Median Fee - Preston Hollow

CPT Code Ref ID CPT Code Description Median Fee
10004 100001 FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL $4,495.50
10005 100002 FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION $2,343.00
10006 100003 FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL $1,322.00
10007 100004 FINE NEEDLE ASPIRATION BX W/FLUOR GDN 1ST LESION $5,515.00
10008 100005 FINE NEEDLE ASPIRATION BX W/FLUOR GDN EA ADDL $3,620.00
10009 100006 FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION $4,211.50
1000F 100007 TOBACCO USE ASSESSED $0.00
10010 100008 FINE NEEDLE ASPIRATION BX W/CT GDN EA ADDL $2,713.50
10011 100009 FINE NEEDLE ASPIRATION BX W/MR GDN 1ST LESION $1,174.00
10012 100010 FINE NEEDLE ASPIRATION BX W/MR GDN EA ADDL $0.00
10021 100011 FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION $966.50
10030 100012 IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ $4,894.00
10035 100013 PLMT SFT TISS LOCLZJ DEV PERQ 1ST LESION $1,614.50
10036 100014 PLMT SFT TISS LOCLZJ DEV PERQ EACH ADDL LESION $2,748.00
1003F 100015 LEVEL ACTIVITY ASSESSED $0.00
10040 100016 ACNE SURGERY $324.00
10060 100017 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE $879.00
10061 100018 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE $1,993.50
10080 100019 INCISION & DRAINAGE PILONIDAL CYST SIMPLE $1,268.00
10081 100020 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED $4,423.50
10120 100021 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE $1,279.00
10121 100022 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP $9,838.00
10140 100023 I&D HEMATOMA SEROMA/FLUID COLLECTION $7,377.00
10160 100024 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST $916.50
10180 100025 INCISION & DRAINAGE COMPLEX PO WOUND INFECTION $10,643.00
11000 100026 DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF $1,795.00
11001 100027 DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10% $378.50
11004 100028 DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER $15,235.50
11005 100029 DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL $11,198.50
11006 100030 DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL $0.00
11008 100031 RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION $11,769.00
1100F 100032 PT FALLS ASSESS DOCD 2/> FALLS/FALL W/INJURY/YR $0.00
11010 100033 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS $8,487.50
11011 100034 DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC $7,983.00
11012 100035 DBRDMT FX&/DISLC SUBQ T/M/F BONE $11,445.00
11042 100036 DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/< $1,791.50
11043 100037 DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/< $1,786.00
11044 100038 DEBRIDEMENT BONE 1ST 20 SQ CM/< $6,480.00
11045 100039 DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM $1,786.00
11046 100040 DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM $1,786.00
11047 100041 DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM $5,364.00
11055 100042 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 $380.50
11056 100043 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 $956.00
11057 100044 PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4 $455.50
11102 100045 TANGENTIAL BIOPSY SKIN SINGLE LESION $1,699.00
11103 100046 TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION $1,349.50
11104 100047 PUNCH BIOPSY SKIN SINGLE LESION $1,715.00
11105 100048 PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION $968.50
11106 100049 INCISIONAL BIOPSY SKIN SINGLE LESION $1,925.00
11107 100050 INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION $1,372.50
1110F 100051 PT DISCHARGE INPT FACILITY WITHIN LAST 60 DAYS $0.00
1111F 100052 DISCHRG MEDS RECONCILED W/CURRENT MED LIST $0.00
1116F 100053 AURICULAR/PERIAURICULAR PAIN ASSESSED $0.00
1118F 100054 GERD SYMPTOMS ASSESSED AFTER 12 MONTHS THERAPY $0.00
1119F 100055 INITIAL EVALUATION FOR CONDITION $0.00
11200 100056 RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15 $395.00
11201 100057 RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10 $179.00
1121F 100058 SUBSEQUENT EVALUATION CONDITION $0.00
1123F 100059 ADV CARE PLN TLKD & ALT DCSN MAKER DOCD $0.00
1124F 100060 ADV CARE PLN/ NO ALT DCSN MKR DOCD OR REFUSAL $0.00
1125F 100061 PAIN SEVERITY QUANTIFIED PAIN PRESENT $0.00
1126F 100062 PAIN SEVERITY QUANTIFIED NO PAIN PRESENT $0.00
1127F 100063 NEW EPISODE FOR CONDITION $0.00
1128F 100064 SUBS EPISODE FOR CONDITION $0.00
11300 100065 SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/< $352.00
11301 100066 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM $368.50
11302 100067 SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM $387.50
11303 100068 SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM $650.00
11305 100069 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/< $474.00
11306 100070 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM $388.50
11307 100071 SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM $507.50
11308 100072 SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM $491.00
1130F 100073 BK PAIN & FXN ASSESSED CERTAIN ASPECTS OF CARE $0.00
11310 100074 SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/< $378.50
11311 100075 SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM $420.00
11312 100076 SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM $646.00
11313 100077 SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM $817.00
1134F 100078 EPISODE BACK PAIN LASTING SIX WEEKS/< $0.00
1135F 100079 EPISODE BACK PAIN LASTING >SIX WEEKS $0.00
1136F 100080 EPISODE BACK PAIN LASTING 12 WEEKS/< $0.00
1137F 100081 EPISODE BACK PAIN LASTING >12 WKS $0.00
11400 100082 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< $3,329.00
11401 100083 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM $1,521.00
11406 100087 EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM $14,163.00
11420 100088 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< $6,662.50
11421 100089 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM $3,652.00
11426 100093 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM $8,200.00
11440 100094 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< $3,050.50
11441 100095 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM $3,314.50
11446 100099 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM $7,111.00
11450 100100 EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR $18,957.50
11451 100101 EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR $19,788.50
11462 100102 EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR $15,324.00
11463 100103 EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR $11,608.00
11470 100104 EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR $9,262.00
11471 100105 EXCISION H/P/P/U COMPLEX REPAIR $10,194.00
1150F 100106 DOC PT W/SUBSTANTIAL RISK DEATH WITHIN 1 YEAR $0.00
1151F 100107 DOC PT W/O SUBSTANTIAL RISK DEATH WITHIN 1 YEAR $0.00
1152F 100108 DOC ADVANCED DISEASE DX CARE GOALS COMFORT $0.00
1153F 100109 DOC ADVANCED DISEASE DX CARE GOALS W/O COMFORT $0.00
1157F 100110 ADVNC CARE PLAN OR EQV LGL DOC IN MED RCRD $0.00
1158F 100111 ADVNC CARE PLANNING TLK DOCD IN MED RCRD $0.00
1159F 100112 MEDICATION LIST DOCUMENTED IN MEDICAL RECORD $0.00
11600 100113 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< $3,340.50
11601 100114 EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM $2,031.00
11606 100118 EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM $7,083.50
11620 100119 EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/< $5,582.50
11621 100120 EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM $2,783.50
11626 100124 EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM $7,306.00
11640 100125 EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/< $2,583.00
11641 100126 EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM $2,672.00
11646 100130 EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM $7,768.00
1170F 100131 FUNCTIONAL STATUS ASSESSED $0.00
11719 100132 TRIMMING NONDYSTROPHIC NAILS ANY NUMBER $216.00
11720 100133 DEBRIDEMENT NAIL ANY METHOD 1-5 $210.50
11721 100134 DEBRIDEMENT NAIL ANY METHOD 6/> $490.00
11730 100135 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 $866.00
11732 100136 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL $334.00
11740 100137 EVACUATION SUBUNGUAL HEMATOMA $655.50
11750 100138 EXCISION NAIL MATRIX PERMANENT REMOVAL $2,277.50
11755 100139 BIOPSY NAIL UNIT SEPARATE PROCEDURE $2,102.00
11760 100140 REPAIR NAIL BED $2,397.00
11762 100141 RECONSTRUCTION NAIL BED W/GRAFT $7,062.00
11765 100142 WEDGE EXCISION SKIN NAIL FOLD $848.50
11770 100143 EXCISION PILONIDAL CYST/SINUS SIMPLE $16,589.00
11771 100144 EXCISION PILONIDAL CYST/SINUS EXTENSIVE $11,366.00
11772 100145 EXCISION PILONIDAL CYST/SINUS COMPLICATED $12,582.50
11900 100146 INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS $674.00
11901 100147 INJECTION INTRALESIONAL >7 LESIONS $710.50
11920 100148 TATTOOING INCL MICROPIGMENTATION 6.0 CM/< $2,482.50
11921 100149 TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM $2,810.00
11922 100150 TATTOOING INCL MICROPIGMENTATION EA 20.0 CM $2,348.00
11950 100151 SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/< $1,167.00
11951 100152 SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC $3,528.50
11952 100153 SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC $7,293.00
11954 100154 SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC $8,511.00
11960 100155 INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ $22,448.00
11970 100156 REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT $15,565.50
11971 100157 REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT $14,856.00
11976 100158 REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES $1,709.00
11980 100159 SUBCUTANEOUS HORMONE PELLET IMPLANTATION $623.50
11981 100160 INSERTION DRUG DELIVERY IMPLANT $1,135.00
11982 100161 REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT $1,180.50
11983 100162 RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT $560.50
12001 100163 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< $701.50
12002 100164 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM $725.00
12004 100165 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM $813.50
12005 100166 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM $1,106.50
12006 100167 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM $1,230.00
12007 100168 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM $1,605.50
12011 100169 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< $679.50
12013 100170 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM $784.00
12014 100171 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM $907.00
12015 100172 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM $1,035.50
12018 100175 SIMPLE REPAIR F/E/E/N/L/M >30.0 CM $2,184.50
12020 100176 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE $4,236.50
12021 100177 TX SUPERFICIAL WOUND DEHISCENCE W/PACKING $1,622.00
12031 100178 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< $1,193.50
12032 100179 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM $2,014.00
12035 100181 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM $3,599.00
12037 100183 REPAIR INTERMEDIATE S/A/T/E >30.0 CM $9,049.50
12041 100184 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< $1,211.00
12042 100185 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM $1,788.50
12044 100186 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM $3,035.00
12045 100187 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM $2,418.50
12046 100188 RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM $5,305.00
12047 100189 REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM $2,513.00
12051 100190 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< $1,299.00
12052 100191 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM $1,359.50
12055 100194 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM $1,737.00
12056 100195 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM $2,681.00
12057 100196 REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM $2,854.00
1205F 100197 ETIOLOGY OF EPILEPSY SYNDROME RVWD & DOCD $0.00
1220F 100198 PATIENT SCREENED DEPRESSION $0.00
13100 100199 REPAIR COMPLEX TRUNK 1.1-2.5 CM $6,023.50
13101 100200 REPAIR COMPLEX TRUNK 2.6-7.5 CM $4,368.50
13102 100201 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< $3,958.00
13120 100202 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM $3,422.50
13121 100203 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM $6,173.00
13122 100204 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< $4,532.50
13131 100205 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM $1,789.50
13132 100206 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM $3,469.50
13133 100207 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< $1,448.50
13151 100208 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM $2,583.00
13152 100209 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM $3,140.00
13153 100210 REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/< $2,227.00
13160 100211 SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP $8,541.00
14000 100212 ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/< $7,144.00
14001 100213 ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM $3,746.50
14020 100214 ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/< $14,641.50
14021 100215 ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM $10,018.50
14040 100216 ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/< $9,180.50
14041 100217 ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM $8,722.50
14060 100218 ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< $7,782.50
14061 100219 ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM $8,678.50
14301 100220 ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM $7,263.50
14302 100221 ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM $2,565.00
14350 100222 FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE $11,983.50
15002 100223 PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT $6,985.00
15003 100224 PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT $3,934.50
15004 100225 PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT $2,689.50
15005 100226 PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT $6,012.50
1500F 100227 SYMP&SIGN DISTAL SYMM POLYNEUROPATHY REVWD&DOCD $0.00
1501F 100228 NOT INITIAL EVALUATION FOR CONDITION $0.00
1502F 100229 PT QUERIED RE PAIN W/FUNC USING RELIABLE INSTRM $0.00
1503F 100230 PT QUERIED RE SYMP RESPIRATORY INSUFFICIENCY $0.00
15040 100231 HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/< $6,952.00
1504F 100232 PATIENT HAS RESPIRATORY INSUFFICIENCY $0.00
15050 100233 PINCH GRAFT 1/MLT SM ULCER TIP/OTH AR UP TO 2 CM $3,351.50
15100 100234 SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD $8,778.00
15101 100235 SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD $4,319.00
15110 100236 EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD $8,742.00
15111 100237 EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD $2,436.00
15115 100238 EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/< $7,062.00
15116 100239 EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM $1,740.00
15120 100240 SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 % $6,360.00
15121 100241 SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 % $4,817.50
15130 100242 DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM $7,688.00
15131 100243 DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA $5,323.00
15135 100244 DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100 $16,139.00
15136 100245 DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA $5,323.00
15150 100246 CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/< $8,646.50
15151 100247 CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM $1,740.00
15152 100248 CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA $1,740.00
15155 100249 CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/< $11,935.50
15156 100250 CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM $1,740.00
15157 100251 CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA $1,740.00
15200 100252 FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/< $10,835.50
15201 100253 FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 SQ CM $7,033.50
15220 100254 FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/< $4,992.00
15221 100255 FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM/< $1,139.00
15240 100256 FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/< $7,319.00
15241 100257 FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL $6,125.00
15260 100258 FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/< $5,066.50
15261 100259 FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM $8,404.00
15271 100260 APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25 $4,238.50
15272 100261 APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC $1,704.50
15273 100262 APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM $5,691.50
15274 100263 APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM $5,020.00
15275 100264 SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM $4,414.00
15276 100265 SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM $3,728.00
15277 100266 SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM $6,047.00
15278 100267 SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM $3,901.00
15570 100268 FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK $11,966.50
15572 100269 FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS $6,851.50
15574 100270 FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F $10,626.50
15576 100271 FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL $7,650.00
15600 100272 DELAY FLAP/SECTIONING FLAP TRUNK $20,315.00
15610 100273 DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS $24,292.00
15620 100274 DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F $12,197.50
15630 100275 DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS $8,603.50
15650 100276 TRANSFER ANY PEDICLE FLAP ANY LOCATION $13,230.00
15730 100277 MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES $7,021.50
15731 100278 FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE $12,727.50
15733 100279 MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL $9,240.50
15734 100280 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK $13,668.50
15736 100281 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR $8,798.00
15738 100282 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR $14,651.50
15740 100283 FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY $9,663.00
15750 100284 FLAP NEUROVASCULAR PEDICLE $10,024.00
15756 100285 FREE MUSCLE/MYOCUTANEOUS FLAP W/MVASC ANAST $0.00
15757 100286 FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS $0.00
15758 100287 FREE FASCIAL FLAP W/MICROVASCULAR ANASTOMOSIS $0.00
15760 100288 GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA $9,466.50
15769 100289 GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC $11,767.00
15770 100290 GRAFT DERMA-FAT-FASCIA $10,373.50
15771 100291 GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS $2,587.50
15772 100292 GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC $2,207.00
15773 100293 GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS $4,010.00
15774 100294 GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC $8,750.00
15775 100295 PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS $775.00
15776 100296 PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS $775.00
15777 100297 IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT $3,461.00
15778 100298 IMPL ABSRB MESH/PRSTH DLYD CLSR DFCT INFCTJ/TRMA $0.00
15780 100299 DERMABRASION TOTAL FACE $7,200.50
15781 100300 DERMABRASION SEGMENTAL FACE $4,496.00
15782 100301 DERMABRASION REGIONAL OTHER THAN FACE $2,165.50
15783 100302 DERMABRASION SUPERFICIAL ANY SITE $3,349.50
15786 100303 ABRASION 1 LESION $639.00
15787 100304 ABRASION EACH ADDITIONAL 4 LESIONS OR LESS $675.50
15788 100305 CHEMICAL PEEL FACIAL EPIDERMAL $2,541.50
15789 100306 CHEMICAL PEEL FACIAL DERMAL $2,721.00
15792 100307 CHEMICAL PEEL NONFACIAL EPIDERMAL $915.50
15793 100308 CHEMICAL PEEL NONFACIAL DERMAL $675.50
15819 100309 CERVICOPLASTY $1,740.00
15820 100310 BLEPHAROPLASTY LOWER EYELID $9,392.50
15821 100311 BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD $7,807.00
15822 100312 BLEPHAROPLASTY UPPER EYELID $9,470.50
15823 100313 BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN $2,672.00
15824 100314 RHYTIDECTOMY FOREHEAD $10,156.50
15825 100315 RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING $25,051.50
15826 100316 RHYTIDECTOMY GLABELLAR FROWN LINES $6,703.00
15828 100317 RHYTIDECTOMY CHEEK CHIN & NECK $12,913.50
15829 100318 RHYTIDECTOMY SMAS FLAP $21,113.50
15830 100319 EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY $22,555.50
15832 100320 EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH $21,790.00
15833 100321 EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG $13,186.00
15834 100322 EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP $13,710.50
15835 100323 EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK $7,200.50
15836 100324 EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM $21,555.00
15837 100325 EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND $5,359.00
15838 100326 EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD $5,359.00
15839 100327 EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA $16,165.50
15840 100328 GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT $17,167.50
15841 100329 GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT $6,703.00
15842 100330 GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG $6,703.00
15845 100331 GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR $8,666.50
15847 100332 EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN $17,022.00
15850 100333 REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON $5,860.50
15851 100334 REMOVAL SUTURES/STAPLES REQUIRING ANESTHESIA $6,541.00
15852 100335 DRESSING CHANGE UNDER ANESTHESIA $2,665.50
15853 100336 REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA $286.00
15854 100337 REMOVAL SUTURES&STAPLES NOT REQUIRING ANESTHESIA $1,428.50
15860 100338 IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT $10,514.50
15876 100339 SUCTION ASSISTED LIPECTOMY HEAD & NECK $11,065.00
15877 100340 SUCTION ASSISTED LIPECTOMY TRUNK $5,242.00
15878 100341 SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY $17,004.00
15879 100342 SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY $16,321.00
15920 100343 EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR $7,750.00
15922 100344 EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR $6,703.00
15931 100345 EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE $10,235.50
15933 100346 EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY $7,200.50
15934 100347 EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR $12,551.50
15935 100348 EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY $6,703.00
15936 100349 EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR $10,207.50
15937 100350 EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC $10,364.50
15940 100351 EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE $12,252.00
15941 100352 EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT $7,200.50
15944 100353 EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE $6,703.00
15945 100354 EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY $6,703.00
15946 100355 EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN $9,539.50
15950 100356 EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR $7,200.50
15951 100357 EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY $7,200.50
15952 100358 EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE $5,323.00
15953 100359 EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY $5,323.00
15956 100360 EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN $5,323.00
15958 100361 EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC $5,323.00
15999 100362 UNLISTED PROCEDURE EXCISION PRESSURE ULCER $0.00
16000 100363 INITIAL TX 1ST DEGREE BURN LOCAL TX $1,030.00
16020 100364 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL $601.00
16025 100365 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM $1,220.00
16030 100366 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE $1,372.50
16035 100367 ESCHAROTOMY FIRST INCISION $2,227.00
16036 100368 ESCHAROTOMY EACH ADDITIONAL INCISION $0.00
17000 100369 DESTRUCTION PREMALIGNANT LESION 1ST $218.00
17003 100370 DESTRUCTION PREMALIGNANT LESION 2-14 EA $208.00
17004 100371 DESTRUCTION PREMALIGNANT LESION 15/> $917.50
17106 100372 DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM $2,334.00
17107 100373 DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM $2,572.00
17108 100374 DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM $7,110.00
17110 100375 DESTRUCTION BENIGN LESIONS UP TO 14 $1,138.00
17111 100376 DESTRUCTION BENIGN LESIONS 15/> $434.50
17250 100377 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE $486.50
17260 100378 DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/< $528.00
17261 100379 DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM $577.00
17262 100380 DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM $632.50
17266 100383 DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM $1,412.00
17270 100384 DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/< $556.50
17271 100385 DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM $580.00
17274 100388 DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM $1,701.00
17276 100389 DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM $1,740.00
17280 100390 DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/< $615.50
17281 100391 DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM $786.50
17284 100394 DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM $1,012.00
17286 100395 DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM $1,117.00
17311 100396 MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS $2,123.50
17312 100397 MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE $1,705.50
17313 100398 MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS $2,163.00
17314 100399 MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE $1,747.00
17315 100400 MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE $1,329.50
17340 100401 CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE $196.00
17360 100402 CHEMICAL EXFOLIATION ACNE $915.50
17380 100403 ELECTROLYSIS EPILATION EACH 30 MINUTES $2,449.50
17999 100404 UNLISTED PX SKIN MUC MEMBRANE & SUBQ TISSUE $0.00
19000 100405 PUNCTURE ASPIRATION CYST OF BREAST $1,824.00
19001 100406 PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST $1,474.00
19020 100407 MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP $12,779.50
19030 100408 INJECTION PX ONLY MAMMARY DUCTOGRAM/GALACTOGRAM $1,509.00
19081 100409 BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID $5,808.00
19082 100410 BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID $3,490.00
19083 100411 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID $6,042.00
19084 100412 BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID $5,270.50
19085 100413 BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID $6,791.50
19086 100414 BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID $3,010.00
19100 100415 BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX $5,484.50
19101 100416 BIOPSY BREAST OPEN INCISIONAL $8,686.00
19105 100417 ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA $9,672.00
19110 100418 NIPPLE EXPLORATION $17,480.00
19112 100419 EXCISION LACTIFEROUS DUCT FISTULA $13,882.00
19120 100420 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION $9,994.00
19125 100421 EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES $11,474.50
19126 100422 EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL $9,467.50
19281 100423 PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE $3,052.00
19282 100424 PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE $2,406.00
19283 100425 PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE $4,122.00
19284 100426 PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC $3,544.00
19285 100427 PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG $2,851.00
19286 100428 PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE $1,616.50
19287 100429 PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID $6,396.50
19288 100430 PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID $6,314.00
19294 100431 PREPJ TUMOR CAVITY IORT W/PARTIAL MASTECTOMY $10,352.50
19296 100432 PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST $26,523.00
19297 100433 PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST $12,032.50
19298 100434 PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST $25,579.00
19300 100435 MASTECTOMY GYNECOMASTIA $22,720.00
19301 100436 MASTECTOMY PARTIAL $10,663.00
19302 100437 MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY $18,099.50
19303 100438 MASTECTOMY SIMPLE COMPLETE $10,889.50
19305 100439 MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES $20,392.00
19306 100440 MAST RAD W/PECTORAL MUSC AX INT MAM LYMPH NODES $0.00
19307 100441 MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN $19,649.50
19316 100442 MASTOPEXY $5,659.00
19318 100443 BREAST REDUCTION $21,471.50
19325 100444 BREAST AUGMENTATION WITH IMPLANT $14,413.00
19328 100445 REMOVAL INTACT BREAST IMPLANT $14,688.00
19330 100446 RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS $16,172.50
19340 100447 INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY $11,880.00
19342 100448 INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY $13,779.50
19350 100449 NIPPLE/AREOLA RECONSTRUCTION $3,808.50
19355 100450 CORRECTION INVERTED NIPPLES $8,018.50
19357 100451 TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION $15,271.00
19361 100452 BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP $21,262.50
19364 100453 BREAST RECONSTRUCTION W/FREE FLAP $21,420.50
19367 100454 BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP $0.00
19368 100455 BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST $0.00
19369 100456 BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP $0.00
19370 100457 REVISION PERI-IMPLANT CAPSULE BREAST $13,152.50
19371 100458 PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE $9,689.00
19380 100459 REVISION OF RECONSTRUCTED BREAST $6,542.00
19396 100460 PREPARATION MOULAGE CUSTOM BREAST IMPLANT $9,672.00
19499 100461 UNLISTED PROCEDURE BREAST $0.00
20100 100462 EXPLORATION PENETRATING WOUND SPX NECK $2,846.50
20101 100463 EXPLORATION PENETRATING WOUND SPX CHEST $6,552.00
20102 100464 EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK $8,799.00
20103 100465 EXPLORATION PENETRATING WOUND SPX EXTREMITY $6,279.00
2010F 100466 VITAL SIGNS RECORDED $0.00
2014F 100467 MENTAL STATUS ASSESSED $0.00
20150 100468 EXCISION EPIPHYSEAL BAR $12,165.50
2015F 100469 ASTHMA IMPAIRMENT ASSESSED $0.00
2016F 100470 ASTHMA RISK ASSESSED $0.00
2018F 100471 HYDRATION STATUS ASSESSED $0.00
2019F 100472 DILATED MACULAR EXAM PERFORMED $0.00
20200 100473 BIOPSY MUSCLE SUPERFICIAL $6,794.00
20205 100474 BIOPSY MUSCLE DEEP $6,441.00
20206 100475 BIOPSY MUSCLE PERCUTANEOUS NEEDLE $2,641.50
20220 100476 BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL $2,957.50
20225 100477 BIOPSY BONE TROCAR/NEEDLE DEEP $3,269.50
20240 100478 BIOPSY BONE OPEN SUPERFICIAL $8,975.00
20245 100479 BIOPSY BONE OPEN DEEP $10,661.00
2024F 100480 7 STANDARD FLD RETINAL PHOTO W/EVC RTNOPTHY $0.00
20250 100481 BIOPSY VERTEBRAL BODY OPEN THORACIC $9,011.00
20251 100482 BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL $11,722.50
2025F 100483 7 STANDARD FLD RETINAL PHOTO W/O EVC RTNOPTHY $0.00
2026F 100484 EYE IMG VALID MATCH DX 7 STND FLD W/EVC RTNOPTHY $0.00
2027F 100485 OPTIC NERVE HEAD EVALUATION PERFORMED $0.00
2028F 100486 FOOT EXAMINATION PERFORMED $0.00
2029F 100487 COMPLETE PHYSICAL SKIN EXAM PERFORMED $0.00
2030F 100488 HYDRATION STATUS DOCD NORMALLY HYDRATED $0.00
2031F 100489 HYDRATION STATUS DOCUMENTED DEHYDRATED $0.00
2033F 100490 EYE IMG VLD MTCH DX 7 STND FLD W/O EVC RTNOPTHY $0.00
2035F 100491 TYMPANIC MEMBRANE MOBILITY ASSESS $0.00
2040F 100492 PHYS EXAM ON DATE OF INIT VST FOR LBP DONE $0.00
2044F 100493 DOC MNTL HLTH ASSES PRIOR INTVN BACK PAIN 6WKS $0.00
20500 100494 INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC $5,320.50
20501 100495 INJECTION SINUS TRACT DIAGNOSTIC $1,726.00
2050F 100496 WOUND CHARACTERISTICS DOCD PRIOR DEBRIDEMENT $0.00
20520 100497 REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE $8,250.50
20525 100498 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP $9,161.50
20526 100499 INJECTION THERAPEUTIC CARPAL TUNNEL $1,147.00
20527 100500 INJECTION ENZYME PALMAR FASCIAL CORD $927.50
20550 100501 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS $1,010.50
20551 100502 INJECTION SINGLE TENDON ORIGIN/INSERTION $618.00
20552 100503 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES $442.00
20553 100504 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES $1,027.50
20555 100505 PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT $9,011.00
20560 100506 NEEDLE INSERTION W/O INJECTION 1 OR 2 MUSCLES $72.50
20561 100507 NEEDLE INSERTION W/O INJECTION 3 OR MORE MUSCLES $94.50
20600 100508 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US $1,228.00
20604 100509 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT $838.00
20605 100510 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US $1,578.00
20606 100511 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US $1,078.00
20610 100512 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US $1,272.50
20611 100513 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US $1,104.00
20612 100514 ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ $636.50
20615 100515 ASPIRATION & INJECTION TREATMENT BONE CYST $4,828.00
20650 100516 INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX $18,574.50
20660 100517 APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX $12,205.50
20661 100518 APPLICATION HALO CRANIAL INCLUDING REMOVAL $15,728.00
20662 100519 APPLICATION HALO PELVIC INCLUDING REMOVAL $6,699.00
20663 100520 APPLICATION HALO FEMORAL INCLUDING REMOVAL $9,011.00
20664 100521 APPL HALO CRANIAL 6/> PINS THIN SKULL OSTEOLOGY $0.00
20665 100522 REMOVAL TONGS/HALO APPLIED BY ANOTHER INDIVIDUAL $1,920.00
20670 100523 REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE $9,524.50
20680 100524 REMOVAL IMPLANT DEEP $13,532.50
20690 100525 APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM $8,507.00
20692 100526 APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM $10,943.00
20693 100527 ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES $14,515.50
20694 100528 REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES $10,545.00
20696 100529 APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT 1ST&SUBSQ $39,152.00
20697 100530 APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE $4,197.00
20700 100531 MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV $7,084.50
20701 100532 REMOVAL DEEP DRUG DELIVERY DEVICE $8,626.00
20702 100533 MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE $12,767.50
20703 100534 REMOVAL INTRAMEDULLARY DRUG DELIVERY DEVICE $0.00
20704 100535 MANUAL PREP&INSJ I-ARTIC DRUG DELIVERY DEVICE $12,923.00
20705 100536 REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE $0.00
20802 100537 REPLANTATION ARM COMPLETE AMPUTATION $53,170.00
20805 100538 REPLANTATION FOREARM COMPLETE AMPUTATION $53,170.00
20808 100539 REPLANTATION HAND COMPLETE AMPUTATION $53,170.00
20816 100540 RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP $0.00
20822 100541 RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP $8,294.50
20824 100542 RPLJ THMB CARP/MTCRPL JT MP JT COMPL AMPUTATION $0.00
20827 100543 RPLJ THUMB DISTAL TIP MP JOINT COMPL AMPUTATION $0.00
20838 100544 REPLANTATION FOOT COMPLETE AMPUTATION $53,170.00
20900 100545 BONE GRAFT ANY DONOR AREA MINOR/SMALL $11,251.50
20902 100546 BONE GRAFT ANY DONOR AREA MAJOR/LARGE $9,195.00
20910 100547 CARTILAGE GRAFT COSTOCHONDRAL $12,505.00
20912 100548 CARTILAGE GRAFT NASAL SEPTUM $10,249.50
20920 100549 FASCIA LATA GRAFT BY STRIPPER $10,016.50
20922 100550 FASCIA LATA GRAFT INCISION & AREA EXPOSURE $18,680.50
20924 100551 TENDON GRAFT FROM A DISTANCE $12,488.50
20930 100552 ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED $8,805.50
20931 100553 ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL $9,150.50
20932 100554 OSTEOARTICULAR ALLOGRAFT W/ARTICULAR SURF & BONE $0.00
20933 100555 HEMICORTICAL INTERCALARY ALLOGRAFT PARTIAL $0.00
20934 100556 INTERCALARY ALLOGRAFT COMPLETE $0.00
20936 100557 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION $2,588.00
20937 100558 AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION $2,223.00
20938 100559 AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC $11,868.50
20939 100560 BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY $7,400.50
20950 100561 MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME $1,847.00
20955 100562 BONE GRAFT MICROVASCULAR ANASTOMOSIS FIBULA $0.00
20956 100563 BONE GRAFT MICROVASCULAR ANAST ILIAC CREST $28,449.50
20957 100564 BONE GRAFT MICROVASCULAR ANAST METATARSAL $0.00
20962 100565 BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR $28,449.50
20969 100566 FREE OSTQ FLAP W/MVASC ANAST METAR/GREAT TOE $0.00
20970 100567 FREE OSTQ FLAP W/MVASC ANASTOMOSIS ILIAC CREST $0.00
20972 100568 FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL $14,465.00
20973 100569 FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE $14,465.00
20974 100570 ELECTRICAL STIMULATION BONE HEALING NONINVASIVE $5,927.50
20975 100571 ELECTRICAL STIMULATION BONE HEALING INVASIVE $14,515.50
20979 100572 LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE $502.00
20982 100573 ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE $16,830.50
20983 100574 ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD $25,109.00
20985 100575 CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS $2,397.00
20999 100576 UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL $0.00
21010 100577 ARTHROTOMY TEMPOROMANDIBULAR JOINT $11,739.50
21011 100578 EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM $9,871.00
21012 100579 EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/> $14,361.00
21013 100580 EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM $15,454.00
21014 100581 EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/> $14,975.00
21015 100582 RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM $10,763.50
21016 100583 RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/> $9,307.50
21025 100584 EXCISION BONE MANDIBLE $7,741.00
21026 100585 EXCISION FACIAL BONE $11,383.00
21029 100586 REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE $15,081.50
21030 100587 EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG $10,601.50
21031 100588 EXCISION TORUS MANDIBULARIS $8,646.50
21032 100589 EXCISION MAXILLARY TORUS PALATINUS $18,659.00
21034 100590 EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA $21,654.50
21040 100591 EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT $10,255.50
21044 100592 EXCISION MALIGNANT TUMOR MANDIBLE $14,860.00
21045 100593 EXCISION MALIGNANT TUMOR MANDIBLE RADICAL $24,353.00
21046 100594 EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT $13,133.00
21047 100595 EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB $23,512.50
21048 100596 EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT $32,953.50
21049 100597 EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC $11,739.50
21050 100598 CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX $27,447.00
21060 100599 MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX $11,739.50
21070 100600 CORONOIDECTOMY SEPARATE PROCEDURE $24,000.00
21073 100601 MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA $9,554.50
21076 100602 IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES $7,476.50
21077 100603 IMPRESSION & PREPARATION ORBITAL PROSTHESIS $11,739.50
21079 100604 IMPRESSION & PREPARATION INTERIM OBTURATOR PROST $12,400.50
21080 100605 IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES $14,963.50
21081 100606 IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES $14,519.50
21082 100607 IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES $11,739.50
21083 100608 IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS $11,739.50
21084 100609 IMPRESSION & PREPARATION SPEECH AID PROSTHESIS $11,739.50
21085 100610 IMPRESSION & PREPARATION ORAL SURGICAL SPLINT $12,490.50
21086 100611 IMPRESSION & PREPARATION AURICULAR PROSTHESIS $11,739.50
21087 100612 IMPRESSION & PREPARATION NASAL PROSTHESIS $11,739.50
21088 100613 IMPRESSION & PREPARATION FACIAL PROSTHESIS $11,739.50
21089 100614 UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE $0.00
21100 100615 APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX $11,739.50
21110 100616 APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC $14,284.50
21116 100617 INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY $1,463.00
21120 100618 GENIOPLASTY AUGMENTATION $24,154.50
21121 100619 GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE $20,670.50
21122 100620 GENIOPLASTY 2/> SLIDING OSTEOTOMIES $31,143.50
21123 100621 GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS $7,476.50
21125 100622 AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL $7,476.50
21127 100623 AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL $11,739.50
21137 100624 REDUCTION FOREHEAD CONTOURING ONLY $7,476.50
21138 100625 RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT $11,739.50
21139 100626 RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL $23,758.50
21141 100627 RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT $25,006.50
21142 100628 RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT $28,384.00
21143 100629 RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT $31,238.50
21145 100630 RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS $33,590.50
21146 100631 RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS $63,279.50
21147 100632 RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS $20,187.00
21150 100633 RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION $11,739.50
21151 100634 RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS $0.00
21154 100635 RCNSTJ MIDFACE LEFORT III W/O LEFORT I $0.00
21155 100636 RCNSTJ MIDFACE LEFORT III W/LEFORT I $0.00
21159 100637 RCNSTJ MIDFACE LEFORT III W/FHD W/O LEFORT I $0.00
21160 100638 RCNSTJ MIDFACE LEFORT III W/FHD W/LEFORT I $0.00
21172 100639 RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD $11,739.50
21175 100640 RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD $11,739.50
21179 100641 RCNSTJ FOREHEAD &/ SUPRAORB RIMS W/ALGRF/PROSTC $0.00
21180 100642 RCNSTJ FOREHEAD &/ SUPRAORBITAL RIMS W/AUTOGRAFT $0.00
21181 100643 RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC $11,739.50
21182 100644 RCNSTJ ORBIT/FHD/NASETHMD EXCBONE TUM GRF<40SQCM $0.00
21183 100645 RCNSTJ ORBIT/FHD/NASETHMD EXC BONE GRF>40 <80 $0.00
21184 100646 RCNSTJ ORBIT/FHD/NASETHMD EXC BONE TUM GRF>80SQ $0.00
21188 100647 RCNSTJ MDFC OTH/THN LEFORT OSTEOT & BONE GRAFTS $0.00
21193 100648 RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF $43,780.50
21194 100649 RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT $24,353.00
21195 100650 RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD $30,938.00
21196 100651 RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI $25,290.50
21198 100652 OSTEOTOMY MANDIBLE SEGMENTAL $33,048.00
21199 100653 OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT $27,815.00
21206 100654 OSTEOTOMY MAXILLA SEGMENTAL $27,813.00
21208 100655 OSTEOPLASTY FACIAL BONES AUGMENTATION $20,849.00
21209 100656 OSTEOPLASTY FACIAL BONES REDUCTION $11,739.50
21210 100657 GRAFT BONE NASAL/MAXILLARY/MALAR AREAS $12,486.50
21215 100658 GRAFT BONE MANDIBLE $13,116.50
21230 100659 GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR $26,344.50
21235 100660 GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR $14,342.50
21240 100661 ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT $44,848.00
21242 100662 ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT $11,739.50
21243 100663 ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT $40,224.00
21244 100664 RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE $22,053.50
21245 100665 RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL $11,739.50
21246 100666 RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE $11,739.50
21247 100667 RCNSTJ MNDBLR CONDYLE W/BONE CARTLG AUTOGRAFTS $0.00
21248 100668 RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL $11,978.50
21249 100669 RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE $20,771.50
21255 100670 RCNSTJ ZYGMTC ARCH/GLENOID FOSSA W/BONE CARTLG $0.00
21256 100671 RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS $11,739.50
21260 100672 PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL $11,739.50
21261 100673 PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR $11,739.50
21263 100674 PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD $11,739.50
21267 100675 ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL $11,739.50
21268 100676 ORBITAL REPOSITIONING W/BONE GRAFTS ICRA & XTRC $0.00
21270 100677 MALAR AUGMENTATION PROSTHETIC MATERIAL $11,739.50
21275 100678 SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ $11,739.50
21280 100679 MEDIAL CANTHOPEXY SEPARATE PROCEDURE $10,897.50
21282 100680 LATERAL CANTHOPEXY $6,710.00
21295 100681 REDUCTION MASSETER MUSCLE & BONE EXTRAORAL $2,846.50
21296 100682 REDUCTION MASSETER MUSCLE & BONE INTRAORAL $7,476.50
21299 100683 UNLISTED CRANIOFACIAL & MAXILLOFACIAL PROCEDURE $0.00
21315 100684 CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION $8,872.00
21320 100685 CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION $6,597.00
21325 100686 OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED $16,294.50
21330 100687 OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI $19,673.50
21335 100688 OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM $17,497.50
21336 100689 OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION $12,535.50
21337 100690 CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION $8,067.50
21338 100691 OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION $11,739.50
21339 100692 OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION $7,476.50
21340 100693 PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE $11,739.50
21343 100694 OPEN TX DEPRESSED FRONTAL SINUS FRACTURE $24,353.00
21344 100695 OPEN TX COMPLICATED FRONTAL SINUS FRACTURE $24,353.00
21345 100696 CLOSED TX NASOMAXILLARY COMPLEX FRACTURE $7,476.50
21346 100697 OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ $23,859.50
21347 100698 OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN $24,353.00
21348 100699 OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT $0.00
21355 100700 PERCUTANEOUS TX MALAR AREA FRACTURE $11,739.50
21356 100701 OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE $14,439.00
21360 100702 OPEN TX DEPRESSED MALAR FRACTURE $16,077.00
21365 100703 OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG $21,326.00
21366 100704 OPEN TX COMP FRACTURE MALAR AREA W/BONE GRAFT $24,353.00
21385 100705 OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL $20,447.50
21386 100706 OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL $27,222.00
21387 100707 OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR $23,228.50
21390 100708 OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC $15,982.50
21395 100709 OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF $11,739.50
21400 100710 CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION $2,846.50
21401 100711 CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION $2,846.50
21406 100712 OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT $21,433.50
21407 100713 OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT $14,289.00
21408 100714 OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT $11,739.50
21421 100715 CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT $11,739.50
21422 100716 OPEN TREATMENT PALATAL/MAXILLARY FRACTURE $21,280.00
21423 100717 OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR $24,353.00
21431 100718 CLOSED TX CRANIOFACIAL SEPARATION $0.00
21432 100719 OPEN TX CRANIOFACIAL SEP W/WIRING&/INT FIXJ $0.00
21433 100720 OPEN TX CRANIOFACIAL SEP COMPLICATED MLT APPR $0.00
21435 100721 OPEN TX CRANIOFACIAL SEP COMP W/INT&/XTRNL FIX $0.00
21436 100722 OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE $0.00
21440 100723 CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX $7,476.50
21445 100724 OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX $7,476.50
21450 100725 CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION $5,272.50
21451 100726 CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION $12,106.50
21452 100727 PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ $5,329.00
21453 100728 CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION $23,307.50
21454 100729 OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION $11,739.50
21461 100730 OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION $21,703.50
21462 100731 OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION $21,684.00
21465 100732 OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE $20,517.00
21470 100733 OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION $39,218.50
21480 100734 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ $1,183.00
21485 100735 CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ $7,476.50
21490 100736 OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION $11,739.50
21497 100737 INTERDENTAL WIRING OTHER THAN FRACTURE $8,444.00
21499 100738 UNLISTED MUSCULOSKELETAL PROCEDURE HEAD $0.00
21501 100739 I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX $16,536.50
21502 100740 I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI $6,699.00
21510 100741 INCISION DEEP OPENING BONE CORTEX THORAX $28,449.50
21550 100742 BIOPSY SOFT TISSUE NECK/THORAX $5,227.50
21552 100743 EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/> $12,149.50
21554 100744 EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/> $11,291.00
21555 100745 EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM $7,983.50
21556 100746 EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM $15,465.50
21557 100747 RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM $13,749.50
21558 100748 RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/> $12,960.00
21600 100749 EXCISION RIB PARTIAL $24,963.50
21601 100750 EXCISION CHEST WALL TUMOR INCLUDING RIBS $16,052.50
21602 100751 EXCISION CH WAL TUM W/RIB W/O MEDSTNL LYMPHADEC $28,449.50
21603 100752 EXCISION CH WAL TUM W/RIB W/MEDSTNL LYMPHADEC $28,449.50
21610 100753 COSTOTRANSVERSECTOMY SEPARATE PROCEDURE $9,011.00
21615 100754 EXCISION 1ST &/CERVICAL RIB $16,499.00
21616 100755 EXCISION 1ST &/CERVICAL RIB W/SYMPATHECTOMY $0.00
21620 100756 OSTECTOMY STERNUM PARTIAL $21,997.00
21627 100757 STERNAL DEBRIDEMENT $0.00
21630 100758 RADICAL RESECTION STERNUM $0.00
21632 100759 RADICAL RESECTION STERNUM W/MEDSTNL LMPHADEC $0.00
21685 100760 HYOID MYOTOMY & SUSPENSION $13,977.50
21700 100761 DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB $19,800.00
21705 100762 DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB $38,885.50
21720 100763 DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST $21,870.00
21725 100764 DIVISION STERNOCLEIDOMASTOID OPEN W/CAST $1,008.00
21740 100765 REPAIR PECTUS EXCAVATUM/CARINATUM OPEN $0.00
21742 100766 REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC $12,165.50
21743 100767 REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC $12,165.50
21750 100768 CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX $28,449.50
21811 100769 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS $8,221.00
21812 100770 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS $8,221.00
21813 100771 OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS $8,221.00
21820 100772 CLOSED TREATMENT STERNUM FRACTURE $1,058.00
21825 100773 OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION $28,449.50
21899 100774 UNLISTED PROCEDURE NECK/THORAX $0.00
21920 100775 BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL $8,043.50
21925 100776 BIOPSY SOFT TISSUE BACK/FLANK DEEP $8,085.00
21930 100777 EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM $6,188.00
21931 100778 EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/> $11,309.50
21932 100779 EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM $15,617.00
21933 100780 EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/> $18,013.00
21935 100781 RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM $15,344.50
21936 100782 RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/> $16,139.50
22010 100783 I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR $17,246.00
22015 100784 I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC $18,400.50
22100 100785 PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV $10,756.50
22101 100786 PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC $12,436.50
22102 100787 PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR $14,419.50
22103 100788 PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA $5,354.00
22110 100789 PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV $14,160.00
22112 100790 PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC $0.00
22114 100791 PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR $0.00
22116 100792 PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA $11,479.50
22206 100793 OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC $0.00
22207 100794 OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR $17,246.00
22208 100795 OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM $0.00
22210 100796 OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM CRV $0.00
22212 100797 OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM THRC $0.00
22214 100798 OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR $9,947.50
22216 100799 OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM $6,880.50
22220 100800 OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM CRV $8,400.00
22222 100801 OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM THRC $0.00
22224 100802 OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM LUMBAR $17,246.00
22226 100803 OSTEOTOMY SPINE W/DSC ANT APPR 1 VRT SGM EA ADDL $0.00
22310 100804 CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING $1,154.50
22315 100805 CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ $3,470.00
22318 100806 OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT $0.00
22319 100807 OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ $0.00
22325 100808 OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM $14,155.00
22326 100809 OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR $0.00
22327 100810 OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH $0.00
22328 100811 OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA $0.00
22505 100812 MANIPULATION SPINE REQUIRING ANESTHESIA $4,089.00
22510 100813 PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC $14,556.50
22511 100814 PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL $14,355.50
22512 100815 VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL $7,143.00
22513 100816 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION $18,388.50
22514 100817 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR $15,888.00
22515 100818 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH $15,251.50
22526 100819 PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL $34,993.00
22527 100820 PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL $0.00
22532 100821 ARTHRODESIS LATERAL EXTRACAVITARY THORACIC $27,230.00
22533 100822 ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR $27,230.00
22534 100823 ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR $0.00
22548 100824 ARTHRD ANT TRANSORL/XTRORAL C1-C2 W/WO EXC ODNTD $27,230.00
22551 100825 ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 $18,777.50
22552 100826 ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC $3,975.50
22554 100827 ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2 $13,555.50
22556 100828 ARTHRD ANT INTERBODY MIN DSC THORACIC $27,230.00
22558 100829 ARTHRD ANT INTERBODY MIN DSC LUMBAR $17,879.00
22585 100830 ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE $5,722.50
22586 100831 ARTHRODESIS PRESACRAL NTRBDY DSC W/INSTRMJ L5-S1 $27,230.00
22590 100832 ARTHRODESIS POSTERIOR CRANIOCERVICAL $27,230.00
22595 100833 ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2 $27,230.00
22600 100834 ARTHRD PST/PSTLAT TQ 1NTRSPC CRV BELW C2 SEGMENT $11,144.00
22610 100835 ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC THORACIC $9,091.50
22612 100836 ARTHRODESIS POSTERIOR/PSTLAT TQ 1NTRSPC LUMBAR $18,034.50
22614 100837 ARTHRODESIS PST/PSTLAT TQ 1NTRSPC EA ADDL NTRSPC $5,383.00
22630 100838 ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC LUMBAR $10,843.00
22632 100839 ARTHRODESIS POSTERIOR INTERBODY 1 NTRSPC EA ADDL $8,355.00
22633 100840 ARTHRODESIS COMBINED TQ 1NTRSPC LUMBAR $12,074.00
22634 100841 ARTHRODESIS CMBN TQ 1NTRSPC EACH ADDITIONAL $11,346.00
22800 100842 ARTHRODESIS POSTERIOR SPINAL DFRM <6 VRT SGM $22,604.50
22802 100843 ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SGM $24,291.50
22804 100844 ARTHRODESIS POSTERIOR SPINAL DFRM 13+ VRT SGM $27,230.00
22808 100845 ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SGM $27,230.00
22810 100846 ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SGM $27,896.00
22812 100847 ARTHRODESIS ANTERIOR SPINAL DFRM 8+ VRT SGM $28,795.50
22818 100848 KYPHECTOMY SINGLE OR TWO SEGMENTS $27,230.00
22819 100849 KYPHECTOMY 3 OR MORE SEGMENTS $27,896.00
22830 100850 EXPLORATION SPINAL FUSION $10,939.00
22836 100851 ANT THORACIC VRT BODY TETHERING <7 VRT SEGMENTS $0.00
22837 100852 ANT THORACIC VRT BODY TETHERING 8+ VRT SEGMENTS $0.00
22838 100853 REVJ RPLCMT/RMVL THORACIC VRT BODY TETHERING $0.00
22840 100854 POSTERIOR NON-SEGMENTAL INSTRUMENTATION $3,814.50
22841 100855 INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS $0.00
22842 100856 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG $8,093.50
22843 100857 POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG $9,899.50
22844 100858 POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE $0.00
22845 100859 ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS $3,621.00
22846 100860 ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS $7,713.50
22847 100861 ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS $0.00
22848 100862 PELVIC FIXATION OTHER THAN SACRUM $8,830.00
22849 100863 REINSERTION SPINAL FIXATION DEVICE $15,590.50
22850 100864 REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION $15,218.00
22852 100865 REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION $15,161.00
22853 100866 INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD $3,893.50
22854 100867 INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD $5,863.50
22855 100868 REMOVAL ANTERIOR INSTRUMENTATION $12,348.00
22856 100869 TOTAL DISC ARTHRP ANT SINGLE INTERSPACE CERVICAL $25,617.00
22857 100870 TOTAL DISC ARTHRP ANT SINGLE INTERSPACE LUMBAR $36,461.00
22858 100871 TOTAL DISC ARTHRP ANT 2ND LEVEL CERVICAL $17,226.00
22859 100872 INSJ BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD $9,181.00
22860 100873 TOTAL DISC ARTHRP ANT SECOND INTERSPACE LUMBAR $0.00
22861 100874 REVJ W/RPLCMT TOT DISC ARTHRP ANT 1 NTRSPC CRV $36,423.00
22862 100875 REVJ W/RPLCMT TOT DISC ARTHRP ANT 1 NTRSPC LMBR $27,230.00
22864 100876 RMVL TOT DISC ARTHRP ANT 1 INTERSPACE CERVICAL $25,762.00
22865 100877 RMVL TOT DISC ARTHRP ANT 1 INTERSPACE LUMBAR $0.00
22867 100878 INSJ STABLJ DEV W/DCMPRN LUMBAR SINGLE LEVEL $32,369.50
22868 100879 INSJ STABLJ DEV W/DCMPRN LUMBAR SECOND LEVEL $10,399.50
22869 100880 INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL $32,369.50
22870 100881 INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL $14,194.50
22899 100882 UNLISTED PROCEDURE SPINE $0.00
22900 100883 EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM $9,992.00
22901 100884 EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/> $11,064.00
22902 100885 EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM $7,105.00
22903 100886 EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/> $8,723.50
22904 100887 RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM $25,907.00
22905 100888 RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/> $21,625.00
22999 100889 UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM $0.00
23000 100890 REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN $5,238.50
23020 100891 CAPSULAR CONTRACTURE RELEASE $10,557.00
23030 100892 I&D SHOULDER DEEP ABSCESS/HEMATOMA $17,962.00
23031 100893 I&D SHOULDER INFECTED BURSA $5,919.00
23035 100894 INCISION BONE CORTEX SHOULDER AREA $6,699.00
23040 100895 ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB $14,601.50
23044 100896 ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB $15,875.00
23065 100897 BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL $6,858.00
23066 100898 BIOPSY SOFT TISSUE SHOULDER DEEP $15,599.50
23071 100899 EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> $8,944.00
23073 100900 EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/> $10,507.00
23075 100901 EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM $7,412.00
23076 100902 EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM $15,875.00
23077 100903 RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM $11,583.00
23078 100904 RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/> $22,911.50
23100 100905 ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY $6,699.00
23101 100906 ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG $9,011.00
23105 100907 ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY $9,011.00
23106 100908 ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX $9,011.00
23107 100909 ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB $18,602.50
23120 100910 CLAVICULECTOMY PARTIAL $2,223.00
23125 100911 CLAVICULECTOMY TOTAL $13,531.00
23130 100912 PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE $9,588.50
23140 100913 EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA $13,338.00
23145 100914 EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT $9,011.00
23146 100915 EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT $9,011.00
23150 100916 EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS $13,739.50
23155 100917 EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT $9,011.00
23156 100918 EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT $17,915.50
23170 100919 SEQUESTRECTOMY CLAVICLE $9,011.00
23172 100920 SEQUESTRECTOMY SCAPULA $9,011.00
23174 100921 SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK $9,011.00
23180 100922 PARTIAL EXCISION BONE CLAVICLE $20,508.00
23182 100923 PARTIAL EXCISION BONE SCAPULA $9,011.00
23184 100924 PARTIAL EXCISION BONE PROXIMAL HUMERUS $25,862.50
23190 100925 OSTECTOMY SCAPULA PARTIAL $24,704.00
23195 100926 RESECTION HUMERAL HEAD $9,011.00
23200 100927 RADICAL RESECTION TUMOR CLAVICLE $28,449.50
23210 100928 RADICAL RESECTION TUMOR SCAPULA $28,449.50
23220 100929 RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS $0.00
23330 100930 REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS $3,204.50
23333 100931 REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM $17,461.50
23334 100932 PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT $26,634.00
23335 100933 PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT $22,288.00
23350 100934 INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG $3,664.00
23395 100935 MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE $21,793.50
23397 100936 MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE $18,175.50
23400 100937 SCAPULOPEXY $31,033.50
23405 100938 TENOTOMY SHOULDER AREA 1 TENDON $1,644.00
23406 100939 TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION $15,037.50
23410 100940 OPEN REPAIR OF ROTATOR CUFF ACUTE $12,405.00
23412 100941 OPEN REPAIR OF ROTATOR CUFF CHRONIC $17,589.00
23415 100942 CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY $11,600.50
23420 100943 RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC $21,064.50
23430 100944 TENODESIS LONG TENDON BICEPS $4,306.50
23440 100945 RESECTION/TRANSPLANTATION LONG TENDON BICEPS $11,190.50
23450 100946 CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON $18,175.50
23455 100947 CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR $19,278.50
23460 100948 CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK $36,438.50
23462 100949 CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR $34,761.50
23465 100950 CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK $18,175.50
23466 100951 CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS $21,135.00
23470 100952 ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY $24,080.50
23472 100953 ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER $20,450.00
23473 100954 REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT $26,630.00
23474 100955 REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT $25,540.00
23480 100956 OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION $22,535.00
23485 100957 OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL $23,726.00
23490 100958 PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE $18,175.50
23491 100959 PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS $18,175.50
23500 100960 CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION $983.00
23505 100961 CLSD TX CLAVICULAR FRACTURE W/MANIPULATION $7,843.00
23515 100962 OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION $19,065.50
23520 100963 CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION $2,406.50
23525 100964 CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION $2,406.50
23530 100965 OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC $34,070.00
23532 100966 OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF $33,729.50
23540 100967 CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION $1,022.00
23545 100968 CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION $1,535.00
23550 100969 OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC $16,582.00
23552 100970 OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF $21,373.00
23570 100971 CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION $973.00
23575 100972 CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION $2,767.50
23585 100973 OPEN TX SCAPULAR FX W/INT FIXATION WHEN PFRMD $35,507.00
23600 100974 CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION $1,196.50
23605 100975 CLTX PROX HUMRL FX W/MNPJ W/WO SKELETAL TRACJ $3,860.50
23615 100976 OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY $22,168.00
23616 100977 OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT $27,850.00
23620 100978 CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ $985.00
23625 100979 CLTX GREATER HUMRL TUBEROSITY FX W/MANIPULATION $6,127.00
23630 100980 OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ $21,086.50
23650 100981 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES $1,397.00
23655 100982 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES $5,822.50
23660 100983 OPEN TX ACUTE SHOULDER DISLOCATION $15,922.00
23665 100984 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ $4,334.50
23670 100985 OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ $20,151.00
23675 100986 CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MNPJ $3,908.50
23680 100987 OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ $23,865.00
23700 100988 MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS $5,210.00
23800 100989 ARTHRODESIS GLENOHUMERAL JOINT $18,175.50
23802 100990 ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT $18,175.50
23900 100991 INTERTHORACOSCAPULAR AMPUTATION $0.00
23920 100992 DISARTICULATION SHOULDER $0.00
23921 100993 DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION $5,204.00
23929 100994 UNLISTED PROCEDURE SHOULDER $0.00
23930 100995 I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA $14,834.50
23931 100996 INCISION&DRAINAGE UPPER ARM/ELBOW BURSA $8,812.00
23935 100997 INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW $6,699.00
24000 100998 ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB $17,656.50
24006 100999 ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX $14,409.50
24065 101000 BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL $11,988.00
24066 101001 BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP $14,902.00
24071 101002 EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/> $8,396.00
24073 101003 EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/> $19,404.50
24075 101004 EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM $5,402.00
24076 101005 EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM $8,919.50
24077 101006 RAD RESCJ TUMOR SOFT TISS UPPER ARM/ELBOW <5CM $10,049.50
24079 101007 RAD RESCJ TUMOR SOFT TISS UPPER ARM/ELBOW 5CM+ $11,783.50
24100 101008 ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY $6,699.00
24101 101009 ARTHRT ELBOW W/JT EXPL W/WOBX W/O RMVL LOOSE/FB $11,251.00
24102 101010 ARTHROTOMY ELBOW W/SYNOVECTOMY $11,167.50
24105 101011 EXCISION OLECRANON BURSA $17,622.50
24110 101012 EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS $19,876.00
24115 101013 EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT $9,011.00
24116 101014 EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT $21,177.00
24120 101015 EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN $8,130.50
24125 101016 EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT $9,011.00
24126 101017 EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT $9,011.00
24130 101018 EXCISION RADIAL HEAD $13,024.00
24134 101019 SEQUESTRECTOMY SHAFT/DISTAL HUMERUS $9,011.00
24136 101020 SEQUESTRECTOMY RADIAL HEAD OR NECK $9,011.00
24138 101021 SEQUESTRECTOMY OLECRANON PROCESS $9,011.00
24140 101022 PARTIAL EXCISION BONE HUMERUS $8,701.00
24145 101023 PARTIAL EXCISION BONE RADIAL HEAD/NECK $9,011.00
24147 101024 PARTIAL EXCISION BONE OLECRANON PROCESS $9,549.50
24149 101025 RAD RESCJ CAPSL TISS&HTRTPC B1 ELBW CONTRCT RLS $18,077.00
24150 101026 RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS $12,165.50
24152 101027 RADICAL RESECTION TUMOR RADIAL HEAD/NECK $12,165.50
24155 101028 RESECTION ELBOW JOINT ARTHRECTOMY $9,011.00
24160 101029 PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS $9,011.00
24164 101030 PROSTHESIS REMOVAL RADIAL HEAD $23,565.00
24200 101031 RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS $6,778.00
24201 101032 REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP $15,881.00
24220 101033 INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY $1,046.00
24300 101034 MANIPULATION ELBOW UNDER ANESTHESIA $9,996.00
24301 101035 MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE $16,056.50
24305 101036 TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON $7,454.00
24310 101037 TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON $12,400.50
24320 101038 TENOPLASTY ELBOW TO SHOULDER SINGLE $9,011.00
24330 101039 FLEXOR-PLASTY ELBOW $18,175.50
24331 101040 FLEXOR-PLASTY ELBOW W/EXTENSOR ADVANCEMENT $12,165.50
24332 101041 TENOLYSIS TRICEPS $9,011.00
24340 101042 TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE $22,326.00
24341 101043 REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC $26,094.50
24342 101044 RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF $14,093.00
24343 101045 REPAIR LATERAL COLLATERAL LIGAMENT ELBOW $17,968.00
24344 101046 RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT $18,175.50
24345 101047 REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW $16,164.50
24346 101048 RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF $32,209.00
24357 101049 TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS $9,279.00
24358 101050 TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN $9,489.00
24359 101051 TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR $12,347.50
24360 101052 ARTHROPLASTY ELBOW W/MEMBRANE $10,615.50
24361 101053 ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT $26,343.50
24362 101054 ARTHRP ELBOW W/IMPLT&FSCA LATA LIGAMENT RCNSTJ $14,772.50
24363 101055 ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM $29,625.00
24365 101056 ARTHROPLASTY RADIAL HEAD $18,892.00
24366 101057 ARTHROPLASTY RADIAL HEAD W/IMPLANT $20,902.00
24370 101058 REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT $28,729.50
24371 101059 REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT $48,188.00
24400 101060 OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION $18,175.50
24410 101061 MLT OSTEOT W/RELIGNMT IMED ROD HUMERAL SHAFT $12,165.50
24420 101062 OSTEOPLASTY HUMERUS $12,165.50
24430 101063 REPAIR NON/MALUNION HUMERUS W/O GRAFT $27,221.00
24435 101064 REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT $29,592.50
24470 101065 HEMIEPIPHYSEAL ARREST $12,165.50
24495 101066 DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL $9,011.00
24498 101067 PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT $30,502.00
24500 101068 CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION $1,369.00
24505 101069 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ $3,241.50
24515 101070 OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE $22,827.50
24516 101071 TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE $21,428.00
24530 101072 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ $1,276.50
24535 101073 CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ $5,513.00
24538 101074 PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX $12,919.00
24545 101075 OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN $27,401.50
24546 101076 OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN $30,473.00
24560 101077 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ $985.00
24565 101078 CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ $4,664.00
24566 101079 PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ $7,815.00
24575 101080 OPEN TX HUMERAL EPICONDYLAR FRACTURE $22,438.00
24576 101081 CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ $1,029.50
24577 101082 CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ $5,834.00
24579 101083 OPEN TREATMENT HUMERAL CONDYLAR FRACTURE $22,291.00
24582 101084 PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ $16,292.50
24586 101085 OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO $40,161.00
24587 101086 OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR $30,012.50
24600 101087 TREATMENT CLOSED ELBOW DISLOCATION W/O ANES $1,342.00
24605 101088 TREATMENT CLOSED ELBOW DISLOCATION REQ ANES $4,149.00
24615 101089 OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION $14,829.00
24620 101090 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ $4,014.50
24635 101091 OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW $23,001.50
24640 101092 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ $705.00
24650 101093 CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION $973.00
24655 101094 CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION $4,193.00
24665 101095 OPEN TX RADIAL HEAD/NECK FRACTURE $16,890.50
24666 101096 OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC $18,206.50
24670 101097 CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ $1,254.00
24675 101098 CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ $4,578.00
24685 101099 OPEN TREATMENT ULNAR FRACTURE PROXIMAL END $15,265.50
24800 101100 ARTHRODESIS ELBOW JOINT LOCAL $12,165.50
24802 101101 ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT $18,175.50
24900 101102 AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE $0.00
24920 101103 AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR $0.00
24925 101104 AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ $6,699.00
24930 101105 AMPUTATION ARM THRU HUMERUS RE-AMPUTATION $0.00
24931 101106 AMPUTATION ARM THRU HUMERUS W/IMPLANT $0.00
24935 101107 STUMP ELONGATION UPPER EXTREMITY $18,175.50
24940 101108 CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE $0.00
24999 101109 UNLISTED PROCEDURE HUMERUS/ELBOW $0.00
25000 101110 INCISION EXTENSOR TENDON SHEATH WRIST $4,898.50
25001 101111 INCISION FLEXOR TENDON SHEATH WRIST $6,522.00
25020 101112 DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT $8,602.00
25023 101113 DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT $9,011.00
25024 101114 DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB $9,011.00
25025 101115 DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT $9,011.00
25028 101116 I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA $9,611.00
25031 101117 INCISION & DRAINAGE FOREARM&/WRIST BURSA $6,699.00
25035 101118 INCISION DEEP BONE CORTEX FOREARM&/WRIST $13,401.00
25040 101119 ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB $9,011.00
25065 101120 BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL $6,738.50
25066 101121 BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP $8,643.50
25071 101122 EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/> $8,003.00
25073 101123 EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/> $9,997.00
25075 101124 EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM $5,323.50
25076 101125 EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM $8,804.50
25077 101126 RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM $5,238.50
25078 101127 RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/> $18,470.00
25085 101128 CAPSULOTOMY WRIST $12,388.50
25100 101129 ARTHROTOMY WRIST JOINT WITH BIOPSY $8,997.00
25101 101130 ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB $9,089.50
25105 101131 ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY $8,808.50
25107 101132 ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE $11,118.50
25109 101133 EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA $9,758.00
25110 101134 EXCISION LESION TENDON SHEATH FOREARM&/WRIST $7,912.00
25111 101135 EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY $8,733.50
25112 101136 EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT $9,059.00
25115 101137 RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS $7,479.50
25116 101138 RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS $7,823.50
25118 101139 SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT $8,146.00
25119 101140 SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA $21,100.00
25120 101141 EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA $9,463.00
25125 101142 EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT $9,011.00
25126 101143 EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT $19,567.00
25130 101144 EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES $10,739.50
25135 101145 EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT $9,011.00
25136 101146 EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT $9,011.00
25145 101147 SEQUESTRECTOMY FOREARM &/WRIST $9,011.00
25150 101148 PARTIAL EXCISION BONE ULNA $15,850.00
25151 101149 PARTIAL EXCISION BONE RADIUS $8,957.50
25170 101150 RADICAL RESECTION TUMOR RADIUS OR ULNA $9,011.00
25210 101151 CARPECTOMY 1 BONE $9,143.00
25215 101152 CARPECTOMY ALL BONES PROXIMAL ROW $13,076.50
25230 101153 RADICAL STYLOIDECTOMY SEPARATE PROCEDURE $6,705.00
25240 101154 EXCISION DISTAL ULNA PARTIAL/COMPLETE $9,495.50
25246 101155 INJECTION WRIST ARTHROGRAPHY $914.50
25248 101156 EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST $8,790.00
25250 101157 REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE $9,011.00
25251 101158 REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST $9,011.00
25259 101159 MANIPULATION WRIST UNDER ANESTHESIA $7,618.00
25260 101160 RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU $7,083.50
25263 101161 RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS $9,011.00
25265 101162 RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA $9,011.00
25270 101163 RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN $12,666.00
25272 101164 RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU $16,194.00
25274 101165 RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN $9,011.00
25275 101166 RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT $18,907.00
25280 101167 LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN $9,901.50
25290 101168 TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA $10,765.50
25295 101169 TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA $7,802.00
25300 101170 TENODESIS WRIST FLEXORS FINGERS $9,011.00
25301 101171 TENODESIS WRIST EXTENSORS FINGERS $7,485.00
25310 101172 TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN $1,644.00
25312 101173 TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR $10,649.50
25315 101174 FLEXOR ORIGIN SLIDE FOREARM &/WRIST $9,011.00
25316 101175 FLEXOR ORIGIN SLIDE F/ARM&/WRST TENDON TRANSFE $18,175.50
25320 101176 CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS $14,585.00
25332 101177 ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ $14,236.00
25335 101178 CENTRALIZATION WRST ULNA $12,165.50
25337 101179 RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ $13,908.00
25350 101180 OSTEOTOMY RADIUS DISTAL THIRD $26,834.50
25355 101181 OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD $12,165.50
25360 101182 OSTEOTOMY ULNA $25,008.00
25365 101183 OSTEOTOMY RADIUS & ULNA $18,175.50
25370 101184 MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS/ULNA $12,165.50
25375 101185 MLT OSTEOTOMIES W/RELIGNMT IMED ROD RADIUS&ULNA $12,165.50
25390 101186 OSTEOPLASTY RADIUS/ULNA SHORTENING $14,286.50
25391 101187 OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT $18,175.50
25392 101188 OSTEOPLASTY RADIUS & ULNA SHORTENING $9,011.00
25393 101189 OSTEOPLASTY RADIUS&ULNA LENGTHENING W/AUTOGRAF $12,165.50
25394 101190 OSTEOPLASTY CARPAL BONE SHORTENING $12,165.50
25400 101191 RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT $19,966.00
25405 101192 RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT $22,480.50
25415 101193 RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF $26,535.00
25420 101194 RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT $49,763.00
25425 101195 REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA $13,056.00
25426 101196 REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA $12,165.50
25430 101197 INSERTION VASCULAR PEDICLE CARPAL BONE $12,165.50
25431 101198 REPAIR NONUNION CARPAL BONE EACH BONE $12,165.50
25440 101199 RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC $32,421.00
25441 101200 ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL RADIUS $26,343.50
25442 101201 ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA $20,118.00
25443 101202 ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL $14,772.50
25444 101203 ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE $14,772.50
25445 101204 ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM $17,260.50
25446 101205 ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS $25,555.50
25447 101206 ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS $13,864.00
25449 101207 REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT $18,910.50
25450 101208 EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U $12,165.50
25455 101209 EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA $12,165.50
25490 101210 PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS $12,165.50
25491 101211 PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA $12,165.50
25492 101212 PROPH TX N/P/PLTWR W/WO METHYLMECRYLATE RAD&UL $12,165.50
25500 101213 CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION $1,152.50
25505 101214 CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION $3,730.00
25515 101215 OPEN TREATMENT RADIAL SHAFT FRACTURE $17,036.50
25520 101216 CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT $4,553.00
25525 101217 OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE $22,380.50
25526 101218 OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE $27,410.00
25530 101219 CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION $1,006.50
25535 101220 CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION $4,166.50
25545 101221 OPEN TREATMENT OF ULNAR SHAFT FRACTURE $15,004.00
25560 101222 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN $1,096.00
25565 101223 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ $2,094.50
25574 101224 OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA $20,203.50
25575 101225 OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA $23,661.50
25600 101226 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ $1,055.00
25605 101227 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF $2,286.50
25606 101228 PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP $11,697.00
25607 101229 OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP $16,409.00
25608 101230 OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG $14,923.00
25609 101231 OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG $14,775.50
25622 101232 CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ $1,344.00
25624 101233 CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ $6,265.00
25628 101234 OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE $13,870.00
25630 101235 CLTX CARPAL BONE FX W/O MANJ EACH BONE $1,169.00
25635 101236 CLTX CARPAL BONE FX W/MANJ EACH BONE $6,654.50
25645 101237 OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA $13,753.50
25650 101238 CLOSED TREATMENT ULNAR STYLOID FRACTURE $1,826.50
25651 101239 PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE $9,882.00
25652 101240 OPEN TREATMENT ULNAR STYLOID FRACTURE $16,008.50
25660 101241 CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ $1,136.00
25670 101242 OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES $15,398.00
25671 101243 PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION $15,258.00
25675 101244 CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ $1,479.00
25676 101245 OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC $14,253.50
25680 101246 CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ $1,058.00
25685 101247 OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC $18,392.00
25690 101248 CLOSED TX LUNATE DISLOCATION W/MANIPULATION $7,535.00
25695 101249 OPEN TREATMENT LUNATE DISLOCATION $19,857.50
25800 101250 ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT $20,873.00
25805 101251 ARTHRODESIS WRIST W/SLIDING GRAFT $18,175.50
25810 101252 ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT $22,370.50
25820 101253 ARTHRODESIS WRIST LIMITED W/O BONE GRAFT $17,945.00
25825 101254 ARTHRODESIS WRIST LIMITED W/AUTOGRAFT $21,218.00
25830 101255 ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE $17,842.00
25900 101256 AMPUTATION FOREARM THROUGH RADIUS & ULNA $0.00
25905 101257 AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR $0.00
25907 101258 AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE $6,699.00
25909 101259 AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION $6,699.00
25915 101260 KRUKENBERG PROCEDURE $0.00
25920 101261 DISARTICULATION THROUGH WRIST $0.00
25922 101262 DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ $6,699.00
25924 101263 DISARTICULATION THRU WRIST RE-AMPUTATION $0.00
25927 101264 TRANSMETACARPAL AMPUTATION $0.00
25929 101265 TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ $5,204.00
25931 101266 TRANSMETACARPAL AMPUTATION RE-AMPUTATION $6,699.00
25999 101267 UNLISTED PROCEDURE FOREARM/WRIST $0.00
26010 101268 DRAINAGE FINGER ABSCESS SIMPLE $837.50
26011 101269 DRAINAGE FINGER ABSCESS COMPLICATED $7,835.50
26020 101270 DRAINAGE TENDON SHEATH DIGIT&/PALM EACH $7,773.50
26025 101271 DRAINAGE OF PALMAR BURSA SINGLE BURSA $5,461.50
26030 101272 DRAINAGE OF PALMAR BURSA MULTIPLE BURSA $5,461.50
26034 101273 INCISION BONE CORTEX HAND/FINGER $7,640.00
26035 101274 DECOMPRESSION FINGERS&/HAND INJECTION INJURY $5,461.50
26037 101275 DECOMPRESSIVE FASCIOTOMY HAND $11,963.00
26040 101276 FASCIOTOMY PALMAR PERCUTANEOUS $6,514.00
26045 101277 FASCIOTOMY PALMAR OPEN PARTIAL $9,411.00
26055 101278 TENDON SHEATH INCISION $6,232.50
26060 101279 TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT $7,770.00
26070 101280 ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT $9,995.00
26075 101281 ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA $9,391.00
26080 101282 ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA $6,787.50
26100 101283 ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH $5,461.50
26105 101284 ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH $13,162.50
26110 101285 ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH $7,065.00
26111 101286 EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/> $7,795.50
26113 101287 EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/> $9,134.00
26115 101288 EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM $6,687.50
26116 101289 EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM $8,027.00
26117 101290 RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM $9,571.00
26118 101291 RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/> $12,524.50
26121 101292 FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT $9,520.50
26123 101293 FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR $13,108.00
26125 101294 FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR $1,644.00
26130 101295 SYNOVECTOMY CARPOMETACARPAL JOINT $10,474.00
26135 101296 SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD $5,901.50
26140 101297 SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT $5,269.00
26145 101298 SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN $5,393.00
26160 101299 EXC LESION TDN SHTH/JT CAPSL HAND/FNGR $7,896.50
26170 101300 EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH $5,330.00
26180 101301 EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH $5,083.00
26185 101302 SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE $5,461.50
26200 101303 EXCISION/CURETTAGE CYST/TUMOR METACARPAL $13,258.00
26205 101304 EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT $8,294.50
26210 101305 EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER $7,979.00
26215 101306 EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT $17,124.50
26230 101307 PARTIAL EXCISION BONE METACARPAL $8,258.00
26235 101308 PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER $5,676.00
26236 101309 PARTIAL EXCISION DISTAL PHALANX FINGER $5,875.50
26250 101310 RADICAL RESECTION TUMOR METACARPAL $5,461.50
26260 101311 RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER $5,461.50
26262 101312 RADICAL RESECTION TUMOR DISTAL PHALANX FINGER $5,461.50
26320 101313 REMOVAL IMPLANT FROM FINGER/HAND $7,571.00
26340 101314 MANIPULATION FINGER JOINT UNDER ANES EACH JOINT $3,809.50
26341 101315 MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD $1,271.50
26350 101316 RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON $8,131.50
26352 101317 RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON $16,272.00
26356 101318 RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON $10,580.50
26357 101319 RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON $18,531.50
26358 101320 RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON $15,043.50
26370 101321 RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN $14,837.50
26372 101322 RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA $31,033.50
26373 101323 RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA $8,294.50
26390 101324 EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F $26,292.50
26392 101325 RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD $25,053.50
26410 101326 REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH $12,092.50
26412 101327 REPAIR EXTENSOR TENDON HAND W/GRAFT EACH $19,966.00
26415 101328 EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA $8,294.50
26416 101329 RMVL SYNTH ROD & INSJ XTNSR TDN GRF H/F EA ROD $8,294.50
26418 101330 REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH $7,639.50
26420 101331 REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH $15,186.00
26426 101332 RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR $9,769.00
26428 101333 RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER $15,466.50
26432 101334 CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING $12,269.00
26433 101335 REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF $14,116.00
26434 101336 REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT $8,294.50
26437 101337 REALIGNMENT EXTENSOR TENDON HAND EACH TENDON $10,894.00
26440 101338 TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON $2,223.00
26442 101339 TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO $9,807.00
26445 101340 TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH $7,767.00
26449 101341 TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA $8,294.50
26450 101342 TENOTOMY FLEXOR PALM OPEN EACH TENDON $7,380.50
26455 101343 TENOTOMY FLEXOR FINGER OPEN EACH TENDON $7,531.00
26460 101344 TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON $8,931.50
26471 101345 TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH $10,558.00
26474 101346 TENODESIS DISTAL JOINT EACH $9,758.00
26476 101347 LENGTHENING TENDON EXTENSOR HAND/FINGER EACH $9,983.50
26477 101348 SHORTENING TENDON EXTENSOR HAND/FINGER EACH $5,461.50
26478 101349 LENGTHENING TENDON FLEXOR HAND/FINGER EACH $7,085.50
26479 101350 SHORTENING TENDON FLEXOR HAND/FINGER EACH $5,461.50
26480 101351 TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN $1,644.00
26483 101352 TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT $11,177.00
26485 101353 TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH $8,674.00
26489 101354 TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH $12,208.00
26490 101355 OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN $10,049.50
26492 101356 OPPONENSPLASTY TDN TR W/GRF EA TDN $13,219.00
26494 101357 OPPONENSPLASTY HYPOTHENAR MUSC TR $8,294.50
26496 101358 OPPONENSPLASTY OTHER METHODS $16,032.50
26497 101359 TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR $10,159.50
26498 101360 TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS $19,230.50
26499 101361 CORRECTION CLAW FINGER OTHER METHODS $8,294.50
26500 101362 RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX $11,923.00
26502 101363 RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX $16,914.50
26508 101364 RELEASE THENAR MUSCLE $5,461.50
26510 101365 CROSS INTRINSIC TRANSFER EACH TENDON $5,124.50
26516 101366 CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT $10,995.50
26517 101367 CAPSULODESIS MTCARPHLNGL JOINT 2 DIGITS $8,294.50
26518 101368 CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS $8,294.50
26520 101369 CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH $7,858.50
26525 101370 CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH $9,158.50
26530 101371 ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH $18,551.00
26531 101372 ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT $16,413.50
26535 101373 ARTHROPLASTY INTERPHALANGEAL JOINT EACH $12,157.00
26536 101374 ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA $13,633.50
26540 101375 RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT $15,604.00
26541 101376 RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF $14,600.50
26542 101377 RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS $17,944.00
26545 101378 RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT $11,708.50
26546 101379 RPR NON-UNION MTCRPL/PHALANX $15,370.00
26548 101380 RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL $9,562.00
26550 101381 POLLICIZATION DIGIT $8,294.50
26551 101382 TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND $0.00
26553 101383 TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 1 $0.00
26554 101384 TR TOE-TO-HAND W/MVASC ANAST OTH/THN GRT TOE 2 $0.00
26555 101385 TR FNGR AXH POS W/O MVASC ANAST $8,294.50
26556 101386 TRANSFER FREE TOE JOINT W/MVASC ANASTOMOSIS $0.00
26560 101387 REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS $18,796.00
26561 101388 REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT $25,898.50
26562 101389 REPAIR SYNDACTYLY EACH SPACE COMPLEX $20,791.00
26565 101390 OSTEOTOMY METACARPAL EACH $15,003.00
26567 101391 OSTEOTOMY PHALANX FINGER EACH $14,513.00
26568 101392 OSTEOPLASTY LENGTHENING METACARPAL/PHALANX $8,294.50
26580 101393 REPAIR CLEFT HAND $5,461.50
26587 101394 RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE $19,975.00
26590 101395 REPAIR MACRODACTYLIA EACH DIGIT $5,461.50
26591 101396 REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE $8,294.50
26593 101397 RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE $5,308.50
26596 101398 EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES $5,461.50
26600 101399 CLTX METACARPAL FX W/O MANIPULATION EACH BONE $962.50
26605 101400 CLTX METACARPAL FX W/MANIPULATION EACH BONE $1,824.50
26607 101401 CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE $4,197.00
26608 101402 PRQ SKELETAL FIXJ METACARPAL FX EACH BONE $9,850.50
26615 101403 OPEN TX METACARPAL FRACTURE SINGLE EA BONE $13,612.50
26641 101404 CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ $1,751.50
26645 101405 CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ $5,399.50
26650 101406 PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB $10,144.50
26665 101407 OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB $17,136.00
26670 101408 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES $1,247.50
26675 101409 CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES $4,664.00
26676 101410 PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT $12,408.50
26685 101411 OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB $14,751.50
26686 101412 OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ $16,223.00
26700 101413 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES $1,087.50
26705 101414 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES $3,372.00
26706 101415 PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ $9,850.50
26715 101416 OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION $17,092.00
26720 101417 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA $905.50
26725 101418 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA $1,557.00
26727 101419 PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T $8,281.00
26735 101420 OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA $10,455.00
26740 101421 CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ $1,365.00
26742 101422 CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ $4,310.00
26746 101423 OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA $10,572.00
26750 101424 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA $891.50
26755 101425 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA $1,318.00
26756 101426 PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA $8,160.00
26765 101427 OPEN TX DISTAL PHALANGEAL FRACTURE EACH $8,549.00
26770 101428 CLTX IPHAL JT DISLC W/MANJ W/O ANES $913.50
26775 101429 CLTX IPHAL JT DISLC W/MANJ REQ ANES $2,353.00
26776 101430 PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ $8,747.00
26785 101431 OPEN TX INTERPHALANGEAL JOINT DISLOCATION $9,212.50
26820 101432 FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT $8,294.50
26841 101433 ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ $12,799.00
26842 101434 ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT $23,297.00
26843 101435 ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH $18,817.00
26844 101436 ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT $17,002.50
26850 101437 ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ $10,549.00
26852 101438 ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT $19,320.50
26860 101439 ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ $11,589.50
26861 101440 ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT $11,186.00
26862 101441 ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT $11,837.00
26863 101442 ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT $11,063.00
26910 101443 AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER $11,617.00
26951 101444 AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR $9,890.00
26952 101445 AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP $8,792.50
26989 101446 UNLISTED PROCEDURE HANDS/FINGERS $0.00
26990 101447 I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA $18,190.00
26991 101448 I&D PELVIS/HIP JOINT AREA INFECTED BURSA $6,699.00
26992 101449 INCISION BONE CORTEX PELVIS&/HIP JOINT $0.00
27000 101450 TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX $6,699.00
27001 101451 TENOTOMY ADDUCTOR HIP OPEN $16,670.50
27003 101452 TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY $9,011.00
27005 101453 TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE $19,401.50
27006 101454 TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX $11,536.00
27025 101455 FASCIOTOMY HIP/THIGH ANY TYPE $13,808.00
27027 101456 DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI $9,011.00
27030 101457 ARTHROTOMY HIP W/DRAINAGE $0.00
27033 101458 ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY $22,934.50
27035 101459 DNRVTJ HIP JT INTRAPEL/XTRPEL INTRA-ARTCLR BRNCH $9,011.00
27036 101460 CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC $19,285.00
27040 101461 BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL $3,720.00
27041 101462 BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM $5,000.50
27043 101463 EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3CM/> $10,048.50
27045 101464 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/> $21,467.50
27047 101465 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM $8,586.00
27048 101466 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM $20,559.50
27049 101467 RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM $5,238.50
27050 101468 ARTHROTOMY W/BIOPSY SACROILIAC JOINT $6,699.00
27052 101469 ARTHROTOMY W/BIOPSY HIP JOINT $13,267.00
27054 101470 ARTHROTOMY W/SYNOVECTOMY HIP JOINT $15,728.00
27057 101471 DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI $6,699.00
27059 101472 RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/> $18,666.00
27060 101473 EXCISION ISCHIAL BURSA $18,338.00
27062 101474 EXCISION TROCHANTERIC BURSA/CALCIFICATION $10,884.50
27065 101475 EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL $25,136.00
27066 101476 EXCISION BONE CYST/BENIGN TUMOR DEEP $27,021.50
