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

APCHCPCSGroup TitleShort DescriptorSIRelative WeightPayment RateNational 

Unadjusted CopaymentMinimum Unadjusted Copayment

0001Level I PhotochemotherapyS0.5043$35.31.$7.07

000196900Ultraviolet light therapy

000196910Photochemotherapy with UV-B

000196912Photochemotherapy with UV-A

0002Fine Needle Biopsy/AspirationT1.6118$112.85.$22.57

000210021Fna w/o image

000219001Drain breast lesion add-on

000236680Insert needle bone cavity

0003Bone Marrow Biopsy/AspirationT3.5548$248.89.$49.78

000338220Bone marrow aspiration

000338221Bone marrow biopsy

0004Level I Needle Biopsy/ Aspiration Except Bone MarrowT4.5721$320.12.$64.03

000410022Fna w/image

000419000Drainage of breast lesion

000419100Bx breast percut w/o image

000420615Treatment of bone cyst

000447399Liver surgery procedure

000448999Pancreas surgery procedure

000454800Biopsy of epididymis

000455000Drainage of hydrocele

000460100Biopsy of thyroid

000460300Aspir/inj thyroid cyst

000462267Interdiscal perq aspir dx

0005Level II Needle Biopsy/Aspiration Except Bone MarrowT8.1596$571.30.$114.26

000519102Bx breast percut w/image

000520206Needle biopsy muscle

000538505Needle biopsy lymph nodes

000542400Biopsy of salivary gland

0006Level I Incision & DrainageT1.4209$99.49.$19.90

000610060Drainage of skin abscess

000610061Drainage of skin abscess

000610080Drainage of pilonidal cyst

000610160Puncture drainage of lesion

000620950Fluid pressure muscle

000621725Revision of neck muscle

000626010Drainage of finger abscess

000640800Drainage of mouth lesion

000641800Drainage of gum lesion

000669000Drain external ear lesion

000669020Drain outer ear canal lesion

0007Level II Incision & DrainageT12.8082$896.78.$179.36

000710081Drainage of pilonidal cyst

000710140Drainage of hematoma/fluid

000720103Explore wound extremity

000726011Drainage of finger abscess

000728001Drainage of bursa of foot

000738300Drainage lymph node lesion

000755100Drainage of scrotum abscess

000757022I & d vaginal hematoma pp

0008Level III Incision and DrainageT20.5510"$1,438.90".$287.78

000810180Complex drainage wound

000819020Incision of breast lesion

000821501Drain neck/chest lesion

000823030Drain shoulder lesion

000823031Drain shoulder bursa

000823930Drainage of arm lesion

000823931Drainage of arm bursa

000827301Drain thigh/knee lesion

000827603Drain lower leg lesion

000838305Drainage lymph node lesion

000851080Drainage of bladder abscess

000854015Drain penis lesion

000854115Treatment of penis lesion
000857023I & d vag hematoma non-ob

000869005Drain external ear lesion

0012Level I Debridement & DestructionT0.3878$27.15.$5.43

001211719Trim nail(s)

001211740Drain blood from under nail

001217003Destruct premalg les 2-14

001217999Skin tissue procedure

001296999Dermatological procedure

0012G0127Trim nail(s)

0013Level II Debridement & DestructionT0.8768$61.39.$12.28

001310040Acne surgery

001311001Debride infected skin add-on

001311055Trim skin lesion

001311056Trim skin lesions 2 to 4

001311101Biopsy skin add-on

001311200Removal of skin tags

001311201Remove skin tags add-on

001311300Shave skin lesion

001311301Shave skin lesion

001311302Shave skin lesion

001311305Shave skin lesion

001311306Shave skin lesion

001311307Shave skin lesion

001311310Shave skin lesion

001311311Shave skin lesion

001311720Debride nail 1-5

001311721Debride nail 6 or more

001311730Removal of nail plate

001311732Remove nail plate add-on

001311765Excision of nail fold toe

001311900Injection into skin lesions

001311901Added skin lesions injection

001315786Abrasion lesion single

001315787Abrasion lesions add-on

001315788Chemical peel face epiderm

001315793Chemical peel nonfacial

001316000Initial treatment of burn(s)

001317000Destruct premalg lesion

001317110Destruct b9 lesion 1-14

001317340Cryotherapy of skin

001336468Injection(s) spider veins

001354056Cryosurgery penis lesion(s)

001369220Clean out mastoid cavity

001397602Wound(s) care non-selective

001397605Neg press wound tx < 50 cm

0013G0247Routine footcare pt w lops

0015Level III Debridement & DestructionT1.4966$104.79.$20.96

00150183TWound ultrasound

001511057Trim skin lesions over 4

001511100Biopsy skin lesion

001511303Shave skin lesion

001511308Shave skin lesion

001511312Shave skin lesion

001511313Shave skin lesion

001515789Chemical peel face dermal

001515792Chemical peel nonfacial

001516020Dress/debrid p-thick burn s

001516025Dress/debrid p-thick burn m

001516030Dress/debrid p-thick burn l

001516035Incision of burn scab initi

001517111Destruct lesion 15 or more

001517250Chemical cautery tissue

001517260Destruction of skin lesions

001517261Destruction of skin lesions

001517262Destruction of skin lesions

001517263Destruction of skin lesions
001517264Destruction of skin lesions

001517270Destruction of skin lesions

001517271Destruction of skin lesions

001517272Destruction of skin lesions

001517280Destruction of skin lesions

001517360Skin peel therapy

001517380Hair removal by electrolysis

001536469Injection(s) spider veins

001536470Injection therapy of vein

001536471Injection therapy of veins

001545520Treatment of rectal prolapse

001546916Cryosurgery anal lesion(s)

001554050Destruction penis lesion(s)

001596567Photodynamic tx skin

001596570Photodynmc tx 30 min add-on

001596571Photodynamic tx addl 15 min

001596920Laser tx skin < 250 sq cm

001596921Laser tx skin 250-500 sq cm

001596922Laser tx skin > 500 sq cm

001597597Rmvl devital tis 20 cm/<

001597598Rmvl devital tis addl 20 cm<

001597606Neg press wound tx > 50 cm

0016Level IV Debridement & DestructionT2.7597$193.22.$38.65

001610120Remove foreign body

001611000Debride infected skin

001611042Deb subq tissue 20 sq cm/<

001611043Deb musc/fascia 20 sq cm/<

001611045Deb subq tissue add-on

001611046Deb musc/fascia add-on

001615783Abrasion treatment of skin

001615850Removal of sutures

001615851Removal of sutures

001617004Destroy premal lesions 15/>

001617106Destruction of skin lesions

001617107Destruction of skin lesions

001617108Destruction of skin lesions

001617266Destruction of skin lesions

001617273Destruction of skin lesions

001617274Destruction of skin lesions

001617276Destruction of skin lesions

001617281Destruction of skin lesions

001617282Destruction of skin lesions

001617283Destruction of skin lesions

001617284Destruction of skin lesions

001617286Destruction of skin lesions

001646900Destruction anal lesion(s)

0017Level V Debridement & DestructionT21.6700"$1,517.25".$303.45

001746910Destruction anal lesion(s)

001746917Laser surgery anal lesions

001746922Excision of anal lesion(s)

001746924Destruction anal lesion(s)

001754055Destruction penis lesion(s)

001754057Laser surg penis lesion(s)

001754060Excision of penis lesion(s)

001754065Destruction penis lesion(s)

001756501Destroy vulva lesions sim

001756515Destroy vulva lesion/s compl

0019Level I Excision/ BiopsyT4.3953$307.74.$61.55

001911010Debride skin at fx site

001911011Debride skin musc at fx site

001911012Deb skin bone at fx site

001911400Exc tr-ext b9+marg 0.5 < cm

001911401Exc tr-ext b9+marg 0.6-1 cm

001911402Exc tr-ext b9+marg 1.1-2 cm

001911440Exc face-mm b9+marg 0.5 < cm

001911441Exc face-mm b9+marg 0.6-1 cm
001911601Exc tr-ext mal+marg 0.6-1 cm

001911602Exc tr-ext mal+marg 1.1-2 cm

001911621Exc s/n/h/f/g mal+mrg 0.6-1

001911640Exc f/e/e/n/l mal+mrg 0.5cm<

001911641Exc f/e/e/n/l mal+mrg 0.6-1

001911642Exc f/e/e/n/l mal+mrg 1.1-2

001911750Removal of nail bed

001911755Biopsy nail unit

001911976Removal of contraceptive cap

001915781Abrasion treatment of skin

001915782Abrasion treatment of skin

001915920Removal of tail bone ulcer

001915999Removal of pressure sore

001920520Removal of foreign body

001924200Removal of arm foreign body

001941108Biopsy of floor of mouth

0020Level II Excision/ BiopsyT8.2918$580.56.$116.12

002011044Deb bone 20 sq cm/<

002011047Deb bone add-on

002011403Exc tr-ext b9+marg 2.1-3 cm

002011420Exc h-f-nk-sp b9+marg 0.5 <

002011421Exc h-f-nk-sp b9+marg 0.6-1

002011422Exc h-f-nk-sp b9+marg 1.1-2

002011442Exc face-mm b9+marg 1.1-2 cm

002011443Exc face-mm b9+marg 2.1-3 cm

002011444Exc face-mm b9+marg 3.1-4 cm

002011600Exc tr-ext mal+marg 0.5 < cm

002011603Exc tr-ext mal+marg 2.1-3 cm

002011604Exc tr-ext mal+marg 3.1-4 cm

002011620Exc h-f-nk-sp mal+marg 0.5 <

002011622Exc s/n/h/f/g mal+mrg 1.1-2

002011643Exc f/e/e/n/l mal+mrg 2.1-3

002020005I&d abscess subfascial

002020220Bone biopsy trocar/needle

002021011Exc face les sc < 2 cm

002021012Exc face les sbq 2 cm/>

002021013Exc face tum deep < 2 cm

002021014Exc face tum deep 2 cm/>

002021920Biopsy soft tissue of back

002023065Biopsy shoulder tissues

002023330Remove shoulder foreign body

002025065Biopsy forearm soft tissues

002027040Biopsy of soft tissues

002027041Biopsy of soft tissues

002027086Remove hip foreign body

002027323Biopsy thigh soft tissues

002027613Biopsy lower leg soft tissue

002028190Removal of foot foreign body

002028193Removal of foot foreign body

002033284Remove pat-active ht record

002035226Repair blood vessel lesion

0021Level III Excision/ BiopsyT16.9957"$1,189.97".$238.00

002110121Remove foreign body

002111404Exc tr-ext b9+marg 3.1-4 cm

002111406Exc tr-ext b9+marg > 4.0 cm

002111423Exc h-f-nk-sp b9+marg 2.1-3

002111424Exc h-f-nk-sp b9+marg 3.1-4

002111606Exc tr-ext mal+marg > 4 cm

002111623Exc s/n/h/f/g mal+mrg 2.1-3

002111624Exc s/n/h/f/g mal+mrg 3.1-4

002111644Exc f/e/e/n/l mal+mrg 3.1-4

002115836Excise excessive skin tissue

002115837Excise excessive skin tissue

002115838Excise excessive skin tissue

002115839Excise excessive skin tissue

002119260Removal of chest wall lesion
002120200Muscle biopsy

002120205Deep muscle biopsy

002120225Bone biopsy trocar/needle

002120670Removal of support implant

002121015Resect face tum < 2 cm

002121550Biopsy of neck/chest

002121555Exc neck les sc < 3 cm

002121557Resect neck tum < 5 cm

002121930Exc back les sc < 3 cm

002121932Exc back tum deep < 5 cm

002121935Resect back tum < 5 cm

002122902Exc abd les sc < 3 cm

002122904Resect abd tum < 5 cm

002123000Removal of calcium deposits

002123075Exc shoulder les sc < 3 cm

002123076Exc shoulder tum deep < 5 cm

002123077Resect shoulder tum < 5 cm

002124065Biopsy arm/elbow soft tissue

002124066Biopsy arm/elbow soft tissue

002124075Exc arm/elbow les sc < 3 cm

002124076Ex arm/elbow tum deep < 5 cm

002124077Resect arm/elbow tum < 5 cm

002124201Removal of arm foreign body

002125075Exc forearm les sc < 3 cm

002125076Exc forearm tum deep < 3 cm

002125077Resect forearm/wrist tum<3cm

002126115Exc hand les sc < 1.5 cm

002126116Exc hand tum deep < 1.5 cm

002126117Exc hand tum ra < 3 cm

002126320Removal of implant from hand

002127047Exc hip/pelvis les sc < 3 cm

002127048Exc hip/pelv tum deep < 5 cm

002127049Resect hip/pelv tum < 5 cm

002127328Exc thigh/knee tum deep <5cm

002127329Resect thigh/knee tum < 5 cm

002127615Resect leg/ankle tum < 5 cm

002127618Exc leg/ankle tum < 3 cm

002127619Exc leg/ankle tum deep <5 cm

002128043Exc foot/toe tum sc < 1.5 cm

002128045Exc foot/toe tum deep <1.5cm

002128046Resect foot/toe tumor < 3 cm

002128192Removal of foot foreign body

002137609Temporal artery procedure

002154100Biopsy of penis

002169110Remove external ear partial

002169145Remove ear canal lesion(s)

0022Level IV Excision/ BiopsyT23.2636"$1,628.82"$350.74$325.77

002211426Exc h-f-nk-sp b9+marg > 4 cm

002211446Exc face-mm b9+marg > 4 cm

002211450Removal sweat gland lesion

002211451Removal sweat gland lesion

002211462Removal sweat gland lesion

002211463Removal sweat gland lesion

002211470Removal sweat gland lesion

002211471Removal sweat gland lesion

002211626Exc s/n/h/f/g mal+mrg > 4 cm

002211646Exc f/e/e/n/l mal+mrg > 4 cm

002211752Remove nail bed/finger tip

002211770Removal of pilonidal lesion

002211771Removal of pilonidal lesion

002211772Removal of pilonidal lesion

002211971Remove tissue expander(s)

002215780Abrasion treatment of skin

002215830Exc skin abd

002215832Excise excessive skin tissue

002215833Excise excessive skin tissue
002215834Excise excessive skin tissue

002215835Excise excessive skin tissue

002215847Exc skin abd add-on

002215931Remove sacrum pressure sore

002215933Remove sacrum pressure sore

002215940Remove hip pressure sore

002215941Remove hip pressure sore

002215950Remove thigh pressure sore

002215951Remove thigh pressure sore

002220240Bone biopsy excisional

002220245Bone biopsy excisional

002220525Removal of foreign body

002220680Removal of support implant

002221016Resect face tum 2 cm/>

002221552Exc neck les sc 3 cm/>

002221554Exc neck tum deep 5 cm/>

002221556Exc neck tum deep < 5 cm

002221558Resect neck tum 5 cm/>

002221925Biopsy soft tissue of back

002221931Exc back les sc 3 cm/>

002221933Exc back tum deep 5 cm/>

002221936Resect back tum 5 cm/>

002222900Exc abdl tum deep < 5 cm

002222901Exc abdl tum deep 5 cm/>

002222903Exc abd les sc 3 cm/>

002222905Resect abd tum 5 cm/>

002223066Biopsy shoulder tissues

002223071Exc shoulder les sc 3 cm/>

002223073Exc shoulder tum deep 5 cm/>

002223078Resect shoulder tum 5 cm/>

002223331Remove shoulder foreign body

002224071Exc arm/elbow les sc 3 cm/>

002224073Ex arm/elbow tum deep 5 cm/>

002224079Resect arm/elbow tum 5 cm/>

002225066Biopsy forearm soft tissues

002225071Exc forearm les sc 3 cm/>

002225073Exc forearm tum deep 3 cm/>

002225078Resect forarm/wrist tum 3cm>

002226111Exc hand les sc 1.5 cm/>

002226113Exc hand tum deep 1.5 cm/>

002226118Exc hand tum ra 3 cm/>

002227043Exc hip pelvis les sc 3 cm/>

002227045Exc hip/pelv tum deep 5 cm/>

002227059Resect hip/pelv tum 5 cm/>

002227324Biopsy thigh soft tissues

002227327Exc thigh/knee les sc < 3 cm

002227337Exc thigh/knee les sc 3 cm/>

002227339Exc thigh/knee tum dep 5cm/>

002227364Resect thigh/knee tum 5 cm/>

002227372Removal of foreign body

002227614Biopsy lower leg soft tissue

002227616Resect leg/ankle tum 5 cm/>

002227632Exc leg/ankle les sc 3 cm/>

002227634Exc leg/ankle tum dep 5 cm/>

002228039Exc foot/toe tum sc 1.5 cm/>

002228041Exc foot/toe tum dep 1.5cm/>

002228047Resect foot/toe tumor 3 cm/>

002254105Biopsy of penis

002260512Autotransplant parathyroid

002269205Clear outer ear canal

0028Level I Breast SurgeryT25.5066"$1,785.87".$357.18

002819101Biopsy of breast open

002819110Nipple exploration

002819112Excise breast duct fistula

002819120Removal of breast lesion

002819125Excision breast lesion
002819126Excision addl breast lesion

002819300Removal of breast tissue

002819301Partical mastectomy

002819350Breast reconstruction

002819499Breast surgery procedure

0028C9726Rxt breast appl place/remov

0029Level II Breast SurgeryT33.3398"$2,334.32"$580.94$466.87

002919105Cryosurg ablate fa each

002919303Mast simple complete

002919304Mast subq

002919316Suspension of breast

002919328Removal of breast implant

002919330Removal of implant material

002919355Correct inverted nipple(s)

002919366Breast reconstruction

002919370Surgery of breast capsule

002919371Removal of breast capsule

002919396Design custom breast implant

0030Level III Breast SurgeryT45.0217"$3,152.24"$747.07$630.45

003019302P-mastectomy w/ln removal

003019307Mast mod rad

003019318Reduction of large breast

003019324Enlarge breast

003019340Immediate breast prosthesis

003019380Revise breast reconstruction

0031Smoking Cessation ServicesX0.2988$20.92.$4.19

003199406Behav chng smoking 3-10 min

003199407Behav chng smoking > 10 min

0031G0436Tobacco-use counsel 3-10 min$0.00$0.00

0031G0437Tobacco-use counsel>10min$0.00$0.00

0035Vascular Puncture and Minor Diagnostic ProceduresX0.2673$18.72.$3.75

00350208TAudiometry air only

00350209TAudiometry air & bone

00350210TSpeech audiometry threshold

00350211TSpeech audiom thresh & recog

003536420Vein access cutdown < 1 yr

003536425Vein access cutdown > 1 yr

003536600Withdrawal of arterial blood

003576514Echo exam of eye thickness

003592227Remote dx retinal imaging

003592228Remote retinal imaging mgmt

003593041Rhythm ecg tracing

003593278ECG/signal-averaged

003593290Icm device eval

003593998Noninvas vasc dx study proc

0037Level IV Needle Biopsy/Aspiration Except Bone 

MarrowT15.3535"$1,074.99"$227.40$215.00

003719103Bx breast percut w/device

003744901Drain app abscess percut

003747011Percut drain liver lesion

003748511Drain pancreatic pseudocyst

003749021Drain abdominal abscess

003749041Drain percut abdom abscess

003749061Drain percut retroper absc

003750021Renal abscess percut drain

003754500Biopsy of testis

0039Level I Implantation of Neurostimulator 

GeneratorS216.9330"$15,188.78"."$3,037.76"

00390268TImplt/rpl crtd sns dev gen

003961885Insrt/redo neurostim 1 array

003963685Insrt/redo spine n generator

003964590Insrt/redo pn/gastr stimul

0040Level I Implantation/Revision/Replacement of Neurostimulator 

ElectrodesS63.3729"$4,437.12".$887.43

00400282TPeriph field stimul trial

004063650Implant neuroelectrodes
004063663Revise spine eltrd perq aray

004063664Revise spine eltrd plate

004064553Implant neuroelectrodes

004064555Implant neuroelectrodes

004064561Implant neuroelectrodes

004064565Implant neuroelectrodes

0041Level I ArthroscopyT29.7721"$2,084.52".$416.91

004129800Jaw arthroscopy/surgery

004129804Jaw arthroscopy/surgery

004129805Shoulder arthroscopy dx

004129822Shoulder arthroscopy/surgery

004129824Shoulder arthroscopy/surgery

004129826Shoulder arthroscopy/surgery

004129830Elbow arthroscopy

004129834Elbow arthroscopy/surgery

004129835Elbow arthroscopy/surgery

004129836Elbow arthroscopy/surgery

004129837Elbow arthroscopy/surgery

004129838Elbow arthroscopy/surgery

004129840Wrist arthroscopy

004129843Wrist arthroscopy/surgery

004129844Wrist arthroscopy/surgery

004129845Wrist arthroscopy/surgery

004129846Wrist arthroscopy/surgery

004129848Wrist endoscopy/surgery

004129850Knee arthroscopy/surgery

004129870Knee arthroscopy dx

004129871Knee arthroscopy/drainage

004129873Knee arthroscopy/surgery

004129874Knee arthroscopy/surgery

004129875Knee arthroscopy/surgery

004129876Knee arthroscopy/surgery

004129877Knee arthroscopy/surgery

004129879Knee arthroscopy/surgery

004129880Knee arthroscopy/surgery

004129881Knee arthroscopy/surgery

004129882Knee arthroscopy/surgery

004129883Knee arthroscopy/surgery

004129884Knee arthroscopy/surgery

004129886Knee arthroscopy/surgery

004129887Knee arthroscopy/surgery

004129894Ankle arthroscopy/surgery

004129895Ankle arthroscopy/surgery

004129897Ankle arthroscopy/surgery

004129898Ankle arthroscopy/surgery

004129900Mcp joint arthroscopy dx

004129901Mcp joint arthroscopy surg

004129902Mcp joint arthroscopy surg

004129904Subtalar arthro w/fb rmvl

004129905Subtalar arthro w/exc

004129906Subtalar arthro w/deb

004129999Arthroscopy of joint

0042Level II ArthroscopyT57.0707"$3,995.86"$804.74$799.18

004229806Shoulder arthroscopy/surgery

004229807Shoulder arthroscopy/surgery

004229819Shoulder arthroscopy/surgery

004229820Shoulder arthroscopy/surgery

004229821Shoulder arthroscopy/surgery

004229823Shoulder arthroscopy/surgery

004229825Shoulder arthroscopy/surgery

004229827Arthroscop rotator cuff repr

004229828Arthroscopy biceps tenodesis

004229847Wrist arthroscopy/surgery

004229851Knee arthroscopy/surgery

004229855Tibial arthroscopy/surgery

004229856Tibial arthroscopy/surgery
004229860Hip arthroscopy dx

004229861Hip arthro w/fb removal

004229862Hip arthr0 w/debridement

004229863Hip arthr0 w/synovectomy

004229866Autgrft implnt knee w/scope

004229867Allgrft implnt knee w/scope

004229868Meniscal trnspl knee w/scpe

004229885Knee arthroscopy/surgery

004229891Ankle arthroscopy/surgery

004229899Ankle arthroscopy/surgery

004229907Subtalar arthro w/fusion

004229914Hip arthro w/femoroplasty

004229915Hip arthro acetabuloplasty

004229916Hip arthro w/labral repair

0045Bone/Joint Manipulation Under AnesthesiaT15.4596"$1,082.42"$268.44$216.49

004522505Manipulation of spine

004523655Treat shoulder dislocation

004523700Fixation of shoulder

004524300Manipulate elbow w/anesth

004524605Treat elbow dislocation

004526775Treat finger dislocation

004527194Treat pelvic ring fracture

004527252Treat hip dislocation

004527257Treat hip dislocation

004527266Treat hip dislocation

004527275Manipulation of hip joint

004527552Treat knee dislocation

004527562Treat kneecap dislocation

004527570Fixation of knee joint

004527842Treat ankle dislocation

004527860Fixation of ankle joint

004528635Treat toe dislocation

004528665Treat toe dislocation

0047Arthroplasty without ProsthesisT41.2873"$2,890.77".$578.16

004724360Reconstruct elbow joint

004724365Reconstruct head of radius

004725332Revise wrist joint

004725447Repair wrist joints

004725449Remove wrist joint implant

004726530Revise knuckle joint

004726535Revise finger joint

004727437Revise kneecap

004727440Revision of knee joint

004727441Revision of knee joint

004727442Revision of knee joint

004727443Revision of knee joint

004727700Revision of ankle joint

0048Level I Arthroplasty or Implantation with 

ProsthesisT60.9147"$4,265.00".$853.00

004824362Reconstruct elbow joint

004825443Reconstruct wrist joint

004825444Reconstruct wrist joint

004825445Reconstruct wrist joint

004826531Revise knuckle with implant

004826536Revise/implant finger joint

004827438Revise kneecap with implant

0049Level I Musculoskeletal Procedures Except Hand and 

FootT22.0797"$1,545.93".$309.19

004920662Application of pelvis brace

004920694Remove bone fixation device

004920999Musculoskeletal surgery

004921502Drain chest lesion

004921700Revision of neck muscle

004921720Revision of neck muscle

004922999Abdomen surgery procedure

004923035Drain shoulder bone lesion
004923100Biopsy of shoulder joint

004923140Removal of bone lesion

004923935Drain arm/elbow bone lesion

004924100Biopsy elbow joint lining

004924105Removal of elbow bursa

004924110Remove humerus lesion

004924120Remove elbow lesion

004924310Revision of arm tendon

004924925Amputation follow-up surgery

004925000Incision of tendon sheath

004925001Incise flexor carpi radialis

004925028Drainage of forearm lesion

004925031Drainage of forearm bursa

004925035Treat forearm bone lesion

004925085Incision of wrist capsule

004925100Biopsy of wrist joint

004925109Excise tendon forearm/wrist

004925110Remove wrist tendon lesion

004925111Remove wrist tendon lesion

004925112Reremove wrist tendon lesion

004925115Remove wrist/forearm lesion

004925116Remove wrist/forearm lesion

004925248Remove forearm foreign body

004925295Release wrist/forearm tendon

004925907Amputation follow-up surgery

004925909Amputation follow-up surgery

004925922Amputate hand at wrist

004925931Amputation follow-up surgery

004926990Drainage of pelvis lesion

004926991Drainage of pelvis bursa

004927000Incision of hip tendon

004927050Biopsy of sacroiliac joint

004927052Biopsy of hip joint

004927057Buttock fasciotomy w/dbrdmt

004927060Removal of ischial bursa

004927062Remove femur lesion/bursa

004927065Remove hip bone les super

004927087Remove hip foreign body

004927305Incise thigh tendon & fascia

004927306Incision of thigh tendon

004927340Removal of kneecap bursa

004927345Removal of knee cyst

004927347Remove knee cyst

004927390Incision of thigh tendon

004927391Incision of thigh tendons

004927497Decompression of thigh/knee

004927594Amputation follow-up surgery

004927600Decompression of lower leg

004927601Decompression of lower leg

004927606Incision of achilles tendon

004927607Treat lower leg bone lesion

004927630Removal of tendon lesion

004927656Repair leg fascia defect

004927658Repair of leg tendon each

004927659Repair of leg tendon each

004927675Repair lower leg tendons

004927704Removal of ankle implant

004927884Amputation follow-up surgery

004928002Treatment of foot infection

004928003Treatment of foot infection

0050Level II Musculoskeletal Procedures Except Hand and 

FootT32.4461"$2,271.75".$454.35

00500101TExtracorp shockwv tx hi enrg

00500102TExtracorp shockwv tx anesth

00500200TPerq sacral augmt unilat inj

00500201TPerq sacral augmt bilat inj
00500221TPlmt post facet implt lumb

00500222TPlmt post facet implt addl

005020250Open bone biopsy

005020251Open bone biopsy

005020555Place ndl musc/tis for rt

005020650Insert and remove bone pin

005020663Application of thigh brace

005020690Apply bone fixation device

005020692Apply bone fixation device

005020693Adjust bone fixation device

005020696Comp multiplane ext fixation

005020900Removal of bone for graft

005020902Removal of bone for graft

005020924Removal of tendon for graft

005021600Partial removal of rib

005021610Partial removal of rib

005022520Percut vertebroplasty thor

005022521Percut vertebroplasty lumb

005022522Percut vertebroplasty addl

005022851Apply spine prosth device

005022899Spine surgery procedure

005023020Release shoulder joint

005023040Exploratory shoulder surgery

005023044Exploratory shoulder surgery

005023101Shoulder joint surgery

005023105Remove shoulder joint lining

005023106Incision of collarbone joint

005023107Explore treat shoulder joint

005023120Partial removal collar bone

005023125Removal of collar bone

005023145Removal of bone lesion

005023146Removal of bone lesion

005023150Removal of humerus lesion

005023155Removal of humerus lesion

005023156Removal of humerus lesion

005023170Remove collar bone lesion

005023172Remove shoulder blade lesion

005023174Remove humerus lesion

005023180Remove collar bone lesion

005023182Remove shoulder blade lesion

005023184Remove humerus lesion

005023190Partial removal of scapula

005023195Removal of head of humerus

005023400Fixation of shoulder blade

005023405Incision of tendon & muscle

005023406Incise tendon(s) & muscle(s)

