Addendum C. - Final HCPCS Codes Payable Under the 2012 OPPS by APC

APC HCPCS Group Title Short Descriptor SI Relative Weight Payment Rate National

Unadjusted Copayment Minimum Unadjusted Copayment

0001 Level I Photochemotherapy S 0.5043 $35.31

. $7.07

0001 96900 Ultraviolet light therapy

0001 96910 Photochemotherapy with UV-B

0001 96912 Photochemotherapy with UV-A

0002 Fine Needle Biopsy/Aspiration T 1.6118 $112.85

. $22.57

0002 10021 Fna w/o image

0002 19001 Drain breast lesion add-on

0002 36680 Insert needle bone cavity

0003 Bone Marrow Biopsy/Aspiration T 3.5548 $248.89

. $49.78

0003 38220 Bone marrow aspiration

0003 38221 Bone marrow biopsy

0004 Level I Needle Biopsy/ Aspiration Except Bone Marrow T 4.5721 $320.12

. $64.03

0004 10022 Fna w/image

0004 19000 Drainage of breast lesion

0004 19100 Bx breast percut w/o image

0004 20615 Treatment of bone cyst

0004 47399 Liver surgery procedure

0004 48999 Pancreas surgery procedure

0004 54800 Biopsy of epididymis

0004 55000 Drainage of hydrocele

0004 60100 Biopsy of thyroid

0004 60300 Aspir/inj thyroid cyst

0004 62267 Interdiscal perq aspir dx

0005 Level II Needle Biopsy/Aspiration Except Bone Marrow T 8.1596 $571.30

. $114.26

0005 19102 Bx breast percut w/image

0005 20206 Needle biopsy muscle

0005 38505 Needle biopsy lymph nodes

0005 42400 Biopsy of salivary gland

0006 Level I Incision & Drainage T 1.4209 $99.49

. $19.90

0006 10060 Drainage of skin abscess

0006 10061 Drainage of skin abscess

0006 10080 Drainage of pilonidal cyst

0006 10160 Puncture drainage of lesion

0006 20950 Fluid pressure muscle

0006 21725 Revision of neck muscle

0006 26010 Drainage of finger abscess

0006 40800 Drainage of mouth lesion

0006 41800 Drainage of gum lesion

0006 69000 Drain external ear lesion

0006 69020 Drain outer ear canal lesion

0007 Level II Incision & Drainage T 12.8082 $896.78

. $179.36

0007 10081 Drainage of pilonidal cyst

0007 10140 Drainage of hematoma/fluid

0007 20103 Explore wound extremity

0007 26011 Drainage of finger abscess

0007 28001 Drainage of bursa of foot

0007 38300 Drainage lymph node lesion

0007 55100 Drainage of scrotum abscess

0007 57022 I & d vaginal hematoma pp

0008 Level III Incision and Drainage T 20.5510 "$1,438.90"

. $287.78

0008 10180 Complex drainage wound

0008 19020 Incision of breast lesion

0008 21501 Drain neck/chest lesion

0008 23030 Drain shoulder lesion

0008 23031 Drain shoulder bursa

0008 23930 Drainage of arm lesion

0008 23931 Drainage of arm bursa

0008 27301 Drain thigh/knee lesion

0008 27603 Drain lower leg lesion

0008 38305 Drainage lymph node lesion

0008 51080 Drainage of bladder abscess

0008 54015 Drain penis lesion

0008 54115 Treatment of penis lesion0008 57023 I & d vag hematoma non-ob

0008 69005 Drain external ear lesion

0012 Level I Debridement & Destruction T 0.3878 $27.15

. $5.43

0012 11719 Trim nail(s)

0012 11740 Drain blood from under nail

0012 17003 Destruct premalg les 2-14

0012 17999 Skin tissue procedure

0012 96999 Dermatological procedure

0012 G0127 Trim nail(s)

0013 Level II Debridement & Destruction T 0.8768 $61.39

. $12.28

0013 10040 Acne surgery

0013 11001 Debride infected skin add-on

0013 11055 Trim skin lesion

0013 11056 Trim skin lesions 2 to 4

0013 11101 Biopsy skin add-on

0013 11200 Removal of skin tags

0013 11201 Remove skin tags add-on

0013 11300 Shave skin lesion

0013 11301 Shave skin lesion

0013 11302 Shave skin lesion

0013 11305 Shave skin lesion

0013 11306 Shave skin lesion

0013 11307 Shave skin lesion

0013 11310 Shave skin lesion

0013 11311 Shave skin lesion

0013 11720 Debride nail 1-5

0013 11721 Debride nail 6 or more

0013 11730 Removal of nail plate

0013 11732 Remove nail plate add-on

0013 11765 Excision of nail fold toe

0013 11900 Injection into skin lesions

0013 11901 Added skin lesions injection

0013 15786 Abrasion lesion single

0013 15787 Abrasion lesions add-on

0013 15788 Chemical peel face epiderm

0013 15793 Chemical peel nonfacial

0013 16000 Initial treatment of burn(s)

0013 17000 Destruct premalg lesion

0013 17110 Destruct b9 lesion 1-14

0013 17340 Cryotherapy of skin

0013 36468 Injection(s) spider veins

0013 54056 Cryosurgery penis lesion(s)

0013 69220 Clean out mastoid cavity

0013 97602 Wound(s) care non-selective

0013 97605 Neg press wound tx < 50 cm

0013 G0247 Routine footcare pt w lops

0015 Level III Debridement & Destruction T 1.4966 $104.79

. $20.96

0015 0183T Wound ultrasound

0015 11057 Trim skin lesions over 4

0015 11100 Biopsy skin lesion

0015 11303 Shave skin lesion

0015 11308 Shave skin lesion

0015 11312 Shave skin lesion

0015 11313 Shave skin lesion

0015 15789 Chemical peel face dermal

0015 15792 Chemical peel nonfacial

0015 16020 Dress/debrid p-thick burn s

0015 16025 Dress/debrid p-thick burn m

0015 16030 Dress/debrid p-thick burn l

0015 16035 Incision of burn scab initi

0015 17111 Destruct lesion 15 or more

0015 17250 Chemical cautery tissue

0015 17260 Destruction of skin lesions

0015 17261 Destruction of skin lesions

0015 17262 Destruction of skin lesions

0015 17263 Destruction of skin lesions0015 17264 Destruction of skin lesions

0015 17270 Destruction of skin lesions

0015 17271 Destruction of skin lesions

0015 17272 Destruction of skin lesions

0015 17280 Destruction of skin lesions

0015 17360 Skin peel therapy

0015 17380 Hair removal by electrolysis

0015 36469 Injection(s) spider veins

0015 36470 Injection therapy of vein

0015 36471 Injection therapy of veins

0015 45520 Treatment of rectal prolapse

0015 46916 Cryosurgery anal lesion(s)

0015 54050 Destruction penis lesion(s)

0015 96567 Photodynamic tx skin

0015 96570 Photodynmc tx 30 min add-on

0015 96571 Photodynamic tx addl 15 min

0015 96920 Laser tx skin < 250 sq cm

0015 96921 Laser tx skin 250-500 sq cm

0015 96922 Laser tx skin > 500 sq cm

0015 97597 Rmvl devital tis 20 cm/<

0015 97598 Rmvl devital tis addl 20 cm<

0015 97606 Neg press wound tx > 50 cm

0016 Level IV Debridement & Destruction T 2.7597 $193.22

. $38.65

0016 10120 Remove foreign body

0016 11000 Debride infected skin

0016 11042 Deb subq tissue 20 sq cm/<

0016 11043 Deb musc/fascia 20 sq cm/<

0016 11045 Deb subq tissue add-on

0016 11046 Deb musc/fascia add-on

0016 15783 Abrasion treatment of skin

0016 15850 Removal of sutures

0016 15851 Removal of sutures

0016 17004 Destroy premal lesions 15/>

0016 17106 Destruction of skin lesions

0016 17107 Destruction of skin lesions

0016 17108 Destruction of skin lesions

0016 17266 Destruction of skin lesions

0016 17273 Destruction of skin lesions

0016 17274 Destruction of skin lesions

0016 17276 Destruction of skin lesions

0016 17281 Destruction of skin lesions

0016 17282 Destruction of skin lesions

0016 17283 Destruction of skin lesions

0016 17284 Destruction of skin lesions

0016 17286 Destruction of skin lesions

0016 46900 Destruction anal lesion(s)

0017 Level V Debridement & Destruction T 21.6700 "$1,517.25"

. $303.45

0017 46910 Destruction anal lesion(s)

0017 46917 Laser surgery anal lesions

0017 46922 Excision of anal lesion(s)

0017 46924 Destruction anal lesion(s)

0017 54055 Destruction penis lesion(s)

0017 54057 Laser surg penis lesion(s)

0017 54060 Excision of penis lesion(s)

0017 54065 Destruction penis lesion(s)

0017 56501 Destroy vulva lesions sim

0017 56515 Destroy vulva lesion/s compl

0019 Level I Excision/ Biopsy T 4.3953 $307.74

. $61.55

0019 11010 Debride skin at fx site

0019 11011 Debride skin musc at fx site

0019 11012 Deb skin bone at fx site

0019 11400 Exc tr-ext b9+marg 0.5 < cm

0019 11401 Exc tr-ext b9+marg 0.6-1 cm

0019 11402 Exc tr-ext b9+marg 1.1-2 cm

0019 11440 Exc face-mm b9+marg 0.5 < cm

0019 11441 Exc face-mm b9+marg 0.6-1 cm0019 11601 Exc tr-ext mal+marg 0.6-1 cm

0019 11602 Exc tr-ext mal+marg 1.1-2 cm

0019 11621 Exc s/n/h/f/g mal+mrg 0.6-1

0019 11640 Exc f/e/e/n/l mal+mrg 0.5cm<

0019 11641 Exc f/e/e/n/l mal+mrg 0.6-1

0019 11642 Exc f/e/e/n/l mal+mrg 1.1-2

0019 11750 Removal of nail bed

0019 11755 Biopsy nail unit

0019 11976 Removal of contraceptive cap

0019 15781 Abrasion treatment of skin

0019 15782 Abrasion treatment of skin

0019 15920 Removal of tail bone ulcer

0019 15999 Removal of pressure sore

0019 20520 Removal of foreign body

0019 24200 Removal of arm foreign body

0019 41108 Biopsy of floor of mouth

0020 Level II Excision/ Biopsy T 8.2918 $580.56

. $116.12

0020 11044 Deb bone 20 sq cm/<

0020 11047 Deb bone add-on

0020 11403 Exc tr-ext b9+marg 2.1-3 cm

0020 11420 Exc h-f-nk-sp b9+marg 0.5 <

0020 11421 Exc h-f-nk-sp b9+marg 0.6-1

0020 11422 Exc h-f-nk-sp b9+marg 1.1-2

0020 11442 Exc face-mm b9+marg 1.1-2 cm

0020 11443 Exc face-mm b9+marg 2.1-3 cm

0020 11444 Exc face-mm b9+marg 3.1-4 cm

0020 11600 Exc tr-ext mal+marg 0.5 < cm

0020 11603 Exc tr-ext mal+marg 2.1-3 cm

0020 11604 Exc tr-ext mal+marg 3.1-4 cm

0020 11620 Exc h-f-nk-sp mal+marg 0.5 <

0020 11622 Exc s/n/h/f/g mal+mrg 1.1-2

0020 11643 Exc f/e/e/n/l mal+mrg 2.1-3

0020 20005 I&d abscess subfascial

0020 20220 Bone biopsy trocar/needle

0020 21011 Exc face les sc < 2 cm

0020 21012 Exc face les sbq 2 cm/>

0020 21013 Exc face tum deep < 2 cm

0020 21014 Exc face tum deep 2 cm/>

0020 21920 Biopsy soft tissue of back

0020 23065 Biopsy shoulder tissues

0020 23330 Remove shoulder foreign body

0020 25065 Biopsy forearm soft tissues

0020 27040 Biopsy of soft tissues

0020 27041 Biopsy of soft tissues

0020 27086 Remove hip foreign body

0020 27323 Biopsy thigh soft tissues

0020 27613 Biopsy lower leg soft tissue

0020 28190 Removal of foot foreign body

0020 28193 Removal of foot foreign body

0020 33284 Remove pat-active ht record

0020 35226 Repair blood vessel lesion

0021 Level III Excision/ Biopsy T 16.9957 "$1,189.97"

. $238.00

0021 10121 Remove foreign body

0021 11404 Exc tr-ext b9+marg 3.1-4 cm

0021 11406 Exc tr-ext b9+marg > 4.0 cm

0021 11423 Exc h-f-nk-sp b9+marg 2.1-3

0021 11424 Exc h-f-nk-sp b9+marg 3.1-4

0021 11606 Exc tr-ext mal+marg > 4 cm

0021 11623 Exc s/n/h/f/g mal+mrg 2.1-3

0021 11624 Exc s/n/h/f/g mal+mrg 3.1-4

0021 11644 Exc f/e/e/n/l mal+mrg 3.1-4

0021 15836 Excise excessive skin tissue

0021 15837 Excise excessive skin tissue

0021 15838 Excise excessive skin tissue

0021 15839 Excise excessive skin tissue

0021 19260 Removal of chest wall lesion0021 20200 Muscle biopsy

0021 20205 Deep muscle biopsy

0021 20225 Bone biopsy trocar/needle

0021 20670 Removal of support implant

0021 21015 Resect face tum < 2 cm

0021 21550 Biopsy of neck/chest

0021 21555 Exc neck les sc < 3 cm

0021 21557 Resect neck tum < 5 cm

0021 21930 Exc back les sc < 3 cm

0021 21932 Exc back tum deep < 5 cm

0021 21935 Resect back tum < 5 cm

0021 22902 Exc abd les sc < 3 cm

0021 22904 Resect abd tum < 5 cm

0021 23000 Removal of calcium deposits

0021 23075 Exc shoulder les sc < 3 cm

0021 23076 Exc shoulder tum deep < 5 cm

0021 23077 Resect shoulder tum < 5 cm

0021 24065 Biopsy arm/elbow soft tissue

0021 24066 Biopsy arm/elbow soft tissue

0021 24075 Exc arm/elbow les sc < 3 cm

0021 24076 Ex arm/elbow tum deep < 5 cm

0021 24077 Resect arm/elbow tum < 5 cm

0021 24201 Removal of arm foreign body

0021 25075 Exc forearm les sc < 3 cm

0021 25076 Exc forearm tum deep < 3 cm

0021 25077 Resect forearm/wrist tum<3cm

0021 26115 Exc hand les sc < 1.5 cm

0021 26116 Exc hand tum deep < 1.5 cm

0021 26117 Exc hand tum ra < 3 cm

0021 26320 Removal of implant from hand

0021 27047 Exc hip/pelvis les sc < 3 cm

0021 27048 Exc hip/pelv tum deep < 5 cm

0021 27049 Resect hip/pelv tum < 5 cm

0021 27328 Exc thigh/knee tum deep <5cm

0021 27329 Resect thigh/knee tum < 5 cm

0021 27615 Resect leg/ankle tum < 5 cm

0021 27618 Exc leg/ankle tum < 3 cm

0021 27619 Exc leg/ankle tum deep <5 cm

0021 28043 Exc foot/toe tum sc < 1.5 cm

0021 28045 Exc foot/toe tum deep <1.5cm

0021 28046 Resect foot/toe tumor < 3 cm

0021 28192 Removal of foot foreign body

0021 37609 Temporal artery procedure

0021 54100 Biopsy of penis

0021 69110 Remove external ear partial

0021 69145 Remove ear canal lesion(s)

0022 Level IV Excision/ Biopsy T 23.2636 "$1,628.82" $350.74 $325.77

0022 11426 Exc h-f-nk-sp b9+marg > 4 cm

0022 11446 Exc face-mm b9+marg > 4 cm

0022 11450 Removal sweat gland lesion

0022 11451 Removal sweat gland lesion

0022 11462 Removal sweat gland lesion

0022 11463 Removal sweat gland lesion

0022 11470 Removal sweat gland lesion

0022 11471 Removal sweat gland lesion

0022 11626 Exc s/n/h/f/g mal+mrg > 4 cm

0022 11646 Exc f/e/e/n/l mal+mrg > 4 cm

0022 11752 Remove nail bed/finger tip

0022 11770 Removal of pilonidal lesion

0022 11771 Removal of pilonidal lesion

0022 11772 Removal of pilonidal lesion

0022 11971 Remove tissue expander(s)

0022 15780 Abrasion treatment of skin

0022 15830 Exc skin abd

0022 15832 Excise excessive skin tissue

0022 15833 Excise excessive skin tissue0022 15834 Excise excessive skin tissue

0022 15835 Excise excessive skin tissue

0022 15847 Exc skin abd add-on

0022 15931 Remove sacrum pressure sore

0022 15933 Remove sacrum pressure sore

0022 15940 Remove hip pressure sore

0022 15941 Remove hip pressure sore

0022 15950 Remove thigh pressure sore

0022 15951 Remove thigh pressure sore

0022 20240 Bone biopsy excisional

0022 20245 Bone biopsy excisional

0022 20525 Removal of foreign body

0022 20680 Removal of support implant

0022 21016 Resect face tum 2 cm/>

0022 21552 Exc neck les sc 3 cm/>

0022 21554 Exc neck tum deep 5 cm/>

0022 21556 Exc neck tum deep < 5 cm

0022 21558 Resect neck tum 5 cm/>

0022 21925 Biopsy soft tissue of back

0022 21931 Exc back les sc 3 cm/>

0022 21933 Exc back tum deep 5 cm/>

0022 21936 Resect back tum 5 cm/>

0022 22900 Exc abdl tum deep < 5 cm

0022 22901 Exc abdl tum deep 5 cm/>

0022 22903 Exc abd les sc 3 cm/>

0022 22905 Resect abd tum 5 cm/>

0022 23066 Biopsy shoulder tissues

0022 23071 Exc shoulder les sc 3 cm/>

0022 23073 Exc shoulder tum deep 5 cm/>

0022 23078 Resect shoulder tum 5 cm/>

0022 23331 Remove shoulder foreign body

0022 24071 Exc arm/elbow les sc 3 cm/>

0022 24073 Ex arm/elbow tum deep 5 cm/>

0022 24079 Resect arm/elbow tum 5 cm/>

0022 25066 Biopsy forearm soft tissues

0022 25071 Exc forearm les sc 3 cm/>

0022 25073 Exc forearm tum deep 3 cm/>

0022 25078 Resect forarm/wrist tum 3cm>

0022 26111 Exc hand les sc 1.5 cm/>

0022 26113 Exc hand tum deep 1.5 cm/>

0022 26118 Exc hand tum ra 3 cm/>

0022 27043 Exc hip pelvis les sc 3 cm/>

0022 27045 Exc hip/pelv tum deep 5 cm/>

0022 27059 Resect hip/pelv tum 5 cm/>

0022 27324 Biopsy thigh soft tissues

0022 27327 Exc thigh/knee les sc < 3 cm

0022 27337 Exc thigh/knee les sc 3 cm/>

0022 27339 Exc thigh/knee tum dep 5cm/>

0022 27364 Resect thigh/knee tum 5 cm/>

0022 27372 Removal of foreign body

0022 27614 Biopsy lower leg soft tissue

0022 27616 Resect leg/ankle tum 5 cm/>

0022 27632 Exc leg/ankle les sc 3 cm/>

0022 27634 Exc leg/ankle tum dep 5 cm/>

0022 28039 Exc foot/toe tum sc 1.5 cm/>

0022 28041 Exc foot/toe tum dep 1.5cm/>

0022 28047 Resect foot/toe tumor 3 cm/>

0022 54105 Biopsy of penis

0022 60512 Autotransplant parathyroid

0022 69205 Clear outer ear canal

0028 Level I Breast Surgery T 25.5066 "$1,785.87"

. $357.18

0028 19101 Biopsy of breast open

0028 19110 Nipple exploration

0028 19112 Excise breast duct fistula

0028 19120 Removal of breast lesion

0028 19125 Excision breast lesion0028 19126 Excision addl breast lesion

0028 19300 Removal of breast tissue

0028 19301 Partical mastectomy

0028 19350 Breast reconstruction

0028 19499 Breast surgery procedure

0028 C9726 Rxt breast appl place/remov

0029 Level II Breast Surgery T 33.3398 "$2,334.32" $580.94 $466.87

0029 19105 Cryosurg ablate fa each

0029 19303 Mast simple complete

0029 19304 Mast subq

0029 19316 Suspension of breast

0029 19328 Removal of breast implant

0029 19330 Removal of implant material

0029 19355 Correct inverted nipple(s)

0029 19366 Breast reconstruction

0029 19370 Surgery of breast capsule

0029 19371 Removal of breast capsule

0029 19396 Design custom breast implant

0030 Level III Breast Surgery T 45.0217 "$3,152.24" $747.07 $630.45

0030 19302 P-mastectomy w/ln removal

0030 19307 Mast mod rad

0030 19318 Reduction of large breast

0030 19324 Enlarge breast

0030 19340 Immediate breast prosthesis

0030 19380 Revise breast reconstruction

0031 Smoking Cessation Services X 0.2988 $20.92

. $4.19

0031 99406 Behav chng smoking 3-10 min

0031 99407 Behav chng smoking > 10 min

0031 G0436 Tobacco-use counsel 3-10 min $0.00 $0.00

0031 G0437 Tobacco-use counsel>10min $0.00 $0.00

0035 Vascular Puncture and Minor Diagnostic Procedures X 0.2673 $18.72

. $3.75

0035 0208T Audiometry air only

0035 0209T Audiometry air & bone

0035 0210T Speech audiometry threshold

0035 0211T Speech audiom thresh & recog

0035 36420 Vein access cutdown < 1 yr

0035 36425 Vein access cutdown > 1 yr

0035 36600 Withdrawal of arterial blood

0035 76514 Echo exam of eye thickness

0035 92227 Remote dx retinal imaging

0035 92228 Remote retinal imaging mgmt

0035 93041 Rhythm ecg tracing

0035 93278 ECG/signal-averaged

0035 93290 Icm device eval

0035 93998 Noninvas vasc dx study proc

0037 Level IV Needle Biopsy/Aspiration Except Bone

Marrow T 15.3535 "$1,074.99" $227.40 $215.00

0037 19103 Bx breast percut w/device

0037 44901 Drain app abscess percut

0037 47011 Percut drain liver lesion

0037 48511 Drain pancreatic pseudocyst

0037 49021 Drain abdominal abscess

0037 49041 Drain percut abdom abscess

0037 49061 Drain percut retroper absc

0037 50021 Renal abscess percut drain

0037 54500 Biopsy of testis

0039 Level I Implantation of Neurostimulator

Generator S 216.9330 "$15,188.78"

. "$3,037.76"

0039 0268T Implt/rpl crtd sns dev gen

0039 61885 Insrt/redo neurostim 1 array

0039 63685 Insrt/redo spine n generator

0039 64590 Insrt/redo pn/gastr stimul

0040 Level I Implantation/Revision/Replacement of Neurostimulator

Electrodes S 63.3729 "$4,437.12"

. $887.43

0040 0282T Periph field stimul trial

0040 63650 Implant neuroelectrodes0040 63663 Revise spine eltrd perq aray

0040 63664 Revise spine eltrd plate

0040 64553 Implant neuroelectrodes

0040 64555 Implant neuroelectrodes

0040 64561 Implant neuroelectrodes

0040 64565 Implant neuroelectrodes

0041 Level I Arthroscopy T 29.7721 "$2,084.52"

. $416.91

0041 29800 Jaw arthroscopy/surgery

0041 29804 Jaw arthroscopy/surgery

0041 29805 Shoulder arthroscopy dx

0041 29822 Shoulder arthroscopy/surgery

0041 29824 Shoulder arthroscopy/surgery

0041 29826 Shoulder arthroscopy/surgery

0041 29830 Elbow arthroscopy

0041 29834 Elbow arthroscopy/surgery

0041 29835 Elbow arthroscopy/surgery

0041 29836 Elbow arthroscopy/surgery

0041 29837 Elbow arthroscopy/surgery

0041 29838 Elbow arthroscopy/surgery

0041 29840 Wrist arthroscopy

0041 29843 Wrist arthroscopy/surgery

0041 29844 Wrist arthroscopy/surgery

0041 29845 Wrist arthroscopy/surgery

0041 29846 Wrist arthroscopy/surgery

0041 29848 Wrist endoscopy/surgery

0041 29850 Knee arthroscopy/surgery

0041 29870 Knee arthroscopy dx

0041 29871 Knee arthroscopy/drainage

0041 29873 Knee arthroscopy/surgery

0041 29874 Knee arthroscopy/surgery

0041 29875 Knee arthroscopy/surgery

0041 29876 Knee arthroscopy/surgery

0041 29877 Knee arthroscopy/surgery

0041 29879 Knee arthroscopy/surgery

0041 29880 Knee arthroscopy/surgery

0041 29881 Knee arthroscopy/surgery

0041 29882 Knee arthroscopy/surgery

0041 29883 Knee arthroscopy/surgery

0041 29884 Knee arthroscopy/surgery

0041 29886 Knee arthroscopy/surgery

0041 29887 Knee arthroscopy/surgery

0041 29894 Ankle arthroscopy/surgery

0041 29895 Ankle arthroscopy/surgery

0041 29897 Ankle arthroscopy/surgery

0041 29898 Ankle arthroscopy/surgery

0041 29900 Mcp joint arthroscopy dx

0041 29901 Mcp joint arthroscopy surg

0041 29902 Mcp joint arthroscopy surg

0041 29904 Subtalar arthro w/fb rmvl

0041 29905 Subtalar arthro w/exc

0041 29906 Subtalar arthro w/deb

0041 29999 Arthroscopy of joint

0042 Level II Arthroscopy T 57.0707 "$3,995.86" $804.74 $799.18

0042 29806 Shoulder arthroscopy/surgery

0042 29807 Shoulder arthroscopy/surgery

0042 29819 Shoulder arthroscopy/surgery

0042 29820 Shoulder arthroscopy/surgery

0042 29821 Shoulder arthroscopy/surgery

0042 29823 Shoulder arthroscopy/surgery

0042 29825 Shoulder arthroscopy/surgery

0042 29827 Arthroscop rotator cuff repr

0042 29828 Arthroscopy biceps tenodesis

0042 29847 Wrist arthroscopy/surgery

0042 29851 Knee arthroscopy/surgery

0042 29855 Tibial arthroscopy/surgery

0042 29856 Tibial arthroscopy/surgery0042 29860 Hip arthroscopy dx

0042 29861 Hip arthro w/fb removal

0042 29862 Hip arthr0 w/debridement

0042 29863 Hip arthr0 w/synovectomy

0042 29866 Autgrft implnt knee w/scope

0042 29867 Allgrft implnt knee w/scope

0042 29868 Meniscal trnspl knee w/scpe

0042 29885 Knee arthroscopy/surgery

0042 29891 Ankle arthroscopy/surgery

0042 29899 Ankle arthroscopy/surgery

0042 29907 Subtalar arthro w/fusion

0042 29914 Hip arthro w/femoroplasty

0042 29915 Hip arthro acetabuloplasty

0042 29916 Hip arthro w/labral repair

0045 Bone/Joint Manipulation Under Anesthesia T 15.4596 "$1,082.42" $268.44 $216.49

0045 22505 Manipulation of spine

0045 23655 Treat shoulder dislocation

0045 23700 Fixation of shoulder

0045 24300 Manipulate elbow w/anesth

0045 24605 Treat elbow dislocation

0045 26775 Treat finger dislocation

0045 27194 Treat pelvic ring fracture

0045 27252 Treat hip dislocation

0045 27257 Treat hip dislocation

0045 27266 Treat hip dislocation

0045 27275 Manipulation of hip joint

0045 27552 Treat knee dislocation

0045 27562 Treat kneecap dislocation

0045 27570 Fixation of knee joint

0045 27842 Treat ankle dislocation

0045 27860 Fixation of ankle joint

0045 28635 Treat toe dislocation

0045 28665 Treat toe dislocation

0047 Arthroplasty without Prosthesis T 41.2873 "$2,890.77"

. $578.16

0047 24360 Reconstruct elbow joint

0047 24365 Reconstruct head of radius

0047 25332 Revise wrist joint

0047 25447 Repair wrist joints

0047 25449 Remove wrist joint implant

0047 26530 Revise knuckle joint

0047 26535 Revise finger joint

0047 27437 Revise kneecap

0047 27440 Revision of knee joint

0047 27441 Revision of knee joint

0047 27442 Revision of knee joint

0047 27443 Revision of knee joint

0047 27700 Revision of ankle joint

0048 Level I Arthroplasty or Implantation with

Prosthesis T 60.9147 "$4,265.00"

. $853.00

0048 24362 Reconstruct elbow joint

0048 25443 Reconstruct wrist joint

0048 25444 Reconstruct wrist joint

0048 25445 Reconstruct wrist joint

0048 26531 Revise knuckle with implant

0048 26536 Revise/implant finger joint

0048 27438 Revise kneecap with implant

0049 Level I Musculoskeletal Procedures Except Hand and

Foot T 22.0797 "$1,545.93"

. $309.19

0049 20662 Application of pelvis brace

0049 20694 Remove bone fixation device

0049 20999 Musculoskeletal surgery

0049 21502 Drain chest lesion

0049 21700 Revision of neck muscle

0049 21720 Revision of neck muscle

0049 22999 Abdomen surgery procedure

0049 23035 Drain shoulder bone lesion0049 23100 Biopsy of shoulder joint

0049 23140 Removal of bone lesion

0049 23935 Drain arm/elbow bone lesion

0049 24100 Biopsy elbow joint lining

0049 24105 Removal of elbow bursa

0049 24110 Remove humerus lesion

0049 24120 Remove elbow lesion

0049 24310 Revision of arm tendon

0049 24925 Amputation follow-up surgery

0049 25000 Incision of tendon sheath

0049 25001 Incise flexor carpi radialis

0049 25028 Drainage of forearm lesion

0049 25031 Drainage of forearm bursa

0049 25035 Treat forearm bone lesion

0049 25085 Incision of wrist capsule

0049 25100 Biopsy of wrist joint

0049 25109 Excise tendon forearm/wrist

0049 25110 Remove wrist tendon lesion

0049 25111 Remove wrist tendon lesion

0049 25112 Reremove wrist tendon lesion

0049 25115 Remove wrist/forearm lesion

0049 25116 Remove wrist/forearm lesion

0049 25248 Remove forearm foreign body

0049 25295 Release wrist/forearm tendon

0049 25907 Amputation follow-up surgery

0049 25909 Amputation follow-up surgery

0049 25922 Amputate hand at wrist

0049 25931 Amputation follow-up surgery

0049 26990 Drainage of pelvis lesion

0049 26991 Drainage of pelvis bursa

0049 27000 Incision of hip tendon

0049 27050 Biopsy of sacroiliac joint

0049 27052 Biopsy of hip joint

0049 27057 Buttock fasciotomy w/dbrdmt

0049 27060 Removal of ischial bursa

0049 27062 Remove femur lesion/bursa

0049 27065 Remove hip bone les super

0049 27087 Remove hip foreign body

0049 27305 Incise thigh tendon & fascia

0049 27306 Incision of thigh tendon

0049 27340 Removal of kneecap bursa

0049 27345 Removal of knee cyst

0049 27347 Remove knee cyst

0049 27390 Incision of thigh tendon

0049 27391 Incision of thigh tendons

0049 27497 Decompression of thigh/knee

0049 27594 Amputation follow-up surgery

0049 27600 Decompression of lower leg

0049 27601 Decompression of lower leg

0049 27606 Incision of achilles tendon

0049 27607 Treat lower leg bone lesion

0049 27630 Removal of tendon lesion

0049 27656 Repair leg fascia defect

0049 27658 Repair of leg tendon each

0049 27659 Repair of leg tendon each

0049 27675 Repair lower leg tendons

0049 27704 Removal of ankle implant

0049 27884 Amputation follow-up surgery

0049 28002 Treatment of foot infection

0049 28003 Treatment of foot infection

0050 Level II Musculoskeletal Procedures Except Hand and

Foot T 32.4461 "$2,271.75"

. $454.35

0050 0101T Extracorp shockwv tx hi enrg

0050 0102T Extracorp shockwv tx anesth

0050 0200T Perq sacral augmt unilat inj

0050 0201T Perq sacral augmt bilat inj0050 0221T Plmt post facet implt lumb

0050 0222T Plmt post facet implt addl

0050 20250 Open bone biopsy

0050 20251 Open bone biopsy

0050 20555 Place ndl musc/tis for rt

0050 20650 Insert and remove bone pin

0050 20663 Application of thigh brace

0050 20690 Apply bone fixation device

0050 20692 Apply bone fixation device

0050 20693 Adjust bone fixation device

0050 20696 Comp multiplane ext fixation

0050 20900 Removal of bone for graft

0050 20902 Removal of bone for graft

0050 20924 Removal of tendon for graft

0050 21600 Partial removal of rib

0050 21610 Partial removal of rib

0050 22520 Percut vertebroplasty thor

0050 22521 Percut vertebroplasty lumb

0050 22522 Percut vertebroplasty addl

0050 22851 Apply spine prosth device

0050 22899 Spine surgery procedure

0050 23020 Release shoulder joint

0050 23040 Exploratory shoulder surgery

0050 23044 Exploratory shoulder surgery

0050 23101 Shoulder joint surgery

0050 23105 Remove shoulder joint lining

0050 23106 Incision of collarbone joint

0050 23107 Explore treat shoulder joint

0050 23120 Partial removal collar bone

0050 23125 Removal of collar bone

0050 23145 Removal of bone lesion

0050 23146 Removal of bone lesion

0050 23150 Removal of humerus lesion

0050 23155 Removal of humerus lesion

0050 23156 Removal of humerus lesion

0050 23170 Remove collar bone lesion

0050 23172 Remove shoulder blade lesion

0050 23174 Remove humerus lesion

0050 23180 Remove collar bone lesion

0050 23182 Remove shoulder blade lesion

0050 23184 Remove humerus lesion

0050 23190 Partial removal of scapula

0050 23195 Removal of head of humerus

0050 23400 Fixation of shoulder blade

0050 23405 Incision of tendon & muscle

0050 23406 Incise tendon(s) & muscle(s)

0050 23440 Remove/transplant tendon

0050 24000 Exploratory elbow surgery

0050 24006 Release elbow joint

0050 24101 Explore/treat elbow joint

0050 24102 Remove elbow joint lining

0050 24115 Remove/graft bone lesion

0050 24116 Remove/graft bone lesion

0050 24125 Remove/graft bone lesion

0050 24126 Remove/graft bone lesion

0050 24130 Removal of head of radius

0050 24134 Removal of arm bone lesion

0050 24136 Remove radius bone lesion

0050 24138 Remove elbow bone lesion

0050 24140 Partial removal of arm bone

0050 24145 Partial removal of radius

0050 24147 Partial removal of elbow

0050 24149 Radical resection of elbow

0050 24155 Removal of elbow joint

0050 24160 Remove elbow joint implant

0050 24164 Remove radius head implant0050 24301 Muscle/tendon transfer

0050 24305 Arm tendon lengthening

0050 24320 Repair of arm tendon

0050 24332 Tenolysis triceps

0050 24343 Repr elbow lat ligmnt w/tiss

0050 24345 Repr elbw med ligmnt w/tissu

0050 24357 Repair elbow perc

0050 24358 Repair elbow w/deb open

0050 24359 Repair elbow deb/attch open

0050 24495 Decompression of forearm

0050 25020 Decompress forearm 1 space

0050 25023 Decompress forearm 1 space

0050 25024 Decompress forearm 2 spaces

0050 25025 Decompress forearm 2 spaces

0050 25040 Explore/treat wrist joint

0050 25101 Explore/treat wrist joint

0050 25105 Remove wrist joint lining

0050 25107 Remove wrist joint cartilage

0050 25118 Excise wrist tendon sheath

0050 25119 Partial removal of ulna

0050 25120 Removal of forearm lesion

0050 25125 Remove/graft forearm lesion

0050 25126 Remove/graft forearm lesion

0050 25130 Removal of wrist lesion

0050 25135 Remove & graft wrist lesion

0050 25136 Remove & graft wrist lesion

0050 25145 Remove forearm bone lesion

0050 25150 Partial removal of ulna

0050 25151 Partial removal of radius

0050 25170 Resect radius/ulnar tumor

0050 25210 Removal of wrist bone

0050 25215 Removal of wrist bones

0050 25230 Partial removal of radius

0050 25240 Partial removal of ulna

0050 25250 Removal of wrist prosthesis

0050 25251 Removal of wrist prosthesis

0050 25260 Repair forearm tendon/muscle

0050 25263 Repair forearm tendon/muscle

0050 25265 Repair forearm tendon/muscle

0050 25270 Repair forearm tendon/muscle

0050 25272 Repair forearm tendon/muscle

0050 25274 Repair forearm tendon/muscle

0050 25275 Repair forearm tendon sheath

0050 25280 Revise wrist/forearm tendon

0050 25290 Incise wrist/forearm tendon

0050 25300 Fusion of tendons at wrist

0050 25301 Fusion of tendons at wrist

0050 25310 Transplant forearm tendon

0050 25315 Revise palsy hand tendon(s)

0050 25392 Shorten radius & ulna

0050 27001 Incision of hip tendon

0050 27003 Incision of hip tendon

0050 27006 Incision of hip tendons

0050 27027 Buttock fasciotomy

0050 27035 Denervation of hip joint

0050 27066 Remove hip bone les deep

0050 27067 Remove/graft hip bone lesion

0050 27080 Removal of tail bone

0050 27097 Revision of hip tendon

0050 27098 Transfer tendon to pelvis

0050 27235 Treat thigh fracture

0050 27307 Incision of thigh tendons

0050 27310 Exploration of knee joint

0050 27330 Biopsy knee joint lining

0050 27331 Explore/treat knee joint

0050 27332 Removal of knee cartilage0050 27333 Removal of knee cartilage

0050 27334 Remove knee joint lining

0050 27335 Remove knee joint lining

0050 27350 Removal of kneecap

0050 27355 Remove femur lesion

0050 27356 Remove femur lesion/graft

0050 27357 Remove femur lesion/graft

0050 27358 Remove femur lesion/fixation

0050 27360 Partial removal leg bone(s)