27067 101477 EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC $9,011.00
27070 101478 PARTIAL EXCISION SUPERFICIAL PELVIS $28,449.50
27071 101479 PARTIAL EXCISION DEEP PELVIS $28,449.50
27075 101480 RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL $0.00
27076 101481 RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC $0.00
27077 101482 RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL $0.00
27078 101483 RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR $0.00
27080 101484 COCCYGECTOMY PRIMARY $28,715.00
27086 101485 RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS $3,204.50
27087 101486 REMOVAL FOREIGN BODY PELVIS/HIP DEEP $14,438.00
27090 101487 REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE $0.00
27091 101488 RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA $0.00
27093 101489 INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA $3,690.00
27095 101490 INJECTION HIP ARTHROGRAPHY W/ANESTHESIA $6,214.00
27096 101491 INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA $2,343.00
27097 101492 RELEASE/RECESSION HAMSTRING PROXIMAL $19,158.50
27098 101493 TRANSFER ADDUCTOR ISCHIUM $9,011.00
27100 101494 TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF $12,165.50
27105 101495 TR PARASPI MUSC HIP FASC/TDN XTN GRF $12,165.50
27110 101496 TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR $12,165.50
27111 101497 TRANSFER ILIOPSOAS FEMORAL NECK $12,165.50
27120 101498 ACETABULOPLASTY $0.00
27122 101499 ACETABULOPLASTY RESECTION FEMORAL HEAD $0.00
27125 101500 HEMIARTHROPLASTY HIP PARTIAL $31,087.00
27130 101501 ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT $20,393.00
27132 101502 CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT $27,376.00
27134 101503 REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT $25,823.50
27137 101504 REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT $52,443.00
27138 101505 REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT $33,547.50
27140 101506 OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX $0.00
27146 101507 OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE $28,449.50
27147 101508 OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ $0.00
27151 101509 OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT $0.00
27156 101510 OSTEOT ILIAC ACTBLR/INNOMINATE BONE OSTEOT RDCTJ $0.00
27158 101511 OSTEOTOMY PELVIS BILATERAL $0.00
27161 101512 OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE $0.00
27165 101513 OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL $28,449.50
27170 101514 B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA $19,519.00
27175 101515 TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION $0.00
27176 101516 TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU $16,429.00
27177 101517 OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT $0.00
27178 101518 OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN $28,449.50
27179 101519 OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX $18,175.50
27181 101520 OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ $0.00
27185 101521 EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR $28,449.50
27187 101522 PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR $27,483.00
27197 101523 CLSD TX PELVIC RING FX W/O MANIPULATION $997.00
27198 101524 CLSD TX PELVIC RING FX W/MANIPULATION W/ANES $1,860.50
27200 101525 CLOSED TREATMENT COCCYGEAL FRACTURE $1,058.00
27202 101526 OPEN TREATMENT COCCYGEAL FRACTURE $13,024.00
27215 101527 OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD $0.00
27216 101528 PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS $44,290.50
27217 101529 OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR $4,264.50
27218 101530 OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD $0.00
27220 101531 CLTX ACETABULUM HIP/SOCKT FX W/O MANJ $1,243.00
27222 101532 CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ $6,824.50
27226 101533 OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ $0.00
27227 101534 OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT $0.00
27228 101535 OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT $0.00
27230 101536 CLTX FEM FX PROX END NCK W/O MANJ $1,456.00
27232 101537 CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ $9,266.00
27235 101538 PRQ SKEL FIXJ FEMORAL FX PROX END NECK $15,486.00
27236 101539 OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT $30,580.50
27238 101540 CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ $4,307.00
27240 101541 CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ $18,457.50
27244 101542 TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT $32,041.00
27245 101543 TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW $24,282.00
27246 101544 CLTX GREATER TROCHANTERIC FX W/O MANJ $1,594.50
27248 101545 OPEN TREATMENT GREATER TROCHANTERIC FRACTURE $34,101.50
27250 101546 CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA $1,311.50
27252 101547 CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA $6,433.00
27253 101548 OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ $0.00
27254 101549 OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD $0.00
27256 101550 TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES $2,149.50
27257 101551 TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES $6,128.00
27258 101552 OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM $45,020.00
27259 101553 OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT $0.00
27265 101554 CLTX POST HIP ARTHRP DISLC W/O ANES $1,561.00
27266 101555 CLTX POST HIP ARTHRP DISLC REQ ANES $4,634.50
27267 101556 CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ $8,441.00
27268 101557 CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ $15,728.00
27269 101558 OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD $0.00
27275 101559 MANIPULATION HIP JOINT GENERAL ANESTHESIA $7,125.00
27278 101560 ARTHRD SI JT PRQ W/PLMT IARTIC IMPLT WO TFXJ DEV $64,318.00
27279 101561 ARTHRODESIS SI JOINT PERCUTANEOUS/MIN INVASIVE $27,609.00
27280 101562 ARTHRODESIS SI JT OPN W/OBTAINING B1 GRF INSTRMJ $38,170.50
27282 101563 ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT $0.00
27284 101564 ARTHRODESIS HIP JOINT W/OBTAINING GRAFT $0.00
27286 101565 ARTHRD HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT $0.00
27290 101566 INTERPELVIABDOMINAL AMPUTATION $0.00
27295 101567 DISARTICULATION HIP $0.00
27299 101568 UNLISTED PROCEDURE PELVIS/HIP JOINT $0.00
27301 101569 I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION $16,941.00
27303 101570 INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE $28,449.50
27305 101571 FASCIOTOMY ILIOTIBIAL OPEN $13,324.50
27306 101572 TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX $12,338.50
27307 101573 TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON $9,011.00
27310 101574 ARTHRT KNE W/EXPL DRG/RMVL FB $11,464.50
27323 101575 BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL $6,539.50
27324 101576 BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP $14,606.50
27325 101577 NEURECTOMY HAMSTRING MUSCLE $6,005.00
27326 101578 NEURECTOMY POPLITEAL $6,005.00
27327 101579 EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM $7,188.00
27328 101580 EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM $10,643.50
27329 101581 RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM $15,945.50
27330 101582 ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY $16,764.50
27331 101583 ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB $21,472.50
27332 101584 ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT $20,100.50
27333 101585 ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT $13,138.50
27334 101586 ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR $22,117.00
27335 101587 ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA $21,685.00
27337 101588 EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/> $9,603.00
27339 101589 EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/> $12,832.50
27340 101590 EXCISION PREPATELLAR BURSA $17,045.00
27345 101591 EXCISION SYNOVIAL CYST POPLITEAL SPACE $19,515.50
27347 101592 EXCISION LESION MENISCUS/CAPSULE KNEE $14,067.00
27350 101593 PATELLECTOMY/HEMIPATELLECTOMY $13,765.00
27355 101594 EXCISION/CURETTAGE CYST/TUMOR FEMUR $13,193.00
27356 101595 EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT $27,109.50
27357 101596 EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT $27,539.50
27358 101597 EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION $16,119.00
27360 101598 PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA $11,328.50
27364 101599 RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/> $15,649.50
27365 101600 RADICAL RESECTION TUMOR FEMOR OR KNEE $28,449.50
27369 101601 NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE $1,783.50
27372 101602 REMOVAL FOREIGN BODY DEEP THIGH/KNEE $15,384.00
27380 101603 SUTURE INFRAPATELLAR TENDON PRIMARY $15,848.50
27381 101604 SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF $21,367.00
27385 101605 SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY $17,694.50
27386 101606 SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ $30,579.50
27390 101607 TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON $6,699.00
27391 101608 TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG $6,699.00
27392 101609 TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI $9,011.00
27393 101610 LENGTHENING HAMSTRING TENDON SINGLE $17,358.50
27394 101611 LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG $18,563.50
27395 101612 LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL $23,003.00
27396 101613 TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON $9,011.00
27397 101614 TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN $12,165.50
27400 101615 TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR $12,165.50
27403 101616 ARTHROTOMY W/MENISCUS REPAIR KNEE $16,518.00
27405 101617 RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL $19,113.00
27407 101618 REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT $18,175.50
27409 101619 RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE $18,175.50
27412 101620 AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE $18,175.50
27415 101621 OSTEOCHONDRAL ALLOGRAFT KNEE OPEN $17,736.00
27416 101622 OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY $21,265.00
27418 101623 ANTERIOR TIBIAL TUBERCLEPLASTY $20,938.00
27420 101624 RCNSTJ DISLOCATING PATELLA $17,902.50
27422 101625 RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL $15,752.00
27424 101626 RCNSTJ DISLC PATELLA W/PATELLECTOMY $12,165.50
27425 101627 LATERAL RETINACULAR RELEASE OPEN $11,111.50
27427 101628 LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR $20,320.50
27428 101629 LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR $21,169.00
27429 101630 LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR $18,175.50
27430 101631 QUADRICEPSPLASTY $15,276.50
27435 101632 CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE $24,522.50
27437 101633 ARTHROPLASTY PATELLA W/O PROSTHESIS $28,546.00
27438 101634 ARTHROPLASTY PATELLA W/PROSTHESIS $28,557.00
27440 101635 ARTHROPLASTY KNEE TIBIAL PLATEAU $28,547.50
27441 101636 ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT $10,615.50
27442 101637 ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE $22,869.00
27443 101638 ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL $10,615.50
27445 101639 ARTHROPLASTY KNEE HINGE PROSTHESIS $0.00
27446 101640 ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT $18,891.50
27447 101641 ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS $22,337.50
27448 101642 OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION $0.00
27450 101643 OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION $26,275.00
27454 101644 OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT $0.00
27455 101645 OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL $13,787.50
27457 101646 OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL $16,978.50
27465 101647 OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876 $0.00
27466 101648 OSTEOPLASTY FEMUR LENGTHENING $48,899.00
27468 101649 OSTPL FEMUR CMBN LNGTH&SHRT W/FEMORAL SGM TRNSFR $0.00
27470 101650 RPR NON/MAL FEMUR DSTL H/N W/O GRF $32,901.00
27472 101651 RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE $35,400.50
27475 101652 ARREST EPIPHYSEAL DISTAL FEMUR $17,415.00
27477 101653 ARREST EPIPHYSEAL TIBIA & FIBULA PROXIMAL $19,996.00
27479 101654 ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB $26,290.00
27485 101655 ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA $18,356.50
27486 101656 REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT $25,165.50
27487 101657 REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE $31,070.50
27488 101658 RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER $22,763.50
27495 101659 PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR $19,383.00
27496 101660 DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT $9,011.00
27497 101661 DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE $6,699.00
27498 101662 DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS $9,011.00
27499 101663 DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE $9,011.00
27500 101664 CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION $2,406.50
27501 101665 CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ $1,058.00
27502 101666 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ $7,131.50
27503 101667 CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ $4,664.00
27506 101668 OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW $25,252.00
27507 101669 OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE $26,746.00
27508 101670 CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ $1,573.00
27509 101671 PRQ SKELETAL FIXJ FEMORAL FX DISTAL END $18,398.00
27510 101672 CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ $7,026.00
27511 101673 OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN $28,449.50
27513 101674 OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN $0.00
27514 101675 OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE $23,819.50
27516 101676 CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ $1,058.00
27517 101677 CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL $4,664.00
27519 101678 OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION $0.00
27520 101679 CLOSED TX PATELLAR FRACTURE W/O MANIPULATION $1,158.50
27524 101680 OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR $18,767.00
27530 101681 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION $1,124.50
27532 101682 CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ $10,452.50
27535 101683 OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR $21,769.00
27536 101684 OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ $25,373.00
27538 101685 CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN $4,724.50
27540 101686 OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE $18,474.00
27550 101687 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA $1,479.00
27552 101688 CLOSED TX KNEE DISLOCATION W/ANESTHESIA $6,248.50
27556 101689 OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR $0.00
27557 101690 OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR $28,449.50
27558 101691 OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION $28,449.50
27560 101692 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA $1,160.50
27562 101693 CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA $3,216.00
27566 101694 OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY $23,017.00
27570 101695 MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA $7,455.50
27580 101696 ARTHRODESIS KNEE ANY TECHNIQUE $0.00
27590 101697 AMPUTATION THIGH THROUGH FEMUR ANY LEVEL $0.00
27591 101698 AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST $0.00
27592 101699 AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR $0.00
27594 101700 AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION $12,655.50
27596 101701 AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION $14,772.50
27598 101702 DISARTICULATION KNEE $0.00
27599 101703 UNLISTED PROCEDURE FEMUR/KNEE $0.00
27600 101704 DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY $15,963.00
27601 101705 DCMPRN FASCT LEG POST COMPARTMENT ONLY $9,471.50
27602 101706 DCMPRN FASCT LEG ANT&/LAT&PST CMPRT $15,247.00
27603 101707 INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA $14,387.00
27604 101708 INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA $9,011.00
27605 101709 TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES $6,955.00
27606 101710 TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES $12,399.50
27607 101711 INCISION LEG/ANKLE $12,704.00
27610 101712 ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB $9,864.50
27612 101713 ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH $16,836.00
27613 101714 BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL $6,727.50
27614 101715 BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP $8,365.50
27615 101716 RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM $9,221.00
27616 101717 RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/> $13,148.50
27618 101718 EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM $8,084.00
27619 101719 EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM $15,815.00
27620 101720 ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB $10,294.50
27625 101721 ARTHROTOMY W/SYNOVECTOMY ANKLE $8,712.00
27626 101722 ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY $9,170.00
27630 101723 EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK $15,272.50
27632 101724 EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/> $8,668.00
27634 101725 EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/> $11,050.00
27635 101726 EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA $10,832.50
27637 101727 EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT $17,768.00
27638 101728 EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT $20,886.00
27640 101729 PARTIAL EXCISION BONE TIBIA $9,334.00
27641 101730 PARTIAL EXCISION BONE FIBULA $7,939.00
27645 101731 RADICAL RESECTION OF TUMOR TIBIA $28,449.50
27646 101732 RADICAL RESECTION TUMOR BONE FIBULA $28,449.50
27647 101733 RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS $9,011.00
27648 101734 INJECTION ANKLE ARTHROGRAPHY $1,029.50
27650 101735 REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON $12,375.00
27652 101736 RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT $20,385.00
27654 101737 REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT $12,324.50
27656 101738 REPAIR FASCIAL DEFECT LEG $12,919.50
27658 101739 REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH $9,318.00
27659 101740 RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH $7,590.50
27664 101741 RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH $14,634.00
27665 101742 RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH $15,540.50
27675 101743 RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY $1,759.00
27676 101744 REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT $10,769.00
27680 101745 TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH $1,641.00
27681 101746 TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN $9,011.00
27685 101747 LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX $1,731.50
27686 101748 LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA $10,661.00
27687 101749 GASTROCNEMIUS RECESSION $7,429.00
27690 101750 TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC $9,453.00
27691 101751 TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP $4,325.50
27692 101752 TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN $8,463.50
27695 101753 RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL $10,247.50
27696 101754 RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS $10,851.50
27698 101755 REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL $11,413.50
27700 101756 ARTHROPLASTY ANKLE $14,714.50
27702 101757 ARTHROPLASTY ANKLE W/IMPLANT $22,016.50
27703 101758 ARTHROPLASTY ANKLE REVISION TOTAL ANKLE $32,407.00
27704 101759 REMOVAL ANKLE IMPLANT $14,030.00
27705 101760 OSTEOTOMY TIBIA $14,254.50
27707 101761 OSTEOTOMY FIBULA $11,461.00
27709 101762 OSTEOTOMY TIBIA & FIBULA $27,183.50
27712 101763 OSTEOT MLT W/RELIGNMT IMED ROD $0.00
27715 101764 OSTEOPLASTY TIBIA & FIBULA LENGTHENING/SHORTENIN $24,555.00
27720 101765 REPAIR NONUNION/MALUNION TIBIA W/O GRAFT $17,736.00
27722 101766 REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT $16,223.00
27724 101767 RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT $23,188.00
27725 101768 RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH $28,449.50
27726 101769 REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION $16,471.00
27727 101770 REPAIR CONGENITAL PSEUDARTHROSIS TIBIA $0.00
27730 101771 ARREST EPIPHYSEAL OPEN DISTAL TIBIA $17,108.00
27732 101772 ARREST EPIPHYSEAL OPEN DISTAL FIBULA $9,011.00
27734 101773 ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA $23,123.50
27740 101774 ARREST EPIPHYSEAL ANY METHOD TIBIA & FIBULA $9,011.00
27742 101775 ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR $12,165.50
27745 101776 PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA $18,175.50
27750 101777 CLTX TIBIAL SHAFT FX W/O MANIPULATION $1,357.50
27752 101778 CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ $5,179.00
27756 101779 PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE $15,092.00
27758 101780 OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE $19,134.00
27759 101781 TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA $20,662.00
27760 101782 CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION $966.50
27762 101783 CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ $4,522.50
27766 101784 OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE $16,411.50
27767 101785 CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ $3,593.00
27768 101786 CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ $5,513.00
27769 101787 OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE $16,911.00
27780 101788 CLTX PROX FIBULA/SHFT FX W/O MANJ $1,045.00
27781 101789 CLTX PROX FIBULA/SHFT FX W/MANJ $5,877.50
27784 101790 OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE $15,190.50
27786 101791 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ $1,085.00
27788 101792 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ $1,999.00
27792 101793 OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS $15,248.00
27808 101794 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ $1,193.00
27810 101795 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ $3,158.50
27814 101796 OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE $17,161.50
27816 101797 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION $1,466.50
27818 101798 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION $3,716.00
27822 101799 OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP $14,146.00
27823 101800 OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP $23,339.00
27824 101801 CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ $1,497.50
27825 101802 CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ $6,519.50
27826 101803 OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA $23,521.00
27827 101804 OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY $20,354.00
27828 101805 OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA $23,855.50
27829 101806 OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION $7,164.50
27830 101807 CLTX PROX TIBFIB JT DISLC W/O ANES $2,029.00
27831 101808 CLTX PROX TIBFIB JT DISLC REQ ANES $4,197.00
27832 101809 OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB $13,024.00
27840 101810 CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA $1,455.00
27842 101811 CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ $7,037.50
27846 101812 OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ $13,024.00
27848 101813 OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ $13,024.00
27860 101814 MANIPULATION ANKLE UNDER GENERAL ANESTHESIA $10,809.50
27870 101815 ARTHRODESIS ANKLE OPEN $19,548.50
27871 101816 ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL $16,584.50
27880 101817 AMPUTATION LEG THROUGH TIBIA&FIBULA $21,027.50
27881 101818 AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST $0.00
27882 101819 AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR $0.00
27884 101820 AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV $14,067.00
27886 101821 AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION $25,626.50
27888 101822 AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV $0.00
27889 101823 ANKLE DISARTICULATION $9,011.00
27892 101824 DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE $17,389.50
27893 101825 DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV $9,011.00
27894 101826 DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS $9,011.00
27899 101827 UNLISTED PROCEDURE LEG/ANKLE $0.00
28001 101828 INCISION&DRAINAGE BURSA FOOT $6,398.00
28002 101829 I&D BELOW FASCIA FOOT 1 BURSAL SPACE $11,362.00
28003 101830 I&D BELOW FASCIA FOOT MULTIPLE AREAS $7,123.50
28005 101831 INCISION BONE CORTEX FOOT $8,597.50
28008 101832 FASCIOTOMY FOOT&/TOE $8,029.50
28010 101833 TENOTOMY PERCUTANEOUS TOE SINGLE TENDON $3,579.00
28011 101834 TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON $4,523.50
28020 101835 ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT $8,467.00
28022 101836 ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT $8,543.00
28024 101837 ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT $9,724.00
28035 101838 RELEASE TARSAL TUNNEL $8,493.00
28039 101839 EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/> $9,340.00
28041 101840 EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/> $15,683.00
28043 101841 EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM $12,467.00
28045 101842 EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM $13,614.00
28046 101843 RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM $11,930.50
28047 101844 RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/> $12,180.50
28050 101845 ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT $6,792.00
28052 101846 ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT $11,548.50
28054 101847 ARTHRTOMY W/BX INTERPHALANGEAL JOINT $8,280.00
28055 101848 NEURECTOMY INTRINSIC MUSCULATURE OF FOOT $12,014.50
28060 101849 FASCIECTOMY PLANTAR FASCIA PARTIAL SPX $8,484.50
28062 101850 FASCIECTOMY PLANTAR FASCIA RADICAL SPX $9,409.50
28070 101851 SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX $6,792.00
28072 101852 SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH $9,816.50
28080 101853 EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH $7,938.00
28086 101854 SYNOVECTOMY TENDON SHEATH FOOT FLEXOR $11,932.50
28088 101855 SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR $12,255.50
28090 101856 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT $8,201.00
28092 101857 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA $7,127.00
28100 101858 EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS $13,594.50
28102 101859 EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT $14,465.00
28103 101860 EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT $14,465.00
28104 101861 EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL $7,640.00
28106 101862 EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT $14,465.00
28107 101863 EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT $14,465.00
28108 101864 EXC/CURTG CST/B9 TUM PHALANGES FOOT $6,741.00
28110 101865 OSTECTOMY PRTL 5TH METAR HEAD SPX $5,422.00
28111 101866 OSTECTOMY COMPLETE 1ST METATARSAL HEAD $9,147.00
28112 101867 OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4 $5,608.00
28113 101868 OSTECTOMY COMPLETE 5TH METATARSAL HEAD $6,808.50
28114 101869 OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC $10,418.50
28116 101870 OSTECTOMY TARSAL COALITION $15,107.50
28118 101871 OSTECTOMY CALCANEUS $5,357.00
28119 101872 OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS $8,816.50
28120 101873 PARTIAL EXCISION BONE TALUS/CALCANEUS $4,311.50
28122 101874 PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS $7,477.00
28124 101875 PARTICAL EXCISION BONE PHALANX TOE $11,491.00
28126 101876 RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH $10,401.00
28130 101877 TALECTOMY ASTRAGALECTOMY $17,536.00
28140 101878 METATARSECTOMY $7,317.50
28150 101879 PHALANGECTOMY TOE EACH TOE $11,201.00
28153 101880 RESECTION CONDYLE DISTAL END PHALANX EACH TOE $6,427.00
28160 101881 HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE $11,518.00
28171 101882 RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS $6,792.00
28173 101883 RADICAL RESECTION TUMOR METATARSAL $9,583.50
28175 101884 RADICAL RESECTION TUMOR PHALANX OR TOE $9,033.00
28190 101885 REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS $4,402.50
28192 101886 REMOVAL FOREIGN BODY FOOT DEEP $13,701.50
28193 101887 REMOVAL FOREIGN BODY FOOT COMPLICATED $9,425.50
28200 101888 RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON $13,483.50
28202 101889 RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON $13,864.50
28208 101890 REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON $14,752.50
28210 101891 RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON $16,430.00
28220 101892 TENOLYSIS FLEXOR FOOT SINGLE TENDON $6,932.00
28222 101893 TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS $6,792.00
28225 101894 TENOLYSIS EXTENSOR FOOT SINGLE TENDON $8,809.50
28226 101895 TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON $12,066.50
28230 101896 TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX $5,939.50
28232 101897 TX OPEN TENDON FLEXOR TOE 1 TENDON SPX $6,081.00
28234 101898 TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON $6,433.00
28238 101899 RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR $13,357.50
28240 101900 TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC $11,618.00
28250 101901 DIVISION PLANTAR FASCIA & MUSCLE SPX $10,447.50
28260 101902 CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX $10,676.50
28261 101903 CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING $11,071.50
28262 101904 CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH $16,172.00
28264 101905 CAPSULOTOMY MIDTARSAL $14,465.00
28270 101906 CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX $1,673.00
28272 101907 CAPSULOTOMY IPHAL JOINT EACH JOINT SPX $3,676.50
28280 101908 SYNDACTYLIZATION TOES $10,708.00
28285 101909 CORRECTION HAMMERTOE $2,884.00
28286 101910 CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE $8,216.50
28288 101911 OSTC PRTL EXOSTC/CONDYLC METAR HEAD $10,167.00
28289 101912 HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT $8,607.50
28291 101913 HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT $16,172.00
28292 101914 CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE $10,599.00
28295 101915 CORRJ HLX VLGS BNCTY SESMDC PROX METAR OSTEOT $15,510.50
28296 101916 CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT $13,872.50
28297 101917 CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS $13,476.00
28298 101918 CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT $9,358.50
28299 101919 CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY $14,906.50
28300 101920 OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION $14,873.50
28302 101921 OSTEOTOMY TALUS $13,605.50
28304 101922 OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS $9,842.00
28305 101923 OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT $10,242.00
28306 101924 OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR $11,838.00
28307 101925 OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE $12,533.50
28308 101926 OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA $1,672.00
28309 101927 OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT $10,005.00
28310 101928 OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE $11,956.50
28312 101929 OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE $10,842.50
28313 101930 RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY $1,644.00
28315 101931 SESAMOIDECTOMY FIRST TOE SPX $13,453.00
28320 101932 REPAIR NONUNION/MALUNION TARSAL BONES $17,554.50
28322 101933 RPR NON/MALUNION METARSAL W/WO BONE GRAFT $15,139.00
28340 101934 RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION $6,792.00
28341 101935 RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION $6,792.00
28344 101936 RECONSTRUCTION TOE POLYDACTYLY $14,694.00
28345 101937 RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB $10,319.50
28360 101938 RECONSTRUCTION CLEFT FOOT $14,465.00
28400 101939 CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION $1,206.00
28405 101940 CLOSED TX CALCANEAL FRACTURE W/MANIPULATION $4,197.00
28406 101941 PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ $17,415.00
28415 101942 OPEN TREATMENT CALCANEAL FRACTURE $21,932.00
28420 101943 OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT $27,240.50
28430 101944 CLOSED TX TALUS FRACTURE W/O MANIPULATION $1,105.00
28435 101945 CLOSED TX TALUS FRACTURE W/MANIPULATION $4,706.00
28436 101946 PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ $7,815.00
28445 101947 OPEN TREATMENT TALUS FRACTURE $14,710.00
28446 101948 OPEN OSTEOCHONDRAL AUTOGRAFT TALUS $14,465.00
28450 101949 TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ $1,153.50
28455 101950 TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ $8,441.00
28456 101951 PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ $16,630.00
28465 101952 OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA $13,908.00
28470 101953 CLOSED TX METATARSAL FRACTURE W/O MANIPULATION $982.00
28475 101954 CLTX METAR FX W/MANJ $3,095.50
28476 101955 PRQ SKEL FIXJ METAR FX W/MANJ $16,627.00
28485 101956 OPEN TREATMENT METATARSAL FRACTURE EACH $11,753.50
28490 101957 CLTX FX GRT TOE PHLX/PHLG W/O MANJ $832.50
28495 101958 CLTX FX GRT TOE PHLX/PHLG W/MANJ $1,487.00
28496 101959 PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ $9,939.50
28505 101960 OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES $12,646.50
28510 101961 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ $822.00
28515 101962 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ $1,513.00
28525 101963 OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE $17,025.00
28530 101964 CLOSED TREATMENT SESAMOID FRACTURE $1,058.00
28531 101965 OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION $7,815.00
28540 101966 CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES $1,058.00
28545 101967 CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES $7,815.00
28546 101968 PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ $7,815.00
28555 101969 OPEN TREATMENT TARSAL BONE DISLOCATION $13,024.00
28570 101970 CLOSED TX TALOTARSAL JOINT DISLC W/O ANES $1,058.00
28575 101971 CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES $4,197.00
28576 101972 PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ $7,815.00
28585 101973 OPEN TREATMENT TALOTARSAL JOINT DISLOCATION $10,331.50
28600 101974 CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES $1,058.00
28605 101975 CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES $10,005.00
28606 101976 PRQ SKEL FIXJ TARS JT DISLC W/MANJ $14,210.50
28615 101977 OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION $3,348.00
28630 101978 CLTX METATARSOPHLNGL JT DISLC W/O ANES $1,152.50
28635 101979 CLTX METATARSOPHLNGL JT DISLC REQ ANES $4,148.00
28636 101980 PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ $5,735.00
28645 101981 OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION $6,625.00
28660 101982 CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES $943.00
28665 101983 CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES $1,898.50
28666 101984 PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ $15,233.50
28675 101985 OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION $9,140.00
28705 101986 ARTHRODESIS PANTALAR $20,583.50
28715 101987 ARTHRODESIS TRIPLE $27,195.00
28725 101988 ARTHRODESIS SUBTALAR $17,845.50
28730 101989 ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS $20,432.50
28735 101990 ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT $17,468.50
28737 101991 ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR $16,652.00
28740 101992 ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT $11,989.50
28750 101993 ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT $14,001.00
28755 101994 ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT $8,763.00
28760 101995 ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK $11,575.50
28800 101996 AMPUTATION FOOT MIDTARSAL $0.00
28805 101997 AMPUTATION FOOT TRANSMETARSAL $12,296.50
28810 101998 AMPUTATION METATARSAL W/TOE SINGLE $8,655.50
28820 101999 AMPUTATION TOE METATARSOPHALANGEAL JOINT $8,503.00
28825 102000 AMPUTATION TOE INTERPHALANGEAL JOINT $8,005.50
28890 102001 ESWT HI NRG PHYS/QHP W/US GDN INVG PLNTAR FASCIA $9,646.00
28899 102002 UNLISTED PROCEDURE FOOT/TOES $0.00
29000 102003 APPLICATION HALO TYPE BODY CAST $815.00
29010 102004 APPLICATION RISSER JACKET LOCALIZER BODY ONLY $7,803.00
29015 102005 APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD $1,374.00
29035 102006 APPLICATION BODY CAST SHOULDER HIPS $1,374.00
29040 102007 APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA $815.00
29044 102008 APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH $1,374.00
29046 102009 APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS $1,374.00
29049 102010 APPLICATION CAST FIGURE-OF-8 $815.00
29055 102011 APPLICATION CAST SHOULDER SPICA $1,374.00
29058 102012 APPLICATION CAST PLASTER VELPEAU $815.00
29065 102013 APPLICATION CAST SHOULDER HAND LONG ARM $1,113.50
29075 102014 APPLICATION CAST ELBOW FINGER SHORT ARM $604.00
29085 102015 APPLICATION CAST HAND & LOWER FOREARM GAUNTLET $617.00
29086 102016 APPLICATION CAST FINGER $669.00
29105 102017 APPLICATION LONG ARM SPLINT SHOULDER HAND $577.50
29125 102018 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC $622.00
29126 102019 APPLICATION SHORT ARM SPLINT DYNAMIC $687.50
29130 102020 APPLICATION FINGER SPLINT STATIC $567.50
29131 102021 APPLICATION FINGER SPLINT DYNAMIC $469.00
29200 102022 STRAPPING THORAX $312.00
29240 102023 STRAPPING SHOULDER $512.00
29260 102024 STRAPPING ELBOW/WRIST $472.00
29280 102025 STRAPPING HAND/FINGER $414.50
29305 102026 APPLICATION HIP SPICA CAST 1 LEG $2,349.00
29325 102027 APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS $10,011.50
29345 102028 APPLICATION LONG LEG CAST THIGH-TOE $1,102.50
29355 102029 APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE $927.50
29358 102030 APPLICATION LONG LEG CAST BRACE $1,529.00
29365 102031 APPLICATION CYLINDER CAST THIGH ANKLE $918.50
29405 102032 APPLICATION SHORT LEG CAST BELOW KNEE-TOE $591.00
29425 102033 APPLICATION SHORT LEG CAST WALKING/AMBULATORY $749.00
29435 102034 APPLICATION PATELLAR TENDON BEARING CAST $1,256.00
29440 102035 ADDING WALKER PREVIOUSLY APPLIED CAST $815.00
29445 102036 APPLICATION RIGID TOTAL CONTACT LEG CAST $1,008.00
29450 102037 APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG $1,454.00
29505 102038 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES $839.50
29515 102039 APPLICATION SHORT LEG SPLINT CALF FOOT $651.50
29520 102040 STRAPPING HIP $270.00
29530 102041 STRAPPING KNEE $517.00
29540 102042 STRAPPING ANKLE &/FOOT $443.00
29550 102043 STRAPPING TOES $536.50
29580 102044 STRAPPING UNNA BOOT $555.00
29581 102045 APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT $890.00
29584 102046 APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING $541.00
29700 102047 REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST $524.50
29705 102048 REMOVAL/BIVALVING FULL ARM/FULL LEG CAST $627.00
29710 102049 RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET $1,374.00
29720 102050 REPAIR SPICA BODY CAST/JACKET $815.00
29730 102051 WINDOWING CAST $429.00
29740 102052 WEDGING CAST EXCEPT CLUBFOOT CASTS $815.00
29750 102053 WEDGING CLUBFOOT CAST $815.00
29799 102054 UNLISTED PROCEDURE CASTING/STRAPPING $0.00
29800 102055 ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX $25,038.50
29804 102056 ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL $16,787.00
29805 102057 DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX $15,344.50
29806 102058 SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY $18,226.50
29807 102059 SURGICAL ARTHROSCOPY SHOULDER REPAIR SLAP LESION $14,990.50
29819 102060 SURGICAL ARTHROSCOPY SHOULDER REMOVAL LOOSE/FB $9,584.50
29820 102061 SURGICAL ARTHROSCOPY SHOULDER PRTL SYNOVECTOMY $10,174.50
29821 102062 SURGICAL ARTHROSCOPY SHOULDER COMPL SYNOVECTOMY $16,873.00
29822 102063 SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2 $2,223.00
29823 102064 SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+ $4,831.50
29824 102065 SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC $7,521.50
29825 102066 SURGICAL ARTHROSCOPY SHOULDER W/LSS&RESCJ ADS $17,684.00
29826 102067 SURGICAL ARTHROSCOPY SHO W/CORACOACRM LIGM RLS $5,228.50
29827 102068 SURGICAL ARTHROSCOPY SHOULDER W/ROTATOR CUFF RPR $7,659.00
29828 102069 SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS $5,806.50
29830 102070 ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX $8,432.00
29834 102071 ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB $13,110.50
29835 102072 ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL $20,272.00
29836 102073 ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE $17,799.00
29837 102074 ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED $11,772.50
29838 102075 ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE $21,769.00
29840 102076 ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX $14,830.00
29843 102077 ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE $8,432.00
29844 102078 ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL $10,711.00
29845 102079 ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE $13,201.50
29846 102080 ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT $12,003.00
29847 102081 ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY $13,326.00
29848 102082 NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM $5,991.50
29850 102083 ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ $8,432.00
29851 102084 ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ $23,843.00
29855 102085 ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR $13,217.00
29856 102086 ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR $27,406.00
29860 102087 ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX $28,397.00
29861 102088 ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB $13,775.50
29862 102089 ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG $18,077.00
29863 102090 ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY $11,563.50
29866 102091 ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST $23,471.50
29867 102092 ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT $17,874.00
29868 102093 ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT $36,386.50
29870 102094 ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX $19,360.00
29871 102095 ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE $12,262.50
29873 102096 ARTHROSCOPY KNEE LATERAL RELEASE $12,013.50
29874 102097 ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY $12,065.50
29875 102098 ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX $15,181.50
29876 102099 ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS $7,914.00
29877 102100 ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG $10,693.00
29879 102101 ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX $4,216.50
29880 102102 ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING $10,724.50
29881 102103 ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG $9,421.50
29882 102104 ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL $13,817.00
29883 102105 ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL $14,339.50
29884 102106 ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX $9,611.00
29885 102107 ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG $26,109.50
29886 102108 ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION $14,944.00
29887 102109 ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ $17,733.00
29888 102110 ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ $20,694.50
29889 102111 ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ $24,943.00
29891 102112 ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT $3,396.50
29892 102113 ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX $15,859.50
29893 102114 ENDOSCOPIC PLANTAR FASCIOTOMY $10,232.00
29894 102115 ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY $8,949.00
29895 102116 ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL $9,705.50
29897 102117 ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED $10,791.00
29898 102118 ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE $5,364.00
29899 102119 ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS $20,162.00
29900 102120 ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY $8,432.00
29901 102121 ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT $8,432.00
29902 102122 ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM $8,432.00
29904 102123 ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY $8,432.00
29905 102124 ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY $15,998.00
29906 102125 ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT $8,432.00
29907 102126 ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS $23,747.50
29914 102127 ARTHROSCOPY HIP W/FEMOROPLASTY $9,935.00
29915 102128 ARTHROSCOPY HIP W/ACETABULOPLASTY $15,207.00
29916 102129 ARTHROSCOPY HIP W/LABRAL REPAIR $11,176.00
29999 102130 UNLISTED PROCEDURE ARTHROSCOPY $0.00
30000 102131 DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH $2,149.50
30020 102132 DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM $7,106.50
3006F 102133 CHEST X-RAY RESULTS DOCUMENTED & REVIEWED $0.00
3008F 102134 BODY MASS INDEX DOCUMENTED $0.00
30100 102135 BIOPSY INTRANASAL $3,721.00
30110 102136 EXCISION NASAL POLYP SIMPLE $5,041.50
30115 102137 EXCISION NASAL POLYP EXTENSIVE $8,016.50
30117 102138 EXCISION/DESTRUCTION INTRANASAL LESION INT APPR $7,414.00
30118 102139 EXCISION/DESTRUCTION INTRANASAL LESION XTRNL $10,547.00
3011F 102140 LIPID PANEL RESULTS DOCUMENTED & REVIEWED $0.00
30120 102141 EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA $12,658.50
30124 102142 EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS $14,088.50
30125 102143 EXC DERMOID CYST NOSE COMPLEX UNDER BONE/CRTLG $23,867.50
30130 102144 EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE $3,509.50
30140 102145 SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL $4,308.50
30150 102146 RHINECTOMY PARTIAL $14,507.00
3015F 102147 CERVICAL CANCER SCREENING RESULTS DOCD & RVWD $0.00
30160 102148 RHINECTOMY TOTAL $11,739.50
3016F 102149 PT SCRND UNHLTHY OH USE BY SYSTMTC SCRNG METHD $0.00
3017F 102150 COLORECTAL CANCER SCREENING RESULTS DOC&REV $0.00
3018F 102151 PRE-PRX RISK ASSESS DEPTH&QUAL BOWEL PREP $0.00
3019F 102152 LVEF ASSESSMENT PLANNED POST DISCHARGE $0.00
30200 102153 INJECTION TURBINATE THERAPEUTIC $3,471.50
3020F 102154 LEFT VENTRICULAR FUNCTION ASSESSMENT DOCUMENTED $0.00
30210 102155 DISPLACEMENT THERAPY PROETZ TYPE $2,846.50
3021F 102156 LEFT VENTRICULAR EJECTION FRACTION <40% $0.00
30220 102157 INSERTION NASAL SEPTAL PROSTHESIS BUTTON $5,595.50
3022F 102158 LEFT VENTRICULAR EJECTION FRACTION >= 40% $0.00
3023F 102159 SPIROMETRY RESULTS DOCUMENTED AND REVIEWED $0.00
3025F 102160 SPIROMETRY TEST RESULTS FEV/FVC <70% W/COPD $0.00
3027F 102161 SPIROMETRY TEST RESULTS FEV/FVC >=70% W/O COPD $0.00
3028F 102162 OXYGEN SATURATION RESULTS DOCUMENTED & REVIEWE $0.00
30300 102163 REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE $570.50
30310 102164 REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES $8,667.00
30320 102165 RMVL FOREIGN BODY INTRANASAL LATERAL RHINOTOMY $7,476.50
3035F 102166 OXYGEN SATUR <= 88%/PAO2 <= 55 MM $0.00
3037F 102167 OXYGEN SATURATION >88%/PAO2 >55 MM HG $0.00
3038F 102168 PULMONARY FUNC TEST WITHIN 12 MON PRIOR SURG $0.00
30400 102169 RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI $10,692.50
3040F 102170 FUNCTIONAL EXPIRATORY VOLUME < 40% $0.00
30410 102171 RHINP PRIM COMPLETE XTRNL PARTS $17,600.00
30420 102172 RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR $9,735.00
30430 102173 RHINOPLASTY SECONDARY MINOR REVISION $25,666.50
30435 102174 RHINOPLASTY SECONDARY INTERMEDIATE REVISION $21,582.50
3044F 102175 MOST RECENT HEMOGLOBIN A1C LEVEL < 7.0% $0.00
30450 102176 RHINOPLASTY SECONDARY MAJOR REVISION $20,877.50
30460 102177 RHINP DFRM W/COLUM LNGTH TIP ONLY $21,680.50
30462 102178 RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT $19,641.00
30465 102179 REPAIR NASAL VESTIBULAR STENOSIS $5,692.00
30468 102180 RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT $8,554.00
30469 102181 RPR NSL VLV COLLAPSE LW NRG SUBQ/SBMCSL RMDLG $14,445.50
30520 102182 SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF $5,664.00
30540 102183 REPAIR CHOANAL ATRESIA INTRANASAL $23,962.00
30545 102184 REPAIR CHOANAL ATRESIA TRANSPALATINE $11,739.50
3055F 102185 LVEF LESS THAN OR EQUAL TO 35% $0.00
30560 102186 LYSIS INTRANASAL SYNECHIA $5,442.00
3056F 102187 LVEF GREATER THAN 35% $0.00
30580 102188 REPAIR FISTULA OROMAXILLARY $11,492.00
30600 102189 REPAIR FISTULA ORONASAL $13,065.50
3060F 102190 POSITIVE MICROALBUMINURIA TEST RESULT DOC&REV $0.00
3061F 102191 NEGATIVE MICROALBUMINURIA TEST RESULT DOC&REV $0.00
30620 102192 SEPTAL/OTHER INTRANASAL DERMATOPLASTY $13,077.50
3062F 102193 POSITIVE MACROALBUMINURIA TEST RESULT DOC&REV $0.00
30630 102194 REPAIR NASAL SEPTAL PERFORATIONS $8,364.50
3066F 102195 DOCUMENTATION OF TREATMENT FOR NEPHROPATHY $0.00
3072F 102196 LOW RISK FOR RETINOPATHY $0.00
3073F 102197 DOCUMENTED LENGTH CORNEAL POWER & LENS POWER $0.00
3074F 102198 MOST RECENT SYSTOLIC BLOOD PRESSURE <130 MM HG $0.00
3075F 102199 MOST RECENT SYSTOLIC BLOOD PRESS 130-139MM HG $0.00
3077F 102200 MOST RECENT SYSTOLIC BLOOD PRES>= 140 MM HG $0.00
3078F 102201 MOST RECENT DIASTOLIC BLOOD PRESSURE < 80 MM HG $0.00
3079F 102202 MOST RECENT DIASTOLIC BLOOD PRESSURE 80-89 MM HG $0.00
30801 102203 ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC $6,863.00
30802 102204 ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL $7,109.50
30901 102205 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE $632.50
30903 102206 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX $866.00
30905 102207 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST $879.50
30906 102208 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ $895.00
3090F 102209 MDD SEVERE WITHOUT PSYCHOTIC FEATURES $0.00
30915 102210 LIGATION ARTERIES ETHMOIDAL $7,968.50
3091F 102211 MAJOR DESPRESV DISORDER SEVERE W/PSYCHOT FEATURE $0.00
30920 102212 LIGATION ARTERIES INT MAXILLARY TRANSANTRAL $7,968.50
30930 102213 FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC $5,302.00
30999 102214 UNLISTED PROCEDURE NOSE $0.00
31000 102215 LAVAGE CANNULATION MAXILLARY SINUS $6,893.00
31002 102216 LAVAGE CANNULATION SPHENOID SINUS $2,239.00
3100F 102217 CAROTID IMAGNG REPORT DIR/INDIR MEAS VESSEL DIAM $0.00
31020 102218 SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL $11,065.00
31030 102219 SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS $11,968.50
31032 102220 SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS $14,019.50
31040 102221 PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH $15,375.00
31050 102222 SINUSOTOMY SPHENOID W/WO BIOPSY $6,559.00
31051 102223 SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP $9,435.50
31070 102224 SINUSOTOMY FRONTAL EXTERNAL SIMPLE $9,979.50
31075 102225 SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL $11,739.50
31080 102226 SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC $11,739.50
31081 102227 SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC $11,739.50
31084 102228 SINUSOT FRNT OBLIT W/OSTPL FLAP BROW INC $11,739.50
31085 102229 SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC $11,739.50
31086 102230 SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC $11,739.50
31087 102231 SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC $11,739.50
31090 102232 SINUSOT UNI 3/> PARANSL SINUSES $8,161.00
3110F 102233 CT/MRI HMRHG/MASS LESION/ACUTE INFRC DOC $0.00
3111F 102234 CT OR MRI BRAIN DONE W/IN 24 HRS HOSP ARRIVAL $0.00
3112F 102235 CT/MRI BRAIN DONE 24 HRS AFTER HOSP ARRIVAL $0.00
3115F 102236 QUANT RESULTS EVAL CURR LEVEL ACTIVITY CLIN SYMP $0.00
3117F 102237 HF DISEASE SPECIFIC ASSESSMENT TOOL COMPLETED $0.00
3118F 102238 NEW YORK HEART ASSOCIATION (NYHA) CLASS DOCD $0.00
3119F 102239 NO EVAL LEVEL OF ACTIVITY OR CLINICAL SYMPTOMS $0.00
31200 102240 ETHMOIDECTOMY INTRANASAL ANTERIOR $13,582.50
31201 102241 ETHMOIDECTOMY INTRANASAL TOTAL $11,676.50
31205 102242 ETHMOIDECTOMY EXTRANASAL TOTAL $14,254.50
3120F 102243 12-LEAD ECG PERFORMED $0.00
31225 102244 MAXILLECTOMY W/O ORBITAL EXENTERATION $18,851.50
31230 102245 MAXILLECTOMY W/ORBITAL EXENTERATION $0.00
31231 102246 NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX $428.00
31233 102247 NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY $3,443.00
31235 102248 NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY $6,029.00
31237 102249 NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX $8,089.00
31238 102250 NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE $5,646.00
31239 102251 NASAL/SINUS NDSC SURG W/DACRYOCYSTORHINOSTOMY $10,333.50
31240 102252 NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION $3,801.50
31241 102253 NASAL/SINUS NDSC SURG W/LIG SPHENOPALATINE ART $11,537.50
31242 102254 NASAL/SINUS NDSC DSTRJ RF ABLATION PST NSL NRV $27,966.00
31243 102255 NASAL/SINUS NDSC DSTRJ CRYOABLATION PST NSL NRV $27,966.00
31253 102256 NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL $8,784.00
31254 102257 NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY $4,665.00
31255 102258 NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY $4,673.50
31256 102259 NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY $3,817.00
31257 102260 NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY $8,864.00
31259 102261 NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL $4,775.00
31267 102262 NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS $4,737.50
31276 102263 NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS $8,175.00
31287 102264 NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY $4,085.50
31288 102265 NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS $10,230.00
31290 102266 NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID $12,799.00
31291 102267 NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID $0.00
31292 102268 NASAL/SINUS NDSC SURG MEDIAL/INF ORB WALL DCMPRN $20,596.50
31293 102269 NASAL/SINUS NDSC SURG MEDIAL&INF ORB WALL DCMPRN $14,737.50
31294 102270 NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN $8,175.50
31295 102271 NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS $7,723.50
31296 102272 NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS $6,248.50
31297 102273 NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS $5,887.00
31298 102274 NASAL/SINUS NDSC SURG W/DILATION FRNT&SPHN SINUS $9,120.00
31299 102275 UNLISTED PROCEDURE ACCESSORY SINUSES $0.00
31300 102276 LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY $21,823.50
31360 102277 LARYNGECTOMY TOTAL W/O RADICAL NECK DISSECTION $0.00
31365 102278 LARYNGECTOMY TOTAL W/RADICAL NECK DISSECTION $0.00
31367 102279 LARYNGECTOMY STOT SUPRAGLOTTIC W/O RAD NECK DSJ $0.00
31368 102280 LARYNGECTOMY STOT SUPRAGLOTTIC W/RAD NCK DSJ $0.00
31370 102281 PARTIAL LARYNGECTOMY HEMILARYGECTOMY HORIZONTAL $0.00
31375 102282 PARTIAL LARYNGECTOMY HEMILARYNG LATEROVERTICAL $0.00
31380 102283 PARTIAL LARYNGECTOMY HEMILARYNG ANTEROVERTICAL $0.00
31382 102284 PARTIAL LARYNG HEMILARYNG ANTERO-LATERO-VERTICAL $0.00
31390 102285 PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/O RCNSTJ $0.00
31395 102286 PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ $0.00
31400 102287 ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH $20,443.00
3140F 102288 UPPER GI ENDO REPORT SHOWS POSS BARRETT'S ESOPH $0.00
3141F 102289 UPPER GI ENDO REPORT SHOW NO SUSPECT BARRETT'S $0.00
31420 102290 EPIGLOTTIDECTOMY $11,739.50
31500 102291 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE $1,037.00
31502 102292 TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT $7,502.50
31505 102293 LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX $433.00
3150F 102294 FORCEPS ESOPHAGEAL BIOPSY PERFORMED $0.00
31510 102295 LARYNGOSCOPY INDIRECT W/BIOPSY $8,945.00
31511 102296 LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY $1,112.50
31512 102297 LARYNGOSCOPY INDIRECT W/REMOVAL LESION $11,637.50
31513 102298 LARYNGOSCOPY INDIRECT W/VOCAL CORD INJECTION $8,796.50
31515 102299 LARYNGOSCOPY W/WO TRACHEOSCOPY ASPIRATION $4,747.00
31520 102300 LARYNGOSCOPY W/WO TRACHEOSCOPY DX NEWBORN $1,112.50
31525 102301 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN $12,743.50
31526 102302 LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE $7,476.00
31527 102303 LARYNGOSCOPY W/WO TRACHEOSCOPY INSERT OBTURATOR $8,175.50
31528 102304 LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN $7,656.00
31529 102305 LARYNGOSCOPY W/WO TRACHEOSCOPY DILATION SUBSQ $2,909.50
31530 102306 LARYNGOSCOPY W/FOREIGN BODY REMOVAL $7,593.00
31531 102307 LARYNGOSCOPY FOREIGN BODY RMVL MICRO/TELESCOPE $12,007.50
31535 102308 LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY $7,522.50
31536 102309 LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE $7,699.00
31540 102310 LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT $10,774.50
31541 102311 LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP $8,748.50
31545 102312 LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP $7,976.00
31546 102313 LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD GRAFT $8,175.50
31551 102314 LARYNGOPLASTY LARYNGEAL STEN W/O STENT < 12 YRS $13,239.50
31552 102315 LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS > $13,239.50
31553 102316 LARYNGOPLASTY LARYNGEAL STEN W/STENT < 12 YRS $13,239.50
31554 102317 LARYNGOPLASTY LARYNGEAL STEN W/STENT 12 YRS > $13,239.50
3155F 102318 CYTOGEN TEST DONE MARROW DIAG OR PRIOR TXMNT $0.00
31560 102319 LARYNGOSCOPY DIRECT OPERATIVE W/ARYTENOIDECTOMY $13,507.50
31561 102320 LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE $11,956.50
31570 102321 LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC $8,249.50
31571 102322 LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE $6,777.50
31572 102323 LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI $5,449.50
31573 102324 LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI $5,661.00
31574 102325 LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI $4,835.00
31575 102326 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC $685.00
31576 102327 LARYNGOSCOPY FLEXIBLE W/BIOPSY(IES) $7,523.00
31577 102328 LARYNGOSCOPY FLX RMVL FOREIGN BODY(S) $3,305.50
31578 102329 LARYNGOSCOPY FLEXIBLE RMVL LESION(S) NON-LASER $11,110.50
31579 102330 LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY $1,845.00
31580 102331 LARYNGOPLASTY LARYN WEB W/KEEL STENT INSERTION $11,739.50
31584 102332 LARYNGOPLASTY W/OPEN REDUCTION FRACTURE W/TRACHS $13,239.50
31587 102333 LARYNGOPLASTY CRICOID SPLIT W/O GRAFT PLACEMENT $13,239.50
31590 102334 LARYNGEAL REINNERVATION NEUROMUSCULAR PEDICLE $11,739.50
31591 102335 LARYNGOPLASTY MEDIALIZATION UNLIATERAL $19,901.00
31592 102336 CRICOTRACHEAL RESECTION $13,239.50
31599 102337 UNLISTED PROCEDURE LARYNX $0.00
31600 102338 TRACHEOSTOMY PLANNED SEPARATE PROCEDURE $8,421.00
31601 102339 TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX $7,476.50
31603 102340 TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL $7,481.00
31605 102341 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE $2,754.00
3160F 102342 DOC IRON STORES PRIOR START EPO THERAPY $0.00
31610 102343 TRACHEOSTOMY FENESTRATION W/SKIN FLAPS $11,739.50
31611 102344 CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH $9,716.50
31612 102345 TRACHEAL PNXR PRQ W/TRANSTRACHEAL ASPIR&/NJX $9,976.50
31613 102346 TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION $9,071.00
31614 102347 TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION $15,168.50
31615 102348 TRACHEOBRNCHSC THRU EST TRACHS INC $3,259.00
31622 102349 BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX $4,118.50
31623 102350 BRNCHSC BRUSHING/PROTECTED BRUSHINGS $7,971.00
31624 102351 BRNCHSC W/BRNCL ALVEOLAR LAVAGE $7,364.50
31625 102352 BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES $8,436.50
31626 102353 BRONCHOSCOPY W/PLMT FIDUCIAL MARKERS SINGLE/MULT $8,564.50
31627 102354 BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION $2,282.00
31628 102355 BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE $7,798.00
31629 102356 BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON $8,037.00
31630 102357 BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX $5,066.00
31631 102358 BRONCHOSCOPY W/PLACEMENT TRACHEAL STENT $12,300.50
31632 102359 BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE $2,965.00
31633 102360 BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE $3,482.00
31634 102361 BRONCHOSCOPY BALLOON OCCLUSION $16,524.50
31635 102362 BRONCHOSCOPY W/REMOVAL FOREIGN BODY $5,988.50
31636 102363 BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS $10,975.00
31637 102364 BRONCHOSCOPY EACH MAJOR BRONCHUS STENTED $3,924.00
31638 102365 BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS $10,798.50
31640 102366 BRONCHOSCOPY W/EXCISION TUMOR $9,545.50
31641 102367 BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC $9,453.00
31643 102368 BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL $6,947.50
31645 102369 BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST $4,673.50
31646 102370 BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ $3,748.50
31647 102371 BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE $13,801.00
31648 102372 BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL $8,328.50
31649 102373 BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL $3,924.00
31651 102374 BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE $6,754.00
31652 102375 BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX $9,834.50
31653 102376 BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX $11,885.00
31654 102377 BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES $1,192.00
31660 102378 BRONCHOSCOPIC THERMOPLASTY ONE LOBE $12,628.00
31661 102379 BRONCHOSCOPIC THERMOPLASTY 2/> LOBES $13,823.50
3170F 102380 BASELINE FLOW CYTOMETRY W/DIAG/PRIOR INITG TX $0.00
31717 102381 CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY $2,121.00
31720 102382 CATHETER ASPIRATION NASOTRACHEAL SPX $559.50
31725 102383 CATH ASPIR TRACHEOBRNCL FIBERSCOPE BEDSIDE SPX $0.00
31730 102384 TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER $5,177.00
31750 102385 TRACHEOPLASTY CERVICAL $11,739.50
31755 102386 TRACHEOPLASTY TRACHEOPHARYNGEAL FSTLJ EA STG $11,739.50
31760 102387 TRACHEOPLASTY INTRATHORACIC $0.00
31766 102388 CARINAL RECONSTRUCTION $0.00
31770 102389 BRONCHOPLASTY GRAFT REPAIR $0.00
31775 102390 BRONCHOPLASTY EXCISION STENOSIS & ANASTOMOSIS $0.00
31780 102391 EXCISION TRACHEAL STENOSIS&ANASTOMOSIS CERVICA $0.00
31781 102392 EXC TRACHEAL STENOSIS&ANAST CERVICOTHORACIC $0.00
31785 102393 EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL $7,476.50
31786 102394 EXCISION TRACHEAL TUMOR/CARCINOMA THORACIC $0.00
31800 102395 SUTURE TRACHEAL WOUND/INJURY CERVICAL $0.00
31805 102396 SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC $0.00
31820 102397 SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR $11,511.50
31825 102398 SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR $12,883.50
31830 102399 REVISION TRACHEOSTOMY SCAR $10,417.50
31899 102400 UNLISTED PROCEDURE TRACHEA BRONCHI $0.00
3200F 102401 BARIUM SWALLOW TEST NOT ORDERED $0.00
32035 102402 THORACOSTOMY W/RIB RESECTION EMPYEMA $0.00
32036 102403 THORACOSTOMY OPEN FLAP DRAINAGE EMPYEMA $0.00
32096 102404 THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL $0.00
32097 102405 THORACTOMY W/DX BX LUNG NODULE/MASS UNILATERAL $0.00
32098 102406 THORACOTOMY W/BIOPSY OF PLEURA $0.00
32100 102407 THORACOTOMY WITH EXPLORATION $0.00
3210F 102408 GROUP A STREP TEST PERFORMED $0.00
32110 102409 THORCOM CTRL TRAUMTC HEMRRG&/RPR LNG TEAR $0.00
32120 102410 THORACOTOMY POSTOPERATIVE COMPLICATIONS $0.00
32124 102411 THORACOTOMY OPN INTRAPLEURAL PNEUMONOLYSIS $0.00
32140 102412 THORCOM W/REMOVAL OF CYST $0.00
32141 102413 THORACOTOMY W/RESECTION BULLAE $0.00
32150 102414 THORCOM W/RMVL INTRAPLEURAL FB/FIBRIN DEP $0.00
32151 102415 THORCOM W/RMVL IPUL FB $0.00
32160 102416 THORACOTOMY W/CARDIAC MASSAGE $6,745.00
32200 102417 PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST $0.00
3220F 102418 HEP C QUANT RNA TEST 12 WKS AFTER ANTIVIRAL TX $0.00
32215 102419 PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX $0.00
32220 102420 DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE $0.00
32225 102421 DECORTICATION PULMONARY PARTIAL SEPARATE PROC $0.00
3230F 102422 HEARING TEST 6 MOS PRIOR TO EAR TUBE INSERTION $0.00
32310 102423 PLEURECTOMY PARIETAL SEPARATE PROCEDURE $0.00
32320 102424 DECORTICATION & PARIETAL PLEURECTOMY $0.00
32400 102425 BIOPSY PLEURA PERCUTANEOUS NEEDLE $5,409.50
32408 102426 CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG $5,407.00
32440 102427 REMOVAL OF LUNG PNEUMONECTOMY $0.00
32442 102428 REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA $0.00
32445 102429 REMOVAL LUNG PNEUMONECTOMY EXTRAPLEURAL $0.00
32480 102430 RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT $0.00
32482 102431 RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC $0.00
32484 102432 RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY $0.00
32486 102433 RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY $0.00
32488 102434 RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC $0.00
32491 102435 RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG $0.00
32501 102436 RESCJ&BRONCHOPLASTY PFRMD TM LOBEC/SGMECTOMY $0.00
32503 102437 RESCJ APICAL LUNG TUMOR W/O CHEST WALL RCNSTJ $0.00
32504 102438 RESCJ APICAL LUNG TUMOR W/CHEST WALL RCNSTJ $0.00
32505 102439 THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL $0.00
32506 102440 THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL $0.00
32507 102441 THORACOTOMY W/DX WEDGE RESEXN & ANTOM LUNG RESE $0.00
3250F 102442 NONPRIM ANATOMIC LOCATION OF SPECIMEN SITE $0.00
32540 102443 EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY $0.00
32550 102444 INSERTION INDWELLING TUNNELED PLEURAL CATHETER $9,181.00
32551 102445 TUBE THORACOSTOMY INCLUDES WATER SEAL $4,319.00
32552 102446 RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF $1,494.00
32553 102447 PLMT NTRSTL DEV RADJ THX GID PRQ INTRATHRC 1/MLT $5,759.00
32554 102448 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING $2,518.50
32555 102449 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING $3,482.00
32556 102450 PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING $4,763.00
32557 102451 PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING $4,084.00
32560 102452 INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS $3,296.00
32561 102453 INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY $2,247.50
32562 102454 INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY $2,469.00
32601 102455 THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX $14,010.50
32604 102456 THORACOSCOPY DX PERICARDIAL SAC W/BIOPSY SPX $9,759.00
32606 102457 THORACOSCOPY DX MEDIASTINAL SPACE W/BIOPSY SPX $18,533.50
32607 102458 THORACOSCOPY W/DX BX OF LUNG INFILTRATE UNILATRL $19,017.00
32608 102459 THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL $25,167.00
32609 102460 THORACOSCOPY WITH BIOPSYIES OF PLEURA $15,248.00
3260F 102461 TUMOR/NODES/HISTO GRADE DOCUMENTED $0.00
32650 102462 THORACOSCOPY W/PLEURODESIS $15,764.00
32651 102463 THORACOSCOPY W/PARTIAL PULMONARY DECORTICATION $0.00
32652 102464 THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS $0.00
32653 102465 THORACOSCOPY RMVL INTRAPLEURAL FB/FIBRIN DEPOSIT $0.00
32654 102466 THORACOSCOPY CONTROL TRAUMATIC HEMORRHAGE $0.00
32655 102467 THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX $0.00
32656 102468 THORACOSCOPY W/PARIETAL PLEURECTOMY $0.00
32658 102469 THORACOSCOPY W/RMVL CLOT/FB FROM PERICARDIAL SAC $0.00
32659 102470 THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC $0.00
3265F 102471 RNA TESTING FOR HEP C VIREMIA ORDERED/DOCD $0.00
32661 102472 THORACOSCOPY W/EXC PERICARDIAL CYST TUMOR/MASS $0.00
32662 102473 THORACOSCOPY W/EXC MEDIASTINAL CYST TUMOR/MASS $53,589.50
32663 102474 THORACOSCOPY W/LOBECTOMY SINGLE LOBE $0.00
32664 102475 THORACOSCOPY W/THORACIC SYMPATHECTOMY $27,276.50
32665 102476 THORACOSCOPY W/ESOPHAGOMYOTOMY HELLER TYPE $0.00
32666 102477 THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT $28,377.50
32667 102478 THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL $12,971.00
32668 102479 THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN $0.00
32669 102480 THORACOSCOPY W/SEGMENTECTOMY $0.00
3266F 102481 HEPATITIS C GENOTYPE PRIOR ANTIVIRAL TREATMENT $0.00
32670 102482 THORACOSCOPY W/BILOBECTOMY $0.00
32671 102483 THORACOSCOPY W/PNEUMONECTOMY $0.00
32672 102484 THORACOSCOPY W/RESEXN-PLICAJ EMPHYSEMA LUNG UNIL $68.50
32673 102485 THORACOSCOPY RESEXN THYMUS UNI/BILATERAL $0.00
32674 102486 THORCOSCPY W/MEDIASTINL & REGIONL LYMPHDENECTOMY $17,466.50
3267F 102487 PATH RPRT INCLUDES PT & PN CAT GLEASON $0.00
3268F 102488 PSA & TUMOR STAGE&GLEASON SCORE PRIOR INIT $0.00
3269F 102489 BONE SCAN PRIOR INITIAT TX/DX PROSTATE CANCER $0.00
32701 102490 THORAX STEREOTACTIC RADIATION TARGET W/TX COURSE $1,553.50
32800 102491 REPAIR LUNG HERNIA THROUGH CHEST WALL $0.00
3280F 102492 HEMOGLOBIN LEVEL 11 G/DL-12.9 G/DL $0.00
32810 102493 CLSR CH WALL FLWG OPN FLAP DRG EMPYEMA $0.00
32815 102494 OPEN CLOSURE MAJOR BRONCHIAL FISTULA $0.00
3281F 102495 HEMOGLOBIN LEVEL <11 G/DL $0.00
32820 102496 MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC $0.00
3284F 102497 IO PRESSURE REDUCED >= 15% PRE-INTERVENTION LVL $0.00
32850 102498 DONOR PNEUMONECTOMY FROM CADAVER DONOR $0.00
32851 102499 LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS $0.00
32852 102500 LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS $0.00
32853 102501 LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS $0.00
32854 102502 LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS $0.00
32855 102503 BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI $0.00
32856 102504 BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT BI $0.00
3285F 102505 IOP REDUCED <15% PRE-INTERVENTION LEVEL $0.00
3288F 102506 FALLS RISK ASSESSMENT DOCUMENTED $0.00
32900 102507 RESECTION RIBS EXTRAPLEURAL ALL STAGES $0.00
32905 102508 THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL $0.00
32906 102509 THORACOP SCHEDE TYP/XTRPLEURAL CLSR BRNCPLR FSTL $0.00
3290F 102510 PATIENT IS D (RH) NEGATIVE AND UNSENSITIZED $0.00
3291F 102511 PATIENT IS D (RH) POSITIVE OR SENSITIZED $0.00
3292F 102512 HIV TSTNG ASK/DOCD/RVWD AT 1ST/2ND PRENATAL VST $0.00
3293F 102513 ABO AND RH BLOOD TYPING DOCUMENTED AS PERFORMED $0.00
32940 102514 PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX $0.00
32960 102515 PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR $2,469.00
32994 102516 ABLATION THER 1+ PULM TUMORS PERQ CRYOABLATION $28,706.00
32997 102517 TOTAL LUNG LAVAGE UNILATERAL $0.00
32998 102518 ABLATION THER 1+ PULM TUMORS PERQ RADIOFREQUENCY $17,606.50
32999 102519 UNLISTED PROCEDURE LUNGS & PLEURA $0.00
33016 102520 PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED $7,870.50
33017 102521 PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY $7,415.00
33018 102522 PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY $0.00
33019 102523 PERQ PERICARDIAL DRG W/INSJ NDWELLG CATH W/CT $0.00
3301F 102524 CANCER STAGE DOCD METASTATIC & REVIEWED $0.00
33020 102525 PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY $0.00
33025 102526 CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX $0.00
33030 102527 PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS $0.00
33031 102528 PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS $0.00
33050 102529 RESECTION PERICARDIAL CYST/TUMOR $0.00
33120 102530 EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP $0.00
33130 102531 RESECTION EXTERNAL CARDIAC TUMOR $0.00
33140 102532 TRANSMYOCARDIAL LASER REVASCULAR THORACOTOMY SPX $0.00
33141 102533 TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX $0.00
3315F 102534 ESTROGEN/PROGEST RECEPTOR POSITIVE BREAST CANCER $0.00
3316F 102535 ESTROGEN/PROGEST RECEPTOR NEGATIVE BREAST CANCER $0.00
3317F 102536 PATH REPRT MALIGNANCY DOCD & RVWD INITIATE CHE $0.00
3318F 102537 PATH REPRT MALIGNANCY DOCD & RVWD INITIA RAD $0.00
3319F 102538 1 DX IMG ORDER CHEST XRAY CT US MRI PET/NUC MED $0.00
33202 102539 INSERTION EPICARDIAL ELECTRODE OPEN $0.00
33203 102540 INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC $0.00
33206 102541 INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL $27,359.50
33207 102542 INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR $26,784.00
33208 102543 INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT $38,528.50
33210 102544 INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH $14,668.00
33211 102545 INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX $14,508.50
33212 102546 INS PM PLS GEN W/EXIST SINGLE LEAD $35,322.50
33213 102547 INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS $24,094.50
33214 102548 UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS $34,777.00
33215 102549 RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE $10,265.50
33216 102550 INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB $15,553.00
33217 102551 INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB $32,003.00
33218 102552 RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB $12,420.50
3321F 102553 AJCC CANCER STAGE 0 OR IA MELANOMA $0.00
33220 102554 RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB $14,014.50
33221 102555 INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS $46,862.50
33222 102556 RELOCATION OF SKIN POCKET FOR PACEMAKER $8,905.00
33223 102557 RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR $9,404.00
33224 102558 INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN $33,428.00
33225 102559 INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN $54,071.00
33226 102560 RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD $12,683.50
33227 102561 REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD $26,505.00
33228 102562 REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS $31,864.50
33229 102563 REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD $33,365.00
33230 102564 INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS $61,940.50
33231 102565 INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS $69,212.00
33233 102566 REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY $21,794.50
33234 102567 RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR $8,899.50
33235 102568 RMVL TRANSVNS PM ELTRD DUAL LEAD SYS $13,737.00
33236 102569 RMVL PRM EPICAR PM&ELTRDS THORCOM 1 LEAD SYS $0.00
33237 102570 RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY $0.00
33238 102571 RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY $0.00
33240 102572 INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD $46,152.00
33241 102573 REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY $9,773.00
33243 102574 RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM $0.00
33244 102575 RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ $19,069.50
33249 102576 INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR $79,453.50
33250 102577 ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/O BYPASS $0.00
33251 102578 ABLATION ARRHYTHMOGENIC FOCI/PATHWAY W/BYPASS $0.00
33254 102579 ABLATION & RECONSTRUCTION ATRIA LIMITED $0.00
33255 102580 ABLATION & RCNSTJ ATRIA EXTNSV W/O BYPASS $0.00
33256 102581 ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS $0.00
33257 102582 ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE $0.00
33258 102583 ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTENSIV W/O BYP $0.00
33259 102584 ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS $0.00
3325F 102585 PREOP ASSES 12 MOS PRIOR CATARACT SURG W/IO LENS $0.00
33261 102586 OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS $0.00
33262 102587 RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD $63,252.00
33263 102588 RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD $73,931.00
33264 102589 RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD $74,713.00
33265 102590 NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPAS $0.00
33266 102591 NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS $0.00
33267 102592 EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD $0.00
33268 102593 EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD $0.00
33269 102594 EXCLUSION L ATR APPENDAGE THORACOSCOPIC ANY METH $0.00
33270 102595 INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD $65,403.50
33271 102596 INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE $38,136.50
33272 102597 RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE $14,059.00
33273 102598 REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB $24,764.50
33274 102599 TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG $75,466.50
33275 102600 TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG $5,529.50
33276 102601 INSERTION PHRENIC NERVE STIMULATOR SYSTEM $0.00
33277 102602 INSJ PHRENIC NRV STIMULATOR TRANSVNS SENSING LD $0.00
33278 102603 REMOVAL PHRENIC NERVE STIMULATOR SYSTEM $18,922.50
33279 102604 RMVL PHRNC NRV STIMULATOR TRANSVNS STIMJ/SNSG LD $18,922.50
33280 102605 RMVL PHRENIC NRV STIMULATOR PULSE GENERATOR ONLY $18,922.50
33281 102606 REPOSITIONING PHRENIC NRV STIMULATOR TRANSVNS LD $18,922.50
33285 102607 INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG $14,856.00
33286 102608 REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR $7,148.50
33287 102609 RMVL&RPLCMT PHRENIC NRV STIMULATOR PLS GENERATOR $0.00
33288 102610 RMVL&RPLCMT PHRNC NRV STIM TRNSVNS STIMJ/SNSG LD $0.00
33289 102611 TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR $67,272.50
33300 102612 REPAIR CARDIAC WOUND W/O BYPASS $0.00
33305 102613 REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS $0.00
3330F 102614 IMAGING STUDY ORDERED $0.00
33310 102615 CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP $0.00
33315 102616 CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP $0.00
3331F 102617 IMAGING STUDY NOT ORDERED $0.00
33320 102618 SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP $0.00
33321 102619 SUTR RPR AORTA/GREAT VESSEL W/SHUNT BYPASS $0.00
33322 102620 SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS $0.00
33330 102621 INSJ GRAFT AORTA/GREAT VESSEL W/O SHUNT/BYPASS $0.00
33335 102622 INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS $0.00
33340 102623 PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT $37,188.50
33361 102624 REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH $63,240.50
33362 102625 REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH $0.00
33363 102626 REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH $0.00
33364 102627 REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH $0.00
33365 102628 REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH $0.00
33366 102629 TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE $0.00
33367 102630 REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH $0.00
33368 102631 REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH $0.00
33369 102632 REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH $0.00
33370 102633 TRANSCATHETER PLACEMENT&SBSQ REMOVAL CEPD PERQ $0.00
33390 102634 VALVULOPLASTY AORTIC VALVE OPEN CARD BYP SIMPLE $32,077.00
33391 102635 VALVULOPLASTY AORTIC VALVE OPEN CARD BYP COMPLEX $37,101.00
33404 102636 CONSTRUCTION APICAL-AORTIC CONDUIT $0.00
33405 102637 RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT $0.00
33406 102638 RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND $0.00
3340F 102639 MAMMO ASSESSMENT CAT INCOMP ADDTNL IMAGE DOCD $0.00
33410 102640 RPLCMT AORTIC VALVE OPN W/STENTLESS TISSUE VALVE $0.00
33411 102641 RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS $0.00
33412 102642 REPLACEMENT AORTIC VALVE KONNO PROCEDURE $0.00
33413 102643 REPLACEMENT AORTIC&PULMON VALVES ROSS PROCEDUR $0.00
33414 102644 RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC $0.00
33415 102645 RESECTION/INCISION SUBVALVULAR TISSUE $0.00
33416 102646 VENTRICULOMYOTOMY-MYECTOMY $0.00
33417 102647 AORTOPLASTY SUPRAVALVULAR STENOSIS $0.00
33418 102648 TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS $75,683.50
33419 102649 TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS $0.00
3341F 102650 MAMMO ASSESSMENT CAT NEGATIVE DOCD $0.00
33420 102651 VALVOTOMY MITRAL VALVE CLOSED HEART $0.00
33422 102652 VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS $0.00
33425 102653 VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS $0.00
33426 102654 VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING $0.00
33427 102655 VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING $0.00
3342F 102656 MAMMO ASSESSMENT CAT BENIGN DOCD $0.00
33430 102657 REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP $0.00
3343F 102658 MAMMO ASSESSMENT CAT PROB BENIGN DOCD $0.00
33440 102659 RPLCMT AORTIC VALVE BY TLCJ AUTOL PULM VALVE $0.00
3344F 102660 MAMMO ASSESSMENT CAT SUSPICIOUS DOCD $0.00
3345F 102661 MAMMO ASSESSMENT CAT HIGH CHANCE MALIG DOCD $0.00
33460 102662 VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP $0.00
33463 102663 VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION $0.00
33464 102664 VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION $0.00
33465 102665 REPLACEMENT TRICUSPID VALVE W/CARD BYPASS $0.00
33468 102666 TRICUSPID VALVE RPSG&PLCTJ EBSTEIN ANOMALY $0.00
33471 102667 VALVOTOMY PULM VALVE CLSD HEART VIA PULM ARTERY $0.00
33474 102668 VALVOTOMY PULMONARY VALVE OPEN HEART W/BYPASS $0.00
33475 102669 REPLACEMENT PULMONARY VALVE $0.00
33476 102670 R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY $0.00
33477 102671 TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH $77,822.00
33478 102672 OUTFLOW TRACT AGMNTJ W/WO COMMISSUR/INFUND RESCJ $0.00
33496 102673 RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS $0.00
33500 102674 RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/BYPASS $0.00
33501 102675 RPR CORONARY AV/ARTERIOCAR CHMBR FSTL W/O BYPASS $0.00
33502 102676 RPR ANOM CORONARY ART PULM ART ORIGIN LIGATION $0.00
33503 102677 RPR ANOM CORONARY ARTERY PULM ART ORIGIN GRAFT $0.00
33504 102678 RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP $0.00
33505 102679 RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL $0.00
33506 102680 RPR ANOM CORONARY ART FROM PULM ART TO AORTA $0.00
33507 102681 RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ $0.00
33508 102682 NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG $225.00
33509 102683 ENDOSCOPIC HARVEST UXTR ARTERY 1 SEGMENT CAB PX $0.00
3350F 102684 MAMMO ASSESSMENT CAT BIOPSY PROVEN MALIG DOCD $0.00
33510 102685 CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT $0.00
33511 102686 CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS $0.00
33516 102690 CORONARY ARTERY BYPASS 6/+ CORONARY VENOUS GRAFT $0.00
33517 102691 CORONARY ARTERY BYP W/VEIN & ARTERY GRAFT 1 VEIN $0.00
3351F 102694 NEG DEP SYMP CAT USING STAND DEP ASSESS TOOL $0.00
33523 102697 CORONARY ARTERY BYP W/VEIN &ARTERY GRAFT 6 VEIN $0.00
3352F 102698 NO SIGNIF DEP SYMP CAT BY STAND DEP ASSESS TOOL $0.00
33530 102699 ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ $0.00
33533 102700 CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT $0.00
33534 102701 CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS $0.00
33535 102702 CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS $0.00
33536 102703 CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS $0.00
3353F 102704 MILD TO MOD DEP SYMP BY STAND DEP ASSESS TOOL $0.00
33542 102705 MYOCARDIAL RESECTION $0.00
33545 102706 RPR POSTINFRCJ VENTRICULAR SEPTAL DEFECT $0.00
33548 102707 SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD $0.00
3354F 102708 CLIN SIGN DEP SYMP BY STAND DEP ASSESS TOOL $0.00
33572 102709 CORONARY ENDARTERCOMY OPEN ANY METHOD $0.00
33600 102710 CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH $0.00
33602 102711 CLOSURE SEMILUNAR VALVE AORTIC/PULM SUTURE/PATCH $0.00
33606 102712 ANAST PULMONARY ART AORTA DAMUS-KAYE-STANSEL PX $0.00
33608 102713 RPR CAR ANOMAL XCP PULM ATRESIA VENTR SEPTL DFCT $0.00
33610 102714 RPR CAR ANOMAL SURG ENLGMENT VENTR SEPTL DFCT $0.00
33611 102715 RPR 2 OUTLET R VNTRC W/INTRAVENTR TUNNEL RPR $0.00
33612 102716 RPR 2 OUTLET R VNTRC RPR R VENTR O/F TRC OBSTRCJ $0.00
33615 102717 RPR CAR ANOMAL CLSR SEPTL DFCT SMPL FONTAN PX $0.00
33617 102718 RPR COMPLEX CARDIAC ANOMALY MODIFIED FONTAN PX $0.00
33619 102719 RPR 1 VNTRC W/O/F OBSTRCJ&AORTIC ARCH HYPOPLAS $0.00
33620 102720 APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND $0.00
33621 102721 TRANSTHORACIC CATHETER INSERTION FOR STENT PLMT $0.00
33622 102722 RECONSTRUCTION COMPLEX CARDIAC ANOMALY $0.00
33641 102723 RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH $0.00
33645 102724 DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG $0.00
33647 102725 RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLS $0.00
33660 102726 RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR $0.00
33665 102727 RPR INTRM/TRANSJ AV CANAL W/WO AV VALVE RPR $0.00
33670 102728 RPR COMPL AV CANAL W/WO PROSTC VALVE $0.00
33675 102729 CLOSURE MULTIPLE VENTRICULAR SEPTAL DEFECTS $0.00
33676 102730 CLOSURE MULTIPLE VSD W/RESECTION $0.00
33677 102731 CLOSURE MULTIPLE VSD W/REMOVAL ARTERY BAND $0.00
33681 102732 CLSR 1 VENTRICULAR SEPTAL DEFECT W/WO PATCH $0.00
33684 102733 CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ $0.00
33688 102734 CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET $0.00
33690 102735 BANDING PULMONARY ARTERY $0.00
33692 102736 COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA $0.00
33694 102737 COMPL RPR T-FALLOT W/O PULM ATRESIA TANULR PATCH $0.00
33697 102738 COMPL RPR T-FALLOT W/PULM ATRESIA $0.00
33702 102739 RPR SINUS VALSALVA FISTULA $0.00
3370F 102740 AJCC BREAST CANCER STAGE 0 DOCUMENTED $0.00
33710 102741 RPR SINUS VALSALVA FISTULA W/RPR V-SEPTAL DEFECT $0.00
33720 102742 RPR SINUS VALSALVA ANEURYSM $0.00
33724 102743 REPAIR ISOLATED PARTIAL PULM VENOUS RETURN $0.00
33726 102744 REPAIR PULMONARY VENOUS STENOSIS $0.00
3372F 102745 AJCC BREAST CANCER STAGE I T1MIC T1A/T1B $0.00
33730 102746 COMPLETE RPR ANOMALOUS PULMONARY VENOUS RETURN $0.00
33732 102747 RPR COR TRIATM/SUPVALVR RING RESCJ L ATRIAL MEMB $0.00
33735 102748 ATRIAL SEPTECTOMY/SEPTOSTOMY CLOSED HEART $0.00
33736 102749 ATRIAL SEPTECTOMY/SEPTOSTOMY OPEN HEART W/BYPASS $0.00
33737 102750 ATRIAL SEPTECT/SEPTOST OPN HRT W/INFL OCCLUSION $0.00
33741 102751 TAS CONGENITAL CARDIAC ANOMALIES ANY METHOD $0.00
33745 102752 TIS CRTJ ST CONGENITAL CARDIAC ANOMAL 1ST SHUNT $0.00
33746 102753 TIS CRTJ ST CONGENITAL CARDIAC ANOMAL EA ADDL $0.00
3374F 102754 AJCC BREAST CANCER STAGE I T1C $0.00
33750 102755 SHUNT SUBCLAVIAN PULMONARY ARTERY $0.00
33755 102756 SHUNT ASCENDING AORTA PULMONARY ARTERY $0.00
33762 102757 SHUNT DESCENDING AORTA PULMONARY ARTERY $0.00
33764 102758 SHUNT CENTRAL W/PROSTHETIC GRAFT $0.00
33766 102759 SHUNT SUPERIOR VENA CAVA PULMONARY ART 1 LUNG $0.00
33767 102760 SHUNT SUPERIOR VENA CAVA PULM ARTERY BOTH LUNGS $0.00
33768 102761 ANASTOMOSIS CAVOPULMARY 2ND SUPRIOR VENA CAVA $0.00
3376F 102762 AJCC BREAST CANCER STAGE II $0.00
33770 102763 RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT $0.00
33771 102764 RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT $0.00
33774 102765 RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS $0.00
33775 102766 RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND $0.00
33776 102767 RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT $0.00
33777 102768 RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC $0.00
33778 102769 RPR TRPOS GRT VESSEL AORTIC PULMONARY ART RCNSTJ $0.00
33779 102770 RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND $0.00
33780 102771 RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT $0.00
33781 102772 RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ $0.00
33782 102773 A-ROOT TLCJ VSD PULM STNS RPR W/O C OST RIMPLTJ $0.00
33783 102774 A-ROOT TLCJ VSD PULM STNS RPR W/RIMPLTJ C OSTIA $0.00
33786 102775 TOTAL REPAIR TRUNCUS ARTERIOSUS $0.00
33788 102776 REIMPLANTATION ANOMALOUS PULMONARY ARTERY $0.00
3378F 102777 AJCC BREAST CANCER STAGE III $0.00
33800 102778 AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX $0.00
33802 102779 DIVISION ABERRANT VESSEL VASCULAR RING $0.00
33803 102780 DIVISION ABERRANT VESSEL W/REANASTOMOSIS $0.00
3380F 102781 AJCC BREAST CANCER STAGE IV $0.00
33813 102782 OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS $0.00
33814 102783 OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS $0.00
33820 102784 REPAIR PATENT DUCTUS ARTERIOSUS LIGATION $0.00
33822 102785 RPR PATENT DUXUS ARTERIOSUS DIV UNDER 18 YR $0.00
33824 102786 RPR PATENT DUXUS ARTERIOSUS DIV 18 YR & OLDER $0.00
3382F 102787 AJCC COLON CANCER STAGE 0 $0.00
33840 102788 EXC COARCJ AORTA W/WO PDA W/DIRECT ANASTOMOSIS $0.00
33845 102789 EXCISION COARCTATION AORTA W/WO PDA W/GRAFT $0.00
3384F 102790 AJCC COLON CANCER STAGE I $0.00
33851 102791 EXC COARCJ AORTA W/L SUBCLAV ART/PROSTC GUSSET $0.00
33852 102792 RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/O BYPASS $0.00
33853 102793 RPR HYPOPLSTC A-ARCH W/AGRFT/PROSTC W/BYPASS $0.00
33858 102794 AS-AORT GRF W/CARD BYP F/AORTIC DISSECTION $0.00
33859 102795 AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ $0.00
33863 102796 AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT $0.00
33864 102797 ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL $0.00
33866 102798 AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS $0.00
3386F 102799 AJCC COLON CANCER STAGE II $0.00
33871 102800 TRANSVRS A-ARCH GRF W/CARD BYP PRFD HYPOTHERMIA $0.00
33875 102801 DESCENDING THORACIC AORTA GRAFT W/WO BYPASS $0.00
33877 102802 RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS $0.00
33880 102803 EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH $0.00
33881 102804 EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN $0.00
33883 102805 PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN $0.00
33884 102806 PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN $0.00
33886 102807 PLMT DSTL XTN PROSTH DLYD AFTER EVASC RPR DTA $0.00
33889 102808 OPN SUBCLA CRTD ART TRPOS NCK INC ULAT $0.00
3388F 102809 AJCC COLON CANCER STAGE III DOCD $0.00
33891 102810 BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC $0.00
33894 102811 EVASC ST RPR COARCJ THRC/AA ACRS MAJ SIDE BRNCH $0.00
33895 102812 EVASC ST RPR COARCJ THRC/AA XCRSG MAJ SIDE BRNCH $0.00
33897 102813 PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA $0.00
33900 102814 PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ UNI $52,767.00
33901 102815 PERQ P-ART REVSC ST 1ST NML NATIVE CONNJ BI $52,767.00
33902 102816 PERQ P-ART REVSC ST 1ST ABNOR CONNJ UNILATERAL $77,668.00
33903 102817 PERQ P-ART REVSC ST 1ST ABNORMAL CONNJ BILATERAL $52,767.00
33904 102818 PERQ P-ART REVSC ST EA ADDL VSL/SEP LES NM/ABNL $0.00
3390F 102819 AJCC COLON CANCER STAGE IV DOCD $0.00
33910 102820 PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS $0.00
33915 102821 PULMONARY ARTERY EMBOLECTOMY W/O CARD BYPASS $0.00
33916 102822 PULMONARY ENDARTERCOMY W/WO EMBOLECTOMY W/BYPASS $0.00
33917 102823 RPR PULMONARY ART STENOSIS RCNSTJ W/PATCH/GRAFT $0.00
33920 102824 RPR PULMONARY ATRESIA W/CONSTJ/RPLCMT CONDUIT $0.00
33922 102825 TRANSECTION PULMONARY ARTERY W/CARD BYPASS $0.00
33924 102826 LIG&TKDN SYSIC-TO-PULM ART SHUNT W/CGEN HEART $0.00
33925 102827 RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/O BYPASS $0.00
33926 102828 RPR P-ART ARBORIZJ ANOMAL UNIFCLIZJ W/BYPASS $0.00
33927 102829 IMPLTJ TOTAL RPLCMT HEART SYS W/RCP CARDIECTOMY $0.00
33928 102830 REMOVAL & RPLCMT TOTAL RPLCMT HEART SYS $0.00
33929 102831 REMOVAL TOTAL RPLCMT HEART SYS FOR HEART TRNSPL $0.00
33930 102832 DONOR CARDIECTOMY-PNEUMONECTOMY $0.00
33933 102833 BKBENCH PREPJ CADAVER DONOR HEART/LUNG ALLOGRAFT $0.00
33935 102834 HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC $0.00
33940 102835 DONOR CARDIECTOMY $0.00
33944 102836 BKBENCH PREPJ CADAVER DONOR HEART ALLOGRAFT $0.00
33945 102837 HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY $0.00
33946 102838 ECMO/ECLS INITIATION VENO-VENOUS $0.00
33947 102839 ECMO/ECLS INITIATION VENO-ARTERIAL $0.00
33948 102840 ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS $0.00
33949 102841 ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL $0.00
3394F 102842 QUANT HER2 IHC EVAL OF BRST CANCER ASCO/CAP $0.00
33951 102843 ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ $0.00
33952 102844 ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ $0.00
33953 102845 ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN $0.00
33954 102846 ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN $0.00
33955 102847 ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS $0.00
33956 102848 ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER $0.00
33957 102849 ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS $0.00
33958 102850 ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER $0.00
33959 102851 ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS $0.00
3395F 102852 QUANT NON-HER2 IHC EVAL OF BRST CANCER PERFORMED $0.00
33962 102853 ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER $0.00
33963 102854 ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS $0.00
33964 102855 ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER $0.00
33965 102856 ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS $0.00
33966 102857 ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER $0.00
33967 102858 INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ $8,050.50
33968 102859 REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ $0.00
33969 102860 ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS $0.00
33970 102861 INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN $0.00
33971 102862 RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF $0.00
33973 102863 INSJ I-AORT BALO ASSIST DEV VIA ASCENDING AORTA $0.00
33974 102864 RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA $0.00
33975 102865 INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE $0.00
33976 102866 INSJ VENTRIC ASSIST DEV XTRCORP BIVENTRICULAR $0.00
33977 102867 REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE $0.00
33978 102868 REMOVAL VENTR ASSIST DEVICE XTRCORP BIVENTR $0.00
33979 102869 INSJ VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC $0.00
33980 102870 RMVL VENTR ASSIST DEV IMPLTABLE ICORP 1 VNTRC $0.00
33981 102871 RPLCMT XTRCORP VAD 1/BIVENTR PUMP 1/EA PUMP $0.00
33982 102872 PLCMT VAD PMP IMPLTBL ICORP 1 VENTR W/O BYPASS $0.00
33983 102873 RPLCMT VAD PMP IMPLTBL ICORP 1 VNTR W/BYPASS $0.00
33984 102874 ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER $0.00
33985 102875 ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS $0.00
33986 102876 ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER $0.00
33987 102877 ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS $0.00
33988 102878 INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS $0.00
33989 102879 RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS $0.00
33990 102880 INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY $24,064.00
33991 102881 INSJ PERQ VAD W/RS&I L HRT ARTERIAL&VEN ACCESS $0.00
33992 102882 REMOVAL PERQ LEFT HRT VAD ARTL/ARTL&VEN SEP INSJ $0.00
33993 102883 REPOSITIONING PERQ R/L VAD W/IMG GDN SEP INSJ $0.00
33995 102884 INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY $0.00
33997 102885 REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ $0.00
33999 102886 UNLISTED PROCEDURE CARDIAC SURGERY $0.00
34001 102887 EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART $0.00
34051 102888 EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY $0.00
34101 102889 EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART $15,404.50
34111 102890 EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC $23,215.50
34151 102891 EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART $0.00
34201 102892 EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART $21,467.00
34203 102893 EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC $22,962.00
34401 102894 THRMBC DIR/W/CATH VENA CAVA ILIAC VEIN ABDL INC $0.00
34421 102895 THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN LEG INC $11,626.50
34451 102896 THRMBC DIR/W/CATH V/C ILIAC FEMPOP VEIN ABDL&LEG $0.00
34471 102897 THRMBC DIR/W/CATH SUBCLAVIAN VEIN NECK INC $11,626.50
34490 102898 THRMBC DIR/W/CATH AXILL&SUBCLAVIAN VEIN ARM IN $11,626.50
34501 102899 VALVULOPLASTY FEMORAL VEIN $11,626.50
34502 102900 RECONSTRUCTION VENA CAVA ANY METHOD $0.00
34510 102901 VENOUS VALVE TRANSPOSITION ANY VEIN DONOR $11,626.50
3451F 102902 DYSPNEA SCRND MOD-SEVERE DYSPNEA $0.00
34520 102903 CROSS-OVER VEIN GRAFT VENOUS SYSTEM $11,626.50
3452F 102904 DYSPNEA NOT SCREENED $0.00
34530 102905 SAPHENOPOPLITEAL VEIN ANASTOMOSIS $11,626.50
34701 102906 EVASC RPR DPLMNT AORTO-AORTIC NDGFT $0.00
34702 102907 EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT $0.00
34703 102908 EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT $0.00
34704 102909 EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT $0.00
34705 102910 EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT $26,171.50
34706 102911 EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT $0.00
34707 102912 EVASC RPR DPLMNT ILIO-ILIAC NDGFT $12,886.00
34708 102913 EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT $0.00
34709 102914 PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR $0.00
3470F 102915 RHEUMATOID ARTHRITIS (RA) DISEASE ACTIVITY LOW $0.00
34710 102916 DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL $0.00
34711 102917 DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL $0.00
34712 102918 TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I $0.00
34713 102919 PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT $11,920.50
34714 102920 OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH $0.00
34715 102921 OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI $0.00
34716 102922 OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ $0.00
34717 102923 EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI $0.00
34718 102924 EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI $0.00
3471F 102925 RHEUMATOID ARTHRITIS (RA) DISEASE ACTIVITY MOD $0.00
3472F 102926 RHEUMATOID ARTHRITIS (RA) DISEASE ACTIVITY HIGH $0.00
3475F 102927 DISEASE PROGNOSIS RA ASSESSED POOR PROG DOCD $0.00
3476F 102928 DISEASE PROGNOSIS RA ASSESSED GOOD PROG DOCD $0.00
34808 102929 EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE $0.00
34812 102930 OPN FEM ART EXPOS DLVR EVASC PROSTH UNI $10,681.00
34813 102931 PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR $0.00
34820 102932 OPN ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI $0.00
34830 102933 OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH $0.00
34831 102934 OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH $0.00
34832 102935 OPN RPR ARYSM RPR ARTL TRMA AORTO-BIFEM PROSTH $0.00
34833 102936 OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP $0.00
34834 102937 OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI $0.00
34839 102938 PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT $0.00
34841 102939 ENDOVASC VISCER AORTA REPAIR FENEST 1 ENDOGRAFT $0.00
34844 102942 ENDOVASC VISCER AORTA REPR FENEST 4+ ENDOGRAFT $0.00
34845 102943 VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS $0.00
34848 102946 VISCER AND INFRARENAL ABDOM AORTA 4+ PROSTHESIS $0.00
3490F 102947 HISTORY OF AIDS-DEFINING CONDITION $0.00
3491F 102948 HIV INDETERMINATE INFANTS BORN OF HIV MOTHERS $0.00
3492F 102949 HISTORY OF NADIR CD4+ CELL COUNT <350 CELLS/MM3 $0.00
3493F 102950 NO HIST NADIR CD4+ CELL CNT <350&AIDS CONDITION $0.00
3494F 102951 CD4+ CELL COUNT <200 CELLS/MM $0.00
3495F 102952 CD4+ CELL COUNT 200-499 CELLS/MM (HIV) $0.00
3496F 102953 CD4+ CELL COUNT >= 500 CELLS/MM $0.00
3497F 102954 CD4+ CELL PERCENTAGE <15% HIV $0.00
3498F 102955 CD4+ CELL PERCENTAGE >= 15% HIV $0.00
35001 102956 DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY $0.00
35002 102957 DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY $0.00
35005 102958 DIR RPR ANEURYSM VERTEBRAL ARTERY $0.00
35011 102959 DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION $19,125.00
35013 102960 DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS $0.00
35021 102961 DIR RPR ANEURYSM INNOMINATE/SUBCLAVIAN ARTERY $0.00
35022 102962 DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN $0.00
35045 102963 DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY $30,052.50
35081 102964 DIR RPR ANEURYSM ABDOMINAL AORTA $0.00
35082 102965 DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA $0.00
35091 102966 DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS $0.00
35092 102967 DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS $0.00
35102 102968 DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS $0.00
35103 102969 DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS $0.00
3510F 102970 DOCJ TB SCREEN PERFORMED & RESULTS INTERPRET $0.00
35111 102971 DIR RPR ANEURYSM SPLENIC ARTERY $0.00
35112 102972 DIR RPR RUPTD ANEURYSM SPLENIC ARTERY $0.00
3511F 102973 CHLAMYDIA/GONORRHEA TSTS DOCD AS DONE $0.00
35121 102974 DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC $0.00
35122 102975 DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN $0.00
3512F 102976 SYPHILIS SCREENING DOCUMENTED AS DONE $0.00
35131 102977 DIR RPR ANEURYSM & GRAFT ILIAC ARTERY $0.00
35132 102978 DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY $0.00
3513F 102979 HEPATITIS B SCREENING DOCUMENTED AS PERFORMED $0.00
35141 102980 DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY $0.00
35142 102981 DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART $0.00
3514F 102982 HEPATITIS C SCREENING DOCUMENTED AS PERFORMED $0.00
35151 102983 DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY $0.00
35152 102984 DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY $0.00
35180 102985 REPAIR CONGENITAL AV FISTULA HEAD & NECK $8,826.00