005023440Remove/transplant tendon

005024000Exploratory elbow surgery

005024006Release elbow joint

005024101Explore/treat elbow joint

005024102Remove elbow joint lining

005024115Remove/graft bone lesion

005024116Remove/graft bone lesion

005024125Remove/graft bone lesion

005024126Remove/graft bone lesion

005024130Removal of head of radius

005024134Removal of arm bone lesion

005024136Remove radius bone lesion

005024138Remove elbow bone lesion

005024140Partial removal of arm bone

005024145Partial removal of radius

005024147Partial removal of elbow

005024149Radical resection of elbow

005024155Removal of elbow joint

005024160Remove elbow joint implant

005024164Remove radius head implant
005024301Muscle/tendon transfer

005024305Arm tendon lengthening

005024320Repair of arm tendon

005024332Tenolysis triceps

005024343Repr elbow lat ligmnt w/tiss

005024345Repr elbw med ligmnt w/tissu

005024357Repair elbow perc

005024358Repair elbow w/deb open

005024359Repair elbow deb/attch open

005024495Decompression of forearm

005025020Decompress forearm 1 space

005025023Decompress forearm 1 space

005025024Decompress forearm 2 spaces

005025025Decompress forearm 2 spaces

005025040Explore/treat wrist joint

005025101Explore/treat wrist joint

005025105Remove wrist joint lining

005025107Remove wrist joint cartilage

005025118Excise wrist tendon sheath

005025119Partial removal of ulna

005025120Removal of forearm lesion

005025125Remove/graft forearm lesion

005025126Remove/graft forearm lesion

005025130Removal of wrist lesion

005025135Remove & graft wrist lesion

005025136Remove & graft wrist lesion

005025145Remove forearm bone lesion

005025150Partial removal of ulna

005025151Partial removal of radius

005025170Resect radius/ulnar tumor

005025210Removal of wrist bone

005025215Removal of wrist bones

005025230Partial removal of radius

005025240Partial removal of ulna

005025250Removal of wrist prosthesis

005025251Removal of wrist prosthesis

005025260Repair forearm tendon/muscle

005025263Repair forearm tendon/muscle

005025265Repair forearm tendon/muscle

005025270Repair forearm tendon/muscle

005025272Repair forearm tendon/muscle

005025274Repair forearm tendon/muscle

005025275Repair forearm tendon sheath

005025280Revise wrist/forearm tendon

005025290Incise wrist/forearm tendon

005025300Fusion of tendons at wrist

005025301Fusion of tendons at wrist

005025310Transplant forearm tendon

005025315Revise palsy hand tendon(s)

005025392Shorten radius & ulna

005027001Incision of hip tendon

005027003Incision of hip tendon

005027006Incision of hip tendons

005027027Buttock fasciotomy

005027035Denervation of hip joint

005027066Remove hip bone les deep

005027067Remove/graft hip bone lesion

005027080Removal of tail bone

005027097Revision of hip tendon

005027098Transfer tendon to pelvis

005027235Treat thigh fracture

005027307Incision of thigh tendons

005027310Exploration of knee joint

005027330Biopsy knee joint lining

005027331Explore/treat knee joint

005027332Removal of knee cartilage
005027333Removal of knee cartilage

005027334Remove knee joint lining

005027335Remove knee joint lining

005027350Removal of kneecap

005027355Remove femur lesion

005027356Remove femur lesion/graft

005027357Remove femur lesion/graft

005027358Remove femur lesion/fixation

005027360Partial removal leg bone(s)

005027380Repair of kneecap tendon

005027381Repair/graft kneecap tendon

005027385Repair of thigh muscle

005027386Repair/graft of thigh muscle

005027392Incision of thigh tendons

005027393Lengthening of thigh tendon

005027394Lengthening of thigh tendons

005027396Transplant of thigh tendon

005027403Repair of knee cartilage

005027425Lat retinacular release open

005027435Incision of knee joint

005027475Surgery to stop leg growth

005027479Surgery to stop leg growth

005027496Decompression of thigh/knee

005027498Decompression of thigh/knee

005027499Decompression of thigh/knee

005027602Decompression of lower leg

005027604Drain lower leg bursa

005027610Explore/treat ankle joint

005027612Exploration of ankle joint

005027620Explore/treat ankle joint

005027625Remove ankle joint lining

005027626Remove ankle joint lining

005027635Remove lower leg bone lesion

005027637Remove/graft leg bone lesion

005027638Remove/graft leg bone lesion

005027640Partial removal of tibia

005027641Partial removal of fibula

005027647Resect talus/calcaneus tum

005027664Repair of leg tendon each

005027665Repair of leg tendon each

005027676Repair lower leg tendons

005027680Release of lower leg tendon

005027681Release of lower leg tendons

005027685Revision of lower leg tendon

005027686Revise lower leg tendons

005027687Revision of calf tendon

005027695Repair of ankle ligament

005027696Repair of ankle ligaments

005027698Repair of ankle ligament

005027707Incision of fibula

005027709Incision of tibia & fibula

005027730Repair of tibia epiphysis

005027732Repair of fibula epiphysis

005027734Repair lower leg epiphyses

005027740Repair of leg epiphyses

005027889Amputation of foot at ankle

005027892Decompression of leg

005027893Decompression of leg

005027894Decompression of leg

005028890High energy eswt plantar f

0050G0413Pelvic ring fracture uni/bil

0051Level III Musculoskeletal Procedures Except Hand and 

FootT47.5032"$3,325.98".$665.20

005111970Replace tissue expander

005120150Excise epiphyseal bar

005120982Ablate bone tumor(s) perq
005121742Repair stern/nuss w/o scope

005121743Repair sternum/nuss w/scope

005123130Remove shoulder bone part

005123395Muscle transfer shoulder/arm

005123410Repair rotator cuff acute

005123412Repair rotator cuff chronic

005123415Release of shoulder ligament

005123420Repair of shoulder

005123430Repair biceps tendon

005123462Repair shoulder capsule

005123466Repair shoulder capsule

005123480Revision of collar bone

005124150Resect distal humerus tumor

005124152Resect radius tumor

005124331Revision of arm muscles

005124340Repair of biceps tendon

005124341Repair arm tendon/muscle

005124342Repair of ruptured tendon

005124410Revision of humerus

005124420Revision of humerus

005124470Revision of elbow joint

005124800Fusion of elbow joint

005125312Transplant forearm tendon

005125320Repair/revise wrist joint

005125335Realignment of hand

005125337Reconstruct ulna/radioulnar

005125350Revision of radius

005125355Revision of radius

005125360Revision of ulna

005125370Revise radius or ulna

005125375Revise radius & ulna

005125390Shorten radius or ulna

005125393Lengthen radius & ulna

005125394Repair carpal bone shorten

005125426Repair/graft radius & ulna

005125430Vasc graft into carpal bone

005125431Repair nonunion carpal bone

005125450Revision of wrist joint

005125455Revision of wrist joint

005125490Reinforce radius

005125491Reinforce ulna

005125492Reinforce radius and ulna

005125820Fusion of hand bones

005127033Exploration of hip joint

005127100Transfer of abdominal muscle

005127105Transfer of spinal muscle

005127110Transfer of iliopsoas muscle

005127111Transfer of iliopsoas muscle

005127395Lengthening of thigh tendons

005127397Transplants of thigh tendons

005127400Revise thigh muscles/tendons

005127405Repair of knee ligament

005127416Osteochondral knee autograft

005127418Repair degenerated kneecap

005127420Revision of unstable kneecap

005127422Revision of unstable kneecap

005127424Revision/removal of kneecap

005127430Revision of thigh muscles

005127650Repair achilles tendon

005127654Repair of achilles tendon

005127690Revise lower leg tendon

005127691Revise lower leg tendon

005127692Revise additional leg tendon

005127705Incision of tibia

005127742Repair of leg epiphyses
0052Level IV Musculoskeletal Procedures Except Hand and 

FootT88.8483"$6,220.80"."$1,244.16"

00520171TLumbar spine proces distract

00520172TLumbar spine process addl

005222523Percut kyphoplasty thor

005222524Percut kyphoplasty lumbar

005222525Percut kyphoplasty add-on

005223397Muscle transfers

005223450Repair shoulder capsule

005223455Repair shoulder capsule

005223460Repair shoulder capsule

005223465Repair shoulder capsule

005223485Revision of collar bone

005223490Reinforce clavicle

005223491Reinforce shoulder bones

005223800Fusion of shoulder joint

005223802Fusion of shoulder joint

005224330Revision of arm muscles

005224344Reconstruct elbow lat ligmnt

005224346Reconstruct elbow med ligmnt

005224400Revision of humerus

005224430Repair of humerus

005224435Repair humerus with graft

005224498Reinforce humerus

005224802Fusion/graft of elbow joint

005224935Revision of amputation

005225316Revise palsy hand tendon(s)

005225365Revise radius & ulna

005225391Lengthen radius or ulna

005225400Repair radius or ulna

005225405Repair/graft radius or ulna

005225415Repair radius & ulna

005225420Repair/graft radius & ulna

005225425Repair/graft radius or ulna

005225440Repair/graft wrist bone

005225800Fusion of wrist joint

005225805Fusion/graft of wrist joint

005225810Fusion/graft of wrist joint

005225825Fuse hand bones with graft

005225830Fusion radioulnar jnt/ulna

005227179Revise head/neck of femur

005227407Repair of knee ligament

005227409Repair of knee ligaments

005227412Autochondrocyte implant knee

005227415Osteochondral knee allograft

005227427Reconstruction knee

005227428Reconstruction knee

005227429Reconstruction knee

005227652Repair/graft achilles tendon

005227745Reinforce tibia

005227870Fusion of ankle joint open

005227871Fusion of tibiofibular joint

005228715Fusion of foot bones

005229888Knee arthroscopy/surgery

005229889Knee arthroscopy/surgery

005229892Ankle arthroscopy/surgery

0053Level I Hand Musculoskeletal ProceduresT17.1902"$1,203.59"$253.49$240.72

005326020Drain hand tendon sheath

005326025Drainage of palm bursa

005326030Drainage of palm bursas

005326034Treat hand bone lesion

005326035Decompress fingers/hand

005326037Decompress fingers/hand

005326040Release palm contracture

005326055Incise finger tendon sheath

005326060Incision of finger tendon

005326070Explore/treat hand joint
005326075Explore/treat finger joint

005326080Explore/treat finger joint

005326100Biopsy hand joint lining

005326105Biopsy finger joint lining

005326110Biopsy finger joint lining

005326125Release palm contracture

005326130Remove wrist joint lining

005326140Revise finger joint each

005326145Tendon excision palm/finger

005326160Remove tendon sheath lesion

005326170Removal of palm tendon each

005326180Removal of finger tendon

005326185Remove finger bone

005326200Remove hand bone lesion

005326210Removal of finger lesion

005326215Remove/graft finger lesion

005326230Partial removal of hand bone

005326235Partial removal finger bone

005326236Partial removal finger bone

005326250Extensive hand surgery

005326260Resect prox finger tumor

005326262Resect distal finger tumor

005326410Repair hand tendon

005326418Repair finger tendon

005326432Repair finger tendon

005326433Repair finger tendon

005326437Realignment of tendons

005326440Release palm/finger tendon

005326445Release hand/finger tendon

005326450Incision of palm tendon

005326455Incision of finger tendon

005326460Incise hand/finger tendon

005326471Fusion of finger tendons

005326474Fusion of finger tendons

005326476Tendon lengthening

005326477Tendon shortening

005326478Lengthening of hand tendon

005326479Shortening of hand tendon

005326500Hand tendon reconstruction

005326508Release thumb contracture

005326520Release knuckle contracture

005326525Release finger contracture

005326540Repair hand joint

005326542Repair hand joint with graft

005326560Repair of web finger

005326580Repair hand deformity

005326587Reconstruct extra finger

005326590Repair finger deformity

005326593Release muscles of hand

005326596Excision constricting tissue

005326951Amputation of finger/thumb

005326952Amputation of finger/thumb

0054Level II Hand Musculoskeletal ProceduresT28.8625"$2,020.84".$404.17

005420822Replantation digit complete

005426045Release palm contracture

005426121Release palm contracture

005426123Release palm contracture

005426135Revise finger joint each

005426205Remove/graft bone lesion

005426350Repair finger/hand tendon

005426352Repair/graft hand tendon

005426356Repair finger/hand tendon

005426357Repair finger/hand tendon

005426358Repair/graft hand tendon

005426370Repair finger/hand tendon

005426372Repair/graft hand tendon
005426373Repair finger/hand tendon

005426390Revise hand/finger tendon

005426392Repair/graft hand tendon

005426412Repair/graft hand tendon

005426415Excision hand/finger tendon

005426416Graft hand or finger tendon

005426420Repair/graft finger tendon

005426426Repair finger/hand tendon

005426428Repair/graft finger tendon

005426434Repair/graft finger tendon

005426442Release palm & finger tendon

005426449Release forearm/hand tendon

005426480Transplant hand tendon

005426483Transplant/graft hand tendon

005426485Transplant palm tendon

005426489Transplant/graft palm tendon

005426490Revise thumb tendon

005426492Tendon transfer with graft

005426494Hand tendon/muscle transfer

005426496Revise thumb tendon

005426497Finger tendon transfer

005426498Finger tendon transfer

005426499Revision of finger

005426502Hand tendon reconstruction

005426510Thumb tendon transfer

005426516Fusion of knuckle joint

005426517Fusion of knuckle joints

005426518Fusion of knuckle joints

005426541Repair hand joint with graft

005426545Reconstruct finger joint

005426546Repair nonunion hand

005426548Reconstruct finger joint

005426550Construct thumb replacement

005426555Positional change of finger

005426561Repair of web finger

005426562Repair of web finger

005426565Correct metacarpal flaw

005426567Correct finger deformity

005426568Lengthen metacarpal/finger

005426591Repair muscles of hand

005426820Thumb fusion with graft

005426841Fusion of thumb

005426842Thumb fusion with graft

005426843Fusion of hand joint

005426844Fusion/graft of hand joint

005426850Fusion of knuckle

005426852Fusion of knuckle with graft

005426860Fusion of finger joint

005426861Fusion of finger jnt add-on

005426862Fusion/graft of finger joint

005426863Fuse/graft added joint

005426910Amputate metacarpal bone

005464821Remove sympathetic nerves

005464822Remove sympathetic nerves

005464823Remove sympathetic nerves

0055Level I Foot Musculoskeletal ProceduresT22.0963"$1,547.09"$353.25$309.42

005527605Incision of achilles tendon

005528005Treat foot bone lesion

005528008Incision of foot fascia

005528010Incision of toe tendon

005528011Incision of toe tendons

005528020Exploration of foot joint

005528022Exploration of foot joint

005528024Exploration of toe joint

005528050Biopsy of foot joint lining

005528052Biopsy of foot joint lining
005528054Biopsy of toe joint lining

005528060Partial removal foot fascia

005528062Removal of foot fascia

005528070Removal of foot joint lining

005528072Removal of foot joint lining

005528080Removal of foot lesion

005528086Excise foot tendon sheath

005528088Excise foot tendon sheath

005528090Removal of foot lesion

005528092Removal of toe lesions

005528100Removal of ankle/heel lesion

005528104Removal of foot lesion

005528108Removal of toe lesions

005528110Part removal of metatarsal

005528111Part removal of metatarsal

005528112Part removal of metatarsal

005528113Part removal of metatarsal

005528114Removal of metatarsal heads

005528116Revision of foot

005528118Removal of heel bone

005528119Removal of heel spur

005528120Part removal of ankle/heel

005528122Partial removal of foot bone

005528124Partial removal of toe

005528126Partial removal of toe

005528130Removal of ankle bone

005528140Removal of metatarsal

005528150Removal of toe

005528153Partial removal of toe

005528160Partial removal of toe

005528171Resect tarsal tumor

005528173Resect metatarsal tumor

005528175Resect phalanx of toe tumor

005528200Repair of foot tendon

005528202Repair/graft of foot tendon

005528208Repair of foot tendon

005528220Release of foot tendon

005528222Release of foot tendons

005528225Release of foot tendon

005528226Release of foot tendons

005528230Incision of foot tendon(s)

005528232Incision of toe tendon

005528234Incision of foot tendon

005528240Release of big toe

005528250Revision of foot fascia

005528260Release of midfoot joint

005528261Revision of foot tendon

005528262Revision of foot and ankle

005528270Release of foot contracture

005528272Release of toe joint each

005528280Fusion of toes

005528285Repair of hammertoe

005528286Repair of hammertoe

005528288Partial removal of foot bone

005528289Repair hallux rigidus

005528302Incision of ankle bone

005528306Incision of metatarsal

005528307Incision of metatarsal

005528308Incision of metatarsal

005528310Revision of big toe

005528312Revision of toe

005528313Repair deformity of toe

005528315Removal of sesamoid bone

005528340Resect enlarged toe tissue

005528341Resect enlarged toe

005528344Repair extra toe(s)
005528345Repair webbed toe(s)

005528755Fusion of big toe joint

005528805Amputation thru metatarsal

005528810Amputation toe & metatarsal

005528820Amputation of toe

005528825Partial amputation of toe

005529893Scope plantar fasciotomy

0056Level II Foot Musculoskeletal ProceduresT58.4586"$4,093.04".$818.61

005620972Bone/skin graft metatarsal

005620973Bone/skin graft great toe

005628102Remove/graft foot lesion

005628103Remove/graft foot lesion

005628106Remove/graft foot lesion

005628107Remove/graft foot lesion

005628210Repair/graft of foot tendon

005628238Revision of foot tendon

005628264Release of midfoot joint

005628300Incision of heel bone

005628304Incision of midfoot bones

005628305Incise/graft midfoot bones

005628309Incision of metatarsals

005628320Repair of foot bones

005628322Repair of metatarsals

005628360Reconstruct cleft foot

005628446Osteochondral talus autogrft

005628705Fusion of foot bones

005628725Fusion of foot bones

005628730Fusion of foot bones

005628735Fusion of foot bones

005628737Revision of foot bones

005628740Fusion of foot bones

005628750Fusion of big toe joint

005628760Fusion of big toe joint

0057Bunion ProceduresT32.7262"$2,291.36"$475.91$458.28

005728290Correction of bunion

005728292Correction of bunion

005728293Correction of bunion

005728294Correction of bunion

005728296Correction of bunion

005728297Correction of bunion

005728298Correction of bunion

005728299Correction of bunion

0058Level I Strapping and Cast ApplicationS1.1255$78.80.$15.76

005829000Application of body cast

005829020Application of body cast

005829025Application of body cast

005829040Application of body cast

005829049Application of figure eight

005829058Application of shoulder cast

005829085Apply hand/wrist cast

005829086Apply finger cast

005829105Apply long arm splint

005829125Apply forearm splint

005829126Apply forearm splint

005829130Application of finger splint

005829131Application of finger splint

005829200Strapping of chest

005829240Strapping of shoulder

005829260Strapping of elbow or wrist

005829280Strapping of hand or finger

005829440Addition of walker to cast

005829450Application of leg cast

005829505Application long leg splint

005829515Application lower leg splint

005829520Strapping of hip

005829530Strapping of knee
005829540Strapping of ankle and/or ft

005829550Strapping of toes

005829580Application of paste boot

005829581Apply multlay comprs lwr leg

005829582Apply multlay comprs upr leg

005829583Apply multlay comprs upr arm

005829584Appl multlay comprs arm/hand

005829590Application of foot splint

005829700Removal/revision of cast

005829705Removal/revision of cast

005829715Removal/revision of cast

005829720Repair of body cast

005829730Windowing of cast

005829740Wedging of cast

005829750Wedging of clubfoot cast

005829799Casting/strapping procedure

0060Manipulation TherapyS0.3428$24.00.$4.80

006098925Osteopathic manipulation

006098926Osteopathic manipulation

006098927Osteopathic manipulation

006098928Osteopathic manipulation

006098929Osteopathic manipulation

006098940Chiropractic manipulation

006098941Chiropractic manipulation

006098942Chiropractic manipulation

0061Level II Implantation/Revision/Replacement of Neurostimulator 

ElectrodesS88.6050"$6,203.77"."$1,240.76"

006143647Lap impl electrode antrum

006163655Implant neuroelectrodes

006164575Implant neuroelectrodes

006164580Implant neuroelectrodes

006164581Implant neuroelectrodes

0062Level I Treatment Fracture/DislocationT26.1202"$1,828.83"$372.85$365.77

00620245TOpen tx rib fx 1-2 ribs

00620246TOpn tx rib fx 3-4 ribs

00620247TOpn tx rib fx 5-6 ribs

00620248TOpen tx rib fx 7/> ribs

006221336Treat nasal septal fracture

006221805Treatment of rib fracture

006223532Treat clavicle dislocation

006224538Treat humerus fracture

006224566Treat humerus fracture

006224582Treat humerus fracture

006225606Treat fx distal radial

006225651Pin ulnar styloid fracture

006225670Treat wrist dislocation

006225671Pin radioulnar dislocation

006225676Treat wrist dislocation

006225685Treat wrist fracture

006225695Treat wrist dislocation

006226608Treat metacarpal fracture

006226650Treat thumb fracture

006226676Pin hand dislocation

006226685Treat hand dislocation

006226715Treat knuckle dislocation

006226727Treat finger fracture each

006226735Treat finger fracture each

006226746Treat finger fracture each

006226756Pin finger fracture each

006226765Treat finger fracture each

006226776Pin finger dislocation

006226785Treat finger dislocation

006227509Treatment of thigh fracture

006227756Treatment of tibia fracture

006228406Treatment of heel fracture

006228436Treatment of ankle fracture
006228456Treat midfoot fracture

006228476Treat metatarsal fracture

006228496Treat big toe fracture

006228505Treat big toe fracture

006228525Treat toe fracture

006228531Treat sesamoid bone fracture

006228545Treat foot dislocation

006228546Treat foot dislocation

006228576Treat foot dislocation

006228585Repair foot dislocation

006228606Treat foot dislocation

006228636Treat toe dislocation

006228645Repair toe dislocation

006228666Treat toe dislocation

006228675Repair of toe dislocation

0063Level II Treatment Fracture/DislocationT49.8979"$3,493.65".$698.73

006323530Treat clavicle dislocation

006323550Treat clavicle dislocation

006323552Treat clavicle dislocation

006323660Treat shoulder dislocation

006323680Treat dislocation/fracture

006324665Treat radius fracture

006324685Treat ulnar fracture

006325515Treat fracture of radius

006325525Treat fracture of radius

006325526Treat fracture of radius

006325545Treat fracture of ulna

006325628Treat wrist bone fracture

006325645Treat wrist bone fracture

006325652Treat fracture ulnar styloid

006326615Treat metacarpal fracture

006326665Treat thumb fracture

006327202Treat tail bone fracture

006327524Treat kneecap fracture

006327566Treat kneecap dislocation

006327720Repair of tibia

006327726Repair fibula nonunion

006327758Treatment of tibia fracture

006327766Optx medial ankle fx

006327769Optx post ankle fx

006327784Treatment of fibula fracture

006327792Treatment of ankle fracture

006327814Treatment of ankle fracture

006327822Treatment of ankle fracture

006327826Treat lower leg fracture

006327829Treat lower leg joint

006327832Treat lower leg dislocation

006327846Treat ankle dislocation

006327848Treat ankle dislocation

006328420Treat/graft heel fracture

006328445Treat ankle fracture

006328465Treat midfoot fracture each

006328485Treat metatarsal fracture

006328555Repair foot dislocation

006328615Repair foot dislocation

0064Level III Treatment Fracture/DislocationT68.1203"$4,769.51".$953.91

006423515Treat clavicle fracture

006423585Treat scapula fracture

006423615Treat humerus fracture

006423616Treat humerus fracture

006423630Treat humerus fracture

006423670Treat dislocation/fracture

006424515Treat humerus fracture

006424516Treat humerus fracture

006424545Treat humerus fracture

006424546Treat humerus fracture
006424575Treat humerus fracture

006424579Treat humerus fracture

006424586Treat elbow fracture

006424587Treat elbow fracture

006424615Treat elbow dislocation

006424635Treat elbow fracture

006424666Treat radius fracture

006425574Treat fracture radius & ulna

006425575Treat fracture radius/ulna

006425607Treat fx rad extra-articul

006425608Treat fx rad intra-articul

006425609Treat fx radial 3+ frag

006426686Treat hand dislocation

006427722Repair/graft of tibia

006427759Treatment of tibia fracture

006427823Treatment of ankle fracture

006427827Treat lower leg fracture

006427828Treat lower leg fracture

006428415Treat heel fracture

0065"Level I Stereotactic Radiosurgery, MRgFUS, and MEG"S12.8903$902.53.$180.51

00650301TMw therapy for breast tumor

006595966Meg evoked single

006595967Meg evoked each addl

0065G0251Linear acc based stero radio

0066"Level II Stereotactic Radiosurgery, MRgFUS, and 

MEG"S35.9961"$2,520.30".$504.06

006695965Meg spontaneous

0066G0340Robt lin-radsurg fractx 2-5

0067"Level III Stereotactic Radiosurgery, MRgFUS, and 

MEG"S48.1833"$3,373.60".$674.72

00670071TU/s leiomyomata ablate <200

00670072TU/s leiomyomata ablate >200

0067G0173Linear acc stereo radsur com

0067G0339"Robot lin-radsurg com, first"

0069ThoracoscopyT34.5272"$2,417.46"$591.64$483.50

006932601Thoracoscopy diagnostic

006932604Thoracoscopy wbx sac

006932606Thoracoscopy w/bx med space

006932607Thoracoscopy w/bx infiltrate

006932608Thoracoscopy w/bx nodule

006932609Thoracoscopy w/bx pleura

006939400Mediastinoscopy incl biopsy

0070Thoracentesis/Lavage ProceduresT5.5061$385.52.$77.11

007032201Drain percut lung lesion

007032420Puncture/clear lung

007032421Thoracentesis for aspiration

007032422Thoracentesis w/tube insert

007032551Insertion of chest tube

007032560Treat pleurodesis w/agent

007032561Lyse chest fibrin init day

007032562Lyse chest fibrin subq day

007032960Therapeutic pneumothorax

007032999Chest surgery procedure

007033010Drainage of heart sac

007033011Repeat drainage of heart sac

007033999Cardiac surgery procedure

007049082Abd paracentesis

007049083Abd paracentesis w/imaging

007049084Peritoneal lavage

0071Level I Endoscopy Upper AirwayT1.0729$75.12.$15.03

007131505Diagnostic laryngoscopy

007192511Nasopharyngoscopy

0072Level II Endoscopy Upper AirwayT1.8643$130.53.$26.11

007231231Nasal endoscopy dx

007231233Nasal/sinus endoscopy dx

007231511Remove foreign body larynx
007231513Injection into vocal cord

007231520Dx laryngoscopy newborn

007231575Diagnostic laryngoscopy

0073Level III Endoscopy Upper AirwayT4.4119$308.90$67.83$61.78

007331577Remove foreign body larynx

007331579Diagnostic laryngoscopy

007331717Bronchial brush biopsy

007331730Intro windpipe wire/tube

0074Level IV Endoscopy Upper AirwayT21.2774"$1,489.76".$297.96

007431235Nasal/sinus endoscopy dx

007431237Nasal/sinus endoscopy surg

007431238Nasal/sinus endoscopy surg

007431240Nasal/sinus endoscopy surg

007431510Laryngoscopy with biopsy

007431512Removal of larynx lesion

007431515Laryngoscopy for aspiration

007431525Dx laryngoscopy excl nb

007431526Dx laryngoscopy w/oper scope

007431528Laryngoscopy and dilation

007431529Laryngoscopy and dilation

007431530Laryngoscopy w/fb removal

007431531Laryngoscopy w/fb & op scope

007431535Laryngoscopy w/biopsy

007431536Laryngoscopy w/bx & op scope

007431540Laryngoscopy w/exc of tumor

007431541Larynscop w/tumr exc + scope

007431570Laryngoscope w/vc inj

007431576Laryngoscopy with biopsy

0075Level V Endoscopy Upper AirwayT30.3487"$2,124.89"$444.55$424.98

007531239Nasal/sinus endoscopy surg

007531254Revision of ethmoid sinus

007531255Removal of ethmoid sinus

007531256Exploration maxillary sinus

007531267Endoscopy maxillary sinus

007531276Sinus endoscopy surgical

007531287Nasal/sinus endoscopy surg

007531288Nasal/sinus endoscopy surg

007531292Nasal/sinus endoscopy surg

007531293Nasal/sinus endoscopy surg

007531294Nasal/sinus endoscopy surg

007531295Sinus endo w/balloon dil

007531296Sinus endo w/balloon dil

007531297Sinus endo w/balloon dil

007531527Laryngoscopy for treatment

007531545Remove vc lesion w/scope

007531546Remove vc lesion scope/graft

007531560Laryngoscop w/arytenoidectom

007531561Larynscop remve cart + scop

007531571Laryngoscop w/vc inj + scope

007531578Removal of larynx lesion

0076Level I Endoscopy Lower AirwayT10.4689$732.99$189.82$146.60

00760251TRemov bronchial valve

00760252TRemov bronch valve addl

007631622Dx bronchoscope/wash

007631623Dx bronchoscope/brush

007631624Dx bronchoscope/lavage

007631625Bronchoscopy w/biopsy(s)

