHOULDER $ 24.05 $ 24.05 3/1/2020 12/31/9999 73040 26 CONTRAST X-RAY OF SHOULDER $ 23.43 $ 23.43 3/1/2020 12/31/9999 73040 TC CONTRAST X-RAY OF SHOULDER $ 62.64 $ 62.64 3/1/2020 12/31/9999 73040 CONTRAST X-RAY OF SHOULDER $ 86.06 $ 86.06 3/1/2020 12/31/9999 73050 26 X-RAY EXAM OF SHOULDERS $ 8.91 $ 8.91 3/1/2020 12/31/9999 73050 TC X-RAY EXAM OF SHOULDERS $ 19.90 $ 19.90 3/1/2020 12/31/9999 73050 X-RAY EXAM OF SHOULDERS $ 28.80 $ 28.80 3/1/2020 12/31/9999 73060 26 X-RAY EXAM OF HUMERUS $ 7.36 $ 7.36 3/1/2020 12/31/9999 73060 TC X-RAY EXAM OF HUMERUS $ 16.09 $ 16.09 3/1/2020 12/31/9999 73060 X-RAY EXAM OF HUMERUS $ 23.44 $ 23.44 3/1/2020 12/31/9999 73070 26 X-RAY EXAM OF ELBOW $ 6.44 $ 6.44 3/1/2020 12/31/9999 73070 TC X-RAY EXAM OF ELBOW $ 15.09 $ 15.09 3/1/2020 12/31/9999 73070 X-RAY EXAM OF ELBOW $ 21.53 $ 21.53 3/1/2020 12/31/9999 73080 26 X-RAY EXAM OF ELBOW $ 7.36 $ 7.36 3/1/2020 12/31/9999 73080 TC X-RAY EXAM OF ELBOW $ 20.20 $ 20.20 3/1/2020 12/31/9999 73080 X-RAY EXAM OF ELBOW $ 27.55 $ 27.55 3/1/2020 12/31/9999 73085 26 CONTRAST X-RAY OF ELBOW $ 23.13 $ 23.13 3/1/2020 12/31/9999 73085 TC CONTRAST X-RAY OF ELBOW $ 54.71 $ 54.71 3/1/2020 12/31/9999 73085 CONTRAST X-RAY OF ELBOW $ 77.84 $ 77.84 3/1/2020 12/31/9999 73090 26 X-RAY EXAM OF FOREARM $ 6.74 $ 6.74 3/1/2020 12/31/9999 73090 TC X-RAY EXAM OF FOREARM $ 15.09 $ 15.09 3/1/2020 12/31/9999 73090 X-RAY EXAM OF FOREARM $ 21.85 $ 21.85 3/1/2020 12/31/9999 73092 26 X-RAY EXAM OF ARM INFANT $ 6.74 $ 6.74 3/1/2020 12/31/9999 73092 TC X-RAY EXAM OF ARM INFANT $ 15.69 $ 15.69 3/1/2020 12/31/9999 73092 X-RAY EXAM OF ARM INFANT $ 22.43 $ 22.43 3/1/2020 12/31/9999 73100 26 X-RAY EXAM OF WRIST $ 7.05 $ 7.05 3/1/2020 12/31/9999 73100 TC X-RAY EXAM OF WRIST $ 15.69 $ 15.69 3/1/2020 12/31/9999 73100 X-RAY EXAM OF WRIST $ 22.72 $ 22.72 3/1/2020 12/31/9999 73110 26 X-RAY EXAM OF WRIST $ 7.36 $ 7.36 3/1/2020 12/31/9999 73110 TC X-RAY EXAM OF WRIST $ 19.79 $ 19.79 3/1/2020 12/31/9999 73110 X-RAY EXAM OF WRIST $ 27.15 $ 27.15 3/1/2020 12/31/9999 73115 26 CONTRAST X-RAY OF WRIST $ 23.43 $ 23.43 3/1/2020 12/31/9999 73115 TC CONTRAST X-RAY OF WRIST $ 59.00 $ 59.00 3/1/2020 12/31/9999 73115 CONTRAST X-RAY OF WRIST $ 82.43 $ 82.43 3/1/2020 12/31/9999 73120 26 X-RAY EXAM OF HAND $ 6.74 $ 6.74 3/1/2020 12/31/9999 73120 TC X-RAY EXAM OF HAND $ 14.78 $ 14.78 3/1/2020 12/31/9999 73120 X-RAY EXAM OF HAND $ 21.56 $ 21.56 3/1/2020 12/31/9999 73130 26 X-RAY EXAM OF HAND $ 7.36 $ 7.36 3/1/2020 12/31/9999 73130 TC X-RAY EXAM OF HAND $ 17.45 $ 17.45 3/1/2020 12/31/9999 73130 X-RAY EXAM OF HAND $ 24.80 $ 24.80 3/1/2020 12/31/9999 73140 26 X-RAY EXAM OF FINGER(S) $ 5.81 $ 5.81 3/1/2020 12/31/9999 73140 TC X-RAY EXAM OF FINGER(S) $ 17.15 $ 17.15 3/1/2020 12/31/9999 73140 X-RAY EXAM OF FINGER(S) $ 22.94 $ 22.94 3/1/2020 12/31/9999 73200 26 CT UPPER EXTREMITY W/O DYE $ 47.37 $ 47.37 3/1/2020 12/31/9999 73200 TC CT UPPER EXTREMITY W/O DYE $ 172.18 $ 172.18 3/1/2020 12/31/9999 73200 CT UPPER EXTREMITY W/O DYE $ 219.54 $ 219.54 3/1/2020 12/31/9999 73201 26 CT UPPER EXTREMITY W/DYE $ 50.47 $ 50.47 3/1/2020 12/31/9999 73201 TC CT UPPER EXTREMITY W/DYE $ 212.74 $ 212.74 3/1/2020 12/31/9999 73201 CT UPPER EXTREMITY W/DYE $ 263.22 $ 263.22 3/1/2020 12/31/9999 73202 26 CT UPPR EXTREMITY W/O&W/DYE $ 52.97 $ 52.97 3/1/2020 12/31/9999 73202 TC CT UPPR EXTREMITY W/O&W/DYE $ 283.38 $ 283.38 3/1/2020 12/31/9999 73202 CT UPPR EXTREMITY W/O&W/DYE $ 336.36 $ 336.36 3/1/2020 12/31/9999 73206 26 CT ANGIO UPR EXTRM W/O&W/DYE $ 79.65 $ 79.65 3/1/2020 12/31/9999 73206 TC CT ANGIO UPR EXTRM W/O&W/DYE $ 310.71 $ 310.71 3/1/2020 12/31/9999 73206 CT ANGIO UPR EXTRM W/O&W/DYE $ 390.35 $ 390.35 3/1/2020 12/31/9999 73218 26 MRI UPPER EXTREMITY W/O DYE $ 58.18 $ 58.18 3/1/2020 12/31/9999 73218 TC MRI UPPER EXTREMITY W/O DYE $ 398.82 $ 398.82 3/1/2020 12/31/9999 73218 MRI UPPER EXTREMITY W/O DYE $ 457.01 $ 457.01 3/1/2020 12/31/9999 73219 26 MRI UPPER EXTREMITY W/DYE $ 70.18 $ 70.18 3/1/2020 12/31/9999 73219 TC MRI UPPER EXTREMITY W/DYE $ 431.87 $ 431.87 3/1/2020 12/31/9999 73219 MRI UPPER EXTREMITY W/DYE $ 502.06 $ 502.06 3/1/2020 12/31/9999 73220 26 MRI UPPR EXTREMITY W/O&W/DYE $ 93.50 $ 93.50 3/1/2020 12/31/9999 73220 TC MRI UPPR EXTREMITY W/O&W/DYE $ 596.77 $ 596.77 3/1/2020 12/31/9999 73220 MRI UPPR EXTREMITY W/O&W/DYE $ 690.26 $ 690.26 3/1/2020 12/31/9999 73221 26 MRI JOINT UPR EXTREM W/O DYE $ 58.47 $ 58.47 3/1/2020 12/31/9999 73221 TC MRI JOINT UPR EXTREM W/O DYE $ 374.16 $ 374.16 3/1/2020 12/31/9999 73221 MRI JOINT UPR EXTREM W/O DYE $ 432.63 $ 432.63 3/1/2020 12/31/9999 73222 26 MRI JOINT UPR EXTREM W/DYE $ 70.18 $ 70.18 3/1/2020 12/31/9999 73222 TC MRI JOINT UPR EXTREM W/DYE $ 407.20 $ 407.20 3/1/2020 12/31/9999 73222 MRI JOINT UPR EXTREM W/DYE $ 477.38 $ 477.38 3/1/2020 12/31/9999 73223 26 MRI JOINT UPR EXTR W/O&W/DYE $ 93.20 $ 93.20 3/1/2020 12/31/9999 73223 TC MRI JOINT UPR EXTR W/O&W/DYE $ 567.11 $ 567.11 3/1/2020 12/31/9999 73223 MRI JOINT UPR EXTR W/O&W/DYE $ 660.30 $ 660.30 3/1/2020 12/31/9999 73225 26 MR ANGIO UPR EXTR W/O&W/DYE $ 74.57 $ 74.57 3/1/2020 12/31/9999 73225 TC MR ANGIO UPR EXTR W/O&W/DYE $ 438.41 $ 438.41 3/1/2020 12/31/9999 73225 MR ANGIO UPR EXTR W/O&W/DYE $ 512.96 $ 512.96 3/1/2020 12/31/9999 73501 26 X-RAY EXAM HIP UNI 1 VIEW $ 8.48 $ 8.48 3/1/2020 12/31/9999 73501 TC X-RAY EXAM HIP UNI 1 VIEW $ 17.09 $ 17.09 3/1/2020 12/31/9999 73501 X-RAY EXAM HIP UNI 1 VIEW $ 25.58 $ 25.58 3/1/2020 12/31/9999 73502 26 X-RAY EXAM HIP UNI 2-3 VIEWS $ 10.07 $ 10.07 3/1/2020 12/31/9999 73502 TC X-RAY EXAM HIP UNI 2-3 VIEWS $ 25.22 $ 25.22 3/1/2020 12/31/9999 73502 X-RAY EXAM HIP UNI 2-3 VIEWS $ 35.29 $ 35.29 3/1/2020 12/31/9999 73503 26 X-RAY EXAM HIP UNI 4/> VIEWS $ 12.84 $ 12.84 3/1/2020 12/31/9999 73503 TC X-RAY EXAM HIP UNI 4/> VIEWS $ 31.24 $ 31.24 3/1/2020 12/31/9999 73503 X-RAY EXAM HIP UNI 4/> VIEWS $ 44.08 $ 44.08 3/1/2020 12/31/9999 73521 26 X-RAY EXAM HIPS BI 2 VIEWS $ 10.37 $ 10.37 3/1/2020 12/31/9999 73521 TC X-RAY EXAM HIPS BI 2 VIEWS $ 23.72 $ 23.72 3/1/2020 12/31/9999 73521 X-RAY EXAM HIPS BI 2 VIEWS $ 34.09 $ 34.09 3/1/2020 12/31/9999 73522 26 X-RAY EXAM HIPS BI 3-4 VIEWS $ 13.49 $ 13.49 3/1/2020 12/31/9999 73522 TC X-RAY EXAM HIPS BI 3-4 VIEWS $ 28.23 $ 28.23 3/1/2020 12/31/9999 73522 X-RAY EXAM HIPS BI 3-4 VIEWS $ 41.72 $ 41.72 3/1/2020 12/31/9999 73523 26 X-RAY EXAM HIPS BI 5/> VIEWS $ 14.44 $ 14.44 3/1/2020 12/31/9999 73523 TC X-RAY EXAM HIPS BI 5/> VIEWS $ 33.95 $ 33.95 3/1/2020 12/31/9999 73523 X-RAY EXAM HIPS BI 5/> VIEWS $ 48.38 $ 48.38 3/1/2020 12/31/9999 73525 26 CONTRAST X-RAY OF HIP $ 23.63 $ 23.63 3/1/2020 12/31/9999 73525 TC CONTRAST X-RAY OF HIP $ 54.12 $ 54.12 3/1/2020 12/31/9999 73525 CONTRAST X-RAY OF HIP $ 77.74 $ 77.74 3/1/2020 12/31/9999 73551 26 X-RAY EXAM OF FEMUR 1 $ 7.53 $ 7.53 3/1/2020 12/31/9999 73551 TC X-RAY EXAM OF FEMUR 1 $ 16.19 $ 16.19 3/1/2020 12/31/9999 73551 X-RAY EXAM OF FEMUR 1 $ 23.73 $ 23.73 3/1/2020 12/31/9999 73552 26 X-RAY EXAM OF FEMUR 2/> $ 8.48 $ 8.48 3/1/2020 12/31/9999 73552 TC X-RAY EXAM OF FEMUR 2/> $ 19.20 $ 19.20 3/1/2020 12/31/9999 73552 X-RAY EXAM OF FEMUR 2/> $ 27.68 $ 27.68 3/1/2020 12/31/9999 73560 26 X-RAY EXAM OF KNEE 1 OR 2 $ 7.36 $ 7.36 3/1/2020 12/31/9999 73560 TC X-RAY EXAM OF KNEE 1 OR 2 $ 15.39 $ 15.39 3/1/2020 12/31/9999 73560 X-RAY EXAM OF KNEE 1 OR 2 $ 22.74 $ 22.74 3/1/2020 12/31/9999 73562 26 X-RAY EXAM OF KNEE 3 $ 7.98 $ 7.98 3/1/2020 12/31/9999 73562 TC X-RAY EXAM OF KNEE 3 $ 19.31 $ 19.31 3/1/2020 12/31/9999 73562 X-RAY EXAM OF KNEE 3 $ 27.29 $ 27.29 3/1/2020 12/31/9999 73564 26 X-RAY EXAM KNEE 4 OR MORE $ 9.53 $ 9.53 3/1/2020 12/31/9999 73564 TC X-RAY EXAM KNEE 4 OR MORE $ 22.25 $ 22.25 3/1/2020 12/31/9999 73564 X-RAY EXAM KNEE 4 OR MORE $ 31.78 $ 31.78 3/1/2020 12/31/9999 73565 26 X-RAY EXAM OF KNEES $ 7.65 $ 7.65 3/1/2020 12/31/9999 73565 TC X-RAY EXAM OF KNEES $ 16.56 $ 16.56 3/1/2020 12/31/9999 73565 X-RAY EXAM OF KNEES $ 24.22 $ 24.22 3/1/2020 12/31/9999 73580 26 CONTRAST X-RAY OF KNEE JOINT $ 23.63 $ 23.63 3/1/2020 12/31/9999 73580 TC CONTRAST X-RAY OF KNEE JOINT $ 73.03 $ 73.03 3/1/2020 12/31/9999 73580 CONTRAST X-RAY OF KNEE JOINT $ 96.64 $ 96.64 3/1/2020 12/31/9999 73590 26 X-RAY EXAM OF LOWER LEG $ 7.36 $ 7.36 3/1/2020 12/31/9999 73590 TC X-RAY EXAM OF LOWER LEG $ 14.50 $ 14.50 3/1/2020 12/31/9999 73590 X-RAY EXAM OF LOWER LEG $ 21.87 $ 21.87 3/1/2020 12/31/9999 73592 26 X-RAY EXAM OF LEG INFANT $ 6.74 $ 6.74 3/1/2020 12/31/9999 73592 TC X-RAY EXAM OF LEG INFANT $ 15.69 $ 15.69 3/1/2020 12/31/9999 73592 X-RAY EXAM OF LEG INFANT $ 22.43 $ 22.43 3/1/2020 12/31/9999 73600 26 X-RAY EXAM OF ANKLE $ 6.74 $ 6.74 3/1/2020 12/31/9999 73600 TC X-RAY EXAM OF ANKLE $ 14.78 $ 14.78 3/1/2020 12/31/9999 73600 X-RAY EXAM OF ANKLE $ 21.56 $ 21.56 3/1/2020 12/31/9999 73610 26 X-RAY EXAM OF ANKLE $ 7.36 $ 7.36 3/1/2020 12/31/9999 73610 TC X-RAY EXAM OF ANKLE $ 17.45 $ 17.45 3/1/2020 12/31/9999 73610 X-RAY EXAM OF ANKLE $ 24.80 $ 24.80 3/1/2020 12/31/9999 73615 26 CONTRAST X-RAY OF ANKLE $ 23.33 $ 23.33 3/1/2020 12/31/9999 73615 TC CONTRAST X-RAY OF ANKLE $ 56.47 $ 56.47 3/1/2020 12/31/9999 73615 CONTRAST X-RAY OF ANKLE $ 79.80 $ 79.80 3/1/2020 12/31/9999 73620 26 X-RAY EXAM OF FOOT $ 6.74 $ 6.74 3/1/2020 12/31/9999 73620 TC X-RAY EXAM OF FOOT $ 14.21 $ 14.21 3/1/2020 12/31/9999 73620 X-RAY EXAM OF FOOT $ 20.96 $ 20.96 3/1/2020 12/31/9999 73630 26 X-RAY EXAM OF FOOT $ 7.36 $ 7.36 3/1/2020 12/31/9999 73630 TC X-RAY EXAM OF FOOT $ 17.15 $ 17.15 3/1/2020 12/31/9999 73630 X-RAY EXAM OF FOOT $ 24.51 $ 24.51 3/1/2020 12/31/9999 73650 26 X-RAY EXAM OF HEEL $ 6.74 $ 6.74 3/1/2020 12/31/9999 73650 TC X-RAY EXAM OF HEEL $ 14.50 $ 14.50 3/1/2020 12/31/9999 73650 X-RAY EXAM OF HEEL $ 21.25 $ 21.25 3/1/2020 12/31/9999 73660 26 X-RAY EXAM OF TOE(S) $ 5.51 $ 5.51 3/1/2020 12/31/9999 73660 TC X-RAY EXAM OF TOE(S) $ 16.26 $ 16.26 3/1/2020 12/31/9999 73660 X-RAY EXAM OF TOE(S) $ 21.78 $ 21.78 3/1/2020 12/31/9999 73700 26 CT LOWER EXTREMITY W/O DYE $ 47.37 $ 47.37 3/1/2020 12/31/9999 73700 TC CT LOWER EXTREMITY W/O DYE $ 172.46 $ 172.46 3/1/2020 12/31/9999 73700 CT LOWER EXTREMITY W/O DYE $ 219.83 $ 219.83 3/1/2020 12/31/9999 73701 26 CT LOWER EXTREMITY W/DYE $ 50.77 $ 50.77 3/1/2020 12/31/9999 73701 TC CT LOWER EXTREMITY W/DYE $ 214.21 $ 214.21 3/1/2020 12/31/9999 73701 CT LOWER EXTREMITY W/DYE $ 264.98 $ 264.98 3/1/2020 12/31/9999 73702 26 CT LWR EXTREMITY W/O&W/DYE $ 53.27 $ 53.27 3/1/2020 12/31/9999 73702 TC CT LWR EXTREMITY W/O&W/DYE $ 283.97 $ 283.97 3/1/2020 12/31/9999 73702 CT LWR EXTREMITY W/O&W/DYE $ 337.24 $ 337.24 3/1/2020 12/31/9999 73706 26 CT ANGIO LWR EXTR W/O&W/DYE $ 83.69 $ 83.69 3/1/2020 12/31/9999 73706 TC CT ANGIO LWR EXTR W/O&W/DYE $ 340.37 $ 340.37 3/1/2020 12/31/9999 73706 CT ANGIO LWR EXTR W/O&W/DYE $ 424.05 $ 424.05 3/1/2020 12/31/9999 73718 26 MRI LOWER EXTREMITY W/O DYE $ 58.47 $ 58.47 3/1/2020 12/31/9999 73718 TC MRI LOWER EXTREMITY W/O DYE $ 390.60 $ 390.60 3/1/2020 12/31/9999 73718 MRI LOWER EXTREMITY W/O DYE $ 449.07 $ 449.07 3/1/2020 12/31/9999 73719 26 MRI LOWER EXTREMITY W/DYE $ 70.18 $ 70.18 3/1/2020 12/31/9999 73719 TC MRI LOWER EXTREMITY W/DYE $ 426.58 $ 426.58 3/1/2020 12/31/9999 73719 MRI LOWER EXTREMITY W/DYE $ 496.77 $ 496.77 3/1/2020 12/31/9999 73720 26 MRI LWR EXTREMITY W/O&W/DYE $ 93.50 $ 93.50 3/1/2020 12/31/9999 73720 TC MRI LWR EXTREMITY W/O&W/DYE $ 596.47 $ 596.47 3/1/2020 12/31/9999 73720 MRI LWR EXTREMITY W/O&W/DYE $ 689.98 $ 689.98 3/1/2020 12/31/9999 73721 26 MRI JNT OF LWR EXTRE W/O DYE $ 58.47 $ 58.47 3/1/2020 12/31/9999 73721 TC MRI JNT OF LWR EXTRE W/O DYE $ 381.50 $ 381.50 3/1/2020 12/31/9999 73721 MRI JNT OF LWR EXTRE W/O DYE $ 439.97 $ 439.97 3/1/2020 12/31/9999 73722 26 MRI JOINT OF LWR EXTR W/DYE $ 70.48 $ 70.48 3/1/2020 12/31/9999 73722 TC MRI JOINT OF LWR EXTR W/DYE $ 410.72 $ 410.72 3/1/2020 12/31/9999 73722 MRI JOINT OF LWR EXTR W/DYE $ 481.20 $ 481.20 3/1/2020 12/31/9999 73723 26 MRI JOINT LWR EXTR W/O&W/DYE $ 93.50 $ 93.50 3/1/2020 12/31/9999 73723 TC MRI JOINT LWR EXTR W/O&W/DYE $ 565.34 $ 565.34 3/1/2020 12/31/9999 73723 MRI JOINT LWR EXTR W/O&W/DYE $ 658.82 $ 658.82 3/1/2020 12/31/9999 73725 26 MR ANG LWR EXT W OR W/O DYE $ 79.38 $ 79.38 3/1/2020 12/31/9999 73725 TC MR ANG LWR EXT W OR W/O DYE $ 409.31 $ 409.31 3/1/2020 12/31/9999 73725 MR ANG LWR EXT W OR W/O DYE $ 488.70 $ 488.70 3/1/2020 12/31/9999 74018 26 X-RAY EXAM ABDOMEN 1 VIEW $ 8.05 $ 8.05 3/1/2020 12/31/9999 74018 TC X-RAY EXAM ABDOMEN 1 VIEW $ 15.36 $ 15.36 3/1/2020 12/31/9999 74018 X-RAY EXAM ABDOMEN 1 VIEW $ 23.41 $ 23.41 3/1/2020 12/31/9999 74019 26 X-RAY EXAM ABDOMEN 2 VIEWS $ 10.24 $ 10.24 3/1/2020 12/31/9999 74019 TC X-RAY EXAM ABDOMEN 2 VIEWS $ 18.39 $ 18.39 3/1/2020 12/31/9999 74019 X-RAY EXAM ABDOMEN 2 VIEWS $ 28.63 $ 28.63 3/1/2020 12/31/9999 74021 26 X-RAY EXAM ABDOMEN 3+ VIEWS $ 12.04 $ 12.04 3/1/2020 12/31/9999 74021 TC X-RAY EXAM ABDOMEN 3+ VIEWS $ 21.41 $ 21.41 3/1/2020 12/31/9999 74021 X-RAY EXAM ABDOMEN 3+ VIEWS $ 33.45 $ 33.45 3/1/2020 12/31/9999 74022 26 X-RAY EXAM COMPLETE ABDOMEN $ 13.88 $ 13.88 3/1/2020 12/31/9999 74022 TC X-RAY EXAM COMPLETE ABDOMEN $ 25.38 $ 25.38 3/1/2020 12/31/9999 74022 X-RAY EXAM COMPLETE ABDOMEN $ 39.28 $ 39.28 3/1/2020 12/31/9999 74150 26 CT ABDOMEN W/O DYE $ 51.72 $ 51.72 3/1/2020 12/31/9999 74150 TC CT ABDOMEN W/O DYE $ 170.54 $ 170.54 3/1/2020 12/31/9999 74150 CT ABDOMEN W/O DYE $ 222.26 $ 222.26 3/1/2020 12/31/9999 74160 26 CT ABDOMEN W/DYE $ 55.64 $ 55.64 3/1/2020 12/31/9999 74160 TC CT ABDOMEN W/DYE $ 239.60 $ 239.60 3/1/2020 12/31/9999 74160 CT ABDOMEN W/DYE $ 295.24 $ 295.24 3/1/2020 12/31/9999 74170 26 CT ABDOMEN W/O & W/DYE $ 60.94 $ 60.94 3/1/2020 12/31/9999 74170 TC CT ABDOMEN W/O & W/DYE $ 325.32 $ 325.32 3/1/2020 12/31/9999 74170 CT ABDOMEN W/O & W/DYE $ 386.25 $ 386.25 3/1/2020 12/31/9999 74174 26 CT ANGIO ABD&PELV W/O&W/DYE $ 63.49 $ 63.49 3/1/2020 12/31/9999 74174 TC CT ANGIO ABD&PELV W/O&W/DYE $ 268.58 $ 268.58 3/1/2020 12/31/9999 74174 CT ANGIO ABD&PELV W/O&W/DYE $ 332.07 $ 332.07 3/1/2020 12/31/9999 74175 26 CT ANGIO ABDOM W/O & W/DYE $ 83.10 $ 83.10 3/1/2020 12/31/9999 74175 TC CT ANGIO ABDOM W/O & W/DYE $ 348.01 $ 348.01 3/1/2020 12/31/9999 74175 CT ANGIO ABDOM W/O & W/DYE $ 431.11 $ 431.11 3/1/2020 12/31/9999 74176 26 CT ABD & PELVIS W/O CONTRAST $ 72.33 $ 72.33 3/1/2020 12/31/9999 74176 TC CT ABD & PELVIS W/O CONTRAST $ 110.76 $ 110.76 3/1/2020 12/31/9999 74176 CT ABD & PELVIS W/O CONTRAST $ 183.10 $ 183.10 3/1/2020 12/31/9999 74177 26 CT ABD & PELV W/CONTRAST $ 75.86 $ 75.86 3/1/2020 12/31/9999 74177 TC CT ABD & PELV W/CONTRAST $ 211.33 $ 211.33 3/1/2020 12/31/9999 74177 CT ABD & PELV W/CONTRAST $ 287.19 $ 287.19 3/1/2020 12/31/9999 74178 26 CT ABD & PELV 1/> REGNS $ 83.91 $ 83.91 3/1/2020 12/31/9999 74178 TC CT ABD & PELV 1/> REGNS $ 279.32 $ 279.32 3/1/2020 12/31/9999 74178 CT ABD & PELV 1/> REGNS $ 363.23 $ 363.23 3/1/2020 12/31/9999 74181 26 MRI ABDOMEN W/O DYE $ 63.43 $ 63.43 3/1/2020 12/31/9999 74181 TC MRI ABDOMEN W/O DYE $ 350.98 $ 350.98 3/1/2020 12/31/9999 74181 MRI ABDOMEN W/O DYE $ 414.41 $ 414.41 3/1/2020 12/31/9999 74182 26 MRI ABDOMEN W/DYE $ 75.35 $ 75.35 3/1/2020 12/31/9999 74182 TC MRI ABDOMEN W/DYE $ 474.30 $ 474.30 3/1/2020 12/31/9999 74182 MRI ABDOMEN W/DYE $ 549.64 $ 549.64 3/1/2020 12/31/9999 74183 26 MRI ABDOMEN W/O & W/DYE $ 98.16 $ 98.16 3/1/2020 12/31/9999 74183 TC MRI ABDOMEN W/O & W/DYE $ 596.62 $ 596.62 3/1/2020 12/31/9999 74183 MRI ABDOMEN W/O & W/DYE $ 694.79 $ 694.79 3/1/2020 12/31/9999 74185 26 MRI ANGIO ABDOM W ORW/O DYE $ 78.46 $ 78.46 3/1/2020 12/31/9999 74185 TC MRI ANGIO ABDOM W ORW/O DYE $ 408.44 $ 408.44 3/1/2020 12/31/9999 74185 MRI ANGIO ABDOM W ORW/O DYE $ 486.90 $ 486.90 3/1/2020 12/31/9999 74190 26 X-RAY EXAM OF PERITONEUM $ 20.94 $ 20.94 3/1/2020 12/31/9999 74190 TC X-RAY EXAM OF PERITONEUM $ 42.45 $ 42.45 3/1/2020 12/31/9999 74190 X-RAY EXAM OF PERITONEUM $ 62.45 $ 62.45 3/1/2020 12/31/9999 74210 26 X-RAY XM PHRNX&/CRV ESOPH C+ $ 15.95 $ 15.95 3/1/2020 12/31/9999 74210 TC X-RAY XM PHRNX&/CRV ESOPH C+ $ 45.86 $ 45.86 3/1/2020 12/31/9999 74210 X-RAY XM PHRNX&/CRV ESOPH C+ $ 61.80 $ 61.80 3/1/2020 12/31/9999 74220 26 X-RAY XM ESOPHAGUS 1CNTRST $ 20.00 $ 20.00 3/1/2020 12/31/9999 74220 TC X-RAY XM ESOPHAGUS 1CNTRST $ 50.26 $ 50.26 3/1/2020 12/31/9999 74220 X-RAY XM ESOPHAGUS 1CNTRST $ 70.28 $ 70.28 3/1/2020 12/31/9999 74221 26 X-RAY XM ESOPHAGUS 2CNTRST $ 31.19 $ 31.19 3/1/2020 12/31/9999 74221 X-RAY XM ESOPHAGUS 2CNTRST $ 93.86 $ 93.86 3/1/2020 12/31/9999 74221 TC X-RAY XM ESOPHAGUS 2CNTRST $ 62.69 $ 62.69 3/1/2020 12/31/9999 74230 26 CINE/VID X-RAY THROAT/ESOPH $ 23.11 $ 23.11 3/1/2020 12/31/9999 74230 TC CINE/VID X-RAY THROAT/ESOPH $ 49.29 $ 49.29 3/1/2020 12/31/9999 74230 CINE/VID X-RAY THROAT/ESOPH $ 72.40 $ 72.40 3/1/2020 12/31/9999 74235 26 REMOVE ESOPHAGUS OBSTRUCTION $ 52.89 $ 52.89 3/1/2020 12/31/9999 74235 TC REMOVE ESOPHAGUS OBSTRUCTION $ 81.81 $ 81.81 3/1/2020 12/31/9999 74235 REMOVE ESOPHAGUS OBSTRUCTION $ 134.70 $ 134.70 3/1/2020 12/31/9999 74240 26 X-RAY XM UPR GI TRC 1CNTRST $ 30.15 $ 30.15 3/1/2020 12/31/9999 74240 TC X-RAY XM UPR GI TRC 1CNTRST $ 57.13 $ 57.13 3/1/2020 12/31/9999 74240 X-RAY XM UPR GI TRC 1CNTRST $ 87.28 $ 87.28 3/1/2020 12/31/9999 74246 26 X-RAY XM UPR GI TRC 2CNTRST $ 30.15 $ 30.15 3/1/2020 12/31/9999 74246 TC X-RAY XM UPR GI TRC 2CNTRST $ 69.57 $ 69.57 3/1/2020 12/31/9999 74246 X-RAY XM UPR GI TRC 2CNTRST $ 99.73 $ 99.73 3/1/2020 12/31/9999 74248 26 X-RAY SM INT F-THRU STD $ 31.19 $ 31.19 3/1/2020 12/31/9999 74248 X-RAY SM INT F-THRU STD $ 71.49 $ 71.49 3/1/2020 12/31/9999 74248 TC X-RAY SM INT F-THRU STD $ 40.31 $ 40.31 3/1/2020 12/31/9999 74250 26 X-RAY XM SM INT 1CNTRST STD $ 20.33 $ 20.33 3/1/2020 12/31/9999 74250 TC X-RAY XM SM INT 1CNTRST STD $ 61.33 $ 61.33 3/1/2020 12/31/9999 74250 X-RAY XM SM INT 1CNTRST STD $ 81.65 $ 81.65 3/1/2020 12/31/9999 74251 26 X-RAY XM SM INT 2CNTRST STD $ 30.15 $ 30.15 3/1/2020 12/31/9999 74251 TC X-RAY XM SM INT 2CNTRST STD $ 223.48 $ 223.48 3/1/2020 12/31/9999 74251 X-RAY XM SM INT 2CNTRST STD $ 253.64 $ 253.64 3/1/2020 12/31/9999 74270 26 X-RAY XM COLON 1CNTRST STD $ 30.15 $ 30.15 3/1/2020 12/31/9999 74270 TC X-RAY XM COLON 1CNTRST STD $ 87.10 $ 87.10 3/1/2020 12/31/9999 74270 X-RAY XM COLON 1CNTRST STD $ 117.26 $ 117.26 3/1/2020 12/31/9999 74280 26 X-RAY XM COLON 2CNTRST STD $ 43.11 $ 43.11 3/1/2020 12/31/9999 74280 TC X-RAY XM COLON 2CNTRST STD $ 119.24 $ 119.24 3/1/2020 12/31/9999 74280 X-RAY XM COLON 2CNTRST STD $ 162.35 $ 162.35 3/1/2020 12/31/9999 74283 26 THER NMA RDCTJ INTUS/OBSTRCJ $ 87.70 $ 87.70 3/1/2020 12/31/9999 74283 TC THER NMA RDCTJ INTUS/OBSTRCJ $ 82.43 $ 82.43 3/1/2020 12/31/9999 74283 THER NMA RDCTJ INTUS/OBSTRCJ $ 170.12 $ 170.12 3/1/2020 12/31/9999 74290 26 CONTRAST X-RAY GALLBLADDER $ 13.88 $ 13.88 3/1/2020 12/31/9999 74290 TC CONTRAST X-RAY GALLBLADDER $ 38.31 $ 38.31 3/1/2020 12/31/9999 74290 CONTRAST X-RAY GALLBLADDER $ 52.20 $ 52.20 3/1/2020 12/31/9999 74300 26 X-RAY BILE DUCTS/PANCREAS $ 15.66 $ 15.66 3/1/2020 12/31/9999 74300 X-RAY BILE DUCTS/PANCREAS $ 44.73 $ 44.73 3/1/2020 12/31/9999 74301 26 X-RAYS AT SURGERY ADD-ON $ 9.22 $ 9.22 3/1/2020 12/31/9999 74328 26 X-RAY BILE DUCT ENDOSCOPY $ 30.75 $ 30.75 3/1/2020 12/31/9999 74328 TC X-RAY BILE DUCT ENDOSCOPY $ 102.41 $ 102.41 3/1/2020 12/31/9999 74328 X-RAY BILE DUCT ENDOSCOPY $ 131.61 $ 131.61 3/1/2020 12/31/9999 74329 26 X-RAY FOR PANCREAS ENDOSCOPY $ 30.75 $ 30.75 3/1/2020 12/31/9999 74329 TC X-RAY FOR PANCREAS ENDOSCOPY $ 97.42 $ 97.42 3/1/2020 12/31/9999 74329 X-RAY FOR PANCREAS ENDOSCOPY $ 128.17 $ 128.17 3/1/2020 12/31/9999 74330 26 X-RAY BILE/PANC ENDOSCOPY $ 39.38 $ 39.38 3/1/2020 12/31/9999 74330 TC X-RAY BILE/PANC ENDOSCOPY $ 102.41 $ 102.41 3/1/2020 12/31/9999 74330 X-RAY BILE/PANC ENDOSCOPY $ 139.80 $ 139.80 3/1/2020 12/31/9999 74340 26 X-RAY GUIDE FOR GI TUBE $ 23.43 $ 23.43 3/1/2020 12/31/9999 74340 TC X-RAY GUIDE FOR GI TUBE $ 85.21 $ 85.21 3/1/2020 12/31/9999 74340 X-RAY GUIDE FOR GI TUBE $ 107.87 $ 107.87 3/1/2020 12/31/9999 74355 26 X-RAY GUIDE INTESTINAL TUBE $ 33.25 $ 33.25 3/1/2020 12/31/9999 74355 TC X-RAY GUIDE INTESTINAL TUBE $ 85.52 $ 85.52 3/1/2020 12/31/9999 74355 X-RAY GUIDE INTESTINAL TUBE $ 116.71 $ 116.71 3/1/2020 12/31/9999 74360 26 X-RAY GUIDE GI DILATION $ 24.31 $ 24.31 3/1/2020 12/31/9999 74360 TC X-RAY GUIDE GI DILATION $ 102.09 $ 102.09 3/1/2020 12/31/9999 74360 X-RAY GUIDE GI DILATION $ 125.39 $ 125.39 3/1/2020 12/31/9999 74363 26 X-RAY BILE DUCT DILATION $ 38.75 $ 38.75 3/1/2020 12/31/9999 74363 TC X-RAY BILE DUCT DILATION $ 184.18 $ 184.18 3/1/2020 12/31/9999 74363 X-RAY BILE DUCT DILATION $ 227.90 $ 227.90 3/1/2020 12/31/9999 74400 26 CONTRST X-RAY URINARY TRACT $ 21.25 $ 21.25 3/1/2020 12/31/9999 74400 TC CONTRST X-RAY URINARY TRACT $ 67.13 $ 67.13 3/1/2020 12/31/9999 74400 CONTRST X-RAY URINARY TRACT $ 88.39 $ 88.39 3/1/2020 12/31/9999 74410 26 CONTRST X-RAY URINARY TRACT $ 21.56 $ 21.56 3/1/2020 12/31/9999 74410 TC CONTRST X-RAY URINARY TRACT $ 71.54 $ 71.54 3/1/2020 12/31/9999 74410 CONTRST X-RAY URINARY TRACT $ 93.08 $ 93.08 3/1/2020 12/31/9999 74415 26 CONTRST X-RAY URINARY TRACT $ 21.25 $ 21.25 3/1/2020 12/31/9999 74415 TC CONTRST X-RAY URINARY TRACT $ 85.25 $ 85.25 3/1/2020 12/31/9999 74415 CONTRST X-RAY URINARY TRACT $ 106.50 $ 106.50 3/1/2020 12/31/9999 74420 26 CONTRST X-RAY URINARY TRACT $ 15.95 $ 15.95 3/1/2020 12/31/9999 74420 TC CONTRST X-RAY URINARY TRACT $ 85.21 $ 85.21 3/1/2020 12/31/9999 74420 CONTRST X-RAY URINARY TRACT $ 100.24 $ 100.24 3/1/2020 12/31/9999 74425 26 CONTRST X-RAY URINARY TRACT $ 15.95 $ 15.95 3/1/2020 12/31/9999 74425 TC CONTRST X-RAY URINARY TRACT $ 42.44 $ 42.44 3/1/2020 12/31/9999 74425 CONTRST X-RAY URINARY TRACT $ 57.48 $ 57.48 3/1/2020 12/31/9999 74430 26 CONTRAST X-RAY BLADDER $ 14.09 $ 14.09 3/1/2020 12/31/9999 74430 TC CONTRAST X-RAY BLADDER $ 49.08 $ 49.08 3/1/2020 12/31/9999 74430 CONTRAST X-RAY BLADDER $ 63.18 $ 63.18 3/1/2020 12/31/9999 74440 26 X-RAY MALE GENITAL TRACT $ 16.58 $ 16.58 3/1/2020 12/31/9999 74440 TC X-RAY MALE GENITAL TRACT $ 51.44 $ 51.44 3/1/2020 12/31/9999 74440 X-RAY MALE GENITAL TRACT $ 68.02 $ 68.02 3/1/2020 12/31/9999 74445 26 X-RAY EXAM OF PENIS $ 50.82 $ 50.82 3/1/2020 12/31/9999 74445 TC X-RAY EXAM OF PENIS $ 35.98 $ 35.98 3/1/2020 12/31/9999 74445 X-RAY EXAM OF PENIS $ 84.60 $ 84.60 3/1/2020 12/31/9999 74450 26 X-RAY URETHRA/BLADDER $ 14.70 $ 14.70 3/1/2020 12/31/9999 74450 TC X-RAY URETHRA/BLADDER $ 47.33 $ 47.33 3/1/2020 12/31/9999 74450 X-RAY URETHRA/BLADDER $ 61.37 $ 61.37 3/1/2020 12/31/9999 74455 26 X-RAY URETHRA/BLADDER $ 14.70 $ 14.70 3/1/2020 12/31/9999 74455 TC X-RAY URETHRA/BLADDER $ 58.41 $ 58.41 3/1/2020 12/31/9999 74455 X-RAY URETHRA/BLADDER $ 73.12 $ 73.12 3/1/2020 12/31/9999 74470 26 X-RAY EXAM OF KIDNEY LESION $ 23.72 $ 23.72 3/1/2020 12/31/9999 74470 TC X-RAY EXAM OF KIDNEY LESION $ 40.89 $ 40.89 3/1/2020 12/31/9999 74470 X-RAY EXAM OF KIDNEY LESION $ 63.23 $ 63.23 3/1/2020 12/31/9999 74485 26 DILATION URTR/URT RS&I $ 23.93 $ 23.93 3/1/2020 12/31/9999 74485 TC DILATION URTR/URT RS&I $ 71.86 $ 71.86 3/1/2020 12/31/9999 74485 DILATION URTR/URT RS&I $ 95.79 $ 95.79 3/1/2020 12/31/9999 74710 26 X-RAY MEASUREMENT OF PELVIS $ 15.02 $ 15.02 3/1/2020 12/31/9999 74710 TC X-RAY MEASUREMENT OF PELVIS $ 20.59 $ 20.59 3/1/2020 12/31/9999 74710 X-RAY MEASUREMENT OF PELVIS $ 35.62 $ 35.62 3/1/2020 12/31/9999 74740 26 X-RAY FEMALE GENITAL TRACT $ 18.80 $ 18.80 3/1/2020 12/31/9999 74740 TC X-RAY FEMALE GENITAL TRACT $ 45.83 $ 45.83 3/1/2020 12/31/9999 74740 X-RAY FEMALE GENITAL TRACT $ 64.63 $ 64.63 3/1/2020 12/31/9999 74775 26 X-RAY EXAM OF PERINEUM $ 27.04 $ 27.04 3/1/2020 12/31/9999 74775 TC X-RAY EXAM OF PERINEUM $ 47.66 $ 47.66 3/1/2020 12/31/9999 74775 X-RAY EXAM OF PERINEUM $ 73.53 $ 73.53 3/1/2020 12/31/9999 75557 26 CARDIAC MRI FOR MORPH $ 106.02 $ 106.02 3/1/2020 12/31/9999 75557 TC CARDIAC MRI FOR MORPH $ 312.44 $ 312.44 3/1/2020 12/31/9999 75557 CARDIAC MRI FOR MORPH $ 418.46 $ 418.46 3/1/2020 12/31/9999 75561 26 CARDIAC MRI FOR MORPH W/DYE $ 117.10 $ 117.10 3/1/2020 12/31/9999 75561 TC CARDIAC MRI FOR MORPH W/DYE $ 446.15 $ 446.15 3/1/2020 12/31/9999 75561 CARDIAC MRI FOR MORPH W/DYE $ 563.24 $ 563.24 3/1/2020 12/31/9999 75572 26 CT HRT W/3D IMAGE $ 72.21 $ 72.21 3/1/2020 12/31/9999 75572 TC CT HRT W/3D IMAGE $ 175.91 $ 175.91 3/1/2020 12/31/9999 75572 CT HRT W/3D IMAGE $ 248.10 $ 248.10 3/1/2020 12/31/9999 75573 26 CT HRT W/3D IMAGE CONGEN $ 80.41 $ 80.41 3/1/2020 12/31/9999 75573 TC CT HRT W/3D IMAGE CONGEN $ 241.24 $ 241.24 3/1/2020 12/31/9999 75573 CT HRT W/3D IMAGE CONGEN $ 321.66 $ 321.66 3/1/2020 12/31/9999 75574 26 CT ANGIO HRT W/3D IMAGE $ 78.80 $ 78.80 3/1/2020 12/31/9999 75574 TC CT ANGIO HRT W/3D IMAGE $ 236.40 $ 236.40 3/1/2020 12/31/9999 75574 CT ANGIO HRT W/3D IMAGE $ 315.19 $ 315.19 3/1/2020 12/31/9999 75600 26 CONTRAST EXAM THORACIC AORTA $ 22.71 $ 22.71 3/1/2020 12/31/9999 75600 TC CONTRAST EXAM THORACIC AORTA $ 235.16 $ 235.16 3/1/2020 12/31/9999 75600 CONTRAST EXAM THORACIC AORTA $ 257.88 $ 257.88 3/1/2020 12/31/9999 75605 26 CONTRAST EXAM THORACIC AORTA $ 51.31 $ 51.31 3/1/2020 12/31/9999 75605 TC CONTRAST EXAM THORACIC AORTA $ 170.54 $ 170.54 3/1/2020 12/31/9999 75605 CONTRAST EXAM THORACIC AORTA $ 221.85 $ 221.85 3/1/2020 12/31/9999 75625 26 CONTRAST EXAM ABDOMINL AORTA $ 50.04 $ 50.04 3/1/2020 12/31/9999 75625 TC CONTRAST EXAM ABDOMINL AORTA $ 168.78 $ 168.78 3/1/2020 12/31/9999 75625 CONTRAST EXAM ABDOMINL AORTA $ 218.81 $ 218.81 3/1/2020 12/31/9999 75630 26 X-RAY AORTA LEG ARTERIES $ 79.92 $ 79.92 3/1/2020 12/31/9999 75630 TC X-RAY AORTA LEG ARTERIES $ 175.16 $ 175.16 3/1/2020 12/31/9999 75630 X-RAY AORTA LEG ARTERIES $ 255.08 $ 255.08 3/1/2020 12/31/9999 75635 26 CT ANGIO ABDOMINAL ARTERIES $ 106.33 $ 106.33 3/1/2020 12/31/9999 75635 TC CT ANGIO ABDOMINAL ARTERIES $ 384.73 $ 384.73 3/1/2020 12/31/9999 75635 CT ANGIO ABDOMINAL ARTERIES $ 491.07 $ 491.07 3/1/2020 12/31/9999 75705 26 ARTERY X-RAYS SPINE $ 96.53 $ 96.53 3/1/2020 12/31/9999 75705 TC ARTERY X-RAYS SPINE $ 178.17 $ 178.17 3/1/2020 12/31/9999 75705 ARTERY X-RAYS SPINE $ 274.70 $ 274.70 3/1/2020 12/31/9999 75710 26 ARTERY X-RAYS ARM/LEG $ 50.24 $ 50.24 3/1/2020 12/31/9999 75710 TC ARTERY X-RAYS ARM/LEG $ 181.11 $ 181.11 3/1/2020 12/31/9999 75710 ARTERY X-RAYS ARM/LEG $ 231.36 $ 231.36 3/1/2020 12/31/9999 75716 26 ARTERY X-RAYS ARMS/LEGS $ 57.70 $ 57.70 3/1/2020 12/31/9999 75716 TC ARTERY X-RAYS ARMS/LEGS $ 200.49 $ 200.49 3/1/2020 12/31/9999 75716 ARTERY X-RAYS ARMS/LEGS $ 258.20 $ 258.20 3/1/2020 12/31/9999 75726 26 ARTERY X-RAYS ABDOMEN $ 50.13 $ 50.13 3/1/2020 12/31/9999 75726 TC ARTERY X-RAYS ABDOMEN $ 178.75 $ 178.75 3/1/2020 12/31/9999 75726 ARTERY X-RAYS ABDOMEN $ 228.89 $ 228.89 3/1/2020 12/31/9999 75731 26 ARTERY X-RAYS ADRENAL GLAND $ 52.68 $ 52.68 3/1/2020 12/31/9999 75731 TC ARTERY X-RAYS ADRENAL GLAND $ 184.05 $ 184.05 3/1/2020 12/31/9999 75731 ARTERY X-RAYS ADRENAL GLAND $ 236.73 $ 236.73 3/1/2020 12/31/9999 75733 26 ARTERY X-RAYS ADRENALS $ 61.32 $ 61.32 3/1/2020 12/31/9999 75733 TC ARTERY X-RAYS ADRENALS $ 206.96 $ 206.96 3/1/2020 12/31/9999 75733 ARTERY X-RAYS ADRENALS $ 268.28 $ 268.28 3/1/2020 12/31/9999 75736 26 ARTERY X-RAYS PELVIS $ 50.63 $ 50.63 3/1/2020 12/31/9999 75736 TC ARTERY X-RAYS PELVIS $ 180.23 $ 180.23 3/1/2020 12/31/9999 75736 ARTERY X-RAYS PELVIS $ 230.85 $ 230.85 3/1/2020 12/31/9999 75741 26 ARTERY X-RAYS LUNG $ 57.79 $ 57.79 3/1/2020 12/31/9999 75741 TC ARTERY X-RAYS LUNG $ 164.37 $ 164.37 3/1/2020 12/31/9999 75741 ARTERY X-RAYS LUNG $ 222.16 $ 222.16 3/1/2020 12/31/9999 75743 26 ARTERY X-RAYS LUNGS $ 73.51 $ 73.51 3/1/2020 12/31/9999 75743 TC ARTERY X-RAYS LUNGS $ 170.25 $ 170.25 3/1/2020 12/31/9999 75743 ARTERY X-RAYS LUNGS $ 243.76 $ 243.76 3/1/2020 12/31/9999 75746 26 ARTERY X-RAYS LUNG $ 49.83 $ 49.83 3/1/2020 12/31/9999 75746 TC ARTERY X-RAYS LUNG $ 174.06 $ 174.06 3/1/2020 12/31/9999 75746 ARTERY X-RAYS LUNG $ 223.90 $ 223.90 3/1/2020 12/31/9999 75756 26 ARTERY X-RAYS CHEST $ 53.16 $ 53.16 3/1/2020 12/31/9999 75756 TC ARTERY X-RAYS CHEST $ 184.34 $ 184.34 3/1/2020 12/31/9999 75756 ARTERY X-RAYS CHEST $ 237.50 $ 237.50 3/1/2020 12/31/9999 75774 26 ARTERY X-RAY EACH VESSEL $ 15.95 $ 15.95 3/1/2020 12/31/9999 75774 TC ARTERY X-RAY EACH VESSEL $ 156.72 $ 156.72 3/1/2020 12/31/9999 75774 ARTERY X-RAY EACH VESSEL $ 172.67 $ 172.67 3/1/2020 12/31/9999 75801 26 LYMPH VESSEL X-RAY ARM/LEG $ 34.67 $ 34.67 3/1/2020 12/31/9999 75801 TC LYMPH VESSEL X-RAY ARM/LEG $ 176.25 $ 176.25 3/1/2020 12/31/9999 75801 LYMPH VESSEL X-RAY ARM/LEG $ 210.85 $ 210.85 3/1/2020 12/31/9999 75803 26 LYMPH VESSEL X-RAY ARMS/LEGS $ 51.39 $ 51.39 3/1/2020 12/31/9999 75803 TC LYMPH VESSEL X-RAY ARMS/LEGS $ 176.56 $ 176.56 3/1/2020 12/31/9999 75803 LYMPH VESSEL X-RAY ARMS/LEGS $ 224.47 $ 224.47 3/1/2020 12/31/9999 75805 26 LYMPH VESSEL X-RAY TRUNK $ 35.83 $ 35.83 3/1/2020 12/31/9999 75805 TC LYMPH VESSEL X-RAY TRUNK $ 198.67 $ 198.67 3/1/2020 12/31/9999 75805 LYMPH VESSEL X-RAY TRUNK $ 232.61 $ 232.61 3/1/2020 12/31/9999 75807 26 LYMPH VESSEL X-RAY TRUNK $ 51.39 $ 51.39 3/1/2020 12/31/9999 75807 TC LYMPH VESSEL X-RAY TRUNK $ 193.27 $ 193.27 3/1/2020 12/31/9999 75807 LYMPH VESSEL X-RAY TRUNK $ 244.65 $ 244.65 3/1/2020 12/31/9999 75809 26 NONVASCULAR SHUNT X-RAY $ 20.33 $ 20.33 3/1/2020 12/31/9999 75809 TC NONVASCULAR SHUNT X-RAY $ 50.36 $ 50.36 3/1/2020 12/31/9999 75809 NONVASCULAR SHUNT X-RAY $ 70.69 $ 70.69 3/1/2020 12/31/9999 75810 26 VEIN X-RAY SPLEEN/LIVER $ 50.42 $ 50.42 3/1/2020 12/31/9999 75810 TC VEIN X-RAY SPLEEN/LIVER $ 409.32 $ 409.32 3/1/2020 12/31/9999 75810 VEIN X-RAY SPLEEN/LIVER $ 456.56 $ 456.56 3/1/2020 12/31/9999 75820 26 VEIN X-RAY ARM/LEG $ 31.06 $ 31.06 3/1/2020 12/31/9999 75820 TC VEIN X-RAY ARM/LEG $ 66.13 $ 66.13 3/1/2020 12/31/9999 75820 VEIN X-RAY ARM/LEG $ 97.19 $ 97.19 3/1/2020 12/31/9999 75822 26 VEIN X-RAY ARMS/LEGS $ 46.13 $ 46.13 3/1/2020 12/31/9999 75822 TC VEIN X-RAY ARMS/LEGS $ 73.28 $ 73.28 3/1/2020 12/31/9999 75822 VEIN X-RAY ARMS/LEGS $ 119.41 $ 119.41 3/1/2020 12/31/9999 75825 26 VEIN X-RAY TRUNK $ 49.67 $ 49.67 3/1/2020 12/31/9999 75825 TC VEIN X-RAY TRUNK $ 161.43 $ 161.43 3/1/2020 12/31/9999 75825 VEIN X-RAY TRUNK $ 211.08 $ 211.08 3/1/2020 12/31/9999 75827 26 VEIN X-RAY CHEST $ 48.67 $ 48.67 3/1/2020 12/31/9999 75827 TC VEIN X-RAY CHEST $ 162.03 $ 162.03 3/1/2020 12/31/9999 75827 VEIN X-RAY CHEST $ 210.67 $ 210.67 3/1/2020 12/31/9999 75831 26 VEIN X-RAY KIDNEY $ 49.74 $ 49.74 3/1/2020 12/31/9999 75831 TC VEIN X-RAY KIDNEY $ 163.79 $ 163.79 3/1/2020 12/31/9999 75831 VEIN X-RAY KIDNEY $ 213.53 $ 213.53 3/1/2020 12/31/9999 75833 26 VEIN X-RAY KIDNEYS $ 64.41 $ 64.41 3/1/2020 12/31/9999 75833 TC VEIN X-RAY KIDNEYS $ 174.35 $ 174.35 3/1/2020 12/31/9999 75833 VEIN X-RAY KIDNEYS $ 238.77 $ 238.77 3/1/2020 12/31/9999 75840 26 VEIN X-RAY ADRENAL GLAND $ 49.07 $ 49.07 3/1/2020 12/31/9999 75840 TC VEIN X-RAY ADRENAL GLAND $ 162.60 $ 162.60 3/1/2020 12/31/9999 75840 VEIN X-RAY ADRENAL GLAND $ 211.68 $ 211.68 3/1/2020 12/31/9999 75842 26 VEIN X-RAY ADRENAL GLANDS $ 65.17 $ 65.17 3/1/2020 12/31/9999 75842 TC VEIN X-RAY ADRENAL GLANDS $ 174.94 $ 174.94 3/1/2020 12/31/9999 75842 VEIN X-RAY ADRENAL GLANDS $ 240.11 $ 240.11 3/1/2020 12/31/9999 75860 26 VEIN X-RAY NECK $ 50.82 $ 50.82 3/1/2020 12/31/9999 75860 TC VEIN X-RAY NECK $ 167.00 $ 167.00 3/1/2020 12/31/9999 75860 VEIN X-RAY NECK $ 217.82 $ 217.82 3/1/2020 12/31/9999 75870 26 VEIN X-RAY SKULL $ 49.55 $ 49.55 3/1/2020 12/31/9999 75870 TC VEIN X-RAY SKULL $ 166.43 $ 166.43 3/1/2020 12/31/9999 75870 VEIN X-RAY SKULL $ 215.97 $ 215.97 3/1/2020 12/31/9999 75872 26 VEIN X-RAY SKULL EPIDURAL $ 52.24 $ 52.24 3/1/2020 12/31/9999 75872 TC VEIN X-RAY SKULL EPIDURAL $ 183.16 $ 183.16 3/1/2020 12/31/9999 75872 VEIN X-RAY SKULL EPIDURAL $ 235.41 $ 235.41 3/1/2020 12/31/9999 75880 26 VEIN X-RAY EYE SOCKET $ 29.88 $ 29.88 3/1/2020 12/31/9999 75880 TC VEIN X-RAY EYE SOCKET $ 68.18 $ 68.18 3/1/2020 12/31/9999 75880 VEIN X-RAY EYE SOCKET $ 98.07 $ 98.07 3/1/2020 12/31/9999 75885 26 VEIN X-RAY LIVER W/HEMODYNAM $ 63.38 $ 63.38 3/1/2020 12/31/9999 75885 TC VEIN X-RAY LIVER W/HEMODYNAM $ 164.37 $ 164.37 3/1/2020 12/31/9999 75885 VEIN X-RAY LIVER W/HEMODYNAM $ 227.75 $ 227.75 3/1/2020 12/31/9999 75887 26 VEIN X-RAY LIVER W/O HEMODYN $ 63.38 $ 63.38 3/1/2020 12/31/9999 75887 TC VEIN X-RAY LIVER W/O HEMODYN $ 166.13 $ 166.13 3/1/2020 12/31/9999 75887 VEIN X-RAY LIVER W/O HEMODYN $ 229.51 $ 229.51 3/1/2020 12/31/9999 75889 26 VEIN X-RAY LIVER W/HEMODYNAM $ 50.13 $ 50.13 3/1/2020 12/31/9999 75889 TC VEIN X-RAY LIVER W/HEMODYNAM $ 164.07 $ 164.07 3/1/2020 12/31/9999 75889 VEIN X-RAY LIVER W/HEMODYNAM $ 214.21 $ 214.21 3/1/2020 12/31/9999 75891 26 VEIN X-RAY LIVER $ 50.13 $ 50.13 3/1/2020 12/31/9999 75891 TC VEIN X-RAY LIVER $ 164.07 $ 164.07 3/1/2020 12/31/9999 75891 VEIN X-RAY LIVER $ 214.21 $ 214.21 3/1/2020 12/31/9999 75893 26 VENOUS SAMPLING BY CATHETER $ 23.43 $ 23.43 3/1/2020 12/31/9999 75893 TC VENOUS SAMPLING BY CATHETER $ 163.79 $ 163.79 3/1/2020 12/31/9999 75893 VENOUS SAMPLING BY CATHETER $ 187.20 $ 187.20 3/1/2020 12/31/9999 75894 26 X-RAYS TRANSCATH THERAPY $ 57.60 $ 57.60 3/1/2020 12/31/9999 75894 TC X-RAYS TRANSCATH THERAPY $ 783.93 $ 783.93 3/1/2020 12/31/9999 75894 X-RAYS TRANSCATH THERAPY $ 838.76 $ 838.76 3/1/2020 12/31/9999 75898 26 FOLLOW-UP ANGIOGRAPHY $ 72.90 $ 72.90 3/1/2020 12/31/9999 75898 TC FOLLOW-UP ANGIOGRAPHY $ 34.10 $ 34.10 3/1/2020 12/31/9999 75898 FOLLOW-UP ANGIOGRAPHY $ 102.97 $ 102.97 3/1/2020 12/31/9999 75901 26 REMOVE CVA DEVICE OBSTRUCT $ 21.25 $ 21.25 3/1/2020 12/31/9999 75901 TC REMOVE CVA DEVICE OBSTRUCT $ 113.64 $ 113.64 3/1/2020 12/31/9999 75901 REMOVE CVA DEVICE OBSTRUCT $ 134.90 $ 134.90 3/1/2020 12/31/9999 75902 26 REMOVE CVA LUMEN OBSTRUCT $ 16.89 $ 16.89 3/1/2020 12/31/9999 75902 TC REMOVE CVA LUMEN OBSTRUCT $ 59.01 $ 59.01 3/1/2020 12/31/9999 75902 REMOVE CVA LUMEN OBSTRUCT $ 75.90 $ 75.90 3/1/2020 12/31/9999 75956 26 XRAY ENDOVASC THOR AO REPR $ 331.52 $ 331.52 3/1/2020 12/31/9999 75956 TC XRAY ENDOVASC THOR AO REPR $ 994.54 $ 994.54 3/1/2020 12/31/9999 75956 XRAY ENDOVASC THOR AO REPR $ 1,326.05 $ 1,326.05 3/1/2020 12/31/9999 75957 26 XRAY ENDOVASC THOR AO REPR $ 284.03 $ 284.03 3/1/2020 12/31/9999 75957 TC XRAY ENDOVASC THOR AO REPR $ 852.09 $ 852.09 3/1/2020 12/31/9999 75957 XRAY ENDOVASC THOR AO REPR $ 1,136.12 $ 1,136.12 3/1/2020 12/31/9999 75958 26 XRAY PLACE PROX EXT THOR AO $ 189.39 $ 189.39 3/1/2020 12/31/9999 75958 TC XRAY PLACE PROX EXT THOR AO $ 568.17 $ 568.17 3/1/2020 12/31/9999 75958 XRAY PLACE PROX EXT THOR AO $ 757.56 $ 757.56 3/1/2020 12/31/9999 75959 26 XRAY PLACE DIST EXT THOR AO $ 165.81 $ 165.81 3/1/2020 12/31/9999 75959 TC XRAY PLACE DIST EXT THOR AO $ 497.41 $ 497.41 3/1/2020 12/31/9999 75959 XRAY PLACE DIST EXT THOR AO $ 663.21 $ 663.21 3/1/2020 12/31/9999 75970 26 VASCULAR BIOPSY $ 36.56 $ 36.56 3/1/2020 12/31/9999 75970 TC VASCULAR BIOPSY $ 362.24 $ 362.24 3/1/2020 12/31/9999 75970 VASCULAR BIOPSY $ 398.80 $ 398.80 3/1/2020 12/31/9999 75984 26 XRAY CONTROL CATHETER CHANGE $ 31.70 $ 31.70 3/1/2020 12/31/9999 75984 TC XRAY CONTROL CATHETER CHANGE $ 61.55 $ 61.55 3/1/2020 12/31/9999 75984 XRAY CONTROL CATHETER CHANGE $ 93.25 $ 93.25 3/1/2020 12/31/9999 75989 26 ABSCESS DRAINAGE UNDER X-RAY $ 52.02 $ 52.02 3/1/2020 12/31/9999 75989 TC ABSCESS DRAINAGE UNDER X-RAY $ 66.29 $ 66.29 3/1/2020 12/31/9999 75989 ABSCESS DRAINAGE UNDER X-RAY $ 118.30 $ 118.30 3/1/2020 12/31/9999 76000 26 FLUOROSCOPY <1 HR PHYS/QHP $ 7.36 $ 7.36 3/1/2020 12/31/9999 76000 TC FLUOROSCOPY <1 HR PHYS/QHP $ 69.86 $ 69.86 3/1/2020 