35182 102986 RPR CONGENITAL AV FISTULA THORAX & ABDOMEN $0.00
35184 102987 RPR CONGENITAL AV FISTULA EXTREMITIES $8,826.00
35188 102988 RPR/TRAUMATIC AV FISTULA HEAD & NECK $11,626.50
35189 102989 RPR/TRAUMATIC AV FISTULA THORAX & ABDOMEN $0.00
35190 102990 RPR/TRAUMATIC AV FISTULA EXTREMITIES $27,388.50
35201 102991 REPAIR BLOOD VESSEL DIRECT NECK $19,237.50
35206 102992 REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY $10,225.00
35207 102993 REPAIR BLOOD VESSEL DIRECT HAND FINGER $10,464.00
35211 102994 RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS $0.00
35216 102995 RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS $0.00
35221 102996 RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL $0.00
35226 102997 RPR BLOOD VESSEL DIRECT LOWER EXTREMITY $6,622.50
35231 102998 REPAIR BLOOD VESSEL W/VEIN GRAFT NECK $8,826.00
35236 102999 REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY $15,884.50
35241 103000 RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP $0.00
35246 103001 RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP $0.00
35251 103002 REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL $0.00
35256 103003 REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY $8,826.00
35261 103004 REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK $10,394.50
35266 103005 RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY $18,090.50
35271 103006 RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP $0.00
35276 103007 RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP $0.00
35281 103008 RPR BLVSL W/GRFT OTHER/THAN VEIN INTRA-ABDOMINAL $0.00
35286 103009 RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY $10,394.50
35301 103010 TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC $29,340.50
35302 103011 TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY $0.00
35303 103012 TEAEC W/GRAFT POPLITEAL ARTERY $0.00
35304 103013 TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY $0.00
35305 103014 TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL $0.00
35306 103015 TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART $0.00
35311 103016 TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC $0.00
35321 103017 TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL $29,454.50
35331 103018 TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA $0.00
35341 103019 TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL $0.00
35351 103020 TEAEC W/WO PATCH GRAFT ILIAC $0.00
35355 103021 TEAEC W/WO PATCH GRAFT ILIOFEMORAL $0.00
35361 103022 TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC $0.00
35363 103023 TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL $0.00
35371 103024 TEAEC W/WO PATCH GRAFT COMMON FEMORAL $23,908.00
35372 103025 TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL $25,707.00
35390 103026 ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO $0.00
35400 103027 ANGIOSCOPY NON-CORONARY VESSEL/GRAFTS THER IVNTJ $0.00
35500 103028 HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX $5,537.50
35501 103029 BYPASS W/VEIN COMMON-IPSILATERAL CAROTID $0.00
35506 103030 BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID $0.00
35508 103031 BYPASS W/VEIN CAROTID-VERTEBRAL $0.00
35509 103032 BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID $0.00
3550F 103033 LOW RISK FOR THROMBOEMBOLISM $0.00
35510 103034 BYPASS W/VEIN CAROTID-BRACHIAL $0.00
35511 103035 BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN $0.00
35512 103036 BYPASS W/VEIN SUBCLAVIAN-BRACHIAL $0.00
35515 103037 BYPASS W/VEIN SUBCLAVIAN-VERTEBRAL $0.00
35516 103038 BYPASS W/VEIN SUBCLAVIAN-AXILLARY $0.00
35518 103039 BYPASS W/VEIN AXILLARY-AXILLARY $0.00
3551F 103040 INTERMEDIATE RISK FOR THROMBOEMBOLISM $0.00
35521 103041 BYPASS W/VEIN AXILLARY-FEMORAL $0.00
35522 103042 BYPASS W/VEIN AXILLARY-BRACHIAL $0.00
35523 103043 BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL $0.00
35525 103044 BYPASS W/VEIN BRACHIAL-BRACHIAL $0.00
35526 103045 BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE $0.00
3552F 103046 HIGH RISK FOR THROMBOEMBOLISM $0.00
35531 103047 BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC $0.00
35533 103048 BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL $0.00
35535 103049 BYPASS W/VEIN HEPATORENAL $0.00
35536 103050 BYPASS W/VEIN SPLENORENAL $0.00
35537 103051 BYPASS W/VEIN AORTOILIAC $0.00
35538 103052 BYPASS W/VEIN AORTOBI-ILIAC $0.00
35539 103053 BYPASS W/VEIN AORTOFEMORAL $0.00
35540 103054 BYPASS W/VEIN AORTOBIFEMORAL $0.00
35556 103055 BYPASS W/VEIN FEMORAL-POPLITEAL $0.00
35558 103056 BYPASS W/VEIN FEMORAL-FEMORAL $0.00
3555F 103057 PT HAD INR MEASUREMENT PERFORMED $0.00
35560 103058 BYPASS W/VEIN AORTORENAL $0.00
35563 103059 BYPASS W/VEIN ILIOILIAC $0.00
35565 103060 BYPASS W/VEIN ILIOFEMORAL $0.00
35566 103061 BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL $0.00
35570 103062 BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL $0.00
35571 103063 BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL $0.00
35572 103064 HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX $2,291.00
35583 103065 IN-SITU VEIN BYPASS FEMORAL-POPLITEAL $0.00
35585 103066 IN-SITU FEM-ANT TIBL PST TIBL/PRONEAL ART $0.00
35587 103067 IN-SITU VEIN BYP POP-TIBL PRONEAL $0.00
35600 103068 OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB $0.00
35601 103069 BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID $0.00
35606 103070 BYP OTH/THN VEIN CAROTID-SUBCLAVIAN $0.00
35612 103071 BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN $0.00
35616 103072 BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY $0.00
35621 103073 BYP OTH/THN VEIN AXILLARY-FEMORAL $0.00
35623 103074 BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL $0.00
35626 103075 BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE $0.00
35631 103076 BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL $0.00
35632 103077 BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC $0.00
35633 103078 BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC $0.00
35634 103079 BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL $0.00
35636 103080 BYP OTH/THN VEIN SPLENORENAL $0.00
35637 103081 BYP OTH/THN VEIN AORTOILIAC $0.00
35638 103082 BYP OTH/THN VEIN AORTOBI-ILIAC $0.00
35642 103083 BYP OTH/THN VEIN CAROTID-VERTEBRAL $0.00
35645 103084 BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL $0.00
35646 103085 BYP OTH/THN VEIN AORTOBIFEMORAL $0.00
35647 103086 BYP OTH/THN VEIN AORTOFEMORAL $0.00
35650 103087 BYP OTH/THN VEIN AXILLARY-AXILLARY $0.00
35654 103088 BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL $0.00
35656 103089 BYP OTH/THN VEIN FEMORAL-POPLITEAL $0.00
35661 103090 BYP OTH/THN VEIN FEMORAL-FEMORAL $0.00
35663 103091 BYP OTH/THN VEIN ILIOILIAC $0.00
35665 103092 BYP OTH/THN VEIN ILIOFEMORAL $0.00
35666 103093 BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL $0.00
35671 103094 BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART $0.00
35681 103095 BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN $0.00
35682 103096 BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS $0.00
35683 103097 BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION $0.00
35685 103098 PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT $8,826.00
35686 103099 CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO $8,826.00
35691 103100 TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART $0.00
35693 103101 TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART $0.00
35694 103102 TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART $0.00
35695 103103 TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART $0.00
35697 103104 RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART $0.00
35700 103105 ROPRTJ > 1 MO AFTER ORIGINAL OPRATION $0.00
35701 103106 EXPLORATION N/FLWD SURG NECK ARTERY $25,911.50
35702 103107 EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY $15,385.50
35703 103108 EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY $37,762.00
3570F 103109 REPORT BONE SCINTIGRAPHY W/X-RAY SAME REGION $0.00
3572F 103110 PT POTENTIAL RISK FRACTURE WEIGHT-BEARING SITE $0.00
3573F 103111 PT NOT POTENT RISK FRACTURE WEIGHT-BEARING SITE $0.00
35800 103112 EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK $21,140.00
35820 103113 EXPL PO HEMRRG THROMBOSIS/INFCTJ CH $0.00
35840 103114 EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD $21,838.00
35860 103115 EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR $11,340.00
35870 103116 RPR GRF-ENTERIC FSTL $0.00
35875 103117 THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL $18,105.00
35876 103118 THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF $20,876.50
35879 103119 REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP $17,980.50
35881 103120 REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS $11,626.50
35883 103121 REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF $11,626.50
35884 103122 REVJ FEM ANAST BPG GRN OPN W/AUTOG VN PATCH GRF $11,626.50
35901 103123 EXCISION INFECTED NECK GRAFT $0.00
35903 103124 EXCISION INFECTED GRAFT EXTREMITY $15,194.00
35905 103125 EXCISION INFECTED GRAFT THORAX $0.00
35907 103126 EXCISION INFECTED GRAFT ABDOMEN $0.00
36000 103127 INTRODUCTION NEEDLE/INTRACATHETER VEIN $1,118.00
36002 103128 INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM $1,936.00
36005 103129 NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH $3,056.00
36010 103130 INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA $3,215.00
36011 103131 SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH $4,559.00
36012 103132 SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC $4,211.50
36013 103133 INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY $3,112.50
36014 103134 SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY $6,627.00
36015 103135 SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART $7,824.50
36100 103136 INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY $742.00
36140 103137 INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY $8,439.00
36160 103138 INTRO NEEDLE/INTRACATH AORTIC TRANSLUMBAR $6,471.50
36200 103139 INTRODUCTION CATHETER AORTA $4,509.00
36215 103140 SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH $4,195.50
36216 103141 SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH $4,020.00
36217 103142 SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH $5,327.00
36218 103143 SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH $1,963.50
36221 103144 NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART $14,263.50
36222 103145 SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART $17,959.00
36223 103146 SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART $19,172.50
36224 103147 SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART $22,866.50
36225 103148 SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY $13,268.50
36226 103149 SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY $15,134.00
36227 103150 SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC $11,146.00
36228 103151 SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT $9,552.50
36245 103152 SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH $7,014.00
36246 103153 SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH $5,837.00
36247 103154 SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH $7,781.50
36248 103155 SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH $7,520.50
36251 103156 SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN $11,894.00
36252 103157 SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL $14,877.50
36253 103158 SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I $14,396.00
36254 103159 SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I $18,388.50
36260 103160 INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM $9,069.00
36261 103161 REVJ IMPLANTED INTRA-ARTERIAL INFUSION PUMP $7,344.00
36262 103162 REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP $15,307.00
36299 103163 UNLISTED PROCEDURE VASCULAR INJECTION $0.00
36400 103164 VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN $259.00
36405 103165 VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN $228.00
36406 103166 VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN $191.00
36410 103167 VNPNXR 3 YEARS/> PHYS/QHP SKILL $1,208.00
36415 103168 COLLECTION VENOUS BLOOD VENIPUNCTURE $46.50
36416 103169 COLLECTION CAPILLARY BLOOD SPECIMEN $71.50
36420 103170 VENIPUNCTURE CUTDOWN YOUNGER THAN AGE 1 YR $294.50
36425 103171 VENIPUNCTURE CUTDOWN AGE 1 YR/> $1,057.00
36430 103172 TRANSFUSION BLOOD/BLOOD COMPONENTS $3,081.00
36440 103173 PUSH TRANSFUSION BLOOD 2 YR OR YOUNGER $3,266.00
36450 103174 BLOOD EXCHANGE TRANSFUSION NEWBORN $1,805.00
36455 103175 BLOOD EXCHANGE TRANSFUSION OTHER THAN NEWBORN $3,287.50
36456 103176 PRTL EXCHANGE TRANSFUSE BLOOD/PLSM/CRYST NEWBORN $1,679.50
36460 103177 TRANSFUSION INTRAUTERINE FETAL $3,926.50
36465 103178 NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN $9,067.00
36466 103179 NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS $6,071.50
36468 103180 INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK $1,302.00
36470 103181 INJECTION SCLEROSANT SINGLE INCMPTNT VEIN $1,607.00
36471 103182 INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS $1,684.50
36473 103183 ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN $15,310.00
36474 103184 ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS $4,180.50
36475 103185 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN $14,130.50
36476 103186 ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS $6,338.00
36478 103187 ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN $10,596.00
36479 103188 ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS $6,677.50
36481 103189 PRQ PORTAL VEIN CATHETERIZATION ANY METHOD $5,254.00
36482 103190 ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN $17,427.50
36483 103191 ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN $9,506.00
36500 103192 VEN CATHJ SLCTV ORGAN BLD SAMPLING $2,468.00
36510 103193 CATHJ UMBILICAL VEIN DX/THER NB $605.00
36511 103194 THERAPEUTIC APHERESIS WHITE BLOOD CELLS $9,358.00
36512 103195 THERAPEUTIC APHERESIS RED BLOOD CELLS $5,196.00
36513 103196 THERAPEUTIC APHERESIS PLATELETS $6,720.50
36514 103197 THERAPEUTIC APHERESIS PLASMA PHERESIS $4,931.50
36516 103198 THER APHERESIS W/EXTRACORPOREAL IMMUNOADSORPTION $12,288.00
36522 103199 PHOTOPHERESIS EXTRACORPOREAL $17,351.00
36555 103200 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y $7,058.50
36556 103201 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> $6,752.00
36557 103202 INSERT TUNNELED CVC W/O SUBQ PORT/PMP AGE <5 YR $14,663.50
36558 103203 INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> $8,342.00
36560 103204 INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR $18,898.00
36561 103205 INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/> $8,817.00
36563 103206 INSJ TUNNELED CTR VAD W/SUBQ PUMP $13,911.00
36565 103207 INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP $11,875.00
36566 103208 INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT $17,240.50
36568 103209 INSERTION PICC W/O IMG GDN < 5 YR $4,108.50
36569 103210 INSERTION PICC W/O IMG GDN 5 YR/> $4,029.00
36570 103211 INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR $7,576.00
36571 103212 INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/> $10,032.50
36572 103213 INSERTION PICC W/RS&I < 5 YR $4,108.50
36573 103214 INSERTION PICC W/RS&I 5 YR/> $3,905.00
36575 103215 RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP $2,830.00
36576 103216 RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT $7,498.50
36578 103217 RPLCMT CATH CTR VAD SUBQ PORT/PMP $14,014.50
36580 103218 RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP $5,149.50
36581 103219 RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP $6,399.50
36582 103220 RPLCMT COMPL TUN CTR VAD W/SUBQ PORT $11,458.00
36583 103221 RPLCMT COMPL TUN CTR VAD W/SUBQ PMP $17,325.00
36584 103222 COMPLETE REPLACEMENT PICC RS&I $4,360.00
36585 103223 RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT $12,125.00
36589 103224 RMVL TUN CVC W/O SUBQ PORT/PMP $8,264.00
36590 103225 RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ $5,433.00
36591 103226 COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE $167.00
36592 103227 COLLECT BLOOD FROM CATHETER VENOUS NOS $149.00
36593 103228 DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH $241.00
36595 103229 MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS $10,748.50
36596 103230 MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN $5,338.50
36597 103231 RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE $4,541.50
36598 103232 CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT $785.50
36600 103233 ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX $309.00
36620 103234 ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ $341.00
36625 103235 ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN $2,474.50
36640 103236 ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN $9,069.00
36660 103237 CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY $0.00
36680 103238 PLACEMENT NEEDLE INTRAOSSEOUS INFUSION $837.50
36800 103239 INSJ CANNULA HEMO OTH PURPOSE SPX VEIN VEIN $20,855.50
36810 103240 INSJ CANNULA HEMO OTH PURPOSE SPX ARVEN XTRNL $10,419.00
36815 103241 INSJ CANNULA HEMO OTH SPX ARVEN XTRNL REVJ/CLSR $17,708.50
36818 103242 ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS $25,377.50
36819 103243 ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS $24,728.50
36820 103244 ARVEN ANAST OPN F/ARM VEIN TRPOS $21,569.00
36821 103245 ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT $22,069.50
36823 103246 INSJ CNULA ISLTD XC-CIRCJ REG CHEMOTX XTR RMVL $0.00
36825 103247 CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF $22,301.00
36830 103248 CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF $20,880.50
36831 103249 THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF $22,501.50
36832 103250 REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF $20,148.00
36833 103251 REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF $17,507.00
36835 103252 INSERTION THOMAS SHUNT SEPARATE PROCEDURE $10,419.00
36836 103253 PERQ AV FISTULA CREATION UXTR SINGLE ACCESS $77,668.00
36837 103254 PERQ AV FISTULA CREATION UXTR SEP ACCESS SITES $77,668.00
36838 103255 DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS $21,794.00
36860 103256 XTRNL CANNULA DECLTNG SPX W/O BALO CATH $4,609.50
36861 103257 XTRNL CANNULA DECLTNG SPX W/BALO CATH $25,099.50
36901 103258 INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I $6,444.00
36902 103259 INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP $24,209.50
36903 103260 INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT $51,513.00
36904 103261 PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH $28,996.50
36905 103262 PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP $27,136.00
36906 103263 PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT $40,627.00
36907 103264 TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I $13,193.00
36908 103265 STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR $24,598.50
36909 103266 DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I $19,092.50
37140 103267 VENOUS ANASTOMOSIS OPEN PORTOCAVAL $0.00
37145 103268 VENOUS ANASTOMOSIS OPEN RENOPORTAL $0.00
37160 103269 VENOUS ANASTOMOSIS OPEN CAVAL-MESENTERIC $0.00
37180 103270 VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL $0.00
37181 103271 VENOUS ANASTOMOSIS OPEN SPLENORENAL DISTAL $0.00
37182 103272 INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT $26,606.00
37183 103273 REVJ TRANSVNS INTRHPTC PORTOSYSTEMIC SHNT (TIPS) $27,094.00
37184 103274 PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST $15,493.50
37185 103275 PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ $12,796.00
37186 103276 SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL $12,597.00
37187 103277 PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN $24,188.50
37188 103278 PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX $11,626.50
37191 103279 INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I $16,144.50
37192 103280 REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I $9,069.00
37193 103281 RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I $17,481.50
37195 103282 THROMBOLYSIS CEREBRAL IV INFUSION $1,619.00
37197 103283 PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING $10,985.00
37200 103284 TRANSCATHETER BIOPSY $5,664.50
37211 103285 THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX $14,195.50
37212 103286 THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX $6,172.50
37213 103287 THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX $10,846.50
37214 103288 CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL $9,452.50
37215 103289 TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ $24,285.50
37216 103290 TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ $29,801.50
37217 103291 TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE $0.00
37218 103292 TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE $0.00
37220 103293 REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL $21,688.50
37221 103294 REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY $37,488.00
37222 103295 REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL $17,065.00
37223 103296 REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL $23,355.00
37224 103297 REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI $29,864.00
37225 103298 REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL $68,715.00
37226 103299 REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL $43,928.50
37227 103300 REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL $49,148.50
37228 103301 REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI $32,240.00
37229 103302 REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL $88,930.00
37230 103303 REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL $39,564.50
37231 103304 REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL $61,257.50
37232 103305 REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL $18,261.50
37233 103306 REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL $31,471.50
37234 103307 REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL $23,386.00
37235 103308 REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP EA VSL $14,144.00
37236 103309 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL $27,559.00
37237 103310 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL $22,394.50
37238 103311 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST $24,193.00
37239 103312 OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL $17,438.00
37241 103313 VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I $31,845.00
37242 103314 VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I $11,428.00
37243 103315 VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT $10,842.50
37244 103316 VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE $27,300.00
37246 103317 TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART $28,082.50
37247 103318 TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART $10,356.50
37248 103319 TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN $24,360.00
37249 103320 TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN $15,037.00
37252 103321 INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL $9,753.00
37253 103322 INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL $6,056.00
37500 103323 VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX $11,413.00
37501 103324 UNLISTED VASCULAR ENDOSCOPY PROCEDURE $0.00
37565 103325 LIGATION INTERNAL JUGULAR VEIN $8,826.00
3756F 103326 PT HAS PSEUDOBULBAR AFFECT/SIALORRHEA/ALS SYMP $0.00
3757F 103327 NO PSEUDOBULBAR AFFECT/SIALORRHEA/ALS SYMP $0.00
3758F 103328 PULM FUNC TESTING/PEAK COUGH EXPIRATORY FLOW $0.00
3759F 103329 PT SCRND DYSPHAGIA WT LOSS IMPAIRED NUTRITION $0.00
37600 103330 LIGATION EXTERNAL CAROTID ARTERY $8,826.00
37605 103331 LIGATION INTERNAL/COMMON CAROTID ARTERY $11,413.00
37606 103332 LIG INT/COMMON CAROTID ART W/GRADUAL OCCLUSION $8,231.50
37607 103333 LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA $15,329.50
37609 103334 LIGATION/BIOPSY TEMPORAL ARTERY $9,919.00
3760F 103335 PT W/DYSPHAG/WT LOSS/IMPAIRED NUTRITION $0.00
37615 103336 LIGATION MAJOR ARTERY NECK $8,231.50
37616 103337 LIGATION MAJOR ARTERY CHEST $0.00
37617 103338 LIGATION MAJOR ARTERY ABDOMEN $17,007.50
37618 103339 LIGATION MAJOR ARTERY EXTREMITY $9,118.00
37619 103340 LIGATION OF INFERIOR VENA CAVA $11,413.00
3761F 103341 PT WO/DYSPHAG/WT LOSS/IMPAIRED NUTRITION $0.00
3762F 103342 PATIENT IS DYSARTHRIC $0.00
3763F 103343 PATIENT IS NOT DYSARTHRIC $0.00
37650 103344 LIGATION OF FEMORAL VEIN $15,559.50
37660 103345 LIGATION OF COMMON ILIAC VEIN $0.00
37700 103346 LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ $12,625.00
37718 103347 LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN $12,476.50
37722 103348 LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW $16,008.00
37735 103349 LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS $11,413.00
3775F 103350 ADENOMA(S)/NEOPLASM DETECTED SCRNG CLNSCPY $0.00
37760 103351 LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG $12,485.50
37761 103352 LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG $15,640.50
37765 103353 STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS $15,965.50
37766 103354 STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS $18,183.00
3776F 103355 ADENOMA(S)/NEOPLASM NOT DETECTED SCRNG CLNSCPY $0.00
37780 103356 LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX $12,876.00
37785 103357 LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG $10,552.00
37788 103358 PENILE REVASCULARIZATION ARTERY W/WO VEIN GRAFT $0.00
37790 103359 PENILE VENOUS OCCLUSIVE PROCEDURE $10,698.00
37799 103360 UNLISTED PROCEDURE VASCULAR SURGERY $0.00
38100 103361 SPLENECTOMY TOTAL SEPARATE PROCEDURE $0.00
38101 103362 SPLENECTOMY PARTIAL SEPARATE PROCEDURE $0.00
38102 103363 SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX $0.00
38115 103364 RPR RPTD SPLEEN SPLENORRHAPHY W/WO PRTL SPLENECT $0.00
38120 103365 LAPAROSCOPIC SURGICAL SPLENECTOMY $47,929.00
38129 103366 UNLISTED LAPAROSCOPY PROCEDURE SPLEEN $0.00
38200 103367 INJECTION PROCEDURE SPLENOPORTOGRAPY $1,117.50
38204 103368 MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ $3,143.50
38205 103369 BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC $8,575.50
38206 103370 BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL $8,497.00
38207 103371 TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR $6,039.00
38208 103372 TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR $3,755.00
38209 103373 TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR $3,406.00
38210 103374 TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL $2,573.00
38211 103375 TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ $2,573.00
38212 103376 TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL $787.00
38213 103377 TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ $2,573.00
38214 103378 TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ $2,959.00
38215 103379 TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM $5,272.50
38220 103380 DIAGNOSTIC BONE MARROW ASPIRATIONS $7,900.00
38221 103381 DIAGNOSTIC BONE MARROW BIOPSIES $1,471.00
38222 103382 DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS $5,234.00
38230 103383 BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC $18,503.50
38232 103384 BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS $11,357.50
38240 103385 TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR $14,371.50
38241 103386 TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR $10,622.00
38242 103387 ALLOGENEIC LYMPHOCYTE INFUSIONS $5,860.50
38243 103388 TRNSPLJ HEMATOPOIETIC CELL BOOST $9,696.00
38300 103389 DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL $7,289.00
38305 103390 DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV $5,919.00
38308 103391 LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS $21,593.50
38380 103392 SUTR&/LIG THORACIC DUCT CERVICAL APPROACH $0.00
38381 103393 SUTR&/LIG THORACIC DUCT THORACIC APPROACH $0.00
38382 103394 SUTR&/LIG THORACIC DUCT ABDOMINAL APPROACH $0.00
38500 103395 BX/EXC LYMPH NODE OPEN SUPERFICIAL $6,387.50
38505 103396 BX/EXC LYMPH NODE NEEDLE SUPERFICIAL $4,629.50
38510 103397 BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE $15,157.00
38520 103398 BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD $11,468.50
38525 103399 BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE $6,016.00
38530 103400 BX/EXC LYMPH NODE OPEN INT MAMMARY NODE $12,929.50
38531 103401 OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES $17,144.50
38542 103402 DISSECTION DEEP JUGULAR NODE $15,411.00
38550 103403 EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ $7,539.50
38555 103404 EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ $7,539.50
38562 103405 LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC $22,828.00
38564 103406 LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC $0.00
38570 103407 LAPS SURG RETROPERITONEAL LYMPH NODE BX 1/MLT $23,663.00
38571 103408 LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY $17,483.50
38572 103409 LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1 $24,221.00
38573 103410 LAPS W/BI TOT PEL LMPHADEC & OMNTC LYMPH BX $30,848.50
38589 103411 UNLISTED LAPAROSCOPY PX LYMPHATIC SYSTEM $0.00
38700 103412 SUPRAHYOID LYMPHADENECTOMY $16,677.00
38720 103413 CERVICAL LYMPHADENECTOMY $14,397.00
38724 103414 CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ $22,281.50
38740 103415 AXILLARY LYMPHADENECTOMY SUPERFICIAL $9,909.50
38745 103416 AXILLARY LYMPHADENECTOMY COMPLETE $17,843.00
38746 103417 THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC $0.00
38747 103418 ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC $0.00
38760 103419 INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX $15,700.50
38765 103420 INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC $0.00
38770 103421 PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR $0.00
38780 103422 RPR TABDL LMPHADEC EXTNSV W/PEL AORTIC&RNL $0.00
38790 103423 INJECTION PROCEDURE LYMPHANGIOGRAPHY $1,644.00
38792 103424 INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE $2,032.00
38794 103425 CANNULATION THORACIC DUCT $0.00
38900 103426 INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION $3,942.50
38999 103427 UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEM $0.00
39000 103428 MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR $0.00
39010 103429 MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR $0.00
39200 103430 RESECTION OF MEDIASTINAL CYST $0.00
39220 103431 RESECTION MEDIASTINAL TUMOR $0.00
39401 103432 MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY $21,028.50
39402 103433 MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES $19,339.00
39499 103434 UNLISTED PROCEDURE MEDIASTINUM $0.00
39501 103435 REPAIR LACERATION DIAPHRAGM ANY APPROACH $0.00
39503 103436 RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ $0.00
39540 103437 RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC AQT $0.00
39541 103438 RPR DIPHRG HRNA OTH/THN NEONATAL TRAUMTC CHRNC $0.00
39545 103439 IMBRICATION DIAPHRAGM EVENTRATION $0.00
39560 103440 RESCJ DIAPHRAGM W/SIMPLE REPAIR $0.00
39561 103441 RESCJ DIAPHRAGM W/COMPLEX REPAIR $0.00
39599 103442 UNLISTED PROCEDURE DIAPHRAGM $0.00
40490 103443 BIOPSY OF LIP $1,098.00
4049F 103444 DOC ORDER GIVEN TO STOP ANTIBIO W/IN 24 HRS SURG $0.00
40500 103445 VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT $9,254.00
4050F 103446 HYPERTENSION PLAN OF CARE DOCUMENTED $0.00
40510 103447 EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR $16,526.50
4051F 103448 REFERRED FOR AN ARTERIO-VENOUS (AV) FISTULA $0.00
40520 103449 EXC LIP V-EXC W/PRIM DIR LINR CLSR $16,326.50
40525 103450 EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP $12,289.50
40527 103451 EXC LIP FULL THKNS RCNSTJ W/CROSS LIP FLAP $19,727.00
4052F 103452 HEMODIAL VIA FUNCTIONG AV FISTULA $0.00
40530 103453 RESCJ LIP > ONE-FOURTH W/O RCNSTJ $9,713.50
4053F 103454 HEMODIALYSIS VIA FUNCTIONING AVGRAFT $0.00
4054F 103455 HEMODIALYSIS VIA CATHETER $0.00
4055F 103456 PATIENT RECEIVING PERITONEAL DIALYSIS $0.00
4056F 103457 APPROPRIATE ORAL REHYD SOLUTION RECOMMENDED $0.00
4058F 103458 PAG PROVIDED TO CAREGIVER $0.00
4060F 103459 PSYCHOTHERAPY SERVICES PROVIDED $0.00
4062F 103460 PATIENT REFERRAL FOR PSYCHOTHERAPY DOCUMENTED $0.00
4063F 103461 ANTIDEPRESSANT RXTHXY CONSIDER & NOT PRESCRIBE $0.00
4064F 103462 ANTIDEPRESSANT PHARMACOTHERAPY PRESCRIBED $0.00
40650 103463 REPAIR LIP FULL THICKNESS VERMILION ONLY $3,251.00
40652 103464 REPAIR LIP FULL THICKNESS <HALF VERTICAL HEIGHT $3,472.50
40654 103465 RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX $4,315.00
4065F 103466 ANTIPSYCHOTIC PHARMACOTHERAPY PRESCRIBED $0.00
4066F 103467 ELECTROCONVULSIVE THERAPY (ECT) PROVIDED $0.00
4067F 103468 PT REFERRAL ELECTROCONVULSIVE THXPY (ECT) DOCD $0.00
4069F 103469 VENOUS THROMBOEMBOLISM (VTE) PROPHYLAXIS RCVD $0.00
40700 103470 PLSTC RPR CL LIP/NSL DFRM PRIM PRTL/COMPL UNI $20,055.50
40701 103471 PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 STG PX $27,824.50
40702 103472 PLSTC RPR CL LIP/NSL DFRM PRIM BI 1 2 STGS $11,739.50
4070F 103473 DEEP VEIN THROMB PROPHYL RECVD BY HOSP DAY 2 $0.00
40720 103474 PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL $21,254.00
4073F 103475 ORAL ANTIPLATELET THERAPY PRESCRBED AT DISCHARGE $0.00
4075F 103476 ANTICOAGULANT THERAPY PRESCRIBED AT DISCHARGE $0.00
40761 103477 PLSTC RPR CL LIP/NSL DFRM W/CROSS LIP PEDCL FLAP $11,739.50
40799 103478 UNLISTED PROCEDURE LIPS $0.00
40800 103479 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL $1,364.00
40801 103480 DRG ABSC CST HMTMA VESTIBULE MOUTH COMP $7,159.50
40804 103481 RMVL EMBEDDED FB VESTIBULE MOUTH SMPL $2,516.50
40805 103482 RMVL EMBEDDED FB VESTIBULE MOUTH COMP $7,476.50
40806 103483 INCISION LABIAL FRENUM FRENOTOMY $4,128.50
40808 103484 BIOPSY VESTIBULE MOUTH $1,643.50
40810 103485 EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR $6,940.00
40812 103486 EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR $6,675.50
40814 103487 EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR $10,944.00
40816 103488 EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC $14,206.50
40818 103489 EXC MUCOSA VESTIBULE MOUTH AS DON GRF $19,850.00
40819 103490 EXC FRENUM LABIAL/BUCCAL $6,601.50
40820 103491 DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS $13,506.50
40830 103492 CLOSURE LACERATION VESTIBULE MOUTH 2.5 CM/< $1,071.00
40831 103493 CLOSURE LACERATION VESTIBULE MOUTH > 2.5 CM/CPL $2,604.50
40840 103494 VESTIBULOPLASTY ANTERIOR $15,633.50
40842 103495 VESTIBULOPLASTY POSTERIOR UNILATERAL $20,832.50
40843 103496 VESTIBULOPLASTY POSTERIOR BILATERAL $7,476.50
40844 103497 VESTIBULOPLASTY ENTIRE ARCH $11,739.50
40845 103498 VESTIBULOPLASTY CPLX W/RIDGE XTN MUSC RPSG $11,739.50
40899 103499 UNLISTED PROCEDURE VESTIBULE MOUTH $0.00
41000 103500 INTRAORAL I&D TONGUE/FLOOR LINGUAL $2,846.50
41005 103501 INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC $1,590.50
41006 103502 INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD $7,476.50
41007 103503 INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE $7,476.50
41008 103504 INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE $9,003.50
41009 103505 INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE $5,220.00
4100F 103506 BISPHOS THXPY VENOUS ORDERED OR RECEIVED $0.00
41010 103507 INCISION LINGUAL FRENUM FRENOTOMY $4,981.00
41015 103508 XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL $1,590.50
41016 103509 XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT $7,476.50
41017 103510 XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB $9,750.50
41018 103511 XTRORAL I&D FLOOR MASTICATOR SPACE $2,846.50
41019 103512 PLACEMENT NEEDLE HEAD/NECK RADIOELEMENT APPLICAT $14,975.00
41100 103513 BIOPSY TONGUE ANTERIOR TWO-THIRDS $3,028.00
41105 103514 BIOPSY TONGUE POSTERIOR ONE-THIRD $5,511.50
41108 103515 BIOPSY FLOOR MOUTH $3,356.50
4110F 103516 LIMA GRAFT USED IN 1ST ISOLATED CABG PXD $0.00
41110 103517 EXCISION LESION TONGUE W/O CLOSURE $7,591.50
41112 103518 EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS $15,071.50
41113 103519 EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD $17,552.50
41114 103520 EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP $11,697.50
41115 103521 EXCISION LINGUAL FRENUM FRENECTOMY $5,651.00
41116 103522 EXCISION LESION FLOOR MOUTH $8,991.50
41120 103523 GLOSSECTOMY <ONE-HALF TONGUE $13,735.00
41130 103524 GLOSSECTOMY HEMIGLOSSECTOMY $28,074.00
41135 103525 GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ $51,964.00
41140 103526 GLSSC COMPL/TOT W/WOTRACHS W/O RAD NECK DSJ $0.00
41145 103527 GLSSC COMPL/TOT W/WO TRACHS W/UNI RAD NECK DSJ $0.00
41150 103528 GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ $0.00
41153 103529 GLSSC COMPOSIT RESCJ FLOOR SUPRAHYOID NCK DSJ $0.00
41155 103530 GLSSC COMPOSIT RESCJ FLR MNDBLR RESCJ & RAD NECK $0.00
41250 103531 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG $1,025.00
41251 103532 RPR LAC 2.5 CM/< PST ONE-THIRD TONGUE $2,782.00
41252 103533 RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX $2,437.00
4130F 103534 ACUTE OTITIS EXTERNA TOPICAL PREPS PRESCRIBED $0.00
4131F 103535 SYSTEMIC ANTIMICROBIAL TX PRESCRIBED $0.00
4132F 103536 SYSTEMIC ANTIMICROBIAL TX NOT PRESCRIBED $0.00
4133F 103537 ANTIHISTAMINE/DECONGESTANT PRESCRIBED $0.00
4134F 103538 ANTIHISTAMINE/DECONGESTANT NOT PRESCRIBED $0.00
4135F 103539 SYSTEMIC CORTICOSTEROIDS PRESCRIBED $0.00
4136F 103540 SYSTEMIC CORTICOSTEROIDS NOT PRESCRIBED $0.00
4140F 103541 INHALED CORTICOSTEROIDS PRESCRIBED $0.00
4142F 103542 CORTICOSTEROID SPARING THERAPY PRESCRIBED $0.00
4144F 103543 ALTERNATIVE LONG-TERM CONTROL MEDICATION RXD $0.00
4145F 103544 2+ ANTI-HYPERTENSIVE AGENTS RXD OR TAKEN $0.00
4148F 103545 HEPATITIS A VACCINE ADMIN OR PREVIOSLY RECVD $0.00
4149F 103546 HEPATITIS B VACCCINE ADMIN OR PREVIOSLY RECVD $0.00
4150F 103547 CURRENT HEPATITIS C ANTIVIRAL TREATMENT $0.00
41510 103548 SUTURE TONGUE LIP MICROGNATHIA $5,329.00
41512 103549 TONGUE BASE SUSPENSION PERMANENT SUTURE TQ $7,476.50
4151F 103550 NO CURRENT HEPATITIS C ANTIVIRAL TREATMENT $0.00
41520 103551 FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY $7,476.50
41530 103552 SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION $12,740.00
41599 103553 UNLISTED PROCEDURE TONGUE FLOOR MOUTH $0.00
41800 103554 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS $796.50
41805 103555 RMVL EMBEDDED FB FROM DENTALVLR STRUXS SOFT TISS $7,476.50
41806 103556 RMVL EMBEDDED FB FROM DENTOALVEOLAR STRUXS BONE $5,329.00
4180F 103557 ADJVNT CHEMO RFRRD RXD/RCVD STAGE III COLON CA $0.00
4181F 103558 CONFORMAL RADIATION THERAPY RECEIVED $0.00
41820 103559 GINGIVECTOMY EXC GINGIVA EACH QUADRANT $6,046.00
41821 103560 OPRCULECTOMY EXC PRICORONAL TISSUE $2,846.50
41822 103561 EXC FIBROUS TUBEROSITIES DENTOALVEOLAR STRUXS $5,329.00
41823 103562 EXC OSS TUBEROSITIES DENTOALVEOLAR STRUXS $11,739.50
41825 103563 EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR $7,762.00
41826 103564 EXC LESION/TUMOR DENTOALVEOLAR STRUX W/SMPL RPR $9,839.50
41827 103565 EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR $22,030.00
41828 103566 EXC HYPRPLSTC ALVEOLAR MUCOSA EA QUADRANT SPEC $13,283.50
4182F 103567 CONFORMAL RADIATION THERAPY NOT RECEIVED $0.00
41830 103568 ALVEOLECTOMY W/CURTG OSTEITIS/SEQUESTRECTOMY $9,679.50
41850 103569 DESTRUCTION LESION DENTOALVEOLAR STRUCTURES $15,867.50
4185F 103570 NONSTOP 12MON THXPY W/PPI OR H2 H2RA RCVD $0.00
4186F 103571 NO CONTIN 12MON THXPY W/PPI OR H2 H2RA RCVD $0.00
41870 103572 PERIODONTAL MUCOSAL GRAFTING $11,739.50
41872 103573 GINGIVOPLASTY EACH QUADRANT SPECIFY $4,700.00
41874 103574 ALVEOLOPLASTY EACH QUADRANT SPECIFY $4,801.50
41899 103575 UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES $0.00
42000 103576 DRAINAGE ABSCESS PALATE UVULA $1,598.00
4200F 103577 EXTRNL BM RADIOTHXPY TO PROST W/WO NODAL IRRAD $0.00
4201F 103578 EXTRNL BM RADIOTHXPY W/WO NODAL IRRAD AS ADJV $0.00
42100 103579 BIOPSY PALATE UVULA $3,575.50
42104 103580 EXC LESION PALATE UVULA W/O CLOSURE $7,397.00
42106 103581 EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE $9,421.50
42107 103582 EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE $12,457.00
4210F 103583 ACE/ARB MEDICATION THERAPY 6 MONTHS/> $0.00
42120 103584 RESCJ PALATE/EXTENSIVE RESCJ LESION $11,545.00
42140 103585 UVULECTOMY EXCISION UVULA $8,497.50
42145 103586 PALATOPHARYNGOPLASTY $10,855.00
42160 103587 DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM $13,093.00
42180 103588 REPAIR LACERATION PALATE <2 CM $3,243.50
42182 103589 REPAIR LACERATION PALATE >2 CM/COMPLEX $7,476.50
42200 103590 PALATOP CL PALATE SOFT&/HARD PALATE ONLY $19,727.00
42205 103591 PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE $11,739.50
4220F 103592 DIGOXIN MEDICATION THERAPY 6 MONTHS/> $0.00
42210 103593 PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE $21,545.50
42215 103594 PALATOPLASTY CLEFT PALATE MAJOR REVJ $23,656.00
4221F 103595 DIURETIC MEDICATION THERAPY 6 MOS/> $0.00
42220 103596 PALATOPLASTY CLEFT PALATE SEC LNGTH PX $21,978.50
42225 103597 PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP $19,785.50
42226 103598 LENGTHENING PALATE & PHARYNGEAL FLAP $24,450.50
42227 103599 LENGTHENING PALATE W/ISLAND FLAP $11,739.50
42235 103600 REPAIR ANTERIOR PALATE W/VOMER FLAP $13,935.50
42260 103601 REPAIR NASOLABIAL FISTULA $14,662.00
42280 103602 MAXILLARY IMPRESJ PALATAL PROSTHESIS $1,590.50
42281 103603 INSJ PIN-RETAINED PALATAL PROSTHESIS $5,329.00
42299 103604 UNLISTED PROCEDURE PALATE UVULA $0.00
42300 103605 DRAINAGE ABSCESS PAROTID SIMPLE $4,519.00
42305 103606 DRAINAGE ABSCESS PAROTID COMPLICATED $7,476.50
4230F 103607 ANTICONVUL MED THERAPY 6 MOS/> $0.00
42310 103608 DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL $6,764.50
42320 103609 DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL $1,590.50
42330 103610 SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL $16,788.00
42335 103611 SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL $11,687.00
42340 103612 SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL $19,800.00
42400 103613 BIOPSY SALIVARY GLAND NEEDLE $2,664.50
42405 103614 BIOPSY SALIVARY GLAND INCISIONAL $10,808.50
42408 103615 EXC SUBLINGUAL SALIVARY CYST RANULA $14,512.00
42409 103616 MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA $14,596.00
4240F 103617 INSTR THER XRCS-DR FLLWUP PT EPSD BACK PN >12 WK $0.00
42410 103618 EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ $21,064.50
42415 103619 EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR $19,385.50
42420 103620 EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR $28,980.00
42425 103621 EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL $24,467.00
42426 103622 EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ $0.00
42440 103623 EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND $19,435.00
42450 103624 EXISION OF SUBLINGUAL GLAND $14,074.50
4245F 103625 PT TLK 1ST VST TO KEEP/RESUME NORMAL ACTIVITIES $0.00
4248F 103626 COUNSEL INIT BACK PAIN AGNST BED REST 4 DAYS/> $0.00
42500 103627 PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM $9,407.00
42505 103628 PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP $13,305.00
42507 103629 PAROTID DUCT DIVERSION BILATERAL WILKE PX $11,739.50
42509 103630 PAROTID DUCT DVRJ BI W/EXC BOTH SUBMNDBLR GLANDS $11,739.50
4250F 103631 ACTV WRMNG INTRAOP FOR NORMOTHERMIA $0.00
42510 103632 PAROTID DUCT DVRJ BILATERAL WITH LIG BOTH DUCTS $11,739.50
42550 103633 INJECTION PROCEDURE SIALOGRAPHY $1,340.00
4255F 103634 DURATION GEN NEUR ANESTH 60 MINS/> DOC RECORD $0.00
4256F 103635 DURATION GEN NEUR ANESTH <60 MIN DOCD RECORD $0.00
42600 103636 CLOSURE SALIVARY FISTULA $5,329.00
4260F 103637 WOUND SURFACE CULTURE TECHNIQUE USED $0.00
4261F 103638 TECH OTHER THAN SURFACE CULTURE WOUND EXUD USED $0.00
42650 103639 DILATION SALIVARY DUCT $8,180.50
4265F 103640 USE OF WET TO DRY DRESSINGS PRESCRIBED RECMD $0.00
42660 103641 DILAT&CATHJ SALIVARY DUCT W/WO INJECTION $11,348.00
42665 103642 LIGATION SALIVARY DUCT INTRAORAL $11,739.50
42699 103643 UNLISTED PX SALIVARY GLANDS/DUCTS $0.00
42700 103644 I&D ABSCESS PERITONSILLAR $2,060.00
42720 103645 I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL $9,415.00
42725 103646 I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR $11,739.50
4274F 103647 FLU IMMUNO ADMIND/PREVIOUSLY RCVD $0.00
4276F 103648 POTENT ANTIRETROVIRAL THERAPY PRESCRIBED $0.00
4279F 103649 PNEUMOCYSTIS JIROVECI PNEUMONIA PROPHYLAXIS RXD $0.00
42800 103650 BIOPSY OROPHARYNX $4,655.50
42804 103651 BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE $11,818.50
42806 103652 BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION $9,216.00
42808 103653 EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD $9,145.00
42809 103654 REMOVAL FOREIGN BODY PHARYNX $1,152.50
4280F 103655 PNEUMOCYS JIROVECI PNEUMO PRPHYLXS PRSCRBD 3 MON $0.00
42810 103656 EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS $19,613.50
42815 103657 EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX $16,164.50
42820 103658 TONSILLECTOMY & ADENOIDECTOMY <AGE 12 $10,658.50
42821 103659 TONSILLECTOMY & ADENOIDECTOMY AGE 12/> $9,512.00
42825 103660 TONSILLECTOMY PRIMARY/SECONDARY <AGE 12 $11,739.50
42826 103661 TONSILLECTOMY PRIMARY/SECONDARY AGE 12/> $5,567.00
42830 103662 ADENOIDECTOMY PRIMARY <AGE 12 $8,284.50
42831 103663 ADENOIDECTOMY PRIMARY AGE 12/> $6,836.50
42835 103664 ADENOIDECTOMY SECONDARY<AGE 12 $7,476.50
42836 103665 ADENOIDECTOMY SECONDARY AGE 12/> $7,476.50
42842 103666 RADICAL RESECTION TONSIL W/O CLOSURE $27,431.50
42844 103667 RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP $23,272.50
42845 103668 RADICAL RESCJ TONSIL CLOSURE W/OTHER FLAP $0.00
42860 103669 EXCISION TONSIL TAGS $11,739.50
42870 103670 EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX $18,131.00
42890 103671 LIMITED PHARYNGECTOMY $14,822.00
42892 103672 RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR $11,739.50
42894 103673 RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS $0.00
42900 103674 SUTURE PHARYNX WOUND/INJURY $7,476.50
4290F 103675 PATIENT SCREENED FOR INJECTION DRUG USE $0.00
4293F 103676 PT SCRND HGH-RSK SEXUAL BEHAVIOR $0.00
42950 103677 PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX $13,790.50
42953 103678 PHARYNGOESOPHAGEAL REPAIR $0.00
42955 103679 PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING $7,476.50
42960 103680 CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE $10,536.00
42961 103681 CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ $0.00
42962 103682 CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ $13,594.50
42970 103683 CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS $1,870.00
42971 103684 CTRL NASOPHARYNGEAL HEMRRG COMP REQ HOSPIZATION $0.00
42972 103685 CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ $5,329.00
42975 103686 DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX $0.00
42999 103687 UNLISTED PROCEDURE PHARYNX ADENOIDS/TONSILS $0.00
43020 103688 ESOPHAGOTOMY CERVICAL APPR W/RMVL FB $2,846.50
43030 103689 CRICOPHARYNGEAL MYOTOMY $14,155.00
43045 103690 ESOPHAGOTOMY THORACIC APPR W/RMVL FB $0.00
4305F 103691 PT EDUC FOOT CARE & DAILY INSPCTN FEET RCVD $0.00
4306F 103692 PT COUNSEL PSYCHOSOC&PHARM TX OPIOID ADDICTION $0.00
43100 103693 EXC LESION ESOPHOGUS W/PRIM RPR CERVICAL APPR $0.00
43101 103694 EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR $0.00
43107 103695 TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY $0.00
43108 103696 TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ $0.00
43112 103697 TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY $0.00
43113 103698 TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ $0.00
43116 103699 PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF $0.00
43117 103700 PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY $0.00
43118 103701 PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ $0.00
43121 103702 PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY $0.00
43122 103703 PRTL ESOPHG THORACOABD W/WO PROXGASTREC/PYLOROPL $0.00
43123 103704 PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ $0.00
43124 103705 TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY $0.00
43130 103706 DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR $33,258.00
43135 103707 DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR $0.00
43180 103708 ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH $15,048.50
43191 103709 ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH $3,790.50
43192 103710 ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL $9,665.50
43193 103711 ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY $10,199.00
43194 103712 ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY $10,964.50
43195 103713 ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION $10,672.00
43196 103714 ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION $9,796.00
43197 103715 ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC $3,896.50
43198 103716 ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY $7,384.00
43200 103717 ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC $6,760.50
43201 103718 ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ $6,493.50
43202 103719 ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY $4,800.00
43204 103720 ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES $3,367.50
43205 103721 ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES $5,726.00
43206 103722 ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY $4,539.00
4320F 103723 PT COUNSEL PSYCHSOC & PHARM TX ALCOHOL DEPEND $0.00
43210 103724 EGD PARTIAL/COMPL ESOPHAGOGASTRIC FUNDOPLASTY $25,563.00
43211 103725 ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN $9,790.50
43212 103726 ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT $12,666.00
43213 103727 ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER $10,079.00
43214 103728 ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM $8,776.00
43215 103729 ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY $6,121.00
43216 103730 ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS $7,742.00
43217 103731 ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE $5,667.50
43220 103732 ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM $5,735.00
43226 103733 ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION $8,925.50
43227 103734 ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL $5,529.00
43229 103735 ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION $8,122.00
4322F 103736 CRGVR PROVIDED W/ED REFERRED ADDL RESOURCES $0.00
43231 103737 ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM $6,290.00
43232 103738 ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX $6,963.50
43233 103739 EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER $5,025.00
43235 103740 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC $3,916.50
43236 103741 ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION $5,353.00
43237 103742 ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS $5,544.50
43238 103743 EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS $6,748.00
43239 103744 EGD TRANSORAL BIOPSY SINGLE/MULTIPLE $4,482.50
43240 103745 EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST $6,976.00
43241 103746 EGD INTRALUMINAL TUBE/CATHETER INSERTION $5,026.50
43242 103747 EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY $9,724.50
43243 103748 EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES $4,238.00
43244 103749 EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES $4,243.00
43245 103750 EGD DILATION GASTRIC/DUODENAL STRICTURE $4,247.00
43246 103751 EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE $6,232.00
43247 103752 EGD FLEXIBLE FOREIGN BODY REMOVAL $4,865.00
43248 103753 EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS $4,067.50
43249 103754 EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM $4,057.50
43250 103755 EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS $4,373.50
43251 103756 EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH $4,494.00
43252 103757 EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY $4,747.00
43253 103758 EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER $6,740.50
43254 103759 EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION $7,342.00
43255 103760 EGD TRANSORAL CONTROL BLEEDING ANY METHOD $4,261.00
43257 103761 EGD DELIVER THERMAL ENERGY SPHNCTR/CARDIA GERD $8,466.00
43259 103762 EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM $7,906.00
43260 103763 ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING $9,995.50
43261 103764 ERCP W/BIOPSY SINGLE/MULTIPLE $9,666.50
43262 103765 ERCP W/SPHINCTEROTOMY/PAPILLOTOMY $9,360.50
43263 103766 ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI $10,487.00
43264 103767 ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT $8,398.00
43265 103768 ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD $10,314.00
43266 103769 EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION $6,458.00
43270 103770 EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE $5,188.50
43273 103771 ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC $6,953.00
43274 103772 ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT $13,052.00
43275 103773 ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT $10,046.50
43276 103774 ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE $12,650.00
43277 103775 ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA $9,097.00
43278 103776 ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE $8,122.00
43279 103777 LAPS ESOPHAGOMYOTOMY W/FUNDOPLASTY IF PERFORMED $46,493.50
43280 103778 LAPS SURG ESOPG/GSTR FUNDOPLASTY $57,537.00
43281 103779 LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH $42,958.00
43282 103780 LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH $27,326.50
43283 103781 LAPS ESOPHAGEAL LENGTHENING ADDL $29,632.50
43284 103782 LAPS ESOPHGL SPHNCTR AGMNTJ PLMT DEV CRRPL $38,905.00
43285 103783 REMOVAL ESOPHAGEAL SPHINCTER AGMNTJ DEVICE $26,119.00
43286 103784 ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ $0.00
43287 103785 ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ $0.00
43288 103786 ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ $0.00
43289 103787 UNLISTED LAPAROSCOPY PROCEDURE ESOPHAGUS $0.00
43290 103788 EGD FLX TRNSORL W/DPLMNT NTRGSTR BARIATRIC BALO $11,665.50
43291 103789 EGD FLX TRNSORL W/RMVL NTRGSTR BARIATRIC BALO $6,829.00
43300 103790 ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL $0.00
43305 103791 ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL $0.00
4330F 103792 EPILEPSY SPECIFIC SAFETY COUNSELING TO PATIENT $0.00
43310 103793 ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL $0.00
43312 103794 ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL $0.00
43313 103795 ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL $0.00
43314 103796 ESPHGP CGEN DFCT THRC APPR W/RPR FSTL $0.00
43320 103797 EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC AP $0.00
43325 103798 ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH $0.00
43327 103799 ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY $0.00
43328 103800 ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY $0.00
43330 103801 ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH $0.00
43331 103802 ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH $0.00
43332 103803 RPR PARAESOPH HIATAL HERNIA W/LAPT W/O MESH $0.00
43333 103804 LAPT RPR PARAESOPH HIATAL HERNIA W/MESH $0.00
43334 103805 RPR PARAESOPH HIATAL HERNIA W/THORCOM W/O MESH $0.00
43335 103806 RPR PARAESOPH HIATAL HERNIA W/THORCOM W/MESH $0.00
43336 103807 RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH $0.00
43337 103808 RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/MESH $0.00
43338 103809 ESOPHAGUS LENGTHENING $0.00
43340 103810 ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR $0.00
43341 103811 ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR $0.00
43351 103812 ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR $0.00
43352 103813 ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR $0.00
43360 103814 GI RCNSTJ PREV ESPHG/EXCLUSION W/STOMACH $0.00
43361 103815 GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT $0.00
43400 103816 LIGATION DIRECT ESOPHAGEAL VARICES $0.00
43405 103817 LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J $0.00
4340F 103818 COUNSEL WOMEN CHILDBEARING POTENTIAL W/EPILEPSY $0.00
43410 103819 SUTR ESOPHGL WND/INJ CRV APPR $0.00
43415 103820 SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR $0.00
43420 103821 CLSR ESOPHAGOSTOMY/FSTL CRV APPR $11,452.50
43425 103822 CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR $0.00
43450 103823 DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS $3,073.00
43453 103824 DILATION ESOPHAGUS GUIDE WIRE $5,338.00
43460 103825 ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE $0.00
43496 103826 FREE JEJUNUM TRSF W/MICROVASC ANASTOMOSIS $0.00
43497 103827 TRANSORAL LOWER ESOPHAGEAL MYOTOMY $9,919.00
43499 103828 UNLISTED PROCEDURE ESOPHAGUS $0.00
43500 103829 GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL $0.00
43501 103830 GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER $0.00
43502 103831 GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC $0.00
43510 103832 GSTRT W/ESOPHGL DILAT&INSJ PRM INTRAL TUBE $3,367.50
43520 103833 PYLOROMYOTOMY CUTTING PYLORIC MUSC $18,296.50
43605 103834 BIOPSY STOMACH LAPAROTOMY $0.00
43610 103835 EXC LOCAL ULCER/BENIGN TUMOR STOMACH $0.00
43611 103836 EXC LOCAL MALIGNANT TUMOR STOMACH $0.00
43620 103837 GSTRCT TOT W/ESOPHAGOENTEROSTOMY $0.00
43621 103838 GSTRCT TOT W/ROUX-EN-Y RCNSTJ $0.00
43622 103839 GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE $0.00
43631 103840 GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY $0.00
43632 103841 GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY $0.00
43633 103842 GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ $0.00
43634 103843 GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH $0.00
43635 103844 VAGOTOMY PFRMD W/PRTL DSTL GSTRCT $0.00
43640 103845 VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV $0.00
43641 103846 VGTMY W/PYLOROPLASTY W/WO GASTROST PARIETAL CELL $0.00
43644 103847 LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM $30,636.00
43645 103848 LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ $0.00
43647 103849 LAPS IMPLTJ/RPLCMT GASTRIC NSTIM ELTRD ANTRUM $19,170.50
43648 103850 LAPS REVISION/RMVL GASTRIC NSTIM ELTRD ANTRUM $20,742.00
43651 103851 LAPS SURG TRNSXJ VAGUS NRV TRUNCAL $16,419.00
43652 103852 LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV $16,419.00
43653 103853 LAPS SURG GASTROSTOMY W/O CONSTJ GSTR TUBE SPX $15,160.50
43659 103854 UNLISTED LAPAROSCOPY PROCEDURE STOMACH $0.00
43752 103855 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE $950.00
43753 103856 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE $627.00
43754 103857 GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN $980.00
43755 103858 GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC $626.00
43756 103859 DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN $940.00
43757 103860 DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN $6,515.50
43761 103861 REPOS NASO/ORO GASTRIC FEEDING TUBE THRU DUO $2,315.00
43762 103862 PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC $854.00
43763 103863 PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC $1,391.00
43770 103864 LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE $30,611.50
43771 103865 LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE $20,016.50
43772 103866 LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE $19,034.50
43773 103867 LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE $35,091.00
43774 103868 LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT $21,036.50
43775 103869 LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY $35,436.50
43800 103870 PYLOROPLASTY $0.00
43810 103871 GASTRODUODENOSTOMY $0.00
43820 103872 GASTROJEJUNOSTOMY W/O VAGOTOMY $0.00
43825 103873 GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE $0.00
43830 103874 GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX $16,739.00
43831 103875 GASTROSTOMY OPN NEONATAL FEEDING $3,367.50
43832 103876 GASTROSTOMY OPN W/CONSTJ GSTR TUBE $0.00
43840 103877 GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ $22,235.00
43842 103878 GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY $5,405.00
43843 103879 GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP $0.00
43845 103880 GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM $0.00
43846 103881 GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< $0.00
43847 103882 GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ $0.00
43848 103883 REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE $0.00
43860 103884 REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY $0.00
43865 103885 REVJ GSTR/JJ ANAST W/RCNSTJ W/VGTMY $0.00
43870 103886 CLOSURE GASTROSTOMY SURG $18,241.00
43880 103887 CLOSURE GASTROCOLIC FISTULA $0.00
43881 103888 IMPLTJ/RPLCMT GASTRIC NSTIM ELTRDE ANTRUM OPEN $0.00
43882 103889 REVISION/RMVL GASTRIC NSTIM ELTRDE ANTRUM OPEN $0.00
43886 103890 GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY $13,339.00
43887 103891 GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY $5,204.00
43888 103892 GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT $14,039.00
43999 103893 UNLISTED PROCEDURE STOMACH $0.00
44005 103894 ENTEROLSS FRING INTSTINAL ADHESION SPX $29,101.50
44010 103895 DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL $0.00
44015 103896 TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD $0.00
44020 103897 ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL $0.00
44021 103898 ENTEROTOMY SM INT OTH/THN DUO DCMPRN $0.00
44025 103899 COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL $0.00
44050 103900 RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT $19,875.00
44055 103901 CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS $0.00
44100 103902 BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS $4,539.00
44110 103903 EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM $0.00
44111 103904 EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE $0.00
44120 103905 ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST $13,965.00
44121 103906 ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA $0.00
44125 103907 ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY $0.00
44126 103908 ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING $0.00
44127 103909 ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING $0.00
44128 103910 ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS $0.00
44130 103911 ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX $0.00
44132 103912 DONOR ENTERECTOMY OPEN CADAVER DONOR $0.00
44133 103913 DONOR ENTERECTOMY OPEN LIVING DONOR $0.00
44135 103914 INTESTINAL ALLOTRANSPLANTATION CADAVER DONOR $0.00
44136 103915 INTESTINAL ALLOTRANSPLANTATION LIVING DONOR $0.00
44137 103916 RMVL TRNSPLED INTESTINAL ALLOGRAFT COMPL $0.00
44139 103917 MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT $0.00
44140 103918 COLECTOMY PARTIAL W/ANASTOMOSIS $30,232.00
44141 103919 COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY $0.00
44143 103920 COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT $0.00
44144 103921 COLECTOMY PRTL W/COLOST/ILEOST & MUCOFISTULA $0.00
44145 103922 COLECTOMY PRTL W/COLOPROCTOSTOMY $0.00
44146 103923 COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY $0.00
44147 103924 COLECTOMY PRTL ABDOMINAL & TRANSANAL APPROACH $0.00
44150 103925 COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS $0.00
44151 103926 COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST $0.00
44155 103927 COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY $0.00
44156 103928 COLECTOMY TOT ABDL W/PROCTECTOMY W/CONTNT ILEOST $0.00
44157 103929 COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST $0.00
44158 103930 COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR $0.00
44160 103931 COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS $0.00
44180 103932 LAPAROSCOPY ENTEROLYSIS SEPARATE PROCEDURE $43,338.00
44186 103933 LAPAROSCOPY SURGICAL JEJUNOSTOMY $17,706.50
44187 103934 LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE $0.00
44188 103935 LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY $26,320.50
44202 103936 LAPS ENTERECT RESCJ 1 SMALL INTEST RESCJ & ANA $18,254.50
44203 103937 LAPAROSCOPY SMALL INTESTINE RESCJ & ANASTOMOSIS $0.00
44204 103938 LAPAROSCOPY COLECTOMY PARTIAL W/ANASTOMOSIS $34,373.50
44205 103939 LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM $37,218.00
44206 103940 LAPS COLECTOMY PRTL W/END CLST & CLSR DSTL SGM $0.00
44207 103941 LAPS COLECTOMY PRTL W/COLOPXTSTMY LW ANAST $0.00
44208 103942 LAPS COLECTMY PRTL W/COLOPXTSTMY LW ANAST W/CLST $0.00
44210 103943 LAPS COLECTOMY TOT W/O PRCTECT W/ILEOST/ILEOPXTS $0.00
44211 103944 LAPS COLCT TTL ABD W/PRCTECT ILEOANAL ANASTOMSIS $0.00
44212 103945 LAPS COLECTOMY ABDL W/PROCTECTOMY W/ILEOSTOMY $0.00
44213 103946 LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLECTOMY $43,818.50
44227 103947 LAPS CLSR NTRSTM LG/SM INT W/RESCJ & ANASTOMOSIS $0.00
44238 103948 UNLISTED LAPAROSCOPY PX INTESTINE XCP RECTUM $0.00
44300 103949 PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN $13,849.00
44310 103950 ILEOSTOMY/JEJUNOSTOMY NON-TUBE $0.00
44312 103951 REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX $13,643.50
44314 103952 REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX $18,514.00
44316 103953 CONTINENT ILEOSTOMY KOCK PROCEDURE SPX $0.00
44320 103954 COLOSTOMY/SKIN LEVEL CECOSTOMY $0.00
44322 103955 COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX $0.00
44340 103956 REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX $22,838.50
44345 103957 REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX $17,169.00
44346 103958 REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX $34,828.00
44360 103959 ENDOSCOPY UPPER SMALL INTESTINE $5,340.00
44361 103960 ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY $5,318.00
44363 103961 ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY $8,768.50
44364 103962 ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE $6,725.50
44365 103963 ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY $5,762.00
44366 103964 ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING $6,686.50
44369 103965 ENTEROSCOPY > 2ND PRTN ABLTJ LESION $6,616.50
44370 103966 ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT $8,447.50
44372 103967 ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE $6,555.50
44373 103968 ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE $5,542.50
44376 103969 ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX $5,468.50
44377 103970 ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE $5,931.00
44378 103971 ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING $7,084.50
44379 103972 ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT $8,447.50
44380 103973 ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD $4,029.50
44381 103974 ILEOSCOPY STOMA W/BALLOON DILATION $8,309.00
44382 103975 ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE $4,559.50
44384 103976 ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT $8,654.00
44385 103977 NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX $3,674.50
44386 103978 NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE $3,994.50
44388 103979 COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX $4,611.50
44389 103980 COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE $4,996.00
44390 103981 COLONOSCOPY STOMA W/RMVL FOREIGN BODY $3,641.00
44391 103982 COLONOSCOPY STOMA CONTROL BLEEDING $5,423.50
44392 103983 COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS $4,978.50
44394 103984 COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE $4,897.00
44401 103985 COLONOSCOPY STOMA ABLATION LESION $4,022.50
44402 103986 COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT $12,717.50
44403 103987 COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ $7,629.50
44404 103988 COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION $4,022.50
44405 103989 COLONOSCOPY STOMA W/BALLOON DILATION $7,451.00
44406 103990 COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND EXAM $4,022.50
44407 103991 COLONOSCOPY STOMA W/US GID NDL ASPIR/BX $4,022.50
44408 103992 COLONOSCOPY THROUGH STOMA WITH DECOMPRESSION $4,022.50
44500 103993 INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE $2,536.00
4450F 103994 SELF-CARE EDUCATION PROVIDED TO PATIENT $0.00
44602 103995 ENTERORRHAPHY SINGLE PERFORATION $15,225.00
44603 103996 ENTERORRHAPHY MULTIPLE PERFORATIONS $0.00
44604 103997 SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY $21,754.50
44605 103998 SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY $0.00
44615 103999 INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ $0.00
44620 104000 CLOSURE ENTEROSTOMY LG/SMALL INTESTINE $27,579.00
44625 104001 CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT $20,050.00
44626 104002 CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS $0.00
44640 104003 CLOSURE INTESTINAL CUTANEOUS FISTULA $0.00
44650 104004 CLSR ENTEROENTERIC/ENTEROCOLIC FSTL $0.00
44660 104005 CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ $0.00
44661 104006 CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ $0.00
44680 104007 INTESTINAL PLICATION SEPARATE PROCEDURE $0.00
44700 104008 EXCLUSION SM INT FROM PELVIS MESH/PROSTH/TISS $0.00
44701 104009 INTRAOPERATIVE COLONIC LAVAGE $1,253.00
44705 104010 PREPARE FECAL MICROBIOTA FOR INSTILLATION $4,832.50
44715 104011 BKBENCH PREP CADAVER/LIVING DONOR INTESTINE $0.00
44720 104012 BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA $0.00
44721 104013 BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA $0.00
44799 104014 UNLISTED PROCEDURE SMALL INTESTINE $0.00
44800 104015 EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT $0.00
4480F 104016 PT RCVNG ACE/ARB BETA BLOCKER TX 3 MONS/LONGER $0.00
4481F 104017 PT RCVNG ACE/ARB AND BETA BLOCKER < 3 MONTHS $0.00
44820 104018 EXCISION LESION MESENTERY SEPARATE PROCEDURE $0.00
44850 104019 SUTURE MESENTERY SEPARATE PROCEDURE $0.00
44899 104020 UNLISTED PX MECKEL'S DIVERTICULUM & MESENTERY $0.00
44900 104021 INCISION AND DRAINAGE APPENDICEAL ABSCESS OPEN $0.00
44950 104022 APPENDECTOMY $22,295.50
44955 104023 APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX $13,122.50
44960 104024 APPENDEC RPTD APPENDIX ABSC/PRITONITIS $19,708.50
44970 104025 LAPAROSCOPIC APPENDECTOMY $22,797.00
44979 104026 UNLISTED LAPAROSCOPY PROCEDURE APPENDIX $0.00
45000 104027 TRANSRECTAL DRAINAGE OF PELVIC ABSCESS $7,569.00
45005 104028 I&D SUBMUCOSAL ABSCESS RECTUM $10,392.00
4500F 104029 REFERRED TO OUTPT CARD REHABILITATION PROGRAM $0.00
45020 104030 I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC $9,867.50
45100 104031 BX ANORECTAL WALL ANAL APPROACH $8,065.50
45108 104032 ANORECTAL MYOMECTOMY $7,569.00
45110 104033 PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST $0.00
45111 104034 PRCTECT PRTL RESCJ RECTUM TABDL APPR $0.00
45112 104035 PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX $0.00
45113 104036 PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR $0.00
45114 104037 PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH $0.00
45116 104038 PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY $0.00
45119 104039 PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM $0.00
45120 104040 PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS $0.00
45121 104041 PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS $0.00
45123 104042 PRCTECT PRTL W/O ANAST PRNL APPR $0.00
45126 104043 PELVIC EXENTERATION COLORECTAL MALIGNANCY $0.00
45130 104044 EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH $21,615.00
45135 104045 EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH $0.00
45136 104046 EXC ILEOANAL RSVR W/ILEOSTOMY $0.00
45150 104047 DIVISION STRICTURE RECTUM $7,569.00
45160 104048 EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL $7,569.00
45171 104049 EXC RCT TUM NOT INCL MUSCULARIS PROPRIA $11,631.00
45172 104050 EXC RCT TUM INCL MUSCULARIS PROPRIA $13,507.50
45190 104051 DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH $8,706.00
4525F 104052 NEUROPSYCHIATRIC INTERVENTION ORDERED $0.00
4526F 104053 NEUROPSYCHIATRIC INTERVENTION RECEIVED $0.00
45300 104054 PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX $5,178.00
45303 104055 PROCTOSGMDSC RIGID W/DILATION $7,353.50
45305 104056 PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE $11,436.50
45307 104057 PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY $17,795.00
45308 104058 PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY $10,399.00
45309 104059 PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ $3,735.50
45315 104060 PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE $3,735.50
45317 104061 PROCTOSGMDSC RIGID CONTROL BLEEDING $14,363.00
45320 104062 PROCTOSGMDSC RIGID ABLATION LESION $12,230.00
45321 104063 PROCTOSGMDSC RIGID DCMPRN VOLVULUS $6,621.00
45327 104064 PROCTOSGMDSC RIGID TNDSC STENT PLMT $8,447.50
45330 104065 SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD $3,065.00
45331 104066 SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE $3,074.00
45332 104067 SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY $5,700.00
45333 104068 SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS $4,318.00
45334 104069 SIGMOIDOSCOPY FLX CONTROL BLEEDING $5,171.00
45335 104070 SGMDSC FLX DIRED SBMCSL NJX ANY SBST $3,175.00
45337 104071 SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE $4,272.00
45338 104072 SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ $4,435.00
45340 104073 SIGMOIDOSCOPY FLX TNDSC BALO DILAT $4,568.50
45341 104074 SIGMOIDOSCOPY FLX NDSC US XM $5,811.00
45342 104075 SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX $6,516.50
45346 104076 SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES $4,165.50
45347 104077 SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT $6,720.00
45349 104078 SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION $7,478.50
45350 104079 SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S) $4,165.50
45378 104080 COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD $4,576.50
45379 104081 COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S) $5,070.00
45380 104082 COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE $5,110.50
45381 104083 COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST $4,358.50
45382 104084 COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD $4,891.00
45384 104085 COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS $4,756.50
45385 104086 COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ $5,132.00
45386 104087 COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT $5,440.00
45388 104088 COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES $4,022.50
45389 104089 COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT $6,640.50
45390 104090 COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION $5,430.00
45391 104091 COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX $5,371.00
45392 104092 COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL $5,866.50
45393 104093 COLONOSCOPY FLEXIBLE WITH DECOMPRESSION $4,022.50
45395 104094 LAPS PROCTECTOMY ABDOMINOPERINEAL W/COLOSTOMY $0.00
45397 104095 LAPS PROCTECTOMY COMBINED PULL-THRU W/RESERVOIR $0.00
45398 104096 COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S) $4,022.50
45399 104097 UNLISTED PROCEDURE COLON $0.00
45400 104098 LAPAROSCOPY PROCTOPEXY PROLAPSE $39,741.00
45402 104099 LAPAROSCOPY PROCTOPEXY PROLAPSE SIGMOID RESCJ $0.00
4540F 104100 DISEASE MODIFYING PHARMACOTHERAPY DISCUSSED $0.00
4541F 104101 TX PSEUDOBULBAR AFFECT SIALORRHEA/ALS SYMP $0.00
45499 104102 UNLISTED LAPAROSCOPY PROCEDURE RECTUM $0.00
45500 104103 PROCTOPLASTY STENOSIS $7,569.00
45505 104104 PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE $9,605.50
4550F 104105 OPTIONS NONINVASIVE RESP SUPPORT DISCUSSED W/PT $0.00
4551F 104106 NUTRITIONAL SUPPORT OFFERED $0.00
45520 104107 PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE $895.00
45540 104108 PROCTOPEXY ABDOMINAL APPROACH $0.00
45541 104109 PROCTOPEXY PERINEAL APPROACH $12,825.00
45550 104110 PROCTOPEXY W/SIGMOID RESCJ ABDL APPR $0.00
45560 104111 REPAIR RECTOCELE SEPARATE PROCEDURE $18,888.50
45562 104112 EXPL RPR & PRESACRAL DRG RECTAL INJURY $0.00
45563 104113 EXPL RPR & PRESACRAL DRG RECTAL INJ W/COLOSTOMY $0.00
4556F 104114 PT SHOWS 3+RISK FACTORS POST-OP NAUSEA&VOMITING $0.00
4557F 104115 PT NO EXHIBIT 3+ RISK FACTORS POST-OP NAUSEA/VOM $0.00
4558F 104116 PT RCEVD 2 PROPHYLACTIC RX AGENTS PRE&INTRA-OP $0.00
4559F 104117 1BODY TEMP MEAS>=35.5C IN 30-15 MINS POST ANESTH $0.00
4560F 104118 ANESTH DID NOT INVOLVE GENERAL/NEURAXIAL ANESTH $0.00
4561F 104119 PATIENT HAS A CORONARY ARTERY STENT $0.00
4562F 104120 PATIENT DOES NOT HAVE A CORONARY ARTERY STENT $0.00
4563F 104121 PT RECVD ASPIRIN W/IN 24 HRS PRIOR ANESTH START $0.00
45800 104122 CLOSURE RECTOVESICAL FISTULA $0.00
45805 104123 CLSR RECTOVESICAL FISTULA W/COLOSTOMY $0.00
45820 104124 CLOSURE RECTOURETHRAL FISTULA $0.00
45825 104125 CLOSURE RECTOURETHRAL FISTULA W/COLOSTOMY $0.00
45900 104126 RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE $4,839.50
45905 104127 DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL $6,780.00
45910 104128 DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL $6,900.00
45915 104129 RMVL FECAL IMPACTION/FB SPX UNDER ANES $10,570.50
45990 104130 ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX $8,969.00
45999 104131 UNLISTED PROCEDURE RECTUM $0.00
46020 104132 PLACEMENT SETON $8,906.50
46030 104133 REMOVAL ANAL SETON OTHER MARKER $9,292.00
46040 104134 I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX $11,522.00
46045 104135 I&D INTRAMURAL IM/ABSC TRANSANAL ANES $6,902.00
46050 104136 I&D PERIANAL ABSCESS SUPERFICIAL $6,504.50
46060 104137 I&D ISCHIORCT/INTRAMURAL ABSC W/WO SETON $16,283.00
46070 104138 INCISION ANAL SEPTUM INFANT $5,781.50
46080 104139 SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX $8,432.00
46083 104140 INCISION THROMBOSED HEMORRHOID EXTERNAL $1,009.00
46200 104141 FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED $7,894.50
46220 104142 EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS $11,099.00
46221 104143 HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS $2,353.00
46230 104144 EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS $10,863.00
46250 104145 HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP $8,443.00
46255 104146 HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP $8,790.50
46257 104147 HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO $9,211.50
46258 104148 HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY $10,975.00
46260 104149 HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO $12,878.00
46261 104150 HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU $10,405.50
46262 104151 HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY $12,461.50
46270 104152 SURG TX ANAL FISTULA SUBQ $5,590.00
46275 104153 SURG TX ANAL FISTULA INTERSPHINCTERIC $9,776.00
46280 104154 TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON $10,544.00
46285 104155 SURG TX ANAL FISTULA 2ND STAGE $16,746.00
46288 104156 CLSR ANAL FSTL W/RCT ADVMNT FLAP $13,832.00
46320 104157 EXC THROMBOSED HEMORRHOID XTRNL $6,708.00
46500 104158 INJECTION SCLEROSING SOLUTION HEMORRHOIDS $3,994.50
46505 104159 CHEMODENERVATION INTERNAL ANAL SPHINCTER $6,045.00
46600 104160 ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD $542.00
46601 104161 ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT $1,046.00
46604 104162 ANOSCOPY W/DILATION $6,001.00
46606 104163 ANOSCOPY W/BX SINGLE/MULTIPLE $9,670.50
46607 104164 ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX $4,165.50
46608 104165 ANOSCOPY W/RMVL FOREIGN BODY $9,675.00
46610 104166 ANOSCOPY W/RMVL LESION CAUTERY $8,289.50
46611 104167 ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ $4,636.50
46612 104168 ANOSC RMVL MULT TUMORS CAUTERY/SNARE $11,513.50
46614 104169 ANOSCOPY CONTROL BLEEDING $12,704.00
46615 104170 ANOSCOPY ABLATION LESION $11,708.50
46700 104171 ANOPLASTY PLASTIC OPERATION STRICTURE ADULT $10,613.50
46705 104172 ANOPLASTY PLASTIC OPERATION STRICTURE INFANT $0.00
46706 104173 REPAIR ANAL FISTULA W/FIBRIN GLUE $9,236.50
46707 104174 REPAIR ANORECTAL FISTULA PLUG $11,759.50
46710 104175 RPR ILEOANAL POUCH FSTL/POUCH ADVMNT TPRNL APPR $0.00
46712 104176 RPR ILEOANAL POUCH FSTL/POUCH ADVMNT CMBN APPR $0.00
46715 104177 RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK $0.00
46716 104178 RPR LW IMPERFORATE ANUS W/TRPOS FISTULA $0.00
46730 104179 RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR $0.00
46735 104180 RPR HI IMPRF ANUS W/O FISTULA CMBN APPR $0.00
46740 104181 RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR $0.00
46742 104182 RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL $0.00
46744 104183 RPR CLOACAL ANOMALY SACROPERINEAL $0.00
46746 104184 RPR CLOACAL ANOMALY CMBN ABDL&SACROPRNL $0.00
46748 104185 RPR CLOACAL ANOMALY CMBN ABDL & SACROPRNL W/GRF $0.00
46750 104186 SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT $17,565.00
46751 104187 SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD $0.00
46753 104188 GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE $11,635.50
46754 104189 RMVL THIERSCH WIRE/SUTURE ANAL CANAL $5,781.50
46760 104190 SPHINCTEROPLASTY ANAL MUSCLE TRANSPLANT $9,184.00
46761 104191 SPHNCTROP ANAL LEVATOR MUSC IMBRCJ $9,184.00
46900 104192 DSTRJ LESION ANUS SIMPLE CHEMICAL $1,370.00
46910 104193 DSTRJ LESION ANUS SMPL ELTRDSICCATION $7,217.00
46916 104194 DSTRJ LESION ANUS SIMPLE CRYOSURGERY $664.00
46917 104195 DSTRJ LESION ANUS SIMPLE LASER SURG $7,866.50
46922 104196 DSTRJ LESION ANUS SIMPLE SURG EXCISION $9,744.00
46924 104197 DSTRJ LESION ANUS EXTENSIVE $8,772.50
46930 104198 DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY $3,398.00
46940 104199 CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST $11,617.00
46942 104200 CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ $2,588.00
46945 104201 INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN $11,857.50
46946 104202 INT HRHC BY LIGATION 2+ HROID W/O IMG GDN $13,962.00
46947 104203 HEMORRHOIDOPEXY STAPLING $10,724.50
46948 104204 INT HRHC TRANSANAL HROID DARTLZJ 2+ W/US GDN $17,060.00
46999 104205 UNLISTED PROCEDURE ANUS $0.00
47000 104206 BIOPSY LIVER NEEDLE PERCUTANEOUS $3,887.50
47001 104207 BX LVR NDL DONE PURPOSE TM OTH MAJOR PX $10,561.00
47010 104208 HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES $0.00
47015 104209 LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS $0.00
47100 104210 BIOPSY LIVER WEDGE $20,259.00
47120 104211 HEPATECTOMY RESCJ PARTIAL LOBECTOMY $33,593.50
47122 104212 HEPATECTOMY RESCJ TRISEGMENTECTOMY $0.00
47125 104213 HEPATECTOMY RESCJ TOTAL LEFT LOBECTOMY $0.00
47130 104214 HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY $0.00
47133 104215 DONOR HEPATECTOMY CADAVER DONOR $0.00
47135 104216 LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE $0.00
47140 104217 DONOR HEPATECTOMY LIVING DONOR SEG II & III $0.00
47141 104218 DONOR HEPATECTOMY LIVING DONOR SEG II III & IV $0.00
47142 104219 DONOR HEPATECTOMY LIVING DONOR SEG V VI VII &VI $0.00
47143 104220 BKBENCH PREP CADAVER DONOR $0.00
47144 104221 BKBENCH PREPJ CADAVER WHOLE LIVER GRF I&IV VII $0.00
47145 104222 BKBENCH PREPJ CADAVER DONOR WHL LVR GRF I&V VI $0.00
47146 104223 BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA $0.00
47147 104224 BKBENCH RCNSTJ LVR GRF ARTL ANAST EA $0.00
47300 104225 MARSUPIALIZATION CST/ABSC LVR $0.00
47350 104226 MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ $0.00
47360 104227 MGMT LVR HEMRRG CPLX SUTR WND/INJ $0.00
47361 104228 MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR $0.00
47362 104229 MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING $0.00
47370 104230 LAPS SURG ABLTJ 1/> LVR TUM RF $25,069.00
47371 104231 LAPS SURG ABLTJ 1 > LVR TUM CRYOSURG $25,260.50
47379 104232 UNLISTED LAPAROSCOPIC PROCEDURE LIVER $0.00
47380 104233 ABLTJ OPN 1/> LVR TUM RF $0.00
47381 104234 ABLTJ OPN 1/> LVR TUM CRYOSURG $0.00
47382 104235 ABLTJ 1/> LVR TUM PRQ RF $49,049.00
47383 104236 ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION $14,022.50
47399 104237 UNLISTED PROCEDURE LIVER $0.00
47400 104238 HEPATCOTOMY/HEPATCOSTOMY W/EXPL DRG/RMVL ST1 $0.00
47420 104239 CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP $0.00
47425 104240 CHOLEDOCHOT/OST W/SPHNCTROTOMY/SPHNCTROP $0.00
47460 104241 TRANSDUOL SPHINCTEROT/PLASTY W/WO RMVL CALCULUS $0.00
47480 104242 CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX $0.00
47490 104243 CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT $7,376.00
47531 104244 NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS $4,113.50
47532 104245 NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS $8,882.50
47533 104246 PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL $16,130.50
47534 104247 PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT $15,775.50
47535 104248 CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH $15,908.50
47536 104249 EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I $6,900.50
47537 104250 REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I $2,731.00
47538 104251 PLMT BILE DUCT STENT PRQ EXISTING ACCESS $14,632.00
47539 104252 PLMT BILE DUCT STENT PRQ NEW ACCESS W/O SEP CATH $14,632.00
47540 104253 PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH $14,632.00
47541 104254 PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW $8,882.50
47542 104255 BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT $6,339.00
47543 104256 ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT $5,259.00
47544 104257 REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I $9,519.50
47550 104258 BILIARY NDSC INTRAOPERATIVE $0.00
47552 104259 BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH $6,713.50
47553 104260 BILIARY NDSC PRQ T-TUBE W/BX SINGLE/MULTIPLE $6,672.00
47554 104261 BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS $17,779.50
47555 104262 BILIARY NDSC PRQ T-TUBE W/DIL DUCT W/O STENT $13,150.50
47556 104263 BILIARY NDSC PRQ T-TUBE DILAT STRIX W/STENT $9,073.50
47562 104264 LAPAROSCOPY SURG CHOLECYSTECTOMY $23,948.00
47563 104265 LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY $41,862.50
47564 104266 LAPS SURG CHOLECSTC W/EXPL COMMON DUCT $40,494.50
47570 104267 LAPAROSCOPY SURG CHOLECYSTOENETEROSTOMY $0.00
47579 104268 UNLISTED LAPAROSCOPY PROCEDURE BILIARY TRACT $0.00
47600 104269 CHOLECYSTECTOMY $33,743.50
47605 104270 CHOLECYSTECTOMY W/CHOLANGIOGRAPHY $22,014.50
47610 104271 CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT $0.00
47612 104272 CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY $0.00
47620 104273 CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP $0.00
47700 104274 EXPL CONGENITAL ATRESIA BILE DUCTS $0.00
47701 104275 PORTOENETEROSTOMY $0.00
47711 104276 EXC BILE DUX TUM W/WO PRIM RPR XTRHEPATC $0.00
47712 104277 EXC BILE DUX TUM W/WO PRIM RPR INTRAHEPATC $0.00
47715 104278 EXCISION CHOLEDOCHAL CYST $0.00
47720 104279 CHOLECYSTOENTEROSTOMY DIRECT $0.00
47721 104280 CHOLECYSTOENTEROSTOMY W/GASTROENTEROSTOMY $0.00
47740 104281 CHOLECYSTOENTEROSTOMY ROUX-EN-Y $0.00
47741 104282 CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM $0.00
47760 104283 ANAST XTRHEPATC BILIARY DUCTS & GI TRACT $0.00
47765 104284 ANAST INTRAHEPATC DUCTS & GI TRACT $0.00
47780 104285 ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI $0.00
47785 104286 ANAST ROUX-EN-Y INTRAHEPATC BILIARY DUCTS & GI $0.00
47800 104287 RCNSTJ PLSTC BILIARY DUCTS W/END-TO-END ANAST $0.00
47801 104288 PLACEMENT CHOLEDOCHAL STENT $0.00
47802 104289 U-TUBE HEPATICOENTEROSTOMY $0.00
47900 104290 SUTURE EXTRAHEPATIC BILE DUCT PRE-EXIST INJURY $0.00
47999 104291 UNLISTED PROCEDURE BILIARY TRACT $0.00
48000 104292 PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS $0.00
48001 104293 PLACE DRAIN PERIPANCREATIC W/CHOLECYSTOSTOMY $0.00
48020 104294 REMOVAL PANCREATIC CALCULUS $0.00
48100 104295 BIOPSY PANCREAS OPEN $0.00
48102 104296 BIOPSY PANCREA PERCUTANEOUS NEEDLE $3,552.50
48105 104297 RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS $0.00
48120 104298 EXCISION LESION PANCREAS $0.00
48140 104299 PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY $0.00
48145 104300 PNCRTECT DSTL STOT W/PNCRTCOJEJUNOSTOMY $0.00
48146 104301 PNCRTECT DSTL NR-TOT W/PRSRV DUO CHLD-TYP PX $0.00
48148 104302 EXCISION AMPULLA VATER $0.00
48150 104303 PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY $0.00
48152 104304 PNCRTECT WHIPPLE W/O PANCREATOJEJUNOSTOMY $0.00
48153 104305 PNCRTECT W/PANCREATOJEJUNOSTOMY $0.00
48154 104306 PNCRTECT PROX STOT W/O PANCREATOJEJUNOSTOMY $0.00
48155 104307 PANCREATECTOMY TOTAL $0.00
48160 104308 PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS $0.00
48400 104309 INJECTION INTRAOPERATIVE PANCREATOGRAPHY $0.00
48500 104310 MARSUPIALIZATION PANCREATIC CYST $0.00
48510 104311 EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN $0.00
48520 104312 INT ANAST PANCREATIC CYST GI TRACT DIRECT $0.00
48540 104313 INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y $0.00
48545 104314 PANCREATORRHAPHY INJURY $0.00
48547 104315 DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ $0.00
48548 104316 PANCREATICOJEJUNOSTOMY SIDE-TO-SIDE ANAST $0.00
48550 104317 DONOR PANCREATECTOMY DUODENAL SGM TRANSPLANT $0.00
48551 104318 BKBENCH PREPJ CADAVER DONOR PANCREAS ALLOGRAFT $0.00
48552 104319 BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA $0.00
48554 104320 TRANSPLANTATION PANCREATIC ALLOGRAFT $0.00
48556 104321 RMVL TRANSPLANTED PANCREATIC ALLOGRAFT $0.00
48999 104322 UNLISTED PROCEDURE PANCREAS $0.00
49000 104323 EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX $23,632.00
49002 104324 REOPENING RECENT LAPAROTOMY $0.00
49010 104325 EXPL RETROPERITONEUM W/WO BX SPX $28,266.50
49013 104326 PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA $0.00
49014 104327 REEXPL PEL WND W/RMVL PREPERITONEAL PEL PACKING $0.00
49020 104328 DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN $13,808.00
49040 104329 DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN $0.00
49060 104330 DRAINAGE OF RETROPERITONEAL ABSCESS OPEN $0.00
49062 104331 DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN $0.00
49082 104332 ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE $3,588.00
49083 104333 ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE $3,102.50
49084 104334 PERITONEAL LAVAGE W/WO IMAGING GUIDANCE $6,376.00
49180 104335 BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE $2,748.00
49185 104336 SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID $6,931.00
49203 104337 EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/< $14,748.00
49204 104338 EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM $14,877.50
49205 104339 EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM $23,233.50
49215 104340 EXC PRESAC/SACROCOCCYGEAL TUMOR $37,665.50
49250 104341 UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX $16,141.50
49255 104342 OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX $15,961.00
49320 104343 LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX $15,224.50
49321 104344 LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE $14,202.50
49322 104345 LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE $18,131.00
49323 104346 LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY $18,303.00
49324 104347 LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER $15,289.00
49325 104348 LAPS W/REVISION INTRAPERITONEAL CATHETER $15,431.00
49326 104349 LAPAROSCOPY W/OMENTOPEXY $7,518.00
49327 104350 LAPS W/INSERTION NTRSTL DEV W/IMG GUID 1/MLT $10,229.00
49329 104351 UNLISTED LAPAROSCOPY PX ABD PERTONEUM & OMENTUM $0.00
49400 104352 INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX $1,197.50
49402 104353 REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY $10,877.50
49405 104354 IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ $5,592.50
49406 104355 IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ $8,463.50
49407 104356 IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL $8,882.50
49411 104357 INTERSTITIAL DEV PLMT RADIATION THERAPY 1/MLT $5,639.00
49412 104358 PLACEMENT INTRSTL DEV OPN W/IMG GUID 1/MLT $0.00
49418 104359 INSJ INTRAPERITONEAL CATHETER W/IMG GUID $11,152.00
49419 104360 INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT $13,255.00
49421 104361 INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN $12,259.00
49422 104362 REMOVAL TUNNELED INTRAPERITONEAL CATHETER $16,319.00
49423 104363 EXCHNG ABSC/CST DRG CATH RAD GID SPX $3,723.50
49424 104364 CNTRST NJX ASSMT ABSC/CST VIA DRG CATH/TUBE SPX $926.50
49425 104365 INSERTION PERITONEAL-VENOUS SHUNT $0.00
49426 104366 REVIS PERITONEAL-VENOUS SHUNT $22,414.50
49427 104367 INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT $1,371.00
49428 104368 LIGATION PERITONEAL-VENOUS SHUNT $0.00
49429 104369 RMVL PERITONEAL-VENOUS SHUNT $7,109.50
49435 104370 INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER $9,638.00
49436 104371 DELAYED CREATION EXIT SITE EMBEDDED CATHETER $8,817.50
49440 104372 INSERT GASTROSTOMY TUBE PERCUTANEOUS $6,433.50
49441 104373 INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ $5,772.00
49442 104374 INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS $5,781.50
49446 104375 CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ $4,541.00
49450 104376 REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS $2,330.00
49451 104377 REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ $2,287.50
49452 104378 REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS $3,471.00
49460 104379 OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE $2,778.00
49465 104380 CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE $707.50
49491 104381 RPR 1ST INGUN HRNA PRETERM INFT RDC $18,203.00
49492 104382 RPR 1ST INGUN HRNA PRETERM INFT INCARCERATED $9,368.00
49495 104383 RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC $15,907.50
49496 104384 RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER $18,399.00
49500 104385 RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE $10,637.50
49501 104386 RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED $18,905.00
49505 104387 RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE $15,986.50
49507 104388 RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED $20,962.50
49520 104389 RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE $13,788.50
49521 104390 RPR RECRT INGUN HERNIA ANY AGE INCARCERATED $27,897.50
49525 104391 RPR INGUN HERNIA SLIDING ANY AGE $14,750.50
49540 104392 REPAIR LUMBAR HERNIA $15,104.00
49550 104393 RPR 1ST FEM HRNA ANY AGE REDUCIBLE $20,288.50
49553 104394 RPR 1ST FEM HERNIA ANY AGE INCARCERATED $12,011.00
49555 104395 RPR RECRT FEM HERNIA REDUCIBLE $13,060.00
49557 104396 RPR RECRT FEM HRNA INCARCERATED $13,379.00
49560 104397 REPAIR FIRST ABDOMINAL WALL HERNIA $9,787.50
49561 104398 RPR 1ST INCAL/VNT HERNIA INCARCERATED $9,698.00
49565 104399 RPR RECRT INCAL/VNT HERNIA REDUCIBLE $10,757.00
49566 104400 RPR RECRT INCAL/VNT HERNIA INCARCERATED $10,764.50
49568 104401 IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE $6,255.50
49570 104402 RPR EPIGASTRIC HERNIA REDUCIBLE SPX $12,423.50
49572 104403 RPR EPIGASTRIC HERNIA INCARCERATED $11,882.00
49580 104404 RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE $9,368.00
49582 104405 RPR UMBILICAL HERNIA < 5 YRS INCARCERATED $9,368.00
49585 104406 RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE $9,954.00
49587 104407 RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED $11,317.50
49590 104408 RPR SPIGELIAN HERNIA $13,253.00
49591 104409 RPR AA HERNIA 1ST < 3 CM REDUCIBLE $21,868.00
49592 104410 RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED $27,777.50
49593 104411 RPR AA HERNIA 1ST 3-10 CM REDUCIBLE $22,787.50
49594 104412 RPR AA HERNIA 1ST 3-10 CM NCRC8/STRANGULATED $32,802.50
49595 104413 RPR AA HERNIA 1ST > 10 CM REDUCIBLE $42,173.50
49596 104414 RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED $0.00
49600 104415 RPR SMALL OMPHALOCELE W/PRIMARY CLOSURE $9,368.00
49605 104416 RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH $0.00
49606 104417 RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH $0.00
49610 104418 RPR OMPHALOCELE GROSS TYP OPRATION 1ST STG $0.00
49611 104419 RPR OMPHALOCELE GROSS TYP OPRATION 2ND STG $0.00
49613 104420 RPR AA HERNIA RECR < 3 CM REDUCIBLE $19,414.00
49614 104421 RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED $25,615.00
49615 104422 RPR AA HERNIA RECR 3-10 CM REDUCIBLE $19,414.00
49616 104423 RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED $0.00
49617 104424 RPR AA HERNIA RECR > 10 CM REDUCIBLE $0.00
49618 104425 RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED $0.00
49621 104426 RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE $0.00
49622 104427 RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED $0.00
49623 104428 RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR $0.00
49650 104429 LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA $36,626.00
49651 104430 LAPS SURG RPR RECURRENT INGUINAL HERNIA $26,216.00
49652 104431 LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE $15,546.50
49653 104432 LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED $17,149.50
49654 104433 LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE $18,507.00
49655 104434 LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED $18,756.00
49656 104435 LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE $20,706.00
49657 104436 LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED $21,867.50
49659 104437 UNLISTED LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY $0.00
49900 104438 SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN $18,068.00
49904 104439 OMENTAL FLAP EXTRA-ABDOMINAL $0.00
49905 104440 OMENTAL FLAP INTRA-ABDOMINAL $15,231.50
49906 104441 FREE OMENTAL FLAP W/MICROVASCULAR ANAST $0.00
49999 104442 UNLISTED PROCEDURE ABDOMEN PERITONEUM & OMENTUM $0.00
50010 104443 RNL EXPL X NECESSITATING OTH SPEC PX $0.00
50020 104444 DRAINAGE PERIRENAL/RENAL ABSCESS OPEN $7,815.00
50040 104445 NEPHROSTOMY NEPHROTOMY W/DRAINAGE $6,820.00
50045 104446 NEPHROTOMY W/EXPLORATION $0.00
5005F 104447 COUNSEL NEW/CHANGING MOLES SELF-EXAMINATION $0.00
50060 104448 NEPHROLITHOTOMY REMOVAL CALCULUS $0.00
50065 104449 NEPHROLITHOTOMY SECONDARY SURG OPERJ CALCULUS $0.00
50070 104450 NEPHROLITHOTOMY COMP CGEN KDN ABNORMALITY $0.00
50075 104451 NEPHROLITHOTOMY RMVL LARGE STAGHORN CALCULUS $0.00
50080 104452 PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION $13,023.50
50081 104453 PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS $16,690.00
50100 104454 TRNSXJ/REPOSITIONING ABERRANT RENAL VESSELS SPX $0.00
5010F 104455 DILATED MACULAR/FUNDUS XM COMMUNJ TX PHYS/QHP $0.00
50120 104456 PYELOTOMY W/EXPLORATION $0.00
50125 104457 PYELOTOMY W/DRAINAGE PYELOSTOMY $0.00
50130 104458 PYELOTOMY WITH REMOVAL CALCULUS $0.00
50135 104459 PYELOTOMY COMPLICATED $0.00
50200 104460 RENAL BIOPSY PRQ TROCAR/NEEDLE $3,138.50
50205 104461 RENAL BIOPSY SURG EXPOSURE KIDNEY $0.00
5020F 104462 TX SUMM RPRT COMMUN PHYS&PT 1 MO COMPLETE $0.00
50220 104463 NEPHRECTOMY W/PRTL URETERECTOMY W/OPEN RIB RESCJ $0.00
50225 104464 NEPHRECTOMY W/PRTL URETERECT OPN RIB RESCJ COMPL $0.00
50230 104465 NEPHRECTOMY W/PRTL URETERECT OPEN RIB RESCJ RAD $0.00
50234 104466 NEPHRECTOMY W/TOT URETERECT&BLDR CUFF SAME INC $0.00
50236 104467 NEPHRECTOMY TOT URETEREC&BLDR CUFF SEPAR INCISN $0.00
50240 104468 NEPHRECTOMY PARTIAL $0.00
50250 104469 OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND $0.00
50280 104470 EXCISION/UNROOFING CYST KIDNEY $0.00
50290 104471 EXCISION PERINEPHRIC CYST $0.00
50300 104472 DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL $0.00
50320 104473 DONOR NEPHRECTOMY OPEN LIVING DONOR $0.00
50323 104474 BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT $0.00
50325 104475 BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT $0.00
50327 104476 BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA $0.00
50328 104477 BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA $0.00
50329 104478 BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA $0.00
50340 104479 RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE $0.00
50360 104480 RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY $0.00
50365 104481 RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY $0.00
50370 104482 RMVL TRNSPLED RENAL ALLOGRAFT $0.00
50380 104483 RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY $0.00
50382 104484 RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ $7,998.00
50384 104485 REMOVAL INDWELLING URETERAL STENT PRQ $12,626.00
50385 104486 REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL $9,685.00
50386 104487 REMOVE INT DWELL URETERAL STENT TRANSURETHRAL $8,165.50
50387 104488 RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH $4,155.00
50389 104489 RMVL NFROS TUBE REQ FLUORO GUIDANCE $4,587.00
50390 104490 ASPIR &/NJX RENAL CYST/PELVIS NEEDLE PRQ $3,361.00
50391 104491 INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUB $1,883.00
50396 104492 MANOMETRIC STDS THRU TUBE/NDWELLG URTRL CATH $2,096.50
50400 104493 PYELOPLASTY SIMPLE $50,596.00
50405 104494 PYELOPLASTY COMPLICATED $62,068.00
50430 104495 NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS $5,649.00
50431 104496 NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS $2,567.00
50432 104497 PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I $9,009.00
50433 104498 PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I $6,010.50
50434 104499 CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ $9,058.00
50435 104500 EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I $4,578.00
50436 104501 PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG $9,579.50
50437 104502 PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS $12,273.00
50500 104503 NEPHRORRHAPHY SUTURE KIDNEY WOUND/INJURY $0.00
5050F 104504 TX COMMUN PROVIDERS CONTINUING CARE 1 MO DX $0.00
50520 104505 CLOSURE NEPHROCUTANEOUS/PYELOCUTANEOUS FISTULA $0.00
50525 104506 CLSR NEPHROVISCERAL FISTULA W/VISC RPR ABDL APPR $0.00
50526 104507 CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR $0.00
50540 104508 SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI $0.00
50541 104509 LAPAROSCOPY SURG ABLATION RENAL CYSTS $31,055.00
50542 104510 LAPS ABLTJ RENAL MASS LESION W/INTRAOP US $29,027.50
50543 104511 LAPAROSCOPY SURG PARTIAL NEPHRECTOMY $34,775.50
50544 104512 LAPAROSCOPY SURG PYELOPLASTY $58,641.50