007631628Bronchoscopy/lung bx each

007631629Bronchoscopy/needle bx each

007631632Bronchoscopy/lung bx addl

007631633Bronchoscopy/needle bx addl

007631634Bronch w/balloon occlusion

007631635Bronchoscopy w/fb removal

007631637Bronchoscopy stent add-on

007631643Diag bronchoscope/catheter

007631645Bronchoscopy clear airways
007631646Bronchoscopy reclear airway

007631656Bronchoscopy inj for x-ray

007631899Airways surgical procedure

0077Level I Pulmonary TreatmentS0.4237$29.67$7.74$5.94

007731720Clearance of airways

007794610Surfactant admin thru tube

007794640Airway inhalation treatment

007794664Evaluate pt use of inhaler

007794667Chest wall manipulation

007794668Chest wall manipulation

0077G0237Therapeutic procd strg endur

0077G0238"Oth resp proc, indiv"

0077G0239"Oth resp proc, group"

0078Level III Pulmonary TreatmentS1.4089$98.65.$19.73

00780243TIntm msr bronchodil wheeze

007831502Change of windpipe airway

007832552Remove lung catheter

007894060Evaluation of wheezing

007894642Aerosol inhalation treatment

007894660Pos airway pressure cpap

0079Ventilation Initiation and ManagementS3.1979$223.90.$44.78

007994002Vent mgmt inpat init day

007994003Vent mgmt inpat subq day

007994662Neg press ventilation cnp

0080Diagnostic Cardiac CatheterizationT38.8523"$2,720.28"$836.90$544.06

008093451Right heart cath

008093452Left hrt cath w/ventrclgrphy

008093453R&l hrt cath w/ventriclgrphy

008093454Coronary artery angio s&i

008093455Coronary art/grft angio s&i

008093456R hrt coronary artery angio

008093457R hrt art/grft angio

008093458L hrt artery/ventricle angio

008093459L hrt art/grft angio

008093460R&l hrt art/ventricle angio

008093461R&l hrt art/ventricle angio

008093462L hrt cath trnsptl puncture

008093530Rt heart cath congenital

008093531R & l heart cath congenital

008093532R & l heart cath congenital

008093533R & l heart cath congenital

0082Coronary or Non-Coronary AtherectomyT105.0651"$7,356.24"."$1,471.25"

00820234TTrluml perip athrc renal art

00820236TTrluml perip athrc abd aorta

00820237TTrluml perip athrc brchiocph

00820238TTrluml perip athrc iliac art

008237204Transcatheter occlusion

008261623Endovasc tempory vessel occl

008261626Transcath occlusion non-cns

008292995Coronary atherectomy

008292996Coronary atherectomy add-on

0083"Coronary Angioplasty, Valvuloplasty, and Level I Endovascular 

Revascularization"T65.8519"$4,610.69".$922.14

008335458Repair arterial blockage

008335460Repair venous blockage

008335471Repair arterial blockage

008335472Repair arterial blockage

008335475Repair arterial blockage

008335476Repair venous blockage

008337220Iliac revasc

008337222Iliac revasc add-on

008337223Iliac revasc w/stent add-on

008337224Fem/popl revas w/tla

008337228Tib/per revasc w/tla

008337232Tib/per revasc add-on

008337234Revsc opn/prq tib/pero stent
008337235Tib/per revasc stnt & ather

008375962Repair arterial blockage

008375966Repair arterial blockage

008392982Coronary artery dilation

008392984Coronary artery dilation

008392986Revision of aortic valve

008392987Revision of mitral valve

008392990Revision of pulmonary valve

008392997Pul art balloon repr percut

008392998Pul art balloon repr percut

0084Level I Electrophysiologic ProceduresS9.9330$695.47.$139.10

008493600Bundle of His recording

008493602Intra-atrial recording

008493603Right ventricular recording

008493610Intra-atrial pacing

008493612Intraventricular pacing

008493615Esophageal recording

008493616Esophageal recording

008493618Heart rhythm pacing

008493642Electrophysiology evaluation

0085Level II Electrophysiologic ProceduresT53.2719"$3,729.89".$745.98

008593619Electrophysiology evaluation

008593620Electrophysiology evaluation

008593624Electrophysiologic study

008593650Ablate heart dysrhythm focus

0086Level III Electrophysiologic ProceduresT121.8174"$8,529.17"."$1,705.84"

008693651Ablate heart dysrhythm focus

008693652Ablate heart dysrhythm focus

0088ThrombectomyT41.0387"$2,873.37"$655.18$574.68

008834101Removal of artery clot

008834111Removal of arm artery clot

008834201Removal of artery clot

008834203Removal of leg artery clot

008834421Removal of vein clot

008834471Removal of vein clot

008834490Removal of vein clot

008834501Repair valve femoral vein

008834510Transposition of vein valve

008834520Cross-over vein graft

008834530Leg vein fusion

008835188Repair blood vessel lesion

008835207Repair blood vessel lesion

008835875Removal of clot in graft

008835876Removal of clot in graft

008835879Revise graft w/vein

008835881Revise graft w/vein

008835883Revise graft w/nonauto graft

008835884Revise graft w/vein

008836818Av fuse uppr arm cephalic

008836819Av fuse uppr arm basilic

008836820Av fusion/forearm vein

008836821Av fusion direct any site

008836825Artery-vein autograft

008836830Artery-vein nonautograft

008836831Open thrombect av fistula

008836832Av fistula revision open

008836833Av fistula revision

008836838Dist revas ligation hemo

008837184Prim art mech thrombectomy

008837185Prim art m-thrombect add-on

008837186Sec art m-thrombect add-on

008837187Venous mech thrombectomy

008837188Venous m-thrombectomy add-on

008892973Percut coronary thrombectomy

0089Insertion/Replacement of Permanent Pacemaker and 
ElectrodesT112.1218"$7,850.32""$1,643.98""$1,570.07"

008933206Insert heart pm atrial

008933207Insert heart pm ventricular

0090Level I Insertion/Replacement of Permanent 

PacemakerT94.2220"$6,597.05""$1,593.50""$1,319.41"

009033212Insert pulse gen sngl lead

009033227Remove&replace pm gen singl

0091Level II Vascular LigationT44.2272"$3,096.61".$619.33

009136475Endovenous rf 1st vein

009137191Ins endovas vena cava filtr

009137500Endoscopy ligate perf veins

009137605Ligation of neck artery

009137619Ligation of inf vena cava

009137722Ligate/strip long leg vein

009137735Removal of leg veins/lesion

0092Level I Vascular LigationT26.8120"$1,877.27".$375.46

009230915Ligation nasal sinus artery

009230920Ligation upper jaw artery

009236476Endovenous rf vein add-on

009236478Endovenous laser 1st vein

009236479Endovenous laser vein addon

009237501Vascular endoscopy procedure

009237606Ligation of neck artery

009237607Ligation of a-v fistula

009237615Ligation of neck artery

009237650Revision of major vein

009237700Revise leg vein

009237718Ligate/strip short leg vein

009237760Ligate leg veins radical

009237761Ligate leg veins open

009237765Stab phleb veins xtr 10-20

009237766Phleb veins - extrem 20+

009237780Revision of leg vein

009237785Ligate/divide/excise vein

0093Vascular Reconstruction/Fistula Repair without 

DeviceT31.1505"$2,181.03".$436.21

009335045Repair defect of arm artery

009335180Repair blood vessel lesion

009335184Repair blood vessel lesion

009335190Repair blood vessel lesion

009335201Repair blood vessel lesion

009335206Repair blood vessel lesion

009335231Repair blood vessel lesion

009335236Repair blood vessel lesion

009335256Repair blood vessel lesion

009335321Rechanneling of artery

009335685Bypass graft patency/patch

009335686Bypass graft/av fist patency

009335761Exploration of artery/vein

009335860Explore limb vessels

009335903Excision graft extremity

009337565Ligation of neck vein

009337600Ligation of neck artery

009375978Repair venous blockage

0094Level I Resuscitation and CardioversionS2.2326$156.32$43.83$31.27

009431500Insert emergency airway

009492950Heart/lung resuscitation cpr

009492953Temporary external pacing

009499465Nb resuscitation

0095Cardiac RehabilitationS0.9930$69.53.$13.91

009593797Cardiac rehab

009593798Cardiac rehab/monitor

0095G0422Intens cardiac rehab w/exerc

0095G0423Intens cardiac rehab no exer

0096Level II Noninvasive Physiologic StudiesS1.5248$106.76$36.86$21.36

009676936Echo guide for artery repair

009693923Upr/lxtr art stdy 3+ lvls
009693924Lwr xtr vasc stdy bilat

009693965Extremity study

0097Level I Noninvasive Physiologic StudiesS0.9350$65.46.$13.10

00970239TBioimpedance spectroscopy

00970296TExt ecg recording

00970297TExt ecg scan w/report

009743755Dx gastr intub w/asp specs

009793225Ecg monit/reprt up to 48 hrs

009793226Ecg monit/reprt up to 48 hrs

009793270Remote 30 day ecg rev/report

009793786Ambulatory BP recording

009793788Ambulatory BP analysis

009793799Cardiovascular procedure

009793922Upr/l xtremity art 2 levels

009793982Aneurysm pressure sens study

009794762Measure blood oxygen level

009794775Ped home apnea rec hk-up

009794776Ped home apnea rec downld

0099Electrocardiograms/CardiographyS0.3817$26.73.$5.35

00990223TAcoustic ecg w/i&r

009993005Electrocardiogram tracing

009993701Bioimpedance cv analysis

0099G0404EKG tracing for initial prev

0100Cardiac Stress TestsX2.5439$178.11$41.37$35.63

01000179T64 lead ecg w/tracing

010093017Cardiovascular stress test

010093024Cardiac drug stress test

010093025Microvolt t-wave assess

0100Q0035Cardiokymography

0101Tilt Table EvaluationS4.2669$298.75$100.24$59.75

010193660Tilt table evaluation

0102Level II Pulmonary TreatmentS0.5346$37.43.$7.49

0102G0424Pulmonary rehab w exer

0103Miscellaneous Vascular ProceduresT16.3852"$1,147.23".$229.45

010335500Harvest vein for bypass

010337201Transcatheter therapy infuse

010337202Transcatheter therapy infuse

010392974Cath place cardio brachytx

010393503Insert/place heart catheter

010393505Biopsy of heart lining

0104Transcatheter Placement of Intracoronary StentsT81.1503"$5,681.82"."$1,136.37"

010492980Insert intracoronary stent

010492981Insert intracoronary stent

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

Devices"T21.7420"$1,522.29".$304.46

010533215Reposition pacing-defib lead

010533218Repair lead pace-defib one

010533220Repair lead pace-defib dual

010533226Reposition l ventric lead

010533233Removal of pm generator

010533234Removal of pacemaker system

010533235Removal pacemaker electrode

010533241Remove pulse generator

010533244Remove eltrd transven

010536261Revision of infusion pump

010536262Removal of infusion pump

010549422Remove tunneled ip cath

010549429Removal of shunt

0106Insertion/Replacement of Pacemaker Leads and/or 

ElectrodesT47.1769"$3,303.14".$660.63

010633210Insert electrd/pm cath sngl

010633211Insert card electrodes dual

010633216Insert 1 electrode pm-defib

010633217Insert 2 electrode pm-defib

0107Insertion of Cardioverter-Defibrillator Pulse 
GeneratorT341.5859"$23,916.48"."$4,783.30"

010733230Insrt pulse gen w/dual leads

010733231Insrt pulse gen w/mult leads

010733240Insrt pulse gen w/singl lead

010733262Remv&replc cvd gen sing lead

010733263Remv&replc cvd gen dual lead

010733264Remv&replc cvd gen mult lead

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

Electrodes"T426.1201"$29,835.22"."$5,967.05"

010833249Nsert pace-defib w/lead

0110TransfusionS3.4217$239.57.$47.92

011036430Blood transfusion service

011036440Bl push transfuse 2 yr or <

011036450Bl exchange/transfuse nb

011036455Bl exchange/transfuse non-nb

011036460Transfusion service fetal

011038207Cryopreserve stem cells

011038208Thaw preserved stem cells

011038209Wash harvest stem cells

011038999Blood/lymph system procedure

0111Blood Product ExchangeS11.6629$816.59$189.89$163.32

011136511Apheresis wbc

011136512Apheresis rbc

011136513Apheresis platelets

011136514Apheresis plasma

011138206Harvest auto stem cells

011138242Lymphocyte infuse transplant

0112Apheresis and Stem Cell ProceduresS35.6252"$2,494.33".$498.87

01120263TIm B1 mrw cel ther cmpl

01120264TIm B1 mrw cel ther xcl hrvst

01120265TIm B1 mrw cel ther hrvst onl

011236515Apheresis adsorp/reinfuse

011236516Apheresis selective

011236522Photopheresis

011238230Bone marrow harvest allogen

011238232Bone marrow harvest autolog

011238240Bn marrow/stm transplt allo

011238241Bn marrow/stm transplt auto

0113Excision Lymphatic SystemT25.2738"$1,769.57".$353.92

011338308Incision of lymph channels

011338500Biopsy/removal lymph nodes

011338510Biopsy/removal lymph nodes

011338520Biopsy/removal lymph nodes

011338525Biopsy/removal lymph nodes

011338530Biopsy/removal lymph nodes

011338550Removal neck/armpit lesion

011338555Removal neck/armpit lesion

011338700Removal of lymph nodes neck

011338720Removal of lymph nodes neck

011338760Remove groin lymph nodes

0114Thyroid/Lymphadenectomy ProceduresT51.2792"$3,590.36".$718.08

011438542Explore deep node(s) neck

011438740Remove armpit lymph nodes

011438745Remove armpit lymph nodes

011460200Remove thyroid lesion

011460210Partial thyroid excision

011460212Partial thyroid excision

011460220Partial removal of thyroid

011460225Partial removal of thyroid

011460240Removal of thyroid

011460280Remove thyroid duct lesion

011460281Remove thyroid duct lesion

011460699Endocrine surgery procedure

0115Cannula/Access Device ProceduresT37.4593"$2,622.75".$524.55

011536800Insertion of cannula

011536810Insertion of cannula

011536815Insertion of cannula
011536835Artery to vein shunt

011536861Cannula declotting

011549419Insert tun ip cath w/port

0121Level I Tube or Catheter Changes or RepositioningT6.2123$434.96.$87.00

012136575Repair tunneled cv cath

012136589Removal tunneled cv cath

012144500Intro gastrointestinal tube

012149450Replace g/c tube perc

012149451Replace duod/jej tube perc

012149452Replace g-j tube perc

012149460Fix g/colon tube w/device

012151710Change of bladder tube

012161070Brain canal shunt procedure

0126Level I Urinary and Anal ProceduresT1.1095$77.68$16.21$15.54

012650391Instll rx agnt into rnal tub

012650686Measure ureter pressure

012651101Drain bladder by trocar/cath

012651703Insert bladder cath complex

012651741Electro-uroflowmetry first

012651784Anal/urinary muscle study

012651792Urinary reflex study

012653601Dilate urethra stricture

012653660Dilation of urethra

012653661Dilation of urethra

012653899Urology surgery procedure

012654240Penis study

012655899Genital surgery procedure

012690911Biofeedback peri/uro/rectal

012691120Rectal sensation test

0127"Level IV Stereotactic Radiosurgery, MRgFUS, and 

MEG"S106.5454"$7,459.88"."$1,491.98"

012777371Srs multisource

0128Echocardiogram with ContrastS7.9593$557.28$166.16$111.46

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

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

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

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

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

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

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

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

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

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

0129Level I Closed Treatment FractureT1.5020$105.16.$21.04

012921800Treatment of rib fracture

012921820Treat sternum fracture

012922305Treat spine process fracture

012923500Treat clavicle fracture

012923540Treat clavicle dislocation

012923570Treat shoulder blade fx

012923600Treat humerus fracture

012923620Treat humerus fracture

012923650Treat shoulder dislocation

012923675Treat dislocation/fracture

012923929Shoulder surgery procedure

012924500Treat humerus fracture

012924505Treat humerus fracture

012924530Treat humerus fracture

012924560Treat humerus fracture

012924565Treat humerus fracture

012924576Treat humerus fracture

012924577Treat humerus fracture

012924600Treat elbow dislocation

012924640Treat elbow dislocation

012924650Treat radius fracture

012924670Treat ulnar fracture
012924675Treat ulnar fracture

012924999Upper arm/elbow surgery

012925500Treat fracture of radius

012925530Treat fracture of ulna

012925535Treat fracture of ulna

012925560Treat fracture radius & ulna

012925600Treat fracture radius/ulna

012925622Treat wrist bone fracture

012925630Treat wrist bone fracture

012925635Treat wrist bone fracture

012925650Treat wrist bone fracture

012925660Treat wrist dislocation

012925675Treat wrist dislocation

012925680Treat wrist fracture

012925999Forearm or wrist surgery

012926600Treat metacarpal fracture

012926605Treat metacarpal fracture

012926641Treat thumb dislocation

012926670Treat hand dislocation

012926675Treat hand dislocation

012926700Treat knuckle dislocation

012926705Treat knuckle dislocation

012926720Treat finger fracture each

012926725Treat finger fracture each

012926740Treat finger fracture each

012926742Treat finger fracture each

012926750Treat finger fracture each

012926755Treat finger fracture each

012926770Treat finger dislocation

012926989Hand/finger surgery

012927193Treat pelvic ring fracture

012927200Treat tail bone fracture

012927220Treat hip socket fracture

012927230Treat thigh fracture

012927250Treat hip dislocation

012927256Treat hip dislocation

012927265Treat hip dislocation

012927267Cltx thigh fx

012927299Pelvis/hip joint surgery

012927501Treatment of thigh fracture

012927503Treatment of thigh fracture

012927508Treatment of thigh fracture

012927516Treat thigh fx growth plate

012927517Treat thigh fx growth plate

012927520Treat kneecap fracture

012927530Treat knee fracture

012927538Treat knee fracture(s)

012927550Treat knee dislocation

012927560Treat kneecap dislocation

012927599Leg surgery procedure

012927750Treatment of tibia fracture

012927760Cltx medial ankle fx

012927767Cltx post ankle fx

012927768Cltx post ankle fx w/mnpj

012927780Treatment of fibula fracture

012927786Treatment of ankle fracture

012927788Treatment of ankle fracture

012927808Treatment of ankle fracture

012927810Treatment of ankle fracture

012927816Treatment of ankle fracture

012927824Treat lower leg fracture

012927830Treat lower leg dislocation

012927840Treat ankle dislocation

012927899Leg/ankle surgery procedure

012928400Treatment of heel fracture

012928430Treatment of ankle fracture
012928435Treatment of ankle fracture

012928450Treat midfoot fracture each

012928455Treat midfoot fracture each

012928470Treat metatarsal fracture

012928475Treat metatarsal fracture

012928490Treat big toe fracture

012928495Treat big toe fracture

012928510Treatment of toe fracture

012928515Treatment of toe fracture

012928530Treat sesamoid bone fracture

012928540Treat foot dislocation

012928570Treat foot dislocation

012928600Treat foot dislocation

012928605Treat foot dislocation

012928630Treat toe dislocation

012928660Treat toe dislocation

012928899Foot/toes surgery procedure

0130Level I LaparoscopyT38.9223"$2,725.18"$659.53$545.04

013038129Laparoscope proc spleen

013038589Laparoscope proc lymphatic

013043289Laparoscope proc esoph

013043648Lap revise/remv eltrd antrum

013043659Laparoscope proc stom

013044213Lap mobil splenic fl add-on

013044238Laparoscope proc intestine

013044979Laparoscope proc app

013045499Laparoscope proc rectum

013047379Laparoscope procedure liver

013047560Laparoscopy w/cholangio

013047561Laparo w/cholangio/biopsy

013047579Laparoscope proc biliary

013049320Diag laparo separate proc

013049321Laparoscopy biopsy

013049322Laparoscopy aspiration

013049323Laparo drain lymphocele

013049324Lap insert tunnel ip cath

013049325Lap revision perm ip cath

013049326Lap w/omentopexy add-on

013049327Lap ins device for rt

013049329Laparo proc abdm/per/oment

013049659Laparo proc hernia repair

013050541Laparo ablate renal cyst

013050549Laparoscope proc renal

013050949Laparoscope proc ureter

013051999Laparoscope proc bla

013054699Laparoscope proc testis

013055559Laparo proc spermatic cord

013058545Laparoscopic myomectomy

013058578Laparo proc uterus

013058679Laparo proc oviduct-ovary

013059898Laparo proc ob care/deliver

013060659Laparo proc endocrine

0131Level II LaparoscopyT47.9394"$3,356.53""$1,001.89"$671.31

013138120Laparoscopy splenectomy

013138570Laparoscopy lymph node biop

013138572Laparoscopy lymphadenectomy

013143653Laparoscopy gastrostomy

013143770Lap place gastr adj device

013144180Lap enterolysis

013144186Lap jejunostomy

013144970Laparoscopy appendectomy

013147562Laparoscopic cholecystectomy

013147563Laparo cholecystectomy/graph

013147564Laparo cholecystectomy/explr

013149650Lap ing hernia repair init

013149651Lap ing hernia repair recur
013150543Laparo partial nephrectomy

013150544Laparoscopy pyeloplasty

013150945Laparoscopy ureterolithotomy

013150947Laparo new ureter/bladder

013150948Laparo new ureter/bladder

013151990Laparo urethral suspension

013151992Laparo sling operation

013154690Laparoscopy orchiectomy

013155550Laparo ligate spermatic vein

013157425Laparoscopy surg colpopexy

013158546Laparo-myomectomy complex

013158552Laparo-vag hyst incl t/o

013158553Laparo-vag hyst complex

013158554Laparo-vag hyst w/t/o compl

013158570Tlh uterus 250 g or less

013158571Tlh w/t/o 250 g or less

013158572Tlh uterus over 250 g

013158573Tlh w/t/o uterus over 250 g

013158660Laparoscopy lysis

013158661Laparoscopy remove adnexa

013158662Laparoscopy excise lesions

013158670Laparoscopy tubal cautery

013158671Laparoscopy tubal block

013158672Laparoscopy fimbrioplasty

013158673Laparoscopy salpingostomy

013159150Treat ectopic pregnancy

013159151Treat ectopic pregnancy

0132Level III LaparoscopyT71.5658"$5,010.75""$1,236.99""$1,002.15"

013238571Laparoscopy lymphadenectomy

013243280Laparoscopy fundoplasty

013243281Lap paraesophag hern repair

013243651Laparoscopy vagus nerve

013243652Laparoscopy vagus nerve

013244206Lap part colectomy w/stoma

013244207L colectomy/coloproctostomy

013244208L colectomy/coloproctostomy

013249652Lap vent/abd hernia repair

013249653Lap vent/abd hern proc comp

013249654Lap inc hernia repair

013249655Lap inc hern repair comp

013249656Lap inc hernia repair recur

013249657Lap inc hern recur comp

013254692Laparoscopy orchiopexy

013258541Lsh uterus 250 g or less

013258542Lsh w/t/o ut 250 g or less

013258543Lsh uterus above 250 g

013258544Lsh w/t/o uterus above 250 g

013258550Laparo-asst vag hysterectomy

0133Level I Skin RepairT1.1922$83.47$23.34$16.70

013311760Repair of nail bed

013311954Therapy for contour defects

013312001Repair superficial wound(s)

013312002Repair superficial wound(s)

013312004Repair superficial wound(s)

013312005Repair superficial wound(s)

013312006Repair superficial wound(s)

013312007Repair superficial wound(s)

013312011Repair superficial wound(s)

013312013Repair superficial wound(s)

013312014Repair superficial wound(s)

013312015Repair superficial wound(s)

013312016Repair superficial wound(s)

013312017Repair superficial wound(s)

013312041Intmd wnd repair n-hf/genit

013312054Intmd wnd repair face/mm

013313122Repair wound/lesion add-on
013315272Skin sub graft t/a/l add-on

013315276Skin sub graft f/n/hf/g addl

013315775Hair transplant punch grafts

013315776Hair transplant punch grafts

0134Level II Skin RepairT3.2354$226.53.$45.31

013411920Correct skin color defects

013411921Correct skin color defects

013411922Correct skin color defects

013411950Therapy for contour defects

013411951Therapy for contour defects

013411952Therapy for contour defects

013412018Repair superficial wound(s)

013412021Closure of split wound

013412031Intmd wnd repair s/a/t/ext

013412032Intmd wnd repair s/a/t/ext

013412034Intmd wnd repair s/tr/ext

013412035Intmd wnd repair s/a/t/ext

013412036Intmd wnd repair s/a/t/ext

013412037Intmd wnd repair s/tr/ext

013412042Intmd wnd repair n-hf/genit

013412044Intmd wnd repair n-hf/genit

013412045Intmd wnd repair n-hf/genit

013412046Intmd wnd repair n-hf/genit

013412047Intmd wnd repair n-hf/genit

013412051Intmd wnd repair face/mm

013412052Intmd wnd repair face/mm

013412053Intmd wnd repair face/mm

013412055Intmd wnd repair face/mm

013412056Intmd wnd repair face/mm

013412057Intmd wnd repair face/mm

013413102Repair wound/lesion add-on

013413120Repair of wound or lesion

013413121Repair of wound or lesion

013413131Repair of wound or lesion

013413133Repair wound/lesion add-on

013413153Repair wound/lesion add-on

013415004Wound prep f/n/hf/g

013415040Harvest cultured skin graft

013415050Skin pinch graft

013415116Epidrm a-grft f/n/hf/g addl

013415150Cult skin grft t/arm/leg

013415151Cult skin grft t/a/l addl

013415152Cult skin graft t/a/l +%

013415155Cult skin graft f/n/hf/g

013415156Cult skin grft f/n/hfg add

013415157Cult epiderm grft f/n/hfg +%

013415241Skin full graft add-on

013415271Skin sub graft trnk/arm/leg

013415274Skn sub grft t/a/l child add

013415275Skin sub graft face/nk/hf/g

013415278Skn sub grft f/n/hf/g ch add

013415819Plastic surgery neck

0135Level III Skin RepairT4.9271$344.98.$69.00

013512020Closure of split wound

013513100Repair of wound or lesion

013513101Repair of wound or lesion

013513132Repair of wound or lesion

013513150Repair of wound or lesion

013513151Repair of wound or lesion

013513152Repair of wound or lesion

013515002Wound prep trk/arm/leg

013515003Wound prep addl 100 cm

013515005Wnd prep f/n/hf/g addl cm

013515110Epidrm autogrft trnk/arm/leg

013515111Epidrm autogrft t/a/l add-on

013515115Epidrm a-grft face/nck/hf/g
013515221Skin full graft add-on

013515273Skin sub grft t/arm/lg child

013515277Skn sub grft f/n/hf/g child

013520926Removal of tissue for graft

013543887Remove gastric port open

0135C9800Dermal filler inj px/suppl

0136Level IV Skin RepairT16.7703"$1,174.19".$234.84

013611762Reconstruction of nail bed

013614000Skin tissue rearrangement

013614001Skin tissue rearrangement

013614020Skin tissue rearrangement

013614021Skin tissue rearrangement

013614040Skin tissue rearrangement

013614041Skin tissue rearrangement

013614060Skin tissue rearrangement

013614061Skin tissue rearrangement

013615130Derm autograft trnk/arm/leg

013615131Derm autograft t/a/l add-on

013615135Derm autograft face/nck/hf/g

013615136Derm autograft f/n/hf/g add

013615200Skin full graft trunk

013615201Skin full graft trunk add-on

013615220Skin full graft sclp/arm/leg

013615240Skin full grft face/genit/hf

013615260Skin full graft een & lips

013615261Skin full graft add-on

013615740Island pedicle flap graft

013615777Acellular derm matrix implt

013615936Remove sacrum pressure sore

013615952Remove thigh pressure sore

013615953Remove thigh pressure sore

013615956Remove thigh pressure sore

013615958Remove thigh pressure sore

013620920Removal of fascia for graft

013620922Removal of fascia for graft

013623921Amputation follow-up surgery

013625929Amputation follow-up surgery

013633222Revise pocket pacemaker

013633223Revise pocket for defib

0137Level V Skin RepairT21.4409"$1,501.21".$300.25

013711960Insert tissue expander(s)

