University Physicians Group: Prices of Provider Services

CPT Unit Base Service Procedure Modifier Code ype Current Procedural Terminology (CPT) Price Price T 00100 PR ANESTH,SALIVARY GLAND W/BX 1.00 5.00 Anesthesia 00102 PR ANESTH,CLEFT LIP REPAIR 1.00 6.00 Anesthesia 00103 PR ANESTH,BLEPHAROPLASTY 1.00 5.00 Anesthesia 00104 ANESTH,ELECTROSHOCK/ ECT 1.00 4.00 Anesthesia 00120 ANESTH,EAR SURGERY 1.00 5.00 Anesthesia 00124 ANESTH,EAR EXAM 1.00 4.00 Anesthesia 00126 PR ANESTH,TYMPANOTOMY 1.00 4.00 Anesthesia 00140 PR ANESTH,PROCEDURES ON EYE 1.00 5.00 Anesthesia 00142 ANESTH, LENS SURGERY 1.00 4.00 Anesthesia 00144 PR ANESTH,CORNEAL TRANSPLANT 1.00 6.00 Anesthesia 00145 ANESTH, VITREORETINAL SURG 1.00 6.00 Anesthesia 00147 PR ANESTH,IRIDECTOMY 1.00 4.00 Anesthesia 00148 ANESTH,EYE EXAM 1.00 4.00 Anesthesia 00160 PR ANESTH,NOSE,SINUS SURGERY 1.00 5.00 Anesthesia 00162 PR ANESTH,NOSE,RADICAL SINUS 1.00 7.00 Anesthesia SURGERY 00164 PR ANESTH,BIOPSY OF NOSE 1.00 4.00 Anesthesia 00170 PR ANESTH,PROCEDURE ON MOUTH 1.00 5.00 Anesthesia 00172 PR ANESTH,CLEFT PALATE REPAIR 1.00 6.00 Anesthesia 00174 PR ANESTH,EXCIS RETROPHARYNG 1.00 6.00 Anesthesia 00176 PR ANESTH,PHARYNX SURG 1.00 7.00 Anesthesia 00190 PR ANESTH,FACIAL BONE SURGERY 1.00 5.00 Anesthesia 00192 PR ANESTH,RADICAL FACIAL BONE 1.00 7.00 Anesthesia SURGERY 00210 PR ANESTH,OPEN HEAD SURGERY 1.00 11.00 Anesthesia 00211 PR ANESTH, INTRACRANIAL 1.00 10.00 Anesthesia HEMATOMA EVACUATION 00212 PR ANESTH,SKULL SURG SUBDUR 1.00 5.00 Anesthesia 00214 PR ANESTH,SKULL SURG BURR 1.00 9.00 Anesthesia 00215 PR ANESTH, CRANIOPLASTY 1.00 9.00 Anesthesia 00216 PR ANESTH,HEAD VESSEL 1.00 15.00 Anesthesia 00218 PR ANESTH,SPECIAL HEAD 1.00 13.00 Anesthesia 00220 PR ANESTH,INTRACRAN PROC; CSF 1.00 10.00 Anesthesia SHUNT PROC 00222 PR ANESTH,INTRACRAN NERVE 1.00 6.00 Anesthesia COAGULATN 00300 PR ANESTH,SKIN SURG HEAD/NECK 1.00 5.00 Anesthesia 00320 PR ANESTH,NECK ORG PROC; NOS, 1.00 6.00 Anesthesia AGE 1 YR/OLD 00322 PR ANESTH,NEEDLE BX THYROID 1.00 3.00 Anesthesia 00326 PR ANESTH,LARYNX/TRACH PROC; 1.00 7.00 Anesthesia CHILDREN <1 YR 00350 PR ANESTH,NECK VESSEL 1.00 10.00 Anesthesia 00352 PR ANESTH,NECK VESSEL SURG 1.00 5.00 Anesthesia SIMPL LIGAT 00400 PR ANESTH,SKIN SURG 1.00 3.00 Anesthesia 00402 PR ANESTH,SURG BREAST 1.00 5.00 Anesthesia RECONSTRUCTIVE 00404 PR ANESTH,SURG BREAST RAD 1.00 5.00 Anesthesia 00406 PR ANESTH,SURG BREAST RAD 1.00 13.00 Anesthesia MAST W NODE 00410 PR ANESTH,CORRECT HEART 1.00 4.00 Anesthesia 0042T CEREBRAL PERFUS ANALYSIS, CT 200.00 W/CONTRAST 00450 PR ANESTH,SURG 1.00 5.00 Anesthesia 00454 PR ANESTH,CLAVICLE BIOPSY 1.00 3.00 Anesthesia 00470 PR ANESTH,PARTIAL RIB RESECTN 1.00 6.00 Anesthesia 00472 PR ANESTH,CHEST WALL REPAIR 1.00 10.00 Anesthesia 00474 PR ANESTH,CHEST WALL REPAIR 1.00 13.00 Anesthesia EXTENSIVE 00500 PR ANESTH,ESOPHAGEAL SURGERY 1.00 15.00 Anesthesia 00520 PR ANESTH,CHEST PROC 1.00 6.00 Anesthesia 00522 PR ANESTH,CHEST PLEURAL 1.00 4.00 Anesthesia 00524 PR ANESTH,CHEST DRAINAGE 1.00 4.00 Anesthesia 00528 PR ANESTH,MEDIASTINOSCOPY 1.00 8.00 Anesthesia 00529 PR ANESTH, CHEST PARTITION VIEW 1.00 11.00 Anesthesia 00530 PR ANESTH,PACEMAKER INSERTION 1.00 4.00 Anesthesia 00532 PR ANESTH,CENTRL VASCULAR 1.00 4.00 Anesthesia 00534 PR ANESTH,CARDIOVERTER/DEFIB 1.00 7.00 Anesthesia 00537 PR ANESTH,CARD ELECTROPHYS 1.00 7.00 Anesthesia 00539 PR ANESTH,TRACHEOBRONCHIAL 1.00 18.00 Anesthesia RECONSTRUCT 00540 PR ANESTH,CHEST 1.00 12.00 Anesthesia SURGERY,THORACOTOMY 00541 PR ANESTH,THORACOTOMY PROC, 1.00 15.00 Anesthesia W/1 LUNG VENT 00542 PR ANESTH,CHEST DECORTICATION 1.00 15.00 Anesthesia 00546 PR ANESTH,LUNG 1.00 15.00 Anesthesia 00548 PR ANESTH,TRACH,BRONCHI 1.00 17.00 Anesthesia INTRATHOR SURG 0054T BONE SURGERY USING COMPUTER 640.00 ASSIST, FLURO GUIDED 00550 PR ANESTH,STERNAL 1.00 10.00 Anesthesia 00560 PR ANESTH,OPEN HEART; W/O 1.00 15.00 Anesthesia PUMP OXYEGENATOR 00561 PR ANESTH, HEART SURG < AGE 1 1.00 25.00 Anesthesia 00562 PR ANESTH,OPEN HEART 1.00 20.00 Anesthesia 00563 PR ANESTH,OPEN 1.00 25.00 Anesthesia HEART,PUMP+HYPOTHERM 00566 PR ANESTH,DIRECT CABG W/O 1.00 25.00 Anesthesia PUMP OXYGENATOR 00567 PR ANESTH, DIRECT CABG W PUMP 1.00 18.00 Anesthesia OXYGENATOR 00580 PR ANESTH,HEART/LUNG 1.00 20.00 Anesthesia 00600 PR ANESTH,CERV SPINE,CORD 1.00 10.00 Anesthesia 00604 PR ANESTH,CERV SPINE, SITTING 1.00 13.00 Anesthesia 00620 PR ANESTH,THOR SPINE,CORD 1.00 10.00 Anesthesia 00630 PR ANESTH,LUMBAR SPINE,CORD 1.00 8.00 Anesthesia SURGERY 00632 PR ANESTH,LUMBAR 1.00 7.00 Anesthesia 00635 PR ANESTH,LUMBAR PUNCTURE 1.00 4.00 Anesthesia 00640 PR ANESTH,CLOSED 1.00 3.00 Anesthesia MANIPULATION, SPINE C/T/L 00670 PR ANESTH,EXTENSIVE SPINE,CORD 1.00 13.00 Anesthesia PROCED 00700 PR ANESTH,ABD WALL,UPER 1.00 4.00 Anesthesia 00702 PR ANESTH,FOR LIVER BIOPSY 1.00 4.00 Anesthesia 0071T U/S LEIOMYOMATA ABLATE <200 CC 2500.00 00730 PR ANESTH,ABD WALL,UPPER 1.00 5.00 Anesthesia 00731 PR ANESTHESIA UPPER GI 1.00 5.00 Anesthesia ENDOSCOPIC PX NOS 00732 PR ANESTHESIA UPPER GI 1.00 6.00 Anesthesia ENDOSCOPIC PX ERCP 00740 PR ANESTH,UGI ENDOSCOPY 1.00 5.00 Anesthesia 00750 PR ANESTH,REPAIR UPPER ABD 1.00 4.00 Anesthesia HERNIA NOS 00752 PR ANESTH,REPAIR UP HERNIA 1.00 6.00 Anesthesia LUMBAR/VENTR 00754 PR ANESTH,REPAIR UP HERNIA 1.00 7.00 Anesthesia OMPHALOCELE 00756 PR ANESTH,REPAIR UP HERNIA 1.00 7.00 Anesthesia 0075T PR TCAT PLMT XTRC VRT CRTD 26 2136.00 STENT RS&I PRQ 1ST VSL 00770 PR ANESTH,MAJOR ABD BLOOD 1.00 15.00 Anesthesia VESSEL REPAIR 00790 PR ANESTH,SURG UPPER ABDOMEN 1.00 7.00 Anesthesia 00792 PR ANESTH,PARTIAL LIVER 1.00 13.00 Anesthesia 00794 PR ANESTH,PANCREAS REMOVAL 1.00 8.00 Anesthesia 00796 PR ANESTH,FOR LIVER 1.00 30.00 Anesthesia 00797 PR ANESTH,GASTRIC RESTRICT, 1.00 11.00 Anesthesia MORBID OBESITY 00800 PR ANESTH,ABD WALL,LOWER 1.00 4.00 Anesthesia 00802 PR ANESTH,FAT LAYER REMOVAL 1.00 5.00 Anesthesia 00810 PR ANESTH,INTESTINE,SCOPE,LOW 1.00 5.00 Anesthesia 00811 PR ANESTHESIA LOWER INTST 1.00 4.00 Anesthesia ENDOSCOPIC PX NOS 00812 PR ANESTHESIA LOWER INTST 1.00 3.00 Anesthesia ENDOSCOPIC PX SCR COLSC 00813 PR ANESTHESIA COMBINED 1.00 5.00 Anesthesia UPPER&LOWER GI ENDOSCOPIC PX 00820 PR ANESTH,ABD WALL,LOWER 1.00 5.00 Anesthesia 00830 PR ANESTH,REPAIR LO ABD HERNIA 1.00 4.00 Anesthesia 00832 PR ANESTH,REPAIR LO HERNIA 1.00 6.00 Anesthesia VENTR/INCIS 00834 PR ANESTH,REPAIR LO ABD HERNIA 1.00 5.00 Anesthesia NOS, < 1 YR 00836 PR ANESTH,REP LO ABD HERN NOS, 1.00 6.00 Anesthesia PREM <50 WKS 00840 PR ANESTH,SURG LOWER 1.00 6.00 Anesthesia 00842 PR ANESTH,AMNIOCENTESIS 1.00 4.00 Anesthesia 00844 PR ANESTH,ABD-PERINEAL 1.00 7.00 Anesthesia 00846 PR ANESTH,RADICAL 1.00 8.00 Anesthesia 00848 PR ANESTH,PELVIC EXENTERATION 1.00 8.00 Anesthesia 00851 PR ANESTH,TUBAL 1.00 6.00 Anesthesia 00860 PR ANESTH,SURG LOW 1.00 6.00 Anesthesia ABD,EXTRAPERINTONEAL 00862 PR ANESTH,KIDNEY,PROX URETER 1.00 7.00 Anesthesia 00864 PR ANESTH,REMOVAL OF BLADDER 1.00 8.00 Anesthesia 00865 PR ANESTH,REMOVAL OF 1.00 7.00 Anesthesia 00866 PR ANESTH,REMOVAL OF ADRENAL 1.00 10.00 Anesthesia 00868 PR ANESTH,KIDNEY TRANSPLANT 1.00 10.00 Anesthesia 00870 PR ANESTH,BLADDER STONE SURG 1.00 5.00 Anesthesia 00872 PR ANESTH,KID STONE 1.00 7.00 Anesthesia DESTRUCT+WATER BATH 00873 PR ANESTH,KID STONE DESTRUCT 1.00 5.00 Anesthesia 00880 PR ANESTH,MAJOR LOW ABD 1.00 15.00 Anesthesia 00882 PR ANESTH,INFER VENA CAVAL 1.00 10.00 Anesthesia 00902 PR ANESTH,ANORECTAL SURGERY 1.00 5.00 Anesthesia 00904 PR ANESTH,RADICAL PERINEAL 1.00 7.00 Anesthesia 00906 PR ANESTH,REMOVAL OF VULVA 1.00 4.00 Anesthesia 00908 PR ANESTH,PERINEAL REMV OF 1.00 6.00 Anesthesia 00910 PR ANESTH,TRANSURETHRAL 1.00 3.00 Anesthesia 00912 PR ANESTH,XURETHRAL BLADDER 1.00 5.00 Anesthesia TUMOR SURG 00914 PR ANESTH,XURETHRAL REMOVAL 1.00 5.00 Anesthesia OF PROSTATE 00916 PR ANESTH,POST XURETHRAL 1.00 5.00 Anesthesia BLEEDING CONTR 00918 PR ANESTH,STONE RMVOVAL 1.00 5.00 Anesthesia 00920 PR ANESTH,MALE GENITALIA 1.00 3.00 Anesthesia 00921 PR ANESTH,VASECTOMY, 1.00 3.00 Anesthesia 00922 PR ANESTH,SPERM DUCT SURGERY 1.00 6.00 Anesthesia 00924 PR ANESTH,TESTIS EXPLORATION 1.00 4.00 Anesthesia 00926 PR ANESTH,RADICAL REMV 1.00 4.00 Anesthesia TESTIS,INGUINAL 00928 PR ANESTH,RADICAL REMV 1.00 6.00 Anesthesia TESTIS,ABDOMINAL 00930 PR ANESTH,TESTIS SUSPENSION 1.00 4.00 Anesthesia 00932 PR ANESTH,AMPUTATION OF PENIS 1.00 4.00 Anesthesia 00934 PR ANESTH,PENIS,NODES REMOVAL 1.00 6.00 Anesthesia 00936 PR ANESTH,PENIS,COMBO NODES 1.00 8.00 Anesthesia REMOVAL 00938 PR ANESTH,INSERT PENIS 1.00 4.00 Anesthesia 00940 PR ANESTH,VAGINAL PROCEDURES 1.00 3.00 Anesthesia 00942 PR 1.00 4.00 Anesthesia ANESTH,COLPOT,VAGINECT,COLPO RR,URETH PRO 00944 PR ANESTH,VAGINAL 1.00 6.00 Anesthesia 00948 PR ANESTH,REPAIR OF CERVIX 1.00 4.00 Anesthesia 00950 PR ANESTH,VAGINAL ENDOSCOPY 1.00 5.00 Anesthesia 00952 PR ANESTH,HYSTEROSCOPY/VAG 1.00 4.00 Anesthesia 01112 PR ANESTH,BONE MARROW ASP/BX 1.00 5.00 Anesthesia ILIAC CRST 01120 PR ANESTH,BONY PELVIS SURGERY 1.00 6.00 Anesthesia 01130 PR ANESTH,BODY CAST 1.00 3.00 Anesthesia 01140 PR ANESTH,AMPUTATION AT PELVIS 1.00 15.00 Anesthesia 01150 PR ANESTH,RADICAL PELVIC TUMOR 1.00 10.00 Anesthesia SURGERY 01160 PR ANESTH,PUBIS,SACROILIAC 1.00 4.00 Anesthesia CLOSED PROC 01170 PR ANESTH,PUBIS,SACROILIAC 1.00 8.00 Anesthesia 01173 PR ANESTH, FX REPAIR, PELVIS 1.00 12.00 Anesthesia 01180 PR ANESTH,PELV NERV REMOVAL 1.00 3.00 Anesthesia EXTRAPELV 01190 PR ANESTH,PELV NERV REMOVAL 1.00 4.00 Anesthesia INTRAPELV 01200 PR ANESTH,HIP JOINT PROCEDURE 1.00 4.00 Anesthesia 01202 PR ANESTH,ARTHROSCOPY OF HIP 1.00 4.00 Anesthesia 01210 PR ANESTH,HIP JOINT SURGERY 1.00 6.00 Anesthesia 01212 PR ANESTH,HIP DISARTICULATION 1.00 10.00 Anesthesia 01214 PR ANESTH,TOTAL HIP 1.00 8.00 Anesthesia 01215 PR ANESTH,REVISE TOTAL HIP 1.00 10.00 Anesthesia ARTHROPLASTY 01220 PR ANESTH,CLOSED PROC UPPER 1.00 4.00 Anesthesia 2/3 FEMUR 01230 PR ANESTH,OPEN PROC UPPER 2/3 1.00 6.00 Anesthesia 01232 PR ANESTH,AMPUTATION OF FEMUR 1.00 5.00 Anesthesia 01234 PR ANESTH,RADICAL FEMUR SURG 1.00 8.00 Anesthesia 01250 PR ANESTH,UPPER LEG SURGERY 1.00 4.00 Anesthesia 01260 PR ANESTH,UPPER LEG VEINS 1.00 3.00 Anesthesia 0126T CAROTID INT-MEDIA THICKNESS 55.00 EVAL FOR ATHERSCLER 01270 PR ANESTH,THIGH ARTERIES SURG 1.00 8.00 Anesthesia 01272 PR ANESTH,FEMORAL ARTERY 1.00 4.00 Anesthesia 01274 PR ANESTH,FEMORAL 1.00 6.00 Anesthesia 01320 PR ANESTH,KNEE AREA SURGERY 1.00 4.00 Anesthesia 01340 PR ANESTH,LOWER 1/3 1.00 4.00 Anesthesia FEMUR,CLOSED PROC 01360 PR ANESTH,LOWER 1/3 1.00 5.00 Anesthesia 01380 PR ANESTH,KNEE JOINT,CLOSED 1.00 3.00 Anesthesia PROCEDURE 01382 PR ANESTH,DX ARTHROSCOPIC 1.00 3.00 Anesthesia PROC KNEE JOINT 01390 PR ANESTH,UPPER LEG,CLOSED 1.00 3.00 Anesthesia PROCEDURE 01392 PR ANESTH,UPPER LEG,OPEN 1.00 4.00 Anesthesia 01400 PR ANESTH,KNEE JOINT; NOS 1.00 4.00 Anesthesia 01402 PR ANESTH,TOTAL KNEE 1.00 7.00 Anesthesia 01404 PR ANESTH,AMPUTATION AT KNEE 1.00 5.00 Anesthesia 01420 PR ANESTH,KNEE JOINT CASTING 1.00 3.00 Anesthesia 01430 PR ANESTH,KNEE VEINS SURGERY 1.00 3.00 Anesthesia 01432 PR ANESTH,KNEE AV FISTULA 1.00 6.00 Anesthesia VESSEL SURG 01440 PR ANESTH,KNEE ARTERIES SURG 1.00 8.00 Anesthesia 01442 PR ANESTH,POPLIT 1.00 8.00 Anesthesia THROMBOENDARTECTOMY 01444 PR ANESTH,POPLIT ARTERY 1.00 8.00 Anesthesia 01462 PR ANESTH,LOWER LEG,CLOSED 1.00 3.00 Anesthesia PROCEDURE 01464 PR ANESTH,ARTHROSCOP 1.00 3.00 Anesthesia PROC,ANKLE &/OR FOOT 01470 PR ANESTH,LOWER LEG,OPEN 1.00 3.00 Anesthesia 01472 PR ANESTH,ACHILLES TENDON 1.00 5.00 Anesthesia 01474 PR ANESTH,GASTROCNEMIUS 1.00 5.00 Anesthesia 01480 PR ANESTH,LOWER LEG BONE 1.00 3.00 Anesthesia 01482 PR ANESTH,RADICAL LEG 1.00 4.00 Anesthesia 01484 PR ANESTH,LOWER LEG BONE 1.00 4.00 Anesthesia 01486 PR ANESTH,ANKLE REPLACEMENT 1.00 7.00 Anesthesia 01490 PR ANESTH,LOWER LEG CASTING 1.00 3.00 Anesthesia 01500 PR ANESTH,LOWER LEG ARTERIES 1.00 8.00 Anesthesia 01502 PR ANESTH,LOWER LEG 1.00 6.00 Anesthesia 01520 PR ANESTH,LOWER LEG VEIN 1.00 3.00 Anesthesia 01522 PR ANESTH,LOWER LEG VEIN 1.00 5.00 Anesthesia THROMBECTOMY 0159T COMPUTER AIDED BREAST MRI 26 314.00 01610 PR ANESTH,SURGERY OF 1.00 5.00 Anesthesia 01620 PR ANESTH,SHOULDER,CLOSED 1.00 4.00 Anesthesia PROCEDURE 01622 PR ANESTH,DX ARTHROSC 1.00 4.00 Anesthesia PROC,SHOULDER JOINT 01630 PR ANESTH,SHOULDER JOINT,NOS 1.00 5.00 Anesthesia 01634 PR ANESTH,SHOULDER JOINT 1.00 9.00 Anesthesia 01636 PR ANESTH,FOREQUARTER AMPUT 1.00 15.00 Anesthesia 01638 PR ANESTH,SHOULDER 1.00 10.00 Anesthesia 01650 PR ANESTH,SHOULDER ARTERY 1.00 6.00 Anesthesia 01652 PR ANESTH,AXILLARY-BRACHIAL 1.00 10.00 Anesthesia ANEURYSM 01654 PR ANESTH,SHLDR VESSEL 1.00 8.00 Anesthesia SURG,BYPASS GRFT 01656 PR ANESTH,AXILL-FEM BYPASS 1.00 10.00 Anesthesia 01670 PR ANESTH,SHOULDER VEIN SURG 1.00 4.00 Anesthesia 01680 PR ANESTH,SHOULDER CASTING 1.00 3.00 Anesthesia 01682 PR ANESTH,SHOULDER SPICA 1.00 4.00 Anesthesia 01710 PR ANESTH,ELBOW AREA SURGERY 1.00 3.00 Anesthesia 01712 PR ANESTH,UPPERARM TENDON 1.00 5.00 Anesthesia 01714 PR ANESTH,UPPERARM TENDON 1.00 5.00 Anesthesia REVISN SURG 01716 PR ANESTH,BICEPS TENDON 1.00 5.00 Anesthesia 01730 PR ANESTH,ARM/ELBOW 1.00 3.00 Anesthesia BONES,CLOSED PROC 01732 PR ANESTH,DX ARTHROSCOPIC 1.00 3.00 Anesthesia PROC ELBOW JOINT 01740 PR ANESTH,ELBOW,NOS 1.00 4.00 Anesthesia 01742 PR ANESTH,HUMERUS SURGERY 1.00 5.00 Anesthesia 01744 PR ANESTH,HUMERUS REPAIR 1.00 5.00 Anesthesia 01756 PR ANESTH,RADICAL HUMERUS 1.00 6.00 Anesthesia 01758 PR ANESTH,HUMERAL LESION SURG 1.00 5.00 Anesthesia 01760 PR ANESTH,ELBOW REPLACEMENT 1.00 7.00 Anesthesia 01770 PR ANESTH,UPPERARM ARTERY 1.00 6.00 Anesthesia 01772 PR ANESTH,UPPERARM 1.00 6.00 Anesthesia 01780 PR ANESTH,UPPER ARM VEIN SURG 1.00 3.00 Anesthesia 01782 PR ANESTH,UPPER ARM VEIN 1.00 4.00 Anesthesia 01810 PR ANESTH,LOWER ARM SURGERY 1.00 3.00 Anesthesia 01820 PR ANESTH,FOREARM 1.00 3.00 Anesthesia BONES,CLOSED PROC 01829 PR ANESTH,DX ARTHROSCOPIC 1.00 3.00 Anesthesia PROC WRIST 01830 PR ANESTH,DISTAL RADIUS/ULNA 1.00 3.00 Anesthesia WRIST/HAND,NOS 01832 PR ANESTH,WRIST REPLACEMENT 1.00 6.00 Anesthesia 01840 PR ANESTH,LOWER ARM ARTERY 1.00 6.00 Anesthesia 01842 PR ANESTH,LOWER ARM 1.00 6.00 Anesthesia 01844 PR ANESTH,LOWER ARM,VASC 1.00 6.00 Anesthesia SHUNT SURG 0184T PR RECTAL TUMOR EXCISION, 2315.00 TRANSANAL ENDOSCOPIC 01850 PR ANESTH,LOWER ARM VEIN SURG 1.00 3.00 Anesthesia 01852 PR ANESTH,LOWER ARM VEIN 1.00 4.00 Anesthesia 01860 PR ANESTH,LOWER ARM CASTING 1.00 3.00 Anesthesia 01916 PR ANESTH,DX 1.00 5.00 Anesthesia ARTERIOGRAPHY/VENOGRAPHY 0191T PR ANT SEGMENT INSERTION 2100.00 DRAINAGE W/O RESERVOIR INT 01920 PR ANESTH,CARDIAC CATH 1.00 7.00 Anesthesia W/CORON ART & VENT 01922 PR ANESTH,CAT/MRI SCAN,RADIATN 1.00 7.00 Anesthesia THERAPY 01924 PR ANESTH,INTER RAD,ARTERIAL 1.00 5.00 Anesthesia 01925 ANESTH,INTER RAD, ARTERIAL, 1.00 7.00 Anesthesia CAROTID/CORONARY 01926 ANESTH,INTER RAD,ARTERIAL, 1.00 8.00 Anesthesia INTRACRA/INTRACAR/AORT 01930 PR ANESTH,INTER 1.00 5.00 Anesthesia RAD,VENOUS/LYMPH SYS,NOS 01931 ANESTH,INTER 1.00 7.00 Anesthesia RAD,VENOUS/LYMPH,INTRAHEPAT/P ORTAL CIRC 01932 ANESTH,INTER 1.00 6.00 Anesthesia RAD,VENOUS/LYMPH,INTRATHORACI C/JUGULAR 01933 ANESTH,INTER 1.00 7.00 Anesthesia RAD,VENOUS/LYMPH,INTRACRANIAL 01935 PR ANESTH,PERC IMAGE GUIDE 1.00 5.00 Anesthesia SPINAL PROC, DIAG 01936 PR ANESTH,PERC IMAGE GUIDE 1.00 5.00 Anesthesia SPINAL PROC, THER 01951 PR ANESTH,BURN TX, <4% TBSA 1.00 3.00 Anesthesia 01952 PR ANESTH,BURN TX, 4-9% TBSA 1.00 5.00 Anesthesia 01958 PR ANESTH, ANTEPARTUM MANIPUL 1.00 5.00 Anesthesia 01960 PR ANESTH,VAGINAL DELIVERY 1 5 Anesthesia 01961 PR ANESTH,CESAREAN DELIVERY 1.00 7.00 Anesthesia 01962 PR ANESTH,URG HYSTERECTOMY 1.00 8.00 Anesthesia FOL DELIVERY 01963 PR ANESTH,CESAREAN HYST W/O 1.00 8.00 Anesthesia LABOR ANAL/ANES 01965 PR ANESTH, INCOMP/MISSED AB 1.00 4.00 Anesthesia 01966 PR ANESTH, INDUCED AB 1.00 4.00 Anesthesia 01967 ANESTH, NEURAXIAL LABOR, PLAN 2500 01968 ANESTH,CES DEL AFTER NEURAXIAL 1.00 2.00 Anesthesia ANESTH 01969 PR ANESTH,CES HYST FOL 1.00 5.00 Anesthesia NEURAXIAL ANAL/ANES 01990 PR PHYS SUPPORT,BRAIN-DEAD 1.00 7.00 Anesthesia ORGAN DONOR 01991 PR ANES DX/THER NRV BLK/NJX 1.00 3.00 Anesthesia OTH/THN PRONE POS 01992 PR ANES DX/THER NERVE 1.00 5.00 Anesthesia BLOCK/INJECTION PRONE POS 01996 PR DAILY MGMT,EPIDUR/SUBARACH 285 CONT DRUG ADM 01999 PR UNLISTED ANESTH PROCEDURE 1.00 3.00 Anesthesia 0232T PR INJECT PLATELET RICH PLASMA 187.00 W/IMG HARVEST/PREPARATOIN 0234T PR TRANSLUMINAL PERIPHERAL 2012.00 ATHERECTOMY, RENAL ARTERY 0237T PR TRANSLUMINAL PERIPHERAL 1868.00 ATHERECTOMY, BRACHIOCEPHAL AND BRANCHES, EACH 0238T PR TRANSLUMINAL PERIPHERAL 1877.00 ATHERECTOMY, ILIAC ARTERY, 0253T PR INSERT ANT SGM DRAINAGE DEV 2153.00 W/O RESERVR INT APPR 0254T PR EVASC RPR ILAC ART BIFUR 3412 ENDGRFT CATHJ RS&I UNI 0281T PR PERC TRANSCTH CLOSR LT 3574.00 ATRIAL APPNDGE IMPLNT S&I 0296T PR EXT ECG > 48HR TO 21 DAY 269 RCRD W/CONECT INTL RCRD 0298T PR EXT ECG > 48HR TO 21 DAY 133 REVIEW AND INTERPRETATN 0346T PR ULTRASOUND ELASTOGRAPHY 276.00 0375T PR TOTAL DISC ARTHRP ANT APPR 8709.00 W/DISCECTOMY CRV 3+ 0376T PR ANT SEGMENT INSERT DRAIN 2568.00 W/O RESERVOIR EA ADDL 0379T PR VISUAL FIELD ASSESSMENT 109.00 TECH SUPPORT W/INSTRUCT 0387T PR TRANSCATH INSERT OR 1124.00 REPLACE LEADLESS PM VENTR 0389T PR PROG DEVICE EVAL IN PERSON 115.00 LEADLESS PM SYSTEM 0389T PR PROG DEVICE EVAL IN PERSON 26 115.00 LEADLESS PM SYSTEM 0391T PR INTERROG DEVICE EVAL IN 87.00 PERSON LEADLESS PM SYST 0397T PR ERCP WITH OPTICAL 1002.00 ENDOMICROSCOPY ADD ON 0398T PR MRGFUS STEREOTACTIC 5500.00 ABLATION LESION INTRACRANIAL 0399T PR MYOCARDIAL STRAIN IMAGING 513.00 QUAN ASSMT 0399T PR MYOCARDIAL STRAIN IMAGING 26 513.00 QUAN ASSMT 0438T PR TPRNL PLMT BIODEGRADABLE 764.00 MATRL PERIPROSTATIC 0449T PR INSJ AQUEOUS DRAIN DEV W/O 2033.00 EO RSVR INITIAL DEV 0466T PR INSRT CH WALL RESPIR 1235.00 ELTRD/RA & CONJ PULSE GEN 0474T PR CYPASS GLAUCOMA IMPLANT 2100.00 0482T PR ABSOLUTE QUAN MYOCARD BLD 26 179.00 FLO PET STRESS & REST 0483T PR TMVI W/PROSTHETIC VALVE 5681.00 PERCUTANEOUS APPROACH 0484T PR TMVI W/PROSTHETIC VALVE 8059.00 TRANSTHORACIC EXPOSURE 0494T PR PREP & CANNULJ CDVR DON 812.00 LNG ORGN PRFUJ SYS 0495T PR INIT & MNTR CDVR DON LNG 7000.00 ORGN PRFUJ SYS 1ST 2 HR 0496T PR MNTR CDVR DON LNG ORGN 3500.00 PRFUJ SYS EA ADDL HR 0497T PR XTRNL PT ACT ECG W/O ATTN 24.00 MNTR IN-OFFICE CONN 0498T PR XTRNL PT ACT ECG W/O ATTN 65.00 MNTR R&I PR 30 DAYS 0499T PR CYSTO W/DIL & URTL RX DEL 967.00 F/URTL STRIX/STENOSIS 0504T PR COR FFR CTA DATA REVIEW 282 W/INTERPJ & FINAL REPORT 10021 PR FINE NEEDLE ASP;W/O IMAGING 308.00 GUIDANCE 10022 PR FINE NEEDLE ASP;W/IMAGING 328.00 GUIDANCE 10030 PR IMAGE-GUIDED CATHETER FLUID 1938.00 COLLECTION DRAINAGE 10035 PR PERQ SFT TISS LOC DEVICE 1359.00 PLMT 1ST LES W/GDNCE 10040 PR ACNE SURGERY OF SKIN 253.00 10060 PR DRAIN SKIN ABSCESS SIMPLE 286.00 10061 PR DRAIN SKIN ABSCESS COMPLIC 507.00 10080 PR DRAIN PILONIDAL CYST SIMPL 452.00 10081 PR DRAIN PILONIDAL CYST COMPLIC 665.00 10120 PR REMOVE FOREIGN BODY SIMPLE 364.00 10121 PR REMOVE FOREIGN BODY 687.00 10140 PR DRAINAGE OF HEMATOMA/FLUID 410.00 10160 PR PUNCTURE DRAINAGE OF 326.00 10180 PR COMPLEX DRAINAGE, WOUND 617.00 11000 PR DEBRIDEMENT, INFECTED SKIN, 131.00 UP TO 10% BSA 11004 PR DEBRIDE NECROTIC SKIN/ 1433.00 TISSUE, GENIT & PERINM 11005 PR DEBRIDE NECROTIC SKIN/ 1940.00 TISSUE, ABD WALL 11006 PR DEBRIDE NECROT SKIN/ TISS, 1739.00 GENIT,PERI, ADB WALL 11008 REMOVE MESH FROM ABD WALL 683.00 FOR INFECTION 11010 PR DEBRIDE ASSOC OPEN 1412.00 FX/DISLOC SKIN/SUBQ 11011 PR DEBRIDE ASSOC OPEN 1676.00 FX/DISLOC SKIN/MUSCLE 11012 PR DEBRIDE ASSOC OPEN FX/DISLO 2446.00 SKIN/MUS/BONE 11042 PR DEBRIDEMENT, SKIN, SUB-Q 395.00 TISSUE,=<20 SQ CM 11043 PR DEBRIDEMENT, SKIN, SUB-Q 575.00 TISSUE,MUSCLE,=<20 SQ CM 11044 PR DEBRIDEMENT, SKIN, SUB-Q 981.00 TISSUE,MUSCLE,BONE,=<20 SQ CM 11045 PR DEBRIDEMENT, SKIN, SUB-Q 102.00 TISSUE,EACH ADD 20 SQ CM 11046 PR DEBRIDEMENT, SKIN, SUB-Q 183.00 TISSUE,MUSCLE,EACH ADD 20 SQ 11047 PR DEBRIDEMENT, SKIN, SUB-Q 313.00 TISSUE,MUSCLE,BONE,EACH ADD 20 11055 PR TRIM HYPERKERATOTIC SKIN 119.00 LESION, ONE 11056 TRIM BENIGN HYPERKERATOTIC 141.00 SKIN LESION,2-4 11057 TRIM BENIGN HYPERKERATOTIC 167.00 SKIN LESION,>4 11100 PR BIOPSY OF SKIN LESION 239.00 11101 PR BIOPSY, EACH ADDED LESION 74.00 11200 PR REMOVAL OF SKIN TAGS, UP TO 226.00 11201 PR REMOVAL OF SKIN TAGS, EACH 56.00 11300 PR SHAV SKIN LES <5MM 225.00 11301 PR SHAV SKIN LES 6-10MM 276.00 11302 PR SHAV SKIN LES 11-20MM 326.00 TRUNK,ARM,LEG 11303 PR SHAV SKIN LES >21MM 358.00 11305 PR SHAV SKIN LES <5MM REMAINDR 226.00 11306 PR SHAV SKIN LES 6-10MM 279.00 REMAINDR BODY 11307 PR SHAV SKIN LES 11-20MM 330.00 REMAINDR BODY 11308 PR SHAV SKIN LES >21MM 350.00 11310 PR SHAV SKIN LES <5MM 262.00 11311 PR SHAV SKIN LES 6-10MM 255.00 11312 PR SHAV SKIN LES 11-20MM 398.00 11313 PR SHAV SKIN LES >21MM 443.00 11400 PR EXC SKIN BENIG <5MM 285.00 11401 PR EXC SKIN BENIG 0.6-1CM 342.00 TRUNK,ARM,LEG 11402 PR EXC SKIN BENIG 1.1-2CM 380.00 TRUNK,ARM,LEG 11403 PR EXC SKIN BENIG 2.1-3CM 475.00 TRUNK,ARM,LEG 11404 PR EXC SKIN BENIG 3.1-4CM 528.00 TRUNK,ARM,LEG 11406 PR EXC SKIN BENIG >4CM 764.00 11420 PR EXC SKIN BENIG <5MM 307.00 11421 PR EXC SKIN BENIG 0.6-1CM 361.00 REMAINDR BODY 11422 PR EXC SKIN BENIG 1.1-2CM 401.00 REMAINDR BODY 11423 PR EXC SKIN BENIG 2.1-3CM 462.00 REMAINDR BODY 11424 PR EXC SKIN BENIG 3.1-4CM 530.00 REMAINDR BODY 11426 PR EXC SKIN BENIG >4CM 682.00 11440 PR EXC SKIN BENIG <5MM 334.00 11441 PR EXC SKIN BENIG 0.6-1CM 395.00 11442 PR EXC SKIN BENIG 1.1-2CM 455.00 11443 PR EXC SKIN BENIG 2.1-3CM 543.00 11444 PR EXC SKIN BENIG 3.1-4CM 1086.00 11446 PR EXC SKIN BENIG >4CM 807.00 11450 PR EXC SWEAT GLAND LESN 810.00 11451 PR EXC SWEAT GLAND LESN 989.00 11462 PR EXC SWEAT GLAND LESN 900.00 11463 PR EXC SWEAT GLAND LESN 1192.00 INGUIN,COMPLX 11470 PR EXC SWEAT GLAND LESN 985.00 PERINEAL,SIMPL 1158F PR ADVANCE CARE PLANNING 0.00 DISCUSS DOCUMENTED IN MEDICAL 11600 PR EXC SKIN MALIG <5MM 466.00 11601 PR EXC SKIN MALIG 0.6-1CM 523.00 TRUNK,ARM,LEG 11602 PR EXC SKIN MALIG 1.1-2CM 568.00 TRUNK,ARM,LEG 11603 PR EXC SKIN MALIG 2.1-3CM 645.00 TRUNK,ARM,LEG 11604 PR EXC SKIN MALIG 3.1-4CM 718.00 TRUNK,ARM,LEG 11606 PR EXC SKIN MALIG >4CM 1095.00 11620 PR EXC SKIN MALIG <5MM 360.00 11621 PR EXC SKIN MALIG 0.6-1CM 527.00 REMAINDR BODY 11622 PR EXC SKIN MALIG 1.1-2CM 587.00 REMAINDR BODY 11623 PR EXC SKIN MALIG 2.1-3CM 735.00 REMAINDR BODY 11624 PR EXC SKIN MALIG 3.1-4CM 829.00 REMAINDR BODY 11626 PR EXC SKIN MALIG >4CM 982.00 11640 PR EXC SKIN MALIG <5MM 485.00 11641 PR EXC SKIN MALIG 0.6-1CM 545.00 11642 PR EXC SKIN MALIG 1.1-2CM 621.00 11643 PR EXC SKIN MALIG 2.1-3CM 681.00 11644 PR EXC SKIN MALIG 3.1-4CM 1189.00 11646 PR EXC SKIN MALIG >4CM 1225.00 11719 PR TRIM NAIL(S) 52.00 11720 PR DEBRIDEMENT OF NAIL(S), 1-5 75.00 11721 PR DEBRIDEMENT OF NAILS, 6 OR 103.00 11730 PR REMOVAL OF NAIL PLATE 240.00 11732 PR REMOVE ADDITIONAL NAIL 89.00 11740 PR DRAIN BLOOD FROM UNDER NAIL 123.00 11750 PR REMOVAL OF NAIL BED 529.00 11752 PR REMOVE NAIL BED/FINGER TIP 680.00 11755 PR BIOPSY, NAIL UNIT (SEP PROC) 309.00 11760 PR RECONSTRUC OF NAIL BED 539.00 11762 PR RECONSTRUC OF NAIL BED W 684.00 11765 PR EXCISION OF NAIL FOLD, TOE 405.00 11770 PR REMV PILONIDAL LESION SIMPLE 694.00 11771 PR REMV PILONIDAL LESION 1112.00 11772 PR REMV PILONIDAL LESION 1738.00 11900 INJECTION INTO SKIN LESIONS, UP 139.00 11901 INJECTION INTO SKIN LESIONS, 8 OR 174.00 11920 PR CORRECT SKIN COLR DEFCT 495.00 11950 PR FILL CONTOUR DEFCT <1CC 195.00 11951 PR FILL CONTOUR DEFCT 1.1-5CC 251.00 11952 PR FILL CONTOUR DEFCT 5.1-10CC 330.00 11954 PR FILL CONTOUR DEFCT >10CC 605.00 11960 PR INSERT TISSUE EXPANDER(S) 2415.00 11970 PR REPLACE TISSUE EXPANDER 2680.00 11971 PR REMOVE TISSUE EXPANDER(S) 1029.00 11976 PR REMOVAL OF CONTRACEPTIVE 341.00 11980 PR 244.00 11981 PR INSERTION DRUG IMPLANT 329.00 11982 PR REMOVAL DRUG IMPLANT 371.00 11983 PR REMOVAL W/ REINSERT DRUG 519.00 IMPLANT DEVICE 12001 PR REPR SUPERF WND BODY 282.00 12002 PR REPR SUP NPTERF WND BODY 300.00 12004 PR REPR SUPERF WND BODY 7.6- 351.00 12005 PR REPR SUPERF WND BODY 12.6- 538.00 12006 PR REPR SUPERF WND BODY 20.1- 537.00 12011 PR REPR SUPERF WND FACE 298.00 12013 PR REPR SUPERF WND FACE 2.6-5 327.00 12014 PR REPR SUPERF WND FACE 5.1-7.5 387.00 12015 PR REPR SUPERF WND FACE 7.6- 598.00 12016 PR REPR SUPERF WND FACE 12.6-20 709.00 12018 PR REPR SUPERF WND FACE >30CM 470.00 12020 PR CLOSURE SUPERF WND DEHIS 704.00 12021 PR CLOSURE SUPERF WND DEHIS W 327.00 PACKING 12031 PR LAYR CLOS WND 547.00 TRUNK,ARM,LEG <2.5 CM 12032 PR LAYR CLOS WND 698.00 TRUNK,ARM,LEG 2.6-7.5 CM 12034 PR LAYR CLOS WND 714.00 TRUNK,ARM,LEG 7.6-12.5 CM 12035 PR LAYR CLOS WND 807.00 TRUNK,ARM,LEG 12.6-20 CM 12036 PR LAYR CLOS WND 906.00 TRUNK,ARM,LEG 20.1-30 CM 12037 PR LAYR CLOS WND 1018.00 TRUNK,ARM,LEG >30 CM 12041 PR LAYR CLOS WND REST BODY 576.00 12042 PR LAYR CLOS WND REST BODY 2.6- 660.00 12044 PR LAYR CLOS WND REST BODY 7.6- 599.00 12045 PR LAYR CLOS WND REST BODY 763.00 12046 PR LAYR CLOS WND REST BODY 1189.00 12047 PR LAYR CLOS WND REST BODY >30 1375.00 12051 PR LAYR CLOS WND FACE,FACIAL 625.00 12052 PR LAYR CLOS WND FACE,FACIAL 673.00 12053 PR LAYR CLOS WND FACE,FACIAL 779.00 5.1-7.5 CM 12054 PR LAYR CLOS WND FACE,FACIAL 873.00 7.6-12.5 CM 12055 PR LAYR CLOS WND FACE,FACIAL 1805.00 12.6-20 CM 12056 PR LAYR CLOS WND FACE,FACIAL 1325.00 20.1-30 CM 13100 PR REPR CMPL WND TRUNK 1.1- 671.00 13101 PR REPR CMPL WND TRUNK 2.6- 993.00 13102 PR REP,SKIN,TRUNK,CMPLX,+5CM/< 400.00 13120 PR REPR CMPL WND SCALP,EXTR 697.00 13121 PR REPR CMPL WND SCALP,EXTR 1006.00 13122 PR REP,SKIN,SCALP/EXTREM+5CM/< 600.00 13131 PR REPR CMPL WND 967.00 HEAD,FAC,HAND 1.1-2.5 13132 PR REPR CMPL WND 1315.00 HEAD,FAC,HAND 2.6-7.5 13133 PR 800.00 13151 PR REPR CMPL WND LID,NOS,EAR 963.00 13152 PR REPR CMPL WND LID,NOS,EAR 1271.00 13153 PR REP,EYELID,NOSE,EAR,LIP+5CM 636.00 13160 PR SECD CLOS SURG WND 2169.00 14000 PR ADJ TISS XFER TRUNK <10SQCM 1311.00 14001 PR ADJ TISS XFER TRUNK 10.1-30 1710.00 14020 PR ADJ TISS XFER SCALP,EXTREM 1516.00 <10SQCM 14021 PR ADJ TISS XFER SCALP,EXTREM 2190.00 14040 PR ADJ TISS XFER HEAD,FAC,HAND 1837.00 <10SQCM 14041 PR ADJ TISS XFER HEAD,FAC,HAND 2748.00 14060 PR ADJ TISS XFER LID,NOS,EAR 1992.00 14061 PR ADJ TISS XFER LID,NOS,EAR 10.1- 3326.00 14301 PR ADJ TISS XFER ANY AREA,30.1-60 3749.00 14302 PR ADJ TISS XFER ANY AREA,EA 854.00 ADD 30.0 SQCM 14350 PR FILLET FINGR/TOE FLAP W PREP 2220.00 15002 PR WOUND PREP, PED, TRK/ARM/LG 950.00 1ST 100 CM 15003 PR WOUND PREP, PED, TRK/ARM/LG 425.00 ADDL 100 CM 15004 PR WND PREP PED, 1050.00 15005 PR WND PREP,PED, 500.00 FACE/NCK/HND/FT/GEN ADD 100 CM 15040 PR SKIN GRAFT, HARVEST 632.00 CULTURED TISSUE 15050 PR SKIN PINCH GRAFT PROCEDURE 1052.00 15100 PR SPLIT GRFT TRUNK,ARM,LEG 2045.00 15101 PR SPLIT GRFT,TRUNK,ARM,LEG EA 508.00 100SQCM 15120 PR SPLIT 2500.00 GRFT,HEAD,FAC,HAND,FEET 15121 PR SPLIT 730.00 GRFT,HEAD,FAC,HAND,FEET EA 15200 PR FULL THICK GRFT TRUNK <20 1650.00 15201 PR FULL THICK GRFT TRUNK ADD 20 363.00 15220 PR FULL THICK GRFT 1760.00 SCALP,ARM,LEG <20SQC 15221 PR FULL THICK GRFT SCALP,ARM 450.00 ADD 20 SQCM 15240 PR FULL THICK GRFT 2270.00 HEAD,FAC,HAND <20SQC 15241 PR FULL THICK GRFT HEAD,FAC,HA 715.00 ADD 20SQ 15260 PR FULL THICK GRFT NOS,EAR,LID 2463.00 <20SQCM 15261 PR FULL THICK GRFT NOS,EAR,LID 1180.00 ADD 20SQ 15271 PR APP SKN SUB GRFT T/A/L 350.00 AREA/<100SCM /<1ST 25 SCM 15272 PR APP SKN SUB GRFT T/A/L 68.00 AREA/<100SCM EA ADL 25SCM 15273 PR APP SKN SUB GRFT T/A/L 1001.00 AREA/>100SCM 1ST 100SCM 15274 PR APP SKN SUB GRFT T/A/L 237.00 AREA/>100SCM ADL 100SCM 15275 PR SUB GRFT F/S/N/H/F/G/M/D 377.00 /<100SCM /<1ST 25 SCM 15276 PR SUB GRFT F/S/N/H/F/G/M/D 85.00 /<100SCM EA ADL 25SCM 15277 PR SUB GRFT F/S/N/H/F/G/M/D 821.00 />100SCM 1ST 100SCM 15278 PR SUB GRFT F/S/N/H/F/G/M/D 215.00 />100SCM ADL 100SCM 15570 PR FORM SKIN PEDICLE FLAP 3230 15572 PR FORM SKIN PEDICLE FLAP 3100.00 SCALP,ARM,LEG 15574 PR FORM SKIN PEDICLE FLAP 1950.00 FACE,GEN,HAND 15576 PR FORM SKIN PEDICLE FLAP 2205.00 LID,EAR,NOSE 15600 PR DELAY/SECTN FLAP TRUNK 895.00 15610 PR DELAY/SECTN FLAP 894.00 15620 PR DELAY/SECTN FLAP 990.00 FACE,GENIT,HAND,FT 15630 PR DELAY/SECTN FLAP 1050.00 15650 PR TRANSFER SKIN PEDICLE FLAP 1270 15730 PR MIDFACE FLAP 5573.00 W/PRESERVATION OF VASCULAR 15731 PR FOREHEAD FLAP W/VASC 3966.00 15732 PR MUSCLE-SKIN FLAP,HEAD/NECK 4529.00 15733 PR MUSC MYOQ/FSCQ FLAP 3801.00 HEAD&NECK W/NAMED VASC PEDCL 15734 PR MUSCLE-SKIN FLAP,TRUNK 4807.00 15736 PR MUSCLE-SKIN FLAP,ARM 4609.00 15738 PR MUSCLE-SKIN FLAP,LEG 4812.00 15740 PR FLAP ISLAND PEDICLE 3519.00 ANATOMIC NAMED AXIAL ARTERY 15750 PR NEUROVASCULAR PEDICLE 3255.00 15756 PR FREE MUSC-SKIN FLAP 8527.00 W/MICROVASC ANAST 15757 PR FREE SKIN FLAP W MICROVASC 8329.00 15760 PR COMPOSITE SKIN GRAFT 2378.00 15770 PR DERMA-FAT-FASCIA GRAFT 2145.00 15777 PR IMPLNT BIO IMPLNT FOR SOFT 531.00 TISSUE REINFORCEMENT 15780 PR DERMABRAS RX SKIN TOTAL 2100.00 15781 PR DERMABRAS RX SKIN SGMENT 1349.00 15786 PR ABRASION SINGLE LESION 616.00 15787 PR ABRASION, EACH ADDN 4 OR 124.00 15788 PR CHEM PEEL, FACE, EPIDERM 803.00 15789 PR CHEM PEEL, FACE, DERMAL 1400.00 15819 PR PLASTIC SURGERY, NECK 3185.00 15820 PR REVISION OF LOWER EYELID 1130.00 15821 PR REV LOWER EYELID EXTEN FAT 1617.00 15822 PR REVISION OF UPPER EYELID 1119.00 15823 PR REV UPPER EYELID W EXCESS 1560.00 15824 PR REMOVAL OF FOREHEAD 2647.00 15825 PR REMOV NECK WRINKLES W 4402.00 PLTSY TIGHT 15828 PR REML OF CHEEK,CHIN,NECK 5045.00 15829 PR REMOVAL OF SKIN WRINKLES 8777.00 15830 PR EXCISE EXCESS SKIN 3550.00 15832 PR EXCISE EXCESS SKIN 2700.00 15833 PR EXCISE EXCESS SKIN 3030.00 15834 PR EXCISE EXCESS SKIN TISSUE,HIP 3146.00 15835 PR EXCISE EXCESS SKIN 3237.00 15836 PR EXCISE EXCESS SKIN 1560.00 15839 PR EXCISE EXCESS SKIN 1738.00 15840 PR GRAFT FACE N PALSY,FREE 3564.00 15841 PR GRAFT FACE N PALSY,FREE 5000.00 15845 PR GRAFT FACE N PALSY,REGN 3565.00 MUSC XFER 15847 PR EXCISE EXCESS SKIN 1250.00 TISSUE,ABDOMEN, ADD-ON 15850 PR REM SUTURES W ANESTH SAME 222.00 SURGEON 15851 PR REM SUTURES W ANESTH OTHR 895.00 SURGEON 15852 PR DRESSING CHANGE,NOT FOR 119.00 15860 PR IV INJ TO TEST BLOOD FLOW IN 450.00 FLAP/GRAFT 15876 PR SUCT ASSIS 1406.00 15877 PR SUCT ASSIS LIPECTOMY,TRUNK 1150.00 15878 PR SUCT ASSIS LIPECTOMY,UP 920.00 15879 PR SUCT ASSIS LIPECTOMY,LOW 1933.00 15920 PR EXC COCCYX/ULCER W SUTURE 1537.00 15931 PR EXC SACR PRESS ULC W PRI 1687.00 15933 PR EXC SACR PRESS ULC BONE & 2486.00 15935 PR EXC SACR PRESS ULC BONE & 2910.00 FLAP CLO 15936 PR EXC SACR PRESS ULC W MUSC 2797.00 FLAP CLO 15937 PR EXC SACR PRESS ULC BONE/W 3668.00 MUSC FLAP 15940 PR EXC ISCH PRES ULC W PRIM 1721.00 15946 PR EXC ISCH PRES ULC BONE 6622.00 MYOCUT FLAP 15950 PR EXC TROC PRES ULC W PRIM 1251.00 15956 PR EXC TROC PRES ULC W MYOCUT 4067.00 15958 PR EXC TROC PRES ULC BONE 3596.00 MYOCUT FLAP 16020 PR DRESS/DEBRID SMALL BURN NO 198.00 16025 PR DRESS/DEBRID MED BURN NO 370.00 16030 PR DRESS/DEBRID LARGE BURN NO 466.00 ANESTH 16035 PR ESCHAROTOMY 895.00 16036 PR INCISION OF BURN SCAB, EACH 207.00 17000 PR DESTRUC PREMALIGNANT, FIRST 187.00 LESION 17003 PR DESTRUC PREMALIGNANT,2-14 24.00 17004 PR DESTRUC PREMALIGNANT,15+ 402.00 17106 PR DESTRUC CUT/VASC <10SQ CM 828.00 17107 PR DESTRUC CUT/VASC 10-50 SQ 1053.00 17108 PR DESTRUC CUT/VASC >50 SQ CM 2735.00 17110 PR DESTRUCTION BENIGN LESIONS 257.00 UP TO 14 17111 DESTRUCTION BENIGN LESIONS 15 304.00 OR MORE 17250 PR CHEMICAL CAUTERIZATION OF 175.00 GRANULATION TISSUE 17260 PR DESTR MALIG TRUNK,EXTREM 215.00 17261 PR DESTR MALIG TRUNK,EXTREM 331.00 17262 PR DESTR MALIG TRUNK,EXTREM 401.00 17263 PR DESTR MALIG TRUNK,EXTREM 437.00 17264 PR DESTR MALIG TRUNK,EXTREM 469.00 17266 PR DESTR MALIG TRUNK,EXTREM 530.00 17270 PR DESTR MALIG SCAL,NCK,HAND 346.00 17271 PR DESTR MALIG SCAL,NCK,HAND 375.00 17272 PR DESTR MALIG SCAL,NCK,HAND 426.00 17273 PR DESTR MALIG SCAL,NCK,HAND 516.00 17274 PR DESTR MALIG SCAL,NCK,HAND 617.00 17276 PR DESTR MALIG SCAL,NCK,HAND 647.00 17280 PR DESTR MALIG FACE,NOSE,LIP 350.00 17281 PR DESTR MALIG FACE,NOSE,LIP 0.6- 407.00 17282 PR DESTR MALIG FACE,NOSE,LIP 1.1- 466.00 17283 PR DESTR MALIG FACE,NOSE,LIP 2.1- 614.00 17284 PR DESTR MALIG FACE,NOSE,LIP 3.1- 702.00 17286 PR DESTR MALIG FACE,NOSE,LIP 899.00 17311 PR MOHS, 1 STAGE, 2300.00 HEAD/NECK/HAND/FEET/GENTIAL 17312 PR MOHS, ADDL STAGE, 963.00 HEAD/NECK/HAND/FEET/GENTIAL 17313 PR MOHS, 1 STAGE, 1531.00 17314 PR MOHS, ADDL STAGE, 924.00 17315 PR MOHS SURG, ADDL BLOCK 198.00 17340 PR CRYOTHERAPY ACNE 130.00 17380 PR HAIR REMOV ELECTROLYSIS EA 190.00 19000 PR PUNC/ASPIR BREAST CYST 250.00 19001 PR PUCT/ASPIR BREAST CYST,EACH 77.00 19020 PR EXPLO/DRAIN BREAST ABSCESS 927.00 19030 PR INJECT 382.00 19081 PR BX BREAST W DEVICE 1ST 1664.00 LESION STEREOTACTIC GUIDE 19082 PR BX BREAST W DEVICE ADDL 1349.00 LESION STEREOTACT GUIDE 19083 PR BX BREAST W DEVICE 1ST 1654.00 LESION ULTRASOUND GUIDE 19084 PR BX BREAST W DEVICE ADDL 1331.00 LESION ULTRASOUND GUIDE 19085 PR BX BREAST W DEVICE 1ST 2505.00 LESION MAGNETIC RES GUIDE 19086 PR BX BREAST W DEVICE ADDL 2005.00 LESION MAGNET RES GUIDE 19100 PR BIOPSY OF BREAST, NEEDLE 344.00 19101 PR BIOPSY OF BREAST, INCISIONAL 861 19110 PR NIPPLE EXPLORATION 1153.00 19112 PR EXCISE BREAST DUCT FISTULA 880.00 19120 PR REMOVAL OF BREAST LESION 1239.00 19125 PR EXCISE BREAST LES W XRAY 1373.00 19126 PR EXCISE BREAST LES XRAY MARK 367.00 19260 PR EXCIS CHEST WALL TUMOR/RIBS 3164.00 19271 PR EXCIS CHEST WALL TUM W 3906.00 19272 PR EXTENSIVE CHEST WALL 3807.00 19281 PR PERQ DEVICE PLACEMT BREAST 603.00 LOC 1ST LES W GUIDNCE 19282 PR PERQ DEVICE PLACEMT BREAST 420.00 LOC EA LES W GUIDNCE 19283 PR PERQ BREAST LOC DEVICE 685.00 PLACEMT 1ST STRTCTC GUID 19285 PR PERQ BREAST LOC DEVICE 1157.00 PLACEMT 1ST LESIO US IMAG 19286 PR PERQ BREAST LOC DEVICE 971.00 PLACEMT EACH LES US IMAGE 19287 PR PERQ BREAST LOC DEVICE 2138.00 PLACEMT 1ST LESIO MR GUID 19288 PR PERQ BREAST LOC DEVICE 1752.00 PLACEMT ADD LESIO MR GUID 19294 PR PREP TUMOR CAVITY IORT 425.00 W/PARTIAL MASTECTOMY 19296 PR PLACE POSTOP BREAST CATH 9315.00 19297 PR PLACE INTRAOP BREAST CATH 244.00 19300 PR MASTECTOMY FOR 1400.00 19301 PR MASTECTOMY, PARTIAL 2306.00 19302 PR MASTECTOMY,PARTIAL, WITH 2182.00 AXILLARY LYMPHADENECTOMY 19303 PR MASTECTOMY, SIMPLE, 3574.00 19304 PR MASTECTOMY, SUBCUTANEOUS 1456.00 19305 PR MASTECTOMY, RADICAL 3996.00 19307 PR MASTECTOMY, MODIFIED 4231.00 19316 PR SUSPENSION OF BREAST 2474.00 19318 PR REDUCTION OF LARGE BREAST 3681.00 19325 PR ENLARGE BREAST WITH 1627.00 19328 PR REMOVAL OF BREAST IMPLANT 1254.00 19330 PR REMOVAL OF IMPLANT MATERIAL 1605.00 19340 PR INSERT BREAST PROS IMMED 3563.00 AFTER EXCIS 19342 PR DELAY BREAST PROS AFTER 3274.00 BREAST SURG 19350 PR NIPPLE/AREOLA 2152.00 19357 PR BREAST RECONSTRUC W TISS 5342.00 EXPANDR 19361 PR BREAST RECONSTRUC W FREE 6255.00 FLAP, W/O IMPLANT 19364 PR BREAST RECONSTRUC W FREE 10095.00 19366 PR BREAST RECONSTRUC W OTHR 5727.00 TECHNIQ 19367 PR BREAST RECONSTRUCT W TRAM 6617.00 1 PEDICL 19368 PR BREAST RECONSTRUCT W TRAM 8963 UVASC ANAS 19370 PR SURGERY OF BREAST CAPSULE 1739.00 19371 PR REMOVAL OF BREAST CAPSULE 2782.00 19380 PR REVISE BREAST 2745.00 20005 PR I&D SOFT TISSUE ABSCESS 1216.00 20100 PR EXPLORE WOUND,NECK 1817.00 20101 PR EXPLORE WOUND,CHEST 858.00 20102 PR EXPLORE 1007.00 WOUND,ABDOMEN/FLANK/BACK 20103 PR EXPLORE WOUND,EXTREMITY 1465.00 20150 PR EXCISION OF EPIPHYSEAL BAR 2753.00 20200 PR MUSCLE BIOPSY 520.00 20205 PR DEEP MUSCLE BIOPSY 644.00 20206 PR NEEDLE BIOPSY,MUSCLE 635.00 20220 PR BONE BIOPSY,TROCAR/NEEDLE 476.00 20225 PR BONE BIOPSY,TROCAR/NEEDLE 2089.00 20240 PR BIOPSY BONE OPEN 770.00 20245 PR BIOPSY BONE OPEN DEEP 1389.00 20250 PR OPEN BONE BIOP VERT DORSAL 1255.00 20251 PR OPEN BONE BIOP VERT 1075.00 20500 PR INJECT SINUS TRACT 260.00 20501 PR INJECT SINUS TRACT FOR DX W 312.00 20520 PR REMOVAL OF FOREIGN BODY 533.00 20525 PR REMOVAL OF FOREIGN BODY 1167.00 DEEP/COMPLIC 20526 PR INJECT CARPAL TUNNEL 247.00 20527 PR INJECTION ENZYME PALMAR 186.00 FASCIAL CORD 20550 PR INJECT TENDON 190.00 20551 PR INJECT TENDON ORIGIN/INSERT 187.00 20552 PR INJECT TRIGGER POINT, 1 OR 2 200.00 20553 PR INJECT TRIGGER POINTS, > 3 231.00 20600 PR ARTHROCENTESIS ASPIR&/INJ 121.00 SMALL JT/BURSA W/O US 20604 PR ARTHROCNT ASPIR&/INJ SMALL 179.00 JT/BURSAW/US REC RPRT 20605 PR ARTHROCENTESIS ASPIR&/INJ 141.00 INTERM JT/BURS W/O US 20605 PR ARTHROCENTESIS ASPIR&/INJ 26 474.00 INTERM JT/BURS W/O US 20606 PR ARTHROCENTESIS ASPIR&/INJ 196.00 INTERM JT/BURS W/US 20610 PR ARTHROCENTESIS ASPIR&/INJ 226.00 MAJOR JT/BURSA W/O US 20611 PR ARTHROCENTESIS ASPIR&/INJ 229.00 MAJOR JT/BURSA W/US 20612 PR ASPIRAT/INJECTION GANGLION 184.00 20615 PR ASPIR/INJEC BONE CYST 607.00 20650 PR INSERT AND REMOVE BONE PIN 613.00 20661 PR APPLY/REMOVE HALO CRANIAL 1274.00 20664 PR APPLY HALO 6/> PINS THIN 3106.00 SKULL OSTEOLOGY 20670 PR REMOVAL SUPERFICIAL IMPLANT 986.00 20680 PR REMOVAL DEEP IMPLANT 1987.00 20690 PR APPLY BONE UNIPLANE,EXT FIX 1507.00 20692 PR APPLY BONE MULTIPLAN,EXT FIX 2786.00 20693 PR ADJUST EXTERN BONE FIX DEV 1517.00 W ANESTH 20694 PR REMOVE EXTERN BONE FIX DEV 1432.00 W ANESTH 20696 PR COMP ASSIST MULTIPLANE EXT 4285.00 FIXATION, INITIAL 20816 PR REPLANTATION DIGIT MCP, 10610.00 20822 PR REPLANTATION DIGIT DISTAL, 9144.00 20824 PR REPLANTATION THUMB MCP, 7949.00 20827 PR REPLANTATION THUMB 7474.00 DISTAL,COMPLETE 20900 PR REMV BONE FOR GRAFT MINOR 1204.00 20902 PR REMV BONE FOR GRAFT MAJOR 1917.00 20910 PR REMV CARTILAGE FOR GRAFT 1145.00 COSTOCH 20912 PR REMV CARTILAGE FOR GRAFT 1208.00 20922 PR REMV FASCIA FOR GRAFT INCIS 1490.00 20924 PR REMV TENDON FOR GRAFT 1642.00 20926 PR REMV TISSUE FOR GRAFT OTHR 1050.00 20930 PR ALLOGRAFT FOR SPINE 624.00 SURGERY ONLY MORSELIZED 20931 PR ALLOGRAFT FOR SPINE 573.00 SURGERY ONLY STRUCTURAL 20936 AUTOGRAFT SPINE SURGERY 414.00 LOCAL FROM SAME INCISION 20937 AUTOGRAFT SPINE SURGERY 858.00 MORSELIZED SEP INCISION 20938 AUTOGRAFT SPINE SURGERY 956.00 BICORT/TRICORT SEP INCISION 20939 PR BONE MARROW ASPIRATION 350.00 BONE GRFG SPI SURG ONLY 20950 PR RECORD FLUID 669.00 20956 PR MICROVASCULAR ILIAC CREST 10821.00 20962 PR MICROVASCULAR BONE 9530.00 20969 PR BONE-SKIN GRAFT, 11239.00 20975 PR ELECT BONE STIM INVASIVE 425.00 20982 PR ABLATION BONE TUMOR RF 9739.00 PERQ W/IMG GDN WHEN DONE 20985 PR CPTR-ASST SURGICAL 640.00 NAVIGATION IMAGE-LESS 21011 PR EXCISION TUMOR SOFT TISS 853.00 FACE/SCALP SUBQ < 2CM 21012 PR EXCISION TUMOR SOFT TISS 832.00 FACE/SCALP SUBQ 2+CM 21013 PR EXC TUMOR SOFT TISS 1273.00 FACE&SCALP SUBFASCIAL < 2CM 21014 PR EXC TUMOR SOFT TISS 1277.00 FACE&SCALP SUBFASCIAL 2+CM 21015 PR RAD RESECTION TUMOR SOFT 1793.00 TISS FACE/SCALP < 2CM 21016 PR RAD RESECTION TUMOR SOFT 3623.00 TISS FACE/SCALP 2 CM/> 21025 PR EXCISION OF BONE, LOWER JAW 2965.00 21026 PR EXCISION OF FACIAL BONE(S) 1571.00 21029 PR CONTOUR OF FACE BONE 1955.00 21030 PR EXCISION,BENIGN 1320.00 TUMOR,MAXILLA/ZYGOMA 21031 PR EXCISION,TORUS MANDIBULARIS 1001.00 21034 PR EXCISION,MALIG TUMOR, 4033.00 MAXILLA/ZYGOMA 21040 PR EXCISION,BENIGN 1044.00 21044 PR REMV MALIG JAW BONE LESION 2669.00 21045 PR REMV MALIG JAW BONE RADICAL 3708.00 21046 PR EXCISION,BEN 3897.00 TUMOR,MANDIBLE,INTRA-ORAL 21047 PR EXCISION,BEN 5368.00 TUMOR,MANDIBLE,EXTRA-ORAL 21048 PR EXCISION,BEN 4018.00 TUMOR,MAXILLA,INTRA-ORAL 21049 PR EXCISION,BEN 4299.00 TUMOR,MAXILLA,EXTRA-ORAL 21070 PR REMV CORONOID PROCESS 1547.00 21079 PR PREP FACE/ORAL PROST TEMP 3412.00 OBTURATOR 21080 PR PREP FACE/ORAL PROST FINL 5000.00 OBTURATOR 21089 PR PREP FACE/ORAL PROST 1700.00 21110 PR INTERDENTAL FIXATION 2044.00 21141 PR RECONST FACE,LEFORT I,1 4854.00 21142 PR RECONST FACE,LEFORT I,2 5866.00 21145 PR RECONST FACE,LEFORT I,1 6510.00 21147 PR RECONST FACE,LEFORT 6849.00 I,3+PIECES+GRFT 21172 PR RECONST ORBIT/FOREHEAD 8433 21175 PR RECONST ORBIT/FOREHEAD 8575.00 21179 PR RECONST ENTIRE 5551.00 21180 PR RECONST ENTIRE 6935.00 FOREHEAD+AUTOGRFT 21181 PR CONTOUR CRANIAL BONE 2632.00 21188 PR RECONST MIDFACE 6643.00 21193 PR RECONST MANDIBLE,C/L 5360.00 21194 PR RECONST MANDIBLE,C/L 6026.00 21196 PR RECONST MANDIBLE,SAG 6790.00 21198 PR OSTEOTOMY, MANDIBLE 4172.00 21199 PR RECONST MANDIBLE,GLOSSAL 3605.00 ADVANCEMT 21206 PR RECONST MAXILLA,SEGMENTAL 4345.00 21208 PR AUGMENT FACIAL BONES 4884.00 21210 PR NASAL,MAXILLA,MALAR BONE 7917.00 21230 PR RIB CARTILAGE GRAFT TO FACE 1737.00 21235 PR EAR CARTILAGE GRAFT TO FACE 1575.00 21240 PR ARTHROPLASTY TMJ 4003.00 21248 PR RECONSTR JAW,PART-ENDO 3957.00 21267 PR REPOSITN ORBITS,EXTRACRAN 6456.00 21270 PR AUGMENTATION CHEEK BONE 3035.00 21280 PR REVISION OF EYELID,MEDIAL 1440.00 21282 PR REVISION OF EYELID,LATERAL 2415.00 21310 PR CLOSED RX NOSE FRACTURE 325.00 21315 PR CLOSED RX NOSE FRACTURE 560.00 21320 PR CLOSED RX NOSE FX W 601.00 21325 PR OPEN RX NOSE FRACTURE 1207.00 21330 PR OPEN RX NOSE FX 1785.00 21335 PR OPEN RX NOSE FX+OPEN FIX 1846.00 21336 PR OPEN RX NASAL SEPTAL 1633.00 21337 PR CLOSED RX NASAL SEPTAL 992.00 21338 PR REPAIR NASOETHMOID 2431.00 21339 PR REPAIR NASOETHMOID 2291.00 FX+EXTERN FIXATN 21340 PR REPAIR NASOETHMOID 2858.00 COMPLEX FRACTURE 21343 PR OPEN RX DEPRES FRONTAL 4631.00 SINUS FRAC 21344 PR OPEN RX COMPLIC FRONT SINUS 4847.00 21345 PR CLOSED RX NOSE/JAW 1999 21346 PR OPEN RX NOSE/JAW 2244.00 21347 PR OPEN RX NOSE/JAW 3809.00 21348 PR OPEN RX NOSE/JAW 4895.00 21356 PR OPEN RX DEPRESS ZYGOMA 1318.00 21360 PR OPEN RX DEPRESS MALAR FRAC 1908.00 21365 PR OPEN RX COMPLX CHEEK BONE 2746.00 21386 PR