university physicians group: prices of provider services · 2019. 1. 2. · 01140 pr...

CPTCode Modifier Unit

PriceBase Price

Service Type

00100 PR ANESTH,SALIVARY GLAND W/BX 1.00 5.00 Anesthesia00102 PR ANESTH,CLEFT LIP REPAIR 1.00 6.00 Anesthesia00103 PR ANESTH,BLEPHAROPLASTY 1.00 5.00 Anesthesia00104 ANESTH,ELECTROSHOCK/ ECT 1.00 4.00 Anesthesia00120 ANESTH,EAR SURGERY 1.00 5.00 Anesthesia00124 ANESTH,EAR EXAM 1.00 4.00 Anesthesia00126 PR ANESTH,TYMPANOTOMY 1.00 4.00 Anesthesia00140 PR ANESTH,PROCEDURES ON EYE 1.00 5.00 Anesthesia00142 ANESTH, LENS SURGERY 1.00 4.00 Anesthesia00144 PR ANESTH,CORNEAL TRANSPLANT 1.00 6.00 Anesthesia00145 ANESTH, VITREORETINAL SURG 1.00 6.00 Anesthesia00147 PR ANESTH,IRIDECTOMY 1.00 4.00 Anesthesia00148 ANESTH,EYE EXAM 1.00 4.00 Anesthesia00160 PR ANESTH,NOSE,SINUS SURGERY 1.00 5.00 Anesthesia00162 PR ANESTH,NOSE,RADICAL SINUS

SURGERY1.00 7.00 Anesthesia

00164 PR ANESTH,BIOPSY OF NOSE 1.00 4.00 Anesthesia00170 PR ANESTH,PROCEDURE ON MOUTH 1.00 5.00 Anesthesia00172 PR ANESTH,CLEFT PALATE REPAIR 1.00 6.00 Anesthesia00174 PR ANESTH,EXCIS RETROPHARYNG 1.00 6.00 Anesthesia00176 PR ANESTH,PHARYNX SURG 1.00 7.00 Anesthesia00190 PR ANESTH,FACIAL BONE SURGERY 1.00 5.00 Anesthesia00192 PR ANESTH,RADICAL FACIAL BONE


00210 PR ANESTH,OPEN HEAD SURGERY 1.00 11.00 Anesthesia00211 PR ANESTH, INTRACRANIAL

HEMATOMA EVACUATION1.00 10.00 Anesthesia

00212 PR ANESTH,SKULL SURG SUBDUR 1.00 5.00 Anesthesia00214 PR ANESTH,SKULL SURG BURR 1.00 9.00 Anesthesia00215 PR ANESTH, CRANIOPLASTY 1.00 9.00 Anesthesia00216 PR ANESTH,HEAD VESSEL 1.00 15.00 Anesthesia00218 PR ANESTH,SPECIAL HEAD 1.00 13.00 Anesthesia00220 PR ANESTH,INTRACRAN PROC; CSF

SHUNT PROC1.00 10.00 Anesthesia

00222 PR ANESTH,INTRACRAN NERVE COAGULATN

1.00 6.00 Anesthesia

00300 PR ANESTH,SKIN SURG HEAD/NECK 1.00 5.00 Anesthesia00320 PR ANESTH,NECK ORG PROC; NOS,

AGE 1 YR/OLD1.00 6.00 Anesthesia

University Physicians Group: Prices of Provider Services

Current Procedural Terminology (CPT)Procedure

00322 PR ANESTH,NEEDLE BX THYROID 1.00 3.00 Anesthesia00326 PR ANESTH,LARYNX/TRACH PROC;

CHILDREN <1 YR1.00 7.00 Anesthesia

00350 PR ANESTH,NECK VESSEL 1.00 10.00 Anesthesia00352 PR ANESTH,NECK VESSEL SURG

SIMPL LIGAT1.00 5.00 Anesthesia

00400 PR ANESTH,SKIN SURG 1.00 3.00 Anesthesia00402 PR ANESTH,SURG BREAST

RECONSTRUCTIVE1.00 5.00 Anesthesia

00404 PR ANESTH,SURG BREAST RAD 1.00 5.00 Anesthesia00406 PR ANESTH,SURG BREAST RAD

MAST W NODE1.00 13.00 Anesthesia

00410 PR ANESTH,CORRECT HEART 1.00 4.00 Anesthesia0042T CEREBRAL PERFUS ANALYSIS, CT

W/CONTRAST200.00

00450 PR ANESTH,SURG 1.00 5.00 Anesthesia00454 PR ANESTH,CLAVICLE BIOPSY 1.00 3.00 Anesthesia00470 PR ANESTH,PARTIAL RIB RESECTN 1.00 6.00 Anesthesia00472 PR ANESTH,CHEST WALL REPAIR 1.00 10.00 Anesthesia00474 PR ANESTH,CHEST WALL REPAIR

EXTENSIVE1.00 13.00 Anesthesia

00500 PR ANESTH,ESOPHAGEAL SURGERY 1.00 15.00 Anesthesia00520 PR ANESTH,CHEST PROC 1.00 6.00 Anesthesia00522 PR ANESTH,CHEST PLEURAL 1.00 4.00 Anesthesia00524 PR ANESTH,CHEST DRAINAGE 1.00 4.00 Anesthesia00528 PR ANESTH,MEDIASTINOSCOPY 1.00 8.00 Anesthesia00529 PR ANESTH, CHEST PARTITION VIEW 1.00 11.00 Anesthesia00530 PR ANESTH,PACEMAKER INSERTION 1.00 4.00 Anesthesia00532 PR ANESTH,CENTRL VASCULAR 1.00 4.00 Anesthesia00534 PR ANESTH,CARDIOVERTER/DEFIB 1.00 7.00 Anesthesia00537 PR ANESTH,CARD ELECTROPHYS 1.00 7.00 Anesthesia00539 PR ANESTH,TRACHEOBRONCHIAL

RECONSTRUCT1.00 18.00 Anesthesia

00540 PR ANESTH,CHEST SURGERY,THORACOTOMY


00541 PR ANESTH,THORACOTOMY PROC, W/1 LUNG VENT


00542 PR ANESTH,CHEST DECORTICATION 1.00 15.00 Anesthesia00546 PR ANESTH,LUNG 1.00 15.00 Anesthesia00548 PR ANESTH,TRACH,BRONCHI

INTRATHOR SURG1.00 17.00 Anesthesia

0054T BONE SURGERY USING COMPUTER ASSIST, FLURO GUIDED

640.00

00550 PR ANESTH,STERNAL 1.00 10.00 Anesthesia00560 PR ANESTH,OPEN HEART; W/O

PUMP OXYEGENATOR1.00 15.00 Anesthesia

00561 PR ANESTH, HEART SURG < AGE 1 1.00 25.00 Anesthesia00562 PR ANESTH,OPEN HEART 1.00 20.00 Anesthesia00563 PR ANESTH,OPEN

HEART,PUMP+HYPOTHERM1.00 25.00 Anesthesia

00566 PR ANESTH,DIRECT CABG W/O PUMP OXYGENATOR


00567 PR ANESTH, DIRECT CABG W PUMP OXYGENATOR


00580 PR ANESTH,HEART/LUNG 1.00 20.00 Anesthesia00600 PR ANESTH,CERV SPINE,CORD 1.00 10.00 Anesthesia00604 PR ANESTH,CERV SPINE, SITTING 1.00 13.00 Anesthesia00620 PR ANESTH,THOR SPINE,CORD 1.00 10.00 Anesthesia00630 PR ANESTH,LUMBAR SPINE,CORD


00632 PR ANESTH,LUMBAR 1.00 7.00 Anesthesia00635 PR ANESTH,LUMBAR PUNCTURE 1.00 4.00 Anesthesia00640 PR ANESTH,CLOSED

MANIPULATION, SPINE C/T/L1.00 3.00 Anesthesia

00670 PR ANESTH,EXTENSIVE SPINE,CORD PROCED


00700 PR ANESTH,ABD WALL,UPER 1.00 4.00 Anesthesia00702 PR ANESTH,FOR LIVER BIOPSY 1.00 4.00 Anesthesia0071T U/S LEIOMYOMATA ABLATE <200 CC 2500.0000730 PR ANESTH,ABD WALL,UPPER 1.00 5.00 Anesthesia00731 PR ANESTHESIA UPPER GI

ENDOSCOPIC PX NOS1.00 5.00 Anesthesia

00732 PR ANESTHESIA UPPER GI ENDOSCOPIC PX ERCP


00740 PR ANESTH,UGI ENDOSCOPY 1.00 5.00 Anesthesia00750 PR ANESTH,REPAIR UPPER ABD

HERNIA NOS1.00 4.00 Anesthesia

00752 PR ANESTH,REPAIR UP HERNIA LUMBAR/VENTR


00754 PR ANESTH,REPAIR UP HERNIA OMPHALOCELE


00756 PR ANESTH,REPAIR UP HERNIA 1.00 7.00 Anesthesia

0075T PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL

26 2136.00

00770 PR ANESTH,MAJOR ABD BLOOD VESSEL REPAIR


00790 PR ANESTH,SURG UPPER ABDOMEN 1.00 7.00 Anesthesia00792 PR ANESTH,PARTIAL LIVER 1.00 13.00 Anesthesia00794 PR ANESTH,PANCREAS REMOVAL 1.00 8.00 Anesthesia00796 PR ANESTH,FOR LIVER 1.00 30.00 Anesthesia00797 PR ANESTH,GASTRIC RESTRICT,

MORBID OBESITY1.00 11.00 Anesthesia

00800 PR ANESTH,ABD WALL,LOWER 1.00 4.00 Anesthesia00802 PR ANESTH,FAT LAYER REMOVAL 1.00 5.00 Anesthesia00810 PR ANESTH,INTESTINE,SCOPE,LOW 1.00 5.00 Anesthesia00811 PR ANESTHESIA LOWER INTST

ENDOSCOPIC PX NOS1.00 4.00 Anesthesia

00812 PR ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC


00813 PR ANESTHESIA COMBINED UPPER&LOWER GI ENDOSCOPIC PX


00820 PR ANESTH,ABD WALL,LOWER 1.00 5.00 Anesthesia00830 PR ANESTH,REPAIR LO ABD HERNIA 1.00 4.00 Anesthesia00832 PR ANESTH,REPAIR LO HERNIA

VENTR/INCIS1.00 6.00 Anesthesia

00834 PR ANESTH,REPAIR LO ABD HERNIA NOS, < 1 YR


00836 PR ANESTH,REP LO ABD HERN NOS, PREM <50 WKS


00840 PR ANESTH,SURG LOWER 1.00 6.00 Anesthesia00842 PR ANESTH,AMNIOCENTESIS 1.00 4.00 Anesthesia00844 PR ANESTH,ABD-PERINEAL 1.00 7.00 Anesthesia00846 PR ANESTH,RADICAL 1.00 8.00 Anesthesia00848 PR ANESTH,PELVIC EXENTERATION 1.00 8.00 Anesthesia00851 PR ANESTH,TUBAL 1.00 6.00 Anesthesia00860 PR ANESTH,SURG LOW

ABD,EXTRAPERINTONEAL1.00 6.00 Anesthesia

00862 PR ANESTH,KIDNEY,PROX URETER 1.00 7.00 Anesthesia00864 PR ANESTH,REMOVAL OF BLADDER 1.00 8.00 Anesthesia00865 PR ANESTH,REMOVAL OF 1.00 7.00 Anesthesia00866 PR ANESTH,REMOVAL OF ADRENAL 1.00 10.00 Anesthesia00868 PR ANESTH,KIDNEY TRANSPLANT 1.00 10.00 Anesthesia00870 PR ANESTH,BLADDER STONE SURG 1.00 5.00 Anesthesia

00872 PR ANESTH,KID STONE DESTRUCT+WATER BATH


00873 PR ANESTH,KID STONE DESTRUCT 1.00 5.00 Anesthesia00880 PR ANESTH,MAJOR LOW ABD 1.00 15.00 Anesthesia00882 PR ANESTH,INFER VENA CAVAL 1.00 10.00 Anesthesia00902 PR ANESTH,ANORECTAL SURGERY 1.00 5.00 Anesthesia00904 PR ANESTH,RADICAL PERINEAL 1.00 7.00 Anesthesia00906 PR ANESTH,REMOVAL OF VULVA 1.00 4.00 Anesthesia00908 PR ANESTH,PERINEAL REMV OF 1.00 6.00 Anesthesia00910 PR ANESTH,TRANSURETHRAL 1.00 3.00 Anesthesia00912 PR ANESTH,XURETHRAL BLADDER

TUMOR SURG1.00 5.00 Anesthesia

00914 PR ANESTH,XURETHRAL REMOVAL OF PROSTATE


00916 PR ANESTH,POST XURETHRAL BLEEDING CONTR


00918 PR ANESTH,STONE RMVOVAL 1.00 5.00 Anesthesia00920 PR ANESTH,MALE GENITALIA 1.00 3.00 Anesthesia00921 PR ANESTH,VASECTOMY, 1.00 3.00 Anesthesia00922 PR ANESTH,SPERM DUCT SURGERY 1.00 6.00 Anesthesia00924 PR ANESTH,TESTIS EXPLORATION 1.00 4.00 Anesthesia00926 PR ANESTH,RADICAL REMV

TESTIS,INGUINAL1.00 4.00 Anesthesia

00928 PR ANESTH,RADICAL REMV TESTIS,ABDOMINAL


00930 PR ANESTH,TESTIS SUSPENSION 1.00 4.00 Anesthesia00932 PR ANESTH,AMPUTATION OF PENIS 1.00 4.00 Anesthesia00934 PR ANESTH,PENIS,NODES REMOVAL 1.00 6.00 Anesthesia00936 PR ANESTH,PENIS,COMBO NODES

REMOVAL1.00 8.00 Anesthesia

00938 PR ANESTH,INSERT PENIS 1.00 4.00 Anesthesia00940 PR ANESTH,VAGINAL PROCEDURES 1.00 3.00 Anesthesia00942 PR

ANESTH,COLPOT,VAGINECT,COLPORR,URETH PRO


00944 PR ANESTH,VAGINAL 1.00 6.00 Anesthesia00948 PR ANESTH,REPAIR OF CERVIX 1.00 4.00 Anesthesia00950 PR ANESTH,VAGINAL ENDOSCOPY 1.00 5.00 Anesthesia00952 PR ANESTH,HYSTEROSCOPY/VAG 1.00 4.00 Anesthesia01112 PR ANESTH,BONE MARROW ASP/BX

ILIAC CRST1.00 5.00 Anesthesia

01120 PR ANESTH,BONY PELVIS SURGERY 1.00 6.00 Anesthesia

01130 PR ANESTH,BODY CAST 1.00 3.00 Anesthesia01140 PR ANESTH,AMPUTATION AT PELVIS 1.00 15.00 Anesthesia01150 PR ANESTH,RADICAL PELVIC TUMOR


01160 PR ANESTH,PUBIS,SACROILIAC CLOSED PROC


01170 PR ANESTH,PUBIS,SACROILIAC 1.00 8.00 Anesthesia01173 PR ANESTH, FX REPAIR, PELVIS 1.00 12.00 Anesthesia01180 PR ANESTH,PELV NERV REMOVAL

EXTRAPELV1.00 3.00 Anesthesia

01190 PR ANESTH,PELV NERV REMOVAL INTRAPELV


01200 PR ANESTH,HIP JOINT PROCEDURE 1.00 4.00 Anesthesia01202 PR ANESTH,ARTHROSCOPY OF HIP 1.00 4.00 Anesthesia01210 PR ANESTH,HIP JOINT SURGERY 1.00 6.00 Anesthesia01212 PR ANESTH,HIP DISARTICULATION 1.00 10.00 Anesthesia01214 PR ANESTH,TOTAL HIP 1.00 8.00 Anesthesia01215 PR ANESTH,REVISE TOTAL HIP

ARTHROPLASTY1.00 10.00 Anesthesia

01220 PR ANESTH,CLOSED PROC UPPER 2/3 FEMUR


01230 PR ANESTH,OPEN PROC UPPER 2/3 1.00 6.00 Anesthesia01232 PR ANESTH,AMPUTATION OF FEMUR 1.00 5.00 Anesthesia01234 PR ANESTH,RADICAL FEMUR SURG 1.00 8.00 Anesthesia01250 PR ANESTH,UPPER LEG SURGERY 1.00 4.00 Anesthesia01260 PR ANESTH,UPPER LEG VEINS 1.00 3.00 Anesthesia0126T CAROTID INT-MEDIA THICKNESS

EVAL FOR ATHERSCLER55.00

01270 PR ANESTH,THIGH ARTERIES SURG 1.00 8.00 Anesthesia01272 PR ANESTH,FEMORAL ARTERY 1.00 4.00 Anesthesia01274 PR ANESTH,FEMORAL 1.00 6.00 Anesthesia01320 PR ANESTH,KNEE AREA SURGERY 1.00 4.00 Anesthesia01340 PR ANESTH,LOWER 1/3

FEMUR,CLOSED PROC1.00 4.00 Anesthesia

01360 PR ANESTH,LOWER 1/3 1.00 5.00 Anesthesia01380 PR ANESTH,KNEE JOINT,CLOSED

PROCEDURE1.00 3.00 Anesthesia

01382 PR ANESTH,DX ARTHROSCOPIC PROC KNEE JOINT


01390 PR ANESTH,UPPER LEG,CLOSED PROCEDURE


01392 PR ANESTH,UPPER LEG,OPEN 1.00 4.00 Anesthesia

01400 PR ANESTH,KNEE JOINT; NOS 1.00 4.00 Anesthesia01402 PR ANESTH,TOTAL KNEE 1.00 7.00 Anesthesia01404 PR ANESTH,AMPUTATION AT KNEE 1.00 5.00 Anesthesia01420 PR ANESTH,KNEE JOINT CASTING 1.00 3.00 Anesthesia01430 PR ANESTH,KNEE VEINS SURGERY 1.00 3.00 Anesthesia01432 PR ANESTH,KNEE AV FISTULA

VESSEL SURG1.00 6.00 Anesthesia

01440 PR ANESTH,KNEE ARTERIES SURG 1.00 8.00 Anesthesia01442 PR ANESTH,POPLIT

THROMBOENDARTECTOMY1.00 8.00 Anesthesia

01444 PR ANESTH,POPLIT ARTERY 1.00 8.00 Anesthesia01462 PR ANESTH,LOWER LEG,CLOSED


01464 PR ANESTH,ARTHROSCOP PROC,ANKLE &/OR FOOT


01470 PR ANESTH,LOWER LEG,OPEN 1.00 3.00 Anesthesia01472 PR ANESTH,ACHILLES TENDON 1.00 5.00 Anesthesia01474 PR ANESTH,GASTROCNEMIUS 1.00 5.00 Anesthesia01480 PR ANESTH,LOWER LEG BONE 1.00 3.00 Anesthesia01482 PR ANESTH,RADICAL LEG 1.00 4.00 Anesthesia01484 PR ANESTH,LOWER LEG BONE 1.00 4.00 Anesthesia01486 PR ANESTH,ANKLE REPLACEMENT 1.00 7.00 Anesthesia01490 PR ANESTH,LOWER LEG CASTING 1.00 3.00 Anesthesia01500 PR ANESTH,LOWER LEG ARTERIES 1.00 8.00 Anesthesia01502 PR ANESTH,LOWER LEG 1.00 6.00 Anesthesia01520 PR ANESTH,LOWER LEG VEIN 1.00 3.00 Anesthesia01522 PR ANESTH,LOWER LEG VEIN

THROMBECTOMY1.00 5.00 Anesthesia

0159T COMPUTER AIDED BREAST MRI 26 314.0001610 PR ANESTH,SURGERY OF 1.00 5.00 Anesthesia01620 PR ANESTH,SHOULDER,CLOSED


01622 PR ANESTH,DX ARTHROSC PROC,SHOULDER JOINT


01630 PR ANESTH,SHOULDER JOINT,NOS 1.00 5.00 Anesthesia01634 PR ANESTH,SHOULDER JOINT 1.00 9.00 Anesthesia01636 PR ANESTH,FOREQUARTER AMPUT 1.00 15.00 Anesthesia01638 PR ANESTH,SHOULDER 1.00 10.00 Anesthesia01650 PR ANESTH,SHOULDER ARTERY 1.00 6.00 Anesthesia01652 PR ANESTH,AXILLARY-BRACHIAL

ANEURYSM1.00 10.00 Anesthesia

01654 PR ANESTH,SHLDR VESSEL SURG,BYPASS GRFT


01656 PR ANESTH,AXILL-FEM BYPASS 1.00 10.00 Anesthesia01670 PR ANESTH,SHOULDER VEIN SURG 1.00 4.00 Anesthesia01680 PR ANESTH,SHOULDER CASTING 1.00 3.00 Anesthesia01682 PR ANESTH,SHOULDER SPICA 1.00 4.00 Anesthesia01710 PR ANESTH,ELBOW AREA SURGERY 1.00 3.00 Anesthesia01712 PR ANESTH,UPPERARM TENDON 1.00 5.00 Anesthesia01714 PR ANESTH,UPPERARM TENDON

REVISN SURG1.00 5.00 Anesthesia

01716 PR ANESTH,BICEPS TENDON 1.00 5.00 Anesthesia01730 PR ANESTH,ARM/ELBOW

BONES,CLOSED PROC1.00 3.00 Anesthesia

01732 PR ANESTH,DX ARTHROSCOPIC PROC ELBOW JOINT


01740 PR ANESTH,ELBOW,NOS 1.00 4.00 Anesthesia01742 PR ANESTH,HUMERUS SURGERY 1.00 5.00 Anesthesia01744 PR ANESTH,HUMERUS REPAIR 1.00 5.00 Anesthesia01756 PR ANESTH,RADICAL HUMERUS 1.00 6.00 Anesthesia01758 PR ANESTH,HUMERAL LESION SURG 1.00 5.00 Anesthesia01760 PR ANESTH,ELBOW REPLACEMENT 1.00 7.00 Anesthesia01770 PR ANESTH,UPPERARM ARTERY 1.00 6.00 Anesthesia01772 PR ANESTH,UPPERARM 1.00 6.00 Anesthesia01780 PR ANESTH,UPPER ARM VEIN SURG 1.00 3.00 Anesthesia01782 PR ANESTH,UPPER ARM VEIN 1.00 4.00 Anesthesia01810 PR ANESTH,LOWER ARM SURGERY 1.00 3.00 Anesthesia01820 PR ANESTH,FOREARM

BONES,CLOSED PROC1.00 3.00 Anesthesia

01829 PR ANESTH,DX ARTHROSCOPIC PROC WRIST


01830 PR ANESTH,DISTAL RADIUS/ULNA WRIST/HAND,NOS


01832 PR ANESTH,WRIST REPLACEMENT 1.00 6.00 Anesthesia01840 PR ANESTH,LOWER ARM ARTERY 1.00 6.00 Anesthesia01842 PR ANESTH,LOWER ARM 1.00 6.00 Anesthesia01844 PR ANESTH,LOWER ARM,VASC

SHUNT SURG1.00 6.00 Anesthesia

0184T PR RECTAL TUMOR EXCISION, TRANSANAL ENDOSCOPIC

2315.00

01850 PR ANESTH,LOWER ARM VEIN SURG 1.00 3.00 Anesthesia01852 PR ANESTH,LOWER ARM VEIN 1.00 4.00 Anesthesia01860 PR ANESTH,LOWER ARM CASTING 1.00 3.00 Anesthesia

01916 PR ANESTH,DX ARTERIOGRAPHY/VENOGRAPHY


0191T PR ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT

2100.00

01920 PR ANESTH,CARDIAC CATH W/CORON ART & VENT


01922 PR ANESTH,CAT/MRI SCAN,RADIATN THERAPY


01924 PR ANESTH,INTER RAD,ARTERIAL 1.00 5.00 Anesthesia01925 ANESTH,INTER RAD, ARTERIAL,

CAROTID/CORONARY1.00 7.00 Anesthesia

01926 ANESTH,INTER RAD,ARTERIAL, INTRACRA/INTRACAR/AORT


01930 PR ANESTH,INTER RAD,VENOUS/LYMPH SYS,NOS


01931 ANESTH,INTER RAD,VENOUS/LYMPH,INTRAHEPAT/PORTAL CIRC


01932 ANESTH,INTER RAD,VENOUS/LYMPH,INTRATHORACIC/JUGULAR


01933 ANESTH,INTER RAD,VENOUS/LYMPH,INTRACRANIAL


01935 PR ANESTH,PERC IMAGE GUIDE SPINAL PROC, DIAG


01936 PR ANESTH,PERC IMAGE GUIDE SPINAL PROC, THER


01951 PR ANESTH,BURN TX, <4% TBSA 1.00 3.00 Anesthesia01952 PR ANESTH,BURN TX, 4-9% TBSA 1.00 5.00 Anesthesia01958 PR ANESTH, ANTEPARTUM MANIPUL 1.00 5.00 Anesthesia01960 PR ANESTH,VAGINAL DELIVERY 1 5 Anesthesia01961 PR ANESTH,CESAREAN DELIVERY 1.00 7.00 Anesthesia01962 PR ANESTH,URG HYSTERECTOMY

FOL DELIVERY1.00 8.00 Anesthesia

01963 PR ANESTH,CESAREAN HYST W/O LABOR ANAL/ANES


01965 PR ANESTH, INCOMP/MISSED AB 1.00 4.00 Anesthesia01966 PR ANESTH, INDUCED AB 1.00 4.00 Anesthesia01967 ANESTH, NEURAXIAL LABOR, PLAN 250001968 ANESTH,CES DEL AFTER NEURAXIAL

ANESTH1.00 2.00 Anesthesia

01969 PR ANESTH,CES HYST FOL NEURAXIAL ANAL/ANES


01990 PR PHYS SUPPORT,BRAIN-DEAD ORGAN DONOR


01991 PR ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS


01992 PR ANES DX/THER NERVE BLOCK/INJECTION PRONE POS


01996 PR DAILY MGMT,EPIDUR/SUBARACH CONT DRUG ADM

285

01999 PR UNLISTED ANESTH PROCEDURE 1.00 3.00 Anesthesia0232T PR INJECT PLATELET RICH PLASMA

W/IMG HARVEST/PREPARATOIN187.00

0234T PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, RENAL ARTERY

2012.00

0237T PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, BRACHIOCEPHAL AND BRANCHES, EACH

1868.00

0238T PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, ILIAC ARTERY,

1877.00

0253T PR INSERT ANT SGM DRAINAGE DEV W/O RESERVR INT APPR

2153.00

0254T PR EVASC RPR ILAC ART BIFUR ENDGRFT CATHJ RS&I UNI

3412

0281T PR PERC TRANSCTH CLOSR LT ATRIAL APPNDGE IMPLNT S&I

3574.00

0296T PR EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD

269

0298T PR EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN

133

0346T PR ULTRASOUND ELASTOGRAPHY 276.000375T PR TOTAL DISC ARTHRP ANT APPR

W/DISCECTOMY CRV 3+8709.00

0376T PR ANT SEGMENT INSERT DRAIN W/O RESERVOIR EA ADDL

2568.00

0379T PR VISUAL FIELD ASSESSMENT TECH SUPPORT W/INSTRUCT

109.00

0387T PR TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR

1124.00

0389T PR PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM

115.00

0389T PR PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM

26 115.00

0391T PR INTERROG DEVICE EVAL IN PERSON LEADLESS PM SYST

87.00

0397T PR ERCP WITH OPTICAL ENDOMICROSCOPY ADD ON

1002.00

0398T PR MRGFUS STEREOTACTIC ABLATION LESION INTRACRANIAL

5500.00

0399T PR MYOCARDIAL STRAIN IMAGING QUAN ASSMT

513.00

0399T PR MYOCARDIAL STRAIN IMAGING QUAN ASSMT

26 513.00

0438T PR TPRNL PLMT BIODEGRADABLE MATRL PERIPROSTATIC

764.00

0449T PR INSJ AQUEOUS DRAIN DEV W/O EO RSVR INITIAL DEV

2033.00

0466T PR INSRT CH WALL RESPIR ELTRD/RA & CONJ PULSE GEN

1235.00

0474T PR CYPASS GLAUCOMA IMPLANT 2100.000482T PR ABSOLUTE QUAN MYOCARD BLD

FLO PET STRESS & REST26 179.00

0483T PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH

5681.00

0484T PR TMVI W/PROSTHETIC VALVE TRANSTHORACIC EXPOSURE

8059.00

0494T PR PREP & CANNULJ CDVR DON LNG ORGN PRFUJ SYS

812.00

0495T PR INIT & MNTR CDVR DON LNG ORGN PRFUJ SYS 1ST 2 HR

7000.00

0496T PR MNTR CDVR DON LNG ORGN PRFUJ SYS EA ADDL HR

3500.00

0497T PR XTRNL PT ACT ECG W/O ATTN MNTR IN-OFFICE CONN

24.00

0498T PR XTRNL PT ACT ECG W/O ATTN MNTR R&I PR 30 DAYS

65.00

0499T PR CYSTO W/DIL & URTL RX DEL F/URTL STRIX/STENOSIS

967.00

0504T PR COR FFR CTA DATA REVIEW W/INTERPJ & FINAL REPORT

282

10021 PR FINE NEEDLE ASP;W/O IMAGING GUIDANCE

308.00

10022 PR FINE NEEDLE ASP;W/IMAGING GUIDANCE

328.00

10030 PR IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE

1938.00

10035 PR PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE

1359.00

10040 PR ACNE SURGERY OF SKIN 253.0010060 PR DRAIN SKIN ABSCESS SIMPLE 286.0010061 PR DRAIN SKIN ABSCESS COMPLIC 507.0010080 PR DRAIN PILONIDAL CYST SIMPL 452.0010081 PR DRAIN PILONIDAL CYST COMPLIC 665.0010120 PR REMOVE FOREIGN BODY SIMPLE 364.0010121 PR REMOVE FOREIGN BODY 687.0010140 PR DRAINAGE OF HEMATOMA/FLUID 410.0010160 PR PUNCTURE DRAINAGE OF 326.0010180 PR COMPLEX DRAINAGE, WOUND 617.0011000 PR DEBRIDEMENT, INFECTED SKIN,

UP TO 10% BSA131.00

11004 PR DEBRIDE NECROTIC SKIN/ TISSUE, GENIT & PERINM

1433.00

11005 PR DEBRIDE NECROTIC SKIN/ TISSUE, ABD WALL

1940.00

11006 PR DEBRIDE NECROT SKIN/ TISS, GENIT,PERI, ADB WALL

1739.00

11008 REMOVE MESH FROM ABD WALL FOR INFECTION

683.00

11010 PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ

1412.00

11011 PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/MUSCLE

1676.00

11012 PR DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE

2446.00

11042 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM

395.00

11043 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM

575.00

11044 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM

981.00

11045 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM

102.00

11046 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ

183.00

11047 PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,EACH ADD 20

313.00

11055 PR TRIM HYPERKERATOTIC SKIN LESION, ONE

119.00

11056 TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4

141.00

11057 TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4

167.00

11100 PR BIOPSY OF SKIN LESION 239.0011101 PR BIOPSY, EACH ADDED LESION 74.0011200 PR REMOVAL OF SKIN TAGS, UP TO 226.0011201 PR REMOVAL OF SKIN TAGS, EACH 56.0011300 PR SHAV SKIN LES <5MM 225.0011301 PR SHAV SKIN LES 6-10MM 276.0011302 PR SHAV SKIN LES 11-20MM

TRUNK,ARM,LEG326.00

11303 PR SHAV SKIN LES >21MM 358.0011305 PR SHAV SKIN LES <5MM REMAINDR 226.0011306 PR SHAV SKIN LES 6-10MM

REMAINDR BODY279.00

11307 PR SHAV SKIN LES 11-20MM REMAINDR BODY

330.00

11308 PR SHAV SKIN LES >21MM 350.0011310 PR SHAV SKIN LES <5MM 262.0011311 PR SHAV SKIN LES 6-10MM 255.0011312 PR SHAV SKIN LES 11-20MM 398.0011313 PR SHAV SKIN LES >21MM 443.0011400 PR EXC SKIN BENIG <5MM 285.0011401 PR EXC SKIN BENIG 0.6-1CM

TRUNK,ARM,LEG342.00

11402 PR EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LEG

380.00


475.00


528.00

11406 PR EXC SKIN BENIG >4CM 764.0011420 PR EXC SKIN BENIG <5MM 307.0011421 PR EXC SKIN BENIG 0.6-1CM

REMAINDR BODY361.00

11422 PR EXC SKIN BENIG 1.1-2CM REMAINDR BODY

401.00


462.00


530.00

11426 PR EXC SKIN BENIG >4CM 682.0011440 PR EXC SKIN BENIG <5MM 334.0011441 PR EXC SKIN BENIG 0.6-1CM 395.0011442 PR EXC SKIN BENIG 1.1-2CM 455.0011443 PR EXC SKIN BENIG 2.1-3CM 543.0011444 PR EXC SKIN BENIG 3.1-4CM 1086.0011446 PR EXC SKIN BENIG >4CM 807.0011450 PR EXC SWEAT GLAND LESN 810.0011451 PR EXC SWEAT GLAND LESN 989.0011462 PR EXC SWEAT GLAND LESN 900.0011463 PR EXC SWEAT GLAND LESN

INGUIN,COMPLX1192.00

11470 PR EXC SWEAT GLAND LESN PERINEAL,SIMPL

985.00

1158F PR ADVANCE CARE PLANNING DISCUSS DOCUMENTED IN MEDICAL

0.00

11600 PR EXC SKIN MALIG <5MM 466.0011601 PR EXC SKIN MALIG 0.6-1CM

TRUNK,ARM,LEG523.00

11602 PR EXC SKIN MALIG 1.1-2CM TRUNK,ARM,LEG

568.00


645.00


718.00

11606 PR EXC SKIN MALIG >4CM 1095.0011620 PR EXC SKIN MALIG <5MM 360.0011621 PR EXC SKIN MALIG 0.6-1CM

REMAINDR BODY527.00

11622 PR EXC SKIN MALIG 1.1-2CM REMAINDR BODY

587.00


735.00


829.00

11626 PR EXC SKIN MALIG >4CM 982.0011640 PR EXC SKIN MALIG <5MM 485.0011641 PR EXC SKIN MALIG 0.6-1CM 545.00

11642 PR EXC SKIN MALIG 1.1-2CM 621.0011643 PR EXC SKIN MALIG 2.1-3CM 681.0011644 PR EXC SKIN MALIG 3.1-4CM 1189.0011646 PR EXC SKIN MALIG >4CM 1225.0011719 PR TRIM NAIL(S) 52.0011720 PR DEBRIDEMENT OF NAIL(S), 1-5 75.0011721 PR DEBRIDEMENT OF NAILS, 6 OR 103.0011730 PR REMOVAL OF NAIL PLATE 240.0011732 PR REMOVE ADDITIONAL NAIL 89.0011740 PR DRAIN BLOOD FROM UNDER NAIL 123.0011750 PR REMOVAL OF NAIL BED 529.0011752 PR REMOVE NAIL BED/FINGER TIP 680.0011755 PR BIOPSY, NAIL UNIT (SEP PROC) 309.0011760 PR RECONSTRUC OF NAIL BED 539.0011762 PR RECONSTRUC OF NAIL BED W 684.0011765 PR EXCISION OF NAIL FOLD, TOE 405.0011770 PR REMV PILONIDAL LESION SIMPLE 694.0011771 PR REMV PILONIDAL LESION 1112.0011772 PR REMV PILONIDAL LESION 1738.0011900 INJECTION INTO SKIN LESIONS, UP 139.0011901 INJECTION INTO SKIN LESIONS, 8 OR 174.0011920 PR CORRECT SKIN COLR DEFCT 495.0011950 PR FILL CONTOUR DEFCT <1CC 195.0011951 PR FILL CONTOUR DEFCT 1.1-5CC 251.0011952 PR FILL CONTOUR DEFCT 5.1-10CC 330.0011954 PR FILL CONTOUR DEFCT >10CC 605.0011960 PR INSERT TISSUE EXPANDER(S) 2415.0011970 PR REPLACE TISSUE EXPANDER 2680.0011971 PR REMOVE TISSUE EXPANDER(S) 1029.0011976 PR REMOVAL OF CONTRACEPTIVE 341.0011980 PR 244.0011981 PR INSERTION DRUG IMPLANT 329.0011982 PR REMOVAL DRUG IMPLANT 371.0011983 PR REMOVAL W/ REINSERT DRUG

IMPLANT DEVICE519.00

12001 PR REPR SUPERF WND BODY 282.0012002 PR REPR SUP NPTERF WND BODY 300.0012004 PR REPR SUPERF WND BODY 7.6- 351.0012005 PR REPR SUPERF WND BODY 12.6- 538.0012006 PR REPR SUPERF WND BODY 20.1- 537.0012011 PR REPR SUPERF WND FACE 298.0012013 PR REPR SUPERF WND FACE 2.6-5 327.00

12014 PR REPR SUPERF WND FACE 5.1-7.5 387.0012015 PR REPR SUPERF WND FACE 7.6- 598.0012016 PR REPR SUPERF WND FACE 12.6-20 709.0012018 PR REPR SUPERF WND FACE >30CM 470.0012020 PR CLOSURE SUPERF WND DEHIS 704.0012021 PR CLOSURE SUPERF WND DEHIS W

PACKING327.00

12031 PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM

547.00

12032 PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM

698.00

12034 PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM

714.00

12035 PR LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM

807.00

12036 PR LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM

906.00

12037 PR LAYR CLOS WND TRUNK,ARM,LEG >30 CM

1018.00

12041 PR LAYR CLOS WND REST BODY 576.0012042 PR LAYR CLOS WND REST BODY 2.6- 660.0012044 PR LAYR CLOS WND REST BODY 7.6- 599.0012045 PR LAYR CLOS WND REST BODY 763.0012046 PR LAYR CLOS WND REST BODY 1189.0012047 PR LAYR CLOS WND REST BODY >30 1375.0012051 PR LAYR CLOS WND FACE,FACIAL 625.0012052 PR LAYR CLOS WND FACE,FACIAL 673.0012053 PR LAYR CLOS WND FACE,FACIAL

5.1-7.5 CM779.00

12054 PR LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM

873.00

12055 PR LAYR CLOS WND FACE,FACIAL 12.6-20 CM

1805.00

12056 PR LAYR CLOS WND FACE,FACIAL 20.1-30 CM

1325.00

13100 PR REPR CMPL WND TRUNK 1.1- 671.0013101 PR REPR CMPL WND TRUNK 2.6- 993.0013102 PR REP,SKIN,TRUNK,CMPLX,+5CM/< 400.0013120 PR REPR CMPL WND SCALP,EXTR 697.0013121 PR REPR CMPL WND SCALP,EXTR 1006.0013122 PR REP,SKIN,SCALP/EXTREM+5CM/< 600.00

13131 PR REPR CMPL WND HEAD,FAC,HAND 1.1-2.5

967.00

13132 PR REPR CMPL WND HEAD,FAC,HAND 2.6-7.5

1315.00

13133 PR 800.0013151 PR REPR CMPL WND LID,NOS,EAR 963.0013152 PR REPR CMPL WND LID,NOS,EAR 1271.0013153 PR REP,EYELID,NOSE,EAR,LIP+5CM 636.0013160 PR SECD CLOS SURG WND 2169.0014000 PR ADJ TISS XFER TRUNK <10SQCM 1311.0014001 PR ADJ TISS XFER TRUNK 10.1-30 1710.0014020 PR ADJ TISS XFER SCALP,EXTREM

<10SQCM1516.00

14021 PR ADJ TISS XFER SCALP,EXTREM 2190.0014040 PR ADJ TISS XFER HEAD,FAC,HAND

<10SQCM1837.00

14041 PR ADJ TISS XFER HEAD,FAC,HAND 2748.0014060 PR ADJ TISS XFER LID,NOS,EAR 1992.0014061 PR ADJ TISS XFER LID,NOS,EAR 10.1- 3326.0014301 PR ADJ TISS XFER ANY AREA,30.1-60 3749.0014302 PR ADJ TISS XFER ANY AREA,EA

ADD 30.0 SQCM854.00

14350 PR FILLET FINGR/TOE FLAP W PREP 2220.0015002 PR WOUND PREP, PED, TRK/ARM/LG

1ST 100 CM950.00

15003 PR WOUND PREP, PED, TRK/ARM/LG ADDL 100 CM

425.00

15004 PR WND PREP PED, 1050.0015005 PR WND PREP,PED,

FACE/NCK/HND/FT/GEN ADD 100 CM500.00

15040 PR SKIN GRAFT, HARVEST CULTURED TISSUE

632.00

15050 PR SKIN PINCH GRAFT PROCEDURE 1052.0015100 PR SPLIT GRFT TRUNK,ARM,LEG 2045.0015101 PR SPLIT GRFT,TRUNK,ARM,LEG EA

100SQCM508.00

15120 PR SPLIT GRFT,HEAD,FAC,HAND,FEET

2500.00

15121 PR SPLIT GRFT,HEAD,FAC,HAND,FEET EA

730.00

15200 PR FULL THICK GRFT TRUNK <20 1650.0015201 PR FULL THICK GRFT TRUNK ADD 20 363.00

15220 PR FULL THICK GRFT SCALP,ARM,LEG <20SQC

1760.00

15221 PR FULL THICK GRFT SCALP,ARM ADD 20 SQCM

450.00

15240 PR FULL THICK GRFT HEAD,FAC,HAND <20SQC

2270.00

15241 PR FULL THICK GRFT HEAD,FAC,HA ADD 20SQ

715.00

15260 PR FULL THICK GRFT NOS,EAR,LID <20SQCM

2463.00

15261 PR FULL THICK GRFT NOS,EAR,LID ADD 20SQ

1180.00

15271 PR APP SKN SUB GRFT T/A/L AREA/<100SCM /<1ST 25 SCM

350.00

15272 PR APP SKN SUB GRFT T/A/L AREA/<100SCM EA ADL 25SCM

68.00

15273 PR APP SKN SUB GRFT T/A/L AREA/>100SCM 1ST 100SCM

1001.00

15274 PR APP SKN SUB GRFT T/A/L AREA/>100SCM ADL 100SCM

237.00

15275 PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM

377.00

15276 PR SUB GRFT F/S/N/H/F/G/M/D /<100SCM EA ADL 25SCM

85.00

15277 PR SUB GRFT F/S/N/H/F/G/M/D />100SCM 1ST 100SCM

821.00

15278 PR SUB GRFT F/S/N/H/F/G/M/D />100SCM ADL 100SCM

215.00

15570 PR FORM SKIN PEDICLE FLAP 323015572 PR FORM SKIN PEDICLE FLAP

SCALP,ARM,LEG3100.00

15574 PR FORM SKIN PEDICLE FLAP FACE,GEN,HAND

1950.00

15576 PR FORM SKIN PEDICLE FLAP LID,EAR,NOSE

2205.00

15600 PR DELAY/SECTN FLAP TRUNK 895.0015610 PR DELAY/SECTN FLAP 894.0015620 PR DELAY/SECTN FLAP

FACE,GENIT,HAND,FT990.00

15630 PR DELAY/SECTN FLAP 1050.0015650 PR TRANSFER SKIN PEDICLE FLAP 1270

15730 PR MIDFACE FLAP W/PRESERVATION OF VASCULAR

5573.00

15731 PR FOREHEAD FLAP W/VASC 3966.0015732 PR MUSCLE-SKIN FLAP,HEAD/NECK 4529.0015733 PR MUSC MYOQ/FSCQ FLAP

HEAD&NECK W/NAMED VASC PEDCL3801.00

15734 PR MUSCLE-SKIN FLAP,TRUNK 4807.0015736 PR MUSCLE-SKIN FLAP,ARM 4609.0015738 PR MUSCLE-SKIN FLAP,LEG 4812.0015740 PR FLAP ISLAND PEDICLE

ANATOMIC NAMED AXIAL ARTERY3519.00

15750 PR NEUROVASCULAR PEDICLE 3255.0015756 PR FREE MUSC-SKIN FLAP

W/MICROVASC ANAST8527.00

15757 PR FREE SKIN FLAP W MICROVASC 8329.0015760 PR COMPOSITE SKIN GRAFT 2378.0015770 PR DERMA-FAT-FASCIA GRAFT 2145.0015777 PR IMPLNT BIO IMPLNT FOR SOFT

TISSUE REINFORCEMENT531.00

15780 PR DERMABRAS RX SKIN TOTAL 2100.0015781 PR DERMABRAS RX SKIN SGMENT 1349.0015786 PR ABRASION SINGLE LESION 616.0015787 PR ABRASION, EACH ADDN 4 OR 124.0015788 PR CHEM PEEL, FACE, EPIDERM 803.0015789 PR CHEM PEEL, FACE, DERMAL 1400.0015819 PR PLASTIC SURGERY, NECK 3185.0015820 PR REVISION OF LOWER EYELID 1130.0015821 PR REV LOWER EYELID EXTEN FAT 1617.0015822 PR REVISION OF UPPER EYELID 1119.0015823 PR REV UPPER EYELID W EXCESS 1560.0015824 PR REMOVAL OF FOREHEAD 2647.0015825 PR REMOV NECK WRINKLES W

PLTSY TIGHT4402.00

15828 PR REML OF CHEEK,CHIN,NECK 5045.0015829 PR REMOVAL OF SKIN WRINKLES 8777.0015830 PR EXCISE EXCESS SKIN 3550.0015832 PR EXCISE EXCESS SKIN 2700.0015833 PR EXCISE EXCESS SKIN 3030.0015834 PR EXCISE EXCESS SKIN TISSUE,HIP 3146.0015835 PR EXCISE EXCESS SKIN 3237.0015836 PR EXCISE EXCESS SKIN 1560.0015839 PR EXCISE EXCESS SKIN 1738.00

15840 PR GRAFT FACE N PALSY,FREE 3564.0015841 PR GRAFT FACE N PALSY,FREE 5000.0015845 PR GRAFT FACE N PALSY,REGN

MUSC XFER3565.00

15847 PR EXCISE EXCESS SKIN TISSUE,ABDOMEN, ADD-ON

1250.00

15850 PR REM SUTURES W ANESTH SAME SURGEON

222.00

15851 PR REM SUTURES W ANESTH OTHR SURGEON

895.00

15852 PR DRESSING CHANGE,NOT FOR 119.0015860 PR IV INJ TO TEST BLOOD FLOW IN

FLAP/GRAFT450.00

15876 PR SUCT ASSIS 1406.0015877 PR SUCT ASSIS LIPECTOMY,TRUNK 1150.0015878 PR SUCT ASSIS LIPECTOMY,UP 920.0015879 PR SUCT ASSIS LIPECTOMY,LOW 1933.0015920 PR EXC COCCYX/ULCER W SUTURE 1537.0015931 PR EXC SACR PRESS ULC W PRI 1687.0015933 PR EXC SACR PRESS ULC BONE & 2486.0015935 PR EXC SACR PRESS ULC BONE &

FLAP CLO2910.00

15936 PR EXC SACR PRESS ULC W MUSC FLAP CLO

2797.00

15937 PR EXC SACR PRESS ULC BONE/W MUSC FLAP

3668.00

15940 PR EXC ISCH PRES ULC W PRIM 1721.0015946 PR EXC ISCH PRES ULC BONE

MYOCUT FLAP6622.00

15950 PR EXC TROC PRES ULC W PRIM 1251.0015956 PR EXC TROC PRES ULC W MYOCUT 4067.0015958 PR EXC TROC PRES ULC BONE

MYOCUT FLAP3596.00

16020 PR DRESS/DEBRID SMALL BURN NO 198.0016025 PR DRESS/DEBRID MED BURN NO 370.0016030 PR DRESS/DEBRID LARGE BURN NO

ANESTH466.00

16035 PR ESCHAROTOMY 895.0016036 PR INCISION OF BURN SCAB, EACH 207.0017000 PR DESTRUC PREMALIGNANT, FIRST

LESION187.00

17003 PR DESTRUC PREMALIGNANT,2-14 24.00

17004 PR DESTRUC PREMALIGNANT,15+ 402.0017106 PR DESTRUC CUT/VASC <10SQ CM 828.0017107 PR DESTRUC CUT/VASC 10-50 SQ 1053.0017108 PR DESTRUC CUT/VASC >50 SQ CM 2735.0017110 PR DESTRUCTION BENIGN LESIONS

UP TO 14257.00

17111 DESTRUCTION BENIGN LESIONS 15 OR MORE

304.00

17250 PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE

175.00

17260 PR DESTR MALIG TRUNK,EXTREM 215.0017261 PR DESTR MALIG TRUNK,EXTREM 331.0017262 PR DESTR MALIG TRUNK,EXTREM 401.0017263 PR DESTR MALIG TRUNK,EXTREM 437.0017264 PR DESTR MALIG TRUNK,EXTREM 469.0017266 PR DESTR MALIG TRUNK,EXTREM 530.0017270 PR DESTR MALIG SCAL,NCK,HAND 346.0017271 PR DESTR MALIG SCAL,NCK,HAND 375.0017272 PR DESTR MALIG SCAL,NCK,HAND 426.0017273 PR DESTR MALIG SCAL,NCK,HAND 516.0017274 PR DESTR MALIG SCAL,NCK,HAND 617.0017276 PR DESTR MALIG SCAL,NCK,HAND 647.0017280 PR DESTR MALIG FACE,NOSE,LIP 350.0017281 PR DESTR MALIG FACE,NOSE,LIP 0.6- 407.0017282 PR DESTR MALIG FACE,NOSE,LIP 1.1- 466.0017283 PR DESTR MALIG FACE,NOSE,LIP 2.1- 614.0017284 PR DESTR MALIG FACE,NOSE,LIP 3.1- 702.0017286 PR DESTR MALIG FACE,NOSE,LIP 899.0017311 PR MOHS, 1 STAGE,

HEAD/NECK/HAND/FEET/GENTIAL2300.00

17312 PR MOHS, ADDL STAGE, HEAD/NECK/HAND/FEET/GENTIAL

963.00

17313 PR MOHS, 1 STAGE, 1531.0017314 PR MOHS, ADDL STAGE, 924.0017315 PR MOHS SURG, ADDL BLOCK 198.0017340 PR CRYOTHERAPY ACNE 130.0017380 PR HAIR REMOV ELECTROLYSIS EA 190.0019000 PR PUNC/ASPIR BREAST CYST 250.0019001 PR PUCT/ASPIR BREAST CYST,EACH 77.0019020 PR EXPLO/DRAIN BREAST ABSCESS 927.0019030 PR INJECT 382.00

19081 PR BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE

1664.00

19082 PR BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE

1349.00

19083 PR BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE

1654.00

19084 PR BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE

1331.00

19085 PR BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE

2505.00

19086 PR BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE

2005.00

19100 PR BIOPSY OF BREAST, NEEDLE 344.0019101 PR BIOPSY OF BREAST, INCISIONAL 86119110 PR NIPPLE EXPLORATION 1153.0019112 PR EXCISE BREAST DUCT FISTULA 880.0019120 PR REMOVAL OF BREAST LESION 1239.0019125 PR EXCISE BREAST LES W XRAY 1373.0019126 PR EXCISE BREAST LES XRAY MARK 367.0019260 PR EXCIS CHEST WALL TUMOR/RIBS 3164.0019271 PR EXCIS CHEST WALL TUM W 3906.0019272 PR EXTENSIVE CHEST WALL 3807.0019281 PR PERQ DEVICE PLACEMT BREAST

LOC 1ST LES W GUIDNCE603.00

19282 PR PERQ DEVICE PLACEMT BREAST LOC EA LES W GUIDNCE

420.00

19283 PR PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GUID

685.00

19285 PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG

1157.00

19286 PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE

971.00

19287 PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID

2138.00

19288 PR PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID

1752.00

19294 PR PREP TUMOR CAVITY IORT W/PARTIAL MASTECTOMY

425.00

19296 PR PLACE POSTOP BREAST CATH 9315.0019297 PR PLACE INTRAOP BREAST CATH 244.0019300 PR MASTECTOMY FOR 1400.0019301 PR MASTECTOMY, PARTIAL 2306.00

19302 PR MASTECTOMY,PARTIAL, WITH AXILLARY LYMPHADENECTOMY

2182.00

19303 PR MASTECTOMY, SIMPLE, 3574.0019304 PR MASTECTOMY, SUBCUTANEOUS 1456.0019305 PR MASTECTOMY, RADICAL 3996.0019307 PR MASTECTOMY, MODIFIED 4231.0019316 PR SUSPENSION OF BREAST 2474.0019318 PR REDUCTION OF LARGE BREAST 3681.0019325 PR ENLARGE BREAST WITH 1627.0019328 PR REMOVAL OF BREAST IMPLANT 1254.0019330 PR REMOVAL OF IMPLANT MATERIAL 1605.0019340 PR INSERT BREAST PROS IMMED

AFTER EXCIS3563.00

19342 PR DELAY BREAST PROS AFTER BREAST SURG

3274.00

19350 PR NIPPLE/AREOLA 2152.0019357 PR BREAST RECONSTRUC W TISS

EXPANDR5342.00

19361 PR BREAST RECONSTRUC W FREE FLAP, W/O IMPLANT

6255.00

19364 PR BREAST RECONSTRUC W FREE 10095.0019366 PR BREAST RECONSTRUC W OTHR

TECHNIQ5727.00

19367 PR BREAST RECONSTRUCT W TRAM 1 PEDICL

6617.00

19368 PR BREAST RECONSTRUCT W TRAM UVASC ANAS

8963

19370 PR SURGERY OF BREAST CAPSULE 1739.0019371 PR REMOVAL OF BREAST CAPSULE 2782.0019380 PR REVISE BREAST 2745.0020005 PR I&D SOFT TISSUE ABSCESS 1216.0020100 PR EXPLORE WOUND,NECK 1817.0020101 PR EXPLORE WOUND,CHEST 858.0020102 PR EXPLORE

WOUND,ABDOMEN/FLANK/BACK1007.00

20103 PR EXPLORE WOUND,EXTREMITY 1465.0020150 PR EXCISION OF EPIPHYSEAL BAR 2753.0020200 PR MUSCLE BIOPSY 520.0020205 PR DEEP MUSCLE BIOPSY 644.0020206 PR NEEDLE BIOPSY,MUSCLE 635.0020220 PR BONE BIOPSY,TROCAR/NEEDLE 476.0020225 PR BONE BIOPSY,TROCAR/NEEDLE 2089.00

20240 PR BIOPSY BONE OPEN 770.0020245 PR BIOPSY BONE OPEN DEEP 1389.0020250 PR OPEN BONE BIOP VERT DORSAL 1255.0020251 PR OPEN BONE BIOP VERT 1075.0020500 PR INJECT SINUS TRACT 260.0020501 PR INJECT SINUS TRACT FOR DX W 312.0020520 PR REMOVAL OF FOREIGN BODY 533.0020525 PR REMOVAL OF FOREIGN BODY

DEEP/COMPLIC1167.00

20526 PR INJECT CARPAL TUNNEL 247.0020527 PR INJECTION ENZYME PALMAR

FASCIAL CORD186.00

20550 PR INJECT TENDON 190.0020551 PR INJECT TENDON ORIGIN/INSERT 187.0020552 PR INJECT TRIGGER POINT, 1 OR 2 200.0020553 PR INJECT TRIGGER POINTS, > 3 231.0020600 PR ARTHROCENTESIS ASPIR&/INJ

SMALL JT/BURSA W/O US121.00

20604 PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT

179.00

20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US

141.00

20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US

26 474.00

20606 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US

196.00

20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

226.00

20611 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US

229.00

20612 PR ASPIRAT/INJECTION GANGLION 184.0020615 PR ASPIR/INJEC BONE CYST 607.0020650 PR INSERT AND REMOVE BONE PIN 613.0020661 PR APPLY/REMOVE HALO CRANIAL 1274.0020664 PR APPLY HALO 6/> PINS THIN

SKULL OSTEOLOGY3106.00

20670 PR REMOVAL SUPERFICIAL IMPLANT 986.0020680 PR REMOVAL DEEP IMPLANT 1987.0020690 PR APPLY BONE UNIPLANE,EXT FIX 1507.0020692 PR APPLY BONE MULTIPLAN,EXT FIX 2786.0020693 PR ADJUST EXTERN BONE FIX DEV

W ANESTH1517.00

20694 PR REMOVE EXTERN BONE FIX DEV W ANESTH

1432.00

20696 PR COMP ASSIST MULTIPLANE EXT FIXATION, INITIAL

4285.00

20816 PR REPLANTATION DIGIT MCP, 10610.0020822 PR REPLANTATION DIGIT DISTAL, 9144.0020824 PR REPLANTATION THUMB MCP, 7949.0020827 PR REPLANTATION THUMB

DISTAL,COMPLETE7474.00

20900 PR REMV BONE FOR GRAFT MINOR 1204.0020902 PR REMV BONE FOR GRAFT MAJOR 1917.0020910 PR REMV CARTILAGE FOR GRAFT

COSTOCH1145.00

20912 PR REMV CARTILAGE FOR GRAFT 1208.0020922 PR REMV FASCIA FOR GRAFT INCIS 1490.0020924 PR REMV TENDON FOR GRAFT 1642.0020926 PR REMV TISSUE FOR GRAFT OTHR 1050.0020930 PR ALLOGRAFT FOR SPINE

SURGERY ONLY MORSELIZED624.00

20931 PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL

573.00

20936 AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION

414.00

20937 AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION

858.00

20938 AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INCISION

956.00

20939 PR BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY

350.00

20950 PR RECORD FLUID 669.0020956 PR MICROVASCULAR ILIAC CREST 10821.0020962 PR MICROVASCULAR BONE 9530.0020969 PR BONE-SKIN GRAFT, 11239.0020975 PR ELECT BONE STIM INVASIVE 425.0020982 PR ABLATION BONE TUMOR RF

PERQ W/IMG GDN WHEN DONE9739.00

20985 PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

640.00

21011 PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM

853.00

21012 PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2+CM

832.00

21013 PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL < 2CM

1273.00

21014 PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2+CM

1277.00

21015 PR RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM

1793.00

21016 PR RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/>

3623.00

21025 PR EXCISION OF BONE, LOWER JAW 2965.0021026 PR EXCISION OF FACIAL BONE(S) 1571.0021029 PR CONTOUR OF FACE BONE 1955.0021030 PR EXCISION,BENIGN

TUMOR,MAXILLA/ZYGOMA1320.00

21031 PR EXCISION,TORUS MANDIBULARIS 1001.0021034 PR EXCISION,MALIG TUMOR,

MAXILLA/ZYGOMA4033.00

21040 PR EXCISION,BENIGN 1044.0021044 PR REMV MALIG JAW BONE LESION 2669.0021045 PR REMV MALIG JAW BONE RADICAL 3708.0021046 PR EXCISION,BEN

TUMOR,MANDIBLE,INTRA-ORAL3897.00

21047 PR EXCISION,BEN TUMOR,MANDIBLE,EXTRA-ORAL

5368.00

21048 PR EXCISION,BEN TUMOR,MAXILLA,INTRA-ORAL

4018.00

21049 PR EXCISION,BEN TUMOR,MAXILLA,EXTRA-ORAL

4299.00

21070 PR REMV CORONOID PROCESS 1547.0021079 PR PREP FACE/ORAL PROST TEMP

OBTURATOR3412.00

21080 PR PREP FACE/ORAL PROST FINL OBTURATOR

5000.00

21089 PR PREP FACE/ORAL PROST 1700.0021110 PR INTERDENTAL FIXATION 2044.0021141 PR RECONST FACE,LEFORT I,1 4854.0021142 PR RECONST FACE,LEFORT I,2 5866.0021145 PR RECONST FACE,LEFORT I,1 6510.0021147 PR RECONST FACE,LEFORT

I,3+PIECES+GRFT6849.00

21172 PR RECONST ORBIT/FOREHEAD 843321175 PR RECONST ORBIT/FOREHEAD 8575.0021179 PR RECONST ENTIRE 5551.00

21180 PR RECONST ENTIRE FOREHEAD+AUTOGRFT

6935.00

21181 PR CONTOUR CRANIAL BONE 2632.0021188 PR RECONST MIDFACE 6643.0021193 PR RECONST MANDIBLE,C/L 5360.0021194 PR RECONST MANDIBLE,C/L 6026.0021196 PR RECONST MANDIBLE,SAG 6790.0021198 PR OSTEOTOMY, MANDIBLE 4172.0021199 PR RECONST MANDIBLE,GLOSSAL