013713160Late closure of wound

013714301Skin tissue rearrangement

013714302Skin tissue rearrange add-on

013714350Skin tissue rearrangement

013715100Skin splt grft trnk/arm/leg

013715101Skin splt grft t/a/l add-on

013715120Skn splt a-grft fac/nck/hf/g

013715121Skn splt a-grft f/n/hf/g add

013715570Form skin pedicle flap

013715572Form skin pedicle flap

013715574Form skin pedicle flap

013715576Form skin pedicle flap

013715600Skin graft

013715610Skin graft

013715620Skin graft

013715630Skin graft

013715650Transfer skin pedicle flap

013715731Forehead flap w/vasc pedicle

013715732Muscle-skin graft head/neck

013715734Muscle-skin graft trunk

013715736Muscle-skin graft arm

013715738Muscle-skin graft leg

013715750Neurovascular pedicle graft

013715760Composite skin graft

013715770Derma-fat-fascia graft
013715820Revision of lower eyelid

013715821Revision of lower eyelid

013715822Revision of upper eyelid

013715823Revision of upper eyelid

013715824Removal of forehead wrinkles

013715825Removal of neck wrinkles

013715826Removal of brow wrinkles

013715828Removal of face wrinkles

013715829Removal of skin wrinkles

013715840Graft for face nerve palsy

013715841Graft for face nerve palsy

013715842Flap for face nerve palsy

013715845Skin and muscle repair face

013715876Suction assisted lipectomy

013715877Suction assisted lipectomy

013715878Suction assisted lipectomy

013715879Suction assisted lipectomy

013715922Removal of tail bone ulcer

013715934Remove sacrum pressure sore

013715935Remove sacrum pressure sore

013715937Remove sacrum pressure sore

013715944Remove hip pressure sore

013715945Remove hip pressure sore

013715946Remove hip pressure sore

013720101Explore wound chest

013720102Explore wound abdomen

013720910Remove cartilage for graft

013720912Remove cartilage for graft

013743886Revise gastric port open

013743888Change gastric port open

013744312Revision of ileostomy

013744340Revision of colostomy

0138Level II Closed Treatment FractureT5.0454$353.26.$70.66

013820660Apply rem fixation device

013822310Treat spine fracture

013823520Treat clavicle dislocation

013823525Treat clavicle dislocation

013823545Treat clavicle dislocation

013823575Treat shoulder blade fx

013823665Treat dislocation/fracture

013824535Treat humerus fracture

013824655Treat radius fracture

013825505Treat fracture of radius

013825520Treat fracture of radius

013825565Treat fracture radius & ulna

013825605Treat fracture radius/ulna

013825624Treat wrist bone fracture

013826340Manipulate finger w/anesth

013826341Manipulat palm cord post inj

013826645Treat thumb fracture

013827238Treat thigh fracture

013827246Treat thigh fracture

013827500Treatment of thigh fracture

013827510Treatment of thigh fracture

013827818Treatment of ankle fracture

0139Level III Closed Treatment FractureT18.9489"$1,326.73".$265.35

013920697Comp ext fixate strut change

013922315Treat spine fracture

013923505Treat clavicle fracture

013923605Treat humerus fracture

013923625Treat humerus fracture

013924620Treat elbow fracture

013925259Manipulate wrist w/anesthes

013925690Treat wrist dislocation

013926607Treat metacarpal fracture

013926706Pin knuckle dislocation
013927502Treatment of thigh fracture

013927532Treat knee fracture

013927752Treatment of tibia fracture

013927762Cltx med ankle fx w/mnpj

013927781Treatment of fibula fracture

013927825Treat lower leg fracture

013927831Treat lower leg dislocation

013928405Treatment of heel fracture

013928575Treat foot dislocation

0140Esophageal Dilation without EndoscopyT6.5866$461.17.$92.24

014043450Dilate esophagus

014043453Dilate esophagus

014043456Dilate esophagus

0141Level I Upper GI ProceduresT8.4511$591.71$138.69$118.35

014143200Esophagus endoscopy

014143202Esophagus endoscopy biopsy

014143204Esoph scope w/sclerosis inj

014143234Upper gi endoscopy exam

014143235Uppr gi endoscopy diagnosis

014143236Uppr gi scope w/submuc inj

014143239Upper gi endoscopy biopsy

014143241Upper GI endoscopy with tube

014143243Upper gi endoscopy & inject

014143247Operative upper GI endoscopy

014143248Uppr gi endoscopy/guide wire

014143499Esophagus surgery procedure

014143510Surgical opening of stomach

014143761Reposition gastrostomy tube

014143831Place gastrostomy tube

014143999Stomach surgery procedure

0142Level I Small Intestine EndoscopyT10.4394$730.93$152.78$146.19

014244360Small bowel endoscopy

014244361Small bowel endoscopy/biopsy

014244363Small bowel endoscopy

014244376Small bowel endoscopy

014244377Small bowel endoscopy/biopsy

014244380Small bowel endoscopy

014244382Small bowel endoscopy

014291110Gi tract capsule endoscopy

0143Lower GI EndoscopyT9.3693$656.00$186.06$131.20

014344385Endoscopy of bowel pouch

014344386Endoscopy bowel pouch/biop

014344388Colonoscopy

014344389Colonoscopy with biopsy

014344390Colonoscopy for foreign body

014344391Colonoscopy for bleeding

014344392Colonoscopy & polypectomy

014344393Colonoscopy lesion removal

014344394Colonoscopy w/snare

014345355Surgical colonoscopy

014345378Diagnostic colonoscopy

014345379Colonoscopy w/fb removal

014345380Colonoscopy and biopsy

014345381Colonoscopy submucous inj

014345382Colonoscopy/control bleeding

014345383Lesion removal colonoscopy

014345384Lesion remove colonoscopy

014345385Lesion removal colonoscopy

014345386Colonoscopy dilate stricture

014345391Colonoscopy w/endoscope us

014345392Colonoscopy w/endoscopic fnb

0146Level I Sigmoidoscopy and AnoscopyT6.2205$435.53.$87.11

01460227TAnoscopy hra w/biopsy

014645300Proctosigmoidoscopy dx

014645330Diagnostic sigmoidoscopy

014645331Sigmoidoscopy and biopsy
014645332Sigmoidoscopy w/fb removal

014645333Sigmoidoscopy & polypectomy

014645335Sigmoidoscopy w/submuc inj

014645337Sigmoidoscopy & decompress

014645338Sigmoidoscopy w/tumr remove

014645341Sigmoidoscopy w/ultrasound

014646606Anoscopy and biopsy

014646608Anoscopy remove for body

014646614Anoscopy control bleeding

0147Level II Sigmoidoscopy and AnoscopyT11.0417$773.10.$154.62

014745303Proctosigmoidoscopy dilate

014745305Proctosigmoidoscopy w/bx

014745308Proctosigmoidoscopy removal

014745309Proctosigmoidoscopy removal

014745315Proctosigmoidoscopy removal

014745317Proctosigmoidoscopy bleed

014745334Sigmoidoscopy for bleeding

014745339Sigmoidoscopy w/ablate tumr

014745340Sig w/balloon dilation

014745342Sigmoidoscopy w/us guide bx

014746604Anoscopy and dilation

014746611Anoscopy

0148Level I Anal/Rectal ProceduresT5.5158$386.19.$77.24

01480288TAnoscopy w/rf delivery

014845900Reduction of rectal prolapse

014845999Rectum surgery procedure

014846030Removal of rectal marker

014846050Incision of anal abscess

014846221Ligation of hemorrhoid(s)

014846500Injection into hemorrhoid(s)

014846930Destroy internal hemorrhoids

014846942Treatment of anal fissure

014846999Anus surgery procedure

0148C9725Place endorectal app

0149Level III Anal/Rectal ProceduresT24.4382"$1,711.07".$342.22

01490184TExc rectal tumor endoscopic

014945000Drainage of pelvic abscess

014945005Drainage of rectal abscess

014945100Biopsy of rectum

014945108Removal of anorectal lesion

014945150Excision of rectal stricture

014945160Excision of rectal lesion

014945171Exc rect tum transanal part

014945172Exc rect tum transanal full

014945190Destruction rectal tumor

014945500Repair of rectum

014945905Dilation of anal sphincter

014945910Dilation of rectal narrowing

014945990Surg dx exam anorectal

014946020Placement of seton

014946040Incision of rectal abscess

014946045Incision of rectal abscess

014946060Incision of rectal abscess

014946080Incision of anal sphincter

014946200Removal of anal fissure

014946230Removal of anal tags

014946250Remove ext hem groups 2+

014946255Remove int/ext hem 1 group

014946257Remove in/ex hem grp & fiss

014946258Remove in/ex hem grp w/fistu

014946260Remove in/ex hem groups 2+

014946261Remove in/ex hem grps & fiss

014946262Remove in/ex hem grps w/fist

014946270Remove anal fist subq

014946275Remove anal fist inter

014946280Remove anal fist complex
014946285Remove anal fist 2 stage

014946288Repair anal fistula

014946320Removal of hemorrhoid clot

014946505Chemodenervation anal musc

014946700Repair of anal stricture

014946753Reconstruction of anus

014946754Removal of suture from anus

014946940Treatment of anal fissure

014946945Remove by ligat int hem grp

014946946Remove by ligat int hem grps

014949442Place cecostomy tube perc

0150Level IV Anal/Rectal ProceduresT32.9805"$2,309.16".$461.84

015045505Repair of rectum

015045541Correct rectal prolapse

015045560Repair of rectocele

015046706Repr of anal fistula w/glue

015046707Repair anorectal fist w/plug

015046750Repair of anal sphincter

015046760Repair of anal sphincter

015046761Repair of anal sphincter

015046762Implant artificial sphincter

015046947Hemorrhoidopexy by stapling

0150C9716Radiofrequency energy to anu

0151Endoscopic Retrograde Cholangio-Pancreatography 

(ERCP)T24.6966"$1,729.16".$345.84

015143260Endo cholangiopancreatograph

015143261Endo cholangiopancreatograph

015143262Endo cholangiopancreatograph

015143263Endo cholangiopancreatograph

015143264Endo cholangiopancreatograph

015143265Endo cholangiopancreatograph

015143267Endo cholangiopancreatograph

015143271Endo cholangiopancreatograph

015143272Endo cholangiopancreatograph

015143273Endoscopic pancreatoscopy

0152Level I Percutaneous Abdominal and Biliary 

ProceduresT29.1415"$2,040.37".$408.08

015247490Incision of gallbladder

015247510Insert catheter bile duct

015247511Insert bile duct drain

015247552Biliary endoscopy thru skin

015247553Biliary endoscopy thru skin

015247554Biliary endoscopy thru skin

015247555Biliary endoscopy thru skin

015247630Remove bile duct stone

015247999Bile tract surgery procedure

0153Peritoneal and Abdominal ProceduresT27.2798"$1,910.02".$382.01

015344799Unlisted procedure intestine

015344950Appendectomy

015344955Appendectomy add-on

015349250Excision of umbilicus

015349402Remove foreign body adbomen

015349426Revise abdomen-venous shunt

015349999Abdomen surgery procedure

015355920Place needles pelvic for rt

0154Hernia/Hydrocele ProceduresT32.9294"$2,305.58"$464.85$461.12

015449491Rpr hern preemie reduc

015449492Rpr ing hern premie blocked

015449495Rpr ing hernia baby reduc

015449496Rpr ing hernia baby blocked

015449500Rpr ing hernia init reduce

015449501Rpr ing hernia init blocked

015449505Prp i/hern init reduc >5 yr

015449507Prp i/hern init block >5 yr

015449520Rerepair ing hernia reduce

015449521Rerepair ing hernia blocked
015449525Repair ing hernia sliding

015449540Repair lumbar hernia

015449550Rpr rem hernia init reduce

015449553Rpr fem hernia init blocked

015449555Rerepair fem hernia reduce

015449557Rerepair fem hernia blocked

015449560Rpr ventral hern init reduc

015449561Rpr ventral hern init block

015449565Rerepair ventrl hern reduce

015449566Rerepair ventrl hern block

015449568Hernia repair w/mesh

015449570Rpr epigastric hern reduce

015449572Rpr epigastric hern blocked

015449580Rpr umbil hern reduc < 5 yr

015449582Rpr umbil hern block < 5 yr

015449585Rpr umbil hern reduc > 5 yr

015449587Rpr umbil hern block > 5 yr

015449590Repair spigelian hernia

015449600Repair umbilical lesion

015451500Removal of bladder cyst

015454530Removal of testis

015454550Exploration for testis

015454640Suspension of testis

015454650Orchiopexy (Fowler-Stephens)

015455040Removal of hydrocele

015455041Removal of hydroceles

015455535Revise spermatic cord veins

015455540Revise hernia & sperm veins

0155Level II Anal/Rectal ProceduresT15.4175"$1,079.47".$215.90

01550249TLigation hemorrhoid w/us

015545020Drainage of rectal abscess

015545915Remove rectal obstruction

015546070Incision of anal septum

015546220Excise anal ext tag/papilla

0156Level III Urinary and Anal ProceduresT3.1886$223.25.$44.65

015651720Treatment of bladder lesion

015651725Simple cystometrogram

015651726Complex cystometrogram

015651727Cystometrogram w/up

015651728Cystometrogram w/vp

015651729Cystometrogram w/vp&up

015653600Dilate urethra stricture

015654450Preputial stretching

015691117Colon motility 6 hr study

015691122Anal pressure record

0157Colorectal Cancer Screening: Barium EnemaS2.7510$192.61.$38.53

0157G0106Colon CA screen;barium enema

0157G0120Colon ca scrn; barium enema

0158Colorectal Cancer Screening: ColonoscopyT8.3164$582.28$0.00$0.00

0158G0105Colorectal scrn; hi risk ind$0.00$0.00

0158G0121Colon ca scrn not hi rsk ind$0.00$0.00

0159Colorectal Cancer Screening: Flexible SigmoidoscopyS5.3772$376.49$0.00$0.00

0159G0104CA screen;flexi sigmoidscope$0.00$0.00

0160Level I Cystourethroscopy and other Genitourinary 

ProceduresT6.7736$474.26.$94.86

016050386Remove stent via transureth

016050389Remove renal tube w/fluoro

016050551Kidney endoscopy

016050555Kidney endoscopy & biopsy

016050562Renal scope w/tumor resect

016050570Kidney endoscopy

016050572Kidney endoscopy

016050574Kidney endoscopy & biopsy

016050951Endoscopy of ureter

016050953Endoscopy of ureter

016050970Ureter endoscopy
016050972Ureter endoscopy & catheter

016051045Incise bladder/drain ureter

016052000Cystoscopy

016052010Cystoscopy & duct catheter

016052265Cystoscopy and treatment

0161Level II Cystourethroscopy and other Genitourinary 

ProceduresT17.4715"$1,223.28".$244.66

016150384Remove ureter stent percut

016150392Insert kidney drain

016150576Kidney endoscopy & treatment

016150580Kidney endoscopy & treatment

016150974Ureter endoscopy & biopsy

016150976Ureter endoscopy & treatment

016152001Cystoscopy removal of clots

016152260Cystoscopy and treatment

016152270Cystoscopy & revise urethra

016152281Cystoscopy and treatment

016152285Cystoscopy and treatment

016152310Cystoscopy and treatment

016153605Dilate urethra stricture

016174475X-ray control cath insert

016174480X-ray control cath insert

016174485X-ray guide gu dilation

0162Level III Cystourethroscopy and other Genitourinary 

ProceduresT26.2973"$1,841.23".$368.25

016250020Renal abscess open drain

016250382Change ureter stent percut

016250385Change stent via transureth

016250393Insert ureteral tube

016250395Create passage to kidney

016250553Kidney endoscopy

016250557Kidney endoscopy & treatment

016250561Kidney endoscopy & treatment

016250955Ureter endoscopy & biopsy

016250957Ureter endoscopy & treatment

016250961Ureter endoscopy & treatment

016250980Ureter endoscopy & treatment

016251020Incise & treat bladder

016251030Incise & treat bladder

016251040Incise & drain bladder

016251050Removal of bladder stone

016251065Remove ureter calculus

016251520Removal of bladder lesion

016251535Repair of ureter lesion

016251860Repair of bladder wound

016251880Repair of bladder opening

016252005Cystoscopy & ureter catheter

016252007Cystoscopy and biopsy

016252204Cystoscopy w/biopsy(s)

016252214Cystoscopy and treatment

016252224Cystoscopy and treatment

016252234Cystoscopy and treatment

016252235Cystoscopy and treatment

016252240Cystoscopy and treatment

016252250Cystoscopy and radiotracer

016252275Cystoscopy & revise urethra

016252276Cystoscopy and treatment

016252277Cystoscopy and treatment

016252283Cystoscopy and treatment

016252290Cystoscopy and treatment

016252300Cystoscopy and treatment

016252301Cystoscopy and treatment

016252305Cystoscopy and treatment

016252315Cystoscopy and treatment

016252317Remove bladder stone

016252318Remove bladder stone
016252320Cystoscopy and treatment

016252325Cystoscopy stone removal

016252330Cystoscopy and treatment

016252332Cystoscopy and treatment

016252334Create passage to kidney

016252341Cysto w/ureter stricture tx

016252342Cysto w/up stricture tx

016252343Cysto w/renal stricture tx

016252344Cysto/uretero stricture tx

016252345Cysto/uretero w/up stricture

016252346Cystouretero w/renal strict

016252351Cystouretero & or pyeloscope

016252352Cystouretero w/stone remove

016252354Cystouretero w/biopsy

016252355Cystouretero w/excise tumor

016252400Cystouretero w/congen repr

016252402Cystourethro cut ejacul duct

016252450Incision of prostate

016252500Revision of bladder neck

016252640Relieve bladder contracture

016252700Drainage of prostate abscess

016255720Drainage of prostate abscess

016255725Drainage of prostate abscess

0163Level IV Cystourethroscopy and other Genitourinary 

ProceduresT37.0730"$2,595.70".$519.14

016350575Kidney endoscopy

016351060Removal of ureter stone

016352282Cystoscopy implant stent

016352327Cystoscopy inject material

016352353Cystouretero w/lithotripsy

016352601Prostatectomy (TURP)

016352630Remove prostate regrowth

016355875Transperi needle place pros

0164Level II Urinary and Anal ProceduresT1.9499$136.52.$27.31

016446083Incise external hemorrhoid

016450396Measure kidney pressure

016451100Drain bladder by needle

016451700Irrigation of bladder

016451705Change of bladder tube

016451785Anal/urinary muscle study

016451797Intraabdominal pressure test

016453621Dilate urethra stricture

016453855Insert prost urethral stent

016454200Treatment of penis lesion

016454220Treatment of penis lesion

016454235Penile injection

016454250Penis study

0165Level IV Urinary and Anal ProceduresT20.4158"$1,429.43".$285.89

016550727Revise ureter

016551102Drain bl w/cath insertion

016553620Dilate urethra stricture

016553860Transurethral rf treatment

016554231Dynamic cavernosometry

016555860Surgical exposure prostate

0166Level I Urethral ProceduresT21.0031"$1,470.55".$294.11

016653000Incision of urethra

016653010Incision of urethra

016653020Incision of urethra

016653025Incision of urethra

016653040Drainage of urethra abscess

016653060Drainage of urethra abscess

016653080Drainage of urinary leakage

016653085Drainage of urinary leakage

016653200Biopsy of urethra

016653215Removal of urethra

016653235Removal of urethra lesion
016653250Removal of urethra gland

016653260Treatment of urethra lesion

016653265Treatment of urethra lesion

016653270Removal of urethra gland

016653275Repair of urethra defect

016653460Revision of urethra

016653502Repair of urethra injury

016653510Repair of urethra injury

016653665Dilation of urethra

016654000Slitting of prepuce

016654001Slitting of prepuce

0168Level II Urethral ProceduresT32.3061"$2,261.94".$452.39

016851715Endoscopic injection/implant

016853210Removal of urethra

016853220Treatment of urethra lesion

016853230Removal of urethra lesion

016853240Surgery for urethra pouch

016853400Revise urethra stage 1

016853405Revise urethra stage 2

016853410Reconstruction of urethra

016853420Reconstruct urethra stage 1

016853425Reconstruct urethra stage 2

016853430Reconstruction of urethra

016853431Reconstruct urethra/bladder

016853442Remove/revise male sling

016853446Remove uro sphincter

016853449Repair uro sphincter

016853450Revision of urethra

016853500Urethrlys transvag w/ scope

016853505Repair of urethra injury

016853515Repair of urethra injury

016853520Repair of urethra defect

0169LithotripsyT52.0882"$3,647.01"$997.74$729.41

016950590Fragmenting of kidney stone

0170DialysisS6.2419$437.03.$87.41

017090935Hemodialysis one evaluation

0170G0257Unsched dialysis ESRD pt hos

0174Level IV LaparoscopyT111.6495"$7,817.25""$2,055.58""$1,563.45"

017447370Laparo ablate liver tumor rf

017447371Laparo ablate liver cryosurg

017450542Laparo ablate renal mass

0181Level II Male Genital ProceduresT34.6069"$2,423.04"$607.60$484.61

018137790Penile venous occlusion

018154110Treatment of penis lesion

018154111Treat penis lesion graft

018154112Treat penis lesion graft

018154120Partial removal of penis

018154205Treatment of penis lesion

018154300Revision of penis

018154304Revision of penis

018154308Reconstruction of urethra

018154312Reconstruction of urethra

018154316Reconstruction of urethra

018154318Reconstruction of urethra

018154322Reconstruction of urethra

018154324Reconstruction of urethra

018154326Reconstruction of urethra

018154328Revise penis/urethra

018154332Revise penis/urethra

018154336Revise penis/urethra

018154340Secondary urethral surgery

018154344Secondary urethral surgery

018154348Secondary urethral surgery

018154352Reconstruct urethra/penis

018154360Penis plastic surgery

018154380Repair penis
018154385Repair penis

018154406Remove muti-comp penis pros

018154408Repair multi-comp penis pros

018154415Remove self-contd penis pros

018154420Revision of penis

018154435Revision of penis

018154440Repair of penis

018154535Extensive testis surgery

0183Level I Male Genital ProceduresT23.5454"$1,648.55".$329.71

018354150Circumcision w/regionl block

018354160Circumcision neonate

018354161Circum 28 days or older

018354162Lysis penil circumic lesion

018354163Repair of circumcision

018354164Frenulotomy of penis

018354505Biopsy of testis

018354512Excise lesion testis

018354520Removal of testis

018354522Orchiectomy partial

018354560Exploration for testis

018354600Reduce testis torsion

018354620Suspension of testis

018354660Revision of testis

018354670Repair testis injury

018354680Relocation of testis(es)

018354700Drainage of scrotum

018354830Remove epididymis lesion

018354840Remove epididymis lesion

018354860Removal of epididymis

018354861Removal of epididymis

018354865Explore epididymis

018354900Fusion of spermatic ducts

018354901Fusion of spermatic ducts

018355060Repair of hydrocele

018355110Explore scrotum

018355120Removal of scrotum lesion

018355150Removal of scrotum

018355175Revision of scrotum

018355180Revision of scrotum

018355200Incision of sperm duct

018355250Removal of sperm duct(s)

018355400Repair of sperm duct

018355450Ligation of sperm duct

018355500Removal of hydrocele

018355520Removal of sperm cord lesion

018355530Revise spermatic cord veins

018355600Incise sperm duct pouch

018355680Remove sperm pouch lesion

0184Prostate BiopsyT13.7727$964.31.$192.87

018455700Biopsy of prostate

018455705Biopsy of prostate

018455706Prostate saturation sampling

0188Level II Female Reproductive ProcT1.5841$110.91.$22.19

018856405I & D of vulva/perineum

018856420Drainage of gland abscess

018856606Biopsy of vulva/perineum

018856820Exam of vulva w/scope

018856821Exam/biopsy of vulva w/scope

018857150Treat vagina infection

018857160Insert pessary/other device

018857180Treat vaginal bleeding

018857452Exam of cervix w/scope

018857511Cryocautery of cervix

018858100Biopsy of uterus lining

018858301Remove intrauterine device

018859020Fetal contract stress test
018859025Fetal non-stress test

018859070Transabdom amnioinfus w/us

018859200Insert cervical dilator

0189Level III Female Reproductive ProcT3.4818$243.78.$48.76

018955870Electroejaculation

018956605Biopsy of vulva/perineum

018957156Ins vag brachytx device

018957420Exam of vagina w/scope

018957421Exam/biopsy of vag w/scope

018957454Bx/curett of cervix w/scope

018957455Biopsy of cervix w/scope

018957456Endocerv curettage w/scope

018958321Artificial insemination

018958322Artificial insemination

018958323Sperm washing

018958970Retrieval of oocyte

018958974Transfer of embryo

018958976Transfer of embryo

018959000Amniocentesis diagnostic

018959012Fetal cord puncture prenatal

018959015Chorion biopsy

018959030Fetal scalp blood sample

018959072Umbilical cord occlud w/us

018959074Fetal fluid drainage w/us

018959076Fetal shunt placement w/us

018959866Abortion (mpr)

0190Level I HysteroscopyT23.0098"$1,611.05"$424.28$322.21

019058555Hysteroscopy dx sep proc

019058558Hysteroscopy biopsy

019058559Hysteroscopy lysis

019058562Hysteroscopy remove fb

019058579Hysteroscope procedure

0191Level I Female Reproductive ProcT0.1337$9.36$1.95$1.88

019157170Fitting of diaphragm/cap

019158999Genital surgery procedure

019159897Fetal invas px w/us

019159899Maternity care procedure

019199170Anogenital exam child

0191Q0091Obtaining screen pap smear$0.00$0.00

0192Level IV Female Reproductive ProcT6.6979$468.96.$93.80

019257020Drainage of pelvic fluid

019257100Biopsy of vagina

019257155Insert uteri tandems/ovoids

019257500Biopsy of cervix

019257505Endocervical curettage

019259001Amniocentesis therapeutic

0193Level V Female Reproductive ProcT20.6493"$1,445.78".$289.16

019356440Surgery for vulva lesion

019356441Lysis of labial lesion(s)

019356442Hymenotomy

019356620Partial removal of vulva

019356625Complete removal of vulva

019356700Partial removal of hymen

019356740Remove vagina gland lesion

019356800Repair of vagina

019356805Repair clitoris

019356810Repair of perineum

019357000Exploration of vagina

019357010Drainage of pelvic abscess

019357061Destroy vag lesions simple

019357065Destroy vag lesions complex

019357105Biopsy of vagina

019357106Remove vagina wall partial

019357130Remove vagina lesion

019357135Remove vagina lesion

019357200Repair of vagina
019357210Repair vagina/perineum

019357295Revise vag graft via vagina

019357400Dilation of vagina

019357410Pelvic examination

019357415Remove vaginal foreign body

019357426Revise prosth vag graft lap

019357460Bx of cervix w/scope leep

019357461Conz of cervix w/scope leep

019357510Cauterization of cervix

019357513Laser surgery of cervix

019357520Conization of cervix

019357522Conization of cervix

019357558D&c of cervical stump

019357700Revision of cervix

019357720Revision of cervix

019357800Dilation of cervical canal

019358120Dilation and curettage

019358345Reopen fallopian tube

019358346Insert heyman uteri capsule

019358615Occlude fallopian tube(s)

019358800Drainage of ovarian cyst(s)

019358823Drain pelvic abscess percut

019358900Biopsy of ovary(s)