12/31/9999 76000 FLUOROSCOPY <1 HR PHYS/QHP $ 77.22 $ 77.22 3/1/2020 12/31/9999 76010 26 X-RAY NOSE TO RECTUM $ 7.98 $ 7.98 3/1/2020 12/31/9999 76010 TC X-RAY NOSE TO RECTUM $ 14.78 $ 14.78 3/1/2020 12/31/9999 76010 X-RAY NOSE TO RECTUM $ 22.77 $ 22.77 3/1/2020 12/31/9999 76080 26 X-RAY EXAM OF FISTULA $ 23.72 $ 23.72 3/1/2020 12/31/9999 76080 TC X-RAY EXAM OF FISTULA $ 28.53 $ 28.53 3/1/2020 12/31/9999 76080 X-RAY EXAM OF FISTULA $ 52.25 $ 52.25 3/1/2020 12/31/9999 76098 26 X-RAY EXAM SURGICAL SPECIMEN $ 7.05 $ 7.05 3/1/2020 12/31/9999 76098 TC X-RAY EXAM SURGICAL SPECIMEN $ 9.22 $ 9.22 3/1/2020 12/31/9999 76098 X-RAY EXAM SURGICAL SPECIMEN $ 16.25 $ 16.25 3/1/2020 12/31/9999 76100 26 X-RAY EXAM OF BODY SECTION $ 25.19 $ 25.19 3/1/2020 12/31/9999 76100 TC X-RAY EXAM OF BODY SECTION $ 83.66 $ 83.66 3/1/2020 12/31/9999 76100 X-RAY EXAM OF BODY SECTION $ 108.84 $ 108.84 3/1/2020 12/31/9999 76101 26 COMPLEX BODY SECTION X-RAY $ 24.90 $ 24.90 3/1/2020 12/31/9999 76101 TC COMPLEX BODY SECTION X-RAY $ 125.28 $ 125.28 3/1/2020 12/31/9999 76101 COMPLEX BODY SECTION X-RAY $ 150.18 $ 150.18 3/1/2020 12/31/9999 76102 26 COMPLEX BODY SECTION X-RAYS $ 24.61 $ 24.61 3/1/2020 12/31/9999 76102 TC COMPLEX BODY SECTION X-RAYS $ 176.40 $ 176.40 3/1/2020 12/31/9999 76102 COMPLEX BODY SECTION X-RAYS $ 201.01 $ 201.01 3/1/2020 12/31/9999 76120 26 CINE/VIDEO X-RAYS $ 16.29 $ 16.29 3/1/2020 12/31/9999 76120 TC CINE/VIDEO X-RAYS $ 44.98 $ 44.98 3/1/2020 12/31/9999 76120 CINE/VIDEO X-RAYS $ 61.27 $ 61.27 3/1/2020 12/31/9999 76125 26 CINE/VIDEO X-RAYS ADD-ON $ 12.31 $ 12.31 3/1/2020 12/31/9999 76125 TC CINE/VIDEO X-RAYS ADD-ON $ 25.66 $ 25.66 3/1/2020 12/31/9999 76125 CINE/VIDEO X-RAYS ADD-ON $ 37.96 $ 37.96 3/1/2020 12/31/9999 76140 X-RAY CONSULTATION $ 32.61 $ 32.61 3/1/2020 12/31/9999 76376 26 3D RENDER W/INTRP POSTPROCES $ 9.10 $ 9.10 3/1/2020 12/31/9999 76376 TC 3D RENDER W/INTRP POSTPROCES $ 55.66 $ 55.66 3/1/2020 12/31/9999 76376 3D RENDER W/INTRP POSTPROCES $ 64.76 $ 64.76 3/1/2020 12/31/9999 76377 26 3D RENDER W/INTRP POSTPROCES $ 35.22 $ 35.22 3/1/2020 12/31/9999 76377 TC 3D RENDER W/INTRP POSTPROCES $ 55.88 $ 55.88 3/1/2020 12/31/9999 76377 3D RENDER W/INTRP POSTPROCES $ 91.10 $ 91.10 3/1/2020 12/31/9999 76380 26 CAT SCAN FOLLOW-UP STUDY $ 42.50 $ 42.50 3/1/2020 12/31/9999 76380 TC CAT SCAN FOLLOW-UP STUDY $ 124.66 $ 124.66 3/1/2020 12/31/9999 76380 CAT SCAN FOLLOW-UP STUDY $ 167.15 $ 167.15 3/1/2020 12/31/9999 76506 26 ECHO EXAM OF HEAD $ 27.97 $ 27.97 3/1/2020 12/31/9999 76506 TC ECHO EXAM OF HEAD $ 66.23 $ 66.23 3/1/2020 12/31/9999 76506 ECHO EXAM OF HEAD $ 94.21 $ 94.21 3/1/2020 12/31/9999 76510 26 OPHTH US B & QUANT A $ 68.33 $ 68.33 3/1/2020 12/31/9999 76510 TC OPHTH US B & QUANT A $ 54.29 $ 54.29 3/1/2020 12/31/9999 76510 OPHTH US B & QUANT A $ 122.62 $ 122.62 3/1/2020 12/31/9999 76511 26 OPHTH US QUANT A ONLY $ 41.33 $ 41.33 3/1/2020 12/31/9999 76511 TC OPHTH US QUANT A ONLY $ 38.42 $ 38.42 3/1/2020 12/31/9999 76511 OPHTH US QUANT A ONLY $ 79.75 $ 79.75 3/1/2020 12/31/9999 76512 26 OPHTH US B W/NON-QUANT A $ 41.42 $ 41.42 3/1/2020 12/31/9999 76512 TC OPHTH US B W/NON-QUANT A $ 33.44 $ 33.44 3/1/2020 12/31/9999 76512 OPHTH US B W/NON-QUANT A $ 74.87 $ 74.87 3/1/2020 12/31/9999 76513 26 ECHO EXAM OF EYE WATER BATH $ 28.40 $ 28.40 3/1/2020 12/31/9999 76513 TC ECHO EXAM OF EYE WATER BATH $ 40.20 $ 40.20 3/1/2020 12/31/9999 76513 ECHO EXAM OF EYE WATER BATH $ 68.62 $ 68.62 3/1/2020 12/31/9999 76514 26 ECHO EXAM OF EYE THICKNESS $ 7.65 $ 7.65 3/1/2020 12/31/9999 76514 TC ECHO EXAM OF EYE THICKNESS $ 2.85 $ 2.85 3/1/2020 12/31/9999 76514 ECHO EXAM OF EYE THICKNESS $ 10.50 $ 10.50 3/1/2020 12/31/9999 76516 26 ECHO EXAM OF EYE $ 23.53 $ 23.53 3/1/2020 12/31/9999 76516 TC ECHO EXAM OF EYE $ 31.37 $ 31.37 3/1/2020 12/31/9999 76516 ECHO EXAM OF EYE $ 54.88 $ 54.88 3/1/2020 12/31/9999 76519 26 ECHO EXAM OF EYE $ 23.81 $ 23.81 3/1/2020 12/31/9999 76519 TC ECHO EXAM OF EYE $ 34.89 $ 34.89 3/1/2020 12/31/9999 76519 ECHO EXAM OF EYE $ 58.71 $ 58.71 3/1/2020 12/31/9999 76529 26 ECHO EXAM OF EYE $ 24.97 $ 24.97 3/1/2020 12/31/9999 76529 TC ECHO EXAM OF EYE $ 30.69 $ 30.69 3/1/2020 12/31/9999 76529 ECHO EXAM OF EYE $ 55.66 $ 55.66 3/1/2020 12/31/9999 76536 26 US EXAM OF HEAD AND NECK $ 23.76 $ 23.76 3/1/2020 12/31/9999 76536 TC US EXAM OF HEAD AND NECK $ 65.95 $ 65.95 3/1/2020 12/31/9999 76536 US EXAM OF HEAD AND NECK $ 89.71 $ 89.71 3/1/2020 12/31/9999 76604 26 US EXAM CHEST $ 23.74 $ 23.74 3/1/2020 12/31/9999 76604 TC US EXAM CHEST $ 46.65 $ 46.65 3/1/2020 12/31/9999 76604 US EXAM CHEST $ 70.39 $ 70.39 3/1/2020 12/31/9999 76641 26 ULTRASOUND BREAST COMPLETE $ 32.21 $ 32.21 3/1/2020 12/31/9999 76641 TC ULTRASOUND BREAST COMPLETE $ 60.08 $ 60.08 3/1/2020 12/31/9999 76641 ULTRASOUND BREAST COMPLETE $ 92.30 $ 92.30 3/1/2020 12/31/9999 76642 26 ULTRASOUND BREAST LIMITED $ 30.00 $ 30.00 3/1/2020 12/31/9999 76642 TC ULTRASOUND BREAST LIMITED $ 45.95 $ 45.95 3/1/2020 12/31/9999 76642 ULTRASOUND BREAST LIMITED $ 75.95 $ 75.95 3/1/2020 12/31/9999 76700 26 US EXAM ABDOM COMPLETE $ 35.05 $ 35.05 3/1/2020 12/31/9999 76700 TC US EXAM ABDOM COMPLETE $ 76.24 $ 76.24 3/1/2020 12/31/9999 76700 US EXAM ABDOM COMPLETE $ 111.28 $ 111.28 3/1/2020 12/31/9999 76705 26 ECHO EXAM OF ABDOMEN $ 25.80 $ 25.80 3/1/2020 12/31/9999 76705 TC ECHO EXAM OF ABDOMEN $ 58.59 $ 58.59 3/1/2020 12/31/9999 76705 ECHO EXAM OF ABDOMEN $ 84.39 $ 84.39 3/1/2020 12/31/9999 76706 26 US ABDL AORTA SCREEN AAA $ 24.87 $ 24.87 3/1/2020 12/31/9999 76706 TC US ABDL AORTA SCREEN AAA $ 56.35 $ 56.35 3/1/2020 12/31/9999 76706 US ABDL AORTA SCREEN AAA $ 81.23 $ 81.23 3/1/2020 12/31/9999 76770 26 US EXAM ABDO BACK WALL COMP $ 32.04 $ 32.04 3/1/2020 12/31/9999 76770 TC US EXAM ABDO BACK WALL COMP $ 74.49 $ 74.49 3/1/2020 12/31/9999 76770 US EXAM ABDO BACK WALL COMP $ 106.51 $ 106.51 3/1/2020 12/31/9999 76775 26 US EXAM ABDO BACK WALL LIM $ 25.49 $ 25.78 3/1/2020 12/31/9999 76775 TC US EXAM ABDO BACK WALL LIM $ 65.06 $ 65.06 3/1/2020 12/31/9999 76775 US EXAM ABDO BACK WALL LIM $ 90.54 $ 90.84 3/1/2020 12/31/9999 76776 26 US EXAM K TRANSPL W/DOPPLER $ 32.97 $ 32.97 3/1/2020 12/31/9999 76776 TC US EXAM K TRANSPL W/DOPPLER $ 85.34 $ 85.34 3/1/2020 12/31/9999 76776 US EXAM K TRANSPL W/DOPPLER $ 118.31 $ 118.31 3/1/2020 12/31/9999 76800 26 US EXAM SPINAL CANAL $ 46.29 $ 46.29 3/1/2020 12/31/9999 76800 TC US EXAM SPINAL CANAL $ 54.78 $ 54.78 3/1/2020 12/31/9999 76800 US EXAM SPINAL CANAL $ 101.07 $ 101.07 3/1/2020 12/31/9999 76801 26 OB US < 14 WKS SINGLE FETUS $ 42.53 $ 42.53 3/1/2020 12/31/9999 76801 TC OB US < 14 WKS SINGLE FETUS $ 64.69 $ 64.69 3/1/2020 12/31/9999 76801 OB US < 14 WKS SINGLE FETUS $ 107.22 $ 107.22 3/1/2020 12/31/9999 76802 26 OB US < 14 WKS ADDL FETUS $ 35.39 $ 35.39 3/1/2020 12/31/9999 76802 TC OB US < 14 WKS ADDL FETUS $ 25.62 $ 25.62 3/1/2020 12/31/9999 76802 OB US < 14 WKS ADDL FETUS $ 61.02 $ 61.02 3/1/2020 12/31/9999 76805 26 OB US >= 14 WKS SNGL FETUS $ 42.24 $ 42.24 3/1/2020 12/31/9999 76805 TC OB US >= 14 WKS SNGL FETUS $ 77.03 $ 77.03 3/1/2020 12/31/9999 76805 OB US >= 14 WKS SNGL FETUS $ 119.26 $ 119.26 3/1/2020 12/31/9999 76810 26 OB US >= 14 WKS ADDL FETUS $ 41.62 $ 41.62 3/1/2020 12/31/9999 76810 TC OB US >= 14 WKS ADDL FETUS $ 41.15 $ 41.15 3/1/2020 12/31/9999 76810 OB US >= 14 WKS ADDL FETUS $ 82.76 $ 82.76 3/1/2020 12/31/9999 76811 26 OB US DETAILED SNGL FETUS $ 80.06 $ 80.06 3/1/2020 12/31/9999 76811 TC OB US DETAILED SNGL FETUS $ 88.56 $ 88.56 3/1/2020 12/31/9999 76811 OB US DETAILED SNGL FETUS $ 168.63 $ 168.63 3/1/2020 12/31/9999 76812 26 OB US DETAILED ADDL FETUS $ 74.88 $ 74.88 3/1/2020 12/31/9999 76812 TC OB US DETAILED ADDL FETUS $ 90.21 $ 90.21 3/1/2020 12/31/9999 76812 OB US DETAILED ADDL FETUS $ 165.09 $ 165.09 3/1/2020 12/31/9999 76813 26 OB US NUCHAL MEAS 1 GEST $ 49.06 $ 49.06 3/1/2020 12/31/9999 76813 TC OB US NUCHAL MEAS 1 GEST $ 55.99 $ 55.99 3/1/2020 12/31/9999 76813 OB US NUCHAL MEAS 1 GEST $ 105.04 $ 105.04 3/1/2020 12/31/9999 76814 26 OB US NUCHAL MEAS ADD-ON $ 41.25 $ 41.25 3/1/2020 12/31/9999 76814 TC OB US NUCHAL MEAS ADD-ON $ 27.49 $ 27.49 3/1/2020 12/31/9999 76814 OB US NUCHAL MEAS ADD-ON $ 68.75 $ 68.75 3/1/2020 12/31/9999 76815 26 OB US LIMITED FETUS(S) $ 27.71 $ 27.71 3/1/2020 12/31/9999 76815 TC OB US LIMITED FETUS(S) $ 46.56 $ 46.56 3/1/2020 12/31/9999 76815 OB US LIMITED FETUS(S) $ 74.26 $ 74.26 3/1/2020 12/31/9999 76816 26 OB US FOLLOW-UP PER FETUS $ 36.03 $ 36.03 3/1/2020 12/31/9999 76816 TC OB US FOLLOW-UP PER FETUS $ 55.25 $ 55.25 3/1/2020 12/31/9999 76816 OB US FOLLOW-UP PER FETUS $ 91.28 $ 91.29 3/1/2020 12/31/9999 76817 26 TRANSVAGINAL US OBSTETRIC $ 31.76 $ 31.76 3/1/2020 12/31/9999 76817 TC TRANSVAGINAL US OBSTETRIC $ 51.14 $ 51.14 3/1/2020 12/31/9999 76817 TRANSVAGINAL US OBSTETRIC $ 82.92 $ 82.92 3/1/2020 12/31/9999 76818 26 FETAL BIOPHYS PROFILE W/NST $ 44.33 $ 44.33 3/1/2020 12/31/9999 76818 TC FETAL BIOPHYS PROFILE W/NST $ 54.88 $ 54.88 3/1/2020 12/31/9999 76818 FETAL BIOPHYS PROFILE W/NST $ 99.23 $ 99.23 3/1/2020 12/31/9999 76819 26 FETAL BIOPHYS PROFIL W/O NST $ 32.70 $ 32.70 3/1/2020 12/31/9999 76819 TC FETAL BIOPHYS PROFIL W/O NST $ 44.02 $ 44.02 3/1/2020 12/31/9999 76819 FETAL BIOPHYS PROFIL W/O NST $ 76.71 $ 76.71 3/1/2020 12/31/9999 76820 26 UMBILICAL ARTERY ECHO $ 21.18 $ 21.18 3/1/2020 12/31/9999 76820 TC UMBILICAL ARTERY ECHO $ 23.27 $ 23.27 3/1/2020 12/31/9999 76820 UMBILICAL ARTERY ECHO $ 44.45 $ 44.45 3/1/2020 12/31/9999 76821 26 MIDDLE CEREBRAL ARTERY ECHO $ 29.60 $ 29.60 3/1/2020 12/31/9999 76821 TC MIDDLE CEREBRAL ARTERY ECHO $ 50.00 $ 50.00 3/1/2020 12/31/9999 76821 MIDDLE CEREBRAL ARTERY ECHO $ 79.60 $ 79.60 3/1/2020 12/31/9999 76825 26 ECHO EXAM OF FETAL HEART $ 70.59 $ 70.59 3/1/2020 12/31/9999 76825 TC ECHO EXAM OF FETAL HEART $ 100.33 $ 100.33 3/1/2020 12/31/9999 76825 ECHO EXAM OF FETAL HEART $ 170.93 $ 170.93 3/1/2020 12/31/9999 76826 26 ECHO EXAM OF FETAL HEART $ 34.60 $ 34.60 3/1/2020 12/31/9999 76826 TC ECHO EXAM OF FETAL HEART $ 59.47 $ 59.47 3/1/2020 12/31/9999 76826 ECHO EXAM OF FETAL HEART $ 94.07 $ 94.07 3/1/2020 12/31/9999 76827 26 ECHO EXAM OF FETAL HEART $ 24.40 $ 24.40 3/1/2020 12/31/9999 76827 TC ECHO EXAM OF FETAL HEART $ 34.44 $ 34.44 3/1/2020 12/31/9999 76827 ECHO EXAM OF FETAL HEART $ 58.84 $ 58.84 3/1/2020 12/31/9999 76828 26 ECHO EXAM OF FETAL HEART $ 23.67 $ 23.67 3/1/2020 12/31/9999 76828 TC ECHO EXAM OF FETAL HEART $ 20.12 $ 20.12 3/1/2020 12/31/9999 76828 ECHO EXAM OF FETAL HEART $ 43.80 $ 43.80 3/1/2020 12/31/9999 76830 26 TRANSVAGINAL US NON-OB $ 29.57 $ 29.57 3/1/2020 12/31/9999 76830 TC TRANSVAGINAL US NON-OB $ 68.10 $ 68.10 3/1/2020 12/31/9999 76830 TRANSVAGINAL US NON-OB $ 97.67 $ 97.67 3/1/2020 12/31/9999 76831 26 ECHO EXAM UTERUS $ 30.23 $ 30.23 3/1/2020 12/31/9999 76831 TC ECHO EXAM UTERUS $ 67.52 $ 67.52 3/1/2020 12/31/9999 76831 ECHO EXAM UTERUS $ 97.74 $ 97.74 3/1/2020 12/31/9999 76856 26 US EXAM PELVIC COMPLETE $ 29.86 $ 29.86 3/1/2020 12/31/9999 76856 TC US EXAM PELVIC COMPLETE $ 68.41 $ 68.41 3/1/2020 12/31/9999 76856 US EXAM PELVIC COMPLETE $ 98.27 $ 98.27 3/1/2020 12/31/9999 76857 26 US EXAM PELVIC LIMITED $ 16.87 $ 16.87 3/1/2020 12/31/9999 76857 TC US EXAM PELVIC LIMITED $ 64.66 $ 64.66 3/1/2020 12/31/9999 76857 US EXAM PELVIC LIMITED $ 81.53 $ 81.53 3/1/2020 12/31/9999 76870 26 US EXAM SCROTUM $ 27.98 $ 27.98 3/1/2020 12/31/9999 76870 TC US EXAM SCROTUM $ 69.28 $ 69.28 3/1/2020 12/31/9999 76870 US EXAM SCROTUM $ 97.27 $ 97.27 3/1/2020 12/31/9999 76872 26 US TRANSRECTAL $ 30.94 $ 30.94 3/1/2020 12/31/9999 76872 TC US TRANSRECTAL $ 84.85 $ 84.85 3/1/2020 12/31/9999 76872 US TRANSRECTAL $ 115.79 $ 115.79 3/1/2020 12/31/9999 76873 26 ECHOGRAP TRANS R PROS STUDY $ 67.48 $ 67.48 3/1/2020 12/31/9999 76873 TC ECHOGRAP TRANS R PROS STUDY $ 79.60 $ 79.60 3/1/2020 12/31/9999 76873 ECHOGRAP TRANS R PROS STUDY $ 147.08 $ 147.08 3/1/2020 12/31/9999 76881 26 US COMPL JOINT R-T W/IMG $ 24.62 $ 24.62 3/1/2020 12/31/9999 76881 TC US COMPL JOINT R-T W/IMG $ 72.48 $ 72.48 3/1/2020 12/31/9999 76881 US COMPL JOINT R-T W/IMG $ 97.11 $ 97.11 3/1/2020 12/31/9999 76882 26 US LMTD JT/NONVASC XTR STRUX $ 17.08 $ 17.08 3/1/2020 12/31/9999 76882 TC US LMTD JT/NONVASC XTR STRUX $ 8.47 $ 8.47 3/1/2020 12/31/9999 76882 US LMTD JT/NONVASC XTR STRUX $ 25.56 $ 25.56 3/1/2020 12/31/9999 76885 26 US EXAM INFANT HIPS DYNAMIC $ 32.04 $ 32.04 3/1/2020 12/31/9999 76885 TC US EXAM INFANT HIPS DYNAMIC $ 78.68 $ 78.68 3/1/2020 12/31/9999 76885 US EXAM INFANT HIPS DYNAMIC $ 110.72 $ 110.72 3/1/2020 12/31/9999 76886 26 US EXAM INFANT HIPS STATIC $ 26.46 $ 26.46 3/1/2020 12/31/9999 76886 TC US EXAM INFANT HIPS STATIC $ 55.37 $ 55.37 3/1/2020 12/31/9999 76886 US EXAM INFANT HIPS STATIC $ 81.83 $ 81.83 3/1/2020 12/31/9999 76932 26 ECHO GUIDE FOR HEART BIOPSY $ 31.07 $ 31.07 3/1/2020 12/31/9999 76932 TC ECHO GUIDE FOR HEART BIOPSY $ 49.79 $ 49.79 3/1/2020 12/31/9999 76932 ECHO GUIDE FOR HEART BIOPSY $ 80.89 $ 80.89 3/1/2020 12/31/9999 76936 26 ECHO GUIDE FOR ARTERY REPAIR $ 87.26 $ 87.26 3/1/2020 12/31/9999 76936 TC ECHO GUIDE FOR ARTERY REPAIR $ 169.28 $ 169.28 3/1/2020 12/31/9999 76936 ECHO GUIDE FOR ARTERY REPAIR $ 256.55 $ 256.55 3/1/2020 12/31/9999 76937 26 US GUIDE VASCULAR ACCESS $ 13.37 $ 13.37 3/1/2020 12/31/9999 76937 TC US GUIDE VASCULAR ACCESS $ 16.12 $ 16.12 3/1/2020 12/31/9999 76937 US GUIDE VASCULAR ACCESS $ 29.47 $ 29.47 3/1/2020 12/31/9999 76940 26 US GUIDE TISSUE ABLATION $ 90.03 $ 90.03 3/1/2020 12/31/9999 76940 TC US GUIDE TISSUE ABLATION $ 54.33 $ 54.33 3/1/2020 12/31/9999 76940 US GUIDE TISSUE ABLATION $ 141.68 $ 141.68 3/1/2020 12/31/9999 76941 26 ECHO GUIDE FOR TRANSFUSION $ 56.89 $ 56.89 3/1/2020 12/31/9999 76941 TC ECHO GUIDE FOR TRANSFUSION $ 45.66 $ 45.66 3/1/2020 12/31/9999 76941 ECHO GUIDE FOR TRANSFUSION $ 102.55 $ 102.55 3/1/2020 12/31/9999 76942 26 ECHO GUIDE FOR BIOPSY $ 29.22 $ 29.22 3/1/2020 12/31/9999 76942 TC ECHO GUIDE FOR BIOPSY $ 120.98 $ 120.98 3/1/2020 12/31/9999 76942 ECHO GUIDE FOR BIOPSY $ 150.20 $ 150.20 3/1/2020 12/31/9999 76945 26 ECHO GUIDE VILLUS SAMPLING $ 28.35 $ 28.35 3/1/2020 12/31/9999 76945 TC ECHO GUIDE VILLUS SAMPLING $ 46.36 $ 46.36 3/1/2020 12/31/9999 76945 ECHO GUIDE VILLUS SAMPLING $ 74.71 $ 74.71 3/1/2020 12/31/9999 76946 26 ECHO GUIDE FOR AMNIOCENTESIS $ 16.00 $ 16.00 3/1/2020 12/31/9999 76946 TC ECHO GUIDE FOR AMNIOCENTESIS $ 20.53 $ 20.53 3/1/2020 12/31/9999 76946 ECHO GUIDE FOR AMNIOCENTESIS $ 36.51 $ 36.51 3/1/2020 12/31/9999 76965 26 ECHO GUIDANCE RADIOTHERAPY $ 59.15 $ 59.15 3/1/2020 12/31/9999 76965 TC ECHO GUIDANCE RADIOTHERAPY $ 61.95 $ 61.95 3/1/2020 12/31/9999 76965 ECHO GUIDANCE RADIOTHERAPY $ 121.09 $ 121.09 3/1/2020 12/31/9999 76970 26 ULTRASOUND EXAM FOLLOW-UP $ 16.63 $ 16.63 3/1/2020 12/31/9999 76970 TC ULTRASOUND EXAM FOLLOW-UP $ 50.85 $ 50.85 3/1/2020 12/31/9999 76970 ULTRASOUND EXAM FOLLOW-UP $ 67.48 $ 67.48 3/1/2020 12/31/9999 76975 26 GI ENDOSCOPIC ULTRASOUND $ 35.64 $ 35.64 3/1/2020 12/31/9999 76975 TC GI ENDOSCOPIC ULTRASOUND $ 47.67 $ 47.67 3/1/2020 12/31/9999 76975 GI ENDOSCOPIC ULTRASOUND $ 83.30 $ 83.30 3/1/2020 12/31/9999 76977 26 US BONE DENSITY MEASURE $ 2.37 $ 2.37 3/1/2020 12/31/9999 76977 TC US BONE DENSITY MEASURE $ 8.94 $ 8.94 3/1/2020 12/31/9999 76977 US BONE DENSITY MEASURE $ 11.32 $ 11.32 3/1/2020 12/31/9999 76978 26 US TRGT DYN MBUBB 1ST LES $ 72.56 $ 72.56 3/1/2020 12/31/9999 76978 US TRGT DYN MBUBB 1ST LES $ 280.93 $ 280.93 3/1/2020 12/31/9999 76978 TC US TRGT DYN MBUBB 1ST LES $ 208.37 $ 208.37 3/1/2020 12/31/9999 76979 26 US TRGT DYN MBUBB EA ADDL $ 38.19 $ 38.19 3/1/2020 12/31/9999 76979 US TRGT DYN MBUBB EA ADDL $ 190.28 $ 190.28 3/1/2020 12/31/9999 76979 TC US TRGT DYN MBUBB EA ADDL $ 152.09 $ 152.09 3/1/2020 12/31/9999 76998 26 US GUIDE INTRAOP $ 52.17 $ 52.17 3/1/2020 12/31/9999 76998 TC US GUIDE INTRAOP $ 85.52 $ 85.52 3/1/2020 12/31/9999 76998 US GUIDE INTRAOP $ 137.10 $ 137.10 3/1/2020 12/31/9999 77001 26 FLUOROGUIDE FOR VEIN DEVICE $ 16.38 $ 16.38 3/1/2020 12/31/9999 77001 TC FLUOROGUIDE FOR VEIN DEVICE $ 68.10 $ 68.10 3/1/2020 12/31/9999 77001 FLUOROGUIDE FOR VEIN DEVICE $ 84.49 $ 84.49 3/1/2020 12/31/9999 77002 26 NEEDLE LOCALIZATION BY XRAY $ 22.84 $ 22.84 3/1/2020 12/31/9999 77002 TC NEEDLE LOCALIZATION BY XRAY $ 35.19 $ 35.19 3/1/2020 12/31/9999 77002 NEEDLE LOCALIZATION BY XRAY $ 58.03 $ 58.03 3/1/2020 12/31/9999 77003 26 FLUOROGUIDE FOR SPINE INJECT $ 24.07 $ 24.06 3/1/2020 12/31/9999 77003 TC FLUOROGUIDE FOR SPINE INJECT $ 24.61 $ 24.61 3/1/2020 12/31/9999 77003 FLUOROGUIDE FOR SPINE INJECT $ 48.68 $ 48.68 3/1/2020 12/31/9999 77011 26 CT SCAN FOR LOCALIZATION $ 52.06 $ 52.06 3/1/2020 12/31/9999 77011 TC CT SCAN FOR LOCALIZATION $ 496.08 $ 496.08 3/1/2020 12/31/9999 77011 CT SCAN FOR LOCALIZATION $ 548.13 $ 548.13 3/1/2020 12/31/9999 77012 26 CT SCAN FOR NEEDLE BIOPSY $ 50.77 $ 50.77 3/1/2020 12/31/9999 77012 TC CT SCAN FOR NEEDLE BIOPSY $ 110.96 $ 110.96 3/1/2020 12/31/9999 77012 CT SCAN FOR NEEDLE BIOPSY $ 161.74 $ 161.74 3/1/2020 12/31/9999 77013 26 CT GUIDE FOR TISSUE ABLATION $ 174.99 $ 174.99 3/1/2020 12/31/9999 77013 TC CT GUIDE FOR TISSUE ABLATION $ 325.01 $ 325.01 3/1/2020 12/31/9999 77013 CT GUIDE FOR TISSUE ABLATION $ 490.27 $ 490.27 3/1/2020 12/31/9999 77014 26 CT SCAN FOR THERAPY GUIDE $ 36.31 $ 36.31 3/1/2020 12/31/9999 77014 TC CT SCAN FOR THERAPY GUIDE $ 114.56 $ 114.56 3/1/2020 12/31/9999 77014 CT SCAN FOR THERAPY GUIDE $ 150.87 $ 150.87 3/1/2020 12/31/9999 77021 26 MRI GUIDANCE NDL PLMT RS&I $ 65.90 $ 65.90 3/1/2020 12/31/9999 77021 TC MRI GUIDANCE NDL PLMT RS&I $ 296.59 $ 296.59 3/1/2020 12/31/9999 77021 MRI GUIDANCE NDL PLMT RS&I $ 362.49 $ 362.49 3/1/2020 12/31/9999 77022 26 MRI GDN PARNCHYMA TISS ABLTJ $ 183.25 $ 183.25 3/1/2020 12/31/9999 77022 TC MRI GDN PARNCHYMA TISS ABLTJ $ 61.10 $ 61.10 3/1/2020 12/31/9999 77022 MRI GDN PARNCHYMA TISS ABLTJ $ 244.34 $ 244.34 3/1/2020 12/31/9999 77046 26 MRI BREAST C- UNILATERAL $ 65.06 $ 65.06 3/1/2020 12/31/9999 77046 MRI BREAST C- UNILATERAL $ 215.26 $ 215.26 3/1/2020 12/31/9999 77046 TC MRI BREAST C- UNILATERAL $ 150.20 $ 150.20 3/1/2020 12/31/9999 77047 26 MRI BREAST C- BILATERAL $ 71.98 $ 71.98 3/1/2020 12/31/9999 77047 MRI BREAST C- BILATERAL $ 221.28 $ 221.28 3/1/2020 12/31/9999 77047 TC MRI BREAST C- BILATERAL $ 149.29 $ 149.29 3/1/2020 12/31/9999 77048 26 MRI BREAST C-+ W/CAD UNI $ 94.08 $ 94.08 3/1/2020 12/31/9999 77048 MRI BREAST C-+ W/CAD UNI $ 341.46 $ 341.46 3/1/2020 12/31/9999 77048 TC MRI BREAST C-+ W/CAD UNI $ 247.38 $ 247.38 3/1/2020 12/31/9999 77049 26 MRI BREAST C-+ W/CAD BI $ 102.94 $ 102.94 3/1/2020 12/31/9999 77049 MRI BREAST C-+ W/CAD BI $ 349.10 $ 349.10 3/1/2020 12/31/9999 77049 TC MRI BREAST C-+ W/CAD BI $ 246.17 $ 246.17 3/1/2020 12/31/9999 77053 26 X-RAY OF MAMMARY DUCT $ 15.66 $ 15.66 3/1/2020 12/31/9999 77053 TC X-RAY OF MAMMARY DUCT $ 46.29 $ 46.29 3/1/2020 12/31/9999 77053 X-RAY OF MAMMARY DUCT $ 61.95 $ 61.95 3/1/2020 12/31/9999 77054 26 X-RAY OF MAMMARY DUCTS $ 19.69 $ 19.69 3/1/2020 12/31/9999 77054 TC X-RAY OF MAMMARY DUCTS $ 63.75 $ 63.75 3/1/2020 12/31/9999 77054 X-RAY OF MAMMARY DUCTS $ 83.43 $ 83.43 3/1/2020 12/31/9999 77063 26 BREAST TOMOSYNTHESIS BI $ 26.34 $ 26.34 3/1/2020 12/31/9999 77063 TC BREAST TOMOSYNTHESIS BI $ 21.49 $ 21.49 3/1/2020 12/31/9999 77063 BREAST TOMOSYNTHESIS BI $ 47.84 $ 47.84 3/1/2020 12/31/9999 77065 26 DX MAMMO INCL CAD UNI $ 29.88 $ 29.88 3/1/2020 12/31/9999 77065 TC DX MAMMO INCL CAD UNI $ 69.66 $ 69.66 3/1/2020 12/31/9999 77065 DX MAMMO INCL CAD UNI $ 99.53 $ 99.53 3/1/2020 12/31/9999 77066 26 DX MAMMO INCL CAD BI $ 36.95 $ 36.95 3/1/2020 12/31/9999 77066 TC DX MAMMO INCL CAD BI $ 88.36 $ 88.36 3/1/2020 12/31/9999 77066 DX MAMMO INCL CAD BI $ 125.31 $ 125.31 3/1/2020 12/31/9999 77067 26 SCR MAMMO BI INCL CAD $ 29.88 $ 29.88 3/1/2020 12/31/9999 77067 TC SCR MAMMO BI INCL CAD $ 76.61 $ 76.61 3/1/2020 12/31/9999 77067 SCR MAMMO BI INCL CAD $ 106.49 $ 106.49 3/1/2020 12/31/9999 77072 26 X-RAYS FOR BONE AGE $ 8.30 $ 8.30 3/1/2020 12/31/9999 77072 TC X-RAYS FOR BONE AGE $ 10.97 $ 10.97 3/1/2020 12/31/9999 77072 X-RAYS FOR BONE AGE $ 19.27 $ 19.27 3/1/2020 12/31/9999 77073 26 X-RAYS BONE LENGTH STUDIES $ 11.72 $ 11.72 3/1/2020 12/31/9999 77073 TC X-RAYS BONE LENGTH STUDIES $ 18.92 $ 18.92 3/1/2020 12/31/9999 77073 X-RAYS BONE LENGTH STUDIES $ 30.64 $ 30.64 3/1/2020 12/31/9999 77074 26 X-RAYS BONE SURVEY LIMITED $ 19.69 $ 19.69 3/1/2020 12/31/9999 77074 TC X-RAYS BONE SURVEY LIMITED $ 36.47 $ 36.47 3/1/2020 12/31/9999 77074 X-RAYS BONE SURVEY LIMITED $ 56.15 $ 56.15 3/1/2020 12/31/9999 77075 26 X-RAYS BONE SURVEY COMPLETE $ 23.43 $ 23.43 3/1/2020 12/31/9999 77075 TC X-RAYS BONE SURVEY COMPLETE $ 57.72 $ 57.72 3/1/2020 12/31/9999 77075 X-RAYS BONE SURVEY COMPLETE $ 81.14 $ 81.14 3/1/2020 12/31/9999 77076 26 X-RAYS BONE SURVEY INFANT $ 29.31 $ 29.31 3/1/2020 12/31/9999 77076 TC X-RAYS BONE SURVEY INFANT $ 46.83 $ 46.83 3/1/2020 12/31/9999 77076 X-RAYS BONE SURVEY INFANT $ 76.14 $ 76.14 3/1/2020 12/31/9999 77077 26 JOINT SURVEY SINGLE VIEW $ 13.47 $ 13.47 3/1/2020 12/31/9999 77077 TC JOINT SURVEY SINGLE VIEW $ 21.19 $ 21.19 3/1/2020 12/31/9999 77077 JOINT SURVEY SINGLE VIEW $ 34.66 $ 34.66 3/1/2020 12/31/9999 77078 26 CT BONE DENSITY AXIAL $ 10.78 $ 10.78 3/1/2020 12/31/9999 77078 TC CT BONE DENSITY AXIAL $ 126.89 $ 126.89 3/1/2020 12/31/9999 77078 CT BONE DENSITY AXIAL $ 137.67 $ 137.67 3/1/2020 12/31/9999 77080 26 DXA BONE DENSITY AXIAL $ 8.61 $ 8.61 3/1/2020 12/31/9999 77080 TC DXA BONE DENSITY AXIAL $ 48.67 $ 48.67 3/1/2020 12/31/9999 77080 DXA BONE DENSITY AXIAL $ 57.27 $ 57.27 3/1/2020 12/31/9999 77081 26 DXA BONE DENSITY/PERIPHERAL $ 9.24 $ 9.24 3/1/2020 12/31/9999 77081 TC DXA BONE DENSITY/PERIPHERAL $ 15.40 $ 15.40 3/1/2020 12/31/9999 77081 DXA BONE DENSITY/PERIPHERAL $ 24.64 $ 24.64 3/1/2020 12/31/9999 77084 26 MAGNETIC IMAGE BONE MARROW $ 69.85 $ 69.85 3/1/2020 12/31/9999 77084 TC MAGNETIC IMAGE BONE MARROW $ 399.33 $ 399.33 3/1/2020 12/31/9999 77084 MAGNETIC IMAGE BONE MARROW $ 469.17 $ 469.17 3/1/2020 12/31/9999 77085 26 DXA BONE DENSITY STUDY $ 13.56 $ 13.56 3/1/2020 12/31/9999 77085 TC DXA BONE DENSITY STUDY $ 34.52 $ 34.52 3/1/2020 12/31/9999 77085 DXA BONE DENSITY STUDY $ 48.08 $ 48.08 3/1/2020 12/31/9999 77086 26 FRACTURE ASSESSMENT VIA DXA $ 7.84 $ 7.84 3/1/2020 12/31/9999 77086 TC FRACTURE ASSESSMENT VIA DXA $ 22.49 $ 22.49 3/1/2020 12/31/9999 77086 FRACTURE ASSESSMENT VIA DXA $ 30.35 $ 30.35 3/1/2020 12/31/9999 77261 RADIATION THERAPY PLANNING $ 60.53 $ 60.53 3/1/2020 12/31/9999 77262 RADIATION THERAPY PLANNING $ 90.96 $ 90.96 3/1/2020 12/31/9999 77263 RADIATION THERAPY PLANNING $ 134.96 $ 134.96 3/1/2020 12/31/9999 77280 26 SET RADIATION THERAPY FIELD $ 30.08 $ 30.08 3/1/2020 12/31/9999 77280 TC SET RADIATION THERAPY FIELD $ 119.66 $ 119.66 3/1/2020 12/31/9999 77280 SET RADIATION THERAPY FIELD $ 149.74 $ 149.74 3/1/2020 12/31/9999 77285 26 SET RADIATION THERAPY FIELD $ 44.93 $ 44.93 3/1/2020 12/31/9999 77285 TC SET RADIATION THERAPY FIELD $ 212.84 $ 212.84 3/1/2020 12/31/9999 77285 SET RADIATION THERAPY FIELD $ 257.76 $ 257.76 3/1/2020 12/31/9999 77290 26 SET RADIATION THERAPY FIELD $ 66.72 $ 66.72 3/1/2020 12/31/9999 77290 TC SET RADIATION THERAPY FIELD $ 333.41 $ 333.41 3/1/2020 12/31/9999 77290 SET RADIATION THERAPY FIELD $ 400.11 $ 400.11 3/1/2020 12/31/9999 77293 26 RESPIRATOR MOTION MGMT SIMUL $ 86.80 $ 86.80 3/1/2020 12/31/9999 77293 TC RESPIRATOR MOTION MGMT SIMUL $ 267.25 $ 267.25 3/1/2020 12/31/9999 77293 RESPIRATOR MOTION MGMT SIMUL $ 354.04 $ 354.04 3/1/2020 12/31/9999 77295 26 3-D RADIOTHERAPY PLAN $ 194.97 $ 194.97 3/1/2020 12/31/9999 77295 TC 3-D RADIOTHERAPY PLAN $ 363.20 $ 363.20 3/1/2020 12/31/9999 77295 3-D RADIOTHERAPY PLAN $ 558.17 $ 558.17 3/1/2020 12/31/9999 77300 26 RADIATION THERAPY DOSE PLAN $ 26.46 $ 26.46 3/1/2020 12/31/9999 77300 TC RADIATION THERAPY DOSE PLAN $ 32.26 $ 32.26 3/1/2020 12/31/9999 77300 RADIATION THERAPY DOSE PLAN $ 58.72 $ 58.72 3/1/2020 12/31/9999 77301 26 RADIOTHERAPY DOSE PLAN IMRT $ 341.69 $ 341.69 3/1/2020 12/31/9999 77301 TC RADIOTHERAPY DOSE PLAN IMRT $ 1,416.57 $ 1,416.57 3/1/2020 12/31/9999 77301 RADIOTHERAPY DOSE PLAN IMRT $ 1,758.26 $ 1,758.26 3/1/2020 12/31/9999 77306 26 TELETHX ISODOSE PLAN SIMPLE $ 62.60 $ 62.60 3/1/2020 12/31/9999 77306 TC TELETHX ISODOSE PLAN SIMPLE $ 61.58 $ 61.58 3/1/2020 12/31/9999 77306 TELETHX ISODOSE PLAN SIMPLE $ 124.17 $ 124.17 3/1/2020 12/31/9999 77307 26 TELETHX ISODOSE PLAN CPLX $ 129.87 $ 129.87 3/1/2020 12/31/9999 77307 TC TELETHX ISODOSE PLAN CPLX $ 112.70 $ 112.70 3/1/2020 12/31/9999 77307 TELETHX ISODOSE PLAN CPLX $ 242.56 $ 242.56 3/1/2020 12/31/9999 77316 26 BRACHYTX ISODOSE PLAN SIMPLE $ 62.84 $ 62.84 3/1/2020 12/31/9999 77316 TC BRACHYTX ISODOSE PLAN SIMPLE $ 95.56 $ 95.56 3/1/2020 12/31/9999 77316 BRACHYTX ISODOSE PLAN SIMPLE $ 158.39 $ 158.39 3/1/2020 12/31/9999 77317 26 BRACHYTX ISODOSE INTERMED $ 82.66 $ 82.66 3/1/2020 12/31/9999 77317 TC BRACHYTX ISODOSE INTERMED $ 124.72 $ 124.72 3/1/2020 12/31/9999 77317 BRACHYTX ISODOSE INTERMED $ 207.38 $ 207.38 3/1/2020 12/31/9999 77318 26 BRACHYTX ISODOSE COMPLEX $ 130.37 $ 130.37 3/1/2020 12/31/9999 77318 TC BRACHYTX ISODOSE COMPLEX $ 169.22 $ 169.22 3/1/2020 12/31/9999 77318 BRACHYTX ISODOSE COMPLEX $ 299.58 $ 299.58 3/1/2020 12/31/9999 77321 26 SPECIAL TELETX PORT PLAN $ 40.57 $ 40.57 3/1/2020 12/31/9999 77321 TC SPECIAL TELETX PORT PLAN $ 59.75 $ 59.75 3/1/2020 12/31/9999 77321 SPECIAL TELETX PORT PLAN $ 100.33 $ 100.33 3/1/2020 12/31/9999 77331 26 SPECIAL RADIATION DOSIMETRY $ 37.24 $ 37.24 3/1/2020 12/31/9999 77331 TC SPECIAL RADIATION DOSIMETRY $ 15.09 $ 15.09 3/1/2020 12/31/9999 77331 SPECIAL RADIATION DOSIMETRY $ 52.34 $ 52.34 3/1/2020 12/31/9999 77332 26 RADIATION TREATMENT AID(S) $ 23.04 $ 23.04 3/1/2020 12/31/9999 77332 TC RADIATION TREATMENT AID(S) $ 40.77 $ 40.77 3/1/2020 12/31/9999 77332 RADIATION TREATMENT AID(S) $ 63.81 $ 63.81 3/1/2020 12/31/9999 77333 26 RADIATION TREATMENT AID(S) $ 35.99 $ 35.99 3/1/2020 12/31/9999 77333 TC RADIATION TREATMENT AID(S) $ 21.30 $ 21.30 3/1/2020 12/31/9999 77333 RADIATION TREATMENT AID(S) $ 57.31 $ 57.31 3/1/2020 12/31/9999 77334 26 RADIATION TREATMENT AID(S) $ 52.92 $ 52.92 3/1/2020 12/31/9999 77334 TC RADIATION TREATMENT AID(S) $ 77.15 $ 77.15 3/1/2020 12/31/9999 77334 RADIATION TREATMENT AID(S) $ 130.07 $ 130.07 3/1/2020 12/31/9999 77336 RADIATION PHYSICS CONSULT $ 49.63 $ 49.63 3/1/2020 12/31/9999 77338 26 DESIGN MLC DEVICE FOR IMRT $ 147.53 $ 147.53 3/1/2020 12/31/9999 77338 TC DESIGN MLC DEVICE FOR IMRT $ 160.71 $ 160.71 3/1/2020 12/31/9999 77338 DESIGN MLC DEVICE FOR IMRT $ 308.24 $ 308.24 3/1/2020 12/31/9999 77370 RADIATION PHYSICS CONSULT $ 94.38 $ 94.38 3/1/2020 12/31/9999 77371 SRS MULTISOURCE $ 680.87 $ 680.87 3/1/2020 12/31/9999 77372 SRS LINEAR BASED $ 680.87 $ 680.87 3/1/2020 12/31/9999 77373 SBRT DELIVERY $ 1,264.15 $ 1,264.15 3/1/2020 12/31/9999 77385 NTSTY MODUL RAD TX DLVR SMPL $ 432.72 $ 432.72 3/1/2020 12/31/9999 77386 NTSTY MODUL RAD TX DLVR CPLX $ 432.72 $ 432.72 3/1/2020 12/31/9999 77387 GUIDANCE FOR RADJ TX DLVR $ 94.90 $ 94.90 3/1/2020 12/31/9999 77401 RADIATION TREATMENT DELIVERY $ 25.42 $ 25.42 3/1/2020 12/31/9999 77402 RADIATION TREATMENT DELIVERY $ 109.43 $ 109.43 3/1/2020 12/31/9999 77407 RADIATION TREATMENT DELIVERY $ 171.62 $ 171.62 3/1/2020 12/31/9999 77412 RADIATION TREATMENT DELIVERY $ 166.24 $ 166.24 3/1/2020 12/31/9999 77417 RADIOLOGY PORT IMAGES(S) $ 12.84 $ 12.84 3/1/2020 12/31/9999 77424 IO RAD TX DELIVERY BY X-RAY $ 107.92 $ 107.92 3/1/2020 12/31/9999 77425 IO RAD TX DELIVER BY ELCTRNS $ 107.92 $ 107.92 3/1/2020 12/31/9999 77427 RADIATION TX MANAGEMENT X5 $ 160.58 $ 160.58 3/1/2020 12/31/9999 77431 RADIATION THERAPY MANAGEMENT $ 81.92 $ 81.92 3/1/2020 12/31/9999 77432 STEREOTACTIC RADIATION TRMT $ 341.43 $ 341.43 3/1/2020 12/31/9999 77435 SBRT MANAGEMENT $ 566.14 $ 566.14 3/1/2020 12/31/9999 77469 IO RADIATION TX MANAGEMENT $ 178.20 $ 178.20 3/1/2020 12/31/9999 77470 26 SPECIAL RADIATION TREATMENT $ 89.45 $ 89.45 3/1/2020 12/31/9999 77470 TC SPECIAL RADIATION TREATMENT $ 120.56 $ 120.56 3/1/2020 12/31/9999 77470 SPECIAL RADIATION TREATMENT $ 210.01 $ 210.01 3/1/2020 12/31/9999 77600 26 HYPERTHERMIA TREATMENT $ 66.72 $ 66.72 3/1/2020 12/31/9999 77600 TC HYPERTHERMIA TREATMENT $ 234.99 $ 234.99 3/1/2020 12/31/9999 77600 HYPERTHERMIA TREATMENT $ 301.70 $ 301.70 3/1/2020 12/31/9999 77605 26 HYPERTHERMIA TREATMENT $ 87.21 $ 87.21 3/1/2020 12/31/9999 77605 TC HYPERTHERMIA TREATMENT $ 450.92 $ 450.92 3/1/2020 12/31/9999 77605 HYPERTHERMIA TREATMENT $ 538.14 $ 538.14 3/1/2020 12/31/9999 77610 26 HYPERTHERMIA TREATMENT $ 64.95 $ 64.95 3/1/2020 12/31/9999 77610 TC HYPERTHERMIA TREATMENT $ 437.09 $ 437.09 3/1/2020 12/31/9999 77610 HYPERTHERMIA TREATMENT $ 502.04 $ 502.04 3/1/2020 12/31/9999 77615 26 HYPERTHERMIA TREATMENT $ 89.15 $ 89.15 3/1/2020 12/31/9999 77615 TC HYPERTHERMIA TREATMENT $ 620.72 $ 620.72 3/1/2020 12/31/9999 77615 HYPERTHERMIA TREATMENT $ 709.86 $ 709.86 3/1/2020 12/31/9999 77620 26 HYPERTHERMIA TREATMENT $ 67.07 $ 67.07 3/1/2020 12/31/9999 77620 TC HYPERTHERMIA TREATMENT $ 248.79 $ 248.79 3/1/2020 12/31/9999 77620 HYPERTHERMIA TREATMENT $ 315.88 $ 315.88 3/1/2020 12/31/9999 77750 26 INFUSE RADIOACTIVE MATERIALS $ 211.27 $ 211.27 3/1/2020 12/31/9999 77750 TC INFUSE RADIOACTIVE MATERIALS $ 73.68 $ 73.68 3/1/2020 12/31/9999 77750 INFUSE RADIOACTIVE MATERIALS $ 284.93 $ 284.93 3/1/2020 12/31/9999 77761 26 APPLY INTRCAV RADIAT SIMPLE $ 162.14 $ 162.14 3/1/2020 12/31/9999 77761 TC APPLY INTRCAV RADIAT SIMPLE $ 130.01 $ 130.01 3/1/2020 12/31/9999 77761 APPLY INTRCAV RADIAT SIMPLE $ 292.15 $ 292.15 3/1/2020 12/31/9999 77762 26 APPLY INTRCAV RADIAT INTERM $ 245.08 $ 245.08 3/1/2020 12/31/9999 77762 TC APPLY INTRCAV RADIAT INTERM $ 154.53 $ 154.53 3/1/2020 12/31/9999 77762 APPLY INTRCAV RADIAT INTERM $ 399.61 $ 399.61 3/1/2020 12/31/9999 77763 26 APPLY INTRCAV RADIAT COMPL $ 367.84 $ 367.84 3/1/2020 12/31/9999 77763 TC APPLY INTRCAV RADIAT COMPL $ 198.80 $ 198.80 3/1/2020 12/31/9999 77763 APPLY INTRCAV RADIAT COMPL $ 566.63 $ 566.63 3/1/2020 12/31/9999 77767 26 HDR RDNCL SKN SURF BRACHYTX $ 48.45 $ 48.45 3/1/2020 12/31/9999 77767 TC HDR RDNCL SKN SURF BRACHYTX $ 144.26 $ 144.26 3/1/2020 12/31/9999 77767 HDR RDNCL SKN SURF BRACHYTX $ 192.72 $ 192.72 3/1/2020 12/31/9999 77768 26 HDR RDNCL SKN SURF BRACHYTX $ 64.24 $ 64.24 3/1/2020 12/31/9999 77768 TC HDR RDNCL SKN SURF BRACHYTX $ 237.13 $ 237.13 3/1/2020 12/31/9999 77768 HDR RDNCL SKN SURF BRACHYTX $ 301.37 $ 301.37 3/1/2020 12/31/9999 77770 26 HDR RDNCL NTRSTL/ICAV BRCHTX $ 89.45 $ 89.45 3/1/2020 12/31/9999 77770 TC HDR RDNCL NTRSTL/ICAV BRCHTX $ 186.64 $ 186.64 3/1/2020 12/31/9999 77770 HDR RDNCL NTRSTL/ICAV BRCHTX $ 276.09 $ 276.09 3/1/2020 12/31/9999 77771 26 HDR RDNCL NTRSTL/ICAV BRCHTX $ 174.75 $ 174.75 3/1/2020 12/31/9999 77771 TC HDR RDNCL NTRSTL/ICAV BRCHTX $ 339.93 $ 339.93 3/1/2020 12/31/9999 77771 HDR RDNCL NTRSTL/ICAV BRCHTX $ 514.68 $ 514.68 3/1/2020 12/31/9999 77772 26 HDR RDNCL NTRSTL/ICAV BRCHTX $ 247.81 $ 247.81 3/1/2020 12/31/9999 77772 TC HDR RDNCL NTRSTL/ICAV BRCHTX $ 536.45 $ 536.45 3/1/2020 12/31/9999 77772 HDR RDNCL NTRSTL/ICAV BRCHTX $ 784.26 $ 784.26 3/1/2020 12/31/9999 77778 26 APPLY INTERSTIT RADIAT COMPL $ 480.90 $ 480.90 3/1/2020 12/31/9999 77778 TC APPLY INTERSTIT RADIAT COMPL $ 206.93 $ 206.93 3/1/2020 12/31/9999 77778 APPLY INTERSTIT RADIAT COMPL $ 687.86 $ 687.86 3/1/2020 12/31/9999 77789 26 APPLY SURF LDR RADIONUCLIDE $ 48.87 $ 48.87 3/1/2020 12/31/9999 77789 TC APPLY SURF LDR RADIONUCLIDE $ 38.00 $ 38.00 3/1/2020 12/31/9999 77789 APPLY SURF LDR RADIONUCLIDE $ 86.87 $ 86.87 3/1/2020 12/31/9999 77790 26 RADIATION HANDLING $ 44.93 $ 44.93 3/1/2020 12/31/9999 77790 TC RADIATION HANDLING $ 28.01 $ 28.01 3/1/2020 12/31/9999 77790 RADIATION HANDLING $ 72.94 $ 72.94 3/1/2020 12/31/9999 78012 26 THYROID UPTAKE MEASUREMENT $ 7.80 $ 7.80 3/1/2020 12/31/9999 78012 TC THYROID UPTAKE MEASUREMENT $ 59.88 $ 59.88 3/1/2020 12/31/9999 78012 THYROID UPTAKE MEASUREMENT $ 67.68 $ 67.68 3/1/2020 12/31/9999 78013 26 THYROID IMAGING W/BLOOD FLOW $ 15.11 $ 15.11 3/1/2020 12/31/9999 78013 TC THYROID IMAGING W/BLOOD FLOW $ 155.88 $ 155.88 3/1/2020 12/31/9999 78013 THYROID IMAGING W/BLOOD FLOW $ 170.97 $ 170.97 3/1/2020 12/31/9999 78014 26 THYROID IMAGING W/BLOOD FLOW $ 20.21 $ 20.21 3/1/2020 12/31/9999 78014 TC THYROID IMAGING W/BLOOD FLOW $ 177.42 $ 177.42 3/1/2020 12/31/9999 78014 THYROID IMAGING W/BLOOD FLOW $ 197.64 $ 197.64 3/1/2020 12/31/9999 78015 26 THYROID MET IMAGING $ 29.22 $ 29.22 3/1/2020 12/31/9999 78015 TC THYROID MET IMAGING $ 134.72 $ 134.72 3/1/2020 12/31/9999 78015 THYROID MET IMAGING $ 163.94 $ 163.94 3/1/2020 12/31/9999 78016 26 THYROID MET IMAGING/STUDIES $ 35.75 $ 35.75 3/1/2020 12/31/9999 78016 TC THYROID MET IMAGING/STUDIES $ 212.77 $ 212.77 3/1/2020 12/31/9999 78016 THYROID MET IMAGING/STUDIES $ 248.52 $ 248.52 3/1/2020 12/31/9999 78018 26 THYROID MET IMAGING BODY $ 37.52 $ 37.52 3/1/2020 12/31/9999 78018 TC THYROID MET IMAGING BODY $ 213.22 $ 213.22 3/1/2020 12/31/9999 78018 THYROID MET IMAGING BODY $ 250.73 $ 250.73 3/1/2020 12/31/9999 78020 26 THYROID MET UPTAKE $ 26.21 $ 26.21 3/1/2020 12/31/9999 78020 TC THYROID MET UPTAKE $ 47.75 $ 47.75 3/1/2020 12/31/9999 78020 THYROID MET UPTAKE $ 73.97 $ 73.97 3/1/2020 12/31/9999 78070 26 PARATHYROID PLANAR IMAGING $ 35.95 $ 35.95 3/1/2020 12/31/9999 78070 TC PARATHYROID PLANAR IMAGING $ 103.55 $ 103.55 3/1/2020 12/31/9999 78070 PARATHYROID PLANAR IMAGING $ 139.50 $ 139.50 3/1/2020 12/31/9999 78071 26 PARATHYRD PLANAR W/WO SUBTRJ $ 48.05 $ 48.05 3/1/2020 12/31/9999 78071 TC PARATHYRD PLANAR W/WO SUBTRJ $ 247.60 $ 247.60 3/1/2020 12/31/9999 78071 PARATHYRD PLANAR W/WO SUBTRJ $ 295.65 $ 295.65 3/1/2020 12/31/9999 78075 26 ADRENAL CORTEX & MEDULLA IMG $ 32.33 $ 32.33 3/1/2020 12/31/9999 78075 TC ADRENAL CORTEX & MEDULLA IMG $ 292.82 $ 292.82 3/1/2020 12/31/9999 78075 ADRENAL CORTEX & MEDULLA IMG $ 325.16 $ 325.16 3/1/2020 12/31/9999 78102 26 BONE MARROW IMAGING LTD $ 24.03 $ 24.03 3/1/2020 12/31/9999 78102 TC BONE MARROW IMAGING LTD $ 104.94 $ 104.94 3/1/2020 12/31/9999 78102 BONE MARROW IMAGING LTD $ 128.97 $ 128.97 3/1/2020 12/31/9999 78103 26 BONE MARROW IMAGING MULT $ 32.64 $ 32.64 3/1/2020 12/31/9999 78103 TC BONE MARROW IMAGING MULT $ 140.61 $ 140.61 3/1/2020 12/31/9999 78103 BONE MARROW IMAGING MULT $ 173.26 $ 173.26 3/1/2020 12/31/9999 78104 26 BONE MARROW IMAGING BODY $ 35.12 $ 35.12 3/1/2020 12/31/9999 78104 TC BONE MARROW IMAGING BODY $ 163.35 $ 163.35 3/1/2020 12/31/9999 78104 BONE MARROW IMAGING BODY $ 198.46 $ 198.46 3/1/2020 12/31/9999 78110 26 PLASMA VOLUME SINGLE $ 8.30 $ 8.30 3/1/2020 12/31/9999 78110 TC PLASMA VOLUME SINGLE $ 53.19 $ 53.19 3/1/2020 12/31/9999 78110 PLASMA VOLUME SINGLE $ 61.50 $ 61.50 3/1/2020 12/31/9999 78111 26 PLASMA VOLUME MULTIPLE $ 9.84 $ 9.84 3/1/2020 12/31/9999 78111 TC PLASMA VOLUME MULTIPLE $ 68.62 $ 68.62 3/1/2020 12/31/9999 78111 PLASMA VOLUME MULTIPLE $ 78.45 $ 78.45 3/1/2020 12/31/9999 78120 26 RED CELL MASS SINGLE $ 10.14 $ 10.14 3/1/2020 12/31/9999 78120 TC RED CELL MASS SINGLE $ 59.79 $ 59.79 3/1/2020 12/31/9999 78120 RED CELL MASS SINGLE $ 69.94 $ 69.94 3/1/2020 12/31/9999 78121 26 RED CELL MASS MULTIPLE $ 13.88 $ 13.88 3/1/2020 12/31/9999 78121 TC RED CELL MASS MULTIPLE $ 70.97 $ 70.97 3/1/2020 12/31/9999 78121 RED CELL MASS MULTIPLE $ 84.86 $ 84.86 3/1/2020 12/31/9999 78122 26 BLOOD VOLUME $ 19.69 $ 19.69 3/1/2020 12/31/9999 78122 TC BLOOD VOLUME $ 85.62 $ 85.62 3/1/2020 12/31/9999 78122 BLOOD VOLUME $ 105.30 $ 105.30 3/1/2020 