Addendum C. - Final HCPCS Codes Payable Under the 2013 OPPS by APC CPT codes and descriptions only are copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Dental codes (D codes) are copyright 2011/12 American Dental Association. All Rights Reserved.

APC HCPCS Group Title 0001 Level I Photochemotherapy 0001 96900 0001 96910 0001 96912 0002 Fine Needle Biopsy/Aspiration 0002 10021 0002 19001 0002 36680 0003 Bone Marrow Biopsy/Aspiration 0003 38220 0003 38221 0004 Level I Needle Biopsy/ Aspiration Except Bone Marrow 0004 10022 0004 19000 0004 19100 000420615 000447399 000448999 0004 54800 0004 55000 0004 60100 0004 60300 0004 62267 0005 Level II Needle Biopsy/Aspiration Except Bone Marrow 0005 19102 0005 20206 0005 38505 0005 42400 0006 Level I Incision & Drainage 0006 10060 0006 10061 0006 10080 0006 10160 0006 20950 0006 21725 0006 26010 000640800 000641800 0006 69000 0006 690200007 Level II Incision & Drainage

0007 10081 0007 10140 000720103 000723931 000726011 000728001 0007 38300 0007 55100 0007 57022 0007 69005 0008 Level III Incision and Drainage 0008 10180 0008 19020 0008 21501 0008 23030 0008 23031 0008 23930 0008 27301 0008 27603 0008 38305 0008 51080 0008 54015 0008 54115 0008 57023 0012 Level I Debridement & Destruction 0012 11719 0012 11740 0012 17003 0012 17999 0012 96999 0012 G0127 0013 Level II Debridement & Destruction 0013 0183T 0013 10040 0013 11001 0013 11055 0013 11056 0013 11101 0013 11200 0013 11201 0013 11300 0013 11301 0013 11302 0013 11305 0013 11306 0013 113070013 11310

0013 11311 0013 11720 0013 11721 0013 11730 0013 11732 0013 11765 0013 11900 0013 11901 0013 15786 0013 15787 0013 15788 0013 15793 0013 16000 0013 17000 0013 17110 0013 17340 0013 36468 0013 54056 0013 69220 0013 97602 0013 97605 0013 G0247 0015 Level III Debridement & Destruction 0015 11057 0015 11100 0015 11303 0015 11308 0015 11312 0015 11313 0015 15789 0015 15792 0015 16020 0015 16025 0015 16030 0015 16035 0015 17111 0015 17250 0015 17260 0015 17261 0015 17262 0015 17263 0015 17264 0015 17270 0015 17271 0015 17272 0015 172800015 17360

0015 17380 0015 36469 0015 36470 0015 36471 0015 45520 0015 46916 0015 54050 0015 96567 0015 96570 0015 96571 0015 96920 0015 96921 0015 96922 0015 97597 0015 97598 0015 97606 0016 Level IV Debridement & Destruction 0016 10120 0016 11000 0016 11042 0016 11043 0016 11045 0016 11046 0016 15783 0016 15850 0016 15851 0016 17004 0016 17106 0016 17107 0016 17108 0016 17266 0016 17273 0016 17274 0016 17276 0016 17281 0016 17282 0016 17283 0016 17284 0016 17286 001646900 0016 G0456 0016 G0457 0017 Level V Debridement & Destruction 001746910 001746917 001746922001746924

0017 54055 0017 54057 0017 54060 0017 54065 0017 56501 0017 56515 0019 Level I Excision/ Biopsy 0019 11010 0019 11011 0019 11012 0019 11047 0019 11400 0019 11401 0019 11402 0019 11440 0019 11441 0019 11601 0019 11602 0019 11621 0019 11640 0019 11641 0019 11642 0019 11750 0019 11755 0019 11976 0019 15781 0019 15782 0019 15920 0019 15999 0019 20520 0019 24200 0019 41108 0020 Level II Excision/ Biopsy 0020 11044 0020 11403 0020 11420 0020 11421 0020 11422 0020 11442 0020 11443 0020 11444 0020 11600 0020 11603 0020 11604 0020 11620 0020 116220020 11623

0020 11643 0020 20005 0020 20220 0020 21011 0020 21012 0020 21013 0020 21014 0020 21920 0020 23065 0020 23330 0020 25065 0020 27040 0020 27041 0020 27086 0020 27323 0020 27613 0020 28190 0020 28193 0020 33284 0020 35226 0021 Level III Excision/ Biopsy 0021 10121 0021 11404 0021 11406 0021 11423 0021 11424 0021 11606 0021 11624 0021 11644 0021 15836 0021 15837 0021 15838 0021 15839 0021 19260 0021 20200 0021 20205 0021 20225 0021 20670 0021 21015 0021 21550 0021 21555 0021 21557 0021 21930 0021 21932 0021 21935 0021 229020021 22904

0021 23000 0021 23075 0021 23076 0021 23077 0021 24065 0021 24066 0021 24075 0021 24076 0021 24077 0021 24201 0021 25075 0021 25076 0021 25077 0021 26115 0021 26116 0021 26117 0021 26320 0021 27047 0021 27048 0021 27049 0021 27328 0021 27329 0021 27615 0021 27618 0021 27619 0021 28043 0021 28045 0021 28046 0021 28192 0021 37609 0021 54100 0021 69110 0021 69145 0022 Level IV Excision/ Biopsy 0022 11426 0022 11446 0022 11450 0022 11451 0022 11462 0022 11463 0022 11470 0022 11471 0022 11626 0022 11646 0022 11752 0022 117700022 11771

0022 11772 0022 11971 0022 15780 0022 15830 0022 15832 0022 15833 0022 15834 0022 15835 0022 15847 0022 15931 0022 15933 0022 15940 0022 15941 0022 15950 0022 15951 0022 20240 0022 20245 0022 20525 0022 20680 0022 21016 0022 21552 0022 21554 0022 21556 0022 21558 0022 21925 0022 21931 0022 21933 0022 21936 0022 22900 0022 22901 0022 22903 0022 22905 0022 23066 0022 23071 0022 23073 0022 23078 0022 23331 0022 24071 0022 24073 0022 24079 0022 25066 0022 25071 0022 25073 0022 25078 0022 26111 0022 261130022 26118

0022 27043 0022 27045 0022 27059 0022 27324 0022 27327 0022 27337 0022 27339 0022 27364 0022 27372 0022 27614 0022 27616 0022 27632 0022 27634 0022 28039 0022 28041 0022 28047 0022 54105 0022 60512 0022 69205 0028 Level I Breast Surgery 0028 19101 0028 19110 0028 19112 0028 19120 0028 19125 0028 19126 0028 19300 0028 19301 0028 19350 0028 19499 0028 C9726 0029 Level II Breast Surgery 0029 19105 0029 19303 0029 19304 0029 19316 0029 19328 0029 19330 0029 19355 0029 19366 0029 19370 0029 19371 0029 19396 0030 Level III Breast Surgery 0030 19302 0030 193070030 19318

0030 19324 0030 19340 0030 19380 0031 Level I Health and Behavior Services 0031 96153 0031 99406 0031 99407 0031 G0436 0035 Vascular Puncture and Minor Diagnostic Procedures 0035 0208T 0035 0209T 0035 0210T 0035 0211T 0035 36420 0035 36425 0035 36600 0035 76514 0035 92227 0035 92228 0035 93041 0035 93278 0035 93290 0035 93998 0037 Level IV Needle Biopsy/Aspiration Except Bone Marrow 0037 19103 003744901 003747011 003748511 003749021 003749041 003749061 0037 50021 0037 54500 0039 Level I Implantation of Neurostimulator Generator 0039 0268T 0039 0316T 0039 61885 0039 63685 0039 64590 0040 Level I Implantation/Revision/Replacement of Neurostimulator Electrodes 0040 0282T 0040 63650 0040 63663 0040 63664 0040 64553 0040 645550040 64561

0040 64565 0040 64569 0041 Level I Arthroscopy 0041 29800 0041 29804 0041 29805 0041 29822 0041 29824 0041 29826 0041 29830 0041 29834 0041 29835 0041 29836 0041 29837 0041 29838 0041 29840 0041 29843 0041 29844 0041 29845 0041 29846 0041 29848 0041 29850 0041 29870 0041 29871 0041 29873 0041 29874 0041 29875 0041 29876 0041 29877 0041 29879 0041 29880 0041 29881 0041 29882 0041 29883 0041 29884 0041 29886 0041 29887 0041 29894 0041 29895 0041 29897 0041 29898 0041 29900 0041 29901 0041 29902 0041 29904 0041 299050041 29906

0041 29999 0042 Level II Arthroscopy 0042 29806 0042 29807 0042 29819 0042 29820 0042 29821 0042 29823 0042 29825 0042 29827 0042 29828 0042 29847 0042 29851 0042 29855 0042 29856 0042 29860 0042 29861 0042 29862 0042 29863 0042 29866 0042 29867 0042 29868 0042 29885 0042 29891 0042 29899 0042 29907 0042 29914 0042 29915 0042 29916 0045 Bone/Joint Manipulation Under Anesthesia 0045 22505 0045 23655 0045 23700 0045 24300 0045 24605 0045 26775 0045 27194 0045 27252 0045 27257 0045 27266 0045 27275 0045 27552 0045 27562 0045 27570 0045 27842 0045 278600045 28635

0045 28665 0047 Arthroplasty without Prosthesis 004724360 004724365 004725332 004725447 004725449 004726530 004726535 004727437 004727440 004727441 004727442 004727443 004727700 0048 Level I Arthroplasty or Implantation with Prosthesis 0048 24362 0048 25443 0048 25444 0048 25445 0048 26531 0048 26536 0048 27438 0049 Level I Musculoskeletal Procedures Except Hand and Foot 0049 20662 0049 20694 0049 20999 0049 21502 0049 21700 0049 21720 0049 22999 0049 23035 0049 23100 0049 23140 0049 23935 0049 24100 0049 24105 0049 24110 0049 24120 0049 24310 0049 24925 0049 25000 0049 25001 0049 25028 0049 25031 0049 250350049 25085

0049 25100 0049 25109 0049 25110 0049 25111 0049 25112 0049 25115 0049 25116 0049 25248 0049 25295 0049 25907 0049 25909 0049 25922 0049 25931 0049 26990 0049 26991 0049 27000 0049 27050 0049 27052 0049 27057 0049 27060 0049 27062 0049 27065 0049 27087 0049 27305 0049 27306 0049 27340 0049 27345 0049 27347 0049 27390 0049 27391 0049 27497 0049 27594 0049 27600 0049 27601 0049 27606 0049 27607 0049 27630 0049 27656 0049 27658 0049 27659 0049 27675 0049 27704 0049 27884 0049 28002 0049 28003 0050 Level II Musculoskeletal Procedures Except Hand and Foot0050 0101T

0050 0102T 0050 0200T 0050 0201T 0050 0221T 0050 0222T 0050 20250 0050 20251 0050 20555 0050 20650 0050 20663 0050 20690 0050 20692 0050 20693 0050 20696 0050 20900 0050 20902 0050 20924 0050 21600 0050 21610 0050 22520 0050 22521 0050 22522 0050 22851 0050 22899 0050 23020 0050 23040 0050 23044 0050 23101 0050 23105 0050 23106 0050 23107 0050 23120 0050 23125 0050 23145 0050 23146 0050 23150 0050 23155 0050 23156 0050 23170 0050 23172 0050 23174 0050 23180 0050 23182 0050 23184 0050 23190 0050 231950050 23400

0050 23405 0050 23406 0050 23440 0050 24000 0050 24006 0050 24101 0050 24102 0050 24115 0050 24116 0050 24125 0050 24126 0050 24130 0050 24134 0050 24136 0050 24138 0050 24140 0050 24145 0050 24147 0050 24149 0050 24155 0050 24160 0050 24164 0050 24301 0050 24305 0050 24320 0050 24332 0050 24343 0050 24345 0050 24357 0050 24358 0050 24359 0050 24495 0050 25020 0050 25023 0050 25024 0050 25025 0050 25040 0050 25101 0050 25105 0050 25107 0050 25118 0050 25119 0050 25120 0050 25125 0050 25126 0050 251300050 25135

0050 25136 0050 25145 0050 25150 0050 25151 0050 25170 0050 25210 0050 25215 0050 25230 0050 25240 0050 25250 0050 25251 0050 25260 0050 25263 0050 25265 0050 25270 0050 25272 0050 25274 0050 25275 0050 25280 0050 25290 0050 25300 0050 25301 0050 25310 0050 25315 0050 25392 0050 27001 0050 27003 0050 27006 0050 27027 0050 27035 0050 27066 0050 27067 0050 27080 0050 27097 0050 27098 0050 27235 0050 27307 0050 27310 0050 27330 0050 27331 0050 27332 0050 27333 0050 27334 0050 27335 0050 27350 0050 273550050 27356

0050 27357 0050 27358 0050 27360 0050 27380 0050 27381 0050 27385 0050 27386 0050 27392 0050 27393 0050 27394 0050 27396 0050 27403 0050 27425 0050 27435 0050 27475 0050 27479 0050 27496 0050 27498 0050 27499 0050 27602 0050 27604 0050 27610 0050 27612 0050 27620 0050 27625 0050 27626 0050 27635 0050 27637 0050 27638 0050 27640 0050 27641 0050 27647 0050 27664 0050 27665 0050 27676 0050 27680 0050 27681 0050 27685 0050 27686 0050 27687 0050 27695 0050 27696 0050 27698 0050 27707 0050 27709 0050 277300050 27732

0050 27734 0050 27740 0050 27889 0050 27892 0050 27893 0050 27894 0050 28890 0050 G0413 0051 Level III Musculoskeletal Procedures Except Hand and Foot 0051 11970 0051 20150 0051 20982 0051 21742 0051 21743 0051 23130 0051 23395 0051 23410 0051 23412 0051 23415 0051 23420 0051 23430 0051 23462 0051 23466 0051 23480 0051 24150 0051 24152 0051 24331 0051 24340 0051 24341 0051 24342 0051 24410 0051 24420 0051 24470 0051 24800 0051 25312 0051 25320 0051 25335 0051 25337 0051 25350 0051 25355 0051 25360 0051 25370 0051 25375 0051 25390 0051 25393 0051 253940051 25426

0051 25430 0051 25431 0051 25450 0051 25455 0051 25490 0051 25491 0051 25492 0051 25820 0051 27033 0051 27100 0051 27105 0051 27110 0051 27111 0051 27395 0051 27397 0051 27400 0051 27405 0051 27416 0051 27418 0051 27420 0051 27422 0051 27424 0051 27430 0051 27650 0051 27654 0051 27690 0051 27691 0051 27692 0051 27705 0051 27742 0052 Level IV Musculoskeletal Procedures Except Hand and Foot 0052 0171T 0052 0172T 0052 22523 0052 22524 0052 22525 0052 23397 0052 23450 0052 23455 0052 23460 0052 23465 0052 23485 0052 23490 0052 23491 0052 23800 0052 238020052 24330

0052 24344 0052 24346 0052 24400 0052 24430 0052 24435 0052 24498 0052 24802 0052 24935 0052 25316 0052 25365 0052 25391 0052 25400 0052 25405 0052 25415 0052 25420 0052 25425 0052 25440 0052 25800 0052 25805 0052 25810 0052 25825 0052 25830 0052 27179 0052 27407 0052 27409 0052 27412 0052 27415 0052 27427 0052 27428 0052 27429 0052 27652 0052 27745 0052 27870 0052 27871 0052 28715 0052 29888 0052 29889 0052 29892 0053 Level I Hand Musculoskeletal Procedures 005326020 005326025 005326030 005326034 005326035 005326037 005326040005326055

005326060 005326070 005326075 005326080 005326100 005326105 005326110 005326125 005326130 005326140 005326145 005326160 005326170 005326180 005326185 005326200 005326210 005326215 005326230 005326235 005326236 005326250 005326260 005326262 005326410 005326418 005326432 005326433 005326437 005326440 005326445 005326450 005326455 005326460 005326471 005326474 005326476 005326477 005326478 005326479 005326500 005326508 005326520 005326525 005326540 005326542005326560

005326580 005326587 005326590 005326593 005326596 005326951 005326952 0054 Level II Hand Musculoskeletal Procedures 005420822 005426045 005426121 005426123 005426135 005426205 005426350 005426352 005426356 005426357 005426358 005426370 005426372 005426373 005426390 005426392 005426412 005426415 005426416 005426420 005426426 005426428 005426434 005426442 005426449 005426480 005426483 005426485 005426489 005426490 005426492 005426494 005426496 005426497 005426498 005426499 005426502 005426510005426516

005426517 005426518 005426541 005426545 005426546 005426548 005426550 005426555 005426561 005426562 005426565 005426567 005426568 005426591 005426820 005426841 005426842 005426843 005426844 005426850 005426852 005426860 005426861 005426862 005426863 005426910 0054 64821 0054 64822 0054 64823 0055 Level I Foot Musculoskeletal Procedures 0055 27605 0055 28005 0055 28008 0055 28010 0055 28011 0055 28020 0055 28022 0055 28024 0055 28050 0055 28052 0055 28054 0055 28060 0055 28062 0055 28070 0055 28072 0055 280800055 28086

0055 28088 0055 28090 0055 28092 0055 28100 0055 28104 0055 28108 0055 28110 0055 28111 0055 28112 0055 28113 0055 28114 0055 28116 0055 28118 0055 28119 0055 28120 0055 28122 0055 28124 0055 28126 0055 28130 0055 28140 0055 28150 0055 28153 0055 28160 0055 28171 0055 28173 0055 28175 0055 28200 0055 28202 0055 28208 0055 28220 0055 28222 0055 28225 0055 28226 0055 28230 0055 28232 0055 28234 0055 28240 0055 28250 0055 28260 0055 28261 0055 28262 0055 28270 0055 28272 0055 28280 0055 28285 0055 282860055 28288

0055 28289 0055 28302 0055 28306 0055 28307 0055 28308 0055 28310 0055 28312 0055 28313 0055 28315 0055 28340 0055 28341 0055 28344 0055 28345 0055 28755 0055 28805 0055 28810 0055 28820 0055 28825 0055 29893 0056 Level II Foot Musculoskeletal Procedures 0056 20972 0056 20973 0056 28102 0056 28103 0056 28106 0056 28107 0056 28210 0056 28238 0056 28264 0056 28300 0056 28304 0056 28305 0056 28309 0056 28320 0056 28322 0056 28360 0056 28446 0056 28705 0056 28725 0056 28730 0056 28735 0056 28737 0056 28740 0056 28750 0056 28760 0057 Bunion Procedures005728290

005728292 005728293 005728294 005728296 005728297 005728298 005728299 0058 Level I Cast Application 0058 29000 0058 29020 0058 29025 0058 29040 0058 29049 0058 29058 0058 29085 0058 29086 0058 29105 0058 29125 0058 29126 0058 29440 0058 29450 0058 29505 0058 29515 0058 29580 0058 29581 0058 29700 0058 29705 0058 29715 0058 29720 0058 29730 0058 29740 0058 29750 0058 29799 0059 Level I Strapping 0059 29130 0059 29131 0059 29200 0059 29240 0059 29260 0059 29280 0059 29520 0059 29530 0059 29540 0059 29550 0059 29582 0059 295830059 29584

0060 Manipulation Therapy 0060 98925 0060 98926 0060 98927 0060 98928 0060 98929 0060 98940 0060 98941 0060 98942 0061 Level II Implantation/Revision/Replacement of Neurostimulator Electrodes 0061 43647 0061 63655 0061 64575 0061 64580 0061 64581 0062 Level I Treatment Fracture/Dislocation 0062 0245T 0062 0246T 0062 0247T 0062 0248T 0062 21336 0062 21805 0062 23532 0062 24538 0062 24566 0062 24582 0062 25606 0062 25651 0062 25670 0062 25671 0062 25676 0062 25685 0062 25695 0062 26608 0062 26650 0062 26676 0062 26685 0062 26715 0062 26727 0062 26735 0062 26746 0062 26756 0062 26765 0062 26776 0062 26785 0062 275090062 27756

0062 28406 0062 28436 0062 28456 0062 28476 0062 28496 0062 28505 0062 28525 0062 28531 0062 28545 0062 28546 0062 28576 0062 28585 0062 28606 0062 28636 0062 28645 0062 28666 0062 28675 0063 Level II Treatment Fracture/Dislocation 006323530 006323550 006323552 006323660 006323680 006324665 006324685 006325515 006325525 006325526 006325545 006325628 006325645 006325652 006326615 006326665 006327202 006327524 006327566 006327720 006327726 006327758 006327766 006327769 006327784 006327792 006327814 006327822006327826

006327829 006327832 006327846 006327848 006328420 006328445 006328465 006328485 006328555 006328615 0064 Level III Treatment Fracture/Dislocation 006423515 006423585 006423615 006423616 006423630 006423670 006424515 006424516 006424545 006424546 006424575 006424579 006424586 006424587 006424615 006424635 006424666 006425574 006425575 006425607 006425608 006425609 006426686 006427722 006427759 006427823 006427827 006427828 006428415 0065 Level I Stereotactic Radiosurgery, MRgFUS, and MEG 0065 0301T 0065 77424 0065 77425 0065 95966 0065 959670065 G0251

0066 Level II Stereotactic Radiosurgery, MRgFUS, and MEG 0066 95965 0066 G0340 0067 Level III Stereotactic Radiosurgery, MRgFUS, and MEG 0067 0071T 0067 0072T 0067 G0173 0067 G0339 0069 Thoracoscopy 0069 32601 0069 32604 0069 32606 0069 32607 0069 32608 0069 32609 0069 39400 0070 Thoracentesis/Lavage Procedures 0070 32201 0070 32551 0070 32552 0070 32554 0070 32555 0070 32556 0070 32557 0070 32560 0070 32561 0070 32562 0070 32960 0070 32999 0070 33010 0070 33011 0070 33999 007049082 007049083 007049084 0071 Level I Endoscopy Upper Airway 0071 31505 0071 92511 0072 Level II Endoscopy Upper Airway 0072 31231 0072 31233 0072 31511 0072 31513 0072 31520 0072 31575 0073 Level III Endoscopy Upper Airway0073 31577

0073 31579 0073 31717 0073 31730 0074 Level IV Endoscopy Upper Airway 0074 31235 0074 31237 0074 31238 0074 31510 0074 31512 0074 31515 0074 31525 0074 31526 0074 31530 0074 31531 0074 31535 0074 31536 0074 31540 0074 31570 0074 31576 0074 31578 0075 Level V Endoscopy Upper Airway 0075 31239 0075 31240 0075 31254 0075 31255 0075 31256 0075 31267 0075 31276 0075 31287 0075 31288 0075 31292 0075 31293 0075 31294 0075 31295 0075 31296 0075 31297 0075 31527 0075 31528 0075 31529 0075 31541 0075 31545 0075 31546 0075 31560 0075 31561 0075 31571 0076 Level I Endoscopy Lower Airway0076 31622

0076 31623 0076 31624 0076 31625 0076 31628 0076 31632 0076 31633 0076 31635 0076 31637 0076 31643 0076 31645 0076 31646 0076 31649 0076 31899 0077 Level I Pulmonary Treatment 0077 31720 0077 94610 0077 94640 0077 94664 0077 94667 0077 94668 0077 G0237 0077 G0238 0077 G0239 0078 Level III Pulmonary Treatment 0078 0243T 0078 31502 0078 94060 0078 94642 0078 94660 0079 Ventilation Initiation and Management 0079 94002 0079 94003 0079 94662 0080 Diagnostic Cardiac Catheterization 0080 93451 0080 93452 0080 93453 0080 93454 0080 93455 0080 93456 0080 93457 0080 93458 0080 93459 0080 93460 0080 93461 0080 934620080 93530

0080 93531 0080 93532 0080 93533 0082 Coronary or Non-Coronary Atherectomy 0082 0234T 0082 0236T 0082 0237T 0082 0238T 0082 37204 0082 61623 0082 61626 0082 92924 0082 92925 0083 Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization 0083 35458 0083 35460 0083 35471 0083 35472 0083 35475 0083 35476 0083 37220 0083 37222 0083 37223 0083 37224 0083 37228 0083 37232 0083 37234 0083 37235 0083 75962 0083 75966 0083 92920 0083 92921 0083 92986 0083 92987 0083 92990 0083 92997 0083 92998 0084 Level I Electrophysiologic Procedures 0084 93600 0084 93602 0084 93603 0084 93610 0084 93612 0084 93615 0084 93616 0084 936180084 93642

0085 Level II Electrophysiologic Procedures 0085 93619 0085 93620 0085 93624 0085 93650 0088 Thrombectomy 0088 34101 0088 34111 0088 34201 0088 34203 0088 34421 0088 34471 0088 34490 0088 34501 0088 34510 0088 34520 0088 34530 0088 35188 0088 35207 0088 35875 0088 35876 0088 35879 0088 35881 0088 35883 0088 35884 0088 36818 0088 36819 0088 36820 0088 36821 0088 36825 0088 36830 0088 36831 0088 36832 0088 36833 0088 36838 0088 37184 0088 37185 0088 37186 0088 37187 0088 37188 0088 92973 0089 Insertion/Replacement of Permanent Pacemaker and Electrodes 0089 0302T 0089 33206 0089 33207 0090 Level I Insertion/Replacement of Permanent Pacemaker0090 0304T

0090 33212 0090 33227 0091 Level II Vascular Ligation 0091 36475 0091 37191 0091 37500 0091 37605 0091 37619 0091 37722 0091 37735 0092 Level I Vascular Ligation 0092 30915 0092 30920 0092 36476 0092 36478 0092 36479 0092 37501 0092 37606 0092 37607 0092 37615 0092 37650 0092 37700 0092 37718 0092 37760 0092 37761 0092 37765 0092 37766 0092 37780 0092 37785 0093 Vascular Reconstruction/Fistula Repair without Device 0093 35045 0093 35180 0093 35184 0093 35190 0093 35201 0093 35206 0093 35231 0093 35236 0093 35256 0093 35321 0093 35685 0093 35686 0093 35761 0093 35860 0093 35903 0093 375650093 37600

0093 75978 0094 Level I Resuscitation and Cardioversion 0094 31500 0094 92950 0094 92953 0094 99465 0095 Cardiac Rehabilitation 0095 93797 0095 93798 0095 G0422 0095 G0423 0096 Level II Noninvasive Physiologic Studies 0096 76936 0096 93923 0096 93924 0096 93965 0097 Level I Noninvasive Physiologic Studies 0097 0239T 0097 0296T 0097 0297T 009743755 0097 93225 0097 93226 0097 93270 0097 93786 0097 93788 0097 93799 0097 93922 0097 93982 0097 94762 0097 94775 0097 94776 0099 Electrocardiograms/Cardiography 0099 0223T 0099 0311T 0099 93005 0099 93701 0099 G0404 0100 Cardiac Stress Tests 0100 0179T 0100 93017 0100 93024 0100 93025 0100 Q0035 0101 Tilt Table Evaluation 0101 936600102 Level II Pulmonary Treatment

0102 G0424 0103 Miscellaneous Vascular Procedures 0103 35500 0103 37202 0103 92974 0103 93503 0103 93505 0104 Transcatheter Placement of Intracoronary Stents 0104 92928 0104 92929 0104 92933 0104 92934 0104 92937 0104 92938 0104 92941 0104 92943 0104 92944 0105 Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices 0105 0307T 0105 0322T 0105 0324T 0105 0325T 0105 33215 0105 33218 0105 33220 0105 33226 0105 33233 0105 33234 0105 33235 0105 33241 0105 33244 0105 36261 0105 36262 0105 49422 0105 49429 0106 Insertion/Replacement of Pacemaker Leads and/or Electrodes 0106 0303T 0106 0320T 0106 33210 0106 33211 0106 33216 0106 33217 0107 Level I Implantation of Cardioverter-Defibrillators (ICDs) 0107 0319T 0107 0321T 0107 0323T0107 33230

0107 33231 0107 33240 0107 33262 0107 33263 0107 33264 0108 Level II Implantation of Cardioverter-Defibrillators (ICDs) 0108 33249 0110 Transfusion 0110 36430 0110 36440 0110 36450 0110 36455 0110 36460 0110 38207 0110 38208 0110 38209 0110 38999 0111 Blood Product Exchange 0111 36511 0111 36512 0111 36513 0111 36514 0111 38206 0111 38242 0111 38243 0112 Apheresis and Stem Cell Procedures 0112 0263T 0112 0264T 0112 0265T 0112 36515 0112 36516 0112 36522 0112 38230 0112 38232 0112 38240 0112 38241 0113 Excision Lymphatic System 0113 38308 0113 38500 0113 38510 0113 38520 0113 38525 0113 38530 0113 38550 0113 38555 0113 387000113 38720

0113 38760 0114 Thyroid/Lymphadenectomy Procedures 0114 38542 0114 38740 0114 38745 0114 60200 0114 60210 0114 60212 0114 60220 0114 60225 0114 60240 0114 60280 0114 60281 0114 60699 0115 Cannula/Access Device Procedures 0115 36800 0115 36810 0115 36815 0115 36835 0115 36861 0115 49419 0121 Level I Tube or Catheter Changes or Repositioning 0121 36575 0121 36589 0121 44500 0121 49450 0121 49451 0121 49452 0121 49460 0121 51710 0121 61070 0126 Level I Urinary and Anal Procedures 0126 50391 0126 50686 0126 51101 0126 51703 0126 51741 0126 51784 0126 51792 0126 53601 0126 53660 0126 53661 0126 53899 0126 54240 0126 55899 0126 909110126 91120

0127 Level IV Stereotactic Radiosurgery, MRgFUS, and MEG 0127 77371 0129 Level I Closed Treatment Fracture 0129 21800 0129 21820 0129 22305 0129 23500 0129 23540 0129 23570 0129 23600 0129 23620 0129 23650 0129 23675 0129 23929 0129 24500 0129 24505 0129 24530 0129 24560 0129 24565 0129 24576 0129 24577 0129 24600 0129 24640 0129 24650 0129 24670 0129 24675 0129 24999 0129 25500 0129 25530 0129 25535 0129 25560 0129 25600 0129 25622 0129 25630 0129 25635 0129 25650 0129 25660 0129 25675 0129 25680 0129 25999 0129 26600 0129 26605 0129 26641 0129 26670 0129 26675 0129 267000129 26705

0129 26720 0129 26725 0129 26740 0129 26742 0129 26750 0129 26755 0129 26770 0129 26989 0129 27193 0129 27200 0129 27220 0129 27230 0129 27250 0129 27256 0129 27265 0129 27267 0129 27299 0129 27501 0129 27503 0129 27508 0129 27516 0129 27517 0129 27520 0129 27530 0129 27538 0129 27550 0129 27560 0129 27599 0129 27750 0129 27760 0129 27767 0129 27768 0129 27780 0129 27786 0129 27788 0129 27808 0129 27810 0129 27816 0129 27824 0129 27830 0129 27840 0129 27899 0129 28400 0129 28430 0129 28435 0129 284500129 28455

0129 28470 0129 28475 0129 28490 0129 28495 0129 28510 0129 28515 0129 28530 0129 28540 0129 28570 0129 28600 0129 28605 0129 28630 0129 28660 0129 28899 0130 Level I Laparoscopy 0130 38129 0130 38589 013043289 013043648 013043659 013044213 013044238 013044979 013045499 013047379 013047560 013047561 013047579 013049320 013049321 013049322 013049323 013049324 013049325 013049326 013049327 013049329 013049659 0130 50541 0130 50549 0130 50949 0130 51999 0130 54699 0130 55559 0130 58545 0130 585780130 58679

0130 59898 0130 60659 0131 Level II Laparoscopy 0131 38120 0131 38570 0131 38572 0131 43653 0131 44180 0131 44186 0131 44970 0131 47562 0131 47563 0131 47564 0131 49650 0131 49651 0131 50543 0131 50544 0131 50945 0131 50947 0131 50948 0131 51990 0131 51992 0131 54690 0131 55550 0131 57425 0131 58546 0131 58552 0131 58553 0131 58554 0131 58570 0131 58571 0131 58572 0131 58573 0131 58660 0131 58661 0131 58662 0131 58670 0131 58671 0131 58672 0131 58673 0131 59150 0131 59151 0132 Level III Laparoscopy 0132 38571 0132 43280 0132 432810132 43651

0132 43652 0132 43770 0132 44206 0132 44207 0132 44208 0132 49652 0132 49653 0132 49654 0132 49655 0132 49656 0132 49657 0132 54692 0132 58541 0132 58542 0132 58543 0132 58544 0132 58550 0133 Level I Skin Repair 0133 0299T 0133 0300T 0133 11760 0133 11954 0133 12001 0133 12002 0133 12004 0133 12005 0133 12006 0133 12007 0133 12011 0133 12013 0133 12014 0133 12015 0133 12016 0133 12017 0133 12041 0133 12054 0133 13122 0133 15272 0133 15276 0133 15775 0133 15776 0134 Level II Skin Repair 0134 11920 0134 11921 0134 11922 0134 119500134 11951

0134 11952 0134 12018 0134 12021 0134 12031 0134 12032 0134 12034 0134 12035 0134 12036 0134 12037 0134 12042 0134 12044 0134 12045 0134 12046 0134 12047 0134 12051 0134 12052 0134 12053 0134 12055 0134 12056 0134 12057 0134 13102 0134 13120 0134 13121 0134 13131 0134 13133 0134 13153 0134 15004 0134 15040 0134 15050 0134 15116 0134 15150 0134 15151 0134 15152 0134 15155 0134 15156 0134 15157 0134 15241 0134 15271 0134 15274 0134 15275 0134 15278 0134 15819 0135 Level III Skin Repair 0135 12020 0135 13100 0135 131010135 13132

0135 13150 0135 13151 0135 13152 0135 15002 0135 15003 0135 15005 0135 15110 0135 15111 0135 15221 0135 15273 0135 15277 0135 C9800 0136 Level IV Skin Repair 0136 11762 0136 14000 0136 14001 0136 14020 0136 14021 0136 14040 0136 14041 0136 14060 0136 14061 0136 15115 0136 15130 0136 15131 0136 15135 0136 15136 0136 15200 0136 15201 0136 15220 0136 15240 0136 15260 0136 15261 0136 15740 0136 15777 0136 15936 0136 15952 0136 15953 0136 15956 0136 15958 0136 20920 0136 20922 0136 20926 0136 23921 0136 25929 0136 332220136 33223

013643887 0137 Level V Skin Repair 0137 11960 0137 13160 0137 14301 0137 14302 0137 14350 0137 15100 0137 15101 0137 15120 0137 15121 0137 15570 0137 15572 0137 15574 0137 15576 0137 15600 0137 15610 0137 15620 0137 15630 0137 15650 0137 15731 0137 15732 0137 15734 0137 15736 0137 15738 0137 15750 0137 15760 0137 15770 0137 15820 0137 15821 0137 15822 0137 15823 0137 15824 0137 15825 0137 15826 0137 15828 0137 15829 0137 15840 0137 15841 0137 15842 0137 15845 0137 15876 0137 15877 0137 15878 0137 15879 0137 159220137 15934

0137 15935 0137 15937 0137 15944 0137 15945 0137 15946 013720101 013720102 013720910 013720912 013743886 013743888 013744312 013744340 0138 Level II Closed Treatment Fracture 0138 20660 0138 22310 0138 23520 0138 23525 0138 23545 0138 23575 0138 23665 0138 24535 0138 24655 0138 25505 0138 25520 0138 25565 0138 25605 0138 25624 0138 26340 0138 26341 0138 26645 0138 27238 0138 27246 0138 27500 0138 27510 0138 27818 0139 Level III Closed Treatment Fracture 0139 20697 0139 22315 0139 23505 0139 23605 0139 23625 0139 24620 0139 25259 0139 25690 0139 266070139 26706

0139 27502 0139 27532 0139 27752 0139 27762 0139 27781 0139 27825 0139 27831 0139 28405 0139 28575 0140 Esophageal Dilation without Endoscopy 014043450 014043453 014043456 0141 Level I Upper GI Procedures 0141 43200 0141 43202 0141 43204 0141 43235 0141 43236 0141 43239 0141 43241 0141 43243 0141 43247 0141 43248 0141 43499 0141 43510 0141 43761 0141 43831 0141 43999 0142 Level I Small Intestine Endoscopy 0142 44360 0142 44361 0142 44363 0142 44376 0142 44377 0142 44380 0142 44382 0142 91110 0143 Lower GI Endoscopy 014344385 014344386 014344388 014344389 014344390 014344391 014344392014344393

014344394 014345355 014345378 014345379 014345380 014345381 014345382 014345383 014345384 014345385 014345386 014345391 014345392 0146 Level I Sigmoidoscopy and Anoscopy 0146 0227T 014645300 014645330 014645331 014645332 014645333 014645335 014646614 0147 Level II Sigmoidoscopy and Anoscopy 014745303 014745305 014745308 014745309 014745315 014745317 014745334 014745337 014745338 014745339 014745340 014745341 014745342 014746604 014746606 014746608 014746611 0148 Level I Anal/Rectal Procedures 0148 45900 0148 45999 0148 46030 0148 46050 0148 462210148 46500