ADVANCEMT3605.00

21206 PR RECONST MAXILLA,SEGMENTAL 4345.0021208 PR AUGMENT FACIAL BONES 4884.0021210 PR NASAL,MAXILLA,MALAR BONE 7917.0021230 PR RIB CARTILAGE GRAFT TO FACE 1737.0021235 PR EAR CARTILAGE GRAFT TO FACE 1575.0021240 PR ARTHROPLASTY TMJ 4003.0021248 PR RECONSTR JAW,PART-ENDO 3957.0021267 PR REPOSITN ORBITS,EXTRACRAN 6456.0021270 PR AUGMENTATION CHEEK BONE 3035.0021280 PR REVISION OF EYELID,MEDIAL 1440.0021282 PR REVISION OF EYELID,LATERAL 2415.0021310 PR CLOSED RX NOSE FRACTURE 325.0021315 PR CLOSED RX NOSE FRACTURE 560.0021320 PR CLOSED RX NOSE FX W 601.0021325 PR OPEN RX NOSE FRACTURE 1207.0021330 PR OPEN RX NOSE FX 1785.0021335 PR OPEN RX NOSE FX+OPEN FIX 1846.0021336 PR OPEN RX NASAL SEPTAL 1633.0021337 PR CLOSED RX NASAL SEPTAL 992.0021338 PR REPAIR NASOETHMOID 2431.0021339 PR REPAIR NASOETHMOID

FX+EXTERN FIXATN2291.00

21340 PR REPAIR NASOETHMOID COMPLEX FRACTURE

2858.00

21343 PR OPEN RX DEPRES FRONTAL SINUS FRAC

4631.00

21344 PR OPEN RX COMPLIC FRONT SINUS 4847.0021345 PR CLOSED RX NOSE/JAW 199921346 PR OPEN RX NOSE/JAW 2244.0021347 PR OPEN RX NOSE/JAW 3809.0021348 PR OPEN RX NOSE/JAW 4895.0021356 PR OPEN RX DEPRESS ZYGOMA 1318.00

21360 PR OPEN RX DEPRESS MALAR FRAC 1908.0021365 PR OPEN RX COMPLX CHEEK BONE 2746.0021386 PR REPAIR EYE 1763.0021387 PR REPAIR EYE 2664.0021390 PR REPAIR EYE

BLOWOUT,PERIORB+IMPLNT2798.00

21401 PR CLOSED RX FX ORBIT W 1316.0021406 PR OPEN RX FX ORBIT 1449.0021407 PR OPEN RX FX ORBIT W IMPLANT 1641.0021422 PR OPEN RX LEFORTE I 1815.0021423 PR OPEN RX LEFORTE 3801.0021432 PR OPEN RX LEFORTE III+FIXATN 2876.0021433 PR OPEN RX LEFORTE 5814.0021435 PR OPEN RX LEFORTE 5163.0021451 PR CLOSED RX MANDIBLE 2086.0021452 PR PERCUT RX MANDIBLE FX EXT 1523.0021453 PR CLOSED RX MANDIBLE 2262.0021454 PR OPEN RX MANDIBLE FX+EXTERN 1468.0021461 PR OPEN RX MANDIBLE FX 3787.0021462 PR OPEN RX MANDIBLE FX+DENTAL 3452.0021470 PR OPEN RX MANDIBLE CONDYLE

FX,COMPL3679.00

21480 PR REDUCE TEMPOROMANDIBL 250.0021501 PR I&D DEEP ABSC/HEMATOMA

NECK/CHEST932.00

21550 PR BIOPSY SOFT TISSUE 525.0021552 PR EXC TUMOR SOFT TISSUE

NECK/ANT THORAX SUBQ 3+CM1030.00

21554 PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBFASCIAL

1653.00

21555 PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM

1056.00

21556 PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBFASCIAL

1340.00

21557 PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM

1831.00

21558 PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>

3102.00

21600 PR PARTIAL REMOVAL OF RIB 1314.0021610 PR COSTOTRANSVERSECTOMY 5956.0021615 PR REMOVAL 1ST/CERVICAL RIB 1975.0021620 PR PARTIAL REMOVAL OF STERNUM 1355.00

21627 PR STERNAL DEBRIDEMENT 1739.0021685 PR HYOID MYOTOMY & SUSPENSION 3482.0021700 PR DIVIDE SCALENUS ANTICUS 1370.0021705 PR DIVIDE SCALENUS+RESECT 1346.0021720 PR DIVIDE STERNOMASTOID OPEN 186621740 PR RECONST PECTUS 3728.0021743 PR RECONST PECTUS EXCAV/CARIN

W/ THORACOS6413.00

21750 PR CLOSE MED STERNOTOMY SEP, W/WO DEBRIDE

2641.00

21811 PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS

2131.00

21812 PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS

2595.00

21820 PR CLOSED RX STERNUM 361.0021825 PR OPEN RX STERNUM FRACTURE 1594.0021925 PR BIOPSY SOFT TISSUE 1436.0021930 PR EXCISION TUMOR SOFT TISSUE

BACK/FLANK SUBQ <3CM2195.00

21931 PR EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM

1235.00

21932 PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM

1515.00

21933 PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5+CM

2541.00

21935 PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM

3967.00

21936 PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>

4037.00

22010 PR I&D, POST SPINE, CERV/THOR/CERV-THOR

3138.00

22015 PR I&D, POST SPINE, LUMB/SACR/LUMBOSAC

3110.00

22100 PR REMV PART POST CERV VERT,1 4644.0022101 PR REMV PART POST THOR VERT,1 4311.0022103 PR REMV PART POST VERT,EA 715.0022110 PR REMV PART CERV VERT BODY,1 5293.0022116 PR REMV PART VERT BODY,EA 360.0022206 PR OSTEOTOMY SPINE POSTERIOR

3 COLUMN THORACIC12452.00

22207 PR OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR

12221.00

22208 PR OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM

2976.00

22210 PR OSTEOTOMY CERV SP,POST,1 9079.0022212 PR OSTEOTOMY THOR SP,POST,1 7548.0022214 PR OSTEOTOMY LUMB SP,POST,1 7567.0022216 PR OSTEOTOMY,POST,EA ADDN 1859.0022220 PR OSTEOTOMY CERV 8124.0022222 PR OSTEOTOMY THOR 5136.0022224 PR OSTEOTOMY LUMB 8048.0022226 PR OSTEOTOMY,DISCECT,ANT,EA

ADDNL SGMT1850.00

22305 PR CLOSED TREAT SPINE PROCESS 684.0022310 PR CLOSED TREAT VERT BODY 979.0022315 PR CLOSED TREAT VERT BODY

FX,MANIPULATN3123.00

22318 PR ODONTOID FX,W/O GRAFT,OPEN 8325.0022319 PR ODONTOID,FX,GRAFTING,OPEN 9273.0022325 PR OPEN POST RX LUMB VERT FX,1 7305.0022326 PR OPEN POST RX CERV VERT FX,1 7569.0022327 PR OPEN POST RX THOR VERT FX,1 7622.0022328 PR OPEN POST REPAIR EA ADDN 1443.0022510 PR PERQ VERTEBROPLASTY UNI/BI

INJX CERVICOTHORACIC4312.00

22511 PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

4271.00

22512 PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL

2388.00

22513 PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

25280.00

22514 PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

1733.00

22515 PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

15233.00

22532 PR LAT THORAX SPINE FUSION 9029.0022533 PR LAT LUMBAR SPINE FUSION 8445.0022534 PR LAT THOR/LUMB, ADDL SEG 1844.0022551 PR ARTHRODESIS ANT INTERBODY

INC DISCECTOMY, CERVICAL BELOW 8709.00

22552 PR ARTHRODESIS ANT INTERBODY INC DISCECTOMY, CERVICAL BELOW C2 EACH ADDL

2038.00

22554 PR CERV SPINE 6380.00

22556 PR THORAX SPINE FUSION,ANTER 8489.0022558 PR LUMBAR SPINE FUSION,ANTER 7825.0022585 PR SPINAL FUSION,ANT,EA ADNL 1681.0022586 PR ARTHRODESIS PRESACRAL

INTRBDY W/INSTRUMENT L5/S17759.00

22590 PR CRANIOCERV FUSN,POST 8030.0022595 PR CERV C1-2 FUSN,POSTER TECH 7662.0022600 PR CERV FUSN,BELOW C2,POST 6554.0022610 PR ARTHRODESIS

POSTERIOR/POSTEROLATERAL 6420.00

22612 PR ARTHRODESIS POSTERIOR/POSTEROLATERAL

8082.00

22614 PR SPINE FUSN,POST TECH,EA ADDNL SGMT

2003.00

22630 PR LUMBAR SPINE FUSN,POST 7990.0022632 PR LUMB SP FUSN,POST

INTERBDY,EA ADDNL1644.00

22633 PR ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR

9438.00

22634 PR ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG

2541.00

22800 PR SPINE FUSN,POSTER,UP TO 6 6874.0022802 PR SPINE FUSION,POSTER,7-12 10698.0022804 PR SPINE FUSION,POSTER,13+ 12367.0022808 PR SPINE FUSION,ANTER,3 SGMTS 9402.0022810 PR SPINE FUSION,ANTER,4-7 SGMTS 10425.0022830 PR EXPLORATION OF SPINAL 4133.0022840 POSTERIOR NON-SEGMENTAL

INSTRUMENTATION3890.00

22842 POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG

3905.00

22843 POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG

4178.00

22844 POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SEG

5050.00

22845 ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS

3738.00

22846 ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS

3881.00

22847 ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS

2868.00

22848 PELVIC FIXATION OTHER THAN 1842.0022849 PR REINSERT SPINAL FIXATION 6609.0022850 PR REMOVE SPINE FIX 3675.0022851 PR APPLICATION INTERVERTEBRAL

BIOMECHANICAL DEVICE2125.00

22852 PR REMOVE SPINE FIX DEV,POST 3519.0022853 PR INSJ BIOMCHN DEV

INTERVERTEBRAL DSC SPC 686.00

22854 PR INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD

888.00

22855 PR REMOVE SPINE FIX 5630.0022856 PR TOT DISC ARTHRP ART DISC ANT

APPRO 1 NTRSPC CRV4906.00

22858 PR TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL

1567.00

22859 PR INSJ BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD

888.00

22867 PR INSJ STABLJ DEV W/DCMPRN LUMBAR SINGLE LEVEL

3587.00

22868 PR INSJ STABLJ DEV W/DCMPRN LUMBAR SECOND LEVEL

641.00

22869 PR INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL

1409.00

22870 PR INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL

374.00

22900 PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM

1091.00

22901 PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM

2364.00

22902 PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM

1074.00

22903 PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM

1083.00

22904 PR RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM

3731.00

22905 PR RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>

5405.00

23030 PR INCIS/DRAIN SHLDR 1114.0023031 PR DRAIN INFECT SHOULDER 1070.0023040 PR DEEP INCIS SHLDR BONE 2554

23044 PR EXPLOR/REMV INFECT GLENO- 1639.0023065 PR EXPLOR INFECT A-C/S-C JT 654.0023066 PR BIOPSY SHLDR SOFT

TISSUES,SUPERFIC1404.00

23071 PR EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM

1055.00

23073 PR EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5+CM

2440.00

23075 PR EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM

1172.00

23076 PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM

1457.00

23077 PR RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM

3877.00

23078 PR RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/>

3761.00

23120 PR PARTIAL REMOVAL, CLAVICLE 1807.0023125 PR TOTAL REMOVAL OF CLAVICLE 1756.0023130 PR PARTIAL 1946.0023140 PR EXCIS/CURET BENIGN TUMR

CLAV/SCAPULA1361.00

23150 PR EXCIS/CURET BENIGN TUMR PROX HUMERUS

2058.00

23170 PR SEQUESTRECTOMY, CLAVICLE 1997.0023180 PR PART EXCIS CLAVICLE 2343.0023195 PR REMOVAL OF HEAD OF 269223330 PR REMOVE SUBCUT SHOULDER

FOREIGN BODY651.00

23333 PR REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM

1186.00

23334 PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT

3736.00

23335 PR PROSTHESIS REMOVAL HUMERAL AND GLENOID

4545.00

23350 PR INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI

794.00

23395 PR MUSCLE TRANSFER,SHOULDER/ARM,SINGLE

4545.00

23397 PR MUSCLE TRANSFER,SHLDR/ARM,MULTIPLE

4050.00

23400 PR FIXATION OF SHOULDER BLADE 3345.0023405 PR INCISE 1575.00

23410 PR REPAIR ROTATOR CUFF,ACUTE 2923.0023412 PR REPAIR ROTATOR 3109.0023420 PR REPAIR COMPL ROTATOR CUFF

AVULSN,CHR3433.00

23430 PR REPAIR BICEPS LONG TENDON 2417.0023455 PR REPAIR SHOULDER 3340.0023460 PR REPAIR SHLDR

CAPSUL,ANT,BONE BLOCK3585.00

23462 PR REPAIR SHLDR CAPSU,ANT,CORACOID XFER

3503.00

23465 PR REPAIR SHLDR CAPSU,POST,RECUR DISLOC

3941.00

23470 PR RECONSTRUCT PROX HUMERAL IMPLANT

3929.00

23472 PR RECONSTR TOTAL SHOULDER 5377.0023473 PR REVIS SHOULDER ARTHRPLSTY

HUMERAL/GLENOID COMPNT6601.00

23474 PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT

6840.00

23485 PR OSTEOTOMY CLAVICLE W BONE 3124.0023491 PR REINFORCE PROX 3618.0023500 PR CLOSED RX CLAVICLE 548.0023505 PR CLOSED RX CLAVICLE 1177.0023515 OPEN TREATMENT CLAVICULAR

FRACTURE INTERNAL FX1854.00

23525 PR CLOSED RX STERN-CLAV 1153.0023530 PR OPEN RX STERN-CLAV DISLOC 1828.0023532 PR OPEN RX STERN-CLAV

DISLOC,FASC GRFT2223.00

23540 PR CLOSED RX A-C JT DISLOC 562.0023545 PR CLOSED RX A-C JT 1010.0023550 PR OPEN RX A-C JT DISLOC 2099.0023552 PR OPEN RX A-C JT DISLOC,FASCIAL 2318.0023570 PR CLOSED RX SCAPULA FX 766.0023585 PR OPEN RX SCAPULA FRACTURE 2227.0023600 PR CLOSED RX PROX HUMERUS 1119.0023605 PR CLOSED RX PROX HUMERUS 1501.0023615 OPEN TREATMENT PROX HUMERAL

FRACTURE2398.00

23616 OPEN PROX HUMERAL FRACTURE PROSHETIC REPLACEMENT

4421

23620 PR CLOSED RX GR TUBEROSITY 979.00

23630 PR OPEN RX GR TUBEROSITY FX 1855.0023650 PR CLOSED RX SHLDR 775.0023655 PR CLOSED RX SHLDR 987.0023660 PR OPEN RX ACUTE SHLDR DISLOC 1909.0023665 PR CLOSED RX SHLDR DISLOC,GR 1496.0023670 PR OPEN RX SHLDR DISLOC,GR TUB 3100.0023675 PR CLOSED RX SHLDR

DISLOC,PROX HUM FX1787.00

23700 PR MANIPULATN SHLDR JT W 641.0023800 PR FUSION SHOULDER JOINT 3298.0023930 PR INCIS/DRAIN ARM,DEEP

ABSC/HEMATOMA892.00

23931 PR INCIS/DRAIN ARM/ELBOW INFECT 1010.0023935 PR INCIS DEEP ARM/ELBOW BONE 179624000 PR EXPLORE/DRAIN ELBOW FOR 1482.0024006 PR ARTHROTOMY/CAPULE RELEASE

ELBOW JT2266.00

24065 PR BX ARM/ELBOW SOFT TISSUE,SUPERFICIAL

646.00

24066 PR BX ARM/ELBOW SOFT 1571.0024071 PR EXC TUMOR SOFT TISSUE

UPPER ARM/ELBOW SUBQ 3+CM1070.00

24073 PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5+CM

4488.00

24075 PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM

1234.00

24076 PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM

1374.00

24077 PR RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM

3239.00

24079 PR RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/>

4968.00

24101 PR EXPLORE ELBOW JOINT 1750.0024102 PR EXPLOR ELBOW JT/REMOV 2290.0024105 PR REMOVAL OF ELBOW BURSA 1046.0024110 PR EXCIS/CURET BENIGN HUMERUS 1909.0024116 PR EXCIS BENIGN HUMERUS

LESN,ALLOGRFT3073.00

24120 PR EXCIS/CURET BENIGN ELBOW 1663.0024130 PR REMOVAL OF HEAD OF RADIUS 1619.0024138 PR

SEQUESTRECTOMY,OLECRANNON 1716.00

24140 PR PARTIAL REMOVAL HUMERUS 2467.0024147 PR PARTIAL REMOVAL

OLECRANNON PROCESS2132.00

24149 PR RADICAL RESECT ELBOW, CONTRAC RELEAS

3414.00

24160 PR PROSTHESIS REMOVAL HUMERAL AND ULNAR

1943.00

24164 PR PROSTHESIS REMOVAL RADIAL 2585.0024200 PR REMOVAL ARM/ELBOW

F.B.,SUPERFICIAL518.00

24201 PR REMOVAL ARM/ELBOW F.B.,DEEP 1928.0024220 PR INJECTION FOR ELBOW 719.0024300 PR MANIPULATE ELBOW W/ANESTH 1048.0024301 PR MUSC/TENDON

XFER,ARM/ELBOW,SINGLE2655.00

24305 PR ARM/ELBOW TENDON LENGTHEN,SINGLE,EA

1875.00

24310 PR TENOTOMY,ELBOW- 1545.0024320 PR TENOPLASTY,ELB-SHLDR,MUSC

XFER,SINGL2782.00

24332 PR TENOLYSIS, TRICEPS 1845.0024340 PR REPAIR OF BICEPS TENDON AT 1969.0024341 PR MUSC/TENDON REPAIR EACH;

ARM/ELBOW2163.00

24342 PR REINSERT BI/TRICEPS 2549.0024343 PR REPR ELBOW LAT LIGMNT 2336.0024344 PR RECONSTRUCT ELBOW LAT

LIGMNT W/GRAFT3865.00

24345 PR REPR ELBW MED LIGMNT W/TISS 1779.0024346 PR RECONSTRUCT ELBOW MED

LIGMNT W/GRAFT3890.00

24357 PR TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS

1083.00

24358 PR TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE OPEN

1575.00

24359 PR TENOTOMY ELBOW LATERAL/MEDIAL DEBRIDE REPAIR

1934.00

24360 PR ARTHROPLASTY,ELBOW,W 3187.0024363 PR ARTHROPLASTY,ELBOW,TOTAL

PROSTH REPL4994.00

24366 PR RECONSTRUCT RADIAL HEAD W IMPLANT

2212.00

24370 PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT

6297.00

24371 PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT

7339.00

24400 PR OSTEOTOMY HUMERUS 2666.0024430 PR REPAIR NON/MALUNION 3020.0024435 PR REPAIR NON/MALUNION

HUMERUS,GRAFT3203.00

24495 PR DECOMPRESS FOREARM,BRACH ART EXPLOR

2248.00

24500 PR CLOSED RX MID HUMERUS 1116.0024505 PR CLOSED RX MID HUMERUS


24515 PR OPEN FIXATN MID HUMERUS 2804.0024516 PR OPEN ROD FIXATN HUMERAL 2776.0024530 PR CLOSED RX HUMERAL

SUPRACONDYLAR FX1157.00

24535 PR CLOSED RX HUM SUPRACONDYLR FX,MANIPU

2007.00

24538 PR PERCUT FIX HUM 2403.0024545 OPEN TX HUMERAL

SUPRACONDYLAR FRACTURE W/O 2522.00

24546 OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W

3620.00

24560 PR CLOSED RX HUMER 804.0024565 PR CLOSED RX HUMER

EPICONDYLR FX,MANIP1336.00

24566 PR PERCUT FIXATN HUMERAL EPICONDYLAR FX

2539.00

24575 OPEN TX HUMERAL EPICONDYLAR FRACTURE

2531.00

24576 PR CLOSED RX HUMER CONDYLR FX 1012.0024577 PR CLOSED RX HUMER CONDYLR 1752.0024579 OPEN TX HUMERAL CONDYLAR 2734.0024582 PR PERCUT FIXATN HUMERAL

CONDYLAR FX2323.00

24586 PR OPEN RX PERIARTIC FX/DISLOC 3837.0024587 PR OPEN RX PERIARTIC FX 3840.0024600 PR CLOSED RX ELBOW 1276.0024605 PR CLOSED RX ELBOW

DISLOCATN,ANESTHESIA1412.00

24615 PR OPEN RX ELBOW DISLOCATION 2289.00

24620 PR CLOSED RX MONTEGGIA FX/DISLOC ELBOW

1737.00

24635 OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW

3620.00

24640 PR CLOSED RX RADIAL HEAD 345.0024650 PR CLOSED RX RADIAL HEAD/NECK 865.0024655 PR CLOSED RX RADIAL HEAD/NECK

FX,MANIP1452.00

24665 OPEN TX RADIAL HEAD/NECK 2076.0024666 OPEN TX RADIAL HEAD/NECK

FRACTURE PROSTHETIC2393.00

24670 CLOSED TX ULNAR FRACTURE PROX END W/O MANIPULATE

905.00

24675 CLOSED TX ULNAR FRACTURE PROX END W MANIPULATION

1134.00

24685 OPEN TX ULNAR FRACTURE PROX 2175.0024900 PR AMPUTATN ARM,THRU

HUMERUS,PRIM CLOS2635.00

24920 PR AMPUTATN ARM,THRU HUMERUS,CIRCULAR

2551.00

24925 PR AMPUTATN ARM,THRU HUMER,SECOND CLOS

1773.00

25000 PR INCIS TENDON SHEATH,RADIAL 1331.0025020 PR DECOMP FOREARM,1

COMPART,W/O DEBRIDE2056.00

25024 PR DECOMP FOREARM,2 COMPART,W/O DEBRIDE

2268.00

25028 PR INCIS/DRAIN FOREARM DEEP 1777.0025040 PR EXPLORE/TREAT WRIST JOINT 1919.0025066 PR BIOPSY FOREARM SOFT 1468.0025071 PR EXC TUMOR SOFT TISS

FOREARM AND/WRIST SUBQ 3+CM1077.00

25073 PR EXC TUMOR SFT TISS FOREARM&//WRIST SUBFASC 3+CM

1307.00

25075 PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM

1167.00

25076 PR EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM

1267.00

25077 PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM

2272.00

25078 PR RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>

2918.00

25085 PR INCISION OF WRIST CAPSULE 1583.0025101 PR EXPLORE/TREAT WRIST JOINT 1425.0025105 PR EXPLOR WRIST JT/REMV 1224.0025107 PR REPAIR TRIANGULAR 1940.0025109 PR EXCISE TENDON FOREARM/ 191525110 PR EXCIS TENDON SHEATH

LESN,WRIST/FORE861.00

25111 PR EXCIS PRIMARY GANGLION 1130.0025112 PR EXCIS RECURRENT GANGLION 1303.0025115 PR RAD EXCIS WRIST

SYNOV/TENDON,FLEXOR3016.00

25116 PR RAD EXCIS WRIST SYNOV/TENDON,EXTEN

2664.00

25118 PR EXCIS SYNOV WRIST,EXTENS 1421.0025119 PR EXCIS SYNOV WRIST,PART REMV 1268.0025120 PR EXCIS/CURET BENIG BONE LES

RAD/ULNA2390.00

25130 PR EXCIS BENIGN LESN CARPALS 1591.0025145 PR 1909.0025150 PR PART REMOVAL BONE,ULNA 2019.0025151 PR PART REMOVAL BONE,RADIUS 2647.0025210 PR REMOVAL OF CARPAL BONE 1685.0025215 PR REMOVAL OF PROX ROW

CARPAL BONES2227.00

25230 PR REMOVAL OF RADIAL STYLOID 1528.0025240 PR EXCIS DISTAL 1602.0025246 PR INJECTION FOR WRIST 958.0025248 PR REMOVE FOREARM/WRIST

FOREIGN BODY1372.00

25259 PR MANIPULATE WRIST 1479.0025260 PR REPR FOREARM

TEND/MUSC,FLEX,PRIM,EA1987.00

25263 PR REPR FOREARM TEND/MUSC,FLEX,SECON,EA

1983.00

25265 PR REPR FOREARM TEND/FLEX,SECOND,GRFT

2646.00

25270 PR REPR FOREARM TEND/MUSC,EXTEN,PRIM,EA

1689.00

25272 PR REPR FOREARM TEND/MUSC,EXTEN,SECOND

1396.00

25274 PR REPR FOREARM TEND/EXT,SECOND,GRAFT,EA

2341.00

25275 PR REPR FOREARM EXT TEND SHEATH,GRAFT

2122.00

25280 PR REVISE WRIST/FOREARM 1423.0025290 PR INCISE WRIST/FOREARM 1541.0025295 PR RELEASE WRIST/FOREARM 2472.0025301 PR FUSION TENDONS WRIST,FINGR

EXTENSORS2189.00

25310 PR TRANSPLANT FOREARM/WRIST 2796.0025312 PR XPLANT FOREARM TENDON,W

TENDON GRFT1825.00

25316 PR REVISE PALSY HAND TENDON(S),W XFER

3254.00

25320 PR REVISE WRIST JOINT,CARPAL 2892.0025332 PR ARTHROPLASTY WRIST JT 2724.0025335 PR REALIGNMENT OF WRIST ON 3346.0025337 PR RECONSTRUCT 2795.0025360 PR OSTEOTOMY ULNA 2109.0025365 PR OSTEOTOMY RADIUS/ULNA 325825375 PR OSTEOTOMY+ROD,RADIUS AND 339425390 PR OSTEOPLASTY,RADIUS OR

ULNA,SHORTEN3302.00

25400 PR REPAIR NONUNION RADIUS OR 3451.0025405 PR REPAIR NONUNION RADIUS OR

ULNAW/GRAFT4198.00

25415 PR REPAIR NONUNION RADIUS AND 3446.0025420 PR REPAIR NONUNION RADIUS AND

ULNA W/GRAFT4119.00

25430 PR INSERT VASC PEDICLE,CARPAL BONE (HARII)

2588.00

25440 PR REPAIR NONUNION SCAPHOID CARPAL BONE

2636.00

25447 PR REPAIR INTERCARP/CARP- 2932.0025449 PR REMOVE WRIST JOINT IMPLANT 3661.0025450 PR EPIPHYSEAL ARREST DIST RAD

OR ULNA2192.00

25500 PR CLOSED RX RADIAL SHAFT FX 834.0025505 PR CLOSED RX RADIAL SHAFT


25515 OPEN TREATMENT RADIAL SHAFT FRACTURE

2218.00

25520 PR CLOSED RX RADIAL SHAFT FX W/DISLOCATION

1802.00

25525 OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE

2777.00

25526 OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE

3369.00

25530 PR CLOSED RX ULNA SHAFT FX 804.0025535 PR CLOSED RX ULNA SHAFT


25545 OPEN TREATMENT OF ULNAR SHAFT FRACTURE

2204.00

25560 PR CLOSED RX RAD/ULNA SHAFT FX 838.0025565 PR CLOSED RX RAD/ULNA SHAFT 1701.0025574 OPEN TX RADIAL & ULNAR SHAFT FX

FIX RADIUS OR ULNA2354.00

25575 OPEN TX RADIAL & ULNAR SHAFT FX FIX RADIUS AND ULNA

2639.00

25600 PR CLOSED RX DIST RAD/ULNA FX 921.0025605 PR CLOSED RX DIST RAD/ULNA 1812.0025606 PR PERCUT SKELETAL FIX, DISTAL

RADIUS FX2112.00

25607 PR OPEN RX DISTAL RADIUS FX, EXTRA-ARTICULAR

2599.00

25608 PR OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 2 FRAG

2915.00

25609 PR OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 3+ FRAG

3708.00

25622 PR CLOSED RX NAVICULAR FX 939.0025628 OPEN TX CARPAL SCAPHOID

NAVICULAR FRACTURE2550.00

25630 PR CLOSED RX CARPAL FX 766.0025645 PR OPEN RX CARPAL BONE 1425.0025650 PR CLOSED RX ULNA STYLOID FX 1023.0025651 PR PERCUT SKELETAL FIX,ULNAR

STYLOID FX1422.00

25660 PR CLOSED TREAT WRIST 1449.0025670 PR OPEN REPAIR WRIST 2142.0025671 PR PERCUT SKELETAL FIX,DIST

RADIOULN DISLOC1350

25675 PR CLOSED RX RADIO-ULNA 1454.0025676 PR OPEN RX RADIO-ULNA 2221.0025680 PR CLOSED RX NAVIC/LUNATE 1209.0025685 PR OPEN RX NAVIC-PERILUNATE 1965.0025690 PR CLOSED RX LUNATE 1190.00

25695 PR OPEN REPAIR LUNATE 1599.0025800 PR FUSION OF WRIST JOINT 2501.0025805 PR FUSION/SLIDING GRAFT WRIST 2856.0025810 PR FUSION/GRAFT WRIST JOINT 3076.0025820 PR FUSION INTERCARPAL 2290.0025825 PR FUSION/GRAFT INTERCARPAL 3105.0025830 PR FUSION RADIOULNAR JNT/ULNA 3333.0025900 PR AMPUTATION FOREARM 1790.0025927 PR AMPUTATION 2725.0026010 PR DRAIN FINGER ABSCESS,SIMPLE 649.0026011 PR DRAIN FINGER 978.0026020 PR DRAIN HAND TENDON SHEATH 1342.0026025 PR DRAINAGE PALM BURSA,SINGLE 1499.0026030 PR DRAINAGE PALM

BURSA,MULTIP/COMPLX1253

26034 PR INCIS DEEP FINGR/HAND BONE 1360.0026035 PR DECOMPRESS

FINGERS/HAND,INJECT INJ2595.00

26040 PR RELEASE PALM CONTRACT,PERCUTANEOUS

786.00

26045 PR RELEASE PALM CONTRACT,OPEN,PARTIAL

1079.00

26055 PR INCISE FINGER TENDON SHEATH 2165.0026075 PR EXPLORE & TREAT METACARPO-

PHAL JT1047.00

26080 PR EXPLORE/TREAT INTERPHALANGEAL JT,EA

983.00

26105 PR BIOPSY SYNOVIUM MC-P JT 1200.0026110 PR BIOPSY SYNOVIUM I-P JT 1136.0026111 PR EX TUM/VASC MALF SFT TISS

HAND/FNGR SUBQ 1.5+CM1022.00

26113 PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5+CM

1341.00

26115 PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM

1562.00

26116 PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM

1506.00

26118 PR RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>

3738.00

26121 PR PALMAR FASCIECTOMY 2268.0026123 PR PART PALMAR FASCIEC,OPEN 1 2617.00

26125 PR PART PALMAR FASCIEC,OPEN ADDNL DIGIT

952.00

26130 PR EXCIS JT 1660.0026135 PR EXCIS JT LINING,MC-P JT,EACH 1942.0026140 PR EXCIS JT LINING,PROX I-P 1700.0026145 PR RAD EXCIS JT 1624.0026160 PR EXCIS TENDON SHEATH LESION,

HAND/FINGER2001.00

26170 PR EXCIS PALM TENDON FLEXOR, 103426180 PR EXCIS FINGER TENDON FLEXOR, 1563.0026200 PR EXCIS BENIGN BONE

LESN,METACARPAL1133.00

26210 PR EXCIS BENIGN BONE 1384.0026230 PR PART REMV BONE,METACARPAL 1615.0026235 PR PART REMV BONE,PROX/MID 1579.0026236 PR PART REMV BONE,DISTAL 1390.0026260 PR RAD RESEC PROX/MID PHALANX 2142.0026320 PR REMOVAL OF IMPLANT FROM

HAND/FINGR1223.00

26340 PR MANIPULATE FINGER JT W/ ANESTH,EACH

934.00

26341 PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD

244.00

26350 PR REPAIR FLEXOR TENDON,HAND,W/O GRAFT,EA

1950.00

26352 PR REPAIR FLEXOR TENDON,HAND,W/ GRAFT,EA

1994.00

26356 PR REPAIR FLEX TENDON,ZONE 2464.0026357 PR REPAIR FLEX TENDON,ZONE

2,SECON,HAND,EA3133.00

26358 PR REPAIR FLEX TEND,ZONE 2,SEC,HAND,W/GRFT

2240.00

26370 PR REPAIR PROFUNDUS 2135.0026372 PR REPAIR PROFUNDUS

TENDON,SECONDARY/GRFT2159.00

26390 PR EXCIS FLEX TEND HAND,IMPL ROD,DELAY GRFT

2999.00

26392 PR REMOV ROD & INSERT FLEX TEND HAND GRFT

3386.00

26410 PR REPAIR EXTEN TENDON,DORSUM HAND,EA

1539.00

26412 PR REPAIR EXTEN TENDON,DORSUM HAND,GRFT

2408.00

26415 PR EXCIS EXT TEND HAND,IMPL ROD,DELAY GRFT

2385.00

26418 PR REPAIR EXTEN TENDON,DORSUM FINGR,EA

2184.00

26420 PR REPAIR EXTEN TENDON,DORSUM FINGR,GRFT

2702.00

26426 PR REPAIR EXT TEND,CENT 1804.0026432 PR REPAIR EXTEN TENDON,DISTAL

INSERT,CLOSE1876.00

26437 PR REALIGNMENT OF 2291.0026440 PR TENOLYSIS, FLEX

TENDON,PALM/FINGER,EA1711.00

26442 PR TENOLYSIS FLEX TENDON,PALM & FINGER,EA

3181.00

26445 PR TENOLYSIS EXT TENDON,HAND/FINGER,EA

2316.00

26449 PR RELEASE FOREARM/HAND EXTEN TENDON

1759

26450 PR TENOTOMY PALM FLEX,SINGLE,OPEN,EACH

1447.00

26455 PR TENOTOMY FINGR FLEX,SINGLE,OPEN,EACH

1434.00

26460 PR TENOTOMY HAND EXTEN,SINGLE,OPEN,EACH

1386.00

26471 PR FUSION FINGER TENDONS,PIP JT 2141.0026478 PR TENDON

LENGTHENING,FLEX,HAND/FINGR1651.00

26479 PR TENDON SHORTENING,FLEX,HAND/FINGR

2201.00

26480 PR TRANSPLANT HAND TENDON 2867.0026483 PR TRANSPLANT/GRAFT HAND 2960.0026485 PR TRANSPLANT PALM TENDON 2006.0026489 PR TRANSPLANT/GRAFT PALM 2352.0026490 PR REVISE THUMB TENDON 2778.0026492 PR THUMB TENDON 2202.0026496 PR REVISE THUMB TENDON,OTHR 3020.0026497 PR FINGER TENDON TRANSFER,4-5 2159.0026500 PR HAND TENDON PULLEY

RECONSTRUCTION1631.00

26502 PR HAND TENDON PULLEY RECONST,GRAFT

1765.00

26508 PR RELEASE THUMB CONTRACTURE 1661.0026516 PR FUSION MC-P JOINT,SINGLE 2439.0026520 PR RELEASE MC-P JT 1781.0026525 PR RELEASE I-P JT CONTRACTURE 2559.0026530 PR ARTHROPLASTY MC-P JT,SINGLE 1835.0026531 PR ARTHROPLASTY MC-P 1976.0026535 PR ARTHROPLASTY I-P JT 1430.0026536 PR ARTHROPLASTY I-P JT,IMPLANT 1890.0026540 PR FIX COLLAT LIG,MC-P JT,I-P JT 1880.0026541 PR FIX COLLAT LIG,MC-P JT,GRAFT 2077.0026542 PR FIX COLLAT LIG,MC-P JT,LOCAL 2478.0026545 PR FIX COLAT LIG,I-P 2538.0026546 PR FIX NONUNION 3125.0026548 PR FIX FINGER,VOLAR PLATE,I-P JT 1968.0026550 PR POLLICIZATION OF DIGIT 6578.0026560 PR REPAIR OF WEB FINGER,EACH 207526561 PR REPAIR OF WEB FINGER,GRAFT 3095.0026562 PR REPAIR OF WEB 5291.0026565 PR CORRECT METACARPAL 1685.0026567 PR CORRECT FINGER DEFORMITY 1765.0026587 PR RECONST POLYDACT DIGIT,SOFT

TIS & BONE3039.00

26591 PR REPAIR MUSCLES OF HAND 109626593 PR RELEASE MUSCLES OF HAND 1536.0026596 PR EXCISION CONSTRICT FINGR 1920.0026600 PR CLOSED RX METACARPAL FX 778.0026605 PR CLOSED RX METACARPAL 701.0026607 PR CLOSED RX METACARP

FX,W/MANIP,W/EXT FIX1629.00

26608 PR CLOSED RX METACARPAL 1320.0026615 OPEN TX METACARPAL FRACTURE

SINGLE EA BONE1433.00

26641 PR TREAT THUMB 941.0026645 PR TREAT THUMB FX/DISLOC,MANIP 912.0026650 PRQ SKEL FIXATION CARP/MTCRPL

FX DISLOCATE THUMB1345.00

26665 OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB

1938.00

26670 PR CLOSED RX, CARPOMETACAR DISLOC,NON-THUMB

851.00

26676 PR PERCUT FIX CARPOMETACAR DISLOC,NON-THUMB

1258.00

26685 OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB

1760.00

26686 PR OPEN RX C-MC 2104.0026700 PR CLOSED RX MC-P DISLOC 1081.0026705 PR CLOSED RX MC-P 1451.0026706 PR PERCUT RX MC-P DISLOC 1086.0026715 OPEN TREATMENT

METACARPOPHALANGEAL 1250.00

26720 PR CLOSE RX PROX/MID FING SHFT 711.0026725 PR CLOSE RX PROX/MID FING SHFT

FX,MANIP1219.00

26727 PR PERCUT RX PROX/MID FING 1140.0026735 OPEN TX PHALANGEAL SHAFT

FRACTURE PROX/MIDDLE EA1460.00

26740 PR CLOSE RX FINGR ARTICULAR FX 711.0026742 PR CLOSE RX FINGR ARTICULAR 839.0026746 OPEN TX ARTICULAR FRACTURE

MCP/IP JOINT EA1698.00

26750 PR CLOSE RX DIST FINGR FX 624.0026755 PR CLOSE RX DIST FINGR 709.0026756 PR PERCUT RX DIST FINGR FX 1030.0026765 OPEN TX DISTAL PHALANGEAL

FRACTURE EACH970.00

26770 PR CLOSED RX IP JT DISLOCATION 683.0026775 PR CLOSED RX IP JT 1238.0026776 PR PERCUT RX IP JT DISLOCATION 1114.0026785 OPEN TX INTERPHALANGEAL JOINT

DISLOCATION 11185.00

26841 PR FUSION 1ST 1916.0026850 PR FUSION MC-P JT 2525.0026852 PR FUSION MC-P JT,GRAFT 2819.0026860 PR FUSION FINGER JOINT 2079.0026861 PR FUSION FINGER JOINT,EACH 692.0026862 PR FUSION/GRAFT FINGER JT 2529.0026910 PR AMPUTATE 1795.0026951 PR AMPUTATION FINGER/THUMB 1949.0026952 PR AMPUTATION 1686.0026990 PR INCIS/DRAIN PELVIS/HIP,DEEP 1990.0026992 PR INCIS/DRAIN PELVIS/HIP,OPEN 3179.0027000 PR INCIS HIP 1444.00

27001 PR INCIS HIP 1741.0027003 PR INCIS HIP ADDUC,OPEN,OBTUR 1840.0027005 PR INCIS ILIOPSOAS,OPEN 2340.0027006 PR INCIS HIP ADDUCTORS,OPEN 2599.0027025 PR INCIS OF HIP/THIGH FASCIA 3276.0027030 PR DRAINAGE OF HIP JOINT 3036.0027035 PR DENERVATION OF HIP JOINT 3000.0027036 PR RELEASE HIP FLEXION 3584.0027040 PR BX SOFT 1214.0027041 PR BX SOFT 1683.0027043 PR EXCISION TUMOR SOFT TISSUE

PELVIS&HIP SUBQ 3+CM1191.00

27045 PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5+CM

2640.00

27047 PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM

1533.00

27048 PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM

1547.00

27049 PR RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM

3469.00

27050 PR OPEN BIOPSY SACROILIAC JOINT 1163.0027052 PR OPEN BIOPSY OF HIP JOINT 206327059 PR RAD RESECTION TUMOR SOFT

TISS PELVIS&HIP 5 CM/>4264.00

27062 PR REMOVE TROCH 1151.0027066 PR EXCISISON BONE CYST BENIGN

TUMOR,PELVIS/HIP,DEEP2880.00

27071 PR PARTIAL EXCISION DEEP PELVIS 3265.0027075 PR RAD RESEC UNILAT ILEUM 8193.0027076 PR RAD RESEC ILIUM+ACETABULUM 8981.0027078 PR RAD RESEC ISCHIAL TUBER+GR 7407.0027080 PR REMOVAL OF COCCYX 1307.0027086 PR REMOVE PELV/HIP 75427090 PR REMOVAL OF HIP PROSTHESIS 2647.0027091 PR REMOVAL OF HIP

PROSTHESIS,COMPLEX5547.00

27093 PR INJECTION HIP ARTHROGRAM 1222.0027095 PR INJECTION HIP 1524.0027096 PR INJECT SI JOINT

ARTHRGRPHY&/ANES/STEROID 505.00

27120 PR RECONSTRUC HIP SOCKET 4594.00

27122 PR RECONSTRUC HIP SOCKET,RESEC FEM HEAD

3470.00

27125 PR PARTIAL HIP REPLACEMENT 3378.0027130 PR TOTAL HIP ARTHROPLASTY 5757.0027132 PR CONV PREV HIP SURG TO TOT

HIP ARTHROPLAS6818.00

27134 PR REVISE TOTAL HIP 7424.0027137 PR REVISE ACETABULAR PART OF

TOTAL HIP5909.00

27138 PR REVISE FEM PART OFTOTAL HIP 5909.0027146 PR OSTEOTOMY OF HIP BONE 4552.0027147 PR OSTEOTOMY HIP BONE,OPEN 6003.0027158 PR OSTEOTOMY PELVIS BILAT 572427161 PR OSTEOTOMY OF NECK OF 4309.0027165 PR OSTEOTOMY/FIX

INTER/SUBTROCH FEMUR4874.00

27170 PR BONE GRAFT FEMUR 3670.0027176 PR CLOSED RX SLIP FEM 3030.0027177 PR OPEN RX SLIP EPIPHYSIS 3475.0027187 PR REINFORCE HIP BONES 3333.0027193 PR CLOSED RX PELVIC RING 1662.0027194 PR CLOSED RX PELV RING

FX/SUBLUX,MANIP2445.00

27197 PR CLSD TX PELVIC RING FX W/O MANIPULATION

301.00

27198 PR CLSD TX PELVIC RING FX W/MANIPULATION W/ANES

767.00

27215 PR OPEN FIX ILIAC FX,INTERN 233427216 PR PERCUT FIX POST PELV RING FX 3357.0027217 PR OPEN INTERN FIX ANTER PELV 3252.0027218 PR OPEN INTERN FIX POST PELV 4894.0027220 PR CLOSED RX ACETABULAR FX 1891.0027222 PR CLOSED RX ACETABULAR


27226 PR OPEN INTERN FIX ACETABULAR WALL FX

3094.00

27227 PR OPEN INTERN FIX ACETABULAR 5962.0027228 PR OPEN INTERN FIX COMPLEX

ACETABUL FX6879.00

27230 PR CLOSED RX PROX/NECK FEMUR 169227235 PR PERCUT FIX PROX/NECK FEMUR 3250.0027236 PR FEMORAL FX, OPEN TX 3562.00

27244 PR TREAT INTER/SUBTROCH FX,W/PLATE/SCREW

3651.00

27245 PR OPEN FIX INTER/SUBTROCH 5226.0027246 PR CLOSED RX GR TROCHANTERIC 1365.0027248 OPEN TREATMENT GREATER

TROCHANTERIC FRACTURE2491.00

27250 PR CLOSED RX TRAUMATIC HIP 1172.0027252 PR CLOSED RX TRAUMA HIP

DISLOC,ANESTH2378.00

27253 PR OPEN RX TRAUMATIC HIP 3345.0027256 PR CLOSED RX SPONTANEOUS HIP 107727257 PR CLOSED RX SPONT HIP 1211.0027258 PR OPEN RX SPONTANEOUS HIP 3962.0027259 PR OPEN RX SPONT HIP

DISLOC,FEM SHORT6341.00

27265 PR CLOSED RX POST HIP ARTHRPLAS DISLOC

1298.00

27266 PR CLOSED RX POST HIP FIX DISLOC,ANESTH

1835.00

27267 PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANIP

1258.00

27269 PR OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD

4437

27275 PR MANIPULATION HIP JOINT W ANESTHESIA

651.00

27279 PR ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS

1409.00

27280 PR ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT

3179.00

27282 PR FUSION OF PUBIC BONES 2585.0027290 PR HINDQUARTER AMPUTATION 5809.0027295 PR DISARTICULATION OF HIP 451727301 PR INCIS/DRAIN THIGH/KNEE

ABSCESS,DEEP1815.00

27303 PR INCIS DEEP BONE 1619.0027305 PR FASCIOTOMY,ILIOTIBIAL,OPEN 1697.0027306 PR INCIS THIGH

TENDON,ADDUC/HAMST,SINGL1244.00

27307 PR INCIS THIGH TENDON,ADDUC/HAMST,MULTI

1500.00

27310 PR EXPLOR/DRAIN KNEE,INFECTN 2245.0027323 PR BX THIGH/KNEE SOFT 682.00

27324 PR BX THIGH/KNEE SOFT 1223.0027327 PR EXCISION TUMOR SOFT TISSUE

THIGH/KNEE SUBQ <3CM1168.00

27328 PR EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM

1572.00

27329 PR RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM

3680.00

27331 PR ARTHROTOMY/EXPLORE/TREAT KNEE JOINT

1199.00

27334 PR RMV KNEE SYNOVIUM,ANT/POST 2144.0027335 PR REMV SYNOVIUM KNEE,ANTER & 271427337 PR EXCISON TUMOR SOFT TISSUE

THIGH/KNEE SUBQ 3+CM976.00

27339 PR EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+CM

1757.00

27340 PR REMOVAL PREPATELLA BURSA 1150.0027345 PR REMOVAL SYNOVIAL CYST,KNEE 1211.0027347 PR REMOVE KNEE CYST/GANGLION 2045.0027350 PR PART/FULL REMOVAL OF 2046.0027355 PR REMV BENIGN FEMUR LESION 2132.0027356 PR REMV BENIGN FEMUR 2314.0027358 PR REMV BENIGN FEMUR 987.0027360 PR PART REMV FEMUR/PROX TIB/FIB 2710.0027364 PR RAD RESECTION TUMOR SOFT

TIS THIGH/KNEE 5 CM/>3530.00

27370 PR INJECTION KNEE 1098.0027372 PR REMV FOREIGN

BODY,KNEE/THIGH,DEEP1450.00

27380 PR FIX INFRAPATELLA 1909.0027381 PR FIX PATELLA 2581.0027385 PR FIX QUAD/HAMSTR MUSC

RUPT,PRIMARY2036.00

27386 PR FIX QUAD/HAMSTR MUSC 2951.0027391 PR TENOTOMY,UNI HAMSTR,KNEE-

THIGH,MULTI1837.00

27392 PR TENOTOMY,BI HAMSTR,KNEE-THIGH,MULTI

2252.00

27393 PR LENGTHEN HAMSTR 1628.0027394 PR LENGTHEN HAMSTR

TENDON,MULTI,ONE LEG2102.00

27395 PR LENGTHEN HAMSTR TENDON,MULTI,2 LEGS

2820.00

27400 PR TENDON/MUSC XFER,HAMSTR- 1729.0027403 PR ARTHROTOMY,OPEN REPAIR 2424.0027405 PR REPAIR COLLAT 2379.0027407 PR REPAIR CRUCIATE 2823.0027412 PR AUTOCHONDROCYTE IMPLANT 6139.0027415 PR OSTEOCHONDRAL KNEE 4699.0027416 PR OSTEOCHONDRAL KNEE 2888.0027418 PR REPAIR ANTER TIBIAL TUBERCLE 3182.0027420 PR REVISION OF UNSTABLE 2515.0027422 PR FIX UNSTABLE PATELLA,EXTEN 2606.0027425 PR LATERAL RETINACULAR 2273.0027427 PR LIGMT REVISION,KNEE,EXTRA- 3636.0027428 PR LIGMT REVISION,KNEE,INTRA- 3983.0027429 PR LIGMT 4242.0027430 PR REVISION QUADRICEPS 2354.0027435 PR POST CAPSULAR RELEASE,KNEE 2855.0027438 PR ARTHROPLASTY PATELLA WITH

IMPLANT2631.00

27445 PR PLASTY KNEE,CONSTRAINED PROSTHESIS

4467

27446 PR PLASTY KNEE,MED OR LAT 3738.0027447 PR TOTAL KNEE ARTHROPLASTY 5696.0027448 PR OSTEOTOMY FEMUR

SHAFT/SUPRACONDY2632.00

27450 PR OSTEOTOMY FEMUR SHAFT,W 3289.0027454 PR OSTEOTOMIES FEMUR

SHAFT+INTRA ROD4033.00

27455 PR OSTEOTOMY PROX TIB,<EPIPHY CLOSUR

3035.00

27457 PR OSTEOTOMY PROX TIB,AFTR EPIPHY CLOS

3130.00

27466 PR LENGTHENING OF FEMUR 4168.0027470 PR FIX NON/MALUNION FEMUR

BELOW NECK3739.00

27472 PR FIX NON/MALUNION FEMUR,W 4083.0027475 PR ARREST,EPIPHYSEAL,DISTAL 2109.0027477 PR SURGERY TO STOP TIB/FIB 2436.0027485 PR HEMIEPIPHYSEAL LEG ARREST

SURGERY2273.00

27486 PR REVISE KNEE JOINT REPLACE,1 4545.0027487 PR REVISE KNEE JOINT

REPLACE,ALL PARTS6666.00

27488 PR REMOVAL OF KNEE PROSTHESIS 3658.0027495 PR REINFORCE FEMUR 4012.0027498 PR DECOMPRESS THIGH/KNEE,>1

COMPARTMT1643.00

27500 PR CLOSED RX FEMUR SHAFT FX 1700.0027502 PR CLOSED RX FEMUR SHAFT 2500.0027503 PR CLOSED RX CONDYLAR 2855.0027506 PR OPEN RX FEMUR FX+INTRAMED 4032.0027507 PR OPEN RX FEMUR 3203.0027509 PR PERCUT FIX DISTAL FEMUR 2270.0027510 PR CLOSED RX 2178.0027511 OPEN TX FEMORAL

SUPRACONDYLAR FRACTURE W/O 3314.00

27513 OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W

4247.00

27514 OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE

4092.00

27520 PR CLOSED RX PATELLA FX 1047.0027524 PR OPEN RX PATELLA FX 2423.0027530 PR CLOSED RX TIBIAL PLATEAU FX 1258.0027532 PR CLOSED RX TIB PLAT FX+MANIP 1999.0027535 OPEN TX TIBIAL FRACTURE

PROXIMAL UNICONDYLAR2874.00

27536 PR OPEN RX BILAT TIB PLAT FX 3637.0027538 PR CLOSED RX TIB TUBER FX 1559.0027540 OPEN TX INTERCONDYLAR

SPINE/TUBRST FRACTURE KNEE3023.00

27550 PR CLOSED RX KNEE DISLOCATN 1253.0027552 PR CLOSED RX KNEE 1966.0027560 PR CLOSED RX KNEECAP 892.0027570 PR MANIPULATN KNEE 515.0027580 PR FUSION OF KNEE 4566.0027590 PR AMPUTATE THIGH,THRU FEMUR 3131.0027594 PR AMPUTATE THIGH,SECONDRY 1449.0027596 PR AMPUTATE THIGH,RE-AMPUTATN 2374.0027600 PR DECOMPRESS ANT/LAT LEG 1378.0027601 PR DECOMPRESS POST LEG 1130.0027602 PR DECOMPRESS ANT/LAT+POST

LEG CMPART1406.00

27603 PR DRAIN LOWER LEG DEEP ABSC/HEMATOMA

1856.00

27605 PR INCIS ACHILLES TENDON+LOCAL ANESTH

1487.00

27606 PR INCIS ACHILLES TENDON+GEN 1818.0027607 PR DRAIN LEG/ANKLE BONE FOR 1939.0027610 PR EXPLORE/TREAT ANKLE JOINT 2053.0027612 PR EXPLORE/RELEASE POST CAP 1793.0027613 PR BX LOW LEG SOFT 645.0027614 PR BX LOW LEG SOFT TISSUE,DEEP 1868.0027615 PR RAD RESECTION TUMOR SOFT

TISSUE LEG/ANKLE <5CM3716.00

27616 PR RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>

3052.00

27618 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM

1826.00

27619 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <3CM

1660.00

27620 PR EXPLOR ANKLE JOINT 1152.0027625 PR EXPLOR ANKLE 2056.0027626 PR EXPLOR ANKLE 157427630 PR EXCIS LESN TENDON SHEALTH

LEG/ANKLE1779.00

27632 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3+CM

1422.00

27634 PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM

2335.00

27635 PR EXCIS BENIGN LESN,TIB/FIB 1945.0027637 PR EXCIS BENIGN 2698.0027638 PR EXCIS BENIGN 2533.0027640 PR PARTIAL REMOVAL OF TIBIA 2940.0027641 PR PARTIAL REMOVAL OF FIBULA 2393.0027645 PR RAD RESEC TUMOR,TIBIA 3531.0027648 PR INJECTION FOR ANKLE 863.0027650 PR REPAIR ACHILLES 2301.0027654 PR REPAIR ACHILLES 2314.0027656 PR REPAIR LEG FASCIA DEFECT 1565.0027658 PR REPAIR FLEX LEG 1833.0027659 PR REPAIR FLEX LEG 2356.0027664 PR REPAIR EXTEN LEG 918.0027665 PR REPAIR EXTEN LEG 2123.0027675 PR REPAIR PERONEAL TENDONS 1733.0027676 PR REPAIR PERONEAL TENDONS,FIB

OSTEOTMY2027.00

27680 PR RELEASE TIB/FIB/ANKLE FLEX TENDON,EA

1453.00

27681 PR RELEASE TIB/FIB/ANKL FLEX TENDON,MUL

1948.00

27685 PR LENGTH/SHORT LEG/ANKL TENDON,SINGLE

1920.00

27686 PR LENGTH/SHORT LEG/ANKL TENDON,MULTI

2604.00

27687 PR GASTROCNEMIUS RECESSION 1554.0027690 PR XFER SINGLE SUPERFICI LOW

LEG TENDON2032.00

27691 PR XFER SINGLE DEEP LOW LEG 2653.0027695 PR REPAIR 1 COLLAT ANKLE

LIGMNT,PRIMARY1652.00

27696 PR REPAIR BOTH COLLAT ANKL LIGMT,PRIMRY

1964.00

27698 PR REPAIR COLLAT ANKLE LIGMNT,SECONDARY

3175.00

27700 PR ARTHROPLASTY ANKLE JOINT 1547.0027702 PR TOTAL ANKLE REPLACEMENT 3541.0027703 PR SECONDARY

RECONSTRUCTION,ANKLE JOINT3622.00

27704 PR REMOVAL OF ANKLE IMPLANT 146927705 PR OSTEOTOMY TIBIA 2486.0027707 PR OSTEOTOMY FIBULA 1235.0027709 PR OSTEOTOMY TIBIA & FIBULA 2424.0027712 PR OSTEOTOMIES 3946.0027715 PR LENGTHENING TIBIA/FIBULA 3727.0027720 RPR NON/MALUNION TIBIA 3100.0027722 RPR NON/MALUNION TIBIA+SLIDING 317527724 RPR NON/MALUNION 4080.0027726 PR RPR FIBULA

NONUNION/MALUNION W INT 2748.00

27730 PR ARREST,EPIPHYSEAL,OPEN,DISTAL

3206.00

27732 PR STOP GROWTH DISTAL FIBULA EPIPHYSIS

1316.00

27734 PR STOP GROWTH DISTAL TIB/FIB EPIPHYSES

1967.00

27745 PR REINFORCE TIBIA 2678.0027750 PR CLOSED RX TIBIA SHAFT FX 1112.00

27752 PR CLOSED RX TIBIA SHAFT FX,MANIPULATN

1737.00

27756 PR PERCUT RX TIBIA SHAFT FX 206327758 PR OPEN RX TIBIA SHAFT 2779.0027759 PR TREAT TIBIAL SHAFT FX,

INTRAMED IMPLANT3225.00

27760 PR CLOSED RX MED MALLEOLUS FX 1071.0027762 PR CLOSED RX MED MALLEOLUS 1619.0027766 OPEN TREATMENT MEDIAL

MALLEOLUS FRACTURE2069.00

27767 PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP

773.00

27768 PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W MANIP

1290.00

27769 PR OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE

2057.00

27780 PR CLOSED RX PROX/SHAFT FIBULA 978.0027781 PR CLOSED RX PROX/SHAFT FIB 1401.0027784 OPEN TREATMENT PROXIMAL

FIBULA/SHAFT FRACTURE1802.00

27786 PR CLOSED RX DIST FIBULA FX 1027.0027788 PR CLOSED RX DIST FIBULA 1425.0027792 OPEN TX DISTAL FIBULAR

FRACTURE LAT MALLEOLUS1937.00

27808 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP

1099.00

27810 CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP

1582.00

27814 OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE

2569.00

27816 PR CLOSED RX TRIMALLEOLAR FX 808.0027818 PR CLOSED RX TRIMALLEOLAR 1646.0027822 OPEN TX TRIMALLEOLAR ANKLE FX

W/O FIX PST LIP2848.00

27823 OPEN TX TRIMALLEOLAR ANKLE FX W FIX PST LIP

3246.00

27824 PR CLOSED RX WEIGHT BEAR DIST 1093.0027825 PR CLOSED RX WEIGHT BEAR DIST

TIB,MANIP1885.00

27826 OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA

2424.00

27827 OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY

3560.00

27828 OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA

4010.00

27829 OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION

1612.00

27830 PR CLOSED RX PROX TIB/FIB 947.0027832 OPEN TX PROX TIBFIB JOINT

DISLOCATE EXC PROX FIB2608.00

27840 PR CLOSED RX ANKLE DISLOCATN 1115.0027842 PR CLOSED RX ANKLE 1498.0027846 PR OPEN RX ANKLE DISLOCATN 2364.0027848 PR OPEN RX ANKLE 2784.0027860 PR MANIPULATION ANKLE JT W

ANESTHESIA579.00

27870 PR ARTHRODESIS,ANKLE,OPEN 3269.0027880 PR AMPUTATION LOW LEG THRU 2578.0027882 PR AMPUTATION LOW 2104.0027884 PR AMPUTATION LOW LEG,SECOND

CLOSURE1489.00

27886 PR RE-AMPUTATION LOWER LEG 2149.0027892 PR DECOMPRESS FASCIOTOMY

LEG,ANT/LAT1971.00

27894 PR DECOMPRESS LEG,ANT/LAT & 3041.0028002 PR DEEP DISSEC FOOT INFEC,1 1536.0028003 PR DEEP DISSEC FOOT 2127.0028008 PR INCISION OF FOOT/TOE FASCIA 1099.0028010 PR INCISION SUBCUT TOE TENDON 1083.0028011 PR INCISION SUBCUT TOE 821.0028020 PR EXPLOR 1377.0028022 PR EXPLOR METATARSO-PHALANG 1409.0028035 PR TARSAL TUNNEL RELEASE 1515.0028039 PR EXCISION TUMOR SOFT TISSUE

FOOT/TOE SUBQ 1.5+CM1185.00

28041 PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5+CM

1087.00

28043 PR EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM

991.00

28045 PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM

1785.00

28046 PR RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM

2579.00

28060 PR PART EXCIS PLANTAR FASCIA 1524.0028080 PR EXCIS INTERDIGITAL 1236.0028086 PR SYNOVECTOMY FLEX TENDN

SHEATH,FOOT1948.00

28090 PR EXCIS TENDN/CAPSULE 1362.0028092 PR EXCIS TENDN/CAPSULE 1290.0028100 PR REMV TALUS/HEEL BENIGN 2167.0028103 PR REMV TALUS/HEEL BENIGN

LESN,ALLOGRFT1955.00

28104 PR REMV TARSAL/METATARSAL BENIGN BONE LESN

1888.00

28107 PR REMV OTHR FOOT BENIGN LESN,ALLOGRFT

1854.00

28108 PR REMV TOE BENIGN BONE LESN 1254.0028110 PR PART EXCIS 5TH METATARSAL 1659.0028111 PR FULL EXCIS 1ST METATARSAL 126228112 PR FULL EXCIS 2,3 OR 4TH METATAR 1457.0028113 PR FULL EXCIS 5TH METATARSAL 1514.0028116 PR EXCIS TARSAL COALITION 1982.0028118 PR REMOVAL OF HEEL BONE 1719.0028119 PR REMOVAL OF HEEL SPUR 134528120 PR PART REMV TALUS OR 1826.0028122 PR PART REMV OTHR 2001.0028124 PR PART REMV PHALANX OF TOE 1428.0028130 PR REMOVAL OF TALUS 1634.0028140 PR REMOVAL OF METATARSAL 1986.0028153 PR RESEC HEAD OF PHALANX,TOE 1181.0028160 PR RESEC TOE AT I-P JT,SINGLE,EA 1228.0028190 PR REMV FOOT FOREIGN