0050 27380 Repair of kneecap tendon

0050 27381 Repair/graft kneecap tendon

0050 27385 Repair of thigh muscle

0050 27386 Repair/graft of thigh muscle

0050 27392 Incision of thigh tendons

0050 27393 Lengthening of thigh tendon

0050 27394 Lengthening of thigh tendons

0050 27396 Transplant of thigh tendon

0050 27403 Repair of knee cartilage

0050 27425 Lat retinacular release open

0050 27435 Incision of knee joint

0050 27475 Surgery to stop leg growth

0050 27479 Surgery to stop leg growth

0050 27496 Decompression of thigh/knee

0050 27498 Decompression of thigh/knee

0050 27499 Decompression of thigh/knee

0050 27602 Decompression of lower leg

0050 27604 Drain lower leg bursa

0050 27610 Explore/treat ankle joint

0050 27612 Exploration of ankle joint

0050 27620 Explore/treat ankle joint

0050 27625 Remove ankle joint lining

0050 27626 Remove ankle joint lining

0050 27635 Remove lower leg bone lesion

0050 27637 Remove/graft leg bone lesion

0050 27638 Remove/graft leg bone lesion

0050 27640 Partial removal of tibia

0050 27641 Partial removal of fibula

0050 27647 Resect talus/calcaneus tum

0050 27664 Repair of leg tendon each

0050 27665 Repair of leg tendon each

0050 27676 Repair lower leg tendons

0050 27680 Release of lower leg tendon

0050 27681 Release of lower leg tendons

0050 27685 Revision of lower leg tendon

0050 27686 Revise lower leg tendons

0050 27687 Revision of calf tendon

0050 27695 Repair of ankle ligament

0050 27696 Repair of ankle ligaments

0050 27698 Repair of ankle ligament

0050 27707 Incision of fibula

0050 27709 Incision of tibia & fibula

0050 27730 Repair of tibia epiphysis

0050 27732 Repair of fibula epiphysis

0050 27734 Repair lower leg epiphyses

0050 27740 Repair of leg epiphyses

0050 27889 Amputation of foot at ankle

0050 27892 Decompression of leg

0050 27893 Decompression of leg

0050 27894 Decompression of leg

0050 28890 High energy eswt plantar f

0050 G0413 Pelvic ring fracture uni/bil

0051 Level III Musculoskeletal Procedures Except Hand and

Foot T 47.5032 "$3,325.98"

. $665.20

0051 11970 Replace tissue expander

0051 20150 Excise epiphyseal bar

0051 20982 Ablate bone tumor(s) perq0051 21742 Repair stern/nuss w/o scope

0051 21743 Repair sternum/nuss w/scope

0051 23130 Remove shoulder bone part

0051 23395 Muscle transfer shoulder/arm

0051 23410 Repair rotator cuff acute

0051 23412 Repair rotator cuff chronic

0051 23415 Release of shoulder ligament

0051 23420 Repair of shoulder

0051 23430 Repair biceps tendon

0051 23462 Repair shoulder capsule

0051 23466 Repair shoulder capsule

0051 23480 Revision of collar bone

0051 24150 Resect distal humerus tumor

0051 24152 Resect radius tumor

0051 24331 Revision of arm muscles

0051 24340 Repair of biceps tendon

0051 24341 Repair arm tendon/muscle

0051 24342 Repair of ruptured tendon

0051 24410 Revision of humerus

0051 24420 Revision of humerus

0051 24470 Revision of elbow joint

0051 24800 Fusion of elbow joint

0051 25312 Transplant forearm tendon

0051 25320 Repair/revise wrist joint

0051 25335 Realignment of hand

0051 25337 Reconstruct ulna/radioulnar

0051 25350 Revision of radius

0051 25355 Revision of radius

0051 25360 Revision of ulna

0051 25370 Revise radius or ulna

0051 25375 Revise radius & ulna

0051 25390 Shorten radius or ulna

0051 25393 Lengthen radius & ulna

0051 25394 Repair carpal bone shorten

0051 25426 Repair/graft radius & ulna

0051 25430 Vasc graft into carpal bone

0051 25431 Repair nonunion carpal bone

0051 25450 Revision of wrist joint

0051 25455 Revision of wrist joint

0051 25490 Reinforce radius

0051 25491 Reinforce ulna

0051 25492 Reinforce radius and ulna

0051 25820 Fusion of hand bones

0051 27033 Exploration of hip joint

0051 27100 Transfer of abdominal muscle

0051 27105 Transfer of spinal muscle

0051 27110 Transfer of iliopsoas muscle

0051 27111 Transfer of iliopsoas muscle

0051 27395 Lengthening of thigh tendons

0051 27397 Transplants of thigh tendons

0051 27400 Revise thigh muscles/tendons

0051 27405 Repair of knee ligament

0051 27416 Osteochondral knee autograft

0051 27418 Repair degenerated kneecap

0051 27420 Revision of unstable kneecap

0051 27422 Revision of unstable kneecap

0051 27424 Revision/removal of kneecap

0051 27430 Revision of thigh muscles

0051 27650 Repair achilles tendon

0051 27654 Repair of achilles tendon

0051 27690 Revise lower leg tendon

0051 27691 Revise lower leg tendon

0051 27692 Revise additional leg tendon

0051 27705 Incision of tibia

0051 27742 Repair of leg epiphyses0052 Level IV Musculoskeletal Procedures Except Hand and

Foot T 88.8483 "$6,220.80"

. "$1,244.16"

0052 0171T Lumbar spine proces distract

0052 0172T Lumbar spine process addl

0052 22523 Percut kyphoplasty thor

0052 22524 Percut kyphoplasty lumbar

0052 22525 Percut kyphoplasty add-on

0052 23397 Muscle transfers

0052 23450 Repair shoulder capsule

0052 23455 Repair shoulder capsule

0052 23460 Repair shoulder capsule

0052 23465 Repair shoulder capsule

0052 23485 Revision of collar bone

0052 23490 Reinforce clavicle

0052 23491 Reinforce shoulder bones

0052 23800 Fusion of shoulder joint

0052 23802 Fusion of shoulder joint

0052 24330 Revision of arm muscles

0052 24344 Reconstruct elbow lat ligmnt

0052 24346 Reconstruct elbow med ligmnt

0052 24400 Revision of humerus

0052 24430 Repair of humerus

0052 24435 Repair humerus with graft

0052 24498 Reinforce humerus

0052 24802 Fusion/graft of elbow joint

0052 24935 Revision of amputation

0052 25316 Revise palsy hand tendon(s)

0052 25365 Revise radius & ulna

0052 25391 Lengthen radius or ulna

0052 25400 Repair radius or ulna

0052 25405 Repair/graft radius or ulna

0052 25415 Repair radius & ulna

0052 25420 Repair/graft radius & ulna

0052 25425 Repair/graft radius or ulna

0052 25440 Repair/graft wrist bone

0052 25800 Fusion of wrist joint

0052 25805 Fusion/graft of wrist joint

0052 25810 Fusion/graft of wrist joint

0052 25825 Fuse hand bones with graft

0052 25830 Fusion radioulnar jnt/ulna

0052 27179 Revise head/neck of femur

0052 27407 Repair of knee ligament

0052 27409 Repair of knee ligaments

0052 27412 Autochondrocyte implant knee

0052 27415 Osteochondral knee allograft

0052 27427 Reconstruction knee

0052 27428 Reconstruction knee

0052 27429 Reconstruction knee

0052 27652 Repair/graft achilles tendon

0052 27745 Reinforce tibia

0052 27870 Fusion of ankle joint open

0052 27871 Fusion of tibiofibular joint

0052 28715 Fusion of foot bones

0052 29888 Knee arthroscopy/surgery

0052 29889 Knee arthroscopy/surgery

0052 29892 Ankle arthroscopy/surgery

0053 Level I Hand Musculoskeletal Procedures T 17.1902 "$1,203.59" $253.49 $240.72

0053 26020 Drain hand tendon sheath

0053 26025 Drainage of palm bursa

0053 26030 Drainage of palm bursas

0053 26034 Treat hand bone lesion

0053 26035 Decompress fingers/hand

0053 26037 Decompress fingers/hand

0053 26040 Release palm contracture

0053 26055 Incise finger tendon sheath

0053 26060 Incision of finger tendon

0053 26070 Explore/treat hand joint0053 26075 Explore/treat finger joint

0053 26080 Explore/treat finger joint

0053 26100 Biopsy hand joint lining

0053 26105 Biopsy finger joint lining

0053 26110 Biopsy finger joint lining

0053 26125 Release palm contracture

0053 26130 Remove wrist joint lining

0053 26140 Revise finger joint each

0053 26145 Tendon excision palm/finger

0053 26160 Remove tendon sheath lesion

0053 26170 Removal of palm tendon each

0053 26180 Removal of finger tendon

0053 26185 Remove finger bone

0053 26200 Remove hand bone lesion

0053 26210 Removal of finger lesion

0053 26215 Remove/graft finger lesion

0053 26230 Partial removal of hand bone

0053 26235 Partial removal finger bone

0053 26236 Partial removal finger bone

0053 26250 Extensive hand surgery

0053 26260 Resect prox finger tumor

0053 26262 Resect distal finger tumor

0053 26410 Repair hand tendon

0053 26418 Repair finger tendon

0053 26432 Repair finger tendon

0053 26433 Repair finger tendon

0053 26437 Realignment of tendons

0053 26440 Release palm/finger tendon

0053 26445 Release hand/finger tendon

0053 26450 Incision of palm tendon

0053 26455 Incision of finger tendon

0053 26460 Incise hand/finger tendon

0053 26471 Fusion of finger tendons

0053 26474 Fusion of finger tendons

0053 26476 Tendon lengthening

0053 26477 Tendon shortening

0053 26478 Lengthening of hand tendon

0053 26479 Shortening of hand tendon

0053 26500 Hand tendon reconstruction

0053 26508 Release thumb contracture

0053 26520 Release knuckle contracture

0053 26525 Release finger contracture

0053 26540 Repair hand joint

0053 26542 Repair hand joint with graft

0053 26560 Repair of web finger

0053 26580 Repair hand deformity

0053 26587 Reconstruct extra finger

0053 26590 Repair finger deformity

0053 26593 Release muscles of hand

0053 26596 Excision constricting tissue

0053 26951 Amputation of finger/thumb

0053 26952 Amputation of finger/thumb

0054 Level II Hand Musculoskeletal Procedures T 28.8625 "$2,020.84"

. $404.17

0054 20822 Replantation digit complete

0054 26045 Release palm contracture

0054 26121 Release palm contracture

0054 26123 Release palm contracture

0054 26135 Revise finger joint each

0054 26205 Remove/graft bone lesion

0054 26350 Repair finger/hand tendon

0054 26352 Repair/graft hand tendon

0054 26356 Repair finger/hand tendon

0054 26357 Repair finger/hand tendon

0054 26358 Repair/graft hand tendon

0054 26370 Repair finger/hand tendon

0054 26372 Repair/graft hand tendon0054 26373 Repair finger/hand tendon

0054 26390 Revise hand/finger tendon

0054 26392 Repair/graft hand tendon

0054 26412 Repair/graft hand tendon

0054 26415 Excision hand/finger tendon

0054 26416 Graft hand or finger tendon

0054 26420 Repair/graft finger tendon

0054 26426 Repair finger/hand tendon

0054 26428 Repair/graft finger tendon

0054 26434 Repair/graft finger tendon

0054 26442 Release palm & finger tendon

0054 26449 Release forearm/hand tendon

0054 26480 Transplant hand tendon

0054 26483 Transplant/graft hand tendon

0054 26485 Transplant palm tendon

0054 26489 Transplant/graft palm tendon

0054 26490 Revise thumb tendon

0054 26492 Tendon transfer with graft

0054 26494 Hand tendon/muscle transfer

0054 26496 Revise thumb tendon

0054 26497 Finger tendon transfer

0054 26498 Finger tendon transfer

0054 26499 Revision of finger

0054 26502 Hand tendon reconstruction

0054 26510 Thumb tendon transfer

0054 26516 Fusion of knuckle joint

0054 26517 Fusion of knuckle joints

0054 26518 Fusion of knuckle joints

0054 26541 Repair hand joint with graft

0054 26545 Reconstruct finger joint

0054 26546 Repair nonunion hand

0054 26548 Reconstruct finger joint

0054 26550 Construct thumb replacement

0054 26555 Positional change of finger

0054 26561 Repair of web finger

0054 26562 Repair of web finger

0054 26565 Correct metacarpal flaw

0054 26567 Correct finger deformity

0054 26568 Lengthen metacarpal/finger

0054 26591 Repair muscles of hand

0054 26820 Thumb fusion with graft

0054 26841 Fusion of thumb

0054 26842 Thumb fusion with graft

0054 26843 Fusion of hand joint

0054 26844 Fusion/graft of hand joint

0054 26850 Fusion of knuckle

0054 26852 Fusion of knuckle with graft

0054 26860 Fusion of finger joint

0054 26861 Fusion of finger jnt add-on

0054 26862 Fusion/graft of finger joint

0054 26863 Fuse/graft added joint

0054 26910 Amputate metacarpal bone

0054 64821 Remove sympathetic nerves

0054 64822 Remove sympathetic nerves

0054 64823 Remove sympathetic nerves

0055 Level I Foot Musculoskeletal Procedures T 22.0963 "$1,547.09" $353.25 $309.42

0055 27605 Incision of achilles tendon

0055 28005 Treat foot bone lesion

0055 28008 Incision of foot fascia

0055 28010 Incision of toe tendon

0055 28011 Incision of toe tendons

0055 28020 Exploration of foot joint

0055 28022 Exploration of foot joint

0055 28024 Exploration of toe joint

0055 28050 Biopsy of foot joint lining

0055 28052 Biopsy of foot joint lining0055 28054 Biopsy of toe joint lining

0055 28060 Partial removal foot fascia

0055 28062 Removal of foot fascia

0055 28070 Removal of foot joint lining

0055 28072 Removal of foot joint lining

0055 28080 Removal of foot lesion

0055 28086 Excise foot tendon sheath

0055 28088 Excise foot tendon sheath

0055 28090 Removal of foot lesion

0055 28092 Removal of toe lesions

0055 28100 Removal of ankle/heel lesion

0055 28104 Removal of foot lesion

0055 28108 Removal of toe lesions

0055 28110 Part removal of metatarsal

0055 28111 Part removal of metatarsal

0055 28112 Part removal of metatarsal

0055 28113 Part removal of metatarsal

0055 28114 Removal of metatarsal heads

0055 28116 Revision of foot

0055 28118 Removal of heel bone

0055 28119 Removal of heel spur

0055 28120 Part removal of ankle/heel

0055 28122 Partial removal of foot bone

0055 28124 Partial removal of toe

0055 28126 Partial removal of toe

0055 28130 Removal of ankle bone

0055 28140 Removal of metatarsal

0055 28150 Removal of toe

0055 28153 Partial removal of toe

0055 28160 Partial removal of toe

0055 28171 Resect tarsal tumor

0055 28173 Resect metatarsal tumor

0055 28175 Resect phalanx of toe tumor

0055 28200 Repair of foot tendon

0055 28202 Repair/graft of foot tendon

0055 28208 Repair of foot tendon

0055 28220 Release of foot tendon

0055 28222 Release of foot tendons

0055 28225 Release of foot tendon

0055 28226 Release of foot tendons

0055 28230 Incision of foot tendon(s)

0055 28232 Incision of toe tendon

0055 28234 Incision of foot tendon

0055 28240 Release of big toe

0055 28250 Revision of foot fascia

0055 28260 Release of midfoot joint

0055 28261 Revision of foot tendon

0055 28262 Revision of foot and ankle

0055 28270 Release of foot contracture

0055 28272 Release of toe joint each

0055 28280 Fusion of toes

0055 28285 Repair of hammertoe

0055 28286 Repair of hammertoe

0055 28288 Partial removal of foot bone

0055 28289 Repair hallux rigidus

0055 28302 Incision of ankle bone

0055 28306 Incision of metatarsal

0055 28307 Incision of metatarsal

0055 28308 Incision of metatarsal

0055 28310 Revision of big toe

0055 28312 Revision of toe

0055 28313 Repair deformity of toe

0055 28315 Removal of sesamoid bone

0055 28340 Resect enlarged toe tissue

0055 28341 Resect enlarged toe

0055 28344 Repair extra toe(s)0055 28345 Repair webbed toe(s)

0055 28755 Fusion of big toe joint

0055 28805 Amputation thru metatarsal

0055 28810 Amputation toe & metatarsal

0055 28820 Amputation of toe

0055 28825 Partial amputation of toe

0055 29893 Scope plantar fasciotomy

0056 Level II Foot Musculoskeletal Procedures T 58.4586 "$4,093.04"

. $818.61

0056 20972 Bone/skin graft metatarsal

0056 20973 Bone/skin graft great toe

0056 28102 Remove/graft foot lesion

0056 28103 Remove/graft foot lesion

0056 28106 Remove/graft foot lesion

0056 28107 Remove/graft foot lesion

0056 28210 Repair/graft of foot tendon

0056 28238 Revision of foot tendon

0056 28264 Release of midfoot joint

0056 28300 Incision of heel bone

0056 28304 Incision of midfoot bones

0056 28305 Incise/graft midfoot bones

0056 28309 Incision of metatarsals

0056 28320 Repair of foot bones

0056 28322 Repair of metatarsals

0056 28360 Reconstruct cleft foot

0056 28446 Osteochondral talus autogrft

0056 28705 Fusion of foot bones

0056 28725 Fusion of foot bones

0056 28730 Fusion of foot bones

0056 28735 Fusion of foot bones

0056 28737 Revision of foot bones

0056 28740 Fusion of foot bones

0056 28750 Fusion of big toe joint

0056 28760 Fusion of big toe joint

0057 Bunion Procedures T 32.7262 "$2,291.36" $475.91 $458.28

0057 28290 Correction of bunion

0057 28292 Correction of bunion

0057 28293 Correction of bunion

0057 28294 Correction of bunion

0057 28296 Correction of bunion

0057 28297 Correction of bunion

0057 28298 Correction of bunion

0057 28299 Correction of bunion

0058 Level I Strapping and Cast Application S 1.1255 $78.80

. $15.76

0058 29000 Application of body cast

0058 29020 Application of body cast

0058 29025 Application of body cast

0058 29040 Application of body cast

0058 29049 Application of figure eight

0058 29058 Application of shoulder cast

0058 29085 Apply hand/wrist cast

0058 29086 Apply finger cast

0058 29105 Apply long arm splint

0058 29125 Apply forearm splint

0058 29126 Apply forearm splint

0058 29130 Application of finger splint

0058 29131 Application of finger splint

0058 29200 Strapping of chest

0058 29240 Strapping of shoulder

0058 29260 Strapping of elbow or wrist

0058 29280 Strapping of hand or finger

0058 29440 Addition of walker to cast

0058 29450 Application of leg cast

0058 29505 Application long leg splint

0058 29515 Application lower leg splint

0058 29520 Strapping of hip

0058 29530 Strapping of knee0058 29540 Strapping of ankle and/or ft

0058 29550 Strapping of toes

0058 29580 Application of paste boot

0058 29581 Apply multlay comprs lwr leg

0058 29582 Apply multlay comprs upr leg

0058 29583 Apply multlay comprs upr arm

0058 29584 Appl multlay comprs arm/hand

0058 29590 Application of foot splint

0058 29700 Removal/revision of cast

0058 29705 Removal/revision of cast

0058 29715 Removal/revision of cast

0058 29720 Repair of body cast

0058 29730 Windowing of cast

0058 29740 Wedging of cast

0058 29750 Wedging of clubfoot cast

0058 29799 Casting/strapping procedure

0060 Manipulation Therapy S 0.3428 $24.00

. $4.80

0060 98925 Osteopathic manipulation

0060 98926 Osteopathic manipulation

0060 98927 Osteopathic manipulation

0060 98928 Osteopathic manipulation

0060 98929 Osteopathic manipulation

0060 98940 Chiropractic manipulation

0060 98941 Chiropractic manipulation

0060 98942 Chiropractic manipulation

0061 Level II Implantation/Revision/Replacement of Neurostimulator

Electrodes S 88.6050 "$6,203.77"

. "$1,240.76"

0061 43647 Lap impl electrode antrum

0061 63655 Implant neuroelectrodes

0061 64575 Implant neuroelectrodes

0061 64580 Implant neuroelectrodes

0061 64581 Implant neuroelectrodes

0062 Level I Treatment Fracture/Dislocation T 26.1202 "$1,828.83" $372.85 $365.77

0062 0245T Open tx rib fx 1-2 ribs

0062 0246T Opn tx rib fx 3-4 ribs

0062 0247T Opn tx rib fx 5-6 ribs

0062 0248T Open tx rib fx 7/> ribs

0062 21336 Treat nasal septal fracture

0062 21805 Treatment of rib fracture

0062 23532 Treat clavicle dislocation

0062 24538 Treat humerus fracture

0062 24566 Treat humerus fracture

0062 24582 Treat humerus fracture

0062 25606 Treat fx distal radial

0062 25651 Pin ulnar styloid fracture

0062 25670 Treat wrist dislocation

0062 25671 Pin radioulnar dislocation

0062 25676 Treat wrist dislocation

0062 25685 Treat wrist fracture

0062 25695 Treat wrist dislocation

0062 26608 Treat metacarpal fracture

0062 26650 Treat thumb fracture

0062 26676 Pin hand dislocation

0062 26685 Treat hand dislocation

0062 26715 Treat knuckle dislocation

0062 26727 Treat finger fracture each

0062 26735 Treat finger fracture each

0062 26746 Treat finger fracture each

0062 26756 Pin finger fracture each

0062 26765 Treat finger fracture each

0062 26776 Pin finger dislocation

0062 26785 Treat finger dislocation

0062 27509 Treatment of thigh fracture

0062 27756 Treatment of tibia fracture

0062 28406 Treatment of heel fracture

0062 28436 Treatment of ankle fracture0062 28456 Treat midfoot fracture

0062 28476 Treat metatarsal fracture

0062 28496 Treat big toe fracture

0062 28505 Treat big toe fracture

0062 28525 Treat toe fracture

0062 28531 Treat sesamoid bone fracture

0062 28545 Treat foot dislocation

0062 28546 Treat foot dislocation

0062 28576 Treat foot dislocation

0062 28585 Repair foot dislocation

0062 28606 Treat foot dislocation

0062 28636 Treat toe dislocation

0062 28645 Repair toe dislocation

0062 28666 Treat toe dislocation

0062 28675 Repair of toe dislocation

0063 Level II Treatment Fracture/Dislocation T 49.8979 "$3,493.65"

. $698.73

0063 23530 Treat clavicle dislocation

0063 23550 Treat clavicle dislocation

0063 23552 Treat clavicle dislocation

0063 23660 Treat shoulder dislocation

0063 23680 Treat dislocation/fracture

0063 24665 Treat radius fracture

0063 24685 Treat ulnar fracture

0063 25515 Treat fracture of radius

0063 25525 Treat fracture of radius

0063 25526 Treat fracture of radius

0063 25545 Treat fracture of ulna

0063 25628 Treat wrist bone fracture

0063 25645 Treat wrist bone fracture

0063 25652 Treat fracture ulnar styloid

0063 26615 Treat metacarpal fracture

0063 26665 Treat thumb fracture

0063 27202 Treat tail bone fracture

0063 27524 Treat kneecap fracture

0063 27566 Treat kneecap dislocation

0063 27720 Repair of tibia

0063 27726 Repair fibula nonunion

0063 27758 Treatment of tibia fracture

0063 27766 Optx medial ankle fx

0063 27769 Optx post ankle fx

0063 27784 Treatment of fibula fracture

0063 27792 Treatment of ankle fracture

0063 27814 Treatment of ankle fracture

0063 27822 Treatment of ankle fracture

0063 27826 Treat lower leg fracture

0063 27829 Treat lower leg joint

0063 27832 Treat lower leg dislocation

0063 27846 Treat ankle dislocation

0063 27848 Treat ankle dislocation

0063 28420 Treat/graft heel fracture

0063 28445 Treat ankle fracture

0063 28465 Treat midfoot fracture each

0063 28485 Treat metatarsal fracture

0063 28555 Repair foot dislocation

0063 28615 Repair foot dislocation

0064 Level III Treatment Fracture/Dislocation T 68.1203 "$4,769.51"

. $953.91

0064 23515 Treat clavicle fracture

0064 23585 Treat scapula fracture

0064 23615 Treat humerus fracture

0064 23616 Treat humerus fracture

0064 23630 Treat humerus fracture

0064 23670 Treat dislocation/fracture

0064 24515 Treat humerus fracture

0064 24516 Treat humerus fracture

0064 24545 Treat humerus fracture

0064 24546 Treat humerus fracture0064 24575 Treat humerus fracture

0064 24579 Treat humerus fracture

0064 24586 Treat elbow fracture

0064 24587 Treat elbow fracture

0064 24615 Treat elbow dislocation

0064 24635 Treat elbow fracture

0064 24666 Treat radius fracture

0064 25574 Treat fracture radius & ulna

0064 25575 Treat fracture radius/ulna

0064 25607 Treat fx rad extra-articul

0064 25608 Treat fx rad intra-articul

0064 25609 Treat fx radial 3+ frag

0064 26686 Treat hand dislocation

0064 27722 Repair/graft of tibia

0064 27759 Treatment of tibia fracture

0064 27823 Treatment of ankle fracture

0064 27827 Treat lower leg fracture

0064 27828 Treat lower leg fracture

0064 28415 Treat heel fracture

0065 "Level I Stereotactic Radiosurgery, MRgFUS, and MEG" S 12.8903 $902.53

. $180.51

0065 0301T Mw therapy for breast tumor

0065 95966 Meg evoked single

0065 95967 Meg evoked each addl

0065 G0251 Linear acc based stero radio

0066 "Level II Stereotactic Radiosurgery, MRgFUS, and

MEG" S 35.9961 "$2,520.30"

. $504.06

0066 95965 Meg spontaneous

0066 G0340 Robt lin-radsurg fractx 2-5

0067 "Level III Stereotactic Radiosurgery, MRgFUS, and

MEG" S 48.1833 "$3,373.60"

. $674.72

0067 0071T U/s leiomyomata ablate <200

0067 0072T U/s leiomyomata ablate >200

0067 G0173 Linear acc stereo radsur com

0067 G0339 "Robot lin-radsurg com, first"

0069 Thoracoscopy T 34.5272 "$2,417.46" $591.64 $483.50

0069 32601 Thoracoscopy diagnostic

0069 32604 Thoracoscopy wbx sac

0069 32606 Thoracoscopy w/bx med space

0069 32607 Thoracoscopy w/bx infiltrate

0069 32608 Thoracoscopy w/bx nodule

0069 32609 Thoracoscopy w/bx pleura

0069 39400 Mediastinoscopy incl biopsy

0070 Thoracentesis/Lavage Procedures T 5.5061 $385.52

. $77.11

0070 32201 Drain percut lung lesion

0070 32420 Puncture/clear lung

0070 32421 Thoracentesis for aspiration

0070 32422 Thoracentesis w/tube insert

0070 32551 Insertion of chest tube

0070 32560 Treat pleurodesis w/agent

0070 32561 Lyse chest fibrin init day

0070 32562 Lyse chest fibrin subq day

0070 32960 Therapeutic pneumothorax

0070 32999 Chest surgery procedure

0070 33010 Drainage of heart sac

0070 33011 Repeat drainage of heart sac

0070 33999 Cardiac surgery procedure

0070 49082 Abd paracentesis

0070 49083 Abd paracentesis w/imaging

0070 49084 Peritoneal lavage

0071 Level I Endoscopy Upper Airway T 1.0729 $75.12

. $15.03

0071 31505 Diagnostic laryngoscopy

0071 92511 Nasopharyngoscopy

0072 Level II Endoscopy Upper Airway T 1.8643 $130.53

. $26.11

0072 31231 Nasal endoscopy dx

0072 31233 Nasal/sinus endoscopy dx

0072 31511 Remove foreign body larynx0072 31513 Injection into vocal cord

0072 31520 Dx laryngoscopy newborn

0072 31575 Diagnostic laryngoscopy

0073 Level III Endoscopy Upper Airway T 4.4119 $308.90 $67.83 $61.78

0073 31577 Remove foreign body larynx

0073 31579 Diagnostic laryngoscopy

0073 31717 Bronchial brush biopsy

0073 31730 Intro windpipe wire/tube

0074 Level IV Endoscopy Upper Airway T 21.2774 "$1,489.76"

. $297.96

0074 31235 Nasal/sinus endoscopy dx

0074 31237 Nasal/sinus endoscopy surg

0074 31238 Nasal/sinus endoscopy surg

0074 31240 Nasal/sinus endoscopy surg

0074 31510 Laryngoscopy with biopsy

0074 31512 Removal of larynx lesion

0074 31515 Laryngoscopy for aspiration

0074 31525 Dx laryngoscopy excl nb

0074 31526 Dx laryngoscopy w/oper scope

0074 31528 Laryngoscopy and dilation

0074 31529 Laryngoscopy and dilation

0074 31530 Laryngoscopy w/fb removal

0074 31531 Laryngoscopy w/fb & op scope

0074 31535 Laryngoscopy w/biopsy

0074 31536 Laryngoscopy w/bx & op scope

0074 31540 Laryngoscopy w/exc of tumor

0074 31541 Larynscop w/tumr exc + scope

0074 31570 Laryngoscope w/vc inj

0074 31576 Laryngoscopy with biopsy

0075 Level V Endoscopy Upper Airway T 30.3487 "$2,124.89" $444.55 $424.98

0075 31239 Nasal/sinus endoscopy surg

0075 31254 Revision of ethmoid sinus

0075 31255 Removal of ethmoid sinus

0075 31256 Exploration maxillary sinus

0075 31267 Endoscopy maxillary sinus

0075 31276 Sinus endoscopy surgical

0075 31287 Nasal/sinus endoscopy surg

0075 31288 Nasal/sinus endoscopy surg

0075 31292 Nasal/sinus endoscopy surg

0075 31293 Nasal/sinus endoscopy surg

0075 31294 Nasal/sinus endoscopy surg

0075 31295 Sinus endo w/balloon dil

0075 31296 Sinus endo w/balloon dil

0075 31297 Sinus endo w/balloon dil

0075 31527 Laryngoscopy for treatment

0075 31545 Remove vc lesion w/scope

0075 31546 Remove vc lesion scope/graft

0075 31560 Laryngoscop w/arytenoidectom

0075 31561 Larynscop remve cart + scop

0075 31571 Laryngoscop w/vc inj + scope

0075 31578 Removal of larynx lesion

0076 Level I Endoscopy Lower Airway T 10.4689 $732.99 $189.82 $146.60

0076 0251T Remov bronchial valve

0076 0252T Remov bronch valve addl

0076 31622 Dx bronchoscope/wash

0076 31623 Dx bronchoscope/brush

0076 31624 Dx bronchoscope/lavage

0076 31625 Bronchoscopy w/biopsy(s)

0076 31628 Bronchoscopy/lung bx each

0076 31629 Bronchoscopy/needle bx each

0076 31632 Bronchoscopy/lung bx addl

0076 31633 Bronchoscopy/needle bx addl

0076 31634 Bronch w/balloon occlusion

0076 31635 Bronchoscopy w/fb removal

0076 31637 Bronchoscopy stent add-on

0076 31643 Diag bronchoscope/catheter

0076 31645 Bronchoscopy clear airways0076 31646 Bronchoscopy reclear airway

0076 31656 Bronchoscopy inj for x-ray

0076 31899 Airways surgical procedure

0077 Level I Pulmonary Treatment S 0.4237 $29.67 $7.74 $5.94

0077 31720 Clearance of airways

0077 94610 Surfactant admin thru tube

0077 94640 Airway inhalation treatment

0077 94664 Evaluate pt use of inhaler

0077 94667 Chest wall manipulation

0077 94668 Chest wall manipulation

0077 G0237 Therapeutic procd strg endur

0077 G0238 "Oth resp proc, indiv"

0077 G0239 "Oth resp proc, group"

0078 Level III Pulmonary Treatment S 1.4089 $98.65

. $19.73

0078 0243T Intm msr bronchodil wheeze

0078 31502 Change of windpipe airway

0078 32552 Remove lung catheter

0078 94060 Evaluation of wheezing

0078 94642 Aerosol inhalation treatment

0078 94660 Pos airway pressure cpap

0079 Ventilation Initiation and Management S 3.1979 $223.90

. $44.78

0079 94002 Vent mgmt inpat init day

0079 94003 Vent mgmt inpat subq day

0079 94662 Neg press ventilation cnp

0080 Diagnostic Cardiac Catheterization T 38.8523 "$2,720.28" $836.90 $544.06

0080 93451 Right heart cath

0080 93452 Left hrt cath w/ventrclgrphy

0080 93453 R&l hrt cath w/ventriclgrphy

0080 93454 Coronary artery angio s&i

0080 93455 Coronary art/grft angio s&i

0080 93456 R hrt coronary artery angio

0080 93457 R hrt art/grft angio

0080 93458 L hrt artery/ventricle angio

0080 93459 L hrt art/grft angio

0080 93460 R&l hrt art/ventricle angio

0080 93461 R&l hrt art/ventricle angio

0080 93462 L hrt cath trnsptl puncture

0080 93530 Rt heart cath congenital

0080 93531 R & l heart cath congenital

0080 93532 R & l heart cath congenital

0080 93533 R & l heart cath congenital

0082 Coronary or Non-Coronary Atherectomy T 105.0651 "$7,356.24"

. "$1,471.25"

0082 0234T Trluml perip athrc renal art

0082 0236T Trluml perip athrc abd aorta

0082 0237T Trluml perip athrc brchiocph

0082 0238T Trluml perip athrc iliac art

0082 37204 Transcatheter occlusion

0082 61623 Endovasc tempory vessel occl

0082 61626 Transcath occlusion non-cns

0082 92995 Coronary atherectomy

0082 92996 Coronary atherectomy add-on

0083 "Coronary Angioplasty, Valvuloplasty, and Level I Endovascular

Revascularization" T 65.8519 "$4,610.69"

. $922.14

0083 35458 Repair arterial blockage

0083 35460 Repair venous blockage

0083 35471 Repair arterial blockage

0083 35472 Repair arterial blockage

0083 35475 Repair arterial blockage

0083 35476 Repair venous blockage

0083 37220 Iliac revasc

0083 37222 Iliac revasc add-on

0083 37223 Iliac revasc w/stent add-on

0083 37224 Fem/popl revas w/tla

0083 37228 Tib/per revasc w/tla

0083 37232 Tib/per revasc add-on

0083 37234 Revsc opn/prq tib/pero stent0083 37235 Tib/per revasc stnt & ather

0083 75962 Repair arterial blockage

0083 75966 Repair arterial blockage

0083 92982 Coronary artery dilation

0083 92984 Coronary artery dilation

0083 92986 Revision of aortic valve

0083 92987 Revision of mitral valve

0083 92990 Revision of pulmonary valve

0083 92997 Pul art balloon repr percut

0083 92998 Pul art balloon repr percut

0084 Level I Electrophysiologic Procedures S 9.9330 $695.47

. $139.10

0084 93600 Bundle of His recording

0084 93602 Intra-atrial recording

0084 93603 Right ventricular recording

0084 93610 Intra-atrial pacing

0084 93612 Intraventricular pacing

0084 93615 Esophageal recording

0084 93616 Esophageal recording

0084 93618 Heart rhythm pacing

0084 93642 Electrophysiology evaluation

0085 Level II Electrophysiologic Procedures T 53.2719 "$3,729.89"

. $745.98

0085 93619 Electrophysiology evaluation

0085 93620 Electrophysiology evaluation

0085 93624 Electrophysiologic study

0085 93650 Ablate heart dysrhythm focus

0086 Level III Electrophysiologic Procedures T 121.8174 "$8,529.17"

. "$1,705.84"

0086 93651 Ablate heart dysrhythm focus

0086 93652 Ablate heart dysrhythm focus

0088 Thrombectomy T 41.0387 "$2,873.37" $655.18 $574.68

0088 34101 Removal of artery clot

0088 34111 Removal of arm artery clot

0088 34201 Removal of artery clot

0088 34203 Removal of leg artery clot

0088 34421 Removal of vein clot

0088 34471 Removal of vein clot

0088 34490 Removal of vein clot

0088 34501 Repair valve femoral vein

0088 34510 Transposition of vein valve

0088 34520 Cross-over vein graft

0088 34530 Leg vein fusion

0088 35188 Repair blood vessel lesion

0088 35207 Repair blood vessel lesion

0088 35875 Removal of clot in graft

0088 35876 Removal of clot in graft

0088 35879 Revise graft w/vein

0088 35881 Revise graft w/vein

0088 35883 Revise graft w/nonauto graft

0088 35884 Revise graft w/vein

0088 36818 Av fuse uppr arm cephalic

0088 36819 Av fuse uppr arm basilic

0088 36820 Av fusion/forearm vein

0088 36821 Av fusion direct any site

0088 36825 Artery-vein autograft

0088 36830 Artery-vein nonautograft

0088 36831 Open thrombect av fistula

0088 36832 Av fistula revision open

0088 36833 Av fistula revision

0088 36838 Dist revas ligation hemo

0088 37184 Prim art mech thrombectomy

0088 37185 Prim art m-thrombect add-on

0088 37186 Sec art m-thrombect add-on

0088 37187 Venous mech thrombectomy

0088 37188 Venous m-thrombectomy add-on

0088 92973 Percut coronary thrombectomy

0089 Insertion/Replacement of Permanent Pacemaker andElectrodes T 112.1218 "$7,850.32" "$1,643.98" "$1,570.07"

0089 33206 Insert heart pm atrial

0089 33207 Insert heart pm ventricular

0090 Level I Insertion/Replacement of Permanent

Pacemaker T 94.2220 "$6,597.05" "$1,593.50" "$1,319.41"

0090 33212 Insert pulse gen sngl lead

0090 33227 Remove&replace pm gen singl

0091 Level II Vascular Ligation T 44.2272 "$3,096.61"

. $619.33

0091 36475 Endovenous rf 1st vein

0091 37191 Ins endovas vena cava filtr

0091 37500 Endoscopy ligate perf veins

0091 37605 Ligation of neck artery

0091 37619 Ligation of inf vena cava

0091 37722 Ligate/strip long leg vein

0091 37735 Removal of leg veins/lesion

0092 Level I Vascular Ligation T 26.8120 "$1,877.27"

. $375.46

0092 30915 Ligation nasal sinus artery

0092 30920 Ligation upper jaw artery

0092 36476 Endovenous rf vein add-on

0092 36478 Endovenous laser 1st vein

0092 36479 Endovenous laser vein addon

0092 37501 Vascular endoscopy procedure

0092 37606 Ligation of neck artery

0092 37607 Ligation of a-v fistula

0092 37615 Ligation of neck artery

0092 37650 Revision of major vein

0092 37700 Revise leg vein

0092 37718 Ligate/strip short leg vein

0092 37760 Ligate leg veins radical

0092 37761 Ligate leg veins open

0092 37765 Stab phleb veins xtr 10-20

0092 37766 Phleb veins - extrem 20+

0092 37780 Revision of leg vein

0092 37785 Ligate/divide/excise vein

0093 Vascular Reconstruction/Fistula Repair without

Device T 31.1505 "$2,181.03"