0148 46930 0148 46942 0148 46999 0148 C9725 0149 Level III Anal/Rectal Procedures 0149 45000 0149 45108 0149 45150 0149 45160 0149 45171 0149 45190 0149 45500 0149 46020 0149 46045 0149 46200 0149 46250 0149 46255 0149 46257 0149 46258 0149 46260 0149 46261 0149 46262 0149 46270 0149 46275 0149 46280 0149 46285 0149 46700 0149 46706 0149 46753 0149 46945 0149 46946 0150 Level IV Anal/Rectal Procedures 0150 0184T 0150 0249T 0150 0288T 015045172 015045505 015045541 015045560 015046288 015046707 015046750 015046760 015046761 015046762 0150469470151 Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

0151 43260 0151 43261 0151 43262 0151 43263 0151 43264 0151 43265 0151 43267 0151 43271 0151 43272 0151 43273 0152 Level I Percutaneous Abdominal and Biliary Procedures 0152 47490 0152 47510 0152 47511 0152 47552 0152 47553 0152 47554 0152 47555 0152 47630 0152 47999 0153 Peritoneal and Abdominal Procedures 015344799 015344950 015344955 015349250 015349402 015349426 015349999 0153 55920 0154 Hernia/Hydrocele Procedures 015449491 015449492 015449495 015449496 015449500 015449501 015449505 015449507 015449520 015449521 015449525 015449540 015449550 015449553 015449555 015449557015449560

015449561 015449565 015449566 015449568 015449570 015449572 015449580 015449582 015449585 015449587 015449590 015449600 0154 51500 0154 54530 0154 54550 0154 54640 0154 54650 0154 55040 0154 55041 0154 55535 0154 55540 0155 Level II Anal/Rectal Procedures 0155 45005 0155 45020 0155 45100 0155 45905 0155 45910 0155 45915 0155 45990 0155 46040 0155 46060 0155 46070 0155 46080 0155 46220 0155 46230 0155 46320 0155 46505 0155 46754 0155 46940 0155 49442 0156 Level III Urinary and Anal Procedures 0156 51720 0156 51725 0156 51726 0156 51727 0156 517280156 51729

0156 53600 0156 54450 0156 91117 0156 91122 0157 Colorectal Cancer Screening: Barium Enema 0157 G0106 0157 G0120 0158 Colorectal Cancer Screening: Colonoscopy 0158 G0105 0158 G0121 0159 Colorectal Cancer Screening: Flexible Sigmoidoscopy 0159 G0104 0160 Level I Cystourethroscopy and other Genitourinary Procedures 0160 50386 0160 50389 0160 50551 0160 50555 0160 50562 0160 50570 0160 50572 0160 50574 0160 50951 0160 50953 0160 50970 0160 50972 0160 51045 0160 52000 0160 52010 0160 52265 0161 Level II Cystourethroscopy and other Genitourinary Procedures 0161 50384 0161 50392 0161 50576 0161 50580 0161 50974 0161 50976 0161 52001 0161 52260 0161 52270 0161 52281 0161 52285 0161 52287 0161 52310 0161 53605 0161 74475 0161 744800161 74485

0162 Level III Cystourethroscopy and other Genitourinary Procedures 0162 50020 0162 50382 0162 50385 0162 50393 0162 50395 0162 50553 0162 50557 0162 50561 0162 50955 0162 50957 0162 50961 0162 50980 0162 51020 0162 51030 0162 51040 0162 51050 0162 51065 0162 51520 0162 51535 0162 51860 0162 51880 0162 52005 0162 52007 0162 52204 0162 52214 0162 52224 0162 52234 0162 52235 0162 52240 0162 52250 0162 52275 0162 52276 0162 52277 0162 52283 0162 52290 0162 52300 0162 52301 0162 52305 0162 52315 0162 52317 0162 52318 0162 52320 0162 52325 0162 52330 0162 523320162 52334

0162 52341 0162 52342 0162 52343 0162 52344 0162 52345 0162 52346 0162 52351 0162 52352 0162 52354 0162 52355 0162 52400 0162 52402 0162 52450 0162 52500 0162 52640 0162 52700 0162 55720 0162 55725 0163 Level IV Cystourethroscopy and other Genitourinary Procedures 0163 50575 0163 51060 0163 52282 0163 52327 0163 52353 0163 52601 0163 52630 0163 55875 0164 Level II Urinary and Anal Procedures 016446083 0164 50396 0164 51100 0164 51700 0164 51705 0164 51785 0164 51797 0164 53621 0164 53855 0164 54200 0164 54220 0164 54235 0164 54250 0165 Level IV Urinary and Anal Procedures 0165 50727 0165 51102 0165 53620 0165 538600165 54231

0165 55860 0166 Level I Urethral Procedures 0166 53000 0166 53010 0166 53020 0166 53025 0166 53040 0166 53060 0166 53080 0166 53085 0166 53200 0166 53215 0166 53235 0166 53250 0166 53260 0166 53265 0166 53270 0166 53275 0166 53460 0166 53502 0166 53510 0166 53665 0166 54000 0166 54001 0168 Level II Urethral Procedures 0168 51715 0168 53210 0168 53220 0168 53230 0168 53240 0168 53400 0168 53405 0168 53410 0168 53420 0168 53425 0168 53430 0168 53431 0168 53442 0168 53446 0168 53449 0168 53450 0168 53500 0168 53505 0168 53515 0168 53520 0169 Lithotripsy0169 50590

0170 Dialysis 0170 90935 0170 G0257 0174 Level IV Laparoscopy 017447370 017447371 0174 50542 0177 Level I Echocardiogram with Contrast 0177 C8922 0177 C8923 0177 C8924 0177 C8927 0178 Level II Echocardiogram with Contrast 0178 C8921 0178 C8925 0178 C8926 0178 C8928 0178 C8929 0178 C8930 0181 Level II Male Genital Procedures 0181 37790 0181 54110 0181 54111 0181 54112 0181 54120 0181 54205 0181 54300 0181 54304 0181 54308 0181 54312 0181 54316 0181 54318 0181 54322 0181 54324 0181 54326 0181 54328 0181 54332 0181 54336 0181 54340 0181 54344 0181 54348 0181 54352 0181 54360 0181 54380 0181 54385 0181 544060181 54408

0181 54415 0181 54420 0181 54435 0181 54440 0181 54535 0183 Level I Male Genital Procedures 0183 54150 0183 54160 0183 54161 0183 54162 0183 54163 0183 54164 0183 54505 0183 54512 0183 54520 0183 54522 0183 54560 0183 54600 0183 54620 0183 54660 0183 54670 0183 54680 0183 54700 0183 54830 0183 54840 0183 54860 0183 54861 0183 54865 0183 54900 0183 54901 0183 55060 0183 55110 0183 55120 0183 55150 0183 55175 0183 55180 0183 55200 0183 55250 0183 55400 0183 55450 0183 55500 0183 55520 0183 55530 0183 55600 0183 55680 0184 Prostate Biopsy0184 55700

0184 55705 0184 55706 0188 Level II Female Reproductive Proc 0188 56405 0188 56420 0188 56606 0188 56820 0188 56821 0188 57150 0188 57160 0188 57180 0188 57452 0188 57511 0188 58100 0188 58301 0188 59020 0188 59025 0188 59070 0188 59200 0189 Level III Female Reproductive Proc 0189 55870 0189 56605 0189 57156 0189 57420 0189 57421 0189 57454 0189 57455 0189 57456 0189 58321 0189 58322 0189 58323 0189 58970 0189 58974 0189 58976 0189 59000 0189 59012 0189 59015 0189 59030 0189 59072 0189 59074 0189 59076 0189 59866 0190 Level I Hysteroscopy 0190 58555 0190 58558 0190 585590190 58562

0190 58579 0191 Level I Female Reproductive Proc 0191 57170 0191 58999 0191 59897 0191 59899 0191 99170 0191 Q0091 0192 Level IV Female Reproductive Proc 0192 57020 0192 57100 0192 57155 0192 57500 0192 57505 0192 59001 0193 Level V Female Reproductive Proc 0193 56440 0193 56441 0193 56442 0193 56620 0193 56625 0193 56700 0193 56740 0193 56800 0193 56805 0193 56810 0193 57000 0193 57010 0193 57061 0193 57065 0193 57105 0193 57106 0193 57130 0193 57135 0193 57200 0193 57210 0193 57295 0193 57400 0193 57410 0193 57415 0193 57426 0193 57460 0193 57461 0193 57510 0193 57513 0193 575200193 57522

0193 57558 0193 57700 0193 57720 0193 57800 0193 58120 0193 58345 0193 58346 0193 58615 0193 58800 0193 58823 0193 58900 0193 59160 0193 59300 0193 59320 0193 59409 0193 59412 0193 59414 0193 59612 0193 59812 0193 59820 0193 59821 0193 59840 0193 59841 0193 59870 0193 59871 0195 Level VI Female Reproductive Procedures 0195 57107 0195 57109 0195 57120 0195 57230 0195 57240 0195 57250 0195 57260 0195 57267 0195 57268 0195 57287 0195 57289 0195 57291 0195 57292 0195 57300 0195 57320 0195 57330 0195 57335 0195 57530 0195 57550 0195 575550195 58145

0195 58260 0195 58262 0195 58263 0195 58270 0195 58350 0195 58353 0195 58600 0195 58770 0195 58805 0195 58820 0195 58920 0195 58925 0195 59100 0202 Level VII Female Reproductive Procedures 0202 51845 0202 57220 0202 57265 0202 57282 0202 57283 0202 57284 0202 57285 0202 57288 0202 57310 0202 57423 0202 57556 0202 58290 0202 58291 0202 58292 0202 58294 0202 58356 0202 58565 0203 Level IV Nerve Injections 0203 61791 0203 62263 0203 62264 0203 62281 0203 62282 0203 62319 0203 62355 0203 63746 0203 64600 0203 64620 0203 64635 0203 64680 0203 64681 0204 Level I Nerve Injections0204 0214T

0204 0215T 0204 0217T 0204 0218T 020420526 020420527 020420550 020420551 020420552 020420553 020420600 020420605 020420610 020420612 0204 64400 0204 64402 0204 64408 0204 64410 0204 64455 0204 64491 0204 64492 0204 64494 0204 64495 0204 64505 0204 64508 0204 64566 0204 64611 0204 64612 0204 64615 0204 64632 0204 64634 0204 64650 0204 64653 0204 64999 0206 Level II Nerve Injections 0206 0229T 0206 0231T 0206 62270 0206 62272 0206 64405 0206 64412 0206 64413 0206 64415 0206 64417 0206 64418 0206 64420 0206 644250206 64435

0206 64447 0206 64450 0206 64480 0206 64484 0206 64613 0206 64614 0207 Level III Nerve Injections 0207 0213T 0207 0216T 0207 0228T 0207 0230T 0207 61000 0207 61001 0207 61020 0207 61026 0207 61050 0207 61055 0207 62194 0207 62268 0207 62273 0207 62280 0207 62292 0207 62294 0207 62310 0207 62311 0207 62318 0207 64416 0207 64421 0207 64430 0207 64445 0207 64446 0207 64448 0207 64449 0207 64479 0207 64483 0207 64490 0207 64493 0207 64510 0207 64517 0207 64520 0207 64530 0207 64630 0207 64633 0207 64636 0207 64640 0207 G02600208 Laminotomies and Laminectomies

0208 0274T 0208 0275T 0208 22100 0208 22101 0208 22102 0208 22103 0208 22222 0208 22551 0208 22554 0208 22612 0208 22614 0208 22856 0208 62351 0208 63001 0208 63003 0208 63005 0208 63011 0208 63012 0208 63015 0208 63016 0208 63017 0208 63020 0208 63030 0208 63035 0208 63040 0208 63042 0208 63045 0208 63046 0208 63047 0208 63048 0208 63055 0208 63056 0208 63057 0208 63064 0208 63066 0208 63075 0208 63076 0209 Level II Extended EEG, Sleep, and Cardiovascular Studies 0209 95782 0209 95783 0209 95805 0209 95807 0209 95808 0209 95810 0209 95811 0209 959500209 95951

0209 95953 0209 95956 0209 G0302 0209 G0303 0213 Level I Extended EEG, Sleep, and Cardiovascular Studies 0213 93229 0213 95800 0213 95801 0213 95806 0213 95812 0213 95813 0213 95816 0213 95819 0213 95822 0213 95827 0213 95958 0213 G0304 0213 G0305 0213 G0398 0213 G0399 0213 G0400 0215 Level I Nerve and Muscle Services 0215 0199T 0215 0278T 0215 95869 0215 95870 0215 95887 0215 95905 0215 95907 0215 95908 0215 95909 0215 95910 0215 95933 0215 95943 0215 95999 0216 Level III Nerve and Muscle Services 0216 90867 0216 90868 0216 90869 0216 92584 0216 92585 0216 95824 0216 95925 0216 95926 0216 95927 0216 959300216 95938

0216 95961 0216 95962 0216 96000 0216 96001 0218 Level II Nerve and Muscle Services 0218 0272T 0218 0273T 0218 0285T 0218 0310T 0218 92586 0218 95803 0218 95857 0218 95860 0218 95861 0218 95863 0218 95864 0218 95865 0218 95866 0218 95867 0218 95868 0218 95872 0218 95875 0218 95885 0218 95886 0218 95911 0218 95912 0218 95913 0218 95921 0218 95922 0218 95923 0218 95924 0218 95928 0218 95929 0218 95937 0218 95939 0218 95954 0218 95970 0218 95973 0218 95975 0218 95981 0218 96002 0218 96003 0220 Level I Nerve Procedures 0220 27325 0220 27326 0220 280350220 28055

0220 61790 0220 63600 0220 63610 0220 63615 0220 64605 0220 64610 0220 64702 0220 64704 0220 64708 0220 64712 0220 64713 0220 64714 0220 64716 0220 64718 0220 64719 0220 64721 0220 64722 0220 64726 0220 64727 0220 64732 0220 64734 0220 64736 0220 64738 0220 64740 0220 64742 0220 64744 0220 64746 0220 64761 0220 64763 0220 64771 0220 64772 0220 64774 0220 64776 0220 64778 0220 64782 0220 64783 0220 64784 0220 64787 0220 64788 0220 64790 0220 64795 0220 64802 0220 64804 0220 64820 0221 Level II Nerve Procedures 0221 0269T0221 61720

0221 61770 0221 62287 0221 62365 0221 64570 0221 64766 0221 64786 0221 64792 0221 64831 0221 64832 0221 64834 0221 64835 0221 64836 0221 64837 0221 64840 0221 64856 0221 64857 0221 64858 0221 64859 0221 64861 0221 64862 0221 64864 0221 64865 0221 64870 0221 64872 0221 64874 0221 64876 0221 64885 0221 64886 0221 64890 0221 64891 0221 64892 0221 64893 0221 64895 0221 64896 0221 64897 0221 64898 0221 64901 0221 64902 0221 64905 0221 64907 0221 64910 0221 64911 0224 Implantation of Catheter/Reservoir/Shunt 0224 61215 0224 62230 0224 623500224 62360

0224 63741 0224 63744 0227 Implantation of Drug Infusion Device 0227 62361 0227 62362 0229 Level II Endovascular Revascularization of the Lower Extremity 0229 37183 0229 37205 0229 37206 0229 37207 0229 37208 0229 37210 0229 37221 0229 37225 0229 37226 0229 37229 0229 37230 0229 37233 0230 Level I Eye Tests & Treatments 0230 0181T 0230 0207T 0230 68200 0230 92020 0230 92025 0230 92060 0230 92065 0230 92081 0230 92082 0230 92132 0230 92133 0230 92134 0230 92140 0230 92225 0230 92226 0230 92250 0230 92260 0230 92265 0230 92270 0230 92283 0230 92284 0230 92285 0230 92312 0230 92317 0230 92326 0230 92354 0230 923550230 92358

0230 92499 0230 G0118 0231 Level III Eye Tests & Treatments 0231 65450 0231 67500 0231 67938 0231 68840 0231 92235 0231 92240 0231 92275 0232 Level I Anterior Segment Eye Procedures 0232 0124T 0232 65900 0232 66500 0232 66999 0232 76510 0233 Level III Anterior Segment Eye Procedures 0233 65235 0233 65400 0233 65410 0233 65420 0233 65436 0233 65772 0233 65775 0233 65778 0233 65779 0233 65865 0233 65880 0233 66020 0233 66030 0233 66250 0233 66700 0233 66710 0233 66720 0233 66840 0233 67880 0233 68130 0234 Level IV Anterior Segment Eye Procedures 0234 0099T 0234 0123T 0234 0308T 0234 65272 0234 65275 0234 65426 0234 65810 0234 658150234 65820

0234 65850 0234 65870 0234 65875 0234 65920 0234 66130 0234 66150 0234 66160 0234 66165 0234 66170 0234 66172 0234 66600 0234 66630 0234 66635 0234 66680 0234 66682 0234 66711 0234 66740 0234 66825 0234 68330 0234 68360 0234 68362 0234 68371 0235 Level I Posterior Segment Eye Procedures 0235 65260 0235 67141 0235 67208 0235 67220 0235 67221 0235 67225 0235 67299 0235 G0186 0237 Level II Posterior Segment Eye Procedures 0237 0186T 0237 0190T 0237 65265 0237 65280 0237 67005 0237 67030 0237 67101 0237 67110 0237 67115 0237 67120 0237 67218 0237 67227 0237 67255 0238 Level I Repair and Plastic Eye Procedures0238 67028

0238 67345 0238 67505 0238 67515 0238 67599 0238 67700 0238 67800 0238 67805 0238 67810 0238 67825 0238 67999 0238 68020 0238 68399 0238 68400 0238 68440 0238 68530 0238 68705 0238 68760 0238 68761 0238 68810 0238 68899 0239 Level II Repair and Plastic Eye Procedures 0239 65435 0239 67710 0239 67801 0239 67830 0239 67840 0239 67850 0239 67875 0239 68100 0239 68135 0240 Level III Repair and Plastic Eye Procedures 0240 65175 0240 65270 0240 65600 0240 67250 0240 67400 0240 67412 0240 67415 0240 67715 0240 67808 0240 67835 0240 67882 0240 67901 0240 67903 0240 67904 0240 679060240 67908

0240 67909 0240 67911 0240 67912 0240 67914 0240 67915 0240 67916 0240 67917 0240 67921 0240 67922 0240 67923 0240 67924 0240 67930 0240 67935 0240 67950 0240 67961 0240 67966 0240 67971 0240 67974 0240 67975 0240 68115 0240 68326 0240 68340 0240 68420 0240 68510 0240 68525 0240 68540 0240 68700 0240 68811 0240 68815 0240 68816 0241 Level IV Repair and Plastic Eye Procedures 0241 65125 0241 65130 0241 65135 0241 65150 0241 67405 0241 67413 0241 67560 0241 67900 0241 67902 0241 67973 0241 68320 0241 68325 0241 68328 0241 68335 0241 685000241 68505

0241 68520 0241 68550 0241 68720 0241 68745 0241 68750 0241 68770 0242 Level V Repair and Plastic Eye Procedures 0242 65091 0242 65093 0242 65101 0242 65103 0242 65105 0242 65110 0242 65112 0242 65114 0242 65140 0242 65155 0242 67414 0242 67420 0242 67430 0242 67440 0242 67445 0242 67450 0242 67550 0242 67570 0243 Strabismus/Muscle Procedures 0243 65290 0243 67311 0243 67312 0243 67314 0243 67316 0243 67318 0243 67320 0243 67331 0243 67332 0243 67334 0243 67335 0243 67340 0243 67343 0243 67399 0244 Corneal and Amniotic Membrane Transplant 0244 65710 0244 65730 0244 65750 0244 65755 0244 657560244 65780

0244 65781 0244 65782 0246 Cataract Procedures with IOL Insert 0246 66982 0246 66983 0246 66984 0246 66985 0246 66986 0247 Laser Eye Procedures 0247 65855 0247 65860 0247 66761 0247 66762 0247 66770 0247 66821 0247 67031 0247 67105 0247 67145 0247 67210 0247 67228 0247 67229 0249 Cataract Procedures without IOL Insert 0249 66850 0249 66852 0249 66920 0249 66930 0250 Level I ENT Procedures 0250 21089 0250 21299 0250 21310 0250 21480 0250 21499 0250 21899 0250 30901 0250 30903 0250 30905 0250 30906 0250 30999 0250 31299 0250 31599 025040799 025040899 025041250 025041599 025041899 025042299025042699

025042960 025042970 025042999 0250 69399 0250 69799 0250 69949 0250 69979 0251 Level II ENT Procedures 0251 21450 0251 30000 0251 30020 0251 30560 0251 31000 0251 40490 0251 40806 0251 40808 0251 40818 0251 40830 0251 41005 0251 41009 0251 41015 0251 41251 0251 42000 0251 42180 0251 42280 0251 42310 0251 42320 0251 42660 0251 42700 0251 69100 0251 69400 0251 69401 0251 69420 0251 92502 0252 Level III ENT Procedures 0252 20100 0252 20500 0252 21085 0252 21110 0252 21295 0252 21400 0252 21401 0252 21497 0252 30100 0252 30110 0252 302000252 30210

0252 31002 0252 31603 0252 31605 0252 31615 0252 40650 0252 40652 0252 40654 0252 40801 0252 40831 0252 41000 0252 41010 0252 41018 0252 41100 0252 41115 0252 41252 0252 41821 0252 42100 0252 42300 0252 43020 0252 60000 0252 69222 0252 69433 0252 C9727 0253 Level IV ENT Procedures 025321235 025321282 025321315 025321320 025321337 025321451 025321452 025321495 0253 30117 0253 30220 0253 30310 0253 30801 0253 30802 025340500 025340520 025340810 025340812 025340819 025340820 025341008 025341017 025341105025341110

025341112 025341113 025341500 025341510 025341806 025341822 025341825 025342104 025342106 025342140 025342160 025342281 025342330 025342340 025342600 025342650 025342720 025342800 025342802 025342804 025342972 0253 69105 0253 69405 0253 69421 0253 69424 0253 69436 0253 69540 0253 69801 0254 Level V ENT Procedures 025421026 025421029 025421030 025421031 025421032 025421040 025421044 025421073 025421076 025421121 025421122 025421123 025421125 025421137 025421195 025421198 025421230025421296

025421325 025421330 025421335 025421339 025421345 025421356 025421440 025421445 025421485 025421685 0254 30115 0254 30118 0254 30120 0254 30124 0254 30130 0254 30140 0254 30320 0254 30400 0254 30430 0254 30520 0254 30630 0254 30930 0254 31020 0254 31040 0254 31200 0254 31201 0254 31205 0254 31300 0254 31600 0254 31601 0254 31611 0254 31613 0254 31785 0254 31820 0254 31825 0254 31830 025440510 025440525 025440530 025440805 025440814 025440816 025440840 025440843 025441006 025441007025441016

025441019 025441114 025441116 025441120 025441512 025441520 025441530 025441805 025441820 025441826 025441827 025441828 025441830 025441850 025441872 025441874 025442120 025442182 025442225 025442235 025442260 025442305 025442335 025442405 025442408 025442409 025442500 025442508 025442806 025442808 025442810 025442820 025442821 025442826 025442831 025442835 025442836 025442870 025442900 025442955 025442962 025443030 025443420 0254 60502 0254 62000 0254 691200254 69150

0254 69300 0254 69610 0254 69620 0254 69666 0254 69667 0254 69676 0254 69700 0255 Level II Anterior Segment Eye Procedures 0255 65286 0255 65800 0255 66505 0255 66625 0255 66820 0255 66830 0255 66940 0256 Level VI ENT Procedures 0256 21010 0256 21025 0256 21034 0256 21046 0256 21047 0256 21048 0256 21049 0256 21050 0256 21060 0256 21070 0256 21077 0256 21079 0256 21080 0256 21081 0256 21082 0256 21083 0256 21084 0256 21086 0256 21087 0256 21088 0256 21100 0256 21120 0256 21127 0256 21138 0256 21139 0256 21150 0256 21172 0256 21175 0256 21181 0256 211930256 21199

0256 21206 0256 21208 0256 21209 0256 21210 0256 21215 0256 21240 0256 21242 0256 21243 0256 21244 0256 21245 0256 21246 0256 21248 0256 21249 0256 21256 0256 21260 0256 21261 0256 21263 0256 21267 0256 21270 0256 21275 0256 21280 0256 21338 0256 21340 0256 21346 0256 21355 0256 21360 0256 21365 0256 21385 0256 21386 0256 21387 0256 21390 0256 21395 0256 21406 0256 21407 0256 21408 0256 21421 0256 21453 0256 21454 0256 21461 0256 21462 0256 21465 0256 21470 0256 21490 0256 30125 0256 30150 0256 301600256 30410

0256 30420 0256 30435 0256 30450 0256 30460 0256 30462 0256 30465 0256 30540 0256 30545 0256 30580 0256 30600 0256 30620 0256 31030 0256 31032 0256 31050 0256 31051 0256 31070 0256 31075 0256 31080 0256 31081 0256 31084 0256 31085 0256 31086 0256 31087 0256 31090 0256 31320 0256 31400 0256 31420 0256 31580 0256 31582 0256 31588 0256 31590 0256 31595 0256 31610 0256 31612 0256 31614 0256 31750 0256 31755 025640527 025640700 025640701 025640702 025640720 025640761 025640842 025640844 025640845025641823

025641870 025642107 025642145 025642200 025642205 025642210 025642215 025642220 025642226 025642227 025642410 025642415 025642420 025642425 025642440 025642450 025642505 025642507 025642509 025642510 025642665 025642725 025642815 025642825 025642830 025642842 025642844 025642860 025642890 025642892 025642950 025643130 0256 60252 0256 60260 0256 60271 0256 60500 0256 60520 0256 61330 0256 61334 0256 69140 0256 69310 0256 69320 0256 69440 0256 69450 0256 69501 0256 695020256 69505

0256 69511 0256 69530 0256 69550 0256 69552 0256 69601 0256 69602 0256 69603 0256 69604 0256 69605 0256 69631 0256 69632 0256 69633 0256 69635 0256 69636 0256 69637 0256 69641 0256 69642 0256 69643 0256 69644 0256 69645 0256 69646 0256 69650 0256 69660 0256 69661 0256 69662 0256 69670 0256 69711 0256 69720 0256 69725 0256 69740 0256 69745 0256 69805 0256 69806 0256 69820 0256 69840 0256 69905 0256 69910 0256 69915 0256 69955 0256 69960 0256 69970 0259 Level VII ENT Procedures 0259 69930 0260 Level I Plain Film Except Teeth 0260 70030 0260 701000260 70130

0260 70140 0260 70160 0260 70190 0260 70210 0260 70240 0260 70250 0260 70328 0260 70330 0260 70350 0260 70360 0260 70380 0260 71010 0260 71015 0260 71020 0260 71021 0260 71022 0260 71035 0260 71100 0260 71120 0260 71130 0260 72020 0260 72040 0260 72069 0260 72070 0260 72074 0260 72080 0260 72100 0260 72170 0260 72190 0260 72200 0260 72202 0260 72220 0260 73000 0260 73010 0260 73020 0260 73030 0260 73050 0260 73060 0260 73070 0260 73080 0260 73090 0260 73092 0260 73100 0260 73110 0260 73120 0260 731300260 73140

0260 73500 0260 73510 0260 73540 0260 73550 0260 73560 0260 73562 0260 73565 0260 73590 0260 73592 0260 73600 0260 73610 0260 73620 0260 73630 0260 73650 0260 73660 0260 74000 0260 74010 0260 74020 0260 76010 0260 76499 0260 77071 0260 77072 0260 77077 0260 77082 0261 Level II Plain Film Except Teeth Including Bone Density Measurement 0261 70110 0261 70120 0261 70134 0261 70150 0261 70200 0261 70220 0261 70260 0261 71030 0261 71101 0261 71110 0261 71111 0261 72010 0261 72050 0261 72052 0261 72072 0261 72090 0261 72110 0261 72114 0261 72120 0261 73520 0261 735640261 74022

0261 74710 0261 75809 0261 76100 0261 77073 0261 77074 0261 77075 0261 77076 0261 G0130 0262 Plain Film of Teeth 0262 70300 0262 70310 0262 70320 0262 70355 0263 Level I Miscellaneous Radiology Procedures 0263 70170 0263 70373 0263 70390 0263 74190 0263 74305 0263 74470 0263 74740 0263 76080 0263 76101 0263 76102 0263 77053 0263 77054 0265 Level I Diagnostic and Screening Ultrasound 0265 76506 0265 76516 0265 76529 0265 76604 0265 76645 0265 76802 0265 76812 0265 76813 0265 76814 0265 76815 0265 76816 0265 76817 0265 76820 0265 76821 0265 76827 0265 76828 0265 76857 0265 76882 0265 768850265 76886

0265 76970 0265 76999 0265 93888 0266 Level II Diagnostic and Screening Ultrasound 0266 76511 0266 76512 0266 76513 0266 76519 0266 76536 0266 76700 0266 76705 0266 76770 0266 76775 0266 76776 0266 76800 0266 76801 0266 76805 0266 76810 0266 76818 0266 76819 0266 76830 0266 76856 0266 76870 0266 76872 0266 76881 0266 93890 0266 93892 0266 93893 0266 93926 0266 93931 0266 93971 0266 93979 0266 93990 0266 G0389 0267 Level III Diagnostic and Screening Ultrasound 0267 36002 0267 75945 0267 76811 0267 76831 0267 76873 0267 76975 0267 93880 0267 93882 0267 93886 0267 93925 0267 939300267 93970

0267 93975 0267 93976 0267 93978 0267 93980 0267 93981 0267 G0365 0269 Level II Echocardiogram Without Contrast 0269 93304 0269 93306 0269 93307 0269 93313 0269 93315 0269 93350 0270 Level III Echocardiogram Without Contrast 0270 93303 0270 93312 0270 93316 0270 93318 0270 93351 0272 Fluoroscopy 0272 43752 0272 43756 0272 43757 0272 70370 0272 70371 0272 71023 0272 71034 0272 76000 0272 76120 0272 76496 0274 Myelography 0274 70010 0274 70015 0274 72240 0274 72255 0274 72265 0274 72270 0275 Arthrography 0275 70332 0275 73040 0275 73085 0275 73115 0275 73525 0275 73580 0275 73615 0276 Level I Digestive Radiology0276 74210

0276 74220 0276 74230 0276 74250 0276 74260 0276 74290 0276 74291 0277 Level II Digestive Radiology 027749465 0277 74240 0277 74241 0277 74245 0277 74246 0277 74247 0277 74249 0277 74251 0277 74270 0277 74280 0277 74283 0278 Diagnostic Urography 0278 74400 0278 74410 0278 74415 0278 74420 0278 74425 0278 74430 0278 74440 0278 74445 0278 74450 0278 74455 0278 74775 0279 Level II Angiography and Venography 0279 36221 0279 36222 0279 36223 0279 36225 0279 36251 0279 36252 0279 36253 0279 36254 0279 75600 0279 75605 0279 75625 0279 75630 0279 75658 0279 75705 0279 757100279 75716

0279 75726 0279 75731 0279 75733 0279 75736 0279 75741 0279 75743 0279 75810 0279 75825 0279 75831 0279 75833 0279 75840 0279 75842 0279 75885 0279 75889 0279 75891 0279 75893 0280 Level III Angiography and Venography 0280 36224 0280 36226 0282 Miscellaneous Computed Axial Tomography 0282 76380 0282 76497 0283 Computed Tomography with Contrast 0283 70460 0283 70481 0283 70487 0283 70491 0283 71260 0283 72126 0283 72129 0283 72132 0283 72193 0283 73201 0283 73701 0283 74160 0283 74262 0284 Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast 0284 70542 0284 70545 0284 70548 0284 70552 0284 70558 0284 71551 0284 72142 0284 72147 0284 721490284 72196

0284 73219 0284 73222 0284 73719 0284 73722 0284 74182 0284 C8900 0284 C8903 0284 C8906 0284 C8909 0284 C8912 0284 C8918 0284 C8931 0284 C8934 0288 Bone Density:Axial Skeleton 0288 77078 0288 77080 0293 Level VI Anterior Segment Eye Procedures 0293 65770 0299 Hyperthermia and Radiation Treatment Procedures 0299 77470 0299 77600 0299 77605 0299 77610 0299 77615 0299 77620 0300 Level I Radiation Therapy 0300 77401 0300 77402 0300 77403 0300 77404 0300 77406 0300 77407 0300 77789 0301 Level II Radiation Therapy 0301 77408 0301 77409 0301 77411 0301 77412 0301 77413 0301 77414 0301 77416 0301 77422 0301 77423 0301 77750 0303 Treatment Device Construction 0303 773320303 77333

0303 77334 0304 Level I Therapeutic Radiation Treatment Preparation 0304 77280 0304 77299 0304 77300 0304 77305 0304 77310 0304 77326 0304 77331 0304 77336 0304 77370 0304 77399 0305 Level II Therapeutic Radiation Treatment Preparation 0305 77285 0305 77290 0305 77315 0305 77321 0305 77327 0305 77328 0305 77338 0308 Positron Emission Tomography (PET) imaging 0308 78459 0308 78491 0308 78492 0308 78608 0308 78811 0308 78812 0308 78813 0308 78814 0308 78815 0308 78816 0310 Level III Therapeutic Radiation Treatment Preparation 0310 32553 031049411 0310 55876 0310 77295 0310 77301 0310 C9728 0312 Radioelement Applications 0312 77761 0312 77762 0312 77763 0312 77776 0312 77777 0312 77799 0313 Brachytherapy0313 0182T

0313 77785 0313 77786 0313 77787 0315 Level II Implantation of Neurostimulator Generator 0315 61886 0317 Level II Miscellaneous Radiology Procedures 0317 74320 0317 75801 0317 75803 0317 75805 0317 75807 0317 76098 0317 78071 0317 78072 0318 Implantation of Neurostimulator Pulse Generator and Electrode 0318 0283T 0318 64568 0319 Level III Endovascular Revascularization of the Lower Extremity 0319 37227 0319 37231 0320 Electroconvulsive Therapy 0320 90870 0322 Brief Individual Psychotherapy 0322 90832 0322 90899 0323 Extended Individual Psychotherapy 0323 90791 0323 90792 0323 90834 0323 90837 0323 90839 0323 90845 0323 90865 0323 90880 0324 Family Psychotherapy 0324 90846 0324 90847 0325 Group Psychotherapy 0325 90849 0325 90853 0330 Dental Procedures 0330 D0150 0330 D0240 0330 D0250 0330 D0260 0330 D02700330 D0272

0330 D0274 0330 D0277 0330 D0460 0330 D1510 0330 D1515 0330 D1520 0330 D1525 0330 D1550 0330 D2999 0330 D3460 0330 D3999 0330 D4260 0330 D4263 0330 D4264 0330 D4268 0330 D4270 0330 D4273 0330 D4355 0330 D4381 0330 D5911 0330 D5912 0330 D5983 0330 D5984 0330 D5985 0330 D5987 0330 D6920 0330 D7111 0330 D7140 0330 D7210 0330 D7220 0330 D7230 0330 D7240 0330 D7241 0330 D7250 0330 D7260 0330 D7261 0330 D7291 0330 D7940 0330 D9630 0330 D9930 0330 D9940 0330 D9950 0330 D9951 0330 D9952 0331 Combined Abdomen and Pelvis CT without Contrast 0331 741760332 Computed Tomography without Contrast

0332 70450 0332 70480 0332 70486 0332 70490 0332 71250 0332 72125 0332 72128 0332 72131 0332 72192 0332 73200 0332 73700 0332 74150 0332 74261 0333 Computed Tomography without Contrast followed by Contrast 0333 70470 0333 70482 0333 70488 0333 70492 0333 71270 0333 72127 0333 72130 0333 72133 0333 72194 0333 73202 0333 73702 0333 74170 0334 Combined Abdomen and Pelvis CT with Contrast 0334 74174 0334 74177 0334 74178 0336 Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast 0336 70336 0336 70540 0336 70544 0336 70547 0336 70551 0336 70554 0336 70555 0336 70557 0336 71550 0336 72141 0336 72146 0336 72148 0336 72195 0336 73218 0336 732210336 73718

0336 73721 0336 74181 0336 75557 0336 75559 0336 76498 0336 77084 0336 C8901 0336 C8904 0336 C8907 0336 C8910 0336 C8913 0336 C8919 0336 C8932 0336 C8935 0337 Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast f 0337 70543 0337 70546 0337 70549 0337 70553 0337 70559 0337 71552 0337 72156 0337 72157 0337 72158 0337 72197 0337 73220 0337 73223 0337 73720 0337 73723 0337 74183 0337 75561 0337 75563 0337 C8902 0337 C8905 0337 C8908 0337 C8911 0337 C8914 0337 C8920 0337 C8933 0337 C8936 0340 Minor Ancillary Procedures 0340 0126T 0340 0206T 0340 0226T 0340 0232T 0340 119800340 11981

0340 11982 0340 11983 0340 15852 0340 15860 0340 19290 0340 19295 0340 20665 0340 20979 0340 30300 034040804 034042809 034043753 034043754 034046600 0340 51701 0340 51702 0340 51736 0340 51798 0340 69200 0340 69210 0340 75571 0340 76977 0340 94644 0340 94645 0340 94780 0340 94781 0340 G0293 0340 G0294 0340 G0364 0340 G0455 0341 Skin Tests 0341 0106T 0341 0107T 0341 0108T 0341 0109T 0341 0110T 0341 86485 0341 86486 0341 86490 0341 86510 0341 86580 0342 Level I Pathology 0342 80502 0342 86077 0342 86152 0342 861530342 88160