BODY,SUBCUTANEOUS738.00

28192 PR REMV FOOT FOREIGN 1151.0028200 PR REPAIR FLEX FOOT TENDON,EA 1379.0028208 PR REPAIR EXTEN LEG 1321.0028220 PR RELEASE FLEX FOOT 1326.0028222 PR RELEASE FLEX FOOT 1834.0028225 PR RELEASE EXTEN FOOT 1057.0028230 PR INCISION FLEX FOOT TENDON(S) 1292.0028232 PR INCISION FLEX TOE TENDON 1177.0028234 PR INCISION EXTEN FOOT/TOE 1191.0028238 PR RECONST POST TIB TEND,EXCIS

ACC TAR NAV2397.00

28250 PR DIVISN PLANTAR 1642.00

28260 PR CAPSULOTOMY MIDFOOT JT,MED RELEASE

2000.00

28261 PR CAPSULOTOMY MIDFOOT,TENDN LENGTH

3580.00

28262 PR CAPSULOTOMY 4011.0028264 PR CAPSULOTOMY MIDTARSAL 2518.0028270 PR CAPSULOTOMY MT-P 1402.0028272 PR CAPSULOTOMY I-P JT,FOOT,EA 1170.0028285 PR REPAIR OF HAMMERTOE,ONE 1384.0028288 PR PART REMV BONE METATARSAL

HEAD,EA1494.00

28289 PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O

2101.00

28291 PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT

2610.00

28292 PR CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL

1959.00

28295 PR CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR OSTEOT

2432.00

28296 PR CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT

2305.00

28297 PR CORRJ HALLUX VALGUS W/SESMDC W/1METAR MEDIAL CNF

2427.00

28298 PR CORRJ HALLUX VALGUS W/SESMDC W/PROX PHLNX OSTEOT

2028.00

28299 PR CORRJ HALLUX VALGUS W/SESMDC W/2 OSTEOT

2554.00

28300 PR OSTEOTOMY HEEL BONE 2963.0028302 PR OSTEOTOMY TALUS 2952.0028304 PR OSTEOTOMY MIDTARSAL BONES 2282.0028306 PR OSTEOTOMY 1ST

METATARSAL,BASE/SHAFT1715.00

28308 PR OSTEOTOMY METATARSAL (NOT 1497.0028309 PR OSTEOTOMY 3204.0028310 PR OSTEOTOMY PROX 1965.0028312 PR OSTEOTOMY,ANY PHALANX,ANY 130328313 PR RECONSTRUC TOE

DEFORM,SOFT TISSUE1500.00

28315 PR REMOV SESAMOID BONE,1ST 1404.0028320 PR REPAIR NON/MALUNION TARSAL

BONE(S)2135.00

28322 PR REPAIR NON/MALUNION 2430.00

28344 PR REPAIR EXTRA TOE(S) 1990.0028345 PR REPAIR WEBBED TOE(S) 1430.0028400 PR CLOSED RX HEEL FX 832.0028405 PR CLOSED RX HEEL 1325.0028406 PR PERCUT RX HEEL FX 1731.0028415 OPEN TREATMENT CALCANEAL 3898.0028420 OPEN TREATMENT CALCANEAL

FRACTURE W BONE GRAFT4515.00

28430 PR CLOSED RX TALUS FX 796.0028435 PR CLOSED RX TALUS 1034.0028436 PR PERCUT RX TALUS FX 114528445 OPEN TREATMENT TALUS 3500.0028446 PR OPEN OSTEOCHONDRAL

AUTOGRAFT TALUS3556.00

28450 PR CLOSED RX TARSAL FX,EACH 769.0028455 PR CLOSED RX TARSAL 728.0028456 PR PERCUT RX TARSAL FX,EACH 796.0028465 OPEN TX TARSAL FRACTURE XCP

TALUS &CALCANEUS EA1770.00

28470 PR CLOSED RX METATARSAL FX 757.0028475 PR CLOSED RX METATARSAL 920.0028476 PR PERCUT RX METATARSAL FX 1091.0028485 OPEN TREATMENT METATARSAL

FRACTURE EACH1493.00

28490 PR CLOSED RX BIG TOE FRACTURE 425.0028495 PR CLOSED RX BIG TOE FX,MANIP 530.0028496 PR PERCUT BIG TOE FX 1593.0028505 OPEN TX FRACTURE GREAT

TOE/PHALANX/PHALANGES1730.00

28510 PR CLOSED RX TOE FX 397.0028515 PR CLOSED RX TOE FX,MANIPULATN 414.0028525 OPEN TX FRACTURE

PHALANX/PHALANGES NOT GREAT 1612.00

28540 PR CLOSED RX TARSAL 639.0028545 PR CLOSED RX TARSAL 699.0028546 PR PERCUT RX TARSAL 1427.0028555 OPEN TREATMENT TARSAL BONE

DISLOCATION2306.00

28570 PR CLOSED RX TALOTARSAL 546.0028576 PR PERCUT RX TALOTARSAL 1836.0028585 OPEN TREATMENT TALOTARSAL

JOINT DISLOCATION2137.00

28600 PR CLOSED RX TAR-METATAR DISLOCATION

671.00

28605 PR CLOSED RX TAR-METATAR DISLOC,ANESTH

843.00

28606 PR PERCUT RX TAR-METATAR FOOT DISLOC

2661.00

28615 OPEN TREATMENT TARSOMETATARSAL JOINT

2085.00

28630 PR CLOSED RX MT-PHAL TOE 387.0028635 PR CLOSED RX MT-PHAL TOE

DISLOC,ANESTH453

28636 PR PERCUT RX MT-PHAL TOE 1242.0028645 OPEN TX METATARSOPHALANGEAL

JOINT DISLOCATION2346.00

28660 PR CLOSED RX I-P JT,TOE 290.0028665 PR CLOSED RX I-P JT,TOE 474.0028666 PR PERCUT RX I-P JT,TOE DISLOC 47828705 PR FUSION FOOT BONES,PANTALAR 5070.0028715 PR FUSION FOOT BONES,TRIPLE 3060.0028725 PR FUSION FOOT BONES,SUBTALAR 2672.0028730 PR FUSION FOOT 2571.0028735 PR FUSION FOOT

BONES,MIDTARSAL,OSTEOTMY2508.00

28737 PR FUSION W/TEND ADV,MIDTAR NAV-CUNEIFORM

2217.00

28740 PR FUSION FOOT 2564.0028750 PR FUSION BIG TOE,MT-P JT 2630.0028755 PR FUSION BIG TOE,I-P JOINT 1512.0028760 PR FUSION BIG TOE,I-P JT+TENDN 2089.0028800 PR AMPUTATION FOOT,MIDTARSAL-

CHOPART1574.00

28805 PR AMPUTATION 1901.0028810 PR AMPUTATION 1281.0028820 PR AMPUTATION TOE,MT-P JT 1388.0028825 PR AMPUTATION TOE,I-P JT 1475.0029010 PR APPLY BODY CAST,RISSER 697.0029065 PR APPLY LONG ARM CAST 278.0029075 PR APPLY FOREARM CAST 257.0029085 PR APPLY HAND/WRIST CAST 274.0029105 PR APPLY LONG ARM SPLINT 218.0029125 PR APPLY FOREARM SPLINT,STATIC 161.0029126 PR APPLY FOREARM 193.00

29130 PR APPLY FINGER SPLINT,STATIC 103.0029131 PR APPLY FINGER SPLINT,DYNAMIC 165.0029200 PR STRAPPING OF CHEST 127.0029240 PR STRAPPING OF SHOULDER 137.0029260 PR STRAPPING OF ELBOW OR 124.0029280 PR STRAPPING OF HAND OR FINGER 122.0029325 PR APPLY OF HIP CASTS,TWO LEGS 743.0029345 PR APPLY LONG LEG CAST 407.0029355 PR APPLY LONG LEG CAST,WALKER 35629365 PR APPLY LONG LEG 438.0029405 PR APPLY SHORT LEG CAST 266.0029425 PR APPLY SHORT LEG 289.0029450 PR APPLY OF CLUBFOOT CAST 461.0029505 PR APPLY LONG LEG SPLINT 207.0029515 PR APPLY LOWER LEG SPLINT 179.0029520 PR STRAPPING OF HIP 179.0029530 PR STRAPPING OF KNEE 126.0029540 PR STRAPPING; ANKLE &/OR FOOT 96.0029550 PR STRAPPING OF TOES 94.0029580 PR APPLY OF PASTE BOOT 122.0029581 PR APPL MLTLAYR COMPRES LEG

BELOW KNEE W/ANKLE FOOT157.00

29582 PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE

178.00

29805 PR SHLDR 1533.0029806 PR SHLDR

ARTHROSCOP,SURG,CAPSULORRHA3387.00

29807 PR SHLDR ARTHROSCOP,SURG,REPAIR,SLAP

3301.00

29819 PR SHLDR ARTHROSCOP,SURG,W/REMOVAL,LOOSE/FB

1902.00

29820 PR SHLDR ARTHROSCOP,PART 1903.0029822 PR SHLDR ARTHROSCOP,PART 1862.0029823 PR SHLDR ARTHROSCOP,EXTEN 2034.0029824 PR SHLDR ARTHROSCOP,SURG,DIS

CLAVICULECTOMY2074.00

29825 PR SHLDR ARTHROSCOP,LYSE 1920.0029826 PR SHOULDER SCOPE BONE 2190.0029827 PR SHLDR

ARTHROSCOP,SURG,W/ROTAT CUFF 3551.00

29828 PR ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS

2731.00

29834 PR ELBOW ARTHROSCOP,REMV LOOSE BODY

1891.00

29835 PR ELBOW ARTHROSCOP,PART 2072.0029837 PR ELBOW ARTHROSCOP,PART 1891.0029838 PR ELBOW ARTHROSCOP,EXTEN 2409.0029840 PR WRIST 1424.0029844 PR WRIST ARTHROSCOP,PART 1813.0029845 PR WRIST ARTHROSCOP,FULL 2072.0029846 PR WRIST ARTHROSCOP,EXCIS

TRIANG CART1943.00

29847 PR WRIST ARTHROSCOP,INTERN 1919.0029848 PR WRIST ARTHROSCOP,RELEASE

XVERS LIG1444.00

29850 PR KNEE SCOPE/SURG/INTERCOND 2149.0029851 PR KNEE SCOPE/SURG/INCOND FX

AID+FIXAT3048.00

29855 PR TIBIAL SCOPE/SURG/FX AID,UNICONDYLR

2733.00

29860 PR HIP ARTHROSCOPY, DX 170129861 PR HIP SCOPE/REMOV

LOOSE/FOREIGN BODY2190.00

29862 PR HIP SCOPE/REMV BODY,PLASTY/RESECTN

2440.00

29863 PR HIP SCOPE/REMV 2434.0029866 PR KNEE SCOPE, AUTOGRAFT 5449.0029867 PR KNEE SCOPE, ALLOGRAFT 3972.0029868 PR KNEE SCOPE, MENISC 6481.0029870 PR KNEE SCOPE,DIAGNOSTIC 1307.0029871 PR KNEE SCOPE,CLEAN/DRAIN 1636.0029873 PR KNEE SCOPE, W/LATERAL 1646.0029874 PR KNEE SCOPE,REMV LOOSE 1824.0029875 PR KNEE SCOPE,PART SYNOVECT 1800.0029876 PR KNEE SCOPE,FULL SYNOVECT 2148.0029877 PR KNEE SCOPE,SHAVE ARTICULAR 1920.0029879 PR KNEE SCOPE,ABRASN 2208.0029880 PR ARTHRS KNEE

W/MENISCECTOMY MED&LAT 2640.00

29881 PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT

2184.00

29882 PR KNEE SCOPE,MED OR LAT MENIS REPAIR

2364.00

29883 PR KNEE SCOPE,MED+LAT MENIS 3072.0029884 PR KNEE SCOPE,LYSIS OF ADHESNS 1847.0029885 PR KNEE SCOPE,DRILL OSTE 2650.0029886 PR KNEE SCOPE,DRILL OSTEIT 1626.0029888 PR KNEE SCOPE,AID ANT CRUCIATE 3864.0029889 PR KNEE SCOPE,AID POST CRUC 3864.0029891 PR ANKLE SCOPE,EXCIS

OSTEOCHON DEFCT2424.00

29894 PR ANKLE SCOPE,REMVL LOOSE 1766.0029895 PR ANKLE SCOPE,PART 1848.0029897 PR ANKLE SCOPE,PART 1732.0029898 PR ANKLE SCOPE,EXTENS 2424.0029899 PR ANKLE SCOPE,W/ANKLE 3685.0029904 PR ARTHROSCOPY SUBTALAR JOINT

REMOVE LOOSE/FOREIGN BODY2225.00

29905 PR ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY

1984.00

29906 PR ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT

2478.00

29907 PR ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS

3106.00

29914 PR ARTHROSCOPY HIP 4023.0029915 PR ARTHROSCOPY HIP

W/ACETABULOPLASTY4023.00

29916 PR ARTHROSCOPY HIP W/LABRAL 3520.0030100 PR INTRANASAL BIOPSY 288.0030110 PR EXCISION NOSE 467.0030117 PR EXCIS/DEST INTRANAS LESION; 2185.0030118 PR EXCIS/DEST INTRANAS LESION; 2957.0030120 PR EXCISION SKIN OF NOSE 2000.0030125 PR EXCIS NASAL DERMOID,COMPLX 1520.0030130 PR EXCISION TURBINATE 94730140 PR EXCISION 1101.0030150 PR PARTIAL EXCISION OF NOSE 1746.0030160 PR EXCISION OF NOSE 2979.003028F OXYGEN SATURATION RESULTS

DOCUMENTED/REVIEWED0.00

30300 PR REMOVE NASAL FOREIGN BODY 575.0030310 PR REMV NASAL FOR BODY,GEN 410.0030400 PR RECONSTR NOSE 2800.00

30410 PR RECONSTR NOSE,COMPLETE+EXTERNAL

3180.00

30420 PR RECONSTR NOSE+MAJ SEPTAL 3449.0030430 PR REVIS NOSE,SECONDARY,MINOR 2026.0030435 PR REVIS

NOSE,SECONDARY,INTERMEDIATE3744.00

30450 PR REVIS 4873.0030460 PR REVIS NOSE/CLEFT LIP/TIP 2445.0030462 PR REVIS NOSE/CLEFT 6329.0030465 PR REPAIR NASAL CAVITY 2500.0030520 PR REPAIR OF NASAL SEPTUM 2106.0030540 PR REPAIR CHOANAL 1824.0030560 PR RELEASE OF NASAL ADHESIONS 565.0030580 PR REPAIR ORO-MAXILLARY 1140.0030600 PR REPAIR ORO-NASAL FISTULA 1785.0030620 PR INTRANASAL RECONSTRUCTION 1971.0030630 PR REPAIR NASAL SEPTUM 1386.0030802 PR CAUTER TURBINATE

MUCOSA,INTRAMURAL611.00

30901 PR CTRL 239.0030903 PR CTRL 407.0030905 PR CTRL

NOSEBLEED,POST,W/PACKS &/OR 510.00

30906 PR REPEAT CONTROL OF 584.0030920 PR LIGATE INTERN MAXILL ARTERY 289830930 PR THERAPEUTIC FRACTURE INFER

TURBINATE244.00

31000 PR IRRIGATION MAXILLARY SINUS 376.003100F PR CAROTID IMG STUDY MEAS

DISTAL INT CAROTID DIAM 0.00

31020 PR EXPLOR MAXILL 1036.0031030 PR EXPLOR MAXILL SINUS,RADICAL 1741.0031032 PR EXPLOR MAXILL SINUS,RMV 1945.0031040 PR EXPLOR PTERYGOMAXILL FOSSA 3039.0031051 PR EXPLOR SPHENOID SINUS+RMV 1490.0031070 PR EXPLOR FRONT 1561.0031075 PR EXPLOR FRONT 1967.0031085 PR OBLITER FRONT

SINUS+FLAP,CORON INCI4557

31201 PR REMOV ETHMOID SINUS,INTRANASAL,TOTL

1854

31205 PR REMOV ETHMOID SINUS,EXTRANASAL,TOTL

2266.00

31225 PR REMV UPPER JAW- 3435.0031230 PR REMV UPPER JAW+ORBIT 824831231 PR NASAL ENDOSCOPY,DX 528.0031233 PR NASAL/MAXILL SINUS 1331.0031235 PR NASAL/SPHENOID SINUS

ENDOSCOPY,DX665.00

31237 PR NASAL SCOPE,BX/RMV 1280.0031238 PR NASAL/SINUS

SCOPY,W/CONTROL NASAL HEM866.00

31239 PR NASAL/SINUS SCOPY,SURG 1457.0031240 PR NASAL/SINUS SCOPY,RMV

CONCHA BULL525.00

31241 PR NASAL/SINUS NDSC W/LIG SPHENOPALATINE ARTERY

1155.00

31253 PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL

1294.00

31254 PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY

1204.00

31255 PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY

2344.00

31256 PR NASAL SCOPY,OPEN MAXILL 926.0031257 PR NASAL/SINUS NDSC TOTAL WITH

SPHENOIDOTOMY1152.00

31259 PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL

1221.00

31267 PR NASAL SCOPY,RMV TISS MAXILL 1737.0031276 PR NASAL/SINUS NDSC W/RMVL

TISS FROM FRONTAL SINUS3500.00

31287 PR NASAL SCOPY,SPHENOIDOTOMY 1379.0031288 PR NASAL SCOPY,REMV TISS 1379.0031290 PR NASAL SCOPY,REPAIR CSF

LEAK,ETHMOID3717.00

31291 PR NASAL SCOPY,REPR CSF LEAK,SPHENOID

3885.00

31292 PR NASAL SCOPY,MED/INF ORBIT DECOMPRES

4200.00

31293 PR NASAL SCOPY,MED+INF ORBIT DECOMPRES

3782

31295 PR NASAL/SINUS ENDOSCOPY,W/DILAT MAXILLARY

5065.00

31296 PR NASAL/SINUS ENDOSCOPY,W/DILAT FRONTAL

5166.00

31297 PR NASAL/SINUS ENDOSCOPY,W/DILAT SPHENOID

5073.00

31298 PR NASAL/SINUS NDSC W/FRONTAL & SPHEN SINS DILATION

9883.00

31299 PR SINUS SURGERY PROC 450.0031300 PR REMOVAL OF LARYNX LESION 3092.0031360 PR REMOVAL OF LARYNX 3645.0031365 PR REMOVAL OF LARYNX+RAD TOTL 5375.0031367 PR PART SUPRAGLOT REMV 9023.0031390 PR REMV LARYNX & PHARYNX 11598.0031395 PR REMV LARYNX+PHARYNX W

RECONSTRUC5672.00

31400 PR REVISION ARYTENOIDS 3460.0031500 PR INSERT EMERGENCY

ENDOTRACH AIRWAY396.00

31502 PR TRACH TUBE CHANGE 84.0031505 PR LARYNGOSCOPY,INDIRECT,DX 207.0031510 PR LARYNGOSCOPY,INDIRECT WITH

BIOPSY533.00

31515 PR LARYNGOSCOPY,DIRECT FOR ASPIRATION

929.00

31520 PR LARYNGOSCOPY,DIRECT,DIAGNOS,NEWBRN

778.00

31525 PR 734.0031526 PR LARYNGOSCOPY,DIRECT,DX,OP

MICROSCOP361.00

31527 PR LARYNGOSCOPY,DIRECT,INSRT OBTURATOR

734.00

31528 PR LARYNGOSCOPY DIRECT,W/DILAT, INITIAL

460.00

31529 PR LARYNGOSCOPY DIRECT,W/DILAT, SUBSEQUENT

763.00

31530 PR LARYNGOSCOPY,DIRCT,OP,F.B. 763.0031535 PR 763.0031536 PR LARYNGOSCOPY,DIRCT,OP

SCOPE,BIOPSY878.00

31540 PR LARYNGOSCOPY,DIRCT,OP,EXC 923.0031541 PR LARYNGOSCOPY,DIRCT,OP

SCOP,EXC TUMR1439.00

31545 PR LARYNGOSCOPY,DIR,OP,EXC TUMR,LCL FLAP

923.00

31551 PR LARYNGOPLASTY LARYNGEAL STEN W/O STENT < 12 YRS

5849.00

31552 PR LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS >

5174.00

31553 PR LARYNGOPLASTY LARYNGEAL STEN W/STENT < 12 YRS

6448.00

31554 PR LARYNGOPLASTY LARYNGEAL STEN W/STENT 12 YRS >

6789.00

31560 PR LARYNGOSCOPY,DIRCT,OP,REMV

2128.00

31561 PR LARYNGOSCOPY,DIRCT,OP SCOP,REMV ARY

1520.00

31570 PR LARYNGOSCOPY,DIRCT,INJ VOCAL CORD

929.00

31571 PR LARYNGOSCOPY,DIRECT,SCOPE,INJ

869.00

31572 PR LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI

1250.00

31573 PR LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI

665.00

31574 PR LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI

2577.00

31575 PR LARYNGOSCOPY FLEXIBLE 260.0031576 PR LARYNGOSCOPY FLEXIBLE

W/BIOPSY(IES)495.00

31577 PR LARYNGOSCOPY FLX RMVL FOREIGN BODY(S)

540.00

31579 PR LARYNGOSCOPY FLX/RGD TELESCOPIC W/STROBOSCOPY

498.00

31580 PR LARYNGOPLASTY LARYN WEB W/KEEL STENT INSERTION

4417.00

31582 PR REVISION LARYNX,STENOSIS W 3844.0031584 PR LARYNGOPLASTY W/OPEN

REDUCTION FRACTURE W/TRACHS3844.00

31587 PR LARYNGOPLASTY CRICOID SPLIT W/O GRAFT PLACEMENT

3844.00

31588 PR REVISION OF LARYNX, 3844.0031590 PR REINNERVATE LARYNX W 2415.0031591 PR LARYNGOPLASTY

MEDIALIZATION UNLIATERAL3672.00

31592 PR CRICOTRACHEAL RESECTION 6934.0031600 PR TRACHEOSTOMY, PLANNED 985.0031601 TRACHEOSTOMY, <2 Y/O 797.0031603 PR 911.0031610 PR 1543.0031611 PR CREATE T-E FISTULA+SPEECH

PROSTHESIS1158.00

31613 PR TRACH REVISION,SIMPLE 957.0031614 PR TRACH REVISION,COMPLEX 1594.0031615 PR TRACHEOBRNCHSC THRU EST

TRACHS INC395.00

31622 PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX

733.00

31623 PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS

853.00

31624 PR BRNCHSC W/BRNCL ALVEOLAR 769.0031625 PR BRONCHOSCOPY

BRONCHIAL/ENDOBRNCL BX 1+ 826.00

31627 PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION

4814.00

31628 PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1

968.00

31629 PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON

1386.00

31630 PR BRONCHOSCOPY,TRACH/BRONCH

735.00

31631 PR BRONCHOSCOPY,TRACH 589.0031632 PR BRONCHOSCOPY

W/TRANSBRONCHIAL LUNG BX 175.00

31633 PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA

214.00

31634 PR BRONCHOSCOPY BALLOON 468731635 PR BRONCHOSCOPY W/REMOVAL

FOREIGN BODY830.00

31636 PR BRONCHOSCOPY, BRONCH 56531640 PR BRONCHOSCOPY,EXCIS LESN 946.0031641 PR BRONCHOSCOPY,RX STENOSIS 946.0031645 PR BRONCHOSCOPY W/THER ASPIR

TRACHBRNCL TREE 1ST717.00

31646 PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ

708.00

31647 PR BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE

540.00

31648 PR BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL

548.00

31649 PR BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL

179.00

31651 PR BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE

191.00

31652 PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX

2301.00

31653 PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX

2445.00

31654 PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES

351.00

31660 PR BRONCHOSCOPIC THERMOPLASTY ONE LOBE

526.00

31661 PR BRONCHOSCOPIC THERMOPLASTY 2/> LOBES

555.00

31720 PR CATHETER 132.0031730 PR INTRO WINDPIPE WIRE/TUBE 3098.0031750 PR REVISN TRACHEA,CERVICAL 4960.0031760 PR REVISN 5645.0031780 PR EXCIS TRACH 3343.0031785 PR EXCIS TRACH LESN,CERVICAL 3398.0031800 PR REPAIR TRACH 1529.0031820 PR SURG CLOSURE TRACH/FISTULA 923.0031825 PR SURG CLOSURE

TRACH/FIST,PLAST REPR1602.00

31830 PR REVISE TRACHEOSTOMY SCAR 1338.0032035 PR THORACOSTOMY,RIB 1558.0032036 PR THORACOSTOMY,OPEN

DRAIN/EMPYEMA1689.00

32096 PR THORACTOMY W/DX BX LUNG INFILTRATE UNILATERAL

2865.00

32098 PR THORACOTOMY W/BIOPSY OF 1907.0032100 PR THORACOTOMY WITH 3279.0032110 PR THORCOM CTRL TRAUMTC

HEMRRG&/RPR LNG TEAR5229.00

32120 PR THORACOTOMY POSTOPERATIVE COMPLICATIONS

3099.00

32141 PR THORACOTOMY W/RESECTION 3368.0032151 PR THORCOM W/RMVL IPUL FB 2232.00

32160 PR THORACOTOMY W/CARDIAC 1702.0032200 PR PNEUMONOSTOMY,OPEN DRAIN

ABSC/CYST4060.00

32220 PR 5507.0032225 PR 3099.0032310 PR REMOVAL PARIETAL PLEURA 2986.0032320 PR DECORTICATE/REMV PARIETAL 5478.0032400 PR NEEDLE BIOPSY PLEURA 342.0032405 PR BIOPSY LUNG/MEDIASTINUM

PERCUTANEOUS NEEDLE1095.00

32440 PR REMOVAL OF LUNG 5524.0032480 PR RMVL LUNG OTHER THAN

PNEUMONECTOMY 1 LOBE LOBECT5325.00

32482 PR RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC

5518.00

32484 PR RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY

4691.00

32486 PR RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE

9583.00

32488 PR RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC

9775

32491 PR RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG

5300.00

32501 PR REPAIR BRONCHUS (ADD-ON) 583.0032504 PR RESECT APICAL LUNG TUM/

CHEST WALL RECONST8348

32505 PR THORACOTOMY W/THERAPEUTIC WEDGE RESEXN INITIAL

2342.00

32506 PR THORACOTOMY W/THERAP WEDGE RESEXN ADDL IPSILATRL

394.00

32507 PR THORACOTOMY W/DX WEDGE RESEXN &ANTOM LUNG RESEXN

394.00

32540 PR EXTRAPLEURAL REMV EMPYEMA 7031.0032550 PR INSERTION INDWELLING

TUNNELED PLEURAL CATHETER1515.00

32551 PR TUBE THORACOSTOMY INCLUDES WATER SEAL

501.00

32552 PR REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER

466.00

32554 PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING

1384.00

32555 PR THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING

1404.00

32556 PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING

1459.00

32557 PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING

2706.00

32560 PR CHEMICAL PLEURODESIS FOR PERSISTENT PNEUMOTHORAX

612.00

32561 PR INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, 1ST DAY

242.00

32562 PR INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, SUBSEQUENT

210.00

32601 PR THORSC DX LUNGS/PERICAR/MED/PLEURAL SPACE W/O BX

810.00

32606 PR THORACOSCOPY,DX MEDIAST W 1176.0032607 PR THORACOSCOPY W/DX BX OF

LUNG INFILTRATE UNILATRL785

32608 PR THORACOSCOPY W/DX BX OF LUNG NODULES UNILATRL

953.00

32609 PR THORACOSCOPY WITH BIOPSYIES OF PLEURA

659.00

32650 PR THORACOSCOPY SURG W/PLEURODESIS

2227.00

32651 PR THORACOSCOPY SURG PART PULM DECORT

2584.00

32652 PR THORACOSCOPY SURG TOT PULM DECORT

3688.00

32653 PR THORACOSCOPY SURG REMOV FB INTRAPLEU

2549.00

32654 PR THORACOSCOPY SURG CTRL TRAUMA BLEED

2584.00

32655 PR THORACOSCOPY W/RESECTION BULLAE W/WO PLEURAL PX

2612.00

32656 PR THORACOSCOPY SURG PART PLEURECTOMY

2850.00

32661 PR THORACOSCOPY SURG EXC PERICARD MASS

2847.00

32662 PR THORACOSCOPY SURG EXC MEDIAST MASS

3240.00

32663 PR THORACOSCOPY W/LOBECTOMY SINGLE LOBE

5036.00

32664 PR THORACOSCOPY SURG THOR SYMPATHECT

2812.00

32665 PR THORACOSCOPY SURG ESOPHAGOMYOTOMY

5027

32666 PR THORACOSCOPY W/THERA WEDGE RESEXN INITIAL UNILAT

2189.00

32667 PR THORACOSCOPY W/THERA WEDGE RESEXN ADDL IPSILATRL

394.00

32668 PR THORACOSCOPY W/DX WEDGE RESEXN ANATO LUNG RESEXN

396.00

32669 PR THORACOSCOPY 3369.0032672 PR THORACOSCOPY W/RESEXN-

PLICAJ EMPHYSEMA LUNG UNIL3819.00

32673 PR THORACOSCOPY RESEXN THYMUS UNI/BILATERAL

3018.00

32674 PR THORCOSCPY W/MEDIASTINL &REGIONL LYMPHADENECTOMY

540.00

32800 PR REPAIR LUNG HERNIA 3363.0032850 PR DONOR PNEUMONECTOMY 2311.0032851 PR LUNG TRANSPLANT,SINGLE 8740.0032852 PR LUNG TRANSPLANT,SINGL W CP 9428.0032853 PR LUNG TRANSPLANT,DOUBLE 10500.0032854 PR LUNG TRANSPLANT,DBL W CP 11200.0032855 PR TRANSPLANT,PREP DONOR

LUNG, SINGLE13596.00

32856 PR TRANSPLANT,PREP DONOR LUNG, DOUBLE

14892.00

32900 PR REMOVAL OF RIB(S) 3478.0032994 PR ABLATION THER 1+ PULM

TUMORS PERQ CRYOABLATION15761.00

32998 PR ABLATION THER 1+ PULM TUMORS PERQ RADIOFREQUENCY

6630.00

32999 PR CHEST SURGERY PROCEDURE UNLISTED

450.00

33010 PR PERICARDIOCENTESIS INITIAL 350.0033015 PR INCIS HEART SAC TUBE 1258.0033020 PR INCIS HEART SAC REMV CLOT/FB 2661.0033025 PR INCIS HEART SAC WINDW FOR 2580.0033030 PR REMOV HEART SAC NO CP 4010.0033031 PR REMOV HEART SAC W CP 5232.0033050 PR RESECTION PERICARDIAL 3176.0033120 PR REMOVAL HEART LESION 5996.00

33130 PR REMOVAL HEART LESION 5618.0033202 PR INSERT EPICARDIAL 3025.0033206 PR INS NEW/RPLCMT PRM

PACEMAKR W/TRANS ELTRD ATRIAL1728.00

33207 PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR

1230.00

33208 PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT

1328.00

33210 PR INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH

650.00

33211 PR INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX

472.00

33212 PR INS PM PLS GEN W/EXIST SINGLE 918.0033213 PR INS PACEMAKER PULSE GEN

ONLY W/EXIST DUAL LEADS1005.00

33214 PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS

1216.00

33215 PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE

773.00

33216 PR INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB

1012.00

33217 PR INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB

950.00

33218 PR RPR 1 TRANSVNS ELTRD PRM PM/PACING IMPLNTBL DFB

993.00

33220 PR RPR 2 TRANSVNS ELECTRODES PRM PM/IMPLANTABLE DFB

995.00

33221 PR INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS

925.00

33222 PR RELOCATION OF SKIN POCKET FOR PACEMAKER

921.00

33223 PR RELOCATE SKIN POCKET IMPLANTABLE DEFIBRILLATOR

1041.00

33224 PR INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN

1285.00

33225 PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN

1158.00

33226 PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD

1237.00

33227 PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD

816.00

33228 PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS

852.00

33229 PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD

886.00

33230 PR INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS

984.00

33233 PR REMOVAL PERMANENT PACEMAKER PULSE GENERATOR

678.00

33234 PR RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR

1263.00

33235 PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS

2253.00

33237 PR REMV EPICARD SYST TWO LD/THORACOTMY

2999.00

33241 PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY

572.00

33243 PR RMVL 1/DUAL CHAMBER DEFIB ELECTRODE BY THORACOM

4969.00

33244 PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ

3032.00

33249 PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR

3222.00

33255 PR ABLATE/ RECONSTUCT ATRIA, EXTENS, W/O BYPASS

6685.00

33256 PR ABLATE/ RECONSTUCT ATRIA, EXTENS, W/ BYPASS

7914.00

33257 PR ABLATE/ RECONSTUCT ATRIA, W OTHER PROCED LIMITED

1367.00

33259 PR ABLATE/ RECONSTUCT ATRIA, W OTHER PROCED EXTENS W/ BYPASS

2000.00

33261 PR ABLAT VENTR DYSRHYTHM 3647.0033262 PR RMVL IMPLTBL DFB PLSE GEN

W/REPL PLSE GEN 1 LEAD886.00

33263 PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD

922.00

33264 PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD

956.00

33265 PR ENDO ABLATE/ RECONSTUCT ATRIA, LIMITED

5543.00

33270 PR INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD

1581.00

33271 PR INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE

1258.00

33272 PR RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE

1058.00

33273 PR REPOS PREVIOUSLY IMPLANTED SUBQ IMPLANTABLE DFB

1039.00

33282 PR IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER

2000.00

33284 PR RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER

593.00

33300 PR REPAIR HEART WOUND 9990.0033315 PR EXPLOR HEART SURG WND W CP

BYPASS7725.00

33322 PR REPR AO/GRT VESSEL W CP 5009.0033340 PR PERQ CLSR TCAT L ATR APNDGE

W/ENDOCARDIAL IMPLNT2917.00

33361 PR REPLACE AORTIC VALVE PERQ FEMORAL ARTRY APPROACH

5554.00

33362 PR REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH

6060.00

33363 PR REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH

6381.00

33364 PR REPLACE AORTIC VALVE OPEN ILIAC ARTERY APPROACH

6615.00

33365 PR REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH

7277.00

33366 PR TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE

7870.00

33367 PR REPLACE AORTIC VALVE W/BYP PRQ ART/VENOUS APPRCH

2234.00

33368 PR REPLACE AORTIC VALVE W/BYP OPEN ART/VENOUS APRCH

2666.00

33369 PR REPLACE AORTA VALVE W/BYP CNTRL ART/VENOUS APRCH

3526.00

33390 PR VALVULOPLASTY AORTIC VALVE OPEN CARD BYP SIMPLE

7949.00

33391 PR VALVULOPLASTY AORTIC VALVE OPEN CARD BYP COMPLEX

9419.00

33400 PR REPR AORT VALV W CP BYPASS 6424.0033403 PR REPR AORT VALV XVENT DIL

W/CP BYPAS5678.00

33405 PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT

7770.00

3340F PR MAMMO ASSESS CAT OF INCOMPLETE NEED ADD IMAGE

0.00

33411 PR REPLACE AORT VALV W ANNULUS ENLRGEMENT

8035.00

33412 PR REPLAC AO VALV XVENT AO ANNUL ENLG

12952.00

33413 PR REPL AORT VALVE,TRANSLOC AUTOL PULM VALV

9386.00

33414 PR REPAIR LV OUTFLOW OBSTR PATCH ENLG

8794.00

33415 PR REVIS SUBVALV TIS SVAS 6385.0033416 PR REVIS VENT MUSC FOR IHSS 6942.0033417 PR AORTOPLAS FOR SUPRAVALV 4598.0033418 PR TCAT MITRAL VALVE REPAIR

INITIAL PROSTHESIS6371.00

33419 PR TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS

1344.00

3341F PR MAMMO ASSESS CAT OF NEGATIVE DOCUMENTED

0.00

33425 PR MITRALPLASTY W CP BYPASS 6087.0033426 PR MITRALPLASTY W PROSTHETIC 7329.0033427 PR MITRALPLASTY W RADICAL 8674.003342F PR MAMMO ASSESS CAT OF BENIGN

DOCUMENTED0.00

33430 PR REPLACEMENT OF MITRAL 9800.0033463 PR VALVULOPLAS TRICUS NO RING 6898.0033464 PR VALVULOPLAS TRICUS W RING 6348.0033465 PR REPLACE TRICUSPID W CP 6164.0033471 PR PULM VALVOTOMY VIA PULM 4265.0033474 PR PULM VALVOTOMY W CP BYPASS 8904.0033475 PR REPLACEMENT, PULMONARY 5805.0033476 PR RV RESEC INFUND STEN 5850.0033477 PR TCAT PULMONARY VALVE

IMPLANTATION PRQ APPROACH5383.00

33478 PR RV OUTFLOW TRACT 6225.0033502 PR REPR ANOMAL CORON ART PA

ORIGIN BY LIGATN3100.00

33507 PR REPR INTRAMURAL COR ART TRANSLOC/ UNROOF

7054

33508 PR ENDOSCOPY W/VIDEO-ASST VEIN HARVEST,CABG

350.00

33510 PR CABG, VEIN, SINGLE 6571.0033511 PR CABG, VEIN, TWO 6827.0033512 PR CABG, VEIN, THREE 7188.0033517 PR CABG, ARTERY-VEIN, SINGLE 426.0033518 PR CABG, ARTERY-VEIN, TWO 931.0033519 PR CABG, ARTERY-VEIN, THREE 1236.0033521 PR CABG, ARTERY-VEIN, FOUR 2331.0033530 CABG, REOPERATE >1 MON ORIG 1189.0033533 PR CABG, ARTERIAL, SINGLE 6745.0033534 PR CABG, ARTERIAL, TWO 7249.0033535 PR CABG, ARTERIAL, THREE 7675.0033542 PR MYOCARD RESECTN 6848.0033548 PR RESTORE/REMODEL VENTRICLE 12083.0033572 PR OPEN CORONARY 585.0033600 PR CLOSURE OF AV VALVE 7029.0033606 PR ANAST PULM ARTERY TO AORTA 7231.0033610 PR REPAIR BY SURG 7260.0033615 PR REPR (SIMPLE FONTAN) 6510.0033617 PR REPR BY MODIFIED FONTAN 8682.0033619 PR REPR HYPOPLAS LT HEART 10622.0033620 PR APPLICATION RIGHT & LEFT

PULMONARY ARTERY BANDS6752.00

33641 PR REPR ASD W BYPASS 4943.0033645 PR REPR/CLOS SINUS VENOSUS 5804.0033647 PR REPR ASD & VSD 6844.0033660 PR REPR ASD OSTIUM PREMUM 6949.0033665 PR REPR INTERMED AV CANAL 6860.0033670 PR REPR COMPL AV CANAL DEFECT 7463.0033675 PR CLOSE MULTIPLE VSD 807233677 PR CLOSE MULTIPLE VSD, REMOVE

PA BAND7982.00

33681 PR CLOSE SINGLE VSD 7186.0033684 PR CLOSE SINGLE VSD, WITH 6907.0033690 PR BANDING PULM ARTERY 4290.0033692 PR REPR TET FALLOT WO PULM 7141.0033694 PR REPR TET FALLOT X-ANNULAR 7778.0033697 PR REPR TET FALLOT W PULM 8253.0033710 PR REPR VALSALVA FISTULA & VSD 840033720 PR REPR VALSALVA ANEURYSM 6337.0033724 PR REPAIR PULMONARY VENOUS 6301.00

33726 PR REPAIR PULMONARY VENOUS STENOSIS

8324

33730 PR REPRAIR ANOMAL PULMONARY VENOUS RETURN

7656.00

33732 PR REPR COR TRIAT/SUPRAVALV MITR RING

5420.00

33735 PR ATR SEPTEC/SEPTOSTOMY 4295.0033737 PR ATR SEPTEC/SEPTOSTMY OPN

INFLW OCCL4340.00

33750 PR SHUNT SUBCL TO PULM ART 5075.0033764 PR SHUNT CENTRAL W PROSTH 5112.0033766 PR SHUNT SVC TO PA, ONE LUNG 4070.0033767 PR SHUNT SVC TO PA, BOTH LUNGS 5875.0033768 PR ANAST SECONDARY SVC TO PA 1136.0033778 PR REPR XPOSTN GRT VES,AO-PUL

ART RECON9007.00

33780 PR REPR XPTN GR VES,AP ART W CLOS VSD

9520.00

33786 PR REPAIR TRUNCUS ARTERIOSUS 9313.0033788 PR REIMPLNT ANOMAL PULM ART 5110.0033800 PR AORTIC SUSPENSN FOR TRACH

DECOMPRE2705.00

33802 PR DIVISN ABERRANT VESSEL 3881.0033814 PR OBLIT AO-PUL SEPTAL DFCT W

CP BYPAS6181.00

33820 PR REPR PDA BY LIGATN 3582.0033822 REPR PDA BY DIVISION <18 Y/O 4016.0033840 PR EXCISN COARCT AORTA DRCT 5086.0033845 PR EXCISN COARCT AORTA W 5504.0033852 PR REPR HYPOPLASTIC AORTIC 3818.0033853 PR REPR HYPOPLASTIC ARCH W CP

BYPASS7512.00

33860 PR ASCEND AORTA GRAFT INCL VAVLE SUSPENSION

11656.00

33863 PR ASCEND AORTA GRAFT W ROOT REPLACMENT.VALVE CONDUIT/CORON RECONSTRUCT

9772.00

33864 PR ASCEND AORTA GRAFT W VALVE SPARING ANNULUS REMODEL

7322.00

33870 PR TRANSV AORTIC ARCH GRAFT W BYPASS

9620.00

33875 PR THORACIC AORTA GRAFT 7447.00

33877 PR REPR THORACOABDOM AA W 9543.0033880 PR ENDOVASC TAA REPR INCL 4180.0033881 PR ENDOVASC TAA REPR W/O 6329.0033883 PR INSERT ENDOVASC PROSTH, 2599.0033884 PR ENDOVASC PROSTH, TAA, EA 950.0033886 PR ENDOVASC DIST EXTENS TAA

PROSTH, DELAYED3400.00

33889 PR SUBCLAV TRANSPOS W/ ENDOVAS TAA REPAIR

1880.00

33891 PR CAR-CAR BYPASS GRFT W/ ENDOVAS TAA REPAIR

2412.00

33910 PR REMOVE PUL ART EMBOLI W CP 10752.0033917 PR REPAIR PULMONARY ART STEN 5981.0033920 PR REPAIR PULM ART 7224.0033922 PR TRANSECT PULMONARY ARTERY 4375.0033924 PR REMV SYS-PULM SHUNT W 689.0033926 PR REPAIR PUL ART UNIFOCAL

ARBOR W/ CP BYPASS10466.00

33927 PR IMPLTJ TOTAL RPLCMT HEART SYS W/RCP CARDIECTOMY

10629.00

33930 PR REMOVAL OF DONOR 5251.0033933 PR TRANSPLANT,PREP DONOR

HEART/LUNG8373.00

33940 PR REMOVAL OF DONOR HEART 5251.0033944 PR TRANSPLANT,PREP DONOR 5796.0033945 PR TRANSPLANTATION OF HEART 10786.0033946 PR ECMO/ECLS INITIATION VENO- 796.0033947 PR ECMO/ECLS INITIATION VENO- 869.0033948 PR ECMO/ECLS DAILY

MANAGEMENT EACH DAY VENO-612.00

33949 PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-

597.00

33951 PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ

1001.00

33952 PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ

976.00

33953 PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN

1115.00

33954 PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN

1087.00

33955 PR ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS

3150.00

33956 PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER

2977.00

33957 PR ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS

712.00

33958 PR ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER

695.00

33959 PR ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS

830.00

33962 PR ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER

791.00

33963 PR ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS

1388.00

33964 PR ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER

1406.00

33965 PR ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS

704.00

33966 PR ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER

786.00

33967 PR INSERT INTRA-AORTIC BALLOON ASST DEVICE

850.00

33968 PR RMV AORTIC BALLOON DEVICE 81.0033969 PR ECMO/ECLS RMVL OF PERPH

CANNULA OPEN BIRTH-5 YRS845.00

33970 PR INSRT AORT BALLOON ASSIST 1166.0033971 PR REMV AORTIC BALLOON ASSIST

FEM ART1627.00

33973 PR INSRT AORTIC BALLOON THRU ASC AORT

1286.00

33974 PR REMV AORTIC BALLOON FROM ASC AORT

3184.00

33975 PR INSERT VENT ASST DEVICE,SINGLE VENTRICLE

4034.00

33976 PR INSERT VENT ASST DEVICE,BIVENTRICULAR

4576.00

33977 PR REMOVE VENT ASST DEVICE,SINGLE VENTRICLE

3869.00

33978 PR REMOVE VENT ASST DEVICE,BIVENTRICULAR

4911.00

33979 PR INSERT VENT ASST DEV,IMPLANT,SINGLE VENT

6668.00

33980 PR REMOVE VENT ASST DEV,IMPLANT,SINGLE VENT

8150.00

33982 PR REPLACE VENT ASST DEV, IMPLANT INTRACORP, SINGLE VENT,

7399.00

33983 PR REPLACE VENT ASST DEV, IMPLANT INTRACORP, SINGLE VENT,

8460.00

33984 PR ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER

827.00

33985 PR ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS

1566.00

33986 PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER

2074.00

33987 PR ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS

624.00

33988 PR INSERT LEFT HEART VENT BY THORACIC INC ECMO/ECLS

2637.00

33989 PR RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS

1248.00

33990 PR INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY

1047.00

33991 PR INSJ PERQ VAD TRNSPTAL W/IMAGE ART&VENOUS ACCESS

2136.00

33992 PR REMOVAL PERCUTANEOUS VAD DIFFERENT SESSION

513.00

33993 PR REPOSITION VAD W/IMAGING DIFFERENT SESSION

448.00

33999 PR CARDIAC SURG PROCEDURE 2000.0034101 PR REMV ART CLOT AXILL-

BRACH,ARM INCIS1416.00

34111 PR REMV ART CLOT ARM,ARM INCIS 1415.0034151 PR REMV ART CLOT VISC,ABD INCIS 5168.0034201 PR REMV ART CLOT ILIAC-POP,LEG 2354.0034203 PR REMV ART CLOT LOW LEG,LEG 3079.0034471 PR REMV VEIN CLOT SUBCLAV,NECK 2978.0034490 PR REMV VEIN CLOT AXILL-

SUBCL,ARM INCIS2185.00

34502 PR RECONSTRUCT, VENA CAVA 5637.0034701 PR EVASC RPR DPLMNT AORTO-

AORTIC NDGFT5143.00

34702 PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT

7682.00

34703 PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT

5795.00

34704 PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT

9639.00

34705 PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT

6384.00

34706 PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT

9608.00

34707 PR EVASC RPR DPLMNT ILIO-ILIAC 4796.0034708 PR EVASC RPR DPLMNT ILIO-ILIAC

NDGFT RPT7718.00

34709 PR PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR

844.00

34710 PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL

2929.00

34711 PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL

780.00

34712 PR TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I

2503.00

34713 PR PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT

337.00

34714 PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH

707.00

34715 PR OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI

790.00

34716 PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ

980.00

34800 PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH

3789.00

34802 PR AAA REPAIR,MODULR BIFURCATED PROSTH

4789.00

34803 PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK

4884.00

34805 PR ENDOVASC ABDO REPAIR 2752.0034808 PR AAA REPAIR,ILIAC ARTERY

OCCLSN DEVICE500.00

34812 PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI

830.00

34813 PR AAA REPAIR, FEMORAL-FEMORAL GRAFT

580.00

34820 PR OPN ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI

1200.00

34825 PR AAA REPR,1ST VESSEL,EXTENSION PROSTH

1628.00

34826 PR AAA REPR,ADD VESSEL,EXTENSION PROSTH

500.00

34830 PR AAA+TRAUMA REPR,OPEN,TUBE PROSTH

4281.00

34833 PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP

1455.00

34834 PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI

1166.00

34839 PR PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT

1035.00

34842 PR ENDOVASC VISCER AORTA REPAIR FENEST 2 ENDOGRAFT

5096.00

34843 PR ENDOVASC VISCER AORTA REPAIR FENEST 3 ENDOGRAFT

5852.00

34846 PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS

4565.00

34847 PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS

5412.00

34900 PR ENDOVASCULAR REPAIR ILIAC ARTERY W ILIO-ILIAC PROSTHESIS

3224.00

35011 PR REPR DFCT ART AXILLO-BRACH 3258.0035045 PR REPR ANEURYSM/GRFT

INS,RADIAL/ULNAR3446.00

35081 PR REPR ANEURYSM/GRFT INS,ABDOMINAL AORTA

5899.00

35082 PR REPR ART RUPTURE, ABD 8983.0035091 PR REPR ANEURYSM/GRFT INS,ABD

AORT W/VISCER7346.00

35102 PR REPR ANEURYSM/GRFT INS,ABD AORT W/ILIAC

7748.00

35121 PR REPR ANEUR/GRFT INS,HEP/CEL/REN/MESENTER

6769.00

35131 PR REPR ANEURYSM/GRFT INS,ILIAC 5713.0035132 PR REPR ART RUPTURE,ILIAC 3982.0035141 PR REPR ANEURYSM/GRFT

INS,COMMON FEMORAL3667.00

35151 PR REPR ANEURYSM/GRFT 4737.0035184 PR REPR CONG AV FIST,EXTREM 3448.0035190 PR REPR ACQ AV FIST,EXTREM 2411.0035201 PR REPR BL VES DIRECT,NECK 2968.0035206 PR REPR BL VES DIRECT,UP 2653.0035207 PR REPR BL VES 3750.00

35211 PR REPR BL VES DIRECT,CHEST W 3137.0035216 PR REPR BL VES DIRECT,CHEST 5220.0035221 PR REPR BL VES DIRECT,ABD 5056.0035226 PR REPR BL VES DIRECT,LOW 2972.0035231 PR REPR BL VES VEIN GRFT,NECK 5084.0035236 PR REPR BL VES VEIN GRFT,UP 4650.0035241 PR REPR BL VES VEIN

GRFT,CHEST/W BYPAS3281.00

35256 PR REPR BL VES VEIN GRFT,LOW 3664.0035261 PR REPR BL VES GRAFT,NECK 3239.0035271 PR REPR BL VES GRAFT,CHEST W 3129.0035276 PR REPR BL VES GRAFT,CHEST 5596.0035281 PR REPR BL VES GRAFT,ABDOMEN 5763.0035286 PR REPR BL VES GRAFT,LOW 3189.0035301 PR THROMBOENDARTECTMY

NECK,NECK INCIS3510.00

35302 PR THROMBOENDARTECTMY SUPERFICIAL FEM ARTERY

4546.00

35303 PR THROMBOENDARTECTMY POPLITEAL ARTERY

5292.00

35305 PR THROMBOENDARTECTMY TIBIAL/ PERON ARTERY, INITIAL

5063.00

35321 PR THROMBOENDARTECTMY AXILLARY-BRACH

2926.00

35331 PR THROMBOENDARTECTMY ABD 5486.0035341 PR THROMBOENDARTECTMY 5284.0035351 PR THROMBOENDARTECTMY ILIAC 5260.0035355 PR THROMBOENDARTECTMY 3706.0035371 PR THROMBOENDARTECTMY

FEMORAL COMMON2744.00

35372 PR THROMBOENDARTECTMY FEMORAL DEEP

3312.00

35390 PR REOPER, CAROTID ENDARTEC>1 398.0035400 PR ANGIOSCOPY DURING RX 391.0035460 PR BALLN ANGIOPLASTY 794.0035471 PR BALLN ANGIOPLASTY 12695.0035472 PR BALLN ANGIOPLASTY 5072.0035475 PR BALLN ANGIOPLASTY

PERC,BRACHIOCEPH5657.00

35476 PR BALLN ANGIOPLASTY,PERC 4321.0035500 PR HARVEST VEIN FOR BYPASS 806.00

35501 PR VEIN BYPASS GRAFT,CAROTID, COMMON-INT CAR ART

3615.00

35506 PR VEIN BYPASS GRAFT,CAROT-SUBCL/ SUBCL-CAROTD

3624.00

35510 PR ARTERY BYPASS GRAFT 5025.0035516 PR VEIN BYPASS GRAFT,SUBCL- 2889.0035523 PR VEIN BYPASS GRAFT, BRACHIAL

ULNAR OR RADIAL5227.00

35525 PR ARTERY BYPASS GRAFT 4556.0035531 PR VEIN BYPASS GRAFT,AORTO- 8348.0035537 PR VEIN BYPASS

GRAFT,AORTOILIOFEMORAL8726.00

35556 PR VEIN BYPASS GRAFT,FEM-POP 4608.0035566 PR VEIN BYPASS GRAFT,FEM-TIBIAL 5731.0035571 PR VEIN BYPASS GRAFT,TIB- 5283.0035600 HARVEST UPPER EXTREMITY ART 1

SEGMENT FOR CABG620.00

35601 PR BYPASS GRAFT OTHR,CAROTID-INT CAROTID

3367.00

35606 PR BYPASS GRAFT OTHR,CAROT- 3270.0035621 PR BYPASS GRAFT OTHR,AXILL-FEM 3689.0035626 PR BYPASS GRAFT

OTHR,AORTOSUBCLAVIAN/AORTOINNOMINATE/AORTOCAROTID

5739.00

35631 PR BYPASS GRAFT OTHR,AORTO-MESENTER

6982.00

35632 PR BYPASS GRAFT OTHR,ILIO- 6493.0035633 PR BYPASS GRAFT OTHR,ILIO- 5797.0035637 PR BYPASS GRAFT 4140.0035638 PR BYPASS GRAFT OTHR,AORTOBI- 6288.0035646 PR BYPASS GRAFT

OTHR,AORTOBIFEMORAL6550.00

35647 PR BYPASS GRAFT 3820.0035654 PR BYPASS GRAFT OTHR,AXILL-FEM- 5201.0035656 PR BYPASS GRAFT OTHR,FEM-POP 3609.0035661 PR BYPASS GRAFT OTHR,FEM-FEM 3481.0035663 PR BYPASS GRAFT OTHR,ILIOILIAC 5147.0035665 PR BYPASS GRAFT 4409.0035666 PR BYPASS GRAFT OTHR,FEM- 4992.0035671 PR BYPASS GRAFT OTHR,POP- 4581.0035681 PR BYPASS GRAFT 207.00

35682 PR BYPASS GRAFT COMPOS/2 VEINS/2 LOCATN

868.00

35685 PR BYPASS GRAFT VEIN PATCH/CUFF,SYNTHETIC

509

35693 PR ART TRANSPOSITN,VERT-SUBCL 2858.0035697 PR REIMPLANT ARTERY EACH 391.0035700 PR REOPERATION, BYPASS GRAFT 384.0035721 PR EXPLORATION, FEMORAL 1119.0035741 PR EXPLORATION POPLITEAL 1316.0035761 PR EXPLORATION OF ARTERY/VEIN 895.0035800 PR EXPLOR POSTOP

BLEED,INFEC,CLOT-NECK1824.00

35820 PR EXPLOR POSTOP BLEED,INFEC,CLOT-CHST

6564.00

35840 PR EXPLOR POSTOP BLEED,INFEC,CLOT-ABD

4867.00

35860 PR EXPLOR POSTOP BLEED,INFEC,CLOT-EXTR

2321.00

35875 PR REMOVAL OF CLOT IN GRAFT 2107.0035876 PR REMOVAL OF CLOT IN GRAFT 3337.0035879 PR REVISE GRAFT/VEIN PATCH 3321.0035881 PR REVISE GRAFT/SEG VEIN 3215.0035883 PR REVISE FEMORAL GRAFT, NON-

AUTOGENOUS GRAFT5133.00

35884 PR REVISE FEMORAL GRAFT, AUTOGENOUS GRAFT

5091.00

35901 PR EXCISION, INFEC GRAFT, NECK 1240.0035903 PR EXCISION, INFEC GRAFT, 1594.0035907 PR EXCISION, INFEC GRAFT, 7238.0036000 PR PLACE NEEDLE IN VEIN 65.0036002 PR INJECTION RX EXTREMITY

PSEUDOANEURYSM416.00

36005 PR INJECTION PROC,EXTREMITY,VENOGRAPHY

780.00

36010 PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA

1958.00

36011 PR PLACE CATH IN VEIN,SELECT 2569.0036012 PR PLACE CATH IN VEIN,SUBSELECT 2016.0036013 PR PLACE CATH IN RT HRT,MAIN 2004.0036014 PR PLACE CATH IN LT/RT PULM ART 2019.0036015 PR PLACE CATH IN SUBSEGMT 2287.0036120 PR PLACE CATH BRACHIAL ART 1120.00

36140 PR INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY

1265.00

36147 PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,1ST ACCESS W/

1813.00

36148 PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,ADDL ACCESS FOR

657.00

36160 PR PLACE CATH AORTA VIA 1389.0036200 PR INTRODUCTION CATHETER 1672.0036215 PR PLACE CATH SELECTIVE 2786.0036216 PR PLACE CATH SUBSELECT 3016.0036217 PR PLACE CATH SUBSUBSELECT 5259.0036218 PR PLACE CATH ADDN SUBSELEC

ART,NECK512.00

36221 PR NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART

540.00

36222 PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART

3526.00

36223 PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART

3843.00

36224 PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART

4177.00

36225 PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY

3813.00

36226 PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY

4261.00

36227 PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC

613.00

36228 PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT

2934.00

36245 PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH

3197.00

36246 PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH

3074.00

36247 PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH

4866.00

36248 PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH

431.00

36251 PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN

3573.00

36252 PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL

3919.00

36253 PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I

5467.00

36254 PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I

5563.00

36406 PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN

64.00

36410 PR VNPNXR 3 YEARS/> PHYS/QHP 41.0036415 PR COLLECTION VENOUS

BLOOD,VENIPUNCTURE8.00

36416 PR COLLECTION CAPILLARY BLOOD SPECIMEN

11.00

36430 PR BLOOD TRANSFUSION SERVICE 89.0036456 PR PRTL EXCHANGE TRANSFUSE

BLOOD/PLSM/CRYST NEWBORN278.00

36460 PR TRANSFUSION 1400.0036465 PR NJX NONCMPND SCLEROSANT

SINGLE INCMPTNT VEIN4060.00

36466 PR NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS

4242.00

36468 PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK

137.00

36470 PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN

373.00

36471 PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

436.00

36473 PR ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN

450.00

36474 PR ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS

226.00

36475 PR ENDOVENOUS RF, 1ST VEIN 4147.0036478 PR ENDOVENOUS LASER, 1ST VEIN 3282.0036479 PR ENDOVEN ABLTJ INCMPTNT VEIN

XTR LASER 2ND+ VEINS958.00

36481 PR PRQ PORTAL VEIN CATHETERIZATION ANY METHOD

4963.00

36482 PR ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN

5404.00

36483 PR ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN

368.00

36500 PR VENOUS SELECT SAMPLING W 424.0036510 PR CATH, VEIN UMBILICAL 232.0036511 PR THER APHERESIS,WHITE BLOOD 232.00

36512 PR THER APHERESIS,RED BLOOD 227.0036513 PR THER APHERESIS,PLATELETS 248.0036514 PR THER APHERESIS,PLASMA 1888.0036522 PR PHOTOPHERESIS 6263.0036555 PR INSJ NON-TUNNELED CENTRAL