50545 104513 LAPAROSCOPY RADICAL NEPHRECTOMY $40,676.00
50546 104514 LAPAROSCOPY NEPHRECTOMY W/PARTIAL URETERECT $46,831.00
50547 104515 LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR $0.00
50548 104516 LAPAROSCOPY NEPHRECTOMY W/TOTAL URETERECTOMY $69,195.50
50549 104517 UNLISTED LAPAROSCOPY PROCEDURE RENAL $0.00
50551 104518 RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION $11,494.00
50553 104519 RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA $11,493.00
50555 104520 RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY $11,447.00
50557 104521 RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI $21,914.50
50561 104522 RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS $11,600.50
50562 104523 RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR $21,914.50
50570 104524 RENAL NDSC NEPHROTOMY W/WO IRRIGATION $2,895.00
50572 104525 RNL NDSC NFROT W/URTRL CATHJ W/WO DILAT URETER $2,895.00
50574 104526 RENAL NDSC NEPHROTOMY W/BIOPSY $2,895.00
50575 104527 RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY $19,455.00
50576 104528 RNL NDSC NFROT FULGURATION &/INCISION W/WO BX $5,272.50
50580 104529 RNL NDSC NFROT/PLOT W/RMVL FB/CALCULUS $21,028.50
50590 104530 LITHOTRIPSY XTRCORP SHOCK WAVE $30,527.00
50592 104531 ABLTJ 1/> RENAL TUMOR PRQ UNI RADIOFREQUENCY $13,502.00
50593 104532 ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY $25,972.50
50600 104533 URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE $0.00
50605 104534 URETEROTOMY INSERTION INDWELLING STENT ALL TYPES $0.00
50606 104535 ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC $6,076.00
50610 104536 URTROLITHOTOMY UPPER ONE-THIRD URETER $0.00
50620 104537 URTROLITHOTOMY MIDDLE ONE-THIRD URETER $0.00
5062F 104538 DOC DIRECT COMM DIAG MAMMO FNDNGS-PHONE/PERSON $0.00
50630 104539 URTROLITHOTOMY LOWER ONE-THIRD URETER $0.00
50650 104540 URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE $0.00
50660 104541 URETERECTOMY TOT ECTOPIC URETER CMBN APPR $0.00
50684 104542 INJ PX URETEROGRAPHY/URETEROPYLOGRAPHY CATH $2,566.50
50686 104543 MANOMETRIC STDS THRU URTROST/NDWELLG URTRL CATH $732.50
50688 104544 CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL $4,404.00
50690 104545 NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG $1,837.00
50693 104546 PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT $9,094.00
50694 104547 PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH $16,262.50
50695 104548 PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH $16,948.00
50700 104549 URETEROPLASTY PLASTIC OPERATION URETER $0.00
50705 104550 URETERAL EMBOLIZATION/OCCLUSION W/IMG GID RS&I $7,436.50
50706 104551 BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I $7,010.50
50715 104552 URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS $28,672.50
50722 104553 URETEROLYSIS FOR OVARIAN VEIN SYNDROME $0.00
50725 104554 URTROLSS RETROCAVAL URTR W/REANAST $0.00
50727 104555 REVJ URINARY-CUTANEOUS ANASTAMOSIS $24,980.00
50728 104556 REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA $0.00
50740 104557 URETEROPYELOSTOMY ANAST URETER RENAL PELVIS $0.00
50750 104558 URETEROCALYCOSTOMY ANAST URETER RENAL CALYX $0.00
50760 104559 URETEROURETEROSTOMY $0.00
50770 104560 TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR $0.00
50780 104561 URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER $41,006.50
50782 104562 URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR $0.00
50783 104563 URETERONEOCYSTOSTOMY W/URETERAL TAILORING $0.00
50785 104564 URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP $0.00
50800 104565 URETEROENTEROSTOMY ANAST URETER INTESTINE $0.00
50810 104566 URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER & COLOSTO $0.00
50815 104567 URETEROCOLON CONDUIT INTESTINE ANASTOMOSIS $0.00
50820 104568 URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS $0.00
50825 104569 CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN $0.00
50830 104570 URINARY UNIDIVERSION $0.00
50840 104571 RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST $0.00
50845 104572 CUTANANEOUS APPENDICO-VESICOSTOMY $0.00
50860 104573 URETEROSTOMY TRANSPLANTATION URETER SKIN $0.00
50900 104574 URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE $0.00
50920 104575 CLOSURE URETEROCUTANEOUS FISTULA $0.00
50930 104576 CLOSURE URETEROCUTANEOUS FISTULA W/VISC RPR $0.00
50940 104577 DELIGATION URETER $0.00
50945 104578 LAPAROSCOPY URTROLITHOTOMY $25,782.50
50947 104579 LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT $53,599.00
50948 104580 LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT $50,549.00
50949 104581 UNLISTED LAPAROSCOPY PROCEDURE URETER $0.00
50951 104582 URETERAL ENDOSCOPY VIA URETEROSTOMY $11,903.50
50953 104583 URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER $14,786.00
50955 104584 URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY $11,909.50
50957 104585 URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY $7,815.00
50961 104586 URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE $23,179.00
50970 104587 URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING $2,895.00
50972 104588 NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER $2,895.00
50974 104589 URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX $5,272.50
50976 104590 URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX $5,272.50
50980 104591 NDSC URETEROTOMY RMVL FB/CALCULUS $7,815.00
5100F 104592 FX RISK REF PHYS/QHP COMMJ 24 HRS IMAGING STUDY $0.00
51020 104593 CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL $7,815.00
51030 104594 CSTOTOMY/CSTOST CRYOSURG DSTRJ INTRAVESICAL LES $7,815.00
51040 104595 CYSTOSTOMY CYSTOTOMY W/DRAINAGE $9,663.50
51045 104596 CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX $7,814.00
51050 104597 CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS $25,149.50
51060 104598 TRANSVESICAL URETROLITHOTOMY $10,248.50
51065 104599 CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO $7,815.00
51080 104600 DRG PRIVESICAL/PREVESICAL SPACE ABSC $5,919.00
51100 104601 ASPIRATION BLADDER NEEDLE $1,169.00
51101 104602 ASPIRATION BLADDER TROCAR/INTRACATHETER $3,482.00
51102 104603 ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER $8,665.00
51500 104604 EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR $19,239.50
51520 104605 CYSTOTOMY SIMPLE EXCISION VESICAL NECK $7,815.00
51525 104606 CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE $0.00
51530 104607 CYSTOTOMY EXCISION BLADDER TUMOR $0.00
51535 104608 CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE $7,815.00
51550 104609 CYSTECTOMY PARTIAL SIMPLE $40,843.50
51555 104610 CYSTECTOMY PARTIAL COMPLICATED $0.00
51565 104611 CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST $0.00
51570 104612 CYSTECTOMY COMPLETE SEPARATE PROCEDURE $0.00
51575 104613 CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY $0.00
51580 104614 CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES $0.00
51585 104615 CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES $0.00
51590 104616 CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST $0.00
51595 104617 CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC $0.00
51596 104618 CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR $0.00
51597 104619 PELVIC EXENTERATION COMPLETE MALIGNANCY $0.00
51600 104620 NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY $626.00
51605 104621 NJX & PLACEMENT CHAIN CONTRAST&/URETHROCSTOGRAPY $2,253.50
51610 104622 NJX RETROGRADE URETHROCSTOGRAPY $563.00
51700 104623 BLDR IRRIGATION SMPL LAVAGE &/INSTLJ $934.00
51701 104624 INSJ NON-NDWELLG BLADDER CATHETER $410.00
51702 104625 INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE $647.00
51703 104626 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED $687.50
51705 104627 CHANGE CYSTOSTOMY TUBE SIMPLE $1,797.50
51710 104628 CHANGE CYSTOSTOMY TUBE COMPLICATED $3,196.50
51715 104629 NDSC NJX IMPLT MATRL URT&/BLDR NCK $8,566.50
51720 104630 BLADDER INSTILLATION ANTICARCINOGENIC AGENT $1,434.50
51725 104631 SIMPLE CYSTOMETROGRAM $1,005.50
51726 104632 BLADDER PRESSURE MEASUREMENT DURING FILLING $850.00
51727 104633 COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE $1,574.00
51728 104634 COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES $1,824.50
51729 104635 COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL $2,059.50
51736 104636 SIMPLE UROFLOMETRY $534.00
51741 104637 COMPLEX UROFLOMETRY $580.50
51784 104638 EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL $858.00
51785 104639 NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ $1,388.50
51792 104640 STIMULUS EVOKED RESPONSE $689.00
51797 104641 VOID PRESSURE STUDIES INTRAABDOMINAL $1,025.00
51798 104642 MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP $404.00
51800 104643 CSTOPLASTY/CSTOURTP PLSTC ANY $0.00
51820 104644 CSTOURTP W/UNI/BI URTRONEOCSTOST $0.00
51840 104645 ANT VESICOURETHROPEXY/URETHROPEXY SMPL $13,342.00
51841 104646 ANT VESICOURETHROPEXY/URETHROPEXY COMP $0.00
51845 104647 ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL $13,601.00
51860 104648 CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE $19,242.50
51865 104649 CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED $0.00
51880 104650 CLOSURE CYSTOSTOMY SEPARATE PROCEDURE $13,183.00
51900 104651 CLSR VESICOVAGINAL FISTUL AABDL APPROACH $0.00
51920 104652 CLOSURE VESICOUTERINE FISTULA $0.00
51925 104653 CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY $0.00
51940 104654 CLOSURE EXSTROPHY BLADDER $0.00
51960 104655 ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS $0.00
51980 104656 CUTANEOUS VESICOSTOMY $0.00
51990 104657 LAPAROSCOPY URETHRAL SUSPENSION STRESS INCONT $22,234.00
51992 104658 LAPAROSCOPY SLING OPERATION STRESS INCONT $16,525.50
51999 104659 UNLISTED LAPAROSCOPY PROCEDURE BLADDER $0.00
52000 104660 CYSTOURETHROSCOPY $5,652.00
52001 104661 CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS $11,646.00
52005 104662 CYSTO BLADDER W/URETERAL CATHETERIZATION $12,234.00
52007 104663 CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS $9,575.00
5200F 104664 CONSID NEURO EVAL APPROP SURG THXPY EPIL 3YRS $0.00
52010 104665 CYSTO W/EJACULATORY DUCT CATHETERIZATION $2,895.00
52204 104666 CYSTOURETHROSCOPY WITH BIOPSY $8,647.50
52214 104667 CYSTO W/DESTRUCTION OF LESIONS $5,916.50
52224 104668 CYSTO W/REMOVAL OF LESIONS SMALL $13,654.00
52234 104669 CYSTO W/REMOVAL OF TUMORS SMALL $7,202.00
52235 104670 CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM $10,852.00
52240 104671 CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE $12,658.50
52250 104672 CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG $10,228.00
52260 104673 CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH $7,547.50
52265 104674 CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA $5,602.00
52270 104675 CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE $5,779.50
52275 104676 CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE $9,022.00
52276 104677 CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY $15,321.00
52277 104678 CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER $7,491.00
52281 104679 CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS $8,787.00
52282 104680 CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT $9,424.50
52283 104681 CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE $6,104.00
52284 104682 CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE $25,583.50
52285 104683 CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME $4,352.00
52287 104684 CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER $6,618.50
52290 104685 CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI $14,235.00
52300 104686 CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI $15,018.00
52301 104687 CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI $14,248.50
52305 104688 CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT $20,080.50
52310 104689 CYSTO W/SIMPLE REMOVAL STONE & STENT $13,813.00
52315 104690 CYSTO W/COMPLEX REMOVAL STONE & STENT $9,558.50
52317 104691 LITHOLAPAXY SMPL/SM <2.5 CM $13,372.50
52318 104692 LITHOLAPAXY COMP/LG > 2.5 CM $15,212.00
52320 104693 CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS $7,598.50
52325 104694 CYSTO FRAGMENTATION URETERAL STONE $9,236.50
52327 104695 CYSTO W/SUBURTRIC NJX IMPLT MATRL $10,407.50
52330 104696 CYSTO MANJ W/O RMVL URETERAL STONE $6,951.00
52332 104697 CYSTO W/INSERT URETERAL STENT $11,006.00
52334 104698 CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR $8,310.00
52341 104699 CYSTO W/TX URETERAL STRICTURE $11,338.00
52342 104700 CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE $12,197.00
52343 104701 CYSTO W/TX INTRA-RENAL STRICTURE $7,815.00
52344 104702 CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE $11,402.50
52345 104703 CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX $12,059.50
52346 104704 CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE $14,941.00
52351 104705 CYSTO W/URTROSCOPY&/PYELOSCOPY DX $9,803.00
52352 104706 CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES $6,489.50
52353 104707 CYSTO W/URETEROSCOPY W/LITHOTRIPSY $18,028.50
52354 104708 CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION $6,460.50
52355 104709 CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR $15,657.00
52356 104710 CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT $24,602.00
52400 104711 CYSTO INC FULG/RESCJ URTL VALVES/FOLDS $18,658.00
52402 104712 CSTO W/TRURL RESCJ/INC EJACULATORY DUXS $14,195.00
52441 104713 CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE $7,708.50
52442 104714 CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL $2,758.00
52450 104715 TRANSURETHRAL INCISION PROSTATE $9,417.00
52500 104716 TRANSURETHRAL RESECTION BLADDER NECK $9,929.00
52601 104717 TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE $15,635.50
52630 104718 TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS $13,754.50
52640 104719 TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE $10,538.50
52647 104720 LASER COAGULATION OF PROSTATE FOR URINE FLOW $16,941.00
52648 104721 LASER VAPORIZATION OF PROSTATE FOR URINE FLOW $11,786.50
52649 104722 LASER ENUCLEATION PROSTATE W/MORCELLATION $23,963.00
52700 104723 TRURL DRAINAGE PROSTATIC ABSCESS $7,815.00
53000 104724 URTT/URTS XTRNL SPX PENDULOUS URETHRA $6,650.50
53010 104725 URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA $23,604.00
53020 104726 MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT $7,577.50
53025 104727 MEATOTOMY CUTTING MEATUS SPX INFANT $6,650.50
53040 104728 DRAINAGE DEEP PERIURETHRAL ABSCESS $6,650.50
53060 104729 DRG OF SKENE'S GLAND ABSCESS OR CYST $6,650.50
53080 104730 DRG PERINEAL URINARY XTRVASATION UNCOMP SPX $6,650.50
53085 104731 DRG PERINEAL URINARY XTRVASATION COMPLIC $6,650.50
53200 104732 BIOPSY URETHRA $11,477.50
53210 104733 URETHRECTOMY TOT W/CYSTOST FEMALE $9,206.00
53215 104734 URETHRECTOMY TOT W/CYSTOST MALE $38,966.00
53220 104735 EXC/FULGURATION CARCINOMA URETHRA $9,875.50
53230 104736 EXC URETHRAL DIVERTICULUM SPX FEMALE $16,583.50
53235 104737 EXC URETHRAL DIVERTICULUM SPX MALE $6,650.50
53240 104738 MARSUPIALIZATION URTL DIVERTICULUM MALE/FEMALE $9,206.00
53250 104739 EXCISION OF BULBOURETHRAL GLAND $6,650.50
53260 104740 EXC/FULGURATION URETHRAL POLYP DSTL URETHRA $16,937.00
53265 104741 EXC/FULGURATION URETHRAL CARUNCLE $13,832.00
53270 104742 EXCISION OR FULGURATION SKENES GLANDS $13,018.00
53275 104743 EXCISION/FULGURATION URETHRAL PROLAPSE $16,209.00
53400 104744 URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX $21,451.00
53405 104745 URETHROPLASTY 2ND STAGE W/URINARY DIVERSION $21,903.50
53410 104746 URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA $11,484.50
53415 104747 URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT $28,246.00
53420 104748 URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE $9,206.00
53425 104749 URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE $9,206.00
53430 104750 URETHROPLASTY RCNSTJ FEMALE URETHRA $22,179.00
53431 104751 URTP W/TUBULARIZATION POST URT&/LWR BLDR $9,206.00
53440 104752 SLING OPRATION CORRJ MALE URINARY INCONTINENCE $20,102.50
53442 104753 RMVL/REVJ SLING MALE URINARY INCONTINENCE $20,237.00
53444 104754 INSERTION TANDEM CUFF $22,172.50
53445 104755 INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER $24,653.00
53446 104756 REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER $17,142.00
53447 104757 RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC $25,208.00
53448 104758 RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD $0.00
53449 104759 RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER $17,284.50
53450 104760 URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT $8,854.50
53451 104761 PERIURETHRAL TPRNL ADJTBL BALO CNTNC DEV BI INSJ $45,117.50
53452 104762 PERIURETHRL TPRNL ADJTBL BALO CNTNC DEV UNI INSJ $22,269.50
53453 104763 PERIURETHRAL TPRNL ADJTBL BALO CNTNC DEV RMVL EA $17,059.00
53454 104764 PERIURETHRAL TPRNL ADJTBL BALO CNTNC DEV ADJMT $2,803.50
53460 104765 URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM $11,857.50
53500 104766 URETHROLSS TRVG SEC OPN W/CSTO $9,795.00
53502 104767 URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE $11,944.50
53505 104768 URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE $18,133.50
53510 104769 URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL $6,650.50
53515 104770 URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS $9,206.00
53520 104771 CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX $21,274.50
53600 104772 DILAT URETHRAL STRIX DILATOR MALE 1ST $2,097.50
53601 104773 DILAT URETHRAL STRIX DILATOR MALE SBSQ $564.50
53605 104774 DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES $13,048.00
53620 104775 DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST $4,135.00
53621 104776 DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ $1,323.50
53660 104777 DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI $528.50
53661 104778 DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ $309.00
53665 104779 DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES $12,190.50
53850 104780 TRURL DSTRJ PRSTATE TISS MICROWAVE THERMOTH $10,157.00
53852 104781 TRURL DSTRJ PRSTATE TISS RF THERMOTH $13,865.50
53854 104782 TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY $10,955.00
53855 104783 INSERT TEMP PROSTATIC URETH STENT W/MEASUREMENT $7,377.50
53860 104784 TRURL RF FEMALE BLADDER NECK STRS URIN INCONT $6,221.50
53899 104785 UNLISTED PROCEDURE URINARY SYSTEM $0.00
54000 104786 SLITTING PREPUCE DORSAL/LATERAL SPX NEWBORN $5,452.00
54001 104787 SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN $5,897.50
54015 104788 I&D PENIS DEEP $4,852.50
54050 104789 DSTRJ LESION PENIS SIMPLE CHEMICAL $1,589.00
54055 104790 DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION $7,700.00
54056 104791 DSTRJ LESION PENIS SIMPLE CRYOSURGERY $432.50
54057 104792 DSTRJ LESION PENIS SIMPLE LASER $7,041.00
54060 104793 DSTRJ LESION PENIS SIMPLE SURG EXCISION $9,912.50
54065 104794 DSTRJ LESION PENIS EXTENSIVE $6,301.50
54100 104795 BIOPSY PENIS SEPARATE PROCEDURE $4,138.00
54105 104796 BIOPSY PENIS DEEP STRUCTURES $9,977.00
54110 104797 EXCISION OF PENILE PLAQUE $19,145.00
54111 104798 EXC PENILE PLAQUE GRAFT &/5 CM LENGTH $20,793.50
54112 104799 EXC PENILE PLAQUE GRAFT > 5 CM LENGTH $22,085.50
54115 104800 REMOVAL FOREIGN BODY DEEP PENILE TISSUE $15,414.00
54120 104801 AMPUTATION PENIS PARTIAL $13,438.00
54125 104802 AMPUTATION PENIS COMPLETE $0.00
54130 104803 AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE $0.00
54135 104804 AMPUTATION PENIS RADICAL W/LYMPH NODES $0.00
54150 104805 CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK $1,999.00
54160 104806 CIRCUMCISION NEONATE $5,864.00
54161 104807 CIRCUMCISION AGE >28 DAYS $11,638.00
54162 104808 LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS $5,723.50
54163 104809 REPAIR INCOMPLETE CIRCUMCISION $7,581.00
54164 104810 FRENULOTOMY PENIS $10,970.50
54200 104811 INJECTION PEYRONIE DISEASE $822.50
54205 104812 NJX PEYRONIE W/SURG EXPOS PLAQUE $8,490.50
54220 104813 IRRIGATION CORPORA CAVERNOSA PRIAPISM $1,020.50
54230 104814 INJECTION CORPORA CAVERNOSOGRAPY $582.00
54231 104815 DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS $5,100.50
54235 104816 NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT $831.00
54240 104817 PENILE PLETHYSMOGRAPHY $600.50
54250 104818 NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST $958.00
54300 104819 PENIS STRAIGHTENING CHORDEE $8,777.50
54304 104820 PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR $14,957.00
54308 104821 URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR <3 CM $20,290.00
54312 104822 URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM $18,342.00
54316 104823 URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF $8,490.50
54318 104824 URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS $8,490.50
54322 104825 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT $15,392.00
54324 104826 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS $15,976.50
54326 104827 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS $15,395.50
54328 104828 1 STAGE DSTL HYPOSPADIAS RPR W/EXTENSIVE DSJ $18,557.00
54332 104829 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR $20,352.50
54336 104830 1 STG PERINEAL HYPOSPADIAS RPR W/GRF&/FLAP $8,490.50
54340 104831 RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE $14,538.00
54344 104832 RPR HYPOSPADIAS COMPLCTJS MOBLJ FLAPS & URTP $16,579.50
54348 104833 RPR HYPOSPADIAS COMPLCTJS DSJ & URTP FLAP/GRF $26,661.50
54352 104834 REVISION PRIOR HYPOSPADIAS REPAIR DSJ&EXC RCNSTJ $21,996.00
54360 104835 PLASTIC RPR PENIS CORRECT ANGULATION $7,831.00
54380 104836 PLASTIC RPR PENIS EPISPADIAS DSTL SPHNCTR $8,490.50
54385 104837 PLASTIC PENIS EPISPADIAS DSTL SPHNCTR W/INCONT $8,490.50
54390 104838 PLASTIC RPR PENIS EPISPADIAS W/EXSTROPHY BLADDER $0.00
54400 104839 INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID $15,405.50
54401 104840 INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED $20,947.00
54405 104841 INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH $18,120.00
54406 104842 RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH $14,897.50
54408 104843 RPR COMPONENT INFLATABLE PENILE PROSTHESIS $15,974.50
54410 104844 RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS $21,941.50
54411 104845 RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL $31,463.00
54415 104846 RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT $12,196.00
54416 104847 RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI $20,031.00
54417 104848 RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD $31,463.00
54420 104849 CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI $8,490.50
54430 104850 CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI $13,117.50
54435 104851 CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM $8,490.50
54437 104852 REPAIR OF TRAUMATIC CORPOREAL TEAR(S) $12,963.50
54438 104853 REPLANTATION PENIS COMP AMPUTATION W/URETH REP $0.00
54440 104854 PLASTIC OPERATION PENIS INJURY $18,403.50
54450 104855 FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING $1,677.00
54500 104856 BIOPSY TESTIS NEEDLE SEPARATE PROCEDURE $4,286.00
54505 104857 BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE $9,993.50
54512 104858 EXC XTRPARENCHYMAL LESION TESTIS $6,496.00
54520 104859 ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH $10,266.00
54522 104860 ORCHIECTOMY PARTIAL $10,590.50
54530 104861 ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH $14,714.50
54535 104862 ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL $8,490.50
54550 104863 EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA $7,680.50
54560 104864 EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL $5,864.00
54600 104865 RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS $11,358.00
54620 104866 FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE $10,371.50
54640 104867 ORCHIOPEXY INGUINAL OR SCROTAL APPROACH $12,083.00
54650 104868 ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS $13,829.50
54660 104869 INSJ TESTICULAR PROSTH SEPARATE PROCEDURE $11,273.00
54670 104870 SUTURE/REPAIR TESTICULAR INJURY $12,332.50
54680 104871 TRANSPLANTATION TESTIS TO THIGH $5,864.00
54690 104872 LAPAROSCOPY SURGICAL ORCHIECTOMY $17,033.50
54692 104873 LAPAROSCOPY ORCHIOPEXY INTRA-ABDOMINAL TESTIS $13,461.00
54699 104874 UNLISTED LAPAROSCOPY PROCEDURE TESTIS $0.00
54700 104875 I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE $6,024.00
54800 104876 BIOPSY EPIDIDYMIS NEEDLE $1,771.50
54830 104877 EXCISION LOCAL LESION EPIDIDYMIS $7,517.50
54840 104878 EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY $8,301.50
54860 104879 EPIDIDYMECTOMY UNILATERAL $8,514.00
54861 104880 EPIDIDYMECTOMY BILATERAL $11,186.00
54865 104881 EXPLORATION EPIDIDYMIS W/WO BIOPSY $13,684.00
54900 104882 EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI $5,864.00
54901 104883 EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI $5,864.00
55000 104884 PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED $1,779.50
55040 104885 EXCISION HYDROCELE UNILATERAL $12,698.00
55041 104886 EXCISION HYDROCELE BILATERAL $11,552.00
55060 104887 RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE $8,316.50
55100 104888 DRAINAGE SCROTAL WALL ABSCESS $6,094.50
55110 104889 SCROTAL EXPLORATION $16,335.00
55120 104890 REMOVAL FOREIGN BODY SCROTUM $11,379.50
55150 104891 RESECTION SCROTUM $9,893.50
55175 104892 SCROTOPLASTY SIMPLE $5,971.50
55180 104893 SCROTOPLASTY COMPLICATED $12,663.00
55200 104894 VASOTOMY CANNULIZATION W/WO VAS INC UNI/BI SPX $5,864.00
55250 104895 VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS $10,053.00
55300 104896 VASOTOMY VASOGRAMS UNI/BI $1,103.00
55400 104897 VASOVASOSTOMY VASOVASORRHAPHY $23,222.50
55500 104898 EXC HYDROCELE SPRMATIC CORD UNI SPX $14,101.50
55520 104899 EXC LESION SPERMATIC CORD SEPARATE PROCEDURE $8,901.50
55530 104900 EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX $18,689.00
55535 104901 EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL $12,932.50
55540 104902 EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR $13,480.50
55550 104903 LAPS LIGATION SPERMATIC VEINS VARICOCELE $17,953.50
55559 104904 UNLISTED LAPROSCOPY PROCEDURE SPERMATIC CORD $0.00
55600 104905 VESICULOTOMY $5,864.00
55605 104906 VESICULOTOMY COMPLICATED $0.00
55650 104907 VESICULECTOMY ANY APPROACH $0.00
55680 104908 EXCISION MULLERIAN DUCT CYST $5,864.00
55700 104909 PROSTATE NEEDLE BIOPSY ANY APPROACH $1,026.00
55705 104910 BIOPSY PROSTATE INCISIONAL ANY APPROACH $13,437.00
55706 104911 BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID $7,237.00
55720 104912 PROSTATOTOMY EXTERNAL DRG ABSCESS SIMPLE $6,407.00
55725 104913 PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED $6,407.00
55801 104914 PROSTATECTOMY PERINEAL SUBTOTAL $0.00
55810 104915 PROSTATECTOMY PERINEAL RADICAL $0.00
55812 104916 PROSTATECTOMY PERINEAL RADICAL W/LYMPH NODE BX $0.00
55815 104917 PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC $0.00
55821 104918 PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES $51,109.00
55831 104919 PROSTATECTOMY RETROPUBIC SUBTOTAL $0.00
55840 104920 PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING $0.00
55842 104921 PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX $0.00
55845 104922 PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM $57,117.50
55860 104923 EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST $13,094.50
55862 104924 EXPOS PROSTATE INSJ RADIOACT SBST W/LYMPH BX $0.00
55865 104925 EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH $0.00
55866 104926 LAPS SURG PRST8ECT RPBIC RAD W/NRV SPARING ROBOT $22,447.00
55867 104927 LAPS SURG PRST8ECT SMPL STOT ROBOTIC ASSISTANCE $0.00
55870 104928 ELECTROEJACULATION $1,321.50
55873 104929 CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI $20,216.00
55874 104930 TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX $9,432.00
55875 104931 TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ $15,781.00
55876 104932 PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT $3,137.50
55880 104933 TRANSRECTAL ABLTJ MAL PRST8 TISSUE HIFU W/US $45,388.50
55899 104934 UNLISTED PROCEDURE MALE GENITAL SYSTEM $0.00
55920 104935 PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL $12,066.00
55970 104936 INTERSEX SURG MALE FEMALE $6,348.50
55980 104937 INTERSEX SURG FEMALE MALE $9,924.00
56405 104938 I&D VULVA/PERINEAL ABSCESS $1,079.00
56420 104939 I&D OF BARTHOLINS GLAND ABSCESS $868.50
56440 104940 MARSUPIALIZATION BARTHOLINS GLAND CYST $12,169.50
56441 104941 LYSIS LABIAL ADHESIONS $9,204.00
56442 104942 HYMENOTOMY SIMPLE INCISION $14,841.50
56501 104943 DESTRUCTION LESIONS VULVA SIMPLE $13,399.00
56515 104944 DESTRUCTION LESIONS VULVA EXTENSIVE $10,848.00
56605 104945 BIOPSY VULVA/PERINEUM 1 LESION SPX $6,985.50
56606 104946 BIOPSY VULVA/PERINEUM EACH ADDL LESION $1,930.00
56620 104947 VULVECTOMY SIMPLE PARTIAL $15,207.00
56625 104948 VULVECTOMY SIMPLE COMPLETE $17,714.50
56630 104949 VULVECTOMY RADICAL PARTIAL $22,535.00
56631 104950 VULVECTOMY RAD PRTL UNI INGUINOFEM LMPHADECTOMY $0.00
56632 104951 VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADECTOMY $0.00
56633 104952 VULVECTOMY RADICAL COMPLETE $0.00
56634 104953 VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADECTOMY $0.00
56637 104954 VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADECTOMY $0.00
56640 104955 VULVECTOMY RAD COMPL ILIAC & PELVIC LMPHADECTOMY $0.00
56700 104956 PRTL HYMENECTOMY/REVJ HYMENAL RING $15,710.50
56740 104957 EXC BARTHOLINS GLAND/CYST $23,496.50
56800 104958 PLASTIC REPAIR INTROITUS $14,312.50
56805 104959 CLITOROPLASTY INTERSEX STATE $26,650.50
56810 104960 PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX $15,411.50
56820 104961 COLPOSCOPY VULVA $876.50
56821 104962 COLPOSCOPY VULVA W/BIOPSY $1,258.00
57000 104963 COLPOTOMY W/EXPLORATION $19,311.50
57010 104964 COLPOTOMY W/DRAINAGE PELVIC ABSCESS $8,299.00
57020 104965 COLPOCENTESIS SEPARATE PROCEDURE $3,707.00
57022 104966 I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM $4,918.50
57023 104967 I&D VAGINAL HEMATOMA NON-OBSTETRICAL $20,280.50
57061 104968 DESTRUCTION VAGINAL LESIONS SIMPLE $19,542.50
57065 104969 DESTRUCTION VAGINAL LESIONS EXTENSIVE $12,924.00
57100 104970 BIOPSY VAGINAL MUCOSA SIMPLE $1,287.50
57105 104971 BIOPSY VAGINAL MUCOSA EXTENSIVE $17,256.50
57106 104972 VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL $12,630.50
57107 104973 VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T $24,594.50
57109 104974 VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC $12,993.50
57110 104975 VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL $23,641.00
57111 104976 VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS $0.00
57120 104977 COLPOCLEISIS LE FORT TYPE $10,157.00
57130 104978 EXCISION VAGINAL SEPTUM $16,940.50
57135 104979 EXCISION VAGINAL CYST/TUMOR $17,502.00
57150 104980 IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE $340.00
57155 104981 INSERTION UTERINE TANDEM&/VAGINAL OVOIDS $12,665.00
57156 104982 INSERTION VAGINAL RADIATION DEVICE $2,531.50
57160 104983 FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI $547.50
57170 104984 DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS $1,029.50
57180 104985 INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX $2,711.50
57200 104986 COLPORRHAPHY SUTURE INJURY VAGINA $21,003.50
57210 104987 COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU $17,392.50
57220 104988 PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH $15,332.00
57230 104989 PLASTIC REPAIR URETHROCELE $10,723.00
57240 104990 ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO $10,447.00
57250 104991 POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY $14,410.00
57260 104992 CMBND ANTERPOST COLPORRAPHY W/CYSTO $25,913.00
57265 104993 CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR $8,093.00
57267 104994 INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE $8,119.50
57268 104995 REPAIR ENTEROCELE VAGINAL APPROACH SPX $21,074.00
57270 104996 REPAIR ENTEROCELE ABDOMINAL APPROACH SPX $22,662.50
57280 104997 COLPOPEXY ABDOMINAL APPROACH $21,573.50
57282 104998 COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH $15,735.00
57283 104999 COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH $4,086.00
57284 105000 PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR $19,166.50
57285 105001 PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH $13,619.00
57287 105002 RMVL/REVJ SLING STRESS INCONTINENCE $9,795.00
57288 105003 SLING OPERATION STRESS INCONTINENCE $7,841.00
57289 105004 PEREYRA PX W/ANTERIOR COLPORRHAPHY $12,993.50
57291 105005 CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT $12,993.50
57292 105006 CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT $12,993.50
57295 105007 REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP $25,339.00
57296 105008 REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR $0.00
57300 105009 CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR $19,377.00
57305 105010 CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH $0.00
57307 105011 CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST $0.00
57308 105012 CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ $0.00
57310 105013 CLOSURE URETHROVAGINAL FISTULA $15,739.00
57311 105014 CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL $0.00
57320 105015 CLOSURE VESICOVAGINAL FISTULA VAGINAL APPROACH $24,099.50
57330 105016 CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR $12,993.50
57335 105017 VAGINOPLASTY INTERSEX STATE $30,420.00
57400 105018 DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL $15,667.00
57410 105019 PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL $9,072.00
57415 105020 REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL $12,229.00
57420 105021 COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT $2,224.00
57421 105022 COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX $2,917.00
57423 105023 PARAVAGINAL DEFECT REPAIR LAPAROSCOPIC APPROACH $24,224.00
57425 105024 LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX $31,394.50
57426 105025 REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC $25,896.00
57452 105026 COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA $1,231.00
57454 105027 COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE $780.00
57455 105028 COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX $1,601.50
57456 105029 COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE $1,604.00
57460 105030 COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX $15,603.00
57461 105031 COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX $9,141.50
57465 105032 COMPUTER-AIDED MAPG CERVIX UTERI DRG COLPOSCOPY $0.00
57500 105033 BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX $3,227.50
57505 105034 ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C $4,049.00
57510 105035 CAUTERY CERVIX ELECTRO/THERMAL $15,203.00
57511 105036 CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT $2,347.00
57513 105037 CAUTERY CERVIX LASER ABLATION $16,737.50
57520 105038 CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER $15,478.00
57522 105039 CONIZATION CERVIX W/WO D&C RPR ELTRD EXC $15,031.00
57530 105040 TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX $25,409.50
57531 105041 RAD TRACHELECTOMY W/BI PEL LMPHADEC $0.00
57540 105042 EXCISION CERVICAL STUMP ABDOMINAL APPROACH $0.00
57545 105043 EXC CERVICAL STUMP ABDL APPR W/PELVIC FLOOR RPR $0.00
57550 105044 EXCISION CERVICAL STUMP VAGINAL APPROACH $12,993.50
57555 105045 EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR $12,993.50
57556 105046 EXC CRV STUMP VAG APPR W/RPR NTRCL $15,739.00
57558 105047 DILATION & CURETTAGE CERVICAL STUMP $8,299.00
57700 105048 CERCLAGE UTERINE CERVIX NONOBSTETRICAL $21,874.50
57720 105049 TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG $13,765.00
57800 105050 DILATION CERVICAL CANAL INSTRUMENTAL SPX $9,293.50
58100 105051 ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX $526.50
58110 105052 ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY $1,815.50
58120 105053 DILATION & CURETTAGE DX&/THER NONOBSTETRIC $15,135.50
58140 105054 MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR $24,570.00
58145 105055 MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR $23,051.00
58146 105056 MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA $35,769.50
58150 105057 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY $39,394.50
58152 105058 TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY $0.00
58180 105059 SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY $29,498.00
58200 105060 TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM $0.00
58210 105061 RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY $0.00
58240 105062 PEL EXNTJ GYNECOLOGIC MAL $0.00
58260 105063 VAGINAL HYSTERECTOMY UTERUS 250 GM/< $16,314.00
58262 105064 VAG HYST 250 GM/< W/RMVL TUBE&/OVARY $4,036.00
58263 105065 VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL $30,485.50
58267 105066 VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY $32,112.00
58270 105067 VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE $27,399.50
58275 105068 VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY $24,951.50
58280 105069 VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE $0.00
58285 105070 VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION $0.00
58290 105071 VAGINAL HYSTERECTOMY UTERUS > 250 GM $23,984.50
58291 105072 VAG HYST > 250 GM RMVL TUBE&/OVARY $33,815.50
58292 105073 VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE $15,739.00
58294 105074 VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE $15,739.00
58300 105075 INSERTION INTRAUTERINE DEVICE IUD $5,097.00
58301 105076 REMOVAL INTRAUTERINE DEVICE IUD $1,811.00
58321 105077 ARTIFICIAL INSEMINATION INTRA-CERVICAL $2,100.00
58322 105078 ARTIFICIAL INSEMINATION INTRA-UTERINE $2,100.00
58323 105079 SPERM WASHING ARTIFICIAL INSEMINATION $1,063.50
58340 105080 CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI $826.00
58345 105081 TRANSCERV FALLOPIAN TUBE CATH W/WO HYSTOSALPING $15,189.00
58346 105082 INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY $8,299.00
58350 105083 CHROMOTUBATION OVIDUCT W/MATERIALS $14,102.00
58353 105084 ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID $12,071.50
58356 105085 ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR $15,739.00
58400 105086 UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX $25,807.00
58410 105087 UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY $16,451.00
58520 105088 HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL $0.00
58540 105089 HYSTEROPLASTY RPR UTERINE ANOMALY $0.00
58541 105090 LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/< $33,422.50
58542 105091 LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR $20,215.50
58543 105092 LAPS SUPRACERVICAL HYSTERECTOMY >250 $35,256.50
58544 105093 LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY $44,497.00
58545 105094 LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/< $28,928.00
58546 105095 LAPS MYOMECTOMY EXC 5/> MYOMAS >250 GRAMS $29,913.50
58548 105096 LAPS W/RAD HYST W/BILAT LMPHADEC RMVL TUBE/OVARY $51,260.50
58550 105097 LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/< $30,535.00
58552 105098 LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES $46,818.50
58553 105099 LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS $46,177.50
58554 105100 LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR $40,716.00
58555 105101 HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE $18,601.50
58558 105102 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C $20,921.00
58559 105103 HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS $14,165.00
58560 105104 HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM $23,217.50
58561 105105 HYSTEROSCOPY REMOVAL LEIOMYOMATA $25,748.00
58562 105106 HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY $16,224.00
58563 105107 HYSTEROSCOPY ENDOMETRIAL ABLATION $19,341.00
58565 105108 HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS $13,525.50
58570 105109 LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/< $53,221.50
58571 105110 LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY $41,370.00
58572 105111 LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM $48,129.00
58573 105112 LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR $38,680.00
58575 105113 LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC $37,175.00
58578 105114 UNLISTED LAPAROSCOPY PROCEDURE UTERUS $0.00
58579 105115 UNLISTED HYSTEROSCOPY PROCEDURE UTERUS $0.00
58580 105116 TRANSCERVICAL ABLATION UTERINE FIBROID RF $49,887.50
58600 105117 LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI $16,336.00
58605 105118 LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX $0.00
58611 105119 LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG $0.00
58615 105120 OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR $17,178.50
58660 105121 LAPAROSCOPY W/LYSIS OF ADHESIONS $17,895.00
58661 105122 LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES $24,876.00
58662 105123 LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE $28,517.50
58670 105124 LAPAROSCOPY FULGURATION OVIDUCTS $15,748.00
58671 105125 LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS $14,573.00
58672 105126 LAPAROSCOPY FIMBRIOPLASTY $16,023.00
58673 105127 LAPAROSCOPY SALPINGOSTOMY $28,904.50
58674 105128 LAPS ABLTJ UTERINE FIBROIDS W/INTRAOP US GDN $26,965.50
58679 105129 UNLISTED LAPAROSCOPY PROCEDURE OVIDUCT OVARY $0.00
58700 105130 SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX $20,863.00
58720 105131 SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX $25,720.50
58740 105132 LYSIS OF ADHESIONS SALPINX/OVARY $30,282.50
58750 105133 TUBOTUBAL ANASTATOMOSIS $0.00
58752 105134 TUBOUTERINE IMPLANTATION $0.00
58760 105135 FIMBRIOPLASTY $0.00
58770 105136 SALPINGOSTOMY $12,993.50
58800 105137 DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR $15,220.00
58805 105138 DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL $23,699.50
58820 105139 DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN $12,993.50
58822 105140 DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH $0.00
58825 105141 TRANSPOSITION OVARY $0.00
58900 105142 BIOPSY OVARY UNI/BI SEPARATE PROCEDURE $8,299.00
58920 105143 WEDGE RESCJ/BISCTJ OVARY UNI/BI $12,993.50
58925 105144 OVARIAN CYSTECTOMY UNI/BI $26,611.00
58940 105145 OOPHORECTOMY PARTIAL/TOTAL UNI/BI $35,869.00
58943 105146 OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY $0.00
58950 105147 RESCJ OVARIAN/TUBAL/PERITONEAL MALIGNANCY W/BSO $0.00
58951 105148 RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD $0.00
58952 105149 RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING $0.00
58953 105150 BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION $0.00
58954 105151 BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY $0.00
58956 105152 BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC $0.00
58957 105153 RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY $0.00
58958 105154 RESECTION RECRT MAL W/OMENTECTOMY PEL LMPHADEC $0.00
58960 105155 LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK $0.00
58970 105156 FOLLICLE PUNCTURE OOCYTE RETRIEVAL ANY METHOD $8,955.50
58974 105157 EMBRYO TRANSFER INTRAUTERINE $2,100.00
58976 105158 GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH $2,100.00
58999 105159 UNLISTED PX FEMALE GENITAL SYSTEM NONOBSTETRICAL $0.00
59000 105160 AMNIOCENTESIS DIAGNOSIC $1,698.00
59001 105161 AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID $5,423.50
59012 105162 CORDOCENTESIS INTRAUTERINE $8,123.00
59015 105163 CHORIONIC VILLUS SAMPLING $2,838.50
59020 105164 FETAL CONTRACTION STRESS TEST $890.50
59025 105165 FETAL NONSTRESS TEST $929.00
59030 105166 FETAL SCALP BLOOD SAMPLING $1,612.00
59050 105167 FETAL MONITORING LABOR PHYS WRITTEN REPORT $990.50
59051 105168 FETAL MONITR LABOR PHYS WRTTN REPRT INTERPJ ONLY $241.50
59070 105169 TRANSABDOMINAL AMNIOINFUSION W/ULTRSND GUIDANCE $5,354.00
59072 105170 FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE $1,612.00
59074 105171 FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE $3,589.50
59076 105172 FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE $1,612.00
59100 105173 HYSTEROTOMY ABDOMINAL $12,993.50
59120 105174 TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR $40,886.00
59121 105175 TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY $0.00
59130 105176 TX ECTOPIC PREGNANCY ABDL PREGNANCY $0.00
59136 105177 TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER $0.00
59140 105178 TX ECTOPIC PREGNANCY CERVICAL W/EVACUATION $0.00
59150 105179 LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY $28,540.00
59151 105180 LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY $23,157.00
59160 105181 CURETTAGE POSTPARTUM $11,100.50
59200 105182 INSERTION CERVICAL DILATOR SEPARATE PROCEDURE $1,980.00
59300 105183 EPISIOTOMY/VAG RPR OTH/THN ATTENDING $14,301.50
59320 105184 CERCLAGE CERVIX PREGNANCY VAGINAL $15,939.50
59325 105185 CERCLAGE CERVIX PREGNANCY ABDOMINAL $0.00
59350 105186 HYSTERORRHAPHY RUPTURED UTERUS $0.00
59400 105187 OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM $11,138.50
59409 105188 VAGINAL DELIVERY ONLY $8,299.00
59410 105189 VAGINAL DELIVERY ONLY W/POSTPARTUM CARE $6,570.50
59412 105190 EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS $8,299.00
59414 105191 DELIVERY PLACENTA SEPARATE PROCEDURE $8,299.00
59425 105192 ANTEPARTUM CARE ONLY 4-6 VISITS $2,042.00
59426 105193 ANTEPARTUM CARE ONLY 7/> VISITS $4,171.00
59430 105194 POSTPARTUM CARE ONLY SEPARATE PROCEDURE $1,072.50
59510 105195 OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM $12,010.50
59514 105196 CESAREAN DELIVERY ONLY $20,538.00
59515 105197 CESAREAN DELIVERY ONLY W/POSTPARTUM CARE $7,597.50
59525 105198 STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY $0.00
59610 105199 ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB $0.00
59612 105200 VAGINAL DELIVERY AFTER CESAREAN DELIVERY $8,299.00
59614 105201 VAGINAL DELIVERY & POSTPARTUM CARE VBAC $0.00
59618 105202 ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC $0.00
59620 105203 CESAREAN DELIVERY ATTEMPTED VBAC $0.00
59622 105204 CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA $0.00
59812 105205 TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL $15,939.50
59820 105206 TX MISSED ABORTION FIRST TRIMESTER SURGICAL $16,049.00
59821 105207 TX MISSED ABORTION SECOND TRIMESTER SURGICAL $14,304.00
59830 105208 TX SEPTIC ABORTION SURGICAL $0.00
59840 105209 INDUCED ABORTION DILATION AND CURETTAGE $14,458.50
59841 105210 INDUCED ABORTION DILATION & EVACUATION $15,846.50
59850 105211 INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ $0.00
59851 105212 INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C $0.00
59852 105213 INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM $0.00
59855 105214 INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS $0.00
59856 105215 INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC $0.00
59857 105216 INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT $0.00
59866 105217 MULTIFETAL PREGNANCY REDUCTION $3,934.00
59870 105218 UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE $15,275.50
59871 105219 REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA $14,241.50
59897 105220 UNLISTED FETAL INVASIVE PX W/ULTRASOUND $0.00
59898 105221 UNLISTED LAPAROSCOPY PX MATERNITY CARE&DELIVERY $0.00
59899 105222 UNLISTED PROCEDURE MATERNITY CARE & DELIVERY $0.00
60000 105223 I&D THYROGLOSSAL DUCT CYST INFECTED $2,846.50
60100 105224 BIOPSY THYROID PERCUTANEOUS CORE NEEDLE $2,807.00
60200 105225 EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS $14,889.50
6020F 105226 NOTHING BY MOUTH ORDERED $0.00
60210 105227 PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY $19,851.00
60212 105228 PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC $21,488.00
60220 105229 TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY $20,472.00
60225 105230 TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC $22,073.50
60240 105231 THYROIDECTOMY TOTAL/COMPLETE $27,060.50
60252 105232 THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT $20,347.50
60254 105233 THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT $58,791.00
60260 105234 THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL $21,366.00
60270 105235 THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC $46,827.00
60271 105236 THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH $19,871.00
60280 105237 EXCISION THYROGLOSSAL DUCT CYST/SINUS $18,131.00
60281 105238 EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT $23,950.00
60300 105239 ASPIRATION AND/OR INJECTION THYROID CYST $1,655.50
60500 105240 PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS $20,350.50
60502 105241 PARATHYROIDECTOMY/EXPLOR PARATHYROIDS RE-EXPLOR $34,255.50
60505 105242 PARATHYRDEC/EXPL PARATHYR MEDSTNL STERNAL/TTHRC $0.00
60512 105243 PARATHYROID AUTOTRANSPLANTATION ADD-ON $10,806.50
60520 105244 THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX $19,277.50
60521 105245 THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX $0.00
60522 105246 THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX $0.00
60540 105247 ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX $0.00
60545 105248 ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR $0.00
60600 105249 EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY $0.00
60605 105250 EXC CAROTID BODY TUMOR W EXC CAROTID ARTERY $0.00
60650 105251 LAPAROSCOPY ADRENALECTOMY PRTL/COMPL TABDL $35,153.50
60659 105252 UNLISTED LAPAROSCOPY PROCEDURE ENDOCRINE SYSTEM $0.00
60699 105253 UNLISTED PROCEDURE ENDOCRINE SYSTEM $0.00
61000 105254 SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT $2,946.00
61001 105255 SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ $2,946.00
6100F 105256 VERIFY CORRECT PT SITE PXD DOCUMENTED $0.00
6101F 105257 SAFETY COUNSELING DEMENTIA PROVIDED $0.00
61020 105258 VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX $2,767.50
61026 105259 VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ $3,492.00
6102F 105260 SAFETY COUNSELING DEMENTIA ORDERED $0.00
61050 105261 CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX $2,946.00
61055 105262 CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION $2,444.00
61070 105263 PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX $1,007.00
61105 105264 TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE $0.00
61107 105265 TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE $27,301.00
61108 105266 TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA $0.00
6110F 105267 COUNSELING PROV RE RISKS DRIVING ALT TO DRIVING $0.00
61120 105268 BURR HOLE VENTRICULAR PUNCTURE $0.00
61140 105269 BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION $0.00
61150 105270 BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST $0.00
61151 105271 BURR HOLE/TREPHINE W/SBSQ TAPPING ICRA ABSC/CST $0.00
61154 105272 BURR HOLE W/EVAC&/DRG HEMATOMA XDRL/SDRL $0.00
61156 105273 BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL $0.00
61210 105274 BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE $21,641.50
61215 105275 INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH $10,977.50
61250 105276 BURR HOLE/TREPHINE SUPRATENTORIAL W/O OTH SURG $0.00
61253 105277 BURR HOLE/TREPHINE INFRATENTORIAL UNI/BI $0.00
61304 105278 CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL $0.00
61305 105279 CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL $0.00
61312 105280 CRANIECTOMY HMTMA SUPRATENTORIAL EXTRA/SUBDURAL $0.00
61313 105281 CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL $0.00
61314 105282 CRANIECTOMY HMTMA INFRATENTORIAL EXTRA/SUBDURAL $0.00
61315 105283 CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL $0.00
61316 105284 INCISION & SUBCUTANEOUS PLMT CRANIAL BONE GRAF $0.00
61320 105285 CRANIECTOMY/CRANIOTMY DRG ABSCESS SUPRATENTORIAL $0.00
61321 105286 CRANIECTOMY/CRANIOTMY DRG ABSCESS INFRATENTORIAL $0.00
61322 105287 CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY $0.00
61323 105288 CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY $0.00
61330 105289 DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH $11,048.00
61333 105290 EXPL ORBIT TRANSCRANIAL APPROACH W/RMVL LESION $0.00
61340 105291 SUBTEMPORAL CRANIAL DECOMPRESSION $0.00
61343 105292 CRNEC SUBOCCIPITAL CRV LAM DCMPRN MEDULLA & CORD $0.00
61345 105293 OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA $0.00
61450 105294 CRNEC STPL SCTJ COMPRESSION/DCMPRN GANGLION $0.00
61458 105295 CRNEC SOPL EXPL/DCMPRN CRNL NRV $0.00
61460 105296 CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NR $0.00
61500 105297 CRANIECTOMY W/EXCISION TUMOR/LESION SKULL $19,508.00
61501 105298 CRANIECTOMY OSTEOMYELITIS $0.00
6150F 105299 PT NOT RCVNG 1ST COURSE OF ANTI-TNF THERAPY $0.00
61510 105300 CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR $0.00
61512 105301 CRNEC TREPHINE BONE FLAP MENINGIOMA SUPRATENTOR $0.00
61514 105302 CRNEC TREPHINE BONE FLAP BRAIN ABSC SUPRATENTOR $0.00
61516 105303 CRNEC TREPHINE BONE FLAP FENEST CYST SUPRATENTOR $0.00
61517 105304 IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT $0.00
61518 105305 CRNEC EXC BRAIN TUMOR INFRATENTORIAL/POST FOSSA $0.00
61519 105306 CRNEC EXC TUM INFRATENTOR/POST FOSSA MENINGIOMA $0.00
61520 105307 CRNEC TUM INFRATTL/POSTFOSSA CRBLOPNT ANGLE TUM $0.00
61521 105308 CRNEC TUM INFRATTL/PFOSSA MIDLINE TUM BASE SKULL $0.00
61522 105309 CRNEC INFRATNTORIAL/POST FOSSA EXC BRAIN ABSCESS $0.00
61524 105310 CRNEC INFRATNTOR/POSTFOSSA EXC/FENESTRATION CYST $0.00
61526 105311 CRNEC TRANSTEMPOR EXC CEREBELLOPONTINE ANGLE TUM $0.00
61530 105312 CRNEC EXC CEREBELLOPNTIN ANGLE TUM MID/POSTFOSSA $0.00
61531 105313 SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING $0.00
61533 105314 CRANIOT SUBDURAL IMPLT ELCTRD SEIZURE MONITORING $0.00
61534 105315 CRANIOT EPILEPTOGENIC FOC W/O ELECTRCORTICOGRPHY $0.00
61535 105316 CRANIOT RMVL EPID/SUBDURL ELCTRD W/O EXC TIS SPX $0.00
61536 105317 CRANIOT EPILEPTOGENIC FOCUS W/ELECTROCORTCOGRPHY $0.00
61537 105318 CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY $0.00
61538 105319 CRANIOT LOBEC TEMPORAL LOBE W/ELECTROCORTCOGRPHY $0.00
61539 105320 CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG $0.00
61540 105321 CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG $0.00
61541 105322 CRANIOTOMY TRANSECTION CORPUS CALLOSUM $0.00
61543 105323 CRANIOTOMY PARTIAL/SUBTOTAL HEMISPHERECTOMY $0.00
61544 105324 CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS $0.00
61545 105325 CRANIOTOMY EXCISION CRANIOPHARYNGIOMA $0.00
61546 105326 CRANIOT HYPOPHYSEC/EXC PITUITARY TUMOR ICRL APPR $0.00
61548 105327 HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL $0.00
61550 105328 CRANIECTOMY CRANIOSYNOSTOSIS 1 CRANIAL SUTURE $0.00
61552 105329 CRANIECT CRANIOSYNOSTOSIS MULT CRANIAL SUTURES $0.00
61556 105330 CRANIEC CRANIOSYNOSTOSIS FRONT/PARIET BONE FLAP $0.00
61557 105331 CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP $0.00
61558 105332 XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS $0.00
61559 105333 XTN CRNEC MLT SUTR CRANIOSYNOSTOSIS W/BONE GRAFT $0.00
61563 105334 EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN $0.00
61564 105335 EXC BENIGN TUM CRANIAL BONE W/OPTIC NRV DCMPRN $0.00
61566 105336 CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY $0.00
61567 105337 CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG $0.00
61570 105338 CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN $0.00
61571 105339 CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN $0.00
61575 105340 TRNSRAL SKULL BSE/BR STEM/CORD BX/DCOMPR/EXC LES $0.00
61576 105341 TRNSRL SKUL BSE/BR STM/CORD BX/DCMP/ SPLT TONGUE $0.00
61580 105342 CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ $0.00
61581 105343 CRANIOFACIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ $0.00
61582 105344 CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT $0.00
61583 105345 CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE $0.00
61584 105346 ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ $0.00
61585 105347 ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ $0.00
61586 105348 BICORONAL TRANSZYGMTC&/LEFORT I W/O BONE GRFT $0.00
61590 105349 INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN $0.00
61591 105350 INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI $0.00
61592 105351 ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE $0.00
61595 105352 TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV $0.00
61596 105353 TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART $0.00
61597 105354 TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL $0.00
61598 105355 TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM $0.00
61600 105356 RESCJ/EXC LES BASE ANT CRANIAL FOSSA EXTRADURAL $0.00
61601 105357 RESCJ/EXC LES BASE ANT CRNL FOSSA INDRL W/WO GRF $0.00
61605 105358 RESCJ/EXC LES INFRATEMPOR FOSSA SPACE APEX XDRL $0.00
61606 105359 RESCJ/EXC LES ITPRL FOSSA SPACE APEX IDRL W/RPR $0.00
61607 105360 RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL $0.00
61608 105361 RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL $0.00
61611 105362 TRNSXJ/LIG CAROTID ARTERY PETROUS CANAL W/O RPR $0.00
61613 105363 OBLTRJ CAROTID ARYSM ARTVEN CAROTID FISTULA DSJ $0.00
61615 105364 RESCJ/EXC LES BASE POST CRNL FOSSA JUG FRMN XDRL $0.00
61616 105365 RESCJ/EXC LES BASE PCF FORAMEN VRT BODIES IDRL $0.00
61618 105366 SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT $0.00
61619 105367 SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP $0.00
61623 105368 EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK $19,925.00
61624 105369 TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS $23,721.00
61626 105370 TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS $21,765.50
61630 105371 BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS $0.00
61635 105372 TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD $17,375.50
61640 105373 BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL $3,221.50
61641 105374 PERQ BALO DILA IC VSPSM EA VSL SM VASC TER $0.00
61642 105375 PERQ BALO DILA IC VSPSM EA VSL DIFF VASC TER $0.00
61645 105376 PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL $32,328.00
61650 105377 EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST $14,487.50
61651 105378 EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL $0.00
61680 105379 INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL $0.00
61682 105380 INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL $0.00
61684 105381 INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL $0.00
61686 105382 INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL $0.00
61690 105383 INTRACRANIAL ARVEN MALFRMJ DURAL SMPL $0.00
61692 105384 INTRACRANIAL ARVEN MALFRMJ DURAL CMPL $0.00
61697 105385 COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION $0.00
61698 105386 CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ $0.00
61700 105387 SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION $0.00
61702 105388 SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ $0.00
61703 105389 ICRA CRV APPL OCCLUDING CLAMP CRV CRTD ART $0.00
61705 105390 ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART $0.00
61708 105391 ARYSM VASC MALFRMJ/ICRA ELECTROTHROMBOSIS $0.00
61710 105392 ARYSM VASC MALFRMJ IA EMBOLIZATION $0.00
61711 105393 ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES $0.00
61720 105394 CRTJ LES STRTCTC BURR GLOBUS PALLIDUS/THALAMUS $8,959.50
61735 105395 CRTJ LES STRTCTC BURR SUBCORTICAL STRUX OTH/THN $0.00
61736 105396 LITT LES ICR SINGLE TRAJECTORY 1 SIMPLE LESION $0.00
61737 105397 LITT LES ICR MLT TRAJECTORIES MLT/CPLX LESIONS $0.00
61750 105398 STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES $56,801.50
61751 105399 STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR $41,411.50
61760 105400 STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING $0.00
61770 105401 STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC $8,959.50
61781 105402 STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL $8,042.00
61782 105403 STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL $3,674.00
61783 105404 STEREOTACTIC COMPUTER ASSISTED PX SPINAL $9,878.50
61790 105405 CREATE LESION STRTCTC PRQ NEUROLYTIC GASSERIAN $15,171.00
61791 105406 CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC $13,571.00
61796 105407 STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES $78,497.00
61797 105408 STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE $32,346.50
61798 105409 STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES $96,930.00
61799 105410 STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX $21,974.50
61800 105411 APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY $45,069.50
61850 105412 TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL $0.00
61860 105413 CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL $0.00
61863 105414 STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY $0.00
61864 105415 STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY $0.00
61867 105416 STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY $69,456.00
61868 105417 STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY $0.00
61880 105418 REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS $13,950.00
61885 105419 INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR $7,390.50
61886 105420 INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS $9,068.00
61888 105421 REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR $16,137.00
61889 105422 INSERTION SKULL-MNTD CRANIAL NSTIM PG/RECEIVER $0.00
61891 105423 REVJ/RPLCMT SKULL-MNTD CRANIAL NSTIM PG/RECEIVER $0.00
61892 105424 REMOVAL SKULL-MNTD CRANIAL NSTIM PG/RCVR W/CRNOP $17,141.00
62000 105425 ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL $7,036.00
62005 105426 ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL $0.00
62010 105427 ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN $0.00
62100 105428 CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA $0.00
62115 105429 RDCTJ CRANIOMEGALIC SKULL W/O GRAFT/CRANIOPLASTY $0.00
62117 105430 RDCTJ CRANIOMEGALIC CRANIO&RECNSTJ W/WO GRAFT $0.00
62120 105431 RPR ENCEPHALOCELE SKULL VAULT W/CRANIOPLASTY $0.00
62121 105432 CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE $0.00
62140 105433 CRANIOPLASTY SKULL DEFECT <5 CM DIAMETER $25,255.50
62141 105434 CRANIOPLASTY SKULL DEFECT >5 CM DIAMETER $42,743.50
62142 105435 RMVL BONE FLAP/PROSTHETIC PLATE SKULL $28,247.50
62143 105436 RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL $0.00
62145 105437 CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG $0.00
62146 105438 CRANIOPLASTY W/AUTOGRAFT <5 CM DIAMETER $0.00
62147 105439 CRANIOPLASTY W/AUTOGRAFT > 5 CM DIAMETER $0.00
62148 105440 INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT $0.00
62160 105441 NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS $17,115.00
62161 105442 NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS $0.00
62162 105443 NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG $0.00
62164 105444 NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY $0.00
62165 105445 NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID $0.00
62180 105446 VENTRICULOCISTERNOSTOMY $0.00
62190 105447 CRTJ SHUNT SARACH/SDRL-ATR-JUG-AUR $0.00
62192 105448 CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH $0.00
62194 105449 RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER $2,946.00
62200 105450 VENTRICULOCISTERNOSTOMY 3RD VENTRICLE $0.00
62201 105451 VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC $0.00
62220 105452 CRTJ SHUNT VENTRICULO-ATR-JUG-AUR $0.00
62223 105453 CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS $22,074.00
62225 105454 RPLCMT/IRRIGATION VENTRICULAR CATHETER $19,275.50
62230 105455 RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS $18,958.50
62252 105456 REPRGRMG PROGRAMMABLE CEREBROSPINAL SHUNT $982.00
62256 105457 RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT $0.00
62258 105458 RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT $0.00
62263 105459 PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS $5,880.50
62264 105460 PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY $4,773.00
62267 105461 PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS $3,045.50
62268 105462 PERCUTANEOUS ASPIRATION SPINAL CORD CYST/SYRINX $3,929.00
62269 105463 BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE $7,029.00
62270 105464 DIAGNOSTIC LUMBAR SPINAL PUNCTURE $1,724.50
62272 105465 THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF $3,719.00
62273 105466 INJECTION EPIDURAL BLOOD/CLOT PATCH $3,701.00
62280 105467 INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID $2,946.00
62281 105468 INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC $6,565.50
62282 105469 INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL $4,491.50
62284 105470 INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR $2,899.00
62287 105471 DCMPRN PX PERQ NUCLEUS PULPOSUS 1/MLT LVL LUMBAR $13,108.00
62290 105472 INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR $5,581.50
62291 105473 INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC $3,073.00
62292 105474 INJECTION PX CHEMONUCLEOLYSIS 1/MLT LUMBAR $2,946.00
62294 105475 NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL $2,946.00
62302 105476 MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL $3,690.00
62303 105477 MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC $5,935.00
62304 105478 MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL $3,664.00
62305 105479 MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS $3,830.00
62320 105480 NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN $3,591.50
62321 105481 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN $2,169.50
62322 105482 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN $3,739.00
62323 105483 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN $3,448.00
62324 105484 NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN $5,390.00
62325 105485 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN $4,515.00
62326 105486 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN $4,835.00
62327 105487 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN $4,814.00
62328 105488 DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT $3,883.00
62329 105489 THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT $3,933.50
62350 105490 IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM $16,102.50
62351 105491 IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM $21,692.50
62355 105492 RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH $12,982.00
62360 105493 IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR $21,441.50
62361 105494 IMPLTJ/RPLCMT FS NON-PRGRBL PUMP $33,104.50
62362 105495 IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP $7,184.50
62365 105496 RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS $13,097.00
62367 105497 ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL $682.00
62368 105498 ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG $546.00
62369 105499 ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL $1,556.00
62370 105500 ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP $1,410.00
62380 105501 NDSC DCMPRN SPINAL CORD 1 W/LAMOT NTRSPC LUMBAR $34,736.00
63001 105502 LAM W/O FACETEC FORAMOT/DSC 1/2 VRT SGM CRV $20,975.00
63003 105503 LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC $22,803.00
63005 105504 LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR $21,281.00
63011 105505 LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL $12,243.50
63012 105506 LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR $23,221.00
63015 105507 LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL $23,681.50
63016 105508 LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC $36,097.50
63017 105509 LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR $46,544.50
63020 105510 LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC $20,865.00
63030 105511 LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR $17,854.50
63035 105512 LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR $18,609.50
63040 105513 LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL $20,751.50
63042 105514 LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR $19,528.00
63043 105515 LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC EA CRV $0.00
63044 105516 LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR $10,507.50
63045 105517 LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM CERVICAL $18,211.00
63046 105518 LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM THORACIC $19,642.50
63047 105519 LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM LUMBAR $18,150.50
63048 105520 LAM FACETECTOMY&FORAMOT 1 VRT SGM EA ADDL SGM $6,359.50
63050 105521 LAMOP CERVICAL W/DCMPRN SPI CORD 2/> VERT SEG $51,434.50
63051 105522 LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ $50,910.00
63052 105523 LAM FACETEC/FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM $12,660.50
63053 105524 LAM FACETEC/FORAMOT DRG ARTHRD LMBR EA ADDL SGM $9,216.50
63055 105525 TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC $24,807.50
63056 105526 TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR $15,461.00
63057 105527 TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR $19,433.00
63064 105528 COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG $12,243.50
63066 105529 COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG $12,243.50
63075 105530 DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC $27,606.00
63076 105531 DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC $12,243.50
63077 105532 DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC $0.00
63078 105533 DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC $0.00
63081 105534 VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG $14,063.00
63082 105535 VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG $9,268.00
63085 105536 VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG $0.00
63086 105537 VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG $0.00
63087 105538 VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG $0.00
63088 105539 VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG $0.00
63090 105540 VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG $0.00
63091 105541 VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG $0.00
63101 105542 VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG $0.00
63102 105543 VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG $0.00
63103 105544 VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG $0.00
63170 105545 LAM W/MYELOTOMY CERVICAL/THORACIC/THORACOLUMBAR $0.00
63172 105546 LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID $0.00
63173 105547 LAM W/DRG INTRMEDULRY CYST/SYRINX PRTL/PLEURAL $0.00
63185 105548 LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS $0.00
63190 105549 LAMINECTOMY W/RHIZOTOMY > 2 SEGMENTS $0.00
63191 105550 LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE $0.00
63197 105551 LAM W/CORDOTOMY SCTJ SPINOTHALAMIC TRC 1STG THRC $0.00
63200 105552 LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR $48,782.50
63250 105553 LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL $0.00
63251 105554 LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC $0.00
63252 105555 LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR $0.00
63265 105556 LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL $31,363.00
63266 105557 LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC $25,156.00
63267 105558 LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR $17,116.00
63268 105559 LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL $25,156.00
63270 105560 LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL $0.00
63271 105561 LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC $0.00
63272 105562 LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR $0.00
63273 105563 LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL $0.00
63275 105564 LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL $0.00
63276 105565 LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC $0.00
63277 105566 LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR $0.00
63278 105567 LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL $0.00
63280 105568 LAM BX/EXC ISPI NEO IDRL XMED CERVICAL $0.00
63281 105569 LAM BX/EXC ISPI NEO IDRL XMED THORACIC $0.00
63282 105570 LAM BX/EXC ISPI NEO IDRL XMED LUMBAR $0.00
63283 105571 LAM BX/EXC ISPI NEO IDRL SACRAL $0.00
63285 105572 LAM BX/EXC ISPI NEO IDRL IMED CERVICAL $0.00
63286 105573 LAM BX/EXC ISPI NEO IDRL IMED THORACIC $0.00
63287 105574 LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR $0.00
63290 105575 LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL $0.00
63295 105576 OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX $0.00
63300 105577 VCRPEC LES 1 SGM XDRL CERVICAL $0.00
63301 105578 VCRPEC LES 1 SGM XDRL THORACIC TTHRC $0.00
63302 105579 VCRPEC LES 1 SEG XDRL THRC THORACOLMBR $0.00
63303 105580 VCRPEC LES 1 SEG XDRL LMBR/SAC TRANSPRTL/RPR $0.00
63304 105581 VERTEBRAL CORPECTOMY EXC LES 1 SEG IDRL CERVICAL $0.00
63305 105582 VERTEBRAL CORPECTOMY LES 1 SEG IDRL THRC TTHRC $0.00
63306 105583 VERTEBRL CORPECT LES 1 SEG IDRL THRC THORACOLMBR $0.00
63307 105584 VCRPEC LES 1 SEG IDRL LMBR/SAC TRANSPRTL/RPR $0.00
63308 105585 VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG $0.00
63600 105586 CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ $5,651.50
63610 105587 STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG $5,651.50
63620 105588 STEREOTACTIC RADIOSURGERY 1 SPINAL LESION $9,022.00
63621 105589 STEREOTACTIC RADIOSURGERY EA ADDL SPINAL LESION $1,594.00
63650 105590 PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL $4,469.50
63655 105591 LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL $16,700.50
63661 105592 RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR $11,196.50
63662 105593 RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR $12,239.50
63663 105594 REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR $14,425.00
63664 105595 REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR $16,680.00
63685 105596 INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ $10,749.00
63688 105597 REVJ/RMVL IMPL SPI NPG/RCVR DTCH CONNJ ELTRD RA $10,707.00
63700 105598 REPAIR MENINGOCELE < 5 CM DIAMETER $0.00
63702 105599 REPAIR MENINGOCELE > 5 CM DIAMETER $0.00
63704 105600 REPAIR MYELOMENINGOCELE < 5 CM DIAMETER $0.00
63706 105601 REPAIR MYELOMENINGOCELE > 5 CM DIAMETER $0.00
63707 105602 RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM $24,147.00
63709 105603 RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM $23,294.50
63710 105604 DURAL GRAFT SPINAL $16,092.00
63740 105605 CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM $0.00
63741 105606 CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM $21,615.00
63744 105607 RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT $22,306.50
63746 105608 RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT $4,025.50
64400 105609 INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH $2,106.50
64405 105610 INJECTION AA&/STRD GREATER OCCIPITAL NERVE $1,710.00
64408 105611 INJECTION AA&/STRD VAGUS NERVE $1,259.00
64415 105612 INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN $3,329.00
64416 105613 INJECTION AA&/STRD BRACH PLEX CONT NFS CATH IMG $5,898.00
64417 105614 INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN $3,630.00
64418 105615 INJECTION AA&/STRD SUPRASCAPULAR NERVE $3,548.50
64420 105616 INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL $2,395.00
64421 105617 INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL $2,330.00
64425 105618 INJECTION AA&/STRD ILIOINGUINAL IH NERVES $2,173.50
64430 105619 INJECTION AA&/STRD PUDENDAL NERVE $5,281.50
64435 105620 INJECTION AA&/STRD PARACERVICAL NERVE $1,993.50
64445 105621 INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN $3,199.00
64446 105622 INJECTION AA&/STRD SCIATIC NRV CONT NFS CATH IMG $1,345.00
64447 105623 INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN $4,567.50
64448 105624 INJECTION AA&/STRD FEM NRV CONT NFS CATH IMG GDN $8,385.00
64449 105625 INJECTION AA&/STRD LUMBAR PLEXUS CONT NFS CATH $6,401.50
64450 105626 INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH $1,831.00
64451 105627 INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG $4,459.50
64454 105628 INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG $2,888.00
64455 105629 NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES $744.50
64461 105630 PVB THORACIC SINGLE INJECTION SITE W/IMG GID $2,988.00
64462 105631 PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID $3,118.00
64463 105632 PVB THORACIC CONT CATHETER INFUSION W/IMG GID $6,746.50
64479 105633 NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL $3,126.50
64480 105634 NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL $1,997.00
64483 105635 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL $3,903.50
64484 105636 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL $716.00
64486 105637 TAP BLOCK UNILATERAL BY INJECTION(S) $5,472.00
64487 105638 TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S) $3,585.00
64488 105639 TAP BLOCK BILATERAL BY INJECTION(S) $19,006.00
64489 105640 TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S) $12,422.00
64490 105641 NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL $8,000.00
64491 105642 NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL $3,206.50
64492 105643 NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL $3,072.00
64493 105644 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL $8,068.50
64494 105645 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL $2,457.50
64495 105646 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL $2,968.00
64505 105647 INJECTION ANES AGENT SPHENOPALATINE GANGLION $1,885.00
64510 105648 NJX ANES STELLATE GANGLION CRV SYMPATHETIC $2,623.50
64517 105649 INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS $3,754.50
64520 105650 INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC $2,918.00
64530 105651 INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG $3,786.00
64553 105652 PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE $24,810.00
64555 105653 PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV $5,234.50
64561 105654 PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING $10,393.00
64566 105655 POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE $1,540.00
64568 105656 OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN $22,882.50
64569 105657 REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV $28,351.00
64570 105658 REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO $16,574.00
64575 105659 OPEN IMPLANTATION NEA PERIPHERAL NERVE $18,437.50
64580 105660 OPEN IMPLANTATION NEA NEUROMUSCULAR $19,107.00
64581 105661 OPEN IMPLANTATION NEA SACRAL NERVE $9,127.50
64582 105662 OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR $18,785.50
64583 105663 REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR $38,833.50
64584 105664 REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG&RESPIR SNR $24,133.50
64585 105665 REVJ/RMVL PERPH NEUROSTIMULATOR ELECTRODE ARRAY $6,753.00
64590 105666 INS/RPLC PERPH SAC/GSTRC NPG/RCVR PCKT CRTJ&CONN $9,450.50
64595 105667 REV/RMV PRPH SAC/GSTRC NPG/RCV DTCH CONN ELTR RA $4,471.50
64596 105668 INSJ/RPLCMT PERQ ELTRD RA PN W/INT NSTIM 1ST RA $0.00
64597 105669 INSJ/RPLCMT PERQ ELTRD RA PN INT NSTIM EA ADD RA $0.00
64598 105670 REVISION/REMOVAL NSTIM ELTRD ARRAY PN INT NSTIM $17,737.00
64600 105671 DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH $6,923.50
64605 105672 DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH $13,381.50
64610 105673 DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR $6,832.50
64611 105674 CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS $1,422.50
64612 105675 CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL $1,153.00
64615 105676 CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE $980.00
64616 105677 CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA $1,353.50
64617 105678 CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG $2,152.00
64620 105679 DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE $4,353.50
64624 105680 DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG $5,420.50
64625 105681 RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN $8,809.00
64628 105682 THERMAL DSTRJ INTRAOSSEOUS BVN 1ST 2 LMBR/SAC $41,426.00
64629 105683 THERMAL DSTRJ INTRAOSSEOUS BVN EA ADDL LMBR/SAC $15,129.00
64630 105684 DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE $5,873.50
64632 105685 DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE $906.50
64633 105686 DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA $4,763.00
64634 105687 DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA $4,065.00
64635 105688 DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL $4,789.00
64636 105689 DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL $3,920.50
64640 105690 DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE $4,245.50
64642 105691 CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE $2,861.00
64643 105692 CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE $2,172.00
64644 105693 CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES $2,622.50
64645 105694 CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES $1,967.50
64646 105695 CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES $1,530.00
64647 105696 CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES $3,089.50
64650 105697 CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE $789.50
64653 105698 CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY $1,081.50
64680 105699 DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS $4,071.50
64681 105700 DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS $4,025.50
64702 105701 NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT $9,498.50
64704 105702 NEUROPLASTY NERVE HAND/FOOT $8,660.50
64708 105703 NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC $8,643.00
64712 105704 NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV $19,832.50
64713 105705 NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS $6,737.50
64714 105706 NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS $14,957.00
64716 105707 NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE $15,103.50
64718 105708 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW $9,916.50
64719 105709 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST $7,321.50
64721 105710 NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE $8,544.50
64722 105711 DECOMPRESSION UNSPECIFIED NERVE $7,540.00
64726 105712 DECOMPRESSION PLANTAR DIGITAL NERVE $8,911.50
64727 105713 INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE $8,743.50
64732 105714 TRANSECTION/AVULSION SUPRAORBITAL NERVE $5,651.50
64734 105715 TRANSECTION/AVULSION INFRAORBITAL NERVE $5,651.50
64736 105716 TRANSECTION/AVULSION MENTAL NERVE $5,651.50
64738 105717 TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO $5,651.50
64740 105718 TRANSECTION/AVULSION LINGUAL NERVE $5,651.50
64742 105719 TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL $14,472.00
64744 105720 TRANSECTION/AVULSION GREATER OCCIPITAL NERVE $22,622.00
64746 105721 TRANSECTION/AVULSION PHRENIC NERVE $5,651.50
64755 105722 TRANSECTION/AVULSION VAGUS NERVES $0.00
64760 105723 TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL $0.00
64763 105724 TRNSXJ/AVLSN OBTURAT NRV XPELV W/WO TENOTOMY $5,651.50
64766 105725 TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY $8,959.50
64771 105726 TRANSECTION/AVULSION OTH CRANIAL NRV XDRL $14,274.50
64772 105727 TRANSECTION/AVULSION OTH SPINAL NRV XDRL $6,772.50
64774 105728 EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE $9,352.00
64776 105729 EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT $11,327.00
64778 105730 EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT $5,651.50
64782 105731 EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE $11,740.50
64783 105732 EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT $7,232.50
64784 105733 EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC $10,946.00
64786 105734 EXCISION NEUROMA SCIATIC NERVE $20,043.00
64787 105735 IMPLANTATION NERVE END BONE/MUSCLE $7,316.50
64788 105736 EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV $9,366.50
64790 105737 EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV $14,902.50
64792 105738 EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV $27,938.00
64795 105739 BIOPSY NERVE $9,201.00
64802 105740 SYMPATHECTOMY CERVICAL $5,651.50
64804 105741 SYMPATHECTOMY CERVICOTHORACIC $5,651.50
64809 105742 SYMPATHECTOMY THORACOLUMBAR $0.00
64818 105743 SYMPATHECTOMY LUMBAR $0.00
64820 105744 SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT $4,734.50
64821 105745 SYMPATHECTOMY RADIAL ARTERY $7,127.00
64822 105746 SYMPATHECTOMY ULNAR ARTERY $5,900.00
64823 105747 SYMPATHECTOMY SUPERFICIAL PALMAR ARCH $7,806.00
64831 105748 SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE $12,601.50
64832 105749 SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV $5,378.50
64834 105750 SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE $8,959.50
64835 105751 SUTURE 1 NERVE MEDIAN MOTOR THENAR $15,895.50
64836 105752 SUTURE 1 NERVE ULNAR MOTOR $9,666.50
64837 105753 SUTURE EACH ADDITIONAL NERVE HAND/FOOT $8,959.50
64840 105754 SUTURE POSTERIOR TIBIAL NERVE $8,959.50
64856 105755 SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS $8,959.50
64857 105756 SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS $11,140.00
64858 105757 SUTURE SCIATIC NERVE $8,959.50
64859 105758 SUTURE EACH ADDITIONAL PERIPHERAL NERVE $8,959.50
64861 105759 SUTURE BRACHIAL PLEXUS $8,959.50
64862 105760 SUTURE LUMBAR PLEXUS $8,959.50
64864 105761 SUTURE FACIAL NERVE EXTRACRANIAL $16,484.00
64865 105762 SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT $8,959.50
64866 105763 ANASTOMOSIS FACIAL-SPINAL ACCESSORY $0.00
64868 105764 ANASTOMOSIS FACIAL HYPOGLOSSAL $0.00
64872 105765 SUTURE NERVE REQ SECONDARY/DELAYED SUTURE $8,959.50
64874 105766 SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE $8,959.50
64876 105767 SUTURE NERVE REQ SHORTENING BONE EXTREMITY $8,959.50
64885 105768 NERVE GRAFT HEAD/NECK <4 CM $8,959.50
64886 105769 NERVE GRAFT HEAD/NECK >4 CM $21,670.50
64890 105770 NERVE GRAFT 1 STRAND HAND/FOOT <4 CM $17,093.50
64891 105771 NERVE GRAFT 1 STRAND HAND/FOOT >4 CM $8,959.50
64892 105772 NERVE GRAFT 1 STRAND ARM/LEG <4 CM $8,959.50
64893 105773 NERVE GRAFT 1 STRAND ARM/LEG >4 CM $8,959.50
64895 105774 NERVE GRAFT MLT STRANDS HAND/FOOT <4 CM $8,959.50
64896 105775 NERVE GRAFT MLT STRANDS HAND/FOOT > 4 CM $8,959.50
64897 105776 NERVE GRAFT MLT STRANDS ARM/LEG <4 CM $8,959.50
64898 105777 NERVE GRAFT MLT STRANDS ARM/LEG >4 CM $8,959.50
64901 105778 NERVE GRAFT EACH NERVE 1 STRAND $8,959.50
64902 105779 NERVE GRAFT EACH NERVE MULTIPLE STRANDS $8,959.50
64905 105780 NERVE PEDICLE TRANSFER FIRST STAGE $19,779.50
64907 105781 NERVE PEDICAL TRANSFER SECOND STAGE $8,959.50
64910 105782 NERVE REPAIR W/CONDUIT EACH NERVE $11,099.50
64911 105783 NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE $8,959.50
64912 105784 NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND $14,076.00
64913 105785 NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND $8,233.50
64999 105786 UNLISTED PROCEDURE NERVOUS SYSTEM $0.00
65091 105787 EVISCERATION OCULAR CONTENTS W/O IMPLANT $12,743.00
65093 105788 EVISCERATION OCULAR CONTENTS W/IMPLANT $13,431.50
65101 105789 ENUCLEATION OF EYE W/O IMPLANT $14,578.50
65103 105790 ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT $14,683.00
65105 105791 ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT $15,438.50
65110 105792 EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY $15,977.50
65112 105793 EXENTERATION ORBIT RMVL ORBIT CONTENTS & BONE $10,516.50
65114 105794 EXNTJ ORBIT RMVL ORB CNTS W/MUSC/MYOQ FLAP $10,516.50
65125 105795 MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX $7,801.00
65130 105796 INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL $7,801.00
65135 105797 INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED $7,801.00
65140 105798 INSJ OC IMPLT AFTER ENCL MUSC ATTACHED $10,516.50
65150 105799 REINSERTION OCULAR IMPLT W/WO CONJUNCTIVAL GRAFT $7,801.00
65155 105800 REINSERTION OCULAR IMPLT RNFCMT &/ ATTACH MUSCLE $10,516.50
65175 105801 REMOVAL OCULAR IMPLANT $8,821.00
65205 105802 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL $558.50
65210 105803 RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR $758.50
65220 105804 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP $1,232.50
65222 105805 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP $736.00
65235 105806 RMVL FB INTRAOCULAR ANT CHAMBER EYE/LENS $6,624.00
65260 105807 RMVL FB IO FROM POST SEG MAG XTRJ ANT/POST ROUTE $2,486.00
65265 105808 RMVL FB IO FROM POST SEG NONMAGNETIC XTRJ $14,485.00
65270 105809 RPR LAC CJNC W/WO NONPERFOR LAC SCLERA DIR CLSR $9,919.00
65272 105810 RPR LAC CJNC MOBLJ& REARGMT W/O HOSPITALIZATION $7,089.00
65273 105811 RPR LAC CJNC MOBLJ & REARGMT W/HOSPIZATION $0.00
65275 105812 RPR LAC CORNEA NONPERFOR W/WO RMVL FOREIGN BODY $15,279.50
65280 105813 RPR LAC CORNEA&/SCLERA PERFOR X INVG UVEAL TIS $23,910.50
65285 105814 RPR LAC CORN&/SCLRA PERF W/REPOS/RESCJ UVEAL T $30,502.00
65286 105815 RPR LAC APPL TISSUE GLUE WOUND CORNEA&/SCLERA $6,106.00
65290 105816 RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU $13,729.50
65400 105817 EXCISION LESION CORNEA XCP PTERYGIUM $5,601.00
65410 105818 BIOPSY CORNEA $7,447.00
65420 105819 EXCISION/TRANSPOSITION PTERYGIUM W/O GRAFT $11,040.00
65426 105820 EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG $10,034.00
65430 105821 CORNEA SCRAPING DIAGNOSTIC SMEAR &/CULTURE $620.50
65435 105822 RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION $2,992.00
65436 105823 RMVL CORNEAL EPITHELIUM W/APPL CHELATING AGENT $5,945.00
65450 105824 DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION $4,334.50
65600 105825 MULTIPLE PUNCTURES ANTERIOR CORNEA $6,082.00
65710 105826 KERATOPLASTY ANTERIOR LAMELLAR $29,750.50
65730 105827 KERATOPLASTY PENTRG EXCEPT APHAKIA/PSEUDOPHAKIA $28,952.50
65750 105828 KERATOPLASTY PENETRAING APHAKIA $27,271.50
65755 105829 KERATOPLASTY PENETRATING PSEUDOPHAKIA $28,225.50
65756 105830 KERATOPLASTY ENDOTHELIAL $13,470.50
65757 105831 BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT $9,801.00
65760 105832 KERATOMILEUSIS $6,505.50
65765 105833 KERATOPHAKIA $6,959.50
65767 105834 EPIKERATOPLASTY $5,885.00
65770 105835 KERATOPROSTHESIS $15,287.00
65771 105836 RADIAL KERATOTOMY $4,843.50
65772 105837 CRNL RELAXING INC CORRJ INDUCED ASTIGMATISM $4,385.00
65775 105838 CRNL WEDGE RESCJ CORRJ INDUCED ASTIGMATISM $5,266.00
65778 105839 PLACE AMNIOTIC MEMBRA OCULAR SURFACE W/O SUTURES $5,792.50
65779 105840 PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED $8,059.50
65780 105841 OCULAR SURFACE RECONSTRUCTION AMNIOTIC MEMBRANE $9,578.00
65781 105842 OCULAR SURFACE RECONSTRUCTION LIMBAL ALLOGRAFT $10,891.00
65782 105843 OCCULAR SURFACE RECONSTRUCTION LIMBAL AUTOGRAFT $20,881.50
65785 105844 IMPLANTATION INTRASTROMAL CORNEAL RING SEGMENTS $12,536.50
65800 105845 PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX $6,545.00
65810 105846 PARACENTSIS ANT CHAM RMVL VITREOUS W/WO AIR INJX $12,945.00
65815 105847 PARACEN ANT CHAM RMVL BLOOD W/WO IRRIG&/AIR IN $9,155.50
65820 105848 GONIOTOMY $3,827.50
65850 105849 TRABECULOTOMY AB EXTERNO $5,925.50
65855 105850 TRABECULOPLASTY BY LASER SURGERY $2,194.00
65860 105851 SEVERING ADHESIONS ANTERIOR SEGMENT LASER SPX $3,233.50
65865 105852 SEVERING ADS ANT SEG INCAL TQ SPX GONIOSYNECHIAE $5,957.00
65870 105853 SEVERING ADS ANT SEG INCAL SPX ANT SYNECHIAE $10,362.00
65875 105854 SEVERING ADS ANT SEG INCAL SPX POST SYNECHIAE $9,143.00
65880 105855 SEVERING ADS ANT SEG INCAL SPX CORNEOVITREAL $5,266.00
65900 105856 RMVL EPITHELIAL DOWNGROWTH ANT CHAMBER EYE $6,588.00
65920 105857 RMVL IMPLANTED MATERIAL ANTERIO SEGMENT EYE $13,040.50
65930 105858 RMVL BLOOD CLOT ANTERIOR SEGMENT EYE $11,618.00
66020 105859 INJX ANTERIOR CHAMBER EYE AIR/LIQUID SPX $5,578.00
66030 105860 INJX ANTERIOR CHAMBER EYE MEDICATION SPX $9,112.50
66130 105861 EXCISION LESION SCLERA $7,089.00
66150 105862 FSTLJ SCLERA GLAUCOMA TREPHIN W/IRIDECTOMY $7,089.00
66155 105863 FSTLJ SCLERA GLAUCOMA THERMOCAUT IRRIDEC $10,920.50
66160 105864 FSTLJ SCLERA SCLERECTOMY PUNCH/SCISSORS IRIDECT $8,833.50
66170 105865 FSTLJ SCLERA GLAUCOMA TRABECULECT AB EXTERNO $15,116.50
66172 105866 FSTLJ SCLERA GLC TRBEC AB EXTERNO SCARRING $17,066.50
66174 105867 TRLUML DILAT AQUEOUS O/F CAN WO RETENTION DEV/ST $12,818.50
66175 105868 TRLUML DILAT AQUEOUS O/F CAN W/RETENTION DEV/ST $16,062.00
66179 105869 AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT $11,674.50
66180 105870 AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT $18,394.50
66183 105871 INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR $11,674.50
66184 105872 REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT $14,333.50
66185 105873 REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR W/GRAFT $19,200.00
66225 105874 REPAIR SCLERAL STAPHYLOMA W/GRAFT $10,920.50
66250 105875 REVJ/RPR OPRATIVE WOUND ANTERIOR SEGMENT $7,207.50
66500 105876 IRIDOTOMY STAB INC SPX XCP TRANSFIXION $8,163.00
66505 105877 IRIDOTOMY STAB INC SPX TRANSFIXION $3,526.50
66600 105878 IRDEC CRNLSCLRL/CRNL SCTJ RMVL LES $13,089.50
66605 105879 IRDEC CRNLSCLRL/CRNL SCTJ CYCLECTOMY $10,920.50
66625 105880 IRDEC CRNLSCLRL/CRNL SCTJ PRPH GLC SPX $10,328.50
66630 105881 IRDEC CRNLSCLRL/CRNL SCTJ SECTOR GLC SPX $7,089.00
66635 105882 IRDEC CRNLSCLRL/CRNL SCTJ OPTICAL SPX $5,749.50
66680 105883 REPAIR IRIS CILIARY BODY $7,989.00
66682 105884 SUTURE IRIS CILIARY BODY SPX RETRIEVAL SUTURE $8,030.50
66700 105885 CILIARY BODY DESTRUCTION DIATHERMY $5,266.00
66710 105886 CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL $6,114.00
66711 105887 ECP CILIARY BODY DSTRJ W/O RMVL CRYSTALLINE LENS $8,596.50
66720 105888 CILIARY BODY DESTRUCTION CRYOTHERAPY $7,228.50
66740 105889 CILIARY BODY DESTRUCTION CYCLODIALYSIS $4,246.00
66761 105890 IRIDOTOMY/IRRIDECTOMY LASER SURG PER SESSION $3,646.00
66762 105891 IRIDOPLASTY PHOTOCOAGULATION 1/> SESSIONS $6,609.00
66770 105892 DSTRJ CYST/LESION IRIS/CILIARY BODY $2,461.00
66820 105893 DISCISSION SECONDARY MEMBRANOUS CATARACT $7,292.50
66821 105894 POST-CATARACT LASER SURGERY $2,280.00
66825 105895 REPOSITIONING IO LENS PROSTHESIS REQ INC SPX $8,040.00
66830 105896 RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ $8,747.00
66840 105897 RMVL LENS MATERIAL ASPIR TQ 1/> STAGES $7,144.50
66850 105898 RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR $7,872.50
66852 105899 RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY $12,636.50
66920 105900 RMVL LENS MATERIAL INTRACAPSULAR $13,890.50
66930 105901 REMOVAL LENS MATRL INTRACAPSULAR DISLOCATED LENS $15,186.00
66940 105902 REMOVAL LENS MATERIAL EXTRACAPSULAR $10,718.00
66982 105903 XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX WO ECP $4,101.00
66983 105904 ICAPSULAR CATARACT XTRJ INSJ IO LENS PRSTH 1 STG $9,380.00
66984 105905 XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP $3,517.50
66985 105906 INSJ IO LENS PROSTHESIS NOT W/CONCURRENT RMVL $8,261.50
66986 105907 EXCHANGE INTRAOCULAR LENS $14,345.50
66987 105908 XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX W/ECP $10,370.50
66988 105909 XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/ECP $12,663.00
66989 105910 XCAPSL CTRC RMVL INSJ IO LENS PRSTH CPLX INSJ 1+ $21,331.00
66990 105911 USE OPHTHALMIC ENDOSCOPE $8,019.50
66991 105912 XCAPSL CTRC RMVL INSJ IO LENS PROSTH INSJ 1+ $21,331.00
66999 105913 UNLISTED PROCEDURE ANTERIOR SEGMENT EYE $0.00
67005 105914 RMVL VITREOUS ANT APPR PARTIAL REMOVAL $10,884.50
67010 105915 RMVL VITREOUS ANT APPR SUBTOT RMVL MECH VITRECT $8,337.50
67015 105916 ASPIRATION/RELEASE VITREOUS SUBRETINAL/CHOROIDAL $10,667.00
67025 105917 INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASPIR SPX $8,652.00
67027 105918 IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS $19,481.00
67028 105919 INTRAVITREAL NJX PHARMACOLOGIC AGT SPX $758.00
67030 105920 DISCISSION VITREOUS STRANS PARS PLANA APPROACH $6,329.50
67031 105921 SEVERING VITREOUS STRANS LASER 1/> STAGES $4,021.50
67036 105922 VITRECTOMY MECHANICAL PARS PLANA $6,032.00
67039 105923 VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC $12,354.00
67040 105924 VTRECTOMY MCHNL PARS PLNA ENDOLASER PANRTA PC $12,805.50
67041 105925 VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE $11,860.50
67042 105926 VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA $12,360.00
67043 105927 VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE $24,914.50
67101 105928 RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX $17,374.00
67105 105929 RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC $5,367.00
67107 105930 REPAIR RETINAL DETACHMENT SCLERAL BUCKLING $19,659.50
67108 105931 RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH $12,542.00
67110 105932 RPR RETINAL DTCHMNT INJECTION AIR/OTHER GAS $12,918.50
67113 105933 RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL $24,034.00
67115 105934 RELEASE ENCIRCLING MATERIAL POSTERIOR SEGMENT $6,329.50
67120 105935 RMVL IMPLNT MATL POSTERIOR SEGMENT EXTRAOCULAR $8,566.00
67121 105936 RMVL IMPLT MATRL POSTERIOR SEGMENT INTRAOCULAR $16,318.00
67141 105937 PROPH RETINAL DTCHMNT W/O DRG CRTX DIATHERMY $2,835.50
67145 105938 PROPH RETINAL DTCHMNT W/O DRG PHOTOCOAGULATION $2,901.00
67208 105939 DSTRJ LOCLZD LESION RETINA 1/> SESS CRTX DTHRM $11,033.50
67210 105940 DSTRJ LOCLZD LESION RETINA 1/> SESS PC $3,107.50
67218 105941 DSTRJ LESION RETINA 1/> SESS RADJ IMPLTJ $10,406.50
67220 105942 DSTRJ LESION CHOROID PC 1/> SESS $4,271.00
67221 105943 DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY $2,906.00
67225 105944 DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION $2,486.00
67227 105945 DESTRUCTION RETINOPATHY CRYOTHERAPY DIATHERMY $9,532.50
67228 105946 TREATMENT EXTENSIVE RETINOPATHY PHOTOCOAGULATION $2,432.00
67229 105947 EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT $2,461.00
67250 105948 SCLERAL REINFORCEMENT SPX W/O GRAFT $6,082.00
67255 105949 SCLERAL REINFORCEMENT SPX W/GRAFT $8,146.00
67299 105950 UNLISTED PROCEDURE POSTERIOR SEGMENT $0.00
67311 105951 STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC $13,155.00
67312 105952 STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC $11,137.00
67314 105953 STRABISMUS RECESSION/RESCJ 1 VER MUSC $7,085.50
67316 105954 STRABISMUS RECESSION/RESCJ 2/MORE VER MUSC $14,288.00
67318 105955 STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE $9,804.00
67320 105956 TRANSPOSITION PROCEDURE EXTRAOCULAR MUSC $4,934.00
67331 105957 STRABISMUS PREVIOUS EYE X INVOLVE EO MUSC $7,692.00
67332 105958 STRABISMUS SCARRING EO MUSC/RSTCV MYOPATHY $4,444.00
67334 105959 STRABISMUS POST FIXJ SUTR TQ W/WO MUSC RECESSION $4,456.00
67335 105960 PLACEMENT ADJUSTABLE SUTURE STRABISMUS $7,548.50
67340 105961 STRABISMUS EXPL&/RPR DETACHED EXTROCULAR MUSC $7,469.50
67343 105962 RLS XTNSV SCAR TISS W/O DETACHING EO MUSC SPX $11,545.00
67345 105963 CHEMODENERVATION EXTRAOCULAR MUSCLE $4,279.00
67346 105964 BIOPSY EXTRAOCULAR MUSCLE $5,273.50
67399 105965 UNLISTED PROCEDURE EXTRAOCULAR MUSCLE $0.00
67400 105966 ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY $9,471.50
67405 105967 ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY $7,801.00
67412 105968 ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION $17,944.00
67413 105969 ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY $17,287.50
67414 105970 ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN $12,222.00
67415 105971 FINE NEEDLE ASPIRATION ORBITAL CONTENTS $12,473.50
67420 105972 ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION $18,697.00
67430 105973 ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB $10,516.50
67440 105974 ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG $10,516.50
67445 105975 ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN $24,717.50
67450 105976 ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX $19,884.00
67500 105977 RETROBULBAR INJECTION MEDICATION SPX $2,910.50
67505 105978 RETROBULBAR INJECTION ALCOHOL $4,057.50
67515 105979 INJECTION MEDICATION/OTHER SUBST TENON CAPSULE $1,396.50
67516 105980 SUPRACHOROIDAL SPACE NJX PHARMACOLOGIC AGENT $0.00
67550 105981 ORBITAL IMPLANT INSERTION $15,375.00
67560 105982 ORBITAL IMPLANT REMOVAL/REVISION $10,230.00
67570 105983 OPTIC NERVE DECOMPRESSION $17,591.50
67599 105984 UNLISTED PROCEDURE ORBIT $0.00
67700 105985 BLEPHAROTOMY DRAINAGE ABSCESS EYELID $2,122.50
67710 105986 SEVERING TARSORRHAPHY $4,684.50
67715 105987 CANTHOTOMY SEPARATE PROCEDURE $5,419.50
67800 105988 EXCISION CHALAZION SINGLE $1,897.50
67801 105989 EXCISION CHALAZION MULTIPLE SAME LID $3,831.50
67805 105990 EXCISION CHALAZION MULTIPLE DIFFERENT LIDS $3,685.00
67808 105991 EXC CHALAZION ANES REQ HOSPIZATION SINGLE/MULT $6,298.50
67810 105992 INCISIONAL BIOPSY EYELID SKIN & LID MARGIN $1,520.50
67820 105993 CORRECTION TRICHIASIS EPILATION FORCEPS ONLY $429.00
67825 105994 CORRECTION TRICHIASIS EPILATION OTH/THAN FORCEPS $1,195.50
67830 105995 CORRECTION TRICHIASIS INCCISION LID MARGIN $4,757.50
67835 105996 CORRJ TRICHIASIS INC LID MRGN W/FR MUC MEMB GRF $6,082.00
67840 105997 EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE $3,158.50
67850 105998 DESTRUCTION LESION LID MARGIN < 1 CM $3,365.50
67875 105999 TEMPORARY CLOSURE EYELIDS SUTURE $2,944.00
67880 106000 CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY $10,022.50
67882 106001 CONSTJ INTERMARGIN ADHES/TARSOR/CANTHOR W/TRPOS $11,374.00
67900 106002 REPAIR BROW PTOSIS $2,611.50
67901 106003 RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL $17,370.00
67902 106004 RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING $11,229.50
67903 106005 RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL $2,934.00
67904 106006 RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL $7,149.00
67906 106007 RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING $9,490.00
67908 106008 RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ $7,890.00
67909 106009 REDUCTION OVERCORRECTION PTOSIS $7,697.50
67911 106010 CORRECTION LID RETRACTION $2,772.50
67912 106011 CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD $8,114.00
67914 106012 REPAIR ECTROPION SUTURE $6,640.50
67915 106013 REPAIR ECTROPION THERMOCAUTERIZATION $6,082.00
67916 106014 REPAIR ECTROPION EXCISION TARSAL WEDGE $6,939.00
67917 106015 REPAIR ECTROPION EXTENSIVE $2,719.00
67921 106016 REPAIR ENTROPION SUTURE $6,949.50