12/31/9999 78130 26 RED CELL SURVIVAL STUDY $ 26.72 $ 26.72 3/1/2020 12/31/9999 78130 TC RED CELL SURVIVAL STUDY $ 96.53 $ 96.53 3/1/2020 12/31/9999 78130 RED CELL SURVIVAL STUDY $ 123.26 $ 123.26 3/1/2020 12/31/9999 78135 26 RED CELL SURVIVAL KINETICS $ 27.98 $ 27.98 3/1/2020 12/31/9999 78135 TC RED CELL SURVIVAL KINETICS $ 227.69 $ 227.69 3/1/2020 12/31/9999 78135 RED CELL SURVIVAL KINETICS $ 255.66 $ 255.66 3/1/2020 12/31/9999 78140 26 RED CELL SEQUESTRATION $ 26.72 $ 26.72 3/1/2020 12/31/9999 78140 TC RED CELL SEQUESTRATION $ 92.64 $ 92.64 3/1/2020 12/31/9999 78140 RED CELL SEQUESTRATION $ 119.37 $ 119.37 3/1/2020 12/31/9999 78185 26 SPLEEN IMAGING $ 17.50 $ 17.50 3/1/2020 12/31/9999 78185 TC SPLEEN IMAGING $ 131.57 $ 131.57 3/1/2020 12/31/9999 78185 SPLEEN IMAGING $ 149.08 $ 149.08 3/1/2020 12/31/9999 78191 26 PLATELET SURVIVAL $ 26.43 $ 26.43 3/1/2020 12/31/9999 78191 TC PLATELET SURVIVAL $ 133.18 $ 133.18 3/1/2020 12/31/9999 78191 PLATELET SURVIVAL $ 159.61 $ 159.61 3/1/2020 12/31/9999 78195 26 LYMPH SYSTEM IMAGING $ 52.53 $ 52.53 3/1/2020 12/31/9999 78195 TC LYMPH SYSTEM IMAGING $ 215.05 $ 215.05 3/1/2020 12/31/9999 78195 LYMPH SYSTEM IMAGING $ 267.58 $ 267.58 3/1/2020 12/31/9999 78201 26 LIVER IMAGING $ 18.78 $ 18.78 3/1/2020 12/31/9999 78201 TC LIVER IMAGING $ 118.94 $ 118.94 3/1/2020 12/31/9999 78201 LIVER IMAGING $ 137.72 $ 137.72 3/1/2020 12/31/9999 78202 26 LIVER IMAGING WITH FLOW $ 21.89 $ 21.89 3/1/2020 12/31/9999 78202 TC LIVER IMAGING WITH FLOW $ 137.06 $ 137.06 3/1/2020 12/31/9999 78202 LIVER IMAGING WITH FLOW $ 158.95 $ 158.95 3/1/2020 12/31/9999 78215 26 LIVER AND SPLEEN IMAGING $ 21.25 $ 21.25 3/1/2020 12/31/9999 78215 TC LIVER AND SPLEEN IMAGING $ 125.90 $ 125.90 3/1/2020 12/31/9999 78215 LIVER AND SPLEEN IMAGING $ 147.16 $ 147.16 3/1/2020 12/31/9999 78216 26 LIVER & SPLEEN IMAGE/FLOW $ 24.66 $ 24.66 3/1/2020 12/31/9999 78216 TC LIVER & SPLEEN IMAGE/FLOW $ 87.06 $ 87.06 3/1/2020 12/31/9999 78216 LIVER & SPLEEN IMAGE/FLOW $ 111.72 $ 111.72 3/1/2020 12/31/9999 78226 26 HEPATOBILIARY SYSTEM IMAGING $ 21.14 $ 21.14 3/1/2020 12/31/9999 78226 TC HEPATOBILIARY SYSTEM IMAGING $ 172.53 $ 172.53 3/1/2020 12/31/9999 78226 HEPATOBILIARY SYSTEM IMAGING $ 193.66 $ 193.66 3/1/2020 12/31/9999 78227 26 HEPATOBIL SYST IMAGE W/DRUG $ 25.49 $ 25.49 3/1/2020 12/31/9999 78227 TC HEPATOBIL SYST IMAGE W/DRUG $ 239.59 $ 239.59 3/1/2020 12/31/9999 78227 HEPATOBIL SYST IMAGE W/DRUG $ 265.08 $ 265.08 3/1/2020 12/31/9999 78230 26 SALIVARY GLAND IMAGING $ 19.39 $ 19.39 3/1/2020 12/31/9999 78230 TC SALIVARY GLAND IMAGING $ 106.02 $ 106.02 3/1/2020 12/31/9999 78230 SALIVARY GLAND IMAGING $ 125.41 $ 125.41 3/1/2020 12/31/9999 78231 26 SERIAL SALIVARY IMAGING $ 22.50 $ 22.50 3/1/2020 12/31/9999 78231 TC SERIAL SALIVARY IMAGING $ 84.79 $ 84.79 3/1/2020 12/31/9999 78231 SERIAL SALIVARY IMAGING $ 107.29 $ 107.29 3/1/2020 12/31/9999 78232 26 SALIVARY GLAND FUNCTION EXAM $ 20.61 $ 20.61 3/1/2020 12/31/9999 78232 TC SALIVARY GLAND FUNCTION EXAM $ 88.52 $ 88.52 3/1/2020 12/31/9999 78232 SALIVARY GLAND FUNCTION EXAM $ 109.14 $ 109.14 3/1/2020 12/31/9999 78258 26 ESOPHAGEAL MOTILITY STUDY $ 32.62 $ 32.62 3/1/2020 12/31/9999 78258 TC ESOPHAGEAL MOTILITY STUDY $ 142.36 $ 142.36 3/1/2020 12/31/9999 78258 ESOPHAGEAL MOTILITY STUDY $ 174.97 $ 174.97 3/1/2020 12/31/9999 78261 26 GASTRIC MUCOSA IMAGING $ 30.15 $ 30.15 3/1/2020 12/31/9999 78261 TC GASTRIC MUCOSA IMAGING $ 162.77 $ 162.77 3/1/2020 12/31/9999 78261 GASTRIC MUCOSA IMAGING $ 192.92 $ 192.92 3/1/2020 12/31/9999 78262 26 GASTROESOPHAGEAL REFLUX EXAM $ 29.25 $ 29.25 3/1/2020 12/31/9999 78262 TC GASTROESOPHAGEAL REFLUX EXAM $ 161.01 $ 161.01 3/1/2020 12/31/9999 78262 GASTROESOPHAGEAL REFLUX EXAM $ 190.25 $ 190.25 3/1/2020 12/31/9999 78264 26 GASTRIC EMPTYING IMAG STUDY $ 33.89 $ 33.89 3/1/2020 12/31/9999 78264 TC GASTRIC EMPTYING IMAG STUDY $ 185.08 $ 185.08 3/1/2020 12/31/9999 78264 GASTRIC EMPTYING IMAG STUDY $ 218.98 $ 218.98 3/1/2020 12/31/9999 78265 26 GASTRIC EMPTYING IMAG STUDY $ 43.18 $ 43.18 3/1/2020 12/31/9999 78265 TC GASTRIC EMPTYING IMAG STUDY $ 307.53 $ 307.53 3/1/2020 12/31/9999 78265 GASTRIC EMPTYING IMAG STUDY $ 350.71 $ 350.71 3/1/2020 12/31/9999 78266 26 GASTRIC EMPTYING IMAG STUDY $ 47.87 $ 47.87 3/1/2020 12/31/9999 78266 TC GASTRIC EMPTYING IMAG STUDY $ 368.01 $ 368.01 3/1/2020 12/31/9999 78266 GASTRIC EMPTYING IMAG STUDY $ 415.88 $ 415.88 3/1/2020 12/31/9999 78267 BREATH TST ATTAIN/ANAL C-14 $ 10.35 $ 10.35 3/1/2020 12/31/9999 78268 BREATH TEST ANALYSIS C-14 $ 88.79 $ 88.79 3/1/2020 12/31/9999 78278 26 ACUTE GI BLOOD LOSS IMAGING $ 43.11 $ 43.11 3/1/2020 12/31/9999 78278 TC ACUTE GI BLOOD LOSS IMAGING $ 220.94 $ 220.94 3/1/2020 12/31/9999 78278 ACUTE GI BLOOD LOSS IMAGING $ 264.04 $ 264.04 3/1/2020 12/31/9999 78282 26 GI PROTEIN LOSS EXAM $ 16.58 $ 16.58 3/1/2020 12/31/9999 78282 TC GI PROTEIN LOSS EXAM $ 41.80 $ 41.80 3/1/2020 12/31/9999 78282 GI PROTEIN LOSS EXAM $ 58.38 $ 58.38 3/1/2020 12/31/9999 78290 26 MECKELS DIVERT EXAM $ 29.83 $ 29.83 3/1/2020 12/31/9999 78290 TC MECKELS DIVERT EXAM $ 205.91 $ 205.91 3/1/2020 12/31/9999 78290 MECKELS DIVERT EXAM $ 235.75 $ 235.75 3/1/2020 12/31/9999 78291 26 LEVEEN/SHUNT PATENCY EXAM $ 38.45 $ 38.45 3/1/2020 12/31/9999 78291 TC LEVEEN/SHUNT PATENCY EXAM $ 154.21 $ 154.21 3/1/2020 12/31/9999 78291 LEVEEN/SHUNT PATENCY EXAM $ 192.65 $ 192.65 3/1/2020 12/31/9999 78300 26 BONE IMAGING LIMITED AREA $ 27.04 $ 27.04 3/1/2020 12/31/9999 78300 TC BONE IMAGING LIMITED AREA $ 108.28 $ 108.28 3/1/2020 12/31/9999 78300 BONE IMAGING LIMITED AREA $ 135.32 $ 135.32 3/1/2020 12/31/9999 78305 26 BONE IMAGING MULTIPLE AREAS $ 35.98 $ 35.98 3/1/2020 12/31/9999 78305 TC BONE IMAGING MULTIPLE AREAS $ 143.94 $ 143.94 3/1/2020 12/31/9999 78305 BONE IMAGING MULTIPLE AREAS $ 179.92 $ 179.92 3/1/2020 12/31/9999 78306 26 BONE IMAGING WHOLE BODY $ 37.52 $ 37.52 3/1/2020 12/31/9999 78306 TC BONE IMAGING WHOLE BODY $ 161.58 $ 161.58 3/1/2020 12/31/9999 78306 BONE IMAGING WHOLE BODY $ 199.11 $ 199.11 3/1/2020 12/31/9999 78315 26 BONE IMAGING 3 PHASE $ 44.35 $ 44.35 3/1/2020 12/31/9999 78315 TC BONE IMAGING 3 PHASE $ 220.06 $ 220.06 3/1/2020 12/31/9999 78315 BONE IMAGING 3 PHASE $ 264.41 $ 264.41 3/1/2020 12/31/9999 78414 26 NON-IMAGING HEART FUNCTION $ 18.50 $ 18.50 3/1/2020 12/31/9999 78414 TC NON-IMAGING HEART FUNCTION $ 49.59 $ 49.59 3/1/2020 12/31/9999 78414 NON-IMAGING HEART FUNCTION $ 68.10 $ 68.10 3/1/2020 12/31/9999 78428 26 CARDIAC SHUNT IMAGING $ 35.36 $ 35.36 3/1/2020 12/31/9999 78428 TC CARDIAC SHUNT IMAGING $ 121.88 $ 121.88 3/1/2020 12/31/9999 78428 CARDIAC SHUNT IMAGING $ 157.24 $ 157.24 3/1/2020 12/31/9999 78445 26 VASCULAR FLOW IMAGING $ 21.25 $ 21.25 3/1/2020 12/31/9999 78445 TC VASCULAR FLOW IMAGING $ 110.31 $ 110.31 3/1/2020 12/31/9999 78445 VASCULAR FLOW IMAGING $ 131.55 $ 131.55 3/1/2020 12/31/9999 78451 26 HT MUSCLE IMAGE SPECT SING $ 43.88 $ 43.88 3/1/2020 12/31/9999 78451 TC HT MUSCLE IMAGE SPECT SING $ 99.07 $ 99.07 3/1/2020 12/31/9999 78451 HT MUSCLE IMAGE SPECT SING $ 142.94 $ 142.94 3/1/2020 12/31/9999 78452 26 HT MUSCLE IMAGE SPECT MULT $ 51.90 $ 51.90 3/1/2020 12/31/9999 78452 TC HT MUSCLE IMAGE SPECT MULT $ 191.53 $ 191.53 3/1/2020 12/31/9999 78452 HT MUSCLE IMAGE SPECT MULT $ 243.43 $ 243.43 3/1/2020 12/31/9999 78453 26 HT MUSCLE IMAGE PLANAR SING $ 31.77 $ 31.77 3/1/2020 12/31/9999 78453 TC HT MUSCLE IMAGE PLANAR SING $ 92.40 $ 92.40 3/1/2020 12/31/9999 78453 HT MUSCLE IMAGE PLANAR SING $ 124.16 $ 124.16 3/1/2020 12/31/9999 78454 26 HT MUSC IMAGE PLANAR MULT $ 42.22 $ 42.22 3/1/2020 12/31/9999 78454 TC HT MUSC IMAGE PLANAR MULT $ 77.67 $ 77.67 3/1/2020 12/31/9999 78454 HT MUSC IMAGE PLANAR MULT $ 119.90 $ 119.90 3/1/2020 12/31/9999 78456 26 ACUTE VENOUS THROMBUS IMAGE $ 46.07 $ 46.07 3/1/2020 12/31/9999 78456 TC ACUTE VENOUS THROMBUS IMAGE $ 232.03 $ 232.03 3/1/2020 12/31/9999 78456 ACUTE VENOUS THROMBUS IMAGE $ 278.10 $ 278.10 3/1/2020 12/31/9999 78457 26 VENOUS THROMBOSIS IMAGING $ 33.29 $ 33.29 3/1/2020 12/31/9999 78457 TC VENOUS THROMBOSIS IMAGING $ 118.27 $ 118.27 3/1/2020 12/31/9999 78457 VENOUS THROMBOSIS IMAGING $ 151.55 $ 151.55 3/1/2020 12/31/9999 78458 26 VEN THROMBOSIS IMAGES BILAT $ 39.38 $ 39.38 3/1/2020 12/31/9999 78458 TC VEN THROMBOSIS IMAGES BILAT $ 127.89 $ 127.89 3/1/2020 12/31/9999 78458 VEN THROMBOSIS IMAGES BILAT $ 167.27 $ 167.27 3/1/2020 12/31/9999 78459 26 MYOCRD IMG PET SINGLE STUDY $ 67.74 $ 67.74 3/1/2020 12/31/9999 78459 TC MYOCRD IMG PET SINGLE STUDY $ 899.02 $ 899.02 3/1/2020 12/31/9999 78459 MYOCRD IMG PET SINGLE STUDY $ 968.82 $ 968.82 3/1/2020 12/31/9999 78466 26 HEART INFARCT IMAGE $ 31.04 $ 31.04 3/1/2020 12/31/9999 78466 TC HEART INFARCT IMAGE $ 113.57 $ 113.57 3/1/2020 12/31/9999 78466 HEART INFARCT IMAGE $ 144.60 $ 144.60 3/1/2020 12/31/9999 78468 26 HEART INFARCT IMAGE (EF) $ 36.88 $ 36.88 3/1/2020 12/31/9999 78468 TC HEART INFARCT IMAGE (EF) $ 145.41 $ 145.41 3/1/2020 12/31/9999 78468 HEART INFARCT IMAGE (EF) $ 182.29 $ 182.29 3/1/2020 12/31/9999 78469 26 HEART INFARCT IMAGE (3D) $ 41.57 $ 41.57 3/1/2020 12/31/9999 78469 TC HEART INFARCT IMAGE (3D) $ 165.73 $ 165.73 3/1/2020 12/31/9999 78469 HEART INFARCT IMAGE (3D) $ 207.29 $ 207.29 3/1/2020 12/31/9999 78472 26 GATED HEART PLANAR SINGLE $ 43.96 $ 43.96 3/1/2020 12/31/9999 78472 TC GATED HEART PLANAR SINGLE $ 167.01 $ 167.01 3/1/2020 12/31/9999 78472 GATED HEART PLANAR SINGLE $ 210.99 $ 210.99 3/1/2020 12/31/9999 78473 26 GATED HEART MULTIPLE $ 66.99 $ 66.99 3/1/2020 12/31/9999 78473 TC GATED HEART MULTIPLE $ 221.72 $ 221.72 3/1/2020 12/31/9999 78473 GATED HEART MULTIPLE $ 288.71 $ 288.71 3/1/2020 12/31/9999 78481 26 HEART FIRST PASS SINGLE $ 45.54 $ 45.54 3/1/2020 12/31/9999 78481 TC HEART FIRST PASS SINGLE $ 139.88 $ 139.88 3/1/2020 12/31/9999 78481 HEART FIRST PASS SINGLE $ 185.42 $ 185.42 3/1/2020 12/31/9999 78483 26 HEART FIRST PASS MULTIPLE $ 69.13 $ 69.13 3/1/2020 12/31/9999 78483 TC HEART FIRST PASS MULTIPLE $ 193.02 $ 193.02 3/1/2020 12/31/9999 78483 HEART FIRST PASS MULTIPLE $ 262.15 $ 262.15 3/1/2020 12/31/9999 78491 26 MYOCRD IMG PET 1STD RST/STRS $ 68.52 $ 68.52 3/1/2020 12/31/9999 78491 TC MYOCRD IMG PET 1STD RST/STRS $ 899.02 $ 899.02 3/1/2020 12/31/9999 78491 MYOCRD IMG PET 1STD RST/STRS $ 969.69 $ 969.69 3/1/2020 12/31/9999 78492 26 MYOCRD IMG PET MLT RST&STRS $ 86.35 $ 86.35 3/1/2020 12/31/9999 78492 TC MYOCRD IMG PET MLT RST&STRS $ 899.02 $ 899.02 3/1/2020 12/31/9999 78492 MYOCRD IMG PET MLT RST&STRS $ 987.15 $ 987.15 3/1/2020 12/31/9999 78494 26 HEART IMAGE SPECT $ 53.78 $ 53.78 3/1/2020 12/31/9999 78494 TC HEART IMAGE SPECT $ 176.72 $ 176.72 3/1/2020 12/31/9999 78494 HEART IMAGE SPECT $ 230.49 $ 230.49 3/1/2020 12/31/9999 78496 26 HEART FIRST PASS ADD-ON $ 23.04 $ 23.04 3/1/2020 12/31/9999 78496 TC HEART FIRST PASS ADD-ON $ 71.83 $ 71.83 3/1/2020 12/31/9999 78496 HEART FIRST PASS ADD-ON $ 94.89 $ 94.89 3/1/2020 12/31/9999 78579 26 LUNG VENTILATION IMAGING $ 13.93 $ 13.93 3/1/2020 12/31/9999 78579 TC LUNG VENTILATION IMAGING $ 89.04 $ 89.04 3/1/2020 12/31/9999 78579 LUNG VENTILATION IMAGING $ 102.98 $ 102.98 3/1/2020 12/31/9999 78580 26 LUNG PERFUSION IMAGING $ 32.33 $ 32.33 3/1/2020 12/31/9999 78580 TC LUNG PERFUSION IMAGING $ 134.63 $ 134.63 3/1/2020 12/31/9999 78580 LUNG PERFUSION IMAGING $ 166.96 $ 166.96 3/1/2020 12/31/9999 78582 26 LUNG VENTILAT&PERFUS IMAGING $ 30.22 $ 30.22 3/1/2020 12/31/9999 78582 TC LUNG VENTILAT&PERFUS IMAGING $ 159.71 $ 159.71 3/1/2020 12/31/9999 78582 LUNG VENTILAT&PERFUS IMAGING $ 189.92 $ 189.92 3/1/2020 12/31/9999 78597 26 LUNG PERFUSION DIFFERENTIAL $ 20.84 $ 20.84 3/1/2020 12/31/9999 78597 TC LUNG PERFUSION DIFFERENTIAL $ 95.46 $ 95.46 3/1/2020 12/31/9999 78597 LUNG PERFUSION DIFFERENTIAL $ 116.30 $ 116.30 3/1/2020 12/31/9999 78598 26 LUNG PERF&VENTILAT DIFERENTL $ 23.70 $ 23.70 3/1/2020 12/31/9999 78598 TC LUNG PERF&VENTILAT DIFERENTL $ 154.70 $ 154.70 3/1/2020 12/31/9999 78598 LUNG PERF&VENTILAT DIFERENTL $ 178.40 $ 178.40 3/1/2020 12/31/9999 78600 26 BRAIN IMAGE < 4 VIEWS $ 19.37 $ 19.37 3/1/2020 12/31/9999 78600 TC BRAIN IMAGE < 4 VIEWS $ 118.85 $ 118.85 3/1/2020 12/31/9999 78600 BRAIN IMAGE < 4 VIEWS $ 138.22 $ 138.22 3/1/2020 12/31/9999 78601 26 BRAIN IMAGE W/FLOW < 4 VIEWS $ 22.19 $ 22.19 3/1/2020 12/31/9999 78601 TC BRAIN IMAGE W/FLOW < 4 VIEWS $ 142.28 $ 142.28 3/1/2020 12/31/9999 78601 BRAIN IMAGE W/FLOW < 4 VIEWS $ 164.45 $ 164.45 3/1/2020 12/31/9999 78605 26 BRAIN IMAGE 4+ VIEWS $ 23.40 $ 23.40 3/1/2020 12/31/9999 78605 TC BRAIN IMAGE 4+ VIEWS $ 130.54 $ 130.54 3/1/2020 12/31/9999 78605 BRAIN IMAGE 4+ VIEWS $ 153.93 $ 153.93 3/1/2020 12/31/9999 78606 26 BRAIN IMAGE W/FLOW 4 + VIEWS $ 27.98 $ 27.98 3/1/2020 12/31/9999 78606 TC BRAIN IMAGE W/FLOW 4 + VIEWS $ 212.79 $ 212.79 3/1/2020 12/31/9999 78606 BRAIN IMAGE W/FLOW 4 + VIEWS $ 240.77 $ 240.77 3/1/2020 12/31/9999 78608 26 BRAIN IMAGING (PET) $ 65.30 $ 65.30 3/1/2020 12/31/9999 78608 TC BRAIN IMAGING (PET) $ 823.27 $ 823.27 3/1/2020 12/31/9999 78608 BRAIN IMAGING (PET) $ 888.56 $ 888.56 3/1/2020 12/31/9999 78609 26 BRAIN IMAGING (PET) $ 63.24 $ 63.24 3/1/2020 12/31/9999 78609 TC BRAIN IMAGING (PET) $ 835.28 $ 835.28 3/1/2020 12/31/9999 78609 BRAIN IMAGING (PET) $ 898.50 $ 898.50 3/1/2020 12/31/9999 78610 26 BRAIN FLOW IMAGING ONLY $ 13.55 $ 13.55 3/1/2020 12/31/9999 78610 TC BRAIN FLOW IMAGING ONLY $ 125.69 $ 125.69 3/1/2020 12/31/9999 78610 BRAIN FLOW IMAGING ONLY $ 139.23 $ 139.23 3/1/2020 12/31/9999 78630 26 CEREBROSPINAL FLUID SCAN $ 29.83 $ 29.83 3/1/2020 12/31/9999 78630 TC CEREBROSPINAL FLUID SCAN $ 225.75 $ 225.75 3/1/2020 12/31/9999 78630 CEREBROSPINAL FLUID SCAN $ 255.58 $ 255.58 3/1/2020 12/31/9999 78635 26 CSF VENTRICULOGRAPHY $ 26.83 $ 26.83 3/1/2020 12/31/9999 78635 TC CSF VENTRICULOGRAPHY $ 205.80 $ 205.80 3/1/2020 12/31/9999 78635 CSF VENTRICULOGRAPHY $ 232.63 $ 232.63 3/1/2020 12/31/9999 78645 26 CSF SHUNT EVALUATION $ 24.97 $ 24.97 3/1/2020 12/31/9999 78645 TC CSF SHUNT EVALUATION $ 210.42 $ 210.42 3/1/2020 12/31/9999 78645 CSF SHUNT EVALUATION $ 235.39 $ 235.39 3/1/2020 12/31/9999 78650 26 CSF LEAKAGE IMAGING $ 26.72 $ 26.72 3/1/2020 12/31/9999 78650 TC CSF LEAKAGE IMAGING $ 222.50 $ 222.50 3/1/2020 12/31/9999 78650 CSF LEAKAGE IMAGING $ 249.23 $ 249.23 3/1/2020 12/31/9999 78660 26 NUCLEAR EXAM OF TEAR FLOW $ 23.11 $ 23.11 3/1/2020 12/31/9999 78660 TC NUCLEAR EXAM OF TEAR FLOW $ 107.28 $ 107.28 3/1/2020 12/31/9999 78660 NUCLEAR EXAM OF TEAR FLOW $ 130.40 $ 130.40 3/1/2020 12/31/9999 78700 26 KIDNEY IMAGING MORPHOL $ 19.69 $ 19.69 3/1/2020 12/31/9999 78700 TC KIDNEY IMAGING MORPHOL $ 117.48 $ 117.48 3/1/2020 12/31/9999 78700 KIDNEY IMAGING MORPHOL $ 137.17 $ 137.17 3/1/2020 12/31/9999 78701 26 KIDNEY IMAGING WITH FLOW $ 21.25 $ 21.25 3/1/2020 12/31/9999 78701 TC KIDNEY IMAGING WITH FLOW $ 142.86 $ 142.86 3/1/2020 12/31/9999 78701 KIDNEY IMAGING WITH FLOW $ 164.12 $ 164.12 3/1/2020 12/31/9999 78707 26 K FLOW/FUNCT IMAGE W/O DRUG $ 41.86 $ 41.86 3/1/2020 12/31/9999 78707 TC K FLOW/FUNCT IMAGE W/O DRUG $ 150.03 $ 150.03 3/1/2020 12/31/9999 78707 K FLOW/FUNCT IMAGE W/O DRUG $ 191.91 $ 191.91 3/1/2020 12/31/9999 78708 26 K FLOW/FUNCT IMAGE W/DRUG $ 52.94 $ 52.94 3/1/2020 12/31/9999 78708 TC K FLOW/FUNCT IMAGE W/DRUG $ 104.21 $ 104.21 3/1/2020 12/31/9999 78708 K FLOW/FUNCT IMAGE W/DRUG $ 157.15 $ 157.15 3/1/2020 12/31/9999 78709 26 K FLOW/FUNCT IMAGE MULTIPLE $ 61.55 $ 61.55 3/1/2020 12/31/9999 78709 TC K FLOW/FUNCT IMAGE MULTIPLE $ 221.13 $ 221.13 3/1/2020 12/31/9999 78709 K FLOW/FUNCT IMAGE MULTIPLE $ 282.67 $ 282.67 3/1/2020 12/31/9999 78725 26 KIDNEY FUNCTION STUDY $ 16.29 $ 16.29 3/1/2020 12/31/9999 78725 TC KIDNEY FUNCTION STUDY $ 63.61 $ 63.61 3/1/2020 12/31/9999 78725 KIDNEY FUNCTION STUDY $ 79.89 $ 79.89 3/1/2020 12/31/9999 78730 26 URINARY BLADDER RETENTION $ 7.52 $ 7.52 3/1/2020 12/31/9999 78730 TC URINARY BLADDER RETENTION $ 53.60 $ 53.60 3/1/2020 12/31/9999 78730 URINARY BLADDER RETENTION $ 61.12 $ 61.12 3/1/2020 12/31/9999 78740 26 URETERAL REFLUX STUDY $ 25.17 $ 25.17 3/1/2020 12/31/9999 78740 TC URETERAL REFLUX STUDY $ 138.13 $ 138.13 3/1/2020 12/31/9999 78740 URETERAL REFLUX STUDY $ 163.30 $ 163.30 3/1/2020 12/31/9999 78761 26 TESTICULAR IMAGING W/FLOW $ 31.08 $ 31.08 3/1/2020 12/31/9999 78761 TC TESTICULAR IMAGING W/FLOW $ 132.96 $ 132.96 3/1/2020 12/31/9999 78761 TESTICULAR IMAGING W/FLOW $ 164.05 $ 164.05 3/1/2020 12/31/9999 78800 26 RP LOCLZJ TUM 1 AREA 1 D IMG $ 28.52 $ 28.52 3/1/2020 12/31/9999 78800 TC RP LOCLZJ TUM 1 AREA 1 D IMG $ 118.19 $ 118.19 3/1/2020 12/31/9999 78800 RP LOCLZJ TUM 1 AREA 1 D IMG $ 146.71 $ 146.71 3/1/2020 12/31/9999 78801 26 RP LOCLZJ TUM 2+AREA 1+D IMG $ 34.62 $ 34.62 3/1/2020 12/31/9999 78801 TC RP LOCLZJ TUM 2+AREA 1+D IMG $ 161.58 $ 161.58 3/1/2020 12/31/9999 78801 RP LOCLZJ TUM 2+AREA 1+D IMG $ 196.20 $ 196.20 3/1/2020 12/31/9999 78802 26 RP LOCLZJ TUM WHBDY 1 D IMG $ 37.52 $ 37.52 3/1/2020 12/31/9999 78802 TC RP LOCLZJ TUM WHBDY 1 D IMG $ 219.01 $ 219.01 3/1/2020 12/31/9999 78802 RP LOCLZJ TUM WHBDY 1 D IMG $ 256.52 $ 256.52 3/1/2020 12/31/9999 78803 26 RP LOCLZJ TUM SPECT 1 AREA $ 47.67 $ 47.67 3/1/2020 12/31/9999 78803 TC RP LOCLZJ TUM SPECT 1 AREA $ 235.28 $ 235.28 3/1/2020 12/31/9999 78803 RP LOCLZJ TUM SPECT 1 AREA $ 282.95 $ 282.95 3/1/2020 12/31/9999 78804 26 RP LOCLZJ TUM WHBDY 2+D IMG $ 46.83 $ 46.83 3/1/2020 12/31/9999 78804 TC RP LOCLZJ TUM WHBDY 2+D IMG $ 404.36 $ 404.36 3/1/2020 12/31/9999 78804 RP LOCLZJ TUM WHBDY 2+D IMG $ 451.20 $ 451.20 3/1/2020 12/31/9999 78808 IV INJ RA DRUG DX STUDY $ 36.19 $ 36.19 3/1/2020 12/31/9999 78811 26 PET IMAGE LTD AREA $ 68.16 $ 68.16 3/1/2020 12/31/9999 78811 TC PET IMAGE LTD AREA $ 823.27 $ 823.27 3/1/2020 12/31/9999 78811 PET IMAGE LTD AREA $ 891.42 $ 891.42 3/1/2020 12/31/9999 78812 26 PET IMAGE SKULL-THIGH $ 84.95 $ 84.95 3/1/2020 12/31/9999 78812 TC PET IMAGE SKULL-THIGH $ 823.27 $ 823.27 3/1/2020 12/31/9999 78812 PET IMAGE SKULL-THIGH $ 908.22 $ 908.22 3/1/2020 12/31/9999 78813 26 PET IMAGE FULL BODY $ 88.05 $ 88.05 3/1/2020 12/31/9999 78813 TC PET IMAGE FULL BODY $ 823.27 $ 823.27 3/1/2020 12/31/9999 78813 PET IMAGE FULL BODY $ 911.33 $ 911.33 3/1/2020 12/31/9999 78814 26 PET IMAGE W/CT LMTD $ 96.45 $ 96.45 3/1/2020 12/31/9999 78814 TC PET IMAGE W/CT LMTD $ 823.27 $ 823.27 3/1/2020 12/31/9999 78814 PET IMAGE W/CT LMTD $ 919.73 $ 919.73 3/1/2020 12/31/9999 78815 26 PET IMAGE W/CT SKULL-THIGH $ 106.73 $ 106.73 3/1/2020 12/31/9999 78815 TC PET IMAGE W/CT SKULL-THIGH $ 823.27 $ 823.27 3/1/2020 12/31/9999 78815 PET IMAGE W/CT SKULL-THIGH $ 930.00 $ 930.00 3/1/2020 12/31/9999 78816 26 PET IMAGE W/CT FULL BODY $ 109.52 $ 109.52 3/1/2020 12/31/9999 78816 TC PET IMAGE W/CT FULL BODY $ 823.27 $ 823.27 3/1/2020 12/31/9999 78816 PET IMAGE W/CT FULL BODY $ 932.78 $ 932.78 3/1/2020 12/31/9999 79005 26 NUCLEAR RX ORAL ADMIN $ 77.57 $ 77.57 3/1/2020 12/31/9999 79005 TC NUCLEAR RX ORAL ADMIN $ 49.81 $ 49.81 3/1/2020 12/31/9999 79005 NUCLEAR RX ORAL ADMIN $ 127.40 $ 127.40 3/1/2020 12/31/9999 79101 26 NUCLEAR RX IV ADMIN $ 89.12 $ 89.12 3/1/2020 12/31/9999 79101 TC NUCLEAR RX IV ADMIN $ 54.22 $ 54.22 3/1/2020 12/31/9999 79101 NUCLEAR RX IV ADMIN $ 143.35 $ 143.35 3/1/2020 12/31/9999 79200 26 NUCLEAR RX INTRACAV ADMIN $ 87.05 $ 87.05 3/1/2020 12/31/9999 79200 TC NUCLEAR RX INTRACAV ADMIN $ 58.34 $ 58.34 3/1/2020 12/31/9999 79200 NUCLEAR RX INTRACAV ADMIN $ 145.37 $ 145.37 3/1/2020 12/31/9999 79300 26 NUCLR RX INTERSTIT COLLOID $ 70.47 $ 70.47 3/1/2020 12/31/9999 79300 TC NUCLR RX INTERSTIT COLLOID $ 113.74 $ 113.74 3/1/2020 12/31/9999 79300 NUCLR RX INTERSTIT COLLOID $ 184.19 $ 184.19 3/1/2020 12/31/9999 79403 26 HEMATOPOIETIC NUCLEAR TX $ 99.02 $ 99.02 3/1/2020 12/31/9999 79403 TC HEMATOPOIETIC NUCLEAR TX $ 82.43 $ 82.43 3/1/2020 12/31/9999 79403 HEMATOPOIETIC NUCLEAR TX $ 181.45 $ 181.45 3/1/2020 12/31/9999 79440 26 NUCLEAR RX INTRA-ARTICULAR $ 86.84 $ 86.84 3/1/2020 12/31/9999 79440 TC NUCLEAR RX INTRA-ARTICULAR $ 47.75 $ 47.75 3/1/2020 12/31/9999 79440 NUCLEAR RX INTRA-ARTICULAR $ 134.60 $ 134.60 3/1/2020 12/31/9999 79445 26 NUCLEAR RX INTRA-ARTERIAL $ 105.37 $ 105.37 3/1/2020 12/31/9999 79445 TC NUCLEAR RX INTRA-ARTERIAL $ 82.50 $ 82.50 3/1/2020 12/31/9999 79445 NUCLEAR RX INTRA-ARTERIAL $ 187.87 $ 187.87 3/1/2020 12/31/9999 80047 METABOLIC PANEL IONIZED CA $ 28.07 $ 28.07 3/1/2020 12/31/9999 80048 METABOLIC PANEL TOTAL CA $ 10.37 $ 10.37 3/1/2020 12/31/9999 80050 GENERAL HEALTH PANEL $ 11.72 $ 11.95 3/1/2020 12/31/9999 80051 ELECTROLYTE PANEL $ 8.94 $ 8.94 3/1/2020 12/31/9999 80053 COMPREHEN METABOLIC PANEL $ 10.94 $ 10.94 3/1/2020 12/31/9999 80055 OBSTETRIC PANEL $ 29.20 $ 29.20 3/1/2020 12/31/9999 80061 LIPID PANEL $ 17.36 $ 17.36 3/1/2020 12/31/9999 80069 RENAL FUNCTION PANEL $ 10.37 $ 10.37 3/1/2020 12/31/9999 80074 ACUTE HEPATITIS PANEL $ 60.34 $ 60.34 3/1/2020 12/31/9999 80076 HEPATIC FUNCTION PANEL $ 10.37 $ 10.37 3/1/2020 12/31/9999 80150 ASSAY OF AMIKACIN $ 19.52 $ 19.52 3/1/2020 12/31/9999 80155 DRUG ASSAY CAFFEINE $ 17.52 $ 17.52 3/1/2020 12/31/9999 80156 ASSAY CARBAMAZEPINE TOTAL $ 18.85 $ 18.85 3/1/2020 12/31/9999 80157 ASSAY CARBAMAZEPINE FREE $ 17.16 $ 17.16 3/1/2020 12/31/9999 80158 DRUG ASSAY CYCLOSPORINE $ 23.38 $ 23.38 3/1/2020 12/31/9999 80159 DRUG ASSAY CLOZAPINE $ 22.92 $ 22.92 3/1/2020 12/31/9999 80162 ASSAY OF DIGOXIN TOTAL $ 17.19 $ 17.19 3/1/2020 12/31/9999 80163 ASSAY OF DIGOXIN FREE $ 17.72 $ 17.72 3/1/2020 12/31/9999 80164 ASSAY DIPROPYLACETIC ACD TOT $ 17.36 $ 17.36 3/1/2020 12/31/9999 80165 DIPROPYLACETIC ACID FREE $ 17.89 $ 17.89 3/1/2020 12/31/9999 80168 ASSAY OF ETHOSUXIMIDE $ 21.17 $ 21.17 3/1/2020 12/31/9999 80169 DRUG ASSAY EVEROLIMUS $ 17.01 $ 17.01 3/1/2020 12/31/9999 80170 ASSAY OF GENTAMICIN $ 4.48 $ 4.48 3/1/2020 12/31/9999 80171 DRUG SCREEN QUANT GABAPENTIN $ 16.43 $ 16.43 3/1/2020 12/31/9999 80173 ASSAY OF HALOPERIDOL $ 18.85 $ 18.85 3/1/2020 12/31/9999 80175 DRUG SCREEN QUAN LAMOTRIGINE $ 16.43 $ 16.43 3/1/2020 12/31/9999 80176 ASSAY OF LIDOCAINE $ 19.02 $ 19.02 3/1/2020 12/31/9999 80177 DRUG SCRN QUAN LEVETIRACETAM $ 16.43 $ 16.43 3/1/2020 12/31/9999 80178 ASSAY OF LITHIUM $ 8.57 $ 8.57 3/1/2020 12/31/9999 80180 DRUG SCRN QUAN MYCOPHENOLATE $ 22.38 $ 22.38 3/1/2020 12/31/9999 80183 DRUG SCRN QUANT OXCARBAZEPIN $ 16.43 $ 16.43 3/1/2020 12/31/9999 80184 ASSAY OF PHENOBARBITAL $ 14.84 $ 14.84 3/1/2020 12/31/9999 80185 ASSAY OF PHENYTOIN TOTAL $ 17.16 $ 17.16 3/1/2020 12/31/9999 80186 ASSAY OF PHENYTOIN FREE $ 17.83 $ 17.83 3/1/2020 12/31/9999 80188 ASSAY OF PRIMIDONE $ 21.09 $ 21.09 3/1/2020 12/31/9999 80190 ASSAY OF PROCAINAMIDE $ 21.69 $ 21.69 3/1/2020 12/31/9999 80192 ASSAY OF PROCAINAMIDE $ 21.69 $ 21.69 3/1/2020 12/31/9999 80194 ASSAY OF QUINIDINE $ 18.89 $ 18.89 3/1/2020 12/31/9999 80195 ASSAY OF SIROLIMUS $ 17.77 $ 17.77 3/1/2020 12/31/9999 80197 ASSAY OF TACROLIMUS $ 17.77 $ 17.77 3/1/2020 12/31/9999 80198 ASSAY OF THEOPHYLLINE $ 18.32 $ 18.32 3/1/2020 12/31/9999 80199 DRUG SCREEN QUANT TIAGABINE $ 22.38 $ 22.38 3/1/2020 12/31/9999 80200 ASSAY OF TOBRAMYCIN $ 20.87 $ 20.87 3/1/2020 12/31/9999 80201 ASSAY OF TOPIRAMATE $ 15.45 $ 15.45 3/1/2020 12/31/9999 80202 ASSAY OF VANCOMYCIN $ 17.36 $ 17.36 3/1/2020 12/31/9999 80203 DRUG SCREEN QUANT ZONISAMIDE $ 16.43 $ 16.43 3/1/2020 12/31/9999 80299 QUANTITATIVE ASSAY DRUG $ 17.73 $ 17.73 3/1/2020 12/31/9999 80305 DRUG TEST PRSMV DIR OPT OBS $ 14.29 $ 14.29 3/1/2020 12/31/9999 80306 DRUG TEST PRSMV INSTRMNT $ 19.44 $ 19.44 3/1/2020 12/31/9999 80307 DRUG TEST PRSMV CHEM ANLYZR $ 76.26 $ 76.26 3/1/2020 12/31/9999 80400 ACTH STIMULATION PANEL $ 42.23 $ 42.23 3/1/2020 12/31/9999 80402 ACTH STIMULATION PANEL $ 112.57 $ 112.57 3/1/2020 12/31/9999 80406 ACTH STIMULATION PANEL $ 101.35 $ 101.35 3/1/2020 12/31/9999 80408 ALDOSTERONE SUPPRESSION EVAL $ 162.51 $ 162.51 3/1/2020 12/31/9999 80410 CALCITONIN STIMUL PANEL $ 104.02 $ 104.02 3/1/2020 12/31/9999 80412 CRH STIMULATION PANEL $ 426.81 $ 426.81 3/1/2020 12/31/9999 80418 PITUITARY EVALUATION PANEL $ 747.92 $ 747.92 3/1/2020 12/31/9999 80420 DEXAMETHASONE PANEL $ 93.27 $ 93.27 3/1/2020 12/31/9999 80422 GLUCAGON TOLERANCE PANEL $ 59.67 $ 59.67 3/1/2020 12/31/9999 80424 GLUCAGON TOLERANCE PANEL $ 65.39 $ 65.39 3/1/2020 12/31/9999 80428 GROWTH HORMONE PANEL $ 86.35 $ 86.35 3/1/2020 12/31/9999 80430 GROWTH HORMONE PANEL $ 101.59 $ 101.59 3/1/2020 12/31/9999 80432 INSULIN SUPPRESSION PANEL $ 143.09 $ 143.09 3/1/2020 12/31/9999 80434 INSULIN TOLERANCE PANEL $ 130.96 $ 130.96 3/1/2020 12/31/9999 80435 INSULIN TOLERANCE PANEL $ 133.32 $ 133.32 3/1/2020 12/31/9999 80436 METYRAPONE PANEL $ 118.04 $ 118.04 3/1/2020 12/31/9999 80438 TRH STIMULATION PANEL $ 63.32 $ 63.32 3/1/2020 12/31/9999 80439 TRH STIMULATION PANEL $ 84.41 $ 84.41 3/1/2020 12/31/9999 80500 LAB PATHOLOGY CONSULTATION $ 15.48 $ 17.54 3/1/2020 12/31/9999 80502 26 LAB PATHOLOGY CONSULTATION $ 41.16 $ 41.91 3/1/2020 12/31/9999 80502 LAB PATHOLOGY CONSULTATION $ 53.91 $ 55.08 3/1/2020 12/31/9999 81000 URINALYSIS NONAUTO W/SCOPE $ 4.11 $ 4.11 3/1/2020 12/31/9999 81001 URINALYSIS AUTO W/SCOPE $ 4.11 $ 4.11 3/1/2020 12/31/9999 81002 URINALYSIS NONAUTO W/O SCOPE $ 3.31 $ 3.31 3/1/2020 12/31/9999 81003 URINALYSIS AUTO W/O SCOPE $ 2.91 $ 2.91 3/1/2020 12/31/9999 81005 URINALYSIS $ 2.81 $ 2.81 3/1/2020 12/31/9999 81007 URINE SCREEN FOR BACTERIA $ 3.33 $ 3.33 3/1/2020 12/31/9999 81015 MICROSCOPIC EXAM OF URINE $ 3.93 $ 3.93 3/1/2020 12/31/9999 81020 URINALYSIS GLASS TEST $ 4.78 $ 4.78 3/1/2020 12/31/9999 81025 URINE PREGNANCY TEST $ 8.19 $ 8.19 3/1/2020 12/31/9999 81050 URINALYSIS VOLUME MEASURE $ 3.89 $ 3.89 3/1/2020 12/31/9999 82009 TEST FOR ACETONE/KETONES $ 5.85 $ 5.85 3/1/2020 12/31/9999 82010 ACETONE ASSAY $ 10.58 $ 10.58 3/1/2020 12/31/9999 82013 ACETYLCHOLINESTERASE ASSAY $ 14.47 $ 14.47 3/1/2020 12/31/9999 82016 ACYLCARNITINES QUAL $ 17.96 $ 17.96 3/1/2020 12/31/9999 82017 ACYLCARNITINES QUANT $ 21.85 $ 21.85 3/1/2020 12/31/9999 82024 ASSAY OF ACTH $ 50.02 $ 50.02 3/1/2020 12/31/9999 82030 ASSAY OF ADP & AMP $ 33.42 $ 33.42 3/1/2020 12/31/9999 82040 ASSAY OF SERUM ALBUMIN $ 6.42 $ 6.42 3/1/2020 12/31/9999 82042 OTHER SOURCE ALBUMIN QUAN EA $ 6.70 $ 6.70 3/1/2020 12/31/9999 82043 UR ALBUMIN QUANTITATIVE $ 7.50 $ 7.50 3/1/2020 12/31/9999 82044 UR ALBUMIN SEMIQUANTITATIVE $ 3.71 $ 3.71 3/1/2020 12/31/9999 82045 ALBUMIN ISCHEMIA MODIFIED $ 43.96 $ 43.96 3/1/2020 12/31/9999 82075 ASSAY OF BREATH ETHANOL $ 15.60 $ 15.60 3/1/2020 12/31/9999 82085 ASSAY OF ALDOLASE $ 12.57 $ 12.57 3/1/2020 12/31/9999 82088 ASSAY OF ALDOSTERONE $ 52.78 $ 52.78 3/1/2020 12/31/9999 82103 ALPHA-1-ANTITRYPSIN TOTAL $ 17.40 $ 17.40 3/1/2020 12/31/9999 82104 ALPHA-1-ANTITRYPSIN PHENO $ 18.72 $ 18.72 3/1/2020 12/31/9999 82105 ALPHA-FETOPROTEIN SERUM $ 21.72 $ 21.72 3/1/2020 12/31/9999 82106 ALPHA-FETOPROTEIN AMNIOTIC $ 21.72 $ 21.72 3/1/2020 12/31/9999 82107 ALPHA-FETOPROTEIN L3 $ 83.40 $ 83.40 3/1/2020 12/31/9999 82108 ASSAY OF ALUMINUM $ 33.00 $ 33.00 3/1/2020 12/31/9999 82120 AMINES VAGINAL FLUID QUAL $ 4.87 $ 4.87 3/1/2020 12/31/9999 82127 AMINO ACID SINGLE QUAL $ 17.96 $ 17.96 3/1/2020 12/31/9999 82128 AMINO ACIDS MULT QUAL $ 17.96 $ 17.96 3/1/2020 12/31/9999 82131 AMINO ACIDS SINGLE QUANT $ 21.85 $ 21.85 3/1/2020 12/31/9999 82135 ASSAY AMINOLEVULINIC ACID $ 21.32 $ 21.32 3/1/2020 12/31/9999 82136 AMINO ACIDS QUANT 2-5 $ 21.85 $ 21.85 3/1/2020 12/31/9999 82139 AMINO ACIDS QUAN 6 OR MORE $ 21.85 $ 21.85 3/1/2020 12/31/9999 82140 ASSAY OF AMMONIA $ 18.87 $ 18.87 3/1/2020 12/31/9999 82143 AMNIOTIC FLUID SCAN $ 8.91 $ 8.91 3/1/2020 12/31/9999 82150 ASSAY OF AMYLASE $ 8.39 $ 8.39 3/1/2020 12/31/9999 82154 ANDROSTANEDIOL GLUCURONIDE $ 37.34 $ 37.34 3/1/2020 12/31/9999 82157 ASSAY OF ANDROSTENEDIONE $ 37.91 $ 37.91 3/1/2020 12/31/9999 82160 ASSAY OF ANDROSTERONE $ 32.39 $ 32.39 3/1/2020 12/31/9999 82163 ASSAY OF ANGIOTENSIN II $ 26.59 $ 26.59 3/1/2020 12/31/9999 82164 ANGIOTENSIN I ENZYME TEST $ 18.89 $ 18.89 3/1/2020 12/31/9999 82172 ASSAY OF APOLIPOPROTEIN $ 20.07 $ 20.07 3/1/2020 12/31/9999 82175 ASSAY OF ARSENIC $ 24.57 $ 24.57 3/1/2020 12/31/9999 82180 ASSAY OF ASCORBIC ACID $ 12.80 $ 12.80 3/1/2020 12/31/9999 82190 ATOMIC ABSORPTION $ 19.31 $ 19.31 3/1/2020 12/31/9999 82232 ASSAY OF BETA-2 PROTEIN $ 20.96 $ 20.96 3/1/2020 12/31/9999 82239 BILE ACIDS TOTAL $ 21.09 $ 21.09 3/1/2020 12/31/9999 82240 BILE ACIDS CHOLYLGLYCINE $ 21.09 $ 21.09 3/1/2020 12/31/9999 82247 BILIRUBIN TOTAL $ 6.51 $ 6.51 3/1/2020 12/31/9999 82248 BILIRUBIN DIRECT $ 6.51 $ 6.51 3/1/2020 12/31/9999 82252 FECAL BILIRUBIN TEST $ 5.89 $ 5.89 3/1/2020 12/31/9999 82261 ASSAY OF BIOTINIDASE $ 21.85 $ 21.85 3/1/2020 12/31/9999 82270 OCCULT BLOOD FECES $ 4.21 $ 4.21 3/1/2020 12/31/9999 82271 OCCULT BLOOD OTHER SOURCES $ 4.21 $ 4.21 3/1/2020 12/31/9999 82272 OCCULT BLD FECES 1-3 TESTS $ 4.21 $ 4.21 3/1/2020 12/31/9999 82274 ASSAY TEST FOR BLOOD FECAL $ 20.59 $ 20.59 3/1/2020 12/31/9999 82286 ASSAY OF BRADYKININ $ 8.91 $ 8.91 3/1/2020 12/31/9999 82300 ASSAY OF CADMIUM $ 29.97 $ 29.97 3/1/2020 12/31/9999 82306 VITAMIN D 25 HYDROXY $ 38.34 $ 38.34 3/1/2020 12/31/9999 82308 ASSAY OF CALCITONIN $ 34.67 $ 34.67 3/1/2020 12/31/9999 82310 ASSAY OF CALCIUM $ 6.67 $ 6.67 3/1/2020 12/31/9999 82330 ASSAY OF CALCIUM $ 17.69 $ 17.69 3/1/2020 12/31/9999 82331 CALCIUM INFUSION TEST $ 6.70 $ 6.70 3/1/2020 12/31/9999 82340 ASSAY OF CALCIUM IN URINE $ 6.74 $ 6.74 3/1/2020 12/31/9999 82355 CALCULUS ANALYSIS QUAL $ 14.98 $ 14.98 3/1/2020 12/31/9999 82360 CALCULUS ASSAY QUANT $ 16.67 $ 16.67 3/1/2020 12/31/9999 82365 CALCULUS SPECTROSCOPY $ 16.70 $ 16.70 3/1/2020 12/31/9999 82370 X-RAY ASSAY CALCULUS $ 16.22 $ 16.22 3/1/2020 12/31/9999 82373 ASSAY C-D TRANSFER MEASURE $ 23.38 $ 23.38 3/1/2020 12/31/9999 82374 ASSAY BLOOD CARBON DIOXIDE $ 6.33 $ 6.33 3/1/2020 12/31/9999 82375 ASSAY CARBOXYHB QUANT $ 14.33 $ 14.33 3/1/2020 12/31/9999 82376 ASSAY CARBOXYHB QUAL $ 7.76 $ 7.76 3/1/2020 12/31/9999 82378 CARCINOEMBRYONIC ANTIGEN $ 24.57 $ 24.57 3/1/2020 12/31/9999 82379 ASSAY OF CARNITINE $ 21.85 $ 21.85 3/1/2020 12/31/9999 82380 ASSAY OF CAROTENE $ 11.95 $ 11.95 3/1/2020 12/31/9999 82382 ASSAY URINE CATECHOLAMINES $ 22.26 $ 22.26 3/1/2020 12/31/9999 82383 ASSAY BLOOD CATECHOLAMINES $ 32.45 $ 32.45 3/1/2020 12/31/9999 82384 ASSAY THREE CATECHOLAMINES $ 32.70 $ 32.70 3/1/2020 12/31/9999 82387 ASSAY OF CATHEPSIN-D $ 17.96 $ 17.96 3/1/2020 12/31/9999 82390 ASSAY OF CERULOPLASMIN $ 13.91 $ 13.91 3/1/2020 12/31/9999 82397 CHEMILUMINESCENT ASSAY $ 17.96 $ 17.96 3/1/2020 12/31/9999 82415 ASSAY OF CHLORAMPHENICOL $ 16.41 $ 16.41 3/1/2020 12/31/9999 82435 ASSAY OF BLOOD CHLORIDE $ 5.94 $ 5.94 3/1/2020 12/31/9999 82436 ASSAY OF URINE CHLORIDE $ 6.51 $ 6.51 3/1/2020 12/31/9999 82438 ASSAY OTHER FLUID CHLORIDES $ 6.33 $ 6.33 3/1/2020 12/31/9999 82441 TEST FOR CHLOROHYDROCARBONS $ 7.77 $ 7.77 3/1/2020 12/31/9999 82465 ASSAY BLD/SERUM CHOLESTEROL $ 5.63 $ 5.63 3/1/2020 12/31/9999 82480 ASSAY SERUM CHOLINESTERASE $ 7.44 $ 7.44 3/1/2020 12/31/9999 82482 ASSAY RBC CHOLINESTERASE $ 5.95 $ 5.95 3/1/2020 12/31/9999 82485 ASSAY CHONDROITIN SULFATE $ 26.73 $ 26.73 3/1/2020 12/31/9999 82495 ASSAY OF CHROMIUM $ 26.27 $ 26.27 3/1/2020 12/31/9999 82507 ASSAY OF CITRATE $ 36.00 $ 36.00 3/1/2020 12/31/9999 82523 COLLAGEN CROSSLINKS $ 18.98 $ 18.98 3/1/2020 12/31/9999 82525 ASSAY OF COPPER $ 16.08 $ 16.08 3/1/2020 12/31/9999 82528 ASSAY OF CORTICOSTERONE $ 29.15 $ 29.15 3/1/2020 12/31/9999 82530 CORTISOL FREE $ 21.64 $ 21.64 3/1/2020 12/31/9999 82533 TOTAL CORTISOL $ 21.12 $ 21.12 3/1/2020 12/31/9999 82540 ASSAY OF CREATINE $ 6.01 $ 6.01 3/1/2020 12/31/9999 82542 COL CHROMOTOGRAPHY QUAL/QUAN $ 23.38 $ 23.38 3/1/2020 12/31/9999 82550 ASSAY OF CK (CPK) $ 8.43 $ 8.43 3/1/2020 12/31/9999 82552 ASSAY OF CPK IN BLOOD $ 17.35 $ 17.35 3/1/2020 12/31/9999 82553 CREATINE MB FRACTION $ 14.95 $ 14.95 3/1/2020 12/31/9999 82554 CREATINE ISOFORMS $ 15.37 $ 15.37 3/1/2020 12/31/9999 82565 ASSAY OF CREATININE $ 6.64 $ 6.64 3/1/2020 12/31/9999 82570 ASSAY OF URINE CREATININE $ 6.70 $ 6.70 3/1/2020 12/31/9999 82575 CREATININE CLEARANCE TEST $ 12.23 $ 12.23 3/1/2020 12/31/9999 82585 ASSAY OF CRYOFIBRINOGEN $ 11.10 $ 11.10 3/1/2020 12/31/9999 82595 ASSAY OF CRYOGLOBULIN $ 8.38 $ 8.38 3/1/2020 12/31/9999 82600 ASSAY OF CYANIDE $ 25.13 $ 25.13 3/1/2020 12/31/9999 82607 VITAMIN B-12 $ 19.52 $ 19.52 3/1/2020 12/31/9999 82608 B-12 BINDING CAPACITY $ 18.54 $ 18.54 3/1/2020 12/31/9999 82610 CYSTATIN C $ 17.61 $ 17.61 3/1/2020 12/31/9999 82615 TEST FOR URINE CYSTINES $ 10.57 $ 10.57 3/1/2020 12/31/9999 82626 DEHYDROEPIANDROSTERONE $ 32.73 $ 32.73 3/1/2020 12/31/9999 82627 DEHYDROEPIANDROSTERONE $ 28.79 $ 28.79 3/1/2020 12/31/9999 82633 DESOXYCORTICOSTERONE $ 40.11 $ 40.11 3/1/2020 12/31/9999 82634 DEOXYCORTISOL $ 37.91 $ 37.91 3/1/2020 12/31/9999 82638 ASSAY OF DIBUCAINE NUMBER $ 15.86 $ 15.86 3/1/2020 12/31/9999 82652 VIT D 1 25-DIHYDROXY $ 49.84 $ 49.84 3/1/2020 12/31/9999 82656 PANCREATIC ELASTASE FECAL $ 14.84 $ 14.84 3/1/2020 12/31/9999 82657 ENZYME CELL ACTIVITY $ 23.38 $ 23.38 3/1/2020 12/31/9999 82658 ENZYME CELL ACTIVITY RA $ 23.38 $ 23.38 3/1/2020 12/31/9999 82664 ELECTROPHORETIC TEST $ 44.49 $ 44.49 3/1/2020 12/31/9999 82668 ASSAY OF ERYTHROPOIETIN $ 24.34 $ 24.34 3/1/2020 12/31/9999 82670 ASSAY OF ESTRADIOL $ 30.84 $ 30.84 3/1/2020 12/31/9999 82671 ASSAY OF ESTROGENS $ 41.83 $ 41.83 3/1/2020 12/31/9999 82672 ASSAY OF ESTROGEN $ 28.08 $ 28.08 3/1/2020 12/31/9999 82677 ASSAY OF ESTRIOL $ 31.32 $ 31.32 3/1/2020 12/31/9999 82679 ASSAY OF ESTRONE $ 32.33 $ 32.33 3/1/2020 12/31/9999 82693 ASSAY OF ETHYLENE GLYCOL $ 17.97 $ 17.97 3/1/2020 12/31/9999 82696 ASSAY OF ETIOCHOLANOLONE $ 30.53 $ 30.53 3/1/2020 12/31/9999 82705 FATS/LIPIDS FECES QUAL $ 6.59 $ 6.59 3/1/2020 12/31/9999 82710 FATS/LIPIDS FECES QUANT $ 21.76 $ 21.76 3/1/2020 12/31/9999 82715 ASSAY OF FECAL FAT $ 22.29 $ 22.29 3/1/2020 12/31/9999 82725 ASSAY OF BLOOD FATTY ACIDS $ 17.24 $ 17.24 3/1/2020 12/31/9999 82726 LONG CHAIN FATTY ACIDS $ 23.38 $ 23.38 3/1/2020 12/31/9999 82728 ASSAY OF FERRITIN $ 17.64 $ 17.64 3/1/2020 12/31/9999 82731 ASSAY OF FETAL FIBRONECTIN $ 83.40 $ 83.40 3/1/2020 12/31/9999 82735 ASSAY OF FLUORIDE $ 24.01 $ 24.01 3/1/2020 12/31/9999 82746 ASSAY OF FOLIC ACID SERUM $ 19.04 $ 19.04 3/1/2020 12/31/9999 82747 ASSAY OF FOLIC ACID RBC $ 19.52 $ 19.52 3/1/2020 12/31/9999 82757 ASSAY OF SEMEN FRUCTOSE $ 22.47 $ 22.47 3/1/2020 12/31/9999 82759 ASSAY OF RBC GALACTOKINASE $ 27.81 $ 27.81 3/1/2020 12/31/9999 82760 ASSAY OF GALACTOSE $ 14.49 $ 14.49 3/1/2020 12/31/9999 82775 ASSAY GALACTOSE TRANSFERASE $ 27.28 $ 27.28 3/1/2020 12/31/9999 82776 GALACTOSE TRANSFERASE TEST $ 10.86 $ 10.86 3/1/2020 12/31/9999 82784 ASSAY IGA/IGD/IGG/IGM EACH $ 12.04 $ 12.04 3/1/2020 12/31/9999 82785 ASSAY OF IGE $ 21.33 $ 21.33 3/1/2020 12/31/9999 82787 IGG 1 2 3 OR 4 EACH $ 10.37 $ 10.37 3/1/2020 12/31/9999 82800 BLOOD PH $ 8.32 $ 8.32 3/1/2020 12/31/9999 82803 BLOOD GASES ANY COMBINATION $ 25.06 $ 25.06 3/1/2020 12/31/9999 82805 BLOOD GASES W/O2 SATURATION $ 36.75 $ 36.75 3/1/2020 12/31/9999 82810 BLOOD GASES O2 SAT ONLY $ 11.31 $ 11.31 3/1/2020 12/31/9999 82820 HEMOGLOBIN-OXYGEN AFFINITY $ 12.94 $ 12.94 3/1/2020 12/31/9999 82930 GASTRIC ANALY W/PH EA SPEC $ 7.11 $ 7.11 3/1/2020 12/31/9999 82938 GASTRIN TEST $ 22.92 $ 22.92 3/1/2020 12/31/9999 82941 ASSAY OF GASTRIN $ 22.84 $ 22.84 3/1/2020 12/31/9999 82943 ASSAY OF GLUCAGON $ 18.50 $ 18.50 3/1/2020 12/31/9999 82945 GLUCOSE OTHER FLUID $ 5.08 $ 5.08 3/1/2020 12/31/9999 82946 GLUCAGON TOLERANCE TEST $ 19.52 $ 19.52 3/1/2020 12/31/9999 82947 ASSAY GLUCOSE BLOOD QUANT $ 5.08 $ 5.08 3/1/2020 12/31/9999 82948 REAGENT STRIP/BLOOD GLUCOSE $ 4.11 $ 4.11 3/1/2020 12/31/9999 