0342 88161 0342 88177 0342 88185 0342 88199 0342 88299 0342 88300 0342 88311 0342 88321 0342 88329 0342 88332 0342 88334 0342 88363 0342 88375 0342 88399 0342 89049 0342 89240 0342 89398 0343 Level III Pathology 0343 85097 0343 88173 0343 88182 0343 88305 0343 88323 0343 88342 0343 88346 0343 88355 0343 88356 0343 88358 0343 88360 0343 88361 0343 88365 0343 88367 0343 89230 0343 89260 0343 89261 0343 89280 0344 Level IV Pathology 0344 0058T 0344 0059T 0344 88307 0344 88325 0344 88362 0344 88368 0344 89250 0344 89251 0344 892530344 89254

0344 89255 0344 89258 0344 89264 0344 89268 0344 89272 0344 89281 0344 89290 0344 89291 0344 89335 0344 89342 0344 89343 0344 89344 0344 89346 0344 89352 0344 89353 0344 89354 0344 89356 0345 Level I Transfusion Laboratory Procedures 0345 86850 0345 86891 0345 86902 0345 86904 0345 86905 0345 86906 0345 86920 0345 86921 0345 86923 0345 86927 0345 86945 0345 86950 0345 86960 0345 86970 0345 86971 0345 86972 0345 86976 0345 86985 0345 86999 0346 Level II Transfusion Laboratory Procedures 0346 86860 0346 86922 0346 86965 0346 86978 0347 Level III Transfusion Laboratory Procedures 0347 86870 0347 86890 0347 869300347 86931

0347 86932 0347 86975 0347 86977 0350 Administration of flu and PPV vaccine 0350 G0008 0350 G0009 0360 Level I Alimentary Tests 0360 91037 0360 91040 0360 91065 0360 91132 0360 91133 0360 91299 0360 95079 0361 Level II Alimentary Tests 0361 0240T 0361 0241T 0361 91010 0361 91013 0361 91020 0361 91022 0361 91030 0361 91034 0361 91035 0361 91038 0361 91112 0361 95076 0363 Level I Otorhinolaryngologic Function Tests 0363 92512 0363 92516 0363 92541 0363 92542 0363 92544 0363 92545 0363 92587 0363 92588 0364 Level I Audiometry 0364 92550 0364 92552 0364 92555 0364 92556 0364 92562 0364 92563 0364 92564 0364 92565 0364 925670364 92568

0364 92571 0364 92575 0364 92576 0364 92583 0364 92596 0364 92700 0365 Level II Audiometry 0365 0212T 0365 92553 0365 92557 0365 92561 0365 92570 0365 92579 0365 92582 0365 92620 0365 92625 0365 92640 0366 Level III Audiometry 0366 92572 0366 92577 0366 92601 0366 92602 0366 92603 0366 92604 0366 92626 0367 Level I Pulmonary Test 0367 94011 0367 94012 0367 94150 0367 94200 0367 94250 0367 94375 0367 94400 0367 94690 0367 94726 0367 94727 0367 94728 0367 94750 0367 94799 0367 95012 0368 Level II Pulmonary Tests 0368 93740 0368 94010 0368 94014 0368 94015 0368 944500368 94452

0368 94453 0368 94620 0368 94729 0368 95071 0369 Level III Pulmonary Tests 0369 0244T 0369 94013 0369 94070 0369 94621 0369 94680 0369 94681 0369 94770 0369 94772 0369 95070 0370 Multiple Allergy Tests 0370 95056 0370 95060 0370 95180 0373 Level I Neuropsychological Testing 0373 96102 0373 96103 0373 96111 0373 96120 0377 Level II Cardiac Imaging 0377 78451 0377 78452 0377 78453 0377 78454 0378 Level II Pulmonary Imaging 0378 78582 0378 78598 0381 Single Allergy Tests 0381 95004 0381 95017 0381 95018 0381 95024 0381 95027 0381 95028 0381 95044 0381 95052 0381 95065 0381 95199 0382 Level II Neuropsychological Testing 0382 96101 0382 96116 0382 961180382 96119

0383 Cardiac Computed Tomographic Imaging 0383 75572 0383 75573 0383 75574 0384 GI Procedures with Stents 038443219 038443256 038443268 038443269 038444370 038444379 038444383 038444397 038445327 038445345 038445387 0385 Level I Prosthetic Urological Procedures 0385 53440 0385 53444 0385 54400 0386 Level II Prosthetic Urological Procedures 0386 53445 0386 53447 0386 54401 0386 54405 0386 54410 0386 54416 0387 Level II Hysteroscopy 0387 58560 0387 58561 0387 58563 0388 Discography 0388 72285 0388 72295 0389 Level I Non-imaging Nuclear Medicine 0389 78012 0389 78730 0389 78999 0390 Level I Endocrine Imaging 0390 78013 0390 78099 0391 Level II Endocrine Imaging 0391 78014 0391 78070 0392 Level II Non-imaging Nuclear Medicine 0392 387920392 78190

0392 78191 0392 78270 0392 78271 0392 78272 0392 78725 0392 78808 0393 Hematologic Processing & Studies 0393 38210 0393 38211 0393 38212 0393 38213 0393 38214 0393 38215 0393 78110 0393 78111 0393 78120 0393 78121 0393 78122 0393 78130 0393 78135 0393 78140 0394 Hepatobiliary Imaging 0394 78201 0394 78202 0394 78205 0394 78206 0394 78215 0394 78216 0394 78226 0394 78227 0395 GI Tract Imaging 0395 78230 0395 78231 0395 78232 0395 78258 0395 78261 0395 78262 0395 78264 0395 78278 0395 78282 0395 78290 0395 78291 0395 78299 0396 Bone Imaging 0396 78300 0396 783050396 78306

0396 78315 0396 78320 0396 78399 0397 Vascular Imaging 0397 75898 0397 78445 0397 78456 0397 78457 0397 78458 0397 C9733 0398 Level I Cardiac Imaging 0398 78414 0398 78428 0398 78466 0398 78468 0398 78469 0398 78472 0398 78473 0398 78481 0398 78483 0398 78494 0398 78499 0400 Hematopoietic Imaging 0400 78102 0400 78103 0400 78104 0400 78185 0400 78195 0400 78199 0401 Level I Pulmonary Imaging 0401 78579 0401 78580 0401 78597 0401 78599 0402 Level II Nervous System Imaging 0402 78601 0402 78606 0402 78607 0402 78630 0402 78635 0402 78647 0402 78650 0403 Level I Nervous System Imaging 0403 78600 0403 78605 0403 786100403 78645

0403 78660 0403 78699 0404 Renal and Genitourinary Studies 0404 78700 0404 78701 0404 78707 0404 78708 0404 78709 0404 78710 0404 78740 0404 78761 0404 78799 0406 Level I Tumor/Infection Imaging 0406 78015 0406 78016 0406 78018 0406 78800 0407 Level I Radionuclide Therapy 0407 79005 0407 79101 0407 79300 0407 79445 0407 79999 0408 Level III Tumor/Infection Imaging 0408 78075 0408 78804 0409 Red Blood Cell Tests 0409 86880 0409 86885 0409 86886 0409 86900 0409 86901 0412 Level III Radiation Therapy 0412 0073T 0412 77418 0413 Level II Radionuclide Therapy 0413 79200 0413 79403 0413 79440 0414 Level II Tumor/Infection Imaging 0414 78801 0414 78802 0414 78803 0414 78805 0414 78806 0414 788070415 Level II Endoscopy Lower Airway

0415 31626 0415 31629 0415 31630 0415 31631 0415 31634 0415 31636 0415 31638 0415 31640 0415 31641 0415 31647 0415 31648 0415 31651 0415 31660 0415 31661 0419 Level II Upper GI Procedures 0419 43201 0419 43205 0419 43206 0419 43215 0419 43217 0419 43220 0419 43226 0419 43227 0419 43231 0419 43232 0419 43237 0419 43238 0419 43240 0419 43242 0419 43244 0419 43245 0419 43246 0419 43249 0419 43250 0419 43251 0419 43252 0419 43255 0419 43258 0419 43259 0419 43458 0419 44100 0419 49440 0419 49441 0419 49446 0419 91111 0422 Level III Upper GI Procedures0422 43216

0422 43228 0422 43257 0422 43830 0422 43870 0422 C9724 0423 Level II Percutaneous Abdominal and Biliary Procedures 0423 32998 042347382 042347556 0423 50592 0423 50593 0424 Level II Small Intestine Endoscopy 042444364 042444365 042444366 042444369 042444372 042444373 042444378 0425 Level II Arthroplasty or Implantation with Prosthesis 0425 23470 0425 23473 0425 24361 0425 24363 0425 24366 0425 24370 0425 24371 0425 25441 0425 25442 0425 25446 0425 27446 0425 69714 0425 69715 0425 69717 0425 69718 0426 Level II Strapping and Cast Application 0426 29010 0426 29015 0426 29035 0426 29044 0426 29046 0426 29055 0426 29065 0426 29075 0426 29305 0426 293250426 29345

0426 29355 0426 29358 0426 29365 0426 29405 0426 29425 0426 29435 0426 29445 0426 29710 0427 Level II Tube or Catheter Changes or Repositioning 042747525 042747530 042749423 042749435 042749436 0427 50387 0427 50398 0427 50688 0427 62225 0428 Level III Sigmoidoscopy and Anoscopy 0428 45307 0428 45320 0428 45321 0428 46610 0428 46612 0428 46615 0429 Level V Cystourethroscopy and other Genitourinary Procedures 0429 50080 0429 50081 0429 52647 0429 52648 0429 52649 0429 53850 0429 53852 0432 Level II Health and Behavior Services 0432 96150 0432 96151 0432 96152 0432 96154 0432 G0396 0432 G0397 0432 G0437 0432 G0442 0432 G0443 0432 G0444 0432 G0445 0432 G04460432 G0447

0432 G0451 0433 Level II Pathology 0433 80500 0433 86078 0433 86079 0433 88104 0433 88106 0433 88108 0433 88112 0433 88125 0433 88162 0433 88172 0433 88184 0433 88187 0433 88188 0433 88189 0433 88302 0433 88304 0433 88312 0433 88313 0433 88314 0433 88319 0433 88331 0433 88333 0433 88347 0433 89220 0433 89257 0433 89259 0434 Cardiac Defect Repair 0434 93580 0434 93581 0436 Level I Drug Administration 0436 90472 0436 90473 0436 90474 0436 95115 0436 95117 0436 95145 0436 95165 0436 96361 0436 96366 0436 96379 0436 96549 0436 G0010 0437 Level II Drug Administration 0437 904710437 95144

0437 95148 0437 95149 0437 95170 0437 96367 0437 96370 0437 96371 0437 96372 0437 96373 0437 96374 0437 96375 0437 96401 0437 96402 0437 96405 0437 96415 0438 Level III Drug Administration 0438 95146 0438 95147 0438 96360 0438 96411 0438 96417 0438 96420 0438 96423 0438 96542 0439 Level IV Drug Administration 0439 95990 0439 95991 0439 96365 0439 96369 0439 96406 0439 96409 0439 96440 0439 96446 0439 96521 0439 96522 0440 Level V Drug Administration 0440 96413 0440 96416 0440 96422 0440 96425 0440 96450 0440 C8957 0442 Dosimetric Drug Administration 0442 G3001 0604 Level 1 Hospital Clinic Visits 0604 99201 0604 992110604 G0101

0604 G0245 0604 G0246 0605 Level 2 Hospital Clinic Visits 0605 92012 0605 92014 0605 99202 0605 99212 0605 99213 0605 99460 0605 99463 0605 99495 0606 Level 3 Hospital Clinic Visits 0606 92002 0606 92004 0606 95250 0606 99203 0606 99214 0606 99496 0606 G0402 0606 M0064 0607 Level 4 Hospital Clinic Visits 0607 99204 0607 99215 0607 G0248 0607 G0249 0608 Level 5 Hospital Clinic Visits 0608 90945 0608 99205 0608 G0175 0608 G0379 0609 Level 1 Type A Emergency Visits 0609 99281 0613 Level 2 Type A Emergency Visits 0613 99282 0614 Level 3 Type A Emergency Visits 0614 99283 0615 Level 4 Type A Emergency Visits 0615 99284 0616 Level 5 Type A Emergency Visits 0616 99285 0617 Critical Care 0617 99291 0618 Trauma Response with Critical Care 0618 G0390 0621 Level I Vascular Access Procedures 0621 365550621 36556

0621 36568 0621 36569 0621 36576 0621 36580 0621 36584 0621 36590 0621 36596 0621 36597 0621 37211 0621 37212 0622 Level II Vascular Access Procedures 0622 36557 0622 36558 0622 36570 0622 36571 0622 36578 0622 36581 0622 36585 0622 36595 0622 37213 0622 37214 0623 Level III Vascular Access Procedures 0623 36260 0623 36560 0623 36561 0623 36563 0623 36565 0623 36566 0623 36582 0623 36583 0623 36640 0623 37192 0623 37193 0623 37197 0623 37200 0624 Phlebotomy and Minor Vascular Access Device Procedures 0624 36591 0624 36592 0624 37799 0624 96523 0624 99195 0626 Level 1 Type B Emergency Visits 0626 G0380 0627 Level 2 Type B Emergency Visits 0627 G0381 0628 Level 3 Type B Emergency Visits0628 G0382

0629 Level 4 Type B Emergency Visits 0629 G0383 0630 Level 5 Type B Emergency Visits 0630 G0384 0648 Level IV Breast Surgery 0648 19296 0648 19297 0648 19298 0648 19325 0648 19342 0648 19357 0651 Complex Interstitial Radiation Source Application 0651 77778 0652 Insertion of Intraperitoneal and Pleural Catheters 0652 32550 0652 49418 0652 49421 0653 Vascular Reconstruction/Fistula Repair with Device 0653 35011 0653 35261 0653 35266 0653 35286 0653 36870 0654 Level II Insertion/Replacement of Permanent Pacemaker 0654 33213 0654 33221 0654 33228 0654 33229 0655 Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker or Pacing 0655 33208 0655 33214 0655 33224 0655 33225 0656 Transcatheter Placement of Intracoronary Drug-Eluting Stents 0656 C9600 0656 C9601 0656 C9602 0656 C9603 0656 C9604 0656 C9605 0656 C9606 0656 C9607 0656 C9608 0659 Hyperbaric Oxygen 0659 C1300 0660 Level II Otorhinolaryngologic Function Tests0660 92520

0660 92540 0660 92543 0660 92546 0660 92548 0661 Level V Pathology 0661 88120 0661 88121 0661 88309 0661 88348 0661 88349 0661 G0416 0661 G0417 0661 G0418 0661 G0419 0662 CT Angiography 0662 70496 0662 70498 0662 71275 0662 72191 0662 73206 0662 73706 0662 74175 0662 75635 0664 Level I Proton Beam Radiation Therapy 0664 77520 0664 77522 0665 Bone Density:AppendicularSkeleton 0665 77081 0667 Level II Proton Beam Radiation Therapy 0667 77523 0667 77525 0668 Level I Angiography and Venography 0668 36147 0668 75746 0668 75756 0668 75791 0668 75820 0668 75822 0668 75827 0668 75860 0668 75870 0668 75872 0668 75880 0668 75887 0672 Level III Posterior Segment Eye Procedures 0672 0100T0672 65285

0672 66220 0672 67010 0672 67015 0672 67025 0672 67027 0672 67036 0672 67039 0672 67040 0672 67041 0672 67042 0672 67043 0672 67107 0672 67108 0672 67112 0672 67113 0672 67121 0673 Level V Anterior Segment Eye Procedures 0673 0191T 0673 0192T 0673 0253T 0673 65930 0673 66155 0673 66174 0673 66175 0673 66180 0673 66185 0673 66225 0673 66605 0674 Prostate Cryoablation 0674 55873 0676 Thrombolysis and Other Device Revisions 0676 36593 0676 36598 0676 36860 0676 37195 067643760 0676 92977 0678 External Counterpulsation 0678 G0166 0679 Level II Resuscitation and Cardioversion 0679 92960 0679 92961 0680 Insertion of Patient Activated Event Recorders 0680 33282 0683 Level II Photochemotherapy 0683 969130685 Level III Needle Biopsy/Aspiration Except Bone Marrow

0685 32400 0685 32405 0685 47000 0685 48102 0685 49180 0685 50200 0685 50390 0685 62269 0687 Revision/Removal of Neurostimulator Electrodes 0687 0267T 0687 0270T 0687 0284T 0687 0313T 0687 61880 0687 63661 0687 63662 0687 64585 0688 Revision/Removal of Neurostimulator Pulse Generator Receiver 0688 0271T 0688 0314T 0688 0315T 0688 61888 0688 63688 0688 64595 0690 Level I Electronic Analysis of Devices 0690 0224T 0690 0225T 0690 0305T 0690 0306T 0690 0317T 0690 0327T 0690 0328T 0690 93279 0690 93280 0690 93281 0690 93282 0690 93283 0690 93284 0690 93285 0690 93288 0690 93289 0690 93291 0690 93292 0690 93293 0690 93296 0690 932990690 93724

0690 93745 0691 Level III Electronic Analysis of Devices 0691 62252 0691 62367 0691 62368 0691 62369 0691 62370 0692 Level II Electronic Analysis of Devices 0692 93271 0692 93750 0692 95971 0692 95972 0692 95974 0692 95978 0692 95979 0692 95982 0694 Mohs Surgery 0694 17311 0694 17312 0694 17313 0694 17314 0694 17315 0697 Level I Echocardiogram Without Contrast 0697 76825 0697 76826 0697 93308 0698 Level II Eye Tests & Treatments 0698 0198T 0698 65205 0698 65210 0698 65220 0698 65222 0698 65430 0698 67820 0698 68040 0698 68801 0698 92083 0698 92136 0698 92230 0698 92286 0698 92287 0698 92311 0698 92313 0698 92315 0698 92316 0698 923250698 92352

0698 92353 0698 92371 0698 G0117 0699 Level IV Eye Tests & Treatments 0699 67346 0699 68110 0699 92018 0699 92019 0701 Sr89 strontium 0701 A9600 0726 Dexrazoxane HCl injection 0726J1190 0728 Filgrastim 300 mcg injection 0728J1440 0731 Sargramostim injection 0731 J2820 0735 Ampho b cholesteryl sulfate 0735J0288 0736 Amphotericin b liposome inj 0736J0289 0738 Rasburicase 0738J2783 0747 Chlorothiazide sodium inj 0747J1205 0751 Mechlorethamine hcl inj 0751 J9230 0752 Dactinomycin injection 0752 J9120 0759 Naltrexone, depot form 0759J2315 0800 Leuprolide acetate 0800J1950 0802 Etoposide oral 0802 J8560 0807 Aldesleukin injection 0807J9015 0809 Bcg live intravesical vac 0809J9031 0810 Goserelin acetate implant 0810J9202 0812 Carmustine injection 0812 J9050 0814 Asparaginase injection 0814J9020 0820 Daunorubicin injection 0820J91500821 Daunorubicin citrate inj

0821 J9151 0823 Docetaxel injection 0823J9171 0825 Nelarabine injection 0825J9261 0827 Floxuridine injection 0827J9200 0828 Gemcitabine hcl injection 0828J9201 0831 Ifosfamide injection 0831 J9208 0832 Idarubicin hcl injection 0832 J9211 0835 Cosyntropin injection NOS 0835J0833 0836 Interferon alfa-2b inj 0836J9214 0838 Interferon gamma 1-b inj 0838J9216 0840 Inj melphalan hydrochl 0840J9245 0842 Fludarabine phosphate inj 0842 J9185 0843 Pegaspargase injection 0843J9266 0844 Pentostatin injection 0844J9268 0849 Rituximab injection 0849J9310 0850 Streptozocin injection 0850J9320 0851 Thiotepa injection 0851 J9340 0856 Porfimer sodium injection 0856J9600 0858 Inj cladribine 0858J9065 0861 Leuprolide acetate injeciton 0861 J9218 0864 Mitoxantrone hydrochl 0864J9293 0868 Oral aprepitant 0868J8501 0873 Hyalgan/supartz inj per dose 0873J7321 0874 Synvisc or synvisc-one0874J7325

0875 Euflexxa inj per dose 0875J7323 0877 Orthovisc inj per dose 0877J7324 0884 Rho d immune globulin inj 0884J2790 0887 Azathioprine parenteral 0887J7501 0890 Lymphocyte immune globulin 0890J7504 0900 Alglucerase injection 0900J0205 0901 Alpha 1 proteinase inhibitor 0901 J0256 0902 Injection,onabotulinumtoxinA 0902 J0585 0903 Cytomegalovirus imm IV /vial 0903J0850 0910 Interferon beta-1b / .25 MG 0910J1830 0913 Ganciclovir long act implant 0913J7310 0917 Adenosine injection 0917J0152 0925 Factor viii 0925J7190 0927 Factor viii recombinant 0927J7192 0928 Factor ix complex 0928J7194 0929 Anti-inhibitor 0929J7198 0931 Factor IX non-recombinant 0931 J7193 0932 Factor IX recombinant 0932 J7195 0933 Gamma globulin > 10 CC inj 0933J1560 0934 Capecitabine, oral 0934J8521 0943 Octagam injection 0943J1568 0944 Gammagard liquid injection 0944J1569 0945 Rhophylac injection 0945J27910946 Hepagam b im injection

0946J1571 0947 Flebogamma injection 0947J1572 0948 Gamunex, Gamunex-C, Gammaked 0948J1561 0949 Frozen plasma, pooled, sd 0949 P9023 0950 Whole blood for transfusion 0950 P9010 0951 Reclast injection 0951 J3488 0952 Cryoprecipitate each unit 0952 P9012 0954 RBC leukocytes reduced 0954 P9016 0955 Plasma, frz between 8-24hour 0955 P9059 0956 Plasma protein fract,5%,50ml 0956 P9043 0957 Platelets, each unit 0957 P9019 0958 Plaelet rich plasma unit 0958 P9020 0959 Red blood cells unit 0959 P9021 0960 Washed red blood cells unit 0960 P9022 0961 Albumin (human),5%, 50ml 0961 P9041 0963 Albumin (human), 5%, 250 ml 0963 P9045 0964 Albumin (human), 25%, 20 ml 0964 P9046 0965 Albumin (human), 25%, 50ml 0965 P9047 0966 Plasmaprotein fract,5%,250ml 0966 P9048 0967 Blood split unit 0967 P9011 0968 Platelets leukoreduced irrad 0968 P9033 0969 RBC leukoreduced irradiated 0969 P9040 1009 Cryoprecipitatereducedplasma 1009 P9044 1010 Blood, l/r, cmv-neg1010 P9051

1011 Platelets, hla-m, l/r, unit 1011 P9052 1013 Platelets leukocytes reduced 1013 P9031 1015 Injection glatiramer acetate 1015J1595 1016 Blood, l/r, froz/degly/wash 1016 P9054 1017 Plt, aph/pher, l/r, cmv-neg 1017 P9055 1018 Blood, l/r, irradiated 1018 P9056 1019 Plate pheres leukoredu irrad 1019 P9037 1020 Plt, pher, l/r cmv-neg, irr 1020 P9053 1021 RBC, frz/deg/wsh, l/r, irrad 1021 P9057 1022 RBC, l/r, cmv-neg, irrad 1022 P9058 1023 Pralidoxime chloride inj 1023J2730 1052 Injection, voriconazole 1052 J3465 1064 I131 iodide cap, rx 1064A9517 1083 Adalimumab injection 1083J0135 1084 Denileukin diftitox inj 1084J9160 1086 Temozolomide 1086J8700 1138 Hepagam b intravenous, inj 1138J1573 1139 Protein c concentrate 1139J2724 1142 Supprelin LA implant 1142 J9226 1150 I131 iodide sol, rx 1150A9530 1166 Cytarabine liposome inj 1166J9098 1167 Inj, epirubicin hcl 1167J9178 1168 Inj, temsirolimus 1168J93301178 Busulfan injection

1178J0594 1203 Verteporfin injection 1203J3396 1207 Octreotide injection, depot 1207J2353 1213 Antihemophilic viii/vwf comp 1213J7186 1214 Inj IVIG privigen 500 mg 1214J1459 1221 Dimethyl sulfoxide 50% 1221 J1212 1232 Mitomycin 5 MG inj 1232 J9280 1235 Valrubicin injection 1235J9357 1236 Levoleucovorin injection 1236J0641 1237 Inj iron dextran 1237J1750 1238 Topotecan oral 1238J8705 1239 Rotavirus vacc 2 dose oral 1239 90681 1240 Apligraf skin sub 1240 Q4101 1241 Oasis wound matrix skin sub 1241 Q4102 1242 Oasis burn matrix skin sub 1242 Q4103 1243 Integra BMWD skin sub 1243 Q4104 1244 Integra DRT 1244 Q4105 1245 Dermagraft skin sub 1245 Q4106 1246 Graftjacket skin sub 1246 Q4107 1247 Integra matrix skin sub 1247 Q4108 1248 Primatrix skin sub 1248 Q4110 1249 Cymetra allograft 1249 Q4112 1250 Graftjacket express allograf 1250 Q4113 1251 Integra flowable wound matri1251 Q4114

1252 Gammagraft skin sub 1252 Q4111 1253 Triamcinolone A inj PRS-free 1253J3300 1263 Antithrombin iii injection 1263J7197 1268 Xyntha inj 1268J7185 1270 Alloderm skin sub 1270 Q4116 1272 Acetylcysteine injection 1272 J0132 1274 Edetate calcium disodium inj 1274J0600 1275 Vivaglobin, inj 1275J1562 1280 Corticotropin injection 1280J0800 1281 Bevacizumab injection 1281 C9257 1287 Alloskin skin sub 1287 Q4115 1289 AbobotulinumtoxinA 1289J0586 1291 Rilonacept injection 1291 J2793 1295 Sm 153 lexidronam 1295A9604 1296 Degarelix injection 1296J9155 1297 Ferumoxytol, non-esrd 1297 Q0138 1307 Oral busulfan 1307J8510 1311 Canakinumab injection 1311 J0638 1312 Hizentra injection 1312 J1559 1327 Imiglucerase injection 1327J1786 1331 Olanzapine long-acting inj 1331 J2358 1332 Antithrombin recombinant 1332 J7196 1338 Methyl aminolevulinate, top 1338J73091339 Oral fludarabine phosphate

1339J8562 1340 Collagenase, clost hist inj 1340J0775 1341 Amobarbital 125 MG inj 1341 J0300 1342 Matristem micromatrix 1342 Q4118 1343 Ganciclovir sodium injection 1343J1570 1344 Gonadorelin hydroch/ 100 mcg 1344J1620 1345 Theraskin 1345 Q4121 1347 Oxacillin sodium injeciton 1347J2700 1349 Anidulafungin injection 1349J0348 1350 Topotecan injection 1350J9351 1351 Matristem wound matrix 1351 Q4119 1352 Wilate injection 1352 J7183 1353 Belimumab injection 1353J0490 1354 Hydroxyprogesterone caproate 1354J1725 1355 Itraconazole injection 1355J1835 1357 Inj protirelin per 250 mcg 1357J2725 1361 Enfuvirtide injection 1361 J1324 1408 Cyclophosphamide 100 MG inj 1408J9070 1413 Lumizyme injection 1413J0221 1414 Human fibrinogen conc inj 1414J7178 1415 Glassia injection 1415J0257 1416 Factor XIII anti-hem factor 1416J7180 1417 Gel-one 1417J7326 1419 Dermacell1419 Q4122

1420 Aflibercept injection 1420J0178 1421 Imported Lipodox inj 1421 Q2049 1422 Anthrax vaccine sc or im 1422 90581 1423 Minocycline hydrochloride 1423J2265 1424 Nabilone oral 1424J8650 1426 Eribulin mesylate injection 1426J9179 1427 Alloskin 1427 Q4123 1428 Arthroflex 1428 Q4125 1429 Flexhd or allopatch hd 1429 Q4128 1430 Unite biomatrix 1430 Q4129 1431 Centruroides immune f(ab) 1431 J0716 1432 Arbutamine hcl injection 1432 J0395 1433 Calcitonin salmon injection 1433J0630 1434 Testosterone enanthate inj 1434J0900 1435 Injection estrone per 1 MG 1435J1435 1437 Gatifloxacin injection 1437J1590 1438 Diazoxide injection 1438J1730 1439 Aprotonin, 10,000 kiu 1439J0365 1440 Inj desmopressin acetate 1440J2597 1441 Intraocular Fomivirsen na 1441 J1452 1442 Non-HEU TC-99M add-on/dose 1442 Q9969 1443 Icatibant injection 1443J1744 1444 Oral everolimus 1444J75271445 Methylnaltrexone injection

1445J2212 1446 Visualization adjunct 1446 Q9968 1447 Interferon alfacon-1 inj 1447J9212 1605 Abciximab injection 1605J0130 1607 Eptifibatide injection 1607J1327 1608 Etanercept injection 1608J1438 1609 Rho(D) immune globulin h, sd 1609J2792 1612 Daclizumab, parenteral 1612 J7513 1613 Trastuzumab injection 1613J9355 1630 Hep b ig, im 1630 90371 1631 Baclofen intrathecal trial 1631 J0476 1633 Alefacept 1633J0215 1643 Y90 ibritumomab, rx 1643A9543 1645 I131 tositumomab, rx 1645A9545 1670 Tetanus immune globulin inj 1670J1670 1675 P32 Na phosphate 1675A9563 1676 P32 chromic phosphate 1676A9564 1683 Basiliximab 1683J0480 1684 Corticorelin ovine triflutal 1684J0795 1685 Darbepoetin alfa, non-esrd 1685J0881 1686 Epoetin alfa, non-esrd 1686J0885 1687 Digoxin immune fab (ovine) 1687J1162 1688 Ethanolamine oleate 1688J1430 1689 Fomepizole1689J1451

1690 Hemin 1690J1640 1693 Lepirudin 1693J1945 1694 Ziconotide injection 1694J2278 1695 Nesiritide injection 1695J2325 1696 Palifermin injection 1696J2425 1697 Pegaptanib sodium injection 1697J2503 1700 Inj secretin synthetic human 1700J2850 1701 Treprostinil injection 1701 J3285 1704 Humate-P, inj 1704J7187 1705 Factor viia 1705J7189 1709 Azacitidine injection 1709J9025 1710 Clofarabine injection 1710J9027 1711 Vantas implant 1711 J9225 1712 Paclitaxel protein bound 1712 J9264 1716 Brachytx, non-str, Gold-198 1716 C1716 1717 Brachytx, non-str, HDR Ir-192 1717 C1717 1719 Brachytx, NS, Non-HDRIr-192 1719 C1719 1738 Oxaliplatin 1738J9263 1739 Pegademase bovine, 25 iu 1739J2504 1741 Urofollitropin, 75 iu 1741 J3355 1830 Power bone marrow bx needle 1830 C1830 1840 Telescopic intraocular lens 1840 C1840 1886 Catheter, ablation 1886 C18862210 Methyldopate hcl injection

2210J0210 2616 Brachytx, non-str,Yttrium-90 2616 C2616 2632 Iodine I-125 sodium iodide 2632A9527 2634 Brachytx, non-str, HA, I-125 2634 C2634 2635 Brachytx, non-str, HA, P-103 2635 C2635 2636 Brachy linear, non-str,P-103 2636 C2636 2638 Brachytx, stranded, I-125 2638 C2638 2639 Brachytx, non-stranded,I-125 2639 C2639 2640 Brachytx, stranded, P-103 2640 C2640 2641 Brachytx, non-stranded,P-103 2641 C2641 2642 Brachytx, stranded, C-131 2642 C2642 2643 Brachytx, non-stranded,C-131 2643 C2643 2698 Brachytx, stranded, NOS 2698 C2698 2699 Brachytx, non-stranded, NOS 2699 C2699 2731 Immune globulin, powder 2731 J1566 2770 Quinupristin/dalfopristin 2770J2770 3041 Bivalirudin 3041 J0583 3043 Gamma globulin 1 CC inj 3043J1460 3050 Sermorelin acetate injection 3050 Q0515 7000 Amifostine 7000J0207 7011 Oprelvekin injection 7011 J2355 7034 Somatropin injection 7034J2941 7035 Teniposide 7035 Q2017 7036 Urokinase 250,000 IU inj7036J3365

7038 Monoclonal antibodies 7038J7505 7041 Tirofiban HCl 7041 J3246 7042 Capecitabine, oral 7042 J8520 7043 Infliximab injection 7043J1745 7046 Doxil injection 7046J9002 7048 Alteplase recombinant 7048J2997 7049 Filgrastim 480 mcg injection 7049J1441 7051 Leuprolide acetate implant 7051 J9219 7308 Aminolevulinic acid hcl top 7308J7308 8000 Cardiac Electrophysiologic Evaluation and Ablation Composite 8000 93653 8000 93654 8000 93656 9001 Linezolid injection 9001 J2020 9002 Tenecteplase injection 9002 J3101 9003 Palivizumab 9003 90378 9004 Gemtuzumab ozogamicin inj 9004J9300 9005 Reteplase injection 9005J2993 9006 Tacrolimus injection 9006J7525 9012 Arsenic trioxide injection 9012 J9017 9018 Inj, rimabotulinumtoxinB 9018J0587 9019 Caspofungin acetate 9019J0637 9022 IM inj interferon beta 1-a 9022 Q3025 9023 Rho d immune globulin 9023J2788 9024 Amphotericin b lipid complex 9024J02879032 Baclofen 10 MG injection

9032 J0475 9033 Cidofovir injection 9033J0740 9038 Inj estrogen conjugate 9038J1410 9042 Glucagon hydrochloride 9042 J1610 9044 Ibutilide fumarate injection 9044J1742 9104 Antithymocyte globuln rabbit 9104J7511 9108 Thyrotropin injection 9108J3240 9110 Alemtuzumab injection 9110J9010 9115 Zoledronic acid 9115J3487 9119 Injection, pegfilgrastim 6mg 9119J2505 9120 Injection, Fulvestrant 9120J9395 9121 Injection, argatroban 9121 C9121 9122 Triptorelin pamoate 9122 J3315 9124 Daptomycin injection 9124J0878 9125 Risperidone, long acting 9125J2794 9126 Natalizumab injection 9126J2323 9133 Rabies ig, im/sc 9133 90375 9134 Rabies ig, heat treated 9134 90376 9135 Varicella-zoster ig, im 9135 90396 9137 Bcg vaccine, percut 9137 90585 9139 Rabies vaccine, im 9139 90675 9140 Rabies vaccine, id 9140 90676 9143 Meningococcal vaccine, sc 9143 90733 9144 Encephalitis vaccine, sc9144 90735

9145 Meningococcal vaccine, im 9145 90734 9207 Bortezomib injection 9207J9041 9208 Agalsidase beta injection 9208J0180 9209 Laronidase injection 9209J1931 9210 Palonosetron hcl 9210J2469 9213 Pemetrexed injection 9213J9305 9214 Bevacizumab injection 9214J9035 9215 Cetuximab injection 9215J9055 9217 Leuprolide acetate suspnsion 9217J9217 9224 Galsulfase injection 9224J1458 9225 Fluocinolone acetonide implt 9225J7311 9227 Micafungin sodium injection 9227J2248 9228 Tigecycline injection 9228J3243 9229 Ibandronate sodium injection 9229J1740 9230 Abatacept injection 9230J0129 9231 Decitabine injection 9231 J0894 9232 Idursulfase injection 9232 J1743 9233 Ranibizumab injection 9233J2778 9234 Alglucosidase alfa injection 9234J0220 9235 Panitumumab injection 9235J9303 9236 Eculizumab injection 9236J1300 9237 Inj, lanreotide acetate 9237J1930 9240 Injection, ixabepilone 9240J92079242 Injection, fosaprepitant

9242 J1453 9243 Bendamustine injection 9243J9033 9244 Regadenoson injection 9244J2785 9245 Romiplostim injection 9245J2796 9248 Inj, clevidipine butyrate 9248 C9248 9249 Certolizumab pegol inj 9249J0718 9250 Artiss fibrin sealant 9250 C9250 9251 C1 esterase inhibitor inj 9251 J0598 9252 Plerixafor injection 9252 J2562 9253 Temozolomide injection 9253J9328 9255 Paliperidone palmitate inj 9255J2426 9256 Dexamethasone intra implant 9256J7312 9258 Telavancin injection 9258J3095 9259 Pralatrexate injection 9259J9307 9260 Ofatumumab injection 9260J9302 9261 Ustekinumab injection 9261 J3357 9263 Ecallantide injection 9263J1290 9264 Tocilizumab injection 9264J3262 9265 Romidepsin injection 9265J9315 9268 Capsaicin 8% patch 9268J7335 9269 C-1 esterase, berinert 9269J0597 9270 Gammaplex IVIG 9270J1557 9271 Velaglucerase alfa 9271 J3385 9272 Inj, denosumab9272 J0897

9273 Sipuleucel-T auto CD54+ 9273 Q2043 9274 Crotalidae Poly Immune Fab 9274J0840 9276 Cabazitaxel injection 9276J9043 9278 Incobotulinumtoxin A 9278J0588 9281 Injection, pegloticase 9281 J2507 9282 Inj, ceftaroline fosamil 9282 J0712 9283 Injection, acetaminophen 9283J0131 9284 Ipilimumab injection 9284J9228 9285 Patch, lidocaine/tetracaine 9285 C9285 9286 Belatacept injection 9286J0485 9287 Brentuximab vedotin inj 9287J9042 9289 Erwinaze injection 9289J9019 9290 Inj, bupivacaine liposome 9290 C9290 9292 Injection, pertuzumab 9292 C9292 9293 Injection, glucarpidase 9293 C9293 9294 Inj, taliglucerase alfa 9294 C9294 9295 Injection, carfilzomib 9295 C9295 9296 Injection, ziv-aflibercept 9296 C9296 9300 Omalizumab injection 9300J2357 9358 SurgiMend, fetal 9358 C9358 9360 SurgiMend, neonatal 9360 C9360 9363 Integra Meshed Bil Wound Mat 9363 C9363 9365 Oasis tri-layer wound matrix 9365 Q41249366 Epifix

9366 Q4131 9367 Endoform Dermal Template 9367 C9367 9368 Grafix core 9368 Q4132 9369 Grafix prime 9369 Q4133 9406 Iodine I-123 ioflupane 9406A9584 9500 Platelets, irradiated 9500 P9032 9501 Platelet pheres leukoreduced 9501 P9035 9502 Platelet pheresis irradiated 9502 P9036 9503 Fr frz plasma donor retested 9503 P9060 9504 RBC deglycerolized 9504 P9039 9505 RBC irradiated 9505 P9038 9506 Granulocytes, pheresis unit 9506 P9050 9507 Platelets, pheresis 9507 P9034 9508 Plasma 1 donor frz w/in 8 hr 9508 P9017Addendum C. - Final HCPCS Codes Payable Under the 2013 OPPS by APC

Short Descriptor SIRelative Weight Payment

Rate National

Unadjusted Copayment S 0.5210 $37.15

. Ultraviolet light therapy Photochemotherapy with UV-B Photochemotherapy with UV-A T 1.7194 $122.62

. Fna w/o image Drain breast lesion add-on Insert needle bone cavity T 3.7917 $270.40

. Bone marrow aspiration Bone marrow biopsy T 4.8451 $345.52

. Fna w/image Drainage of breast lesion Bx breast percut w/o image Treatment of bone cyst Liver surgery procedure Pancreas surgery procedure Biopsy of epididymis Drainage of hydrocele Biopsy of thyroid Aspir/inj thyroid cyst Interdiscal perq aspir dx T 8.7675 $625.24

. Bx breast percut w/image Needle biopsy muscle Needle biopsy lymph nodes Biopsy of salivary gland T 1.7592 $125.45

. Drainage of skin abscess Drainage of skin abscess Drainage of pilonidal cyst Puncture drainage of lesion Fluid pressure muscle Revision of neck muscle Drainage of finger abscess Drainage of mouth lesion Drainage of gum lesion Drain external ear lesion Drain outer ear canal lesioT 10.1746 $725.58

.