67922 106017 REPAIR ENTROPION THERMOCAUTERIZATION $6,082.00
67923 106018 REPAIR ENTROPION EXCISION TARSAL WEDGE $7,916.00
67924 106019 REPAIR ENTROPION EXTENSIVE $7,806.00
67930 106020 SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK $6,082.00
67935 106021 SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK $6,226.00
67938 106022 REMOVAL EMBEDDED FOREIGN BODY EYELID $1,421.50
67950 106023 CANTHOPLASTY $10,844.50
67961 106024 EXCISION & REPAIR EYELID < ONE-FOURTH LID MARGIN $8,005.50
67966 106025 EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN $5,462.00
67971 106026 RCNSTJ EYELID FULL THICKNESS <TWO-THIRDS 1 STG $8,084.00
67973 106027 RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG $9,483.50
67974 106028 RCNSTJ EYELID FULL THICKNESS UPPER EYELID 1 STG $6,082.00
67975 106029 RCNSTJ EYELID FULL THICKNESS SECOND STAGE $7,277.50
67999 106030 UNLISTED PROCEDURE EYELIDS $0.00
68020 106031 INCISION CONJUNCTIVA DRAINAGE OF CYST $3,738.50
68040 106032 EXPRESSION CONJUNCTIVAL FOLLICLES $678.00
68100 106033 BIOPSY CONJUNCTIVA $6,759.50
68110 106034 EXCISION LESION CONJUNCTIVA <1 CM $10,417.50
68115 106035 EXCISION LESION CONJUNCTIVA > 1 CM $7,861.50
68130 106036 EXCISION LESION CONJUNCTIVA ADJACENT SCLERA $7,582.00
68135 106037 DESTRUCTION LESION CONJUNCTIVA $6,893.00
68200 106038 SUBCONJUNCTIVAL INJECTION $1,141.00
68320 106039 CONJUNCTIVOPLASTY W/GRF/XTNSV REARRANGEMENT $7,222.00
68325 106040 CONJUNCTIVOPLASTY W/BUCCAL MUC MEMB GRAFT $11,690.00
68326 106041 CJP RCNSTJ CUL-DE-SAC BUCCAL GRF/XTNSV REARRGMT $2,793.50
68328 106042 CONJUNCTPL CUL-DE-SAC W/BUCCAL MUC MEMB GRAFT $7,801.00
68330 106043 RPR SYMBLEPHARON CONJUNCTIVOPLASTY W/O GRAFT $7,089.00
68335 106044 RPR SYMBLEPHARON FR GRF CJNC/BUCCAL MUC MEMB $11,229.50
68340 106045 RPR & DIV SYMBLEPHARON W/WO CONFORM/CONTACT LE $5,387.50
68360 106046 CONJUNCTIVAL FLAP BRIDGE/PARTIAL SPX $7,089.00
68362 106047 CONJUNCTIVAL FLAP TOTAL $13,307.50
68371 106048 HARVESTING CONJUNCIVAL ALLOGRAPHY LIVING DONOR $7,089.00
68399 106049 UNLISTED PROCEDURE CONJUNCTIVA $0.00
68400 106050 INCISION DRAINAGE LACRIMAL GLAND $1,600.00
68420 106051 INCISION DRAINAGE LACRIMAL SAC $7,038.50
68440 106052 SNIP INCISION LACRIMAL PUNCTUM $3,507.00
68500 106053 EXCISION LACRIMAL GLAND XCPT TUMOR TOTAL $7,801.00
68505 106054 EXCISION LACRIMAL GLAND XCPT TUMOR PRTL $7,801.00
68510 106055 BIOPSY LACRIMAL GLAND $8,180.50
68520 106056 EXCISION LACRIMAL SAC $10,223.50
68525 106057 BIOPSY LACRIMAL SAC $5,337.00
68530 106058 RMVL FB/DACRYOLITH LACRIMAL PASSAGES $6,870.00
68540 106059 EXC LACRIMAL GLAND TUMOR FRONTAL APPROACH $6,082.00
68550 106060 EXC LACRIMAL GLAND TUMOR W/OSTEOTOMY $7,801.00
68700 106061 PLASTIC REPAIR CANALICULI $3,054.50
68705 106062 CORRECTION EVERTED PUNCTUM CAUTERY $4,580.00
68720 106063 DACRYOCSTORHINOSTOMY $4,279.00
68745 106064 CONJUNCTIVORHINOSTOMY W/O TUBE $7,801.00
68750 106065 CONJUNCTIVORHINOSTOMY INSJ TUBE/STENT $17,889.50
68760 106066 CLSR LACRIMAL PUNCTUM THERMOCAUT LIG/LASER $1,571.00
68761 106067 CLSR LACRIMAL PUNCTUM PLUG EACH $1,028.50
68770 106068 CLOSURE LACRIMAL FISTULA SPX $7,801.00
68801 106069 DILATION LACRIMAL PUNCTUM W/WO IRRGATION $1,450.00
68810 106070 PROBE NASOLACRIMAL DUCT W/WO IRRIGATION $1,375.00
68811 106071 PROBE NASOLACRIMAL DUCT W/WO IRRIG REQ GEN ANES $9,281.00
68815 106072 PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT $4,698.50
68816 106073 PROBE NASOLACRIMAL DUCT WITH CATHETER DILATION $9,736.00
68840 106074 PROBE LACRIMAL CANALICULI W/WO IRRIGATION $1,322.50
68841 106075 INSJ RX ELUTING IMPLT PUNCTAL DILAT LAC CANAL EA $3,203.50
68850 106076 INJECTION CONTRAST MEDIUM DACRYOCYSTOGRAPY $2,982.00
68899 106077 UNLISTED PROCEDURE LACRIMAL SYSTEM $0.00
69000 106078 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE $2,146.50
69005 106079 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX $5,827.50
69020 106080 DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS $2,870.00
69090 106081 EAR PIERCING $428.00
69100 106082 BIOPSY EXTERNAL EAR $1,274.50
69105 106083 BIOPSY EXTERNAL AUDITORY CANAL $5,913.50
69110 106084 EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR $13,740.50
69120 106085 EXCISION EXTERNAL EAR COMPLETE AMPUTATION $13,293.00
69140 106086 EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL $26,392.00
69145 106087 EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL $8,275.00
69150 106088 RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ $19,956.50
69155 106089 RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ $0.00
69200 106090 RMVL FB XTRNL AUDITORY CANAL W/O ANES $609.50
69205 106091 RMVL FB XTRNL AUDITORY CANAL ANES $6,372.50
69209 106092 REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT $766.50
69210 106093 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT $248.50
69220 106094 DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE $407.00
69222 106095 DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX $3,956.50
69300 106096 OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ $17,017.00
69310 106097 RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX $15,556.00
69320 106098 RCNSTJ XTRNL AUD CANAL CONGENITAL ATRESIA 1 STG $24,122.00
69399 106099 UNLISTED PROCEDURE EXTERNAL EAR $0.00
69420 106100 MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ $1,212.50
69421 106101 MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES $6,670.00
69424 106102 VENTILATING TUBE RMVL REQUIRING GENERAL ANES $6,503.50
69433 106103 TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA $2,185.50
69436 106104 TYMPANOSTOMY GENERAL ANESTHESIA $6,452.50
69440 106105 MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC $24,017.50
69450 106106 TYMPANOLYSIS TRANSCANAL $13,168.00
69501 106107 TRANSMASTOID ANTROTOMY $20,011.00
69502 106108 MASTOIDECTOMY COMPLETE $21,050.50
69505 106109 MASTOIDECTOMY MODIFIED RADICAL $27,396.00
69511 106110 MASTOIDECTOMY RADICAL $28,424.50
69530 106111 PETROUS APICECTOMY RADICAL MASTOIDECTOMY $31,532.00
69535 106112 RESCJ TEMPORAL BONE EXTERNAL APPROACH $0.00
69540 106113 EXCISION AURAL POLYP $7,505.50
69550 106114 EXCISION AURAL GLOMUS TUMOR TRANSCANAL $21,409.50
69552 106115 EXCISION AURAL GLOMUS TUMOR TRANSMASTOID $11,739.50
69554 106116 EXCISION AURAL GLOMUS TUMOR EXTENDED $0.00
69601 106117 REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY $21,546.50
69602 106118 REVJ MASTOIDECTOMY RSLTG MODF RAD MSTDC $26,071.00
69603 106119 REVJ MASTOIDECTOMY RSLTG RAD MASTOIDECTOMY $26,748.00
69604 106120 REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY $41,227.50
69610 106121 TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH $9,076.50
69620 106122 MYRINGOPLASTY $9,882.00
69631 106123 TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ $15,449.00
69632 106124 TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ $20,280.00
69633 106125 TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP $17,304.50
69635 106126 TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ $23,681.00
69636 106127 TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ $23,496.00
69637 106128 TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP $31,129.00
69641 106129 TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ $25,843.00
69642 106130 TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ $25,777.50
69643 106131 TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR $26,213.50
69644 106132 TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR $31,183.50
69645 106133 TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR $22,977.00
69646 106134 TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR $29,386.50
69650 106135 STAPES MOBILIZATION $25,859.00
69660 106136 STAPEDECTOMY/STAPEDOTOMY $17,079.50
69661 106137 STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT $18,700.50
69662 106138 REVISION STAPEDECTOMY/STAPEDOTOMY $26,880.00
69666 106139 REPAIR OVAL WINDOW FISTULA $13,515.00
69667 106140 REPAIR ROUND WINDOW FISTULA $20,547.50
69670 106141 MASTOID OBLITERATION SEPARATE PROCEDURE $23,056.00
69676 106142 TYMPANIC NEURECTOMY $7,476.50
69700 106143 CLOSURE POSTAURICULAR FISTULA MASTOID SPX $7,476.50
69705 106144 SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI $9,730.50
69706 106145 SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI $11,541.50
69710 106146 IMPLTJ/RPLCMT EMGNT BONE CNDJ DEV TEMPORAL BONE $22,874.50
69711 106147 RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE $23,766.00
69714 106148 IMPL OI IMPLT SKULL PERQ ATTACHMENT ESP $15,963.00
69716 106149 IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP<100 $47,545.00
69717 106150 RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP $26,343.50
69719 106151 RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP<100 $47,545.00
69720 106152 DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION $11,739.50
69725 106153 DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE $11,739.50
69726 106154 REMOVAL ENTIRE OI IMPLT SKL PERQ ATTACHMENT ESP $16,055.50
69727 106155 REMOVAL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP<100 $16,055.50
69728 106156 RMVL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP>=100 $17,137.00
69729 106157 IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100 $49,481.50
69730 106158 RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100 $49,481.50
69740 106159 SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE $11,739.50
69745 106160 SUTR NRV ITPRL W/WO GRF/DCMPRN MEDIAL GENICULATE $11,739.50
69799 106161 UNLISTED PROCEDURE MIDDLE EAR $0.00
69801 106162 LABYRINTHOTOMY TRANSCANAL $5,454.00
69805 106163 ENDOLYMPHATIC SAC W/O SHUNT $27,887.00
69806 106164 ENDOLYMPHATIC SAC SHUNT $18,660.00
69905 106165 LABYRINTHECTOMY TRANSCANAL $11,739.50
69910 106166 LABYRINTHECTOMY W/MASTOIDECTOMY $22,358.50
69915 106167 VESTIBULAR NRV SECTION TRANSLABYRINTHINE APPR $11,739.50
69930 106168 COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY $19,404.50
69949 106169 UNLISTED PROCEDURE INNER EAR $0.00
69950 106170 VESTIBULAR NRV SECTION TRANSCRANIAL APPROACH $0.00
69955 106171 TOTAL FACIAL NERVE DECOMPRESSION &/REPAIR $11,739.50
69960 106172 DECOMPRESSION INTERNAL AUDITORY CANAL $11,739.50
69970 106173 REMOVAL TUMOR TEMPORAL BONE $11,739.50
69979 106174 UNLISTED PROCEDURE TEMPORAL BONE MIDDLE FOSSA $0.00
69990 106175 MICROSURG TQS REQ USE OPERATING MICROSCOPE $10,216.50
70010 106176 MYELOGRAPY POST FOSSA RS&I $2,104.50
70015 106177 CISTERNOGRAPHY POSITIVE CONTRAST RS&I $2,654.00
70030 106178 RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY $237.00
70100 106179 RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS $675.50
7010F 106180 PT INFORMATION ENTERED INTO RECALL SYSTEM $0.00
70110 106181 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS $907.50
70120 106182 RADIOLOGIC EXAM MASTOIDS < 3 VIEWS PER SIDE $638.50
70130 106183 RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDE $665.00
70134 106184 RADEX INTERNAL AUDITORY MEATI COMPLETE $898.00
70140 106185 RADEX FACIAL BONES < 3 VIEWS $633.50
70150 106186 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS $798.00
70160 106187 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS $742.50
70170 106188 DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I $2,451.00
70190 106189 RADEX OPTIC FORAMINA $694.00
70200 106190 RADEX ORBITS COMPLETE MINIMUM 4 VIEWS $859.00
7020F 106191 MAMMO ASSESSMENT CAT IN DATABASE FOR RATE $0.00
70210 106192 RADEX SINUSES PARANASAL <3 VIEWS $519.00
70220 106193 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS $782.50
70240 106194 RADIOLOGIC EXAMINATION SELLA TURCICA $657.00
70250 106195 RADIOLOGIC EXAMINATION SKULL 4< VIEWS $455.00
70260 106196 RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS $1,091.00
70300 106197 RADIOLOGIC EXAMINATION TEETH 1 VIEW $307.50
70310 106198 RADIOLOGIC EXAM TEETH PRTL EXAM < FULL MOUTH $710.50
70320 106199 RADIOLOGIC EXAM TEETH COMPLETE FULL MOUTH $793.50
70328 106200 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT $576.00
70330 106201 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT $706.50
70332 106202 TEMPOROMANDBLE JT ARTHROGRAPHY RS&I $2,532.50
70336 106203 MRI TEMPOROMANDIBULAR JOINT $2,149.00
70350 106204 CEPHALOGRAM ORTHODONTIC $283.00
70355 106205 ORTHOPANTOGRAM $408.00
70360 106206 RADIOLOGIC EXAMINATION NECK SOFT TISSUE $352.50
70370 106207 RADEX PHARYNX/LARX W/FLUOR&/MAGNIFICATION TQ $739.00
70371 106208 CPLX DYNAMIC PHARYNGEAL&SP EVAL C/V REC $1,504.00
70380 106209 RADIOLOGIC EXAMINATION SALIVARY GLAND CALCULUS $657.00
70390 106210 SIALOGRAPHY RS&I $1,384.00
70450 106211 CT HEAD/BRAIN W/O CONTRAST MATERIAL $3,571.50
70460 106212 CT HEAD/BRAIN W/CONTRAST MATERIAL $4,302.00
70470 106213 CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL $2,533.00
70480 106214 CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL $3,272.00
70481 106215 CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL $4,247.00
70482 106216 CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR $5,042.00
70486 106217 CT MAXILLOFACIAL W/O CONTRAST MATERIAL $3,470.00
70487 106218 CT MAXILLOFACIAL W/CONTRAST MATERIAL $4,182.50
70488 106219 CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL $4,846.00
70490 106220 CT SOFT TISSUE NECK W/O CONTRAST MATERIAL $4,014.00
70491 106221 CT SOFT TISSUE NECK W/CONTRAST MATERIAL $2,970.00
70492 106222 CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL $2,525.00
70496 106223 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST $5,731.50
70498 106224 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST $5,562.50
70540 106225 MRI ORBIT FACE &/NECK W/O CONTRAST $3,216.00
70542 106226 MRI ORBIT FACE & NECK W/CONTRAST MATERIAL $6,349.00
70543 106227 MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL $4,222.00
70544 106228 MRA HEAD W/O CONTRST MATERIAL $3,753.50
70545 106229 MRA HEAD W/CONTRAST MATERIAL $5,334.00
70546 106230 MRA HEAD W/O & W/CONTRAST MATERIAL $4,610.00
70547 106231 MRA NECK W/O CONTRST MATERIAL $4,024.50
70548 106232 MRA NECK W/CONTRAST MATERIAL $5,104.00
70549 106233 MRA NECK W/O &W/CONTRAST MATERIAL $4,667.50
70551 106234 MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL $4,224.00
70552 106235 MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL $4,650.50
70553 106236 MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL $5,010.00
70554 106237 MRI BRAIN FUNCTIONAL W/O PHYSICIAN ADMNISTRATION $5,499.00
70555 106238 MRI BRAIN FUNCTIONAL W/PHYSICIAN ADMNISTRATION $814.00
70557 106239 MRI BRAIN OPEN INTRACRANIAL PX W/O CONTRAST MATL $5,236.50
70558 106240 MRI BRAIN OPEN INTRACRANIAL PX W/CONTRAST MATL $3,428.00
70559 106241 MRI BRAIN OPEN INTRACRANIAL PX W/O & W/CONTRAST $3,930.50
71045 106242 RADIOLOGIC EXAM CHEST SINGLE VIEW $641.50
71046 106243 RADIOLOGIC EXAM CHEST 2 VIEWS $712.50
71047 106244 RADIOLOGIC EXAM CHEST 3 VIEWS $437.00
71048 106245 RADIOLOGIC EXAM CHEST 4+ VIEWS $605.00
71100 106246 RADEX RIBS UNILATERAL 2 VIEWS $814.00
71101 106247 RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS $580.00
71110 106248 RADEX RIBS BILATERAL 3 VIEWS $981.00
71111 106249 RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS $369.00
71120 106250 RADEX STERNUM MINIMUM 2 VIEWS $623.00
71130 106251 RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS $656.00
71250 106252 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST $1,722.00
71260 106253 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST $2,991.50
71270 106254 DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+ $5,849.00
71271 106255 COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C- $349.00
71275 106256 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST $5,863.50
71550 106257 MRI CHEST W/O CONTRAST MATERIAL $3,231.00
71551 106258 MRI CHEST W/CONTRAST MATERIAL $5,046.00
71552 106259 MRI CHEST W/O & W/CONTRAST MATERIAL $4,222.00
71555 106260 MRA CHEST W/O & W/CONTRAST MATERIAL $4,028.00
72020 106261 RADEX SPINE 1 VIEW SPECIFY LEVEL $373.00
72040 106262 RADEX SPINE CERVICAL 2 OR 3 VIEWS $702.50
72050 106263 RADEX SPINE CERVICAL 4 OR 5 VIEWS $576.00
72052 106264 RADEX SPINE CERVICAL 6 OR MORE VIEWS $441.00
72070 106265 RADEX SPINE THORACIC 2 VIEWS $749.00
72072 106266 RADEX SPINE THORACIC 3 VIEWS $872.00
72074 106267 RADEX SPINE THORACIC MINIMUM 4 VIEWS $973.00
72080 106268 RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS $558.00
72081 106269 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW $369.50
72082 106270 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW $449.00
72083 106271 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW $649.00
72084 106272 RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW $372.00
72100 106273 RADEX SPINE LUMBOSACRAL 2/3 VIEWS $900.50
72110 106274 RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS $441.00
72114 106275 RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 $441.00
72120 106276 RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS $437.00
72125 106277 CT CERVICAL SPINE W/O CONTRAST MATERIAL $4,572.00
72126 106278 CT CERVICAL SPINE W/CONTRAST MATERIAL $2,985.50
72127 106279 CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL $5,291.50
72128 106280 CT THORACIC SPINE W/O CONTRAST MATERIAL $5,550.00
72129 106281 CT THORACIC SPINE W/CONTRAST MATERIAL $7,083.00
72130 106282 CT THORACIC SPINE W/O & W/CONTRAST MATERIAL $5,163.50
72131 106283 CT LUMBAR SPINE W/O CONTRAST MATERIAL $4,909.00
72132 106284 CT LUMBAR SPINE W/CONTRAST MATERIAL $5,941.00
72133 106285 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL $2,578.00
72141 106286 MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL $3,803.50
72142 106287 MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL $4,487.00
72146 106288 MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL $4,786.50
72147 106289 MRI SPINAL CANAL THORACIC W/CONTRAST MATRL $4,386.00
72148 106290 MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL $3,117.00
72149 106291 MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL $4,240.00
72156 106292 MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL $4,223.00
72157 106293 MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL $4,252.50
72158 106294 MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL $4,149.00
72159 106295 MRA SPINAL CANAL W/WO CONTRAST MATERIAL $7,760.50
72170 106296 RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS $591.00
72190 106297 RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS $1,058.00
72191 106298 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST $4,577.50
72192 106299 CT PELVIS W/O CONTRAST MATERIAL $3,959.00
72193 106300 CT PELVIS W/CONTRAST MATERIAL $4,718.00
72194 106301 CT PELVIS W/O & W/CONTRAST MATERIAL $5,028.50
72195 106302 MRI PELVIS W/O CONTRAST MATERIAL $3,891.00
72196 106303 MRI PELVIS W/CONTRAST MATERIAL $6,550.00
72197 106304 MRI PELVIS W/O & W/CONTRAST MATERIAL $4,222.00
72198 106305 MRA PELVIS W/WO CONTRAST MATERIAL $8,062.00
72200 106306 RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS $287.00
72202 106307 RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS $347.50
72220 106308 RADEX SACRUM & COCCYX MINIMUM 2 VIEWS $643.00
72240 106309 MYELOGRAPHY CERVICAL RS&I $3,477.00
72255 106310 MYELOGRAPHY THORACIC RS&I $3,181.00
72265 106311 MYELOGRAPY LUMBOSACRAL RS&I $3,257.00
72270 106312 MYELOGRAPY 2/MORE REGIONS RS&I $4,079.00
72285 106313 DISKOGRAPY CERVICAL/THORACIC RS&I $4,895.00
72295 106314 DISKOGRAPY LUMBAR RS&I $2,606.00
73000 106315 RADEX CLAVICLE COMPLETE $605.00
73010 106316 RADEX SCAPULA COMPLETE $751.00
73020 106317 RADEX SHOULDER 1 VIEW $524.50
73030 106318 RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS $634.00
73040 106319 RADEX SHOULDER ARTHROGRAPHY RS&I $297.00
73050 106320 RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ $685.00
73060 106321 RADEX HUMERUS MINIMUM 2 VIEWS $518.00
73070 106322 RADEX ELBOW 2 VIEWS $584.00
73080 106323 RADEX ELBOW COMPLETE MINIMUM 3 VIEWS $597.00
73085 106324 RADEX ELBOW ARTHROGRAPHY RS&I $1,695.50
73090 106325 RADEX FOREARM 2 VIEWS $757.00
73092 106326 RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS $657.00
73100 106327 RADEX WRIST 2 VIEWS $557.50
73110 106328 RADEX WRIST COMPLETE MINIMUM 3 VIEWS $812.50
73115 106329 RADEX WRIST ARTHROGRAPHY RS&I $1,643.50
73120 106330 RADEX HAND 2 VIEWS $409.00
73130 106331 RADEX HAND MINIMUM 3 VIEWS $710.00
73140 106332 RADEX FINGR MINIMUM 2 VIEWS $501.50
73200 106333 CT UPPER EXTREMITY W/O CONTRAST MATERIAL $2,733.50
73201 106334 CT UPPER EXTREMITY W/CONTRAST MATERIAL $3,236.50
73202 106335 CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL $4,687.00
73206 106336 CT ANGIOGRAPHY UPPER EXTREMITY $6,703.50
73218 106337 MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL $2,708.50
73219 106338 MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL $6,074.00
73220 106339 MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS $3,893.00
73221 106340 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL $3,797.50
73222 106341 MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL $4,659.50
73223 106342 MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL $3,857.50
73225 106343 MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL $6,990.50
73501 106344 RADEX HIP UNILATERAL WITH PELVIS 1 VIEW $640.50
73502 106345 RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS $751.00
73503 106346 RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS $946.00
73521 106347 RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS $570.00
73522 106348 RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS $901.50
73523 106349 RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS $839.00
73525 106350 RADEX HIP ARTHROGRAPHY RS&I $1,070.50
73551 106351 RADIOLOGIC EXAMINATION FEMUR 1 VIEW $190.50
73552 106352 RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS $638.50
73560 106353 RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS $629.50
73562 106354 RADIOLOGIC EXAMINATION KNEE 3 VIEWS $429.00
73564 106355 RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS $520.50
73565 106356 RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST $951.00
73580 106357 RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I $1,912.00
73590 106358 RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS $736.00
73592 106359 RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS $657.00
73600 106360 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS $524.50
73610 106361 RADEX ANKLE COMPLETE MINIMUM 3 VIEWS $678.50
73615 106362 RADEX ANKLE ARTHROGRAPHY RS&I $1,589.00
73620 106363 RADIOLOGIC EXAMINATION FOOT 2 VIEWS $444.00
73630 106364 RADEX FOOT COMPLETE MINIMUM 3 VIEWS $595.00
73650 106365 RADEX CALCANEUS MINIMUM 2 VIEWS $395.00
73660 106366 RADEX TOE MINIMUM 2 VIEWS $498.00
73700 106367 CT LOWER EXTREMITY W/O CONTRAST MATERIAL $3,414.50
73701 106368 CT LOWER EXTREMITY W/CONTRAST MATERIAL $3,912.00
73702 106369 CT LOWER EXTREMITY W/O & W/CONTRAST MATRL $4,969.00
73706 106370 CT ANGIOGRAPHY LOWER EXTREMITY $6,689.50
73718 106371 MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL $4,254.50
73719 106372 MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL $6,250.50
73720 106373 MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR $3,893.00
73721 106374 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL $3,476.50
73722 106375 MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL $3,624.00
73723 106376 MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL $5,909.00
73725 106377 MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL $6,618.50
74018 106378 RADIOLOGIC EXAM ABDOMEN 1 VIEW $635.00
74019 106379 RADIOLOGIC EXAM ABDOMEN 2 VIEWS $788.00
74021 106380 RADIOLOGIC EXAM ABDOMEN 3+ VIEWS $865.00
74022 106381 RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES $887.00
74150 106382 CT ABDOMEN W/O CONTRAST MATERIAL $1,936.50
74160 106383 CT ABDOMEN W/CONTRAST MATERIAL $2,966.00
74170 106384 CT ABDOMEN W/O & W/CONTRAST MATERIAL $2,521.00
74174 106385 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMG $5,337.50
74175 106386 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST $6,819.00
74176 106387 CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL $7,728.00
74177 106388 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL $8,968.00
74178 106389 CT ABDOMEN & PELVIS W/O CONTRST 1/> BODY RE $3,707.00
74181 106390 MRI ABDOMEN W/O CONTRAST MATERIAL $4,098.00
74182 106391 MRI ABDOMEN W/CONTRAST MATERIAL $3,472.50
74183 106392 MRI ABDOMEN W/O & W/CONTRAST MATERIAL $4,222.00
74185 106393 MRA ABDOMEN W/WO CONTRAST MATERIAL $7,095.50
74190 106394 PERITONEOGRAM RS&I $1,488.50
74210 106395 RADIOLOGIC EXAM PHRNX&/CRV ESOPH CONTRAST STUDY $968.50
74220 106396 RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY $843.00
74221 106397 RADIOLOGIC EXAM ESOPHAGUS DOUBLE CONTRAST STUDY $770.00
74230 106398 RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY $965.00
74235 106399 RMVL FB ESOPHAGEAL W/USE BALLOON CATH RS&I $1,804.00
74240 106400 RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY $1,854.00
74246 106401 RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY $1,270.00
74248 106402 RADIOLOGIC SMALL INTESTINE FOLLOW-THROUGH STUDY $1,140.00
74250 106403 RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY $1,421.00
74251 106404 RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY $1,901.50
74261 106405 CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST $2,451.00
74262 106406 CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST $3,928.50
74263 106407 CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING $2,969.00
74270 106408 RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY $983.00
74280 106409 RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY $1,804.00
74283 106410 THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ $1,660.00
74290 106411 CHOLECYSTOGRAPHY ORAL CONTRST $1,195.00
74300 106412 CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I $1,953.00
74301 106413 CHOLANGIO&/PANCREATOGRAPHY ADDL SET INTRAOP RS $783.50
74328 106414 ENDOSCOPIC CATHJ BILIARY DUCTAL SYSTEM RS&I $1,682.00
74329 106415 ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS RS&I $1,649.00
74330 106416 CMBN NDSC CATHJ BILIARY&PNCRTC DUCTAL SYS RS&I $2,301.00
74340 106417 INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I $1,477.00
74355 106418 PERCUTANEOUS PLACEMENT ENTEROCLYSIS TUBE RS&I $1,944.50
74360 106419 INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I $1,882.50
74363 106420 PRQ TRANSHEPATC DILAT BILIARY DUCT STRICTRE RS&I $3,921.00
74400 106421 UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY $1,924.50
74410 106422 UROGRAPHY INFUSION DRIP &/BOLUS TECHNIQUE $1,807.50
74415 106423 UROGRAPHY NFS DRIP &/BOLUS W/NEPHROTOMOGRAPHY $2,255.50
74420 106424 UROGRAPHY RETROGRADE WITH/WO KUB $2,576.00
74425 106425 ANTEGRADE UROGRAPHY RADIOLOGICAL SUPVJ & INTERPJ $1,609.50
74430 106426 CYSTOGRAPHY MINIMUM 3 VIEWS RS&I $989.00
74440 106427 VASOGRAPY VESICULOGRAPY/EPIDIDYMOGRAPY RS&I $1,961.50
74445 106428 CORPORA CAVERNOSOGRAPY RS&I $1,961.50
74450 106429 URETHROCYSTOGRAPHY RETROGRADE RS&I $991.00
74455 106430 URETHROCYSTOGRAPHY VOIDING RS&I $1,358.00
74470 106431 RADEX RENAL CYST STUDY TRANSLUMBAR RS&I $2,934.00
74485 106432 DILATION URETERS/URETHRA RS&I $5,158.50
74710 106433 PELVIMETRY W/WOPLACENTAL LOCALIZATION $898.00
74712 106434 FETAL MRI W/PLACNTL MATRNL PLVC IMG SING/1ST GES $1,927.50
74713 106435 FETAL MRI W/PLACNTL MATRNL PLVC IMG EA ADDL GES $2,285.00
74740 106436 HYSTEROSALPINGOGRAPHY RS&I $1,416.00
74742 106437 TRANSCERVICAL CATHJ FALLOPIAN TUBE RS&I $1,528.00
74775 106438 PERINEOGRAM $1,342.00
75557 106439 CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST $3,226.00
75559 106440 CARDIAC MRI W/O CONTRAST W/STRESS IMAGING $5,121.50
75561 106441 CARDIAC MRI W/WO CONTRAST & FURTHER SEQ $5,117.00
75563 106442 CARDIAC MRI W/W/O CONTRAST W/STRESS $6,432.00
75565 106443 CARDIAC MRI FOR VELOCITY FLOW MAPPING $1,144.50
75571 106444 CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM $284.00
75572 106445 CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH $1,900.00
75573 106446 CT HEART C+ CARDIAC STRUX&MORPH CGEN HRT DS $2,647.00
75574 106447 CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST $2,339.00
75580 106448 N-INVAS EST C FFR AUGMNT SW ALYS CTA I&R PHY/QHP $0.00
75600 106449 AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I $7,610.50
75605 106450 AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I $13,344.00
75625 106451 AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I $6,090.00
75630 106452 AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I $9,099.50
75635 106453 CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP $4,255.00
75705 106454 ANGIOGRAPHY SPINAL SELECTIVE RS&I $10,487.00
75710 106455 ANGIOGRAPHY EXTREMITY UNILATERAL RS&I $4,829.50
75716 106456 ANGIOGRAPHY EXTREMITY BILATERAL RS&I $5,848.50
75726 106457 ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I $9,221.50
75731 106458 ANGIOGRAPHY ADRENAL UNILATERAL SLCTV RS&I $10,755.00
75733 106459 ANGIOGRAPHY ADRENAL BILATERAL SLCTV RS&I $10,755.00
75736 106460 ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I $12,589.00
75741 106461 ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I $8,491.50
75743 106462 ANGIOGRAPHY PULMONARY BILATERAL SLCTV RS&I $8,156.00
75746 106463 ANGRPH PULMONARY NONSLCTV CATH/VEN NJX RS&I $9,603.50
75756 106464 ANGIOGRAPHY INTERNAL MAMMARY RS&I $9,728.50
75774 106465 ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I $2,704.50
75801 106466 LYMPHANGIOGRAPHY EXTREMITY ONLY UNILATERAL RS&I $2,673.50
75803 106467 LYMPHANGIOGRAPHY EXTREMITY ONLY BILATERAL RS&I $5,154.00
75805 106468 LYMPHANGIOGRAPHY PELVIC/ABDOMINAL UNILAT RS&I $5,740.00
75807 106469 LYMPHANGIOGRAPHY PELVIC/ABDOMINAL BILATERAL RS&I $5,769.50
75809 106470 SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I $1,077.50
75810 106471 SPLENOPORTOGRAPY RS&I $10,755.00
75820 106472 VENOGRAPHY EXTREMITY UNILATERAL RS&I $2,931.50
75822 106473 VENOGRAPHY EXTREMITY BILATERAL RS&I $2,909.00
75825 106474 VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I $5,298.00
75827 106475 VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I $3,414.00
75831 106476 VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I $6,737.00
75833 106477 VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I $8,149.00
75840 106478 VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I $10,755.00
75842 106479 VENOGRAPHY ADRENAL BILATERAL SELECTIVE RS&I $20,024.00
75860 106480 VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I $4,501.50
75870 106481 VENOGRAPHY SUPERIOR SAGITTAL SINUS RS&I $3,661.50
75872 106482 VENOGRAPHY EPIDURAL RS&I $3,090.00
75880 106483 VENOGRAPHY ORBITAL RS&I $4,756.50
75885 106484 PRQ TRANSHEPATC PORTOGRAPY HEMODYN EVAL RS&I $7,988.00
75887 106485 PRQ TRANSHEPATC PORTOGRAPY W/O HEMODYN EVL INTRP $4,753.50
75889 106486 HEPATC VNGRPH WDG/FR HEMODYN EVAL RS&I $10,241.00
75891 106487 HEPATC VNGRPH WDG/FR W/O HEMODYN EVAL RS&I $7,152.50
75893 106488 VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS& $11,453.00
75894 106489 TRANSCATHETER EMBOLIZATION ANY METH RS&I $9,400.50
75898 106490 ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS $4,877.00
75901 106491 MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I $2,566.00
75902 106492 MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I $996.50
75956 106493 EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I $0.00
75957 106494 EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I $0.00
75958 106495 PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I $0.00
75959 106496 PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I $0.00
75970 106497 TRANSCATHETER BIOPSY RS&I $3,208.00
75984 106498 CHANGE PRQ TUBE/DRAINAGE CATH W CONTRAST RS&I $1,353.50
75989 106499 RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I $3,715.00
76000 106500 FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME $712.00
76010 106501 RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW CHLD $900.00
76080 106502 RADEX ABSCESS/FISTULA/SINUS TRACT RS&I $673.00
76098 106503 RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN $1,067.00
76100 106504 RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY $1,064.00
76120 106505 CINERADIOGRAPY/VIDRADIOGRAPY XCPT WHERE SPEC $912.50
76125 106506 CINERADIOGRAPY/VIDRADIOGRAPY ROUTINE EXAMINATION $443.00
76140 106507 CONSLTJ X-RAY XM MADE ELSEWHERE WRTTN REPRT $151.50
76145 106508 MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT $1,915.00
76376 106509 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION $1,788.00
76377 106510 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION $451.00
76380 106511 CT LIMITED/LOCALIZED FOLLOW UP STUDY $2,134.50
76390 106512 MRI SPECTROSCOPY $4,465.50
76391 106513 MAGNETIC RESONANCE ELASTOGRAPHY $1,101.50
76496 106514 UNLISTED FLUOROSCOPIC PROCEDURE $0.00
76497 106515 UNLISTED COMPUTED TOMOGRAPHY PROCEDURE $0.00
76498 106516 UNLISTED MAGNETIC RESONANCE PROCEDURE $0.00
76499 106517 UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE $0.00
76506 106518 ECHOENCEPHALOGRAPHY REAL TIME IMAGING $933.50
76510 106519 OPHTHALMIC US DX B-SCAN&QUAN A-SCAN SM PT ENCTR $1,400.00
76511 106520 OPHTHALMIC US DX QUANTITATIVE A-SCAN ONLY $882.00
76512 106521 OPHTHALMIC US DX B-SCAN W/WO NON-QUAN A-SCAN $522.50
76513 106522 DX OPHTHALMIC US ANT SEGMENT IMMERSION UNI/BI $1,007.50
76514 106523 OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI $221.00
76516 106524 OPHTHALMIC BIOMETRY US ECHOGRAPY A-SCAN $724.50
76519 106525 OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL $725.50
76529 106526 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION $839.50
76536 106527 US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM $868.00
76604 106528 US CHEST REAL TIME W/IMAGE DOCUMENTATION $1,196.00
76641 106529 US BREAST UNI REAL TIME WITH IMAGE COMPLETE $1,206.00
76642 106530 US BREAST UNI REAL TIME WITH IMAGE LIMITED $588.50
76700 106531 US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION $2,003.00
76705 106532 US ABDOMINAL REAL TIME W/IMAGE LIMITED $1,504.00
76706 106533 US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA $1,029.00
76770 106534 US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE $1,025.00
76775 106535 US RETROPERITONEAL REAL TIME W/IMAGE LIMITED $1,003.00
76776 106536 US TRNSPLNT KIDNEY REAL TIME W/IMAGE DOCMTN $2,259.50
76800 106537 ULTRASOUND SPINAL CANAL & CONTENTS $1,704.00
76801 106538 US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT $1,413.00
76802 106539 US PREG UTERUS 14 WK TRANSABDL EACH GESTATION $845.00
76805 106540 US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION $1,205.50
76810 106541 US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO $1,361.00
76811 106542 US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION $1,614.00
76812 106543 US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT $916.50
76813 106544 US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION $984.50
76814 106545 US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION $631.50
76815 106546 US PREGNANT UTERUS LIMITED 1/> FETUSES $1,010.50
76816 106547 US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS $772.50
76817 106548 US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG $867.50
76818 106549 FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING $1,044.50
76819 106550 FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING $687.00
76820 106551 DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY $760.50
76821 106552 DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART $820.50
76825 106553 ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING $5,401.00
76826 106554 ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD $1,458.00
76827 106555 DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE $1,352.00
76828 106556 DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT $806.00
76830 106557 US TRANSVAGINAL $1,389.00
76831 106558 SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER $1,368.50
76856 106559 US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE $1,873.00
76857 106560 US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U $535.00
76870 106561 US SCROTUM & CONTENTS $1,376.50
76872 106562 US TRANSRECTAL $1,309.00
76873 106563 US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX $1,645.50
76881 106564 US COMPL JOINT R-T W/IMAGE DOCUMENTATION $1,393.50
76882 106565 US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG $716.00
76883 106566 US NRV&ACC STRUX 1 XTR COMPRE W/IMG PR EXTREMITY $340.00
76885 106567 US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ $415.00
76886 106568 US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ $415.00
76932 106569 US ENDOMYOCARDIAL BIOPSY RS&I $1,368.50
76936 106570 US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL $1,945.50
76937 106571 US VASC ACCESS SITS VSL PATENCY NDL ENTRY $1,033.50
76940 106572 US &MNTR PARENCHYMAL TISSUE ABLATION $1,602.00
76941 106573 US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I $1,332.50
76942 106574 US GUIDANCE NEEDLE PLACEMENT IMG S&I $1,471.50
76945 106575 US GUIDANCE CHORIONIC VILLUS SAMPLING IMG S&I $1,065.00
76946 106576 US GUIDANCE AMNIOCENTESIS IMG S&I $1,082.50
76948 106577 US GUIDANCE ASPIRATION OVA IMG S&I $524.50
76965 106578 US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION $1,950.00
76975 106579 GI ENDOSCOPIC US S&I $1,733.50
76977 106580 US BONE DENSITY MEAS & INTERP PERIPH ANY METHO $295.00
76978 106581 ULTRASOUND TRGT DYNAMIC MICROBUBBLE 1ST LESION $653.00
76979 106582 ULTRASOUND TRGT DYNAMIC MICROBUBBLE EA ADDL LES $327.00
76981 106583 ULTRASOUND ELASTOGRAPHY PARENCHYMA $431.00
76982 106584 ULTRASOUND ELASTOGRAPHY FIRST TARGET LESION $427.00
76983 106585 ULTRASOUND ELASTOGRAPHY EA ADDL TAGET LESION $417.50
76984 106586 DX INTRAOPERATIVE THORACIC AORTA ULTRASOUND $0.00
76987 106587 DX NTRAOP EPICAR CAR US CHD PLMT&MNP TRNSDCR I&R $0.00
76988 106588 DX NTRAOP EPCAR CAR US CHD PLMT MNPJ&IMG ACQUISJ $0.00
76989 106589 DX INTRAOP EPICAR CARDIAC US CHD I&R ONLY $0.00
76998 106590 ULTRASONIC GUIDANCE INTRAOPERATIVE $2,088.00
76999 106591 UNLISTED US PROCEDURE $0.00
77001 106592 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT $830.00
77002 106593 FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON $1,261.00
77003 106594 FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON $529.00
77011 106595 CT GUIDANCE STEREOTACTIC LOCALIZATION $4,164.00
77012 106596 CT GUIDANCE NEEDLE PLACEMENT $4,033.00
77013 106597 CT GUIDANCE &MONITORING VISC TISS ABLATION $3,593.50
77014 106598 CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT $2,289.00
77021 106599 MRI GUIDANCE NEEDLE PLACEMENT RS&I $1,640.00
77022 106600 MRI GUIDANCE FOR PARENCHYMAL TISSUE ABLATION $7,484.50
77046 106601 MRI BREAST WITHOUT CONTRAST MATERIAL UNILATERAL $4,642.00
77047 106602 MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL $3,786.00
77048 106603 MRI BREAST W/OUT&WITH CONTRAST W/CAD UNILATERAL $8,436.00
77049 106604 MRI BREAST WITHOUT&WITH CONTRAST W/CAD BILATERAL $3,820.00
77053 106605 MAMMARY DUCTOGRAM OR GALACTOGRAM SINGLE $1,218.00
77054 106606 MAMMARY DUCTOGRAM OR GALACTOGRAM MULTIPLE $1,320.50
77061 106607 DIGITAL BREAST TOMOSYNTHESIS UNILATERAL $133.00
77062 106608 DIGITAL BREAST TOMOSYNTHESIS BILATERAL $219.50
77063 106609 SCREENING DIGITAL BREAST TOMOSYNTHESIS BI $184.00
77065 106610 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI $657.50
77066 106611 DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI $961.00
77067 106612 SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD $700.50
77071 106613 MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS $604.00
77072 106614 BONE AGE STUDIES $806.00
77073 106615 BONE LENGTH STUDIES $652.00
77074 106616 RADIOLOGIC EXAMINATION OSSEOUS SURVEY LIMITED $442.00
77075 106617 RADIOLOGIC EXAMINATION OSSEOUS SURVEY COMPL $1,238.00
77076 106618 RADIOLOGIC EXAMINATION OSSEOUS SURVEY INFANT $898.00
77077 106619 JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS $601.50
77078 106620 CT BONE MINERL DENSITY STUDY 1/> SITS AXIAL SKE $935.00
77080 106621 DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL $1,004.50
77081 106622 DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL $705.00
77084 106623 BONE MARROW BLOOD SUPPLY $3,416.50
77085 106624 DXA BONE DENSITY STUDY AXIAL SKELETON $1,161.50
77086 106625 VERTEBRAL FRACTURE ASSESSMENT VIA DXA $811.00
77089 106626 TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK $900.00
77090 106627 TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR $0.00
77091 106628 TBS TECHNICAL CALCULATION ONLY $0.00
77092 106629 TBS INTERPRETATION & REPORT FX RISK BY OTHER QHP $0.00
77261 106630 THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE $903.00
77262 106631 THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE $1,212.00
77263 106632 THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX $1,513.00
77280 106633 THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE $4,213.00
77285 106634 THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED $3,111.00
77290 106635 THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX $4,531.00
77293 106636 RESPIRATORY MOTION MANAGEMENT SIMULATION $2,534.50
77295 106637 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS $5,553.00
77299 106638 UNLISTED PX THER RADIOLOGY CLINICAL TX PLANNING $0.00
77300 106639 BASIC RADIATION DOSIMETRY CALCULATION $742.00
77301 106640 NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS $7,317.00
77306 106641 TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION $2,070.50
77307 106642 TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY $4,031.00
77316 106643 BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL $2,884.50
77317 106644 BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL $2,627.50
77318 106645 BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL $4,445.50
77321 106646 SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY $1,583.00
77331 106647 SPEC DOSIM ONLY PRESCRIBED TREATING PHYS $1,060.00
77332 106648 TX DEVICES DESIGN & CONSTRUCTION SIMPLE $1,192.50
77333 106649 TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE $3,908.00
77334 106650 TX DEVICES DESIGN & CONSTRUCTION COMPLEX $1,649.00
77336 106651 CONTINUING MEDICAL PHYSICS CONSLTJ PR WK $708.00
77338 106652 MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN $4,266.00
77370 106653 SPEC MEDICAL RADJ PHYSICS CONSLTJ $1,603.00
77371 106654 RADIATION DELIVERY STEREOTACTIC CRANIAL COBALT $53,362.00
77372 106655 RADIATION DELIVERY STEREOTACTIC CRANIAL LINEAR $31,050.00
77373 106656 STEREOTACTIC BODY RADIATION DELIVERY $11,596.00
77385 106657 INTENSITY MODULATED RADIATION TX DLVR SIMPLE $4,672.00
77386 106658 INTENSITY MODULATED RADIATION TX DLVR COMPLEX $5,262.00
77387 106659 GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR $483.00
77399 106660 UNLISTD PX MED RADJ PHYSIC DOSIM&TX DEV&SPEC SVC $0.00
77401 106661 RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA $870.50
77402 106662 RADIATION TREATMENT DELIVERY 1 MEV >= SIMPLE $1,189.50
77407 106663 RADIATION TX DELIVERY 1 MEV >= INTERMEDIATE $1,684.50
77412 106664 RADIATION TREATMENT DELIVERY 1 MEV >= COMPLEX $4,204.00
77417 106665 THERAPEUTIC RADIOLOGY PORT IMAGES(S) $94.00
77423 106666 HIGH ENERGY NEUTRON RADJ TX DLVR 1/> ISOCENTER $4,758.50
77424 106667 INTRAOP RADIAJ TX DELIVER XRAY SINGLE TX SESSION $27,931.50
77425 106668 INTRAOP RADIAJ TX DELIVER ELECTRONS SNGL TX SESS $29,663.50
77427 106669 RADIATION TREATMENT MANAGEMENT 5 TREATMENTS $1,044.50
77431 106670 RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY $1,133.50
77432 106671 STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION $0.00
77435 106672 STEREOTACTIC BODY RADIATION MANAGEMENT $3,722.50
77469 106673 INTRAOPERATIVE RADIATION TREATMENT MANAGEMENT $2,547.50
77470 106674 SPECIAL TREATMENT PROCEDURE $3,949.00
77499 106675 UNLISTED PROCEDURE THERAPEUTIC RADIOLOGY TX MGMT $0.00
77520 106676 PROTON TX DELIVERY SIMPLE W/O COMPENSATION $8,022.00
77522 106677 PROTON TX DELIVERY SIMPLE W/COMPENSATION $10,130.50
77523 106678 PROTON TX DELIVERY INTERMEDIATE $13,252.00
77525 106679 PROTON TX DELIVERY COMPLEX $14,074.50
77600 106680 HYPERTHERMIA EXTERNAL GENERATED SUPERFICIAL $3,297.00
77605 106681 HYPERTHERMIA EXTERNAL GENERATED DEEP $6,447.00
77610 106682 HYPERTHERMIA INTERSTITIAL PROBE 5/< APPLICATORS $3,083.50
77615 106683 HYPERTHERMIA INTERSTIAL PROBE 5/> APPLICATORS $3,083.50
77620 106684 HYPERTHERMIA INTRACAVITARY PROBES $3,083.50
77750 106685 NFS/INSTLJ RADIOELMNT SLN 3 MO FOLLOW-UP CARE $1,804.00
77761 106686 INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE $3,755.00
77762 106687 INTRACAVITARY RADIATION SOURCE APPLIC INTERMED $3,187.00
77763 106688 INTRACAVITARY RADIATION SOURCE APPLIC COMPLEX $4,800.00
77767 106689 HDR RDNCL SKN SURF BRACHYTX LES <2CM/1 CHAN $2,011.50
77768 106690 HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES $2,011.50
77770 106691 HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL $4,495.00
77771 106692 HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL $4,091.00
77772 106693 HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS $9,382.00
77778 106694 INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX $11,029.50
77789 106695 SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE $2,170.00
77790 106696 SUPERVISION HANDLING LOADING RADIATION SOURCE $2,177.50
77799 106697 UNLISTED PROCEDURE CLINICAL BRACHYTHERAPY $0.00
78012 106698 THYROID UPTAKE SINGLE/MULTIPLE QUANT MEASUREMENT $1,759.50
78013 106699 THYROID IMAGING WITH VASCULAR FLOW $1,651.50
78014 106700 THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS $1,947.50
78015 106701 THYROID CARCINOMA METASTASES IMG LMTD AREA $2,127.50
78016 106702 THYROID CARCINOMA METASTASES IMG ADDL STUDY $2,541.00
78018 106703 THYROID CARCINOMA METASTASES IMG WHOLE BODY $3,399.50
78020 106704 THYROID CARCINOMA METASTASES UPTAKE $1,200.50
78070 106705 PARATHYROID PLANAR IMAGING $2,692.00
78071 106706 PARATHYROID PLANAR IMAGING W/WO SUBTRACTION $3,588.00
78072 106707 PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT $2,957.00
78075 106708 ADRENAL IMAGING CORTEX &/MEDULLA $4,977.50
78099 106709 UNLISTED ENDOCRINE PX DX NUCLEAR MEDICINE $0.00
78102 106710 BONE MARROW IMAGING LIMITED AREA $1,348.00
78103 106711 BONE MARROW IMAGING MULTIPLE AREAS $2,167.00
78104 106712 BONE MARROW IMAGING WHOLE BODY $2,905.00
78110 106713 PLASMA VOL RADIOPHARM VOL DILUTION SPX 1 SAMPLE $3,324.50
78111 106714 PLASMA VOL RADIOPHARM VOL DILUTE SPX MULT SMPLES $7,569.50
78120 106715 RED CELL VOLUME DETERMINATION SPX 1 SAMPLING $3,324.50
78121 106716 RED CELL VOLUME DETERMINATION SPX MULT SAMPLINGS $3,324.50
78122 106717 WHOLE BLOOD VOLUME DETERM PLASMA&RED CELL VOLU $3,331.00
78130 106718 RED CELL SURVIVAL STUDY $3,324.50
78140 106719 LABELED RBC SEQUESTRATION DIFFERNTL ORGAN/TISSUE $3,324.50
78185 106720 SPLEEN IMAGING ONLY W/WO VASCULAR FLOW $2,416.50
78191 106721 PLATELET SURVIVAL STUDY $1,873.00
78195 106722 LYMPHATICS & LYMPH NODES IMAGING $2,915.00
78199 106723 UNLISTED HEMATOP RET/ENDO&LYMPHATIC DX NUC MED $0.00
78201 106724 LIVER IMAGING STATIC ONLY $4,511.00
78202 106725 LIVER IMAGING W/VASCULAR FLOW $4,278.00
78215 106726 LIVER & SPLEEN IMAGING STATIC ONLY $2,918.50
78216 106727 LIVER & SPLEEN IMAGING W/VASCULAR FLOW $2,935.00
78226 106728 HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER $3,023.00
78227 106729 HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ $4,038.50
78230 106730 SALIVARY GLAND IMAGING $2,270.50
78231 106731 SALIVARY GLAND IMAGING SERIAL IMAGES $2,270.50
78232 106732 SALIVARY GLAND FUNCTION STUDY $4,060.50
78258 106733 ESOPHAGEAL MOTILITY $1,717.00
78261 106734 GASTRIC MUCOSA IMAGING $2,270.50
78262 106735 GASTROESOPHAGEAL REFLUX STUDY $3,079.50
78264 106736 GASTRIC EMPTYING IMAGING STUDY $2,955.00
78265 106737 GASTRIC EMPTYNG IMAG STD W/SM BWL TRANSIT $2,924.00
78266 106738 GSTRC EMPTNG IMAG STD W/SM BWL COL TRNST MLT DAY $3,560.50
78267 106739 UREA BREATH TEST C-14 ISOTOPIC ACQUISJ ANALYSIS $594.50
78268 106740 UREA BREATH TEST C-14 ISOTOPIC ANALYSIS $1,061.00
78278 106741 ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING $3,000.00
78282 106742 GASTROINTESTINAL PROTEIN LOSS $2,270.50
78290 106743 INTESTINE IMAGING $2,552.50
78291 106744 PERITONEAL-VENOUS SHUNT PATENCY TEST $2,449.00
78299 106745 UNLISTED GASTROINTESTINAL PX DX NUCLEAR MEDICINE $0.00
78300 106746 BONE &/JOINT IMAGING LIMITED AREA $2,360.00
78305 106747 BONE &/JOINT IMAGING MULTIPLE AREAS $2,647.00
78306 106748 BONE &/JOINT IMAGING WHOLE BODY $2,548.50
78315 106749 BONE &/JOINT IMAGING 3 PHASE STUDY $2,902.00
78350 106750 BONE DENSITY 1/> SITES 1 PHOTON ABSORPTIOMETRY $1,682.50
78351 106751 BONE DENSTY 1/> SITES DUAL PHOTON ABSORPTIOMETR $256.00
78399 106752 UNLISTED MUSCULOSKELETAL PX DX NUCLEAR MEDICINE $0.00
78414 106753 CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM $2,563.00
78428 106754 CARDIAC SHUNT DETECTION $2,567.50
78429 106755 MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT $4,900.00
78430 106756 MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT $10,549.00
78431 106757 MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT $14,309.00
78432 106758 MYOCRD IMG PET PRFUJ W/METAB DUAL RADIOTRACER $18,180.00
78433 106759 MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT $15,024.50
78434 106760 AQMBF PET REST AND PHARMACOLOGIC STRESS $1,677.00
78445 106761 NONCARDIAC VASCULAR FLOW IMAGING $3,189.50
78451 106762 MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS $5,765.50
78452 106763 MYOCARDIAL SPECT MULTIPLE STUDIES $8,298.50
78453 106764 MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS $8,229.00
78454 106765 MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES $5,807.00
78456 106766 ACUTE VENOUS THROMBOSIS IMAGING PEPTIDE $2,727.00
78457 106767 VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL $2,727.00
78458 106768 VENOUS THROMBOSIS IMAGING VENOGRAM BILATERAL $2,727.00
78459 106769 MYOCRD IMG PET METAB EVAL SINGLE STUDY $8,990.50
78466 106770 MYOCARDIAL IMAGING INFARCT AVID PLANAR QUAL/QUAN $986.00
78468 106771 MYOCRD IMG INFARCT AVID PLNR EJEC FXJ 1ST PS TQ $1,458.00
78469 106772 MYOCRD INFARCT AVID PLNR TOMOG SPECT W/WO QUANTJ $4,463.50
78472 106773 CARD BLOOD POOL GATED PLANAR 1 STUDY REST/STRESS $4,135.50
78473 106774 CARD BL POOL GATED MLT STDY WAL MOTN EJECT FRACT $4,506.50
78481 106775 CARD BL POOL PLANAR 1 STDY WAL MOTN EJECT FRACT $3,615.50
78483 106776 CARD BL POOL PLNR MLT STDY WAL MOTN EJECT FRACT $4,154.00
78491 106777 MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS $9,756.00
78492 106778 MYOCRD IMG PET PRFUJ MULTIPLE STUDY REST&STRESS $10,644.00
78494 106779 CARD BL POOL GATED SPECT REST WAL MOTN EJCT FRCT $4,866.50
78496 106780 CARD BL POOL GATED 1 STDY REST RT VENT EJCT FRCT $1,854.50
78499 106781 UNLISTED CARDIOVASCULAR PX DX NUCLEAR MEDICINE $0.00
78579 106782 PULMONARY VENTILATION IMAGING $2,915.50
78580 106783 PULMONARY PERFUSION IMAGING PARTICULATE $1,784.00
78582 106784 PULMONARY VENTILATION & PERFUSION IMAGING $3,493.00
78597 106785 QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING $1,613.00
78598 106786 QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGIN $2,496.00
78599 106787 UNLISTED RESPIRATORY PX DX NUCLEAR MEDICINE $0.00
78600 106788 BRAIN IMAGING <4 STATIC VIEWS $2,317.00
78601 106789 BRAIN IMAGING <4 STATIC VIEWS W/VASCULAR FLOW $3,448.50
78605 106790 BRAIN IMAGING MINIMUM 4 STATIC VIEWS $4,116.00
78606 106791 BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW $3,448.50
78608 106792 BRAIN IMAGING PET METABOLIC EVALUATION $12,152.00
78609 106793 BRAIN IMAGING PET PERFUSION EVALUATION $12,417.50
78610 106794 BRAIN IMAGING VASCULAR FLOW ONLY $2,317.00
78630 106795 CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY $3,694.50
78635 106796 CEREBROSPINAL FLUID FLOW W/O MATL VENTRICLGRAPHY $3,448.50
78645 106797 CEREBROSPINAL FLUID FLOW W/O MATL SHUNT EVALTJ $2,822.50
78650 106798 CEREBROSPINAL FLUID LEAK DETECTION&LOCALIZATIO $3,527.50
78660 106799 RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY $1,821.00
78699 106800 UNLISTED NERVOUS SYSTEM PX DX NUCLEAR MEDICINE $0.00
78700 106801 KIDNEY IMAGING MORPHOLOGY $3,229.00
78701 106802 KIDNEY IMAGING MORPHOOGY W/VASCULAR FLOW $3,109.00
78707 106803 KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/O RX $6,646.00
78708 106804 KIDNEY IMG MORPHOLOGY VASCULAR FLOW 1 W/RX $2,460.00
78709 106805 KIDNEY IMG MORPHOLOGY VASCULAR FLOW MULTIPLE $4,186.50
78725 106806 KIDNEY FUNCJ STUDY NON-IMG RADIOISOTOPIC STUDY $2,083.00
78730 106807 URINARY BLADDER RESIDUAL STUDY $1,265.00
78740 106808 URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM $2,039.00
78761 106809 TESTICULAR IMAGING WITH VASCULAR FLOW $2,739.00
78799 106810 UNLISTED GENITOURINARY PX DX NUCLEAR MEDICINE $0.00
78800 106811 RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING $2,649.00
78801 106812 RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D $3,551.00
78802 106813 RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING $2,811.50
78803 106814 RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG $2,884.00
78804 106815 RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING $6,386.00
78808 106816 NJX RP LOCLZJ NON-IMG PROBE STUDY INTRAVENOUS $1,043.50
78811 106817 PET IMAGING LIMITED AREA CHEST HEAD/NECK $9,305.50
78812 106818 PET IMAGING SKULL BASE TO MID-THIGH $10,168.50
78813 106819 PET IMAGING WHOLE BODY $11,869.00
78814 106820 PET IMAGING CT FOR ATTENUATION LIMITED AREA $9,670.00
78815 106821 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH $9,174.50
78816 106822 PET IMAGING FOR CT ATTENUATION WHOLE BODY $9,240.00
78830 106823 RP LOCLZJ TUM SPECT W/CT 1 AREA/ACQUISJ 1DAY IMG $6,827.00
78831 106824 RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG $7,427.50
78832 106825 RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG $7,219.00
78835 106826 RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA $1,182.00
78999 106827 UNLISTED MISCELLANEOUS PX DX NUCLEAR MEDICINE $0.00
79005 106828 RP THERAPY ORAL ADMINISTRATION $2,572.50
79101 106829 RP THERAPY INTRAVENOUS ADMINISTRATION $3,080.00
79200 106830 RP THERAPY INRACAVITARY ADMINISTRATION $2,886.00
79300 106831 RP THERAPY INTERSTITIAL RADIOACTIVE COLLOID ADMN $2,141.50
79403 106832 RP THER RADIOLBLD MONOCLONAL ANTIBODY IV INFUS $4,055.50
79440 106833 RP THERAPY INTRA-ARTICULAR ADMINISTRATION $2,546.50
79445 106834 RP THERAPY INTRA-ARTERIAL PARTICULATE ADMN $3,485.00
79999 106835 RP THERAPY UNLISTED PROCEDURE $0.00
80047 106836 BASIC METABOLIC PANEL CALCIUM IONIZED $476.00
80048 106837 BASIC METABOLIC PANEL CALCIUM TOTAL $524.00
80050 106838 GENERAL HEALTH PANEL $283.00
80051 106839 ELECTROLYTE PANEL $345.00
80053 106840 COMPREHENSIVE METABOLIC PANEL $692.00
80055 106841 OBSTETRIC PANEL $751.50
80061 106842 LIPID PANEL $388.50
80069 106843 RENAL FUNCTION PANEL $2,015.00
80074 106844 ACUTE HEPATITIS PANEL $722.00
80076 106845 HEPATIC FUNCTION PANEL $470.00
80081 106846 OBSTETRIC PANEL $1,019.00
80143 106847 DRUG ASSAY ACETAMINOPHEN $521.00
80145 106848 DRUG ASSAY ADALIMUMAB $718.00
80150 106849 DRUG SCREEN QUANTITATIVE AMIKACIN $402.50
80151 106850 DRUG ASSAY AMIODARONE $267.50
80155 106851 DRUG ASSAY CAFFEINE $328.00
80156 106852 DRUG ASSAY CARBAMAZEPINE TOTAL $424.00
80157 106853 DRUG ASSAY CARBAMAZEPINE FREE $326.50
80158 106854 DRUG ASSAY CYCLOSPORINE $311.00
80159 106855 DRUG ASSAY CLOZAPINE $322.00
80161 106856 DRUG ASSAY CARBAMAZEPINE -10,11-EPOXIDE $334.00
80162 106857 DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL $171.00
80163 106858 DRUG SCREEN QUANTITATIVE DIGOXIN FREE $610.50
80164 106859 DRUG ASSAY VALPROIC DIPROPYLACETIC ACID TOTAL $373.50
80165 106860 DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE $364.50
80167 106861 DRUG ASSAY FELBAMATE $399.50
80168 106862 DRUG SCREEN QUANTITATIVE ETHOSUXIMIDE $311.50
80169 106863 DRUG ASSAY EVEROLIMUS $176.00
80170 106864 DRUG SCREEN QUANTITATIVE GENTAMICIN $479.50
80171 106865 DRUG SCREEN QUANTITATIVE GABAPENTIN $273.00
80173 106866 DRUG SCREEN QUANTITATIVE HALOPRIDOL $235.00
80175 106867 DRUG SCREEN QUANTITATIVE LAMOTRIGINE $150.00
80176 106868 DRUG SCREEN QUANTITATIVE LIDOCAINE $426.50
80177 106869 DRUG SCREEN QUANTITATIVE LEVETIRACETAM $186.50
80178 106870 DRUG SCREEN QUANTITATIVE LITHIUM $308.50
80179 106871 DRUG ASSAY SALICYLATE $266.50
80180 106872 DRUG SCREEN QUANTITATIVE MYCOPHENOLATE $208.00
80181 106873 DRUG ASSAY FLECAINIDE $312.50
80183 106874 DRUG SCREEN QUANTITATIVE OXCARBAZEPINE $191.50
80184 106875 DRUG SCREEN QUANTITATIVE PHENOBARBITAL $216.00
80185 106876 DRUG SCREEN QUANTITATIVE PHENYTOIN TOTAL $368.00
80186 106877 DRUG SCREEN QUANTITATIVE PHENYTOIN FREE $329.50
80187 106878 DRUG ASSAY POSACONAZOLE $43.00
80188 106879 DRUG SCREEN QUANTITATIVE PRIMIDONE $302.00
80189 106880 DRUG ASSAY ITRACONAZOLE $367.00
80190 106881 DRUG SCREEN QUANTITATIVE PROCAINAMIDE $262.50
80192 106882 DRUG SCREEN QUANTITATIVE PROCAINAMIDE METABOLITE $392.00
80193 106883 DRUG ASSAY LEFLUNOMIDE $701.50
80194 106884 DRUG SCREEN QUANTITATIVE QUINIDINE $442.00
80195 106885 DRUG SCREEN QUANTITATIVE SIROLIMUS $272.50
80197 106886 DRUG SCREEN QUANTITATIVE TACROLIMUS $888.00
80198 106887 DRUG SCREEN QUANTITATIVE THEOPHYLLINE $376.50
80199 106888 DRUG SCREEN QUANTITATIVE TIAGABINE $340.00
80200 106889 DRUG SCREEN QUANTITATIVE TOBRAMYCIN $493.50
80201 106890 DRUG SCREEN QUANTITATIVE TOPIRAMATE $116.00
80202 106891 DRUG SCREEN QUANTITATIVE VANCOMYCIN $424.00
80203 106892 DRUG SCREEN QUANTITATIVE ZONISAMIDE $188.50
80204 106893 DRUG ASSAY METHOTREXATE $413.00
80210 106894 DRUG ASSAY RUFINAMIDE $455.50
80220 106895 DRUG ASSAY HYDROXYCHLOROQUINE $469.00
80230 106896 DRUG ASSAY INFLIXIMAB $742.00
80235 106897 DRUG ASSAY LACOSAMIDE $211.50
80280 106898 DRUG ASSAY VEDOLIZUMAB $683.50
80285 106899 DRUG ASSAY VORICONAZOLE $188.50
80299 106900 QUANTITATION DRUG NOT ELSEWHERE SPECIFIED $341.00
80305 106901 DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE $423.00
80306 106902 DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS $488.00
80307 106903 DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE $1,233.50
80320 106904 DRUG SCREEN QUANTITATIVE ALCOHOLS $312.00
80321 106905 DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 $227.00
80322 106906 DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 3 OR MORE $501.00
80323 106907 ALKALOIDS NOT OTHERWISE SPECIFIED $322.00
80324 106908 DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 $289.50
80325 106909 DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 $372.00
80326 106910 DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE $109.50
80327 106911 DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2 $446.50
80328 106912 DRUG SCREEN QUANT ANABOLIC STEROID 3 OR MORE $0.00
80329 106913 DRUG SCREEN ANALGESICS NON-OPIOID 1 OR 2 $559.00
80330 106914 DRUG SCREEN ANALGESICS NON-OPIOID 3-5 $628.50
80331 106915 DRUG SCREEN ANALGESICS NON-OPIOID 6 OR MORE $76.00
80332 106916 ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 $481.00
80333 106917 ANTIDEPRESSANTS SEROTONERGIC CLASS 3-5 $322.00
80334 106918 ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE $48.50
80335 106919 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 $392.00
80336 106920 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 3-5 $431.00
80337 106921 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE $463.00
80338 106922 ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED $48.50
80339 106923 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1-3 $446.50
80340 106924 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 4-6 $315.50
80341 106925 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE $48.50
80342 106926 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1-3 $370.00
80343 106927 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 4-6 $416.00
80344 106928 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 7/MORE $54.50
80345 106929 DRUG SCREENING BARBITURATES $283.00
80346 106930 DRUG SCREENING BENZODIAZEPINES 1-12 $303.50
80347 106931 DRUG SCREENING BENZODIAZEPINES 13 OR MORE $395.00
80348 106932 DRUG SCREENING BUPRENORPHINE $303.50
80349 106933 DRUG SCREENING CANNABINOIDS NATURAL $218.00
80350 106934 DRUG SCREENING CANNABINOIDS SYNTHETIC 1-3 $258.00
80351 106935 DRUG SCREENING CANNABINOIDS SYNTHETIC 4-6 $519.50
80352 106936 DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE $567.50
80353 106937 DRUG SCREENING COCAINE $261.00
80354 106938 DRUG SCREENING FENTANYL $138.00
80355 106939 DRUG SCREENING GABAPENTIN NON-BLOOD $284.00
80356 106940 DRUG SCREENING HEROIN METABOLITE $239.50
80357 106941 DRUG SCREENING KETAMINE AND NORKETAMINE $188.00
80358 106942 DRUG SCREENING METHADONE $423.50
80359 106943 DRUG SCREENING METHYLENEDIOXYAMPHETAMINES $332.50
80360 106944 DRUG SCREENING METHYLPHENIDATE $479.50
80361 106945 DRUG SCREENING OPIATES 1 OR MORE $352.00
80362 106946 DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 $400.50
80363 106947 DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 3 OR 4 $392.00
80364 106948 DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE $364.50
80365 106949 DRUG SCREENING OXYCODONE $21.00
80366 106950 DRUG SCREENING PREGABALIN $328.00
80367 106951 DRUG SCREENING PROPOXYPHENE $97.00
80368 106952 DRUG SCREENING SEDATIVE HYPNOTICS $322.00
80369 106953 DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 $224.50
80370 106954 DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE $355.50
80371 106955 DRUG SCREENING STIMULANTS SYNTHETIC $76.00
80372 106956 DRUG SCREENING TAPENTADOL $155.00
80373 106957 DRUG SCREENING TRAMADOL $145.50
80374 106958 DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS $0.00
80375 106959 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 $398.00
80376 106960 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4-6 $0.00
80377 106961 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE $315.50
80400 106962 ACTH STIMULATION PANEL ADRENAL INSUFFICIENCY $835.00
80402 106963 ACTH STIMULATION PANEL 21 HYDROXYLASE DEFICIENCY $1,053.50
80406 106964 ACTH STIMJ PANEL 3 BETA-HYDROXYDEHYD DEFNCY $990.00
80408 106965 ALDOSTERONE SUPPRESSION EVALUATION PANEL $1,315.00
80410 106966 CALCITONIN STIMULATION PANEL $1,004.50
80412 106967 CORTICOTROPIC RELEASING HORM STIMJ PANEL $2,348.50
80414 106968 CHORNC GONAD STIMJ PANEL TESTOSTERONE RESPONSE $771.50
80415 106969 CHORNC GONAD STIMJ PNL TOTAL ESTRADIOL RESPONSE $1,433.00
80416 106970 RENAL VEIN RENIN STIMULATION PANEL $1,354.00
80417 106971 PERIPHERAL VEIN RENIN STIMULATION PANEL $700.00
80418 106972 COMBINED RAPID ANT PITUITARY EVALUATION PANEL $3,295.50
80420 106973 DEXMETHASONE SUPPRESSION PANEL 48 HR $1,903.50
80422 106974 GLUCOSE TOLERANCE PANEL INSULINOMA $660.50
80424 106975 GLUCOSE TOLERANCE PANEL PHEOCHROMOCYTOMA $1,430.00
80426 106976 GONADOTROPIN RELEASING HORMONE STIMJ PANEL $1,454.00
80428 106977 GROWTH HORMONE STIMULATION PANEL $1,667.00
80430 106978 GROWTH HORMONE SUPRJ PANEL GLUCOSE ADMN $991.00
80432 106979 INSULIN-INDUCED C-PEPTIDE SUPRESSION PANEL $1,373.50
80434 106980 INSULIN TOLERANCE PANEL ACTH INSUFFICIENCY $1,154.00
80435 106981 INSULIN TOLERANCE PANEL GROWTH HORM DEFNCY $4,480.00
80436 106982 METYRAPONE PANEL $1,084.00
80438 106983 THYROTROPIN RELEASING HORMONE STMLJ PANEL 1 HR $760.50
80439 106984 THYROTROPIN RELEASING HORMONE STMLJ PANEL 2 HR $903.00
80503 106985 PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN $830.00
80504 106986 PATHOLOGY CLINICAL CONSULTATION MOD MDM 21-40MIN $1,483.00
80505 106987 PATHOLOGY CLINICAL CONSULTATION HI MDM 41-60 MIN $1,483.00
80506 106988 PATHOLOGY CLINICAL CONSLTJ PROLNG SVC EA ADDL 30 $0.00
81000 106989 URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY $121.50
81001 106990 URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY $206.00
81002 106991 URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP $132.00
81003 106992 URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY $194.00
81005 106993 URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS $115.00
81007 106994 URINALYSIS BACTERIURIA SCR XCPT CULTURE/DIPSTICK $325.00
81015 106995 URINALYSIS MICROSCOPIC ONLY $72.00
81020 106996 URINALYSIS 2/3 GLASS TEST $158.00
81025 106997 URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS $321.00
81050 106998 VOLUME MEASUREMENT TIMED COLLECTION EACH $42.00
81099 106999 UNLISTED URINALYSIS PROCEDURE $0.00
81105 107000 HPA-1 GENOTYPING GENE ANALYSIS COMMON VARIANT $1,381.50
81120 107008 IDH1 COMMON VARIANTS $1,659.00
81121 107009 IDH2 COMMON VARIANTS $2,063.00
81161 107010 DMD DUPLICATION/DELETION ANALYSIS $2,785.50
81162 107011 BRCA1 BRCA2 GENE ALYS FULL SEQ FULL DUP/DEL ALYS $8,388.50
81163 107012 BRCA1 BRCA2 GENE ANALYSIS FULL SEQUENCE ANALYSIS $4,819.50
81164 107013 BRCA1 BRCA2 GENE ANALYSIS FULL DUP/DEL ANALYSIS $0.00
81165 107014 BRCA1 GENE ANALYSIS FULL SEQUENCE ANALYSIS $4,672.50
81166 107015 BRCA1 GENE ANALYSIS FULL DUP/DEL ANALYSIS $0.00
81167 107016 BRCA2 GENE ANALYSIS FULL DUP/DEL ANALYSIS $0.00
81168 107017 CCND1/IGH TRANSLOCATION ALYS MAJOR BP QUAL&QUAN $1,366.00
81170 107018 ABL1 GENE ANALYSIS KINASE DOMAIN VARIANTS $2,210.50
81171 107019 AFF2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $0.00
81172 107020 AFF2 GENE ANALYSIS CHARACTERIZATION OF ALLELES $0.00
81173 107021 AR GENE ANALYSIS FULL GENE SEQUENCE $0.00
81174 107022 AR GENE ANALYSIS KNOWN FAMILIAL VARIANT $0.00
81175 107023 ASXL1 GENE ANALYSIS FULL GENE SEQUENCE $3,466.00
81176 107024 ASXL1 GENE ANALYSIS TARGETED SEQ ANALYSIS $2,075.00
81177 107025 ATN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $0.00
81178 107026 ATXN1 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $1,128.00
81181 107029 ATXN7 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $927.50
81182 107030 ATXN8OS GENE ANALYSIS EVAL DETECT ABNOR ALLELES $0.00
81183 107031 ATXN10 GENE ANALYSIS EVAL DETC ABNORMAL ALLELES $0.00
81184 107032 CACNA1A GENE ANALYSIS EVAL DETECT ABNOR ALLELES $1,165.50
81185 107033 CACNA1A GENE ANALYSIS FULL GENE SEQUENCE $2,652.00
81186 107034 CACNA1A GENE ANALYSIS KNOWN FAMILIAL VARIANT $0.00
81187 107035 CNBP GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $4,253.50
81188 107036 CSTB GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $0.00
81189 107037 CSTB GENE ANALYSIS FULL GENE SEQUENCE $0.00
81190 107038 CSTB GENE ANALYSIS KNOWN FAMILIAL VARIANTS $0.00
81191 107039 NTRK1 TRANSLOCATION ANALYSIS $3,420.00
81194 107042 NTRK TRANSLOCATION ANALYSIS $4,173.00
81200 107043 ASPA GENE ANALYSIS COMMON VARIANTS $728.50
81201 107044 APC GENE ANALYSIS FULL GENE SEQUENCE $3,097.00
81202 107045 APC GENE ANALYSIS KNOWN FAMILIAL VARIANTS $906.00
81203 107046 APC GENE ANALYSIS DUPLICATION/DELETION VARIANTS $1,781.00
81204 107047 AR GENE ANALYSIS CHARACTERIZATION OF ALLELES $2,160.50
81205 107048 BCKDHB GENE ANALYSIS COMMON VARIANTS $894.00
81206 107049 BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE $740.00
81207 107050 BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE $734.50
81208 107051 BCR/ABL1 OTHER BREAKPNT QUALITATIVE/QUANTITATIVE $651.00
81209 107052 BLM GENE ANALYSIS 2281DEL6INS7 VARIANT $467.50
81210 107053 BRAF GENE ANALYSIS V600 VARIANT(S) $874.00
81212 107054 BRCA1 BRCA 2 GEN ALYS 185DELAG 5385INSC 6174DELT $2,852.50
81215 107055 BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT $907.50
81216 107056 BRCA2 GENE ANALYSIS FULL SEQUENCE ANALYSIS $5,246.00
81217 107057 BRCA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT $907.50
81218 107058 CEBPA GENE ANALYSIS FULL GENE SEQUENCE $2,210.50
81219 107059 CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 $849.00
81220 107060 CFTR GENE ANALYSIS COMMON VARIANTS $2,741.50
81221 107061 CFTR GENE ANALYSIS KNOWN FAMILIAL VARIANTS $114.00
81222 107062 CFTR GENE ANALYSIS DUPLICATION/DELETION VARIANTS $3,188.00
81223 107063 CFTR GENE ANALYSIS FULL GENE SEQUENCE $7,793.50
81224 107064 CFTR GENE ANALYSIS INTRON 8 POLY-T ANALYSIS $2,151.00
81225 107065 CYP2C19 GENE ANALYSIS COMMON VARIANTS $2,169.00
81226 107066 CYP2D6 GENE ANALYSIS COMMON VARIANTS $1,160.00
81227 107067 CYP2C9 GENE ANALYSIS COMMON VARIANTS $63.00
81228 107068 CYTOG ALYS CHRMOML ABNOR COPY NUMBER VRNT CGH $7,101.50
81229 107069 CYTOG ALYS CHRMOML ABNOR CPY NUMBER&SNP VRNT CGH $5,346.50
81230 107070 CYP3A4 GENE ANALYSIS COMMON VARIANTS $1,507.50
81231 107071 CYP3A5 GENE ANALYSIS COMMON VARIANTS $1,507.50
81232 107072 DPYD GENE ANALYSIS COMMON VARIANTS $1,507.50
81233 107073 BTK GENE ANALYSIS COMMON VARIANTS $1,830.50
81234 107074 DMPK GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $1,956.50
81235 107075 EGFR GENE ANALYSIS COMMON VARIANTS $3,966.50
81236 107076 EZH2 GENE ANALYSIS FULL GENE SEQUENCE $1,168.50
81237 107077 EZH2 GENE ANALYSIS COMMON VARIANTS $1,281.50
81238 107078 F9 FULL GENE SEQUENCE $3,144.00
81239 107079 DMPK GENE ANALYSIS CHARACTERIZATION OF ALLELES $0.00
81240 107080 F2 GENE ANALYSIS 20210G >A VARIANT $260.00
81241 107081 F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT $162.50
81242 107082 FANCC GENE ANALYSIS COMMON VARIANT $949.00
81243 107083 FMR1 GENE ALYS EVAL TO DETECT ABNORMAL ALLELES $1,389.00
81244 107084 FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES $1,336.00
81245 107085 FLT3 GENE ANALYSIS INTERNAL TANDEM DUP VARIANTS $411.00
81246 107086 FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS $375.50
81247 107087 G6PD GENE ANALYSIS COMMON VARIANTS $1,507.50
81248 107088 G6PD GENE ANALYSIS KNOWN FAMILIAL VARIANTS $2,377.00
81249 107089 G6PD GENE ANALYSIS FULL GENE SEQUENCE $3,144.00
81250 107090 G6PC GENE ANALYSIS COMMON VARIANTS $681.50
81251 107091 GBA GLUCOSIDASE/BETA/ACID ANAL COMM VARIANTS $1,055.00
81252 107092 GJB2 GENE ANALYSIS FULL GENE SEQUENCE $2,043.50
81253 107093 GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS $1,094.50
81254 107094 GJB6 GENE ANALYSIS COMMON VARIANTS $791.00
81255 107095 HEXA GENE ANALYSIS COMMON VARIANTS $1,085.00
81256 107096 HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS $365.00
81257 107097 HBA1/HBA2 GENE ANALYSIS COMMON DELETIONS/VARIANT $2,219.00
81258 107098 HBA1/HBA2 GENE ANALYSIS KNOWN FAMILIAL VARIANT $2,377.00
81259 107099 HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE $3,144.00
81260 107100 IKBKAP GENE ANALYSIS COMMON VARIANTS $721.00
81261 107101 IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED $485.00
81262 107102 IGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBE $1,050.50
81263 107103 IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS $3,150.00
81264 107104 IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP $2,057.00
81265 107105 COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC $1,571.00
81266 107106 COMPARATIVE ANAL STR MARKERS EA ADDL SPECIMEN $2,251.50
81267 107107 CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION $1,625.00
81268 107108 CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA $2,192.50
81269 107109 HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIANTS $1,645.50
81270 107110 JAK2 GENE ANALYSIS P.VAL617PHE VARIANT $723.50
81271 107111 HTT GENE ANALYSIS DETECT ABNORMAL ALLELES $1,351.50
81272 107112 KIT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS $2,210.50
81273 107113 KIT GENE ANALYSIS D816 VARIANT(S) $1,989.00
81274 107114 HTT GENE ANALYSIS CHARACTERIZATION ALLELES $0.00
81275 107115 KRAS GENE ANALYSIS VARIANTS IN EXON 2 $775.00
81276 107116 KRAS GENE ANALYSIS ADDITIONAL VARIANT(S) $1,575.50
81277 107117 CYTOGENOMIC NEOPLASIA MICROARRAY ANALYSIS $7,705.50
81278 107118 IGH@/BCL2 TLCJ ALYS MBR & MCR BP QUAL/QUAN $3,710.00
81279 107119 JAK2 TARGETED SEQUENCE ANALYSIS $1,742.50
81283 107120 IFNL3 GENE ANALYSIS RS12979860 VARIANT $913.50
81284 107121 FXN GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $1,539.50
81285 107122 FXN GENE ANALYSIS CHARACTERIZATION ALLELES $0.00
81286 107123 FXN GENE ANALYSIS FULL GENE SEQUENCE $0.00
81287 107124 MGMT GENE PROMOTER METHYLATION ANALYSIS $2,468.00
81288 107125 MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS $1,940.00
81289 107126 FXN GENE ANALYSIS KNOWN FAMILIAL VARIANTS $0.00
81290 107127 MCOLN1 MUCOLIPIN1 GENE ANALYSIS COMMON VARIANTS $724.00
81291 107128 MTHFR GENE ANALYSIS COMMON VARIANTS $979.50
81292 107129 MLH1 GENE ANALYSIS FULL SEQUENCE ANALYSIS $2,657.00
81293 107130 MLH1 GENE ANALYSIS KNOWN FAMILIAL VARIANTS $1,677.50
81294 107131 MLH1 GENE ANALYSIS DUPLICATION/DELETION VARIANTS $1,430.00
81295 107132 MSH2 GENE ANALYSIS FULL SEQUENCE ANALYSIS $2,591.00
81296 107133 MSH2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS $1,107.00
81297 107134 MSH2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS $1,315.00
81298 107135 MSH6 GENE ANALYSIS FULL SEQUENCE ANALYSIS $2,609.50
81299 107136 MSH6 GENE ANALYSIS KNOWN FAMILIAL VARIANTS $1,261.50
81300 107137 MSH6 GENE ANALYSIS DUPLICATION/DELETION VARIA $1,190.50
81301 107138 MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF $2,454.50
81302 107139 MECP2 GENE ANALYSIS FULL SEQUENCE $1,536.50
81303 107140 MECP2 GENE ANALYSIS KNOWN FAMILIAL VARIANT $1,037.00
81304 107141 MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT $2,014.50
81305 107142 MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT $3,151.50
81306 107143 NUDT15 GENE ANALYSIS COMMON VARIANTS $1,063.00
81307 107144 PALB2 GENE ANALYSIS FULL GENE SEQUENCE $1,225.00
81308 107145 PALB2 GENE ANALYSIS KNOWN FAMILIAL VARIANT $1,739.50
81309 107146 PIK3CA GENE ANALYSIS TARGETED SEQUENCE ANALYSIS $3,188.00
81310 107147 NPM1 NUCLEOPHOSMIN GENE ANAL EXON 12 VARIANTS $662.00
81311 107148 NRAS GENE ANALYSIS VARIANTS IN EXON 2&3 $2,058.50
81312 107149 PABPN1 GENE ANALYSIS EVAL DETC ABNORMAL ALLELES $0.00
81313 107150 PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO $2,016.00
81314 107151 PDGFRA GENE ANALYS TARGETED SEQUENCE ANALYS $2,210.50
81315 107152 PML/RARALPHA COMMON BREAKPOINTS QUAL/QUANT $1,184.00
81316 107153 PML/RARALPHA SINGLE BREAKPOINT QUAL/QUAN $2,280.00
81317 107154 PMS2 GENE ANALYSIS FULL SEQUENCE $4,384.00
81318 107155 PMS2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS $1,369.50
81319 107156 PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS $1,528.50
81320 107157 PLCG2 GENE ANALYSIS COMMON VARIANTS $0.00
81321 107158 PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS $2,755.00
81322 107159 PTEN GENE ANALYSIS KNOWN FAMILIAL VARIANT $329.00
81323 107160 PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT $1,802.00
81324 107161 PMP22 GENE ANAL DUPLICATION/DELETION ANALYSIS $4,323.00
81325 107162 PMP22 GENE ANALYSIS FULL SEQUENCE ANALYSIS $4,425.00
81326 107163 PMP22 GENE ANALYSIS KNOWN FAMILIAL VARIANT $906.00
81327 107164 SEPT9 GENE PROMOTER METHYLATION ANALYSIS $986.50
81328 107165 SLCO1B1 GENE ANALYSIS COMMON VARIANTS $63.00
81329 107166 SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS $1,766.50
81330 107167 SMPD1 GENE ANALYSIS COMMON VARIANTS $858.00
81331 107168 SNRPN/UBE3A METHYLATION ANALYSIS $1,346.50
81332 107169 SERPINA1 GENE ANALYSIS COMMON VARIANTS $918.50
81333 107170 TGFBI GENE ANALYSIS COMMON VARIANTS $0.00
81334 107171 RUNX1 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS $2,199.50
81335 107172 TPMT GENE ANALAYSIS COMMON VARIANTS $1,507.50
81336 107173 SMN1 GENE ANALYSIS FULL GENE SEQUENCE $0.00
81337 107174 SMN1 GENE ANALYSIS KNOWN FAMILIAL SEQ VARIANTS $1,162.50
81338 107175 MPL GENE ANALYSIS COMMON VARIANTS $1,484.50
81339 107176 MPL GENE ANALYSIS SEQUENCE ANALYSIS EXON 10 $1,688.00
81340 107177 TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD $2,088.50
81341 107178 TRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGY $1,138.50
81342 107179 TRG@ GENE REARRANGEMENT ANALYSIS $1,829.00
81343 107180 PPP2R2B GENE ANALYSIS EVAL DETC ABNORMAL ALLELES $0.00
81344 107181 TBP GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES $0.00
81345 107182 TERT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS $2,409.00
81346 107183 TYMS GENE ANALYSIS COMMON VARIANTS $1,507.50
81347 107184 SF3B1 GENE ANALYSIS COMMON VARIANTS $1,272.00
81348 107185 SRSF2 GENE ANALYSIS COMMON VARIANTS $3,056.00
81349 107186 CYTOG ALYS CHRMOML ABNOR LOW-PASS SEQ ALYS $0.00
81350 107187 UGT1A1 GENE ANALYSIS COMMON VARIANTS $2,565.50
81351 107188 TP53 GENE ANALYSIS FULL GENE SEQUENCE $3,655.50
81352 107189 TP53 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS $2,146.00
81353 107190 TP53 GENE ANALYSIS KNOWN FAMILIAL VARIANT $0.00
81355 107191 VKORC1 GENE ANALYSIS COMMON VARIANT(S) $68.00
81357 107192 U2AF1 GENE ANALYSIS COMMON VARIANTS $1,184.00
81360 107193 ZRSR2 GENE ANALYSIS COMMON VARIANT(S) $1,184.00
81361 107194 HBB COMMON VARIANTS $1,507.50
81362 107195 HBB KNOWN FAMILIAL VARIANTS $2,377.00
81363 107196 HBB DUPLICATION/DELETION VARIANTS $1,645.50
81364 107197 HBB FULL GENE SEQUENCE $2,180.00
81370 107198 HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&DQB $2,492.00
81371 107199 HLA I&LI LOW RESOLUTION HLA-A -B&-DRB1 $1,777.00
81372 107200 HLA CLASS I TYPING LOW RESOLUTION COMPLETE $4,697.00
81373 107201 HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH $597.00
81374 107202 HLA I LOW RESOLUTION ONE ANTIGEN EQUIVALENT EACH $658.50
81375 107203 HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1 $4,697.00
81376 107204 HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA $663.00
81377 107205 HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA $917.00
81378 107206 HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1 $2,654.00
81379 107207 HLA CLASS I TYPING HIGH RESOLUTION COMPLETE $2,016.50
81380 107208 HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EA $2,201.00
81381 107209 HLA I TYPING HIGH RESOLUTION 1 ALLELE/ALLELE GRP $1,134.00
81382 107210 HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA $3,967.00
81383 107211 HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP $889.50
81400 107212 MOLECULAR PATHOLOGY PROCEDURE LEVEL 1 $1,026.50
81401 107213 MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 $823.00
81410 107221 AORTIC DYSFUNCTION/DILATION GENOMIC SEQ ANALYSIS $7,814.50
81411 107222 AORTIC DYSFUNCTION/DILATION DUP/DEL ANALYSIS $8,943.00
81412 107223 ASHKENAZI JEWISH ASSOC DSRDRS GEN SEQ ANAL 9 GEN $6,171.00
81413 107224 CAR ION CHNNLPATH GENOMIC SEQ ALYS INC 10 GNS $4,114.00
81414 107225 CAR ION CHNNLPATH DUP/DEL GN ALYS PANEL 2 GENES $4,114.00
81415 107226 EXOME SEQUENCE ANALYSIS $20,654.00
81416 107227 EXOME SEQUENCE ANALYSIS EACH COMPARATOR EXOME $7,966.50
81417 107228 EXOME RE-EVAL OF PREVIOUSLY OBTAINED EXOME SEQ $5,938.50
81418 107229 RX METAB GENOMIC SEQ ALYS PANEL AT LEAST 6 GENES $0.00
81419 107230 EPILEPSY GENOMIC SEQUENCE ANALYSIS PANEL $10,071.00
81420 107231 FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS $3,757.00
81422 107232 FETAL CHROMOSOMAL MICRODELTJ GENOMIC SEQ ANALYS $4,114.00
81425 107233 GENOME SEQUENCE ANALYSIS $24,322.00
81426 107234 GENOME SEQUENCE ANALYSIS EACH COMPARATOR GENOME $14,099.50
81427 107235 GENOME RE-EVALUATION OF PREC OBTAINED GENOME SEQ $0.00
81430 107236 HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES $8,256.50
81431 107237 HEARING LOSS DUP/DEL ANALYSIS $5,099.00
81432 107238 HEREDITARY BRST CA-RELATED GEN SEQ ANALYS 10 GEN $8,725.50
81433 107239 HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS $0.00
81434 107240 HEREDITARY RETINAL DSRDRS GEN SEQ ANALYS 15 GEN $9,882.50
81435 107241 HEREDITARY COLON CA DSRDRS GEN SEQ ANALYS 10 GEN $4,439.00
81436 107242 HEREDITARY COLON CA DSRDRS DUP/DEL ANALYS 5 GEN $0.00
81437 107243 HEREDTRY NURONDCRN TUM DSRDRS GEN SEQ ANAL 6 GEN $0.00
81438 107244 HEREDTRY NURONDCRN TUM DSRDRS DUP/DEL ANALYSIS $0.00
81439 107245 HEREDITARY CARDIOMYOPATHY GEN SEQ ANALYS 5 GEN $9,108.00
81440 107246 NUCLEAR MITOCHONDRIAL 100 GENE GENOMIC SEQ $0.00
81441 107247 IBMFS SEQUENCE ANALYSIS PANEL AT LEAST 30 GENES $0.00
81442 107248 NOONAN SPECTRUM DISORDERS GEN SEQ ANALYS 12 GEN $5,622.50
81443 107249 GENETIC TESTING FOR SEVERE INHERITED CONDITIONS $18,243.50
81445 107250 SOLID ORGAN NEOPLASM GSAP 5-50 DNA/DNA&RNA ALYS $7,317.00
81448 107251 HEREDITARY PERIPHERAL NEUROPATHY GEN SEQ PNL $9,302.50
81449 107252 SOLID ORGAN NEOPLASM GSAP 5-50 RNA ANALYSIS $0.00
81450 107253 HEMATOLYMPHOID NEO/DO GSAP 5-50DNA/DNA&RNA ALYS $4,307.00
81451 107254 HEMATOLYMPHOID NEO/DO GSAP 5-50 RNA ANALYSIS $0.00
81455 107255 SO/HEMATOLYMPHOID NEO/DO 51/>GSAP DNA/DNA&RNA $5,918.00
81456 107256 SO/HEMATOLYMPHOID NEO/DO 51/>RNA ANALYSIS $0.00
81457 107257 SO NEO GSAP DNA ALYS MICROSATELLITE INSTABILITY $0.00
81458 107258 SO NEO GSAP DNA ALY CPY NMBR&MICROSATELLITE INS $0.00
81459 107259 SO NEO GSAP DNA ALYS/DNA&RNA CPY NMBR MCRSTL INS $0.00
81460 107260 WHOLE MITOCHONDRIAL GENOME $7,590.50
81462 107261 SO NEO GSAP CLL FR DNA/DNA&RNA CPY NMBR&REARGMT $0.00
81463 107262 SO NEO GSAP CLL FR DNA ALYS CPY NMBR&MCRSTL INS $0.00
81464 107263 SO NEO GSAP CL FR DNA/DNA&RNA CPY NMBR MCRST INS $0.00
81465 107264 WHOLE MITOCHONDRIAL GENOME ANALYSIS PANEL $5,495.00
81470 107265 X-LINKED INTELLECTUAL DBLT GENOMIC SEQ ANALYS $7,598.00
81471 107266 X-LINKED INTELLECTUAL DBLT DUP/DEL GENE ANALYS $7,703.50
81479 107267 UNLISTED MOLECULAR PATHOLOGY PROCEDURE $0.00
81490 107268 AUTOIMMUNE RHEUMATOID ARTHRITIS ALYS 12 BMRK $5,255.50
81493 107269 COR ART DISEASE MRNA GENE EXPRESSION 23 GENES $0.00
81500 107270 ONCO (OVARIAN) BIOCHEMICAL ASSAY TWO PROTEINS $1,420.50
81503 107271 ONCO (OVARIAN) BIOCHEMICAL ASSAY FIVE PROTEINS $2,072.00
81504 107272 ONCOLOGY TISSUE OF ORIGIN SIMILAR SCOR ALGORITHM $0.00
81506 107273 ENDOCRINOLOGY BIOCHEMICAL ASSAY SEVEN ANAL $0.00
81507 107274 FETAL ANEUPLOIDY 21 18 13 SEQ ANALY TRISOM RISK $7,210.50
81508 107275 FETAL CONGENITAL ABNOR ASSAY TWO PROTEINS $510.00
81509 107276 FETAL CONGENITAL ABNOR ASSAY 3 PROTEINS $0.00
81510 107277 FETAL CONGENITAL ABNOR ASSAY THREE ANAL $0.00
81511 107278 FETAL CONGENITAL ABNOR ASSAY FOUR ANAL $795.50
81512 107279 FETAL CONGENITAL ABNOR ASSAY FIVE ANAL $0.00
81513 107280 NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG $1,319.00
81514 107281 NFCT DS BCT VAGINOSIS&VAGINITIS DNA VAG FLU ALG $1,803.00
81517 107282 LIVER DS ALYS 3 BIOMARKERS IA SRM PROGNOSTIC ALG $0.00
81518 107283 ONCOLOGY BREAST MRNA GENE EXPRESSION 11 GENES $0.00
81519 107284 ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES $23,517.00
81520 107285 ONC BREAST MRNA GENE XPRSN PRFL HYBRD 58 GENES $24,595.00
81521 107286 ONC BREAST MRNA MICRORA GENE XPRSN PRFL 70 GENES $9,545.50
81522 107287 ONCOLOGY BREAST MRNA GENE XPRSN PRFL 12 GENES $0.00
81523 107288 ONC BRST MRNA NEXT GNRJ SEQ GEN XPRSN 70 CNT&31 $0.00
81525 107289 ONCOLOGY COLON MRNA GENE EXPRESSION 12 GENES $0.00
81528 107290 ONCOLOGY COLORECTAL SCREENING QUAN 10 DNA MARKRS $2,944.50
81529 107291 ONC CUTAN MLNMA MRNA GENE XPRS PRFL 31 GENES ALG $0.00
81535 107292 ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP 1ST $3,209.00
81536 107293 ONCOLOGY GYNE LIVE TUM CELL CLTR&CHEMO RESP ADD $1,469.50
81538 107294 ONCOLOGY LUNG MS 8-PROTEIN SIGNATURE $0.00
81539 107295 ONCOLOGY PROSTATE BIOCHEMICAL ASSAY 4 PROTEINS $3,437.00
81540 107296 ONCOLOGY TUM UNKNOWN ORIGIN MRNA 92 GENES $0.00
81541 107297 ONC PRST8 MRNA GENE XPRSN PRFL RT-PCR 46 GENES $9,545.50
81542 107298 ONC PRST8 MRNA MICRORA GENE XPRSN PRFL 22 GENES $0.00
81546 107299 ONC THYR MRNA 10,196 GENES FINE NDL ASPIRATE ALG $0.00
81551 107300 ONC PRST8 PRMTR METHYLATION PRFL R-T PCR 3 GENES $0.00
81552 107301 ONC UVEAL MLNMA MRNA GENE XPRSN PRFL 15 GENES $0.00
81554 107302 PULM DS IPF MRNA 190 GENE TRANSBRONCHIAL BX ALG $0.00
81560 107303 TRNSPLJ PED LVR&BWL MES CD154+T CLL WHL PRPH BLD $0.00
81595 107304 CARDIOLOGY HRT TRNSPL MRNA GENE EXPRESS 20 GENES $9,404.00
81596 107305 NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR $1,254.00
81599 107306 UNLISTED MULTIANALYTE ASSAY ALGORITHMIC ANALYSIS $0.00
82009 107307 KETONE BODIES SERUM QUALITATIVE $161.00
82010 107308 KETONE BODIES SERUM QUANTITATIVE $163.00
82013 107309 ASSAY OF ACETYLCHOLINESTERASE $684.50
82016 107310 ACYLCARNITINES QUALITATIVE EACH SPECIMEN $1,209.00
82017 107311 ACYLCARNITINES QUANTIATIVE EACH SPECIMEN $842.50
82024 107312 ADRENOCORTICOTROPIC HORMONE ACTH $311.00
82030 107313 ADENOSINE 5-MONOPHOSPHATE CYCLIC $558.50
82040 107314 ALBUMIN SERUM PLASMA/WHOLE BLOOD $223.00
82042 107315 OTHER SOURCE ALBUMIN QUANTITATIVE EACH SPECIMEN $189.00
82043 107316 URINE ALBUMIN QUANTITATIVE $172.00
82044 107317 URINE ALBUMIN SEMIQUANTITATIVE $115.00
82045 107318 ALBUMIN ISCHEMIA MODIFIED $658.50
82075 107319 ASSAY OF ALCOHOL (ETHANOL) BREATH $229.00
82077 107320 ASSAY OF ALCOHOL (ETHANOL) SPEC XCP UR&BREATH IA $540.50
82085 107321 ASSAY OF ALDOLASE $105.00
82088 107322 ASSAY OF ALDOSTERONE $326.50
82103 107323 ALPHA-1-ANTITRYPSIN TOTAL $147.00
82104 107324 ALPHA-1-ANTITRYPSIN PHENOTYPE $170.50
82105 107325 ALPHA-FETOPROTEIN SERUM $211.50
82106 107326 ALPHA-FETOPROTEIN AMNIOTIC FLUID $337.00
82107 107327 AFP-L3 FRACTION ISOFORM & TOTAL AFP W/RATIO $740.00
82108 107328 ASSAY OF ALUMINUM $1,163.00
82120 107329 AMINES VAGINAL FLUID QUALITATIVE $80.50
82127 107330 AMINO ACIDS 1 QUALITATIVE EACH SPECIMEN $246.00
82128 107331 AMINO ACIDS MULTIPLE QUALITATIVE EACH SPECIMEN $112.00
82131 107332 AMINO ACIDS 1 QUANTITATIVE EACH SPECIMEN $728.00
82135 107333 AMINOLEVULINIC ACID DELTA $523.50
82136 107334 AMINO ACIDS 2-5 AMINO ACIDS QUANTITATIVE EA SPEC $630.00
82139 107335 AMINO ACIDS 6/> AMINO ACIDS QUANTITATIVE EA SPE $728.00
82140 107336 ASSAY OF AMMONIA $349.50
82143 107337 AMNIOTIC FLU SCAN $860.50
82150 107338 ASSAY OF AMYLASE $560.50
82154 107339 ANDROSTANEDIOL GLUCURONIDE $902.00
82157 107340 ANDROSTENEDIONE $716.00
82160 107341 ANDROSTERONE $497.50
82163 107342 ANGIOTENSIN II $564.50
82164 107343 ANGIOTENSIN I-CONVERTING ENZYME $127.50
82166 107344 ASSAY OF ANTI-MULLERIAN HORMONE $0.00
82172 107345 APOLIPOPROTEIN EACH $132.00
82175 107346 ASSAY OF ARSENIC $215.00
82180 107347 ASSAY OF ASCORBIC ACID BLOOD $106.00
82190 107348 ATOMIC ABSRPJ SPECTROSCOPY EA ANALYTE $367.00
82232 107349 BETA-2 MICROGLOBULIN $168.00
82239 107350 BILE ACIDS TOTAL $221.00
82240 107351 BILE ACIDS CHOLYLGLYCINE $517.50
82247 107352 BILIRUBIN TOTAL $218.50
82248 107353 BILIRUBIN DIRECT $71.00
82252 107354 BILIRUBIN FECES QUALITATIVE $179.00
82261 107355 BIOTINIDASE EACH SPECIMEN $155.00
82270 107356 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER $299.00
82271 107357 BLOOD OCCULT PEROXIDASE ACTV QUAL OTHER SOURCES $115.00
82272 107358 BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1-3 SPEC $168.50
82274 107359 BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3 $203.50
82286 107360 BRADYKININ $107.50
82300 107361 CADMIUM $184.00
82306 107362 25 HYDROXY INCLUDES FRACTIONS IF PERFORMED $410.00
82308 107363 CALCITONIN $441.00
82310 107364 CALCIUM TOTAL $232.00
82330 107365 CALCIUM IONIZED $240.00
82331 107366 CALCIUM AFTER CALCIUM INFUSION TEST $42.50
82340 107367 CALCIUM URINE QUANTITATIVE TIMED SPECIMEN $115.00
82355 107368 CALCULUS QUALITATIVE ANALYSIS $402.50
82360 107369 CALCULUS QUANTITATIVE CHEMICAL $44.00
82365 107370 CALCULUS INFRARED SPECTROSCOPY $149.50
82370 107371 CALCULUS XRAY DIFFRACTION $289.50
82373 107372 CARBOHYDRATE DEFICIENT TRANSFERRIN $541.50
82374 107373 CARBON DIOXIDE BICARBONATE $321.00
82375 107374 CARBOXYHEMOGLOBIN QUANTITATIVE $98.00
82376 107375 CARBOXYHEMOGLOBIN QUALITATIVE $309.50
82378 107376 CARCINOEMBRYONIC ANTIGEN CEA $285.00
82379 107377 CARNITINE QUANTITATIVE EACH SPECIMEN $881.00
82380 107378 CAROTENE $194.50
82382 107379 CATECHOLAMINES TOTAL URINE $497.50
82383 107380 CATECHOLAMINES BLOOD $710.50
82384 107381 CATECHOLAMINES FRACTIONATED $316.50
82387 107382 CATHEPSIN-D $349.00
82390 107383 CERULOPLASMIN $95.00
82397 107384 CHEMILUMINESCENT ASSAY $212.00
82415 107385 CHLORAMPHENICOL $331.00
82435 107386 CHLORIDE BLD $200.00
82436 107387 CHLORIDE URINE $192.50
82438 107388 CHLORIDE OTHER SOURCE $475.00
82441 107389 CHLORINATED HYDROCARBONS SCREEN $101.50
82465 107390 CHOLESTEROL SERUM/WHOLE BLOOD TOTAL $63.50
82480 107391 CHOLINESTERASE SERUM $229.00
82482 107392 CHOLINESTERASE RBC $279.00
82485 107393 CHONDROITIN B SULFATE QUANTITATIVE $54.50
82495 107394 ASSAY OF CHROMIUM $328.00
82507 107395 ASSAY OF CITRATE $64.00
82523 107396 COLLAGEN CROSS LINKS ANY METHOD $182.00
82525 107397 ASSAY OF COPPER $145.00
82528 107398 CORTICOSTERONE $253.50
82530 107399 CORTISOL FREE $229.50
82533 107400 CORTISOL TOTAL $226.00
82540 107401 ASSAY OF CREATINE $140.00
82542 107402 COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC $525.50
82550 107403 CREATINE KINASE TOTAL $321.00
82552 107404 CREATINE KINASE ISOENZYMES $337.00
82553 107405 CREATINE KINASE MB FRACTION ONLY $715.50
82554 107406 CREATINE KINASE ISOFORMS $816.50
82565 107407 CREATININE BLOOD $224.50
82570 107408 CREATININE OTHER SOURCE $557.00
82575 107409 CREATININE CLEARANCE $54.50
82585 107410 ASSAY OF CRYOFIBRN $77.50
82595 107411 CRYOGLOBULIN QUALITATIVE/SEMI-QUANTITATIVE $65.00
82600 107412 ASSAY OF CYANIDE $375.00
82607 107413 CYANOCOBALAMIN VITAMIN B-12 $327.50
82608 107414 CYANOCOBALAMIN VIT B-12 UNSAT BINDING CAPACITY $311.50
82610 107415 CYSTATIN C $145.00
82615 107416 CSTINE&HOMOCSTINE URINE QUALITATIVE $174.50
82626 107417 DEHYDROEPIANDROSTERONE $221.00
82627 107418 DEHYDROEPIANDROSTERONE-SULFATE $180.00
82633 107419 DESOXYCORTICOSTERONE 11- $613.50
82634 107420 DEOXYCORTISOL 11- $376.50
82638 107421 ASSAY OF DIBUCAINE NUMBER $184.00
82642 107422 DIHYDROTESTOSTERONE (DHT) $381.50
82652 107423 1 25 DIHYDROXY INCLUDES FRACTIONS IF PERFORMED $310.00
82653 107424 ELASTASE PANCREATIC FECAL QUANTITATIVE $153.00
82656 107425 ELASTASE PANCREATIC FECAL QUAL/SEMI-QUANTITATIVE $668.00
82657 107426 NZYM ACTIV BLD CELLS/TISS NONRADACT SUBSTRATE EA $456.50
82658 107427 NZYM ACTV BLOOD CELLS/TISS RADACT SUBSTRATE EA $1,184.00
82664 107428 ELCTROPHORETIC TECHNIQUE NOT ELSEWHERE SPECIFIED $473.00
82668 107429 ASSAY OF ERYTHROPOIETIN $177.00
82670 107430 ASSAY OF TOTAL ESTRADIOL $265.50
82671 107431 ASSAY OF ESTROGENS FRACTIONATED $399.50
82672 107432 ASSAY OF ESTROGENS TOTAL $426.50
82677 107433 ASSAY OF ESTRIOL $311.00
82679 107434 ASSAY OF ESTRONE $240.00
82681 107435 ASSAY OF DIRECT MEASUREMENT FREE ESTRADIOL $583.00
82693 107436 ASSAY OF ETHYLENE GLYCOL $376.50
82696 107437 ASSAY OF ETIOCHOLANOLONE $481.00
82705 107438 FAT/LIPIDS FECES QUALITATIVE $179.00
82710 107439 FAT/LIPIDS FECES QUANTITATIVE $180.00
82715 107440 FAT DIFFIAL FECES QUANTITATIVE $390.00
82725 107441 FATTY ACIDS NONESTERIFIED $358.50
82726 107442 VERY LONG CHAIN FATTY ACIDS $891.50
82728 107443 ASSAY OF FERRITIN $470.50
82731 107444 FTL FIBRONECTIN CERVICOVAG SECRETIONS SEMI-QUAN $912.00
82735 107445 ASSAY OF FLUORIDE $264.50
82746 107446 ASSAY OF FOLIC ACID SERUM $518.50
82747 107447 ASSAY OF FOLIC ACID RBC $356.50
82757 107448 ASSAY OF FRUCTOSE SEMEN $400.50
82759 107449 ASSAY OF GALACTOKINASE RBC $455.50
82760 107450 ASSAY OF GALACTOSE $308.00
82775 107451 GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE QUAN $449.50
82776 107452 GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE SCREEN $167.00
82777 107453 GALECTIN-3 $499.50
82784 107454 ASSAY OF GAMMAGLOBULIN IGA IGD IGG IGM EACH $105.00
82785 107455 ASSAY OF GAMMAGLOBULIN IGE $216.00
82787 107456 GAMMAGLOBULIN IMMUNOGLOBULIN SUBCLASSES $145.00
82800 107457 GASES BLOOD PH ONLY $151.00
82803 107458 BLOOD GASES ANY COMBINATION PH PCO2 PO2 CO2 HCO3 $600.50
82805 107459 GASES BLOOD PH DIRECT MEAS XCPT PULSE OXIMITRY $1,000.00
82810 107460 GASES BLOOD O2 SATURATION ONLY DIRECT MEAS $343.00
82820 107461 HGB-O2 AFFINITY PO2 50% SATURATION OXYGEN $536.00
82930 107462 GASTRIC ACID ANALYIS W/PH EACH SPECIMEN $364.50
82938 107463 GASTRIN AFTER SECRETIN STIMULATION $405.50
82941 107464 ASSAY OF GASTRIN $703.00
82943 107465 ASSAY OF GLUCAGON $355.50
82945 107466 GLUCOSE BODY FLUID OTHER THAN BLOOD $174.00
82946 107467 GLUCOSE TOLERANCE TEST $367.00
82947 107468 GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP $171.50
82948 107469 GLUCOSE BLOOD REAGENT STRIP $85.00
82950 107470 GLUCOSE POST GLUCOSE DOSE $159.00
82951 107471 GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS $356.00
82952 107472 GLUCOSE TOLERANCE EA ADDL BEYOND 3 SPECIMENS $116.00
82955 107473 GLUC-6-PHOSPHATE DEHYDROGENASE QUANTITATIVE $135.00
82960 107474 GLUC-6-PHOSPHATE DEHYDROGENASE SCREEN $230.50
82962 107475 GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE $57.50
82963 107476 ASSAY OF GLUCOSIDASE BETA $955.00
82965 107477 ASSAY OF GLUTAMATE DEHYDROGENASE $106.50
82977 107478 ASSAY OF GLUTAMYLTRASE GAMMA $208.50
82978 107479 ASSAY OF GLUTATHIONE $423.50
82979 107480 ASSAY OF GLUTATHIONE REDUCTASE RBC $229.00
82985 107481 ASSAY OF GLYCATED PROTEIN $119.00
83001 107482 GONADOTROPIN FOLLICLE STIMULATING HORMONE $227.50
83002 107483 GONADOTROPIN LUTEINIZING HORMONE $231.00
83003 107484 ASSAY OF GROWTH HORMONE HUMAN $1,074.00
83006 107485 GROWTH STIMULATION EXPRESSED GENE 2 $686.00
83009 107486 HPYLORI BLOOD ANAL UREASE ACT NON-RADACT ISOTOPE $772.50
83010 107487 ASSAY OF HAPTOGLOBIN QUANTITATIVE $176.00
83012 107488 ASSAY OF HAPTOGLOBIN PHENOTYPES $398.00
83013 107489 HPYLORI BREATH ANAL UREASE ACT NON-RADACT ISTOPE $543.00
83014 107490 HPYLORI DRUG ADMINISTRATION $202.00
83015 107491 HEAVY METAL QUALITATIVE ANY ANALYTES $593.50
83018 107492 HEAVY METAL QUANTIATIVE EACH NES $411.50
83020 107493 HEMOGLOBIN FRACTJ/QUANTJ ELECTROPHORESIS $138.00
83021 107494 HEMOGLOBIN FRACTJ/QUANTJ CHROMOTOGRAPHY $263.50
83026 107495 HEMOGLOBIN COPPER SULFATE METHOD NON-AUTOMATED $50.00
83030 107496 HEMOGLOBIN F FETAL CHEMICAL $331.00
83033 107497 HEMOGLOBIN F FETAL QUALITATIVE $382.50
83036 107498 HEMOGLOBIN GLYCOSYLATED A1C $247.50
83037 107499 HGB GLYCOSYLATED A1C DEVICE CLEARED FDA HOME USE $138.00
83045 107500 HEMOGLOBIN METHEMOGLOBIN QUALITATIVE $226.00
83050 107501 HEMOGLOBIN METHEMOGLOBIN QUANTITATIVE $143.00
83051 107502 HEMOGLOBIN PLASMA $253.50
83060 107503 HEMOGLOBIN SULFHEMOGLOBIN QUANTITATIVE $224.50
83065 107504 HEMOGLOBIN THERMOLABILE $60.50
83068 107505 HEMOGLOBIN UNSTABLE SCREEN $239.50
83069 107506 HEMOGLOBIN URINE $137.00
83070 107507 ASSAY OF HEMOSIDERIN QUALITATIVE $167.00
83080 107508 ASSAY OF B-HEXOSAMINIDASE EACH ASSAY $674.00
83088 107509 ASSAY OF HISTAMINE $560.00
83090 107510 ASSAY OF HOMOCYSTEINE $178.50
83150 107511 ASSAY OF HOMOVANILLIC ACID $331.00
83491 107512 ASSAY OF HYDROXYCORTICOSTEROIDS 17 $417.50
83497 107513 ASSAY OF HYDROXYINDOLACETIC ACID 5-HIAA $107.00
83498 107514 ASSAY OF HYDROXYPROGESTERONE 17-D $424.00
83500 107515 ASSAY OF FREE HYDROXYPROLINE $429.50
83505 107516 ASSAY OF TOTAL HYDROXYPROLINE $490.50
83516 107517 IMMUNOASSAY ANALYTE QUAL/SEMIQUAN MULTIPLE STEP $380.00
83518 107518 IMMUNOASSAY ANALYTE QUAL/SEMIQUAL SINGLE STEP $137.00
83519 107519 IMMUNOASSAY ANALYTE QUANT RADIOIMMUNOASSAY $1,159.00
83520 107520 IMMUNOASSAY ANALYTE QUANTITATIVE NOS $452.00
83521 107521 IMMUNOGLOBULIN LIGHT CHAINS FREE EACH $124.00
83525 107522 ASSAY OF INSULIN TOTAL $162.00
83527 107523 ASSAY OF INSULIN FREE $253.50
83528 107524 ASSAY OF INTRINSIC FACTOR $379.50
83529 107525 ASSAY OF INTERLEUKIN-6 (IL-6) $153.00
83540 107526 ASSAY OF IRON $288.50
83550 107527 IRON BINDING CAPACITY $386.00
83570 107528 ISOCITRIC DEHYDROGENASE $194.50
83582 107529 ASSAY OF KETOGENIC STEROIDS FRACTIONATION $355.50
83586 107530 ASSAY OF KETOSTEROIDS 17- TOTAL $331.00
83593 107531 KETOSTEROIDS 17- FRACTIONATION $514.50
83605 107532 ASSAY OF LACTATE $318.00
83615 107533 LACTATE DEHYDROGENASE LDH $86.00
83625 107534 LACTATE DEHYDROGENASE ISOENZYMES SEP&QUAN $264.50
83630 107535 LACTOFERRIN FECAL QUALITATIVE $158.00
83631 107536 LACTOFERRIN FECAL QUANTITATIVE $429.50
83632 107537 LACTOGEN HPL HUMAN CHORIONIC SOMATOMAMMOTROPIN $439.00
83633 107538 LACTOSE URINE QUALITATIVE $200.50
83655 107539 ASSAY OF LEAD $159.00
83661 107540 FETAL LUNG MATURITY LECITHIN SPHINGOMYELIN RATIO $461.50
83662 107541 FETAL LUNG MATURITY FOAM STABILITY TEST $422.00
83663 107542 FETAL LUNG MATURITY FLUORESCENCE POLARIZATION $422.00
83664 107543 FETAL LUNG MATURITY LAMELLAR BODY DENSITY $312.50
83670 107544 LEUCINE AMINOPEPTIDASE LAP $457.00
83690 107545 ASSAY OF LIPASE $295.00
83695 107546 LIPOPROTEIN (A) $139.00
83698 107547 LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 $598.00
83700 107548 LIPOPROTEIN BLOOD ELECTROPHORECTIC SEP&QUAN $314.50
83701 107549 LIPOPROTEIN BLOOD HIGH RESOLTJ&QUANTJ SUBCLASS $276.00
83704 107550 LIPOPROTEIN BLOOD QUAN NUMBERS & SUBCLASSES $439.00
83718 107551 LIPOPROTEIN DIR MEAS HIGH DENSITY CHOLESTEROL $361.00
83719 107552 LIPOPROTEIN DIRECT MEASUREMENT VLDL CHOLESTEROL $353.50
83721 107553 LIPOPROTEIN DIRECT MEASUREMENT LDL CHOLESTEROL $440.00
83722 107554 DIR MEAS LIPOPROTEIN SMALL DENSE LDL CHOLESTEROL $190.00
83727 107555 LUTEINIZING RELEASING FACTOR $818.50
83735 107556 ASSAY OF MAGNESIUM $245.50
83775 107557 ASSAY OF MALATE DEHYDROGENASE $239.50
83785 107558 ASSAY OF MANGANESE $356.50
83789 107559 MASS SPECT&TANDEM MASS SPECT NONDRG ANAL NES EA $295.00
83825 107560 ASSAY OF MERCURY QUANTITATIVE $131.00
83835 107561 METANEPHRINES $182.00
83857 107562 METHEMALBUMIN $301.00
83861 107563 MICROFLUIDIC ANALYSIS TEAR OSMOLARITY $176.00
83864 107564 MUCOPOLYSACCHARIDES ACID QUANTITATIVE $859.00
83872 107565 MUCIN SYNOVIAL FLUID ROPES TEST $126.00
83873 107566 MYELIN BASIC PROTEIN CEREBROSPINAL FLUID $220.50
83874 107567 MYOGLOBIN $571.00
83876 107568 MYELOPEROXIDASE MPO $403.50
83880 107569 NATRIURETIC PEPTIDE $376.00
83883 107570 ASSAY OF NEPHELOMETRY EACH ANALYTE NES $151.00
83885 107571 ASSAY OF NICKEL $350.50
83915 107572 ASSAY OF NUCLEOTIDASE 5'- $228.00
83916 107573 OLIGOCLONAL IMMUNE $571.00
83918 107574 ORGANIC ACIDS TOTAL QUANTITATIVE EACH SPECIMEN $809.00
83919 107575 ORGANIC ACIDS QUALITATIVE EACH SPECIMEN $1,311.00
83921 107576 ORGANIC ACID 1 QUANTITATIVE $160.00
83930 107577 ASSAY OF OSMOLALITY BLOOD $218.50
83935 107578 ASSAY OF OSMOLALITY URINE $281.50
83937 107579 ASSAY OF OSTEOCALCIN $432.50
83945 107580 ASSAY OF OXALATE $225.00
83950 107581 ONCOPROTEIN HER-2/NEU $1,978.00
83951 107582 ONCOPROTEIN DES-GAMMA-CARBOXY-PROTHROMBIN DCP $514.50
83970 107583 ASSAY OF PARATHORMONE $1,824.00
83986 107584 PH BODY FLUID NOT ELSEWHERE SPECIFIED $82.00
83987 107585 PH EXHALED BREATH CONDENSATE $379.50
83992 107586 ASSAY OF PHENCYCLIDINE $212.50
83993 107587 ASSAY OF CALPROTECTIN FECAL $183.00
84030 107588 ASSAY OF PHENYLALANINE BLOOD $141.50
84035 107589 ASSAY OF PHENYLKETONES QUALITATIVE $158.00
84060 107590 ASSAY OF PHOSPHATASE ACID TOTAL $305.00
84066 107591 ASSAY OF PHOSPHATASE ACID PROSTATIC $255.00
84075 107592 ASSAY OF PHOSPHATASE ALKALINE $287.50
84078 107593 ASSAY OF PHOSPHATASE ALKALINE HEAT STABLE $270.50
84080 107594 ASSAY OF PHOSPHATASE ALKALINE ISOENZYMES $119.00
84081 107595 PHOSPHATIDYLGLYCEROL $299.00
84085 107596 PHOSPHOGLUCONATE 6-DEHYD RBC $226.00
84087 107597 ASSAY OF PHOSPHOHEXOSE ISOMERASE $504.00
84100 107598 ASSAY OF PHOSPHORUS INORGANIC $179.00
84105 107599 ASSAY OF PHOSPHORUS INORGANIC URINE $139.00
84106 107600 PORPHOBILINOGEN URINE QUALITATIVE $165.50
84110 107601 ASSAY OF PORPHOBILINOGEN URINE QUANTITATIVE $223.00
84112 107602 EVAL C/V AMNIOTIC FLUID PROTEIN QUAL EA SPECIMEN $1,099.00
84119 107603 PORPHYRINS URINE QUALITATAIVE $282.50
84120 107604 PORPHYRINS URINE QUANTITATION & FRACTIONATION $358.50
84126 107605 PORPHYRINS FECES QUANTITATIVE $501.00
84132 107606 POTASSIUM SERUM PLASMA/WHOLE BLOOD $207.00
84133 107607 POTASSIUM URINE $240.00
84134 107608 PREALBUMIN $194.50
84135 107609 PREGNANEDIOL $425.00
84138 107610 PREGNANETRIOL $422.00
84140 107611 PREGNENOLONE $335.50
84143 107612 17-HYDROXYPREGNENOLONE $372.00
84144 107613 ASSAY OF PROGESTERONE $201.00
84145 107614 PROCALCITONIN (PCT) $316.50
84146 107615 ASSAY OF PROLACTIN $386.50
84150 107616 ASSAY OF PROSTAGLNDIN EACH $1,077.50
84152 107617 ASSAY OF PROSTATE SPECIFIC ANTIGEN COMPLEXED $387.00
84153 107618 ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL $236.00
84154 107619 ASSAY OF PROSTATE SPECIFIC ANTIGEN FREE $149.00
84155 107620 PROTEIN XCPT REFRACTOMETRY SERUM PLASMA/WHL BLD $53.00
84156 107621 PROTEIN TOTAL XCPT REFRACTOMETRY URINE $168.50
84157 107622 PROTEIN TOTAL XCPT REFRACTOMETRY OTH SRC $220.50
84160 107623 PROTEIN TOTAL REFRACTOMETRY ANY SRC $89.50
84163 107624 PREGNANCY-ASSOCIATED PLASMA PROTEIN-A $356.50
84165 107625 PROTEIN ELECTROPHORETIC FRACTJ&QUANTJ SERUM $105.00
84166 107626 PROTEIN ELECTROP FXJ&QUAN OTH FLUS CONCENTRATI $175.00
84181 107627 PROTEIN WESTRN BLOT I&R BLOOD/OTHER FLUID $154.00
84182 107628 PROTEIN WESTRN BLOT BLOOD/OTH FLU IMMUNOLOGICAL $643.00
84202 107629 PROTOPORPHYRIN RBC QUANTITATIVE $309.50
84203 107630 PROTOPORPHYRIN RBC SCREEN $198.50
84206 107631 ASSAY OF PROINSULIN $157.00
84207 107632 ASSAY OF PYRIDOXAL PHOSPHATE $227.00
84210 107633 ASSAY OF PYRUVATE $349.00
84220 107634 ASSAY OF PYRUVATE KINASE $359.50
84228 107635 ASSAY OF QUININE $314.50
84233 107636 ASSAY OF RECEPTOR ASSAY ESTROGEN $1,610.50
84234 107637 ASSAY OF RECEPTOR ASSAY PROGESTERONE $1,196.00
84235 107638 RECEPTOR ASSAY ENDOCRINE OTH/THN ESTRGN/PROGST $271.00
84238 107639 RECEPTOR ASSAY NON-ENDOCRINE SPECIFY RECEPTOR $637.50
84244 107640 ASSAY OF RENIN $179.00
84252 107641 ASSAY OF RIBOFLAVIN-VITAMIN B-2 $483.00
84255 107642 ASSAY OF SELENIUM $298.00
84260 107643 ASSAY OF SEROTONIN $584.50
84270 107644 ASSAY OF SEX HORMONE BINDING GLOBULIN $233.00
84275 107645 ASSAY OF SIALIC ACID $367.00
84285 107646 ASSAY OF SILICA $481.00
84295 107647 SODIUM SERUM PLASMA OR WHOLE BLOOD $95.00
84300 107648 ASSAY OF URINE SODIUM $188.00
84302 107649 ASSAY OF SODIUM OTHER SOURCE $133.50
84305 107650 ASSAY OF SOMATOMEDIN $168.00
84307 107651 ASSAY OF SOMATOSTATIN $628.50
84311 107652 SPECTROPHOTOMETRY ANALYT NOT ELSEWHERE SPECIFIED $453.00
84315 107653 SPECIFIC GRAVITY EXCEPT URINE $111.00
84375 107654 SUGARS CHROMATOGRAPHIC TLC/PAPER CHROMATOGRAPHY $1,624.50
84376 107655 SUGARS MONO DI&OLIGOS 1 QUALITATAIVE EACH SPEC $203.50
84377 107656 SUGARS MONO DI&OLIGOS MLT QUALITATIVE EACH SPE $194.50
84378 107657 SUGARS MONO DI&OLIGOS 1 QUANTITATIVE EACH SPEC $279.00
84379 107658 SUGARS MONO DI&OLIGOS MLT QUANTITATIVE EA SPEC $613.50
84392 107659 ASSAY OF SULFATE URINE $126.00
84402 107660 ASSAY OF TESTOSTERONE FREE $226.00
84403 107661 ASSAY OF TESTOSTERONE TOTAL $254.00
84410 107662 ASSAY BIOVLBL TESTOSTERONE DIRECT MEASUREMENT $425.00
84425 107663 ASSAY OF THIAMINE-VITAMIN B-1 $185.00
84430 107664 ASSAY OF THIOCYANATE $375.00
84431 107665 THROMBOXANE METABOLITE W/WO THROMBOXANE URINE $625.50
84432 107666 ASSAY OF THYROGLOBULIN $206.50
84433 107667 ASSAY THIOPURINE S-METHYLTRANSFERASE $0.00
84436 107668 ASSAY OF THYROXINE TOTAL $188.50
84437 107669 ASSAY OF THYROXINE REQUIRING ELUTION $130.50
84439 107670 ASSAY OF FREE THYROXINE $127.00
84442 107671 ASSAY OF THYROXINE BINDING GLOBULIN $291.50
84443 107672 ASSAY OF THYROID STIMULATING HORMONE TSH $364.00
84445 107673 THYROID STIMULATING IMMUNE GLOBULINS TSI $445.00
84446 107674 ASSAY OF TOCOPHEROL ALPHA VITAMIN E $165.00
84449 107675 ASSAY OF TRANSCORTIN CORTISOL BINDING GLOBULIN $312.50
84450 107676 TRANSFERASE ASPARTATE AMINO AST SGOT $194.00
84460 107677 TRANSFERASE ALANINE AMINO ALT SGPT $164.00
84466 107678 ASSAY OF L7383TRANSFERRIN $1,073.00
84478 107679 ASSAY OF TRIGLYCERIDES $104.00
84479 107680 THYROID HORM UPTK/THYROID HORMONE BINDING RATIO $184.00
84480 107681 ASSAY OF TRIIODOTHYRONINE T3 TOTAL TT3 $199.00
84481 107682 ASSAY OF TRIIODOTHYRONINE T3 FREE $182.00
84482 107683 TRIIODOTHYRONINE T3 REVERSE $372.00
84484 107684 ASSAY OF TROPONIN QUANTITATIVE $551.00
84485 107685 ASSAY OF TRYPSIN DUODENAL FLUID $241.50
84488 107686 ASSAY OF TRYPSIN FECES QUALITATIVE $206.50
84490 107687 TRYPSIN FECES QUANTITATIVE 24-HR COLLECTION $244.50
84510 107688 ASSAY OF TYROSINE $259.50
84512 107689 ASSAY OF TROPONIN QUALITATIVE $345.00
84520 107690 ASSAY OF UREA NITROGEN QUANTITATIVE $177.00
84525 107691 ASSAY OF UREA NITROGEN SEMIQUANTITATIVE $176.00
84540 107692 ASSAY OF UREA NITROGEN URINE $202.00
84545 107693 UREA NITROGEN CLEARANCE $306.50
84550 107694 ASSAY OF BLOOD/URIC ACID $66.00
84560 107695 ASSAY OF URIC ACID OTHER SOURCE $155.50
84577 107696 ASSAY OF UROBILINOGEN FECES QUANTITATIVE $328.00