REPAIR EYE 1763.00 21387 PR REPAIR EYE 2664.00 21390 PR REPAIR EYE 2798.00 BLOWOUT,PERIORB+IMPLNT 21401 PR CLOSED RX FX ORBIT W 1316.00 21406 PR OPEN RX FX ORBIT 1449.00 21407 PR OPEN RX FX ORBIT W IMPLANT 1641.00 21422 PR OPEN RX LEFORTE I 1815.00 21423 PR OPEN RX LEFORTE 3801.00 21432 PR OPEN RX LEFORTE III+FIXATN 2876.00 21433 PR OPEN RX LEFORTE 5814.00 21435 PR OPEN RX LEFORTE 5163.00 21451 PR CLOSED RX MANDIBLE 2086.00 21452 PR PERCUT RX MANDIBLE FX EXT 1523.00 21453 PR CLOSED RX MANDIBLE 2262.00 21454 PR OPEN RX MANDIBLE FX+EXTERN 1468.00 21461 PR OPEN RX MANDIBLE FX 3787.00 21462 PR OPEN RX MANDIBLE FX+DENTAL 3452.00 21470 PR OPEN RX MANDIBLE CONDYLE 3679.00 FX,COMPL 21480 PR REDUCE TEMPOROMANDIBL 250.00 21501 PR I&D DEEP ABSC/HEMATOMA 932.00 NECK/CHEST 21550 PR BIOPSY SOFT TISSUE 525.00 21552 PR EXC TUMOR SOFT TISSUE 1030.00 NECK/ANT THORAX SUBQ 3+CM 21554 PR EXC TUMOR SOFT TISSUE 1653.00 NECK/ANT THORAX SUBFASCIAL 21555 PR EXC TUMOR SOFT TISSUE 1056.00 NECK/ANT THORAX SUBQ <3CM 21556 PR EXC TUMOR SOFT TISSUE 1340.00 NECK/ANT THORAX SUBFASCIAL 21557 PR RAD RESECT TUMOR SOFT TISS 1831.00 NECK/ANT THORAX <5CM 21558 PR RAD RESECT TUMOR SOFT TISS 3102.00 NECK/ANT THORAX 5CM/> 21600 PR PARTIAL REMOVAL OF RIB 1314.00 21610 PR COSTOTRANSVERSECTOMY 5956.00 21615 PR REMOVAL 1ST/CERVICAL RIB 1975.00 21620 PR PARTIAL REMOVAL OF STERNUM 1355.00 21627 PR STERNAL DEBRIDEMENT 1739.00 21685 PR HYOID MYOTOMY & SUSPENSION 3482.00 21700 PR DIVIDE SCALENUS ANTICUS 1370.00 21705 PR DIVIDE SCALENUS+RESECT 1346.00 21720 PR DIVIDE STERNOMASTOID OPEN 1866 21740 PR RECONST PECTUS 3728.00 21743 PR RECONST PECTUS EXCAV/CARIN 6413.00 W/ THORACOS 21750 PR CLOSE MED STERNOTOMY SEP, 2641.00 W/WO DEBRIDE 21811 PR OPEN TX RIB FX W/FIXJ 2131.00 THORACOSCOPIC VIS 1-3 RIBS 21812 PR OPEN TX RIB FX W/FIXJ 2595.00 THORACOSCOPIC VIS 4-6 RIBS 21820 PR CLOSED RX STERNUM 361.00 21825 PR OPEN RX STERNUM FRACTURE 1594.00 21925 PR BIOPSY SOFT TISSUE 1436.00 21930 PR EXCISION TUMOR SOFT TISSUE 2195.00 BACK/FLANK SUBQ <3CM 21931 PR EXCISION TUMOR SOFT TISSUE 1235.00 BACK/FLANK SUBQ 3+CM 21932 PR EXC TUMOR SOFT TISS 1515.00 BACK/FLANK SUBFASCIAL <5CM 21933 PR EXC TUMOR SOFT TISS 2541.00 BACK/FLANK SUBFASCIAL 5+CM 21935 PR RAD RESECTION TUMOR SOFT 3967.00 TISSUE BACK/FLANK <5CM 21936 PR RAD RESECTION TUMOR SOFT 4037.00 TISSUE BACK/FLANK 5CM/> 22010 PR I&D, POST SPINE, 3138.00 CERV/THOR/CERV-THOR 22015 PR I&D, POST SPINE, 3110.00 LUMB/SACR/LUMBOSAC 22100 PR REMV PART POST CERV VERT,1 4644.00 22101 PR REMV PART POST THOR VERT,1 4311.00 22103 PR REMV PART POST VERT,EA 715.00 22110 PR REMV PART CERV VERT BODY,1 5293.00 22116 PR REMV PART VERT BODY,EA 360.00 22206 PR OSTEOTOMY SPINE POSTERIOR 12452.00 3 COLUMN THORACIC 22207 PR OSTEOTOMY SPINE POSTERIOR 12221.00 3 COLUMN LUMBAR 22208 PR OSTEOTOMY SPINE POSTERIOR 2976.00 3 COLUMN EA ADDL SGM 22210 PR OSTEOTOMY CERV SP,POST,1 9079.00 22212 PR OSTEOTOMY THOR SP,POST,1 7548.00 22214 PR OSTEOTOMY LUMB SP,POST,1 7567.00 22216 PR OSTEOTOMY,POST,EA ADDN 1859.00 22220 PR OSTEOTOMY CERV 8124.00 22222 PR OSTEOTOMY THOR 5136.00 22224 PR OSTEOTOMY LUMB 8048.00 22226 PR OSTEOTOMY,DISCECT,ANT,EA 1850.00 ADDNL SGMT 22305 PR CLOSED TREAT SPINE PROCESS 684.00 22310 PR CLOSED TREAT VERT BODY 979.00 22315 PR CLOSED TREAT VERT BODY 3123.00 FX,MANIPULATN 22318 PR ODONTOID FX,W/O GRAFT,OPEN 8325.00 22319 PR ODONTOID,FX,GRAFTING,OPEN 9273.00 22325 PR OPEN POST RX LUMB VERT FX,1 7305.00 22326 PR OPEN POST RX CERV VERT FX,1 7569.00 22327 PR OPEN POST RX THOR VERT FX,1 7622.00 22328 PR OPEN POST REPAIR EA ADDN 1443.00 22510 PR PERQ VERTEBROPLASTY UNI/BI 4312.00 INJX CERVICOTHORACIC 22511 PR PERQ VERTEBROPLASTY UNI/BI 4271.00 INJECTION LUMBOSACRAL 22512 PR VERTEBROPLASTY EACH ADDL 2388.00 CERVICOTHOR/LUMBOSACRAL 22513 PR PERQ VERT AGMNTJ CAVITY 25280.00 CRTJ UNI/BI CANNULATION 22514 PR PERQ VERT AGMNTJ CAVITY 1733.00 CRTJ UNI/BI CANNULJ LMBR 22515 PR PERQ VERT AGMNTJ CAVITY 15233.00 CRTJ UNI/BI CANNULJ EACH 22532 PR LAT THORAX SPINE FUSION 9029.00 22533 PR LAT LUMBAR SPINE FUSION 8445.00 22534 PR LAT THOR/LUMB, ADDL SEG 1844.00 22551 PR ARTHRODESIS ANT INTERBODY 8709.00 INC DISCECTOMY, CERVICAL BELOW 22552 PR ARTHRODESIS ANT INTERBODY 2038.00 INC DISCECTOMY, CERVICAL BELOW C2 EACH ADDL 22554 PR CERV SPINE 6380.00 22556 PR THORAX SPINE FUSION,ANTER 8489.00 22558 PR LUMBAR SPINE FUSION,ANTER 7825.00 22585 PR SPINAL FUSION,ANT,EA ADNL 1681.00 22586 PR ARTHRODESIS PRESACRAL 7759.00 INTRBDY W/INSTRUMENT L5/S1 22590 PR CRANIOCERV FUSN,POST 8030.00 22595 PR CERV C1-2 FUSN,POSTER TECH 7662.00 22600 PR CERV FUSN,BELOW C2,POST 6554.00 22610 PR ARTHRODESIS 6420.00 POSTERIOR/POSTEROLATERAL 22612 PR ARTHRODESIS 8082.00 POSTERIOR/POSTEROLATERAL 22614 PR SPINE FUSN,POST TECH,EA 2003.00 ADDNL SGMT 22630 PR LUMBAR SPINE FUSN,POST 7990.00 22632 PR LUMB SP FUSN,POST 1644.00 INTERBDY,EA ADDNL 22633 PR ARTHDSIS 9438.00 POST/POSTEROLATRL/POSTINTERB ODY LUMBAR 22634 PR ARTHDSIS 2541.00 POST/POSTERLATRL/POSTINTRBDY ADL SPC/SEG 22800 PR SPINE FUSN,POSTER,UP TO 6 6874.00 22802 PR SPINE FUSION,POSTER,7-12 10698.00 22804 PR SPINE FUSION,POSTER,13+ 12367.00 22808 PR SPINE FUSION,ANTER,3 SGMTS 9402.00 22810 PR SPINE FUSION,ANTER,4-7 SGMTS 10425.00 22830 PR EXPLORATION OF SPINAL 4133.00 22840 POSTERIOR NON-SEGMENTAL 3890.00 INSTRUMENTATION 22842 POSTERIOR SEGMENTAL 3905.00 INSTRUMENTATION 3-6 VRT SEG 22843 POSTERIOR SEGMENTAL 4178.00 INSTRUMENTATION 7-12 VRT SEG 22844 POSTERIOR SEGMENTAL 5050.00 INSTRUMENTATION 13/> VRT SEG 22845 ANTERIOR INSTRUMENTATION 2-3 3738.00 VERTEBRAL SEGMENTS 22846 ANTERIOR INSTRUMENTATION 4-7 3881.00 VERTEBRAL SEGMENTS 22847 ANTERIOR INSTRUMENTATION 8/> 2868.00 VERTEBRAL SEGMENTS 22848 PELVIC FIXATION OTHER THAN 1842.00 22849 PR REINSERT SPINAL FIXATION 6609.00 22850 PR REMOVE SPINE FIX 3675.00 22851 PR APPLICATION INTERVERTEBRAL 2125.00 BIOMECHANICAL DEVICE 22852 PR REMOVE SPINE FIX DEV,POST 3519.00 22853 PR INSJ BIOMCHN DEV 686.00 INTERVERTEBRAL DSC SPC 22854 PR INSJ BIOMCHN DEV VRT 888.00 CORPECTOMY DEFECT W/ARTHRD 22855 PR REMOVE SPINE FIX 5630.00 22856 PR TOT DISC ARTHRP ART DISC ANT 4906.00 APPRO 1 NTRSPC CRV 22858 PR TOT DISC ARTHRP ANT APPR 1567.00 DISC 2ND LEVEL CERVICAL 22859 PR INSJ BIOMCHN DEV NTRVRT 888.00 DISC SPACE W/O ARTHRD 22867 PR INSJ STABLJ DEV W/DCMPRN 3587.00 LUMBAR SINGLE LEVEL 22868 PR INSJ STABLJ DEV W/DCMPRN 641.00 LUMBAR SECOND LEVEL 22869 PR INSJ STABLJ DEV W/O DCMPRN 1409.00 LUMBAR SINGLE LEVEL 22870 PR INSJ STABLJ DEV W/O DCMPRN 374.00 LUMBAR SECOND LEVEL 22900 PR EXC TUMOR SOFT TISSUE ABDL 1091.00 WALL SUBFASCIAL <5CM 22901 PR EXC TUMOR SOFT TISSUE ABDL 2364.00 WALL SUBFASCIAL 5+CM 22902 PR EXC TUMOR SOFT TISSUE 1074.00 ABDOMINAL WALL SUBQ <3CM 22903 PR EXC TUMOR SOFT TISSUE 1083.00 ABDOMINAL WALL SUBQ 3+CM 22904 PR RAD RESECTION TUMOR SOFT 3731.00 TISSUE ABDL WALL <5CM 22905 PR RAD RESECTION TUMOR SOFT 5405.00 TISSUE ABDL WALL 5 CM/> 23030 PR INCIS/DRAIN SHLDR 1114.00 23031 PR DRAIN INFECT SHOULDER 1070.00 23040 PR DEEP INCIS SHLDR BONE 2554 23044 PR EXPLOR/REMV INFECT GLENO- 1639.00 23065 PR EXPLOR INFECT A-C/S-C JT 654.00 23066 PR BIOPSY SHLDR SOFT 1404.00 TISSUES,SUPERFIC 23071 PR EXCISION TUMOR SOFT TISSUE 1055.00 SHOULDER SUBQ 3+CM 23073 PR EXC TUMOR SOFT TISSUE 2440.00 SHOULDER SUBFASCIAL 5+CM 23075 PR EXCISION TUMOR SOFT TISSUE 1172.00 SHOULDER SUBQ <3CM 23076 PR EXC TUMOR SOFT TISS 1457.00 SHOULDER SUBFASC <5CM 23077 PR RAD RESECTION TUMOR SOFT 3877.00 TISSUE SHOULDER <5CM 23078 PR RAD RESECTION TUMOR SOFT 3761.00 TISSUE SHOULDER 5 CM/> 23120 PR PARTIAL REMOVAL, CLAVICLE 1807.00 23125 PR TOTAL REMOVAL OF CLAVICLE 1756.00 23130 PR PARTIAL 1946.00 23140 PR EXCIS/CURET BENIGN TUMR 1361.00 CLAV/SCAPULA 23150 PR EXCIS/CURET BENIGN TUMR 2058.00 PROX HUMERUS 23170 PR SEQUESTRECTOMY, CLAVICLE 1997.00 23180 PR PART EXCIS CLAVICLE 2343.00 23195 PR REMOVAL OF HEAD OF 2692 23330 PR REMOVE SUBCUT SHOULDER 651.00 FOREIGN BODY 23333 PR REMOVAL SHOULDER FOREIGN 1186.00 BODY DEEP SUBFASCIAL/IM 23334 PR PROSTHESIS REMOVAL 3736.00 HUMERAL/GLENOID COMPONENT 23335 PR PROSTHESIS REMOVAL 4545.00 HUMERAL AND GLENOID 23350 PR INJ PROC SHOULDER 794.00 ARTHROGRAPHY/CT/MRI 23395 PR MUSCLE 4545.00 TRANSFER,SHOULDER/ARM,SINGLE 23397 PR MUSCLE 4050.00 TRANSFER,SHLDR/ARM,MULTIPLE 23400 PR FIXATION OF SHOULDER BLADE 3345.00 23405 PR INCISE 1575.00 23410 PR REPAIR ROTATOR CUFF,ACUTE 2923.00 23412 PR REPAIR ROTATOR 3109.00 23420 PR REPAIR COMPL ROTATOR CUFF 3433.00 AVULSN,CHR 23430 PR REPAIR BICEPS LONG TENDON 2417.00 23455 PR REPAIR SHOULDER 3340.00 23460 PR REPAIR SHLDR 3585.00 CAPSUL,ANT,BONE BLOCK 23462 PR REPAIR SHLDR 3503.00 CAPSU,ANT,CORACOID XFER 23465 PR REPAIR SHLDR 3941.00 CAPSU,POST,RECUR DISLOC 23470 PR RECONSTRUCT PROX HUMERAL 3929.00 IMPLANT 23472 PR RECONSTR TOTAL SHOULDER 5377.00 23473 PR REVIS SHOULDER ARTHRPLSTY 6601.00 HUMERAL/GLENOID COMPNT 23474 PR REVIS SHOULDER ARTHRPLSTY 6840.00 HUMERAL&GLENOID COMPNT 23485 PR OSTEOTOMY CLAVICLE W BONE 3124.00 23491 PR REINFORCE PROX 3618.00 23500 PR CLOSED RX CLAVICLE 548.00 23505 PR CLOSED RX CLAVICLE 1177.00 23515 OPEN TREATMENT CLAVICULAR 1854.00 FRACTURE INTERNAL FX 23525 PR CLOSED RX STERN-CLAV 1153.00 23530 PR OPEN RX STERN-CLAV DISLOC 1828.00 23532 PR OPEN RX STERN-CLAV 2223.00 DISLOC,FASC GRFT 23540 PR CLOSED RX A-C JT DISLOC 562.00 23545 PR CLOSED RX A-C JT 1010.00 23550 PR OPEN RX A-C JT DISLOC 2099.00 23552 PR OPEN RX A-C JT DISLOC,FASCIAL 2318.00 23570 PR CLOSED RX SCAPULA FX 766.00 23585 PR OPEN RX SCAPULA FRACTURE 2227.00 23600 PR CLOSED RX PROX HUMERUS 1119.00 23605 PR CLOSED RX PROX HUMERUS 1501.00 23615 OPEN TREATMENT PROX HUMERAL 2398.00 FRACTURE 23616 OPEN PROX HUMERAL FRACTURE 4421 PROSHETIC REPLACEMENT 23620 PR CLOSED RX GR TUBEROSITY 979.00 23630 PR OPEN RX GR TUBEROSITY FX 1855.00 23650 PR CLOSED RX SHLDR 775.00 23655 PR CLOSED RX SHLDR 987.00 23660 PR OPEN RX ACUTE SHLDR DISLOC 1909.00 23665 PR CLOSED RX SHLDR DISLOC,GR 1496.00 23670 PR OPEN RX SHLDR DISLOC,GR TUB 3100.00 23675 PR CLOSED RX SHLDR 1787.00 DISLOC,PROX HUM FX 23700 PR MANIPULATN SHLDR JT W 641.00 23800 PR FUSION SHOULDER JOINT 3298.00 23930 PR INCIS/DRAIN ARM,DEEP 892.00 ABSC/HEMATOMA 23931 PR INCIS/DRAIN ARM/ELBOW INFECT 1010.00 23935 PR INCIS DEEP ARM/ELBOW BONE 1796 24000 PR EXPLORE/DRAIN ELBOW FOR 1482.00 24006 PR ARTHROTOMY/CAPULE RELEASE 2266.00 ELBOW JT 24065 PR BX ARM/ELBOW SOFT 646.00 TISSUE,SUPERFICIAL 24066 PR BX ARM/ELBOW SOFT 1571.00 24071 PR EXC TUMOR SOFT TISSUE 1070.00 UPPER ARM/ELBOW SUBQ 3+CM 24073 PR EXC TUMOR SOFT TISS UPPER 4488.00 ARM/ELBW SUBFASC 5+CM 24075 PR EXC TUMOR SOFT TISS UPPER 1234.00 ARM/ELBOW SUBQ <3CM 24076 PR EXC TUMOR SOFT TISS UPR 1374.00 ARM/ELBOW SUBFASC <5CM 24077 PR RAD RESECT TUMOR SOFT TISS 3239.00 UPPER ARM/ELBOW <5CM 24079 PR RAD RESECT TUMOR SOFT TISS 4968.00 UPPER ARM/ELBOW 5CM/> 24101 PR EXPLORE ELBOW JOINT 1750.00 24102 PR EXPLOR ELBOW JT/REMOV 2290.00 24105 PR REMOVAL OF ELBOW BURSA 1046.00 24110 PR EXCIS/CURET BENIGN HUMERUS 1909.00 24116 PR EXCIS BENIGN HUMERUS 3073.00 LESN,ALLOGRFT 24120 PR EXCIS/CURET BENIGN ELBOW 1663.00 24130 PR REMOVAL OF HEAD OF RADIUS 1619.00 24138 PR 1716.00 SEQUESTRECTOMY,OLECRANNON 24140 PR PARTIAL REMOVAL HUMERUS 2467.00 24147 PR PARTIAL REMOVAL 2132.00 OLECRANNON PROCESS 24149 PR RADICAL RESECT ELBOW, 3414.00 CONTRAC RELEAS 24160 PR PROSTHESIS REMOVAL 1943.00 HUMERAL AND ULNAR 24164 PR PROSTHESIS REMOVAL RADIAL 2585.00 24200 PR REMOVAL ARM/ELBOW 518.00 F.B.,SUPERFICIAL 24201 PR REMOVAL ARM/ELBOW F.B.,DEEP 1928.00 24220 PR INJECTION FOR ELBOW 719.00 24300 PR MANIPULATE ELBOW W/ANESTH 1048.00 24301 PR MUSC/TENDON 2655.00 XFER,ARM/ELBOW,SINGLE 24305 PR ARM/ELBOW TENDON 1875.00 LENGTHEN,SINGLE,EA 24310 PR TENOTOMY,ELBOW- 1545.00 24320 PR TENOPLASTY,ELB-SHLDR,MUSC 2782.00 XFER,SINGL 24332 PR TENOLYSIS, TRICEPS 1845.00 24340 PR REPAIR OF BICEPS TENDON AT 1969.00 24341 PR MUSC/TENDON REPAIR EACH; 2163.00 ARM/ELBOW 24342 PR REINSERT BI/TRICEPS 2549.00 24343 PR REPR ELBOW LAT LIGMNT 2336.00 24344 PR RECONSTRUCT ELBOW LAT 3865.00 LIGMNT W/GRAFT 24345 PR REPR ELBW MED LIGMNT W/TISS 1779.00 24346 PR RECONSTRUCT ELBOW MED 3890.00 LIGMNT W/GRAFT 24357 PR TENOTOMY ELBOW 1083.00 LATERAL/MEDIAL PERCUTANEOUS 24358 PR TENOTOMY ELBOW 1575.00 LATERAL/MEDIAL DEBRIDE OPEN 24359 PR TENOTOMY ELBOW 1934.00 LATERAL/MEDIAL DEBRIDE REPAIR 24360 PR ARTHROPLASTY,ELBOW,W 3187.00 24363 PR ARTHROPLASTY,ELBOW,TOTAL 4994.00 PROSTH REPL 24366 PR RECONSTRUCT RADIAL HEAD W 2212.00 IMPLANT 24370 PR REVIS ELBOW ARTHRPLSTY 6297.00 HUMERAL/ULNA COMPNT 24371 PR REVIS ELBOW ARTHRPLSTY 7339.00 HUMERAL&ULNA COMPNT 24400 PR OSTEOTOMY HUMERUS 2666.00 24430 PR REPAIR NON/MALUNION 3020.00 24435 PR REPAIR NON/MALUNION 3203.00 HUMERUS,GRAFT 24495 PR DECOMPRESS FOREARM,BRACH 2248.00 ART EXPLOR 24500 PR CLOSED RX MID HUMERUS 1116.00 24505 PR CLOSED RX MID HUMERUS 1630.00 FX,MANIPULATN 24515 PR OPEN FIXATN MID HUMERUS 2804.00 24516 PR OPEN ROD FIXATN HUMERAL 2776.00 24530 PR CLOSED RX HUMERAL 1157.00 SUPRACONDYLAR FX 24535 PR CLOSED RX HUM 2007.00 SUPRACONDYLR FX,MANIPU 24538 PR PERCUT FIX HUM 2403.00 24545 OPEN TX HUMERAL 2522.00 SUPRACONDYLAR FRACTURE W/O 24546 OPEN TX HUMERAL 3620.00 SUPRACONDYLAR FRACTURE W 24560 PR CLOSED RX HUMER 804.00 24565 PR CLOSED RX HUMER 1336.00 EPICONDYLR FX,MANIP 24566 PR PERCUT FIXATN HUMERAL 2539.00 EPICONDYLAR FX 24575 OPEN TX HUMERAL EPICONDYLAR 2531.00 FRACTURE 24576 PR CLOSED RX HUMER CONDYLR FX 1012.00 24577 PR CLOSED RX HUMER CONDYLR 1752.00 24579 OPEN TX HUMERAL CONDYLAR 2734.00 24582 PR PERCUT FIXATN HUMERAL 2323.00 CONDYLAR FX 24586 PR OPEN RX PERIARTIC FX/DISLOC 3837.00 24587 PR OPEN RX PERIARTIC FX 3840.00 24600 PR CLOSED RX ELBOW 1276.00 24605 PR CLOSED RX ELBOW 1412.00 DISLOCATN,ANESTHESIA 24615 PR OPEN RX ELBOW DISLOCATION 2289.00 24620 PR CLOSED RX MONTEGGIA 1737.00 FX/DISLOC ELBOW 24635 OPEN TX MONTEGGIA FRACTURE 3620.00 DISLOCATION ELBOW 24640 PR CLOSED RX RADIAL HEAD 345.00 24650 PR CLOSED RX RADIAL HEAD/NECK 865.00 24655 PR CLOSED RX RADIAL HEAD/NECK 1452.00 FX,MANIP 24665 OPEN TX RADIAL HEAD/NECK 2076.00 24666 OPEN TX RADIAL HEAD/NECK 2393.00 FRACTURE PROSTHETIC 24670 CLOSED TX ULNAR FRACTURE 905.00 PROX END W/O MANIPULATE 24675 CLOSED TX ULNAR FRACTURE 1134.00 PROX END W MANIPULATION 24685 OPEN TX ULNAR FRACTURE PROX 2175.00 24900 PR AMPUTATN ARM,THRU 2635.00 HUMERUS,PRIM CLOS 24920 PR AMPUTATN ARM,THRU 2551.00 HUMERUS,CIRCULAR 24925 PR AMPUTATN ARM,THRU 1773.00 HUMER,SECOND CLOS 25000 PR INCIS TENDON SHEATH,RADIAL 1331.00 25020 PR DECOMP FOREARM,1 2056.00 COMPART,W/O DEBRIDE 25024 PR DECOMP FOREARM,2 2268.00 COMPART,W/O DEBRIDE 25028 PR INCIS/DRAIN FOREARM DEEP 1777.00 25040 PR EXPLORE/TREAT WRIST JOINT 1919.00 25066 PR BIOPSY FOREARM SOFT 1468.00 25071 PR EXC TUMOR SOFT TISS 1077.00 FOREARM AND/WRIST SUBQ 3+CM 25073 PR EXC TUMOR SFT TISS 1307.00 FOREARM&//WRIST SUBFASC 3+CM 25075 PR EXC TUMOR SOFT TISSUE 1167.00 FOREARM &/WRIST SUBQ <3CM 25076 PR EXC TUMOR SOFT TISS 1267.00 FOREARM&/WRIST SUBFASC <3CM 25077 PR RAD RESECT TUMOR SOFT TISS 2272.00 FOREARM&/WRIST <3 CM 25078 PR RAD RESCJ TUM SOFT TISSUE 2918.00 FOREARM&/WRIST 3 CM/> 25085 PR INCISION OF WRIST CAPSULE 1583.00 25101 PR EXPLORE/TREAT WRIST JOINT 1425.00 25105 PR EXPLOR WRIST JT/REMV 1224.00 25107 PR REPAIR TRIANGULAR 1940.00 25109 PR EXCISE TENDON FOREARM/ 1915 25110 PR EXCIS TENDON SHEATH 861.00 LESN,WRIST/FORE 25111 PR EXCIS PRIMARY GANGLION 1130.00 25112 PR EXCIS RECURRENT GANGLION 1303.00 25115 PR RAD EXCIS WRIST 3016.00 SYNOV/TENDON,FLEXOR 25116 PR RAD EXCIS WRIST 2664.00 SYNOV/TENDON,EXTEN 25118 PR EXCIS SYNOV WRIST,EXTENS 1421.00 25119 PR EXCIS SYNOV WRIST,PART REMV 1268.00 25120 PR EXCIS/CURET BENIG BONE LES 2390.00 RAD/ULNA 25130 PR EXCIS BENIGN LESN CARPALS 1591.00 25145 PR 1909.00 25150 PR PART REMOVAL BONE,ULNA 2019.00 25151 PR PART REMOVAL BONE,RADIUS 2647.00 25210 PR REMOVAL OF CARPAL BONE 1685.00 25215 PR REMOVAL OF PROX ROW 2227.00 CARPAL BONES 25230 PR REMOVAL OF RADIAL STYLOID 1528.00 25240 PR EXCIS DISTAL 1602.00 25246 PR INJECTION FOR WRIST 958.00 25248 PR REMOVE FOREARM/WRIST 1372.00 FOREIGN BODY 25259 PR MANIPULATE WRIST 1479.00 25260 PR REPR FOREARM 1987.00 TEND/MUSC,FLEX,PRIM,EA 25263 PR REPR FOREARM 1983.00 TEND/MUSC,FLEX,SECON,EA 25265 PR REPR FOREARM 2646.00 TEND/FLEX,SECOND,GRFT 25270 PR REPR FOREARM 1689.00 TEND/MUSC,EXTEN,PRIM,EA 25272 PR REPR FOREARM 1396.00 TEND/MUSC,EXTEN,SECOND 25274 PR REPR FOREARM 2341.00 TEND/EXT,SECOND,GRAFT,EA 25275 PR REPR FOREARM EXT TEND 2122.00 SHEATH,GRAFT 25280 PR REVISE WRIST/FOREARM 1423.00 25290 PR INCISE WRIST/FOREARM 1541.00 25295 PR RELEASE WRIST/FOREARM 2472.00 25301 PR FUSION TENDONS WRIST,FINGR 2189.00 EXTENSORS 25310 PR TRANSPLANT FOREARM/WRIST 2796.00 25312 PR XPLANT FOREARM TENDON,W 1825.00 TENDON GRFT 25316 PR REVISE PALSY HAND 3254.00 TENDON(S),W XFER 25320 PR REVISE WRIST JOINT,CARPAL 2892.00 25332 PR ARTHROPLASTY WRIST JT 2724.00 25335 PR REALIGNMENT OF WRIST ON 3346.00 25337 PR RECONSTRUCT 2795.00 25360 PR OSTEOTOMY ULNA 2109.00 25365 PR OSTEOTOMY RADIUS/ULNA 3258 25375 PR OSTEOTOMY+ROD,RADIUS AND 3394 25390 PR OSTEOPLASTY,RADIUS OR 3302.00 ULNA,SHORTEN 25400 PR REPAIR NONUNION RADIUS OR 3451.00 25405 PR REPAIR NONUNION RADIUS OR 4198.00 ULNAW/GRAFT 25415 PR REPAIR NONUNION RADIUS AND 3446.00 25420 PR REPAIR NONUNION RADIUS AND 4119.00 ULNA W/GRAFT 25430 PR INSERT VASC PEDICLE,CARPAL 2588.00 BONE (HARII) 25440 PR REPAIR NONUNION SCAPHOID 2636.00 CARPAL BONE 25447 PR REPAIR INTERCARP/CARP- 2932.00 25449 PR REMOVE WRIST JOINT IMPLANT 3661.00 25450 PR EPIPHYSEAL ARREST DIST RAD 2192.00 OR ULNA 25500 PR CLOSED RX RADIAL SHAFT FX 834.00 25505 PR CLOSED RX RADIAL SHAFT 1624.00 FX,MANIPULATN 25515 OPEN TREATMENT RADIAL SHAFT 2218.00 FRACTURE 25520 PR CLOSED RX RADIAL SHAFT FX 1802.00 W/DISLOCATION 25525 OPEN RDL SHAFT FX CLOSED 2777.00 RAD/ULN JT DISLOCATE 25526 OPEN RDL SHAFT FX OPEN RAD/ULN 3369.00 JT DISLOCATE 25530 PR CLOSED RX ULNA SHAFT FX 804.00 25535 PR CLOSED RX ULNA SHAFT 1568.00 FX,MANIPULATN 25545 OPEN TREATMENT OF ULNAR SHAFT 2204.00 FRACTURE 25560 PR CLOSED RX RAD/ULNA SHAFT FX 838.00 25565 PR CLOSED RX RAD/ULNA SHAFT 1701.00 25574 OPEN TX RADIAL & ULNAR SHAFT FX 2354.00 FIX RADIUS OR ULNA 25575 OPEN TX RADIAL & ULNAR SHAFT FX 2639.00 FIX RADIUS AND ULNA 25600 PR CLOSED RX DIST RAD/ULNA FX 921.00 25605 PR CLOSED RX DIST RAD/ULNA 1812.00 25606 PR PERCUT SKELETAL FIX, DISTAL 2112.00 RADIUS FX 25607 PR OPEN RX DISTAL RADIUS FX, 2599.00 EXTRA-ARTICULAR 25608 PR OPEN RX DISTAL RADIUS FX, 2915.00 INTRA-ARTICULAR, 2 FRAG 25609 PR OPEN RX DISTAL RADIUS FX, 3708.00 INTRA-ARTICULAR, 3+ FRAG 25622 PR CLOSED RX NAVICULAR FX 939.00 25628 OPEN TX CARPAL SCAPHOID 2550.00 NAVICULAR FRACTURE 25630 PR CLOSED RX CARPAL FX 766.00 25645 PR OPEN RX CARPAL BONE 1425.00 25650 PR CLOSED RX ULNA STYLOID FX 1023.00 25651 PR PERCUT SKELETAL FIX,ULNAR 1422.00 STYLOID FX 25660 PR CLOSED TREAT WRIST 1449.00 25670 PR OPEN REPAIR WRIST 2142.00 25671 PR PERCUT SKELETAL FIX,DIST 1350 RADIOULN DISLOC 25675 PR CLOSED RX RADIO-ULNA 1454.00 25676 PR OPEN RX RADIO-ULNA 2221.00 25680 PR CLOSED RX NAVIC/LUNATE 1209.00 25685 PR OPEN RX NAVIC-PERILUNATE 1965.00 25690 PR CLOSED RX LUNATE 1190.00 25695 PR OPEN REPAIR LUNATE 1599.00 25800 PR FUSION OF WRIST JOINT 2501.00 25805 PR FUSION/SLIDING GRAFT WRIST 2856.00 25810 PR FUSION/GRAFT WRIST JOINT 3076.00 25820 PR FUSION INTERCARPAL 2290.00 25825 PR FUSION/GRAFT INTERCARPAL 3105.00 25830 PR FUSION RADIOULNAR JNT/ULNA 3333.00 25900 PR AMPUTATION FOREARM 1790.00 25927 PR AMPUTATION 2725.00 26010 PR DRAIN FINGER ABSCESS,SIMPLE 649.00 26011 PR DRAIN FINGER 978.00 26020 PR DRAIN HAND TENDON SHEATH 1342.00 26025 PR DRAINAGE PALM BURSA,SINGLE 1499.00 26030 PR DRAINAGE PALM 1253 BURSA,MULTIP/COMPLX 26034 PR INCIS DEEP FINGR/HAND BONE 1360.00 26035 PR DECOMPRESS 2595.00 FINGERS/HAND,INJECT INJ 26040 PR RELEASE PALM 786.00 CONTRACT,PERCUTANEOUS 26045 PR RELEASE PALM 1079.00 CONTRACT,OPEN,PARTIAL 26055 PR INCISE FINGER TENDON SHEATH 2165.00 26075 PR EXPLORE & TREAT METACARPO- 1047.00 PHAL JT 26080 PR EXPLORE/TREAT 983.00 INTERPHALANGEAL JT,EA 26105 PR BIOPSY SYNOVIUM MC-P JT 1200.00 26110 PR BIOPSY SYNOVIUM I-P JT 1136.00 26111 PR EX TUM/VASC MALF SFT TISS 1022.00 HAND/FNGR SUBQ 1.5+CM 26113 PR EX TUM/VASC MAL SFT TIS 1341.00 HAND/FNGR SUBFSC 1.5+CM 26115 PR EXC TUM/VASC MAL SFT TISS 1562.00 HAND/FNGR SUBQ <1.5CM 26116 PR EXC TUM/VAS MAL SFT TIS 1506.00 HAND/FNGR SUBFASC<1.5CM 26118 PR RAD RESCJ TUM SOFT TISSUE 3738.00 HAND/FINGER 3 CM/> 26121 PR PALMAR FASCIECTOMY 2268.00 26123 PR PART PALMAR FASCIEC,OPEN 1 2617.00 26125 PR PART PALMAR FASCIEC,OPEN 952.00 ADDNL DIGIT 26130 PR EXCIS JT 1660.00 26135 PR EXCIS JT LINING,MC-P JT,EACH 1942.00 26140 PR EXCIS JT LINING,PROX I-P 1700.00 26145 PR RAD EXCIS JT 1624.00 26160 PR EXCIS TENDON SHEATH LESION, 2001.00 HAND/FINGER 26170 PR EXCIS PALM TENDON FLEXOR, 1034 26180 PR EXCIS FINGER TENDON FLEXOR, 1563.00 26200 PR EXCIS BENIGN BONE 1133.00 LESN,METACARPAL 26210 PR EXCIS BENIGN BONE 1384.00 26230 PR PART REMV BONE,METACARPAL 1615.00 26235 PR PART REMV BONE,PROX/MID 1579.00 26236 PR PART REMV BONE,DISTAL 1390.00 26260 PR RAD RESEC PROX/MID PHALANX 2142.00 26320 PR REMOVAL OF IMPLANT FROM 1223.00 HAND/FINGR 26340 PR MANIPULATE FINGER JT W/ 934.00 ANESTH,EACH 26341 PR MANIPLATN PALAR FASCIAL CRD 244.00 POST INJ SINGLE CORD 26350 PR REPAIR FLEXOR 1950.00 TENDON,HAND,W/O GRAFT,EA 26352 PR REPAIR FLEXOR 1994.00 TENDON,HAND,W/ GRAFT,EA 26356 PR REPAIR FLEX TENDON,ZONE 2464.00 26357 PR REPAIR FLEX TENDON,ZONE 3133.00 2,SECON,HAND,EA 26358 PR REPAIR FLEX TEND,ZONE 2240.00 2,SEC,HAND,W/GRFT 26370 PR REPAIR PROFUNDUS 2135.00 26372 PR REPAIR PROFUNDUS 2159.00 TENDON,SECONDARY/GRFT 26390 PR EXCIS FLEX TEND HAND,IMPL 2999.00 ROD,DELAY GRFT 26392 PR REMOV ROD & INSERT FLEX 3386.00 TEND HAND GRFT 26410 PR REPAIR EXTEN 1539.00 TENDON,DORSUM HAND,EA 26412 PR REPAIR EXTEN 2408.00 TENDON,DORSUM HAND,GRFT 26415 PR EXCIS EXT TEND HAND,IMPL 2385.00 ROD,DELAY GRFT 26418 PR REPAIR EXTEN 2184.00 TENDON,DORSUM FINGR,EA 26420 PR REPAIR EXTEN 2702.00 TENDON,DORSUM FINGR,GRFT 26426 PR REPAIR EXT TEND,CENT 1804.00 26432 PR REPAIR EXTEN TENDON,DISTAL 1876.00 INSERT,CLOSE 26437 PR REALIGNMENT OF 2291.00 26440 PR TENOLYSIS, FLEX 1711.00 TENDON,PALM/FINGER,EA 26442 PR TENOLYSIS FLEX TENDON,PALM 3181.00 & FINGER,EA 26445 PR TENOLYSIS EXT 2316.00 TENDON,HAND/FINGER,EA 26449 PR RELEASE FOREARM/HAND 1759 EXTEN TENDON 26450 PR TENOTOMY PALM 1447.00 FLEX,SINGLE,OPEN,EACH 26455 PR TENOTOMY FINGR 1434.00 FLEX,SINGLE,OPEN,EACH 26460 PR TENOTOMY HAND 1386.00 EXTEN,SINGLE,OPEN,EACH 26471 PR FUSION FINGER TENDONS,PIP JT 2141.00 26478 PR TENDON 1651.00 LENGTHENING,FLEX,HAND/FINGR 26479 PR TENDON 2201.00 SHORTENING,FLEX,HAND/FINGR 26480 PR TRANSPLANT HAND TENDON 2867.00 26483 PR TRANSPLANT/GRAFT HAND 2960.00 26485 PR TRANSPLANT PALM TENDON 2006.00 26489 PR TRANSPLANT/GRAFT PALM 2352.00 26490 PR REVISE THUMB TENDON 2778.00 26492 PR THUMB TENDON 2202.00 26496 PR REVISE THUMB TENDON,OTHR 3020.00 26497 PR FINGER TENDON TRANSFER,4-5 2159.00 26500 PR HAND TENDON PULLEY 1631.00 RECONSTRUCTION 26502 PR HAND TENDON PULLEY 1765.00 RECONST,GRAFT 26508 PR RELEASE THUMB CONTRACTURE 1661.00 26516 PR FUSION MC-P JOINT,SINGLE 2439.00 26520 PR RELEASE MC-P JT 1781.00 26525 PR RELEASE I-P JT CONTRACTURE 2559.00 26530 PR ARTHROPLASTY MC-P JT,SINGLE 1835.00 26531 PR ARTHROPLASTY MC-P 1976.00 26535 PR ARTHROPLASTY I-P JT 1430.00 26536 PR ARTHROPLASTY I-P JT,IMPLANT 1890.00 26540 PR FIX COLLAT LIG,MC-P JT,I-P JT 1880.00 26541 PR FIX COLLAT LIG,MC-P JT,GRAFT 2077.00 26542 PR FIX COLLAT LIG,MC-P JT,LOCAL 2478.00 26545 PR FIX COLAT LIG,I-P 2538.00 26546 PR FIX NONUNION 3125.00 26548 PR FIX FINGER,VOLAR PLATE,I-P JT 1968.00 26550 PR POLLICIZATION OF DIGIT 6578.00 26560 PR REPAIR OF WEB FINGER,EACH 2075 26561 PR REPAIR OF WEB FINGER,GRAFT 3095.00 26562 PR REPAIR OF WEB 5291.00 26565 PR CORRECT METACARPAL 1685.00 26567 PR CORRECT FINGER DEFORMITY 1765.00 26587 PR RECONST POLYDACT DIGIT,SOFT 3039.00 TIS & BONE 26591 PR REPAIR MUSCLES OF HAND 1096 26593 PR RELEASE MUSCLES OF HAND 1536.00 26596 PR EXCISION CONSTRICT FINGR 1920.00 26600 PR CLOSED RX METACARPAL FX 778.00 26605 PR CLOSED RX METACARPAL 701.00 26607 PR CLOSED RX METACARP 1629.00 FX,W/MANIP,W/EXT FIX 26608 PR CLOSED RX METACARPAL 1320.00 26615 OPEN TX METACARPAL FRACTURE 1433.00 SINGLE EA BONE 26641 PR TREAT THUMB 941.00 26645 PR TREAT THUMB FX/DISLOC,MANIP 912.00 26650 PRQ SKEL FIXATION CARP/MTCRPL 1345.00 FX DISLOCATE THUMB 26665 OPEN TX CARPOMETACARPAL 1938.00 FRACTURE DISLOCATE THUMB 26670 PR CLOSED RX, CARPOMETACAR 851.00 DISLOC,NON-THUMB 26676 PR PERCUT FIX CARPOMETACAR 1258.00 DISLOC,NON-THUMB 26685 OPEN TX CARPOMETACARPAL 1760.00 DISLOCATE NOT THUMB 26686 PR OPEN RX C-MC 2104.00 26700 PR CLOSED RX MC-P DISLOC 1081.00 26705 PR CLOSED RX MC-P 1451.00 26706 PR PERCUT RX MC-P DISLOC 1086.00 26715 OPEN TREATMENT 1250.00 METACARPOPHALANGEAL 26720 PR CLOSE RX PROX/MID FING SHFT 711.00 26725 PR CLOSE RX PROX/MID FING SHFT 1219.00 FX,MANIP 26727 PR PERCUT RX PROX/MID FING 1140.00 26735 OPEN TX PHALANGEAL SHAFT 1460.00 FRACTURE PROX/MIDDLE EA 26740 PR CLOSE RX FINGR ARTICULAR FX 711.00 26742 PR CLOSE RX FINGR ARTICULAR 839.00 26746 OPEN TX ARTICULAR FRACTURE 1698.00 MCP/IP JOINT EA 26750 PR CLOSE RX DIST FINGR FX 624.00 26755 PR CLOSE RX DIST FINGR 709.00 26756 PR PERCUT RX DIST FINGR FX 1030.00 26765 OPEN TX DISTAL PHALANGEAL 970.00 FRACTURE EACH 26770 PR CLOSED RX IP JT DISLOCATION 683.00 26775 PR CLOSED RX IP JT 1238.00 26776 PR PERCUT RX IP JT DISLOCATION 1114.00 26785 OPEN TX INTERPHALANGEAL JOINT 1185.00 DISLOCATION 1 26841 PR FUSION 1ST 1916.00 26850 PR FUSION MC-P JT 2525.00 26852 PR FUSION MC-P JT,GRAFT 2819.00 26860 PR FUSION FINGER JOINT 2079.00 26861 PR FUSION FINGER JOINT,EACH 692.00 26862 PR FUSION/GRAFT FINGER JT 2529.00 26910 PR AMPUTATE 1795.00 26951 PR AMPUTATION FINGER/THUMB 1949.00 26952 PR AMPUTATION 1686.00 26990 PR INCIS/DRAIN PELVIS/HIP,DEEP 1990.00 26992 PR INCIS/DRAIN PELVIS/HIP,OPEN 3179.00 27000 PR INCIS HIP 1444.00 27001 PR INCIS HIP 1741.00 27003 PR INCIS HIP ADDUC,OPEN,OBTUR 1840.00 27005 PR INCIS ILIOPSOAS,OPEN 2340.00 27006 PR INCIS HIP ADDUCTORS,OPEN 2599.00 27025 PR INCIS OF HIP/THIGH FASCIA 3276.00 27030 PR DRAINAGE OF HIP JOINT 3036.00 27035 PR DENERVATION OF HIP JOINT 3000.00 27036 PR RELEASE HIP FLEXION 3584.00 27040 PR BX SOFT 1214.00 27041 PR BX SOFT 1683.00 27043 PR EXCISION TUMOR SOFT TISSUE 1191.00 PELVIS&HIP SUBQ 3+CM 27045 PR EXC TUMOR SOFT TISSUE 2640.00 PELVIS & HIP SUBFASC 5+CM 27047 PR EXC TUMOR SOFT TISSUE 1533.00 PELVIS & HIP SUBQ <3CM 27048 PR EXC TUMOR SOFT TISSUE 1547.00 PELVIS & HIP SUBFASC <5CM 27049 PR RAD RESECT TUMOR SOFT 3469.00 TISSUE PELVIS & HIP <5 CM 27050 PR OPEN BIOPSY SACROILIAC JOINT 1163.00 27052 PR OPEN BIOPSY OF HIP JOINT 2063 27059 PR RAD RESECTION TUMOR SOFT 4264.00 TISS PELVIS&HIP 5 CM/> 27062 PR REMOVE TROCH 1151.00 27066 PR EXCISISON BONE CYST BENIGN 2880.00 TUMOR,PELVIS/HIP,DEEP 27071 PR PARTIAL EXCISION DEEP PELVIS 3265.00 27075 PR RAD RESEC UNILAT ILEUM 8193.00 27076 PR RAD RESEC ILIUM+ACETABULUM 8981.00 27078 PR RAD RESEC ISCHIAL TUBER+GR 7407.00 27080 PR REMOVAL OF COCCYX 1307.00 27086 PR REMOVE PELV/HIP 754 27090 PR REMOVAL OF HIP PROSTHESIS 2647.00 27091 PR REMOVAL OF HIP 5547.00 PROSTHESIS,COMPLEX 27093 PR INJECTION HIP ARTHROGRAM 1222.00 27095 PR INJECTION HIP 1524.00 27096 PR INJECT SI JOINT 505.00 ARTHRGRPHY&/ANES/STEROID 27120 PR RECONSTRUC HIP SOCKET 4594.00 27122 PR RECONSTRUC HIP 3470.00 SOCKET,RESEC FEM HEAD 27125 PR PARTIAL HIP REPLACEMENT 3378.00 27130 PR TOTAL HIP ARTHROPLASTY 5757.00 27132 PR CONV PREV HIP SURG TO TOT 6818.00 HIP ARTHROPLAS 27134 PR REVISE TOTAL HIP 7424.00 27137 PR REVISE ACETABULAR PART OF 5909.00 TOTAL HIP 27138 PR REVISE FEM PART OFTOTAL HIP 5909.00 27146 PR OSTEOTOMY OF HIP BONE 4552.00 27147 PR OSTEOTOMY HIP BONE,OPEN 6003.00 27158 PR OSTEOTOMY PELVIS BILAT 5724 27161 PR OSTEOTOMY OF NECK OF 4309.00 27165 PR OSTEOTOMY/FIX 4874.00 INTER/SUBTROCH FEMUR 27170 PR BONE GRAFT FEMUR 3670.00 27176 PR CLOSED RX SLIP FEM 3030.00 27177 PR OPEN RX SLIP EPIPHYSIS 3475.00 27187 PR REINFORCE HIP BONES 3333.00 27193 PR CLOSED RX PELVIC RING 1662.00 27194 PR CLOSED RX PELV RING 2445.00 FX/SUBLUX,MANIP 27197 PR CLSD TX PELVIC RING FX W/O 301.00 MANIPULATION 27198 PR CLSD TX PELVIC RING FX 767.00 W/MANIPULATION W/ANES 27215 PR OPEN FIX ILIAC FX,INTERN 2334 27216 PR PERCUT FIX POST PELV RING FX 3357.00 27217 PR OPEN INTERN FIX ANTER PELV 3252.00 27218 PR OPEN INTERN FIX POST PELV 4894.00 27220 PR CLOSED RX ACETABULAR FX 1891.00 27222 PR CLOSED RX ACETABULAR 3019.00 FX,MANIPULATN 27226 PR OPEN INTERN FIX ACETABULAR 3094.00 WALL FX 27227 PR OPEN INTERN FIX ACETABULAR 5962.00 27228 PR OPEN INTERN FIX COMPLEX 6879.00 ACETABUL FX 27230 PR CLOSED RX PROX/NECK FEMUR 1692 27235 PR PERCUT FIX PROX/NECK FEMUR 3250.00 27236 PR FEMORAL FX, OPEN TX 3562.00 27244 PR TREAT INTER/SUBTROCH 3651.00 FX,W/PLATE/SCREW 27245 PR OPEN FIX INTER/SUBTROCH 5226.00 27246 PR CLOSED RX GR TROCHANTERIC 1365.00 27248 OPEN TREATMENT GREATER 2491.00 TROCHANTERIC FRACTURE 27250 PR CLOSED RX TRAUMATIC HIP 1172.00 27252 PR CLOSED RX TRAUMA HIP 2378.00 DISLOC,ANESTH 27253 PR OPEN RX TRAUMATIC HIP 3345.00 27256 PR CLOSED RX SPONTANEOUS HIP 1077 27257 PR CLOSED RX SPONT HIP 1211.00 27258 PR OPEN RX SPONTANEOUS HIP 3962.00 27259 PR OPEN RX SPONT HIP 6341.00 DISLOC,FEM SHORT 27265 PR CLOSED RX POST HIP 1298.00 ARTHRPLAS DISLOC 27266 PR CLOSED RX POST HIP FIX 1835.00 DISLOC,ANESTH 27267 PR CLOSED TX FEMORAL 1258.00 FRACTURE PROX HEAD W/O MANIP 27269 PR OPEN TX FEMORAL FRACTURE 4437 PROXIMAL END HEAD 27275 PR MANIPULATION HIP JOINT W 651.00 ANESTHESIA 27279 PR ARTHRODESIS SACROILIAC 1409.00 JOINT PERCUTANEOUS 27280 PR ARTHRODESIS SACROILIAC 3179.00 JOINT W/OBTAINING GRAFT 27282 PR FUSION OF PUBIC BONES 2585.00 27290 PR HINDQUARTER AMPUTATION 5809.00 27295 PR DISARTICULATION OF HIP 4517 27301 PR INCIS/DRAIN THIGH/KNEE 1815.00 ABSCESS,DEEP 27303 PR INCIS DEEP BONE 1619.00 27305 PR FASCIOTOMY,ILIOTIBIAL,OPEN 1697.00 27306 PR INCIS THIGH 1244.00 TENDON,ADDUC/HAMST,SINGL 27307 PR INCIS THIGH 1500.00 TENDON,ADDUC/HAMST,MULTI 27310 PR EXPLOR/DRAIN KNEE,INFECTN 2245.00 27323 PR BX THIGH/KNEE SOFT 682.00 27324 PR BX THIGH/KNEE SOFT 1223.00 27327 PR EXCISION TUMOR SOFT TISSUE 1168.00 THIGH/KNEE SUBQ <3CM 27328 PR EXC TUMOR SOFT TISSUE 1572.00 THIGH/KNEE SUBFASC <5CM 27329 PR RAD RESECT TUMOR SOFT 3680.00 TISSUE THIGH/KNEE <5CM 27331 PR ARTHROTOMY/EXPLORE/TREAT 1199.00 KNEE JOINT 27334 PR RMV KNEE SYNOVIUM,ANT/POST 2144.00 27335 PR REMV SYNOVIUM KNEE,ANTER & 2714 27337 PR EXCISON TUMOR SOFT TISSUE 976.00 THIGH/KNEE SUBQ 3+CM 27339 PR EXC TUMOR SOFT TISSUE 1757.00 THIGH/KNEE SUBFASC 5+CM 27340 PR REMOVAL PREPATELLA BURSA 1150.00 27345 PR REMOVAL SYNOVIAL CYST,KNEE 1211.00 27347 PR REMOVE KNEE CYST/GANGLION 2045.00 27350 PR PART/FULL REMOVAL OF 2046.00 27355 PR REMV BENIGN FEMUR LESION 2132.00 27356 PR REMV BENIGN FEMUR 2314.00 27358 PR REMV BENIGN FEMUR 987.00 27360 PR PART REMV FEMUR/PROX TIB/FIB 2710.00 27364 PR RAD RESECTION TUMOR SOFT 3530.00 TIS THIGH/KNEE 5 CM/> 27370 PR INJECTION KNEE 1098.00 27372 PR REMV FOREIGN 1450.00 BODY,KNEE/THIGH,DEEP 27380 PR FIX INFRAPATELLA 1909.00 27381 PR FIX PATELLA 2581.00 27385 PR FIX QUAD/HAMSTR MUSC 2036.00 RUPT,PRIMARY 27386 PR FIX QUAD/HAMSTR MUSC 2951.00 27391 PR TENOTOMY,UNI HAMSTR,KNEE- 1837.00 THIGH,MULTI 27392 PR TENOTOMY,BI HAMSTR,KNEE- 2252.00 THIGH,MULTI 27393 PR LENGTHEN HAMSTR 1628.00 27394 PR LENGTHEN HAMSTR 2102.00 TENDON,MULTI,ONE LEG 27395 PR LENGTHEN HAMSTR 2820.00 TENDON,MULTI,2 LEGS 27400 PR TENDON/MUSC XFER,HAMSTR- 1729.00 27403 PR ARTHROTOMY,OPEN REPAIR 2424.00 27405 PR REPAIR COLLAT 2379.00 27407 PR REPAIR CRUCIATE 2823.00 27412 PR AUTOCHONDROCYTE IMPLANT 6139.00 27415 PR OSTEOCHONDRAL KNEE 4699.00 27416 PR OSTEOCHONDRAL KNEE 2888.00 27418 PR REPAIR ANTER TIBIAL TUBERCLE 3182.00 27420 PR REVISION OF UNSTABLE 2515.00 27422 PR FIX UNSTABLE PATELLA,EXTEN 2606.00 27425 PR LATERAL RETINACULAR 2273.00 27427 PR LIGMT REVISION,KNEE,EXTRA- 3636.00 27428 PR LIGMT REVISION,KNEE,INTRA- 3983.00 27429 PR LIGMT 4242.00 27430 PR REVISION QUADRICEPS 2354.00 27435 PR POST CAPSULAR RELEASE,KNEE 2855.00 27438 PR ARTHROPLASTY PATELLA WITH 2631.00 IMPLANT 27445 PR PLASTY KNEE,CONSTRAINED 4467 PROSTHESIS 27446 PR PLASTY KNEE,MED OR LAT 3738.00 27447 PR TOTAL KNEE ARTHROPLASTY 5696.00 27448 PR OSTEOTOMY FEMUR 2632.00 SHAFT/SUPRACONDY 27450 PR OSTEOTOMY FEMUR SHAFT,W 3289.00 27454 PR OSTEOTOMIES FEMUR 4033.00 SHAFT+INTRA ROD 27455 PR OSTEOTOMY PROX TIB,1 1643.00 COMPARTMT 27500 PR CLOSED RX FEMUR SHAFT FX 1700.00 27502 PR CLOSED RX FEMUR SHAFT 2500.00 27503 PR CLOSED RX CONDYLAR 2855.00 27506 PR OPEN RX FEMUR FX+INTRAMED 4032.00 27507 PR OPEN RX FEMUR 3203.00 27509 PR PERCUT FIX DISTAL FEMUR 2270.00 27510 PR CLOSED RX 2178.00 27511 OPEN TX FEMORAL 3314.00 SUPRACONDYLAR FRACTURE W/O 27513 OPEN TX FEMORAL 4247.00 SUPRACONDYLAR FRACTURE W 27514 OPEN TX FEMORAL FRACTURE 4092.00 DISTAL MED/LAT CONDYLE 27520 PR CLOSED RX PATELLA FX 1047.00 27524 PR OPEN RX PATELLA FX 2423.00 27530 PR CLOSED RX TIBIAL PLATEAU FX 1258.00 27532 PR CLOSED RX TIB PLAT FX+MANIP 1999.00 27535 OPEN TX TIBIAL FRACTURE 2874.00 PROXIMAL UNICONDYLAR 27536 PR OPEN RX BILAT TIB PLAT FX 3637.00 27538 PR CLOSED RX TIB TUBER FX 1559.00 27540 OPEN TX INTERCONDYLAR 3023.00 SPINE/TUBRST FRACTURE KNEE 27550 PR CLOSED RX KNEE DISLOCATN 1253.00 27552 PR CLOSED RX KNEE 1966.00 27560 PR CLOSED RX KNEECAP 892.00 27570 PR MANIPULATN KNEE 515.00 27580 PR FUSION OF KNEE 4566.00 27590 PR AMPUTATE THIGH,THRU FEMUR 3131.00 27594 PR AMPUTATE THIGH,SECONDRY 1449.00 27596 PR AMPUTATE THIGH,RE-AMPUTATN 2374.00 27600 PR DECOMPRESS ANT/LAT LEG 1378.00 27601 PR DECOMPRESS POST LEG 1130.00 27602 PR DECOMPRESS ANT/LAT+POST 1406.00 LEG CMPART 27603 PR DRAIN LOWER LEG DEEP 1856.00 ABSC/HEMATOMA 27605 PR INCIS ACHILLES TENDON+LOCAL 1487.00 ANESTH 27606 PR INCIS ACHILLES TENDON+GEN 1818.00 27607 PR DRAIN LEG/ANKLE BONE FOR 1939.00 27610 PR EXPLORE/TREAT ANKLE JOINT 2053.00 27612 PR EXPLORE/RELEASE POST CAP 1793.00 27613 PR BX LOW LEG SOFT 645.00 27614 PR BX LOW LEG SOFT TISSUE,DEEP 1868.00 27615 PR RAD RESECTION TUMOR SOFT 3716.00 TISSUE LEG/ANKLE <5CM 27616 PR RAD RESECTION TUMOR SOFT 3052.00 TISSUE LEG/ANKLE 5 CM/> 27618 PR EXC TUMOR SOFT TISSUE 1826.00 LEG/ANKLE SUBQ <3CM 27619 PR EXC TUMOR SOFT TISSUE 1660.00 LEG/ANKLE SUBFASCIAL <3CM 27620 PR EXPLOR ANKLE JOINT 1152.00 27625 PR EXPLOR ANKLE 2056.00 27626 PR EXPLOR ANKLE 1574 27630 PR EXCIS LESN TENDON SHEALTH 1779.00 LEG/ANKLE 27632 PR EXC TUMOR SOFT TISSUE 1422.00 LEG/ANKLE SUBQ 3+CM 27634 PR EXC TUMOR SOFT TISSUE 2335.00 LEG/ANKLE SUBFASC 5+CM 27635 PR EXCIS BENIGN LESN,TIB/FIB 1945.00 27637 PR EXCIS BENIGN 2698.00 27638 PR EXCIS BENIGN 2533.00 27640 PR PARTIAL REMOVAL OF TIBIA 2940.00 27641 PR PARTIAL REMOVAL OF FIBULA 2393.00 27645 PR RAD RESEC TUMOR,TIBIA 3531.00 27648 PR INJECTION FOR ANKLE 863.00 27650 PR REPAIR ACHILLES 2301.00 27654 PR REPAIR ACHILLES 2314.00 27656 PR REPAIR LEG FASCIA DEFECT 1565.00 27658 PR REPAIR FLEX LEG 1833.00 27659 PR REPAIR FLEX LEG 2356.00 27664 PR REPAIR EXTEN LEG 918.00 27665 PR REPAIR EXTEN LEG 2123.00 27675 PR REPAIR PERONEAL TENDONS 1733.00 27676 PR REPAIR PERONEAL TENDONS,FIB 2027.00 OSTEOTMY 27680 PR RELEASE TIB/FIB/ANKLE FLEX 1453.00 TENDON,EA 27681 PR RELEASE TIB/FIB/ANKL FLEX 1948.00 TENDON,MUL 27685 PR LENGTH/SHORT LEG/ANKL 1920.00 TENDON,SINGLE 27686 PR LENGTH/SHORT LEG/ANKL 2604.00 TENDON,MULTI 27687 PR GASTROCNEMIUS RECESSION 1554.00 27690 PR XFER SINGLE SUPERFICI LOW 2032.00 LEG TENDON 27691 PR XFER SINGLE DEEP LOW LEG 2653.00 27695 PR REPAIR 1 COLLAT ANKLE 1652.00 LIGMNT,PRIMARY 27696 PR REPAIR BOTH COLLAT ANKL 1964.00 LIGMT,PRIMRY 27698 PR REPAIR COLLAT ANKLE 3175.00 LIGMNT,SECONDARY 27700 PR ARTHROPLASTY ANKLE JOINT 1547.00 27702 PR TOTAL ANKLE REPLACEMENT 3541.00 27703 PR SECONDARY 3622.00 RECONSTRUCTION,ANKLE JOINT 27704 PR REMOVAL OF ANKLE IMPLANT 1469 27705 PR OSTEOTOMY TIBIA 2486.00 27707 PR OSTEOTOMY FIBULA 1235.00 27709 PR OSTEOTOMY TIBIA & FIBULA 2424.00 27712 PR OSTEOTOMIES 3946.00 27715 PR LENGTHENING TIBIA/FIBULA 3727.00 27720 RPR NON/MALUNION TIBIA 3100.00 27722 RPR NON/MALUNION TIBIA+SLIDING 3175 27724 RPR NON/MALUNION 4080.00 27726 PR RPR FIBULA 2748.00 NONUNION/MALUNION W INT 27730 PR 3206.00 ARREST,EPIPHYSEAL,OPEN,DISTAL 27732 PR STOP GROWTH DISTAL FIBULA 1316.00 EPIPHYSIS 27734 PR STOP GROWTH DISTAL TIB/FIB 1967.00 EPIPHYSES 27745 PR REINFORCE TIBIA 2678.00 27750 PR CLOSED RX TIBIA SHAFT FX 1112.00 27752 PR CLOSED RX TIBIA SHAFT 1737.00 FX,MANIPULATN 27756 PR PERCUT RX TIBIA SHAFT FX 2063 27758 PR OPEN RX TIBIA SHAFT 2779.00 27759 PR TREAT TIBIAL SHAFT FX, 3225.00 INTRAMED IMPLANT 27760 PR CLOSED RX MED MALLEOLUS FX 1071.00 27762 PR CLOSED RX MED MALLEOLUS 1619.00 27766 OPEN TREATMENT MEDIAL 2069.00 MALLEOLUS FRACTURE 27767 PR CLOSED TREATMENT PST 773.00 MALLEOLUS FRACTURE W/O MANIP 27768 PR CLOSED TREATMENT PST 1290.00 MALLEOLUS FRACTURE W MANIP 27769 PR OPEN TREATMENT POSTERIOR 2057.00 MALLEOLUS FRACTURE 27780 PR CLOSED RX PROX/SHAFT FIBULA 978.00 27781 PR CLOSED RX PROX/SHAFT FIB 1401.00 27784 OPEN TREATMENT PROXIMAL 1802.00 FIBULA/SHAFT FRACTURE 27786 PR CLOSED RX DIST FIBULA FX 1027.00 27788 PR CLOSED RX DIST FIBULA 1425.00 27792 OPEN TX DISTAL FIBULAR 1937.00 FRACTURE LAT MALLEOLUS 27808 CLOSED TX BIMALLEOLAR ANKLE 1099.00 FRACTURE W/O MANIP 27810 CLOSED TX BIMALLEOLAR ANKLE 1582.00 FRACTURE W MANIP 27814 OPEN TREATMENT BIMALLEOLAR 2569.00 ANKLE FRACTURE 27816 PR CLOSED RX TRIMALLEOLAR FX 808.00 27818 PR CLOSED RX TRIMALLEOLAR 1646.00 27822 OPEN TX TRIMALLEOLAR ANKLE FX 2848.00 W/O FIX PST LIP 27823 OPEN TX TRIMALLEOLAR ANKLE FX 3246.00 W FIX PST LIP 27824 PR CLOSED RX WEIGHT BEAR DIST 1093.00 27825 PR CLOSED RX WEIGHT BEAR DIST 1885.00 TIB,MANIP 27826 OPEN TREATMENT FRACTURE 2424.00 DISTAL TIBIA FIBULA 27827 OPEN TREATMENT FRACTURE 3560.00 DISTAL TIBIA ONLY 27828 OPEN TREATMENT FRACTURE 4010.00 DISTAL TIBIA & FIBULA 27829 OPEN TX DISTAL TIBIOFIBULAR 1612.00 JOINT DISRUPTION 27830 PR CLOSED RX PROX TIB/FIB 947.00 27832 OPEN TX PROX TIBFIB JOINT 2608.00 DISLOCATE EXC PROX FIB 27840 PR CLOSED RX ANKLE DISLOCATN 1115.00 27842 PR CLOSED RX ANKLE 1498.00 27846 PR OPEN RX ANKLE DISLOCATN 2364.00 27848 PR OPEN RX ANKLE 2784.00 27860 PR MANIPULATION ANKLE JT W 579.00 ANESTHESIA 27870 PR ARTHRODESIS,ANKLE,OPEN 3269.00 27880 PR AMPUTATION LOW LEG THRU 2578.00 27882 PR AMPUTATION LOW 2104.00 27884 PR AMPUTATION LOW LEG,SECOND 1489.00 CLOSURE 27886 PR RE-AMPUTATION LOWER LEG 2149.00 27892 PR DECOMPRESS FASCIOTOMY 1971.00 LEG,ANT/LAT 27894 PR DECOMPRESS LEG,ANT/LAT & 3041.00 28002 PR DEEP DISSEC FOOT INFEC,1 1536.00 28003 PR DEEP DISSEC FOOT 2127.00 28008 PR INCISION OF FOOT/TOE FASCIA 1099.00 28010 PR INCISION SUBCUT TOE TENDON 1083.00 28011 PR INCISION SUBCUT TOE 821.00 28020 PR EXPLOR 1377.00 28022 PR EXPLOR METATARSO-PHALANG 1409.00 28035 PR TARSAL TUNNEL RELEASE 1515.00 28039 PR EXCISION TUMOR SOFT TISSUE 1185.00 FOOT/TOE SUBQ 1.5+CM 28041 PR EXC TUMOR SOFT TISSUE 1087.00 FOOT/TOE SUBFASC 1.5+CM 28043 PR EXCISION TUMOR SOFT TISSUE 991.00 FOOT/TOE SUBQ <1.5CM 28045 PR EXC TUMOR SOFT TISSUE 1785.00 FOOT/TOE SUBFASC <1.5CM 28046 PR RAD RESECTION TUMOR SOFT 2579.00 TISSUE FOOT/TOE <3CM 28060 PR PART EXCIS PLANTAR FASCIA 1524.00 28080 PR EXCIS INTERDIGITAL 1236.00 28086 PR SYNOVECTOMY FLEX TENDN 1948.00 SHEATH,FOOT 28090 PR EXCIS TENDN/CAPSULE 1362.00 28092 PR EXCIS TENDN/CAPSULE 1290.00 28100 PR REMV TALUS/HEEL BENIGN 2167.00 28103 PR REMV TALUS/HEEL BENIGN 1955.00 LESN,ALLOGRFT 28104 PR REMV TARSAL/METATARSAL 1888.00 BENIGN BONE LESN 28107 PR REMV OTHR FOOT BENIGN 1854.00 LESN,ALLOGRFT 28108 PR REMV TOE BENIGN BONE LESN 1254.00 28110 PR PART EXCIS 5TH METATARSAL 1659.00 28111 PR FULL EXCIS 1ST METATARSAL 1262 28112 PR FULL EXCIS 2,3 OR 4TH METATAR 1457.00 28113 PR FULL EXCIS 5TH METATARSAL 1514.00 28116 PR EXCIS TARSAL COALITION 1982.00 28118 PR REMOVAL OF HEEL BONE 1719.00 28119 PR REMOVAL OF HEEL SPUR 1345 28120 PR PART REMV TALUS OR 1826.00 28122 PR PART REMV OTHR 2001.00 28124 PR PART REMV PHALANX OF TOE 1428.00 28130 PR REMOVAL OF TALUS 1634.00 28140 PR REMOVAL OF METATARSAL 1986.00 28153 PR RESEC HEAD OF PHALANX,TOE 1181.00 28160 PR RESEC TOE AT I-P JT,SINGLE,EA 1228.00 28190 PR REMV FOOT FOREIGN 738.00 BODY,SUBCUTANEOUS 28192 PR REMV FOOT FOREIGN 1151.00 28200 PR REPAIR FLEX FOOT TENDON,EA 1379.00 28208 PR REPAIR EXTEN LEG 1321.00 28220 PR RELEASE FLEX FOOT 1326.00 28222 PR RELEASE FLEX FOOT 1834.00 28225 PR RELEASE EXTEN FOOT 1057.00 28230 PR INCISION FLEX FOOT TENDON(S) 1292.00 28232 PR INCISION FLEX TOE TENDON 1177.00 28234 PR INCISION EXTEN FOOT/TOE 1191.00 28238 PR RECONST POST TIB TEND,EXCIS 2397.00 ACC TAR NAV 28250 PR DIVISN PLANTAR 1642.00 28260 PR CAPSULOTOMY MIDFOOT JT,MED 2000.00 RELEASE 28261 PR CAPSULOTOMY MIDFOOT,TENDN 3580.00 LENGTH 28262 PR CAPSULOTOMY 4011.00 28264 PR CAPSULOTOMY MIDTARSAL 2518.00 28270 PR CAPSULOTOMY MT-P 1402.00 28272 PR CAPSULOTOMY I-P JT,FOOT,EA 1170.00 28285 PR REPAIR OF HAMMERTOE,ONE 1384.00 28288 PR PART REMV BONE METATARSAL 1494.00 HEAD,EA 28289 PR HALLUX RIGIDUS 2101.00 W/CHEILECTOMY 1ST MP JT W/O 28291 PR HALLUX RIGIDUS 2610.00 W/CHEILECTOMY 1ST MP JT 28292 PR CORRJ HALLUX VALGUS 1959.00 W/SESMDC W/RESCJ PROX PHAL 28295 PR CORRJ HALLUX VALGUS 2432.00 W/SESMDC W/PROX METAR OSTEOT 28296 PR CORRJ HALLUX VALGUS 2305.00 W/SESMDC W/DIST METAR OSTEOT 28297 PR CORRJ HALLUX VALGUS 2427.00 W/SESMDC W/1METAR MEDIAL CNF 28298 PR CORRJ HALLUX VALGUS 2028.00 W/SESMDC W/PROX PHLNX OSTEOT 28299 PR CORRJ HALLUX VALGUS 2554.00 W/SESMDC W/2 OSTEOT 28300 PR OSTEOTOMY HEEL BONE 2963.00 28302 PR OSTEOTOMY TALUS 2952.00 28304 PR OSTEOTOMY MIDTARSAL BONES 