. $436.21

0093 35045 Repair defect of arm artery

0093 35180 Repair blood vessel lesion

0093 35184 Repair blood vessel lesion

0093 35190 Repair blood vessel lesion

0093 35201 Repair blood vessel lesion

0093 35206 Repair blood vessel lesion

0093 35231 Repair blood vessel lesion

0093 35236 Repair blood vessel lesion

0093 35256 Repair blood vessel lesion

0093 35321 Rechanneling of artery

0093 35685 Bypass graft patency/patch

0093 35686 Bypass graft/av fist patency

0093 35761 Exploration of artery/vein

0093 35860 Explore limb vessels

0093 35903 Excision graft extremity

0093 37565 Ligation of neck vein

0093 37600 Ligation of neck artery

0093 75978 Repair venous blockage

0094 Level I Resuscitation and Cardioversion S 2.2326 $156.32 $43.83 $31.27

0094 31500 Insert emergency airway

0094 92950 Heart/lung resuscitation cpr

0094 92953 Temporary external pacing

0094 99465 Nb resuscitation

0095 Cardiac Rehabilitation S 0.9930 $69.53

. $13.91

0095 93797 Cardiac rehab

0095 93798 Cardiac rehab/monitor

0095 G0422 Intens cardiac rehab w/exerc

0095 G0423 Intens cardiac rehab no exer

0096 Level II Noninvasive Physiologic Studies S 1.5248 $106.76 $36.86 $21.36

0096 76936 Echo guide for artery repair

0096 93923 Upr/lxtr art stdy 3+ lvls0096 93924 Lwr xtr vasc stdy bilat

0096 93965 Extremity study

0097 Level I Noninvasive Physiologic Studies S 0.9350 $65.46

. $13.10

0097 0239T Bioimpedance spectroscopy

0097 0296T Ext ecg recording

0097 0297T Ext ecg scan w/report

0097 43755 Dx gastr intub w/asp specs

0097 93225 Ecg monit/reprt up to 48 hrs

0097 93226 Ecg monit/reprt up to 48 hrs

0097 93270 Remote 30 day ecg rev/report

0097 93786 Ambulatory BP recording

0097 93788 Ambulatory BP analysis

0097 93799 Cardiovascular procedure

0097 93922 Upr/l xtremity art 2 levels

0097 93982 Aneurysm pressure sens study

0097 94762 Measure blood oxygen level

0097 94775 Ped home apnea rec hk-up

0097 94776 Ped home apnea rec downld

0099 Electrocardiograms/Cardiography S 0.3817 $26.73

. $5.35

0099 0223T Acoustic ecg w/i&r

0099 93005 Electrocardiogram tracing

0099 93701 Bioimpedance cv analysis

0099 G0404 EKG tracing for initial prev

0100 Cardiac Stress Tests X 2.5439 $178.11 $41.37 $35.63

0100 0179T 64 lead ecg w/tracing

0100 93017 Cardiovascular stress test

0100 93024 Cardiac drug stress test

0100 93025 Microvolt t-wave assess

0100 Q0035 Cardiokymography

0101 Tilt Table Evaluation S 4.2669 $298.75 $100.24 $59.75

0101 93660 Tilt table evaluation

0102 Level II Pulmonary Treatment S 0.5346 $37.43

. $7.49

0102 G0424 Pulmonary rehab w exer

0103 Miscellaneous Vascular Procedures T 16.3852 "$1,147.23"

. $229.45

0103 35500 Harvest vein for bypass

0103 37201 Transcatheter therapy infuse

0103 37202 Transcatheter therapy infuse

0103 92974 Cath place cardio brachytx

0103 93503 Insert/place heart catheter

0103 93505 Biopsy of heart lining

0104 Transcatheter Placement of Intracoronary Stents T 81.1503 "$5,681.82"

. "$1,136.37"

0104 92980 Insert intracoronary stent

0104 92981 Insert intracoronary stent

0105 "Repair/Revision/Removal of Pacemakers, AICDs, or Vascular

Devices" T 21.7420 "$1,522.29"

. $304.46

0105 33215 Reposition pacing-defib lead

0105 33218 Repair lead pace-defib one

0105 33220 Repair lead pace-defib dual

0105 33226 Reposition l ventric lead

0105 33233 Removal of pm generator

0105 33234 Removal of pacemaker system

0105 33235 Removal pacemaker electrode

0105 33241 Remove pulse generator

0105 33244 Remove eltrd transven

0105 36261 Revision of infusion pump

0105 36262 Removal of infusion pump

0105 49422 Remove tunneled ip cath

0105 49429 Removal of shunt

0106 Insertion/Replacement of Pacemaker Leads and/or

Electrodes T 47.1769 "$3,303.14"

. $660.63

0106 33210 Insert electrd/pm cath sngl

0106 33211 Insert card electrodes dual

0106 33216 Insert 1 electrode pm-defib

0106 33217 Insert 2 electrode pm-defib

0107 Insertion of Cardioverter-Defibrillator PulseGenerator T 341.5859 "$23,916.48"

. "$4,783.30"

0107 33230 Insrt pulse gen w/dual leads

0107 33231 Insrt pulse gen w/mult leads

0107 33240 Insrt pulse gen w/singl lead

0107 33262 Remv&replc cvd gen sing lead

0107 33263 Remv&replc cvd gen dual lead

0107 33264 Remv&replc cvd gen mult lead

0108 "Insertion/Replacement/Repair of AICD Leads, Generator, and Pacing

Electrodes" T 426.1201 "$29,835.22"

. "$5,967.05"

0108 33249 Nsert pace-defib w/lead

0110 Transfusion S 3.4217 $239.57

. $47.92

0110 36430 Blood transfusion service

0110 36440 Bl push transfuse 2 yr or <

0110 36450 Bl exchange/transfuse nb

0110 36455 Bl exchange/transfuse non-nb

0110 36460 Transfusion service fetal

0110 38207 Cryopreserve stem cells

0110 38208 Thaw preserved stem cells

0110 38209 Wash harvest stem cells

0110 38999 Blood/lymph system procedure

0111 Blood Product Exchange S 11.6629 $816.59 $189.89 $163.32

0111 36511 Apheresis wbc

0111 36512 Apheresis rbc

0111 36513 Apheresis platelets

0111 36514 Apheresis plasma

0111 38206 Harvest auto stem cells

0111 38242 Lymphocyte infuse transplant

0112 Apheresis and Stem Cell Procedures S 35.6252 "$2,494.33"

. $498.87

0112 0263T Im B1 mrw cel ther cmpl

0112 0264T Im B1 mrw cel ther xcl hrvst

0112 0265T Im B1 mrw cel ther hrvst onl

0112 36515 Apheresis adsorp/reinfuse

0112 36516 Apheresis selective

0112 36522 Photopheresis

0112 38230 Bone marrow harvest allogen

0112 38232 Bone marrow harvest autolog

0112 38240 Bn marrow/stm transplt allo

0112 38241 Bn marrow/stm transplt auto

0113 Excision Lymphatic System T 25.2738 "$1,769.57"

. $353.92

0113 38308 Incision of lymph channels

0113 38500 Biopsy/removal lymph nodes

0113 38510 Biopsy/removal lymph nodes

0113 38520 Biopsy/removal lymph nodes

0113 38525 Biopsy/removal lymph nodes

0113 38530 Biopsy/removal lymph nodes

0113 38550 Removal neck/armpit lesion

0113 38555 Removal neck/armpit lesion

0113 38700 Removal of lymph nodes neck

0113 38720 Removal of lymph nodes neck

0113 38760 Remove groin lymph nodes

0114 Thyroid/Lymphadenectomy Procedures T 51.2792 "$3,590.36"

. $718.08

0114 38542 Explore deep node(s) neck

0114 38740 Remove armpit lymph nodes

0114 38745 Remove armpit lymph nodes

0114 60200 Remove thyroid lesion

0114 60210 Partial thyroid excision

0114 60212 Partial thyroid excision

0114 60220 Partial removal of thyroid

0114 60225 Partial removal of thyroid

0114 60240 Removal of thyroid

0114 60280 Remove thyroid duct lesion

0114 60281 Remove thyroid duct lesion

0114 60699 Endocrine surgery procedure

0115 Cannula/Access Device Procedures T 37.4593 "$2,622.75"

. $524.55

0115 36800 Insertion of cannula

0115 36810 Insertion of cannula

0115 36815 Insertion of cannula0115 36835 Artery to vein shunt

0115 36861 Cannula declotting

0115 49419 Insert tun ip cath w/port

0121 Level I Tube or Catheter Changes or Repositioning T 6.2123 $434.96

. $87.00

0121 36575 Repair tunneled cv cath

0121 36589 Removal tunneled cv cath

0121 44500 Intro gastrointestinal tube

0121 49450 Replace g/c tube perc

0121 49451 Replace duod/jej tube perc

0121 49452 Replace g-j tube perc

0121 49460 Fix g/colon tube w/device

0121 51710 Change of bladder tube

0121 61070 Brain canal shunt procedure

0126 Level I Urinary and Anal Procedures T 1.1095 $77.68 $16.21 $15.54

0126 50391 Instll rx agnt into rnal tub

0126 50686 Measure ureter pressure

0126 51101 Drain bladder by trocar/cath

0126 51703 Insert bladder cath complex

0126 51741 Electro-uroflowmetry first

0126 51784 Anal/urinary muscle study

0126 51792 Urinary reflex study

0126 53601 Dilate urethra stricture

0126 53660 Dilation of urethra

0126 53661 Dilation of urethra

0126 53899 Urology surgery procedure

0126 54240 Penis study

0126 55899 Genital surgery procedure

0126 90911 Biofeedback peri/uro/rectal

0126 91120 Rectal sensation test

0127 "Level IV Stereotactic Radiosurgery, MRgFUS, and

MEG" S 106.5454 "$7,459.88"

. "$1,491.98"

0127 77371 Srs multisource

0128 Echocardiogram with Contrast S 7.9593 $557.28 $166.16 $111.46

0128 C8921 "TTE w or w/o fol w/cont, com"

0128 C8922 "TTE w or w/o fol w/cont, f/u"

0128 C8923 "2D TTE w or w/o fol w/con,co"

0128 C8924 "2D TTE w or w/o fol w/con,fu"

0128 C8925 "2D TEE w or w/o fol w/con,in"

0128 C8926 "TEE w or w/o fol w/cont,cong"

0128 C8927 "TEE w or w/o fol w/cont, mon"

0128 C8928 "TTE w or w/o fol w/con,stres"

0128 C8929 "TTE w or wo fol wcon,Doppler"

0128 C8930 "TTE w or w/o contr, cont ECG"

0129 Level I Closed Treatment Fracture T 1.5020 $105.16

. $21.04

0129 21800 Treatment of rib fracture

0129 21820 Treat sternum fracture

0129 22305 Treat spine process fracture

0129 23500 Treat clavicle fracture

0129 23540 Treat clavicle dislocation

0129 23570 Treat shoulder blade fx

0129 23600 Treat humerus fracture

0129 23620 Treat humerus fracture

0129 23650 Treat shoulder dislocation

0129 23675 Treat dislocation/fracture

0129 23929 Shoulder surgery procedure

0129 24500 Treat humerus fracture

0129 24505 Treat humerus fracture

0129 24530 Treat humerus fracture

0129 24560 Treat humerus fracture

0129 24565 Treat humerus fracture

0129 24576 Treat humerus fracture

0129 24577 Treat humerus fracture

0129 24600 Treat elbow dislocation

0129 24640 Treat elbow dislocation

0129 24650 Treat radius fracture

0129 24670 Treat ulnar fracture0129 24675 Treat ulnar fracture

0129 24999 Upper arm/elbow surgery

0129 25500 Treat fracture of radius

0129 25530 Treat fracture of ulna

0129 25535 Treat fracture of ulna

0129 25560 Treat fracture radius & ulna

0129 25600 Treat fracture radius/ulna

0129 25622 Treat wrist bone fracture

0129 25630 Treat wrist bone fracture

0129 25635 Treat wrist bone fracture

0129 25650 Treat wrist bone fracture

0129 25660 Treat wrist dislocation

0129 25675 Treat wrist dislocation

0129 25680 Treat wrist fracture

0129 25999 Forearm or wrist surgery

0129 26600 Treat metacarpal fracture

0129 26605 Treat metacarpal fracture

0129 26641 Treat thumb dislocation

0129 26670 Treat hand dislocation

0129 26675 Treat hand dislocation

0129 26700 Treat knuckle dislocation

0129 26705 Treat knuckle dislocation

0129 26720 Treat finger fracture each

0129 26725 Treat finger fracture each

0129 26740 Treat finger fracture each

0129 26742 Treat finger fracture each

0129 26750 Treat finger fracture each

0129 26755 Treat finger fracture each

0129 26770 Treat finger dislocation

0129 26989 Hand/finger surgery

0129 27193 Treat pelvic ring fracture

0129 27200 Treat tail bone fracture

0129 27220 Treat hip socket fracture

0129 27230 Treat thigh fracture

0129 27250 Treat hip dislocation

0129 27256 Treat hip dislocation

0129 27265 Treat hip dislocation

0129 27267 Cltx thigh fx

0129 27299 Pelvis/hip joint surgery

0129 27501 Treatment of thigh fracture

0129 27503 Treatment of thigh fracture

0129 27508 Treatment of thigh fracture

0129 27516 Treat thigh fx growth plate

0129 27517 Treat thigh fx growth plate

0129 27520 Treat kneecap fracture

0129 27530 Treat knee fracture

0129 27538 Treat knee fracture(s)

0129 27550 Treat knee dislocation

0129 27560 Treat kneecap dislocation

0129 27599 Leg surgery procedure

0129 27750 Treatment of tibia fracture

0129 27760 Cltx medial ankle fx

0129 27767 Cltx post ankle fx

0129 27768 Cltx post ankle fx w/mnpj

0129 27780 Treatment of fibula fracture

0129 27786 Treatment of ankle fracture

0129 27788 Treatment of ankle fracture

0129 27808 Treatment of ankle fracture

0129 27810 Treatment of ankle fracture

0129 27816 Treatment of ankle fracture

0129 27824 Treat lower leg fracture

0129 27830 Treat lower leg dislocation

0129 27840 Treat ankle dislocation

0129 27899 Leg/ankle surgery procedure

0129 28400 Treatment of heel fracture

0129 28430 Treatment of ankle fracture0129 28435 Treatment of ankle fracture

0129 28450 Treat midfoot fracture each

0129 28455 Treat midfoot fracture each

0129 28470 Treat metatarsal fracture

0129 28475 Treat metatarsal fracture

0129 28490 Treat big toe fracture

0129 28495 Treat big toe fracture

0129 28510 Treatment of toe fracture

0129 28515 Treatment of toe fracture

0129 28530 Treat sesamoid bone fracture

0129 28540 Treat foot dislocation

0129 28570 Treat foot dislocation

0129 28600 Treat foot dislocation

0129 28605 Treat foot dislocation

0129 28630 Treat toe dislocation

0129 28660 Treat toe dislocation

0129 28899 Foot/toes surgery procedure

0130 Level I Laparoscopy T 38.9223 "$2,725.18" $659.53 $545.04

0130 38129 Laparoscope proc spleen

0130 38589 Laparoscope proc lymphatic

0130 43289 Laparoscope proc esoph

0130 43648 Lap revise/remv eltrd antrum

0130 43659 Laparoscope proc stom

0130 44213 Lap mobil splenic fl add-on

0130 44238 Laparoscope proc intestine

0130 44979 Laparoscope proc app

0130 45499 Laparoscope proc rectum

0130 47379 Laparoscope procedure liver

0130 47560 Laparoscopy w/cholangio

0130 47561 Laparo w/cholangio/biopsy

0130 47579 Laparoscope proc biliary

0130 49320 Diag laparo separate proc

0130 49321 Laparoscopy biopsy

0130 49322 Laparoscopy aspiration

0130 49323 Laparo drain lymphocele

0130 49324 Lap insert tunnel ip cath

0130 49325 Lap revision perm ip cath

0130 49326 Lap w/omentopexy add-on

0130 49327 Lap ins device for rt

0130 49329 Laparo proc abdm/per/oment

0130 49659 Laparo proc hernia repair

0130 50541 Laparo ablate renal cyst

0130 50549 Laparoscope proc renal

0130 50949 Laparoscope proc ureter

0130 51999 Laparoscope proc bla

0130 54699 Laparoscope proc testis

0130 55559 Laparo proc spermatic cord

0130 58545 Laparoscopic myomectomy

0130 58578 Laparo proc uterus

0130 58679 Laparo proc oviduct-ovary

0130 59898 Laparo proc ob care/deliver

0130 60659 Laparo proc endocrine

0131 Level II Laparoscopy T 47.9394 "$3,356.53" "$1,001.89" $671.31

0131 38120 Laparoscopy splenectomy

0131 38570 Laparoscopy lymph node biop

0131 38572 Laparoscopy lymphadenectomy

0131 43653 Laparoscopy gastrostomy

0131 43770 Lap place gastr adj device

0131 44180 Lap enterolysis

0131 44186 Lap jejunostomy

0131 44970 Laparoscopy appendectomy

0131 47562 Laparoscopic cholecystectomy

0131 47563 Laparo cholecystectomy/graph

0131 47564 Laparo cholecystectomy/explr

0131 49650 Lap ing hernia repair init

0131 49651 Lap ing hernia repair recur0131 50543 Laparo partial nephrectomy

0131 50544 Laparoscopy pyeloplasty

0131 50945 Laparoscopy ureterolithotomy

0131 50947 Laparo new ureter/bladder

0131 50948 Laparo new ureter/bladder

0131 51990 Laparo urethral suspension

0131 51992 Laparo sling operation

0131 54690 Laparoscopy orchiectomy

0131 55550 Laparo ligate spermatic vein

0131 57425 Laparoscopy surg colpopexy

0131 58546 Laparo-myomectomy complex

0131 58552 Laparo-vag hyst incl t/o

0131 58553 Laparo-vag hyst complex

0131 58554 Laparo-vag hyst w/t/o compl

0131 58570 Tlh uterus 250 g or less

0131 58571 Tlh w/t/o 250 g or less

0131 58572 Tlh uterus over 250 g

0131 58573 Tlh w/t/o uterus over 250 g

0131 58660 Laparoscopy lysis

0131 58661 Laparoscopy remove adnexa

0131 58662 Laparoscopy excise lesions

0131 58670 Laparoscopy tubal cautery

0131 58671 Laparoscopy tubal block

0131 58672 Laparoscopy fimbrioplasty

0131 58673 Laparoscopy salpingostomy

0131 59150 Treat ectopic pregnancy

0131 59151 Treat ectopic pregnancy

0132 Level III Laparoscopy T 71.5658 "$5,010.75" "$1,236.99" "$1,002.15"

0132 38571 Laparoscopy lymphadenectomy

0132 43280 Laparoscopy fundoplasty

0132 43281 Lap paraesophag hern repair

0132 43651 Laparoscopy vagus nerve

0132 43652 Laparoscopy vagus nerve

0132 44206 Lap part colectomy w/stoma

0132 44207 L colectomy/coloproctostomy

0132 44208 L colectomy/coloproctostomy

0132 49652 Lap vent/abd hernia repair

0132 49653 Lap vent/abd hern proc comp

0132 49654 Lap inc hernia repair

0132 49655 Lap inc hern repair comp

0132 49656 Lap inc hernia repair recur

0132 49657 Lap inc hern recur comp

0132 54692 Laparoscopy orchiopexy

0132 58541 Lsh uterus 250 g or less

0132 58542 Lsh w/t/o ut 250 g or less

0132 58543 Lsh uterus above 250 g

0132 58544 Lsh w/t/o uterus above 250 g

0132 58550 Laparo-asst vag hysterectomy

0133 Level I Skin Repair T 1.1922 $83.47 $23.34 $16.70

0133 11760 Repair of nail bed

0133 11954 Therapy for contour defects

0133 12001 Repair superficial wound(s)

0133 12002 Repair superficial wound(s)

0133 12004 Repair superficial wound(s)

0133 12005 Repair superficial wound(s)

0133 12006 Repair superficial wound(s)

0133 12007 Repair superficial wound(s)

0133 12011 Repair superficial wound(s)

0133 12013 Repair superficial wound(s)

0133 12014 Repair superficial wound(s)

0133 12015 Repair superficial wound(s)

0133 12016 Repair superficial wound(s)

0133 12017 Repair superficial wound(s)

0133 12041 Intmd wnd repair n-hf/genit

0133 12054 Intmd wnd repair face/mm

0133 13122 Repair wound/lesion add-on0133 15272 Skin sub graft t/a/l add-on

0133 15276 Skin sub graft f/n/hf/g addl

0133 15775 Hair transplant punch grafts

0133 15776 Hair transplant punch grafts

0134 Level II Skin Repair T 3.2354 $226.53

. $45.31

0134 11920 Correct skin color defects

0134 11921 Correct skin color defects

0134 11922 Correct skin color defects

0134 11950 Therapy for contour defects

0134 11951 Therapy for contour defects

0134 11952 Therapy for contour defects

0134 12018 Repair superficial wound(s)

0134 12021 Closure of split wound

0134 12031 Intmd wnd repair s/a/t/ext

0134 12032 Intmd wnd repair s/a/t/ext

0134 12034 Intmd wnd repair s/tr/ext

0134 12035 Intmd wnd repair s/a/t/ext

0134 12036 Intmd wnd repair s/a/t/ext

0134 12037 Intmd wnd repair s/tr/ext

0134 12042 Intmd wnd repair n-hf/genit

0134 12044 Intmd wnd repair n-hf/genit

0134 12045 Intmd wnd repair n-hf/genit

0134 12046 Intmd wnd repair n-hf/genit

0134 12047 Intmd wnd repair n-hf/genit

0134 12051 Intmd wnd repair face/mm

0134 12052 Intmd wnd repair face/mm

0134 12053 Intmd wnd repair face/mm

0134 12055 Intmd wnd repair face/mm

0134 12056 Intmd wnd repair face/mm

0134 12057 Intmd wnd repair face/mm

0134 13102 Repair wound/lesion add-on

0134 13120 Repair of wound or lesion

0134 13121 Repair of wound or lesion

0134 13131 Repair of wound or lesion

0134 13133 Repair wound/lesion add-on

0134 13153 Repair wound/lesion add-on

0134 15004 Wound prep f/n/hf/g

0134 15040 Harvest cultured skin graft

0134 15050 Skin pinch graft

0134 15116 Epidrm a-grft f/n/hf/g addl

0134 15150 Cult skin grft t/arm/leg

0134 15151 Cult skin grft t/a/l addl

0134 15152 Cult skin graft t/a/l +%

0134 15155 Cult skin graft f/n/hf/g

0134 15156 Cult skin grft f/n/hfg add

0134 15157 Cult epiderm grft f/n/hfg +%

0134 15241 Skin full graft add-on

0134 15271 Skin sub graft trnk/arm/leg

0134 15274 Skn sub grft t/a/l child add

0134 15275 Skin sub graft face/nk/hf/g

0134 15278 Skn sub grft f/n/hf/g ch add

0134 15819 Plastic surgery neck

0135 Level III Skin Repair T 4.9271 $344.98

. $69.00

0135 12020 Closure of split wound

0135 13100 Repair of wound or lesion

0135 13101 Repair of wound or lesion

0135 13132 Repair of wound or lesion

0135 13150 Repair of wound or lesion

0135 13151 Repair of wound or lesion

0135 13152 Repair of wound or lesion

0135 15002 Wound prep trk/arm/leg

0135 15003 Wound prep addl 100 cm

0135 15005 Wnd prep f/n/hf/g addl cm

0135 15110 Epidrm autogrft trnk/arm/leg

0135 15111 Epidrm autogrft t/a/l add-on

0135 15115 Epidrm a-grft face/nck/hf/g0135 15221 Skin full graft add-on

0135 15273 Skin sub grft t/arm/lg child

0135 15277 Skn sub grft f/n/hf/g child

0135 20926 Removal of tissue for graft

0135 43887 Remove gastric port open

0135 C9800 Dermal filler inj px/suppl

0136 Level IV Skin Repair T 16.7703 "$1,174.19"

. $234.84

0136 11762 Reconstruction of nail bed

0136 14000 Skin tissue rearrangement

0136 14001 Skin tissue rearrangement

0136 14020 Skin tissue rearrangement

0136 14021 Skin tissue rearrangement

0136 14040 Skin tissue rearrangement

0136 14041 Skin tissue rearrangement

0136 14060 Skin tissue rearrangement

0136 14061 Skin tissue rearrangement

0136 15130 Derm autograft trnk/arm/leg

0136 15131 Derm autograft t/a/l add-on

0136 15135 Derm autograft face/nck/hf/g

0136 15136 Derm autograft f/n/hf/g add

0136 15200 Skin full graft trunk

0136 15201 Skin full graft trunk add-on

0136 15220 Skin full graft sclp/arm/leg

0136 15240 Skin full grft face/genit/hf

0136 15260 Skin full graft een & lips

0136 15261 Skin full graft add-on

0136 15740 Island pedicle flap graft

0136 15777 Acellular derm matrix implt

0136 15936 Remove sacrum pressure sore

0136 15952 Remove thigh pressure sore

0136 15953 Remove thigh pressure sore

0136 15956 Remove thigh pressure sore

0136 15958 Remove thigh pressure sore

0136 20920 Removal of fascia for graft

0136 20922 Removal of fascia for graft

0136 23921 Amputation follow-up surgery

0136 25929 Amputation follow-up surgery

0136 33222 Revise pocket pacemaker

0136 33223 Revise pocket for defib

0137 Level V Skin Repair T 21.4409 "$1,501.21"

. $300.25

0137 11960 Insert tissue expander(s)

0137 13160 Late closure of wound

0137 14301 Skin tissue rearrangement

0137 14302 Skin tissue rearrange add-on

0137 14350 Skin tissue rearrangement

0137 15100 Skin splt grft trnk/arm/leg

0137 15101 Skin splt grft t/a/l add-on

0137 15120 Skn splt a-grft fac/nck/hf/g

0137 15121 Skn splt a-grft f/n/hf/g add

0137 15570 Form skin pedicle flap

0137 15572 Form skin pedicle flap

0137 15574 Form skin pedicle flap

0137 15576 Form skin pedicle flap

0137 15600 Skin graft

0137 15610 Skin graft

0137 15620 Skin graft

0137 15630 Skin graft

0137 15650 Transfer skin pedicle flap

0137 15731 Forehead flap w/vasc pedicle

0137 15732 Muscle-skin graft head/neck

0137 15734 Muscle-skin graft trunk

0137 15736 Muscle-skin graft arm

0137 15738 Muscle-skin graft leg

0137 15750 Neurovascular pedicle graft

0137 15760 Composite skin graft

0137 15770 Derma-fat-fascia graft0137 15820 Revision of lower eyelid

0137 15821 Revision of lower eyelid

0137 15822 Revision of upper eyelid

0137 15823 Revision of upper eyelid

0137 15824 Removal of forehead wrinkles

0137 15825 Removal of neck wrinkles

0137 15826 Removal of brow wrinkles

0137 15828 Removal of face wrinkles

0137 15829 Removal of skin wrinkles

0137 15840 Graft for face nerve palsy

0137 15841 Graft for face nerve palsy

0137 15842 Flap for face nerve palsy

0137 15845 Skin and muscle repair face

0137 15876 Suction assisted lipectomy

0137 15877 Suction assisted lipectomy

0137 15878 Suction assisted lipectomy

0137 15879 Suction assisted lipectomy

0137 15922 Removal of tail bone ulcer

0137 15934 Remove sacrum pressure sore

0137 15935 Remove sacrum pressure sore

0137 15937 Remove sacrum pressure sore

0137 15944 Remove hip pressure sore

0137 15945 Remove hip pressure sore

0137 15946 Remove hip pressure sore

0137 20101 Explore wound chest

0137 20102 Explore wound abdomen

0137 20910 Remove cartilage for graft

0137 20912 Remove cartilage for graft

0137 43886 Revise gastric port open

0137 43888 Change gastric port open

0137 44312 Revision of ileostomy

0137 44340 Revision of colostomy

0138 Level II Closed Treatment Fracture T 5.0454 $353.26

. $70.66

0138 20660 Apply rem fixation device

0138 22310 Treat spine fracture

0138 23520 Treat clavicle dislocation

0138 23525 Treat clavicle dislocation

0138 23545 Treat clavicle dislocation

0138 23575 Treat shoulder blade fx

0138 23665 Treat dislocation/fracture

0138 24535 Treat humerus fracture

0138 24655 Treat radius fracture

0138 25505 Treat fracture of radius

0138 25520 Treat fracture of radius

0138 25565 Treat fracture radius & ulna

0138 25605 Treat fracture radius/ulna

0138 25624 Treat wrist bone fracture

0138 26340 Manipulate finger w/anesth

0138 26341 Manipulat palm cord post inj

0138 26645 Treat thumb fracture

0138 27238 Treat thigh fracture

0138 27246 Treat thigh fracture

0138 27500 Treatment of thigh fracture

0138 27510 Treatment of thigh fracture

0138 27818 Treatment of ankle fracture

0139 Level III Closed Treatment Fracture T 18.9489 "$1,326.73"

. $265.35

0139 20697 Comp ext fixate strut change

0139 22315 Treat spine fracture

0139 23505 Treat clavicle fracture

0139 23605 Treat humerus fracture

0139 23625 Treat humerus fracture

0139 24620 Treat elbow fracture

0139 25259 Manipulate wrist w/anesthes

0139 25690 Treat wrist dislocation

0139 26607 Treat metacarpal fracture

0139 26706 Pin knuckle dislocation0139 27502 Treatment of thigh fracture

0139 27532 Treat knee fracture

0139 27752 Treatment of tibia fracture

0139 27762 Cltx med ankle fx w/mnpj

0139 27781 Treatment of fibula fracture

0139 27825 Treat lower leg fracture

0139 27831 Treat lower leg dislocation

0139 28405 Treatment of heel fracture

0139 28575 Treat foot dislocation

0140 Esophageal Dilation without Endoscopy T 6.5866 $461.17

. $92.24

0140 43450 Dilate esophagus

0140 43453 Dilate esophagus

0140 43456 Dilate esophagus

0141 Level I Upper GI Procedures T 8.4511 $591.71 $138.69 $118.35

0141 43200 Esophagus endoscopy

0141 43202 Esophagus endoscopy biopsy

0141 43204 Esoph scope w/sclerosis inj

0141 43234 Upper gi endoscopy exam

0141 43235 Uppr gi endoscopy diagnosis

0141 43236 Uppr gi scope w/submuc inj

0141 43239 Upper gi endoscopy biopsy

0141 43241 Upper GI endoscopy with tube

0141 43243 Upper gi endoscopy & inject

0141 43247 Operative upper GI endoscopy

0141 43248 Uppr gi endoscopy/guide wire

0141 43499 Esophagus surgery procedure

0141 43510 Surgical opening of stomach

0141 43761 Reposition gastrostomy tube

0141 43831 Place gastrostomy tube

0141 43999 Stomach surgery procedure

0142 Level I Small Intestine Endoscopy T 10.4394 $730.93 $152.78 $146.19

0142 44360 Small bowel endoscopy

0142 44361 Small bowel endoscopy/biopsy

0142 44363 Small bowel endoscopy

0142 44376 Small bowel endoscopy

0142 44377 Small bowel endoscopy/biopsy

0142 44380 Small bowel endoscopy

0142 44382 Small bowel endoscopy

0142 91110 Gi tract capsule endoscopy

0143 Lower GI Endoscopy T 9.3693 $656.00 $186.06 $131.20

0143 44385 Endoscopy of bowel pouch

0143 44386 Endoscopy bowel pouch/biop

0143 44388 Colonoscopy

0143 44389 Colonoscopy with biopsy

0143 44390 Colonoscopy for foreign body

0143 44391 Colonoscopy for bleeding

0143 44392 Colonoscopy & polypectomy

0143 44393 Colonoscopy lesion removal

0143 44394 Colonoscopy w/snare

0143 45355 Surgical colonoscopy

0143 45378 Diagnostic colonoscopy

0143 45379 Colonoscopy w/fb removal

0143 45380 Colonoscopy and biopsy

0143 45381 Colonoscopy submucous inj

0143 45382 Colonoscopy/control bleeding

0143 45383 Lesion removal colonoscopy

0143 45384 Lesion remove colonoscopy

0143 45385 Lesion removal colonoscopy

0143 45386 Colonoscopy dilate stricture

0143 45391 Colonoscopy w/endoscope us

0143 45392 Colonoscopy w/endoscopic fnb

0146 Level I Sigmoidoscopy and Anoscopy T 6.2205 $435.53

. $87.11

0146 0227T Anoscopy hra w/biopsy

0146 45300 Proctosigmoidoscopy dx

0146 45330 Diagnostic sigmoidoscopy

0146 45331 Sigmoidoscopy and biopsy0146 45332 Sigmoidoscopy w/fb removal

0146 45333 Sigmoidoscopy & polypectomy

0146 45335 Sigmoidoscopy w/submuc inj

0146 45337 Sigmoidoscopy & decompress

0146 45338 Sigmoidoscopy w/tumr remove

0146 45341 Sigmoidoscopy w/ultrasound

0146 46606 Anoscopy and biopsy

0146 46608 Anoscopy remove for body

0146 46614 Anoscopy control bleeding

0147 Level II Sigmoidoscopy and Anoscopy T 11.0417 $773.10

. $154.62

0147 45303 Proctosigmoidoscopy dilate

0147 45305 Proctosigmoidoscopy w/bx

0147 45308 Proctosigmoidoscopy removal

0147 45309 Proctosigmoidoscopy removal

0147 45315 Proctosigmoidoscopy removal

0147 45317 Proctosigmoidoscopy bleed

0147 45334 Sigmoidoscopy for bleeding

0147 45339 Sigmoidoscopy w/ablate tumr

0147 45340 Sig w/balloon dilation

0147 45342 Sigmoidoscopy w/us guide bx

0147 46604 Anoscopy and dilation

0147 46611 Anoscopy

0148 Level I Anal/Rectal Procedures T 5.5158 $386.19

. $77.24

0148 0288T Anoscopy w/rf delivery

0148 45900 Reduction of rectal prolapse

0148 45999 Rectum surgery procedure

0148 46030 Removal of rectal marker

0148 46050 Incision of anal abscess

0148 46221 Ligation of hemorrhoid(s)

0148 46500 Injection into hemorrhoid(s)

0148 46930 Destroy internal hemorrhoids

0148 46942 Treatment of anal fissure

0148 46999 Anus surgery procedure

0148 C9725 Place endorectal app

0149 Level III Anal/Rectal Procedures T 24.4382 "$1,711.07"

. $342.22

0149 0184T Exc rectal tumor endoscopic

0149 45000 Drainage of pelvic abscess

0149 45005 Drainage of rectal abscess

0149 45100 Biopsy of rectum

0149 45108 Removal of anorectal lesion

0149 45150 Excision of rectal stricture

0149 45160 Excision of rectal lesion

0149 45171 Exc rect tum transanal part

0149 45172 Exc rect tum transanal full

0149 45190 Destruction rectal tumor

0149 45500 Repair of rectum

0149 45905 Dilation of anal sphincter

0149 45910 Dilation of rectal narrowing

0149 45990 Surg dx exam anorectal

0149 46020 Placement of seton

0149 46040 Incision of rectal abscess

0149 46045 Incision of rectal abscess

0149 46060 Incision of rectal abscess

0149 46080 Incision of anal sphincter

0149 46200 Removal of anal fissure

0149 46230 Removal of anal tags

0149 46250 Remove ext hem groups 2+

0149 46255 Remove int/ext hem 1 group

0149 46257 Remove in/ex hem grp & fiss

0149 46258 Remove in/ex hem grp w/fistu

0149 46260 Remove in/ex hem groups 2+

0149 46261 Remove in/ex hem grps & fiss

0149 46262 Remove in/ex hem grps w/fist

0149 46270 Remove anal fist subq

0149 46275 Remove anal fist inter

0149 46280 Remove anal fist complex0149 46285 Remove anal fist 2 stage

0149 46288 Repair anal fistula

0149 46320 Removal of hemorrhoid clot

0149 46505 Chemodenervation anal musc

0149 46700 Repair of anal stricture

0149 46753 Reconstruction of anus

0149 46754 Removal of suture from anus

0149 46940 Treatment of anal fissure

0149 46945 Remove by ligat int hem grp

0149 46946 Remove by ligat int hem grps

0149 49442 Place cecostomy tube perc

0150 Level IV Anal/Rectal Procedures T 32.9805 "$2,309.16"

. $461.84

0150 45505 Repair of rectum

0150 45541 Correct rectal prolapse

0150 45560 Repair of rectocele

0150 46706 Repr of anal fistula w/glue

0150 46707 Repair anorectal fist w/plug

0150 46750 Repair of anal sphincter

0150 46760 Repair of anal sphincter

0150 46761 Repair of anal sphincter

0150 46762 Implant artificial sphincter

0150 46947 Hemorrhoidopexy by stapling

0150 C9716 Radiofrequency energy to anu

0151 Endoscopic Retrograde Cholangio-Pancreatography

(ERCP) T 24.6966 "$1,729.16"

. $345.84

0151 43260 Endo cholangiopancreatograph

0151 43261 Endo cholangiopancreatograph

0151 43262 Endo cholangiopancreatograph

0151 43263 Endo cholangiopancreatograph

0151 43264 Endo cholangiopancreatograph

0151 43265 Endo cholangiopancreatograph

0151 43267 Endo cholangiopancreatograph

0151 43271 Endo cholangiopancreatograph

0151 43272 Endo cholangiopancreatograph

0151 43273 Endoscopic pancreatoscopy

0152 Level I Percutaneous Abdominal and Biliary

Procedures T 29.1415 "$2,040.37"

. $408.08

0152 47490 Incision of gallbladder

0152 47510 Insert catheter bile duct

0152 47511 Insert bile duct drain

0152 47552 Biliary endoscopy thru skin

0152 47553 Biliary endoscopy thru skin

0152 47554 Biliary endoscopy thru skin

0152 47555 Biliary endoscopy thru skin

0152 47630 Remove bile duct stone

0152 47999 Bile tract surgery procedure

0153 Peritoneal and Abdominal Procedures T 27.2798 "$1,910.02"

. $382.01

0153 44799 Unlisted procedure intestine

0153 44950 Appendectomy

0153 44955 Appendectomy add-on

0153 49250 Excision of umbilicus

0153 49402 Remove foreign body adbomen

0153 49426 Revise abdomen-venous shunt

0153 49999 Abdomen surgery procedure

0153 55920 Place needles pelvic for rt

0154 Hernia/Hydrocele Procedures T 32.9294 "$2,305.58" $464.85 $461.12

0154 49491 Rpr hern preemie reduc

0154 49492 Rpr ing hern premie blocked

0154 49495 Rpr ing hernia baby reduc

0154 49496 Rpr ing hernia baby blocked

0154 49500 Rpr ing hernia init reduce

0154 49501 Rpr ing hernia init blocked

0154 49505 Prp i/hern init reduc >5 yr

0154 49507 Prp i/hern init block >5 yr

0154 49520 Rerepair ing hernia reduce

0154 49521 Rerepair ing hernia blocked0154 49525 Repair ing hernia sliding

0154 49540 Repair lumbar hernia

0154 49550 Rpr rem hernia init reduce

0154 49553 Rpr fem hernia init blocked

0154 49555 Rerepair fem hernia reduce

0154 49557 Rerepair fem hernia blocked

0154 49560 Rpr ventral hern init reduc

0154 49561 Rpr ventral hern init block

0154 49565 Rerepair ventrl hern reduce

0154 49566 Rerepair ventrl hern block

0154 49568 Hernia repair w/mesh

0154 49570 Rpr epigastric hern reduce

0154 49572 Rpr epigastric hern blocked

0154 49580 Rpr umbil hern reduc < 5 yr

0154 49582 Rpr umbil hern block < 5 yr

0154 49585 Rpr umbil hern reduc > 5 yr

0154 49587 Rpr umbil hern block > 5 yr

0154 49590 Repair spigelian hernia

0154 49600 Repair umbilical lesion

0154 51500 Removal of bladder cyst

0154 54530 Removal of testis

0154 54550 Exploration for testis

0154 54640 Suspension of testis

0154 54650 Orchiopexy (Fowler-Stephens)