019359160D & c after delivery

019359300Episiotomy or vaginal repair

019359320Revision of cervix

019359409Obstetrical care

019359412Antepartum manipulation

019359414Deliver placenta

019359612Vbac delivery only

019359812Treatment of miscarriage

019359820Care of miscarriage

019359821Treatment of miscarriage

019359840Abortion

019359841Abortion

019359870Evacuate mole of uterus

019359871Remove cerclage suture

0195Level VI Female Reproductive ProceduresT35.9087"$2,514.18".$502.84

019557107Remove vagina tissue part

019557109Vaginectomy partial w/nodes

019557120Closure of vagina

019557230Repair of urethral lesion

019557240Repair bladder & vagina

019557250Repair rectum & vagina

019557260Repair of vagina

019557267Insert mesh/pelvic flr addon

019557268Repair of bowel bulge

019557287Revise/remove sling repair

019557289Repair bladder & vagina

019557291Construction of vagina

019557292Construct vagina with graft

019557300Repair rectum-vagina fistula

019557320Repair bladder-vagina lesion

019557330Repair bladder-vagina lesion

019557335Repair vagina

019557530Removal of cervix

019557550Removal of residual cervix

019557555Remove cervix/repair vagina

019558145Myomectomy vag method

019558260Vaginal hysterectomy

019558262Vag hyst including t/o

019558263Vag hyst w/t/o & vag repair

019558270Vag hyst w/enterocele repair

019558350Reopen fallopian tube

019558353Endometr ablate thermal

019558600Division of fallopian tube
019558770Create new tubal opening

019558805Drainage of ovarian cyst(s)

019558820Drain ovary abscess open

019558920Partial removal of ovary(s)

019558925Removal of ovarian cyst(s)

019559100Remove uterus lesion

0202Level VII Female Reproductive ProceduresT45.9895"$3,220.00"$981.50$644.00

020251845Repair bladder neck

020257220Revision of urethra

020257265Extensive repair of vagina

020257282Colpopexy extraperitoneal

020257283Colpopexy intraperitoneal

020257284Repair paravag defect open

020257285Repair paravag defect vag

020257288Repair bladder defect

020257310Repair urethrovaginal lesion

020257423Repair paravag defect lap

020257556Remove cervix repair bowel

020258290Vag hyst complex

020258291Vag hyst incl t/o complex

020258292Vag hyst t/o & repair compl

020258294Vag hyst w/enterocele compl

020258356Endometrial cryoablation

020258565Hysteroscopy sterilization

0203Level IV Nerve InjectionsT12.7996$896.18.$179.24

020361791Treat trigeminal tract

020362263Epidural lysis mult sessions

020362264Epidural lysis on single day

020362281Treat spinal cord lesion

020362282Treat spinal canal lesion

020362319Inject spine w/cath l/s (cd)

020362355Remove spinal canal catheter

020363746Removal of spinal shunt

020364600Injection treatment of nerve

020364620Injection treatment of nerve

020364635Destroy lumb/sac facet jnt

020364680Injection treatment of nerve

020364681Injection treatment of nerve

0204Level I Nerve InjectionsT2.6055$182.43.$36.49

02040214TNjx paravert w/us cer/thor

02040215TNjx paravert w/us cer/thor

02040217TNjx paravert w/us lumb/sac

02040218TNjx paravert w/us lumb/sac

020420526Ther injection carp tunnel

020420527Inj dupuytren cord w/enzyme

020420550Inj tendon sheath/ligament

020420551Inj tendon origin/insertion

020420552Inj trigger point 1/2 muscl

020420553Inject trigger points =/> 3

020420600Drain/inject joint/bursa

020420605Drain/inject joint/bursa

020420610Drain/inject joint/bursa

020420612Aspirate/inj ganglion cyst

020464400N block inj trigeminal

020464402N block inj facial

020464408N block inj vagus

020464410N block inj phrenic

020464455N block inj plantar digit

020464491Inj paravert f jnt c/t 2 lev

020464492Inj paravert f jnt c/t 3 lev

020464494Inj paravert f jnt l/s 2 lev

020464495Inj paravert f jnt l/s 3 lev

020464505N block spenopalatine gangl

020464508N block carotid sinus s/p

020464566Neuroeltrd stim post tibial

020464611Chemodenerv saliv glands
020464612Destroy nerve face muscle

020464632N block inj common digit

020464634Destroy c/th facet jnt addl

020464650Chemodenerv eccrine glands

020464653Chemodenerv eccrine glands

020464999Nervous system surgery

0206Level II Nerve InjectionsT3.8754$271.34.$54.27

02060229TNjx tfrml eprl w/us cer/thor

02060231TNjx tfrml eprl w/us lumb/sac

020662270Spinal fluid tap diagnostic

020662272Drain cerebro spinal fluid

020664405N block inj occipital

020664412N block inj spinal accessor

020664413N block inj cervical plexus

020664415N block inj brachial plexus

020664417N block inj axillary

020664418N block inj suprascapular

020664420N block inj intercost sng

020664425N block inj ilio-ing/hypogi

020664435N block inj paracervical

020664447N block inj fem single

020664450N block other peripheral

020664480Inj foramen epidural add-on

020664484Inj foramen epidural add-on

020664613Destroy nerve neck muscle

020664614Destroy nerve extrem musc

0207Level III Nerve InjectionsT7.4537$521.88.$104.38

02070213TNjx paravert w/us cer/thor

02070216TNjx paravert w/us lumb/sac

02070228TNjx tfrml eprl w/us cer/thor

02070230TNjx tfrml eprl w/us lumb/sac

020761000Remove cranial cavity fluid

020761001Remove cranial cavity fluid

020761020Remove brain cavity fluid

020761026Injection into brain canal

020761050Remove brain canal fluid

020761055Injection into brain canal

020762194Replace/irrigate catheter

020762268Drain spinal cord cyst

020762273Inject epidural patch

020762280Treat spinal cord lesion

020762292Injection into disk lesion

020762294Injection into spinal artery

020762310Inject spine c/t

020762311Inject spine l/s (cd)

020762318Inject spine w/cath c/t

020764416N block cont infuse b plex

020764421N block inj intercost mlt

020764430N block inj pudendal

020764445N block inj sciatic sng

020764446N blk inj sciatic cont inf

020764448N block inj fem cont inf

020764449N block inj lumbar plexus

020764479Inj foramen epidural c/t

020764483Inj foramen epidural l/s

020764490Inj paravert f jnt c/t 1 lev

020764493Inj paravert f jnt l/s 1 lev

020764510N block stellate ganglion

020764517N block inj hypogas plxs

020764520N block lumbar/thoracic

020764530N block inj celiac pelus

020764630Injection treatment of nerve

020764633Destroy cerv/thor facet jnt

020764636Destroy l/s facet jnt addl

020764640Injection treatment of nerve

0207G0260Inj for sacroiliac jt anesth
0208Laminotomies and LaminectomiesT50.7343"$3,552.21".$710.45

02080274TPerq lamot/lam crv/thrc

02080275TPerq lamot/lam lumbar

020822100Remove part of neck vertebra

020822101Remove part thorax vertebra

020822102Remove part lumbar vertebra

020822103Remove extra spine segment

020822222Revision of thorax spine

020822551Neck spine fuse&remov bel c2

020822554Neck spine fusion

020822612Lumbar spine fusion

020822614Spine fusion extra segment

020862351Implant spinal canal cath

020863001Removal of spinal lamina

020863003Removal of spinal lamina

020863005Removal of spinal lamina

020863011Removal of spinal lamina

020863012Removal of spinal lamina

020863015Removal of spinal lamina

020863016Removal of spinal lamina

020863017Removal of spinal lamina

020863020Neck spine disk surgery

020863030Low back disk surgery

020863035Spinal disk surgery add-on

020863040Laminotomy single cervical

020863042Laminotomy single lumbar

020863045Removal of spinal lamina

020863046Removal of spinal lamina

020863047Removal of spinal lamina

020863048Remove spinal lamina add-on

020863055Decompress spinal cord

020863056Decompress spinal cord

020863057Decompress spine cord add-on

020863064Decompress spinal cord

020863066Decompress spine cord add-on

020863075Neck spine disk surgery

020863076Neck spine disk surgery

0209"Level II Extended EEG, Sleep, and Cardiovascular 

Studies"S11.3569$795.16$268.73$159.04

020993229Remote 30 day ecg tech supp

020995805Multiple sleep latency test

020995807Sleep study attended

020995808Polysomnography 1-3

020995810Polysomnography 4 or more

020995811Polysomnography w/cpap

020995950Ambulatory eeg monitoring

020995951EEG monitoring/videorecord

020995953EEG monitoring/computer

020995956Eeg monitor technol attended

0209G0302Pre-op service LVRS complete

0209G0303Pre-op service LVRS 10-15dos

0213"Level I Extended EEG, Sleep, and Cardiovascular 

Studies"S2.4298$170.12$53.58$34.03

021395800Slp stdy unattended

021395801Slp stdy unatnd w/anal

021395806Sleep study unatt&resp efft

021395812Eeg 41-60 minutes

021395813Eeg over 1 hour

021395816Eeg awake and drowsy

021395819Eeg awake and asleep

021395822Eeg coma or sleep only

021395827Eeg all night recording

021395958EEG monitoring/function test

0213G0304Pre-op service LVRS 1-9 dos

0213G0305Post op service LVRS min 6

0213G0398Home sleep test/type 2 Porta
0213G0399Home sleep test/type 3 Porta

0213G0400Home sleep test/type 4 Porta

0215Level I Nerve and Muscle TestsS0.6335$44.36.$8.88

02150199TPhysiologic tremor record

02150278TTempr

021595869Muscle test thor paraspinal

021595870Muscle test nonparaspinal

021595887Musc tst done w/n tst nonext

021595900Motor nerve conduction test

021595903Motor nerve conduction test

021595904Sense nerve conduction test

021595905Motor/sens nrve conduct test

021595933Blink reflex test

021595934H-reflex test

021595936H-reflex test

021595999Neurological procedure

0216Level III Nerve and Muscle TestsS2.6488$185.46.$37.10

021692584Electrocochleography

021692585Auditor evoke potent compre

021695824Eeg cerebral death only

021695925Somatosensory testing

021695926Somatosensory testing

021695927Somatosensory testing

021695930Visual evoked potential test

021695938Somatosensory testing

021695961Electrode stimulation brain

021695962Electrode stim brain add-on

021696000Motion analysis video/3d

021696001Motion test w/ft press meas

0218Level II Nerve and Muscle TestsS1.2025$84.19.$16.84

02180272TInterrogate crtd sns dev

02180273TInterrogate crtd sns w/pgrmg

02180285TPeriph field stimul analys

021890867Tcranial magn stim tx plan

021890868Tcranial magn stim tx deli

021890869Tcran magn stim redetemine

021892586Auditor evoke potent limit

021895803Actigraphy testing

021895857Cholinesterase challenge

021895860Muscle test one limb

021895861Muscle test 2 limbs

021895863Muscle test 3 limbs

021895864Muscle test 4 limbs

021895865Muscle test larynx

021895866Muscle test hemidiaphragm

021895867Muscle test cran nerv unilat

021895868Muscle test cran nerve bilat

021895872Muscle test one fiber

021895875Limb exercise test

021895885Musc tst done w/nerv tst lim

021895886Musc test done w/n test comp

021895921Autonomic nerv function test

021895922Autonomic nerv function test

021895923Autonomic nerv function test

021895928C motor evoked uppr limbs

021895929C motor evoked lwr limbs

021895937Neuromuscular junction test

021895939C motor evoked upr&lwr limbs

021895954EEG monitoring/giving drugs

021895970Analyze neurostim no prog

021895973Analyze neurostim complex

021895975Cranial neurostim complex

021895981Io anal gast n-stim subsq

021896002Dynamic surface emg

021896003Dynamic fine wire emg

0220Level I Nerve ProceduresT18.8921"$1,322.75".$264.55
022027325Neurectomy hamstring

022027326Neurectomy popliteal

022028035Decompression of tibia nerve

022028055Neurectomy foot

022061790Treat trigeminal nerve

022063600Remove spinal cord lesion

022063610Stimulation of spinal cord

022063615Remove lesion of spinal cord

022064605Injection treatment of nerve

022064610Injection treatment of nerve

022064702Revise finger/toe nerve

022064704Revise hand/foot nerve

022064708Revise arm/leg nerve

022064712Revision of sciatic nerve

022064713Revision of arm nerve(s)

022064714Revise low back nerve(s)

022064716Revision of cranial nerve

022064718Revise ulnar nerve at elbow

022064719Revise ulnar nerve at wrist

022064721Carpal tunnel surgery

022064722Relieve pressure on nerve(s)

022064726Release foot/toe nerve

022064727Internal nerve revision

022064732Incision of brow nerve

022064734Incision of cheek nerve

022064736Incision of chin nerve

022064738Incision of jaw nerve

022064740Incision of tongue nerve

022064742Incision of facial nerve

022064744Incise nerve back of head

022064746Incise diaphragm nerve

022064761Incision of pelvis nerve

022064763Incise hip/thigh nerve

022064771Sever cranial nerve

022064772Incision of spinal nerve

022064774Remove skin nerve lesion

022064776Remove digit nerve lesion

022064778Digit nerve surgery add-on

022064782Remove limb nerve lesion

022064783Limb nerve surgery add-on

022064784Remove nerve lesion

022064787Implant nerve end

022064788Remove skin nerve lesion

022064790Removal of nerve lesion

022064795Biopsy of nerve

022064802Remove sympathetic nerves

022064804Remove sympathetic nerves

022064820Remove sympathetic nerves

0221Level II Nerve ProceduresT36.1290"$2,529.61".$505.93

02210269TRev/remvl crtd sns dev total

022161720Incise skull/brain surgery

022161770Incise skull for treatment

022162287Percutaneous diskectomy

022162365Remove spine infusion device

022164570Remove vagus n eltrd

022164766Incise hip/thigh nerve

022164786Remove sciatic nerve lesion

022164792Removal of nerve lesion

022164831Repair of digit nerve

022164832Repair nerve add-on

022164834Repair of hand or foot nerve

022164835Repair of hand or foot nerve

022164836Repair of hand or foot nerve

022164837Repair nerve add-on

022164840Repair of leg nerve

022164856Repair/transpose nerve
022164857Repair arm/leg nerve

022164858Repair sciatic nerve

022164859Nerve surgery

022164861Repair of arm nerves

022164862Repair of low back nerves

022164864Repair of facial nerve

022164865Repair of facial nerve

022164870Fusion of facial/other nerve

022164872Subsequent repair of nerve

022164874Repair & revise nerve add-on

022164876Repair nerve/shorten bone

022164885Nerve graft head or neck

022164886Nerve graft head or neck

022164890Nerve graft hand or foot

022164891Nerve graft hand or foot

022164892Nerve graft arm or leg

022164893Nerve graft arm or leg

022164895Nerve graft hand or foot

022164896Nerve graft hand or foot

022164897Nerve graft arm or leg

022164898Nerve graft arm or leg

022164901Nerve graft add-on

022164902Nerve graft add-on

022164905Nerve pedicle transfer

022164907Nerve pedicle transfer

022164910Nerve repair w/allograft

022164911Neurorraphy w/vein autograft

0224Implantation of Catheter/Reservoir/ShuntT41.5547"$2,909.49".$581.90

022461215Insert brain-fluid device

022462230Replace/revise brain shunt

022462350Implant spinal canal cath

022462360Insert spine infusion device

022463741Install spinal shunt

022463744Revision of spinal shunt

0227Implantation of Drug Infusion DeviceT192.7379"$13,494.74"."$2,698.95"

022762361Implant spine infusion pump

022762362Implant spine infusion pump

0229Level II Endovascular Revascularization of the Lower 

ExtremityT115.5014"$8,086.95"."$1,617.39"

022937183Remove hepatic shunt (tips)

022937205Transcath iv stent percut

022937206Transcath iv stent/perc addl

022937207Transcath iv stent open

022937208Transcath iv stent/open addl

022937210Embolization uterine fibroid

022937221Iliac revasc w/stent

022937225Fem/popl revas w/ather

022937226Fem/popl revasc w/stent

022937229Tib/per revasc w/ather

022937230Tib/per revasc w/stent

022937233Tibper revasc w/ather add-on

0230Level I Eye Tests & TreatmentsS0.6424$44.98.$9.00

02300181TCorneal hysteresis

02300207TClear eyelid gland w/heat

023068200Treat eyelid by injection

023092020Special eye evaluation

023092025Corneal topography

023092060Special eye evaluation

023092065Orthoptic/pleoptic training

023092081Visual field examination(s)

023092082Visual field examination(s)

023092132Cmptr ophth dx img ant segmt

023092133Cmptr ophth img optic nerve

023092134Cptr ophth dx img post segmt

023092140Glaucoma provocative tests

023092225Special eye exam initial
023092226Special eye exam subsequent

023092250Eye exam with photos

023092260Ophthalmoscopy/dynamometry

023092265Eye muscle evaluation

023092270Electro-oculography

023092283Color vision examination

023092284Dark adaptation eye exam

023092285Eye photography

023092312Contact lens fitting

023092317Prescription of contact lens

023092326Replacement of contact lens

023092354Special spectacles fitting

023092355Special spectacles fitting

023092358Eye prosthesis service

023092499Eye service or procedure

0230G0118Glaucoma scrn hgh risk direc

0231Level III Eye Tests & TreatmentsS2.0294$142.09.$28.42

023165450Treatment of corneal lesion

023167500Inject/treat eye socket

023167938Remove eyelid foreign body

023168840Explore/irrigate tear ducts

023192235Eye exam with photos

023192240Icg angiography

023192275Electroretinography

0232Level I Anterior Segment Eye ProceduresT2.8247$197.77$42.27$39.56

02320124TConjunctival drug placement

023265900Remove eye lesion

023266500Incision of iris

023266999Eye surgery procedure

023276510Ophth us b & quant a

0233Level III Anterior Segment Eye ProceduresT16.6214"$1,163.76".$232.76

023365235Remove foreign body from eye

023365400Removal of eye lesion

023365410Biopsy of cornea

023365420Removal of eye lesion

023365436Curette/treat cornea

023365772Correction of astigmatism

023365775Correction of astigmatism

023365778Cover eye w/membrane

023365779Cover eye w/membrane suture

023365865Incise inner eye adhesions

023365880Incise inner eye adhesions

023366020Injection treatment of eye

023366030Injection treatment of eye

023366250Follow-up surgery of eye

023366700Destruction ciliary body

023366710Ciliary transsleral therapy

023366720Destruction ciliary body

023366840Removal of lens material

023367880Revision of eyelid

023368130Remove eyelid lining lesion

0234Level IV Anterior Segment Eye ProceduresT23.2851"$1,630.33"$347.90$326.07

02340099TImplant corneal ring

02340123TScleral fistulization

023465272Repair of eye wound

023465275Repair of eye wound

023465426Removal of eye lesion

023465805Drainage of eye

023465810Drainage of eye

023465815Drainage of eye

023465820Relieve inner eye pressure

023465850Incision of eye

023465870Incise inner eye adhesions

023465875Incise inner eye adhesions

023465920Remove implant of eye

023465930Remove blood clot from eye
023466130Remove eye lesion

023466150Glaucoma surgery

023466155Glaucoma surgery

023466160Glaucoma surgery

023466165Glaucoma surgery

023466170Glaucoma surgery

023466172Incision of eye

023466185Revise eye shunt

023466600Remove iris and lesion

023466605Removal of iris

023466630Removal of iris

023466635Removal of iris

023466680Repair iris & ciliary body

023466682Repair iris & ciliary body

023466711Ciliary endoscopic ablation

023466740Destruction ciliary body

023466825Reposition intraocular lens

023468330Revise eyelid lining

023468360Revise eyelid lining

023468362Revise eyelid lining

023468371Harvest eye tissue alograft

0235Level I Posterior Segment Eye ProceduresT4.8135$337.02.$67.41

023565260Remove foreign body from eye

023567141Treatment of retina

023567208Treatment of retinal lesion

023567220Treatment of choroid lesion

023567221Ocular photodynamic ther

023567225Eye photodynamic ther add-on

023567299Eye surgery procedure

0235G0186"Dstry eye lesn,fdr vssl tech"

0237Level II Posterior Segment Eye ProceduresT21.5368"$1,507.92".$301.59

02370186TSuprachoroidal drug delivery

02370190TPlace intraoc radiation src

023765265Remove foreign body from eye

023765280Repair of eye wound

023767005Partial removal of eye fluid

023767030Incise inner eye strands

023767101Repair detached retina

023767110Repair detached retina

023767115Release encircling material

023767120Remove eye implant material

023767218Treatment of retinal lesion

023767227Treatment of retinal lesion

023767255Reinforce/graft eye wall

0238Level I Repair and Plastic Eye ProceduresT3.1036$217.30.$43.46

023867028Injection eye drug

023867345Destroy nerve of eye muscle

023867505Inject/treat eye socket

023867515Inject/treat eye socket

023867599Orbit surgery procedure

023867700Drainage of eyelid abscess

023867800Remove eyelid lesion

023867805Remove eyelid lesions

023867810Biopsy of eyelid

023867825Revise eyelashes

023867999Revision of eyelid

023868020Incise/drain eyelid lining

023868399Eyelid lining surgery

023868400Incise/drain tear gland

023868440Incise tear duct opening

023868530Clearance of tear duct

023868705Revise tear duct opening

023868760Close tear duct opening

023868761Close tear duct opening

023868810Probe nasolacrimal duct

023868899Tear duct system surgery
0239Level II Repair and Plastic Eye ProceduresT7.6566$536.08.$107.22

023965435Curette/treat cornea

023967710Incision of eyelid

023967801Remove eyelid lesions

023967830Revise eyelashes

023967840Remove eyelid lesion

023967850Treat eyelid lesion

023967875Closure of eyelid by suture

023968100Biopsy of eyelid lining

023968135Remove eyelid lining lesion

0240Level III Repair and Plastic Eye ProceduresT19.7786"$1,384.82"$296.20$276.97

024065175Removal of ocular implant

024065270Repair of eye wound

024065600Revision of cornea

024067250Reinforce eye wall

024067400Explore/biopsy eye socket

024067412Explore/treat eye socket

024067415Aspiration orbital contents

024067715Incision of eyelid fold

024067808Remove eyelid lesion(s)

024067835Revise eyelashes

024067882Revision of eyelid

024067901Repair eyelid defect

024067903Repair eyelid defect

024067904Repair eyelid defect

024067906Repair eyelid defect

024067908Repair eyelid defect

024067909Revise eyelid defect

024067911Revise eyelid defect

024067912Correction eyelid w/implant

024067914Repair eyelid defect

024067915Repair eyelid defect

024067916Repair eyelid defect

024067917Repair eyelid defect

024067921Repair eyelid defect

024067922Repair eyelid defect

024067923Repair eyelid defect

024067924Repair eyelid defect

024067930Repair eyelid wound

024067935Repair eyelid wound

024067950Revision of eyelid

024067961Revision of eyelid

024067966Revision of eyelid

024067971Reconstruction of eyelid

024067974Reconstruction of eyelid

024067975Reconstruction of eyelid

024068115Remove eyelid lining lesion

024068326Revise/graft eyelid lining

024068340Separate eyelid adhesions

024068420Incise/drain tear sac

024068510Biopsy of tear gland

024068525Biopsy of tear sac

024068540Remove tear gland lesion

024068700Repair tear ducts

024068811Probe nasolacrimal duct

024068815Probe nasolacrimal duct

024068816Probe nl duct w/balloon

0241Level IV Repair and Plastic Eye ProceduresT27.3416"$1,914.35"$383.45$382.87

024165125Revise ocular implant

024165130Insert ocular implant

024165135Insert ocular implant

024165150Revise ocular implant

024167405Explore/drain eye socket

024167413Explore/treat eye socket

024167560Revise eye socket implant

024167900Repair brow defect
024167902Repair eyelid defect

024167973Reconstruction of eyelid

024168320Revise/graft eyelid lining

024168325Revise/graft eyelid lining

024168328Revise/graft eyelid lining

024168335Revise/graft eyelid lining

024168500Removal of tear gland

024168505Partial removal tear gland

024168520Removal of tear sac

024168550Remove tear gland lesion

024168720Create tear sac drain

024168745Create tear duct drain

024168750Create tear duct drain

024168770Close tear system fistula

0242Level V Repair and Plastic Eye ProceduresT40.4039"$2,828.92"$597.36$565.79

024265091Revise eye

024265093Revise eye with implant

024265101Removal of eye

024265103Remove eye/insert implant

024265105Remove eye/attach implant

024265110Removal of eye

024265112Remove eye/revise socket

024265114Remove eye/revise socket

024265140Attach ocular implant

024265155Reinsert ocular implant

024267414Explr/decompress eye socket

024267420Explore/treat eye socket

024267430Explore/treat eye socket

024267440Explore/drain eye socket

024267445Explr/decompress eye socket

024267450Explore/biopsy eye socket

024267550Insert eye socket implant

024267570Decompress optic nerve

0243Strabismus/Muscle ProceduresT24.8671"$1,741.09"$411.91$348.22

024365290Repair of eye socket wound

024367311Revise eye muscle

024367312Revise two eye muscles

024367314Revise eye muscle

024367316Revise two eye muscles

024367318Revise eye muscle(s)

024367320Revise eye muscle(s) add-on

024367331Eye surgery follow-up add-on

024367332Rerevise eye muscles add-on

024367334Revise eye muscle w/suture

024367335Eye suture during surgery

024367340Revise eye muscle add-on

024367343Release eye tissue

024367399Eye muscle surgery procedure

0244Corneal and Amniotic Membrane TransplantT37.8979"$2,653.46"$794.94$530.70

024465710Corneal transplant

024465730Corneal transplant

024465750Corneal transplant

024465755Corneal transplant

024465756Corneal trnspl endothelial

024465780Ocular reconst transplant

024465781Ocular reconst transplant

024465782Ocular reconst transplant

0246Cataract Procedures with IOL InsertT23.8810"$1,672.05"$490.37$334.41

024666982Cataract surgery complex

024666983Cataract surg w/iol 1 stage

024666984Cataract surg w/iol 1 stage

024666985Insert lens prosthesis

024666986Exchange lens prosthesis

0247Laser Eye ProceduresT5.4120$378.93$102.28$75.79

024765855Laser surgery of eye

024765860Incise inner eye adhesions
024766761Revision of iris

024766762Revision of iris

024766770Removal of inner eye lesion

024766821After cataract laser surgery

024767031Laser surgery eye strands

024767105Repair detached retina

024767145Treatment of retina

024767210Treatment of retinal lesion

024767228Treatment of retinal lesion

024767229Tr retinal les preterm inf

0249Cataract Procedures without IOL InsertT30.9855"$2,169.48"$516.99$433.90

024966850Removal of lens material

024966852Removal of lens material

024966920Extraction of lens

024966930Extraction of lens

0250Level I ENT ProceduresT1.0709$74.98$24.12$15.00

025021089Prepare face/oral prosthesis

025021299Cranio/maxillofacial surgery

025021310Treatment of nose fracture

025021480Reset dislocated jaw

025021499Head surgery procedure

025021899Neck/chest surgery procedure

025030901Control of nosebleed

025030903Control of nosebleed

025030905Control of nosebleed

025030906Repeat control of nosebleed

025030999Nasal surgery procedure

025031299Sinus surgery procedure

025031599Larynx surgery procedure

025040799Lip surgery procedure

025040899Mouth surgery procedure

025041250Repair tongue laceration

025041599Tongue and mouth surgery

025041899Dental surgery procedure

025042299Palate/uvula surgery

025042699Salivary surgery procedure

025042960Control throat bleeding

025042970Control nose/throat bleeding

025042999Throat surgery procedure

025069399Outer ear surgery procedure

025069799Middle ear surgery procedure

025069949Inner ear surgery procedure

025069979Temporal bone surgery

0251Level II ENT ProceduresT3.1150$218.10.$43.62

025121450Treat lower jaw fracture

025130000Drainage of nose lesion

025130020Drainage of nose lesion

025130560Release of nasal adhesions

025131000Irrigation maxillary sinus

025140490Biopsy of lip

025140806Incision of lip fold

025140808Biopsy of mouth lesion

025140818Excise oral mucosa for graft

025140830Repair mouth laceration

025141005Drainage of mouth lesion

025141009Drainage of mouth lesion

025141015Drainage of mouth lesion

025141251Repair tongue laceration

025142000Drainage mouth roof lesion

025142180Repair palate

025142280Preparation palate mold

025142310Drainage of salivary gland

025142320Drainage of salivary gland

025142660Dilation of salivary duct

025142700Drainage of tonsil abscess

025169100Biopsy of external ear
025169400Inflate middle ear canal

025169401Inflate middle ear canal

025169420Incision of eardrum

025192502Ear and throat examination

0252Level III ENT ProceduresT7.4614$522.42$104.55$104.49

025220100Explore wound neck

025220500Injection of sinus tract

025221073Mnpj of tmj w/anesth

025221110Interdental fixation

025221295Revision of jaw muscle/bone

025221400Treat eye socket fracture

025221451Treat lower jaw fracture

025221685Hyoid myotomy & suspension

025230100Intranasal biopsy

025230124Removal of nose lesion

025230200Injection treatment of nose

025230210Nasal sinus therapy

025230220Insert nasal septal button

025230801Ablate inf turbinate superf

025231002Irrigation sphenoid sinus

025231603Incision of windpipe

025231605Incision of windpipe

025231615Visualization of windpipe

025240650Repair lip

025240652Repair lip

025240654Repair lip

025240801Drainage of mouth lesion

025240805Removal foreign body mouth

025240819Excise lip or cheek fold

025240831Repair mouth laceration

025241010Incision of tongue fold

025241016Drainage of mouth lesion

025241017Drainage of mouth lesion

025241018Drainage of mouth lesion

025241100Biopsy of tongue

025241115Excision of tongue fold

025241252Repair tongue laceration

025241512Tongue suspension

025241520Reconstruction tongue fold

025241820Excision gum each quadrant

025241821Excision of gum flap

025242100Biopsy roof of mouth

025242140Excision of uvula

025242650Dilation of salivary duct

025242800Biopsy of throat

025242900Repair throat wound

025243020Incision of esophagus

025260000Drain thyroid/tongue cyst

025269150Extensive ear canal surgery

025269405Catheterize middle ear canal

025269433Create eardrum opening

0252C9727Insert palate implants

0253Level IV ENT ProceduresT16.8699"$1,181.16"$279.20$236.24

025321085Prepare face/oral prosthesis

025321282Revision of eyelid

025321315Treatment of nose fracture

025321320Treatment of nose fracture

025321337Treat nasal septal fracture

025321401Treat eye socket fracture

025321452Treat lower jaw fracture

025321485Reset dislocated jaw

025321495Treat hyoid bone fracture

025321497Interdental wiring

025330110Removal of nose polyp(s)