Drainage of pilonidal cyst Drainage of hematoma/fluid Explore wound extremity Drainage of arm bursa Drainage of finger abscess Drainage of bursa of foot Drainage lymph node lesion Drainage of scrotum abscess I & d vaginal hematoma pp Drain external ear lesion T 18.4976$1,319.12

. Complex drainage wound Incision of breast lesion Drain neck/chest lesion Drain shoulder lesion Drain shoulder bursa Drainage of arm lesion Drain thigh/knee lesion Drain lower leg lesion Drainage lymph node lesion Drainage of bladder abscess Drain penis lesion Treatment of penis lesion I & d vag hematoma non-ob T 0.3982 $28.40

. Trim nail(s) any number Drain blood from under nail Destruct premalg les 2-14 Skin tissue procedure Dermatological procedure Trim nail(s) T 1.0032 $71.54

. Wound ultrasound Acne surgery Debride infected skin add-o Trim skin lesion Trim skin lesions 2 to 4 Biopsy skin add-on Removal of skin tags <w/15 Remove skin tags add-on Shave skin lesion 0.5 cm/< Shave skin lesion 0.6-1.0 c Shave skin lesion 1.1-2.0 c Shave skin lesion 0.5 cm/< Shave skin lesion 0.6-1.0 c Shave skin lesion 1.1-2.0 cShave skin lesion 0.5 cm/<

Shave skin lesion 0.6-1.0 c Debride nail 1-5 Debride nail 6 or more Removal of nail plate Remove nail plate add-on Excision of nail fold toe Inject skin lesions </w 7 Inject skin lesions >7 Abrasion lesion single Abrasion lesions add-on Chemical peel face epiderm Chemical peel nonfacial Initial treatment of burn(s Destruct premalg lesion Destruct b9 lesion 1-14 Cryotherapy of skin Injection(s) spider veins Cryosurgery penis lesion(s) Clean out mastoid cavity Wound(s) care non-selective Neg press wound tx </=50 cm Routine footcare pt w lops T 1.4998 $106.96

. Trim skin lesions over 4 Biopsy skin lesion Shave skin lesion >2.0 cm Shave skin lesion >2.0 cm Shave skin lesion 1.1-2.0 c Shave skin lesion >2.0 cm Chemical peel face dermal Chemical peel nonfacial Dress/debrid p-thick burn s Dress/debrid p-thick burn m Dress/debrid p-thick burn l Incision of burn scab initi Destruct lesion 15 or more Chemical cautery tissue Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesionsSkin peel therapy

Hair removal by electrolysi Injection(s) spider veins Injection therapy of vein Injection therapy of veins Treatment of rectal prolaps Cryosurgery anal lesion(s) Destruction penis lesion(s) Photodynamic tx skin Photodynmc tx 30 min add-on Photodynamic tx addl 15 min Laser tx skin < 250 sq cm Laser tx skin 250-500 sq cm Laser tx skin >500 sq cm Rmvl devital tis 20 cm/< Rmvl devital tis addl 20cm/ Neg press wound tx >50 cm T 2.9399 $209.65

. Remove foreign body Debride infected skin Deb subq tissue 20 sq cm/< Deb musc/fascia 20 sq cm/< Deb subq tissue add-on Deb musc/fascia add-on Dermabrasion suprfl any sit Remove sutures same surgeon Remove sutures diff surgeon Destroy premal lesions 15/> Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction anal lesion(s) Neg pre wound <50 sq cm Neg pres wound >50 sq cm T 19.8814$1,417.80

. Destruction anal lesion(s) Laser surgery anal lesions Excision of anal lesion(s)Destruction anal lesion(s)

Destruction penis lesion(s) Laser surg penis lesion(s) Excision of penis lesion(s) Destruction penis lesion(s) Destroy vulva lesions sim Destroy vulva lesion/s comp T 4.7170 $336.38

. Debride skin at fx site Debride skin musc at fx sit Deb skin bone at fx site Deb bone add-on Exc tr-ext b9+marg 0.5 cm< Exc tr-ext b9+marg 0.6-1 cm Exc tr-ext b9+marg 1.1-2 cm Exc face-mm b9+marg 0.5 cm/ Exc face-mm b9+marg 0.6-1 c Exc tr-ext mal+marg 0.6-1 c Exc tr-ext mal+marg 1.1-2 c Exc s/n/h/f/g mal+mrg 0.6-1 Exc f/e/e/n/l mal+mrg 0.5cm Exc f/e/e/n/l mal+mrg 0.6-1 Exc f/e/e/n/l mal+mrg 1.1-2 Removal of nail bed Biopsy nail unit Remove contraceptive capsul Dermabrasion segmental face Dermabrasion other than fac Removal of tail bone ulcer Removal of pressure sore Removal of foreign body Removal of arm foreign body Biopsy of floor of mouth T 8.1838 $583.61

. Deb bone 20 sq cm/< Exc tr-ext b9+marg 2.1-3cm/ Exc h-f-nk-sp b9+marg 0.5/< Exc h-f-nk-sp b9+marg 0.6-1 Exc h-f-nk-sp b9+marg 1.1-2 Exc face-mm b9+marg 1.1-2 c Exc face-mm b9+marg 2.1-3 c Exc face-mm b9+marg 3.1-4 c Exc tr-ext mal+marg 0.5 cm/ Exc tr-ext mal+marg 2.1-3 c Exc tr-ext mal+marg 3.1-4 c Exc h-f-nk-sp mal+marg 0.5/ Exc s/n/h/f/g mal+mrg 1.1-2Exc s/n/h/f/g mal+mrg 2.1-3

Exc f/e/e/n/l mal+mrg 2.1-3 I&d abscess subfascial Bone biopsy trocar/needle Exc face les sc <2 cm Exc face les sbq 2 cm/< Exc face tum deep < 2 cm Exc face tum deep 2 cm/> Biopsy soft tissue of back Biopsy shoulder tissues Remove shoulder foreign bod Biopsy forearm soft tissues Biopsy of soft tissues Biopsy of soft tissues Remove hip foreign body Biopsy thigh soft tissues Biopsy lower leg soft tissu Removal of foot foreign bod Removal of foot foreign bod Remove pat-active ht record Repair blood vessel lesion T 15.7299$1,121.75

. Remove foreign body Exc tr-ext b9+marg 3.1-4 cm Exc tr-ext b9+marg >4.0 cm Exc h-f-nk-sp b9+marg 2.1-3 Exc h-f-nk-sp b9+marg 3.1-4 Exc tr-ext mal+marg >4 cm Exc s/n/h/f/g mal+mrg 3.1-4 Exc f/e/e/n/l mal+mrg 3.1-4 Excise excessive skin arm Excise excess skin arm/hand Excise excess skin fat pad Excise excess skin & tissue Removal of chest wall lesio Muscle biopsy Deep muscle biopsy Bone biopsy trocar/needle Removal of support implant Resect face tum < 2 cm Biopsy of neck/chest Exc neck les sc < 3 cm Resect neck tum < 5 cm Exc back les sc < 3 cm Exc back tum deep < 5 cm Resect back tum < 5 cm Exc abd les sc < 3 cmResect abd tum < 5 cm

Removal of calcium deposits Exc shoulder les sc < 3 cm Exc shoulder tum deep < 5 c Resect shoulder tum < 5 cm Biopsy arm/elbow soft tissu Biopsy arm/elbow soft tissu Exc arm/elbow les sc < 3 cm Ex arm/elbow tum deep < 5 c Resect arm/elbow tum < 5 cm Removal of arm foreign body Exc forearm les sc < 3 cm Exc forearm tum deep < 3 cm Resect forearm/wrist tum<3c Exc hand les sc < 1.5 cm Exc hand tum deep < 1.5 cm Exc hand tum ra < 3 cm Removal of implant from han Exc hip/pelvis les sc < 3 c Exc hip/pelv tum deep < 5 c Resect hip/pelv tum < 5 cm Exc thigh/knee tum deep <5c Resect thigh/knee tum < 5 c Resect leg/ankle tum < 5 cm Exc leg/ankle tum < 3 cm Exc leg/ankle tum deep <5 c Exc foot/toe tum sc < 1.5 c Exc foot/toe tum deep <1.5c Resect foot/toe tumor < 3 c Removal of foot foreign bod Temporal artery procedure Biopsy of penis Remove external ear partial Remove ear canal lesion(s) T 23.2928$1,661.08 $350.78 Exc h-f-nk-sp b9+marg >4 cm Exc face-mm b9+marg >4 cm Removal sweat gland lesion Removal sweat gland lesion Removal sweat gland lesion Removal sweat gland lesion Removal sweat gland lesion Removal sweat gland lesion Exc s/n/h/f/g mal+mrg >4 cm Exc f/e/e/n/l mal+mrg >4 cm Remove nail bed/finger tip Remove pilonidal cyst simplRemove pilonidal cyst exten

Remove pilonidal cyst compl Remove tissue expander(s) Dermabrasion total face Exc skin abd Excise excessive skin thigh Excise excessive skin leg Excise excessive skin hip Excise excessive skin buttc Exc skin abd add-on Remove sacrum pressure sore Remove sacrum pressure sore Remove hip pressure sore Remove hip pressure sore Remove thigh pressure sore Remove thigh pressure sore Bone biopsy excisional Bone biopsy excisional Removal of foreign body Removal of support implant Resect face tum 2 cm/> Exc neck les sc 3 cm/> Exc neck tum deep 5 cm/> Exc neck tum deep < 5 cm Resect neck tum 5 cm/> Biopsy soft tissue of back Exc back les sc 3 cm/> Exc back tum deep 5 cm/> Resect back tum 5 cm/> Exc abdl tum deep < 5 cm Exc abdl tum deep 5 cm/> Exc abd les sc 3 cm/> Resect abd tum 5 cm/> Biopsy shoulder tissues Exc shoulder les sc 3 cm/> Exc shoulder tum deep 5 cm/ Resect shoulder tum 5 cm/> Remove shoulder foreign bod Exc arm/elbow les sc 3 cm/> Ex arm/elbow tum deep 5 cm/ Resect arm/elbow tum 5 cm/> Biopsy forearm soft tissues Exc forearm les sc 3 cm/> Exc forearm tum deep 3 cm/> Resect forarm/wrist tum 3cm Exc hand les sc 1.5 cm/> Exc hand tum deep 1.5 cm/>Exc hand tum ra 3 cm/>

Exc hip pelvis les sc 3 cm/ Exc hip/pelv tum deep 5 cm/ Resect hip/pelv tum 5 cm/> Biopsy thigh soft tissues Exc thigh/knee les sc < 3 c Exc thigh/knee les sc 3 cm/ Exc thigh/knee tum dep 5cm/ Resect thigh/knee tum 5 cm/ Removal of foreign body Biopsy lower leg soft tissu Resect leg/ankle tum 5 cm/> Exc leg/ankle les sc 3 cm/> Exc leg/ankle tum dep 5 cm/ Exc foot/toe tum sc 1.5 cm/ Exc foot/toe tum dep 1.5cm/ Resect foot/toe tumor 3 cm/ Biopsy of penis Autotransplant parathyroid Clear outer ear canal T 26.1210$1,862.77

. Biopsy of breast open Nipple exploration Excise breast duct fistula Removal of breast lesion Excision breast lesion Excision addl breast lesion Removal of breast tissue Partical mastectomy Breast reconstruction Breast surgery procedure Rxt breast appl place/remov T 34.4816$2,458.99 $581.52 Cryosurg ablate fa each Mast simple complete Mast subq Suspension of breast Removal of breast implant Removal of implant material Correct inverted nipple(s) Breast reconstruction Surgery of breast capsule Removal of breast capsule Design custom breast implan T 45.3768$3,235.96 $747.07 P-mastectomy w/ln removal Mast mod radReduction of large breast

Enlarge breast Immediate breast prosthesis Revise breast reconstructio S 0.3135 $22.36

. Intervene hlth/behave group Behav chng smoking 3-10 min Behav chng smoking > 10 min Tobacco-use counsel 3-10 mi $0.00 X 0.3286 $23.43

. Audiometry air only Audiometry air & bone Speech audiometry threshold Speech audiom thresh & reco Vein access cutdown < 1 yr Vein access cutdown > 1 yr Withdrawal of arterial bloo Echo exam of eye thickness Remote dx retinal imaging Remote retinal imaging mgmt Rhythm ecg tracing ECG/signal-averaged Icm device eval Noninvas vasc dx study proc T 15.6849$1,118.54 $227.35 Bx breast percut w/device Drain app abscess percut Percut drain liver lesion Drain pancreatic pseudocyst Drain abdominal abscess Drain percut abdom abscess Drain percut retroper absc Renal abscess percut drain Biopsy of testis S229.8982$16,394.73

. Implt/rpl crtd sns dev gen Replc vagus nerve pls gen Insrt/redo neurostim 1 arra Insrt/redo spine n generato Insrt/redo pn/gastr stimul Level I Implantation/Revision/Replacement of Neurostimulator Electrodes S 61.6966$4,399.77

. Periph field stimul trial Implant neuroelectrodes Revise spine eltrd perq ara Revise spine eltrd plate Implant neuroelectrodes Implant neuroelectrodesImplant neuroelectrodes

Implant neuroelectrodes Revise/repl vagus n eltrd T 29.6106$2,111.62

. Jaw arthroscopy/surgery Jaw arthroscopy/surgery Shoulder arthroscopy dx Shoulder arthroscopy/surger Shoulder arthroscopy/surger Shoulder arthroscopy/surger Elbow arthroscopy Elbow arthroscopy/surgery Elbow arthroscopy/surgery Elbow arthroscopy/surgery Elbow arthroscopy/surgery Elbow arthroscopy/surgery Wrist arthroscopy Wrist arthroscopy/surgery Wrist arthroscopy/surgery Wrist arthroscopy/surgery Wrist arthroscopy/surgery Wrist endoscopy/surgery Knee arthroscopy/surgery Knee arthroscopy dx Knee arthroscopy/drainage Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Mcp joint arthroscopy dx Mcp joint arthroscopy surg Mcp joint arthroscopy surg Subtalar arthro w/fb rmvl Subtalar arthro w/excSubtalar arthro w/deb

Arthroscopy of joint T 54.4111$3,880.22 $782.23 Shoulder arthroscopy/surger Shoulder arthroscopy/surger Shoulder arthroscopy/surger Shoulder arthroscopy/surger Shoulder arthroscopy/surger Shoulder arthroscopy/surger Shoulder arthroscopy/surger Arthroscop rotator cuff rep Arthroscopy biceps tenodesi Wrist arthroscopy/surgery Knee arthroscopy/surgery Tibial arthroscopy/surgery Tibial arthroscopy/surgery Hip arthroscopy dx Hip arthro w/fb removal Hip arthr0 w/debridement Hip arthr0 w/synovectomy Autgrft implnt knee w/scope Allgrft implnt knee w/scope Meniscal trnspl knee w/scpe Knee arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Subtalar arthro w/fusion Hip arthro w/femoroplasty Hip arthro acetabuloplasty Hip arthro w/labral repair T 14.5706$1,039.07 $257.70 Manipulation of spine Treat shoulder dislocation Fixation of shoulder Manipulate elbow w/anesth Treat elbow dislocation Treat finger dislocation Treat pelvic ring fracture Treat hip dislocation Treat hip dislocation Treat hip dislocation Manipulation of hip joint Treat knee dislocation Treat kneecap dislocation Fixation of knee joint Treat ankle dislocation Fixation of ankle jointTreat toe dislocation

Treat toe dislocation T 40.2172$2,868.01

. Reconstruct elbow joint Reconstruct head of radius Revise wrist joint Repair wrist joints Remove wrist joint implant Revise knuckle joint Revise finger joint Revise kneecap Revision of knee joint Revision of knee joint Revision of knee joint Revision of knee joint Revision of ankle joint T 62.4025$4,450.11

. Reconstruct elbow joint Reconstruct wrist joint Reconstruct wrist joint Reconstruct wrist joint Revise knuckle with implant Revise/implant finger joint Revise kneecap with implant T 21.8096$1,555.31

. Application of pelvis brace Remove bone fixation device Musculoskeletal surgery Drain chest lesion Revision of neck muscle Revision of neck muscle Abdomen surgery procedure Drain shoulder bone lesion Biopsy of shoulder joint Removal of bone lesion Drain arm/elbow bone lesion Biopsy elbow joint lining Removal of elbow bursa Remove humerus lesion Remove elbow lesion Revision of arm tendon Amputation follow-up surger Incision of tendon sheath Incise flexor carpi radiali Drainage of forearm lesion Drainage of forearm bursa Treat forearm bone lesionIncision of wrist capsule

Biopsy of wrist joint Excise tendon forearm/wrist Remove wrist tendon lesion Remove wrist tendon lesion Reremove wrist tendon lesio Remove wrist/forearm lesion Remove wrist/forearm lesion Remove forearm foreign body Release wrist/forearm tendo Amputation follow-up surger Amputation follow-up surger Amputate hand at wrist Amputation follow-up surger Drainage of pelvis lesion Drainage of pelvis bursa Incision of hip tendon Biopsy of sacroiliac joint Biopsy of hip joint Buttock fasciotomy w/dbrdmt Removal of ischial bursa Remove femur lesion/bursa Remove hip bone les super Remove hip foreign body Incise thigh tendon & fasci Incision of thigh tendon Removal of kneecap bursa Removal of knee cyst Remove knee cyst Incision of thigh tendon Incision of thigh tendons Decompression of thigh/knee Amputation follow-up surger Decompression of lower leg Decompression of lower leg Incision of achilles tendon Treat lower leg bone lesion Removal of tendon lesion Repair leg fascia defect Repair of leg tendon each Repair of leg tendon each Repair lower leg tendons Removal of ankle implant Amputation follow-up surger Treatment of foot infection Treatment of foot infection T 32.3471$2,306.77

.Extracorp shockwv tx hi enr

Extracorp shockwv tx anesth Perq sacral augmt unilat in Perq sacral augmt bilat inj Plmt post facet implt lumb Plmt post facet implt addl Open bone biopsy Open bone biopsy Place ndl musc/tis for rt Insert and remove bone pin Application of thigh brace Apply bone fixation device Apply bone fixation device Adjust bone fixation device Comp multiplane ext fixatio Removal of bone for graft Removal of bone for graft Removal of tendon for graft Partial removal of rib Partial removal of rib Percut vertebroplasty thor Percut vertebroplasty lumb Percut vertebroplasty addl Apply spine prosth device Spine surgery procedure Release shoulder joint Exploratory shoulder surger Exploratory shoulder surger Shoulder joint surgery Remove shoulder joint linin Incision of collarbone join Explore treat shoulder join Partial removal collar bone Removal of collar bone Removal of bone lesion Removal of bone lesion Removal of humerus lesion Removal of humerus lesion Removal of humerus lesion Remove collar bone lesion Remove shoulder blade lesio Remove humerus lesion Remove collar bone lesion Remove shoulder blade lesio Remove humerus lesion Partial removal of scapula Removal of head of humerusFixation of shoulder blade

Incision of tendon & muscle Incise tendon(s) & muscle(s Remove/transplant tendon Exploratory elbow surgery Release elbow joint Explore/treat elbow joint Remove elbow joint lining Remove/graft bone lesion Remove/graft bone lesion Remove/graft bone lesion Remove/graft bone lesion Removal of head of radius Removal of arm bone lesion Remove radius bone lesion Remove elbow bone lesion Partial removal of arm bone Partial removal of radius Partial removal of elbow Radical resection of elbow Removal of elbow joint Remove elbow joint implant Remove radius head implant Muscle/tendon transfer Arm tendon lengthening Repair of arm tendon Tenolysis triceps Repr elbow lat ligmnt w/tis Repr elbw med ligmnt w/tiss Repair elbow perc Repair elbow w/deb open Repair elbow deb/attch open Decompression of forearm Decompress forearm 1 space Decompress forearm 1 space Decompress forearm 2 spaces Decompress forearm 2 spaces Explore/treat wrist joint Explore/treat wrist joint Remove wrist joint lining Remove wrist joint cartilag Excise wrist tendon sheath Partial removal of ulna Removal of forearm lesion Remove/graft forearm lesion Remove/graft forearm lesion Removal of wrist lesionRemove & graft wrist lesion

Remove & graft wrist lesion Remove forearm bone lesion Partial removal of ulna Partial removal of radius Resect radius/ulnar tumor Removal of wrist bone Removal of wrist bones Partial removal of radius Partial removal of ulna Removal of wrist prosthesis Removal of wrist prosthesis Repair forearm tendon/muscl Repair forearm tendon/muscl Repair forearm tendon/muscl Repair forearm tendon/muscl Repair forearm tendon/muscl Repair forearm tendon/muscl Repair forearm tendon sheat Revise wrist/forearm tendon Incise wrist/forearm tendon Fusion of tendons at wrist Fusion of tendons at wrist Transplant forearm tendon Revise palsy hand tendon(s) Shorten radius & ulna Incision of hip tendon Incision of hip tendon Incision of hip tendons Buttock fasciotomy Denervation of hip joint Remove hip bone les deep Remove/graft hip bone lesio Removal of tail bone Revision of hip tendon Transfer tendon to pelvis Treat thigh fracture Incision of thigh tendons Exploration of knee joint Biopsy knee joint lining Explore/treat knee joint Removal of knee cartilage Removal of knee cartilage Remove knee joint lining Remove knee joint lining Removal of kneecap Remove femur lesionRemove femur lesion/graft

Remove femur lesion/graft Remove femur lesion/fixatio Partial removal leg bone(s) Repair of kneecap tendon Repair/graft kneecap tendon Repair of thigh muscle Repair/graft of thigh muscl Incision of thigh tendons Lengthening of thigh tendon Lengthening of thigh tendon Transplant of thigh tendon Repair of knee cartilage Lat retinacular release ope Incision of knee joint Surgery to stop leg growth Surgery to stop leg growth Decompression of thigh/knee Decompression of thigh/knee Decompression of thigh/knee Decompression of lower leg Drain lower leg bursa Explore/treat ankle joint Exploration of ankle joint Explore/treat ankle joint Remove ankle joint lining Remove ankle joint lining Remove lower leg bone lesio Remove/graft leg bone lesio Remove/graft leg bone lesio Partial removal of tibia Partial removal of fibula Resect talus/calcaneus tum Repair of leg tendon each Repair of leg tendon each Repair lower leg tendons Release of lower leg tendon Release of lower leg tendon Revision of lower leg tendo Revise lower leg tendons Revision of calf tendon Repair of ankle ligament Repair of ankle ligaments Repair of ankle ligament Incision of fibula Incision of tibia & fibula Repair of tibia epiphysisRepair of fibula epiphysis

Repair lower leg epiphyses Repair of leg epiphyses Amputation of foot at ankle Decompression of leg Decompression of leg Decompression of leg Hi enrgy eswt plantar fasci Pelvic ring fracture uni/bi T 48.2042$3,437.59

. Replace tissue expander Excise epiphyseal bar Ablate bone tumor(s) perq Repair stern/nuss w/o scope Repair sternum/nuss w/scope Remove shoulder bone part Muscle transfer shoulder/ar Repair rotator cuff acute Repair rotator cuff chronic Release of shoulder ligamen Repair of shoulder Repair biceps tendon Repair shoulder capsule Repair shoulder capsule Revision of collar bone Resect distal humerus tumor Resect radius tumor Revision of arm muscles Repair of biceps tendon Repair arm tendon/muscle Repair of ruptured tendon Revision of humerus Revision of humerus Revision of elbow joint Fusion of elbow joint Transplant forearm tendon Repair/revise wrist joint Realignment of hand Reconstruct ulna/radioulnar Revision of radius Revision of radius Revision of ulna Revise radius or ulna Revise radius & ulna Shorten radius or ulna Lengthen radius & ulna Repair carpal bone shortenRepair/graft radius & ulna

Vasc graft into carpal bone Repair nonunion carpal bone Revision of wrist joint Revision of wrist joint Reinforce radius Reinforce ulna Reinforce radius and ulna Fusion of hand bones Exploration of hip joint Transfer of abdominal muscl Transfer of spinal muscle Transfer of iliopsoas muscl Transfer of iliopsoas muscl Lengthening of thigh tendon Transplants of thigh tendon Revise thigh muscles/tendon Repair of knee ligament Osteochondral knee autograf Repair degenerated kneecap Revision of unstable kneeca Revision of unstable kneeca Revision/removal of kneecap Revision of thigh muscles Repair achilles tendon Repair of achilles tendon Revise lower leg tendon Revise lower leg tendon Revise additional leg tendo Incision of tibia Repair of leg epiphyses T 82.2078$5,862.48

. Lumbar spine proces distrac Lumbar spine process addl Percut kyphoplasty thor Percut kyphoplasty lumbar Percut kyphoplasty add-on Muscle transfers Repair shoulder capsule Repair shoulder capsule Repair shoulder capsule Repair shoulder capsule Revision of collar bone Reinforce clavicle Reinforce shoulder bones Fusion of shoulder joint Fusion of shoulder jointRevision of arm muscles

Reconstruct elbow lat ligmn Reconstruct elbow med ligmn Revision of humerus Repair of humerus Repair humerus with graft Reinforce humerus Fusion/graft of elbow joint Revision of amputation Revise palsy hand tendon(s) Revise radius & ulna Lengthen radius or ulna Repair radius or ulna Repair/graft radius or ulna Repair radius & ulna Repair/graft radius & ulna Repair/graft radius or ulna Repair/graft wrist bone Fusion of wrist joint Fusion/graft of wrist joint Fusion/graft of wrist joint Fuse hand bones with graft Fusion radioulnar jnt/ulna Revise head/neck of femur Repair of knee ligament Repair of knee ligaments Autochondrocyte implant kne Osteochondral knee allograf Reconstruction knee Reconstruction knee Reconstruction knee Repair/graft achilles tendo Reinforce tibia Fusion of ankle joint open Fusion of tibiofibular join Fusion of foot bones Knee arthroscopy/surgery Knee arthroscopy/surgery Ankle arthroscopy/surgery T 16.6230$1,185.44 $249.64 Drain hand tendon sheath Drainage of palm bursa Drainage of palm bursas Treat hand bone lesion Decompress fingers/hand Decompress fingers/hand Release palm contractureIncise finger tendon sheath

Incision of finger tendon Explore/treat hand joint Explore/treat finger joint Explore/treat finger joint Biopsy hand joint lining Biopsy finger joint lining Biopsy finger joint lining Release palm contracture Remove wrist joint lining Revise finger joint each Tendon excision palm/finger Remove tendon sheath lesion Removal of palm tendon each Removal of finger tendon Remove finger bone Remove hand bone lesion Removal of finger lesion Remove/graft finger lesion Partial removal of hand bon Partial removal finger bone Partial removal finger bone Extensive hand surgery Resect prox finger tumor Resect distal finger tumor Repair hand tendon Repair finger tendon Repair finger tendon Repair finger tendon Realignment of tendons Release palm/finger tendon Release hand/finger tendon Incision of palm tendon Incision of finger tendon Incise hand/finger tendon Fusion of finger tendons Fusion of finger tendons Tendon lengthening Tendon shortening Lengthening of hand tendon Shortening of hand tendon Hand tendon reconstruction Release thumb contracture Release knuckle contracture Release finger contracture Repair hand joint Repair hand joint with grafRepair of web finger

Repair hand deformity Reconstruct extra finger Repair finger deformity Release muscles of hand Excision constricting tissu Amputation of finger/thumb Amputation of finger/thumb T 28.9725$2,066.12

. Replantation digit complete Release palm contracture Release palm contracture Release palm contracture Revise finger joint each Remove/graft bone lesion Repair finger/hand tendon Repair/graft hand tendon Repair finger/hand tendon Repair finger/hand tendon Repair/graft hand tendon Repair finger/hand tendon Repair/graft hand tendon Repair finger/hand tendon Revise hand/finger tendon Repair/graft hand tendon Repair/graft hand tendon Excision hand/finger tendon Graft hand or finger tendon Repair/graft finger tendon Repair finger/hand tendon Repair/graft finger tendon Repair/graft finger tendon Release palm & finger tendo Release forearm/hand tendon Transplant hand tendon Transplant/graft hand tendo Transplant palm tendon Transplant/graft palm tendo Revise thumb tendon Tendon transfer with graft Hand tendon/muscle transfer Revise thumb tendon Finger tendon transfer Finger tendon transfer Revision of finger Hand tendon reconstruction Thumb tendon transferFusion of knuckle joint

Fusion of knuckle joints Fusion of knuckle joints Repair hand joint with graf Reconstruct finger joint Repair nonunion hand Reconstruct finger joint Construct thumb replacement Positional change of finger Repair of web finger Repair of web finger Correct metacarpal flaw Correct finger deformity Lengthen metacarpal/finger Repair muscles of hand Thumb fusion with graft Fusion of thumb Thumb fusion with graft Fusion of hand joint Fusion/graft of hand joint Fusion of knuckle Fusion of knuckle with graf Fusion of finger joint Fusion of finger jnt add-on Fusion/graft of finger join Fuse/graft added joint Amputate metacarpal bone Remove sympathetic nerves Remove sympathetic nerves Sympathectomy supfc palmar T 22.2111$1,583.94 $353.37 Incision of achilles tendon Treat foot bone lesion Incision of foot fascia Incision of toe tendon Incision of toe tendons Exploration of foot joint Exploration of foot joint Exploration of toe joint Biopsy of foot joint lining Biopsy of foot joint lining Biopsy of toe joint lining Partial removal foot fascia Removal of foot fascia Removal of foot joint linin Removal of foot joint linin Removal of foot lesionExcise foot tendon sheath

Excise foot tendon sheath Removal of foot lesion Removal of toe lesions Removal of ankle/heel lesio Removal of foot lesion Removal of toe lesions Part removal of metatarsal Part removal of metatarsal Part removal of metatarsal Part removal of metatarsal Removal of metatarsal heads Revision of foot Removal of heel bone Removal of heel spur Part removal of ankle/heel Partial removal of foot bon Partial removal of toe Partial removal of toe Removal of ankle bone Removal of metatarsal Removal of toe Partial removal of toe Partial removal of toe Resect tarsal tumor Resect metatarsal tumor Resect phalanx of toe tumor Repair of foot tendon Repair/graft of foot tendon Repair of foot tendon Release of foot tendon Release of foot tendons Release of foot tendon Release of foot tendons Incision of foot tendon(s) Incision of toe tendon Incision of foot tendon Release of big toe Revision of foot fascia Release of midfoot joint Revision of foot tendon Revision of foot and ankle Release of foot contracture Release of toe joint each Fusion of toes Repair of hammertoe Repair of hammertoePartial removal of foot bon

Repair hallux rigidus Incision of ankle bone Incision of metatarsal Incision of metatarsal Incision of metatarsal Revision of big toe Revision of toe Repair deformity of toe Removal of sesamoid bone Resect enlarged toe tissue Resect enlarged toe Repair extra toe(s) Repair webbed toe(s) Fusion of big toe joint Amputation thru metatarsal Amputation toe & metatarsal Amputation of toe Partial amputation of toe Scope plantar fasciotomy T 60.6876$4,327.81

. Bone/skin graft metatarsal Bone/skin graft great toe Remove/graft foot lesion Remove/graft foot lesion Remove/graft foot lesion Remove/graft foot lesion Repair/graft of foot tendon Revision of foot tendon Release of midfoot joint Incision of heel bone Incision of midfoot bones Incise/graft midfoot bones Incision of metatarsals Repair of foot bones Repair of metatarsals Reconstruct cleft foot Osteochondral talus autogrf Fusion of foot bones Fusion of foot bones Fusion of foot bones Fusion of foot bones Revision of foot bones Fusion of foot bones Fusion of big toe joint Fusion of big toe joint T 34.4317$2,455.43

.Correction of bunion

Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion S 1.3257 $94.54

. Application of body cast Application of body cast Application of body cast Application of body cast Application of figure eight Application of shoulder cas Apply hand/wrist cast Apply finger cast Apply long arm splint Apply forearm splint Apply forearm splint Addition of walker to cast Application of leg cast Application long leg splint Application lower leg splin Application of paste boot Apply multlay comprs lwr le Removal/revision of cast Removal/revision of cast Removal/revision of cast Repair of body cast Windowing of cast Wedging of cast Wedging of clubfoot cast Casting/strapping procedure S 0.7563 $53.93

. Application of finger splin Application of finger splin Strapping of chest Strapping of shoulder Strapping of elbow or wrist Strapping of hand or finger Strapping of hip Strapping of knee Strapping of ankle and/or f Strapping of toes Apply multlay comprs upr le Apply multlay comprs upr arAppl multlay comprs arm/han S 0.2738 $19.53

.

Osteopath manj 1-2 regions Osteopath manj 3-4 regions Osteopath manj 5-6 regions Osteopath manj 7-8 regions Osteopath manj 9-10 regions Chiropract manj 1-2 regions Chiropract manj 3-4 regions Chiropractic manj 5 regions Level II Implantation/Revision/Replacement of Neurostimulator Electrodes S 95.2427$6,792.04

. Lap impl electrode antrum Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes T 26.7671$1,908.84

. Open tx rib fx 1-2 ribs Opn tx rib fx 3-4 ribs Opn tx rib fx 5-6 ribs Open tx rib fx 7/> ribs Open tx septal fx w/wo stab Treatment of rib fracture Treat clavicle dislocation Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat fx distal radial Pin ulnar styloid fracture Treat wrist dislocation Pin radioulnar dislocation Treat wrist dislocation Treat wrist fracture Treat wrist dislocation Treat metacarpal fracture Treat thumb fracture Pin hand dislocation Treat hand dislocation Treat knuckle dislocation Treat finger fracture each Treat finger fracture each Treat finger fracture each Pin finger fracture each Treat finger fracture each Pin finger dislocation Treat finger dislocation Treatment of thigh fractureTreatment of tibia fracture

Treatment of heel fracture Treatment of ankle fracture Treat midfoot fracture Treat metatarsal fracture Treat big toe fracture Treat big toe fracture Treat toe fracture Treat sesamoid bone fractur Treat foot dislocation Treat foot dislocation Treat foot dislocation Repair foot dislocation Treat foot dislocation Treat toe dislocation Repair toe dislocation Treat toe dislocation Repair of toe dislocation T 52.7806$3,763.94

. Treat clavicle dislocation Treat clavicle dislocation Treat clavicle dislocation Treat shoulder dislocation Treat dislocation/fracture Treat radius fracture Treat ulnar fracture Treat fracture of radius Treat fracture of radius Treat fracture of radius Treat fracture of ulna Treat wrist bone fracture Treat wrist bone fracture Treat fracture ulnar styloi Treat metacarpal fracture Treat thumb fracture Treat tail bone fracture Treat kneecap fracture Treat kneecap dislocation Repair of tibia Repair fibula nonunion Treatment of tibia fracture Optx medial ankle fx Optx post ankle fx Treatment of fibula fractur Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fractureTreat lower leg fracture

Treat lower leg joint Treat lower leg dislocation Treat ankle dislocation Treat ankle dislocation Treat/graft heel fracture Treat ankle fracture Treat midfoot fracture each Treat metatarsal fracture Repair foot dislocation Repair foot dislocation T 70.6785$5,040.30

. Treat clavicle fracture Treat scapula fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat dislocation/fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat elbow fracture Treat elbow fracture Treat elbow dislocation Treat elbow fracture Treat radius fracture Treat fracture radius & uln Treat fracture radius/ulna Treat fx rad extra-articul Treat fx rad intra-articul Treat fx radial 3+ frag Treat hand dislocation Repair/graft of tibia Treatment of tibia fracture Treatment of ankle fracture Treat lower leg fracture Treat lower leg fracture Treat heel fracture S 13.7177 $978.25

. Mw therapy for breast tumor Io rad tx delivery by x-ray Io rad tx deliver by elctrn Meg evoked single Meg evoked each addlLinear acc based stero radi S 33.0205$2,354.79

.