0154 55040 Removal of hydrocele

0154 55041 Removal of hydroceles

0154 55535 Revise spermatic cord veins

0154 55540 Revise hernia & sperm veins

0155 Level II Anal/Rectal Procedures T 15.4175 "$1,079.47"

. $215.90

0155 0249T Ligation hemorrhoid w/us

0155 45020 Drainage of rectal abscess

0155 45915 Remove rectal obstruction

0155 46070 Incision of anal septum

0155 46220 Excise anal ext tag/papilla

0156 Level III Urinary and Anal Procedures T 3.1886 $223.25

. $44.65

0156 51720 Treatment of bladder lesion

0156 51725 Simple cystometrogram

0156 51726 Complex cystometrogram

0156 51727 Cystometrogram w/up

0156 51728 Cystometrogram w/vp

0156 51729 Cystometrogram w/vp&up

0156 53600 Dilate urethra stricture

0156 54450 Preputial stretching

0156 91117 Colon motility 6 hr study

0156 91122 Anal pressure record

0157 Colorectal Cancer Screening: Barium Enema S 2.7510 $192.61

. $38.53

0157 G0106 Colon CA screen;barium enema

0157 G0120 Colon ca scrn; barium enema

0158 Colorectal Cancer Screening: Colonoscopy T 8.3164 $582.28 $0.00 $0.00

0158 G0105 Colorectal scrn; hi risk ind $0.00 $0.00

0158 G0121 Colon ca scrn not hi rsk ind $0.00 $0.00

0159 Colorectal Cancer Screening: Flexible Sigmoidoscopy S 5.3772 $376.49 $0.00 $0.00

0159 G0104 CA screen;flexi sigmoidscope $0.00 $0.00

0160 Level I Cystourethroscopy and other Genitourinary

Procedures T 6.7736 $474.26

. $94.86

0160 50386 Remove stent via transureth

0160 50389 Remove renal tube w/fluoro

0160 50551 Kidney endoscopy

0160 50555 Kidney endoscopy & biopsy

0160 50562 Renal scope w/tumor resect

0160 50570 Kidney endoscopy

0160 50572 Kidney endoscopy

0160 50574 Kidney endoscopy & biopsy

0160 50951 Endoscopy of ureter

0160 50953 Endoscopy of ureter

0160 50970 Ureter endoscopy0160 50972 Ureter endoscopy & catheter

0160 51045 Incise bladder/drain ureter

0160 52000 Cystoscopy

0160 52010 Cystoscopy & duct catheter

0160 52265 Cystoscopy and treatment

0161 Level II Cystourethroscopy and other Genitourinary

Procedures T 17.4715 "$1,223.28"

. $244.66

0161 50384 Remove ureter stent percut

0161 50392 Insert kidney drain

0161 50576 Kidney endoscopy & treatment

0161 50580 Kidney endoscopy & treatment

0161 50974 Ureter endoscopy & biopsy

0161 50976 Ureter endoscopy & treatment

0161 52001 Cystoscopy removal of clots

0161 52260 Cystoscopy and treatment

0161 52270 Cystoscopy & revise urethra

0161 52281 Cystoscopy and treatment

0161 52285 Cystoscopy and treatment

0161 52310 Cystoscopy and treatment

0161 53605 Dilate urethra stricture

0161 74475 X-ray control cath insert

0161 74480 X-ray control cath insert

0161 74485 X-ray guide gu dilation

0162 Level III Cystourethroscopy and other Genitourinary

Procedures T 26.2973 "$1,841.23"

. $368.25

0162 50020 Renal abscess open drain

0162 50382 Change ureter stent percut

0162 50385 Change stent via transureth

0162 50393 Insert ureteral tube

0162 50395 Create passage to kidney

0162 50553 Kidney endoscopy

0162 50557 Kidney endoscopy & treatment

0162 50561 Kidney endoscopy & treatment

0162 50955 Ureter endoscopy & biopsy

0162 50957 Ureter endoscopy & treatment

0162 50961 Ureter endoscopy & treatment

0162 50980 Ureter endoscopy & treatment

0162 51020 Incise & treat bladder

0162 51030 Incise & treat bladder

0162 51040 Incise & drain bladder

0162 51050 Removal of bladder stone

0162 51065 Remove ureter calculus

0162 51520 Removal of bladder lesion

0162 51535 Repair of ureter lesion

0162 51860 Repair of bladder wound

0162 51880 Repair of bladder opening

0162 52005 Cystoscopy & ureter catheter

0162 52007 Cystoscopy and biopsy

0162 52204 Cystoscopy w/biopsy(s)

0162 52214 Cystoscopy and treatment

0162 52224 Cystoscopy and treatment

0162 52234 Cystoscopy and treatment

0162 52235 Cystoscopy and treatment

0162 52240 Cystoscopy and treatment

0162 52250 Cystoscopy and radiotracer

0162 52275 Cystoscopy & revise urethra

0162 52276 Cystoscopy and treatment

0162 52277 Cystoscopy and treatment

0162 52283 Cystoscopy and treatment

0162 52290 Cystoscopy and treatment

0162 52300 Cystoscopy and treatment

0162 52301 Cystoscopy and treatment

0162 52305 Cystoscopy and treatment

0162 52315 Cystoscopy and treatment

0162 52317 Remove bladder stone

0162 52318 Remove bladder stone0162 52320 Cystoscopy and treatment

0162 52325 Cystoscopy stone removal

0162 52330 Cystoscopy and treatment

0162 52332 Cystoscopy and treatment

0162 52334 Create passage to kidney

0162 52341 Cysto w/ureter stricture tx

0162 52342 Cysto w/up stricture tx

0162 52343 Cysto w/renal stricture tx

0162 52344 Cysto/uretero stricture tx

0162 52345 Cysto/uretero w/up stricture

0162 52346 Cystouretero w/renal strict

0162 52351 Cystouretero & or pyeloscope

0162 52352 Cystouretero w/stone remove

0162 52354 Cystouretero w/biopsy

0162 52355 Cystouretero w/excise tumor

0162 52400 Cystouretero w/congen repr

0162 52402 Cystourethro cut ejacul duct

0162 52450 Incision of prostate

0162 52500 Revision of bladder neck

0162 52640 Relieve bladder contracture

0162 52700 Drainage of prostate abscess

0162 55720 Drainage of prostate abscess

0162 55725 Drainage of prostate abscess

0163 Level IV Cystourethroscopy and other Genitourinary

Procedures T 37.0730 "$2,595.70"

. $519.14

0163 50575 Kidney endoscopy

0163 51060 Removal of ureter stone

0163 52282 Cystoscopy implant stent

0163 52327 Cystoscopy inject material

0163 52353 Cystouretero w/lithotripsy

0163 52601 Prostatectomy (TURP)

0163 52630 Remove prostate regrowth

0163 55875 Transperi needle place pros

0164 Level II Urinary and Anal Procedures T 1.9499 $136.52

. $27.31

0164 46083 Incise external hemorrhoid

0164 50396 Measure kidney pressure

0164 51100 Drain bladder by needle

0164 51700 Irrigation of bladder

0164 51705 Change of bladder tube

0164 51785 Anal/urinary muscle study

0164 51797 Intraabdominal pressure test

0164 53621 Dilate urethra stricture

0164 53855 Insert prost urethral stent

0164 54200 Treatment of penis lesion

0164 54220 Treatment of penis lesion

0164 54235 Penile injection

0164 54250 Penis study

0165 Level IV Urinary and Anal Procedures T 20.4158 "$1,429.43"

. $285.89

0165 50727 Revise ureter

0165 51102 Drain bl w/cath insertion

0165 53620 Dilate urethra stricture

0165 53860 Transurethral rf treatment

0165 54231 Dynamic cavernosometry

0165 55860 Surgical exposure prostate

0166 Level I Urethral Procedures T 21.0031 "$1,470.55"

. $294.11

0166 53000 Incision of urethra

0166 53010 Incision of urethra

0166 53020 Incision of urethra

0166 53025 Incision of urethra

0166 53040 Drainage of urethra abscess

0166 53060 Drainage of urethra abscess

0166 53080 Drainage of urinary leakage

0166 53085 Drainage of urinary leakage

0166 53200 Biopsy of urethra

0166 53215 Removal of urethra

0166 53235 Removal of urethra lesion0166 53250 Removal of urethra gland

0166 53260 Treatment of urethra lesion

0166 53265 Treatment of urethra lesion

0166 53270 Removal of urethra gland

0166 53275 Repair of urethra defect

0166 53460 Revision of urethra

0166 53502 Repair of urethra injury

0166 53510 Repair of urethra injury

0166 53665 Dilation of urethra

0166 54000 Slitting of prepuce

0166 54001 Slitting of prepuce

0168 Level II Urethral Procedures T 32.3061 "$2,261.94"

. $452.39

0168 51715 Endoscopic injection/implant

0168 53210 Removal of urethra

0168 53220 Treatment of urethra lesion

0168 53230 Removal of urethra lesion

0168 53240 Surgery for urethra pouch

0168 53400 Revise urethra stage 1

0168 53405 Revise urethra stage 2

0168 53410 Reconstruction of urethra

0168 53420 Reconstruct urethra stage 1

0168 53425 Reconstruct urethra stage 2

0168 53430 Reconstruction of urethra

0168 53431 Reconstruct urethra/bladder

0168 53442 Remove/revise male sling

0168 53446 Remove uro sphincter

0168 53449 Repair uro sphincter

0168 53450 Revision of urethra

0168 53500 Urethrlys transvag w/ scope

0168 53505 Repair of urethra injury

0168 53515 Repair of urethra injury

0168 53520 Repair of urethra defect

0169 Lithotripsy T 52.0882 "$3,647.01" $997.74 $729.41

0169 50590 Fragmenting of kidney stone

0170 Dialysis S 6.2419 $437.03

. $87.41

0170 90935 Hemodialysis one evaluation

0170 G0257 Unsched dialysis ESRD pt hos

0174 Level IV Laparoscopy T 111.6495 "$7,817.25" "$2,055.58" "$1,563.45"

0174 47370 Laparo ablate liver tumor rf

0174 47371 Laparo ablate liver cryosurg

0174 50542 Laparo ablate renal mass

0181 Level II Male Genital Procedures T 34.6069 "$2,423.04" $607.60 $484.61

0181 37790 Penile venous occlusion

0181 54110 Treatment of penis lesion

0181 54111 Treat penis lesion graft

0181 54112 Treat penis lesion graft

0181 54120 Partial removal of penis

0181 54205 Treatment of penis lesion

0181 54300 Revision of penis

0181 54304 Revision of penis

0181 54308 Reconstruction of urethra

0181 54312 Reconstruction of urethra

0181 54316 Reconstruction of urethra

0181 54318 Reconstruction of urethra

0181 54322 Reconstruction of urethra

0181 54324 Reconstruction of urethra

0181 54326 Reconstruction of urethra

0181 54328 Revise penis/urethra

0181 54332 Revise penis/urethra

0181 54336 Revise penis/urethra

0181 54340 Secondary urethral surgery

0181 54344 Secondary urethral surgery

0181 54348 Secondary urethral surgery

0181 54352 Reconstruct urethra/penis

0181 54360 Penis plastic surgery

0181 54380 Repair penis0181 54385 Repair penis

0181 54406 Remove muti-comp penis pros

0181 54408 Repair multi-comp penis pros

0181 54415 Remove self-contd penis pros

0181 54420 Revision of penis

0181 54435 Revision of penis

0181 54440 Repair of penis

0181 54535 Extensive testis surgery

0183 Level I Male Genital Procedures T 23.5454 "$1,648.55"

. $329.71

0183 54150 Circumcision w/regionl block

0183 54160 Circumcision neonate

0183 54161 Circum 28 days or older

0183 54162 Lysis penil circumic lesion

0183 54163 Repair of circumcision

0183 54164 Frenulotomy of penis

0183 54505 Biopsy of testis

0183 54512 Excise lesion testis

0183 54520 Removal of testis

0183 54522 Orchiectomy partial

0183 54560 Exploration for testis

0183 54600 Reduce testis torsion

0183 54620 Suspension of testis

0183 54660 Revision of testis

0183 54670 Repair testis injury

0183 54680 Relocation of testis(es)

0183 54700 Drainage of scrotum

0183 54830 Remove epididymis lesion

0183 54840 Remove epididymis lesion

0183 54860 Removal of epididymis

0183 54861 Removal of epididymis

0183 54865 Explore epididymis

0183 54900 Fusion of spermatic ducts

0183 54901 Fusion of spermatic ducts

0183 55060 Repair of hydrocele

0183 55110 Explore scrotum

0183 55120 Removal of scrotum lesion

0183 55150 Removal of scrotum

0183 55175 Revision of scrotum

0183 55180 Revision of scrotum

0183 55200 Incision of sperm duct

0183 55250 Removal of sperm duct(s)

0183 55400 Repair of sperm duct

0183 55450 Ligation of sperm duct

0183 55500 Removal of hydrocele

0183 55520 Removal of sperm cord lesion

0183 55530 Revise spermatic cord veins

0183 55600 Incise sperm duct pouch

0183 55680 Remove sperm pouch lesion

0184 Prostate Biopsy T 13.7727 $964.31

. $192.87

0184 55700 Biopsy of prostate

0184 55705 Biopsy of prostate

0184 55706 Prostate saturation sampling

0188 Level II Female Reproductive Proc T 1.5841 $110.91

. $22.19

0188 56405 I & D of vulva/perineum

0188 56420 Drainage of gland abscess

0188 56606 Biopsy of vulva/perineum

0188 56820 Exam of vulva w/scope

0188 56821 Exam/biopsy of vulva w/scope

0188 57150 Treat vagina infection

0188 57160 Insert pessary/other device

0188 57180 Treat vaginal bleeding

0188 57452 Exam of cervix w/scope

0188 57511 Cryocautery of cervix

0188 58100 Biopsy of uterus lining

0188 58301 Remove intrauterine device

0188 59020 Fetal contract stress test0188 59025 Fetal non-stress test

0188 59070 Transabdom amnioinfus w/us

0188 59200 Insert cervical dilator

0189 Level III Female Reproductive Proc T 3.4818 $243.78

. $48.76

0189 55870 Electroejaculation

0189 56605 Biopsy of vulva/perineum

0189 57156 Ins vag brachytx device

0189 57420 Exam of vagina w/scope

0189 57421 Exam/biopsy of vag w/scope

0189 57454 Bx/curett of cervix w/scope

0189 57455 Biopsy of cervix w/scope

0189 57456 Endocerv curettage w/scope

0189 58321 Artificial insemination

0189 58322 Artificial insemination

0189 58323 Sperm washing

0189 58970 Retrieval of oocyte

0189 58974 Transfer of embryo

0189 58976 Transfer of embryo

0189 59000 Amniocentesis diagnostic

0189 59012 Fetal cord puncture prenatal

0189 59015 Chorion biopsy

0189 59030 Fetal scalp blood sample

0189 59072 Umbilical cord occlud w/us

0189 59074 Fetal fluid drainage w/us

0189 59076 Fetal shunt placement w/us

0189 59866 Abortion (mpr)

0190 Level I Hysteroscopy T 23.0098 "$1,611.05" $424.28 $322.21

0190 58555 Hysteroscopy dx sep proc

0190 58558 Hysteroscopy biopsy

0190 58559 Hysteroscopy lysis

0190 58562 Hysteroscopy remove fb

0190 58579 Hysteroscope procedure

0191 Level I Female Reproductive Proc T 0.1337 $9.36 $1.95 $1.88

0191 57170 Fitting of diaphragm/cap

0191 58999 Genital surgery procedure

0191 59897 Fetal invas px w/us

0191 59899 Maternity care procedure

0191 99170 Anogenital exam child

0191 Q0091 Obtaining screen pap smear $0.00 $0.00

0192 Level IV Female Reproductive Proc T 6.6979 $468.96

. $93.80

0192 57020 Drainage of pelvic fluid

0192 57100 Biopsy of vagina

0192 57155 Insert uteri tandems/ovoids

0192 57500 Biopsy of cervix

0192 57505 Endocervical curettage

0192 59001 Amniocentesis therapeutic

0193 Level V Female Reproductive Proc T 20.6493 "$1,445.78"

. $289.16

0193 56440 Surgery for vulva lesion

0193 56441 Lysis of labial lesion(s)

0193 56442 Hymenotomy

0193 56620 Partial removal of vulva

0193 56625 Complete removal of vulva

0193 56700 Partial removal of hymen

0193 56740 Remove vagina gland lesion

0193 56800 Repair of vagina

0193 56805 Repair clitoris

0193 56810 Repair of perineum

0193 57000 Exploration of vagina

0193 57010 Drainage of pelvic abscess

0193 57061 Destroy vag lesions simple

0193 57065 Destroy vag lesions complex

0193 57105 Biopsy of vagina

0193 57106 Remove vagina wall partial

0193 57130 Remove vagina lesion

0193 57135 Remove vagina lesion

0193 57200 Repair of vagina0193 57210 Repair vagina/perineum

0193 57295 Revise vag graft via vagina

0193 57400 Dilation of vagina

0193 57410 Pelvic examination

0193 57415 Remove vaginal foreign body

0193 57426 Revise prosth vag graft lap

0193 57460 Bx of cervix w/scope leep

0193 57461 Conz of cervix w/scope leep

0193 57510 Cauterization of cervix

0193 57513 Laser surgery of cervix

0193 57520 Conization of cervix

0193 57522 Conization of cervix

0193 57558 D&c of cervical stump

0193 57700 Revision of cervix

0193 57720 Revision of cervix

0193 57800 Dilation of cervical canal

0193 58120 Dilation and curettage

0193 58345 Reopen fallopian tube

0193 58346 Insert heyman uteri capsule

0193 58615 Occlude fallopian tube(s)

0193 58800 Drainage of ovarian cyst(s)

0193 58823 Drain pelvic abscess percut

0193 58900 Biopsy of ovary(s)

0193 59160 D & c after delivery

0193 59300 Episiotomy or vaginal repair

0193 59320 Revision of cervix

0193 59409 Obstetrical care

0193 59412 Antepartum manipulation

0193 59414 Deliver placenta

0193 59612 Vbac delivery only

0193 59812 Treatment of miscarriage

0193 59820 Care of miscarriage

0193 59821 Treatment of miscarriage

0193 59840 Abortion

0193 59841 Abortion

0193 59870 Evacuate mole of uterus

0193 59871 Remove cerclage suture

0195 Level VI Female Reproductive Procedures T 35.9087 "$2,514.18"

. $502.84

0195 57107 Remove vagina tissue part

0195 57109 Vaginectomy partial w/nodes

0195 57120 Closure of vagina

0195 57230 Repair of urethral lesion

0195 57240 Repair bladder & vagina

0195 57250 Repair rectum & vagina

0195 57260 Repair of vagina

0195 57267 Insert mesh/pelvic flr addon

0195 57268 Repair of bowel bulge

0195 57287 Revise/remove sling repair

0195 57289 Repair bladder & vagina

0195 57291 Construction of vagina

0195 57292 Construct vagina with graft

0195 57300 Repair rectum-vagina fistula

0195 57320 Repair bladder-vagina lesion

0195 57330 Repair bladder-vagina lesion

0195 57335 Repair vagina

0195 57530 Removal of cervix

0195 57550 Removal of residual cervix

0195 57555 Remove cervix/repair vagina

0195 58145 Myomectomy vag method

0195 58260 Vaginal hysterectomy

0195 58262 Vag hyst including t/o

0195 58263 Vag hyst w/t/o & vag repair

0195 58270 Vag hyst w/enterocele repair

0195 58350 Reopen fallopian tube

0195 58353 Endometr ablate thermal

0195 58600 Division of fallopian tube0195 58770 Create new tubal opening

0195 58805 Drainage of ovarian cyst(s)

0195 58820 Drain ovary abscess open

0195 58920 Partial removal of ovary(s)

0195 58925 Removal of ovarian cyst(s)

0195 59100 Remove uterus lesion

0202 Level VII Female Reproductive Procedures T 45.9895 "$3,220.00" $981.50 $644.00

0202 51845 Repair bladder neck

0202 57220 Revision of urethra

0202 57265 Extensive repair of vagina

0202 57282 Colpopexy extraperitoneal

0202 57283 Colpopexy intraperitoneal

0202 57284 Repair paravag defect open

0202 57285 Repair paravag defect vag

0202 57288 Repair bladder defect

0202 57310 Repair urethrovaginal lesion

0202 57423 Repair paravag defect lap

0202 57556 Remove cervix repair bowel

0202 58290 Vag hyst complex

0202 58291 Vag hyst incl t/o complex

0202 58292 Vag hyst t/o & repair compl

0202 58294 Vag hyst w/enterocele compl

0202 58356 Endometrial cryoablation

0202 58565 Hysteroscopy sterilization

0203 Level IV Nerve Injections T 12.7996 $896.18

. $179.24

0203 61791 Treat trigeminal tract

0203 62263 Epidural lysis mult sessions

0203 62264 Epidural lysis on single day

0203 62281 Treat spinal cord lesion

0203 62282 Treat spinal canal lesion

0203 62319 Inject spine w/cath l/s (cd)

0203 62355 Remove spinal canal catheter

0203 63746 Removal of spinal shunt

0203 64600 Injection treatment of nerve

0203 64620 Injection treatment of nerve

0203 64635 Destroy lumb/sac facet jnt

0203 64680 Injection treatment of nerve

0203 64681 Injection treatment of nerve

0204 Level I Nerve Injections T 2.6055 $182.43

. $36.49

0204 0214T Njx paravert w/us cer/thor

0204 0215T Njx paravert w/us cer/thor

0204 0217T Njx paravert w/us lumb/sac

0204 0218T Njx paravert w/us lumb/sac

0204 20526 Ther injection carp tunnel

0204 20527 Inj dupuytren cord w/enzyme

0204 20550 Inj tendon sheath/ligament

0204 20551 Inj tendon origin/insertion

0204 20552 Inj trigger point 1/2 muscl

0204 20553 Inject trigger points =/> 3

0204 20600 Drain/inject joint/bursa

0204 20605 Drain/inject joint/bursa

0204 20610 Drain/inject joint/bursa

0204 20612 Aspirate/inj ganglion cyst

0204 64400 N block inj trigeminal

0204 64402 N block inj facial

0204 64408 N block inj vagus

0204 64410 N block inj phrenic

0204 64455 N block inj plantar digit

0204 64491 Inj paravert f jnt c/t 2 lev

0204 64492 Inj paravert f jnt c/t 3 lev

0204 64494 Inj paravert f jnt l/s 2 lev

0204 64495 Inj paravert f jnt l/s 3 lev

0204 64505 N block spenopalatine gangl

0204 64508 N block carotid sinus s/p

0204 64566 Neuroeltrd stim post tibial

0204 64611 Chemodenerv saliv glands0204 64612 Destroy nerve face muscle

0204 64632 N block inj common digit

0204 64634 Destroy c/th facet jnt addl

0204 64650 Chemodenerv eccrine glands

0204 64653 Chemodenerv eccrine glands

0204 64999 Nervous system surgery

0206 Level II Nerve Injections T 3.8754 $271.34

. $54.27

0206 0229T Njx tfrml eprl w/us cer/thor

0206 0231T Njx tfrml eprl w/us lumb/sac

0206 62270 Spinal fluid tap diagnostic

0206 62272 Drain cerebro spinal fluid

0206 64405 N block inj occipital

0206 64412 N block inj spinal accessor

0206 64413 N block inj cervical plexus

0206 64415 N block inj brachial plexus

0206 64417 N block inj axillary

0206 64418 N block inj suprascapular

0206 64420 N block inj intercost sng

0206 64425 N block inj ilio-ing/hypogi

0206 64435 N block inj paracervical

0206 64447 N block inj fem single

0206 64450 N block other peripheral

0206 64480 Inj foramen epidural add-on

0206 64484 Inj foramen epidural add-on

0206 64613 Destroy nerve neck muscle

0206 64614 Destroy nerve extrem musc

0207 Level III Nerve Injections T 7.4537 $521.88

. $104.38

0207 0213T Njx paravert w/us cer/thor

0207 0216T Njx paravert w/us lumb/sac

0207 0228T Njx tfrml eprl w/us cer/thor

0207 0230T Njx tfrml eprl w/us lumb/sac

0207 61000 Remove cranial cavity fluid

0207 61001 Remove cranial cavity fluid

0207 61020 Remove brain cavity fluid

0207 61026 Injection into brain canal

0207 61050 Remove brain canal fluid

0207 61055 Injection into brain canal

0207 62194 Replace/irrigate catheter

0207 62268 Drain spinal cord cyst

0207 62273 Inject epidural patch

0207 62280 Treat spinal cord lesion

0207 62292 Injection into disk lesion

0207 62294 Injection into spinal artery

0207 62310 Inject spine c/t

0207 62311 Inject spine l/s (cd)

0207 62318 Inject spine w/cath c/t

0207 64416 N block cont infuse b plex

0207 64421 N block inj intercost mlt

0207 64430 N block inj pudendal

0207 64445 N block inj sciatic sng

0207 64446 N blk inj sciatic cont inf

0207 64448 N block inj fem cont inf

0207 64449 N block inj lumbar plexus

0207 64479 Inj foramen epidural c/t

0207 64483 Inj foramen epidural l/s

0207 64490 Inj paravert f jnt c/t 1 lev

0207 64493 Inj paravert f jnt l/s 1 lev

0207 64510 N block stellate ganglion

0207 64517 N block inj hypogas plxs

0207 64520 N block lumbar/thoracic

0207 64530 N block inj celiac pelus

0207 64630 Injection treatment of nerve

0207 64633 Destroy cerv/thor facet jnt

0207 64636 Destroy l/s facet jnt addl

0207 64640 Injection treatment of nerve

0207 G0260 Inj for sacroiliac jt anesth0208 Laminotomies and Laminectomies T 50.7343 "$3,552.21"

. $710.45

0208 0274T Perq lamot/lam crv/thrc

0208 0275T Perq lamot/lam lumbar

0208 22100 Remove part of neck vertebra

0208 22101 Remove part thorax vertebra

0208 22102 Remove part lumbar vertebra

0208 22103 Remove extra spine segment

0208 22222 Revision of thorax spine

0208 22551 Neck spine fuse&remov bel c2

0208 22554 Neck spine fusion

0208 22612 Lumbar spine fusion

0208 22614 Spine fusion extra segment

0208 62351 Implant spinal canal cath

0208 63001 Removal of spinal lamina

0208 63003 Removal of spinal lamina

0208 63005 Removal of spinal lamina

0208 63011 Removal of spinal lamina

0208 63012 Removal of spinal lamina

0208 63015 Removal of spinal lamina

0208 63016 Removal of spinal lamina

0208 63017 Removal of spinal lamina

0208 63020 Neck spine disk surgery

0208 63030 Low back disk surgery

0208 63035 Spinal disk surgery add-on

0208 63040 Laminotomy single cervical

0208 63042 Laminotomy single lumbar

0208 63045 Removal of spinal lamina

0208 63046 Removal of spinal lamina

0208 63047 Removal of spinal lamina

0208 63048 Remove spinal lamina add-on

0208 63055 Decompress spinal cord

0208 63056 Decompress spinal cord

0208 63057 Decompress spine cord add-on

0208 63064 Decompress spinal cord

0208 63066 Decompress spine cord add-on

0208 63075 Neck spine disk surgery

0208 63076 Neck spine disk surgery

0209 "Level II Extended EEG, Sleep, and Cardiovascular

Studies" S 11.3569 $795.16 $268.73 $159.04

0209 93229 Remote 30 day ecg tech supp

0209 95805 Multiple sleep latency test

0209 95807 Sleep study attended

0209 95808 Polysomnography 1-3

0209 95810 Polysomnography 4 or more

0209 95811 Polysomnography w/cpap

0209 95950 Ambulatory eeg monitoring

0209 95951 EEG monitoring/videorecord

0209 95953 EEG monitoring/computer

0209 95956 Eeg monitor technol attended

0209 G0302 Pre-op service LVRS complete

0209 G0303 Pre-op service LVRS 10-15dos

0213 "Level I Extended EEG, Sleep, and Cardiovascular

Studies" S 2.4298 $170.12 $53.58 $34.03

0213 95800 Slp stdy unattended

0213 95801 Slp stdy unatnd w/anal

0213 95806 Sleep study unatt&resp efft

0213 95812 Eeg 41-60 minutes

0213 95813 Eeg over 1 hour

0213 95816 Eeg awake and drowsy

0213 95819 Eeg awake and asleep

0213 95822 Eeg coma or sleep only

0213 95827 Eeg all night recording

0213 95958 EEG monitoring/function test

0213 G0304 Pre-op service LVRS 1-9 dos

0213 G0305 Post op service LVRS min 6

0213 G0398 Home sleep test/type 2 Porta0213 G0399 Home sleep test/type 3 Porta

0213 G0400 Home sleep test/type 4 Porta

0215 Level I Nerve and Muscle Tests S 0.6335 $44.36

. $8.88

0215 0199T Physiologic tremor record

0215 0278T Tempr

0215 95869 Muscle test thor paraspinal

0215 95870 Muscle test nonparaspinal

0215 95887 Musc tst done w/n tst nonext

0215 95900 Motor nerve conduction test

0215 95903 Motor nerve conduction test

0215 95904 Sense nerve conduction test

0215 95905 Motor/sens nrve conduct test

0215 95933 Blink reflex test

0215 95934 H-reflex test

0215 95936 H-reflex test

0215 95999 Neurological procedure

0216 Level III Nerve and Muscle Tests S 2.6488 $185.46

. $37.10

0216 92584 Electrocochleography

0216 92585 Auditor evoke potent compre

0216 95824 Eeg cerebral death only

0216 95925 Somatosensory testing

0216 95926 Somatosensory testing

0216 95927 Somatosensory testing

0216 95930 Visual evoked potential test

0216 95938 Somatosensory testing

0216 95961 Electrode stimulation brain

0216 95962 Electrode stim brain add-on

0216 96000 Motion analysis video/3d

0216 96001 Motion test w/ft press meas

0218 Level II Nerve and Muscle Tests S 1.2025 $84.19

. $16.84

0218 0272T Interrogate crtd sns dev

0218 0273T Interrogate crtd sns w/pgrmg

0218 0285T Periph field stimul analys

0218 90867 Tcranial magn stim tx plan

0218 90868 Tcranial magn stim tx deli

0218 90869 Tcran magn stim redetemine

0218 92586 Auditor evoke potent limit

0218 95803 Actigraphy testing

0218 95857 Cholinesterase challenge

0218 95860 Muscle test one limb

0218 95861 Muscle test 2 limbs

0218 95863 Muscle test 3 limbs

0218 95864 Muscle test 4 limbs

0218 95865 Muscle test larynx

0218 95866 Muscle test hemidiaphragm

0218 95867 Muscle test cran nerv unilat

0218 95868 Muscle test cran nerve bilat

0218 95872 Muscle test one fiber

0218 95875 Limb exercise test

0218 95885 Musc tst done w/nerv tst lim

0218 95886 Musc test done w/n test comp

0218 95921 Autonomic nerv function test

0218 95922 Autonomic nerv function test

0218 95923 Autonomic nerv function test

0218 95928 C motor evoked uppr limbs

0218 95929 C motor evoked lwr limbs

0218 95937 Neuromuscular junction test

0218 95939 C motor evoked upr&lwr limbs

0218 95954 EEG monitoring/giving drugs

0218 95970 Analyze neurostim no prog

0218 95973 Analyze neurostim complex

0218 95975 Cranial neurostim complex

0218 95981 Io anal gast n-stim subsq

0218 96002 Dynamic surface emg

0218 96003 Dynamic fine wire emg

0220 Level I Nerve Procedures T 18.8921 "$1,322.75"

. $264.550220 27325 Neurectomy hamstring

0220 27326 Neurectomy popliteal

0220 28035 Decompression of tibia nerve

0220 28055 Neurectomy foot

0220 61790 Treat trigeminal nerve

0220 63600 Remove spinal cord lesion

0220 63610 Stimulation of spinal cord

0220 63615 Remove lesion of spinal cord

0220 64605 Injection treatment of nerve

0220 64610 Injection treatment of nerve

0220 64702 Revise finger/toe nerve

0220 64704 Revise hand/foot nerve

0220 64708 Revise arm/leg nerve

0220 64712 Revision of sciatic nerve

0220 64713 Revision of arm nerve(s)

0220 64714 Revise low back nerve(s)

0220 64716 Revision of cranial nerve

0220 64718 Revise ulnar nerve at elbow

0220 64719 Revise ulnar nerve at wrist

0220 64721 Carpal tunnel surgery

0220 64722 Relieve pressure on nerve(s)

0220 64726 Release foot/toe nerve

0220 64727 Internal nerve revision

0220 64732 Incision of brow nerve

0220 64734 Incision of cheek nerve

0220 64736 Incision of chin nerve

0220 64738 Incision of jaw nerve

0220 64740 Incision of tongue nerve

0220 64742 Incision of facial nerve

0220 64744 Incise nerve back of head

0220 64746 Incise diaphragm nerve

0220 64761 Incision of pelvis nerve

0220 64763 Incise hip/thigh nerve

0220 64771 Sever cranial nerve

0220 64772 Incision of spinal nerve

0220 64774 Remove skin nerve lesion

0220 64776 Remove digit nerve lesion

0220 64778 Digit nerve surgery add-on

0220 64782 Remove limb nerve lesion

0220 64783 Limb nerve surgery add-on

0220 64784 Remove nerve lesion

0220 64787 Implant nerve end

0220 64788 Remove skin nerve lesion

0220 64790 Removal of nerve lesion

0220 64795 Biopsy of nerve

0220 64802 Remove sympathetic nerves

0220 64804 Remove sympathetic nerves

0220 64820 Remove sympathetic nerves

0221 Level II Nerve Procedures T 36.1290 "$2,529.61"

. $505.93

0221 0269T Rev/remvl crtd sns dev total

0221 61720 Incise skull/brain surgery

0221 61770 Incise skull for treatment

0221 62287 Percutaneous diskectomy

0221 62365 Remove spine infusion device

0221 64570 Remove vagus n eltrd

0221 64766 Incise hip/thigh nerve

0221 64786 Remove sciatic nerve lesion

0221 64792 Removal of nerve lesion

0221 64831 Repair of digit nerve

0221 64832 Repair nerve add-on

0221 64834 Repair of hand or foot nerve

0221 64835 Repair of hand or foot nerve

0221 64836 Repair of hand or foot nerve

0221 64837 Repair nerve add-on

0221 64840 Repair of leg nerve

0221 64856 Repair/transpose nerve0221 64857 Repair arm/leg nerve

0221 64858 Repair sciatic nerve

0221 64859 Nerve surgery

0221 64861 Repair of arm nerves

0221 64862 Repair of low back nerves

0221 64864 Repair of facial nerve

0221 64865 Repair of facial nerve

0221 64870 Fusion of facial/other nerve

0221 64872 Subsequent repair of nerve

0221 64874 Repair & revise nerve add-on

0221 64876 Repair nerve/shorten bone

0221 64885 Nerve graft head or neck

0221 64886 Nerve graft head or neck

0221 64890 Nerve graft hand or foot

0221 64891 Nerve graft hand or foot

0221 64892 Nerve graft arm or leg

0221 64893 Nerve graft arm or leg

0221 64895 Nerve graft hand or foot

0221 64896 Nerve graft hand or foot

0221 64897 Nerve graft arm or leg

0221 64898 Nerve graft arm or leg

0221 64901 Nerve graft add-on

0221 64902 Nerve graft add-on

0221 64905 Nerve pedicle transfer

0221 64907 Nerve pedicle transfer

0221 64910 Nerve repair w/allograft

0221 64911 Neurorraphy w/vein autograft

0224 Implantation of Catheter/Reservoir/Shunt T 41.5547 "$2,909.49"

. $581.90

0224 61215 Insert brain-fluid device

0224 62230 Replace/revise brain shunt

0224 62350 Implant spinal canal cath

0224 62360 Insert spine infusion device

0224 63741 Install spinal shunt

0224 63744 Revision of spinal shunt

0227 Implantation of Drug Infusion Device T 192.7379 "$13,494.74"

. "$2,698.95"

0227 62361 Implant spine infusion pump

0227 62362 Implant spine infusion pump

0229 Level II Endovascular Revascularization of the Lower

Extremity T 115.5014 "$8,086.95"

. "$1,617.39"

0229 37183 Remove hepatic shunt (tips)

0229 37205 Transcath iv stent percut

0229 37206 Transcath iv stent/perc addl

0229 37207 Transcath iv stent open

0229 37208 Transcath iv stent/open addl

0229 37210 Embolization uterine fibroid

0229 37221 Iliac revasc w/stent

0229 37225 Fem/popl revas w/ather

0229 37226 Fem/popl revasc w/stent

0229 37229 Tib/per revasc w/ather

0229 37230 Tib/per revasc w/stent

0229 37233 Tibper revasc w/ather add-on

0230 Level I Eye Tests & Treatments S 0.6424 $44.98

. $9.00

0230 0181T Corneal hysteresis

0230 0207T Clear eyelid gland w/heat

0230 68200 Treat eyelid by injection

0230 92020 Special eye evaluation

0230 92025 Corneal topography

0230 92060 Special eye evaluation

0230 92065 Orthoptic/pleoptic training

0230 92081 Visual field examination(s)

0230 92082 Visual field examination(s)