2282.00 28306 PR OSTEOTOMY 1ST 1715.00 METATARSAL,BASE/SHAFT 28308 PR OSTEOTOMY METATARSAL (NOT 1497.00 28309 PR OSTEOTOMY 3204.00 28310 PR OSTEOTOMY PROX 1965.00 28312 PR OSTEOTOMY,ANY PHALANX,ANY 1303 28313 PR RECONSTRUC TOE 1500.00 DEFORM,SOFT TISSUE 28315 PR REMOV SESAMOID BONE,1ST 1404.00 28320 PR REPAIR NON/MALUNION TARSAL 2135.00 BONE(S) 28322 PR REPAIR NON/MALUNION 2430.00 28344 PR REPAIR EXTRA TOE(S) 1990.00 28345 PR REPAIR WEBBED TOE(S) 1430.00 28400 PR CLOSED RX HEEL FX 832.00 28405 PR CLOSED RX HEEL 1325.00 28406 PR PERCUT RX HEEL FX 1731.00 28415 OPEN TREATMENT CALCANEAL 3898.00 28420 OPEN TREATMENT CALCANEAL 4515.00 FRACTURE W BONE GRAFT 28430 PR CLOSED RX TALUS FX 796.00 28435 PR CLOSED RX TALUS 1034.00 28436 PR PERCUT RX TALUS FX 1145 28445 OPEN TREATMENT TALUS 3500.00 28446 PR OPEN OSTEOCHONDRAL 3556.00 AUTOGRAFT TALUS 28450 PR CLOSED RX TARSAL FX,EACH 769.00 28455 PR CLOSED RX TARSAL 728.00 28456 PR PERCUT RX TARSAL FX,EACH 796.00 28465 OPEN TX TARSAL FRACTURE XCP 1770.00 TALUS &CALCANEUS EA 28470 PR CLOSED RX METATARSAL FX 757.00 28475 PR CLOSED RX METATARSAL 920.00 28476 PR PERCUT RX METATARSAL FX 1091.00 28485 OPEN TREATMENT METATARSAL 1493.00 FRACTURE EACH 28490 PR CLOSED RX BIG TOE FRACTURE 425.00 28495 PR CLOSED RX BIG TOE FX,MANIP 530.00 28496 PR PERCUT BIG TOE FX 1593.00 28505 OPEN TX FRACTURE GREAT 1730.00 TOE/PHALANX/PHALANGES 28510 PR CLOSED RX TOE FX 397.00 28515 PR CLOSED RX TOE FX,MANIPULATN 414.00 28525 OPEN TX FRACTURE 1612.00 PHALANX/PHALANGES NOT GREAT 28540 PR CLOSED RX TARSAL 639.00 28545 PR CLOSED RX TARSAL 699.00 28546 PR PERCUT RX TARSAL 1427.00 28555 OPEN TREATMENT TARSAL BONE 2306.00 DISLOCATION 28570 PR CLOSED RX TALOTARSAL 546.00 28576 PR PERCUT RX TALOTARSAL 1836.00 28585 OPEN TREATMENT TALOTARSAL 2137.00 JOINT DISLOCATION 28600 PR CLOSED RX TAR-METATAR 671.00 DISLOCATION 28605 PR CLOSED RX TAR-METATAR 843.00 DISLOC,ANESTH 28606 PR PERCUT RX TAR-METATAR FOOT 2661.00 DISLOC 28615 OPEN TREATMENT 2085.00 TARSOMETATARSAL JOINT 28630 PR CLOSED RX MT-PHAL TOE 387.00 28635 PR CLOSED RX MT-PHAL TOE 453 DISLOC,ANESTH 28636 PR PERCUT RX MT-PHAL TOE 1242.00 28645 OPEN TX METATARSOPHALANGEAL 2346.00 JOINT DISLOCATION 28660 PR CLOSED RX I-P JT,TOE 290.00 28665 PR CLOSED RX I-P JT,TOE 474.00 28666 PR PERCUT RX I-P JT,TOE DISLOC 478 28705 PR FUSION FOOT BONES,PANTALAR 5070.00 28715 PR FUSION FOOT BONES,TRIPLE 3060.00 28725 PR FUSION FOOT BONES,SUBTALAR 2672.00 28730 PR FUSION FOOT 2571.00 28735 PR FUSION FOOT 2508.00 BONES,MIDTARSAL,OSTEOTMY 28737 PR FUSION W/TEND ADV,MIDTAR 2217.00 NAV-CUNEIFORM 28740 PR FUSION FOOT 2564.00 28750 PR FUSION BIG TOE,MT-P JT 2630.00 28755 PR FUSION BIG TOE,I-P JOINT 1512.00 28760 PR FUSION BIG TOE,I-P JT+TENDN 2089.00 28800 PR AMPUTATION FOOT,MIDTARSAL- 1574.00 CHOPART 28805 PR AMPUTATION 1901.00 28810 PR AMPUTATION 1281.00 28820 PR AMPUTATION TOE,MT-P JT 1388.00 28825 PR AMPUTATION TOE,I-P JT 1475.00 29010 PR APPLY BODY CAST,RISSER 697.00 29065 PR APPLY LONG ARM CAST 278.00 29075 PR APPLY FOREARM CAST 257.00 29085 PR APPLY HAND/WRIST CAST 274.00 29105 PR APPLY LONG ARM SPLINT 218.00 29125 PR APPLY FOREARM SPLINT,STATIC 161.00 29126 PR APPLY FOREARM 193.00 29130 PR APPLY FINGER SPLINT,STATIC 103.00 29131 PR APPLY FINGER SPLINT,DYNAMIC 165.00 29200 PR STRAPPING OF CHEST 127.00 29240 PR STRAPPING OF SHOULDER 137.00 29260 PR STRAPPING OF ELBOW OR 124.00 29280 PR STRAPPING OF HAND OR FINGER 122.00 29325 PR APPLY OF HIP CASTS,TWO LEGS 743.00 29345 PR APPLY LONG LEG CAST 407.00 29355 PR APPLY LONG LEG CAST,WALKER 356 29365 PR APPLY LONG LEG 438.00 29405 PR APPLY SHORT LEG CAST 266.00 29425 PR APPLY SHORT LEG 289.00 29450 PR APPLY OF CLUBFOOT CAST 461.00 29505 PR APPLY LONG LEG SPLINT 207.00 29515 PR APPLY LOWER LEG SPLINT 179.00 29520 PR STRAPPING OF HIP 179.00 29530 PR STRAPPING OF KNEE 126.00 29540 PR STRAPPING; ANKLE &/OR FOOT 96.00 29550 PR STRAPPING OF TOES 94.00 29580 PR APPLY OF PASTE BOOT 122.00 29581 PR APPL MLTLAYR COMPRES LEG 157.00 BELOW KNEE W/ANKLE FOOT 29582 PR APPL MLTLAYR COMPRES THGH 178.00 LEG ANKLE FT WHEN DONE 29805 PR SHLDR 1533.00 29806 PR SHLDR 3387.00 ARTHROSCOP,SURG,CAPSULORRHA 29807 PR SHLDR 3301.00 ARTHROSCOP,SURG,REPAIR,SLAP 29819 PR SHLDR 1902.00 ARTHROSCOP,SURG,W/REMOVAL,L OOSE/FB 29820 PR SHLDR ARTHROSCOP,PART 1903.00 29822 PR SHLDR ARTHROSCOP,PART 1862.00 29823 PR SHLDR ARTHROSCOP,EXTEN 2034.00 29824 PR SHLDR ARTHROSCOP,SURG,DIS 2074.00 CLAVICULECTOMY 29825 PR SHLDR ARTHROSCOP,LYSE 1920.00 29826 PR SHOULDER SCOPE BONE 2190.00 29827 PR SHLDR 3551.00 ARTHROSCOP,SURG,W/ROTAT CUFF 29828 PR ARTHROSCOPY SHOULDER 2731.00 SURGICAL BICEPS TENODESIS 29834 PR ELBOW ARTHROSCOP,REMV 1891.00 LOOSE BODY 29835 PR ELBOW ARTHROSCOP,PART 2072.00 29837 PR ELBOW ARTHROSCOP,PART 1891.00 29838 PR ELBOW ARTHROSCOP,EXTEN 2409.00 29840 PR WRIST 1424.00 29844 PR WRIST ARTHROSCOP,PART 1813.00 29845 PR WRIST ARTHROSCOP,FULL 2072.00 29846 PR WRIST ARTHROSCOP,EXCIS 1943.00 TRIANG CART 29847 PR WRIST ARTHROSCOP,INTERN 1919.00 29848 PR WRIST ARTHROSCOP,RELEASE 1444.00 XVERS LIG 29850 PR KNEE SCOPE/SURG/INTERCOND 2149.00 29851 PR KNEE SCOPE/SURG/INCOND FX 3048.00 AID+FIXAT 29855 PR TIBIAL SCOPE/SURG/FX 2733.00 AID,UNICONDYLR 29860 PR HIP ARTHROSCOPY, DX 1701 29861 PR HIP SCOPE/REMOV 2190.00 LOOSE/FOREIGN BODY 29862 PR HIP SCOPE/REMV 2440.00 BODY,PLASTY/RESECTN 29863 PR HIP SCOPE/REMV 2434.00 29866 PR KNEE SCOPE, AUTOGRAFT 5449.00 29867 PR KNEE SCOPE, ALLOGRAFT 3972.00 29868 PR KNEE SCOPE, MENISC 6481.00 29870 PR KNEE SCOPE,DIAGNOSTIC 1307.00 29871 PR KNEE SCOPE,CLEAN/DRAIN 1636.00 29873 PR KNEE SCOPE, W/LATERAL 1646.00 29874 PR KNEE SCOPE,REMV LOOSE 1824.00 29875 PR KNEE SCOPE,PART SYNOVECT 1800.00 29876 PR KNEE SCOPE,FULL SYNOVECT 2148.00 29877 PR KNEE SCOPE,SHAVE ARTICULAR 1920.00 29879 PR KNEE SCOPE,ABRASN 2208.00 29880 PR ARTHRS KNEE 2640.00 W/MENISCECTOMY MED&LAT 29881 PR ARTHRS KNE SURG 2184.00 W/MENISCECTOMY MED/LAT 29882 PR KNEE SCOPE,MED OR LAT MENIS 2364.00 REPAIR 29883 PR KNEE SCOPE,MED+LAT MENIS 3072.00 29884 PR KNEE SCOPE,LYSIS OF ADHESNS 1847.00 29885 PR KNEE SCOPE,DRILL OSTE 2650.00 29886 PR KNEE SCOPE,DRILL OSTEIT 1626.00 29888 PR KNEE SCOPE,AID ANT CRUCIATE 3864.00 29889 PR KNEE SCOPE,AID POST CRUC 3864.00 29891 PR ANKLE SCOPE,EXCIS 2424.00 OSTEOCHON DEFCT 29894 PR ANKLE SCOPE,REMVL LOOSE 1766.00 29895 PR ANKLE SCOPE,PART 1848.00 29897 PR ANKLE SCOPE,PART 1732.00 29898 PR ANKLE SCOPE,EXTENS 2424.00 29899 PR ANKLE SCOPE,W/ANKLE 3685.00 29904 PR ARTHROSCOPY SUBTALAR JOINT 2225.00 REMOVE LOOSE/FOREIGN BODY 29905 PR ARTHROSCOPY SUBTALAR JOINT 1984.00 WITH SYNOVECTOMY 29906 PR ARTHROSCOPY SUBTALAR JOINT 2478.00 WITH DEBRIDEMENT 29907 PR ARTHROSCOPY SUBTALAR JOINT 3106.00 SUBTALAR ARTHRODESIS 29914 PR ARTHROSCOPY HIP 4023.00 29915 PR ARTHROSCOPY HIP 4023.00 W/ACETABULOPLASTY 29916 PR ARTHROSCOPY HIP W/LABRAL 3520.00 30100 PR INTRANASAL BIOPSY 288.00 30110 PR EXCISION NOSE 467.00 30117 PR EXCIS/DEST INTRANAS LESION; 2185.00 30118 PR EXCIS/DEST INTRANAS LESION; 2957.00 30120 PR EXCISION SKIN OF NOSE 2000.00 30125 PR EXCIS NASAL DERMOID,COMPLX 1520.00 30130 PR EXCISION TURBINATE 947 30140 PR EXCISION 1101.00 30150 PR PARTIAL EXCISION OF NOSE 1746.00 30160 PR EXCISION OF NOSE 2979.00 3028F OXYGEN SATURATION RESULTS 0.00 DOCUMENTED/REVIEWED 30300 PR REMOVE NASAL FOREIGN BODY 575.00 30310 PR REMV NASAL FOR BODY,GEN 410.00 30400 PR RECONSTR NOSE 2800.00 30410 PR RECONSTR 3180.00 NOSE,COMPLETE+EXTERNAL 30420 PR RECONSTR NOSE+MAJ SEPTAL 3449.00 30430 PR REVIS NOSE,SECONDARY,MINOR 2026.00 30435 PR REVIS 3744.00 NOSE,SECONDARY,INTERMEDIATE 30450 PR REVIS 4873.00 30460 PR REVIS NOSE/CLEFT LIP/TIP 2445.00 30462 PR REVIS NOSE/CLEFT 6329.00 30465 PR REPAIR NASAL CAVITY 2500.00 30520 PR REPAIR OF NASAL SEPTUM 2106.00 30540 PR REPAIR CHOANAL 1824.00 30560 PR RELEASE OF NASAL ADHESIONS 565.00 30580 PR REPAIR ORO-MAXILLARY 1140.00 30600 PR REPAIR ORO-NASAL FISTULA 1785.00 30620 PR INTRANASAL RECONSTRUCTION 1971.00 30630 PR REPAIR NASAL SEPTUM 1386.00 30802 PR CAUTER TURBINATE 611.00 MUCOSA,INTRAMURAL 30901 PR CTRL 239.00 30903 PR CTRL 407.00 30905 PR CTRL 510.00 NOSEBLEED,POST,W/PACKS &/OR 30906 PR REPEAT CONTROL OF 584.00 30920 PR LIGATE INTERN MAXILL ARTERY 2898 30930 PR THERAPEUTIC FRACTURE INFER 244.00 TURBINATE 31000 PR IRRIGATION MAXILLARY SINUS 376.00 3100F PR CAROTID IMG STUDY MEAS 0.00 DISTAL INT CAROTID DIAM 31020 PR EXPLOR MAXILL 1036.00 31030 PR EXPLOR MAXILL SINUS,RADICAL 1741.00 31032 PR EXPLOR MAXILL SINUS,RMV 1945.00 31040 PR EXPLOR PTERYGOMAXILL FOSSA 3039.00 31051 PR EXPLOR SPHENOID SINUS+RMV 1490.00 31070 PR EXPLOR FRONT 1561.00 31075 PR EXPLOR FRONT 1967.00 31085 PR OBLITER FRONT 4557 SINUS+FLAP,CORON INCI 31201 PR REMOV ETHMOID 1854 SINUS,INTRANASAL,TOTL 31205 PR REMOV ETHMOID 2266.00 SINUS,EXTRANASAL,TOTL 31225 PR REMV UPPER JAW- 3435.00 31230 PR REMV UPPER JAW+ORBIT 8248 31231 PR NASAL ENDOSCOPY,DX 528.00 31233 PR NASAL/MAXILL SINUS 1331.00 31235 PR NASAL/SPHENOID SINUS 665.00 ENDOSCOPY,DX 31237 PR NASAL SCOPE,BX/RMV 1280.00 31238 PR NASAL/SINUS 866.00 SCOPY,W/CONTROL NASAL HEM 31239 PR NASAL/SINUS SCOPY,SURG 1457.00 31240 PR NASAL/SINUS SCOPY,RMV 525.00 CONCHA BULL 31241 PR NASAL/SINUS NDSC W/LIG 1155.00 SPHENOPALATINE ARTERY 31253 PR NASAL/SINUS NDSC TOT W/FRNT 1294.00 SINS EXPL TISS RMVL 31254 PR NASAL/SINUS NDSC W/PARTIAL 1204.00 ETHMOIDECTOMY 31255 PR NASAL/SINUS NDSC W/TOTAL 2344.00 ETHOIDECTOMY 31256 PR NASAL SCOPY,OPEN MAXILL 926.00 31257 PR NASAL/SINUS NDSC TOTAL WITH 1152.00 SPHENOIDOTOMY 31259 PR NASAL/SINUS NDSC TOT 1221.00 W/SPHENDT W/SPHEN TISS RMVL 31267 PR NASAL SCOPY,RMV TISS MAXILL 1737.00 31276 PR NASAL/SINUS NDSC W/RMVL 3500.00 TISS FROM FRONTAL SINUS 31287 PR NASAL SCOPY,SPHENOIDOTOMY 1379.00 31288 PR NASAL SCOPY,REMV TISS 1379.00 31290 PR NASAL SCOPY,REPAIR CSF 3717.00 LEAK,ETHMOID 31291 PR NASAL SCOPY,REPR CSF 3885.00 LEAK,SPHENOID 31292 PR NASAL SCOPY,MED/INF ORBIT 4200.00 DECOMPRES 31293 PR NASAL SCOPY,MED+INF ORBIT 3782 DECOMPRES 31295 PR NASAL/SINUS 5065.00 ENDOSCOPY,W/DILAT MAXILLARY 31296 PR NASAL/SINUS 5166.00 ENDOSCOPY,W/DILAT FRONTAL 31297 PR NASAL/SINUS 5073.00 ENDOSCOPY,W/DILAT SPHENOID 31298 PR NASAL/SINUS NDSC W/FRONTAL 9883.00 & SPHEN SINS DILATION 31299 PR SINUS SURGERY PROC 450.00 31300 PR REMOVAL OF LARYNX LESION 3092.00 31360 PR REMOVAL OF LARYNX 3645.00 31365 PR REMOVAL OF LARYNX+RAD TOTL 5375.00 31367 PR PART SUPRAGLOT REMV 9023.00 31390 PR REMV LARYNX & PHARYNX 11598.00 31395 PR REMV LARYNX+PHARYNX W 5672.00 RECONSTRUC 31400 PR REVISION ARYTENOIDS 3460.00 31500 PR INSERT EMERGENCY 396.00 ENDOTRACH AIRWAY 31502 PR TRACH TUBE CHANGE 84.00 31505 PR LARYNGOSCOPY,INDIRECT,DX 207.00 31510 PR LARYNGOSCOPY,INDIRECT WITH 533.00 BIOPSY 31515 PR LARYNGOSCOPY,DIRECT FOR 929.00 ASPIRATION 31520 PR 778.00 LARYNGOSCOPY,DIRECT,DIAGNOS, NEWBRN 31525 PR 734.00 31526 PR LARYNGOSCOPY,DIRECT,DX,OP 361.00 MICROSCOP 31527 PR LARYNGOSCOPY,DIRECT,INSRT 734.00 OBTURATOR 31528 PR LARYNGOSCOPY 460.00 DIRECT,W/DILAT, INITIAL 31529 PR LARYNGOSCOPY 763.00 DIRECT,W/DILAT, SUBSEQUENT 31530 PR LARYNGOSCOPY,DIRCT,OP,F.B. 763.00 31535 PR 763.00 31536 PR LARYNGOSCOPY,DIRCT,OP 878.00 SCOPE,BIOPSY 31540 PR LARYNGOSCOPY,DIRCT,OP,EXC 923.00 31541 PR LARYNGOSCOPY,DIRCT,OP 1439.00 SCOP,EXC TUMR 31545 PR LARYNGOSCOPY,DIR,OP,EXC 923.00 TUMR,LCL FLAP 31551 PR LARYNGOPLASTY LARYNGEAL 5849.00 STEN W/O STENT < 12 YRS 31552 PR LARYNGOPLASTY LARYNGEAL 5174.00 STEN W/O STENT 12 YRS > 31553 PR LARYNGOPLASTY LARYNGEAL 6448.00 STEN W/STENT < 12 YRS 31554 PR LARYNGOPLASTY LARYNGEAL 6789.00 STEN W/STENT 12 YRS > 31560 PR 2128.00 LARYNGOSCOPY,DIRCT,OP,REMV 31561 PR LARYNGOSCOPY,DIRCT,OP 1520.00 SCOP,REMV ARY 31570 PR LARYNGOSCOPY,DIRCT,INJ 929.00 VOCAL CORD 31571 PR 869.00 LARYNGOSCOPY,DIRECT,SCOPE,INJ 31572 PR LARYNGOSCOPY FLEXIBLE 1250.00 ABLATJ DESTJ LESION(S) UNI 31573 PR LARYNGOSCOPY FLEXIBLE 665.00 THERAPEUTIC INJECTION UNI 31574 PR LARYNGOSCOPY FLEXIBLE 2577.00 W/INJECTION AGMNTJ UNI 31575 PR LARYNGOSCOPY FLEXIBLE 260.00 31576 PR LARYNGOSCOPY FLEXIBLE 495.00 W/BIOPSY(IES) 31577 PR LARYNGOSCOPY FLX RMVL 540.00 FOREIGN BODY(S) 31579 PR LARYNGOSCOPY FLX/RGD 498.00 TELESCOPIC W/STROBOSCOPY 31580 PR LARYNGOPLASTY LARYN WEB 4417.00 W/KEEL STENT INSERTION 31582 PR REVISION LARYNX,STENOSIS W 3844.00 31584 PR LARYNGOPLASTY W/OPEN 3844.00 REDUCTION FRACTURE W/TRACHS 31587 PR LARYNGOPLASTY CRICOID SPLIT 3844.00 W/O GRAFT PLACEMENT 31588 PR REVISION OF LARYNX, 3844.00 31590 PR REINNERVATE LARYNX W 2415.00 31591 PR LARYNGOPLASTY 3672.00 MEDIALIZATION UNLIATERAL 31592 PR CRICOTRACHEAL RESECTION 6934.00 31600 PR TRACHEOSTOMY, PLANNED 985.00 31601 TRACHEOSTOMY, <2 Y/O 797.00 31603 PR 911.00 31610 PR 1543.00 31611 PR CREATE T-E FISTULA+SPEECH 1158.00 PROSTHESIS 31613 PR TRACH REVISION,SIMPLE 957.00 31614 PR TRACH REVISION,COMPLEX 1594.00 31615 PR TRACHEOBRNCHSC THRU EST 395.00 TRACHS INC 31622 PR BRNCHSC INCL FLUOR GDNCE 733.00 DX W/CELL WASHG SPX 31623 PR BRNCHSC 853.00 BRUSHING/PROTECTED BRUSHINGS 31624 PR BRNCHSC W/BRNCL ALVEOLAR 769.00 31625 PR BRONCHOSCOPY 826.00 BRONCHIAL/ENDOBRNCL BX 1+ 31627 PR BRONCHOSCOPY W/CPTR-ASST 4814.00 IMAGE-GUIDED NAVIGATION 31628 PR BRONCHOSCOPY 968.00 W/TRANSBRONCHIAL LUNG BX 1 31629 PR BRONCHOSCOPY NEEDLE BX 1386.00 TRACHEA MAIN STEM&/BRON 31630 PR 735.00 BRONCHOSCOPY,TRACH/BRONCH 31631 PR BRONCHOSCOPY,TRACH 589.00 31632 PR BRONCHOSCOPY 175.00 W/TRANSBRONCHIAL LUNG BX 31633 PR BRONCHOSCOPY 214.00 W/TRANSBRONCL NDL ASPIR BX EA 31634 PR BRONCHOSCOPY BALLOON 4687 31635 PR BRONCHOSCOPY W/REMOVAL 830.00 FOREIGN BODY 31636 PR BRONCHOSCOPY, BRONCH 565 31640 PR BRONCHOSCOPY,EXCIS LESN 946.00 31641 PR BRONCHOSCOPY,RX STENOSIS 946.00 31645 PR BRONCHOSCOPY W/THER ASPIR 717.00 TRACHBRNCL TREE 1ST 31646 PR BRONCHOSCOPY W/THER ASPIR 708.00 TRACHBRNCL TREE SBSQ 31647 PR BRNCHSC OCCLUSION&INSERT 540.00 BRONCH VALVE INIT LOBE 31648 PR BRNCHSC REMOVAL BRONCHIAL 548.00 VALVE INITIAL 31649 PR BRNCHSC REMOVAL BRONCHIAL 179.00 VALVE EA ADDL 31651 PR BRNCHSC OCCLUSION&INSERT 191.00 BRONCH VALVE ADDL LOBE 31652 PR BRNCHSC EBUS GUIDED SAMPL 2301.00 1/2 NODE STATION/STRUX 31653 PR BRNCHSC EBUS GUIDED SAMPL 2445.00 3/> NODE STATION/STRUX 31654 PR BRNSCHSC TNDSC EBUS DX/TX 351.00 INTERVENTION PERPH LES 31660 PR BRONCHOSCOPIC 526.00 THERMOPLASTY ONE LOBE 31661 PR BRONCHOSCOPIC 555.00 THERMOPLASTY 2/> LOBES 31720 PR CATHETER 132.00 31730 PR INTRO WINDPIPE WIRE/TUBE 3098.00 31750 PR REVISN TRACHEA,CERVICAL 4960.00 31760 PR REVISN 5645.00 31780 PR EXCIS TRACH 3343.00 31785 PR EXCIS TRACH LESN,CERVICAL 3398.00 31800 PR REPAIR TRACH 1529.00 31820 PR SURG CLOSURE TRACH/FISTULA 923.00 31825 PR SURG CLOSURE 1602.00 TRACH/FIST,PLAST REPR 31830 PR REVISE TRACHEOSTOMY SCAR 1338.00 32035 PR THORACOSTOMY,RIB 1558.00 32036 PR THORACOSTOMY,OPEN 1689.00 DRAIN/EMPYEMA 32096 PR THORACTOMY W/DX BX LUNG 2865.00 INFILTRATE UNILATERAL 32098 PR THORACOTOMY W/BIOPSY OF 1907.00 32100 PR THORACOTOMY WITH 3279.00 32110 PR THORCOM CTRL TRAUMTC 5229.00 HEMRRG&/RPR LNG TEAR 32120 PR THORACOTOMY 3099.00 POSTOPERATIVE COMPLICATIONS 32141 PR THORACOTOMY W/RESECTION 3368.00 32151 PR THORCOM W/RMVL IPUL FB 2232.00 32160 PR THORACOTOMY W/CARDIAC 1702.00 32200 PR PNEUMONOSTOMY,OPEN DRAIN 4060.00 ABSC/CYST 32220 PR 5507.00 32225 PR 3099.00 32310 PR REMOVAL PARIETAL PLEURA 2986.00 32320 PR DECORTICATE/REMV PARIETAL 5478.00 32400 PR NEEDLE BIOPSY PLEURA 342.00 32405 PR BIOPSY LUNG/MEDIASTINUM 1095.00 PERCUTANEOUS NEEDLE 32440 PR REMOVAL OF LUNG 5524.00 32480 PR RMVL LUNG OTHER THAN 5325.00 PNEUMONECTOMY 1 LOBE LOBECT 32482 PR RMVL LUNG OTHER THAN 5518.00 PNEUMONECT 2 LOBES BILOBEC 32484 PR RMVL LUNG OTHER THAN 4691.00 PNEUMONECT 1 SEGMENTECTOMY 32486 PR RMVL LUNG XCP TOT 9583.00 PNEUMONECTOMY SLEEVE 32488 PR RMVL LUNG OTHER/THAN 9775 PNUMEC COMPLETION PNUMEC 32491 PR RMVL LUNG OTH/THN PNUMEC 5300.00 RESXN-PLCTJ EMPHY LUNG 32501 PR REPAIR BRONCHUS (ADD-ON) 583.00 32504 PR RESECT APICAL LUNG TUM/ 8348 CHEST WALL RECONST 32505 PR THORACOTOMY W/THERAPEUTIC 2342.00 WEDGE RESEXN INITIAL 32506 PR THORACOTOMY W/THERAP 394.00 WEDGE RESEXN ADDL IPSILATRL 32507 PR THORACOTOMY W/DX WEDGE 394.00 RESEXN &ANTOM LUNG RESEXN 32540 PR EXTRAPLEURAL REMV EMPYEMA 7031.00 32550 PR INSERTION INDWELLING 1515.00 TUNNELED PLEURAL CATHETER 32551 PR TUBE THORACOSTOMY 501.00 INCLUDES WATER SEAL 32552 PR REMOVAL OF INDWELLING 466.00 TUNNELED PLEURAL CATHETER 32554 PR THORACENTESIS NEEDLE/CATH 1384.00 PLEURA W/O IMAGING 32555 PR THORACENTESIS NEEDLE/CATH 1404.00 PLEURA W/IMAGING 32556 PR PERQ DRAINAGE PLEURA 1459.00 INSERT CATH W/O IMAGING 32557 PR PERQ DRAINAGE PLEURA 2706.00 INSERT CATH W/IMAGING 32560 PR CHEMICAL PLEURODESIS FOR 612.00 PERSISTENT PNEUMOTHORAX 32561 PR INSTILL VIA CHEST TUBE AGENT 242.00 FOR FIBRINOLYSIS, 1ST DAY 32562 PR INSTILL VIA CHEST TUBE AGENT 210.00 FOR FIBRINOLYSIS, SUBSEQUENT 32601 PR THORSC DX 810.00 LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX 32606 PR THORACOSCOPY,DX MEDIAST W 1176.00 32607 PR THORACOSCOPY W/DX BX OF 785 LUNG INFILTRATE UNILATRL 32608 PR THORACOSCOPY W/DX BX OF 953.00 LUNG NODULES UNILATRL 32609 PR THORACOSCOPY WITH 659.00 BIOPSYIES OF PLEURA 32650 PR THORACOSCOPY SURG 2227.00 W/PLEURODESIS 32651 PR THORACOSCOPY SURG PART 2584.00 PULM DECORT 32652 PR THORACOSCOPY SURG TOT 3688.00 PULM DECORT 32653 PR THORACOSCOPY SURG REMOV 2549.00 FB INTRAPLEU 32654 PR THORACOSCOPY SURG CTRL 2584.00 TRAUMA BLEED 32655 PR THORACOSCOPY W/RESECTION 2612.00 BULLAE W/WO PLEURAL PX 32656 PR THORACOSCOPY SURG PART 2850.00 PLEURECTOMY 32661 PR THORACOSCOPY SURG EXC 2847.00 PERICARD MASS 32662 PR THORACOSCOPY SURG EXC 3240.00 MEDIAST MASS 32663 PR THORACOSCOPY W/LOBECTOMY 5036.00 SINGLE LOBE 32664 PR THORACOSCOPY SURG THOR 2812.00 SYMPATHECT 32665 PR THORACOSCOPY SURG 5027 ESOPHAGOMYOTOMY 32666 PR THORACOSCOPY W/THERA 2189.00 WEDGE RESEXN INITIAL UNILAT 32667 PR THORACOSCOPY W/THERA 394.00 WEDGE RESEXN ADDL IPSILATRL 32668 PR THORACOSCOPY W/DX WEDGE 396.00 RESEXN ANATO LUNG RESEXN 32669 PR THORACOSCOPY 3369.00 32672 PR THORACOSCOPY W/RESEXN- 3819.00 PLICAJ EMPHYSEMA LUNG UNIL 32673 PR THORACOSCOPY RESEXN 3018.00 THYMUS UNI/BILATERAL 32674 PR THORCOSCPY W/MEDIASTINL 540.00 ®IONL LYMPHADENECTOMY 32800 PR REPAIR LUNG HERNIA 3363.00 32850 PR DONOR PNEUMONECTOMY 2311.00 32851 PR LUNG TRANSPLANT,SINGLE 8740.00 32852 PR LUNG TRANSPLANT,SINGL W CP 9428.00 32853 PR LUNG TRANSPLANT,DOUBLE 10500.00 32854 PR LUNG TRANSPLANT,DBL W CP 11200.00 32855 PR TRANSPLANT,PREP DONOR 13596.00 LUNG, SINGLE 32856 PR TRANSPLANT,PREP DONOR 14892.00 LUNG, DOUBLE 32900 PR REMOVAL OF RIB(S) 3478.00 32994 PR ABLATION THER 1+ PULM 15761.00 TUMORS PERQ CRYOABLATION 32998 PR ABLATION THER 1+ PULM 6630.00 TUMORS PERQ RADIOFREQUENCY 32999 PR CHEST SURGERY PROCEDURE 450.00 UNLISTED 33010 PR PERICARDIOCENTESIS INITIAL 350.00 33015 PR INCIS HEART SAC TUBE 1258.00 33020 PR INCIS HEART SAC REMV CLOT/FB 2661.00 33025 PR INCIS HEART SAC WINDW FOR 2580.00 33030 PR REMOV HEART SAC NO CP 4010.00 33031 PR REMOV HEART SAC W CP 5232.00 33050 PR RESECTION PERICARDIAL 3176.00 33120 PR REMOVAL HEART LESION 5996.00 33130 PR REMOVAL HEART LESION 5618.00 33202 PR INSERT EPICARDIAL 3025.00 33206 PR INS NEW/RPLCMT PRM 1728.00 PACEMAKR W/TRANS ELTRD ATRIAL 33207 PR INS NEW/RPLC PRM PACEMAKER 1230.00 W/TRANSV ELTRD VENTR 33208 PR INS NEW/RPLCMT PRM PM 1328.00 W/TRANSV ELTRD ATRIAL&VENT 33210 PR INSJ/RPLCMT TEMP TRANSVNS 650.00 1CHMBR ELTRD/PM CATH 33211 PR INSJ/RPLCMT TEMP TRANSVNS 472.00 2CHMBR PACG ELTRDS SPX 33212 PR INS PM PLS GEN W/EXIST SINGLE 918.00 33213 PR INS PACEMAKER PULSE GEN 1005.00 ONLY W/EXIST DUAL LEADS 33214 PR UPG PACEMAKER SYS CONVERT 1216.00 1CHMBR SYS 2CHMBR SYS 33215 PR RPSG PREV IMPLTED PM/DFB R 773.00 ATR/R VENTR ELECTRODE 33216 PR INSJ 1 TRANSVNS ELTRD PERM 1012.00 PACEMAKER/IMPLTBL DFB 33217 PR INSJ 2 TRANSVNS ELTRD PERM 950.00 PACEMAKER/IMPLTBL DFB 33218 PR RPR 1 TRANSVNS ELTRD PRM 993.00 PM/PACING IMPLNTBL DFB 33220 PR RPR 2 TRANSVNS ELECTRODES 995.00 PRM PM/IMPLANTABLE DFB 33221 PR INS PACEMAKER PULSE GEN 925.00 ONLY W/EXIST MULT LEADS 33222 PR RELOCATION OF SKIN POCKET 921.00 FOR PACEMAKER 33223 PR RELOCATE SKIN POCKET 1041.00 IMPLANTABLE DEFIBRILLATOR 33224 PR INSJ ELTRD CAR VEN SYS ATTCH 1285.00 PREV PM/DFB PLS GEN 33225 PR INSJ ELTRD CAR VEN SYS TM 1158.00 INSJ DFB/PM PLS GEN 33226 PR RPSG PREV IMPLTED CAR VEN 1237.00 SYS L VENTR ELTRD 33227 PR REMVL PERM PM PLSE GEN 816.00 W/REPL PLSE GEN SNGL LEAD 33228 PR REMVL PERM PM PLS GEN 852.00 W/REPL PLSE GEN 2 LEAD SYS 33229 PR REMVL PERM PM PLS GEN 886.00 W/REPL PLSE GEN MULT LEAD 33230 PR INSJ IMPLNTBL DEFIB PULSE 984.00 GEN W/EXIST DUAL LEADS 33233 PR REMOVAL PERMANENT 678.00 PACEMAKER PULSE GENERATOR 33234 PR RMVL TRANSVNS PM ELTRD 1 1263.00 LEAD SYS ATR/VENTR 33235 PR RMVL TRANSVNS PM ELTRD 2253.00 DUAL LEAD SYS 33237 PR REMV EPICARD SYST TWO 2999.00 LD/THORACOTMY 33241 PR REMOVAL IMPLANTABLE DEFIB 572.00 PULSE GENERATOR ONLY 33243 PR RMVL 1/DUAL CHAMBER DEFIB 4969.00 ELECTRODE BY THORACOM 33244 PR RMVL1/DUAL CHMBR IMPLTBL 3032.00 DFB ELTRD TRANSVNS XTRJ 33249 PR INSJ/RPLCMT PERM DFB 3222.00 W/TRNSVNS LDS 1/DUAL CHMBR 33255 PR ABLATE/ RECONSTUCT ATRIA, 6685.00 EXTENS, W/O BYPASS 33256 PR ABLATE/ RECONSTUCT ATRIA, 7914.00 EXTENS, W/ BYPASS 33257 PR ABLATE/ RECONSTUCT ATRIA, W 1367.00 OTHER PROCED LIMITED 33259 PR ABLATE/ RECONSTUCT ATRIA, W 2000.00 OTHER PROCED EXTENS W/ BYPASS 33261 PR ABLAT VENTR DYSRHYTHM 3647.00 33262 PR RMVL IMPLTBL DFB PLSE GEN 886.00 W/REPL PLSE GEN 1 LEAD 33263 PR RMVL IMPLTBL DFB PLSE GEN 922.00 W/RPLCMT PLSE GEN 2 LD 33264 PR RMVL IMPLTBL DFB PLS GEN 956.00 W/RPLCMT PLS GEN MLT LD 33265 PR ENDO ABLATE/ RECONSTUCT 5543.00 ATRIA, LIMITED 33270 PR INS/RPLCMNT PERM SUBQ 1581.00 IMPLTBL DFB W/SUBQ ELTRD 33271 PR INSJ OF SUBQ IMPLANTABLE 1258.00 DEFIBRILLATOR ELECTRODE 33272 PR RMVL OF SUBQ IMPLANTABLE 1058.00 DEFIBRILLATOR ELECTRODE 33273 PR REPOS PREVIOUSLY IMPLANTED 1039.00 SUBQ IMPLANTABLE DFB 33282 PR IMPLANTATION PT-ACTIVATED 2000.00 CARDIAC EVENT RECORDER 33284 PR RMVL IMPLANTABLE PT- 593.00 ACTIVATED CAR EVENT RECORDER 33300 PR REPAIR HEART WOUND 9990.00 33315 PR EXPLOR HEART SURG WND W CP 7725.00 BYPASS 33322 PR REPR AO/GRT VESSEL W CP 5009.00 33340 PR PERQ CLSR TCAT L ATR APNDGE 2917.00 W/ENDOCARDIAL IMPLNT 33361 PR REPLACE AORTIC VALVE PERQ 5554.00 FEMORAL ARTRY APPROACH 33362 PR REPLACE AORTIC VALVE 6060.00 OPENFEMORAL ARTERY APPROACH 33363 PR REPLACE AORTIC VALVE OPEN 6381.00 AXILLRY ARTRY APPROACH 33364 PR REPLACE AORTIC VALVE OPEN 6615.00 ILIAC ARTERY APPROACH 33365 PR REPLACE AORTIC VALVE OPEN 7277.00 TRANSAORTIC APPROACH 33366 PR TRANSCATHETER TRANSAPICAL 7870.00 REPLACEMT AORTIC VALVE 33367 PR REPLACE AORTIC VALVE W/BYP 2234.00 PRQ ART/VENOUS APPRCH 33368 PR REPLACE AORTIC VALVE W/BYP 2666.00 OPEN ART/VENOUS APRCH 33369 PR REPLACE AORTA VALVE W/BYP 3526.00 CNTRL ART/VENOUS APRCH 33390 PR VALVULOPLASTY AORTIC VALVE 7949.00 OPEN CARD BYP SIMPLE 33391 PR VALVULOPLASTY AORTIC VALVE 9419.00 OPEN CARD BYP COMPLEX 33400 PR REPR AORT VALV W CP BYPASS 6424.00 33403 PR REPR AORT VALV XVENT DIL 5678.00 W/CP BYPAS 33405 PR RPLCMT PROST AORTIC VALVE 7770.00 OPEN XCP HOMOGRF/STENT 3340F PR MAMMO ASSESS CAT OF 0.00 INCOMPLETE NEED ADD IMAGE 33411 PR REPLACE AORT VALV W 8035.00 ANNULUS ENLRGEMENT 33412 PR REPLAC AO VALV XVENT AO 12952.00 ANNUL ENLG 33413 PR REPL AORT VALVE,TRANSLOC 9386.00 AUTOL PULM VALV 33414 PR REPAIR LV OUTFLOW OBSTR 8794.00 PATCH ENLG 33415 PR REVIS SUBVALV TIS SVAS 6385.00 33416 PR REVIS VENT MUSC FOR IHSS 6942.00 33417 PR AORTOPLAS FOR SUPRAVALV 4598.00 33418 PR TCAT MITRAL VALVE REPAIR 6371.00 INITIAL PROSTHESIS 33419 PR TCAT MITRAL VALVE REPAIR 1344.00 ADDL PROSTHESIS 3341F PR MAMMO ASSESS CAT OF 0.00 NEGATIVE DOCUMENTED 33425 PR MITRALPLASTY W CP BYPASS 6087.00 33426 PR MITRALPLASTY W PROSTHETIC 7329.00 33427 PR MITRALPLASTY W RADICAL 8674.00 3342F PR MAMMO ASSESS CAT OF BENIGN 0.00 DOCUMENTED 33430 PR REPLACEMENT OF MITRAL 9800.00 33463 PR VALVULOPLAS TRICUS NO RING 6898.00 33464 PR VALVULOPLAS TRICUS W RING 6348.00 33465 PR REPLACE TRICUSPID W CP 6164.00 33471 PR PULM VALVOTOMY VIA PULM 4265.00 33474 PR PULM VALVOTOMY W CP BYPASS 8904.00 33475 PR REPLACEMENT, PULMONARY 5805.00 33476 PR RV RESEC INFUND STEN 5850.00 33477 PR TCAT PULMONARY VALVE 5383.00 IMPLANTATION PRQ APPROACH 33478 PR RV OUTFLOW TRACT 6225.00 33502 PR REPR ANOMAL CORON ART PA 3100.00 ORIGIN BY LIGATN 33507 PR REPR INTRAMURAL COR ART 7054 TRANSLOC/ UNROOF 33508 PR ENDOSCOPY W/VIDEO-ASST 350.00 VEIN HARVEST,CABG 33510 PR CABG, VEIN, SINGLE 6571.00 33511 PR CABG, VEIN, TWO 6827.00 33512 PR CABG, VEIN, THREE 7188.00 33517 PR CABG, ARTERY-VEIN, SINGLE 426.00 33518 PR CABG, ARTERY-VEIN, TWO 931.00 33519 PR CABG, ARTERY-VEIN, THREE 1236.00 33521 PR CABG, ARTERY-VEIN, FOUR 2331.00 33530 CABG, REOPERATE >1 MON ORIG 1189.00 33533 PR CABG, ARTERIAL, SINGLE 6745.00 33534 PR CABG, ARTERIAL, TWO 7249.00 33535 PR CABG, ARTERIAL, THREE 7675.00 33542 PR MYOCARD RESECTN 6848.00 33548 PR RESTORE/REMODEL VENTRICLE 12083.00 33572 PR OPEN CORONARY 585.00 33600 PR CLOSURE OF AV VALVE 7029.00 33606 PR ANAST PULM ARTERY TO AORTA 7231.00 33610 PR REPAIR BY SURG 7260.00 33615 PR REPR (SIMPLE FONTAN) 6510.00 33617 PR REPR BY MODIFIED FONTAN 8682.00 33619 PR REPR HYPOPLAS LT HEART 10622.00 33620 PR APPLICATION RIGHT & LEFT 6752.00 PULMONARY ARTERY BANDS 33641 PR REPR ASD W BYPASS 4943.00 33645 PR REPR/CLOS SINUS VENOSUS 5804.00 33647 PR REPR ASD & VSD 6844.00 33660 PR REPR ASD OSTIUM PREMUM 6949.00 33665 PR REPR INTERMED AV CANAL 6860.00 33670 PR REPR COMPL AV CANAL DEFECT 7463.00 33675 PR CLOSE MULTIPLE VSD 8072 33677 PR CLOSE MULTIPLE VSD, REMOVE 7982.00 PA BAND 33681 PR CLOSE SINGLE VSD 7186.00 33684 PR CLOSE SINGLE VSD, WITH 6907.00 33690 PR BANDING PULM ARTERY 4290.00 33692 PR REPR TET FALLOT WO PULM 7141.00 33694 PR REPR TET FALLOT X-ANNULAR 7778.00 33697 PR REPR TET FALLOT W PULM 8253.00 33710 PR REPR VALSALVA FISTULA & VSD 8400 33720 PR REPR VALSALVA ANEURYSM 6337.00 33724 PR REPAIR PULMONARY VENOUS 6301.00 33726 PR REPAIR PULMONARY VENOUS 8324 STENOSIS 33730 PR REPRAIR ANOMAL PULMONARY 7656.00 VENOUS RETURN 33732 PR REPR COR TRIAT/SUPRAVALV 5420.00 MITR RING 33735 PR ATR SEPTEC/SEPTOSTOMY 4295.00 33737 PR ATR SEPTEC/SEPTOSTMY OPN 4340.00 INFLW OCCL 33750 PR SHUNT SUBCL TO PULM ART 5075.00 33764 PR SHUNT CENTRAL W PROSTH 5112.00 33766 PR SHUNT SVC TO PA, ONE LUNG 4070.00 33767 PR SHUNT SVC TO PA, BOTH LUNGS 5875.00 33768 PR ANAST SECONDARY SVC TO PA 1136.00 33778 PR REPR XPOSTN GRT VES,AO-PUL 9007.00 ART RECON 33780 PR REPR XPTN GR VES,AP ART W 9520.00 CLOS VSD 33786 PR REPAIR TRUNCUS ARTERIOSUS 9313.00 33788 PR REIMPLNT ANOMAL PULM ART 5110.00 33800 PR AORTIC SUSPENSN FOR TRACH 2705.00 DECOMPRE 33802 PR DIVISN ABERRANT VESSEL 3881.00 33814 PR OBLIT AO-PUL SEPTAL DFCT W 6181.00 CP BYPAS 33820 PR REPR PDA BY LIGATN 3582.00 33822 REPR PDA BY DIVISION <18 Y/O 4016.00 33840 PR EXCISN COARCT AORTA DRCT 5086.00 33845 PR EXCISN COARCT AORTA W 5504.00 33852 PR REPR HYPOPLASTIC AORTIC 3818.00 33853 PR REPR HYPOPLASTIC ARCH W CP 7512.00 BYPASS 33860 PR ASCEND AORTA GRAFT INCL 11656.00 VAVLE SUSPENSION 33863 PR ASCEND AORTA GRAFT W ROOT 9772.00 REPLACMENT.VALVE CONDUIT/CORON RECONSTRUCT 33864 PR ASCEND AORTA GRAFT W VALVE 7322.00 SPARING ANNULUS REMODEL 33870 PR TRANSV AORTIC ARCH GRAFT W 9620.00 BYPASS 33875 PR THORACIC AORTA GRAFT 7447.00 33877 PR REPR THORACOABDOM AA W 9543.00 33880 PR ENDOVASC TAA REPR INCL 4180.00 33881 PR ENDOVASC TAA REPR W/O 6329.00 33883 PR INSERT ENDOVASC PROSTH, 2599.00 33884 PR ENDOVASC PROSTH, TAA, EA 950.00 33886 PR ENDOVASC DIST EXTENS TAA 3400.00 PROSTH, DELAYED 33889 PR SUBCLAV TRANSPOS W/ 1880.00 ENDOVAS TAA REPAIR 33891 PR CAR-CAR BYPASS GRFT W/ 2412.00 ENDOVAS TAA REPAIR 33910 PR REMOVE PUL ART EMBOLI W CP 10752.00 33917 PR REPAIR PULMONARY ART STEN 5981.00 33920 PR REPAIR PULM ART 7224.00 33922 PR TRANSECT PULMONARY ARTERY 4375.00 33924 PR REMV SYS-PULM SHUNT W 689.00 33926 PR REPAIR PUL ART UNIFOCAL 10466.00 ARBOR W/ CP BYPASS 33927 PR IMPLTJ TOTAL RPLCMT HEART 10629.00 SYS W/RCP CARDIECTOMY 33930 PR REMOVAL OF DONOR 5251.00 33933 PR TRANSPLANT,PREP DONOR 8373.00 HEART/LUNG 33940 PR REMOVAL OF DONOR HEART 5251.00 33944 PR TRANSPLANT,PREP DONOR 5796.00 33945 PR TRANSPLANTATION OF HEART 10786.00 33946 PR ECMO/ECLS INITIATION VENO- 796.00 33947 PR ECMO/ECLS INITIATION VENO- 869.00 33948 PR ECMO/ECLS DAILY 612.00 MANAGEMENT EACH DAY VENO- 33949 PR ECMO/ECLS DAILY 597.00 MANAGEMENT EA DAY VENO- 33951 PR ECMO/ECLS INSJ OF PRPH 1001.00 CANNULA BIRTH-5 YRS PERQ 33952 PR ECMO/ECLS INSJ OF PRPH 976.00 CANNULA 6 YRS&OLDER PERQ 33953 PR ECMO/ECLS INSJ OF PRPH 1115.00 CANNULA BIRTH-5 YRS OPEN 33954 PR ECMO/ECLS INSJ OF PRPH 1087.00 CANNULA 6 YRS&OLDER OPEN 33955 PR ECMO/ECLS INSJ OF CENTRAL 3150.00 CANNULA BIRTH-5 YRS 33956 PR ECMO/ECLS INSJ OF CENTRAL 2977.00 CANNULA 6 YRS & OLDER 33957 PR ECMO/ECLS REPOS PERIPH 712.00 CANNULA PERQ BIRTH-5 YRS 33958 PR ECMO/ECLS REPOS PERPH 695.00 CANNULA PRQ 6 YRS & OLDER 33959 PR ECMO/ECLS REPOS PERPH 830.00 CANNULA OPEN BIRTH-5 YRS 33962 PR ECMO/ECLS REPOS PERPH 791.00 CANNULA OPEN 6 YRS & OLDER 33963 PR ECMO/ECLS REPOS CENTRAL 1388.00 PERPH CANNULA BIRTH-5YRS 33964 PR ECMO/ECLS ECLS REPOS 1406.00 CENTRAL CNULA 6YRS & OLDER 33965 PR ECMO/ECLS RMVL OF PERPH 704.00 CANNULA PERQ BIRTH-5 YRS 33966 PR ECMO/ECLS RMVL OF PRPH 786.00 CANNULA PRQ 6 YRS & OLDER 33967 PR INSERT INTRA-AORTIC BALLOON 850.00 ASST DEVICE 33968 PR RMV AORTIC BALLOON DEVICE 81.00 33969 PR ECMO/ECLS RMVL OF PERPH 845.00 CANNULA OPEN BIRTH-5 YRS 33970 PR INSRT AORT BALLOON ASSIST 1166.00 33971 PR REMV AORTIC BALLOON ASSIST 1627.00 FEM ART 33973 PR INSRT AORTIC BALLOON THRU 1286.00 ASC AORT 33974 PR REMV AORTIC BALLOON FROM 3184.00 ASC AORT 33975 PR INSERT VENT ASST 4034.00 DEVICE,SINGLE VENTRICLE 33976 PR INSERT VENT ASST 4576.00 DEVICE,BIVENTRICULAR 33977 PR REMOVE VENT ASST 3869.00 DEVICE,SINGLE VENTRICLE 33978 PR REMOVE VENT ASST 4911.00 DEVICE,BIVENTRICULAR 33979 PR INSERT VENT ASST 6668.00 DEV,IMPLANT,SINGLE VENT 33980 PR REMOVE VENT ASST 8150.00 DEV,IMPLANT,SINGLE VENT 33982 PR REPLACE VENT ASST DEV, 7399.00 IMPLANT INTRACORP, SINGLE VENT, 33983 PR REPLACE VENT ASST DEV, 8460.00 IMPLANT INTRACORP, SINGLE VENT, 33984 PR ECMO/ECLS RMVL PRPH 827.00 CANNULA OPEN 6 YRS & OLDER 33985 PR ECMO/ECLS REMOVAL OF 1566.00 CENTRAL CANNULA BIRTH-5 YRS 33986 PR ECMO/ECLS RMVL OF CENTRAL 2074.00 CANNULA 6 YRS & OLDER 33987 PR ARTERY EXPOS/GRAFT ARTERY 624.00 PERFUSION ECMO/ECLS 33988 PR INSERT LEFT HEART VENT BY 2637.00 THORACIC INC ECMO/ECLS 33989 PR RMVL LEFT HEART VENT BY 1248.00 THORACIC INCIS ECMO/ECLS 33990 PR INSJ PERQ VAD W/IMAGING 1047.00 ARTERY ACCESS ONLY 33991 PR INSJ PERQ VAD TRNSPTAL 2136.00 W/IMAGE ART&VENOUS ACCESS 33992 PR REMOVAL PERCUTANEOUS VAD 513.00 DIFFERENT SESSION 33993 PR REPOSITION VAD W/IMAGING 448.00 DIFFERENT SESSION 33999 PR CARDIAC SURG PROCEDURE 2000.00 34101 PR REMV ART CLOT AXILL- 1416.00 BRACH,ARM INCIS 34111 PR REMV ART CLOT ARM,ARM INCIS 1415.00 34151 PR REMV ART CLOT VISC,ABD INCIS 5168.00 34201 PR REMV ART CLOT ILIAC-POP,LEG 2354.00 34203 PR REMV ART CLOT LOW LEG,LEG 3079.00 34471 PR REMV VEIN CLOT SUBCLAV,NECK 2978.00 34490 PR REMV VEIN CLOT AXILL- 2185.00 SUBCL,ARM INCIS 34502 PR RECONSTRUCT, VENA CAVA 5637.00 34701 PR EVASC RPR DPLMNT AORTO- 5143.00 AORTIC NDGFT 34702 PR EVASC RPR DPLMNT AORTO- 7682.00 AORTIC NDGFT RPT 34703 PR EVASC RPR DPLMNT AORTO-UN- 5795.00 ILIAC NDGFT 34704 PR EVASC RPR DPLMNT AORTO-UN- 9639.00 ILIAC NDGFT RPT 34705 PR EVASC RPR DPLMNT AORTO-BI- 6384.00 ILIAC NDGFT 34706 PR EVASC RPR DPLMNT AORTO-BI- 9608.00 ILIAC NDGFT RPT 34707 PR EVASC RPR DPLMNT ILIO-ILIAC 4796.00 34708 PR EVASC RPR DPLMNT ILIO-ILIAC 7718.00 NDGFT RPT 34709 PR PLACEMENT XTN PROSTH FOR 844.00 ENDOVASCULAR RPR 34710 PR DLYD PLACEMENT XTN PROSTH 2929.00 FOR EVASC RPR 1ST VSL 34711 PR DLYD PLACEMENT XTN PROSTH 780.00 FOR EVASC RPR EA ADDL 34712 PR TRANSCATHETER DLVR ENHNCD 2503.00 FIXATION DEVICES RS&I 34713 PR PERQ ACCESS & CLOSURE FEM 337.00 ART FOR DELIVERY NDGFT 34714 PR OPN FEM ART EXPOS W/CNDT 707.00 CRTJ DLVR EVASC PROSTH 34715 PR OPN AX/SUBCLA ART EXPOS 790.00 DLVR EVASC PROSTH UNI 34716 PR OPN AXILLARY/SUBCLAVIAN ART 980.00 EXPOS W/CNDT CRTJ 34800 PR AAA REPAIR,AORTO-AORTIC 3789.00 TUBE PROSTH 34802 PR AAA REPAIR,MODULR 4789.00 BIFURCATED PROSTH 34803 PR AAA REPAIR,MODULR BIFUR 4884.00 PROSTH,2-DOCK 34805 PR ENDOVASC ABDO REPAIR 2752.00 34808 PR AAA REPAIR,ILIAC ARTERY 500.00 OCCLSN DEVICE 34812 PR OPN FEM ART EXPOS DLVR 830.00 EVASC PROSTH UNI 34813 PR AAA REPAIR, FEMORAL- 580.00 FEMORAL GRAFT 34820 PR OPN ILIAC ART EXPOS 1200.00 PROSTH/ILIAC OCCLS EVASC UNI 34825 PR AAA REPR,1ST 1628.00 VESSEL,EXTENSION PROSTH 34826 PR AAA REPR,ADD 500.00 VESSEL,EXTENSION PROSTH 34830 PR AAA+TRAUMA REPR,OPEN,TUBE 4281.00 PROSTH 34833 PR OPN ILIAC ART EXPOS CRTJ 1455.00 PROSTH EST CARD BYP 34834 PR OPN BRACHIAL ARTERY EXPOS 1166.00 DLVR EVASC PROSTH UNI 34839 PR PLNNING PT SPEC FENEST 1035.00 VISCERAL AORTIC GRAFT 34842 PR ENDOVASC VISCER AORTA 5096.00 REPAIR FENEST 2 ENDOGRAFT 34843 PR ENDOVASC VISCER AORTA 5852.00 REPAIR FENEST 3 ENDOGRAFT 34846 PR VISCER AND INFRARENAL 4565.00 ABDOM AORTA 2 PROSTHESIS 34847 PR VISCER AND INFRARENAL 5412.00 ABDOM AORTA 3 PROSTHESIS 34900 PR ENDOVASCULAR REPAIR ILIAC 3224.00 ARTERY W ILIO-ILIAC PROSTHESIS 35011 PR REPR DFCT ART AXILLO-BRACH 3258.00 35045 PR REPR ANEURYSM/GRFT 3446.00 INS,RADIAL/ULNAR 35081 PR REPR ANEURYSM/GRFT 5899.00 INS,ABDOMINAL AORTA 35082 PR REPR ART RUPTURE, ABD 8983.00 35091 PR REPR ANEURYSM/GRFT INS,ABD 7346.00 AORT W/VISCER 35102 PR REPR ANEURYSM/GRFT INS,ABD 7748.00 AORT W/ILIAC 35121 PR REPR ANEUR/GRFT 6769.00 INS,HEP/CEL/REN/MESENTER 35131 PR REPR ANEURYSM/GRFT INS,ILIAC 5713.00 35132 PR REPR ART RUPTURE,ILIAC 3982.00 35141 PR REPR ANEURYSM/GRFT 3667.00 INS,COMMON FEMORAL 35151 PR REPR ANEURYSM/GRFT 4737.00 35184 PR REPR CONG AV FIST,EXTREM 3448.00 35190 PR REPR ACQ AV FIST,EXTREM 2411.00 35201 PR REPR BL VES DIRECT,NECK 2968.00 35206 PR REPR BL VES DIRECT,UP 2653.00 35207 PR REPR BL VES 3750.00 35211 PR REPR BL VES DIRECT,CHEST W 3137.00 35216 PR REPR BL VES DIRECT,CHEST 5220.00 35221 PR REPR BL VES DIRECT,ABD 5056.00 35226 PR REPR BL VES DIRECT,LOW 2972.00 35231 PR REPR BL VES VEIN GRFT,NECK 5084.00 35236 PR REPR BL VES VEIN GRFT,UP 4650.00 35241 PR REPR BL VES VEIN 3281.00 GRFT,CHEST/W BYPAS 35256 PR REPR BL VES VEIN GRFT,LOW 3664.00 35261 PR REPR BL VES GRAFT,NECK 3239.00 35271 PR REPR BL VES GRAFT,CHEST W 3129.00 35276 PR REPR BL VES GRAFT,CHEST 5596.00 35281 PR REPR BL VES GRAFT,ABDOMEN 5763.00 35286 PR REPR BL VES GRAFT,LOW 3189.00 35301 PR THROMBOENDARTECTMY 3510.00 NECK,NECK INCIS 35302 PR THROMBOENDARTECTMY 4546.00 SUPERFICIAL FEM ARTERY 35303 PR THROMBOENDARTECTMY 5292.00 POPLITEAL ARTERY 35305 PR THROMBOENDARTECTMY TIBIAL/ 5063.00 PERON ARTERY, INITIAL 35321 PR THROMBOENDARTECTMY 2926.00 AXILLARY-BRACH 35331 PR THROMBOENDARTECTMY ABD 5486.00 35341 PR THROMBOENDARTECTMY 5284.00 35351 PR THROMBOENDARTECTMY ILIAC 5260.00 35355 PR THROMBOENDARTECTMY 3706.00 35371 PR THROMBOENDARTECTMY 2744.00 FEMORAL COMMON 35372 PR THROMBOENDARTECTMY 3312.00 FEMORAL DEEP 35390 PR REOPER, CAROTID ENDARTEC>1 398.00 35400 PR ANGIOSCOPY DURING RX 391.00 35460 PR BALLN ANGIOPLASTY 794.00 35471 PR BALLN ANGIOPLASTY 12695.00 35472 PR BALLN ANGIOPLASTY 5072.00 35475 PR BALLN ANGIOPLASTY 5657.00 PERC,BRACHIOCEPH 35476 PR BALLN ANGIOPLASTY,PERC 4321.00 35500 PR HARVEST VEIN FOR BYPASS 806.00 35501 PR VEIN BYPASS GRAFT,CAROTID, 3615.00 COMMON-INT CAR ART 35506 PR VEIN BYPASS GRAFT,CAROT- 3624.00 SUBCL/ SUBCL-CAROTD 35510 PR ARTERY BYPASS GRAFT 5025.00 35516 PR VEIN BYPASS GRAFT,SUBCL- 2889.00 35523 PR VEIN BYPASS GRAFT, BRACHIAL 5227.00 ULNAR OR RADIAL 35525 PR ARTERY BYPASS GRAFT 4556.00 35531 PR VEIN BYPASS GRAFT,AORTO- 8348.00 35537 PR VEIN BYPASS 8726.00 GRAFT,AORTOILIOFEMORAL 35556 PR VEIN BYPASS GRAFT,FEM-POP 4608.00 35566 PR VEIN BYPASS GRAFT,FEM-TIBIAL 5731.00 35571 PR VEIN BYPASS GRAFT,TIB- 5283.00 35600 HARVEST UPPER EXTREMITY ART 1 620.00 SEGMENT FOR CABG 35601 PR BYPASS GRAFT OTHR,CAROTID- 3367.00 INT CAROTID 35606 PR BYPASS GRAFT OTHR,CAROT- 3270.00 35621 PR BYPASS GRAFT OTHR,AXILL-FEM 3689.00 35626 PR BYPASS GRAFT 5739.00 OTHR,AORTOSUBCLAVIAN/AORTOIN NOMINATE/AORTOCAROTID 35631 PR BYPASS GRAFT OTHR,AORTO- 6982.00 MESENTER 35632 PR BYPASS GRAFT OTHR,ILIO- 6493.00 35633 PR BYPASS GRAFT OTHR,ILIO- 5797.00 35637 PR BYPASS GRAFT 4140.00 35638 PR BYPASS GRAFT OTHR,AORTOBI- 6288.00 35646 PR BYPASS GRAFT 6550.00 OTHR,AORTOBIFEMORAL 35647 PR BYPASS GRAFT 3820.00 35654 PR BYPASS GRAFT OTHR,AXILL-FEM- 5201.00 35656 PR BYPASS GRAFT OTHR,FEM-POP 3609.00 35661 PR BYPASS GRAFT OTHR,FEM-FEM 3481.00 35663 PR BYPASS GRAFT OTHR,ILIOILIAC 5147.00 35665 PR BYPASS GRAFT 4409.00 35666 PR BYPASS GRAFT OTHR,FEM- 4992.00 35671 PR BYPASS GRAFT OTHR,POP- 4581.00 35681 PR BYPASS GRAFT 207.00 35682 PR BYPASS GRAFT COMPOS/2 868.00 VEINS/2 LOCATN 35685 PR BYPASS GRAFT VEIN 509 PATCH/CUFF,SYNTHETIC 35693 PR ART TRANSPOSITN,VERT-SUBCL 2858.00 35697 PR REIMPLANT ARTERY EACH 391.00 35700 PR REOPERATION, BYPASS GRAFT 384.00 35721 PR EXPLORATION, FEMORAL 1119.00 35741 PR EXPLORATION POPLITEAL 1316.00 35761 PR EXPLORATION OF ARTERY/VEIN 895.00 35800 PR EXPLOR POSTOP 1824.00 BLEED,INFEC,CLOT-NECK 35820 PR EXPLOR POSTOP 6564.00 BLEED,INFEC,CLOT-CHST 35840 PR EXPLOR POSTOP 4867.00 BLEED,INFEC,CLOT-ABD 35860 PR EXPLOR POSTOP 2321.00 BLEED,INFEC,CLOT-EXTR 35875 PR REMOVAL OF CLOT IN GRAFT 2107.00 35876 PR REMOVAL OF CLOT IN GRAFT 3337.00 35879 PR REVISE GRAFT/VEIN PATCH 3321.00 35881 PR REVISE GRAFT/SEG VEIN 3215.00 35883 PR REVISE FEMORAL GRAFT, NON- 5133.00 AUTOGENOUS GRAFT 35884 PR REVISE FEMORAL GRAFT, 5091.00 AUTOGENOUS GRAFT 35901 PR EXCISION, INFEC GRAFT, NECK 1240.00 35903 PR EXCISION, INFEC GRAFT, 1594.00 35907 PR EXCISION, INFEC GRAFT, 7238.00 36000 PR PLACE NEEDLE IN VEIN 65.00 36002 PR INJECTION RX EXTREMITY 416.00 PSEUDOANEURYSM 36005 PR INJECTION 780.00 PROC,EXTREMITY,VENOGRAPHY 36010 PR INTRO CATHETER 1958.00 SUPERIOR/INFERIOR VENA CAVA 36011 PR PLACE CATH IN VEIN,SELECT 2569.00 36012 PR PLACE CATH IN VEIN,SUBSELECT 2016.00 36013 PR PLACE CATH IN RT HRT,MAIN 2004.00 36014 PR PLACE CATH IN LT/RT PULM ART 2019.00 36015 PR PLACE CATH IN SUBSEGMT 2287.00 36120 PR PLACE CATH BRACHIAL ART 1120.00 36140 PR INTRO OF NEEDLE OR 1265.00 INTRACATHETER UPR/LXTR ARTERY 36147 PR PLACE NEEDLE/CATH A-V 1813.00 DIALYSIS SHUNT,1ST ACCESS W/ 36148 PR PLACE NEEDLE/CATH A-V 657.00 DIALYSIS SHUNT,ADDL ACCESS FOR 36160 PR PLACE CATH AORTA VIA 1389.00 36200 PR INTRODUCTION CATHETER 1672.00 36215 PR PLACE CATH SELECTIVE 2786.00 36216 PR PLACE CATH SUBSELECT 3016.00 36217 PR PLACE CATH SUBSUBSELECT 5259.00 36218 PR PLACE CATH ADDN SUBSELEC 512.00 ART,NECK 36221 PR NONSLCTV CATH THOR AORTA 540.00 ANGIO INTR/XTRCRANL ART 36222 PR SLCTV CATH CAROTID/INNOM 3526.00 ART ANGIO XTRCRANL ART 36223 PR SLCTV CATH CAROTID/INNOM 3843.00 ART ANGIO INTRCRANL ART 36224 PR SLCTV CATH INTRNL CAROTID 4177.00 ART ANGIO INTRCRNL ART 36225 PR SLCTV CATH SUBCLAVIAN ART 3813.00 ANGIO VERTEBRAL ARTERY 36226 PR SLCTV CATH VERTEBRAL ART 4261.00 ANGIO VERTEBRAL ARTERY 36227 PR SLCTV CATH XTRNL CAROTID 613.00 ANGIO XTRNL CAROTD CIRC 36228 PR SLCTV CATH INTRCRNL BRNCH 2934.00 ANGIO INTRL CAROT/VERT 36245 PR SLCTV CATHJ EA 1ST ORD ABDL 3197.00 PEL/LXTR ART BRNCH 36246 PR SLCTV CATHJ 2ND ORDER ABDL 3074.00 PEL/LXTR ART BRNCH 36247 PR SLCTV CATHJ 3RD+ ORD SLCTV 4866.00 ABDL PEL/LXTR BRNCH 36248 PR SLCTV CATHJ EA 2ND+ ORD 431.00 ABDL PEL/LXTR ART BRNCH 36251 PR SLCTV CATH 1STORD W/WO ART 3573.00 PUNCT/FLUORO/S&I UN 36252 PR SLCTV CATH 1STORD W/WO ART 3919.00 PUNCT/FLUOR/S&I BIL 36253 PR SUPSLCTV CATH 2ND+ORD 5467.00 RENAL&ACCESSORY ARTERY/S&I 36254 PR SUPSLCTV CATH 2ND+ORD 5563.00 RENAL&ACCESSORY ARTERY/S&I 36406 PR VNPNXR <3 YEARS PHYS/QHP 64.00 SKILL OTHER VEIN 36410 PR VNPNXR 3 YEARS/> PHYS/QHP 41.00 36415 PR COLLECTION VENOUS 8.00 BLOOD,VENIPUNCTURE 36416 PR COLLECTION CAPILLARY BLOOD 11.00 SPECIMEN 36430 PR BLOOD TRANSFUSION SERVICE 89.00 36456 PR PRTL EXCHANGE TRANSFUSE 278.00 BLOOD/PLSM/CRYST NEWBORN 36460 PR TRANSFUSION 1400.00 36465 PR NJX NONCMPND SCLEROSANT 4060.00 SINGLE INCMPTNT VEIN 36466 PR NJX NONCMPND SCLEROSANT 4242.00 MULTIPLE INCMPTNT VEINS 36468 PR INJECTIONS SCLEROSANT FOR 137.00 SPIDER VEINS LIM/TRNK 36470 PR INJECTION SCLEROSANT SINGLE 373.00 INCMPTNT VEIN 36471 PR INJECTION SCLEROSANT 436.00 MULTIPLE INCMPTNT VEINS 36473 PR ENDOVEN ABLTJ INCMPTNT VEIN 450.00 MCHNCHEM 1ST VEIN 36474 PR ENDOVEN ABLTJ INCMPTNT VEIN 226.00 MCHNCHEM SBSQ VEINS 36475 PR ENDOVENOUS RF, 1ST VEIN 4147.00 36478 PR ENDOVENOUS LASER, 1ST VEIN 3282.00 36479 PR ENDOVEN ABLTJ INCMPTNT VEIN 958.00 XTR LASER 2ND+ VEINS 36481 PR PRQ PORTAL VEIN 4963.00 CATHETERIZATION ANY METHOD 36482 PR ENDOVEN ABLTI THER CHEM 5404.00 ADHESIVE 1ST VEIN 36483 PR ENDOVEN ABLTI THER CHEM 368.00 ADHESIVE SBSQ VEIN 36500 PR VENOUS SELECT SAMPLING W 424.00 36510 PR CATH, VEIN UMBILICAL 232.00 36511 PR THER APHERESIS,WHITE BLOOD 232.00 36512 PR THER APHERESIS,RED BLOOD 227.00 36513 PR THER APHERESIS,PLATELETS 248.00 36514 PR THER APHERESIS,PLASMA 1888.00 36522 PR PHOTOPHERESIS 6263.00 36555 PR INSJ NON-TUNNELED CENTRAL 711.00 VENOUS CATH AGE < 5 Y 36556 PR INSERT NON-TUNNEL CV CATH 664.00 36557 PR INSERT TUNNELED CVC W/O 2201.00 SUBQ PORT/PMP AGE <5 YR 36558 PR INSJ TUNNELED CVC W/O SUBQ 2170.00 PORT/PMP AGE 5 YR/> 36560 PR INSJ TUNNELED CTR VAD 3168.00 W/SUBQ PORT UNDER 5 YR 36561 PR INSJ TUNNELED CTR VAD 3010.00 W/SUBQ PORT AGE 5 YR/> 36566 PR INSJ TUN VAD REQ 2 CATH 2 SITS 8520.00 W/SUBQ PORT 36568 PR INSJ PRPH CVC W/O SUBQ 798.00 PORT/PMP UNDER 5 YR 36569 PR INSERT TUNNELED CV CATH 751.00 36571 PR INSJ PRPH CTR VAD W/SUBQ 3251.00 PORT AGE 5 YR/> 36575 PR REPAIR