82950 GLUCOSE TEST $ 6.15 $ 6.15 3/1/2020 12/31/9999 82951 GLUCOSE TOLERANCE TEST (GTT) $ 16.67 $ 16.67 3/1/2020 12/31/9999 82952 GTT-ADDED SAMPLES $ 5.08 $ 5.08 3/1/2020 12/31/9999 82955 ASSAY OF G6PD ENZYME $ 6.03 $ 6.03 3/1/2020 12/31/9999 82960 TEST FOR G6PD ENZYME $ 7.85 $ 7.85 3/1/2020 12/31/9999 82962 GLUCOSE BLOOD TEST $ 3.03 $ 3.03 3/1/2020 12/31/9999 82963 ASSAY OF GLUCOSIDASE $ 27.81 $ 27.81 3/1/2020 12/31/9999 82965 ASSAY OF GDH ENZYME $ 10.02 $ 10.02 3/1/2020 12/31/9999 82977 ASSAY OF GGT $ 9.32 $ 9.32 3/1/2020 12/31/9999 82978 ASSAY OF GLUTATHIONE $ 18.46 $ 18.46 3/1/2020 12/31/9999 82979 ASSAY RBC GLUTATHIONE $ 8.91 $ 8.91 3/1/2020 12/31/9999 82985 ASSAY OF GLYCATED PROTEIN $ 19.52 $ 19.52 3/1/2020 12/31/9999 83001 ASSAY OF GONADOTROPIN (FSH) $ 24.07 $ 24.07 3/1/2020 12/31/9999 83002 ASSAY OF GONADOTROPIN (LH) $ 23.98 $ 23.98 3/1/2020 12/31/9999 83003 ASSAY GROWTH HORMONE (HGH) $ 21.58 $ 21.58 3/1/2020 12/31/9999 83009 H PYLORI (C-13) BLOOD $ 87.22 $ 87.22 3/1/2020 12/31/9999 83010 ASSAY OF HAPTOGLOBIN QUANT $ 16.30 $ 16.30 3/1/2020 12/31/9999 83012 ASSAY OF HAPTOGLOBINS $ 22.26 $ 22.26 3/1/2020 12/31/9999 83013 H PYLORI (C-13) BREATH $ 87.22 $ 87.22 3/1/2020 12/31/9999 83014 H PYLORI DRUG ADMIN $ 10.17 $ 10.17 3/1/2020 12/31/9999 83015 HEAVY METAL QUAL ANY ANAL $ 24.38 $ 24.38 3/1/2020 12/31/9999 83018 HEAVY METAL QUANT EACH NES $ 28.43 $ 28.43 3/1/2020 12/31/9999 83020 26 HEMOGLOBIN ELECTROPHORESIS $ 15.77 $ 15.77 3/1/2020 12/31/9999 83020 HEMOGLOBIN ELECTROPHORESIS $ 16.28 $ 16.28 3/1/2020 12/31/9999 83021 HEMOGLOBIN CHROMOTOGRAPHY $ 23.38 $ 23.38 3/1/2020 12/31/9999 83026 HEMOGLOBIN COPPER SULFATE $ 3.06 $ 3.06 3/1/2020 12/31/9999 83030 FETAL HEMOGLOBIN CHEMICAL $ 10.71 $ 10.71 3/1/2020 12/31/9999 83033 FETAL HEMOGLOBIN ASSAY QUAL $ 7.72 $ 7.72 3/1/2020 12/31/9999 83036 GLYCOSYLATED HEMOGLOBIN TEST $ 12.57 $ 12.57 3/1/2020 12/31/9999 83045 BLOOD METHEMOGLOBIN TEST $ 6.43 $ 6.43 3/1/2020 12/31/9999 83050 BLOOD METHEMOGLOBIN ASSAY $ 9.48 $ 9.48 3/1/2020 12/31/9999 83051 ASSAY OF PLASMA HEMOGLOBIN $ 9.46 $ 9.46 3/1/2020 12/31/9999 83060 BLOOD SULFHEMOGLOBIN ASSAY $ 10.71 $ 10.71 3/1/2020 12/31/9999 83065 ASSAY OF HEMOGLOBIN HEAT $ 8.91 $ 8.91 3/1/2020 12/31/9999 83068 HEMOGLOBIN STABILITY SCREEN $ 3.73 $ 3.73 3/1/2020 12/31/9999 83069 ASSAY OF URINE HEMOGLOBIN $ 5.10 $ 5.10 3/1/2020 12/31/9999 83070 ASSAY OF HEMOSIDERIN QUAL $ 0.71 $ 0.71 3/1/2020 12/31/9999 83080 ASSAY OF B HEXOSAMINIDASE $ 21.85 $ 21.85 3/1/2020 12/31/9999 83088 ASSAY OF HISTAMINE $ 38.24 $ 38.24 3/1/2020 12/31/9999 83090 ASSAY OF HOMOCYSTINE $ 21.85 $ 21.85 3/1/2020 12/31/9999 83150 ASSAY OF HOMOVANILLIC ACID $ 25.06 $ 25.06 3/1/2020 12/31/9999 83491 ASSAY OF CORTICOSTEROIDS 17 $ 22.68 $ 22.68 3/1/2020 12/31/9999 83497 ASSAY OF 5-HIAA $ 16.70 $ 16.70 3/1/2020 12/31/9999 83498 ASSAY OF PROGESTERONE 17-D $ 35.16 $ 35.16 3/1/2020 12/31/9999 83500 ASSAY FREE HYDROXYPROLINE $ 29.34 $ 29.34 3/1/2020 12/31/9999 83505 ASSAY TOTAL HYDROXYPROLINE $ 31.47 $ 31.47 3/1/2020 12/31/9999 83516 IMMUNOASSAY NONANTIBODY $ 14.84 $ 14.84 3/1/2020 12/31/9999 83518 IMMUNOASSAY DIPSTICK $ 9.90 $ 9.90 3/1/2020 12/31/9999 83519 RIA NONANTIBODY $ 17.49 $ 17.49 3/1/2020 12/31/9999 83520 IMMUNOASSAY QUANT NOS NONAB $ 16.77 $ 16.77 3/1/2020 12/31/9999 83525 ASSAY OF INSULIN $ 14.81 $ 14.81 3/1/2020 12/31/9999 83527 ASSAY OF INSULIN $ 16.39 $ 16.39 3/1/2020 12/31/9999 83528 ASSAY OF INTRINSIC FACTOR $ 20.59 $ 20.59 3/1/2020 12/31/9999 83540 ASSAY OF IRON $ 8.39 $ 8.39 3/1/2020 12/31/9999 83550 IRON BINDING TEST $ 11.32 $ 11.32 3/1/2020 12/31/9999 83570 ASSAY OF IDH ENZYME $ 11.46 $ 11.46 3/1/2020 12/31/9999 83582 ASSAY OF KETOGENIC STEROIDS $ 18.35 $ 18.35 3/1/2020 12/31/9999 83586 ASSAY 17- KETOSTEROIDS $ 16.58 $ 16.58 3/1/2020 12/31/9999 83593 FRACTIONATION KETOSTEROIDS $ 34.06 $ 34.06 3/1/2020 12/31/9999 83605 ASSAY OF LACTIC ACID $ 13.83 $ 13.83 3/1/2020 12/31/9999 83615 LACTATE (LD) (LDH) ENZYME $ 7.82 $ 7.82 3/1/2020 12/31/9999 83625 ASSAY OF LDH ENZYMES $ 12.05 $ 12.05 3/1/2020 12/31/9999 83630 LACTOFERRIN FECAL (QUAL) $ 26.57 $ 26.57 3/1/2020 12/31/9999 83632 PLACENTAL LACTOGEN $ 26.18 $ 26.18 3/1/2020 12/31/9999 83633 TEST URINE FOR LACTOSE $ 7.13 $ 7.13 3/1/2020 12/31/9999 83655 ASSAY OF LEAD $ 15.68 $ 15.68 3/1/2020 12/31/9999 83661 L/S RATIO FETAL LUNG $ 28.47 $ 28.47 3/1/2020 12/31/9999 83662 FOAM STABILITY FETAL LUNG $ 24.50 $ 24.50 3/1/2020 12/31/9999 83663 FLUORO POLARIZE FETAL LUNG $ 24.50 $ 24.50 3/1/2020 12/31/9999 83664 LAMELLAR BDY FETAL LUNG $ 24.50 $ 24.50 3/1/2020 12/31/9999 83670 ASSAY OF LAP ENZYME $ 11.87 $ 11.87 3/1/2020 12/31/9999 83690 ASSAY OF LIPASE $ 8.91 $ 8.91 3/1/2020 12/31/9999 83695 ASSAY OF LIPOPROTEIN(A) $ 16.77 $ 16.77 3/1/2020 12/31/9999 83700 LIPOPRO BLD ELECTROPHORETIC $ 14.57 $ 14.57 3/1/2020 12/31/9999 83701 LIPOPROTEIN BLD HR FRACTION $ 32.14 $ 32.14 3/1/2020 12/31/9999 83704 LIPOPROTEIN BLD QUAN PART $ 35.32 $ 35.32 3/1/2020 12/31/9999 83718 ASSAY OF LIPOPROTEIN $ 10.61 $ 10.61 3/1/2020 12/31/9999 83719 ASSAY OF BLOOD LIPOPROTEIN $ 15.08 $ 15.08 3/1/2020 12/31/9999 83721 ASSAY OF BLOOD LIPOPROTEIN $ 12.36 $ 12.36 3/1/2020 12/31/9999 83727 ASSAY OF LRH HORMONE $ 22.26 $ 22.26 3/1/2020 12/31/9999 83735 ASSAY OF MAGNESIUM $ 8.67 $ 8.67 3/1/2020 12/31/9999 83775 ASSAY MALATE DEHYDROGENASE $ 9.54 $ 9.54 3/1/2020 12/31/9999 83785 ASSAY OF MANGANESE $ 31.85 $ 31.85 3/1/2020 12/31/9999 83789 MASS SPECTROMETRY QUAL/QUAN $ 23.38 $ 23.38 3/1/2020 12/31/9999 83825 ASSAY OF MERCURY $ 21.06 $ 21.06 3/1/2020 12/31/9999 83835 ASSAY OF METANEPHRINES $ 21.93 $ 21.93 3/1/2020 12/31/9999 83857 ASSAY OF METHEMALBUMIN $ 13.91 $ 13.91 3/1/2020 12/31/9999 83861 MICROFLUID ANALY TEARS $ 5.38 $ 5.38 3/1/2020 12/31/9999 83864 MUCOPOLYSACCHARIDES $ 25.79 $ 25.79 3/1/2020 12/31/9999 83872 ASSAY SYNOVIAL FLUID MUCIN $ 7.59 $ 7.59 3/1/2020 12/31/9999 83873 ASSAY OF CSF PROTEIN $ 22.28 $ 22.28 3/1/2020 12/31/9999 83874 ASSAY OF MYOGLOBIN $ 16.73 $ 16.73 3/1/2020 12/31/9999 83876 ASSAY MYELOPEROXIDASE $ 17.52 $ 17.52 3/1/2020 12/31/9999 83880 ASSAY OF NATRIURETIC PEPTIDE $ 43.96 $ 43.96 3/1/2020 12/31/9999 83883 ASSAY NEPHELOMETRY NOT SPEC $ 17.61 $ 17.61 3/1/2020 12/31/9999 83885 ASSAY OF NICKEL $ 31.73 $ 31.73 3/1/2020 12/31/9999 83915 ASSAY OF NUCLEOTIDASE $ 14.44 $ 14.44 3/1/2020 12/31/9999 83916 OLIGOCLONAL BANDS $ 26.03 $ 26.03 3/1/2020 12/31/9999 83918 ORGANIC ACIDS TOTAL QUANT $ 21.32 $ 21.32 3/1/2020 12/31/9999 83919 ORGANIC ACIDS QUAL EACH $ 21.32 $ 21.32 3/1/2020 12/31/9999 83921 ORGANIC ACID SINGLE QUANT $ 21.32 $ 21.32 3/1/2020 12/31/9999 83930 ASSAY OF BLOOD OSMOLALITY $ 8.57 $ 8.57 3/1/2020 12/31/9999 83935 ASSAY OF URINE OSMOLALITY $ 8.82 $ 8.82 3/1/2020 12/31/9999 83937 ASSAY OF OSTEOCALCIN $ 36.87 $ 36.87 3/1/2020 12/31/9999 83945 ASSAY OF OXALATE $ 16.67 $ 16.67 3/1/2020 12/31/9999 83950 ONCOPROTEIN HER-2/NEU $ 83.40 $ 83.40 3/1/2020 12/31/9999 83951 ONCOPROTEIN DCP $ 87.16 $ 87.16 3/1/2020 12/31/9999 83970 ASSAY OF PARATHORMONE $ 53.46 $ 53.46 3/1/2020 12/31/9999 83986 ASSAY PH BODY FLUID NOS $ 4.63 $ 4.63 3/1/2020 12/31/9999 83993 ASSAY FOR CALPROTECTIN FECAL $ 25.41 $ 25.41 3/1/2020 12/31/9999 84030 ASSAY OF BLOOD PKU $ 7.13 $ 7.13 3/1/2020 12/31/9999 84035 ASSAY OF PHENYLKETONES $ 4.74 $ 4.74 3/1/2020 12/31/9999 84060 ASSAY ACID PHOSPHATASE $ 9.57 $ 9.57 3/1/2020 12/31/9999 84066 ASSAY PROSTATE PHOSPHATASE $ 12.52 $ 12.52 3/1/2020 12/31/9999 84075 ASSAY ALKALINE PHOSPHATASE $ 6.70 $ 6.70 3/1/2020 12/31/9999 84078 ASSAY ALKALINE PHOSPHATASE $ 9.45 $ 9.45 3/1/2020 12/31/9999 84080 ASSAY ALKALINE PHOSPHATASES $ 19.15 $ 19.15 3/1/2020 12/31/9999 84081 ASSAY PHOSPHATIDYLGLYCEROL $ 21.40 $ 21.40 3/1/2020 12/31/9999 84085 ASSAY OF RBC PG6D ENZYME $ 8.73 $ 8.73 3/1/2020 12/31/9999 84087 ASSAY PHOSPHOHEXOSE ENZYMES $ 13.37 $ 13.37 3/1/2020 12/31/9999 84100 ASSAY OF PHOSPHORUS $ 6.14 $ 6.14 3/1/2020 12/31/9999 84105 ASSAY OF URINE PHOSPHORUS $ 6.70 $ 6.70 3/1/2020 12/31/9999 84106 TEST FOR PORPHOBILINOGEN $ 5.55 $ 5.55 3/1/2020 12/31/9999 84110 ASSAY OF PORPHOBILINOGEN $ 10.94 $ 10.94 3/1/2020 12/31/9999 84112 EVAL AMNIOTIC FLUID PROTEIN $ 84.01 $ 84.01 3/1/2020 12/31/9999 84119 TEST URINE FOR PORPHYRINS $ 11.15 $ 11.15 3/1/2020 12/31/9999 84120 ASSAY OF URINE PORPHYRINS $ 19.05 $ 19.05 3/1/2020 12/31/9999 84126 ASSAY OF FECES PORPHYRINS $ 32.99 $ 32.99 3/1/2020 12/31/9999 84132 ASSAY OF SERUM POTASSIUM $ 5.94 $ 5.94 3/1/2020 12/31/9999 84133 ASSAY OF URINE POTASSIUM $ 5.58 $ 5.58 3/1/2020 12/31/9999 84134 ASSAY OF PREALBUMIN $ 18.89 $ 18.89 3/1/2020 12/31/9999 84135 ASSAY OF PREGNANEDIOL $ 24.77 $ 24.77 3/1/2020 12/31/9999 84138 ASSAY OF PREGNANETRIOL $ 24.53 $ 24.53 3/1/2020 12/31/9999 84140 ASSAY OF PREGNENOLONE $ 25.92 $ 25.92 3/1/2020 12/31/9999 84143 ASSAY OF 17-HYDROXYPREGNENO $ 29.56 $ 29.56 3/1/2020 12/31/9999 84144 ASSAY OF PROGESTERONE $ 27.02 $ 27.02 3/1/2020 12/31/9999 84145 PROCALCITONIN (PCT) $ 25.73 $ 25.73 3/1/2020 12/31/9999 84146 ASSAY OF PROLACTIN $ 25.10 $ 25.10 3/1/2020 12/31/9999 84150 ASSAY OF PROSTAGLANDIN $ 32.33 $ 32.33 3/1/2020 12/31/9999 84152 ASSAY OF PSA COMPLEXED $ 23.82 $ 23.82 3/1/2020 12/31/9999 84153 ASSAY OF PSA TOTAL $ 23.82 $ 23.82 3/1/2020 12/31/9999 84154 ASSAY OF PSA FREE $ 23.82 $ 23.82 3/1/2020 12/31/9999 84155 ASSAY OF PROTEIN SERUM $ 4.75 $ 4.75 3/1/2020 12/31/9999 84156 ASSAY OF PROTEIN URINE $ 4.75 $ 4.75 3/1/2020 12/31/9999 84157 ASSAY OF PROTEIN OTHER $ 4.75 $ 4.75 3/1/2020 12/31/9999 84160 ASSAY OF PROTEIN ANY SOURCE $ 6.70 $ 6.70 3/1/2020 12/31/9999 84163 PAPPA SERUM $ 11.33 $ 11.33 3/1/2020 12/31/9999 84165 26 PROTEIN E-PHORESIS SERUM $ 15.48 $ 15.48 3/1/2020 12/31/9999 84165 PROTEIN E-PHORESIS SERUM $ 13.85 $ 13.85 3/1/2020 12/31/9999 84166 26 PROTEIN E-PHORESIS/URINE/CSF $ 15.48 $ 15.48 3/1/2020 12/31/9999 84166 PROTEIN E-PHORESIS/URINE/CSF $ 23.10 $ 23.10 3/1/2020 12/31/9999 84181 26 WESTERN BLOT TEST $ 15.48 $ 15.48 3/1/2020 12/31/9999 84181 WESTERN BLOT TEST $ 15.23 $ 15.23 3/1/2020 12/31/9999 84182 26 PROTEIN WESTERN BLOT TEST $ 15.97 $ 15.97 3/1/2020 12/31/9999 84182 PROTEIN WESTERN BLOT TEST $ 15.23 $ 15.23 3/1/2020 12/31/9999 84202 ASSAY RBC PROTOPORPHYRIN $ 18.59 $ 18.59 3/1/2020 12/31/9999 84203 TEST RBC PROTOPORPHYRIN $ 11.15 $ 11.15 3/1/2020 12/31/9999 84206 ASSAY OF PROINSULIN $ 23.07 $ 23.07 3/1/2020 12/31/9999 84207 ASSAY OF VITAMIN B-6 $ 36.38 $ 36.38 3/1/2020 12/31/9999 84210 ASSAY OF PYRUVATE $ 14.06 $ 14.06 3/1/2020 12/31/9999 84220 ASSAY OF PYRUVATE KINASE $ 12.21 $ 12.21 3/1/2020 12/31/9999 84228 ASSAY OF QUININE $ 15.08 $ 15.08 3/1/2020 12/31/9999 84233 ASSAY OF ESTROGEN $ 83.40 $ 83.40 3/1/2020 12/31/9999 84234 ASSAY OF PROGESTERONE $ 84.01 $ 84.01 3/1/2020 12/31/9999 84235 ASSAY OF ENDOCRINE HORMONE $ 67.77 $ 67.77 3/1/2020 12/31/9999 84238 ASSAY NONENDOCRINE RECEPTOR $ 47.36 $ 47.36 3/1/2020 12/31/9999 84244 ASSAY OF RENIN $ 28.48 $ 28.48 3/1/2020 12/31/9999 84252 ASSAY OF VITAMIN B-2 $ 26.21 $ 26.21 3/1/2020 12/31/9999 84255 ASSAY OF SELENIUM $ 33.06 $ 33.06 3/1/2020 12/31/9999 84260 ASSAY OF SEROTONIN $ 21.09 $ 21.09 3/1/2020 12/31/9999 84270 ASSAY OF SEX HORMONE GLOBUL $ 28.14 $ 28.14 3/1/2020 12/31/9999 84275 ASSAY OF SIALIC ACID $ 17.40 $ 17.40 3/1/2020 12/31/9999 84285 ASSAY OF SILICA $ 30.49 $ 30.49 3/1/2020 12/31/9999 84295 ASSAY OF SERUM SODIUM $ 6.24 $ 6.24 3/1/2020 12/31/9999 84300 ASSAY OF URINE SODIUM $ 6.29 $ 6.29 3/1/2020 12/31/9999 84302 ASSAY OF SWEAT SODIUM $ 6.29 $ 6.29 3/1/2020 12/31/9999 84305 ASSAY OF SOMATOMEDIN $ 17.96 $ 17.96 3/1/2020 12/31/9999 84307 ASSAY OF SOMATOSTATIN $ 17.96 $ 17.96 3/1/2020 12/31/9999 84311 SPECTROPHOTOMETRY $ 9.05 $ 9.05 3/1/2020 12/31/9999 84315 BODY FLUID SPECIFIC GRAVITY $ 3.24 $ 3.24 3/1/2020 12/31/9999 84375 CHROMATOGRAM ASSAY SUGARS $ 25.38 $ 25.38 3/1/2020 12/31/9999 84376 SUGARS SINGLE QUAL $ 7.13 $ 7.13 3/1/2020 12/31/9999 84377 SUGARS MULTIPLE QUAL $ 7.13 $ 7.13 3/1/2020 12/31/9999 84378 SUGARS SINGLE QUANT $ 14.92 $ 14.92 3/1/2020 12/31/9999 84379 SUGARS MULTIPLE QUANT $ 14.92 $ 14.92 3/1/2020 12/31/9999 84392 ASSAY OF URINE SULFATE $ 6.15 $ 6.15 3/1/2020 12/31/9999 84402 ASSAY OF FREE TESTOSTERONE $ 32.97 $ 32.97 3/1/2020 12/31/9999 84403 ASSAY OF TOTAL TESTOSTERONE $ 33.44 $ 33.44 3/1/2020 12/31/9999 84410 TESTOSTERONE BIOAVAILABLE $ 33.44 $ 33.44 3/1/2020 12/31/9999 84425 ASSAY OF VITAMIN B-1 $ 27.50 $ 27.50 3/1/2020 12/31/9999 84430 ASSAY OF THIOCYANATE $ 7.47 $ 7.47 3/1/2020 12/31/9999 84431 THROMBOXANE URINE $ 17.21 $ 17.21 3/1/2020 12/31/9999 84432 ASSAY OF THYROGLOBULIN $ 20.80 $ 20.80 3/1/2020 12/31/9999 84436 ASSAY OF TOTAL THYROXINE $ 7.47 $ 7.47 3/1/2020 12/31/9999 84437 ASSAY OF NEONATAL THYROXINE $ 8.38 $ 8.38 3/1/2020 12/31/9999 84439 ASSAY OF FREE THYROXINE $ 11.69 $ 11.69 3/1/2020 12/31/9999 84442 ASSAY OF THYROID ACTIVITY $ 19.15 $ 19.15 3/1/2020 12/31/9999 84443 ASSAY THYROID STIM HORMONE $ 21.11 $ 21.11 3/1/2020 12/31/9999 84445 ASSAY OF TSI GLOBULIN $ 65.86 $ 65.86 3/1/2020 12/31/9999 84446 ASSAY OF VITAMIN E $ 18.36 $ 18.36 3/1/2020 12/31/9999 84449 ASSAY OF TRANSCORTIN $ 23.31 $ 23.31 3/1/2020 12/31/9999 84450 TRANSFERASE (AST) (SGOT) $ 6.69 $ 6.69 3/1/2020 12/31/9999 84460 ALANINE AMINO (ALT) (SGPT) $ 6.86 $ 6.86 3/1/2020 12/31/9999 84466 ASSAY OF TRANSFERRIN $ 16.53 $ 16.53 3/1/2020 12/31/9999 84478 ASSAY OF TRIGLYCERIDES $ 7.46 $ 7.46 3/1/2020 12/31/9999 84479 ASSAY OF THYROID (T3 OR T4) $ 7.72 $ 7.72 3/1/2020 12/31/9999 84480 ASSAY TRIIODOTHYRONINE (T3) $ 18.36 $ 18.36 3/1/2020 12/31/9999 84481 FREE ASSAY (FT-3) $ 21.93 $ 21.93 3/1/2020 12/31/9999 84482 T3 REVERSE $ 20.41 $ 20.41 3/1/2020 12/31/9999 84484 ASSAY OF TROPONIN QUANT $ 12.74 $ 12.74 3/1/2020 12/31/9999 84485 ASSAY DUODENAL FLUID TRYPSIN $ 9.72 $ 9.72 3/1/2020 12/31/9999 84488 TEST FECES FOR TRYPSIN $ 9.45 $ 9.45 3/1/2020 12/31/9999 84490 ASSAY OF FECES FOR TRYPSIN $ 9.85 $ 9.85 3/1/2020 12/31/9999 84510 ASSAY OF TYROSINE $ 13.46 $ 13.46 3/1/2020 12/31/9999 84512 ASSAY OF TROPONIN QUAL $ 8.05 $ 8.05 3/1/2020 12/31/9999 84520 ASSAY OF UREA NITROGEN $ 5.10 $ 5.10 3/1/2020 12/31/9999 84525 UREA NITROGEN SEMI-QUANT $ 4.87 $ 4.87 3/1/2020 12/31/9999 84540 ASSAY OF URINE/UREA-N $ 6.15 $ 6.15 3/1/2020 12/31/9999 84545 UREA-N CLEARANCE TEST $ 7.47 $ 7.47 3/1/2020 12/31/9999 84550 ASSAY OF BLOOD/URIC ACID $ 5.85 $ 5.85 3/1/2020 12/31/9999 84560 ASSAY OF URINE/URIC ACID $ 6.15 $ 6.15 3/1/2020 12/31/9999 84577 ASSAY OF FECES/UROBILINOGEN $ 16.15 $ 16.15 3/1/2020 12/31/9999 84578 TEST URINE UROBILINOGEN $ 3.03 $ 3.03 3/1/2020 12/31/9999 84580 ASSAY OF URINE UROBILINOGEN $ 9.20 $ 9.20 3/1/2020 12/31/9999 84583 ASSAY OF URINE UROBILINOGEN $ 6.51 $ 6.51 3/1/2020 12/31/9999 84585 ASSAY OF URINE VMA $ 20.08 $ 20.08 3/1/2020 12/31/9999 84586 ASSAY OF VIP $ 20.70 $ 20.70 3/1/2020 12/31/9999 84588 ASSAY OF VASOPRESSIN $ 43.96 $ 43.96 3/1/2020 12/31/9999 84590 ASSAY OF VITAMIN A $ 15.02 $ 15.02 3/1/2020 12/31/9999 84597 ASSAY OF VITAMIN K $ 17.76 $ 17.76 3/1/2020 12/31/9999 84600 ASSAY OF VOLATILES $ 18.03 $ 18.03 3/1/2020 12/31/9999 84620 XYLOSE TOLERANCE TEST $ 15.34 $ 15.34 3/1/2020 12/31/9999 84630 ASSAY OF ZINC $ 14.75 $ 14.75 3/1/2020 12/31/9999 84681 ASSAY OF C-PEPTIDE $ 20.57 $ 20.57 3/1/2020 12/31/9999 84702 CHORIONIC GONADOTROPIN TEST $ 11.33 $ 11.33 3/1/2020 12/31/9999 84703 CHORIONIC GONADOTROPIN ASSAY $ 9.72 $ 9.72 3/1/2020 12/31/9999 84704 HCG FREE BETACHAIN TEST $ 11.33 $ 11.33 3/1/2020 12/31/9999 85002 BLEEDING TIME TEST $ 5.83 $ 5.83 3/1/2020 12/31/9999 85004 AUTOMATED DIFF WBC COUNT $ 8.38 $ 8.38 3/1/2020 12/31/9999 85007 BL SMEAR W/DIFF WBC COUNT $ 4.46 $ 4.46 3/1/2020 12/31/9999 85008 BL SMEAR W/O DIFF WBC COUNT $ 4.46 $ 4.46 3/1/2020 12/31/9999 85009 MANUAL DIFF WBC COUNT B-COAT $ 4.81 $ 4.81 3/1/2020 12/31/9999 85013 SPUN MICROHEMATOCRIT $ 3.07 $ 3.07 3/1/2020 12/31/9999 85014 HEMATOCRIT $ 3.07 $ 3.07 3/1/2020 12/31/9999 85018 HEMOGLOBIN $ 3.07 $ 3.07 3/1/2020 12/31/9999 85025 COMPLETE CBC W/AUTO DIFF WBC $ 10.06 $ 10.06 3/1/2020 12/31/9999 85027 COMPLETE CBC AUTOMATED $ 8.38 $ 8.38 3/1/2020 12/31/9999 85032 MANUAL CELL COUNT EACH $ 5.58 $ 5.58 3/1/2020 12/31/9999 85041 AUTOMATED RBC COUNT $ 3.90 $ 3.90 3/1/2020 12/31/9999 85044 MANUAL RETICULOCYTE COUNT $ 5.58 $ 5.58 3/1/2020 12/31/9999 85045 AUTOMATED RETICULOCYTE COUNT $ 5.19 $ 5.19 3/1/2020 12/31/9999 85046 RETICYTE/HGB CONCENTRATE $ 7.23 $ 7.23 3/1/2020 12/31/9999 85048 AUTOMATED LEUKOCYTE COUNT $ 3.29 $ 3.29 3/1/2020 12/31/9999 85049 AUTOMATED PLATELET COUNT $ 5.80 $ 5.80 3/1/2020 12/31/9999 85055 RETICULATED PLATELET ASSAY $ 34.67 $ 34.67 3/1/2020 12/31/9999 85060 26 BLOOD SMEAR INTERPRETATION $ 13.74 $ 13.74 3/1/2020 12/31/9999 85060 BLOOD SMEAR INTERPRETATION $ 19.11 $ 19.11 3/1/2020 12/31/9999 85097 26 BONE MARROW INTERPRETATION $ 30.95 $ 62.16 3/1/2020 12/31/9999 85097 BONE MARROW INTERPRETATION $ 39.76 $ 71.79 3/1/2020 12/31/9999 85130 CHROMOGENIC SUBSTRATE ASSAY $ 15.40 $ 15.40 3/1/2020 12/31/9999 85170 BLOOD CLOT RETRACTION $ 4.68 $ 4.68 3/1/2020 12/31/9999 85175 BLOOD CLOT LYSIS TIME $ 5.89 $ 5.89 3/1/2020 12/31/9999 85210 CLOT FACTOR II PROTHROM SPEC $ 16.81 $ 16.81 3/1/2020 12/31/9999 85220 BLOOC CLOT FACTOR V TEST $ 22.86 $ 22.86 3/1/2020 12/31/9999 85230 CLOT FACTOR VII PROCONVERTIN $ 23.19 $ 23.19 3/1/2020 12/31/9999 85240 CLOT FACTOR VIII AHG 1 STAGE $ 23.19 $ 23.19 3/1/2020 12/31/9999 85244 CLOT FACTOR VIII RELTD ANTGN $ 26.44 $ 26.44 3/1/2020 12/31/9999 85245 CLOT FACTOR VIII VW RISTOCTN $ 29.70 $ 29.70 3/1/2020 12/31/9999 85246 CLOT FACTOR VIII VW ANTIGEN $ 29.70 $ 29.70 3/1/2020 12/31/9999 85247 CLOT FACTOR VIII MULTIMETRIC $ 29.70 $ 29.70 3/1/2020 12/31/9999 85250 CLOT FACTOR IX PTC/CHRSTMAS $ 24.65 $ 24.65 3/1/2020 12/31/9999 85260 CLOT FACTOR X STUART-POWER $ 23.19 $ 23.19 3/1/2020 12/31/9999 85270 CLOT FACTOR XI PTA $ 23.19 $ 23.19 3/1/2020 12/31/9999 85280 CLOT FACTOR XII HAGEMAN $ 25.06 $ 25.06 3/1/2020 12/31/9999 85290 CLOT FACTOR XIII FIBRIN STAB $ 21.17 $ 21.17 3/1/2020 12/31/9999 85291 CLOT FACTOR XIII FIBRIN SCRN $ 11.51 $ 11.51 3/1/2020 12/31/9999 85292 CLOT FACTOR FLETCHER FACT $ 24.53 $ 24.53 3/1/2020 12/31/9999 85293 CLOT FACTOR WGHT KININOGEN $ 24.53 $ 24.53 3/1/2020 12/31/9999 85300 ANTITHROMBIN III ACTIVITY $ 15.34 $ 15.34 3/1/2020 12/31/9999 85301 ANTITHROMBIN III ANTIGEN $ 14.01 $ 14.01 3/1/2020 12/31/9999 85302 CLOT INHIBIT PROT C ANTIGEN $ 15.57 $ 15.57 3/1/2020 12/31/9999 85303 CLOT INHIBIT PROT C ACTIVITY $ 17.90 $ 17.90 3/1/2020 12/31/9999 85305 CLOT INHIBIT PROT S TOTAL $ 15.02 $ 15.02 3/1/2020 12/31/9999 85306 CLOT INHIBIT PROT S FREE $ 18.50 $ 18.50 3/1/2020 12/31/9999 85307 ASSAY ACTIVATED PROTEIN C $ 18.50 $ 18.50 3/1/2020 12/31/9999 85335 FACTOR INHIBITOR TEST $ 16.67 $ 16.67 3/1/2020 12/31/9999 85337 THROMBOMODULIN $ 13.49 $ 13.49 3/1/2020 12/31/9999 85345 COAGULATION TIME LEE & WHITE $ 5.58 $ 5.58 3/1/2020 12/31/9999 85347 COAGULATION TIME ACTIVATED $ 5.51 $ 5.51 3/1/2020 12/31/9999 85348 COAGULATION TIME OTR METHOD $ 4.82 $ 4.82 3/1/2020 12/31/9999 85360 EUGLOBULIN LYSIS $ 10.88 $ 10.88 3/1/2020 12/31/9999 85362 FIBRIN DEGRADATION PRODUCTS $ 8.91 $ 8.91 3/1/2020 12/31/9999 85370 FIBRINOGEN TEST $ 11.93 $ 11.93 3/1/2020 12/31/9999 85378 FIBRIN DEGRADE SEMIQUANT $ 9.24 $ 9.24 3/1/2020 12/31/9999 85379 FIBRIN DEGRADATION QUANT $ 11.93 $ 11.93 3/1/2020 12/31/9999 85380 FIBRIN DEGRADJ D-DIMER $ 11.93 $ 11.93 3/1/2020 12/31/9999 85384 FIBRINOGEN ACTIVITY $ 11.00 $ 11.00 3/1/2020 12/31/9999 85385 FIBRINOGEN ANTIGEN $ 11.00 $ 11.00 3/1/2020 12/31/9999 85390 26 FIBRINOLYSINS SCREEN I&R $ 15.77 $ 15.77 3/1/2020 12/31/9999 85390 FIBRINOLYSINS SCREEN I&R $ 6.69 $ 6.69 3/1/2020 12/31/9999 85396 CLOTTING ASSAY WHOLE BLOOD $ 16.09 $ 16.09 3/1/2020 12/31/9999 85397 CLOTTING FUNCT ACTIVITY $ 31.06 $ 31.06 3/1/2020 12/31/9999 85400 FIBRINOLYTIC PLASMIN $ 11.46 $ 11.46 3/1/2020 12/31/9999 85410 FIBRINOLYTIC ANTIPLASMIN $ 9.99 $ 9.99 3/1/2020 12/31/9999 85415 FIBRINOLYTIC PLASMINOGEN $ 22.26 $ 22.26 3/1/2020 12/31/9999 85420 FIBRINOLYTIC PLASMINOGEN $ 8.46 $ 8.46 3/1/2020 12/31/9999 85421 FIBRINOLYTIC PLASMINOGEN $ 13.19 $ 13.19 3/1/2020 12/31/9999 85441 HEINZ BODIES DIRECT $ 5.45 $ 5.45 3/1/2020 12/31/9999 85445 HEINZ BODIES INDUCED $ 8.82 $ 8.82 3/1/2020 12/31/9999 85460 HEMOGLOBIN FETAL $ 9.75 $ 9.75 3/1/2020 12/31/9999 85461 HEMOGLOBIN FETAL $ 8.59 $ 8.59 3/1/2020 12/31/9999 85475 HEMOLYSIN ACID $ 9.75 $ 9.75 3/1/2020 12/31/9999 85520 HEPARIN ASSAY $ 16.95 $ 16.95 3/1/2020 12/31/9999 85525 HEPARIN NEUTRALIZATION $ 15.34 $ 15.34 3/1/2020 12/31/9999 85530 HEPARIN-PROTAMINE TOLERANCE $ 18.36 $ 18.36 3/1/2020 12/31/9999 85536 IRON STAIN PERIPHERAL BLOOD $ 8.38 $ 8.38 3/1/2020 12/31/9999 85540 WBC ALKALINE PHOSPHATASE $ 11.14 $ 11.14 3/1/2020 12/31/9999 85547 RBC MECHANICAL FRAGILITY $ 5.30 $ 5.30 3/1/2020 12/31/9999 85549 MURAMIDASE $ 24.29 $ 24.29 3/1/2020 12/31/9999 85555 RBC OSMOTIC FRAGILITY $ 8.66 $ 8.66 3/1/2020 12/31/9999 85557 RBC OSMOTIC FRAGILITY $ 17.29 $ 17.29 3/1/2020 12/31/9999 85576 26 BLOOD PLATELET AGGREGATION $ 15.77 $ 15.77 3/1/2020 12/31/9999 85576 BLOOD PLATELET AGGREGATION $ 27.81 $ 27.81 3/1/2020 12/31/9999 85597 PHOSPHOLIPID PLTLT NEUTRALIZ $ 23.28 $ 23.28 3/1/2020 12/31/9999 85598 HEXAGNAL PHOSPH PLTLT NEUTRL $ 23.45 $ 23.45 3/1/2020 12/31/9999 85610 PROTHROMBIN TIME $ 5.09 $ 5.09 3/1/2020 12/31/9999 85611 PROTHROMBIN TEST $ 5.10 $ 5.10 3/1/2020 12/31/9999 85612 VIPER VENOM PROTHROMBIN TIME $ 12.39 $ 12.39 3/1/2020 12/31/9999 85613 RUSSELL VIPER VENOM DILUTED $ 12.39 $ 12.39 3/1/2020 12/31/9999 85635 REPTILASE TEST $ 12.75 $ 12.75 3/1/2020 12/31/9999 85651 RBC SED RATE NONAUTOMATED $ 4.59 $ 4.59 3/1/2020 12/31/9999 85652 RBC SED RATE AUTOMATED $ 3.50 $ 3.50 3/1/2020 12/31/9999 85660 RBC SICKLE CELL TEST $ 7.15 $ 7.15 3/1/2020 12/31/9999 85670 THROMBIN TIME PLASMA $ 7.48 $ 7.48 3/1/2020 12/31/9999 85675 THROMBIN TIME TITER $ 8.88 $ 8.88 3/1/2020 12/31/9999 85705 THROMBOPLASTIN INHIBITION $ 12.46 $ 12.46 3/1/2020 12/31/9999 85730 THROMBOPLASTIN TIME PARTIAL $ 7.77 $ 7.77 3/1/2020 12/31/9999 85732 THROMBOPLASTIN TIME PARTIAL $ 8.38 $ 8.38 3/1/2020 12/31/9999 85810 BLOOD VISCOSITY EXAMINATION $ 13.13 $ 13.13 3/1/2020 12/31/9999 86000 AGGLUTININS FEBRILE ANTIGEN $ 9.03 $ 9.03 3/1/2020 12/31/9999 86001 ALLERGEN SPECIFIC IGG $ 6.76 $ 6.76 3/1/2020 12/31/9999 86003 ALLG SPEC IGE CRUDE XTRC EA $ 6.76 $ 6.76 3/1/2020 12/31/9999 86005 ALLG SPEC IGE MULTIALLG SCR $ 10.33 $ 10.33 3/1/2020 12/31/9999 86008 ALLG SPEC IGE RECOMB EA $ 6.76 $ 6.76 3/1/2020 12/31/9999 86021 WBC ANTIBODY IDENTIFICATION $ 19.50 $ 19.50 3/1/2020 12/31/9999 86022 PLATELET ANTIBODIES $ 23.78 $ 23.78 3/1/2020 12/31/9999 86023 IMMUNOGLOBULIN ASSAY $ 16.13 $ 16.13 3/1/2020 12/31/9999 86038 ANTINUCLEAR ANTIBODIES $ 15.66 $ 15.66 3/1/2020 12/31/9999 86039 ANTINUCLEAR ANTIBODIES (ANA) $ 14.46 $ 14.46 3/1/2020 12/31/9999 86060 ANTISTREPTOLYSIN O TITER $ 9.45 $ 9.45 3/1/2020 12/31/9999 86063 ANTISTREPTOLYSIN O SCREEN $ 7.48 $ 7.48 3/1/2020 12/31/9999 86077 26 PHYS BLOOD BANK SERV XMATCH $ 30.32 $ 31.59 3/1/2020 12/31/9999 86077 PHYS BLOOD BANK SERV XMATCH $ 39.86 $ 41.61 3/1/2020 12/31/9999 86078 26 PHYS BLOOD BANK SERV REACTJ $ 30.60 $ 32.28 3/1/2020 12/31/9999 86078 PHYS BLOOD BANK SERV REACTJ $ 39.86 $ 42.21 3/1/2020 12/31/9999 86079 26 PHYS BLOOD BANK SERV AUTHRJ $ 30.41 $ 31.89 3/1/2020 12/31/9999 86079 PHYS BLOOD BANK SERV AUTHRJ $ 40.15 $ 42.49 3/1/2020 12/31/9999 86140 C-REACTIVE PROTEIN $ 6.70 $ 6.70 3/1/2020 12/31/9999 86141 C-REACTIVE PROTEIN HS $ 16.77 $ 16.77 3/1/2020 12/31/9999 86146 BETA-2 GLYCOPROTEIN ANTIBODY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86147 CARDIOLIPIN ANTIBODY EA IG $ 18.80 $ 18.80 3/1/2020 12/31/9999 86148 ANTI-PHOSPHOLIPID ANTIBODY $ 19.33 $ 19.33 3/1/2020 12/31/9999 86155 CHEMOTAXIS ASSAY $ 20.70 $ 20.70 3/1/2020 12/31/9999 86156 COLD AGGLUTININ SCREEN $ 8.32 $ 8.32 3/1/2020 12/31/9999 86157 COLD AGGLUTININ TITER $ 8.32 $ 8.32 3/1/2020 12/31/9999 86160 COMPLEMENT ANTIGEN $ 15.55 $ 15.55 3/1/2020 12/31/9999 86161 COMPLEMENT/FUNCTION ACTIVITY $ 15.55 $ 15.55 3/1/2020 12/31/9999 86162 COMPLEMENT TOTAL (CH50) $ 26.31 $ 26.31 3/1/2020 12/31/9999 86171 COMPLEMENT FIXATION EACH $ 12.98 $ 12.98 3/1/2020 12/31/9999 86200 CCP ANTIBODY $ 16.77 $ 16.77 3/1/2020 12/31/9999 86215 DEOXYRIBONUCLEASE ANTIBODY $ 17.15 $ 17.15 3/1/2020 12/31/9999 86225 DNA ANTIBODY NATIVE $ 17.80 $ 17.80 3/1/2020 12/31/9999 86226 DNA ANTIBODY SINGLE STRAND $ 15.69 $ 15.69 3/1/2020 12/31/9999 86235 NUCLEAR ANTIGEN ANTIBODY $ 23.23 $ 23.23 3/1/2020 12/31/9999 86255 26 FLUORESCENT ANTIBODY SCREEN $ 15.77 $ 15.77 3/1/2020 12/31/9999 86255 FLUORESCENT ANTIBODY SCREEN $ 15.60 $ 15.60 3/1/2020 12/31/9999 86256 26 FLUORESCENT ANTIBODY TITER $ 15.77 $ 15.77 3/1/2020 12/31/9999 86256 FLUORESCENT ANTIBODY TITER $ 15.60 $ 15.60 3/1/2020 12/31/9999 86277 GROWTH HORMONE ANTIBODY $ 20.38 $ 20.38 3/1/2020 12/31/9999 86280 HEMAGGLUTINATION INHIBITION $ 10.61 $ 10.61 3/1/2020 12/31/9999 86294 IMMUNOASSAY TUMOR QUAL $ 25.40 $ 25.40 3/1/2020 12/31/9999 86300 IMMUNOASSAY TUMOR CA 15-3 $ 26.94 $ 26.94 3/1/2020 12/31/9999 86301 IMMUNOASSAY TUMOR CA 19-9 $ 26.94 $ 26.94 3/1/2020 12/31/9999 86304 IMMUNOASSAY TUMOR CA 125 $ 26.94 $ 26.94 3/1/2020 12/31/9999 86308 HETEROPHILE ANTIBODY SCREEN $ 6.70 $ 6.70 3/1/2020 12/31/9999 86309 HETEROPHILE ANTIBODY TITER $ 8.38 $ 8.38 3/1/2020 12/31/9999 86310 HETEROPHILE ANTIBODY ABSRBJ $ 9.54 $ 9.54 3/1/2020 12/31/9999 86316 IMMUNOASSAY TUMOR OTHER $ 26.94 $ 26.94 3/1/2020 12/31/9999 86317 IMMUNOASSAY INFECTIOUS AGENT $ 18.80 $ 18.80 3/1/2020 12/31/9999 86318 IMMUNOASSAY INFECTIOUS AGENT $ 16.77 $ 16.77 3/1/2020 12/31/9999 86320 26 SERUM IMMUNOELECTROPHORESIS $ 15.77 $ 15.77 3/1/2020 12/31/9999 86320 SERUM IMMUNOELECTROPHORESIS $ 29.03 $ 29.03 3/1/2020 12/31/9999 86325 26 OTHER IMMUNOELECTROPHORESIS $ 15.48 $ 15.48 3/1/2020 12/31/9999 86325 OTHER IMMUNOELECTROPHORESIS $ 28.96 $ 28.96 3/1/2020 12/31/9999 86327 26 IMMUNOELECTROPHORESIS ASSAY $ 18.15 $ 18.15 3/1/2020 12/31/9999 86327 IMMUNOELECTROPHORESIS ASSAY $ 29.38 $ 29.38 3/1/2020 12/31/9999 86328 IA NFCT AB SARSCOV2 COVID19 $ 45.23 $ 45.23 4/10/2020 12/31/9999 86329 IMMUNODIFFUSION NES $ 18.18 $ 18.18 3/1/2020 12/31/9999 86331 IMMUNODIFFUSION OUCHTERLONY $ 14.70 $ 14.70 3/1/2020 12/31/9999 86332 IMMUNE COMPLEX ASSAY $ 31.56 $ 31.56 3/1/2020 12/31/9999 86334 26 IMMUNOFIX E-PHORESIS SERUM $ 15.77 $ 15.77 3/1/2020 12/31/9999 86334 IMMUNOFIX E-PHORESIS SERUM $ 28.93 $ 28.93 3/1/2020 12/31/9999 86335 26 IMMUNFIX E-PHORSIS/URINE/CSF $ 15.48 $ 15.48 3/1/2020 12/31/9999 86335 IMMUNFIX E-PHORSIS/URINE/CSF $ 38.00 $ 38.00 3/1/2020 12/31/9999 86337 INSULIN ANTIBODIES $ 27.73 $ 27.73 3/1/2020 12/31/9999 86340 INTRINSIC FACTOR ANTIBODY $ 19.52 $ 19.52 3/1/2020 12/31/9999 86341 ISLET CELL ANTIBODY $ 17.40 $ 17.40 3/1/2020 12/31/9999 86344 LEUKOCYTE PHAGOCYTOSIS $ 10.35 $ 10.35 3/1/2020 12/31/9999 86353 LYMPHOCYTE TRANSFORMATION $ 63.48 $ 63.48 3/1/2020 12/31/9999 86355 B CELLS TOTAL COUNT $ 48.85 $ 48.85 3/1/2020 12/31/9999 86356 MONONUCLEAR CELL ANTIGEN $ 34.67 $ 34.67 3/1/2020 12/31/9999 86357 NK CELLS TOTAL COUNT $ 48.85 $ 48.85 3/1/2020 12/31/9999 86359 T CELLS TOTAL COUNT $ 48.85 $ 48.85 3/1/2020 12/31/9999 86360 T CELL ABSOLUTE COUNT/RATIO $ 60.85 $ 60.85 3/1/2020 12/31/9999 86361 T CELL ABSOLUTE COUNT $ 34.67 $ 34.67 3/1/2020 12/31/9999 86367 STEM CELLS TOTAL COUNT $ 48.85 $ 48.85 3/1/2020 12/31/9999 86376 MICROSOMAL ANTIBODY EACH $ 17.94 $ 17.94 3/1/2020 12/31/9999 86382 NEUTRALIZATION TEST VIRAL $ 21.89 $ 21.89 3/1/2020 12/31/9999 86384 NITROBLUE TETRAZOLIUM DYE $ 14.75 $ 14.75 3/1/2020 12/31/9999 86403 PARTICLE AGGLUT ANTBDY SCRN $ 13.20 $ 13.20 3/1/2020 12/31/9999 86406 PARTICLE AGGLUT ANTBDY TITR $ 13.78 $ 13.78 3/1/2020 12/31/9999 86430 RHEUMATOID FACTOR TEST QUAL $ 7.35 $ 7.35 3/1/2020 12/31/9999 86431 RHEUMATOID FACTOR QUANT $ 7.35 $ 7.35 3/1/2020 12/31/9999 86480 TB TEST CELL IMMUN MEASURE $ 80.26 $ 80.26 3/1/2020 12/31/9999 86481 TB AG RESPONSE T-CELL SUSP $ 80.84 $ 80.84 3/1/2020 12/31/9999 86485 SKIN TEST CANDIDA $ 6.45 $ 6.45 3/1/2020 12/31/9999 86486 SKIN TEST NOS ANTIGEN $ 3.93 $ 3.93 3/1/2020 12/31/9999 86490 COCCIDIOIDOMYCOSIS SKIN TEST $ 5.40 $ 5.40 3/1/2020 12/31/9999 86510 HISTOPLASMOSIS SKIN TEST $ 5.40 $ 5.40 3/1/2020 12/31/9999 86580 TB INTRADERMAL TEST $ 5.69 $ 5.69 3/1/2020 12/31/9999 86590 STREPTOKINASE ANTIBODY $ 14.28 $ 14.28 3/1/2020 12/31/9999 86592 SYPHILIS TEST NON-TREP QUAL $ 5.52 $ 5.52 3/1/2020 12/31/9999 86593 SYPHILIS TEST NON-TREP QUANT $ 5.71 $ 5.71 3/1/2020 12/31/9999 86602 ANTINOMYCES ANTIBODY $ 13.18 $ 13.18 3/1/2020 12/31/9999 86603 ADENOVIRUS ANTIBODY $ 16.51 $ 16.51 3/1/2020 12/31/9999 86606 ASPERGILLUS ANTIBODY $ 16.51 $ 16.51 3/1/2020 12/31/9999 86609 BACTERIUM ANTIBODY $ 16.51 $ 16.51 3/1/2020 12/31/9999 86611 BARTONELLA ANTIBODY $ 13.18 $ 13.18 3/1/2020 12/31/9999 86612 BLASTOMYCES ANTIBODY $ 16.51 $ 16.51 3/1/2020 12/31/9999 86615 BORDETELLA ANTIBODY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86617 LYME DISEASE ANTIBODY $ 15.33 $ 15.33 3/1/2020 12/31/9999 86618 LYME DISEASE ANTIBODY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86619 BORRELIA ANTIBODY $ 17.33 $ 17.33 3/1/2020 12/31/9999 86622 BRUCELLA ANTIBODY $ 9.75 $ 9.75 3/1/2020 12/31/9999 86625 CAMPYLOBACTER ANTIBODY $ 9.75 $ 9.75 3/1/2020 12/31/9999 86628 CANDIDA ANTIBODY $ 14.70 $ 14.70 3/1/2020 12/31/9999 86631 CHLAMYDIA ANTIBODY $ 15.31 $ 15.31 3/1/2020 12/31/9999 86632 CHLAMYDIA IGM ANTIBODY $ 16.44 $ 16.44 3/1/2020 12/31/9999 86635 COCCIDIOIDES ANTIBODY $ 14.86 $ 14.86 3/1/2020 12/31/9999 86638 Q FEVER ANTIBODY $ 15.71 $ 15.71 3/1/2020 12/31/9999 86641 CRYPTOCOCCUS ANTIBODY $ 18.67 $ 18.67 3/1/2020 12/31/9999 86644 CMV ANTIBODY $ 18.61 $ 18.61 3/1/2020 12/31/9999 86645 CMV ANTIBODY IGM $ 18.80 $ 18.80 3/1/2020 12/31/9999 86648 DIPHTHERIA ANTIBODY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86651 ENCEPHALITIS CALIFORN ANTBDY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86652 ENCEPHALTIS EAST EQNE ANBDY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86653 ENCEPHALTIS ST LOUIS ANTBODY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86654 ENCEPHALTIS WEST EQNE ANTBDY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86658 ENTEROVIRUS ANTIBODY $ 16.51 $ 16.51 3/1/2020 12/31/9999 86663 EPSTEIN-BARR ANTIBODY $ 16.99 $ 16.99 3/1/2020 12/31/9999 86664 EPSTEIN-BARR NUCLEAR ANTIGEN $ 18.80 $ 18.80 3/1/2020 12/31/9999 86665 EPSTEIN-BARR CAPSID VCA $ 21.04 $ 21.04 3/1/2020 12/31/9999 86666 EHRLICHIA ANTIBODY $ 13.18 $ 13.18 3/1/2020 12/31/9999 86668 FRANCISELLA TULARENSIS $ 13.46 $ 13.46 3/1/2020 12/31/9999 86671 FUNGUS NES ANTIBODY $ 15.88 $ 15.88 3/1/2020 12/31/9999 86674 GIARDIA LAMBLIA ANTIBODY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86677 HELICOBACTER PYLORI ANTIBODY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86682 HELMINTH ANTIBODY $ 16.83 $ 16.83 3/1/2020 12/31/9999 86684 HEMOPHILUS INFLUENZA ANTIBDY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86687 HTLV-I ANTIBODY $ 10.87 $ 10.87 3/1/2020 12/31/9999 86688 HTLV-II ANTIBODY $ 15.23 $ 15.23 3/1/2020 12/31/9999 86689 HTLV/HIV CONFIRMJ ANTIBODY $ 25.07 $ 25.07 3/1/2020 12/31/9999 86692 HEPATITIS DELTA AGENT ANTBDY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86694 HERPES SIMPLEX NES ANTBDY $ 18.61 $ 18.61 3/1/2020 12/31/9999 86695 HERPES SIMPLEX TYPE 1 TEST $ 17.08 $ 17.08 3/1/2020 12/31/9999 86696 HERPES SIMPLEX TYPE 2 TEST $ 25.07 $ 25.07 3/1/2020 12/31/9999 86698 HISTOPLASMA ANTIBODY $ 16.18 $ 16.18 3/1/2020 12/31/9999 86701 HIV-1ANTIBODY $ 11.50 $ 11.50 3/1/2020 12/31/9999 86702 HIV-2 ANTIBODY $ 15.23 $ 15.23 3/1/2020 12/31/9999 86703 HIV-1/HIV-2 1 RESULT ANTBDY $ 15.23 $ 15.23 3/1/2020 12/31/9999 86704 HEP B CORE ANTIBODY TOTAL $ 15.08 $ 15.08 3/1/2020 12/31/9999 86705 HEP B CORE ANTIBODY IGM $ 15.24 $ 15.24 3/1/2020 12/31/9999 86706 HEP B SURFACE ANTIBODY $ 13.91 $ 13.91 3/1/2020 12/31/9999 86707 HEPATITIS BE ANTIBODY $ 14.98 $ 14.98 3/1/2020 12/31/9999 86708 HEPATITIS A ANTIBODY $ 16.04 $ 16.04 3/1/2020 12/31/9999 86709 HEPATITIS A IGM ANTIBODY $ 14.57 $ 14.57 3/1/2020 12/31/9999 86710 INFLUENZA VIRUS ANTIBODY $ 17.56 $ 17.56 3/1/2020 12/31/9999 86711 JOHN CUNNINGHAM ANTIBODY $ 18.30 $ 18.30 3/1/2020 12/31/9999 86713 LEGIONELLA ANTIBODY $ 19.82 $ 19.82 3/1/2020 12/31/9999 86717 LEISHMANIA ANTIBODY $ 10.86 $ 10.86 3/1/2020 12/31/9999 86720 LEPTOSPIRA ANTIBODY $ 12.77 $ 12.77 3/1/2020 12/31/9999 86723 LISTERIA MONOCYTOGENES $ 17.08 $ 17.08 3/1/2020 12/31/9999 86727 LYMPH CHORIOMENINGITIS AB $ 16.51 $ 16.51 3/1/2020 12/31/9999 86732 MUCORMYCOSIS ANTIBODY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86735 MUMPS ANTIBODY $ 16.89 $ 16.89 3/1/2020 12/31/9999 86738 MYCOPLASMA ANTIBODY $ 17.15 $ 17.15 3/1/2020 12/31/9999 86744 NOCARDIA ANTIBODY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86747 PARVOVIRUS ANTIBODY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86750 MALARIA ANTIBODY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86753 PROTOZOA ANTIBODY NOS $ 10.86 $ 10.86 3/1/2020 12/31/9999 86756 RESPIRATORY VIRUS ANTIBODY $ 16.70 $ 16.70 3/1/2020 12/31/9999 86757 RICKETTSIA ANTIBODY $ 25.07 $ 25.07 3/1/2020 12/31/9999 86759 ROTAVIRUS ANTIBODY $ 16.51 $ 16.51 3/1/2020 12/31/9999 86762 RUBELLA ANTIBODY $ 18.61 $ 18.61 3/1/2020 12/31/9999 86765 RUBEOLA ANTIBODY $ 16.68 $ 16.68 3/1/2020 12/31/9999 86768 SALMONELLA ANTIBODY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86769 SARS-COV-2 COVID-19 ANTIBODY $ 42.13 $ 42.13 4/10/2020 12/31/9999 86771 SHIGELLA ANTIBODY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86774 TETANUS ANTIBODY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86777 TOXOPLASMA ANTIBODY $ 18.61 $ 18.61 3/1/2020 12/31/9999 86778 TOXOPLASMA ANTIBODY IGM $ 18.65 $ 18.65 3/1/2020 12/31/9999 86780 TREPONEMA PALLIDUM $ 17.58 $ 17.58 3/1/2020 12/31/9999 86784 TRICHINELLA ANTIBODY $ 16.26 $ 16.26 3/1/2020 12/31/9999 86787 VARICELLA-ZOSTER ANTIBODY $ 16.68 $ 16.68 3/1/2020 12/31/9999 86788 WEST NILE VIRUS AB IGM $ 18.80 $ 18.80 3/1/2020 12/31/9999 86789 WEST NILE VIRUS ANTIBODY $ 18.61 $ 18.61 3/1/2020 12/31/9999 86790 VIRUS ANTIBODY NOS $ 16.68 $ 16.68 3/1/2020 12/31/9999 86793 YERSINIA ANTIBODY $ 17.08 $ 17.08 3/1/2020 12/31/9999 86794 ZIKA VIRUS IGM ANTIBODY $ 18.80 $ 18.80 3/1/2020 12/31/9999 86800 THYROGLOBULIN ANTIBODY $ 20.59 $ 20.59 3/1/2020 12/31/9999 86803 HEPATITIS C AB TEST $ 18.49 $ 18.49 3/1/2020 12/31/9999 86804 HEP C AB TEST CONFIRM $ 15.33 $ 15.33 3/1/2020 12/31/9999 86805 LYMPHOCYTOTOXICITY ASSAY $ 67.71 $ 67.71 3/1/2020 12/31/9999 86806 LYMPHOCYTOTOXICITY ASSAY $ 61.62 $ 61.62 3/1/2020 12/31/9999 86807 CYTOTOXIC ANTIBODY SCREENING $ 51.24 $ 51.24 3/1/2020 12/31/9999 86808 CYTOTOXIC ANTIBODY SCREENING $ 38.44 $ 38.44 3/1/2020 12/31/9999 86812 HLA TYPING A B OR C $ 33.42 $ 33.42 3/1/2020 12/31/9999 86813 HLA TYPING A B OR C $ 75.10 $ 75.10 3/1/2020 12/31/9999 86816 HLA TYPING DR/DQ $ 36.08 $ 36.08 3/1/2020 12/31/9999 86817 HLA TYPING DR/DQ $ 83.36 $ 83.36 3/1/2020 12/31/9999 86821 LYMPHOCYTE CULTURE MIXED $ 73.11 $ 73.11 3/1/2020 12/31/9999 86825 HLA X-MATH NON-CYTOTOXIC $ 106.63 $ 106.63 3/1/2020 12/31/9999 86826 HLA X-MATCH NONCYTOTOXC ADDL $ 35.54 $ 35.54 3/1/2020 12/31/9999 86828 HLA CLASS I&II ANTIBODY QUAL $ 50.42 $ 50.42 3/1/2020 12/31/9999 86829 HLA CLASS I/II ANTIBODY QUAL $ 37.82 $ 37.82 3/1/2020 12/31/9999 86830 HLA CLASS I PHENOTYPE QUAL $ 102.11 $ 102.11 3/1/2020 12/31/9999 86831 HLA CLASS II PHENOTYPE QUAL $ 87.53 $ 87.53 3/1/2020 12/31/9999 86832 HLA CLASS I HIGH DEFIN QUAL $ 160.47 $ 160.47 3/1/2020 12/31/9999 86833 HLA CLASS II HIGH DEFIN QUAL $ 145.88 $ 145.88 