0230 92132 Cmptr ophth dx img ant segmt

0230 92133 Cmptr ophth img optic nerve

0230 92134 Cptr ophth dx img post segmt

0230 92140 Glaucoma provocative tests

0230 92225 Special eye exam initial0230 92226 Special eye exam subsequent

0230 92250 Eye exam with photos

0230 92260 Ophthalmoscopy/dynamometry

0230 92265 Eye muscle evaluation

0230 92270 Electro-oculography

0230 92283 Color vision examination

0230 92284 Dark adaptation eye exam

0230 92285 Eye photography

0230 92312 Contact lens fitting

0230 92317 Prescription of contact lens

0230 92326 Replacement of contact lens

0230 92354 Special spectacles fitting

0230 92355 Special spectacles fitting

0230 92358 Eye prosthesis service

0230 92499 Eye service or procedure

0230 G0118 Glaucoma scrn hgh risk direc

0231 Level III Eye Tests & Treatments S 2.0294 $142.09

. $28.42

0231 65450 Treatment of corneal lesion

0231 67500 Inject/treat eye socket

0231 67938 Remove eyelid foreign body

0231 68840 Explore/irrigate tear ducts

0231 92235 Eye exam with photos

0231 92240 Icg angiography

0231 92275 Electroretinography

0232 Level I Anterior Segment Eye Procedures T 2.8247 $197.77 $42.27 $39.56

0232 0124T Conjunctival drug placement

0232 65900 Remove eye lesion

0232 66500 Incision of iris

0232 66999 Eye surgery procedure

0232 76510 Ophth us b & quant a

0233 Level III Anterior Segment Eye Procedures T 16.6214 "$1,163.76"

. $232.76

0233 65235 Remove foreign body from eye

0233 65400 Removal of eye lesion

0233 65410 Biopsy of cornea

0233 65420 Removal of eye lesion

0233 65436 Curette/treat cornea

0233 65772 Correction of astigmatism

0233 65775 Correction of astigmatism

0233 65778 Cover eye w/membrane

0233 65779 Cover eye w/membrane suture

0233 65865 Incise inner eye adhesions

0233 65880 Incise inner eye adhesions

0233 66020 Injection treatment of eye

0233 66030 Injection treatment of eye

0233 66250 Follow-up surgery of eye

0233 66700 Destruction ciliary body

0233 66710 Ciliary transsleral therapy

0233 66720 Destruction ciliary body

0233 66840 Removal of lens material

0233 67880 Revision of eyelid

0233 68130 Remove eyelid lining lesion

0234 Level IV Anterior Segment Eye Procedures T 23.2851 "$1,630.33" $347.90 $326.07

0234 0099T Implant corneal ring

0234 0123T Scleral fistulization

0234 65272 Repair of eye wound

0234 65275 Repair of eye wound

0234 65426 Removal of eye lesion

0234 65805 Drainage of eye

0234 65810 Drainage of eye

0234 65815 Drainage of eye

0234 65820 Relieve inner eye pressure

0234 65850 Incision of eye

0234 65870 Incise inner eye adhesions

0234 65875 Incise inner eye adhesions

0234 65920 Remove implant of eye

0234 65930 Remove blood clot from eye0234 66130 Remove eye lesion

0234 66150 Glaucoma surgery

0234 66155 Glaucoma surgery

0234 66160 Glaucoma surgery

0234 66165 Glaucoma surgery

0234 66170 Glaucoma surgery

0234 66172 Incision of eye

0234 66185 Revise eye shunt

0234 66600 Remove iris and lesion

0234 66605 Removal of iris

0234 66630 Removal of iris

0234 66635 Removal of iris

0234 66680 Repair iris & ciliary body

0234 66682 Repair iris & ciliary body

0234 66711 Ciliary endoscopic ablation

0234 66740 Destruction ciliary body

0234 66825 Reposition intraocular lens

0234 68330 Revise eyelid lining

0234 68360 Revise eyelid lining

0234 68362 Revise eyelid lining

0234 68371 Harvest eye tissue alograft

0235 Level I Posterior Segment Eye Procedures T 4.8135 $337.02

. $67.41

0235 65260 Remove foreign body from eye

0235 67141 Treatment of retina

0235 67208 Treatment of retinal lesion

0235 67220 Treatment of choroid lesion

0235 67221 Ocular photodynamic ther

0235 67225 Eye photodynamic ther add-on

0235 67299 Eye surgery procedure

0235 G0186 "Dstry eye lesn,fdr vssl tech"

0237 Level II Posterior Segment Eye Procedures T 21.5368 "$1,507.92"

. $301.59

0237 0186T Suprachoroidal drug delivery

0237 0190T Place intraoc radiation src

0237 65265 Remove foreign body from eye

0237 65280 Repair of eye wound

0237 67005 Partial removal of eye fluid

0237 67030 Incise inner eye strands

0237 67101 Repair detached retina

0237 67110 Repair detached retina

0237 67115 Release encircling material

0237 67120 Remove eye implant material

0237 67218 Treatment of retinal lesion

0237 67227 Treatment of retinal lesion

0237 67255 Reinforce/graft eye wall

0238 Level I Repair and Plastic Eye Procedures T 3.1036 $217.30

. $43.46

0238 67028 Injection eye drug

0238 67345 Destroy nerve of eye muscle

0238 67505 Inject/treat eye socket

0238 67515 Inject/treat eye socket

0238 67599 Orbit surgery procedure

0238 67700 Drainage of eyelid abscess

0238 67800 Remove eyelid lesion

0238 67805 Remove eyelid lesions

0238 67810 Biopsy of eyelid

0238 67825 Revise eyelashes

0238 67999 Revision of eyelid

0238 68020 Incise/drain eyelid lining

0238 68399 Eyelid lining surgery

0238 68400 Incise/drain tear gland

0238 68440 Incise tear duct opening

0238 68530 Clearance of tear duct

0238 68705 Revise tear duct opening

0238 68760 Close tear duct opening

0238 68761 Close tear duct opening

0238 68810 Probe nasolacrimal duct

0238 68899 Tear duct system surgery0239 Level II Repair and Plastic Eye Procedures T 7.6566 $536.08

. $107.22

0239 65435 Curette/treat cornea

0239 67710 Incision of eyelid

0239 67801 Remove eyelid lesions

0239 67830 Revise eyelashes

0239 67840 Remove eyelid lesion

0239 67850 Treat eyelid lesion

0239 67875 Closure of eyelid by suture

0239 68100 Biopsy of eyelid lining

0239 68135 Remove eyelid lining lesion

0240 Level III Repair and Plastic Eye Procedures T 19.7786 "$1,384.82" $296.20 $276.97

0240 65175 Removal of ocular implant

0240 65270 Repair of eye wound

0240 65600 Revision of cornea

0240 67250 Reinforce eye wall

0240 67400 Explore/biopsy eye socket

0240 67412 Explore/treat eye socket

0240 67415 Aspiration orbital contents

0240 67715 Incision of eyelid fold

0240 67808 Remove eyelid lesion(s)

0240 67835 Revise eyelashes

0240 67882 Revision of eyelid

0240 67901 Repair eyelid defect

0240 67903 Repair eyelid defect

0240 67904 Repair eyelid defect

0240 67906 Repair eyelid defect

0240 67908 Repair eyelid defect

0240 67909 Revise eyelid defect

0240 67911 Revise eyelid defect

0240 67912 Correction eyelid w/implant

0240 67914 Repair eyelid defect

0240 67915 Repair eyelid defect

0240 67916 Repair eyelid defect

0240 67917 Repair eyelid defect

0240 67921 Repair eyelid defect

0240 67922 Repair eyelid defect

0240 67923 Repair eyelid defect

0240 67924 Repair eyelid defect

0240 67930 Repair eyelid wound

0240 67935 Repair eyelid wound

0240 67950 Revision of eyelid

0240 67961 Revision of eyelid

0240 67966 Revision of eyelid

0240 67971 Reconstruction of eyelid

0240 67974 Reconstruction of eyelid

0240 67975 Reconstruction of eyelid

0240 68115 Remove eyelid lining lesion

0240 68326 Revise/graft eyelid lining

0240 68340 Separate eyelid adhesions

0240 68420 Incise/drain tear sac

0240 68510 Biopsy of tear gland

0240 68525 Biopsy of tear sac

0240 68540 Remove tear gland lesion

0240 68700 Repair tear ducts

0240 68811 Probe nasolacrimal duct

0240 68815 Probe nasolacrimal duct

0240 68816 Probe nl duct w/balloon

0241 Level IV Repair and Plastic Eye Procedures T 27.3416 "$1,914.35" $383.45 $382.87

0241 65125 Revise ocular implant

0241 65130 Insert ocular implant

0241 65135 Insert ocular implant

0241 65150 Revise ocular implant

0241 67405 Explore/drain eye socket

0241 67413 Explore/treat eye socket

0241 67560 Revise eye socket implant

0241 67900 Repair brow defect0241 67902 Repair eyelid defect

0241 67973 Reconstruction of eyelid

0241 68320 Revise/graft eyelid lining

0241 68325 Revise/graft eyelid lining

0241 68328 Revise/graft eyelid lining

0241 68335 Revise/graft eyelid lining

0241 68500 Removal of tear gland

0241 68505 Partial removal tear gland

0241 68520 Removal of tear sac

0241 68550 Remove tear gland lesion

0241 68720 Create tear sac drain

0241 68745 Create tear duct drain

0241 68750 Create tear duct drain

0241 68770 Close tear system fistula

0242 Level V Repair and Plastic Eye Procedures T 40.4039 "$2,828.92" $597.36 $565.79

0242 65091 Revise eye

0242 65093 Revise eye with implant

0242 65101 Removal of eye

0242 65103 Remove eye/insert implant

0242 65105 Remove eye/attach implant

0242 65110 Removal of eye

0242 65112 Remove eye/revise socket

0242 65114 Remove eye/revise socket

0242 65140 Attach ocular implant

0242 65155 Reinsert ocular implant

0242 67414 Explr/decompress eye socket

0242 67420 Explore/treat eye socket

0242 67430 Explore/treat eye socket

0242 67440 Explore/drain eye socket

0242 67445 Explr/decompress eye socket

0242 67450 Explore/biopsy eye socket

0242 67550 Insert eye socket implant

0242 67570 Decompress optic nerve

0243 Strabismus/Muscle Procedures T 24.8671 "$1,741.09" $411.91 $348.22

0243 65290 Repair of eye socket wound

0243 67311 Revise eye muscle

0243 67312 Revise two eye muscles

0243 67314 Revise eye muscle

0243 67316 Revise two eye muscles

0243 67318 Revise eye muscle(s)

0243 67320 Revise eye muscle(s) add-on

0243 67331 Eye surgery follow-up add-on

0243 67332 Rerevise eye muscles add-on

0243 67334 Revise eye muscle w/suture

0243 67335 Eye suture during surgery

0243 67340 Revise eye muscle add-on

0243 67343 Release eye tissue

0243 67399 Eye muscle surgery procedure

0244 Corneal and Amniotic Membrane Transplant T 37.8979 "$2,653.46" $794.94 $530.70

0244 65710 Corneal transplant

0244 65730 Corneal transplant

0244 65750 Corneal transplant

0244 65755 Corneal transplant

0244 65756 Corneal trnspl endothelial

0244 65780 Ocular reconst transplant

0244 65781 Ocular reconst transplant

0244 65782 Ocular reconst transplant

0246 Cataract Procedures with IOL Insert T 23.8810 "$1,672.05" $490.37 $334.41

0246 66982 Cataract surgery complex

0246 66983 Cataract surg w/iol 1 stage

0246 66984 Cataract surg w/iol 1 stage

0246 66985 Insert lens prosthesis

0246 66986 Exchange lens prosthesis

0247 Laser Eye Procedures T 5.4120 $378.93 $102.28 $75.79

0247 65855 Laser surgery of eye

0247 65860 Incise inner eye adhesions0247 66761 Revision of iris

0247 66762 Revision of iris

0247 66770 Removal of inner eye lesion

0247 66821 After cataract laser surgery

0247 67031 Laser surgery eye strands

0247 67105 Repair detached retina

0247 67145 Treatment of retina

0247 67210 Treatment of retinal lesion

0247 67228 Treatment of retinal lesion

0247 67229 Tr retinal les preterm inf

0249 Cataract Procedures without IOL Insert T 30.9855 "$2,169.48" $516.99 $433.90

0249 66850 Removal of lens material

0249 66852 Removal of lens material

0249 66920 Extraction of lens

0249 66930 Extraction of lens

0250 Level I ENT Procedures T 1.0709 $74.98 $24.12 $15.00

0250 21089 Prepare face/oral prosthesis

0250 21299 Cranio/maxillofacial surgery

0250 21310 Treatment of nose fracture

0250 21480 Reset dislocated jaw

0250 21499 Head surgery procedure

0250 21899 Neck/chest surgery procedure

0250 30901 Control of nosebleed

0250 30903 Control of nosebleed

0250 30905 Control of nosebleed

0250 30906 Repeat control of nosebleed

0250 30999 Nasal surgery procedure

0250 31299 Sinus surgery procedure

0250 31599 Larynx surgery procedure

0250 40799 Lip surgery procedure

0250 40899 Mouth surgery procedure

0250 41250 Repair tongue laceration

0250 41599 Tongue and mouth surgery

0250 41899 Dental surgery procedure

0250 42299 Palate/uvula surgery

0250 42699 Salivary surgery procedure

0250 42960 Control throat bleeding

0250 42970 Control nose/throat bleeding

0250 42999 Throat surgery procedure

0250 69399 Outer ear surgery procedure

0250 69799 Middle ear surgery procedure

0250 69949 Inner ear surgery procedure

0250 69979 Temporal bone surgery

0251 Level II ENT Procedures T 3.1150 $218.10

. $43.62

0251 21450 Treat lower jaw fracture

0251 30000 Drainage of nose lesion

0251 30020 Drainage of nose lesion

0251 30560 Release of nasal adhesions

0251 31000 Irrigation maxillary sinus

0251 40490 Biopsy of lip

0251 40806 Incision of lip fold

0251 40808 Biopsy of mouth lesion

0251 40818 Excise oral mucosa for graft

0251 40830 Repair mouth laceration

0251 41005 Drainage of mouth lesion

0251 41009 Drainage of mouth lesion

0251 41015 Drainage of mouth lesion

0251 41251 Repair tongue laceration

0251 42000 Drainage mouth roof lesion

0251 42180 Repair palate

0251 42280 Preparation palate mold

0251 42310 Drainage of salivary gland

0251 42320 Drainage of salivary gland

0251 42660 Dilation of salivary duct

0251 42700 Drainage of tonsil abscess

0251 69100 Biopsy of external ear0251 69400 Inflate middle ear canal

0251 69401 Inflate middle ear canal

0251 69420 Incision of eardrum

0251 92502 Ear and throat examination

0252 Level III ENT Procedures T 7.4614 $522.42 $104.55 $104.49

0252 20100 Explore wound neck

0252 20500 Injection of sinus tract

0252 21073 Mnpj of tmj w/anesth

0252 21110 Interdental fixation

0252 21295 Revision of jaw muscle/bone

0252 21400 Treat eye socket fracture

0252 21451 Treat lower jaw fracture

0252 21685 Hyoid myotomy & suspension

0252 30100 Intranasal biopsy

0252 30124 Removal of nose lesion

0252 30200 Injection treatment of nose

0252 30210 Nasal sinus therapy

0252 30220 Insert nasal septal button

0252 30801 Ablate inf turbinate superf

0252 31002 Irrigation sphenoid sinus

0252 31603 Incision of windpipe

0252 31605 Incision of windpipe

0252 31615 Visualization of windpipe

0252 40650 Repair lip

0252 40652 Repair lip

0252 40654 Repair lip

0252 40801 Drainage of mouth lesion

0252 40805 Removal foreign body mouth

0252 40819 Excise lip or cheek fold

0252 40831 Repair mouth laceration

0252 41010 Incision of tongue fold

0252 41016 Drainage of mouth lesion

0252 41017 Drainage of mouth lesion

0252 41018 Drainage of mouth lesion

0252 41100 Biopsy of tongue

0252 41115 Excision of tongue fold

0252 41252 Repair tongue laceration

0252 41512 Tongue suspension

0252 41520 Reconstruction tongue fold

0252 41820 Excision gum each quadrant

0252 41821 Excision of gum flap

0252 42100 Biopsy roof of mouth

0252 42140 Excision of uvula

0252 42650 Dilation of salivary duct

0252 42800 Biopsy of throat

0252 42900 Repair throat wound

0252 43020 Incision of esophagus

0252 60000 Drain thyroid/tongue cyst

0252 69150 Extensive ear canal surgery

0252 69405 Catheterize middle ear canal

0252 69433 Create eardrum opening

0252 C9727 Insert palate implants

0253 Level IV ENT Procedures T 16.8699 "$1,181.16" $279.20 $236.24

0253 21085 Prepare face/oral prosthesis

0253 21282 Revision of eyelid

0253 21315 Treatment of nose fracture

0253 21320 Treatment of nose fracture

0253 21337 Treat nasal septal fracture

0253 21401 Treat eye socket fracture

0253 21452 Treat lower jaw fracture

0253 21485 Reset dislocated jaw

0253 21495 Treat hyoid bone fracture

0253 21497 Interdental wiring

0253 30110 Removal of nose polyp(s)

0253 30115 Removal of nose polyp(s)

0253 30117 Removal of intranasal lesion0253 30130 Excise inferior turbinate

0253 30310 Remove nasal foreign body

0253 30320 Remove nasal foreign body

0253 30802 Ablate inf turbinate submuc

0253 30930 Ther fx nasal inf turbinate

0253 40500 Partial excision of lip

0253 40520 Partial excision of lip

0253 40810 Excision of mouth lesion

0253 40812 Excise/repair mouth lesion

0253 40814 Excise/repair mouth lesion

0253 40820 Treatment of mouth lesion

0253 41000 Drainage of mouth lesion

0253 41007 Drainage of mouth lesion

0253 41008 Drainage of mouth lesion

0253 41105 Biopsy of tongue

0253 41110 Excision of tongue lesion

0253 41112 Excision of tongue lesion

0253 41113 Excision of tongue lesion

0253 41116 Excision of mouth lesion

0253 41510 Tongue to lip surgery

0253 41806 Removal foreign body jawbone

0253 41822 Excision of gum lesion

0253 41825 Excision of gum lesion

0253 41828 Excision of gum lesion

0253 41830 Removal of gum tissue

0253 41850 Treatment of gum lesion

0253 41872 Repair gum

0253 42104 Excision lesion mouth roof

0253 42106 Excision lesion mouth roof

0253 42160 Treatment mouth roof lesion

0253 42235 Repair palate

0253 42281 Insertion palate prosthesis

0253 42300 Drainage of salivary gland

0253 42305 Drainage of salivary gland

0253 42330 Removal of salivary stone

0253 42335 Removal of salivary stone

0253 42340 Removal of salivary stone

0253 42408 Excision of salivary cyst

0253 42409 Drainage of salivary cyst

0253 42600 Closure of salivary fistula

0253 42720 Drainage of throat abscess

0253 42802 Biopsy of throat

0253 42804 Biopsy of upper nose/throat

0253 42972 Control nose/throat bleeding

0253 43030 Throat muscle surgery

0253 69105 Biopsy of external ear canal

0253 69222 Clean out mastoid cavity

0253 69421 Incision of eardrum

0253 69424 Remove ventilating tube

0253 69436 Create eardrum opening

0253 69540 Remove ear lesion

0253 69801 Incise inner ear

0254 Level V ENT Procedures T 24.8895 "$1,742.66"

. $348.54

0254 21010 Incision of jaw joint

0254 21030 Excise max/zygoma b9 tumor

0254 21031 Remove exostosis mandible

0254 21032 Remove exostosis maxilla

0254 21040 Excise mandible lesion

0254 21076 Prepare face/oral prosthesis

0254 21120 Reconstruction of chin

0254 21121 Reconstruction of chin

0254 21122 Reconstruction of chin

0254 21123 Reconstruction of chin

0254 21125 Augmentation lower jaw bone

0254 21137 Reduction of forehead

0254 21181 Contour cranial bone lesion0254 21235 Ear cartilage graft

0254 21296 Revision of jaw muscle/bone

0254 21325 Treatment of nose fracture

0254 21330 Treatment of nose fracture

0254 21335 Treatment of nose fracture

0254 21338 Treat nasoethmoid fracture

0254 21339 Treat nasoethmoid fracture

0254 21345 Treat nose/jaw fracture

0254 21346 Treat nose/jaw fracture

0254 21356 Treat cheek bone fracture

0254 21360 Treat cheek bone fracture

0254 21421 Treat mouth roof fracture

0254 21440 Treat dental ridge fracture

0254 21445 Treat dental ridge fracture

0254 21454 Treat lower jaw fracture

0254 30118 Removal of intranasal lesion

0254 30120 Revision of nose

0254 30140 Resect inferior turbinate

0254 30430 Revision of nose

0254 30520 Repair of nasal septum

0254 30630 Repair nasal septum defect

0254 31020 Exploration maxillary sinus

0254 31040 Exploration behind upper jaw

0254 31070 Exploration of frontal sinus

0254 31300 Removal of larynx lesion

0254 31600 Incision of windpipe

0254 31601 Incision of windpipe

0254 31610 Incision of windpipe

0254 31611 Surgery/speech prosthesis

0254 31612 Puncture/clear windpipe

0254 31613 Repair windpipe opening

0254 31785 Remove windpipe lesion

0254 31820 Closure of windpipe lesion

0254 31825 Repair of windpipe defect

0254 31830 Revise windpipe scar

0254 40510 Partial excision of lip

0254 40525 Reconstruct lip with flap

0254 40527 Reconstruct lip with flap

0254 40530 Partial removal of lip

0254 40816 Excision of mouth lesion

0254 40840 Reconstruction of mouth

0254 40842 Reconstruction of mouth

0254 40843 Reconstruction of mouth

0254 41006 Drainage of mouth lesion

0254 41019 Place needles h&n for rt

0254 41114 Excision of tongue lesion

0254 41120 Partial removal of tongue

0254 41500 Fixation of tongue

0254 41530 Tongue base vol reduction

0254 41805 Removal foreign body gum

0254 41823 Excision of gum lesion

0254 41826 Excision of gum lesion

0254 41827 Excision of gum lesion

0254 41870 Gum graft

0254 41874 Repair tooth socket

0254 42107 Excision lesion mouth roof

0254 42145 Repair palate pharynx/uvula

0254 42260 Repair nose to lip fistula

0254 42405 Biopsy of salivary gland

0254 42450 Excise sublingual gland

0254 42500 Repair salivary duct

0254 42665 Ligation of salivary duct

0254 42806 Biopsy of upper nose/throat

0254 42808 Excise pharynx lesion

0254 42810 Excision of neck cyst

0254 42820 Remove tonsils and adenoids0254 42821 Remove tonsils and adenoids

0254 42825 Removal of tonsils

0254 42826 Removal of tonsils

0254 42830 Removal of adenoids

0254 42831 Removal of adenoids

0254 42835 Removal of adenoids

0254 42836 Removal of adenoids

0254 42842 Extensive surgery of throat

0254 42860 Excision of tonsil tags

0254 42870 Excision of lingual tonsil

0254 42950 Reconstruction of throat

0254 42955 Surgical opening of throat

0254 43420 Repair esophagus opening

0254 62000 Treat skull fracture

0254 69120 Removal of external ear

0254 69140 Remove ear canal lesion(s)

0254 69300 Revise external ear

0254 69440 Exploration of middle ear

0254 69502 Mastoidectomy

0254 69610 Repair of eardrum

0254 69620 Repair of eardrum

0254 69650 Release middle ear bone

0255 Level II Anterior Segment Eye Procedures T 7.2190 $505.45 $101.81 $101.09

0255 65286 Repair of eye wound

0255 65800 Drainage of eye

0255 66505 Incision of iris

0255 66625 Removal of iris

0255 66820 Incision secondary cataract

0255 66830 Removal of lens lesion

0255 66940 Extraction of lens

0256 Level VI ENT Procedures T 45.0377 "$3,153.36"

. $630.68

0256 21025 Excision of bone lower jaw

0256 21026 Excision of facial bone(s)

0256 21029 Contour of face bone lesion

0256 21034 Excise max/zygoma mal tumor

0256 21044 Removal of jaw bone lesion

0256 21046 Remove mandible cyst complex

0256 21047 Excise lwr jaw cyst w/repair

0256 21048 Remove maxilla cyst complex

0256 21049 Excis uppr jaw cyst w/repair

0256 21050 Removal of jaw joint

0256 21060 Remove jaw joint cartilage

0256 21070 Remove coronoid process

0256 21077 Prepare face/oral prosthesis

0256 21079 Prepare face/oral prosthesis

0256 21080 Prepare face/oral prosthesis

0256 21081 Prepare face/oral prosthesis

0256 21082 Prepare face/oral prosthesis

0256 21083 Prepare face/oral prosthesis

0256 21084 Prepare face/oral prosthesis

0256 21086 Prepare face/oral prosthesis

0256 21087 Prepare face/oral prosthesis

0256 21088 Prepare face/oral prosthesis

0256 21100 Maxillofacial fixation

0256 21127 Augmentation lower jaw bone

0256 21138 Reduction of forehead

0256 21139 Reduction of forehead

0256 21150 Reconstruct midface lefort

0256 21172 Reconstruct orbit/forehead

0256 21175 Reconstruct orbit/forehead

0256 21193 Reconst lwr jaw w/o graft

0256 21195 Reconst lwr jaw w/o fixation

0256 21198 Reconstr lwr jaw segment

0256 21199 Reconstr lwr jaw w/advance

0256 21206 Reconstruct upper jaw bone

0256 21208 Augmentation of facial bones0256 21209 Reduction of facial bones

0256 21210 Face bone graft

0256 21215 Lower jaw bone graft

0256 21230 Rib cartilage graft

0256 21240 Reconstruction of jaw joint

0256 21242 Reconstruction of jaw joint

0256 21243 Reconstruction of jaw joint

0256 21244 Reconstruction of lower jaw

0256 21245 Reconstruction of jaw

0256 21246 Reconstruction of jaw

0256 21248 Reconstruction of jaw

0256 21249 Reconstruction of jaw

0256 21256 Reconstruction of orbit

0256 21260 Revise eye sockets

0256 21261 Revise eye sockets

0256 21263 Revise eye sockets

0256 21267 Revise eye sockets

0256 21270 Augmentation cheek bone

0256 21275 Revision orbitofacial bones

0256 21280 Revision of eyelid

0256 21340 Treatment of nose fracture

0256 21355 Treat cheek bone fracture

0256 21365 Treat cheek bone fracture

0256 21385 Treat eye socket fracture

0256 21386 Treat eye socket fracture

0256 21387 Treat eye socket fracture

0256 21390 Treat eye socket fracture

0256 21395 Treat eye socket fracture

0256 21406 Treat eye socket fracture

0256 21407 Treat eye socket fracture

0256 21408 Treat eye socket fracture

0256 21453 Treat lower jaw fracture

0256 21461 Treat lower jaw fracture

0256 21462 Treat lower jaw fracture

0256 21465 Treat lower jaw fracture

0256 21470 Treat lower jaw fracture

0256 21490 Repair dislocated jaw

0256 30125 Removal of nose lesion

0256 30150 Partial removal of nose

0256 30160 Removal of nose

0256 30400 Reconstruction of nose

0256 30410 Reconstruction of nose

0256 30420 Reconstruction of nose

0256 30435 Revision of nose

0256 30450 Revision of nose

0256 30460 Revision of nose

0256 30462 Revision of nose

0256 30465 Repair nasal stenosis

0256 30540 Repair nasal defect

0256 30545 Repair nasal defect

0256 30580 Repair upper jaw fistula

0256 30600 Repair mouth/nose fistula

0256 30620 Intranasal reconstruction

0256 31030 Exploration maxillary sinus

0256 31032 Explore sinus remove polyps

0256 31050 Exploration sphenoid sinus

0256 31051 Sphenoid sinus surgery

0256 31075 Exploration of frontal sinus

0256 31080 Removal of frontal sinus

0256 31081 Removal of frontal sinus

0256 31084 Removal of frontal sinus

0256 31085 Removal of frontal sinus

0256 31086 Removal of frontal sinus

0256 31087 Removal of frontal sinus

0256 31090 Exploration of sinuses

0256 31200 Removal of ethmoid sinus0256 31201 Removal of ethmoid sinus

0256 31205 Removal of ethmoid sinus

0256 31320 Diagnostic incision larynx

0256 31400 Revision of larynx

0256 31420 Removal of epiglottis

0256 31580 Revision of larynx

0256 31582 Revision of larynx

0256 31588 Revision of larynx

0256 31590 Reinnervate larynx

0256 31595 Larynx nerve surgery

0256 31614 Repair windpipe opening

0256 31750 Repair of windpipe

0256 31755 Repair of windpipe

0256 40700 Repair cleft lip/nasal

0256 40701 Repair cleft lip/nasal

0256 40702 Repair cleft lip/nasal

0256 40720 Repair cleft lip/nasal

0256 40761 Repair cleft lip/nasal

0256 40844 Reconstruction of mouth

0256 40845 Reconstruction of mouth

0256 42120 Remove palate/lesion

0256 42182 Repair palate

0256 42200 Reconstruct cleft palate

0256 42205 Reconstruct cleft palate

0256 42210 Reconstruct cleft palate

0256 42215 Reconstruct cleft palate

0256 42220 Reconstruct cleft palate

0256 42225 Reconstruct cleft palate

0256 42226 Lengthening of palate

0256 42227 Lengthening of palate

0256 42410 Excise parotid gland/lesion

0256 42415 Excise parotid gland/lesion

0256 42420 Excise parotid gland/lesion

0256 42425 Excise parotid gland/lesion

0256 42440 Excise submaxillary gland

0256 42505 Repair salivary duct

0256 42507 Parotid duct diversion

0256 42508 Parotid duct diversion

0256 42509 Parotid duct diversion

0256 42510 Parotid duct diversion

0256 42725 Drainage of throat abscess

0256 42815 Excision of neck cyst

0256 42844 Extensive surgery of throat

0256 42890 Partial removal of pharynx

0256 42892 Revision of pharyngeal walls

0256 42962 Control throat bleeding

0256 43130 Removal of esophagus pouch

0256 60252 Removal of thyroid

0256 60260 Repeat thyroid surgery

0256 60271 Removal of thyroid

0256 60500 Explore parathyroid glands

0256 60502 Re-explore parathyroids

0256 60520 Removal of thymus gland

0256 61330 Decompress eye socket

0256 61334 Explore orbit/remove object

0256 69310 Rebuild outer ear canal

0256 69320 Rebuild outer ear canal

0256 69450 Eardrum revision

0256 69501 Mastoidectomy

0256 69505 Remove mastoid structures

0256 69511 Extensive mastoid surgery

0256 69530 Extensive mastoid surgery

0256 69550 Remove ear lesion

0256 69552 Remove ear lesion

0256 69601 Mastoid surgery revision

0256 69602 Mastoid surgery revision0256 69603 Mastoid surgery revision

0256 69604 Mastoid surgery revision

0256 69605 Mastoid surgery revision

0256 69631 Repair eardrum structures

0256 69632 Rebuild eardrum structures

0256 69633 Rebuild eardrum structures

0256 69635 Repair eardrum structures

0256 69636 Rebuild eardrum structures

0256 69637 Rebuild eardrum structures

0256 69641 Revise middle ear & mastoid

0256 69642 Revise middle ear & mastoid

0256 69643 Revise middle ear & mastoid

0256 69644 Revise middle ear & mastoid

0256 69645 Revise middle ear & mastoid

0256 69646 Revise middle ear & mastoid

0256 69660 Revise middle ear bone

0256 69661 Revise middle ear bone

0256 69662 Revise middle ear bone

0256 69666 Repair middle ear structures

0256 69667 Repair middle ear structures

0256 69670 Remove mastoid air cells

0256 69676 Remove middle ear nerve

0256 69700 Close mastoid fistula

0256 69711 Remove/repair hearing aid

0256 69720 Release facial nerve

0256 69725 Release facial nerve

0256 69740 Repair facial nerve

0256 69745 Repair facial nerve

0256 69805 Explore inner ear

0256 69806 Explore inner ear

0256 69820 Establish inner ear window

0256 69840 Revise inner ear window

0256 69905 Remove inner ear

0256 69910 Remove inner ear & mastoid

0256 69915 Incise inner ear nerve

0256 69955 Release facial nerve

0256 69960 Release inner ear canal

0256 69970 Remove inner ear lesion

0259 Level VII ENT Procedures T 412.7299 "$28,897.70" "$7,948.75" "$5,779.54"

0259 69930 Implant cochlear device

0260 Level I Plain Film Except Teeth X 0.6409 $44.87

. $8.98

0260 70030 X-ray eye for foreign body

0260 70100 X-ray exam of jaw

0260 70110 X-ray exam of jaw

0260 70120 X-ray exam of mastoids

0260 70130 X-ray exam of mastoids

0260 70140 X-ray exam of facial bones

0260 70150 X-ray exam of facial bones

0260 70160 X-ray exam of nasal bones

0260 70190 X-ray exam of eye sockets

0260 70200 X-ray exam of eye sockets

0260 70210 X-ray exam of sinuses

0260 70220 X-ray exam of sinuses

0260 70240 X-ray exam pituitary saddle

0260 70250 X-ray exam of skull

0260 70328 X-ray exam of jaw joint

0260 70330 X-ray exam of jaw joints

0260 70350 X-ray head for orthodontia

0260 70360 X-ray exam of neck

0260 70380 X-ray exam of salivary gland

0260 71010 Chest x-ray

0260 71015 Chest x-ray

0260 71020 Chest x-ray

0260 71021 Chest x-ray

0260 71022 Chest x-ray

0260 71030 Chest x-ray0260 71035 Chest x-ray

0260 71100 X-ray exam of ribs

0260 71101 X-ray exam of ribs/chest

0260 71110 X-ray exam of ribs

0260 71120 X-ray exam of breastbone

0260 71130 X-ray exam of breastbone

0260 72020 X-ray exam of spine

0260 72040 X-ray exam of neck spine

0260 72069 X-ray exam of trunk spine

0260 72070 X-ray exam of thoracic spine

0260 72072 X-ray exam of thoracic spine

0260 72074 X-ray exam of thoracic spine

0260 72080 X-ray exam of trunk spine

0260 72100 X-ray exam of lower spine

0260 72120 X-ray exam of lower spine

0260 72170 X-ray exam of pelvis

0260 72190 X-ray exam of pelvis

0260 72200 X-ray exam sacroiliac joints

0260 72202 X-ray exam sacroiliac joints

0260 72220 X-ray exam of tailbone

0260 73000 X-ray exam of collar bone

0260 73010 X-ray exam of shoulder blade

0260 73020 X-ray exam of shoulder

0260 73030 X-ray exam of shoulder

0260 73050 X-ray exam of shoulders

0260 73060 X-ray exam of humerus

0260 73070 X-ray exam of elbow

0260 73080 X-ray exam of elbow

0260 73090 X-ray exam of forearm

0260 73092 X-ray exam of arm infant

0260 73100 X-ray exam of wrist

0260 73110 X-ray exam of wrist

0260 73120 X-ray exam of hand

0260 73130 X-ray exam of hand

0260 73140 X-ray exam of finger(s)

0260 73500 X-ray exam of hip

0260 73510 X-ray exam of hip

0260 73520 X-ray exam of hips

0260 73540 X-ray exam of pelvis & hips

0260 73550 X-ray exam of thigh

0260 73560 X-ray exam of knee 1 or 2

0260 73562 X-ray exam of knee 3

0260 73564 X-ray exam knee 4 or more

0260 73565 X-ray exam of knees

0260 73590 X-ray exam of lower leg

0260 73592 X-ray exam of leg infant

0260 73600 X-ray exam of ankle

0260 73610 X-ray exam of ankle

0260 73620 X-ray exam of foot

0260 73630 X-ray exam of foot

0260 73650 X-ray exam of heel

0260 73660 X-ray exam of toe(s)

0260 74000 X-ray exam of abdomen

0260 74010 X-ray exam of abdomen

0260 74020 X-ray exam of abdomen

0260 76010 X-ray nose to rectum

0260 76499 Radiographic procedure

0260 77071 X-ray stress view

0260 77072 X-rays for bone age

0260 77073 X-rays bone length studies

0260 77077 Joint survey single view

0260 77082 Dxa bone density vert fx

0260 G0130 Single energy x-ray study $0.00 $0.00

0261 Level II Plain Film Except Teeth Including Bone Density

Measurement X 1.0790 $75.55

. $15.11

0261 70134 X-ray exam of middle ear0261 70260 X-ray exam of skull

0261 71111 X-ray exam of ribs/chest

0261 72010 X-ray exam of spine

0261 72050 X-ray exam of neck spine

0261 72052 X-ray exam of neck spine

0261 72090 X-ray exam of trunk spine

0261 72110 X-ray exam of lower spine

0261 72114 X-ray exam of lower spine

0261 74022 X-ray exam series abdomen

0261 74710 X-ray measurement of pelvis

0261 75809 Nonvascular shunt x-ray

0261 75898 Follow-up angiography

0261 76100 X-ray exam of body section

0261 77074 X-rays bone survey limited

0261 77075 X-rays bone survey complete

0261 77076 X-rays bone survey infant

0262 Plain Film of Teeth X 0.4640 $32.49

. $6.50

0262 70300 X-ray exam of teeth

0262 70310 X-ray exam of teeth

0262 70320 Full mouth x-ray of teeth

0262 70355 Panoramic x-ray of jaws

0263 Level I Miscellaneous Radiology Procedures X 3.3643 $235.55

. $47.11

0263 70170 X-ray exam of tear duct

0263 70373 Contrast x-ray of larynx

0263 70390 X-ray exam of salivary duct

0263 71040 Contrast x-ray of bronchi

0263 71060 Contrast x-ray of bronchi

0263 74190 X-ray exam of peritoneum

0263 74305 X-ray bile ducts/pancreas

0263 74470 X-ray exam of kidney lesion

0263 74740 X-ray female genital tract

0263 76080 X-ray exam of fistula

0263 76101 Complex body section x-ray

0263 76102 Complex body section x-rays

0263 77053 X-ray of mammary duct

0263 77054 X-ray of mammary ducts

0265 Level I Diagnostic and Screening Ultrasound S 0.8990 $62.94 $22.26 $12.59

0265 76506 Echo exam of head

0265 76516 Echo exam of eye

0265 76529 Echo exam of eye

0265 76604 Us exam chest

0265 76645 Us exam breast(s)

0265 76802 Ob us < 14 wks addl fetus

0265 76812 Ob us detailed addl fetus

0265 76813 Ob us nuchal meas 1 gest

0265 76814 Ob us nuchal meas add-on

0265 76815 Ob us limited fetus(s)