TUNNELED CV CATH 386.00 36578 PR RPLCMT CATH CTR VAD SUBQ 1278.00 PORT/PMP 36580 PR REPLACE NON-TUNNELED 672.00 CENTRAL LINE, W/O PORT/PUMP 36581 PR RPLCMT COMPL TUN CVC W/O 1940.00 SUBQ PORT/PMP 36582 PR RPLCMT COMPL TUN CTR VAD 2686.00 W/SUBQ PORT 36584 PR REPLACE COMPLETE PICC W/O 663.00 PORT/PUMP, SAME ACCESS 36585 PR RPLCMT COMPL PRPH CTR VAD 2767.00 W/SUBQ PORT 36589 PR REMOVAL TUNNELED CV CATH 397.00 36590 PR RMVL TUN CTR VAD W/SUBQ 745.00 PORT/PMP CTR/PRPH INSJ 36593 PR DECLOT BY THROMBOLYTIC 67.00 AGENT IMPLANT DEVICE/CATH 36595 PR MECH REMOV TUNNELED CV 1701.00 36596 PR MECH REMOV TUNNELED CV 368.00 36597 PR REPOSITION VENOUS CATHETER 395.00 36598 PR CONTRAST INJ CENT VEN CATH, 292.00 INC FLOURO 36600 PR WITHDRAWAL OF ARTERIAL 78.00 36620 PR INSERT 270.00 36625 PR INSERT 244.00 CATH,ART,CUTDOWN,SHORTTERM 36680 PR INSERT NEEDLE,INTRAOSSEOUS 188.00 INFUSN 36800 PR INSERT CANNULA,VEIN-VEIN 405.00 36818 PR AV ANAST,UP ARM CEPHALIC 1647.00 VEIN TRANSPOSIT 36819 PR AV ANAST,UP ARM BASILIC VEIN 2648.00 TRANSPOSIT 36820 PR AV ANAST,FOREARM VEIN 2636.00 TRANSPOSITION 36821 PR ANASTOMOSIS,AV,ANY SITE 1539.00 36825 PR CREAT AV 1810.00 FISTULA,AUTOGENOUS GRAFT 36830 PR CREAT AV FISTULA,NON- 2343.00 AUTOGENOUS GRAFT 36831 PR THROMBECTOMY,AV FISTULA 2219.00 DIALYS GRFT 36832 PR REVISE AV FISTULA,W/O 2071.00 THROMBECTOMY 36833 PR AV FIST REVISE GRFT,W 2322.00 THROMBECTOMY 36838 PR DIST REVAS LIGATION, HEMO 4708.00 36870 PR 4878.00 THROMBECTOMY,ARTERIOVENOUS 36901 PR INTRO CATH DIALYSIS CIRCUIT 1429.00 DX ANGRPH FLUOR S&I 36902 PR INTRO CATH DIALYSIS CIRCUIT 563.00 W/TRLUML BALO ANGIOP 36903 PR INTRO CATH DIALYSIS CIRCUIT 770.00 W/TCAT PLMT IV STENT 36904 PR PERQ THRMBC/NFS DIALYSIS 887.00 CIRCUIT IMG DX ANGRPH 36905 PR PERQ THRMBC/NFS DIAL 1113.00 CIRCUIT TRLUML BALO ANGIOP 36906 PR PERQ THRMBC/NFS DIAL 1299.00 CIRCUIT TCAT PLMT IV STENT 36907 PR TRLUML BALO ANGIOP CTR 324.00 DIALYSIS SEG W/IMG S&I 36908 PR STENT PLMT CENTRAL DIAYLSIS 486.00 SEG PFRMD DIAL CIR 36909 PR DIALYIS CIRCUIT VASC EMBOLI 462.00 OCCLS EVASC IMG S&I 37140 PR VENOUS 4929.00 ANASTOMOSIS,OPEN,PORTOCAVAL 37182 PR INSERT TRANSVEN INTRAHEP 2827.00 PORTOSYS SHUNT 37183 PR REVJ TRANSVNS INTRAHEPATIC 965.00 PORTOSYSTEMIC SHUNT 37184 PR PRIM PRQ TRLUML MCHNL 6625.00 THRMBC N-COR N-ICRA 1ST 37185 PR PRIM PRQ TRLUML MCHNL 2166.00 THRMBC N-COR N-ICRA SBSQ 37186 PR SEC PRQ TRLUML THRMBC N- 4003.00 CORONARY N-INTRACRANIAL 37187 PR PRQ TRANSLUMINAL 6443.00 MECHANICAL THROMBECTOMY VEIN 37188 PR PRQ TRLUML MCHNL THRMBC 5558.00 VEIN REPEAT TX 37191 PR INS INTRVAS VC FILTR W/WO 6509.00 VAS ACS VSL SELXN RS&I 37192 PR REPSNG INTRVAS VC FILTR 3917.00 W/WO ACS VSL SELXN RS&I 37193 PR RTRVL INTRVAS VC FILTR W/WO 4160.00 ACS VSL SELXN RS&I 37197 PR PRQ TRANSCATHETER RTRVL 3777.00 INTRVAS FB WITH IMAGING 37200 PR TRANSCATHETER BIOPSY 533.00 37211 PR THROMBOLYSIS ARTERIAL 976.00 INFUSION ICRA RS&I INIT TX 37212 PR THROMBOLYSIS VENOUS 862.00 INFUSION W/IMAGING INIT TX 37213 PR THROMBOLYSIS ART/VENOUS 602.00 INFSN W/IMAGE SUBSQ TX 37214 PR CESSATION THROMBOLYTIC 354.00 THER W/CATHETER REMOVAL 37215 PR TCAT IV STENT CRV CRTD ART 3586.00 EMBOLIC PROTECJ 37216 PR TCAT IV STENT CRV CRTD ART 3333.00 W/O EMBOLIC PROTECJ 37217 PR TCATH STENT PLACEMT 2679.00 RETROGRAD CAROTID/INNOMINATE 37218 PR TCATH STENT PLACEMT 3034.00 ANTEGRADE CAROTID/INNOMINATE 37220 PR REVASCULARIZATION ILIAC 1052.00 ARTERY ANGIOP 1ST VSL 37221 PR REVSC OPN/PRQ ILIAC ART 1285.00 W/STNT PLMT & ANGIOPLSTY 37222 PR REVASCULARIZATION ILIAC ART 2225.00 ANGIOP EA IPSI VSL 37223 PR REVSC OPN/PRQ ILIAC ART 543.00 W/STNT & ANGIOP IPSILATL 37224 PR REVSC OPN/PRG FEM/POP 1165.00 W/ANGIOPLASTY UNI 37225 PR REVSC OPN/PRQ FEM/POP 1570.00 W/ATHRC/ANGIOP SM VSL 37226 PR REVSC OPN/PRQ FEM/POP 1824.00 W/STNT/ANGIOP SM VSL 37227 PR REVSC OPN/PRQ FEM/POP 2646.00 W/STNT/ATHRC/ANGIOP SM VSL 37228 PR REVSC OPN/PRQ TIB/PERO 1420.00 W/ANGIOPLASTY UNI 37229 PR REVSC OPN/PRQ TIB/PERO 2568.00 W/ATHRC/ANGIOP SM VSL 37230 PR REVSC OPN/PRQ TIB/PERO 2497.00 W/STNT/ANGIOP SM VSL 37231 PR REVSC OPN/PRQ TIB/PERO 1955.00 W/STNT/ATHR/ANGIOP SM VSL 37232 PR REVSC OPN/PRQ TIB/PERO 2967.00 W/ANGIOPLASTY UNI EA VSL 37233 PR REVSC OPN/PRQ TIB/PERO 3702.00 W/ATHRC/ANGIOP UNI EA VSL 37234 PR REVSC OPN/PRQ TIB/PERO 714.00 W/STNT/ANGIOP UNI EA VSL 37236 PR OPEN/PERQ PLACEMENT 1795.00 INTRAVASCULAR STENT INITIAL 37237 PR OPEN/PERQ PLACEMENT 546.00 INTRAVASCULAR STENT EA ADDL 37238 PR OPEN/PERQ PLACEMENT 819.00 INTRAVASCULAR STENT SAME 1ST 37239 PR OPEN/PERQ PLACEMENT 381.00 INTRAVASC STENT SAME EA ADDL 37241 PR VASCULAR EMBOLIZATION OR 1727.00 OCCLUSION VENOUS RS&I 37242 PR VASCULAR EMBOLIZATION OR 1773.00 OCCLUSION ARTERIAL RS&I 37243 PR VASCULAR EMBOLIZE/OCCLUDE 2113.00 ORGAN TUMOR INFARCT 37244 PR VASCULAR EMBOLIZATION OR 2465.00 OCCLUSION HEMORRHAGE 37246 PR TRLML BALO ANGIOP 924.00 OPEN/PERQ IMG S&I 1ST ART 37247 PR TRLML BALO ANGIOP 458.00 OPEN/PERQ IMG S&I EA ADDL ART 37248 PR TRLML BALO ANGIOP 795.00 OPEN/PERQ W/IMG S&I 1ST VEIN 37249 PR TRLML BALO ANGIOP 390.00 OPEN/PERQ W/IMG S&I ADDL VEIN 37252 PR INTRAVASCULAR US 3554.00 NONCORONARY RS&I INTIAL 37253 PR INTRAVASCULAR US 530.00 NONCORONARY RS&I ADDL VESSEL 37607 PR LIGATN ANGIOACCESS AV 903.00 37609 PR TEMPORAL ARTERY LIGATN OR 779.00 37617 PR LIGATN OF ABDOMEN ARTERY 4619.00 37618 PR LIGATN OF EXTREMITY ARTERY 979.00 37619 PR INS INTRVAS VC FILTR W/WO 4021.00 VAS ACS VSL SELXN RS&I 37765 PR PHLEB VEINS - EXTREM - TO 20 1108.00 37766 PR PHLEB VEINS - EXTREM 20+ 1500.00 37785 PR REVISE SECONDARY 913.00 38100 PR REMOVAL SPLEEN, TOTAL 2713.00 38101 PR REMOVAL SPLEEN, PARTIAL 2867.00 38102 PR REMOVAL SPLEEN, TOTAL W 602.00 OTHR PROC 38115 PR REPAIR OF RUPTURED SPLEEN 3220.00 38120 PR LAP,SPLENECTOMY 3155.00 38200 PR INJECTION FOR SPLEEN X-RAY 327.00 38205 PR PROG CELL 197.00 HARVEST,TRANSPLANT,ALLOGENIC 38206 PR PROG CELL 198.00 HARVEST,TRANSPLANT,AUTOLOGO 38220 PR DIAGNOSTIC BONE MARROW 422.00 ASPIRATIONS 38221 PR DIAGNOSTIC BONE MARROW 421.00 38222 PR DIAGNOSTIC BONE MARROW 436.00 BIOPSIES & ASPIRATIONS 38230 PR BONE MARROW HARVEST 1500.00 TRANSPLANTATION ALLOGENEIC 38232 PR BONE MARROW HARVEST 500.00 TRANSPLANTATION AUTOLOGOUS 38240 PR TRNSPLJ ALLOGENEIC 500.00 HEMATOPOIETIC CELLS PER DONOR 38241 PR TRNSPLJ AUTOLOGOUS 500.00 HEMATOPOIETIC CELLS PER DONOR 38242 PR ALLOGENEIC LYMPHOCYTE 304.00 38243 PR TRNSPLJ HEMATOPOIETIC CELL 304.00 38300 PR DRAINAGE LYMPH NODE,SIMPLE 800.00 38305 PR DRAINAGE LYMPH 988.00 38308 PR INCISION OF LYMPH CHANNELS 1136 38380 PR LIGATN THOR DUCT,CERV 1224.00 38381 PR LIGATN THOR DUCT,THOR 2921.00 38500 PR BIOPSY/EXCISION, LYMPH 835.00 38505 PR NEEDLE BIOPSY, LYMPH 285.00 38510 PR BX/REMV,LYMPH NODE,DEEP 1310.00 38525 PR BX/REMV,LYMPH NODE,DEEP 1113 38530 PR BX/REMV,LYMPH NODE,INTERN 1423.00 38562 PR REMOVAL, PELVIC LYMPH 2225.00 NODES,STAGING 38570 PR LAP,LYMPH NODE BX 1300.00 38571 PR LAP,PELVIC 2580.00 38572 PR LAP,PELVIC 3225.00 38573 PR LAPS W/BI TOT PEL LMPHADEC & 4232.00 OMNTC LYMPH BX 38700 PR REMOVAL NODES, 2685.00 38720 PR REMOVAL NODES, NECK,CERV 2841.00 38724 PR REMOVAL NODES, NECK,CERV 5599.00 38740 PR REMOVE ARMPIT LYMPH NODES 2014.00 SUPERFIC 38745 PR REMOVE ARMPITS LYMPH 2714.00 NODES COMPLT 38746 PR REMOVE THOR LYMPH NODES 658.00 RAD REGNL 38747 PR REMOVE ABD LYMPH NODES 754.00 RAD REGNL 38760 PR REMOVE GROIN LYMPH NODES 2560.00 38765 PR REMOVE GROIN LYMPH NODES 3983.00 38770 PR REMOVE PELVIS LYMPH NODES 2600.00 38780 PR REMOVE ABD LYMPH NODES 3977.00 38790 PR INJECTION FOR LYMPHATIC 776.00 38792 PR INJ RADIOACTIVE TRACER FOR 102 ID OF SENTINEL NODE 38794 PR ACCESS THORACIC LYMPH DUCT 768.00 38900 PR INTRAOPERATIVE SENTINEL 328.00 LYMPH NODE ID W DYE INJECTION 39000 PR MEDIASTINOSCOPY, CERV 1239.00 39010 PR MEDIASTINOSCOPY, CHST 2456.00 39200 PR RESECTION OF MEDIASTINAL 3120.00 39220 PR RESECTION MEDIASTINAL 3435.00 39401 PR MEDIASTINOSCOPY INCLUDES 802.00 MEDIASTINAL MASS BIOPSY 39402 PR MEDIASTINOSCOPY WITH LYMPH 1063.00 NODE BIOPSY/IES 39501 PR REPAIR DIAPHRAGM 2693.00 39503 PR REPAIR DIAPHR 18769.00 39540 PR REPAIR DIAPHR HERNIA TRAUMA 2715.00 39541 PR REPAIR DIAPHR HERNIA TRAUMA 2873.00 39545 PR REVISION OF DIAPHRAGM 2916.00 39560 PR RESECT DIAPHRAM,SIMPLE 2517.00 39561 PR RESECT DIAPHRAM,COMPLX REP 4432.00 40490 PR BIOPSY OF LIP 299.00 40500 PR LIP SHAVE 1280.00 40510 PR PARTIAL EXCIS LIP,WEDGE PRIM 1520.00 40520 PR PARTIAL EXCIS LIP,V-EXC PRIM 1251 40525 PR FULL THICK EXCIS LIP,RECON W 1410.00 40527 PR FULL THICK EXCIS LIP,FIX W 3570.00 40530 PR PARTIAL REMOVAL OF LIP,>1/4 1180.00 40650 PR REPAIR LIP,FULL 1111.00 40652 PR REPAIR LIP,<1/2 VERT HEIGHT 1246.00 40654 PR REPAIR LIP,>1/2 VERT HEIGHT 2128.00 40700 PR REPAIR CLEFT LIP/NASAL,UNILAT 2897.00 40701 PR REPR CLEFT LIP,BILAT,1 STAGE 4285.00 40702 PR REPR CLEFT LIP,BILAT,1OF2 3225.00 40720 PR REPR CLEFT 3561.00 40761 PR REPR CLEFT LIP/NASAL,XLIP PED 3890.00 40800 PR DRAIN MOUTH 413.00 ABSC/CYST/HEMATOMA,SIMPL 40801 PR DRAIN MOUTH 806.00 ABSC/CYST/HEMAT,COMPLX 40806 PR INCISION OF LIP FOLD 325.00 40808 PR BIOPSY OF MOUTH LESION 476.00 40810 PR EXCIS MOUTH MUCOSA/SUB,NO 415.00 40812 PR EXCIS MOUTH 527.00 MUCOSA/SUB,SIMPL REPAIR 40814 PR EXCIS MOUTH 1902.00 MUCOSA/SUB,COMPLX REPR 40816 PR EXCIS MOUTH COMPLEX,EXC 1031.00 THRU MUSCLE 40819 PR EXCISE LIP OR CHEEK FOLD 691.00 40820 PR DESTRUC MOUTH LESION/SCAR 696.00 40830 PR REPAIR MOUTH 686.00 40831 PR REPAIR MOUTH 714.00 40840 PR RECONSTRUC MOUTH ANTERIOR 1709.00 41005 PR I&D MOUTH/TONG 588.00 INTRA,SUBLING,SUPERF 41007 PR I&D MOUTH/TONG 977.00 41008 PR I&D MOUTH/TONG 979.00 INTRA,SUBMANDIBULAR 41010 PR INCISION OF TONGUE FOLD 512.00 41015 PR I&D MOUTH/TONG 1171.00 41017 PR I&D MOUTH/TONG 1144 41100 PR BIOPSY TONGUE,ANTER 2/3 383.00 41105 PR BIOPSY TONGUE,POSTER 1/3 352.00 41108 PR BIOPSY OF FLOOR OF MOUTH 302.00 41110 PR EXCIS TONGUE LESN 434.00 41112 PR EXCIS TONGUE LESN,ANT 686.00 41113 PR EXCIS TONGUE LESN,POST 1/3 949.00 41115 PR EXCIS TONGUE FOLD 628.00 41116 PR EXCIS FLOOR MOUTH LESION 836.00 41120 PR PART REMOVAL TONGUE,<1/2 3212.00 41130 PR PART REMOVAL TONGUE, 1/2 4769.00 41135 PR PART EXC TONGUE,UNILAT RAD 7415.00 41140 PR REMOVAL OF TONGUE 9029.00 41145 PR EXCIS TONGUE,UNILAT RAD 9540.00 41150 PR EXCIS TONGUE,MOUTH,JAW 7569.00 41153 PR EXCIS TONGUE,MOUTH,NECK 4344.00 41155 PR EXCIS TONGUE,MOUTH,JAW,RAD 5536.00 41250 PR REPAIR TONGUE LACER,<2.6CM 675.00 41252 PR REPAIR TONGUE 708.00 LACER,2.6CM+/COMPLX 41500 PR FIXATION OF 1153.00 41800 PR DRAINAGE OF GUM LESION 682.00 41822 PR EXCIS FIBROUS 800.00 41823 PR EXCIS OSSEOUS 833.00 41827 PR EXCIS DENTOALV LESN,COMPLX 2007.00 41828 PR EXCISION OF GUM LESION 790.00 41830 PR REMOVAL OF GUM TISSUE 800.00 41870 PR GUM GRAFT 775.00 41874 PR REPAIR TOOTH SOCKET 980.00 41899 PR DENTAL SURGERY PROCEDURE 190.00 42000 PR DRAINAGE ABSCESS 496.00 42100 PR BIOPSY PALATE/UVULA 315.00 42104 PR EXCIS LESN,PALATE/UVULA 469.00 42106 PR EXCIS LESN,PALATE/UVULA- 699 42120 PR REMOVE PALATE/LESION 2925.00 42140 PR EXCISION OF UVULA 518.00 42145 PR PALATOPHAYNGOPLASTY 2128.00 42160 PR DESTRUC LESN PALATE/UVULA 600 42182 PR REPAIR PALATE LACER 2+CM OR 826.00 COMPLX 42200 PR RECONST CLEFT 3003.00 42205 PR RECONST CLEFT PALATE,CLOS 3570.00 ALVE RDG 42210 PR RECONST CLEFT PALATE,BONE 4020.00 42215 PR RECONST CLEFT PALATE,MAJOR 1854.00 42220 PR RECONST CLEFT 1350.00 42225 PR RECONST CLEFT 3050.00 42226 PR LENGTHENING PALATE+PHARY 3142.00 42235 PR REPAIR ANTER PALATE W 1840.00 42281 PR INSERTION, PALATE 428.00 42300 PR DRAIN ABSCESS 441.00 42305 PR DRAIN ABSCESS 1114.00 42330 PR REMOVAL SALIVARY 492.00 42335 PR REMOVAL SUBMAND 714.00 STONE,COMPLICATED 42400 PR BIOPSY SALIVARY 269.00 42405 PR BIOPSY SALIVARY 687.00 42408 PR EXCISION SUBLING SALIVARY 963.00 42409 PR DRAINAGE SUBLING SALIVARY 847.00 42410 PR EXC PAROTD LESN,LATER LOBE 1985.00 42415 PR EXC PAROTD,LAT LOBE,DISSECT 3801.00 5TH NERV 42420 PR EXC PAROTD,TOTAL,DISSECT 3528.00 42425 PR EXC PAROTD,TOTAL,SACRIFICE 2556.00 5TH NERV 42426 PR EXC PAROTD,TOTAL,UNILAT RAD 4851.00 42440 PR EXCISION SUBMAXILLARY GLAND 1473.00 42450 PR EXCISION SUBLINGUAL GLAND 1216.00 42500 PR REPAIR SALIVARY DUCT SIMPLE 1103.00 42650 PR DILATION OF SALIVARY DUCT 285.00 42700 PR INC/DRAIN PERITONSIL ABSCESS 478 42720 PR INC/DRAIN RETROPHARYNG 1153.00 ABSCESS,ORAL 42725 PR INC/DRAIN RETROPHARYNG 2476.00 ABSCESS,EXT 42800 PR BIOPSY OROPHARYNX 397.00 42804 PR BIOPSY NASOPHARYNX,SIMPLE 495.00 42808 PR EXCISE PHARYNX LESION 687.00 42809 PR REMOVE PHARYNX FOREIGN 911.00 42810 PR EXCISION BRACH CLFT 804.00 CYST,SUPERFICIAL 42815 PR EXCISION BRANC CLFT 1474.00 42820 REMOVE TONSILS/ADENOIDS,<12 645.00 42821 PR REMOVE TONSILS/ADENOIDS,12+ 744.00 42825 REMOVAL OF TONSILS,<12 Y/O 645.00 42826 PR REMOVAL OF TONSILS,12+ Y/O 744.00 42830 REMOVAL ADENOIDS,PRIMARY,<12 528.00 42831 PR REMOVAL 490.00 42835 REMOVAL ADENOIDS,SECOND,<12 423.00 42836 PR REMOVAL 537.00 42842 PR RAD RESEC TONSIL/PILLARS 3605 42844 PR RAD RESEC 5010.00 TONSIL/PILLARS,CLOS LOCAL 42845 PR RAD RESEC 4316.00 42870 PR EXCISION OF LINGUAL TONSIL 1256.00 42890 PR PARTIAL REMOVAL OF PHARYNX 2776.00 42894 PR RESEC PHARYN WALL,CLOS 5774.00 MYOCUT FLAP 42950 PR RECONSTRUCTION OF THROAT 2080 42953 PR REPAIR THROAT, ESOPHAGUS 2229.00 42960 PR CONTROL THROAT 401.00 42961 PR CONTROL THROAT 1076.00 BLEED,COMPL IN HOSP 42962 PR CONTROL THROAT BLEED,SURG 1203.00 INTERVENTN 42972 PR CNTRL NASOPHARYNG 1318.00 BLEED,SURGERY 42999 PR THROAT SURGERY PROCEDURE 3784.00 UNLISTED 43030 PR CRICOPHAYNGEAL MYOTOMY 1763.00 43101 PR EXCIS ESOPHAGUS LESN,THOR 3215.00 APPROACH 43107 PR REMOVAL ESOPHAGUS,NO 8521.00 THORACOTOMY 43112 PR TOTAL ESOPHAGECTOMY 9258.00 W/THORCOM W/WO PYLORPLASTY 43117 PR PART REMOV 9157.00 43123 PR PART RMV ESOPH,THORACOABD 15000.00 APP,W/COL INT 43124 PR REMOVAL OF ESOPHAGUS,NO 15528.00 RECONSTRUC 43130 PR REMOV ESOPHAG 2674.00 DIVERTIC,CERV APPRCH 43135 PR REMOV ESOPHAG 6040.00 DIVERTIC,THOR APPRCH 43180 PR ESOPHAGOSCP RIG TRANSORAL 1321.00 HYPOPHARYNX CRV ESOPH 43191 PR ESOPHAGOSCOPY RIGID 890.00 TRANSORAL DIAGNOSTIC BRUSH 43192 PR ESOPHAGOSCOPY RIGID 435.00 TRANSORAL INJ SUBMUCOSAL 43193 PR ESOPHAGOSCOPY RIGID 441 TRANSORAL WITH BIOPSY 43194 PR ESOPHAGOSCOPY RIG 495.00 TRANSORAL REMOVAL FOREIGN 43197 PR ESOPHAGOSCOPY FLEXIBLE 475.00 TRANSNASAL DIAGNOSTIC 43200 PR ESOPHAGOSCOPY FLEXIBLE 697.00 TRANSORAL DIAGNOSTIC 43201 PR ESOPHAGOSCOPY FLEXIBLE 722.00 TRANSORAL W SUBMUCOUS INJ 43202 PR ESOPHAGOSCOPY FLEXIBLE 849.00 TRANSORAL WITH BIOPSY 43205 PR ESPHGOSCOPY FLEX W/BAND 760.00 LIGATION ESOPHGL VARICES 43206 PR ESOPHAGOSCOPY TRANSORAL 713.00 W/OPTICAL ENDOMICROSCOPY 43212 PR ESOPHAGOSCOPY TRANSORAL 485.00 STENT PLACEMENT 43213 PR ESOPHAGOSCOPY 2919.00 RETROGRADE DILATE 43214 PR ESOPHAGOSCOPY DILATE 499.00 ESOPHAGUS BALLOON 30 MM 43215 PR ESOPHAGOSCOPY FLEXIBLE 403.00 REMOVAL FOREIGN BODY 43217 PR ESOPHAGOSCOPY FLEXIB 1125.00 LESION REMOVAL TUMOR SNARE 43220 PR ESOPHAGOSCOPY FLEX 470.00 BALLOON DILAT <30 MM DIAM 43226 PR ESOPHAGOSCOPY FLEXIBLE 926.00 GUIDE WIRE DILATION 43229 PR ESOPHAGOSCOPY FLEX 1761 TRANSORAL LESION ABLATION 43231 PR ESOPHAGOSCOPY FLEXIBLE 675.00 TRANSORAL ULTRASOUND EXAM 43232 PR ESOPHAGOSCOPY 647.00 INTRA/TRANSMURAL NEEDLE 43233 PR EGD ESOPHAGUS BALLOON 600.00 DILATION 30 MM OR LARGER 43235 PR 725.00 ESOPHAGOGASTRODUODENOSCOP 43236 PR 969.00 ESOPHAGOGASTRODUODENOSCOP 43237 PR 582.00 ESOPHAGOGASTRODUODENOSCOP 43238 PR EGD INTRMURAL US NEEDLE 725.00 ASPIRATE/BIOPSY ESOPHAGS 43239 PR EGD TRANSORAL BIOPSY 856.00 SINGLE/MULTIPLE 43240 PR EGD TRANSORAL TRANSMURAL 995.00 DRAINAGE PSEUDOCYST 43241 PR EGD INTRALUMINAL 565.00 TUBE/CATHETER INSERTION 43242 PR EGD INTRMURAL NEEDLE 1045.00 ASPIR/BIOP ALTERED ANATOMY 43243 PR EGD INJECTION SCLEROSIS 970.00 ESOPHGL/GASTRIC VARICES 43244 PR EGD BAND LIGATION 920.00 ESOPHGEAL/GASTRIC VARICES 43245 PR EGD DILATION 729.00 GASTRIC/DUODENAL STRICTURE 43246 PR EGD PERCUTANEOUS 729.00 PLACEMENT GASTROSTOMY TUBE 43247 PR EGD FLEXIBLE FOREIGN BODY 725.00 REMOVAL 43248 PR EGD INSERT GUIDE WIRE 680.00 DILATOR PASSAGE ESOPHAGUS 43249 PR EGD BALLOON DILATION 429.00 ESOPHAGUS <30 MM DIAM 43250 PR EGD FLEX REMOVAL LESION(S) 465.00 BY HOT BIOPSY FORCEPS 43251 PR EGD REMOVAL TUMOR 795.00 POLYP/OTHER LESION SNARE TECH 43252 PR EGD FLEX TRANSORAL 900.00 W/OPTICAL ENDOMICROSCOPY 43253 PR EGD US GUIDED TRANSMURAL 683.00 INJXN/FIDUCIAL MARKER 43254 PR EGD TRANSORAL ENDOSCOPIC 709.00 MUCOSAL RESECTION 43255 PR EGD TRANSORAL CONTROL 925.00 BLEEDING ANY METHOD 43259 PR EDG US EXAM SURGICAL ALTER 825.00 STOM DUODENUM/JEJUNUM 43260 PR ERCP DX COLLECTION 1050.00 SPECIMEN BRUSHING/WASHING 43261 PR ERCP W/BIOPSY 1150.00 43262 PR ERCP 1440.00 W/SPHINCTEROTOMY/PAPILLOTOMY 43264 PR ERCP REMOVE CALCULI/DEBRIS 1650.00 BILIARY/PANCREAS DUCT 43265 PR ERCP 1550.00 DESTRUCTION/LITHOTRIPSY 43266 PR EGD ENDOSCOPIC STENT 587.00 PLACEMENT W/WIRE& DILATION 43270 PR EGD ABLATE TUMOR 1802.00 POLYP/LESION W/DILATION& WIRE 43273 PR ENDOSCOPIC PAPILLA 316.00 CANNULATION BILE/PANCREATIC 43274 PR ERCP STENT PLACEMENT 1791.00 BILIARY/PANCREATIC DUCT 43275 PR ERCP REMOVE FOREIGN 1002.00 BODY/STENT BILIARY/PANC DUCT 43276 PR ERCP BILIARY/PANC DUCT 1264.00 STENT EXCHANGE W/DIL&WIRE 43277 PR ERCP BALLOON DILATE 1008.00 BILIARY/PANC DUCT/AMPULLA EA 43278 PR ERCP TUMOR/POLYP/LESION 1146.00 ABLATION W/DILATION&WIRE 43279 PR LAP, ESOPHAGOMYOTOMY W 3195.00 FUNDOPLASTY 43280 PR LAP,ESOPHAGOGAST 3289.00 43281 PR LAP, REPAIR PARAESOPHAGEAL 4505.00 HERNIA, INCL FUNDOPLASTY W/O 43282 PR LAP, REPAIR PARAESOPHAGEAL 4605.00 HERNIA, INCL FUNDOPLASTY W/ 43283 PR LAP ESOPHAGEAL 403.00 43284 PR LAPS ESOPHGL SPHNCTR 1686.00 AGMNTJ PLMT DEV CRRPL 43285 PR REMOVAL ESOPHAGEAL 1706.00 SPHINCTER AGMNTJ DEVICE 43286 PR ESOPHAGECTOMY TOTAL NEAR 13109.00 TOTAL W/LAPS MOBLJ 43287 PR ESOPHAGECTOMY DISTAL 2/3 14972.00 W/LAPAROSCOPIC MOBLJ 43288 PR ESOPHAGECTOMY TOTAL NEAR 15622.00 TOTAL W/THRSC MOBLJ 43300 PR ESOPHAGOPLASTY,CERV 2735.00 43305 PR REPAIR TRACHEOESOPHAGEAL 2728.00 43310 PR ESOPHAGOPLASTY,THORACIC 6055.00 43312 PR REPAIR TRACHEOESOPHAGEAL 6563.00 43314 PR ESOPHAGOPLASTY CON 10954.00 DEF,W/REPAIR TE FIST 43325 PR ESOPHAGOGASTRIC 2832.00 FUNDOPLASTY+PATCH 43327 PR ESOPHAGOGASTRIC 2028.00 FUNDOPLASTY PARTIAL OR 43328 PR ESOPHAGOGASTRIC 4016.00 FUNDOPLASTY PARTIAL OR 43330 PR ESOPHAGOMYOTOMY,ABD 3757.00 43331 PR ESOPHAGOMYOTOMY,THORACIC 5475 APPRCH 43332 PR REPAIR PARAESOPHAGEAL 2903.00 HIATAL HERNIA,LAPAROTOMY, WO 43333 PR REPAIR PARAESOPHAGEAL 3153.00 HIATAL HERNIA,LAPAROTOMY, W 43334 PR REPAIR PARAESOPHAGEAL 3185.00 HIATAL HERNIA,THORACOTOMY, WO 43335 PR REPAIR PARAESOPHAGEAL 5471.00 HIATAL HERNIA,THORACOTOMY, W 43336 PR REPAIR PARAESOPHAGEAL 6142.00 HIATAL 43338 PR ESOPHAGUS LENGTHENING 334.00 43351 PR SURG 2877.00 OPENING,ESOPHAGUS,THOR 43352 PR SURG 3813.00 OPENING,ESOPHAGUS,CERV 43361 PR GI RECON,PRIOR 11004.00 ESOPHAGECT,W/COLON INTERP 43400 PR LIGATE ESOPHAGUS VARICES 6219.00 43410 PR SUTURE ESOPHAGUS 1801.00 WOUND,CERV APPRCH 43415 PR SUTURE ESOPHAGUS 10547.00 WOUND,THOR APPRCH 43420 PR REPAIR ESOPHAGUS 3006.00 OPENING,CERV APPRCH 43450 PR DILATE ESOPHAGUS 361.00 43453 PR DILATION ESOPHAGUS GUIDE 738.00 43500 PR SURGICAL OPENING OF 2798.00 43520 PR INCISION OF PYLORIC MUSCLE 1470.00 43605 PR BIOPSY OF STOMACH,BY 2952.00 43610 PR EXCIS STOMACH 2731.00 43611 PR EXCIS STOAMCH MALIG 3307.00 43621 PR REMOVAL STOMACH,ROUX-EN-Y 6401.00 43622 PR REMOVAL STOMACH,FORM 9450.00 INTEST POUCH 43631 PR REMV 4721.00 STOMACH,PART,DISTAL,GASTRODU 43632 PR REMV 4724.00 STOMACH,PART,DISTAL,GASTROJEJ 43633 PR REMV 7818.00 STOMACH,PART,DISTAL,ROUX-EN-Y 43640 PR 3162.00 43641 PR VAGOTOMY/PYLOROPLASTY,HI 4299 43644 PR LAP GASTRIC BYPASS/ROUX-EN- 6702.00 43653 PR LAP,GASTROSTOMY,W/O TUBE 1455.00 43752 PR PLACEMENT NG/OG TUBE BY 93.00 43753 PR GASTRIC 56.00 INTUBATION/ASPIRATION, 43756 PR DUODENAL 510.00 INTUBATION/ASPIRATION, 43757 PR DUODENAL 781.00 INTUBATION/ASPIRATION, 43760 CHANGE GASTROSTOMY TUBE 1137.00 PERCUTANEOUS W/O GUIDE 43761 PR REPOSITION GASTRIC FEEDING 278.00 TUBE THRU DUODENUM 43771 LAP, REVISE ADJUST GAST 2332.00 RESTRICT DEVICE 43772 LAP, REMOVE ADJUST GAST 2566.00 RESTRICT DEVICE 43774 LAP, REMOVE ADJUST GAST 2360.00 RESTRICT DEVICE/PORT 43775 PR LAP, GAST RESTRICT PROC, 4151.00 LONGITUDINAL GASTRECTOMY 43800 PR RECONSTRUCTION OF PYLORUS 2581.00 43820 PR GASTROJEJUNOSTOMY 3412.00 43830 PR GASTROSTOMY,OPEN,W/O TUBE 1444.00 43831 PR PLACE GASTROSTOMY 1517.00 43840 PR REPAIR PERF DUOD/GAST ULC- 5550 43846 PR GASTRIC BYPASS,OBESE<150CM 6608.00 ROUX-EN-Y 43848 REVISION GASTROPLASTY,OBESITY, 7859.00 NON-GAST RESTRICT DEVICE 43860 PR REVISE,GASTROJEJUN 5191.00 ANAST,W/O VAGOTOMY 43870 PR CLOSURE OF 1475.00 43880 PR CLOSURE GASTROCOLIC 5184.00 43886 PR REVISE GASTRIC PORT, OPEN 927 44005 PR FREEING BOWEL 3015.00 ADHESION,ENTEROLYSIS 44010 PR DUODENOTOMY FOR 3078.00 EXPLOR,BX,FB REMOV 44015 PR INSERT TUBE-BOWEL,ENTERAL 442.00 44020 PR ENTEROTOMY,NON- 3476.00 DUOD,EXPLOR/BX/FB REMOVAL 44021 PR ENTEROTOMY DECOMPRESS 2046.00 SMALL BOWEL 44025 PR INCIS COLON FOR EXPLOR,BX,FB 3466.00 44050 PR REDUCE 2627.00 VOLVULUS,INTUSS,INTERN HERNIA 44055 PR CORRECT MALROTATION OF 4552.00 44110 PR EXCIS BOWEL LESION(S),SINGLE 2248.00 ENTEROTOMY 44111 PR EXCIS BOWEL LESION(S),MULT 2740.00 ENTEROTOMIES 44120 PR RESECT SMALL INTEST,SINGL 4563.00 RESEC/ANAS 44121 PR RESECT SMALL INTEST,EACH 558.00 44125 PR RESECT SMALL INTEST W 3241.00 ENTEROSTOMY 44126 PR RESECT SM INTEST,CONG 10077.00 ATRESIA,W/O TAPER 44127 PR RESECT SM INTEST,CONG 8766.00 ATRESIA,W/TAPER 44130 PR BOWEL TO BOWEL 4907.00 44139 PR MOBILIZE SPLENIC FLEX 302.00 44140 PR PART REMOVAL COLON W 4421.00 ANASTOMOSIS 44141 PR PART REMOVAL COLON W 3829.00 44143 PR PART REMOVAL COLON W END 4980.00 COLOSTOMY 44144 PR PART REMOVAL COLON W 4595.00 OSTOMY/MUCOFIST 44145 PR PART REMOVAL COLON W 5512.00 COLOPROCTOSTOMY 44146 PR PART REMOVAL COLON W 5960.00 COLOPROC,COLOST 44147 PR PART REMOVAL 7936.00 COLON,ABD/TRANSANAL APP 44150 PR REMOVAL COLON/ILEOSTOMY 5302.00 44155 PR REMOVAL 6072.00 COLON/PROCTECTOMY/ILEOSTOMY 44157 PR REMOVAL COLON/PROCTEC/ 8964.00 ILEOANAL ANAST 44158 PR REMOVAL 7429.00 COLON/PROCTEC/ILEOANAL ANAST 44160 PR REMVL COLON & TERM ILEUM 3436.00 W/ILEOCOLOSTOMY 44180 PR LAP, SURG ENTEROLYSIS 1925.00 44186 PR LAP, SURG JEJUNOSTOMY 1456.00 44187 PR LAP, SURG ILEO/JEJUNO-STOMY 3544.00 44188 PR LAP, SURG COLOSTOMY 2948.00 44202 PR 4612.00 LAP,SURG,ENTERECTOMY,RESECT 44203 PR LAP,SURG,EA ADDL RESECT & 550.00 44204 PR LAP,SURG,COLECTOMY, 5228.00 PARTIAL, W/ANAST 44205 PR 4635.00 LAP,SURG,COLECTOMY,W/REMVL 44206 PR LAP,SURG,COLECTOMY,W/END 5606.00 COLOST & CLOSUR 44207 PR 7447.00 44208 PR 6647.00 LAP,SURG,COLECTOMY,W/ANAST,W/ COLOSTOMY 44210 PR 5876.00 LAP,SURG,COLECTOMY,TOTAL,W/O 44211 PR 8930.00 LAP,SURG,COLECTOMY,TOTAL,W/PR OCTECTOMY 44212 PR 6826.00 LAP,SURG,COLECT,TOT,W/PROCTEC T,W/ILEOST 44213 PR LAP, SURG MOBIL SPLENIC FL 414.00 DUR PTL COLECTOMY 44227 PR LAP, SURG CLOSE 6808.00 ENTEROSTOMY RESECT ANAST 44300 PLACEMENT 2271.00 ENTEROSTOMY/CECOSTOMY TUBE 44310 PR 2924.00 44312 PR REVISION OF 1513.00 44314 PR REVISION OF 2781.00 44320 PR COLOSTOMY 3263.00 44322 PR COLOSTOMY,W/MULTIPLE 3581.00 44340 PR REVISION OF 1272.00 44345 PR REVISION OF 2875.00 COLOSTOMY,COMPLICATED 44346 PR REVIS COLOSTOMY,REPR 3140.00 PARACOLO HERNIA 44360 PR ENDOSCOPY UPPER SMALL 590.00 44361 PR ENDOSCOPY UPPER SMALL 660.00 INTESTINE W/BIOPSY 44364 PR ENTEROSCOPY > 2ND PRTN 550.00 W/RMVL LESION SNARE 44366 PR ENTEROSCOPY > 2ND PRTN 960.00 W/CONTROL BLEEDING 44369 PR ENTEROSCOPY > 2ND PRTN 1030.00 ABLTJ LESION 44372 PR ENTEROSCOPY > 2ND PRTN 975.00 W/PLMT PRQ TUBE 44373 PR ENTEROSCOPY > 2ND PRTN 800.00 CONV GSTRST TUBE 44376 PR ENTEROSC >2ND PRTN W/ILEUM 850.00 W/WO COLLJ SPEC SPX 44377 PR ENTEROSC >2ND PRTN W/ILEUM 793.00 W/BX SINGLE/MULTIPLE 44378 PR ENTEROSCOPY > 2ND PRTN 1018.00 ILEUM CONTROL BLEEDING 44379 PR ENTEROSCOPY > 2ND PRTN 1080.00 W/ILEUM W/STENT PLMT 44380 PR ILEOSCOPY THRU STOMA DX 536.00 W/COLLJ SPEC WHEN PRFMD 44381 PR ILEOSCOPY STOMA W/BALLOON 464.00 DILATION 44382 PR ILEOSCOPY STOMA W/BX 776.00 SINGLE/MULTIPLE 44384 PR ILEOSCOPY STOMA W/PLMT OF 587.00 ENDOSCOPIC STENT 44385 PR NDSC EVAL INTSTINAL POUCH 667.00 DX W/COLLJ SPEC SPX 44386 PR NDSC EVAL INTSTINAL POUCH 849.00 W/BX SINGLE/MULTIPLE 44388 PR COLONOSCOPY STOMA DX 858.00 INCLUDING COLLJ SPEC SPX 44389 PR COLONOSCOPY STOMA 971.00 W/BIOPSY SINGLE/MULTIPLE 44390 PR COLONOSCOPY STOMA W/RMVL 1114.00 FOREIGN BODY 44391 PR COLONOSCOPY STOMA 1862.00 CONTROL BLEEDING 44392 PR COLONOSCOPY STOMA RMVL 1058.00 LES BY HOT BIOPSY FORCEPS 44394 PR COLONOSCOPY STOMA W/RMVL 1074.00 TUM POLYP/OTH LES SNARE 44401 PR COLONOSCOPY STOMA 1156.00 ABLATION LESION 44403 PR COLONOSCOPY STOMA 788.00 W/ENDOSCOPIC MUCOSAL RESCJ 44404 PR COLONOSCOPY STOMA 1000.00 W/SUBMUCOSAL INJECTION 44405 PR COLONOSCOPY STOMA 1491 W/BALLOON DILATION 44406 PR COLONOSCOPY STOMA 612.00 W/ENDOSCOPIC ULTRASOUND 44500 PR INTRODUCTION LONG GI TUBE 58.00 SEPARATE PROCEDURE 44602 PR SUTURE SM INTEST,SINGLE 5746.00 44603 PR SUTURE SM INTEST,MULTPL 3366.00 44604 PR SUTURE LRG INTEST 2930.00 44615 PR INTESTINAL STRICTUROPLASTY 2940.00 44620 PR CLOSE ENTEROSTOMY 2275.00 44625 PR CLOSE 2774.00 44626 PR CLOSE 5251.00 ENTEROSTOMY,RESEC+COLOREC 44640 PR REPAIR BOWEL-SKIN FISTULA 4459.00 44650 PR REPAIR BOWEL-BOWEL FISTULA 4868.00 44661 PR REPR BOW-BLAD 5057.00 FIST,W/INTEST/BLAD RESECT 44700 PR EXCLUSION,SMALL BOWEL FROM 3634.00 PELVIS 44701 PR INTRAOPERATIVE COLONIC 382.00 44705 PR PREPARE FECAL MICROBIOTA 310.00 FOR INSTILLATION 44800 PR EXCISION 2158.00 44820 PR EXCISION OF MESENTERY 1752.00 44850 PR SUTURE OF MESENTERY 2044.00 44950 PR APPENDECTOMY 1340.00 44955 PR APPENDECTOMY,W OTHR PROC 300.00 44960 PR APPENDECTOMY,RUPT 2300.00 APPENDX+ABSCESS 44970 PR LAP,APPENDECTOMY 1526.00 45005 PR I&D RECTAL SUBMUCOSAL 577.00 45020 PR DRAINAGE OF DEEP RECTAL 1156.00 45100 PR BIOPSY OF RECTUM 761.00 45110 PR PROCTECTOMY,AP 5947.00 45112 PR PROCTECTOMY,AP RESEC,PULL- 3984.00 45113 PR PROCTECTOMY,PART,ILEAL 7793 45119 PR PROCTECTOMY,A-P PULLTHRU 4095.00 W/RESERVOIR 45120 PR PROCTECTOMY,COMPLT,PULL- 6502.00 THRU,ANAST 45121 PR 5676.00 PROCTECTOMY,COMPL,COLECTOM 45123 PR PROCTECTOMY,PART,NO 3032.00 ANAST,PERINEAL 45126 PR PELVIC EXENTERATION 9764.00 45130 PR EXCIS RECTAL 2992.00 45160 PR EXCIS RECTAL LESION 2095.00 45171 PR EXCIS RECTAL TUMOR, 1501.00 TRANSANAL, PARTIAL THICKNESS 45172 PR EXCIS RECTAL TUMOR, 2886.00 TRANSANAL, FULL THICKNESS 45300 PR 231.00 PROCTOSIGMOIDOSCOPY,RIGID,DIA 45305 PR PROCTOSGMDSC RIGID W/BX 443.00 SINGLE/MULTIPLE 45307 PR PROCTOSGMDSC RIGID W/RMVL 593.00 FOREIGN BODY 45309 PR PROCTOSGMDSC RIGID RMVL 1 564.00 LESION SNARE TQ 45317 PR PROCTOSGMDSC RIGID 596.00 CONTROL BLEEDING 45330 PR SIGMOIDOSCOPY FLX DX 419.00 W/COLLJ SPEC BR/WA IF PFRMD 45331 PR SIGMOIDOSCOPY,BIOPSY 643.00 45332 PR SIGMOIDOSCOPY FLX W/RMVL 755.00 FOREIGN BODY 45333 PR SIGMOIDOSCOPY FLX W/RMVL 877.00 TUMOR BY HOT BX FORCEPS 45334 PR SIGMOIDOSCOPY FLX CONTROL 550.00 BLEEDING 45335 PR SGMDSC FLX DIRED SBMCSL NJX 616.00 ANY SBST 45337 PR SGMDSC FLX W/DCMPRN 490.00 W/PLMT DCMPRN TUBE 45338 PR SGMDSC FLX RMVL TUM 788.00 POLYP/OTH LES SNARE TQ 45340 PR SIGMOIDOSCOPY FLX TNDSC 1108.00 BALO DILAT 45341 PR SIGMOIDOSCOPY FLX NDSC US 585.00 45342 PR SIGMOIDOSCOPY FLX TNDSC US 675.00 GID NDL ASPIR/BX 45346 PR SIGMOIDOSCOPY FLX ABLATION 443.00 TUMOR POLYP/OTH LES 45347 PR SIGMOIDOSCOPY FLX 443.00 PLACEMENT OF ENDOSCOPIC 45349 PR SGMDSC FLX WITH ENDOSCOPIC 443.00 MUCOSAL RESECTION 45378 PR COLONOSCOPY FLX DX W/COLLJ 961.00 SPEC WHEN PFRMD 45379 PR COLONOSCOPY FLX W/REMOVAL 1226.00 OF FOREIGN BODY(S) 45380 PR COLONOSCOPY W/BIOPSY 1149.00 SINGLE/MULTIPLE 45381 PR COLSC FLX WITH DIRECTED 1119.00 SUBMUCOSAL NJX ANY SBST 45382 PR COLSC FLEXIBLE W/CONTROL 1926.00 BLEEDING ANY METHOD 45384 PR COLSC FLX W/REMOVAL LESION 1136.00 BY HOT BX FORCEPS 45385 PR COLSC FLX W/RMVL OF TUMOR 1294.00 POLYP LESION SNARE TQ 45386 PR COLSC FLEXIBLE 1743.00 W/TRANSENDOSCOPIC BALLOON 45388 PR COLONOSCOPY FLX ABLATION 443.00 TUMOR POLYP/OTHER LES 45389 PR COLONOSCOPY FLX WITH 837.00 ENDOSCOPIC STENT PLACEMENT 45390 PR COLONOSCOPY FLX 864.00 W/ENDOSCOPIC MUCOSAL 45391 PR COLSC FLX W/NDSC US XM 730.00 RCTM ET AL LMTD&ADJ STRUX 45392 PR COLSC FLX W/US GUID NDL 875.00 ASPIR/BX W/US RCTM ET AL 45393 PR COLONOSCOPY FLEXIBLE WITH 1071.00 DECOMPRESSION 45395 PR LAP, SURG PROCTECTOMY W 4898.00 COLOSTOMY 45397 PR LAP, SURG PROCTECTOMY W J- 8800.00 45398 PR COLONOSCOPY FLEXIBLE WITH 1785 BAND LIGATION(S) 45400 PR LAP, SURG PROCTOPEXY 4027.00 45500 PR REPAIR OF RECTUM,STENOSIS 1067.00 45505 PR REPAIR OF RECTUM,PROLAPSE 1506.00 MUCOSA 45540 PR FIX RECTAL PROLAPSE,ABD 3908.00 45550 PR REPAIR RECTUM; REMOVE 4847.00 45562 PR EXPLOR/REPAIR RECTUM 2327.00 45563 PR EXPLOR/REPAIR 5038.00 RECTUM,INJ,COLOSTOMY 45800 PR CLOSE RECTUM-BLADDER 5089.00 45905 PR DILATION ANAL SPHINCTER W 1203.00 45910 PR DILATION RECTAL STRICTURE W 1629.00 45915 PR REMV RECTAL 693.00 OBSTR:FECES/F.B. W ANEST 45990 PR SURG DIAGNOSTIC EXAM, 275.00 46020 PR PLACEMENT,SETON 698.00 46030 PR REMOVAL OF RECTAL MARKER 351.00 46040 PR I&D PERIRECTAL ABSCESS 1028.00 46050 PR I&D PERIANAL 499.00 46060 PR I&D RECTAL ABSCESS + 1209.00 46080 PR ANAL SPHINCTEROTOMY 547.00 46083 PR INCISE EXTERNAL HEMORRHOID 413.00 46200 PR REMOVAL OF ANAL FISSURE 816.00 46220 PR EXCISION SINGLE EXTERNAL 390.00 PAPILLA OR TAG ANUS 46221 PR HEMORRHOIDECTOMY INTERNAL 511.00 RUBBER BAND LIGATIONS 46230 PR EXCISION MULTIPLE EXTERNAL 610.00 PAPILLAE/TAGS ANUS 46250 PR 1167.00 HEMORRHOIDECTOMY,EXTERNAL, 46255 PR HEMORRHOIDECTOMY,INT/EXT,1 1277.00 COLUMN/GROUP 46260 PR HEMORRHOIDECTOMY,INT/EXT, 1095.00 2+ COLUMNS/GROUPS 46270 PR REMOVAL ANAL 1281.00 FISTULA,SUBCUTANEOUS 46275 PR REMOVAL ANAL 1359.00 FISTULA,INTERSPNINCTERIC 46280 PR REMOVAL ANAL 1200 FISTULA,TRANS/SUPRA/EXTRAPHIN CT, +/-SETON 46285 PR REMOVAL ANAL 1351.00 FISTULA,SECOND STAGE 46288 PR REPAIR ANAL FISTULA,RECT 1398.00 46320 PR EXCISION THROMBOSED 485.00 HEMORRHOID, EXTERNAL 46505 PR CHEMODENERVATION ANAL 700.00 46600 PR ANOSCOPY DX W/COLLJ SPEC 217.00 BR/WA SPX WHEN PRFRMD 46601 PR ANOSCOPY DX W/HRA &CHEM 346.00 AGNTS ENHANCEMENT 46604 PR ANOSCOPY,W/DILATION 1561.00 46606 PR ANOSCOPY AND BIOPSY 569.00 46607 PR ANOSCOPY DX W/HRA &CHEM 486.00 AGNTS ENHANCEMENT W/BX 46611 PR ANOSCOPY,REMOVE 409.00 46614 PR 331.00 46615 PR ANOSCOPY,ABLATE LESION 367.00 46715 PR REPR LO IMPERF ANUS W 1051.00 46716 PR REPR LO IMPERF ANUS W 2884.00 46730 PR REPR HI IMPERF ANUS 7436.00 46740 PR REPR HI IMPERF ANUS,W 6221.00 46750 PR REPAIR OF ANAL 2075.00 46900 PR DESTRUCT,ANAL 607.00 46910 PR ELECTRODESSICATN,ANAL 647.00 46916 PR CRYOSURGERY, ANAL LESION(S) 580.00 46917 PR LASER SURGERY, ANAL 1115.00 46922 PR SURG EXCISION OF ANAL 509.00 46924 PR DESTRUCTION,ANAL 1342.00 LESION(S),EXTENSIVE 46945 PR HEMORRHOIDECTOMY, INT, 687.00 LIGATION NOT RUBBER BAND, 46946 PR HEMORRHOIDECTOMY, INT, 791.00 LIGATION NOT RUBBER BAND, 2+ 47000 PR BIOPSY LIVER NEEDLE 884.00 47000 PR BIOPSY LIVER NEEDLE 26 537.00 47001 PR NEEDLE BIOPSY LIVER,W OTHR 295.00 47010 PR DRAINAGE OF LIVER LESION, 3237.00 47015 PR INJECT/ASPIRATE LIVER 4155.00 47100 PR WEDGE BIOPSY OF LIVER 2288.00 47120 PR RESEC LIVER,PART LOBECTOMY 8227.00 47122 PR RESEC 11481.00 47125 PR RESEC LIVER,TOTAL LT 6750.00 47130 PR RESEC LIVER,TOTAL RT 11138.00 47133 PR REMOVAL OF DONOR LIVER 5566.00 47135 PR TRANSPLANT 19900.00 47142 PR PARTIAL REMOVAL, DONOR 14000.00 LIVER, RIGHT LOBE 47143 PR TRANSPLANT,PREP DONOR 13092.00 LIVER, WHOLE 47144 PR TRANSPLANT,PREP DONOR 12523.00 LIVER, 3-SEGMENT 47145 PR TRANSPLANT,PREP DONOR 11730.00 LIVER, LOBE SPLIT 47146 PR TRANSPLANT,PREP DONOR 702.00 LIVER/VENOUS 47147 PR TRANSPLANT,PREP DONOR 819.00 LIVER/ARTERIAL 47300 PR MARSUPIALIZE LIVER 4029.00 47350 PR REPAIR BLEED LIVER/SUTURE 3671.00 47360 PR REPR BLEED LIVER/COMPLX 5750.00 SUTURE WND 47361 PR EXPLOR LIVER 9752.00 WOUND,EXTENSIV DEBRIDE 47362 PR RE-EXPLORE LIVER 3576.00 WOUND,REMV PACKING 47370 PR LAP,ABLAT 1+ LIVER 3723.00 TUMOR(S),RADIOFREQ 47380 PR ABLAT,OPEN,1+ LIVER 4912.00 TUMOR(S),RADIOFREQ 47382 PR ABLTJ 1/> LVR TUM PRQ RF 2613.00 47383 PR ABLATION 1/> LIVER TUMOR 18361.00 PERQ CRYOABLATION 47400 PR INCISION OF LIVER 8649.00 47420 PR INCIS BILE 3733.00 DUCT/EXPL,DRAIN,REMV CALC 47490 PR 1184.00 CHOLECYSTOSTOMY,PERCUTANEO 47525 PR CHANGE PERCUT BILE DUCT 1812.00 47531 PR NJX CHOLANGIO PRQ W/IMG GID 946.00 RS&I EXISTING ACCESS 47532 PR NJX CHOLANGIO PRQ W/IMG GID 2014.00 RS&I NEW ACCESS 47533 PR PRQ PLMT BILIARY DRG CATH 3394.00 W/IMG GID RS&I EXTERNL 47534 PR PRQ PLMT BILIARY DRG CATH 4183.00 W/IMG GID RS&I INT-EXT 47535 PR CONV EXT BIL DRG CATH TO INT- 2805.00 EXT BIL DRG CATH 47536 PR EXCHANGE BILIARY DRG 2070.00 CATHETER PRQ W/IMG GID RS&I 47537 PR REMOVAL BILIARY DRG 1024.00 CATHETER REQ FLUOR GID RS&I 47538 PR PLMT BILE DUCT STENT PRQ 3500.00 EXISTING ACCESS 47540 PR PLMT BILE DUCT STENT PRQ 4400.00 NEW ACCESS W/SEP CATH 47542 PR BALLOON DILAT BILIARY 1312.00 DUCT/AMPULLA PRQ EACH DUCT 47543 PR ENDOLUMINAL BX BILIARY TREE 3374.00 PRQ ANY METH 1/MLT 47544 PR REMOVAL BILIARY DUCT 2061.00 &/GLBLDR CALCULI PERQ RS&I 47550 PR BILE DUCT 377.00 ENDOSCOPY,INTRAOPERATIVE 47552 PR BILIARY ENDO PRQ T-TUBE DX 775.00 W/COLLECT SPEC BRUSH 47555 PR BILIARY ENDOSCOPY 882.00 PERCUT,DIL STRICT 47562 PR LAP,CHOLECYSTECTOMY 2083.00 47563 PR LAP,CHOLECYSTECTOMY/GRAPH 2310.00 47564 PR 2540.00 47600 PR REMOVAL GALLBLADDER 2601.00 47605 PR REMV GALLBLADDER W 2791.00 CHOLANGIOGRAM 47610 PR REMV GALLBLADDER,EXPLOR 3525.00 COMMON DUCT 47612 PR REMV GB,W 5153.00 CHOLEDOCHOENTEROSTOMY 47701 PR BILE DUCT REVISION 7085 47711 PR EXCIS BILE DUCT 5001.00 TUMOR,EXTRAHEPATIC 47712 PR EXCIS BILE DUCT 6456.00 47715 PR EXCISION CHOLEDOCHAL CYST 3541.00 47720 PR CHOLECYSTOENTEROSTOMY 4124 47760 PR ANAST EXTRAHEP DUCT TO GI 5552.00 47765 PR ANAST INTRAHEP DUCT TO GI 12413 47780 PR ANAST,ROUX-EN-Y,EXTRAHEP 5684.00 TO GI TRCT 47785 PR ANAST,ROUX-EN-Y,INTRAHEP TO 7914.00 GI TRCT 47800 PR RECONSTR EXTRAHEP 6413.00 47999 PR BILE TRACT SURG PROC, 615.00 48020 PR REMOVAL OF PANCREATIC 2439.00 48100 PR BIOPSY,PANCREAS,OPEN 2444.00 48102 PR NEEDLE BIOPSY OF PANCREAS 1147.00 48105 PR RESECT/DEBRIDE ACUTE 9512.00 NECROT PANCREAS 48120 PR EXCISION OF PANCREAS LESION 3938.00 48140 PR PART REMV PANCREAS,DISTAL 4928.00 SUBTOTAL 48145 PR PART REMV PANC,DIST+ANAST 22550.00 PANC-JEJU 48150 PR PART REMV PANC,PROX+REMV 10227.00 DUOD+ANAST 48153 PR PART REMV PANC,PROX+PART 10236.00 DUOD+ANAST 48154 PR PART REMV PANC,PROX+PART 7467.00 REMV DUOD 48155 PR REMOVAL OF PANCREAS, TOTAL 5669.00 48160 PR 8226.00 PANCREATECTOMY,W/AUTOLOGOU 48510 PR EXTERN DRAIN PANC 3924 PSEUDOCYST,OPEN 48545 PR PANCREATORRHAPHY,INJURY 5464.00 48548 PR ANAST PANCREAS- 5747.00 48550 PR DONOR PANCREATECTOMY 5251.00 48551 PR TRANSPLANT,PREP DONOR 9655.00 48554 PR TRANSPLANT ALLOGRAFT 6838.00 48556 PR REMOVAL ALLOGRAFT 4555.00 49000 PR EXPLORATORY OF ABDOMEN 2287.00 49002 PR REOPEN RECENT ABD 2551.00 49010 PR EXPLORATORY 2471.00 49020 PR DRAIN ABD ABSCESS OPEN 4978.00 49040 PR DRAIN SUBDIAPH/SUBPHR 3554.00 ABSCESS,OPEN 49060 PR DRAIN RETROPERITONEAL 3216.00 ABSCESS,OPEN 49062 PR DRAIN LYMPH-PERITONEAL 2363.00 CAVITY,OPEN 49082 PR ABDOM PARACENTESIS DX/THER 400.00 W/O IMAGING GUIDANCE 49083 PR ABDOM PARACENTESIS DX/THER 754.00 W IMAGING GUIDANCE 49084 PR PERITONEAL LAVAGE W/WO 279.00 IMAGING GUIDANCE 49180 PR PERCUT BIOPSY, ABDOMINAL 412.00 49185 PR SCLEROTHERAPY FLUID 2527.00 COLLECTION PRQ W/IMG GID 49203 PR EXCISION/DESTRUCTION OPEN 4891 ABDOMINAL TUMORS 5 CM 49204 PR EXCISION/DESTRUCTION OPEN 6261 ABDOMINAL TUMORS 5.1-10.0 CM 49205 PR EXCISION/DESTRUCTION OPEN 4353.00 ABDOMINAL TUMORS >10.0 CM 49215 PR EXCISE PRESACRAL/SACRAL 7067.00 49250 PR EXCISION OF UMBILICUS 1232.00 49255 PR REMOVAL OF OMENTUM 2300.00 49320 PR LAP,DIAGNOSTIC ABDOMEN 744.00 49321 PR LAP,DX SURGICAL ABD 1015.00 49322 PR LAP,ABDOMEN,ASPIRATE CYST 1400.00 49323 PR LAP,ABDOMEN,DRAIN 2276 49324 PR LAP INSERTION TUNNELED 912.00 INTRAPERITONEAL CATHETER 49325 PR LAP REVISE INTRAPERITONEAL 992.00 CATHETER 49326 PR LAP OMENTOPEXY ADD-ON 412.00 49400 PR AIR/CONTRAST INJECT INTO 426.00 49402 PR REMOVE PERITONEAL FOREIGN 2838.00 49405 PR IMAGE-GUIDE FLUID COLLXN 2173.00 DRAINAGE CATH VISC PERQ 49406 PR IMG-GUIDE FLUID COLLXN 497.00 DRAINAG CATH PERITON PERQ 49407 PR IMAGE FLUID COLLXN DRAINAG 1836.00 CATH TRANSREC/VAGINAL 49418 PR INSJ INTRAPERITONEAL 3707.00 CATHETER W/IMG GUID 49419 PR INSERTION TUNNEL 957.00 INTRAPERITONEAL CATH W SUBQ 49421 PR INSERTION TUNNEL 877.00 INTRAPERITONEAL CATH DIAL OPEN 49422 PR REMOVAL TUNNELED 960.00 INTRAPERITONEAL CATHETER 49423 PR DRAINAGE CATHETER 1349.00 49424 PR CONTRAST INJ,ABSCESS/CYST 380.00 VIA CATH TUBE 49435 PR INSERT SUBQ EXTENSION 310.00 INTRAPERITONEAL CATH 49440 PR INSERT GASTROSTOMY TUBE 2041.00 PERCUTANEOUS 49441 PR INSERT 2416.00 DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ 49442 PR INSERT CECOSTOMY/OTHER 2440 COLONIC TUBE PERCUTANEOUS 49446 PR CONVERT GASTROSTOMY- 2131.00 GASTRO-JEJUNOSTOMY TUBE PERQ 49450 PR REPLACE 1401.00 GASTROSTOMY/CECOSTOMY TUBE 49451 PR REPLACE 1487.00 DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS 49452 PR REPLACEMENT GASTRO- 2257.00 JEJUNOSTOMY TUBE 49460 PR OBSTRUCTIVE MATERIAL 1482.00 REMOVAL FROM GI TUBE 49465 PR CONTRAST INJECTION 312.00 PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE 49491 REPAIR ING HERNIA,PRETERM 2146.00 INFANT,REDUC 49495 REPAIR ING HERNIA,FULL/PRETERM 1046 INF,REDUC 49496 REPAIR ING HERNIA,<6MO,STRANG 1577.00 49500 REPAIR ING HERNIA,6MO- 1181.00 49501 PR REPAIR ING HERNIA,6MO- 1489.00 49505 PR REPAIR ING 1320.00 49507 PR REPAIR ING 2090.00 49520 PR REPAIR RECURR INGUIN 1371.00 HERN,REDUCIBL 49521 PR REPAIR RECURR INGUIN 2269.00 49525 PR REPAIR SLIDING INGUINAL 1340.00 49550 PR REPAIR FEMORAL 1348.00 49553 PR REPAIR FEMORAL 1310.00 49560 PR REPAIR INCISIONAL 2249.00 49561 PR REPAIR INCISIONAL 2673.00 49565 PR REPAIR RECURR INCIS 2268.00 49566 PR REPAIR RECURR INCIS 2701.00 49568 PR IMPLANT MESH HERNIA 626.00 REPAIR/DEBRIDEMENT CLOSURE 49570 PR REPAIR EPIGASTRIC 1050.00 49572 PR REPAIR EPIGASTRIC 1054.00 49580 REPAIR UMBILICAL 832.00 49585 REPAIR UMBILICAL 1173.00 49587 REPAIR UMBILICAL 1077.00 49590 PR REPAIR SPIEGELIAN HERNIA 1225.00 49600 PR REPAIR SMALL OMPHALOCELE 2607.00 49605 PR REPAIR LARGE OMPHALOCELE 10497.00 49606 PR REPAIR LARGE 3593.00 49610 PR REPAIR OMPHALOCELE,FIRST 2453.00 49650 PR LAP,INGUINAL HERNIA 1048.00 49651 PR LAP,INGUINAL HERNIA 1364.00 49652 PR LAP, VENTRAL HERNIA 3349.00 REPAIR,REDUCIBLE 49653 PR LAP, VENTRAL HERNIA 3773.00 REPAIR,INCARCERATED 49654 PR LAP, INCISIONAL HERNIA 3349.00 REPAIR,REDUCIBLE 49655 PR LAP, INCISIONAL HERNIA 3773.00 REPAIR,INCARCERATED 49656 PR LAP, RECURRENT INCISIONAL 3555.00 HERNIA REPAIR,REDUCIBLE 49657 PR LAP, RECURRENT INCISIONAL 3368.00 HERNIA REPAIR,INCARCERATED 49900 PR SUTURE ABD WALL- 2896.00 49904 PR OMENTAL FLAP,EXTRA- 5790.00 49905 PR OMENTAL FLAP,INTRA- 823.00 49906 PR FREE OMENTAL 4247.00 FLAP,MICROVASC ANAST 50060 PR REMOVAL OF KIDNEY STONE 3439.00 50080 PR PERCUT REMV KID STONE,UP TO 3486.00 50081 PR PERCUT REMV KID STONE,2+ CM 5317.00 50200 PR RENAL BIOPSY PRQ 1496.00 50205 PR BIOPSY OF KIDNEY,OPEN EXPOS 2242.00 50220 PR REMV KIDNEY,W/RIB RESECTION 3282.00 50225 PR REMV KIDNEY,COMPLICATED 4861.00 50230 PR REMV KIDNEY,RADICAL 5283.00 50234 PR REMV KIDNEY/URETER,SAME 5272.00 50236 PR REMV KIDNEY/URETER,SEPAR 6017.00 50240 PR PARTIAL REMOVAL OF KIDNEY 5404.00 50280 PR EXCIS/UNROOF RENAL CYST 3428.00 50300 PR RMV,DONOR KIDNEY,CADAVER 2359.00 50320 PR RMV,KIDNEY,DONOR,LIVING 4760.00 50323 PR TRANSPLANT,PREP CADAVER 10839.00 RENAL GRAFT 50325 PR TRANSPLANT,PREP LIVING 11614.00 RENAL GRAFT 50327 PR TRANSPLANT,PREP RENAL 468.00 GRAFT/VENOUS 50328 PR TRANSPLANT,PREP RENAL 410.18 GRAFT/ARTERIAL 50329 PR TRANSPLANT,PREP RENAL 460.00 GRAFT/URETERAL 50340 PR REMOVAL OF RECIPIENT KIDNEY 2709.00 50360 PR TRANSPLANTATION OF KIDNEY 7189.00 50365 PR TRANSPLANT KIDNEY+RECIP 11669.00 50370 PR REMOVE TRANSPLANTED 2963.00 50380 PR REIMPLANTATION OF KIDNEY 7809.00 50382 PR RMVL & RPLCMT INTLY 2952.00 DWELLING URETERAL STENT PRQ 50384 PR REMOVAL INDWELLING 2306.00 URETERAL STENT PRQ 50387 PR RMVL & RPLCMT XTRNL 1664.00 ACCESSIBLE NEPHROURTRL CATH 50389 PR REMOVE RENAL TUBE 748.00 50390 PR PERCUT DRAIN/INJECT RENAL 229.00 50395 PR PERCUT DILATN RENAL TRACT 430.00 50396 PR MEASURE KIDNEY PRESSURE 301.00 THRU TUBE 50400 PR REVISION RENAL PELVIS,SIMPLE 3621.00 50405 PR REVISION RENAL 5764.00 50430 PR NJX PX ANTEGRDE NFROSGRM 1323.00 &/URTRGRM NEW ACCESS 50431 PR NJX PX ANTEGRDE NFROSGRM 411.00 &/URTRGRM EXSTNG ACESS 50432 PR PLMT NEPHROSTOMY CATH PRQ 2144.00 NEW ACCESS RS&I 50433 PR PLMT NEPHROURETERAL CATH 2886.00 PRQ NEW ACCESS RS&I 50434 PR CONVERT NEPHROSTOMY CATH 2285.00 TO NEPHROURTRL CATH PRQ 50435 PR EXCHANGE NEPHROSTOMY 1199.00 CATHETER PRQ W/IMG GID RS&I 50500 PR REPAIR OF KIDNEY WOUND 5249 50520 PR CLOSE KIDNEY-SKIN FISTULA 3689.00 50541 PR LAP,ABLATION OF RENAL CYSTS 3246.00 50543 PR LAP,PARTIAL NEPHRECTOMY 4926.00 50544 PR LAP,PYELOPLASTY 5037.00 50545 PR LAP, RADICAL NEPHRECTOMY 5418.00 50546 PR NEPHRECTOMY 4392.00 50547 PR LAP,DONOR KIDNEY 5331.00 50548 PR NEPHRECTOMY, W/PART. 5155.00 50551 PR RENAL ENDOSCOPY 884.00 50553 PR RENAL ENDOSCOPY,CATH 1065.00 50555 PR RENAL ENDOSCOPY,BIOPSY 1060.00 50557 PR RENAL ENDOSCOPY,TREATMENT 1069.00 50561 PR RENAL ENDOSCOPY,REMV 3344.00 50562 PR RENAL 1808.00 50574 PR RENAL SCOPE,BIOPSY 901.00 50575 PR RENAL 3509.00 50590 PR FRAGMENT KIDNEY STONE/ 3250.00 50592 PR ABLTJ 1/> RENAL TUMOR PRQ 1200.00 UNI RADIOFREQUENCY 50593 PR ABLATION RENAL TUMOR 1600.00 UNILATERAL PERQ CRYOTHERAPY 50605 PR URETEROTOMY TO INSERT 3299.00 50650 PR REMOVAL URETER,BLADDER 