3/1/2020 12/31/9999 86834 HLA CLASS I SEMIQUANT PANEL $ 452.25 $ 452.25 3/1/2020 12/31/9999 86835 HLA CLASS II SEMIQUANT PANEL $ 408.48 $ 408.48 3/1/2020 12/31/9999 86850 RBC ANTIBODY SCREEN $ 15.09 $ 15.09 3/1/2020 12/31/9999 86860 RBC ANTIBODY ELUTION $ 14.76 $ 14.76 3/1/2020 12/31/9999 86870 RBC ANTIBODY IDENTIFICATION $ 26.64 $ 26.64 3/1/2020 12/31/9999 86880 COOMBS TEST DIRECT $ 6.96 $ 6.96 3/1/2020 12/31/9999 86885 COOMBS TEST INDIRECT QUAL $ 7.40 $ 7.40 3/1/2020 12/31/9999 86886 COOMBS TEST INDIRECT TITER $ 6.70 $ 6.70 3/1/2020 12/31/9999 86900 BLOOD TYPING SEROLOGIC ABO $ 3.86 $ 3.86 3/1/2020 12/31/9999 86901 BLOOD TYPING SEROLOGIC RH(D) $ 3.86 $ 3.86 3/1/2020 12/31/9999 86902 BLOOD TYPE ANTIGEN DONOR EA $ 4.99 $ 4.99 3/1/2020 12/31/9999 86904 BLOOD TYPING PATIENT SERUM $ 12.31 $ 12.31 3/1/2020 12/31/9999 86905 BLOOD TYPING RBC ANTIGENS $ 4.95 $ 4.95 3/1/2020 12/31/9999 86906 BLD TYPING SEROLOGIC RH PHNT $ 10.04 $ 10.04 3/1/2020 12/31/9999 86940 HEMOLYSINS/AGGLUTININS AUTO $ 10.63 $ 10.63 3/1/2020 12/31/9999 86941 HEMOLYSINS/AGGLUTININS $ 15.69 $ 15.69 3/1/2020 12/31/9999 87003 SMALL ANIMAL INOCULATION $ 21.80 $ 21.80 3/1/2020 12/31/9999 87015 SPECIMEN INFECT AGNT CONCNTJ $ 8.65 $ 8.65 3/1/2020 12/31/9999 87040 BLOOD CULTURE FOR BACTERIA $ 13.37 $ 13.37 3/1/2020 12/31/9999 87045 FECES CULTURE AEROBIC BACT $ 12.21 $ 12.21 3/1/2020 12/31/9999 87046 STOOL CULTR AEROBIC BACT EA $ 12.21 $ 12.21 3/1/2020 12/31/9999 87070 CULTURE OTHR SPECIMN AEROBIC $ 11.15 $ 11.15 3/1/2020 12/31/9999 87071 CULTURE AEROBIC QUANT OTHER $ 12.21 $ 12.21 3/1/2020 12/31/9999 87073 CULTURE BACTERIA ANAEROBIC $ 12.21 $ 12.21 3/1/2020 12/31/9999 87075 CULTR BACTERIA EXCEPT BLOOD $ 12.25 $ 12.25 3/1/2020 12/31/9999 87076 CULTURE ANAEROBE IDENT EACH $ 10.46 $ 10.46 3/1/2020 12/31/9999 87077 CULTURE AEROBIC IDENTIFY $ 10.46 $ 10.46 3/1/2020 12/31/9999 87081 CULTURE SCREEN ONLY $ 7.47 $ 7.47 3/1/2020 12/31/9999 87084 CULTURE OF SPECIMEN BY KIT $ 11.15 $ 11.15 3/1/2020 12/31/9999 87086 URINE CULTURE/COLONY COUNT $ 10.45 $ 10.45 3/1/2020 12/31/9999 87088 URINE BACTERIA CULTURE $ 10.48 $ 10.48 3/1/2020 12/31/9999 87101 SKIN FUNGI CULTURE $ 9.99 $ 9.99 3/1/2020 12/31/9999 87102 FUNGUS ISOLATION CULTURE $ 10.88 $ 10.88 3/1/2020 12/31/9999 87103 BLOOD FUNGUS CULTURE $ 11.69 $ 11.69 3/1/2020 12/31/9999 87106 FUNGI IDENTIFICATION YEAST $ 13.37 $ 13.37 3/1/2020 12/31/9999 87107 FUNGI IDENTIFICATION MOLD $ 13.37 $ 13.37 3/1/2020 12/31/9999 87109 MYCOPLASMA $ 19.93 $ 19.93 3/1/2020 12/31/9999 87110 CHLAMYDIA CULTURE $ 25.37 $ 25.37 3/1/2020 12/31/9999 87116 MYCOBACTERIA CULTURE $ 14.00 $ 14.00 3/1/2020 12/31/9999 87118 MYCOBACTERIC IDENTIFICATION $ 14.16 $ 14.16 3/1/2020 12/31/9999 87140 CULTURE TYPE IMMUNOFLUORESC $ 7.22 $ 7.22 3/1/2020 12/31/9999 87143 CULTURE TYPING GLC/HPLC $ 16.22 $ 16.22 3/1/2020 12/31/9999 87147 CULTURE TYPE IMMUNOLOGIC $ 6.70 $ 6.70 3/1/2020 12/31/9999 87149 DNA/RNA DIRECT PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87150 DNA/RNA AMPLIFIED PROBE $ 32.55 $ 32.55 3/1/2020 12/31/9999 87152 CULTURE TYPE PULSE FIELD GEL $ 6.77 $ 6.77 3/1/2020 12/31/9999 87153 DNA/RNA SEQUENCING $ 78.55 $ 78.55 3/1/2020 12/31/9999 87158 CULTURE TYPING ADDED METHOD $ 6.77 $ 6.77 3/1/2020 12/31/9999 87164 26 DARK FIELD EXAMINATION $ 15.48 $ 15.48 3/1/2020 12/31/9999 87164 DARK FIELD EXAMINATION $ 8.20 $ 8.20 3/1/2020 12/31/9999 87166 DARK FIELD EXAMINATION $ 14.63 $ 14.63 3/1/2020 12/31/9999 87168 MACROSCOPIC EXAM ARTHROPOD $ 4.94 $ 4.94 3/1/2020 12/31/9999 87169 MACROSCOPIC EXAM PARASITE $ 4.94 $ 4.94 3/1/2020 12/31/9999 87172 PINWORM EXAM $ 4.94 $ 4.94 3/1/2020 12/31/9999 87176 TISSUE HOMOGENIZATION CULTR $ 7.62 $ 7.62 3/1/2020 12/31/9999 87177 OVA AND PARASITES SMEARS $ 11.52 $ 11.52 3/1/2020 12/31/9999 87181 MICROBE SUSCEPTIBLE DIFFUSE $ 6.15 $ 6.15 3/1/2020 12/31/9999 87184 MICROBE SUSCEPTIBLE DISK $ 8.93 $ 8.93 3/1/2020 12/31/9999 87185 MICROBE SUSCEPTIBLE ENZYME $ 6.15 $ 6.15 3/1/2020 12/31/9999 87186 MICROBE SUSCEPTIBLE MIC $ 11.19 $ 11.19 3/1/2020 12/31/9999 87187 MICROBE SUSCEPTIBLE MLC $ 13.42 $ 13.42 3/1/2020 12/31/9999 87188 MICROBE SUSCEPT MACROBROTH $ 8.60 $ 8.60 3/1/2020 12/31/9999 87190 MICROBE SUSCEPT MYCOBACTERI $ 7.32 $ 7.32 3/1/2020 12/31/9999 87197 BACTERICIDAL LEVEL SERUM $ 19.46 $ 19.46 3/1/2020 12/31/9999 87205 SMEAR GRAM STAIN $ 5.52 $ 5.52 3/1/2020 12/31/9999 87206 SMEAR FLUORESCENT/ACID STAI $ 6.96 $ 6.96 3/1/2020 12/31/9999 87207 26 SMEAR SPECIAL STAIN $ 15.77 $ 15.77 3/1/2020 12/31/9999 87207 SMEAR SPECIAL STAIN $ 7.76 $ 7.76 3/1/2020 12/31/9999 87209 SMEAR COMPLEX STAIN $ 23.27 $ 23.27 3/1/2020 12/31/9999 87210 SMEAR WET MOUNT SALINE/INK $ 4.94 $ 4.94 3/1/2020 12/31/9999 87220 TISSUE EXAM FOR FUNGI $ 5.52 $ 5.52 3/1/2020 12/31/9999 87230 ASSAY TOXIN OR ANTITOXIN $ 25.58 $ 25.58 3/1/2020 12/31/9999 87250 VIRUS INOCULATE EGGS/ANIMAL $ 21.09 $ 21.09 3/1/2020 12/31/9999 87252 VIRUS INOCULATION TISSUE $ 21.09 $ 21.09 3/1/2020 12/31/9999 87253 VIRUS INOCULATE TISSUE ADDL $ 21.09 $ 21.09 3/1/2020 12/31/9999 87254 VIRUS INOCULATION SHELL VIA $ 21.09 $ 21.09 3/1/2020 12/31/9999 87255 GENET VIRUS ISOLATE HSV $ 31.65 $ 31.65 3/1/2020 12/31/9999 87260 ADENOVIRUS AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87265 PERTUSSIS AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87267 ENTEROVIRUS ANTIBODY DFA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87269 GIARDIA AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87270 CHLAMYDIA TRACHOMATIS AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87271 CYTOMEGALOVIRUS DFA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87272 CRYPTOSPORIDIUM AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87273 HERPES SIMPLEX 2 AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87274 HERPES SIMPLEX 1 AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87275 INFLUENZA B AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87276 INFLUENZA A AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87278 LEGION PNEUMOPHILIA AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87279 PARAINFLUENZA AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87280 RESPIRATORY SYNCYTIAL AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87281 PNEUMOCYSTIS CARINII AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87283 RUBEOLA AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87285 TREPONEMA PALLIDUM AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87290 VARICELLA ZOSTER AG IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87299 ANTIBODY DETECTION NOS IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87300 AG DETECTION POLYVAL IF $ 14.84 $ 14.84 3/1/2020 12/31/9999 87301 ADENOVIRUS AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87305 ASPERGILLUS AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87320 CHYLMD TRACH AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87324 CLOSTRIDIUM AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87327 CRYPTOCOCCUS NEOFORM AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87328 CRYPTOSPORIDIUM AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87329 GIARDIA AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87332 CYTOMEGALOVIRUS AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87335 E COLI 0157 AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87336 ENTAMOEB HIST DISPR AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87337 ENTAMOEB HIST GROUP AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87338 HPYLORI STOOL IA $ 18.63 $ 18.63 3/1/2020 12/31/9999 87339 H PYLORI AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87340 HEPATITIS B SURFACE AG IA $ 12.05 $ 12.05 3/1/2020 12/31/9999 87341 HEPATITIS B SURFACE AG IA $ 12.05 $ 12.05 3/1/2020 12/31/9999 87350 HEPATITIS BE AG IA $ 14.33 $ 14.33 3/1/2020 12/31/9999 87380 HEPATITIS DELTA AG IA $ 21.26 $ 21.26 3/1/2020 12/31/9999 87385 HISTOPLASMA CAPSUL AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87389 HIV-1 AG W/HIV-1 & HIV-2 AB $ 31.09 $ 31.09 3/1/2020 12/31/9999 87390 HIV-1 AG IA $ 22.85 $ 22.85 3/1/2020 12/31/9999 87391 HIV-2 AG IA $ 22.85 $ 22.85 3/1/2020 12/31/9999 87400 INFLUENZA A/B AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87420 RESP SYNCYTIAL AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87425 ROTAVIRUS AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87427 SHIGA-LIKE TOXIN AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87430 STREP A AG IA $ 14.84 $ 14.84 3/1/2020 12/31/9999 87449 AG DETECT NOS IA MULT $ 14.84 $ 14.84 3/1/2020 12/31/9999 87450 AG DETECT NOS IA SINGLE $ 9.90 $ 9.90 3/1/2020 12/31/9999 87451 AG DETECT POLYVAL IA MULT $ 9.90 $ 9.90 3/1/2020 12/31/9999 87471 BARTONELLA DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87472 BARTONELLA DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87475 LYME DIS DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87476 LYME DIS DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87480 CANDIDA DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87481 CANDIDA DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87482 CANDIDA DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87483 CNS DNA AMP PROBE TYPE 12-25 $ 255.62 $ 255.62 3/1/2020 12/31/9999 87485 CHYLMD PNEUM DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87486 CHYLMD PNEUM DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87487 CHYLMD PNEUM DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87490 CHYLMD TRACH DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87491 CHYLMD TRACH DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87492 CHYLMD TRACH DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87493 C DIFF AMPLIFIED PROBE $ 32.55 $ 32.55 3/1/2020 12/31/9999 87495 CYTOMEG DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87496 CYTOMEG DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87497 CYTOMEG DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87498 ENTEROVIRUS PROBE&REVRS TRNS $ 31.75 $ 31.75 3/1/2020 12/31/9999 87500 VANOMYCIN DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87501 INFLUENZA DNA AMP PROB 1+ $ 37.36 $ 37.36 3/1/2020 12/31/9999 87502 INFLUENZA DNA AMP PROBE $ 69.34 $ 69.34 3/1/2020 12/31/9999 87503 INFLUENZA DNA AMP PROB ADDL $ 12.03 $ 12.04 3/1/2020 12/31/9999 87505 NFCT AGENT DETECTION GI $ 94.04 $ 94.04 3/1/2020 12/31/9999 87506 IADNA-DNA/RNA PROBE TQ 6-11 $ 142.46 $ 142.46 3/1/2020 12/31/9999 87507 IADNA-DNA/RNA PROBE TQ 12-25 $ 263.53 $ 263.53 3/1/2020 12/31/9999 87510 GARDNER VAG DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87511 GARDNER VAG DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87512 GARDNER VAG DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87516 HEPATITIS B DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87517 HEPATITIS B DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87520 HEPATITIS C RNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87521 HEPATITIS C PROBE&RVRS TRNSC $ 31.75 $ 31.75 3/1/2020 12/31/9999 87522 HEPATITIS C REVRS TRNSCRPJ $ 42.18 $ 42.18 3/1/2020 12/31/9999 87525 HEPATITIS G DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87526 HEPATITIS G DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87527 HEPATITIS G DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87528 HSV DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87529 HSV DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87530 HSV DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87531 HHV-6 DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87532 HHV-6 DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87533 HHV-6 DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87534 HIV-1 DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87535 HIV-1 PROBE&REVERSE TRNSCRPJ $ 31.75 $ 31.75 3/1/2020 12/31/9999 87536 HIV-1 QUANT&REVRSE TRNSCRPJ $ 68.84 $ 68.84 3/1/2020 12/31/9999 87537 HIV-2 DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87538 HIV-2 PROBE&REVRSE TRNSCRIPJ $ 31.75 $ 31.75 3/1/2020 12/31/9999 87539 HIV-2 QUANT&REVRSE TRNSCRIPJ $ 42.18 $ 42.18 3/1/2020 12/31/9999 87540 LEGION PNEUMO DNA DIR PROB $ 25.98 $ 25.98 3/1/2020 12/31/9999 87541 LEGION PNEUMO DNA AMP PROB $ 31.75 $ 31.75 3/1/2020 12/31/9999 87542 LEGION PNEUMO DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87550 MYCOBACTERIA DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87551 MYCOBACTERIA DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87552 MYCOBACTERIA DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87555 M.TUBERCULO DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87556 M.TUBERCULO DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87557 M.TUBERCULO DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87560 M.AVIUM-INTRA DNA DIR PROB $ 25.98 $ 25.98 3/1/2020 12/31/9999 87561 M.AVIUM-INTRA DNA AMP PROB $ 31.75 $ 31.75 3/1/2020 12/31/9999 87562 M.AVIUM-INTRA DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87563 M. GENITALIUM AMP PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87580 M.PNEUMON DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87581 M.PNEUMON DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87582 M.PNEUMON DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87590 N.GONORRHOEAE DNA DIR PROB $ 25.98 $ 25.98 3/1/2020 12/31/9999 87591 N.GONORRHOEAE DNA AMP PROB $ 31.75 $ 31.75 3/1/2020 12/31/9999 87592 N.GONORRHOEAE DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87623 HPV LOW-RISK TYPES $ 32.74 $ 32.74 3/1/2020 12/31/9999 87624 HPV HIGH-RISK TYPES $ 32.74 $ 32.74 3/1/2020 12/31/9999 87625 HPV TYPES 16 & 18 ONLY $ 32.74 $ 32.74 3/1/2020 12/31/9999 87631 RESP VIRUS 3-5 TARGETS $ 91.21 $ 91.21 3/1/2020 12/31/9999 87632 RESP VIRUS 6-11 TARGETS $ 138.19 $ 138.19 3/1/2020 12/31/9999 87633 RESP VIRUS 12-25 TARGETS $ 255.62 $ 255.62 3/1/2020 12/31/9999 87634 RSV DNA/RNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87635 SARS-COV-2 COVID-19 AMP PRB $ 69.34 $ 69.34 3/13/2020 12/31/9999 87640 STAPH A DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87641 MR-STAPH DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87650 STREP A DNA DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87651 STREP A DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87652 STREP A DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87653 STREP B DNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87660 TRICHOMONAS VAGIN DIR PROBE $ 25.98 $ 25.98 3/1/2020 12/31/9999 87661 TRICHOMONAS VAGINALIS AMPLIF $ 30.39 $ 30.39 3/1/2020 12/31/9999 87662 ZIKA VIRUS DNA/RNA AMP PROBE $ 31.75 $ 31.75 3/1/2020 12/31/9999 87797 DETECT AGENT NOS DNA DIR $ 25.98 $ 25.98 3/1/2020 12/31/9999 87798 DETECT AGENT NOS DNA AMP $ 31.75 $ 31.75 3/1/2020 12/31/9999 87799 DETECT AGENT NOS DNA QUANT $ 42.18 $ 42.18 3/1/2020 12/31/9999 87800 DETECT AGNT MULT DNA DIREC $ 51.93 $ 51.93 3/1/2020 12/31/9999 87801 DETECT AGNT MULT DNA AMPLI $ 63.50 $ 63.50 3/1/2020 12/31/9999 87802 STREP B ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87803 CLOSTRIDIUM TOXIN A W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87804 INFLUENZA ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87806 HIV ANTIGEN W/HIV ANTIBODIES $ 32.06 $ 32.06 3/1/2020 12/31/9999 87807 RSV ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87808 TRICHOMONAS ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87809 ADENOVIRUS ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87810 CHYLMD TRACH ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87850 N. GONORRHOEAE ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87880 STREP A ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87899 AGENT NOS ASSAY W/OPTIC $ 14.84 $ 14.84 3/1/2020 12/31/9999 87900 PHENOTYPE INFECT AGENT DRUG $ 105.47 $ 105.47 3/1/2020 12/31/9999 87901 GENOTYPE DNA HIV REVERSE T $ 101.07 $ 101.07 3/1/2020 12/31/9999 87902 GENOTYPE DNA/RNA HEP C $ 101.07 $ 101.07 3/1/2020 12/31/9999 87903 PHENOTYPE DNA HIV W/CULTURE $ 352.44 $ 352.44 3/1/2020 12/31/9999 87904 PHENOTYPE DNA HIV W/CLT ADD $ 21.09 $ 21.09 3/1/2020 12/31/9999 87905 SIALIDASE ENZYME ASSAY $ 17.24 $ 17.24 3/1/2020 12/31/9999 87906 GENOTYPE DNA/RNA HIV $ 50.90 $ 50.90 3/1/2020 12/31/9999 87910 GENOTYPE CYTOMEGALOVIRUS $ 99.42 $ 99.42 3/1/2020 12/31/9999 87912 GENOTYPE DNA HEPATITIS B $ 99.42 $ 99.42 3/1/2020 12/31/9999 88104 26 CYTOPATH FL NONGYN SMEARS $ 23.48 $ 23.48 3/1/2020 12/31/9999 88104 TC CYTOPATH FL NONGYN SMEARS $ 26.84 $ 26.84 3/1/2020 12/31/9999 88104 CYTOPATH FL NONGYN SMEARS $ 50.32 $ 50.32 3/1/2020 12/31/9999 88106 26 CYTOPATH FL NONGYN FILTER $ 23.48 $ 23.48 3/1/2020 12/31/9999 88106 TC CYTOPATH FL NONGYN FILTER $ 38.87 $ 38.87 3/1/2020 12/31/9999 88106 CYTOPATH FL NONGYN FILTER $ 62.35 $ 62.35 3/1/2020 12/31/9999 88108 26 CYTOPATH CONCENTRATE TECH $ 23.48 $ 23.48 3/1/2020 12/31/9999 88108 TC CYTOPATH CONCENTRATE TECH $ 35.66 $ 35.66 3/1/2020 12/31/9999 88108 CYTOPATH CONCENTRATE TECH $ 59.13 $ 59.13 3/1/2020 12/31/9999 88112 26 CYTOPATH CELL ENHANCE TECH $ 48.15 $ 48.15 3/1/2020 12/31/9999 88112 TC CYTOPATH CELL ENHANCE TECH $ 36.24 $ 36.24 3/1/2020 12/31/9999 88112 CYTOPATH CELL ENHANCE TECH $ 84.39 $ 84.39 3/1/2020 12/31/9999 88120 26 CYTP URNE 3-5 PROBES EA SPEC $ 45.15 $ 45.15 3/1/2020 12/31/9999 88120 TC CYTP URNE 3-5 PROBES EA SPEC $ 339.43 $ 339.43 3/1/2020 12/31/9999 88120 CYTP URNE 3-5 PROBES EA SPEC $ 384.59 $ 384.59 3/1/2020 12/31/9999 88121 26 CYTP URINE 3-5 PROBES CMPTR $ 40.07 $ 40.07 3/1/2020 12/31/9999 88121 TC CYTP URINE 3-5 PROBES CMPTR $ 284.75 $ 284.75 3/1/2020 12/31/9999 88121 CYTP URINE 3-5 PROBES CMPTR $ 324.82 $ 324.82 3/1/2020 12/31/9999 88125 26 FORENSIC CYTOPATHOLOGY $ 11.10 $ 11.10 3/1/2020 12/31/9999 88125 TC FORENSIC CYTOPATHOLOGY $ 6.66 $ 6.66 3/1/2020 12/31/9999 88125 FORENSIC CYTOPATHOLOGY $ 17.77 $ 17.77 3/1/2020 12/31/9999 88130 26 SEX CHROMATIN IDENTIFICATION $ 20.49 $ 20.49 3/1/2020 12/31/9999 88130 SEX CHROMATIN IDENTIFICATION $ 19.49 $ 19.49 3/1/2020 12/31/9999 88140 26 SEX CHROMATIN IDENTIFICATION $ 10.45 $ 10.45 3/1/2020 12/31/9999 88140 SEX CHROMATIN IDENTIFICATION $ 10.35 $ 10.35 3/1/2020 12/31/9999 88141 CYTOPATH C/V INTERPRET $ 22.85 $ 22.85 3/1/2020 12/31/9999 88142 CYTOPATH C/V THIN LAYER $ 26.24 $ 26.24 3/1/2020 12/31/9999 88143 CYTOPATH C/V THIN LAYER REDO $ 26.24 $ 26.24 3/1/2020 12/31/9999 88147 CYTOPATH C/V AUTOMATED $ 13.68 $ 13.68 3/1/2020 12/31/9999 88148 CYTOPATH C/V AUTO RESCREEN $ 13.68 $ 13.68 3/1/2020 12/31/9999 88150 CYTOPATH C/V MANUAL $ 13.68 $ 13.68 3/1/2020 12/31/9999 88152 CYTOPATH C/V AUTO REDO $ 13.68 $ 13.68 3/1/2020 12/31/9999 88153 CYTOPATH C/V REDO $ 13.68 $ 13.68 3/1/2020 12/31/9999 88155 CYTOPATH C/V INDEX ADD-ON $ 7.76 $ 7.76 3/1/2020 12/31/9999 88160 26 CYTOPATH SMEAR OTHER SOURCE $ 20.98 $ 20.98 3/1/2020 12/31/9999 88160 TC CYTOPATH SMEAR OTHER SOURCE $ 21.56 $ 21.56 3/1/2020 12/31/9999 88160 CYTOPATH SMEAR OTHER SOURCE $ 42.54 $ 42.54 3/1/2020 12/31/9999 88161 26 CYTOPATH SMEAR OTHER SOURCE $ 20.69 $ 20.69 3/1/2020 12/31/9999 88161 TC CYTOPATH SMEAR OTHER SOURCE $ 23.60 $ 23.60 3/1/2020 12/31/9999 88161 CYTOPATH SMEAR OTHER SOURCE $ 44.30 $ 44.30 3/1/2020 12/31/9999 88162 26 CYTOPATH SMEAR OTHER SOURCE $ 32.09 $ 32.09 3/1/2020 12/31/9999 88162 TC CYTOPATH SMEAR OTHER SOURCE $ 32.12 $ 32.12 3/1/2020 12/31/9999 88162 CYTOPATH SMEAR OTHER SOURCE $ 64.21 $ 64.21 3/1/2020 12/31/9999 88164 CYTOPATH TBS C/V MANUAL $ 13.68 $ 13.68 3/1/2020 12/31/9999 88165 CYTOPATH TBS C/V REDO $ 13.68 $ 13.68 3/1/2020 12/31/9999 88166 CYTOPATH TBS C/V AUTO REDO $ 13.68 $ 13.68 3/1/2020 12/31/9999 88167 CYTOPATH TBS C/V SELECT $ 13.68 $ 13.68 3/1/2020 12/31/9999 88172 26 CYTP DX EVAL FNA 1ST EA SITE $ 25.33 $ 25.33 3/1/2020 12/31/9999 88172 TC CYTP DX EVAL FNA 1ST EA SITE $ 18.03 $ 18.03 3/1/2020 12/31/9999 88172 CYTP DX EVAL FNA 1ST EA SITE $ 43.35 $ 43.35 3/1/2020 12/31/9999 88173 26 CYTOPATH EVAL FNA REPORT $ 58.36 $ 58.36 3/1/2020 12/31/9999 88173 TC CYTOPATH EVAL FNA REPORT $ 51.51 $ 51.51 3/1/2020 12/31/9999 88173 CYTOPATH EVAL FNA REPORT $ 109.88 $ 109.88 3/1/2020 12/31/9999 88174 CYTOPATH C/V AUTO IN FLUID $ 27.67 $ 27.67 3/1/2020 12/31/9999 88175 CYTOPATH C/V AUTO FLUID REDO $ 33.65 $ 33.65 3/1/2020 12/31/9999 88177 26 CYTP FNA EVAL EA ADDL $ 18.42 $ 18.42 3/1/2020 12/31/9999 88177 TC CYTP FNA EVAL EA ADDL $ 5.34 $ 5.34 3/1/2020 12/31/9999 88177 CYTP FNA EVAL EA ADDL $ 23.75 $ 23.75 3/1/2020 12/31/9999 88182 26 CELL MARKER STUDY $ 30.35 $ 30.35 3/1/2020 12/31/9999 88182 TC CELL MARKER STUDY $ 53.09 $ 53.09 3/1/2020 12/31/9999 88182 CELL MARKER STUDY $ 83.43 $ 83.43 3/1/2020 12/31/9999 88184 FLOWCYTOMETRY/ TC 1 MARKER $ 63.57 $ 63.57 3/1/2020 12/31/9999 88185 FLOWCYTOMETRY/TC ADD-ON $ 37.72 $ 37.72 3/1/2020 12/31/9999 88187 FLOWCYTOMETRY/READ 2-8 $ 55.44 $ 55.44 3/1/2020 12/31/9999 88188 FLOWCYTOMETRY/READ 9-15 $ 68.26 $ 68.26 3/1/2020 12/31/9999 88189 FLOWCYTOMETRY/READ 16 & > $ 87.17 $ 87.17 3/1/2020 12/31/9999 88230 26 TISSUE CULTURE LYMPHOCYTE $ 123.41 $ 123.41 3/1/2020 12/31/9999 88230 TC TISSUE CULTURE LYMPHOCYTE $ 40.52 $ 40.52 3/1/2020 12/31/9999 88230 TISSUE CULTURE LYMPHOCYTE $ 150.86 $ 150.86 3/1/2020 12/31/9999 88233 26 TISSUE CULTURE SKIN/BIOPSY $ 149.27 $ 149.27 3/1/2020 12/31/9999 88233 TC TISSUE CULTURE SKIN/BIOPSY $ 49.14 $ 49.14 3/1/2020 12/31/9999 88233 TISSUE CULTURE SKIN/BIOPSY $ 182.24 $ 182.24 3/1/2020 12/31/9999 88235 26 TISSUE CULTURE PLACENTA $ 156.24 $ 156.24 3/1/2020 12/31/9999 88235 TC TISSUE CULTURE PLACENTA $ 51.45 $ 51.45 3/1/2020 12/31/9999 88235 TISSUE CULTURE PLACENTA $ 190.68 $ 190.68 3/1/2020 12/31/9999 88237 26 TISSUE CULTURE BONE MARROW $ 133.88 $ 133.88 3/1/2020 12/31/9999 88237 TC TISSUE CULTURE BONE MARROW $ 44.01 $ 44.01 3/1/2020 12/31/9999 88237 TISSUE CULTURE BONE MARROW $ 163.56 $ 163.56 3/1/2020 12/31/9999 88239 26 TISSUE CULTURE TUMOR $ 156.52 $ 156.52 3/1/2020 12/31/9999 88239 TC TISSUE CULTURE TUMOR $ 51.56 $ 51.56 3/1/2020 12/31/9999 88239 TISSUE CULTURE TUMOR $ 191.04 $ 191.04 3/1/2020 12/31/9999 88245 26 CHROMOSOME ANALYSIS 20-25 $ 157.95 $ 157.95 3/1/2020 12/31/9999 88245 TC CHROMOSOME ANALYSIS 20-25 $ 52.03 $ 52.03 3/1/2020 12/31/9999 88245 CHROMOSOME ANALYSIS 20-25 $ 192.76 $ 192.76 3/1/2020 12/31/9999 88248 26 CHROMOSOME ANALYSIS 50-100 $ 183.90 $ 183.90 3/1/2020 12/31/9999 88248 TC CHROMOSOME ANALYSIS 50-100 $ 60.68 $ 60.68 3/1/2020 12/31/9999 88248 CHROMOSOME ANALYSIS 50-100 $ 224.25 $ 224.25 3/1/2020 12/31/9999 88261 26 CHROMOSOME ANALYSIS 5 $ 187.70 $ 187.70 3/1/2020 12/31/9999 88261 TC CHROMOSOME ANALYSIS 5 $ 61.95 $ 61.95 3/1/2020 12/31/9999 88261 CHROMOSOME ANALYSIS 5 $ 228.87 $ 228.87 3/1/2020 12/31/9999 88262 26 CHROMOSOME ANALYSIS 15-20 $ 132.10 $ 132.10 3/1/2020 12/31/9999 88262 TC CHROMOSOME ANALYSIS 15-20 $ 43.41 $ 43.41 3/1/2020 12/31/9999 88262 CHROMOSOME ANALYSIS 15-20 $ 161.41 $ 161.41 3/1/2020 12/31/9999 88263 26 CHROMOSOME ANALYSIS 45 $ 159.46 $ 159.46 3/1/2020 12/31/9999 88263 TC CHROMOSOME ANALYSIS 45 $ 52.53 $ 52.53 3/1/2020 12/31/9999 88263 CHROMOSOME ANALYSIS 45 $ 194.61 $ 194.61 3/1/2020 12/31/9999 88264 26 CHROMOSOME ANALYSIS 20-25 $ 132.10 $ 132.10 3/1/2020 12/31/9999 88264 TC CHROMOSOME ANALYSIS 20-25 $ 43.41 $ 43.41 3/1/2020 12/31/9999 88264 CHROMOSOME ANALYSIS 20-25 $ 161.41 $ 161.41 3/1/2020 12/31/9999 88267 26 CHROMOSOME ANALYS PLACENTA $ 190.94 $ 190.94 3/1/2020 12/31/9999 88267 TC CHROMOSOME ANALYS PLACENTA $ 63.02 $ 63.02 3/1/2020 12/31/9999 88267 CHROMOSOME ANALYS PLACENTA $ 232.79 $ 232.79 3/1/2020 12/31/9999 88269 26 CHROMOSOME ANALYS AMNIOTIC $ 176.59 $ 176.59 3/1/2020 12/31/9999 88269 TC CHROMOSOME ANALYS AMNIOTIC $ 58.23 $ 58.23 3/1/2020 12/31/9999 88269 CHROMOSOME ANALYS AMNIOTIC $ 215.39 $ 215.39 3/1/2020 12/31/9999 88271 26 CYTOGENETICS DNA PROBE $ 14.52 $ 14.52 3/1/2020 12/31/9999 88271 TC CYTOGENETICS DNA PROBE $ 4.22 $ 4.22 3/1/2020 12/31/9999 88271 CYTOGENETICS DNA PROBE $ 18.74 $ 18.74 3/1/2020 12/31/9999 88272 26 CYTOGENETICS 3-5 $ 27.66 $ 27.66 3/1/2020 12/31/9999 88272 TC CYTOGENETICS 3-5 $ 8.60 $ 8.60 3/1/2020 12/31/9999 88272 CYTOGENETICS 3-5 $ 34.67 $ 34.67 3/1/2020 12/31/9999 88273 26 CYTOGENETICS 10-30 $ 33.37 $ 33.37 3/1/2020 12/31/9999 88273 TC CYTOGENETICS 10-30 $ 10.50 $ 10.50 3/1/2020 12/31/9999 88273 CYTOGENETICS 10-30 $ 41.60 $ 41.60 3/1/2020 12/31/9999 88274 26 CYTOGENETICS 25-99 $ 36.21 $ 36.21 3/1/2020 12/31/9999 88274 TC CYTOGENETICS 25-99 $ 11.46 $ 11.46 3/1/2020 12/31/9999 88274 CYTOGENETICS 25-99 $ 45.07 $ 45.07 3/1/2020 12/31/9999 88275 26 CYTOGENETICS 100-300 $ 41.93 $ 41.93 3/1/2020 12/31/9999 88275 TC CYTOGENETICS 100-300 $ 13.37 $ 13.37 3/1/2020 12/31/9999 88275 CYTOGENETICS 100-300 $ 52.01 $ 52.01 3/1/2020 12/31/9999 88280 26 CHROMOSOME KARYOTYPE STUDY $ 25.86 $ 25.86 3/1/2020 12/31/9999 88280 TC CHROMOSOME KARYOTYPE STUDY $ 8.00 $ 8.00 3/1/2020 12/31/9999 88280 CHROMOSOME KARYOTYPE STUDY $ 32.50 $ 32.50 3/1/2020 12/31/9999 88283 26 CHROMOSOME BANDING STUDY $ 19.62 $ 19.62 3/1/2020 12/31/9999 88283 TC CHROMOSOME BANDING STUDY $ 5.93 $ 5.93 3/1/2020 12/31/9999 88283 CHROMOSOME BANDING STUDY $ 24.95 $ 24.95 3/1/2020 12/31/9999 88285 26 CHROMOSOME COUNT ADDITIONAL $ 19.35 $ 19.35 3/1/2020 12/31/9999 88285 TC CHROMOSOME COUNT ADDITIONAL $ 5.83 $ 5.83 3/1/2020 12/31/9999 88285 CHROMOSOME COUNT ADDITIONAL $ 24.60 $ 24.60 3/1/2020 12/31/9999 88289 26 CHROMOSOME STUDY ADDITIONAL $ 35.27 $ 35.27 3/1/2020 12/31/9999 88289 TC CHROMOSOME STUDY ADDITIONAL $ 11.14 $ 11.14 3/1/2020 12/31/9999 88289 CHROMOSOME STUDY ADDITIONAL $ 43.92 $ 43.92 3/1/2020 12/31/9999 88291 CYTO/MOLECULAR REPORT $ 24.26 $ 24.26 3/1/2020 12/31/9999 88300 26 SURGICAL PATH GROSS $ 3.62 $ 3.62 3/1/2020 12/31/9999 88300 TC SURGICAL PATH GROSS $ 15.18 $ 15.18 3/1/2020 12/31/9999 88300 SURGICAL PATH GROSS $ 18.81 $ 18.81 3/1/2020 12/31/9999 88302 26 TISSUE EXAM BY PATHOLOGIST $ 5.51 $ 5.51 3/1/2020 12/31/9999 88302 TC TISSUE EXAM BY PATHOLOGIST $ 33.89 $ 33.89 3/1/2020 12/31/9999 88302 TISSUE EXAM BY PATHOLOGIST $ 39.40 $ 39.40 3/1/2020 12/31/9999 88304 26 TISSUE EXAM BY PATHOLOGIST $ 9.25 $ 9.25 3/1/2020 12/31/9999 88304 TC TISSUE EXAM BY PATHOLOGIST $ 40.93 $ 40.93 3/1/2020 12/31/9999 88304 TISSUE EXAM BY PATHOLOGIST $ 50.19 $ 50.19 3/1/2020 12/31/9999 88305 26 TISSUE EXAM BY PATHOLOGIST $ 31.76 $ 31.76 3/1/2020 12/31/9999 88305 TC TISSUE EXAM BY PATHOLOGIST $ 53.97 $ 53.97 3/1/2020 12/31/9999 88305 TISSUE EXAM BY PATHOLOGIST $ 85.73 $ 85.73 3/1/2020 12/31/9999 88307 26 TISSUE EXAM BY PATHOLOGIST $ 67.57 $ 67.57 3/1/2020 12/31/9999 88307 TC TISSUE EXAM BY PATHOLOGIST $ 104.32 $ 104.32 3/1/2020 12/31/9999 88307 TISSUE EXAM BY PATHOLOGIST $ 171.87 $ 171.87 3/1/2020 12/31/9999 88309 26 TISSUE EXAM BY PATHOLOGIST $ 116.67 $ 116.67 3/1/2020 12/31/9999 88309 TC TISSUE EXAM BY PATHOLOGIST $ 143.09 $ 143.09 3/1/2020 12/31/9999 88309 TISSUE EXAM BY PATHOLOGIST $ 259.77 $ 259.77 3/1/2020 12/31/9999 88311 26 DECALCIFY TISSUE $ 10.17 $ 10.17 3/1/2020 12/31/9999 88311 TC DECALCIFY TISSUE $ 4.90 $ 4.90 3/1/2020 12/31/9999 88311 DECALCIFY TISSUE $ 15.08 $ 15.08 3/1/2020 12/31/9999 88312 26 SPECIAL STAINS GROUP 1 $ 22.54 $ 22.54 3/1/2020 12/31/9999 88312 TC SPECIAL STAINS GROUP 1 $ 58.07 $ 58.07 3/1/2020 12/31/9999 88312 SPECIAL STAINS GROUP 1 $ 80.62 $ 80.62 3/1/2020 12/31/9999 88313 26 SPECIAL STAINS GROUP 2 $ 9.88 $ 9.88 3/1/2020 12/31/9999 88313 TC SPECIAL STAINS GROUP 2 $ 48.67 $ 48.67 3/1/2020 12/31/9999 88313 SPECIAL STAINS GROUP 2 $ 58.55 $ 58.55 3/1/2020 12/31/9999 88314 26 HISTOCHEMICAL STAINS ADD-ON $ 19.11 $ 19.11 3/1/2020 12/31/9999 88314 TC HISTOCHEMICAL STAINS ADD-ON $ 52.69 $ 52.69 3/1/2020 12/31/9999 88314 HISTOCHEMICAL STAINS ADD-ON $ 71.80 $ 71.80 3/1/2020 12/31/9999 88319 26 ENZYME HISTOCHEMISTRY $ 22.23 $ 22.23 3/1/2020 12/31/9999 88319 TC ENZYME HISTOCHEMISTRY $ 89.70 $ 89.70 3/1/2020 12/31/9999 88319 ENZYME HISTOCHEMISTRY $ 111.92 $ 111.92 3/1/2020 12/31/9999 88321 MICROSLIDE CONSULTATION $ 67.45 $ 74.51 3/1/2020 12/31/9999 88323 26 MICROSLIDE CONSULTATION $ 73.22 $ 73.22 3/1/2020 12/31/9999 88323 TC MICROSLIDE CONSULTATION $ 45.64 $ 45.64 3/1/2020 12/31/9999 88323 MICROSLIDE CONSULTATION $ 118.86 $ 118.86 3/1/2020 12/31/9999 88325 COMPREHENSIVE REVIEW OF DATA $ 104.88 $ 158.35 3/1/2020 12/31/9999 88329 PATH CONSULT INTROP $ 28.43 $ 41.07 3/1/2020 12/31/9999 88331 26 PATH CONSULT INTRAOP 1 BLOC $ 50.93 $ 50.93 3/1/2020 12/31/9999 88331 TC PATH CONSULT INTRAOP 1 BLOC $ 23.43 $ 23.43 3/1/2020 12/31/9999 88331 PATH CONSULT INTRAOP 1 BLOC $ 74.36 $ 74.36 3/1/2020 12/31/9999 88332 26 PATH CONSULT INTRAOP ADDL $ 25.01 $ 25.01 3/1/2020 12/31/9999 88332 TC PATH CONSULT INTRAOP ADDL $ 8.33 $ 8.33 3/1/2020 12/31/9999 88332 PATH CONSULT INTRAOP ADDL $ 33.35 $ 33.35 3/1/2020 12/31/9999 88333 26 INTRAOP CYTO PATH CONSULT 1 $ 50.96 $ 50.96 3/1/2020 12/31/9999 88333 TC INTRAOP CYTO PATH CONSULT 1 $ 25.18 $ 25.18 3/1/2020 12/31/9999 88333 INTRAOP CYTO PATH CONSULT 1 $ 76.15 $ 76.15 3/1/2020 12/31/9999 88334 26 INTRAOP CYTO PATH CONSULT 2 $ 30.64 $ 30.64 3/1/2020 12/31/9999 88334 TC INTRAOP CYTO PATH CONSULT 2 $ 15.39 $ 15.39 3/1/2020 12/31/9999 88334 INTRAOP CYTO PATH CONSULT 2 $ 46.01 $ 46.01 3/1/2020 12/31/9999 88341 26 IMMUNOHISTO ANTB ADDL SLIDE $ 19.24 $ 19.24 3/1/2020 12/31/9999 88341 TC IMMUNOHISTO ANTB ADDL SLIDE $ 38.14 $ 38.14 3/1/2020 12/31/9999 88341 IMMUNOHISTO ANTB ADDL SLIDE $ 57.37 $ 57.37 3/1/2020 12/31/9999 88342 26 IMMUNOHISTO ANTB 1ST STAIN $ 35.24 $ 35.24 3/1/2020 12/31/9999 88342 TC IMMUNOHISTO ANTB 1ST STAIN $ 46.23 $ 46.23 3/1/2020 12/31/9999 88342 IMMUNOHISTO ANTB 1ST STAIN $ 81.46 $ 81.46 3/1/2020 12/31/9999 88344 26 IMMUNOHISTO ANTIBODY SLIDE $ 35.36 $ 35.36 3/1/2020 12/31/9999 88344 TC IMMUNOHISTO ANTIBODY SLIDE $ 64.60 $ 64.60 3/1/2020 12/31/9999 88344 IMMUNOHISTO ANTIBODY SLIDE $ 99.95 $ 99.95 3/1/2020 12/31/9999 88346 26 IMMUNOFLUOR ANTB 1ST STAIN $ 35.85 $ 35.85 3/1/2020 12/31/9999 88346 TC IMMUNOFLUOR ANTB 1ST STAIN $ 45.94 $ 45.94 3/1/2020 12/31/9999 88346 IMMUNOFLUOR ANTB 1ST STAIN $ 81.77 $ 81.77 3/1/2020 12/31/9999 88348 26 ELECTRON MICROSCOPY $ 63.26 $ 63.26 3/1/2020 12/31/9999 88348 TC ELECTRON MICROSCOPY $ 442.03 $ 442.03 3/1/2020 12/31/9999 88348 ELECTRON MICROSCOPY $ 505.29 $ 505.29 3/1/2020 12/31/9999 88350 26 IMMUNOFLUOR ANTB ADDL STAIN $ 25.28 $ 25.28 3/1/2020 12/31/9999 88350 TC IMMUNOFLUOR ANTB ADDL STAIN $ 36.71 $ 36.71 3/1/2020 12/31/9999 88350 IMMUNOFLUOR ANTB ADDL STAIN $ 61.99 $ 61.99 3/1/2020 12/31/9999 88355 26 ANALYSIS SKELETAL MUSCLE $ 74.26 $ 74.26 3/1/2020 12/31/9999 88355 TC ANALYSIS SKELETAL MUSCLE $ 121.36 $ 121.36 3/1/2020 12/31/9999 88355 ANALYSIS SKELETAL MUSCLE $ 195.62 $ 195.62 3/1/2020 12/31/9999 88356 26 ANALYSIS NERVE $ 118.59 $ 118.59 3/1/2020 12/31/9999 88356 TC ANALYSIS NERVE $ 120.08 $ 120.08 3/1/2020 12/31/9999 88356 ANALYSIS NERVE $ 238.67 $ 238.67 3/1/2020 12/31/9999 88358 26 ANALYSIS TUMOR $ 38.65 $ 38.65 3/1/2020 12/31/9999 88358 TC ANALYSIS TUMOR $ 25.20 $ 25.20 3/1/2020 12/31/9999 88358 ANALYSIS TUMOR $ 63.85 $ 63.85 3/1/2020 12/31/9999 88360 26 TUMOR IMMUNOHISTOCHEM/MANUAL $ 45.83 $ 45.83 3/1/2020 12/31/9999 88360 TC TUMOR IMMUNOHISTOCHEM/MANUAL $ 52.69 $ 52.69 3/1/2020 12/31/9999 88360 TUMOR IMMUNOHISTOCHEM/MANUAL $ 98.52 $ 98.52 3/1/2020 12/31/9999 88361 26 TUMOR IMMUNOHISTOCHEM/COMPUT $ 49.17 $ 49.17 3/1/2020 12/31/9999 88361 TC TUMOR IMMUNOHISTOCHEM/COMPUT $ 74.55 $ 74.55 3/1/2020 12/31/9999 88361 TUMOR IMMUNOHISTOCHEM/COMPUT $ 123.74 $ 123.74 3/1/2020 12/31/9999 88362 26 NERVE TEASING PREPARATIONS $ 90.70 $ 90.70 3/1/2020 12/31/9999 88362 TC NERVE TEASING PREPARATIONS $ 124.29 $ 124.29 3/1/2020 12/31/9999 88362 NERVE TEASING PREPARATIONS $ 214.99 $ 214.99 3/1/2020 12/31/9999 88364 26 INSITU HYBRIDIZATION (FISH) $ 23.99 $ 23.99 3/1/2020 12/31/9999 88364 TC INSITU HYBRIDIZATION (FISH) $ 58.87 $ 58.87 3/1/2020 12/31/9999 88364 INSITU HYBRIDIZATION (FISH) $ 82.88 $ 82.88 3/1/2020 12/31/9999 88365 26 INSITU HYBRIDIZATION (FISH) $ 49.29 $ 49.29 3/1/2020 12/31/9999 88365 TC INSITU HYBRIDIZATION (FISH) $ 78.83 $ 78.83 3/1/2020 12/31/9999 88365 INSITU HYBRIDIZATION (FISH) $ 128.12 $ 128.12 3/1/2020 12/31/9999 88366 26 INSITU HYBRIDIZATION (FISH) $ 55.67 $ 55.67 3/1/2020 12/31/9999 88366 TC INSITU HYBRIDIZATION (FISH) $ 72.40 $ 72.40 3/1/2020 12/31/9999 88366 INSITU HYBRIDIZATION (FISH) $ 128.07 $ 128.07 3/1/2020 12/31/9999 88367 26 INSITU HYBRIDIZATION AUTO $ 52.78 $ 52.78 3/1/2020 12/31/9999 88367 TC INSITU HYBRIDIZATION AUTO $ 142.50 $ 142.50 3/1/2020 12/31/9999 88367 INSITU HYBRIDIZATION AUTO $ 195.28 $ 195.28 3/1/2020 12/31/9999 88368 26 INSITU HYBRIDIZATION MANUAL $ 55.66 $ 55.66 3/1/2020 12/31/9999 88368 TC INSITU HYBRIDIZATION MANUAL $ 116.64 $ 116.64 3/1/2020 12/31/9999 88368 INSITU HYBRIDIZATION MANUAL $ 172.31 $ 172.31 3/1/2020 12/31/9999 88369 26 M/PHMTRC ALYSISHQUANT/SEMIQ $ 22.20 $ 22.20 3/1/2020 12/31/9999 88369 TC M/PHMTRC ALYSISHQUANT/SEMIQ $ 40.83 $ 40.83 3/1/2020 12/31/9999 88369 M/PHMTRC ALYSISHQUANT/SEMIQ $ 63.03 $ 63.03 3/1/2020 12/31/9999 88371 26 PROTEIN WESTERN BLOT TISSUE $ 15.48 $ 15.48 3/1/2020 12/31/9999 88372 26 PROTEIN ANALYSIS W/PROBE $ 15.48 $ 15.48 3/1/2020 12/31/9999 88372 TC PROTEIN ANALYSIS W/PROBE $ 15.80 $ 15.80 3/1/2020 12/31/9999 88373 26 M/PHMTRC ALYS ISHQUANT/SEMIQ $ 18.66 $ 18.66 3/1/2020 12/31/9999 88373 TC M/PHMTRC ALYS ISHQUANT/SEMIQ $ 32.72 $ 32.72 3/1/2020 12/31/9999 88373 M/PHMTRC ALYS ISHQUANT/SEMIQ $ 51.38 $ 51.38 3/1/2020 12/31/9999 88374 26 M/PHMTRC ALYS ISHQUANT/SEMIQ $ 39.93 $ 39.93 3/1/2020 12/31/9999 88374 TC M/PHMTRC ALYS ISHQUANT/SEMIQ $ 134.34 $ 134.34 3/1/2020 12/31/9999 88374 M/PHMTRC ALYS ISHQUANT/SEMIQ $ 174.28 $ 174.28 3/1/2020 12/31/9999 88377 26 M/PHMTRC ALYS ISHQUANT/SEMIQ $ 58.14 $ 58.14 3/1/2020 12/31/9999 88377 TC M/PHMTRC ALYS ISHQUANT/SEMIQ $ 125.02 $ 125.02 3/1/2020 12/31/9999 88377 M/PHMTRC ALYS ISHQUANT/SEMIQ $ 183.15 $ 183.15 3/1/2020 12/31/9999 88387 26 TISS EXAM MOLECULAR STUDY $ 20.66 $ 20.66 3/1/2020 12/31/9999 88387 TC TISS EXAM MOLECULAR STUDY $ 4.99 $ 4.99 3/1/2020 12/31/9999 88387 TISS EXAM MOLECULAR STUDY $ 25.65 $ 25.65 3/1/2020 12/31/9999 88388 26 TISS EX MOLECUL STUDY ADD-ON $ 12.87 $ 12.87 3/1/2020 12/31/9999 88388 TC TISS EX MOLECUL STUDY ADD-ON $ 2.46 $ 2.46 3/1/2020 12/31/9999 88388 TISS EX MOLECUL STUDY ADD-ON $ 15.33 $ 15.33 3/1/2020 12/31/9999 88720 BILIRUBIN TOTAL TRANSCUT $ 6.54 $ 6.54 3/1/2020 12/31/9999 88738 HGB QUANT TRANSCUTANEOUS $ 6.66 $ 6.66 3/1/2020 12/31/9999 88740 TRANSCUTANEOUS CARBOXYHB $ 6.79 $ 6.79 3/1/2020 12/31/9999 88741 TRANSCUTANEOUS METHB $ 6.79 $ 6.79 3/1/2020 12/31/9999 89049 CHCT FOR MAL HYPERTHERMIA $ 58.00 $ 194.60 3/1/2020 12/31/9999 89050 BODY FLUID CELL COUNT $ 6.13 $ 6.13 3/1/2020 12/31/9999 89051 BODY FLUID CELL COUNT $ 6.74 $ 6.74 3/1/2020 12/31/9999 89055 LEUKOCYTE ASSESSMENT FECAL $ 5.52 $ 5.52 3/1/2020 12/31/9999 89060 EXAM SYNOVIAL FLUID CRYSTALS $ 9.26 $ 9.26 3/1/2020 12/31/9999 89125 SPECIMEN FAT STAIN $ 5.60 $ 5.60 3/1/2020 12/31/9999 89160 EXAM FECES FOR MEAT FIBERS $ 4.78 $ 4.78 3/1/2020 12/31/9999 89190 NASAL SMEAR FOR EOSINOPHILS $ 6.03 $ 6.03 3/1/2020 12/31/9999 89300 SEMEN ANALYSIS W/HUHNER $ 11.54 $ 11.54 3/1/2020 12/31/9999 89310 SEMEN ANALYSIS W/COUNT $ 10.86 $ 10.86 3/1/2020 12/31/9999 89320 SEMEN ANAL VOL/COUNT/MOT $ 15.60 $ 15.60 3/1/2020 12/31/9999 89325 SPERM ANTIBODY TEST $ 13.82 $ 13.82 3/1/2020 12/31/9999 90460 EP IM ADMIN 1ST/ONLY COMPONENT $ 21.47 $ 21.47 3/1/2020 12/31/9999 90471 EP IMMUNIZATION ADMIN $ 21.47 $ 21.47 3/1/2020 12/31/9999 90471 IMMUNIZATION ADMIN $ 13.97 $ 13.97 3/1/2020 12/31/9999 90472 EP IMMUNIZATION ADMIN EACH ADD $ 