0265 76816 Ob us follow-up per fetus

0265 76817 Transvaginal us obstetric

0265 76820 Umbilical artery echo

0265 76821 Middle cerebral artery echo

0265 76827 Echo exam of fetal heart

0265 76828 Echo exam of fetal heart

0265 76857 Us exam pelvic limited

0265 76882 Us xtr non-vasc lmtd

0265 76885 Us exam infant hips dynamic

0265 76886 Us exam infant hips static

0265 76970 Ultrasound exam follow-up

0265 76999 Echo examination procedure

0265 93888 Intracranial study

0266 Level II Diagnostic and Screening Ultrasound S 1.3781 $96.49 $37.23 $19.30

0266 76511 Ophth us quant a only

0266 76512 Ophth us b w/non-quant a

0266 76513 Echo exam of eye water bath

0266 76519 Echo exam of eye

0266 76536 Us exam of head and neck0266 76700 Us exam abdom complete

0266 76705 Echo exam of abdomen

0266 76770 Us exam abdo back wall comp

0266 76775 Us exam abdo back wall lim

0266 76776 Us exam k transpl w/doppler

0266 76800 Us exam spinal canal

0266 76801 Ob us < 14 wks single fetus

0266 76805 Ob us >/= 14 wks sngl fetus

0266 76810 Ob us >/= 14 wks addl fetus

0266 76818 Fetal biophys profile w/nst

0266 76819 Fetal biophys profil w/o nst

0266 76830 Transvaginal us non-ob

0266 76856 Us exam pelvic complete

0266 76870 Us exam scrotum

0266 76872 Us transrectal

0266 76873 Echograp trans r pros study

0266 76881 Us xtr non-vasc complete

0266 93890 Tcd vasoreactivity study

0266 93892 Tcd emboli detect w/o inj

0266 93893 Tcd emboli detect w/inj

0266 93926 Lower extremity study

0266 93931 Upper extremity study

0266 93971 Extremity study

0266 93979 Vascular study

0266 93990 Doppler flow testing

0266 G0389 Ultrasound exam AAA screen $0.00 $0.00

0267 Level III Diagnostic and Screening Ultrasound S 2.1681 $151.80 $59.37 $30.36

0267 36002 Pseudoaneurysm injection trt

0267 75945 Intravascular us

0267 76811 Ob us detailed sngl fetus

0267 76831 Echo exam uterus

0267 76975 GI endoscopic ultrasound

0267 93880 Extracranial study

0267 93882 Extracranial study

0267 93886 Intracranial study

0267 93925 Lower extremity study

0267 93930 Upper extremity study

0267 93970 Extremity study

0267 93975 Vascular study

0267 93976 Vascular study

0267 93978 Vascular study

0267 93980 Penile vascular study

0267 93981 Penile vascular study

0267 G0365 Vessel mapping hemo access

0269 Level II Echocardiogram Without Contrast S 5.6156 $393.18

. $78.64

0269 93304 Echo transthoracic

0269 93306 Tte w/doppler complete

0269 93307 Tte w/o doppler complete

0269 93313 Echo transesophageal

0269 93315 Echo transesophageal

0269 93350 Stress tte only

0270 Level III Echocardiogram Without Contrast S 8.2952 $580.80 $133.61 $116.16

0270 93303 Echo transthoracic

0270 93312 Echo transesophageal

0270 93316 Echo transesophageal

0270 93318 Echo transesophageal intraop

0270 93351 Stress tte complete

0272 Fluoroscopy X 1.2171 $85.22 $30.47 $17.05

0272 43752 Nasal/orogastric w/stent

0272 43756 Dx duod intub w/asp spec

0272 43757 Dx duod intub w/asp specs

0272 70370 Throat x-ray & fluoroscopy

0272 70371 Speech evaluation complex

0272 71023 Chest x-ray and fluoroscopy

0272 71034 Chest x-ray and fluoroscopy

0272 76000 Fluoroscope examination0272 76120 Cine/video x-rays

0272 76496 Fluoroscopic procedure

0274 Myelography S 7.0678 $494.86

. $98.98

0274 70010 Contrast x-ray of brain

0274 70015 Contrast x-ray of brain

0274 72240 Contrast x-ray of neck spine

0274 72255 Contrast x-ray thorax spine

0274 72265 Contrast x-ray lower spine

0274 72270 Contrast x-ray spine

0275 Arthrography S 4.0104 $280.79 $68.90 $56.16

0275 70332 X-ray exam of jaw joint

0275 73040 Contrast x-ray of shoulder

0275 73085 Contrast x-ray of elbow

0275 73115 Contrast x-ray of wrist

0275 73525 Contrast x-ray of hip

0275 73580 Contrast x-ray of knee joint

0275 73615 Contrast x-ray of ankle

0276 Level I Digestive Radiology S 1.2186 $85.32 $33.87 $17.07

0276 74210 Contrst x-ray exam of throat

0276 74220 Contrast x-ray esophagus

0276 74230 Cine/vid x-ray throat/esoph

0276 74240 X-ray exam upper gi tract

0276 74241 X-ray exam upper gi tract

0276 74246 Contrst x-ray uppr gi tract

0276 74247 Contrst x-ray uppr gi tract

0276 74250 X-ray exam of small bowel

0276 74260 X-ray exam of small bowel

0276 74270 Contrast x-ray exam of colon

0276 74283 Contrast x-ray exam of colon

0276 74290 Contrast x-ray gallbladder

0276 74291 Contrast x-rays gallbladder

0277 Level II Digestive Radiology S 2.0340 $142.41 $53.90 $28.49

0277 49465 Fluoro exam of g/colon tube

0277 74245 X-ray exam upper gi tract

0277 74249 Contrst x-ray uppr gi tract

0277 74251 X-ray exam of small bowel

0277 74280 Contrast x-ray exam of colon

0278 Diagnostic Urography S 2.6196 $183.41 $58.44 $36.69

0278 74400 Contrst x-ray urinary tract

0278 74410 Contrst x-ray urinary tract

0278 74415 Contrst x-ray urinary tract

0278 74420 Contrst x-ray urinary tract

0278 74425 Contrst x-ray urinary tract

0278 74430 Contrast x-ray bladder

0278 74440 X-ray male genital tract

0278 74445 X-ray exam of penis

0278 74450 X-ray urethra/bladder

0278 74455 X-ray urethra/bladder

0278 74775 X-ray exam of perineum

0279 Level II Angiography and Venography S 29.7209 "$2,080.94"

. $416.19

0279 36251 Ins cath ren art 1st unilat

0279 36252 Ins cath ren art 1st bilat

0279 36253 Ins cath ren art 2nd+ unilat

0279 36254 Ins cath ren art 2nd+ bilat

0279 75600 Contrast x-ray exam of aorta

0279 75605 Contrast x-ray exam of aorta

0279 75625 Contrast x-ray exam of aorta

0279 75630 X-ray aorta leg arteries

0279 75658 Artery x-rays arm

0279 75665 Artery x-rays head & neck

0279 75676 Artery x-rays neck

0279 75680 Artery x-rays neck

0279 75685 Artery x-rays spine

0279 75705 Artery x-rays spine

0279 75710 Artery x-rays arm/leg

0279 75716 Artery x-rays arms/legs0279 75726 Artery x-rays abdomen

0279 75731 Artery x-rays adrenal gland

0279 75733 Artery x-rays adrenals

0279 75736 Artery x-rays pelvis

0279 75741 Artery x-rays lung

0279 75743 Artery x-rays lungs

0279 75810 Vein x-ray spleen/liver

0279 75825 Vein x-ray trunk

0279 75831 Vein x-ray kidney

0279 75833 Vein x-ray kidneys

0279 75840 Vein x-ray adrenal gland

0279 75842 Vein x-ray adrenal glands

0279 75885 Vein x-ray liver

0279 75889 Vein x-ray liver

0279 75891 Vein x-ray liver

0279 75893 Venous sampling by catheter

0280 Level III Angiography and Venography S 49.6878 "$3,478.94"

. $695.79

0280 75650 Artery x-rays head & neck

0280 75660 Artery x-rays head & neck

0280 75662 Artery x-rays head & neck

0280 75671 Artery x-rays head & neck

0282 Miscellaneous Computed Axial Tomography S 1.5251 $106.78 $35.57 $21.36

0282 76380 CAT scan follow-up study

0282 76497 Ct procedure

0283 Computed Tomography with Contrast S 4.2929 $300.57 $96.62 $60.12

0283 70460 Ct head/brain w/dye

0283 70481 Ct orbit/ear/fossa w/dye

0283 70487 Ct maxillofacial w/dye

0283 70491 Ct soft tissue neck w/dye

0283 71260 Ct thorax w/dye

0283 72126 Ct neck spine w/dye

0283 72129 Ct chest spine w/dye

0283 72132 Ct lumbar spine w/dye

0283 72193 Ct pelvis w/dye

0283 73201 Ct upper extremity w/dye

0283 73701 Ct lower extremity w/dye

0283 74160 Ct abdomen w/dye

0283 74262 Ct colonography dx w/dye

0284 Magnetic Resonance Imaging and Magnetic Resonance Angiography with

Contrast S 6.2343 $436.50 $146.69 $87.30

0284 70542 Mri orbit/face/neck w/dye

0284 70545 Mr angiography head w/dye

0284 70548 Mr angiography neck w/dye

0284 70552 Mri brain w/dye

0284 70558 Mri brain w/dye

0284 71551 Mri chest w/dye

0284 72142 Mri neck spine w/dye

0284 72147 Mri chest spine w/dye

0284 72149 Mri lumbar spine w/dye

0284 72196 Mri pelvis w/dye

0284 73219 Mri upper extremity w/dye

0284 73222 Mri joint upr extrem w/dye

0284 73719 Mri lower extremity w/dye

0284 73722 Mri joint of lwr extr w/dye

0284 74182 Mri abdomen w/dye

0284 C8900 "MRA w/cont, abd"

0284 C8903 "MRI w/cont, breast, uni"

0284 C8906 "MRI w/cont, breast, bi"

0284 C8909 "MRA w/cont, chest"

0284 C8912 "MRA w/cont, lwr ext"

0284 C8918 "MRA w/cont, pelvis"

0284 C8931 "MRA, w/dye, spinal canal"

0284 C8934 "MRA, w/dye, upper extremity"

0288 Bone Density:Axial Skeleton S 1.0218 $71.54 $0.00 $0.00

0288 77078 Ct bone density axial $0.00 $0.00

0288 77080 Dxa bone density axial $0.00 $0.000293 Level VI Anterior Segment Eye Procedures T 117.1298 "$8,200.96"

. "$1,640.20"

0293 65770 Revise cornea with implant

0299 Hyperthermia and Radiation Treatment Procedures S 5.6386 $394.79

. $78.96

0299 77470 Special radiation treatment

0299 77600 Hyperthermia treatment

0299 77605 Hyperthermia treatment

0299 77610 Hyperthermia treatment

0299 77615 Hyperthermia treatment

0299 77620 Hyperthermia treatment

0300 Level I Radiation Therapy S 1.4252 $99.79

. $19.96

0300 77401 Radiation treatment delivery

0300 77402 Radiation treatment delivery

0300 77403 Radiation treatment delivery

0300 77404 Radiation treatment delivery

0300 77406 Radiation treatment delivery

0300 77407 Radiation treatment delivery

0300 77789 Apply surface radiation

0301 Level II Radiation Therapy S 2.4149 $169.08

. $33.82

0301 77408 Radiation treatment delivery

0301 77409 Radiation treatment delivery

0301 77411 Radiation treatment delivery

0301 77412 Radiation treatment delivery

0301 77413 Radiation treatment delivery

0301 77414 Radiation treatment delivery

0301 77416 Radiation treatment delivery

0301 77422 Neutron beam tx simple

0301 77423 Neutron beam tx complex

0301 77750 Infuse radioactive materials

0303 Treatment Device Construction X 2.8573 $200.06 $66.95 $40.02

0303 77332 Radiation treatment aid(s)

0303 77333 Radiation treatment aid(s)

0303 77334 Radiation treatment aid(s)

0304 Level I Therapeutic Radiation Treatment Preparation X 1.5329 $107.33 $34.63 $21.47

0304 77280 Set radiation therapy field

0304 77299 Radiation therapy planning

0304 77300 Radiation therapy dose plan

0304 77305 Teletx isodose plan simple

0304 77310 Teletx isodose plan intermed

0304 77326 Brachytx isodose calc simp

0304 77331 Special radiation dosimetry

0304 77336 Radiation physics consult

0304 77370 Radiation physics consult

0304 77399 External radiation dosimetry

0305 Level II Therapeutic Radiation Treatment Preparation X 3.7681 $263.83 $88.76 $52.77

0305 77285 Set radiation therapy field

0305 77290 Set radiation therapy field

0305 77315 Teletx isodose plan complex

0305 77321 Special teletx port plan

0305 77327 Brachytx isodose calc interm

0305 77328 Brachytx isodose plan compl

0305 77338 Design mlc device for imrt

0308 Positron Emission Tomography (PET) imaging S 14.8260 "$1,038.06"

. $207.62

0308 78459 Heart muscle imaging (PET)

0308 78491 Heart image (pet) single

0308 78492 Heart image (pet) multiple

0308 78608 Brain imaging (PET)

0308 78811 Pet image ltd area

0308 78812 Pet image skull-thigh

0308 78813 Pet image full body

0308 78814 Pet image w/ct lmtd

0308 78815 Pet image w/ct skull-thigh

0308 78816 Pet image w/ct full body

0310 Level III Therapeutic Radiation Treatment

Preparation X 13.6332 $954.54 $325.27 $190.91

0310 32553 Ins mark thor for rt perq

0310 49411 Ins mark abd/pel for rt perq0310 55876 Place rt device/marker pros

0310 77295 Set radiation therapy field

0310 77301 Radiotherapy dose plan imrt

0310 C9728 "Place device/marker, non pro"

0312 Radioelement Applications S 5.4044 $378.39

. $75.68

0312 77761 Apply intrcav radiat simple

0312 77762 Apply intrcav radiat interm

0312 77763 Apply intrcav radiat compl

0312 77776 Apply interstit radiat simpl

0312 77777 Apply interstit radiat inter

0312 77799 Radium/radioisotope therapy

0313 Brachytherapy S 9.9687 $697.97 $263.92 $139.60

0313 0182T Hdr elect brachytherapy

0313 77785 Hdr brachytx 1 channel

0313 77786 Hdr brachytx 2-12 channel

0313 77787 Hdr brachytx over 12 chan

0315 Level II Implantation of Neurostimulator

Generator S 285.5893 "$19,995.82"

. "$3,999.17"

0315 61886 Implant neurostim arrays

0317 Level II Miscellaneous Radiology Procedures X 5.7208 $400.55

. $80.11

0317 74320 Contrast x-ray of bile ducts

0317 75801 Lymph vessel x-ray arm/leg

0317 75803 Lymph vessel x-ray arms/legs

0317 75805 Lymph vessel x-ray trunk

0317 75807 Lymph vessel x-ray trunk

0317 76098 X-ray exam breast specimen

0318 Implantation of Neurostimulator Pulse Generator and

Electrode S 346.4693 "$24,258.39" "$9,121.76" "$4,851.68"

0318 0283T Periph field stimul perm

0318 64568 Inc for vagus n elect impl

0319 Level III Endovascular Revascularization of the Lower

Extremity T 203.0553 "$14,217.12" "$5,559.48" "$2,843.43"

0319 37227 Fem/popl revasc stnt & ather

0319 37231 Tib/per revasc stent & ather

0320 Electroconvulsive Therapy S 5.9715 $418.10

. $83.62

0320 90870 Electroconvulsive therapy

0322 Brief Individual Psychotherapy S 1.1395 $79.78

. $15.96

0322 90804 Psytx office 20-30 min

0322 90805 Psytx off 20-30 min w/e&m

0322 90810 Intac psytx off 20-30 min

0322 90811 Intac psytx 20-30 w/e&m

0322 90899 Psychiatric service/therapy

0322 G0397 Alcohol/subs interv >30 min

0323 Extended Individual Psychotherapy S 1.5910 $111.40

. $22.28

0323 90801 Psy dx interview

0323 90802 Intac psy dx interview

0323 90806 Psytx off 45-50 min

0323 90807 Psytx off 45-50 min w/e&m

0323 90808 Psytx office 75-80 min

0323 90809 Psytx off 75-80 w/e&m

0323 90812 Intac psytx off 45-50 min

0323 90813 Intac psytx 45-50 min w/e&m

0323 90814 Intac psytx off 75-80 min

0323 90815 Intac psytx 75-80 w/e&m

0323 90845 Psychoanalysis

0323 90865 Narcosynthesis

0323 90880 Hypnotherapy

0324 Family Psychotherapy S 1.8190 $127.36

. $25.48

0324 90846 Family psytx w/o patient

0324 90847 Family psytx w/patient

0325 Group Psychotherapy S 0.8088 $56.63 $11.70 $11.33

0325 90849 Multiple family group psytx

0325 90853 Group psychotherapy

0325 90857 Intac group psytx

0330 Dental Procedures S 8.2687 $578.94

. $115.79

0330 D0150 Comprehensve oral evaluation0330 D0240 Intraoral occlusal film

0330 D0250 Extraoral first film

0330 D0260 Extraoral ea additional film

0330 D0270 Dental bitewing single film

0330 D0272 Dental bitewings two films

0330 D0274 Dental bitewings four films

0330 D0277 Vert bitewings-sev to eight

0330 D0460 Pulp vitality test

0330 D1510 Space maintainer fxd unilat

0330 D1515 Fixed bilat space maintainer

0330 D1520 Remove unilat space maintain

0330 D1525 Remove bilat space maintain

0330 D1550 Recement space maintainer

0330 D2999 Dental unspec restorative pr

0330 D3460 Endodontic endosseous implan

0330 D3999 Endodontic procedure

0330 D4260 Osseous surgery per quadrant

0330 D4263 Bone replce graft first site

0330 D4264 Bone replce graft each add

0330 D4268 Surgical revision procedure

0330 D4270 Pedicle soft tissue graft pr

0330 D4271 Free soft tissue graft proc

0330 D4273 Subepithelial tissue graft

0330 D4355 Full mouth debridement

0330 D4381 Localized delivery antimicro

0330 D5911 Facial moulage sectional

0330 D5912 Facial moulage complete

0330 D5983 Radiation applicator

0330 D5984 Radiation shield

0330 D5985 Radiation cone locator

0330 D5987 Commissure splint

0330 D6920 Dental connector bar

0330 D7111 Extraction coronal remnants

0330 D7140 Extraction erupted tooth/exr

0330 D7210 Rem imp tooth w mucoper flp

0330 D7220 Impact tooth remov soft tiss

0330 D7230 Impact tooth remov part bony

0330 D7240 Impact tooth remov comp bony

0330 D7241 Impact tooth rem bony w/comp

0330 D7250 Tooth root removal

0330 D7260 Oral antral fistula closure

0330 D7261 Primary closure sinus perf

0330 D7291 Transseptal fiberotomy

0330 D7940 Reshaping bone orthognathic

0330 D9630 Other drugs/medicaments

0330 D9930 Treatment of complications

0330 D9940 Dental occlusal guard

0330 D9950 Occlusion analysis

0330 D9951 Limited occlusal adjustment

0330 D9952 Complete occlusal adjustment

0331 Combined Abdomen and Pelvis CT without Contrast S 5.7930 $405.60 $156.82 $81.12

0331 74176 Ct abd & pelvis

0332 Computed Tomography without Contrast S 2.7436 $192.10 $74.27 $38.42

0332 70450 Ct head/brain w/o dye

0332 70480 Ct orbit/ear/fossa w/o dye

0332 70486 Ct maxillofacial w/o dye

0332 70490 Ct soft tissue neck w/o dye

0332 71250 Ct thorax w/o dye

0332 72125 Ct neck spine w/o dye

0332 72128 Ct chest spine w/o dye

0332 72131 Ct lumbar spine w/o dye

0332 72192 Ct pelvis w/o dye

0332 73200 Ct upper extremity w/o dye

0332 73700 Ct lower extremity w/o dye

0332 74150 Ct abdomen w/o dye

0332 74261 Ct colonography dx0333 Computed Tomography without Contrast followed by

Contrast S 4.7767 $334.45 $116.13 $66.89

0333 70470 Ct head/brain w/o & w/dye

0333 70482 Ct orbit/ear/fossa w/o&w/dye

0333 70488 Ct maxillofacial w/o & w/dye

0333 70492 Ct sft tsue nck w/o & w/dye

0333 71270 Ct thorax w/o & w/dye

0333 72127 Ct neck spine w/o & w/dye

0333 72130 Ct chest spine w/o & w/dye

0333 72133 Ct lumbar spine w/o & w/dye

0333 72194 Ct pelvis w/o & w/dye

0333 73202 Ct uppr extremity w/o&w/dye

0333 73702 Ct lwr extremity w/o&w/dye

0333 74170 Ct abdomen w/o & w/dye

0334 Combined Abdomen and Pelvis CT with Contrast S 8.2987 $581.04 $187.25 $116.21

0334 74174 Ct angio abd&pelv w/o&w/dye

0334 74177 Ct abd & pelv w/contrast

0334 74178 Ct abd & pelv 1/> regns

0336 Magnetic Resonance Imaging and Magnetic Resonance Angiography without

Contrast S 4.8381 $338.74 $133.48 $67.75

0336 70336 Magnetic image jaw joint

0336 70540 Mri orbit/face/neck w/o dye

0336 70544 Mr angiography head w/o dye

0336 70547 Mr angiography neck w/o dye

0336 70551 Mri brain w/o dye

0336 70554 Fmri brain by tech

0336 70555 Fmri brain by phys/psych

0336 70557 Mri brain w/o dye

0336 71550 Mri chest w/o dye

0336 72141 Mri neck spine w/o dye

0336 72146 Mri chest spine w/o dye

0336 72148 Mri lumbar spine w/o dye

0336 72195 Mri pelvis w/o dye

0336 73218 Mri upper extremity w/o dye

0336 73221 Mri joint upr extrem w/o dye

0336 73718 Mri lower extremity w/o dye

0336 73721 Mri jnt of lwr extre w/o dye

0336 74181 Mri abdomen w/o dye

0336 75557 Cardiac mri for morph

0336 75559 Cardiac mri w/stress img

0336 76498 Mri procedure

0336 77084 Magnetic image bone marrow

0336 C8901 "MRA w/o cont, abd"

0336 C8904 "MRI w/o cont, breast, uni"

0336 C8907 "MRI w/o cont, breast, bi"

0336 C8910 "MRA w/o cont, chest"

0336 C8913 "MRA w/o cont, lwr ext"

0336 C8919 "MRA w/o cont, pelvis"

0336 C8932 "MRA, w/o dye, spinal canal"

0336 C8935 "MRA, w/o dye, upper extr"

0337 Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast

f S 7.6347 $534.55 $197.64 $106.91

0337 70543 Mri orbt/fac/nck w/o & w/dye

0337 70546 Mr angiograph head w/o&w/dye

0337 70549 Mr angiograph neck w/o&w/dye

0337 70553 Mri brain w/o & w/dye

0337 70559 Mri brain w/o & w/dye

0337 71552 Mri chest w/o & w/dye

0337 72156 Mri neck spine w/o & w/dye

0337 72157 Mri chest spine w/o & w/dye

0337 72158 Mri lumbar spine w/o & w/dye

0337 72197 Mri pelvis w/o & w/dye

0337 73220 Mri uppr extremity w/o&w/dye

0337 73223 Mri joint upr extr w/o&w/dye

0337 73720 Mri lwr extremity w/o&w/dye

0337 73723 Mri joint lwr extr w/o&w/dye0337 74183 Mri abdomen w/o & w/dye

0337 75561 Cardiac mri for morph w/dye

0337 75563 Card mri w/stress img & dye

0337 C8902 "MRA w/o fol w/cont, abd"

0337 C8905 "MRI w/o fol w/cont, brst, un"

0337 C8908 "MRI w/o fol w/cont, breast,"

0337 C8911 "MRA w/o fol w/cont, chest"

0337 C8914 "MRA w/o fol w/cont, lwr ext"

0337 C8920 "MRA w/o fol w/cont, pelvis"

0337 C8933 "MRA, w/o&w/dye, spinal canal"

0337 C8936 "MRA, w/o&w/dye, upper extr"

0340 Minor Ancillary Procedures X 0.6499 $45.50

. $9.10

0340 0126T Chd risk imt study

0340 0206T Remote algorithm analys ecg

0340 0226T Anoscopy hra w/spec collect

0340 0232T Njx platelet plasma

0340 0299T Esw wound healing init wound

0340 0300T Esw wound healing addl wound

0340 11980 Implant hormone pellet(s)

0340 11981 Insert drug implant device

0340 11982 Remove drug implant device

0340 11983 Remove/insert drug implant

0340 15852 Dressing change not for burn

0340 15860 Test for blood flow in graft

0340 19295 Place breast clip percut

0340 20665 Removal of fixation device

0340 20979 Us bone stimulation

0340 30300 Remove nasal foreign body

0340 40804 Removal foreign body mouth

0340 42809 Remove pharynx foreign body

0340 43753 Tx gastro intub w/asp

0340 43754 Dx gastr intub w/asp spec

0340 46600 Diagnostic anoscopy

0340 51701 Insert bladder catheter

0340 51702 Insert temp bladder cath

0340 51736 Urine flow measurement

0340 51798 Us urine capacity measure

0340 69200 Clear outer ear canal

0340 69210 Remove impacted ear wax

0340 75571 Ct hrt w/o dye w/ca test

0340 76977 Us bone density measure $0.00 $0.00

0340 94644 Cbt 1st hour

0340 94645 Cbt each addl hour

0340 94780 Car seat/bed test 60 min

0340 94781 Car seat/bed test + 30 min

0340 G0293 "Non-cov surg proc,clin trial"

0340 G0294 "Non-cov proc, clinical trial"

0340 G0364 Bone marrow aspirate &biopsy

0341 Skin Tests X 0.0806 $5.64 $2.09 $1.13

0341 0106T Touch quant sensory test

0341 0107T Vibrate quant sensory test

0341 0108T Cool quant sensory test

0341 0109T Heat quant sensory test

0341 0110T Nos quant sensory test

0341 86485 Skin test candida

0341 86486 Skin test nos antigen

0341 86490 Coccidioidomycosis skin test

0341 86510 Histoplasmosis skin test

0341 86580 TB intradermal test

0342 Level I Pathology X 0.1601 $11.21

. $2.25

0342 0279T Ctc test

0342 0280T Ctc test w/i & r

0342 80500 Lab pathology consultation

0342 80502 Lab pathology consultation

0342 86077 Physician blood bank service

0342 86079 Physician blood bank service0342 88177 Cytp fna eval ea addl

0342 88187 Flowcytometry/read 2-8

0342 88199 Cytopathology procedure

0342 88299 Cytogenetic study

0342 88300 Surgical path gross

0342 88311 Decalcify tissue

0342 88332 Path consult intraop addl

0342 88363 Xm archive tissue molec anal

0342 88399 Surgical pathology procedure

0342 89049 Chct for mal hyperthermia

0342 89240 Pathology lab procedure

0342 89398 Unlisted reprod med lab proc

0343 Level III Pathology X 0.5259 $36.82 $10.84 $7.37

0343 85097 Bone marrow interpretation

0343 86078 Physician blood bank service

0343 88112 Cytopath cell enhance tech

0343 88162 Cytopath smear other source

0343 88173 Cytopath eval fna report

0343 88182 Cell marker study

0343 88188 Flowcytometry/read 9-15

0343 88189 Flowcytometry/read 16 & >

0343 88304 Tissue exam by pathologist

0343 88305 Tissue exam by pathologist

0343 88323 Microslide consultation

0343 88331 Path consult intraop 1 bloc

0343 88342 Immunohistochemistry

0343 88346 Immunofluorescent study

0343 88347 Immunofluorescent study

0343 88355 Analysis skeletal muscle

0343 88358 Analysis tumor

0343 88360 Tumor immunohistochem/manual

0343 88367 Insitu hybridization auto

0343 88385 Eval molecul probes 51-250

0343 89230 Collect sweat for test

0343 89257 Sperm identification

0343 89260 Sperm isolation simple

0343 89261 Sperm isolation complex

0344 Level IV Pathology X 0.8180 $57.27 $15.56 $11.46

0344 0058T Cryopreservation ovary tiss

0344 0059T Cryopreservation oocyte

0344 88120 Cytp urne 3-5 probes ea spec

0344 88121 Cytp urine 3-5 probes cmptr

0344 88307 Tissue exam by pathologist

0344 88309 Tissue exam by pathologist

0344 88325 Comprehensive review of data

0344 88356 Analysis nerve

0344 88361 Tumor immunohistochem/comput

0344 88362 Nerve teasing preparations

0344 88365 Insitu hybridization (fish)

0344 88368 Insitu hybridization manual

0344 88386 Eval molecul probes 251-500

0344 89250 Cultr oocyte/embryo <4 days

0344 89251 Cultr oocyte/embryo <4 days

0344 89253 Embryo hatching

0344 89254 Oocyte identification

0344 89255 Prepare embryo for transfer

0344 89258 Cryopreservation embryo(s)

0344 89264 Identify sperm tissue

0344 89268 Insemination of oocytes

0344 89272 Extended culture of oocytes

0344 89280 Assist oocyte fertilization

0344 89281 Assist oocyte fertilization

0344 89290 Biopsy oocyte polar body

0344 89291 Biopsy oocyte polar body

0344 89335 Cryopreserve testicular tiss

0344 89342 Storage/year embryo(s)0344 89343 Storage/year sperm/semen

0344 89344 Storage/year reprod tissue

0344 89346 Storage/year oocyte(s)

0344 89352 Thawing cryopresrved embryo

0344 89353 Thawing cryopresrved sperm

0344 89354 Thaw cryoprsvrd reprod tiss

0344 89356 Thawing cryopresrved oocyte

0345 Level I Transfusion Laboratory Procedures X 0.2135 $14.95

. $2.99

0345 86850 RBC antibody screen

0345 86891 Autologous blood op salvage

0345 86902 Blood type antigen donor ea

0345 86904 Blood typing patient serum

0345 86905 Blood typing rbc antigens

0345 86906 Blood typing rh phenotype

0345 86920 Compatibility test spin

0345 86921 Compatibility test incubate

0345 86923 Compatibility test electric

0345 86927 Plasma fresh frozen

0345 86945 Blood product/irradiation

0345 86950 Leukacyte transfusion

0345 86960 Vol reduction of blood/prod

0345 86970 RBC pretreatment

0345 86971 RBC pretreatment

0345 86972 RBC pretreatment

0345 86976 Rbc pretreatment serum

0345 86985 Split blood or products

0345 86999 Transfusion procedure

0346 Level II Transfusion Laboratory Procedures X 0.3538 $24.77

. $4.96

0346 86860 RBC antibody elution

0346 86870 RBC antibody identification

0346 86922 Compatibility test antiglob

0346 86965 Pooling blood platelets

0346 86975 Rbc pretreatment serum

0346 86978 Rbc pretreatment serum

0347 Level III Transfusion Laboratory Procedures X 0.6730 $47.12

. $9.43

0347 86890 Autologous blood process

0347 86930 Frozen blood prep

0347 86931 Frozen blood thaw

0347 86932 Frozen blood freeze/thaw

0347 86977 Rbc pretreatment serum

0350 Administration of flu and PPV vaccine S 0.3545 $24.82 $0.00 $0.00

0350 G0008 Admin influenza virus vac $0.00 $0.00

0350 G0009 Admin pneumococcal vaccine $0.00 $0.00

0350 G9141 "Influenza A H1N1,admin w cou" $0.00 $0.00

0360 Level I Alimentary Tests X 1.7152 $120.09 $33.87 $24.02

0360 91037 Esoph imped function test

0360 91040 Esoph balloon distension tst

0360 91065 Breath hydrogen test

0360 91132 Electrogastrography

0360 91133 Electrogastrography w/test

0360 91299 Gastroenterology procedure

0361 Level II Alimentary Tests X 4.0827 $285.85 $83.23 $57.17

0361 0240T Esoph motility 3d topography

0361 0241T Esoph motility w/stim/perf

0361 0242T Gi tract transit & pres meas

0361 91010 Esophagus motility study

0361 91013 Esophgl motil w/stim/perfus

0361 91020 Gastric motility studies

0361 91022 Duodenal motility study

0361 91030 Acid perfusion of esophagus

0361 91034 Gastroesophageal reflux test

0361 91035 G-esoph reflx tst w/electrod

0361 91038 Esoph imped funct test > 1h

0361 95075 Ingestion challenge test

0363 Level I Otorhinolaryngologic Function Tests X 0.9638 $67.48 $17.10 $13.50

0363 92512 Nasal function studies0363 92516 Facial nerve function test

0363 92541 Spontaneous nystagmus test

0363 92542 Positional nystagmus test

0363 92544 Optokinetic nystagmus test

0363 92545 Oscillating tracking test

0363 92587 Evoked auditory test limited

0363 92588 Evoked auditory tst complete

0364 Level I Audiometry X 0.4911 $34.38 $7.06 $6.88

0364 92550 Tympanometry & reflex thresh

0364 92552 Pure tone audiometry air

0364 92555 Speech threshold audiometry

0364 92556 Speech audiometry complete

0364 92562 Loudness balance test

0364 92563 Tone decay hearing test

0364 92564 Sisi hearing test

0364 92565 Stenger test pure tone

0364 92567 Tympanometry

0364 92568 Acoustic refl threshold tst

0364 92571 Filtered speech hearing test

0364 92575 Sensorineural acuity test

0364 92576 Synthetic sentence test

0364 92583 Select picture audiometry

0364 92596 Ear protector evaluation

0364 92700 Ent procedure/service

0365 Level II Audiometry X 1.2175 $85.24 $18.05 $17.05

0365 0212T Compre audiometry evaluation

0365 92553 Audiometry air & bone

0365 92557 Comprehensive hearing test

0365 92561 Bekesy audiometry diagnosis

0365 92570 Acoustic immitance testing

0365 92579 Visual audiometry (vra)

0365 92582 Conditioning play audiometry

0365 92620 Auditory function 60 min

0365 92625 Tinnitus assessment

0365 92640 Aud brainstem implt programg

0366 Level III Audiometry X 1.6864 $118.07 $23.65 $23.62

0366 92572 Staggered spondaic word test

0366 92577 Stenger test speech

0366 92601 Cochlear implt f/up exam < 7

0366 92602 Reprogram cochlear implt < 7

0366 92603 Cochlear implt f/up exam 7 >

0366 92604 Reprogram cochlear implt 7 >

0366 92626 Eval aud rehab status

0367 Level I Pulmonary Test X 0.7420 $51.95 $13.76 $10.39

0367 93740 Temperature gradient studies

0367 94010 Breathing capacity test

0367 94011 Spirometry up to 2 yrs old

0367 94012 Spirmtry w/brnchdil inf-2 yr

0367 94014 Patient recorded spirometry

0367 94015 Patient recorded spirometry

0367 94150 Vital capacity test

0367 94200 Lung function test (MBC/MVV)

0367 94250 Expired gas collection

0367 94375 Respiratory flow volume loop

0367 94400 CO2 breathing response curve

0367 94453 Hast w/oxygen titrate

0367 94690 Exhaled air analysis

0367 94726 Pulm funct tst plethysmograp

0367 94727 Pulm function test by gas

0367 94728 Pulm funct test oscillometry

0367 94750 Pulmonary compliance study

0367 94799 Pulmonary service/procedure

0367 95012 Exhaled nitric oxide meas

0368 Level II Pulmonary Tests X 0.8906 $62.36 $20.93 $12.48

0368 94450 Hypoxia response curve

0368 94452 Hast w/report0368 94620 Pulmonary stress test/simple

0368 94680 Exhaled air analysis o2

0368 94729 C02/membane diffuse capacity

0368 94770 Exhaled carbon dioxide test

0368 95071 Bronchial allergy tests

0369 Level III Pulmonary Tests X 2.6868 $188.12 $38.23 $37.63

0369 0244T Cont msr bronchodil wheeze

0369 94013 Meas lung vol thru 2 yrs

0369 94070 Evaluation of wheezing

0369 94621 Pulm stress test/complex

0369 94681 Exhaled air analysis o2/co2

0369 94772 Breath recording infant

0369 95070 Bronchial allergy tests

0370 Multiple Allergy Tests X 1.1369 $79.60

. $15.92

0370 95056 Photosensitivity tests

0370 95060 Eye allergy tests

0370 95180 Rapid desensitization

0373 Level I Neuropsychological Testing X 1.3842 $96.92

. $19.39

0373 96102 Psycho testing by technician

0373 96103 Psycho testing admin by comp

0373 96111 Developmental test extend

0377 Level II Cardiac Imaging S 9.6018 $672.28

. $134.46

0377 78451 Ht muscle image spect sing

0377 78452 Ht muscle image spect mult

0377 78453 Ht muscle image planar sing

0377 78454 Ht musc image planar mult

0378 Level II Pulmonary Imaging S 4.5192 $316.42 $126.56 $63.29

0378 78582 Lung ventilat&perfus imaging

0378 78598 Lung perf&ventilat diferentl

0381 Single Allergy Tests X 0.4426 $30.99

. $6.20

0381 95004 Percut allergy skin tests

0381 95010 Percut allergy titrate test

0381 95015 Id allergy titrate-drug/bug

0381 95024 Id allergy test drug/bug

0381 95027 Id allergy titrate-airborne

0381 95028 Id allergy test-delayed type

0381 95044 Allergy patch tests

0381 95052 Photo patch test

0381 95065 Nose allergy test

0381 95199 Allergy immunology services

0382 Level II Neuropsychological Testing X 2.5717 $180.06

. $36.02

0382 96101 Psycho testing by psych/phys

0382 96116 Neurobehavioral status exam

0382 96118 Neuropsych tst by psych/phys

0382 96119 Neuropsych testing by tec

0382 96120 Neuropsych tst admin w/comp

0383 Cardiac Computed Tomographic Imaging S 3.7417 $261.98

. $52.40

0383 75572 Ct hrt w/3d image

0383 75573 Ct hrt w/3d image congen

0383 75574 Ct angio hrt w/3d image

0384 GI Procedures with Stents T 29.2172 "$2,045.67"

. $409.14

0384 43219 Esophagus endoscopy

0384 43256 Uppr gi endoscopy w/stent

0384 43268 Endo cholangiopancreatograph

0384 43269 Endo cholangiopancreatograph

0384 44370 Small bowel endoscopy/stent

0384 44379 S bowel endoscope w/stent

0384 44383 Ileoscopy w/stent

0384 44397 Colonoscopy w/stent

0384 45327 Proctosigmoidoscopy w/stent

0384 45345 Sigmoidoscopy w/stent

0384 45387 Colonoscopy w/stent

0385 Level I Prosthetic Urological Procedures S 104.8530 "$7,341.39"

. "$1,468.28"

0385 53440 Male sling procedure

0385 53444 Insert tandem cuff

0385 54400 Insert semi-rigid prosthesis0386 Level II Prosthetic Urological Procedures S 169.3017 "$11,853.83"

. "$2,370.77"