3726.00 50660 PR REMOVAL 4701 50684 PR INJECT INDWELL CATH,URETER 468.00 50686 PR MEASURE URETER 391.00 PRESS,INDWELL CATH 50688 PR CHANGE OF URETEROSTOMY 238.00 TUBE VIA ILEAL CONDUIT 50690 PR INJECT RETROGRADE/CONDUIT 404.00 50693 PR PLMT URTRL STENT PRQ PRE- 2686.00 EXISTING NFROS TRACT 50694 PR PLMT URTRL STNT PRQ NEW 2958.00 ACESS W/O SEP NFROS CATH 50695 PR PLMT URTRL STENT PRQ NEW 3580.00 ACCESS W/SEP NFROS CATH 50706 PR BALLOON DILAT URETERAL 1942.00 STRICTURE W/IMG GID RS&I 50715 PR RELEASE URETER,RETROPER 3508.00 50727 PR REVISE URINARY-CUTAN ANAST 2500.00 50728 PR REVISE URINARY-CUTAN 1683.00 50740 PR ANASTOMOSE URETER/RENAL 3527.00 50760 PR ANASTOMSIS OF URETER 3623.00 50780 PR REIMPLANT URETER,SINGLE 3500.00 50782 PR REIMPLANT 4238.00 URETER,DUPLICATED URETER 50783 PR REIMPLANT URETER,EXTENSIVE 4636.00 TAILORING 50785 PR REIMPLANT 4907.00 URETER,VESICOPSOAS HITCH 50815 PR URETEROCOLON 5014.00 CONDUIT,W/BOWEL ANASTOMOSIS 50820 PR URETEROILEAL 5351.00 CONDUIT,W/BOWEL ANASTOMOSIS 50825 PR CONTINENT 7150.00 DIVERSION,W/BOWEL 50830 PR URINARY UN-DIVERSION 7436.00 50845 PR APPENDICO-VESICOSTOMY 4830.00 50860 PR TRANSPLANT URETER TO SKIN 3478.00 50930 PR CLOSURE URETER/BOWEL 4443.00 50947 PR LAP,REIMPLANT URETER 5555.00 W/CYSTO,STENT 50948 PR LAP,REIMPLANT URETER W/O 5241 CYSTO,STENT 50957 PR URETER 1104.00 51040 PR INCISE/DRAIN BLADDER 1507.00 51050 PR OPEN BLADDER,REMV 2003.00 51065 PR CYSTOTOMY,EXTRACT &/OR 1486 FRAG URETER CALC 51080 PR DRAIN PERI-BLADDER ABSCESS 1050.00 51101 PR ASPIRATION BLADDER 311.00 TROCAR/INTRACATHETER 51102 PR ASPIRATION BLADDER INSERT 706.00 SUPRAPUBIC CATHETER 51500 PR REMOVAL URACHAL CYST 2048.00 51525 PR CYSTOTOMY,EXCIS BLADDER 3074.00 51530 PR CYSTOTOMY,EXCIS BLADDER 2806.00 51550 PR PART REMV BLADDER,SIMPLE 2820.00 51555 PR PART REMV 5181.00 51565 PR PART REMV BLADDER,REIMPLNT 5317.00 URETER 51575 PR REMV BLADDER/NODES 7218.00 51590 PR CYSTECTOMY,ILEAL 7700.00 CONDUIT/SIGMOID BLADDER 51595 PR REMV BLADDER/NODES,ILEAL 8907.00 51596 PR CYSTECTOMY,W/CONTINENT 9456.00 51597 PR PELVIC EXENTERATION 9196.00 51600 PR INJECTION FOR BLADDER X-RAY 493.00 51610 PR INJECT FOR RETROGRADE 408.00 URETHOCYSTO 51700 PR IRRIGATION OF BLADDER 216.00 51701 PR INSERT,NON-INDWELLING 155.00 BLADDER CATHETER 51702 PR INSERT,TEMP INDWELLING BLAD 204.00 CATH,SIMPLE 51703 PR INSERT,TEMP INDWELLING BLAD 353.00 CATH,COMP 51705 PR CHANGE OF BLADDER 284.00 51710 PR CHANGE OF BLADDER 404.00 TUBE,COMPLICATED 51715 PR ENDOSCOPIC 1029.00 51720 PR INSTILL ANTICANCER AGENT IN 285.00 BLADDER 51725 PR SIMPLE CYSTOMETROGRAM 26 197.00 51726 PR COMPLEX CYSTOMETROGRAM 26 250.00 51728 PR COMPLEX CYSTOMETROGRAM 26 690.00 VOIDING PRESSURE STUDIES 51729 PR COMPLEX CYSTOMETROGRAM 26 305.00 W/VOID PRESS&URETHRAL PROFILE 51741 PR ELECTRO-UROFLOWMETRY, 26 165.00 51784 PR ANAL/URINARY MUSCLE STUDY 26 200.00 51785 PR ANAL/URINARY MUSCLE 26 225.00 51797 PR VOIDING PRESS STUDY INTRA- 26 233.00 ABDOMINAL VOID 51798 PR MEAS,POST-VOID RES,US,NON- 42.00 51798 PR MEAS,POST-VOID RES,US,NON- 26 48.00 51800 PR REVISION OF 3740.00 51860 PR REPAIR BLADDER 2661.00 51865 PR REPAIR BLADDER 2958.00 51880 PR CLOSE CYSTOSTOMY 1348.00 51900 PR CLOSE BLADDER/VAGINA 2997.00 FISTULA,ABDOM 51960 PR 6378.00 ENTEROCYSTOPLASTY,W/BOWEL 51980 PR CONSTRUCT BLADDER OPENING- 3403.00 CUTANEOUS 52000 PR CYSTOURETHROSCOPY 550.00 52001 PR CYSTOURETHROSCOPY W/IRRIG 933.00 & EVAC CLOTS 52005 PR CYSTOURETHROSCOPY,URETER 738.00 CATHETER 52007 PR 1117.00 CYSTOURETHROSCOPY,URETERAL 52204 PR 1251.00 52214 PR 3067.00 52224 PR CYSTOURETHROSCOPY,FULGUR 2903.00 <.5CM LESN 52234 PR CYSTOURETHROSCOPY,FULGUR 998.00 .5-2CM LESN 52235 PR CYSTOURETHROSCOPY,FULGUR 845.00 2-5CM LESN 52240 PR CYSTOURETHROSCOPY,FULGUR 2263.00 >5CM LESN 52260 PR CYSTOSCOPY,DIL BLADDER,GEN 630.00 ANESTH 52265 PR CYSTOSCOPY,DIL 1207.00 BLADDER,LOCAL ANESTH 52270 PR CYSTOSCOPY,INTERN 897.00 URETHROTOMY,FEMALE 52275 PR CYSTOSCOPY,INTERN 1528.00 URETHROTOMY,MALE 52276 PR CYSTOSCOPY,DIR VIS INT 1140.00 URETHROTOMY 52281 PR CYSTOSCOPY,DIL URETHRAL 802.00 STRICTURE 52287 PR CYSTOURETHROSCOPY INJ 755.00 CHEMODENERVATION BLADDER 52290 PR CYSTOSCOPY,URETERAL 625.00 52300 PR CYSTOSCOPY,RESECT ORTHO 1340.00 URETEROCELE 52301 PR CYSTOSCOPY,RESECT ECTOPIC 725.00 URETEROCEL 52310 PR CYSTOSCOPY,REMV 706.00 52315 PR CYSTOSCOPY,REMV 1114.00 CALCULUS,COMPLIC 52317 PR REMOVE BLADDER 2655.00 52318 PR REMOVE BLADDER 2186.00 52320 PR CYSTOSCOPY,REMV URETERAL 636.00 52327 PR CYSTOSCOPY,INJECT IMPLNT 672.00 52330 PR CYSTOSCOPY,MANIPULATN 1246.00 52332 PR CYSTOSCOPY,INSERT 1231.00 52334 PR CYSTOSCOPY,GUIDE,PERCUT 641.00 52342 PR CYSTOSCOPY,TX 798.00 URETEROPELVC STRICTURE 52344 PR CYSTO/URETEROSCOPY,TX 963.00 URETER STRICT 52345 PR CYSTO/URETEROSCOPY,TX 1015.00 URET/PELV STRICT 52346 PR CYSTO/URETEROSCOPY,TX 1159.00 INTRARENAL STRICT 52351 PR CYSTO/URETERO/PYELOSCOPY, 794.00 52352 PR CYSTO/URETERO/PYELOSCOPY, 933.00 CALCULUS TX 52353 PR CYSTO/URETERO/PYELOSCOPY 3545.00 W/LITHOTRIPSY 52354 PR CYSTO/URETERO/PYELOSC,BX 2130.00 &/OR FULG LESN 52355 PR 2500.00 CYSTO/URETERO/PYELOSCOPY,W/R ESECT TUMOR 52356 PR CYSTO/URETERO 1040.00 W/LITHOTRIPSY &INDWELL STENT 52400 PR CYSTOSCOPY,RESEC CONGEN 1199.00 MUCOSAL FOLDS 52402 PR CYSTOSCOPY,RESEC 677.00 EJACULATORY DUCT 52441 PR CYSTO INSERTION 590.00 TRANSPROSTATIC IMPLANT SINGLE 52442 PR CYSTO INSERTION 197.00 TRANSPROSTATIC IMPLANT EA 52450 PR TRANSURETHRAL INCISION OF 2420.00 PROSTATE 52500 PR TRANSURETHRAL RESEC 1863.00 BLADDER NECK 52601 PR TRANSURETHRAL ELEC-SURG 3113.00 PROSTATECTOM 52630 PR REMV RESID OBSTRUC 2916.00 52640 PR RELIEVE POSTOP BLADDER 1646.00 CONTRACTURE 52648 PR LASER VAPORIZATION SURGERY 8787.00 PROSTATE, COMPLETE 52649 PR LASER ENUCLEATION PROSTATE 2903.00 W MORCELLATION 52700 PR DRAINAGE OF PROSTATE 1136.00 53000 PR INCISION OF URETHRA 381 53010 PR INCISION OF URETHRA,PERINEAL 1730.00 53020 PR INCISION OF URETHRAL MEATUS 361.00 53025 PR INCISION OF URETHRAL 387.00 53040 PR DRAINAGE DEEP URETHRAL 1191.00 53200 PR BIOPSY OF URETHRA 403.00 53215 PR REMOVAL OF URETHRA,MALE 2782.00 53230 PR EXCIS URETHRAL TIC,FEMALE 2167.00 53240 PR MARSUP URETHRAL TIC 1085.00 53260 PR EXCIS URETHRAL POLYP(S) 511.00 53275 PR EXCIS URETHRAL PROLAPSE 673.00 53400 PR REVISE URETHRA, 1ST STAGE 2329.00 53405 PR REVISE URETHRA, 2ND STAGE 3713.00 53410 PR RECONSTRUC ANT MALE 2865.00 53415 PR RECONSTRUC PROSTATIC 4037.00 53420 PR RECONSTRUC PROS 3781.00 URETHRA,1ST STAGE 53425 PR RECONSTRUC PROS 3352.00 URETHRA,2ND STAGE 53430 PR RECONSTRUC FEMALE URETHRA 2823.00 53431 PR 4745.00 53440 PR SLING 2708.00 OPERATION,CORRECTION,MALE 53445 PR INSERT,INFLATABLE SPHINCTER 5477.00 53446 PR REMOVAL,INFLATABLE 2027.00 53447 PR REMOVAL & 2611.00 REPLACE,INFLATABLE SPHINCTER 53450 PR URETHRAL MEATAL REVISION 984.00 53460 PR URETHROPLASTY,EXCIS DIST 1153.00 53502 PR REPAIR URETHRA 1250.00 53505 PR REPAIR URETHRA 1241.00 53520 PR CLOSE 1643.00 53600 PR DIL URETHRA 210.00 53601 PR DIL URETHRA 208 53660 PR DIL URETHRA,FEMALE,INITIAL 181.00 53661 PR DIL 180.00 53665 PR DIL URETHRA,GEN/SPINAL 100.00 54001 PR SLITTING OF PREPUCE 475.00 54050 PR DESTR PENIS 335.00 54056 PR DESTR PENIS 327.00 54057 PR DESTR PENIS LESN,SIMPL,LASER 532.00 54060 PR DESTR PENIS LESN,SIMPL,SURG 450.00 54065 PR DESTR PENIS LESN,EXTENSIVE 502.00 54100 PR BX,PENIS (SEPARATE 442.00 54110 PR EXCIS PENILE PLAQUE 2555.00 54111 PR EXCIS PENILE PLAQUE,GRAFT 3328.00 54115 PR REMV FOR.BODY DEEP PENILE 1129.00 54120 PR REMOVAL PENIS,PARTIAL 2012.00 54125 PR REMOVAL PENIS,TOTAL 2913.00 54150 PR 400.00 CIRCUMCISION,CLAMP,NEWBORN 54160 PR CIRCUMCISION,OTHER,<28 D/O 577.00 54161 PR CIRCUMCISION,OTHER,28+ D/O 677.00 54162 PR LYSIS/EXCIS,PENILE 670.00 POSTCIRCUM ADHESIONS 54163 PR REPAIR,INCOMPLETE 629.00 54164 PR FRENULOTOMY,PENIS 498.00 54200 PR INJECT PROC PENILE PLAQUE 267.00 54220 PR IRRIGAT CORPUS 1065.00 54230 PR INJECT CORPORA CAVERN XRAY 507.00 54235 PR INJECT CORPORA 210.00 CAVERN,PHARM AGNT 54300 PR STRAIGHTEN PENIS 2237.00 54304 PR HYPOSPADIUS REPAIR,1ST 2695.00 54308 PR HYPOSPADIUS REPAIR,2ND 3993.00 54312 PR HYPOSPADIUS REPAIR,2ND 4662.00 54322 PR HYPOSPAD REPAIR,1 2436.00 54324 PR HYPOSPAD REPAIR,1 3142.00 STAGE,DIST,PLASTY 54326 PR HYPOSPAD REPAIR,1 4411.00 STAGE,DIST,PLASTY 54328 PR HYPOSPAD REPR,1 3872.00 STAGE,DIST,EXTENSV 54332 PR HYPOSPAD REPR,1 3872.00 STAGE,PROX,EXTENSV 54340 PR REPAIR HYPOSPAD 1635.00 54344 PR REPAIR HYPOSPAD 3279.00 54360 PR PENIS PLASTIC SURG,CORRECT 2536.00 ANGULATN 54380 PR REPAIR PENIS,EPISPADIUS 2895.00 54405 PR INSERT,INFLATABLE PENILE 3708.00 PROSTHESIS 54406 PR REMVL,INFLAT PENILE PROSTH 2614.00 W/O REPLACMT 54408 PR REPAIR,INFLATABLE PENILE 2828.00 PROSTHESIS 54410 PR REPLACE,INFLATABLE PENILE 2602.00 PROSTHESIS 54415 PR REMOVAL,PENILE PROSTHESIS 1551.00 W/O REPLACMT 54416 PR REPLACE,PENILE PROSTHESIS 2555.00 54430 PR CORPORA CAVER-SPONGIOSA 2616.00 54435 PR CORPORA-GLANS FISTULIZATN 1072.00 54440 PR REPAIR PENIS POST INJURY 2411.00 54450 PR PREPUTIAL STRETCHING 250.00 54505 PR BIOPSY OF TESTIS,INCISIONAL 734.00 54512 PR EXCIS TESTIS 1271.00 EXTRAPARENCHYMAL LESION 54520 PR REMOVAL TESTIS,SIMPLE 1186.00 54530 PR REMOVAL TESTIS,RADICAL 1796.00 54550 PR EXPLORE UNDESC 1628.00 TESTIS,INGUIN/SCROTAL 54560 PR EXPLORE UNDESC 2470 54600 PR REDUCE TESTIS TORSION 1559.00 54620 PR FIXATN OF TESTIS OPP TORSN 1134.00 54640 PR ORCHIOPEXY,INGUNIAL 1519.00 54660 PR INSERT TESTICULAR 919 54670 PR REPAIR TESTIS INJURY 1047.00 54680 PR RELOCATION OF TESTIS(ES) 2778.00 54692 PR LAP,ORCHIOPEXY 2779.00 54700 PR INCIS/DRAIN 576.00 SCROTUM/TESTIS,EPIDIDYM 54830 PR EXCIS EPIDIDYMIS LOCAL 1157.00 54840 PR EXCIS SPERMATOCELE 2133.00 55000 PR DRAINAGE OF 303 55040 PR REMOVAL OF 1163.00 HYDROCELE,TUNICA,UNILAT 55041 PR REMOVAL OF 2048.00 55060 PR REPAIR OF HYDROCELE,TUNICA 1375.00 55100 PR DRAINAGE SCROTAL WALL 541.00 55110 PR EXPLORE SCROTUM 1235.00 55150 PR REMOVAL OF SCROTUM 1361.00 55175 PR REVISION OF SCROTUM,SIMPLE 1467.00 55180 PR REVISION OF 2000.00 55250 PR REMOVAL OF SPERM DUCT(S) 1237.00 55400 PR REPAIR OF SPERM DUCT 5200.00 55450 PR LIGATION OF SPERM DUCT 178.00 55500 PR REMV HYDROCELE,SPERM 1223.00 CORD,UNILAT 55520 PR REMOVAL OF SPERM CORD 1149.00 55530 PR EXCISE VARICOCELE 1573.00 55550 PR LAP,LIGATION SPERMATIC VEINS 1066.00 55680 PR EXCISE MULLERIAN DUCT CYST 927.00 55700 PR BIOPSY OF 625.00 55705 PR BIOPSY OF 944.00 55706 PR BIOPSY OF 944.00 PROSTATE,NEEDLE,TRANSPERINEA 55810 PR REMV 5421.00 55821 PR REMV 3127.00 PROSTATE,SUPRAPUBIC,SUBTOTAL 55840 PR REMV 5432.00 55842 PR REMV 4818.00 PROSTATE,RETROPUB,RAD,LTD 55845 PR REMV 6883.00 PROSTATE,RETROPUB,RAD,TOT 55866 PR 6342.00 LAP,PROSTATECTOMY,RADICAL,W/N ERVE SPARE,INCL ROBOTIC 55873 PR CRYOSURG ABLATION OF 2730.00 55874 PR TRANSPERINEAL PLMT 9491.00 BIODEGRADABLE MATRL 1/MLT NJX 55875 PR PERCUT/NEEDLE 2690.00 INSERT,PROSTATE,RADIOISOT 55875 PR PERCUT/NEEDLE 26 2690.00 INSERT,PROSTATE,RADIOISOT 55876 PR PLACE RADIOTHER 552.00 DEVICE/MARKER, PROSTATE 55920 PR PLACEMENT NEEDLE PELVIC 1065.00 ORGAN RADIOELEMENT APPL 56405 PR I&D OF VULVA/PERINEUM 275.00 56420 PR I&D BARTHOLIN GLAND ABSCESS 305.00 56440 PR MARSUP BARTHOLIN GLAND 450.00 56441 PR LYSIS OF LABIAL LESION(S) 366.00 56442 PR HYMENOTOMY, SIMPLE INCISION 121.00 56501 PR 350.00 56515 PR 525.00 DESTRUCTION,LESION(S),VULVA;EX TENSIVE 56605 PR BIOPSY VULVA/PERINEUM,ONE 225.00 56606 PR BX,VULVA/PERINEUM,ADDL 130.00 56620 PR PART SIMPLE REMV VULVA 1200.00 56625 PR COMPLETE SIMPLE REMV VULVA 1600 56630 PR VULVA 2625.00 56631 PR VULVA RESECT,RAD,PART,UNI 3400.00 56632 PR VULVA RESECT,RAD,PART,BILAT 4625.00 56633 PR VULVA RESECT,RAD,TOTAL 3425.00 56634 PR VULVA RESECT,RAD,TOTAL,UNI 5300.00 56700 PR PARTIAL REMOVAL OF HYMEN 550.00 56740 PR EXCIS BARTHOLIN GLAND/CYST 800.00 56800 PR REPAIR OF VAGINA 615.00 56805 PR REPAIR CLITORIS 4000.00 56810 PR REPAIR OF PERINEUM,NON 900.00 OBSTETRICAL 56820 PR COLPOSCOPY,VULVA 265.00 56821 PR 345.00 57020 PR DRAINAGE OF PELVIC FLUID 250.00 57022 PR I&D VAGINAL 400.00 HEMATOMA,OBSTET/POSTPART 57061 PR DESTRUCT,VAGINAL 275.00 57065 PR DESTRUCT,VAGINAL 500.00 LESION(S),EXTENSIVE 57100 PR BIOPSY OF VAGINA,SIMPLE 200.00 57105 PR BIOPSY OF VAGINA,EXTENSIVE 350.00 57106 PR REMOVE VAGINA WALL, PARTIAL 1250 57110 PR COMPLETE REMOVAL OF VAGINA 3300.00 57120 PR CLOSURE OF VAGINA 1900.00 57130 PR EXCIS VAGINAL SEPTUM 450.00 57135 PR EXCIS VAGINAL CYST/TUMOR 478.00 57155 PR INSERTION UTERINE 1638.00 TANDEM&/VAGINAL OVOIDS 57156 PR INSERT VAGINAL RADIATION 586.00 57160 PR FIT/INSERT INTRAVAG SUPPORT 190.00 57170 PR FITTING OF DIAPHRAGM/CAP 221.00 57180 PR TREAT VAGINAL BLEEDING 375.00 57200 PR REPAIR OF VAGINA 754.00 57220 PR REVISION OF URETHRA 1200.00 57240 PR ANTERIOR COLPORRAPHY RPR 1675.00 CYSTOCELE W/CYSTO 57250 PR POST 1600.00 57260 PR CMBND ANTERPOST 2100.00 COLPORRAPHY W/CYSTO 57265 PR CMBND ANTERPOST 3006 COLPORRAPHY W/CYSTO W/NTRCL 57280 PR SUSPENSION OF VAGINA,ABD 2900.00 57282 PR REPR VAGINAL 2900.00 57283 PR REPR VAGINAL 2500.00 PROLAPSE,UTEROSACRAL 57285 PR PARAVAGINAL DEFECT REPAIR 2366.00 VAGINAL APPROACH 57287 PR REMV/REVS SLING FOR STRES 1800.00 INCONTINENCE 57288 PR SLING OPER STRES 2500.00 57291 PR CONSTRUCTION ARTIFIC VAGINA 3639.00 57292 PR CONSTRUCT ARTIFIC VAGINA W 2850.00 57295 PR REVISION VAGINAL GRAFT, VAG 2900.00 APPROACH 57300 PR REPAIR RECTO-VAG FISTULA 1421 57307 PR REPR REC-VAG 3715.00 57310 PR CLOSE URETHROVAGINAL 1184 57320 PR CLOSE BLAD-VAG FISTULA,VAG 2471.00 57400 PR DILATION OF VAGINA W ANESTH 350.00 57410 PR PELVIC EXAMINATION W ANESTH 375.00 57415 PR REMOVAL VAGINAL FOR.BODY W 375.00 ANESTH 57420 PR COLPOSCOPY,ENTIRE VAGINA 300.00 57421 PR COLPOSCOPY,ENTIRE 400.00 VAGINA,W/BIOPSY(S) 57425 PR LAPAROSCOPY, SURG, 3050.00 57452 PR COLPOSCOPY,CERVIX W/ADJ 270.00 57454 PR COLPOSC,CERVIX W/ADJ 370.00 VAG,W/BX & CURRETAG 57455 PR COLPOSCOPY,CERVIX W/ADJ 330.00 VAGINA,W/BX 57456 PR COLPOSCOPY,CERVIX W/ADJ 315.00 VAGINA, CURETTAG 57460 PR COLPOSCOPY,CERVIX W/ADJ 710.00 VAG,W/LOOP BX 57461 PR COLPOSCOPY,CERVIX W/ADJ 900.00 VAG,W/LOOP CONIZ 57500 PR BIOPSY CERVIX, 1 OR MORE, OR 320.00 EXCISION OF LESION 57505 PR ENDOCERVICAL CURETTAGE 240.00 57510 PR 330.00 CAUTERIZATION,CERVIX,ELECTRO/T HERMAL 57511 PR CRYOCAUTERY OF CERVIX 350.00 57513 PR LASER SURGERY OF CERVIX 370 57520 PR CONIZATION 825.00 57522 PR CONIZATION CERVIX,LOOP 655.00 57540 PR REMV CERV STUMP,ABD 2717.00 57555 PR REMV CERV 1520.00 57558 PR D&C OF CERVIX STUMP 320.00 57700 PR REVISION OF CERVIX,NON 650.00 OBSTETRICAL 57720 PR PLASTIC REPR CERVIX,VAG 770.00 57800 PR DILATION OF CERVICAL CANAL 150.00 58100 PR BIOPSY OF UTERUS LINING 275.00 58110 PR ENDOMET BIOPSY DONE 122.00 W/COLPOSCOPY 58120 PR 625.00 58140 PR MYOMECTOMY 1-4,W/TOT 2975.00 250GMS/<,ABD APPRCH 58145 PR EXCIS UTERINE FIBROID,VAG 1400.00 58146 PR MYOMECTOMY 5/>,TOT>250 2900.00 GMS,ABD APPRCH 58150 PR TOTAL ABDOM HYSTERECTOMY 3100.00 58180 PR SUPRACERV ABD 3100.00 58200 PR TOTAL ABD HYSTEREC+LTD 4925.00 58210 PR RADICAL ABD HYSTEREC+PELV 7500.00 58240 PR PELVIC EXENTERATN,GYN 8700.00 58260 PR VAGINAL 2675.00 HYSTERECTOMY,UTERUS 250 GMS/< 58262 PR VAG HYST,RMV TUBE/OVARY 3025.00 58263 PR VAG HYST,RMV TUBE/OVARY,FIX 3275.00 ENTEROCE 58267 PR VAG HYST,REV VAG/URETHRA 3475.00 58290 PR VAG HYST,UTERUS >250 GMS 3850.00 58300 PR INSERT INTRAUTERINE DEVICE 210.00 58301 PR REMOVE INTRAUTERINE DEVICE 243.00 58322 PR ARTIF INSEMINATION,INTRA- 211.00 58340 PR CATH/INJECT 620.00 58345 PR REOPEN FALLOPIAN 700.00 TUBE,TRANSCERV CATH 58350 PR REOPEN FALLOPIAN 240.00 TUBE,CHROMOTUBATION 58353 PR ENDOMETRIAL ABLATION, 2520.00 58542 PR LAP, SUPRACERVIAL 2920.00 HYSTERECTOMY W/ TUBE&OV, 58545 PR LAP,MYOMECTOMY 1-4,TOT WT 2975.00 58546 PR LAP,MYOMECTOMY 5/>,TOTAL 2950.00 WT >250 GMS 58548 PR LAP, RADICAL HYST W/ 6410.00 TUBE&OV, NODE BX 58550 PR LAP,VAG HYST,UTERUS 3100.00 58552 PR LAP,VAG HYST,UTERUS 3250.00 250GMS/<,SALP-OOPH 58554 PR LAP,VAG HYST,UTERUS 5025.00 >250GMS,SALP-OOPH 58555 PR HYSTEROSCOPY,DX,SEP PROC 1000.00 58558 PR HYSTEROSCOPY,W/ENDO BX 1300.00 58559 PR HYSTEROSCOPY,LYSIS 850.00 58560 PR HYSTEROSCOPY,RESECT 1000.00 58561 PR HYSTEROSCOPY,RMV MYOMA 2300.00 58562 PR HYSTEROSCOPY,RMV FB 1000.00 58563 PR 5643.00 HYSTEROSCOPY,W/ENDOMETRIAL 58565 PR HYSTEROSCOPY, STERILIZE W 5150.00 IMPLANTS 58570 PR LAPAROSCOPY W TOT 2825.00 HYSTERECT UTERUS 250 GRAM OR 58571 PR LAPAROSCOPY W TOT 3100.00 HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY 58572 PR LAPAROSCOPY TOTAL 3600.00 HYSTERECTOMY UTERUS > 250 58573 PR LAPAROSCOPY TOT 3400.00 HYSTERECTOMY UTERUS >250 58575 PR LAPS TOT HYSTERECTOMY RESJ 2789.00 MALIGNANCY W/OMNTC 58605 PR LIGATE FALLOPIAN 1225.00 58611 PR LIGATION,FALLOPIAN TUBE W/C- 600.00 SECTION 58660 PR LAP,LYSIS OF ADHESIONS 2000.00 58661 PR LAP,RMV ADNEXAL STRUCTURE 1900.00 58662 PR LAP,FULGURATE/EXCISE 2200.00 58670 PR LAP,TUBAL CAUTERY 909.00 58671 PR LAP,TUBAL BLOCK BY DEVICE 1225.00 58674 PR LAPS ABLTJ UTERINE FIBROIDS 2918.00 W/INTRAOP US GDN 58700 PR REMOVAL OF FALLOPIAN TUBE 1700.00 58720 PR REMOVAL OF OVARY/TUBE(S) 1900.00 58740 PR LYSIS ADNEXAL ADHESIONS 3110.00 58800 PR DRAIN OVARIAN CYST(S),VAG 774.00 58805 PR DRAIN OVARIAN CYST(S),ABD 888.00 58825 PR TRANSPOSITION, OVARY(S) 2423.00 58900 PR BIOPSY OF OVARY(S) 908.00 58925 PR REMOVAL OF OVARIAN CYST(S) 2325.00 58940 PR REMOVAL OF OVARY(S) 1098.00 58943 PR OOPHORECTORMY FOR MALIG, 4100.00 58950 PR RESEC OVAR MALIG+BILAT 3450.00 OVAR+OMENTUM 58951 PR RESEC OVAR MALIG+TAH+PELV 5125.00 58952 PR OOPH W/RADIC DISSECT FOR 5725.00 DEBULKING 58953 PR BIL SALP-OOPH 7250.00 W/OMENTECT,TAH,RAD DISSECT 58954 PR BIL SAL-OOPH 7900.00 W/OMENTECT,TAH,RAD DIS,LYMP 58956 PR BSO, OMENTECTOMY W/TAH 4975.00 58957 PR RESECT RECURRENT GYN MALIG 6450.00 59000 PR AMNIOCENTESIS,DIAGNOSTIC 295.00 59001 PR AMNIOCENTESIS,THER AMNIOTIC 460.00 FLUID REDUCT 59012 PR FETAL CORD 850.00 59015 PR CHORION VILLUS BIOPSY 400.00 59025 PR FETAL NON-STRESS TEST 119.00 59025 PR FETAL NON-STRESS TEST 26 100.00 59051 PR FETAL MONITOR/INTERPRET 110.00 59120 PR TREAT ECTOPIC PREG,RMV 1800.00 TUBE/OVARY 59150 PR RX ECTOP PREG BY 2000.00 59151 PR RX ECTOP PREG BY SCOPE,RMV 2100.00 TUBE/OVRY 59160 PR D&C AFTER DELIVERY 625.00 59200 PR INSERT CERVICAL DILATOR 210.00 59300 PR EPISIOTOMY/VAG RPR OTH/THN 485.00 ATTENDING 59320 PR REVISION CERVIX W PREG,VAG 850.00 59325 PR REVISION CERVIX W PREG,ABD 900.00 59400 PR FULL ROUT OBSTE 4900.00 59409 PR OBSTETRICAL CARE,VAG DELIV 2400.00 59410 PR OBSTE CARE,VAG 2800.00 59412 PR ANTEPARTUM HEAD 600.00 59414 PR DELIVER PLACENTA 600.00 59425 PR ANTEPARTUM CARE ONLY, 4-6 1150.00 59426 PR ANTEPARTUM CARE ONLY, >7 2400.00 59430 PR CARE AFTER DELIVERY ONLY 475.00 59510 PR FULL ROUT OBSTE 5400.00 CARE,CESAREAN DELIV 59514 PR CESAREAN DELIVERY ONLY 3250.00 59515 PR CESAREAN 3100.00 DELIVERY+POSTPARTUM CARE 59525 PR REMOVE UTERUS AFTER 1150.00 59610 PR ROUT OB CARE,VAG DELIV,PREV 4900.00 59612 PR VAG DELIV ONLY,PREV C-SECTN 3225.00 59614 PR VAG DELIV+POSTPARTUM 2900.00 CARE,PREV C-SEC 59618 PR ROUT OB CARE,C-SEC,PREV C- 5200.00 59620 PR C-SEC ONLY,PREV C-SEC 3350.00 59622 PR C-SEC+POSTPARTUM 3200.00 59812 PR SURG RX INCOMPLETE ABORTN 800.00 59820 PR SURG RX MISSED ABORTN,1ST 900.00 59821 PR SURG RX MISSED ABORTN,2ND 970.00 59840 PR INDUCED ABORTN BY D&C 750.00 59841 PR INDUCED ABORTN BY DIL/EVAC 800.00 59855 PR INDUCED AB BY VAG SUPPOS 875.00 59870 PR EVACUATE MOLE OF UTERUS 2000.00 59871 PR REMOVE CERCLAGE SUTURE 342.00 60100 PR BIOPSY OF THYROID,PERCUT 259.00 60200 PR REMOVE BENIGN THYROID 2342.00 60210 PR PARTIAL EXCISION 2222.00 60220 PR THYROID LOBECTOMY,UNILAT 2414.00 60225 PR THYR LOBECTOMY+PART REMOV 2755.00 CONTRA 60240 PR THYROIDECTOMY 3224.00 60252 PR THYROIDECTOMY,MALIG,LTD 4670.00 NECK SURG 60254 PR THYROIDECTOMY W RAD NECK 5859.00 SURGERY 60260 PR THYROIDECTOMY POST PREV 3881.00 THYR SURG 60270 PR 3385.00 THYROIDECTOMY,SUBSTERNAL,TRA NSTHOR APP 60271 PR 4700.00 THYROIDECTOMY=SUBSTERNAL,TR ANSCERV 60280 PR EXCIS THYROID DUCT 1529.00 60300 PR ASPIRATION AND/OR INJECTION 187.00 THYROID CYST 60500 PR EXPLORE PARATHYROID 3096.00 60502 PR RE-EXPLORE PARATHYROIDS 4417.00 60512 PR AUTOTRANSPLANT, 688.00 60520 PR THYMECTOMY,TRANSCERVICAL 3436.00 60521 PR THYMECTOMY,TRANSTHORACIC 3963.00 60522 PR THYMECTOMY,RADICAL MEDIAST 5347.00 DISSSEC 60540 PR EXCISE ADRENAL GLAND 3172.00 60545 PR EXCISE ADRENAL+ADJ 3758.00 RETROPER TUMOR 60600 PR EXCISE CAROTID BODY LESION 5647.00 60605 PR EXCISE CAROTID 3374.00 BODY+CAROTID ARTERY 60650 PR LAP,ADRENALECTOMY 3635.00 61020 PR VENTRICULAR PUCTURE 325.00 61070 PR BRAIN SHUNT TUBE/RESERV 300.00 61107 PR TWIST HOLE SKULL,IMPLANT 2117.00 CATH/DEVICE 61140 PR BURR HOLE FOR BIOPSY 6503.00 61150 PR BURR HOLE FOR DRAINAGE 7081.00 61154 PR BURR HOLE EVAC 6351.00 SUBDUR/EXTRA HEMATOMA 61210 PR BURR HOLE IMPLANT 2419.00 61304 PR OPEN SKULL SUPRATENT 9084.00 61312 PR OPEN SKULL EVAC 10053.00 SUB/EXTRADUR BLOOD 61313 PR OPEN SKULL EVAC 10176.00 INTRACEREBR BLOOD 61314 PR OPEN SKULL EVAC 9622.00 SUB/EXTRADUR BLOOD 61315 PR OPEN SKULL EVAC 11135.00 INTRACEREBR BLOOD 61320 PR OPEN SKULL DRAIN SUPRATENT 10095.00 61322 PR OPEN 10963.00 SKULL,DECOMPRES,W/DURAPLASTY 61323 PR OPEN 11205.00 61330 PR DECOMPRESS 4366.00 61340 PR SUBTEMPORAL CRANIAL 7509.00 DECOMPRESSION 61343 PR SUBOCCIPT DECOMP 12283.00 61345 PR CRANIAL DECOMPRESSN POST 10718.00 61458 PR CRANIECT EXPL/DECOM 11122.00 61460 PR CRANIECT SECTN 1+ CRAN 11389.00 61500 PR CRANIECT EXCIS SKULL BONE 7491.00 61510 PR EXCIS SUPRATENT BRAIN 11543.00 61512 PR EXCIS SUPRATENT MENINGIOMA 13933.00 61516 PR EXCIS SUPRATENT BRAIN CYST 11448.00 61518 PR EXCIS INFRATENT BRAIN TUMOR 14904.00 61519 PR EXCIS INFRATENT MENINGIOMA 16293.00 61520 PR EXCIS INFRATENT CP ANGLE 21041.00 61521 PR EXCIS INFRATENT MIDLINE 17519.00 61524 PR EXCIS INFRATENT BRAIN CYST 11355.00 61526 PR EXCIS TRANSTEMP CP ANGLE 19784.00 61531 PR SUBDUR IMPLNT ELECTR,BURR 6039.00 61533 SUBDUR IMPLNT ELECTR, CRAN 7980.00 61534 PR EXCIS EPILEPTOGENIC FOCUS 7707.00 61535 PR REMOVE BRAIN ELECTRODES 4538.00 61537 PR REMOVAL OF BRAIN TISSUE 11168.00 61540 PR REMOVAL OF BRAIN TISSUE 13458.00 61541 PR TRANSECT CORPUS CALLOSUM 7241.00 61545 PR EXCISION CRANIOPHARYNGIOMA 19586.00 61546 PR EXCIS PITUITARY,INTRACRANIAL 12530.00 61548 PR EXCIS 9020.00 61550 PR CRANIECTOMY 7275.00 SYNSOTOSIS,SINGLE SUT 61557 PR OPEN FLAP 8762.00 61559 PR EXTEN CRANIEC W RECONTOUR 8449.00 SYNOSTOSIS 61566 PR REMOVAL OF BRAIN TISSUE 13823.00 61581 PR CRANIOFACIAL 13333.00 APPROACH,EXTRADURAL+ 61583 PR CRANIOFACIAL 14302.00 61584 PR ORBITOCRANIAL 13610.00 61586 PR BICOR,XZYGOMA APPROACH 9223.00 ANT CRAN FOSS 61590 PR INFRATEMPORAL 7771.00 APPROACH/PREAURICULAR 61591 PR INFRATEMPORAL 16642.00 APPROACH/POSTAURICULAR 61592 PR ORBITOCRANIAL 15518.00 APPROACH/ZYGOMATIC 61595 PR TRANSTEMPORAL 6044.00 61600 PR RESECT BASE ANT CRAN 10103.00 FOSSA/EXTRADURL 61601 PR RESECT BASE ANT CRAN 11002.00 FOSSA/INTRADURL 61605 PR RESECT INFRATEMP 5365.00 61606 PR RESECT INFRATEMP 17964.00 61608 PR RESECT PARASELLAR 16454.00 FOSSA/INTRADURL 61616 PR EXCIS BASE POST CRAN 11400.00 FOSSA/INTRADURL 61618 PR SEC REPR,CSF LEAK/CRANIAL 3408.00 61619 PR REPAIR DURA POSTOP SK BASE- 5742.00 PEDICLE 61623 PR ENDOVASC TEMP BALLOON 1477.00 OCCLUS,HEAD/NCK 61624 PR PERM 4680.00 OCCLUSION/EMBOLIZATION,PERCUT 61626 PR PERCUT CATH OCCLUSN NON 2744.00 61630 PR INTRACRANIAL BALLOON 2624.00 61635 PR INTRACRANIAL BALLOON 5200.00 ANGIOPLSTY W/STENT 61640 PR BALLOON DILATION 2383.00 INTRACRANIAL VASOSPASM, INIT 61645 PR PERQ ART TRLUML M- 2831.00 THROMBEC &/NFS INTRACRANIAL 61650 PR EVASC INTRACRANIAL PROLNG 1385.00 ADMN RX AGENT ART 1ST 61651 PR EVASC INTRACRANIAL PROLNG 590.00 ADMN RX AGENT ART ADDL 61680 PR BRAIN AVM 12672.00 61682 PR BRAIN AVM 23372.00 61686 PR BRAIN AVM 24497.00 61690 PR BRAIN AVM SURG,DURAL,SIMPLE 13484.00 61692 PR BRAIN AVM 19670.00 61697 PR COMPLEX ANEURYSM 19317.00 SURG/CAROTID CIRC 61698 PR COMPLX ANEURYSM SURG/VERT- 27954.00 BASILAR CIRC 61700 PR ANEURYSM, INTRACRAN, SIMPLE 13923.00 61711 PR INTRA-EXTRACRANIAL ART 10655.00 61720 PR CREATE LESN GLOBUS/THAL 7148.00 61735 PR CREATE LESN SUBCORTICAL 9771.00 61750 PR STEREOTACTIC BRAIN 7258.00 61751 PR STEREO 7410.00 BX/ASPIR/EXCIS,INTRACRANIAL 61760 STEREO IMPLANT BRAIN 8741.00 ELECTRODES, SEIZURE MONITOR 61781 PR STEREOTACTIC COMP ASSIST 1365.00 PROC,CRANIAL,INTRADURAL 61782 PR STEREOTACTIC COMP ASSIST 753.00 PROC,CRANIAL,EXTRADURAL 61783 PR STEREOTACTIC COMP ASSIST 1365.00 PROC,SPINAL 61791 PR STEREO TREAT TRIGEMINAL 4513.00 61796 PR STEREOTACTIC RADIOSURGERY, 6600.00 CRANIAL,SIMPLE,SINGLE 61797 PR STEREOTACTIC RADIOSURGERY, 6600.00 CRANIAL,SIMPLE,EA ADD 61798 PR STEREOTACTIC RADIOSURGERY, 9900.00 CRANIAL,COMPLEX,SINGLE 61799 PR STEREOTACTIC RADIOSURGERY, 9900.00 CRANIAL,COMPLEX,EA ADD 61800 PR APPLY STEREOTACTIC 2000.00 HEADFRAME FOR RADIOSURGERY 61863 PR IMPLANT NEUROELECTRODE 6229.00 61864 PR IMPLANT NEUROELECTRDE, 1733.00 61867 PR IMPLANT NEUROELECTRODE 9357.00 61868 PR IMPLANT NEUROELECTRDE, 3077.00 61880 PR REVISE/REMOVE INTRACRAN 2754.00 NEUROELEC 61885 PR IMP STIM,CRANIAL,SUBQ,1 2472.00 61886 PR IMP STIM,CRANIAL,SUBQ,>1 3170.00 62000 PR FIX SIMPL DEPRESS SKULL FX 3534.00 62010 PR FIX DEPRESS SKULL FX,REPR 8104.00 62100 PR 4001.00 62120 PR REPAIR ENCEPHALOCELE,VAULT 8744.00 62121 PR REPAIR ENCEPHALOCELE,BASE 6936.00 62140 PR REPAIR SKULL DEFECT,UP TO 5629.00 62141 PR REPAIR SKULL DEFECT,>5CM 6350.00 62142 PR REMOVE SKULL PLATE/FLAP 4629.00 62143 PR REPLACE SKULL PLATE/FLAP 5285.00 62146 PR REPAIR SKULL W GRAFT,UP TO 5772.00 62147 PR REPAIR SKULL W GRAFT,>5CM 6000.00 62160 PR 979.00 NEUROENDOSCOP,PLACE/REPLACE 62161 PR NEUROENDOSCOP,DISS 7271.00 ADHESION/FENESTRATION 62162 PR 8968.00 NEUROENDOSCOP,W/FENESTRAT/E 62163 PR 7547.00 62164 PR NEUROENDOSCOP,W/EXCISE 12728.00 BRAIN TUMOR 62165 PR NEUROENDOSCOP,EXC,PIT 6243.00 TUM,TRANSNAS/SPHEN 62192 PR CREATE SHUNT:SUBARCH/DUR- 5272.00 PLEURAL 62200 PR VENTRICULO- 4835.00 CISTERNOSTOMY,3RD VENT 62201 PR VENTRICULO- 4843.00 CISTERNOSTOMY,3RD 62220 PR CREATE SHUNT:VENTRIC-ATRIAL 6214.00 62223 PR CREATE SHUNT:VENTRIC- 5508.00 62225 PR REPLACE/IRRIGATE VENTRIC 2331.00 62230 PR REPLACEMENT/REVISION,CSF 4350.00 62252 PR 26 263.00 REPROGRAMMING,PROGRAMMABLE 62256 PR REMOVAL,COMPLETE CSF 2940.00 SHUNT,W/O REPLACE 62258 PR REMOVE & REPLACE CSF SHUNT 6003.00 62267 PR PERCUT ASPIRATION 570.00 62270 PR SPINAL 373.00 PUNCTURE,LUMBAR,DIAGNOSTIC 62272 PR SPINAL 588.00 PUNCTURE,THERAPEUTIC 62273 PR INJ,LUMB EPIDUR,BLOOD/CLOT 409.00 62281 PR INJECT 610.00 NEUROLYTIC,EPIDUR,CERV/THOR 62282 PR 741.00 62284 PR INJECTION PROCEDURE 552.00 MYELOGRAPHY/CT LUMBAR 62287 PR DCMPRN PERQ NUCLEUS 1459.00 PULPOSUS 1/> LEVELS LUMBAR 62290 PR INJECT DISCOGRAM,LUMBAR,EA 829.00 62292 PR INJECT CHEMONUCLEOLYSIS 2941.00 62294 PR INJECT SPINAL 4844.00 62302 PR MYELOGRAPHY VIA LUMBAR 606.00 INJECTION RS&I CERVICAL 62303 PR MYELOGRAPHY VIA LUMBAR 630.00 INJECTION RS&I THORACIC 62304 PR MYELOGRAPHY VIA LUMBAR 597.00 INJECT RS&I LUMBOSACRAL 62305 PR MYELOGRAPHY VIA LUMBAR 652.00 INJECTION RS&I 2+ REGIONS 62310 PR NJX DX/THER SBST 725.00 EPIDURAL/SUBRACH 62311 PR NJX DX/THER SBST 614.00 EPIDURAL/SUBARACH 62318 PR 738.00 62319 PR NJX INFUS/BOLUS DX/SBST 563.00 EDRL/SUBARACH LUM/SACRAL 62320 PR NJX DX/THER SBST INTRLMNR 427.00 CRV/THRC W/O IMG GDN 62321 PR NJX DX/THER SBST INTRLMNR 634.00 CRV/THRC W/IMG GDN 62322 PR NJX DX/THER SBST INTRLMNR 398.00 LMBR/SAC W/O IMG GDN 62323 PR NJX DX/THER SBST INTRLMNR 622.00 LMBR/SAC W/IMG GDN 62324 PR NJX DX/THER SBST INTRLMNR 373.00 CRV/THRC W/O IMG GDN 62325 PR NJX DX/THER SBST INTRLMNR 562.00 CRV/THRC W/IMG GDN 62326 PR NJX DX/THER SBST INTRLMNR 392.00 LMBR/SAC W/O IMG GDN 62327 PR NJX DX/THER SBST INTRLMNR 573.00 LMBR/SAC W/IMG GDN 62350 PR IMP SPINAL CANAL CATH 2460.00 62355 PR REMOVE SPINAL CANAL 893.00 62362 INSERT/ REPLACE INFUSN 2600.00 PUMP,PROGRAMMABLE 62365 PR REMOVE INFUSN DEVICE/PUMP 2023.00 62367 PR ELECT ANLYS IMPLT ITHCL/EDRL 89.00 PMP W/O REPRG/REFIL 62368 PR ANALYZE INFUSN 165.00 62370 PR ELEC ANLYS IMPLT ITHCL/EDRL 445.00 PMP W/REPR PHYS/QHP 63001 LAM W/O FACETEC FORAMOT/DSKC 6317.00 1/2 VRT SEG, CERVICAL 63003 LAM W/O FACETEC FORAMOT/DSKC 6312.00 1/2 VRT SEG, THORACIC 63005 LAM W/O FACETEC FORAMOT/DSKC 6014.00 1/2 VRT SEG, LUMBAR 63011 LAM W/O FACETEC FORAMOT/DSKC 5559.00 1/2 VRT SEG, SACRAL 63012 PR 6060.00 63015 PR LAMINECTOMY,>2 7547.00 63016 PR LAMINECTOMY,>2 7766.00 63017 PR LAMINECTOMY,>2 SGMT,LUMBAR 6396.00 63020 PR LAMNOTMY INCL W/DCMPRSN 5909.00 NRV ROOT 1 INTRSPC CERVC 63030 PR LAMNOTMY INCL W/DCMPRSN 4933.00 NRV ROOT 1 INTRSPC LUMBR 63035 PR LAMNOTMY W/DCMPRSN NRV 980.00 EACH ADDL CRVCL/LMBR 63040 PR LAMINOTOMY 7093.00 63042 PR REDO EXCIS LUMBAR DISC 6595.00 63043 PR REDO EXCIS CERV DISC, ADDN 990.00 CERV INTERSPC 63044 PR REDO EXCIS CERV DISC, ADDN 990.00 LUMB INTERSPC 63045 LAMINEC/FACETECT/FORAMIN,CERV 6558.00 ICAL 1 SEG 63046 LAMINEC/FACETECT/FORAMIN,THOR 6220.00 ACIC 1 SEG 63047 LAMINEC/FACETECT/FORAMIN,LUMB 5608.00 AR 1 SEG 63048 PR 1081.00 LAMINEC/FACETECT/FORAMIN,EACH 63050 PR C- LAMINOPLASTY, 2 OR MORE 5090.00 63051 PR C-LAMINOPLASTY 8708.00 W/GRAFT/PLATE, 2 OR MORE 63055 PR XPEDICUL DECOMPRESS 8296.00 THROACIC CORD 63056 PR DECOMPRESS SPINAL CORD,1 6043.00 63064 PR COSTOVERT DECOMPRESS 9029.00 THORACIC CORD 63066 PR COSTOVERT DECOMP THOR 1056.00 CORD,EACH ADDN 63075 PR DISK 6893.00 SURG,ANTER,CERVICAL,SINGLE LVL 63076 PR DISK SURG,ANTER,CERV,EA 1267.00 63077 PR DISK SURG,THORAX,SINGLE 7595.00 63081 PR REMV VERT BODY,CERV,ONE 8946.00 63082 PR REMV VERT BODY,CERV,EACH 8946.00 ADDNL SGMT 63085 PR REMV VERT BODY,THOR,ONE 9753.00 63086 PR REMV VERT BODY,THOR,EACH 975.00 ADDNL SGMT 63087 PR REMV VERT BODY,LO 12284.00 63088 PR REMV VERT BODY,LO 1330.00 THOR/LUMB,EA ADDNL 63090 PR REMV VERT 9969.00 BODY,LOWER,RETROPER,ONE 63091 PR REMV VERT 909.00 BODY,LOWR,RETROPER,EA ADDN 63101 PR REMOVAL OF VERTEBRAL BODY 11789.00 63102 PR REMOVAL OF VERTEBRAL BODY 11577.00 63103 PR REMOVE VERTEBRAL BODY ADD- 2497.00 63170 PR INCISE SPINAL CORD TRACT(S) 8155.00 63172 PR DRAIN INTRAMEDULLARY- 7188.00 63173 PR DRAIN INTRAMEDULLARY- 8712.00 63185 PR INCISE SP 5815.00 COLUMN/NERVES,ONE/TWO LVL 63190 PR INCISE SP COLUMN/NERVES,>2 6522.00 63191 PR INCISE SPINAL ACCESS NERVE 6465.00 63194 PR INCIS 1 SPINOTHAL,CERV,1 7131.00 63195 PR INCIS 1 SPINOTHAL,THOR,1 6489.00 63200 PR RELEASE TETHERED SPINAL 7828.00 CORD,LUMBR 63250 PR EXCIS/OCCLUD CORD 15227.00 63251 PR EXCIS/OCCLUD CORD 15424.00 63252 PR EXCIS/OCCLUD CORD 15479.00 AVM,THORCOLUMBAR 63265 PR EXCIS INTRASP 8500.00 63266 PR EXCIS INTRASP 8760.00 LESN,XDURAL,THORACIC 63267 PR EXCIS INTRASP 6969.00 63268 PR EXCIS INTRASP 7120.00 63270 PR EXCIS INTRASP 10599.00 63271 PR EXCIS INTRASP 10516.00 63272 PR EXCIS INTRASP 9619.00 63275 PR BX/EXCIS SPINAL 9161.00 63276 PR BX/EXCIS SPINAL 9111.00 63277 PR BX/EXCIS SPINAL 7898.00 63278 PR BX/EXCIS SPINAL 8050.00 63280 PR BX/EXCIS SPIN 10755.00 63281 PR BX/EXCIS SPIN 10672.00 63282 PR BX/EXCIS SPIN 10040.00 63283 PR BX/EXCIS SPIN 9629.00 63285 PR BX/EXCIS SPIN 13414.00 63286 PR BX/EXCIS SPIN 13089.00 63287 PR BX/EXCIS SPIN 14075.00 TUM,INDUR,INMED,THLUM 63290 PR BX/EXCIS SPIN 11399.00 63300 PR REMV VERT,EXDUR,CERV 9344.00 63301 PR REMV 10591.00 VERT,EXUDR,XTHOR,THOR TUMOR 63302 PR REMV 10979.00 VERT,EXDUR,THORLUM,THOR 63303 PR REMV VERT,EXDUR,LUMB/SACR 11484.00 63305 PR REMV 10280 VERT,INDURAL,XTHOR,THOR 63307 PR REMV 11110.00 VERT,INDURAL,LUMB/SACR TUMOR 63308 PR REMV VERT,EACH ADDNL 1650.00 63600 PR CREATE SP CORD 4568.00 63650 PR PERCUT IMPLNT 3294.00 NEUROELECT,EPIDURAL 63655 PR SURG IMPLNT 4210.00 63661 PR REMOVE SPINAL NEUROSTIM 2921.00 ELECTRODE PERC ARRAY, INCL 63662 PR REMOVE SPINAL NEUROSTIM 4252.00 ELECTRODE PLATE/PADDLE, INCL 63663 PR REVISION SPINAL NEUROSTIM 2500.00 ELECTRODE PERC ARRAY, INCL 63664 PR REVISION SPINAL NEUROSTIM 4390.00 ELECTRODE PLATE/PADDLE, INCL 63685 PR IMPLANT NEUROSTIM/RECEIVER 1853.00 63688 PR REVISE/REMOVE 1883.00 63704 PR REPR MYELOMENIGOCELE,<5CM 7451.00 63706 PR REPR MYELOMENIGOCELE,5+CM 8888.00 63707 PR REPR,DURAL/CSF LEAK,NOT REQ 4682.00 LAMINECTOMY 63709 PR REPR,DURAL/CSF 5600.00 LEAK,W/LAMINECTOMY 63710 PR DURAL GRAFT REPAIR,SPINE 5506.00 63740 PR INSTALL SPINAL 4759.00 63741 PR INSTALL SPINAL SHUNT,PERCUT 3438.00 63744 PR REVISION OF SPINAL SHUNT 3364.00 63746 PR REMOVAL OF SPINAL SHUNT 3066.00 64400 PR INJECT NERV BLCK,TRIGEMINAL 308.00 64402 PR INJECT NERV BLCK,FACIAL NERV 318.00 64405 PR INJECT NERV BLCK,GREAT 285.00 64413 PR INJECT NERV BLCK,CERV 320.00 64415 PR INJ,ANES AGENT,BRACHIAL 401.00 PLEXUS,SINGLE 64416 PR INJ,ANES AGENT,BRACHIAL 420.00 PLEXUS,CONT INF 64417 PR INJECT NERV BLCK,AXILLARY 366.00 64418 PR INJECT NERV BLCK,SUPRASCAP 365.00 64420 PR INJECT NERV 418.00 64421 PR INJECT NERV 634.00 64425 PR INJECT NERV 395.00 64430 PR INJECT NERV BLCK,PUDENDAL 413.00 64445 PR INJ,ANES AGENT,SCIATIC 400.00 64446 PR INJ,ANES AGENT,SCIATIC 420.00 NERVE,CONT INF 64447 PR INJ,ANES AGENT,FEMORAL 365.00 NERVE,SINGLE 64448 PR INJ,ANES AGENT,FEMORAL 400.00 NERVE,CONT INF 64449 PR N BLOCK INJ, LUMBAR PLEXUS 216 64450 PR INJECT NERV BLCK,OTHR 310.00 64455 PR INJECT PLANTAR COMMON 121.00 DIGITAL NERVE 64479 PR INJECT ANES/STEROID 589.00 FORAMEN CERV/THORACIC W IMG 64480 PR INJECT ANES/STEROID 286.00 FORAMEN CERV/THORACIC W IMG GUIDE ,EA ADD LEVEL 64483 PR INJECT ANES/STEROID 547.00 FORAMEN LUMBAR/SACRAL W IMG 64484 PR INJECT ANES/STEROID 220.00 FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL 64486 PR TAP BLOCK UNILATERAL BY 308.00 INJECTION(S) 64488 PR TAP BLOCK BILATERAL BY 379.00 64490 PR INJ DX/THER AGNT PARAVERT 732.00 FACET JOINT, CERV/THORAC, 1ST 64491 PR INJ DX/THER AGNT PARAVERT 298.00 FACET JOINT, CERV/THORAC, 2ND 64492 PR INJ DX/THER AGNT PARAVERT 298.00 FACET JOINT, CERV/THORAC, ADD 64493 PR INJ DX/THER AGNT PARAVERT 668.00 FACET JOINT, LUMBAR/SAC, 1ST 64494 PR INJ DX/THER AGNT PARAVERT 264.00 FACET JOINT, LUMBAR/SAC, 2ND 64495 PR INJ DX/THER AGNT PARAVERT 217.00 FACET JOINT, LUMBAR/SAC, ADD 64505 PR INJECT NERV 295.00 BLCK,SPHENOPALAT GANGLN 64510 PR INJECT NERV BLCK,STELLATE 397.00 GANGLION 64520 PR INJECT NERV BLCK,PARAVERT 581.00 SYMPATH 64530 PR INJECT NERV BLCK,CELIAC 592.00 64550 PR APPLICATION OF SURFACE 40.00 NEUROSTIMULATOR 64555 PR PRQ IMPLTJ NEUROSTIMULATOR 3047.00 ELTRD PERIPHERAL NRV 64561 PR PRQ IMPLTJ NEUROSTIM ELTRD 2101.00 SACRAL NRVE W/IMAGING 64566 PR POST TIBIAL 418.00 NEUROSTIMULATION,PERC NEEDLE 64568 PR INCISION IMPLANT CRANIAL 1650.00 NERVE STIM ELECTRODE/PULSE 64569 PR REVISE/REPLACE CRANIAL 4713.00 NERVE STIM ELECTRODE/CONNECT 64570 PR REMOVE IMPLANT CRANIAL 1665.00 NERVE STIM ELECTRODE/PULSE 64575 PR INC IMPLTJ PERIPH NERVE 1622.00 NEUROSTIMULATOR ELTRD 64581 PR INC IMPLTJ NEUROSTIMULATOR 1800.00 ELTRD SACRAL NERVE 64585 PR REVJ/RMVL PERIPHERAL 617.00 NEUROSTIMULATOR ELECTRODE 64590 PR IMPLANT GASTRIC 800.00 NEUROSTIM/RECEIVER 64595 PR REVISE/REMOVE GASTRIC 619.00 NEUROSTIM/RECEIVER 64600 PR INJECT TRIGEM NERV,1ST 986.00 64610 PR INJECT 5TH N.-2,3 2836.00 64611 PR CHEMODENERVATION 295.00 PAROTID/SUBMANDIBULAR SALIVARY GLANDS,BILATERAL 64612 PR CHEMODNRVTJ MUSC MUSC 350.00 INNERVATED FACIAL NRV UNIL 64615 PR CHEMODERVATE 435.00 FACIAL/TRIGEM/CERV MUSC 64616 PR CHEMODENERVATION MUSCLE 344.00 NECK UNILAT FOR DYSTONIA 64617 PR CHEMODENERVATION MUSCLE 428.00 LARYNX UNILAT W/EMG 64630 PR DESTRUCT BY NEURO AGENT; 677.00 PUDENDAL 64633 PR DSTR NROLYTC AGNT 1329.00 PARVERTEB FCT SNGL 64634 PR DSTR NROLYTC AGNT 609.00 PARVERTEB FCT ADDL 64635 PR DSTR NROLYTC AGNT 1306.00 PARVERTEB FCT SNGL 64636 PR DSTR NROLYTC AGNT 548.00 PARVERTEB FCT ADDL 64640 PR INJECT RX OTHER PERIPH 646.00 64642 PR CHEMODENERVATION ONE 371.00 EXTREMITY 1-4 MUSCLE 64643 PR CHEMODENERVATION 1 275.00 EXTREMITY EA ADDL 1-4 MUSCLE 64644 PR CHEMODENERVATION 1 410.00 EXTREMITY 5 OR MORE MUSCLES 64645 PR CHEMODENERVATION 1 313.00 EXTREMITY EA ADDL 5/< MUSCLES 64646 PR CHEMODENERVATION OF TRUNK 405.00 MUSCLE 1-5 MUSCLES 64647 PR CHEMODENERVATION OF TRUNK 475.00 6 OR MORE MUSCLES 64650 PR CHEMODENERV ECCRINE 286.00 GLANDS BOTH AXILLAE 64653 PR CHEMODENERV ECCRINE 356.00 GLANDS, NON-AXILLARY 64680 PR INJECT RX CELIAC PLEXUS 950.00 64681 PR INJECTION TREATMENT OF 1312.00 64702 PR REVISE/REPAIR FINGER/TOE 1265.00 64704 PR REVISE/REPAIR HAND/FOOT 1430.00 64708 PR NEUROPLASTY OTHER ARM/LEG 2521.00 NERVE,OPEN 64712 PR NEUROPLASTY SCIATIC 2940.00 64713 PR NEUROPLASTY BRACHIAL 3889.00 64714 PR NEUROPLASTY LUMBAR 2517.00 64716 PR REVISION OF CRANIAL NERVE 1351.00 64718 PR REVISE ULNAR NERVE AT 2990.00 64719 PR REVISE ULNAR NERVE AT WRIST 2022.00 64721 PR REVISE MEDIAN N/CARPAL 1467.00 TUNNEL SURG 64722 PR RELIEVE PRESSURE ON 919.00 64726 PR RELEASE FOOT/TOE NERVE 932.00 64727 PR INTERN NERVE REVIS,OPER 940.00 MICROSCOPE 64734 PR TRANSECT INFRAORBITAL NERV 2090.00 64744 PR TRANSECT GREAT OCCIPITAL 1725.00 64763 PR TRANSECT 1613.00 OBTURATR,XTRAPELV,HIP/LEG 64771 PR TRANSECT OTHER CRAN 3043.00 N,EXTRADURAL 64772 PR TRANSECT OTHR SPINAL 2854.00 64774 PR EXCISE CUTANEOUS NEUROMA 2098.00 64776 PR EXCISE DIGITAL NEUROMA 1172.00 64782 PR EXCISE HAND/FOOT NEUROMA 1075.00 64783 PR EXCISE HAND/FOOT 790.00 NEUROMA,EACH ADDNL 64784 PR EXCISE MAJOR PERIPHERAL 3697.00 64786 PR EXCISE SCIATIC NERVE 5494.00 64787 PR IMPLANT NERVE END TO 1078.00 64788 PR EXCISE CUTANEOUS 2019.00 64790 PR EXCISE MAJOR PERIPH 4284.00 64792 PR EXCISE NEUROFIBROMA 5507.00 64795 PR BIOPSY OF NERVE 983.00 64804 PR 4267.00 64820 PR SYMPATHECTOMY,DIGITAL 2680.00 ARTERIES, EA 64821 PR SYMPATHECTOMY,RADIAL 2450.00 64822 PR SYMPATHECTOMY,ULNAR 1750.00 64831 PR REPAIR OF DIGIT NERVE 1599.00 64832 PR REPAIR EACH ADDNL DIGIT 843.00 64834 SUTURE 1 NERVE HAND/FOOT 2349.00 COMMON SENSORY NERVE 64835 SUTURE 1 NERVE MEDIAN MOTOR 2535.00 64836 SUTURE 1 NERVE ULNAR MOTOR 2927.00 64837 PR REPAIR EACH ADDNL 1075.00 HAND/FOOT NERVE 64856 PR REPAIR/TRANSPOS MAJ PERIPH 3071.00 64857 PR REPAIR MAJOR PERIPHERAL 3290.00 64858 PR REPAIR SCIATIC NERVE 4210.00 64859 PR REPAIR ADDNL MAJ PERIPH 642.00 64864 PR REPR FACIAL 2853.00 64868 PR ANAST FACIAL-HYPOGLOSSAL 3513.00 64872 PR REPR 418.00 64874 PR REPR/TRANSPOSE 425.00 64885 PR NERVE 3478.00 64886 PR NERVE 4691.00 64890 PR NERVE 3427.00 64893 PR NERVE 4008 64896 PR NERV 5857.00 64898 PR NERV 5990.00 64902 PR EA ADDNL NERVE 2326.00 GRAFT,MULTPL STRANDS 64905 PR NERVE PEDICLE XFER,FIRST 3547.00 64910 PR NERVE REPAIR W/ALLOGRAFT 2906.00 OR SYNTH 64912 PR NERVE REPAIR W/NERVE 2821.00 ALLOGRAFT FIRST STRAND 64913 PR NERVE REPAIR W/NERVE 572.00 ALLOGRAFT EA ADDL STRAND 65101 PR REMOVAL OF EYE 1878.00 65103 PR REMOVE EYE W IMPLANT 1948.00 65105 PR REMOVE EYE W MUSC TO 2167.00 65110 PR REMOVAL OF ORBITAL 4321.00 65205 PR REMV F.B.,EYE,SUPERF 142.00 65210 PR REMV F.B.,EYE,EMBED CONJUNC 173.00 65220 PR REMV F.B.,EYE,CORNEA,NO SLIT 229.00 65222 PR REMV F.B.,EYE,CORNEA,SLIT 170.00 65235 PR REMOVAL,FB,INTRAOCULAR,ANT 1782.00 CHAMBER/LENS 65260 PR REMV F.B.,EYE,POST 3401.00 65265 PR REMV F.B.,EYE,POST 3817.00 SGMT,NONMAGNETIC 65270 PR REPAIR CONJUNC LACERATN 665.00 65275 PR REPAIR CORNEA 1445.00 LAC,NONPERFORATING 65280 PR REPAIR CORNEA LAC,PERF,NO 1732.00 65285 PR REPAIR CORNEA 2960.00 LAC,PERF,RESEC UVEAL 65286 PR REPAIR CORNEA LAC,APPLY 1755.00 65400 PR EXCIS CORNEA LESN 1703.00 65410 PR BIOPSY OF CORNEA 358.00 65426 PR EXCIS PTERYGIUM,W GRAFT 1624.00 65430 PR CORNEAL SMEAR 290.00 65435 PR CURETTE/TREAT CORNEA 203.00 65436 PR CURETTE/TREAT CORNEA,APPLY 986.00 CHELATE 65450 PR DESTR CORNEAL 813.00 LESN,CRYO,PHOTO,THERM 65600 PR MULT PUNC ANTER CORNEA 987.00 65730 PR CORNEAL 3681.00 65750 PR CORNEAL 3681.00 TRANSPLANT,PENETRAT,APHAKIA 65755 PR CORNEAL 3681.00 TRANSPLANT,PEN,PSEUDOAPHAK 65756 PR CORNEAL 3400.00 65770 PR REVISE CORNEA WITH IMPLANT 4100.00 65778 PR PLACE AMNIOTIC MEMBRA 3431.00 OCULAR SURFACE W/O SUTURES 65779 PR PLACE AMNIOTIC MEMBRANE 600 OCULAR SURFACE SUTURED 65780 PR OCULAR SURF RECONST, 2500.00 AMNIOTIC TRANSPLANT, MULTIPLE 65800 PR PARACENTSIS ANT CHAMB EYE 301.00 ASPIR AQUEOUS SPX 65815 PR DRAIN ANT CHMBR,REMV BLOOD 1605.00 65820 PR RELIEVE INNER EYE PRESSURE 1878.00 65850 PR INCISION OF EYE 2400.00 65855 PR TRABECULOPLASTY BY LASER 854.00 SURGERY 65860 PR INCISE INNER EYE 814.00 65865 PR INCISE INNER EYE 1181.00 65875 PR INCISE POST SYNECHIAE,EYE 1595.00 65920 PR REMVL,IMPLANT MATERIAL,ANT 1980.00 SEGMENT,EYE 66020 PR INJECTION,ANT 500.00 CHAMBER,EYE,AIR/LIQUID 66030 PR INJECT ANTER CHMBR 412.00 66170 PR GLAUCOMA SURG,TRABECU AB 3400.00 EXTERNO 66172 PR GLAUCOMA SURG,TRAB AB 4100.00 EXT,PREV SCAR 66180 PR AQUEOUS SHUNT EXTRAOC 3400.00 EQUAT PLATE RSVR W/GRAFT 66183 PR INSERT ANTER DRAINAGE DEV 3588.00 W/O EXTRAOC RESERVOIR 66184 PR REVJ SHUNT EXTRAOCULAR 1987.00 RESERVOIR W/O GRAFT 66185 PR REVJ AQUEOUS SHUNT 2400.00 EXTRAOCULAR RESERVOIR 66250 PR REVIS/REPAIR OP WOUND 1895.00 66605 PR REMV IRIS,CYCLECTOMY 3739.00 66625 PR REMV IRIS,PERIPH FOR 1400.00 66682 PR SUTURE IRIS/CILIARY BODY 1601.00 66710 PR DESTRUC,CILIARY 1097.00 BODY,CYCLOPHOTOCOAG 66711 PR DESTRUC,CILIARY 1603.00 BODY,CYCLOPHOTO,ENDOSCO 66761 PR IRIDOTOMY/IRIDECTOMY BY 900.00 LASER, PER SESSION 66762 PR IRIDOPLASTY BY PHOTOCOAG 1183.00 66821 PR DISCISSION,2ND 828.00 66825 PR REPOSITION INTRAOCULAR 1904.00 LENS W INCIS 66840 PR REMV LENS MATERIAL,ASPIRATN 1759.00 66850 PR REMV LENS 2300.00 66852 PR REMV LENS MATERIAL,PARS 2500.00 PLANAR APPRC 66982 PR REMV CATARACT 2800.00 EXTRACAP,INSERT LENS,COMP 66984 PR REMV CATARACT 2100.00 EXTRACAP,INSERT LENS 66985 PR INSERT LENS PROSTHESIS ONLY 2200.00 66986 PR EXCHANGE LENS PROSTHESIS 2500.00 66990 PR OPHTHALMIC ENDOSCOPE USE 250.00 67005 PR PART REMV VITREOUS,ANT 1181.00 67010 PR SUBTOT REMV VITREOUS,MECH 1369.00 VIRECTOMY 67015 PR RELEAS 1460.00 VITREOUS,SUBRET/CHOROID FLUID 67025 PR REPLACE EYE FLUID 1842.00 67028 PR INJECT INTRAVITREAL 400.00 