Meg spontaneous Robt lin-radsurg fractx 2-5 S 46.2838$3,300.64

. U/s leiomyomata ablate <200 U/s leiomyomata ablate >200 Linear acc stereo radsur co Robot lin-radsurg com, firs T 35.9647$2,564.75 $591.64 Thoracoscopy diagnostic Thoracoscopy wbx sac Thoracoscopy w/bx med space Thoracoscopy w/bx infiltrat Thoracoscopy w/bx nodule Thoracoscopy w/bx pleura Mediastinoscopy incl biopsy T 5.7828 $412.39

. Drain percut lung lesion Insertion of chest tube Remove lung catheter Aspirate pleura w/o imaging Aspirate pleura w/ imaging Insert cath pleura w/o imag Insert cath pleura w/ image Treat pleurodesis w/agent Lyse chest fibrin init day Lyse chest fibrin subq day Therapeutic pneumothorax Chest surgery procedure Drainage of heart sac Repeat drainage of heart sa Cardiac surgery procedure Abd paracentesis Abd paracentesis w/imaging Peritoneal lavage T 1.0839 $77.30

. Diagnostic laryngoscopy Nasopharyngoscopy T 2.0036 $142.88

. Nasal endoscopy dx Nasal/sinus endoscopy dx Remove foreign body larynx Injection into vocal cord Dx laryngoscopy newborn Diagnostic laryngoscopy T 4.7291 $337.25 $67.83Remove foreign body larynx

Diagnostic laryngoscopy Bronchial brush biopsy Intro windpipe wire/tube T 18.9594$1,352.05

. Nasal/sinus endoscopy dx Nasal/sinus endoscopy surg Nasal/sinus endoscopy surg Laryngoscopy with biopsy Removal of larynx lesion Laryngoscopy for aspiration Dx laryngoscopy excl nb Dx laryngoscopy w/oper scop Laryngoscopy w/fb removal Laryngoscopy w/fb & op scop Laryngoscopy w/biopsy Laryngoscopy w/bx & op scop Laryngoscopy w/exc of tumor Laryngoscope w/vc inj Laryngoscopy with biopsy Removal of larynx lesion T 28.4215$2,026.82

. Nasal/sinus endoscopy surg Nasal/sinus endoscopy surg Revision of ethmoid sinus Removal of ethmoid sinus Exploration maxillary sinus Endoscopy maxillary sinus Sinus endoscopy surgical Nasal/sinus endoscopy surg Nasal/sinus endoscopy surg Nasal/sinus endoscopy surg Nasal/sinus endoscopy surg Nasal/sinus endoscopy surg Sinus endo w/balloon dil Sinus endo w/balloon dil Sinus endo w/balloon dil Laryngoscopy for treatment Laryngoscopy and dilation Laryngoscopy and dilation Larynscop w/tumr exc + scop Remove vc lesion w/scope Remove vc lesion scope/graf Laryngoscop w/arytenoidecto Larynscop remve cart + scop Laryngoscop w/vc inj + scop T 10.7117 $763.88 $189.82Dx bronchoscope/wash

Dx bronchoscope/brush Dx bronchoscope/lavage Bronchoscopy w/biopsy(s) Bronchoscopy/lung bx each Bronchoscopy/lung bx addl Bronchoscopy/needle bx addl Bronchoscopy w/fb removal Bronchoscopy stent add-on Diag bronchoscope/catheter Bronchoscopy clear airways Bronchoscopy reclear airway Bronchial valve remov init Airways surgical procedure S 0.4920 $35.09 $7.74 Clearance of airways Surfactant admin thru tube Airway inhalation treatment Evaluate pt use of inhaler Chest wall manipulation Chest wall manipulation Therapeutic procd strg endu Oth resp proc, indiv Oth resp proc, group S 1.4155 $100.94

. Intm msr bronchodil wheeze Change of windpipe airway Evaluation of wheezing Aerosol inhalation treatmen Pos airway pressure cpap S 3.4693 $247.41

. Vent mgmt inpat init day Vent mgmt inpat subq day Neg press ventilation cnp T 37.1534$2,649.52 $815.13 Right heart cath Left hrt cath w/ventrclgrph R&l hrt cath w/ventriclgrph Coronary artery angio s&i Coronary art/grft angio s&i R hrt coronary artery angio R hrt art/grft angio L hrt artery/ventricle angi L hrt art/grft angio R&l hrt art/ventricle angio R&l hrt art/ventricle angio L hrt cath trnsptl punctureRt heart cath congenital

R & l heart cath congenital R & l heart cath congenital R & l heart cath congenital T 107.5706$7,671.18

. Trluml perip athrc renal ar Trluml perip athrc abd aort Trluml perip athrc brchiocp Trluml perip athrc iliac ar Transcatheter occlusion Endovasc tempory vessel occ Transcath occlusion non-cns Prq card angio/athrect 1 ar Prq card angio/athrect addl Coronary Angioplasty, Valvuloplasty, and Level I Endovascular Revascularization T 56.4140$4,023.05

. Repair arterial blockage Repair venous blockage Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair venous blockage Iliac revasc Iliac revasc add-on Iliac revasc w/stent add-on Fem/popl revas w/tla Tib/per revasc w/tla Tib/per revasc add-on Revsc opn/prq tib/pero sten Tib/per revasc stnt & ather Repair arterial blockage Repair arterial blockage Prq cardiac angioplast 1 ar Prq cardiac angio addl art Revision of aortic valve Revision of mitral valve Revision of pulmonary valve Pul art balloon repr percut Pul art balloon repr percut S 9.8911 $705.36

. Bundle of His recording Intra-atrial recording Right ventricular recording Intra-atrial pacing Intraventricular pacing Esophageal recording Esophageal recording Heart rhythm pacingElectrophysiology evaluatio T 55.0013$3,922.31

.

Electrophysiology evaluatio Electrophysiology evaluatio Electrophysiologic study Ablate heart dysrhythm focu T 43.4735$3,100.23 $655.22 Removal of artery clot Removal of arm artery clot Removal of artery clot Removal of leg artery clot Removal of vein clot Removal of vein clot Removal of vein clot Repair valve femoral vein Transposition of vein valve Cross-over vein graft Leg vein fusion Repair blood vessel lesion Repair blood vessel lesion Removal of clot in graft Removal of clot in graft Revise graft w/vein Revise graft w/vein Revise graft w/nonauto graf Revise graft w/vein Av fuse uppr arm cephalic Av fuse uppr arm basilic Av fusion/forearm vein Av fusion direct any site Artery-vein autograft Artery-vein nonautograft Open thrombect av fistula Av fistula revision open Av fistula revision Dist revas ligation hemo Prim art mech thrombectomy Prim art m-thrombect add-on Sec art m-thrombect add-on Venous mech thrombectomy Venous m-thrombectomy add-o Prq coronary mech thrombect Insertion/Replacement of Permanent Pacemaker and Electrodes T 115.4087$8,230.14

. Icar ischm mntrng sys compl Insert heart pm atrial Insert heart pm ventricular T 92.7231$6,612.36 $1,593.50Icar ischm mntrng sys devic

Insert pulse gen sngl lead Remove&replace pm gen singl T 42.4137$3,024.65

. Endovenous rf 1st vein Ins endovas vena cava filtr Endoscopy ligate perf veins Ligation of neck artery Ligation of inf vena cava Ligate/strip long leg vein Removal of leg veins/lesion T 27.4658$1,958.67

. Ligation nasal sinus artery Ligation upper jaw artery Endovenous rf vein add-on Endovenous laser 1st vein Endovenous laser vein addon Vascular endoscopy procedur Ligation of neck artery Ligation of a-v fistula Ligation of neck artery Revision of major vein Revise leg vein Ligate/strip short leg vein Ligate leg veins radical Ligate leg veins open Stab phleb veins xtr 10-20 Phleb veins - extrem 20+ Revision of leg vein Ligate/divide/excise vein T 30.1384$2,149.26

. Repair defect of arm artery Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Rechanneling of artery Bypass graft patency/patch Bypass graft/av fist patenc Exploration of artery/vein Explore limb vessels Excision graft extremity Ligation of neck veinLigation of neck artery

Repair venous blockage S 2.2552 $160.83 $43.80 Insert emergency airway Heart/lung resuscitation cp Temporary external pacing Nb resuscitation S 1.1206 $79.91

. Cardiac rehab Cardiac rehab/monitor Intens cardiac rehab w/exer Intens cardiac rehab no exe S 1.5230 $108.61 $36.86 Echo guide for artery repai Upr/lxtr art stdy 3+ lvls Lwr xtr vasc stdy bilat Extremity study S 0.9328 $66.52

. Bioimpedance spectroscopy Ext ecg recording Ext ecg scan w/report Dx gastr intub w/asp specs Ecg monit/reprt up to 48 hr Ecg monit/reprt up to 48 hr Remote 30 day ecg rev/repor Ambulatory BP recording Ambulatory BP analysis Cardiovascular procedure Upr/l xtremity art 2 levels Aneurysm pressure sens stud Measure blood oxygen level Ped home apnea rec hk-up Ped home apnea rec downld S 0.3740 $26.67

. Acoustic ecg w/i&r Cal & alys cntrl artl press Electrocardiogram tracing Bioimpedance cv analysis EKG tracing for initial pre X 2.4795 $176.82 $41.07 64 lead ecg w/tracing Cardiovascular stress test Cardiac drug stress test Microvolt t-wave assess Cardiokymography S 4.2562 $303.52 $100.24 Tilt table evaluationS 0.5512 $39.31

.

Pulmonary rehab w exer T 16.2173$1,156.50

. Harvest vein for bypass Transcatheter therapy infus Cath place cardio brachytx Insert/place heart catheter Biopsy of heart lining T 85.6848$6,110.44

. Prq card stent w/angio 1 vs Prq card stent w/angio addl Prq card stent/ath/angio Prq card stent/ath/angio Prq revasc byp graft 1 vsl Prq revasc byp graft addl Prq card revasc mi 1 vsl Prq card revasc chronic 1vs Prq card revasc chronic add Repair/Revision/Removal of Pacemakers, AICDs, or Vascular Devices T 23.6020$1,683.13

. Rmvl icar ischm mntrng dvce Rmvl subq defib pls gen Rmvl subq defib electrode Repos subq defib eltrd &/ge Reposition pacing-defib lea Repair lead pace-defib one Repair lead pace-defib dual Reposition l ventric lead Removal of pm generator Removal of pacemaker system Removal pacemaker electrode Remove pulse generator Remove eltrd transven Revision of infusion pump Removal of infusion pump Remove tunneled ip cath Removal of shunt T 52.8101$3,766.05

. Icar ischm mntrng sys eltrd Insert subq defib electrode Insert electrd/pm cath sngl Insert card electrodes dual Insert 1 electrode pm-defib Insert 2 electrode pm-defib T315.6793$22,512.04

. Insert subq defib w/eltrd Insert subq defib pls gen Rmvl & replc subq pls genInsrt pulse gen w/dual lead

Insrt pulse gen w/mult lead Insrt pulse gen w/singl lea Remv&replc cvd gen sing lea Remv&replc cvd gen dual lea Remv&replc cvd gen mult lea T430.2162$30,680.01

. Nsert pace-defib w/lead S 3.6520 $260.44

. Blood transfusion service Bl push transfuse 2 yr/< Bl exchange/transfuse nb Bl exchange/transfuse non-n Transfusion service fetal Cryopreserve stem cells Thaw preserved stem cells Wash harvest stem cells Blood/lymph system procedur S 13.3306 $950.65

. Apheresis wbc Apheresis rbc Apheresis platelets Apheresis plasma Harvest auto stem cells Transplt allo lymphocytes Transplj hematopoietic boos S 40.5074$2,888.70

. Im B1 mrw cel ther cmpl Im B1 mrw cel ther xcl hrvs Im B1 mrw cel ther hrvst on Apheresis adsorp/reinfuse Apheresis selective Photopheresis Bone marrow harvest allogen Bone marrow harvest autolog Transplt allo hct/donor Transplt autol hct/donor T 25.5213$1,820.00

. Incision of lymph channels Biopsy/removal lymph nodes Biopsy/removal lymph nodes Biopsy/removal lymph nodes Biopsy/removal lymph nodes Biopsy/removal lymph nodes Removal neck/armpit lesion Removal neck/armpit lesion Removal of lymph nodes neckRemoval of lymph nodes neck

Remove groin lymph nodes T 51.4794$3,671.15

. Explore deep node(s) neck Remove armpit lymph nodes Remove armpit lymph nodes Remove thyroid lesion Partial thyroid excision Partial thyroid excision Partial removal of thyroid Partial removal of thyroid Removal of thyroid Remove thyroid duct lesion Remove thyroid duct lesion Endocrine surgery procedure T 37.5770$2,679.73

. Insertion of cannula Insertion of cannula Insertion of cannula Artery to vein shunt Cannula declotting Insert tun ip cath w/port T 6.1648 $439.63

. Repair tunneled cv cath Removal tunneled cv cath Intro gastrointestinal tube Replace g/c tube perc Replace duod/jej tube perc Replace g-j tube perc Fix g/colon tube w/device Change of bladder tube Brain canal shunt procedure T 1.1497 $81.99

. Instll rx agnt into rnal tu Measure ureter pressure Drain bladder by trocar/cat Insert bladder cath complex Electro-uroflowmetry first Anal/urinary muscle study Urinary reflex study Dilate urethra stricture Dilation of urethra Dilation of urethra Urology surgery procedure Penis study Genital surgery procedure Biofeedback peri/uro/rectalRectal sensation test S110.9266$7,910.51

.

Srs multisource T 1.8741 $133.65

. Treatment of rib fracture Treat sternum fracture Closed tx spine process fx Treat clavicle fracture Treat clavicle dislocation Treat shoulder blade fx Treat humerus fracture Treat humerus fracture Treat shoulder dislocation Treat dislocation/fracture Shoulder surgery procedure Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat elbow dislocation Treat elbow dislocation Treat radius fracture Treat ulnar fracture Treat ulnar fracture Upper arm/elbow surgery Treat fracture of radius Treat fracture of ulna Treat fracture of ulna Treat fracture radius & uln Treat fracture radius/ulna Treat wrist bone fracture Treat wrist bone fracture Treat wrist bone fracture Treat wrist bone fracture Treat wrist dislocation Treat wrist dislocation Treat wrist fracture Forearm or wrist surgery Treat metacarpal fracture Treat metacarpal fracture Treat thumb dislocation Treat hand dislocation Treat hand dislocation Treat knuckle dislocationTreat knuckle dislocation

Treat finger fracture each Treat finger fracture each Treat finger fracture each Treat finger fracture each Treat finger fracture each Treat finger fracture each Treat finger dislocation Hand/finger surgery Treat pelvic ring fracture Treat tail bone fracture Treat hip socket fracture Treat thigh fracture Treat hip dislocation Treat hip dislocation Treat hip dislocation Cltx thigh fx Pelvis/hip joint surgery Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treat thigh fx growth plate Treat thigh fx growth plate Treat kneecap fracture Treat knee fracture Treat knee fracture(s) Treat knee dislocation Treat kneecap dislocation Leg surgery procedure Treatment of tibia fracture Cltx medial ankle fx Cltx post ankle fx Cltx post ankle fx w/mnpj Treatment of fibula fractur Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treat lower leg fracture Treat lower leg dislocation Treat ankle dislocation Leg/ankle surgery procedure Treatment of heel fracture Treatment of ankle fracture Treatment of ankle fracture Treat midfoot fracture eachTreat midfoot fracture each

Treat metatarsal fracture Treat metatarsal fracture Treat big toe fracture Treat big toe fracture Treatment of toe fracture Treatment of toe fracture Treat sesamoid bone fractur Treat foot dislocation Treat foot dislocation Treat foot dislocation Treat foot dislocation Treat toe dislocation Treat toe dislocation Foot/toes surgery procedure T 38.2829$2,730.07 $659.53 Laparoscope proc spleen Laparoscope proc lymphatic Laparoscope proc esoph Lap revise/remv eltrd antru Laparoscope proc stom Lap mobil splenic fl add-on Laparoscope proc intestine Laparoscope proc app Laparoscope proc rectum Laparoscope procedure liver Laparoscopy w/cholangio Laparo w/cholangio/biopsy Laparoscope proc biliary Diag laparo separate proc Laparoscopy biopsy Laparoscopy aspiration Laparo drain lymphocele Lap insert tunnel ip cath Lap revision perm ip cath Lap w/omentopexy add-on Lap ins device for rt Laparo proc abdm/per/oment Laparo proc hernia repair Laparo ablate renal cyst Laparoscope proc renal Laparoscope proc ureter Laparoscope proc bla Laparoscope proc testis Laparo proc spermatic cord Laparoscopic myomectomy Laparo proc uterusLaparo proc oviduct-ovary

Laparo proc ob care/deliver Laparo proc endocrine T 48.8992$3,487.15 $1,001.89 Laparoscopy splenectomy Laparoscopy lymph node biop Laparoscopy lymphadenectomy Laparoscopy gastrostomy Lap enterolysis Lap jejunostomy Laparoscopy appendectomy Laparoscopic cholecystectom Laparo cholecystectomy/grap Laparo cholecystectomy/expl Lap ing hernia repair init Lap ing hernia repair recur Laparo partial nephrectomy Laparoscopy pyeloplasty Laparoscopy ureterolithotom Laparo new ureter/bladder Laparo new ureter/bladder Laparo urethral suspension Laparo sling operation Laparoscopy orchiectomy Laparo ligate spermatic vei Laparoscopy surg colpopexy Laparo-myomectomy complex Laparo-vag hyst incl t/o Laparo-vag hyst complex Laparo-vag hyst w/t/o compl Tlh uterus 250 g or less Tlh w/t/o 250 g or less Tlh uterus over 250 g Tlh w/t/o uterus over 250 g Laparoscopy lysis Laparoscopy remove adnexa Laparoscopy excise lesions Laparoscopy tubal cautery Laparoscopy tubal block Laparoscopy fimbrioplasty Laparoscopy salpingostomy Treat ectopic pregnancy Treat ectopic pregnancy T 71.8156$5,121.39 $1,236.99 Laparoscopy lymphadenectomy Laparoscopy fundoplasty Lap paraesophag hern repairLaparoscopy vagus nerve

Laparoscopy vagus nerve Lap place gastr adj device Lap part colectomy w/stoma L colectomy/coloproctostomy L colectomy/coloproctostomy Lap vent/abd hernia repair Lap vent/abd hern proc comp Lap inc hernia repair Lap inc hern repair comp Lap inc hernia repair recur Lap inc hern recur comp Laparoscopy orchiopexy Lsh uterus 250 g or less Lsh w/t/o ut 250 g or less Lsh uterus above 250 g Lsh w/t/o uterus above 250 Laparo-asst vag hysterectom T 1.2024 $85.75 $23.38 Esw wound healing init woun Esw wound healing addl woun Repair of nail bed Tx contour defects >10.0 cc Rpr s/n/ax/gen/trnk 2.5cm/< Rpr s/n/ax/gen/trnk2.6-7.5c Rpr s/n/ax/gen/trk7.6-12.5c Rpr s/n/a/gen/trk12.6-20.0c Rpr s/n/a/gen/trk20.1-30.0c Rpr s/n/ax/gen/trnk >30.0 c Rpr f/e/e/n/l/m 2.5 cm/< Rpr f/e/e/n/l/m 2.6-5.0 cm Rpr f/e/e/n/l/m 5.1-7.5 cm Rpr f/e/e/n/l/m 7.6-12.5 cm Rpr fe/e/en/l/m 12.6-20.0 c Rpr fe/e/en/l/m 20.1-30.0 c Intmd rpr n-hf/genit 2.5cm/ Intmd rpr face/mm 7.6-12.5c Cmplx rpr s/a/l addl 5 cm/> Skin sub graft t/a/l add-on Skin sub graft f/n/hf/g add Hair trnspl 1-15 punch grft Hair trnspl >15 punch graft T 3.5264 $251.48

. Correct skin color 6.0 cm/< Corect skin color 6.1-20.0c Correct skin color ea 20.0c Tx contour defects 1 cc/<Tx contour defects 1.1-5.0c

Tx contour defects 5.1-10cc Rpr f/e/e/n/l/m >30.0 cm Closure of split wound Intmd rpr s/a/t/ext 2.5 cm/ Intmd rpr s/a/t/ext 2.6-7.5 Intmd rpr s/tr/ext 7.6-12.5 Intmd rpr s/a/t/ext 12.6-20 Intmd rpr s/a/t/ext 20.1-30 Intmd rpr s/tr/ext >30.0 cm Intmd rpr n-hf/genit2.6-7.5 Intmd rpr n-hf/genit7.6-12. Intmd rpr n-hf/genit12.6-20 Intmd rpr n-hf/genit20.1-30 Intmd rpr n-hf/genit >30.0c Intmd rpr face/mm 2.5 cm/< Intmd rpr face/mm 2.6-5.0 c Intmd rpr face/mm 5.1-7.5 c Intmd rpr face/mm 12.6-20 c Intmd rpr face/mm 20.1-30.0 Intmd rpr face/mm >30.0 cm Cmplx rpr trunk addl 5cm/< Cmplx rpr s/a/l 1.1-2.5 cm Cmplx rpr s/a/l 2.6-7.5 cm Cmplx rpr f/c/c/m/n/ax/g/h/ Cmplx rpr f/c/c/m/n/ax/g/h/ Cmplx rpr e/n/e/l addl 5cm/ Wound prep f/n/hf/g Harvest cultured skin graft Skin pinch graft Epidrm a-grft f/n/hf/g addl Cult skin grft t/arm/leg Cult skin grft t/a/l addl Cult skin graft t/a/l +% Cult skin graft f/n/hf/g Cult skin grft f/n/hfg add Cult epiderm grft f/n/hfg + Skin full graft add-on Skin sub graft trnk/arm/leg Skn sub grft t/a/l child ad Skin sub graft face/nk/hf/g Skn sub grft f/n/hf/g ch ad Plastic surgery neck T 5.5162 $393.38

. Closure of split wound Cmplx rpr trunk 1.1-2.5 cm Cmplx rpr trunk 2.6-7.5 cmCmplx rpr f/c/c/m/n/ax/g/h/

Cmplx rpr e/n/e/l 1.0 cm/< Cmplx rpr e/n/e/l 1.1-2.5 c Cmplx rpr e/n/e/l 2.6-7.5 c Wound prep trk/arm/leg Wound prep addl 100 cm Wnd prep f/n/hf/g addl cm Epidrm autogrft trnk/arm/le Epidrm autogrft t/a/l add-o Skin full graft add-on Skin sub grft t/arm/lg chil Skn sub grft f/n/hf/g child Dermal filler inj px/suppl T 15.5878$1,111.61

. Reconstruction of nail bed Tis trnfr trunk 10 sq cm/< Tis trnfr trunk 10.1-30sqcm Tis trnfr s/a/l 10 sq cm/< Tis trnfr s/a/l 10.1-30 sqc Tis trnfr f/c/c/m/n/a/g/h/f Tis trnfr f/c/c/m/n/a/g/h/f Tis trnfr e/n/e/l 10 sq cm/ Tis trnfr e/n/e/l10.1-30sqc Epidrm a-grft face/nck/hf/g Derm autograft trnk/arm/leg Derm autograft t/a/l add-on Derm autograft face/nck/hf/ Derm autograft f/n/hf/g add Skin full graft trunk Skin full graft trunk add-o Skin full graft sclp/arm/le Skin full grft face/genit/h Skin full graft een & lips Skin full graft add-on Island pedicle flap graft Acellular derm matrix implt Remove sacrum pressure sore Remove thigh pressure sore Remove thigh pressure sore Remove thigh pressure sore Remove thigh pressure sore Removal of fascia for graft Removal of fascia for graft Removal of tissue for graft Amputation follow-up surger Amputation follow-up surger Revise pocket pacemakerRevise pocket for defib

Remove gastric port open T 21.1752$1,510.07

. Insert tissue expander(s) Late closure of wound Tis trnfr any 30.1-60 sq cm Tis trnfr addl 30 sq cm/< Filleted finger/toe flap Skin splt grft trnk/arm/leg Skin splt grft t/a/l add-on Skn splt a-grft fac/nck/hf/ Skn splt a-grft f/n/hf/g ad Skin pedicle flap trunk Skin pedicle flap arms/legs Pedcle fh/ch/ch/m/n/ax/g/h/ Pedicle e/n/e/l/ntroral Delay flap trunk Delay flap arms/legs Delay flap f/c/c/n/ax/g/h/f Delay flap eye/nos/ear/lip Transfer skin pedicle flap Forehead flap w/vasc pedicl Muscle-skin graft head/neck Muscle-skin graft trunk Muscle-skin graft arm Muscle-skin graft leg Neurovascular pedicle flap Composite skin graft Derma-fat-fascia graft Revision of lower eyelid Revision of lower eyelid Revision of upper eyelid Revision of upper eyelid Removal of forehead wrinkle Removal of neck wrinkles Removal of brow wrinkles Removal of face wrinkles Removal of skin wrinkles Nerve palsy fascial graft Nerve palsy muscle graft Nerve palsy microsurg graft Skin and muscle repair face Suction lipectomy head&neck Suction lipectomy trunk Suction lipectomy upr extre Suction lipectomy lwr extre Removal of tail bone ulcerRemove sacrum pressure sore

Remove sacrum pressure sore Remove sacrum pressure sore Remove hip pressure sore Remove hip pressure sore Remove hip pressure sore Explore wound chest Explore wound abdomen Remove cartilage for graft Remove cartilage for graft Revise gastric port open Change gastric port open Revision of ileostomy Revision of colostomy T 5.5931 $398.86

. Apply rem fixation device Closed tx vert fx w/o manj Treat clavicle dislocation Treat clavicle dislocation Treat clavicle dislocation Treat shoulder blade fx Treat dislocation/fracture Treat humerus fracture Treat radius fracture Treat fracture of radius Treat fracture of radius Treat fracture radius & uln Treat fracture radius/ulna Treat wrist bone fracture Manipulate finger w/anesth Manipulat palm cord post in Treat thumb fracture Treat thigh fracture Treat thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of ankle fracture T 11.7147 $835.41

. Comp ext fixate strut chang Closed tx vert fx w/manj Treat clavicle fracture Treat humerus fracture Treat humerus fracture Treat elbow fracture Manipulate wrist w/anesthes Treat wrist dislocation Treat metacarpal fracturePin knuckle dislocation

Treatment of thigh fracture Treat knee fracture Treatment of tibia fracture Cltx med ankle fx w/mnpj Treatment of fibula fractur Treat lower leg fracture Treat lower leg dislocation Treatment of heel fracture Treat foot dislocation T 6.7737 $483.05

. Dilate esophagus Dilate esophagus Dilate esophagus T 8.7424 $623.45 $138.69 Esophagus endoscopy Esophagus endoscopy biopsy Esoph scope w/sclerosis inj Uppr gi endoscopy diagnosis Uppr gi scope w/submuc inj Upper gi endoscopy biopsy Upper GI endoscopy with tub Upper gi endoscopy & inject Operative upper GI endoscop Uppr gi endoscopy/guide wir Esophagus surgery procedure Surgical opening of stomach Reposition gastrostomy tube Place gastrostomy tube Stomach surgery procedure T 10.5266 $750.68 $152.78 Small bowel endoscopy Small bowel endoscopy/biops Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy/biops Small bowel endoscopy Small bowel endoscopy Gi tract capsule endoscopy T 9.6941 $691.32 $186.06 Endoscopy of bowel pouch Endoscopy bowel pouch/biop Colonoscopy Colonoscopy with biopsy Colonoscopy for foreign bod Colonoscopy for bleeding Colonoscopy & polypectomyColonoscopy lesion removal

Colonoscopy w/snare Surgical colonoscopy Diagnostic colonoscopy Colonoscopy w/fb removal Colonoscopy and biopsy Colonoscopy submucous inj Colonoscopy/control bleedin Lesion removal colonoscopy Lesion remove colonoscopy Lesion removal colonoscopy Colonoscopy dilate strictur Colonoscopy w/endoscope us Colonoscopy w/endoscopic fn T 5.8940 $420.32

. Anoscopy hra w/biopsy Proctosigmoidoscopy dx Diagnostic sigmoidoscopy Sigmoidoscopy and biopsy Sigmoidoscopy w/fb removal Sigmoidoscopy & polypectomy Sigmoidoscopy w/submuc inj Anoscopy control bleeding T 10.0341 $715.56

. Proctosigmoidoscopy dilate Proctosigmoidoscopy w/bx Proctosigmoidoscopy removal Proctosigmoidoscopy removal Proctosigmoidoscopy removal Proctosigmoidoscopy bleed Sigmoidoscopy for bleeding Sigmoidoscopy & decompress Sigmoidoscopy w/tumr remove Sigmoidoscopy w/ablate tumr Sig w/balloon dilation Sigmoidoscopy w/ultrasound Sigmoidoscopy w/us guide bx Anoscopy and dilation Anoscopy and biopsy Anoscopy remove for body Anoscopy T 6.1609 $439.35

. Reduction of rectal prolaps Rectum surgery procedure Removal of rectal marker Incision of anal abscess Ligation of hemorrhoid(s)Injection into hemorrhoid(s

Destroy internal hemorrhoid Treatment of anal fissure Anus surgery procedure Place endorectal app T 25.6535$1,829.43

. Drainage of pelvic abscess Removal of anorectal lesion Excision of rectal strictur Excision of rectal lesion Exc rect tum transanal part Destruction rectal tumor Repair of rectum Placement of seton Incision of rectal abscess Removal of anal fissure Remove ext hem groups 2+ Remove int/ext hem 1 group Remove in/ex hem grp & fiss Remove in/ex hem grp w/fist Remove in/ex hem groups 2+ Remove in/ex hem grps & fis Remove in/ex hem grps w/fis Remove anal fist subq Remove anal fist inter Remove anal fist complex Remove anal fist 2 stage Repair of anal stricture Repr of anal fistula w/glue Reconstruction of anus Remove by ligat int hem grp Remove by ligat int hem grp T 33.1772$2,365.97

. Exc rectal tumor endoscopic Ligation hemorrhoid w/us Anoscopy w/rf delivery Exc rect tum transanal full Repair of rectum Correct rectal prolapse Repair of rectocele Repair anal fistula Repair anorectal fist w/plu Repair of anal sphincter Repair of anal sphincter Repair of anal sphincter Implant artificial sphincte Hemorrhoidopexy by staplingT 24.2214$1,727.30

.

Endo cholangiopancreatograp Endo cholangiopancreatograp Endo cholangiopancreatograp Endo cholangiopancreatograp Endo cholangiopancreatograp Endo cholangiopancreatograp Endo cholangiopancreatograp Endo cholangiopancreatograp Endo cholangiopancreatograp Endoscopic pancreatoscopy T 28.4347$2,027.76

. Incision of gallbladder Insert catheter bile duct Insert bile duct drain Biliary endoscopy thru skin Biliary endoscopy thru skin Biliary endoscopy thru skin Biliary endoscopy thru skin Remove bile duct stone Bile tract surgery procedur T 25.9781$1,852.58

. Unlisted procedure intestin Appendectomy Appendectomy add-on Excision of umbilicus Remove foreign body adbomen Revise abdomen-venous shunt Abdomen surgery procedure Place needles pelvic for rt T 34.0627$2,429.11

. Rpr hern preemie reduc Rpr ing hern premie blocked Rpr ing hernia baby reduc Rpr ing hernia baby blocked Rpr ing hernia init reduce Rpr ing hernia init blocked Prp i/hern init reduc >5 yr Prp i/hern init block >5 yr Rerepair ing hernia reduce Rerepair ing hernia blocked Repair ing hernia sliding Repair lumbar hernia Rpr rem hernia init reduce Rpr fem hernia init blocked Rerepair fem hernia reduce Rerepair fem hernia blockedRpr ventral hern init reduc

Rpr ventral hern init block Rerepair ventrl hern reduce Rerepair ventrl hern block Hernia repair w/mesh Rpr epigastric hern reduce Rpr epigastric hern blocked Rpr umbil hern reduc < 5 yr Rpr umbil hern block < 5 yr Rpr umbil hern reduc > 5 yr Rpr umbil hern block > 5 yr Repair spigelian hernia Repair umbilical lesion Removal of bladder cyst Removal of testis Exploration for testis Suspension of testis Orchiopexy (Fowler-Stephens Removal of hydrocele Removal of hydroceles Revise spermatic cord veins Revise hernia & sperm veins T 17.9329$1,278.85

. Drainage of rectal abscess Drainage of rectal abscess Biopsy of rectum Dilation of anal sphincter Dilation of rectal narrowin Remove rectal obstruction Surg dx exam anorectal Incision of rectal abscess Incision of rectal abscess Incision of anal septum Incision of anal sphincter Excise anal ext tag/papilla Removal of anal tags Removal of hemorrhoid clot Chemodenervation anal musc Removal of suture from anus Treatment of anal fissure Place cecostomy tube perc T 3.2577 $232.32

. Treatment of bladder lesion Simple cystometrogram Complex cystometrogram Cystometrogram w/up Cystometrogram w/vpCystometrogram w/vp&up

Dilate urethra stricture Preputial stretching Colon motility 6 hr study Anal pressure record S 2.5831 $184.21

. Colon CA screen;barium enem Colon ca scrn; barium enema T 8.5787 $611.77 $0.00 Colorectal scrn; hi risk in $0.00 Colon ca scrn not hi rsk in $0.00 S 5.8206 $415.08 $0.00 CA screen;flexi sigmoidscop $0.00 T 7.1482 $509.76

. Remove stent via transureth Remove renal tube w/fluoro Kidney endoscopy Kidney endoscopy & biopsy Renal scope w/tumor resect Kidney endoscopy Kidney endoscopy Kidney endoscopy & biopsy Endoscopy of ureter Endoscopy of ureter Ureter endoscopy Ureter endoscopy & catheter Incise bladder/drain ureter Cystoscopy Cystoscopy & duct catheter Cystoscopy and treatment T 15.8635$1,131.27

. Remove ureter stent percut Insert kidney drain Kidney endoscopy & treatmen Kidney endoscopy & treatmen Ureter endoscopy & biopsy Ureter endoscopy & treatmen Cystoscopy removal of clots Cystoscopy and treatment Cystoscopy & revise urethra Cystoscopy and treatment Cystoscopy and treatment Cystoscopy chemodenervation Cystoscopy and treatment Dilate urethra stricture X-ray control cath insert X-ray control cath insertX-ray guide gu dilation T 26.7673$1,908.86

.