0386 53445 Insert uro/ves nck sphincter

0386 53447 Remove/replace ur sphincter

0386 54401 Insert self-contd prosthesis

0386 54405 Insert multi-comp penis pros

0386 54410 Remove/replace penis prosth

0386 54416 Remv/repl penis contain pros

0387 Level II Hysteroscopy T 38.3457 "$2,684.81" $655.55 $536.97

0387 58560 Hysteroscopy resect septum

0387 58561 Hysteroscopy remove myoma

0387 58563 Hysteroscopy ablation

0388 Discography S 22.7689 "$1,594.19"

. $318.84

0388 72285 X-ray c/t spine disk

0388 72295 X-ray of lower spine disk

0389 Level I Non-imaging Nuclear Medicine S 1.5569 $109.01 $26.88 $21.81

0389 78000 Thyroid single uptake

0389 78001 Thyroid multiple uptakes

0389 78003 Thyroid suppress/stimul

0389 78730 Urinary bladder retention

0389 78999 Nuclear diagnostic exam

0390 Level I Endocrine Imaging S 1.8944 $132.64 $47.64 $26.53

0390 78010 Thyroid imaging

0390 78011 Thyroid imaging with flow

0390 78099 Endocrine nuclear procedure

0391 Level II Endocrine Imaging S 3.1610 $221.32 $65.46 $44.27

0391 78006 Thyroid imaging with uptake

0391 78007 Thyroid image mult uptakes

0391 78070 Parathyroid nuclear imaging

0392 Level II Non-imaging Nuclear Medicine S 2.2892 $160.28 $39.07 $32.06

0392 38792 Ra tracer id of sentinl node

0392 78190 Platelet survival kinetics

0392 78191 Platelet survival

0392 78270 Vit B-12 absorption exam

0392 78271 Vit b-12 absrp exam int fac

0392 78272 Vit b-12 absorp combined

0392 78725 Kidney function study

0392 78808 Iv inj ra drug dx study

0393 Hematologic Processing & Studies S 6.9196 $484.48

. $96.90

0393 38210 T-cell depletion of harvest

0393 38211 Tumor cell deplete of harvst

0393 38212 Rbc depletion of harvest

0393 38213 Platelet deplete of harvest

0393 38214 Volume deplete of harvest

0393 38215 Harvest stem cell concentrte

0393 78110 Plasma volume single

0393 78111 Plasma volume multiple

0393 78120 Red cell mass single

0393 78121 Red cell mass multiple

0393 78122 Blood volume

0393 78130 Red cell survival study

0393 78135 Red cell survival kinetics

0393 78140 Red cell sequestration

0394 Hepatobiliary Imaging S 4.1909 $293.43 $90.78 $58.69

0394 78201 Liver imaging

0394 78202 Liver imaging with flow

0394 78205 Liver imaging (3D)

0394 78206 Liver image (3d) with flow

0394 78215 Liver and spleen imaging

0394 78216 Liver & spleen image/flow

0394 78226 Hepatobiliary system imaging

0394 78227 Hepatobil syst image w/drug

0395 GI Tract Imaging S 3.4841 $243.94 $87.01 $48.79

0395 78230 Salivary gland imaging

0395 78231 Serial salivary imaging

0395 78232 Salivary gland function exam

0395 78258 Esophageal motility study0395 78261 Gastric mucosa imaging

0395 78262 Gastroesophageal reflux exam

0395 78264 Gastric emptying study

0395 78278 Acute GI blood loss imaging

0395 78282 GI protein loss exam

0395 78290 Meckels divert exam

0395 78291 Leveen/shunt patency exam

0395 78299 GI nuclear procedure

0396 Bone Imaging S 3.5304 $247.18 $94.20 $49.44

0396 78300 Bone imaging limited area

0396 78305 Bone imaging multiple areas

0396 78306 Bone imaging whole body

0396 78315 Bone imaging 3 phase

0396 78320 Bone imaging (3D)

0396 78399 Musculoskeletal nuclear exam

0397 Vascular Imaging S 2.0980 $146.89 $33.94 $29.38

0397 78445 Vascular flow imaging

0397 78456 Acute venous thrombus image

0397 78457 Venous thrombosis imaging

0397 78458 Ven thrombosis images bilat

0398 Level I Cardiac Imaging S 4.2548 $297.90 $93.33 $59.58

0398 78414 Non-imaging heart function

0398 78428 Cardiac shunt imaging

0398 78466 Heart infarct image

0398 78468 Heart infarct image (ef)

0398 78469 Heart infarct image (3D)

0398 78472 Gated heart planar single

0398 78473 Gated heart multiple

0398 78481 Heart first pass single

0398 78483 Heart first pass multiple

0398 78494 Heart image spect

0398 78499 Cardiovascular nuclear exam

0400 Hematopoietic Imaging S 3.6580 $256.12 $90.92 $51.23

0400 78102 Bone marrow imaging ltd

0400 78103 Bone marrow imaging mult

0400 78104 Bone marrow imaging body

0400 78185 Spleen imaging

0400 78195 Lymph system imaging

0400 78199 Blood/lymph nuclear exam

0401 Level I Pulmonary Imaging S 2.8915 $202.45 $71.16 $40.49

0401 78579 Lung ventilation imaging

0401 78580 Lung perfusion imaging

0401 78597 Lung perfusion differential

0401 78599 Respiratory nuclear exam

0402 Level II Nervous System Imaging S 8.6793 $607.69

. $121.54

0402 78601 Brain image w/flow < 4 views

0402 78606 Brain image w/flow 4 + views

0402 78607 Brain imaging (3D)

0402 78630 Cerebrospinal fluid scan

0402 78635 CSF ventriculography

0402 78647 Cerebrospinal fluid scan

0402 78650 CSF leakage imaging

0403 Level I Nervous System Imaging S 3.4408 $240.91 $72.42 $48.19

0403 78600 Brain image < 4 views

0403 78605 Brain image 4+ views

0403 78610 Brain flow imaging only

0403 78645 CSF shunt evaluation

0403 78660 Nuclear exam of tear flow

0403 78699 Nervous system nuclear exam

0404 Renal and Genitourinary Studies S 4.5536 $318.82 $81.52 $63.77

0404 78700 Kidney imaging morphol

0404 78701 Kidney imaging with flow

0404 78707 K flow/funct image w/o drug

0404 78708 K flow/funct image w/drug

0404 78709 K flow/funct image multiple

0404 78710 Kidney imaging (3D)0404 78740 Ureteral reflux study

0404 78761 Testicular imaging w/flow

0404 78799 Genitourinary nuclear exam

0406 Level I Tumor/Infection Imaging S 4.0053 $280.44 $85.08 $56.09

0406 78015 Thyroid met imaging

0406 78016 Thyroid met imaging/studies

0406 78018 Thyroid met imaging body

0406 78800 Tumor imaging limited area

0407 Level I Radionuclide Therapy S 3.2941 $230.64 $78.13 $46.13

0407 79005 Nuclear rx oral admin

0407 79101 Nuclear rx iv admin

0407 79300 Nuclr rx interstit colloid

0407 79445 Nuclear rx intra-arterial

0407 79999 Nuclear medicine therapy

0408 Level III Tumor/Infection Imaging S 13.6750 $957.47

. $191.50

0408 78075 Adrenal nuclear imaging

0408 78804 Tumor imaging whole body

0409 Red Blood Cell Tests X 0.1101 $7.71 $2.17 $1.55

0409 86880 Coombs test direct

0409 86885 Coombs test indirect qual

0409 86886 Coombs test indirect titer

0409 86900 Blood typing abo

0409 86901 Blood typing rh (d)

0412 IMRT Treatment Delivery S 6.5452 $458.27

. $91.66

0412 0073T Delivery comp imrt

0412 77418 Radiation tx delivery imrt

0413 Level II Radionuclide Therapy S 4.0373 $282.68

. $56.54

0413 79200 Nuclear rx intracav admin

0413 79403 Hematopoietic nuclear tx

0413 79440 Nuclear rx intra-articular

0414 Level II Tumor/Infection Imaging S 7.0664 $494.76

. $98.96

0414 78801 Tumor imaging mult areas

0414 78802 Tumor imaging whole body

0414 78803 Tumor imaging (3D)

0414 78805 Abscess imaging ltd area

0414 78806 Abscess imaging whole body

0414 78807 Nuclear localization/abscess

0415 Level II Endoscopy Lower Airway T 28.9051 "$2,023.82" $459.92 $404.77

0415 0250T Insert bronchial valve

0415 0276T Bronch thermoplasty 1 lobe

0415 0277T Bronch thermoplasty lobes

0415 31626 Bronchoscopy w/markers

0415 31630 Bronchoscopy dilate/fx repr

0415 31631 Bronchoscopy dilate w/stent

0415 31636 Bronchoscopy bronch stents

0415 31638 Bronchoscopy revise stent

0415 31640 Bronchoscopy w/tumor excise

0415 31641 Bronchoscopy treat blockage

0419 Level II Upper GI Procedures T 12.6671 $886.90 $207.88 $177.38

0419 43201 Esoph scope w/submucous inj

0419 43205 Esophagus endoscopy/ligation

0419 43215 Esophagus endoscopy

0419 43217 Esophagus endoscopy

0419 43220 Esoph endoscopy dilation

0419 43226 Esoph endoscopy dilation

0419 43227 Esoph endoscopy repair

0419 43231 Esoph endoscopy w/us exam

0419 43232 Esoph endoscopy w/us fn bx

0419 43237 Endoscopic us exam esoph

0419 43238 Uppr gi endoscopy w/us fn bx

0419 43240 Esoph endoscope w/drain cyst

0419 43242 Uppr gi endoscopy w/us fn bx

0419 43244 Upper GI endoscopy/ligation

0419 43245 Uppr gi scope dilate strictr

0419 43246 Place gastrostomy tube

0419 43249 Esoph endoscopy dilation0419 43250 Upper GI endoscopy/tumor

0419 43251 Operative upper GI endoscopy

0419 43255 Operative upper GI endoscopy

0419 43258 Operative upper GI endoscopy

0419 43259 Endoscopic ultrasound exam

0419 43458 Dilate esophagus

0419 44100 Biopsy of bowel

0419 49440 Place gastrostomy tube perc

0419 49441 Place duod/jej tube perc

0419 49446 Change g-tube to g-j perc

0419 91111 Esophageal capsule endoscopy

0422 Level III Upper GI Procedures T 25.9792 "$1,818.96"

. $363.80

0422 43216 Esophagus endoscopy/lesion

0422 43228 Esoph endoscopy ablation

0422 43257 Uppr gi scope w/thrml txmnt

0422 43830 Place gastrostomy tube

0422 43870 Repair stomach opening

0422 C9724 EPS gast cardia plic

0423 Level II Percutaneous Abdominal and Biliary

Procedures T 58.4890 "$4,095.17"

. $819.04

0423 32998 Perq rf ablate tx pul tumor

0423 47382 Percut ablate liver rf

0423 47556 Biliary endoscopy thru skin

0423 50592 Perc rf ablate renal tumor

0423 50593 Perc cryo ablate renal tum

0424 Level II Small Intestine Endoscopy T 15.7819 "$1,104.99" $240.64 $221.00

0424 44364 Small bowel endoscopy

0424 44365 Small bowel endoscopy

0424 44366 Small bowel endoscopy

0424 44369 Small bowel endoscopy

0424 44372 Small bowel endoscopy

0424 44373 Small bowel endoscopy

0424 44378 Small bowel endoscopy

0425 Level II Arthroplasty or Implantation with

Prosthesis T 132.5319 "$9,279.35"

. "$1,855.87"

0425 23470 Reconstruct shoulder joint

0425 24361 Reconstruct elbow joint

0425 24363 Replace elbow joint

0425 24366 Reconstruct head of radius

0425 25441 Reconstruct wrist joint

0425 25442 Reconstruct wrist joint

0425 25446 Wrist replacement

0425 27446 Revision of knee joint

0425 69714 Implant temple bone w/stimul

0425 69715 Temple bne implnt w/stimulat

0425 69717 Temple bone implant revision

0425 69718 Revise temple bone implant

0426 Level II Strapping and Cast Application S 2.5699 $179.93

. $35.99

0426 29010 Application of body cast

0426 29015 Application of body cast

0426 29035 Application of body cast

0426 29044 Application of body cast

0426 29046 Application of body cast

0426 29055 Application of shoulder cast

0426 29065 Application of long arm cast

0426 29075 Application of forearm cast

0426 29305 Application of hip cast

0426 29325 Application of hip casts

0426 29345 Application of long leg cast

0426 29355 Application of long leg cast

0426 29358 Apply long leg cast brace

0426 29365 Application of long leg cast

0426 29405 Apply short leg cast

0426 29425 Apply short leg cast

0426 29435 Apply short leg cast

0426 29445 Apply rigid leg cast0426 29710 Removal/revision of cast

0427 Level II Tube or Catheter Changes or Repositioning T 16.2412 "$1,137.14"

. $227.43

0427 47525 Change bile duct catheter

0427 47530 Revise/reinsert bile tube

0427 49423 Exchange drainage catheter

0427 49435 Insert subq exten to ip cath

0427 49436 Embedded ip cath exit-site

0427 50387 Change ext/int ureter stent

0427 50398 Change kidney tube

0427 50688 Change of ureter tube/stent

0427 62225 Replace/irrigate catheter

0428 Level III Sigmoidoscopy and Anoscopy T 23.9777 "$1,678.82"

. $335.77

0428 45307 Proctosigmoidoscopy fb

0428 45320 Proctosigmoidoscopy ablate

0428 45321 Proctosigmoidoscopy volvul

0428 46610 Anoscopy remove lesion

0428 46612 Anoscopy remove lesions

0428 46615 Anoscopy

0429 Level V Cystourethroscopy and other Genitourinary

Procedures T 45.7676 "$3,204.46"

. $640.90

0429 50080 Removal of kidney stone

0429 50081 Removal of kidney stone

0429 52647 Laser surgery of prostate

0429 52648 Laser surgery of prostate

0429 52649 Prostate laser enucleation

0429 53850 Prostatic microwave thermotx

0429 53852 Prostatic rf thermotx

0432 Health and Behavior Services S 0.5154 $36.09

. $7.22

0432 96150 Assess hlth/behave init

0432 96151 Assess hlth/behave subseq

0432 96152 Intervene hlth/behave indiv

0432 96153 Intervene hlth/behave group

0432 96154 Interv hlth/behav fam w/pt

0432 G0396 Alcohol/subs interv 15-30mn

0432 G0451 Devlopment test interpt&rep

0433 Level II Pathology X 0.2434 $17.04 $5.06 $3.41

0433 88104 Cytopath fl nongyn smears

0433 88106 Cytopath fl nongyn filter

0433 88108 Cytopath concentrate tech

0433 88125 Forensic cytopathology

0433 88160 Cytopath smear other source

0433 88161 Cytopath smear other source

0433 88172 Cytp dx eval fna 1st ea site

0433 88184 Flowcytometry/ tc 1 marker

0433 88185 Flowcytometry/tc add-on

0433 88302 Tissue exam by pathologist

0433 88312 Special stains group 1

0433 88313 Special stains group 2

0433 88314 Histochemical stains add-on

0433 88319 Enzyme histochemistry

0433 88321 Microslide consultation

0433 88329 Path consult introp

0433 88333 Intraop cyto path consult 1

0433 88334 Intraop cyto path consult 2

0433 88384 Eval molecular probes 11-50

0433 89220 Sputum specimen collection

0433 89259 Cryopreservation sperm

0434 Cardiac Defect Repair T 171.3141 "$11,994.73"

. "$2,398.95"

0434 93580 Transcath closure of asd

0434 93581 Transcath closure of vsd

0436 Level I Drug Administration S 0.3545 $24.82

. $4.97

0436 90472 Immunization admin each add

0436 90473 Immune admin oral/nasal

0436 90474 Immune admin oral/nasal addl

0436 95115 Immunotherapy one injection

0436 95117 Immunotherapy injections0436 95165 Antigen therapy services

0436 96361 Hydrate iv infusion add-on

0436 96379 Ther/prop/diag inj/inf proc

0436 96549 Chemotherapy unspecified

0437 Level II Drug Administration S 0.4972 $34.81

. $6.97

0437 90471 Immunization admin

0437 95144 Antigen therapy services

0437 95145 Antigen therapy services

0437 95148 Antigen therapy services

0437 95149 Antigen therapy services

0437 95170 Antigen therapy services

0437 96366 Ther/proph/diag iv inf addon

0437 96367 Tx/proph/dg addl seq iv inf

0437 96370 Sc ther infusion addl hr

0437 96371 Sc ther infusion reset pump

0437 96372 Ther/proph/diag inj sc/im

0437 96373 Ther/proph/diag inj ia

0437 96374 Ther/proph/diag inj iv push

0437 96375 Tx/pro/dx inj new drug addon

0437 96401 Chemo anti-neopl sq/im

0437 96402 Chemo hormon antineopl sq/im

0437 96405 Chemo intralesional up to 7

0437 96415 Chemo iv infusion addl hr

0437 G0010 Admin hepatitis b vaccine $0.00 $0.00

0438 Level III Drug Administration S 1.0388 $72.73

. $14.55

0438 95146 Antigen therapy services

0438 95147 Antigen therapy services

0438 96360 Hydration iv infusion init

0438 96411 Chemo iv push addl drug

0438 96417 Chemo iv infus each addl seq

0438 96420 Chemo ia push tecnique

0438 96423 Chemo ia infuse each addl hr

0438 96542 Chemotherapy injection

0439 Level IV Drug Administration S 1.8098 $126.71

. $25.35

0439 95990 Spin/brain pump refil & main

0439 95991 Spin/brain pump refil & main

0439 96365 Ther/proph/diag iv inf init

0439 96369 Sc ther infusion up to 1 hr

0439 96406 Chemo intralesional over 7

0439 96409 Chemo iv push sngl drug

0439 96440 Chemotherapy intracavitary

0439 96446 Chemotx admn prtl cavity

0439 96521 Refill/maint portable pump

0439 96522 Refill/maint pump/resvr syst

0440 Level V Drug Administration S 2.9679 $207.80

. $41.56

0440 96413 Chemo iv infusion 1 hr

0440 96416 Chemo prolong infuse w/pump

0440 96422 Chemo ia infusion up to 1 hr

0440 96425 Chemotherapy infusion method

0440 96450 Chemotherapy into cns

0440 C8957 "Prolonged IV inf, req pump"

0442 Dosimetric Drug Administration S 21.9850 "$1,539.30"

. $307.86

0442 G3001 "Admin + supply, tositumomab"

0604 Level 1 Hospital Clinic Visits V 0.7689 $53.84

. $10.77

0604 99201 Office/outpatient visit new

0604 99211 Office/outpatient visit est

0604 G0101 CA screen;pelvic/breast exam $0.00 $0.00

0604 G0245 Initial foot exam pt lops

0604 G0379 Direct refer hospital observ

0605 Level 2 Hospital Clinic Visits V 1.0311 $72.19

. $14.44

0605 90862 Medication management

0605 92012 Eye exam established pat

0605 92014 Eye exam & treatment

0605 99202 Office/outpatient visit new

0605 99212 Office/outpatient visit est

0605 99213 Office/outpatient visit est0605 99460 Init nb em per day hosp

0605 99463 Same day nb discharge

0605 G0246 Followup eval of foot pt lop

0606 Level 3 Hospital Clinic Visits V 1.3588 $95.14

. $19.03

0606 92002 Eye exam new patient

0606 92004 Eye exam new patient

0606 99203 Office/outpatient visit new

0606 99214 Office/outpatient visit est

0606 G0402 Initial preventive exam $0.00 $0.00

0607 Level 4 Hospital Clinic Visits V 1.8647 $130.56

. $26.12

0607 95250 Glucose monitoring cont

0607 99204 Office/outpatient visit new

0607 99215 Office/outpatient visit est

0607 G0175 "OPPS Service,sched team conf"

0607 G0248 Demonstrate use home inr mon

0607 G0249 Provide INR test mater/equip

0607 M0064 Visit for drug monitoring

0608 Level 5 Hospital Clinic Visits V 2.5237 $176.70

. $35.34

0608 90945 Dialysis one evaluation

0608 99205 Office/outpatient visit new

0609 Level 1 Type A Emergency Visits V 0.7181 $50.28 $12.04 $10.06

0609 99281 Emergency dept visit

0613 Level 2 Type A Emergency Visits V 1.2356 $86.51 $20.79 $17.31

0613 99282 Emergency dept visit

0614 Level 3 Type A Emergency Visits V 1.9447 $136.16 $33.59 $27.24

0614 99283 Emergency dept visit

0615 Level 4 Type A Emergency Visits V 3.1277 $218.99 $47.70 $43.80

0615 99284 Emergency dept visit

0616 Level 5 Type A Emergency Visits V 4.6152 $323.14 $71.44 $64.63

0616 99285 Emergency dept visit

0617 Critical Care S 6.6453 $465.28 $104.95 $93.06

0617 99291 Critical care first hour

0618 Trauma Response with Critical Care S 11.2658 $788.79

. $157.76

0618 G0390 Trauma Respons w/hosp criti

0621 Level I Vascular Access Procedures T 11.0639 $774.65

. $154.93

0621 36555 Insert non-tunnel cv cath

0621 36556 Insert non-tunnel cv cath

0621 36568 Insert picc cath

0621 36569 Insert picc cath

0621 36576 Repair tunneled cv cath

0621 36580 Replace cvad cath

0621 36584 Replace picc cath

0621 36590 Removal tunneled cv cath

0621 36596 Mech remov tunneled cv cath

0621 36597 Reposition venous catheter

0622 Level II Vascular Access Procedures T 25.2672 "$1,769.11"

. $353.83

0622 36557 Insert tunneled cv cath

0622 36558 Insert tunneled cv cath

0622 36570 Insert picvad cath

0622 36571 Insert picvad cath

0622 36578 Replace tunneled cv cath

0622 36581 Replace tunneled cv cath

0622 36585 Replace picvad cath

0622 36595 Mech remov tunneled cv cath

0623 Level III Vascular Access Procedures T 30.3507 "$2,125.03"

. $425.01

0623 36260 Insertion of infusion pump

0623 36560 Insert tunneled cv cath

0623 36561 Insert tunneled cv cath

0623 36563 Insert tunneled cv cath

0623 36565 Insert tunneled cv cath

0623 36566 Insert tunneled cv cath

0623 36582 Replace tunneled cv cath

0623 36583 Replace tunneled cv cath

0623 36640 Insertion catheter artery

0623 37192 Redo endovas vena cava filtr

0623 37193 Rem endovas vena cava filter0623 37200 Transcatheter biopsy

0623 37203 Transcatheter retrieval

0623 37209 Change iv cath at thromb tx

0624 Phlebotomy and Minor Vascular Access Device Procedures X 0.6068 $42.49 $12.33 $8.50

0624 36591 Draw blood off venous device

0624 36592 Collect blood from picc

0624 37799 Vascular surgery procedure

0624 96523 Irrig drug delivery device

0624 99195 Phlebotomy

0626 Level 1 Type B Emergency Visits V 0.5627 $39.40

. $7.88

0626 G0380 Lev 1 hosp type B ED visit

0627 Level 2 Type B Emergency Visits V 0.7972 $55.82

. $11.17

0627 G0381 Lev 2 hosp type B ED visit

0628 Level 3 Type B Emergency Visits V 1.3178 $92.27

. $18.46

0628 G0382 Lev 3 hosp type B ED visit

0629 Level 4 Type B Emergency Visits V 1.9503 $136.55

. $27.31

0629 G0383 Lev 4 hosp type B ED visit

0630 Level 5 Type B Emergency Visits V 3.7639 $263.53

. $52.71

0630 G0384 Lev 5 hosp type B ED visit

0648 Level IV Breast Surgery T 62.4125 "$4,369.87"

. $873.98

0648 19296 Place po breast cath for rad

0648 19297 Place breast cath for rad

0648 19298 Place breast rad tube/caths

0648 19325 Enlarge breast with implant

0648 19342 Delayed breast prosthesis

0648 19357 Breast reconstruction

0651 Complex Interstitial Radiation Source Application S 11.9274 $835.11

. $167.03

0651 77778 Apply interstit radiat compl

0652 Insertion of Intraperitoneal and Pleural Catheters T 30.8430 "$2,159.50"

. $431.90

0652 32550 Insert pleural cath

0652 49418 Insert tun ip cath perc

0652 49421 Ins tun ip cath for dial opn

0653 Vascular Reconstruction/Fistula Repair with Device T 43.8023 "$3,066.86"

. $613.38

0653 35011 Repair defect of artery

0653 35261 Repair blood vessel lesion

0653 35266 Repair blood vessel lesion

0653 35286 Repair blood vessel lesion

0653 36870 Percut thrombect av fistula

0654 Level II Insertion/Replacement of Permanent

Pacemaker T 103.3418 "$7,235.58"

. "$1,447.12"

0654 33213 Insert pulse gen dual leads

0654 33221 Insert pulse gen mult leads

0654 33228 Remv&replc pm gen dual lead

0654 33229 Remv&replc pm gen mult leads

0655 Insertion/Replacement/Conversion of a Permanent Dual Chamber Pacemaker or

Pacing T 137.6558 "$9,638.11"

. "$1,927.63"

0655 33208 Insrt heart pm atrial & vent

0655 33214 Upgrade of pacemaker system

0655 33224 Insert pacing lead & connect

0655 33225 L ventric pacing lead add-on

0656 Transcatheter Placement of Intracoronary Drug-Eluting

Stents T 105.6644 "$7,398.20"

. "$1,479.64"

0656 G0290 "Drug-eluting stents, single"

0656 G0291 "Drug-eluting stents,each add"

0659 Hyperbaric Oxygen S 1.4941 $104.61

. $20.93

0659 C1300 HYPERBARIC Oxygen

0660 Level II Otorhinolaryngologic Function Tests X 1.8189 $127.35 $27.10 $25.47

0660 92520 Laryngeal function studies

0660 92540 Basic vestibular evaluation

0660 92543 Caloric vestibular test

0660 92546 Sinusoidal rotational test

0660 92548 Posturography

0661 Level V Pathology X 2.3496 $164.51

. $32.91

0661 88348 Electron microscopy

0661 88349 Scanning electron microscopy

0661 G0416 Sat biopsy prostate 1-20 spc0662 CT Angiography S 4.8375 $338.70 $114.37 $67.74

0662 70496 Ct angiography head

0662 70498 Ct angiography neck

0662 71275 Ct angiography chest

0662 72191 Ct angiograph pelv w/o&w/dye

0662 73206 Ct angio upr extrm w/o&w/dye

0662 73706 Ct angio lwr extr w/o&w/dye

0662 74175 Ct angio abdom w/o & w/dye

0662 75635 Ct angio abdominal arteries

0664 Level I Proton Beam Radiation Therapy S 16.9101 "$1,183.98"

. $236.80

0664 77520 Proton trmt simple w/o comp

0664 77522 Proton trmt simple w/comp

0665 Bone Density:AppendicularSkeleton S 0.4865 $34.06 $0.00 $0.00

0665 77081 Dxa bone density/peripheral $0.00 $0.00

0667 Level II Proton Beam Radiation Therapy S 22.1209 "$1,548.82"

. $309.77

0667 77523 Proton trmt intermediate

0667 77525 Proton treatment complex

0668 Level I Angiography and Venography T 9.4045 $658.47

. $131.70

0668 36147 Access av dial grft for eval

0668 75746 Artery x-rays lung

0668 75756 Artery x-rays chest

0668 75791 Av dialysis shunt imaging

0668 75820 Vein x-ray arm/leg

0668 75822 Vein x-ray arms/legs

0668 75827 Vein x-ray chest

0668 75860 Vein x-ray neck

0668 75870 Vein x-ray skull

0668 75872 Vein x-ray skull

0668 75880 Vein x-ray eye socket

0668 75887 Vein x-ray liver

0672 Level III Posterior Segment Eye Procedures T 41.0159 "$2,871.77"

. $574.36

0672 0100T Prosth retina receive&gen

0672 65285 Repair of eye wound

0672 66220 Repair eye lesion

0672 67010 Partial removal of eye fluid

0672 67015 Release of eye fluid

0672 67025 Replace eye fluid

0672 67027 Implant eye drug system

0672 67036 Removal of inner eye fluid

0672 67039 Laser treatment of retina

0672 67040 Laser treatment of retina

0672 67041 Vit for macular pucker

0672 67042 Vit for macular hole

0672 67043 Vit for membrane dissect

0672 67107 Repair detached retina

0672 67108 Repair detached retina

0672 67112 Rerepair detached retina

0672 67113 Repair retinal detach cplx

0672 67121 Remove eye implant material

0673 Level V Anterior Segment Eye Procedures T 41.5778 "$2,911.11" $634.95 $582.23

0673 0191T Insert ant segment drain int

0673 0192T Insert ant segment drain ext

0673 0253T Insert aqueous drain device

0673 66174 Translum dil eye canal

0673 66175 Trnslum dil eye canal w/stnt

0673 66180 Implant eye shunt

0673 66225 Repair/graft eye lesion

0674 Prostate Cryoablation T 113.8112 "$7,968.60"

. "$1,593.72"

0674 55873 Cryoablate prostate

0676 Thrombolysis and Other Device Revisions T 2.3021 $161.18

. $32.24

0676 36593 Declot vascular device

0676 36598 Inj w/fluor eval cv device

0676 36860 External cannula declotting

0676 37195 Thrombolytic therapy stroke

0676 43760 Change gastrostomy tube

0676 92977 Dissolve clot heart vessel0678 External Counterpulsation T 1.3360 $93.54

. $18.71

0678 G0166 "Extrnl counterpulse, per tx"

0679 Level II Resuscitation and Cardioversion S 5.3254 $372.86 $95.30 $74.58

0679 92960 Cardioversion electric ext

0679 92961 Cardioversion electric int

0680 Insertion of Patient Activated Event Recorders S 80.3579 "$5,626.34"

. "$1,125.27"

0680 33282 Implant pat-active ht record

0683 Level II Photochemotherapy S 3.0368 $212.62

. $42.53

0683 96913 Photochemotherapy uv-a or b

0685 Level III Needle Biopsy/Aspiration Except Bone Marrow T 9.6713 $677.15

. $135.43

0685 32400 Needle biopsy chest lining

0685 32405 Percut bx lung/mediastinum

0685 47000 Needle biopsy of liver

0685 48102 Needle biopsy pancreas

0685 49180 Biopsy abdominal mass

0685 50200 Renal biopsy perq

0685 50390 Drainage of kidney lesion

0685 62269 Needle biopsy spinal cord

0687 Revision/Removal of Neurostimulator

Electrodes T 20.7198 "$1,450.72" $385.30 $290.15

0687 0267T Implt/rpl crtd sns dev lead

0687 0270T Rev/remvl crtd sns dev lead

0687 0284T Periph field stimul revise

0687 61880 Revise/remove neuroelectrode

0687 63661 Remove spine eltrd perq aray

0687 63662 Remove spine eltrd plate

0687 64569 Revise/repl vagus n eltrd

0687 64585 Revise/remove neuroelectrode

0688 Revision/Removal of Neurostimulator Pulse Generator

Receiver T 31.1002 "$2,177.51" $768.94 $435.51

0688 0271T Rev/remvl crtd sns dev gen

0688 61888 Revise/remove neuroreceiver

0688 63688 Revise/remove neuroreceiver

0688 64595 Revise/rmv pn/gastr stimul

0690 Level I Electronic Analysis of Devices S 0.4928 $34.50

. $6.90

0690 0224T Acoustic ecg 1+ analysis

0690 0225T Acoustic ecg analy & reprog

0690 93279 Pm device progr eval sngl

0690 93280 Pm device progr eval dual

0690 93281 Pm device progr eval multi

0690 93282 Icd device prog eval 1 sngl

0690 93283 Icd device progr eval dual

0690 93284 Icd device progr eval mult

0690 93285 Ilr device eval progr

0690 93288 Pm device eval in person

0690 93289 Icd device interrogate

0690 93291 Ilr device interrogate

0690 93292 Wcd device interrogate

0690 93293 Pm phone r-strip device eval

0690 93296 Pm/icd remote tech serv

0690 93299 Icm/ilr remote tech serv

0690 93724 Analyze pacemaker system

0690 93745 Set-up cardiovert-defibrill

0691 Level III Electronic Analysis of Devices S 2.3930 $167.55

. $33.51

0691 62252 Csf shunt reprogram

0691 62367 Analyze spine infus pump

0691 62368 Analyze sp inf pump w/reprog

0691 62369 Anal sp inf pmp w/reprg&fill

0691 62370 Anl sp inf pmp w/mdreprg&fil

0692 Level II Electronic Analysis of Devices S 1.5944 $111.63

. $22.33

0692 93271 Ecg/monitoring and analysis

0692 93750 Interrogation vad in person

0692 95971 Analyze neurostim simple

0692 95972 Analyze neurostim complex

0692 95974 Cranial neurostim complex

0692 95978 Analyze neurostim brain/1h0692 95979 Analyz neurostim brain addon

0692 95982 Io ga n-stim subsq w/reprog

0694 Mohs Surgery T 5.0714 $355.08 $88.08 $71.02

0694 17311 Mohs 1 stage h/n/hf/g

0694 17312 Mohs addl stage

0694 17313 Mohs 1 stage t/a/l

0694 17314 Mohs addl stage t/a/l

0694 17315 Mohs surg addl block

0697 Level I Echocardiogram Without Contrast S 3.1615 $221.36

. $44.28

0697 76825 Echo exam of fetal heart

0697 76826 Echo exam of fetal heart

0697 93308 Tte f-up or lmtd

0698 Level II Eye Tests & Treatments S 1.0589 $74.14

. $14.83

0698 0198T Ocular blood flow measure

0698 65205 Remove foreign body from eye

0698 65210 Remove foreign body from eye

0698 65220 Remove foreign body from eye

0698 65222 Remove foreign body from eye

0698 65430 Corneal smear

0698 67820 Revise eyelashes

0698 68040 Treatment of eyelid lesions

0698 68801 Dilate tear duct opening

0698 92083 Visual field examination(s)

0698 92136 Ophthalmic biometry

0698 92230 Eye exam with photos

0698 92286 Internal eye photography

0698 92287 Internal eye photography

0698 92311 Contact lens fitting

0698 92313 Contact lens fitting

0698 92315 Prescription of contact lens

0698 92316 Prescription of contact lens

0698 92325 Modification of contact lens

0698 92352 Special spectacles fitting

0698 92353 Special spectacles fitting

0698 92371 Repair & adjust spectacles

0698 G0117 Glaucoma scrn hgh risk direc

0699 Level IV Eye Tests & Treatments T 15.4248 "$1,079.98"

. $216.00

0699 67346 Biopsy eye muscle

0699 68110 Remove eyelid lining lesion

0699 92018 New eye exam & treatment

0699 92019 Eye exam & treatment

0701 Sr89 strontium K $954.77

. $190.96

0701 A9600 Sr89 strontium

0726 Dexrazoxane HCl injection K $207.92

. $41.59

0726 J1190 Dexrazoxane HCl injection

0728 Filgrastim 300 mcg injection K $246.80

. $49.36

0728 J1440 Filgrastim 300 mcg injection

0731 Sargramostim injection K $24.22

. $4.85

0731 J2820 Sargramostim injection

0735 Ampho b cholesteryl sulfate K $14.56

. $2.92

0735 J0288 Ampho b cholesteryl sulfate

0736 Amphotericin b liposome inj K $14.25

. $2.85

0736 J0289 Amphotericin b liposome inj

0738 Rasburicase K $188.98

. $37.80

0738 J2783 Rasburicase

0747 Chlorothiazide sodium inj K $269.86

. $53.98

0747 J1205 Chlorothiazide sodium inj

0751 Mechlorethamine hcl inj K $154.88

. $30.98

0751 J9230 Mechlorethamine hcl inj

0752 Dactinomycin injection K $567.28

. $113.46

0752 J9120 Dactinomycin injection

0759 "Naltrexone, depot form" K $2.78

. $0.56

0759 J2315 "Naltrexone, depot form"

0800 Leuprolide acetate K $590.71

. $118.15

0800 J1950 Leuprolide acetate /3.75 MG

0802 Etoposide oral K $37.54

. $7.510802 J8560 Etoposide oral 50 MG

0807 Aldesleukin injection K $969.60

. $193.92

0807 J9015 Aldesleukin injection

0809 Bcg live intravesical vac K $117.34

. $23.47

0809 J9031 Bcg live intravesical vac

0810 Goserelin acetate implant K $186.43

. $37.29

0810 J9202 Goserelin acetate implant

0812 Carmustine injection K $172.53

. $34.51

0812 J9050 Carmustine injection

0814 Asparaginase injection K $62.08

. $12.42

0814 J9020 Asparaginase injection

0820 Daunorubicin injection K $15.60

. $3.12

0820 J9150 Daunorubicin injection

0821 Daunorubicin citrate inj K $56.58

. $11.32

0821 J9151 Daunorubicin citrate inj

0823 Docetaxel injection K $15.75

. $3.15

0823 J9171 Docetaxel injection

0825 Nelarabine injection K $113.99

. $22.80

0825 J9261 Nelarabine injection

0827 Floxuridine injection K $60.82

. $12.17

0827 J9200 Floxuridine injection

0828 Gemcitabine hcl injection K $89.64

. $17.93

0828 J9201 Gemcitabine hcl injection

0830 Irinotecan injection K $6.42

. $1.29

0830 J9206 Irinotecan injection

0831 Ifosfamide injection K $32.03

. $6.41

0831 J9208 Ifosfamide injection

0832 Idarubicin hcl injection K $58.32

. $11.67

0832 J9211 Idarubicin hcl injection

0835 Cosyntropin injection NOS K $99.76

. $19.96

0835 J0833 Cosyntropin injection NOS

0836 Interferon alfa-2b inj K $16.82

. $3.37

0836 J9214 Interferon alfa-2b inj

0838 Interferon gamma 1-b inj K $582.59

. $116.52

0838 J9216 Interferon gamma 1-b inj

0840 Inj melphalan hydrochl K "$1,512.71"

. $302.55

0840 J9245 Inj melphalan hydrochl 50 MG

0842 Fludarabine phosphate inj K $101.84

. $20.37

0842 J9185 Fludarabine phosphate inj

0843 Pegaspargase injection K "$2,675.40"

. $535.08

0843 J9266 Pegaspargase injection

0844 Pentostatin injection K "$1,084.10"

. $216.82

0844 J9268 Pentostatin injection

0849 Rituximab injection K $615.22

. $123.05

0849 J9310 Rituximab injection

0850 Streptozocin injection K $265.69

. $53.14

0850 J9320 Streptozocin injection

0851 Thiotepa injection K $131.18

. $26.24

0851 J9340 Thiotepa injection

0856 Porfimer sodium injection K "$19,348.11"

. "$3,869.63"

0856 J9600 Porfimer sodium injection

0858 Inj cladribine K $23.94

. $4.79

0858 J9065 Inj cladribine per 1 MG

0861 Leuprolide acetate injeciton K $4.42

. $0.89

0861 J9218 Leuprolide acetate injeciton

0864 Mitoxantrone hydrochl K $37.36

. $7.48

0864 J9293 Mitoxantrone hydrochl / 5 MG

0865 Interferon alfa-n3 inj K $31.20

. $6.24

0865 J9215 Interferon alfa-n3 inj

0868 Oral aprepitant K $6.06

. $1.22

0868 J8501 Oral aprepitant

0873 Hyalgan/supartz inj per dose K $88.00

. $17.60

0873 J7321 Hyalgan/supartz inj per dose

0874 Synvisc or synvisc-one K $11.93

. $2.39

0874 J7325 Synvisc or Synvisc-One

0875 Euflexxa inj per dose K $146.10

. $29.220875 J7323 Euflexxa inj per dose

0877 Orthovisc inj per dose K $166.14

. $33.23

0877 J7324 Orthovisc inj per dose

0884 Rho d immune globulin inj K $82.14

. $16.43

0884 J2790 Rho d immune globulin inj

0887 Azathioprine parenteral K $122.53

. $24.51

0887 J7501 Azathioprine parenteral

0890 Lymphocyte immune globulin K $556.51

. $111.31

0890 J7504 Lymphocyte immune globulin

0900 Alglucerase injection K $41.24

. $8.25

0900 J0205 Alglucerase injection

0901 Alpha 1 proteinase inhibitor K $3.83

. $0.77

0901 J0256 Alpha 1 proteinase inhibitor

0902 "Injection,onabotulinumtoxinA" K $5.38

. $1.08

0902 J0585 "Injection,onabotulinumtoxinA"

0903 Cytomegalovirus imm IV /vial K $947.86

. $189.58

0903 J0850 Cytomegalovirus imm IV /vial

0910 Interferon beta-1b / .25 MG K $211.59

. $42.32

0910 J1830 Interferon beta-1b / .25 MG

0913 Ganciclovir long act implant K "$16,640.00"

. "$3,328.00"