67036 PR VITRECTOMY,MECHANICAL 3200.00 67039 PR VITRECTOMY,FOCAL LASER RX 3400.00 67040 PR VITRECTOMY,PANRETINAL 3700.00 67041 PR VITRECTOMY PARS PLANA 3800.00 REMOVE PRERETINAL MEMBRANE 67042 PR VITRECTOMY PARS PLANA 4032.00 REMOVE INT MEMB RETINA 67043 PR VITRECTOMY PARS PLANA 4300.00 REMOVE SUBRETINAL MEMBRANE 67101 PR RPR RETINAL DTCHMNT DRG 2100.00 SUBRETINAL FLUID CRTX 67105 PR RPR RETINAL DTCHMNT DRG 1802.00 SUBRETINAL FLUID PC 67107 PR REPAIR RETINAL DETACHMENT 3600.00 SCLERAL BUCKLING 67108 PR RPR RETINAL DTCHMNT 6412.00 W/VITRECTOMY ANY METH 67110 PR REPAIR DETACD RETINA,INJECT 2400.00 AIR/GAS 67113 PR RPR COMPLEX RETINA DETACH 4800.00 VITRECT &MEMBRANE PEEL 67115 PR RELEASE ENCIRCL 610.00 MATERIAL,POST SGMT 67120 PR REMV POST EYE IMPLNT 1800.00 MATER,EXTRAOCUL 67121 PR REMV POST EYE IMPLNT 2600.00 MATER,INTRAOCUL 67141 PR PROPHYLAXIS RETINA 1331.00 DETACH,CRYO/DIATH 67145 PR PROPHYLAXIS RETINA 1500.00 DETACH,PHOTOCOAG 67208 PR DESTRUC RETINAL 1500.00 67210 PR DESTRUC RETINAL 1293.00 67218 PR DESTRUC RETINAL LESN,RADN 3600.00 67220 PR DEST,CHOROID 1700.00 67221 PR DEST,CHOROID 820.00 LESN,PHOTODYNAMIC THERAPY 67228 PR TREATMENT EXTENSIVE 2700.00 RETINOPATHY 67229 PR TX EXTENSIVE RETINOPATHY, 3268.00 PRETERM INFANT 67255 PR REINFORCE SCLERA EYE W 2400.00 67311 PR STABISMUS SURG,ONE HORIZ 1600.00 67312 PR STABISMUS SURG,TWO HORIZ 1900.00 67314 PR STABISMUS SURG,ONE VERT 1800.00 67316 PR STABISMUS SURG,2+ VERT 2200.00 67318 PR STRABISMUS SURG,SUPER- 1787.00 67320 PR TRANSPOSITION ANY 830.00 67331 PR STRABISM SURG,PREV EYE 800.00 SURG,NOT MUSC 67332 PR STRABISMUS SURG,SCAR 920.00 EXTRAOCUL MUSC 67334 PR STRABISMUS SURG,POST 756.00 FIXATN SUTURE 67335 PR STRABISMUS SURG,PLACE 430.00 ADJUST SUTURE 67345 PR DESTROY NERVE OF EYE 700.00 67400 PR EXPLORE EYE SOCKET 2700.00 67405 PR EXPLORE EYE 2100.00 67412 PR EXPLORE EYE SOCKET,REMV 2600.00 67413 PR EXPLORE EYE SOCKET,REMV 2400.00 67414 PR EXPLORE EYE 3600.00 67415 PR NEEDLE ASPIR ORBITAL 420.00 67420 PR LAT EXPLOR EYE SOCK,REMV 4300.00 67445 PR LAT EXPLOR EYE 4931.00 67500 PR RETROBULBAR 197.00 67515 PR INJ,THER AGENT INTO TENON'S 260.00 CAPSULE 67550 PR INSERT EYE SOCKET IMPLANT 3414.00 67560 PR REVISE EYE SOCKET IMPLANT 3501.00 67710 PR INCISION OF EYELID 555.00 67715 PR INCISION OF EYELID FOLD 610.00 67800 PR EXCIS CHALAZION,SINGLE 330.00 67801 PR EXCIS CHALAZION,MULT,SAME 422.00 67805 PR EXCIS CHALAZION,MULT,BOTH 527.00 67808 PR EXCIS CHALAZION,GEN 970.00 67810 PR INCISIONAL BIOPSY EYELID SKIN 430.00 & LID MARGIN 67820 PR REVISE EYELASHES,FORCEPS 125.00 67825 PR REVISE EYELASHES 340.00 67840 PR REMOVE EYELID LESN (NOT 720.00 67850 PR DESTRUC EYELID LESN, <1 CM 543.00 67875 PR TEMP CLOSURE EYELID BY 440.00 67880 PR REVISION OF EYELID 990.00 67882 PR REVISION EYELID,XPOSITN 1490.00 TARSAL PLATE 67900 PR REPAIR BROW PTOSIS 1619 67901 PR FIX LID PTOSIS,FRONTALIS 1914.00 67902 PR FIX LID PTOSIS,FRONT 1829.00 67903 PR FIX LID PTOSIS,LEVATR 1580.00 67904 PR FIX LID PTOSIS,LEVATR 1900.00 67911 PR CORRECT LID RETRACTN 1520.00 67912 PR CORRECTION EYELID W/ 2190.00 67914 PR FIX ECTROPION,SUTURE 1167.00 67917 PR FIX ECTROPION,ENTENSV LID 1560.00 67921 PR FIX ENTROPION,SUTURE 1143.00 67923 PR FIX ENTROPION,EXCIS TARSAL 1479.00 67924 PR FIX ENTROPION,EXTENSV LID 1600.00 67930 PR SUTURE EYELID 940.00 67935 PR SUTURE EYELID WOUND,FULL 1540.00 67938 PR REMOVE EYELID FOREIGN 530.00 BODY,EMBEDDED 67950 PR CANTHOPLASTY 1434.00 67961 PR REVISION OF EYELID,< 1/4 LID 1500.00 67966 PR REVISION OF EYELID,> 1/4 LID 1980.00 67971 PR RECONSTRUC EYELID,<2/3,ONE 2548.00 67973 PR RECONSTRUC EYELID,TOT 2703.00 LOWER,1 STAGE 67974 PR RECONSTRUC EYELID,TOT 3271.00 UPPER,1 STAGE 67975 PR RECONSTRUC EYELID,SECOND 1780.00 68100 PR BIOPSY OF CONJUNCTIVA 440.00 68110 PR EXCIS CONJUNC LESN,=<1 CM 580.00 68115 PR EXCIS CONJUNC LESN,>1 CM 780.00 68135 PR DESTRUC CONJUNC LESN 420.00 68200 PR SUBCONJUNCTIVAL INJECTN 105.00 68320 PR REVISE CONJUNC,CONJUNC 1812.00 68326 PR REVISE CONJUNC,FIX CUL-DE- 1627.00 SAC+GRFT 68328 PR REVISE CONJUNC,FIX CUL-DE- 1830.00 SAC=BUCCAL 68335 PR REPAIR SYMBLEPHARON+FREE 1670.00 68340 PR DIVISION OF SYMBLEPHARON 1380.00 68362 PR CONJUNC FLAP,TOTAL 1700.00 68440 PR INCISE TEAR DUCT OPENING 280.00 68510 PR BIOPSY OF TEAR GLAND 1113.00 68700 PR REPAIR TEAR DUCTS 1600.00 68720 PR CREATE TEAR SAC-NASAL 2040.00 68750 PR CREATE CONJUNC-NASAL 2786.00 FISTULA+STENT 68760 PR CLOSE TEAR DUCT OPENING 525.00 68761 PR CLOSE TEAR DUCT OPENING BY 380.00 PLUG,EA 68801 PR DILATION NASOLACRIMAL DUCT 310.00 68810 PR PROBE NASOLACRIMAL DUCT 620.00 68811 PR PROBE NASOLAC DUCT W GEN 517 68815 PR PROBE NASOLAC DUCT,INSERT 1060.00 TUBE/STENT 68840 PR EXPLORE LACRIMAL CANALICULI 340.00 68850 PR INJECTION FOR TEAR SAC X-RAY 155.00 69000 PR DRAIN EXT EAR 417.00 69005 PR DRAIN EXT EAR 455.00 69020 PR DRAIN EXT AUD CANAL ABSCESS 584.00 69090 PR PIERCE EARLOBES 68.00 69100 PR BIOPSY OF EXTERNAL EAR 233.00 69105 PR BIOPSY OF EXT AUDITORY 299.00 69110 PR REMOVAL EXTERNAL 963.00 69120 PR REMOVAL EXTERNAL EAR,TOTAL 882.00 69140 PR REMV EXT CANAL EXOSTOSIS 1900.00 69145 PR REMV EXT CANAL SOFT TISSUE 699.00 69150 PR RAD EXCIS EXT CANAL LESN 3702.00 69155 PR RAD EXCIS EXT CANAL 4500.00 LESN+NECK DISSEC 69200 PR REMV EXT CANAL FOREIGN 273.00 69205 PR REMV EXT CANAL F.B.,GEN 359.00 69209 PR REMOVAL IMPACTED CERUMEN 33.00 IRRIGATION/LVG UNILAT 69210 PR REMOVAL IMPACTED CERUMEN 113.00 INSTRUMENTATION UNILAT 69220 PR DEBRIDE MASTOID 287.00 69222 PR DEBRIDE MASTOID 468.00 69300 PR OTOPLASTY PROTRUDING EAR 1216.00 W/WO SIZE RDCTJ 69310 PR RECONSTRUCTION,EXT 3338.00 AUDITORY CANAL 69320 PR REBUILD EXT AUD CANAL,CONG 6000.00 ANOMALY 69420 PR INCISION EARDRUM,ASPIR 400.00 69421 PR INCISION EARDRUM,ASPIR,GEN 420.00 69424 PR VENT TUBE REMVL REQ GEN 271.00 ANESTHESIA 69433 PR CREATE EARDRUM 507.00 OPENING,LOCAL ANESTH 69436 PR CREATE EARDRUM 519.00 OPENING,GEN ANESTH 69440 PR EXPLORATION OF MIDDLE EAR 2358.00 69501 PR MASTOIDECTOMY,SIMPLE 1920.00 69502 PR MASTOIDECTOMY,COMPLETE 3450.00 69505 PR MASTOIDECTOMY,MOD RADICAL 3161.00 69511 PR MASTOIDECTOMY,RADICAL 3161.00 69535 PR RESECT TEMPORAL 9487.00 BONE,EXTERN APPRCH 69540 PR REMV AURAL POLYP 1423.00 69550 PR REMV AURAL GLOMUS 3640.00 TUMOR,TRANSCANAL 69552 PR REMV AURAL GLOMUS 4468.00 TUMOR,TRANSMASTOID 69601 PR MASTOIDECT REVISN W 3698.00 COMPLETE REMVAL 69602 PR MASTOID REVISN ->MOD RAD 3861.00 MASTOIDECT 69603 PR MASTOID REVISN ->RAD 4408.00 MASTOIDECTOMY 69610 PR REPAIR TYMPANIC MEMBRANE 936.00 69620 PR MYRINGOPLASTY 1770.00 69631 PR TYMPANOPLASTY 5000.00 69632 PR TYMPANOPLASTY,REBUILD 3079.00 OSSICUL CHAIN 69633 PR TYMPANOPLASTY,REBLD OSSIC 6500.00 CHAIN+PROS 69635 PR TYMPANOPLAS/ANTROTOMY 3109.00 69636 PR TYMPANOPLAS/ANTROT,REBLD 4875.00 OSSIC CHAIN 69637 PR TYMPANOPLAS/ANTROT,REBLD 3152.00 OSSIC+PROST 69641 PR 3500.00 69642 PR 3858.00 TYMPANOPLAS/MASTOIDEC,REBLD 69643 PR 3858.00 TYMPANOPLAS/MASTOIDEC,INTACT 69644 PR TYMPANOPLAS/MASTOID,INTCT 3914.00 WALL,REBLD 69645 PR 3840.00 TYMPANOPLAS/MASTOIDEC,RADICA L/COMPLE 69646 PR 7575.00 TYMPANOPLAS/MASTOIDEC,RAD,RE 69650 PR STAPES MOBILIZATION 2063 69660 PR STAPEDECTOMY 2932.00 69661 PR STAPEDECTOMY,FOOTPLATE 3258.00 69662 PR REVISE 4056.00 STAPEDECTOMY/STAPEDOTOMY 69666 PR REPAIR OVAL WINDOW FISTULA 2688.00 69667 PR REPAIR ROUND WINDOW 2688.00 69670 PR MASTOID OBLITERATION 3320.00 69710 PR IMPLANT/REPLACE HEAR 2655.00 AID,TEMP BONE 69711 PR REMOVE/REPAIR HEAR AID,TEMP 3015.00 69714 PR IMPLNT,TEMPORAL 3308.00 69717 PR REPLCE IMPLNT,TEMPORAL 3527.00 BONE,W/EXTRN STIM 69718 PR REPLCE IMPLNT,TEMPORAL 4750.00 BONE,REMV MASTOID 69720 PR RELEASE FACIAL NERVE,LAT TO 4300.00 GANGLION 69740 PR REPAIR FACIAL NERVE,LAT TO 3407.00 GANGLION 69801 PR LABYRINTHOTOMY W 1602.00 PERFUSION VESTIBULOACTIVE 69805 PR ENDOLYMPH SAC OPERATN,NO 3263.00 69806 PR ENDOLYMPH SAC OP W SHUNT 3263.00 69905 PR EXCIS LABYRINTH,TRANSCANAL 3903.00 69930 PR IMPLANT COCHLEAR DEVICE 4468.00 69960 PR DECOMPRESS INTERN 7714.00 AUDITORY CANAL 69990 PR MICROSURG TECHNIQUES,REQ 1117.00 OPER MICROSCOPE 70015 PR CISTERNOGRAPHY,POS 26 206.00 70030 PR X-RAY EYE FOR FOREIGN BODY 26 30.00 70100 CHG X-RAY JAW <4 VW 84.00 70100 CHG X-RAY JAW <4 VW 26 31.00 70110 CHG X-RAY JAW 4+ VW 96.00 70110 CHG X-RAY JAW 4+ VW 26 43.00 70120 CHG X-RAY MASTOIDS <3 VW 26 31.00 70140 CHG X-RAY FACIAL BONES <3 VW 75.00 70140 CHG X-RAY FACIAL BONES <3 VW 26 34.00 70150 CHG X-RAY FACIAL BONES 3+ VW 104.00 70150 CHG X-RAY FACIAL BONES 3+ VW 26 45.00 70160 PR X-RAY NASAL BONES 82.00 70160 PR X-RAY NASAL BONES 26 30.00 70190 PR X-RAY OPTIC FORAMEN 26 36.00 70200 CHG X-RAY ORBITS 106.00 70200 CHG X-RAY ORBITS 26 48.00 70200 CHG X-RAY ORBITS TC 73.00 70210 CHG X-RAY SINUSES <3 VW 26 30.00 70220 CHG X-RAY SINUSES 3+ VW 94.00 70220 CHG X-RAY SINUSES 3+ VW 26 43.00 70250 CHG X-RAY SKULL <4 VW 91.00 70250 CHG X-RAY SKULL <4 VW 26 41.00 7025F PR PT INFO IN REMIND SYSTEM W/ 0.00 TARGET DATE FOR NEXT MAMMO 70260 CHG X-RAY SKULL 4+ VW 115.00 70260 CHG X-RAY SKULL 4+ VW 26 58.00 70300 PR X-RAY TEETH SINGLE 20.00 70300 PR X-RAY TEETH SINGLE 26 20.00 70310 PR X-RAY TEETH PARTIAL 25.00 70328 PR X-RAY TMJ UNILAT 78 70328 PR X-RAY TMJ UNILAT 26 24 70330 PR X-RAY TMJ BILAT 118 70330 PR X-RAY TMJ BILAT 26 32 70332 PR X-RAY TMJ ARTHROGRAM 26 184.00 70336 PR MRI, TMJ 26 257.00 70355 PR ORTHOPANTOGRAM 53.00 70355 PR ORTHOPANTOGRAM 26 35.00 70360 PR X-RAY NECK SOFT TISSUE 61.00 70360 PR X-RAY NECK SOFT TISSUE 26 30.00 70450 PR CT SCAN,HEAD/BRAIN,W/O 26 148.00 CONTRAST MATL 70460 PR CT SCAN HEAD CONTRAST 26 197.00 70470 PR CT SCAN HEAD COMBO 26 221.00 70480 PR CT SCAN,ORBIT/SELLA/POST 26 222.00 FOSSA/EAR,W/O 70481 PR CT SCAN SKULL CONTRAST 26 239.00 70482 PR CT SCAN SKULL COMBO 26 251.00 70486 PR CT SCAN,MAXILLOFACIAL 26 221.00 AREA,W/O CONTRAST 70487 PR CT SCAN, FACE/JAW CONTRAST 26 227.00 70488 PR CT SCANS FACE/JAW COMBO 26 246.00 70490 PR CT SCAN,SOFT TISSUE 26 222.00 NECK,W/O CONTRAST 70491 PR CT NECK TISSUE CONTRAST 26 239.00 70492 PR CT NECK TISSUE COMBO 26 251.00 70496 PR CT ANGIO,HEAD COMBO,INCL 26 314.00 IMAGE PROCESS 70498 PR CT ANGIO,NECK COMBO,INCL 26 314.00 IMAGE PROCESS 70540 PR MRI, FACE, NECK 26 233.00 70542 PR MRI, FACE, NECK W/CONTRAST 26 280.00 70543 PR MRI, FACE, NECK, COMBO 26 371.00 70544 PR MR ANGIO, HEAD 26 208.00 70545 PR MR ANGIO, HEAD W/CONTRAST 26 208.00 70546 PR MR ANGIO, HEAD, COMBO 26 312.00 70547 PR MR ANGIO, NECK 26 208.00 70548 PR MR ANGIO, NECK W/CONTRAST 26 208.00 70549 PR MR ANGIO, NECK, COMBO 26 312.00 70551 PR MRI BRAIN 26 257.00 70552 PR MRI BRAIN CONTRAST 26 311.00 70553 PR MRI BRAIN COMBO 26 409.00 70554 PR FUNCTIONAL MRI BRAIN BY TECH 26 239.00 70555 PR FUNCTIONAL MRI BRAIN BY 26 414.00 PHYS/PSYCH 70557 PR MRI BRAIN W/O DYE 26 433.00 70558 PR MRI BRAIN W/ DYE 26 400.00 70559 PR MRI BRAIN W/O & W/ DYE 26 404.00 71010 PR CHEST X-RAY 1 VW 57.00 71010 PR CHEST X-RAY 1 VW 26 31.00 71020 CHG CHEST X-RAY 2 VW 77.00 71020 CHG CHEST X-RAY 2 VW 26 39.00 71021 CHG CHEST X-RAY W APICAL LORD 26 46.00 71022 CHG CHEST X-RAY W OBLIQUES 26 54.00 71023 CHG CHEST X-RAY W FLUORO 26 67.00 71030 CHG CHEST X-RAY 4 VW 26 51.00 71035 PR CHEST X-RAY SPEC VIEWS 86.00 71035 PR CHEST X-RAY SPEC VIEWS 26 31.00 71045 CHG RADIOLOGIC EXAM CHEST 51.00 SINGLE VIEW 71045 CHG RADIOLOGIC EXAM CHEST 26 24.00 SINGLE VIEW 71045 CHG RADIOLOGIC EXAM CHEST TC 27.00 SINGLE VIEW 71046 CHG RADIOLOGIC EXAM CHEST 2 78.00 71046 CHG RADIOLOGIC EXAM CHEST 2 26 28.00 71047 CHG RADIOLOGIC EXAM CHEST 3 99.00 71047 CHG RADIOLOGIC EXAM CHEST 3 26 36.00 71048 CHG RADIOLOGIC EXAM CHEST 4+ 107.00 71048 CHG RADIOLOGIC EXAM CHEST 4+ 26 42.00 71100 CHG X-RAY RIBS 2 VW UNILAT 74.00 71100 CHG X-RAY RIBS 2 VW UNILAT 26 39.00 71100 CHG X-RAY RIBS 2 VW UNILAT TC 55.00 71101 CHG X-RAY RIBS, CHEST 3+ VW 89.00 71101 CHG X-RAY RIBS, CHEST 3+ VW 26 46.00 71101 CHG X-RAY RIBS, CHEST 3+ VW TC 65.00 71110 CHG X-RAY RIBS 3 VW BILAT 26 46.00 71110 CHG X-RAY RIBS 3 VW BILAT TC 67.00 71111 CHG X-RAY RIBS, CHEST 4+ VW 128.00 71111 CHG X-RAY RIBS, CHEST 4+ VW 26 55.00 71111 CHG X-RAY RIBS, CHEST 4+ VW TC 91.00 71120 CHG X-RAY STERNUM 2+ VW 76.00 71120 CHG X-RAY STERNUM 2+ VW 26 35.00 71120 CHG X-RAY STERNUM 2+ VW TC 53.00 71130 CHG X-RAY STERNO-CLAVICLUAR JT 26 39.00 71130 CHG X-RAY STERNO-CLAVICLUAR JT TC 64.00 71250 PR CT SCAN,THORAX,W/O 26 202.00 71260 PR CAT SCAN OF CHEST CONTRAST 26 214.00 71270 PR CAT SCAN OF CHEST COMBO 26 239.00 71275 PR CT ANGIO, CHEST (NON-CORON), 26 343.00 COMBO, INCL IMG PROC 71550 PR MRI, CHEST 26 251.00 71551 PR MRI, CHEST, W/CONTRAST 26 298.00 71552 PR MRI, CHEST, COMBO 26 381.00 71555 PR MR ANGIO CHEST (MRA) 26 315.00 72020 PR X-RAY SPINE ONE VIEW 67.00 72020 PR X-RAY SPINE ONE VIEW 26 26.00 72020 PR X-RAY SPINE ONE VIEW TC 38.00 72040 CHG RADEX SPINE CERVICAL 2 OR 3 92.00 72040 CHG RADEX SPINE CERVICAL 2 OR 3 26 39.00 72040 CHG RADEX SPINE CERVICAL 2 OR 3 TC 59.00 72050 CHG RADEX SPINE CERVICAL 4 OR 5 120.00 72050 CHG RADEX SPINE CERVICAL 4 OR 5 26 54.00 72050 CHG RADEX SPINE CERVICAL 4 OR 5 TC 80.00 72052 CHG RADEX SPINE CERVICAL 6 OR 150.00 MORE VIEWS 72052 CHG RADEX SPINE CERVICAL 6 OR 26 64.00 MORE VIEWS 72052 CHG RADEX SPINE CERVICAL 6 OR TC 107.00 MORE VIEWS 72070 CHG X-RAY THORACIC SPINE 2 VW 79.00 72070 CHG X-RAY THORACIC SPINE 2 VW 26 39.00 72070 CHG X-RAY THORACIC SPINE 2 VW TC 57.00 72072 CHG X-RAY THORACIC SPINE+SWIM 87.00 72072 CHG X-RAY THORACIC SPINE+SWIM 26 39.00 72072 CHG X-RAY THORACIC SPINE+SWIM TC 65.00 72074 CHG X-RAY THORACIC SPINE 4 VW 107.00 72074 CHG X-RAY THORACIC SPINE 4 VW 26 39.00 72074 CHG X-RAY THORACIC SPINE 4 VW TC 82.00 72080 CHG RADEX SPINE 88.00 THORACOLUMBAR JUNCTION MIN 2 72080 CHG RADEX SPINE 26 39.00 THORACOLUMBAR JUNCTION MIN 2 72080 CHG RADEX SPINE TC 60.00 THORACOLUMBAR JUNCTION MIN 2 72081 CHG RADEX ENTIR THRC LMBR CRV 98.00 SAC SPI W/SKULL 1 VW 72081 CHG RADEX ENTIR THRC LMBR CRV 26 34.00 SAC SPI W/SKULL 1 VW 72081 CHG RADEX ENTIR THRC LMBR CRV TC 63.00 SAC SPI W/SKULL 1 VW 72082 CHG RADEX ENTIR THRC LMBR CRV 156.00 SAC SPI W/SKULL 2/3 VW 72082 CHG RADEX ENTIR THRC LMBR CRV 26 42.00 SAC SPI W/SKULL 2/3 VW 72082 CHG RADEX ENTIR THRC LMBR CRV TC 116.00 SAC SPI W/SKULL 2/3 VW 72083 CHG RADEX ENTIR THRC LMBR CRV 169.00 SAC SPI W/SKULL 4/5 VW 72083 CHG RADEX ENTIR THRC LMBR CRV 26 45.00 SAC SPI W/SKULL 4/5 VW 72083 CHG RADEX ENTIR THRC LMBR CRV TC 142.00 SAC SPI W/SKULL 4/5 VW 72084 CHG RADEX ENTIR THRC LMBR CRV 201.00 SAC SPI W/SKULL 6/> VW 72084 CHG RADEX ENTIR THRC LMBR CRV 26 52.00 SAC SPI W/SKULL 6/> VW 72084 CHG RADEX ENTIR THRC LMBR CRV TC 165.00 SAC SPI W/SKULL 6/> VW 72100 CHG X-RAY LUMBAR SPINE 2/3 VW 87.00 72100 CHG X-RAY LUMBAR SPINE 2/3 VW 26 39.00 72100 CHG X-RAY LUMBAR SPINE 2/3 VW TC 60.00 72110 CHG X-RAY LUMBAR SPINE 4 VW 120.00 72110 CHG X-RAY LUMBAR SPINE 4 VW 26 54.00 72110 CHG X-RAY LUMBAR SPINE 4 VW TC 83.00 72114 PR RADEX SPINE LUMBSCRL COMPL 26 64.00 W/BENDING VIEWS MIN 6 72114 PR RADEX SPINE LUMBSCRL COMPL TC 115.00 W/BENDING VIEWS MIN 6 72120 PR RADEX SPINE LUMBOSACRAL 102.00 ONLY BENDING 2/3 VIEWS 72120 PR RADEX SPINE LUMBOSACRAL 26 29.00 ONLY BENDING 2/3 VIEWS 72120 PR RADEX SPINE LUMBOSACRAL TC 74.00 ONLY BENDING 2/3 VIEWS 72125 PR CT SCAN,CERVICAL SPINE,W/O 26 202.00 CONTRAST 72126 PR CT SCAN CERV SPINE 26 211.00 72127 PR CT SCAN CERV SP COMBO 26 148.00 72128 PR CT SCAN,THORACIC SPINE,W/O 26 135.00 CONTRAST 72129 PR CT SCAN DORSAL SP CONTRAST 26 142.00 72130 PR CT SCAN DORSAL SP COMBO 26 148.00 72131 PR CT SCAN,LUMBAR SPINE,W/O 26 135.00 CONTRAST 72132 PR CT SCAN LUMBAR SP CONTRAST 26 142.00 72133 PR CT SCAN LUMBAR SP COMBO 26 148.00 72141 PR MRI, CERV SPINE 26 186.00 72142 PR MRI, CERV SPINE CONTRAST 26 225.00 72146 PR MRI, DORSAL SPINE 26 186.00 72147 PR MRI, DORSAL SPINE CONTRAST 26 224.00 72148 PR MRI, LUMBAR SPINE 26 173.00 72149 PR MRI, LUMBAR SPINE CONTRAST 26 208.00 72156 PR MRI, CERV SPINE COMBO 26 298.00 72157 PR MRI, DORSAL SPINE COMBO 26 298.00 72158 PR MRI, LUMBAR SPINE COMBO 26 274.00 72159 PR MR ANGIO SPINE (MRA) 26 215.00 72170 CHG X-RAY PELVIS 1/2 VW 68.00 72170 CHG X-RAY PELVIS 1/2 VW 26 21.00 72170 CHG X-RAY PELVIS 1/2 VW TC 58.00 72190 CHG X-RAY PELVIS 3+ VW 101.00 72190 CHG X-RAY PELVIS 3+ VW 26 25.00 72191 PR CT ANGIO, PELVIS, COMBO, INCL 26 211.00 IMAGE PROC 72192 PR CT SCAN,PELVIS,W/O CONTRAST 26 127.00 72193 PR CT SCAN OF PELVIS CONTRAST 26 135.00 72194 PR CT SCAN OF PELVIS COMBO 26 142.00 72195 PR MRI, PELVIS, W/O CONTRAST 26 170.00 72196 PR MRI, PELVIS W/CONTRAST 26 202.00 72197 PR MRI, PELVIS, COMBO 26 262.00 72198 PR MR ANGIO PELVIS(MRA) 26 209.00 72200 CHG X-RAY SACROILIAC JTS <3 VW 26 21.00 72202 CHG X-RAY SACROILIAC JTS 3+ VW 84.00 72202 CHG X-RAY SACROILIAC JTS 3+ VW 26 22.00 72220 CHG X-RAY SACRUM/COCCYX 2+ VW 70.00 72220 CHG X-RAY SACRUM/COCCYX 2+ VW 26 21.00 72220 CHG X-RAY SACRUM/COCCYX 2+ VW TC 50.00 72240 PR MYELOGRAPHY CERV SPINE 26 105.00 72275 PR 26 100.00 72285 PR X- 26 151.00 73000 PR X-RAY CLAVICLE 69.00 73000 PR X-RAY CLAVICLE 26 19.00 73000 PR X-RAY CLAVICLE TC 51.00 73010 PR X-RAY SCAPULA 78.00 73010 PR X-RAY SCAPULA 26 21.00 73010 PR X-RAY SCAPULA TC 55.00 73020 CHG X-RAY SHOULDER 1 VW 57.00 73020 CHG X-RAY SHOULDER 1 VW 26 18.00 73020 CHG X-RAY SHOULDER 1 VW TC 40.00 73030 CHG X-RAY SHOULDER 2+ VW 72.00 73030 CHG X-RAY SHOULDER 2+ VW 26 22.00 73030 CHG X-RAY SHOULDER 2+ VW TC 51.00 73040 PR ARTHROGRAM OF SHOULDER 26 64.00 73050 PR X-RAY AC JTS 98.00 73050 PR X-RAY AC JTS 26 24.00 73050 PR X-RAY AC JTS TC 70.00 73060 CHG X-RAY HUMERUS 68.00 73060 CHG X-RAY HUMERUS 26 21.00 73060 CHG X-RAY HUMERUS TC 52.00 73070 CHG X-RAY ELBOW 2 VW 68.00 73070 CHG X-RAY ELBOW 2 VW 26 18.00 73080 CHG X-RAY ELBOW 3+ VW 79.00 73080 CHG X-RAY ELBOW 3+ VW 26 21.00 73080 CHG X-RAY ELBOW 3+ VW TC 61.00 73085 PR ARTHROGRAM OF ELBOW 26 64.00 73090 CHG X-RAY FOREARM 2 VW 68.00 73090 CHG X-RAY FOREARM 2 VW 26 19.00 73090 CHG X-RAY FOREARM 2 VW TC 48.00 73092 CHG X-RAY ARM, INFANT 79.00 73092 CHG X-RAY ARM, INFANT 26 19.00 73092 CHG X-RAY ARM, INFANT TC 50.00 73100 CHG X-RAY WRIST 2 VW 75.00 73100 CHG X-RAY WRIST 2 VW 26 19.00 73110 CHG X-RAY WRIST 3+ VW 88.00 73110 CHG X-RAY WRIST 3+ VW 26 21.00 73115 PR ARTHROGRAM OF WRIST 26 64.00 73120 CHG X-RAY HAND 2 VW 65.00 73120 CHG X-RAY HAND 2 VW 26 19.00 73130 CHG X-RAY HAND 3+ VW 77.00 73130 CHG X-RAY HAND 3+ VW 26 21.00 73140 CHG X-RAY EXAM OF FINGER(S) 82.00 73140 CHG X-RAY EXAM OF FINGER(S) 26 16.00 73140 CHG X-RAY EXAM OF FINGER(S) TC 64.00 73200 PR CT SCAN,UPPER EXTREMITY,W/O 26 127.00 CONTRAST 73201 PR CT SCAN OF ARM CONTRAST 26 135.00 73202 PR CT SCAN OF ARM COMBO 26 142.00 73206 PR CT ANGIO,UPPER 26 211.00 73218 PR MRI, UPPER EXTREM 26 157.00 73219 PR MRI, UPPER EXTREM 26 189.00 73220 PR MRI UPPER EXTR, W/CONTRAST 26 250.00 73221 PR MRI, JOINT UPPER EXTREM 26 157.00 73222 PR MRI, JOINT UPPER EXTREM 26 189.00 W/CONTRAST 73223 PR MRI, JOINT UPPER EXTREM 26 250.00 73225 PR MR ANGIO UPPER EXTREM 26 207.00 73501 CHG RADEX HIP UNILATERAL WITH 76.00 PELVIS 1 VIEW 73501 CHG RADEX HIP UNILATERAL WITH 26 25.00 PELVIS 1 VIEW 73501 CHG RADEX HIP UNILATERAL WITH TC 52.00 PELVIS 1 VIEW 73502 CHG RADEX HIP UNILATERAL WITH 104.00 PELVIS 2-3 VIEWS 73502 CHG RADEX HIP UNILATERAL WITH 26 29.00 PELVIS 2-3 VIEWS 73502 CHG RADEX HIP UNILATERAL WITH TC 76.00 PELVIS 2-3 VIEWS 73503 CHG RADEX HIP UNILATERAL WITH 130.00 PELVIS MINIMUM 4 VIEWS 73503 CHG RADEX HIP UNILATERAL WITH 26 37.00 PELVIS MINIMUM 4 VIEWS 73521 CHG RADEX HIPS BILATERAL WITH 101.00 PELVIS 2 VIEWS 73521 CHG RADEX HIPS BILATERAL WITH 26 30.00 PELVIS 2 VIEWS 73521 CHG RADEX HIPS BILATERAL WITH TC 70.00 PELVIS 2 VIEWS 73522 CHG RADEX HIPS BILATERAL WITH 123.00 PELVIS 3-4 VIEWS 73522 CHG RADEX HIPS BILATERAL WITH 26 39.00 PELVIS 3-4 VIEWS 73522 CHG RADEX HIPS BILATERAL WITH TC 85.00 PELVIS 3-4 VIEWS 73523 CHG RADEX HIPS BILATERAL WITH 143.00 PELVIS MINIMUM 5 VIEWS 73523 CHG RADEX HIPS BILATERAL WITH 26 42.00 PELVIS MINIMUM 5 VIEWS 73523 CHG RADEX HIPS BILATERAL WITH TC 102.00 PELVIS MINIMUM 5 VIEWS 73525 PR ARTHROGRAM OF HIP 26 65.00 73551 CHG RADIOLOGIC EXAMINATION 70.00 FEMUR 1 VIEW 73551 CHG RADIOLOGIC EXAMINATION 26 22.00 FEMUR 1 VIEW 73551 CHG RADIOLOGIC EXAMINATION TC 49.00 FEMUR 1 VIEW 73552 CHG RADIOLOGIC EXAMINATION 82.00 FEMUR MINIMUM 2 VIEWS 73552 CHG RADIOLOGIC EXAMINATION 26 25.00 FEMUR MINIMUM 2 VIEWS 73552 CHG RADIOLOGIC EXAMINATION TC 59.00 FEMUR MINIMUM 2 VIEWS 73560 CHG X-RAY KNEE 1 OR 2 VIEW 73.00 73560 CHG X-RAY KNEE 1 OR 2 VIEW 26 21.00 73560 CHG X-RAY KNEE 1 OR 2 VIEW TC 57.00 73562 CHG X-RAY KNEE 3 VIEW 88.00 73562 CHG X-RAY KNEE 3 VIEW 26 22.00 73562 CHG X-RAY KNEE 3 VIEW TC 67.00 73564 CHG X-RAY KNEE 4+ VIEW 106.00 73564 CHG X-RAY KNEE 4+ VIEW 26 26.00 73564 CHG X-RAY KNEE 4+ VIEW TC 77.00 73565 PR X-RAY KNEE BILAT STANDING 84.00 73565 PR X-RAY KNEE BILAT STANDING 26 21.00 73580 PR ARTHROGRAM OF KNEE JOINT 26 64.00 73590 CHG X-RAY TIB + FIB, 2VW 72.00 73590 CHG X-RAY TIB + FIB, 2VW 26 21.00 73590 CHG X-RAY TIB + FIB, 2VW TC 51.00 73592 CHG X-RAY LEG, INFANT 69.00 73592 CHG X-RAY LEG, INFANT 26 19.00 73592 CHG X-RAY LEG, INFANT TC 50.00 73600 CHG X-RAY ANKLE 2 VW 68.00 73600 CHG X-RAY ANKLE 2 VW 26 19.00 73600 CHG X-RAY ANKLE 2 VW TC 54.00 73610 CHG X-RAY ANKLE 3+ VW 81.00 73610 CHG X-RAY ANKLE 3+ VW 26 21.00 73610 CHG X-RAY ANKLE 3+ VW TC 61.00 73620 CHG X-RAY FOOT 2 VW 67.00 73620 CHG X-RAY FOOT 2 VW 26 19.00 73620 CHG X-RAY FOOT 2 VW TC 48.00 73630 CHG X-RAY FOOT 3+ VW 77.00 73630 CHG X-RAY FOOT 3+ VW 26 21.00 73630 CHG X-RAY FOOT 3+ VW TC 50.00 73650 CHG X-RAY HEEL 69.00 73650 CHG X-RAY HEEL 26 19.00 73660 CHG X-RAY TOE(S) 68.00 73660 CHG X-RAY TOE(S) 26 16.00 73660 CHG X-RAY TOE(S) TC 58.00 73700 PR CT SCAN,LOWER 26 127.00 EXTREMITY,W/O CONTRAST 73701 PR CT SCAN OF LEG CONTRAST 26 135.00 73702 PR CT SCAN OF LEG COMBO 26 142.00 73706 PR CT ANGIO,LOWER 26 222.00 EXTREM,COMBO,IMAGE PRC 73718 PR MRI, LOWER EXTREM 26 157.00 73719 PR MRI, LOWER EXTREM 26 188.00 73720 PR MRI, LOWER EXTR, W/O 26 249.00 CONTRAST F/U BY CONTRAST 73721 PR MRI LOWER EXTREM JT, W/O 26 157.00 73722 PR MRI, JOINT OF LEG W/CONTRAST 26 189.00 73723 PR MRI, JOINT OF LEG. COMBO 26 250.00 73725 PR MR ANGIO LOWER EXTREM 26 212.00 74000 PR X-RAY ABDOMEN 1 VW 60.00 74000 PR X-RAY ABDOMEN 1 VW 26 22.00 74010 PR X-RAY ABDOMEN 1+ VW 26 28.00 74018 CHG RADIOLOGIC EXAM ABDOMEN 1 70.00 74018 CHG RADIOLOGIC EXAM ABDOMEN 1 26 24.00 74018 CHG RADIOLOGIC EXAM ABDOMEN 1 TC 46.00 74019 CHG RADIOLOGIC EXAM ABDOMEN 2 85.00 74019 CHG RADIOLOGIC EXAM ABDOMEN 2 26 30.00 74019 CHG RADIOLOGIC EXAM ABDOMEN 2 TC 55.00 74020 PR X-RAY ABDOMEN 2 VW 90.00 74020 PR X-RAY ABDOMEN 2 VW 26 32.00 74021 CHG RADIOLOGIC EXAM ABDOMEN 99.00 3+ VIEWS 74021 CHG RADIOLOGIC EXAM ABDOMEN 26 36.00 3+ VIEWS 74021 CHG RADIOLOGIC EXAM ABDOMEN TC 63.00 3+ VIEWS 74022 PR X-RAY ABDOMEN,COMP ACUTE 117.00 74022 PR X-RAY ABDOMEN,COMP ACUTE 26 37.00 74022 PR X-RAY ABDOMEN,COMP ACUTE TC 81.00 74150 PR CT SCAN,ABDOMEN,W/O 26 138.00 74160 PR CT SCAN OF ABDOMEN 26 148.00 74170 PR CT SCAN OF ABDOMEN COMBO 26 163.00 74174 PR CT ANGIO ABD&PLVIS CNTRST 26 260.00 MTRL W/WO CNTRST IMGES 74175 PR CT ANGIO, ABD, COMBO,INCL 26 221.00 IMAGE PROC 74176 CHG CT SCAN,ABDOMENT AND 26 208.00 PELVIS,W/O CONTRAST 74177 PR CT SCAN,ABDOMEN AND 26 218.00 PELVIS,W CONTRAST 74178 CHG CT SCAN,ABDOMENT AND 26 241.00 PELVIS,COMBO 74181 PR MRI, ABDOMEN (MRI) 26 169.00 74182 PR MRI, ABDOMEN W/CONTRAST 26 202.00 74183 PR MRI, ABDOMEN, COMBO 26 262.00 74185 PR MR ANGIO ABDOMEN (MRA) 26 209.00 74190 PR X-RAY PERITONEUM 26 57.00 74210 PR CONTRAST XRAY THROAT/CERV 26 43.00 ESOPHA 74220 PR ESOPHAGRAM 26 54.00 74230 PR SWALLOWING FCN,W/CINE &/OR 26 62.00 74240 CHG RADEX GI TRACT UPPER W/WO 26 80.00 DELAYED IMAGES W/O KUB 74241 CHG RADEX GI TRACT UPPER W/WO 26 80.00 DELAYED IMAGES W/KUB 74245 CHG RADEX GI TRACT UPR W/SM 26 106.00 INT W/MULT SERIAL IMAGES 74246 CHG RADEX UPPER GI W/WO 26 80.00 GLUCAGON/DELAY IMGES W/O KUB 74247 CHG RADEX UPPER GI W/WO 26 80.00 GLUCAGON/DELAY IMAGES W/KUB 74249 CHG X-RAY,UPPER GI TRACT 26 106.00 W/CONT,SMALL INTEST 74250 CHG RADEX SMALL INTESTINE 26 55.00 W/MULTIPLE SERIAL IMAGES 74261 CHG CT COLONOGRAPHY INC 26 267.00 IMAGE PROCESS, DIAGNOSTIC, W/O 74262 CHG CT COLONOGRAPHY INC 26 293.00 IMAGE PROCESS, DIAGNOSTIC, W/ 74263 CHG CT COLONOGRAPHY INC 26 279.00 IMAGE PROCESS, SCREENING 74270 CHG X-RAY COLON CONTRAST 26 80.00 74280 PR X-RAY COLON AIR CONTRAST 26 115.00 74283 PR X-RAY B.E. REDUCTN INTUSS 26 235.00 74300 PR X-RAY OPER CHOLANGIOGRAM 26 43.00 74328 PR X-RAY FOR BILE DUCT 26 82.00 74329 PR X-RAY FOR PANCREAS 26 82.00 74330 PR X-RAY BILE/PANCREAS 26 105.00 74340 CHG INTRO LONG GI TUBE W/MULT 26 64.00 FLUORO & IMAGES RS&I 74360 PR X-RAY GUIDE, GI DILATION 26 66.00 74363 PR PERCUT TRANSHEPAT 26 102.00 DILAT,BILE DUCT STRICT 74400 PR X-RAY IV PYELOGRAM (IVP) 276.00 74400 PR X-RAY IV PYELOGRAM (IVP) 26 63.00 74420 PR X-RAY RETROGRADE 26 46.00 74425 PR X-RAY ANTEGRADE PYELOGRAM 26 43.00 74430 X-RAY CYSTOGRAM, MIN 3 VIEW 26 38.00 74445 PR X-RAY PENIS 26 137.00 74450 PR X-RAY URETHROCYSTOGRAM 26 43.00 74455 PR X-RAY 26 40.00 74485 PR X-RAY GUIDE, GU DILATION 26 64.00 74712 CHG FETAL MRI W/PLACNTL MATRNL 26 384.00 PLVC IMG SING/1ST GES 74740 PR X-RAY HYSTEROSALPINGOGRAM 26 45.00 75557 CHG CARDIAC MRI MORPHOLOGY & 26 254.00 FUNCTION W/O CONTRAST 75559 CHG CARDIAC MRI W/O CONTRAST 26 362.00 W STRESS IMAGING 75561 CHG CARDIAC MRI W/W/O 26 281.00 CONTRAST & FURTHER SEQ 75563 CHG CARDIAC MRI W/W/O 26 337.00 CONTRAST W STRESS 75565 CHG CARDIAC MRI FOR VELOCITY 26 31.00 FLOW MAPPING 75571 CHG CT HEART W/O CONTRAST 26 69.00 QUANT EVAL CORONARY CALCIUM 75572 CHG CT HEART CONTRAST EVAL 26 207.00 CARDIAC STRUCT/MORPH 75573 CHG CT HEART CONTRAST EVAL 26 296.00 CARDIAC STRUCT/MORPH, CONGEN 75574 PR CT ANGIO HRT CORNRY 26 282.00 ART/BYPASS GRFTS CONTRST 3D 75600 PR ANGIO AORTOGRAM THORACIC 26 65.00 75605 PR ANGIO AORTOGRAM THOR 26 196.00 75625 PR ANGIO AORTOGRAM ABD SERIAL 26 146.00 75630 PR ANGIO AORTOBIFEMORAL W 26 216.00 75635 PR CT ANGIO AORTOBIFEMORAL, 26 281.00 75658 PR ANGIO RETRO BRACHIAL ANGIO 26 159.00 75705 PR ANGIO SPINAL SELECTV 26 289.00 75710 PR ANGIO EXTREMITY UNILAT 26 147.00 75716 PR ANGIO EXTERMITY BILAT 26 167.00 75726 PR ANGIO VISCERAL 26 134.00 75731 PR ANGIO ADRENAL UNILAT SELECT 26 135.00 75736 PR ANGIO PELVIS 26 135.00 75741 PR ANGIO PULMON UNILAT SELECT 26 154.00 75743 PR ANGIO PULMON BILAT SELECT 26 193.00 75756 PR ANGIO INTERN MAMMARY 26 203.00 75774 PR ANGIO EA ADDNL SELECTV 26 43.00 75791 CHG ANGIO AV SHUNT COMPLETE 26 201.00 75801 PR LYMPHANGIO EXTREM UNILAT 26 97.00 75803 PR LYMPHANGIO EXTREM BILAT 26 154.00 75805 PR LYMPHANGIO ABD/PELV UNILAT 26 96.00 75807 PR LYMPHANGIO ABD/PELV BILAT 26 136.00 75809 PR NONVASCULAR SHUNTOGRAM 26 100.00 75810 PR VENOGRAM 26 146.00 75820 PR VENOGRAM EXTREM UNILAT 26 83.00 75822 PR VENOGRAM EXTREM BILAT 26 132.00 75825 PR VENOGRAM INFER VENA CAVA 26 134.00 75827 PR VENOGRAM SUPER VENA CAVA 26 133.00 75831 PR VENOGRAM RENAL UNILAT 26 133.00 75833 PR VENOGRAM RENAL BILAT 26 175.00 75840 PR VENOGRAM ADRENAL UNILAT 26 137.00 75860 PR VENOGRAM SINUS/JUGULAR 26 138.00 75870 PR VENOGRAM SUPER SAG SINUS 26 136.00 75885 PR PERCUT XHEPATIC 26 168.00 75887 PR PERCUT XHEPATIC PORTOGRAM 26 169.00 75889 PR VENOGRAM HEPATIC W 26 133.00 HEMODYNAMICS 75891 PR VENOGRAM HEPATIC 377.00 75891 PR VENOGRAM HEPATIC 26 142.00 75893 PR VENOUS SAMPLING BY 26 64.00 75894 PR TRANSCATHETER RX 26 172.00 75898 CHG ANGRPH CATH F-UP STD TCAT 26 218.00 OTHER THAN THROMBYLSIS 75901 PR REMOVE,OBST MATL,CVA DEV 26 58.00 VIA SEP VEN ACC 75902 PR REMOVE,OBST MATL,CVA 26 46.00 DEVICE VIA LUMEN 75952 PR ENDOVASC REPAIR AAA 26 560.00 75953 PR PLACEMNT,PROX/DIST EXT 26 162.00 PROS, INFRARENAL 75954 CHG REPAIR,ILIAC 26 260.00 ANRYSM/PSEUDO/AV MALF/TRAUMA 75956 PR ENDOVASC REPAIR THOR AORTA 855.00 INCL SUBCLAVIAN 75956 PR ENDOVASC REPAIR THOR AORTA 26 855.00 INCL SUBCLAVIAN 75957 PR ENDOVASC REPAIR THOR AORTA 26 733.00 EXCL SUBCLAVIAN 75958 PR PROXIMAL EXTENS DURNG 26 488.00 ENDOVASC REPR THOR AORTA 75959 PR DELAYED PROX EXTENS 26 450.00 ENDOVASC REPR THOR AORTA 75962 PR TRANSLUMINAL BALLOON 26 65.00 ANGIOP PERIPHERAL ART RSI 75966 PR BALLOON ANGIOPLASTY 26 159.00 75968 PR BALLOON ANGIO ADDNL 26 44.00 75970 PR VASCULAR BIOPSY 26 99.00 75978 PR BALLOON ANGIO VENOUS 26 64.00 75984 CHANGE PERCUT TUBE/DRAIN CATH 26 84.00 W CONTRAST MONIT 75989 PR RAD GUIDED,PERCUT 26 138.00 DRAINAGE,W/CATH PLACE 76000 CHG FLUOROSCOPY UP TO 1 HOUR 26 121.00 PHYSICIAN/QHP TIME 76001 CHG FLUOROSCOPY SPX >1 HOUR 26 80.00 PHYS/QHP TIME 76010 PR X-RAY NOSE-RECTUM CHILD F.B. 26 22.00 76080 PR X-RAY FISTULA,ABSCESS,SINUS 26 64.00 76098 PR X-RAY EXAM, BREAST SPECIMEN 26 19.00 76120 PR CINE/VIDEORADIOLOGY,EXC 26 47.00 WHERE SPEC INCL 76140 PR X-RAY CONSULTATION 115.00 76376 CHG 3D RENDERING W/INTERP & 162.00 POSTPROCESS SUPERVISION 76376 CHG 3D RENDERING W/INTERP & 26 25.00 POSTPROCESS SUPERVISION 76377 CHG 3D RENDERING 212.00 W/INTERP&POSTPROC DIFF WORK 76377 CHG 3D RENDERING 26 96.00 W/INTERP&POSTPROC DIFF WORK 76380 PR CT SCAN,LIMITED/LOCALIZED F/U 26 114.00 76390 PR MRI SPECTROSCOPY 26 162.00 76496 CHG UNLISTED FLUOROSCOPIC 26 205.00 PROCEDURE 76497 PR UNLISTED CT PROCEDURE 26 150.00 76498 PR UNLISTED MR PROCEDURE 26 308.00 76499 CHG UNLISTED DX RADIOGRAPHIC 26 100.00 PROCEDURE 76506 US, HEAD, REAL TIME 26 78.00 76511 US, EYE A-SCAN 26 135.00 76512 US, EYE B-SCAN 26 135.00 76513 US, EYE,ANTERIOR 26 91.00 76514 US, EYE, FOR CORNEAL THICKNESS 26 25.00 76516 US, EYE BIOMETRY 197.00 76516 US, EYE BIOMETRY 26 78.00 76519 US, EYE BIOMETRY W LENS CALC 212.00 76519 US, EYE BIOMETRY W LENS CALC 26 80.00 76536 US, HEAD/NECK TISSUES,REAL TIME 302.00 76536 US, HEAD/NECK TISSUES,REAL TIME 26 64.00 76604 US, CHEST,REAL TIME 26 63.00 76641 CHG US BREAST UNI REAL TIME 26 91.00 WITH IMAGE COMPLETE 76642 CHG US BREAST UNI REAL TIME 26 85.00 WITH IMAGE LIMITED 76700 US, ABDOM,B-SCAN &/OR REAL 26 95.00 TIME,COMPLETE 76705 US ABDOMEN LIMITED 270.00 76705 US ABDOMEN LIMITED 26 69.00 76706 CHG US ABDOMINAL AORTA REAL 239.00 TIME SCREEN STUDY AAA 76706 CHG US ABDOMINAL AORTA REAL 26 71.00 TIME SCREEN STUDY AAA 76770 PR US,RETROPERIT,REAL 321.00 76770 PR US,RETROPERIT,REAL 26 87.00 76775 US, RETROPERITNL ABD, LTD 259.00 76775 US, RETROPERITNL ABD, LTD 26 88.00 76776 PR US,TRANSPLANTED KIDNEY, 26 87.00 REAL TIME/ DOPPLER 76800 US, SPINAL CANAL & CONTENTS 26 151.00 76801 US, OB < 14 WKS, SINGLE FETUS 310.00 76801 US, OB < 14 WKS, SINGLE FETUS 26 123.00 76802 US, OB < 14 WKS, ADD'L FETUS 163.00 76802 US, OB < 14 WKS, ADD'L FETUS 26 95.00 76805 US, OB >/= 14 WKS, SNGL FETUS 358.00 76805 US, OB >/= 14 WKS, SNGL FETUS 26 130.00 76810 US, OB >/= 14 WKS, ADDL FETUS 26 145.00 76811 PR US,PREG UTER,FET & MAT,+ 464.00 DETL FET EXM 76811 PR US,PREG UTER,FET & MAT,+ 26 225.00 DETL FET EXM 76812 PR US,PREG UTER,FET & MAT,+ 26 210.00 DETL FET,ADDL 76813 PR US,PREG UTER,NUCHAL MEAS, 303.00 1ST TRIMEST, SINGLETON 76813 PR US,PREG UTER,NUCHAL MEAS, 26 135.00 1ST TRIMEST, SINGLETON 76814 PR US,PREG UTER,NUCHAL MEAS, 202.00 1ST TRI,ADDL GEST 76814 PR US,PREG UTER,NUCHAL MEAS, 26 115.00 1ST TRI,ADDL GEST 76815 CHG US,PREGNANT 219.00 UTERUS,LIMITED, 1/> FETUSES 76815 CHG US,PREGNANT 26 90.00 UTERUS,LIMITED, 1/> FETUSES 76816 PR US,PREGNANT 288.00 UTERUS,F/U,TRANSABD APP 76816 PR US,PREGNANT 26 103.00 UTERUS,F/U,TRANSABD APP 76817 PR US,PREGNANT 247.00 76817 PR US,PREGNANT 26 95.00 76818 PR FETAL BIOPHYSICAL PROFILE 305.00 76818 PR FETAL BIOPHYSICAL PROFILE 26 160.00 76819 PR FETAL BIOPHYS PROF,W/O NST 222.00 76819 PR FETAL BIOPHYS PROF,W/O NST 26 94.00 76820 CHG US DOPPLER FETAL UMBILICAL 118.00 ARTERY 76820 CHG US DOPPLER FETAL UMBILICAL 26 59.00 ARTERY 76821 CHG US DOPPLER FETAL MID 26 240.00 CEREBRAL ARTERY 76825 ECHOCARDIOGRAPHY 691.00 76825 ECHOCARDIOGRAPHY 26 210.00 76826 ECHOCARDIOGRAPHY 410.00 76826 ECHOCARDIOGRAPHY 26 107.00 76827 FETAL ECHOCARDIOGRAPHY 191.00 DOPPLER,COMP 76827 FETAL ECHOCARDIOGRAPHY 26 86.00 DOPPLER,COMP 76828 FETAL ECHO DOPPLER F/U 134.00 76828 FETAL ECHO DOPPLER F/U 26 75.00 76830 PR ECHOGRAPHY,TRANSVAGINAL 305.00 76830 PR ECHOGRAPHY,TRANSVAGINAL 26 80.00 76831 PR SONO EXAM, 26 160.00 76856 PR US,PELVIC 300.00 (NONOBSTETRIC),REAL 76856 PR US,PELVIC 26 81.00 (NONOBSTETRIC),REAL 76857 PR US,PELVIC 26 64.00 (NONOBSTETRIC),REAL 76870 PR ECHO,SCROTUM & CONTENTS 26 82.00 76872 PR ECHO,TRANSRECTAL 240.00 76872 PR ECHO,TRANSRECTAL 26 121.00 76873 PR ECHO,TRANSRECTAL,PROSTATE 195.00 76873 PR ECHO,TRANSRECTAL,PROSTATE 26 195.00 76881 CHG US COMPL JOINT R-T W/IMAGE 26 71.00 DOCUMENTATION 76882 CHG US LMTD JOINT/OTH NONVASC 91.00 XTR STRUX R-T W/IMG 76882 CHG US LMTD JOINT/OTH NONVASC 26 63.00 XTR STRUX R-T W/IMG 76885 CHG US INFT HIPS R-T IMG DYNAMIC 26 86.00 REQ PHYS/QHP MANJ 76886 CHG US INFT HIPS R-T IMG LMTD 26 72.00 STATIC PHYS/QHP MANJ 76930 PR SONO GUIDE PERICARD TAP 26 84.00 76932 PR SONO GUIDE HEART BIOPSY 26 93.00 76936 PR US GUID,COMP REPAIR,PSEUDO- 26 244.00 ANEUR/AV FIST 76937 PR US GUIDE, VASCULAR ACCESS 85.00 76937 PR US GUIDE, VASCULAR ACCESS 26 37.00 76940 PR US GUIDE, TISSUE ABLATION 26 265.00 76941 PR SONO GUIDE INTRAUTER XFUSN 26 163.00 76942 PR SONO GUIDE NEEDLE BIOPSY 487.00 76942 PR SONO GUIDE NEEDLE BIOPSY 26 100.00 76945 PR SONO GUIDE CHOR VILL 26 81.00 76946 PR SONO GUIDE AMNIOCENTESIS 26 60.00 76965 PR SONO GUIDE RADIOELEMT 26 169.00 76975 PR GI ENDOSCOPIC ULTRASOUND 559.00 76975 PR GI ENDOSCOPIC ULTRASOUND 26 108.00 76998 PR ULTRASONIC GUIDANCE, 26 152.00 INTRAOPERATIVE 76999 PR UNLISTED ULTRASOUND 26 3500.00 77001 PR FLUOROGUIDE CNTRL VEN 26 45.00 ACCESS,PLACE,REPLACE,REMOVE 77002 CHG FLUOROSCOPIC GUIDANCE 239.00 NEEDLE PLACEMENT ADD ON 77002 CHG FLUOROSCOPIC GUIDANCE 26 71 NEEDLE PLACEMENT ADD ON 77003 CHG FLUOR NEEDLE/CATH 145.00 SPINE/PARASPINAL DX/THER ADDON 77003 CHG FLUOR NEEDLE/CATH 26 67.00 SPINE/PARASPINAL DX/THER ADDON 77011 PR CT GUIDANCE STEREOTACTIC 26 155.00 LOCALIZATION 77012 PR CT GUIDANCE NEEDLE 26 135.00 77013 PR CT GUIDANCE TISSUE ABLATION 26 467.00 77014 PR CT GUIDANCE PLACEMENT RAD 26 152.00 THERAPY FIELDS 77021 PR MRI GUIDANCE NEEDLE 26 177.00 77022 PR MRI GUIDANCE TISSUE 26 547.00 77051 CHG COMPUTER-AIDED DETECTION 26 8.00 DX MAMMOGRAPHY 77052 CHG COMPUTER-AIDED DETECTION 26 8.00 SCREENING MAMMOGRAPHY 77053 PR MAMMARY DUCTOGRAM, SINGLE 26 43.00 77055 PR MAMMOGRAPHY; UNILATERAL 26 66.00 77056 PR MAMMOGRAPHY; BILATERAL 26 101.00 77057 CHG SCREENING MAMMOGRAPHY 26 81.00 BILATERAL 77058 PR MRI BREAST, W/WO CONTRAST, 26 189.00 77059 PR MRI BREAST, W/WO CONTRAST, 26 189.00 BILATERAL 77061 CHG DIGITAL BREAST 26 107.00 TOMOSYNTHESIS UNILATERAL 77062 CHG DIGITAL BREAST 423.00 TOMOSYNTHESIS BILATERAL 77062 CHG DIGITAL BREAST 26 123.00 TOMOSYNTHESIS BILATERAL 77063 CHG SCREENING DIGITAL BREAST 26 76.00 TOMOSYNTHESIS BI 77065 CHG DIAGNOSTIC MAMMOGRAPHY 26 100.00 COMPUTER-AIDED DETCJ UNI 77066 CHG DIAGNOSTIC MAMMOGRAPHY 26 109.00 COMPUTER-AIDED DETCJ BI 77067 CHG SCREENING MAMMOGRAPHY BI 26 108.00 2-VIEW BREAST INC CAD 77072 PR X-RAYS FOR BONE AGE 58.00 77072 PR X-RAYS FOR BONE AGE 26 22.00 77073 PR X-RAYS, BONE LENGTH STUDIES 26 32.00 77074 PR X-RAYS, BONE SURVEY, LIMITED 26 53.00 77075 PR X-RAYS, BONE SURVEY 26 64.00 77076 PR X-RAYS, BONE SURVEY, INFANT 26 81.00 77077 PR JOINT SURVEY, SINGLE VIEW 97.00 77077 PR JOINT SURVEY, SINGLE VIEW 26 41.00 77078 PR CT BONE DENS STUDY, 1+ 26 29.00 77080 PR DEXA,BONE DENSITY,AXIAL 309.00 77080 PR DEXA,BONE DENSITY,AXIAL 26 26.00 77081 PR DEXA,BONE 77.00 DENSITY,APPENDICULR SKELTN 77081 PR DEXA,BONE 26 27.00 DENSITY,APPENDICULR SKELTN 77261 CHG RADIATION THERAPY PLAN 290.00 77262 CHG RADIATION THERAPY PLAN 286.00 77263 CHG RADIATION THERAPY PLAN 648.00 77280 CHG SET RADN THERAPY FIELD 26 190.00 77290 CHG SET RADN THERAPY FIELD 26 315.00 77293 CHG RESPIRATORY MOTION 26 257.00 MANAGEMENT SIMULATION 77295 CHG 3-D RADIOTHERAPY PLAN 26 919.00 DOSE-VOLUME HISTOGRAMS 77300 CHG RADIATION 26 128.00 THERAPY,DOSIMETRY PLAN 77301 CHG INTEN MOD RADIOTHER PLAN 26 1613.00 W/DOSE VOL HIST 77306 CHG TELETHX ISODOSE PLN SMPL 26 177.00 W/DOSIMETRY CALCULATION 77307 CHG TELETHX ISODOSE PLN CPLX 26 366.00 W/BASIC DOSIMETRY 77316 CHG BRACHYTX ISODOSE PLN SMPL 26 177.00 W/DOSIMETRY CAL 77317 CHG BRACHYTX ISODOSE PLN 26 233.00 INTERMED W/DOSIMETRY CAL 77318 CHG BRACHYTX ISODOSE PLN CPLX 26 367.00 W/DOSIMETRY CAL 77321 CHG TELETHER ISO-PORT PLAN 26 191.00 77331 CHG SPECIAL RADIATION 26 175.00 77332 CHG RADN TREATMENT AID(S) 26 109.00 77333 CHG RADN TREATMENT AID(S) 26 169.00 77334 CHG RADN TREATMENT AID(S) 26 250.00 77338 CHG MLC IMRT DESIGN & 26 870.00 CONSTRUCTION PER IMRT PLAN 77387 CHG GUIDANCE FOR LOC OF 187.00 TARGET VOL RADIAJ TX DLVR 77387 CHG GUIDANCE FOR LOC OF 26 60.00 TARGET VOL RADIAJ TX DLVR 77401 CHG RADIATION TX DELIVERY 51.00 SUPERFICIAL&/ORTHO VOLTA 77427 CHG RADIATION,MANGEMENT,5 TX'S 668.00 77431 CHG RADIATION THERAPY 379.00 77432 CHG STEREOTACTIC RADIATION TX 2640.00 MANAGEMENT CRANIAL LESION 77435 CHG RADN RX DELIV,BODY, 2277.00 MANAGEMENT, PER COURSE 77470 PR SPECIAL TREATMENT 26 422.00 77767 CHG HDR RDNCL SKN SURF 26 138 BRACHYTX LES 2CM&2CHAN/MLT LES 77770 CHG HDR RDNCL NTRSTL/INTRCAV 26 255.00 BRACHYTX 1 CHANNEL 77771 CHG HDR RDNCL NTRSTL/INTRCAV 26 497.00 BRACHYTX 2-12 CHANNEL 77772 CHG HDR RDNCL NTRSTL/INTRCAV 26 705.00 BRACHYTX >12 CHANNELS 77778 CHG INTERSTITIAL RADIATION 26 2253.00 SOURCE APPLIC COMPLEX 77789 CHG SURFACE APPLIC LOW DOSE 26 228.00 RATE RADIONUCLIDE SOURCE 77799 PR RADIUM/RADIOISOTOPE 26 800.00 THERAPY UNLIST 78012 CHG THYROID UPTAKE 26 23.00 SINGLE/MULTIPLE QUANT 78013 CHG THYROID IMAGING WITH 26 44.00 VASCULAR FLOW 78014 CHG THYROID UPTAKE W/BLOOD 26 59.00 FLOW SNGLE/MULT QUAN MEAS 78015 PR THYROID MET IMAGING LTD 26 79.00 78018 PR THYROID MET IMAGING BODY 26 101.00 78020 PR THYROID MET UPTAKE 26 78.00 78070 CHG PARATHYROID PLANAR 26 97.00 78071 CHG PARATHYROID PLANAR 26 139.00 IMAGING W/WO SUBTRACTION 78072 CHG PARATHYROID IMAGING 26 193.00 W/TOMOGRAPHIC SPECT & CT 78102 PR BONE MARROW IMAGING, LTD 26 64.00 78103 PR BONE MARROW IMAGING, MULT 26 92.00 78195 PR LYMPHATICS & LYMPH GLANDS 26 141.00 78201 PR LIVER IMAGING 26 54.00 78202 PR LIVER IMAGING WITH FLOW 26 59.00 78205 PR LIVER IMAGING (SPECT) 26 83.00 78206 PR LIVER IMAGE (3-D) W/FLOW 26 113.00 78215 PR LIVER AND SPLEEN IMAGING 26 58.00 78226 PR HEPATOBILIARY SYST IMAGING 26 87.00 INCLUDING GALLBLADDER 78227 PR HEPATOBIL SYST IMAG INC GB 26 105.00 W/PHARMA INTERVENJ 78264 CHG GASTRIC EMPTYING IMAGING 26 91.00 78278 PR ACUTE GI BLOOD LOSS IMAGING 26 116.00 78290 PR BOWEL IMAGING 26 80.00 78300 PR BONE IMAGING, LIMITED AREA 26 73.00 78305 PR BONE IMAGING, MULTIPLE 26 104.00 78306 PR BONE IMAGING, WHOLE BODY 26 101.00 78315 CHG BONE IMAGING, 3 PHASE 26 119.00 78320 PR BONE IMAGING (SPECT) 26 122.00 78350 CHG BONE MINERAL, SINGLE 83.00 78350 CHG BONE MINERAL, SINGLE 26 28.00 78451 MYOCARDIAL SPECT,SINGLE,REST 26 162.00 OR STRESS,EF,WALL MOTION 78452 MYOCARDIAL SPECT MULTIPLE 26 192.00 STUDIES,REST,STRESS,BLOOD POOL IMAGING GTD 78459 PR HEART MUSCLE IMAGING (PET) 26 194.00 78469 PR HEART INFARCT IMAGE SPECT 26 115.00 78472 CARDIAC BLOOD POOL IMAGING, 26 117.00 PLANAR,SINGLE 78491 PR HEART IMAGE (PET) SINGLE 26 184.00 78492 PR HEART IMAGE (PET) MULTIPLE 26 229.00 78579 PR PULMONARY VENTILATION 26 61.00 78580 PR PULMONARY PERFUSION 26 87.00 IMAGING PARTICULATE 78582 PR PULMONARY VENTILATION & 26 124.00 PERFUSION IMAGING 78597 PR QUANT DIFFERENTIAL PULM 26 86.00 PERFUSION W/WO IMAGING 78598 PR QUANT DIFF PULM PRFUSION & 26 97.00 VENTLAJ W/WO IMAGING 78606 BRAIN IMAGING MIN 4 STATIC VIEWS 26 75.00 W VASCULAR FLOW 78607 BRAIN IMAGING TOMOGRAPHIC 26 145.00 78608 PR BRAIN IMAGING PET METABOLIC 26 175.00 78609 PR BRAIN IMAGING PET PERFUSION 26 252.00 78645 PR CSF SHUNT EVALUATION 26 66.00 78707 PR RENAL IMAGING, MORPH W/ 26 112.00 78708 PR RENAL IMAGING, MORPH W/ 26 141.00 FLOW/FUNC, PHARM, SINGLE 78709 PR RENAL IMAGING, MORPH W/ 26 164.00 FLOW/FUNC, PHARM, MULTI 78740 PR URETERAL REFLUX STUDY 566.00 78740 PR URETERAL REFLUX STUDY 26 70.00 78800 PR TUMOR IMAGING, LIMITED AREA 26 77.00 78801 PR TUMOR IMAGING, MULT AREAS 26 94.00 78802 PR TUMOR IMAGING, WHOLE BODY 26 101.00 78803 PR TUMOR IMAGING SPECT 26 128.00 78804 CHG TUMOR IMAGING, WHOLE 26 125.00 BODY, 2 OR MORE DAYS 78805 PR ABSCESS IMAGING, LTD AREA 26 86.00 78806 PR ABSCESS IMAGING, WHOLE 26 101.00 78807 PR NUCLEAR 26 129.00 78814 PET IMAGING CT FOR ATTENUATION 26 259.00 LIMITED AREA 78815 PET IMAGING CT ATTENUATION 26 286.00 SKULL BASE MID-THIGH 78816 PET IMAGING FOR CT ATTENUATION 26 294.00 WHOLE BODY 79005 CHG NUC THERAPY INTRACAVITARY 26 210.00 RADIOCOLLOID 79101 CHG NUC THERAPY INTRA- 26 231.00 79403 PR NUCLEAR THERAPY, 26 272.00 80048 CHG BASIC METABOLIC PANEL 29.00 CALCIUM TOTAL 80053 CHG METABOLIC 36.00 80061 CHG LIPID PANEL 44.00 80360 CHG DRUG SCREENING 60 80500 CHG LAB PATHOLOGY CONSULT- 100.00 80500 CHG LAB PATHOLOGY CONSULT- 26 100.00 81000 CHG URINALYSIS, NONAUTO, 19.00 81001 CHG URINALYSIS, AUTO, W/SCOPE 11.00 81002 CHG URINALYSIS NONAUTO W/O 14.00 81003 CHG URINALYSIS, AUTO, W/O SCOPE 8.00 81025 CHG URINE PREGNANCY TEST 21.00 81120 CHG IDH1 COMMON VARIANTS 100 81121 CHG IDH2 COMMON VARIANTS 100 81206 PR BCR/ABL1 MAJOR BREAKPNT 100.00 QUALITATIVE/QUANTITATIVE 81210 CHG BRAF GENE ANALYSIS V600 100.00 VARIANT(S) 81215 PR BRCA1 GENE ANALYSIS KNOWN 939.00 FAMILIAL VARIANT 81229 PR CYTOGENOM CONST 100.00 MICROARRAY COPY NUMBER&SNP 81235 CHG EGFR GENE ANALYSIS 348.00 COMMON VARIANTS 81235 CHG EGFR GENE ANALYSIS 26 100.00 COMMON VARIANTS 81240 PR F2 GENE ANALYSIS 20210G >A 100.00 81241 PR F5 COAGULATION FACTOR V 100.00 ANAL LEIDEN VARIANT 81243 PR FMR1 ANALYSIS EVAL TO 100.00 DETECT ABNORMAL ALLELES 81244 PR FMR1 GENE ANALYSIS 100.00 CHARACTERIZATION OF ALLELES 81256 PR HFE HEMOCHROMATOSIS GENE 100.00 ANAL COMMON