025330115Removal of nose polyp(s)

025330117Removal of intranasal lesion
025330130Excise inferior turbinate

025330310Remove nasal foreign body

025330320Remove nasal foreign body

025330802Ablate inf turbinate submuc

025330930Ther fx nasal inf turbinate

025340500Partial excision of lip

025340520Partial excision of lip

025340810Excision of mouth lesion

025340812Excise/repair mouth lesion

025340814Excise/repair mouth lesion

025340820Treatment of mouth lesion

025341000Drainage of mouth lesion

025341007Drainage of mouth lesion

025341008Drainage of mouth lesion

025341105Biopsy of tongue

025341110Excision of tongue lesion

025341112Excision of tongue lesion

025341113Excision of tongue lesion

025341116Excision of mouth lesion

025341510Tongue to lip surgery

025341806Removal foreign body jawbone

025341822Excision of gum lesion

025341825Excision of gum lesion

025341828Excision of gum lesion

025341830Removal of gum tissue

025341850Treatment of gum lesion

025341872Repair gum

025342104Excision lesion mouth roof

025342106Excision lesion mouth roof

025342160Treatment mouth roof lesion

025342235Repair palate

025342281Insertion palate prosthesis

025342300Drainage of salivary gland

025342305Drainage of salivary gland

025342330Removal of salivary stone

025342335Removal of salivary stone

025342340Removal of salivary stone

025342408Excision of salivary cyst

025342409Drainage of salivary cyst

025342600Closure of salivary fistula

025342720Drainage of throat abscess

025342802Biopsy of throat

025342804Biopsy of upper nose/throat

025342972Control nose/throat bleeding

025343030Throat muscle surgery

025369105Biopsy of external ear canal

025369222Clean out mastoid cavity

025369421Incision of eardrum

025369424Remove ventilating tube

025369436Create eardrum opening

025369540Remove ear lesion

025369801Incise inner ear

0254Level V ENT ProceduresT24.8895"$1,742.66".$348.54

025421010Incision of jaw joint

025421030Excise max/zygoma b9 tumor

025421031Remove exostosis mandible

025421032Remove exostosis maxilla

025421040Excise mandible lesion

025421076Prepare face/oral prosthesis

025421120Reconstruction of chin

025421121Reconstruction of chin

025421122Reconstruction of chin

025421123Reconstruction of chin

025421125Augmentation lower jaw bone

025421137Reduction of forehead

025421181Contour cranial bone lesion
025421235Ear cartilage graft

025421296Revision of jaw muscle/bone

025421325Treatment of nose fracture

025421330Treatment of nose fracture

025421335Treatment of nose fracture

025421338Treat nasoethmoid fracture

025421339Treat nasoethmoid fracture

025421345Treat nose/jaw fracture

025421346Treat nose/jaw fracture

025421356Treat cheek bone fracture

025421360Treat cheek bone fracture

025421421Treat mouth roof fracture

025421440Treat dental ridge fracture

025421445Treat dental ridge fracture

025421454Treat lower jaw fracture

025430118Removal of intranasal lesion

025430120Revision of nose

025430140Resect inferior turbinate

025430430Revision of nose

025430520Repair of nasal septum

025430630Repair nasal septum defect

025431020Exploration maxillary sinus

025431040Exploration behind upper jaw

025431070Exploration of frontal sinus

025431300Removal of larynx lesion

025431600Incision of windpipe

025431601Incision of windpipe

025431610Incision of windpipe

025431611Surgery/speech prosthesis

025431612Puncture/clear windpipe

025431613Repair windpipe opening

025431785Remove windpipe lesion

025431820Closure of windpipe lesion

025431825Repair of windpipe defect

025431830Revise windpipe scar

025440510Partial excision of lip

025440525Reconstruct lip with flap

025440527Reconstruct lip with flap

025440530Partial removal of lip

025440816Excision of mouth lesion

025440840Reconstruction of mouth

025440842Reconstruction of mouth

025440843Reconstruction of mouth

025441006Drainage of mouth lesion

025441019Place needles h&n for rt

025441114Excision of tongue lesion

025441120Partial removal of tongue

025441500Fixation of tongue

025441530Tongue base vol reduction

025441805Removal foreign body gum

025441823Excision of gum lesion

025441826Excision of gum lesion

025441827Excision of gum lesion

025441870Gum graft

025441874Repair tooth socket

025442107Excision lesion mouth roof

025442145Repair palate pharynx/uvula

025442260Repair nose to lip fistula

025442405Biopsy of salivary gland

025442450Excise sublingual gland

025442500Repair salivary duct

025442665Ligation of salivary duct

025442806Biopsy of upper nose/throat

025442808Excise pharynx lesion

025442810Excision of neck cyst

025442820Remove tonsils and adenoids
025442821Remove tonsils and adenoids

025442825Removal of tonsils

025442826Removal of tonsils

025442830Removal of adenoids

025442831Removal of adenoids

025442835Removal of adenoids

025442836Removal of adenoids

025442842Extensive surgery of throat

025442860Excision of tonsil tags

025442870Excision of lingual tonsil

025442950Reconstruction of throat

025442955Surgical opening of throat

025443420Repair esophagus opening

025462000Treat skull fracture

025469120Removal of external ear

025469140Remove ear canal lesion(s)

025469300Revise external ear

025469440Exploration of middle ear

025469502Mastoidectomy

025469610Repair of eardrum

025469620Repair of eardrum

025469650Release middle ear bone

0255Level II Anterior Segment Eye ProceduresT7.2190$505.45$101.81$101.09

025565286Repair of eye wound

025565800Drainage of eye

025566505Incision of iris

025566625Removal of iris

025566820Incision secondary cataract

025566830Removal of lens lesion

025566940Extraction of lens

0256Level VI ENT ProceduresT45.0377"$3,153.36".$630.68

025621025Excision of bone lower jaw

025621026Excision of facial bone(s)

025621029Contour of face bone lesion

025621034Excise max/zygoma mal tumor

025621044Removal of jaw bone lesion

025621046Remove mandible cyst complex

025621047Excise lwr jaw cyst w/repair

025621048Remove maxilla cyst complex

025621049Excis uppr jaw cyst w/repair

025621050Removal of jaw joint

025621060Remove jaw joint cartilage

025621070Remove coronoid process

025621077Prepare face/oral prosthesis

025621079Prepare face/oral prosthesis

025621080Prepare face/oral prosthesis

025621081Prepare face/oral prosthesis

025621082Prepare face/oral prosthesis

025621083Prepare face/oral prosthesis

025621084Prepare face/oral prosthesis

025621086Prepare face/oral prosthesis

025621087Prepare face/oral prosthesis

025621088Prepare face/oral prosthesis

025621100Maxillofacial fixation

025621127Augmentation lower jaw bone

025621138Reduction of forehead

025621139Reduction of forehead

025621150Reconstruct midface lefort

025621172Reconstruct orbit/forehead

025621175Reconstruct orbit/forehead

025621193Reconst lwr jaw w/o graft

025621195Reconst lwr jaw w/o fixation

025621198Reconstr lwr jaw segment

025621199Reconstr lwr jaw w/advance

025621206Reconstruct upper jaw bone

025621208Augmentation of facial bones
025621209Reduction of facial bones

025621210Face bone graft

025621215Lower jaw bone graft

025621230Rib cartilage graft

025621240Reconstruction of jaw joint

025621242Reconstruction of jaw joint

025621243Reconstruction of jaw joint

025621244Reconstruction of lower jaw

025621245Reconstruction of jaw

025621246Reconstruction of jaw

025621248Reconstruction of jaw

025621249Reconstruction of jaw

025621256Reconstruction of orbit

025621260Revise eye sockets

025621261Revise eye sockets

025621263Revise eye sockets

025621267Revise eye sockets

025621270Augmentation cheek bone

025621275Revision orbitofacial bones

025621280Revision of eyelid

025621340Treatment of nose fracture

025621355Treat cheek bone fracture

025621365Treat cheek bone fracture

025621385Treat eye socket fracture

025621386Treat eye socket fracture

025621387Treat eye socket fracture

025621390Treat eye socket fracture

025621395Treat eye socket fracture

025621406Treat eye socket fracture

025621407Treat eye socket fracture

025621408Treat eye socket fracture

025621453Treat lower jaw fracture

025621461Treat lower jaw fracture

025621462Treat lower jaw fracture

025621465Treat lower jaw fracture

025621470Treat lower jaw fracture

025621490Repair dislocated jaw

025630125Removal of nose lesion

025630150Partial removal of nose

025630160Removal of nose

025630400Reconstruction of nose

025630410Reconstruction of nose

025630420Reconstruction of nose

025630435Revision of nose

025630450Revision of nose

025630460Revision of nose

025630462Revision of nose

025630465Repair nasal stenosis

025630540Repair nasal defect

025630545Repair nasal defect

025630580Repair upper jaw fistula

025630600Repair mouth/nose fistula

025630620Intranasal reconstruction

025631030Exploration maxillary sinus

025631032Explore sinus remove polyps

025631050Exploration sphenoid sinus

025631051Sphenoid sinus surgery

025631075Exploration of frontal sinus

025631080Removal of frontal sinus

025631081Removal of frontal sinus

025631084Removal of frontal sinus

025631085Removal of frontal sinus

025631086Removal of frontal sinus

025631087Removal of frontal sinus

025631090Exploration of sinuses

025631200Removal of ethmoid sinus
025631201Removal of ethmoid sinus

025631205Removal of ethmoid sinus

025631320Diagnostic incision larynx

025631400Revision of larynx

025631420Removal of epiglottis

025631580Revision of larynx

025631582Revision of larynx

025631588Revision of larynx

025631590Reinnervate larynx

025631595Larynx nerve surgery

025631614Repair windpipe opening

025631750Repair of windpipe

025631755Repair of windpipe

025640700Repair cleft lip/nasal

025640701Repair cleft lip/nasal

025640702Repair cleft lip/nasal

025640720Repair cleft lip/nasal

025640761Repair cleft lip/nasal

025640844Reconstruction of mouth

025640845Reconstruction of mouth

025642120Remove palate/lesion

025642182Repair palate

025642200Reconstruct cleft palate

025642205Reconstruct cleft palate

025642210Reconstruct cleft palate

025642215Reconstruct cleft palate

025642220Reconstruct cleft palate

025642225Reconstruct cleft palate

025642226Lengthening of palate

025642227Lengthening of palate

025642410Excise parotid gland/lesion

025642415Excise parotid gland/lesion

025642420Excise parotid gland/lesion

025642425Excise parotid gland/lesion

025642440Excise submaxillary gland

025642505Repair salivary duct

025642507Parotid duct diversion

025642508Parotid duct diversion

025642509Parotid duct diversion

025642510Parotid duct diversion

025642725Drainage of throat abscess

025642815Excision of neck cyst

025642844Extensive surgery of throat

025642890Partial removal of pharynx

025642892Revision of pharyngeal walls

025642962Control throat bleeding

025643130Removal of esophagus pouch

025660252Removal of thyroid

025660260Repeat thyroid surgery

025660271Removal of thyroid

025660500Explore parathyroid glands

025660502Re-explore parathyroids

025660520Removal of thymus gland

025661330Decompress eye socket

025661334Explore orbit/remove object

025669310Rebuild outer ear canal

025669320Rebuild outer ear canal

025669450Eardrum revision

025669501Mastoidectomy

025669505Remove mastoid structures

025669511Extensive mastoid surgery

025669530Extensive mastoid surgery

025669550Remove ear lesion

025669552Remove ear lesion

025669601Mastoid surgery revision

025669602Mastoid surgery revision
025669603Mastoid surgery revision

025669604Mastoid surgery revision

025669605Mastoid surgery revision

025669631Repair eardrum structures

025669632Rebuild eardrum structures

025669633Rebuild eardrum structures

025669635Repair eardrum structures

025669636Rebuild eardrum structures

025669637Rebuild eardrum structures

025669641Revise middle ear & mastoid

025669642Revise middle ear & mastoid

025669643Revise middle ear & mastoid

025669644Revise middle ear & mastoid

025669645Revise middle ear & mastoid

025669646Revise middle ear & mastoid

025669660Revise middle ear bone

025669661Revise middle ear bone

025669662Revise middle ear bone

025669666Repair middle ear structures

025669667Repair middle ear structures

025669670Remove mastoid air cells

025669676Remove middle ear nerve

025669700Close mastoid fistula

025669711Remove/repair hearing aid

025669720Release facial nerve

025669725Release facial nerve

025669740Repair facial nerve

025669745Repair facial nerve

025669805Explore inner ear

025669806Explore inner ear

025669820Establish inner ear window

025669840Revise inner ear window

025669905Remove inner ear

025669910Remove inner ear & mastoid

025669915Incise inner ear nerve

025669955Release facial nerve

025669960Release inner ear canal

025669970Remove inner ear lesion

0259Level VII ENT ProceduresT412.7299"$28,897.70""$7,948.75""$5,779.54"

025969930Implant cochlear device

0260Level I Plain Film Except TeethX0.6409$44.87.$8.98

026070030X-ray eye for foreign body

026070100X-ray exam of jaw

026070110X-ray exam of jaw

026070120X-ray exam of mastoids

026070130X-ray exam of mastoids

026070140X-ray exam of facial bones

026070150X-ray exam of facial bones

026070160X-ray exam of nasal bones

026070190X-ray exam of eye sockets

026070200X-ray exam of eye sockets

026070210X-ray exam of sinuses

026070220X-ray exam of sinuses

026070240X-ray exam pituitary saddle

026070250X-ray exam of skull

026070328X-ray exam of jaw joint

026070330X-ray exam of jaw joints

026070350X-ray head for orthodontia

026070360X-ray exam of neck

026070380X-ray exam of salivary gland

026071010Chest x-ray

026071015Chest x-ray

026071020Chest x-ray

026071021Chest x-ray

026071022Chest x-ray

026071030Chest x-ray
026071035Chest x-ray

026071100X-ray exam of ribs

026071101X-ray exam of ribs/chest

026071110X-ray exam of ribs

026071120X-ray exam of breastbone

026071130X-ray exam of breastbone

026072020X-ray exam of spine

026072040X-ray exam of neck spine

026072069X-ray exam of trunk spine

026072070X-ray exam of thoracic spine

026072072X-ray exam of thoracic spine

026072074X-ray exam of thoracic spine

026072080X-ray exam of trunk spine

026072100X-ray exam of lower spine

026072120X-ray exam of lower spine

026072170X-ray exam of pelvis

026072190X-ray exam of pelvis

026072200X-ray exam sacroiliac joints

026072202X-ray exam sacroiliac joints

026072220X-ray exam of tailbone

026073000X-ray exam of collar bone

026073010X-ray exam of shoulder blade

026073020X-ray exam of shoulder

026073030X-ray exam of shoulder

026073050X-ray exam of shoulders

026073060X-ray exam of humerus

026073070X-ray exam of elbow

026073080X-ray exam of elbow

026073090X-ray exam of forearm

026073092X-ray exam of arm infant

026073100X-ray exam of wrist

026073110X-ray exam of wrist

026073120X-ray exam of hand

026073130X-ray exam of hand

026073140X-ray exam of finger(s)

026073500X-ray exam of hip

026073510X-ray exam of hip

026073520X-ray exam of hips

026073540X-ray exam of pelvis & hips

026073550X-ray exam of thigh

026073560X-ray exam of knee 1 or 2

026073562X-ray exam of knee 3

026073564X-ray exam knee 4 or more

026073565X-ray exam of knees

026073590X-ray exam of lower leg

026073592X-ray exam of leg infant

026073600X-ray exam of ankle

026073610X-ray exam of ankle

026073620X-ray exam of foot

026073630X-ray exam of foot

026073650X-ray exam of heel

026073660X-ray exam of toe(s)

026074000X-ray exam of abdomen

026074010X-ray exam of abdomen

026074020X-ray exam of abdomen

026076010X-ray nose to rectum

026076499Radiographic procedure

026077071X-ray stress view

026077072X-rays for bone age

026077073X-rays bone length studies

026077077Joint survey single view

026077082Dxa bone density vert fx

0260G0130Single energy x-ray study$0.00$0.00

0261Level II Plain Film Except Teeth Including Bone Density 

MeasurementX1.0790$75.55.$15.11

026170134X-ray exam of middle ear
026170260X-ray exam of skull

026171111X-ray exam of ribs/chest

026172010X-ray exam of spine

026172050X-ray exam of neck spine

026172052X-ray exam of neck spine

026172090X-ray exam of trunk spine

026172110X-ray exam of lower spine

026172114X-ray exam of lower spine

026174022X-ray exam series abdomen

026174710X-ray measurement of pelvis

026175809Nonvascular shunt x-ray

026175898Follow-up angiography

026176100X-ray exam of body section

026177074X-rays bone survey limited

026177075X-rays bone survey complete

026177076X-rays bone survey infant

0262Plain Film of TeethX0.4640$32.49.$6.50

026270300X-ray exam of teeth

026270310X-ray exam of teeth

026270320Full mouth x-ray of teeth

026270355Panoramic x-ray of jaws

0263Level I Miscellaneous Radiology ProceduresX3.3643$235.55.$47.11

026370170X-ray exam of tear duct

026370373Contrast x-ray of larynx

026370390X-ray exam of salivary duct

026371040Contrast x-ray of bronchi

026371060Contrast x-ray of bronchi

026374190X-ray exam of peritoneum

026374305X-ray bile ducts/pancreas

026374470X-ray exam of kidney lesion

026374740X-ray female genital tract

026376080X-ray exam of fistula

026376101Complex body section x-ray

026376102Complex body section x-rays

026377053X-ray of mammary duct

026377054X-ray of mammary ducts

0265Level I Diagnostic and Screening UltrasoundS0.8990$62.94$22.26$12.59

026576506Echo exam of head

026576516Echo exam of eye

026576529Echo exam of eye

026576604Us exam chest

026576645Us exam breast(s)

026576802Ob us < 14 wks addl fetus

026576812Ob us detailed addl fetus

026576813Ob us nuchal meas 1 gest

026576814Ob us nuchal meas add-on

026576815Ob us limited fetus(s)

026576816Ob us follow-up per fetus

026576817Transvaginal us obstetric

026576820Umbilical artery echo

026576821Middle cerebral artery echo

026576827Echo exam of fetal heart

026576828Echo exam of fetal heart

026576857Us exam pelvic limited

026576882Us xtr non-vasc lmtd

026576885Us exam infant hips dynamic

026576886Us exam infant hips static

026576970Ultrasound exam follow-up

026576999Echo examination procedure

026593888Intracranial study

0266Level II Diagnostic and Screening UltrasoundS1.3781$96.49$37.23$19.30

026676511Ophth us quant a only

026676512Ophth us b w/non-quant a

026676513Echo exam of eye water bath

026676519Echo exam of eye

026676536Us exam of head and neck
026676700Us exam abdom complete

026676705Echo exam of abdomen

026676770Us exam abdo back wall comp

026676775Us exam abdo back wall lim

026676776Us exam k transpl w/doppler

026676800Us exam spinal canal

026676801Ob us < 14 wks single fetus

026676805Ob us >/= 14 wks sngl fetus

026676810Ob us >/= 14 wks addl fetus

026676818Fetal biophys profile w/nst

026676819Fetal biophys profil w/o nst

026676830Transvaginal us non-ob

026676856Us exam pelvic complete

026676870Us exam scrotum

026676872Us transrectal

026676873Echograp trans r pros study

026676881Us xtr non-vasc complete

026693890Tcd vasoreactivity study

026693892Tcd emboli detect w/o inj

026693893Tcd emboli detect w/inj

026693926Lower extremity study

026693931Upper extremity study

026693971Extremity study

026693979Vascular study

026693990Doppler flow testing

0266G0389Ultrasound exam AAA screen$0.00$0.00

0267Level III Diagnostic and Screening UltrasoundS2.1681$151.80$59.37$30.36

026736002Pseudoaneurysm injection trt

026775945Intravascular us

026776811Ob us detailed sngl fetus

026776831Echo exam uterus

026776975GI endoscopic ultrasound

026793880Extracranial study

026793882Extracranial study

026793886Intracranial study

026793925Lower extremity study

026793930Upper extremity study

026793970Extremity study

026793975Vascular study

026793976Vascular study

026793978Vascular study

026793980Penile vascular study

026793981Penile vascular study

0267G0365Vessel mapping hemo access

0269Level II Echocardiogram Without ContrastS5.6156$393.18.$78.64

026993304Echo transthoracic

026993306Tte w/doppler complete

026993307Tte w/o doppler complete

026993313Echo transesophageal

026993315Echo transesophageal

026993350Stress tte only

0270Level III Echocardiogram Without ContrastS8.2952$580.80$133.61$116.16

027093303Echo transthoracic

027093312Echo transesophageal

027093316Echo transesophageal

027093318Echo transesophageal intraop

027093351Stress tte complete

0272FluoroscopyX1.2171$85.22$30.47$17.05

027243752Nasal/orogastric w/stent

027243756Dx duod intub w/asp spec

027243757Dx duod intub w/asp specs

027270370Throat x-ray & fluoroscopy

027270371Speech evaluation complex

027271023Chest x-ray and fluoroscopy

027271034Chest x-ray and fluoroscopy

027276000Fluoroscope examination
027276120Cine/video x-rays

027276496Fluoroscopic procedure

0274MyelographyS7.0678$494.86.$98.98

027470010Contrast x-ray of brain

027470015Contrast x-ray of brain

027472240Contrast x-ray of neck spine

027472255Contrast x-ray thorax spine

027472265Contrast x-ray lower spine

027472270Contrast x-ray spine

0275ArthrographyS4.0104$280.79$68.90$56.16

027570332X-ray exam of jaw joint

027573040Contrast x-ray of shoulder

027573085Contrast x-ray of elbow

027573115Contrast x-ray of wrist

027573525Contrast x-ray of hip

027573580Contrast x-ray of knee joint

027573615Contrast x-ray of ankle

0276Level I Digestive RadiologyS1.2186$85.32$33.87$17.07

027674210Contrst x-ray exam of throat

027674220Contrast x-ray esophagus

027674230Cine/vid x-ray throat/esoph

027674240X-ray exam upper gi tract

027674241X-ray exam upper gi tract

027674246Contrst x-ray uppr gi tract

027674247Contrst x-ray uppr gi tract

027674250X-ray exam of small bowel

027674260X-ray exam of small bowel

027674270Contrast x-ray exam of colon

027674283Contrast x-ray exam of colon

027674290Contrast x-ray gallbladder

027674291Contrast x-rays gallbladder

0277Level II Digestive RadiologyS2.0340$142.41$53.90$28.49

027749465Fluoro exam of g/colon tube

027774245X-ray exam upper gi tract

027774249Contrst x-ray uppr gi tract

027774251X-ray exam of small bowel

027774280Contrast x-ray exam of colon

0278Diagnostic UrographyS2.6196$183.41$58.44$36.69

027874400Contrst x-ray urinary tract

027874410Contrst x-ray urinary tract

027874415Contrst x-ray urinary tract

027874420Contrst x-ray urinary tract

027874425Contrst x-ray urinary tract

027874430Contrast x-ray bladder

027874440X-ray male genital tract

027874445X-ray exam of penis

027874450X-ray urethra/bladder

027874455X-ray urethra/bladder

027874775X-ray exam of perineum

0279Level II Angiography and VenographyS29.7209"$2,080.94".$416.19

027936251Ins cath ren art 1st unilat

027936252Ins cath ren art 1st bilat

027936253Ins cath ren art 2nd+ unilat

027936254Ins cath ren art 2nd+ bilat

027975600Contrast x-ray exam of aorta

027975605Contrast x-ray exam of aorta

027975625Contrast x-ray exam of aorta

027975630X-ray aorta leg arteries

027975658Artery x-rays arm

027975665Artery x-rays head & neck

027975676Artery x-rays neck

027975680Artery x-rays neck

027975685Artery x-rays spine

027975705Artery x-rays spine

027975710Artery x-rays arm/leg

027975716Artery x-rays arms/legs
027975726Artery x-rays abdomen

027975731Artery x-rays adrenal gland

027975733Artery x-rays adrenals

027975736Artery x-rays pelvis

027975741Artery x-rays lung

027975743Artery x-rays lungs

027975810Vein x-ray spleen/liver

027975825Vein x-ray trunk

027975831Vein x-ray kidney

027975833Vein x-ray kidneys

027975840Vein x-ray adrenal gland

027975842Vein x-ray adrenal glands

027975885Vein x-ray liver

027975889Vein x-ray liver

027975891Vein x-ray liver

027975893Venous sampling by catheter

0280Level III Angiography and VenographyS49.6878"$3,478.94".$695.79

028075650Artery x-rays head & neck

028075660Artery x-rays head & neck

028075662Artery x-rays head & neck

028075671Artery x-rays head & neck

0282Miscellaneous Computed Axial TomographyS1.5251$106.78$35.57$21.36

028276380CAT scan follow-up study

028276497Ct procedure

0283Computed Tomography with ContrastS4.2929$300.57$96.62$60.12

028370460Ct head/brain w/dye

028370481Ct orbit/ear/fossa w/dye

028370487Ct maxillofacial w/dye

028370491Ct soft tissue neck w/dye

028371260Ct thorax w/dye

028372126Ct neck spine w/dye

028372129Ct chest spine w/dye

028372132Ct lumbar spine w/dye

028372193Ct pelvis w/dye

028373201Ct upper extremity w/dye

028373701Ct lower extremity w/dye

028374160Ct abdomen w/dye

028374262Ct colonography dx w/dye

0284Magnetic Resonance Imaging and Magnetic Resonance Angiography with 

ContrastS6.2343$436.50$146.69$87.30

028470542Mri orbit/face/neck w/dye

028470545Mr angiography head w/dye

028470548Mr angiography neck w/dye

028470552Mri brain w/dye

028470558Mri brain w/dye

028471551Mri chest w/dye

028472142Mri neck spine w/dye

028472147Mri chest spine w/dye

028472149Mri lumbar spine w/dye

028472196Mri pelvis w/dye

028473219Mri upper extremity w/dye

028473222Mri joint upr extrem w/dye

028473719Mri lower extremity w/dye

028473722Mri joint of lwr extr w/dye

028474182Mri abdomen w/dye

0284C8900"MRA w/cont, abd"