21.47 $ 21.47 3/1/2020 12/31/9999 90472 IMMUNIZATION ADMIN EACH ADD $ 13.97 $ 13.97 3/1/2020 12/31/9999 90473 EP IMMUNE ADMIN ORAL/NASAL $ 21.47 $ 21.47 3/1/2020 12/31/9999 90473 IMMUNE ADMIN ORAL/NASAL $ 13.97 $ 13.97 3/1/2020 12/31/9999 90474 EP IMMUNE ADMIN ORAL/NASAL ADDL $ 21.47 $ 21.47 3/1/2020 12/31/9999 90474 IMMUNE ADMIN ORAL/NASAL ADDL $ 13.97 $ 13.97 3/1/2020 12/31/9999 90785 PSYTX COMPLEX INTERACTIVE $ 4.03 $ 4.03 3/1/2020 12/31/9999 90791 PSYCH DIAGNOSTIC EVALUATION $ 100.36 $ 127.71 3/1/2020 12/31/9999 90792 PSYCH DIAG EVAL W/MED SRVCS $ 103.75 $ 106.51 3/1/2020 12/31/9999 90832 PSYTX W PT 30 MINUTES $ 42.16 $ 53.20 3/1/2020 12/31/9999 90833 PSYTX W PT W E/M 30 MIN $ 35.28 $ 35.55 3/1/2020 12/31/9999 90834 PSYTX W PT 45 MINUTES $ 63.30 $ 69.10 3/1/2020 12/31/9999 90836 PSYTX W PT W E/M 45 MIN $ 57.77 $ 57.77 3/1/2020 12/31/9999 90837 PSYTX W PT 60 MINUTES $ 95.46 $ 101.26 3/1/2020 12/31/9999 90838 PSYTX W PT W E/M 60 MIN $ 92.73 $ 93.28 3/1/2020 12/31/9999 90839 PSYTX CRISIS INITIAL 60 MIN $ 119.60 $ 127.60 3/1/2020 12/31/9999 90840 PSYTX CRISIS EA ADDL 30 MIN $ 99.67 $ 107.43 3/1/2020 12/31/9999 90845 PSYCHOANALYSIS $ 69.10 $ 70.58 3/1/2020 12/31/9999 90846 FAMILY PSYTX W/O PT 50 MIN $ 73.31 $ 75.08 3/1/2020 12/31/9999 90847 FAMILY PSYTX W/PT 50 MIN $ 87.93 $ 93.22 3/1/2020 12/31/9999 90849 MULTIPLE FAMILY GROUP PSYTX $ 25.60 $ 27.96 3/1/2020 12/31/9999 90853 GROUP PSYCHOTHERAPY $ 25.11 $ 26.58 3/1/2020 12/31/9999 90865 NARCOSYNTHESIS $ 114.05 $ 131.67 3/1/2020 12/31/9999 90870 ELECTROCONVULSIVE THERAPY $ 73.44 $ 115.44 3/1/2020 12/31/9999 90935 HEMODIALYSIS ONE EVALUATION $ 56.58 $ 56.58 3/1/2020 12/31/9999 90937 HEMODIALYSIS REPEATED EVAL $ 93.09 $ 93.09 3/1/2020 12/31/9999 90945 DIALYSIS ONE EVALUATION $ 58.79 $ 58.79 3/1/2020 12/31/9999 90947 DIALYSIS REPEATED EVAL $ 95.27 $ 95.27 3/1/2020 12/31/9999 90951 ESRD SERV 4 VISITS P MO <2YR $ 821.75 $ 821.75 3/1/2020 12/31/9999 90952 ESRD SERV 2-3 VSTS P MO <2YR $ 382.02 $ 382.02 3/1/2020 12/31/9999 90953 ESRD SERV 1 VISIT P MO <2YRS $ 258.78 $ 258.78 3/1/2020 12/31/9999 90954 ESRD SERV 4 VSTS P MO 2-11 $ 674.73 $ 674.73 3/1/2020 12/31/9999 90955 ESRD SRV 2-3 VSTS P MO 2-11 $ 382.02 $ 382.02 3/1/2020 12/31/9999 90956 ESRD SRV 1 VISIT P MO 2-11 $ 258.77 $ 258.77 3/1/2020 12/31/9999 90957 ESRD SRV 4 VSTS P MO 12-19 $ 541.56 $ 541.56 3/1/2020 12/31/9999 90958 ESRD SRV 2-3 VSTS P MO 12-19 $ 365.37 $ 365.37 3/1/2020 12/31/9999 90959 ESRD SERV 1 VST P MO 12-19 $ 239.78 $ 239.78 3/1/2020 12/31/9999 90960 ESRD SRV 4 VISITS P MO 20+ $ 240.19 $ 240.19 3/1/2020 12/31/9999 90961 ESRD SRV 2-3 VSTS P MO 20+ $ 193.91 $ 193.91 3/1/2020 12/31/9999 90962 ESRD SERV 1 VISIT P MO 20+ $ 140.23 $ 140.23 3/1/2020 12/31/9999 90963 ESRD HOME PT SERV P MO <2YRS $ 464.21 $ 464.21 3/1/2020 12/31/9999 90964 ESRD HOME PT SERV P MO 2-11 $ 387.37 $ 387.37 3/1/2020 12/31/9999 90965 ESRD HOME PT SERV P MO 12-19 $ 368.46 $ 368.46 3/1/2020 12/31/9999 90966 ESRD HOME PT SERV P MO 20+ $ 191.86 $ 191.86 3/1/2020 12/31/9999 90967 ESRD SVC PR DAY PT <2 $ 16.60 $ 16.60 3/1/2020 12/31/9999 90968 ESRD SVC PR DAY PT 2-11 $ 12.96 $ 12.96 3/1/2020 12/31/9999 90969 ESRD SVC PR DAY PT 12-19 $ 12.64 $ 12.64 3/1/2020 12/31/9999 90970 ESRD SVC PR DAY PT 20+ $ 6.70 $ 6.70 3/1/2020 12/31/9999 90989 DIALYSIS TRAINING COMPLETE ** ** 90993 DIALYSIS TRAINING INCOMPL ** ** 91010 26 ESOPHAGUS MOTILITY STUDY $ 56.77 $ 56.77 3/1/2020 12/31/9999 91010 TC ESOPHAGUS MOTILITY STUDY $ 95.80 $ 95.80 3/1/2020 12/31/9999 91010 ESOPHAGUS MOTILITY STUDY $ 152.57 $ 152.57 3/1/2020 12/31/9999 91013 26 ESOPHGL MOTIL W/STIM/PERFUS $ 8.41 $ 8.41 3/1/2020 12/31/9999 91013 TC ESOPHGL MOTIL W/STIM/PERFUS $ 11.05 $ 11.05 3/1/2020 12/31/9999 91013 ESOPHGL MOTIL W/STIM/PERFUS $ 19.47 $ 19.47 3/1/2020 12/31/9999 91020 26 GASTRIC MOTILITY STUDIES $ 65.05 $ 65.05 3/1/2020 12/31/9999 91020 TC GASTRIC MOTILITY STUDIES $ 120.17 $ 120.17 3/1/2020 12/31/9999 91020 GASTRIC MOTILITY STUDIES $ 185.23 $ 185.23 3/1/2020 12/31/9999 91022 26 DUODENAL MOTILITY STUDY $ 66.81 $ 66.81 3/1/2020 12/31/9999 91022 DUODENAL MOTILITY STUDY $ 152.92 $ 152.92 3/1/2020 12/31/9999 91030 26 ACID PERFUSION OF ESOPHAGUS $ 42.04 $ 42.04 3/1/2020 12/31/9999 91030 TC ACID PERFUSION OF ESOPHAGUS $ 69.14 $ 69.14 3/1/2020 12/31/9999 91030 ACID PERFUSION OF ESOPHAGUS $ 111.18 $ 111.18 3/1/2020 12/31/9999 91034 26 GASTROESOPHAGEAL REFLUX TEST $ 44.05 $ 44.05 3/1/2020 12/31/9999 91034 TC GASTROESOPHAGEAL REFLUX TEST $ 115.19 $ 115.19 3/1/2020 12/31/9999 91034 GASTROESOPHAGEAL REFLUX TEST $ 159.24 $ 159.24 3/1/2020 12/31/9999 91035 26 G-ESOPH REFLX TST W/ELECTROD $ 70.93 $ 70.93 3/1/2020 12/31/9999 91035 TC G-ESOPH REFLX TST W/ELECTROD $ 358.79 $ 358.79 3/1/2020 12/31/9999 91035 G-ESOPH REFLX TST W/ELECTROD $ 429.72 $ 429.72 3/1/2020 12/31/9999 91037 26 ESOPH IMPED FUNCTION TEST $ 44.65 $ 44.65 3/1/2020 12/31/9999 91037 TC ESOPH IMPED FUNCTION TEST $ 83.46 $ 83.46 3/1/2020 12/31/9999 91037 ESOPH IMPED FUNCTION TEST $ 128.10 $ 128.10 3/1/2020 12/31/9999 91038 26 ESOPH IMPED FUNCT TEST > 1HR $ 50.53 $ 50.53 3/1/2020 12/31/9999 91038 TC ESOPH IMPED FUNCT TEST > 1HR $ 62.90 $ 62.90 3/1/2020 12/31/9999 91038 ESOPH IMPED FUNCT TEST > 1HR $ 113.43 $ 113.43 3/1/2020 12/31/9999 91040 26 ESOPH BALLOON DISTENSION TST $ 45.81 $ 45.81 3/1/2020 12/31/9999 91040 TC ESOPH BALLOON DISTENSION TST $ 255.89 $ 255.89 3/1/2020 12/31/9999 91040 ESOPH BALLOON DISTENSION TST $ 301.70 $ 301.70 3/1/2020 12/31/9999 91065 26 BREATH HYDROGEN/METHANE TEST $ 8.91 $ 8.91 3/1/2020 12/31/9999 91065 TC BREATH HYDROGEN/METHANE TEST $ 43.29 $ 43.29 3/1/2020 12/31/9999 91065 BREATH HYDROGEN/METHANE TEST $ 52.19 $ 52.19 3/1/2020 12/31/9999 91110 26 GI TRACT CAPSULE ENDOSCOPY $ 165.28 $ 165.28 3/1/2020 12/31/9999 91110 TC GI TRACT CAPSULE ENDOSCOPY $ 555.71 $ 555.71 3/1/2020 12/31/9999 91110 GI TRACT CAPSULE ENDOSCOPY $ 720.99 $ 720.99 3/1/2020 12/31/9999 91120 26 RECTAL SENSATION TEST $ 41.61 $ 41.61 3/1/2020 12/31/9999 91120 TC RECTAL SENSATION TEST $ 267.53 $ 267.53 3/1/2020 12/31/9999 91120 RECTAL SENSATION TEST $ 309.13 $ 309.13 3/1/2020 12/31/9999 91122 26 ANAL PRESSURE RECORD $ 77.04 $ 77.04 3/1/2020 12/31/9999 91122 TC ANAL PRESSURE RECORD $ 110.01 $ 110.01 3/1/2020 12/31/9999 91122 ANAL PRESSURE RECORD $ 187.05 $ 187.05 3/1/2020 12/31/9999 91200 26 LIVER ELASTOGRAPHY $ 13.20 $ 13.20 3/1/2020 12/31/9999 91200 TC LIVER ELASTOGRAPHY $ 17.99 $ 17.99 3/1/2020 12/31/9999 91200 LIVER ELASTOGRAPHY $ 31.19 $ 31.19 3/1/2020 12/31/9999 92002 EYE EXAM NEW PATIENT $ 37.16 $ 56.54 3/1/2020 12/31/9999 92004 EYE EXAM NEW PATIENT $ 77.11 $ 106.77 3/1/2020 12/31/9999 92012 EYE EXAM ESTABLISH PATIENT $ 39.31 $ 59.58 3/1/2020 12/31/9999 92014 EYE EXAM&TX ESTAB PT 1/>VST $ 60.39 $ 87.11 3/1/2020 12/31/9999 92015 DETERMINE REFRACTIVE STATE $ 16.10 $ 26.37 3/1/2020 12/31/9999 92018 NEW EYE EXAM & TREATMENT $ 109.29 $ 109.29 3/1/2020 12/31/9999 92019 EYE EXAM & TREATMENT $ 54.54 $ 54.54 3/1/2020 12/31/9999 92020 SPECIAL EYE EVALUATION $ 16.07 $ 20.18 3/1/2020 12/31/9999 92025 26 CORNEAL TOPOGRAPHY $ 15.13 $ 15.13 3/1/2020 12/31/9999 92025 TC CORNEAL TOPOGRAPHY $ 10.77 $ 10.77 3/1/2020 12/31/9999 92025 CORNEAL TOPOGRAPHY $ 25.91 $ 25.91 3/1/2020 12/31/9999 92060 26 SPECIAL EYE EVALUATION $ 29.96 $ 29.96 3/1/2020 12/31/9999 92060 TC SPECIAL EYE EVALUATION $ 15.18 $ 15.18 3/1/2020 12/31/9999 92060 SPECIAL EYE EVALUATION $ 45.14 $ 45.14 3/1/2020 12/31/9999 92071 CONTACT LENS FITTING FOR TX $ 20.07 $ 22.47 3/1/2020 12/31/9999 92072 FIT CONTAC LENS FOR MANAGMNT $ 57.61 $ 71.63 3/1/2020 12/31/9999 92081 26 VISUAL FIELD EXAMINATION(S) $ 16.70 $ 16.70 3/1/2020 12/31/9999 92081 TC VISUAL FIELD EXAMINATION(S) $ 24.29 $ 24.29 3/1/2020 12/31/9999 92081 VISUAL FIELD EXAMINATION(S) $ 39.74 $ 39.74 3/1/2020 12/31/9999 92082 26 VISUAL FIELD EXAMINATION(S) $ 18.87 $ 18.87 3/1/2020 12/31/9999 92082 TC VISUAL FIELD EXAMINATION(S) $ 33.69 $ 33.69 3/1/2020 12/31/9999 92082 VISUAL FIELD EXAMINATION(S) $ 52.56 $ 52.56 3/1/2020 12/31/9999 92083 26 VISUAL FIELD EXAMINATION(S) $ 21.66 $ 21.66 3/1/2020 12/31/9999 92083 TC VISUAL FIELD EXAMINATION(S) $ 38.39 $ 38.39 3/1/2020 12/31/9999 92083 VISUAL FIELD EXAMINATION(S) $ 60.05 $ 60.05 3/1/2020 12/31/9999 92132 26 CMPTR OPHTH DX IMG ANT SEGMT $ 17.86 $ 17.86 3/1/2020 12/31/9999 92132 TC CMPTR OPHTH DX IMG ANT SEGMT $ 12.77 $ 12.77 3/1/2020 12/31/9999 92132 CMPTR OPHTH DX IMG ANT SEGMT $ 30.63 $ 30.63 3/1/2020 12/31/9999 92133 26 CMPTR OPHTH IMG OPTIC NERVE $ 24.91 $ 24.91 3/1/2020 12/31/9999 92133 TC CMPTR OPHTH IMG OPTIC NERVE $ 12.77 $ 12.77 3/1/2020 12/31/9999 92133 CMPTR OPHTH IMG OPTIC NERVE $ 37.67 $ 37.67 3/1/2020 12/31/9999 92134 26 CPTR OPHTH DX IMG POST SEGMT $ 24.91 $ 24.91 3/1/2020 12/31/9999 92134 TC CPTR OPHTH DX IMG POST SEGMT $ 12.77 $ 12.77 3/1/2020 12/31/9999 92134 CPTR OPHTH DX IMG POST SEGMT $ 37.67 $ 37.67 3/1/2020 12/31/9999 92136 26 OPHTHALMIC BIOMETRY $ 23.81 $ 23.81 3/1/2020 12/31/9999 92136 TC OPHTHALMIC BIOMETRY $ 38.42 $ 38.42 3/1/2020 12/31/9999 92136 OPHTHALMIC BIOMETRY $ 62.24 $ 62.24 3/1/2020 12/31/9999 92228 26 REMOTE RETINAL IMAGING MGMT $ 14.84 $ 14.84 3/1/2020 12/31/9999 92228 TC REMOTE RETINAL IMAGING MGMT $ 10.48 $ 10.48 3/1/2020 12/31/9999 92228 REMOTE RETINAL IMAGING MGMT $ 25.32 $ 25.32 3/1/2020 12/31/9999 92235 26 FLUORESCEIN ANGRPH UNI/BI $ 35.82 $ 35.82 3/1/2020 12/31/9999 92235 TC FLUORESCEIN ANGRPH UNI/BI $ 60.54 $ 60.54 3/1/2020 12/31/9999 92235 FLUORESCEIN ANGRPH UNI/BI $ 96.36 $ 96.36 3/1/2020 12/31/9999 92240 26 ICG ANGIOGRAPHY UNI/BI $ 48.75 $ 48.75 3/1/2020 12/31/9999 92240 TC ICG ANGIOGRAPHY UNI/BI $ 129.29 $ 129.29 3/1/2020 12/31/9999 92240 ICG ANGIOGRAPHY UNI/BI $ 178.04 $ 178.04 3/1/2020 12/31/9999 92242 26 FLUORESCEIN ICG ANGIOGRAPHY $ 49.36 $ 49.36 3/1/2020 12/31/9999 92242 TC FLUORESCEIN ICG ANGIOGRAPHY $ 145.67 $ 145.67 3/1/2020 12/31/9999 92242 FLUORESCEIN ICG ANGIOGRAPHY $ 195.03 $ 195.03 3/1/2020 12/31/9999 92250 26 EYE EXAM WITH PHOTOS $ 19.68 $ 19.68 3/1/2020 12/31/9999 92250 TC EYE EXAM WITH PHOTOS $ 43.32 $ 43.32 3/1/2020 12/31/9999 92250 EYE EXAM WITH PHOTOS $ 63.00 $ 63.00 3/1/2020 12/31/9999 92265 26 EYE MUSCLE EVALUATION $ 33.87 $ 33.87 3/1/2020 12/31/9999 92265 TC EYE MUSCLE EVALUATION $ 25.37 $ 25.37 3/1/2020 12/31/9999 92265 EYE MUSCLE EVALUATION $ 59.24 $ 59.24 3/1/2020 12/31/9999 92270 26 ELECTRO-OCULOGRAPHY $ 34.25 $ 34.25 3/1/2020 12/31/9999 92270 TC ELECTRO-OCULOGRAPHY $ 33.60 $ 33.60 3/1/2020 12/31/9999 92270 ELECTRO-OCULOGRAPHY $ 67.85 $ 67.85 3/1/2020 12/31/9999 92273 26 FULL FIELD ERG W/I&R $ 33.59 $ 33.59 3/1/2020 12/31/9999 92273 FULL FIELD ERG W/I&R $ 115.92 $ 115.92 3/1/2020 12/31/9999 92273 TC FULL FIELD ERG W/I&R $ 82.33 $ 82.33 3/1/2020 12/31/9999 92274 26 MULTIFOCAL ERG W/I&R $ 29.78 $ 29.78 3/1/2020 12/31/9999 92274 MULTIFOCAL ERG W/I&R $ 78.78 $ 78.78 3/1/2020 12/31/9999 92274 TC MULTIFOCAL ERG W/I&R $ 49.00 $ 49.00 3/1/2020 12/31/9999 92283 26 COLOR VISION EXAMINATION $ 7.36 $ 7.36 3/1/2020 12/31/9999 92283 TC COLOR VISION EXAMINATION $ 26.64 $ 26.64 3/1/2020 12/31/9999 92283 COLOR VISION EXAMINATION $ 34.01 $ 34.01 3/1/2020 12/31/9999 92284 26 DARK ADAPTATION EYE EXAM $ 9.88 $ 9.88 3/1/2020 12/31/9999 92284 TC DARK ADAPTATION EYE EXAM $ 35.75 $ 35.75 3/1/2020 12/31/9999 92284 DARK ADAPTATION EYE EXAM $ 45.63 $ 45.63 3/1/2020 12/31/9999 92502 EAR AND THROAT EXAMINATION $ 77.46 $ 77.46 3/1/2020 12/31/9999 92504 EAR MICROSCOPY EXAMINATION $ 7.98 $ 22.66 3/1/2020 12/31/9999 92507 SPEECH/HEARING THERAPY $ 24.87 $ 69.51 3/1/2020 12/31/9999 92508 SPEECH/HEARING THERAPY $ 11.39 $ 24.32 3/1/2020 12/31/9999 92511 NASOPHARYNGOSCOPY $ 47.84 $ 119.51 3/1/2020 12/31/9999 92512 NASAL FUNCTION STUDIES $ 23.45 $ 47.84 3/1/2020 12/31/9999 92516 FACIAL NERVE FUNCTION TEST $ 18.85 $ 49.10 3/1/2020 12/31/9999 92520 LARYNGEAL FUNCTION STUDIES $ 32.94 $ 49.09 3/1/2020 12/31/9999 92521 EVALUATION OF SPEECH FLUENCY $ 95.27 $ 95.27 3/1/2020 12/31/9999 92522 EVALUATE SPEECH PRODUCTION $ 77.48 $ 77.48 3/1/2020 12/31/9999 92523 SPEECH SOUND LANG COMPREHEN $ 160.72 $ 160.72 3/1/2020 12/31/9999 92524 BEHAVRAL QUALIT ANALYS VOICE $ 80.37 $ 80.37 3/1/2020 12/31/9999 92526 ORAL FUNCTION THERAPY $ 23.15 $ 64.87 3/1/2020 12/31/9999 92531 SPONTANEOUS NYSTAGMUS STUDY $ 18.39 $ 18.39 3/1/2020 12/31/9999 92532 POSITIONAL NYSTAGMUS TEST $ 18.75 $ 18.75 3/1/2020 12/31/9999 92533 CALORIC VESTIBULAR TEST $ 11.95 $ 11.95 3/1/2020 12/31/9999 92534 OPTOKINETIC NYSTAGMUS TEST $ 35.31 $ 35.31 3/1/2020 12/31/9999 92537 26 CALORIC VSTBLR TEST W/REC $ 28.33 $ 28.33 3/1/2020 12/31/9999 92537 TC CALORIC VSTBLR TEST W/REC $ 7.17 $ 7.17 3/1/2020 12/31/9999 92537 CALORIC VSTBLR TEST W/REC $ 35.50 $ 35.50 3/1/2020 12/31/9999 92538 26 CALORIC VSTBLR TEST W/REC $ 14.16 $ 14.16 3/1/2020 12/31/9999 92538 TC CALORIC VSTBLR TEST W/REC $ 3.86 $ 3.86 3/1/2020 12/31/9999 92538 CALORIC VSTBLR TEST W/REC $ 18.03 $ 18.03 3/1/2020 12/31/9999 92540 26 BASIC VESTIBULAR EVALUATION $ 51.45 $ 51.45 3/1/2020 12/31/9999 92540 TC BASIC VESTIBULAR EVALUATION $ 10.51 $ 10.51 3/1/2020 12/31/9999 92540 BASIC VESTIBULAR EVALUATION $ 61.96 $ 61.96 3/1/2020 12/31/9999 92541 26 SPONTANEOUS NYSTAGMUS TEST $ 17.22 $ 17.22 3/1/2020 12/31/9999 92541 TC SPONTANEOUS NYSTAGMUS TEST $ 29.78 $ 29.78 3/1/2020 12/31/9999 92541 SPONTANEOUS NYSTAGMUS TEST $ 47.00 $ 47.00 3/1/2020 12/31/9999 92542 26 POSITIONAL NYSTAGMUS TEST $ 14.21 $ 14.21 3/1/2020 12/31/9999 92542 TC POSITIONAL NYSTAGMUS TEST $ 34.47 $ 34.47 3/1/2020 12/31/9999 92542 POSITIONAL NYSTAGMUS TEST $ 48.69 $ 48.69 3/1/2020 12/31/9999 92544 26 OPTOKINETIC NYSTAGMUS TEST $ 11.10 $ 11.10 3/1/2020 12/31/9999 92544 TC OPTOKINETIC NYSTAGMUS TEST $ 28.01 $ 28.01 3/1/2020 12/31/9999 92544 OPTOKINETIC NYSTAGMUS TEST $ 39.11 $ 39.11 3/1/2020 12/31/9999 92545 26 OSCILLATING TRACKING TEST $ 9.85 $ 9.85 3/1/2020 12/31/9999 92545 TC OSCILLATING TRACKING TEST $ 26.84 $ 26.84 3/1/2020 12/31/9999 92545 OSCILLATING TRACKING TEST $ 36.70 $ 36.70 3/1/2020 12/31/9999 92546 26 SINUSOIDAL ROTATIONAL TEST $ 12.35 $ 12.35 3/1/2020 12/31/9999 92546 TC SINUSOIDAL ROTATIONAL TEST $ 53.28 $ 53.28 3/1/2020 12/31/9999 92546 SINUSOIDAL ROTATIONAL TEST $ 65.64 $ 65.64 3/1/2020 12/31/9999 92547 SUPPLEMENTAL ELECTRICAL TEST $ 4.15 $ 4.15 3/1/2020 12/31/9999 92550 TYMPANOMETRY & REFLEX THRESH $ 13.44 $ 13.44 3/1/2020 12/31/9999 92551 PURE TONE HEARING TEST AIR $ 8.42 $ 8.42 3/1/2020 12/31/9999 92552 PURE TONE AUDIOMETRY AIR $ 16.96 $ 16.96 3/1/2020 12/31/9999 92553 AUDIOMETRY AIR & BONE $ 22.65 $ 22.65 3/1/2020 12/31/9999 92555 SPEECH THRESHOLD AUDIOMETRY $ 12.56 $ 12.56 3/1/2020 12/31/9999 92556 SPEECH AUDIOMETRY COMPLETE $ 19.41 $ 19.41 3/1/2020 12/31/9999 92557 COMPREHENSIVE HEARING TEST $ 34.98 $ 37.03 3/1/2020 12/31/9999 92560 BEKESY AUDIOMETRY SCREEN $ 17.83 $ 17.83 3/1/2020 12/31/9999 92561 BEKESY AUDIOMETRY DIAGNOSIS $ 22.07 $ 22.07 3/1/2020 12/31/9999 92562 LOUDNESS BALANCE TEST $ 17.84 $ 17.84 3/1/2020 12/31/9999 92563 TONE DECAY HEARING TEST $ 16.09 $ 16.09 3/1/2020 12/31/9999 92564 SISI HEARING TEST $ 15.40 $ 15.40 3/1/2020 12/31/9999 92565 STENGER TEST PURE TONE $ 9.91 $ 9.91 3/1/2020 12/31/9999 92567 TYMPANOMETRY $ 12.84 $ 14.32 3/1/2020 12/31/9999 92568 ACOUSTIC REFL THRESHOLD TST $ 15.00 $ 15.00 3/1/2020 12/31/9999 92570 ACOUSTIC IMMITANCE TESTING $ 19.36 $ 20.52 3/1/2020 12/31/9999 92571 FILTERED SPEECH HEARING TEST $ 12.84 $ 12.84 3/1/2020 12/31/9999 92572 STAGGERED SPONDAIC WORD TEST $ 13.72 $ 13.72 3/1/2020 12/31/9999 92575 SENSORINEURAL ACUITY TEST $ 27.72 $ 27.72 3/1/2020 12/31/9999 92576 SYNTHETIC SENTENCE TEST $ 16.57 $ 16.57 3/1/2020 12/31/9999 92577 STENGER TEST SPEECH $ 13.44 $ 13.44 3/1/2020 12/31/9999 92579 VISUAL AUDIOMETRY (VRA) $ 34.30 $ 36.66 3/1/2020 12/31/9999 92582 CONDITIONING PLAY AUDIOMETRY $ 32.35 $ 32.35 3/1/2020 12/31/9999 92583 SELECT PICTURE AUDIOMETRY $ 25.99 $ 25.99 3/1/2020 12/31/9999 92584 ELECTROCOCHLEOGRAPHY $ 52.70 $ 52.70 3/1/2020 12/31/9999 92585 26 AUDITOR EVOKE POTENT COMPRE $ 21.78 $ 21.78 3/1/2020 12/31/9999 92585 TC AUDITOR EVOKE POTENT COMPRE $ 58.93 $ 58.93 3/1/2020 12/31/9999 92585 AUDITOR EVOKE POTENT COMPRE $ 80.68 $ 80.68 3/1/2020 12/31/9999 92586 AUDITOR EVOKE POTENT LIMIT $ 48.94 $ 48.94 3/1/2020 12/31/9999 92587 26 EVOKED AUDITORY TEST LIMITED $ 5.81 $ 5.81 3/1/2020 12/31/9999 92587 TC EVOKED AUDITORY TEST LIMITED $ 24.83 $ 24.83 3/1/2020 12/31/9999 92587 EVOKED AUDITORY TEST LIMITED $ 30.64 $ 30.64 3/1/2020 12/31/9999 92588 26 EVOKED AUDITORY TST COMPLETE $ 15.45 $ 15.45 3/1/2020 12/31/9999 92588 TC EVOKED AUDITORY TST COMPLETE $ 35.22 $ 35.22 3/1/2020 12/31/9999 92588 EVOKED AUDITORY TST COMPLETE $ 50.68 $ 50.68 3/1/2020 12/31/9999 92590 HEARING AID EXAM ONE EAR $ 36.18 $ 36.18 3/1/2020 12/31/9999 92591 HEARING AID EXAM BOTH EARS $ 54.35 $ 54.35 3/1/2020 12/31/9999 92592 HEARING AID CHECK ONE EAR $ 15.83 $ 15.83 3/1/2020 12/31/9999 92593 HEARING AID CHECK BOTH EARS $ 23.94 $ 23.94 3/1/2020 12/31/9999 92594 ELECTRO HEARNG AID TEST ONE $ 17.48 $ 17.48 3/1/2020 12/31/9999 92595 ELECTRO HEARNG AID TST BOTH $ 26.13 $ 26.13 3/1/2020 12/31/9999 92596 EAR PROTECTOR EVALUATION $ 27.34 $ 27.34 3/1/2020 12/31/9999 92601 COCHLEAR IMPLT F/UP EXAM <7 $ 117.93 $ 128.50 3/1/2020 12/31/9999 92602 REPROGRAM COCHLEAR IMPLT <7 $ 70.30 $ 79.99 3/1/2020 12/31/9999 92603 COCHLEAR IMPLT F/UP EXAM 7/> $ 106.34 $ 116.04 3/1/2020 12/31/9999 92604 REPROGRAM COCHLEAR IMPLT 7/> $ 60.78 $ 68.72 3/1/2020 12/31/9999 92607 EX FOR SPEECH DEVICE RX 1HR $ 122.03 $ 122.03 3/1/2020 12/31/9999 92608 EX FOR SPEECH DEVICE RX ADDL $ 23.32 $ 23.32 3/1/2020 12/31/9999 92609 USE OF SPEECH DEVICE SERVICE $ 64.84 $ 64.84 3/1/2020 12/31/9999 92610 EVALUATE SWALLOWING FUNCTION $ 62.71 $ 62.71 3/1/2020 12/31/9999 92611 MOTION FLUOROSCOPY/SWALLOW $ 68.29 $ 68.29 3/1/2020 12/31/9999 92612 ENDOSCOPY SWALLOW (FEES) VID $ 55.83 $ 126.03 3/1/2020 12/31/9999 92614 LARYNGOSCOPIC SENSORY VID $ 55.83 $ 112.52 3/1/2020 12/31/9999 92616 FEES W/LARYNGEAL SENSE TEST $ 82.34 $ 154.92 3/1/2020 12/31/9999 92620 AUDITORY FUNCTION 60 MIN $ 61.36 $ 61.36 3/1/2020 12/31/9999 92621 AUDITORY FUNCTION + 15 MIN $ 14.26 $ 14.26 3/1/2020 12/31/9999 92625 TINNITUS ASSESSMENT $ 48.58 $ 48.58 3/1/2020 12/31/9999 92626 EVAL AUD FUNCJ 1ST HOUR $ 66.71 $ 66.71 3/1/2020 12/31/9999 92627 EVAL AUD FUNCJ EA ADDL 15 $ 16.26 $ 16.26 3/1/2020 12/31/9999 92630 AUD REHAB PRE-LING HEAR LOSS $ 45.80 $ 120.09 3/1/2020 12/31/9999 92633 AUD REHAB POSTLING HEAR LOSS $ 45.80 $ 120.09 3/1/2020 12/31/9999 92640 AUD BRAINSTEM IMPLT PROGRAMG $ 45.81 $ 45.81 3/1/2020 12/31/9999 92920 PRQ CARDIAC ANGIOPLAST 1 ART $ 448.57 $ 448.57 3/1/2020 12/31/9999 92924 PRQ CARD ANGIO/ATHRECT 1 ART $ 533.20 $ 533.20 3/1/2020 12/31/9999 92928 PRQ CARD STENT W/ANGIO 1 VSL $ 498.08 $ 498.08 3/1/2020 12/31/9999 92933 PRQ CARD STENT/ATH/ANGIO $ 556.97 $ 556.97 3/1/2020 12/31/9999 92937 PRQ REVASC BYP GRAFT 1 VSL $ 497.51 $ 497.51 3/1/2020 12/31/9999 92941 PRQ CARD REVASC MI 1 VSL $ 558.05 $ 558.05 3/1/2020 12/31/9999 92943 PRQ CARD REVASC CHRONIC 1VSL $ 558.05 $ 558.05 3/1/2020 12/31/9999 92950 HEART/LUNG RESUSCITATION CPR $ 150.66 $ 226.45 3/1/2020 12/31/9999 92953 TEMPORARY EXTERNAL PACING $ 10.05 $ 10.05 3/1/2020 12/31/9999 92960 CARDIOVERSION ELECTRIC EXT $ 113.40 $ 212.39 3/1/2020 12/31/9999 92961 CARDIOVERSION ELECTRIC INT $ 221.81 $ 221.81 3/1/2020 12/31/9999 92970 CARDIOASSIST INTERNAL $ 154.94 $ 154.94 3/1/2020 12/31/9999 92971 CARDIOASSIST EXTERNAL $ 87.97 $ 87.97 3/1/2020 12/31/9999 92973 PRQ CORONARY MECH THROMBECT $ 157.26 $ 157.26 3/1/2020 12/31/9999 92974 CATH PLACE CARDIO BRACHYTX $ 144.14 $ 144.14 3/1/2020 12/31/9999 92975 DISSOLVE CLOT HEART VESSEL $ 345.44 $ 345.44 3/1/2020 12/31/9999 92977 DISSOLVE CLOT HEART VESSEL $ 105.02 $ 105.02 3/1/2020 12/31/9999 92978 26 ENDOLUMINL IVUS OCT C 1ST $ 84.81 $ 84.81 3/1/2020 12/31/9999 92978 TC ENDOLUMINL IVUS OCT C 1ST $ 145.79 $ 145.79 3/1/2020 12/31/9999 92978 ENDOLUMINL IVUS OCT C 1ST $ 226.39 $ 226.39 3/1/2020 12/31/9999 92979 26 ENDOLUMINL IVUS OCT C EA $ 68.39 $ 68.39 3/1/2020 12/31/9999 92979 TC ENDOLUMINL IVUS OCT C EA $ 72.82 $ 72.82 3/1/2020 12/31/9999 92979 ENDOLUMINL IVUS OCT C EA $ 137.54 $ 137.54 3/1/2020 12/31/9999 92986 REVISION OF AORTIC VALVE $ 1,173.10 $ 1,173.10 3/1/2020 12/31/9999 92987 REVISION OF MITRAL VALVE $ 1,214.17 $ 1,214.17 3/1/2020 12/31/9999 92990 REVISION OF PULMONARY VALVE $ 934.47 $ 934.47 3/1/2020 12/31/9999 92992 REVISION OF HEART CHAMBER $ 912.69 $ 912.69 3/1/2020 12/31/9999 92993 REVISION OF HEART CHAMBER $ 912.69 $ 912.69 3/1/2020 12/31/9999 92997 PUL ART BALLOON REPR PERCUT $ 542.71 $ 542.71 3/1/2020 12/31/9999 92998 PUL ART BALLOON REPR PERCUT $ 277.81 $ 277.81 3/1/2020 12/31/9999 93000 ELECTROCARDIOGRAM COMPLETE $ 17.16 $ 17.16 3/1/2020 12/31/9999 93005 ELECTROCARDIOGRAM TRACING $ 9.51 $ 9.51 3/1/2020 12/31/9999 93010 ELECTROCARDIOGRAM REPORT $ 7.65 $ 7.65 3/1/2020 12/31/9999 93015 CARDIOVASCULAR STRESS TEST $ 82.15 $ 82.15 3/1/2020 12/31/9999 93016 CARDIOVASCULAR STRESS TEST $ 20.86 $ 20.86 3/1/2020 12/31/9999 93017 CARDIOVASCULAR STRESS TEST $ 47.45 $ 47.45 3/1/2020 12/31/9999 93018 CARDIOVASCULAR STRESS TEST $ 13.84 $ 13.84 3/1/2020 12/31/9999 93024 26 CARDIAC DRUG STRESS TEST $ 53.81 $ 53.81 3/1/2020 12/31/9999 93024 TC CARDIAC DRUG STRESS TEST $ 47.13 $ 47.13 3/1/2020 12/31/9999 93024 CARDIAC DRUG STRESS TEST $ 100.97 $ 100.97 3/1/2020 12/31/9999 93025 26 MICROVOLT T-WAVE ASSESS $ 35.00 $ 35.00 3/1/2020 12/31/9999 93025 TC MICROVOLT T-WAVE ASSESS $ 139.09 $ 139.09 3/1/2020 12/31/9999 93025 MICROVOLT T-WAVE ASSESS $ 174.09 $ 174.09 3/1/2020 12/31/9999 93040 RHYTHM ECG WITH REPORT $ 11.06 $ 11.07 3/1/2020 12/31/9999 93041 RHYTHM ECG TRACING $ 4.31 $ 4.31 3/1/2020 12/31/9999 93042 RHYTHM ECG REPORT $ 6.75 $ 6.75 3/1/2020 12/31/9999 93224 ECG MONIT/REPRT UP TO 48 HRS $ 96.25 $ 96.25 3/1/2020 12/31/9999 93225 ECG MONIT/REPRT UP TO 48 HRS $ 28.35 $ 28.35 3/1/2020 12/31/9999 93226 ECG MONIT/REPRT UP TO 48 HRS $ 43.65 $ 43.65 3/1/2020 12/31/9999 93227 ECG MONIT/REPRT UP TO 48 HRS $ 24.27 $ 24.26 3/1/2020 12/31/9999 93228 REMOTE 30 DAY ECG REV/REPORT $ 21.90 $ 21.90 3/1/2020 12/31/9999 93229 REMOTE 30 DAY ECG TECH SUPP $ 21.90 $ 21.90 3/1/2020 12/31/9999 93260 26 PRGRMG DEV EVAL IMPLTBL SYS $ 39.65 $ 39.65 3/1/2020 12/31/9999 93260 TC PRGRMG DEV EVAL IMPLTBL SYS $ 17.69 $ 17.69 3/1/2020 12/31/9999 93260 PRGRMG DEV EVAL IMPLTBL SYS $ 57.33 $ 57.33 3/1/2020 12/31/9999 93261 26 INTERROGATE SUBQ DEFIB $ 34.60 $ 34.60 3/1/2020 12/31/9999 93261 TC INTERROGATE SUBQ DEFIB $ 17.69 $ 17.69 3/1/2020 12/31/9999 93261 INTERROGATE SUBQ DEFIB $ 52.28 $ 52.28 3/1/2020 12/31/9999 93268 ECG RECORD/REVIEW $ 214.85 $ 214.85 3/1/2020 12/31/9999 93270 REMOTE 30 DAY ECG REV/REPORT $ 16.88 $ 16.88 3/1/2020 12/31/9999 93271 ECG/MONITORING AND ANALYSIS $ 174.59 $ 174.59 3/1/2020 12/31/9999 93272 ECG/REVIEW INTERPRET ONLY $ 23.37 $ 23.37 3/1/2020 12/31/9999 93279 26 PRGRMG DEV EVAL PM/LDLS PM $ 30.73 $ 30.73 3/1/2020 12/31/9999 93279 TC PRGRMG DEV EVAL PM/LDLS PM $ 15.79 $ 15.79 3/1/2020 12/31/9999 93279 PRGRMG DEV EVAL PM/LDLS PM $ 46.53 $ 46.53 3/1/2020 12/31/9999 93280 26 PM DEVICE PROGR EVAL DUAL $ 36.90 $ 36.90 3/1/2020 12/31/9999 93280 TC PM DEVICE PROGR EVAL DUAL $ 18.23 $ 18.23 3/1/2020 12/31/9999 93280 PM DEVICE PROGR EVAL DUAL $ 55.14 $ 55.14 3/1/2020 12/31/9999 93281 26 PM DEVICE PROGR EVAL MULTI $ 43.08 $ 43.08 3/1/2020 12/31/9999 93281 TC PM DEVICE PROGR EVAL MULTI $ 21.37 $ 21.37 3/1/2020 12/31/9999 93281 PM DEVICE PROGR EVAL MULTI $ 64.45 $ 64.45 3/1/2020 12/31/9999 93282 26 PRGRMG EVAL IMPLANTABLE DFB $ 40.23 $ 40.23 3/1/2020 12/31/9999 93282 TC PRGRMG EVAL IMPLANTABLE DFB $ 19.31 $ 19.31 3/1/2020 12/31/9999 93282 PRGRMG EVAL IMPLANTABLE DFB $ 59.55 $ 59.55 3/1/2020 12/31/9999 93283 26 PRGRMG EVAL IMPLANTABLE DFB $ 50.60 $ 50.60 3/1/2020 12/31/9999 93283 TC PRGRMG EVAL IMPLANTABLE DFB $ 21.96 $ 21.96 3/1/2020 12/31/9999 93283 PRGRMG EVAL IMPLANTABLE DFB $ 72.54 $ 72.54 3/1/2020 12/31/9999 93284 26 PRGRMG EVAL IMPLANTABLE DFB $ 60.19 $ 60.19 3/1/2020 12/31/9999 93284 TC PRGRMG EVAL IMPLANTABLE DFB $ 24.90 $ 24.90 3/1/2020 12/31/9999 93284 PRGRMG EVAL IMPLANTABLE DFB $ 85.07 $ 85.07 3/1/2020 12/31/9999 93285 26 PRGRMG DEV EVAL SCRMS IP $ 25.15 $ 25.15 3/1/2020 12/31/9999 93285 TC PRGRMG DEV EVAL SCRMS IP $ 14.90 $ 14.90 3/1/2020 12/31/9999 93285 PRGRMG DEV EVAL SCRMS IP $ 40.05 $ 40.05 3/1/2020 12/31/9999 93286 26 PERI-PX EVAL PM/LDLS PM IP $ 12.86 $ 12.86 3/1/2020 12/31/9999 93286 TC PERI-PX EVAL PM/LDLS PM IP $ 9.81 $ 9.81 3/1/2020 12/31/9999 93286 PERI-PX EVAL PM/LDLS PM IP $ 22.67 $ 22.67 3/1/2020 12/31/9999 93287 26 PERI-PX DEVICE EVAL & PRGR $ 18.89 $ 18.89 3/1/2020 12/31/9999 93287 TC PERI-PX DEVICE EVAL & PRGR $ 11.08 $ 11.08 3/1/2020 12/31/9999 93287 PERI-PX DEVICE EVAL & PRGR $ 29.99 $ 29.99 3/1/2020 12/31/9999 93288 26 INTERROG EVL PM/LDLS PM IP $ 20.61 $ 20.61 3/1/2020 12/31/9999 93288 TC INTERROG EVL PM/LDLS PM IP $ 15.19 $ 15.19 3/1/2020 12/31/9999 93288 INTERROG EVL PM/LDLS PM IP $ 35.82 $ 35.82 3/1/2020 12/31/9999 93289 26 INTERROG DEVICE EVAL HEART $ 37.21 $ 37.21 3/1/2020 12/31/9999 93289 TC INTERROG DEVICE EVAL HEART $ 18.23 $ 18.23 3/1/2020 12/31/9999 93289 INTERROG DEVICE EVAL HEART $ 55.45 $ 55.45 3/1/2020 12/31/9999 93290 26 INTERROG DEV EVAL ICPMS IP $ 18.17 $ 18.17 3/1/2020 12/31/9999 93290 TC INTERROG DEV EVAL ICPMS IP $ 8.44 $ 8.44 3/1/2020 12/31/9999 93290 INTERROG DEV EVAL ICPMS IP $ 26.62 $ 26.62 3/1/2020 12/31/9999 93291 26 INTERROG DEV EVAL SCRMS IP $ 20.82 $ 20.82 3/1/2020 12/31/9999 93291 TC INTERROG DEV EVAL SCRMS IP $ 13.53 $ 13.53 3/1/2020 12/31/9999 93291 INTERROG DEV EVAL SCRMS IP $ 34.35 $ 34.35 3/1/2020 12/31/9999 93292 26 WCD DEVICE INTERROGATE $ 20.61 $ 20.61 3/1/2020 12/31/9999 93292 TC WCD DEVICE INTERROGATE $ 10.50 $ 10.50 3/1/2020 12/31/9999 93292 WCD DEVICE INTERROGATE $ 31.11 $ 31.11 3/1/2020 12/31/9999 93293 26 PM PHONE R-STRIP DEVICE EVAL $ 14.39 $ 14.39 3/1/2020 12/31/9999 93293 TC PM PHONE R-STRIP DEVICE EVAL $ 33.94 $ 33.94 3/1/2020 12/31/9999 93293 PM PHONE R-STRIP DEVICE EVAL $ 48.33 $ 48.33 3/1/2020 12/31/9999 93294 REM INTERROG EVL PM/LDLS PM $ 31.24 $ 31.24 3/1/2020 12/31/9999 93295 DEV INTERROG REMOTE 1/2/MLT $ 56.47 $ 56.47 3/1/2020 12/31/9999 93296 REM INTERROG EVL PM/IDS $ 29.58 $ 29.58 3/1/2020 12/31/9999 93297 REM INTERROG DEV EVAL ICPMS $ 21.90 $ 21.90 3/1/2020 12/31/9999 93298 REM INTERROG DEV EVAL SCRMS $ 25.15 $ 25.15 3/1/2020 12/31/9999 93303 26 ECHO TRANSTHORACIC $ 58.84 $ 58.84 3/1/2020 12/31/9999 93303 TC ECHO TRANSTHORACIC $ 119.49 $ 119.49 3/1/2020 12/31/9999 93303 ECHO TRANSTHORACIC $ 178.31 $ 178.31 3/1/2020 12/31/9999 93304 26 ECHO TRANSTHORACIC $ 33.33 $ 33.33 3/1/2020 12/31/9999 93304 TC ECHO TRANSTHORACIC $ 76.93 $ 76.93 3/1/2020 12/31/9999 93304 ECHO TRANSTHORACIC $ 110.26 $ 110.26 3/1/2020 12/31/9999 93306 26 TTE W/DOPPLER COMPLETE $ 61.18 $ 61.18 3/1/2020 12/31/9999 93306 TC TTE W/DOPPLER COMPLETE $ 156.46 $ 156.46 3/1/2020 12/31/9999 93306 TTE W/DOPPLER COMPLETE $ 217.64 $ 217.64 3/1/2020 12/31/9999 93307 26 TTE W/O DOPPLER COMPLETE $ 42.45 $ 42.45 3/1/2020 12/31/9999 93307 TC TTE W/O DOPPLER COMPLETE $ 101.58 $ 101.58 3/1/2020 12/31/9999 93307 TTE W/O DOPPLER COMPLETE $ 144.02 $ 144.02 3/1/2020 12/31/9999 93308 26 TTE F-UP OR LMTD $ 24.87 $ 24.87 3/1/2020 12/31/9999 93308 TC TTE F-UP OR LMTD $ 66.06 $ 66.06 3/1/2020 12/31/9999 93308 TTE F-UP OR LMTD $ 90.94 $ 90.94 3/1/2020 12/31/9999 93312 26 ECHO TRANSESOPHAGEAL $ 99.09 $ 99.09 3/1/2020 12/31/9999 93312 TC ECHO TRANSESOPHAGEAL $ 167.99 $ 167.99 3/1/2020 12/31/9999 93312 ECHO TRANSESOPHAGEAL $ 267.08 $ 267.08 3/1/2020 12/31/9999 93313 ECHO TRANSESOPHAGEAL $ 35.48 $ 35.48 3/1/2020 12/31/9999 93314 26 ECHO TRANSESOPHAGEAL $ 56.08 $ 56.08 3/1/2020 12/31/9999 93314 TC ECHO TRANSESOPHAGEAL $ 172.11 $ 172.11 3/1/2020 12/31/9999 93314 ECHO TRANSESOPHAGEAL $ 228.17 $ 228.17 3/1/2020 12/31/9999 93315 26 ECHO TRANSESOPHAGEAL $ 126.81 $ 126.81 3/1/2020 12/31/9999 93315 TC ECHO TRANSESOPHAGEAL $ 118.16 $ 118.16 3/1/2020 12/31/9999 93315 ECHO TRANSESOPHAGEAL $ 246.63 $ 246.63 3/1/2020 12/31/9999 93316 ECHO TRANSESOPHAGEAL $ 38.82 $ 38.82 3/1/2020 12/31/9999 93317 26 ECHO TRANSESOPHAGEAL $ 78.82 $ 78.82 3/1/2020 12/31/9999 93317 TC ECHO TRANSESOPHAGEAL $ 118.16 $ 118.16 3/1/2020 12/31/9999 93317 ECHO TRANSESOPHAGEAL $ 202.27 $ 202.27 3/1/2020 12/31/9999 93318 26 ECHO TRANSESOPHAGEAL INTRAOP $ 95.90 $ 95.90 3/1/2020 12/31/9999 93318 TC ECHO TRANSESOPHAGEAL INTRAOP $ 108.13 $ 108.13 3/1/2020 12/31/9999 93318 ECHO TRANSESOPHAGEAL INTRAOP $ 204.03 $ 204.03 3/1/2020 12/31/9999 93320 26 DOPPLER ECHO EXAM HEART $ 17.56 $ 17.56 3/1/2020 12/31/9999 93320 TC DOPPLER ECHO EXAM HEART $ 45.89 $ 45.89 3/1/2020 12/31/9999 93320 DOPPLER ECHO EXAM HEART $ 63.45 $ 63.45 3/1/2020 12/31/9999 93321 26 DOPPLER ECHO EXAM HEART $ 7.02 $ 7.02 3/1/2020 12/31/9999 93321 TC DOPPLER ECHO EXAM HEART $ 21.00 $ 21.00 3/1/2020 12/31/9999 93321 DOPPLER ECHO EXAM HEART $ 28.01 $ 28.01 3/1/2020 12/31/9999 93325 26 DOPPLER COLOR FLOW ADD-ON $ 3.31 $ 3.31 3/1/2020 12/31/9999 93325 TC DOPPLER COLOR FLOW ADD-ON $ 38.88 $ 38.88 3/1/2020 12/31/9999 93325 DOPPLER COLOR FLOW ADD-ON $ 42.20 $ 42.20 3/1/2020 12/31/9999 93350 26 STRESS TTE ONLY $ 68.52 $ 68.52 3/1/2020 12/31/9999 93350 TC STRESS TTE ONLY $ 105.72 $ 105.72 3/1/2020 12/31/9999 93350 STRESS TTE ONLY $ 174.25 $ 174.25 3/1/2020 12/31/9999 93351 26 STRESS TTE COMPLETE $ 56.68 $ 56.68 3/1/2020 12/31/9999 93351 TC STRESS TTE COMPLETE $ 170.04 $ 170.04 3/1/2020 12/31/9999 93351 STRESS TTE COMPLETE $ 226.72 $ 226.72 3/1/2020 12/31/9999 93352 ADMIN ECG CONTRAST AGENT $ 31.51 $ 31.51 3/1/2020 12/31/9999 93355 ECHO TRANSESOPHAGEAL (TEE) $ 202.02 $ 202.02 3/1/2020 12/31/9999 93451 26 RIGHT HEART CATH $ 122.89 $ 122.89 3/1/2020 12/31/9999 93451 TC RIGHT HEART CATH $ 516.85 $ 516.85 3/1/2020 12/31/9999 93451 RIGHT HEART CATH $ 639.74 $ 639.74 3/1/2020 12/31/9999 93452 26 LEFT HRT CATH W/VENTRCLGRPHY $ 215.17 $ 215.17 3/1/2020 12/31/9999 93452 TC LEFT HRT CATH W/VENTRCLGRPHY $ 493.71 $ 493.71 3/1/2020 12/31/9999 93452 LEFT HRT CATH W/VENTRCLGRPHY $ 708.88 $ 708.88 3/1/2020 12/31/9999 93453 26 R&L HRT CATH W/VENTRICLGRPHY $ 282.20 $ 282.20 3/1/2020 12/31/9999 93453 TC R&L HRT CATH W/VENTRICLGRPHY $ 645.61 $ 645.61 3/1/2020 12/31/9999 93453 R&L HRT CATH W/VENTRICLGRPHY $ 927.81 $ 927.81 3/1/2020 12/31/9999 93454 26 CORONARY ARTERY ANGIO S&I $ 216.92 $ 216.92 3/1/2020 12/31/9999 93454 TC CORONARY ARTERY ANGIO S&I $ 514.28 $ 514.28 3/1/2020 12/31/9999 93454 CORONARY ARTERY ANGIO S&I $ 731.20 $ 731.20 3/1/2020 12/31/9999 93455 26 CORONARY ART/GRFT ANGIO S&I $ 250.49 $ 250.49 3/1/2020 12/31/9999 93455 TC CORONARY ART/GRFT ANGIO S&I $ 602.76 $ 602.76 3/1/2020 12/31/9999 93455 CORONARY ART/GRFT ANGIO S&I $ 853.25 $ 853.25 3/1/2020 12/31/9999 93456 26 R HRT CORONARY ARTERY ANGIO $ 277.88 $ 277.88 3/1/2020 12/31/9999 93456 TC R HRT CORONARY ARTERY ANGIO $ 637.33 $ 637.33 3/1/2020 12/31/9999 93456 R HRT CORONARY ARTERY ANGIO $ 915.20 $ 915.20 3/1/2020 12/31/9999 93457 26 R HRT ART/GRFT ANGIO $ 311.54 $ 311.54 3/1/2020 12/31/9999 93457 TC R HRT ART/GRFT ANGIO $ 725.60 $ 725.60 3/1/2020 12/31/9999 93457 R HRT ART/GRFT ANGIO $ 1,037.15 $ 1,037.15 3/1/2020 12/31/9999 93458 26 L HRT ARTERY/VENTRICLE ANGIO $ 264.73 $ 264.73 3/1/2020 12/31/9999 93458 TC L HRT ARTERY/VENTRICLE ANGIO $ 617.61 $ 617.61 3/1/2020 12/31/9999 93458 L HRT ARTERY/VENTRICLE ANGIO $ 882.34 $ 882.34 3/1/2020 12/31/9999 93459 26 L HRT ART/GRFT ANGIO $ 298.10 $ 298.10 3/1/2020 12/31/9999 93459 TC L HRT ART/GRFT ANGIO $ 676.46 $ 676.46 3/1/2020 12/31/9999 93459 L HRT ART/GRFT ANGIO $ 974.56 $ 974.56 3/1/2020 12/31/9999 93460 26 R&L HRT ART/VENTRICLE ANGIO $ 332.16 $ 332.16 3/1/2020 12/31/9999 93460 TC R&L HRT ART/VENTRICLE ANGIO $ 710.75 $ 710.75 3/1/2020 12/31/9999 93460 R&L HRT ART/VENTRICLE ANGIO $ 1,042.90 $ 1,042.90 3/1/2020 12/31/9999 93461 26 R&L HRT ART/VENTRICLE ANGIO $ 366.31 $ 366.31 3/1/2020 12/31/9999 93461 TC R&L HRT ART/VENTRICLE ANGIO $ 828.65 $ 828.65 3/1/2020 12/31/9999 93461 R&L HRT ART/VENTRICLE ANGIO $ 1,194.96 $ 1,194.96 3/1/2020 12/31/9999 93462 L HRT CATH TRNSPTL PUNCTURE $ 168.82 $ 168.82 3/1/2020 12/31/9999 93463 DRUG ADMIN & HEMODYNMIC MEAS $ 89.80 $ 89.80 3/1/2020 12/31/9999 93464 26 EXERCISE W/HEMODYNAMIC MEAS $ 79.05 $ 79.05 3/1/2020 12/31/9999 93464 TC EXERCISE W/HEMODYNAMIC MEAS $ 131.90 $ 131.90 3/1/2020 12/31/9999 93464 EXERCISE W/HEMODYNAMIC MEAS $ 210.97 $ 210.97 3/1/2020 12/31/9999 93503 INSERT/PLACE HEART CATHETER $ 96.44 $ 96.44 3/1/2020 12/31/9999 93505 26 BIOPSY OF HEART LINING $ 207.67 $ 207.67 3/1/2020 12/31/9999 93505 TC BIOPSY OF HEART LINING $ 406.54 $ 406.54 3/1/2020 12/31/9999 93505 BIOPSY OF HEART LINING $ 614.22 $ 614.22 3/1/2020 12/31/9999 93530 26 RT HEART CATH CONGENITAL $ 198.30 $ 198.30 3/1/2020 12/31/9999 93530 TC RT HEART CATH CONGENITAL $ 552.90 $ 552.90 3/1/2020 12/31/9999 93530 RT HEART CATH CONGENITAL $ 747.96 $ 747.96 3/1/2020 12/31/9999 93531 26 R & L HEART CATH CONGENITAL $ 388.45 $ 388.45 3/1/2020 12/31/9999 93531 TC R & L HEART CATH CONGENITAL $ 1,577.58 $ 1,577.58 3/1/2020 12/31/9999 93531 R & L HEART CATH CONGENITAL $ 1,957.73 $ 1,957.73 3/1/2020 12/31/9999 93532 26 R & L HEART CATH CONGENITAL $ 460.69 $ 460.69 3/1/2020 12/31/9999 93532 TC R & L HEART CATH CONGENITAL $ 1,456.20 $ 1,456.20 3/1/2020 12/31/9999 93532 R & L HEART CATH CONGENITAL $ 1,916.87 $ 1,916.87 3/1/2020 12/31/9999 93533 26 R & L HEART CATH CONGENITAL $ 310.03 $ 310.03 3/1/2020 12/31/9999 93533 TC R & L HEART CATH CONGENITAL $ 1,469.92 $ 1,469.92 3/1/2020 12/31/9999 93533 R & L HEART CATH CONGENITAL $ 1,779.96 $ 1,779.96 3/1/2020 12/31/9999 93561 26 CARDIAC OUTPUT MEASUREMENT $ 20.39 $ 20.39 3/1/2020 12/31/9999 93561 TC CARDIAC OUTPUT MEASUREMENT $ 17.54 $ 17.54 3/1/2020 12/31/9999 93561 CARDIAC OUTPUT MEASUREMENT $ 38.21 $ 38.21 3/1/2020 12/31/9999 93562 26 CARD OUTPUT MEASURE SUBSQ $ 6.46 $ 6.46 3/1/2020 12/31/9999 93562 TC CARD OUTPUT MEASURE SUBSQ $ 10.86 $ 10.86 3/1/2020 12/31/9999 93562 CARD OUTPUT MEASURE SUBSQ $ 17.38 $ 17.38 3/1/2020 12/31/9999 93563 INJECT CONGENITAL CARD CATH $ 47.59 $ 47.59 3/1/2020 12/31/9999 93564 INJECT HRT CONGNTL ART/GRFT $ 48.38 $ 48.38 3/1/2020 12/31/9999 93565 INJECT L VENTR/ATRIAL ANGIO $ 36.60 $ 36.60 3/1/2020 12/31/9999 93566 INJECT R VENTR/ATRIAL ANGIO $ 36.60 $ 142.60 3/1/2020 12/31/9999 93567 INJECT SUPRVLV AORTOGRAPHY $ 41.31 $ 117.87 3/1/2020 12/31/9999 93568 INJECT PULM ART HRT CATH $ 37.49 $ 128.91 3/1/2020 12/31/9999 93571 26 HEART FLOW RESERVE MEASURE $ 84.50 $ 84.50 3/1/2020 12/31/9999 93571 TC HEART FLOW RESERVE MEASURE $ 145.48 $ 145.48 3/1/2020 12/31/9999 93571 HEART FLOW RESERVE MEASURE $ 225.46 $ 225.46 3/1/2020 12/31/9999 93572 26 HEART FLOW RESERVE MEASURE $ 66.51 $ 66.51 3/1/2020 12/31/9999 93572 TC HEART FLOW RESERVE MEASURE $ 74.99 $ 74.99 3/1/2020 12/31/9999 93572 HEART FLOW RESERVE MEASURE $ 141.50 $ 141.50 3/1/2020 12/31/9999 93580 TRANSCATH CLOSURE OF ASD $ 861.08 $ 861.08 3/1/2020 12/31/9999 93581 TRANSCATH CLOSURE OF VSD $ 1,129.05 $ 1,129.05 3/1/2020 12/31/9999 93582 PERQ TRANSCATH CLOSURE PDA $ 569.48 $ 569.48 3/1/2020 12/31/9999 93590 PERQ TRANSCATH CLS MITRAL $ 1,062.90 $ 1,062.90 3/1/2020 12/31/9999 93591 PERQ TRANSCATH CLS AORTIC $ 882.09 $ 882.09 3/1/2020 12/31/9999 93592 PERQ TRANSCATH CLOSURE EACH $ 388.70 $ 388.70 3/1/2020 12/31/9999 93600 26 BUNDLE OF HIS RECORDING $ 100.80 $ 100.80 3/1/2020 12/31/9999 93600 TC BUNDLE OF HIS RECORDING $ 61.86 $ 61.86 3/1/2020 12/31/9999 93600 BUNDLE OF HIS RECORDING $ 158.15 $ 158.15 3/1/2020 12/31/9999 93602 26 INTRA-ATRIAL RECORDING $ 100.41 $ 100.41 3/1/2020 12/31/9999 93602 TC INTRA-ATRIAL RECORDING $ 34.01 $ 34.01 3/1/2020 12/31/9999 93602 INTRA-ATRIAL RECORDING $ 130.22 $ 130.22 3/1/2020 12/31/9999 93603 26 RIGHT VENTRICULAR RECORDING $ 100.62 $ 100.62 3/1/2020 12/31/9999 93603 TC RIGHT VENTRICULAR RECORDING $ 52.68 $ 52.68 3/1/2020 12/31/9999 93603 RIGHT VENTRICULAR RECORDING $ 148.79 $ 148.79 3/1/2020 12/31/9999 93609 26 MAP TACHYCARDIA ADD-ON $ 237.77 $ 237.77 3/1/2020 12/31/9999 93609 TC MAP TACHYCARDIA ADD-ON $ 83.03 $ 83.03 3/1/2020 12/31/9999 93609 MAP TACHYCARDIA ADD-ON $ 309.94 $ 309.94 3/1/2020 12/31/9999 93610 26 INTRA-ATRIAL PACING $ 142.75 $ 142.75 3/1/2020 12/31/9999 93610 TC INTRA-ATRIAL PACING $ 41.52 $ 41.52 3/1/2020 12/31/9999 93610 INTRA-ATRIAL PACING $ 177.94 $ 177.94 3/1/2020 12/31/9999 93612 26 INTRAVENTRICULAR PACING $ 142.07 $ 142.07 3/1/2020 12/31/9999 93612 TC INTRAVENTRICULAR PACING $ 50.17 $ 50.17 3/1/2020 12/31/9999 93612 INTRAVENTRICULAR PACING $ 186.49 $ 186.49 3/1/2020 12/31/9999 93613 26 ELECTROPHYS MAP 3D ADD-ON $ 192.24 $ 192.24 3/1/2020 12/31/9999 93613 TC ELECTROPHYS MAP 3D ADD-ON $ 124.70 $ 124.70 3/1/2020 12/31/9999 93613 ELECTROPHYS MAP 3D ADD-ON $ 334.07 $ 334.07 3/1/2020 12/31/9999 93618 26 HEART RHYTHM PACING $ 204.16 $ 204.16 3/1/2020 12/31/9999 93618 TC HEART RHYTHM PACING $ 123.91 $ 123.91 3/1/2020 12/31/9999 93618 HEART RHYTHM PACING $ 317.34 $ 317.34 3/1/2020 12/31/9999 93619 26 ELECTROPHYSIOLOGY EVALUATION $ 352.56 $ 352.56 3/1/2020 12/31/9999 93619 TC ELECTROPHYSIOLOGY EVALUATION $ 245.74 $ 245.74 3/1/2020 12/31/9999 93619 ELECTROPHYSIOLOGY EVALUATION $ 584.75 $ 584.75 3/1/2020 12/31/9999 93620 26 ELECTROPHYSIOLOGY EVALUATION $ 554.20 $ 554.20 3/1/2020 12/31/9999 93620 TC ELECTROPHYSIOLOGY EVALUATION $ 277.49 $ 277.49 3/1/2020 12/31/9999 93620 ELECTROPHYSIOLOGY EVALUATION $ 822.89 $ 822.89 3/1/2020 12/31/9999 93621 26 ELECTROPHYSIOLOGY EVALUATION $ 100.25 $ 100.25 3/1/2020 12/31/9999 93621 TC ELECTROPHYSIOLOGY EVALUATION $ 77.07 $ 77.07 3/1/2020 12/31/9999 93621 ELECTROPHYSIOLOGY EVALUATION $ 177.33 $ 177.33 3/1/2020 12/31/9999 93622 26 ELECTROPHYSIOLOGY EVALUATION $ 146.64 $ 146.64 3/1/2020 12/31/9999 93622 TC ELECTROPHYSIOLOGY EVALUATION $ 112.56 $ 112.56 3/1/2020 12/31/9999 93622 ELECTROPHYSIOLOGY EVALUATION $ 259.21 $ 259.21 3/1/2020 12/31/9999 93623 26 STIMULATION PACING HEART $ 135.95 $ 135.95 3/1/2020 12/31/9999 93640 26 EVALUATION HEART DEVICE $ 166.82 $ 166.82 3/1/2020 12/31/9999 93640 TC EVALUATION HEART DEVICE $ 229.34 $ 229.34 3/1/2020 12/31/9999 93640 EVALUATION HEART DEVICE $ 388.50 $ 388.50 3/1/2020 12/31/9999 93641 26 ELECTROPHYSIOLOGY EVALUATION $ 282.32 $ 282.32 3/1/2020 12/31/9999 93641 TC ELECTROPHYSIOLOGY EVALUATION $ 226.84 $ 226.84 3/1/2020 12/31/9999 93641 ELECTROPHYSIOLOGY EVALUATION $ 495.38 $ 495.38 3/1/2020 12/31/9999 93642 26 ELECTROPHYSIOLOGY EVALUATION $ 231.71 $ 231.71 3/1/2020 12/31/9999 93642 TC ELECTROPHYSIOLOGY EVALUATION $ 159.74 $ 159.74 3/1/2020 12/31/9999 93642 ELECTROPHYSIOLOGY EVALUATION $ 391.46 $ 391.46 3/1/2020 12/31/9999 93644 26 ELECTROPHYSIOLOGY EVALUATION $ 175.90 $ 175.90 3/1/2020 12/31/9999 93644 TC ELECTROPHYSIOLOGY EVALUATION $ 88.54 $ 88.54 3/1/2020 12/31/9999 93644 ELECTROPHYSIOLOGY EVALUATION $ 264.43 $ 264.43 3/1/2020 12/31/9999 93650 ABLATE HEART DYSRHYTHM FOCUS $ 508.49 $ 508.49 3/1/2020 12/31/9999 93653 EP & ABLATE SUPRAVENT ARRHYT $ 678.02 $ 678.02 3/1/2020 12/31/9999 93654 EP & ABLATE VENTRIC TACHY $ 904.85 $ 904.85 3/1/2020 12/31/9999 93655 ABLATE ARRHYTHMIA ADD ON $ 339.03 $ 339.03 3/1/2020 12/31/9999 93656 TX ATRIAL FIB PULM VEIN ISOL $ 905.16 $ 905.16 3/1/2020 12/31/9999 93657 TX L/R ATRIAL FIB ADDL $ 339.26 $ 339.26 3/1/2020 12/31/9999 93660 26 TILT TABLE EVALUATION $ 88.55 $ 88.55 3/1/2020 12/31/9999 93660 TILT TABLE EVALUATION $ 143.29 $ 143.29 3/1/2020 12/31/9999 93662 26 INTRACARDIAC ECG (ICE) $ 131.26 $ 131.26 3/1/2020 12/31/9999 93662 TC INTRACARDIAC ECG (ICE) $ 105.80 $ 105.80 3/1/2020 12/31/9999 93662 INTRACARDIAC ECG (ICE) $ 258.35 $ 258.35 3/1/2020 12/31/9999 93701 26 BIOIMPEDANCE CV ANALYSIS $ 7.65 $ 7.65 3/1/2020 12/31/9999 93701 TC BIOIMPEDANCE CV ANALYSIS $ 20.18 $ 20.18 3/1/2020 12/31/9999 93701 BIOIMPEDANCE CV ANALYSIS $ 27.84 $ 27.84 3/1/2020 12/31/9999 93724 26 ANALYZE PACEMAKER SYSTEM $ 227.90 $ 227.90 3/1/2020 12/31/9999 93724 TC ANALYZE PACEMAKER SYSTEM $ 52.71 $ 52.71 3/1/2020 12/31/9999 93724 ANALYZE PACEMAKER SYSTEM $ 280.61 $ 280.61 3/1/2020 12/31/9999 93740 26 TEMPERATURE GRADIENT STUDIES $ 6.74 $ 6.74 3/1/2020 12/31/9999 93740 TC TEMPERATURE GRADIENT STUDIES $ 1.38 $ 1.38 3/1/2020 12/31/9999 93740 TEMPERATURE GRADIENT STUDIES $ 8.13 $ 8.13 3/1/2020 12/31/9999 93745 26 SET-UP CARDIOVERT-DEFIBRILL $ 38.33 $ 38.33 3/1/2020 12/31/9999 93745 TC SET-UP CARDIOVERT-DEFIBRILL $ 22.35 $ 22.35 3/1/2020 12/31/9999 93745 SET-UP CARDIOVERT-DEFIBRILL $ 60.68 $ 60.68 3/1/2020 12/31/9999 93750 INTERROGATION VAD IN PERSON $ 29.93 $ 34.07 3/1/2020 12/31/9999 93770 26 MEASURE VENOUS PRESSURE $ 6.74 $ 6.74 3/1/2020 12/31/9999 93770 TC MEASURE VENOUS PRESSURE $ 0.49 $ 0.49 3/1/2020 12/31/9999 93770 MEASURE VENOUS PRESSURE $ 7.26 $ 7.26 3/1/2020 12/31/9999 93797 CARDIAC REHAB $ 8.27 $ 15.03 3/1/2020 12/31/9999 93798 CARDIAC REHAB/MONITOR $ 12.92 $ 21.72 3/1/2020 12/31/9999 93880 26 EXTRACRANIAL BILAT STUDY $ 26.31 $ 26.31 3/1/2020 12/31/9999 93880 TC EXTRACRANIAL BILAT STUDY $ 173.89 $ 173.89 3/1/2020 12/31/9999 93880 EXTRACRANIAL BILAT STUDY $ 200.21 $ 200.21 3/1/2020 12/31/9999 93882 26 EXTRACRANIAL UNI/LTD STUDY $ 17.33 $ 17.33 3/1/2020 12/31/9999 93882 TC EXTRACRANIAL UNI/LTD STUDY $ 114.59 $ 114.59 3/1/2020 12/31/9999 93882 EXTRACRANIAL UNI/LTD STUDY $ 131.90 $ 131.90 3/1/2020 12/31/9999 93886 26 INTRACRANIAL COMPLETE STUDY $ 40.17 $ 40.17 3/1/2020 12/31/9999 93886 TC INTRACRANIAL COMPLETE STUDY $ 200.55 $ 200.55 3/1/2020 12/31/9999 93886 INTRACRANIAL COMPLETE STUDY $ 240.72 $ 240.72 3/1/2020 12/31/9999 93888 26 INTRACRANIAL LIMITED STUDY $ 27.15 $ 27.15 3/1/2020 12/31/9999 93888 TC INTRACRANIAL LIMITED STUDY $ 136.74 $ 136.74 3/1/2020 12/31/9999 93888 INTRACRANIAL LIMITED STUDY $ 163.89 $ 163.89 3/1/2020 12/31/9999 93890 26 TCD VASOREACTIVITY STUDY $ 42.66 $ 42.66 3/1/2020 12/31/9999 93890 TC TCD VASOREACTIVITY STUDY $ 168.83 $ 168.83 3/1/2020 12/31/9999 93890 TCD VASOREACTIVITY STUDY $ 211.48 $ 211.48 3/1/2020 12/31/9999 93892 26 TCD EMBOLI DETECT W/O INJ $ 48.59 $ 48.59 3/1/2020 12/31/9999 93892 TC TCD EMBOLI DETECT W/O INJ $ 183.51 $ 183.51 3/1/2020 12/31/9999 93892 TCD EMBOLI DETECT W/O INJ $ 232.10 $ 232.10 3/1/2020 12/31/9999 93893 26 TCD EMBOLI DETECT W/INJ $ 48.89 $ 48.89 3/1/2020 12/31/9999 93893 TC TCD EMBOLI DETECT W/INJ $ 182.64 $ 182.64 3/1/2020 12/31/9999 93893 TCD EMBOLI DETECT W/INJ $ 231.53 $ 231.53 3/1/2020 12/31/9999 93922 26 UPR/L XTREMITY ART 2 LEVELS $ 10.70 $ 10.70 3/1/2020 12/31/9999 93922 TC UPR/L XTREMITY ART 2 LEVELS $ 86.64 $ 86.64 3/1/2020 12/31/9999 93922 UPR/L XTREMITY ART 2 LEVELS $ 97.31 $ 97.31 3/1/2020 12/31/9999 93923 26 UPR/LXTR ART STDY 3+ LVLS $ 19.51 $ 19.51 3/1/2020 12/31/9999 93923 TC UPR/LXTR ART STDY 3+ LVLS $ 130.74 $ 130.74 3/1/2020 12/31/9999 93923 UPR/LXTR ART STDY 3+ LVLS $ 150.23 $ 150.23 3/1/2020 12/31/9999 93924 26 LWR XTR VASC STDY BILAT $ 22.18 $ 22.18 3/1/2020 12/31/9999 93924 TC LWR XTR VASC STDY BILAT $ 162.78 $ 162.78 3/1/2020 12/31/9999 93924 LWR XTR VASC STDY BILAT $ 184.95 $ 184.95 3/1/2020 12/31/9999 93925 26 LOWER EXTREMITY STUDY $ 25.10 $ 25.10 3/1/2020 12/31/9999 93925 TC LOWER EXTREMITY STUDY $ 223.84 $ 223.84 3/1/2020 12/31/9999 93925 LOWER EXTREMITY STUDY $ 248.93 $ 248.93 3/1/2020 12/31/9999 93926 26 LOWER EXTREMITY STUDY $ 17.01 $ 17.01 3/1/2020 12/31/9999 93926 TC LOWER EXTREMITY STUDY $ 141.81 $ 141.81 3/1/2020 12/31/9999 93926 LOWER EXTREMITY STUDY $ 158.82 $ 158.82 3/1/2020 12/31/9999 93930 26 UPPER EXTREMITY STUDY $ 20.12 $ 20.12 3/1/2020 12/31/9999 93930 TC UPPER EXTREMITY STUDY $ 176.05 $ 176.05 3/1/2020 12/31/9999 93930 UPPER EXTREMITY STUDY $ 196.17 $ 196.17 3/1/2020 12/31/9999 93931 26 UPPER EXTREMITY STUDY $ 13.39 $ 13.39 3/1/2020 12/31/9999 93931 TC UPPER EXTREMITY STUDY $ 117.93 $ 117.93 3/1/2020 12/31/9999 93931 UPPER EXTREMITY STUDY $ 131.31 $ 131.31 3/1/2020 12/31/9999 93970 26 EXTREMITY STUDY $ 29.56 $ 29.56 3/1/2020 12/31/9999 93970 TC EXTREMITY STUDY $ 174.60 $ 174.60 3/1/2020 12/31/9999 93970 EXTREMITY STUDY $ 204.16 $ 204.16 3/1/2020 12/31/9999 93971 26 EXTREMITY STUDY $ 19.59 $ 19.59 3/1/2020 12/31/9999 93971 TC EXTREMITY STUDY $ 115.61 $ 115.61 3/1/2020 12/31/9999 93971 EXTREMITY STUDY $ 135.19 $ 135.19 3/1/2020 12/31/9999 93975 26 VASCULAR STUDY $ 78.88 $ 78.88 3/1/2020 12/31/9999 93975 TC VASCULAR STUDY $ 228.38 $ 228.38 3/1/2020 12/31/9999 93975 VASCULAR STUDY $ 307.25 $ 307.25 3/1/2020 12/31/9999 93976 26 VASCULAR STUDY $ 52.36 $ 52.36 3/1/2020 12/31/9999 93976 TC VASCULAR STUDY $ 125.01 $ 125.01 3/1/2020 12/31/9999 93976 VASCULAR STUDY $ 177.38 $ 177.38 3/1/2020 12/31/9999 93978 26 VASCULAR STUDY $ 28.32 $ 28.32 3/1/2020 12/31/9999 93978 TC VASCULAR STUDY $ 163.73 $ 163.73 3/1/2020 12/31/9999 93978 VASCULAR STUDY $ 192.02 $ 192.02 3/1/2020 12/31/9999 93979 26 VASCULAR STUDY $ 18.98 $ 18.98 3/1/2020 12/31/9999 93979 TC VASCULAR STUDY $ 113.82 $ 113.82 3/1/2020 12/31/9999 93979 VASCULAR STUDY $ 132.79 $ 132.79 3/1/2020 12/31/9999 93985 26 DUP-SCAN HEMO COMPL BI STD $ 34.37 $ 34.37 3/1/2020 12/31/9999 93985 DUP-SCAN HEMO COMPL BI STD $ 229.08 $ 229.08 3/1/2020 12/31/9999 93985 TC DUP-SCAN HEMO COMPL BI STD $ 194.71 $ 194.71 3/1/2020 12/31/9999 93986 26 DUP-SCAN HEMO COMPL UNI STD $ 22.03 $ 22.03 3/1/2020 12/31/9999 93986 DUP-SCAN HEMO COMPL UNI STD $ 132.85 $ 132.85 3/1/2020 12/31/9999 93986 TC DUP-SCAN HEMO COMPL UNI STD $ 110.82 $ 110.82 3/1/2020 12/31/9999 93990 26 DOPPLER FLOW TESTING $ 10.61 $ 10.61 3/1/2020 12/31/9999 93990 TC DOPPLER FLOW TESTING $ 144.74 $ 144.74 3/1/2020 12/31/9999 93990 DOPPLER FLOW TESTING $ 155.35 $ 155.35 3/1/2020 12/31/9999 94002 VENT MGMT INPAT INIT DAY $ 75.29 $ 75.29 3/1/2020 12/31/9999 94003 VENT MGMT INPAT SUBQ DAY $ 54.41 $ 54.41 3/1/2020 12/31/9999 94004 VENT MGMT NF PER DAY $ 39.61 $ 39.61 3/1/2020 12/31/9999 94010 26 BREATHING CAPACITY TEST $ 7.07 $ 7.07 3/1/2020 12/31/9999 94010 TC BREATHING CAPACITY TEST $ 19.79 $ 19.79 3/1/2020 12/31/9999 94010 BREATHING CAPACITY TEST $ 26.86 $ 26.86 3/1/2020 12/31/9999 94011 SPIROMETRY UP TO 2 YRS OLD $ 63.39 $ 63.39 3/1/2020 12/31/9999 94012 SPIRMTRY W/BRNCHDIL INF-2 YR $ 97.59 $ 97.59 3/1/2020 12/31/9999 94013 MEAS LUNG VOL THRU 2 YRS $ 20.56 $ 20.56 3/1/2020 12/31/9999 94060 26 EVALUATION OF WHEEZING $ 12.39 $ 12.39 3/1/2020 12/31/9999 94060 TC EVALUATION OF WHEEZING $ 34.69 $ 34.69 3/1/2020 12/31/9999 94060 EVALUATION OF WHEEZING $ 47.09 $ 47.09 3/1/2020 12/31/9999 94070 26 EVALUATION OF WHEEZING $ 24.35 $ 24.35 3/1/2020 12/31/9999 94070 TC EVALUATION OF WHEEZING $ 24.93 $ 24.93 3/1/2020 12/31/9999 94070 EVALUATION OF WHEEZING $ 49.28 $ 49.28 3/1/2020 12/31/9999 94150 26 VITAL CAPACITY TEST $ 3.31 $ 3.31 3/1/2020 12/31/9999 94150 TC VITAL CAPACITY TEST $ 14.88 $ 14.88 3/1/2020 12/31/9999 94150 VITAL CAPACITY TEST $ 18.19 $ 18.19 3/1/2020 12/31/9999 94200 26 LUNG FUNCTION TEST (MBC/MVV) $ 4.59 $ 4.59 3/1/2020 12/31/9999 94200 TC LUNG FUNCTION TEST (MBC/MVV) $ 13.63 $ 13.63 3/1/2020 12/31/9999 94200 LUNG FUNCTION TEST (MBC/MVV) $ 18.19 $ 18.19 3/1/2020 12/31/9999 94250 26 EXPIRED GAS COLLECTION $ 4.59 $ 4.59 3/1/2020 12/31/9999 94250 TC EXPIRED GAS COLLECTION $ 15.18 $ 15.18 3/1/2020 12/31/9999 94250 EXPIRED GAS COLLECTION $ 19.76 $ 19.76 3/1/2020 12/31/9999 94375 26 RESPIRATORY FLOW VOLUME LOOP $ 12.39 $ 12.39 3/1/2020 12/31/9999 94375 TC RESPIRATORY FLOW VOLUME LOOP $ 18.03 $ 18.03 3/1/2020 12/31/9999 94375 RESPIRATORY FLOW VOLUME LOOP $ 30.42 $ 30.42 3/1/2020 12/31/9999 94400 26 CO2 BREATHING RESPONSE CURVE $ 16.53 $ 16.53 3/1/2020 12/31/9999 94400 TC CO2 BREATHING RESPONSE CURVE $ 26.47 $ 26.47 3/1/2020 12/31/9999 94400 CO2 BREATHING RESPONSE CURVE $ 43.00 $ 43.00 3/1/2020 12/31/9999 94450 26 HYPOXIA RESPONSE CURVE $ 16.04 $ 16.04 3/1/2020 12/31/9999 94450 TC HYPOXIA RESPONSE CURVE $ 25.37 $ 25.37 3/1/2020 12/31/9999 94450 HYPOXIA RESPONSE CURVE $ 41.41 $ 41.41 3/1/2020 12/31/9999 94610 SURFACTANT ADMIN THRU TUBE $ 52.94 $ 52.94 3/1/2020 12/31/9999 94617 26 EXERCISE TST BRNCSPSM $ 29.53 $ 29.53 3/1/2020 12/31/9999 94617 TC EXERCISE TST BRNCSPSM $ 52.81 $ 52.81 3/1/2020 12/31/9999 94617 EXERCISE TST BRNCSPSM $ 82.34 $ 82.34 3/1/2020 12/31/9999 94618 26 PULMONARY STRESS TESTING $ 20.20 $ 20.20 3/1/2020 12/31/9999 94618 TC PULMONARY STRESS TESTING $ 9.61 $ 9.61 3/1/2020 12/31/9999 94618 PULMONARY STRESS TESTING $ 29.81 $ 29.81 3/1/2020 12/31/9999 94621 26 CARDIOPULM EXERCISE TESTING $ 60.10 $ 60.10 3/1/2020 12/31/9999 94621 TC CARDIOPULM EXERCISE TESTING $ 72.81 $ 72.81 3/1/2020 12/31/9999 94621 CARDIOPULM EXERCISE TESTING $ 132.92 $ 132.92 3/1/2020 12/31/9999 94640 AIRWAY INHALATION TREATMENT $ 10.69 $ 10.69 3/1/2020 12/31/9999 94642 AEROSOL INHALATION TREATMENT $ 9.37 $ 9.37 3/1/2020 12/31/9999 94644 CBT 1ST HOUR $ 27.43 $ 27.43 3/1/2020 12/31/9999 94645 CBT EACH ADDL HOUR $ 10.69 $ 10.69 3/1/2020 12/31/9999 94660 POS AIRWAY PRESSURE CPAP $ 30.82 $ 46.98 3/1/2020 12/31/9999 94662 NEG PRESS VENTILATION CNP $ 30.62 $ 30.62 3/1/2020 12/31/9999 94664 EVALUATE PT USE OF INHALER $ 11.68 $ 11.69 3/1/2020 12/31/9999 94667 CHEST WALL MANIPULATION $ 16.29 $ 16.29 3/1/2020 12/31/9999 94668 CHEST WALL MANIPULATION $ 15.39 $ 15.39 3/1/2020 12/31/9999 94680 26 EXHALED AIR ANALYSIS O2 $ 10.51 $ 10.51 3/1/2020 12/31/9999 94680 TC EXHALED AIR ANALYSIS O2 $ 36.16 $ 36.16 3/1/2020 12/31/9999 94680 EXHALED AIR ANALYSIS O2 $ 46.68 $ 46.68 3/1/2020 12/31/9999 94681 26 EXHALED AIR ANALYSIS O2/CO2 $ 8.01 $ 8.01 3/1/2020 12/31/9999 94681 TC EXHALED AIR ANALYSIS O2/CO2 $ 42.37 $ 42.37 3/1/2020 12/31/9999 94681 EXHALED AIR ANALYSIS O2/CO2 $ 50.39 $ 50.39 3/1/2020 12/31/9999 94690 26 EXHALED AIR ANALYSIS $ 3.01 $ 3.01 3/1/2020 12/31/9999 94690 TC EXHALED AIR ANALYSIS $ 37.53 $ 37.53 3/1/2020 12/31/9999 94690 EXHALED AIR ANALYSIS $ 40.54 $ 40.54 3/1/2020 12/31/9999 94726 26 PULM FUNCT TST PLETHYSMOGRAP $ 7.41 $ 7.41 3/1/2020 12/31/9999 94726 TC PULM FUNCT TST PLETHYSMOGRAP $ 24.34 $ 24.34 3/1/2020 12/31/9999 94726 PULM FUNCT TST PLETHYSMOGRAP $ 31.75 $ 31.75 3/1/2020 12/31/9999 94727 26 PULM FUNCTION TEST BY GAS $ 7.41 $ 7.41 3/1/2020 12/31/9999 94727 TC PULM FUNCTION TEST BY GAS $ 17.58 $ 17.58 3/1/2020 12/31/9999 94727 PULM FUNCTION TEST BY GAS $ 24.99 $ 24.99 3/1/2020 12/31/9999 94728 26 AIRWY RESIST BY OSCILLOMETRY $ 7.41 $ 7.41 3/1/2020 12/31/9999 94728 TC AIRWY RESIST BY OSCILLOMETRY $ 17.58 $ 17.58 3/1/2020 12/31/9999 94728 AIRWY RESIST BY OSCILLOMETRY $ 24.99 $ 24.99 3/1/2020 12/31/9999 94729 26 CO/MEMBANE DIFFUSE CAPACITY $ 4.91 $ 4.91 3/1/2020 12/31/9999 94729 TC CO/MEMBANE DIFFUSE CAPACITY $ 26.60 $ 26.60 3/1/2020 12/31/9999 94729 CO/MEMBANE DIFFUSE CAPACITY $ 31.51 $ 31.51 3/1/2020 12/31/9999 94750 26 PULMONARY COMPLIANCE STUDY $ 9.27 $ 9.27 3/1/2020 12/31/9999 94750 TC PULMONARY COMPLIANCE STUDY $ 48.10 $ 48.10 3/1/2020 12/31/9999 94750 PULMONARY COMPLIANCE STUDY $ 57.36 $ 57.36 3/1/2020 12/31/9999 94760 MEASURE BLOOD OXYGEN LEVEL $ 2.17 $ 2.17 3/1/2020 12/31/9999 94761 MEASURE BLOOD OXYGEN LEVEL $ 4.15 $ 4.15 3/1/2020 12/31/9999 94762 MEASURE BLOOD OXYGEN LEVEL $ 23.16 $ 23.16 3/1/2020 12/31/9999 94770 26 EXHALED CARBON DIOXIDE TEST $ 6.13 $ 6.13 3/1/2020 12/31/9999 94770 TC EXHALED CARBON DIOXIDE TEST $ 23.14 $ 23.14 3/1/2020 12/31/9999 94770 EXHALED CARBON DIOXIDE TEST $ 29.30 $ 29.30 3/1/2020 12/31/9999 94772 26 BREATH RECORDING INFANT $ 51.30 $ 51.30 3/1/2020 12/31/9999 94772 TC BREATH RECORDING INFANT $ 46.13 $ 46.13 3/1/2020 12/31/9999 94772 BREATH RECORDING INFANT $ 97.42 $ 97.42 3/1/2020 12/31/9999 94777 PED HOME APNEA REC REPORT $ 70.44 $ 70.44 3/1/2020 12/31/9999 95004 PERCUT ALLERGY SKIN TESTS $ 4.63 $ 4.63 3/1/2020 12/31/9999 95012 EXHALED NITRIC OXIDE MEAS $ 17.18 $ 17.18 3/1/2020 12/31/9999 95017 PERQ & ICUT ALLG TEST VENOMS $ 3.13 $ 7.27 3/1/2020 12/31/9999 95018 PERQ&IC ALLG TEST DRUGS/BIOL $ 6.04 $ 17.91 3/1/2020 12/31/9999 95024 ICUT ALLERGY TEST DRUG/BUG $ 5.51 $ 5.51 3/1/2020 12/31/9999 95027 ICUT ALLERGY TITRATE-AIRBORN $ 3.76 $ 3.76 3/1/2020 12/31/9999 95028 ICUT ALLERGY TEST-DELAYED $ 8.72 $ 8.72 3/1/2020 12/31/9999 95044 ALLERGY PATCH TESTS $ 4.90 $ 4.90 3/1/2020 12/31/9999 95052 PHOTO PATCH TEST $ 5.49 $ 5.49 3/1/2020 12/31/9999 95056 PHOTOSENSITIVITY TESTS $ 27.81 $ 27.81 3/1/2020 12/31/9999 95060 EYE ALLERGY TESTS $ 18.61 $ 18.61 3/1/2020 12/31/9999 95065 NOSE ALLERGY TEST $ 16.94 $ 16.94 3/1/2020 12/31/9999 95070 BRONCHIAL ALLERGY TESTS $ 34.47 $ 34.47 3/1/2020 12/31/9999 95071 BRONCHIAL ALLERGY TESTS $ 42.69 $ 42.69 3/1/2020 12/31/9999 95076 INGEST CHALLENGE INI 120 MIN $ 61.22 $ 97.94 3/1/2020 12/31/9999 95079 INGEST CHALLENGE ADDL 60 MIN $ 56.25 $ 69.51 3/1/2020 12/31/9999 95115 IMMUNOTHERAPY ONE INJECTION $ 8.33 $ 8.33 3/1/2020 12/31/9999 95117 IMMUNOTHERAPY INJECTIONS $ 10.09 $ 10.09 3/1/2020 12/31/9999 95130 IMMNTX 1 STING INSECT $ 29.04 $ 29.04 3/1/2020 12/31/9999 95131 IMMNTX 2 STING INSECTS $ 36.18 $ 36.18 3/1/2020 12/31/9999 95132 IMMNTX 3 STING INSECTS $ 28.49 $ 28.49 3/1/2020 12/31/9999 95133 IMMNTX 4 STING INSECTS $ 52.70 $ 52.70 3/1/2020 12/31/9999 95134 IMMNTX 5 STING INSECTS $ 63.07 $ 63.07 3/1/2020 12/31/9999 95144 ANTIGEN THERAPY SERVICES $ 2.70 $ 9.45 3/1/2020 12/31/9999 95145 ANTIGEN THERAPY SERVICES $ 2.70 $ 12.39 3/1/2020 12/31/9999 95146 ANTIGEN THERAPY SERVICES $ 2.70 $ 20.32 3/1/2020 12/31/9999 95147 ANTIGEN THERAPY SERVICES $ 2.70 $ 19.73 3/1/2020 12/31/9999 95148 ANTIGEN THERAPY SERVICES $ 2.70 $ 27.67 3/1/2020 12/31/9999 95149 ANTIGEN THERAPY SERVICES $ 2.70 $ 36.18 3/1/2020 12/31/9999 95165 ANTIGEN THERAPY SERVICES $ 2.70 $ 9.45 3/1/2020 12/31/9999 95170 ANTIGEN THERAPY SERVICES $ 2.70 $ 7.39 3/1/2020 12/31/9999 95180 RAPID DESENSITIZATION $ 89.89 $ 117.52 3/1/2020 12/31/9999 95249 CONT GLUC MNTR PT PROV EQP $ 47.04 $ 47.04 3/1/2020 12/31/9999 95250 CONT GLUC MNTR PHYS/QHP EQP $ 128.76 $ 128.76 3/1/2020 12/31/9999 95251 CONT GLUC MNTR ANALYSIS I&R $ 31.87 $ 31.87 3/1/2020 12/31/9999 95705 EEG W/O VID 2-12 HR UNMNTR $ 192.17 $ 192.17 3/1/2020 12/31/9999 95706 EEG WO VID 2-12HR INTMT MNTR $ 192.17 $ 192.17 3/1/2020 12/31/9999 95707 EEG W/O VID 2-12HR CONT MNTR $ 192.17 $ 192.17 3/1/2020 12/31/9999 95708 EEG WO VID EA 12-26HR UNMNTR $ 192.17 $ 192.17 3/1/2020 12/31/9999 95709 EEG W/O VID EA 12-26HR INTMT $ 192.17 $ 192.17 3/1/2020 12/31/9999 95710 EEG W/O VID EA 12-26HR CONT $ 192.17 $ 192.17 3/1/2020 12/31/9999 95711 VEEG 2-12 HR UNMONITORED $ 1,462.78 $ 1,462.78 3/1/2020 12/31/9999 95712 VEEG 2-12 HR INTMT MNTR $ 185.35 $ 185.35 3/1/2020 12/31/9999 95713 VEEG 2-12 HR CONT MNTR $ 1,462.78 $ 1,462.78 3/1/2020 12/31/9999 95714 VEEG EA 12-26 HR UNMNTR $ 1,462.78 $ 1,462.78 3/1/2020 12/31/9999 95715 VEEG EA 12-26HR INTMT MNTR $ 1,462.78 $ 1,462.78 3/1/2020 12/31/9999 95716 VEEG EA 12-26HR CONT MNTR $ 1,462.78 $ 1,462.78 3/1/2020 12/31/9999 95717 EEG PHYS/QHP 2-12 HR W/O VID $ 91.06 $ 92.27 3/1/2020 12/31/9999 95718 EEG PHYS/QHP 2-12 HR W/VEEG $ 119.27 $ 121.09 3/1/2020 12/31/9999 95719 EEG PHYS/QHP EA INCR W/O VID $ 140.97 $ 142.49 3/1/2020 12/31/9999 95720 EEG PHY/QHP EA INCR W/VEEG $ 184.66 $ 187.38 3/1/2020 12/31/9999 95721 EEG PHY/QHP>36<60 HR W/O VID $ 185.26 $ 188.91 3/1/2020 12/31/9999 95722 EEG PHY/QHP>36<60 HR W/VEEG $ 225.28 $ 229.22 3/1/2020 12/31/9999 95723 EEG PHY/QHP>60<84 HR W/O VID $ 229.20 $ 234.06 3/1/2020 12/31/9999 95724 EEG PHY/QHP>60<84 HR W/VEEG $ 287.28 $ 292.74 3/1/2020 12/31/9999 95725 EEG PHY/QHP>84 HR W/O VID $ 260.78 $ 267.14 3/1/2020 12/31/9999 95726 EEG PHY/QHP>84 HR W/VEEG $ 362.99 $ 369.96 3/1/2020 12/31/9999 95782 26 POLYSOM <6 YRS 4/> PARAMTRS $ 108.56 $ 108.56 3/1/2020 12/31/9999 95782 TC POLYSOM <6 YRS 4/> PARAMTRS $ 743.75 $ 743.75 3/1/2020 12/31/9999 95782 POLYSOM <6 YRS 4/> PARAMTRS $ 852.32 $ 852.32 3/1/2020 12/31/9999 95783 26 POLYSOM <6 YRS CPAP/BILVL $ 118.60 $ 118.60 3/1/2020 12/31/9999 95783 TC POLYSOM <6 YRS CPAP/BILVL $ 791.13 $ 791.13 3/1/2020 12/31/9999 95783 POLYSOM <6 YRS CPAP/BILVL $ 909.71 $ 909.71 3/1/2020 12/31/9999 95805 26 MULTIPLE SLEEP LATENCY TEST $ 77.96 $ 77.96 3/1/2020 12/31/9999 95805 TC MULTIPLE SLEEP LATENCY TEST $ 265.93 $ 265.93 3/1/2020 12/31/9999 95805 MULTIPLE SLEEP LATENCY TEST $ 343.90 $ 343.90 3/1/2020 12/31/9999 95806 26 SLEEP STUDY UNATT&RESP EFFT $ 69.02 $ 69.02 3/1/2020 12/31/9999 95806 TC SLEEP STUDY UNATT&RESP EFFT $ 101.70 $ 101.70 3/1/2020 12/31/9999 95806 SLEEP STUDY UNATT&RESP EFFT $ 170.72 $ 170.72 3/1/2020 12/31/9999 95807 26 SLEEP STUDY ATTENDED $ 68.43 $ 68.43 3/1/2020 12/31/9999 95807 TC SLEEP STUDY ATTENDED $ 332.76 $ 332.76 3/1/2020 12/31/9999 95807 SLEEP STUDY ATTENDED $ 401.17 $ 401.17 3/1/2020 12/31/9999 95808 26 POLYSOM ANY AGE 1-3> PARAM $ 109.68 $ 109.68 3/1/2020 12/31/9999 95808 TC POLYSOM ANY AGE 1-3> PARAM $ 417.06 $ 417.06 3/1/2020 12/31/9999 95808 POLYSOM ANY AGE 1-3> PARAM $ 526.73 $ 526.73 3/1/2020 12/31/9999 95810 26 POLYSOM 6/> YRS 4/> PARAM $ 144.57 $ 144.57 3/1/2020 12/31/9999 95810 TC POLYSOM 6/> YRS 4/> PARAM $ 483.45 $ 483.45 3/1/2020 12/31/9999 95810 POLYSOM 6/> YRS 4/> PARAM $ 628.03 $ 628.03 3/1/2020 12/31/9999 95811 26 POLYSOM 6/>YRS CPAP 4/> PARM $ 155.41 $ 155.41 3/1/2020 12/31/9999 95811 TC POLYSOM 6/>YRS CPAP 4/> PARM $ 536.52 $ 536.52 3/1/2020 12/31/9999 95811 POLYSOM 6/>YRS CPAP 4/> PARM $ 691.93 $ 691.93 3/1/2020 12/31/9999 95812 26 EEG 41-60 MINUTES $ 45.78 $ 45.78 3/1/2020 12/31/9999 95812 TC EEG 41-60 MINUTES $ 146.74 $ 146.74 3/1/2020 12/31/9999 95812 EEG 41-60 MINUTES $ 192.53 $ 192.53 3/1/2020 12/31/9999 95813 26 EEG EXTND MNTR 61-119 MIN $ 72.90 $ 72.90 3/1/2020 12/31/9999 95813 TC EEG EXTND MNTR 61-119 MIN $ 164.07 $ 164.07 3/1/2020 12/31/9999 95813 EEG EXTND MNTR 61-119 MIN $ 236.97 $ 236.97 3/1/2020 12/31/9999 95816 26 EEG AWAKE AND DROWSY $ 45.78 $ 45.78 3/1/2020 12/31/9999 95816 TC EEG AWAKE AND DROWSY $ 130.97 $ 130.97 3/1/2020 12/31/9999 95816 EEG AWAKE AND DROWSY $ 176.76 $ 176.76 3/1/2020 12/31/9999 95819 26 EEG AWAKE AND ASLEEP $ 45.78 $ 45.78 3/1/2020 12/31/9999 95819 TC EEG AWAKE AND ASLEEP $ 143.89 $ 143.89 3/1/2020 12/31/9999 95819 EEG AWAKE AND ASLEEP $ 189.67 $ 189.67 3/1/2020 12/31/9999 95822 26 EEG COMA OR SLEEP ONLY $ 45.78 $ 45.78 3/1/2020 12/31/9999 95822 TC EEG COMA OR SLEEP ONLY $ 143.03 $ 143.03 3/1/2020 12/31/9999 95822 EEG COMA OR SLEEP ONLY $ 188.82 $ 188.82 3/1/2020 12/31/9999 95824 26 EEG CEREBRAL DEATH ONLY $ 31.36 $ 31.36 3/1/2020 12/31/9999 95824 TC EEG CEREBRAL DEATH ONLY $ 13.69 $ 13.69 3/1/2020 12/31/9999 95824 EEG CEREBRAL DEATH ONLY $ 50.82 $ 50.82 3/1/2020 12/31/9999 95829 26 SURGERY ELECTROCORTICOGRAM $ 265.60 $ 265.60 3/1/2020 12/31/9999 95829 TC SURGERY ELECTROCORTICOGRAM $ 719.80 $ 719.80 3/1/2020 12/31/9999 95829 SURGERY ELECTROCORTICOGRAM $ 985.38 $ 985.38 3/1/2020 12/31/9999 95830 26 INSERT ELECTRODES FOR EEG $ 23.90 $ 25.42 3/1/2020 12/31/9999 95830 INSERT ELECTRODES FOR EEG $ 72.06 $ 144.91 3/1/2020 12/31/9999 95851 26 RANGE OF MOTION MEASUREMENTS $ 5.07 $ 10.88 3/1/2020 12/31/9999 95851 RANGE OF MOTION MEASUREMENTS $ 6.74 $ 13.50 3/1/2020 12/31/9999 95852 26 RANGE OF MOTION MEASUREMENTS $ 1.21 $ 2.61 3/1/2020 12/31/9999 95852 RANGE OF MOTION MEASUREMENTS $ 4.87 $ 10.45 3/1/2020 12/31/9999 95857 26 CHOLINESTERASE CHALLENGE $ 5.70 $ 8.57 3/1/2020 12/31/9999 95857 CHOLINESTERASE CHALLENGE $ 22.82 $ 34.27 3/1/2020 12/31/9999 95860 26 MUSCLE TEST ONE LIMB $ 41.77 $ 41.77 3/1/2020 12/31/9999 95860 TC MUSCLE TEST ONE LIMB $ 25.37 $ 25.37 3/1/2020 12/31/9999 95860 MUSCLE TEST ONE LIMB $ 67.15 $ 67.15 3/1/2020 12/31/9999 95861 26 MUSCLE TEST 2 LIMBS $ 66.76 $ 66.76 3/1/2020 12/31/9999 95861 TC MUSCLE TEST 2 LIMBS $ 30.87 $ 30.87 3/1/2020 12/31/9999 95861 MUSCLE TEST 2 LIMBS $ 97.64 $ 97.64 3/1/2020 12/31/9999 95863 26 MUSCLE TEST 3 LIMBS $ 79.99 $ 79.99 3/1/2020 12/31/9999 95863 TC MUSCLE TEST 3 LIMBS $ 36.47 $ 36.47 3/1/2020 12/31/9999 95863 MUSCLE TEST 3 LIMBS $ 116.46 $ 116.46 3/1/2020 12/31/9999 95864 26 MUSCLE TEST 4 LIMBS $ 85.56 $ 85.56 3/1/2020 12/31/9999 95864 TC MUSCLE TEST 4 LIMBS $ 47.65 $ 47.65 3/1/2020 12/31/9999 95864 MUSCLE TEST 4 LIMBS $ 133.22 $ 133.22 3/1/2020 12/31/9999 95865 26 MUSCLE TEST LARYNX $ 68.80 $ 68.80 3/1/2020 12/31/9999 95865 TC MUSCLE TEST LARYNX $ 24.98 $ 24.98 3/1/2020 12/31/9999 95865 MUSCLE TEST LARYNX $ 93.79 $ 93.79 3/1/2020 12/31/9999 95866 26 MUSCLE TEST HEMIDIAPHRAGM $ 54.62 $ 54.62 3/1/2020 12/31/9999 95866 TC MUSCLE TEST HEMIDIAPHRAGM $ 22.05 $ 22.05 3/1/2020 12/31/9999 95866 MUSCLE TEST HEMIDIAPHRAGM $ 76.67 $ 76.67 3/1/2020 12/31/9999 95867 26 MUSCLE TEST CRAN NERV UNILAT $ 33.92 $ 33.92 3/1/2020 12/31/9999 95867 TC MUSCLE TEST CRAN NERV UNILAT $ 24.30 $ 24.30 3/1/2020 12/31/9999 95867 MUSCLE TEST CRAN NERV UNILAT $ 58.22 $ 58.22 3/1/2020 12/31/9999 95868 26 MUSCLE TEST CRAN NERVE BILAT $ 50.52 $ 50.52 3/1/2020 12/31/9999 95868 TC MUSCLE TEST CRAN NERVE BILAT $ 29.51 $ 29.51 3/1/2020 12/31/9999 95868 MUSCLE TEST CRAN NERVE BILAT $ 80.02 $ 80.02 3/1/2020 12/31/9999 95869 26 MUSCLE TEST THOR PARASPINAL $ 15.97 $ 15.97 3/1/2020 12/31/9999 95869 TC MUSCLE TEST THOR PARASPINAL $ 20.96 $ 20.96 3/1/2020 12/31/9999 95869 MUSCLE TEST THOR PARASPINAL $ 36.93 $ 36.93 3/1/2020 12/31/9999 95870 26 MUSCLE TEST NONPARASPINAL $ 15.97 $ 15.97 3/1/2020 12/31/9999 95870 TC MUSCLE TEST NONPARASPINAL $ 20.09 $ 20.09 3/1/2020 12/31/9999 95870 MUSCLE TEST NONPARASPINAL $ 36.06 $ 36.06 3/1/2020 12/31/9999 95872 26 MUSCLE TEST ONE FIBER $ 118.04 $ 118.04 3/1/2020 12/31/9999 95872 TC MUSCLE TEST ONE FIBER $ 21.26 $ 21.26 3/1/2020 12/31/9999 95872 MUSCLE TEST ONE FIBER $ 139.31 $ 139.31 3/1/2020 12/31/9999 95873 26 GUIDE NERV DESTR ELEC STIM $ 16.84 $ 16.84 3/1/2020 12/31/9999 95873 TC GUIDE NERV DESTR ELEC STIM $ 20.66 $ 20.66 3/1/2020 12/31/9999 95873 GUIDE NERV DESTR ELEC STIM $ 37.53 $ 37.53 3/1/2020 12/31/9999 95874 26 GUIDE NERV DESTR NEEDLE EMG $ 16.26 $ 16.26 3/1/2020 12/31/9999 95874 TC GUIDE NERV DESTR NEEDLE EMG $ 19.20 $ 19.20 3/1/2020 12/31/9999 95874 GUIDE NERV DESTR NEEDLE EMG $ 35.48 $ 35.48 3/1/2020 12/31/9999 95875 26 LIMB EXERCISE TEST $ 46.81 $ 46.81 3/1/2020 12/31/9999 95875 TC LIMB EXERCISE TEST $ 29.70 $ 29.70 3/1/2020 12/31/9999 95875 LIMB EXERCISE TEST $ 76.51 $ 76.51 3/1/2020 12/31/9999 95885 26 MUSC TST DONE W/NERV TST LIM $ 10.70 $ 10.70 3/1/2020 12/31/9999 95885 TC MUSC TST DONE W/NERV TST LIM $ 22.39 $ 22.39 3/1/2020 12/31/9999 95885 MUSC TST DONE W/NERV TST LIM $ 33.09 $ 33.09 3/1/2020 12/31/9999 95886 26 MUSC TEST DONE W/N TEST COMP $ 28.57 $ 28.57 3/1/2020 12/31/9999 95886 TC MUSC TEST DONE W/N TEST COMP $ 23.58 $ 23.58 3/1/2020 12/31/9999 95886 MUSC TEST DONE W/N TEST COMP $ 52.15 $ 52.15 3/1/2020 12/31/9999 95887 26 MUSC TST DONE W/N TST NONEXT $ 22.43 $ 22.43 3/1/2020 12/31/9999 95887 TC MUSC TST DONE W/N TST NONEXT $ 23.99 $ 23.99 3/1/2020 12/31/9999 95887 MUSC TST DONE W/N TST NONEXT $ 46.42 $ 46.42 3/1/2020 12/31/9999 95907 26 NVR CNDJ TST 1-2 STUDIES $ 43.96 $ 43.96 3/1/2020 12/31/9999 95907 TC NVR CNDJ TST 1-2 STUDIES $ 34.60 $ 34.60 3/1/2020 12/31/9999 95907 NVR CNDJ TST 1-2 STUDIES $ 78.56 $ 78.56 3/1/2020 12/31/9999 95908 26 NRV CNDJ TST 3-4 STUDIES $ 55.20 $ 55.20 3/1/2020 12/31/9999 95908 TC NRV CNDJ TST 3-4 STUDIES $ 41.78 $ 41.78 3/1/2020 12/31/9999 95908 NRV CNDJ TST 3-4 STUDIES $ 96.99 $ 96.99 3/1/2020 12/31/9999 95909 26 NRV CNDJ TST 5-6 STUDIES $ 65.97 $ 65.97 3/1/2020 12/31/9999 95909 TC NRV CNDJ TST 5-6 STUDIES $ 50.21 $ 50.21 3/1/2020 12/31/9999 95909 NRV CNDJ TST 5-6 STUDIES $ 116.18 $ 116.18 3/1/2020 12/31/9999 95910 26 NRV CNDJ TEST 7-8 STUDIES $ 88.19 $ 88.19 3/1/2020 12/31/9999 95910 TC NRV CNDJ TEST 7-8 STUDIES $ 64.77 $ 64.77 3/1/2020 12/31/9999 95910 NRV CNDJ TEST 7-8 STUDIES $ 152.97 $ 152.97 3/1/2020 12/31/9999 95911 26 NRV CNDJ TEST 9-10 STUDIES $ 110.21 $ 110.21 3/1/2020 12/31/9999 95911 TC NRV CNDJ TEST 9-10 STUDIES $ 75.15 $ 75.15 3/1/2020 12/31/9999 95911 NRV CNDJ TEST 9-10 STUDIES $ 185.35 $ 185.35 3/1/2020 12/31/9999 95912 26 NRV CNDJ TEST 11-12 STUDIES $ 132.15 $ 132.15 3/1/2020 12/31/9999 95912 TC NRV CNDJ TEST 11-12 STUDIES $ 85.02 $ 85.02 3/1/2020 12/31/9999 95912 NRV CNDJ TEST 11-12 STUDIES $ 217.17 $ 217.17 3/1/2020 12/31/9999 95913 26 NRV CNDJ TEST 13/> STUDIES $ 156.79 $ 156.79 3/1/2020 12/31/9999 95913 TC NRV CNDJ TEST 13/> STUDIES $ 95.10 $ 95.10 3/1/2020 12/31/9999 95913 NRV CNDJ TEST 13/> STUDIES $ 251.88 $ 251.88 3/1/2020 12/31/9999 95921 26 AUTONOMIC NRV PARASYM INERVJ $ 37.91 $ 37.91 3/1/2020 12/31/9999 95921 TC AUTONOMIC NRV PARASYM INERVJ $ 22.72 $ 22.72 3/1/2020 12/31/9999 95921 AUTONOMIC NRV PARASYM INERVJ $ 60.63 $ 60.63 3/1/2020 12/31/9999 95922 26 AUTONOMIC NRV ADRENRG INERVJ $ 40.59 $ 40.59 3/1/2020 12/31/9999 95922 TC AUTONOMIC NRV ADRENRG INERVJ $ 31.84 $ 31.84 3/1/2020 12/31/9999 95922 AUTONOMIC NRV ADRENRG INERVJ $ 72.44 $ 72.44 3/1/2020 12/31/9999 95923 26 AUTONOMIC NRV SYST FUNJ TEST $ 38.40 $ 38.40 3/1/2020 12/31/9999 95923 TC AUTONOMIC NRV SYST FUNJ TEST $ 55.92 $ 55.92 3/1/2020 12/31/9999 95923 AUTONOMIC NRV SYST FUNJ TEST $ 94.32 $ 94.32 3/1/2020 12/31/9999 95924 26 ANS PARASYMP & SYMP W/TILT $ 73.66 $ 73.66 3/1/2020 12/31/9999 95924 TC ANS PARASYMP & SYMP W/TILT $ 49.38 $ 49.38 3/1/2020 12/31/9999 95924 ANS PARASYMP & SYMP W/TILT $ 123.04 $ 123.04 3/1/2020 12/31/9999 95925 26 SOMATOSENSORY TESTING $ 23.25 $ 23.25 3/1/2020 12/31/9999 95925 TC SOMATOSENSORY TESTING $ 71.72 $ 71.72 3/1/2020 12/31/9999 95925 SOMATOSENSORY TESTING $ 94.94 $ 94.94 3/1/2020 12/31/9999 95926 26 SOMATOSENSORY TESTING $ 23.04 $ 23.04 3/1/2020 12/31/9999 95926 TC SOMATOSENSORY TESTING $ 70.23 $ 70.23 3/1/2020 12/31/9999 95926 SOMATOSENSORY TESTING $ 93.27 $ 93.27 3/1/2020 12/31/9999 95927 26 SOMATOSENSORY TESTING $ 23.53 $ 23.53 3/1/2020 12/31/9999 95927 TC SOMATOSENSORY TESTING $ 72.00 $ 72.00 3/1/2020 12/31/9999 95927 SOMATOSENSORY TESTING $ 95.54 $ 95.54 3/1/2020 12/31/9999 95928 26 C MOTOR EVOKED UPPR LIMBS $ 71.61 $ 71.61 3/1/2020 12/31/9999 95928 TC C MOTOR EVOKED UPPR LIMBS $ 119.00 $ 119.00 3/1/2020 12/31/9999 95928 C MOTOR EVOKED UPPR LIMBS $ 190.60 $ 190.60 3/1/2020 12/31/9999 95929 26 C MOTOR EVOKED LWR LIMBS $ 71.90 $ 71.90 3/1/2020 12/31/9999 95929 TC C MOTOR EVOKED LWR LIMBS $ 123.23 $ 123.23 3/1/2020 12/31/9999 95929 C MOTOR EVOKED LWR LIMBS $ 195.14 $ 195.14 3/1/2020 12/31/9999 95930 26 VISUAL EP TEST CNS W/I&R $ 15.05 $ 15.05 3/1/2020 12/31/9999 95930 TC VISUAL EP TEST CNS W/I&R $ 68.94 $ 68.94 3/1/2020 12/31/9999 95930 VISUAL EP TEST CNS W/I&R $ 83.99 $ 83.99 3/1/2020 12/31/9999 95933 26 BLINK REFLEX TEST $ 25.41 $ 25.41 3/1/2020 12/31/9999 95933 TC BLINK REFLEX TEST $ 26.76 $ 26.76 3/1/2020 12/31/9999 95933 BLINK REFLEX TEST $ 52.17 $ 52.17 3/1/2020 12/31/9999 95937 26 NEUROMUSCULAR JUNCTION TEST $ 28.71 $ 28.71 3/1/2020 12/31/9999 95937 TC NEUROMUSCULAR JUNCTION TEST $ 18.03 $ 18.03 3/1/2020 12/31/9999 95937 NEUROMUSCULAR JUNCTION TEST $ 46.74 $ 46.74 3/1/2020 12/31/9999 95938 26 SOMATOSENSORY TESTING $ 26.26 $ 26.26 3/1/2020 12/31/9999 95938 TC SOMATOSENSORY TESTING $ 148.29 $ 148.29 3/1/2020 12/31/9999 95938 SOMATOSENSORY TESTING $ 174.55 $ 174.55 3/1/2020 12/31/9999 95939 26 C MOTOR EVOKED UPR&LWR LIMBS $ 107.75 $ 107.75 3/1/2020 12/31/9999 95939 TC C MOTOR EVOKED UPR&LWR LIMBS $ 336.91 $ 336.91 3/1/2020 12/31/9999 95939 C MOTOR EVOKED UPR&LWR LIMBS $ 444.65 $ 444.65 3/1/2020 12/31/9999 95940 IONM IN OPERATNG ROOM 15 MIN $ 27.06 $ 27.06 3/1/2020 12/31/9999 95941 IONM REMOTE/>1 PT OR PER HR $ 125.10 $ 125.10 3/1/2020 12/31/9999 95954 26 EEG MONITORING/GIVING DRUGS $ 96.87 $ 96.87 3/1/2020 12/31/9999 95954 TC EEG MONITORING/GIVING DRUGS $ 105.49 $ 105.49 3/1/2020 12/31/9999 95954 EEG MONITORING/GIVING DRUGS $ 202.36 $ 202.36 3/1/2020 12/31/9999 95955 26 EEG DURING SURGERY $ 42.19 $ 42.19 3/1/2020 12/31/9999 95955 TC EEG DURING SURGERY $ 69.51 $ 69.51 3/1/2020 12/31/9999 95955 EEG DURING SURGERY $ 111.70 $ 111.70 3/1/2020 12/31/9999 95957 26 EEG DIGITAL ANALYSIS $ 84.19 $ 84.19 3/1/2020 12/31/9999 95957 TC EEG DIGITAL ANALYSIS $ 127.25 $ 127.25 3/1/2020 12/31/9999 95957 EEG DIGITAL ANALYSIS $ 211.45 $ 211.45 3/1/2020 12/31/9999 95958 26 EEG MONITORING/FUNCTION TEST $ 180.00 $ 180.00 3/1/2020 12/31/9999 95958 TC EEG MONITORING/FUNCTION TEST $ 134.52 $ 134.52 3/1/2020 12/31/9999 95958 EEG MONITORING/FUNCTION TEST $ 314.52 $ 314.52 3/1/2020 12/31/9999 95961 26 ELECTRODE STIMULATION BRAIN $ 133.94 $ 133.94 3/1/2020 12/31/9999 95961 TC ELECTRODE STIMULATION BRAIN $ 56.63 $ 56.63 3/1/2020 12/31/9999 95961 ELECTRODE STIMULATION BRAIN $ 190.58 $ 190.58 3/1/2020 12/31/9999 95962 26 ELECTRODE STIM BRAIN ADD-ON $ 139.22 $ 139.22 3/1/2020 12/31/9999 95962 TC ELECTRODE STIM BRAIN ADD-ON $ 37.84 $ 37.84 3/1/2020 12/31/9999 95962 ELECTRODE STIM BRAIN ADD-ON $ 177.06 $ 177.06 3/1/2020 12/31/9999 95970 ALYS NPGT W/O PRGRMG $ 18.71 $ 40.74 3/1/2020 12/31/9999 95971 ALYS SMPL SP/PN NPGT W/PRGRM $ 33.82 $ 47.33 3/1/2020 12/31/9999 95972 ALYS CPLX SP/PN NPGT W/PRGRM $ 64.26 $ 84.53 3/1/2020 12/31/9999 95976 ALYS SMPL CN NPGT PRGRMG $ 35.64 $ 36.25 3/1/2020 12/31/9999 95977 ALYS CPLX CN NPGT PRGRMG $ 47.54 $ 48.14 3/1/2020 12/31/9999 95983 ALYS BRN NPGT PRGRMG 15 MIN $ 44.91 $ 45.51 3/1/2020 12/31/9999 95984 ALYS BRN NPGT PRGRMG ADDL 15 $ 39.35 $ 39.66 3/1/2020 12/31/9999 95990 SPIN/BRAIN PUMP REFIL & MAIN $ 47.03 $ 47.03 3/1/2020 12/31/9999 95991 SPIN/BRAIN PUMP REFIL & MAIN $ 30.94 $ 71.79 3/1/2020 12/31/9999 96040 GENETIC COUNSELING 30 MIN $ 32.64 $ 32.64 3/1/2020 12/31/9999 96105 ASSESSMENT OF APHASIA $ 58.25 $ 58.25 3/1/2020 12/31/9999 96110 EP DEVELOPMENTAL SCREEN W/SCORE $ 8.91 $ 8.91 3/1/2020 12/31/9999 96110 DEVELOPMENTAL SCREEN W/SCORE $ 8.91 $ 8.91 3/1/2020 12/31/9999 96112 DEVEL TST PHYS/QHP 1ST HR $ 114.05 $ 120.72 3/1/2020 12/31/9999 96113 DEVEL TST PHYS/QHP EA ADDL $ 52.06 $ 53.88 3/1/2020 12/31/9999 96116 NUBHVL XM PHYS/QHP 1ST HR $ 76.50 $ 80.61 3/1/2020 12/31/9999 96121 NUBHVL XM PHY/QHP EA ADDL HR $ 70.18 $ 73.52 3/1/2020 12/31/9999 96125 COGNITIVE TEST BY HC PRO $ 68.38 $ 79.83 3/1/2020 12/31/9999 96127 EP BRIEF EMOTIONAL/BEHAV ASSMT $ 4.46 $ 4.46 3/1/2020 12/31/9999 96127 BRIEF EMOTIONAL/BEHAV ASSMT $ 4.46 $ 4.46 3/1/2020 12/31/9999 96130 PSYCL TST EVAL PHYS/QHP 1ST $ 98.90 $ 104.96 3/1/2020 12/31/9999 96131 PSYCL TST EVAL PHYS/QHP EA $ 75.37 $ 79.92 3/1/2020 12/31/9999 96132 NRPSYC TST EVAL PHYS/QHP 1ST $ 97.17 $ 117.46 3/1/2020 12/31/9999 96133 NRPSYC TST EVAL PHYS/QHP EA $ 74.46 $ 89.61 3/1/2020 12/31/9999 96136 PSYCL/NRPSYC TST PHY/QHP 1ST $ 22.22 $ 41.30 3/1/2020 12/31/9999 96137 PSYCL/NRPSYC TST PHY/QHP EA $ 17.55 $ 38.15 3/1/2020 12/31/9999 96138 PSYCL/NRPSYC TECH 1ST $ 32.64 $ 32.64 3/1/2020 12/31/9999 96139 PSYCL/NRPSYC TST TECH EA $ 32.64 $ 32.64 3/1/2020 12/31/9999 96146 PSYCL/NRPSYC TST AUTO RESULT $ 1.74 $ 1.74 3/1/2020 12/31/9999 96156 HLTH BHV ASSMT/REASSESSMENT $ 79.60 $ 87.49 3/1/2020 12/31/9999 96158 HLTH BHV IVNTJ INDIV 1ST 30 $ 54.33 $ 59.79 3/1/2020 12/31/9999 96158 EP HLTH BHV IVNTJ INDIV 1ST 30 $ 50.54 $ 55.62 3/1/2020 12/31/9999 96159 HLTH BHV IVNTJ INDIV EA ADDL $ 18.73 $ 20.85 3/1/2020 12/31/9999 96159 EP HLTH BHV IVNTJ INDIV EA ADDL $ 17.42 $ 19.40 3/1/2020 12/31/9999 96160 EP PT-FOCUSED HLTH RISK ASSMT $ 3.93 $ 3.93 3/1/2020 12/31/9999 96160 PT-FOCUSED HLTH RISK ASSMT $ 3.93 $ 3.93 3/1/2020 12/31/9999 96161 EP CAREGIVER HEALTH RISK ASSMT $ 3.93 $ 3.93 3/1/2020 12/31/9999 96161 CAREGIVER