Renal abscess open drain Change ureter stent percut Change stent via transureth Insert ureteral tube Create passage to kidney Kidney endoscopy Kidney endoscopy & treatmen Kidney endoscopy & treatmen Ureter endoscopy & biopsy Ureter endoscopy & treatmen Ureter endoscopy & treatmen Ureter endoscopy & treatmen Incise & treat bladder Incise & treat bladder Incise & drain bladder Removal of bladder stone Remove ureter calculus Removal of bladder lesion Repair of ureter lesion Repair of bladder wound Repair of bladder opening Cystoscopy & ureter cathete Cystoscopy and biopsy Cystoscopy w/biopsy(s) Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and radiotracer Cystoscopy & revise urethra Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Remove bladder stone Remove bladder stone Cystoscopy and treatment Cystoscopy stone removal Cystoscopy and treatment Cystoscopy and treatmentCreate passage to kidney

Cysto w/ureter stricture tx Cysto w/up stricture tx Cysto w/renal stricture tx Cysto/uretero stricture tx Cysto/uretero w/up strictur Cystouretero w/renal strict Cystouretero & or pyeloscop Cystouretero w/stone remove Cystouretero w/biopsy Cystouretero w/excise tumor Cystouretero w/congen repr Cystourethro cut ejacul duc Incision of prostate Revision of bladder neck Relieve bladder contracture Drainage of prostate absces Drainage of prostate absces Drainage of prostate absces Level IV Cystourethroscopy and other Genitourinary Procedures T 38.3814$2,737.09

. Kidney endoscopy Removal of ureter stone Cystoscopy implant stent Cystoscopy inject material Cystouretero w/lithotripsy Prostatectomy (TURP) Remove prostate regrowth Transperi needle place pros T 2.1419 $152.75

. Incise external hemorrhoid Measure kidney pressure Drain bladder by needle Irrigation of bladder Change of bladder tube Anal/urinary muscle study Intraabdominal pressure tes Dilate urethra stricture Insert prost urethral stent Treatment of penis lesion Treatment of penis lesion Penile injection Penis study T 19.7656$1,409.54

. Revise ureter Drain bl w/cath insertion Dilate urethra stricture Transurethral rf treatmentDynamic cavernosometry

Surgical exposure prostate T 21.5966$1,540.12

. Incision of urethra Incision of urethra Incision of urethra Incision of urethra Drainage of urethra abscess Drainage of urethra abscess Drainage of urinary leakage Drainage of urinary leakage Biopsy of urethra Removal of urethra Removal of urethra lesion Removal of urethra gland Treatment of urethra lesion Treatment of urethra lesion Removal of urethra gland Repair of urethra defect Revision of urethra Repair of urethra injury Repair of urethra injury Dilation of urethra Slitting of prepuce Slitting of prepuce T 33.2789$2,373.22

. Endoscopic injection/implan Removal of urethra Treatment of urethra lesion Removal of urethra lesion Surgery for urethra pouch Revise urethra stage 1 Revise urethra stage 2 Reconstruction of urethra Reconstruct urethra stage 1 Reconstruct urethra stage 2 Reconstruction of urethra Reconstruct urethra/bladder Remove/revise male sling Remove uro sphincter Repair uro sphincter Revision of urethra Urethrlys transvag w/ scope Repair of urethra injury Repair of urethra injury Repair of urethra defect T 39.8005$2,838.29 $979.42Fragmenting of kidney stone S 6.9597 $496.32

.

Hemodialysis one evaluation Unsched dialysis ESRD pt ho T 127.3348$9,080.63 $2,020.00 Laparo ablate liver tumor r Laparo ablate liver cryosur Laparo ablate renal mass S 6.0848 $433.93 $129.40 TTE w or w/o fol w/cont, f/ 2D TTE w or w/o fol w/con,c 2D TTE w or w/o fol w/con,f TEE w or w/o fol w/cont, mo S 8.1101 $578.36 $172.48 TTE w or w/o fol w/cont, co 2D TEE w or w/o fol w/con,i TEE w or w/o fol w/cont,con TTE w or w/o fol w/con,stre TTE w or wo fol wcon,Dopple TTE w or w/o contr, cont EC T 38.9199$2,775.49 $607.88 Penile venous occlusion Treatment of penis lesion Treat penis lesion graft Treat penis lesion graft Partial removal of penis Treatment of penis lesion Revision of penis Revision of penis Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Revise penis/urethra Revise penis/urethra Revise penis/urethra Secondary urethral surgery Secondary urethral surgery Secondary urethral surgery Reconstruct urethra/penis Penis plastic surgery Repair penis Repair penis Remove muti-comp penis prosRepair multi-comp penis pro

Remove self-contd penis pro Revision of penis Revision of penis Repair of penis Extensive testis surgery T 23.7942$1,696.84

. Circumcision w/regionl bloc Circumcision neonate Circum 28 days or older Lysis penil circumic lesion Repair of circumcision Frenulotomy of penis Biopsy of testis Excise lesion testis Removal of testis Orchiectomy partial Exploration for testis Reduce testis torsion Suspension of testis Revision of testis Repair testis injury Relocation of testis(es) Drainage of scrotum Remove epididymis lesion Remove epididymis lesion Removal of epididymis Removal of epididymis Explore epididymis Fusion of spermatic ducts Fusion of spermatic ducts Repair of hydrocele Explore scrotum Removal of scrotum lesion Removal of scrotum Revision of scrotum Revision of scrotum Incision of sperm duct Removal of sperm duct(s) Repair of sperm duct Ligation of sperm duct Removal of hydrocele Removal of sperm cord lesio Revise spermatic cord veins Incise sperm duct pouch Remove sperm pouch lesion T 13.5630 $967.22

.Biopsy of prostate

Biopsy of prostate Prostate saturation samplin T 1.6625 $118.56

. I & D of vulva/perineum Drainage of gland abscess Biopsy of vulva/perineum Exam of vulva w/scope Exam/biopsy of vulva w/scop Treat vagina infection Insert pessary/other device Treat vaginal bleeding Exam of cervix w/scope Cryocautery of cervix Biopsy of uterus lining Remove intrauterine device Fetal contract stress test Fetal non-stress test Transabdom amnioinfus w/us Insert cervical dilator T 3.2826 $234.09

. Electroejaculation Biopsy of vulva/perineum Ins vag brachytx device Exam of vagina w/scope Exam/biopsy of vag w/scope Bx/curett of cervix w/scope Biopsy of cervix w/scope Endocerv curettage w/scope Artificial insemination Artificial insemination Sperm washing Retrieval of oocyte Transfer of embryo Transfer of embryo Amniocentesis diagnostic Fetal cord puncture prenata Chorion biopsy Fetal scalp blood sample Umbilical cord occlud w/us Fetal fluid drainage w/us Fetal shunt placement w/us Abortion (mpr) T 23.5870$1,682.06 $424.28 Hysteroscopy dx sep proc Hysteroscopy biopsy Hysteroscopy lysisHysteroscopy remove fb

Hysteroscope procedure T 0.1157 $8.25 $1.73 Fitting of diaphragm/cap Genital surgery procedure Fetal invas px w/us Maternity care procedure Anogenital exam child Obtaining screen pap smear $0.00 T 6.9849 $498.11

. Drainage of pelvic fluid Biopsy of vagina Insert uteri tandem/ovoids Biopsy of cervix Endocervical curettage Amniocentesis therapeutic T 20.3967$1,454.55

. Surgery for vulva lesion Lysis of labial lesion(s) Hymenotomy Partial removal of vulva Complete removal of vulva Partial removal of hymen Remove vagina gland lesion Repair of vagina Repair clitoris Repair of perineum Exploration of vagina Drainage of pelvic abscess Destroy vag lesions simple Destroy vag lesions complex Biopsy of vagina Remove vagina wall partial Remove vagina lesion Remove vagina lesion Repair of vagina Repair vagina/perineum Revise vag graft via vagina Dilation of vagina Pelvic examination Remove vaginal foreign body Revise prosth vag graft lap Bx of cervix w/scope leep Conz of cervix w/scope leep Cauterization of cervix Laser surgery of cervix Conization of cervixConization of cervix

D&c of cervical stump Revision of cervix Revision of cervix Dilation of cervical canal Dilation and curettage Reopen fallopian tube Insert heyman uteri capsule Occlude fallopian tube(s) Drainage of ovarian cyst(s) Drain pelvic abscess percut Biopsy of ovary(s) D & c after delivery Episiotomy or vaginal repai Revision of cervix Obstetrical care Antepartum manipulation Deliver placenta Vbac delivery only Treatment of miscarriage Care of miscarriage Treatment of miscarriage Abortion Abortion Evacuate mole of uterus Remove cerclage suture T 37.0120$2,639.44

. Remove vagina tissue part Vaginectomy partial w/nodes Closure of vagina Repair of urethral lesion Repair bladder & vagina Repair rectum & vagina Repair of vagina Insert mesh/pelvic flr addo Repair of bowel bulge Revise/remove sling repair Repair bladder & vagina Construction of vagina Construct vagina with graft Repair rectum-vagina fistul Repair bladder-vagina lesio Repair bladder-vagina lesio Repair vagina Removal of cervix Removal of residual cervix Remove cervix/repair vaginaMyomectomy vag method

Vaginal hysterectomy Vag hyst including t/o Vag hyst w/t/o & vag repair Vag hyst w/enterocele repai Reopen fallopian tube Endometr ablate thermal Division of fallopian tube Create new tubal opening Drainage of ovarian cyst(s) Drain ovary abscess open Partial removal of ovary(s) Removal of ovarian cyst(s) Remove uterus lesion T 47.7547$3,405.53 $981.50 Repair bladder neck Revision of urethra Extensive repair of vagina Colpopexy extraperitoneal Colpopexy intraperitoneal Repair paravag defect open Repair paravag defect vag Repair bladder defect Repair urethrovaginal lesio Repair paravag defect lap Remove cervix repair bowel Vag hyst complex Vag hyst incl t/o complex Vag hyst t/o & repair compl Vag hyst w/enterocele compl Endometrial cryoablation Hysteroscopy sterilization T 12.0130 $856.68

. Treat trigeminal tract Epidural lysis mult session Epidural lysis on single da Treat spinal cord lesion Treat spinal canal lesion Inject spine w/cath lmb/scr Remove spinal canal cathete Removal of spinal shunt Injection treatment of nerv Injection treatment of nerv Destroy lumb/sac facet jnt Injection treatment of nerv Injection treatment of nerv T 2.5607 $182.61

.Njx paravert w/us cer/thor

Njx paravert w/us cer/thor Njx paravert w/us lumb/sac Njx paravert w/us lumb/sac Ther injection carp tunnel Inj dupuytren cord w/enzyme Inj tendon sheath/ligament Inj tendon origin/insertion Inj trigger point 1/2 muscl Inject trigger points 3/> Drain/inject joint/bursa Drain/inject joint/bursa Drain/inject joint/bursa Aspirate/inj ganglion cyst N block inj trigeminal N block inj facial N block inj vagus N block inj phrenic N block inj plantar digit Inj paravert f jnt c/t 2 le Inj paravert f jnt c/t 3 le Inj paravert f jnt l/s 2 le Inj paravert f jnt l/s 3 le N block spenopalatine gangl N block carotid sinus s/p Neuroeltrd stim post tibial Chemodenerv saliv glands Destroy nerve face muscle Chemodenerv musc migraine N block inj common digit Destroy c/th facet jnt addl Chemodenerv eccrine glands Chemodenerv eccrine glands Nervous system surgery T 4.0910 $291.74

. Njx tfrml eprl w/us cer/tho Njx tfrml eprl w/us lumb/sa Spinal fluid tap diagnostic Drain cerebro spinal fluid N block inj occipital N block inj spinal accessor N block inj cervical plexus N block inj brachial plexus N block inj axillary N block inj suprascapular N block inj intercost sng N block inj ilio-ing/hypogiN block inj paracervical

N block inj fem single N block other peripheral Inj foramen epidural add-on Inj foramen epidural add-on Destroy nerve neck muscle Destroy nerve extrem musc T 7.9333 $565.75

. Njx paravert w/us cer/thor Njx paravert w/us lumb/sac Njx tfrml eprl w/us cer/tho Njx tfrml eprl w/us lumb/sa Remove cranial cavity fluid Remove cranial cavity fluid Remove brain cavity fluid Injection into brain canal Remove brain canal fluid Injection into brain canal Replace/irrigate catheter Drain spinal cord cyst Inject epidural patch Treat spinal cord lesion Injection into disk lesion Injection into spinal arter Inject spine cerv/thoracic Inject spine lumbar/sacral Inject spine w/cath crv/thr N block cont infuse b plex N block inj intercost mlt N block inj pudendal N block inj sciatic sng N blk inj sciatic cont inf N block inj fem cont inf N block inj lumbar plexus Inj foramen epidural c/t Inj foramen epidural l/s Inj paravert f jnt c/t 1 le Inj paravert f jnt l/s 1 le N block stellate ganglion N block inj hypogas plxs N block lumbar/thoracic N block inj celiac pelus Injection treatment of nerv Destroy cerv/thor facet jnt Destroy l/s facet jnt addl Injection treatment of nerv Inj for sacroiliac jt anestT 52.7056$3,758.59

.

Perq lamot/lam crv/thrc Perq lamot/lam lumbar Remove part of neck vertebr Remove part thorax vertebra Remove part lumbar vertebra Remove extra spine segment Incis w/discectomy thoracic Neck spine fuse&remov bel c Neck spine fusion Lumbar spine fusion Spine fusion extra segment Cerv artific diskectomy Implant spinal canal cath Remove spine lamina 1/2 crv Remove spine lamina 1/2 thr Remove spine lamina 1/2 lmb Remove spine lamina 1/2 scr Remove lamina/facets lumbar Remove spine lamina >2 crvc Remove spine lamina >2 thrc Remove spine lamina >2 lmbr Neck spine disk surgery Low back disk surgery Spinal disk surgery add-on Laminotomy single cervical Laminotomy single lumbar Remove spine lamina 1 crvl Remove spine lamina 1 thrc Remove spine lamina 1 lmbr Remove spinal lamina add-on Decompress spinal cord thrc Decompress spinal cord lmbr Decompress spine cord add-o Decompress spinal cord thrc Decompress spine cord add-o Neck spine disk surgery Neck spine disk surgery S 11.3041 $806.13 $268.73 Polysom <6 yrs 4/> paramtrs Polysom <6 yrs cpap/bilvl Multiple sleep latency test Sleep study attended Polysom any age 1-3> param Polysom 6/> yrs 4/> param Polysom 6/>yrs cpap 4/> par Ambulatory eeg monitoringEEG monitoring/videorecord

EEG monitoring/computer Eeg monitor technol attende Pre-op service LVRS complet Pre-op service LVRS 10-15do S 2.4204 $172.61 $53.58 Remote 30 day ecg tech supp Slp stdy unattended Slp stdy unatnd w/anal Sleep study unatt&resp efft Eeg 41-60 minutes Eeg over 1 hour Eeg awake and drowsy Eeg awake and asleep Eeg coma or sleep only Eeg all night recording EEG monitoring/function tes Pre-op service LVRS 1-9 dos Post op service LVRS min 6 Home sleep test/type 2 Port Home sleep test/type 3 Port Home sleep test/type 4 Port S 0.6045 $43.11

. Physiologic tremor record Tempr Muscle test thor paraspinal Muscle test nonparaspinal Musc tst done w/n tst nonex Motor &/ sens nrve cndj tes Motor&/sens 1-2 nrv cndj ts Motor&/sens 3-4 nrv cndj ts Motor&/sens 5-6 nrv cndj ts Motor&sens 7-8 nrv cndj tes Blink reflex test Parasymp&symp hrt rate test Neurological procedure S 2.5805 $184.02

. Tcranial magn stim tx plan Tcranial magn stim tx deli Tcran magn stim redetemine Electrocochleography Auditor evoke potent compre Eeg cerebral death only Somatosensory testing Somatosensory testing Somatosensory testing Visual evoked potential tesSomatosensory testing

Electrode stimulation brain Electrode stim brain add-on Motion analysis video/3d Motion test w/ft press meas S 1.1195 $79.83

. Interrogate crtd sns dev Interrogate crtd sns w/pgrm Periph field stimul analys Motor function mapping ntms Auditor evoke potent limit Actigraphy testing Cholinesterase challenge Muscle test one limb Muscle test 2 limbs Muscle test 3 limbs Muscle test 4 limbs Muscle test larynx Muscle test hemidiaphragm Muscle test cran nerv unila Muscle test cran nerve bila Muscle test one fiber Limb exercise test Musc tst done w/nerv tst li Musc test done w/n test com Motor&sen 9-10 nrv cndj tes Motor&sen 11-12 nrv cnd tes Motor&sens 13/> nrv cnd tes Autonomic nrv parasym inerv Autonomic nrv adrenrg inerv Autonomic nrv syst funj tes Ans parasymp & symp w/tilt C motor evoked uppr limbs C motor evoked lwr limbs Neuromuscular junction test C motor evoked upr&lwr limb EEG monitoring/giving drugs Analyze neurostim no prog Analyze neurostim complex Cranial neurostim complex Io anal gast n-stim subsq Dynamic surface emg Dynamic fine wire emg T 18.8566$1,344.72

. Neurectomy hamstring Neurectomy popliteal Decompression of tibia nervNeurectomy foot

Treat trigeminal nerve Remove spinal cord lesion Stimulation of spinal cord Remove lesion of spinal cor Injection treatment of nerv Injection treatment of nerv Revise finger/toe nerve Revise hand/foot nerve Revise arm/leg nerve Revision of sciatic nerve Revision of arm nerve(s) Revise low back nerve(s) Revision of cranial nerve Revise ulnar nerve at elbow Revise ulnar nerve at wrist Carpal tunnel surgery Relieve pressure on nerve(s Release foot/toe nerve Internal nerve revision Incision of brow nerve Incision of cheek nerve Incision of chin nerve Incision of jaw nerve Incision of tongue nerve Incision of facial nerve Incise nerve back of head Incise diaphragm nerve Incision of pelvis nerve Incise hip/thigh nerve Sever cranial nerve Incision of spinal nerve Remove skin nerve lesion Remove digit nerve lesion Digit nerve surgery add-on Remove limb nerve lesion Limb nerve surgery add-on Remove nerve lesion Implant nerve end Remove skin nerve lesion Removal of nerve lesion Biopsy of nerve Sympathectomy cervical Remove sympathetic nerves Sympathectomy digital arter T 34.7984$2,481.58

. Rev/remvl crtd sns dev totaIncise skull/brain surgery

Incise skull for treatment Percutaneous diskectomy Remove spine infusion devic Remove vagus n eltrd Incise hip/thigh nerve Remove sciatic nerve lesion Removal of nerve lesion Repair of digit nerve Repair nerve add-on Repair of hand or foot nerv Repair of hand or foot nerv Repair of hand or foot nerv Repair nerve add-on Repair of leg nerve Repair/transpose nerve Repair arm/leg nerve Repair sciatic nerve Nerve surgery Repair of arm nerves Repair of low back nerves Repair of facial nerve Repair of facial nerve Fusion of facial/other nerv Subsequent repair of nerve Repair & revise nerve add-o Repair nerve/shorten bone Nerve graft head/neck </4 c Nerve graft head/neck >4 cm Nerve graft hand/foot </4 c Nerve graft hand/foot >4 cm Nerve graft arm/leg <4 cm Nerve graft arm/leg >4 cm Nerve graft hand/foot </4 c Nerve graft hand/foot >4 cm Nerve graft arm/leg </4 cm Nerve graft arm/leg >4 cm Nerve graft add-on Nerve graft add-on Nerve pedicle transfer Nerve pedicle transfer Nerve repair w/allograft Neurorraphy w/vein autograf T 45.5890$3,251.09

. Insert brain-fluid device Replace/revise brain shunt Implant spinal canal cathInsert spine infusion devic

Install spinal shunt Revision of spinal shunt T 197.8775$14,111.24

. Implant spine infusion pump Implant spine infusion pump T 121.3919$8,656.82

. Remove hepatic shunt (tips) Transcath iv stent percut Transcath iv stent/perc add Transcath iv stent open Transcath iv stent/open add Embolization uterine fibroi Iliac revasc w/stent Fem/popl revas w/ather Fem/popl revasc w/stent Tib/per revasc w/ather Tib/per revasc w/stent Tibper revasc w/ather add-o S 0.6788 $48.41

. Corneal hysteresis Clear eyelid gland w/heat Treat eyelid by injection Special eye evaluation Corneal topography Special eye evaluation Orthoptic/pleoptic training Visual field examination(s) Visual field examination(s) Cmptr ophth dx img ant segm Cmptr ophth img optic nerve Cptr ophth dx img post segm Glaucoma provocative tests Special eye exam initial Special eye exam subsequent Eye exam with photos Ophthalmoscopy/dynamometry Eye muscle evaluation Electro-oculography Color vision examination Dark adaptation eye exam Eye photography Contact lens fitting Rx corneoscleral cntact len Replacement of contact lens Fit spectacles single syste Fit spectacles compound lenAphakia prosth service temp

Eye service or procedure Glaucoma scrn hgh risk dire S 2.0317 $144.89

. Treatment of corneal lesion Inject/treat eye socket Remove eyelid foreign body Explore/irrigate tear ducts Eye exam with photos Icg angiography Electroretinography T 2.0304 $144.79 $30.45 Conjunctival drug placement Remove eye lesion Incision of iris Eye surgery procedure Ophth us b & quant a T 15.8380$1,129.46

. Remove foreign body from ey Removal of eye lesion Biopsy of cornea Removal of eye lesion Curette/treat cornea Correction of astigmatism Correction of astigmatism Cover eye w/membrane Cover eye w/membrane suture Incise inner eye adhesions Incise inner eye adhesions Injection treatment of eye Injection treatment of eye Follow-up surgery of eye Destruction ciliary body Ciliary transsleral therapy Destruction ciliary body Removal of lens material Revision of eyelid Remove eyelid lining lesion T 23.5107$1,676.62 $347.84 Implant corneal ring Scleral fistulization Insj ocular telescope prost Repair of eye wound Repair of eye wound Removal of eye lesion Drainage of eye Drainage of eyeRelieve inner eye pressure

Incision of eye Incise inner eye adhesions Incise inner eye adhesions Remove implant of eye Remove eye lesion Glaucoma surgery Glaucoma surgery Glaucoma surgery Glaucoma surgery Incision of eye Remove iris and lesion Removal of iris Removal of iris Repair iris & ciliary body Repair iris & ciliary body Ciliary endoscopic ablation Destruction ciliary body Reposition intraocular lens Revise eyelid lining Revise eyelid lining Revise eyelid lining Harvest eye tissue alograft T 5.8389 $416.39

. Remove foreign body from ey Treatment of retina Treatment of retinal lesion Treatment of choroid lesion Ocular photodynamic ther Eye photodynamic ther add-o Eye surgery procedure Dstry eye lesn,fdr vssl tec T 20.2224$1,442.12

. Suprachoroidal drug deliver Place intraoc radiation src Remove foreign body from ey Repair of eye wound Partial removal of eye flui Incise inner eye strands Repair detached retina Repair detached retina Release encircling material Remove eye implant material Treatment of retinal lesion Treatment of retinal lesion Reinforce/graft eye wall T 3.2499 $231.76

.Injection eye drug

Destroy nerve of eye muscle Inject/treat eye socket Inject/treat eye socket Orbit surgery procedure Drainage of eyelid abscess Remove eyelid lesion Remove eyelid lesions Biopsy eyelid & lid margin Revise eyelashes Revision of eyelid Incise/drain eyelid lining Eyelid lining surgery Incise/drain tear gland Incise tear duct opening Clearance of tear duct Revise tear duct opening Close tear duct opening Close tear duct opening Probe nasolacrimal duct Tear duct system surgery T 8.6336 $615.69

. Curette/treat cornea Incision of eyelid Remove eyelid lesions Revise eyelashes Remove eyelid lesion Treat eyelid lesion Closure of eyelid by suture Biopsy of eyelid lining Remove eyelid lining lesion T 19.1819$1,367.92 $294.00 Removal of ocular implant Repair of eye wound Revision of cornea Reinforce eye wall Explore/biopsy eye socket Explore/treat eye socket Aspiration orbital contents Incision of eyelid fold Remove eyelid lesion(s) Revise eyelashes Revision of eyelid Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defectRepair eyelid defect

Revise eyelid defect Revise eyelid defect Correction eyelid w/implant Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid wound Repair eyelid wound Revision of eyelid Revision of eyelid Revision of eyelid Reconstruction of eyelid Reconstruction of eyelid Reconstruction of eyelid Remove eyelid lining lesion Revise/graft eyelid lining Separate eyelid adhesions Incise/drain tear sac Biopsy of tear gland Biopsy of tear sac Remove tear gland lesion Repair tear ducts Probe nasolacrimal duct Probe nasolacrimal duct Probe nl duct w/balloon T 26.7000$1,904.06 $382.94 Revise ocular implant Insert ocular implant Insert ocular implant Revise ocular implant Explore/drain eye socket Explore/treat eye socket Revise eye socket implant Repair brow defect Repair eyelid defect Reconstruction of eyelid Revise/graft eyelid lining Revise/graft eyelid lining Revise/graft eyelid lining Revise/graft eyelid lining Removal of tear glandPartial removal tear gland

Removal of tear sac Remove tear gland lesion Create tear sac drain Create tear duct drain Create tear duct drain Close tear system fistula T 39.7223$2,832.72 $597.36 Revise eye Revise eye with implant Removal of eye Remove eye/insert implant Remove eye/attach implant Removal of eye Remove eye/revise socket Remove eye/revise socket Attach ocular implant Reinsert ocular implant Explr/decompress eye socket Explore/treat eye socket Explore/treat eye socket Explore/drain eye socket Explr/decompress eye socket Explore/biopsy eye socket Insert eye socket implant Decompress optic nerve T 25.2082$1,797.67 $412.25 Repair of eye socket wound Revise eye muscle Revise two eye muscles Revise eye muscle Revise two eye muscles Revise eye muscle(s) Revise eye muscle(s) add-on Eye surgery follow-up add-o Rerevise eye muscles add-on Revise eye muscle w/suture Eye suture during surgery Revise eye muscle add-on Release eye tissue Eye muscle surgery procedur T 41.6106$2,967.38 $794.86 Corneal transplant Corneal transplant Corneal transplant Corneal transplant Corneal trnspl endothelialOcular reconst transplant

Ocular reconst transplant Ocular reconst transplant T 24.2659$1,730.47 $490.32 Cataract surgery complex Cataract surg w/iol 1 stage Cataract surg w/iol 1 stage Insert lens prosthesis Exchange lens prosthesis T 5.7604 $410.79 $102.26 Laser surgery of eye Incise inner eye adhesions Revision of iris Revision of iris Removal of inner eye lesion After cataract laser surger Laser surgery eye strands Repair detached retina Treatment of retina Treatment of retinal lesion Treatment of retinal lesion Tr retinal les preterm inf T 29.3838$2,095.45 $499.26 Removal of lens material Removal of lens material Extraction of lens Extraction of lens T 1.0950 $78.09 $24.11 Prepare face/oral prosthesi Cranio/maxillofacial surger Closed tx nose fx w/o manj Reset dislocated jaw Head surgery procedure Neck/chest surgery procedur Control of nosebleed Control of nosebleed Control of nosebleed Repeat control of nosebleed Nasal surgery procedure Sinus surgery procedure Larynx surgery procedure Lip surgery procedure Mouth surgery procedure Repair tongue laceration Tongue and mouth surgery Dental surgery procedure Palate/uvula surgerySalivary surgery procedure

Control throat bleeding Control nose/throat bleedin Throat surgery procedure Outer ear surgery procedure Middle ear surgery procedur Inner ear surgery procedure Temporal bone surgery T 3.2225 $229.81

. Treat lower jaw fracture Drainage of nose lesion Drainage of nose lesion Release of nasal adhesions Irrigation maxillary sinus Biopsy of lip Incision of lip fold Biopsy of mouth lesion Excise oral mucosa for graf Repair mouth laceration Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Repair tongue laceration Drainage mouth roof lesion Repair palate Preparation palate mold Drainage of salivary gland Drainage of salivary gland Dilation of salivary duct Drainage of tonsil abscess Biopsy of external ear Inflate middle ear canal Inflate middle ear canal Incision of eardrum Ear and throat examination T 6.9913 $498.57 $99.78 Explore wound neck Injection of sinus tract Prepare face/oral prosthesi Interdental fixation Revision of jaw muscle/bone Closed tx orbit w/o manipul Closed tx orbit w/ manipulj Interdental wiring Intranasal biopsy Removal of nose polyp(s) Injection treatment of noseNasal sinus therapy

Irrigation sphenoid sinus Incision of windpipe Incision of windpipe Visualization of windpipe Repair lip Repair lip Repair lip Drainage of mouth lesion Repair mouth laceration Drainage of mouth lesion Incision of tongue fold Drainage of mouth lesion Biopsy of tongue Excision of tongue fold Repair tongue laceration Excision of gum flap Biopsy roof of mouth Drainage of salivary gland Incision of esophagus Drain thyroid/tongue cyst Clean out mastoid cavity Create eardrum opening Insert palate implants T 16.0895$1,147.39

. Ear cartilage graft Revision of eyelid Closed tx nose fx w/o stabl Closed tx nose fx w/ stablj Closed tx septal&nose fx Treat lower jaw fracture Treat lower jaw fracture Treat hyoid bone fracture Removal of intranasal lesio Insert nasal septal button Remove nasal foreign body Ablate inf turbinate superf Ablate inf turbinate submuc Partial excision of lip Partial excision of lip Excision of mouth lesion Excise/repair mouth lesion Excise lip or cheek fold Treatment of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Biopsy of tongueExcision of tongue lesion

Excision of tongue lesion Excision of tongue lesion Fixation of tongue Tongue to lip surgery Removal foreign body jawbon Excision of gum lesion Excision of gum lesion Excision lesion mouth roof Excision lesion mouth roof Excision of uvula Treatment mouth roof lesion Insertion palate prosthesis Removal of salivary stone Removal of salivary stone Closure of salivary fistula Dilation of salivary duct Drainage of throat abscess Biopsy of throat Biopsy of throat Biopsy of upper nose/throat Control nose/throat bleedin Biopsy of external ear cana Catheterize middle ear cana Incision of eardrum Remove ventilating tube Create eardrum opening Remove ear lesion Incise inner ear T 25.2377$1,799.78

. Excision of facial bone(s) Contour of face bone lesion Excise max/zygoma b9 tumor Remove exostosis mandible Remove exostosis maxilla Excise mandible lesion Removal of jaw bone lesion Mnpj of tmj w/anesth Prepare face/oral prosthesi Reconstruction of chin Reconstruction of chin Reconstruction of chin Augmentation lower jaw bone Reduction of forehead Reconst lwr jaw w/o fixatio Reconstr lwr jaw segment Rib cartilage graftRevision of jaw muscle/bone

Open tx nose fx uncomplicat Open tx nose fx w/skele fix Open tx nose & septal fx Open nasoethmoid fx w/ fixj Closed tx nose/jaw fx Opn tx dprsd zygomatic arch Treat dental ridge fracture Treat dental ridge fracture Reset dislocated jaw Hyoid myotomy & suspension Removal of nose polyp(s) Removal of intranasal lesio Revision of nose Removal of nose lesion Excise inferior turbinate Resect inferior turbinate Remove nasal foreign body Reconstruction of nose Revision of nose Repair of nasal septum Repair nasal septum defect Ther fx nasal inf turbinate Exploration maxillary sinus Exploration behind upper ja Removal of ethmoid sinus Removal of ethmoid sinus Removal of ethmoid sinus Removal of larynx lesion Incision of windpipe Incision of windpipe Surgery/speech prosthesis Repair windpipe opening Remove windpipe lesion Closure of windpipe lesion Repair of windpipe defect Revise windpipe scar Partial excision of lip Reconstruct lip with flap Partial removal of lip Removal foreign body mouth Excise/repair mouth lesion Excision of mouth lesion Reconstruction of mouth Reconstruction of mouth Drainage of mouth lesion Drainage of mouth lesionDrainage of mouth lesion

Place needles h&n for rt Excision of tongue lesion Excision of mouth lesion Partial removal of tongue Tongue suspension Reconstruction tongue fold Tongue base vol reduction Removal foreign body gum Excision gum each quadrant Excision of gum lesion Excision of gum lesion Excision of gum lesion Removal of gum tissue Treatment of gum lesion Repair gum Repair tooth socket Remove palate/lesion Repair palate Reconstruct cleft palate Repair palate Repair nose to lip fistula Drainage of salivary gland Removal of salivary stone Biopsy of salivary gland Excision of salivary cyst Drainage of salivary cyst Repair salivary duct Parotid duct diversion Biopsy of upper nose/throat Excise pharynx lesion Excision of neck cyst Remove tonsils and adenoids Remove tonsils and adenoids Removal of tonsils Removal of adenoids Removal of adenoids Removal of adenoids Excision of lingual tonsil Repair throat wound Surgical opening of throat Control throat bleeding Throat muscle surgery Repair esophagus opening Re-explore parathyroids Treat skull fracture Removal of external earExtensive ear canal surgery

Revise external ear Repair of eardrum Repair of eardrum Repair middle ear structure Repair middle ear structure Remove middle ear nerve Close mastoid fistula T 9.2948 $662.84

. Repair of eye wound Drainage of eye Incision of iris Removal of iris Incision secondary cataract Removal of lens lesion Extraction of lens T 45.9788$3,278.89

. Incision of jaw joint Excision of bone lower jaw Excise max/zygoma mal tumor Remove mandible cyst comple Excise lwr jaw cyst w/repai Remove maxilla cyst complex Excis uppr jaw cyst w/repai Removal of jaw joint Remove jaw joint cartilage Remove coronoid process Prepare face/oral prosthesi Prepare face/oral prosthesi Prepare face/oral prosthesi Prepare face/oral prosthesi Prepare face/oral prosthesi Prepare face/oral prosthesi Prepare face/oral prosthesi Prepare face/oral prosthesi Prepare face/oral prosthesi Prepare face/oral prosthesi Maxillofacial fixation Reconstruction of chin Augmentation lower jaw bone Reduction of forehead Reduction of forehead Lefort ii anterior intrusio Reconstruct orbit/forehead Reconstruct orbit/forehead Contour cranial bone lesion Reconst lwr jaw w/o graftReconstr lwr jaw w/advance

Reconstruct upper jaw bone Augmentation of facial bone Reduction of facial bones Face bone graft Lower jaw bone graft Reconstruction of jaw joint Reconstruction of jaw joint Reconstruction of jaw joint Reconstruction of lower jaw Reconstruction of jaw Reconstruction of jaw Reconstruction of jaw Reconstruction of jaw Reconstruction of orbit Revise eye sockets Revise eye sockets Revise eye sockets Revise eye sockets Augmentation cheek bone Revision orbitofacial bones Revision of eyelid Open nasoethmoid fx w/o fix Perq tx nasoethmoid fx Opn tx nasomax fx w/fixj Perq tx malar fracture Opn tx dprsd malar fracture Opn tx complx malar fx Opn tx orbit fx transantral Opn tx orbit fx periorbital Opn tx orbit fx combined Opn tx orbit periorbtl impl Opn tx orbit periorbt w/grf Opn tx orbit fx w/o implant Opn tx orbit fx w/implant Opn tx orbit fx w/bone grft Treat mouth roof fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Repair dislocated jaw Removal of nose lesion Partial removal of nose Removal of noseReconstruction of nose

Reconstruction of nose Revision of nose Revision of nose Revision of nose Revision of nose Repair nasal stenosis Repair nasal defect Repair nasal defect Repair upper jaw fistula Repair mouth/nose fistula Intranasal reconstruction Exploration maxillary sinus Explore sinus remove polyps Exploration sphenoid sinus Sphenoid sinus surgery Exploration of frontal sinu Exploration of frontal sinu Removal of frontal sinus Removal of frontal sinus Removal of frontal sinus Removal of frontal sinus Removal of frontal sinus Removal of frontal sinus Exploration of sinuses Diagnostic incision larynx Revision of larynx Removal of epiglottis Revision of larynx Revision of larynx Revision of larynx Reinnervate larynx Larynx nerve surgery Incision of windpipe Puncture/clear windpipe Repair windpipe opening Repair of windpipe Repair of windpipe Reconstruct lip with flap Repair cleft lip/nasal Repair cleft lip/nasal Repair cleft lip/nasal Repair cleft lip/nasal Repair cleft lip/nasal Reconstruction of mouth Reconstruction of mouth Reconstruction of mouthExcision of gum lesion

Gum graft Excision lesion mouth roof Repair palate pharynx/uvula Reconstruct cleft palate Reconstruct cleft palate Reconstruct cleft palate Reconstruct cleft palate Reconstruct cleft palate Lengthening of palate Lengthening of palate Excise parotid gland/lesion Excise parotid gland/lesion Excise parotid gland/lesion Excise parotid gland/lesion Excise submaxillary gland Excise sublingual gland Repair salivary duct Parotid duct diversion Parotid duct diversion Parotid duct diversion Ligation of salivary duct Drainage of throat abscess Excision of neck cyst Removal of tonsils Removal of adenoids Extensive surgery of throat Extensive surgery of throat Excision of tonsil tags Partial removal of pharynx Revision of pharyngeal wall Reconstruction of throat Removal of esophagus pouch Removal of thyroid Repeat thyroid surgery Removal of thyroid Explore parathyroid glands Removal of thymus gland Decompress eye socket Explore orbit/remove object Remove ear canal lesion(s) Rebuild outer ear canal Rebuild outer ear canal Exploration of middle ear Eardrum revision Mastoidectomy MastoidectomyRemove mastoid structures

Extensive mastoid surgery Extensive mastoid surgery Remove ear lesion Remove ear lesion Mastoid surgery revision Mastoid surgery revision Mastoid surgery revision Mastoid surgery revision Mastoid surgery revision Repair eardrum structures Rebuild eardrum structures Rebuild eardrum structures Repair eardrum structures Rebuild eardrum structures Rebuild eardrum structures Revise middle ear & mastoid Revise middle ear & mastoid Revise middle ear & mastoid Revise middle ear & mastoid Revise middle ear & mastoid Revise middle ear & mastoid Release middle ear bone Revise middle ear bone Revise middle ear bone Revise middle ear bone Remove mastoid air cells Remove/repair hearing aid Release facial nerve Release facial nerve Repair facial nerve Repair facial nerve Explore inner ear Explore inner ear Establish inner ear window Revise inner ear window Remove inner ear Remove inner ear & mastoid Incise inner ear nerve Release facial nerve Release inner ear canal Remove inner ear lesion T425.2643$30,326.87 $7,921.74 Implant cochlear device X 0.6443 $45.95