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

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

0284C8909"MRA w/cont, chest"

0284C8912"MRA w/cont, lwr ext"

0284C8918"MRA w/cont, pelvis"

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

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

0288Bone Density:Axial SkeletonS1.0218$71.54$0.00$0.00

028877078Ct bone density axial$0.00$0.00

028877080Dxa bone density axial$0.00$0.00
0293Level VI Anterior Segment Eye ProceduresT117.1298"$8,200.96"."$1,640.20"

029365770Revise cornea with implant

0299Hyperthermia and Radiation Treatment ProceduresS5.6386$394.79.$78.96

029977470Special radiation treatment

029977600Hyperthermia treatment

029977605Hyperthermia treatment

029977610Hyperthermia treatment

029977615Hyperthermia treatment

029977620Hyperthermia treatment

0300Level I Radiation TherapyS1.4252$99.79.$19.96

030077401Radiation treatment delivery

030077402Radiation treatment delivery

030077403Radiation treatment delivery

030077404Radiation treatment delivery

030077406Radiation treatment delivery

030077407Radiation treatment delivery

030077789Apply surface radiation

0301Level II Radiation TherapyS2.4149$169.08.$33.82

030177408Radiation treatment delivery

030177409Radiation treatment delivery

030177411Radiation treatment delivery

030177412Radiation treatment delivery

030177413Radiation treatment delivery

030177414Radiation treatment delivery

030177416Radiation treatment delivery

030177422Neutron beam tx simple

030177423Neutron beam tx complex

030177750Infuse radioactive materials

0303Treatment Device ConstructionX2.8573$200.06$66.95$40.02

030377332Radiation treatment aid(s)

030377333Radiation treatment aid(s)

030377334Radiation treatment aid(s)

0304Level I Therapeutic Radiation Treatment PreparationX1.5329$107.33$34.63$21.47

030477280Set radiation therapy field

030477299Radiation therapy planning

030477300Radiation therapy dose plan

030477305Teletx isodose plan simple

030477310Teletx isodose plan intermed

030477326Brachytx isodose calc simp

030477331Special radiation dosimetry

030477336Radiation physics consult

030477370Radiation physics consult

030477399External radiation dosimetry

0305Level II Therapeutic Radiation Treatment PreparationX3.7681$263.83$88.76$52.77

030577285Set radiation therapy field

030577290Set radiation therapy field

030577315Teletx isodose plan complex

030577321Special teletx port plan

030577327Brachytx isodose calc interm

030577328Brachytx isodose plan compl

030577338Design mlc device for imrt

0308Positron Emission Tomography (PET) imagingS14.8260"$1,038.06".$207.62

030878459Heart muscle imaging (PET)

030878491Heart image (pet) single

030878492Heart image (pet) multiple

030878608Brain imaging (PET)

030878811Pet image ltd area

030878812Pet image skull-thigh

030878813Pet image full body

030878814Pet image w/ct lmtd

030878815Pet image w/ct skull-thigh

030878816Pet image w/ct full body

0310Level III Therapeutic Radiation Treatment 

PreparationX13.6332$954.54$325.27$190.91

031032553Ins mark thor for rt perq

031049411Ins mark abd/pel for rt perq
031055876Place rt device/marker pros

031077295Set radiation therapy field

031077301Radiotherapy dose plan imrt

0310C9728"Place device/marker, non pro"

0312Radioelement ApplicationsS5.4044$378.39.$75.68

031277761Apply intrcav radiat simple

031277762Apply intrcav radiat interm

031277763Apply intrcav radiat compl

031277776Apply interstit radiat simpl

031277777Apply interstit radiat inter

031277799Radium/radioisotope therapy

0313BrachytherapyS9.9687$697.97$263.92$139.60

03130182THdr elect brachytherapy

031377785Hdr brachytx 1 channel

031377786Hdr brachytx 2-12 channel

031377787Hdr brachytx over 12 chan

0315Level II Implantation of Neurostimulator 

GeneratorS285.5893"$19,995.82"."$3,999.17"

031561886Implant neurostim arrays

0317Level II Miscellaneous Radiology ProceduresX5.7208$400.55.$80.11

031774320Contrast x-ray of bile ducts

031775801Lymph vessel x-ray arm/leg

031775803Lymph vessel x-ray arms/legs

031775805Lymph vessel x-ray trunk

031775807Lymph vessel x-ray trunk

031776098X-ray exam breast specimen

0318Implantation of Neurostimulator Pulse Generator and 

ElectrodeS346.4693"$24,258.39""$9,121.76""$4,851.68"

03180283TPeriph field stimul perm

031864568Inc for vagus n elect impl

0319Level III Endovascular Revascularization of the Lower 

ExtremityT203.0553"$14,217.12""$5,559.48""$2,843.43"

031937227Fem/popl revasc stnt & ather

031937231Tib/per revasc stent & ather

0320Electroconvulsive TherapyS5.9715$418.10.$83.62

032090870Electroconvulsive therapy

0322Brief Individual PsychotherapyS1.1395$79.78.$15.96

032290804Psytx office 20-30 min

032290805Psytx off 20-30 min w/e&m

032290810Intac psytx off 20-30 min

032290811Intac psytx 20-30 w/e&m

032290899Psychiatric service/therapy

0322G0397Alcohol/subs interv >30 min

0323Extended Individual PsychotherapyS1.5910$111.40.$22.28

032390801Psy dx interview

032390802Intac psy dx interview

032390806Psytx off 45-50 min

032390807Psytx off 45-50 min w/e&m

032390808Psytx office 75-80 min

032390809Psytx off 75-80 w/e&m

032390812Intac psytx off 45-50 min

032390813Intac psytx 45-50 min w/e&m

032390814Intac psytx off 75-80 min

032390815Intac psytx 75-80 w/e&m

032390845Psychoanalysis

032390865Narcosynthesis

032390880Hypnotherapy

0324Family PsychotherapyS1.8190$127.36.$25.48

032490846Family psytx w/o patient

032490847Family psytx w/patient

0325Group PsychotherapyS0.8088$56.63$11.70$11.33

032590849Multiple family group psytx

032590853Group psychotherapy

032590857Intac group psytx

0330Dental ProceduresS8.2687$578.94.$115.79

0330D0150Comprehensve oral evaluation
0330D0240Intraoral occlusal film

0330D0250Extraoral first film

0330D0260Extraoral ea additional film

0330D0270Dental bitewing single film

0330D0272Dental bitewings two films

0330D0274Dental bitewings four films

0330D0277Vert bitewings-sev to eight

0330D0460Pulp vitality test

0330D1510Space maintainer fxd unilat

0330D1515Fixed bilat space maintainer

0330D1520Remove unilat space maintain

0330D1525Remove bilat space maintain

0330D1550Recement space maintainer

0330D2999Dental unspec restorative pr

0330D3460Endodontic endosseous implan

0330D3999Endodontic procedure

0330D4260Osseous surgery per quadrant

0330D4263Bone replce graft first site

0330D4264Bone replce graft each add

0330D4268Surgical revision procedure

0330D4270Pedicle soft tissue graft pr

0330D4271Free soft tissue graft proc

0330D4273Subepithelial tissue graft

0330D4355Full mouth debridement

0330D4381Localized delivery antimicro

0330D5911Facial moulage sectional

0330D5912Facial moulage complete

0330D5983Radiation applicator

0330D5984Radiation shield

0330D5985Radiation cone locator

0330D5987Commissure splint

0330D6920Dental connector bar

0330D7111Extraction coronal remnants

0330D7140Extraction erupted tooth/exr

0330D7210Rem imp tooth w mucoper flp

0330D7220Impact tooth remov soft tiss

0330D7230Impact tooth remov part bony

0330D7240Impact tooth remov comp bony

0330D7241Impact tooth rem bony w/comp

0330D7250Tooth root removal

0330D7260Oral antral fistula closure

0330D7261Primary closure sinus perf

0330D7291Transseptal fiberotomy

0330D7940Reshaping bone orthognathic

0330D9630Other drugs/medicaments

0330D9930Treatment of complications

0330D9940Dental occlusal guard

0330D9950Occlusion analysis

0330D9951Limited occlusal adjustment

0330D9952Complete occlusal adjustment

0331Combined Abdomen and Pelvis CT without ContrastS5.7930$405.60$156.82$81.12

033174176Ct abd & pelvis

0332Computed Tomography without ContrastS2.7436$192.10$74.27$38.42

033270450Ct head/brain w/o dye

033270480Ct orbit/ear/fossa w/o dye

033270486Ct maxillofacial w/o dye

033270490Ct soft tissue neck w/o dye

033271250Ct thorax w/o dye

033272125Ct neck spine w/o dye

033272128Ct chest spine w/o dye

033272131Ct lumbar spine w/o dye

033272192Ct pelvis w/o dye

033273200Ct upper extremity w/o dye

033273700Ct lower extremity w/o dye

033274150Ct abdomen w/o dye

033274261Ct colonography dx
0333Computed Tomography without Contrast followed by 

ContrastS4.7767$334.45$116.13$66.89

033370470Ct head/brain w/o & w/dye

033370482Ct orbit/ear/fossa w/o&w/dye

033370488Ct maxillofacial w/o & w/dye

033370492Ct sft tsue nck w/o & w/dye

033371270Ct thorax w/o & w/dye

033372127Ct neck spine w/o & w/dye

033372130Ct chest spine w/o & w/dye

033372133Ct lumbar spine w/o & w/dye

033372194Ct pelvis w/o & w/dye

033373202Ct uppr extremity w/o&w/dye

033373702Ct lwr extremity w/o&w/dye

033374170Ct abdomen w/o & w/dye

0334Combined Abdomen and Pelvis CT with ContrastS8.2987$581.04$187.25$116.21

033474174Ct angio abd&pelv w/o&w/dye

033474177Ct abd & pelv w/contrast

033474178Ct abd & pelv 1/> regns

0336Magnetic Resonance Imaging and Magnetic Resonance Angiography without 

ContrastS4.8381$338.74$133.48$67.75

033670336Magnetic image jaw joint

033670540Mri orbit/face/neck w/o dye

033670544Mr angiography head w/o dye

033670547Mr angiography neck w/o dye

033670551Mri brain w/o dye

033670554Fmri brain by tech

033670555Fmri brain by phys/psych

033670557Mri brain w/o dye

033671550Mri chest w/o dye

033672141Mri neck spine w/o dye

033672146Mri chest spine w/o dye

033672148Mri lumbar spine w/o dye

033672195Mri pelvis w/o dye

033673218Mri upper extremity w/o dye

033673221Mri joint upr extrem w/o dye

033673718Mri lower extremity w/o dye

033673721Mri jnt of lwr extre w/o dye

033674181Mri abdomen w/o dye

033675557Cardiac mri for morph

033675559Cardiac mri w/stress img

033676498Mri procedure

033677084Magnetic image bone marrow

0336C8901"MRA w/o cont, abd"

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

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

0336C8910"MRA w/o cont, chest"

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

0336C8919"MRA w/o cont, pelvis"

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

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

0337Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast 

fS7.6347$534.55$197.64$106.91

033770543Mri orbt/fac/nck w/o & w/dye

033770546Mr angiograph head w/o&w/dye

033770549Mr angiograph neck w/o&w/dye

033770553Mri brain w/o & w/dye

033770559Mri brain w/o & w/dye

033771552Mri chest w/o & w/dye

033772156Mri neck spine w/o & w/dye

033772157Mri chest spine w/o & w/dye

033772158Mri lumbar spine w/o & w/dye

033772197Mri pelvis w/o & w/dye

033773220Mri uppr extremity w/o&w/dye

033773223Mri joint upr extr w/o&w/dye

033773720Mri lwr extremity w/o&w/dye

033773723Mri joint lwr extr w/o&w/dye
033774183Mri abdomen w/o & w/dye

033775561Cardiac mri for morph w/dye

033775563Card mri w/stress img & dye

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

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

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

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

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

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

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

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

0340Minor Ancillary ProceduresX0.6499$45.50.$9.10

03400126TChd risk imt study

03400206TRemote algorithm analys ecg

03400226TAnoscopy hra w/spec collect

03400232TNjx platelet plasma

03400299TEsw wound healing init wound

03400300TEsw wound healing addl wound

034011980Implant hormone pellet(s)

034011981Insert drug implant device

034011982Remove drug implant device

034011983Remove/insert drug implant

034015852Dressing change not for burn

034015860Test for blood flow in graft

034019295Place breast clip percut

034020665Removal of fixation device

034020979Us bone stimulation

034030300Remove nasal foreign body

034040804Removal foreign body mouth

034042809Remove pharynx foreign body

034043753Tx gastro intub w/asp

034043754Dx gastr intub w/asp spec

034046600Diagnostic anoscopy

034051701Insert bladder catheter

034051702Insert temp bladder cath

034051736Urine flow measurement

034051798Us urine capacity measure

034069200Clear outer ear canal

034069210Remove impacted ear wax

034075571Ct hrt w/o dye w/ca test

034076977Us bone density measure$0.00$0.00

034094644Cbt 1st hour

034094645Cbt each addl hour

034094780Car seat/bed test 60 min

034094781Car seat/bed test + 30 min

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

0340G0294"Non-cov proc, clinical trial"

0340G0364Bone marrow aspirate &biopsy

0341Skin TestsX0.0806$5.64$2.09$1.13

03410106TTouch quant sensory test

03410107TVibrate quant sensory test

03410108TCool quant sensory test

03410109THeat quant sensory test

03410110TNos quant sensory test

034186485Skin test candida

034186486Skin test nos antigen

034186490Coccidioidomycosis skin test

034186510Histoplasmosis skin test

034186580TB intradermal test

0342Level I PathologyX0.1601$11.21.$2.25

03420279TCtc test

03420280TCtc test w/i & r

034280500Lab pathology consultation

034280502Lab pathology consultation

034286077Physician blood bank service

034286079Physician blood bank service
034288177Cytp fna eval ea addl

034288187Flowcytometry/read 2-8

034288199Cytopathology procedure

034288299Cytogenetic study

034288300Surgical path gross

034288311Decalcify tissue

034288332Path consult intraop addl

034288363Xm archive tissue molec anal

034288399Surgical pathology procedure

034289049Chct for mal hyperthermia

034289240Pathology lab procedure

034289398Unlisted reprod med lab proc

0343Level III PathologyX0.5259$36.82$10.84$7.37

034385097Bone marrow interpretation

034386078Physician blood bank service

034388112Cytopath cell enhance tech

034388162Cytopath smear other source

034388173Cytopath eval fna report

034388182Cell marker study

034388188Flowcytometry/read 9-15

034388189Flowcytometry/read 16 & >

034388304Tissue exam by pathologist

034388305Tissue exam by pathologist

034388323Microslide consultation

034388331Path consult intraop 1 bloc

034388342Immunohistochemistry

034388346Immunofluorescent study

034388347Immunofluorescent study

034388355Analysis skeletal muscle

034388358Analysis tumor

034388360Tumor immunohistochem/manual

034388367Insitu hybridization auto

034388385Eval molecul probes 51-250

034389230Collect sweat for test

034389257Sperm identification

034389260Sperm isolation simple

034389261Sperm isolation complex

0344Level IV PathologyX0.8180$57.27$15.56$11.46

03440058TCryopreservation ovary tiss

03440059TCryopreservation oocyte

034488120Cytp urne 3-5 probes ea spec

034488121Cytp urine 3-5 probes cmptr

034488307Tissue exam by pathologist

034488309Tissue exam by pathologist

034488325Comprehensive review of data

034488356Analysis nerve

034488361Tumor immunohistochem/comput

034488362Nerve teasing preparations

034488365Insitu hybridization (fish)

034488368Insitu hybridization manual

034488386Eval molecul probes 251-500

034489250Cultr oocyte/embryo <4 days

034489251Cultr oocyte/embryo <4 days

034489253Embryo hatching

034489254Oocyte identification

034489255Prepare embryo for transfer

034489258Cryopreservation embryo(s)

034489264Identify sperm tissue

034489268Insemination of oocytes

034489272Extended culture of oocytes

034489280Assist oocyte fertilization

034489281Assist oocyte fertilization

034489290Biopsy oocyte polar body

034489291Biopsy oocyte polar body

034489335Cryopreserve testicular tiss

034489342Storage/year embryo(s)
034489343Storage/year sperm/semen

034489344Storage/year reprod tissue

034489346Storage/year oocyte(s)

034489352Thawing cryopresrved embryo

034489353Thawing cryopresrved sperm

034489354Thaw cryoprsvrd reprod tiss

034489356Thawing cryopresrved oocyte

0345Level I Transfusion Laboratory ProceduresX0.2135$14.95.$2.99

034586850RBC antibody screen

034586891Autologous blood op salvage

034586902Blood type antigen donor ea

034586904Blood typing patient serum

034586905Blood typing rbc antigens

034586906Blood typing rh phenotype

034586920Compatibility test spin

034586921Compatibility test incubate

034586923Compatibility test electric

034586927Plasma fresh frozen

034586945Blood product/irradiation

034586950Leukacyte transfusion

034586960Vol reduction of blood/prod

034586970RBC pretreatment

034586971RBC pretreatment

034586972RBC pretreatment

034586976Rbc pretreatment serum

034586985Split blood or products

034586999Transfusion procedure

0346Level II Transfusion Laboratory ProceduresX0.3538$24.77.$4.96

034686860RBC antibody elution

034686870RBC antibody identification

034686922Compatibility test antiglob

034686965Pooling blood platelets

034686975Rbc pretreatment serum

034686978Rbc pretreatment serum

0347Level III Transfusion Laboratory ProceduresX0.6730$47.12.$9.43

034786890Autologous blood process

034786930Frozen blood prep

034786931Frozen blood thaw

034786932Frozen blood freeze/thaw

034786977Rbc pretreatment serum

0350Administration of flu and PPV vaccineS0.3545$24.82$0.00$0.00

0350G0008Admin influenza virus vac$0.00$0.00

0350G0009Admin pneumococcal vaccine$0.00$0.00

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

0360Level I Alimentary TestsX1.7152$120.09$33.87$24.02

036091037Esoph imped function test

036091040Esoph balloon distension tst

036091065Breath hydrogen test

036091132Electrogastrography

036091133Electrogastrography w/test

036091299Gastroenterology procedure

0361Level II Alimentary TestsX4.0827$285.85$83.23$57.17

03610240TEsoph motility 3d topography

03610241TEsoph motility w/stim/perf

03610242TGi tract transit & pres meas

036191010Esophagus motility study

036191013Esophgl motil w/stim/perfus

036191020Gastric motility studies

036191022Duodenal motility study

036191030Acid perfusion of esophagus

036191034Gastroesophageal reflux test

036191035G-esoph reflx tst w/electrod

036191038Esoph imped funct test > 1h

036195075Ingestion challenge test

0363Level I Otorhinolaryngologic Function TestsX0.9638$67.48$17.10$13.50

036392512Nasal function studies
036392516Facial nerve function test

036392541Spontaneous nystagmus test

036392542Positional nystagmus test

036392544Optokinetic nystagmus test

036392545Oscillating tracking test

036392587Evoked auditory test limited

036392588Evoked auditory tst complete

0364Level I AudiometryX0.4911$34.38$7.06$6.88

036492550Tympanometry & reflex thresh

036492552Pure tone audiometry air

036492555Speech threshold audiometry

036492556Speech audiometry complete

036492562Loudness balance test

036492563Tone decay hearing test

036492564Sisi hearing test

036492565Stenger test pure tone

036492567Tympanometry

036492568Acoustic refl threshold tst

036492571Filtered speech hearing test

036492575Sensorineural acuity test

036492576Synthetic sentence test

036492583Select picture audiometry

036492596Ear protector evaluation

036492700Ent procedure/service

0365Level II AudiometryX1.2175$85.24$18.05$17.05

03650212TCompre audiometry evaluation

036592553Audiometry air & bone

036592557Comprehensive hearing test

036592561Bekesy audiometry diagnosis

036592570Acoustic immitance testing

036592579Visual audiometry (vra)

036592582Conditioning play audiometry

036592620Auditory function 60 min

036592625Tinnitus assessment

036592640Aud brainstem implt programg

0366Level III AudiometryX1.6864$118.07$23.65$23.62

036692572Staggered spondaic word test

036692577Stenger test speech

036692601Cochlear implt f/up exam < 7

036692602Reprogram cochlear implt < 7

036692603Cochlear implt f/up exam 7 >

036692604Reprogram cochlear implt 7 >

036692626Eval aud rehab status

0367Level I Pulmonary TestX0.7420$51.95$13.76$10.39

036793740Temperature gradient studies

036794010Breathing capacity test

036794011Spirometry up to 2 yrs old

036794012Spirmtry w/brnchdil inf-2 yr

036794014Patient recorded spirometry

036794015Patient recorded spirometry

036794150Vital capacity test

036794200Lung function test (MBC/MVV)

036794250Expired gas collection

036794375Respiratory flow volume loop

036794400CO2 breathing response curve

036794453Hast w/oxygen titrate

036794690Exhaled air analysis

036794726Pulm funct tst plethysmograp

036794727Pulm function test by gas

036794728Pulm funct test oscillometry

036794750Pulmonary compliance study

036794799Pulmonary service/procedure

036795012Exhaled nitric oxide meas

0368Level II Pulmonary TestsX0.8906$62.36$20.93$12.48

036894450Hypoxia response curve

036894452Hast w/report
036894620Pulmonary stress test/simple

036894680Exhaled air analysis o2

036894729C02/membane diffuse capacity

036894770Exhaled carbon dioxide test

036895071Bronchial allergy tests

0369Level III Pulmonary TestsX2.6868$188.12$38.23$37.63

03690244TCont msr bronchodil wheeze

036994013Meas lung vol thru 2 yrs

036994070Evaluation of wheezing

036994621Pulm stress test/complex

036994681Exhaled air analysis o2/co2

036994772Breath recording infant

036995070Bronchial allergy tests

0370Multiple Allergy TestsX1.1369$79.60.$15.92

037095056Photosensitivity tests

037095060Eye allergy tests

037095180Rapid desensitization

0373Level I Neuropsychological TestingX1.3842$96.92.$19.39

037396102Psycho testing by technician

037396103Psycho testing admin by comp

037396111Developmental test extend

0377Level II Cardiac ImagingS9.6018$672.28.$134.46

037778451Ht muscle image spect sing

037778452Ht muscle image spect mult

037778453Ht muscle image planar sing

037778454Ht musc image planar mult

0378Level II Pulmonary ImagingS4.5192$316.42$126.56$63.29

037878582Lung ventilat&perfus imaging

037878598Lung perf&ventilat diferentl

0381Single Allergy TestsX0.4426$30.99.$6.20

038195004Percut allergy skin tests

038195010Percut allergy titrate test

038195015Id allergy titrate-drug/bug

038195024Id allergy test drug/bug

038195027Id allergy titrate-airborne

038195028Id allergy test-delayed type

038195044Allergy patch tests

038195052Photo patch test

038195065Nose allergy test

038195199Allergy immunology services

0382Level II Neuropsychological TestingX2.5717$180.06.$36.02

038296101Psycho testing by psych/phys

038296116Neurobehavioral status exam

038296118Neuropsych tst by psych/phys

038296119Neuropsych testing by tec

038296120Neuropsych tst admin w/comp

0383Cardiac Computed Tomographic ImagingS3.7417$261.98.$52.40

038375572Ct hrt w/3d image

038375573Ct hrt w/3d image congen

038375574Ct angio hrt w/3d image

0384GI Procedures with StentsT29.2172"$2,045.67".$409.14

038443219Esophagus endoscopy

038443256Uppr gi endoscopy w/stent

038443268Endo cholangiopancreatograph

038443269Endo cholangiopancreatograph

038444370Small bowel endoscopy/stent

038444379S bowel endoscope w/stent

038444383Ileoscopy w/stent

038444397Colonoscopy w/stent

038445327Proctosigmoidoscopy w/stent

038445345Sigmoidoscopy w/stent

038445387Colonoscopy w/stent

0385Level I Prosthetic Urological ProceduresS104.8530"$7,341.39"."$1,468.28"

038553440Male sling procedure

038553444Insert tandem cuff

038554400Insert semi-rigid prosthesis
0386Level II Prosthetic Urological ProceduresS169.3017"$11,853.83"."$2,370.77"

038653445Insert uro/ves nck sphincter

038653447Remove/replace ur sphincter

038654401Insert self-contd prosthesis

038654405Insert multi-comp penis pros

038654410Remove/replace penis prosth

038654416Remv/repl penis contain pros

0387Level II HysteroscopyT38.3457"$2,684.81"$655.55$536.97

038758560Hysteroscopy resect septum

038758561Hysteroscopy remove myoma

038758563Hysteroscopy ablation

0388DiscographyS22.7689"$1,594.19".$318.84

038872285X-ray c/t spine disk

038872295X-ray of lower spine disk

0389Level I Non-imaging Nuclear MedicineS1.5569$109.01$26.88$21.81

038978000Thyroid single uptake

038978001Thyroid multiple uptakes

038978003Thyroid suppress/stimul

038978730Urinary bladder retention

038978999Nuclear diagnostic exam

0390Level I Endocrine ImagingS1.8944$132.64$47.64$26.53

039078010Thyroid imaging

039078011Thyroid imaging with flow

039078099Endocrine nuclear procedure

0391Level II Endocrine ImagingS3.1610$221.32$65.46$44.27

039178006Thyroid imaging with uptake

039178007Thyroid image mult uptakes

039178070Parathyroid nuclear imaging

0392Level II Non-imaging Nuclear MedicineS2.2892$160.28$39.07$32.06

039238792Ra tracer id of sentinl node

039278190Platelet survival kinetics

039278191Platelet survival

039278270Vit B-12 absorption exam

039278271Vit b-12 absrp exam int fac

039278272Vit b-12 absorp combined

039278725Kidney function study

039278808Iv inj ra drug dx study

0393Hematologic Processing & StudiesS6.9196$484.48.$96.90

039338210T-cell depletion of harvest

039338211Tumor cell deplete of harvst

039338212Rbc depletion of harvest

039338213Platelet deplete of harvest

039338214Volume deplete of harvest

039338215Harvest stem cell concentrte

039378110Plasma volume single

039378111Plasma volume multiple

039378120Red cell mass single

039378121Red cell mass multiple

039378122Blood volume

039378130Red cell survival study

039378135Red cell survival kinetics

039378140Red cell sequestration

0394Hepatobiliary ImagingS4.1909$293.43$90.78$58.69

039478201Liver imaging

039478202Liver imaging with flow

039478205Liver imaging (3D)

039478206Liver image (3d) with flow

039478215Liver and spleen imaging

039478216Liver & spleen image/flow

039478226Hepatobiliary system imaging

039478227Hepatobil syst image w/drug

0395GI Tract ImagingS3.4841$243.94$87.01$48.79

039578230Salivary gland imaging

039578231Serial salivary imaging

039578232Salivary gland function exam

039578258Esophageal motility study
039578261Gastric mucosa imaging

039578262Gastroesophageal reflux exam

039578264Gastric emptying study

039578278Acute GI blood loss imaging

039578282GI protein loss exam

039578290Meckels divert exam

039578291Leveen/shunt patency exam

039578299GI nuclear procedure

0396Bone ImagingS3.5304$247.18$94.20$49.44

039678300Bone imaging limited area

039678305Bone imaging multiple areas

039678306Bone imaging whole body

039678315Bone imaging 3 phase

039678320Bone imaging (3D)

039678399Musculoskeletal nuclear exam

0397Vascular ImagingS2.0980$146.89$33.94$29.38

039778445Vascular flow imaging

039778456Acute venous thrombus image

039778457Venous thrombosis imaging

039778458Ven thrombosis images bilat

0398Level I Cardiac ImagingS4.2548$297.90$93.33$59.58

039878414Non-imaging heart function

039878428Cardiac shunt imaging

039878466Heart infarct image

039878468Heart infarct image (ef)

039878469Heart infarct image (3D)

039878472Gated heart planar single

039878473Gated heart multiple

039878481Heart first pass single

039878483Heart first pass multiple

039878494Heart image spect

039878499Cardiovascular nuclear exam

0400Hematopoietic ImagingS3.6580$256.12$90.92$51.23

040078102Bone marrow imaging ltd

040078103Bone marrow imaging mult

040078104Bone marrow imaging body

040078185Spleen imaging

040078195Lymph system imaging

040078199Blood/lymph nuclear exam

0401Level I Pulmonary ImagingS2.8915$202.45$71.16$40.49

040178579Lung ventilation imaging

040178580Lung perfusion imaging

040178597Lung perfusion differential

040178599Respiratory nuclear exam

0402Level II Nervous System ImagingS8.6793$607.69.$121.54

040278601Brain image w/flow < 4 views

040278606Brain image w/flow 4 + views

040278607Brain imaging (3D)