VENOUS CATH AGE < 5 Y711.00

36556 PR INSERT NON-TUNNEL CV CATH 664.0036557 PR INSERT TUNNELED CVC W/O

SUBQ PORT/PMP AGE <5 YR2201.00

36558 PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>

2170.00

36560 PR INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR

3168.00

36561 PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>

3010.00

36566 PR INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT

8520.00

36568 PR INSJ PRPH CVC W/O SUBQ PORT/PMP UNDER 5 YR

798.00

36569 PR INSERT TUNNELED CV CATH 751.0036571 PR INSJ PRPH CTR VAD W/SUBQ

PORT AGE 5 YR/>3251.00

36575 PR REPAIR TUNNELED CV CATH 386.0036578 PR RPLCMT CATH CTR VAD SUBQ

PORT/PMP1278.00

36580 PR REPLACE NON-TUNNELED CENTRAL LINE, W/O PORT/PUMP

672.00

36581 PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP

1940.00

36582 PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT

2686.00

36584 PR REPLACE COMPLETE PICC W/O PORT/PUMP, SAME ACCESS

663.00

36585 PR RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT

2767.00

36589 PR REMOVAL TUNNELED CV CATH 397.0036590 PR RMVL TUN CTR VAD W/SUBQ

PORT/PMP CTR/PRPH INSJ745.00

36593 PR DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH

67.00

36595 PR MECH REMOV TUNNELED CV 1701.0036596 PR MECH REMOV TUNNELED CV 368.00

36597 PR REPOSITION VENOUS CATHETER 395.0036598 PR CONTRAST INJ CENT VEN CATH,

INC FLOURO292.00

36600 PR WITHDRAWAL OF ARTERIAL 78.0036620 PR INSERT 270.0036625 PR INSERT

CATH,ART,CUTDOWN,SHORTTERM244.00

36680 PR INSERT NEEDLE,INTRAOSSEOUS INFUSN

188.00

36800 PR INSERT CANNULA,VEIN-VEIN 405.0036818 PR AV ANAST,UP ARM CEPHALIC

VEIN TRANSPOSIT1647.00

36819 PR AV ANAST,UP ARM BASILIC VEIN TRANSPOSIT

2648.00

36820 PR AV ANAST,FOREARM VEIN TRANSPOSITION

2636.00

36821 PR ANASTOMOSIS,AV,ANY SITE 1539.0036825 PR CREAT AV

FISTULA,AUTOGENOUS GRAFT1810.00

36830 PR CREAT AV FISTULA,NON-AUTOGENOUS GRAFT

2343.00

36831 PR THROMBECTOMY,AV FISTULA DIALYS GRFT

2219.00

36832 PR REVISE AV FISTULA,W/O THROMBECTOMY

2071.00

36833 PR AV FIST REVISE GRFT,W THROMBECTOMY

2322.00

36838 PR DIST REVAS LIGATION, HEMO 4708.0036870 PR

THROMBECTOMY,ARTERIOVENOUS 4878.00

36901 PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I

1429.00

36902 PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP

563.00

36903 PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT

770.00

36904 PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH

887.00

36905 PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP

1113.00

36906 PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT

1299.00

36907 PR TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I

324.00

36908 PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR

486.00

36909 PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I

462.00

37140 PR VENOUS ANASTOMOSIS,OPEN,PORTOCAVAL

4929.00

37182 PR INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT

2827.00

37183 PR REVJ TRANSVNS INTRAHEPATIC PORTOSYSTEMIC SHUNT

965.00

37184 PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST

6625.00

37185 PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ

2166.00

37186 PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL

4003.00

37187 PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN

6443.00

37188 PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX

5558.00

37191 PR INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I

6509.00

37192 PR REPSNG INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I

3917.00

37193 PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I

4160.00

37197 PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING

3777.00

37200 PR TRANSCATHETER BIOPSY 533.0037211 PR THROMBOLYSIS ARTERIAL

INFUSION ICRA RS&I INIT TX976.00

37212 PR THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX

862.00

37213 PR THROMBOLYSIS ART/VENOUS INFSN W/IMAGE SUBSQ TX

602.00

37214 PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL

354.00

37215 PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ

3586.00

37216 PR TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ

3333.00

37217 PR TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE

2679.00

37218 PR TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE

3034.00

37220 PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL

1052.00

37221 PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY

1285.00

37222 PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL

2225.00

37223 PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL

543.00

37224 PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI

1165.00

37225 PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL

1570.00

37226 PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL

1824.00

37227 PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL

2646.00

37228 PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI

1420.00

37229 PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL

2568.00

37230 PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL

2497.00

37231 PR REVSC OPN/PRQ TIB/PERO W/STNT/ATHR/ANGIOP SM VSL

1955.00

37232 PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL

2967.00

37233 PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL

3702.00

37234 PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL

714.00

37236 PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL

1795.00

37237 PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL

546.00

37238 PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST

819.00

37239 PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL

381.00

37241 PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I

1727.00

37242 PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I

1773.00

37243 PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT

2113.00

37244 PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE

2465.00

37246 PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART

924.00

37247 PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART

458.00

37248 PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN

795.00

37249 PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN

390.00

37252 PR INTRAVASCULAR US NONCORONARY RS&I INTIAL

3554.00

37253 PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL

530.00

37607 PR LIGATN ANGIOACCESS AV 903.0037609 PR TEMPORAL ARTERY LIGATN OR 779.0037617 PR LIGATN OF ABDOMEN ARTERY 4619.0037618 PR LIGATN OF EXTREMITY ARTERY 979.0037619 PR INS INTRVAS VC FILTR W/WO

VAS ACS VSL SELXN RS&I4021.00

37765 PR PHLEB VEINS - EXTREM - TO 20 1108.0037766 PR PHLEB VEINS - EXTREM 20+ 1500.0037785 PR REVISE SECONDARY 913.0038100 PR REMOVAL SPLEEN, TOTAL 2713.0038101 PR REMOVAL SPLEEN, PARTIAL 2867.0038102 PR REMOVAL SPLEEN, TOTAL W

OTHR PROC602.00

38115 PR REPAIR OF RUPTURED SPLEEN 3220.0038120 PR LAP,SPLENECTOMY 3155.0038200 PR INJECTION FOR SPLEEN X-RAY 327.0038205 PR PROG CELL

HARVEST,TRANSPLANT,ALLOGENIC197.00

38206 PR PROG CELL HARVEST,TRANSPLANT,AUTOLOGO

198.00

38220 PR DIAGNOSTIC BONE MARROW ASPIRATIONS

422.00

38221 PR DIAGNOSTIC BONE MARROW 421.0038222 PR DIAGNOSTIC BONE MARROW

BIOPSIES & ASPIRATIONS436.00

38230 PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC

1500.00

38232 PR BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS

500.00

38240 PR TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR

500.00

38241 PR TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR

500.00

38242 PR ALLOGENEIC LYMPHOCYTE 304.0038243 PR TRNSPLJ HEMATOPOIETIC CELL 304.0038300 PR DRAINAGE LYMPH NODE,SIMPLE 800.0038305 PR DRAINAGE LYMPH 988.0038308 PR INCISION OF LYMPH CHANNELS 113638380 PR LIGATN THOR DUCT,CERV 1224.0038381 PR LIGATN THOR DUCT,THOR 2921.0038500 PR BIOPSY/EXCISION, LYMPH 835.0038505 PR NEEDLE BIOPSY, LYMPH 285.0038510 PR BX/REMV,LYMPH NODE,DEEP 1310.0038525 PR BX/REMV,LYMPH NODE,DEEP 111338530 PR BX/REMV,LYMPH NODE,INTERN 1423.0038562 PR REMOVAL, PELVIC LYMPH

NODES,STAGING2225.00

38570 PR LAP,LYMPH NODE BX 1300.0038571 PR LAP,PELVIC 2580.0038572 PR LAP,PELVIC 3225.0038573 PR LAPS W/BI TOT PEL LMPHADEC &

OMNTC LYMPH BX4232.00

38700 PR REMOVAL NODES, 2685.0038720 PR REMOVAL NODES, NECK,CERV 2841.0038724 PR REMOVAL NODES, NECK,CERV 5599.0038740 PR REMOVE ARMPIT LYMPH NODES

SUPERFIC2014.00

38745 PR REMOVE ARMPITS LYMPH NODES COMPLT

2714.00

38746 PR REMOVE THOR LYMPH NODES RAD REGNL

658.00

38747 PR REMOVE ABD LYMPH NODES RAD REGNL

754.00

38760 PR REMOVE GROIN LYMPH NODES 2560.0038765 PR REMOVE GROIN LYMPH NODES 3983.0038770 PR REMOVE PELVIS LYMPH NODES 2600.0038780 PR REMOVE ABD LYMPH NODES 3977.0038790 PR INJECTION FOR LYMPHATIC 776.0038792 PR INJ RADIOACTIVE TRACER FOR

ID OF SENTINEL NODE102

38794 PR ACCESS THORACIC LYMPH DUCT 768.0038900 PR INTRAOPERATIVE SENTINEL

LYMPH NODE ID W DYE INJECTION328.00

39000 PR MEDIASTINOSCOPY, CERV 1239.0039010 PR MEDIASTINOSCOPY, CHST 2456.0039200 PR RESECTION OF MEDIASTINAL 3120.0039220 PR RESECTION MEDIASTINAL 3435.0039401 PR MEDIASTINOSCOPY INCLUDES

MEDIASTINAL MASS BIOPSY802.00

39402 PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES

1063.00

39501 PR REPAIR DIAPHRAGM 2693.0039503 PR REPAIR DIAPHR 18769.0039540 PR REPAIR DIAPHR HERNIA TRAUMA 2715.0039541 PR REPAIR DIAPHR HERNIA TRAUMA 2873.0039545 PR REVISION OF DIAPHRAGM 2916.0039560 PR RESECT DIAPHRAM,SIMPLE 2517.0039561 PR RESECT DIAPHRAM,COMPLX REP 4432.0040490 PR BIOPSY OF LIP 299.0040500 PR LIP SHAVE 1280.0040510 PR PARTIAL EXCIS LIP,WEDGE PRIM 1520.0040520 PR PARTIAL EXCIS LIP,V-EXC PRIM 125140525 PR FULL THICK EXCIS LIP,RECON W 1410.0040527 PR FULL THICK EXCIS LIP,FIX W 3570.0040530 PR PARTIAL REMOVAL OF LIP,>1/4 1180.0040650 PR REPAIR LIP,FULL 1111.0040652 PR REPAIR LIP,<1/2 VERT HEIGHT 1246.0040654 PR REPAIR LIP,>1/2 VERT HEIGHT 2128.0040700 PR REPAIR CLEFT LIP/NASAL,UNILAT 2897.0040701 PR REPR CLEFT LIP,BILAT,1 STAGE 4285.0040702 PR REPR CLEFT LIP,BILAT,1OF2 3225.0040720 PR REPR CLEFT 3561.0040761 PR REPR CLEFT LIP/NASAL,XLIP PED 3890.00

40800 PR DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL

413.00

40801 PR DRAIN MOUTH ABSC/CYST/HEMAT,COMPLX

806.00

40806 PR INCISION OF LIP FOLD 325.0040808 PR BIOPSY OF MOUTH LESION 476.0040810 PR EXCIS MOUTH MUCOSA/SUB,NO 415.0040812 PR EXCIS MOUTH

MUCOSA/SUB,SIMPL REPAIR527.00

40814 PR EXCIS MOUTH MUCOSA/SUB,COMPLX REPR

1902.00

40816 PR EXCIS MOUTH COMPLEX,EXC THRU MUSCLE

1031.00

40819 PR EXCISE LIP OR CHEEK FOLD 691.0040820 PR DESTRUC MOUTH LESION/SCAR 696.0040830 PR REPAIR MOUTH 686.0040831 PR REPAIR MOUTH 714.0040840 PR RECONSTRUC MOUTH ANTERIOR 1709.0041005 PR I&D MOUTH/TONG

INTRA,SUBLING,SUPERF588.00

41007 PR I&D MOUTH/TONG 977.0041008 PR I&D MOUTH/TONG

INTRA,SUBMANDIBULAR979.00

41010 PR INCISION OF TONGUE FOLD 512.0041015 PR I&D MOUTH/TONG 1171.0041017 PR I&D MOUTH/TONG 114441100 PR BIOPSY TONGUE,ANTER 2/3 383.0041105 PR BIOPSY TONGUE,POSTER 1/3 352.0041108 PR BIOPSY OF FLOOR OF MOUTH 302.0041110 PR EXCIS TONGUE LESN 434.0041112 PR EXCIS TONGUE LESN,ANT 686.0041113 PR EXCIS TONGUE LESN,POST 1/3 949.0041115 PR EXCIS TONGUE FOLD 628.0041116 PR EXCIS FLOOR MOUTH LESION 836.0041120 PR PART REMOVAL TONGUE,<1/2 3212.0041130 PR PART REMOVAL TONGUE, 1/2 4769.0041135 PR PART EXC TONGUE,UNILAT RAD 7415.0041140 PR REMOVAL OF TONGUE 9029.0041145 PR EXCIS TONGUE,UNILAT RAD 9540.0041150 PR EXCIS TONGUE,MOUTH,JAW 7569.0041153 PR EXCIS TONGUE,MOUTH,NECK 4344.0041155 PR EXCIS TONGUE,MOUTH,JAW,RAD 5536.00

41250 PR REPAIR TONGUE LACER,<2.6CM 675.0041252 PR REPAIR TONGUE

LACER,2.6CM+/COMPLX708.00

41500 PR FIXATION OF 1153.0041800 PR DRAINAGE OF GUM LESION 682.0041822 PR EXCIS FIBROUS 800.0041823 PR EXCIS OSSEOUS 833.0041827 PR EXCIS DENTOALV LESN,COMPLX 2007.0041828 PR EXCISION OF GUM LESION 790.0041830 PR REMOVAL OF GUM TISSUE 800.0041870 PR GUM GRAFT 775.0041874 PR REPAIR TOOTH SOCKET 980.0041899 PR DENTAL SURGERY PROCEDURE 190.0042000 PR DRAINAGE ABSCESS 496.0042100 PR BIOPSY PALATE/UVULA 315.0042104 PR EXCIS LESN,PALATE/UVULA 469.0042106 PR EXCIS LESN,PALATE/UVULA- 69942120 PR REMOVE PALATE/LESION 2925.0042140 PR EXCISION OF UVULA 518.0042145 PR PALATOPHAYNGOPLASTY 2128.0042160 PR DESTRUC LESN PALATE/UVULA 60042182 PR REPAIR PALATE LACER 2+CM OR

COMPLX826.00

42200 PR RECONST CLEFT 3003.0042205 PR RECONST CLEFT PALATE,CLOS

ALVE RDG3570.00

42210 PR RECONST CLEFT PALATE,BONE 4020.0042215 PR RECONST CLEFT PALATE,MAJOR 1854.0042220 PR RECONST CLEFT 1350.0042225 PR RECONST CLEFT 3050.0042226 PR LENGTHENING PALATE+PHARY 3142.0042235 PR REPAIR ANTER PALATE W 1840.0042281 PR INSERTION, PALATE 428.0042300 PR DRAIN ABSCESS 441.0042305 PR DRAIN ABSCESS 1114.0042330 PR REMOVAL SALIVARY 492.0042335 PR REMOVAL SUBMAND

STONE,COMPLICATED714.00

42400 PR BIOPSY SALIVARY 269.0042405 PR BIOPSY SALIVARY 687.0042408 PR EXCISION SUBLING SALIVARY 963.0042409 PR DRAINAGE SUBLING SALIVARY 847.00

42410 PR EXC PAROTD LESN,LATER LOBE 1985.0042415 PR EXC PAROTD,LAT LOBE,DISSECT

5TH NERV3801.00

42420 PR EXC PAROTD,TOTAL,DISSECT 3528.0042425 PR EXC PAROTD,TOTAL,SACRIFICE

5TH NERV2556.00

42426 PR EXC PAROTD,TOTAL,UNILAT RAD 4851.0042440 PR EXCISION SUBMAXILLARY GLAND 1473.0042450 PR EXCISION SUBLINGUAL GLAND 1216.0042500 PR REPAIR SALIVARY DUCT SIMPLE 1103.0042650 PR DILATION OF SALIVARY DUCT 285.0042700 PR INC/DRAIN PERITONSIL ABSCESS 47842720 PR INC/DRAIN RETROPHARYNG

ABSCESS,ORAL1153.00

42725 PR INC/DRAIN RETROPHARYNG ABSCESS,EXT

2476.00

42800 PR BIOPSY OROPHARYNX 397.0042804 PR BIOPSY NASOPHARYNX,SIMPLE 495.0042808 PR EXCISE PHARYNX LESION 687.0042809 PR REMOVE PHARYNX FOREIGN 911.0042810 PR EXCISION BRACH CLFT

CYST,SUPERFICIAL804.00

42815 PR EXCISION BRANC CLFT 1474.0042820 REMOVE TONSILS/ADENOIDS,<12 645.0042821 PR REMOVE TONSILS/ADENOIDS,12+ 744.0042825 REMOVAL OF TONSILS,<12 Y/O 645.0042826 PR REMOVAL OF TONSILS,12+ Y/O 744.0042830 REMOVAL ADENOIDS,PRIMARY,<12 528.0042831 PR REMOVAL 490.0042835 REMOVAL ADENOIDS,SECOND,<12 423.0042836 PR REMOVAL 537.0042842 PR RAD RESEC TONSIL/PILLARS 360542844 PR RAD RESEC

TONSIL/PILLARS,CLOS LOCAL5010.00

42845 PR RAD RESEC 4316.0042870 PR EXCISION OF LINGUAL TONSIL 1256.0042890 PR PARTIAL REMOVAL OF PHARYNX 2776.0042894 PR RESEC PHARYN WALL,CLOS

MYOCUT FLAP5774.00

42950 PR RECONSTRUCTION OF THROAT 208042953 PR REPAIR THROAT, ESOPHAGUS 2229.0042960 PR CONTROL THROAT 401.00

42961 PR CONTROL THROAT BLEED,COMPL IN HOSP

1076.00

42962 PR CONTROL THROAT BLEED,SURG INTERVENTN

1203.00

42972 PR CNTRL NASOPHARYNG BLEED,SURGERY

1318.00

42999 PR THROAT SURGERY PROCEDURE UNLISTED

3784.00

43030 PR CRICOPHAYNGEAL MYOTOMY 1763.0043101 PR EXCIS ESOPHAGUS LESN,THOR

APPROACH3215.00

43107 PR REMOVAL ESOPHAGUS,NO THORACOTOMY

8521.00

43112 PR TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY

9258.00

43117 PR PART REMOV 9157.0043123 PR PART RMV ESOPH,THORACOABD

APP,W/COL INT15000.00

43124 PR REMOVAL OF ESOPHAGUS,NO RECONSTRUC

15528.00

43130 PR REMOV ESOPHAG DIVERTIC,CERV APPRCH

2674.00

43135 PR REMOV ESOPHAG DIVERTIC,THOR APPRCH

6040.00

43180 PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH

1321.00

43191 PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH

890.00

43192 PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL

435.00

43193 PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY

441

43194 PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN

495.00

43197 PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC

475.00

43200 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC

697.00

43201 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ

722.00

43202 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY

849.00

43205 PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES

760.00

43206 PR ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY

713.00

43212 PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT

485.00

43213 PR ESOPHAGOSCOPY RETROGRADE DILATE

2919.00

43214 PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM

499.00

43215 PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY

403.00

43217 PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE

1125.00

43220 PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM

470.00

43226 PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION

926.00

43229 PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION

1761

43231 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM

675.00

43232 PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE

647.00

43233 PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER

600.00

43235 PR ESOPHAGOGASTRODUODENOSCOP

725.00


969.00


582.00

43238 PR EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS

725.00

43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE

856.00

43240 PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST

995.00

43241 PR EGD INTRALUMINAL TUBE/CATHETER INSERTION

565.00

43242 PR EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY

1045.00

43243 PR EGD INJECTION SCLEROSIS ESOPHGL/GASTRIC VARICES

970.00

43244 PR EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES

920.00

43245 PR EGD DILATION GASTRIC/DUODENAL STRICTURE

729.00

43246 PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE

729.00

43247 PR EGD FLEXIBLE FOREIGN BODY REMOVAL

725.00

43248 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS

680.00

43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM

429.00

43250 PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS

465.00

43251 PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH

795.00

43252 PR EGD FLEX TRANSORAL W/OPTICAL ENDOMICROSCOPY

900.00

43253 PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER

683.00

43254 PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION

709.00

43255 PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD

925.00

43259 PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM

825.00

43260 PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING

1050.00

43261 PR ERCP W/BIOPSY 1150.0043262 PR ERCP

W/SPHINCTEROTOMY/PAPILLOTOMY1440.00

43264 PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT

1650.00

43265 PR ERCP DESTRUCTION/LITHOTRIPSY

1550.00

43266 PR EGD ENDOSCOPIC STENT PLACEMENT W/WIRE& DILATION

587.00

43270 PR EGD ABLATE TUMOR POLYP/LESION W/DILATION& WIRE

1802.00

43273 PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC

316.00

43274 PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT

1791.00

43275 PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT

1002.00

43276 PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE

1264.00

43277 PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA

1008.00

43278 PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE

1146.00

43279 PR LAP, ESOPHAGOMYOTOMY W FUNDOPLASTY

3195.00

43280 PR LAP,ESOPHAGOGAST 3289.0043281 PR LAP, REPAIR PARAESOPHAGEAL

HERNIA, INCL FUNDOPLASTY W/O 4505.00

43282 PR LAP, REPAIR PARAESOPHAGEAL HERNIA, INCL FUNDOPLASTY W/

4605.00

43283 PR LAP ESOPHAGEAL 403.0043284 PR LAPS ESOPHGL SPHNCTR

AGMNTJ PLMT DEV CRRPL1686.00

43285 PR REMOVAL ESOPHAGEAL SPHINCTER AGMNTJ DEVICE

1706.00

43286 PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ

13109.00

43287 PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ

14972.00

43288 PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ

15622.00

43300 PR ESOPHAGOPLASTY,CERV 2735.0043305 PR REPAIR TRACHEOESOPHAGEAL 2728.0043310 PR ESOPHAGOPLASTY,THORACIC 6055.0043312 PR REPAIR TRACHEOESOPHAGEAL 6563.0043314 PR ESOPHAGOPLASTY CON

DEF,W/REPAIR TE FIST10954.00

43325 PR ESOPHAGOGASTRIC FUNDOPLASTY+PATCH

2832.00

43327 PR ESOPHAGOGASTRIC FUNDOPLASTY PARTIAL OR

2028.00

43328 PR ESOPHAGOGASTRIC FUNDOPLASTY PARTIAL OR

4016.00

43330 PR ESOPHAGOMYOTOMY,ABD 3757.0043331 PR ESOPHAGOMYOTOMY,THORACIC

APPRCH5475

43332 PR REPAIR PARAESOPHAGEAL HIATAL HERNIA,LAPAROTOMY, WO

2903.00

43333 PR REPAIR PARAESOPHAGEAL HIATAL HERNIA,LAPAROTOMY, W

3153.00

43334 PR REPAIR PARAESOPHAGEAL HIATAL HERNIA,THORACOTOMY, WO

3185.00

43335 PR REPAIR PARAESOPHAGEAL HIATAL HERNIA,THORACOTOMY, W

5471.00

43336 PR REPAIR PARAESOPHAGEAL HIATAL

6142.00

43338 PR ESOPHAGUS LENGTHENING 334.0043351 PR SURG

OPENING,ESOPHAGUS,THOR 2877.00

43352 PR SURG OPENING,ESOPHAGUS,CERV

3813.00

43361 PR GI RECON,PRIOR ESOPHAGECT,W/COLON INTERP

11004.00

43400 PR LIGATE ESOPHAGUS VARICES 6219.0043410 PR SUTURE ESOPHAGUS

WOUND,CERV APPRCH1801.00

43415 PR SUTURE ESOPHAGUS WOUND,THOR APPRCH

10547.00

43420 PR REPAIR ESOPHAGUS OPENING,CERV APPRCH

3006.00

43450 PR DILATE ESOPHAGUS 361.0043453 PR DILATION ESOPHAGUS GUIDE 738.0043500 PR SURGICAL OPENING OF 2798.0043520 PR INCISION OF PYLORIC MUSCLE 1470.0043605 PR BIOPSY OF STOMACH,BY 2952.0043610 PR EXCIS STOMACH 2731.0043611 PR EXCIS STOAMCH MALIG 3307.0043621 PR REMOVAL STOMACH,ROUX-EN-Y 6401.0043622 PR REMOVAL STOMACH,FORM

INTEST POUCH9450.00

43631 PR REMV STOMACH,PART,DISTAL,GASTRODU

4721.00

43632 PR REMV STOMACH,PART,DISTAL,GASTROJEJ

4724.00

43633 PR REMV STOMACH,PART,DISTAL,ROUX-EN-Y

7818.00

43640 PR 3162.0043641 PR VAGOTOMY/PYLOROPLASTY,HI 429943644 PR LAP GASTRIC BYPASS/ROUX-EN- 6702.0043653 PR LAP,GASTROSTOMY,W/O TUBE 1455.0043752 PR PLACEMENT NG/OG TUBE BY 93.0043753 PR GASTRIC

INTUBATION/ASPIRATION, 56.00

43756 PR DUODENAL INTUBATION/ASPIRATION,

510.00

43757 PR DUODENAL INTUBATION/ASPIRATION,

781.00

43760 CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

1137.00

43761 PR REPOSITION GASTRIC FEEDING TUBE THRU DUODENUM

278.00

43771 LAP, REVISE ADJUST GAST RESTRICT DEVICE

2332.00

43772 LAP, REMOVE ADJUST GAST RESTRICT DEVICE

2566.00

43774 LAP, REMOVE ADJUST GAST RESTRICT DEVICE/PORT

2360.00

43775 PR LAP, GAST RESTRICT PROC, LONGITUDINAL GASTRECTOMY

4151.00

43800 PR RECONSTRUCTION OF PYLORUS 2581.0043820 PR GASTROJEJUNOSTOMY 3412.0043830 PR GASTROSTOMY,OPEN,W/O TUBE 1444.0043831 PR PLACE GASTROSTOMY 1517.0043840 PR REPAIR PERF DUOD/GAST ULC- 555043846 PR GASTRIC BYPASS,OBESE<150CM

ROUX-EN-Y6608.00

43848 REVISION GASTROPLASTY,OBESITY, NON-GAST RESTRICT DEVICE

7859.00

43860 PR REVISE,GASTROJEJUN ANAST,W/O VAGOTOMY

5191.00

43870 PR CLOSURE OF 1475.0043880 PR CLOSURE GASTROCOLIC 5184.0043886 PR REVISE GASTRIC PORT, OPEN 92744005 PR FREEING BOWEL

ADHESION,ENTEROLYSIS3015.00

44010 PR DUODENOTOMY FOR EXPLOR,BX,FB REMOV

3078.00

44015 PR INSERT TUBE-BOWEL,ENTERAL 442.0044020 PR ENTEROTOMY,NON-

DUOD,EXPLOR/BX/FB REMOVAL3476.00

44021 PR ENTEROTOMY DECOMPRESS SMALL BOWEL

2046.00

44025 PR INCIS COLON FOR EXPLOR,BX,FB 3466.0044050 PR REDUCE

VOLVULUS,INTUSS,INTERN HERNIA2627.00

44055 PR CORRECT MALROTATION OF 4552.0044110 PR EXCIS BOWEL LESION(S),SINGLE

ENTEROTOMY2248.00

44111 PR EXCIS BOWEL LESION(S),MULT ENTEROTOMIES

2740.00

44120 PR RESECT SMALL INTEST,SINGL RESEC/ANAS

4563.00

44121 PR RESECT SMALL INTEST,EACH 558.0044125 PR RESECT SMALL INTEST W

ENTEROSTOMY3241.00

44126 PR RESECT SM INTEST,CONG ATRESIA,W/O TAPER

10077.00

44127 PR RESECT SM INTEST,CONG ATRESIA,W/TAPER

8766.00

44130 PR BOWEL TO BOWEL 4907.0044139 PR MOBILIZE SPLENIC FLEX 302.0044140 PR PART REMOVAL COLON W

ANASTOMOSIS4421.00

44141 PR PART REMOVAL COLON W 3829.0044143 PR PART REMOVAL COLON W END

COLOSTOMY4980.00

44144 PR PART REMOVAL COLON W OSTOMY/MUCOFIST

4595.00

44145 PR PART REMOVAL COLON W COLOPROCTOSTOMY

5512.00

44146 PR PART REMOVAL COLON W COLOPROC,COLOST

5960.00

44147 PR PART REMOVAL COLON,ABD/TRANSANAL APP

7936.00

44150 PR REMOVAL COLON/ILEOSTOMY 5302.0044155 PR REMOVAL

COLON/PROCTECTOMY/ILEOSTOMY6072.00

44157 PR REMOVAL COLON/PROCTEC/ ILEOANAL ANAST

8964.00

44158 PR REMOVAL COLON/PROCTEC/ILEOANAL ANAST

7429.00

44160 PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY

3436.00

44180 PR LAP, SURG ENTEROLYSIS 1925.0044186 PR LAP, SURG JEJUNOSTOMY 1456.0044187 PR LAP, SURG ILEO/JEJUNO-STOMY 3544.0044188 PR LAP, SURG COLOSTOMY 2948.0044202 PR

LAP,SURG,ENTERECTOMY,RESECT 4612.00

44203 PR LAP,SURG,EA ADDL RESECT & 550.0044204 PR LAP,SURG,COLECTOMY,

PARTIAL, W/ANAST5228.00

44205 PR LAP,SURG,COLECTOMY,W/REMVL

4635.00

44206 PR LAP,SURG,COLECTOMY,W/END COLOST & CLOSUR

5606.00

44207 PR 7447.0044208 PR

LAP,SURG,COLECTOMY,W/ANAST,W/COLOSTOMY

6647.00

44210 PR LAP,SURG,COLECTOMY,TOTAL,W/O

5876.00

44211 PR LAP,SURG,COLECTOMY,TOTAL,W/PROCTECTOMY

8930.00

44212 PR LAP,SURG,COLECT,TOT,W/PROCTECT,W/ILEOST

6826.00

44213 PR LAP, SURG MOBIL SPLENIC FL DUR PTL COLECTOMY

414.00

44227 PR LAP, SURG CLOSE ENTEROSTOMY RESECT ANAST

6808.00

44300 PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE

2271.00

44310 PR 2924.0044312 PR REVISION OF 1513.0044314 PR REVISION OF 2781.0044320 PR COLOSTOMY 3263.0044322 PR COLOSTOMY,W/MULTIPLE 3581.00

44340 PR REVISION OF 1272.0044345 PR REVISION OF

COLOSTOMY,COMPLICATED2875.00

44346 PR REVIS COLOSTOMY,REPR PARACOLO HERNIA

3140.00

44360 PR ENDOSCOPY UPPER SMALL 590.0044361 PR ENDOSCOPY UPPER SMALL

INTESTINE W/BIOPSY660.00

44364 PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE

550.00

44366 PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING

960.00

44369 PR ENTEROSCOPY > 2ND PRTN ABLTJ LESION

1030.00

44372 PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE

975.00

44373 PR ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE

800.00

44376 PR ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX

850.00

44377 PR ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE

793.00

44378 PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING

1018.00

44379 PR ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT

1080.00

44380 PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD

536.00

44381 PR ILEOSCOPY STOMA W/BALLOON DILATION

464.00

44382 PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE

776.00

44384 PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT

587.00

44385 PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX

667.00

44386 PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE

849.00

44388 PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX

858.00

44389 PR COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE

971.00

44390 PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY

1114.00

44391 PR COLONOSCOPY STOMA CONTROL BLEEDING

1862.00

44392 PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS

1058.00

44394 PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE

1074.00

44401 PR COLONOSCOPY STOMA ABLATION LESION

1156.00

44403 PR COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ

788.00

44404 PR COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION

1000.00

44405 PR COLONOSCOPY STOMA W/BALLOON DILATION

1491

44406 PR COLONOSCOPY STOMA W/ENDOSCOPIC ULTRASOUND

612.00

44500 PR INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE

58.00

44602 PR SUTURE SM INTEST,SINGLE 5746.0044603 PR SUTURE SM INTEST,MULTPL 3366.0044604 PR SUTURE LRG INTEST 2930.0044615 PR INTESTINAL STRICTUROPLASTY 2940.0044620 PR CLOSE ENTEROSTOMY 2275.0044625 PR CLOSE 2774.0044626 PR CLOSE

ENTEROSTOMY,RESEC+COLOREC 5251.00

44640 PR REPAIR BOWEL-SKIN FISTULA 4459.0044650 PR REPAIR BOWEL-BOWEL FISTULA 4868.0044661 PR REPR BOW-BLAD

FIST,W/INTEST/BLAD RESECT5057.00

44700 PR EXCLUSION,SMALL BOWEL FROM PELVIS

3634.00

44701 PR INTRAOPERATIVE COLONIC 382.0044705 PR PREPARE FECAL MICROBIOTA

FOR INSTILLATION310.00

44800 PR EXCISION 2158.0044820 PR EXCISION OF MESENTERY 1752.0044850 PR SUTURE OF MESENTERY 2044.0044950 PR APPENDECTOMY 1340.0044955 PR APPENDECTOMY,W OTHR PROC 300.00

44960 PR APPENDECTOMY,RUPT APPENDX+ABSCESS

2300.00

44970 PR LAP,APPENDECTOMY 1526.0045005 PR I&D RECTAL SUBMUCOSAL 577.0045020 PR DRAINAGE OF DEEP RECTAL 1156.0045100 PR BIOPSY OF RECTUM 761.0045110 PR PROCTECTOMY,AP 5947.0045112 PR PROCTECTOMY,AP RESEC,PULL- 3984.0045113 PR PROCTECTOMY,PART,ILEAL 779345119 PR PROCTECTOMY,A-P PULLTHRU

W/RESERVOIR4095.00

45120 PR PROCTECTOMY,COMPLT,PULL-THRU,ANAST

6502.00

45121 PR PROCTECTOMY,COMPL,COLECTOM

5676.00

45123 PR PROCTECTOMY,PART,NO ANAST,PERINEAL

3032.00

45126 PR PELVIC EXENTERATION 9764.0045130 PR EXCIS RECTAL 2992.0045160 PR EXCIS RECTAL LESION 2095.0045171 PR EXCIS RECTAL TUMOR,

TRANSANAL, PARTIAL THICKNESS1501.00

45172 PR EXCIS RECTAL TUMOR, TRANSANAL, FULL THICKNESS

2886.00

45300 PR PROCTOSIGMOIDOSCOPY,RIGID,DIA

231.00

45305 PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE

443.00

45307 PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY

593.00

45309 PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ

564.00

45317 PR PROCTOSGMDSC RIGID CONTROL BLEEDING

596.00

45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD

419.00

45331 PR SIGMOIDOSCOPY,BIOPSY 643.0045332 PR SIGMOIDOSCOPY FLX W/RMVL

FOREIGN BODY755.00

45333 PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS

877.00

45334 PR SIGMOIDOSCOPY FLX CONTROL BLEEDING

550.00

45335 PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST

616.00

45337 PR SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE

490.00

45338 PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ

788.00

45340 PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT

1108.00

45341 PR SIGMOIDOSCOPY FLX NDSC US 585.0045342 PR SIGMOIDOSCOPY FLX TNDSC US

GID NDL ASPIR/BX675.00

45346 PR SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES

443.00

45347 PR SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC

443.00

45349 PR SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION

443.00

45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD

961.00

45379 PR COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S)

1226.00

45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE

1149.00

45381 PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST

1119.00

45382 PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD

1926.00

45384 PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS

1136.00

45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ

1294.00

45386 PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON

1743.00

45388 PR COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES

443.00

45389 PR COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT

837.00

45390 PR COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL

864.00

45391 PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX

730.00

45392 PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL

875.00

45393 PR COLONOSCOPY FLEXIBLE WITH DECOMPRESSION

1071.00

45395 PR LAP, SURG PROCTECTOMY W COLOSTOMY

4898.00

45397 PR LAP, SURG PROCTECTOMY W J- 8800.0045398 PR COLONOSCOPY FLEXIBLE WITH

BAND LIGATION(S)1785

45400 PR LAP, SURG PROCTOPEXY 4027.0045500 PR REPAIR OF RECTUM,STENOSIS 1067.0045505 PR REPAIR OF RECTUM,PROLAPSE

MUCOSA1506.00

45540 PR FIX RECTAL PROLAPSE,ABD 3908.0045550 PR REPAIR RECTUM; REMOVE 4847.0045562 PR EXPLOR/REPAIR RECTUM 2327.0045563 PR EXPLOR/REPAIR

RECTUM,INJ,COLOSTOMY5038.00

45800 PR CLOSE RECTUM-BLADDER 5089.0045905 PR DILATION ANAL SPHINCTER W 1203.0045910 PR DILATION RECTAL STRICTURE W 1629.0045915 PR REMV RECTAL

OBSTR:FECES/F.B. W ANEST693.00

45990 PR SURG DIAGNOSTIC EXAM, 275.0046020 PR PLACEMENT,SETON 698.0046030 PR REMOVAL OF RECTAL MARKER 351.0046040 PR I&D PERIRECTAL ABSCESS 1028.0046050 PR I&D PERIANAL 499.0046060 PR I&D RECTAL ABSCESS + 1209.0046080 PR ANAL SPHINCTEROTOMY 547.0046083 PR INCISE EXTERNAL HEMORRHOID 413.0046200 PR REMOVAL OF ANAL FISSURE 816.0046220 PR EXCISION SINGLE EXTERNAL

PAPILLA OR TAG ANUS390.00

46221 PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS

511.00

46230 PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS

610.00

46250 PR HEMORRHOIDECTOMY,EXTERNAL,

1167.00

46255 PR HEMORRHOIDECTOMY,INT/EXT,1 COLUMN/GROUP

1277.00

46260 PR HEMORRHOIDECTOMY,INT/EXT, 2+ COLUMNS/GROUPS

1095.00

46270 PR REMOVAL ANAL FISTULA,SUBCUTANEOUS

1281.00

46275 PR REMOVAL ANAL FISTULA,INTERSPNINCTERIC

1359.00

46280 PR REMOVAL ANAL FISTULA,TRANS/SUPRA/EXTRAPHINCT, +/-SETON

1200

46285 PR REMOVAL ANAL FISTULA,SECOND STAGE

1351.00

46288 PR REPAIR ANAL FISTULA,RECT 1398.0046320 PR EXCISION THROMBOSED

HEMORRHOID, EXTERNAL485.00

46505 PR CHEMODENERVATION ANAL 700.0046600 PR ANOSCOPY DX W/COLLJ SPEC

BR/WA SPX WHEN PRFRMD217.00

46601 PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT

346.00

46604 PR ANOSCOPY,W/DILATION 1561.0046606 PR ANOSCOPY AND BIOPSY 569.0046607 PR ANOSCOPY DX W/HRA &CHEM

AGNTS ENHANCEMENT W/BX486.00

46611 PR ANOSCOPY,REMOVE 409.0046614 PR 331.0046615 PR ANOSCOPY,ABLATE LESION 367.0046715 PR REPR LO IMPERF ANUS W 1051.0046716 PR REPR LO IMPERF ANUS W 2884.0046730 PR REPR HI IMPERF ANUS 7436.0046740 PR REPR HI IMPERF ANUS,W 6221.0046750 PR REPAIR OF ANAL 2075.0046900 PR DESTRUCT,ANAL 607.0046910 PR ELECTRODESSICATN,ANAL 647.0046916 PR CRYOSURGERY, ANAL LESION(S) 580.0046917 PR LASER SURGERY, ANAL 1115.0046922 PR SURG EXCISION OF ANAL 509.0046924 PR DESTRUCTION,ANAL

LESION(S),EXTENSIVE1342.00

46945 PR HEMORRHOIDECTOMY, INT, LIGATION NOT RUBBER BAND,

687.00

46946 PR HEMORRHOIDECTOMY, INT, LIGATION NOT RUBBER BAND, 2+

791.00

47000 PR BIOPSY LIVER NEEDLE 884.0047000 PR BIOPSY LIVER NEEDLE 26 537.0047001 PR NEEDLE BIOPSY LIVER,W OTHR 295.0047010 PR DRAINAGE OF LIVER LESION, 3237.0047015 PR INJECT/ASPIRATE LIVER 4155.0047100 PR WEDGE BIOPSY OF LIVER 2288.0047120 PR RESEC LIVER,PART LOBECTOMY 8227.0047122 PR RESEC 11481.0047125 PR RESEC LIVER,TOTAL LT 6750.0047130 PR RESEC LIVER,TOTAL RT 11138.0047133 PR REMOVAL OF DONOR LIVER 5566.0047135 PR TRANSPLANT 19900.0047142 PR PARTIAL REMOVAL, DONOR

LIVER, RIGHT LOBE14000.00

47143 PR TRANSPLANT,PREP DONOR LIVER, WHOLE

13092.00

47144 PR TRANSPLANT,PREP DONOR LIVER, 3-SEGMENT

12523.00

47145 PR TRANSPLANT,PREP DONOR LIVER, LOBE SPLIT

11730.00

47146 PR TRANSPLANT,PREP DONOR LIVER/VENOUS

702.00

47147 PR TRANSPLANT,PREP DONOR LIVER/ARTERIAL

819.00

47300 PR MARSUPIALIZE LIVER 4029.0047350 PR REPAIR BLEED LIVER/SUTURE 3671.0047360 PR REPR BLEED LIVER/COMPLX

SUTURE WND5750.00

47361 PR EXPLOR LIVER WOUND,EXTENSIV DEBRIDE

9752.00

47362 PR RE-EXPLORE LIVER WOUND,REMV PACKING

3576.00

47370 PR LAP,ABLAT 1+ LIVER TUMOR(S),RADIOFREQ

3723.00

47380 PR ABLAT,OPEN,1+ LIVER TUMOR(S),RADIOFREQ

4912.00

47382 PR ABLTJ 1/> LVR TUM PRQ RF 2613.0047383 PR ABLATION 1/> LIVER TUMOR

PERQ CRYOABLATION18361.00

47400 PR INCISION OF LIVER 8649.00

47420 PR INCIS BILE DUCT/EXPL,DRAIN,REMV CALC

3733.00

47490 PR CHOLECYSTOSTOMY,PERCUTANEO

1184.00

47525 PR CHANGE PERCUT BILE DUCT 1812.0047531 PR NJX CHOLANGIO PRQ W/IMG GID

RS&I EXISTING ACCESS946.00

47532 PR NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS

2014.00

47533 PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL

3394.00

47534 PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT

4183.00

47535 PR CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH

2805.00

47536 PR EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I

2070.00

47537 PR REMOVAL BILIARY DRG CATHETER REQ FLUOR GID RS&I

1024.00

47538 PR PLMT BILE DUCT STENT PRQ EXISTING ACCESS

3500.00

47540 PR PLMT BILE DUCT STENT PRQ NEW ACCESS W/SEP CATH

4400.00

47542 PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT

1312.00

47543 PR ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT

3374.00

47544 PR REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I

2061.00

47550 PR BILE DUCT ENDOSCOPY,INTRAOPERATIVE

377.00

47552 PR BILIARY ENDO PRQ T-TUBE DX W/COLLECT SPEC BRUSH

775.00

47555 PR BILIARY ENDOSCOPY PERCUT,DIL STRICT

882.00

47562 PR LAP,CHOLECYSTECTOMY 2083.0047563 PR LAP,CHOLECYSTECTOMY/GRAPH 2310.0047564 PR 2540.0047600 PR REMOVAL GALLBLADDER 2601.0047605 PR REMV GALLBLADDER W

CHOLANGIOGRAM2791.00

47610 PR REMV GALLBLADDER,EXPLOR COMMON DUCT

3525.00

47612 PR REMV GB,W CHOLEDOCHOENTEROSTOMY

5153.00

47701 PR BILE DUCT REVISION 708547711 PR EXCIS BILE DUCT

TUMOR,EXTRAHEPATIC5001.00

47712 PR EXCIS BILE DUCT 6456.0047715 PR EXCISION CHOLEDOCHAL CYST 3541.0047720 PR CHOLECYSTOENTEROSTOMY 412447760 PR ANAST EXTRAHEP DUCT TO GI 5552.0047765 PR ANAST INTRAHEP DUCT TO GI 1241347780 PR ANAST,ROUX-EN-Y,EXTRAHEP

TO GI TRCT5684.00

47785 PR ANAST,ROUX-EN-Y,INTRAHEP TO GI TRCT

7914.00

47800 PR RECONSTR EXTRAHEP 6413.0047999 PR BILE TRACT SURG PROC, 615.0048020 PR REMOVAL OF PANCREATIC 2439.0048100 PR BIOPSY,PANCREAS,OPEN 2444.0048102 PR NEEDLE BIOPSY OF PANCREAS 1147.0048105 PR RESECT/DEBRIDE ACUTE

NECROT PANCREAS9512.00

48120 PR EXCISION OF PANCREAS LESION 3938.0048140 PR PART REMV PANCREAS,DISTAL

SUBTOTAL4928.00

48145 PR PART REMV PANC,DIST+ANAST PANC-JEJU

22550.00

48150 PR PART REMV PANC,PROX+REMV DUOD+ANAST

10227.00

48153 PR PART REMV PANC,PROX+PART DUOD+ANAST

10236.00

48154 PR PART REMV PANC,PROX+PART REMV DUOD

7467.00

48155 PR REMOVAL OF PANCREAS, TOTAL 5669.0048160 PR

PANCREATECTOMY,W/AUTOLOGOU8226.00

48510 PR EXTERN DRAIN PANC PSEUDOCYST,OPEN

3924

48545 PR PANCREATORRHAPHY,INJURY 5464.0048548 PR ANAST PANCREAS- 5747.0048550 PR DONOR PANCREATECTOMY 5251.00

48551 PR TRANSPLANT,PREP DONOR 9655.0048554 PR TRANSPLANT ALLOGRAFT 6838.0048556 PR REMOVAL ALLOGRAFT 4555.0049000 PR EXPLORATORY OF ABDOMEN 2287.0049002 PR REOPEN RECENT ABD 2551.0049010 PR EXPLORATORY 2471.0049020 PR DRAIN ABD ABSCESS OPEN 4978.0049040 PR DRAIN SUBDIAPH/SUBPHR

ABSCESS,OPEN3554.00

49060 PR DRAIN RETROPERITONEAL ABSCESS,OPEN

3216.00

49062 PR DRAIN LYMPH-PERITONEAL CAVITY,OPEN

2363.00

49082 PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE

400.00

49083 PR ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE

754.00

49084 PR PERITONEAL LAVAGE W/WO IMAGING GUIDANCE

279.00

49180 PR PERCUT BIOPSY, ABDOMINAL 412.0049185 PR SCLEROTHERAPY FLUID

COLLECTION PRQ W/IMG GID2527.00

49203 PR EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5 CM

4891

49204 PR EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5.1-10.0 CM

6261

49205 PR EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM

4353.00

49215 PR EXCISE PRESACRAL/SACRAL 7067.0049250 PR EXCISION OF UMBILICUS 1232.0049255 PR REMOVAL OF OMENTUM 2300.0049320 PR LAP,DIAGNOSTIC ABDOMEN 744.0049321 PR LAP,DX SURGICAL ABD 1015.0049322 PR LAP,ABDOMEN,ASPIRATE CYST 1400.0049323 PR LAP,ABDOMEN,DRAIN 227649324 PR LAP INSERTION TUNNELED

INTRAPERITONEAL CATHETER912.00

49325 PR LAP REVISE INTRAPERITONEAL CATHETER

992.00

49326 PR LAP OMENTOPEXY ADD-ON 412.0049400 PR AIR/CONTRAST INJECT INTO 426.0049402 PR REMOVE PERITONEAL FOREIGN 2838.00

49405 PR IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ

2173.00

49406 PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ

497.00

49407 PR IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL

1836.00

49418 PR INSJ INTRAPERITONEAL CATHETER W/IMG GUID

3707.00

49419 PR INSERTION TUNNEL INTRAPERITONEAL CATH W SUBQ

957.00

49421 PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN

877.00

49422 PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER

960.00

49423 PR DRAINAGE CATHETER 1349.0049424 PR CONTRAST INJ,ABSCESS/CYST

VIA CATH TUBE380.00

49435 PR INSERT SUBQ EXTENSION INTRAPERITONEAL CATH

310.00

49440 PR INSERT GASTROSTOMY TUBE PERCUTANEOUS

2041.00

49441 PR INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ

2416.00

49442 PR INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS

2440

49446 PR CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ

2131.00

49450 PR REPLACE GASTROSTOMY/CECOSTOMY TUBE

1401.00

49451 PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS

1487.00

49452 PR REPLACEMENT GASTRO-JEJUNOSTOMY TUBE

2257.00

49460 PR OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE

1482.00

49465 PR CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE

312.00

49491 REPAIR ING HERNIA,PRETERM INFANT,REDUC

2146.00

49495 REPAIR ING HERNIA,FULL/PRETERM INF,REDUC

1046

49496 REPAIR ING HERNIA,<6MO,STRANG 1577.0049500 REPAIR ING HERNIA,6MO- 1181.0049501 PR REPAIR ING HERNIA,6MO- 1489.0049505 PR REPAIR ING 1320.0049507 PR REPAIR ING 2090.0049520 PR REPAIR RECURR INGUIN

HERN,REDUCIBL1371.00

49521 PR REPAIR RECURR INGUIN 2269.0049525 PR REPAIR SLIDING INGUINAL 1340.0049550 PR REPAIR FEMORAL 1348.0049553 PR REPAIR FEMORAL 1310.0049560 PR REPAIR INCISIONAL 2249.0049561 PR REPAIR INCISIONAL 2673.0049565 PR REPAIR RECURR INCIS 2268.0049566 PR REPAIR RECURR INCIS 2701.0049568 PR IMPLANT MESH HERNIA

REPAIR/DEBRIDEMENT CLOSURE626.00

49570 PR REPAIR EPIGASTRIC 1050.0049572 PR REPAIR EPIGASTRIC 1054.0049580 REPAIR UMBILICAL 832.0049585 REPAIR UMBILICAL 1173.0049587 REPAIR UMBILICAL 1077.0049590 PR REPAIR SPIEGELIAN HERNIA 1225.0049600 PR REPAIR SMALL OMPHALOCELE 2607.0049605 PR REPAIR LARGE OMPHALOCELE 10497.0049606 PR REPAIR LARGE 3593.0049610 PR REPAIR OMPHALOCELE,FIRST 2453.0049650 PR LAP,INGUINAL HERNIA 1048.0049651 PR LAP,INGUINAL HERNIA 1364.0049652 PR LAP, VENTRAL HERNIA

REPAIR,REDUCIBLE3349.00

49653 PR LAP, VENTRAL HERNIA REPAIR,INCARCERATED

3773.00

49654 PR LAP, INCISIONAL HERNIA REPAIR,REDUCIBLE

3349.00

49655 PR LAP, INCISIONAL HERNIA REPAIR,INCARCERATED

3773.00

49656 PR LAP, RECURRENT INCISIONAL HERNIA REPAIR,REDUCIBLE

3555.00

49657 PR LAP, RECURRENT INCISIONAL HERNIA REPAIR,INCARCERATED

3368.00

49900 PR SUTURE ABD WALL- 2896.0049904 PR OMENTAL FLAP,EXTRA- 5790.0049905 PR OMENTAL FLAP,INTRA- 823.0049906 PR FREE OMENTAL

FLAP,MICROVASC ANAST4247.00

50060 PR REMOVAL OF KIDNEY STONE 3439.0050080 PR PERCUT REMV KID STONE,UP TO 3486.0050081 PR PERCUT REMV KID STONE,2+ CM 5317.0050200 PR RENAL BIOPSY PRQ 1496.0050205 PR BIOPSY OF KIDNEY,OPEN EXPOS 2242.0050220 PR REMV KIDNEY,W/RIB RESECTION 3282.0050225 PR REMV KIDNEY,COMPLICATED 4861.0050230 PR REMV KIDNEY,RADICAL 5283.0050234 PR REMV KIDNEY/URETER,SAME 5272.0050236 PR REMV KIDNEY/URETER,SEPAR 6017.0050240 PR PARTIAL REMOVAL OF KIDNEY 5404.0050280 PR EXCIS/UNROOF RENAL CYST 3428.0050300 PR RMV,DONOR KIDNEY,CADAVER 2359.0050320 PR RMV,KIDNEY,DONOR,LIVING 4760.0050323 PR TRANSPLANT,PREP CADAVER

RENAL GRAFT10839.00

50325 PR TRANSPLANT,PREP LIVING RENAL GRAFT

11614.00

50327 PR TRANSPLANT,PREP RENAL GRAFT/VENOUS

468.00

50328 PR TRANSPLANT,PREP RENAL GRAFT/ARTERIAL

410.18

50329 PR TRANSPLANT,PREP RENAL GRAFT/URETERAL

460.00

50340 PR REMOVAL OF RECIPIENT KIDNEY 2709.0050360 PR TRANSPLANTATION OF KIDNEY 7189.0050365 PR TRANSPLANT KIDNEY+RECIP 11669.0050370 PR REMOVE TRANSPLANTED 2963.0050380 PR REIMPLANTATION OF KIDNEY 7809.0050382 PR RMVL & RPLCMT INTLY

DWELLING URETERAL STENT PRQ2952.00

50384 PR REMOVAL INDWELLING URETERAL STENT PRQ

2306.00

50387 PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH

1664.00

50389 PR REMOVE RENAL TUBE 748.0050390 PR PERCUT DRAIN/INJECT RENAL 229.0050395 PR PERCUT DILATN RENAL TRACT 430.0050396 PR MEASURE KIDNEY PRESSURE

THRU TUBE301.00

50400 PR REVISION RENAL PELVIS,SIMPLE 3621.0050405 PR REVISION RENAL 5764.0050430 PR NJX PX ANTEGRDE NFROSGRM

&/URTRGRM NEW ACCESS1323.00

50431 PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS

411.00

50432 PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I

2144.00

50433 PR PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I

2886.00

50434 PR CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ

2285.00

50435 PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I

1199.00

50500 PR REPAIR OF KIDNEY WOUND 524950520 PR CLOSE KIDNEY-SKIN FISTULA 3689.0050541 PR LAP,ABLATION OF RENAL CYSTS 3246.0050543 PR LAP,PARTIAL NEPHRECTOMY 4926.0050544 PR LAP,PYELOPLASTY 5037.0050545 PR LAP, RADICAL NEPHRECTOMY 5418.0050546 PR NEPHRECTOMY 4392.0050547 PR LAP,DONOR KIDNEY 5331.0050548 PR NEPHRECTOMY, W/PART. 5155.0050551 PR RENAL ENDOSCOPY 884.0050553 PR RENAL ENDOSCOPY,CATH 1065.0050555 PR RENAL ENDOSCOPY,BIOPSY 1060.0050557 PR RENAL ENDOSCOPY,TREATMENT 1069.0050561 PR RENAL ENDOSCOPY,REMV 3344.0050562 PR RENAL 1808.0050574 PR RENAL SCOPE,BIOPSY 901.0050575 PR RENAL 3509.0050590 PR FRAGMENT KIDNEY STONE/ 3250.0050592 PR ABLTJ 1/> RENAL TUMOR PRQ

UNI RADIOFREQUENCY1200.00

50593 PR ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY

1600.00

50605 PR URETEROTOMY TO INSERT 3299.00

50650 PR REMOVAL URETER,BLADDER 3726.0050660 PR REMOVAL 470150684 PR INJECT INDWELL CATH,URETER 468.0050686 PR MEASURE URETER

PRESS,INDWELL CATH391.00

50688 PR CHANGE OF URETEROSTOMY TUBE VIA ILEAL CONDUIT

238.00

50690 PR INJECT RETROGRADE/CONDUIT 404.0050693 PR PLMT URTRL STENT PRQ PRE-

EXISTING NFROS TRACT2686.00

50694 PR PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH

2958.00

50695 PR PLMT URTRL STENT PRQ NEW ACCESS W/SEP NFROS CATH

3580.00

50706 PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I

1942.00

50715 PR RELEASE URETER,RETROPER 3508.0050727 PR REVISE URINARY-CUTAN ANAST 2500.0050728 PR REVISE URINARY-CUTAN 1683.0050740 PR ANASTOMOSE URETER/RENAL 3527.0050760 PR ANASTOMSIS OF URETER 3623.0050780 PR REIMPLANT URETER,SINGLE 3500.0050782 PR REIMPLANT

URETER,DUPLICATED URETER4238.00

50783 PR REIMPLANT URETER,EXTENSIVE TAILORING

4636.00

50785 PR REIMPLANT URETER,VESICOPSOAS HITCH

4907.00

50815 PR URETEROCOLON CONDUIT,W/BOWEL ANASTOMOSIS

5014.00

50820 PR URETEROILEAL CONDUIT,W/BOWEL ANASTOMOSIS

5351.00

50825 PR CONTINENT DIVERSION,W/BOWEL

7150.00

50830 PR URINARY UN-DIVERSION 7436.0050845 PR APPENDICO-VESICOSTOMY 4830.0050860 PR TRANSPLANT URETER TO SKIN 3478.0050930 PR CLOSURE URETER/BOWEL 4443.0050947 PR LAP,REIMPLANT URETER

W/CYSTO,STENT5555.00

50948 PR LAP,REIMPLANT URETER W/O CYSTO,STENT

5241

50957 PR URETER 1104.0051040 PR INCISE/DRAIN BLADDER 1507.0051050 PR OPEN BLADDER,REMV 2003.0051065 PR CYSTOTOMY,EXTRACT &/OR

FRAG URETER CALC1486

51080 PR DRAIN PERI-BLADDER ABSCESS 1050.0051101 PR ASPIRATION BLADDER

TROCAR/INTRACATHETER311.00

51102 PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER

706.00

51500 PR REMOVAL URACHAL CYST 2048.0051525 PR CYSTOTOMY,EXCIS BLADDER 3074.0051530 PR CYSTOTOMY,EXCIS BLADDER 2806.0051550 PR PART REMV BLADDER,SIMPLE 2820.0051555 PR PART REMV 5181.0051565 PR PART REMV BLADDER,REIMPLNT

URETER5317.00

51575 PR REMV BLADDER/NODES 7218.0051590 PR CYSTECTOMY,ILEAL

CONDUIT/SIGMOID BLADDER7700.00

51595 PR REMV BLADDER/NODES,ILEAL 8907.0051596 PR CYSTECTOMY,W/CONTINENT 9456.0051597 PR PELVIC EXENTERATION 9196.0051600 PR INJECTION FOR BLADDER X-RAY 493.0051610 PR INJECT FOR RETROGRADE

URETHOCYSTO408.00

51700 PR IRRIGATION OF BLADDER 216.0051701 PR INSERT,NON-INDWELLING

BLADDER CATHETER155.00

51702 PR INSERT,TEMP INDWELLING BLAD CATH,SIMPLE

204.00

51703 PR INSERT,TEMP INDWELLING BLAD CATH,COMP

353.00

51705 PR CHANGE OF BLADDER 284.0051710 PR CHANGE OF BLADDER

TUBE,COMPLICATED404.00

51715 PR ENDOSCOPIC 1029.0051720 PR INSTILL ANTICANCER AGENT IN

BLADDER285.00

51725 PR SIMPLE CYSTOMETROGRAM 26 197.0051726 PR COMPLEX CYSTOMETROGRAM 26 250.00

51728 PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES

26 690.00

51729 PR COMPLEX CYSTOMETROGRAM W/VOID PRESS&URETHRAL PROFILE

26 305.00

51741 PR ELECTRO-UROFLOWMETRY, 26 165.0051784 PR ANAL/URINARY MUSCLE STUDY 26 200.0051785 PR ANAL/URINARY MUSCLE 26 225.0051797 PR VOIDING PRESS STUDY INTRA-

ABDOMINAL VOID26 233.00

51798 PR MEAS,POST-VOID RES,US,NON- 42.0051798 PR MEAS,POST-VOID RES,US,NON- 26 48.0051800 PR REVISION OF 3740.0051860 PR REPAIR BLADDER 2661.0051865 PR REPAIR BLADDER 2958.0051880 PR CLOSE CYSTOSTOMY 1348.0051900 PR CLOSE BLADDER/VAGINA

FISTULA,ABDOM2997.00

51960 PR ENTEROCYSTOPLASTY,W/BOWEL

6378.00

51980 PR CONSTRUCT BLADDER OPENING-CUTANEOUS

3403.00

52000 PR CYSTOURETHROSCOPY 550.0052001 PR CYSTOURETHROSCOPY W/IRRIG

& EVAC CLOTS933.00

52005 PR CYSTOURETHROSCOPY,URETER CATHETER

738.00

52007 PR CYSTOURETHROSCOPY,URETERAL

1117.00

52204 PR 1251.0052214 PR 3067.0052224 PR CYSTOURETHROSCOPY,FULGUR

<.5CM LESN2903.00

52234 PR CYSTOURETHROSCOPY,FULGUR .5-2CM LESN

998.00

52235 PR CYSTOURETHROSCOPY,FULGUR 2-5CM LESN

845.00

52240 PR CYSTOURETHROSCOPY,FULGUR >5CM LESN

2263.00

52260 PR CYSTOSCOPY,DIL BLADDER,GEN ANESTH

630.00

52265 PR CYSTOSCOPY,DIL BLADDER,LOCAL ANESTH

1207.00

52270 PR CYSTOSCOPY,INTERN URETHROTOMY,FEMALE

897.00

52275 PR CYSTOSCOPY,INTERN URETHROTOMY,MALE

1528.00

52276 PR CYSTOSCOPY,DIR VIS INT URETHROTOMY

1140.00

52281 PR CYSTOSCOPY,DIL URETHRAL STRICTURE

802.00

52287 PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER

755.00

52290 PR CYSTOSCOPY,URETERAL 625.0052300 PR CYSTOSCOPY,RESECT ORTHO

URETEROCELE1340.00

52301 PR CYSTOSCOPY,RESECT ECTOPIC URETEROCEL

725.00

52310 PR CYSTOSCOPY,REMV 706.0052315 PR CYSTOSCOPY,REMV

CALCULUS,COMPLIC1114.00

52317 PR REMOVE BLADDER 2655.0052318 PR REMOVE BLADDER 2186.0052320 PR CYSTOSCOPY,REMV URETERAL 636.0052327 PR CYSTOSCOPY,INJECT IMPLNT 672.0052330 PR CYSTOSCOPY,MANIPULATN 1246.0052332 PR CYSTOSCOPY,INSERT 1231.0052334 PR CYSTOSCOPY,GUIDE,PERCUT 641.0052342 PR CYSTOSCOPY,TX