VARIANTS 81261 PR IGH@ REARRANGE ABNORMAL 100.00 CLONAL POP AMPLIFIED 81265 PR COMPARATIVE ANAL STR 100.00 MARKERS PATIENT&COMP SPEC 81267 PR CHIMERISM W/COMP TO 100.00 BASELINE W/O CELL SELECTION 81270 PR JAK2 GENE ANALYSIS 100.00 P.VAL617PHE VARIANT 81275 CHG KRAS GENE ANALYSIS 100.00 VARIANTS IN EXON 2 81287 CHG MGMT METHYLATION ANALYSIS 100.00 81288 CHG MLH1 GENE ANALYSIS 26 100.00 PROMOTER METHYLATION 81301 PR MICROSATELLITE INSTAB ANAL 100.00 MISMATCH REPAIR DEF 81340 PR TRB@ REARRANGEMENT ANAL 100.00 AMPLIFICATION METHOD 81342 PR TRG@ GENE REARRANGEMENT 100.00 ANALYSIS 81403 CHG MOLECULAR PATHOLOGY 100.00 PROCEDURE LEVEL 4 81404 CHG MOLECULAR PATHOLOGY 26 115.00 PROCEDURE LEVEL 5 81406 CHG MOLECULAR PATHOLOGY 100 PROCEDURE LEVEL 7 81445 CHG GEN SEQ ANALYS SOLID 1495.00 ORGAN NEOPLASM 5-50 GENE 81445 CHG GEN SEQ ANALYS SOLID 26 200.00 ORGAN NEOPLASM 5-50 GENE 81455 CHG GEN SEQ ANALYS SOL 1645 ORG/HEMTOLMPHOID NEO 51/> GEN 81455 CHG GEN SEQ ANALYS SOL 26 200.00 ORG/HEMTOLMPHOID NEO 51/> GEN 81479 CHG UNLISTED MOLELCULAR 100.00 PATHOLOGY PROCEDURE 82270 BLOOD OCCULT,BY 11.00 PEROXID,FECES,SINGLE, COLORECTAL SCREEN 82272 BLOOD OCCULT,BY PEROXID, 11.00 FECES, 1-3 SIMULT, NON CA 82656 PR PANCREATIC ELASTASE, FECAL, 40.00 QUAL/SEMI-QUANT 82710 CHG FATS/LIPIDS, FECES, 48.00 82962 CHG GLUCOSE BLOOD TEST 9.00 83020 CHG HEMOGLOBIN 26 60.00 83036 PR GLYCOSYLATED HEMOGLOBIN 32.00 83655 ASSAY OF LEAD 40.00 83986 CHG PH BODY FLUID NOS 10.00 83993 CHG ASSAY FOR CALPROTECTIN 67.00 84145 CHG ASSAY OF PROCALCITONIN 92.00 84165 CHG PROTEIN E-PHORESIS, SERUM 26 47.00 84166 PR PROTEIN E- 61.00 84403 ASSAY OF TOTAL TESTOSTERONE 85.00 85013 CHG MICROHEMATOCRIT,SPUN 8.00 85014 CHG HEMATOCRIT 8.00 85018 CHG HEMOGLOBIN 8.00 85025 CHG COMPLETE CBC & AUTO DIFF 26.00 85060 PR BLOOD SMEAR INTERPRETATION 62.00 85097 PR BONE MARROW, SMEAR 231 INTERPRETATION 85097 PR BONE MARROW, SMEAR 26 214.00 INTERPRETATION 85390 CHG FIBRINOLYSINS SCREEN 26 60.00 85576 CHG BLOOD PLATELET 26 62.00 85610 CHG PROTHROMBIN TIME 13.00 86077 CHG PHYS BLD BANK SERV,DIFF 143 86078 CHG PHYS BLD BANK SERV,XFUSN 143 86308 CHG HETEROPHILE 17.00 86325 CHG IMMUNOELECTROPHOR,OTHER 74.00 FLUIDS W/CONC 86325 CHG IMMUNOELECTROPHOR,OTHER 26 64.00 FLUIDS W/CONC 86580 CHG TB INTRADERMAL TEST 19.00 86788 PR WEST NILE VIRUS AB, IGM 56.00 87210 CHG SMEAR,STAIN,WET 14.00 87220 CHG TISSUE EXAM BY KOH 10.00 87662 CHG IADNA DNA/RNA ZIKA VIRUS 159.00 AMPLIFIED PROBE TQ 87804 CHG DETECT AGENT,IMMUN,DIR 39.00 OBS,INFLUENZA 87807 PR DETECT AGENT,IMMUN,DIR OBS, 41.00 87880 CHG STREP A ASSAY W/OPTIC 39.00 88020 CHG AUTOPSY COMPL,W/O CNS 1696.00 88025 CHG AUTOPSY COMPL,W BRAIN 2355.00 88028 CHG AUTOPSY COMPL,INFANT W 2355.00 88029 CHG AUTOPSY COMPL,NEWBORN W 1884.00 88037 CHG LTD AUTOPSY,SINGLE ORGAN 866 88099 CHG NECROPSY (AUTOPSY) 330.00 88104 CHG CYTOPATH 26 75.00 88108 CHG CYTOPATH 26 84.00 FLUIDS,CONCENTRATN,INTERP 88112 CHG CYTOPATH, CELL ENHANCE 26 161.00 88141 CHG CYTOPATH CERV/VAG 82.00 88142 CHG CYTOPATH CERV/VAG THIN 70.00 88143 CHG CYTOPATH CERV/VAG THIN 70.00 LAYER REDO 88160 CHG CYTOPATH,OTHR 26 79.00 SOURC,SCREEN,INTERP 88172 CHG EVALUATION OF FNA SMEAR 26 134.00 TO DETERMINE ADEQUACY, FIRST 88173 CHG INTERPRETATION OF FNA 26 250.00 88174 CHG CYTOPATH,CERV/VAG,AUTO 74.00 THIN LAYER,INTERP 88177 CHG EVALUATION OF FNA SMEAR 26 58.00 TO DETERMINE ADEQUACY, EA ADD 88187 PR FLOWCYTOMETRY/READ, 2-8 175.00 88188 PR FLOWCYTOMETRY/READ, 9-15 220.00 88189 PR FLOWCYTOMETRY/READ, 16 & > 278.00 MARKERS 88237 CHG TISSUE CULTURE, BONE 434.00 88261 CHG CHROMOSOME ANAL:5 CELLS,1 607.00 KARYOTYPE 88263 CHG CHROMOSOME ANAL:45 493.00 CELLS,MOSAICISM 88271 CHG CYTOGENETICS, DNA PROBE 74.00 88291 CHG CYTO/MOLECULAR REPORT 84 88300 CHG SURG PATH,GROSS,LEVEL I 26 39.00 88302 CHG SURG PATH,LEVEL II 26 60.00 88304 CHG SURG PATH,LEVEL III 26 94.00 88305 CHG SURG PATH,LEVEL IV 26 178.00 88307 CHG SURG PATH,LEVEL V 325.00 88307 CHG SURG PATH,LEVEL V 26 314 88309 CHG SURG PATH,LEVEL VI 26 462.00 88311 CHG DECALCIFY TISSUE 26 34.00 88312 PR SPECIAL STAIN GROUP 1 60.00 MICROORGANISMS I&R 88312 PR SPECIAL STAIN GROUP 1 26 67.00 MICROORGANISMS I&R 88313 PR SPCL STN 2 I&R EXCPT 70.00 MICROORG/ENZYME/IMCYT&IMHIS 88313 PR SPCL STN 2 I&R EXCPT 26 65.00 MICROORG/ENZYME/IMCYT&IMHIS 88314 PR SPECIAL STAIN I&R 26 158.00 HISTOCHEMICAL W/FROZEN TISSUE 88319 PR SPECIAL STAIN I&R GROUP III 26 86.00 ENZYME CONSITUENTS 88321 CHG MICROSLIDE CONSULT 368 88323 CHG MICROSLIDE CONSULT W 368 88323 CHG MICROSLIDE CONSULT W 26 197.00 88325 CHG COMPREHENSIVE REVIEW OF 400 88329 CHG PATH CONSULT IN SURGERY GC 136 88331 PR PATH CONSULT IN SURG,W FRZ 26 204.00 88332 CHG PATH CONSULT IN SURG,W 26 135.00 ADDN FRZ SEC 88333 PR INTRAOPERATIVE CYTO PATH 26 164.00 CONSULT, INITIAL SITE 88334 CHG INTRAOPERATIVE CYTO PATH 26 101 CONSULT, ADD SITES 88334 CHG INTRAOPERATIVE CYTO PATH GC 101 CONSULT, ADD SITES 88341 CHG IMHISTOCHEM/CYTCHM EA 228.00 ADDL ANTIBODY SLIDE 88341 CHG IMHISTOCHEM/CYTCHM EA 26 74.00 ADDL ANTIBODY SLIDE 88342 CHG IMHISTOCHEM/CYTCHM INIT 268.00 ANTIBODY STAIN PROCEDURE 88342 CHG IMHISTOCHEM/CYTCHM INIT 26 93.00 ANTIBODY STAIN PROCEDURE 88346 CHG IMMUNOFLUORESCENCE PER 26 101.00 SPEC 1ST SINGL ANTB STAIN 88348 CHG ELECTRON 26 468.00 88350 CHG IMMUNOFLUORESCENCE PER 26 75 SPEC ADD SINGL ANTB STAIN 88360 CHG M/PHMTRC ALYS TUMOR 26 134.00 IMHCHEM EA ANTIBODY MANUAL 88363 CHG EXAM & SELECT ARCHIVE 55.00 TISSUE MOLECULAR ANALYSIS 88364 CHG IN SITU HYBRIDIZATION EA 26 91.00 ADDL PROBE STAIN 88365 CHG IN SITU HYBRIDIZATION 1ST 440.00 PROBE STAIN 88365 CHG IN SITU HYBRIDIZATION 1ST 26 144 PROBE STAIN 88366 CHG IN SITU HYBRIDIZATION EA 26 162.00 MULTIPLEX PROBE STAIN 88367 CHG M/PHMTRC ALYS ISH CPTR- 604.00 ASST TECH 1ST PROBE STAIN 88367 CHG M/PHMTRC ALYS ISH CPTR- 26 160.00 ASST TECH 1ST PROBE STAIN 88368 CHG M/PHMTRC ALYS IN SITU 149.00 HYBRIDIZATION EA PROBE MNL 88368 CHG M/PHMTRC ALYS IN SITU 26 160.00 HYBRIDIZATION EA PROBE MNL 88369 CHG M/PHMTRC ALYS ISH 26 84.00 QUANT/SEMIQ MNL PER SPEC EACH 88377 CHG M/PHMTRC ALYS ISH 166.00 QUANT/SEMIQ MNL EACH MULTIPRB 88377 CHG M/PHMTRC ALYS ISH 26 166 QUANT/SEMIQ MNL EACH MULTIPRB 88720 CHG BILIRUBIN TOTAL 18.00 89060 CHG EXAM,SYNOVIAL FLUID 26 47 90389 PR TETANUS IG, IM 776.00 90460 PR IM ADM THRU 18YR ANY RTE 21 1ST/ONLY COMPT VAC/TOX 90461 PR IM ADM THRU 18YR ANY RTE 21 ADDL VAC/TOX COMPT 90471 PR IMMUNIZ ADMIN,1 SINGLE/COMB 21 VAC/TOXOID 90472 PR IMMUNIZ,ADMIN,EACH ADDL 21 90473 PR IMMUNIZ 21 ADMIN,INTRANASAL/ORAL,1 90474 PR IMMUNIZ 21 ADMIN,INTRANASAL/ORAL,EACH 90620 PR MENB-4C RECOMBNT PROT & 675 OUTER MEMB VESIC VACC IM 90630 PR INFLUENZA VACC IIV4 SPLIT 49.00 VIRUS PRSRV FREE ID 90632 PR HEPA VACCINE ADULT DOSE 134 FOR INTRAMUSCULAR USE 90633 PR HEPA VACCINE 2 DOSE 63 SCHEDULE PED/ADOLESC IM USE 90636 PR HEPA/HEPB VACCINE ADULT IM 200 90647 PR HIB PRP-OMP VACCINE 3 DOSE 55.00 SCHEDULE IM USE 90648 PR HIB PRP-T VACCINE 4 DOSE 61 SCHEDULE IM USE 90649 PR 4VHPV VACCINE 3 DOSE 336 SCHEDULE FOR IM USE 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM 346 90655 PR IIV3 VACC PRESRV FREE 0.25 ML 51.00 DOSAGE IM USE 90656 PR IIV3 VACC PRESERVATIVE FREE 35.00 0.5 ML DOSAGE IM USE 90657 PR IIV3 VACCINE SPLIT VIRUS 0.25 11.00 ML DOSAGE IM USE 90658 PR IIV3 VACCINE SPLIT VIRUS 0.5 ML 41.00 DOSAGE IM USE 90660 PR LAIV3 VACCINE LIVE FOR 55.00 INTRANASAL USE 90662 PR IIV VACCINE PRESERV FREE 50 INCREASED AG COUNT IM 90670 PR PCV13 VACCINE FOR 334 INTRAMUSCULAR USE 90672 PR LAIV4 VACCINE FOR INTRANASAL 56.00 90673 PR RIV3 VACCINE PRESERVATIVE 79.00 FREE FOR IM USE 90675 PR RABIES VACCINE, IM 636 90680 PR RV5 VACCINE 3 DOSE SCHEDULE 182.00 LIVE FOR ORAL USE 90681 PR RV1 VACCINE 2 DOSE SCHEDULE 230.00 LIVE FOR ORAL USE 90682 PR RIV4 VACC RECOMBINANT DNA 50 PRSRV ANTIBIO FREE IM 90685 PR IIV4 VACC PRSRV FREE 0.25 ML 52.00 DOS FOR IM USE 90686 PR IIV4 VACC PRESRV FREE 0.5 ML 20 DOS FOR IM USE 90691 PR TYPHOID VACCINE, IM 186 90696 PR DTAP-IPV VACCINE CHILD 4-6 104 YRS FOR IM USE 90698 PR DTAP-IPV/HIB VACCINE FOR 178.00 INTRAMUSCULAR USE 90700 DTAP IMMUNIZATION, IM, <7 YO 60 90702 PR DT VACCINE YOUNGER THAN 7 80.00 YRS FOR IM USE 90707 PR MMR VIRUS IMMUNIZATION, 132 90710 PR COMBINED 378 VACCINE,MMR+VARICELLA,SUB-Q 90713 PR POLIOMYELITIS 63 IMMUNIZATN,INACTV,SUB-Q 90714 PR TD VACCINE PRSRV FREE 7 YRS 55 OR OLDER FOR IM USE 90715 PR TDAP VACCINE IM 91 90716 PR VAR VACCINE LIVE FOR 226 SUBCUTANEOUS USE 90717 PR YELLOW FEVER 295 IMMUNIZATN,LIVE,SUB-Q 90723 PR DTAP-HEPB-IPV VACCINE 153 INTRAMUSCULAR 90732 PR PPSV23 VACCINE 2 YRS OR 166 OLDER FOR SUBQ/IM USE 90733 PR MPSV4 VACCINE GROUPS ACYW- 129 135 SUBQ USE 90734 PR MCV4/MENACWY CONJ VACC 126 GRPS ACYW-135 IM USE 90736 PR ZOSTER VACCINE HZV LIVE FOR 414 SUBCUTANEOUS USE 90738 CHG JAPANESE ENCEPH VACC, 487.00 INACTIVATED, IM 90744 PR HEPB VACCINE PED/ADOLESC 3 47 DOSE SCHEDULE IM 90746 PR HEPB VACCINE ADULT 3 DOSE 114 SCHEDULE FOR IM USE 90750 PR HZV ZOSTER VACC 175.00 RECOMBINANT ADJUVANTED IM NJX 90785 PR PSYCHOTHERAPY COMPLEX 40.00 INTERACTIVE 90791 PR PSYCHIATRIC DIAGNOSTIC 399.00 90792 PR PSYCHIATRIC DIAGNOSTIC EVAL 361.00 W/MEDICAL SERVICES 90832 PR PSYCHOTHERAPY W/PATIENT 30 166.00 MINUTES 90833 PR PSYCHOTHERAPY W/PATIENT 166.00 W/E&M SRVCS 30 MIN 90834 PR PSYCHOTHERAPY W/PATIENT 45 214.00 MINUTES 90836 PR PSYCHOTHERAPY W/PATIENT 214.00 W/E&M SRVCS 45 MIN 90837 PR PSYCHOTHERAPY W/PATIENT 60 315.00 MINUTES 90838 PR PSYCHOTHERAPY W/PATIENT 315.00 W/E&M SRVCS 60 MIN 90839 PR PSYCHOTHERAPY FOR CRISIS 343.00 INITIAL 60 MINUTES 90840 PR PSYCHOTHERAPY FOR CRISIS 183.00 EACH ADDL 30 MINUTES 90846 PR FAMILY PSYCHOTHERAPY W/O 256.00 PATIENT PRESENT 50 MINS 90847 PR FAMILY PSYCHOTHERAPY 286.00 W/PATIENT PRESENT 50 MINS 90849 PR MULTIP FAMILY-GROUP 88.00 PSYCHOTHERAPY 90853 PR GROUP PSYCHOTHERAPY 85.00 90867 PR REPET TMS TX INITIAL 852.00 W/MAP/MOTR THRESHLD/DEL&MNG 90868 PR THERAP REPETITIVE TMS TX 463.00 SUBSEQ DELIVERY & MNGT 90869 PR REPET TMS TX SUBSEQ MOTR 1053.00 THRESHLD W/DELIV & MNGT 90870 PR ELECTROCONVULSIVE 410.00 90887 PR CONSULTATION WITH FAMILY 216.00 90899 PR PSYCHIATRIC SERVICE/THERAPY 400.00 90911 PR BIOFEEDBACK PERI/URO/RECTAL 230.00 90935 PR HEMODIALYSIS PROCEDURE W/ 225.00 PHYS/QHP EVALUATION 90937 PR HEMODIALYSIS, REPEATED 375.00 90945 PR DIALYSIS OTHER/THAN 210.00 HEMODIALYSIS 1 PHYS/QHP EVAL 90947 PR DIALYSIS OTH/THN HEMODIALY 350.00 REPEAT PHYS/QHP EVALS 90953 PR ESRD RELATED SVC MONTHLY 1216.00 <2 YR OLD 1 VISIT 90956 PR ESRD RELATED SVC MONTHLY 2- 798.00 11 YR OLD 1 VISIT 90957 PR ESRD RELATED SVC MONTHLY 2184.00 12-19 YR OLD 4/> VISITS 90958 PR ESRD RELATED SVC MONTHLY 1058.00 12-19 YR OLD 2/3 VISITS 90959 PR ESRD RELATED SVC MONTHLY 711.00 12-19 YR OLD 1 VISIT 90960 PR ESRD RELATED SVC MONTHLY 700.00 20&/> YR OLD 4/> VISITS 90961 PR ESRD RELATED SVC MONTHLY 575.00 20/>YR OLD 2/3 VISITS 90962 PR ESRD RELATED SVC MONTHLY 430.00 20&/>YR OLD 1 VISIT 90963 PR ESRD SERVICES, HOME 1904.00 DIALYSIS, PER MONTH, < 2 YR OLD 90964 PR ESRD SERVICES, HOME 1189.00 DIALYSIS, PER MONTH, 2-11 YR OLD 90965 PR ESRD SERVICES, HOME 1132.00 DIALYSIS, PER MONTH, 12-19 YR 90966 PR ESRD SERVICES, HOME 572.00 DIALYSIS, PER MONTH, 20+ YR OLD 90967 PR ESRD SERVICES, PER DAY, < 2 48.00 90968 PR ESRD SERVICES, PER DAY, 2-11 39.00 90969 PR ESRD SERVICES, PER DAY, 12-19 38.00 YR OLD 90970 PR ESRD SERVICES, PER DAY,20+ 20.00 90989 PR DIALYSIS TRAINING/COMPLETE 767.00 91010 PR ESOPHAGEAL MOTILITY STUDY 26 300.00 W/INTERP&RPT 91034 PR GERD TST W/ NASAL PH 26 128.00 91035 PR GERD TST W/ MUCOS PH 26 208.00 91038 PR GERD TST W/ MUCOS IMPEDE 26 145.00 ELECTROD,>1HR 91065 PR BREATH HYDROGEN/METHANE 26 60.00 91110 PR GI IMAG INTRALUMINAL 2350.00 ESOPHAGUS-ILEUM W/I&R 91110 PR GI IMAG INTRALUMINAL 26 540.00 ESOPHAGUS-ILEUM W/I&R 91112 PR GI TRANSIT & PRES MEAS 26 280.00 WIRELESS CAPSULE W/INTERP 91122 PR ANAL PRESSURE RECORD 26 300.00 91200 PR LIVER ELASTOGRAPHY W/O IMAG 26 38.00 92002 PR EYE EXAM, NEW 185.00 92004 PR EYE EXAM, NEW 325.00 92012 PR EYE EXAM ESTABLISHED PT 185.00 92012 PR EYE EXAM ESTABLISHED PT 26 185.00 92014 PR EYE EXAM, EST 265.00 92015 PR REFRACTION 30.00 92018 PR NEW EYE EXAM & TREATMENT 367.00 92019 PR EYE EXAM & TREATMENT 184.00 92020 PR SPECIAL EYE EVAL,GONIOSCOPY 68.00 92020 PR SPECIAL EYE EVAL,GONIOSCOPY 26 68.00 92025 PR CORNEAL TOPOGRAPHY 26 51.00 92060 PR SPECIAL EYE 26 98.00 92071 PR FIT CONTACT LENS TX OCULAR 95.00 SURFACE DISEASE 92072 PR FITTING CONTACT LENS FOR 341.00 MNGT OF KERATOCONUS 92081 PR VISUAL FIELD EXAM,LIMITED 26 42.00 92082 PR VISUAL FIELD EXAM,INTERMED 122.00 92082 PR VISUAL FIELD EXAM,INTERMED 26 57.00 92083 PR VISUAL FIELD EXAM,EXTENDED 26 71.00 92100 PR SERIAL TONOMETRY EXAM(S) 199.00 92132 PR COMPUTERIZED OPHTHALMIC 26 50.00 IMAGING ANTERIOR SEGMENT 92133 PR COMPUTERIZED OPHTHALMIC 26 71.00 IMAGING OPTIC NERVE 92134 PR COMPUTERIZED OPHTHALMIC 261.00 IMAGING RETINA 92134 PR COMPUTERIZED OPHTHALMIC 26 74.00 IMAGING RETINA 92136 PR OPHTHAL BIOMETRY,INTRAOC 225.00 LENS POW CALC 92136 PR OPHTHAL BIOMETRY,INTRAOC 26 79.00 LENS POW CALC 92225 PR SPECIAL EYE EXAM, INITIAL 70.00 92226 PR SPECIAL EYE EXAM, 70.00 92230 PR FLUORESCEIN ANGIOSCOPY 145.00 92235 PR FLUORESCEIN ANGRPH 26 116.00 W/MULTIFRAME I&R UNI/BI 92240 PR INDOCYANINE-GREEN ANGRPH 26 161.00 W/MULTIFRAME I&R UNI/BI 92242 PR FLUORESCEIN ICG ANGRPH 575.00 W/MULTIFRAME I&R UNI/BI 92242 PR FLUORESCEIN ICG ANGRPH 26 141.00 W/MULTIFRAME I&R UNI/BI 92250 PR FUNDAL PHOTOGRAPHY 26 61.00 92265 PR EYE MUSCLE EVALUATION 214.00 92265 PR EYE MUSCLE EVALUATION 26 118.00 92275 PR ELECTRORETINOGRAPHY 26 148.00 92283 PR COLOR VISION EXAMINATION 26 24.00 92285 PR EYE PHOTOGRAPHY 26 16.00 92286 PR ANT SGM IMAGING 26 56.00 W/MICROSCOPY ENDOTHELIAL 92310 PR CONTACT LENS FITTING,BILAT 75.00 92311 PR CONTACT LENS FIT,APHAKIA 252.00 92312 PR CONTACT LENS FIT,APHAKIA 290.00 92313 PR CONTACT LENS 243.00 FIT,CORNEOSCLERAL LENS 92502 PR EAR AND THROAT EXAMINATION 221.00 92504 PR EAR MICROSCOPY EXAMINATION 71.00 92511 PR NASOPHARYNGOSCOPY 361.00 92516 PR FACIAL NERVE FUNCTION TEST 175.00 92532 PR POSITIONAL NYSTAGMUS 61.00 92537 PR CALORIC VESTIBULAR TEST 388.00 W/REC BI BITHERMAL 92537 PR CALORIC VESTIBULAR TEST 26 128.00 W/REC BI BITHERMAL 92538 PR CALORIC VESTIBULAR TEST 194.00 W/REC BI MONOTHERMAL 92538 PR CALORIC VESTIBULAR TEST 26 64.00 W/REC BI MONOTHERMAL 92540 PR VESTIBULAR EVAL NYSTAG 320.00 FOVL&PERPH STIM OSCIL TRACKING 92540 PR VESTIBULAR EVAL NYSTAG 26 320.00 FOVL&PERPH STIM OSCIL TRACKING 92541 PR SPONTANEOUS NYSTAGMUS 134.00 92541 PR SPONTANEOUS NYSTAGMUS 26 48.00 92542 PR POSITIONAL NYSTAGMUS TEST 139.00 92542 PR POSITIONAL NYSTAGMUS TEST 26 64.00 92544 PR OPTOKINETIC NYSTAGMUS TEST 111.00 92544 PR OPTOKINETIC NYSTAGMUS TEST 26 38.00 92545 PR OSCILLATING TRACKING TEST 102.00 92545 PR OSCILLATING TRACKING TEST 26 30.00 92546 PR SINUSOIDAL ROTATIONAL TEST 197.00 92546 PR SINUSOIDAL ROTATIONAL TEST 26 119.00 92548 PR COMPUTERIZED DYNAMIC 250.00 POSTUROGRAPHY 92548 PR COMPUTERIZED DYNAMIC 26 66.00 POSTUROGRAPHY 92550 PR TYMPANOMETRY AND REFLEX 85.00 THRESHOLD MEASUREMENTS 92551 PR PURE TONE HEARING TEST, AIR 31.00 92552 PR PURE TONE AUDIOMETRY, AIR 78.00 92553 PR AUDIOMETRY, AIR & BONE 93.00 92555 PR SPEECH THRESHOLD 58.00 92556 PR SPEECH AUDIOMETRY, 95.00 92557 PR COMPREHENSIVE HEARING TEST 115.00 92565 PR STENGER TEST, PURE TONE 35.00 92567 PR TYMPANOMETRY 49.00 92568 PR ACOUSTIC REFLEX TESTING 47.00 92575 PR SENSORINEURAL ACUITY TEST 178.00 92577 PR STENGER TEST, SPEECH 46.00 92579 PR VISUAL AUDIOMETRY (VRA) 107.00 92582 PR CONDITIONING PLAY 167.00 92583 PR SELECT PICTURE AUDIOMETRY 200.00 92584 PR ELECTROCOCHLEOGRAPHY 190.00 92585 PR AUDITORY EVOKED POTENTIAL 294.00 92585 PR AUDITORY EVOKED POTENTIAL 26 294.00 92586 PR AUDITORY EVOKED POTENTIAL, 339.00 92587 PR DISTORT PRODUCT EVOKED 115.00 OTOACOUSTIC EMISNS LIMITD 92587 PR DISTORT PRODUCT EVOKED 26 65.00 OTOACOUSTIC EMISNS LIMITD 92588 PR DISTRT PROD EVOKD 163.00 OTOACOUSTIC EMSNS COMP/DX 92588 PR DISTRT PROD EVOKD 26 95.00 OTOACOUSTIC EMSNS COMP/DX 92601 DX ANAL COCHLEAR IMP,PT <7 403.00 YRS,W/PROG 92602 DX ANAL COCHLEAR IMP,PT <7 257.00 YRS,REPROG 92603 PR DX ANAL COCHLEAR IMP,PT >7 343.00 YRS,W/PROG 92604 PR DX ANAL COCHLEAR IMP,PT >7 204.00 YRS,REPROG 92607 PR EVAL,SPEECH-GEN AUG/ALT 330.00 COMM DEV,1ST HR 92608 PR EVAL,SPEECH-GEN AUG/ALT 133.00 COMM DEV,ADDL 30 92612 PR FLEXIBLE ENDOSCOPIC EVAL 471.00 SWALLOW C/V REC 92613 PR FLEXIBLE ENDOSCOPIC EVAL 145.00 SWALLOW C/V REC I&R 92620 PR AUDITORY FUNCTION, 60 MIN 239.00 92621 PR EVAL CENTRAL AUDITORY 57.00 FUNCJ W/REPRT EA 15 MIN 92625 PR TINNITUS ASSESSMENT 165.00 92626 PR EVAL AUDITORY REHAB STATUS, 230.00 1ST HOUR 92627 PR EVAL AUDITORY REHAB STATUS, 70.00 EA ADD 15 MIN 92920 PR PRQ TRLUML CORONARY 1814.00 ANGIOPLASTY ONE ART/BRANCH 92921 PR PRQ TRLUML CORONARY 493.00 ANGIOPLASTY ADDL BRANCH 92924 PR PRQ TRLUML CORONARY 2156.00 ANGIO/ATHERECT ONE ART/BRNCH 92928 PR PRQ TRLUML CORONARY STENT 2013.00 W/ANGIO ONE ART/BRNCH 92929 PR PRQ TRLUML CORONARY STENT 775.00 W/ANGIO ADDL ART/BRNCH 92929 PR PRQ TRLUML CORONARY STENT 26 548.00 W/ANGIO ADDL ART/BRNCH 92933 PR PRQ TRLUML CORONRY 2253.00 STENT/ATH/ANGIO ONE ART/BRNCH 92934 PR PRQ TRLUML CORONARY 705.00 STENT/ATH/ANGIO ADDL BRANCH 92937 PR PRQ TRLUML CORONARY BYP 2012.00 GRFT REVASC ONE VESSEL 92941 PR PRQ TRLUML CORONRY TOT 2424.00 OCCLUS REVASC MI ONE VSL 92943 PR PRQ TRLUML CORONRY 2257.00 CHRONIC OCCLUS REVASC ONE VSL 92944 PR PRQ TRLUML CORONRY CHRNIC 906.00 OCCLUS REVASC ADDL VSL 92950 PR HEART/LUNG RESUSCITATION 687.00 92960 PR CARDIOVERSION ELECTIVE 672.00 ARRHYTHMIA EXTERNAL 92961 PR CARDIOVERSION ELECTIVE 980.00 ARRHYTHMIA INTERNAL SPX 92970 PR CARDIOASSIST, INTERNAL 439.00 92978 PR ENDOLUMINAL CORONARY IVUS 26 243.00 OCT I&R INITIAL VESSEL 92979 PR ENDOLUMINAL CORONARY IVUS 26 188.00 OCT I&R ADDL VESSEL 92986 PR PRQ BALLOON VALVULOPLASTY 5512.00 AORTIC VALVE 92987 PR PRQ BALLOON VALVULOPLASTY 5689.00 MITRAL VALVE 92990 PR PERCUT PULMONARY 3755.00 92992 PR ATRIAL 4000.00 SEPTOSTOMY,XVENOUS,BALLOON 92993 PR ATRIAL 4500.00 92997 PR PUL ART BALLOON 3200.00 REPAIR,PERC,1ST VESL 92998 PR PUL ART BALLOON 1600.00 REPAIR,PERC,ADDN VES 93000 PR ELECTROCARDIOGRAM, 52.00 93005 PR ELECTROCARDIOGRAM, 34.00 93010 PR ELECTROCARDIOGRAM REPORT 30.00 93010 PR ELECTROCARDIOGRAM REPORT 76 30.00 93015 PR CV STRS TST XERS&/OR RX 227.00 CONT ECG W/SI&R 93016 PR CV STRS TST XERS&/OR RX 125.00 CONT ECG W/O I&R 93017 CARDIAC STRESS TEST 136.00 93018 PR CARDIAC STRESS 120.00 TST,INTERP/REPT ONLY 93040 PR RHYTHM ECG WITH REPORT 31.00 93041 PR RHYTHM ECG, TRACING 14.00 93042 PR RHYTHM ECG, REPORT 25.00 93224 PR XTRNL ECG & 48 HR RECORD 228.00 SCAN STOR W/R&I 93225 PR EXT ECG RECORD CONTIN 48 92.00 HR, RECORD 93226 PR EXT ECG RECORD CONTIN 48 97.00 HR, SCAN ANALYSIS W REPORT 93227 PR XTRNL ECG CONTINUOUS 78.00 RHYTHM W/I&R UP TO 48 HRS 93228 PR XTRNL MOBILE CV TELEMETRY 64.00 W/I&REPORT 30 DAYS 93260 PR PRGRMG DEV EVAL 26 112.00 IMPLANTABLE SUBQ LEAD DFB 93261 PR INTERROGATION EVAL F2F 26 107.00 IMPLANT SUBQ LEAD DEFIB 93270 PR EXT ECG,PT DEMAND EVENT, 27.00 SYMPT MEMORY LOOP, RECORD 93271 PR EXT ECG,PT DEMAND EVENT, 454.00 SYMPT MEMORY LOOP, TRANSMIT 93272 PR XTRNL PT ACTIVTD ECG DWNLD 65.00 W/R&I HR REVIEW 93792 PR PT/CAREGIVER TRAINJ FOR 138.00 INITIATION HOME INR MNTR 93793 PR ANTICOAGULANT MGMT FOR PT 31.00 TAKING WARFARIN 93880 PR DUPLEX SCAN 26 102.00 93882 PR DUPLEX SCAN 26 54.00 93886 PR TRANSCRAN DOPPLER 26 115.00 93922 PR NON-INVAS PHYSIOLOGIC STD 26 31.00 EXTREMITY ART 1-2 LEVEL 93923 PR NON-INVASIVE PHYSIOLOGIC 26 56.00 STUDY EXTREMITY 3 LEVELS 93924 PR NON-INVASIVE LOWER EXTREM 26 73.00 ART STRESS/REST, 93925 PR DUPLEX LO EXTREM ART BILAT 26 100.00 93926 PR DUPLEX LO EXTREM ART 26 62.00 93930 PR DUPLEX UP EXTREM ART BILAT 26 101.00 93931 PR DUPLEX UP EXTREM ART 26 62.00 93970 PR DUPLEX EXTREM VENOUS,BILAT 498.00 93970 PR DUPLEX EXTREM VENOUS,BILAT 26 81.00 93971 PR DUPLEX EXTREM VENOUS,UNI 306.00 93971 PR DUPLEX EXTREM VENOUS,UNI 26 53.00 93975 PR DUPLEX ABD/PEL VASC 26 215.00 STUDY,COMPLETE 93976 PR DUPLEX ABD/PEL VASC 501.00 93976 PR DUPLEX ABD/PEL VASC 26 141.00 93978 PR DUPLEX LARGE 26 100.00 93979 PR DUPLEX LARGE 26 55.00 93980 PR PENILE VASCULAR 26 210.00 93990 PR DUPLEX HEMODIALYSIS ACCESS 26 31.00 94010 PR BREATHING CAPACITY TEST 86.00 94010 PR BREATHING CAPACITY TEST 26 31.00 94060 PR EVAL OF BRONCHOSPASM 152.00 94060 PR EVAL OF BRONCHOSPASM 26 48.00 94070 PR EVAL OF 26 71.00 94150 PR VITAL CAPACITY TEST 56.00 94150 PR VITAL CAPACITY TEST 26 56.00 94200 PR LUNG FUNCTION TEST 65.00 94375 PR RESPIRATORY FLOW VOLUME 26 41.00 94452 PR HIGH ALTITUDE SIMULATJ TEST 26 37.00 W/PHYS INTERP&REPORT 94453 PR HIGH ALTITUDE SIMULATJ 26 48.00 W/PHYS I&R W/O2 TITRATION 94617 PR EXERCISE TEST FOR 243.00 94617 PR EXERCISE TEST FOR 26 86.00 94618 PR PULMONARY STRESS TESTING 88.00 94618 PR PULMONARY STRESS TESTING 26 59.00 94620 PR PULMONARY STRESS 136.00 94620 PR PULMONARY STRESS 26 100.00 94621 PR CARDIOPULMONARY EXERCISE 26 170.00 TESTING 94640 PR 46.00 PRESSURIZED/NONPRESSURIZED 94640 PR 26 46.00 PRESSURIZED/NONPRESSURIZED 94645 PR CONTINUOUS INHALATION TX, 37.00 EACH ADD HR 94664 PR DEMO &/OR EVAL,PT 40.00 USE,AEROSOL DEVICE 94690 PR EXHALED AIR ANALYSIS 129.00 94690 PR EXHALED AIR ANALYSIS 26 10.00 94726 PR PLETHYSMOGRAPHY LUNG 26 31.00 VOLUMES W/WO AIRWAY RESIST 94727 PR GAS DILUT/WASHOUT LUNG VOL 26 31.00 W/WO DISTRIB VENT&VOL 94728 PR AIRWAY RESISTANCE BY 108.00 IMPULSE OSCILLOMETRY 94729 PR DIFFUSING CAPACITY 26 21.00 94750 PR PULMONARY COMPLIANCE 26 30.00 94760 PR NONINVASV OXYGEN 8.00 94761 PR NONINVASV OXYGEN 13.00 94780 PR CAR SEAT/BED TESTING 125.00 W/INTERP & REPORT 60 MIN 94781 PR CAR SEAT/BED TESTNG 49.00 W/INTERP & REPORT +30MIN 95004 PR PERCUTANEOUS TESTS 16.00 W/ALLERGENIC EXTRACTS 95017 PR ALLG TSTG PERQ & IC VENOMS 227.00 IMMED REACT W/ I&R 95018 PR ALLG TEST PERQ & IC 54.00 DRUG/BIOL IMMED REACT W/ I&R 95024 PR INTRACUTANEOUS TESTS 19.00 W/ALLERGENIC EXTRACTS 95028 PR ALLERGY SKIN TESTS 31.00 95044 PR ALLERGY PATCH TESTS 17.00 95070 PR BRONCHIAL ALLERGY 77.00 95076 PR INGESTION CHALLENGE TEST 288.00 INITIAL 120 MINUTES 95079 PR INGESTION CHALLENGE TEST 203.00 EACH ADDL 60 MINUTES 95115 PR IMMUNOTHERAPY, ONE 26.00 95117 PR IMMUNOTHERAPY, 2+ 32.00 95145 PR PROFES SVC,IMMUNOTHERAPY,1 50.00 INSECT VENOM 95165 PR PROFES 39.00 SVC,IMMUNOTHER,SINGLE/MULT 95180 PR RAPID DESENSITIZATION 347.00 PROC,EACH HOUR 95249 PR CONT GLUC MONITORING 141.00 PATIENT PROVIDED EQUIPTMENT 95251 PR CONTINUOUS GLUCOSE 104.00 MONITORING ANALYSIS I&R 95782 PR POLYSOM <6 YRS SLEEP STAGE 26 315.00 4/> ADDL PARAM ATTND 95783 PR POLYSOM <6 YRS SLEEP 26 344.00 W/CPAP/BILVL VENT 4/> PARAM 95800 PR SLEEP STUDY, UNATTENDED, 26 144.00 RECORD HEART RATE/O2 SAT/RESP ANAL/SLEEP TIME 95801 PR SLEEP STUDY, UNATTENDED, 26 127.00 RECORD HEART RATE/O2 SAT/RESP 95803 PR ACTIGRAPHY TESTING, 3-14 DAY 26 111.00 95805 PR MULTIPLE SLEEP LATENCY TEST 26 216.00 95806 PR SLEEP STUDY, UNATTENDED, 26 177.00 SIMUL RECORD HR/O2 SAT/RESP 95808 PR POLYSOM ANY AGE SLEEP 26 290.00 STAGE 1-3 ADDL PARAM ATTND 95810 PR POLYSOM 6/>YRS SLEEP 4/> 26 424.00 ADDL PARAM ATTND 95811 PR POLYSOM 6/>YRS SLEEP W/CPAP 26 473.00 4/> ADDL PARAM ATTND 95812 PR EEG,EXTENDED MONITORING,41- 26 146.00 60 MINUTES 95813 PR EEG >1 HR 26 232.00 95816 PR EEG,W/AWAKE & DROWSY 26 207.00 95819 PR EEG,W/AWAKE & ASLEEP 26 207.00 95822 PR EEG,COMA/SLEEP RECORD 26 150.00 95824 PR EEG EVAL CEREBRAL DEATH 26 101.00 95827 PR EEG,ALL NIGHT RECORD 26 125.00 95829 PR SURGERY 4787.00 95829 PR SURGERY 26 750.00 95860 PR EMG, NEEDLE, ONE LIMB 26 175.00 95861 PR EMG, NEEDLE, TWO LIMBS 26 235.00 95863 PR EMG, NEEDLE, 3 LIMBS 26 280.00 95865 PR EMG, NEEDLE, LARYNX 368.00 95866 PR EMG, NEEDLE, HEMIDIAPHRAGM 341.00 95866 PR EMG, NEEDLE, HEMIDIAPHRAGM 26 171.00 95867 PR EMG,NEEDLE,CRANIAL NERVE 26 108.00 SUPP MUS,UNILAT 95869 PR EMG,NEEDLE,THOR PARASPIN 237.00 MUS,EXC T1/T12 95869 PR EMG,NEEDLE,THOR PARASPIN 26 51.00 MUS,EXC T1/T12 95870 PR EMG,1 EXTREM,NONPARASPINAL 26 70.00 95872 PR EMG, NEEDLE, ONE FIBER 26 363.33 95873 PR ELECTRIC STIM GUIDANCE FOR 26 49.00 CHEMODENERVATION 95874 PR NEEDLE EMG GUIDANCE FOR 26 65.00 CHEMODENERVATION 95885 PR NEEDLE EMG EA EXTREMITY 26 137.00 W/PARASPINL AREA LIMITED 95886 PR NEEDLE EMG EA EXTREMTY 26 214.00 W/PARASPINL AREA COMPLETE 95887 PR NEEDLE EMG NONEXTREMTY 26 191.00 MSCLES W/NERVE CONDUCTION 95907 PR MOTOR &/SENS 1-2 NRV CNDJ 26 205.00 PRECONF ELTRODE LIMB 95908 PR MOTOR &/SENS 3-4 NRV CNDJ 26 258.00 PRECONF ELTRODE LIMB 95909 PR MOTOR &/SENS 5-6 NRV CNDJ 26 308.00 PRECONF ELTRODE LIMB 95910 PR MOTOR &/SENS 7-8 NRV CNDJ 26 412.00 PRECONF ELTRODE LIMB 95911 PR MOTOR &/SENS 9-10 NRV CNDJ 26 513.00 PRECONF ELTRODE LIMB 95912 PR MOTOR &/SENS 11-12 NRV CNDJ 26 617.00 PRECONF ELTRODE LIMB 95913 PR MOTOR &/SENS 13/> NRV CNDJ 26 730.00 PRECONF ELTRODE LIMB 95925 PR SOMATOSENSORY TEST,UPPER 26 80.00 95926 PR SOMATOSENSORY TEST,LOWER 26 80.00 95930 PR VISUAL EP TESTING CNS EXCEPT 26 48.00 GLAUCOMA W/I&R 95933 PR BLINK REFLEX TEST 26 80.00 95937 PR NEUROMUSCULAR JUNCTION 26 115.00 95938 PR SHORT-LATENCY SOMATOSENS 26 721.00 EP STD UPR & LOW LIMBS 95950 PR AMBULATORY EEG MONITORING 26 205.00 95951 PR EEG 790.00 95951 PR EEG 26 939.00 95953 PR EEG MONITORING/COMPUTER, 26 399.00 EA 24 HOURS, UNATTENDED 95955 PR EEG DURING SURGERY 26 137.00 95956 PR EEG MONITORING/COMPUTER, 4073.00 EA 24 HOURS, ATTENDED BY 95956 PR EEG MONITORING/COMPUTER, 26 616.00 EA 24 HOURS, ATTENDED BY 95958 PR EEG MONITORING/FUNCTION 26 600.00 95961 PR FUNCJAL CORT&SUBCORT MAPG 768.00 PHYS/QHP ATTND INIT HR 95961 PR FUNCJAL CORT&SUBCORT MAPG 26 425.00 PHYS/QHP ATTND INIT HR 95962 PR FUNCJAL CORT&SUBCORT MAPG 659.00 PHYS/QHP ATTND ADDL HR 95962 PR FUNCJAL CORT&SUBCORT MAPG 26 446.00 PHYS/QHP ATTND ADDL HR 95970 PR ELEC ALYS NSTIM PLS GEN 171.00 BRN/SC/PERPH W/O REPRGRM 95971 PR ELEC ALYS NSTIM PLS GEN SMPL 129.00 SC/PERPH W/PRGRMG 95972 PR ELEC ALYS NSTIM PLS GEN CPLX 300.00 SC/PERPH W/PRGRMG 95974 PR ELEC ALYS NSTIM PLS GEN CPLX 519.00 CRNL NRV 1ST HR 95975 PR ELEC ALYS NSTIM PLS GEN CPLX 283.00 CRNL NRV EA 30 MIN 95978 PR ANALYZE NEUROSTIM BRAIN, 514.00 95979 PR ANALYZ NEUROSTIM BRAIN, 240.00 EACH ADD 30 MIN 95990 PR REFILL&MAINTENANCE PUMP 226.00 DRUG DLVR SPINAL/BRAIN 95991 PR RFL&MAIN IMPLT PMP/RSVR 280.00 DLVR SPI/BRN PHY/QHP 95992 PR CANALITH REPOSITIONING 122.00 PROCEDURE, PER DAY 96002 PR DYN SURF EMG,WALKING/FUNC 56.00 ACT,1-12 MUS 96101 PR PSYCHOLOGIC TESTING BY 300.00 PSYCH/PHYS 96103 PR PSYCHOLOGIC TESTING ADMIN 158.00 BY COMPUTER 96110 PR DEVELOPMENTAL SCREEN 30.00 W/SCORING & DOC STD INSTRM 96111 PR DEVELOPMENTAL TESTING 320.00 W/INTERP & REPORT 96116 PR NEUROBEHAVIORAL STATUS 250.00 EXAM BY PSYCH/PHYS 96118 PR NEUROPSYCH TESTING BY 300.00 96119 PR NEUROPSYCH TESTING BY 201.00 96127 PR BEHAV ASSMT W/SCORE & 12.00 DOCD/STAND INSTRUMENT 96150 PR HEAL & BEHAV ASSESS,EA 15 64.00 96151 PR HEAL & BEHAV ASSESS,EA 15 63.00 MIN,RE-ASSESS 96152 PR HEAL & BEHAV INTERVENT,EA 15 60.00 MIN,INDIV 96154 PR HEAL & BEHAV INTERV,EA 15 59.00 MIN,FAM W/PT 96155 PR HEAL & BEHAV INTERV,EA 15 59.00 MIN,FAM W/O PT 96160 PR PT-FOCUSED HLTH RISK ASSMT 12.00 SCORE DOC STND INSTRM 96161 PR CAREGIVER HLTH RISK ASSMT 30.00 SCORE DOC STND INSTRM 96360 PR IV INFUSION, HYDRATION, 31-60 130.00 96361 PR IV INFUSION, HYDRATION, EA 110.00 96365 PR IV INFUSION, 159.00 THERAP/PROPH/DIAGNOST,INITIAL,1 ST HOUR 96366 PR IV INFUSION, 53.00 THERAP/PROPH/DIAGNOST,INITIAL,E A ADD HOUR 96367 PR IV INFUSION THER PROPH ADDL 88.00 SEQUENTIAL TO 1 HR 96368 PR IV INFUSION, 51.00 THERAP/PROPH/DIAGNOST,CONCUR RENT INFUSION 96372 PR 56.00 INJECTION,THERAP/PROPH/DIAGNO 96373 PR 48.00 INJECTION,THERAP/PROPH/DIAGNO 96374 PR 119.00 INJECTION,THERAP/PROPH/DIAGNO 96375 PR 55.00 INJECTION,THERAP/PROPH/DIAGNO 96401 PR CHEMOTHER,NON-HORMONE 156.00 ANTI-NEOPL, SUB-Q/IM 96402 PR CHEMOTHER HORMON 106.00 ANTINEOPL SUB-Q/IM 96405 PR INTRALESIONAL CHEMO 417.00 96409 PR CHEMOTHER, IV PUSH, SNGL 298.00 96411 PR CHEMOTHER, IV PUSH,EA ADD 183.00 96413 PR CHEMOTHER, IV INFUSION, 1 HR 485.00 96415 PR CHEMOTHER, IV INFUSION, EA 149.00 96417 PR CHEMOTHER, IV INFUSE, EACH 218.00 SEQU INFUS 96450 PR CHEMOTHER,CNS,W/LUMBAR 1291.00 PUNCTURE 96542 PR CHEMOTHER 770.00 INJECT,SUBARACH/INTRAVENT 96573 PR PDT DSTR PRMLG LES SKN 484.00 ILLUM/ACTIVJ BY PHYS/QHP 96574 PR DEBRIDEMENT PRMLG 623.00 HYPERKERATOTIC LES W/PDT 97012 PR MECHANICAL TRACTION 41.00 97032 PR ELECTRICAL STIMULATION 46.00 97112 PR NEUROMUSC REEDUCAT,1+ 88.00 AREAS, EA 15 MIN 97161 PR PHYSICAL THERAPY 205.00 EVALUATION LOW COMPLEX 20 97162 PR PHYSICAL THERAPY 205.00 EVALUATION MOD COMPLEX 30 97163 PR PHYSICAL THERAPY 205.00 EVALUATION HIGH COMPLEX 45 97164 PR PHYSICAL THERAPY RE-EVAL 140.00 EST PLAN CARE 20 MINS 97165 PR OCCUPATIONAL THERAPY EVAL 199.00 LOW COMPLEX 30 MINS 97166 PR OCCUPATIONAL THERAPY EVAL 199.00 MOD COMPLEX 45 MINS 97167 PR OCCUPATIONAL THERAPY EVAL 199.00 HIGH COMPLEX 60 MINS 97168 PR OCCUPATIONAL THER RE-EVAL 131.00 EST PLAN CARE 30 MINS 97597 PR DEBRIDEMENT OPEN WOUND 20 189.00 97598 PR DEBRIDEMENT OPEN WOUND EA 63.00 ADDL 20 SQ CM 97602 PR RMVL DEVITAL TISS N-SLCTV 137.00 DBRDMT W/O ANES 1 SESS 97605 PR NEGATIVE PRESSURE WOUND 100.00 THERAPY DME 50 SQ CM 97607 PR NEG PRESSURE WOUND 446.00 THERAPY NON DME 50 SQ CM 97750 PR PHYSICAL PERFORMANCE TEST 83.00 97760 PR ORTHOTICS MGMT & TRAINJ 119.00 INITIAL ENCTR EA 15 MINS 97763 PR ORTHOTICS/PROSTH MGMT 124.00 &/TRAINJ SBSQ ENCTR 15 MIN 97802 PR MED NUTR THER, 1ST, INDIV, EA 88.00 97803 PR MED NUTR THER, SUBSQ, INDIV, 76.00 EA 15 MIN 97804 PR MED NUTR THER, GROUP, EA 30 40.00 97810 PR ACUPUNCT W/O ELEC STIMUL 15 136.00 97813 PR ACUPUNCT W/ ELEC STIMUL 15 136.00 98925 PR OSTEOPATHIC MANIP,1-2 BODY 79.00 98926 PR OSTEOPATHIC MANIP,3-4 BODY 100.00 98927 PR OSTEOPATHIC MANIP,5-6 BODY 151.00 98928 PR OSTEOPATHIC MANIP,7-8 BODY 145.00 98929 PR OSTEOPATHIC MANIP,9-10 BODY 219.00 98961 PR SELF-MGMT EDUC/TRAIN, 2-4 PT, 46.00 EA 30 MIN 98968 PR NONPHYSICIAN TELEPHONE 150.00 ASSESSMENT 21-30 MIN 99000 PR HANDLG&/OR CONVEY OF SPEC 0.00 FOR TR OFFICE TO LAB 99024 PR POST-OP FOLLOW-UP VISIT 0.00 99050 PR MEDICAL SERVICES AFTER HRS 47.00 99053 PR MEDICAL SERVICES 10PM-8AM, 55.00 24 HR FAC 99058 PR EMERGENCY CARE DISRUPTING 144.00 99070 PR SUPPLIES&MATERIALS 50.00 ABOVE/BEYOND PROV BY PHYS/QHP 99080 PR SPECIAL REPORTS OR FORMS 49.00 99100 SPECIAL ANESTHESIA SERVICE 132.00 99140 PR EMERGENCY ANESTHESIA 263.00 99143 PR MODERATE SEDATJ SAME 148.00 PHYS/QHP <5 YRS INIT 30 MIN 99144 PR MODERATE SEDATJ SAME 135.00 PHYS/QHP 5/>YRS INIT 30 MIN 99144 PR MODERATE SEDATJ SAME 26 135.00 PHYS/QHP 5/>YRS INIT 30 MIN 99145 PR MODERATE SEDATJ SAME 63.00 PHYS/QHP EACH ADDL 15 MIN 99145 PR MODERATE SEDATJ SAME 26 63.00 PHYS/QHP EACH ADDL 15 MIN 99148 PR MOD SEDATJ DIFF PHYS/QHP <5 137.00 YRS INIT 30 MIN 99149 PR MODERATE SEDATJ DIFF 128.00 PHYS/QHP 5/>YRS INIT 30 MIN 99150 PR MODERATE SEDATJ DIFF 70.00 PHYS/QHP EA ADDL 15 MIN 99151 PR MOD SED SAME PHYS/QHP 196.00 INITIAL 15 MINS <5 YRS 99152 PR MOD SED SAME PHYS/QHP 131.00 INITIAL 15 MINS 5/> YRS 99153 PR MOD SED SAME PHYS/QHP EACH 28.00 ADDL 15 MINS 99155 PR MOD SED OTHER PHYS/QHP 236.00 INITIAL 15 MINS <5 YRS 99156 PR MOD SED OTHER PHYS/QHP 193.00 INITIAL 15 MINS 5/> YRS 99157 PR MOD SED OTHER PHYS/QHP 147.00 EACH ADDL 15 MINS 99173 PR VISUAL SCREENING TEST, BILAT 72.00 99174 PR INSTRUMENT BASED OCULAR 67.00 SCR BI W/RMT ANAL & RPT 99184 PR INITIAT SELECTIVE HEAD/BODY 565.00 HYPOTHERMIA NEONATE 99188 PR APPLICATION TOPICAL 49.00 FLUORIDE VARNISH BY PHS/QHP 99201 PR OFFICE OUTPATIENT NEW 10 106.00 99202 PR OFFICE OUTPATIENT NEW 20 181.00 99203 PR OFFICE OUTPATIENT NEW 30 262.00 99204 PR OFFICE OUTPATIENT NEW 45 396.00 99205 PR OFFICE OUTPATIENT NEW 60 494.00 99211 PR OFFICE OUTPATIENT VISIT 5 49.00 99212 PR OFFICE OUTPATIENT VISIT 10 105.00 99213 PR OFFICE OUTPATIENT VISIT 15 177.00 99214 PR OFFICE OUTPATIENT VISIT 25 258.00 99214 PR OFFICE OUTPATIENT VISIT 25 26 250.00 99215 PR OFFICE OUTPATIENT VISIT 40 345.00 99217 PR OBSERVATION CARE 184.00 DISCHARGE MANAGEMENT 99218 PR INITIAL OBSERVATION CARE/DAY 252.00 30 MINUTES 99219 PR INITIAL OBSERVATION CARE/DAY 342.00 50 MINUTES 99220 PR INITIAL OBSERVATION CARE/DAY 468.00 70 MINUTES 99221 PR INITIAL HOSPITAL CARE/DAY 30 255.00 MINUTES 99222 PR INITIAL HOSPITAL CARE/DAY 50 344.00 MINUTES 99223 PR INITIAL HOSPITAL CARE/DAY 70 510.00 MINUTES 99224 PR SBSQ OBSERVATION CARE/DAY 101.00 15 MINUTES 99225 PR SBSQ OBSERVATION CARE/DAY 184.00 25 MINUTES 99226 PR SBSQ OBSERVATION CARE/DAY 264.00 35 MINUTES 99231 PR SBSQ HOSPITAL CARE/DAY 15 99.00 99232 PR SBSQ HOSPITAL CARE/DAY 25 183.00 99233 PR SBSQ HOSPITAL CARE/DAY 35 262.00 99234 PR OBSERVATION/INPATIENT 335.00 HOSPITAL CARE 40 MINUTES 99235 PR OBSERVATION/INPATIENT 435.00 HOSPITAL CARE 50 MINUTES 99236 PR OBSERVATION/INPATIENT 549.00 HOSPITAL CARE 55 MINUTES 99238 PR HOSPITAL DISCHARGE DAY,<30 184.00 99239 PR HOSPITAL DISCHARGE DAY,>30 271.00 99241 PR OFFICE CONSULTATION 117.00 NEW/ESTAB PATIENT 15 MIN 99242 PR OFFICE CONSULTATION 219.00 NEW/ESTAB PATIENT 30 MIN 99243 PR OFFICE CONSULTATION 300.00 NEW/ESTAB PATIENT 40 MIN 99244 PR OFFICE CONSULTATION 444.00 NEW/ESTAB PATIENT 60 MIN 99245 PR OFFICE CONSULTATION 662.00 NEW/ESTAB PATIENT 80 MIN 99251 PR INITL INPATIENT CONSULT 123.00 NEW/ESTAB PT 20 MIN 99252 PR INITL INPATIENT CONSULT 188.00 NEW/ESTAB PT 40 MIN 99253 PR INITL INPATIENT CONSULT 289.00 NEW/ESTAB PT 55 MIN 99254 PR INITL INPATIENT CONSULT 420.00 NEW/ESTAB PT 80 MIN 99255 PR INITIAL INPATIENT CONSULT 505.00 NEW/ESTAB PT 110 MIN 99281 PR EMERGENCY DEPARTMENT VISIT 60.00 LIMITED/MINOR PROB 99282 PR EMERGENCY DEPARTMENT VISIT 104.00 LOW/MODER SEVERITY 99283 PR EMERGENCY DEPARTMENT VISIT 156.00 MODERATE SEVERITY 99284 PR EMERGENCY DEPARTMENT VISIT 295.00 HIGH/URGENT SEVERITY 99285 PR EMERGENCY DEPT VISIT HIGH 435.00 SEVERITY&THREAT FUNCJ 99288 PR PHYS/QHP DIRECTION 297.00 EMERGENCY MEDICAL SYSTEMS 99291 PR CRITICAL CARE, E/M 30-74 775.00 99292 PR CRITICAL CARE, ADDL 30 MIN 308.00 99304 PR INITIAL NURSING FACILITY 230.00 CARE/DAY 25 MINUTES 99305 PR INITIAL NURSING FACILITY 328.00 CARE/DAY 35 MINUTES 99306 PR INITIAL NURSING FACILITY 420.00 CARE/DAY 45 MINUTES 99307 PR SBSQ NURSING FACILITY 112.00 CARE/DAY E/M STABLE 10 MIN 99308 PR SBSQ NURSING FACIL CARE/DAY 174.00 MINOR COMPLJ 15 MIN 99308 PR SBSQ NURSING FACIL CARE/DAY 26 173.00 MINOR COMPLJ 15 MIN 99309 PR SBSQ NURSING FACIL CARE/DAY 230.00 NEW PROBLEM 25 MIN 99310 PR SBSQ NURS FACIL CARE/DAY 342.00 UNSTABL/NEW PROB 35 MIN 99315 PR NURSING FAC DISCHRGE DAY,1- 184.00 99316 PR NURSING FAC DISCHRGE 267.00 DAY,MORE 30 MIN 99318 PR E/M ANNUAL NURSING FACILITY 242.00 ASSESS STABLE 30 MIN 99324 PR DOMICIL/REST HOME NEW PT 139.00 VISIT LOW SEVER 20 MIN 99325 PR DOMICIL/REST HOME NEW PT 202.00 VISIT MOD SEVER 30 MIN 99326 PR DOMICIL/REST HOME NEW PT HI- 350.00 MOD SEVER 45 MINUTES 99327 PR DOMICIL/REST HOME NEW PT 468.00 VISIT HI SEVER 60 MIN 99328 PR DOM/R-HOME E/M NEW PT SIGNIF 548.00 NEW PROB 75 MINUTES 99334 PR DOM/R-HOME E/M EST PT SELF- 151.00 LMTD/MINOR 15 MINUTES 99335 PR DOM/R-HOME E/M EST PT LW 238.00 MOD SEVERITY 25 MINUTES 99336 PR DOM/R-HOME E/M EST PT MOD HI 340.00 SEVERITY 40 MINUTES 99337 PR DOM/R-HOME E/M EST PT SIGNIF 486.00 NEW PROB 60 MINUTES 99339 PR DOMICIL/REST-HOME CARE 195.00 SUPERVISION, <30 MIN 99340 PR DOMICIL/REST-HOME CARE 273.00 SUPERVISION, =>30 MIN 99341 PR HOME VISIT NEW PATIENT LOW 138.00 SEVERITY 20 MINUTES 99342 PR HOME VISIT NEW PATIENT MOD 200.00 SEVERITY 30 MINUTES 99343 PR HOME VST NEW PATIENT MOD-HI 328.00 SEVERITY 45 MINUTES 99344 PR HOME VISIT NEW PATIENT HI 459.00 SEVERITY 60 MINUTES 99345 PR HOME VISIT NEW PT 558.00 UNSTABL/SIGNIF NEW PROB 75 MIN 99347 PR HOME VISIT EST PT SELF 139.00 LIMITED/MINOR 15 MINUTES 99348 PR HOME VISIT EST PT LOW-MOD 212.00 SEVERITY 25 MINUTES 99349 PR HOME VISIT EST PT MOD-HI 324.00 SEVERITY 40 MINUTES 99350 PR HOME VST EST PT 450.00 UNSTABLE/SIGNIF NEW PROB 60 99354 PR PROLNG E&M/PSYCTX SVC 328.00 OFFICE O/P DIR CON 1ST HR 99355 PR PROLNG E&M/PSYCTX SVC 248.00 OFFICE O/P DIR CON ADDL 30 99356 PR PROLONGED SERVICE I/P REQ 232.00 UNIT/FLOOR TIME 1ST HR 99357 PR PROLONGED SVC I/P REQ 233.00 UNIT/FLOOR TIME EA 30 MIN 99358 PR PROLNG E/M SVC 294.00 BEFORE&/AFTER DIR PT CARE 1ST 99359 PR PROLNG E/M BEFORE&/AFTER 147.00 DIR CARE EA 30 MIN 99360 PR PHYS STANDBY SVC PROLNG 202.00 PHYS ATTN EA 30 MINUTES 99363 PR ANTICOAG MGMT, INITIAL 90 318.00 99364 PR ANTICOAG MGMT, EACH SUBSEQ 109.00 90 DAYS 99366 PR TEAM CONFERENCE FACE-TO- 108.00 FACE NONPHYSICIAN 99367 PR TEAM CONFERENCE NON-FACE- 143.00 TO-FACE PHYSICIAN 99368 PR TEAM CONFERENCE NON-FACE- 93.00 TO-FACE NONPHYSICIAN 99374 PR SUPVJ PT HOME HEALTH 176.00 AGENCY MO 15-29 MINUTES 99375 PR SUPERVISION PT HOME HEALTH 263.00 AGENCY MONTH 30 MIN/> 99377 PR SUPERVISION HOSPICE 176.00 PATIENT/MONTH 15-29 MIN 99378 PR SUPERVISION HOSPICE 278.00 PATIENT/MONTH 30 MINUTES/> 99379 PR SUPERVISION NURS FACILITY 176.00 PATIENT MO 15-29 MIN 99380 PR SUPERVISION NURS FACILITY 263.00 PATIENT MONTH 30 MIN/> 99381 PR PREVENTIVE VISIT,NEW,INFANT < 275.00 99382 PR PREVENTIVE VISIT,NEW,AGE 1-4 287.00 99383 PR PREVENTIVE VISIT,NEW,AGE5-11 300.00 99384 PR PREVENTIVE VISIT,NEW,12-17 339.00 99385 PR PREVENTIVE VISIT,NEW,18-39 327.00 99386 PR PREVENTIVE VISIT,NEW,40-64 380.00 99387 PR PREVENTIVE VISIT,NEW,65 & 412.00 99391 PR PREVENTIVE VISIT,EST, INFANT < 248.00 99392 PR PREVENTIVE VISIT,EST,AGE 1-4 264.00 99393 PR PREVENTIVE VISIT,EST,AGE5-11 264.00 99394 PR PREVENTIVE VISIT,EST,12-17 289.00 99395 PR PREVENTIVE VISIT,EST,18-39 295.00 99396 PR PREVENTIVE VISIT,EST,40-64 315.00 99397 PR PREVENTIVE VISIT,EST,65 & 339.00 99401 PR PREVENT COUNSEL,INDIV,15 MIN 91.00 99402 PR PREVENT COUNSEL,INDIV,30 MIN 155.00 99403 PR PREVENT COUNSEL,INDIV,45 MIN 216.00 99404 PR PREVENT COUNSEL,INDIV,60 MIN 279.00 99406 PR TOBACCO USE CESSATION 37.00 INTERMEDIATE 3-10 MINUTES 99407 PR TOBACCO USE CESSATION 71.00 INTENSIVE >10 MINUTES 99408 PR ALCOHOL/SUBSTANCE SCREEN 89.00 & INTERVEN 15-30 MIN 99409 PR ALCOHOL/SUBSTANCE SCREEN 173.00 & INTERVEN >30 MIN 99411 PR PREVENT COUNSEL,GROUP,30 41.00 99412 PR PREVENT COUNSEL,GROUP,60 54.00 99415 PR PROLNG CLINCL STAFF SVC 25.00 DURING O/P E/M 1ST HR 99416 PR PROLNG CLINCL STAFF SVC 20.00 DURING O/P E/M EA 30 MIN 99441 PR PHYS/QHP TELEPHONE 36.00 EVALUATION 5-10 MIN 99442 PR PHYS/QHP TELEPHONE 68.00 EVALUATION 11-20 MIN 99443 PR PHYS/QHP TELEPHONE 100.00 EVALUATION 21-30 MIN 99444 PR PHYS/QHP ONLINE EVALUATION 84.00 & MANAGEMENT SERVICE 99446 PR INTERPROF PHONE/INTERNET 30.00 ASSESS/MANAGE 5-10 99450 PR LIFE/DISABILITY EVALUATION 334.00 99455 PR DISABILITY EXAM/TREATING DR 459.00 99456 PR DISABILITY EXAM/OTHER DR 528.00 99460 PR INITIAL NORMAL NEWBORN 252.00 CARE, HOSPITAL OR BIRTH CENTER 99461 PR INITIAL NORMAL NEWBORN 245.00 CARE, EXCEPT HOSPITAL OR BIRTH 99462 PR SUBSEQUENT HOSPITAL CARE, 112.00 NORMAL NEWBORN 99463 PR INITIAL NORMAL NEWBORN 301.00 CARE, SAME DAY DISCHARGE 99464 PR ATTN AT DELIVERY 1ST 194.00 STABILIZATION OF NEWBORN 99465 PR DELIVERY/BIRTHING ROOM 384.00 RESUSCITATION 99466 PR CRITICAL CARE INTERFACILITY 639.00 TRANSPORT 30-74 MIN 99467 PR CRITICAL CARE INTERFACILITY 309.00 TRANSPORT EA 30 MIN 99468 PR INITIAL HOSP NEONATE 28 DAY 3484.00 OR LESS, CRITICALLY ILL 99469 PR SUBSEQUENT HOSP NEONATE 1004.00 28 DAY OR LESS, CRITICALLY ILL 99471 PR INITIAL PED CRITICAL CARE 29 3050.00 DAY THRU 24 MO 99472 PR SUBSEQUENT PED CRITICAL 1035.00 CARE 29 DAY THRU 24 MO 99475 PR INITIAL PED CRITICAL CARE 2 YR 2027.00 THRU 5 YR 99476 PR SUBSEQUENT PED CRITICAL 868.00 CARE 2 YR THRU 5 YR 99477 PR INITIAL HOSP NEONATE 28 DAY 897.00 OR LESS, NOT CRITICALLY ILL 99478 PR SUBSEQUENT INTENSIVE CARE 353.00 INFANT < 1500 GRAMS 99479 PR SUBSEQUENT INTENSIVE CARE 314.00 INFANT 1500-2500 GRAMS 99480 PR SUBSEQUENT INTENSIVE CARE 303.00 INFANT 2501-5000 GRAMS 99483 PR ASSMT & CARE PLANNING PT 597.00 W/COGNITIVE IMPAIRMENT 99484 PR CARE MGMT SERVICES 120.00 BEHAVIORAL HLTH COND 20 MINS 99485 PR SUPERVISION INTERFACILITY 193.00 TRANSPORT INIT 30 MIN 99486 PR SUPERVISION INTERFACILITY 168.00 TRANSPORT ADDL 30 MIN 99487 PR CMPLX CHRON CARE MGMT W/O 205.00 PT VST 1ST HR PER MO 99489 PR CMPLX CHRON CARE MGMT EA 115.67 ADDL 30 MIN PER MONTH 99490 PR CHRON CARE MANAGEMENT 106.00 SRVC 20 MIN PER MONTH 99492 PR 1ST PSYCHIATRIC COLLAB CARE 404.00 MGMT 1ST 70 MINS 99493 PR SBSQ PSYCHIATRIC COLLAB 323.00 CARE MGMT 1ST 60 MINS 99494 PR 1ST/SBSQ PSYCH COLLAB CARE 167.00 MGMT EA ADDL 30 MINS 99495 PR TRANSITIONAL CARE MANAGE 496.00 SERVICE 14 DAY DISCHRGE 99496 PR TRANSITIONAL CARE MANAGE 584.00 SERVICE 7 DAY DISCHARGE 99497 PR ADVANCE CARE PLANNING FIRST 213.00 30 MINS 99498 PR ADVANCE CARE PLANNING EA 188.00 ADDL 30 MINS 99499 PR UNLISTED E/M SERVICE 0.00 99502 HOME VISIT,NEWBORN 121.00 A4351 PR STRAIGHT TIP URINE CATHETER 5.00 A4353 PR INTERMITTENT URINARY CATH 17.00 A4358 PR URINARY LEG OR ABDOMEN BAG 16.00 A4495 PR THIGH LENGTH SURG STOCKING 22.00 A4500 PR BELOW KNEE SURGICAL 20.00 A4550 PR SURGICAL TRAYS 55.00 A4562 PR PESSARY, NON RUBBER,ANY 139.00 A4565 PR SLINGS 14.00 A4570 PR SPLINT 31.00 A4595 PR TENS SUPPL 2 LEAD PER MONTH 39.00 A4615 CANNULA NASAL 2.00 A4617 MOUTH PIECE 9.00 A4627 PR SPACER BAG/RESERVOIR 28.00 A5500 PR DIAB SHOE FOR DENSITY INSERT 78.00 A5501 PR DIABETIC CUSTOM MOLDED 232.00 A5503 PR DIABETIC SHOE 35.00 A5504 PR DIABETIC SHOE WITH WEDGE 44.00 A5507 PR MODIFICATION DIABETIC SHOE 80.00 A5512 PR MULTI DEN INSERT DIRECT 55.00 A5513 PR MULTI DEN INSERT CUSTOM 139.00 A6504 PR CMPRSBURNGARMENT GLOVE- 315.00 A6530 PR COMPRESSION STOCKING BK18- 38.00 A6531 PR COMPRESSION STOCKING BK30- 38.00 A6533 PR GC STOCKING THIGHLNGTH 18- 51.00 A6536 PR GC STOCKING