0913 J7310 Ganciclovir long act implant

0917 Adenosine injection K $94.42

. $18.89

0917 J0152 Adenosine injection

0925 Factor viii K $0.85

. $0.17

0925 J7190 Factor viii

0927 Factor viii recombinant K $1.09

. $0.22

0927 J7192 Factor viii recombinant NOS

0928 Factor ix complex K $0.91

. $0.19

0928 J7194 Factor ix complex

0929 Anti-inhibitor K $1.60

. $0.32

0929 J7198 Anti-inhibitor

0931 Factor IX non-recombinant K $0.89

. $0.18

0931 J7193 Factor IX non-recombinant

0932 Factor IX recombinant K $1.14

. $0.23

0932 J7195 Factor IX recombinant

0933 Gamma globulin > 10 CC inj K $206.16

. $41.24

0933 J1560 Gamma globulin > 10 CC inj

0934 "Capecitabine, oral" K $24.63

. $4.93

0934 J8521 "Capecitabine, oral, 500 mg"

0943 Octagam injection K $55.80

. $11.16

0943 J1568 Octagam injection

0944 Gammagard liquid injection K $37.08

. $7.42

0944 J1569 Gammagard liquid injection

0945 Rhophylac injection K $5.09

. $1.02

0945 J2791 Rhophylac injection

0946 Hepagam b im injection K $52.11

. $10.43

0946 J1571 Hepagam b im injection

0947 Flebogamma injection G $35.15

. $6.90

0947 J1572 Flebogamma injection

0948 Gamunex/gamunex c K $36.78

. $7.36

0948 J1561 Gamunex/gamunex c

0949 "Frozen plasma, pooled, sd" R 0.9547 $66.84

. $13.37

0949 P9023 "Frozen plasma, pooled, sd"

0950 Whole blood for transfusion R 2.7245 $190.76

. $38.16

0950 P9010 Whole blood for transfusion

0951 Reclast injection K $218.44

. $43.69

0951 J3488 Reclast injection

0952 Cryoprecipitate each unit R 1.1823 $82.78

. $16.56

0952 P9012 Cryoprecipitate each unit

0954 RBC leukocytes reduced R 2.8408 $198.90

. $39.78

0954 P9016 RBC leukocytes reduced

0955 "Plasma, frz between 8-24hour" R 1.0400 $72.82

. $14.57

0955 P9059 "Plasma, frz between 8-24hour"

0956 "Plasma protein fract,5%,50ml" R 0.2574 $18.02

. $3.61

0956 P9043 "Plasma protein fract,5%,50ml"

0957 "Platelets, each unit" R 1.2822 $89.77

. $17.960957 P9019 "Platelets, each unit"

0958 Plaelet rich plasma unit R 2.0257 $141.83

. $28.37

0958 P9020 Plaelet rich plasma unit

0959 Red blood cells unit R 2.1303 $149.16

. $29.84

0959 P9021 Red blood cells unit

0960 Washed red blood cells unit R 4.1045 $287.38

. $57.48

0960 P9022 Washed red blood cells unit

0961 "Albumin (human),5%, 50ml" K $21.32

. $4.27

0961 P9041 "Albumin (human),5%, 50ml"

0963 "Albumin (human), 5%, 250 ml" K $61.94

. $12.39

0963 P9045 "Albumin (human), 5%, 250 ml"

0964 "Albumin (human), 25%, 20 ml" K $26.84

. $5.37

0964 P9046 "Albumin (human), 25%, 20 ml"

0965 "Albumin (human), 25%, 50ml" K $68.03

. $13.61

0965 P9047 "Albumin (human), 25%, 50ml"

0966 "Plasmaprotein fract,5%,250ml" R 1.0362 $72.55

. $14.51

0966 P9048 "Plasmaprotein fract,5%,250ml"

0967 Blood split unit R 1.6761 $117.35

. $23.47

0967 P9011 Blood split unit

0968 Platelets leukoreduced irrad R 1.9996 $140.00

. $28.00

0968 P9033 Platelets leukoreduced irrad

0969 RBC leukoreduced irradiated R 3.7309 $261.22

. $52.25

0969 P9040 RBC leukoreduced irradiated

1009 Cryoprecipitatereducedplasma R 1.0622 $74.37

. $14.88

1009 P9044 Cryoprecipitatereducedplasma

1010 "Blood, l/r, cmv-neg" R 2.6930 $188.55

. $37.71

1010 P9051 "Blood, l/r, cmv-neg"

1011 "Platelets, hla-m, l/r, unit" R 11.4695 $803.05

. $160.61

1011 P9052 "Platelets, hla-m, l/r, unit"

1013 Platelets leukocytes reduced R 1.8720 $131.07

. $26.22

1013 P9031 Platelets leukocytes reduced

1015 Injection glatiramer acetate K $109.30

. $21.86

1015 J1595 Injection glatiramer acetate

1016 "Blood, l/r, froz/degly/wash" R 1.4989 $104.95

. $20.99

1016 P9054 "Blood, l/r, froz/degly/wash"

1017 "Plt, aph/pher, l/r, cmv-neg" R 5.4802 $383.70

. $76.74

1017 P9055 "Plt, aph/pher, l/r, cmv-neg"

1018 "Blood, l/r, irradiated" R 2.0966 $146.80

. $29.36

1018 P9056 "Blood, l/r, irradiated"

1019 Plate pheres leukoredu irrad R 9.8804 $691.79

. $138.36

1019 P9037 Plate pheres leukoredu irrad

1020 "Plt, pher, l/r cmv-neg, irr" R 8.7936 $615.69

. $123.14

1020 P9053 "Plt, pher, l/r cmv-neg, irr"

1021 "RBC, frz/deg/wsh, l/r, irrad" R 6.4103 $448.82

. $89.77

1021 P9057 "RBC, frz/deg/wsh, l/r, irrad"

1022 "RBC, l/r, cmv-neg, irrad" R 4.3700 $305.97

. $61.20

1022 P9058 "RBC, l/r, cmv-neg, irrad"

1023 Pralidoxime chloride inj K $88.51

. $17.71

1023 J2730 Pralidoxime chloride inj

1052 "Injection, voriconazole" K $6.07

. $1.22

1052 J3465 "Injection, voriconazole"

1064 "I131 iodide cap, rx" K $17.26

. $3.46

1064 A9517 "I131 iodide cap, rx"

1083 Adalimumab injection K $410.95

. $82.19

1083 J0135 Adalimumab injection

1084 Denileukin diftitox inj K "$1,603.01"

. $320.61

1084 J9160 Denileukin diftitox inj

1086 Temozolomide K $9.48

. $1.90

1086 J8700 Temozolomide

1138 "Hepagam b intravenous, inj" K $52.11

. $10.43

1138 J1573 "Hepagam b intravenous, inj"

1139 Protein c concentrate K $12.90

. $2.58

1139 J2724 Protein c concentrate

1142 Supprelin LA implant K "$15,418.48"

. "$3,083.70"

1142 J9226 Supprelin LA implant

1150 "I131 iodide sol, rx" K $10.49

. $2.101150 A9530 "I131 iodide sol, rx"

1166 Cytarabine liposome inj K $503.48

. $100.70

1166 J9098 Cytarabine liposome inj

1167 "Inj, epirubicin hcl" K $1.87

. $0.38

1167 J9178 "Inj, epirubicin hcl, 2 mg"

1168 "Inj, temsirolimus" K $50.57

. $10.12

1168 J9330 Temsirolimus injection

1178 Busulfan injection K $18.72

. $3.75

1178 J0594 Busulfan injection

1203 Verteporfin injection K $9.76

. $1.96

1203 J3396 Verteporfin injection

1207 "Octreotide injection, depot" K $117.11

. $23.43

1207 J2353 "Octreotide injection, depot"

1213 Antihemophilic viii/vwf comp K $0.90

. $0.18

1213 J7186 Antihemophilic viii/vwf comp

1214 Inj IVIG privigen 500 mg K $34.42

. $6.89

1214 J1459 Inj IVIG privigen 500 mg

1221 Dimethyl sulfoxide 50% K $94.38

. $18.88

1221 J1212 Dimethyl sulfoxide 50% 50 ML

1222 Pentastarch 10% solution K $13.23

. $2.65

1222 J2513 Pentastarch 10% solution

1226 Inj streptokinase /250000 IU K $19.78

. $3.96

1226 J2995 Inj streptokinase /250000 IU

1232 Mitomycin 5 MG inj K $19.55

. $3.91

1232 J9280 Mitomycin 5 MG inj

1235 Valrubicin injection K $959.07

. $191.82

1235 J9357 Valrubicin injection

1236 Levoleucovorin injection K $1.58

. $0.32

1236 J0641 Levoleucovorin injection

1237 Inj iron dextran K $11.53

. $2.31

1237 J1750 Inj iron dextran

1238 Topotecan oral K $77.92

. $15.59

1238 J8705 Topotecan oral

1239 Rotavirus vacc 2 dose oral K $106.60

. $21.32

1239 90681 Rotavirus vacc 2 dose oral

1240 Apligraf skin sub K $35.88

. $7.18

1240 Q4101 Apligraf

1241 Oasis wound matrix skin sub K $5.74

. $1.15

1241 Q4102 Oasis wound matrix

1242 Oasis burn matrix skin sub K $5.74

. $1.15

1242 Q4103 Oasis burn matrix

1243 Integra BMWD skin sub K $16.26

. $3.26

1243 Q4104 Integra BMWD

1244 Integra DRT skin sub K $9.62

. $1.93

1244 Q4105 Integra DRT

1245 Dermagraft skin sub K $40.51

. $8.11

1245 Q4106 Dermagraft

1246 Graftjacket skin sub K $94.95

. $18.99

1246 Q4107 Graftjacket

1247 Integra matrix skin sub K $21.73

. $4.35

1247 Q4108 Integra matrix

1248 Primatrix skin sub K $31.42

. $6.29

1248 Q4110 Primatrix

1249 Cymetra allograft K $332.25

. $66.45

1249 Q4112 Cymetra injectable

1250 Graftjacket express allograf K $332.25

. $66.45

1250 Q4113 Graftjacket xpress

1251 Integra flowable wound matri K "$1,019.89"

. $203.98

1251 Q4114 Integra flowable wound matri

1252 Gammagraft skin sub K $6.78

. $1.36

1252 Q4111 Gammagraft

1253 Triamcinolone A inj PRS-free K $3.41

. $0.69

1253 J3300 Triamcinolone A inj PRS-free

1263 Antithrombin iii injection K $2.71

. $0.55

1263 J7197 Antithrombin iii injection

1268 Xyntha inj K $1.07

. $0.221268 J7185 Xyntha inj

1270 Alloderm skin sub K $31.72

. $6.35

1270 Q4116 Alloderm

1272 Acetylcysteine injection K $2.74

. $0.55

1272 J0132 Acetylcysteine injection

1274 Edetate calcium disodium inj K $189.47

. $37.90

1274 J0600 Edetate calcium disodium inj

1275 "Vivaglobin, inj" K $12.48

. $2.50

1275 J1562 "Vivaglobin, inj"

1279 Factor VIII (porcine) K $9.12

. $1.83

1279 J7191 Factor VIII (porcine)

1280 Corticotropin injection K "$2,516.22"

. $503.25

1280 J0800 Corticotropin injection

1281 Bevacizumab injection K $1.50

. $0.30

1281 C9257 Bevacizumab injection

1287 Alloskin skin sub K $8.26

. $1.66

1287 Q4115 Alloskin

1289 AbobotulinumtoxinA K $7.29

. $1.46

1289 J0586 AbobotulinumtoxinA

1290 Human fibrinogen conc inj K $71.57

. $14.32

1290 J1680 Human fibrinogen conc inj

1291 Rilonacept injection K $23.64

. $4.73

1291 J2793 Rilonacept injection

1295 Sm 153 lexidronam K "$7,592.00"

. "$1,518.40"

1295 A9604 Sm 153 lexidronam

1296 Degarelix injection K $2.71

. $0.55

1296 J9155 Degarelix injection

1297 "Ferumoxytol, non-esrd" K $0.65

. $0.13

1297 Q0138 "Ferumoxytol, non-esrd"

1304 Perphenazine injeciton K $19.54

. $3.91

1304 J3310 Perphenazine injeciton

1306 Urea injection K $72.00

. $14.40

1306 J3350 Urea injection

1307 Oral busulfan K $3.77

. $0.76

1307 J8510 Oral busulfan

1308 Mecasermin injection K $25.65

. $5.13

1308 J2170 Mecasermin injection

1311 Canakinumab injection G $88.97

. $17.46

1311 J0638 Canakinumab injection

1312 Hizentra injection K $7.15

. $1.43

1312 J1559 Hizentra injection

1327 Imiglucerase injection K $41.20

. $8.24

1327 J1786 Imuglucerase injection

1331 Olanzapine long-acting inj K $2.70

. $0.54

1331 J2358 Olanzapine long-acting inj

1332 Antithrombin recombinant K $101.40

. $20.28

1332 J7196 Antithrombin recombinant

1338 "Methyl aminolevulinate, top" K $74.52

. $14.91

1338 J7309 "Methyl aminolevulinate, top"

1339 Oral fludarabine phosphate G $77.93

. $15.30

1339 J8562 Oral fludarabine phosphate

1340 "Collagenase, clost hist inj" G $37.51

. $7.36

1340 J0775 "Collagenase, clost hist inj"

1341 Amobarbital 125 MG inj K $113.08

. $22.62

1341 J0300 Amobarbital 125 MG inj

1342 Matristem micromatrix K $2.94

. $0.59

1342 Q4118 Matristem micromatrix

1343 Ganciclovir sodium injection K $66.58

. $13.32

1343 J1570 Ganciclovir sodium injection

1344 Gonadorelin hydroch/ 100 mcg K $167.25

. $33.45

1344 J1620 Gonadorelin hydroch/ 100 mcg

1345 Theraskin K $32.84

. $6.57

1345 Q4121 Theraskin

1347 Oxacillin sodium injeciton K $2.51

. $0.51

1347 J2700 Oxacillin sodium injeciton

1349 Anidulafungin injection K $1.20

. $0.241349 J0348 Anidulafungin injection

1350 Topotecan injection K $9.85

. $1.97

1350 J9351 Topotecan injection

1351 Matristem wound matrix K $4.52

. $0.91

1351 Q4119 Matristem wound matrix

1352 Wilate injection G $0.87

. $0.17

1352 J7183 Wilate injection

1353 Belimumab injection G $38.61

. $7.58

1353 J0490 Belimumab injection

1354 Hydroxyprogesterone caproate K $2.52

. $0.51

1354 J1725 Hydroxyprogesterone caproate

1355 Itraconazole injection K $372.55

. $74.51

1355 J1835 Itraconazole injection

1357 Inj protirelin per 250 mcg K $27.03

. $5.41

1357 J2725 Inj protirelin per 250 mcg

1358 Phentolaine mesylate inj K $53.76

. $10.76

1358 J2760 Phentolaine mesylate inj

1359 Foscarnet sodium injection K $14.37

. $2.88

1359 J1455 Foscarnet sodium injection

1360 Apomorphine hydrochloride K $5.12

. $1.03

1360 J0364 Apomorphine hydrochloride

1361 Enfuvirtide injection K $0.51

. $0.11

1361 J1324 Enfuvirtide injection

1362 Inj heparin sodium per 10 u K $0.18

. $0.04

1362 J1642 Inj heparin sodium per 10 u

1373 Inj heparin sodium per 1000u K $0.27

. $0.06

1373 J1644 Inj heparin sodium per 1000u

1374 Sumatriptan succinate / 6 MG K $76.71

. $15.35

1374 J3030 Sumatriptan succinate / 6 MG

1408 Cyclophosphamide 100 MG inj K $13.43

. $2.69

1408 J9070 Cyclophosphamide 100 MG inj

1412 Vinorelbine tartrate inj K $17.45

. $3.49

1412 J9390 Vinorelbine tartrate inj

1413 Lumizyme injection G $148.30

. $29.10

1413 J0221 Lumizyme injection

1415 Glassia injection K $3.81

. $0.77

1415 J0257 Glassia injection

1416 Factor XIII anti-hem factor G $8.44

. $1.66

1416 J7180 Factor XIII anti-hem factor

1417 Gel-one K "$1,014.00"

. $202.80

1417 J7326 Gel-one

1418 Oral everolimus K $5.68

. $1.14

1418 J8561 Oral everolimus

1419 Dermacell K $31.52

. $6.31

1419 Q4122 Dermacell

1426 Eribulin mesylate injection G $90.06

. $17.68

1426 J9179 Eribulin mesylate injection

1505 New Technology - Level V ($300 - $400) S $350.00

. $70.00

1505 G0417 Sat biopsy prostate 21-40

1506 New Technology - Level VI ($400 - $500) S $450.00

. $90.00

1506 G0418 Sat biopsy prostate 41-60

1508 New Technology - Level VIII ($600 - $700) S $650.00

. $130.00

1508 G0419 Sat biopsy prostate: >60

1605 Abciximab injection K $548.95

. $109.79

1605 J0130 Abciximab injection

1607 Eptifibatide injection K $22.02

. $4.41

1607 J1327 Eptifibatide injection

1608 Etanercept injection K $204.31

. $40.87

1608 J1438 Etanercept injection

1609 "Rho(D) immune globulin h, sd" K $17.21

. $3.45

1609 J2792 "Rho(D) immune globulin h, sd"

1612 "Daclizumab, parenteral" K $516.41

. $103.29

1612 J7513 "Daclizumab, parenteral"

1613 Trastuzumab injection K $71.08

. $14.22

1613 J9355 Trastuzumab injection

1630 "Hep b ig, im" K $113.50

. $22.701630 90371 Hep b ig im

1631 Baclofen intrathecal trial K $76.39

. $15.28

1631 J0476 Baclofen intrathecal trial

1633 Alefacept K $38.72

. $7.75

1633 J0215 Alefacept

1643 "Y90 ibritumomab, rx" K "$36,100.41"

. "$7,220.09"

1643 A9543 "Y90 ibritumomab, rx"

1645 "I131 tositumomab, rx" K "$29,618.96"

. "$5,923.80"

1645 A9545 "I131 tositumomab, rx"

1670 Tetanus immune globulin inj K $245.02

. $49.01

1670 J1670 Tetanus immune globulin inj

1675 P32 Na phosphate K $126.14

. $25.23

1675 A9563 P32 Na phosphate

1676 P32 chromic phosphate K $579.98

. $116.00

1676 A9564 P32 chromic phosphate

1683 Basiliximab K "$2,190.58"

. $438.12

1683 J0480 Basiliximab

1684 Corticorelin ovine triflutal K $5.58

. $1.12

1684 J0795 Corticorelin ovine triflutal

1685 "Darbepoetin alfa, non-esrd" K $3.14

. $0.63

1685 J0881 "Darbepoetin alfa, non-esrd"

1686 "Epoetin alfa, non-esrd" K $9.70

. $1.94

1686 J0885 "Epoetin alfa, non-esrd"

1687 Digoxin immune fab (ovine) K $626.71

. $125.35

1687 J1162 Digoxin immune fab (ovine)

1688 Ethanolamine oleate K $294.28

. $58.86

1688 J1430 Ethanolamine oleate 100 mg

1689 Fomepizole K $6.91

. $1.39

1689 J1451 "Fomepizole, 15 mg"

1690 Hemin K $10.41

. $2.09

1690 J1640 "Hemin, 1 mg"

1693 Lepirudin K $346.19

. $69.24

1693 J1945 Lepirudin

1694 Ziconotide injection K $6.48

. $1.30

1694 J2278 Ziconotide injection

1695 Nesiritide injection K $46.36

. $9.28

1695 J2325 Nesiritide injection

1696 Palifermin injection K $11.45

. $2.29

1696 J2425 Palifermin injection

1697 Pegaptanib sodium injection K "$1,001.34"

. $200.27

1697 J2503 Pegaptanib sodium injection

1700 Inj secretin synthetic human K $26.98

. $5.40

1700 J2850 Inj secretin synthetic human

1701 Treprostinil injection K $60.08

. $12.02

1701 J3285 Treprostinil injection

1704 "Humate-P, inj" K $0.88

. $0.18

1704 J7187 "Humate-P, inj"

1705 Factor viia K $1.52

. $0.31

1705 J7189 Factor viia

1709 Azacitidine injection K $5.15

. $1.03

1709 J9025 Azacitidine injection

1710 Clofarabine injection K $119.68

. $23.94

1710 J9027 Clofarabine injection

1711 Vantas implant K "$3,816.98"

. $763.40

1711 J9225 Vantas implant

1712 Paclitaxel protein bound K $9.33

. $1.87

1712 J9264 Paclitaxel protein bound

1716 "Brachytx, non-str, Gold-198" U 0.5004 $35.04

. $7.01

1716 C1716 "Brachytx, non-str, Gold-198"

1717 "Brachytx, non-str, HDR Ir-192" U 3.3224 $232.62

. $46.53

1717 C1717 "Brachytx, non-str,HDR Ir-192"

1719 "Brachytx, NS, Non-HDRIr-192" U 0.4544 $31.82

. $6.37

1719 C1719 "Brachytx, NS, Non-HDRIr-192"

1738 Oxaliplatin K $9.96

. $2.00

1738 J9263 Oxaliplatin

1739 "Pegademase bovine, 25 iu" K $248.56

. $49.721739 J2504 "Pegademase bovine, 25 iu"

1741 "Urofollitropin, 75 iu" K $65.66

. $13.14

1741 J3355 "Urofollitropin, 75 iu"

1749 "Endo, colon, retro imaging" H

1749 C1749 "Endo, colon, retro imaging"

1830 Power bone marrow bx needle H

1830 C1830 Power bone marrow bx needle

1840 Telescopic intraocular lens H

1840 C1840 Telescopic intraocular lens

1886 "Catheter, ablation" H

1886 C1886 "Catheter, ablation"

2210 Methyldopate hcl injection K $39.16

. $7.84

2210 J0210 Methyldopate hcl injection

2616 "Brachytx, non-str,Yttrium-90" U 224.7054 "$15,732.97"

. "$3,146.60"

2616 C2616 "Brachytx, non-str,Yttrium-90"

2632 Iodine I-125 sodium iodide U 0.2404 $16.83

. $3.37

2632 A9527 Iodine I-125 sodium iodide

2634 "Brachytx, non-str, HA, I-125" U 0.8944 $62.62

. $12.53

2634 C2634 "Brachytx, non-str, HA, I-125"

2635 "Brachytx, non-str, HA, P-103" U 0.3855 $26.99

. $5.40

2635 C2635 "Brachytx, non-str, HA, P-103"

2636 "Brachy linear, non-str,P-103" U 0.5294 $37.07

. $7.42

2636 C2636 "Brachy linear, non-str,P-103"

2638 "Brachytx, stranded, I-125" U 0.6498 $45.50

. $9.10

2638 C2638 "Brachytx, stranded, I-125"

2639 "Brachytx, non-stranded,I-125" U 0.5078 $35.55

. $7.11

2639 C2639 "Brachytx, non-stranded,I-125"

2640 "Brachytx, stranded, P-103" U 1.1433 $80.05

. $16.01

2640 C2640 "Brachytx, stranded, P-103"

2641 "Brachytx, non-stranded,P-103" U 0.9180 $64.27

. $12.86

2641 C2641 "Brachytx, non-stranded,P-103"

2642 "Brachytx, stranded, C-131" U 1.7379 $121.68

. $24.34

2642 C2642 "Brachytx, stranded, C-131"

2643 "Brachytx, non-stranded,C-131" U 1.1044 $77.33

. $15.47

2643 C2643 "Brachytx, non-stranded,C-131"

2698 "Brachytx, stranded, NOS" U 0.6498 $45.50

. $9.10

2698 C2698 "Brachytx, stranded, NOS"

2699 "Brachytx, non-stranded, NOS" U 0.3855 $26.99

. $5.40

2699 C2699 "Brachytx, non-stranded, NOS"

2731 "Immune globulin, powder" K $30.46

. $6.10

2731 J1566 "Immune globulin, powder"

2770 Quinupristin/dalfopristin K $171.48

. $34.30

2770 J2770 Quinupristin/dalfopristin

3041 Bivalirudin K $2.71

. $0.55

3041 J0583 Bivalirudin

3043 Gamma globulin 1 CC inj K $20.62

. $4.13

3043 J1460 Gamma globulin 1 CC inj

3050 Sermorelin acetate injection K $1.77

. $0.36

3050 Q0515 Sermorelin acetate injection

7000 Amifostine K $315.94

. $63.19

7000 J0207 Amifostine

7011 Oprelvekin injection K $239.90

. $47.98

7011 J2355 Oprelvekin injection

7034 Somatropin injection K $61.81

. $12.37

7034 J2941 Somatropin injection

7035 Teniposide K $316.31

. $63.27

7035 Q2017 "Teniposide, 50 mg"

7036 "Urokinase 250,000 IU inj" K $449.09

. $89.82

7036 J3365 "Urokinase 250,000 IU inj"

7038 Monoclonal antibodies K "$1,111.59"

. $222.32

7038 J7505 Monoclonal antibodies

7041 Tirofiban HCl K $8.92

. $1.79

7041 J3246 Tirofiban HCl

7042 "Capecitabine, oral" K $7.32

. $1.47

7042 J8520 "Capecitabine, oral, 150 mg"

7043 Infliximab injection K $62.01

. $12.417043 J1745 Infliximab injection

7046 Doxorubicin hcl liposome inj K $525.35

. $105.07

7046 J9001 Doxorubicin hcl liposome inj

7048 Alteplase recombinant K $42.24

. $8.45

7048 J2997 Alteplase recombinant

7049 Filgrastim 480 mcg injection K $390.07

. $78.02

7049 J1441 Filgrastim 480 mcg injection

7051 Leuprolide acetate implant K "$4,728.88"

. $945.78

7051 J9219 Leuprolide acetate implant

7308 Aminolevulinic acid hcl top K $147.80

. $29.56

7308 J7308 Aminolevulinic acid hcl top

9001 Linezolid injection K $34.48

. $6.90

9001 J2020 Linezolid injection

9002 Tenecteplase injection K $57.15

. $11.43

9002 J3101 Tenecteplase injection

9003 Palivizumab K "$1,158.85"

. $231.77

9003 90378 Rsv mab im 50mg

9004 Gemtuzumab ozogamicin inj K "$2,690.84"

. $538.17

9004 J9300 Gemtuzumab ozogamicin inj

9005 Reteplase injection K "$1,623.59"

. $324.72

9005 J2993 Reteplase injection

9006 Tacrolimus injection K $136.86

. $27.38

9006 J7525 Tacrolimus injection

9012 Arsenic trioxide injection K $40.10

. $8.02

9012 J9017 Arsenic trioxide injection

9018 "Inj, rimabotulinumtoxinB" K $10.78

. $2.16

9018 J0587 "Inj, rimabotulinumtoxinB"

9019 Caspofungin acetate K $13.32

. $2.67

9019 J0637 Caspofungin acetate

9022 IM inj interferon beta 1-a K $238.30

. $47.66

9022 Q3025 IM inj interferon beta 1-a

9023 Rho d immune globulin K $21.52

. $4.31

9023 J2788 Rho d immune globulin 50 mcg

9024 Amphotericin b lipid complex K $8.42

. $1.69

9024 J0287 Amphotericin b lipid complex

9032 Baclofen 10 MG injection K $187.46

. $37.50

9032 J0475 Baclofen 10 MG injection

9033 Cidofovir injection K $742.66

. $148.54

9033 J0740 Cidofovir injection

9038 Inj estrogen conjugate K $103.54

. $20.71

9038 J1410 Inj estrogen conjugate 25 MG

9042 Glucagon hydrochloride K $101.30

. $20.26

9042 J1610 Glucagon hydrochloride/1 MG

9044 Ibutilide fumarate injection K $133.80

. $26.76

9044 J1742 Ibutilide fumarate injection

9046 Iron sucrose injection K $0.32

. $0.07

9046 J1756 Iron sucrose injection

9104 Antithymocyte globuln rabbit K $432.20

. $86.44

9104 J7511 Antithymocyte globuln rabbit

9108 Thyrotropin injection K "$1,032.25"

. $206.45

9108 J3240 Thyrotropin injection

9110 Alemtuzumab injection K $575.18

. $115.04

9110 J9010 Alemtuzumab injection

9115 Zoledronic acid K $220.30

. $44.06

9115 J3487 Zoledronic acid

9119 "Injection, pegfilgrastim 6mg" K "$2,676.49"

. $535.30

9119 J2505 "Injection, pegfilgrastim 6mg"

9120 "Injection, Fulvestrant" K $83.63

. $16.73

9120 J9395 "Injection, Fulvestrant"

9121 "Injection, argatroban" K $20.16

. $4.04

9121 C9121 "Injection, argatroban"

9122 Triptorelin pamoate K $176.18

. $35.24

9122 J3315 Triptorelin pamoate

9124 Daptomycin injection K $0.48

. $0.10

9124 J0878 Daptomycin injection

9125 "Risperidone, long acting" K $5.07

. $1.029125 J2794 "Risperidone, long acting"

9126 Natalizumab injection K $10.32

. $2.07

9126 J2323 Natalizumab injection

9133 "Rabies ig, im/sc" K $185.74

. $37.15

9133 90375 Rabies ig im/sc

9134 "Rabies ig, heat treated" K $177.81

. $35.57

9134 90376 Rabies ig heat treated

9135 "Varicella-zoster ig, im" K $94.28

. $18.86

9135 90396 Varicella-zoster ig im

9137 "Bcg vaccine, percut" K $112.23

. $22.45

9137 90585 Bcg vaccine percut

9139 "Rabies vaccine, im" K $205.48

. $41.10

9139 90675 Rabies vaccine im

9140 "Rabies vaccine, id" K $139.69

. $27.94

9140 90676 Rabies vaccine id

9143 "Meningococcal vaccine, sc" K $110.75

. $22.15

9143 90733 Meningococcal vaccine sc

9144 "Encephalitis vaccine, sc" K $100.15

. $20.03

9144 90735 Encephalitis vaccine sc

9145 "Meningococcal vaccine, im" K $92.92

. $18.59

9145 90734 Meningococcal vaccine im

9207 Bortezomib injection K $40.67

. $8.14

9207 J9041 Bortezomib injection

9208 Agalsidase beta injection K $138.53

. $27.71

9208 J0180 Agalsidase beta injection

9209 Laronidase injection K $26.33

. $5.27

9209 J1931 Laronidase injection

9210 Palonosetron hcl K $18.83

. $3.77

9210 J2469 Palonosetron hcl

9213 Pemetrexed injection K $52.76

. $10.56

9213 J9305 Pemetrexed injection

9214 Bevacizumab injection K $59.98

. $12.00

9214 J9035 Bevacizumab injection

9215 Cetuximab injection K $49.53

. $9.91

9215 J9055 Cetuximab injection

9217 Leuprolide acetate suspnsion K $216.90

. $43.38

9217 J9217 Leuprolide acetate suspnsion

9224 Galsulfase injection K $341.40

. $68.28

9224 J1458 Galsulfase injection

9225 Fluocinolone acetonide implt K "$18,980.00"

. "$3,796.00"

9225 J7311 Fluocinolone acetonide implt

9227 Micafungin sodium injection K $0.98

. $0.20

9227 J2248 Micafungin sodium injection

9228 Tigecycline injection K $1.30

. $0.26

9228 J3243 Tigecycline injection

9229 Ibandronate sodium injection K $148.02

. $29.61

9229 J1740 Ibandronate sodium injection

9230 Abatacept injection K $20.72

. $4.15

9230 J0129 Abatacept injection

9231 Decitabine injection K $31.94

. $6.39

9231 J0894 Decitabine injection

9232 Idursulfase injection K $446.44

. $89.29

9232 J1743 Idursulfase injection

9233 Ranibizumab injection K $395.53

. $79.11

9233 J2778 Ranibizumab injection

9234 Alglucosidase alfa injection K $155.84

. $31.17

9234 J0220 Alglucosidase alfa injection

9235 Panitumumab injection K $85.59

. $17.12

9235 J9303 Panitumumab injection

9236 Eculizumab injection K $186.37

. $37.28

9236 J1300 Eculizumab injection

9237 "Inj, lanreotide acetate" K $30.98

. $6.20

9237 J1930 Lanreotide injection

9240 "Injection, ixabepilone" K $63.47

. $12.70

9240 J9207 Ixabepilone injection

9242 "Injection, fosaprepitant" K $1.69

. $0.349242 J1453 Fosaprepitant injection

9243 Bendamustine injection K $18.47

. $3.70

9243 J9033 Bendamustine injection

9244 Regadenoson injection K $51.22

. $10.25

9244 J2785 Regadenoson injection

9245 Romiplostim injection K $45.87

. $9.18

9245 J2796 Romiplostim injection

9248 "Inj, clevidipine butyrate" K $2.66

. $0.54

9248 C9248 "Inj, clevidipine butyrate"

9249 Certolizumab pegol inj K $4.12

. $0.83

9249 J0718 Certolizumab pegol inj

9250 Artiss fibrin sealant K $129.72

. $25.95

9250 C9250 Artiss fibrin sealant

9251 C1 esterase inhibitor inj K $43.37

. $8.68

9251 J0598 "C-1 esterase, cinryze"

9252 Plerixafor injection K $275.80

. $55.16

9252 J2562 Plerixafor injection

9253 Temozolomide injection K $4.75

. $0.95

9253 J9328 Temozolomide injection

9254 "Injection, lacosamide" K $0.15

. $0.03

9254 C9254 "Injection, lacosamide"

9255 Paliperidone palmitate inj K $6.56

. $1.32

9255 J2426 Paliperidone palmitate inj

9256 Dexamethasone intra implant K $192.26

. $38.46

9256 J7312 Dexamethasone intra implant

9258 Telavancin injection G $2.10

. $0.42

9258 J3095 Telavancin injection

9259 Pralatrexate injection G $165.63

. $32.50

9259 J9307 Pralatrexate injection

9260 Ofatumumab injection G $45.41

. $8.91

9260 J9302 Ofatumumab injection

9261 Ustekinumab injection G $117.56

. $23.07

9261 J3357 Ustekinumab injection

9263 Ecallantide injection G $289.07

. $56.73

9263 J1290 Ecallantide injection

9264 Tocilizumab injection G $3.47

. $0.68

9264 J3262 Tocilizumab injection

9265 Romidepsin injection G $224.79

. $44.11

9265 J9315 Romidepsin injection

9268 Capsaicin 8% patch G $25.55

. $5.02

9268 J7335 Capsaicin 8% patch

9269 "C-1 esterase, berinert" G $30.23

. $5.94

9269 J0597 "C-1 esterase, berinert"

9270 Gammaplex IVIG G $37.29

. $7.32

9270 J1557 Gammaplex injection

9271 Velaglucerase alfa G $349.51

. $68.59

9271 J3385 Velaglucerase alfa

9272 "Inj, denosumab" G $14.47

. $2.84

9272 J0897 Denosumab injection

9273 Sipleucel-T auto CD54+ G "$32,860.00"

. "$6,448.00"

9273 Q2043 Sipuleucel-T auto CD54+

9274 Crotalidae Poly Immune Fab G "$2,111.36"

. $414.31

9274 J0840 Crotalidae poly immune fab

9275 Hexaminolevulinate HCl G $623.28 $0.00 $0.00

9275 C9275 Hexaminolevulinate HCl $0.00 $0.00

9276 Cabazitaxel injection G $135.57

. $26.61

9276 J9043 Cabazitaxel injection

9278 Incobotulinumtoxin A G $5.53

. $1.08

9278 J0588 Incobotulinumtoxin a

9279 "Injection, ibuprofen" G $1.62

. $0.32

9279 C9279 "Injection, ibuprofen"

9281 "Injection, pegloticase " G $301.75

. $59.22

9281 J2507 Pegloticase injection

9282 "Injection, ceftaroline fosamil " G $0.74

. $0.14

9282 J0712 Ceftaroline fosamil inj

9283 "Injection, acetaminophen" G $0.11

. $0.039283 J0131 Acetaminophen injection

9284 Ipilimumab injection G $127.20

. $24.96

9284 J9228 Ipilimumab injection

9285 "Patch, lidocaine/tetracaine" G $13.57

. $2.67

9285 C9285 "Patch, lidocaine/tetracaine"

9286 "Injection, belatacept" G $3.91

. $0.77

9286 C9286 "Injection, belatacept"

9287 "Inj, brentuximab vedotin" G $95.40

. $18.72

9287 C9287 "Inj, brentuximab vedotin"

9300 Omalizumab injection K $21.34

. $4.27

9300 J2357 Omalizumab injection

9358 "SurgiMend, fetal" K $10.91

. $2.19

9358 C9358 "SurgiMend, fetal"

9360 "SurgiMend, neonatal" K $11.23

. $2.25

9360 C9360 "SurgiMend, neonatal"

9363 Integra Meshed Bil Wound Mat K $20.60

. $4.12

9363 C9363 Integra Meshed Bil Wound Mat

9365 Oasis tri-layer wound matrix G $10.39

. $2.04

9365 Q4124 Oasis tri-layer wound matrix

9366 EpiFix wound cover G $177.77

. $34.89

9366 C9366 EpiFix wound cover

9367 Endoform Dermal Template G $4.35

. $0.86

9367 C9367 Endoform Dermal Template

9406 Iodine I-123 ioflupane G "$1,908.00" $0.00 $0.00

9406 A9584 Iodine i-123 ioflupane $0.00 $0.00

9500 "Platelets, irradiated" R 1.8342 $128.42

. $25.69

9500 P9032 "Platelets, irradiated"

9501 Platelet pheres leukoreduced R 7.6960 $538.84

. $107.77

9501 P9035 Platelet pheres leukoreduced

9502 Platelet pheresis irradiated R 7.9257 $554.93

. $110.99

9502 P9036 Platelet pheresis irradiated

9503 Fr frz plasma donor retested R 1.1562 $80.95

. $16.19

9503 P9060 Fr frz plasma donor retested

9504 RBC deglycerolized R 3.4084 $238.64

. $47.73

9504 P9039 RBC deglycerolized

9505 RBC irradiated R 2.8419 $198.98

. $39.80

9505 P9038 RBC irradiated

9506 "Granulocytes, pheresis unit" R 19.1478 "$1,340.65"

. $268.13

9506 P9050 "Granulocytes, pheresis unit"

9507 "Platelets, pheresis" R 6.3148 $442.14

. $88.43

9507 P9034 "Platelets, pheresis"

9508 Plasma 1 donor frz w/in 8 hr R 1.1408 $79.87

. $15.98

9508 P9017 Plasma 1 donor frz w/in 8 hr