. X-ray eye for foreign body X-ray exam of jaw <4viewsX-ray exam of mastoids

X-ray exam of facial bones X-ray exam of nasal bones X-ray exam of eye sockets X-ray exam of sinuses X-ray exam pituitary saddle X-ray exam of skull X-ray exam of jaw joint X-ray exam of jaw joints X-ray head for orthodontia X-ray exam of neck X-ray exam of salivary glan Chest x-ray 1 view frontal Chest x-ray stereo frontal Chest x-ray 2vw frontal&lat Chest x-ray frnt lat lordot Chest x-ray frnt lat obliqu Chest x-ray special views X-ray exam ribs uni 2 views X-ray exam breastbone 2/>vw X-ray strenoclavic jt 3/>vw X-ray exam of spine 1 view X-ray exam neck spine 3/<vw X-ray exam trunk spine stan X-ray exam thorac spine 2vw X-ray exam thorac spine4/>v X-ray exam trunk spine 2 vw X-ray exam l-s spine 2/3 vw X-ray exam of pelvis X-ray exam of pelvis X-ray exam si joints X-ray exam si joints 3/> vw X-ray exam sacrum tailbone X-ray exam of collar bone X-ray exam of shoulder blad X-ray exam of shoulder X-ray exam of shoulder X-ray exam of shoulders X-ray exam of humerus X-ray exam of elbow X-ray exam of elbow X-ray exam of forearm X-ray exam of arm infant X-ray exam of wrist X-ray exam of wrist X-ray exam of hand X-ray exam of handX-ray exam of finger(s)

X-ray exam of hip X-ray exam of hip X-ray exam of pelvis & hips X-ray exam of thigh X-ray exam of knee 1 or 2 X-ray exam of knee 3 X-ray exam of knees X-ray exam of lower leg X-ray exam of leg infant X-ray exam of ankle X-ray exam of ankle X-ray exam of foot X-ray exam of foot X-ray exam of heel X-ray exam of toe(s) X-ray exam of abdomen X-ray exam of abdomen X-ray exam of abdomen X-ray nose to rectum Radiographic procedure X-ray stress view X-rays for bone age Joint survey single view Dxa bone density vert fx Level II Plain Film Except Teeth Including Bone Density Measurement X 0.9933 $70.84

. X-ray exam of jaw 4/> views X-ray exam of mastoids X-ray exam of middle ear X-ray exam of facial bones X-ray exam of eye sockets X-ray exam of sinuses X-ray exam of skull Chest x-ray 4/> views X-ray exam unilat ribs/ches X-ray exam ribs bil 3 views X-ray exam ribs/chest4/> vw X-ray exam spine ap&lat X-ray exam neck spine 4/5vw X-ray exam neck spine 6/>vw X-ray exam thorac spine 3vw X-ray exam scloiosis erect X-ray exam l-2 spine 4/>vws X-ray exam l-s spine bendin X-ray bend only l-s spine X-ray exam of hips X-ray exam knee 4 or moreX-ray exam series abdomen

X-ray measurement of pelvis Nonvascular shunt x-ray X-ray exam of body section X-rays bone length studies X-rays bone survey limited X-rays bone survey complete X-rays bone survey infant Single energy x-ray study $0.00 X 0.5031 $35.88

. X-ray exam of teeth X-ray exam of teeth Full mouth x-ray of teeth Panoramic x-ray of jaws X 3.5823 $255.46

. X-ray exam of tear duct Contrast x-ray of larynx X-ray exam of salivary duct X-ray exam of peritoneum X-ray bile ducts/pancreas X-ray exam of kidney lesion X-ray female genital tract X-ray exam of fistula Complex body section x-ray Complex body section x-rays X-ray of mammary duct X-ray of mammary ducts S 0.9054 $64.57 $22.26 Echo exam of head Echo exam of eye Echo exam of eye Us exam chest Us exam breast(s) Ob us < 14 wks addl fetus Ob us detailed addl fetus Ob us nuchal meas 1 gest Ob us nuchal meas add-on Ob us limited fetus(s) Ob us follow-up per fetus Transvaginal us obstetric Umbilical artery echo Middle cerebral artery echo Echo exam of fetal heart Echo exam of fetal heart Us exam pelvic limited Us xtr non-vasc lmtd Us exam infant hips dynamicUs exam infant hips static

Ultrasound exam follow-up Echo examination procedure Intracranial limited study S 1.3928 $99.32 $37.23 Ophth us quant a only Ophth us b w/non-quant a Echo exam of eye water bath Echo exam of eye Us exam of head and neck Us exam abdom complete Echo exam of abdomen Us exam abdo back wall comp Us exam abdo back wall lim Us exam k transpl w/doppler Us exam spinal canal Ob us < 14 wks single fetus Ob us >/= 14 wks sngl fetus Ob us >/= 14 wks addl fetus Fetal biophys profile w/nst Fetal biophys profil w/o ns Transvaginal us non-ob Us exam pelvic complete Us exam scrotum Us transrectal Us xtr non-vasc complete Tcd vasoreactivity study Tcd emboli detect w/o inj Tcd emboli detect w/inj Lower extremity study Upper extremity study Extremity study Vascular study Doppler flow testing Ultrasound exam AAA screen $0.00 S 2.1699 $154.74 $59.55 Pseudoaneurysm injection tr Intravascular us Ob us detailed sngl fetus Echo exam uterus Echograp trans r pros study GI endoscopic ultrasound Extracranial bilat study Extracranial uni/ltd study Intracranial complete study Lower extremity study Upper extremity studyExtremity study

Vascular study Vascular study Vascular study Penile vascular study Penile vascular study Vessel mapping hemo access S 5.4757 $390.49

. Echo transthoracic Tte w/doppler complete Tte w/o doppler complete Echo transesophageal Echo transesophageal Stress tte only S 7.8339 $558.66 $128.73 Echo transthoracic Echo transesophageal Echo transesophageal Echo transesophageal intrao Stress tte complete X 1.6023 $114.26 $30.47 Nasal/orogastric w/stent Dx duod intub w/asp spec Dx duod intub w/asp specs Throat x-ray & fluoroscopy Speech evaluation complex Chest x-ray and fluoroscopy Chest x-ray&fluoro 4/> view Fluoroscope examination Cine/video x-rays Fluoroscopic procedure S 7.1179 $507.60

. Contrast x-ray of brain Contrast x-ray of brain Myelography neck spine Myelography thoracic spine Myelography l-s spine Myelogphy 2/> spine regions S 4.1881 $298.67 $68.90 X-ray exam of jaw joint Contrast x-ray of shoulder Contrast x-ray of elbow Contrast x-ray of wrist Contrast x-ray of hip Contrast x-ray of knee join Contrast x-ray of ankle S 1.1600 $82.72 $32.84Contrst x-ray exam of throa

Contrast x-ray esophagus Cine/vid x-ray throat/esoph X-ray exam of small bowel X-ray exam of small bowel Contrast x-ray gallbladder Contrast x-rays gallbladder S 1.7222 $122.82 $46.51 Fluoro exam of g/colon tube X-ray upper gi delay w/o ku X-rayupper gi delay w/kub X-ray upper gi&small intest Contrst x-ray uppr gi tract Contrst x-ray uppr gi tract Contrst x-ray uppr gi tract X-ray exam of small bowel Contrast x-ray exam of colo Contrast x-ray exam of colo Contrast x-ray exam of colo S 2.9385 $209.55 $58.44 Contrst x-ray urinary tract Contrst x-ray urinary tract Contrst x-ray urinary tract Contrst x-ray urinary tract Contrst x-ray urinary tract Contrast x-ray bladder X-ray male genital tract X-ray exam of penis X-ray urethra/bladder X-ray urethra/bladder X-ray exam of perineum S 31.1279$2,219.82

. Place cath thoracic aorta Place cath carotid/inom art Place cath carotid/inom art Place cath subclavian art Ins cath ren art 1st unilat Ins cath ren art 1st bilat Ins cath ren art 2nd+ unila Ins cath ren art 2nd+ bilat Contrast exam thoracic aort Contrast exam thoracic aort Contrast exam abdominl aort X-ray aorta leg arteries Artery x-rays arm Artery x-rays spine Artery x-rays arm/legArtery x-rays arms/legs

Artery x-rays abdomen Artery x-rays adrenal gland Artery x-rays adrenals Artery x-rays pelvis Artery x-rays lung Artery x-rays lungs Vein x-ray spleen/liver Vein x-ray trunk Vein x-ray kidney Vein x-ray kidneys Vein x-ray adrenal gland Vein x-ray adrenal glands Vein x-ray liver w/hemodyna Vein x-ray liver w/hemodyna Vein x-ray liver Venous sampling by catheter S 50.9080$3,630.40

. Place cath carotd art Place cath vertebral art S 1.3864 $98.87 $32.94 CAT scan follow-up study Ct procedure S 4.1669 $297.15 $95.46 Ct head/brain w/dye Ct orbit/ear/fossa w/dye Ct maxillofacial w/dye Ct soft tissue neck w/dye Ct thorax w/dye Ct neck spine w/dye Ct chest spine w/dye Ct lumbar spine w/dye Ct pelvis w/dye Ct upper extremity w/dye Ct lower extremity w/dye Ct abdomen w/dye Ct colonography dx w/dye Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast S 6.3741 $454.56 $146.59 Mri orbit/face/neck w/dye Mr angiography head w/dye Mr angiography neck w/dye Mri brain stem w/dye Mri brain w/dye Mri chest w/dye Mri neck spine w/dye Mri chest spine w/dye Mri lumbar spine w/dyeMri pelvis w/dye

Mri upper extremity w/dye Mri joint upr extrem w/dye Mri lower extremity w/dye Mri joint of lwr extr w/dye Mri abdomen w/dye MRA w/cont, abd MRI w/cont, breast, uni MRI w/cont, breast, bi MRA w/cont, chest MRA w/cont, lwr ext MRA w/cont, pelvis MRA, w/dye, spinal canal MRA, w/dye, upper extremity S 1.0359 $73.87 $0.00 Ct bone density axial $0.00 Dxa bone density axial $0.00 T 123.3630$8,797.39

. Revise cornea with implant S 5.5027 $392.41

. Special radiation treatment Hyperthermia treatment Hyperthermia treatment Hyperthermia treatment Hyperthermia treatment Hyperthermia treatment S 1.3392 $95.50

. Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Apply surface radiation S 2.5173 $179.52

. Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Radiation treatment deliver Neutron beam tx simple Neutron beam tx complex Infuse radioactive material X 2.8292 $201.76 $66.95 Radiation treatment aid(s)Radiation treatment aid(s)

Radiation treatment aid(s) X 1.5387 $109.73 $34.63 Set radiation therapy field Radiation therapy planning Radiation therapy dose plan Teletx isodose plan simple Teletx isodose plan interme Brachytx isodose calc simp Special radiation dosimetry Radiation physics consult Radiation physics consult External radiation dosimetr X 4.0804 $290.99 $88.78 Set radiation therapy field Set radiation therapy field Teletx isodose plan complex Special teletx port plan Brachytx isodose calc inter Brachytx isodose plan compl Design mlc device for imrt S 14.8096$1,056.12

. Heart muscle imaging (PET) Heart image (pet) single Heart image (pet) multiple Brain imaging (PET) Pet image ltd area Pet image skull-thigh Pet image full body Pet image w/ct lmtd Pet image w/ct skull-thigh Pet image w/ct full body X 13.8052 $984.49 $325.27 Ins mark thor for rt perq Ins mark abd/pel for rt per Place rt device/marker pros Set radiation therapy field Radiotherapy dose plan imrt Place device/marker, non pr S 5.7609 $410.83

. Apply intrcav radiat simple Apply intrcav radiat interm Apply intrcav radiat compl Apply interstit radiat simp Apply interstit radiat inte Radium/radioisotope therapy S 9.6431 $687.68 $259.86Hdr elect brachytherapy

Hdr brachytx 1 channel Hdr brachytx 2-12 channel Hdr brachytx over 12 chan S288.8990$20,602.25

. Implant neurostim arrays X 4.5159 $322.04

. Contrast x-ray of bile duct Lymph vessel x-ray arm/leg Lymph vessel x-ray arms/leg Lymph vessel x-ray trunk Lymph vessel x-ray trunk X-ray exam breast specimen Parathyrd planar w/wo subtr Parathyrd planar w/spect&ct S359.7987$25,658.32 $9,121.76 Periph field stimul perm Inc for vagus n elect impl T204.6785$14,596.24 $5,559.48 Fem/popl revasc stnt & athe Tib/per revasc stent & athe S 6.1511 $438.65

. Electroconvulsive therapy S 1.1619 $82.86

. Psytx pt&/family 30 minutes Psychiatric service/therapy S 1.5448 $110.16

. Psych diagnostic evaluation Psych diag eval w/med srvcs Psytx pt&/family 45 minutes Psytx pt&/family 60 minutes Psytx crisis initial 60 min Psychoanalysis Narcosynthesis Hypnotherapy S 1.7979 $128.21

. Family psytx w/o patient Family psytx w/patient S 0.8506 $60.66

. Multiple family group psytx Group psychotherapy S 7.5832 $540.78

. Comprehensve oral evaluatio Intraoral occlusal film Extraoral first film Extraoral ea additional fil Dental bitewing single imagDental bitewings two images

Bitewings four images Vert bitewings 7 to 8 image Pulp vitality test Space maintainer fxd unilat Fixed bilat space maintaine Remove unilat space maintai Remove bilat space maintain Recement space maintainer Dental unspec restorative p Endodontic endosseous impla Endodontic procedure Osseous surgery 4 or more Bone replce graft first sit Bone replce graft each add Surgical revision procedure Pedicle soft tissue graft p Subepithelial tissue graft Full mouth debridement Localized delivery antimicr Facial moulage sectional Facial moulage complete Radiation applicator Radiation shield Radiation cone locator Commissure splint Dental connector bar Extraction coronal remnants Extraction erupted tooth/ex Rem imp tooth w mucoper flp Impact tooth remov soft tis Impact tooth remov part bon Impact tooth remov comp bon Impact tooth rem bony w/com Tooth root removal Oral antral fistula closure Primary closure sinus perf Transseptal fiberotomy Reshaping bone orthognathic Other drugs/medicaments Treatment of complications Dental occlusal guard Occlusion analysis Limited occlusal adjustment Complete occlusal adjustmen S 4.2917 $306.05 $118.33 Ct abd & pelvisS 2.4340 $173.58 $67.11

Ct head/brain w/o dye Ct orbit/ear/fossa w/o dye Ct maxillofacial w/o dye Ct soft tissue neck w/o dye Ct thorax w/o dye Ct neck spine w/o dye Ct chest spine w/o dye Ct lumbar spine w/o dye Ct pelvis w/o dye Ct upper extremity w/o dye Ct lower extremity w/o dye Ct abdomen w/o dye Ct colonography dx S 4.6182 $329.34 $114.38 Ct head/brain w/o & w/dye Ct orbit/ear/fossa w/o&w/dy Ct maxillofacial w/o & w/dy Ct sft tsue nck w/o & w/dye Ct thorax w/o & w/dye Ct neck spine w/o & w/dye Ct chest spine w/o & w/dye Ct lumbar spine w/o & w/dye Ct pelvis w/o & w/dye Ct uppr extremity w/o&w/dye Ct lwr extremity w/o&w/dye Ct abdomen w/o & w/dye S 6.7671 $482.58 $155.52 Ct angio abd&pelv w/o&w/dye Ct abd & pelv w/contrast Ct abd & pelv 1/> regns Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast S 4.7466 $338.49 $133.38 Magnetic image jaw joint Mri orbit/face/neck w/o dye Mr angiography head w/o dye Mr angiography neck w/o dye Mri brain stem w/o dye Fmri brain by tech Fmri brain by phys/psych Mri brain w/o dye Mri chest w/o dye Mri neck spine w/o dye Mri chest spine w/o dye Mri lumbar spine w/o dye Mri pelvis w/o dye Mri upper extremity w/o dye Mri joint upr extrem w/o dyMri lower extremity w/o dye

Mri jnt of lwr extre w/o dy Mri abdomen w/o dye Cardiac mri for morph Cardiac mri w/stress img Mri procedure Magnetic image bone marrow MRA w/o cont, abd MRI w/o cont, breast, uni MRI w/o cont, breast, bi MRA w/o cont, chest MRA w/o cont, lwr ext MRA w/o cont, pelvis MRA, w/o dye, spinal canal MRA, w/o dye, upper extr Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast f S 7.7051 $549.47 $197.64 Mri orbt/fac/nck w/o &w/dye Mr angiograph head w/o&w/dy Mr angiograph neck w/o&w/dy Mri brain stem w/o & w/dye Mri brain w/o & w/dye Mri chest w/o & w/dye Mri neck spine w/o & w/dye Mri chest spine w/o & w/dye Mri lumbar spine w/o & w/dy Mri pelvis w/o & w/dye Mri uppr extremity w/o&w/dy Mri joint upr extr w/o&w/dy Mri lwr extremity w/o&w/dye Mri joint lwr extr w/o&w/dy Mri abdomen w/o & w/dye Cardiac mri for morph w/dye Card mri w/stress img & dye MRA w/o fol w/cont, abd MRI w/o fol w/cont, brst, u MRI w/o fol w/cont, breast, MRA w/o fol w/cont, chest MRA w/o fol w/cont, lwr ext MRA w/o fol w/cont, pelvis MRA, w/o&w/dye, spinal cana MRA, w/o&w/dye, upper extr X 0.6961 $49.64

. Chd risk imt study Remote algorithm analys ecg Anoscopy hra w/spec collect Njx platelet plasma Implant hormone pellet(s)Insert drug implant device

Remove drug implant device Remove/insert drug implant Dressing change not for bur Test for blood flow in graf Place needle wire breast Place breast clip percut Removal of fixation device Us bone stimulation Remove nasal foreign body Removal foreign body mouth Remove pharynx foreign body Tx gastro intub w/asp Dx gastr intub w/asp spec Diagnostic anoscopy Insert bladder catheter Insert temp bladder cath Urine flow measurement Us urine capacity measure Clear outer ear canal Remove impacted ear wax Ct hrt w/o dye w/ca test Us bone density measure $0.00 Cbt 1st hour Cbt each addl hour Car seat/bed test 60 min Car seat/bed test + 30 min Non-cov surg proc,clin tria Non-cov proc, clinical tria Bone marrow aspirate &biops Fecal microbiota prep insti X 0.0957 $6.82 $2.09 Touch quant sensory test Vibrate quant sensory test Cool quant sensory test Heat quant sensory test Nos quant sensory test Skin test candida Skin test nos antigen Coccidioidomycosis skin tes Histoplasmosis skin test TB intradermal test X 0.1782 $12.71

. Lab pathology consultation Phys blood bank serv xmatch Cell enumeration & id Cell enumeration phys interCytopath smear other source

Cytopath smear other source Cytp fna eval ea addl Flowcytometry/tc add-on Cytopathology procedure Cytogenetic study Surgical path gross Decalcify tissue Microslide consultation Path consult introp Path consult intraop addl Intraop cyto path consult 2 Xm archive tissue molec ana Optical endomicroscpy inter Surgical pathology procedur Chct for mal hyperthermia Pathology lab procedure Unlisted reprod med lab pro X 0.5342 $38.10 $10.84 Bone marrow interpretation Cytopath eval fna report Cell marker study Tissue exam by pathologist Microslide consultation Immunohistochemistry Immunofluorescent study Analysis skeletal muscle Analysis nerve Analysis tumor Tumor immunohistochem/manua Tumor immunohistochem/compu Insitu hybridization (fish) Insitu hybridization auto Collect sweat for test Sperm isolation simple Sperm isolation complex Assist oocyte fertilization X 0.8477 $60.45 $15.56 Cryopreservation ovary tiss Cryopreservation oocyte Tissue exam by pathologist Comprehensive review of dat Nerve teasing preparations Insitu hybridization manual Cultr oocyte/embryo <4 days Cultr oocyte/embryo <4 days Embryo hatchingOocyte identification

Prepare embryo for transfer Cryopreservation embryo(s) Identify sperm tissue Insemination of oocytes Extended culture of oocytes Assist oocyte fertilization Biopsy oocyte polar body Biopsy oocyte polar body Cryopreserve testicular tis Storage/year embryo(s) Storage/year sperm/semen Storage/year reprod tissue Storage/year oocyte(s) Thawing cryopresrved embryo Thawing cryopresrved sperm Thaw cryoprsvrd reprod tiss Thawing cryopresrved oocyte X 0.2519 $17.96

. RBC antibody screen Autologous blood op salvage Blood type antigen donor ea Blood typing patient serum Blood typing rbc antigens Blood typing rh phenotype Compatibility test spin Compatibility test incubate Compatibility test electric Plasma fresh frozen Blood product/irradiation Leukacyte transfusion Vol reduction of blood/prod Rbc pretx incubatj w/chemic Rbc pretx incubatj w/enzyme Rbc pretx incubatj w/densit Rbc serum pretx id dilution Split blood or products Transfusion procedure X 0.3504 $24.99

. RBC antibody elution Compatibility test antiglob Pooling blood platelets Rbc pretreatment serum X 0.4810 $34.30

. RBC antibody identification Autologous blood process Frozen blood prepFrozen blood thaw

Frozen blood freeze/thaw Rbc serum pretx incubj drug Rbc serum pretx incubj/inhi S 0.3788 $27.01 $0.00 Admin influenza virus vac $0.00 Admin pneumococcal vaccine $0.00 X 1.9249 $137.27 $33.59 Esoph imped function test Esoph balloon distension ts Breath hydrogen test Electrogastrography Electrogastrography w/test Gastroenterology procedure Ingest challenge addl 60 mi X 4.2433 $302.60 $83.23 Esoph motility 3d topograph Esoph motility w/stim/perf Esophagus motility study Esophgl motil w/stim/perfus Gastric motility studies Duodenal motility study Acid perfusion of esophagus Gastroesophageal reflux tes G-esoph reflx tst w/electro Esoph imped funct test > 1h Gi wireless capsule measure Ingest challenge ini 120 mi X 0.9156 $65.29 $16.12 Nasal function studies Facial nerve function test Spontaneous nystagmus test Positional nystagmus test Optokinetic nystagmus test Oscillating tracking test Evoked auditory test limite Evoked auditory tst complet X 0.5032 $35.88

. Tympanometry & reflex thres Pure tone audiometry air Speech threshold audiometry Speech audiometry complete Loudness balance test Tone decay hearing test Sisi hearing test Stenger test pure tone TympanometryAcoustic refl threshold tst

Filtered speech hearing tes Sensorineural acuity test Synthetic sentence test Select picture audiometry Ear protector evaluation Ent procedure/service X 1.2424 $88.60 $18.04 Compre audiometry evaluatio Audiometry air & bone Comprehensive hearing test Bekesy audiometry diagnosis Acoustic immitance testing Visual audiometry (vra) Conditioning play audiometr Auditory function 60 min Tinnitus assessment Aud brainstem implt program X 1.6401 $116.96 $23.43 Staggered spondaic word tes Stenger test speech Cochlear implt f/up exam <7 Reprogram cochlear implt 7/ Cochlear implt f/up exam 7/ Reprogram cochlear implt 7/ Eval aud rehab status X 0.6318 $45.06 $11.97 Spirometry up to 2 yrs old Spirmtry w/brnchdil inf-2 y Vital capacity test Lung function test (MBC/MVV Expired gas collection Respiratory flow volume loo CO2 breathing response curv Exhaled air analysis Pulm funct tst plethysmogra Pulm function test by gas Pulm funct test oscillometr Pulmonary compliance study Pulmonary service/procedure Exhaled nitric oxide meas X 0.8816 $62.87 $20.93 Temperature gradient studie Breathing capacity test Patient recorded spirometry Patient recorded spirometry Hypoxia response curveHast w/report

Hast w/oxygen titrate Pulmonary stress test/simpl Co/membane diffuse capacity Bronchial allergy tests X 2.5221 $179.86 $36.55 Cont msr bronchodil wheeze Meas lung vol thru 2 yrs Evaluation of wheezing Pulm stress test/complex Exhaled air analysis o2 Exhaled air analysis o2/co2 Exhaled carbon dioxide test Breath recording infant Bronchial allergy tests X 1.3347 $95.18

. Photosensitivity tests Eye allergy tests Rapid desensitization X 1.2128 $86.49

. Psycho testing by technicia Psycho testing admin by com Developmental test extend Neuropsych tst admin w/comp S 9.5309 $679.68

. Ht muscle image spect sing Ht muscle image spect mult Ht muscle image planar sing Ht musc image planar mult S 4.7173 $336.40 $126.64 Lung ventilat&perfus imagin Lung perf&ventilat diferent X 0.3478 $24.80

. Percut allergy skin tests Perq & icut allg test venom Perq&ic allg test drugs/bio Icut allergy test drug/bug Icut allergy titrate-airbor Icut allergy test-delayed Allergy patch tests Photo patch test Nose allergy test Allergy immunology services X 2.4863 $177.31

. Psycho testing by psych/phy Neurobehavioral status exam Neuropsych tst by psych/phyNeuropsych testing by tec S 3.7468 $267.20

.

Ct hrt w/3d image Ct hrt w/3d image congen Ct angio hrt w/3d image T 29.6863$2,117.02

. Esophagus endoscopy Uppr gi endoscopy w/stent Endo cholangiopancreatograp Endo cholangiopancreatograp Small bowel endoscopy/stent S bowel endoscope w/stent Ileoscopy w/stent Colonoscopy w/stent Proctosigmoidoscopy w/stent Sigmoidoscopy w/stent Colonoscopy w/stent S107.0677$7,635.32

. Male sling procedure Insert tandem cuff Insert semi-rigid prosthesi S175.4934$12,514.96

. Insert uro/ves nck sphincte Remove/replace ur sphincter Insert self-contd prosthesi Insert multi-comp penis pro Remove/replace penis prosth Remv/repl penis contain pro T 37.5259$2,676.08 $654.35 Hysteroscopy resect septum Hysteroscopy remove myoma Hysteroscopy ablation S 24.2728$1,730.97

. Discography cerv/thor spine X-ray of lower spine disk S 1.5990 $114.03 $26.88 Thyroid uptake measurement Urinary bladder retention Nuclear diagnostic exam S 2.1040 $150.04 $47.69 Thyroid imaging w/blood flo Endocrine nuclear procedure S 3.2664 $232.94 $65.46 Thyroid imaging w/blood flo Parathyroid planar imaging S 2.7567 $196.59

. Ra tracer id of sentinl nodPlatelet survival kinetics

Platelet survival Vit B-12 absorption exam Vit b-12 absrp exam int fac Vit b-12 absorp combined Kidney function study Iv inj ra drug dx study S 6.1109 $435.79

. T-cell depletion of harvest Tumor cell deplete of harvs Rbc depletion of harvest Platelet deplete of harvest Volume deplete of harvest Harvest stem cell concentrt Plasma volume single Plasma volume multiple Red cell mass single Red cell mass multiple Blood volume Red cell survival study Red cell survival kinetics Red cell sequestration S 4.4086 $314.39 $90.78 Liver imaging Liver imaging with flow Liver imaging (3D) Liver image (3d) with flow Liver and spleen imaging Liver & spleen image/flow Hepatobiliary system imagin Hepatobil syst image w/drug S 3.6004 $256.76 $87.01 Salivary gland imaging Serial salivary imaging Salivary gland function exa Esophageal motility study Gastric mucosa imaging Gastroesophageal reflux exa Gastric emptying study Acute GI blood loss imaging GI protein loss exam Meckels divert exam Leveen/shunt patency exam GI nuclear procedure S 3.6694 $261.68 $94.20 Bone imaging limited area Bone imaging multiple areasBone imaging whole body

Bone imaging 3 phase Bone imaging (3D) Musculoskeletal nuclear exa S 4.6411 $330.97

. Follow-up angiography Vascular flow imaging Acute venous thrombus image Venous thrombosis imaging Ven thrombosis images bilat Non-ophthalmic FVA S 4.3329 $308.99 $93.33 Non-imaging heart function Cardiac shunt imaging Heart infarct image Heart infarct image (ef) Heart infarct image (3D) Gated heart planar single Gated heart multiple Heart first pass single Heart first pass multiple Heart image spect Cardiovascular nuclear exam S 3.9257 $279.95 $90.90 Bone marrow imaging ltd Bone marrow imaging mult Bone marrow imaging body Spleen imaging Lymph system imaging Blood/lymph nuclear exam S 3.0984 $220.96 $71.16 Lung ventilation imaging Lung perfusion imaging Lung perfusion differential Respiratory nuclear exam S 6.4272 $458.34

. Brain image w/flow < 4 view Brain image w/flow 4 + view Brain imaging (3D) Cerebrospinal fluid scan CSF ventriculography Cerebrospinal fluid scan CSF leakage imaging S 3.7033 $264.09 $72.42 Brain image < 4 views Brain image 4+ views Brain flow imaging onlyCSF shunt evaluation

Nuclear exam of tear flow Nervous system nuclear exam S 4.6683 $332.91 $81.55 Kidney imaging morphol Kidney imaging with flow K flow/funct image w/o drug K flow/funct image w/drug K flow/funct image multiple Kidney imaging (3D) Ureteral reflux study Testicular imaging w/flow Genitourinary nuclear exam S 4.2080 $300.09 $85.06 Thyroid met imaging Thyroid met imaging/studies Thyroid met imaging body Tumor imaging limited area S 3.3193 $236.71 $78.13 Nuclear rx oral admin Nuclear rx iv admin Nuclr rx interstit colloid Nuclear rx intra-arterial Nuclear medicine therapy S 13.4001 $955.60

. Adrenal cortex & medulla im Tumor imaging whole body X 0.1356 $9.67 $2.17 Coombs test direct Coombs test indirect qual Coombs test indirect titer Blood typing abo Blood typing rh (d) S 6.7828 $483.70

. Delivery comp imrt Radiation tx delivery imrt S 4.2209 $301.01

. Nuclear rx intracav admin Hematopoietic nuclear tx Nuclear rx intra-articular S 7.0469 $502.54

. Tumor imaging mult areas Tumor imaging whole body Tumor imaging (3D) Abscess imaging ltd area Abscess imaging whole body Nuclear localization/abscesT 22.0465$1,572.20 $357.09

Bronchoscopy w/markers Bronchoscopy/needle bx each Bronchoscopy dilate/fx repr Bronchoscopy dilate w/stent Bronch w/balloon occlusion Bronchoscopy bronch stents Bronchoscopy revise stent Bronchoscopy w/tumor excise Bronchoscopy treat blockage Bronchial valve init insert Bronchial valve addl insert Bronchial valve remov addl Bronch thermoplsty 1 lobe Bronch thermoplsty 2/> lobe T 12.9960 $926.78 $207.70 Esoph scope w/submucous inj Esophagus endoscopy/ligatio Esoph optical endomicroscop Esophagus endoscopy Esophagus endoscopy Esoph endoscopy dilation Esoph endoscopy dilation Esoph endoscopy repair Esoph endoscopy w/us exam Esoph endoscopy w/us fn bx Endoscopic us exam esoph Uppr gi endoscopy w/us fn b Esoph endoscope w/drain cys Uppr gi endoscopy w/us fn b Upper GI endoscopy/ligation Uppr gi scope dilate strict Place gastrostomy tube Esoph endoscopy dilation Upper GI endoscopy/tumor Operative upper GI endoscop Uppr gi opticl endomicrscop Operative upper GI endoscop Operative upper GI endoscop Endoscopic ultrasound exam Dilate esophagus Biopsy of bowel Place gastrostomy tube perc Place duod/jej tube perc Change g-tube to g-j perc Esophageal capsule endoscop T 26.1852$1,867.35

.Esophagus endoscopy/lesion

Esoph endoscopy ablation Uppr gi scope w/thrml txmnt Place gastrostomy tube Repair stomach opening EPS stomach plic T 56.7444$4,046.61

. Perq rf ablate tx pul tumor Percut ablate liver rf Biliary endoscopy thru skin Perc rf ablate renal tumor Perc cryo ablate renal tum T 15.5387$1,108.11 $240.83 Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy T 134.6442$9,601.88

. Reconstruct shoulder joint Revis reconst shoulder join Reconstruct elbow joint Replace elbow joint Reconstruct head of radius Revise reconst elbow joint Revise reconst elbow joint Reconstruct wrist joint Reconstruct wrist joint Wrist replacement Revision of knee joint Implant temple bone w/stimu Temple bne implnt w/stimula Temple bone implant revisio Revise temple bone implant S 2.6522 $189.14

. Application of body cast Application of body cast Application of body cast Application of body cast Application of body cast Application of shoulder cas Application of long arm cas Application of forearm cast Application of hip cast Application of hip castsApplication of long leg cas

Application of long leg cas Apply long leg cast brace Application of long leg cas Apply short leg cast Apply short leg cast Apply short leg cast Apply rigid leg cast Removal/revision of cast T 16.8497$1,201.60

. Change bile duct catheter Revise/reinsert bile tube Exchange drainage catheter Insert subq exten to ip cat Embedded ip cath exit-site Change ext/int ureter stent Change kidney tube Change of ureter tube/stent Replace/irrigate catheter T 21.4711$1,531.17

. Proctosigmoidoscopy fb Proctosigmoidoscopy ablate Proctosigmoidoscopy volvul Anoscopy remove lesion Anoscopy remove lesions Anoscopy T 45.7285$3,261.04

. Removal of kidney stone Removal of kidney stone Laser surgery of prostate Laser surgery of prostate Prostate laser enucleation Prostatic microwave thermot Prostatic rf thermotx S 0.6290 $44.86

. Assess hlth/behave init Assess hlth/behave subseq Intervene hlth/behave indiv Interv hlth/behav fam w/pt Alcohol/subs interv 15-30mn Alcohol/subs interv >30 min Tobacco-use counsel>10min $0.00 Annual alcohol screen 15 mi $0.00 Brief alcohol misuse counse $0.00 Depression screen annual $0.00 High inten beh couns STD 30 $0.00 Intens behave ther cardio d $0.00Behavior counsel obesity 15 $0.00

Devlopment test interpt&rep X 0.3285 $23.43 $5.17 Lab pathology consultation Phys blood bank serv reactj Phys blood bank serv authrj Cytopath fl nongyn smears Cytopath fl nongyn filter Cytopath concentrate tech Cytopath cell enhance tech Forensic cytopathology Cytopath smear other source Cytp dx eval fna 1st ea sit Flowcytometry/ tc 1 marker Flowcytometry/read 2-8 Flowcytometry/read 9-15 Flowcytometry/read 16 & > Tissue exam by pathologist Tissue exam by pathologist Special stains group 1 Special stains group 2 Histochemical stains add-on Enzyme histochemistry Path consult intraop 1 bloc Intraop cyto path consult 1 Immunofluorescent study Sputum specimen collection Sperm identification Cryopreservation sperm T 167.9170$11,974.67

. Transcath closure of asd Transcath closure of vsd S 0.3788 $27.01

. Immunization admin each add Immune admin oral/nasal Immune admin oral/nasal add Immunotherapy one injection Immunotherapy injections Antigen therapy services Antigen therapy services Hydrate iv infusion add-on Ther/proph/diag iv inf addo Ther/prop/diag inj/inf proc Chemotherapy unspecified Admin hepatitis b vaccine $0.00 S 0.5487 $39.13

. Immunization adminAntigen therapy services

Antigen therapy services Antigen therapy services Antigen therapy services Tx/proph/dg addl seq iv inf Sc ther infusion addl hr Sc ther infusion reset pump Ther/proph/diag inj sc/im Ther/proph/diag inj ia Ther/proph/diag inj iv push Tx/pro/dx inj new drug addo Chemo anti-neopl sq/im Chemo hormon antineopl sq/i Chemo intralesional up to 7 Chemo iv infusion addl hr S 1.0473 $74.69

. Antigen therapy services Antigen therapy services Hydration iv infusion init Chemo iv push addl drug Chemo iv infus each addl se Chemo ia push tecnique Chemo ia infuse each addl h Chemotherapy injection S 2.0507 $146.24

. Spin/brain pump refil & mai Spin/brain pump refil & mai Ther/proph/diag iv inf init Sc ther infusion up to 1 hr Chemo intralesional over 7 Chemo iv push sngl drug Chemotherapy intracavitary Chemotx admn prtl cavity Refill/maint portable pump Refill/maint pump/resvr sys S 3.2322 $230.50

. Chemo iv infusion 1 hr Chemo prolong infuse w/pump Chemo ia infusion up to 1 h Chemotherapy infusion metho Chemotherapy into cns Prolonged IV inf, req pump S 27.5195$1,962.50

. Admin + supply, tositumomab V 0.7960 $56.77

. Office/outpatient visit new Office/outpatient visit estCA screen;pelvic/breast exa $0.00

Initial foot exam pt lops Followup eval of foot pt lo V 1.0332 $73.68

. Eye exam establish patient Eye exam&tx estab pt 1/>vst Office/outpatient visit new Office/outpatient visit est Office/outpatient visit est Init nb em per day hosp Same day nb discharge Trans care mgmt 14 day disc V 1.3596 $96.96

. Eye exam new patient Eye exam new patient Glucose monitoring cont Office/outpatient visit new Office/outpatient visit est Trans care mgmt 7 day disch Initial preventive exam $0.00 Visit for drug monitoring V 1.8017 $128.48

. Office/outpatient visit new Office/outpatient visit est Demonstrate use home inr mo Provide INR test mater/equi V 2.4650 $175.79

. Dialysis one evaluation Office/outpatient visit new OPPS Service,sched team con Direct refer hospital obser V 0.7266 $51.82 $12.04 Emergency dept visit V 1.2923 $92.16 $20.80 Emergency dept visit V 2.0103 $143.36 $33.60 Emergency dept visit V 3.2164 $229.37 $47.70 Emergency dept visit V 4.8338 $344.71 $71.54 Emergency dept visit S 7.5142 $535.86

. Critical care first hour S 12.8233 $914.47

. Trauma Respons w/hosp criti T 11.0230 $786.08

. Insert non-tunnel cv cathInsert non-tunnel cv cath

Insert picc cath Insert picc cath Repair tunneled cv cath Replace cvad cath Replace picc cath Removal tunneled cv cath Mech remov tunneled cv cath Reposition venous catheter Thrombolytic art therapy Thrombolytic venous therapy T 24.5972$1,754.10

. Insert tunneled cv cath Insert tunneled cv cath Insert picvad cath Insert picvad cath Replace tunneled cv cath Replace tunneled cv cath Replace picvad cath Mech remov tunneled cv cath Thromblytic art/ven therapy Cessj therapy cath removal T 31.2425$2,228.00

. Insertion of infusion pump Insert tunneled cv cath Insert tunneled cv cath Insert tunneled cv cath Insert tunneled cv cath Insert tunneled cv cath Replace tunneled cv cath Replace tunneled cv cath Insertion catheter artery Redo endovas vena cava filt Rem endovas vena cava filte Remove intrvas foreign body Transcatheter biopsy X 0.6889 $49.13 $12.39 Draw blood off venous devic Collect blood from picc Vascular surgery procedure Irrig drug delivery device Phlebotomy V 0.9504 $67.78

. Lev 1 hosp type B ED visit V 0.7589 $54.12

. Lev 2 hosp type B ED visit V 1.2605 $89.89

.Lev 3 hosp type B ED visit V 1.9113 $136.30

.