FULL LNGTH 18-30 57.00 A6537 PR GC STOCKING FULL LNGTH 30-40 65.00 A6539 PR GC STOCKING WAISTLNGTH 18- 134.00 A6540 PR GC STOCKING WAISTLNGTH 30- 185.00 A6549 PR G COMPRESSION STOCKING 108.00 A7003 PR NEBULIZER ADMINISTRATION 5.00 A7015 PR AEROSOL MASK USED W 4.00 A8000 PR SOFT PROTECT HELMET PREFAB 209.00 A8001 PR HARD PROTECT HELMET 209.00 A8002 PR SOFT PROTECT HELMET 329.00 A8003 PR HARD PROTECT HELMET 2492 A9270 PR NON-COVERED ITEM OR 25.00 A9279 PR MONITORING 250.00 D0120 PR PERIODIC ORAL EVALUATION 55.00 D0140 PR LIMIT ORAL EVAL PROBLM 75.00 D0145 PR ORAL EVALUATION, PT < 3YRS 60 D0150 PR COMPREHENSVE ORAL 90.00 D0160 PR EXTENSV ORAL EVAL PROB 75.00 D0170 PR RE-EVAL,EST PT,PROBLEM 75.00 D0171 PR RE-EVAL POST-OP VISIT 0 D0180 PR COMP PERIODONTAL 100 D0210 PR INTRAOR COMPLETE FILM 140.00 D0220 PR INTRAORAL PERIAPICAL FIRST F 32.00 D0230 PR INTRAORAL PERIAPICAL EA ADD 26.00 D0240 PR INTRAORAL OCCLUSAL FILM 48.00 D0250 PR EXTRAORAL FIRST FILM 50.00 D0251 EXTRA-ORAL POSTERIOR DENTAL 75.00 RADIOGRAPHIC IMAGE D0270 PR DENTAL BITEWING SINGLE FILM 32.00 D0272 PR DENTAL BITEWINGS TWO FILMS 50.00 D0273 PR BITEWINGS - THREE FILMS 50.00 D0274 PR DENTAL BITEWINGS FOUR FILMS 70.00 D0277 PR VERT BITEWINGS-SEV TO EIGHT 100 D0330 PR DENTAL PANORAMIC FILM 125.00 D0340 PR DENTAL CEPHALOMETRIC FILM 140.00 D0350 PR ORAL/FACIAL PHOTO IMAGES 70 D0351 PR 3D PHOTOGRAPHIC IMAGE 0 D0363 PR CONE BEAM, THREE 300 D0364 CONE BEAM CT CAPT & INTERP 400.00 D0365 CONE BEAM CT INTERPRETE MAN 400.00 D0366 CONE BEAM CT INTERPRETE MAX 400.00 D0367 CONE BEAM CT INTERP BOTH JAW 400.00 D0368 CONE BEAM CT INTERPRETE TMJ 400.00 D0380 PR CONE BEAM CT CAPTURE 300.00 D0381 PR CONE BEAM CT CAPT MANDIBLE 300.00 D0382 PR CONE BEAM CT CAPT MAXILLA 300.00 D0383 PR CONE BEAM CT BOTH JAWS 300.00 D0384 PR CONE BEAM CT CAPTURE TMJ 300.00 D0391 PR INTERPRETE DIAGNOSTIC IMAGE 250.00 D0460 PR PULP VITALITY TEST 65.00 D0470 PR DIAGNOSTIC CASTS 90.00 D1110 PR DENTAL PROPHYLAXIS ADULT 95.00 D1120 PR DENTAL PROPHYLAXIS CHILD 75.00 D1206 PR TOPICAL FLUORIDE VARNISH 45.00 D1208 TOPICAL APPLICATION FLOURIDE 45.00 D1310 PR NUTRI COUNSEL-CONTROL 28.00 D1320 PR TOBACCO COUNSELING 0 D1330 PR ORAL HYGIENE INSTRUCTION 0.00 D1351 PR DENTAL SEALANT PER TOOTH 60.00 D1352 PREV RESIN REST, PERM TOOTH 75.00 D1353 PR SEALANT REPAIR PER TOOTH 60 D1354 INTERIM CARIES ARRESTING 50.00 MEDICAMENT APPLICATION - PER D1510 PR SPACE MAINTAINER FXD UNILAT 300 D1515 PR FIXED BILAT SPACE MAINTAINER 400.00 D1520 PR REMOVE UNILAT SPACE 300 D1525 PR REMOVE BILAT SPACE MAINTAIN 400 D1550 PR RECEMENT SPACE MAINTAINER 70 D1555 PR REMOVE FIX SPACE MAINTAINER 75 D1575 PR DIST SPACE MAINT, FIXED UNIL 300 D2140 PR AMALGAM ONE SURFACE 150.00 D2150 PR AMALGAM TWO SURFACES 200.00 D2160 PR AMALGAM THREE SURFACES 250 D2161 PR AMALGAM 4 OR > SURFACES 300 D2330 PR RESIN ONE SURFACE-ANTERIOR 180.00 D2331 PR RESIN TWO SURFACES- 220.00 D2332 PR RESIN THREE SURFACES- 290.00 D2335 PR RESIN 4/> SURF OR W INCIS AN 350.00 D2390 PR ANT RESIN-BASED CMPST 500 D2391 PR POST 1 SRFC RESINBASED 200.00 D2392 PR POST 2 SRFC RESINBASED 260.00 D2393 PR POST 3 SRFC RESINBASED 320.00 D2394 PR POST >=4SRFC RESINBASE 380.00 D2520 PR DENTAL INLAY METALLIC 2 SURF 1000 D2530 PR DENTAL INLAY METL 3/MORE 1100 D2542 PR DENTAL ONLAY METALLIC 2 1000 D2543 PR DENTAL ONLAY METALLIC 3 1100 D2620 PR INLAY PORCELAIN/CERAMIC 2 SU 1050 D2642 PR DENTAL ONLAY PORCELIN 2 1100 D2643 PR DENTAL ONLAY PORCELIN 3 1160 D2644 PR DENTAL ONLAY PORC 4/MORE 1200 D2651 PR INLAY COMPOSITE/RESIN TWO 950 D2652 PR DENTAL INLAY RESIN 3/MRE SUR 1000 D2662 PR DENTAL ONLAY RESIN 2 1100 D2663 PR DENTAL ONLAY RESIN 3 1150 D2664 PR DENTAL ONLAY RESIN 4/MRE 1000 D2740 PR CROWN PORCELAIN/CERAMIC 1200.00 D2750 PR CROWN PORCELAIN W/ H NOBLE 1200.00 D2751 PR CROWN PORCELAIN FUSED 1200 D2752 PR CROWN PORCELAIN W/ NOBLE 1200 D2780 PR CROWN 3/4 CAST HI NOBLE MET 1200 D2781 PR CROWN 3/4 CAST BASE METAL 1200 D2782 PR CROWN 3/4 CAST NOBLE METAL 1200 D2783 PR CROWN 3/4 1200 D2790 PR CROWN FULL CAST HIGH NOBLE 1200.00 D2799 PR PROVISIONAL CROWN 350 D2910 PR RECEMENT INLAY ONLAY OR 120.00 D2920 PR DENTAL RECEMENT CROWN 120.00 D2921 PR REATTACH TOOTH FRAGMENT 180 D2929 PREFABRICATED 400 PORCELAIN/CERAMIC CROWN, D2930 PR PREFAB STNLSS STEEL CRWN 290.00 D2931 PR PREFAB STNLSS STEEL CROWN 300.00 D2940 PR DENTAL SEDATIVE FILLING 120.00 D2941 PR INT THERAPEUTIC RESTORATION 100.00 D2950 PR CORE BUILD-UP INCL ANY PINS 300.00 D2951 PR TOOTH PIN RETENTION 70.00 D2952 PR POST AND CORE CAST + CROWN 500.00 D2954 PR PREFAB POST/CORE + CROWN 380.00 D2960 PR LAMINATE LABIAL VENEER 700.00 D2962 PR LAB LABIAL VENEER PORCELAIN 1200.00 D2975 PR COPING 200.00 D2980 PR CROWN REPAIR 225.00 D2999 PR DENTAL UNSPEC RESTORATIVE 0.00 D3110 PR PULP CAP DIRECT 95.00 D3120 PR PULP CAP INDIRECT 95 D3220 PR THERAPEUTIC PULPOTOMY 200.00 D3221 PR GROSS PULPAL DEBRIDEMENT 250.00 D3222 PR PART PULP FOR APEXOGENESIS 200 D3230 PR PULPAL THERAPY ANTERIOR 300 D3240 PR PULPAL THERAPY POSTERIOR 350 D3310 PR ANTERIOR 800.00 D3320 PR ROOT CANAL THERAPY 2 900.00 D3330 PR ROOT CANAL THERAPY 3 1100 D3331 PR NON-SURG TX ROOT CANAL OBS 800 D3332 PR INCOMPLETE ENDODONTIC TX 500 D3333 PR INTERNAL ROOT REPAIR 300 D3346 PR RETREAT ROOT CANAL 950 D3347 PR RETREAT ROOT CANAL BICUSPID 1100 D3348 PR RETREAT ROOT CANAL MOLAR 1200 D3351 PR APEXIFICATION/RECALC INITIAL 350 D3352 PR APEXIFICATION/RECALC INTERIM 300.00 D3353 PR APEXIFICATION/RECALC FINAL 800 D3355 PR PULPAL REGENERATION INITIAL 200.00 D3356 PR PULPAL REGENERATION 150.00 D3410 PR APICOECT/PERIRAD SURG 800 D3421 PR ROOT SURGERY BICUSPID 900 D3425 PR ROOT SURGERY MOLAR 1100 D3426 PR ROOT SURGERY EA ADD ROOT 300 D3427 PR PERIRADICULAR SURGERY 550 D3450 PR ROOT AMPUTATION 500.00 D3460 PR ENDODONTIC ENDOSSEOUS 2000 D3470 PR INTENTIONAL REPLANTATION 1000 D4210 PR GINGIVECTOMY/PLASTY PER 680.00 D4212 GINGIVECTOMY/PLASTY REST 247.00 D4240 PR GINGIVAL FLAP PROC W/ PLANIN 680 D4241 PR GNGVL FLAP W ROOTPLAN 1-3 500 D4245 PR APICALLY POSITIONED FLAP 550 D4249 PR CROWN LENGTHEN HARD 900.00 D4260 PR OSSEOUS SURGERY PER 1100.00 D4261 PR OSSEOUS SURGL- 800.00 D4263 PR BONE REPLCE GRAFT FIRST SITE 650 D4264 PR BONE REPLCE GRAFT EACH ADD 450 D4265 PR BIO MTRLS TO AID SOFT/OS REG 527.00 D4266 PR GUIDED TISS REGEN RESORBLE 800 D4270 PR PEDICLE SOFT TISSUE GRAFT PR 1000.00 D4273 PR SUBEPITHELIAL TISSUE GRAFT 1100.00 D4274 PR DISTAL/PROXIMAL WEDGE PROC 350.00 D4277 SOFT TISSUE GRAFT 1ST TOOTH 1000.00 D4278 SOFT TISSUE GRAFT ADDL TOOTH 500.00 D4283 AUTO TISSUE GRAFT ADDL TOOTH 550.00 D4320 PR PROVISION SPLNT 600.00 D4321 PR PROVISIONAL SPLINT 500 D4341 PR PERIODONTAL SCALING & ROOT 275.00 D4342 PR PERIODONTAL SCALING 1- 190 D4355 PR FULL MOUTH DEBRIDEMENT 190.00 D4381 PR LOCALIZED DELIVERY 125 D4910 PR PERIODONTAL MAINT 160.00 D5110 PR DENTURES COMPLETE 2000.00 D5120 PR DENTURES COMPLETE 2000.00 D5130 PR DENTURES IMMEDIAT 1300 D5140 PR DENTURES IMMEDIAT MANDIBLE 1300 D5211 PR DENTURES MAXILL PART RESIN 1500.00 D5212 PR DENTURES MAND PART RESIN 1500.00 D5213 PR DENTURES MAXILL PART METAL 2000.00 D5214 PR DENTURES MANDIBL PART 2000.00 D5221 IMMED MAX PART DENTURE RESIN 1250 D5222 IMMED MAN PART DENTURE RESIN 1250 D5223 IMMED MAX PART DENT METAL 1500 D5224 IMMED MAND PART DENT METAL 1500 D5225 PR MAXILLARY PART DENTURE FLEX 1800.00 D5226 PR MANDIBULAR PART DENTURE 1800.00 D5281 PR REMOVABLE PARTIAL DENTURE 1200 D5410 PR DENTURES ADJUST CMPLT 100.00 D5411 PR DENTURES ADJUST CMPLT 100.00 D5421 PR DENTURES ADJUST PART MAXILL 100.00 D5422 PR DENTURES ADJUST PART 100.00 D5510 PR DENTUR REPR BROKEN COMPL 230.00 D5511 REPAIR BROKEN COMPLETE 300 DENTURE BASE, MANDIBULAR D5512 REPAIR BROKEN COMPLETE 250.00 DENTURE BASE, MAXILLARY D5520 PR REPLACE DENTURE TEETH 200.00 D5610 PR DENTURES REPAIR RESIN BASE 230.00 D5611 REPAIR RESIN PARTIAL DENTURE 300 BASE, MANDIBULAR D5612 REPAIR RESIN PARTIAL DENTURE 300 BASE, MAXILLARY D5621 REPAIR CAST PARTIAL 300 FRAMEWORK, MANDIBULAR D5622 REPAIR CAST PARTIAL 300 FRAMEWORK, MAXILLARY D5630 PR REP PARTIAL DENTURE CLASP 300.00 D5640 PR REPLACE PART DENTURE TEETH 200.00 D5650 PR ADD TOOTH TO PARTIAL 230.00 D5660 PR ADD CLASP TO PARTIAL 300.00 D5710 PR DENTURES REBASE CMPLT 600.00 D5711 PR DENTURES REBASE CMPLT 600.00 D5720 PR DENTURES REBASE PART 600.00 D5721 PR DENTURES REBASE PART 600.00 D5730 PR DENTURE RELN CMPLT MAXIL CH 400.00 D5731 PR DENTURE RELN CMPLT MAND 400.00 D5740 PR DENTURE RELN PART MAXIL CHR 400 D5741 PR DENTURE RELN PART MAND CHR 400 D5750 PR DENTURE RELN CMPLT MAX LAB 500 D5751 PR DENTURE RELN CMPLT MAND 500 D5760 PR DENTURE RELN PART MAXIL LAB 500.00 D5761 PR DENTURE RELN PART MAND LAB 500.00 D5810 PR DENTURE INTERM CMPLT MAXILL 1000.00 D5811 PR DENTURE INTERM CMPLT 1000.00 D5820 PR DENTURE INTERM PART MAXILL 800.00 D5821 PR DENTURE INTERM PART MANDBL 800.00 D5850 PR DENTURE TISS CONDITN MAXILL 250.00 D5851 PR DENTURE TISS CONDTIN 250.00 D5862 PR PRECISION ATTACHMENT 700.00 D5863 OVERDENTURE COMPLETE 2000 D5864 OVERDENTURE PARTIAL MAXILLARY 2000 D5865 OVERDENTURE COMPLETE 2000 D5866 OVERDENTURE PARTIAL 2000 D5875 PR PROSTHESIS MODIFICATION 800 D5933 PR REFITTING OF OBTURATOR 250.00 D5982 PR SURGICAL STENT 500.00 D5983 PR RADIATION APPLICATOR 450 D5986 PR FLUORIDE APPLICATOR 190.00 D5988 PR SURGICAL SPLINT 500 D6010 PR ODONTICS ENDOSTEAL IMPLANT 2000.00 D6056 PR PREFABRICATED ABUTMENT 1000.00 D6057 PR CUSTOM ABUTMENT 1100.00 D6058 PR ABUTMENT SUPPORTED CROWN 1400.00 D6059 PR ABUTMENT SUPPORTED MTL 1400.00 D6065 PR IMPLANT SUPPORTED CROWN 1336.00 D6066 PR IMPLANT SUPPORTED MTL 1015.00 D6068 PR ABUTMENT SUPPORTED 1125.00 D6071 PR ABUTMENT SUPPORTED 1000.00 D6076 PR IMPLANT SUPPORTED RETAINER 1100.00 D6090 PR REPAIR IMPLANT 250 D6091 PR REPL SEMI/PRECISION ATTACH 150.00 D6092 PR RECEMENT SUPP CROWN 200.00 D6096 REMOVE BROKEN IMPLANT 300.00 RETAINING SCREW D6100 PR REMOVAL OF IMPLANT 1000.00 D6104 BONE GRAFT TIME OF IMPLANT 800.00 D6111 IMPLNT/ABUT REMOV DENT MAND 2000.00 D6118 IMPLANT/ABUT SUPPORTED 3500.00 INTERIM FIXED DENTURE FOR D6119 IMPLANT/ABUT SUPPORTED 3500.00 INTERIM FIXED DENTURE FOR D6212 PR BRIDGE NOBLE METAL CAST 1100.00 D6240 PR BRIDGE PORCELAIN HIGH NOBLE 1100.00 D6242 PR BRIDGE PORCELAIN NOBEL 1100.00 D6245 PR BRIDGE PORCELAIN/CERAMIC 950.00 D6545 PR DENTAL RETAINR CAST METL 800.00 D6740 PR CROWN PORCELAIN/CERAMIC 975.00 D6750 PR CROWN PORCELAIN HIGH NOBLE 1200.00 D6752 PR CROWN PORCELAIN NOBLE 1100.00 D6930 PR DENTAL RECEMENT BRIDGE 200.00 D7111 PR EXTRACTION CORONAL 100.00 D7140 PR EXTRACTION ERUPTED 180.00 D7210 PR REM IMP TOOTH W MUCOPER 300.00 D7220 PR IMPACT TOOTH REMOV SOFT 375.00 D7230 PR IMPACT TOOTH REMOV PART 450.00 D7240 PR IMPACT TOOTH REMOV COMP 600.00 D7260 PR ORAL ANTRAL FISTULA CLOSURE 1300.00 D7270 PR TOOTH REIMPLANTATION 700.00 D7280 PR EXPOSURE IMPACT TOOTH 400.00 D7283 PR PLACE DEVICE IMPACTED 300.00 D7285 PR BIOPSY OF ORAL TISSUE HARD 500.00 D7286 PR BIOPSY OF ORAL TISSUE SOFT 400.00 D7310 PR ALVEOPLASTY W/ EXTRACTION 350.00 D7311 PR ALVEOLOPLASTY W/EXTRACT 1-3 145.00 D7320 PR ALVEOPLASTY W/O EXTRACTION 600.00 D7321 PR ALVEOLOPLASTY NOT 125.00 D7411 PR EXCISION BENIGN LESION>1.25C 470.00 D7451 PR REM ODONTOGEN CYST > 1.25 250.00 D7465 PR LESION DESTRUCTION 294.00 D7471 PR REM EXOSTOSIS ANY SITE 800.00 D7472 PR REMOVAL OF TORUS PALATINUS 625.00 D7473 PR REMOVE TORUS MANDIBULARIS 625.00 D7510 PR I&D ABSC INTRAORAL SOFT TISS 280.00 D7530 PR REMOVAL FB SKIN/AREOLAR 408.00 D7540 PR REMOVAL OF FB REACTION 180.00 D7670 PR CLOSD RDUCTN SPLINT 2000.00 D7910 PR DENT SUTUR RECENT WND TO 400.00 D7951 PR SINUS AUG W BONE/BONE SUP 1500.00 D7953 PR BONE REPLACEMENT GRAFT 800.00 D7960 PR FRENULECTOMY/FRENULOTOMY 500.00 D7970 PR EXCISION HYPERPLASTIC 600.00 D7971 PR EXCISION PERICORONAL 450.00 D8030 PR LIMITED DENTAL TX 3500.00 D8080 PR COMPRE DENTAL TX 6500.00 D8210 PR ORTHODONTIC REM APPLIANCE 800.00 D8220 PR FIXED APPLIANCE THERAPY 1200.00 D8660 PR PREORTHODONTIC TX VISIT 37.00 D8670 PR PERIODIC ORTHODONTC TX 702.00 D8680 PR ORTHODONTIC RETENTION 190.00 D8690 PR ORTHODONTIC TREATMENT 184.00 D8692 PR REPLACEMENT RETAINER 500.00 D8693 PR REBOND/CEMENT/REPAIR 45.00 D8695 REMOVAL OF FIXED ORTHO 350.00 APPLIANCES FOR REASONS OTHER D9110 PR TX DENTAL PAIN MINOR PROC 150.00 D9120 PR FIX PARTIAL DENTURE SECTION 225.00 D9230 PR ANALGESIA 100.00 D9239 INTRAVENOUS MODERATE 200.00 (CONSCIOUS) SEDATION/ANALGESIA- D9243 IV SEDATION EACH 15M 155.00 D9248 PR SEDATION (NON-IV) 300.00 D9310 PR DENTAL CONSULTATION 98.00 D9430 PR OFFICE VISIT DURING HOURS 90.00 D9450 PR CASE PRESENTATION TX PLAN 0.00 D9630 PR OTHER DRUGS/MEDICAMENTS 57.00 D9910 PR DENT APPL DESENSITIZING MED 50 D9940 PR DENTAL OCCLUSAL GUARD 700.00 D9941 PR FABRICATION ATHLETIC GUARD 250.00 D9943 OCCLUSAL GUARD ADJUSTMENT 44.00 D9951 PR LIMITED OCCLUSAL 225.00 D9970 PR ENAMEL MICROABRASION 35.00 D9971 PR ODONTOPLASTY 1-2 TEETH 150.00 D9973 PR EXTRNL BLEACHING PER TOOTH 300.00 D9974 PR INTRNL BLEACHING PER TOOTH 350.00 D9975 EXTERNAL BLEACHING HOME ARCH 200.00 TOOTH WHITENING FROM OUTSIDE E0191 PR PROTECTOR HEEL OR ELBOW 145.00 E0486 PR ORAL DEVICE/APPLIANCE 1700.00 E0720 PR TENS TWO LEAD 510.00 E0731 PR CONDUCTIVE GARMENT FOR 462.00 E0860 PR TRACT EQUIP CERVICAL TRACT 69.00 G0008 PR ADMIN INFLUENZA VIRUS VAC 21 G0009 PR ADMIN PNEUMOCOCCAL 21 G0010 PR ADMIN HEPATITIS B VACCINE 21 G0101 PR CA SCREEN;PELVIC/BREAST 95.00 G0103 PR PSA, TOTAL SCREENING 61 G0104 PR CA SCREEN;FLEXI 335.00 G0105 PR COLORECTAL SCRN; HI RISK IND 1036.00 G0108 PR DIAB MANAGE TRN PER INDIV 132.00 G0117 PR GLAUCOMA SCRN HGH RISK 136.00 G0120 PR COLON CA SCRN; BARIUM 539.00 G0120 PR COLON CA SCRN; BARIUM 26 133.00 G0121 PR COLON CA SCRN NOT HI RSK IND 961.00 G0124 PR SCREEN C/V THIN LAYER BY MD 82 G0127 PR TRIM NAIL(S) 45.00 G0168 PR WOUND CLOSURE BY ADHESIVE 257.00 G0179 PR MD RECERTIFICATION HHA PT 140.00 G0180 PR MD CERTIFICATION HHA PATIENT 150.00 G0181 PR HOME HEALTH CARE 271.00 G0182 PR HOSPICE CARE SUPERVISION 273.00 G0202 PR SCR MAMMO BI INCL CAD 341.00 G0202 PR SCR MAMMO BI INCL CAD 26 81.00 G0204 PR DX MAMMO INCL CAD BI 26 101.00 G0206 PR DX MAMMO INCL CAD UNI 26 81.00 G0270 PR MNT SUBS TX FOR CHANGE DX 76.00 G0271 PR GROUP MNT 2 OR MORE 30 MINS 40.00 G0279 PR TOMOSYNTHESIS, MAMMO 26 129.00 G0289 PR ARTHRO, LOOSE BODY + 286.00 G0296 PR VISIT TO DETERM LDCT ELIG 136.00 G0297 PR LDCT FOR LUNG CA SCREEN 507.00 G0297 PR LDCT FOR LUNG CA SCREEN 26 129.00 G0364 PR BONE MARROW ASPIRATE 35.00 G0365 PR VESSEL MAPPING HEMO ACCESS 503.00 G0365 PR VESSEL MAPPING HEMO ACCESS 26 31.00 G0372 PR MD SERVICE REQUIRED FOR 52.00 G0389 PR ULTRASOUND EXAM AAA 26 68.00 G0399 PR HOME SLEEP TEST/TYPE 3 26 147.00 G0402 PR INITIAL PREVENTIVE EXAM 415.00 G0403 PR EKG FOR INITIAL PREVENT EXAM 50.00 G0403 PR EKG FOR INITIAL PREVENT EXAM 26 50.00 G0405 PR EKG INTERPRET & REPORT 22.00 G0413 PR PELVIC RING FRACTURE UNI/BIL 3357.00 G0414 PR PELVIC RING FX TREAT INT FIX 3480.00 G0415 PR OPEN TX POST PELVIC FXCTURE 4894.00 G0416 PR PROSTATE BIOPSY, ANY MTHD 26 462 G0420 PR ED SVC CKD IND PER SESSION 272.00 G0425 INPT/ED TELECONSULT30 245.00 G0432 PR EIA HIV-1/HIV-2 SCREEN 49.00 G0436 PR TOBACCO-USE COUNSEL 3-10 35.00 G0437 PR TOBACCO-USE COUNSEL>10MIN 70.00 G0438 PR PPPS, INITIAL VISIT 427.00 G0439 PR PPPS, SUBSEQ VISIT 290.00 G0442 PR ANNUAL ALCOHOL SCREEN 15 42.00 G0443 PR BRIEF ALCOHOL MISUSE 65 G0444 PR DEPRESSION SCREEN ANNUAL 43.00 G0446 PR INTENS BEHAVE THER CARDIO 59.00 G0447 PR BEHAVIOR COUNSEL OBESITY 65 G0451 PR DEVLOPMENT TEST 26.00 G0452 PR MOLECULAR PATHOLOGY 26 100.00 G0455 PR FECAL MICROBIOTA PREP INSTIL 274.00 G0500 PR MOD SEDAT ENDO SERVICE 149.00 G0502 PR INIT PSYCH CARE MANAG, 70MIN 358.00 G0503 PR SUBSEQ PSYCH CARE MAN,60MI 316.00 G0504 PR INIT/SUB PSYCH CARE ADD 30 M 166.00 G0505 PR COG/FUNC ASSESSMENT OUTPT 596.00 G0506 PR COMP ASSES CARE PLAN CCM 160.00 G0508 PR CRIT CARE TELEHEA CONSULT 504.00 G0509 PR CRIT CARE TELEHEA CONSULT 486.00 G6002 PR STEREOSCOPIC X-RAY 26 50.00 G8600 PR TPA INITI W/IN 3 HRS 0.00 G8601 PR NO ELIG TPA INIT W/IN 3 HRS 0.00 G8602 PR NO TPA INIT W/IN 3 HRS 0.00 H2036 PR A/D TX PROGRAM, PER DIEM 280.00 J0171 PR ADRENALIN EPINEPHRINE 19.00 J0558 PR PENG BENZATHINE/PROCAINE 9.00 J0561 PR PENICILLIN G BENZATHINE INJ 20.00 J0585 PR 15.5 J0670 PR INJ MEPIVACAINE HCL/10 ML 10.00 J0696 PR CEFTRIAXONE SODIUM 20.00 J1020 PR METHYLPREDNISOLONE 20 MG 10.00 J1030 PR METHYLPREDNISOLONE 40 MG 11.00 J1040 PR METHYLPREDNISOLONE 80 MG 26.00 J1050 PR MEDROXYPROGESTERONE 1.00 J1071 PR INJ TESTOSTERONE CYPIONATE 1.00 J1100 PR DEXAMETHASONE SODIUM PHOS 2.00 J1439 PR INJ FERRIC CARBOXYMALTOS 3.00 J1815 PR INSULIN INJECTION 2.00 J1885 PR KETOROLAC TROMETHAMINE INJ 10.00 J2001 PR LIDOCAINE INJECTION 0.00 J2357 PR OMALIZUMAB INJECTION 76.00 J2405 PR ONDANSETRON HCL INJECTION 3.00 J2790 PR RHO D IMMUNE GLOBULIN INJ 184.00 J2930 PR METHYLPREDNISOLONE 12.00 J3301 PR TRIAMCINOLONE ACETONIDE INJ 5.00 J3420 PR VITAMIN B12 INJECTION 8.00 J7030 PR NORMAL SALINE SOLUTION 16.00 J7042 PR 5% DEXTROSE/NORMAL SALINE 11.00 J7296 PR KYLEENA, 19.5 MG 1818 J7298 PR MIRENA, 52 MG 1810 J7300 PR INTRAUT COPPER 1848.00 J7301 PR SKYLA, 13.5 MG 1620 J7307 ETONOGESTREL IMPLANT SYSTEM 1670 J7323 EUFLEXXA INJ PER DOSE 381.00 J7510 PR PREDNISOLONE ORAL PER 5 MG 1.00 J7613 PR ALBUTEROL NON-COMP UNIT 2.00 J7620 PR ALBUTEROL IPRATROP NON- 3.00 J7644 PR IPRATROPIUM BROMIDE NON- 5.00 J9267 PR PACLITAXEL INJECTION 1.00 J9306 PR INJECTION, PERTUZUMAB, 1 MG 92.00 L0112 PR CRANIAL CERVICAL ORTHOSIS 1531.00 L0120 PR CERV FLEX N/ADJ FOAM PRE 97.00 L0160 PR CERV SR WIRE OCC/MAN PRE 154.00 L0172 PR CERV COL SR FOAM 2PC PRE 137.00 L0174 PR CERV SR 2PC THOR EXT PRE 269.00 L0200 PR CERV COL SUPP ADJ BAR & 565.00 L0450 PR TLSO FLEX TRUNK/THOR PRE 174.00 L0456 PR TLSO FLEX TRNK SJ-SS PRE CST 1133.00 L0457 PR TLSO FLEX TRNK SJ-SS PRE OTS 1157.00 L0464 PR TLSO 4MOD SACRO-SCAP PRE 1519.00 L0472 PR TLSO RIGID FRAME HYPEREX 396.00 L0480 PR TLSO RIGID PLASTIC CUSTOM FA 1394.00 L0482 PR TLSO RIGID LINED CUSTOM FAB 1856.00 L0486 PR TLSO RIGIDLINED CUST FAB TWO 1846.00 L0488 PR TLSO RIGID LINED PRE ONE PIE 1192.00 L0491 PR TLSO 2 PIECE RIGID SHELL 785.00 L0621 PR SIO FLEX PELVIC/SACR PRE OTS 94.00 L0626 PR LO SAG RIG PNL STAYS PRE CST 83.00 L0627 PR LO SAG RI AN/POS PNL PRE CST 444.00 L0628 PR LSO FLEX NO RI STAYS PRE OTS 109.00 L0630 PR LSO R POST PNL SJ-T9 PRE CST 192.00 L0631 PR LSO SAG R AN/POS PNL PRE CST 1049.00 L0637 PR LSO SC R ANT/POS PNL PRE CST 971.00 L0638 PR LSO SAG-CORONAL PANEL 1348.00 L0639 PR LSO S/C SHELL/PANEL PREFAB 1098.00 L0640 PR LSO S/C SHELL/PANEL CUSTOM 1069.00 L0710 PR CTLSO A-P-L CONTROL W/ INTER 2044.00 L0810 PR HALO CERVICAL INTO JCKT VEST 2963 L0859 PR MRI COMPATIBLE SYSTEM 1562 L0861 PR HALO REPL LINER/INTERFACE 253.00 L0974 PR TLSO FULL CORSET 176.00 L0984 PR PROTECT BODY SOCK EA PRE 67.00 L1000 PR CTLSO MILWAUKE INITIAL MODEL 2008.00 L1005 PR TENSION BASED SCOLIOSIS 3588.00 L1020 PR KYPHOSIS PAD 98.00 L1040 PR LUMBAR OR LUMBAR RIB PAD 82.00 L1050 PR STERNAL PAD 117.00 L1060 PR THORACIC PAD 118.00 L1110 PR RING FLANGE PLAS/LEATHER 287.00 L1210 PR LATERAL THORACIC EXTENSION 257.00 L1220 PR ANTERIOR THORACIC 281.00 L1290 PR LATERAL TROCHANTERIC PAD 81.00 L1300 PR BODY JACKET MOLD TO PATIENT 1803.00 L1499 PR SPINAL ORTHOSIS NOS 525.00 L1620 PR HO FLEX PAVLIK HARNS PRE CST 183.00 L1650 PR HO ABDUCTION HIP ADJUSTABLE 256.00 L1686 PR HO POST-OP HIP ABDUCTION 1124.00 L1690 PR COMBINATION BILATERAL HO 1976.00 L1810 PR KO ELASTIC WITH JOINTS 97.00 L1812 PR KO ELASTIC W/JOINTS PRE OTS 111.00 L1820 PR KO ELAS W/ CONDYLE PADS & JO 172.00 L1830 PR KO IMMOB CANVAS LONG PRE 177.00 L1831 PR KNEE ORTH POS LOCKING JOINT 349.00 L1832 PR KO ADJ JNT POS R SUP PRE CST 794.00 L1833 PR KO ADJ JNT POS R SUP PRE OTS 794.00 L1836 PR KO RIGID W/O JOINTS PRE OTS 159.00 L1843 PR KO SINGLE UPRIGHT PRE CST 1063 L1844 PR KO W/ADJ JT ROT CNTRL 1589.00 L1845 PR KO DOUBLE UPRIGHT PRE CST 1091.00 L1846 PR KO W ADJ FLEX/EXT ROTAT 1080.00 L1850 PR KO SWEDISH TYPE PRE OTS 298.00 L1851 PR KO SINGLE UPRIGHT PREFAB 1063 L1902 PR AFO ANKLE GAUNTLET PRE OTS 105.00 L1906 PR AFO MULTILIG ANK SUP PRE OTS 229.00 L1907 PR AFO SUPRAMALLEOLAR CUSTOM 660.00 L1930 PR AFO PLASTIC 232.00 L1932 PR AFO RIG ANT TIB PREFAB TCF/= 912.00 L1940 PR AFO MOLDED TO PATIENT 484.00 L1945 PR AFO MOLDED PLAS RIG ANT TIB 1158.00 L1950 PR AFO SPIRAL MOLDED TO PT 768.00 L1951 PR AFO SPIRAL PREFABRICATED 919.00 L1960 PR AFO POS SOLID ANK PLASTIC MO 664.00 L1970 PR AFO PLASTIC MOLDED W/ANKLE 799.00 L1971 PR AFO W/ANKLE JOINT, PREFAB 499.00 L1990 PR AFO DOUB SOLID STIRRUP CALF 509.00 L2010 PR KAFO SNG SOLID STIRRUP W/O J 965.00 L2020 PR KAFO DBL SOLID STIRRUP BAND/ 1214.00 L2030 PR KAFO DBL SOLID STIRRUP W/O J 1102.00 L2034 PR KAFO PLA SIN UP W/WO K/A CUS 2171.00 L2035 PR KAFO PLASTIC PEDIATRIC SIZE 179.00 L2036 PR KAFO PLAS DOUB FREE KNEE 1882.00 L2037 PR KAFO PLAS SING FREE KNEE 1756.00 L2038 PR KAFO W/O JOINT MULTI-AXIS AN 2006 L2070 PR HKAFO TORSION UNILAT ROT 167.00 L2106 PR AFO TIB FX CAST PLASTER MOLD 771.00 L2108 PR AFO TIB FX CAST MOLDED TO PT 1329.00 L2112 PR AFO TIBIAL FRACTURE SOFT 533.00 L2114 PR AFO TIB FX SEMI-RIGID 669.00 L2116 PR AFO TIBIAL FRACTURE RIGID 769.00 L2128 PR KAFO FEM FX CAST MOLDED TO 1822.00 L2180 PR PLAS SHOE INSERT W ANK JOINT 136.00 L2182 PR DROP LOCK KNEE 98.00 L2200 PR LIMITED ANKLE MOTION EA JNT 47.00 L2210 PR DORSIFLEXION ASSIST EACH JOI 68.00 L2220 PR DORSI & PLANTAR FLEX ASS/RES 81.00 L2230 PR SPLIT FLAT CALIPER STIRR & P 76.00 L2232 PR ROCKER BOTTOM, CONTACT 106.00 L2250 PR FOOT PLATE MOLDED STIRRUP 377.00 L2260 PR REINFORCED SOLID STIRRUP 228.00 L2265 PR LONG TONGUE STIRRUP 123.00 L2270 PR VARUS/VALGUS STRAP 55.00 L2275 PR PLASTIC MOD LOW EXT PAD/LINE 147.00 L2280 PR MOLDED INNER BOOT 511.00 L2300 PR ABDUCTION BAR JOINTED 314.00 L2320 PR NON-MOLDED LACER 202.00 L2330 PR LACER MOLDED TO PATIENT 422.00 L2340 PR PRE-TIBIAL SHELL MOLDED TO P 564.00 L2350 PR PROSTHETIC TYPE SOCKET 973.00 L2360 PR EXTENDED STEEL SHANK 51.00 L2380 PR TORSION STRAIGHT KNEE JOINT 132.00 L2385 PR STRAIGHT KNEE JOINT HEAVY 132.00 L2390 PR OFFSET KNEE JOINT EACH 110.00 L2395 PR OFFSET KNEE JOINT HEAVY 177.00 L2405 PR KNEE JOINT DROP LOCK EA JNT 90.00 L2415 PR KNEE JOINT CAM LOCK EACH JOI 155.00 L2425 PR KNEE DISC/DIAL LOCK/ADJ FLEX 150.00 L2430 PR KNEE JNT RATCHET LOCK EA 168.00 L2510 PR TH/WGHT BEAR QUAD-LAT BRIM 714.00 L2525 PR TH/WGHT BEAR NAR M-L BRIM 1452.00 L2526 PR TH/WGHT BEAR NAR M-L BRIM 725.00 L2540 PR THIGH/WGHT BEAR LACER 414.00 L2610 PR HIP CLEVIS/THRUST BEARING LO 306.00 L2624 PR HIP ADJ FLEX EXT ABDUCT CONT 325.00 L2640 PR PELVIC CONTROL BAND & BELT B 369.00 L2660 PR THORACIC CONTROL THORACIC 183.00 L2680 PR THORAC CONT LAT SUPPORT 197.00 L2750 PR PLATING CHROME/NICKEL PR 82.00 L2755 PR CARBON GRAPHITE LAMINATION 134.00 L2760 PR EXTENSION PER EXTENSION 60.00 L2768 PR ORTHO SIDEBAR DISCONNECT 150.00 L2780 PR NON-CORROSIVE FINISH 67.00 L2785 PR DROP LOCK RETAINER EACH 32.00 L2795 PR KNEE CONTROL FULL KNEECAP 85.00 L2800 PR KNEE CAP MEDIAL OR LATERAL 130.00 L2810 PR KNEE CONTROL CONDYLAR PAD 102.00 L2820 PR SOFT INTERFACE BELOW KNEE 85.00 L2830 PR SOFT INTERFACE ABOVE KNEE 92.00 L2840 PR TIBIAL LENGTH SOCK FX OR EQU 63.00 L3000 PR FT INSERT UCB BERKELEY 321.00 L3010 PR FOOT LONGITUDINAL ARCH 178.00 L3020 PR FOOT LONGITUD/METATARSAL 173.00 L3030 PR FOOT ARCH SUPPORT REMOV 78.00 L3031 PR FOOT LAMIN/PREPREG 50.00 L3050 PR FOOT ARCH SUPP PREMOLD 33.00 L3060 PR FOOT ARCH SUPP 76.00 L3090 PR ARCH SUPP ATT TO SHOE 42.00 L3100 PR HALLUS-VALGUS NT DYN PRE 52 L3150 PR ABDUCT ROTATION BAR W/O 103.00 L3160 PR SHOE STYLED POSITIONING DEV 157.00 L3202 PR OXFORD W/ SUPINAT/PRONATOR 45.00 L3203 PR OXFORD W/ 45.00 L3204 PR HIGHTOP W/ SUPP/PRONATOR 45.00 L3206 PR HIGHTOP W/ SUPP/PRONATOR 58.00 L3207 PR HIGHTOP W/ SUPP/PRONATOR 63.00 L3216 PR ORTHOPED LADIES SHOES DPTH 82.50 L3221 PR ORTHOPEDIC MENS SHOES 82.50 L3222 PR MENS SHOES HIGHTOP DEPTH 85.00 L3224 PR WOMAN'S SHOE OXFORD BRACE 100.00 L3225 PR MAN'S SHOE OXFORD BRACE 100.00 L3230 PR CUSTOM SHOES DEPTH INLAY 247.50 L3250 PR CUSTOM MOLD SHOE REMOV 247.50 L3253 PR SHOE MOLDED PLASTAZOTE 140.00 L3257 PR ORTH FOOT ADD CHARGE SPLIT 192.00 L3260 PR AMBULATORY SURGICAL BOOT 40.00 L3300 PR SHO LIFT TAPER TO 54.00 L3310 PR SHOE LIFT ELEV HEEL/SOLE NEO 96.00 L3330 PR LIFTS ELEVATION METAL 663.00 L3332 PR SHOE LIFTS TAPERED TO ONE- 87.00 L3334 PR SHOE LIFTS ELEVATION HEEL /I 39.00 L3350 PR SHOE HEEL WEDGE 36.00 L3360 PR SHOE SOLE WEDGE OUTSIDE 37.00 L3370 PR SHOE SOLE WEDGE BETWEEN 51.00 L3390 PR SHOE OUTFLARE WEDGE 92.00 L3400 PR SHOE METATARSAL BAR WEDGE 54.00 L3410 PR SHOE METATARSAL BAR 95.00 L3440 PR HEEL LEATHER REINFORCED 78.00 L3450 PR SHOE HEEL SACH CUSHION 108.00 L3485 PR SHOE HEEL PAD REMOVABLE 45.00 L3530 PR ORTHO SHOE ADD HALF SOLE 38.00 L3540 PR ORTHO SHOE ADD FULL SOLE 52.00 L3550 PR O SHOE ADD STANDARD TOE 11.00 L3600 PR TRANS SHOE CALIP PLATE EXIST 90 L3610 PR TRANS SHOE CALIPER PLATE 150.00 L3620 PR TRANS SHOE SOLID STIRRUP EXI 130.00 L3630 PR TRANS SHOE SOLID STIRRUP 195.00 L3649 PR ORTHOPEDIC SHOE MODIFICA 105.00 L3650 PR SO 8 ABD RESTRAINT PRE OTS 66.00 L3660 PR SO 8 AB RSTR CAN/WEB PRE 99.00 L3670 PR SO ACRO/CLAV CAN WEB PRE 150.00 L3674 PR SO AIRPLANE W/WO JOINT CF 1274.00 L3675 PR SO VEST CANVAS/WEB PRE OTS 188.00 L3740 PR CUFFS ADJ LOCK W/ ACTIVE CON 1024.00 L3760 PR EO ADJ JT PREFAB CUSTOM FIT 465.00 L3762 PR EO RIGID W/O JOINTS PRE OTS 111.00 L3807 PR WHFO W/O JOINTS PRE CST 261.00 L3808 PR WHFO, RIGID W/O JOINTS 399.00 L3900 PR HINGE EXTENSION/FLEX WRIST/F 1356.00 L3906 PR WHO W/O JOINTS CF 410.00 L3908 PR WHO COCK-UP NONMOLDE PRE 126.00 L3915 PR WHO NONTORSION JNTS PRE 573 L3919 PR HO W/O JOINTS CF 289.00 L3960 PR SEWHO AIRPLAN DESIG ABDU 705.00 L3980 PR UP EXT FX ORTHOS HUMERAL 307.00 L3982 PR UPPER EXT FX ORTHOSIS 410.00 L3984 PR UPPER EXT FX ORTHOSIS WRIST 330.00 L4002 PR REPLACE STRAP, ANY ORTHOSIS 12.00 L4100 PR REPL LEATH CUFF KAFO PROX 118.00 L4110 PR REPL LEATH CUFF KAFO-AFO 89.00 L4205 PR ORTHO DVC REPAIR PER 15 MIN 20.00 L4210 PR ORTH DEV REPAIR/REPL MINOR 12.00 L4350 PR ANKLE CONTROL ORTHO PRE 114.00 L4360 PR PNEUMAT WALKING BOOT PRE 346.00 L4370 PR PNEUM FULL LEG SPLNT PRE 200.00 L4386 PR NON-PNEUM WALK BOOT PRE 186.00 L4396 PR STATIC OR DYNAMI AFO PRE CST 172.00 L4398 PR FOOT DROP SPLINT PRE OTS 79.00 L4631 PR AFO, WALK BOOT TYPE, CUS FAB 1868.00 L5000 PR SHO INSERT W ARCH TOE FILLER 582.00 L5010 PR MOLD SOCKET ANK HGT W/ TOE 1270.00 L5100 PR MOLDED SOCKET SHIN SACH 2493.00 L5250 PR HIP CANAD SING AXI CONS FRIC 5794.00 L5301 PR BK MOLD SOCKET SACH FT 2394.00 L5321 PR AK OPEN END SACH 3427.00 L5341 PR HEMIPELVECTOMY CANADIAN 6000.00 L5450 PR POSTOP APP NON-WGT BEAR 448.00 L5611 PR AK 4 BAR LINK W/FRIC SWING 1680.00 L5618 PR TEST SOCKET SYMES 382.00 L5620 PR TEST SOCKET BELOW KNEE 290.00 L5622 PR TEST SOCKET KNEE 443.00 L5624 PR TEST SOCKET ABOVE KNEE 423.00 L5626 PR TEST SOCKET HIP DISARTICULAT 594.00 L5628 PR TEST SOCKET 563.00 L5629 PR BELOW KNEE ACRYLIC SOCKET 430.00 L5631 PR AK/KNEE DISARTIC ACRYLIC SOC 560.00 L5637 PR BELOW KNEE TOTAL CONTACT 355.00 L5643 PR HIP FLEX INNER SOCKET EXT FR 1623.00 L5645 PR BK FLEX INNER SOCKET EXT FRA 832.00 L5646 PR BELOW KNEE CUSHION SOCKET 655.00 L5647 PR BELOW KNEE SUCTION SOCKET 830.00 L5649 PR ISCH CONTAINMT/NARROW M-L 2084.00 L5650 PR TOT CONTACT AK/KNEE DISART 509.00 L5651 PR AK FLEX INNER SOCKET EXT FRA 1253.00 L5652 PR SUCTION SUSP AK/KNEE DISART 485.00 L5654 PR SOCKET INSERT SYMES 401.00 L5655 PR SOCKET INSERT BELOW KNEE 336.00 L5656 PR SOCKET INSERT KNEE 413.00 L5666 PR BELOW KNEE CUFF SUSPENSION 92 L5670 PR BK MOLDED SUPRACONDYLAR 323.00 L5671 PR BK/AK LOCKING MECHANISM 519.00 L5673 PR SOCKET INSERT W LOCK MECH 733.00 L5679 PR SOCKET INSERT W/O LOCK 611.00 L5681 PR INTL CUSTM CONG/LATYP 1544.00 L5683 PR INITIAL CUSTOM SOCKET INSERT 1514.00 L5685 PR BELOW KNEE SUS/SEAL SLEEVE 151.00 L5694 PR AK PELVIC CONTROL BELT PAD/L 190.00 L5695 PR AK SLEEVE SUSP 199.00 L5698 PR AK/KNEE DISARTIC SILESIAN BA 110.00 L5700 PR REPLACE SOCKET BELOW KNEE 3004.00 L5701 PR REPLACE SOCKET ABOVE KNEE 3727.00 L5704 PR CUSTOM SHAPE COVER BK 613.00 L5705 PR CUSTOM SHAPE COVER AK 1123.00 L5781 PR LOWER LIMB PROS VACUUM 4096.00 L5782 PR HD LOW LIMB PROS VACUUM 4738.00 L5811 PR ENDO KNEE-SHIN MNL LCK 761.00 L5814 PR ENDO KNEE-SHIN HYDRAL SWG 3802.00 L5828 PR ENDO KNEE-SHIN FLUID 3048.00 L5845 PR KNEE-SHIN SYS STANCE 1913.00 L5848 PR KNEE-SHIN SYS HYDRAUL 1101.00 L5850 PR ENDO AK/HIP KNEE EXTENS ASSI 139.00 L5855 PR MECH HIP EXTENSION ASSIST 322.00 L5856 PR ELEC KNEE-SHIN SWING/STANCE 24570.00 L5910 PR ENDO BELOW KNEE ALIGNABLE 381.00 L5920 PR ENDO AK/HIP ALIGNABLE 554.00 L5925 PR ABOVE KNEE MANUAL LOCK 350.00 L5930 PR HIGH ACTIVITY KNEE FRAME 3445.00 L5940 PR ENDO BK ULTRA-LIGHT 523.00 L5950 PR ENDO AK ULTRA-LIGHT 884.00 L5960 PR ENDO HIP ULTRA-LIGHT MATERIA 1059.00 L5962 PR BELOW KNEE FLEX COVER 613.00 L5968 PR MULTIAXIAL ANKLE W 3984.00 L5970 PR FOOT EXTERNAL KEEL SACH 229.00 L5972 PR FLEXIBLE KEEL FOOT 368.00 L5974 PR FOOT SINGLE AXIS ANKLE/FOOT 310.00 L5976 PR ENERGY STORING FOOT 584.00 L5979 PR MULTI-AXIAL ANKLE/FT PROSTH 2442.00 L5980 PR FLEX FOOT SYSTEM 3866.00 L5981 PR FLEX-WALK SYS LOW EXT 3342.00 L5984 PR ENDOSKELETAL AXIAL 598.00 L5986 PR MULTI-AXIAL ROTATION UNIT 665.00 L5987 PR SHANK FT W VERT LOAD PYLON 7363.00 L5988 PR VERTICAL SHOCK REDUCING 2045.00 L5990 PR USER ADJUSTABLE HEEL HEIGHT 1857.00 L5999 PR LOWR EXTREMITY PROSTHES 15600.00 L6050 PR WRST MLD SCK FLX HNG TRI 2296 L6100 PR ELB MOLD SOCK FLEX HINGE 2007.00 L6110 PR ELBOW MOLD SOCK 2129.00 L6500 PR ABOVE ELBOW PROSTH TISS 3217.00 L6611 PR ADDITIONAL SWITCH, EXT 483.00 L6615 PR DISCONNECT LOCKING WRIST 215.00 L6616 PR DISCONNECT INSERT LOCKING 91.00 L6629 PR LAMINATION COLLAR W/ 177.00 L6630 PR STAINLESS STEEL ANY WRIST 225.00 L6635 PR LIFT ASSIST FOR ELBOW 239.00 L6638 PR ELEC LOCK ON MANUAL PW 2967.00 L6655 PR STANDARD CONTROL CABLE 90.00 L6660 PR HEAVY DUTY CONTROL CABLE 96.00 L6670 PR HOOK TO HAND CABLE ADAPTER 55.00 L6672 PR HARNESS CHEST/SHLDER 176.00 L6675 PR HARNESS FIGURE OF 8 SING 126.00 L6676 PR HARNESS FIGURE OF 8 DUAL 127.00 L6680 PR TEST SOCK WRIST DISART/BEL E 270.00 L6682 PR TEST SOCK ELBW DISART/ABOVE 272.00 L6686 PR SUCTION SOCKET 784.00 L6687 PR FRAME TYP SOCKET BEL 697 L6688 PR FRAME TYP SOCK ABOVE 675.00 L6693 PR LOCKINGELBOW FOREARM 3369.00 L6694 PR ELBOW SOCKET INS USE 648.00 L6695 PR ELBOW SOCKET INS USE W/O 681.00 L6696 PR CUS ELBO SKT IN FOR CON/ATYP 1501.00 L6698 PR BELOW/ABOVE ELBOW LOCK 459.00 L6703 PR TERM DEV, PASSIVE HAND MITT 385.00 L6704 PR TERM DEV, SPORT/REC/WORK 637.00 L6706 PR TERM DEV MECH HOOK VOL 379.00 L6708 PR TERM DEV MECH HAND VOL 910.00 L6715 PR TERM DEVICE, MULTI ART DIGIT 3603.00 L6722 PR HOOK/HAND, HVY DTY, VOL 2406 L6881 PR TERM DEV AUTO GRASP 4479.00 L6882 PR MICROPROCESSOR CONTROL 3539.00 L6890 PR PREFAB GLOVE FOR TERM 198.00 L6955 PR ABOVE ELBOW MYOELECTRONIC 14809.00 L7007 PR ADULT ELECTRIC HAND 4384.00 L7367 PR REPLACEMNT LITHIUM 444.00 L7368 LITHIUM ION BATTERY CHARGER 576.00 L7400 PR ADD UE PROST BE/WD, ULTLITE 350.00 L7402 PR ADD UE PROST S/D ULTLITE MAT 427.00 L7403 PR ADD UE PROST B/E ACRYLIC 420.00 L7404 PR ADD UE PROST A/E ACRYLIC 641.00 L7499 PR UPPER EXTREMITY PROSTHES 2595.00 L7510 PR PROSTHETIC DEVICE REPAIR 62.00 L7520 PR REPAIR PROSTHESIS PER 15 MIN 16.00 L7700 PR PROS SOC INSERT GASKET/SEAL 350.00 L8300 PR TRUSS SINGLE W/ STANDARD 88.00 L8400 PR SHEATH BELOW KNEE 20.00 L8417 PR PROS SHEATH/SOCK W GEL 77.00 L8420 PR PROSTHETIC SOCK MULTI PLY 25.00 L8430 PR PROSTHETIC SOCK MULTI PLY 24.00 L8435 PR PROS SOCK MULTI PLY UPPER 22.00 L8440 PR SHRINKER BELOW KNEE 44.00 L8460 PR SHRINKER ABOVE KNEE 70.00 L8470 PR PROS SOCK SINGLE PLY BK 8.00 L8480 PR PROS SOCK SINGLE PLY AK 10.00 L8681 PR PT PRGRM FOR IMPLT 1290.00 L8689 PR EXTERNAL RECHARG SYS 2025.00 M0076 PR PROLOTHERAPY 250.00 P3001 PR SCREENING PAP SMEAR BY 82.00 Q0091 PR OBTAINING SCREEN PAP SMEAR 50.00 Q0111 PR WET MOUNTS/ W PREPARATIONS 14.00 Q0112 PR POTASSIUM HYDROXIDE PREPS 10.00 Q0138 PR FERUMOXYTOL, NON-ESRD 1.80 Q2036 PR FLULAVAL VACC, 3 YRS & >, IM 31.00 Q2038 PR FLUZONE VACC, 3 YRS & >, IM 41.00 Q3014 PR TELEHEALTH FACILITY FEE 43.00 Q4008 PR CAST SUP LONG ARM PED 67.00 Q4010 PR CAST SUP SHT ARM ADULT 61.00 Q4012 PR CAST SUP SHT ARM PED 61.00 Q4022 PR CAST SUP SHT ARM SPLINT 61.00 S0610 PR ANNUAL GYNECOLOGICAL 107.00 S0620 PR ROUTINE OPHTHALMOLOGICAL 90.00 S0621 PR ROUTINE OPHTHALMOLOGICAL 90.00 S0630 PR REMOVAL OF SUTURES 183.00 S1040 PR CRANIAL REMOLDING ORTHOSIS 2592.00 S2083 PR ADJUSTMENT GASTRIC BAND 500.00 S8032 PR LOW DOSE CT LUNG SCREENING 26 200.00 S8422 PR CUSTOM GRAD SLEEVE MED 198.00 S8424 PR READY GRADIENT SLEEVE 187.00 S8425 PR CUSTOM GRAD GLOVE MED 326.00 S8427 PR READY GRADIENT GLOVE 80.00 S8450 PR SPLINT DIGIT 10.00 S8451 PR SPLINT WRIST OR ANKLE 17.00 S9453 PR SMOKING CESSATION CLASS 31.00 S9470 PR NUTRITIONAL COUNSELING, DIET 51.00 V2520 PR CONTACT LENS HYDROPHILIC 135.00 V2627 PR SCLERAL COVER SHELL 3115.00 V5008 PR HEARING SCREENING 101.00 V5010 PR ASSESSMENT FOR HEARING AID 0.00 V5011 PR HEARING AID FITTING/CHECKING 85.00 V5014 PR HEARING AID REPAIR/MODIFYING 125.00 V5160 PR DISPENSING FEE BINAURAL 660.00 V5200 PR CROS HEARING AID DISPENS 330.00 V5210 PR IN EAR BICROS HEARING AID 51.00 V5240 PR DISPENSING FEE BICROS 660.00 V5241 PR DISPENSING FEE, MONAURAL 330.00 V5254 PR HEARING ID, DIGIT, MON, CIC 2900.00 V5255 PR HEARING AID, DIGIT, MON, ITC 2750.00 V5256 PR HEARING AID, DIGIT, MON, ITE 2500.00 V5257 PR HEARING AID, DIGIT, MON, BTE 2600.00 V5258 PR HEARING AID, DIGIT, BIN, CIC 5800.00 V5260 PR HEARING AID, DIGIT, BIN, ITE 5000.00 V5261 PR HEARING AID, DIGIT, BIN, BTE 5200.00 V5264 PR EAR MOLD/INSERT 75.00 V5265 PR EAR MOLD/INSERT, DISP 5.00 V5266 PR BATTERY FOR HEARING DEVICE 6.00 V5267 PR HEARING AID SUP/ACCESS/DEV 53.00 V5274 PR ALD UNSPECIFIED 150.00 V5275 PR EAR IMPRESSION 25.00 21499A STYLOID PROCESS EXCISION 2965.00 22899H POSTERIOR ROD LENGTHENING 1800.00 27299O OPN FEM HIP DISLOC-ACTAB IMPIN 5909.00 33999E PR UNLISTED TRICUSPID VALVE 6371.00 33999G CARDIOBAND REPAIR OF TRICUSPID 9492 36468A PR INJ SCLERO SOLN VEIN 300.00 36471A PR INJ SCLERO SOLN VEIN MULTI 350.00 37799E RELEASE MED ARCUATE LIGAMENT 1700.00 38999C BATS CELL INFUSION 304 40000A PR PSYC-UVA NO SHOW CHG 25.00 41899A PR TOOTH EXTRACT PRIOR TO 180.00 43659A PARTIAL LAP GASTRECTOMY 4013 43999C PERORAL ENDOSCOPIC MYOTOMY 2378.00 43999D ESM DISSECTION STOMACH 2969.00 43999E POEM 4157.00 45399A ESM DISSECTION COLON 2969.00 45399B UNDERWATER EMR 1218.00 47379A LAPAROSCOPIC LIVER BIOPSY 1015.00 47379B LAPAROSCOPIC PART 8093.00 48999C LAP PANCREATECT W/WO 6000.00 48999F PANCREATIC ESWL 2000 48999H ENDO PANCREATIC 9750.00 48999I ROBOTIC ASSISTED LAP PANCREAS 6838 TRANSPLANT 49329B LAP REMOVAL INTRAABDOMIN CYST 4528.00 49999A FALCIFORM LIGAMENT FLAP 823.00 50549A ROBOTIC ASSISTED LAP KIDNEY 7189 TRANSPLANT 67999A ENDO REPAIR BROW PTOSIS 2024 88036A CHEST CAVITY AND NECK ORGANS 848.00 88036B ABDOMINAL CAVITY AND PELVIC 848.00 ORGANS ONLY 88037A BRAIN ONLY (REMOVED AT UVA) 848.00 88037B BRAIN ONLY (WITHOUT REMOVAL) 800.00 88037C BRAIN ONLY (DEGENERATIVE WORK- 1413.00 UP REMOVED AT UVA) 88037D BRAIN ONLY (DEGENERATIVE WORK- 1366.00 UP, PREVIOUSLY REMOVED) 88037E BRAIN ONLY (CJD PREVAUTIONS) 1696.00 88037F AUTOPSY, BRAIN ME 0.00 88305C CORE BIOP. PROSTATE 26 178.00 88305M DERM TISSUE EXAM 13 26 100.00 88321A CONSULT AND SLIDE REVIEW 130.00 88321B CHG WINCHESTER 330.00 CYTOLOGY/NEUROPATHOLOGY 88321S DERM CONSULT UVA REFRL 190.00 90899S PR DRIVING EVALUATIONS 150.00 92310A PR NEW CONTACT LENS FIT W 100.00 92310B PR NEW CONTACT LENS FIT - TORIC 90.00 92310C PR NEW CONTACT LENS FIT - 105.00 92310D PR EST CONTACT LENS FIT 75.00 92310E PR DAVIS VISION LENS FIT 60.00 92310F PR CONTACT LENS FIT- IMAGE 130.00 93882A PR DUPLEX EXTRACRANIAL UNILAT 26 22.00 93922A PR DOPPLER ARTERIAL EXT 26 22.00 93979A PR DUPLEX AORTA/IVC/GRAFT/LTD 22.00 94799A PR CAR SEAT/BED TESTING 223.00 W/INTERP & REPORT 60 MIN >28 94799B PR CAR SEAT/BED TESTING 49.00 W/INTERP & REPORT +30MIN >28 99024B PR POST-OP FOLLOW-UP VISIT 0.00 99211A PR PROSTHETICS/ORTHOTICS 0 99211B PR NURSE VISIT 49.00 99231A PR SUBSEQUENT HOSP CARE,LEVL 99.00 I, CONCURRENT 99231B PR SUBSEQUENT HOSP CARE,LEVL 99.00 I, CONCURRENT 99232A PR SUBSEQUENT HOSP CARE,LEVL 183.00 II, CONCURRENT 99232B PR SUBSEQUENT HOSP CARE,LEVL 183.00 II, CONCURRENT 99233A PR SUBSEQUENT HOSP CARE,LEVL 262.00 III, CONCURRENT 99233B PR SUBSEQUENT HOSP CARE,LEVL 262.00 III, CONCURRENT 99234A PR OBSERVATION/INPATIENT 335.00 HOSPITAL CARE 40 MINUTES 99235A PR OBSERVATION/INPATIENT 435.00 HOSPITAL CARE 50 MINUTES 99236A PR OBSERVATION/INPATIENT 547.00 HOSPITAL CARE 55 MINUTES 99238A PR HOSPITAL DISCHARGE DAY,<30 183.00 99239A PR HOSPITAL DISCHARGE DAY,>30 270.00 99291A PR CRITICAL CARE, E/M 30-74 752.00 99292A PR CRITICAL CARE, ADDL 30 MIN 308.00 99356A PR PROLONGED SERVICE I/P REQ 231.00 UNIT/FLOOR TIME 1ST HR 99357A PR PROLONGED SVC I/P REQ 231.00 UNIT/FLOOR TIME EA 30 MIN 99446A E-CONSULT REQUEST 0.00 99446B E-CONSULT 5-10 MIN. 0.00 99446C E-CONSULT REQUIRES FACE-TO- 0.00 99446D E-CONSULT DECLINED 0.00 99447A E-CONSULT 11-20 MIN. 0.00 99448A E-CONSULT 21-30 MIN. 0.00 99449A E-CONSULT 31+ MIN. 0.00 99463A PR INITIAL NORMAL NEWBORN 301.00 CARE, SAME DAY DISCHARGE 99464A PR ATTN AT DELIVERY 1ST 194.00 STABILIZATION OF NEWBORN 99465A PR DELIVERY/BIRTHING ROOM 384.00 RESUSCITATION 99499A PR INSUFFICIENT DOCUMENTATION 0.00 99499B PR PRE-OPERATIVE PHYSICAL EXAM 0.00 99499D PR BUS DRIVE/CDL (DOT) PHYSICAL 85.00 99499E PR MRO CALL 85.00 99499G PR SPORTS PHYSICAL 25.00 99499H PR AMBULATORY CARE 0.00 99499I PR WALK OUT/NOT SEEN 0.00 99499J PR NO CHARGE/LAB ONLY 0.00 99499L PR FU WITHIN 90 DAYS OF 0.00 99499N PR CLOSE ENCOUNTER - NO LOS 0.00 99499O PR FU WITHIN 90 DAYS OF 0.00 99499P PR CLOSE ENCOUNTER - NO LOS 0.00 99499R PR OB/GYN SERVICE 0.00 99499S PR OB/GYN SERVICE 0.00 99499U PR PRE-OPERATIVE PHYSICAL EXAM 0.00 99999C PR SUTURE LACERATION 0.00 99999E PR CPT CODE UNDETERMINED 0.00 A4466A KNEE ORTHOTIC, ELASTIC OR 75.00 SIMILAR STRETCHABLE MATERIAL A4466H ABDOMINAL BINDER, ELASTIC 40.00 A4467A KNEE ORTHOTIC, ELASTIC OR 75.00 SIMILAR STRETCHABLE MATERIAL A4467B HINGED KNEE BRACE 103.00 A4467C KNEE ORTHOTIC 66.00 A4467D ELBOW SLEEVE 67.00 A4467E PREFABRICATED SHOULDER 62.00 A4467F THORACIC,RIB BELT,CUSTOM FIT 47.00 A4467G HEEL PROTECTOR (HEELBO) 69.00 A4467H ABDOMINAL BINDER, ELASTIC 40.00 A6545A GRADIENT COMPRESSION WRAP- 198 LOWER LEG A6545B GRADIENT COMPRESSION WRAP- 220 UPPER LEG WITH KNEE A6545C GRADIENT COMPRESSION WRAP- 44 SINGLE BAND ANKLE FOOT WRAP A6545D GRADIENT COMPRESSION WRAP- 60 HAND WRAP A6545E GRADIENT COMPRESSION WRAP- 224 ARM WRAP A6549A COMPRESS STOCKING,CUSTOM 370.00 A9900A FACE SHIELD 208 D9940A PR OCCLUSAL GUARD, IN OFFICE 190.00 D9999A DENTAL PREPARATION 0 L1499F NATL ORTHOSIS.. 550.00 L1499Z PECTUS THORACIC BRACE 900.00 L2999J PR ADJUST-A-LIFT 11.00 L2999K PR HAMMERTOE SPL PR 15.00 L2999L PR HAPADS PAIR 12.00 L2999M TOE CAP/GUARD 13 L2999N PR TOE SEPARATOR PR 4.00 L2999O PR SHIPPING & HANDLING 1.00 L2999Z REMOVABLE HEEL WEDGE 18.00 L3999D SHLD IMMOBIL ELA 37.00 L3999G TENNIS ELBOW AOA 22.00 L3999N SHOULDER IMMOBILIZER 229.00 L5999B PR FOOT SHELL FOR PATH FINDER 150.00 L5999D PR REPLACE FLEX-FOOT SHELL 215.00 L7499A PR ONE FINGER PROS 416.00 L7499C SURELOCK UPPER EXTREMITY 844 L7499D TOUGHWARE SELF-SUSPENDING 800 HUMERAL CUFF L7499R PARTIAL FINGER PROSTHESIS, 2508 L8499A PR PROTECTIVE STOCKING 30.00 S0620D PR DAVIS VISION EXAM NEW PT 51.50 S0621D PR DAVIS VISION EXAM RTRN PT 51.50 V2599D PR DAVIS VISION CONTACT LENS 110.50 V5011B FIT/CHECKING OF HA (ALL PLANS) 0.00 V5014B REPAIR/MODIFY HA (ALL PLANS) 0.00 V5014K HA REP (OTICON) ALL WARR 6 MO 220.00 V5014L HA REP (OTICON) ALL WARR 12 MO 260.00 V5014P HA REP (OTCON) W/AI WARR 12 MO 260.00 V5014U HA (WID) BTE&CUST REP WAR 6MO 230.00 V5014V HA (WID) BTE&CUST REP WAR 12MO 260.00 V5014Y HA WI CUS REM 6MO REM WAR ONL 160.00 V5264A MICROMOLD (EACH) 60.00 V5264B ELAN SHELL 40.00 V5267B HEARING AID SUPPLY, WAX GUARDS 53.00 V5267D HEARING AID SUPPLY, DRI-AID KIT 15.00 V5267E HA REMOTE CONTROL/STREAMER 53.00 V5267H HA SUPPLY, TUBING 5.00 V5267I HA SUPPLY, RIC REC. (OTICON) 75.00 V5267K HA SUPPLY, RIC REC. (WIDEX) 100.00 V5299A HA FU UNLIM 2YRS PER AID W/PUR 200.00 V5299B HA FU UNLIM 5YRS PER AID W/PUR 350.00 V5299D HEARING AID DROP-OFF FEE 25.00 V5299E NEUROMONICS PROCESSOR(OASIS) 3590.00 V5299G NEUROMONIC PROCESS 960.00 V5299I NEUROMONIC PROCESS F/U 105.00 V5299K HA REPLACEMENT FEE 300.00 V5299M HA FU 15 VIST OVR 5YRS PER AID 350.00 V5299N HA FU UNLIM 1 YR NON UVA PURCH 200.00 V5299O HA FU UNLIM 2 YR NON UVA PURCH 350.00 V5299Q HA ADD YR L&D (OTICON) 40.00 V5299R HA ADD YR REP WARR (OTICON) 110.00 V5299S HA ADD YR EXT WARR (OTICON) 140.00 V5299W HA (WID) ALL OTHRE 3RD REP WARR 110.00 V5299X HA (WIDEX) ALL 2ND YEAR L&D 110.00 76499AU CONTRAST ENHANC SPECTRAL 100.00 93799ZA PR PULM ARTERY PRESS SENS 7300.00 99499ZA NURSING HOME PE, ESTAB PAT 250.00 L2999AD METATARSAL PAD 6.00 L2999AE HAL-VALG SPLINT 25.00 L2999AN HEEL CUP 30.00 L2999BF ADD PPT TO FO 12.00 L2999BY KNEE SLEEVE 45 L7499AG PREM FUNCT AESTHETIC P. FING 5672.00 L7499AI BIOMECHANICAL FUNCTION THUMB 21375.00 L7499AL PR TWO FINGER FUNCTION AESTH 8536 V5014AA HA WI BTE&CUS REP WAR GT 5YR 305.00 V5014AE HA REP (PHON) CLAS SVC PLN 6MO 210.00 V5014AF HA REP (PHO) CLAS SVC PLN 12MO 240.00 V5014AG HA REP(PHO) DHC (REM) SPLN 6MO 120.00 V5014AI REPAIR/MODIFICATION OF A 220.00 V5014AJ HA REP (PHO) DIG SVC PLN 12 MO 250.00 V5014AR HA REP(PH)WLS CRS/BICRS 12 MO 240.00 V5014BB HA REP(STAR)CIC/CANAL WAR 12MO 250.00 V5014BF HA REP(STAR) CUST DIG 1YR WARR 240.00 V5299AF HA WAR PHO EXT SVC CON DIG YR 180.00