URETEROPELVC STRICTURE798.00

52344 PR CYSTO/URETEROSCOPY,TX URETER STRICT

963.00

52345 PR CYSTO/URETEROSCOPY,TX URET/PELV STRICT

1015.00

52346 PR CYSTO/URETEROSCOPY,TX INTRARENAL STRICT

1159.00

52351 PR CYSTO/URETERO/PYELOSCOPY, 794.0052352 PR CYSTO/URETERO/PYELOSCOPY,

CALCULUS TX933.00

52353 PR CYSTO/URETERO/PYELOSCOPY W/LITHOTRIPSY

3545.00

52354 PR CYSTO/URETERO/PYELOSC,BX &/OR FULG LESN

2130.00

52355 PR CYSTO/URETERO/PYELOSCOPY,W/RESECT TUMOR

2500.00

52356 PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT

1040.00

52400 PR CYSTOSCOPY,RESEC CONGEN MUCOSAL FOLDS

1199.00

52402 PR CYSTOSCOPY,RESEC EJACULATORY DUCT

677.00

52441 PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE

590.00

52442 PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA

197.00

52450 PR TRANSURETHRAL INCISION OF PROSTATE

2420.00

52500 PR TRANSURETHRAL RESEC BLADDER NECK

1863.00

52601 PR TRANSURETHRAL ELEC-SURG PROSTATECTOM

3113.00

52630 PR REMV RESID OBSTRUC 2916.0052640 PR RELIEVE POSTOP BLADDER

CONTRACTURE1646.00

52648 PR LASER VAPORIZATION SURGERY PROSTATE, COMPLETE

8787.00

52649 PR LASER ENUCLEATION PROSTATE W MORCELLATION

2903.00

52700 PR DRAINAGE OF PROSTATE 1136.0053000 PR INCISION OF URETHRA 38153010 PR INCISION OF URETHRA,PERINEAL 1730.0053020 PR INCISION OF URETHRAL MEATUS 361.0053025 PR INCISION OF URETHRAL 387.0053040 PR DRAINAGE DEEP URETHRAL 1191.0053200 PR BIOPSY OF URETHRA 403.0053215 PR REMOVAL OF URETHRA,MALE 2782.0053230 PR EXCIS URETHRAL TIC,FEMALE 2167.0053240 PR MARSUP URETHRAL TIC 1085.0053260 PR EXCIS URETHRAL POLYP(S) 511.0053275 PR EXCIS URETHRAL PROLAPSE 673.0053400 PR REVISE URETHRA, 1ST STAGE 2329.0053405 PR REVISE URETHRA, 2ND STAGE 3713.0053410 PR RECONSTRUC ANT MALE 2865.0053415 PR RECONSTRUC PROSTATIC 4037.00

53420 PR RECONSTRUC PROS URETHRA,1ST STAGE

3781.00

53425 PR RECONSTRUC PROS URETHRA,2ND STAGE

3352.00

53430 PR RECONSTRUC FEMALE URETHRA 2823.0053431 PR 4745.0053440 PR SLING

OPERATION,CORRECTION,MALE 2708.00

53445 PR INSERT,INFLATABLE SPHINCTER 5477.0053446 PR REMOVAL,INFLATABLE 2027.0053447 PR REMOVAL &

REPLACE,INFLATABLE SPHINCTER2611.00

53450 PR URETHRAL MEATAL REVISION 984.0053460 PR URETHROPLASTY,EXCIS DIST 1153.0053502 PR REPAIR URETHRA 1250.0053505 PR REPAIR URETHRA 1241.0053520 PR CLOSE 1643.0053600 PR DIL URETHRA 210.0053601 PR DIL URETHRA 20853660 PR DIL URETHRA,FEMALE,INITIAL 181.0053661 PR DIL 180.0053665 PR DIL URETHRA,GEN/SPINAL 100.0054001 PR SLITTING OF PREPUCE 475.0054050 PR DESTR PENIS 335.0054056 PR DESTR PENIS 327.0054057 PR DESTR PENIS LESN,SIMPL,LASER 532.0054060 PR DESTR PENIS LESN,SIMPL,SURG 450.0054065 PR DESTR PENIS LESN,EXTENSIVE 502.0054100 PR BX,PENIS (SEPARATE 442.0054110 PR EXCIS PENILE PLAQUE 2555.0054111 PR EXCIS PENILE PLAQUE,GRAFT 3328.0054115 PR REMV FOR.BODY DEEP PENILE 1129.0054120 PR REMOVAL PENIS,PARTIAL 2012.0054125 PR REMOVAL PENIS,TOTAL 2913.0054150 PR

CIRCUMCISION,CLAMP,NEWBORN 400.00

54160 PR CIRCUMCISION,OTHER,<28 D/O 577.0054161 PR CIRCUMCISION,OTHER,28+ D/O 677.0054162 PR LYSIS/EXCIS,PENILE

POSTCIRCUM ADHESIONS670.00

54163 PR REPAIR,INCOMPLETE 629.0054164 PR FRENULOTOMY,PENIS 498.00

54200 PR INJECT PROC PENILE PLAQUE 267.0054220 PR IRRIGAT CORPUS 1065.0054230 PR INJECT CORPORA CAVERN XRAY 507.0054235 PR INJECT CORPORA

CAVERN,PHARM AGNT210.00

54300 PR STRAIGHTEN PENIS 2237.0054304 PR HYPOSPADIUS REPAIR,1ST 2695.0054308 PR HYPOSPADIUS REPAIR,2ND 3993.0054312 PR HYPOSPADIUS REPAIR,2ND 4662.0054322 PR HYPOSPAD REPAIR,1 2436.0054324 PR HYPOSPAD REPAIR,1

STAGE,DIST,PLASTY3142.00

54326 PR HYPOSPAD REPAIR,1 STAGE,DIST,PLASTY

4411.00

54328 PR HYPOSPAD REPR,1 STAGE,DIST,EXTENSV

3872.00

54332 PR HYPOSPAD REPR,1 STAGE,PROX,EXTENSV

3872.00

54340 PR REPAIR HYPOSPAD 1635.0054344 PR REPAIR HYPOSPAD 3279.0054360 PR PENIS PLASTIC SURG,CORRECT

ANGULATN2536.00

54380 PR REPAIR PENIS,EPISPADIUS 2895.0054405 PR INSERT,INFLATABLE PENILE

PROSTHESIS3708.00

54406 PR REMVL,INFLAT PENILE PROSTH W/O REPLACMT

2614.00

54408 PR REPAIR,INFLATABLE PENILE PROSTHESIS

2828.00

54410 PR REPLACE,INFLATABLE PENILE PROSTHESIS

2602.00

54415 PR REMOVAL,PENILE PROSTHESIS W/O REPLACMT

1551.00

54416 PR REPLACE,PENILE PROSTHESIS 2555.0054430 PR CORPORA CAVER-SPONGIOSA 2616.0054435 PR CORPORA-GLANS FISTULIZATN 1072.0054440 PR REPAIR PENIS POST INJURY 2411.0054450 PR PREPUTIAL STRETCHING 250.0054505 PR BIOPSY OF TESTIS,INCISIONAL 734.0054512 PR EXCIS TESTIS

EXTRAPARENCHYMAL LESION1271.00

54520 PR REMOVAL TESTIS,SIMPLE 1186.00

54530 PR REMOVAL TESTIS,RADICAL 1796.0054550 PR EXPLORE UNDESC

TESTIS,INGUIN/SCROTAL1628.00

54560 PR EXPLORE UNDESC 247054600 PR REDUCE TESTIS TORSION 1559.0054620 PR FIXATN OF TESTIS OPP TORSN 1134.0054640 PR ORCHIOPEXY,INGUNIAL 1519.0054660 PR INSERT TESTICULAR 91954670 PR REPAIR TESTIS INJURY 1047.0054680 PR RELOCATION OF TESTIS(ES) 2778.0054692 PR LAP,ORCHIOPEXY 2779.0054700 PR INCIS/DRAIN

SCROTUM/TESTIS,EPIDIDYM576.00

54830 PR EXCIS EPIDIDYMIS LOCAL 1157.0054840 PR EXCIS SPERMATOCELE 2133.0055000 PR DRAINAGE OF 30355040 PR REMOVAL OF

HYDROCELE,TUNICA,UNILAT1163.00

55041 PR REMOVAL OF 2048.0055060 PR REPAIR OF HYDROCELE,TUNICA 1375.0055100 PR DRAINAGE SCROTAL WALL 541.0055110 PR EXPLORE SCROTUM 1235.0055150 PR REMOVAL OF SCROTUM 1361.0055175 PR REVISION OF SCROTUM,SIMPLE 1467.0055180 PR REVISION OF 2000.0055250 PR REMOVAL OF SPERM DUCT(S) 1237.0055400 PR REPAIR OF SPERM DUCT 5200.0055450 PR LIGATION OF SPERM DUCT 178.0055500 PR REMV HYDROCELE,SPERM

CORD,UNILAT1223.00

55520 PR REMOVAL OF SPERM CORD 1149.0055530 PR EXCISE VARICOCELE 1573.0055550 PR LAP,LIGATION SPERMATIC VEINS 1066.0055680 PR EXCISE MULLERIAN DUCT CYST 927.0055700 PR BIOPSY OF 625.0055705 PR BIOPSY OF 944.0055706 PR BIOPSY OF

PROSTATE,NEEDLE,TRANSPERINEA944.00

55810 PR REMV 5421.0055821 PR REMV

PROSTATE,SUPRAPUBIC,SUBTOTAL3127.00

55840 PR REMV 5432.00

55842 PR REMV PROSTATE,RETROPUB,RAD,LTD

4818.00

55845 PR REMV PROSTATE,RETROPUB,RAD,TOT

6883.00

55866 PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE,INCL ROBOTIC

6342.00

55873 PR CRYOSURG ABLATION OF 2730.0055874 PR TRANSPERINEAL PLMT

BIODEGRADABLE MATRL 1/MLT NJX9491.00

55875 PR PERCUT/NEEDLE INSERT,PROSTATE,RADIOISOT

2690.00

55875 PR PERCUT/NEEDLE INSERT,PROSTATE,RADIOISOT

26 2690.00

55876 PR PLACE RADIOTHER DEVICE/MARKER, PROSTATE

552.00

55920 PR PLACEMENT NEEDLE PELVIC ORGAN RADIOELEMENT APPL

1065.00

56405 PR I&D OF VULVA/PERINEUM 275.0056420 PR I&D BARTHOLIN GLAND ABSCESS 305.0056440 PR MARSUP BARTHOLIN GLAND 450.0056441 PR LYSIS OF LABIAL LESION(S) 366.0056442 PR HYMENOTOMY, SIMPLE INCISION 121.0056501 PR 350.0056515 PR

DESTRUCTION,LESION(S),VULVA;EXTENSIVE

525.00

56605 PR BIOPSY VULVA/PERINEUM,ONE 225.0056606 PR BX,VULVA/PERINEUM,ADDL 130.0056620 PR PART SIMPLE REMV VULVA 1200.0056625 PR COMPLETE SIMPLE REMV VULVA 160056630 PR VULVA 2625.0056631 PR VULVA RESECT,RAD,PART,UNI 3400.0056632 PR VULVA RESECT,RAD,PART,BILAT 4625.0056633 PR VULVA RESECT,RAD,TOTAL 3425.0056634 PR VULVA RESECT,RAD,TOTAL,UNI 5300.0056700 PR PARTIAL REMOVAL OF HYMEN 550.0056740 PR EXCIS BARTHOLIN GLAND/CYST 800.0056800 PR REPAIR OF VAGINA 615.0056805 PR REPAIR CLITORIS 4000.0056810 PR REPAIR OF PERINEUM,NON

OBSTETRICAL900.00

56820 PR COLPOSCOPY,VULVA 265.0056821 PR 345.0057020 PR DRAINAGE OF PELVIC FLUID 250.0057022 PR I&D VAGINAL

HEMATOMA,OBSTET/POSTPART400.00

57061 PR DESTRUCT,VAGINAL 275.0057065 PR DESTRUCT,VAGINAL

LESION(S),EXTENSIVE500.00

57100 PR BIOPSY OF VAGINA,SIMPLE 200.0057105 PR BIOPSY OF VAGINA,EXTENSIVE 350.0057106 PR REMOVE VAGINA WALL, PARTIAL 125057110 PR COMPLETE REMOVAL OF VAGINA 3300.0057120 PR CLOSURE OF VAGINA 1900.0057130 PR EXCIS VAGINAL SEPTUM 450.0057135 PR EXCIS VAGINAL CYST/TUMOR 478.0057155 PR INSERTION UTERINE

TANDEM&/VAGINAL OVOIDS1638.00

57156 PR INSERT VAGINAL RADIATION 586.0057160 PR FIT/INSERT INTRAVAG SUPPORT 190.0057170 PR FITTING OF DIAPHRAGM/CAP 221.0057180 PR TREAT VAGINAL BLEEDING 375.0057200 PR REPAIR OF VAGINA 754.0057220 PR REVISION OF URETHRA 1200.0057240 PR ANTERIOR COLPORRAPHY RPR

CYSTOCELE W/CYSTO1675.00

57250 PR POST 1600.0057260 PR CMBND ANTERPOST

COLPORRAPHY W/CYSTO2100.00

57265 PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL

3006

57280 PR SUSPENSION OF VAGINA,ABD 2900.0057282 PR REPR VAGINAL 2900.0057283 PR REPR VAGINAL

PROLAPSE,UTEROSACRAL2500.00

57285 PR PARAVAGINAL DEFECT REPAIR VAGINAL APPROACH

2366.00

57287 PR REMV/REVS SLING FOR STRES INCONTINENCE

1800.00

57288 PR SLING OPER STRES 2500.0057291 PR CONSTRUCTION ARTIFIC VAGINA 3639.0057292 PR CONSTRUCT ARTIFIC VAGINA W 2850.00

57295 PR REVISION VAGINAL GRAFT, VAG APPROACH

2900.00

57300 PR REPAIR RECTO-VAG FISTULA 142157307 PR REPR REC-VAG 3715.0057310 PR CLOSE URETHROVAGINAL 118457320 PR CLOSE BLAD-VAG FISTULA,VAG 2471.0057400 PR DILATION OF VAGINA W ANESTH 350.0057410 PR PELVIC EXAMINATION W ANESTH 375.0057415 PR REMOVAL VAGINAL FOR.BODY W

ANESTH375.00

57420 PR COLPOSCOPY,ENTIRE VAGINA 300.0057421 PR COLPOSCOPY,ENTIRE

VAGINA,W/BIOPSY(S)400.00

57425 PR LAPAROSCOPY, SURG, 3050.0057452 PR COLPOSCOPY,CERVIX W/ADJ 270.0057454 PR COLPOSC,CERVIX W/ADJ

VAG,W/BX & CURRETAG370.00

57455 PR COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX

330.00

57456 PR COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG

315.00

57460 PR COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP BX

710.00

57461 PR COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP CONIZ

900.00

57500 PR BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION

320.00

57505 PR ENDOCERVICAL CURETTAGE 240.0057510 PR

CAUTERIZATION,CERVIX,ELECTRO/THERMAL

330.00

57511 PR CRYOCAUTERY OF CERVIX 350.0057513 PR LASER SURGERY OF CERVIX 37057520 PR CONIZATION 825.0057522 PR CONIZATION CERVIX,LOOP 655.0057540 PR REMV CERV STUMP,ABD 2717.0057555 PR REMV CERV 1520.0057558 PR D&C OF CERVIX STUMP 320.0057700 PR REVISION OF CERVIX,NON

OBSTETRICAL650.00

57720 PR PLASTIC REPR CERVIX,VAG 770.0057800 PR DILATION OF CERVICAL CANAL 150.00

58100 PR BIOPSY OF UTERUS LINING 275.0058110 PR ENDOMET BIOPSY DONE

W/COLPOSCOPY122.00

58120 PR 625.0058140 PR MYOMECTOMY 1-4,W/TOT

250GMS/<,ABD APPRCH2975.00

58145 PR EXCIS UTERINE FIBROID,VAG 1400.0058146 PR MYOMECTOMY 5/>,TOT>250

GMS,ABD APPRCH2900.00

58150 PR TOTAL ABDOM HYSTERECTOMY 3100.0058180 PR SUPRACERV ABD 3100.0058200 PR TOTAL ABD HYSTEREC+LTD 4925.0058210 PR RADICAL ABD HYSTEREC+PELV 7500.0058240 PR PELVIC EXENTERATN,GYN 8700.0058260 PR VAGINAL

HYSTERECTOMY,UTERUS 250 GMS/<2675.00

58262 PR VAG HYST,RMV TUBE/OVARY 3025.0058263 PR VAG HYST,RMV TUBE/OVARY,FIX

ENTEROCE3275.00

58267 PR VAG HYST,REV VAG/URETHRA 3475.0058290 PR VAG HYST,UTERUS >250 GMS 3850.0058300 PR INSERT INTRAUTERINE DEVICE 210.0058301 PR REMOVE INTRAUTERINE DEVICE 243.0058322 PR ARTIF INSEMINATION,INTRA- 211.0058340 PR CATH/INJECT 620.0058345 PR REOPEN FALLOPIAN

TUBE,TRANSCERV CATH700.00

58350 PR REOPEN FALLOPIAN TUBE,CHROMOTUBATION

240.00

58353 PR ENDOMETRIAL ABLATION, 2520.0058542 PR LAP, SUPRACERVIAL

HYSTERECTOMY W/ TUBE&OV, 2920.00

58545 PR LAP,MYOMECTOMY 1-4,TOT WT 2975.0058546 PR LAP,MYOMECTOMY 5/>,TOTAL

WT >250 GMS2950.00

58548 PR LAP, RADICAL HYST W/ TUBE&OV, NODE BX

6410.00

58550 PR LAP,VAG HYST,UTERUS 3100.0058552 PR LAP,VAG HYST,UTERUS

250GMS/<,SALP-OOPH3250.00

58554 PR LAP,VAG HYST,UTERUS >250GMS,SALP-OOPH

5025.00

58555 PR HYSTEROSCOPY,DX,SEP PROC 1000.0058558 PR HYSTEROSCOPY,W/ENDO BX 1300.0058559 PR HYSTEROSCOPY,LYSIS 850.0058560 PR HYSTEROSCOPY,RESECT 1000.0058561 PR HYSTEROSCOPY,RMV MYOMA 2300.0058562 PR HYSTEROSCOPY,RMV FB 1000.0058563 PR

HYSTEROSCOPY,W/ENDOMETRIAL 5643.00

58565 PR HYSTEROSCOPY, STERILIZE W IMPLANTS

5150.00

58570 PR LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR

2825.00

58571 PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY

3100.00

58572 PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS > 250

3600.00

58573 PR LAPAROSCOPY TOT HYSTERECTOMY UTERUS >250

3400.00

58575 PR LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC

2789.00

58605 PR LIGATE FALLOPIAN 1225.0058611 PR LIGATION,FALLOPIAN TUBE W/C-

SECTION600.00

58660 PR LAP,LYSIS OF ADHESIONS 2000.0058661 PR LAP,RMV ADNEXAL STRUCTURE 1900.0058662 PR LAP,FULGURATE/EXCISE 2200.0058670 PR LAP,TUBAL CAUTERY 909.0058671 PR LAP,TUBAL BLOCK BY DEVICE 1225.0058674 PR LAPS ABLTJ UTERINE FIBROIDS

W/INTRAOP US GDN2918.00

58700 PR REMOVAL OF FALLOPIAN TUBE 1700.0058720 PR REMOVAL OF OVARY/TUBE(S) 1900.0058740 PR LYSIS ADNEXAL ADHESIONS 3110.0058800 PR DRAIN OVARIAN CYST(S),VAG 774.0058805 PR DRAIN OVARIAN CYST(S),ABD 888.0058825 PR TRANSPOSITION, OVARY(S) 2423.0058900 PR BIOPSY OF OVARY(S) 908.0058925 PR REMOVAL OF OVARIAN CYST(S) 2325.0058940 PR REMOVAL OF OVARY(S) 1098.0058943 PR OOPHORECTORMY FOR MALIG, 4100.00

58950 PR RESEC OVAR MALIG+BILAT OVAR+OMENTUM

3450.00

58951 PR RESEC OVAR MALIG+TAH+PELV 5125.0058952 PR OOPH W/RADIC DISSECT FOR

DEBULKING5725.00

58953 PR BIL SALP-OOPH W/OMENTECT,TAH,RAD DISSECT

7250.00

58954 PR BIL SAL-OOPH W/OMENTECT,TAH,RAD DIS,LYMP

7900.00

58956 PR BSO, OMENTECTOMY W/TAH 4975.0058957 PR RESECT RECURRENT GYN MALIG 6450.0059000 PR AMNIOCENTESIS,DIAGNOSTIC 295.0059001 PR AMNIOCENTESIS,THER AMNIOTIC

FLUID REDUCT460.00

59012 PR FETAL CORD 850.0059015 PR CHORION VILLUS BIOPSY 400.0059025 PR FETAL NON-STRESS TEST 119.0059025 PR FETAL NON-STRESS TEST 26 100.0059051 PR FETAL MONITOR/INTERPRET 110.0059120 PR TREAT ECTOPIC PREG,RMV

TUBE/OVARY1800.00

59150 PR RX ECTOP PREG BY 2000.0059151 PR RX ECTOP PREG BY SCOPE,RMV

TUBE/OVRY2100.00

59160 PR D&C AFTER DELIVERY 625.0059200 PR INSERT CERVICAL DILATOR 210.0059300 PR EPISIOTOMY/VAG RPR OTH/THN

ATTENDING485.00

59320 PR REVISION CERVIX W PREG,VAG 850.0059325 PR REVISION CERVIX W PREG,ABD 900.0059400 PR FULL ROUT OBSTE 4900.0059409 PR OBSTETRICAL CARE,VAG DELIV 2400.0059410 PR OBSTE CARE,VAG 2800.0059412 PR ANTEPARTUM HEAD 600.0059414 PR DELIVER PLACENTA 600.0059425 PR ANTEPARTUM CARE ONLY, 4-6 1150.0059426 PR ANTEPARTUM CARE ONLY, >7 2400.0059430 PR CARE AFTER DELIVERY ONLY 475.0059510 PR FULL ROUT OBSTE

CARE,CESAREAN DELIV5400.00

59514 PR CESAREAN DELIVERY ONLY 3250.00

59515 PR CESAREAN DELIVERY+POSTPARTUM CARE

3100.00

59525 PR REMOVE UTERUS AFTER 1150.0059610 PR ROUT OB CARE,VAG DELIV,PREV 4900.0059612 PR VAG DELIV ONLY,PREV C-SECTN 3225.0059614 PR VAG DELIV+POSTPARTUM

CARE,PREV C-SEC2900.00

59618 PR ROUT OB CARE,C-SEC,PREV C- 5200.0059620 PR C-SEC ONLY,PREV C-SEC 3350.0059622 PR C-SEC+POSTPARTUM 3200.0059812 PR SURG RX INCOMPLETE ABORTN 800.0059820 PR SURG RX MISSED ABORTN,1ST 900.0059821 PR SURG RX MISSED ABORTN,2ND 970.0059840 PR INDUCED ABORTN BY D&C 750.0059841 PR INDUCED ABORTN BY DIL/EVAC 800.0059855 PR INDUCED AB BY VAG SUPPOS 875.0059870 PR EVACUATE MOLE OF UTERUS 2000.0059871 PR REMOVE CERCLAGE SUTURE 342.0060100 PR BIOPSY OF THYROID,PERCUT 259.0060200 PR REMOVE BENIGN THYROID 2342.0060210 PR PARTIAL EXCISION 2222.0060220 PR THYROID LOBECTOMY,UNILAT 2414.0060225 PR THYR LOBECTOMY+PART REMOV

CONTRA2755.00

60240 PR THYROIDECTOMY 3224.0060252 PR THYROIDECTOMY,MALIG,LTD

NECK SURG4670.00

60254 PR THYROIDECTOMY W RAD NECK SURGERY

5859.00

60260 PR THYROIDECTOMY POST PREV THYR SURG

3881.00

60270 PR THYROIDECTOMY,SUBSTERNAL,TRANSTHOR APP

3385.00

60271 PR THYROIDECTOMY=SUBSTERNAL,TRANSCERV

4700.00

60280 PR EXCIS THYROID DUCT 1529.0060300 PR ASPIRATION AND/OR INJECTION

THYROID CYST187.00

60500 PR EXPLORE PARATHYROID 3096.0060502 PR RE-EXPLORE PARATHYROIDS 4417.00

60512 PR AUTOTRANSPLANT, 688.0060520 PR THYMECTOMY,TRANSCERVICAL 3436.0060521 PR THYMECTOMY,TRANSTHORACIC 3963.0060522 PR THYMECTOMY,RADICAL MEDIAST

DISSSEC5347.00

60540 PR EXCISE ADRENAL GLAND 3172.0060545 PR EXCISE ADRENAL+ADJ

RETROPER TUMOR3758.00

60600 PR EXCISE CAROTID BODY LESION 5647.0060605 PR EXCISE CAROTID

BODY+CAROTID ARTERY3374.00

60650 PR LAP,ADRENALECTOMY 3635.0061020 PR VENTRICULAR PUCTURE 325.0061070 PR BRAIN SHUNT TUBE/RESERV 300.0061107 PR TWIST HOLE SKULL,IMPLANT

CATH/DEVICE2117.00

61140 PR BURR HOLE FOR BIOPSY 6503.0061150 PR BURR HOLE FOR DRAINAGE 7081.0061154 PR BURR HOLE EVAC

SUBDUR/EXTRA HEMATOMA6351.00

61210 PR BURR HOLE IMPLANT 2419.0061304 PR OPEN SKULL SUPRATENT 9084.0061312 PR OPEN SKULL EVAC

SUB/EXTRADUR BLOOD10053.00

61313 PR OPEN SKULL EVAC INTRACEREBR BLOOD

10176.00

61314 PR OPEN SKULL EVAC SUB/EXTRADUR BLOOD

9622.00

61315 PR OPEN SKULL EVAC INTRACEREBR BLOOD

11135.00

61320 PR OPEN SKULL DRAIN SUPRATENT 10095.0061322 PR OPEN

SKULL,DECOMPRES,W/DURAPLASTY10963.00

61323 PR OPEN 11205.0061330 PR DECOMPRESS 4366.0061340 PR SUBTEMPORAL CRANIAL

DECOMPRESSION7509.00

61343 PR SUBOCCIPT DECOMP 12283.0061345 PR CRANIAL DECOMPRESSN POST 10718.0061458 PR CRANIECT EXPL/DECOM 11122.0061460 PR CRANIECT SECTN 1+ CRAN 11389.0061500 PR CRANIECT EXCIS SKULL BONE 7491.00

61510 PR EXCIS SUPRATENT BRAIN 11543.0061512 PR EXCIS SUPRATENT MENINGIOMA 13933.0061516 PR EXCIS SUPRATENT BRAIN CYST 11448.0061518 PR EXCIS INFRATENT BRAIN TUMOR 14904.0061519 PR EXCIS INFRATENT MENINGIOMA 16293.0061520 PR EXCIS INFRATENT CP ANGLE 21041.0061521 PR EXCIS INFRATENT MIDLINE 17519.0061524 PR EXCIS INFRATENT BRAIN CYST 11355.0061526 PR EXCIS TRANSTEMP CP ANGLE 19784.0061531 PR SUBDUR IMPLNT ELECTR,BURR 6039.0061533 SUBDUR IMPLNT ELECTR, CRAN 7980.0061534 PR EXCIS EPILEPTOGENIC FOCUS 7707.0061535 PR REMOVE BRAIN ELECTRODES 4538.0061537 PR REMOVAL OF BRAIN TISSUE 11168.0061540 PR REMOVAL OF BRAIN TISSUE 13458.0061541 PR TRANSECT CORPUS CALLOSUM 7241.0061545 PR EXCISION CRANIOPHARYNGIOMA 19586.0061546 PR EXCIS PITUITARY,INTRACRANIAL 12530.0061548 PR EXCIS 9020.0061550 PR CRANIECTOMY

SYNSOTOSIS,SINGLE SUT7275.00

61557 PR OPEN FLAP 8762.0061559 PR EXTEN CRANIEC W RECONTOUR

SYNOSTOSIS8449.00

61566 PR REMOVAL OF BRAIN TISSUE 13823.0061581 PR CRANIOFACIAL

APPROACH,EXTRADURAL+13333.00

61583 PR CRANIOFACIAL 14302.0061584 PR ORBITOCRANIAL 13610.0061586 PR BICOR,XZYGOMA APPROACH

ANT CRAN FOSS9223.00

61590 PR INFRATEMPORAL APPROACH/PREAURICULAR

7771.00

61591 PR INFRATEMPORAL APPROACH/POSTAURICULAR

16642.00

61592 PR ORBITOCRANIAL APPROACH/ZYGOMATIC

15518.00

61595 PR TRANSTEMPORAL 6044.0061600 PR RESECT BASE ANT CRAN

FOSSA/EXTRADURL10103.00

61601 PR RESECT BASE ANT CRAN FOSSA/INTRADURL

11002.00

61605 PR RESECT INFRATEMP 5365.0061606 PR RESECT INFRATEMP 17964.0061608 PR RESECT PARASELLAR

FOSSA/INTRADURL16454.00

61616 PR EXCIS BASE POST CRAN FOSSA/INTRADURL

11400.00

61618 PR SEC REPR,CSF LEAK/CRANIAL 3408.0061619 PR REPAIR DURA POSTOP SK BASE-

PEDICLE5742.00

61623 PR ENDOVASC TEMP BALLOON OCCLUS,HEAD/NCK

1477.00

61624 PR PERM OCCLUSION/EMBOLIZATION,PERCUT

4680.00

61626 PR PERCUT CATH OCCLUSN NON 2744.0061630 PR INTRACRANIAL BALLOON 2624.0061635 PR INTRACRANIAL BALLOON

ANGIOPLSTY W/STENT5200.00

61640 PR BALLOON DILATION INTRACRANIAL VASOSPASM, INIT

2383.00

61645 PR PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL

2831.00

61650 PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST

1385.00

61651 PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL

590.00

61680 PR BRAIN AVM 12672.0061682 PR BRAIN AVM 23372.0061686 PR BRAIN AVM 24497.0061690 PR BRAIN AVM SURG,DURAL,SIMPLE 13484.0061692 PR BRAIN AVM 19670.0061697 PR COMPLEX ANEURYSM

SURG/CAROTID CIRC19317.00

61698 PR COMPLX ANEURYSM SURG/VERT-BASILAR CIRC

27954.00

61700 PR ANEURYSM, INTRACRAN, SIMPLE 13923.0061711 PR INTRA-EXTRACRANIAL ART 10655.0061720 PR CREATE LESN GLOBUS/THAL 7148.0061735 PR CREATE LESN SUBCORTICAL 9771.0061750 PR STEREOTACTIC BRAIN 7258.0061751 PR STEREO

BX/ASPIR/EXCIS,INTRACRANIAL 7410.00

61760 STEREO IMPLANT BRAIN ELECTRODES, SEIZURE MONITOR

8741.00

61781 PR STEREOTACTIC COMP ASSIST PROC,CRANIAL,INTRADURAL

1365.00

61782 PR STEREOTACTIC COMP ASSIST PROC,CRANIAL,EXTRADURAL

753.00

61783 PR STEREOTACTIC COMP ASSIST PROC,SPINAL

1365.00

61791 PR STEREO TREAT TRIGEMINAL 4513.0061796 PR STEREOTACTIC RADIOSURGERY,

CRANIAL,SIMPLE,SINGLE6600.00

61797 PR STEREOTACTIC RADIOSURGERY, CRANIAL,SIMPLE,EA ADD

6600.00

61798 PR STEREOTACTIC RADIOSURGERY, CRANIAL,COMPLEX,SINGLE

9900.00

61799 PR STEREOTACTIC RADIOSURGERY, CRANIAL,COMPLEX,EA ADD

9900.00

61800 PR APPLY STEREOTACTIC HEADFRAME FOR RADIOSURGERY

2000.00

61863 PR IMPLANT NEUROELECTRODE 6229.0061864 PR IMPLANT NEUROELECTRDE, 1733.0061867 PR IMPLANT NEUROELECTRODE 9357.0061868 PR IMPLANT NEUROELECTRDE, 3077.0061880 PR REVISE/REMOVE INTRACRAN

NEUROELEC2754.00

61885 PR IMP STIM,CRANIAL,SUBQ,1 2472.0061886 PR IMP STIM,CRANIAL,SUBQ,>1 3170.0062000 PR FIX SIMPL DEPRESS SKULL FX 3534.0062010 PR FIX DEPRESS SKULL FX,REPR 8104.0062100 PR 4001.0062120 PR REPAIR ENCEPHALOCELE,VAULT 8744.0062121 PR REPAIR ENCEPHALOCELE,BASE 6936.0062140 PR REPAIR SKULL DEFECT,UP TO 5629.0062141 PR REPAIR SKULL DEFECT,>5CM 6350.0062142 PR REMOVE SKULL PLATE/FLAP 4629.0062143 PR REPLACE SKULL PLATE/FLAP 5285.0062146 PR REPAIR SKULL W GRAFT,UP TO 5772.0062147 PR REPAIR SKULL W GRAFT,>5CM 6000.0062160 PR

NEUROENDOSCOP,PLACE/REPLACE 979.00

62161 PR NEUROENDOSCOP,DISS ADHESION/FENESTRATION

7271.00

62162 PR NEUROENDOSCOP,W/FENESTRAT/E

8968.00

62163 PR 7547.0062164 PR NEUROENDOSCOP,W/EXCISE

BRAIN TUMOR12728.00

62165 PR NEUROENDOSCOP,EXC,PIT TUM,TRANSNAS/SPHEN

6243.00

62192 PR CREATE SHUNT:SUBARCH/DUR-PLEURAL

5272.00

62200 PR VENTRICULO-CISTERNOSTOMY,3RD VENT

4835.00

62201 PR VENTRICULO-CISTERNOSTOMY,3RD

4843.00

62220 PR CREATE SHUNT:VENTRIC-ATRIAL 6214.0062223 PR CREATE SHUNT:VENTRIC- 5508.0062225 PR REPLACE/IRRIGATE VENTRIC 2331.0062230 PR REPLACEMENT/REVISION,CSF 4350.0062252 PR

REPROGRAMMING,PROGRAMMABLE 26 263.00

62256 PR REMOVAL,COMPLETE CSF SHUNT,W/O REPLACE

2940.00

62258 PR REMOVE & REPLACE CSF SHUNT 6003.0062267 PR PERCUT ASPIRATION 570.0062270 PR SPINAL

PUNCTURE,LUMBAR,DIAGNOSTIC373.00

62272 PR SPINAL PUNCTURE,THERAPEUTIC

588.00

62273 PR INJ,LUMB EPIDUR,BLOOD/CLOT 409.0062281 PR INJECT

NEUROLYTIC,EPIDUR,CERV/THOR610.00

62282 PR 741.0062284 PR INJECTION PROCEDURE

MYELOGRAPHY/CT LUMBAR552.00

62287 PR DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR

1459.00

62290 PR INJECT DISCOGRAM,LUMBAR,EA 829.0062292 PR INJECT CHEMONUCLEOLYSIS 2941.0062294 PR INJECT SPINAL 4844.0062302 PR MYELOGRAPHY VIA LUMBAR

INJECTION RS&I CERVICAL606.00

62303 PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC

630.00

62304 PR MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL

597.00

62305 PR MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS

652.00

62310 PR NJX DX/THER SBST EPIDURAL/SUBRACH

725.00

62311 PR NJX DX/THER SBST EPIDURAL/SUBARACH

614.00

62318 PR 738.0062319 PR NJX INFUS/BOLUS DX/SBST

EDRL/SUBARACH LUM/SACRAL563.00

62320 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN

427.00

62321 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN

634.00

62322 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN

398.00

62323 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

622.00

62324 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN

373.00

62325 PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN

562.00

62326 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN

392.00

62327 PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN

573.00

62350 PR IMP SPINAL CANAL CATH 2460.0062355 PR REMOVE SPINAL CANAL 893.0062362 INSERT/ REPLACE INFUSN

PUMP,PROGRAMMABLE2600.00

62365 PR REMOVE INFUSN DEVICE/PUMP 2023.0062367 PR ELECT ANLYS IMPLT ITHCL/EDRL

PMP W/O REPRG/REFIL89.00

62368 PR ANALYZE INFUSN 165.0062370 PR ELEC ANLYS IMPLT ITHCL/EDRL

PMP W/REPR PHYS/QHP445.00

63001 LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, CERVICAL

6317.00

63003 LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, THORACIC

6312.00

63005 LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, LUMBAR

6014.00

63011 LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG, SACRAL

5559.00

63012 PR 6060.0063015 PR LAMINECTOMY,>2 7547.0063016 PR LAMINECTOMY,>2 7766.0063017 PR LAMINECTOMY,>2 SGMT,LUMBAR 6396.0063020 PR LAMNOTMY INCL W/DCMPRSN

NRV ROOT 1 INTRSPC CERVC5909.00

63030 PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR

4933.00

63035 PR LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR

980.00

63040 PR LAMINOTOMY 7093.0063042 PR REDO EXCIS LUMBAR DISC 6595.0063043 PR REDO EXCIS CERV DISC, ADDN

CERV INTERSPC990.00

63044 PR REDO EXCIS CERV DISC, ADDN LUMB INTERSPC

990.00

63045 LAMINEC/FACETECT/FORAMIN,CERVICAL 1 SEG

6558.00

63046 LAMINEC/FACETECT/FORAMIN,THORACIC 1 SEG

6220.00

63047 LAMINEC/FACETECT/FORAMIN,LUMBAR 1 SEG

5608.00

63048 PR LAMINEC/FACETECT/FORAMIN,EACH

1081.00

63050 PR C- LAMINOPLASTY, 2 OR MORE 5090.0063051 PR C-LAMINOPLASTY

W/GRAFT/PLATE, 2 OR MORE8708.00

63055 PR XPEDICUL DECOMPRESS THROACIC CORD

8296.00

63056 PR DECOMPRESS SPINAL CORD,1 6043.0063064 PR COSTOVERT DECOMPRESS

THORACIC CORD9029.00

63066 PR COSTOVERT DECOMP THOR CORD,EACH ADDN

1056.00

63075 PR DISK SURG,ANTER,CERVICAL,SINGLE LVL

6893.00

63076 PR DISK SURG,ANTER,CERV,EA 1267.0063077 PR DISK SURG,THORAX,SINGLE 7595.00

63081 PR REMV VERT BODY,CERV,ONE 8946.0063082 PR REMV VERT BODY,CERV,EACH

ADDNL SGMT8946.00

63085 PR REMV VERT BODY,THOR,ONE 9753.0063086 PR REMV VERT BODY,THOR,EACH

ADDNL SGMT975.00

63087 PR REMV VERT BODY,LO 12284.0063088 PR REMV VERT BODY,LO

THOR/LUMB,EA ADDNL1330.00

63090 PR REMV VERT BODY,LOWER,RETROPER,ONE

9969.00

63091 PR REMV VERT BODY,LOWR,RETROPER,EA ADDN

909.00

63101 PR REMOVAL OF VERTEBRAL BODY 11789.0063102 PR REMOVAL OF VERTEBRAL BODY 11577.0063103 PR REMOVE VERTEBRAL BODY ADD- 2497.0063170 PR INCISE SPINAL CORD TRACT(S) 8155.0063172 PR DRAIN INTRAMEDULLARY- 7188.0063173 PR DRAIN INTRAMEDULLARY- 8712.0063185 PR INCISE SP

COLUMN/NERVES,ONE/TWO LVL5815.00

63190 PR INCISE SP COLUMN/NERVES,>2 6522.0063191 PR INCISE SPINAL ACCESS NERVE 6465.0063194 PR INCIS 1 SPINOTHAL,CERV,1 7131.0063195 PR INCIS 1 SPINOTHAL,THOR,1 6489.0063200 PR RELEASE TETHERED SPINAL

CORD,LUMBR7828.00

63250 PR EXCIS/OCCLUD CORD 15227.0063251 PR EXCIS/OCCLUD CORD 15424.0063252 PR EXCIS/OCCLUD CORD

AVM,THORCOLUMBAR15479.00

63265 PR EXCIS INTRASP 8500.0063266 PR EXCIS INTRASP

LESN,XDURAL,THORACIC8760.00

63267 PR EXCIS INTRASP 6969.0063268 PR EXCIS INTRASP 7120.0063270 PR EXCIS INTRASP 10599.0063271 PR EXCIS INTRASP 10516.0063272 PR EXCIS INTRASP 9619.0063275 PR BX/EXCIS SPINAL 9161.0063276 PR BX/EXCIS SPINAL 9111.0063277 PR BX/EXCIS SPINAL 7898.00

63278 PR BX/EXCIS SPINAL 8050.0063280 PR BX/EXCIS SPIN 10755.0063281 PR BX/EXCIS SPIN 10672.0063282 PR BX/EXCIS SPIN 10040.0063283 PR BX/EXCIS SPIN 9629.0063285 PR BX/EXCIS SPIN 13414.0063286 PR BX/EXCIS SPIN 13089.0063287 PR BX/EXCIS SPIN

TUM,INDUR,INMED,THLUM14075.00

63290 PR BX/EXCIS SPIN 11399.0063300 PR REMV VERT,EXDUR,CERV 9344.0063301 PR REMV

VERT,EXUDR,XTHOR,THOR TUMOR10591.00

63302 PR REMV VERT,EXDUR,THORLUM,THOR

10979.00

63303 PR REMV VERT,EXDUR,LUMB/SACR 11484.0063305 PR REMV

VERT,INDURAL,XTHOR,THOR 10280

63307 PR REMV VERT,INDURAL,LUMB/SACR TUMOR

11110.00

63308 PR REMV VERT,EACH ADDNL 1650.0063600 PR CREATE SP CORD 4568.0063650 PR PERCUT IMPLNT

NEUROELECT,EPIDURAL3294.00

63655 PR SURG IMPLNT 4210.0063661 PR REMOVE SPINAL NEUROSTIM

ELECTRODE PERC ARRAY, INCL 2921.00

63662 PR REMOVE SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL

4252.00

63663 PR REVISION SPINAL NEUROSTIM ELECTRODE PERC ARRAY, INCL

2500.00

63664 PR REVISION SPINAL NEUROSTIM ELECTRODE PLATE/PADDLE, INCL

4390.00

63685 PR IMPLANT NEUROSTIM/RECEIVER 1853.0063688 PR REVISE/REMOVE 1883.0063704 PR REPR MYELOMENIGOCELE,<5CM 7451.0063706 PR REPR MYELOMENIGOCELE,5+CM 8888.0063707 PR REPR,DURAL/CSF LEAK,NOT REQ

LAMINECTOMY4682.00

63709 PR REPR,DURAL/CSF LEAK,W/LAMINECTOMY

5600.00

63710 PR DURAL GRAFT REPAIR,SPINE 5506.00

63740 PR INSTALL SPINAL 4759.0063741 PR INSTALL SPINAL SHUNT,PERCUT 3438.0063744 PR REVISION OF SPINAL SHUNT 3364.0063746 PR REMOVAL OF SPINAL SHUNT 3066.0064400 PR INJECT NERV BLCK,TRIGEMINAL 308.0064402 PR INJECT NERV BLCK,FACIAL NERV 318.0064405 PR INJECT NERV BLCK,GREAT 285.0064413 PR INJECT NERV BLCK,CERV 320.0064415 PR INJ,ANES AGENT,BRACHIAL

PLEXUS,SINGLE401.00

64416 PR INJ,ANES AGENT,BRACHIAL PLEXUS,CONT INF

420.00

64417 PR INJECT NERV BLCK,AXILLARY 366.0064418 PR INJECT NERV BLCK,SUPRASCAP 365.0064420 PR INJECT NERV 418.0064421 PR INJECT NERV 634.0064425 PR INJECT NERV 395.0064430 PR INJECT NERV BLCK,PUDENDAL 413.0064445 PR INJ,ANES AGENT,SCIATIC 400.0064446 PR INJ,ANES AGENT,SCIATIC

NERVE,CONT INF420.00

64447 PR INJ,ANES AGENT,FEMORAL NERVE,SINGLE

365.00

64448 PR INJ,ANES AGENT,FEMORAL NERVE,CONT INF

400.00

64449 PR N BLOCK INJ, LUMBAR PLEXUS 21664450 PR INJECT NERV BLCK,OTHR 310.0064455 PR INJECT PLANTAR COMMON

DIGITAL NERVE121.00

64479 PR INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG

589.00

64480 PR INJECT ANES/STEROID FORAMEN CERV/THORACIC W IMG GUIDE ,EA ADD LEVEL

286.00

64483 PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG

547.00

64484 PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,EA ADD LEVEL

220.00

64486 PR TAP BLOCK UNILATERAL BY INJECTION(S)

308.00

64488 PR TAP BLOCK BILATERAL BY 379.00

64490 PR INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, 1ST

732.00

64491 PR INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, 2ND

298.00

64492 PR INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, ADD

298.00

64493 PR INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 1ST

668.00

64494 PR INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 2ND

264.00

64495 PR INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, ADD

217.00

64505 PR INJECT NERV BLCK,SPHENOPALAT GANGLN

295.00

64510 PR INJECT NERV BLCK,STELLATE GANGLION

397.00

64520 PR INJECT NERV BLCK,PARAVERT SYMPATH

581.00

64530 PR INJECT NERV BLCK,CELIAC 592.0064550 PR APPLICATION OF SURFACE

NEUROSTIMULATOR40.00

64555 PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV

3047.00

64561 PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING

2101.00

64566 PR POST TIBIAL NEUROSTIMULATION,PERC NEEDLE

418.00

64568 PR INCISION IMPLANT CRANIAL NERVE STIM ELECTRODE/PULSE

1650.00

64569 PR REVISE/REPLACE CRANIAL NERVE STIM ELECTRODE/CONNECT

4713.00

64570 PR REMOVE IMPLANT CRANIAL NERVE STIM ELECTRODE/PULSE

1665.00

64575 PR INC IMPLTJ PERIPH NERVE NEUROSTIMULATOR ELTRD

1622.00

64581 PR INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE

1800.00

64585 PR REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE

617.00

64590 PR IMPLANT GASTRIC NEUROSTIM/RECEIVER

800.00

64595 PR REVISE/REMOVE GASTRIC NEUROSTIM/RECEIVER

619.00

64600 PR INJECT TRIGEM NERV,1ST 986.0064610 PR INJECT 5TH N.-2,3 2836.0064611 PR CHEMODENERVATION

PAROTID/SUBMANDIBULAR SALIVARY GLANDS,BILATERAL

295.00

64612 PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL

350.00

64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC

435.00

64616 PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA

344.00

64617 PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG

428.00

64630 PR DESTRUCT BY NEURO AGENT; PUDENDAL

677.00

64633 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL

1329.00

64634 PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL

609.00

64635 PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL

1306.00

64636 PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL

548.00

64640 PR INJECT RX OTHER PERIPH 646.0064642 PR CHEMODENERVATION ONE

EXTREMITY 1-4 MUSCLE371.00

64643 PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE

275.00

64644 PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES

410.00

64645 PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/< MUSCLES

313.00

64646 PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES

405.00

64647 PR CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES

475.00

64650 PR CHEMODENERV ECCRINE GLANDS BOTH AXILLAE

286.00

64653 PR CHEMODENERV ECCRINE GLANDS, NON-AXILLARY

356.00

64680 PR INJECT RX CELIAC PLEXUS 950.0064681 PR INJECTION TREATMENT OF 1312.0064702 PR REVISE/REPAIR FINGER/TOE 1265.0064704 PR REVISE/REPAIR HAND/FOOT 1430.0064708 PR NEUROPLASTY OTHER ARM/LEG

NERVE,OPEN2521.00

64712 PR NEUROPLASTY SCIATIC 2940.0064713 PR NEUROPLASTY BRACHIAL 3889.0064714 PR NEUROPLASTY LUMBAR 2517.0064716 PR REVISION OF CRANIAL NERVE 1351.0064718 PR REVISE ULNAR NERVE AT 2990.0064719 PR REVISE ULNAR NERVE AT WRIST 2022.0064721 PR REVISE MEDIAN N/CARPAL

TUNNEL SURG1467.00

64722 PR RELIEVE PRESSURE ON 919.0064726 PR RELEASE FOOT/TOE NERVE 932.0064727 PR INTERN NERVE REVIS,OPER

MICROSCOPE940.00

64734 PR TRANSECT INFRAORBITAL NERV 2090.0064744 PR TRANSECT GREAT OCCIPITAL 1725.0064763 PR TRANSECT

OBTURATR,XTRAPELV,HIP/LEG1613.00

64771 PR TRANSECT OTHER CRAN N,EXTRADURAL

3043.00

64772 PR TRANSECT OTHR SPINAL 2854.0064774 PR EXCISE CUTANEOUS NEUROMA 2098.0064776 PR EXCISE DIGITAL NEUROMA 1172.0064782 PR EXCISE HAND/FOOT NEUROMA 1075.0064783 PR EXCISE HAND/FOOT

NEUROMA,EACH ADDNL790.00

64784 PR EXCISE MAJOR PERIPHERAL 3697.0064786 PR EXCISE SCIATIC NERVE 5494.0064787 PR IMPLANT NERVE END TO 1078.0064788 PR EXCISE CUTANEOUS 2019.0064790 PR EXCISE MAJOR PERIPH 4284.0064792 PR EXCISE NEUROFIBROMA 5507.0064795 PR BIOPSY OF NERVE 983.0064804 PR 4267.0064820 PR SYMPATHECTOMY,DIGITAL

ARTERIES, EA2680.00

64821 PR SYMPATHECTOMY,RADIAL 2450.0064822 PR SYMPATHECTOMY,ULNAR 1750.00

64831 PR REPAIR OF DIGIT NERVE 1599.0064832 PR REPAIR EACH ADDNL DIGIT 843.0064834 SUTURE 1 NERVE HAND/FOOT

COMMON SENSORY NERVE2349.00

64835 SUTURE 1 NERVE MEDIAN MOTOR 2535.0064836 SUTURE 1 NERVE ULNAR MOTOR 2927.0064837 PR REPAIR EACH ADDNL

HAND/FOOT NERVE1075.00

64856 PR REPAIR/TRANSPOS MAJ PERIPH 3071.0064857 PR REPAIR MAJOR PERIPHERAL 3290.0064858 PR REPAIR SCIATIC NERVE 4210.0064859 PR REPAIR ADDNL MAJ PERIPH 642.0064864 PR REPR FACIAL 2853.0064868 PR ANAST FACIAL-HYPOGLOSSAL 3513.0064872 PR REPR 418.0064874 PR REPR/TRANSPOSE 425.0064885 PR NERVE 3478.0064886 PR NERVE 4691.0064890 PR NERVE 3427.0064893 PR NERVE 400864896 PR NERV 5857.0064898 PR NERV 5990.0064902 PR EA ADDNL NERVE

GRAFT,MULTPL STRANDS2326.00

64905 PR NERVE PEDICLE XFER,FIRST 3547.0064910 PR NERVE REPAIR W/ALLOGRAFT

OR SYNTH2906.00

64912 PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND

2821.00

64913 PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND

572.00

65101 PR REMOVAL OF EYE 1878.0065103 PR REMOVE EYE W IMPLANT 1948.0065105 PR REMOVE EYE W MUSC TO 2167.0065110 PR REMOVAL OF ORBITAL 4321.0065205 PR REMV F.B.,EYE,SUPERF 142.0065210 PR REMV F.B.,EYE,EMBED CONJUNC 173.0065220 PR REMV F.B.,EYE,CORNEA,NO SLIT 229.0065222 PR REMV F.B.,EYE,CORNEA,SLIT 170.0065235 PR REMOVAL,FB,INTRAOCULAR,ANT

CHAMBER/LENS1782.00

65260 PR REMV F.B.,EYE,POST 3401.00

65265 PR REMV F.B.,EYE,POST SGMT,NONMAGNETIC

3817.00

65270 PR REPAIR CONJUNC LACERATN 665.0065275 PR REPAIR CORNEA

LAC,NONPERFORATING1445.00

65280 PR REPAIR CORNEA LAC,PERF,NO 1732.0065285 PR REPAIR CORNEA

LAC,PERF,RESEC UVEAL2960.00

65286 PR REPAIR CORNEA LAC,APPLY 1755.0065400 PR EXCIS CORNEA LESN 1703.0065410 PR BIOPSY OF CORNEA 358.0065426 PR EXCIS PTERYGIUM,W GRAFT 1624.0065430 PR CORNEAL SMEAR 290.0065435 PR CURETTE/TREAT CORNEA 203.0065436 PR CURETTE/TREAT CORNEA,APPLY

CHELATE986.00

65450 PR DESTR CORNEAL LESN,CRYO,PHOTO,THERM

813.00

65600 PR MULT PUNC ANTER CORNEA 987.0065730 PR CORNEAL 3681.0065750 PR CORNEAL

TRANSPLANT,PENETRAT,APHAKIA3681.00

65755 PR CORNEAL TRANSPLANT,PEN,PSEUDOAPHAK

3681.00

65756 PR CORNEAL 3400.0065770 PR REVISE CORNEA WITH IMPLANT 4100.0065778 PR PLACE AMNIOTIC MEMBRA

OCULAR SURFACE W/O SUTURES3431.00

65779 PR PLACE AMNIOTIC MEMBRANE OCULAR SURFACE SUTURED

600

65780 PR OCULAR SURF RECONST, AMNIOTIC TRANSPLANT, MULTIPLE

2500.00

65800 PR PARACENTSIS ANT CHAMB EYE ASPIR AQUEOUS SPX

301.00

65815 PR DRAIN ANT CHMBR,REMV BLOOD 1605.0065820 PR RELIEVE INNER EYE PRESSURE 1878.0065850 PR INCISION OF EYE 2400.0065855 PR TRABECULOPLASTY BY LASER

SURGERY854.00

65860 PR INCISE INNER EYE 814.0065865 PR INCISE INNER EYE 1181.0065875 PR INCISE POST SYNECHIAE,EYE 1595.00

65920 PR REMVL,IMPLANT MATERIAL,ANT SEGMENT,EYE

1980.00

66020 PR INJECTION,ANT CHAMBER,EYE,AIR/LIQUID

500.00

66030 PR INJECT ANTER CHMBR 412.0066170 PR GLAUCOMA SURG,TRABECU AB

EXTERNO3400.00

66172 PR GLAUCOMA SURG,TRAB AB EXT,PREV SCAR

4100.00

66180 PR AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT

3400.00

66183 PR INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR

3588.00

66184 PR REVJ SHUNT EXTRAOCULAR RESERVOIR W/O GRAFT

1987.00

66185 PR REVJ AQUEOUS SHUNT EXTRAOCULAR RESERVOIR

2400.00

66250 PR REVIS/REPAIR OP WOUND 1895.0066605 PR REMV IRIS,CYCLECTOMY 3739.0066625 PR REMV IRIS,PERIPH FOR 1400.0066682 PR SUTURE IRIS/CILIARY BODY 1601.0066710 PR DESTRUC,CILIARY

BODY,CYCLOPHOTOCOAG1097.00

66711 PR DESTRUC,CILIARY BODY,CYCLOPHOTO,ENDOSCO

1603.00

66761 PR IRIDOTOMY/IRIDECTOMY BY LASER, PER SESSION

900.00

66762 PR IRIDOPLASTY BY PHOTOCOAG 1183.0066821 PR DISCISSION,2ND 828.0066825 PR REPOSITION INTRAOCULAR

LENS W INCIS1904.00

66840 PR REMV LENS MATERIAL,ASPIRATN 1759.0066850 PR REMV LENS 2300.0066852 PR REMV LENS MATERIAL,PARS

PLANAR APPRC2500.00

66982 PR REMV CATARACT EXTRACAP,INSERT LENS,COMP

2800.00

66984 PR REMV CATARACT EXTRACAP,INSERT LENS

2100.00

66985 PR INSERT LENS PROSTHESIS ONLY 2200.0066986 PR EXCHANGE LENS PROSTHESIS 2500.0066990 PR OPHTHALMIC ENDOSCOPE USE 250.00

67005 PR PART REMV VITREOUS,ANT 1181.0067010 PR SUBTOT REMV VITREOUS,MECH

VIRECTOMY1369.00

67015 PR RELEAS VITREOUS,SUBRET/CHOROID FLUID

1460.00

67025 PR REPLACE EYE FLUID 1842.0067028 PR INJECT INTRAVITREAL 400.0067036 PR VITRECTOMY,MECHANICAL 3200.0067039 PR VITRECTOMY,FOCAL LASER RX 3400.0067040 PR VITRECTOMY,PANRETINAL 3700.0067041 PR VITRECTOMY PARS PLANA

REMOVE PRERETINAL MEMBRANE3800.00

67042 PR VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA

4032.00

67043 PR VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE

4300.00

67101 PR RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID CRTX

2100.00

67105 PR RPR RETINAL DTCHMNT DRG SUBRETINAL FLUID PC

1802.00

67107 PR REPAIR RETINAL DETACHMENT SCLERAL BUCKLING

3600.00

67108 PR RPR RETINAL DTCHMNT W/VITRECTOMY ANY METH

6412.00

67110 PR REPAIR DETACD RETINA,INJECT AIR/GAS

2400.00

67113 PR RPR COMPLEX RETINA DETACH VITRECT &MEMBRANE PEEL

4800.00

67115 PR RELEASE ENCIRCL MATERIAL,POST SGMT

610.00

67120 PR REMV POST EYE IMPLNT MATER,EXTRAOCUL

1800.00

67121 PR REMV POST EYE IMPLNT MATER,INTRAOCUL

2600.00

67141 PR PROPHYLAXIS RETINA DETACH,CRYO/DIATH

1331.00

67145 PR PROPHYLAXIS RETINA DETACH,PHOTOCOAG

1500.00

67208 PR DESTRUC RETINAL 1500.0067210 PR DESTRUC RETINAL 1293.0067218 PR DESTRUC RETINAL LESN,RADN 3600.0067220 PR DEST,CHOROID 1700.00

67221 PR DEST,CHOROID LESN,PHOTODYNAMIC THERAPY

820.00

67228 PR TREATMENT EXTENSIVE RETINOPATHY

2700.00

67229 PR TX EXTENSIVE RETINOPATHY, PRETERM INFANT

3268.00

67255 PR REINFORCE SCLERA EYE W 2400.0067311 PR STABISMUS SURG,ONE HORIZ 1600.0067312 PR STABISMUS SURG,TWO HORIZ 1900.0067314 PR STABISMUS SURG,ONE VERT 1800.0067316 PR STABISMUS SURG,2+ VERT 2200.0067318 PR STRABISMUS SURG,SUPER- 1787.0067320 PR TRANSPOSITION ANY 830.0067331 PR STRABISM SURG,PREV EYE

SURG,NOT MUSC800.00

67332 PR STRABISMUS SURG,SCAR EXTRAOCUL MUSC

920.00

67334 PR STRABISMUS SURG,POST FIXATN SUTURE

756.00

67335 PR STRABISMUS SURG,PLACE ADJUST SUTURE

430.00

67345 PR DESTROY NERVE OF EYE 700.0067400 PR EXPLORE EYE SOCKET 2700.0067405 PR EXPLORE EYE 2100.0067412 PR EXPLORE EYE SOCKET,REMV 2600.0067413 PR EXPLORE EYE SOCKET,REMV 2400.0067414 PR EXPLORE EYE 3600.0067415 PR NEEDLE ASPIR ORBITAL 420.0067420 PR LAT EXPLOR EYE SOCK,REMV 4300.0067445 PR LAT EXPLOR EYE 4931.0067500 PR RETROBULBAR 197.0067515 PR INJ,THER AGENT INTO TENON'S

CAPSULE260.00

67550 PR INSERT EYE SOCKET IMPLANT 3414.0067560 PR REVISE EYE SOCKET IMPLANT 3501.0067710 PR INCISION OF EYELID 555.0067715 PR INCISION OF EYELID FOLD 610.0067800 PR EXCIS CHALAZION,SINGLE 330.0067801 PR EXCIS CHALAZION,MULT,SAME 422.0067805 PR EXCIS CHALAZION,MULT,BOTH 527.0067808 PR EXCIS CHALAZION,GEN 970.00

67810 PR INCISIONAL BIOPSY EYELID SKIN & LID MARGIN

430.00

67820 PR REVISE EYELASHES,FORCEPS 125.0067825 PR REVISE EYELASHES 340.0067840 PR REMOVE EYELID LESN (NOT 720.0067850 PR DESTRUC EYELID LESN, <1 CM 543.0067875 PR TEMP CLOSURE EYELID BY 440.0067880 PR REVISION OF EYELID 990.0067882 PR REVISION EYELID,XPOSITN