Lev 4 hosp type B ED visit V 2.9070 $207.31

. Lev 5 hosp type B ED visit T 63.9715$4,562.00

. Place po breast cath for ra Place breast cath for rad Place breast rad tube/caths Enlarge breast with implant Delayed breast prosthesis Breast reconstruction S 12.2772 $875.52

. Apply interstit radiat comp T 31.6784$2,259.08

. Insert pleural cath Insert tun ip cath perc Ins tun ip cath for dial op T 37.4589$2,671.31

. Repair defect of artery Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Percut thrombect av fistula T 108.1809$7,714.70

. Insert pulse gen dual leads Insert pulse gen mult leads Remv&replc pm gen dual lead Remv&replc pm gen mult lead Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker or Pacing T 142.8432$10,186.58

. Insrt heart pm atrial & ven Upgrade of pacemaker system Insert pacing lead & connec L ventric pacing lead add-o T 108.8606$7,763.18

. Perc drug-el cor stent sing Perc drug-el cor stent bran Perc d-e cor stent ather s Perc d-e cor stent ather br Perc d-e cor revasc t cabg Perc d-e cor revasc t cabg Perc d-e cor revasc w AMI s Perc d-e cor revasc chro si Perc d-e cor revasc chro ad S 1.5109 $107.75

. HYPERBARIC Oxygen X 1.8519 $132.06 $27.10Laryngeal function studies

Basic vestibular evaluation Caloric vestibular test Sinusoidal rotational test Posturography X 2.2023 $157.05

. Cytp urne 3-5 probes ea spe Cytp urine 3-5 probes cmptr Tissue exam by pathologist Electron microscopy Scanning electron microscop Sat biopsy 10-20 Sat biopsy prostate 21-40 Sat biopsy prostate 41-60 Sat biopsy prostate: >60 S 4.7570 $339.24 $114.37 Ct angiography head Ct angiography neck Ct angiography chest Ct angiograph pelv w/o&w/dy Ct angio upr extrm w/o&w/dy Ct angio lwr extr w/o&w/dye Ct angio abdom w/o & w/dye Ct angio abdominal arteries S 15.9383$1,136.61

. Proton trmt simple w/o comp Proton trmt simple w/comp S 0.4941 $35.24 $0.00 Dxa bone density/peripheral $0.00 S 9.5685 $682.36

. Proton trmt intermediate Proton treatment complex T 10.0404 $716.01

. Access av dial grft for eva Artery x-rays lung Artery x-rays chest Av dialysis shunt imaging Vein x-ray arm/leg Vein x-ray arms/legs Vein x-ray chest Vein x-ray neck Vein x-ray skull Vein x-ray skull epidural Vein x-ray eye socket Vein x-ray liver w/o hemody T 40.8587$2,913.76

. Prosth retina receive&genRepair of eye wound

Repair eye lesion Partial removal of eye flui Release of eye fluid Replace eye fluid Implant eye drug system Removal of inner eye fluid Laser treatment of retina Laser treatment of retina Vit for macular pucker Vit for macular hole Vit for membrane dissect Repair detached retina Repair detached retina Rerepair detached retina Repair retinal detach cplx Remove eye implant material T 41.7586$2,977.93 $635.64 Insert ant segment drain in Insert ant segment drain ex Insert aqueous drain device Remove blood clot from eye Glaucoma surgery Translum dil eye canal Trnslum dil eye canal w/stn Implant eye shunt Revise eye shunt Repair/graft eye lesion Removal of iris T 109.7287$7,825.08

. Cryoablate prostate T 2.4212 $172.66

. Declot vascular device Inj w/fluor eval cv device External cannula declotting Thrombolytic therapy stroke Change gastrostomy tube Dissolve clot heart vessel T 1.3951 $99.49

. Extrnl counterpulse, per tx S 5.6047 $399.69 $95.30 Cardioversion electric ext Cardioversion electric int S 82.6392$5,893.25

. Implant pat-active ht recor S 2.4161 $172.30

. Photochemotherapy uv-a or bT 10.0060 $713.56

.

Needle biopsy chest lining Percut bx lung/mediastinum Needle biopsy of liver Needle biopsy pancreas Biopsy abdominal mass Renal biopsy perq Drainage of kidney lesion Needle biopsy spinal cord T 21.1894$1,511.08 $389.48 Implt/rpl crtd sns dev lead Rev/remvl crtd sns dev lead Periph field stimul revise Laps rmvl nstim array vagus Revise/remove neuroelectrod Remove spine eltrd perq ara Remove spine eltrd plate Revise/remove neuroelectrod Revision/Removal of Neurostimulator Pulse Generator Receiver T 36.4346$2,598.26 $768.94 Rev/remvl crtd sns dev gen Laps rmvl vgl arry & pls ge Rmvl vagus nerve pls gen Revise/remove neuroreceiver Revise/remove neuroreceiver Revise/rmv pn/gastr stimul S 0.4761 $33.95

. Acoustic ecg 1+ analysis Acoustic ecg analy & reprog Icar ischm mntrng prgrm eva icar ischm mntr interr eval Elec alys vagus nrv pls gen Implt subq defib interogat Implt subq defib sys dev ev Pm device progr eval sngl Pm device progr eval dual Pm device progr eval multi Icd device progr eval 1 sng Icd device progr eval dual Icd device progr eval mult Ilr device eval progr Pm device eval in person Icd device interrogate Ilr device interrogate Wcd device interrogate Pm phone r-strip device eva Pm/icd remote tech serv Icm/ilr remote tech servAnalyze pacemaker system

Set-up cardiovert-defibrill S 2.6879 $191.68

. Csf shunt reprogram Analyze spine infus pump Analyze sp inf pump w/repro Anal sp inf pmp w/reprg&fil Anl sp inf pmp w/mdreprg&fi S 1.5631 $111.47

. Ecg/monitoring and analysis Interrogation vad in person Analyze neurostim simple Analyze neurostim complex Cranial neurostim complex Analyze neurostim brain/1h Analyz neurostim brain addo Io ga n-stim subsq w/reprog T 5.1585 $367.87 $88.07 Mohs 1 stage h/n/hf/g Mohs addl stage Mohs 1 stage t/a/l Mohs addl stage t/a/l Mohs surg addl block S 2.9820 $212.66

. Echo exam of fetal heart Echo exam of fetal heart Tte f-up or lmtd S 1.0386 $74.07

. Ocular blood flow measure Remove foreign body from ey Remove foreign body from ey Remove foreign body from ey Remove foreign body from ey Corneal smear Revise eyelashes Treatment of eyelid lesions Dilate tear duct opening Visual field examination(s) Ophthalmic biometry Eye exam with photos Internal eye photography Internal eye photography Contact lens fitting Contact lens fitting Rx cntact lens aphakia 1 ey Rx cntact lens aphakia 2 ey Modification of contact lenFit aphakia spectcl monofoc

Fit aphakia spectcl multifo Repair & adjust spectacles Glaucoma scrn hgh risk dire T 15.8683$1,131.62

. Biopsy eye muscle Remove eyelid lining lesion New eye exam & treatment Eye exam & treatment K $1,071.86

. Sr89 strontium K $159.00

. Dexrazoxane HCl injection K $268.91

. Filgrastim 300 mcg injectio K $31.59

. Sargramostim injection K $14.84

. Ampho b cholesteryl sulfate K $14.83

. Amphotericin b liposome inj K $204.73

. Rasburicase K $259.14

. Chlorothiazide sodium inj K $157.86

. Mechlorethamine hcl inj K $578.93

. Dactinomycin injection K $2.85

. Naltrexone, depot form K $663.95

. Leuprolide acetate /3.75 MG K $52.17

. Etoposide oral 50 MG K $1,246.98

. Aldesleukin injection K $116.81

. Bcg live intravesical vac K $166.01

. Goserelin acetate implant K $175.76

. Carmustine injection K $63.21

. Asparaginase, NOS K $19.19

. Daunorubicin injectionK $243.80

.

Daunorubicin citrate inj K $6.69

. Docetaxel injection K $122.65

. Nelarabine injection K $52.39

. Floxuridine injection K $12.25

. Gemcitabine hcl injection K $30.49

. Ifosfamide injection K $100.00

. Idarubicin hcl injection K $101.68

. Cosyntropin injection NOS K $19.06

. Interferon alfa-2b inj K $2,517.90

. Interferon gamma 1-b inj K $1,312.54

. Inj melphalan hydrochl 50 M K $84.88

. Fludarabine phosphate inj K $5,890.00

. Pegaspargase injection K $946.92

. Pentostatin injection K $659.72

. Rituximab injection K $274.16

. Streptozocin injection K $175.30

. Thiotepa injection K $19,325.78

. Porfimer sodium injection K $28.24

. Inj cladribine per 1 MG K $5.98

. Leuprolide acetate injecito K $36.22

. Mitoxantrone hydrochl / 5 M K $6.29

. Oral aprepitant K $92.25

. Hyalgan/supartz inj per dos K $12.22

.Synvisc or Synvisc-One K $151.09

.

Euflexxa inj per dose K $169.91

. Orthovisc inj per dose K $83.77

. Rho d immune globulin inj K $144.62

. Azathioprine parenteral K $646.10

. Lymphocyte immune globulin K $41.99

. Alglucerase injection K $3.97

. Alpha 1 proteinase inhibito K $5.47

. Injection,onabotulinumtoxin K $1,013.87

. Cytomegalovirus imm IV /via K $243.35

. Interferon beta-1b / .25 MG K $16,960.00

. Ganciclovir long act implan K $109.40

. Adenosine injection K $0.90

. Factor viii K $1.11

. Factor viii recombinant NOS K $1.03

. Factor ix complex K $1.63

. Anti-inhibitor K $0.94

. Factor IX non-recombinant K $1.24

. Factor IX recombinant K $233.37

. Gamma globulin > 10 CC inj K $27.55

. Capecitabine, oral, 500 mg K $33.21

. Octagam injection K $37.62

. Gammagard liquid injection K $5.19

. Rhophylac injectionK $52.14

.

Hepagam b im injection G $34.43

. Flebogamma injection K $38.28

. Gamunex-C/Gammaked R 1.0129 $72.23

. Frozen plasma, pooled, sd R 2.3815 $169.83

. Whole blood for transfusion K $224.75

. Reclast injection R 1.1028 $78.64

. Cryoprecipitate each unit R 2.7097 $193.24

. RBC leukocytes reduced R 1.0591 $75.53

. Plasma, frz between 8-24hou R 0.2848 $20.31

. Plasma protein fract,5%,50m R 1.2846 $91.61

. Platelets, each unit R 2.4626 $175.62

. Plaelet rich plasma unit R 2.1285 $151.79

. Red blood cells unit R 4.1562 $296.39

. Washed red blood cells unit K $22.63

. Albumin (human),5%, 50ml K $60.67

. Albumin (human), 5%, 250 ml K $30.24

. Albumin (human), 25%, 20 ml K $69.20

. Albumin (human), 25%, 50ml R 0.6613 $47.16

. Plasmaprotein fract,5%,250m R 1.9121 $136.36

. Blood split unit R 2.1939 $156.45

. Platelets leukoreduced irra R 3.8309 $273.19

. RBC leukoreduced irradiated R 0.9531 $67.97

. Cryoprecipitatereducedplasm R 2.5982 $185.29

.Blood, l/r, cmv-neg R 10.8739 $775.45

.

Platelets, hla-m, l/r, unit R 1.6595 $118.34

. Platelets leukocytes reduce K $129.42

. Injection glatiramer acetat R 1.7169 $122.44

. Blood, l/r, froz/degly/wash R 4.7192 $336.54

. Plt, aph/pher, l/r, cmv-neg R 2.4667 $175.91

. Blood, l/r, irradiated R 9.4536 $674.16

. Plate pheres leukoredu irra R 9.2615 $660.47

. Plt, pher, l/r cmv-neg, irr R 5.1700 $368.69

. RBC, frz/deg/wsh, l/r, irra R 4.0183 $286.56

. RBC, l/r, cmv-neg, irrad K $88.60

. Pralidoxime chloride inj K $6.63

. Injection, voriconazole K $40.70

. I131 iodide cap, rx K $456.38

. Adalimumab injection K $1,646.18

. Denileukin diftitox inj K $10.67

. Temozolomide K $52.14

. Hepagam b intravenous, inj K $13.59

. Protein c concentrate K $16,172.58

. Supprelin LA implant K $11.23

. I131 iodide sol, rx K $523.87

. Cytarabine liposome inj K $1.61

. Inj, epirubicin hcl, 2 mg K $53.51

. Temsirolimus injectionK $21.90

.

Busulfan injection K $10.16

. Verteporfin injection K $127.00

. Octreotide injection, depot K $0.93

. Antihemophilic viii/vwf com K $35.14

. Inj IVIG privigen 500 mg K $87.15

. Dimethyl sulfoxide 50% 50 M K $22.90

. Mitomycin injection K $1,006.27

. Valrubicin injection K $1.91

. Levoleucovorin injection K $12.00

. Inj iron dextran K $83.93

. Topotecan oral K $108.65

. Rotavirus vacc 2 dose oral K $38.06

. Apligraf K $7.78

. Oasis wound matrix K $7.78

. Oasis burn matrix K $20.97

. Integra BMWD K $11.40

. Integra DRT K $42.57

. Dermagraft K $98.39

. Graftjacket K $25.17

. Integra matrix K $37.76

. Primatrix K $442.20

. Cymetra injectable K $442.20

. Graftjacket xpress K $1,176.14

.Integra flowable wound matr K $6.87

.

Gammagraft K $3.57

. Triamcinolone A inj PRS-fre K $3.04

. Antithrombin iii injection K $1.10

. Xyntha inj K $32.21

. Alloderm K $3.04

. Acetylcysteine injection K $201.40

. Edetate calcium disodium in K $12.72

. Vivaglobin, inj K $2,948.92

. Corticotropin injection K $1.56

. Bevacizumab injection K $10.19

. Alloskin K $6.95

. AbobotulinumtoxinA K $24.09

. Rilonacept injection K $7,919.26

. Sm 153 lexidronam K $2.99

. Degarelix injection K $0.64

. Ferumoxytol, non-esrd K $5.31

. Oral busulfan G $89.41

. Canakinumab injection K $7.29

. Hizentra injection K $41.74

. Imuglucerase injection K $2.75

. Olanzapine long-acting inj K $103.35

. Antithrombin recombinant K $75.95

. Methyl aminolevulinate, topK $81.77

.

Oral fludarabine phosphate K $37.51

. Collagenase, clost hist inj K $152.43

. Amobarbital 125 MG inj K $2.87

. Matristem micromatrix K $73.04

. Ganciclovir sodium injectio K $6.06

. Gonadorelin hydroch/ 100 mc K $22.29

. Theraskin K $2.38

. Oxacillin sodium injeciton K $1.25

. Anidulafungin injection K $3.13

. Topotecan injection K $4.40

. Matristem wound matrix K $0.88

. Wilate injection G $38.32

. Belimumab injection K $2.70

. Hydroxyprogesterone caproat K $88.27

. Itraconazole injection K $29.74

. Inj protirelin per 250 mcg K $0.53

. Enfuvirtide injection K $23.48

. Cyclophosphamide 100 MG inj K $153.61

. Lumizyme injection K $0.91

. Human fibrinogen conc inj K $3.92

. Glassia injection G $6.41

. Factor XIII anti-hem factor K $614.91

. Gel-one K $86.61

.Dermacell G $980.50

.

Aflibercept injection K $498.27

. Imported lipodox inj K $112.86

. Anthrax vaccine sc or im K $0.58

. Minocycline hydrochloride K $25.78

. Nabilone oral G $92.81

. Eribulin mesylate injection K $13.37

. Alloskin K $134.24

. Arthroflex K $46.69

. Flexhd/Allopatchhd/matrixhd K $31.26

. Unite biomatrix G $3,635.80

. Centruroides immune f(ab) K $86.37

. Arbutamine hcl injection K $62.74

. Calcitonin salmon injection K $33.36

. Testosterone enanthate inj K $1.54

. Injection estrone per 1 MG K $86.33

. Gatifloxacin injection K $88.27

. Diazoxide injection K $2.65

. Aprotonin, 10,000 kiu K $6.12

. Inj desmopressin acetate K $85.00

. Intraocular Fomivirsen na K $10.00

. Non-HEU TC-99M add-on/dose K $235.05

. Icatibant injection K $6.18

. Oral everolimusK $0.37

.

Methylnaltrexone injection K $1.77

. Visualization adjunct K $17.06

. Interferon alfacon-1 inj K $575.03

. Abciximab injection K $24.64

. Eptifibatide injection K $231.10

. Etanercept injection K $18.43

. Rho(D) immune globulin h, s K $526.34

. Daclizumab, parenteral K $76.40

. Trastuzumab injection K $97.15

. Hep b ig im K $76.47

. Baclofen intrathecal trial K $41.64

. Alefacept K $38,058.06

. Y90 ibritumomab, rx K $30,188.56

. I131 tositumomab, rx K $276.27

. Tetanus immune globulin inj K $170.10

. P32 Na phosphate K $114.95

. P32 chromic phosphate K $2,324.18

. Basiliximab K $5.82

. Corticorelin ovine trifluta K $3.32

. Darbepoetin alfa, non-esrd K $9.87

. Epoetin alfa, non-esrd K $899.63

. Digoxin immune fab (ovine) K $299.94

. Ethanolamine oleate 100 mg K $6.51

.Fomepizole, 15 mg K $13.26

.

Hemin, 1 mg K $551.76

. Lepirudin K $6.61

. Ziconotide injection K $51.81

. Nesiritide injection K $12.12

. Palifermin injection K $1,029.95

. Pegaptanib sodium injection K $27.49

. Inj secretin synthetic huma K $61.24

. Treprostinil injection K $0.90

. Humate-P, inj K $1.61

. Factor viia K $5.52

. Azacitidine injection K $125.76

. Clofarabine injection K $3,016.50

. Vantas implant K $9.59

. Paclitaxel protein bound U 1.5340 $109.39

. Brachytx, non-str, Gold-198 U 3.4927 $249.07

. Brachytx, non-str,HDR Ir-19 U 0.5205 $37.12

. Brachytx, NS, Non-HDRIr-192 K $9.25

. Oxaliplatin K $265.48

. Pegademase bovine, 25 iu K $66.69

. Urofollitropin, 75 iu H Power bone marrow bx needle H Telescopic intraocular lens H Catheter, ablationK $42.40

.

Methyldopate hcl injection U219.7241$15,669.18

. Brachytx, non-str,Yttrium-9 U 0.2949 $21.03

. Iodine I-125 sodium iodide U 0.9229 $65.81

. Brachytx, non-str, HA, I-12 U 0.4285 $30.56

. Brachytx, non-str, HA, P-10 U 0.4994 $35.61

. Brachy linear, non-str,P-10 U 0.6548 $46.70

. Brachytx, stranded, I-125 U 0.5005 $35.69

. Brachytx, non-stranded,I-12 U 1.0578 $75.43

. Brachytx, stranded, P-103 U 0.8481 $60.48

. Brachytx, non-stranded,P-10 U 1.5461 $110.26

. Brachytx, stranded, C-131 U 0.9259 $66.03

. Brachytx, non-stranded,C-13 U 0.6548 $46.70

. Brachytx, stranded, NOS U 0.4285 $30.56

. Brachytx, non-stranded, NOS K $32.21

. Immune globulin, powder K $175.05

. Quinupristin/dalfopristin K $2.98

. Bivalirudin K $23.34

. Gamma globulin 1 CC inj K $1.80

. Sermorelin acetate injectio K $310.18

. Amifostine K $244.00

. Oprelvekin injection K $66.98

. Somatropin injection K $321.83

. Teniposide, 50 mg K $457.73

.Urokinase 250,000 IU inj K $1,156.08

.

Monoclonal antibodies K $8.69

. Tirofiban HCl K $8.28

. Capecitabine, oral, 150 mg K $65.18

. Infliximab injection K $532.03

. Doxil injection K $49.22

. Alteplase recombinant K $426.87

. Filgrastim 480 mcg injectio K $4,819.82

. Leuprolide acetate implant K $161.18

. Aminolevulinic acid hcl top T 156.2930$11,145.72 $4,458.28 Ep & ablate supravent arrhy Ep & ablate ventric tachy Tx atrial fib pulm vein iso K $39.32

. Linezolid injection K $66.50

. Tenecteplase injection K $1,240.19

. Rsv mab im 50mg K $2,742.59

. Gemtuzumab ozogamicin inj K $2,301.90

. Reteplase injection K $139.36

. Tacrolimus injection K $44.99

. Arsenic trioxide injection K $10.89

. Inj, rimabotulinumtoxinB K $12.85

. Caspofungin acetate K $287.09

. IM inj interferon beta 1-a K $25.86

. Rho d immune globulin 50 mc K $10.99

. Amphotericin b lipid compleK $179.99

.

Baclofen 10 MG injection K $757.02

. Cidofovir injection K $125.45

. Inj estrogen conjugate 25 M K $111.23

. Glucagon hydrochloride/1 MG K $139.24

. Ibutilide fumarate injectio K $465.73

. Antithymocyte globuln rabbi K $1,053.79

. Thyrotropin injection K $587.78

. Alemtuzumab injection K $224.10

. Zoledronic acid K $2,838.89

. Injection, pegfilgrastim 6m K $87.04

. Injection, Fulvestrant K $18.30

. Injection, argatroban K $160.30

. Triptorelin pamoate K $0.54

. Daptomycin injection K $5.45

. Risperidone, long acting K $11.59

. Natalizumab injection K $207.35

. Rabies ig im/sc K $194.67

. Rabies ig heat treated K $79.88

. Varicella-zoster ig im K $116.14

. Bcg vaccine percut K $208.73

. Rabies vaccine im K $155.64

. Rabies vaccine id K $106.49

. Meningococcal vaccine sc K $102.08

.Encephalitis vaccine sc K $94.13

.

Meningococcal vaccine im K $43.47

. Bortezomib injection K $140.30

. Agalsidase beta injection K $26.67

. Laronidase injection K $19.02

. Palonosetron hcl K $56.51

. Pemetrexed injection K $62.32

. Bevacizumab injection K $51.09

. Cetuximab injection K $217.02

. Leuprolide acetate suspnsio K $354.35

. Galsulfase injection K $19,345.00

. Fluocinolone acetonide impl K $0.94

. Micafungin sodium injection K $1.46

. Tigecycline injection K $151.64

. Ibandronate sodium injectio K $22.19

. Abatacept injection K $33.40

. Decitabine injection K $455.03

. Idursulfase injection K $398.31

. Ranibizumab injection K $204.42

. Alglucosidase alfa injectio K $89.02

. Panitumumab injection K $195.46

. Eculizumab injection K $33.82

. Lanreotide injection K $66.49

. Ixabepilone injectionK $1.72

.

Fosaprepitant injection K $20.61

. Bendamustine injection K $53.67

. Regadenoson injection K $48.18

. Romiplostim injection K $2.96

. Inj, clevidipine butyrate K $4.91

. Certolizumab pegol inj K $66.43

. Artiss fibrin sealant K $45.70

. C-1 esterase, cinryze K $287.45

. Plerixafor injection K $4.82

. Temozolomide injection K $7.02

. Paliperidone palmitate inj K $195.76

. Dexamethasone intra implant K $2.65

. Telavancin injection K $173.94

. Pralatrexate injection K $45.44

. Ofatumumab injection K $130.53

. Ustekinumab injection K $318.22

. Ecallantide injection K $3.57

. Tocilizumab injection K $233.16

. Romidepsin injection K $25.55

. Capsaicin 8% patch K $30.23

. C-1 esterase, berinert K $37.25

. Gammaplex injection K $349.31

. Velaglucerase alfa K $14.32

.Denosumab injection K $32,696.25

.

Sipuleucel-T auto CD54+ K $2,216.80

. Crotalidae poly immune fab K $136.07

. Cabazitaxel injection K $4.46

. Incobotulinumtoxin a G $320.77

. Pegloticase injection G $0.78

. Ceftaroline fosamil inj G $0.11

. Acetaminophen injection G $125.16

. Ipilimumab injection G $13.28 $0.00 Patch, lidocaine/tetracaine $0.00 G $3.80

. Belatacept injection G $95.40

. Brentuximab vedotin inj G $334.32

. Erwinaze injection G $1.14 $0.00 Inj, bupivacaine liposome $0.00 G $102.86

. Injection, pertuzumab G $233.73

. Injection, glucarpidase G $31.54

. Inj, taliglucerase alfa G $29.29

. Injection, carfilzomib G $16.96

. Injection, ziv-aflibercept K $23.53

. Omalizumab injection K $12.03

. SurgiMend, fetal K $11.80

. SurgiMend, neonatal K $24.15

. Integra Meshed Bil Wound Ma G $10.36

. Oasis tri-layer wound matriG $129.38

.

Epifix K $4.35

. Endoform Dermal Template G $137.47

. Grafix core G $109.40

. Grafix prime G $1,974.93 $0.00 Iodine I-123 ioflupane $0.00 R 1.8822 $134.23

. Platelets, irradiated R 7.1694 $511.27

. Platelet pheres leukoreduce R 9.4761 $675.77

. Platelet pheresis irradiate R 0.7967 $56.82

. Fr frz plasma donor reteste R 6.7273 $479.74

. RBC deglycerolized R 2.8319 $201.95

. RBC irradiated R 22.6900$1,618.09

. Granulocytes, pheresis unit R 6.0577 $431.99

. Platelets, pheresis R 1.1037 $78.71

. Plasma 1 donor frz w/in 8 hMinimum

Unadjusted Copayment $7.43

$24.53

$54.08

$69.11

$125.05

$25.09$145.12

$263.83

$5.68

$14.31$21.40$41.93

$283.56$67.28

$116.73$224.35$332.22$372.56

$491.80

$647.20$4.48

$0.00 $4.69

$223.71

$3,278.95

$879.96$422.33$776.05

$207.82$573.61

$890.03

$311.07$461.36$687.52$1,172.50$237.09$413.23$316.79$865.57

$491.09$18.91

$10.79$3.91

$1,358.41

$381.77$752.79$1,008.06

$195.65$470.96

$660.13

$512.95

$82.48

$15.46

$28.58

$67.45$270.41

$405.37

$152.78$7.02

$20.19

$49.49

$529.91$1,534.24

$804.61

$141.08$784.47

$620.05

$1,646.03

$1,322.48$604.93

$391.74

$429.86$32.17

$15.99

$21.73

$13.31

$5.34

$35.37

$60.71$7.87

$231.30

$1,222.09

$336.63

$753.21

$4,502.41$6,136.01

$52.09

$190.13

$577.74

$364.00$734.23

$535.95

$87.93

$16.40$1,582.11

$26.73$546.02$697.43

$1,024.28$17.15

$50.30$78.68$222.33$302.02$79.78

$167.09$96.61

$124.69

$150.14

$138.27$84.07

$143.12

$87.87$365.89

$473.20$345.46

$405.56

$370.52

$485.83$255.77

$46.47$36.85

$0.00 $0.00 $0.00 $0.00 $0.00 $101.96

$226.26$381.78$547.42

$30.55

$281.91$308.03

$474.65

$567.66$99.27

$1,816.13

$86.79

$115.68

$555.10$339.37

$193.45$23.72

$46.82

$336.42$1.65

$0.00 $99.63

$290.91$527.89$681.11

$171.34

$36.53$58.35$113.15$751.72

$161.23$34.53

$8.63

$36.81$15.97

$268.95$496.32$650.22$2,822.25

$1,731.37

$9.69$28.98

$28.96

$225.90

$335.33$83.28

$288.43

$46.36$123.14

$273.59$380.82$566.55

$359.54

$593.48$346.10

$82.16

$419.09

$15.62$45.97

$99.72$229.48$359.96$132.57

$655.78$6,065.38

$9.19$14.17$0.00

$7.18

$51.10

$12.92$19.87

$0.00 $30.95$78.10

$111.74

$22.86

$101.52

$59.74

$16.55$24.57

$41.91

$443.97$726.08

$19.78

$59.43

$90.92$0.00

$0.00 $0.00 $1,759.48

$78.49

$19.10

$35.91

$40.36$21.95

$58.20

$211.23

$196.90

$82.17

$137.54$4,120.45

$64.41

$5,131.67

$2,919.25

$87.73

$16.58

$22.04

$25.65

$12.14

$108.16$61.21$34.72

$65.87

$96.52

$67.70$109.90

$9.93$0.00

$1.37

$2.55$7.62

$12.09$3.60

$5.00

$6.86$0.00

$0.00 $0.00 $27.46

$60.52

$13.06

$7.18$17.72

$23.40

$9.02

$12.58$35.98

$19.04

$17.30

$135.94

$67.28

$4.96

$35.47$53.44

$423.41

$1,527.07

$2,503.00

$535.22

$346.20

$22.81

$30.01

$46.59

$39.32$87.16

$62.88

$51.36

$52.34$66.20

$61.80

$55.99

$44.20

$91.67

$52.82$66.59

$60.02

$47.35

$191.12

$1.94

$96.74

$60.21

$100.51$314.44

$185.36

$373.47$809.33

$221.63

$1,920.38

$37.83$240.32

$306.24

$652.21

$8.98

$0.00 $0.00 $0.00 $0.00 $0.00 $0.00$0.00

$4.69

$2,394.94

$5.41

$0.00 $7.83$14.94

$29.25

$46.10

$392.50

$11.36$0.00

$14.74

$19.40

$0.00

$25.70

$35.16

$10.37

$18.44

$28.68

$45.88

$68.95

$107.18

$182.90

$157.22$350.82

$445.60

$9.83

$13.56

$10.83

$17.98$27.26

$41.47

$912.40

$175.11

$451.82

$534.27

$1,542.94

$2,037.32

$1,552.64

$21.55

$26.42$31.41

$67.85

$227.33

$0.00 $0.00 $136.48

$143.21

$582.76$595.59

$1,565.02

$34.54

$19.90

$79.94

$1,178.65

$34.46$142.72

$302.22

$519.66

$6.79$38.34

$22.30

$73.58

$42.54

$14.82$226.33

$214.38

$31.80

$53.79

$6.32

$2.97

$2.97

$40.95

$51.83

$31.58

$115.79

$0.57

$132.79

$10.44

$249.40

$23.37

$33.21

$35.16

$12.65

$3.84$48.76

$1.34

$24.53

$10.48

$2.45

$6.10

$20.00

$20.34

$3.82

$503.58

$262.51

$16.98

$1,178.00

$189.39

$131.95

$54.84

$35.06

$3,865.16

$5.65

$1.20

$7.25

$1.26

$18.45

$2.45$30.22

$33.99

$16.76

$28.93

$129.22

$8.40

$0.80

$1.10

$202.78

$48.67

$3,392.00

$21.88

$0.18

$0.23

$0.21

$0.33

$0.19

$0.25

$46.68

$5.51

$6.65

$7.53

$1.04$10.43

$6.89

$7.66

$14.45

$33.97

$44.95

$15.73

$38.65

$15.11

$4.07

$18.33

$35.13

$30.36

$59.28

$4.53

$12.14

$6.05

$13.84

$9.44

$27.28

$31.29

$54.64

$13.60

$37.06$155.09

$23.67

$25.89

$24.49

$67.31

$35.19

$134.84

$132.10

$73.74

$57.32

$17.72

$1.33

$8.14

$91.28

$329.24

$2.14

$10.43

$2.72

$3,234.52

$2.25

$104.78

$0.33

$10.71$4.38

$2.04

$25.40

$0.19

$7.03

$17.43

$4.58

$201.26

$0.39

$2.40

$16.79

$21.73

$7.62

$1.56

$1.56

$4.20

$2.28

$8.52

$19.68

$5.04

$7.56

$88.44

$88.44

$235.23$1.38

$0.72

$0.61

$0.22

$6.45

$0.61

$40.28

$2.55

$589.79

$0.32

$2.04

$1.39

$4.82

$1,583.86

$0.60

$0.13

$1.07

$17.89

$1.46

$8.35

$0.55

$20.67

$15.19$16.36

$7.51

$30.49

$0.58

$14.61

$1.22

$4.46

$0.48

$0.25

$0.63

$0.88

$0.18

$7.67

$0.54

$17.66

$5.95

$0.11

$4.70

$30.73

$0.19

$0.79

$1.29

$122.99

$17.33$196.10

$99.66

$22.58

$0.12

$5.16

$18.57

$2.68

$26.85

$9.34

$6.26

$727.16

$17.28

$12.55

$6.68

$0.31

$17.27

$17.66

$0.53

$1.23

$17.00

$2.00

$47.01

$1.24$0.08

$0.36

$3.42

$115.01

$4.93

$46.22

$3.69

$105.27

$15.28

$19.43

$15.30

$8.33

$7,611.62

$6,037.72

$55.26

$34.02

$22.99

$464.84

$1.17

$0.67

$1.98

$179.93

$59.99

$1.31$2.66

$110.36

$1.33

$10.37

$2.43

$205.99

$5.50

$12.25

$0.18

$0.33

$1.11

$25.16

$603.30

$1.92

$21.88

$49.82

$7.43

$1.85

$53.10

$13.34$8.48

$3,133.84

$4.21

$13.17

$6.12

$7.13

$9.34

$7.14

$15.09

$12.10

$22.06

$13.21

$9.34

$6.12

$6.45

$35.01

$0.60

$4.67

$0.36

$62.04

$48.80

$13.40

$64.37

$91.55$231.22

$1.74

$1.66

$13.04

$106.41

$9.85

$85.38

$963.97

$32.24

$2,229.15

$7.87

$13.30

$248.04

$548.52

$460.38

$27.88

$9.00

$2.18

$2.57

$57.42

$5.18

$2.20$36.00

$151.41

$25.09

$22.25

$27.85

$93.15

$210.76

$117.56

$44.82

$567.78

$17.41

$3.66

$32.06

$0.11

$1.09

$2.32

$41.47

$38.94

$15.98

$23.23

$41.75

$31.13

$21.30

$20.42$18.83

$8.70

$28.06

$5.34

$3.81

$11.31

$12.47

$10.22

$43.41

$70.87

$3,869.00

$0.19

$0.30

$30.33

$4.44

$6.68

$91.01

$79.67

$40.89

$17.81

$39.10

$6.77

$13.30$0.35

$4.13

$10.74

$9.64

$0.60

$0.99

$13.29

$9.14

$57.49

$0.97

$1.41

$39.16

$0.53

$34.79

$9.09

$26.11

$63.65

$0.72

$46.64

$5.11

$6.05

$7.45

$69.87

$2.87$6,539.25

$443.36

$27.22

$0.90

$64.16

$0.16

$0.03

$25.04

$0.00 $0.00 $0.76

$19.08

$66.87

$0.00 $0.00 $20.58

$46.75

$6.31

$5.86

$3.40

$4.71

$2.41

$2.36

$4.83

$2.08$25.88

$0.87

$27.50

$21.88

$0.00 $0.00 $26.85

$102.26

$135.16

$11.37

$95.95

$40.39

$323.62

$86.40

$15.75