84578 107697 ASSAY OF UROBILINOGEN URINE QUALITATIVE $86.50
84580 107698 UROBILINOGEN URINE QUANTITATIVE TIMED SPECIMEN $483.00
84583 107699 ASSAY OF UROBILINOGEN URINE SEMIQUANTITATIVE $190.00
84585 107700 ASSAY OF VANILLYLMANDELIC ACID URINE $207.00
84586 107701 ASSAY OF VASOACTIVE INTESTINAL PEPTIDE $608.50
84588 107702 ASSAY OF VASOPRESSIN ANTI-DIURETIC HORMONE $460.00
84590 107703 ASSAY OF VITAMIN A $150.00
84591 107704 ASSAY OF VITAMIN NOT OTHERWISE SPECIFIED $694.00
84597 107705 ASSAY OF VITAMIN K $148.00
84600 107706 ASSAY OF VOLATILES $363.00
84620 107707 XYLOSE ABSORPTION TEST BLOOD &/URINE $278.00
84630 107708 ASSAY OF ZINC $123.00
84681 107709 ASSAY OF C-PEPTIDE $221.00
84702 107710 GONADOTROPIN CHORIONIC QUANTITATIVE $532.00
84703 107711 GONADOTROPIN CHORIONIC QUALITATIVE $343.50
84704 107712 GONADOTROPIN CHORIONIC HCG FREE BETA CHAIN $320.00
84830 107713 OVULATION TEST VISUAL COLOR COMPARISON HLH $288.50
84999 107714 UNLISTED CHEMISTRY PROCEDURE $0.00
85002 107715 BLEEDING TIME TEST $281.00
85004 107716 BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT $155.00
85007 107717 BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT $108.00
85008 107718 BLD COUNT SMEAR MCRSCP W/O MNL DIFRNTL WBC COUNT $93.50
85009 107719 BLOOD COUNT MANUAL DIFRNTL WBC COUNT BUFFY COAT $111.00
85013 107720 BLOOD COUNT SPUN MICROHEMATOCRIT $96.00
85014 107721 BLOOD COUNT HEMATOCRIT $103.50
85018 107722 BLOOD COUNT HEMOGLOBIN $106.00
85025 107723 BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC $270.00
85027 107724 BLOOD COUNT COMPLETE AUTOMATED $1,031.50
85032 107725 BLOOD COUNT MANUAL CELL COUNT EACH $209.50
85041 107726 BLOOD COUNT RED BLOOD CELL AUTOMATED $63.00
85044 107727 BLOOD COUNT RETICULOCYTE MANUAL $514.00
85045 107728 BLOOD COUNT RETICULOCYTE AUTOMATED $110.50
85046 107729 BLOOD COUNT RETICULOCYTES AUTO 1/> CELL MEAS $361.00
85048 107730 BLOOD COUNT LEUKOCYTE WBC AUTOMATED $53.00
85049 107731 BLOOD COUNT PLATELET AUTOMATED $113.00
85055 107732 RETICULATED PLATELET ASSAY $143.50
85060 107733 BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT $264.50
85097 107734 BONE MARROW SMEAR INTERPRETATION $891.00
85130 107735 CHROMOGENIC SUBSTRATE ASSAY $396.00
85170 107736 BLOOD CLOT RETRACTION $156.50
85175 107737 CLOT LYSIS TIME WHOLE BLOOD DILUTION $224.50
85210 107738 CLOTTING FACTOR II PROTHROMBIN SPECIFIC $135.50
85220 107739 CLOTTING FACTOR V ACG/PROACCELERIN LABILE FACTOR $636.50
85230 107740 CLOTTING FACTOR VII PROCONVERTIN STABLE FACTOR $650.00
85240 107741 CLOTTING FACTOR VIII AHG 1 STAGE $227.50
85244 107742 CLOTTING FACTOR VIII RELATED ANTIGEN $669.00
85245 107743 CLOTTING FACTOR VIII VW FACTOR RISTOCETIN COFACT $645.00
85246 107744 CLOTTING FACTOR VIII VW FACTOR ANTIGEN $637.00
85247 107745 CLOTTING FACTOR VIII MULTIMETRIC ANALYSIS $537.50
85250 107746 CLOTTING FACTOR IX PTC/CHRISTMAS $180.00
85260 107747 CLOTTING FACTOR X STUART-PROWER $158.00
85270 107748 CLOTTING FACTOR XI PTA $192.00
85280 107749 CLOTTING FACTOR XII HAGEMAN $586.00
85290 107750 CLOTTING FACTOR XIII FIBRIN STABILIZING $549.50
85291 107751 CLOTTING FACTOR XIII FIBRN STABILIZ SCREEN SOLUB $285.50
85292 107752 CLOTTING PREKALLIKREIN ASSAY FLETCHER FACT ASSAY $631.50
85293 107753 CLOTTING HI MOLEC WEIGHT KININOGEN ASSAY $792.50
85300 107754 CLOTTING INHIBITORS ANTITHROMBIN III ACTIVITY $123.00
85301 107755 CLOTTING INHIBITRS ANTITHROMBN III ANTIGEN ASSAY $319.00
85302 107756 CLOTTING INHIBITORS PROTEIN C ANTIGEN $358.50
85303 107757 CLOTTING INHIBITORS PROTEIN C ACTIVITY $138.00
85305 107758 CLOTTING INHIBITORS PROTEIN S TOTAL $648.00
85306 107759 CLOTTING INHIBITORS PROTEIN S FREE $138.00
85307 107760 ACTIVATED PROTEIN C APC RESISTANCE ASSAY $137.00
85335 107761 FACTOR INHIBITOR TEST $607.00
85337 107762 THROMBOMODULIN $294.50
85345 107763 COAGULATION TIME LEE AND WHITE $217.00
85347 107764 COAGULATION TIME ACTIVATED $172.00
85348 107765 COAGULATION TIME OTHER METHODS $273.00
85360 107766 EUGLOBULIN LYSIS $239.50
85362 107767 FIBRIN DGRADJ SPLT PRODUXS AGGLUJ SLIDE SEMIQUAN $303.50
85366 107768 FIBRIN DGRADJ SPLT PRODUXS PARACOAGJ $373.50
85370 107769 FIBRIN DGRADJ SPLT PRODUCTS QUANTITATIVE $252.00
85378 107770 FIBRIN DGRADJ PRODUCTS D-DIMER QUAL/SEMIQUAN $559.00
85379 107771 FIBRIN DGRADJ PRODUCTS D-DIMER QUANTITATIVE $590.50
85380 107772 FIBRIN DGRADJ PRODUCTS D-DIMER ULTRASENSITIVE $896.00
85384 107773 FIBRINOGEN ACTIVITY $252.00
85385 107774 FIBRINOGEN ANTIGEN $291.50
85390 107775 FIBRINOLYSINS/COAGULOPATHY SCREEN INTERP&REPOR $74.00
85396 107776 COAGJ/FBRNLYS ASSAY WHOLE BLOOD ADDITIVE PER DAY $507.00
85397 107777 COAGJ&FIBRINOLYSIS FUNCTIONAL ACTV NOS EA ANAL $896.00
85400 107778 FIBRINOLYTIC FACTORS & INHIBITORS PLASMIN $267.50
85410 107779 FBRNLYC FACTORS&INHIBITORS ALPHA-2 ANTIPLASMIN $449.50
85415 107780 FBRNLYC FACTORS&INHIBITORS PLSMNG ACTIVATOR $470.50
85420 107781 FBRNLYC FACTORS&INHIBITRS PLSMNG XCPT AGIC ASS $350.50
85421 107782 FBRNLYC FACTORS&INHIBITORS PLSMNG AGIC ASSAY $289.50
85441 107783 HEINZ BODIES DIRECT $171.50
85445 107784 HEINZ BODIES INDUCED ACETYL PHENYLHYDRAZINE $228.00
85460 107785 HGB/RBCS FETAL FETOMATERNAL HEMRRG DIFRNTL LYSIS $289.00
85461 107786 HGB/RBCS FETAL FETOMATERNAL HEMRRG ROSETTE $153.00
85475 107787 HEMOLYSIN ACID $267.50
85520 107788 HEPARIN ASSAY $358.50
85525 107789 HEPARIN NEUTRALIZATION $337.00
85530 107790 HEPARIN-PROTAMINE TOLERANCE TST $355.50
85536 107791 IRON STAIN PERIPHERAL BLOOD $218.50
85540 107792 WBC ALKALINE PHOSPHATASE COUNT $315.50
85547 107793 MECHANICAL FRAGILITY RBC $262.50
85549 107794 MURAMIDASE $154.00
85555 107795 OSMOTIC FRAGILITY RBC UNINCUBATED $363.00
85557 107796 OSMOTIC FRAGILITY RBC INCUBATED $449.50
85576 107797 PLATELET AGGREGATION IN VITRO EACH AGENT $299.00
85597 107798 PHOSPHOLIPID NEUTRALIZATION PLATELET $371.00
85598 107799 PHOSPHOLIPID NEUTRALIZATION HEXAGONAL $364.50
85610 107800 PROTHROMBIN TIME $201.00
85611 107801 PROTHROMBIN TIME SUBSTITUTION PLASMA FRCTJ EACH $212.50
85612 107802 RUSSELL VIPER VENON TIME UNDILUTED $267.50
85613 107803 RUSSELL VIPER VENOM TIME DILUTED $104.00
85635 107804 REPTILASE TEST $325.00
85651 107805 SEDIMENTATION RATE RBC NON-AUTOMATED $156.00
85652 107806 SEDIMENTATION RATE RBC AUTOMATED $39.00
85660 107807 SICKLING RBC REDUCTION $182.50
85670 107808 THROMBIN TIME PLASMA $209.00
85675 107809 THROMBIN TIME TITER $229.00
85705 107810 THROMBOPLASTIN INHIBITION TISSUE $239.50
85730 107811 THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD $217.50
85732 107812 THROMBOPLASTIN TIME PRTL SUBSTIT PLASMA FRCTJ EA $43.00
85810 107813 VISCOSITY $94.00
85999 107814 UNLISTED HEMATOLOGY & COAGULATION PROCEDURE $0.00
86000 107815 AGGLUTININS FEBRILE EACH ANTIGEN $247.50
86001 107816 ALLERGEN SPECIFIC IGG QUAN/SEMIQUAN EA ALLERGEN $75.50
86003 107817 ALLERGEN SPEC IGE CRUDE ALLERGEN EXTRACT EACH $150.00
86005 107818 ALLERGEN SPEC IGE QUAL MULTIALLERGEN SCREEN $130.50
86008 107819 ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA $104.00
86015 107820 ACTIN SMOOTH MUSCLE ANTIBODY EACH $28.00
86021 107821 ANTIBODY IDENTIFICATION LEUKOCYTE ANTIBODIES $343.00
86022 107822 ANTIBODY IDENTIFICATION PLATELET ANTIBODIES $721.00
86023 107823 ANTIBODY IDENTIFICATION PLATELET IMMUNOGL ASSAY $293.00
86036 107824 ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB $399.00
86037 107825 ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB $352.00
86038 107826 ANTINUCLEAR ANTIBODIES ANA $169.00
86039 107827 ANTINUCLEAR ANTIBODIES ANA TITER $297.00
86041 107828 ACETYLCHOLINE RECEPTOR BINDING ANTIBODY $0.00
86042 107829 ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY $0.00
86043 107830 ACETYLCHOLINE RECEPTOR MODULATING ANTIBODY $0.00
86051 107831 AQUAPORIN-4 ANTIBODY ELISA $1,650.50
86052 107832 AQUAPORIN-4 ANTIBODY CELL-BASED IMFLUOR ASSAY EA $1,121.50
86053 107833 AQUAPORIN-4 ANTIBODY FLOW CYTOMETRY EACH $2,877.00
86060 107834 ANTISTREPTOLYSIN O TITER $61.00
86063 107835 ANTISTREPTOLYSIN O SCREEN $249.00
86077 107836 BLD BANK PHYS SVCS DIFFC CROSS MATCH&/EVAL REP $549.50
86078 107837 BLD BANK PHYS SVCS INVSTGJ TFUJ RXN REPRT $575.00
86079 107838 BLD BANK PHYS SVCS AUTHJ DEVIJ STANDARD REPRT $636.50
86140 107839 C-REACTIVE PROTEIN $210.00
86141 107840 C-REACTIVE PROTEIN HIGH SENSITIVITY $138.00
86146 107841 BETA 2 GLYCOPROTEIN I ANTIBODY EACH $122.00
86147 107842 CARDIOLIPIN ANTIBODY EACH IG CLASS $220.00
86148 107843 ANTI-PHOSPHATIDYLSERINE ANTIBODY $315.00
86152 107844 CELL ENUMERATION IMMUNE SELECTJ & ID FLUID SPEC $3,075.50
86153 107845 CELL ENUMERATION IMMUNE SELECTJ & ID PHYS INTERP $880.50
86155 107846 CHEMOTAXIS ASSAY SPECIFY METHOD $381.50
86156 107847 COLD AGGLUTININ SCREEN $188.00
86157 107848 COLD AGGLUTININ TITER $223.00
86160 107849 COMPLEMENT ANTIGEN EACH COMPONENT $256.00
86161 107850 COMPLEMENT FUNCTIONAL ACTIVITY EACH COMPONENT $960.00
86162 107851 COMPLEMENT TOTAL HEMOLYTIC $230.00
86171 107852 COMPLEMENT FIXATION TESTS EACH ANTIGEN $1,348.00
86200 107853 CYCLIC CITRULLINATED PEPTIDE ANTIBODY $105.00
86215 107854 DEOXYRIBONUCLEASE ANTIBODY $230.00
86225 107855 DNA ANTIBODY NATIVE/DOUBLE STRANDED $322.00
86226 107856 DNA ANTIBODY SINGLE STRANDED $363.00
86231 107857 ENDOMYSIAL ANTIBODY EACH IMMUNOGLOBULIN CLASS $500.50
86235 107858 EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD $157.00
86255 107859 FLUORESCENT NONNFCT AGT ANTB SCREEN EA ANTIBODY $777.00
86256 107860 FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY $210.50
86258 107861 GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS $57.00
86277 107862 GROWTH HORMONE HUMAN ANTIBODY $237.00
86280 107863 HEMAGGLUTINATION INHIBITION TEST HAI $255.00
86294 107864 IMMUNOASSAY TUMOR ANTIGEN QUAL/SEMIQUANTITATIVE $217.00
86300 107865 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 15-3 $168.00
86301 107866 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 19-9 $256.00
86304 107867 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE CA 125 $287.00
86305 107868 HUMAN EPIDIDYMIS PROTEIN 4 (HE4) $744.00
86308 107869 HETEROPHILE ANTIBODIES SCREEN $318.50
86309 107870 HETEROPHILE ANTIBODIES TITER $282.50
86310 107871 HETEROPHILE ANTIBODIES TITER AFTER ABSORPTION $264.50
86316 107872 IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE $216.00
86317 107873 IMMUNOASSAY INFECTIOUS AGENT ANTIBODY QUAN NOS $227.00
86318 107874 IA INFECTIOUS AGT ANTIBODY QUAL/SEMIQ 1STEP METH $337.00
86320 107875 IMMUNOELECTROPHORESIS SERUM $658.00
86325 107876 IMMUNOELECTROPHORESIS OTHER FLUIDS CONCENTRATION $680.50
86327 107877 IMMUNOELECTROPHORESIS CROSSED $381.50
86328 107878 IA INFECTIOUS AGT ANTIBODY SARS-COV-2 COVID-19 $721.00
86329 107879 IMMUNODIFFUSION NOT ELSEWHERE SPECIFIED $504.00
86331 107880 IMMUNODIFFUSION GEL DIFFUSION QUAL EA AG/ANTBDY $208.50
86332 107881 IMMUNE COMPLEX ASSAY $426.50
86334 107882 IMMUNOFIXJ ELECTROPHORESIS SERUM $238.00
86335 107883 IMMUNOFIXJ ELECTROPHORESIS OTHER FLUIDS $312.00
86336 107884 INHIBIN A $327.00
86337 107885 INSULIN ANTIBODIES $194.00
86340 107886 INTRINSIC FACTOR ANTIBODIES $121.00
86341 107887 ISLET CELL ANTIBODY $176.00
86343 107888 LEUKOCYTE HISTAMINE RELEASE TEST LHR $425.00
86344 107889 LEUKOCYTE PHAGOCYTOSIS $297.50
86352 107890 CELLULAR FUNCTION ASSAY STIMUL&DETECT BIOMARKE $871.00
86353 107891 LYMPHOCYTE TR MITOGEN/AG INDUCED BLASTOGENESIS $693.50
86355 107892 B CELLS TOTAL COUNT $123.00
86356 107893 MONONUCLEAR CELL ANTIGEN QUANTITATIVE NOS EA $71.50
86357 107894 NATURAL KILLER CELLS TOTAL COUNT $123.00
86359 107895 T CELLS TOTAL COUNT $126.00
86360 107896 T CELLS ABSOLUTE CD4&CD8 COUNT RATIO $135.00
86361 107897 T CELLS ABSOLUTE CD4 COUNT $432.00
86362 107898 MOG-IGG1 ANTIBODY CELL-BASED IMFLUOR ASSAY EACH $1,443.50
86363 107899 MOG-IGG1 ANTIBODY FLOW CYTOMETRY EACH $1,055.00
86364 107900 TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS $28.00
86366 107901 MUSCLE-SPECIFIC KINASE ANTIBODY $0.00
86367 107902 STEM CELLS TOTAL COUNT $976.00
86376 107903 MICROSOMAL ANTIBODIES EACH $160.00
86381 107904 MITOCHONDRIAL ANTIBODY EACH $35.00
86382 107905 NEUTRALIZATION TEST VIRAL $497.50
86384 107906 NITROBLUE TETRAZOLIUM DYE TEST NTD $311.50
86386 107907 NUCLEAR MATRIX PROTEIN 22 NMP22 QUALITATIVE $262.50
86403 107908 PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY $282.50
86406 107909 PARTICLE AGGLUTINATION TITER EACH ANTIBODY $533.00
86408 107910 NEUTRALIZING ANTIBODY SARS-COV-2 SCREEN $520.50
86409 107911 NEUTRALIZING ANTIBODY SARS-COV-2 TITER $410.00
86413 107912 SEV AQT RESPIR SYND CORONAVIRUS 2 ANTIBODY QUAN $910.50
86430 107913 RHEUMATOID FACTOR QUALITATIVE $160.00
86431 107914 RHEUMATOID FACTOR QUANTITATIVE $102.00
86480 107915 TB CELL MEDIATED ANTIGN RESPNSE GAMMA INTERFERON $365.00
86481 107916 TB ANTIGEN RESPONSE GAMMA INTERFERON T-CELL SUSP $603.00
86485 107917 SKIN TEST CANDIDA $440.00
86486 107918 SKIN TEST UNLISTED ANTIGEN EACH $226.00
86490 107919 SKIN TEST COCCIDIOIDOMYCOSIS $188.00
86510 107920 SKIN TEST HISTOPLASMOSIS $144.00
86580 107921 SKIN TEST TUBERCULOSIS INTRADERMAL $33.00
86590 107922 STREPTOKINASE ANTIBODY $511.50
86592 107923 SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL $176.00
86593 107924 SYPHILIS TEST QUANTITATIVE $172.00
86596 107925 VOLTAGE-GATED CALCIUM CHANNEL ANTIBODY EACH $527.00
86602 107926 ANTIBODY ACTINOMYCES $212.50
86603 107927 ANTIBODY ADENOVIRUS $275.00
86606 107928 ANTIBODY ASPERGILLUS $140.50
86609 107929 ANTIBODY BACTERIUM NOT ELSEWHERE SPECIFIED $107.00
86611 107930 ANTIBODY BARTONELLA $95.00
86612 107931 ANTIBODY BLASTOMYCES $105.00
86615 107932 ANTIBODY BORDETELLA $199.50
86617 107933 ANTIBODY BORRELIA BURGDORFERI CONFIRMATORY TST $126.00
86618 107934 ANTIBODY BORRELIA BURGDORFERI LYME DISEASE $115.00
86619 107935 ANTIBODY BORRELIA RELAPSING FEVER $528.00
86622 107936 ANTIBODY BRUCELLA $231.00
86625 107937 ANTIBODY CAMPYLOBACTER $270.50
86628 107938 ANTIBODY CANDIDA $211.00
86631 107939 ANTIBODY CHLAMYDIA $143.00
86632 107940 ANTIBODY CHLAMYDIA IGM $155.00
86635 107941 ANTIBODY COCCIDIOIDES $137.00
86638 107942 ANTIBODY COXIELLA BURNETII Q FEVER $232.00
86641 107943 ANTIBODY CRYPTOCOCCUS $335.50
86644 107944 ANTIBODY CYTOMEGALOVIRUS CMV $188.50
86645 107945 ANTIBODY CYTOMEGALOVIRUS CMV IGM $1,047.00
86648 107946 ANTIBODY DIPHTHERIA $366.00
86651 107947 ANTIBODY ENCEPHALITIS CALIFORNIA LA CROSSE $167.00
86652 107948 ANTIBODY ENCEPHALITIS EASTERN EQUINE $267.50
86653 107949 ANTIBODY ENCEPHALITIS ST. LOUIS $259.50
86654 107950 ANTIBODY ENCEPHALITIS WESTRN EQUINE $250.50
86658 107951 ANTIBODY ENTEROVIRUS $91.00
86663 107952 ANTIBODY EPSTEIN-BARR EB VIRUS EARLY ANTIGEN EA $256.50
86664 107953 ANTIBODY EPSTEIN-BARR EB VIRUS NUCLEAR AG EBNA $144.00
86665 107954 ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA $190.00
86666 107955 ANTIBODY EHRLICHIA $312.50
86668 107956 ANTIBODY FRANCISELLA TULARENSIS $322.00
86671 107957 ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED $299.00
86674 107958 ANTIBODY GIARDIA LAMBLIA $322.00
86677 107959 ANTIBODY HELICOBACTER PYLORI $443.00
86682 107960 ANTIBODY HELMINTH NOT ELSEWHERE SPECIFIED $315.00
86684 107961 ANTIBODY HAEMOPHILUS INFLUENZA $486.00
86687 107962 ANTIBODY HTLV-I $123.00
86688 107963 ANTIBODY HTLV-II $206.50
86689 107964 ANTIBODY HTLV/HIV ANTIBODY CONFIRMATORY TEST $545.00
86692 107965 ANTIBODY HEP DELTA AGENT $175.00
86694 107966 ANTIBODY HERPES SMPLX NON-SPECIFIC TYPE TEST $243.00
86695 107967 ANTIBODY HERPES SMPLX TYPE 1 $129.00
86696 107968 ANTIBODY HERPES SMPLX TYPE 2 $253.50
86698 107969 ANTIBODY HISTOPLASMA $112.00
86701 107970 ANTIBODY HIV-1 $265.00
86702 107971 ANTIBODY HIV-2 $286.00
86703 107972 ANTIBODY HIV-1&HIV-2 SINGLE RESULT $317.00
86704 107973 HEPATITIS B CORE ANTIBODY HBCAB TOTAL $169.00
86705 107974 HEPATITIS B CORE ANTIBODY HBCAB IGM ANTIBODY $488.50
86706 107975 HEPATITIS B SURF ANTIBODY HBSAB $484.00
86707 107976 HEPATITIS BE ANTIBODY HBEAB $102.50
86708 107977 HEPATITIS A ANTIBODY HAAB $275.00
86709 107978 HEPATITIS ANTIBODY HAAB IGM ANTIBODY $316.00
86710 107979 ANTIBODY INFLUENZA VIRUS $348.00
86711 107980 ANTIBODY JOHN CUNNINGHAM VIRUS $116.00
86713 107981 ANTIBODY LEGIONELLA $315.50
86717 107982 ANTIBODY LEISHMANIA $286.50
86720 107983 ANTIBODY LEPTOSPIRA $282.50
86723 107984 ANTIBODY LISTERIA MONOCYTOGENES $637.50
86727 107985 ANTIBODY LYMPHOCYTIC CHORIOMENINGITIS $176.00
86732 107986 ANTIBODY MUCORMYCOSIS $340.00
86735 107987 ANTIBODY MUMPS $166.50
86738 107988 ANTIBODY MYCOPLSM $364.50
86741 107989 ANTIBODY NEISSERIA MENINGITIDIS $268.50
86744 107990 ANTIBODY NOCARDIA $148.50
86747 107991 ANTIBODY PARVOVIRUS $120.00
86750 107992 ANTIBODY PLASMODIUM MALARIA $279.00
86753 107993 ANTIBODY PROTOZOA NES $221.50
86756 107994 ANTIBODY RESPIRATORY SYNCTIAL VIRUS $301.00
86757 107995 ANTIBODY RICKETTSIA $204.00
86759 107996 ANTIBODY ROTAVIRUS $367.00
86762 107997 ANTIBODY RUBELLA $251.50
86765 107998 ANTIBODY RUBEOLA $151.00
86768 107999 ANTIBODY SALMONELLA $168.50
86769 108000 ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID-19 $231.00
86771 108001 ANTIBODY SHIGELLA $317.50
86774 108002 ANTIBODY TETANUS $379.50
86777 108003 ANTIBODY TOXOPLASMA $126.00
86778 108004 ANTIBODY TOXOPLASMA IGM $176.50
86780 108005 ANTIBODY TREPONEMA PALLIDUM $233.00
86784 108006 ANTIBODY TRICHINELLA $348.00
86787 108007 ANTIBODY VARICELLA-ZOSTER $210.00
86788 108008 ANTIBODY WEST NILE VIRUS IGM $342.00
86789 108009 ANTIBODY WEST NILE VIRUS $280.00
86790 108010 ANTIBODY VIRUS NOT ELSEWHERE SPECIFIFED $150.00
86793 108011 ANTIBODY YERSINIA $275.00
86794 108012 ZIKA VIRUS IGM ANTIBODY $425.00
86800 108013 THYROGLOBULIN ANTIBODY $107.00
86803 108014 HEPATITIS C ANTIBODY $349.00
86804 108015 HEPATITIS C ANTIBODY CONFIRMATORY TEST $492.00
86805 108016 LYMPHOCYTOTOXICITY ASSAY VIS CROSSMATCH TITRATJ $2,088.00
86806 108017 LMPHOCYTOTOXICITY ASSAY VIS CROSSMTCH W/O TITRAT $2,088.00
86807 108018 SERUM SCREENING % REACTIVE ANTIBODY STANDRD METH $1,811.00
86808 108019 SERUM SCREENING % REACTIVE ANTIBODY QUICK METH $3,218.50
86812 108020 HLA TYPING A/B/C SINGLE ANTIGEN $706.50
86813 108021 HLA TYPING A/B/C MULTIPLE ANTIGENS $1,419.50
86816 108022 HLA TYPING DR/DQ SINGLE ANTIGEN $858.00
86817 108023 HLA TYPING DR/DQ MULTIPLE ANTIGENS $1,815.50
86821 108024 HLA TYPING LYMPHOCYTE CULTURE MIXED $2,423.00
86825 108025 HLA CROSSMATCH NONCYTOTOXIC 1ST SERUM/DILUTION $1,498.00
86826 108026 HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION $910.50
86828 108027 ANTIBODY HLA CLASS I & CLASS II ANTIGENS QUAL $1,584.50
86829 108028 ANTIBODY HLA CLASS I OR CLASS II ANTIGENS QUAL $1,716.00
86830 108029 ANTIBODY HLA CLASS I PHENOTYPE PANEL QUALITATIVE $1,158.00
86831 108030 ANTIBODY HLA CLASS II PHENOTYPE PANEL QUAL $1,061.00
86832 108031 ANTIBODY HLA CLASS I HIGH DEFINITION PANEL QUAL $1,797.00
86833 108032 ANTIBODY HLA CLASS II HIGH DEFINITION PANEL QUAL $939.00
86834 108033 ANTIBODY HLA CLASS I SEMIQUANTITATIVE PANEL $9,053.00
86835 108034 ANTIBODY HLA CLASS II SEMIQUANTITATIVE PANEL $9,053.00
86849 108035 UNLISTED IMMUNOLOGY $0.00
86850 108036 ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE $279.00
86860 108037 ANTIBODY ELUTION RBC EACH ELUTION $276.00
86870 108038 ANTIBODY ID RBC ANTIBODIES EA PANEL EA SERUM TQ $532.00
86880 108039 ANTIHUMAN GLOBULIN DIRECT EACH ANTISERUM $214.00
86885 108040 ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL $195.00
86886 108041 ANTIHUMAN GLOBULIN INDIRECT EACH ANTIBODY TITER $1,123.00
86890 108042 AUTOL BLD/COMPONENT COLLJ STORAGE PREDEPOSITED $1,506.00
86891 108043 AUTOL BLD/COMPONENT COLLJ STORAGE SALVAGE $2,718.50
86900 108044 BLOOD TYPING SEROLOGIC ABO $229.50
86901 108045 BLOOD TYPING SEROLOGIC RH (D) $132.50
86902 108046 BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH $510.00
86904 108047 BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT $309.50
86905 108048 BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH $329.00
86906 108049 BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE $382.50
86910 108050 BLOOD TYPING PATERNITY PR INDIV ABO RH&MN $634.50
86911 108051 BLOOD TYPING PATERNITY INDIV ADDL ANTIGEN SYS $261.00
86920 108052 COMPATIBILITY EACH UNIT IMMEDIATE SPIN TECHNIQUE $338.00
86921 108053 COMPATIBILITY EACH UNIT INCUBATION $510.00
86922 108054 COMPATIBILITY EACH UNIT ANTIGLOBULIN $274.00
86923 108055 COMPATIBILITY EACH UNIT ELECTRONIC $317.00
86927 108056 FRESH FROZEN PLASMA THAWING EACH UNIT $486.00
86930 108057 FROZEN BLOOD EACH UNIT FREEZING $3,081.50
86931 108058 FROZEN BLOOD EACH UNIT THAWING $432.50
86932 108059 FROZEN BLOOD EACH UNIT FREEZING & THAWING $192.50
86940 108060 HEMOLYSINS&AGGLUTININS AUTO SCREEN EACH $244.50
86941 108061 HEMOLYSINS&AGGLUTININS INCUBATED $297.50
86945 108062 IRRADIATION BLOOD PRODUCT EACH UNIT $385.50
86950 108063 LEUKOCYTE TRANSFUSION $1,068.50
86960 108064 VOLUME REDUCTION BLOOD/BLOOD PRODUCT EACH UNIT $595.00
86965 108065 POOLING PLATELETS/OTHER BLOOD PRODUCTS $214.00
86970 108066 PRETX RBC ANTIBODY INCUBAT W/CHEM AGNTS/DRUGS EA $203.00
86971 108067 PRETX RBC ANTIBODY INCUBAT W/ENZYMES EACH $144.00
86972 108068 PRETX RBC ANTIBODY INCUBAT W/DENSITY GRAD SEP $479.50
86975 108069 PRETX SERUM RBC ANTIBODY INCUBATION DRUGS EACH $523.50
86976 108070 PRETX SERUM RBC ANTIBODY IDENTIFICATION DILUTION $276.00
86977 108071 PRETX SERUM RBC ANTB ID INCUBATION INHIBITORS EA $678.50
86978 108072 PRETX SERUM RBC ANTIBODY ID DIFFIAL EACH ABSRPJ $486.00
86985 108073 SPLITTING BLOOD/BLOOD PRODUCTS EACH UNIT $348.00
86999 108074 UNLISTED TRANSFUSION MEDICINE PROCEDURE $0.00
87003 108075 ANIMAL INOCULATION SMALL ANIMAL W/OBS&DSJ $393.00
87015 108076 CONCENTRATION INFECTIOUS AGENTS $78.00
87040 108077 CULTURE BACTERIAL BLOOD AEROBIC W/ID ISOLATES $483.50
87045 108078 CUL BACT STOOL AEROBIC ISOL SALMONELLA&SHIGELL $356.00
87046 108079 CUL BACT STOOL AEROBIC ADDL PATHOGENS&ID EA $108.00
87070 108080 CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL $762.50
87071 108081 CUL BACT QUAN AEROBIC ISOL XCPT UR BLOOD/STOOL $452.00
87073 108082 CUL BACT QUAN ANAERC ISOL XCPT UR BLOOD/STOOL $382.50
87075 108083 CULTURE BACTERIAL ANY SOURCE ANAEROBIC ISO&ID $608.00
87076 108084 CUL BACT ANAEROBIC ADDL METHS DEFINITIVE EA ISOL $104.00
87077 108085 CUL BACT AEROBIC ADDL METHS DEFINITIVE EA ISOL $113.00
87081 108086 CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ $243.50
87084 108087 CUL PRSMPTV PTHGNC ORGANISMS SCR DNS CHART $165.50
87086 108088 CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE $379.00
87088 108089 CULTURE BCT ISOL&PRSMPTV ID ISOLATE EA URINE $46.00
87101 108090 CUL FNGI MOLD/YEAST PRSMPTV ID SKN HAIR/NAIL $273.00
87102 108091 CULTURE FNGI MOLD/YEAST PRSMPTV OTH XCPT BLOOD $287.50
87103 108092 CULTURE FNGI MOLD/YEAST ISOL PRSMPTV ISOL BLOOD $127.00
87106 108093 CULTURE FUNGI DEFINITIVE ID EACH ORGANISM YEAST $128.00
87107 108094 CULTURE FUNGI DEFINITIVE ID EACH ORGANISM MOLD $143.00
87109 108095 CULTURE MYCOPLASMA ANY SOURCE $434.00
87110 108096 CULTURE CHLAMYDIA ANY SOURCE $439.00
87116 108097 CULTURE TUBERCLE/OTH ACID-FAST BACILLI ANY ISOL $230.00
87118 108098 CULTURE MYCOBACTERIAL DEFINITIVE ID EA ISOL $315.50
87140 108099 CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM $151.50
87143 108100 CULTURE TYPING GAS/HIGH PRES LIQ CHROMATOGRAPHY $299.00
87147 108101 CULTURE TYPING IMMUNOLOGIC OTH/THN IMMUNOFLUORES $324.00
87149 108102 CULTURE TYPING NUCLEIC ACID PROBE DIR EA ORGANSM $147.00
87150 108103 CULTYP NUC ACID AMP PRB CULT/ISOLATE EA ORGNISM $447.00
87152 108104 CULTURE TYPING IDENTIFJ PULSE FIELD GEL TYPING $194.50
87153 108105 CULTYP NUCLEIC ACID SEQUENCING METH EA ISOLATE $1,071.50
87154 108106 CULTURE TYPING ID BLD PTHGN&RESIST TYPING 6+TRGT $1,289.00
87158 108107 CULTURE TYPING OTHER METHODS $271.50
87164 108108 DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION $159.00
87166 108109 DARK FIELD EXAM ANY SOURCE W/O SPECIMEN COLLECT $147.50
87168 108110 MACROSCOPIC EXAMINATION ARTHROPOD $140.00
87169 108111 MACROSCOPIC EXAMINATION PARASITE $148.50
87172 108112 PINWORM EXAMINATION $158.00
87176 108113 HOMOGENIZATION TISSUE CULTURE $170.00
87177 108114 OVA&PARASITES DIRECT SMEARS CONCENTRATION & ID $36.00
87181 108115 SUSCEPTBILTY STDY ANTIMICRBIAL AGNT AGAR DILUTJ $138.00
87184 108116 SUSCEPTIBILITY STUDY ANTIMICROBIAL DISK METHOD $98.00
87185 108117 SUSCEPTIBILITY STUDY ANTIMICROBIAL ENZYME DETCJ $347.00
87186 108118 SUSCEPTIBLTY STDY ANTIMICRBIAL MICRO/AGAR DILUTJ $323.50
87187 108119 SUSCEPTIBLTY STDY ANTMCRB MICRO/AGAR DILUTJ EA $224.50
87188 108120 SC STD ANTMCRB AGT MACROBROTH DIL METH EA AGT $185.00
87190 108121 SUSCEPTIBLTY STDY ANTMCRB MYCOBACT PROPORJ MTHD $133.50
87197 108122 SERUM BACTERICIDAL TITER $674.00
87205 108123 SMR PRIM SRC GRAM/GIEMSA STAIN BCT FUNGI/CELL $139.50
87206 108124 SMR PRIM SRC FLUORESCENT&/AFS BCT FNGI PARASIT $133.00
87207 108125 SMR PRIM SRC SPEC STAIN BODIES/PARASITS $101.00
87209 108126 SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS $206.00
87210 108127 SMR PRIM SRC WET MOUNT NFCT AGT $157.00
87220 108128 TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT $184.00
87230 108129 TOXIN/ANTITOXIN ASSAY TISSUE CULTURE $92.00
87250 108130 VIRUS INOCULATION EGGS/SM ANIMAL OBS&DSJ $567.50
87252 108131 VIRUS TISS CUL INOCULATION CYTOPATHIC EFFECT $418.00
87253 108132 VIRUS TISSUE CULTURE ADDL STDY/ID EACH ISOLATE $489.00
87254 108133 VIRUS CENTRIFUGE ENHNCD ID IMFLUOR STAIN EA $340.00
87255 108134 VIRUS ID NON-IMMUNOLOGIC OTH/THN CYTOPATHIC $533.00
87260 108135 IAADI ADENOVIRUS $111.00
87265 108136 IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS $747.00
87267 108137 IAADI ENTEROVIRUS DIRECT FLUORESCENT ANTIBODY $223.00
87269 108138 IAADI GIARDIA $122.00
87270 108139 IAADI CHLAMYDIA TRACHOMATIS $470.50
87271 108140 IAADI CYTOMEGALOVIRUS DIR FLUORESCENT ANTIBODY $660.50
87272 108141 IAADI CRYPTOSPORIDIUM $235.00
87273 108142 IAADI HERPES SMPLX VIRUS TYPE 2 $303.50
87274 108143 IAADI HERPES SMPLX VIRUS TYPE 1 $335.50
87275 108144 IAADI INFLUENZA B VIRUS $145.50
87276 108145 IAADI INFFLUENZA A VIRUS $145.50
87278 108146 IAADI LEGIONELLA PNEUMOPHILA $193.50
87279 108147 IAADI PARAINFLUENZA VIRUS EACH TYPE $111.00
87280 108148 IAADI RESPIRATORY SYNCTIAL VIRUS $137.00
87281 108149 IAADI PNEUMOCUSTIS CARINII $110.00
87283 108150 IAADI RUBEOLA $320.00
87285 108151 IAADI TREPONEMA PALLIDUM $320.00
87290 108152 IAADI VARICELLA ZOSTER VIRUS $308.00
87299 108153 IAADI NOT OTHERWISE SPECIFIED EACH ORGANISM $147.00
87300 108154 IAADI POLYV MLT ORGANISMS EA POLYV ANTISERUM $289.00
87301 108155 IAAD IA ADENOVIRUS ENTERIC TYP 40/41 $234.00
87305 108156 IAAD IA ASPERGILLUS $124.00
87320 108157 IAAD IA CHLAMYDIA TRACHOMATIS $479.50
87324 108158 IAAD IA CLOSTRIDIUM DIFFICILE TOXIN $567.00
87327 108159 IAAD IA CRYPTOCOCCUS NEOFORMANS $289.50
87328 108160 IAAD IA CRYPTOSPORIDIUM $169.50
87329 108161 IAAD IA GIARDIA $175.00
87332 108162 IAAD IA CYTOMEGALOVIRUS $195.50
87335 108163 IAAD IA ESCHERICHIA COLI 0157 $261.00
87336 108164 IAAD IA ENTAMOEBA HISTOLYTICA DISPAR GRP $558.50
87337 108165 IAAD IA ENTAMOEBA HISTOLYTICA GRP $228.00
87338 108166 IAAD IA HPYLORI STOOL $109.00
87339 108167 IAAD IA HPYLORI $353.50
87340 108168 IAAD IA HEPATITIS B SURFACE ANTIGEN $460.00
87341 108169 IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION $264.00
87350 108170 IAAD IA HEPATITIS BE ANTIGEN $102.00
87380 108171 IAAD IA HEPATITIS DELTA ANTIGEN $683.50
87385 108172 IAAD IA HISTOPLASM CAPSULATUM $158.50
87389 108173 IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE $335.00
87390 108174 IAAD IA HIV-1 $297.50
87391 108175 IAAD IA HIV-2 $449.50
87400 108176 IAAD IA INFLUENZA A/B EACH $195.00
87420 108177 IAAD IA RESPIRATORY SYNCTIAL VIRUS $467.50
87425 108178 IAAD IA ROTAVIRUS $328.00
87426 108179 IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS $381.00
87427 108180 IAAD IA SHIGA-LIKE TOXIN $214.00
87428 108181 IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B $734.50
87430 108182 IAAD IA STREPTOCOCCUS GROUP A $312.50
87449 108183 IAAD IA NOT OTHERWISE SPECIFIED EACH ORGANISM $235.50
87451 108184 IAAD IA POLYV MLT ORGANISMS EA POLYV ANTISERUM $247.50
87467 108185 HEPATITIS B SURFACE ANTIGEN QUANTITATIVE $0.00
87468 108186 IADNA ANAPLASMA PHAGOCYTOPHILUM AMPLIFED PRB TQ $510.00
87469 108187 IADNA BABESIA MICROTI AMPLIFIED PROBE TECHNIQUE $593.50
87471 108188 IADNA BARTONELLA AMPLIFIED PROBE TECHNIQUE $1,085.00
87472 108189 IADNA BARTONELLA HENSELAE&QUINTANA QUANTJ $689.00
87475 108190 IADNA BORRELIA BURGDORFERI DIRECT PROBE TQ $437.00
87476 108191 IADNA BORRELIA BURGDORFERI AMPLIFIED PROBE TQ $1,000.50
87478 108192 IADNA BORRELIA MIYAMOTOI AMPLIFIED PRB TECHNIQUE $531.00
87480 108193 IADNA CANDIDA SPECIES DIRECT PROBE TQ $262.50
87481 108194 IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ $369.00
87482 108195 IADNA CANDIDA SPECIES QUANTIFICATION $302.00
87483 108196 CNS DNA/RNA AMP PROBE MULTIPLE SUBTYPES 12-25 $1,315.00
87484 108197 IADNA EHRLICHIA CHAFFEENSIS AMPLIFIED PROBE TQ $610.50
87485 108198 IADNA CHLAMYDIA PNEUMONIAE DIRECT PROBE TQ $1,562.00
87486 108199 IADNA CHLAMYDIA PNEUMONIAE AMPLIFIED PROBE TQ $411.50
87487 108200 IADNA CHLAMYDIA PNEUMONIAE QUANTIFICATION $689.00
87490 108201 IADNA CHLAMYDIA TRACHOMATIS DIRECT PROBE TQ $323.00
87491 108202 IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ $339.50
87492 108203 IADNA CHLAMYDIA TRACHOMATIS QUANTIFICATION $996.00
87493 108204 INF AGENT DET NUCLEIC ACID CLOSTRIDIUM AMP PROBE $348.50
87495 108205 IADNA CYTOMEGALOVIRUS DIRECT PROBE TQ $947.00
87496 108206 IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ $1,035.00
87497 108207 IADNA CYTOMEGALOVIRUS QUANTIFICATION $511.50
87498 108208 IADNA ENTEROVIRUS AMPLIF PROBE & REVRSE TRNSCRIP $974.00
87500 108209 INFECTIOUS AGENT DNA/RNA VANCOMYCIN RESISTANCE $511.50
87501 108210 INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE $939.50
87502 108211 INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES $727.50
87503 108212 NFCT AGENT DNA/RNA INFLUENZA >2 TYPES EA ADDL $305.00
87505 108213 NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN $953.50
87506 108214 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 $743.00
87507 108215 IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12-25 $1,400.00
87510 108216 IADNA GARDNERELLA VAGINALIS DIRECT PROBE TQ $258.00
87511 108217 IADNA GARDNERELLA VAGINALIS AMPLIFIED PROBE TQ $300.00
87512 108218 IADNA GARDNERELLA VAGINALIS QUANTIFICATION $473.50
87516 108219 IADNA HEPATITIS B VIRUS AMPLIFIED PROBE TQ $1,013.00
87517 108220 IADNA HEPATITIS B VIRUS QUANTIFICATION $502.00
87520 108221 IADNA HEPATITIS C DIRECT PROBE TECHNIQUE $1,125.00
87521 108222 IADNA HEPATITIS C AMPLIFIED PROBE&REVRSE TRANSCR $1,956.00
87522 108223 IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION $648.00
87523 108224 IADNA HEPATITIS D DELTA QUAN W/REV TRANSCRIPTION $0.00
87525 108225 IADNA HEPATITIS G DIRECT PROBE TECHNIQUE $437.00
87526 108226 IADNA HEPATITIS G AMPLIFIED PROBE TECHNIQUE $611.50
87527 108227 IADNA HEPATITIS G QUANTIFICATION $678.50
87528 108228 IADNA HERPES SIMPLX VIRUS DIRECT PROBE TQ $2,514.00
87529 108229 IADNA HERPES SOMPLX VIRUS AMPLIFIED PROBE TQ $548.50
87530 108230 IADNA HERPES SOMPLX VIRUS QUANTIFICATION $678.50
87531 108231 IADNA HERPES VIRUS-6 DIRECT PROBE TQ $437.00
87532 108232 IADNA HERPES VIRUS-6 AMPLIFIED PROBE TQ $282.00
87533 108233 IADNA HERPES VIRUS-6 QUANTIFICATION $1,063.50
87534 108234 IADNA HIV-1 DIRECT PROBE TECHNIQUE $285.50
87535 108235 IADNA HIV-1 AMPLIFIED PROBE & REVERSE TRANSCRPJ $164.00
87536 108236 IADNA HIV-1 QUANT & REVERSE TRANSCRIPTION $1,177.00
87537 108237 IADNA HIV-2 DIRECT PROBE TECHNIQUE $306.50
87538 108238 IADNA HIV-2 AMPLIFIED PROBE & REVERSE TRANSCRIPJ $1,140.00
87539 108239 IADNA HIV-2 QUANT & REVERSE TRANSCRIPTION $1,412.00
87540 108240 IADNA LEGIONELLA PNEUMOPHILA DIRECT PROBE TQ $826.00
87541 108241 IADNA LEGIONELLA PNEUMOPHILA AMPLIFIED PROBE TQ $783.00
87542 108242 IADNA LEGIONELLA PNEUMOPHILA QUANTIFICATION $229.00
87550 108243 IADNA MYCOBACTERIA SPECIES DIRECT PROBE TQ $432.50
87551 108244 IADNA MYCOBACTERIA SPECIES AMPLIFIED PROBE TQ $3,195.00
87552 108245 IADNA MYCOBACTERIA SPECIES QUANTIFICATION $505.50
87555 108246 IADNA MYCOBACTERIA TUBERCULOSIS DIR PRB $548.00
87556 108247 IADNA MYCOBACTERIA TUBERCULOSIS AMP PRB $415.00
87557 108248 IADNA MYCOBACTERIA TUBERCULOSIS QUANTIFICATION $470.50
87560 108249 IADNA MYCOBACTERIA AVIUM-INTRACLRE DIR PRB $475.50
87561 108250 IADNA MYCOBACTERIA AVIUM-INTRACLRE AMP PRB $957.50
87562 108251 IADNA MYCOBACTERIA AVIUM-INTRACELLULARE QUANT $689.00
87563 108252 IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH $385.50
87580 108253 IADNA MYCOPLSM PNEUMONIAE DIRECT PROBE TQ $2,020.50
87581 108254 IADNA MYCOPLSM PNEUMONIAE AMPLIFIED PROBE TQ $402.00
87582 108255 IADNA MYCOPLSM PNEUMONIAE QUANTIFICATION $678.50
87590 108256 IADNA NEISSERIA GONORRHOEAE DIRECT PROBE TQ $335.50
87591 108257 IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ $325.00
87592 108258 IADNA NEISSERIA GONORRHOEAE QUANTIFICATION $1,135.50
87593 108259 IADNA ORTHOPOXVIRUS AMPLIFIED PROBE TECHNIQUE EA $382.00
87623 108260 IADNA HUMAN PAPILLOMAVIRUS LOW-RISK TYPES $349.00
87624 108261 IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES $334.00
87625 108262 IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY $328.00
87631 108263 IADNA RESPIRATRY PROBE & REV TRNSCR 3-5 TARGETS $614.00
87632 108264 IADNA RESPIRATRY PROBE & REV TRNSCR 6-11 TARGETS $1,891.00
87633 108265 IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET $1,841.50
87634 108266 IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE $993.00
87635 108267 IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ $208.50
87636 108268 IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ $603.00
87637 108269 IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ $493.00
87640 108270 IADNA S AUREUS AMPLIFIED PROBE TQ $543.50
87641 108271 IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ $344.50
87650 108272 IADNA STREPTOCOCCUS GROUP A DIRECT PROBE TQ $320.00
87651 108273 IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ $208.00
87652 108274 IADNA STREPTOCOCCUS GROUP A QUANTIFICATION $678.50
87653 108275 IADNA STREPTOCOCCUS GROUP B AMPLIFIED PROBE TQ $359.50
87660 108276 IADNA TRICHOMONAS VAGINALIS DIRECT PROBE TQ $256.50
87661 108277 IADNA TRICHOMONAS VAGINALIS AMPLIFIED PROBE TECH $166.50
87662 108278 IADNA DNA/RNA ZIKA VIRUS AMPLIFIED PROBE TQ $824.50
87797 108279 IADNA NOS DIRECT PROBE TQ EACH ORGANISM $612.00
87798 108280 IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM $496.00
87799 108281 IADNA NOS QUANTIFICATION EACH ORGANISM $545.00
87800 108282 IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ $575.00
87801 108283 IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ $894.50
87802 108284 IAADIADOO STREPTOCOCCUS GROUP B $293.00
87803 108285 IAADIADOO CLOSTRIDIUM DIFFICILE TOXIN A $403.50
87804 108286 IAADIADOO INFLUENZA $402.00
87806 108287 IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES $319.00
87807 108288 IAADIADOO RESPIRATORY SYNCTIAL VIRUS $116.00
87808 108289 IAADIADOO TRICHOMONAS VAGINALIS $106.00
87809 108290 IAADIADOO ADENOVIRUS $320.00
87810 108291 IAADIADOO CHLAMYDIA TRACHOMATIS $588.50
87811 108292 IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS $384.00
87850 108293 IAADIADOO NEISSERIA GONORRHOEAE $320.00
87880 108294 IAADIADOO STREPTOCOCCUS GROUP A $418.00
87899 108295 IAADIADOO NOT OTHERWISE SPECIFIED $525.50
87900 108296 NFCT AGT DRUG SUSCEPT PHENOTYPE PREDICTION $346.50
87901 108297 NFCT AGT GNOTYP ALYS NUCLE ACD HIV1 REV TRNSCRPT $731.00
87902 108298 NFCT AGENT GENOTYPE ALYS NUCLEIC ACD HEP C VIRUS $646.50
87903 108299 NFCT PHEXYP RESIST TISS CUL HIV FIRST 1-10 DRUGS $4,356.50
87904 108300 NFCT PHEXYP RESIST TISS CUL HIV EA ADDL DRUG $431.00
87905 108301 INFECTIOUS AGENT ENZYMATIC ACTV OTH/THN VIRUS $209.00
87906 108302 NFCT AGT GNOTYP ALYS NUCLE ACD HIV1 OTHER REGION $588.00
87910 108303 NFCT AGT GENOTYPE ALYS NUCLEIC ACID CMV $2,676.00
87912 108304 NFCT AGENT GENOTYPE ALYS NUCLEIC ACD HEP B VIRUS $3,174.50
87913 108305 NFCT AGENT GENOTYPE ALYS NUCLEIC ACID SARSCOV2 $0.00
87999 108306 UNLISTED MICROBIOLOGY PROCEDURE $0.00
88000 108307 NECROPSY GROSS EXAMINATION ONLY W/O CNS $0.00
88005 108308 NECROPSY GROSS EXAMINATION W/BRAIN $2,424.00
88007 108309 NECROPSY GROSS EXAMINATION W/BRAIN&SPINAL CORD $2,582.00
88012 108310 NECROPSY GROSS EXAMINATION INFANT W/BRAIN $0.00
88014 108311 NECROPSY GROSS EXAM STILLBORN/NEWBORN W/BRAIN $0.00
88016 108312 NECROPSY GROSS EXAM MACERATED STILLBORN $0.00
88020 108313 NECROPSY GROSS & MICROSCOPIC W/O CNS $0.00
88025 108314 NECROPSY GROSS & MICROSCOPIC W/BRAIN $2,734.00
88027 108315 NECROPSY GROSS&MCRSCP BRAIN & SPINAL CORD $2,881.00
88028 108316 NECROPSY GROSS & MICROSCOPIC INFANT W/BRAIN $0.00
88029 108317 NECROPSY GROSS&MCRSCP STILLBORN/NEWBORN BRAIN $0.00
88036 108318 NECROPSY LIMITED GROSS&/MCRSCP REGIONAL $2,359.00
88037 108319 NECROPSY LIMITD GROSS&/MCRSCP SINGLE ORGAN $2,083.00
88040 108320 NECROPSY FORENSIC EXAMINATION $0.00
88045 108321 NECROPSY CORONER CALL $0.00
88099 108322 UNLISTED NECROPSY (AUTOPSY) PROCEDURE $0.00
88104 108323 CYTP FLU WASHGS/BRUSHINGS XCPT C/V SMRS INTERPJ $580.00
88106 108324 CYTP FLU BR/WA XCPT C/V FILTER METH ONLY INTERPJ $517.50
88108 108325 CYTP CONCENTRATION SMEARS & INTERPRETATION $290.00
88112 108326 CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V $288.50
88120 108327 CYTP INSITU HYBRID URINE SPEC 3-5 PROBES EA MNL $913.00
88121 108328 CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA $2,995.00
88125 108329 CYTOPATHOLOGY FORENSIC $140.00
88130 108330 SEX CHROMATIN IDENTIFICATION BARR BODIES $367.00
88140 108331 SEX CHROMATIN IDENTJ PERIPHERAL BLOOD SMEAR $187.00
88141 108332 CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN $213.00
88142 108333 CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN $284.00
88143 108334 CYTP C/V FLU AUTO THIN MNL SCR&RESCR PHYS $449.50
88147 108335 CYTP SMRS C/V SCR AUTOMATED SYSTEM PHYS SUPV $133.50
88148 108336 CYTP SMRS C/V SCR AUTO SYS MNL RESCR PHYS $370.00
88150 108337 CYTP SLIDES C/V MNL SCR UNDER PHYS $235.00
88152 108338 CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS $297.50
88153 108339 CYTP SLIDES C/V MNL SCR&RESCR PHYS $297.50
88155 108340 CYTP SLIDES C/V DEFINITIVE HORMONAL EVAL $132.00
88160 108341 CYTP SMRS ANY OTH SRC SCR&INTERPJ $349.00
88161 108342 CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ $90.00
88162 108343 CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES $431.00
88164 108344 CYTP SLIDES CERV/VAG MNL SCRN PHYSICIAN SUPV $162.00
88165 108345 CYTP SLIDES C/V MNL SCR&RESCR PHYS SUPV $320.00
88166 108346 CYTP SLIDES C/V MNL SCR&CPTR RESCR PHYS SUPV $297.50
88167 108347 CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&I $297.50
88172 108348 CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD DX 1ST $294.00
88173 108349 CYTP EVAL FINE NEEDLE ASPIRATE INTERP & REPORT $403.00
88174 108350 CYTP C/V AUTO THIN LYR PREPJ SCR SYS PHYS $326.50
88175 108351 CYTP C/V AUTO THIN LYR PREPJ SCR MNL RESCR PHYS $331.00
88177 108352 CYTP FINE NDL ASPIRATE IMMT CYTOHIST STD EA EVAL $168.00
88182 108353 FLOW CYTOMETRY CELL CYCLE/DNA ANALYSIS $727.50
88184 108354 FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST $265.00
88185 108355 FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA $145.50
88187 108356 FLOW CYTOMETRY INTERPJ 2-8 MARKERS $583.00
88188 108357 FLOW CYTOMETRY INTERPJ 9-15 MARKERS $475.50
88189 108358 FLOW CYTOMETRY INTERPRETATION 16/> MARKERS $467.50
88199 108359 UNLISTED CYTOPATHOLOGY PROCEDURE $0.00
88230 108360 TISS CUL NON-NEO DISORDERS LYMPHOCYTE $1,457.00
88233 108361 TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX $1,594.00
88235 108362 TISS CUL NON-NEO DISORDERS AMNIOTIC/CHORNC CELLS $1,721.50
88237 108363 TISS CUL NEO DISORDERS BONE MARROW BLOOD CELLS $553.00
88239 108364 TISS CUL NEO DISORDERS SOLID TUMOR $1,560.00
88240 108365 CRYOPRSRV FRZING&STORAGE CELLS EA CELL LINE $67.50
88241 108366 THAWING&EXPANSION FROZEN CELLS EACH ALIQUOT $647.00
88245 108367 CHRMSM BREAKAGE BASELINE SISTER 20-25 CLL $1,456.00
88248 108368 CHRMSM BREAKAGE BASELINE BREAKAGE 50-100 CLL $3,427.50
88249 108369 CHRMSM BREAKAGE SYNDS SCORE 100 CLL $3,433.50
88261 108370 CHRMSM COUNT 5 CELL 1KARYOTYPE BANDING $3,121.00
88262 108371 CHRMSM COUNT 15-20 CLL 2KARYOTYP BANDING $1,126.00
88263 108372 CHRMSM COUNT 45 CELL MOSAICISM 2KARYOTYPE $1,464.50
88264 108373 CHRMSM ANALYZE 20-25 CELLS $3,932.00
88267 108374 CHRMSM ALYS AMNIOTIC/VILLUS 15 CELL 1KARYOTYPE $2,567.00
88269 108375 CHRMSM SITU AMNIOTIC CLL 6-12 COLONIES 1KARYOTYP $2,101.00
88271 108376 MOLECULAR CYTOGENETICS DNA PROBE EACH $229.00
88272 108377 MOLECULAR CYTOGENETICS CHRMOML ISH 3-5 CELLS $760.50
88273 108378 MOLECULAR CYTOGENETICS CHRMOML ISH 10-30 CLL $929.00
88274 108379 MOLECULAR CYTOGENETICS INTERPHASE ISH 25-99 CLL $268.00
88275 108380 MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL $426.00
88280 108381 CHRMSM ANALYSIS ADDL KARYOTYP EACH STUDY $243.00
88283 108382 CHRMSM ANALYSIS ADDL SPECIALIZED BANDING $1,480.00
88285 108383 CHRMSM ANALYSIS ADDL CELLS COUNTED EACH STUDY $202.00
88289 108384 CHRMSM ANALYSIS ADDL HIGH RESOLUTION STUDY $885.00
88291 108385 CYTOGENETICS&MOLEC CYTOGENETICS INTERP&REP $384.00
88299 108386 UNLISTED CYTOGENETIC STUDY $0.00
88300 108387 LEVEL I SURG PATHOLOGY GROSS EXAMINATION ONLY $159.50
88302 108388 LEVEL II SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $240.50
88304 108389 LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $319.50
88305 108390 LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $497.50
88307 108391 LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $714.50
88309 108392 LEVEL VI SURG PATHOLOGY GROSS&MICROSCOPIC EXAM $1,190.00
88311 108393 DECALCIFICATION PROCEDURE $417.00
88312 108394 SPECIAL STAIN GROUP 1 MICROORGANISMS I&R $255.00
88313 108395 SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT $256.50
88314 108396 SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSU $181.00
88319 108397 SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS $641.00
88321 108398 CONSLTJ&REPRT REFERRED SLIDES PREPARED ELSEWHERE $555.00
88323 108399 CONSLTJ&REPRT REFERRED MATRL REQUIRING PREPJ SLD $803.00
88325 108400 CONSLTJ COMPRE RVW RECORD REPRT REFERRED MATRL $1,154.00
88329 108401 PATHOLOGY CONSULTATION DURING SURGERY $494.50
88331 108402 PATH CONSLTJ SURG 1ST BLK FROZEN SCTJ 1ST SPEC $618.00
88332 108403 PATH CONSLTJ SURG EA ADDL BLK FROZEN SECTION $237.00
88333 108404 PATH CONSLTJ SURG CYTOLOGIC EXAM INITIAL SITE $534.00
88334 108405 PATH CONSLTJ SURG CYTOLOGIC EXAM EACH ADDL SITE $129.00
88341 108406 IMHCHEM/IMCYTCHM EA ADDL SINGLE ANTB STAIN PX $478.00
88342 108407 IMHCHEM/IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE $688.50
88344 108408 IMHCHEM/IMCYTCHM EA MULTIPLEX ANTIBODY STAIN PX $528.00
88346 108409 IMMUNOFLUORESCENCE PER SPEC 1ST SINGLE ANTB STN $375.00
88348 108410 ELECTRON MICROSCOPY DIAGNOSTIC $1,882.50
88350 108411 IMMUNOFLUORESCENCE PR SPEC EA ADD SINGL ANTB STN $305.00
88355 108412 MORPHOMETRIC ANALYSIS SKELETAL MUSCLE $1,694.00
88356 108413 MORPHOMETRIC ANALYSIS NERVE $1,665.00
88358 108414 MORPHOMETRIC ANALYSIS TUMOR $1,008.00
88360 108415 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL $414.50
88361 108416 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST $1,404.00
88362 108417 NERVE TEASING PREPARATIONS $1,365.00
88363 108418 EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSI $273.00
88364 108419 IN SITU HYBRIDIZATION EA ADDL PROBE STAIN $2,511.50
88365 108420 IN SITU HYBRIDIZATION 1ST PROBE STAIN $600.50
88366 108421 IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN $605.00
88367 108422 M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN $1,439.00
88368 108423 M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL $708.50
88369 108424 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH $1,044.50
88371 108425 PROTEIN ANAL TISSUE WESTERN BLOT W/INTERP&REPO $464.50
88372 108426 PROTEIN ALYS WSTRN BLOT I&R IMMUNOLOGICAL EA $470.50
88373 108427 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH $674.00
88374 108428 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB $1,114.00
88375 108429 OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT $275.00
88377 108430 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB $1,178.00
88380 108431 MICRODISSECTION PREP IDENTIFIED TARGET LASER $1,867.00
88381 108432 MICRODISSECTION PREP IDENTIFIED TARGET MANUAL $674.50
88387 108433 MACRO EXAM DISSECT&PREP TISS NONMICRO STD EA $55.00
88388 108434 MACR EXM DISS&PRP NONMICR IMPRNT/CONSLT/FRZ SE $244.50
88399 108435 UNLISTED SURGICAL PATHOLOGY PROCEDURE $0.00
88720 108436 BILIRUBIN TOTAL TRANSCUTANEOUS $53.50
88738 108437 HGB QUANTITATIVE TRANSCUTANEOUS $58.00
88740 108438 HEMOGLOBIN QUAN TC PER DAY CARBOXYHEMOGLOBIN $147.50
88741 108439 HEMOGLOBIN QUANTITATIVE TC PER DAY METHEMOGLOBIN $94.00
88749 108440 UNLISTED IN VIVO LABORTORY SERVICE $0.00
89049 108441 CAFFEINE HALOTHANE CONTRACTURE TEST $275.00
89050 108442 CELL COUNT MISCELLANEOUS BODY FLUIDS $249.00
89051 108443 CELL COUNT MISC BODY FLUIDS W/DIFFERENTIAL COUNT $278.00
89055 108444 LEUKOCYTE ASSMT FECAL QUAL/SEMIQUANTITATIVE $149.00
89060 108445 CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID $142.50
89125 108446 FAT STAIN FECES URINE/RESPIR SECRETIONS $188.00
89160 108447 MEAT FIBERS FECES $103.50
89190 108448 NASAL SMEAR EOSINOPHILS $148.50
89220 108449 SPUTUM OBTAINING SPEC AEROSOL INDUCED TX SPX $364.50
89230 108450 SWEAT COLLECTION IONTOPHORESIS $473.00
89240 108451 UNLISTED MISCELLANEOUS PATHOLOGY TEST $0.00
89250 108452 CUL OOCYTE/EMBRYO <4 DAYS $4,715.00
89251 108453 CUL OOCYTE/EMBRYO < 4 D CO-CULT OCYTE/EMBRY $1,337.00
89253 108454 ASSTD EMBRYO HATCHING MICROTQS ANY METH $1,594.00
89254 108455 OOCYTE ID FROM FOLLICULAR FLU $2,413.50
89255 108456 PREPJ EMBRYO TR $1,581.50
89257 108457 SPRM ID FROM ASPIR OTH/THN SEMINAL $396.00
89258 108458 CRYOPRSRV EMBRYO $2,954.00
89259 108459 CRYOPRSRV SPRM $1,003.50
89260 108460 SPRM ISOL SMPL PREP INSEMINATION/DX SEMEN ALYS $918.50
89261 108461 SPRM ISOL CPLX PREP INSEMINATION/DX SEMEN ALYS $1,216.00
89264 108462 SPRM ID FROM TSTIS TISS FRSH/CRYOPRSRVD $2,717.50
89268 108463 INSEMINATION OOCYTES $1,648.50
89272 108464 EXTND CUL OOCYTE/EMBRYO 4-7 DAYS $2,286.00
89280 108465 ASSTD FERTILIZATION MICROTQ <= 10 OOCYTES $6,183.00
89281 108466 ASSTD FERTILIZATION MICROTQ > 10 OOCYTES $5,941.50
89290 108467 BX OOCYTE POLR BDY/EMBRY BLST MICROTQ <= 5 EMBRY $3,676.50
89291 108468 BX OOCYTE MICROTQ >5 EMBRY $6,333.00
89300 108469 SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER $268.50
89310 108470 SEMEN ALYS MOTILITY&CNT X W/HUHNER TST $256.50
89320 108471 SEMEN ANALYSIS VOLUME COUNT MOTILITY DIFFERENT $437.00
89321 108472 SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM $284.00
89322 108473 SEMEN ANALYSIS STRICT MORPHOLOGIC CRITERIA $663.50
89325 108474 SPERM ANTIBODIES $593.50
89329 108475 SPERM EVALUATION HAMSTER PENETRATION TEST $851.50
89330 108476 SPERM EVALUATION CERVICAL MUCOUS PENETRATION $285.50
89331 108477 SPERM EVALUATION RETROGRADE EJACULATION URINE $429.50
89335 108478 CRYOPRSRV REPRODUCTIVE TISSUE TESTICULAR $700.00
89337 108479 CRYOPRESERVATION MATURE OOCYTE(S) $2,732.50
89342 108480 STORAGE PER YEAR EMBRYO $1,442.50
89343 108481 STORAGE PER YEAR SPERM/SEMEN $1,290.00
89344 108482 STORAGE PER YR REPRDTVE TISS TSTICULAR/OVARIAN $700.00
89346 108483 STORAGE PER YEAR OOCYTE $1,770.00
89352 108484 THAWING CRYOPRESERVED EMBRYO $1,825.00
89353 108485 THAWING CRYOPRESERVED SPERM/SEMEN EACH ALIQUOT $700.00
89354 108486 THAWING CRYOPRESERVED TESTICULAR/OVARIAN $700.00
89356 108487 THAWING CRYOPRESERVED OOCYTES EACH ALIQUOT $2,295.50
89398 108488 UNLISTED REPRODUCTIVE MEDICINE LAB PROCEDURE $0.00
90281 108489 IMMUNE GLOBULIN IG HUMAN IM USE $131.50
90283 108490 IMMUNE GLOBULIN IGIV HUMAN IV USE $835.00
90284 108491 IMMUNE GLOBULIN HUMAN SUBQ INFUSION 100 MG EA $0.00
90287 108492 BOTULINUM ANTITOXIN EQUINE ANY ROUTE $131.50
90288 108493 BOTULISM IMMUNE GLOBULIN HUMAN INTRAVENOUS USE $0.00
90291 108494 CYTOMEGALOVIRUS IMMUNE GLOBULIN HUMAN IV $131.50
90296 108495 DIPHTHERIA ANTITOXIN EQUINE ANY ROUTE $0.00
90371 108496 HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM $1,473.00
90375 108497 RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ $1,430.00
90376 108498 RABIES IG HEAT-TREATED HUMAN IM/SUBQ $2,755.00
90377 108499 RABIES IG HEAT&SOLVENT/DETERGENT HUMAN IM&/SUBQ $961.50
90378 108500 RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E $10,105.00
90380 108501 RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE $0.00
90381 108502 RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE $0.00
90384 108503 RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM $495.50
90385 108504 RHO(D) IMMUNE GLOBULIN HUMAN MINI-DOSE IM $440.50
90386 108505 RHO(D) IMMUNE GLOBULIN HUMAN IV $0.00
90389 108506 TETANUS IMMUNE GLOBULIN TIG HUMAN IM $694.00
90393 108507 VACCINIA IMMUNE GLOBULIN HUMAN IM $0.00
90396 108508 VARICELLA-ZOSTER IMMUNE GLOBULIN HUMAN IM $1,077.00
90399 108509 UNLISTED IMMUNE GLOBULIN $0.00
90460 108510 IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX $121.50
90461 108511 IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT $71.00
90471 108512 IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE $138.00
90472 108513 IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE $115.00
90473 108514 IM ADM INTRANSL/ORAL 1 VACCINE $75.50
90474 108515 IM ADM INTRANSL/ORAL EA VACCINE $15.00
90476 108516 ADENOVIRUS VACCINE TYPE 4 LIVE ORAL $131.50
90477 108517 ADENOVIRUS VACCINE TYPE 7 LIVE FOR ORAL $0.00
90480 108518 IMM ADMN SARSCOV2 VACCINE SINGLE DOSE $283.50
90581 108519 ANTHRAX VACCINE SUBCUTANEOUS/IM USE $787.00
90584 108520 DENGUE VACC QUAD LIVE 2 DOSE SCHEDULE SUBQ USE $0.00
90585 108521 BACILLUS CALMETTE-GUERIN VACC FOR TB LIVE PERQ $468.00
90586 108522 BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL $1,138.00
90587 108523 DENGUE VACC QUAD LIVE 3 DOSE SCHEDULE SUBQ USE $0.00
90589 108524 CHIKUNGUNYA VIRUS VACCINE LIVE FOR IM USE $0.00
90611 108525 SMALLPOX&MONKEYPOX VACC 0.5ML DOS FOR SUBQ USE $228.50
90619 108526 MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE $688.00
90620 108527 MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM $2,206.00
90621 108528 MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM $775.00
90622 108529 VACCINIA VIRUS VACC LIVE 0.3 ML DOS FOR PERQ USE $1.00
90623 108530 MENIGCCAL PNTVLNT MENACWY TT MENB FHBP VACC IM $0.00
90625 108531 CHOLERA VACCINE ADULT 1 DOSE LIVE FOR ORAL USE $1,071.50
90626 108532 TICK-BORNE ENCEPH VACC INACTIVATED 0.25ML IM USE $0.00
90627 108533 TICK-BORNE ENCEPH VACC INACTIVATED 0.5ML IM USE $0.00
90630 108534 INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID $69.00
90632 108535 HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE $497.50
90633 108536 HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE $460.00
90634 108537 HEPA VACCINE 3 DOSE SCHEDULE PED/ADOLESC IM USE $266.00
90636 108538 HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM $493.50
90637 108539 VACCINE QIRV MRNA 30 MCG/0.5 ML FOR IM USE $0.00
90638 108540 VACCINE QIRV MRNA 60 MCG/0.5 ML FOR IM USE $0.00
90644 108541 HIB-MENCY VACC 4 DOSE SCHED 6 WKS-18 MONTHS IM $340.50
90647 108542 HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE $184.00
90648 108543 HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE $241.00
90649 108544 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE $665.50
90650 108545 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE $862.50
90651 108546 9VHPV VACC 2/3 DOSE SCHED IM USE $1,683.00
90653 108547 IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE $227.50
90654 108548 INFLUENZA VACC IIV3 SPLIT VIRUS PRSRV FREE ID $161.00
90655 108549 IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE $58.50
90656 108550 IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE $101.00
90657 108551 IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE $49.00
90658 108552 IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE $106.00
90660 108553 LAIV3 VACCINE LIVE FOR INTRANASAL USE $306.00
90661 108554 CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE $138.50
90662 108555 IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM $403.00
90664 108556 LAIV VACCINE PANDEMIC FORMULA FOR INTRANASAL USE $209.00
90666 108557 INFLUENZA VACCINE PANDEMIC SPLT PRSRV FREE IM $208.00
90667 108558 IIV VACCINE PANDEMIC ADJUVANT FOR IM USE $57.00
90668 108559 IIV VACCINE PANDEMIC FOR INTRAMUSCULAR USE $0.00
90670 108560 PCV13 VACCINE FOR INTRAMUSCULAR USE $2,378.00
90671 108561 PCV15 VACCINE FOR INTRAMUSCULAR USE $0.00
90672 108562 LAIV4 VACCINE FOR INTRANASAL USE $79.50
90673 108563 RIV3 VACCINE PRESERVATIVE FREE FOR IM USE $100.00
90674 108564 CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE $213.00
90675 108565 RABIES VACCINE INTRAMUSCULAR $2,307.00
90676 108566 RABIES VACCINE INTRADERMAL $2,243.00
90677 108567 PCV20 VACCINE FOR INTRAMUSCULAR USE $1,640.00
90678 108568 RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE $0.00
90679 108569 RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE $1,579.50
90680 108570 RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE $533.00
90681 108571 RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE $722.00
90682 108572 RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM $398.00
90683 108573 RSV VACCINE MRNA LIPID NANOPARTICLES FOR IM USE $0.00
90685 108574 IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE $93.00
90686 108575 IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE $141.00
90687 108576 IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE $58.00
90688 108577 IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE $116.00
90689 108578 IIV4 VACC INACTIVATED PRSRV FR 0.25ML DOS IM USE $155.00
90690 108579 TYPHOID VACCINE LIVE ORAL $161.00
90691 108580 TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM $522.00
90694 108581 AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE $264.00
90696 108582 DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE $220.50
90697 108583 DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR $591.00
90698 108584 DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE $499.00
90700 108585 DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM $173.50
90702 108586 DT VACCINE YOUNGER THAN 7 YRS FOR IM USE $289.50
90707 108587 MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ $582.00
90710 108588 MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ $643.50
90713 108589 POLIOVIRUS VACCINE INACTIVATED SUBQ/IM $282.50
90714 108590 TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE $235.50
90715 108591 TDAP VACCINE 7 YRS/> IM $290.00
90716 108592 VAR VACCINE LIVE FOR SUBCUTANEOUS USE $836.00
90717 108593 YELLOW FEVER VACCINE LIVE SUBQ $739.00
90723 108594 DTAP-HEPB-IPV VACCINE INTRAMUSCULAR $765.50
90732 108595 PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE $762.50
90733 108596 MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE $770.00
90734 108597 MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE $944.00
90736 108598 ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE $689.50
90738 108599 JAPANESE ENCEPHALITIS VACCINE INACTIVATED IM $1,040.50
90739 108600 HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE $1,728.00
90740 108601 HEPB VACCINE DIALYSIS/IMMUNSUP PAT 3 DOSE IM $5,239.00
90743 108602 HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM $251.00
90744 108603 HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM $296.00
90746 108604 HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE $292.00
90747 108605 HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM $2,920.00
90748 108606 HIB-HEPB VACCINE FOR INTRAMUSCULAR USE $343.00
90749 108607 UNLISTED VACCINE/TOXOID $0.00
90750 108608 HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX $751.00
90756 108609 CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE $142.00
90758 108610 ZAIRE EBOLAVIRUS VACCINE LIVE FOR IM USE $0.00
90759 108611 HEP B VACC 3 AG 10 MCG 3 DOSE SCHED FOR IM USE $305.00
90785 108612 PSYCHOTHERAPY COMPLEX INTERACTIVE $49.00
90791 108613 PSYCHIATRIC DIAGNOSTIC EVALUATION $862.50
90792 108614 PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES $474.50
90832 108615 PSYCHOTHERAPY W/PATIENT 30 MINUTES $784.50
90833 108616 PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN $248.00
90834 108617 PSYCHOTHERAPY W/PATIENT 45 MINUTES $1,126.50
90837 108619 PSYCHOTHERAPY W/PATIENT 60 MINUTES $1,509.00
90839 108621 PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES $865.50
90840 108622 PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES $434.00
90845 108623 PSYCHOANALYSIS $942.50
90846 108624 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS $711.00
90847 108625 FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS $576.00
90849 108626 MULTIPLE FAMILY GROUP PSYCHOTHERAPY $591.50
90853 108627 GROUP PSYCHOTHERAPY $712.00
90863 108628 PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY $344.50
90865 108629 NARCOSYNTHESIS PSYC DX&THER PURPOSES $1,611.00
90867 108630 REPET TMS TX INITIAL W/MAP/MOTR THRESHLD/DEL&M $1,000.50
90868 108631 THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG $921.00
90869 108632 REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN $1,307.00
90870 108633 ELECTROCONVULSIVE THERAPY $2,240.00
90875 108634 INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 30 MIN $489.50
90876 108635 INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN $1,829.00
90880 108636 HYPNOTHERAPY $822.50
90882 108637 ENVIRONMENTAL IVNTJ MGMT PURPOSES PSYC PT $337.50
90885 108638 PSYCHIATRIC EVAL HOSPITAL RECORDS DX PURPOSES $816.50
90887 108639 INTERPJ/EXPLNAJ RESULTS PSYCHIATRIC EXAM FAMILY $422.00
90889 108640 PREP REPORT PT PSYCH STATUS AGENCY/PAYER $409.50
90899 108641 UNLISTED PSYCHIATRIC SERVICE/PROCEDURE $0.00
90901 108642 BIOFEEDBACK TRAINING ANY MODALITY $285.50
90912 108643 BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT $442.50
90913 108644 BFB TRAING W/EMG&/MANOMETRY EA ADDL 15 MIN CNTCT $235.50
90935 108645 HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION $8,919.00
90937 108646 HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX $4,411.00
90940 108647 HEMODIALYSIS ACCESS FLOW STUDY $1,819.50
90945 108648 DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL $5,738.50
90947 108649 DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS $1,530.50
90951 108650 ESRD RELATED SVC MONTHLY & <2 YR OLD 4/> VISITS $0.00
90952 108651 ESRD RELATED SVC MONTHLY <2 YR OLD 2/3 VISITS $0.00
90953 108652 ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT $0.00
90954 108653 ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS $0.00
90955 108654 ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS $0.00
90956 108655 ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT $0.00
90957 108656 ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS $0.00
90958 108657 ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS $0.00
90959 108658 ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT $0.00
90960 108659 ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS $3,238.50
90961 108660 ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS $1,102.50
90962 108661 ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT $14,423.00
90963 108662 ESRD SVC HOME DIALYSIS FULL MONTH <2YR OLD $2,014.50
90964 108663 ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD $2,207.50
90965 108664 ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD $2,207.50
90966 108665 ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD $1,924.00
90967 108666 ESRD RELATED SVC <FULL MONTH <2 YR OLD $2,666.50
90968 108667 ESRD RELATED SVC <FULL MONTH 2-11 YR OLD $5,504.00
90969 108668 ESRD RELATED SVC <FULL MONTH 12-19 YR OLD $7,346.50
90970 108669 ESRD RELATED SVC <FULL MONTH 20/>YR OLD $2,372.50
90989 108670 DIALYSIS TRAINING PATIENT COMPLETED COURSE $1,287.00
90993 108671 DIALYSIS TRAINING PATIENT PER TRAINING SESSION $8,490.00
90997 108672 HEMOPERFUSION $631.00
90999 108673 UNLISTED DIALYSIS PROCEDURE INPATIENT/OUTPATIENT $0.00
91010 108674 ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT $1,834.50
91013 108675 ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION $3,619.50
91020 108676 GASTRIC MOTILITY MANOMETRIC STUDIES $5,596.00
91022 108677 DUODENAL MOTILITY MANOMETRIC STUDY $4,635.00
91030 108678 ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS $1,918.00
91034 108679 GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT $3,238.50
91035 108680 GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD $2,755.00
91037 108681 GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD $1,513.50
91038 108682 ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG $1,814.00
91040 108683 ESOPHGL BALO DISTENSION DX STD W/PROVOCATION $2,554.50
91065 108684 BREATH HYDROGEN/METHANE TEST $888.50
91110 108685 GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R $5,403.00
91111 108686 GI TRACT IMAGING INTRALUMINAL ESOPHAGUS WI&R $4,961.50
91112 108687 GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP $4,290.50
91113 108688 GI TRACT IMAGING INTRALUMINAL COLON I&R $6,797.00
91117 108689 COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R $3,441.50
91120 108690 RECTAL SESATION TONE & COMPLIANCE TEST $2,246.50
91122 108691 ANORECTAL MANOMETRY $2,344.00
91132 108692 ELECTROGASTROGRAPHY DX TRANSCUTANEOUS $938.50
91133 108693 ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG $938.50
91200 108694 LIVER ELASTOGRAPHY W/O IMAG W/I&R $1,310.00
91299 108695 UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE $0.00
91300 108696 SARSCOV2 VACCINE DIL RECON 30 MCG/0.3 ML IM USE $172.00
91301 108697 SARSCOV2 VACCINE 100 MCG/0.5 ML IM USE $164.00
91302 108698 SARSCOV2 VACCINE CHADOX1 5X1010 VP/0.5ML IM USE $0.00
91303 108699 SARSCOV2 VACCINE AD26 5X1010VP/0.5ML IM USE $344.50
91304 108700 SARSCOV2 VACC SAPONIN-BSD ADJT 5MCG/0.5ML IM USE $0.00
91305 108701 SARSCOV2 VACCINE 30MCG/0.3ML TRIS-SUCROSE IM USE $102.00
91310 108706 SARSCOV2 VACC 5MCG/0.5ML ADJT AS03 EMULSN IM USE $0.00
91312 108708 SARSCOV2 VACCINE BIVALENT 30 MCG/0.3 ML IM USE $156.00
91318 108714 SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE $0.00
91321 108717 SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE $939.50
91322 108718 SARSCOV2 VACCINE 50 MCG/0.5 ML FOR IM USE $0.00
92002 108719 OPH SCVS MEDICAL XM&EVAL INTERMEDIATE NEW PT $500.50
92004 108720 OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST $504.50
92012 108721 OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT $501.00
92014 108722 OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST $500.00
92015 108723 DETERMINATION REFRACTIVE STATE $115.50
92018 108724 COMPL OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE $6,632.00
92019 108725 LMTD OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE $6,180.00
92020 108726 GONIOSCOPY SEPARATE PROCEDURE $248.00
92025 108727 COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI W/I&R $836.00
92060 108728 SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX $475.00
92065 108729 ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP $532.50
92066 108730 ORTHOPTIC TRAINING UNDER SUPERVISION OF PHYS/QHP $772.00
92071 108731 FIT CONTACT LENS TX OCULAR SURFACE DISEASE $257.00
92072 108732 FITTING CONTACT LENS FOR MGMT OF KERATOCONUS 1ST $423.00
92081 108733 LIMITED VISUAL FIELD XM UNI/BI I&R $300.50
92082 108734 INTERMEDIATE VISUAL FIELD XM UNI/BI I&R $404.00
92083 108735 EXTENDED VISUAL FIELD XM UNI/BI I&R $482.50
92100 108736 SERIAL TONOMETRY SPX W/MLT MEAS INTRAOCULAR PRS $311.00
92132 108737 CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI $346.50
92133 108738 COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE $355.00
92134 108739 COMPUTERIZED OPHTHALMIC IMAGING RETINA $346.00
92136 108740 OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL $543.00
92145 108741 CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI $391.50
92201 108742 OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI $326.00
92202 108743 OPSCPY EXTND OPTIC NRV/MACULA DRAWING I&R UNI/BI $170.00
92227 108744 IMG RETINA DETCJ/MNTR DS REM CLIN STAFF UNI/BI $147.00
92228 108745 IMG RETINA DETCJ/MNTR DS REM PHYS/QHP I&R UNI/BI $0.00
92229 108746 IMG RETINA DETCJ/MNTR DS POC AUTON A/R UNI/BI $0.00
92230 108747 FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT $1,109.50
92235 108748 FLUORESCEIN ANGRPH W/MULTIFRAME IMG I&R UNI/BI $1,312.50
92240 108749 INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R UNI/BI $1,880.50
92242 108750 FLUORESCEIN&ICG ANGRPH MULTIFRAME IMG I&R UNI/BI $2,427.50
92250 108751 FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT $468.00
92260 108752 OPHTHALMODYNAMOMETRY $366.00
92265 108753 NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE $366.00
92270 108754 ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT $749.50
92273 108755 FULL FIELD ELECTRORETINOGRAPHY W/I&R $1,601.50
92274 108756 MULTIFOCAL ELECTRORETINOGRAPHY W/I&R $862.50
92283 108757 COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV $407.00
92284 108758 DX DARK ADAPTATION EXAM INTERPRETATION & REPORT $800.50
92285 108759 XTRNL OCULAR PHOTOG W/I&R DOCMT MED PROGRESS $272.00
92286 108760 ANT SGM IMAGING I&R SPECLR MICROSCOPY&NDTHL ALYS $928.00
92287 108761 ANT SGM IMAGING W/I&R W/FLUOROSCEIN ANGRPH $538.00
92310 108762 RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK $187.00
92311 108763 RX&FITG CONTACT LENS CORNEAL LENS APHAKIA 1 EYE $1,137.00
92312 108764 RX&FITG CONTACT LENS CORNEAL LENS APHAKIA OU $366.00
92313 108765 RX&FITG CONTACT LENS CORNEOSCLERAL LENS $538.00
92314 108766 RX&FITG C-LENS TECH CRNL LENS OU XCPT APHAKIA $277.50
92315 108767 RX&FITG C-LENS TECH CRNL LENS APHAKIA 1 EYE $538.00
92316 108768 RX&FITG C-LENS TECH CRNL LENS APHAKIA BOTH EYES $538.00
92317 108769 RX&FITG CONTACT LENS TECH CORNEOSCLERAL LENS $366.00
92325 108770 MODIFICAJ CONTACT LENS SPX SUPVJ ADAPTATION $538.00
92326 108771 REPLACEMENT OF CONTACT LENS $366.00
92340 108772 FITTING SPECTACLES XCPT APHAKIA MONOFOCAL $183.50
92341 108773 FITTING SPECTACLES XCPT APHAKIA BIFOCAL $206.50
92342 108774 FITTING SPECTACLES XCPT APHAKIA MULTIFOCAL $290.50
92352 108775 FITTING SPECTACLE PROSTH APHAKIA MONOFOCAL $538.00
92353 108776 FITTING SPECTACLE PROSTH APHAKIA MULTIFOCAL $538.00
92354 108777 FITTING SPECTACLE MNTD LOW VISION AID 1ELMNT SYS $366.00
92355 108778 FITTING SPECTACLE MNTD LOW VISION AID CMPND LENS $366.00
92358 108779 PROSTHESIS SERVICE APHAKIA TEMPORARY $366.00
92370 108780 REPAIR&REFITTING SPECTACLES EXCEPT FOR APHAKIA $251.00
92371 108781 REPAIR&REFITTING SPECTACLE PROSTH FOR APHAKIA $538.00
92499 108782 UNLISTED OPHTHALMOLOGICAL SERVICE/PROCEDURE $0.00
92502 108783 OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA $4,657.50
92504 108784 BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE $57.00
92507 108785 TX SPEECH LANG VOICE COMMJ &/AUDITORY PROC IND $449.00
92508 108786 TX SPEECH LANGUAGE VOICE COMMJ AUDITRY 2/>INDIV $259.00
92511 108787 NASOPHARYNGOSCOPY W/ENDOSCOPE SPX $405.50
92512 108788 NASAL FUNCTION STUDIES $561.00
92516 108789 FACIAL NERVE FUNCTION STUDIES $1,461.50
92517 108790 CERVICAL VEMP TESTING W/I&R $1,330.50
92518 108791 OCULAR VEMP TESTING W/I&R $1,330.50
92519 108792 CERVICAL & OCULAR VEMP TESTING W/I&R $1,481.50
92520 108793 LARYNGEAL FUNCTION STUDIES $664.00
92521 108794 EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER) $975.00
92522 108795 EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE $560.00
92523 108796 EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION $1,003.50
92524 108797 BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE $269.00
92526 108798 TX SWALLOWING DYSFUNCTION&/ORAL FUNCJ FEEDING $350.00
92531 108799 SPONTANEOUS NYSTAGMUS W/GAZE $514.00
92532 108800 POSITIONAL NYSTAGMUS TEST $488.50
92533 108801 CALORIC VESTIBULAR TEST EACH IRRIGATION $455.50
92534 108802 OPTOKINETIC NYSTAGMUS TEST $943.00
92537 108803 CALORIC VESTIBULAR TEST W/REC BI BITHERMAL $1,172.50
92538 108804 CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL $1,172.50
92540 108805 VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK $1,449.00
92541 108806 SPONTANEOUS NYSTAGMUS TEST $615.00
92542 108807 POSITIONAL NYSTAGMUS TEST $560.00
92544 108808 OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC $752.50
92545 108809 OSCILLATING TRACKING TEST W/RECORDING $445.50
92546 108810 SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING $1,040.50
92547 108811 USE VERTICAL ELECTRODES $825.00
92548 108812 CDP-SOT 6 CONDITIONS W/INTERPRETATION & REPORT $1,057.50
92549 108813 CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT $1,258.50
92550 108814 TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS $264.00
92551 108815 SCREENING TEST PURE TONE AIR ONLY $92.00
92552 108816 PURE TONE AUDIOMETRY AIR ONLY $257.50
92553 108817 PURE TONE AUDIOMETRY AIR & BONE $421.00
92555 108818 SPEECH AUDIOMETRY THRESHOLD $209.00
92556 108819 SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ $236.00
92557 108820 COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ $553.00
92558 108821 EVOKED OTOACOUSTIC EMISSIONS SCREEN AUTO ANALYS $439.50
92562 108822 LOUDNESS BALANCE BINAURAL/MONAURAL $661.00
92563 108823 TONE DECAY TEST $232.50
92565 108824 STENGER TEST PURE TONE $268.50
92567 108825 TYMPANOMETRY $210.50
92568 108826 ACOUSTIC REFLEX THRESHOLD $257.00
92570 108827 ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY $496.50
92571 108828 FILTERED SPEECH TEST $278.50
92572 108829 STAGGERED SPONDAIC WORD $1,362.00
92575 108830 SENSORINEURAL ACUITY LEVEL $278.50
92576 108831 SYNTHETIC SENTENCE IDENTIFICATION TEST $278.50
92577 108832 STENGER TEST SPEECH $1,945.50
92579 108833 VISUAL REINFORCEMENT AUDIOMETRY $524.00
92582 108834 CONDITIONING PLAY AUDIOMETRY $668.00
92583 108835 SELECT PICTURE AUDIOMETRY $267.00
92584 108836 ELECTROCOCHLEOGRAPHY $1,211.50
92587 108837 DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD $538.00
92588 108838 DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL $753.50
92590 108839 HEARING AID EXAMINATION & SELECTION MONAURAL $300.50
92591 108840 HEARING AID EXAMINATION & SELECTION BINAURAL $493.50
92592 108841 HEARING AID CHECK MONAURAL $184.50
92593 108842 HEARING AID CHECK BINAURAL $238.50
92594 108843 ELECTROACOUS EVAL HEARING AID MONAURAL $156.00
92595 108844 ELECTROACOUS EVAL HEARING AID BINAURAL $231.50
92596 108845 EAR PROTECTOR ATTENUATION MEASUREMENTS $278.50
92597 108846 EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC $984.00
92601 108847 ANALYSIS COCHLEAR IMPLT PT <7 YR PRGRMG $1,442.00
92602 108848 ANALYSIS COCHLEAR IMPLT PT <7 YR SBSQ REPRGRMG $812.50
92603 108849 ANALYSIS COCHLEAR IMPLT 7 YR/> PRGRMG $1,103.50
92604 108850 ANALYSIS COCHLEAR IMPLT 7 YR/> SBSQ REPRGRMG $824.00
92605 108851 EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV F2F 1ST HR $684.00
92606 108852 THER SVC N-SP-GENRATJ DEV PRGRMG&MODIFICAJ $507.00
92607 108853 RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR $854.50
92608 108854 RX SP-GENRATJ AUGMNT&COMUNICAJ DEV EA 30 MIN $400.50
92609 108855 THER SP-GENRATJ DEV PRGRMG&MODIFICAJ $746.50
92610 108856 EVAL ORAL&PHARYNGEAL SWLNG FUNCJ $597.00
92611 108857 MOTION FLUOR EVAL SWLNG FUNCJ C/V REC $819.00
92612 108858 FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC $1,321.50
92613 108859 FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R $757.50
92614 108860 FLEXIBLE ENDOSCOPIC EVAL LARYN SENSORY C/V REC $491.00
92615 108861 FLEXIBLE ENDOSCOPIC EVAL LARYN SENS C/V REC I&R $259.00
92616 108862 FLEXIBLE NDSC EVAL SWLNG&LARYN SENS C/V REC $1,458.00
92617 108863 FLEXIBLE NDSC EVAL SWLNG&LARYN SENS C/V I&R $317.00
92618 108864 EVAL RX N-SP-GEN AUGMT ALT COMMUN DEV ADD 30 MIN $258.00
92620 108865 EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN $1,295.00
92621 108866 EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN $155.00
92622 108867 DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR 1ST 60 $0.00
92623 108868 DX ALY PRGRMG&VERIF AUD OI SOUND PROCESSR EA ADL $0.00
92625 108869 ASSESSMENT TINNITUS $664.00
92626 108870 EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR $622.00
92627 108871 EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15 $180.50
92630 108872 AUDITORY REHABILITATION PRELINGUAL HEARING LOSS $789.00
92633 108873 AUDITORY REHABILITATION POSTLINGUAL HEARING LOSS $679.00
92640 108874 ANALYSIS W/PRGRMG AUD BRAINSTEM IMPLANT PR HR $632.00
92650 108875 AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS $907.50
92651 108876 AEP HEARING STATUS DETER BROADBAND STIMULI I&R $1,330.50
92652 108877 AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R $5,298.00
92653 108878 AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT $1,821.00
92700 108879 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE/PX $0.00
92920 108880 PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH $20,267.00
92921 108881 PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH $20,703.00
92924 108882 PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH $41,759.00
92925 108883 PRQ TRLUML CORONARY ANGIO/ATHEREC ADDL ART/BRNCH $43,076.50
92928 108884 PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH $38,680.00
92929 108885 PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH $29,508.50
92933 108886 PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH $41,470.00
92934 108887 PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH $31,070.50
92937 108888 PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL $39,504.00
92938 108889 PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL $35,584.50
92941 108890 PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL $40,752.50
92943 108891 PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL $34,156.00
92944 108892 PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL $32,640.50
92950 108893 CARDIOPULMONARY RESUSCITATION $2,013.00
92953 108894 TEMPORARY TRANSCUTANEOUS PACING $1,819.50
92960 108895 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL $3,037.00
92961 108896 CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX $4,414.00
92970 108897 CARDIOASSIST-METH CIRCULATORY ASSIST INTERNAL $0.00
92971 108898 CARDIOASSIST-METH CIRCULATORY ASSIST EXTERNAL $4,876.50
92972 108899 PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY $0.00
92973 108900 PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY $14,055.50
92974 108901 TCAT PLACEMENT RADJ DLVR DEV SBSQ C IV BRACHYTX $15,612.50
92975 108902 THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH $0.00
92977 108903 THROMBOLYSIS CORONARY INTRAVENOUS INFUSION $1,606.50
92978 108904 ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL $9,276.00
92979 108905 ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL $6,353.50
92986 108906 PRQ BALLOON VALVULOPLASTY AORTIC VALVE $26,462.50
92987 108907 PRQ BALLOON VALVULOPLASTY MITRAL VALVE $28,972.00
92990 108908 PRQ BALLOON VALVULOPLASTY PULMONARY VALVE $38,796.50
92997 108909 PRQ TRLUML PULMONARY ART BALLOON ANGIOP 1 VSL $17,615.50
92998 108910 PRQ TRLUML PULMONARY ART BALLOON ANGIOP EA VSL $17,537.00
93000 108911 ECG ROUTINE ECG W/LEAST 12 LDS W/I&R $275.50
93005 108912 ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R $538.50
93010 108913 ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY $97.50
93015 108914 CV STRS TST XERS&/OR RX CONT ECG W/SI&R $2,053.50
93016 108915 CV STRS TST XERS&/OR RX CONT ECG W/O I&R $248.00
93017 108916 CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY $3,527.00
93018 108917 CV STRS TST XERS&/OR RX CONT ECG I&R ONLY $244.50
93024 108918 ERGONOVINE PROVOCATION TST $1,333.00
93025 108919 MICROVOLT T-WAVE ASSESS VENTRICULAR ARRHYTHMIAS $1,710.50
93040 108920 RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT $1,039.00
93041 108921 RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R $436.00
93042 108922 RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON $103.00
93050 108923 ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE $337.50
93150 108924 THER ACTIVATION IMPL PHRENIC NRV STIMULATOR SYS $0.00
93151 108925 INTERROG&PRGRMG IMPL PHRENIC NRV STIMULATOR SYS $0.00
93152 108926 INTERROG&PRGRMG IPNSS DURING POLYSOMNOGRAPHY $0.00
93153 108927 INTERROGATION WITHOUT PROGRAMMING IPNSS $0.00
93224 108928 XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I $1,544.00
93225 108929 XTRNL ECG & 48 HR RECORDING $1,560.00
93226 108930 EXTERNAL ECG SCANNING ANALYSIS REPORT $1,761.50
93227 108931 XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS $286.50
93228 108932 XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS $890.00
93229 108933 XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT $2,161.50
93241 108934 EXTERNAL ECG REC>48HR<7D SCAN ALYS REPORT R&I $1,870.00
93242 108935 EXTERNAL ECG REC>48HR<7D RECORDING $555.50
93243 108936 EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT $608.00
93244 108937 EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION $411.00
93245 108938 EXTERNAL ECG REC>7D<15D SCAN ALYS REPORT R&I $2,667.50
93246 108939 EXTERNAL ECG REC>7D<15D RECORDING $589.50
93247 108940 EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT $1,094.50
93248 108941 EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION $397.00
93260 108942 PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM $274.00
93261 108943 INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB $274.00
93264 108944 REMOTE MNTR WIRELESS P-ART PRS SNR UP TO 30 D $385.50
93268 108945 XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS $1,431.50
93270 108946 XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS $1,661.00
93271 108947 XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS $1,414.50
93272 108948 XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS $273.00
93278 108949 SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG $1,018.50
93279 108950 PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP $328.00
93280 108951 PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER $361.00
93281 108952 PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER $394.50
93282 108953 PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB $476.00
93283 108954 PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB $468.00
93284 108955 PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB $261.00
93285 108956 PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON $199.50
93286 108957 PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON $454.50
93287 108958 PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB $636.00
93288 108959 INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON $147.00
93289 108960 INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB $225.00
93290 108961 INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON $102.00
93291 108962 INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON $284.50
93292 108963 INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR $378.50
93293 108964 TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL $360.00
93294 108965 REM INTERROG PM/LDLS PM <90 D PHYS/QHP $232.50
93295 108966 INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB $304.00
93296 108967 REM INTERROG PM/LDLS PM/IDS <90 D TECH REVIEW $287.00
93297 108968 REM INTERROG ICPMS <30 D PHYS/QHP $216.00
93298 108969 REM INTERROG SCRMS <30 D PHYS/QHP $382.00
93303 108970 COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY $3,850.00
93304 108971 F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY $3,455.00
93306 108972 ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D $5,260.50
93307 108973 ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP $4,343.00
93308 108974 ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD $1,662.50
93312 108975 ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R $4,710.00
93313 108976 ECHO R-T 2D W/PROBE PLACEMENT ONLY $5,058.50
93314 108977 ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY $4,784.00
93315 108978 ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R $4,193.00
93316 108979 ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY $3,337.50
93317 108980 ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT $4,248.00
93318 108981 ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ $5,664.00
93319 108982 3D ECHO IMG&PST-PXESSING TEE/TTE CGEN CAR ANOMAL $1,685.00
93320 108983 DOPPLER ECHOCARD PULSE WAVE W/SPECTRAL DISPLAY $1,642.50
93321 108984 DOP ECHOCARD PULSE WAVE W/SPECTRAL F-UP/LMTD STD $395.00
93325 108985 DOP ECHOCARD COLOR FLOW VELOCITY MAPPING $1,344.00
93350 108986 ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST $3,704.50
93351 108987 ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG $7,559.00
93352 108988 USE OF ECHO CONTRAST AGENT DURING STRESS ECHO $695.50
93355 108989 ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN $12,103.00
93356 108990 MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH $1,020.00
93451 108991 RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT $13,623.00
93452 108992 L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I $24,876.50
93453 108993 R & L HRT CATH W/NJX L VENTRICULOG IMG S&I $27,851.00
93454 108994 CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I $17,129.00
93455 108995 CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I $21,367.50
93456 108996 CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I $39,610.00
93457 108997 CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I $33,099.50
93458 108998 CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I $26,817.50
93459 108999 CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I $29,300.50
93460 109000 R & L HRT CATH WINJX HRT ART& L VENTR IMG $32,935.00
93461 109001 R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I $33,204.50
93462 109002 LEFT HEART CATH BY TRANSEPTAL PUNCTURE $13,538.00
93463 109003 MEDICATION ADMIN & HEMODYNAMIC MEASURMENT $2,638.00
93464 109004 PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU $3,634.00
93503 109005 INSERTION FLOW DIRECTED CATHETER FOR MONITORING $9,056.00
93505 109006 ENDOMYOCARDIAL BIOPSY $8,072.00
93563 109007 NJX DRG CGEN C-CATHJ SLCTV CORONARY ANGRPH S&I $4,714.50
93564 109008 NJX DRG CGEN C-CATHJ SLCTV OPACIFICATION S&I $449.00
93565 109009 NJX DRG C-CATHJ SLCTV L VNTRC/R ATRIAL ANGRPHS&I $5,605.00
93566 109010 NJX DRG C-CATHJ SLCTV R VNTRC/R ATRIAL ANGRPHS&I $5,840.00
93567 109011 NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY S&I $5,562.50
93568 109012 NJX DRG C-CATHJ NSLCTV P-ART ANGIOGRAPHY $5,572.00
93569 109013 NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY UNI $10,719.00
93571 109014 IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL $6,155.50
93572 109015 IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL $5,198.00
93573 109016 NJX DRG C-CATHJ SLCTV P-ART ANGIOGRAPHY BI $19,402.00
93574 109017 NJX DRG C-CATHJ SLCTV PULM VEN ANGIOGRAPHY $6,866.00
93575 109018 NJX DRG C-CATHJ SLCTV PULM ANGRPH MAPCA CHD EA $0.00
93580 109019 PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT $38,374.50
93581 109020 PRQ TCAT CLSR CGEN VENTR SEPTAL DFCT W/IMPLT $57,060.50
93582 109021 PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS $69,268.00
93583 109022 PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER $0.00
93584 109023 VENOGRAPHY CHD ANOMALOUS/PERSISTENT SVC NT DRG $0.00
93585 109024 VENOGRAPHY CHD AZYGOS/HEMIAZYGOS VENOUS SYSTEM $0.00
93586 109025 VENOGRAPHY CHD CORONARY SINUS $0.00
93587 109026 VENOGRAPHY CHD VENOVENOUS COLTRL AT/ABOVE HRT $0.00
93588 109027 VENOGRAPHY CHD VENOVENOUS COLLATERAL BELOW HEART $0.00
93590 109028 PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE $65,070.50
93591 109029 PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE $65,070.50
93592 109030 PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV $5,402.00
93593 109031 R HRT CATH CHD W/IMG CATH TRGT ZONE NML NT CONNJ $24,220.50
93594 109032 R HRT CATH CHD W/IMG CATH TRGT ZON ABNL NT CONNJ $24,220.50
93595 109033 L HRT CATH CHD IMG CATH TRGT ZON NML/ABNL NT CNJ $24,220.50
93596 109034 R&L HRT CATH CHD IMG CATH TRGT ZONE NML NT CONNJ $24,220.50
93597 109035 R&L HRT CATH CHD IMG CATH TRGT ZON ABNL NT CONNJ $14,110.00
93598 109036 CAR OUTP MEAS DRG CAR CATH EVAL CGEN HRT DEFECT $4,608.50
93600 109037 BUNDLE OF HIS RECORDING $16,278.00
93602 109038 INTRA-ATRIAL RECORDING $16,664.50
93603 109039 RIGHT VENTRICULAR RECORDING $9,004.00
93609 109040 INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA $13,035.00
93610 109041 INTRA-ATRIAL PACING $11,457.50
93612 109042 INTRAVENTRICULAR PACING $15,656.00
93613 109043 INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING $14,014.00
93615 109044 ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS $13,062.50
93616 109045 ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG $8,662.00
93618 109046 INDUCTION ARRHYTHMIA ELECTRICAL PACING $12,246.00
93619 109047 COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION $21,731.00
93620 109048 COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION $27,215.50
93621 109049 COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC $14,697.50
93622 109050 COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC $7,538.00
93623 109051 PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS $4,929.00
93624 109052 ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT $19,848.50
93631 109053 INTRAOP EPICAR& ENDOCAR PACG& MAPG $13,370.00
93640 109054 EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE $5,868.50
93641 109055 EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN $6,483.00
93642 109056 EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS $7,521.50
93644 109057 EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR $6,459.00
93650 109058 ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION $22,868.00
93653 109059 COMPRE EP EVAL ABLTJ 3D MAPG TX SVT $88,653.00
93654 109060 COMPRE EP EVAL ABLTJ 3D MAPG TX VT $82,591.50
93655 109061 ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA $22,994.00
93656 109062 COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION $73,825.50
93657 109063 ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN $37,877.00
93660 109064 CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR $4,016.00
93662 109065 INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I $8,767.00
93668 109066 PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION $180.00
93701 109067 BIOMPEDANCE-DERIVED PHYSIOLOGIC CV ANALYSIS $436.00
93702 109068 BIS EXTRACELLULAR FLUID ALYS LYMPHEDEMA ASSMNT $179.00
93724 109069 ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM $1,660.00
93740 109070 TEMPRATURE GRADIENT STUDY $463.50
93745 109071 1ST SET-UP & PRGRMG PHYS/QHP OF WEARABLE CVDFB $266.00
93750 109072 INTERROGATION VAD IN PRSON W/PHYS/QHP ANALYSIS $698.00
93770 109073 DERMINATION OF VENOUS PRESSUE $425.50
93784 109074 AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R $392.50
93786 109075 AMBULATORY BP MNTR W/SW 24 HR+ RECORDING ONLY $890.00
93788 109076 AMBULATORY BP MNTR W/SW 24 HR+ SCANNING A/R $690.50
93790 109077 AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R $485.50
93792 109078 PT/CAREGIVER TRAING FOR INITIATION HOME INR MNTR $0.00
93793 109079 ANTICOAGULANT MGMT FOR PT TAKING WARFARIN $101.00
93797 109080 OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR $422.00
93798 109081 OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING $496.00
93799 109082 UNLISTED CARDIOVASCULAR SERVICE/PROCEDURE $0.00
93880 109083 DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY $3,137.50
93882 109084 DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY $1,672.50
93886 109085 TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL $1,725.50
93888 109086 TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD $1,101.50
93890 109087 TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY $1,624.50
93892 109088 TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT $1,741.50
93893 109089 TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ $1,307.00
93895 109090 CAROTID INTIMA MEDIA & CAROTID ATHEROMA EVAL BI $393.50
93922 109091 NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL $1,250.00
93923 109092 NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS $1,685.00
93924 109093 N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI $1,645.00
93925 109094 DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY $3,403.00
93926 109095 DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY $1,908.00
93930 109096 DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY $2,601.50
93931 109097 DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY $1,946.50
93970 109098 DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY $3,088.50
93971 109099 DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY $1,843.50
93975 109100 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM $1,730.00
93976 109101 DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT $1,150.00
93978 109102 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE $1,643.00
93979 109103 DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD $1,437.50
93980 109104 DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL $1,948.00
93981 109105 DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD $1,881.50
93985 109106 DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD $2,810.00
93986 109107 DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD $1,285.00
93990 109108 DUPLEX SCAN HEMODIALYSIS ACCESS $955.50
93998 109109 UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY $0.00
94002 109110 VENTILATION ASSIST & MGMT INPATIENT 1ST DAY $5,063.00
94003 109111 VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA $3,688.00
94004 109112 VENTILATION ASSIST & MGMT NURSING FAC PR DAY $277.00
94005 109113 HOME VENTILATOR MGMT CARE OVERSIGHT 30 MIN/> $707.50
94010 109114 SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ $677.50
94011 109115 MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT&/2 Y $343.00
94012 109116 MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF/2YRS $343.00
94013 109117 MEASUREMENT LUNG VOLUMES INFANT/CHILD/2 YRS $1,199.00
94014 109118 PT-INITIATE SPIROMETRIC RECORDING PHYS/QHP R&I $673.00
94015 109119 PATIENT-INITIATED SPIROMETRIC RECORDING $837.50
94016 109120 PATIENT-INITIATED SPIROMETRIC PHYS/QHP R&I ONLY $255.00
94060 109121 BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN $935.00
94070 109122 BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT $1,578.00
94150 109123 VITAL CAPACITY TOTAL SEPARATE PROCEDURE $1,096.00
94200 109124 MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ $366.00
94375 109125 RESPIRATORY FLOW VOLUME LOOP $757.00
94450 109126 BREATHING RESPONSE TO HYPOXIA $1,024.50
94452 109127 HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT $834.00
94453 109128 HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION $1,023.50
94610 109129 INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP $529.00
94617 109130 XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG $771.00
94618 109131 PULMONARY STRESS TESTING $631.00
94619 109132 XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG $681.50
94621 109133 CARDIOPULMONARY EXERCISE TESTING $2,337.00
94625 109134 PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR $419.00
94626 109135 PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR $120.00
94640 109136 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT $282.00
94642 109137 PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH $1,223.00
94644 109138 CONTINUOUS INHALATION TREATMENT 1ST HR $468.00
94645 109139 CONTINUOUS INHALATION TREATMENT EA ADDL HR $468.00
94660 109140 CPAP VENTILATION CPAP INITIATION&MGMT $2,838.50
94662 109141 CONTINUOUS NEGATIVE PRESSURE VENTJ INITIAT&MGM $2,081.00
94664 109142 DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP $278.00
94667 109143 MANJ CH WALL FACILITATE LNG FUNCJ 1 DEMO&/EVAL $327.00
94668 109144 MANJ CHEST WALL FACILITATE LUNG FUNCTION SUBSQ $207.00
94669 109145 MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION $631.00
94680 109146 O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP $546.00
94681 109147 O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC $1,600.50
94690 109148 O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX $344.50
94726 109149 PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST $1,257.00
94727 109150 GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V $694.00
94728 109151 AIRWAY RESISTANCE BY OSCILLOMETRY $630.00
94729 109152 CO DIFFUSING CAPACITY $579.00
94760 109153 NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER $281.00
94761 109154 NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER $740.00
94762 109155 NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR $667.00
94772 109156 CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT $2,923.00
94774 109157 PEDIATRIC APNEA MONITOR ATTACHMENT PHYS I&R $0.00
94775 109158 PEDIATRIC APNEA MONITOR ATTACHMENT $487.50
94776 109159 PEDIATRIC APNEA MONITOR ANALYSES COMPUTER $1,101.50
94777 109160 PEDIATRIC APNEA MONITOR PHYS/QHP REVIEW $0.00
94780 109161 CAR SEAT/BED TEST INFT THRU 12 MO 60 MIN $374.00
94781 109162 CAR SEAT/BED TEST INFT THRU 12 MO EA ADDL 30 MIN $374.00
94799 109163 UNLISTED PULMONARY SERVICE/PROCEDURE $0.00
95004 109164 PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS $80.00
95012 109165 NITRIC OXIDE EXPIRED GAS DETERMINATION $274.00
95017 109166 ALLG TSTG PERQ & IC VENOMS IMMED REACT W/I&R $192.50
95018 109167 ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/I&R $122.50
95024 109168 INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS $510.00
95027 109169 INTRACUTANEOUS TESTS W/ALLERGENIC XTRCS AIRBORNE $144.50
95028 109170 IC TSTS W/ALLGIC XTRCS DLYD TYP RXN W/READING $175.50
95044 109171 PATCH/APPLICATION TEST SPECIFY NUMBER TESTS $102.00
95052 109172 PHOTO PATCH TEST SPECIFY NUMBER TSTS $199.50
95056 109173 PHOTO TESTS $391.50
95060 109174 OPHTHALMIC MUCOUS MEMBRANE TESTS $337.50
95065 109175 DIRECT NASAL MUCOUS MEMBRANE TEST $199.50
95070 109176 INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL $1,290.00
95076 109177 INGESTION CHALLENGE TEST INITIAL 120 MINUTES $1,113.50
95079 109178 INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES $1,020.00
95115 109179 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX $351.00
95117 109180 PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS $363.00
95120 109181 PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX $434.50
95125 109182 PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 2/> NJX $446.50
95130 109183 PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT $82.50
95144 109188 PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO $302.00
95145 109189 PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT $162.00
95165 109194 PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN $351.00
95170 109195 PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE $302.00
95180 109196 RAPID DESENSITIZATION PROCEDURE EACH HOUR $1,071.50
95199 109197 UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SVC/PX $0.00
95249 109198 CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT $434.50
95250 109199 CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT $910.50
95251 109200 CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R $174.50
95700 109201 EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS $1,266.00
95705 109202 EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED $2,759.00
95706 109203 EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR $2,460.50
95707 109204 EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS R-T MNTR $2,976.00
95708 109205 EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED $7,214.50
95709 109206 EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR $5,626.00
95710 109207 EEG W/O VID TECH EA INCR 12-26 HR CONT R-T MNTR $4,738.00
95711 109208 VEEG BY TECH 2-12 HOURS UNMONITORED $2,804.00
95712 109209 VEEG BY TECH 2-12 HR INTERMITTENT MONITORING $3,608.00
95713 109210 VEEG BY TECH 2-12 HR CONTINUOUS R-T MONITORING $4,736.00
95714 109211 VEEG BY TECH EA INCR 12-26 HR UNMONITORED $5,571.00
95715 109212 VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR $7,282.00
95716 109213 VEEG BY TECH EA INCR 12-26 HR CONT R-T MNTR $3,606.00
95717 109214 EEG PHYS/QHP 2-12 HR WITHOUT VIDEO $0.00
95718 109215 EEG PHYS/QHP 2-12 HR WITH VEEG $0.00
95719 109216 EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID $0.00
95720 109217 EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG $1,198.00
95721 109218 EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO $0.00
95722 109219 EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG $0.00
95723 109220 EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO $0.00
95724 109221 EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG $0.00
95725 109222 EEG COMPLETE STD PHYS/QHP>84 HR W/O VID $0.00
95726 109223 EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG $0.00
95782 109224 POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND $9,489.00
95783 109225 POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM $13,016.50
95800 109226 SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME $1,454.50
95801 109227 SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL $826.50
95803 109228 ACTIGRAPHY TESTING RECORDING ANALYSIS I&R $677.00
95805 109229 MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG $4,812.00
95806 109230 SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT $1,317.00
95807 109231 SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN $5,025.00
95808 109232 POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND $7,052.00
95810 109233 POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND $3,289.50
95811 109234 POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND $5,998.00
95812 109235 ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN $2,743.50
95813 109236 EEG EXTENDED MONITORING 61-119 MINUTES $3,208.00
95816 109237 ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY $1,688.50
95819 109238 ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP $1,708.50
95822 109239 ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY $2,586.00
95824 109240 ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY $2,028.00
95829 109241 ELECTROCORTICOGRAM SURGERY SPX $5,048.00
95830 109242 INSERTION SPHENOIDAL ELECTRODES EEG PHYS/QHP $648.50
95836 109243 ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS $298.50
95851 109244 ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPI $133.50
95852 109245 ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID $106.00
95857 109246 CHOLINESTERASE INHIBITOR CHALLENGE TEST $665.50
95860 109247 NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS $924.50
95861 109248 NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS $1,326.50
95865 109251 NEEDLE ELECTROMYOGRAPHY LARYNX $759.50
95866 109252 NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM $575.00
95867 109253 NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI $836.00
95868 109254 NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI $945.50
95869 109255 NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12 $748.00
95870 109256 NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI $2,022.00
95872 109257 NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER $943.00
95873 109258 ELECTRICAL STIMULATION GUID W/CHEMODENERVATION $210.00
95874 109259 NEEDLE EMG GUID W/CHEMODENERVATION $244.00
95875 109260 ISCHEMIC LIMB XERS TST SPEC ACQUISJ METAB $942.00
95885 109261 NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED $763.50
95886 109262 NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE $684.00
95887 109263 NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION $535.50
95905 109264 MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB $931.50
95907 109265 NERVE CONDUCTION STUDIES 1-2 STUDIES $713.50
95909 109267 NERVE CONDUCTION STUDIES 5-6 STUDIES $1,093.50
95913 109271 NERVE CONDUCTION STUDIES 13/> STUDIES $3,353.00
95919 109272 QUANTITATIVE PUPILLOMETRY PHYS/QHP I&R UNI/BI $1,298.00
95921 109273 TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP $803.50
95922 109274 TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ $486.00
95923 109275 TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION $968.50
95924 109276 TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT $1,013.00
95925 109277 SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS $2,302.50
95926 109278 SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS $2,186.50
95927 109279 SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD $2,193.50
95928 109280 CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS $6,316.50
95929 109281 CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS $2,601.00
95930 109282 VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R $1,799.00
95933 109283 ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST $597.50
95937 109284 NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH $2,219.00
95938 109285 SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB $2,219.00
95939 109286 CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI $4,948.50
95940 109287 IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES $433.00
95941 109288 IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR $1,993.50
95954 109289 RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE $3,034.50
95955 109290 EEG NONINTRACRANIAL SURGERY $2,774.00
95957 109291 DIGITAL ANALYSIS ELECTROENCEPHALOGRAM $1,317.00
95958 109292 WADA ACTIVATION TEST HEMISPHERIC FUNCTION W/EEG $3,603.50
95961 109293 FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR $6,156.00
95962 109294 FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR $2,041.00
95965 109295 MAGNETOENCEPHALOGRAPHY SPON BRAIN ACTIVITY $27,133.00
95966 109296 MAGNETOENCEPHALOGRAPY EVOKED FIELDS 1 MODALITY $10,487.00
95967 109297 MAGNETOENCEPHALOGRAPY EVOKED FIELDS EACH ADDL $9,444.00
95970 109298 ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING $788.00
95971 109299 ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG $1,824.00
95972 109300 ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG $1,085.00
95976 109301 ELEC ALYS IMPLT SMPL CN NPGT PRGRMG $739.00
95977 109302 ELEC ALYS IMPLT CPLX CN NPGT PRGRMG $991.00
95980 109303 ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG $10,278.00
95981 109304 ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG $484.00
95982 109305 ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG $564.50
95983 109306 ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN $564.50
95984 109307 ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN $328.00
95990 109308 REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN $1,207.00
95991 109309 RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP $1,155.50
95992 109310 CANALITH REPOSITIONING PROCEDURE $188.00
95999 109311 UNLISTED NEUROLOGICAL/NEUROMUSCULAR DX PX $0.00
96000 109312 COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS $2,048.50
96001 109313 COMPRE CPTR MTN ALYS W/DYN PLNTR PRES MEAS WALKG $7,813.50
96002 109314 DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC $2,325.50
96003 109315 DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC $1,027.00
96004 109316 PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR $497.50
96020 109317 TEST SELECT & ADMN FUNCTL BRAIN MAP PHYS/QHP $989.00
96040 109318 MEDICAL GENETICS COUNSELING EACH 30 MINUTES $202.00
96105 109319 ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR $533.00
96110 109320 DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM $314.00
96112 109321 DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR $1,041.00
96113 109322 DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN $337.00
96116 109323 NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR $754.00
96121 109324 NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR $617.00