TARSAL PLATE1490.00

67900 PR REPAIR BROW PTOSIS 161967901 PR FIX LID PTOSIS,FRONTALIS 1914.0067902 PR FIX LID PTOSIS,FRONT 1829.0067903 PR FIX LID PTOSIS,LEVATR 1580.0067904 PR FIX LID PTOSIS,LEVATR 1900.0067911 PR CORRECT LID RETRACTN 1520.0067912 PR CORRECTION EYELID W/ 2190.0067914 PR FIX ECTROPION,SUTURE 1167.0067917 PR FIX ECTROPION,ENTENSV LID 1560.0067921 PR FIX ENTROPION,SUTURE 1143.0067923 PR FIX ENTROPION,EXCIS TARSAL 1479.0067924 PR FIX ENTROPION,EXTENSV LID 1600.0067930 PR SUTURE EYELID 940.0067935 PR SUTURE EYELID WOUND,FULL 1540.0067938 PR REMOVE EYELID FOREIGN

BODY,EMBEDDED530.00

67950 PR CANTHOPLASTY 1434.0067961 PR REVISION OF EYELID,< 1/4 LID 1500.0067966 PR REVISION OF EYELID,> 1/4 LID 1980.0067971 PR RECONSTRUC EYELID,<2/3,ONE 2548.0067973 PR RECONSTRUC EYELID,TOT

LOWER,1 STAGE2703.00

67974 PR RECONSTRUC EYELID,TOT UPPER,1 STAGE

3271.00

67975 PR RECONSTRUC EYELID,SECOND 1780.0068100 PR BIOPSY OF CONJUNCTIVA 440.0068110 PR EXCIS CONJUNC LESN,=<1 CM 580.0068115 PR EXCIS CONJUNC LESN,>1 CM 780.0068135 PR DESTRUC CONJUNC LESN 420.0068200 PR SUBCONJUNCTIVAL INJECTN 105.0068320 PR REVISE CONJUNC,CONJUNC 1812.00

68326 PR REVISE CONJUNC,FIX CUL-DE-SAC+GRFT

1627.00

68328 PR REVISE CONJUNC,FIX CUL-DE-SAC=BUCCAL

1830.00

68335 PR REPAIR SYMBLEPHARON+FREE 1670.0068340 PR DIVISION OF SYMBLEPHARON 1380.0068362 PR CONJUNC FLAP,TOTAL 1700.0068440 PR INCISE TEAR DUCT OPENING 280.0068510 PR BIOPSY OF TEAR GLAND 1113.0068700 PR REPAIR TEAR DUCTS 1600.0068720 PR CREATE TEAR SAC-NASAL 2040.0068750 PR CREATE CONJUNC-NASAL

FISTULA+STENT2786.00

68760 PR CLOSE TEAR DUCT OPENING 525.0068761 PR CLOSE TEAR DUCT OPENING BY

PLUG,EA380.00

68801 PR DILATION NASOLACRIMAL DUCT 310.0068810 PR PROBE NASOLACRIMAL DUCT 620.0068811 PR PROBE NASOLAC DUCT W GEN 51768815 PR PROBE NASOLAC DUCT,INSERT

TUBE/STENT1060.00

68840 PR EXPLORE LACRIMAL CANALICULI 340.0068850 PR INJECTION FOR TEAR SAC X-RAY 155.0069000 PR DRAIN EXT EAR 417.0069005 PR DRAIN EXT EAR 455.0069020 PR DRAIN EXT AUD CANAL ABSCESS 584.0069090 PR PIERCE EARLOBES 68.0069100 PR BIOPSY OF EXTERNAL EAR 233.0069105 PR BIOPSY OF EXT AUDITORY 299.0069110 PR REMOVAL EXTERNAL 963.0069120 PR REMOVAL EXTERNAL EAR,TOTAL 882.0069140 PR REMV EXT CANAL EXOSTOSIS 1900.0069145 PR REMV EXT CANAL SOFT TISSUE 699.0069150 PR RAD EXCIS EXT CANAL LESN 3702.0069155 PR RAD EXCIS EXT CANAL

LESN+NECK DISSEC4500.00

69200 PR REMV EXT CANAL FOREIGN 273.0069205 PR REMV EXT CANAL F.B.,GEN 359.0069209 PR REMOVAL IMPACTED CERUMEN

IRRIGATION/LVG UNILAT33.00

69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT

113.00

69220 PR DEBRIDE MASTOID 287.0069222 PR DEBRIDE MASTOID 468.0069300 PR OTOPLASTY PROTRUDING EAR

W/WO SIZE RDCTJ1216.00

69310 PR RECONSTRUCTION,EXT AUDITORY CANAL

3338.00

69320 PR REBUILD EXT AUD CANAL,CONG ANOMALY

6000.00

69420 PR INCISION EARDRUM,ASPIR 400.0069421 PR INCISION EARDRUM,ASPIR,GEN 420.0069424 PR VENT TUBE REMVL REQ GEN

ANESTHESIA271.00

69433 PR CREATE EARDRUM OPENING,LOCAL ANESTH

507.00

69436 PR CREATE EARDRUM OPENING,GEN ANESTH

519.00

69440 PR EXPLORATION OF MIDDLE EAR 2358.0069501 PR MASTOIDECTOMY,SIMPLE 1920.0069502 PR MASTOIDECTOMY,COMPLETE 3450.0069505 PR MASTOIDECTOMY,MOD RADICAL 3161.0069511 PR MASTOIDECTOMY,RADICAL 3161.0069535 PR RESECT TEMPORAL

BONE,EXTERN APPRCH9487.00

69540 PR REMV AURAL POLYP 1423.0069550 PR REMV AURAL GLOMUS

TUMOR,TRANSCANAL3640.00

69552 PR REMV AURAL GLOMUS TUMOR,TRANSMASTOID

4468.00

69601 PR MASTOIDECT REVISN W COMPLETE REMVAL

3698.00

69602 PR MASTOID REVISN ->MOD RAD MASTOIDECT

3861.00

69603 PR MASTOID REVISN ->RAD MASTOIDECTOMY

4408.00

69610 PR REPAIR TYMPANIC MEMBRANE 936.0069620 PR MYRINGOPLASTY 1770.0069631 PR TYMPANOPLASTY 5000.0069632 PR TYMPANOPLASTY,REBUILD

OSSICUL CHAIN3079.00

69633 PR TYMPANOPLASTY,REBLD OSSIC CHAIN+PROS

6500.00

69635 PR TYMPANOPLAS/ANTROTOMY 3109.00

69636 PR TYMPANOPLAS/ANTROT,REBLD OSSIC CHAIN

4875.00

69637 PR TYMPANOPLAS/ANTROT,REBLD OSSIC+PROST

3152.00

69641 PR 3500.0069642 PR

TYMPANOPLAS/MASTOIDEC,REBLD 3858.00

69643 PR TYMPANOPLAS/MASTOIDEC,INTACT

3858.00

69644 PR TYMPANOPLAS/MASTOID,INTCT WALL,REBLD

3914.00

69645 PR TYMPANOPLAS/MASTOIDEC,RADICAL/COMPLE

3840.00

69646 PR TYMPANOPLAS/MASTOIDEC,RAD,RE

7575.00

69650 PR STAPES MOBILIZATION 206369660 PR STAPEDECTOMY 2932.0069661 PR STAPEDECTOMY,FOOTPLATE 3258.0069662 PR REVISE

STAPEDECTOMY/STAPEDOTOMY4056.00

69666 PR REPAIR OVAL WINDOW FISTULA 2688.0069667 PR REPAIR ROUND WINDOW 2688.0069670 PR MASTOID OBLITERATION 3320.0069710 PR IMPLANT/REPLACE HEAR

AID,TEMP BONE2655.00

69711 PR REMOVE/REPAIR HEAR AID,TEMP 3015.0069714 PR IMPLNT,TEMPORAL 3308.0069717 PR REPLCE IMPLNT,TEMPORAL

BONE,W/EXTRN STIM3527.00

69718 PR REPLCE IMPLNT,TEMPORAL BONE,REMV MASTOID

4750.00

69720 PR RELEASE FACIAL NERVE,LAT TO GANGLION

4300.00

69740 PR REPAIR FACIAL NERVE,LAT TO GANGLION

3407.00

69801 PR LABYRINTHOTOMY W PERFUSION VESTIBULOACTIVE

1602.00

69805 PR ENDOLYMPH SAC OPERATN,NO 3263.0069806 PR ENDOLYMPH SAC OP W SHUNT 3263.0069905 PR EXCIS LABYRINTH,TRANSCANAL 3903.0069930 PR IMPLANT COCHLEAR DEVICE 4468.00

69960 PR DECOMPRESS INTERN AUDITORY CANAL

7714.00

69990 PR MICROSURG TECHNIQUES,REQ OPER MICROSCOPE

1117.00

70015 PR CISTERNOGRAPHY,POS 26 206.0070030 PR X-RAY EYE FOR FOREIGN BODY 26 30.0070100 CHG X-RAY JAW <4 VW 84.0070100 CHG X-RAY JAW <4 VW 26 31.0070110 CHG X-RAY JAW 4+ VW 96.0070110 CHG X-RAY JAW 4+ VW 26 43.0070120 CHG X-RAY MASTOIDS <3 VW 26 31.0070140 CHG X-RAY FACIAL BONES <3 VW 75.0070140 CHG X-RAY FACIAL BONES <3 VW 26 34.0070150 CHG X-RAY FACIAL BONES 3+ VW 104.0070150 CHG X-RAY FACIAL BONES 3+ VW 26 45.0070160 PR X-RAY NASAL BONES 82.0070160 PR X-RAY NASAL BONES 26 30.0070190 PR X-RAY OPTIC FORAMEN 26 36.0070200 CHG X-RAY ORBITS 106.0070200 CHG X-RAY ORBITS 26 48.0070200 CHG X-RAY ORBITS TC 73.0070210 CHG X-RAY SINUSES <3 VW 26 30.0070220 CHG X-RAY SINUSES 3+ VW 94.0070220 CHG X-RAY SINUSES 3+ VW 26 43.0070250 CHG X-RAY SKULL <4 VW 91.0070250 CHG X-RAY SKULL <4 VW 26 41.007025F PR PT INFO IN REMIND SYSTEM W/

TARGET DATE FOR NEXT MAMMO0.00

70260 CHG X-RAY SKULL 4+ VW 115.0070260 CHG X-RAY SKULL 4+ VW 26 58.0070300 PR X-RAY TEETH SINGLE 20.0070300 PR X-RAY TEETH SINGLE 26 20.0070310 PR X-RAY TEETH PARTIAL 25.0070328 PR X-RAY TMJ UNILAT 7870328 PR X-RAY TMJ UNILAT 26 2470330 PR X-RAY TMJ BILAT 11870330 PR X-RAY TMJ BILAT 26 3270332 PR X-RAY TMJ ARTHROGRAM 26 184.0070336 PR MRI, TMJ 26 257.0070355 PR ORTHOPANTOGRAM 53.0070355 PR ORTHOPANTOGRAM 26 35.0070360 PR X-RAY NECK SOFT TISSUE 61.00

70360 PR X-RAY NECK SOFT TISSUE 26 30.0070450 PR CT SCAN,HEAD/BRAIN,W/O

CONTRAST MATL26 148.00

70460 PR CT SCAN HEAD CONTRAST 26 197.0070470 PR CT SCAN HEAD COMBO 26 221.0070480 PR CT SCAN,ORBIT/SELLA/POST

FOSSA/EAR,W/O26 222.00

70481 PR CT SCAN SKULL CONTRAST 26 239.0070482 PR CT SCAN SKULL COMBO 26 251.0070486 PR CT SCAN,MAXILLOFACIAL

AREA,W/O CONTRAST26 221.00

70487 PR CT SCAN, FACE/JAW CONTRAST 26 227.0070488 PR CT SCANS FACE/JAW COMBO 26 246.0070490 PR CT SCAN,SOFT TISSUE

NECK,W/O CONTRAST26 222.00

70491 PR CT NECK TISSUE CONTRAST 26 239.0070492 PR CT NECK TISSUE COMBO 26 251.0070496 PR CT ANGIO,HEAD COMBO,INCL

IMAGE PROCESS26 314.00

70498 PR CT ANGIO,NECK COMBO,INCL IMAGE PROCESS

26 314.00

70540 PR MRI, FACE, NECK 26 233.0070542 PR MRI, FACE, NECK W/CONTRAST 26 280.0070543 PR MRI, FACE, NECK, COMBO 26 371.0070544 PR MR ANGIO, HEAD 26 208.0070545 PR MR ANGIO, HEAD W/CONTRAST 26 208.0070546 PR MR ANGIO, HEAD, COMBO 26 312.0070547 PR MR ANGIO, NECK 26 208.0070548 PR MR ANGIO, NECK W/CONTRAST 26 208.0070549 PR MR ANGIO, NECK, COMBO 26 312.0070551 PR MRI BRAIN 26 257.0070552 PR MRI BRAIN CONTRAST 26 311.0070553 PR MRI BRAIN COMBO 26 409.0070554 PR FUNCTIONAL MRI BRAIN BY TECH 26 239.0070555 PR FUNCTIONAL MRI BRAIN BY

PHYS/PSYCH26 414.00

70557 PR MRI BRAIN W/O DYE 26 433.0070558 PR MRI BRAIN W/ DYE 26 400.0070559 PR MRI BRAIN W/O & W/ DYE 26 404.0071010 PR CHEST X-RAY 1 VW 57.0071010 PR CHEST X-RAY 1 VW 26 31.0071020 CHG CHEST X-RAY 2 VW 77.00

71020 CHG CHEST X-RAY 2 VW 26 39.0071021 CHG CHEST X-RAY W APICAL LORD 26 46.0071022 CHG CHEST X-RAY W OBLIQUES 26 54.0071023 CHG CHEST X-RAY W FLUORO 26 67.0071030 CHG CHEST X-RAY 4 VW 26 51.0071035 PR CHEST X-RAY SPEC VIEWS 86.0071035 PR CHEST X-RAY SPEC VIEWS 26 31.0071045 CHG RADIOLOGIC EXAM CHEST

SINGLE VIEW51.00

71045 CHG RADIOLOGIC EXAM CHEST SINGLE VIEW

26 24.00

71045 CHG RADIOLOGIC EXAM CHEST SINGLE VIEW

TC 27.00

71046 CHG RADIOLOGIC EXAM CHEST 2 78.0071046 CHG RADIOLOGIC EXAM CHEST 2 26 28.0071047 CHG RADIOLOGIC EXAM CHEST 3 99.0071047 CHG RADIOLOGIC EXAM CHEST 3 26 36.0071048 CHG RADIOLOGIC EXAM CHEST 4+ 107.0071048 CHG RADIOLOGIC EXAM CHEST 4+ 26 42.0071100 CHG X-RAY RIBS 2 VW UNILAT 74.0071100 CHG X-RAY RIBS 2 VW UNILAT 26 39.0071100 CHG X-RAY RIBS 2 VW UNILAT TC 55.0071101 CHG X-RAY RIBS, CHEST 3+ VW 89.0071101 CHG X-RAY RIBS, CHEST 3+ VW 26 46.0071101 CHG X-RAY RIBS, CHEST 3+ VW TC 65.0071110 CHG X-RAY RIBS 3 VW BILAT 26 46.0071110 CHG X-RAY RIBS 3 VW BILAT TC 67.0071111 CHG X-RAY RIBS, CHEST 4+ VW 128.0071111 CHG X-RAY RIBS, CHEST 4+ VW 26 55.0071111 CHG X-RAY RIBS, CHEST 4+ VW TC 91.0071120 CHG X-RAY STERNUM 2+ VW 76.0071120 CHG X-RAY STERNUM 2+ VW 26 35.0071120 CHG X-RAY STERNUM 2+ VW TC 53.0071130 CHG X-RAY STERNO-CLAVICLUAR JT 26 39.0071130 CHG X-RAY STERNO-CLAVICLUAR JT TC 64.0071250 PR CT SCAN,THORAX,W/O 26 202.0071260 PR CAT SCAN OF CHEST CONTRAST 26 214.0071270 PR CAT SCAN OF CHEST COMBO 26 239.0071275 PR CT ANGIO, CHEST (NON-CORON),

COMBO, INCL IMG PROC26 343.00

71550 PR MRI, CHEST 26 251.0071551 PR MRI, CHEST, W/CONTRAST 26 298.00

71552 PR MRI, CHEST, COMBO 26 381.0071555 PR MR ANGIO CHEST (MRA) 26 315.0072020 PR X-RAY SPINE ONE VIEW 67.0072020 PR X-RAY SPINE ONE VIEW 26 26.0072020 PR X-RAY SPINE ONE VIEW TC 38.0072040 CHG RADEX SPINE CERVICAL 2 OR 3 92.0072040 CHG RADEX SPINE CERVICAL 2 OR 3 26 39.0072040 CHG RADEX SPINE CERVICAL 2 OR 3 TC 59.0072050 CHG RADEX SPINE CERVICAL 4 OR 5 120.0072050 CHG RADEX SPINE CERVICAL 4 OR 5 26 54.0072050 CHG RADEX SPINE CERVICAL 4 OR 5 TC 80.0072052 CHG RADEX SPINE CERVICAL 6 OR

MORE VIEWS150.00

72052 CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS

26 64.00

72052 CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS

TC 107.00

72070 CHG X-RAY THORACIC SPINE 2 VW 79.0072070 CHG X-RAY THORACIC SPINE 2 VW 26 39.0072070 CHG X-RAY THORACIC SPINE 2 VW TC 57.0072072 CHG X-RAY THORACIC SPINE+SWIM 87.0072072 CHG X-RAY THORACIC SPINE+SWIM 26 39.0072072 CHG X-RAY THORACIC SPINE+SWIM TC 65.0072074 CHG X-RAY THORACIC SPINE 4 VW 107.0072074 CHG X-RAY THORACIC SPINE 4 VW 26 39.0072074 CHG X-RAY THORACIC SPINE 4 VW TC 82.0072080 CHG RADEX SPINE

THORACOLUMBAR JUNCTION MIN 2 88.00

72080 CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2

26 39.00

72080 CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2

TC 60.00

72081 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW

98.00


26 34.00


TC 63.00

72082 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW

156.00


26 42.00


TC 116.00


169.00


26 45.00


TC 142.00

72084 CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW

201.00


26 52.00


TC 165.00

72100 CHG X-RAY LUMBAR SPINE 2/3 VW 87.0072100 CHG X-RAY LUMBAR SPINE 2/3 VW 26 39.0072100 CHG X-RAY LUMBAR SPINE 2/3 VW TC 60.0072110 CHG X-RAY LUMBAR SPINE 4 VW 120.0072110 CHG X-RAY LUMBAR SPINE 4 VW 26 54.0072110 CHG X-RAY LUMBAR SPINE 4 VW TC 83.0072114 PR RADEX SPINE LUMBSCRL COMPL

W/BENDING VIEWS MIN 626 64.00

72114 PR RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6

TC 115.00

72120 PR RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS

102.00


26 29.00


TC 74.00

72125 PR CT SCAN,CERVICAL SPINE,W/O CONTRAST

26 202.00

72126 PR CT SCAN CERV SPINE 26 211.0072127 PR CT SCAN CERV SP COMBO 26 148.0072128 PR CT SCAN,THORACIC SPINE,W/O

CONTRAST26 135.00

72129 PR CT SCAN DORSAL SP CONTRAST 26 142.0072130 PR CT SCAN DORSAL SP COMBO 26 148.0072131 PR CT SCAN,LUMBAR SPINE,W/O

CONTRAST26 135.00

72132 PR CT SCAN LUMBAR SP CONTRAST 26 142.0072133 PR CT SCAN LUMBAR SP COMBO 26 148.00

72141 PR MRI, CERV SPINE 26 186.0072142 PR MRI, CERV SPINE CONTRAST 26 225.0072146 PR MRI, DORSAL SPINE 26 186.0072147 PR MRI, DORSAL SPINE CONTRAST 26 224.0072148 PR MRI, LUMBAR SPINE 26 173.0072149 PR MRI, LUMBAR SPINE CONTRAST 26 208.0072156 PR MRI, CERV SPINE COMBO 26 298.0072157 PR MRI, DORSAL SPINE COMBO 26 298.0072158 PR MRI, LUMBAR SPINE COMBO 26 274.0072159 PR MR ANGIO SPINE (MRA) 26 215.0072170 CHG X-RAY PELVIS 1/2 VW 68.0072170 CHG X-RAY PELVIS 1/2 VW 26 21.0072170 CHG X-RAY PELVIS 1/2 VW TC 58.0072190 CHG X-RAY PELVIS 3+ VW 101.0072190 CHG X-RAY PELVIS 3+ VW 26 25.0072191 PR CT ANGIO, PELVIS, COMBO, INCL

IMAGE PROC26 211.00

72192 PR CT SCAN,PELVIS,W/O CONTRAST 26 127.0072193 PR CT SCAN OF PELVIS CONTRAST 26 135.0072194 PR CT SCAN OF PELVIS COMBO 26 142.0072195 PR MRI, PELVIS, W/O CONTRAST 26 170.0072196 PR MRI, PELVIS W/CONTRAST 26 202.0072197 PR MRI, PELVIS, COMBO 26 262.0072198 PR MR ANGIO PELVIS(MRA) 26 209.0072200 CHG X-RAY SACROILIAC JTS <3 VW 26 21.0072202 CHG X-RAY SACROILIAC JTS 3+ VW 84.0072202 CHG X-RAY SACROILIAC JTS 3+ VW 26 22.0072220 CHG X-RAY SACRUM/COCCYX 2+ VW 70.0072220 CHG X-RAY SACRUM/COCCYX 2+ VW 26 21.0072220 CHG X-RAY SACRUM/COCCYX 2+ VW TC 50.0072240 PR MYELOGRAPHY CERV SPINE 26 105.0072275 PR 26 100.0072285 PR X- 26 151.0073000 PR X-RAY CLAVICLE 69.0073000 PR X-RAY CLAVICLE 26 19.0073000 PR X-RAY CLAVICLE TC 51.0073010 PR X-RAY SCAPULA 78.0073010 PR X-RAY SCAPULA 26 21.0073010 PR X-RAY SCAPULA TC 55.0073020 CHG X-RAY SHOULDER 1 VW 57.0073020 CHG X-RAY SHOULDER 1 VW 26 18.0073020 CHG X-RAY SHOULDER 1 VW TC 40.00

73030 CHG X-RAY SHOULDER 2+ VW 72.0073030 CHG X-RAY SHOULDER 2+ VW 26 22.0073030 CHG X-RAY SHOULDER 2+ VW TC 51.0073040 PR ARTHROGRAM OF SHOULDER 26 64.0073050 PR X-RAY AC JTS 98.0073050 PR X-RAY AC JTS 26 24.0073050 PR X-RAY AC JTS TC 70.0073060 CHG X-RAY HUMERUS 68.0073060 CHG X-RAY HUMERUS 26 21.0073060 CHG X-RAY HUMERUS TC 52.0073070 CHG X-RAY ELBOW 2 VW 68.0073070 CHG X-RAY ELBOW 2 VW 26 18.0073080 CHG X-RAY ELBOW 3+ VW 79.0073080 CHG X-RAY ELBOW 3+ VW 26 21.0073080 CHG X-RAY ELBOW 3+ VW TC 61.0073085 PR ARTHROGRAM OF ELBOW 26 64.0073090 CHG X-RAY FOREARM 2 VW 68.0073090 CHG X-RAY FOREARM 2 VW 26 19.0073090 CHG X-RAY FOREARM 2 VW TC 48.0073092 CHG X-RAY ARM, INFANT 79.0073092 CHG X-RAY ARM, INFANT 26 19.0073092 CHG X-RAY ARM, INFANT TC 50.0073100 CHG X-RAY WRIST 2 VW 75.0073100 CHG X-RAY WRIST 2 VW 26 19.0073110 CHG X-RAY WRIST 3+ VW 88.0073110 CHG X-RAY WRIST 3+ VW 26 21.0073115 PR ARTHROGRAM OF WRIST 26 64.0073120 CHG X-RAY HAND 2 VW 65.0073120 CHG X-RAY HAND 2 VW 26 19.0073130 CHG X-RAY HAND 3+ VW 77.0073130 CHG X-RAY HAND 3+ VW 26 21.0073140 CHG X-RAY EXAM OF FINGER(S) 82.0073140 CHG X-RAY EXAM OF FINGER(S) 26 16.0073140 CHG X-RAY EXAM OF FINGER(S) TC 64.0073200 PR CT SCAN,UPPER EXTREMITY,W/O

CONTRAST26 127.00

73201 PR CT SCAN OF ARM CONTRAST 26 135.0073202 PR CT SCAN OF ARM COMBO 26 142.0073206 PR CT ANGIO,UPPER 26 211.0073218 PR MRI, UPPER EXTREM 26 157.0073219 PR MRI, UPPER EXTREM 26 189.0073220 PR MRI UPPER EXTR, W/CONTRAST 26 250.00

73221 PR MRI, JOINT UPPER EXTREM 26 157.0073222 PR MRI, JOINT UPPER EXTREM

W/CONTRAST26 189.00

73223 PR MRI, JOINT UPPER EXTREM 26 250.0073225 PR MR ANGIO UPPER EXTREM 26 207.0073501 CHG RADEX HIP UNILATERAL WITH

PELVIS 1 VIEW76.00

73501 CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW

26 25.00

73501 CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW

TC 52.00

73502 CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS

104.00


26 29.00


TC 76.00

73503 CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS

130.00

73503 CHG RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS

26 37.00

73521 CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS

101.00


26 30.00


TC 70.00

73522 CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS

123.00


26 39.00


TC 85.00

73523 CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS

143.00


26 42.00


TC 102.00

73525 PR ARTHROGRAM OF HIP 26 65.0073551 CHG RADIOLOGIC EXAMINATION

FEMUR 1 VIEW70.00

73551 CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW

26 22.00

73551 CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW

TC 49.00

73552 CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS

82.00


26 25.00


TC 59.00

73560 CHG X-RAY KNEE 1 OR 2 VIEW 73.0073560 CHG X-RAY KNEE 1 OR 2 VIEW 26 21.0073560 CHG X-RAY KNEE 1 OR 2 VIEW TC 57.0073562 CHG X-RAY KNEE 3 VIEW 88.0073562 CHG X-RAY KNEE 3 VIEW 26 22.0073562 CHG X-RAY KNEE 3 VIEW TC 67.0073564 CHG X-RAY KNEE 4+ VIEW 106.0073564 CHG X-RAY KNEE 4+ VIEW 26 26.0073564 CHG X-RAY KNEE 4+ VIEW TC 77.0073565 PR X-RAY KNEE BILAT STANDING 84.0073565 PR X-RAY KNEE BILAT STANDING 26 21.0073580 PR ARTHROGRAM OF KNEE JOINT 26 64.0073590 CHG X-RAY TIB + FIB, 2VW 72.0073590 CHG X-RAY TIB + FIB, 2VW 26 21.0073590 CHG X-RAY TIB + FIB, 2VW TC 51.0073592 CHG X-RAY LEG, INFANT 69.0073592 CHG X-RAY LEG, INFANT 26 19.0073592 CHG X-RAY LEG, INFANT TC 50.0073600 CHG X-RAY ANKLE 2 VW 68.0073600 CHG X-RAY ANKLE 2 VW 26 19.0073600 CHG X-RAY ANKLE 2 VW TC 54.0073610 CHG X-RAY ANKLE 3+ VW 81.0073610 CHG X-RAY ANKLE 3+ VW 26 21.0073610 CHG X-RAY ANKLE 3+ VW TC 61.0073620 CHG X-RAY FOOT 2 VW 67.0073620 CHG X-RAY FOOT 2 VW 26 19.0073620 CHG X-RAY FOOT 2 VW TC 48.0073630 CHG X-RAY FOOT 3+ VW 77.0073630 CHG X-RAY FOOT 3+ VW 26 21.0073630 CHG X-RAY FOOT 3+ VW TC 50.0073650 CHG X-RAY HEEL 69.0073650 CHG X-RAY HEEL 26 19.00

73660 CHG X-RAY TOE(S) 68.0073660 CHG X-RAY TOE(S) 26 16.0073660 CHG X-RAY TOE(S) TC 58.0073700 PR CT SCAN,LOWER

EXTREMITY,W/O CONTRAST26 127.00

73701 PR CT SCAN OF LEG CONTRAST 26 135.0073702 PR CT SCAN OF LEG COMBO 26 142.0073706 PR CT ANGIO,LOWER

EXTREM,COMBO,IMAGE PRC26 222.00

73718 PR MRI, LOWER EXTREM 26 157.0073719 PR MRI, LOWER EXTREM 26 188.0073720 PR MRI, LOWER EXTR, W/O

CONTRAST F/U BY CONTRAST26 249.00

73721 PR MRI LOWER EXTREM JT, W/O 26 157.0073722 PR MRI, JOINT OF LEG W/CONTRAST 26 189.0073723 PR MRI, JOINT OF LEG. COMBO 26 250.0073725 PR MR ANGIO LOWER EXTREM 26 212.0074000 PR X-RAY ABDOMEN 1 VW 60.0074000 PR X-RAY ABDOMEN 1 VW 26 22.0074010 PR X-RAY ABDOMEN 1+ VW 26 28.0074018 CHG RADIOLOGIC EXAM ABDOMEN 1 70.0074018 CHG RADIOLOGIC EXAM ABDOMEN 1 26 24.0074018 CHG RADIOLOGIC EXAM ABDOMEN 1 TC 46.0074019 CHG RADIOLOGIC EXAM ABDOMEN 2 85.0074019 CHG RADIOLOGIC EXAM ABDOMEN 2 26 30.0074019 CHG RADIOLOGIC EXAM ABDOMEN 2 TC 55.0074020 PR X-RAY ABDOMEN 2 VW 90.0074020 PR X-RAY ABDOMEN 2 VW 26 32.0074021 CHG RADIOLOGIC EXAM ABDOMEN

3+ VIEWS99.00

74021 CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS

26 36.00

74021 CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS

TC 63.00

74022 PR X-RAY ABDOMEN,COMP ACUTE 117.0074022 PR X-RAY ABDOMEN,COMP ACUTE 26 37.0074022 PR X-RAY ABDOMEN,COMP ACUTE TC 81.0074150 PR CT SCAN,ABDOMEN,W/O 26 138.0074160 PR CT SCAN OF ABDOMEN 26 148.0074170 PR CT SCAN OF ABDOMEN COMBO 26 163.0074174 PR CT ANGIO ABD&PLVIS CNTRST

MTRL W/WO CNTRST IMGES26 260.00

74175 PR CT ANGIO, ABD, COMBO,INCL IMAGE PROC

26 221.00

74176 CHG CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST

26 208.00

74177 PR CT SCAN,ABDOMEN AND PELVIS,W CONTRAST

26 218.00

74178 CHG CT SCAN,ABDOMENT AND PELVIS,COMBO

26 241.00

74181 PR MRI, ABDOMEN (MRI) 26 169.0074182 PR MRI, ABDOMEN W/CONTRAST 26 202.0074183 PR MRI, ABDOMEN, COMBO 26 262.0074185 PR MR ANGIO ABDOMEN (MRA) 26 209.0074190 PR X-RAY PERITONEUM 26 57.0074210 PR CONTRAST XRAY THROAT/CERV

ESOPHA26 43.00

74220 PR ESOPHAGRAM 26 54.0074230 PR SWALLOWING FCN,W/CINE &/OR 26 62.0074240 CHG RADEX GI TRACT UPPER W/WO

DELAYED IMAGES W/O KUB26 80.00

74241 CHG RADEX GI TRACT UPPER W/WO DELAYED IMAGES W/KUB

26 80.00

74245 CHG RADEX GI TRACT UPR W/SM INT W/MULT SERIAL IMAGES

26 106.00

74246 CHG RADEX UPPER GI W/WO GLUCAGON/DELAY IMGES W/O KUB

26 80.00

74247 CHG RADEX UPPER GI W/WO GLUCAGON/DELAY IMAGES W/KUB

26 80.00

74249 CHG X-RAY,UPPER GI TRACT W/CONT,SMALL INTEST

26 106.00

74250 CHG RADEX SMALL INTESTINE W/MULTIPLE SERIAL IMAGES

26 55.00

74261 CHG CT COLONOGRAPHY INC IMAGE PROCESS, DIAGNOSTIC, W/O

26 267.00

74262 CHG CT COLONOGRAPHY INC IMAGE PROCESS, DIAGNOSTIC, W/

26 293.00

74263 CHG CT COLONOGRAPHY INC IMAGE PROCESS, SCREENING

26 279.00

74270 CHG X-RAY COLON CONTRAST 26 80.0074280 PR X-RAY COLON AIR CONTRAST 26 115.0074283 PR X-RAY B.E. REDUCTN INTUSS 26 235.0074300 PR X-RAY OPER CHOLANGIOGRAM 26 43.0074328 PR X-RAY FOR BILE DUCT 26 82.00

74329 PR X-RAY FOR PANCREAS 26 82.0074330 PR X-RAY BILE/PANCREAS 26 105.0074340 CHG INTRO LONG GI TUBE W/MULT

FLUORO & IMAGES RS&I26 64.00

74360 PR X-RAY GUIDE, GI DILATION 26 66.0074363 PR PERCUT TRANSHEPAT

DILAT,BILE DUCT STRICT26 102.00

74400 PR X-RAY IV PYELOGRAM (IVP) 276.0074400 PR X-RAY IV PYELOGRAM (IVP) 26 63.0074420 PR X-RAY RETROGRADE 26 46.0074425 PR X-RAY ANTEGRADE PYELOGRAM 26 43.0074430 X-RAY CYSTOGRAM, MIN 3 VIEW 26 38.0074445 PR X-RAY PENIS 26 137.0074450 PR X-RAY URETHROCYSTOGRAM 26 43.0074455 PR X-RAY 26 40.0074485 PR X-RAY GUIDE, GU DILATION 26 64.0074712 CHG FETAL MRI W/PLACNTL MATRNL

PLVC IMG SING/1ST GES26 384.00

74740 PR X-RAY HYSTEROSALPINGOGRAM 26 45.0075557 CHG CARDIAC MRI MORPHOLOGY &

FUNCTION W/O CONTRAST26 254.00

75559 CHG CARDIAC MRI W/O CONTRAST W STRESS IMAGING

26 362.00

75561 CHG CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ

26 281.00

75563 CHG CARDIAC MRI W/W/O CONTRAST W STRESS

26 337.00

75565 CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING

26 31.00

75571 CHG CT HEART W/O CONTRAST QUANT EVAL CORONARY CALCIUM

26 69.00

75572 CHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH

26 207.00

75573 CHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH, CONGEN

26 296.00

75574 PR CT ANGIO HRT CORNRY ART/BYPASS GRFTS CONTRST 3D

26 282.00

75600 PR ANGIO AORTOGRAM THORACIC 26 65.0075605 PR ANGIO AORTOGRAM THOR 26 196.0075625 PR ANGIO AORTOGRAM ABD SERIAL 26 146.0075630 PR ANGIO AORTOBIFEMORAL W 26 216.0075635 PR CT ANGIO AORTOBIFEMORAL, 26 281.00

75658 PR ANGIO RETRO BRACHIAL ANGIO 26 159.0075705 PR ANGIO SPINAL SELECTV 26 289.0075710 PR ANGIO EXTREMITY UNILAT 26 147.0075716 PR ANGIO EXTERMITY BILAT 26 167.0075726 PR ANGIO VISCERAL 26 134.0075731 PR ANGIO ADRENAL UNILAT SELECT 26 135.0075736 PR ANGIO PELVIS 26 135.0075741 PR ANGIO PULMON UNILAT SELECT 26 154.0075743 PR ANGIO PULMON BILAT SELECT 26 193.0075756 PR ANGIO INTERN MAMMARY 26 203.0075774 PR ANGIO EA ADDNL SELECTV 26 43.0075791 CHG ANGIO AV SHUNT COMPLETE 26 201.0075801 PR LYMPHANGIO EXTREM UNILAT 26 97.0075803 PR LYMPHANGIO EXTREM BILAT 26 154.0075805 PR LYMPHANGIO ABD/PELV UNILAT 26 96.0075807 PR LYMPHANGIO ABD/PELV BILAT 26 136.0075809 PR NONVASCULAR SHUNTOGRAM 26 100.0075810 PR VENOGRAM 26 146.0075820 PR VENOGRAM EXTREM UNILAT 26 83.0075822 PR VENOGRAM EXTREM BILAT 26 132.0075825 PR VENOGRAM INFER VENA CAVA 26 134.0075827 PR VENOGRAM SUPER VENA CAVA 26 133.0075831 PR VENOGRAM RENAL UNILAT 26 133.0075833 PR VENOGRAM RENAL BILAT 26 175.0075840 PR VENOGRAM ADRENAL UNILAT 26 137.0075860 PR VENOGRAM SINUS/JUGULAR 26 138.0075870 PR VENOGRAM SUPER SAG SINUS 26 136.0075885 PR PERCUT XHEPATIC 26 168.0075887 PR PERCUT XHEPATIC PORTOGRAM 26 169.0075889 PR VENOGRAM HEPATIC W

HEMODYNAMICS26 133.00

75891 PR VENOGRAM HEPATIC 377.0075891 PR VENOGRAM HEPATIC 26 142.0075893 PR VENOUS SAMPLING BY 26 64.0075894 PR TRANSCATHETER RX 26 172.0075898 CHG ANGRPH CATH F-UP STD TCAT

OTHER THAN THROMBYLSIS26 218.00

75901 PR REMOVE,OBST MATL,CVA DEV VIA SEP VEN ACC

26 58.00

75902 PR REMOVE,OBST MATL,CVA DEVICE VIA LUMEN

26 46.00

75952 PR ENDOVASC REPAIR AAA 26 560.00

75953 PR PLACEMNT,PROX/DIST EXT PROS, INFRARENAL

26 162.00

75954 CHG REPAIR,ILIAC ANRYSM/PSEUDO/AV MALF/TRAUMA

26 260.00

75956 PR ENDOVASC REPAIR THOR AORTA INCL SUBCLAVIAN

855.00

75956 PR ENDOVASC REPAIR THOR AORTA INCL SUBCLAVIAN

26 855.00

75957 PR ENDOVASC REPAIR THOR AORTA EXCL SUBCLAVIAN

26 733.00

75958 PR PROXIMAL EXTENS DURNG ENDOVASC REPR THOR AORTA

26 488.00

75959 PR DELAYED PROX EXTENS ENDOVASC REPR THOR AORTA

26 450.00

75962 PR TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI

26 65.00

75966 PR BALLOON ANGIOPLASTY 26 159.0075968 PR BALLOON ANGIO ADDNL 26 44.0075970 PR VASCULAR BIOPSY 26 99.0075978 PR BALLOON ANGIO VENOUS 26 64.0075984 CHANGE PERCUT TUBE/DRAIN CATH

W CONTRAST MONIT26 84.00

75989 PR RAD GUIDED,PERCUT DRAINAGE,W/CATH PLACE

26 138.00

76000 CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME

26 121.00

76001 CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME

26 80.00

76010 PR X-RAY NOSE-RECTUM CHILD F.B. 26 22.0076080 PR X-RAY FISTULA,ABSCESS,SINUS 26 64.0076098 PR X-RAY EXAM, BREAST SPECIMEN 26 19.0076120 PR CINE/VIDEORADIOLOGY,EXC

WHERE SPEC INCL26 47.00

76140 PR X-RAY CONSULTATION 115.0076376 CHG 3D RENDERING W/INTERP &

POSTPROCESS SUPERVISION162.00

76376 CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION

26 25.00

76377 CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK

212.00

76377 CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK

26 96.00

76380 PR CT SCAN,LIMITED/LOCALIZED F/U 26 114.0076390 PR MRI SPECTROSCOPY 26 162.0076496 CHG UNLISTED FLUOROSCOPIC

PROCEDURE26 205.00

76497 PR UNLISTED CT PROCEDURE 26 150.0076498 PR UNLISTED MR PROCEDURE 26 308.0076499 CHG UNLISTED DX RADIOGRAPHIC

PROCEDURE26 100.00

76506 US, HEAD, REAL TIME 26 78.0076511 US, EYE A-SCAN 26 135.0076512 US, EYE B-SCAN 26 135.0076513 US, EYE,ANTERIOR 26 91.0076514 US, EYE, FOR CORNEAL THICKNESS 26 25.0076516 US, EYE BIOMETRY 197.0076516 US, EYE BIOMETRY 26 78.0076519 US, EYE BIOMETRY W LENS CALC 212.0076519 US, EYE BIOMETRY W LENS CALC 26 80.0076536 US, HEAD/NECK TISSUES,REAL TIME 302.0076536 US, HEAD/NECK TISSUES,REAL TIME 26 64.0076604 US, CHEST,REAL TIME 26 63.0076641 CHG US BREAST UNI REAL TIME

WITH IMAGE COMPLETE26 91.00

76642 CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED

26 85.00

76700 US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE

26 95.00

76705 US ABDOMEN LIMITED 270.0076705 US ABDOMEN LIMITED 26 69.0076706 CHG US ABDOMINAL AORTA REAL

TIME SCREEN STUDY AAA239.00

76706 CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA

26 71.00

76770 PR US,RETROPERIT,REAL 321.0076770 PR US,RETROPERIT,REAL 26 87.0076775 US, RETROPERITNL ABD, LTD 259.0076775 US, RETROPERITNL ABD, LTD 26 88.0076776 PR US,TRANSPLANTED KIDNEY,

REAL TIME/ DOPPLER26 87.00

76800 US, SPINAL CANAL & CONTENTS 26 151.0076801 US, OB < 14 WKS, SINGLE FETUS 310.0076801 US, OB < 14 WKS, SINGLE FETUS 26 123.0076802 US, OB < 14 WKS, ADD'L FETUS 163.00

76802 US, OB < 14 WKS, ADD'L FETUS 26 95.0076805 US, OB >/= 14 WKS, SNGL FETUS 358.0076805 US, OB >/= 14 WKS, SNGL FETUS 26 130.0076810 US, OB >/= 14 WKS, ADDL FETUS 26 145.0076811 PR US,PREG UTER,FET & MAT,+

DETL FET EXM464.00

76811 PR US,PREG UTER,FET & MAT,+ DETL FET EXM

26 225.00

76812 PR US,PREG UTER,FET & MAT,+ DETL FET,ADDL

26 210.00

76813 PR US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON

303.00

76813 PR US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON

26 135.00

76814 PR US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST

202.00

76814 PR US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST

26 115.00

76815 CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES

219.00

76815 CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES

26 90.00

76816 PR US,PREGNANT UTERUS,F/U,TRANSABD APP

288.00

76816 PR US,PREGNANT UTERUS,F/U,TRANSABD APP

26 103.00

76817 PR US,PREGNANT 247.0076817 PR US,PREGNANT 26 95.0076818 PR FETAL BIOPHYSICAL PROFILE 305.0076818 PR FETAL BIOPHYSICAL PROFILE 26 160.0076819 PR FETAL BIOPHYS PROF,W/O NST 222.0076819 PR FETAL BIOPHYS PROF,W/O NST 26 94.0076820 CHG US DOPPLER FETAL UMBILICAL

ARTERY118.00

76820 CHG US DOPPLER FETAL UMBILICAL ARTERY

26 59.00

76821 CHG US DOPPLER FETAL MID CEREBRAL ARTERY

26 240.00

76825 ECHOCARDIOGRAPHY 691.0076825 ECHOCARDIOGRAPHY 26 210.0076826 ECHOCARDIOGRAPHY 410.0076826 ECHOCARDIOGRAPHY 26 107.00

76827 FETAL ECHOCARDIOGRAPHY DOPPLER,COMP

191.00

76827 FETAL ECHOCARDIOGRAPHY DOPPLER,COMP

26 86.00

76828 FETAL ECHO DOPPLER F/U 134.0076828 FETAL ECHO DOPPLER F/U 26 75.0076830 PR ECHOGRAPHY,TRANSVAGINAL 305.0076830 PR ECHOGRAPHY,TRANSVAGINAL 26 80.0076831 PR SONO EXAM, 26 160.0076856 PR US,PELVIC

(NONOBSTETRIC),REAL 300.00

76856 PR US,PELVIC (NONOBSTETRIC),REAL

26 81.00

76857 PR US,PELVIC (NONOBSTETRIC),REAL

26 64.00

76870 PR ECHO,SCROTUM & CONTENTS 26 82.0076872 PR ECHO,TRANSRECTAL 240.0076872 PR ECHO,TRANSRECTAL 26 121.0076873 PR ECHO,TRANSRECTAL,PROSTATE 195.0076873 PR ECHO,TRANSRECTAL,PROSTATE 26 195.0076881 CHG US COMPL JOINT R-T W/IMAGE

DOCUMENTATION26 71.00

76882 CHG US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG

91.00

76882 CHG US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG

26 63.00

76885 CHG US INFT HIPS R-T IMG DYNAMIC REQ PHYS/QHP MANJ

26 86.00

76886 CHG US INFT HIPS R-T IMG LMTD STATIC PHYS/QHP MANJ

26 72.00

76930 PR SONO GUIDE PERICARD TAP 26 84.0076932 PR SONO GUIDE HEART BIOPSY 26 93.0076936 PR US GUID,COMP REPAIR,PSEUDO-

ANEUR/AV FIST26 244.00

76937 PR US GUIDE, VASCULAR ACCESS 85.0076937 PR US GUIDE, VASCULAR ACCESS 26 37.0076940 PR US GUIDE, TISSUE ABLATION 26 265.0076941 PR SONO GUIDE INTRAUTER XFUSN 26 163.0076942 PR SONO GUIDE NEEDLE BIOPSY 487.0076942 PR SONO GUIDE NEEDLE BIOPSY 26 100.0076945 PR SONO GUIDE CHOR VILL 26 81.0076946 PR SONO GUIDE AMNIOCENTESIS 26 60.00

76965 PR SONO GUIDE RADIOELEMT 26 169.0076975 PR GI ENDOSCOPIC ULTRASOUND 559.0076975 PR GI ENDOSCOPIC ULTRASOUND 26 108.0076998 PR ULTRASONIC GUIDANCE,

INTRAOPERATIVE26 152.00

76999 PR UNLISTED ULTRASOUND 26 3500.0077001 PR FLUOROGUIDE CNTRL VEN

ACCESS,PLACE,REPLACE,REMOVE26 45.00

77002 CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

239.00

77002 CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

26 71

77003 CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

145.00

77003 CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

26 67.00

77011 PR CT GUIDANCE STEREOTACTIC LOCALIZATION

26 155.00

77012 PR CT GUIDANCE NEEDLE 26 135.0077013 PR CT GUIDANCE TISSUE ABLATION 26 467.0077014 PR CT GUIDANCE PLACEMENT RAD

THERAPY FIELDS26 152.00

77021 PR MRI GUIDANCE NEEDLE 26 177.0077022 PR MRI GUIDANCE TISSUE 26 547.0077051 CHG COMPUTER-AIDED DETECTION

DX MAMMOGRAPHY26 8.00

77052 CHG COMPUTER-AIDED DETECTION SCREENING MAMMOGRAPHY

26 8.00

77053 PR MAMMARY DUCTOGRAM, SINGLE 26 43.0077055 PR MAMMOGRAPHY; UNILATERAL 26 66.0077056 PR MAMMOGRAPHY; BILATERAL 26 101.0077057 CHG SCREENING MAMMOGRAPHY

BILATERAL26 81.00

77058 PR MRI BREAST, W/WO CONTRAST, 26 189.0077059 PR MRI BREAST, W/WO CONTRAST,

BILATERAL26 189.00

77061 CHG DIGITAL BREAST TOMOSYNTHESIS UNILATERAL

26 107.00

77062 CHG DIGITAL BREAST TOMOSYNTHESIS BILATERAL

423.00

77062 CHG DIGITAL BREAST TOMOSYNTHESIS BILATERAL

26 123.00

77063 CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI

26 76.00

77065 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI

26 100.00

77066 CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI

26 109.00

77067 CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD

26 108.00

77072 PR X-RAYS FOR BONE AGE 58.0077072 PR X-RAYS FOR BONE AGE 26 22.0077073 PR X-RAYS, BONE LENGTH STUDIES 26 32.0077074 PR X-RAYS, BONE SURVEY, LIMITED 26 53.0077075 PR X-RAYS, BONE SURVEY 26 64.0077076 PR X-RAYS, BONE SURVEY, INFANT 26 81.0077077 PR JOINT SURVEY, SINGLE VIEW 97.0077077 PR JOINT SURVEY, SINGLE VIEW 26 41.0077078 PR CT BONE DENS STUDY, 1+ 26 29.0077080 PR DEXA,BONE DENSITY,AXIAL 309.0077080 PR DEXA,BONE DENSITY,AXIAL 26 26.0077081 PR DEXA,BONE

DENSITY,APPENDICULR SKELTN77.00

77081 PR DEXA,BONE DENSITY,APPENDICULR SKELTN

26 27.00

77261 CHG RADIATION THERAPY PLAN 290.0077262 CHG RADIATION THERAPY PLAN 286.0077263 CHG RADIATION THERAPY PLAN 648.0077280 CHG SET RADN THERAPY FIELD 26 190.0077290 CHG SET RADN THERAPY FIELD 26 315.0077293 CHG RESPIRATORY MOTION

MANAGEMENT SIMULATION26 257.00

77295 CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

26 919.00

77300 CHG RADIATION THERAPY,DOSIMETRY PLAN

26 128.00

77301 CHG INTEN MOD RADIOTHER PLAN W/DOSE VOL HIST

26 1613.00

77306 CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION

26 177.00

77307 CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY

26 366.00

77316 CHG BRACHYTX ISODOSE PLN SMPL W/DOSIMETRY CAL

26 177.00

77317 CHG BRACHYTX ISODOSE PLN INTERMED W/DOSIMETRY CAL

26 233.00

77318 CHG BRACHYTX ISODOSE PLN CPLX W/DOSIMETRY CAL

26 367.00

77321 CHG TELETHER ISO-PORT PLAN 26 191.0077331 CHG SPECIAL RADIATION 26 175.0077332 CHG RADN TREATMENT AID(S) 26 109.0077333 CHG RADN TREATMENT AID(S) 26 169.0077334 CHG RADN TREATMENT AID(S) 26 250.0077338 CHG MLC IMRT DESIGN &

CONSTRUCTION PER IMRT PLAN26 870.00

77387 CHG GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR

187.00

77387 CHG GUIDANCE FOR LOC OF TARGET VOL RADIAJ TX DLVR

26 60.00

77401 CHG RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA

51.00

77427 CHG RADIATION,MANGEMENT,5 TX'S 668.0077431 CHG RADIATION THERAPY 379.0077432 CHG STEREOTACTIC RADIATION TX

MANAGEMENT CRANIAL LESION2640.00

77435 CHG RADN RX DELIV,BODY, MANAGEMENT, PER COURSE

2277.00

77470 PR SPECIAL TREATMENT 26 422.0077767 CHG HDR RDNCL SKN SURF

BRACHYTX LES </2CM/1 CHAN26 138

77768 CHG HDR RDNCL SK SRF BRCHYTX LES >2CM&2CHAN/MLT LES

26 185

77770 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL

26 255.00

77771 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 2-12 CHANNEL

26 497.00

77772 CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX >12 CHANNELS

26 705.00

77778 CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX

26 2253.00

77789 CHG SURFACE APPLIC LOW DOSE RATE RADIONUCLIDE SOURCE

26 228.00

77799 PR RADIUM/RADIOISOTOPE THERAPY UNLIST

26 800.00

78012 CHG THYROID UPTAKE SINGLE/MULTIPLE QUANT

26 23.00

78013 CHG THYROID IMAGING WITH VASCULAR FLOW

26 44.00

78014 CHG THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS

26 59.00

78015 PR THYROID MET IMAGING LTD 26 79.0078018 PR THYROID MET IMAGING BODY 26 101.0078020 PR THYROID MET UPTAKE 26 78.0078070 CHG PARATHYROID PLANAR 26 97.0078071 CHG PARATHYROID PLANAR

IMAGING W/WO SUBTRACTION26 139.00

78072 CHG PARATHYROID IMAGING W/TOMOGRAPHIC SPECT & CT

26 193.00

78102 PR BONE MARROW IMAGING, LTD 26 64.0078103 PR BONE MARROW IMAGING, MULT 26 92.0078195 PR LYMPHATICS & LYMPH GLANDS 26 141.0078201 PR LIVER IMAGING 26 54.0078202 PR LIVER IMAGING WITH FLOW 26 59.0078205 PR LIVER IMAGING (SPECT) 26 83.0078206 PR LIVER IMAGE (3-D) W/FLOW 26 113.0078215 PR LIVER AND SPLEEN IMAGING 26 58.0078226 PR HEPATOBILIARY SYST IMAGING

INCLUDING GALLBLADDER26 87.00

78227 PR HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ

26 105.00

78264 CHG GASTRIC EMPTYING IMAGING 26 91.0078278 PR ACUTE GI BLOOD LOSS IMAGING 26 116.0078290 PR BOWEL IMAGING 26 80.0078300 PR BONE IMAGING, LIMITED AREA 26 73.0078305 PR BONE IMAGING, MULTIPLE 26 104.0078306 PR BONE IMAGING, WHOLE BODY 26 101.0078315 CHG BONE IMAGING, 3 PHASE 26 119.0078320 PR BONE IMAGING (SPECT) 26 122.0078350 CHG BONE MINERAL, SINGLE 83.0078350 CHG BONE MINERAL, SINGLE 26 28.0078451 MYOCARDIAL SPECT,SINGLE,REST

OR STRESS,EF,WALL MOTION26 162.00

78452 MYOCARDIAL SPECT MULTIPLE STUDIES,REST,STRESS,BLOOD POOL IMAGING GTD

26 192.00

78459 PR HEART MUSCLE IMAGING (PET) 26 194.0078469 PR HEART INFARCT IMAGE SPECT 26 115.00

78472 CARDIAC BLOOD POOL IMAGING, PLANAR,SINGLE

26 117.00

78491 PR HEART IMAGE (PET) SINGLE 26 184.0078492 PR HEART IMAGE (PET) MULTIPLE 26 229.0078579 PR PULMONARY VENTILATION 26 61.0078580 PR PULMONARY PERFUSION

IMAGING PARTICULATE26 87.00

78582 PR PULMONARY VENTILATION & PERFUSION IMAGING

26 124.00

78597 PR QUANT DIFFERENTIAL PULM PERFUSION W/WO IMAGING

26 86.00

78598 PR QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING

26 97.00

78606 BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW

26 75.00

78607 BRAIN IMAGING TOMOGRAPHIC 26 145.0078608 PR BRAIN IMAGING PET METABOLIC 26 175.0078609 PR BRAIN IMAGING PET PERFUSION 26 252.0078645 PR CSF SHUNT EVALUATION 26 66.0078707 PR RENAL IMAGING, MORPH W/ 26 112.0078708 PR RENAL IMAGING, MORPH W/

FLOW/FUNC, PHARM, SINGLE26 141.00

78709 PR RENAL IMAGING, MORPH W/ FLOW/FUNC, PHARM, MULTI

26 164.00

78740 PR URETERAL REFLUX STUDY 566.0078740 PR URETERAL REFLUX STUDY 26 70.0078800 PR TUMOR IMAGING, LIMITED AREA 26 77.0078801 PR TUMOR IMAGING, MULT AREAS 26 94.0078802 PR TUMOR IMAGING, WHOLE BODY 26 101.0078803 PR TUMOR IMAGING SPECT 26 128.0078804 CHG TUMOR IMAGING, WHOLE

BODY, 2 OR MORE DAYS26 125.00

78805 PR ABSCESS IMAGING, LTD AREA 26 86.0078806 PR ABSCESS IMAGING, WHOLE 26 101.0078807 PR NUCLEAR 26 129.0078814 PET IMAGING CT FOR ATTENUATION

LIMITED AREA26 259.00

78815 PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH

26 286.00

78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

26 294.00

79005 CHG NUC THERAPY INTRACAVITARY RADIOCOLLOID

26 210.00

79101 CHG NUC THERAPY INTRA- 26 231.0079403 PR NUCLEAR THERAPY, 26 272.0080048 CHG BASIC METABOLIC PANEL

CALCIUM TOTAL29.00

80053 CHG METABOLIC 36.0080061 CHG LIPID PANEL 44.0080360 CHG DRUG SCREENING 6080500 CHG LAB PATHOLOGY CONSULT- 100.0080500 CHG LAB PATHOLOGY CONSULT- 26 100.0081000 CHG URINALYSIS, NONAUTO, 19.0081001 CHG URINALYSIS, AUTO, W/SCOPE 11.0081002 CHG URINALYSIS NONAUTO W/O 14.0081003 CHG URINALYSIS, AUTO, W/O SCOPE 8.0081025 CHG URINE PREGNANCY TEST 21.0081120 CHG IDH1 COMMON VARIANTS 10081121 CHG IDH2 COMMON VARIANTS 10081206 PR BCR/ABL1 MAJOR BREAKPNT

QUALITATIVE/QUANTITATIVE100.00

81210 CHG BRAF GENE ANALYSIS V600 VARIANT(S)

100.00

81215 PR BRCA1 GENE ANALYSIS KNOWN FAMILIAL VARIANT

939.00

81229 PR CYTOGENOM CONST MICROARRAY COPY NUMBER&SNP

100.00

81235 CHG EGFR GENE ANALYSIS COMMON VARIANTS

348.00

81235 CHG EGFR GENE ANALYSIS COMMON VARIANTS

26 100.00

81240 PR F2 GENE ANALYSIS 20210G >A 100.0081241 PR F5 COAGULATION FACTOR V

ANAL LEIDEN VARIANT100.00

81243 PR FMR1 ANALYSIS EVAL TO DETECT ABNORMAL ALLELES

100.00

81244 PR FMR1 GENE ANALYSIS CHARACTERIZATION OF ALLELES

100.00

81256 PR HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS

100.00

81261 PR IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED

100.00

81265 PR COMPARATIVE ANAL STR MARKERS PATIENT&COMP SPEC

100.00

81267 PR CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION

100.00

81270 PR JAK2 GENE ANALYSIS P.VAL617PHE VARIANT

100.00

81275 CHG KRAS GENE ANALYSIS VARIANTS IN EXON 2

100.00

81287 CHG MGMT METHYLATION ANALYSIS 100.0081288 CHG MLH1 GENE ANALYSIS

PROMOTER METHYLATION 26 100.00

81301 PR MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF

100.00

81340 PR TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD

100.00

81342 PR TRG@ GENE REARRANGEMENT ANALYSIS

100.00

81403 CHG MOLECULAR PATHOLOGY PROCEDURE LEVEL 4

100.00


26 115.00


100

81445 CHG GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE

1495.00

81445 CHG GEN SEQ ANALYS SOLID ORGAN NEOPLASM 5-50 GENE

26 200.00

81455 CHG GEN SEQ ANALYS SOL ORG/HEMTOLMPHOID NEO 51/> GEN

1645

81455 CHG GEN SEQ ANALYS SOL ORG/HEMTOLMPHOID NEO 51/> GEN

26 200.00

81479 CHG UNLISTED MOLELCULAR PATHOLOGY PROCEDURE

100.00

82270 BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN

11.00

82272 BLOOD OCCULT,BY PEROXID, FECES, 1-3 SIMULT, NON CA

11.00

82656 PR PANCREATIC ELASTASE, FECAL, QUAL/SEMI-QUANT

40.00

82710 CHG FATS/LIPIDS, FECES, 48.0082962 CHG GLUCOSE BLOOD TEST 9.00

83020 CHG HEMOGLOBIN 26 60.0083036 PR GLYCOSYLATED HEMOGLOBIN 32.0083655 ASSAY OF LEAD 40.0083986 CHG PH BODY FLUID NOS 10.0083993 CHG ASSAY FOR CALPROTECTIN 67.0084145 CHG ASSAY OF PROCALCITONIN 92.0084165 CHG PROTEIN E-PHORESIS, SERUM 26 47.0084166 PR PROTEIN E- 61.0084403 ASSAY OF TOTAL TESTOSTERONE 85.0085013 CHG MICROHEMATOCRIT,SPUN 8.0085014 CHG HEMATOCRIT 8.0085018 CHG HEMOGLOBIN 8.0085025 CHG COMPLETE CBC & AUTO DIFF 26.0085060 PR BLOOD SMEAR INTERPRETATION 62.0085097 PR BONE MARROW, SMEAR

INTERPRETATION231

85097 PR BONE MARROW, SMEAR INTERPRETATION

26 214.00

85390 CHG FIBRINOLYSINS SCREEN 26 60.0085576 CHG BLOOD PLATELET 26 62.0085610 CHG PROTHROMBIN TIME 13.0086077 CHG PHYS BLD BANK SERV,DIFF 14386078 CHG PHYS BLD BANK SERV,XFUSN 14386308 CHG HETEROPHILE 17.0086325 CHG IMMUNOELECTROPHOR,OTHER