HEALTH RISK ASSMT $ 3.93 $ 3.93 3/1/2020 12/31/9999 96360 HYDRATION IV INFUSION INIT $ 45.89 $ 45.89 3/1/2020 12/31/9999 96361 HYDRATE IV INFUSION ADD-ON $ 13.36 $ 13.36 3/1/2020 12/31/9999 96365 THER/PROPH/DIAG IV INF INIT $ 55.97 $ 55.97 3/1/2020 12/31/9999 96366 THER/PROPH/DIAG IV INF ADDON $ 17.98 $ 17.98 3/1/2020 12/31/9999 96367 TX/PROPH/DG ADDL SEQ IV INF $ 28.29 $ 28.29 3/1/2020 12/31/9999 96368 THER/DIAG CONCURRENT INF $ 16.78 $ 16.78 3/1/2020 12/31/9999 96369 SC THER INFUSION UP TO 1 HR $ 121.85 $ 121.85 3/1/2020 12/31/9999 96370 SC THER INFUSION ADDL HR $ 12.99 $ 12.99 3/1/2020 12/31/9999 96371 SC THER INFUSION RESET PUMP $ 58.95 $ 58.95 3/1/2020 12/31/9999 96372 THER/PROPH/DIAG INJ SC/IM $ 17.36 $ 17.36 3/1/2020 12/31/9999 96373 THER/PROPH/DIAG INJ IA $ 14.90 $ 14.90 3/1/2020 12/31/9999 96374 THER/PROPH/DIAG INJ IV PUSH $ 44.42 $ 44.42 3/1/2020 12/31/9999 96375 TX/PRO/DX INJ NEW DRUG ADDON $ 19.26 $ 19.26 3/1/2020 12/31/9999 96377 APPLICATON ON-BODY INJECTOR $ 17.36 $ 17.36 3/1/2020 12/31/9999 96401 CHEMO ANTI-NEOPL SQ/IM $ 55.35 $ 55.35 3/1/2020 12/31/9999 96402 CHEMO HORMON ANTINEOPL SQ/IM $ 30.33 $ 30.33 3/1/2020 12/31/9999 96405 CHEMO INTRALESIONAL UP TO 7 $ 24.45 $ 69.70 3/1/2020 12/31/9999 96406 CHEMO INTRALESIONAL OVER 7 $ 35.70 $ 96.52 3/1/2020 12/31/9999 96409 CHEMO IV PUSH SNGL DRUG $ 91.09 $ 91.09 3/1/2020 12/31/9999 96411 CHEMO IV PUSH ADDL DRUG $ 51.91 $ 51.91 3/1/2020 12/31/9999 96413 CHEMO IV INFUSION 1 HR $ 120.07 $ 120.07 3/1/2020 12/31/9999 96415 CHEMO IV INFUSION ADDL HR $ 27.13 $ 27.13 3/1/2020 12/31/9999 96416 CHEMO PROLONG INFUSE W/PUMP $ 130.78 $ 130.78 3/1/2020 12/31/9999 96417 CHEMO IV INFUS EACH ADDL SEQ $ 59.79 $ 59.79 3/1/2020 12/31/9999 96420 CHEMO IA PUSH TECNIQUE $ 87.49 $ 87.49 3/1/2020 12/31/9999 96422 CHEMO IA INFUSION UP TO 1 HR $ 141.25 $ 141.25 3/1/2020 12/31/9999 96423 CHEMO IA INFUSE EACH ADDL HR $ 63.38 $ 63.38 3/1/2020 12/31/9999 96425 CHEMOTHERAPY INFUSION METHOD $ 139.19 $ 139.19 3/1/2020 12/31/9999 96440 CHEMOTHERAPY INTRACAVITARY $ 111.88 $ 491.10 3/1/2020 12/31/9999 96446 CHEMOTX ADMN PRTL CAVITY $ 17.83 $ 148.68 3/1/2020 12/31/9999 96450 CHEMOTHERAPY INTO CNS $ 74.50 $ 172.31 3/1/2020 12/31/9999 96521 REFILL/MAINT PORTABLE PUMP $ 103.35 $ 103.35 3/1/2020 12/31/9999 96522 REFILL/MAINT PUMP/RESVR SYST $ 87.78 $ 87.78 3/1/2020 12/31/9999 96523 IRRIG DRUG DELIVERY DEVICE $ 20.56 $ 20.56 3/1/2020 12/31/9999 96542 CHEMOTHERAPY INJECTION $ 38.16 $ 110.42 3/1/2020 12/31/9999 96567 PDT DSTR PRMLG LES SKN $ 94.80 $ 94.80 3/1/2020 12/31/9999 96570 PHOTODYNMC TX 30 MIN ADD-ON $ 48.90 $ 48.90 3/1/2020 12/31/9999 96571 PHOTODYNAMIC TX ADDL 15 MIN $ 23.65 $ 23.65 3/1/2020 12/31/9999 96573 PDT DSTR PRMLG LES PHYS/QHP $ 162.98 $ 162.98 3/1/2020 12/31/9999 96900 ULTRAVIOLET LIGHT THERAPY $ 15.69 $ 15.69 3/1/2020 12/31/9999 96910 PHOTOCHEMOTHERAPY WITH UV-B $ 50.75 $ 50.75 3/1/2020 12/31/9999 96912 PHOTOCHEMOTHERAPY WITH UV-A $ 65.04 $ 65.04 3/1/2020 12/31/9999 96913 PHOTOCHEMOTHERAPY UV-A OR B $ 90.14 $ 90.14 3/1/2020 12/31/9999 96920 LASER TX SKIN < 250 SQ CM $ 54.25 $ 132.98 3/1/2020 12/31/9999 96921 LASER TX SKIN 250-500 SQ CM $ 53.91 $ 130.28 3/1/2020 12/31/9999 96922 LASER TX SKIN >500 SQ CM $ 96.27 $ 193.80 3/1/2020 12/31/9999 97010 HOT OR COLD PACKS THERAPY $ 3.86 $ 3.86 3/1/2020 12/31/9999 97012 MECHANICAL TRACTION THERAPY $ 12.25 $ 12.25 3/1/2020 12/31/9999 97014 ELECTRIC STIMULATION THERAPY $ 11.20 $ 11.20 3/1/2020 12/31/9999 97016 VASOPNEUMATIC DEVICE THERAPY $ 12.67 $ 12.67 3/1/2020 12/31/9999 97018 PARAFFIN BATH THERAPY $ 6.52 $ 6.52 3/1/2020 12/31/9999 97022 WHIRLPOOL THERAPY $ 14.42 $ 14.42 3/1/2020 12/31/9999 97024 DIATHERMY EG MICROWAVE $ 4.46 $ 4.46 3/1/2020 12/31/9999 97026 INFRARED THERAPY $ 4.17 $ 4.17 3/1/2020 12/31/9999 97028 ULTRAVIOLET THERAPY $ 5.09 $ 5.09 3/1/2020 12/31/9999 97032 ELECTRICAL STIMULATION $ 13.72 $ 13.72 3/1/2020 12/31/9999 97034 CONTRAST BATH THERAPY $ 12.44 $ 12.44 3/1/2020 12/31/9999 97035 ULTRASOUND THERAPY $ 9.81 $ 9.81 3/1/2020 12/31/9999 97036 HYDROTHERAPY $ 21.15 $ 21.15 3/1/2020 12/31/9999 97110 THERAPEUTIC EXERCISES $ 23.80 $ 23.80 3/1/2020 12/31/9999 97112 NEUROMUSCULAR REEDUCATION $ 24.48 $ 24.48 3/1/2020 12/31/9999 97113 AQUATIC THERAPY/EXERCISES $ 28.86 $ 28.86 3/1/2020 12/31/9999 97116 GAIT TRAINING THERAPY $ 20.84 $ 20.84 3/1/2020 12/31/9999 97124 MASSAGE THERAPY $ 18.95 $ 18.95 3/1/2020 12/31/9999 97140 MANUAL THERAPY 1/> REGIONS $ 22.08 $ 22.08 3/1/2020 12/31/9999 97151 BHV ID ASSMT BY PHYS/QHP $ 19.31 $ 19.60 3/1/2020 12/31/9999 97152 BHV ID SUPRT ASSMT BY 1 TECH $ 19.31 $ 19.60 3/1/2020 12/31/9999 97153 ADAPTIVE BEHAVIOR TX BY TECH $ 17.50 $ 17.50 3/1/2020 12/31/9999 97154 GRP ADAPT BHV TX BY TECH $ 3.78 $ 4.39 3/1/2020 12/31/9999 97155 ADAPT BEHAVIOR TX PHYS/QHP $ 17.50 $ 17.50 3/1/2020 12/31/9999 97156 FAM ADAPT BHV TX GDN PHY/QHP $ 16.91 $ 18.43 3/1/2020 12/31/9999 97161 PT EVAL LOW COMPLEX 20 MIN $ 70.83 $ 70.83 3/1/2020 12/31/9999 97162 PT EVAL MOD COMPLEX 30 MIN $ 70.83 $ 70.83 3/1/2020 12/31/9999 97163 PT EVAL HIGH COMPLEX 45 MIN $ 70.83 $ 70.83 3/1/2020 12/31/9999 97164 PT RE-EVAL EST PLAN CARE $ 48.00 $ 48.00 3/1/2020 12/31/9999 97165 OT EVAL LOW COMPLEX 30 MIN $ 68.71 $ 68.71 3/1/2020 12/31/9999 97166 OT EVAL MOD COMPLEX 45 MIN $ 68.71 $ 68.71 3/1/2020 12/31/9999 97167 OT EVAL HIGH COMPLEX 60 MIN $ 68.71 $ 68.71 3/1/2020 12/31/9999 97168 OT RE-EVAL EST PLAN CARE $ 45.34 $ 45.34 3/1/2020 12/31/9999 97530 THERAPEUTIC ACTIVITIES $ 25.04 $ 25.04 3/1/2020 12/31/9999 97597 RMVL DEVITAL TIS 20 CM/< $ 27.06 $ 48.51 3/1/2020 12/31/9999 97598 RMVL DEVITAL TIS ADDL 20CM/< $ 36.11 $ 60.20 3/1/2020 12/31/9999 97750 PHYSICAL PERFORMANCE TEST $ 24.38 $ 24.38 3/1/2020 12/31/9999 97760 ORTHOTIC MGMT&TRAING 1ST ENC $ 26.93 $ 26.93 3/1/2020 12/31/9999 97761 PROSTHETIC TRAING 1ST ENC $ 24.09 $ 24.09 3/1/2020 12/31/9999 97763 ORTHC/PROSTC MGMT SBSQ ENC $ 42.00 $ 42.00 3/1/2020 12/31/9999 97802 MEDICAL NUTRITION INDIV IN $ 23.50 $ 24.96 3/1/2020 12/31/9999 97803 MED NUTRITION INDIV SUBSEQ $ 20.36 $ 21.84 3/1/2020 12/31/9999 98940 CHIROPRACT MANJ 1-2 REGIONS $ 18.02 $ 20.96 3/1/2020 12/31/9999 98941 CHIROPRACT MANJ 3-4 REGIONS $ 26.12 $ 29.06 3/1/2020 12/31/9999 98942 CHIROPRACTIC MANJ 5 REGIONS $ 35.08 $ 38.02 3/1/2020 12/31/9999 99050 MEDICAL SERVICES AFTER HRS $ 27.80 $ 27.80 3/1/2020 12/31/9999 99051 MED SERV EVE/WKEND/HOLIDAY $ 27.80 $ 27.80 3/1/2020 12/31/9999 99053 MED SERV 10PM-8AM 24 HR FAC $ 27.80 $ 27.80 3/1/2020 12/31/9999 99058 OFFICE EMERGENCY CARE $ 18.53 $ 18.53 3/1/2020 12/31/9999 99060 OUT OF OFFICE EMERG MED SERV $ 9.94 $ 9.94 3/1/2020 12/31/9999 99070 SPECIAL SUPPLIES PHYS/QHP $ 9.89 $ 9.89 3/1/2020 12/31/9999 99082 UNUSUAL PHYSICIAN TRAVEL $ 0.86 $ 0.86 3/1/2020 12/31/9999 99100 SPECIAL ANESTHESIA SERVICE $ 18.23 $ 18.23 3/1/2020 12/31/9999 99116 ANESTHESIA WITH HYPOTHERMIA $ 18.23 $ 18.23 3/1/2020 12/31/9999 99135 SPECIAL ANESTHESIA PROCEDURE $ 17.83 $ 17.83 3/1/2020 12/31/9999 99140 EMERGENCY ANESTHESIA $ 18.23 $ 18.23 3/1/2020 12/31/9999 99151 MOD SED SAME PHYS/QHP <5 YRS $ 21.01 $ 66.57 3/1/2020 12/31/9999 99152 MOD SED SAME PHYS/QHP 5/>YRS $ 10.99 $ 44.17 3/1/2020 12/31/9999 99153 MOD SED SAME PHYS/QHP EA $ 9.29 $ 9.29 3/1/2020 12/31/9999 99155 MOD SED OTH PHYS/QHP <5 YRS $ 82.50 $ 82.50 3/1/2020 12/31/9999 99156 MOD SED OTH PHYS/QHP 5/>YRS $ 67.59 $ 67.59 3/1/2020 12/31/9999 99157 MOD SED OTHER PHYS/QHP EA $ 51.26 $ 51.26 3/1/2020 12/31/9999 99170 ANOGENITAL EXAM CHILD W IMAG $ 80.09 $ 119.16 3/1/2020 12/31/9999 99175 INDUCTION OF VOMITING $ 20.22 $ 20.22 3/1/2020 12/31/9999 99183 HYPERBARIC OXYGEN THERAPY $ 96.34 $ 158.32 3/1/2020 12/31/9999 99190 SPECIAL PUMP SERVICES $ 94.23 $ 94.23 3/1/2020 12/31/9999 99191 SPECIAL PUMP SERVICES $ 60.51 $ 60.51 3/1/2020 12/31/9999 99192 SPECIAL PUMP SERVICES $ 43.82 $ 43.82 3/1/2020 12/31/9999 99195 PHLEBOTOMY $ 57.10 $ 57.10 3/1/2020 12/31/9999 99201 OFFICE/OUTPATIENT VISIT NEW $ 21.86 $ 33.79 3/1/2020 12/31/9999 99202 OFFICE/OUTPATIENT VISIT NEW $ 42.15 $ 58.60 3/1/2020 12/31/9999 99203 OFFICE/OUTPATIENT VISIT NEW $ 63.61 $ 84.90 3/1/2020 12/31/9999 99204 OFFICE/OUTPATIENT VISIT NEW $ 106.81 $ 131.66 3/1/2020 12/31/9999 99205 OFFICE/OUTPATIENT VISIT NEW $ 139.00 $ 166.44 3/1/2020 12/31/9999 99211 OFFICE/OUTPATIENT VISIT EST $ 8.09 $ 17.14 3/1/2020 12/31/9999 99212 OFFICE/OUTPATIENT VISIT EST $ 21.54 $ 34.13 3/1/2020 12/31/9999 99213 OFFICE/OUTPATIENT VISIT EST $ 42.14 $ 56.97 3/1/2020 12/31/9999 99214 OFFICE/OUTPATIENT VISIT EST $ 65.18 $ 85.85 3/1/2020 12/31/9999 99215 OFFICE/OUTPATIENT VISIT EST $ 92.55 $ 116.11 3/1/2020 12/31/9999 99217 OBSERVATION CARE DISCHARGE $ 62.45 $ 62.45 3/1/2020 12/31/9999 99218 INITIAL OBSERVATION CARE $ 58.91 $ 58.91 3/1/2020 12/31/9999 99219 INITIAL OBSERVATION CARE $ 97.56 $ 97.56 3/1/2020 12/31/9999 99220 INITIAL OBSERVATION CARE $ 136.82 $ 136.82 3/1/2020 12/31/9999 99221 INITIAL HOSPITAL CARE $ 84.59 $ 84.59 3/1/2020 12/31/9999 99222 INITIAL HOSPITAL CARE $ 115.44 $ 115.44 3/1/2020 12/31/9999 99223 INITIAL HOSPITAL CARE $ 169.97 $ 169.97 3/1/2020 12/31/9999 99224 SUBSEQUENT OBSERVATION CARE $ 23.72 $ 23.72 3/1/2020 12/31/9999 99225 SUBSEQUENT OBSERVATION CARE $ 42.14 $ 42.14 3/1/2020 12/31/9999 99226 SUBSEQUENT OBSERVATION CARE $ 63.00 $ 63.00 3/1/2020 12/31/9999 99231 SUBSEQUENT HOSPITAL CARE $ 34.93 $ 34.93 3/1/2020 12/31/9999 99232 SUBSEQUENT HOSPITAL CARE $ 62.96 $ 62.96 3/1/2020 12/31/9999 99233 SUBSEQUENT HOSPITAL CARE $ 90.16 $ 90.16 3/1/2020 12/31/9999 99234 OBSERV/HOSP SAME DATE $ 119.33 $ 119.33 3/1/2020 12/31/9999 99235 OBSERV/HOSP SAME DATE $ 156.75 $ 156.75 3/1/2020 12/31/9999 99236 OBSERV/HOSP SAME DATE $ 194.83 $ 194.83 3/1/2020 12/31/9999 99238 HOSPITAL DISCHARGE DAY $ 62.24 $ 62.24 3/1/2020 12/31/9999 99239 HOSPITAL DISCHARGE DAY $ 90.46 $ 90.46 3/1/2020 12/31/9999 99241 OFFICE CONSULTATION $ 28.08 $ 40.72 3/1/2020 12/31/9999 99242 OFFICE CONSULTATION $ 59.25 $ 76.28 3/1/2020 12/31/9999 99243 OFFICE CONSULTATION $ 82.59 $ 104.91 3/1/2020 12/31/9999 99244 OFFICE CONSULTATION $ 131.16 $ 155.82 3/1/2020 12/31/9999 99245 OFFICE CONSULTATION $ 163.60 $ 191.51 3/1/2020 12/31/9999 99251 INPATIENT CONSULTATION $ 41.58 $ 41.58 3/1/2020 12/31/9999 99252 INPATIENT CONSULTATION $ 64.43 $ 64.42 3/1/2020 12/31/9999 99253 INPATIENT CONSULTATION $ 97.81 $ 97.80 3/1/2020 12/31/9999 99254 INPATIENT CONSULTATION $ 141.46 $ 141.46 3/1/2020 12/31/9999 99255 INPATIENT CONSULTATION $ 172.36 $ 172.36 3/1/2020 12/31/9999 99281 EMERGENCY DEPT VISIT $ 17.35 $ 17.35 3/1/2020 12/31/9999 99282 EMERGENCY DEPT VISIT $ 33.75 $ 33.75 3/1/2020 12/31/9999 99283 EMERGENCY DEPT VISIT $ 52.30 $ 52.30 3/1/2020 12/31/9999 99284 EMERGENCY DEPT VISIT $ 97.92 $ 97.92 3/1/2020 12/31/9999 99285 EMERGENCY DEPT VISIT $ 145.57 $ 145.57 3/1/2020 12/31/9999 99288 DIRECT ADVANCED LIFE SUPPORT $ 45.45 $ 45.45 3/1/2020 12/31/9999 99291 CRITICAL CARE FIRST HOUR $ 199.46 $ 236.89 3/1/2020 12/31/9999 99292 CRITICAL CARE ADDL 30 MIN $ 99.67 $ 107.43 3/1/2020 12/31/9999 99304 NURSING FACILITY CARE INIT $ 75.37 $ 75.37 3/1/2020 12/31/9999 99305 NURSING FACILITY CARE INIT $ 105.38 $ 105.38 3/1/2020 12/31/9999 99306 NURSING FACILITY CARE INIT $ 135.41 $ 135.41 3/1/2020 12/31/9999 99307 NURSING FAC CARE SUBSEQ $ 37.19 $ 37.19 3/1/2020 12/31/9999 99308 NURSING FAC CARE SUBSEQ $ 56.87 $ 56.87 3/1/2020 12/31/9999 99309 NURSING FAC CARE SUBSEQ $ 75.43 $ 75.43 3/1/2020 12/31/9999 99310 NURSING FAC CARE SUBSEQ $ 111.53 $ 111.53 3/1/2020 12/31/9999 99315 NURSING FAC DISCHARGE DAY $ 54.42 $ 54.42 3/1/2020 12/31/9999 99316 NURSING FAC DISCHARGE DAY $ 71.11 $ 71.11 3/1/2020 12/31/9999 99318 ANNUAL NURSING FAC ASSESSMNT $ 78.86 $ 78.86 3/1/2020 12/31/9999 99324 DOMICIL/R-HOME VISIT NEW PAT $ 50.56 $ 50.56 3/1/2020 12/31/9999 99325 DOMICIL/R-HOME VISIT NEW PAT $ 73.64 $ 73.64 3/1/2020 12/31/9999 99326 DOMICIL/R-HOME VISIT NEW PAT $ 121.75 $ 121.75 3/1/2020 12/31/9999 99327 DOMICIL/R-HOME VISIT NEW PAT $ 158.80 $ 158.80 3/1/2020 12/31/9999 99328 DOMICIL/R-HOME VISIT NEW PAT $ 186.94 $ 186.94 3/1/2020 12/31/9999 99334 DOMICIL/R-HOME VISIT EST PAT $ 52.11 $ 52.11 3/1/2020 12/31/9999 99335 DOMICIL/R-HOME VISIT EST PAT $ 80.71 $ 80.71 3/1/2020 12/31/9999 99336 DOMICIL/R-HOME VISIT EST PAT $ 113.66 $ 113.66 3/1/2020 12/31/9999 99337 DOMICIL/R-HOME VISIT EST PAT $ 163.32 $ 163.32 3/1/2020 12/31/9999 99341 HOME VISIT NEW PATIENT $ 50.56 $ 50.56 3/1/2020 12/31/9999 99342 HOME VISIT NEW PATIENT $ 73.64 $ 73.64 3/1/2020 12/31/9999 99343 HOME VISIT NEW PATIENT $ 118.59 $ 118.59 3/1/2020 12/31/9999 99344 HOME VISIT NEW PATIENT $ 155.68 $ 155.68 3/1/2020 12/31/9999 99345 HOME VISIT NEW PATIENT $ 187.26 $ 187.26 3/1/2020 12/31/9999 99347 HOME VISIT EST PATIENT $ 49.34 $ 49.34 3/1/2020 12/31/9999 99348 HOME VISIT EST PATIENT $ 74.50 $ 74.50 3/1/2020 12/31/9999 99349 HOME VISIT EST PATIENT $ 108.48 $ 108.48 3/1/2020 12/31/9999 99350 HOME VISIT EST PATIENT $ 151.24 $ 151.24 3/1/2020 12/31/9999 99354 PROLONG E&M/PSYCTX SERV O/P $ 81.62 $ 86.13 3/1/2020 12/31/9999 99355 PROLONG E&M/PSYCTX SERV O/P $ 80.75 $ 85.27 3/1/2020 12/31/9999 99356 PROLONGED SERVICE INPATIENT $ 78.66 $ 78.66 3/1/2020 12/31/9999 99357 PROLONGED SERVICE INPATIENT $ 79.20 $ 79.20 3/1/2020 12/31/9999 99360 PHYSICIAN STANDBY SERVICES $ 50.86 $ 50.86 3/1/2020 12/31/9999 99367 TEAM CONF W/O PAT BY PHYS $ 51.44 $ 51.44 3/1/2020 12/31/9999 99375 HOME HEALTH CARE SUPERVISION $ 88.39 $ 97.76 3/1/2020 12/31/9999 99378 HOSPICE CARE SUPERVISION $ 91.61 $ 100.99 3/1/2020 12/31/9999 99381 EP INIT PM E/M NEW PAT INFANT $ 81.82 $ 81.82 3/1/2020 12/31/9999 99381 INIT PM E/M NEW PAT INFANT $ 55.86 $ 83.63 3/1/2020 12/31/9999 99382 EP INIT PM E/M NEW PAT 1-4 YRS $ 81.82 $ 81.82 3/1/2020 12/31/9999 99382 INIT PM E/M NEW PAT 1-4 YRS $ 63.74 $ 91.17 3/1/2020 12/31/9999 99383 EP PREV VISIT NEW AGE 5-11 $ 81.82 $ 81.82 3/1/2020 12/31/9999 99383 PREV VISIT NEW AGE 5-11 $ 63.74 $ 90.53 3/1/2020 12/31/9999 99384 EP PREV VISIT NEW AGE 12-17 $ 81.82 $ 81.82 3/1/2020 12/31/9999 99384 PREV VISIT NEW AGE 12-17 $ 71.82 $ 98.63 3/1/2020 12/31/9999 99385 EP PREV VISIT NEW AGE 18-39 $ 81.82 $ 81.82 3/1/2020 12/31/9999 99385 PREV VISIT NEW AGE 18-39 $ 71.82 $ 98.63 3/1/2020 12/31/9999 99386 PREV VISIT NEW AGE 40-64 $ 88.14 $ 115.58 3/1/2020 12/31/9999 99387 INIT PM E/M NEW PAT 65+ YRS $ 96.67 $ 126.70 3/1/2020 12/31/9999 99391 EP PER PM REEVAL EST PAT INFANT $ 81.82 $ 81.82 3/1/2020 12/31/9999 99391 PER PM REEVAL EST PAT INFANT $ 47.78 $ 69.73 3/1/2020 12/31/9999 99392 EP PREV VISIT EST AGE 1-4 $ 81.82 $ 81.82 3/1/2020 12/31/9999 99392 PREV VISIT EST AGE 1-4 $ 55.86 $ 77.83 3/1/2020 12/31/9999 99393 EP PREV VISIT EST AGE 5-11 $ 81.82 $ 81.82 3/1/2020 12/31/9999 99393 PREV VISIT EST AGE 5-11 $ 55.86 $ 77.50 3/1/2020 12/31/9999 99394 EP PREV VISIT EST AGE 12-17 $ 81.82 $ 81.82 3/1/2020 12/31/9999 99394 PREV VISIT EST AGE 12-17 $ 63.74 $ 85.37 3/1/2020 12/31/9999 99395 EP PREV VISIT EST AGE 18-39 $ 81.82 $ 81.82 3/1/2020 12/31/9999 99395 PREV VISIT EST AGE 18-39 $ 63.74 $ 85.69 3/1/2020 12/31/9999 99396 PREV VISIT EST AGE 40-64 $ 71.82 $ 93.79 3/1/2020 12/31/9999 99397 PER PM REEVAL EST PAT 65+ YR $ 80.37 $ 105.22 3/1/2020 12/31/9999 99406 EP BEHAV CHNG SMOKING 3-10 MIN $ 10.86 $ 12.15 3/1/2020 12/31/9999 99406 BEHAV CHNG SMOKING 3-10 MIN $ 10.86 $ 12.15 3/1/2020 12/31/9999 99407 EP BEHAV CHNG SMOKING > 10 MIN $ 22.51 $ 23.48 3/1/2020 12/31/9999 99407 BEHAV CHNG SMOKING > 10 MIN $ 22.51 $ 23.48 3/1/2020 12/31/9999 99408 EP AUDIT/DAST 15-30 MIN $ 30.01 $ 31.30 3/1/2020 12/31/9999 99408 AUDIT/DAST 15-30 MIN $ 30.01 $ 31.30 3/1/2020 12/31/9999 99409 EP AUDIT/DAST OVER 30 MIN $ 60.24 $ 61.53 3/1/2020 12/31/9999 99409 AUDIT/DAST OVER 30 MIN $ 60.24 $ 61.53 3/1/2020 12/31/9999 99421 OL DIG E/M SVC 5-10 MIN $ 16.41 $ 26.00 3/10/2020 12/31/2020 99422 OL DIG E/M SVC 11-20 MIN $ 32.10 $ 43.41 3/10/2020 12/31/2020 99423 OL DIG E/M SVC 21+ MIN $ 49.66 $ 65.41 3/10/2020 12/31/2020 99441 PHONE E/M PHYS/QHP 5-10 MIN $ 16.41 $ 26.00 3/10/2020 12/31/2020 99442 PHONE E/M PHYS/QHP 11-20 MIN $ 32.10 $ 43.41 3/10/2020 12/31/2020 99443 PHONE E/M PHYS/QHP 21-30 MIN $ 49.66 $ 65.41 3/10/2020 12/31/2020 99446 NTRPROF PH1/NTRNET/EHR 5-10 $ 15.96 $ 15.96 3/10/2020 12/31/9999 99447 NTRPROF PH1/NTRNET/EHR 11-20 $ 32.22 $ 32.22 3/10/2020 12/31/9999 99448 NTRPROF PH1/NTRNET/EHR 21-30 $ 48.18 $ 48.18 3/10/2020 12/31/9999 99449 NTRPROF PH1/NTRNET/EHR 31/> $ 64.21 $ 64.21 3/10/2020 12/31/9999 99453 REM MNTR PHYSIOL PARAM SETUP $ 15.71 $ 15.71 3/10/2020 12/31/9999 99454 REM MNTR PHYSIOL PARAM DEV $ 52.37 $ 52.37 3/10/2020 12/31/9999 99457 REM PHYSIOL MNTR 1ST 20 MIN $ 28.48 $ 44.23 3/10/2020 12/31/9999 99458 REM PHYSIOL MNTR EA ADDL 20 $ 28.48 $ 36.35 3/10/2020 12/31/9999 99460 INIT NB EM PER DAY HOSP $ 52.91 $ 52.91 3/1/2020 12/31/9999 99461 INIT NB EM PER DAY NON-FAC $ 59.07 $ 78.12 3/1/2020 12/31/9999 99462 SBSQ NB EM PER DAY HOSP $ 28.21 $ 28.21 3/1/2020 12/31/9999 99463 SAME DAY NB DISCHARGE $ 70.79 $ 70.79 3/1/2020 12/31/9999 99464 ATTENDANCE AT DELIVERY $ 60.61 $ 60.61 3/1/2020 12/31/9999 99465 NB RESUSCITATION $ 123.95 $ 123.95 3/1/2020 12/31/9999 99466 PED CRIT CARE TRANSPORT $ 198.08 $ 198.08 3/1/2020 12/31/9999 99467 PED CRIT CARE TRANSPORT ADDL $ 98.91 $ 98.91 3/1/2020 12/31/9999 99468 NEONATE CRIT CARE INITIAL $ 742.34 $ 742.34 3/1/2020 12/31/9999 99469 NEONATE CRIT CARE SUBSQ $ 325.09 $ 325.09 3/1/2020 12/31/9999 99471 PED CRITICAL CARE INITIAL $ 661.32 $ 661.32 3/1/2020 12/31/9999 99472 PED CRITICAL CARE SUBSQ $ 327.72 $ 327.72 3/1/2020 12/31/9999 99473 SELF-MEAS BP PT EDUCAJ/TRAIN $ 9.33 $ 9.33 3/10/2020 12/31/9999 99474 SELF-MEAS BP 2 READG BID 30D $ 7.86 $ 13.02 3/10/2020 12/31/9999 99475 PED CRIT CARE AGE 2-5 INIT $ 456.30 $ 456.30 3/1/2020 12/31/9999 99476 PED CRIT CARE AGE 2-5 SUBSQ $ 271.94 $ 271.94 3/1/2020 12/31/9999 99477 INIT DAY HOSP NEONATE CARE $ 288.96 $ 288.96 3/1/2020 12/31/9999 99478 IC LBW INF < 1500 GM SUBSQ $ 117.48 $ 117.48 3/1/2020 12/31/9999 99479 IC LBW INF 1500-2500 G SUBSQ $ 103.47 $ 103.47 3/1/2020 12/31/9999 99480 IC INF PBW 2501-5000 G SUBSQ $ 99.51 $ 99.51 3/1/2020 12/31/9999 99492 1ST PSYC COLLAB CARE MGMT $ 77.55 $ 137.17 3/1/2020 12/31/9999 99493 SBSQ PSYC COLLAB CARE MGMT $ 70.12 $ 109.77 3/1/2020 12/31/9999 99494 1ST/SBSQ PSYC COLLAB CARE $ 37.41 $ 56.78 3/1/2020 12/31/9999 99499* UNLISTED E&M SERVICE $ 575.00 $ 575.00 1/1/2019 12/31/9999 A4263 PERMANENT TEAR DUCT PLUG $ 9.98 $ 9.98 3/1/2020 12/31/9999 A4550 SURGICAL TRAYS $ 10.53 $ 10.53 3/1/2020 12/31/9999 A4570 SPLINT $ 9.72 $ 9.72 3/1/2020 12/31/9999 D0145 ORAL EVALUATION, PT < 3YRS $ 39.91 $ 39.91 3/1/2020 12/31/9999 D1206 TOPICAL FLUORIDE VARNISH $ 17.62 $ 17.62 3/1/2020 12/31/9999 G0108 DIAB MANAGE TRN PER INDIV $ 18.71 $ 18.71 3/1/2020 12/31/9999 G0109 DIAB MANAGE TRN IND/GROUP $ 10.48 $ 10.48 3/1/2020 12/31/9999 G0127 TRIM NAIL(S) $ 7.07 $ 15.59 3/1/2020 12/31/9999 G0267 BONE MARROW OR PERIPHERAL STEM CELL HARV $ 79.37 $ 79.37 3/1/2020 12/31/9999 G0279 26 TOMOSYNTHESIS, MAMMO $ 26.34 $ 26.34 3/1/2020 12/31/9999 G0279 TC TOMOSYNTHESIS, MAMMO $ 21.49 $ 21.49 3/1/2020 12/31/9999 G0279 TOMOSYNTHESIS, MAMMO $ 47.84 $ 47.84 3/1/2020 12/31/9999 G0297 26 LDCT FOR LUNG CA SCREEN $ 46.06 $ 46.06 3/1/2020 12/31/9999 G0297 TC LDCT FOR LUNG CA SCREEN $ 158.38 $ 158.38 3/1/2020 12/31/9999 G0297 LDCT FOR LUNG CA SCREEN $ 204.45 $ 204.45 3/1/2020 12/31/9999 G0328 FECAL BLOOD SCRN IMMUNOASSAY $ 20.75 $ 20.75 3/1/2020 12/31/9999 G0413 PELVIC RING FRACTURE UNI/BIL $ 928.29 $ 928.29 3/1/2020 12/31/9999 G0416 26 PROSTATE BIOPSY, ANY MTHD $ 156.40 $ 156.40 3/1/2020 12/31/9999 G0416 TC PROSTATE BIOPSY, ANY MTHD $ 363.35 $ 363.35 3/1/2020 12/31/9999 G0416 PROSTATE BIOPSY, ANY MTHD $ 519.08 $ 519.08 3/1/2020 12/31/9999 G0455 FECAL MICROBIOTA PREP INSTIL $ 43.96 $ 92.58 3/1/2020 12/31/9999 G0480 DRUG TEST DEF 1-7 CLASSES $ 76.39 $ 76.39 3/1/2020 12/31/9999 G0481 DRUG TEST DEF 8-14 CLASSES $ 117.52 $ 117.52 3/1/2020 12/31/9999 G0482 DRUG TEST DEF 15-21 CLASSES $ 158.64 $ 158.64 3/1/2020 12/31/9999 G0483 DRUG TEST DEF 22+ CLASSES $ 205.65 $ 205.65 3/1/2020 12/31/9999 G2011 ALCOHOL/SUB ABUSE ASSESS $ 14.83 $ 14.83 3/1/2020 12/31/9999 G2012 BRIEF CHECK IN BY MD/QHP $ 16.41 $ 26.00 3/10/2020 12/31/2020 H0001 ALCOHOL AND/OR DRUG ASSESS $ 20.18 $ 20.18 3/1/2020 12/31/9999 H0005 ALCOHOL AND/OR DRUG SERVICES $ 7.43 $ 7.43 3/1/2020 12/31/9999 H0031 MH HEALTH ASSESS BY NON-MD $ 20.18 $ 20.18 3/1/2020 12/31/9999 Q0111 WET MOUNTS/ W PREPARATIONS $ 5.15 $ 5.15 3/1/2020 12/31/9999 Q0112 POTASSIUM HYDROXIDE PREPS $ 5.74 $ 5.74 3/1/2020 12/31/9999 Q0113 PINWORM EXAMINATIONS $ 3.96 $ 3.96 3/1/2020 12/31/9999 Q3014 TELEHEALTH FACILITY FEE $ 21.64 $ 21.64 3/1/2020 12/31/9999 Q4101 APLIGRAF $ 29.09 $ 29.09 3/1/2020 12/31/9999 Q4104 INTEGRA BMWD $ 23.71 $ 23.71 3/1/2020 12/31/9999 Q4106 DERMAGRAFT $ 35.64 $ 35.64 3/1/2020 12/31/9999 Q4116 ALLODERM $ 33.01 $ 33.01 3/1/2020 12/31/9999 Q4121 THERASKIN $ 22.33 $ 22.33 3/1/2020 12/31/9999 Q4186 EPIFIX 1 SQ CM $ 277.98 $ 277.98 3/1/2020 12/31/9999 S0620 ROUTINE OPHTHALMOLOGICAL EXA $ 79.50 $ 110.08 3/1/2020 12/31/9999 S0621 ROUTINE OPHTHALMOLOGICAL EXA $ 62.25 $ 89.81 3/1/2020 12/31/9999 S2065 SIMULT PANC KIDN TRANS $ 81.83 $ 81.83 3/1/2020 12/31/9999 S2102 ISLET CELL TISSUE TRANSPLANT $ 1,414.74 $ 1,414.74 3/1/2020 12/31/9999 S2140 CORD BLOOD HARVESTING $ 81.83 $ 81.83 3/1/2020 12/31/9999 S2142 CORD BLOOD-DERIVED STEM-CELL $ 81.83 $ 81.83 3/1/2020 12/31/9999 S2150 BMT HARV/TRANSPL 28D PKG $ 81.83 $ 81.83 3/1/2020 12/31/9999 S2235 IMPLANT AUDITORY BRAIN IMP $ 836.15 $ 836.15 3/1/2020 12/31/9999 S9442 BIRTHING CLASS $ 8.85 $ 8.85 3/1/2020 12/31/9999 T1017 TARGETED CASE MANAGEMENT $ 18.00 $ 18.00 3/1/2020 12/31/9999 U0001 2019- NCOV DIAGNOSTIC P $ 37.71 $ 37.71 3/1/2020 12/31/9999 U0002 COVID-19 LAB TEST NON-CDC $ 53.88 $ 53.88 3/1/2020 12/31/9999 U0003 COV-19 AMP PRB HGH THRUPUT $ 100.00 $ 100.00 3/18/2020 12/31/9999 U0004 COV-19 TEST NON-CDC HGH THRU $ 100.00 $ 100.00 3/18/2020 12/31/9999

Notes: *-All other “Unlisted E & M Services” billed under 99499 will be mannually priced based on the type of service. **-Rates set at procedure maximum.

NC Medicaid Physician Services Fee Schedule

E & M Codes Physician Service Fee Schedule-Affordable Care Act(ACA) Taxonomy Defined Rates Pricing Specialty 01E Fee Schedule Updated on: 6/26/2020

***Rate changes are based on the January 1, 2018 RVU *** Rates apply to the following taxonomies only in combination with the listed procedure codes: 207K00000X,207KA0200X,207Q00000X,207R00000X,207RA0000X,207RA0201X,207RC0000X,207RC0001X,207RC0200X,207RE0101X,207RG0100X,207RG0300X, 207RH0000X,207RH0002X,207RH0003X,207RI0011X,207RI0200X,207RN0300X,207RP1001X,207RR0500X,207RS0010X,207RS0012X,207RT0003X,207RX0202X,

The inclusion of a rate on this table does not guarantee that a service is covered. Please refer to the Medicaid Billing Guide and the Medicaid and Health Choice Clinical Policies on the DHB Web Site.

Providers should always bill their usual and customary charges. Please use the monthly NC Medicaid Bulletins for additions, changes and deletion to this schedule.

Medicaid Maximum Allowable

FEE EFFECTIVE CPT HCPCS CODE MOD FACTOR CODE FACILITY NON-FACILITY FEE END DATE DATE

99201 NEW PATIENT OFFICE OR OTHER OUTPATIENT V $ 27.55 $ 45.15 3/1/2020 12/31/9999 99202 NEW PATIENT OFFICE OR OTHER OUTPATIENT V $ 52.04 $ 76.31 3/1/2020 12/31/9999 99203 NEW PATIENT OFFICE OR OTHER OUTPATIENT V $ 78.73 $ 109.70 3/1/2020 12/31/9999 99204 NEW PATIENT OFFICE OR OTHER OUTPATIENT V $ 133.17 $ 168.01 3/1/2020 12/31/9999 99205 NEW PATIENT OFFICE OR OTHER OUTPATIENT V $ 173.90 $ 211.55 3/1/2020 12/31/9999 99211 ESTABLISHED PATIENT OFFICE OR OTHER OUTP $ 9.53 $ 21.85 3/1/2020 12/31/9999 99212 ESTABLISHED PATIENT OFFICE OR OTHER OUTP $ 26.23 $ 44.53 3/1/2020 12/31/9999 99213 ESTABLISHED PATIENT OFFICE OR OTHER OUTP $ 52.93 $ 74.40 3/1/2020 12/31/9999 99214 ESTABLISHED PATIENT OFFICE OR OTHER OUTP $ 81.14 $ 110.00 3/1/2020 12/31/9999 99215 ESTABLISHED PATIENT OFFICE OR OTHER OUTP $ 114.67 $ 148.45 3/1/2020 12/31/9999 99217 HOSPITAL OBSERVATION CARE DISCHARGE $ 67.84 $ 75.38 3/1/2020 12/31/9999 99218 HOSPITAL OBSERVATION CARE TYPICALLY 30 M $ 92.86 $ 103.17 3/1/2020 12/31/9999 99219 HOSPITAL OBSERVATION CARE TYPICALLY 50 M $ 126.52 $ 140.57 3/1/2020 12/31/9999 99220 HOSPITAL OBSERVATION CARE TYPICALLY 70 M $ 173.27 $ 192.52 3/1/2020 12/31/9999 99221 INITIAL HOSPITAL INPATIENT CARE, TYPICAL $ 93.88 $ 104.31 3/1/2020 12/31/9999 99222 INITIAL HOSPITAL INPATIENT CARE, TYPICAL $ 127.01 $ 141.12 3/1/2020 12/31/9999 99223 INITIAL HOSPITAL INPATIENT CARE, TYPICAL $ 188.53 $ 209.48 3/1/2020 12/31/9999 99224 SUBSEQUENT OBSERVATION CARE, TYPICALLY 1 $ 37.09 $ 41.21 3/1/2020 12/31/9999 99225 SUBSEQUENT OBSERVATION CARE, TYPICALLY 2 $ 68.11 $ 75.67 3/1/2020 12/31/9999 99226 SUBSEQUENT OBSERVATION CARE, TYPICALLY 3 $ 97.71 $ 108.57 3/1/2020 12/31/9999 99231 SUBSEQUENT HOSPITAL INPATIENT CARE, TYPI $ 36.46 $ 40.51 3/1/2020 12/31/9999 99232 SUBSEQUENT HOSPITAL INPATIENT CARE, TYPI $ 67.71 $ 75.23 3/1/2020 12/31/9999 99233 SUBSEQUENT HOSPITAL INPATIENT CARE, TYPI $ 97.00 $ 107.78 3/1/2020 12/31/9999 99234 HOSPITAL OBSERVATION OR INPATIENT CARE L $ 123.80 $ 137.56 3/1/2020 12/31/9999 99235 OBSERV/HOSP SAME DATE $ 157.47 $ 174.96 3/1/2020 12/31/9999 99236 HOSPITAL OBSERVATION OR INPATIENT CARE H $ 203.27 $ 225.86 3/1/2020 12/31/9999 99238 HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MI $ 67.84 $ 75.38 3/1/2020 12/31/9999 99239 HOSPITAL DISCHARGE DAY MANAGEMENT; MORE $ 100.09 $ 111.22 3/1/2020 12/31/9999 99241 PATIENT OFFICE CONSULTATION, TYPICALLY 1 $ 33.09 $ 47.86 3/1/2020 12/31/9999 99242 PATIENT OFFICE CONSULTATION, TYPICALLY 3 $ 69.44 $ 90.20 3/1/2020 12/31/9999 99243 PATIENT OFFICE CONSULTATION, TYPICALLY 4 $ 97.17 $ 123.55 3/1/2020 12/31/9999 99244 PATIENT OFFICE CONSULTATION, TYPICALLY 6 $ 156.15 $ 185.01 3/1/2020 12/31/9999 99245 PATIENT OFFICE CONSULTATION, TYPICALLY 8 $ 193.28 $ 225.67 3/1/2020 12/31/9999 99251 INPATIENT HOSPITAL CONSULTATION, TYPICAL $ 44.73 $ 49.70 3/1/2020 12/31/9999 99252 INPATIENT HOSPITAL CONSULTATION, TYPICAL $ 68.35 $ 75.95 3/1/2020 12/31/9999 99253 INPATIENT HOSPITAL CONSULTATION, TYPICAL $ 105.21 $ 116.90 3/1/2020 12/31/9999 99254 INPATIENT HOSPITAL CONSULTATION, TYPICAL $ 152.82 $ 169.80 3/1/2020 12/31/9999 99255 INPATIENT HOSPITAL CONSULTATION, TYPICAL $ 183.96 $ 204.40 3/1/2020 12/31/9999 99281 EMERGENCY DEPARTMENT VISIT, SELF LIMITED $ 19.74 $ 21.93 3/1/2020 12/31/9999 99282 EMERGENCY DEPARTMENT VISIT, LOW TO MODER $ 38.48 $ 42.76 3/1/2020 12/31/9999 99283 EMERGENCY DEPARTMENT VISIT, MODERATELY S $ 57.61 $ 64.01 3/1/2020 12/31/9999 99284 EMERGENCY DEPARTMENT VISIT, PROBLEM OF H $ 109.32 $ 121.46 3/1/2020 12/31/9999 99285 EMERGENCY DEPARTMENT VISIT, PROBLEM WITH $ 161.07 $ 178.96 3/1/2020 12/31/9999 99288 PHYSICIAN DIRECTION OF EMERGENCY ADVANCE $ 45.45 $ 45.45 3/1/2020 12/31/9999 99291 CRITICAL CARE, EVALUATION AND MANAGEMENT $ 230.06 $ 281.43 3/1/2020 12/31/9999 99292 CRITICAL CARE, EVALUATION AND MANAGEMENT $ 115.29 $ 126.20 3/1/2020 12/31/9999 99304 INITIAL NURSING FACILITY INITIAL VISIT, $ 84.68 $ 94.09 3/1/2020 12/31/9999 99305 INITIAL NURSING FACILITY VISIT, TYPICALL $ 121.19 $ 134.65 3/1/2020 12/31/9999 99306 INITIAL NURSING FACILITY VISIT, TYPICALL $ 155.15 $ 172.39 3/1/2020 12/31/9999 99307 SUBSEQUENT NURSING FACILITY VISIT, TYPIC $ 41.29 $ 45.87 3/1/2020 12/31/9999 99308 SUBSEQUENT NURSING FACILITY VISIT, TYPIC $ 64.16 $ 71.28 3/1/2020 12/31/9999 99309 SUBSEQUENT NURSING FACILITY VISIT, TYPIC $ 84.79 $ 94.21 3/1/2020 12/31/9999 99310 SUBSEQUENT NURSING FACILITY VISIT, TYPIC $ 126.17 $ 140.19 3/1/2020 12/31/9999 99315 NURSING FACILITY DISCHARGE DAY MANAGEMEN $ 67.61 $ 75.12 3/1/2020 12/31/9999 99316 NURSING FACILITY DISCHARGE DAY MANAGEMEN $ 98.43 $ 109.37 3/1/2020 12/31/9999 99318 NURSING FACILITY ANNUAL ASSESSMENT, TYPI $ 89.28 $ 99.20 3/1/2020 12/31/9999 99324 NEW PATIENT ASSISTED LIVING VISIT, TYPIC $ 51.22 $ 56.91 3/1/2020 12/31/9999 99325 NEW PATIENT ASSISTED LIVING VISIT, TYPIC $ 74.66 $ 82.96 3/1/2020 12/31/9999 99326 NEW PATIENT ASSISTED LIVING VISIT, TYPIC $ 129.60 $ 144.00 3/1/2020 12/31/9999 99327 NEW PATIENT ASSISTED LIVING VISIT, TYPIC $ 173.19 $ 192.43 3/1/2020 12/31/9999 99328 NEW PATIENT ASSISTED LIVING VISIT, TYPIC $ 202.93 $ 225.48 3/1/2020 12/31/9999 99334 ESTABLISHED PATIENT ASSISTED LIVING VISI $ 55.79 $ 61.99 3/1/2020 12/31/9999 99335 ESTABLISHED PATIENT ASSISTED LIVING VISI $ 88.04 $ 97.82 3/1/2020 12/31/9999 99336 ESTABLISHED PATIENT ASSISTED LIVING VISI $ 125.71 $ 139.68 3/1/2020 12/31/9999 99337 ESTABLISHED PATIENT ASSISTED LIVING VISI $ 179.72 $ 199.69 3/1/2020 12/31/9999 99341 NEW PATIENT HOME VISIT, TYPICALLY 20 MIN $ 50.90 $ 56.55 3/1/2020 12/31/9999 99342 NEW PATIENT HOME VISIT, TYPICALLY 30 MIN $ 73.95 $ 82.16 3/1/2020 12/31/9999 99343 NEW PATIENT HOME VISIT, TYPICALLY 45 MIN $ 121.37 $ 134.85 3/1/2020 12/31/9999 99344 NEW PATIENT HOME VISIT, TYPICALLY 60 MIN $ 169.84 $ 188.71 3/1/2020 12/31/9999 99345 NEW PATIENT HOME VISIT, TYPICALLY 75 MIN $ 206.17 $ 229.08 3/1/2020 12/31/9999 99347 ESTABLISHED PATIENT HOME VISIT, TYPICALL $ 51.19 $ 56.88 3/1/2020 12/31/9999 99348 ESTABLISHED PATIENT HOME VISIT, TYPICALL $ 78.16 $ 86.85 3/1/2020 12/31/9999 99349 ESTABLISHED PATIENT HOME VISIT, TYPICALL $ 119.48 $ 132.75 3/1/2020 12/31/9999 99350 ESTABLISHED PATIENT HOME VISIT, TYPICALL $ 166.11 $ 184.57 3/1/2020 12/31/9999 99354 PROLONG E&M/PSYCTX SERV O/P $ 126.06 $ 134.51 3/1/2020 12/31/9999 99355 PROLONG E&M/PSYCTX SERV O/P $ 94.69 $ 101.73 3/1/2020 12/31/9999 99356 PROLONGED PHYSICIAN SERVICE IN THE INPAT $ 85.80 $ 95.33 3/1/2020 12/31/9999 99357 PROLONGED PHYSICIAN SERVICE IN THE INPAT $ 86.11 $ 95.68 3/1/2020 12/31/9999 99360 PROLONGED PHYSICIAN STANDBY SERVICE, EAC $ 56.34 $ 62.60 3/1/2020 12/31/9999 99367 MEDICAL TEAM CONFERENCE WITH INTERDISCIP $ 51.76 $ 57.51 3/1/2020 12/31/9999 99375 PHYSICIAN SUPERVISION OF PATIENT HOME HE $ 89.96 $ 106.16 3/1/2020 12/31/9999 99378 PHYSICIAN SUPERVISION OF PATIENT HOSPICE $ 91.61 $ 100.99 3/1/2020 12/31/9999 99381 INIT PM E/M NEW PAT INFANT $ 78.06 $ 111.85 3/1/2020 12/31/9999 99381 EP INIT PM E/M NEW PAT INFANT $ 112.97 $ 112.97 3/1/2020 12/31/9999 99382 INIT PM E/M NEW PAT 1-4 YRS $ 83.41 $ 116.84 3/1/2020 12/31/9999 99382 EP INIT PM E/M NEW PAT 1-4 YRS $ 118.01 $ 118.01 3/1/2020 12/31/9999 99383 PREV VISIT NEW AGE 5-11 $ 88.50 $ 121.59 3/1/2020 12/31/9999 99383 EP PREV VISIT NEW AGE 5-11 $ 122.81 $ 122.81 3/1/2020 12/31/9999 99384 PREV VISIT NEW AGE 12-17 $ 103.96 $ 137.39 3/1/2020 12/31/9999 99384 EP PREV VISIT NEW AGE 12-17 $ 138.77 $ 138.77 3/1/2020 12/31/9999 99385 PREV VISIT NEW AGE 18-39 $ 99.69 $ 133.12 3/1/2020 12/31/9999 99385 EP PREV VISIT NEW AGE 18-39 $ 134.45 $ 134.45 3/1/2020 12/31/9999 99386 PREV VISIT NEW AGE 40-64 $ 121.22 $ 154.65 3/1/2020 12/31/9999 99387 INIT PM E/M NEW PAT 65+ YRS $ 129.86 $ 167.52 3/1/2020 12/31/9999 99391 PERIODIC PREVENTIVE MEDICINE UNDER ONE Y $ 71.24 $ 100.45 3/1/2020 12/31/9999 99391 EP PERIODIC PREVENTIVE MEDICINE UNDER ONE Y $ 101.46 $ 101.46 3/1/2020 12/31/9999 99392 PERIODIC PREVENTIVE MEDICINE AGE 001-004 $ 78.06 $ 107.27 3/1/2020 12/31/9999 99392 EP PERIODIC PREVENTIVE MEDICINE AGE 001-004 $ 108.34 $ 108.34 3/1/2020 12/31/9999 99393 PERIODIC PREVENTIVE MEDICINE AGE 005-011 $ 78.06 $ 106.91 3/1/2020 12/31/9999 99393 EP PERIODIC PREVENTIVE MEDICINE AGE 005-011 $ 107.98 $ 107.98 3/1/2020 12/31/9999 99394 PERIODIC PREVENTIVE MEDICINE AGES 012-01 $ 88.50 $ 117.36 3/1/2020 12/31/9999 99394 EP PERIODIC PREVENTIVE MEDICINE AGES 012-01 $ 118.53 $ 118.53 3/1/2020 12/31/9999 99395 ESTAB. PT PHYSICAL EXAM: 18 TO 39 YEARS $ 91.06 $ 119.91 3/1/2020 12/31/9999 99395 EP ESTAB. PT PHYSICAL EXAM: 18 TO 39 YEARS $ 121.11 $ 121.11 3/1/2020 12/31/9999 99396 ESTAB. PT PHYSICAL EXAM: 40 TO 64 YEARS $ 98.61 $ 127.82 3/1/2020 12/31/9999 99397 ESTAB. PT PHYSICAL EXAM: 65 YEARS AND OV $ 103.96 $ 137.74 3/1/2020 12/31/9999 99406 BEHAV CHNG SMOKING 3-10 MIN $ 12.77 $ 14.88 3/1/2020 12/31/9999 99406 EP BEHAV CHNG SMOKING 3-10 MIN $ 10.86 $ 12.15 3/1/2020 12/31/9999 99407 BEHAV CHNG SMOKING > 10 MIN $ 26.64 $ 28.75 3/1/2020 12/31/9999 99407 EP BEHAV CHNG SMOKING > 10 MIN $ 22.51 $ 23.48 3/1/2020 12/31/9999 99408 AUDIT/DAST 15-30 MIN $ 33.80 $ 35.92 3/1/2020 12/31/9999 99408 EP AUDIT/DAST 15-30 MIN $ 36.28 $ 36.28 3/1/2020 12/31/9999 99409 AUDIT/DAST OVER 30 MIN $ 67.96 $ 69.72 3/1/2020 12/31/9999 99409 EP AUDIT/DAST OVER 30 MIN $ 70.42 $ 70.42 3/1/2020 12/31/9999 99421 OL DIG E/M SVC 5-10 MIN $ 19.98 $ 33.93 3/10/2020 12/31/2020 99422 OL DIG E/M SVC 11-20 MIN $ 40.33 $ 56.69 3/10/2020 12/31/2020 99423 OL DIG E/M SVC 21+ MIN $ 61.82 $ 83.81 3/10/2020 12/31/2020 99441 PHONE E/M PHYS/QHP 5-10 MIN $ 19.98 $ 33.93 3/10/2020 12/31/2020 99442 PHONE E/M PHYS/QHP 11-20 MIN $ 40.33 $ 56.69 3/10/2020 12/31/2020 99443 PHONE E/M PHYS/QHP 21-30 MIN $ 61.82 $ 83.81 3/10/2020 12/31/2020 99446 NTRPROF PH1/NTRNET/EHR 5-10 $ 16.71 $ 18.56 3/10/2020 12/31/9999 99447 NTRPROF PH1/NTRNET/EHR 11-20 $ 33.73 $ 37.47 3/10/2020 12/31/9999 99448 NTRPROF PH1/NTRNET/EHR 21-30 $ 50.42 $ 56.03 3/10/2020 12/31/9999 99449 NTRPROF PH1/NTRNET/EHR 31/> $ 67.19 $ 74.66 3/10/2020 12/31/9999 99453 REM MNTR PHYSIOL PARAM SETUP $ 16.43 $ 18.26 3/10/2020 12/31/9999 99454 REM MNTR PHYSIOL PARAM DEV $ 54.81 $ 60.90 3/10/2020 12/31/9999 99457 REM PHYSIOL MNTR 1ST 20 MIN $ 33.11 $ 51.43 3/10/2020 12/31/9999 99458 REM PHYSIOL MNTR EA ADDL 20 $ 33.11 $ 42.27 3/10/2020 12/31/9999 99460 INITIAL HOSPITAL OR BIRTHING CENTER CARE $ 89.38 $ 99.31 3/1/2020 12/31/9999 99461 INITIAL CARE, PER DAY, FOR EVALUATION AN $ 65.22 $ 93.02 3/1/2020 12/31/9999 99462 SUBSEQUENT HOSPITAL CARE, PER DAY, FOR E $ 38.94 $ 43.27 3/1/2020 12/31/9999 99463 INITIAL HOSPITAL OR BIRTHING CENTER CARE $ 103.33 $ 114.81 3/1/2020 12/31/9999 99464 PHYSICIAN ATTENDANCE AT DELIVERY AND STA $ 69.86 $ 77.63 3/1/2020 12/31/9999 99465 DELIVERY/BIRTHING ROOM RESUSCITATION, PR $ 136.16 $ 151.28 3/1/2020 12/31/9999 99466 CRITICAL CARE OF ILL OR INJURED PEDIATRI $ 222.94 $ 247.72 3/1/2020 12/31/9999 99467 CRITICAL CARE OF ILL OR INJURED PEDIATRI $ 111.48 $ 123.87 3/1/2020 12/31/9999 99468 INITIAL INPATIENT NEONATAL CRITICAL CARE $ 858.68 $ 954.09 3/1/2020 12/31/9999 99469 SUBSEQUENT INPATIENT NEONATAL CRITICAL C $ 371.61 $ 412.90 3/1/2020 12/31/9999 99471 INITIAL INPATIENT PEDIATRIC CRITICAL CAR $ 743.30 $ 825.89 3/1/2020 12/31/9999 99472 SUBSEQUENT INPATIENT PEDIATRIC CRITICAL $ 382.59 $ 425.10 3/1/2020 12/31/9999 99473 SELF-MEAS BP PT EDUCAJ/TRAIN $ 9.78 $ 10.86 3/10/2020 12/31/9999 99474 SELF-MEAS BP 2 READG BID 30D $ 9.15 $ 15.14 3/10/2020 12/31/9999 99475 INITIAL INPATIENT PEDIATRIC CRITICAL CAR $ 523.27 $ 581.41 3/1/2020 12/31/9999 99476 SUBSEQUENT INPATIENT PEDIATRIC CRITICAL $ 321.35 $ 357.05 3/1/2020 12/31/9999 99477 INITIAL HOSPITAL CARE, PER DAY, FOR THE $ 325.74 $ 361.94 3/1/2020 12/31/9999 99478 SUBSEQUENT INTENSIVE CARE, PER DAY, FOR $ 127.90 $ 142.11 3/1/2020 12/31/9999 99479 SUBSEQUENT INTENSIVE CARE, PER DAY, FOR $ 116.07 $ 128.97 3/1/2020 12/31/9999 99480 SUBSEQUENT INTENSIVE CARE, PER DAY, FOR $ 111.80 $ 124.23 3/1/2020 12/31/9999 99492 1ST PSYC COLLAB CARE MGMT $ 91.78 $ 161.11 3/1/2020 12/31/9999 99493 SBSQ PSYC COLLAB CARE MGMT $ 82.98 $ 129.09 3/1/2020 12/31/9999 99494 1ST/SBSQ PSYC COLLAB CARE $ 44.28 $ 66.80 3/1/2020 12/31/9999 99499* Child Medical Evaluation(CME) only $ 575.00 $ 575.00 1/1/2019 12/31/9999

Notes: *-All other “Unlisted E & M Services” billed under 99499 will be mannually priced based on the type of service.