96125 109325 STANDARDIZED COGNITIVE PERFORMANCE TESTING $588.00
96127 109326 BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT $92.00
96130 109327 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR $610.50
96131 109328 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR $768.50
96132 109329 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR $628.50
96133 109330 NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR $575.00
96136 109331 PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN $363.00
96137 109332 PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN $348.50
96138 109333 PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN $446.00
96139 109334 PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN $314.00
96146 109335 PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT $185.00
96156 109336 HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT $574.00
96158 109337 HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN $383.00
96159 109338 HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN $190.50
96160 109339 PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM $71.50
96161 109340 CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM $190.00
96164 109341 HEALTH BEHAVIOR IVNTJ GROUP F2F 1ST 30 MIN $242.50
96165 109342 HEALTH BEHAVIOR IVNTJ GROUP F2F EA ADDL 15 MIN $162.00
96167 109343 HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN $485.00
96168 109344 HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN $243.00
96170 109345 HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN $461.00
96171 109346 HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15 $231.00
96202 109347 MLT FAM GROUP BHV MGMT/MODIFICAJ TRAING 1ST 60 $401.00
96203 109348 MLT FAM GROUP BHV MGMT/MODIFICAJ TRAING EA ADDL $0.00
96360 109349 IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR $845.00
96361 109350 IV INFUSION HYDRATION EACH ADDITIONAL HOUR $325.50
96365 109351 IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR $909.50
96366 109352 IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR $409.00
96367 109353 IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR $473.50
96368 109354 IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS $519.00
96369 109355 SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP $935.00
96370 109356 SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR $338.50
96371 109357 SUBQ INFUSION ADDITIONAL PUMP INFUSION SITE $633.00
96372 109358 THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM $328.00
96373 109359 THERAPEUTIC PROPHYLACTIC/DX NJX INTRA-ARTERIAL $392.00
96374 109360 THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG $532.50
96375 109361 THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG $407.50
96376 109362 THER PROPH/DX NJX EA SEQL IV PUSH SBST/DRUG FAC $402.00
96377 109363 APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION $248.00
96379 109364 UNLISTED THERAPEUTIC PROPH/DX IV/IA NJX/NFS $0.00
96380 109365 ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP $0.00
96381 109366 ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX $0.00
96401 109367 CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO $634.00
96402 109368 CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO $457.00
96405 109369 CHEMOTHERAPY ADMINISTRATION INTRALESIONAL </7 $486.50
96406 109370 CHEMOTHERAPY ADMINISTRATION INTRALESIONAL >7 $994.50
96409 109371 CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG $795.00
96411 109372 CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG $663.00
96413 109373 CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG $884.00
96415 109374 CHEMOTHERAPY ADMN IV INFUSION TQ EA HR $548.00
96416 109375 CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP $1,024.50
96417 109376 CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR $530.00
96420 109377 CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ $1,054.00
96422 109378 CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS <1 HR $1,956.00
96423 109379 CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR $541.50
96425 109380 CHEMOTX ADMN IA NFS >8 HR PRTBLE IMPLTBL PMP $1,451.00
96440 109381 CHEMOTX ADMN PLEURAL CAVITY REQ&W/THORACNTS $994.50
96446 109382 CHEMOTX ADMN PERTL CAVITY IMPLANTED PORT/CATH $1,617.50
96450 109383 CHEMOTX ADMN CNS REQ SPINAL PUNCTURE $2,300.00
96521 109384 REFILLING & MAINTENANCE PORTABLE PUMP $691.00
96522 109385 REFILL&MAINTENANCE PUMP DRUG DLVR SYSTEMIC $789.00
96523 109386 IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST $438.50
96542 109387 CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT $324.50
96547 109388 INTRAOPERATIVE HIPEC PX FIRST 60 MINUTES $0.00
96548 109389 INTRAOPERATIVE HIPEC PX EACH ADDL 30 MINUTES $0.00
96549 109390 UNLISTED CHEMOTHERAPY PROCEDURE $0.00
96567 109391 PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY $835.00
96570 109392 PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX 30 MIN $9,577.50
96571 109393 PDT NDSC ABL ABNOR TISS VIA ACTIVJ RX A 15 MIN $749.50
96573 109394 PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP $1,187.50
96574 109395 DEBRIDEMENT PRMLG HYPERKERATOTIC LES W/PDT $1,187.50
96900 109396 ACTINOTHERAPY ULTRAVIOLET LIGHT $238.50
96902 109397 MCRSCP XM HAIR PLUCK/CLIP FOR CNTS/STRUCT ABNORM $0.00
96904 109398 WHOLE BODY INTEGUMENTARY PHOTOGRAPHY $1,211.50
96910 109399 PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB $375.00
96912 109400 PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA $459.00
96913 109401 PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION $2,120.00
96920 109402 EXCIMER LASER TX PSORIASIS TOT AREA <250 SQ CM $1,103.50
96921 109403 EXCIMER LASER TX PSORIASIS 250-500 SQ CM $1,116.50
96922 109404 EXCIMER LASER TX PSORIASIS >500 SQ CM $1,010.50
96931 109405 RCM CELULR & SUBCELULR SKN IMGNG IMG ACQ I&R 1ST $0.00
96932 109406 RCM CELULR & SUBCELULR SKN IMGNG IMG ACQUISITION $641.50
96933 109407 RCM CELULR & SUBCELULR SKN IMGNG I&R 1ST LES $0.00
96934 109408 RCM CELULR & SUBCELULR SKN IMGNG IMG ACQ I&R ADD $0.00
96935 109409 RCM CELULR & SUBCELULR SKN IMGNG IMG ACQ EA ADDL $0.00
96936 109410 RCM CELULR & SUBCELULR SKN IMGNG I&R EA ADDL $0.00
96999 109411 UNLISTED SPECIAL DERMATOLOGICAL SERVICE/PX $0.00
97010 109412 APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS $24.00
97012 109413 APPL MODALITY 1/> AREAS TRACTION MECHANICAL $62.00
97014 109414 APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED $45.00
97016 109415 APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES $145.50
97018 109416 APPL MODALITY 1/> AREAS PARAFFIN BATH $158.50
97022 109417 APPLICATION MODALITY 1/> AREAS WHIRLPOOL $45.00
97024 109418 APPLICATION MODALITY 1/> AREAS DIATHERMY $8.00
97026 109419 APPLICATION MODALITY 1/> AREAS INFRARED $85.50
97028 109420 APPL MODALITY 1/> AREAS ULTRAVIOLET $147.50
97032 109421 APPL MODALITY 1+ AREAS ESTIM EA 15 MIN $112.50
97033 109422 APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN $187.50
97034 109423 APPL MODALITY 1+ AREAS CONTRAST BATHS EA 15 MIN $137.00
97035 109424 APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN $57.50
97036 109425 APPL MODALITY 1+ AREAS HUBBARD TANK EA 15 MIN $306.00
97037 109426 APPL MODALITY 1+ AREAS LLLT PO PAIN REDUCTION $0.00
97039 109427 UNLISTED MODALITY SPEC TYPE&TIME CONSTANT ATTN $0.00
97110 109428 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES $105.00
97112 109429 THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA $105.50
97113 109430 THER PX 1/> AREAS EACH 15 MIN AQUA THER W/XERSS $185.00
97116 109431 THER PX 1/> AREAS EA 15 MIN GAIT TRAING W/STAIR $177.00
97124 109432 THER PX 1/> AREAS EACH 15 MINUTES MASSAGE $163.00
97129 109433 THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES $226.00
97130 109434 THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES $243.50
97139 109435 UNLISTED THERAPEUTIC PROCEDURE SPECIFY $0.00
97140 109436 MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES $124.50
97150 109437 THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS $105.00
97151 109438 BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN $338.50
97152 109439 BEHAVIOR ID SUPPORT ASSMT BY 1 TECH EA 15 MIN $304.50
97153 109440 ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN $47.00
97154 109441 GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN $71.50
97155 109442 ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN $262.50
97156 109443 FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN $164.50
97157 109444 MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN $71.50
97158 109445 GRP ADAPT BHV PRTCL MODIFCAJ PHYS/QHP EA 15 MIN $130.00
97161 109446 PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS $362.50
97162 109447 PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS $457.00
97163 109448 PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS $497.00
97164 109449 PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS $97.00
97165 109450 OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS $460.50
97166 109451 OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS $631.50
97167 109452 OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS $711.50
97168 109453 OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS $210.50
97169 109454 ATHLETIC TRAINING EVAL LOW COMPLEX 15 MINS $320.50
97170 109455 ATHLETIC TRAINING EVAL MOD COMPLEX 30 MINS $649.00
97171 109456 ATHLETIC TRAINING EVAL HIGH COMPLEX 45 MINS $0.00
97172 109457 ATHLETIC TRAINING RE-EVAL EST PLAN CARE 20 MINS $185.00
97530 109458 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN $104.00
97533 109459 SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES $105.50
97535 109460 SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES $194.50
97537 109461 COMMUNITY/WORK REINTEGRATION TRAING EA 15 MIN $105.00
97542 109462 WHEELCHAIR MGMT EA 15 MIN $99.50
97545 109463 WORK HARDENING/CONDITIONING 1ST 2 HR $350.00
97546 109464 WORK HARDENING/CONDITIONING EACH HOUR $110.00
97550 109465 CAREGIVER TRAINING STRATEGIES&TQ 1ST 30 MINUTES $0.00
97551 109466 CAREGIVER TRAINING STRATEGIES&TQ EA ADDL 15 MIN $0.00
97552 109467 GROUP CAREGIVER TRAINING STRATEGIES & TECHNIQUE $0.00
97597 109468 DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/< $505.50
97598 109469 DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF $528.00
97602 109470 RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS $346.50
97605 109471 NEGATIVE PRESSURE WOUND THERAPY DME <= 50 SQ CM $487.00
97606 109472 NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM $739.50
97607 109473 NEG PRESSURE WOUND THERAPY NON DME <= 50 SQ CM $973.00
97608 109474 NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM $1,889.00
97610 109475 LOW FREQUENCY NON-THERMAL ULTRASOUND PER DAY $384.00
97750 109476 PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN $198.00
97755 109477 ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN $404.00
97760 109478 ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS $245.50
97761 109479 PROSTHETICS TRAINING INITIAL ENCTR EA 15 MINS $107.00
97763 109480 ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN $181.50
97799 109481 UNLISTED PHYSICAL MEDICINE/REHAB SERVICE/PX $0.00
97802 109482 MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI $109.00
97803 109483 MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M $111.50
97804 109484 MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI $60.00
97810 109485 ACUPUNCTURE 1/> NDLES W/O ELEC STIMJ INIT 15 MIN $191.00
97811 109486 ACUPUNCTURE 1/> NDLS W/O ELEC STIMJ EA 15 MIN $92.50
97813 109487 ACUPUNCTURE 1/> NDLS W/ELEC STIMJ 1ST 15 MIN $204.00
97814 109488 ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ $118.50
98925 109489 OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS $86.50
98940 109494 CHIROPRACTIC MANIPULATIVE TX SPINAL 1-2 REGIONS $130.00
98941 109495 CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS $130.50
98942 109496 CHIROPRACTIC MANIPULATIVE TX SPINAL 5 REGIONS $130.50
98943 109497 CHIROPRACTIC MANIPLTV TX EXTRASPINAL 1/> REGION $163.00
98960 109498 EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT $258.50
98961 109499 EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS $119.00
98962 109500 EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS $147.50
98966 109501 NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN $120.00
98970 109504 QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 5-10 MIN $76.00
98971 109505 QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN $189.00
98972 109506 QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ MIN $309.00
98975 109507 REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP $179.00
98976 109508 REM THER MNTR DEV SUPPLY W/REC RESPIR SYS EA 30D $285.50
98977 109509 REM THER MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30D $285.50
98978 109510 REM THER MNTR DEV SPLY W/REC COG BHV THER EA 30D $535.50
98980 109511 REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN $0.00
98981 109512 REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN $183.50
99000 109513 HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB $621.00
99001 109514 HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB $112.00
99002 109515 HANDLE/CONVEY/ANY OTH SVC DEVICE FIT PHYS/QHP $187.00
99024 109516 POSTOP FOLLOW UP VISIT RELATED TO ORIGINAL PX $725.00
99026 109517 HOSPITAL MANDATED CALL SERVICE IN-HOSPITAL EA HR $0.00
99027 109518 HOSPITAL MANDATED CALL SVC OUT-OF-HOSPITAL EA HR $0.00
99050 109519 SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS $150.50
99051 109520 SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS $127.50
99053 109521 SERVICES PROVIDED BTW 10 PM&8 AM AT 24-HR FACI $313.00
99056 109522 SVC TYPICAL PRV OFFICE PRV OUT OFFICE REQUEST PT $39.50
99058 109523 SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS $143.50
99060 109524 SVC PRV EMER OUT OFFICE DISRUPTS OFFICE SVC $0.00
99070 109525 SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP $283.00
99071 109526 EDUCATIONAL SUPPLIES PRV BY THE PHYS AT COST $72.00
99072 109527 ADDL SUPL MATRL&STAF TM DRG PHE RES-TR NFCT DS $115.00
99075 109528 MEDICAL TESTIMONY $473.00
99078 109529 PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING $511.00
99080 109530 SPEC REPORTS > USUAL MED COMUNICAJ/STAND RPRTG $125.00
99082 109531 UNUSUAL TRAVEL $406.00
99091 109532 COLLJ & INTERPJ PHYSIOL DATA MIN 30 MIN EA 30 D $672.00
99100 109533 ANESTHESIA EXTREME AGE PATIENT<1 YR&>70 $0.00
99116 109534 ANES COMP BY UTILIZATION TOTAL BODY HYPOTHERMIA $0.00
99135 109535 ANES COMP UTILIZATION CONTROLLED HYPOTENSION $0.00
99140 109536 ANES COMP BY EMERGENCY CONDITIONS SPECIFY $0.00
99151 109537 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS $655.00
99152 109538 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS $415.00
99153 109539 MOD SED SAME PHYS/QHP EACH ADDL 15 MINS $193.00
99155 109540 MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS $1,160.00
99156 109541 MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS $961.50
99157 109542 MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS $742.50
99170 109543 ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG $865.00
99172 109544 VISUAL FUNCT SCRNG AUTO SEMI-AUTO BI QUAN DETERM $138.50
99173 109545 SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT $163.00
99174 109546 INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT $211.00
99175 109547 IPECAC/SIMILAR ADMN EMESIS&OBS STOMACH EMPTIED $142.50
99177 109548 INSTRUMENT BASED OCULAR SCR BI W/ONSITE ANALYSIS $69.00
99183 109549 PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION $4,791.00
99184 109550 INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE $0.00
99188 109551 APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP $113.50
99190 109552 ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH EA HR $0.00
99191 109553 ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 45 MI $0.00
99192 109554 ASSEMBLY&OPERJ PUMP OXYGENATOR/HEAT EXCH 30 MI $0.00
99195 109555 PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE $352.50
99199 109556 UNLISTED SPECIAL SERVICE PROCEDURE/REPORT $0.00
99202 109557 OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES $392.50
99203 109558 OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES $641.00
99204 109559 OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES $686.50
99205 109560 OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES $901.50
99211 109561 OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP $210.00
99212 109562 OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN $340.00
99213 109563 OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN $504.00
99214 109564 OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN $588.50
99215 109565 OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN $671.00
99217 109566 OBSERVATION CARE DISCHARGE MANAGEMENT $394.50
99218 109567 INITIAL OBSERVATION CARE/DAY 30 MINUTES $1,154.50
99219 109568 INITIAL OBSERVATION CARE/DAY 50 MINUTES $656.50
99220 109569 INITIAL OBSERVATION CARE/DAY 70 MINUTES $901.50
99221 109570 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES $462.50
99222 109571 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES $691.00
99223 109572 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES $946.50
99224 109573 SBSQ OBSERVATION CARE/DAY 15 MINUTES $234.50
99231 109576 SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES $175.00
99232 109577 SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES $322.00
99233 109578 SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES $496.00
99234 109579 HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN $499.50
99235 109580 HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN $868.50
99236 109581 HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN $1,205.50
99238 109582 HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/< $364.00
99239 109583 HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN $531.50
99241 109584 OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN $364.00
99242 109585 OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES $826.50
99243 109586 OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES $887.00
99244 109587 OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES $1,055.00
99245 109588 OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES $1,209.00
99251 109589 INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN $244.00
99252 109590 IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES $678.00
99253 109591 IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES $798.00
99254 109592 IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES $957.50
99255 109593 IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES $0.00
99281 109594 EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP $545.50
99282 109595 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM $851.50
99283 109596 EMERGENCY DEPARTMENT VISIT LOW MDM $1,815.00
99284 109597 EMERGENCY DEPARTMENT VISIT MODERATE MDM $2,673.00
99285 109598 EMERGENCY DEPARTMENT VISIT HIGH MDM $3,589.00
99288 109599 PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS $848.50
99291 109600 CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN $3,905.00
99292 109601 CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN $3,003.00
99304 109602 INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN $349.00
99305 109603 INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES $465.50
99306 109604 INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES $546.50
99307 109605 SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES $200.00
99308 109606 SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES $273.50
99309 109607 SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES $371.00
99310 109608 SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES $496.00
99315 109609 NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME $318.00
99316 109610 NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME $404.50
99318 109611 E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN $366.00
99324 109612 DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN $235.50
99325 109613 DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN $412.00
99326 109614 DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES $503.00
99327 109615 DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN $783.50
99328 109616 DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES $885.50
99334 109617 DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES $252.00
99335 109618 DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES $339.50
99336 109619 DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES $449.00
99337 109620 DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES $520.50
99339 109621 INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 15-29 MIN $380.00
99340 109622 INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/> $0.00
99341 109623 HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES $269.00
99342 109624 HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES $415.50
99343 109625 HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES $572.50
99344 109626 HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES $723.00
99345 109627 HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES $866.00
99347 109628 HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES $288.50
99348 109629 HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES $374.00
99349 109630 HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES $551.00
99350 109631 HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES $710.50
99354 109632 PROLONGED SVC OUTPATIENT SETTING 1ST HOUR $439.00
99355 109633 PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN $534.00
99356 109634 PROLONGED SVC I/P OR OBS SETTING 1ST HOUR $518.50
99357 109635 PROLONGED SVC I/P OR OBS SETTING EA ADDL 30 MIN $0.00
99358 109636 PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR $556.00
99359 109637 PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES $427.00
99360 109638 PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES $280.00
99366 109639 TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN $477.50
99367 109640 TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN $556.00
99368 109641 TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN $448.00
99374 109642 SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES $197.50
99375 109643 SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/> $302.00
99377 109644 SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN $0.00
99378 109645 SUPERVISION HOSPICE PATIENT/MONTH 30 MINUTES/> $0.00
99379 109646 SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN $0.00
99380 109647 SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/> $0.00
99381 109648 INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR $366.00
99382 109649 INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS $393.50
99383 109650 INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS $422.00
99384 109651 INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR $515.50
99385 109652 INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS $482.50
99386 109653 INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS $516.50
99387 109654 INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&> $556.00
99391 109655 PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y $138.00
99392 109656 PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS $161.00
99395 109659 PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS $461.00
99397 109661 PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER $471.50
99401 109662 PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 15 MIN $136.00
99403 109664 PREV MED CNSL&/RSK FCTR RDCTJ INDV ARPROX 45 MIN $443.00
99406 109666 TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES $79.50
99407 109667 TOBACCO USE CESSATION INTENSIVE >10 MINUTES $155.50
99408 109668 ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN $195.00
99409 109669 ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN $530.50
99411 109670 PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 30 M $399.50
99412 109671 PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M $425.50
99415 109672 PROLONGED CLINICAL STAFF SVC OFFICE/O/P 1ST HR $287.50
99416 109673 PROLONGED CLINICAL STAFF SVC OFFICE/O/P EA ADDL $0.00
99417 109674 PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES $197.50
99418 109675 PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN $0.00
99421 109676 ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES $111.00
99422 109677 ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES $143.00
99423 109678 ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES $247.00
99424 109679 PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO $0.00
99425 109680 PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO $0.00
99426 109681 PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO $567.50
99427 109682 PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MO $281.50
99429 109683 UNLISTED PREVENTIVE MEDICINE SERVICE $0.00
99437 109684 CHRONIC CARE MGMT SVC PHYS EA ADDL 30 MIN CAL MO $0.00
99439 109685 CHRONIC CARE MGMT SVC STAF EA ADDL 20 MIN CAL MO $192.50
99441 109686 PHYS/QHP TELEPHONE EVALUATION 5-10 MIN $247.00
99446 109689 NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN $579.50
99449 109692 NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN $794.50
99450 109693 BASIC LIFE AND/OR DISABILITY EXAMINATION $997.00
99451 109694 NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5/> MIN $148.00
99452 109695 NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30 MIN $0.00
99453 109696 REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP $265.50
99454 109697 REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D $247.00
99455 109698 WORK RELATED/MED DBLT XM TREATING PHYS $259.00
99456 109699 WORK RELATED/MED DBLT XM OTH/THN TREATING PHYS $1,011.50
99457 109700 REMOTE PHYSIOLOGIC MONITORING 1ST 20 MIN MONTH $178.00
99458 109701 REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO $152.50
99459 109702 PELVIC EXAMINATION $0.00
99460 109703 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB $599.50
99461 109704 1ST CARE PR DAY NML NB XCPT HOSP/BIRTHING CENTER $0.00
99462 109705 SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN $0.00
99463 109706 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT $599.50
99464 109707 ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN $0.00
99465 109708 DELIVERY/BIRTHING ROOM RESUSCITATION $3,845.50
99466 109709 CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN $0.00
99467 109710 CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN $0.00
99468 109711 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/< $0.00
99469 109712 SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/< $0.00
99471 109713 INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS $0.00
99472 109714 SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO $0.00
99473 109715 SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION $128.00
99474 109716 SELF-MEAS BP 2 READG 1 MIN APART BID 30 DAY PD $169.00
99475 109717 INITIAL PED CRITICAL CARE 2 THRU 5 YEARS $0.00
99476 109718 SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS $0.00
99477 109719 INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL $0.00
99478 109720 SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS $0.00
99479 109721 SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS $0.00
99480 109722 SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS $0.00
99483 109723 ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT $579.50
99484 109724 CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS $278.50
99485 109725 SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN $0.00
99486 109726 SUPERVISION INTERFACILITY TRANSPORT ADDL 30 MIN $0.00
99487 109727 COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO $412.00
99489 109728 CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO $206.00
99490 109729 CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO $229.50
99491 109730 CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MONTH $700.50
99492 109731 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS $579.50
99493 109732 SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS $579.50
99494 109733 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS $234.50
99495 109734 TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE $392.50
99496 109735 TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE $549.00
99497 109736 ADVANCE CARE PLANNING FIRST 30 MINS $359.00
99498 109737 ADVANCE CARE PLANNING EA ADDL 30 MINS $290.00
99499 109738 UNLISTED EVALUATION AND MANAGEMENT SERVICE $0.00
99500 109739 HOME VISIT PRENATAL MONITORING & ASSESSMENT $0.00
99501 109740 HOME VISIT POSTNATAL ASSMT&F-UP CARE $0.00
99502 109741 HOME VISIT NEWBORN CARE & ASSESSMENT $0.00
99503 109742 HOME VISIT RESPIRATORY THERAPY CARE $306.50
99504 109743 HOME VISIT MECHANICAL VENTILATION CARE $0.00
99505 109744 HOME VISIT STOMA CARE&MAINT CLST&CSTOST $0.00
99506 109745 HOME VISIT INTRAMUSCULAR INJECTIONS $0.00
99507 109746 HOME VISIT CARE&MAINT CATH $0.00
99509 109747 HOME VISIT ASSISTANCE DAILY LIV&PRSONAL CARE $394.50
99510 109748 HOME VISIT INDIV FAM/MARRIAGE COUNSELING $0.00
99511 109749 HOME VISIT FECAL IMPACTION MGMT&ENEMA ADMN $0.00
99512 109750 HOME VISIT HEMODIALYSIS $3,048.00
99600 109751 UNLISTED HOME VISIT SERVICE/PROCEDURE $0.00
99601 109752 HOME NFS/SPECIALTY DRUG ADMN PER VISIT <2 HR $458.00
99602 109753 HOME NFS/SPECIALTY DRUG ADMN PR VST<2 HR EA ADDL $127.50
99605 109754 MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT $451.00
99606 109755 MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT $391.00
99607 109756 MEDICATION THERAPY EACH ADDITIONAL 15 MIN(04/24) $427.00
A2001 109757 INNOVAMATRIX AC, PER SQ CM $492.50
A2002 109758 MIRRAGEN ADV WND MAT PER SQ $2,128.00
A2004 109759 XCELLISTEM, 1 MG $14.00
A2006 109760 NOVOSORB SYNPATH PER SQ CM $101.00
A2007 109761 RESTRATA, PER SQ CM $430.00
A2012 109762 SUPRATHEL, PER SQ CM $11.50
A4206 109763 1 CC STERILE SYRINGE&NEEDLE $4.00
A4209 109766 5+ CC STERILE SYRINGE&NEEDLE $176.00
A4210 109767 NONNEEDLE INJECTION DEVICE $21.00
A4212 109768 NON CORING NEEDLE OR STYLET $35.00
A4213 109769 20+ CC SYRINGE ONLY $19.00
A4215 109770 STERILE NEEDLE $34.00
A4216 109771 STERILE WATER/SALINE, 10 ML $39.00
A4217 109772 STERILE WATER/SALINE, 500 ML $39.00
A4218 109773 STERILE SALINE OR WATER $19.00
A4220 109774 INFUSION PUMP REFILL KIT $308.50
A4221 109775 SUPP NON-INSULIN INF CATH/WK $54.00
A4222 109776 INFUSION SUPPLIES WITH PUMP $405.00
A4223 109777 INFUSION SUPPLIES W/O PUMP $27.00
A4224 109778 SUPPLY INSULIN INF CATH/WK $87.00
A4225 109779 SUP/EXT INSULIN INF PUMP SYR $33.00
A4239 109780 NON-ADJU CGM SUPPLY ALLOW $605.50
A4244 109781 ALCOHOL OR PEROXIDE PER PINT $176.00
A4245 109782 ALCOHOL WIPES PER BOX $7.00
A4246 109783 BETADINE/PHISOHEX SOLUTION $177.50
A4247 109784 BETADINE/IODINE SWABS/WIPES $42.00
A4248 109785 CHLORHEXIDINE ANTISEPT $10.00
A4256 109786 CALIBRATOR SOLUTION/CHIPS $31.00
A4258 109787 LANCET DEVICE EACH $13.00
A4259 109788 LANCETS PER BOX $24.50
A4262 109789 TEMPORARY TEAR DUCT PLUG $95.50
A4263 109790 PERMANENT TEAR DUCT PLUG $388.00
A4264 109791 INTRATUBAL OCCLUSION DEVICE $1,040.00
A4265 109792 PARAFFIN $50.00
A4270 109793 DISPOSABLE ENDOSCOPE SHEATH $291.50
A4280 109794 BRST PRSTHS ADHSV ATTCHMNT $54.00
A4300 109795 CATH IMPL VASC ACCESS PORTAL $172.00
A4301 109796 IMPLANTABLE ACCESS SYST PERC $117.00
A4305 109797 DRUG DELIVERY SYSTEM >=50 ML $102.00
A4306 109798 DRUG DELIVERY SYSTEM <=50 ML $512.00
A4310 109799 INSERT TRAY W/O BAG/CATH $28.00
A4311 109800 CATHETER W/O BAG 2-WAY LATEX $72.50
A4312 109801 CATH W/O BAG 2-WAY SILICONE $132.00
A4313 109802 CATHETER W/BAG 3-WAY $75.50
A4314 109803 CATH W/DRAINAGE 2-WAY LATEX $117.00
A4315 109804 CATH W/DRAINAGE 2-WAY SILCNE $43.00
A4316 109805 CATH W/DRAINAGE 3-WAY $184.00
A4320 109806 IRRIGATION TRAY $22.00
A4322 109807 IRRIGATION SYRINGE $15.00
A4326 109808 MALE EXTERNAL CATHETER $80.00
A4327 109809 FEM URINARY COLLECT DEV CUP $174.50
A4328 109810 FEM URINARY COLLECT POUCH $56.00
A4330 109811 STOOL COLLECTION POUCH $51.00
A4331 109812 EXTENSION DRAINAGE TUBING $56.50
A4332 109813 LUBE STERILE PACKET $1.00
A4333 109814 URINARY CATH ANCHOR DEVICE $207.50
A4334 109815 URINARY CATH LEG STRAP $26.50
A4336 109816 URETHRAL INSERT $19.00
A4338 109817 INDWELLING CATHETER LATEX $63.50
A4340 109818 INDWELLING CATHETER SPECIAL $33.00
A4344 109819 CATH INDW FOLEY 2 WAY SILICN $53.50
A4346 109820 CATH INDW FOLEY 3 WAY $85.50
A4349 109821 DISPOSABLE MALE EXTERNAL CAT $4.00
A4351 109822 STRAIGHT TIP URINE CATHETER $21.00
A4352 109823 COUDE TIP URINARY CATHETER $44.00
A4353 109824 INTERMITTENT URINARY CATH $23.50
A4354 109825 CATH INSERTION TRAY W/BAG $75.50
A4355 109826 BLADDER IRRIGATION TUBING $28.50
A4356 109827 EXT URETH CLMP OR COMPR DVC $233.00
A4357 109828 BEDSIDE DRAINAGE BAG $13.00
A4358 109829 URINARY LEG OR ABDOMEN BAG $26.50
A4360 109830 DISPOSABLE EXT URETHRAL DEV $12.50
A4361 109831 OSTOMY FACE PLATE $107.50
A4362 109832 SOLID SKIN BARRIER $8.50
A4363 109833 OSTOMY CLAMP, REPLACEMENT $29.50
A4364 109834 ADHESIVE, LIQUID OR EQUAL $83.00
A4366 109835 OSTOMY VENT $8.50
A4367 109836 OSTOMY BELT $14.00
A4368 109837 OSTOMY FILTER $6.50
A4369 109838 SKIN BARRIER LIQUID PER OZ $41.50
A4371 109839 SKIN BARRIER POWDER PER OZ $12.50
A4372 109840 SKIN BARRIER SOLID 4X4 EQUIV $6.50
A4373 109841 SKIN BARRIER WITH FLANGE $61.50
A4375 109842 DRAINABLE PLASTIC PCH W FCPL $75.00
A4376 109843 DRAINABLE RUBBER PCH W FCPLT $180.00
A4377 109844 DRAINABLE PLSTIC PCH W/O FP $47.50
A4378 109845 DRAINABLE RUBBER PCH W/O FP $123.50
A4379 109846 URINARY PLASTIC POUCH W FCPL $112.50
A4380 109847 URINARY RUBBER POUCH W FCPLT $146.00
A4381 109848 URINARY PLASTIC POUCH W/O FP $50.00
A4382 109849 URINARY HVY PLSTC PCH W/O FP $102.00
A4383 109850 URINARY RUBBER POUCH W/O FP $115.00
A4384 109851 OSTOMY FACEPLT/SILICONE RING $83.00
A4385 109852 OST SKN BARRIER SLD EXT WEAR $11.50
A4387 109853 OST CLSD POUCH W ATT ST BARR $30.00
A4388 109854 DRAINABLE PCH W EX WEAR BARR $23.00
A4389 109855 DRAINABLE PCH W ST WEAR BARR $61.00
A4390 109856 DRAINABLE PCH EX WEAR CONVEX $83.00
A4391 109857 URINARY POUCH W EX WEAR BARR $67.00
A4392 109858 URINARY POUCH W ST WEAR BARR $34.00
A4393 109859 URINE PCH W EX WEAR BAR CONV $84.00
A4394 109860 OSTOMY POUCH LIQ DEODORANT $17.00
A4395 109861 OSTOMY POUCH SOLID DEODORANT $2.00
A4396 109862 PERISTOMAL HERNIA SUPPRT BLT $168.50
A4398 109863 OSTOMY IRRIGATION BAG $460.50
A4399 109864 OSTOMY IRRIG CONE/CATH W BRS $101.00
A4400 109865 OSTOMY IRRIGATION SET $213.00
A4402 109866 LUBRICANT PER OUNCE $15.00
A4404 109867 OSTOMY RING EACH $184.50
A4405 109868 NONPECTIN BASED OSTOMY PASTE $42.50
A4406 109869 PECTIN BASED OSTOMY PASTE $26.50
A4407 109870 EXT WEAR OST SKN BARR <=4SQ" $61.50
A4408 109871 EXT WEAR OST SKN BARR >4SQ" $89.50
A4409 109872 OST SKN BARR CONVEX <=4 SQ I $17.00
A4410 109873 OST SKN BARR EXTND >4 SQ $84.00
A4411 109874 OST SKN BARR EXTND =4SQ $11.50
A4412 109875 OST POUCH DRAIN HIGH OUTPUT $36.50
A4413 109876 2 PC DRAINABLE OST POUCH $60.00
A4414 109877 OST SKNBAR W/O CONV<=4 SQ IN $6.00
A4415 109878 OST SKN BARR W/O CONV >4 SQI $63.50
A4416 109879 OST PCH CLSD W BARRIER/FILTR $35.00
A4417 109880 OST PCH W BAR/BLTINCONV/FLTR $42.50
A4418 109881 OST PCH CLSD W/O BAR W FILTR $26.50
A4419 109882 OST PCH FOR BAR W FLANGE/FLT $25.50
A4422 109883 OST POUCH ABSORBENT MATERIAL $4.50
A4423 109884 OST PCH FOR BAR W LK FL/FLTR $28.50
A4424 109885 OST PCH DRAIN W BAR & FILTER $6.50
A4425 109886 OST PCH DRAIN FOR BARRIER FL $20.50
A4426 109887 OST PCH DRAIN 2 PIECE SYSTEM $37.00
A4427 109888 OST PCH DRAIN/BARR LK FLNG/F $4.50
A4428 109889 URINE OST POUCH W FAUCET/TAP $13.00
A4429 109890 URINE OST POUCH W BLTINCONV $79.00
A4430 109891 OST URINE PCH W B/BLTIN CONV $76.00
A4431 109892 OST PCH URINE W BARRIER/TAPV $40.50
A4432 109893 OS PCH URINE W BAR/FANGE/TAP $17.00
A4433 109894 URINE OST PCH BAR W LOCK FLN $39.50
A4434 109895 OST PCH URINE W LOCK FLNG/FT $20.50
A4435 109896 1PC OST PCH DRAIN HGH OUTPUT $30.00
A4436 109897 IRR SUPPLY SLEEV REUS PER MO $145.00
A4437 109898 IRR SUPPLY SLEEV DISP PER MO $145.00
A4450 109899 NON-WATERPROOF TAPE $6.00
A4452 109900 WATERPROOF TAPE $25.50
A4455 109901 ADHESIVE REMOVER PER OUNCE $19.00
A4456 109902 ADHESIVE REMOVER, WIPES $2.00
A4461 109903 SURGICL DRESS HOLD NON-REUSE $115.50
A4463 109904 SURGICAL DRESS HOLDER REUSE $203.50
A4465 109905 NON-ELASTIC EXTREMITY BINDER $33.00
A4467 109906 BELT STRAP SLEEV GRMNT COVER $69.00
A4481 109907 TRACHEOSTOMA FILTER $10.50
A4495 109908 THIGH LENGTH SURG STOCKING $143.50
A4500 109909 BELOW KNEE SURGICAL STOCKING $29.50
A4550 109910 SURGICAL TRAYS $1,094.50
A4554 109911 DISPOSABLE UNDERPADS $6.50
A4556 109912 ELECTRODES, PAIR $205.50
A4557 109913 LEAD WIRES, PAIR $221.50
A4558 109914 CONDUCTIVE GEL OR PASTE $69.00
A4561 109915 PESSARY RUBBER, ANY TYPE $138.50
A4562 109916 PESSARY, NON RUBBER,ANY TYPE $152.50
A4563 109917 VAG INSER RECTAL CONTROL SYS $2,216.00
A4565 109918 SLINGS $103.50
A4566 109919 SHOULD SLING/VEST/ABRESTRAIN $194.00
A4570 109920 SPLINT $345.00
A4580 109921 CAST SUPPLIES (PLASTER) $21.00
A4590 109922 SPECIAL CASTING MATERIAL $17.00
A4595 109923 TENS SUPPL 2 LEAD PER MONTH $114.50
A4600 109924 SLEEVE, INTER LIMB COMP DEV $55.50
A4604 109925 TUBING WITH HEATING ELEMENT $127.50
A4605 109926 TRACH SUCTION CATH CLOSE SYS $77.50
A4606 109927 OXYGEN PROBE USED W OXIMETER $179.00
A4608 109928 TRANSTRACHEAL OXYGEN CATH $202.50
A4613 109929 BATTERY CHARGER $76.00
A4614 109930 HAND-HELD PEFR METER $97.00
A4615 109931 CANNULA NASAL $15.00
A4616 109932 TUBING (OXYGEN) PER FOOT $4.00
A4617 109933 MOUTH PIECE $4.50
A4618 109934 BREATHING CIRCUITS $24.00
A4619 109935 FACE TENT $124.50
A4620 109936 VARIABLE CONCENTRATION MASK $5.00
A4623 109937 TRACHEOSTOMY INNER CANNULA $76.50
A4624 109938 TRACHEAL SUCTION TUBE $4.50
A4625 109939 TRACH CARE KIT FOR NEW TRACH $155.50
A4626 109940 TRACHEOSTOMY CLEANING BRUSH $16.00
A4627 109941 SPACER BAG/RESERVOIR $56.00
A4628 109942 OROPHARYNGEAL SUCTION CATH $10.50
A4629 109943 TRACHEOSTOMY CARE KIT $6.50
A4637 109944 REPL TIP CANE/CRUTCH/WALKER $147.50
A4640 109945 ALTERNATING PRESSURE PAD $127.00
A4648 109946 IMPLANTABLE TISSUE MARKER $504.00
A4651 109947 CALIBRATED MICROCAP TUBE $84.00
A4652 109948 MICROCAPILLARY TUBE SEALANT $15.00
A4657 109949 SYRINGE W/WO NEEDLE $1.00
A4660 109950 SPHYG/BP APP W CUFF AND STET $91.50
A4663 109951 DIALYSIS BLOOD PRESSURE CUFF $18.50
A4670 109952 AUTOMATIC BP MONITOR, DIAL $86.00
A4673 109953 EXT LINE W EASY LOCK CONNECT $20.50
A4674 109954 CHEM/ANTISEPT SOLUTION, 8OZ $132.00
A4680 109955 ACTIVATED CARBON FILTER, EA $382.00
A4690 109956 DIALYZER, EACH $227.00
A4706 109957 BICARBONATE CONC SOL PER GAL $68.00
A4707 109958 BICARBONATE CONC POW PER PAC $25.50
A4708 109959 ACETATE CONC SOL PER GALLON $31.00
A4709 109960 ACID CONC SOL PER GALLON $66.00
A4714 109961 TREATED WATER PER GALLON $28.00
A4722 109962 DIALYS SOL FLD VOL > 1999CC $274.50
A4728 109966 DIALYSATE SOLUTION, NON-DEX $216.00
A4730 109967 FISTULA CANNULATION SET, EA $32.00
A4740 109968 SHUNT ACCESSORY $369.00
A4750 109969 ART OR VENOUS BLOOD TUBING $75.50
A4755 109970 COMB ART/VENOUS BLOOD TUBING $151.00
A4770 109971 BLOOD COLLECTION TUBE/VACUUM $915.50
A4890 109972 REPAIR/MAINT CONT HEMO EQUIP $718.00
A4927 109973 NON-STERILE GLOVES $37.50
A4928 109974 SURGICAL MASK $51.00
A4929 109975 TOURNIQUET FOR DIALYSIS, EA $375.50
A4930 109976 STERILE, GLOVES PER PAIR $63.50
A5051 109977 POUCH CLSD W BARR ATTACHED $30.50
A5052 109978 CLSD OSTOMY POUCH W/O BARR $24.50
A5053 109979 CLSD OSTOMY POUCH FACEPLATE $27.50
A5054 109980 CLSD OSTOMY POUCH W/FLANGE $23.50
A5055 109981 STOMA CAP $22.00
A5056 109982 1 PC OST POUCH W FILTER $8.50
A5057 109983 1 PC OST POU W BUILT-IN CONV $45.50
A5061 109984 POUCH DRAINABLE W BARRIER AT $7.50
A5062 109985 DRNBLE OSTOMY POUCH W/O BARR $29.50
A5063 109986 DRAIN OSTOMY POUCH W/FLANGE $4.00
A5071 109987 URINARY POUCH W/BARRIER $14.00
A5072 109988 URINARY POUCH W/O BARRIER $21.00
A5073 109989 URINARY POUCH ON BARR W/FLNG $6.50
A5081 109990 STOMA PLUG OR SEAL, ANY TYPE $19.50
A5082 109991 CONTINENT STOMA CATHETER $89.50
A5083 109992 STOMA ABSORPTIVE COVER $13.50
A5093 109993 OSTOMY ACCESSORY CONVEX INSE $11.50
A5102 109994 BEDSIDE DRAIN BTL W/WO TUBE $143.50
A5105 109995 URINARY SUSPENSORY $284.50
A5112 109996 URINARY LEG BAG $72.50
A5113 109997 LATEX LEG STRAP $57.50
A5114 109998 FOAM/FABRIC LEG STRAP $22.50
A5120 109999 SKIN BARRIER, WIPE OR SWAB $2.00
A5121 110000 SOLID SKIN BARRIER 6X6 $57.50
A5122 110001 SOLID SKIN BARRIER 8X8 $28.00
A5126 110002 DISK/FOAM PAD +OR- ADHESIVE $83.00
A5131 110003 APPLIANCE CLEANER $174.50
A5200 110004 PERCUTANEOUS CATHETER ANCHOR $31.00
A5500 110005 DIAB SHOE FOR DENSITY INSERT $146.50
A5501 110006 DIABETIC CUSTOM MOLDED SHOE $508.00
A5503 110007 DIABETIC SHOE W/ROLLER/ROCKR $90.00
A5504 110008 DIABETIC SHOE WITH WEDGE $71.50
A5505 110009 DIAB SHOE W/METATARSAL BAR $71.50
A5506 110010 DIABETIC SHOE W/OFF SET HEEL $71.50
A5507 110011 MODIFICATION DIABETIC SHOE $83.00
A5512 110012 MULTI DEN INSERT DIRECT FORM $52.00
A5513 110013 MULTI DEN INSERT CUSTOM MOLD $257.50
A6010 110014 COLLAGEN BASED WOUND FILLER $50.00
A6011 110015 COLLAGEN GEL/PASTE WOUND FIL $23.00
A6021 110016 COLLAGEN DRESSING <=16 SQ IN $52.00
A6022 110017 COLLAGEN DRSG>16<=48 SQ IN $260.00
A6023 110018 COLLAGEN DRESSING >48 SQ IN $635.00
A6024 110019 COLLAGEN DSG WOUND FILLER $34.00
A6025 110020 SILICONE GEL SHEET, EACH $79.00
A6154 110021 WOUND POUCH EACH $74.50
A6196 110022 ALGINATE DRESSING <=16 SQ IN $148.00
A6197 110023 ALGINATE DRSG >16 <=48 SQ IN $44.00
A6198 110024 ALGINATE DRESSING > 48 SQ IN $185.50
A6199 110025 ALGINATE DRSG WOUND FILLER $44.50
A6203 110026 COMPOSITE DRSG <= 16 SQ IN $143.00
A6204 110027 COMPOSITE DRSG >16<=48 SQ IN $11.50
A6205 110028 COMPOSITE DRSG > 48 SQ IN $37.00
A6206 110029 CONTACT LAYER <= 16 SQ IN $75.50
A6207 110030 CONTACT LAYER >16<= 48 SQ IN $56.00
A6208 110031 CONTACT LAYER > 48 SQ IN $171.50
A6209 110032 FOAM DRSG <=16 SQ IN W/O BDR $34.50
A6210 110033 FOAM DRG >16<=48 SQ IN W/O B $51.00
A6211 110034 FOAM DRG > 48 SQ IN W/O BRDR $86.00
A6212 110035 FOAM DRG <=16 SQ IN W/BORDER $47.00
A6213 110036 FOAM DRG >16<=48 SQ IN W/BDR $35.50
A6214 110037 FOAM DRG > 48 SQ IN W/BORDER $89.00
A6215 110038 FOAM DRESSING WOUND FILLER $35.00
A6216 110039 NON-STERILE GAUZE<=16 SQ IN $248.50
A6217 110040 NON-STERILE GAUZE>16<=48 SQ $4.00
A6218 110041 NON-STERILE GAUZE > 48 SQ IN $59.50
A6219 110042 GAUZE <= 16 SQ IN W/BORDER $53.50
A6220 110043 GAUZE >16 <=48 SQ IN W/BORDR $20.00
A6221 110044 GAUZE > 48 SQ IN W/BORDER $1.00
A6222 110045 GAUZE <=16 IN NO W/SAL W/O B $7.50
A6223 110046 GAUZE >16<=48 NO W/SAL W/O B $6.50
A6224 110047 GAUZE > 48 IN NO W/SAL W/O B $12.50
A6228 110048 GAUZE <= 16 SQ IN WATER/SAL $17.00
A6229 110049 GAUZE >16<=48 SQ IN WATR/SAL $48.00
A6231 110050 HYDROGEL DSG<=16 SQ IN $34.00
A6232 110051 HYDROGEL DSG>16<=48 SQ IN $69.50
A6233 110052 HYDROGEL DRESSING >48 SQ IN $26.50
A6234 110053 HYDROCOLLD DRG <=16 W/O BDR $21.50
A6235 110054 HYDROCOLLD DRG >16<=48 W/O B $53.50
A6236 110055 HYDROCOLLD DRG > 48 IN W/O B $120.00
A6237 110056 HYDROCOLLD DRG <=16 IN W/BDR $17.00
A6238 110057 HYDROCOLLD DRG >16<=48 W/BDR $108.50
A6240 110058 HYDROCOLLD DRG FILLER PASTE $68.00
A6241 110059 HYDROCOLLOID DRG FILLER DRY $35.00
A6242 110060 HYDROGEL DRG <=16 IN W/O BDR $33.00
A6243 110061 HYDROGEL DRG >16<=48 W/O BDR $117.00
A6244 110062 HYDROGEL DRG >48 IN W/O BDR $164.00
A6245 110063 HYDROGEL DRG <= 16 IN W/BDR $99.00
A6246 110064 HYDROGEL DRG >16<=48 IN W/B $89.50
A6247 110065 HYDROGEL DRG > 48 SQ IN W/B $126.00
A6248 110066 HYDROGEL DRSG GEL FILLER $54.50
A6250 110067 SKIN SEAL PROTECT MOISTURIZR $143.00
A6251 110068 ABSORPT DRG <=16 SQ IN W/O B $37.50
A6252 110069 ABSORPT DRG >16 <=48 W/O BDR $63.00
A6253 110070 ABSORPT DRG > 48 SQ IN W/O B $18.00
A6254 110071 ABSORPT DRG <=16 SQ IN W/BDR $11.50
A6255 110072 ABSORPT DRG >16<=48 IN W/BDR $132.00
A6256 110073 ABSORPT DRG > 48 SQ IN W/BDR $18.00
A6257 110074 TRANSPARENT FILM <= 16 SQ IN $24.00
A6258 110075 TRANSPARENT FILM >16<=48 IN $5.00
A6259 110076 TRANSPARENT FILM > 48 SQ IN $18.50
A6260 110077 WOUND CLEANSER ANY TYPE/SIZE $191.00
A6261 110078 WOUND FILLER GEL/PASTE /OZ $239.00
A6262 110079 WOUND FILLER DRY FORM / GRAM $35.50
A6266 110080 IMPREG GAUZE NO H20/SAL/YARD $7.00
A6402 110081 STERILE GAUZE <= 16 SQ IN $32.00
A6403 110082 STERILE GAUZE>16 <= 48 SQ IN $23.00
A6404 110083 STERILE GAUZE > 48 SQ IN $7.50
A6407 110084 PACKING STRIPS, NON-IMPREG $30.50
A6410 110085 STERILE EYE PAD $6.50
A6412 110086 OCCLUSIVE EYE PATCH $87.00
A6413 110087 ADHESIVE BANDAGE, FIRST-AID $53.00
A6441 110088 PAD BAND W>=3" <5"/YD $50.50
A6442 110089 CONFORM BAND N/S W<3"/YD $5.50
A6443 110090 CONFORM BAND N/S W>=3"<5"/YD $27.50
A6444 110091 CONFORM BAND N/S W>=5"/YD $59.50
A6445 110092 CONFORM BAND S W <3"/YD $7.00
A6446 110093 CONFORM BAND S W>=3" <5"/YD $12.50
A6447 110094 CONFORM BAND S W >=5"/YD $5.50
A6448 110095 LT COMPRES BAND <3"/YD $66.00
A6449 110096 LT COMPRES BAND >=3" <5"/YD $22.50
A6450 110097 LT COMPRES BAND >=5"/YD $29.00
A6451 110098 MOD COMPRES BAND W>=3"<5"/YD $21.50
A6452 110099 HIGH COMPRES BAND W>=3"<5"YD $19.00
A6453 110100 SELF-ADHER BAND W <3"/YD $28.00
A6454 110101 SELF-ADHER BAND W>=3" <5"/YD $6.00
A6455 110102 SELF-ADHER BAND >=5"/YD $27.50
A6456 110103 ZINC PASTE BAND W >=3"<5"/YD $41.50
A6457 110104 TUBULAR DRESSING $49.00
A6504 110105 CMPRSBURNGARMENT GLOVE-WRIST $473.50
A6506 110106 CMPRSBURNGRMNT GLOVE-AXILLA $624.00
A6507 110107 CMPRS BURNGARMENT FOOT-KNEE $304.00
A6530 110108 COMPRESSION STOCKING BK18-30 $157.50
A6531 110109 COMPRESS STKING BK30-40 SURG $177.50
A6533 110110 GC STOCKING THIGHLNGTH 18-30 $220.50
A6534 110111 GC STOCKING THIGHLNGTH 30-40 $206.50
A6539 110112 GC STOCKING WAISTLNGTH 18-30 $522.50
A6545 110113 GRAD COM NON-ELASTIC BK SURG $218.50
A6550 110114 NEG PRES WOUND THER DRSG SET $1,148.50
A7000 110115 DISPOSABLE CANISTER FOR PUMP $19.00
A7002 110116 TUBING USED W SUCTION PUMP $321.50
A7003 110117 NEBULIZER ADMINISTRATION SET $155.00
A7004 110118 DISPOSABLE NEBULIZER SML VOL $21.50
A7015 110119 AEROSOL MASK USED W NEBULIZE $96.00
A7016 110120 NEBULIZER DOME & MOUTHPIECE $155.50
A7018 110121 WATER DISTILLED W/NEBULIZER $8.50
A7027 110122 COMBINATION ORAL/NASAL MASK $552.00
A7028 110123 REPL ORAL CUSHION COMBO MASK $171.50
A7029 110124 REPL NASAL PILLOW COMB MASK $136.00
A7030 110125 CPAP FULL FACE MASK $314.00
A7031 110126 REPLACEMENT FACEMASK INTERFA $139.50
A7032 110127 REPLACEMENT NASAL CUSHION $82.00
A7033 110128 REPLACEMENT NASAL PILLOWS $69.00
A7034 110129 NASAL APPLICATION DEVICE $229.00
A7035 110130 POS AIRWAY PRESS HEADGEAR $89.00
A7036 110131 POS AIRWAY PRESS CHINSTRAP $108.50
A7037 110132 POS AIRWAY PRESSURE TUBING $119.00
A7038 110133 POS AIRWAY PRESSURE FILTER $12.50
A7039 110134 FILTER, NON DISPOSABLE W PAP $72.50
A7040 110135 ONE WAY CHEST DRAIN VALVE $209.50
A7041 110136 WATER SEAL DRAIN CONTAINER $203.50
A7046 110137 REPL WATER CHAMBER, PAP DEV $118.00
A7048 110138 VACUUM DRAIN BOTTLE/TUBE KIT $337.00
A7501 110139 TRACHEOSTOMA VALVE W DIAPHRA $381.50
A7502 110140 REPLACEMENT DIAPHRAGM/FPLATE $202.00
A7503 110141 HMES FILTER HOLDER OR CAP $143.50
A7504 110142 TRACHEOSTOMA HMES FILTER $14.00
A7505 110143 HMES OR TRACH VALVE HOUSING $53.50
A7506 110144 HMES/TRACHVALVE ADHESIVEDISK $8.50
A7507 110145 INTEGRATED FILTER & HOLDER $35.00
A7508 110146 HOUSING & INTEGRATED ADHESIV $38.50
A7509 110147 HEAT & MOISTURE EXCHANGE SYS $23.50
A7520 110148 TRACH/LARYN TUBE NON-CUFFED $525.50
A7521 110149 TRACH/LARYN TUBE CUFFED $1,014.00
A7522 110150 TRACH/LARYN TUBE STAINLESS $254.50
A7524 110151 TRACHEOSTOMA STENT/STUD/BTTN $294.00
A7525 110152 TRACHEOSTOMY MASK $30.50
A7526 110153 TRACHEOSTOMY TUBE COLLAR $8.50
A7527 110154 TRACH/LARYN TUBE PLUG/STOP $44.50
A9152 110155 SINGLE VITAMIN NOS $8.50
A9153 110156 MULTI-VITAMIN NOS $6.00
A9272 110157 DISP WOUND SUCT, DRSG/ACCESS $1,251.50
A9273 110158 HOT/COLD BOTLE/CAP/COL/WRAP $25.50
A9281 110159 REACHING/GRABBING DEVICE $64.50
A9282 110160 WIG ANY TYPE $560.50
A9283 110161 FOOT PRESS OFF LOAD SUPP DEV $29.50
A9284 110162 NON-ELECTRONIC SPIROMETER $30.50
A9500 110163 TC99M SESTAMIBI $346.50
A9501 110164 TECHNETIUM TC-99M TEBOROXIME $204.00
A9502 110165 TC99M TETROFOSMIN $736.00
A9503 110166 TC99M MEDRONATE $242.00
A9505 110167 TL201 THALLIUM $232.00
A9509 110168 IODINE I-123 SOD IODIDE MIL $2,608.00
A9510 110169 TC99M DISOFENIN $410.50
A9512 110170 TC99M PERTECHNETATE $33.00
A9513 110171 LUTETIUM LU 177 DOTATAT THER $536.00
A9515 110172 CHOLINE C-11 $14,094.50
A9516 110173 IODINE I-123 SOD IODIDE MIC $193.00
A9517 110174 I131 IODIDE CAP, RX $66.00
A9520 110175 TC99 TILMANOCEPT DIAG 0.5MCI $3,323.00
A9521 110176 TC99M EXAMETAZIME $4,945.50
A9524 110177 I131 SERUM ALBUMIN, DX $330.00
A9526 110178 NITROGEN N-13 AMMONIA $1,648.50
A9527 110179 IODINE I-125 SODIUM IODIDE $303.50
A9528 110180 IODINE I-131 IODIDE CAP, DX $87.00
A9529 110181 I131 IODIDE SOL, DX $104.00
A9530 110182 I131 IODIDE SOL, RX $48.00
A9531 110183 I131 MAX 100UCI $23.50
A9537 110184 TC99M MEBROFENIN $532.50
A9538 110185 TC99M PYROPHOSPHATE $318.00
A9539 110186 TC99M PENTETATE $674.00
A9540 110187 TC99M MAA $713.50
A9541 110188 TC99M SULFUR COLLOID $600.00
A9543 110189 Y90 IBRITUMOMAB, RX $133,222.00
A9547 110190 IN111 OXYQUINOLINE $6,594.00
A9548 110191 IN111 PENTETATE $4,945.50
A9551 110192 TC99M SUCCIMER $608.00
A9552 110193 F18 FDG $1,020.00
A9554 110194 I125 IOTHALAMATE, DX $500.00
A9555 110195 RB82 RUBIDIUM $1,267.00
A9556 110196 GA67 GALLIUM $296.00
A9557 110197 TC99M BICISATE $4,587.50
A9558 110198 XE133 XENON 10MCI $1,062.00
A9560 110199 TC99M LABELED RBC $836.00
A9561 110200 TC99M OXIDRONATE $277.00
A9562 110201 TC99M MERTIATIDE $1,477.50
A9563 110202 P32 NA PHOSPHATE $344.50
A9567 110203 TECHNETIUM TC-99M AEROSOL $553.00
A9569 110204 TECHNETIUM TC-99M AUTO WBC $4,048.00
A9570 110205 INDIUM IN-111 AUTO WBC $5,799.50
A9572 110206 INDIUM IN-111 PENTETREOTIDE $14,824.00
A9573 110207 INJ, GADOPICLENOL, 1 ML $38.50
A9575 110208 INJ GADOTERATE MEGLUMI 0.1ML $2.00
A9576 110209 INJ PROHANCE MULTIPACK $8.00
A9577 110210 INJ MULTIHANCE $32.00
A9578 110211 INJ MULTIHANCE MULTIPACK $19.50
A9579 110212 GAD-BASE MR CONTRAST NOS,1ML $58.00
A9580 110213 SODIUM FLUORIDE F-18 $878.50
A9581 110214 GADOXETATE DISODIUM INJ $78.00
A9582 110215 IODINE I-123 IOBENGUANE $13,797.00
A9584 110216 IODINE I-123 IOFLUPANE $8,681.00
A9585 110217 GADOBUTROL INJECTION $5.00
A9586 110218 FLORBETAPIR F18 $6.00
A9587 110219 GALLIUM GA-68 $106.50
A9588 110220 FLUCICLOVINE F-18 $762.00
A9589 110221 INSTI HEXAMINOLEVULINATE HCL $5,088.00
A9590 110222 IODINE I-131 IOBENGUANE 1MCI $1,828.00
A9591 110223 FLUOROESTRADIOL F 18 $3,156.00
A9592 110224 COPPER CU 64 DOTATATE DIAG $4,384.00
A9593 110225 GALLIUM GA-68 PSMA-11 UCSF $6,193.50
A9594 110226 GALLIUM GA-68 PSMA-11, UCLA $3,194.00
A9595 110227 PIFLU F-18, DIA 1 MILLICURIE $1,693.00
A9596 110228 GALLIUM ILLUCCIX 1 MILLICURE $4,753.00
A9598 110229 PET DX FOR NON-TUMOR ID, NOC $16.50
A9600 110230 SR89 STRONTIUM $14,827.00
A9602 110231 FLUORODOPA F-18 DIAG PER MCI $2,369.50
A9604 110232 SM 153 LEXIDRONAM $32,640.00
A9606 110233 RADIUM RA223 DICHLORIDE THER $590.00
A9607 110234 LUTETIUM LU 177 VIPIVOTIDE $578.50
A9608 110235 FLOTUFOLASTAT F18 DIAG 1 MCI $3,544.50
A9700 110236 ECHOCARDIOGRAPHY CONTRAST $1,684.50
A9800 110237 GALLIUM LOCAMETZ 1 MILLICURI $1,136.50
A9901 110238 DELIVERY/SET UP/DISPENSING $215.50
B4034 110239 ENTER FEED SUPKIT SYR BY DAY $44.50
B4035 110240 ENTERAL FEED SUPP PUMP PER D $69.00
B4036 110241 ENTERAL FEED SUP KIT GRAV BY $54.50
B4081 110242 ENTERAL NG TUBING W/ STYLET $146.00
B4082 110243 ENTERAL NG TUBING W/O STYLET $25.50
B4083 110244 ENTERAL STOMACH TUBE LEVINE $73.50
B4087 110245 GASTRO/JEJUNO TUBE, STD $617.50
B4088 110246 GASTRO/JEJUNO TUBE, LOW-PRO $763.00
B4149 110247 EF BLENDERIZED FOODS $22.50
B4150 110248 EF COMPLET W/INTACT NUTRIENT $11.00
B4152 110249 EF CALORIE DENSE>/=1.5KCAL $9.50
B4153 110250 EF HYDROLYZED/AMINO ACIDS $27.00
B4154 110251 EF SPEC METABOLIC NONINHERIT $17.50
B4164 110252 PARENTERAL 50% DEXTROSE SOLU $185.50
B4168 110253 PARENTERAL SOL AMINO ACID 3. $250.00
B4176 110254 PARENTERAL SOL AMINO ACID 7- $421.00
B4178 110255 PARENTERAL SOL AMINO ACID > $486.00
B4180 110256 PARENTERAL SOL CARB > 50% $247.00
B4185 110257 PN SOLN NOS 10 GRAMS LIPIDS $81.50
B4187 110258 OMEGAVEN, 10 GRAMS LIPIDS $148.50
B4189 110259 PARENTERAL SOL AMINO ACID & $753.00
B4193 110260 PARENTERAL SOL 52-73 GM PROT $1,451.50
B4197 110261 PARENTERAL SOL 74-100 GM PRO $1,695.00
B4199 110262 PARENTERAL SOL > 100GM PROTE $1,883.50
B4216 110263 PARENTERAL NUTRITION ADDITIV $100.00
B4220 110264 PARENTERAL SUPPLY KIT PREMIX $132.00
B4222 110265 PARENTERAL SUPPLY KIT HOMEMI $121.00
B5000 110266 PARENTERAL SOL RENAL-AMIROSY $140.00
B5100 110267 PARENTERAL SOLUTION HEPATIC $67.00
C1052 110268 HEMOSTATIC AGENT, GI, TOPIC $8,826.00
C1062 110269 INTRAVERTEBRAL FX AUG IMPL $17,595.00
C1713 110270 ANCHOR/SCREW BN/BN,TIS/BN $2,087.00
C1714 110271 CATH, TRANS ATHERECTOMY, DIR $14,706.00
C1715 110272 BRACHYTHERAPY NEEDLE $161.00
C1716 110273 BRACHYTX, NON-STR, GOLD-198 $2,794.00
C1717 110274 BRACHYTX, NON-STR,HDR IR-192 $1,055.00
C1719 110275 BRACHYTX, NS, NON-HDRIR-192 $675.50
C1721 110276 AICD, DUAL CHAMBER $47,867.50
C1722 110277 AICD, SINGLE CHAMBER $45,234.50
C1724 110278 CATH, TRANS ATHEREC,ROTATION $15,379.50
C1725 110279 CATH, TRANSLUMIN NON-LASER $1,096.50
C1726 110280 CATH, BAL DIL, NON-VASCULAR $1,225.50
C1727 110281 CATH, BAL TIS DIS, NON-VAS $1,606.00
C1728 110282 CATH, BRACHYTX SEED ADM $5,634.50
C1729 110283 CATH, DRAINAGE $462.00
C1730 110284 CATH, EP, 19 OR FEW ELECT $2,405.00
C1731 110285 CATH, EP, 20 OR MORE ELEC $10,410.00
C1732 110286 CATH, EP, DIAG/ABL, 3D/VECT $10,992.00
C1733 110287 CATH, EP, OTHR THAN COOL-TIP $17,570.00
C1734 110288 ORTH/DEVIC/DRUG BN/BN,TIS/BN $12,916.50
C1748 110289 ENDOSCOPE, SINGLE, UGI $11,754.00
C1749 110290 ENDO, COLON, RETRO IMAGING $1,329.00
C1750 110291 CATH, HEMODIALYSIS,LONG-TERM $1,142.50
C1751 110292 CATH, INF, PER/CENT/MIDLINE $1,206.00
C1752 110293 CATH,HEMODIALYSIS,SHORT-TERM $683.00
C1753 110294 CATH, INTRAVAS ULTRASOUND $3,525.50
C1754 110295 CATHETER, INTRADISCAL $928.00
C1755 110296 CATHETER, INTRASPINAL $387.00
C1756 110297 CATH, PACING, TRANSESOPH $997.50
C1757 110298 CATH, THROMBECTOMY/EMBOLECT $687.50
C1758 110299 CATHETER, URETERAL $73.50
C1759 110300 CATH, INTRA ECHOCARDIOGRAPHY $8,983.50
C1760 110301 CLOSURE DEV, VASC $1,295.00
C1761 110302 CATH, TRANS INTRA LITHO/CORO $19,805.00
C1762 110303 CONN TISS, HUMAN(INC FASCIA) $11,820.00
C1763 110304 CONN TISS, NON-HUMAN $9,283.00
C1764 110305 EVENT RECORDER, CARDIAC $19,431.00
C1765 110306 ADHESION BARRIER $2,522.00
C1766 110307 INTRO/SHEATH,STRBLE,NON-PEEL $4,444.50
C1767 110308 GENERATOR, NEURO NON-RECHARG $70,736.50
C1768 110309 GRAFT, VASCULAR $6,776.00
C1769 110310 GUIDE WIRE $506.00
C1770 110311 IMAGING COIL, MR, INSERTABLE $738.00
C1771 110312 REP DEV, URINARY, W/SLING $4,609.00
C1772 110313 INFUSION PUMP, PROGRAMMABLE $49,656.00
C1773 110314 RET DEV, INSERTABLE $2,583.00
C1776 110315 JOINT DEVICE (IMPLANTABLE) $6,758.00
C1777 110316 LEAD, AICD, ENDO SINGLE COIL $11,857.00
C1778 110317 LEAD, NEUROSTIMULATOR $13,484.00
C1779 110318 LEAD, PMKR, TRANSVENOUS VDD $9,319.00
C1780 110319 LENS, INTRAOCULAR (NEW TECH) $798.50
C1781 110320 MESH (IMPLANTABLE) $3,293.50
C1782 110321 MORCELLATOR $9,018.50
C1783 110322 OCULAR IMP, AQUEOUS DRAIN DE $8,294.00
C1784 110323 OCULAR DEV, INTRAOP, DET RET $2,408.50
C1785 110324 PMKR, DUAL, RATE-RESP $14,410.00
C1786 110325 PMKR, SINGLE, RATE-RESP $40,927.50
C1787 110326 PATIENT PROGR, NEUROSTIM $5,596.00
C1788 110327 PORT, INDWELLING, IMP $1,439.00
C1789 110328 PROSTHESIS, BREAST, IMP $4,612.00
C1813 110329 PROSTHESIS, PENILE, INFLATAB $38,673.00
C1814 110330 RETINAL TAMP, SILICONE OIL $1,711.00
C1815 110331 PROS, URINARY SPH, IMP $23,863.00
C1816 110332 RECEIVER/TRANSMITTER, NEURO $1,505.50
C1817 110333 SEPTAL DEFECT IMP SYS $32,846.00
C1818 110334 INTEGRATED KERATOPROSTHESIS $19,227.00
C1819 110335 TISSUE LOCALIZATION-EXCISION $462.00
C1820 110336 GENERATOR NEURO RECHG BAT SY $63,095.50
C1821 110337 INTERSPINOUS IMPLANT $15,040.50
C1822 110338 GEN, NEURO, HF, RECHG BAT $67,708.00
C1823 110339 GEN, NEURO, TRANS SEN/STIM $71,139.50
C1824 110340 GENERATOR, CCM, IMPLANT $79,204.50
C1825 110341 GEN, NEURO, CAROT SINUS BARO $81,084.00
C1826 110342 GEN, NEURO, CLO LOOP, RECHG $68,614.50
C1830 110343 POWER BONE MARROW BX NEEDLE $615.00
C1831 110344 PERSONALIZED INTERBODY CAGE $15,181.50
C1839 110345 IRIS PROSTHESIS $34,321.50
C1840 110346 TELESCOPIC INTRAOCULAR LENS $352.50
C1841 110347 RETINAL PROSTH INT/EXT COMP $111.50
C1849 110348 SKIN SUBSTITUTE, SYNTHETIC $33.50
C1874 110349 STENT, COATED/COV W/DEL SYS $9,209.50
C1875 110350 STENT, COATED/COV W/O DEL SY $1,526.50
C1876 110351 STENT, NON-COA/NON-COV W/DEL $6,878.00
C1877 110352 STENT, NON-COAT/COV W/O DEL $1,207.50
C1878 110353 MATRL FOR VOCAL CORD $3,012.00
C1880 110354 VENA CAVA FILTER $6,515.00
C1881 110355 DIALYSIS ACCESS SYSTEM $1,599.00
C1882 110356 AICD, OTHER THAN SING/DUAL $60,840.50
C1883 110357 ADAPT/EXT, PACING/NEURO LEAD $3,786.50
C1884 110358 EMBOLIZATION PROTECT SYST $5,792.50
C1885 110359 CATH, TRANSLUMIN ANGIO LASER $12,531.00
C1886 110360 CATHETER, ABLATION $7,435.50
C1887 110361 CATHETER, GUIDING $434.50
C1888 110362 ENDOVAS NON-CARDIAC ABL CATH $4,052.00
C1891 110363 INFUSION PUMP,NON-PROG, PERM $1,884.50
C1892 110364 INTRO/SHEATH,FIXED,PEEL-AWAY $606.00
C1893 110365 INTRO/SHEATH, FIXED,NON-PEEL $2,488.00
C1894 110366 INTRO/SHEATH, NON-LASER $268.50
C1895 110367 LEAD, AICD, ENDO DUAL COIL $15,990.50
C1896 110368 LEAD, AICD, NON SING/DUAL $16,829.50
C1897 110369 LEAD, NEUROSTIM TEST KIT $4,645.00
C1898 110370 LEAD, PMKR, OTHER THAN TRANS $2,054.00
C1899 110371 LEAD, PMKR/AICD COMBINATION $8,217.00
C1900 110372 LEAD, CORONARY VENOUS $7,219.00
C1982 110373 CATH, PRESSURE,VALVE-OCCLU $28,914.00
C2596 110374 PROBE, ROBOTIC, WATER-JET $12,895.00
C2613 110375 LUNG BX PLUG W/DEL SYS $1,233.50
C2614 110376 PROBE, PERC LUMB DISC $3,567.50
C2615 110377 SEALANT, PULMONARY, LIQUID $1,194.00
C2616 110378 BRACHYTX, NON-STR,YTTRIUM-90 $66,925.00
C2617 110379 STENT, NON-COR, TEM W/O DEL $827.00
C2618 110380 PROBE/NEEDLE, CRYO $8,034.00
C2619 110381 PMKR, DUAL, NON RATE-RESP $15,642.50
C2620 110382 PMKR, SINGLE, NON RATE-RESP $13,327.00
C2621 110383 PMKR, OTHER THAN SING/DUAL $24,534.50
C2622 110384 PROSTHESIS, PENILE, NON-INF $25,677.00
C2623 110385 CATH, TRANSLUMIN, DRUG-COAT $8,841.50
C2624 110386 WIRELESS PRESSURE SENSOR $67,289.50
C2625 110387 STENT, NON-COR, TEM W/DEL SY $1,469.50
C2626 110388 INFUSION PUMP, NON-PROG,TEMP $2,524.00
C2627 110389 CATH, SUPRAPUBIC/CYSTOSCOPIC $248.00
C2628 110390 CATHETER, OCCLUSION $1,081.50
C2629 110391 INTRO/SHEATH, LASER $255.50
C2630 110392 CATH, EP, COOL-TIP $11,308.50
C2631 110393 REP DEV, URINARY, W/O SLING $2,972.50
C2634 110394 BRACHYTX, NON-STR, HA, I-125 $1,101.00
C2635 110395 BRACHYTX, NON-STR, HA, P-103 $191.50
C2636 110396 BRACHY LINEAR, NON-STR,P-103 $426.50
C2638 110397 BRACHYTX, STRANDED, I-125 $145.00
C2639 110398 BRACHYTX, NON-STRANDED,I-125 $316.00
C2640 110399 BRACHYTX, STRANDED, P-103 $299.00
C2641 110400 BRACHYTX, NON-STRANDED,P-103 $203.50
C2642 110401 BRACHYTX, STRANDED, C-131 $147.00
C2643 110402 BRACHYTX, NON-STRANDED,C-131 $469.00
C2645 110403 BRACHYTX PLANAR, P-103 $58.50
C2698 110404 BRACHYTX, STRANDED, NOS $159.00
C5271 110405 LOW COST SKIN SUBSTITUTE APP $1,681.00
C7500 110413 DEB BONE 20 CM2 W/DRUG DEV $4,706.00
C7501 110414 PERC BX BREAST LESIONS STERO $4,706.00
C7502 110415 PERC BX BREAST LESIONS MR $4,706.00
C7503 110416 OPEN EXC CERV NODE(S) W/ ID $9,401.00
C7504 110417 PERQ CVT&LS INJ VERT BODIES $11,784.00
C7505 110418 PERQ LS&CVT INJ VERT BODIES $11,784.00
C7506 110419 FUSION OF FINGER JOINTS $11,784.00
C7507 110420 PERQ THOR&LUMB VERT AUG $21,771.50
C7508 110421 PERQ LUMB&THOR VERT AUG $21,771.50
C7509 110422 DX BRONCH W/ NAVIGATION $5,959.00
C7510 110423 BRONCH/LAVAG W/ NAVIGATION $5,959.00
C7511 110424 BRONCH/BPSY(S) W/ NAVIGATION $5,959.00
C7512 110425 BRONCH/BPSY(S) W/ EBUS $5,959.00
C7513 110426 CATH/ANGIO DIALCIR W/APLASTY $6,068.50
C7514 110427 CATH/ANGIO DIAL CIR W/STENTS $6,068.50
C7515 110428 CATH/ANGIO DIAL CIR W/EMBOL $6,068.50
C7516 110429 COR ANGIO W/ IVUS OR OCT $9,126.00
C7517 110430 COR ANGIO W/ILIC/FEM ANGIO $9,126.00
C7518 110431 COR/GFT ANGIO W/ IVUS OR OCT $9,126.00
C7519 110432 COR/GFT ANGIO W/ FLOW RESRV $9,126.00
C7520 110433 COR/GFT ANGIO W/ILIC/FEM ANG $9,126.00
C7521 110434 R HRT ANGIO W/ IVUS OR OCT $9,126.00
C7522 110435 R HRT ANGIO W/FLOW RESRV $9,126.00
C7523 110436 L HRT ANGIO W/ IVUS OR OCT $9,126.00
C7524 110437 L HRT ANGIO W/FLOW RESRV $9,126.00
C7525 110438 L HRT GFT ANG W/ IVUS OR OCT $9,126.00
C7526 110439 L HRT GFT ANG W/FLOW RESRV $9,126.00
C7527 110440 R&L HRT ANGIO W/ IVUS OR OCT $9,126.00
C7528 110441 R&L HRT ANGIO W/FLOW RESRV $9,126.00
C7529 110442 R&L HRT GFT ANG W/FLOW RESRV $9,126.00
C7530 110443 CATH/APLASTY DIAL CIR W/STNT $16,278.50
C7531 110444 ANGIO FEM/POP W/ US $18,986.00
C7532 110445 ANGIO W/ US NON-CORONARY $18,413.50
C7533 110446 PTCA W/ PLCMT BRACHYTX DEV $19,117.00
C7534 110447 FEM/POP REVASC W/ARTHR & US $31,976.50
C7535 110448 FEM/POP REVASC W/STENT & US $31,738.50
C7537 110449 INSRT ATRIL PM W/L VENT LEAD $32,005.00
C7538 110450 INSRT VENT PM W/L VENT LEAD $31,930.00
C7539 110451 INSRT A & V PM W/L VENT LEAD $32,451.00
C7540 110452 RMV&RPLC PM DUL W/L VNT LEAD $31,978.50
C7541 110453 ERCP W/ PANCREATOSCOPY $8,945.50
C7542 110454 ERCP W/BX & PANCREATOSCOPY $8,945.50
C7543 110455 ERCP W/OTOMY, PANCREATOSCOPY $8,945.50
C7544 110456 ERCP RMV CALC PANCREATOSCOPY $8,945.50
C7545 110457 EXCH BIL CATH W/ RMV CALCULI $8,945.50
C7546 110458 REP NPH/URT CATH W/DIL STRIC $6,257.00
C7547 110459 CNVRT NEPH CATH W/ DIL STRIC $7,098.50
C7548 110460 EXCH NEPH CATH W/ DIL STRIC $6,257.00
C7549 110461 CHGE URTR STENT W/ DIL STRIC $6,257.00
C7550 110462 CYSTO W/ BX(S) W/ BLUE LIGHT $6,257.00
C7551 110463 EXC NEUROMA W/ IMPLNT NV END $10,138.00
C7552 110464 R HRT ART/GRFT ANG HRT FLOW $9,126.00
C7553 110465 R&I HRT ART/VENT ANG DRG AD $9,126.00
C7554 110466 CYSTURETH BLU LI CYST FL IMG $3,850.50
C7555 110467 RMVL THYRD W/AUTOTRAN PARATH $15,364.50
C7900 110468 HOPD MNTL HLT, 15-29 MIN $219.00
C7901 110469 HOPD MNTL HLT, 30-60 MIN $321.00
C7902 110470 HOPD MNTL HLT, EA ADDL $66.00
C8900 110471 MRA W/CONT, ABD $3,161.00
C8901 110472 MRA W/O CONT, ABD $3,112.50
C8902 110473 MRA W/O FOL W/CONT, ABD $3,994.50
C8903 110474 MRI W/CONT, BREAST, UNI $3,275.50
C8905 110475 MRI W/O FOL W/CONT, BRST, UN $4,238.50
C8906 110476 MRI W/CONT, BREAST, BI $4,794.00
C8908 110477 MRI W/O FOL W/CONT, BREAST, $3,848.50
C8909 110478 MRA W/CONT, CHEST $3,445.00
C8910 110479 MRA W/O CONT, CHEST $3,631.50
C8911 110480 MRA W/O FOL W/CONT, CHEST $4,336.50
C8912 110481 MRA W/CONT, LWR EXT $3,993.00
C8913 110482 MRA W/O CONT, LWR EXT $3,455.00
C8914 110483 MRA W/O FOL W/CONT, LWR EXT $4,893.50
C8918 110484 MRA W/CONT, PELVIS $3,650.50
C8919 110485 MRA W/O CONT, PELVIS $2,604.50
C8920 110486 MRA W/O FOL W/CONT, PELVIS $3,995.50
C8921 110487 TTE W OR W/O FOL W/CONT, COM $2,344.00
C8922 110488 TTE W OR W/O FOL W/CONT, F/U $1,676.50
C8923 110489 2D TTE W OR W/O FOL W/CON,CO $6,746.00
C8924 110490 2D TTE W OR W/O FOL W/CON,FU $1,661.00
C8925 110491 2D TEE W OR W/O FOL W/CON,IN $4,020.50
C8926 110492 TEE W OR W/O FOL W/CONT,CONG $2,251.50
C8927 110493 TEE W OR W/O FOL W/CONT, MON $3,788.50
C8928 110494 TTE W OR W/O FOL W/CON,STRES $3,704.50
C8929 110495 TTE W OR WO FOL WCON,DOPPLER $4,537.50
C8930 110496 TTE W OR W/O CONTR, CONT ECG $3,011.00
C8931 110497 MRA, W/DYE, SPINAL CANAL $2,749.50
C8932 110498 MRA, W/O DYE, SPINAL CANAL $1,278.50
C8933 110499 MRA, W/O&W/DYE, SPINAL CANAL $3,497.50
C8934 110500 MRA, W/DYE, UPPER EXTREMITY $1,888.00
C8935 110501 MRA, W/O DYE, UPPER EXTR $1,278.50
C8936 110502 MRA, W/O&W/DYE, UPPER EXTR $3,464.00
C8937 110503 CAD BREAST MRI $304.50
C8957 110504 PROLONGED IV INF, REQ PUMP $749.00
C9046 110505 COCAINE HCL NASAL SOLUTION $7.00
C9047 110506 INJECTION, CAPLACIZUMAB-YHDP $3,178.00
C9067 110507 GALLIUM GA-68 DOTATOC $38.50
C9084 110508 LONCASTUXIMAB-LPYL, 0.1 MG $1,344.00
C9085 110509 INJ AVALGLUCOSID ALFA-NGPT $458.50
C9086 110510 INJ, ANIFROLUMAB-FNIA $128.00
C9087 110511 INJ CYCLOPHOSPHAMD AUROMEDIC $36.50
C9088 110512 INSTILL, BUPIVAC AND MELOXIC $3.00
C9091 110513 SIROLIMUS, PROTEIN-BOUND,1MG $347.00
C9094 110514 INJ, SUTIMLIMAB-JOME, 10 MG $79.00
C9095 110515 INJ, TEBENTAFUSP-TEBN, 1 MCG $1,087.50
C9097 110516 INJ, FARICIMAB-SVOA, 0.1 MG $264.00
C9098 110517 CILTACABTAGENE CAR POS T $946,634.03
C9101 110518 INJ, OLICERIDINE 0.1 MG $5.00
C9113 110519 INJ PANTOPRAZOLE SODIUM, VIA $31.50
C9143 110520 COCAINE HCL NASAL (NUMBRINO) $7.00
C9145 110521 INJ, APONVIE, 1 MG $10.00
C9146 110522 INJ, ELAHERE, 1 MG $277.50
C9147 110523 INJ, TREMELIMUMAB-ACTL, 1 MG $586.00
C9148 110524 INJ, TECLISTAMAB-CQYV, 0.5MG $120.00
C9149 110525 INJ, TEPLIZUMAB-MZWV, 5 MCG $161.50
C9151 110526 INJ, PEGCETACOPLAN 1 MG $877.00
C9153 110527 INJ, AMISULPRIDE, 1 MG $40.00
C9155 110528 INJ EPCORITAMAB-BYSP,0.16 MG $204.00
C9248 110529 INJ, CLEVIDIPINE BUTYRATE $13.00
C9250 110530 ARTISS FIBRIN SEALANT $851.00
C9254 110531 INJECTION, LACOSAMIDE $2.50
C9257 110532 BEVACIZUMAB INJECTION $13.00
C9285 110533 PATCH, LIDOCAINE/TETRACAINE $48.50
C9290 110534 INJ, BUPIVACAINE LIPOSOME $6.00
C9352 110535 NEURAGEN NERVE GUIDE, PER CM $4,287.00
C9353 110536 NEURAWRAP NERVE PROTECTOR,CM $5,420.50
C9354 110537 VERITAS COLLAGEN MATRIX, CM2 $238.00
C9355 110538 NEUROMATRIX NERVE CUFF, CM $3,848.00
C9356 110539 TENOGLIDE TENDON PROT, CM2 $461.00
C9358 110540 SURGIMEND, FETAL $52.50
C9359 110541 IMPLNT,BON VOID FILLER-PUTTY $4,884.00
C9360 110542 SURGIMEND, NEONATAL $68.00
C9361 110543 NEUROMEND NERVE WRAP $577.00
C9362 110544 IMPLNT,BON VOID FILLER-STRIP $410.50
C9363 110545 INTEGRA MESHED BIL WOUND MAT $231.00
C9460 110546 INJECTION, CANGRELOR $69.00
C9482 110547 SOTALOL HYDROCHLORIDE IV $110.50
C9488 110548 CONIVAPTAN HCL $303.00
C9507 110549 COVID-19 CONVALESCENT PLASMA $3,518.00
C9600 110550 PERC DRUG-EL COR STENT SING $37,971.00
C9601 110551 PERC DRUG-EL COR STENT BRAN $32,316.00
C9602 110552 PERC D-E COR STENT ATHER S $42,655.00
C9603 110553 PERC D-E COR STENT ATHER BR $20,815.00
C9604 110554 PERC D-E COR REVASC T CABG S $37,021.00
C9605 110555 PERC D-E COR REVASC T CABG B $19,273.50
C9606 110556 PERC D-E COR REVASC W AMI S $37,121.50
C9607 110557 PERC D-E COR REVASC CHRO SIN $31,535.50
C9608 110558 PERC D-E COR REVASC CHRO ADD $17,760.00
C9725 110559 PLACE ENDORECTAL APP $2,418.00
C9726 110560 RXT BREAST APPL PLACE/REMOV $4,032.00
C9727 110561 INSERT PALATE IMPLANTS $5,868.50
C9728 110562 PLACE DEVICE/MARKER, NON PRO $3,329.00
C9733 110563 NON-OPHTHALMIC FVA $1,068.50
C9734 110564 U/S TRTMT, NOT LEIOMYOMATA $38,323.00
C9738 110565 BLUE LIGHT CYSTO IMAG AGENT $4,045.00
C9739 110566 CYSTOSCOPY PROSTATIC IMP 1-3 $7,323.50
C9740 110567 CYSTO IMPL 4 OR MORE $9,028.50
C9751 110568 MICROWAVE BRONCH, 3D, EBUS $16,234.00
C9756 110569 FLUORESCENCE LYMPH MAP W/ICG $8,591.00
C9757 110570 SPINE DEVICE IMPLANT SURGERY $16,112.00
C9761 110571 CYSTO, LITHO, VACUUM KIDNEY $8,924.50
C9762 110572 CARDIAC MRI SEG DYS STRAIN $2,464.50
C9763 110573 CARDIAC MRI SEG DYS STRESS $2,464.50
C9764 110574 REVASC INTRAVASC LITHOTRIPSY $13,462.50
C9765 110575 REVASC INTRA LITHOTRIP-STENT $33,695.00
C9766 110576 REVASC INTRA LITHOTRIP-ATHER $30,224.50
C9767 110577 REVASC LITHOTRIP-STENT-ATHER $48,022.50
C9769 110578 CYSTO W/TEMP PROS IMPLANT $15,308.00
C9770 110579 VITREC/MECH PARS, SUBRET INJ $13,725.50
C9771 110580 NSL/SINS CRYO POST NASAL TIS $5,804.00
C9772 110581 REVASC LITHOTRIP TIBI/PERONE $18,702.00
C9773 110582 REVASC LITHOTR-STENT TIB/PER $28,541.00
C9774 110583 REVASC LITHOTR-ATHER TIB/PER $28,541.00
C9775 110584 REVASC LITH-STEN-ATH TIB/PER $50,407.50
C9776 110585 FLUO BILE DUCT IMAGING W/ICG $6,723.50
C9777 110586 ESOPHAG MUC INTEG W/ESO EGD $11,665.50
C9778 110587 COLPOPEXY, MIN/INV, EX-PERIT $15,885.00
C9779 110588 ESD ENDOSCOPY OR COLONOSCOPY $8,163.00
C9780 110589 INSERT CV CATH INF & SUP APP $26,626.00
C9781 110590 ARTHRO/SHOUL SURG; W/SPACER $22,458.50
C9789 110591 INSTILL PHARM RENAL PELVIS $9,380.50
C9790 110592 KIDNEY HISTOTRIPSY W/IMAGE $38,591.50
C9791 110593 MRI HYPERPOLARIZED XENON129 $5,777.50
C9793 110594 PRE-PLAN 3D MODEL W/CCTA $4,793.50
C9794 110595 COMPLEX SIMULATION W/PET-CT $8,336.50
C9795 110596 SBRT W/POSITRON EMISSION DEL $14,295.50
C9803 110597 HOPD COVID-19 SPEC COLLECT $75.50
C9898 110598 INPNT STAY RADIOLABELED ITEM $1.00
G0008 110599 ADMIN INFLUENZA VIRUS VAC $136.00
G0009 110600 ADMIN PNEUMOCOCCAL VACCINE $149.00
G0010 110601 ADMIN HEPATITIS B VACCINE $242.00
G0019 110602 COMM HLTH INTG SVS SDOH 60MN $803.00
G0023 110603 PIN SERVICE 60M PER MONTH $803.00
G0027 110604 SEMEN ANALYSIS $197.00
G0101 110605 CA SCREEN;PELVIC/BREAST EXAM $389.00
G0102 110606 PROSTATE CA SCREENING; DRE $126.00
G0103 110607 PSA SCREENING $281.00
G0104 110608 CA SCREEN;FLEXI SIGMOIDSCOPE $4,758.50
G0105 110609 COLORECTAL SCRN; HI RISK IND $3,980.00
G0106 110610 COLON CA SCREEN;BARIUM ENEMA $2,515.50
G0108 110611 DIAB MANAGE TRN PER INDIV $435.50
G0109 110612 DIAB MANAGE TRN IND/GROUP $234.00
G0117 110613 GLAUCOMA SCRN HGH RISK DIREC $1,011.00
G0118 110614 GLAUCOMA SCRN HGH RISK DIREC $294.00
G0120 110615 COLON CA SCRN; BARIUM ENEMA $4,760.00
G0121 110616 COLON CA SCRN NOT HI RSK IND $4,395.50
G0123 110617 SCREEN CERV/VAG THIN LAYER $288.00
G0124 110618 SCREEN C/V THIN LAYER BY MD $199.50
G0127 110619 TRIM NAIL(S) $196.50
G0128 110620 CORF SKILLED NURSING SERVICE $24.00
G0129 110621 PHP/IOP OT SERVICE $478.50
G0130 110622 SINGLE ENERGY X-RAY STUDY $582.50
G0140 110623 NAV SRV PEER SUP 60 MIN PR M $803.00
G0143 110624 SCR C/V CYTO,THINLAYER,RESCR $486.00
G0147 110627 SCR C/V CYTO, AUTOMATED SYS $162.50
G0148 110628 SCR C/V CYTO, AUTOSYS, RESCR $328.50
G0151 110629 HHCP-SERV OF PT,EA 15 MIN $153.00
G0152 110630 HHCP-SERV OF OT,EA 15 MIN $153.00
G0153 110631 HHCP-SVS OF S/L PATH,EA 15MN $160.00
G0155 110632 HHCP-SVS OF CSW,EA 15 MIN $170.00
G0156 110633 HHCP-SVS OF AIDE,EA 15 MIN $57.50
G0157 110634 HHC PT ASSISTANT EA 15 $356.00
G0166 110635 EXTRNL COUNTERPULSE, PER TX $1,324.00
G0168 110636 WOUND CLOSURE BY ADHESIVE $710.50
G0175 110637 OPPS SERVICE,SCHED TEAM CONF $2,063.50
G0176 110638 OPPS/PHP/IOP; ACTIVITY THRPY $481.00
G0177 110639 OPPS/PHP/IOP; TRAIN & EDUC $334.00
G0186 110640 DSTRY EYE LESN,FDR VSSL TECH $2,133.50
G0237 110641 THERAPEUTIC PROCD STRG ENDUR $223.50
G0238 110642 OTH RESP PROC, INDIV $208.50
G0239 110643 OTH RESP PROC, GROUP $148.00
G0245 110644 INITIAL FOOT EXAM PT LOPS $336.00
G0246 110645 FOLLOWUP EVAL OF FOOT PT LOP $553.50
G0247 110646 ROUTINE FOOTCARE PT W LOPS $454.50
G0257 110647 UNSCHED DIALYSIS ESRD PT HOS $6,688.00
G0259 110648 INJECT FOR SACROILIAC JOINT $4,566.00
G0260 110649 INJ FOR SACROILIAC JT ANESTH $2,699.50
G0268 110650 REMOVAL OF IMPACTED WAX MD $269.00
G0269 110651 OCCLUSIVE DEVICE IN VEIN ART $2,173.00
G0270 110652 MNT SUBS TX FOR CHANGE DX $199.50
G0271 110653 GROUP MNT 2 OR MORE 30 MINS $135.00
G0277 110654 HBOT, FULL BODY CHAMBER, 30M $3,448.00
G0279 110655 TOMOSYNTHESIS, MAMMO $190.50
G0281 110656 ELEC STIM UNATTEND FOR PRESS $29.00
G0282 110657 ELECT STIM WOUND CARE NOT PD $166.00
G0283 110658 ELEC STIM OTHER THAN WOUND $223.00
G0288 110659 RECON, CTA FOR SURG PLAN $3,361.50
G0289 110660 ARTHRO, LOOSE BODY + CHONDRO $9,110.00
G0296 110661 VISIT TO DETERM LDCT ELIG $271.50
G0299 110662 HHS/HOSPICE OF RN EA 15 MIN $137.50
G0300 110663 HHS/HOSPICE OF LPN EA 15 MIN $140.00
G0302 110664 PRE-OP SERVICE LVRS COMPLETE $3,810.50
G0303 110665 PRE-OP SERVICE LVRS 10-15DOS $1,167.00
G0304 110666 PRE-OP SERVICE LVRS 1-9 DOS $3,705.00
G0305 110667 POST OP SERVICE LVRS MIN 6 $3,705.00
G0306 110668 CBC/DIFFWBC W/O PLATELET $323.00
G0307 110669 CBC WITHOUT PLATELET $266.50
G0323 110670 CARE MANAGE BEH SVS 20MINS $149.00
G0328 110671 FECAL BLOOD SCRN IMMUNOASSAY $177.00
G0330 110672 FACILITY SVS DENTAL REHAB $12,543.50
G0339 110673 ROBOT LIN-RADSURG COM, FIRST $62,410.00
G0340 110674 ROBT LIN-RADSURG FRACTX 2-5 $37,367.00
G0378 110675 HOSPITAL OBSERVATION PER HR $205.50
G0379 110676 DIRECT REFER HOSPITAL OBSERV $2,872.00
G0380 110677 LEV 1 HOSP TYPE B ED VISIT $557.00
G0381 110678 LEV 2 HOSP TYPE B ED VISIT $683.00
G0382 110679 LEV 3 HOSP TYPE B ED VISIT $1,518.00
G0390 110682 TRAUMA RESPONS W/HOSP CRITI $15,145.50
G0396 110683 ALCOHOL/SUBS INTERV 15-30MN $754.00
G0397 110684 ALCOHOL/SUBS INTERV >30 MIN $972.50
G0402 110685 INITIAL PREVENTIVE EXAM $406.50
G0404 110686 EKG TRACING FOR INITIAL PREV $143.00
G0409 110687 CORF RELATED SERV 15 MINS EA $119.00
G0410 110688 GRP PSYCH PHP/IOP 45-50 $571.00
G0411 110689 INTERACTIVE GRP PSYC PHP/IOP $436.50
G0413 110690 PELVIC RING FRACTURE UNI/BIL $28,470.00
G0416 110691 PROSTATE BIOPSY, ANY MTHD $2,349.00
G0422 110692 INTENS CARDIAC REHAB W/EXERC $609.00
G0423 110693 INTENS CARDIAC REHAB NO EXER $609.00
G0424 110694 PULMONARY REHAB W EXER $593.50
G0429 110695 DERMAL FILLER INJECTION(S) $3,213.00
G0432 110696 EIA HIV-1/HIV-2 SCREEN $313.00
G0433 110697 ELISA HIV-1/HIV-2 SCREEN $320.00
G0435 110698 ORAL HIV-1/HIV-2 SCREEN $268.50
G0438 110699 PPPS, INITIAL VISIT $608.00
G0439 110700 PPPS, SUBSEQ VISIT $495.00
G0442 110701 ANNUAL ALCOHOL SCREEN 15 MIN $54.00
G0443 110702 BRIEF ALCOHOL MISUSE COUNSEL $682.00
G0444 110703 DEPRESSION SCREEN ANNUAL $150.50
G0445 110704 HIGH INTEN BEH COUNS STD 30M $284.00
G0446 110705 INTENS BEHAVE THER CARDIO DX $79.00
G0447 110706 BEHAVIOR COUNSEL OBESITY 15M $223.00
G0451 110707 DEVLOPMENT TEST INTERPT&REP $417.50
G0452 110708 MOLECULAR PATHOLOGY INTERPR $428.00
G0453 110709 CONT INTRAOP NEURO MONITOR $423.50
G0455 110710 FECAL MICROBIOTA PREP INSTIL $5,863.50
G0460 110711 AUTOLOG PRP NOT DIAB ULCER $8,751.50
G0463 110712 HOSPITAL OUTPT CLINIC VISIT $445.00
G0465 110713 AUTOLOG PRP DIAB WOUND ULCER $12,294.50
G0467 110714 FQHC VISIT, ESTAB PT $369.50
G0472 110715 HEP C SCREEN HIGH RISK/OTHER $246.00
G0473 110716 GROUP BEHAVE COUNS 2-10 $353.50
G0475 110717 HIV COMBINATION ASSAY $343.00
G0476 110718 HPV COMBO ASSAY CA SCREEN $434.00
G0480 110719 DRUG TEST DEF 1-7 CLASSES $625.50
G0481 110720 DRUG TEST DEF 8-14 CLASSES $1,367.00
G0482 110721 DRUG TEST DEF 15-21 CLASSES $1,607.00
G0483 110722 DRUG TEST DEF 22+ CLASSES $2,335.50
G0491 110723 DIALYSIS ACU KIDNEY NO ESRD $9,442.00
G0498 110724 CHEMO EXTEND IV INFUS W/PUMP $1,017.00
G0499 110725 HEPB SCREEN HIGH RISK INDIV $217.00
G0500 110726 MOD SEDAT ENDO SERVICE >5YRS $809.00
G0506 110727 COMP ASSES CARE PLAN CCM SVC $186.00
G0511 110728 CCM/BHI BY RHC/FQHC 20MIN MO $171.00
G0516 110729 INSERT DRUG DEL IMPLANT, >=4 $2,867.00
G0517 110730 REMOVE DRUG IMPLANT $2,867.00
G0518 110731 REMOVE W INSERT DRUG IMPLANT $2,867.00
G0659 110732 DRUG TEST DEF SIMPLE ALL CL $522.00
G2023 110733 SPECIMEN COLLECT COVID-19 $55.00
G2024 110734 SPEC COLL SNF/LAB COVID-19 $52.00
G2025 110735 DIS SITE TELE SVCS RHC/FQHC $312.50
G2066 110736 INTER DEVC REMOTE 30D $274.50
G2067 110737 MED ASSIST TX METH WK $889.00
G2068 110738 MED ASSIST TX BUPRE ORAL $970.50
G2074 110739 MED ASSIST TX NO DRUG $874.00
G2077 110740 PERIODIC ASSESSMENT $666.50
G2078 110741 TAKE-HOME METH $124.00
G2079 110742 TAKE-HOM BUPRENORPHINE $325.00
G2080 110743 ADD 30 MINS COUNSEL $100.50
G2082 110744 VISIT ESKETAMINE 56M OR LESS $7,007.00
G2083 110745 VISIT ESKETAMINE, > 56M $8,309.00
G2086 110746 OFF BASE OPIOID TX 70MIN $891.50
G2087 110747 OFF BASE OPIOID TX, 60 M $891.50
G2170 110748 AVF BY TISSUE W THERMAL E $70,399.00
G2171 110749 AVF USE MAGNETIC/ART/VEN $61,652.50
G2212 110750 PROLONG OUTPT/OFFICE VIS $123.50
G2214 110751 INIT/SUB PSYCH CARE M 1ST 30 $222.50
G2252 110752 BRIEF CHKIN BY MD/QHP, 11-20 $217.00
G6002 110753 STEREOSCOPIC X-RAY GUIDANCE $803.50
G6011 110754 RADIATION TREATMENT DELIVERY $1,746.50
G6015 110758 RADIATION TX DELIVERY IMRT $2,175.50
G6016 110759 DELIVERY COMP IMRT $5,733.50
G6017 110760 INTRAFRACTION TRACK MOTION $553.00
G9143 110761 WARFARIN RESPON GENETIC TEST $1,057.50
H0001 110762 ALCOHOL AND/OR DRUG ASSESS $909.00
H0002 110763 ALCOHOL AND/OR DRUG SCREENIN $1,067.50
H0003 110764 ALCOHOL AND/OR DRUG SCREENIN $71.00
H0004 110765 ALCOHOL AND/OR DRUG SERVICES $465.50
H0006 110767 ALCOHOL AND/OR DRUG SERVICES $1,855.50
H0022 110781 ALCOHOL AND/OR DRUG INTERVEN $474.50
H0025 110782 ALCOHOL AND/OR DRUG PREVENTI $669.00
H0031 110783 MH HEALTH ASSESS BY NON-MD $2,294.00
H0032 110784 MH SVC PLAN DEV BY NON-MD $277.50
H0033 110785 ORAL MED ADM DIRECT OBSERVE $1,798.00
H0035 110786 MH PARTIAL HOSP TX UNDER 24H $2,376.50
H0036 110787 COMM PSY FACE-FACE PER 15MIN $90.50
H0037 110788 COMM PSY SUP TX PGM PER DIEM $4,000.00
H0038 110789 SELF-HELP/PEER SVC PER 15MIN $49.50
H0039 110790 ASSER COM TX FACE-FACE/15MIN $153.00
H0040 110791 ASSERT COMM TX PGM PER DIEM $2,857.00
H0048 110792 SPEC COLL NON-BLOOD:A/D TEST $2,653.50
H0049 110793 ALCOHOL/DRUG SCREENING $174.00
H0050 110794 ALCOHOL/DRUG SERVICE 15 MIN $501.00
H1010 110795 NONMED FAMILY PLANNING ED $2,787.50
H2001 110796 REHABILITATION PROGRAM 1/2 D $405.00
H2010 110797 COMPREHENSIVE MED SVC 15 MIN $237.00
H2011 110798 CRISIS INTERVEN SVC, 15 MIN $582.50
H2012 110799 BEHAV HLTH DAY TREAT, PER HR $33.00
H2013 110800 PSYCH HLTH FAC SVC, PER DIEM $3,559.00
H2015 110801 COMP COMM SUPP SVC, 15 MIN $132.00
H2016 110802 COMP COMM SUPP SVC, PER DIEM $1,384.50
H2017 110803 PSYSOC REHAB SVC, PER 15 MIN $72.50
H2018 110804 PSYSOC REHAB SVC, PER DIEM $1,508.50
H2019 110805 THER BEHAV SVC, PER 15 MIN $66.50
H2020 110806 THER BEHAV SVC, PER DIEM $1,926.00
H2021 110807 COM WRAP-AROUND SV, 15 MIN $58.00
H2027 110808 PSYCHOED SVC, PER 15 MIN $113.00
H2032 110809 ACTIVITY THERAPY, PER 15 MIN $157.50
H2035 110810 A/D TX PROGRAM, PER HOUR $571.50
H2036 110811 A/D TX PROGRAM, PER DIEM $2,993.00
J0120 110812 TETRACYCLIN INJECTION $146.50
J0121 110813 INJ., OMADACYCLINE, 1 MG $26.00
J0122 110814 INJ., ERAVACYCLINE, 1 MG $10.00
J0129 110815 ABATACEPT INJECTION $332.50
J0131 110816 INJ, ACETAMINOPHEN (NOS) $2.00
J0132 110817 ACETYLCYSTEINE INJECTION $27.00
J0133 110818 ACYCLOVIR INJECTION $1.00
J0134 110819 INJ ACETAMINOPHEN -FRESENIUS $1.00
J0135 110820 ADALIMUMAB INJECTION $9,372.00
J0136 110821 INJ, ACETAMINOPHEN (B BRAUN) $1.00
J0137 110822 INJ, ACETAMINOPHEN (HIKMA) $1.00
J0153 110823 ADENOSINE INJ 1MG $13.00
J0171 110824 ADRENALIN EPINEPHRINE INJECT $10.00
J0172 110825 INJ, ADUCANUMAB-AVWA, 2 MG $61.50
J0173 110826 INJ, EPINEPHRINE (BELCHER) $5.00
J0178 110827 AFLIBERCEPT INJECTION $5,984.00
J0179 110828 INJ, BROLUCIZUMAB-DBLL, 1 MG $1,830.00
J0180 110829 AGALSIDASE BETA INJECTION $836.00
J0185 110830 INJ., APREPITANT, 1 MG $21.00
J0202 110831 INJECTION, ALEMTUZUMAB $10,689.50
J0208 110832 INJ SODIUM THIOSULFATE 100MG $932.00
J0217 110833 INJ VELMANASE ALFA-TYCV 1 MG $2,615.00
J0218 110834 INJ OLIPUDASE ALFA-RPCP 1MG $2,251.00
J0219 110835 INJ AVAL ALFA-NQPT 4MG $481.00
J0220 110836 ALGLUCOSIDASE ALFA INJECTION $896.00
J0221 110837 LUMIZYME INJECTION $964.50
J0222 110838 INJ., PATISIRAN, 0.1 MG $312.00
J0223 110839 INJ GIVOSIRAN 0.5 MG $764.50
J0224 110840 INJ. LUMASIRAN, 0.5 MG $1,768.50
J0225 110841 INJ, VUTRISIRAN, 1 MG $19,674.50
J0248 110842 INJ, REMDESIVIR, 1 MG $25.00
J0256 110843 ALPHA 1 PROTEINASE INHIBITOR $26.50
J0257 110844 GLASSIA INJECTION $26.50
J0270 110845 ALPROSTADIL FOR INJECTION $47.50
J0278 110846 AMIKACIN SULFATE INJECTION $11.50
J0280 110847 AMINOPHYLLIN 250 MG INJ $63.00
J0282 110848 AMIODARONE HCL $31.00
J0283 110849 INJ, AMIODARONE (NEXTERONE) $29.00
J0285 110850 AMPHOTERICIN B $269.00
J0287 110851 AMPHOTERICIN B LIPID COMPLEX $43.00
J0289 110852 AMPHOTERICIN B LIPOSOME INJ $264.00
J0290 110853 AMPICILLIN 500 MG INJ $16.50
J0291 110854 INJ., PLAZOMICIN, 5 MG $20.50
J0295 110855 AMPICILLIN SULBACTAM 1.5 GM $49.50
J0300 110856 AMOBARBITAL 125 MG INJ $1,027.50
J0330 110857 SUCCINYCHOLINE CHLORIDE INJ $12.50
J0348 110858 ANIDULAFUNGIN INJECTION $9.00
J0360 110859 HYDRALAZINE HCL INJECTION $66.00
J0390 110860 CHLOROQUINE INJECTION $14.50
J0400 110861 ARIPIPRAZOLE INJECTION $73.00
J0401 110862 INJ ARIPIPRAZOLE EXT REL 1MG $20.50
J0456 110863 AZITHROMYCIN $56.50
J0457 110864 INJECTION, AZTREONAM, 100 MG $15.00
J0461 110865 ATROPINE SULFATE INJECTION $1.00
J0470 110866 DIMECAPROL INJECTION $403.50
J0475 110867 BACLOFEN 10 MG INJECTION $1,149.00
J0476 110868 BACLOFEN INTRATHECAL TRIAL $613.50
J0480 110869 BASILIXIMAB $15,376.00
J0485 110870 BELATACEPT INJECTION $19.00
J0490 110871 BELIMUMAB INJECTION $307.50
J0491 110872 INJ ANIFROLUMAB-FNIA 1MG $68.00
J0500 110873 DICYCLOMINE INJECTION $342.00
J0515 110874 INJ BENZTROPINE MESYLATE $138.50
J0517 110875 INJ., BENRALIZUMAB, 1 MG $1,171.00
J0558 110876 PENG BENZATHINE/PROCAINE INJ $182.00
J0561 110877 PENICILLIN G BENZATHINE INJ $141.00
J0565 110878 INJ, BEZLOTOXUMAB, 10 MG $187.00
J0567 110879 INJ., CERLIPONASE ALFA 1 MG $634.00
J0570 110880 BUPRENORPHINE IMPLANT 74.2MG $4,839.50
J0571 110881 BUPRENORPHINE ORAL 1MG $8.00
J0572 110882 BUPREN/NAL UP TO 3MG BUPRENO $24.50
J0573 110883 BUPREN/NAL 3.1 TO 6MG BUPREN $31.00
J0574 110884 BUPREN/NAL 6.1 TO 10MG BUPRE $39.50
J0575 110885 BUPREN/NAL OVER 10MG BUPRENO $43.50
J0583 110886 BIVALIRUDIN $7.00
J0584 110887 INJECTION, BUROSUMAB-TWZA 1M $1,962.00
J0585 110888 INJECTION,ONABOTULINUMTOXINA $34.00
J0586 110889 ABOBOTULINUMTOXINA $54.50
J0587 110890 INJ, RIMABOTULINUMTOXINB $57.00
J0588 110891 INCOBOTULINUMTOXIN A $25.00
J0592 110892 BUPRENORPHINE HYDROCHLORIDE $44.50
J0594 110893 BUSULFAN INJECTION $61.00
J0595 110894 BUTORPHANOL TARTRATE 1 MG $28.50
J0596 110895 INJECTION, RUCONEST $269.50
J0597 110896 C-1 ESTERASE, BERINERT $253.00
J0598 110897 C-1 ESTERASE, CINRYZE $320.50
J0600 110898 EDETATE CALCIUM DISODIUM INJ $15,687.50
J0604 110899 CINACALCET, ESRD ON DIALYSIS $2.00
J0606 110900 INJ, ETELCALCETIDE, 0.1 MG $33.50
J0610 110901 CALCIUM GLUCON (FRESENIUS) $50.50
J0612 110902 CALCIUM GLUCON (FRESENIUS) $1.00
J0613 110903 CALCIUM GLUCON (WG CRITICAL) $1.00
J0630 110904 CALCITONIN SALMON INJECTION $12,412.00
J0636 110905 INJ CALCITRIOL PER 0.1 MCG $48.50
J0637 110906 CASPOFUNGIN ACETATE $174.50
J0638 110907 CANAKINUMAB INJECTION $496.00
J0640 110908 LEUCOVORIN CALCIUM INJECTION $49.00
J0641 110909 INJ LEVOLEUCOVORIN NOS 0.5MG $2.00
J0642 110910 INJECTION, KHAPZORY, 0.5 MG $32.00
J0665 110911 INJ, BUPIVACAINE, NOS, 0.5MG #NUM!
J0670 110912 INJ MEPIVACAINE HCL/10 ML $14.50
J0689 110913 INJ CEFAZOLIN SODIUM, BAXTER $19.50
J0690 110914 CEFAZOLIN SODIUM INJECTION $8.50
J0691 110915 INJ LEFAMULIN 1 MG $173.50
J0692 110916 CEFEPIME HCL FOR INJECTION $21.00
J0694 110917 CEFOXITIN SODIUM INJECTION $41.00
J0695 110918 INJ CEFTOLOZANE TAZOBACTAM $29.00
J0696 110919 CEFTRIAXONE SODIUM INJECTION $22.00
J0697 110920 STERILE CEFUROXIME INJECTION $39.50
J0698 110921 CEFOTAXIME SODIUM INJECTION $79.50
J0699 110922 INJ, CEFIDEROCOL, 10 MG $19.50
J0701 110923 INJ. CEFEPIME HCL (BAXTER) $75.00
J0702 110924 BETAMETHASONE ACET&SOD PHOSP $56.00
J0703 110925 INJ, CEFEPIME HCL (B BRAUN) $71.00
J0706 110926 CAFFEINE CITRATE INJECTION $23.00
J0712 110927 CEFTAROLINE FOSAMIL INJ $19.50
J0713 110928 INJ CEFTAZIDIME PER 500 MG $268.00
J0714 110929 CEFTAZIDIME AND AVIBACTAM $563.50
J0716 110930 CENTRUROIDES IMMUNE F(AB) $16,982.50
J0717 110931 CERTOLIZUMAB PEGOL INJ 1MG $47.00
J0720 110932 CHLORAMPHENICOL SODIUM INJEC $306.50
J0725 110933 CHORIONIC GONADOTROPIN/1000U $60.00
J0735 110934 CLONIDINE HYDROCHLORIDE $172.00
J0736 110935 INJ, CLINDAMYCIN PHOSP 300MG $32.00
J0737 110936 INJ, CLINDAMYCIN (BAXTER) $29.00
J0739 110937 INJECTION, CABOTEGRAVIR 1 MG $36.50
J0740 110938 CIDOFOVIR INJECTION $4,727.00
J0741 110939 INJ, CABOTE RILPIVIR 2MG 3MG $108.50
J0742 110940 INJ IMIP 4 CILAS 4 RELEB 2MG $15.50
J0743 110941 CILASTATIN SODIUM INJECTION $96.00
J0744 110942 CIPROFLOXACIN IV $14.00
J0745 110943 INJ CODEINE PHOSPHATE /30 MG $494.50
J0770 110944 COLISTIMETHATE SODIUM INJ $245.50
J0775 110945 COLLAGENASE, CLOST HIST INJ $240.00
J0780 110946 PROCHLORPERAZINE INJECTION $109.50
J0791 110947 INJ CRIZANLIZUMAB-TMCA 5MG $750.50
J0800 110948 CORTICOTROPIN INJECTION $11,946.00
J0801 110949 INJ. ACTHAR GEL TO 40 UNITS $16,736.00
J0802 110950 INJ. (ANI), UP TO 40 UNITS $14,653.50
J0834 110951 INJ., COSYNTROPIN, 0.25 MG $432.50
J0840 110952 CROTALIDAE POLY IMMUNE FAB $20,301.00
J0841 110953 INJ CROTALIDAE IM F(AB')2 EQ $8,811.00
J0850 110954 CYTOMEGALOVIRUS IMM IV /VIAL $7,871.00
J0875 110955 INJECTION, DALBAVANCIN $110.50
J0877 110956 INJ, DAPTOMYCIN (HOSPIRA) $1.00
J0878 110957 DAPTOMYCIN INJECTION $1.00
J0879 110958 DIFELIKEFALIN, ESRD ON DIALY #NUM!
J0881 110959 DARBEPOETIN ALFA, NON-ESRD $38.50
J0882 110960 DARBEPOETIN ALFA, ESRD USE $65.00
J0883 110961 ARGATROBAN NONESRD USE 1MG $10.00
J0884 110962 ARGATROBAN ESRD DIALYSIS 1MG $25.00
J0885 110963 EPOETIN ALFA, NON-ESRD $38.00
J0887 110964 EPOETIN BETA ESRD USE $202.00
J0888 110965 EPOETIN BETA NON ESRD $198.00
J0891 110966 ARGATROBAN NONESRD (ACCORD) $12.50
J0892 110967 ARGATROBAN DIALYSIS (ACCORD) $12.50
J0893 110968 INJ, DECITABINE (SUN PHARMA) $28.00
J0894 110969 DECITABINE INJECTION $46.00
J0895 110970 DEFEROXAMINE MESYLATE INJ $105.50
J0896 110971 INJ LUSPATERCEPT-AAMT 0.25MG $158.00
J0897 110972 DENOSUMAB INJECTION $113.50
J0898 110973 ARGATROBAN NONESRD (AUROMED) $35.00
J0899 110974 ARGATROBAN DIALYSIS, AUROMED $35.00
J1000 110975 DEPO-ESTRADIOL CYPIONATE INJ $193.50
J1020 110976 METHYLPREDNISOLONE 20 MG INJ $47.50
J1050 110979 MEDROXYPROGESTERONE ACETATE $2.00
J1071 110980 INJ TESTOSTERONE CYPIONATE $1.00
J1094 110981 INJ DEXAMETHASONE ACETATE $18.50
J1095 110982 INJECTION, DEXAMETHASONE 9% $8.50
J1096 110983 DEXAMETHA OPTH INSERT 0.1 MG $1,031.50
J1097 110984 PHENYLEP KETOROLAC OPTH SOLN $670.50
J1100 110985 DEXAMETHASONE SODIUM PHOS $3.00
J1110 110986 INJ DIHYDROERGOTAMINE MESYLT $650.50
J1120 110987 ACETAZOLAMID SODIUM INJECTIO $198.00
J1160 110988 DIGOXIN INJECTION $35.50
J1162 110989 DIGOXIN IMMUNE FAB (OVINE) $25,866.50
J1165 110990 PHENYTOIN SODIUM INJECTION $9.00
J1170 110991 HYDROMORPHONE INJECTION $33.00
J1190 110992 DEXRAZOXANE HCL INJECTION $1,781.00
J1200 110993 DIPHENHYDRAMINE HCL INJECTIO $13.50
J1201 110994 INJ. CETIRIZINE HCL 0.5MG $189.00
J1205 110995 CHLOROTHIAZIDE SODIUM INJ $299.00
J1212 110996 DIMETHYL SULFOXIDE 50% 50 ML $2,612.00
J1230 110997 METHADONE INJECTION $92.00
J1240 110998 DIMENHYDRINATE INJECTION $65.00
J1245 110999 DIPYRIDAMOLE INJECTION $39.00
J1250 111000 INJ DOBUTAMINE HCL/250 MG $120.00
J1265 111001 DOPAMINE INJECTION $7.00
J1270 111002 INJECTION, DOXERCALCIFEROL $309.00
J1290 111003 ECALLANTIDE INJECTION $2,600.00
J1300 111004 ECULIZUMAB INJECTION $1,072.00
J1301 111005 INJECTION, EDARAVONE, 1 MG $97.00
J1302 111006 INJ, SUTIMLIMAB-JOME, 10 MG $80.00
J1303 111007 INJ., RAVULIZUMAB-CWVZ 10 MG $936.00
J1305 111008 INJ, EVINACUMAB-DGNB, 5MG $513.00
J1306 111009 INJECTION, INCLISIRAN, 1 MG $48.50
J1322 111010 ELOSULFASE ALFA, INJECTION $1,458.50
J1325 111011 EPOPROSTENOL INJECTION $117.50
J1327 111012 EPTIFIBATIDE INJECTION $83.00
J1335 111013 ERTAPENEM INJECTION $254.00
J1364 111014 ERYTHRO LACTOBIONATE /500 MG $482.00
J1380 111015 ESTRADIOL VALERATE 10 MG INJ $96.00
J1410 111016 INJ ESTROGEN CONJUGATE 25 MG $3,821.00
J1411 111017 INJ, HEMGENIX, PER TX DOSE $4,425,490.62
J1412 111018 INJ ROCTAVIAN ML 2X10^13VC G $40,431.50
J1413 111019 INJ DELANDISTROGENE MOX ROKL $4,112,325.52
J1426 111020 INJECTION, CASIMERSEN, 10 MG $1,104.00
J1427 111021 INJ. VILTOLARSEN $195.00
J1428 111022 INJ, ETEPLIRSEN, 10 MG $1,163.50
J1429 111023 INJ GOLODIRSEN 10 MG $1,142.00
J1430 111024 ETHANOLAMINE OLEATE 100 MG $3,280.50
J1437 111025 INJ. FE DERISOMALTOSE 10 MG $123.00
J1438 111026 ETANERCEPT INJECTION $3,972.50
J1439 111027 INJ FERRIC CARBOXYMALTOS 1MG $9.50
J1442 111028 INJ FILGRASTIM EXCL BIOSIMIL $11.00
J1447 111029 INJ TBO FILGRASTIM 1 MICROG $9.50
J1448 111030 INJECTION, TRILACICLIB, 1MG $33.00
J1449 111031 INJ EFLAPEGRASTIM-XNST 0.1MG $305.50
J1450 111032 FLUCONAZOLE $48.50
J1451 111033 FOMEPIZOLE, 15 MG $69.00
J1453 111034 FOSAPREPITANT INJECTION $3.00
J1454 111035 INJ FOSNETUPITANT, PALONOSET $2,802.50
J1455 111036 FOSCARNET SODIUM INJECTION $420.00
J1456 111037 INJ, FOSAPREPITANT (TEVA) $8.50
J1458 111038 GALSULFASE INJECTION $877.00
J1459 111039 INJ IVIG PRIVIGEN 500 MG $440.00
J1460 111040 GAMMA GLOBULIN 1 CC INJ $434.50
J1551 111041 INJ CUTAQUIG 100 MG $140.50
J1554 111042 INJ. ASCENIV $2,617.00
J1555 111043 INJ CUVITRU, 100 MG $82.50
J1556 111044 INJ, IMM GLOB BIVIGAM, 500MG $365.00
J1557 111045 GAMMAPLEX INJECTION $442.00
J1558 111046 INJ. XEMBIFY, 100 MG $154.00
J1559 111047 HIZENTRA INJECTION $137.50
J1560 111048 GAMMA GLOBULIN > 10 CC INJ $2,652.00
J1561 111049 GAMUNEX-C/GAMMAKED $387.00
J1566 111050 IMMUNE GLOBULIN, POWDER $404.50
J1568 111051 OCTAGAM INJECTION $358.00
J1569 111052 GAMMAGARD LIQUID INJECTION $392.00
J1570 111053 GANCICLOVIR SODIUM INJECTION $509.50
J1571 111054 HEPAGAM B IM INJECTION $246.00
J1572 111055 FLEBOGAMMA INJECTION $263.00
J1573 111056 HEPAGAM B INTRAVENOUS, INJ $421.00
J1575 111057 HYQVIA 100MG IMMUNEGLOBULIN $177.50
J1580 111058 GARAMYCIN GENTAMICIN INJ $20.00
J1595 111059 INJECTION GLATIRAMER ACETATE $625.00
J1599 111060 IVIG NON-LYOPHILIZED, NOS $231.00
J1602 111061 GOLIMUMAB FOR IV USE 1MG $145.00
J1610 111062 GLUCAGON HYDROCHLORIDE/1 MG $821.00
J1611 111063 INJ GLUCAGON HCL, FRESENIUS $809.00
J1626 111064 GRANISETRON HCL INJECTION $4.00
J1627 111065 INJ, GRANISETRON, XR, 0.1 MG $40.50
J1628 111066 INJ., GUSELKUMAB, 1 MG $512.50
J1630 111067 HALOPERIDOL INJECTION $34.00
J1631 111068 HALOPERIDOL DECANOATE INJ $134.00
J1632 111069 INJ., BREXANOLONE, 1 MG $214.50
J1640 111070 HEMIN, 1 MG $69.00
J1642 111071 INJ HEPARIN SODIUM PER 10 U $1.00
J1643 111072 INJ HEPARIN, PFIZER, 1000U $4.00
J1644 111073 INJ HEPARIN SODIUM PER 1000U $20.50
J1645 111074 DALTEPARIN SODIUM $118.00
J1650 111075 INJ ENOXAPARIN SODIUM $18.00
J1652 111076 FONDAPARINUX SODIUM $14.00
J1670 111077 TETANUS IMMUNE GLOBULIN INJ $4,040.00
J1710 111078 HYDROCORTISONE SODIUM PH INJ $23.00
J1720 111079 HYDROCORTISONE SODIUM SUCC I $165.00
J1726 111080 MAKENA, 10 MG $195.00
J1729 111081 INJ HYDROXYPROGST CAPOAT NOS $100.50
J1738 111082 INJ. MELOXICAM 1 MG $35.00
J1740 111083 IBANDRONATE SODIUM INJECTION $568.50
J1741 111084 IBUPROFEN INJECTION $18.50
J1742 111085 IBUTILIDE FUMARATE INJECTION $2,452.00
J1743 111086 IDURSULFASE INJECTION $3,474.00
J1744 111087 ICATIBANT INJECTION $1,856.00
J1745 111088 INFLIXIMAB NOT BIOSIMIL 10MG $736.00
J1746 111089 INJ., IBALIZUMAB-UIYK, 10 MG $429.00
J1747 111090 INJ, SPESOLIMAB-SBZO, 1 MG $511.50
J1750 111091 INJ IRON DEXTRAN $68.00
J1756 111092 IRON SUCROSE INJECTION $36.00
J1786 111093 IMUGLUCERASE INJECTION $271.00
J1790 111094 DROPERIDOL INJECTION $46.00
J1800 111095 PROPRANOLOL INJECTION $104.50
J1805 111096 INJ, ESMOLOL HCL, 10MG $7.00
J1806 111097 INJ ESMOLOL HCL WG CRIT CARE $3.00
J1815 111098 INSULIN INJECTION $7.00
J1817 111099 INSULIN FOR INSULIN PUMP USE $23.50
J1823 111100 INJ. INEBILIZUMAB-CDON, 1 MG $2,407.00
J1826 111101 INTERFERON BETA-1A INJ $13,895.50
J1833 111102 INJECTION, ISAVUCONAZONIUM $5.00
J1836 111103 INJ, METRONIDAZOLE, 10 MG $1.00
J1885 111104 KETOROLAC TROMETHAMINE INJ $18.50
J1920 111105 INJ, LABETALOL HCL, 5MG $11.00
J1930 111106 LANREOTIDE INJECTION $317.00
J1931 111107 LARONIDASE INJECTION $261.50
J1932 111108 INJ, LANREOTIDE, (CIPLA) 1MG $428.00
J1940 111109 FUROSEMIDE INJECTION $12.00
J1943 111110 INJ., ARISTADA INITIO, 1 MG $41.50
J1944 111111 ARIPIRAZOLE LAUROXIL 1 MG $26.00
J1950 111112 LEUPROLIDE ACETATE /3.75 MG $9,834.00
J1951 111113 INJ FENSOLVI 0.25 MG $891.50
J1952 111114 LEUPROLIDE INJ, CAMCEVI, 1MG $693.00
J1953 111115 LEVETIRACETAM INJECTION $2.00
J1954 111116 LEUPROLIDE DEPOT CIPLA 7.5MG $2,479.50
J1955 111117 INJ LEVOCARNITINE PER 1 GM $82.00
J1956 111118 LEVOFLOXACIN INJECTION $22.00
J1980 111119 HYOSCYAMINE SULFATE INJ $199.00
J2001 111120 LIDOCAINE INJECTION $4.00
J2010 111121 LINCOMYCIN INJECTION $125.00
J2020 111122 LINEZOLID INJECTION $84.00
J2021 111123 INJ, LINEZOLID (HOSPIRA) $180.50
J2060 111124 LORAZEPAM INJECTION $12.50
J2150 111125 MANNITOL INJECTION $23.00
J2175 111126 MEPERIDINE HYDROCHL /100 MG $158.00
J2180 111127 MEPERIDINE/PROMETHAZINE INJ $49.50
J2182 111128 INJECTION, MEPOLIZUMAB, 1MG $218.00
J2184 111129 INJ, MEROPENEM (B. BRAUN) $35.50
J2185 111130 MEROPENEM $12.50
J2186 111131 INJ., MEROPENEM, VABORBACTAM $11.50
J2210 111132 METHYLERGONOVIN MALEATE INJ $166.50
J2212 111133 METHYLNALTREXONE INJECTION $6.00
J2247 111134 INJ, MICAFUNGIN (PAR PHARM) $5.00
J2248 111135 MICAFUNGIN SODIUM INJECTION $9.00
J2249 111136 INJ, REMIMAZOLAM, 1 MG $18.50
J2250 111137 INJ MIDAZOLAM HYDROCHLORIDE $7.00
J2251 111138 INJ MIDAZOLAM (WG CRIT CARE) $3.00
J2260 111139 INJ MILRINONE LACTATE / 5 MG $25.00
J2265 111140 MINOCYCLINE HYDROCHLORIDE $19.00
J2270 111141 MORPHINE SULFATE INJECTION $73.50
J2272 111142 INJ, MORPHINE (FRESENIUS) $24.50
J2274 111143 INJ MORPHINE PF EPID ITHC $56.00
J2278 111144 ZICONOTIDE INJECTION $68.50
J2280 111145 INJ, MOXIFLOXACIN 100 MG $48.00
J2281 111146 INJ MOXIFLOXACIN (FRES KABI) $47.00
J2300 111147 INJ NALBUPHINE HYDROCHLORIDE $117.00
J2305 111148 INJ, NITROGLYCERIN, 5 MG $16.00
J2310 111149 INJ NALOXONE HYDROCHLORIDE $184.50
J2311 111150 INJ, NALOXONE HCL (ZIMHI) $105.50
J2315 111151 NALTREXONE, DEPOT FORM $30.00
J2323 111152 NATALIZUMAB INJECTION $123.50
J2326 111153 INJ, NUSINERSEN, 0.1MG $4,501.50
J2327 111154 INJ RISANKIZUMAB-RZAA 1 MG $66.00
J2350 111155 INJECTION, OCRELIZUMAB, 1 MG $266.00
J2353 111156 OCTREOTIDE INJECTION, DEPOT $1,365.50
J2354 111157 OCTREOTIDE INJ, NON-DEPOT $16.00
J2356 111158 INJ TEZEPELUMAB-EKKO, 1MG $191.50
J2357 111159 OMALIZUMAB INJECTION $342.00
J2358 111160 OLANZAPINE LONG-ACTING INJ $41.00
J2360 111161 ORPHENADRINE INJECTION $204.50
J2370 111162 PHENYLEPHRINE HCL INJECTION $19.50
J2371 111163 INJ PHENYLEPHRINE HCL 20 MCG #NUM!
J2372 111164 INJ, BIORPHEN, 20 MICROGRAMS $2.00
J2400 111165 CHLOROPROCAINE HCL INJECTION $130.00
J2401 111166 CHLOROPROCAINE HCL INJECTION #NUM!
J2402 111167 CHLOROPROCAINE (CLOROTEKAL) $2.00
J2403 111168 CHLOROPROCAINE OPHT GEL, 1MG $14.50
J2405 111169 ONDANSETRON HCL INJECTION $3.00
J2406 111170 INJECTION, ORITAVANCIN 10 MG $371.00
J2407 111171 INJECTION, ORITAVANCIN $151.50
J2425 111172 PALIFERMIN INJECTION $151.50
J2426 111173 INJ, INVEGA SUSTENNA, 1 MGJ $88.00
J2430 111174 PAMIDRONATE DISODIUM /30 MG $140.00
J2440 111175 PAPAVERIN HCL INJECTION $249.50
J2469 111176 PALONOSETRON HCL $30.00
J2502 111177 INJ, PASIREOTIDE LONG ACTING $1,646.50
J2506 111178 INJ PEGFILGRAST EX BIO 0.5MG $2,257.00
J2507 111179 PEGLOTICASE INJECTION $11,488.00
J2508 111180 PEGUNIGALSIDASE ALFA-IWXJ $1,523.00
J2510 111181 PENICILLIN G PROCAINE INJ $277.50
J2515 111182 PENTOBARBITAL SODIUM INJ $415.50
J2540 111183 PENICILLIN G POTASSIUM INJ $9.00
J2543 111184 PIPERACILLIN/TAZOBACTAM $36.00
J2545 111185 PENTAMIDINE NON-COMP UNIT $763.50
J2547 111186 INJECTION, PERAMIVIR $29.50
J2550 111187 PROMETHAZINE HCL INJECTION $11.00
J2560 111188 PHENOBARBITAL SODIUM INJ $186.50
J2562 111189 PLERIXAFOR INJECTION $2,781.00
J2590 111190 OXYTOCIN INJECTION $146.00
J2597 111191 INJ DESMOPRESSIN ACETATE $100.00
J2598 111192 INJ, VASOPRESSIN, 1 UNIT $44.00
J2599 111193 INJ VASOPRESSIN (AM REG) 1 U $37.00
J2675 111194 INJ PROGESTERONE PER 50 MG $43.00
J2680 111195 FLUPHENAZINE DECANOATE 25 MG $117.00
J2690 111196 PROCAINAMIDE HCL INJECTION $786.00
J2700 111197 OXACILLIN SODIUM INJECITON $22.50
J2704 111198 INJ, PROPOFOL, 10 MG $1.00
J2710 111199 NEOSTIGMINE METHYLSLFTE INJ $10.00
J2720 111200 INJ PROTAMINE SULFATE/10 MG $24.00
J2724 111201 PROTEIN C CONCENTRATE $139.00
J2730 111202 PRALIDOXIME CHLORIDE INJ $18.50
J2760 111203 PHENTOLAINE MESYLATE INJ $2,046.00
J2765 111204 METOCLOPRAMIDE HCL INJECTION $12.50
J2770 111205 QUINUPRISTIN/DALFOPRISTIN $2,023.00
J2777 111206 INJ, FARICIMAB-SVOA, 0.1MG $315.00
J2778 111207 RANIBIZUMAB INJECTION $1,908.50
J2779 111208 INJ, SUSVIMO 0.1 MG $647.50
J2780 111209 RANITIDINE HYDROCHLORIDE INJ $11.50
J2781 111210 INJ, PEGCETACOPLAN, 1MG $1,138.00
J2783 111211 RASBURICASE $1,478.00
J2785 111212 REGADENOSON INJECTION $435.00
J2786 111213 INJECTION, RESLIZUMAB, 1MG $42.00
J2788 111214 RHO D IMMUNE GLOBULIN 50 MCG $379.50
J2790 111215 RHO D IMMUNE GLOBULIN INJ $315.00
J2791 111216 RHOPHYLAC INJECTION $54.00
J2792 111217 RHO(D) IMMUNE GLOBULIN H, SD $175.00
J2794 111218 INJ RISPERDAL CONSTA, 0.5 MG $73.00
J2795 111219 ROPIVACAINE HCL INJECTION $1.00
J2796 111220 ROMIPLOSTIM INJECTION $489.00
J2798 111221 INJ., PERSERIS, 0.5 MG $111.50
J2800 111222 METHOCARBAMOL INJECTION $91.50
J2805 111223 SINCALIDE INJECTION $409.00
J2820 111224 SARGRAMOSTIM INJECTION $245.50
J2840 111225 INJ SEBELIPASE ALFA 1 MG $2,286.00
J2850 111226 INJ SECRETIN SYNTHETIC HUMAN $126.00
J2860 111227 INJECTION, SILTUXIMAB $540.00
J2916 111228 NA FERRIC GLUCONATE COMPLEX $66.50
J2920 111229 METHYLPREDNISOLONE INJECTION $38.50
J2930 111230 METHYLPREDNISOLONE INJECTION $59.00
J2941 111231 SOMATROPIN INJECTION $1,550.50
J2950 111232 PROMAZINE HCL INJECTION $43.00
J2993 111233 RETEPLASE INJECTION $16,423.00
J2997 111234 ALTEPLASE RECOMBINANT $924.00
J2998 111235 INJ PLASMINOGEN TVMH 1MG $295.00
J3000 111236 STREPTOMYCIN INJECTION $306.50
J3010 111237 FENTANYL CITRATE INJECTION $14.50
J3030 111238 SUMATRIPTAN SUCCINATE / 6 MG $277.50
J3031 111239 INJ., FREMANEZUMAB-VFRM 1 MG $37.00
J3032 111240 INJ. EPTINEZUMAB-JJMR 1 MG $70.00
J3060 111241 INJ, TALIGLUCERASE ALFA 10 U $289.00
J3090 111242 INJ TEDIZOLID PHOSPHATE $23.50
J3095 111243 TELAVANCIN INJECTION $42.50
J3101 111244 TENECTEPLASE INJECTION $820.00
J3105 111245 TERBUTALINE SULFATE INJ $123.00
J3111 111246 INJ. ROMOSOZUMAB-AQQG 1 MG $45.00
J3121 111247 INJ TESTOSTERO ENANTHATE 1MG $1.00
J3145 111248 TESTOSTERONE UNDECANOATE 1MG $8.00
J3230 111249 CHLORPROMAZINE HCL INJECTION $235.00
J3240 111250 THYROTROPIN INJECTION $11,016.00
J3241 111251 INJ. TEPROTUMUMAB-TRBW 10 MG $1,808.50
J3243 111252 TIGECYCLINE INJECTION $11.00
J3245 111253 INJ., TILDRAKIZUMAB, 1 MG $789.00
J3246 111254 TIROFIBAN HCL $26.00
J3250 111255 TRIMETHOBENZAMIDE HCL INJ $297.00
J3260 111256 TOBRAMYCIN SULFATE INJECTION $27.50
J3262 111257 TOCILIZUMAB INJECTION $35.00
J3285 111258 TREPROSTINIL INJECTION $267.00
J3299 111259 INJ XIPERE 1 MG $383.00
J3300 111260 TRIAMCINOLONE A INJ PRS-FREE $21.00
J3301 111261 TRIAMCINOLONE ACET INJ NOS $14.00
J3302 111262 TRIAMCINOLONE DIACETATE INJ $3.00
J3304 111263 INJ TRIAMCINOLONE ACE XR 1MG $83.00
J3315 111264 TRIPTORELIN PAMOATE $3,981.00
J3316 111265 INJ., TRIPTORELIN XR 3.75 MG $20,746.00
J3357 111266 USTEKINUMAB SUB CU INJ, 1 MG $1,431.00
J3358 111267 USTEKINUMAB, IV INJECT, 1 MG $73.50
J3360 111268 DIAZEPAM INJECTION $88.50
J3370 111269 VANCOMYCIN HCL INJECTION $58.50
J3371 111270 INJ, VANCOMYCIN HCL (MYLAN) $45.00
J3372 111271 INJ, VANCOMYCIN HCL (XELLIA) $53.50
J3380 111272 INJECTION, VEDOLIZUMAB $138.00
J3385 111273 VELAGLUCERASE ALFA $2,565.50
J3396 111274 VERTEPORFIN INJECTION $68.50
J3398 111275 INJ LUXTURNA 1 BILLION VEC G $9,370.00
J3401 111276 VYJUVEK 5X10^9PFU/ML, 0.1 ML $11,440.50
J3410 111277 HYDROXYZINE HCL INJECTION $112.50
J3411 111278 THIAMINE HCL 100 MG $101.00
J3415 111279 PYRIDOXINE HCL 100 MG $124.00
J3420 111280 VITAMIN B12 INJECTION $46.50
J3430 111281 VITAMIN K PHYTONADIONE INJ $22.50
J3465 111282 INJECTION, VORICONAZOLE $38.50
J3470 111283 HYALURONIDASE INJECTION $239.00
J3471 111284 OVINE, UP TO 999 USP UNITS $3.00
J3472 111285 OVINE, 1000 USP UNITS $3,106.50
J3473 111286 HYALURONIDASE RECOMBINANT $2.00
J3475 111287 INJ MAGNESIUM SULFATE $20.50
J3480 111288 INJ POTASSIUM CHLORIDE $5.00
J3485 111289 ZIDOVUDINE $24.00
J3486 111290 ZIPRASIDONE MESYLATE $126.00
J3489 111291 ZOLEDRONIC ACID 1MG $318.00
J7030 111292 NORMAL SALINE SOLUTION INFUS $75.00
J7042 111294 5% DEXTROSE/NORMAL SALINE $55.50
J7060 111296 5% DEXTROSE/WATER $54.00
J7070 111297 D5W INFUSION $178.00
J7100 111298 DEXTRAN 40 INFUSION $319.50
J7110 111299 DEXTRAN 75 INFUSION $141.50
J7120 111300 RINGERS LACTATE INFUSION $54.50
J7121 111301 5% DEXTROSE IN LAC RINGERS $138.00
J7131 111302 HYPERTONIC SALINE SOL $1.00
J7168 111303 PROTHROMBIN COMPLEX KCENTRA $13.50
J7169 111304 INJ ANDEXXA, 10 MG $1,347.50
J7170 111305 INJ., EMICIZUMAB-KXWH 0.5 MG $102.50
J7175 111306 INJ, FACTOR X, (HUMAN), 1IU $84.50
J7177 111307 INJ., FIBRYGA, 1 MG $7.50
J7178 111308 INJ HUMAN FIBRINOGEN CON NOS $24.50
J7179 111309 VONVENDI INJ 1 IU VWF:RCO $18.00
J7180 111310 FACTOR XIII ANTI-HEM FACTOR $93.00
J7181 111311 FACTOR XIII RECOMB A-SUBUNIT $147.50
J7182 111312 FACTOR VIII RECOMB NOVOEIGHT $21.50
J7183 111313 WILATE INJECTION $8.00
J7185 111314 XYNTHA INJ $8.00
J7186 111315 ANTIHEMOPHILIC VIII/VWF COMP $7.00
J7187 111316 HUMATE-P, INJ $4.00
J7188 111317 FACTOR VIII RECOMB OBIZUR $53.00
J7189 111318 FACTOR VIIA RECOMB NOVOSEVEN $13.00
J7190 111319 FACTOR VIII $7.00
J7192 111320 FACTOR VIII RECOMBINANT NOS $10.00
J7193 111321 FACTOR IX NON-RECOMBINANT $5.50
J7194 111322 FACTOR IX COMPLEX $29.00
J7195 111323 FACTOR IX RECOMBINANT NOS $9.00
J7197 111324 ANTITHROMBIN III INJECTION $27.00
J7198 111325 ANTI-INHIBITOR $13.50
J7200 111326 FACTOR IX RECOMBINAN RIXUBIS $22.50
J7201 111327 FACTOR IX ALPROLIX RECOMB $5.00
J7202 111328 FACTOR IX IDELVION INJ $20.50
J7203 111329 FACTOR IX RECOMB GLY REBINYN $27.00
J7204 111330 INJ RECOMBIN ESPEROCT PER IU $34.00
J7205 111331 FACTOR VIII FC FUSION RECOMB $8.00
J7207 111332 FACTOR VIII PEGYLATED RECOMB $3.50
J7208 111333 INJ. JIVI 1 IU $36.00
J7209 111334 FACTOR VIII NUWIQ RECOMB 1IU $22.50
J7210 111335 INJ, AFSTYLA, 1 I.U. $8.50
J7211 111336 INJ, KOVALTRY, 1 I.U. $10.00
J7212 111337 FACTOR VIIA RECOMB SEVENFACT $19.50
J7213 111338 INJ, IXINITY, 1 I.U. $29.00
J7296 111339 KYLEENA, 19.5 MG $4,111.00
J7297 111340 LILETTA, 52 MG $3,601.00
J7298 111341 MIRENA, 52 MG $6,104.00
J7300 111342 INTRAUT COPPER CONTRACEPTIVE $3,208.00
J7301 111343 SKYLA, 13.5 MG $2,420.00
J7307 111344 ETONOGESTREL IMPLANT SYSTEM $5,717.50
J7308 111345 AMINOLEVULINIC ACID HCL TOP $1,620.50
J7311 111346 INJ., RETISERT, 0.01 MG $2,025.00
J7312 111347 DEXAMETHASONE INTRA IMPLANT $942.00
J7313 111348 INJ., ILUVIEN, 0.01 MG $2,296.00
J7314 111349 INJ., YUTIQ, 0.01 MG $2,125.50
J7315 111350 OPHTHALMIC MITOMYCIN $932.50
J7316 111351 INJ, OCRIPLASMIN, 0.125 MG $3,614.00
J7318 111352 INJ, DUROLANE 1 MG $91.50
J7320 111353 GENVISC 850, INJ, 1MG $166.00
J7321 111354 HYALGAN SUPARTZ VISCO-3 DOSE $775.00
J7322 111355 HYMOVIS INJECTION 1 MG $101.00
J7323 111356 EUFLEXXA INJ PER DOSE $2,281.50
J7324 111357 ORTHOVISC INJ PER DOSE $1,033.00
J7325 111358 SYNVISC OR SYNVISC-ONE $185.00
J7326 111359 GEL-ONE $4,938.00
J7327 111360 MONOVISC INJ PER DOSE $4,193.50
J7328 111361 GELSYN-3 INJECTION 0.1 MG $21.50
J7329 111362 INJ, TRIVISC 1 MG $46.50
J7330 111363 CULTURED CHONDROCYTES IMPLNT $134,081.50
J7331 111364 SYNOJOYNT, INJ., 1 MG $24.50
J7332 111365 INJ., TRILURON, 1 MG $120.00
J7336 111366 CAPSAICIN 8% PATCH $17.50
J7340 111367 CARBIDOPA LEVODOPA ENT 100ML $1,213.00
J7342 111368 CIPROFLOXACIN OTIC SUSP 6 MG $264.50
J7345 111369 AMINOLEVULINIC ACID, 10% GEL $5.00
J7351 111370 INJ BIMATOPROST ITC IMP1MCG $656.00
J7352 111371 AFAMELANOTIDE IMPLANT, 1 MG $19,052.50
J7402 111372 MOMETASONE SINUS SINUVA $42.00
J7500 111373 AZATHIOPRINE ORAL 50MG $23.50
J7501 111374 AZATHIOPRINE PARENTERAL $1,312.50
J7502 111375 CYCLOSPORINE ORAL 100 MG $47.00
J7503 111376 TACROL ENVARSUS EX REL ORAL $21.50
J7504 111377 LYMPHOCYTE IMMUNE GLOBULIN $6,586.00
J7507 111378 TACROLIMUS IMME REL ORAL 1MG $17.00
J7508 111379 TACROL ASTAGRAF EX REL ORAL $3.50
J7509 111380 METHYLPREDNISOLONE ORAL $4.00
J7510 111381 PREDNISOLONE ORAL PER 5 MG $3.00
J7511 111382 ANTITHYMOCYTE GLOBULN RABBIT $3,051.00
J7512 111383 PREDNISONE IR OR DR ORAL 1MG #NUM!