FLUIDS W/CONC74.00

86325 CHG IMMUNOELECTROPHOR,OTHER FLUIDS W/CONC

26 64.00

86580 CHG TB INTRADERMAL TEST 19.0086788 PR WEST NILE VIRUS AB, IGM 56.0087210 CHG SMEAR,STAIN,WET 14.0087220 CHG TISSUE EXAM BY KOH 10.0087662 CHG IADNA DNA/RNA ZIKA VIRUS

AMPLIFIED PROBE TQ159.00

87804 CHG DETECT AGENT,IMMUN,DIR OBS,INFLUENZA

39.00

87807 PR DETECT AGENT,IMMUN,DIR OBS, 41.0087880 CHG STREP A ASSAY W/OPTIC 39.0088020 CHG AUTOPSY COMPL,W/O CNS 1696.0088025 CHG AUTOPSY COMPL,W BRAIN 2355.0088028 CHG AUTOPSY COMPL,INFANT W 2355.0088029 CHG AUTOPSY COMPL,NEWBORN W 1884.00

88037 CHG LTD AUTOPSY,SINGLE ORGAN 86688099 CHG NECROPSY (AUTOPSY) 330.0088104 CHG CYTOPATH 26 75.0088108 CHG CYTOPATH

FLUIDS,CONCENTRATN,INTERP26 84.00

88112 CHG CYTOPATH, CELL ENHANCE 26 161.0088141 CHG CYTOPATH CERV/VAG 82.0088142 CHG CYTOPATH CERV/VAG THIN 70.0088143 CHG CYTOPATH CERV/VAG THIN

LAYER REDO70.00

88160 CHG CYTOPATH,OTHR SOURC,SCREEN,INTERP

26 79.00

88172 CHG EVALUATION OF FNA SMEAR TO DETERMINE ADEQUACY, FIRST

26 134.00

88173 CHG INTERPRETATION OF FNA 26 250.0088174 CHG CYTOPATH,CERV/VAG,AUTO

THIN LAYER,INTERP74.00

88177 CHG EVALUATION OF FNA SMEAR TO DETERMINE ADEQUACY, EA ADD

26 58.00

88187 PR FLOWCYTOMETRY/READ, 2-8 175.0088188 PR FLOWCYTOMETRY/READ, 9-15 220.0088189 PR FLOWCYTOMETRY/READ, 16 & >

MARKERS278.00

88237 CHG TISSUE CULTURE, BONE 434.0088261 CHG CHROMOSOME ANAL:5 CELLS,1

KARYOTYPE607.00

88263 CHG CHROMOSOME ANAL:45 CELLS,MOSAICISM

493.00

88271 CHG CYTOGENETICS, DNA PROBE 74.0088291 CHG CYTO/MOLECULAR REPORT 8488300 CHG SURG PATH,GROSS,LEVEL I 26 39.0088302 CHG SURG PATH,LEVEL II 26 60.0088304 CHG SURG PATH,LEVEL III 26 94.0088305 CHG SURG PATH,LEVEL IV 26 178.0088307 CHG SURG PATH,LEVEL V 325.0088307 CHG SURG PATH,LEVEL V 26 31488309 CHG SURG PATH,LEVEL VI 26 462.0088311 CHG DECALCIFY TISSUE 26 34.0088312 PR SPECIAL STAIN GROUP 1

MICROORGANISMS I&R60.00

88312 PR SPECIAL STAIN GROUP 1 MICROORGANISMS I&R

26 67.00

88313 PR SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS

70.00

88313 PR SPCL STN 2 I&R EXCPT MICROORG/ENZYME/IMCYT&IMHIS

26 65.00

88314 PR SPECIAL STAIN I&R HISTOCHEMICAL W/FROZEN TISSUE

26 158.00

88319 PR SPECIAL STAIN I&R GROUP III ENZYME CONSITUENTS

26 86.00

88321 CHG MICROSLIDE CONSULT 36888323 CHG MICROSLIDE CONSULT W 36888323 CHG MICROSLIDE CONSULT W 26 197.0088325 CHG COMPREHENSIVE REVIEW OF 40088329 CHG PATH CONSULT IN SURGERY GC 13688331 PR PATH CONSULT IN SURG,W FRZ 26 204.0088332 CHG PATH CONSULT IN SURG,W

ADDN FRZ SEC26 135.00

88333 PR INTRAOPERATIVE CYTO PATH CONSULT, INITIAL SITE

26 164.00

88334 CHG INTRAOPERATIVE CYTO PATH CONSULT, ADD SITES

26 101

88334 CHG INTRAOPERATIVE CYTO PATH CONSULT, ADD SITES

GC 101

88341 CHG IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE

228.00

88341 CHG IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE

26 74.00

88342 CHG IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE

268.00

88342 CHG IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE

26 93.00

88346 CHG IMMUNOFLUORESCENCE PER SPEC 1ST SINGL ANTB STAIN

26 101.00

88348 CHG ELECTRON 26 468.0088350 CHG IMMUNOFLUORESCENCE PER

SPEC ADD SINGL ANTB STAIN26 75

88360 CHG M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL

26 134.00

88363 CHG EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS

55.00

88364 CHG IN SITU HYBRIDIZATION EA ADDL PROBE STAIN

26 91.00

88365 CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN

440.00

88365 CHG IN SITU HYBRIDIZATION 1ST PROBE STAIN

26 144

88366 CHG IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN

26 162.00

88367 CHG M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN

604.00

88367 CHG M/PHMTRC ALYS ISH CPTR-ASST TECH 1ST PROBE STAIN

26 160.00

88368 CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL

149.00

88368 CHG M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL

26 160.00

88369 CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH

26 84.00

88377 CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB

166.00

88377 CHG M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB

26 166

88720 CHG BILIRUBIN TOTAL 18.0089060 CHG EXAM,SYNOVIAL FLUID 26 4790389 PR TETANUS IG, IM 776.0090460 PR IM ADM THRU 18YR ANY RTE

1ST/ONLY COMPT VAC/TOX21

90461 PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT

21

90471 PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID

21

90472 PR IMMUNIZ,ADMIN,EACH ADDL 2190473 PR IMMUNIZ

ADMIN,INTRANASAL/ORAL,1 21

90474 PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH

21

90620 PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM

675

90630 PR INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID

49.00

90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE

134

90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE

63

90636 PR HEPA/HEPB VACCINE ADULT IM 20090647 PR HIB PRP-OMP VACCINE 3 DOSE

SCHEDULE IM USE55.00

90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE

61

90649 PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

336

90651 PR 9VHPV VACC 2/3 DOSE SCHED IM 34690655 PR IIV3 VACC PRESRV FREE 0.25 ML

DOSAGE IM USE51.00

90656 PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE

35.00

90657 PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE

11.00

90658 PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE

41.00

90660 PR LAIV3 VACCINE LIVE FOR INTRANASAL USE

55.00

90662 PR IIV VACCINE PRESERV FREE INCREASED AG COUNT IM

50

90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE

334

90672 PR LAIV4 VACCINE FOR INTRANASAL 56.0090673 PR RIV3 VACCINE PRESERVATIVE

FREE FOR IM USE79.00

90675 PR RABIES VACCINE, IM 63690680 PR RV5 VACCINE 3 DOSE SCHEDULE

LIVE FOR ORAL USE182.00

90681 PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE

230.00

90682 PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM

50

90685 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE

52.00

90686 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE

20

90691 PR TYPHOID VACCINE, IM 18690696 PR DTAP-IPV VACCINE CHILD 4-6

YRS FOR IM USE104

90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE

178.00

90700 DTAP IMMUNIZATION, IM, <7 YO 60

90702 PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE

80.00

90707 PR MMR VIRUS IMMUNIZATION, 13290710 PR COMBINED

VACCINE,MMR+VARICELLA,SUB-Q378

90713 PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q

63

90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE

55

90715 PR TDAP VACCINE IM 9190716 PR VAR VACCINE LIVE FOR

SUBCUTANEOUS USE226

90717 PR YELLOW FEVER IMMUNIZATN,LIVE,SUB-Q

295

90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR

153

90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE

166

90733 PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE

129

90734 PR MCV4/MENACWY CONJ VACC GRPS ACYW-135 IM USE

126

90736 PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE

414

90738 CHG JAPANESE ENCEPH VACC, INACTIVATED, IM

487.00

90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM

47

90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE

114

90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX

175.00

90785 PR PSYCHOTHERAPY COMPLEX INTERACTIVE

40.00

90791 PR PSYCHIATRIC DIAGNOSTIC 399.0090792 PR PSYCHIATRIC DIAGNOSTIC EVAL

W/MEDICAL SERVICES361.00

90832 PR PSYCHOTHERAPY W/PATIENT 30 MINUTES

166.00

90833 PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN

166.00


214.00


214.00


315.00


315.00

90839 PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES

343.00

90840 PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES

183.00

90846 PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS

256.00

90847 PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS

286.00

90849 PR MULTIP FAMILY-GROUP PSYCHOTHERAPY

88.00

90853 PR GROUP PSYCHOTHERAPY 85.0090867 PR REPET TMS TX INITIAL

W/MAP/MOTR THRESHLD/DEL&MNG852.00

90868 PR THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNGT

463.00

90869 PR REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MNGT

1053.00

90870 PR ELECTROCONVULSIVE 410.0090887 PR CONSULTATION WITH FAMILY 216.0090899 PR PSYCHIATRIC SERVICE/THERAPY 400.0090911 PR BIOFEEDBACK PERI/URO/RECTAL 230.0090935 PR HEMODIALYSIS PROCEDURE W/

PHYS/QHP EVALUATION225.00

90937 PR HEMODIALYSIS, REPEATED 375.0090945 PR DIALYSIS OTHER/THAN

HEMODIALYSIS 1 PHYS/QHP EVAL210.00

90947 PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS

350.00

90953 PR ESRD RELATED SVC MONTHLY <2 YR OLD 1 VISIT

1216.00

90956 PR ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT

798.00

90957 PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS

2184.00

90958 PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS

1058.00

90959 PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT

711.00

90960 PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS

700.00

90961 PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS

575.00

90962 PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT

430.00

90963 PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, < 2 YR OLD

1904.00

90964 PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, 2-11 YR OLD

1189.00

90965 PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, 12-19 YR

1132.00

90966 PR ESRD SERVICES, HOME DIALYSIS, PER MONTH, 20+ YR OLD

572.00

90967 PR ESRD SERVICES, PER DAY, < 2 48.0090968 PR ESRD SERVICES, PER DAY, 2-11 39.0090969 PR ESRD SERVICES, PER DAY, 12-19

YR OLD38.00

90970 PR ESRD SERVICES, PER DAY,20+ 20.0090989 PR DIALYSIS TRAINING/COMPLETE 767.0091010 PR ESOPHAGEAL MOTILITY STUDY

W/INTERP&RPT26 300.00

91034 PR GERD TST W/ NASAL PH 26 128.0091035 PR GERD TST W/ MUCOS PH 26 208.0091038 PR GERD TST W/ MUCOS IMPEDE

ELECTROD,>1HR26 145.00

91065 PR BREATH HYDROGEN/METHANE 26 60.0091110 PR GI IMAG INTRALUMINAL

ESOPHAGUS-ILEUM W/I&R2350.00

91110 PR GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R

26 540.00

91112 PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP

26 280.00

91122 PR ANAL PRESSURE RECORD 26 300.0091200 PR LIVER ELASTOGRAPHY W/O IMAG 26 38.0092002 PR EYE EXAM, NEW 185.0092004 PR EYE EXAM, NEW 325.0092012 PR EYE EXAM ESTABLISHED PT 185.00

92012 PR EYE EXAM ESTABLISHED PT 26 185.0092014 PR EYE EXAM, EST 265.0092015 PR REFRACTION 30.0092018 PR NEW EYE EXAM & TREATMENT 367.0092019 PR EYE EXAM & TREATMENT 184.0092020 PR SPECIAL EYE EVAL,GONIOSCOPY 68.0092020 PR SPECIAL EYE EVAL,GONIOSCOPY 26 68.0092025 PR CORNEAL TOPOGRAPHY 26 51.0092060 PR SPECIAL EYE 26 98.0092071 PR FIT CONTACT LENS TX OCULAR

SURFACE DISEASE95.00

92072 PR FITTING CONTACT LENS FOR MNGT OF KERATOCONUS

341.00

92081 PR VISUAL FIELD EXAM,LIMITED 26 42.0092082 PR VISUAL FIELD EXAM,INTERMED 122.0092082 PR VISUAL FIELD EXAM,INTERMED 26 57.0092083 PR VISUAL FIELD EXAM,EXTENDED 26 71.0092100 PR SERIAL TONOMETRY EXAM(S) 199.0092132 PR COMPUTERIZED OPHTHALMIC

IMAGING ANTERIOR SEGMENT26 50.00

92133 PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE

26 71.00

92134 PR COMPUTERIZED OPHTHALMIC IMAGING RETINA

261.00

92134 PR COMPUTERIZED OPHTHALMIC IMAGING RETINA

26 74.00

92136 PR OPHTHAL BIOMETRY,INTRAOC LENS POW CALC

225.00

92136 PR OPHTHAL BIOMETRY,INTRAOC LENS POW CALC

26 79.00

92225 PR SPECIAL EYE EXAM, INITIAL 70.0092226 PR SPECIAL EYE EXAM, 70.0092230 PR FLUORESCEIN ANGIOSCOPY 145.0092235 PR FLUORESCEIN ANGRPH

W/MULTIFRAME I&R UNI/BI26 116.00

92240 PR INDOCYANINE-GREEN ANGRPH W/MULTIFRAME I&R UNI/BI

26 161.00

92242 PR FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI

575.00

92242 PR FLUORESCEIN ICG ANGRPH W/MULTIFRAME I&R UNI/BI

26 141.00

92250 PR FUNDAL PHOTOGRAPHY 26 61.00

92265 PR EYE MUSCLE EVALUATION 214.0092265 PR EYE MUSCLE EVALUATION 26 118.0092275 PR ELECTRORETINOGRAPHY 26 148.0092283 PR COLOR VISION EXAMINATION 26 24.0092285 PR EYE PHOTOGRAPHY 26 16.0092286 PR ANT SGM IMAGING

W/MICROSCOPY ENDOTHELIAL 26 56.00

92310 PR CONTACT LENS FITTING,BILAT 75.0092311 PR CONTACT LENS FIT,APHAKIA 252.0092312 PR CONTACT LENS FIT,APHAKIA 290.0092313 PR CONTACT LENS

FIT,CORNEOSCLERAL LENS243.00

92502 PR EAR AND THROAT EXAMINATION 221.0092504 PR EAR MICROSCOPY EXAMINATION 71.0092511 PR NASOPHARYNGOSCOPY 361.0092516 PR FACIAL NERVE FUNCTION TEST 175.0092532 PR POSITIONAL NYSTAGMUS 61.0092537 PR CALORIC VESTIBULAR TEST

W/REC BI BITHERMAL388.00

92537 PR CALORIC VESTIBULAR TEST W/REC BI BITHERMAL

26 128.00

92538 PR CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL

194.00

92538 PR CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL

26 64.00

92540 PR VESTIBULAR EVAL NYSTAG FOVL&PERPH STIM OSCIL TRACKING

320.00

92540 PR VESTIBULAR EVAL NYSTAG FOVL&PERPH STIM OSCIL TRACKING

26 320.00

92541 PR SPONTANEOUS NYSTAGMUS 134.0092541 PR SPONTANEOUS NYSTAGMUS 26 48.0092542 PR POSITIONAL NYSTAGMUS TEST 139.0092542 PR POSITIONAL NYSTAGMUS TEST 26 64.0092544 PR OPTOKINETIC NYSTAGMUS TEST 111.0092544 PR OPTOKINETIC NYSTAGMUS TEST 26 38.0092545 PR OSCILLATING TRACKING TEST 102.0092545 PR OSCILLATING TRACKING TEST 26 30.0092546 PR SINUSOIDAL ROTATIONAL TEST 197.0092546 PR SINUSOIDAL ROTATIONAL TEST 26 119.0092548 PR COMPUTERIZED DYNAMIC

POSTUROGRAPHY250.00

92548 PR COMPUTERIZED DYNAMIC POSTUROGRAPHY

26 66.00

92550 PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS

85.00

92551 PR PURE TONE HEARING TEST, AIR 31.0092552 PR PURE TONE AUDIOMETRY, AIR 78.0092553 PR AUDIOMETRY, AIR & BONE 93.0092555 PR SPEECH THRESHOLD 58.0092556 PR SPEECH AUDIOMETRY, 95.0092557 PR COMPREHENSIVE HEARING TEST 115.0092565 PR STENGER TEST, PURE TONE 35.0092567 PR TYMPANOMETRY 49.0092568 PR ACOUSTIC REFLEX TESTING 47.0092575 PR SENSORINEURAL ACUITY TEST 178.0092577 PR STENGER TEST, SPEECH 46.0092579 PR VISUAL AUDIOMETRY (VRA) 107.0092582 PR CONDITIONING PLAY 167.0092583 PR SELECT PICTURE AUDIOMETRY 200.0092584 PR ELECTROCOCHLEOGRAPHY 190.0092585 PR AUDITORY EVOKED POTENTIAL 294.0092585 PR AUDITORY EVOKED POTENTIAL 26 294.0092586 PR AUDITORY EVOKED POTENTIAL, 339.0092587 PR DISTORT PRODUCT EVOKED

OTOACOUSTIC EMISNS LIMITD115.00

92587 PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD

26 65.00

92588 PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX

163.00

92588 PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX

26 95.00

92601 DX ANAL COCHLEAR IMP,PT <7 YRS,W/PROG

403.00

92602 DX ANAL COCHLEAR IMP,PT <7 YRS,REPROG

257.00

92603 PR DX ANAL COCHLEAR IMP,PT >7 YRS,W/PROG

343.00

92604 PR DX ANAL COCHLEAR IMP,PT >7 YRS,REPROG

204.00

92607 PR EVAL,SPEECH-GEN AUG/ALT COMM DEV,1ST HR

330.00

92608 PR EVAL,SPEECH-GEN AUG/ALT COMM DEV,ADDL 30

133.00

92612 PR FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC

471.00

92613 PR FLEXIBLE ENDOSCOPIC EVAL SWALLOW C/V REC I&R

145.00

92620 PR AUDITORY FUNCTION, 60 MIN 239.0092621 PR EVAL CENTRAL AUDITORY

FUNCJ W/REPRT EA 15 MIN57.00

92625 PR TINNITUS ASSESSMENT 165.0092626 PR EVAL AUDITORY REHAB STATUS,

1ST HOUR230.00

92627 PR EVAL AUDITORY REHAB STATUS, EA ADD 15 MIN

70.00

92920 PR PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH

1814.00

92921 PR PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH

493.00

92924 PR PRQ TRLUML CORONARY ANGIO/ATHERECT ONE ART/BRNCH

2156.00

92928 PR PRQ TRLUML CORONARY STENT W/ANGIO ONE ART/BRNCH

2013.00

92929 PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH

775.00

92929 PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH

26 548.00

92933 PR PRQ TRLUML CORONRY STENT/ATH/ANGIO ONE ART/BRNCH

2253.00

92934 PR PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH

705.00

92937 PR PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL

2012.00

92941 PR PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL

2424.00

92943 PR PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL

2257.00

92944 PR PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL

906.00

92950 PR HEART/LUNG RESUSCITATION 687.0092960 PR CARDIOVERSION ELECTIVE

ARRHYTHMIA EXTERNAL672.00

92961 PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX

980.00

92970 PR CARDIOASSIST, INTERNAL 439.00

92978 PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL

26 243.00

92979 PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL

26 188.00

92986 PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE

5512.00

92987 PR PRQ BALLOON VALVULOPLASTY MITRAL VALVE

5689.00

92990 PR PERCUT PULMONARY 3755.0092992 PR ATRIAL

SEPTOSTOMY,XVENOUS,BALLOON4000.00

92993 PR ATRIAL 4500.0092997 PR PUL ART BALLOON

REPAIR,PERC,1ST VESL3200.00

92998 PR PUL ART BALLOON REPAIR,PERC,ADDN VES

1600.00

93000 PR ELECTROCARDIOGRAM, 52.0093005 PR ELECTROCARDIOGRAM, 34.0093010 PR ELECTROCARDIOGRAM REPORT 30.0093010 PR ELECTROCARDIOGRAM REPORT 76 30.0093015 PR CV STRS TST XERS&/OR RX

CONT ECG W/SI&R227.00

93016 PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R

125.00

93017 CARDIAC STRESS TEST 136.0093018 PR CARDIAC STRESS

TST,INTERP/REPT ONLY120.00

93040 PR RHYTHM ECG WITH REPORT 31.0093041 PR RHYTHM ECG, TRACING 14.0093042 PR RHYTHM ECG, REPORT 25.0093224 PR XTRNL ECG & 48 HR RECORD

SCAN STOR W/R&I228.00

93225 PR EXT ECG RECORD CONTIN 48 HR, RECORD

92.00

93226 PR EXT ECG RECORD CONTIN 48 HR, SCAN ANALYSIS W REPORT

97.00

93227 PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS

78.00

93228 PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS

64.00

93260 PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB

26 112.00

93261 PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB

26 107.00

93270 PR EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, RECORD

27.00

93271 PR EXT ECG,PT DEMAND EVENT, SYMPT MEMORY LOOP, TRANSMIT

454.00

93272 PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS

65.00

93279 PR PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER

124.00

93279 PR PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER

26 85.00

93280 PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER

145.00

93280 PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER

26 106.00

93281 PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER

170.00

93281 PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER

26 118.00

93282 PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB

157.00

93282 PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB

26 115.00

93283 PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB

204.00

93283 PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB

26 148.00

93284 PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB

224.00

93284 PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB

26 172.00

93285 PR PROGRAM EVAL IMPLANTABLE DEV IN PRSN ILR SYSTEM

26 72.00

93286 PR PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM

26 37.00

93287 PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB

57.00

93287 PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB

26 55.00

93288 PR INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM

26 59.00

93289 PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB

163.00

93289 PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB

26 116.00

93290 PR INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS

26 52.00

93291 PR INTERROGATION EVALUATION IN PERSON ILR SYSTEM

26 60.00

93292 PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR

93.00

93292 PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR

26 55.00

93293 PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL

26 42.00

93294 PR INTERROGATION EVAL REMOTE </90 D 1/2/MLT LEAD PM

90.00

93295 PR INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB

168.00

93296 PR INTERROGATION REMOTE </90 D TECHNICIAN REVIEW

86.00

93297 PR INTERROGATION EVAL REMOTE </30 D CV MNTR SYS

63.00

93298 PR INTERROGATION EVALUATION REMOTE </30 D ILR SYS

72.00

93299 PR INTERROG EVAL, REMOTE, UP TO 90 DAYS, CV MON/LOOP

346.00

93303 PR ECHO XTHORACIC,CONG ANOM,COMPLETE

594.00

93303 PR ECHO XTHORACIC,CONG ANOM,COMPLETE

26 594.00

93304 PR ECHO XTHORACIC,CONG 388.0093304 PR ECHO XTHORACIC,CONG 26 388.0093306 PR ECHO HEART

XTHORACIC,COMPLETE W DOPPLER567.00

93306 PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER

26 175.00

93307 PR ECHO HEART XTHORACIC,COMPLETE, W/O

326.00

93307 PR ECHO HEART XTHORACIC,COMPLETE, W/O

26 115.00

93308 PR ECHO HEART 311.0093308 PR ECHO HEART 26 66.00

93312 PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R

26 350.00

93313 PR ECHO R-T 2D W/PROBE PLACEMENT ONLY

180.00

93314 PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY

26 253.00

93315 PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R

26 771.00

93317 PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT

26 666.00

93318 PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ

26 294

93320 DOPPLER ECHO HEART,COMPLETE 184.0093320 DOPPLER ECHO HEART,COMPLETE 26 103.0093321 ECHO XTHORACIC, LIMITED, F/U, 91.0093321 ECHO XTHORACIC, LIMITED, F/U, 26 58.0093325 DOPPLER COLOR FLOW VELOCITY 167.0093325 DOPPLER COLOR FLOW VELOCITY 26 115.0093350 93350 ECHO REST & STRESS W/PF 26 188.0093351 PR ECHO TTHRC R-T 2D W/WO M-

MODE REST&STRS CONT ECG26 217.00

93352 93352 ECHO STRESS CONTRAST 85.0093355 PR ECHO TEE GUID TCAT

ICAR/VESSEL STRUCTURAL INTVN476.00

93355 PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN

26 476.00

93451 PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT

26 354.00

93452 PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I

26 620.00

93453 PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I

26 813.00

93454 PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I

26 625.00

93455 PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I

26 722.00

93456 PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I

26 800.00

93457 PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I

26 897.00

93458 PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I

26 763.00

93459 PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I

26 859.00

93460 PR R & L HRT CATH WINJX HRT ART& L VENTR IMG

26 957.00

93461 PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I

26 1055.00

93462 PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE

486.00

93463 PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

259.00

93464 PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU

26 228.00

93503 PR INSERT/PLACE FLOW DIRECT 900.0093503 PR INSERT/PLACE FLOW DIRECT 26 391.0093505 PR ENDOMYOCARDIAL BIOPSY 26 1050.0093530 PR R HRT CATHETERIZATION

CONGENITAL CARDIAC ANOMALY26 1155.00

93531 PR R/L RETRO HEART CATH, CONG 26 1680.0093532 PR R/L INTACT XSEPTAL HT

CATH,CONGEN AB26 1325.00

93533 PR R/L OPEN XSEPTAL HRT CATH,CONGEN ABL

26 910.00

93563 PR NJX SEL HRT ART CONGENITAL HRT CATH W/S&I

140.00

93565 PR NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I

109.00

93566 PR NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I

424.00

93567 PR NJX SUPRAVALV AORTOG HRT CATH W/S&I

349.00

93568 PR NJX PULMONARY ANGIO HRT CATH W/S&I

379.00

93571 PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL

26 243.00

93572 PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL

26 198.00

93580 PR PERC CLOS,CONG INTERATRIAL COMMUN W/IMPL

3529.00

93581 PR PERC CLOSURE,CONG VSD 5348.0093582 PR PERCUTAN TRANSCATH

CLOSURE PAT DUCT ARTERIOSUS2358.00

93583 PR PERCUTANEOUS TRANSCATHETER SEPTAL

2624.00

93590 PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 MITRAL VALVE

4982.00

93591 PR PERQ TRANSCATH CLS PARAVALVR LEAK 1 AORTIC VALVE

3618.00

93592 PR PERQ TRANSCATH CLS PARAVALVR LEAK EACH OCCLS DEV

1139.00

93600 PR BUNDLE OF HIS RECORDING 26 380.0093602 PR INTRA-ATRIAL RECORDING 26 325.0093603 PR RIGHT VENTRICULAR 26 293.0093609 PR INTRA-VENTRIC&/ATRIAL MAPG

TACHYCARD W/CATH MA26 787.00

93610 PR INTRA-ATRIAL PACING 26 535.0093612 PR INTRAVENTRICULAR PACING 26 419.0093613 PR INTRACARDIAC

ELECTROPHYSIOLOGIC 3D MAPPING1448.00

93619 PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION

1793.00

93619 PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION

26 999.00

93620 PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION

2813.00

93620 PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION

26 2257.00

93621 PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC

990.00

93621 PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC

26 330.00

93622 PR COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC

587.00

93622 PR COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC

26 3500.00

93623 PR STIM/PACING HEART POST IV DRUG INFU

26 408.00

93624 PR ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT

26 1600.00

93631 PR HEART PACING, MAPPING 26 1007.0093641 PR EPHYS EVAL PACG CVDFB LDS

W/TSTG OF PULSE GEN26 906.00

93642 PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS

26 776.50

93644 PR EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR

26 462.00

93650 PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION

2120.00

93653 PR EPHYS EVAL W/ABLATION SUPRAVENT ARRHYTHMIA

2980.00

93654 PR EPHYS EVAL W/ABLATION VENTRICULAR TACHYCARDIA

3962.00

93655 PR ICAR CATHETER ABLATION ARRHYTHMIA ADD ON

1062.00

93656 PR EPHYS EVL TRNSPTL TX ATRIAL FIB ISOLAT PULM VEIN

4548.00

93657 PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN

1062.00

93662 PR INTRACARD ECHO, THER/DX 26 443.0093724 PR ANALYZE PACER SYS 26 658.0093750 PR INTERROGATION VAD IN PRSON

W/PHYS/QHP ANALYSIS131.00

93784 PR AMBULATORY BP MONITORING 135.0093790 PR AMBL BLD PRESS TAPE&/DISK

24/> HR REVIEW50.00

93792 PR PT/CAREGIVER TRAINJ FOR INITIATION HOME INR MNTR

138.00

93793 PR ANTICOAGULANT MGMT FOR PT TAKING WARFARIN

31.00

93880 PR DUPLEX SCAN 26 102.0093882 PR DUPLEX SCAN 26 54.0093886 PR TRANSCRAN DOPPLER 26 115.0093922 PR NON-INVAS PHYSIOLOGIC STD

EXTREMITY ART 1-2 LEVEL26 31.00

93923 PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS

26 56.00

93924 PR NON-INVASIVE LOWER EXTREM ART STRESS/REST,

26 73.00

93925 PR DUPLEX LO EXTREM ART BILAT 26 100.0093926 PR DUPLEX LO EXTREM ART 26 62.0093930 PR DUPLEX UP EXTREM ART BILAT 26 101.0093931 PR DUPLEX UP EXTREM ART 26 62.0093970 PR DUPLEX EXTREM VENOUS,BILAT 498.0093970 PR DUPLEX EXTREM VENOUS,BILAT 26 81.0093971 PR DUPLEX EXTREM VENOUS,UNI 306.0093971 PR DUPLEX EXTREM VENOUS,UNI 26 53.00

93975 PR DUPLEX ABD/PEL VASC STUDY,COMPLETE

26 215.00

93976 PR DUPLEX ABD/PEL VASC 501.0093976 PR DUPLEX ABD/PEL VASC 26 141.0093978 PR DUPLEX LARGE 26 100.0093979 PR DUPLEX LARGE 26 55.0093980 PR PENILE VASCULAR 26 210.0093990 PR DUPLEX HEMODIALYSIS ACCESS 26 31.0094010 PR BREATHING CAPACITY TEST 86.0094010 PR BREATHING CAPACITY TEST 26 31.0094060 PR EVAL OF BRONCHOSPASM 152.0094060 PR EVAL OF BRONCHOSPASM 26 48.0094070 PR EVAL OF 26 71.0094150 PR VITAL CAPACITY TEST 56.0094150 PR VITAL CAPACITY TEST 26 56.0094200 PR LUNG FUNCTION TEST 65.0094375 PR RESPIRATORY FLOW VOLUME 26 41.0094452 PR HIGH ALTITUDE SIMULATJ TEST

W/PHYS INTERP&REPORT26 37.00

94453 PR HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION

26 48.00

94617 PR EXERCISE TEST FOR 243.0094617 PR EXERCISE TEST FOR 26 86.0094618 PR PULMONARY STRESS TESTING 88.0094618 PR PULMONARY STRESS TESTING 26 59.0094620 PR PULMONARY STRESS 136.0094620 PR PULMONARY STRESS 26 100.0094621 PR CARDIOPULMONARY EXERCISE

TESTING26 170.00

94640 PR PRESSURIZED/NONPRESSURIZED

46.00

94640 PR PRESSURIZED/NONPRESSURIZED

26 46.00

94645 PR CONTINUOUS INHALATION TX, EACH ADD HR

37.00

94664 PR DEMO &/OR EVAL,PT USE,AEROSOL DEVICE

40.00

94690 PR EXHALED AIR ANALYSIS 129.0094690 PR EXHALED AIR ANALYSIS 26 10.0094726 PR PLETHYSMOGRAPHY LUNG

VOLUMES W/WO AIRWAY RESIST26 31.00

94727 PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL

26 31.00

94728 PR AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY

108.00

94729 PR DIFFUSING CAPACITY 26 21.0094750 PR PULMONARY COMPLIANCE 26 30.0094760 PR NONINVASV OXYGEN 8.0094761 PR NONINVASV OXYGEN 13.0094780 PR CAR SEAT/BED TESTING

W/INTERP & REPORT 60 MIN125.00

94781 PR CAR SEAT/BED TESTNG W/INTERP & REPORT +30MIN

49.00

95004 PR PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS

16.00

95017 PR ALLG TSTG PERQ & IC VENOMS IMMED REACT W/ I&R

227.00

95018 PR ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R

54.00

95024 PR INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS

19.00

95028 PR ALLERGY SKIN TESTS 31.0095044 PR ALLERGY PATCH TESTS 17.0095070 PR BRONCHIAL ALLERGY 77.0095076 PR INGESTION CHALLENGE TEST

INITIAL 120 MINUTES288.00

95079 PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES

203.00

95115 PR IMMUNOTHERAPY, ONE 26.0095117 PR IMMUNOTHERAPY, 2+ 32.0095145 PR PROFES SVC,IMMUNOTHERAPY,1

INSECT VENOM50.00

95165 PR PROFES SVC,IMMUNOTHER,SINGLE/MULT

39.00

95180 PR RAPID DESENSITIZATION PROC,EACH HOUR

347.00

95249 PR CONT GLUC MONITORING PATIENT PROVIDED EQUIPTMENT

141.00

95251 PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R

104.00

95782 PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND

26 315.00

95783 PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM

26 344.00

95800 PR SLEEP STUDY, UNATTENDED, RECORD HEART RATE/O2 SAT/RESP ANAL/SLEEP TIME

26 144.00

95801 PR SLEEP STUDY, UNATTENDED, RECORD HEART RATE/O2 SAT/RESP

26 127.00

95803 PR ACTIGRAPHY TESTING, 3-14 DAY 26 111.0095805 PR MULTIPLE SLEEP LATENCY TEST 26 216.0095806 PR SLEEP STUDY, UNATTENDED,

SIMUL RECORD HR/O2 SAT/RESP 26 177.00

95808 PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND

26 290.00

95810 PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND

26 424.00

95811 PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND

26 473.00

95812 PR EEG,EXTENDED MONITORING,41-60 MINUTES

26 146.00

95813 PR EEG >1 HR 26 232.0095816 PR EEG,W/AWAKE & DROWSY 26 207.0095819 PR EEG,W/AWAKE & ASLEEP 26 207.0095822 PR EEG,COMA/SLEEP RECORD 26 150.0095824 PR EEG EVAL CEREBRAL DEATH 26 101.0095827 PR EEG,ALL NIGHT RECORD 26 125.0095829 PR SURGERY 4787.0095829 PR SURGERY 26 750.0095860 PR EMG, NEEDLE, ONE LIMB 26 175.0095861 PR EMG, NEEDLE, TWO LIMBS 26 235.0095863 PR EMG, NEEDLE, 3 LIMBS 26 280.0095865 PR EMG, NEEDLE, LARYNX 368.0095866 PR EMG, NEEDLE, HEMIDIAPHRAGM 341.0095866 PR EMG, NEEDLE, HEMIDIAPHRAGM 26 171.0095867 PR EMG,NEEDLE,CRANIAL NERVE

SUPP MUS,UNILAT26 108.00

95869 PR EMG,NEEDLE,THOR PARASPIN MUS,EXC T1/T12

237.00

95869 PR EMG,NEEDLE,THOR PARASPIN MUS,EXC T1/T12

26 51.00

95870 PR EMG,1 EXTREM,NONPARASPINAL 26 70.0095872 PR EMG, NEEDLE, ONE FIBER 26 363.33

95873 PR ELECTRIC STIM GUIDANCE FOR CHEMODENERVATION

26 49.00

95874 PR NEEDLE EMG GUIDANCE FOR CHEMODENERVATION

26 65.00

95885 PR NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED

26 137.00

95886 PR NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE

26 214.00

95887 PR NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION

26 191.00

95907 PR MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB

26 205.00


26 258.00


26 308.00


26 412.00


26 513.00


26 617.00

95913 PR MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB

26 730.00

95925 PR SOMATOSENSORY TEST,UPPER 26 80.0095926 PR SOMATOSENSORY TEST,LOWER 26 80.0095930 PR VISUAL EP TESTING CNS EXCEPT

GLAUCOMA W/I&R26 48.00

95933 PR BLINK REFLEX TEST 26 80.0095937 PR NEUROMUSCULAR JUNCTION 26 115.0095938 PR SHORT-LATENCY SOMATOSENS

EP STD UPR & LOW LIMBS26 721.00

95950 PR AMBULATORY EEG MONITORING 26 205.0095951 PR EEG 790.0095951 PR EEG 26 939.0095953 PR EEG MONITORING/COMPUTER,

EA 24 HOURS, UNATTENDED26 399.00

95955 PR EEG DURING SURGERY 26 137.0095956 PR EEG MONITORING/COMPUTER,

EA 24 HOURS, ATTENDED BY 4073.00

95956 PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY

26 616.00

95958 PR EEG MONITORING/FUNCTION 26 600.0095961 PR FUNCJAL CORT&SUBCORT MAPG

PHYS/QHP ATTND INIT HR768.00

95961 PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR

26 425.00

95962 PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR

659.00

95962 PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR

26 446.00

95970 PR ELEC ALYS NSTIM PLS GEN BRN/SC/PERPH W/O REPRGRM

171.00

95971 PR ELEC ALYS NSTIM PLS GEN SMPL SC/PERPH W/PRGRMG

129.00

95972 PR ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH W/PRGRMG

300.00

95974 PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR

519.00

95975 PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV EA 30 MIN

283.00

95978 PR ANALYZE NEUROSTIM BRAIN, 514.0095979 PR ANALYZ NEUROSTIM BRAIN,

EACH ADD 30 MIN240.00

95990 PR REFILL&MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN

226.00

95991 PR RFL&MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP

280.00

95992 PR CANALITH REPOSITIONING PROCEDURE, PER DAY

122.00

96002 PR DYN SURF EMG,WALKING/FUNC ACT,1-12 MUS

56.00

96101 PR PSYCHOLOGIC TESTING BY PSYCH/PHYS

300.00

96103 PR PSYCHOLOGIC TESTING ADMIN BY COMPUTER

158.00

96110 PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM

30.00

96111 PR DEVELOPMENTAL TESTING W/INTERP & REPORT

320.00

96116 PR NEUROBEHAVIORAL STATUS EXAM BY PSYCH/PHYS

250.00

96118 PR NEUROPSYCH TESTING BY 300.0096119 PR NEUROPSYCH TESTING BY 201.00

96127 PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

12.00

96150 PR HEAL & BEHAV ASSESS,EA 15 64.0096151 PR HEAL & BEHAV ASSESS,EA 15

MIN,RE-ASSESS63.00

96152 PR HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV

60.00

96154 PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT

59.00

96155 PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT

59.00

96160 PR PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM

12.00

96161 PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM

30.00

96360 PR IV INFUSION, HYDRATION, 31-60 130.0096361 PR IV INFUSION, HYDRATION, EA 110.0096365 PR IV INFUSION,

THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR

159.00

96366 PR IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR

53.00

96367 PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR

88.00

96368 PR IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION

51.00

96372 PR INJECTION,THERAP/PROPH/DIAGNO

56.00


48.00


119.00


55.00

96401 PR CHEMOTHER,NON-HORMONE ANTI-NEOPL, SUB-Q/IM

156.00

96402 PR CHEMOTHER HORMON ANTINEOPL SUB-Q/IM

106.00

96405 PR INTRALESIONAL CHEMO 417.0096409 PR CHEMOTHER, IV PUSH, SNGL 298.00

96411 PR CHEMOTHER, IV PUSH,EA ADD 183.0096413 PR CHEMOTHER, IV INFUSION, 1 HR 485.0096415 PR CHEMOTHER, IV INFUSION, EA 149.0096417 PR CHEMOTHER, IV INFUSE, EACH

SEQU INFUS218.00

96450 PR CHEMOTHER,CNS,W/LUMBAR PUNCTURE

1291.00

96542 PR CHEMOTHER INJECT,SUBARACH/INTRAVENT

770.00

96573 PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP

484.00

96574 PR DEBRIDEMENT PRMLG HYPERKERATOTIC LES W/PDT

623.00

97012 PR MECHANICAL TRACTION 41.0097032 PR ELECTRICAL STIMULATION 46.0097112 PR NEUROMUSC REEDUCAT,1+

AREAS, EA 15 MIN88.00

97161 PR PHYSICAL THERAPY EVALUATION LOW COMPLEX 20

205.00

97162 PR PHYSICAL THERAPY EVALUATION MOD COMPLEX 30

205.00

97163 PR PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45

205.00

97164 PR PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS

140.00

97165 PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS

199.00

97166 PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS

199.00

97167 PR OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS

199.00

97168 PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS

131.00

97597 PR DEBRIDEMENT OPEN WOUND 20 189.0097598 PR DEBRIDEMENT OPEN WOUND EA

ADDL 20 SQ CM63.00

97602 PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS

137.00

97605 PR NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM

100.00

97606 PR NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM

123.00

97607 PR NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM

446.00

97608 PR NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM

446

97750 PR PHYSICAL PERFORMANCE TEST 83.0097760 PR ORTHOTICS MGMT & TRAINJ

INITIAL ENCTR EA 15 MINS119.00

97763 PR ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN

124.00

97802 PR MED NUTR THER, 1ST, INDIV, EA 88.0097803 PR MED NUTR THER, SUBSQ, INDIV,

EA 15 MIN76.00

97804 PR MED NUTR THER, GROUP, EA 30 40.0097810 PR ACUPUNCT W/O ELEC STIMUL 15 136.0097813 PR ACUPUNCT W/ ELEC STIMUL 15 136.0098925 PR OSTEOPATHIC MANIP,1-2 BODY 79.0098926 PR OSTEOPATHIC MANIP,3-4 BODY 100.0098927 PR OSTEOPATHIC MANIP,5-6 BODY 151.0098928 PR OSTEOPATHIC MANIP,7-8 BODY 145.0098929 PR OSTEOPATHIC MANIP,9-10 BODY 219.0098961 PR SELF-MGMT EDUC/TRAIN, 2-4 PT,

EA 30 MIN46.00

98968 PR NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN

150.00

99000 PR HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB

0.00

99024 PR POST-OP FOLLOW-UP VISIT 0.0099050 PR MEDICAL SERVICES AFTER HRS 47.0099053 PR MEDICAL SERVICES 10PM-8AM,

24 HR FAC55.00

99058 PR EMERGENCY CARE DISRUPTING 144.0099070 PR SUPPLIES&MATERIALS

ABOVE/BEYOND PROV BY PHYS/QHP50.00

99080 PR SPECIAL REPORTS OR FORMS 49.0099100 SPECIAL ANESTHESIA SERVICE 132.0099140 PR EMERGENCY ANESTHESIA 263.0099143 PR MODERATE SEDATJ SAME

PHYS/QHP <5 YRS INIT 30 MIN148.00

99144 PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN

135.00

99144 PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN

26 135.00

99145 PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN

63.00

99145 PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN

26 63.00

99148 PR MOD SEDATJ DIFF PHYS/QHP <5 YRS INIT 30 MIN

137.00

99149 PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN

128.00

99150 PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN

70.00

99151 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS

196.00

99152 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS

131.00

99153 PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS

28.00

99155 PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS

236.00

99156 PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS

193.00

99157 PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS

147.00

99173 PR VISUAL SCREENING TEST, BILAT 72.0099174 PR INSTRUMENT BASED OCULAR

SCR BI W/RMT ANAL & RPT67.00

99184 PR INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE

565.00

99188 PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP

49.00

99201 PR OFFICE OUTPATIENT NEW 10 106.0099202 PR OFFICE OUTPATIENT NEW 20 181.0099203 PR OFFICE OUTPATIENT NEW 30 262.0099204 PR OFFICE OUTPATIENT NEW 45 396.0099205 PR OFFICE OUTPATIENT NEW 60 494.0099211 PR OFFICE OUTPATIENT VISIT 5 49.0099212 PR OFFICE OUTPATIENT VISIT 10 105.0099213 PR OFFICE OUTPATIENT VISIT 15 177.0099214 PR OFFICE OUTPATIENT VISIT 25 258.0099214 PR OFFICE OUTPATIENT VISIT 25 26 250.0099215 PR OFFICE OUTPATIENT VISIT 40 345.0099217 PR OBSERVATION CARE

DISCHARGE MANAGEMENT184.00

99218 PR INITIAL OBSERVATION CARE/DAY 30 MINUTES

252.00


342.00


468.00

99221 PR INITIAL HOSPITAL CARE/DAY 30 MINUTES

255.00


344.00


510.00

99224 PR SBSQ OBSERVATION CARE/DAY 15 MINUTES

101.00


184.00


264.00

99231 PR SBSQ HOSPITAL CARE/DAY 15 99.0099232 PR SBSQ HOSPITAL CARE/DAY 25 183.0099233 PR SBSQ HOSPITAL CARE/DAY 35 262.0099234 PR OBSERVATION/INPATIENT

HOSPITAL CARE 40 MINUTES335.00

99235 PR OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES

435.00

99236 PR OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES

549.00

99238 PR HOSPITAL DISCHARGE DAY,<30 184.0099239 PR HOSPITAL DISCHARGE DAY,>30 271.0099241 PR OFFICE CONSULTATION

NEW/ESTAB PATIENT 15 MIN117.00

99242 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN

219.00


300.00


444.00


662.00

99251 PR INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN

123.00


188.00


289.00


420.00

99255 PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN

505.00

99281 PR EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB

60.00

99282 PR EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY

104.00

99283 PR EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY

156.00

99284 PR EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY

295.00

99285 PR EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ

435.00

99288 PR PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS

297.00

99291 PR CRITICAL CARE, E/M 30-74 775.0099292 PR CRITICAL CARE, ADDL 30 MIN 308.0099304 PR INITIAL NURSING FACILITY

CARE/DAY 25 MINUTES230.00

99305 PR INITIAL NURSING FACILITY CARE/DAY 35 MINUTES

328.00

99306 PR INITIAL NURSING FACILITY CARE/DAY 45 MINUTES

420.00

99307 PR SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN

112.00

99308 PR SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN

174.00

99308 PR SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN

26 173.00

99309 PR SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN

230.00

99310 PR SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN

342.00

99315 PR NURSING FAC DISCHRGE DAY,1- 184.0099316 PR NURSING FAC DISCHRGE

DAY,MORE 30 MIN267.00

99318 PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN

242.00

99324 PR DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN

139.00

99325 PR DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN

202.00

99326 PR DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES

350.00

99327 PR DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN

468.00

99328 PR DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES

548.00

99334 PR DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES

151.00

99335 PR DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES

238.00

99336 PR DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES

340.00

99337 PR DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES

486.00

99339 PR DOMICIL/REST-HOME CARE SUPERVISION, <30 MIN

195.00

99340 PR DOMICIL/REST-HOME CARE SUPERVISION, =>30 MIN

273.00

99341 PR HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES

138.00

99342 PR HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES

200.00

99343 PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES

328.00

99344 PR HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES

459.00

99345 PR HOME VISIT NEW PT UNSTABL/SIGNIF NEW PROB 75 MIN

558.00

99347 PR HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES

139.00

99348 PR HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES

212.00

99349 PR HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES

324.00

99350 PR HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60

450.00

99354 PR PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON 1ST HR

328.00

99355 PR PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30

248.00

99356 PR PROLONGED SERVICE I/P REQ UNIT/FLOOR TIME 1ST HR

232.00

99357 PR PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN

233.00

99358 PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST

294.00

99359 PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MIN

147.00

99360 PR PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES

202.00

99363 PR ANTICOAG MGMT, INITIAL 90 318.0099364 PR ANTICOAG MGMT, EACH SUBSEQ

90 DAYS109.00

99366 PR TEAM CONFERENCE FACE-TO-FACE NONPHYSICIAN

108.00

99367 PR TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN

143.00

99368 PR TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN

93.00

99374 PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES

176.00

99375 PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>

263.00

99377 PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN

176.00

99378 PR SUPERVISION HOSPICE PATIENT/MONTH 30 MINUTES/>

278.00

99379 PR SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN

176.00

99380 PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>

263.00

99381 PR PREVENTIVE VISIT,NEW,INFANT < 275.0099382 PR PREVENTIVE VISIT,NEW,AGE 1-4 287.0099383 PR PREVENTIVE VISIT,NEW,AGE5-11 300.0099384 PR PREVENTIVE VISIT,NEW,12-17 339.0099385 PR PREVENTIVE VISIT,NEW,18-39 327.0099386 PR PREVENTIVE VISIT,NEW,40-64 380.0099387 PR PREVENTIVE VISIT,NEW,65 & 412.00

99391 PR PREVENTIVE VISIT,EST, INFANT < 248.0099392 PR PREVENTIVE VISIT,EST,AGE 1-4 264.0099393 PR PREVENTIVE VISIT,EST,AGE5-11 264.0099394 PR PREVENTIVE VISIT,EST,12-17 289.0099395 PR PREVENTIVE VISIT,EST,18-39 295.0099396 PR PREVENTIVE VISIT,EST,40-64 315.0099397 PR PREVENTIVE VISIT,EST,65 & 339.0099401 PR PREVENT COUNSEL,INDIV,15 MIN 91.0099402 PR PREVENT COUNSEL,INDIV,30 MIN 155.0099403 PR PREVENT COUNSEL,INDIV,45 MIN 216.0099404 PR PREVENT COUNSEL,INDIV,60 MIN 279.0099406 PR TOBACCO USE CESSATION

INTERMEDIATE 3-10 MINUTES37.00

99407 PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES

71.00

99408 PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN

89.00

99409 PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN >30 MIN

173.00

99411 PR PREVENT COUNSEL,GROUP,30 41.0099412 PR PREVENT COUNSEL,GROUP,60 54.0099415 PR PROLNG CLINCL STAFF SVC

DURING O/P E/M 1ST HR25.00

99416 PR PROLNG CLINCL STAFF SVC DURING O/P E/M EA 30 MIN

20.00

99441 PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN

36.00


68.00


100.00

99444 PR PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE

84.00

99446 PR INTERPROF PHONE/INTERNET ASSESS/MANAGE 5-10

30.00

99450 PR LIFE/DISABILITY EVALUATION 334.0099455 PR DISABILITY EXAM/TREATING DR 459.0099456 PR DISABILITY EXAM/OTHER DR 528.0099460 PR INITIAL NORMAL NEWBORN

CARE, HOSPITAL OR BIRTH CENTER252.00

99461 PR INITIAL NORMAL NEWBORN CARE, EXCEPT HOSPITAL OR BIRTH

245.00

99462 PR SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN

112.00

99463 PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE

301.00

99464 PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN

194.00

99465 PR DELIVERY/BIRTHING ROOM RESUSCITATION

384.00

99466 PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN

639.00

99467 PR CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN

309.00

99468 PR INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL

3484.00

99469 PR SUBSEQUENT HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL

1004.00

99471 PR INITIAL PED CRITICAL CARE 29 DAY THRU 24 MO

3050.00

99472 PR SUBSEQUENT PED CRITICAL CARE 29 DAY THRU 24 MO

1035.00

99475 PR INITIAL PED CRITICAL CARE 2 YR THRU 5 YR

2027.00

99476 PR SUBSEQUENT PED CRITICAL CARE 2 YR THRU 5 YR

868.00

99477 PR INITIAL HOSP NEONATE 28 DAY OR LESS, NOT CRITICALLY ILL

897.00

99478 PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS

353.00

99479 PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS

314.00

99480 PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS

303.00

99483 PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT

597.00

99484 PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS

120.00

99485 PR SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN

193.00

99486 PR SUPERVISION INTERFACILITY TRANSPORT ADDL 30 MIN

168.00

99487 PR CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER MO

205.00

99489 PR CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER MONTH

115.67

99490 PR CHRON CARE MANAGEMENT SRVC 20 MIN PER MONTH

106.00

99492 PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS

404.00

99493 PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS

323.00

99494 PR 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS

167.00

99495 PR TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE

496.00

99496 PR TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE

584.00

99497 PR ADVANCE CARE PLANNING FIRST 30 MINS

213.00

99498 PR ADVANCE CARE PLANNING EA ADDL 30 MINS

188.00

99499 PR UNLISTED E/M SERVICE 0.0099502 HOME VISIT,NEWBORN 121.00A4351 PR STRAIGHT TIP URINE CATHETER 5.00A4353 PR INTERMITTENT URINARY CATH 17.00A4358 PR URINARY LEG OR ABDOMEN BAG 16.00A4495 PR THIGH LENGTH SURG STOCKING 22.00A4500 PR BELOW KNEE SURGICAL 20.00A4550 PR SURGICAL TRAYS 55.00A4562 PR PESSARY, NON RUBBER,ANY 139.00A4565 PR SLINGS 14.00A4570 PR SPLINT 31.00A4595 PR TENS SUPPL 2 LEAD PER MONTH 39.00A4615 CANNULA NASAL 2.00A4617 MOUTH PIECE 9.00A4627 PR SPACER BAG/RESERVOIR 28.00A5500 PR DIAB SHOE FOR DENSITY INSERT 78.00A5501 PR DIABETIC CUSTOM MOLDED 232.00A5503 PR DIABETIC SHOE 35.00A5504 PR DIABETIC SHOE WITH WEDGE 44.00A5507 PR MODIFICATION DIABETIC SHOE 80.00A5512 PR MULTI DEN INSERT DIRECT 55.00A5513 PR MULTI DEN INSERT CUSTOM 139.00A6504 PR CMPRSBURNGARMENT GLOVE- 315.00A6530 PR COMPRESSION STOCKING BK18- 38.00

A6531 PR COMPRESSION STOCKING BK30- 38.00A6533 PR GC STOCKING THIGHLNGTH 18- 51.00A6536 PR GC STOCKING FULL LNGTH 18-30 57.00A6537 PR GC STOCKING FULL LNGTH 30-40 65.00A6539 PR GC STOCKING WAISTLNGTH 18- 134.00A6540 PR GC STOCKING WAISTLNGTH 30- 185.00A6549 PR G COMPRESSION STOCKING 108.00A7003 PR NEBULIZER ADMINISTRATION 5.00A7015 PR AEROSOL MASK USED W 4.00A8000 PR SOFT PROTECT HELMET PREFAB 209.00A8001 PR HARD PROTECT HELMET 209.00A8002 PR SOFT PROTECT HELMET 329.00A8003 PR HARD PROTECT HELMET 2492A9270 PR NON-COVERED ITEM OR 25.00A9279 PR MONITORING 250.00D0120 PR PERIODIC ORAL EVALUATION 55.00D0140 PR LIMIT ORAL EVAL PROBLM 75.00D0145 PR ORAL EVALUATION, PT < 3YRS 60D0150 PR COMPREHENSVE ORAL 90.00D0160 PR EXTENSV ORAL EVAL PROB 75.00D0170 PR RE-EVAL,EST PT,PROBLEM 75.00D0171 PR RE-EVAL POST-OP VISIT 0D0180 PR COMP PERIODONTAL 100D0210 PR INTRAOR COMPLETE FILM 140.00D0220 PR INTRAORAL PERIAPICAL FIRST F 32.00D0230 PR INTRAORAL PERIAPICAL EA ADD 26.00D0240 PR INTRAORAL OCCLUSAL FILM 48.00D0250 PR EXTRAORAL FIRST FILM 50.00D0251 EXTRA-ORAL POSTERIOR DENTAL

RADIOGRAPHIC IMAGE75.00

D0270 PR DENTAL BITEWING SINGLE FILM 32.00D0272 PR DENTAL BITEWINGS TWO FILMS 50.00D0273 PR BITEWINGS - THREE FILMS 50.00D0274 PR DENTAL BITEWINGS FOUR FILMS 70.00D0277 PR VERT BITEWINGS-SEV TO EIGHT 100D0330 PR DENTAL PANORAMIC FILM 125.00D0340 PR DENTAL CEPHALOMETRIC FILM 140.00D0350 PR ORAL/FACIAL PHOTO IMAGES 70D0351 PR 3D PHOTOGRAPHIC IMAGE 0D0363 PR CONE BEAM, THREE 300D0364 CONE BEAM CT CAPT & INTERP 400.00D0365 CONE BEAM CT INTERPRETE MAN 400.00

D0366 CONE BEAM CT INTERPRETE MAX 400.00D0367 CONE BEAM CT INTERP BOTH JAW 400.00D0368 CONE BEAM CT INTERPRETE TMJ 400.00D0380 PR CONE BEAM CT CAPTURE 300.00D0381 PR CONE BEAM CT CAPT MANDIBLE 300.00D0382 PR CONE BEAM CT CAPT MAXILLA 300.00D0383 PR CONE BEAM CT BOTH JAWS 300.00D0384 PR CONE BEAM CT CAPTURE TMJ 300.00D0391 PR INTERPRETE DIAGNOSTIC IMAGE 250.00D0460 PR PULP VITALITY TEST 65.00D0470 PR DIAGNOSTIC CASTS 90.00D1110 PR DENTAL PROPHYLAXIS ADULT 95.00D1120 PR DENTAL PROPHYLAXIS CHILD 75.00D1206 PR TOPICAL FLUORIDE VARNISH 45.00D1208 TOPICAL APPLICATION FLOURIDE 45.00D1310 PR NUTRI COUNSEL-CONTROL 28.00D1320 PR TOBACCO COUNSELING 0D1330 PR ORAL HYGIENE INSTRUCTION 0.00D1351 PR DENTAL SEALANT PER TOOTH 60.00D1352 PREV RESIN REST, PERM TOOTH 75.00D1353 PR SEALANT REPAIR PER TOOTH 60D1354 INTERIM CARIES ARRESTING

MEDICAMENT APPLICATION - PER 50.00

D1510 PR SPACE MAINTAINER FXD UNILAT 300D1515 PR FIXED BILAT SPACE MAINTAINER 400.00D1520 PR REMOVE UNILAT SPACE 300D1525 PR REMOVE BILAT SPACE MAINTAIN 400D1550 PR RECEMENT SPACE MAINTAINER 70D1555 PR REMOVE FIX SPACE MAINTAINER 75D1575 PR DIST SPACE MAINT, FIXED UNIL 300D2140 PR AMALGAM ONE SURFACE 150.00D2150 PR AMALGAM TWO SURFACES 200.00D2160 PR AMALGAM THREE SURFACES 250D2161 PR AMALGAM 4 OR > SURFACES 300D2330 PR RESIN ONE SURFACE-ANTERIOR 180.00D2331 PR RESIN TWO SURFACES- 220.00D2332 PR RESIN THREE SURFACES- 290.00D2335 PR RESIN 4/> SURF OR W INCIS AN 350.00D2390 PR ANT RESIN-BASED CMPST 500D2391 PR POST 1 SRFC RESINBASED 200.00D2392 PR POST 2 SRFC RESINBASED 260.00D2393 PR POST 3 SRFC RESINBASED 320.00

D2394 PR POST >=4SRFC RESINBASE 380.00D2520 PR DENTAL INLAY METALLIC 2 SURF 1000D2530 PR DENTAL INLAY METL 3/MORE 1100D2542 PR DENTAL ONLAY METALLIC 2 1000D2543 PR DENTAL ONLAY METALLIC 3 1100D2620 PR INLAY PORCELAIN/CERAMIC 2 SU 1050D2642 PR DENTAL ONLAY PORCELIN 2 1100D2643 PR DENTAL ONLAY PORCELIN 3 1160D2644 PR DENTAL ONLAY PORC 4/MORE 1200D2651 PR INLAY COMPOSITE/RESIN TWO 950D2652 PR DENTAL INLAY RESIN 3/MRE SUR 1000D2662 PR DENTAL ONLAY RESIN 2 1100D2663 PR DENTAL ONLAY RESIN 3 1150D2664 PR DENTAL ONLAY RESIN 4/MRE 1000D2740 PR CROWN PORCELAIN/CERAMIC 1200.00D2750 PR CROWN PORCELAIN W/ H NOBLE 1200.00D2751 PR CROWN PORCELAIN FUSED 1200D2752 PR CROWN PORCELAIN W/ NOBLE 1200D2780 PR CROWN 3/4 CAST HI NOBLE MET 1200D2781 PR CROWN 3/4 CAST BASE METAL 1200D2782 PR CROWN 3/4 CAST NOBLE METAL 1200D2783 PR CROWN 3/4 1200D2790 PR CROWN FULL CAST HIGH NOBLE 1200.00D2799 PR PROVISIONAL CROWN 350D2910 PR RECEMENT INLAY ONLAY OR 120.00D2920 PR DENTAL RECEMENT CROWN 120.00D2921 PR REATTACH TOOTH FRAGMENT 180D2929 PREFABRICATED

PORCELAIN/CERAMIC CROWN, 400

D2930 PR PREFAB STNLSS STEEL CRWN 290.00D2931 PR PREFAB STNLSS STEEL CROWN 300.00D2940 PR DENTAL SEDATIVE FILLING 120.00D2941 PR INT THERAPEUTIC RESTORATION 100.00D2950 PR CORE BUILD-UP INCL ANY PINS 300.00D2951 PR TOOTH PIN RETENTION 70.00D2952 PR POST AND CORE CAST + CROWN 500.00D2954 PR PREFAB POST/CORE + CROWN 380.00D2960 PR LAMINATE LABIAL VENEER 700.00D2962 PR LAB LABIAL VENEER PORCELAIN 1200.00D2975 PR COPING 200.00D2980 PR CROWN REPAIR 225.00D2999 PR DENTAL UNSPEC RESTORATIVE 0.00

D3110 PR PULP CAP DIRECT 95.00D3120 PR PULP CAP INDIRECT 95D3220 PR THERAPEUTIC PULPOTOMY 200.00D3221 PR GROSS PULPAL DEBRIDEMENT 250.00D3222 PR PART PULP FOR APEXOGENESIS 200D3230 PR PULPAL THERAPY ANTERIOR 300D3240 PR PULPAL THERAPY POSTERIOR 350D3310 PR ANTERIOR 800.00D3320 PR ROOT CANAL THERAPY 2 900.00D3330 PR ROOT CANAL THERAPY 3 1100D3331 PR NON-SURG TX ROOT CANAL OBS 800D3332 PR INCOMPLETE ENDODONTIC TX 500D3333 PR INTERNAL ROOT REPAIR 300D3346 PR RETREAT ROOT CANAL 950D3347 PR RETREAT ROOT CANAL BICUSPID 1100D3348 PR RETREAT ROOT CANAL MOLAR 1200D3351 PR APEXIFICATION/RECALC INITIAL 350D3352 PR APEXIFICATION/RECALC INTERIM 300.00D3353 PR APEXIFICATION/RECALC FINAL 800D3355 PR PULPAL REGENERATION INITIAL 200.00D3356 PR PULPAL REGENERATION 150.00D3410 PR APICOECT/PERIRAD SURG 800D3421 PR ROOT SURGERY BICUSPID 900D3425 PR ROOT SURGERY MOLAR 1100D3426 PR ROOT SURGERY EA ADD ROOT 300D3427 PR PERIRADICULAR SURGERY 550D3450 PR ROOT AMPUTATION 500.00D3460 PR ENDODONTIC ENDOSSEOUS 2000D3470 PR INTENTIONAL REPLANTATION 1000D4210 PR GINGIVECTOMY/PLASTY PER 680.00D4212 GINGIVECTOMY/PLASTY REST 247.00D4240 PR GINGIVAL FLAP PROC W/ PLANIN 680D4241 PR GNGVL FLAP W ROOTPLAN 1-3 500D4245 PR APICALLY POSITIONED FLAP 550D4249 PR CROWN LENGTHEN HARD 900.00D4260 PR OSSEOUS SURGERY PER 1100.00D4261 PR OSSEOUS SURGL- 800.00D4263 PR BONE REPLCE GRAFT FIRST SITE 650D4264 PR BONE REPLCE GRAFT EACH ADD 450D4265 PR BIO MTRLS TO AID SOFT/OS REG 527.00D4266 PR GUIDED TISS REGEN RESORBLE 800D4270 PR PEDICLE SOFT TISSUE GRAFT PR 1000.00

D4273 PR SUBEPITHELIAL TISSUE GRAFT 1100.00D4274 PR DISTAL/PROXIMAL WEDGE PROC 350.00D4277 SOFT TISSUE GRAFT 1ST TOOTH 1000.00D4278 SOFT TISSUE GRAFT ADDL TOOTH 500.00D4283 AUTO TISSUE GRAFT ADDL TOOTH 550.00D4320 PR PROVISION SPLNT 600.00D4321 PR PROVISIONAL SPLINT 500D4341 PR PERIODONTAL SCALING & ROOT 275.00D4342 PR PERIODONTAL SCALING 1- 190D4355 PR FULL MOUTH DEBRIDEMENT 190.00D4381 PR LOCALIZED DELIVERY 125D4910 PR PERIODONTAL MAINT 160.00D5110 PR DENTURES COMPLETE 2000.00D5120 PR DENTURES COMPLETE 2000.00D5130 PR DENTURES IMMEDIAT 1300D5140 PR DENTURES IMMEDIAT MANDIBLE 1300D5211 PR DENTURES MAXILL PART RESIN 1500.00D5212 PR DENTURES MAND PART RESIN 1500.00D5213 PR DENTURES MAXILL PART METAL 2000.00D5214 PR DENTURES MANDIBL PART 2000.00D5221 IMMED MAX PART DENTURE RESIN 1250D5222 IMMED MAN PART DENTURE RESIN 1250D5223 IMMED MAX PART DENT METAL 1500D5224 IMMED MAND PART DENT METAL 1500D5225 PR MAXILLARY PART DENTURE FLEX 1800.00D5226 PR MANDIBULAR PART DENTURE 1800.00D5281 PR REMOVABLE PARTIAL DENTURE 1200D5410 PR DENTURES ADJUST CMPLT 100.00D5411 PR DENTURES ADJUST CMPLT 100.00D5421 PR DENTURES ADJUST PART MAXILL 100.00D5422 PR DENTURES ADJUST PART 100.00D5510 PR DENTUR REPR BROKEN COMPL 230.00D5511 REPAIR BROKEN COMPLETE

DENTURE BASE, MANDIBULAR300

D5512 REPAIR BROKEN COMPLETE DENTURE BASE, MAXILLARY

250.00

D5520 PR REPLACE DENTURE TEETH 200.00D5610 PR DENTURES REPAIR RESIN BASE 230.00D5611 REPAIR RESIN PARTIAL DENTURE

BASE, MANDIBULAR300

D5612 REPAIR RESIN PARTIAL DENTURE BASE, MAXILLARY

300

D5621 REPAIR CAST PARTIAL FRAMEWORK, MANDIBULAR

300

D5622 REPAIR CAST PARTIAL FRAMEWORK, MAXILLARY

300

D5630 PR REP PARTIAL DENTURE CLASP 300.00D5640 PR REPLACE PART DENTURE TEETH 200.00D5650 PR ADD TOOTH TO PARTIAL 230.00D5660 PR ADD CLASP TO PARTIAL 300.00D5710 PR DENTURES REBASE CMPLT 600.00D5711 PR DENTURES REBASE CMPLT 600.00D5720 PR DENTURES REBASE PART 600.00D5721 PR DENTURES REBASE PART 600.00D5730 PR DENTURE RELN CMPLT MAXIL CH 400.00D5731 PR DENTURE RELN CMPLT MAND 400.00D5740 PR DENTURE RELN PART MAXIL CHR 400D5741 PR DENTURE RELN PART MAND CHR 400D5750 PR DENTURE RELN CMPLT MAX LAB 500D5751 PR DENTURE RELN CMPLT MAND 500D5760 PR DENTURE RELN PART MAXIL LAB 500.00D5761 PR DENTURE RELN PART MAND LAB 500.00D5810 PR DENTURE INTERM CMPLT MAXILL 1000.00D5811 PR DENTURE INTERM CMPLT 1000.00D5820 PR DENTURE INTERM PART MAXILL 800.00D5821 PR DENTURE INTERM PART MANDBL 800.00D5850 PR DENTURE TISS CONDITN MAXILL 250.00D5851 PR DENTURE TISS CONDTIN 250.00D5862 PR PRECISION ATTACHMENT 700.00D5863 OVERDENTURE COMPLETE 2000D5864 OVERDENTURE PARTIAL MAXILLARY 2000D5865 OVERDENTURE COMPLETE 2000D5866 OVERDENTURE PARTIAL 2000D5875 PR PROSTHESIS MODIFICATION 800D5933 PR REFITTING OF OBTURATOR 250.00D5982 PR SURGICAL STENT 500.00D5983 PR RADIATION APPLICATOR 450D5986 PR FLUORIDE APPLICATOR 190.00D5988 PR SURGICAL SPLINT 500D6010 PR ODONTICS ENDOSTEAL IMPLANT 2000.00D6056 PR PREFABRICATED ABUTMENT 1000.00D6057 PR CUSTOM ABUTMENT 1100.00D6058 PR ABUTMENT SUPPORTED CROWN 1400.00D6059 PR ABUTMENT SUPPORTED MTL 1400.00

D6065 PR IMPLANT SUPPORTED CROWN 1336.00D6066 PR IMPLANT SUPPORTED MTL 1015.00D6068 PR ABUTMENT SUPPORTED 1125.00D6071 PR ABUTMENT SUPPORTED 1000.00D6076 PR IMPLANT SUPPORTED RETAINER 1100.00D6090 PR REPAIR IMPLANT 250D6091 PR REPL SEMI/PRECISION ATTACH 150.00D6092 PR RECEMENT SUPP CROWN 200.00D6096 REMOVE BROKEN IMPLANT

RETAINING SCREW300.00

D6100 PR REMOVAL OF IMPLANT 1000.00D6104 BONE GRAFT TIME OF IMPLANT 800.00D6111 IMPLNT/ABUT REMOV DENT MAND 2000.00D6118 IMPLANT/ABUT SUPPORTED

INTERIM FIXED DENTURE FOR 3500.00

D6119 IMPLANT/ABUT SUPPORTED INTERIM FIXED DENTURE FOR

3500.00

D6212 PR BRIDGE NOBLE METAL CAST 1100.00D6240 PR BRIDGE PORCELAIN HIGH NOBLE 1100.00D6242 PR BRIDGE PORCELAIN NOBEL 1100.00D6245 PR BRIDGE PORCELAIN/CERAMIC 950.00D6545 PR DENTAL RETAINR CAST METL 800.00D6740 PR CROWN PORCELAIN/CERAMIC 975.00D6750 PR CROWN PORCELAIN HIGH NOBLE 1200.00D6752 PR CROWN PORCELAIN NOBLE 1100.00D6930 PR DENTAL RECEMENT BRIDGE 200.00D7111 PR EXTRACTION CORONAL 100.00D7140 PR EXTRACTION ERUPTED 180.00D7210 PR REM IMP TOOTH W MUCOPER 300.00D7220 PR IMPACT TOOTH REMOV SOFT 375.00D7230 PR IMPACT TOOTH REMOV PART 450.00D7240 PR IMPACT TOOTH REMOV COMP 600.00D7260 PR ORAL ANTRAL FISTULA CLOSURE 1300.00D7270 PR TOOTH REIMPLANTATION 700.00D7280 PR EXPOSURE IMPACT TOOTH 400.00D7283 PR PLACE DEVICE IMPACTED 300.00D7285 PR BIOPSY OF ORAL TISSUE HARD 500.00D7286 PR BIOPSY OF ORAL TISSUE SOFT 400.00D7310 PR ALVEOPLASTY W/ EXTRACTION 350.00D7311 PR ALVEOLOPLASTY W/EXTRACT 1-3 145.00D7320 PR ALVEOPLASTY W/O EXTRACTION 600.00D7321 PR ALVEOLOPLASTY NOT 125.00

D7411 PR EXCISION BENIGN LESION>1.25C 470.00D7451 PR REM ODONTOGEN CYST > 1.25 250.00D7465 PR LESION DESTRUCTION 294.00D7471 PR REM EXOSTOSIS ANY SITE 800.00D7472 PR REMOVAL OF TORUS PALATINUS 625.00D7473 PR REMOVE TORUS MANDIBULARIS 625.00D7510 PR I&D ABSC INTRAORAL SOFT TISS 280.00D7530 PR REMOVAL FB SKIN/AREOLAR 408.00D7540 PR REMOVAL OF FB REACTION 180.00D7670 PR CLOSD RDUCTN SPLINT 2000.00D7910 PR DENT SUTUR RECENT WND TO 400.00D7951 PR SINUS AUG W BONE/BONE SUP 1500.00D7953 PR BONE REPLACEMENT GRAFT 800.00D7960 PR FRENULECTOMY/FRENULOTOMY 500.00D7970 PR EXCISION HYPERPLASTIC 600.00D7971 PR EXCISION PERICORONAL 450.00D8030 PR LIMITED DENTAL TX 3500.00D8080 PR COMPRE DENTAL TX 6500.00D8210 PR ORTHODONTIC REM APPLIANCE 800.00D8220 PR FIXED APPLIANCE THERAPY 1200.00D8660 PR PREORTHODONTIC TX VISIT 37.00D8670 PR PERIODIC ORTHODONTC TX 702.00D8680 PR ORTHODONTIC RETENTION 190.00D8690 PR ORTHODONTIC TREATMENT 184.00D8692 PR REPLACEMENT RETAINER 500.00D8693 PR REBOND/CEMENT/REPAIR 45.00D8695 REMOVAL OF FIXED ORTHO

APPLIANCES FOR REASONS OTHER 350.00

D9110 PR TX DENTAL PAIN MINOR PROC 150.00D9120 PR FIX PARTIAL DENTURE SECTION 225.00D9230 PR ANALGESIA 100.00D9239 INTRAVENOUS MODERATE

(CONSCIOUS) SEDATION/ANALGESIA- 200.00

D9243 IV SEDATION EACH 15M 155.00D9248 PR SEDATION (NON-IV) 300.00D9310 PR DENTAL CONSULTATION 98.00D9430 PR OFFICE VISIT DURING HOURS 90.00D9450 PR CASE PRESENTATION TX PLAN 0.00D9630 PR OTHER DRUGS/MEDICAMENTS 57.00D9910 PR DENT APPL DESENSITIZING MED 50D9940 PR DENTAL OCCLUSAL GUARD 700.00D9941 PR FABRICATION ATHLETIC GUARD 250.00

D9943 OCCLUSAL GUARD ADJUSTMENT 44.00D9951 PR LIMITED OCCLUSAL 225.00D9970 PR ENAMEL MICROABRASION 35.00D9971 PR ODONTOPLASTY 1-2 TEETH 150.00D9973 PR EXTRNL BLEACHING PER TOOTH 300.00D9974 PR INTRNL BLEACHING PER TOOTH 350.00D9975 EXTERNAL BLEACHING HOME ARCH

TOOTH WHITENING FROM OUTSIDE 200.00

E0191 PR PROTECTOR HEEL OR ELBOW 145.00E0486 PR ORAL DEVICE/APPLIANCE 1700.00E0720 PR TENS TWO LEAD 510.00E0731 PR CONDUCTIVE GARMENT FOR 462.00E0860 PR TRACT EQUIP CERVICAL TRACT 69.00G0008 PR ADMIN INFLUENZA VIRUS VAC 21G0009 PR ADMIN PNEUMOCOCCAL 21G0010 PR ADMIN HEPATITIS B VACCINE 21G0101 PR CA SCREEN;PELVIC/BREAST 95.00G0103 PR PSA, TOTAL SCREENING 61G0104 PR CA SCREEN;FLEXI 335.00G0105 PR COLORECTAL SCRN; HI RISK IND 1036.00G0108 PR DIAB MANAGE TRN PER INDIV 132.00G0117 PR GLAUCOMA SCRN HGH RISK 136.00G0120 PR COLON CA SCRN; BARIUM 539.00G0120 PR COLON CA SCRN; BARIUM 26 133.00G0121 PR COLON CA SCRN NOT HI RSK IND 961.00G0124 PR SCREEN C/V THIN LAYER BY MD 82G0127 PR TRIM NAIL(S) 45.00G0168 PR WOUND CLOSURE BY ADHESIVE 257.00G0179 PR MD RECERTIFICATION HHA PT 140.00G0180 PR MD CERTIFICATION HHA PATIENT 150.00G0181 PR HOME HEALTH CARE 271.00G0182 PR HOSPICE CARE SUPERVISION 273.00G0202 PR SCR MAMMO BI INCL CAD 341.00G0202 PR SCR MAMMO BI INCL CAD 26 81.00G0204 PR DX MAMMO INCL CAD BI 26 101.00G0206 PR DX MAMMO INCL CAD UNI 26 81.00G0270 PR MNT SUBS TX FOR CHANGE DX 76.00G0271 PR GROUP MNT 2 OR MORE 30 MINS 40.00G0279 PR TOMOSYNTHESIS, MAMMO 26 129.00G0289 PR ARTHRO, LOOSE BODY + 286.00G0296 PR VISIT TO DETERM LDCT ELIG 136.00G0297 PR LDCT FOR LUNG CA SCREEN 507.00

G0297 PR LDCT FOR LUNG CA SCREEN 26 129.00G0364 PR BONE MARROW ASPIRATE 35.00G0365 PR VESSEL MAPPING HEMO ACCESS 503.00G0365 PR VESSEL MAPPING HEMO ACCESS 26 31.00G0372 PR MD SERVICE REQUIRED FOR 52.00G0389 PR ULTRASOUND EXAM AAA 26 68.00G0399 PR HOME SLEEP TEST/TYPE 3 26 147.00G0402 PR INITIAL PREVENTIVE EXAM 415.00G0403 PR EKG FOR INITIAL PREVENT EXAM 50.00G0403 PR EKG FOR INITIAL PREVENT EXAM 26 50.00G0405 PR EKG INTERPRET & REPORT 22.00G0413 PR PELVIC RING FRACTURE UNI/BIL 3357.00G0414 PR PELVIC RING FX TREAT INT FIX 3480.00G0415 PR OPEN TX POST PELVIC FXCTURE 4894.00G0416 PR PROSTATE BIOPSY, ANY MTHD 26 462G0420 PR ED SVC CKD IND PER SESSION 272.00G0425 INPT/ED TELECONSULT30 245.00G0432 PR EIA HIV-1/HIV-2 SCREEN 49.00G0436 PR TOBACCO-USE COUNSEL 3-10 35.00G0437 PR TOBACCO-USE COUNSEL>10MIN 70.00G0438 PR PPPS, INITIAL VISIT 427.00G0439 PR PPPS, SUBSEQ VISIT 290.00G0442 PR ANNUAL ALCOHOL SCREEN 15 42.00G0443 PR BRIEF ALCOHOL MISUSE 65G0444 PR DEPRESSION SCREEN ANNUAL 43.00G0446 PR INTENS BEHAVE THER CARDIO 59.00G0447 PR BEHAVIOR COUNSEL OBESITY 65G0451 PR DEVLOPMENT TEST 26.00G0452 PR MOLECULAR PATHOLOGY 26 100.00G0455 PR FECAL MICROBIOTA PREP INSTIL 274.00G0500 PR MOD SEDAT ENDO SERVICE 149.00G0502 PR INIT PSYCH CARE MANAG, 70MIN 358.00G0503 PR SUBSEQ PSYCH CARE MAN,60MI 316.00G0504 PR INIT/SUB PSYCH CARE ADD 30 M 166.00G0505 PR COG/FUNC ASSESSMENT OUTPT 596.00G0506 PR COMP ASSES CARE PLAN CCM 160.00G0508 PR CRIT CARE TELEHEA CONSULT 504.00G0509 PR CRIT CARE TELEHEA CONSULT 486.00G6002 PR STEREOSCOPIC X-RAY 26 50.00G8600 PR TPA INITI W/IN 3 HRS 0.00G8601 PR NO ELIG TPA INIT W/IN 3 HRS 0.00G8602 PR NO TPA INIT W/IN 3 HRS 0.00

H2036 PR A/D TX PROGRAM, PER DIEM 280.00J0171 PR ADRENALIN EPINEPHRINE 19.00J0558 PR PENG BENZATHINE/PROCAINE 9.00J0561 PR PENICILLIN G BENZATHINE INJ 20.00J0585 PR 15.5J0670 PR INJ MEPIVACAINE HCL/10 ML 10.00J0696 PR CEFTRIAXONE SODIUM 20.00J1020 PR METHYLPREDNISOLONE 20 MG 10.00J1030 PR METHYLPREDNISOLONE 40 MG 11.00J1040 PR METHYLPREDNISOLONE 80 MG 26.00J1050 PR MEDROXYPROGESTERONE 1.00J1071 PR INJ TESTOSTERONE CYPIONATE 1.00J1100 PR DEXAMETHASONE SODIUM PHOS 2.00J1439 PR INJ FERRIC CARBOXYMALTOS 3.00J1815 PR INSULIN INJECTION 2.00J1885 PR KETOROLAC TROMETHAMINE INJ 10.00J2001 PR LIDOCAINE INJECTION 0.00J2357 PR OMALIZUMAB INJECTION 76.00J2405 PR ONDANSETRON HCL INJECTION 3.00J2790 PR RHO D IMMUNE GLOBULIN INJ 184.00J2930 PR METHYLPREDNISOLONE 12.00J3301 PR TRIAMCINOLONE ACETONIDE INJ 5.00J3420 PR VITAMIN B12 INJECTION 8.00J7030 PR NORMAL SALINE SOLUTION 16.00J7042 PR 5% DEXTROSE/NORMAL SALINE 11.00J7296 PR KYLEENA, 19.5 MG 1818J7298 PR MIRENA, 52 MG 1810J7300 PR INTRAUT COPPER 1848.00J7301 PR SKYLA, 13.5 MG 1620J7307 ETONOGESTREL IMPLANT SYSTEM 1670J7323 EUFLEXXA INJ PER DOSE 381.00J7510 PR PREDNISOLONE ORAL PER 5 MG 1.00J7613 PR ALBUTEROL NON-COMP UNIT 2.00J7620 PR ALBUTEROL IPRATROP NON- 3.00J7644 PR IPRATROPIUM BROMIDE NON- 5.00J9267 PR PACLITAXEL INJECTION 1.00J9306 PR INJECTION, PERTUZUMAB, 1 MG 92.00L0112 PR CRANIAL CERVICAL ORTHOSIS 1531.00L0120 PR CERV FLEX N/ADJ FOAM PRE 97.00L0160 PR CERV SR WIRE OCC/MAN PRE 154.00L0172 PR CERV COL SR FOAM 2PC PRE 137.00L0174 PR CERV SR 2PC THOR EXT PRE 269.00

L0200 PR CERV COL SUPP ADJ BAR & 565.00L0450 PR TLSO FLEX TRUNK/THOR PRE 174.00L0456 PR TLSO FLEX TRNK SJ-SS PRE CST 1133.00L0457 PR TLSO FLEX TRNK SJ-SS PRE OTS 1157.00L0464 PR TLSO 4MOD SACRO-SCAP PRE 1519.00L0472 PR TLSO RIGID FRAME HYPEREX 396.00L0480 PR TLSO RIGID PLASTIC CUSTOM FA 1394.00L0482 PR TLSO RIGID LINED CUSTOM FAB 1856.00L0486 PR TLSO RIGIDLINED CUST FAB TWO 1846.00L0488 PR TLSO RIGID LINED PRE ONE PIE 1192.00L0491 PR TLSO 2 PIECE RIGID SHELL 785.00L0621 PR SIO FLEX PELVIC/SACR PRE OTS 94.00L0626 PR LO SAG RIG PNL STAYS PRE CST 83.00L0627 PR LO SAG RI AN/POS PNL PRE CST 444.00L0628 PR LSO FLEX NO RI STAYS PRE OTS 109.00L0630 PR LSO R POST PNL SJ-T9 PRE CST 192.00L0631 PR LSO SAG R AN/POS PNL PRE CST 1049.00L0637 PR LSO SC R ANT/POS PNL PRE CST 971.00L0638 PR LSO SAG-CORONAL PANEL 1348.00L0639 PR LSO S/C SHELL/PANEL PREFAB 1098.00L0640 PR LSO S/C SHELL/PANEL CUSTOM 1069.00L0710 PR CTLSO A-P-L CONTROL W/ INTER 2044.00L0810 PR HALO CERVICAL INTO JCKT VEST 2963L0859 PR MRI COMPATIBLE SYSTEM 1562L0861 PR HALO REPL LINER/INTERFACE 253.00L0974 PR TLSO FULL CORSET 176.00L0984 PR PROTECT BODY SOCK EA PRE 67.00L1000 PR CTLSO MILWAUKE INITIAL MODEL 2008.00L1005 PR TENSION BASED SCOLIOSIS 3588.00L1020 PR KYPHOSIS PAD 98.00L1040 PR LUMBAR OR LUMBAR RIB PAD 82.00L1050 PR STERNAL PAD 117.00L1060 PR THORACIC PAD 118.00L1110 PR RING FLANGE PLAS/LEATHER 287.00L1210 PR LATERAL THORACIC EXTENSION 257.00L1220 PR ANTERIOR THORACIC 281.00L1290 PR LATERAL TROCHANTERIC PAD 81.00L1300 PR BODY JACKET MOLD TO PATIENT 1803.00L1499 PR SPINAL ORTHOSIS NOS 525.00L1620 PR HO FLEX PAVLIK HARNS PRE CST 183.00L1650 PR HO ABDUCTION HIP ADJUSTABLE 256.00L1686 PR HO POST-OP HIP ABDUCTION 1124.00

L1690 PR COMBINATION BILATERAL HO 1976.00L1810 PR KO ELASTIC WITH JOINTS 97.00L1812 PR KO ELASTIC W/JOINTS PRE OTS 111.00L1820 PR KO ELAS W/ CONDYLE PADS & JO 172.00L1830 PR KO IMMOB CANVAS LONG PRE 177.00L1831 PR KNEE ORTH POS LOCKING JOINT 349.00L1832 PR KO ADJ JNT POS R SUP PRE CST 794.00L1833 PR KO ADJ JNT POS R SUP PRE OTS 794.00L1836 PR KO RIGID W/O JOINTS PRE OTS 159.00L1843 PR KO SINGLE UPRIGHT PRE CST 1063L1844 PR KO W/ADJ JT ROT CNTRL 1589.00L1845 PR KO DOUBLE UPRIGHT PRE CST 1091.00L1846 PR KO W ADJ FLEX/EXT ROTAT 1080.00L1850 PR KO SWEDISH TYPE PRE OTS 298.00L1851 PR KO SINGLE UPRIGHT PREFAB 1063L1902 PR AFO ANKLE GAUNTLET PRE OTS 105.00L1906 PR AFO MULTILIG ANK SUP PRE OTS 229.00L1907 PR AFO SUPRAMALLEOLAR CUSTOM 660.00L1930 PR AFO PLASTIC 232.00L1932 PR AFO RIG ANT TIB PREFAB TCF/= 912.00L1940 PR AFO MOLDED TO PATIENT 484.00L1945 PR AFO MOLDED PLAS RIG ANT TIB 1158.00L1950 PR AFO SPIRAL MOLDED TO PT 768.00L1951 PR AFO SPIRAL PREFABRICATED 919.00L1960 PR AFO POS SOLID ANK PLASTIC MO 664.00L1970 PR AFO PLASTIC MOLDED W/ANKLE 799.00L1971 PR AFO W/ANKLE JOINT, PREFAB 499.00L1990 PR AFO DOUB SOLID STIRRUP CALF 509.00L2010 PR KAFO SNG SOLID STIRRUP W/O J 965.00L2020 PR KAFO DBL SOLID STIRRUP BAND/ 1214.00L2030 PR KAFO DBL SOLID STIRRUP W/O J 1102.00L2034 PR KAFO PLA SIN UP W/WO K/A CUS 2171.00L2035 PR KAFO PLASTIC PEDIATRIC SIZE 179.00L2036 PR KAFO PLAS DOUB FREE KNEE 1882.00L2037 PR KAFO PLAS SING FREE KNEE 1756.00L2038 PR KAFO W/O JOINT MULTI-AXIS AN 2006L2070 PR HKAFO TORSION UNILAT ROT 167.00L2106 PR AFO TIB FX CAST PLASTER MOLD 771.00L2108 PR AFO TIB FX CAST MOLDED TO PT 1329.00L2112 PR AFO TIBIAL FRACTURE SOFT 533.00L2114 PR AFO TIB FX SEMI-RIGID 669.00L2116 PR AFO TIBIAL FRACTURE RIGID 769.00

L2128 PR KAFO FEM FX CAST MOLDED TO 1822.00L2180 PR PLAS SHOE INSERT W ANK JOINT 136.00L2182 PR DROP LOCK KNEE 98.00L2200 PR LIMITED ANKLE MOTION EA JNT 47.00L2210 PR DORSIFLEXION ASSIST EACH JOI 68.00L2220 PR DORSI & PLANTAR FLEX ASS/RES 81.00L2230 PR SPLIT FLAT CALIPER STIRR & P 76.00L2232 PR ROCKER BOTTOM, CONTACT 106.00L2250 PR FOOT PLATE MOLDED STIRRUP 377.00L2260 PR REINFORCED SOLID STIRRUP 228.00L2265 PR LONG TONGUE STIRRUP 123.00L2270 PR VARUS/VALGUS STRAP 55.00L2275 PR PLASTIC MOD LOW EXT PAD/LINE 147.00L2280 PR MOLDED INNER BOOT 511.00L2300 PR ABDUCTION BAR JOINTED 314.00L2320 PR NON-MOLDED LACER 202.00L2330 PR LACER MOLDED TO PATIENT 422.00L2340 PR PRE-TIBIAL SHELL MOLDED TO P 564.00L2350 PR PROSTHETIC TYPE SOCKET 973.00L2360 PR EXTENDED STEEL SHANK 51.00L2380 PR TORSION STRAIGHT KNEE JOINT 132.00L2385 PR STRAIGHT KNEE JOINT HEAVY 132.00L2390 PR OFFSET KNEE JOINT EACH 110.00L2395 PR OFFSET KNEE JOINT HEAVY 177.00L2405 PR KNEE JOINT DROP LOCK EA JNT 90.00L2415 PR KNEE JOINT CAM LOCK EACH JOI 155.00L2425 PR KNEE DISC/DIAL LOCK/ADJ FLEX 150.00L2430 PR KNEE JNT RATCHET LOCK EA 168.00L2510 PR TH/WGHT BEAR QUAD-LAT BRIM 714.00L2525 PR TH/WGHT BEAR NAR M-L BRIM 1452.00L2526 PR TH/WGHT BEAR NAR M-L BRIM 725.00L2540 PR THIGH/WGHT BEAR LACER 414.00L2610 PR HIP CLEVIS/THRUST BEARING LO 306.00L2624 PR HIP ADJ FLEX EXT ABDUCT CONT 325.00L2640 PR PELVIC CONTROL BAND & BELT B 369.00L2660 PR THORACIC CONTROL THORACIC 183.00L2680 PR THORAC CONT LAT SUPPORT 197.00L2750 PR PLATING CHROME/NICKEL PR 82.00L2755 PR CARBON GRAPHITE LAMINATION 134.00L2760 PR EXTENSION PER EXTENSION 60.00L2768 PR ORTHO SIDEBAR DISCONNECT 150.00L2780 PR NON-CORROSIVE FINISH 67.00

L2785 PR DROP LOCK RETAINER EACH 32.00L2795 PR KNEE CONTROL FULL KNEECAP 85.00L2800 PR KNEE CAP MEDIAL OR LATERAL 130.00L2810 PR KNEE CONTROL CONDYLAR PAD 102.00L2820 PR SOFT INTERFACE BELOW KNEE 85.00L2830 PR SOFT INTERFACE ABOVE KNEE 92.00L2840 PR TIBIAL LENGTH SOCK FX OR EQU 63.00L3000 PR FT INSERT UCB BERKELEY 321.00L3010 PR FOOT LONGITUDINAL ARCH 178.00L3020 PR FOOT LONGITUD/METATARSAL 173.00L3030 PR FOOT ARCH SUPPORT REMOV 78.00L3031 PR FOOT LAMIN/PREPREG 50.00L3050 PR FOOT ARCH SUPP PREMOLD 33.00L3060 PR FOOT ARCH SUPP 76.00L3090 PR ARCH SUPP ATT TO SHOE 42.00L3100 PR HALLUS-VALGUS NT DYN PRE 52L3150 PR ABDUCT ROTATION BAR W/O 103.00L3160 PR SHOE STYLED POSITIONING DEV 157.00L3202 PR OXFORD W/ SUPINAT/PRONATOR 45.00L3203 PR OXFORD W/ 45.00L3204 PR HIGHTOP W/ SUPP/PRONATOR 45.00L3206 PR HIGHTOP W/ SUPP/PRONATOR 58.00L3207 PR HIGHTOP W/ SUPP/PRONATOR 63.00L3216 PR ORTHOPED LADIES SHOES DPTH 82.50L3221 PR ORTHOPEDIC MENS SHOES 82.50L3222 PR MENS SHOES HIGHTOP DEPTH 85.00L3224 PR WOMAN'S SHOE OXFORD BRACE 100.00L3225 PR MAN'S SHOE OXFORD BRACE 100.00L3230 PR CUSTOM SHOES DEPTH INLAY 247.50L3250 PR CUSTOM MOLD SHOE REMOV 247.50L3253 PR SHOE MOLDED PLASTAZOTE 140.00L3257 PR ORTH FOOT ADD CHARGE SPLIT 192.00L3260 PR AMBULATORY SURGICAL BOOT 40.00L3300 PR SHO LIFT TAPER TO 54.00L3310 PR SHOE LIFT ELEV HEEL/SOLE NEO 96.00L3330 PR LIFTS ELEVATION METAL 663.00L3332 PR SHOE LIFTS TAPERED TO ONE- 87.00L3334 PR SHOE LIFTS ELEVATION HEEL /I 39.00L3350 PR SHOE HEEL WEDGE 36.00L3360 PR SHOE SOLE WEDGE OUTSIDE 37.00L3370 PR SHOE SOLE WEDGE BETWEEN 51.00L3390 PR SHOE OUTFLARE WEDGE 92.00

L3400 PR SHOE METATARSAL BAR WEDGE 54.00L3410 PR SHOE METATARSAL BAR 95.00L3440 PR HEEL LEATHER REINFORCED 78.00L3450 PR SHOE HEEL SACH CUSHION 108.00L3485 PR SHOE HEEL PAD REMOVABLE 45.00L3530 PR ORTHO SHOE ADD HALF SOLE 38.00L3540 PR ORTHO SHOE ADD FULL SOLE 52.00L3550 PR O SHOE ADD STANDARD TOE 11.00L3600 PR TRANS SHOE CALIP PLATE EXIST 90L3610 PR TRANS SHOE CALIPER PLATE 150.00L3620 PR TRANS SHOE SOLID STIRRUP EXI 130.00L3630 PR TRANS SHOE SOLID STIRRUP 195.00L3649 PR ORTHOPEDIC SHOE MODIFICA 105.00L3650 PR SO 8 ABD RESTRAINT PRE OTS 66.00L3660 PR SO 8 AB RSTR CAN/WEB PRE 99.00L3670 PR SO ACRO/CLAV CAN WEB PRE 150.00L3674 PR SO AIRPLANE W/WO JOINT CF 1274.00L3675 PR SO VEST CANVAS/WEB PRE OTS 188.00L3740 PR CUFFS ADJ LOCK W/ ACTIVE CON 1024.00L3760 PR EO ADJ JT PREFAB CUSTOM FIT 465.00L3762 PR EO RIGID W/O JOINTS PRE OTS 111.00L3807 PR WHFO W/O JOINTS PRE CST 261.00L3808 PR WHFO, RIGID W/O JOINTS 399.00L3900 PR HINGE EXTENSION/FLEX WRIST/F 1356.00L3906 PR WHO W/O JOINTS CF 410.00L3908 PR WHO COCK-UP NONMOLDE PRE 126.00L3915 PR WHO NONTORSION JNTS PRE 573L3919 PR HO W/O JOINTS CF 289.00L3960 PR SEWHO AIRPLAN DESIG ABDU 705.00L3980 PR UP EXT FX ORTHOS HUMERAL 307.00L3982 PR UPPER EXT FX ORTHOSIS 410.00L3984 PR UPPER EXT FX ORTHOSIS WRIST 330.00L4002 PR REPLACE STRAP, ANY ORTHOSIS 12.00L4100 PR REPL LEATH CUFF KAFO PROX 118.00L4110 PR REPL LEATH CUFF KAFO-AFO 89.00L4205 PR ORTHO DVC REPAIR PER 15 MIN 20.00L4210 PR ORTH DEV REPAIR/REPL MINOR 12.00L4350 PR ANKLE CONTROL ORTHO PRE 114.00L4360 PR PNEUMAT WALKING BOOT PRE 346.00L4370 PR PNEUM FULL LEG SPLNT PRE 200.00L4386 PR NON-PNEUM WALK BOOT PRE 186.00L4396 PR STATIC OR DYNAMI AFO PRE CST 172.00

L4398 PR FOOT DROP SPLINT PRE OTS 79.00L4631 PR AFO, WALK BOOT TYPE, CUS FAB 1868.00L5000 PR SHO INSERT W ARCH TOE FILLER 582.00L5010 PR MOLD SOCKET ANK HGT W/ TOE 1270.00L5100 PR MOLDED SOCKET SHIN SACH 2493.00L5250 PR HIP CANAD SING AXI CONS FRIC 5794.00L5301 PR BK MOLD SOCKET SACH FT 2394.00L5321 PR AK OPEN END SACH 3427.00L5341 PR HEMIPELVECTOMY CANADIAN 6000.00L5450 PR POSTOP APP NON-WGT BEAR 448.00L5611 PR AK 4 BAR LINK W/FRIC SWING 1680.00L5618 PR TEST SOCKET SYMES 382.00L5620 PR TEST SOCKET BELOW KNEE 290.00L5622 PR TEST SOCKET KNEE 443.00L5624 PR TEST SOCKET ABOVE KNEE 423.00L5626 PR TEST SOCKET HIP DISARTICULAT 594.00L5628 PR TEST SOCKET 563.00L5629 PR BELOW KNEE ACRYLIC SOCKET 430.00L5631 PR AK/KNEE DISARTIC ACRYLIC SOC 560.00L5637 PR BELOW KNEE TOTAL CONTACT 355.00L5643 PR HIP FLEX INNER SOCKET EXT FR 1623.00L5645 PR BK FLEX INNER SOCKET EXT FRA 832.00L5646 PR BELOW KNEE CUSHION SOCKET 655.00L5647 PR BELOW KNEE SUCTION SOCKET 830.00L5649 PR ISCH CONTAINMT/NARROW M-L 2084.00L5650 PR TOT CONTACT AK/KNEE DISART 509.00L5651 PR AK FLEX INNER SOCKET EXT FRA 1253.00L5652 PR SUCTION SUSP AK/KNEE DISART 485.00L5654 PR SOCKET INSERT SYMES 401.00L5655 PR SOCKET INSERT BELOW KNEE 336.00L5656 PR SOCKET INSERT KNEE 413.00L5666 PR BELOW KNEE CUFF SUSPENSION 92L5670 PR BK MOLDED SUPRACONDYLAR 323.00L5671 PR BK/AK LOCKING MECHANISM 519.00L5673 PR SOCKET INSERT W LOCK MECH 733.00L5679 PR SOCKET INSERT W/O LOCK 611.00L5681 PR INTL CUSTM CONG/LATYP 1544.00L5683 PR INITIAL CUSTOM SOCKET INSERT 1514.00L5685 PR BELOW KNEE SUS/SEAL SLEEVE 151.00L5694 PR AK PELVIC CONTROL BELT PAD/L 190.00L5695 PR AK SLEEVE SUSP 199.00L5698 PR AK/KNEE DISARTIC SILESIAN BA 110.00

L5700 PR REPLACE SOCKET BELOW KNEE 3004.00L5701 PR REPLACE SOCKET ABOVE KNEE 3727.00L5704 PR CUSTOM SHAPE COVER BK 613.00L5705 PR CUSTOM SHAPE COVER AK 1123.00L5781 PR LOWER LIMB PROS VACUUM 4096.00L5782 PR HD LOW LIMB PROS VACUUM 4738.00L5811 PR ENDO KNEE-SHIN MNL LCK 761.00L5814 PR ENDO KNEE-SHIN HYDRAL SWG 3802.00L5828 PR ENDO KNEE-SHIN FLUID 3048.00L5845 PR KNEE-SHIN SYS STANCE 1913.00L5848 PR KNEE-SHIN SYS HYDRAUL 1101.00L5850 PR ENDO AK/HIP KNEE EXTENS ASSI 139.00L5855 PR MECH HIP EXTENSION ASSIST 322.00L5856 PR ELEC KNEE-SHIN SWING/STANCE 24570.00L5910 PR ENDO BELOW KNEE ALIGNABLE 381.00L5920 PR ENDO AK/HIP ALIGNABLE 554.00L5925 PR ABOVE KNEE MANUAL LOCK 350.00L5930 PR HIGH ACTIVITY KNEE FRAME 3445.00L5940 PR ENDO BK ULTRA-LIGHT 523.00L5950 PR ENDO AK ULTRA-LIGHT 884.00L5960 PR ENDO HIP ULTRA-LIGHT MATERIA 1059.00L5962 PR BELOW KNEE FLEX COVER 613.00L5968 PR MULTIAXIAL ANKLE W 3984.00L5970 PR FOOT EXTERNAL KEEL SACH 229.00L5972 PR FLEXIBLE KEEL FOOT 368.00L5974 PR FOOT SINGLE AXIS ANKLE/FOOT 310.00L5976 PR ENERGY STORING FOOT 584.00L5979 PR MULTI-AXIAL ANKLE/FT PROSTH 2442.00L5980 PR FLEX FOOT SYSTEM 3866.00L5981 PR FLEX-WALK SYS LOW EXT 3342.00L5984 PR ENDOSKELETAL AXIAL 598.00L5986 PR MULTI-AXIAL ROTATION UNIT 665.00L5987 PR SHANK FT W VERT LOAD PYLON 7363.00L5988 PR VERTICAL SHOCK REDUCING 2045.00L5990 PR USER ADJUSTABLE HEEL HEIGHT 1857.00L5999 PR LOWR EXTREMITY PROSTHES 15600.00L6050 PR WRST MLD SCK FLX HNG TRI 2296L6100 PR ELB MOLD SOCK FLEX HINGE 2007.00L6110 PR ELBOW MOLD SOCK 2129.00L6500 PR ABOVE ELBOW PROSTH TISS 3217.00L6611 PR ADDITIONAL SWITCH, EXT 483.00L6615 PR DISCONNECT LOCKING WRIST 215.00

L6616 PR DISCONNECT INSERT LOCKING 91.00L6629 PR LAMINATION COLLAR W/ 177.00L6630 PR STAINLESS STEEL ANY WRIST 225.00L6635 PR LIFT ASSIST FOR ELBOW 239.00L6638 PR ELEC LOCK ON MANUAL PW 2967.00L6655 PR STANDARD CONTROL CABLE 90.00L6660 PR HEAVY DUTY CONTROL CABLE 96.00L6670 PR HOOK TO HAND CABLE ADAPTER 55.00L6672 PR HARNESS CHEST/SHLDER 176.00L6675 PR HARNESS FIGURE OF 8 SING 126.00L6676 PR HARNESS FIGURE OF 8 DUAL 127.00L6680 PR TEST SOCK WRIST DISART/BEL E 270.00L6682 PR TEST SOCK ELBW DISART/ABOVE 272.00L6686 PR SUCTION SOCKET 784.00L6687 PR FRAME TYP SOCKET BEL 697L6688 PR FRAME TYP SOCK ABOVE 675.00L6693 PR LOCKINGELBOW FOREARM 3369.00L6694 PR ELBOW SOCKET INS USE 648.00L6695 PR ELBOW SOCKET INS USE W/O 681.00L6696 PR CUS ELBO SKT IN FOR CON/ATYP 1501.00L6698 PR BELOW/ABOVE ELBOW LOCK 459.00L6703 PR TERM DEV, PASSIVE HAND MITT 385.00L6704 PR TERM DEV, SPORT/REC/WORK 637.00L6706 PR TERM DEV MECH HOOK VOL 379.00L6708 PR TERM DEV MECH HAND VOL 910.00L6715 PR TERM DEVICE, MULTI ART DIGIT 3603.00L6722 PR HOOK/HAND, HVY DTY, VOL 2406L6881 PR TERM DEV AUTO GRASP 4479.00L6882 PR MICROPROCESSOR CONTROL 3539.00L6890 PR PREFAB GLOVE FOR TERM 198.00L6955 PR ABOVE ELBOW MYOELECTRONIC 14809.00L7007 PR ADULT ELECTRIC HAND 4384.00L7367 PR REPLACEMNT LITHIUM 444.00L7368 LITHIUM ION BATTERY CHARGER 576.00L7400 PR ADD UE PROST BE/WD, ULTLITE 350.00L7402 PR ADD UE PROST S/D ULTLITE MAT 427.00L7403 PR ADD UE PROST B/E ACRYLIC 420.00L7404 PR ADD UE PROST A/E ACRYLIC 641.00L7499 PR UPPER EXTREMITY PROSTHES 2595.00L7510 PR PROSTHETIC DEVICE REPAIR 62.00L7520 PR REPAIR PROSTHESIS PER 15 MIN 16.00L7700 PR PROS SOC INSERT GASKET/SEAL 350.00

L8300 PR TRUSS SINGLE W/ STANDARD 88.00L8400 PR SHEATH BELOW KNEE 20.00L8417 PR PROS SHEATH/SOCK W GEL 77.00L8420 PR PROSTHETIC SOCK MULTI PLY 25.00L8430 PR PROSTHETIC SOCK MULTI PLY 24.00L8435 PR PROS SOCK MULTI PLY UPPER 22.00L8440 PR SHRINKER BELOW KNEE 44.00L8460 PR SHRINKER ABOVE KNEE 70.00L8470 PR PROS SOCK SINGLE PLY BK 8.00L8480 PR PROS SOCK SINGLE PLY AK 10.00L8681 PR PT PRGRM FOR IMPLT 1290.00L8689 PR EXTERNAL RECHARG SYS 2025.00M0076 PR PROLOTHERAPY 250.00P3001 PR SCREENING PAP SMEAR BY 82.00Q0091 PR OBTAINING SCREEN PAP SMEAR 50.00Q0111 PR WET MOUNTS/ W PREPARATIONS 14.00Q0112 PR POTASSIUM HYDROXIDE PREPS 10.00Q0138 PR FERUMOXYTOL, NON-ESRD 1.80Q2036 PR FLULAVAL VACC, 3 YRS & >, IM 31.00Q2038 PR FLUZONE VACC, 3 YRS & >, IM 41.00Q3014 PR TELEHEALTH FACILITY FEE 43.00Q4008 PR CAST SUP LONG ARM PED 67.00Q4010 PR CAST SUP SHT ARM ADULT 61.00Q4012 PR CAST SUP SHT ARM PED 61.00Q4022 PR CAST SUP SHT ARM SPLINT 61.00S0610 PR ANNUAL GYNECOLOGICAL 107.00S0620 PR ROUTINE OPHTHALMOLOGICAL 90.00S0621 PR ROUTINE OPHTHALMOLOGICAL 90.00S0630 PR REMOVAL OF SUTURES 183.00S1040 PR CRANIAL REMOLDING ORTHOSIS 2592.00S2083 PR ADJUSTMENT GASTRIC BAND 500.00S8032 PR LOW DOSE CT LUNG SCREENING 26 200.00S8422 PR CUSTOM GRAD SLEEVE MED 198.00S8424 PR READY GRADIENT SLEEVE 187.00S8425 PR CUSTOM GRAD GLOVE MED 326.00S8427 PR READY GRADIENT GLOVE 80.00S8450 PR SPLINT DIGIT 10.00S8451 PR SPLINT WRIST OR ANKLE 17.00S9453 PR SMOKING CESSATION CLASS 31.00S9470 PR NUTRITIONAL COUNSELING, DIET 51.00V2520 PR CONTACT LENS HYDROPHILIC 135.00V2627 PR SCLERAL COVER SHELL 3115.00

V5008 PR HEARING SCREENING 101.00V5010 PR ASSESSMENT FOR HEARING AID 0.00V5011 PR HEARING AID FITTING/CHECKING 85.00V5014 PR HEARING AID REPAIR/MODIFYING 125.00V5160 PR DISPENSING FEE BINAURAL 660.00V5200 PR CROS HEARING AID DISPENS 330.00V5210 PR IN EAR BICROS HEARING AID 51.00V5240 PR DISPENSING FEE BICROS 660.00V5241 PR DISPENSING FEE, MONAURAL 330.00V5254 PR HEARING ID, DIGIT, MON, CIC 2900.00V5255 PR HEARING AID, DIGIT, MON, ITC 2750.00V5256 PR HEARING AID, DIGIT, MON, ITE 2500.00V5257 PR HEARING AID, DIGIT, MON, BTE 2600.00V5258 PR HEARING AID, DIGIT, BIN, CIC 5800.00V5260 PR HEARING AID, DIGIT, BIN, ITE 5000.00V5261 PR HEARING AID, DIGIT, BIN, BTE 5200.00V5264 PR EAR MOLD/INSERT 75.00V5265 PR EAR MOLD/INSERT, DISP 5.00V5266 PR BATTERY FOR HEARING DEVICE 6.00V5267 PR HEARING AID SUP/ACCESS/DEV 53.00V5274 PR ALD UNSPECIFIED 150.00V5275 PR EAR IMPRESSION 25.0021499A STYLOID PROCESS EXCISION 2965.0022899H POSTERIOR ROD LENGTHENING 1800.0027299O OPN FEM HIP DISLOC-ACTAB IMPIN 5909.0033999E PR UNLISTED TRICUSPID VALVE 6371.0033999G CARDIOBAND REPAIR OF TRICUSPID 949236468A PR INJ SCLERO SOLN VEIN 300.0036471A PR INJ SCLERO SOLN VEIN MULTI 350.0037799E RELEASE MED ARCUATE LIGAMENT 1700.0038999C BATS CELL INFUSION 30440000A PR PSYC-UVA NO SHOW CHG 25.0041899A PR TOOTH EXTRACT PRIOR TO 180.0043659A PARTIAL LAP GASTRECTOMY 401343999C PERORAL ENDOSCOPIC MYOTOMY 2378.0043999D ESM DISSECTION STOMACH 2969.0043999E POEM 4157.0045399A ESM DISSECTION COLON 2969.0045399B UNDERWATER EMR 1218.0047379A LAPAROSCOPIC LIVER BIOPSY 1015.0047379B LAPAROSCOPIC PART 8093.0048999C LAP PANCREATECT W/WO 6000.00

48999F PANCREATIC ESWL 200048999H ENDO PANCREATIC 9750.0048999I ROBOTIC ASSISTED LAP PANCREAS

TRANSPLANT6838

49329B LAP REMOVAL INTRAABDOMIN CYST 4528.0049999A FALCIFORM LIGAMENT FLAP 823.0050549A ROBOTIC ASSISTED LAP KIDNEY

TRANSPLANT7189

67999A ENDO REPAIR BROW PTOSIS 202488036A CHEST CAVITY AND NECK ORGANS 848.0088036B ABDOMINAL CAVITY AND PELVIC

ORGANS ONLY848.00

88037A BRAIN ONLY (REMOVED AT UVA) 848.0088037B BRAIN ONLY (WITHOUT REMOVAL) 800.0088037C BRAIN ONLY (DEGENERATIVE WORK-

UP REMOVED AT UVA)1413.00

88037D BRAIN ONLY (DEGENERATIVE WORK-UP, PREVIOUSLY REMOVED)

1366.00

88037E BRAIN ONLY (CJD PREVAUTIONS) 1696.0088037F AUTOPSY, BRAIN ME 0.0088305C CORE BIOP. PROSTATE 26 178.0088305M DERM TISSUE EXAM 13 26 100.0088321A CONSULT AND SLIDE REVIEW 130.0088321B CHG WINCHESTER

CYTOLOGY/NEUROPATHOLOGY 330.00

88321S DERM CONSULT UVA REFRL 190.0090899S PR DRIVING EVALUATIONS 150.0092310A PR NEW CONTACT LENS FIT W 100.0092310B PR NEW CONTACT LENS FIT - TORIC 90.0092310C PR NEW CONTACT LENS FIT - 105.0092310D PR EST CONTACT LENS FIT 75.0092310E PR DAVIS VISION LENS FIT 60.0092310F PR CONTACT LENS FIT- IMAGE 130.0093882A PR DUPLEX EXTRACRANIAL UNILAT 26 22.0093922A PR DOPPLER ARTERIAL EXT 26 22.0093979A PR DUPLEX AORTA/IVC/GRAFT/LTD 22.0094799A PR CAR SEAT/BED TESTING

W/INTERP & REPORT 60 MIN >28 223.00

94799B PR CAR SEAT/BED TESTING W/INTERP & REPORT +30MIN >28

49.00

99024B PR POST-OP FOLLOW-UP VISIT 0.0099211A PR PROSTHETICS/ORTHOTICS 0

99211B PR NURSE VISIT 49.0099231A PR SUBSEQUENT HOSP CARE,LEVL

I, CONCURRENT99.00

99231B PR SUBSEQUENT HOSP CARE,LEVL I, CONCURRENT

99.00

99232A PR SUBSEQUENT HOSP CARE,LEVL II, CONCURRENT

183.00

99232B PR SUBSEQUENT HOSP CARE,LEVL II, CONCURRENT

183.00

99233A PR SUBSEQUENT HOSP CARE,LEVL III, CONCURRENT

262.00

99233B PR SUBSEQUENT HOSP CARE,LEVL III, CONCURRENT

262.00

99234A PR OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES

335.00


435.00


547.00

99238A PR HOSPITAL DISCHARGE DAY,<30 183.0099239A PR HOSPITAL DISCHARGE DAY,>30 270.0099291A PR CRITICAL CARE, E/M 30-74 752.0099292A PR CRITICAL CARE, ADDL 30 MIN 308.0099356A PR PROLONGED SERVICE I/P REQ

UNIT/FLOOR TIME 1ST HR231.00

99357A PR PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN

231.00

99446A E-CONSULT REQUEST 0.0099446B E-CONSULT 5-10 MIN. 0.0099446C E-CONSULT REQUIRES FACE-TO- 0.0099446D E-CONSULT DECLINED 0.0099447A E-CONSULT 11-20 MIN. 0.0099448A E-CONSULT 21-30 MIN. 0.0099449A E-CONSULT 31+ MIN. 0.0099463A PR INITIAL NORMAL NEWBORN

CARE, SAME DAY DISCHARGE301.00

99464A PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN

194.00

99465A PR DELIVERY/BIRTHING ROOM RESUSCITATION

384.00

99499A PR INSUFFICIENT DOCUMENTATION 0.0099499B PR PRE-OPERATIVE PHYSICAL EXAM 0.00

99499D PR BUS DRIVE/CDL (DOT) PHYSICAL 85.0099499E PR MRO CALL 85.0099499G PR SPORTS PHYSICAL 25.0099499H PR AMBULATORY CARE 0.0099499I PR WALK OUT/NOT SEEN 0.0099499J PR NO CHARGE/LAB ONLY 0.0099499L PR FU WITHIN 90 DAYS OF 0.0099499N PR CLOSE ENCOUNTER - NO LOS 0.0099499O PR FU WITHIN 90 DAYS OF 0.0099499P PR CLOSE ENCOUNTER - NO LOS 0.0099499R PR OB/GYN SERVICE 0.0099499S PR OB/GYN SERVICE 0.0099499U PR PRE-OPERATIVE PHYSICAL EXAM 0.0099999C PR SUTURE LACERATION 0.0099999E PR CPT CODE UNDETERMINED 0.00A4466A KNEE ORTHOTIC, ELASTIC OR

SIMILAR STRETCHABLE MATERIAL75.00

A4466H ABDOMINAL BINDER, ELASTIC 40.00A4467A KNEE ORTHOTIC, ELASTIC OR

SIMILAR STRETCHABLE MATERIAL75.00

A4467B HINGED KNEE BRACE 103.00A4467C KNEE ORTHOTIC 66.00A4467D ELBOW SLEEVE 67.00A4467E PREFABRICATED SHOULDER 62.00A4467F THORACIC,RIB BELT,CUSTOM FIT 47.00A4467G HEEL PROTECTOR (HEELBO) 69.00A4467H ABDOMINAL BINDER, ELASTIC 40.00A6545A GRADIENT COMPRESSION WRAP-

LOWER LEG198

A6545B GRADIENT COMPRESSION WRAP-UPPER LEG WITH KNEE

220

A6545C GRADIENT COMPRESSION WRAP-SINGLE BAND ANKLE FOOT WRAP

44

A6545D GRADIENT COMPRESSION WRAP-HAND WRAP

60

A6545E GRADIENT COMPRESSION WRAP-ARM WRAP

224

A6549A COMPRESS STOCKING,CUSTOM 370.00A9900A FACE SHIELD 208D9940A PR OCCLUSAL GUARD, IN OFFICE 190.00D9999A DENTAL PREPARATION 0L1499F NATL ORTHOSIS.. 550.00

L1499Z PECTUS THORACIC BRACE 900.00L2999J PR ADJUST-A-LIFT 11.00L2999K PR HAMMERTOE SPL PR 15.00L2999L PR HAPADS PAIR 12.00L2999M TOE CAP/GUARD 13L2999N PR TOE SEPARATOR PR 4.00L2999O PR SHIPPING & HANDLING 1.00L2999Z REMOVABLE HEEL WEDGE 18.00L3999D SHLD IMMOBIL ELA 37.00L3999G TENNIS ELBOW AOA 22.00L3999N SHOULDER IMMOBILIZER 229.00L5999B PR FOOT SHELL FOR PATH FINDER 150.00L5999D PR REPLACE FLEX-FOOT SHELL 215.00L7499A PR ONE FINGER PROS 416.00L7499C SURELOCK UPPER EXTREMITY 844L7499D TOUGHWARE SELF-SUSPENDING

HUMERAL CUFF800

L7499R PARTIAL FINGER PROSTHESIS, 2508L8499A PR PROTECTIVE STOCKING 30.00S0620D PR DAVIS VISION EXAM NEW PT 51.50S0621D PR DAVIS VISION EXAM RTRN PT 51.50V2599D PR DAVIS VISION CONTACT LENS 110.50V5011B FIT/CHECKING OF HA (ALL PLANS) 0.00V5014B REPAIR/MODIFY HA (ALL PLANS) 0.00V5014K HA REP (OTICON) ALL WARR 6 MO 220.00V5014L HA REP (OTICON) ALL WARR 12 MO 260.00V5014P HA REP (OTCON) W/AI WARR 12 MO 260.00V5014U HA (WID) BTE&CUST REP WAR 6MO 230.00V5014V HA (WID) BTE&CUST REP WAR 12MO 260.00V5014Y HA WI CUS REM 6MO REM WAR ONL 160.00V5264A MICROMOLD (EACH) 60.00V5264B ELAN SHELL 40.00V5267B HEARING AID SUPPLY, WAX GUARDS 53.00V5267D HEARING AID SUPPLY, DRI-AID KIT 15.00V5267E HA REMOTE CONTROL/STREAMER 53.00V5267H HA SUPPLY, TUBING 5.00V5267I HA SUPPLY, RIC REC. (OTICON) 75.00V5267K HA SUPPLY, RIC REC. (WIDEX) 100.00V5299A HA FU UNLIM 2YRS PER AID W/PUR 200.00V5299B HA FU UNLIM 5YRS PER AID W/PUR 350.00V5299D HEARING AID DROP-OFF FEE 25.00V5299E NEUROMONICS PROCESSOR(OASIS) 3590.00

V5299G NEUROMONIC PROCESS 960.00V5299I NEUROMONIC PROCESS F/U 105.00V5299K HA REPLACEMENT FEE 300.00V5299M HA FU 15 VIST OVR 5YRS PER AID 350.00V5299N HA FU UNLIM 1 YR NON UVA PURCH 200.00V5299O HA FU UNLIM 2 YR NON UVA PURCH 350.00V5299Q HA ADD YR L&D (OTICON) 40.00V5299R HA ADD YR REP WARR (OTICON) 110.00V5299S HA ADD YR EXT WARR (OTICON) 140.00V5299W HA (WID) ALL OTHRE 3RD REP WARR 110.00V5299X HA (WIDEX) ALL 2ND YEAR L&D 110.0076499AU CONTRAST ENHANC SPECTRAL 100.0093799ZA PR PULM ARTERY PRESS SENS 7300.0099499ZA NURSING HOME PE, ESTAB PAT 250.00L2999AD METATARSAL PAD 6.00L2999AE HAL-VALG SPLINT 25.00L2999AN HEEL CUP 30.00L2999BF ADD PPT TO FO 12.00L2999BY KNEE SLEEVE 45L7499AG PREM FUNCT AESTHETIC P. FING 5672.00L7499AI BIOMECHANICAL FUNCTION THUMB 21375.00L7499AL PR TWO FINGER FUNCTION AESTH 8536V5014AA HA WI BTE&CUS REP WAR GT 5YR 305.00V5014AE HA REP (PHON) CLAS SVC PLN 6MO 210.00V5014AF HA REP (PHO) CLAS SVC PLN 12MO 240.00V5014AG HA REP(PHO) DHC (REM) SPLN 6MO 120.00V5014AI REPAIR/MODIFICATION OF A 220.00V5014AJ HA REP (PHO) DIG SVC PLN 12 MO 250.00V5014AR HA REP(PH)WLS CRS/BICRS 12 MO 240.00V5014BB HA REP(STAR)CIC/CANAL WAR 12MO 250.00V5014BF HA REP(STAR) CUST DIG 1YR WARR 240.00V5299AF HA WAR PHO EXT SVC CON DIG YR 180.00

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