J7515 111384 CYCLOSPORINE ORAL 25 MG $2.00
J7516 111385 CYCLOSPORIN PARENTERAL 250MG $413.50
J7517 111386 MYCOPHENOLATE MOFETIL ORAL $8.00
J7518 111387 MYCOPHENOLIC ACID $19.50
J7520 111388 SIROLIMUS, ORAL $96.00
J7525 111389 TACROLIMUS INJECTION $1,264.50
J7527 111390 ORAL EVEROLIMUS $15.50
J7605 111391 ARFORMOTEROL NON-COMP UNIT $111.50
J7606 111392 FORMOTEROL FUMARATE, INH $131.00
J7608 111393 ACETYLCYSTEINE NON-COMP UNIT $80.50
J7609 111394 ALBUTEROL COMP UNIT $3.50
J7610 111395 ALBUTEROL COMP CON $3.00
J7611 111396 ALBUTEROL NON-COMP CON $2.00
J7612 111397 LEVALBUTEROL NON-COMP CON $16.00
J7613 111398 ALBUTEROL NON-COMP UNIT $2.00
J7614 111399 LEVALBUTEROL NON-COMP UNIT $4.00
J7615 111400 LEVALBUTEROL COMP UNIT $44.50
J7620 111401 ALBUTEROL IPRATROP NON-COMP $8.00
J7626 111402 BUDESONIDE NON-COMP UNIT $91.50
J7627 111403 BUDESONIDE COMP UNIT $61.00
J7631 111404 CROMOLYN SODIUM NONCOMP UNIT $29.00
J7633 111405 BUDESONIDE NON-COMP CON $31.00
J7637 111406 DEXAMETHASONE COMP CON $43.50
J7638 111407 DEXAMETHASONE COMP UNIT $58.00
J7639 111408 DORNASE ALFA NON-COMP UNIT $499.00
J7640 111409 FORMOTEROL COMP UNIT $57.50
J7642 111410 GLYCOPYRROLATE COMP CON $47.00
J7643 111411 GLYCOPYRROLATE COMP UNIT $263.00
J7644 111412 IPRATROPIUM BROMIDE NON-COMP $35.00
J7665 111413 MANNITOL FOR INHALER $9.50
J7674 111414 METHACHOLINE CHLORIDE, NEB $3.00
J7676 111415 PENTAMIDINE COMP UNIT DOSE $1,275.00
J7677 111416 REVEFENACIN INH NON-COM 1MCG $1.00
J7682 111417 TOBRAMYCIN NON-COMP UNIT $632.00
J7686 111418 TREPROSTINIL, NON-COMP UNIT $2,736.00
J8501 111419 ORAL APREPITANT $54.00
J8515 111420 CABERGOLINE, ORAL 0.25MG $28.50
J8520 111421 CAPECITABINE, ORAL, 150 MG $20.00
J8521 111422 CAPECITABINE, ORAL, 500 MG $14.00
J8530 111423 CYCLOPHOSPHAMIDE ORAL 25 MG $40.50
J8540 111424 ORAL DEXAMETHASONE $1.00
J8560 111425 ETOPOSIDE ORAL 50 MG $410.50
J8610 111426 METHOTREXATE ORAL 2.5 MG $31.00
J8655 111427 ORAL NETUPITANT, PALONOSETRO $1,846.50
J8670 111428 ROLAPITANT, ORAL, 1MG $17.50
J8700 111429 TEMOZOLOMIDE $26.00
J8705 111430 TOPOTECAN ORAL $672.50
J9000 111431 DOXORUBICIN HCL INJECTION $38.00
J9015 111432 ALDESLEUKIN INJECTION $16,803.00
J9017 111433 ARSENIC TRIOXIDE INJECTION $410.50
J9019 111434 ERWINAZE INJECTION $2,438.50
J9021 111435 INJ, ASPARA, RYLAZE, 0.1 MG $200.00
J9022 111436 INJ, ATEZOLIZUMAB,10 MG $364.00
J9023 111437 INJECTION, AVELUMAB, 10 MG $426.00
J9025 111438 AZACITIDINE INJECTION $11.00
J9027 111439 CLOFARABINE INJECTION $680.00
J9029 111440 INJ, ADSTILADRIN, PER TX DOS $154,690.01
J9030 111441 BCG LIVE INTRAVESICAL 1MG $21.00
J9032 111442 INJECTION, BELINOSTAT, 10MG $208.50
J9033 111443 INJ., TREANDA 1 MG $155.50
J9034 111444 INJ., BENDEKA 1 MG $162.00
J9035 111445 BEVACIZUMAB INJECTION $555.00
J9036 111446 INJ. BELRAPZO/BENDAMUSTINE $117.00
J9037 111447 INJ BELANTAMAB MAFODONT BLMF $377.50
J9039 111448 INJECTION, BLINATUMOMAB $673.00
J9040 111449 BLEOMYCIN SULFATE INJECTION $299.50
J9041 111450 INJECTION, BORTEZOMIB, 0.1MG $81.50
J9042 111451 BRENTUXIMAB VEDOTIN INJ $897.00
J9043 111452 CABAZITAXEL INJECTION $951.00
J9044 111453 INJ, BORTEZOMIB, NOS, 0.1 MG $301.00
J9045 111454 CARBOPLATIN INJECTION $45.00
J9046 111455 INJ, BORTEZOMIB, DR. REDDY'S $131.00
J9047 111456 INJECTION, CARFILZOMIB, 1 MG $203.00
J9048 111457 INJ, BORTEZOMIB FRESENIUSKAB $42.50
J9049 111458 INJ, BORTEZOMIB, HOSPIRA $24.50
J9050 111459 CARMUSTINE INJECTION $8,160.00
J9052 111460 INJ, CARMUSTINE (ACCORD) $3,446.50
J9055 111461 CETUXIMAB INJECTION $396.50
J9057 111462 INJ., COPANLISIB, 1 MG $475.00
J9060 111463 CISPLATIN 10 MG INJECTION $20.00
J9061 111464 INJ, AMIVANTAMAB-VMJW $80.00
J9065 111465 INJ CLADRIBINE PER 1 MG $190.00
J9070 111466 CYCLOPHOSPHAMIDE 100 MG INJ $269.00
J9071 111467 INJ CYCLOPHOSPHAMD AUROMEDIC $24.50
J9100 111468 CYTARABINE HCL 100 MG INJ $19.00
J9118 111469 INJ. CALASPARGASE PEGOL-MKNL $278.00
J9119 111470 INJ., CEMIPLIMAB-RWLC, 1 MG $116.00
J9120 111471 DACTINOMYCIN INJECTION $10,517.50
J9130 111472 DACARBAZINE 100 MG INJ $59.00
J9144 111473 DARATUMUMAB, HYALURONIDASE $210.00
J9145 111474 INJECTION, DARATUMUMAB 10 MG $325.00
J9150 111475 DAUNORUBICIN INJECTION $379.50
J9153 111476 INJ DAUNORUBICIN, CYTARABINE $887.00
J9155 111477 DEGARELIX INJECTION $27.00
J9171 111478 DOCETAXEL INJECTION $17.00
J9173 111479 INJ., DURVALUMAB, 10 MG $333.50
J9175 111480 ELLIOTTS B SOLUTION PER ML $51.00
J9176 111481 INJECTION, ELOTUZUMAB, 1MG $37.00
J9177 111482 INJ ENFORT VEDO-EJFV 0.25MG $138.00
J9178 111483 INJ, EPIRUBICIN HCL, 2 MG $16.50
J9179 111484 ERIBULIN MESYLATE INJECTION $560.00
J9181 111485 ETOPOSIDE INJECTION $5.00
J9185 111486 FLUDARABINE PHOSPHATE INJ $2,270.00
J9190 111487 FLUOROURACIL INJECTION $31.00
J9196 111488 INJ GEMCITABINE HCL (ACCORD) $98.00
J9198 111489 INJ. INFUGEM, 100 MG $278.50
J9200 111490 FLOXURIDINE INJECTION $14,028.00
J9201 111491 IN GEMCITABINE HCL NOS 200MG $50.50
J9202 111492 GOSERELIN ACETATE IMPLANT $3,668.00
J9203 111493 GEMTUZUMAB OZOGAMICIN 0.1 MG $1,176.00
J9204 111494 INJ MOGAMULIZUMAB-KPKC, 1 MG $910.00
J9205 111495 INJ IRINOTECAN LIPOSOME 1 MG $296.00
J9206 111496 IRINOTECAN INJECTION $33.00
J9207 111497 IXABEPILONE INJECTION $500.00
J9208 111498 IFOSFAMIDE INJECTION $235.00
J9209 111499 MESNA INJECTION $37.50
J9210 111500 INJ., EMAPALUMAB-LZSG, 1 MG $2,359.50
J9211 111501 IDARUBICIN HCL INJECTION $427.50
J9214 111502 INTERFERON ALFA-2B INJ $200.00
J9217 111503 LEUPROLIDE ACETATE SUSPNSION $7,947.00
J9218 111504 LEUPROLIDE ACETATE INJECITON $210.50
J9223 111505 INJ. LURBINECTEDIN, 0.1 MG $750.00
J9225 111506 VANTAS IMPLANT $14,836.50
J9226 111507 SUPPRELIN LA IMPLANT $107,026.50
J9227 111508 INJ. ISATUXIMAB-IRFC 10 MG $525.50
J9228 111509 IPILIMUMAB INJECTION $707.00
J9229 111510 INJ INOTUZUMAB OZOGAM 0.1 MG $10,355.00
J9245 111511 INJ MELPHALAN HYDROCHL 50 MG $4,958.00
J9246 111512 INJ., EVOMELA, 1 MG $246.50
J9247 111513 INJ, MELPHALAN FLUFENAMI 1MG $2,621.50
J9250 111514 METHOTREXATE SODIUM INJ $4.00
J9260 111515 METHOTREXATE SODIUM INJ $86.00
J9261 111516 NELARABINE INJECTION $898.50
J9262 111517 INJ, OMACETAXINE MEP, 0.01MG $16.50
J9263 111518 OXALIPLATIN $3.00
J9264 111519 PACLITAXEL PROTEIN BOUND $64.50
J9266 111520 PEGASPARGASE INJECTION $91,893.00
J9267 111521 PACLITAXEL INJECTION $2.00
J9268 111522 PENTOSTATIN INJECTION $11,179.50
J9269 111523 INJ. TAGRAXOFUSP-ERZS 10 MCG $1,291.00
J9271 111524 INJ PEMBROLIZUMAB $231.00
J9272 111525 INJ, DOSTARLIMAB-GXLY, 10 MG $1,351.50
J9273 111526 INJ TISOTU VEDOTIN-TFTV, 1MG $621.00
J9274 111527 INJ, TEBENTAFUSP-TEBN, 1 MCG $678.00
J9280 111528 MITOMYCIN INJECTION $1,292.50
J9281 111529 MITOMYCIN INSTILLATION $1,152.50
J9286 111530 INJ GLOFITAMAB GXBM, 2.5 MG $11,662.00
J9293 111531 MITOXANTRONE HYDROCHL / 5 MG $494.50
J9294 111532 INJ PEMETREXED, HOSPIRA 10MG $63.50
J9295 111533 INJECTION, NECITUMUMAB, 1 MG $78.50
J9296 111534 INJ PEMETREXED (ACCORD) 10MG $57.00
J9297 111535 INJ PEMETREXED (SANDOZ) 10MG $29.00
J9298 111536 INJ NIVOL RELATLIMAB 3MG/1MG $750.00
J9299 111537 INJECTION, NIVOLUMAB $144.00
J9301 111538 OBINUTUZUMAB INJ $371.00
J9302 111539 OFATUMUMAB INJECTION $338.50
J9303 111540 PANITUMUMAB INJECTION $725.50
J9304 111541 INJ. PEMETREXED, 10 MG $397.00
J9305 111542 PEMETREXED INJECTION $505.00
J9306 111543 INJECTION, PERTUZUMAB, 1 MG $62.00
J9307 111544 PRALATREXATE INJECTION $1,391.00
J9308 111545 INJECTION, RAMUCIRUMAB $324.00
J9309 111546 INJ, POLATUZUMAB VEDOTIN 1MG $468.00
J9311 111547 INJ RITUXIMAB, HYALURONIDASE $304.00
J9312 111548 INJ., RITUXIMAB, 10 MG $602.00
J9313 111549 INJ., LUMOXITI, 0.01 MG $194.00
J9314 111550 INJ PEMETREXED (TEVA) 10MG $152.50
J9316 111551 PERTUZU, TRASTUZU, 10 MG $445.00
J9317 111552 SACITUZUMAB GOVITECAN-HZIY $135.50
J9318 111553 INJ ROMIDEPSIN NON-LYO 0.1MG $129.00
J9319 111554 INJ ROMIDEPSIN LYOPHIL 0.1MG $140.00
J9320 111555 STREPTOZOCIN INJECTION $1,949.00
J9325 111556 INJ TALIMOGENE LAHERPAREPVEC $283.50
J9328 111557 TEMOZOLOMIDE INJECTION $50.50
J9330 111558 TEMSIROLIMUS INJECTION $398.00
J9331 111559 INJ SIROLIMUS PROT PART 1 MG $758.00
J9332 111560 INJ EFGARTIGIMOD 2MG $205.00
J9340 111561 THIOTEPA INJECTION $3,075.00
J9348 111562 INJ. NAXITAMAB-GQGK, 1 MG $1,657.50
J9349 111563 INJ., TAFASITAMAB-CXIX $59.00
J9351 111564 TOPOTECAN INJECTION $18.00
J9352 111565 INJECTION TRABECTEDIN 0.1MG $1,323.00
J9353 111566 INJ. MARGETUXIMAB-CMKB, 5 MG $289.00
J9354 111567 INJ, ADO-TRASTUZUMAB EMT 1MG $159.00
J9355 111568 INJ TRASTUZUMAB EXCL BIOSIMI $561.00
J9356 111569 INJ. HERCEPTIN HYLECTA, 10MG $499.50
J9357 111570 VALRUBICIN INJECTION $5,406.50
J9358 111571 INJ FAM-TRASTU DERU-NXKI 1MG $109.50
J9359 111572 INJ LON TESIRIN-LPYL 0.075MG $773.00
J9360 111573 VINBLASTINE SULFATE INJ $28.00
J9370 111574 VINCRISTINE SULFATE 1 MG INJ $214.00
J9371 111575 INJ, VINCRISTINE SUL LIP 1MG $17,445.00
J9380 111576 INJ TECLISTAMAB CQYV 0.5 MG $119.00
J9390 111577 VINORELBINE TARTRATE INJ $114.00
J9393 111578 INJ, FULVESTRANT (TEVA) $172.00
J9395 111579 INJECTION, FULVESTRANT $219.00
J9400 111580 INJ, ZIV-AFLIBERCEPT, 1MG $100.00
J9600 111581 PORFIMER SODIUM INJECTION $86,278.00
L0112 111582 CRANIAL CERVICAL ORTHOSIS $2,736.00
L0113 111583 CRANIAL CERVICAL TORTICOLLIS $575.00
L0120 111584 CERV FLEX N/ADJ FOAM PRE OTS $87.50
L0130 111585 FLEX THERMOPLASTIC COLLAR MO $232.00
L0140 111586 CERVICAL SEMI-RIGID ADJUSTAB $224.50
L0150 111587 CERV SEMI-RIG ADJ MOLDED CHN $242.00
L0160 111588 CERV SR WIRE OCC/MAN PRE OTS $383.00
L0170 111589 CERVICAL COLLAR MOLDED TO PT $1,573.50
L0172 111590 CERV COL SR FOAM 2PC PRE OTS $317.50
L0174 111591 CERV SR 2PC THOR EXT PRE OTS $771.00
L0180 111592 CER POST COL OCC/MAN SUP ADJ $1,090.50
L0190 111593 CERV COLLAR SUPP ADJ CERV BA $1,435.50
L0200 111594 CERV COL SUPP ADJ BAR & THOR $1,770.50
L0450 111595 TLSO FLEX TRUNK/THOR PRE OTS $486.50
L0454 111596 TLSO TRNK SJ-T9 PRE CST $1,075.00
L0455 111597 TLSO FLEX TRNK SJ-T9 PRE OTS $696.50
L0456 111598 TLSO FLEX TRNK SJ-SS PRE CST $3,438.50
L0457 111599 TLSO FLEX TRNK SJ-SS PRE OTS $3,849.50
L0458 111600 TLSO 2MOD SYMPHIS-XIPHO PRE $2,163.00
L0460 111601 TLSO 2 SHL SYMPHYS-STERN CST $2,683.50
L0462 111602 TLSO 3MOD SACRO-SCAP PRE $5,595.50
L0464 111603 TLSO 4MOD SACRO-SCAP PRE $6,196.50
L0466 111604 TLSO R FRAM SOFT ANT PRE CST $944.50
L0467 111605 TLSO R FRAM SOFT PRE OTS $944.50
L0468 111606 TLSO RIG FRAM PELVIC PRE CST $1,959.00
L0469 111607 TLSO RIG FRAM PELVIC PRE OTS $1,959.00
L0470 111608 TLSO RIGID FRAME PRE SUBCLAV $2,003.00
L0472 111609 TLSO RIGID FRAME HYPEREX PRE $1,936.00
L0480 111610 TLSO RIGID PLASTIC CUSTOM FA $3,131.50
L0482 111611 TLSO RIGID LINED CUSTOM FAB $5,581.50
L0484 111612 TLSO RIGID PLASTIC CUST FAB $6,270.50
L0486 111613 TLSO RIGIDLINED CUST FAB TWO $6,781.50
L0488 111614 TLSO RIGID LINED PRE ONE PIE $2,427.50
L0490 111615 TLSO RIGID PLASTIC PRE ONE $621.00
L0491 111616 TLSO 2 PIECE RIGID SHELL $1,519.00
L0492 111617 TLSO 3 PIECE RIGID SHELL $979.50
L0621 111618 SIO FLEX PELVIC/SACR PRE OTS $188.00
L0622 111619 SIO FLEX PELVISACRAL CUSTOM $746.50
L0623 111620 SIO RIG PNL PELV/SAC PRE OTS $360.50
L0625 111621 LO FLEX L1-BELOW L5 PRE OTS $131.50
L0626 111622 LO SAG RIG PNL STAYS PRE CST $318.50
L0627 111623 LO SAG RI AN/POS PNL PRE CST $1,049.50
L0628 111624 LSO FLEX NO RI STAYS PRE OTS $196.50
L0630 111625 LSO R POST PNL SJ-T9 PRE CST $372.50
L0631 111626 LSO SAG R AN/POS PNL PRE CST $4,229.50
L0633 111627 LSO SC R POS/LAT PNL PRE CST $436.50
L0635 111628 LSO SAGIT RIGID PANEL PREFAB $6,976.50
L0636 111629 LSO SAGITTAL RIGID PANEL CUS $4,893.00
L0637 111630 LSO SC R ANT/POS PNL PRE CST $4,665.00
L0638 111631 LSO SAG-CORONAL PANEL CUSTOM $3,166.00
L0639 111632 LSO S/C SHELL/PANEL PREFAB $3,608.50
L0640 111633 LSO S/C SHELL/PANEL CUSTOM $2,925.00
L0641 111634 LO RIG POS PNL L1-L5 PRE OTS $256.50
L0642 111635 LO SAG RI AN/POS PNL PRE OTS $1,241.00
L0643 111636 LSO SAG CTR RIGI POS PRE OTS $330.50
L0648 111637 LSO SAG R AN/POS PNL PRE OTS $1,817.00
L0649 111638 LSO SC R POS/LAT PNL PRE OTS $578.00
L0650 111639 LSO SC R ANT/POS PNL PRE OTS $4,535.00
L0651 111640 LSO SAG-CO SHELL PNL PRE OTS $2,496.50
L0700 111641 CTLSO A-P-L CONTROL MOLDED $5,005.50
L0710 111642 CTLSO A-P-L CONTROL W/ INTER $5,118.50
L0810 111643 HALO CERVICAL INTO JCKT VEST $6,848.00
L0820 111644 HALO CERVICAL INTO BODY JACK $4,848.50
L0830 111645 HALO CERV INTO MILWAUKEE TYP $10,057.00
L0859 111646 MRI COMPATIBLE SYSTEM $2,765.00
L0861 111647 HALO REPL LINER/INTERFACE $436.50
L0970 111648 TLSO CORSET FRONT $342.00
L0972 111649 LSO CORSET FRONT $306.50
L0974 111650 TLSO FULL CORSET $545.50
L0976 111651 LSO FULL CORSET $315.00
L0978 111652 AXILLARY CRUTCH EXTENSION $1,046.00
L0980 111653 PERONEAL STRAPS PAIR PRE OTS $43.00
L0982 111654 STOCKING SUP GRIPS 4 PRE OTS $40.50
L0984 111655 PROTECT BODY SOCK EA PRE OTS $122.00
L1000 111656 CTLSO MILWAUKE INITIAL MODEL $5,928.00
L1005 111657 TENSION BASED SCOLIOSIS ORTH $6,157.50
L1010 111658 CTLSO AXILLA SLING $161.50
L1020 111659 KYPHOSIS PAD $233.00
L1025 111660 KYPHOSIS PAD FLOATING $496.00
L1030 111661 LUMBAR BOLSTER PAD $153.00
L1040 111662 LUMBAR OR LUMBAR RIB PAD $371.00
L1050 111663 STERNAL PAD $276.00
L1060 111664 THORACIC PAD $283.00
L1070 111665 TRAPEZIUS SLING $225.50
L1080 111666 OUTRIGGER $129.50
L1085 111667 OUTRIGGER BIL W/ VERT EXTENS $464.00
L1090 111668 LUMBAR SLING $260.00
L1100 111669 RING FLANGE PLASTIC/LEATHER $411.50
L1110 111670 RING FLANGE PLAS/LEATHER MOL $795.50
L1120 111671 COVERS FOR UPRIGHT EACH $179.00
L1200 111672 FURNSH INITIAL ORTHOSIS ONLY $3,622.50
L1210 111673 LATERAL THORACIC EXTENSION $527.00
L1220 111674 ANTERIOR THORACIC EXTENSION $858.50
L1230 111675 MILWAUKEE TYPE SUPERSTRUCTUR $1,711.50
L1240 111676 LUMBAR DEROTATION PAD $168.50
L1250 111677 ANTERIOR ASIS PAD $174.50
L1260 111678 ANTERIOR THORACIC DEROTATION $241.00
L1270 111679 ABDOMINAL PAD $322.00
L1280 111680 RIB GUSSET (ELASTIC) EACH $259.00
L1290 111681 LATERAL TROCHANTERIC PAD $159.00
L1300 111682 BODY JACKET MOLD TO PATIENT $6,853.50
L1310 111683 POST-OPERATIVE BODY JACKET $3,873.00
L1600 111684 HO FLEX FREJKA W/COV PRE CST $184.00
L1610 111685 HO FREJKA COV ONLY PRE CST $119.00
L1620 111686 HO FLEX PAVLIK HARNS PRE CST $342.50
L1630 111687 ABDUCT CONTROL HIP SEMI-FLEX $400.00
L1640 111688 PELV BAND/SPREAD BAR THIGH C $1,708.00
L1650 111689 HO ABDUCTION HIP ADJUSTABLE $538.00
L1652 111690 HO BI THIGHCUFFS W SPRDR BAR $715.50
L1660 111691 HO ABDUCTION STATIC PLASTIC $455.00
L1680 111692 PELVIC & HIP CONTROL THIGH C $4,713.50
L1685 111693 POST-OP HIP ABDUCT CUSTOM FA $5,508.00
L1686 111694 HO POST-OP HIP ABDUCTION $3,472.50
L1690 111695 COMBINATION BILATERAL HO $4,091.00
L1700 111696 LEG PERTHES ORTH TORONTO TYP $4,909.00
L1710 111697 LEGG PERTHES ORTH NEWINGTON $5,425.50
L1720 111698 LEGG PERTHES ORTHOSIS TRILAT $4,788.00
L1730 111699 LEGG PERTHES ORTH SCOTTISH R $3,553.00
L1755 111700 LEGG PERTHES PATTEN BOTTOM T $3,854.50
L1810 111701 KO ELASTIC WITH JOINTS $259.00
L1812 111702 KO ELASTIC W/JOINTS PRE OTS $282.50
L1820 111703 KO ELAS W/ CONDYLE PADS & JO $380.50
L1830 111704 KO IMMOB CANVAS LONG PRE OTS $345.50
L1831 111705 KNEE ORTH POS LOCKING JOINT $547.50
L1832 111706 KO ADJ JNT POS R SUP PRE CST $850.50
L1833 111707 KO ADJ JNT POS R SUP PRE OTS $1,031.00
L1834 111708 KO W/0 JOINT RIGID MOLDED TO $2,680.50
L1836 111709 KO RIGID W/O JOINTS PRE OTS $302.50
L1840 111710 KO DEROT ANT CRUCIATE CUSTOM $2,386.00
L1843 111711 KO SINGLE UPRIGHT PRE CST $1,714.50
L1844 111712 KO W/ADJ JT ROT CNTRL MOLDED $3,590.50
L1845 111713 KO DOUBLE UPRIGHT PRE CST $1,720.00
L1846 111714 KO W ADJ FLEX/EXT ROTAT MOLD $2,980.00
L1847 111715 KO DBL UPRIGHT W/AIR PRE CST $1,246.00
L1848 111716 KO DBL UPRIGHT W/AIR PRE OTS $1,246.00
L1850 111717 KO SWEDISH TYPE PRE OTS $733.50
L1851 111718 KO SINGLE UPRIGHT PREFAB OTS $1,576.50
L1852 111719 KO DOUBLE UPRIGHT PREFAB OTS $1,863.00
L1860 111720 KO SUPRACONDYLAR SOCKET MOLD $2,938.00
L1900 111721 AFO SPRNG WIR DRSFLX CALF BD $754.00
L1902 111722 AFO ANKLE GAUNTLET PRE OTS $163.50
L1904 111723 AFO MOLDED ANKLE GAUNTLET $1,181.50
L1906 111724 AFO MULTILIG ANK SUP PRE OTS $217.00
L1907 111725 AFO SUPRAMALLEOLAR CUSTOM $1,207.00
L1910 111726 AFO SING BAR CLASP ATTACH SH $826.50
L1920 111727 AFO SING UPRIGHT W/ ADJUST S $1,811.50
L1930 111728 AFO PLASTIC $634.50
L1932 111729 AFO RIG ANT TIB PREFAB TCF/= $2,111.50
L1940 111730 AFO MOLDED TO PATIENT PLASTI $1,067.00
L1945 111731 AFO MOLDED PLAS RIG ANT TIB $2,519.50
L1950 111732 AFO SPIRAL MOLDED TO PT PLAS $1,980.50
L1951 111733 AFO SPIRAL PREFABRICATED $3,266.50
L1960 111734 AFO POS SOLID ANK PLASTIC MO $1,114.50
L1970 111735 AFO PLASTIC MOLDED W/ANKLE J $1,441.00
L1971 111736 AFO W/ANKLE JOINT, PREFAB $1,196.50
L1980 111737 AFO SING SOLID STIRRUP CALF $1,478.00
L1990 111738 AFO DOUB SOLID STIRRUP CALF $3,419.50
L2000 111739 KAFO SING FRE STIRR THI/CALF $3,787.00
L2005 111740 KAFO SNG/DBL MECHANICAL ACT $7,846.00
L2006 111741 KAF SNG/DBL SWG/STN MCPR CUS $74,160.00
L2010 111742 KAFO SNG SOLID STIRRUP W/O J $3,318.00
L2020 111743 KAFO DBL SOLID STIRRUP BAND/ $4,599.00
L2030 111744 KAFO DBL SOLID STIRRUP W/O J $2,878.00
L2034 111745 KAFO PLA SIN UP W/WO K/A CUS $4,188.50
L2035 111746 KAFO PLASTIC PEDIATRIC SIZE $384.00
L2036 111747 KAFO PLAS DOUB FREE KNEE MOL $7,759.50
L2037 111748 KAFO PLAS SING FREE KNEE MOL $4,344.50
L2038 111749 KAFO W/O JOINT MULTI-AXIS AN $3,235.00
L2040 111750 HKAFO TORSION BIL ROT STRAPS $407.50
L2050 111751 HKAFO TORSION CABLE HIP PELV $1,536.00
L2060 111752 HKAFO TORSION BALL BEARING J $1,875.00
L2070 111753 HKAFO TORSION UNILAT ROT STR $318.50
L2080 111754 HKAFO UNILAT TORSION CABLE $1,001.00
L2090 111755 HKAFO UNILAT TORSION BALL BR $1,337.00
L2106 111756 AFO TIB FX CAST PLASTER MOLD $2,185.00
L2108 111757 AFO TIB FX CAST MOLDED TO PT $2,464.50
L2112 111758 AFO TIBIAL FRACTURE SOFT $822.50
L2114 111759 AFO TIB FX SEMI-RIGID $1,299.50
L2116 111760 AFO TIBIAL FRACTURE RIGID $1,689.00
L2126 111761 KAFO FEM FX CAST THERMOPLAS $2,718.50
L2128 111762 KAFO FEM FX CAST MOLDED TO P $4,095.50
L2132 111763 KAFO FEMORAL FX CAST SOFT $2,126.00
L2134 111764 KAFO FEM FX CAST SEMI-RIGID $2,542.00
L2136 111765 KAFO FEMORAL FX CAST RIGID $5,125.00
L2180 111766 PLAS SHOE INSERT W ANK JOINT $424.50
L2182 111767 DROP LOCK KNEE $218.50
L2184 111768 LIMITED MOTION KNEE JOINT $294.00
L2186 111769 ADJ MOTION KNEE JNT LERMAN T $334.50
L2188 111770 QUADRILATERAL BRIM $698.50
L2190 111771 WAIST BELT $208.50
L2192 111772 PELVIC BAND & BELT THIGH FLA $1,108.00
L2200 111773 LIMITED ANKLE MOTION EA JNT $127.00
L2210 111774 DORSIFLEXION ASSIST EACH JOI $237.50
L2220 111775 DORSI & PLANTAR FLEX ASS/RES $207.50
L2230 111776 SPLIT FLAT CALIPER STIRR & P $341.00
L2232 111777 ROCKER BOTTOM, CONTACT AFO $219.00
L2240 111778 ROUND CALIPER AND PLATE ATTA $339.00
L2250 111779 FOOT PLATE MOLDED STIRRUP AT $1,796.50
L2260 111780 REINFORCED SOLID STIRRUP $1,262.50
L2265 111781 LONG TONGUE STIRRUP $669.50
L2270 111782 VARUS/VALGUS STRAP PADDED/LI $172.00
L2275 111783 PLASTIC MOD LOW EXT PAD/LINE $264.00
L2280 111784 MOLDED INNER BOOT $903.00
L2300 111785 ABDUCTION BAR JOINTED ADJUST $972.00
L2310 111786 ABDUCTION BAR-STRAIGHT $522.00
L2320 111787 NON-MOLDED LACER $499.50
L2330 111788 LACER MOLDED TO PATIENT MODE $1,192.50
L2335 111789 ANTERIOR SWING BAND $705.00
L2340 111790 PRE-TIBIAL SHELL MOLDED TO P $1,232.00
L2350 111791 PROSTHETIC TYPE SOCKET MOLDE $3,728.00
L2360 111792 EXTENDED STEEL SHANK $141.00
L2370 111793 PATTEN BOTTOM $1,085.50
L2375 111794 TORSION ANK & HALF SOLID STI $318.50
L2380 111795 TORSION STRAIGHT KNEE JOINT $375.00
L2385 111796 STRAIGHT KNEE JOINT HEAVY DU $632.00
L2387 111797 ADD LE POLY KNEE CUSTOM KAFO $448.00
L2390 111798 OFFSET KNEE JOINT EACH $230.00
L2395 111799 OFFSET KNEE JOINT HEAVY DUTY $387.00
L2397 111800 SUSPENSION SLEEVE LOWER EXT $755.50
L2405 111801 KNEE JOINT DROP LOCK EA JNT $678.00
L2415 111802 KNEE JOINT CAM LOCK EACH JOI $311.00
L2425 111803 KNEE DISC/DIAL LOCK/ADJ FLEX $664.00
L2430 111804 KNEE JNT RATCHET LOCK EA JNT $510.50
L2492 111805 KNEE LIFT LOOP DROP LOCK RIN $242.50
L2500 111806 THI/GLUT/ISCHIA WGT BEARING $854.50
L2510 111807 TH/WGHT BEAR QUAD-LAT BRIM M $2,131.50
L2520 111808 TH/WGHT BEAR QUAD-LAT BRIM C $1,288.00
L2525 111809 TH/WGHT BEAR NAR M-L BRIM MO $2,798.00
L2526 111810 TH/WGHT BEAR NAR M-L BRIM CU $3,370.50
L2530 111811 THIGH/WGHT BEAR LACER NON-MO $834.50
L2540 111812 THIGH/WGHT BEAR LACER MOLDED $1,355.00
L2550 111813 THIGH/WGHT BEAR HIGH ROLL CU $921.00
L2570 111814 HIP CLEVIS TYPE 2 POSIT JNT $1,804.00
L2580 111815 PELVIC CONTROL PELVIC SLING $2,446.00
L2600 111816 HIP CLEVIS/THRUST BEARING FR $803.00
L2610 111817 HIP CLEVIS/THRUST BEARING LO $889.50
L2620 111818 PELVIC CONTROL HIP HEAVY DUT $846.50
L2622 111819 HIP JOINT ADJUSTABLE FLEXION $1,056.50
L2624 111820 HIP ADJ FLEX EXT ABDUCT CONT $1,575.00
L2627 111821 PLASTIC MOLD RECIPRO HIP & C $3,865.00
L2628 111822 METAL FRAME RECIPRO HIP & CA $3,779.00
L2630 111823 PELVIC CONTROL BAND & BELT U $1,218.00
L2640 111824 PELVIC CONTROL BAND & BELT B $1,438.50
L2650 111825 PELV & THOR CONTROL GLUTEAL $284.50
L2660 111826 THORACIC CONTROL THORACIC BA $471.50
L2670 111827 THORAC CONT PARASPINAL UPRIG $403.00
L2680 111828 THORAC CONT LAT SUPPORT UPRI $370.00
L2750 111829 PLATING CHROME/NICKEL PR BAR $200.00
L2755 111830 CARBON GRAPHITE LAMINATION $326.00
L2760 111831 EXTENSION PER EXTENSION PER $235.00
L2768 111832 ORTHO SIDEBAR DISCONNECT $284.00
L2780 111833 NON-CORROSIVE FINISH $394.00
L2785 111834 DROP LOCK RETAINER EACH $180.00
L2795 111835 KNEE CONTROL FULL KNEECAP $247.00
L2800 111836 KNEE CAP MEDIAL OR LATERAL P $260.50
L2810 111837 KNEE CONTROL CONDYLAR PAD $241.50
L2820 111838 SOFT INTERFACE BELOW KNEE SE $343.50
L2830 111839 SOFT INTERFACE ABOVE KNEE SE $614.00
L2840 111840 TIBIAL LENGTH SOCK FX OR EQU $97.50
L2850 111841 FEMORAL LGTH SOCK FX OR EQUA $134.00
L3000 111842 FT INSERT UCB BERKELEY SHELL $617.00
L3001 111843 FOOT INSERT REMOV MOLDED SPE $271.50
L3002 111844 FOOT INSERT PLASTAZOTE OR EQ $389.50
L3003 111845 FOOT INSERT SILICONE GEL EAC $394.50
L3010 111846 FOOT LONGITUDINAL ARCH SUPPO $379.00
L3020 111847 FOOT LONGITUD/METATARSAL SUP $422.50
L3030 111848 FOOT ARCH SUPPORT REMOV PREM $158.00
L3031 111849 FOOT LAMIN/PREPREG COMPOSITE $224.50
L3040 111850 FT ARCH SUPRT PREMOLD LONGIT $98.50
L3050 111851 FOOT ARCH SUPP PREMOLD METAT $88.50
L3060 111852 FOOT ARCH SUPP LONGITUD/META $130.50
L3070 111853 ARCH SUPRT ATT TO SHO LONGIT $67.00
L3080 111854 ARCH SUPP ATT TO SHOE METATA $67.00
L3090 111855 ARCH SUPP ATT TO SHOE LONG/M $85.50
L3100 111856 HALLUS-VALGUS NT DYN PRE OTS $73.00
L3140 111857 ABDUCTION ROTATION BAR SHOE $183.50
L3150 111858 ABDUCT ROTATION BAR W/O SHOE $176.00
L3170 111859 FOOT PLAS HEEL STABI PRE OTS $90.00
L3202 111860 OXFORD W/ SUPINAT/PRONATOR C $63.00
L3203 111861 OXFORD W/ SUPINATOR/PRONATOR $146.50
L3216 111862 ORTHOPED LADIES SHOES DPTH I $217.50
L3221 111863 ORTHOPEDIC MENS SHOES DPTH I $238.50
L3222 111864 MENS SHOES HIGHTOP DEPTH INL $255.50
L3224 111865 WOMAN'S SHOE OXFORD BRACE $236.50
L3225 111866 MAN'S SHOE OXFORD BRACE $274.00
L3250 111867 CUSTOM MOLD SHOE REMOV PROST $202.00
L3260 111868 AMBULATORY SURGICAL BOOT EAC $241.00
L3265 111869 PLASTAZOTE SANDAL EACH $42.00
L3300 111870 SHO LIFT TAPER TO METATARSAL $135.00
L3310 111871 SHOE LIFT ELEV HEEL/SOLE NEO $242.50
L3330 111872 LIFTS ELEVATION METAL EXTENS $1,126.00
L3332 111873 SHOE LIFTS TAPERED TO ONE-HA $126.50
L3334 111874 SHOE LIFTS ELEVATION HEEL /I $56.50
L3340 111875 SHOE WEDGE SACH $175.50
L3350 111876 SHOE HEEL WEDGE $82.50
L3360 111877 SHOE SOLE WEDGE OUTSIDE SOLE $134.00
L3370 111878 SHOE SOLE WEDGE BETWEEN SOLE $103.50
L3380 111879 SHOE CLUBFOOT WEDGE $103.50
L3390 111880 SHOE OUTFLARE WEDGE $147.50
L3400 111881 SHOE METATARSAL BAR WEDGE RO $101.50
L3410 111882 SHOE METATARSAL BAR BETWEEN $191.50
L3420 111883 FULL SOLE/HEEL WEDGE BTWEEN $113.50
L3430 111884 SHO HEEL COUNT PLAST REINFOR $327.00
L3440 111885 HEEL LEATHER REINFORCED $158.00
L3450 111886 SHOE HEEL SACH CUSHION TYPE $271.50
L3455 111887 SHOE HEEL NEW LEATHER STANDA $85.50
L3460 111888 SHOE HEEL NEW RUBBER STANDAR $72.00
L3465 111889 SHOE HEEL THOMAS WITH WEDGE $122.00
L3470 111890 SHOE HEEL THOMAS EXTEND TO B $129.50
L3480 111891 SHOE HEEL PAD & DEPRESS FOR $140.00
L3485 111892 SHOE HEEL PAD REMOVABLE FOR $43.00
L3500 111893 ORTHO SHOE ADD LEATHER INSOL $62.00
L3510 111894 ORTHOPEDIC SHOE ADD RUB INSL $85.50
L3520 111895 O SHOE ADD FELT W LEATH INSL $67.00
L3530 111896 ORTHO SHOE ADD HALF SOLE $67.00
L3540 111897 ORTHO SHOE ADD FULL SOLE $96.00
L3550 111898 O SHOE ADD STANDARD TOE TAP $19.00
L3560 111899 O SHOE ADD HORSESHOE TOE TAP $48.50
L3570 111900 O SHOE ADD INSTEP EXTENSION $175.50
L3590 111901 O SHOE CONVERT TO SOF COUNTE $111.00
L3595 111902 ORTHO SHOE ADD MARCH BAR $88.00
L3600 111903 TRANS SHOE CALIP PLATE EXIST $158.00
L3610 111904 TRANS SHOE CALIPER PLATE NEW $206.50
L3620 111905 TRANS SHOE SOLID STIRRUP EXI $236.50
L3630 111906 TRANS SHOE SOLID STIRRUP NEW $206.50
L3640 111907 SHOE DENNIS BROWNE SPLINT BO $113.50
L3650 111908 SO 8 ABD RESTRAINT PRE OTS $158.50
L3660 111909 SO 8 AB RSTR CAN/WEB PRE OTS $232.50
L3670 111910 SO ACRO/CLAV CAN WEB PRE OTS $311.50
L3671 111911 SO CAP DESIGN W/O JNTS CF $1,619.50
L3674 111912 SO AIRPLANE W/WO JOINT CF $2,058.50
L3675 111913 SO VEST CANVAS/WEB PRE OTS $424.00
L3677 111914 SO HARD PLAS STABILI PRE CST $371.50
L3702 111915 EO W/O JOINTS CF $535.50
L3710 111916 EO ELAS W/METAL JNTS PRE OTS $350.00
L3720 111917 FOREARM/ARM CUFFS FREE MOTIO $2,785.00
L3730 111918 FOREARM/ARM CUFFS EXT/FLEX A $2,443.50
L3740 111919 CUFFS ADJ LOCK W/ ACTIVE CON $3,230.00
L3760 111920 EO ADJ JT PREFAB CUSTOM FIT $854.50
L3761 111921 EO, ADJ LOCK JOINT PREFAB OT $990.50
L3762 111922 EO RIGID W/O JOINTS PRE OTS $160.50
L3763 111923 EWHO RIGID W/O JNTS CF $1,161.50
L3764 111924 EWHO W/JOINT(S) CF $2,045.00
L3765 111925 EWHFO RIGID W/O JNTS CF $1,718.50
L3766 111926 EWHFO W/JOINT(S) CF $2,421.50
L3806 111927 WHFO W/JOINT(S) CUSTOM FAB $834.00
L3807 111928 WHFO W/O JOINTS PRE CST $382.50
L3808 111929 WHFO, RIGID W/O JOINTS $509.00
L3809 111930 WHFO W/O JOINTS PRE OTS $476.00
L3900 111931 HINGE EXTENSION/FLEX WRIST/F $2,503.00
L3901 111932 HINGE EXT/FLEX WRIST FINGER $3,894.00
L3904 111933 WHFO ELECTRIC CUSTOM FITTED $9,233.50
L3905 111934 WHO W/NONTORSION JNT(S) CF $1,597.50
L3906 111935 WHO W/O JOINTS CF $802.00
L3908 111936 WHO COCK-UP NONMOLDE PRE OTS $154.00
L3912 111937 HFO FLEXION GLOVE PRE OTS $207.50
L3913 111938 HFO W/O JOINTS CF $644.00
L3915 111939 WHO NONTORSION JNTS PRE CST $1,193.50
L3916 111940 WHO NONTORSION JNTS PRE OTS $965.50
L3917 111941 METACARP FX ORTHOSIS PRE CST $156.00
L3918 111942 METACARP FX ORTHOSIS PRE OTS $198.00
L3919 111943 HO W/O JOINTS CF $459.00
L3921 111944 HFO W/JOINT(S) CF $578.50
L3923 111945 HFO WITHOUT JOINTS PRE CST $182.50
L3924 111946 HFO WITHOUT JOINTS PRE OTS $144.50
L3925 111947 FO PIP DIP JNT/SPRNG PRE OTS $129.50
L3927 111948 FO PIP DIP NO JT SPR PRE OTS $87.00
L3929 111949 HFO NONTORSION JNTS PRE CST $213.00
L3930 111950 HFO NONTORSION JNTS PRE OTS $253.50
L3931 111951 WHFO NONTORSION JOINT PREFAB $477.00
L3933 111952 FO W/O JOINTS CF $381.00
L3935 111953 FO NONTORSION JOINT CF $422.50
L3960 111954 SEWHO AIRPLAN DESIG ABDU POS $1,625.50
L3961 111955 SEWHO CAP DESIGN W/O JNTS CF $2,984.00
L3962 111956 SEWHO ERBS PALSEY DESIGN ABD $2,005.50
L3967 111957 SEWHO AIRPLANE W/O JNTS CF $3,512.00
L3971 111958 SEWHO CAP DESIGN W/JNT(S) CF $3,337.00
L3973 111959 SEWHO AIRPLANE W/JNT(S) CF $3,512.00
L3975 111960 SEWHFO CAP DESIGN W/O JNT CF $2,984.00
L3976 111961 SEWHFO AIRPLANE W/O JNTS CF $2,984.00
L3977 111962 SEWHFO CAP DESGN W/JNT(S) CF $3,337.00
L3978 111963 SEWHFO AIRPLANE W/JNT(S) CF $3,512.00
L3980 111964 UP EXT FX ORTHOS HUMERAL NOS $752.00
L3981 111965 UE FX ORTH SHOUL CAP FOREARM $1,805.50
L3982 111966 UPPER EXT FX ORTHOSIS RAD/UL $741.00
L3984 111967 UPPER EXT FX ORTHOSIS WRIST $353.00
L3995 111968 SOCK FRACTURE OR EQUAL EACH $87.50
L4000 111969 REPL GIRDLE MILWAUKEE ORTH $3,252.50
L4002 111970 REPLACE STRAP, ANY ORTHOSIS $82.50
L4010 111971 REPLACE TRILATERAL SOCKET BR $1,925.00
L4020 111972 REPLACE QUADLAT SOCKET BRIM $2,134.00
L4030 111973 REPLACE SOCKET BRIM CUST FIT $1,708.00
L4040 111974 REPLACE MOLDED THIGH LACER $2,042.50
L4045 111975 REPLACE NON-MOLDED THIGH LAC $1,113.00
L4050 111976 REPLACE MOLDED CALF LACER $1,708.00
L4055 111977 REPLACE NON-MOLDED CALF LACE $1,036.50
L4060 111978 REPLACE HIGH ROLL CUFF $1,041.50
L4070 111979 REPLACE PROX & DIST UPRIGHT $1,424.50
L4080 111980 REPL MET BAND KAFO-AFO PROX $241.00
L4090 111981 REPL MET BAND KAFO-AFO CALF/ $222.50
L4100 111982 REPL LEATH CUFF KAFO PROX TH $265.50
L4110 111983 REPL LEATH CUFF KAFO-AFO CAL $331.50
L4130 111984 REPLACE PRETIBIAL SHELL $1,228.00
L4205 111985 ORTHO DVC REPAIR PER 15 MIN $70.50
L4210 111986 ORTH DEV REPAIR/REPL MINOR P $228.00
L4350 111987 ANKLE CONTROL ORTHO PRE OTS $481.50
L4360 111988 PNEUMAT WALKING BOOT PRE CST $484.50
L4361 111989 PNEUMA/VAC WALK BOOT PRE OTS $564.00
L4370 111990 PNEUM FULL LEG SPLNT PRE OTS $552.50
L4386 111991 NON-PNEUM WALK BOOT PRE CST $464.00
L4387 111992 NON-PNEUM WALK BOOT PRE OTS $288.00
L4392 111993 REPLACE AFO SOFT INTERFACE $143.50
L4394 111994 REPLACE FOOT DROP SPINT $39.50
L4396 111995 STATIC OR DYNAMI AFO PRE CST $401.00
L4397 111996 STATIC OR DYNAMI AFO PRE OTS $363.50
L4398 111997 FOOT DROP SPLINT PRE OTS $171.50
L4631 111998 AFO, WALK BOOT TYPE, CUS FAB $4,345.50
L5000 111999 SHO INSERT W ARCH TOE FILLER $1,147.00
L5010 112000 MOLD SOCKET ANK HGT W/ TOE F $3,027.00
L5020 112001 TIBIAL TUBERCLE HGT W/ TOE F $5,480.50
L5050 112002 ANK SYMES MOLD SCKT SACH FT $5,738.00
L5060 112003 SYMES MET FR LEATH SOCKET AR $7,113.50
L5100 112004 MOLDED SOCKET SHIN SACH FOOT $5,738.00
L5105 112005 PLAST SOCKET JTS/THGH LACER $9,996.50
L5150 112006 MOLD SCKT EXT KNEE SHIN SACH $9,887.00
L5160 112007 MOLD SOCKET BENT KNEE SHIN S $11,059.50
L5200 112008 KNE SING AXIS FRIC SHIN SACH $8,786.50
L5210 112009 NO KNEE/ANKLE JOINTS W/ FT B $8,235.00
L5220 112010 NO KNEE JOINT WITH ARTIC ALI $8,341.00
L5230 112011 FEM FOCAL DEFIC CONSTANT FRI $10,490.50
L5250 112012 HIP CANAD SING AXI CONS FRIC $18,048.00
L5270 112013 TILT TABLE LOCKING HIP SING $16,923.00
L5280 112014 HEMIPELVECT CANAD SING AXIS $18,841.50
L5301 112015 BK MOLD SOCKET SACH FT ENDO $5,652.50
L5312 112016 KNEE DISART, SACH FT, ENDO $8,037.50
L5321 112017 AK OPEN END SACH $8,298.50
L5331 112018 HIP DISART CANADIAN SACH FT $11,119.50
L5341 112019 HEMIPELVECTOMY CANADIAN SACH $18,839.00
L5400 112020 POSTOP DRESS & 1 CAST CHG BK $3,290.00
L5410 112021 POSTOP DSG BK EA ADD CAST CH $1,078.50
L5420 112022 POSTOP DSG & 1 CAST CHG AK/D $4,092.50
L5430 112023 POSTOP DSG AK EA ADD CAST CH $1,427.50
L5450 112024 POSTOP APP NON-WGT BEAR DSG $985.50
L5460 112025 POSTOP APP NON-WGT BEAR DSG $1,397.00
L5500 112026 INIT BK PTB PLASTER DIRECT $3,492.00
L5505 112027 INIT AK ISCHAL PLSTR DIRECT $6,017.00
L5510 112028 PREP BK PTB PLASTER MOLDED $4,619.50
L5520 112029 PERP BK PTB THERMOPLS DIRECT $4,619.50
L5530 112030 PREP BK PTB THERMOPLS MOLDED $4,995.00
L5535 112031 PREP BK PTB OPEN END SOCKET $5,366.50
L5540 112032 PREP BK PTB LAMINATED SOCKET $6,543.00
L5560 112033 PREP AK ISCHIAL PLAST MOLDED $6,851.00
L5570 112034 PREP AK ISCHIAL DIRECT FORM $5,183.00
L5580 112035 PREP AK ISCHIAL THERMO MOLD $6,229.50
L5585 112036 PREP AK ISCHIAL OPEN END $6,851.00
L5590 112037 PREP AK ISCHIAL LAMINATED $6,395.00
L5595 112038 HIP DISARTIC SACH THERMOPLS $16,376.50
L5600 112039 HIP DISART SACH LAMINAT MOLD $14,778.50
L5610 112040 ABOVE KNEE HYDRACADENCE $5,738.00
L5611 112041 AK 4 BAR LINK W/FRIC SWING $4,178.50
L5613 112042 AK 4 BAR LING W/HYDRAUL SWIG $6,841.00
L5614 112043 4-BAR LINK ABOVE KNEE W/SWNG $3,413.00
L5616 112044 AK UNIV MULTIPLEX SYS FRICT $3,392.50
L5617 112045 AK/BK SELF-ALIGNING UNIT EA $1,167.00
L5618 112046 TEST SOCKET SYMES $734.00
L5620 112047 TEST SOCKET BELOW KNEE $571.50
L5622 112048 TEST SOCKET KNEE DISARTICULA $1,924.00
L5624 112049 TEST SOCKET ABOVE KNEE $737.00
L5626 112050 TEST SOCKET HIP DISARTICULAT $2,354.50
L5628 112051 TEST SOCKET HEMIPELVECTOMY $2,010.50
L5629 112052 BELOW KNEE ACRYLIC SOCKET $623.00
L5630 112053 SYME TYP EXPANDABL WALL SCKT $1,163.00
L5631 112054 AK/KNEE DISARTIC ACRYLIC SOC $885.50
L5632 112055 SYMES TYPE PTB BRIM DESIGN S $583.00
L5634 112056 SYMES TYPE POSTER OPENING SO $1,058.50
L5636 112057 SYMES TYPE MEDIAL OPENING SO $666.50
L5637 112058 BELOW KNEE TOTAL CONTACT $703.50
L5638 112059 BELOW KNEE LEATHER SOCKET $1,471.00
L5639 112060 BELOW KNEE WOOD SOCKET $5,459.00
L5640 112061 KNEE DISARTICULAT LEATHER SO $1,633.00
L5642 112062 ABOVE KNEE LEATHER SOCKET $1,581.50
L5643 112063 HIP FLEX INNER SOCKET EXT FR $3,873.00
L5644 112064 ABOVE KNEE WOOD SOCKET $1,510.00
L5645 112065 BK FLEX INNER SOCKET EXT FRA $1,565.00
L5646 112066 BELOW KNEE CUSHION SOCKET $1,403.50
L5647 112067 BELOW KNEE SUCTION SOCKET $1,584.00
L5648 112068 ABOVE KNEE CUSHION SOCKET $1,678.00
L5649 112069 ISCH CONTAINMT/NARROW M-L SO $4,492.50
L5650 112070 TOT CONTACT AK/KNEE DISART S $1,174.50
L5651 112071 AK FLEX INNER SOCKET EXT FRA $2,573.00
L5652 112072 SUCTION SUSP AK/KNEE DISART $1,197.50
L5653 112073 KNEE DISART EXPAND WALL SOCK $2,925.00
L5654 112074 SOCKET INSERT SYMES $861.50
L5655 112075 SOCKET INSERT BELOW KNEE $753.00
L5656 112076 SOCKET INSERT KNEE ARTICULAT $1,055.50
L5658 112077 SOCKET INSERT ABOVE KNEE $1,635.50
L5661 112078 MULTI-DUROMETER SYMES $1,584.00
L5665 112079 MULTI-DUROMETER BELOW KNEE $1,639.00
L5666 112080 BELOW KNEE CUFF SUSPENSION $219.50
L5668 112081 BK MOLDED DISTAL CUSHION $286.00
L5670 112082 BK MOLDED SUPRACONDYLAR SUSP $1,058.00
L5671 112083 BK/AK LOCKING MECHANISM $1,190.50
L5672 112084 BK REMOVABLE MEDIAL BRIM SUS $776.50
L5673 112085 SOCKET INSERT W LOCK MECH $1,517.50
L5676 112086 BK KNEE JOINTS SINGLE AXIS P $1,418.50
L5677 112087 BK KNEE JOINTS POLYCENTRIC P $1,694.00
L5678 112088 BK JOINT COVERS PAIR $179.00
L5679 112089 SOCKET INSERT W/O LOCK MECH $1,246.50
L5680 112090 BK THIGH LACER NON-MOLDED $762.00
L5681 112091 INTL CUSTM CONG/LATYP INSERT $2,679.00
L5682 112092 BK THIGH LACER GLUT/ISCHIA M $1,939.00
L5683 112093 INITIAL CUSTOM SOCKET INSERT $2,679.00
L5684 112094 BK FORK STRAP $232.00
L5685 112095 BELOW KNEE SUS/SEAL SLEEVE $275.00
L5686 112096 BK BACK CHECK $139.50
L5688 112097 BK WAIST BELT WEBBING $236.00
L5690 112098 BK WAIST BELT PADDED AND LIN $287.00
L5692 112099 AK PELVIC CONTROL BELT LIGHT $475.00
L5694 112100 AK PELVIC CONTROL BELT PAD/L $604.50
L5695 112101 AK SLEEVE SUSP NEOPRENE/EQUA $450.00
L5696 112102 AK/KNEE DISARTIC PELVIC JOIN $587.00
L5697 112103 AK/KNEE DISARTIC PELVIC BAND $260.50
L5698 112104 AK/KNEE DISARTIC SILESIAN BA $326.00
L5699 112105 SHOULDER HARNESS $680.50
L5700 112106 REPLACE SOCKET BELOW KNEE $6,908.00
L5701 112107 REPLACE SOCKET ABOVE KNEE $8,478.50
L5702 112108 REPLACE SOCKET HIP $21,436.50
L5703 112109 SYMES ANKLE W/O (SACH) FOOT $5,249.50
L5704 112110 CUSTOM SHAPE COVER BK $1,056.00
L5705 112111 CUSTOM SHAPE COVER AK $2,223.50
L5706 112112 CUSTOM SHAPE CVR KNEE DISART $2,194.50
L5707 112113 CUSTOM SHAPE CVR HIP DISART $2,871.50
L5710 112114 KNE-SHIN EXO SNG AXI MNL LOC $1,317.50
L5711 112115 KNEE-SHIN EXO MNL LOCK ULTRA $1,541.50
L5712 112116 KNEE-SHIN EXO FRICT SWG & ST $1,524.50
L5714 112117 KNEE-SHIN EXO VARIABLE FRICT $992.00
L5716 112118 KNEE-SHIN EXO MECH STANCE PH $2,361.50
L5718 112119 KNEE-SHIN EXO FRCT SWG & STA $2,540.00
L5722 112120 KNEE-SHIN PNEUM SWG FRCT EXO $2,210.00
L5724 112121 KNEE-SHIN EXO FLUID SWING PH $3,856.50
L5726 112122 KNEE-SHIN EXT JNTS FLD SWG E $4,315.00
L5728 112123 KNEE-SHIN FLUID SWG & STANCE $7,036.50
L5780 112124 KNEE-SHIN PNEUM/HYDRA PNEUM $3,579.50
L5781 112125 LOWER LIMB PROS VACUUM PUMP $7,900.50
L5782 112126 HD LOW LIMB PROS VACUUM PUMP $8,316.50
L5785 112127 EXOSKELETAL BK ULTRALT MATER $1,333.00
L5790 112128 EXOSKELETAL AK ULTRA-LIGHT M $1,827.50
L5795 112129 EXOSKEL HIP ULTRA-LIGHT MATE $2,699.50
L5810 112130 ENDOSKEL KNEE-SHIN MNL LOCK $1,760.50
L5811 112131 ENDO KNEE-SHIN MNL LCK ULTRA $2,548.00
L5812 112132 ENDO KNEE-SHIN FRCT SWG & ST $2,659.50
L5814 112133 ENDO KNEE-SHIN HYDRAL SWG PH $7,348.50
L5816 112134 ENDO KNEE-SHIN POLYC MCH STA $3,103.50
L5818 112135 ENDO KNEE-SHIN FRCT SWG & ST $3,127.00
L5822 112136 ENDO KNEE-SHIN PNEUM SWG FRC $4,226.50
L5824 112137 ENDO KNEE-SHIN FLUID SWING P $5,323.50
L5826 112138 MINIATURE KNEE JOINT $6,756.50
L5828 112139 ENDO KNEE-SHIN FLUID SWG/STA $10,269.00
L5830 112140 ENDO KNEE-SHIN PNEUM/SWG PHA $6,321.00
L5840 112141 MULTI-AXIAL KNEE/SHIN SYSTEM $7,906.00
L5845 112142 KNEE-SHIN SYS STANCE FLEXION $3,508.50
L5848 112143 KNEE-SHIN SYS HYDRAUL STANCE $2,270.00
L5850 112144 ENDO AK/HIP KNEE EXTENS ASSI $256.50
L5855 112145 MECH HIP EXTENSION ASSIST $826.50
L5856 112146 ELEC KNEE-SHIN SWING/STANCE $58,812.00
L5857 112147 ELEC KNEE-SHIN SWING ONLY $16,470.00
L5858 112148 STANCE PHASE ONLY $45,646.00
L5859 112149 KNEE-SHIN PRO FLEX/EXT CONT $27,640.50
L5910 112150 ENDO BELOW KNEE ALIGNABLE SY $716.50
L5920 112151 ENDO AK/HIP ALIGNABLE SYSTEM $1,037.00
L5925 112152 ABOVE KNEE MANUAL LOCK $1,574.00
L5930 112153 HIGH ACTIVITY KNEE FRAME $6,678.00
L5940 112154 ENDO BK ULTRA-LIGHT MATERIAL $1,001.00
L5950 112155 ENDO AK ULTRA-LIGHT MATERIAL $1,589.50
L5960 112156 ENDO HIP ULTRA-LIGHT MATERIA $3,563.00
L5961 112157 ENDO POLY HIP, PNEU/HYD/ROT $9,883.50
L5962 112158 BELOW KNEE FLEX COVER SYSTEM $1,229.00
L5964 112159 ABOVE KNEE FLEX COVER SYSTEM $2,182.00
L5966 112160 HIP FLEXIBLE COVER SYSTEM $2,808.50
L5968 112161 MULTIAXIAL ANKLE W DORSIFLEX $7,107.50
L5970 112162 FOOT EXTERNAL KEEL SACH FOOT $561.50
L5971 112163 SACH FOOT, REPLACEMENT $561.50
L5972 112164 FLEXIBLE KEEL FOOT $857.00
L5973 112165 ANK-FOOT SYS DORS-PLANT FLEX $44,201.50
L5974 112166 FOOT SINGLE AXIS ANKLE/FOOT $843.50
L5975 112167 COMBO ANKLE/FOOT PROSTHESIS $1,057.50
L5976 112168 ENERGY STORING FOOT $2,533.50
L5978 112169 FT PROSTH MULTIAXIAL ANKL/FT $1,032.50
L5979 112170 MULTI-AXIAL ANKLE/FT PROSTH $5,617.50
L5980 112171 FLEX FOOT SYSTEM $14,297.50
L5981 112172 FLEX-WALK SYS LOW EXT PROSTH $6,366.00
L5982 112173 EXOSKELETAL AXIAL ROTATION U $1,677.00
L5984 112174 ENDOSKELETAL AXIAL ROTATION $2,212.00
L5985 112175 LWR EXT DYNAMIC PROSTH PYLON $600.50
L5986 112176 MULTI-AXIAL ROTATION UNIT $2,280.50
L5987 112177 SHANK FT W VERT LOAD PYLON $14,070.00
L5988 112178 VERTICAL SHOCK REDUCING PYLO $4,376.50
L5990 112179 USER ADJUSTABLE HEEL HEIGHT $3,662.00
L6000 112180 PART HAND THUMB REM $4,465.00
L6010 112181 PART HAND LITTLE/RING $5,036.50
L6020 112182 PART HAND NO FINGERS $4,623.50
L6026 112183 PART HAND MYO EXCLU TERM DEV $9,103.50
L6050 112184 WRST MLD SCK FLX HNG TRI PAD $5,162.00
L6055 112185 WRST MOLD SOCK W/EXP INTERFA $6,562.00
L6100 112186 ELB MOLD SOCK FLEX HINGE PAD $4,761.00
L6110 112187 ELBOW MOLD SOCK SUSPENSION T $5,613.50
L6120 112188 ELBOW MOLD DOUB SPLT SOC STE $6,286.50
L6130 112189 ELBOW STUMP ACTIVATED LOCK H $8,324.50
L6200 112190 ELBOW MOLD OUTSID LOCK HINGE $7,423.00
L6205 112191 ELBOW MOLDED W/ EXPAND INTER $9,005.00
L6250 112192 ELBOW INTER LOC ELBOW FORARM $7,894.00
L6300 112193 SHLDER DISART INT LOCK ELBOW $10,229.00
L6310 112194 SHOULDER PASSIVE RESTOR COMP $8,298.00
L6320 112195 SHOULDER PASSIVE RESTOR CAP $5,390.00
L6350 112196 THORACIC INTERN LOCK ELBOW $10,282.00
L6360 112197 THORACIC PASSIVE RESTOR COMP $11,039.50
L6370 112198 THORACIC PASSIVE RESTOR CAP $5,892.00
L6380 112199 POSTOP DSG CAST CHG WRST/ELB $3,209.00
L6382 112200 POSTOP DSG CAST CHG ELB DIS/ $5,179.50
L6384 112201 POSTOP DSG CAST CHG SHLDER/T $6,017.00
L6386 112202 POSTOP EA CAST CHG & REALIGN $2,211.50
L6388 112203 POSTOP APPLICAT RIGID DSG ON $1,133.00
L6400 112204 BELOW ELBOW PROSTH TISS SHAP $6,369.50
L6450 112205 ELB DISART PROSTH TISS SHAP $7,527.00
L6500 112206 ABOVE ELBOW PROSTH TISS SHAP $7,405.50
L6550 112207 SHLDR DISAR PROSTH TISS SHAP $11,025.00
L6570 112208 SCAP THORAC PROSTH TISS SHAP $12,721.50
L6580 112209 WRIST/ELBOW BOWDEN CABLE MOL $3,791.50
L6582 112210 WRIST/ELBOW BOWDEN CBL DIR F $4,057.00
L6584 112211 ELBOW FAIR LEAD CABLE MOLDED $5,179.50
L6586 112212 ELBOW FAIR LEAD CABLE DIR FO $4,619.50
L6588 112213 SHDR FAIR LEAD CABLE MOLDED $6,587.50
L6590 112214 SHDR FAIR LEAD CABLE DIRECT $5,977.00
L6600 112215 POLYCENTRIC HINGE PAIR $656.50
L6605 112216 SINGLE PIVOT HINGE PAIR $681.00
L6610 112217 FLEXIBLE METAL HINGE PAIR $572.00
L6611 112218 ADDITIONAL SWITCH, EXT POWER $866.00
L6615 112219 DISCONNECT LOCKING WRIST UNI $428.50
L6616 112220 DISCONNECT INSERT LOCKING WR $176.00
L6620 112221 FLEXION/EXTENSION WRIST UNIT $819.00
L6621 112222 FLEX/EXT WRIST W/WO FRICTION $4,587.00
L6623 112223 SPRING-ASS ROT WRST W/ LATCH $1,636.00
L6624 112224 FLEX/EXT/ROTATION WRIST UNIT $7,448.50
L6625 112225 ROTATION WRST W/ CABLE LOCK $1,849.00
L6628 112226 QUICK DISCONN HOOK ADAPTER O $1,231.50
L6629 112227 LAMINATION COLLAR W/ COUPLIN $388.50
L6630 112228 STAINLESS STEEL ANY WRIST $566.50
L6632 112229 LATEX SUSPENSION SLEEVE EACH $177.00
L6635 112230 LIFT ASSIST FOR ELBOW $529.50
L6637 112231 NUDGE CONTROL ELBOW LOCK $951.00
L6638 112232 ELEC LOCK ON MANUAL PW ELBOW $5,002.50
L6640 112233 SHOULDER ABDUCTION JOINT PAI $731.00
L6641 112234 EXCURSION AMPLIFIER PULLEY T $543.50
L6642 112235 EXCURSION AMPLIFIER LEVER TY $1,054.00
L6645 112236 SHOULDER FLEXION-ABDUCTION J $945.50
L6646 112237 MULTIPO LOCKING SHOULDER JNT $6,269.00
L6647 112238 SHOULDER LOCK ACTUATOR $1,085.00
L6648 112239 EXT PWRD SHLDER LOCK/UNLOCK $6,460.00
L6650 112240 SHOULDER UNIVERSAL JOINT $986.00
L6655 112241 STANDARD CONTROL CABLE EXTRA $257.50
L6660 112242 HEAVY DUTY CONTROL CABLE $342.00
L6665 112243 TEFLON OR EQUAL CABLE LINING $126.50
L6670 112244 HOOK TO HAND CABLE ADAPTER $198.00
L6672 112245 HARNESS CHEST/SHLDER SADDLE $907.50
L6675 112246 HARNESS FIGURE OF 8 SING CON $332.50
L6676 112247 HARNESS FIGURE OF 8 DUAL CON $402.00
L6677 112248 UE TRIPLE CONTROL HARNESS $630.00
L6680 112249 TEST SOCK WRIST DISART/BEL E $1,653.50
L6682 112250 TEST SOCK ELBW DISART/ABOVE $1,520.00
L6684 112251 TEST SOCKET SHLDR DISART/THO $1,209.00
L6686 112252 SUCTION SOCKET $2,111.00
L6687 112253 FRAME TYP SOCKET BEL ELBOW/W $2,354.50
L6688 112254 FRAME TYP SOCK ABOVE ELB/DIS $2,340.50
L6689 112255 FRAME TYP SOCKET SHOULDER DI $2,711.50
L6690 112256 FRAME TYP SOCK INTERSCAP-THO $2,854.00
L6691 112257 REMOVABLE INSERT EACH $1,273.00
L6692 112258 SILICONE GEL INSERT OR EQUAL $1,780.00
L6693 112259 LOCKINGELBOW FOREARM CNTRBAL $6,159.00
L6694 112260 ELBOW SOCKET INS USE W/LOCK $1,863.00
L6695 112261 ELBOW SOCKET INS USE W/O LCK $1,560.00
L6696 112262 CUS ELBO SKT IN FOR CON/ATYP $2,679.00
L6697 112263 CUS ELBO SKT IN NOT CON/ATYP $2,679.00
L6698 112264 BELOW/ABOVE ELBOW LOCK MECH $1,793.50
L6703 112265 TERM DEV, PASSIVE HAND MITT $844.50
L6704 112266 TERM DEV, SPORT/REC/WORK ATT $1,688.00
L6706 112267 TERM DEV MECH HOOK VOL OPEN $904.50
L6707 112268 TERM DEV MECH HOOK VOL CLOSE $3,355.00
L6708 112269 TERM DEV MECH HAND VOL OPEN $2,473.50
L6709 112270 TERM DEV MECH HAND VOL CLOSE $3,721.50
L6711 112271 PED TERM DEV, HOOK, VOL OPEN $1,395.00
L6712 112272 PED TERM DEV, HOOK, VOL CLOS $2,525.50
L6713 112273 PED TERM DEV, HAND, VOL OPEN $3,166.50
L6714 112274 PED TERM DEV, HAND, VOL CLOS $2,694.50
L6715 112275 TERM DEVICE, MULTI ART DIGIT $6,275.00
L6721 112276 HOOK/HAND, HVY DTY, VOL OPEN $4,713.00
L6722 112277 HOOK/HAND, HVY DTY, VOL CLOS $4,282.50
L6805 112278 TERM DEV MODIFIER WRIST UNIT $882.00
L6810 112279 TERM DEV PRECISION PINCH DEV $492.50
L6880 112280 ELEC HAND IND ART DIGITS $58,537.50
L6881 112281 TERM DEV AUTO GRASP FEATURE $8,067.50
L6882 112282 MICROPROCESSOR CONTROL UPLMB $6,167.00
L6883 112283 REPLC SOCKT BELOW E/W DISA $3,946.00
L6884 112284 REPLC SOCKT ABOVE ELBOW DISA $6,997.50
L6885 112285 REPLC SOCKT SHLDR DIS/INTERC $11,039.50
L6890 112286 PREFAB GLOVE FOR TERM DEVICE $371.50
L6895 112287 CUSTOM GLOVE FOR TERM DEVICE $1,429.50
L6900 112288 HAND RESTORAT THUMB/1 FINGER $4,080.50
L6905 112289 HAND RESTORATION MULTIPLE FI $4,376.50
L6910 112290 HAND RESTORATION NO FINGERS $6,016.50
L6915 112291 HAND RESTORATION REPLACMNT G $1,705.50
L6920 112292 WRIST DISARTICUL SWITCH CTRL $15,342.50
L6925 112293 WRIST DISART MYOELECTRONIC C $16,454.00
L6930 112294 BELOW ELBOW SWITCH CONTROL $15,293.50
L6935 112295 BELOW ELBOW MYOELECTRONIC CT $16,387.50
L6940 112296 ELBOW DISARTICULATION SWITCH $20,806.00
L6945 112297 ELBOW DISART MYOELECTRONIC C $25,433.50
L6950 112298 ABOVE ELBOW SWITCH CONTROL $25,433.50
L6955 112299 ABOVE ELBOW MYOELECTRONIC CT $28,081.00
L6960 112300 SHLDR DISARTIC SWITCH CONTRO $28,315.00
L6965 112301 SHLDR DISARTIC MYOELECTRONIC $43,003.50
L6970 112302 INTERSCAPULAR-THOR SWITCH CT $43,703.50
L6975 112303 INTERSCAP-THOR MYOELECTRONIC $45,308.00
L7007 112304 ADULT ELECTRIC HAND $8,375.50
L7008 112305 PEDIATRIC ELECTRIC HAND $13,016.50
L7009 112306 ADULT ELECTRIC HOOK $8,540.50
L7040 112307 PREHENSILE ACTUATOR $6,900.00
L7045 112308 PEDIATRIC ELECTRIC HOOK $4,017.50
L7170 112309 ELECTRONIC ELBOW HOSMER SWIT $14,061.50
L7180 112310 ELECTRONIC ELBOW SEQUENTIAL $92,262.50
L7181 112311 ELECTRONIC ELBO SIMULTANEOUS $97,676.00
L7185 112312 ELECTRON ELBOW ADOLESCENT SW $14,234.00
L7186 112313 ELECTRON ELBOW CHILD SWITCH $20,581.00
L7190 112314 ELBOW ADOLESCENT MYOELECTRON $19,514.50
L7191 112315 ELBOW CHILD MYOELECTRONIC CT $21,578.00
L7259 112316 ELECTRONIC WRIST ROTATOR ANY $8,056.00
L7360 112317 SIX VOLT BAT OTTO BOCK/EQ EA $774.50
L7362 112318 BATTERY CHRGR SIX VOLT OTTO $1,471.50
L7364 112319 TWELVE VOLT BATTERY UTAH/EQU $1,471.50
L7366 112320 BATTERY CHRGR 12 VOLT UTAH/E $1,619.00
L7367 112321 REPLACEMNT LITHIUM IONBATTER $1,096.00
L7368 112322 LITHIUM ION BATTERY CHARGER $1,055.50
L7400 112323 ADD UE PROST BE/WD, ULTLITE $662.50
L7401 112324 ADD UE PROST A/E ULTLITE MAT $725.50
L7402 112325 ADD UE PROST S/D ULTLITE MAT $781.50
L7403 112326 ADD UE PROST B/E ACRYLIC $795.50
L7404 112327 ADD UE PROST A/E ACRYLIC $1,159.00
L7405 112328 ADD UE PROST S/D ACRYLIC $1,505.00
L7510 112329 PROSTHETIC DEVICE REPAIR REP $134.50
L7520 112330 REPAIR PROSTHESIS PER 15 MIN $92.50
L7700 112331 PROS SOC INSERT GASKET/SEAL $302.00
L8000 112332 MASTECTOMY BRA $123.50
L8001 112333 BREAST PROSTHESIS BRA & FORM $272.50
L8002 112334 BRST PRSTH BRA & BILAT FORM $469.00
L8010 112335 MASTECTOMY SLEEVE $208.50
L8015 112336 EXT BREASTPROSTHESIS GARMENT $146.50
L8020 112337 MASTECTOMY FORM $298.00
L8030 112338 BREAST PROSTHES W/O ADHESIVE $495.00
L8031 112339 BREAST PROSTHESIS W ADHESIVE $1,096.00
L8032 112340 REUSABLE NIPPLE PROSTHESIS $87.50
L8035 112341 CUSTOM BREAST PROSTHESIS $7,892.00
L8040 112342 NASAL PROSTHESIS $5,401.50
L8041 112343 MIDFACIAL PROSTHESIS $6,476.50
L8042 112344 ORBITAL PROSTHESIS $7,254.00
L8043 112345 UPPER FACIAL PROSTHESIS $8,098.50
L8044 112346 HEMI-FACIAL PROSTHESIS $8,941.00
L8045 112347 AURICULAR PROSTHESIS $6,041.50
L8046 112348 PARTIAL FACIAL PROSTHESIS $5,839.00
L8047 112349 NASAL SEPTAL PROSTHESIS $3,048.50
L8300 112350 TRUSS SINGLE W/ STANDARD PAD $173.00
L8310 112351 TRUSS DOUBLE W/ STANDARD PAD $293.00
L8320 112352 TRUSS ADDITION TO STD PAD WA $176.00
L8330 112353 TRUSS ADD TO STD PAD SCROTAL $215.00
L8400 112354 SHEATH BELOW KNEE $32.00
L8410 112355 SHEATH ABOVE KNEE $62.00
L8415 112356 SHEATH UPPER LIMB $60.00
L8417 112357 PROS SHEATH/SOCK W GEL CUSHN $142.50
L8420 112358 PROSTHETIC SOCK MULTI PLY BK $44.00
L8430 112359 PROSTHETIC SOCK MULTI PLY AK $49.00
L8435 112360 PROS SOCK MULTI PLY UPPER LM $77.50
L8440 112361 SHRINKER BELOW KNEE $102.50
L8460 112362 SHRINKER ABOVE KNEE $179.00
L8465 112363 SHRINKER UPPER LIMB $133.50
L8470 112364 PROS SOCK SINGLE PLY BK $17.00
L8480 112365 PROS SOCK SINGLE PLY AK $31.50
L8485 112366 PROS SOCK SINGLE PLY UPPER L $31.50
L8500 112367 ARTIFICIAL LARYNX $2,273.00
L8501 112368 TRACHEOSTOMY SPEAKING VALVE $344.00
L8507 112369 TRACH-ESOPH VOICE PROS PT IN $686.00
L8509 112370 TRACH-ESOPH VOICE PROS MD IN $786.50
L8510 112371 VOICE AMPLIFIER $460.50
L8511 112372 INDWELLING TRACH INSERT $214.50
L8512 112373 GEL CAP FOR TRACH VOICE PROS $28.00
L8513 112374 TRACH PROS CLEANING DEVICE $22.50
L8514 112375 REPL TRACH PUNCTURE DILATOR $609.50
L8515 112376 GEL CAP APP DEVICE FOR TRACH $221.50
L8600 112377 IMPLANT BREAST SILICONE/EQ $4,568.50
L8603 112378 COLLAGEN IMP URINARY 2.5 ML $3,302.00
L8604 112379 DEXTRANOMER/HYALURONIC ACID $6,595.50
L8605 112380 INJ BULKING AGENT ANAL CANAL $1,675.00
L8606 112381 SYNTHETIC IMPLNT URINARY 1ML $4,491.00
L8607 112382 INJ VOCAL CORD BULKING AGENT $2,421.50
L8609 112383 ARTIFICIAL CORNEA $6,234.50
L8610 112384 OCULAR IMPLANT $1,588.00
L8612 112385 AQUEOUS SHUNT PROSTHESIS $2,589.50
L8613 112386 OSSICULAR IMPLANT $1,064.50
L8614 112387 COCHLEAR DEVICE $107,870.00
L8615 112388 COCH IMPLANT HEADSET REPLACE $894.50
L8616 112389 COCH IMPLANT MICROPHONE REPL $217.00
L8617 112390 COCH IMPLANT TRANS COIL REPL $190.00
L8618 112391 COCH IMPLANT TRAN CABLE REPL $72.00
L8619 112392 COCH IMP EXT PROC/CONTR RPLC $25,681.50
L8622 112393 REPL ALKALINE BATTERY $1.00
L8623 112394 LITH ION BATT CID,NON-EARLVL $135.50
L8624 112395 LITH ION BATT CID, EAR LEVEL $618.00
L8625 112396 CHARGER COCH IMPL/AOI BATTRY $383.50
L8627 112397 CID EXT SPEECH PROCESS REPL $12,967.00
L8628 112398 CID EXT CONTROLLER REPL $2,448.00
L8629 112399 CID TRANSMIT COIL AND CABLE $385.50
L8630 112400 METACARPOPHALANGEAL IMPLANT $3,671.50
L8631 112401 MCP JOINT REPL 2 PC OR MORE $5,261.00
L8641 112402 METATARSAL JOINT IMPLANT $5,641.00
L8642 112403 HALLUX IMPLANT $6,246.00
L8658 112404 INTERPHALANGEAL JOINT SPACER $4,454.00
L8659 112405 INTERPHALANGEAL JOINT REPL $4,971.50
L8670 112406 VASCULAR GRAFT, SYNTHETIC $3,654.00
L8679 112407 IMP NEUROSTI PLS GN ANY TYPE $43,848.00
L8680 112408 IMPLT NEUROSTIM ELCTR EACH $1,059.50
L8681 112409 PT PRGRM FOR IMPLT NEUROSTIM $4,503.00
L8682 112410 IMPLT NEUROSTIM RADIOFQ REC $11,149.00
L8683 112411 RADIOFQ TRSMTR FOR IMPLT NEU $13,699.00
L8684 112412 RADIOF TRSMTR IMPLT SCRL NEU $1,627.00
L8686 112413 IMPLT NROSTM PLS GEN SNG NON $65,768.00
L8688 112414 IMPLT NROSTM PLS GEN DUA NON $58,243.50
L8689 112415 EXTERNAL RECHARG SYS INTERN $7,430.50
L8690 112416 AUD OSSEO DEV, INT/EXT COMP $16,105.50
L8691 112417 AOI SND PROC REPL EXCL ACTUA $34,317.50
L8692 112418 NON-OSSEOINTEGRATED SND PROC $10,194.50
L8693 112419 AUD OSSEO DEV, ABUTMENT $7,841.00
L8695 112420 EXTERNAL RECHARG SYS EXTERN $7,415.50
L8696 112421 EXT ANTENNA PHREN NERVE STIM $614.50
M0220 112422 TIXAGEV AND CILGAV INJ $276.50
M0221 112423 TIXAGEV AND CILGAV INJ HM $1,176.00
M0222 112424 BEBTELOVIMAB INJECTION $768.00
M0240 112425 CASIRI AND IMDEV REPEAT $1,443.00
M0243 112426 CASIRIVI AND IMDEVI INJ $1,481.50
M0245 112427 BAMLAN AND ETESEV INFUSION $1,941.00
M0247 112428 SOTROVIMAB INFUSION $3,641.50
M0249 112429 ADM TOCILIZU COVID-19 1ST $2,135.50
M0250 112430 ADM TOCILIZU COVID-19 2ND $2,799.00
P2028 112431 CEPHALIN FLOCULATION TEST $97.00
P2029 112432 CONGO RED BLOOD TEST $97.00
P2031 112433 HAIR ANALYSIS $97.00
P2033 112434 BLOOD THYMOL TURBIDITY $97.00
P2038 112435 BLOOD MUCOPROTEIN $97.00
P3000 112436 SCREEN PAP BY TECH W MD SUPV $243.00
P7001 112437 CULTURE BACTERIAL URINE $612.50
P9010 112438 WHOLE BLOOD FOR TRANSFUSION $1,263.50
P9011 112439 BLOOD SPLIT UNIT $1,346.00
P9012 112440 CRYOPRECIPITATE EACH UNIT $265.00
P9016 112441 RBC LEUKOCYTES REDUCED $917.00
P9017 112442 PLASMA 1 DONOR FRZ W/IN 8 HR $416.00
P9019 112443 PLATELETS, EACH UNIT $696.00
P9020 112444 PLAELET RICH PLASMA UNIT $3,117.50
P9021 112445 RED BLOOD CELLS UNIT $1,112.00
P9022 112446 WASHED RED BLOOD CELLS UNIT $1,768.00
P9023 112447 FROZEN PLASMA, POOLED, SD $535.50
P9025 112448 PLASMA CRYO REDU PATH EACH $663.50
P9026 112449 CRYO FIB COMP PATH REDU EACH $759.50
P9031 112450 PLATELETS LEUKOCYTES REDUCED $1,404.50
P9032 112451 PLATELETS, IRRADIATED $1,992.00
P9033 112452 PLATELETS LEUKOREDUCED IRRAD $4,151.50
P9034 112453 PLATELETS, PHERESIS $2,795.00
P9035 112454 PLATELET PHERES LEUKOREDUCED $2,403.50
P9036 112455 PLATELET PHERESIS IRRADIATED $3,700.50
P9037 112456 PLATE PHERES LEUKOREDU IRRAD $2,533.00
P9038 112457 RBC IRRADIATED $1,734.50
P9039 112458 RBC DEGLYCEROLIZED $2,988.00
P9040 112459 RBC LEUKOREDUCED IRRADIATED $1,103.00
P9041 112460 ALBUMIN (HUMAN),5%, 50ML $144.50
P9043 112461 PLASMA PROTEIN FRACT,5%,50ML $130.50
P9044 112462 CRYOPRECIPITATEREDUCEDPLASMA $614.50
P9045 112463 ALBUMIN (HUMAN), 5%, 250 ML $506.00
P9046 112464 ALBUMIN (HUMAN), 25%, 20 ML $265.50
P9047 112465 ALBUMIN (HUMAN), 25%, 50ML $382.00
P9048 112466 PLASMAPROTEIN FRACT,5%,250ML $1,334.00
P9051 112467 BLOOD, L/R, CMV-NEG $1,859.00
P9052 112468 PLATELETS, HLA-M, L/R, UNIT $4,493.50
P9053 112469 PLT, PHER, L/R CMV-NEG, IRR $3,440.00
P9054 112470 BLOOD, L/R, FROZ/DEGLY/WASH $1,741.00
P9055 112471 PLT, APH/PHER, L/R, CMV-NEG $5,235.00
P9056 112472 BLOOD, L/R, IRRADIATED $2,080.00
P9057 112473 RBC, FRZ/DEG/WSH, L/R, IRRAD $1,761.00
P9058 112474 RBC, L/R, CMV-NEG, IRRAD $1,733.50
P9059 112475 PLASMA, FRZ BETWEEN 8-24HOUR $595.50
P9060 112476 FR FRZ PLASMA DONOR RETESTED $584.50
P9070 112477 PATHOGEN REDUCED PLASMA POOL $438.50
P9071 112478 PATHOGEN REDUCED PLASMA SING $576.50
P9073 112479 PLATELETS PHERESIS PATH REDU $1,503.00
P9100 112480 PATHOGEN TEST FOR PLATELETS $185.00
P9603 112481 ONE-WAY ALLOW PRORATED MILES $2.00
P9604 112482 ONE-WAY ALLOW PRORATED TRIP $20.50
P9612 112483 CATHETERIZE FOR URINE SPEC $19.00
P9615 112484 URINE SPECIMEN COLLECT MULT $220.50
Q0035 112485 CARDIOKYMOGRAPHY $315.50
Q0081 112486 INFUSION THER OTHER THAN CHE $194.50
Q0091 112487 OBTAINING SCREEN PAP SMEAR $186.50
Q0092 112488 SET UP PORT XRAY EQUIPMENT $140.50
Q0111 112489 WET MOUNTS/ W PREPARATIONS $115.00
Q0112 112490 POTASSIUM HYDROXIDE PREPS $124.00
Q0113 112491 PINWORM EXAMINATIONS $65.50
Q0114 112492 FERN TEST $118.00
Q0115 112493 POST-COITAL MUCOUS EXAM $88.00
Q0138 112494 FERUMOXYTOL, NON-ESRD $12.00
Q0139 112495 FERUMOXYTOL, ESRD USE $5.50
Q0144 112496 AZITHROMYCIN DIHYDRATE, ORAL $267.00
Q0161 112497 CHLORPROMAZINE HCL 5MG ORAL $6.00
Q0162 112498 ONDANSETRON ORAL $1.00
Q0163 112499 DIPHENHYDRAMINE HCL 50MG $2.50
Q0164 112500 PROCHLORPERAZINE MALEATE 5MG $3.00
Q0166 112501 GRANISETRON HCL 1 MG ORAL $34.00
Q0167 112502 DRONABINOL 2.5MG ORAL $10.50
Q0169 112503 PROMETHAZINE HCL 12.5MG ORAL $3.00
Q0175 112504 PERPHENAZINE 4MG ORAL $8.00
Q0177 112505 HYDROXYZINE PAMOATE 25MG $1.00
Q0240 112506 CASIRIVI AND IMDEVI 600 MG $2.00
Q0243 112507 CASIRIVIMAB AND IMDEVIMAB $2.00
Q0244 112508 CASIRIVI AND IMDEVI 1200 MG $2.00
Q0245 112509 BAMLANIVIMAB AND ETESEVIMA $2.00
Q0249 112510 TOCILIZUMAB FOR COVID-19 $30.00
Q0477 112511 PWR MODULE PT CABLE LVAD RPL $2,044.50
Q0478 112512 POWER ADAPTER, COMBO VAD $492.50
Q0479 112513 POWER MODULE COMBO VAD, REP $28,885.50
Q0480 112514 DRIVER PNEUMATIC VAD, REP $237,416.50
Q0481 112515 MICROPRCSR CU ELEC VAD, REP $23,446.50
Q0482 112516 MICROPRCSR CU COMBO VAD, REP $13,398.00
Q0483 112517 MONITOR ELEC VAD, REP $46,045.00
Q0484 112518 MONITOR ELEC OR COMB VAD REP $7,208.00
Q0485 112519 MONITOR CABLE ELEC VAD, REP $991.00
Q0486 112520 MON CABLE ELEC/PNEUM VAD REP $826.50
Q0487 112521 LEADS ANY TYPE VAD, REP ONLY $840.00
Q0489 112522 PWR PCK BASE COMBO VAD, REP $43,741.00
Q0490 112523 EMR PWR SOURCE ELEC VAD, REP $1,457.00
Q0491 112524 EMR PWR SOURCE COMBO VAD REP $2,262.00
Q0492 112525 EMR PWR CBL ELEC VAD, REP $195.50
Q0493 112526 EMR PWR CBL COMBO VAD, REP $540.50
Q0494 112527 EMR HD PMP ELEC/COMBO, REP $564.50
Q0495 112528 CHARGER ELEC/COMBO VAD, REP $23,289.50
Q0496 112529 BATTERY ELEC/COMBO VAD, REP $3,388.50
Q0497 112530 BAT CLPS ELEC/COMB VAD, REP $4,336.00
Q0498 112531 HOLSTER ELEC/COMBO VAD, REP $2,119.00
Q0499 112532 BELT/VEST ELEC/COMBO VAD REP $1,639.00
Q0500 112533 FILTERS ELEC/COMBO VAD, REP $106.50
Q0501 112534 SHWR COV ELEC/COMBO VAD, REP $1,522.50
Q0502 112535 MOBILITY CART PNEUM VAD, REP $1,350.50
Q0503 112536 BATTERY PNEUM VAD REPLACEMNT $2,649.00
Q0504 112537 PWR ADPT PNEUM VAD, REP VEH $1,422.50
Q0506 112538 LITH-ION BATT ELEC/PNEUM VAD $4,193.50
Q0512 112539 PX SUP FEE ANTI-CAN SUB PRES $26.50
Q2004 112540 BLADDER CALCULI IRRIG SOL $1,097.50
Q2009 112541 FOSPHENYTOIN INJ PE $50.50
Q2026 112542 RADIESSE INJECTION $1,464.00
Q2028 112543 INJ, SCULPTRA, 0.5MG $24.50
Q2035 112544 AFLURIA VACC, 3 YRS & >, IM $425.00
Q2036 112545 FLULAVAL VACC, 3 YRS & >, IM $71.50
Q2037 112546 FLUVIRIN VACC, 3 YRS & >, IM $88.50
Q2038 112547 FLUZONE VACC, 3 YRS & >, IM $109.00
Q2039 112548 INFLUENZA VIRUS VACCINE, NOS $83.00
Q2041 112549 AXICABTAGENE CILOLEUCEL CAR+ $2,494,620.02
Q2042 112550 TISAGENLECLEUCEL CAR-POS T $1,697,698.05
Q2043 112551 SIPULEUCEL-T AUTO CD54+ $328,207.49
Q2049 112552 IMPORTED LIPODOX INJ $3,169.00
Q2050 112553 DOXORUBICIN INJ 10MG $2,107.50
Q2053 112554 BREXUCABTAGENE CAR POS T $1,559,736.98
Q2054 112555 LISOCABTAGENE MARA CAR POS T $2,517,340.94
Q2055 112556 IDECABTAGENE VICLEUCEL CAR $2,462,819.53
Q2056 112557 CILTACABTAGENE CAR-POS T $1,763,224.50
Q3014 112558 TELEHEALTH FACILITY FEE $88.00
Q3027 112559 INJ BETA INTERFERON IM 1 MCG $229.00
Q4001 112560 CAST SUP BODY CAST PLASTER $154.50
Q4002 112561 CAST SUP BODY CAST FIBERGLAS $481.50
Q4003 112562 CAST SUP SHOULDER CAST PLSTR $116.00
Q4004 112563 CAST SUP SHOULDER CAST FBRGL $336.50
Q4005 112564 CAST SUP LONG ARM ADULT PLST $138.50
Q4006 112565 CAST SUP LONG ARM ADULT FBRG $118.00
Q4007 112566 CAST SUP LONG ARM PED PLSTER $54.50
Q4008 112567 CAST SUP LONG ARM PED FBRGLS $108.50
Q4009 112568 CAST SUP SHT ARM ADULT PLSTR $90.50
Q4010 112569 CAST SUP SHT ARM ADULT FBRGL $75.50
Q4011 112570 CAST SUP SHT ARM PED PLASTER $41.50
Q4012 112571 CAST SUP SHT ARM PED FBRGLAS $108.50
Q4013 112572 CAST SUP GAUNTLET PLASTER $101.00
Q4014 112573 CAST SUP GAUNTLET FIBERGLASS $92.00
Q4015 112574 CAST SUP GAUNTLET PED PLSTER $62.50
Q4016 112575 CAST SUP GAUNTLET PED FBRGLS $89.50
Q4017 112576 CAST SUP LNG ARM SPLINT PLST $84.50
Q4018 112577 CAST SUP LNG ARM SPLINT FBRG $137.50
Q4019 112578 CAST SUP LNG ARM SPLNT PED P $43.00
Q4020 112579 CAST SUP LNG ARM SPLNT PED F $58.50
Q4021 112580 CAST SUP SHT ARM SPLINT PLST $56.50
Q4022 112581 CAST SUP SHT ARM SPLINT FBRG $123.50
Q4023 112582 CAST SUP SHT ARM SPLNT PED P $35.00
Q4024 112583 CAST SUP SHT ARM SPLNT PED F $50.00
Q4025 112584 CAST SUP HIP SPICA PLASTER $123.50
Q4026 112585 CAST SUP HIP SPICA FIBERGLAS $327.50
Q4027 112586 CAST SUP HIP SPICA PED PLSTR $114.00
Q4028 112587 CAST SUP HIP SPICA PED FBRGL $181.00
Q4029 112588 CAST SUP LONG LEG PLASTER $98.00
Q4030 112589 CAST SUP LONG LEG FIBERGLASS $175.50
Q4031 112590 CAST SUP LNG LEG PED PLASTER $95.00
Q4032 112591 CAST SUP LNG LEG PED FBRGLS $174.50
Q4033 112592 CAST SUP LNG LEG CYLINDER PL $92.50
Q4034 112593 CAST SUP LNG LEG CYLINDER FB $202.00
Q4035 112594 CAST SUP LNGLEG CYLNDR PED P $90.50
Q4036 112595 CAST SUP LNGLEG CYLNDR PED F $111.50
Q4037 112596 CAST SUP SHRT LEG PLASTER $103.50
Q4038 112597 CAST SUP SHRT LEG FIBERGLASS $179.00
Q4039 112598 CAST SUP SHRT LEG PED PLSTER $64.50
Q4040 112599 CAST SUP SHRT LEG PED FBRGLS $197.50
Q4041 112600 CAST SUP LNG LEG SPLNT PLSTR $71.50
Q4042 112601 CAST SUP LNG LEG SPLNT FBRGL $205.00
Q4043 112602 CAST SUP LNG LEG SPLNT PED P $73.50
Q4044 112603 CAST SUP LNG LEG SPLNT PED F $65.00
Q4045 112604 CAST SUP SHT LEG SPLNT PLSTR $154.00
Q4046 112605 CAST SUP SHT LEG SPLNT FBRGL $217.50
Q4047 112606 CAST SUP SHT LEG SPLNT PED P $50.50
Q4048 112607 CAST SUP SHT LEG SPLNT PED F $95.00
Q4049 112608 FINGER SPLINT, STATIC $335.00
Q4074 112609 ILOPROST NON-COMP UNIT DOSE $861.50
Q4081 112610 EPOETIN ALFA, 100 UNITS ESRD $38.00
Q4101 112611 APLIGRAF $48.00
Q4102 112612 OASIS WOUND MATRIX $46.50
Q4103 112613 OASIS BURN MATRIX $80.00
Q4104 112614 INTEGRA BMWD $184.00
Q4105 112615 INTEGRA DRT OR OMNIGRAFT $187.00
Q4106 112616 DERMAGRAFT $164.00
Q4107 112617 GRAFTJACKET $365.50
Q4108 112618 INTEGRA MATRIX $253.00
Q4110 112619 PRIMATRIX $323.00
Q4111 112620 GAMMAGRAFT $43.50
Q4114 112621 INTEGRA FLOWABLE WOUND MATRI $2,953.50
Q4115 112622 ALLOSKIN $48.00
Q4116 112623 ALLODERM $122.00
Q4117 112624 HYALOMATRIX $106.50
Q4118 112625 MATRISTEM MICROMATRIX $12.50
Q4121 112626 THERASKIN $345.00
Q4122 112627 DERMACELL, AWM, POROUS SQ CM $133.00
Q4123 112628 ALLOSKIN $117.00
Q4124 112629 OASIS TRI-LAYER WOUND MATRIX $58.50
Q4125 112630 ARTHROFLEX $411.00
Q4126 112631 MEMODERM/DERMA/TRANZ/INTEGUP $305.50
Q4127 112632 TALYMED $266.50
Q4128 112633 FLEXHD/ALLOPATCHHD/SQ CM $288.50
Q4130 112634 STRATTICE TM $99.00
Q4132 112635 GRAFIX CORE, GRAFIXPL CORE $816.50
Q4133 112636 GRAFIX STRAVIX PRIME PL SQCM $1,033.50
Q4134 112637 HMATRIX $440.50
Q4137 112638 AMNIOEXCEL BIODEXCEL 1SQ CM $464.00
Q4139 112639 AMNIO OR BIODMATRIX, INJ 1CC $7,909.50
Q4140 112640 BIODFENCE 1CM $1,574.50
Q4143 112641 REPRIZA, 1CM $117.50
Q4145 112642 EPIFIX, INJ, 1MG $61.00
Q4148 112643 NEOX NEOX RT OR CLARIX CORD $919.50
Q4150 112644 ALLOWRAP DS OR DRY 1 SQ CM $902.50
Q4151 112645 AMNIOBAND, GUARDIAN 1 SQ CM $595.00
Q4152 112646 DERMAPURE 1 SQUARE CM $197.00
Q4153 112647 DERMAVEST, PLURIVEST SQ CM $424.00
Q4154 112648 BIOVANCE 1 SQUARE CM $677.00
Q4155 112649 NEOXFLO OR CLARIXFLO 1 MG $88.00
Q4156 112650 NEOX 100 OR CLARIX 100 $270.50
Q4158 112651 KERECIS OMEGA3, PER SQ CM $299.00
Q4159 112652 AFFINITY1 SQUARE CM $867.50
Q4160 112653 NUSHIELD 1 SQUARE CM $427.00
Q4161 112654 BIO-CONNEKT PER SQUARE CM $375.50
Q4162 112655 WNDEX FLW, BIOSKN FLW, 0.5CC $3,816.00
Q4163 112656 WOUNDEX, BIOSKIN, PER SQ CM $617.50
Q4166 112657 CYTAL, PER SQUARE CENTIMETER $84.00
Q4168 112658 AMNIOBAND, 1 MG $117.00
Q4169 112659 ARTACENT WOUND, PER SQ CM $616.50
Q4170 112660 CYGNUS, PER SQ CM $682.00
Q4171 112661 INTERFYL, 1 MG $126.00
Q4173 112662 PALINGEN OR PALINGEN XPLUS $353.50
Q4174 112663 PALINGEN OR PROMATRX $1,465.50
Q4175 112664 MIRODERM $384.50
Q4176 112665 NEOPATCH, PER SQ CENTIMETER $1,861.50
Q4178 112666 FLOWERAMNIOPATCH, PER SQ CM $292.50
Q4180 112667 REVITA, PER SQ CM $892.00
Q4183 112668 SURGIGRAFT, 1 SQ CM $317.00
Q4186 112669 EPIFIX 1 SQ CM $750.50
Q4187 112670 EPICORD 1 SQ CM $1,038.00
Q4190 112671 ARTACENT AC 1 SQ CM $1,062.50
Q4195 112672 PURAPLY 1 SQ CM $648.00
Q4196 112673 PURAPLY AM 1 SQ CM $458.00
Q4197 112674 PURAPLY XT 1 SQ CM $370.50
Q4199 112675 CYGNUS MATRIX, PER SQ CM $703.50
Q4201 112676 MATRION 1 SQ CM $2,238.50
Q4203 112677 DERMA-GIDE, 1 SQ CM $551.50
Q4205 112678 MEMBRANE GRAFT OR WRAP SQ CM $1,790.50
Q4210 112679 AXOLOTL GRAF DUALGRAF SQ CM $1,383.00
Q4222 112680 PROGENAMATRIX, PER SQ CM $349.00
Q4227 112681 AMNIOCORE PER SQ CM $605.00
Q4229 112682 COGENEX AMNIO MEMB PER SQ CM $454.50
Q4231 112683 CORPLEX P, PER CC $1,185.00
Q4232 112684 CORPLEX, PER SQ CM $1,198.00
Q4234 112685 XCELLERATE, PER SQ CM $473.00
Q4235 112686 AMNIOREPAIR OR ALTIPLY SQ CM $657.00
Q4239 112687 AMNIO-MAXX OR LITE PER SQ CM $10,532.50
Q4244 112688 PROCENTA, PER 200 MG $7,786.50
Q4246 112689 CORETEXT OR PROTEXT, PER CC $3,272.00
Q4247 112690 AMNIOTEXT PATCH, PER SQ CM $1,001.50
Q4248 112691 DERMACYTE AMN MEM ALLO SQ CM $389.50
Q4250 112692 AMNIOAMP-MP PER SQ CM $524.50
Q4252 112693 VENDAJE, PER SQUARE CENTIMET $468.50
Q4253 112694 ZENITH AMNIOTIC MEMBRANE PSC $1,100.50
Q4254 112695 NOVAFIX DL PER SQ CM $761.50
Q4258 112696 ENVERSE, PER SQ CM $227.00
Q4259 112697 CELERA PER SQ CM $1,533.00
Q5001 112698 HOSPICE OR HOME HLTH IN HOME $465.50
Q5002 112699 HOSPICE/HOME HLTH IN ASST LV $460.50
Q5003 112700 HOSPICE IN LT/NON-SKILLED NF $460.50
Q5004 112701 HOSPICE IN SNF $476.50
Q5005 112702 HOSPICE, INPATIENT HOSPITAL $1,987.50
Q5006 112703 HOSPICE IN HOSPICE FACILITY $438.00
Q5007 112704 HOSPICE IN LTCH $403.00
Q5010 112705 HOSPICE HOME CARE IN HOSPICE $477.50
Q5101 112706 INJECTION, ZARXIO $4.00
Q5103 112707 INJECTION, INFLECTRA $415.00
Q5104 112708 INJECTION, RENFLEXIS $494.00
Q5105 112709 INJ RETACRIT ESRD ON DIALYSI $75.00
Q5106 112710 INJ RETACRIT NON-ESRD USE $88.00
Q5107 112711 INJ MVASI 10 MG $344.00
Q5108 112712 INJECTION, FULPHILA $1,420.00
Q5110 112713 NIVESTYM $3.00
Q5111 112714 INJECTION, UDENYCA 0.5 MG $1,468.00
Q5112 112715 INJ ONTRUZANT 10 MG $683.00
Q5113 112716 INJ HERZUMA 10 MG $676.00
Q5114 112717 INJ OGIVRI 10 MG $586.00
Q5115 112718 INJ TRUXIMA 10 MG $411.00
Q5116 112719 INJ., TRAZIMERA, 10 MG $351.00
Q5117 112720 INJ., KANJINTI, 10 MG $394.00
Q5118 112721 INJ., ZIRABEV, 10 MG $425.00
Q5119 112722 INJ RUXIENCE, 10 MG $376.50
Q5120 112723 INJ PEGFILGRASTIM-BMEZ 0.5MG $1,380.00
Q5121 112724 INJ. AVSOLA, 10 MG $427.00
Q5122 112725 INJ, NYVEPRIA $1,859.00
Q5123 112726 INJ. RIABNI, 10 MG $520.50
Q5124 112727 INJ. BYOOVIZ, 0.1 MG $1,509.50
Q5125 112728 INJ, RELEUKO 1 MCG $4.50
Q5126 112729 INJ ALYMSYS 10 MG $613.50
Q5127 112730 INJ, STIMUFEND, 0.5 MG $2,158.50
Q5128 112731 INJ, CIMERLI, 0.1 MG $1,766.00
Q5129 112732 INJ, VEGZELMA, 10 MG $576.00
Q5130 112733 INJ, FYLNETRA, 0.5 MG $1,460.50
Q9950 112734 INJ SULF HEXA LIPID MICROSPH $142.00
Q9951 112735 LOCM >= 400 MG/ML IODINE,1ML $3.00
Q9953 112736 INJ FE-BASED MR CONTRAST,1ML $547.00
Q9954 112737 ORAL MR CONTRAST, 100 ML $7.00
Q9955 112738 INJ PERFLEXANE LIP MICROS,ML $851.50
Q9956 112739 INJ OCTAFLUOROPROPANE MIC,ML $305.00
Q9957 112740 INJ PERFLUTREN LIP MICROS,ML $716.00
Q9958 112741 HOCM <=149 MG/ML IODINE, 1ML $1.00
Q9959 112742 HOCM 150-199MG/ML IODINE,1ML $1.00
Q9964 112747 HOCM>= 400MG/ML IODINE, 1ML $7.00
Q9965 112748 LOCM 100-199MG/ML IODINE,1ML $3.00
Q9968 112751 VISUALIZATION ADJUNCT $74.50
Q9969 112752 NON-HEU TC-99M ADD-ON/DOSE $34.00
Q9991 112753 BUPRENORPH XR 100 MG OR LESS $10,405.50
Q9992 112754 BUPRENORPHINE XR OVER 100 MG $6,051.50
R0070 112755 TRANSPORT PORTABLE X-RAY $120.50
S0013 112756 ESKETAMINE, NASAL SPRAY $27.00
S0017 112757 INJECTION, AMINOCAPROIC ACID $150.50
S0020 112758 INJECTION, BUPIVICAINE HYDRO $25.00
S0028 112759 INJECTION, FAMOTIDINE, 20 MG $11.00
S0030 112760 INJECTION, METRONIDAZOLE $13.00
S0032 112761 INJECTION, NAFCILLIN SODIUM $258.00
S0039 112762 INJECTION, SULFAMETHOXAZOLE $23.50
S0073 112763 INJECTION, AZTREONAM, 500 MG $94.00
S0074 112764 INJECTION, CEFOTETAN DISODIU $81.50
S0077 112765 INJECTION, CLINDAMYCIN PHOSP $46.50
S0080 112766 INJECTION, PENTAMIDINE ISETH $1,314.00
S0090 112767 SILDENAFIL CITRATE, 25 MG $149.50
S0092 112768 HYDROMORPHONE 250 MG $26.00
S0093 112769 MORPHINE 500 MG $3.00
S0106 112770 BUPROPION HCL SR 60 TABLETS $12.50
S0108 112771 MERCAPTOPURINE 50 MG $91.50
S0109 112772 METHADONE ORAL 5MG $1.00
S0119 112773 ONDANSETRON 4 MG $12.00
S0136 112774 CLOZAPINE, 25 MG $3.00
S0138 112775 FINASTERIDE, 5 MG $14.50
S0139 112776 MINOXIDIL, 10 MG $12.50
S0145 112777 PEG INTERFERON ALFA-2A/180 $5,984.50
S0156 112778 EXEMESTANE, 25 MG $85.50
S0160 112779 DEXTROAMPHETAMINE $1.00
S0164 112780 INJECTION PANTROPRAZOLE $256.50
S0166 112781 INJ OLANZAPINE 2.5MG $83.50
S0169 112782 CALCITROL $3.00
S0170 112783 ANASTROZOLE 1 MG $49.50
S0171 112784 BUMETANIDE 0.5 MG $10.00
S0176 112785 HYDROXYUREA 500 MG $19.50
S0178 112786 LOMUSTINE 10 MG $643.50
S0179 112787 MEGESTROL 20 MG $2.00
S0183 112788 PROCHLORPERAZINE 5 MG $11.00
S0187 112789 TAMOXIFEN 10 MG $18.50
S0189 112790 TESTOSTERONE PELLET 75 MG $681.00
S0190 112791 MIFEPRISTONE, ORAL, 200 MG $442.50
S0191 112792 MISOPROSTOL, ORAL, 200 MCG $8.50
S0197 112793 PRENATAL VITAMINS 30 DAY $2.50
S0201 112794 PARTIAL HOSPITALIZATION SERV $4,114.00
S0316 112795 FOLLOW-UP/REASSESSMENT $245.50
S0317 112796 DISEASE MGMT PER DIEM $489.00
S0340 112797 LIFESTYLE MOD 1ST STAGE $118.00
S0341 112798 LIFESTYLE MOD 2 OR 3 STAGE $119.00
S0353 112799 CANCER TREATMENTPLAN INITIAL $651.50
S0354 112800 CANCER TREATMENT PLAN CHANGE $651.50
S0395 112801 IMPRESSION CASTING FT $175.00
S0610 112802 ANNUAL GYNECOLOGICAL EXAMINA $673.00
S0612 112803 ANNUAL GYNECOLOGICAL EXAMINA $664.50
S0630 112804 REMOVAL OF SUTURES $197.00
S1015 112805 IV TUBING EXTENSION SET $115.00
S1016 112806 NON-PVC INTRAVENOUS ADMINIST $45.50
S1040 112807 CRANIAL REMOLDING ORTHOSIS $4,872.00
S2070 112808 CYSTO LASER TX URETERAL CALC $2,042.00
S2083 112809 ADJUSTMENT GASTRIC BAND $1,062.00
S2411 112810 FETOSCOP LASER THER TTTS $46,794.00
S2900 112811 ROBOTIC SURGICAL SYSTEM $26,718.00
S3620 112812 NEWBORN METABOLIC SCREENING $566.00
S4005 112813 INTERIM LABOR FACILITY GLOBA $6,664.00
S4016 112814 FROZEN IVF CASE RATE $8,541.00
S4021 112815 IVF CANC P ASPIR CASE RATE $28,961.50
S4989 112816 CONTRACEPT IUD $8,484.50
S4990 112817 NICOTINE PATCH LEGEND $22.50
S4991 112818 NICOTINE PATCH NONLEGEND $10.00
S4993 112819 CONTRACEPTIVE PILLS FOR BC $20.50
S4995 112820 SMOKING CESSATION GUM $11.00
S5010 112821 5% DEXTROSE AND 0.45% SALINE $35.00
S5012 112822 5% DEXTROSE WITH POTASSIUM $365.00
S5190 112823 WELLNESS ASSESSMENT BY NONPH $1,081.50
S5550 112824 INSULIN RAPID 5 U $12.00
S5551 112825 INSULIN MOST RAPID 5 U $18.00
S5553 112826 INSULIN LONG ACTING 5 U $3.00
S5571 112827 INSULIN DISPOS PEN 3 ML $378.50
S8037 112828 MRCP $6,142.50
S8100 112829 SPACER WITHOUT MASK $86.50
S8101 112830 SPACER WITH MASK $174.50
S8422 112831 CUSTOM GRAD SLEEVE MED $1,487.00
S8423 112832 CUSTOM GRAD SLEEVE HEAVY $917.50
S8424 112833 READY GRADIENT SLEEVE $475.00
S8427 112834 READY GRADIENT GLOVE $342.50
S8428 112835 READY GRADIENT GAUNTLET $121.50
S8430 112836 PADDING FOR COMPRSSN BDG $28.00
S8431 112837 COMPRESSION BANDAGE $9.50
S8450 112838 SPLINT DIGIT $161.00
S8451 112839 SPLINT WRIST OR ANKLE $87.00
S8490 112840 100 INSULIN SYRINGES $44.50
S8948 112841 LOW-LEVEL LASER TRMT 15 MIN $1,543.00
S8950 112842 COMPLEX LYMPHEDEMA THERAPY, $318.00
S9090 112843 VERTEBRAL AXIAL DECOMPRESSIO $449.50
S9140 112844 DIABETIC MANAGEMENT PROGRAM, $531.00
S9152 112845 SPEECH THERAPY, RE-EVAL $660.00
S9401 112846 ANTICOAG CLINIC PER SESSION $356.00
S9442 112847 BIRTHING CLASS $237.00
S9443 112848 LACTATION CLASS $673.50
S9444 112849 PARENTING CLASS $113.00
S9447 112850 INFANT SAFETY CLASS $71.50
S9449 112851 WEIGHT MGMT CLASS $118.00
S9451 112852 EXERCISE CLASS $251.50
S9452 112853 NUTRITION CLASS $326.50
S9454 112854 STRESS MGMT CLASS $3,203.00
S9470 112857 NUTRITIONAL COUNSELING, DIET $320.00
S9472 112858 CARDIAC REHABILITATION PROGR $641.00
S9473 112859 PULMONARY REHABILITATION PRO $576.50
S9474 112860 ENTEROSTOMAL THERAPY BY A RE $262.00
S9475 112861 AMBULATORY SETTING SUBSTANCE $4,981.50
S9480 112862 INTENSIVE OUTPATIENT PSYCHIA $1,590.00
S9482 112863 FAMILY STABILIZATION 15 MIN $593.50
S9484 112864 CRISIS INTERVENTION PER HOUR $578.50
S9485 112865 CRISIS INTERVENTION MENTAL H $2,348.50
S9999 112866 SALES TAX $79.00
T1001 112867 NURSING ASSESSMENT/EVALUATN $313.50
T1006 112868 FAMILY/COUPLE COUNSELING $2,253.50
T1007 112869 TREATMENT PLAN DEVELOPMENT $2,307.00
T1013 112870 SIGN LANG/ORAL INTERPRETER $71.50
T1014 112871 TELEHEALTH TRANSMIT, PER MIN $2.00
T1015 112872 CLINIC SERVICE $995.00
T1016 112873 CASE MANAGEMENT $339.00
T1017 112874 TARGETED CASE MANAGEMENT $144.50
T1023 112875 PROGRAM INTAKE ASSESSMENT $346.50
T1025 112876 PED COMPR CARE PKG, PER DIEM $6,581.50
T1040 112877 COMM BH CLINIC SVC PER DIEM $493.00
T2044 112878 HOSPICE RESPITE CARE $1,139.00
T2045 112879 HOSPICE GENERAL CARE $2,847.00
T2048 112880 BH LTC RES R&B, PER DIEM $4,335.50
U0001 112881 2019-NCOV DIAGNOSTIC P $796.50
U0002 112882 COVID-19 LAB TEST NON-CDC $99.50
U0003 112883 SARS-COV-2 COVID-19 AMP PRB HTT $328.00
U0004 112884 COVID-19 LAB TEST NON-CDC HTT $323.00
U0005 112885 INFEC AGEN DETEC AMPLI PROBE $82.00
V2020 112886 VISION SVCS FRAMES PURCHASES $111.50
V2025 112887 EYEGLASSES DELUX FRAMES $135.50
V2100 112888 LENS SPHER SINGLE PLANO 4.00 $96.50
V2101 112889 SINGLE VISN SPHERE 4.12-7.00 $61.00
V2102 112890 SINGL VISN SPHERE 7.12-20.00 $158.50
V2103 112891 SPHEROCYLINDR 4.00D/12-2.00D $49.00
V2104 112892 SPHEROCYLINDR 4.00D/2.12-4D $134.50
V2105 112893 SPHEROCYLINDER 4.00D/4.25-6D $113.00
V2106 112894 SPHEROCYLINDER 4.00D/>6.00D $125.00
V2107 112895 SPHEROCYLINDER 4.25D/12-2D $169.00
V2110 112898 SPHEROCYLINDER 4.25D/OVER 6D $134.00
V2111 112899 SPHEROCYLINDR 7.25D/.25-2.25 $141.50
V2114 112902 SPHEROCYLINDER OVER 12.00D $184.50
V2115 112903 LENS LENTICULAR BIFOCAL $225.00
V2118 112904 LENS ANISEIKONIC SINGLE $229.00
V2121 112905 LENTICULAR LENS, SINGLE $290.00
V2200 112906 LENS SPHER BIFOC PLANO 4.00D $113.00
V2201 112907 LENS SPHERE BIFOCAL 4.12-7.0 $163.00
V2202 112908 LENS SPHERE BIFOCAL 7.12-20. $233.00
V2203 112909 LENS SPHCYL BIFOCAL 4.00D/.1 $91.50
V2204 112910 LENS SPHCY BIFOCAL 4.00D/2.1 $192.00
V2205 112911 LENS SPHCY BIFOCAL 4.00D/4.2 $159.50
V2206 112912 LENS SPHCY BIFOCAL 4.00D/OVE $171.00
V2207 112913 LENS SPHCY BIFOCAL 4.25-7D/. $204.50
V2208 112914 LENS SPHCY BIFOCAL 4.25-7/2. $174.00
V2209 112915 LENS SPHCY BIFOCAL 4.25-7/4. $173.00
V2210 112916 LENS SPHCY BIFOCAL 4.25-7/OV $193.00
V2211 112917 LENS SPHCY BIFO 7.25-12/.25- $218.00
V2212 112918 LENS SPHCYL BIFO 7.25-12/2.2 $206.50
V2213 112919 LENS SPHCYL BIFO 7.25-12/4.2 $208.50
V2214 112920 LENS SPHCYL BIFOCAL OVER 12. $226.00
V2215 112921 LENS LENTICULAR BIFOCAL $322.50
V2218 112922 LENS ANISEIKONIC BIFOCAL $271.50
V2219 112923 LENS BIFOCAL SEG WIDTH OVER $158.50
V2220 112924 LENS BIFOCAL ADD OVER 3.25D $161.50
V2221 112925 LENTICULAR LENS, BIFOCAL $367.50
V2300 112926 LENS SPHERE TRIFOCAL 4.00D $132.50
V2301 112927 LENS SPHERE TRIFOCAL 4.12-7. $205.50
V2302 112928 LENS SPHERE TRIFOCAL 7.12-20 $221.50
V2303 112929 LENS SPHCY TRIFOCAL 4.0/.12- $73.00
V2304 112930 LENS SPHCY TRIFOCAL 4.0/2.25 $239.00
V2305 112931 LENS SPHCY TRIFOCAL 4.0/4.25 $199.50
V2306 112932 LENS SPHCYL TRIFOCAL 4.00/>6 $216.50
V2307 112933 LENS SPHCY TRIFOCAL 4.25-7/. $199.50
V2308 112934 LENS SPHC TRIFOCAL 4.25-7/2. $205.50
V2309 112935 LENS SPHC TRIFOCAL 4.25-7/4. $239.00
V2310 112936 LENS SPHC TRIFOCAL 4.25-7/>6 $231.00
V2311 112937 LENS SPHC TRIFO 7.25-12/.25- $251.50
V2312 112938 LENS SPHC TRIFO 7.25-12/2.25 $318.50
V2313 112939 LENS SPHC TRIFO 7.25-12/4.25 $349.00
V2314 112940 LENS SPHCYL TRIFOCAL OVER 12 $289.00
V2315 112941 LENS LENTICULAR TRIFOCAL $363.50
V2318 112942 LENS ANISEIKONIC TRIFOCAL $711.50
V2319 112943 LENS TRIFOCAL SEG WIDTH > 28 $136.00
V2320 112944 LENS TRIFOCAL ADD OVER 3.25D $193.00
V2321 112945 LENTICULAR LENS, TRIFOCAL $345.00
V2410 112946 LENS VARIAB ASPHERICITY SING $283.00
V2430 112947 LENS VARIABLE ASPHERICITY BI $409.50
V2500 112948 CONTACT LENS PMMA SPHERICAL $622.00
V2501 112949 CNTCT LENS PMMA-TORIC/PRISM $697.00
V2502 112950 CONTACT LENS PMMA BIFOCAL $695.00
V2503 112951 CNTCT LENS PMMA COLOR VISION $393.50
V2510 112952 CNTCT GAS PERMEABLE SPHERICL $274.00
V2511 112953 CNTCT TORIC PRISM BALLAST $926.00
V2512 112954 CNTCT LENS GAS PERMBL BIFOCL $695.00
V2513 112955 CONTACT LENS EXTENDED WEAR $827.00
V2520 112956 CONTACT LENS HYDROPHILIC $219.00
V2521 112957 CNTCT LENS HYDROPHILIC TORIC $328.50
V2522 112958 CNTCT LENS HYDROPHIL BIFOCL $697.00
V2523 112959 CNTCT LENS HYDROPHIL EXTEND $239.50
V2524 112960 CNTCT LENS HYDROPHIL PHOTOCH $859.50
V2530 112961 CONTACT LENS GAS IMPERMEABLE $586.00
V2531 112962 CONTACT LENS GAS PERMEABLE $632.00
V2623 112963 PLASTIC EYE PROSTH CUSTOM $3,385.00
V2624 112964 POLISHING ARTIFICAL EYE $289.00
V2625 112965 ENLARGEMNT OF EYE PROSTHESIS $958.50
V2626 112966 REDUCTION OF EYE PROSTHESIS $516.50
V2627 112967 SCLERAL COVER SHELL $4,403.00
V2628 112968 FABRICATION & FITTING $663.50
V2630 112969 ANTER CHAMBER INTRAOCUL LENS $614.00
V2631 112970 IRIS SUPPORT INTRAOCLR LENS $393.00
V2632 112971 POST CHMBR INTRAOCULAR LENS $597.50
V2700 112972 BALANCE LENS $166.00
V2710 112973 GLASS/PLASTIC SLAB OFF PRISM $255.50
V2715 112974 PRISM LENS/ES $212.50
V2718 112975 FRESNELL PRISM PRESS-ON LENS $66.00
V2730 112976 SPECIAL BASE CURVE $64.00
V2744 112977 TINT PHOTOCHROMATIC LENS/ES $57.00
V2745 112978 TINT, ANY COLOR/SOLID/GRAD $31.00
V2750 112979 ANTI-REFLECTIVE COATING $64.00
V2755 112980 UV LENS/ES $19.50
V2760 112981 SCRATCH RESISTANT COATING $19.50
V2762 112982 POLARIZATION, ANY LENS $171.50
V2770 112983 OCCLUDER LENS/ES $88.50
V2780 112984 OVERSIZE LENS/ES $66.00
V2782 112985 LENS, 1.54-1.65 P/1.60-1.79G $185.00
V2783 112986 LENS, >= 1.66 P/>=1.80 G $126.00
V2784 112987 LENS POLYCARB OR EQUAL $94.50
V2785 112988 CORNEAL TISSUE PROCESSING $17,454.00
V2787 112989 ASTIGMATISM-CORRECT FUNCTION $827.00
V2788 112990 PRESBYOPIA-CORRECT FUNCTION $1,398.50
V2790 112991 AMNIOTIC MEMBRANE $5,207.00
V2797 112992 VIS ITEM/SVC IN OTHER CODE $847.50
V5010 112993 ASSESSMENT FOR HEARING AID $737.00
V5011 112994 HEARING AID FITTING/CHECKING $501.00
V5014 112995 HEARING AID REPAIR/MODIFYING $304.50
V5020 112996 CONFORMITY EVALUATION $263.00
V5060 112997 BEHIND EAR HEARING AID $3,874.00
V5090 112998 HEARING AID DISPENSING FEE $337.50
V5110 112999 HEARING AID DISPENSING FEE $783.50
V5130 113000 IN EAR BINAURAL HEARING AID $8,470.50
V5140 113001 BEHIND EAR BINAUR HEARING AI $7,786.50
V5160 113002 DISPENSING FEE BINAURAL $1,261.50
V5181 113003 HEARING AID MONAURAL BTE $1,948.50
V5221 113004 HEARING AID BINAURAL BTE/BTE $3,715.00
V5240 113005 DISP FEE CONTRALATERAL BINAU $1,075.50
V5241 113006 DISPENSING FEE, MONAURAL $396.00
V5256 113007 HEARING AID, DIGIT, MON, ITE $1,588.50
V5257 113008 HEARING AID, DIGIT, MON, BTE $2,473.00
V5258 113009 HEARING AID, DIGIT, BIN, CIC $6,333.50
V5259 113010 HEARING AID, DIGIT, BIN, ITC $5,107.00
V5260 113011 HEARING AID, DIGIT, BIN, ITE $5,096.50
V5261 113012 HEARING AID, DIGIT, BIN, BTE $5,217.00
V5264 113013 EAR MOLD/INSERT $319.00
V5265 113014 EAR MOLD/INSERT, DISP $63.00
V5266 113015 BATTERY FOR HEARING DEVICE $2.00
V5275 113016 EAR IMPRESSION $75.50
V5362 113017 SPEECH SCREENING $301.50
V5363 113018 LANGUAGE SCREENING $301.50
V5364 113019 DYSPHAGIA SCREENING(04/24) $414.00

Median Fee - Preston Hollow

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