040278630Cerebrospinal fluid scan

040278635CSF ventriculography

040278647Cerebrospinal fluid scan

040278650CSF leakage imaging

0403Level I Nervous System ImagingS3.4408$240.91$72.42$48.19

040378600Brain image < 4 views

040378605Brain image 4+ views

040378610Brain flow imaging only

040378645CSF shunt evaluation

040378660Nuclear exam of tear flow

040378699Nervous system nuclear exam

0404Renal and Genitourinary StudiesS4.5536$318.82$81.52$63.77

040478700Kidney imaging morphol

040478701Kidney imaging with flow

040478707K flow/funct image w/o drug

040478708K flow/funct image w/drug

040478709K flow/funct image multiple

040478710Kidney imaging (3D)
040478740Ureteral reflux study

040478761Testicular imaging w/flow

040478799Genitourinary nuclear exam

0406Level I Tumor/Infection ImagingS4.0053$280.44$85.08$56.09

040678015Thyroid met imaging

040678016Thyroid met imaging/studies

040678018Thyroid met imaging body

040678800Tumor imaging limited area

0407Level I Radionuclide TherapyS3.2941$230.64$78.13$46.13

040779005Nuclear rx oral admin

040779101Nuclear rx iv admin

040779300Nuclr rx interstit colloid

040779445Nuclear rx intra-arterial

040779999Nuclear medicine therapy

0408Level III Tumor/Infection ImagingS13.6750$957.47.$191.50

040878075Adrenal nuclear imaging

040878804Tumor imaging whole body

0409Red Blood Cell TestsX0.1101$7.71$2.17$1.55

040986880Coombs test direct

040986885Coombs test indirect qual

040986886Coombs test indirect titer

040986900Blood typing abo

040986901Blood typing rh (d)

0412IMRT Treatment DeliveryS6.5452$458.27.$91.66

04120073TDelivery comp imrt

041277418Radiation tx delivery imrt

0413Level II Radionuclide TherapyS4.0373$282.68.$56.54

041379200Nuclear rx intracav admin

041379403Hematopoietic nuclear tx

041379440Nuclear rx intra-articular

0414Level II Tumor/Infection ImagingS7.0664$494.76.$98.96

041478801Tumor imaging mult areas

041478802Tumor imaging whole body

041478803Tumor imaging (3D)

041478805Abscess imaging ltd area

041478806Abscess imaging whole body

041478807Nuclear localization/abscess

0415Level II Endoscopy Lower AirwayT28.9051"$2,023.82"$459.92$404.77

04150250TInsert bronchial valve

04150276TBronch thermoplasty 1 lobe

04150277TBronch thermoplasty lobes

041531626Bronchoscopy w/markers

041531630Bronchoscopy dilate/fx repr

041531631Bronchoscopy dilate w/stent

041531636Bronchoscopy bronch stents

041531638Bronchoscopy revise stent

041531640Bronchoscopy w/tumor excise

041531641Bronchoscopy treat blockage

0419Level II Upper GI ProceduresT12.6671$886.90$207.88$177.38

041943201Esoph scope w/submucous inj

041943205Esophagus endoscopy/ligation

041943215Esophagus endoscopy

041943217Esophagus endoscopy

041943220Esoph endoscopy dilation

041943226Esoph endoscopy dilation

041943227Esoph endoscopy repair

041943231Esoph endoscopy w/us exam

041943232Esoph endoscopy w/us fn bx

041943237Endoscopic us exam esoph

041943238Uppr gi endoscopy w/us fn bx

041943240Esoph endoscope w/drain cyst

041943242Uppr gi endoscopy w/us fn bx

041943244Upper GI endoscopy/ligation

041943245Uppr gi scope dilate strictr

041943246Place gastrostomy tube

041943249Esoph endoscopy dilation
041943250Upper GI endoscopy/tumor

041943251Operative upper GI endoscopy

041943255Operative upper GI endoscopy

041943258Operative upper GI endoscopy

041943259Endoscopic ultrasound exam

041943458Dilate esophagus

041944100Biopsy of bowel

041949440Place gastrostomy tube perc

041949441Place duod/jej tube perc

041949446Change g-tube to g-j perc

041991111Esophageal capsule endoscopy

0422Level III Upper GI ProceduresT25.9792"$1,818.96".$363.80

042243216Esophagus endoscopy/lesion

042243228Esoph endoscopy ablation

042243257Uppr gi scope w/thrml txmnt

042243830Place gastrostomy tube

042243870Repair stomach opening

0422C9724EPS gast cardia plic

0423Level II Percutaneous Abdominal and Biliary 

ProceduresT58.4890"$4,095.17".$819.04

042332998Perq rf ablate tx pul tumor

042347382Percut ablate liver rf

042347556Biliary endoscopy thru skin

042350592Perc rf ablate renal tumor

042350593Perc cryo ablate renal tum

0424Level II Small Intestine EndoscopyT15.7819"$1,104.99"$240.64$221.00

042444364Small bowel endoscopy

042444365Small bowel endoscopy

042444366Small bowel endoscopy

042444369Small bowel endoscopy

042444372Small bowel endoscopy

042444373Small bowel endoscopy

042444378Small bowel endoscopy

0425Level II Arthroplasty or Implantation with 

ProsthesisT132.5319"$9,279.35"."$1,855.87"

042523470Reconstruct shoulder joint

042524361Reconstruct elbow joint

042524363Replace elbow joint

042524366Reconstruct head of radius

042525441Reconstruct wrist joint

042525442Reconstruct wrist joint

042525446Wrist replacement

042527446Revision of knee joint

042569714Implant temple bone w/stimul

042569715Temple bne implnt w/stimulat

042569717Temple bone implant revision

042569718Revise temple bone implant

0426Level II Strapping and Cast ApplicationS2.5699$179.93.$35.99

042629010Application of body cast

042629015Application of body cast

042629035Application of body cast

042629044Application of body cast

042629046Application of body cast

042629055Application of shoulder cast

042629065Application of long arm cast

042629075Application of forearm cast

042629305Application of hip cast

042629325Application of hip casts

042629345Application of long leg cast

042629355Application of long leg cast

042629358Apply long leg cast brace

042629365Application of long leg cast

042629405Apply short leg cast

042629425Apply short leg cast

042629435Apply short leg cast

042629445Apply rigid leg cast
042629710Removal/revision of cast

0427Level II Tube or Catheter Changes or RepositioningT16.2412"$1,137.14".$227.43

042747525Change bile duct catheter

042747530Revise/reinsert bile tube

042749423Exchange drainage catheter

042749435Insert subq exten to ip cath

042749436Embedded ip cath exit-site

042750387Change ext/int ureter stent

042750398Change kidney tube

042750688Change of ureter tube/stent

042762225Replace/irrigate catheter

0428Level III Sigmoidoscopy and AnoscopyT23.9777"$1,678.82".$335.77

042845307Proctosigmoidoscopy fb

042845320Proctosigmoidoscopy ablate

042845321Proctosigmoidoscopy volvul

042846610Anoscopy remove lesion

042846612Anoscopy remove lesions

042846615Anoscopy

0429Level V Cystourethroscopy and other Genitourinary 

ProceduresT45.7676"$3,204.46".$640.90

042950080Removal of kidney stone

042950081Removal of kidney stone

042952647Laser surgery of prostate

042952648Laser surgery of prostate

042952649Prostate laser enucleation

042953850Prostatic microwave thermotx

042953852Prostatic rf thermotx

0432Health and Behavior ServicesS0.5154$36.09.$7.22

043296150Assess hlth/behave init

043296151Assess hlth/behave subseq

043296152Intervene hlth/behave indiv

043296153Intervene hlth/behave group

043296154Interv hlth/behav fam w/pt

0432G0396Alcohol/subs interv 15-30mn

0432G0451Devlopment test interpt&rep

0433Level II PathologyX0.2434$17.04$5.06$3.41

043388104Cytopath fl nongyn smears

043388106Cytopath fl nongyn filter

043388108Cytopath concentrate tech

043388125Forensic cytopathology

043388160Cytopath smear other source

043388161Cytopath smear other source

043388172Cytp dx eval fna 1st ea site

043388184Flowcytometry/ tc 1 marker

043388185Flowcytometry/tc add-on

043388302Tissue exam by pathologist

043388312Special stains group 1

043388313Special stains group 2

043388314Histochemical stains add-on

043388319Enzyme histochemistry

043388321Microslide consultation

043388329Path consult introp

043388333Intraop cyto path consult 1

043388334Intraop cyto path consult 2

043388384Eval molecular probes 11-50

043389220Sputum specimen collection

043389259Cryopreservation sperm

0434Cardiac Defect RepairT171.3141"$11,994.73"."$2,398.95"

043493580Transcath closure of asd

043493581Transcath closure of vsd

0436Level I Drug AdministrationS0.3545$24.82.$4.97

043690472Immunization admin each add

043690473Immune admin oral/nasal

043690474Immune admin oral/nasal addl

043695115Immunotherapy one injection

043695117Immunotherapy injections
043695165Antigen therapy services

043696361Hydrate iv infusion add-on

043696379Ther/prop/diag inj/inf proc

043696549Chemotherapy unspecified

0437Level II Drug AdministrationS0.4972$34.81.$6.97

043790471Immunization admin

043795144Antigen therapy services

043795145Antigen therapy services

043795148Antigen therapy services

043795149Antigen therapy services

043795170Antigen therapy services

043796366Ther/proph/diag iv inf addon

043796367Tx/proph/dg addl seq iv inf

043796370Sc ther infusion addl hr

043796371Sc ther infusion reset pump

043796372Ther/proph/diag inj sc/im

043796373Ther/proph/diag inj ia

043796374Ther/proph/diag inj iv push

043796375Tx/pro/dx inj new drug addon

043796401Chemo anti-neopl sq/im

043796402Chemo hormon antineopl sq/im

043796405Chemo intralesional up to 7

043796415Chemo iv infusion addl hr

0437G0010Admin hepatitis b vaccine$0.00$0.00

0438Level III Drug AdministrationS1.0388$72.73.$14.55

043895146Antigen therapy services

043895147Antigen therapy services

043896360Hydration iv infusion init

043896411Chemo iv push addl drug

043896417Chemo iv infus each addl seq

043896420Chemo ia push tecnique

043896423Chemo ia infuse each addl hr

043896542Chemotherapy injection

0439Level IV Drug AdministrationS1.8098$126.71.$25.35

043995990Spin/brain pump refil & main

043995991Spin/brain pump refil & main

043996365Ther/proph/diag iv inf init

043996369Sc ther infusion up to 1 hr

043996406Chemo intralesional over 7

043996409Chemo iv push sngl drug

043996440Chemotherapy intracavitary

043996446Chemotx admn prtl cavity

043996521Refill/maint portable pump

043996522Refill/maint pump/resvr syst

0440Level V Drug AdministrationS2.9679$207.80.$41.56

044096413Chemo iv infusion 1 hr

044096416Chemo prolong infuse w/pump

044096422Chemo ia infusion up to 1 hr

044096425Chemotherapy infusion method

044096450Chemotherapy into cns

0440C8957"Prolonged IV inf, req pump"

0442Dosimetric Drug AdministrationS21.9850"$1,539.30".$307.86

0442G3001"Admin + supply, tositumomab"

0604Level 1 Hospital Clinic VisitsV0.7689$53.84.$10.77

060499201Office/outpatient visit new

060499211Office/outpatient visit est

0604G0101CA screen;pelvic/breast exam$0.00$0.00

0604G0245Initial foot exam pt lops

0604G0379Direct refer hospital observ

0605Level 2 Hospital Clinic VisitsV1.0311$72.19.$14.44

060590862Medication management

060592012Eye exam established pat

060592014Eye exam & treatment

060599202Office/outpatient visit new

060599212Office/outpatient visit est

060599213Office/outpatient visit est
060599460Init nb em per day hosp

060599463Same day nb discharge

0605G0246Followup eval of foot pt lop

0606Level 3 Hospital Clinic VisitsV1.3588$95.14.$19.03

060692002Eye exam new patient

060692004Eye exam new patient

060699203Office/outpatient visit new

060699214Office/outpatient visit est

0606G0402Initial preventive exam$0.00$0.00

0607Level 4 Hospital Clinic VisitsV1.8647$130.56.$26.12

060795250Glucose monitoring cont

060799204Office/outpatient visit new

060799215Office/outpatient visit est

0607G0175"OPPS Service,sched team conf"

0607G0248Demonstrate use home inr mon

0607G0249Provide INR test mater/equip

0607M0064Visit for drug monitoring

0608Level 5 Hospital Clinic VisitsV2.5237$176.70.$35.34

060890945Dialysis one evaluation

060899205Office/outpatient visit new

0609Level 1 Type A Emergency VisitsV0.7181$50.28$12.04$10.06

060999281Emergency dept visit

0613Level 2 Type A Emergency VisitsV1.2356$86.51$20.79$17.31

061399282Emergency dept visit

0614Level 3 Type A Emergency VisitsV1.9447$136.16$33.59$27.24

061499283Emergency dept visit

0615Level 4 Type A Emergency VisitsV3.1277$218.99$47.70$43.80

061599284Emergency dept visit

0616Level 5 Type A Emergency VisitsV4.6152$323.14$71.44$64.63

061699285Emergency dept visit

0617Critical CareS6.6453$465.28$104.95$93.06

061799291Critical care first hour

0618Trauma Response with Critical CareS11.2658$788.79.$157.76

0618G0390Trauma Respons w/hosp criti

0621Level I Vascular Access ProceduresT11.0639$774.65.$154.93

062136555Insert non-tunnel cv cath

062136556Insert non-tunnel cv cath

062136568Insert picc cath

062136569Insert picc cath

062136576Repair tunneled cv cath

062136580Replace cvad cath

062136584Replace picc cath

062136590Removal tunneled cv cath

062136596Mech remov tunneled cv cath

062136597Reposition venous catheter

0622Level II Vascular Access ProceduresT25.2672"$1,769.11".$353.83

062236557Insert tunneled cv cath

062236558Insert tunneled cv cath

062236570Insert picvad cath

062236571Insert picvad cath

062236578Replace tunneled cv cath

062236581Replace tunneled cv cath

062236585Replace picvad cath

062236595Mech remov tunneled cv cath

0623Level III Vascular Access ProceduresT30.3507"$2,125.03".$425.01

062336260Insertion of infusion pump

062336560Insert tunneled cv cath

062336561Insert tunneled cv cath

062336563Insert tunneled cv cath

062336565Insert tunneled cv cath

062336566Insert tunneled cv cath

062336582Replace tunneled cv cath

062336583Replace tunneled cv cath

062336640Insertion catheter artery

062337192Redo endovas vena cava filtr

062337193Rem endovas vena cava filter
062337200Transcatheter biopsy

062337203Transcatheter retrieval

062337209Change iv cath at thromb tx

0624Phlebotomy and Minor Vascular Access Device ProceduresX0.6068$42.49$12.33$8.50

062436591Draw blood off venous device

062436592Collect blood from picc

062437799Vascular surgery procedure

062496523Irrig drug delivery device

062499195Phlebotomy

0626Level 1 Type B Emergency VisitsV0.5627$39.40.$7.88

0626G0380Lev 1 hosp type B ED visit

0627Level 2 Type B Emergency VisitsV0.7972$55.82.$11.17

0627G0381Lev 2 hosp type B ED visit

0628Level 3 Type B Emergency VisitsV1.3178$92.27.$18.46

0628G0382Lev 3 hosp type B ED visit

0629Level 4 Type B Emergency VisitsV1.9503$136.55.$27.31

0629G0383Lev 4 hosp type B ED visit

0630Level 5 Type B Emergency VisitsV3.7639$263.53.$52.71

0630G0384Lev 5 hosp type B ED visit

0648Level IV Breast SurgeryT62.4125"$4,369.87".$873.98

064819296Place po breast cath for rad

064819297Place breast cath for rad

064819298Place breast rad tube/caths

064819325Enlarge breast with implant

064819342Delayed breast prosthesis

064819357Breast reconstruction

0651Complex Interstitial Radiation Source ApplicationS11.9274$835.11.$167.03

065177778Apply interstit radiat compl

0652Insertion of Intraperitoneal and Pleural CathetersT30.8430"$2,159.50".$431.90

065232550Insert pleural cath

065249418Insert tun ip cath perc

065249421Ins tun ip cath for dial opn

0653Vascular Reconstruction/Fistula Repair with DeviceT43.8023"$3,066.86".$613.38

065335011Repair defect of artery

065335261Repair blood vessel lesion

065335266Repair blood vessel lesion

065335286Repair blood vessel lesion

065336870Percut thrombect av fistula

0654Level II Insertion/Replacement of Permanent 

PacemakerT103.3418"$7,235.58"."$1,447.12"

065433213Insert pulse gen dual leads

065433221Insert pulse gen mult leads

065433228Remv&replc pm gen dual lead

065433229Remv&replc pm gen mult leads

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

PacingT137.6558"$9,638.11"."$1,927.63"

065533208Insrt heart pm atrial & vent

065533214Upgrade of pacemaker system

065533224Insert pacing lead & connect

065533225L ventric pacing lead add-on

0656Transcatheter Placement of Intracoronary Drug-Eluting 

StentsT105.6644"$7,398.20"."$1,479.64"

0656G0290"Drug-eluting stents, single"

0656G0291"Drug-eluting stents,each add"

0659Hyperbaric OxygenS1.4941$104.61.$20.93

0659C1300HYPERBARIC Oxygen

0660Level II Otorhinolaryngologic Function TestsX1.8189$127.35$27.10$25.47

066092520Laryngeal function studies

066092540Basic vestibular evaluation

066092543Caloric vestibular test

066092546Sinusoidal rotational test

066092548Posturography

0661Level V PathologyX2.3496$164.51.$32.91

066188348Electron microscopy

066188349Scanning electron microscopy

0661G0416Sat biopsy prostate 1-20 spc
0662CT AngiographyS4.8375$338.70$114.37$67.74

066270496Ct angiography head

066270498Ct angiography neck

066271275Ct angiography chest

066272191Ct angiograph pelv w/o&w/dye

066273206Ct angio upr extrm w/o&w/dye

066273706Ct angio lwr extr w/o&w/dye

066274175Ct angio abdom w/o & w/dye

066275635Ct angio abdominal arteries

0664Level I Proton Beam Radiation TherapyS16.9101"$1,183.98".$236.80

066477520Proton trmt simple w/o comp

066477522Proton trmt simple w/comp

0665Bone Density:AppendicularSkeletonS0.4865$34.06$0.00$0.00

066577081Dxa bone density/peripheral$0.00$0.00

0667Level II Proton Beam Radiation TherapyS22.1209"$1,548.82".$309.77

066777523Proton trmt intermediate

066777525Proton treatment complex

0668Level I Angiography and VenographyT9.4045$658.47.$131.70

066836147Access av dial grft for eval

066875746Artery x-rays lung

066875756Artery x-rays chest

066875791Av dialysis shunt imaging

066875820Vein x-ray arm/leg

066875822Vein x-ray arms/legs

066875827Vein x-ray chest

066875860Vein x-ray neck

066875870Vein x-ray skull

066875872Vein x-ray skull

066875880Vein x-ray eye socket

066875887Vein x-ray liver

0672Level III Posterior Segment Eye ProceduresT41.0159"$2,871.77".$574.36

06720100TProsth retina receive&gen

067265285Repair of eye wound

067266220Repair eye lesion

067267010Partial removal of eye fluid

067267015Release of eye fluid

067267025Replace eye fluid

067267027Implant eye drug system

067267036Removal of inner eye fluid

067267039Laser treatment of retina

067267040Laser treatment of retina

067267041Vit for macular pucker

067267042Vit for macular hole

067267043Vit for membrane dissect

067267107Repair detached retina

067267108Repair detached retina

067267112Rerepair detached retina

067267113Repair retinal detach cplx

067267121Remove eye implant material

0673Level V Anterior Segment Eye ProceduresT41.5778"$2,911.11"$634.95$582.23

06730191TInsert ant segment drain int

06730192TInsert ant segment drain ext

06730253TInsert aqueous drain device

067366174Translum dil eye canal

067366175Trnslum dil eye canal w/stnt

067366180Implant eye shunt

067366225Repair/graft eye lesion

0674Prostate CryoablationT113.8112"$7,968.60"."$1,593.72"

067455873Cryoablate prostate

0676Thrombolysis and Other Device RevisionsT2.3021$161.18.$32.24

067636593Declot vascular device

067636598Inj w/fluor eval cv device

067636860External cannula declotting

067637195Thrombolytic therapy stroke

067643760Change gastrostomy tube

067692977Dissolve clot heart vessel
0678External CounterpulsationT1.3360$93.54.$18.71

0678G0166"Extrnl counterpulse, per tx"

0679Level II Resuscitation and CardioversionS5.3254$372.86$95.30$74.58

067992960Cardioversion electric ext

067992961Cardioversion electric int

0680Insertion of Patient Activated Event RecordersS80.3579"$5,626.34"."$1,125.27"

068033282Implant pat-active ht record

0683Level II PhotochemotherapyS3.0368$212.62.$42.53

068396913Photochemotherapy uv-a or b

0685Level III Needle Biopsy/Aspiration Except Bone MarrowT9.6713$677.15.$135.43

068532400Needle biopsy chest lining

068532405Percut bx lung/mediastinum

068547000Needle biopsy of liver

068548102Needle biopsy pancreas

068549180Biopsy abdominal mass

068550200Renal biopsy perq

068550390Drainage of kidney lesion

068562269Needle biopsy spinal cord

0687Revision/Removal of Neurostimulator 

ElectrodesT20.7198"$1,450.72"$385.30$290.15

06870267TImplt/rpl crtd sns dev lead

06870270TRev/remvl crtd sns dev lead

06870284TPeriph field stimul revise

068761880Revise/remove neuroelectrode

068763661Remove spine eltrd perq aray

068763662Remove spine eltrd plate

068764569Revise/repl vagus n eltrd

068764585Revise/remove neuroelectrode

0688Revision/Removal of Neurostimulator Pulse Generator 

ReceiverT31.1002"$2,177.51"$768.94$435.51

06880271TRev/remvl crtd sns dev gen

068861888Revise/remove neuroreceiver

068863688Revise/remove neuroreceiver

068864595Revise/rmv pn/gastr stimul

0690Level I Electronic Analysis of DevicesS0.4928$34.50.$6.90

06900224TAcoustic ecg 1+ analysis

06900225TAcoustic ecg analy & reprog

069093279Pm device progr eval sngl

069093280Pm device progr eval dual

069093281Pm device progr eval multi

069093282Icd device prog eval 1 sngl

069093283Icd device progr eval dual

069093284Icd device progr eval mult

069093285Ilr device eval progr

069093288Pm device eval in person

069093289Icd device interrogate

069093291Ilr device interrogate

069093292Wcd device interrogate

069093293Pm phone r-strip device eval

069093296Pm/icd remote tech serv

069093299Icm/ilr remote tech serv

069093724Analyze pacemaker system

069093745Set-up cardiovert-defibrill

0691Level III Electronic Analysis of DevicesS2.3930$167.55.$33.51

069162252Csf shunt reprogram

069162367Analyze spine infus pump

069162368Analyze sp inf pump w/reprog

069162369Anal sp inf pmp w/reprg&fill

069162370Anl sp inf pmp w/mdreprg&fil

0692Level II Electronic Analysis of DevicesS1.5944$111.63.$22.33

069293271Ecg/monitoring and analysis

069293750Interrogation vad in person

069295971Analyze neurostim simple

069295972Analyze neurostim complex

069295974Cranial neurostim complex

069295978Analyze neurostim brain/1h
069295979Analyz neurostim brain addon

069295982Io ga n-stim subsq w/reprog

0694Mohs SurgeryT5.0714$355.08$88.08$71.02

069417311Mohs 1 stage h/n/hf/g

069417312Mohs addl stage

069417313Mohs 1 stage t/a/l

069417314Mohs addl stage t/a/l

069417315Mohs surg addl block

0697Level I Echocardiogram Without ContrastS3.1615$221.36.$44.28

069776825Echo exam of fetal heart

069776826Echo exam of fetal heart

069793308Tte f-up or lmtd

0698Level II Eye Tests & TreatmentsS1.0589$74.14.$14.83

06980198TOcular blood flow measure

069865205Remove foreign body from eye

069865210Remove foreign body from eye

069865220Remove foreign body from eye

069865222Remove foreign body from eye

069865430Corneal smear

069867820Revise eyelashes

069868040Treatment of eyelid lesions

069868801Dilate tear duct opening

069892083Visual field examination(s)

069892136Ophthalmic biometry

069892230Eye exam with photos

069892286Internal eye photography

069892287Internal eye photography

069892311Contact lens fitting

069892313Contact lens fitting

069892315Prescription of contact lens

069892316Prescription of contact lens

069892325Modification of contact lens

069892352Special spectacles fitting

069892353Special spectacles fitting

069892371Repair & adjust spectacles

0698G0117Glaucoma scrn hgh risk direc

0699Level IV Eye Tests & TreatmentsT15.4248"$1,079.98".$216.00

069967346Biopsy eye muscle

069968110Remove eyelid lining lesion

069992018New eye exam & treatment

069992019Eye exam & treatment

0701Sr89 strontiumK$954.77.$190.96

0701A9600Sr89 strontium

0726Dexrazoxane HCl injectionK$207.92.$41.59

0726J1190Dexrazoxane HCl injection

0728Filgrastim 300 mcg injectionK$246.80.$49.36

0728J1440Filgrastim 300 mcg injection

0731Sargramostim injectionK$24.22.$4.85

0731J2820Sargramostim injection

0735Ampho b cholesteryl sulfateK$14.56.$2.92

0735J0288Ampho b cholesteryl sulfate

0736Amphotericin b liposome injK$14.25.$2.85

0736J0289Amphotericin b liposome inj

0738RasburicaseK$188.98.$37.80

0738J2783Rasburicase

0747Chlorothiazide sodium injK$269.86.$53.98

0747J1205Chlorothiazide sodium inj

0751Mechlorethamine hcl injK$154.88.$30.98

0751J9230Mechlorethamine hcl inj

0752Dactinomycin injectionK$567.28.$113.46

0752J9120Dactinomycin injection

0759"Naltrexone, depot form"K$2.78.$0.56

0759J2315"Naltrexone, depot form"

0800Leuprolide acetateK$590.71.$118.15

0800J1950Leuprolide acetate /3.75 MG

0802Etoposide oralK$37.54.$7.51
0802J8560Etoposide oral 50 MG

0807Aldesleukin injectionK$969.60.$193.92

0807J9015Aldesleukin injection

0809Bcg live intravesical vacK$117.34.$23.47

0809J9031Bcg live intravesical vac

0810Goserelin acetate implantK$186.43.$37.29

0810J9202Goserelin acetate implant

0812Carmustine injectionK$172.53.$34.51

0812J9050Carmustine injection

0814Asparaginase injectionK$62.08.$12.42

0814J9020Asparaginase injection

0820Daunorubicin injectionK$15.60.$3.12

0820J9150Daunorubicin injection

0821Daunorubicin citrate injK$56.58.$11.32

0821J9151Daunorubicin citrate inj

0823Docetaxel injectionK$15.75.$3.15

0823J9171Docetaxel injection

0825Nelarabine injectionK$113.99.$22.80

0825J9261Nelarabine injection

0827Floxuridine injectionK$60.82.$12.17

0827J9200Floxuridine injection

0828Gemcitabine hcl injectionK$89.64.$17.93

0828J9201Gemcitabine hcl injection

0830Irinotecan injectionK$6.42.$1.29

0830J9206Irinotecan injection

0831Ifosfamide injectionK$32.03.$6.41

0831J9208Ifosfamide injection

0832Idarubicin hcl injectionK$58.32.$11.67

0832J9211Idarubicin hcl injection

0835Cosyntropin injection NOSK$99.76.$19.96

0835J0833Cosyntropin injection NOS

0836Interferon alfa-2b injK$16.82.$3.37

0836J9214Interferon alfa-2b inj

0838Interferon gamma 1-b injK$582.59.$116.52

0838J9216Interferon gamma 1-b inj

0840Inj melphalan hydrochlK"$1,512.71".$302.55

0840J9245Inj melphalan hydrochl 50 MG

0842Fludarabine phosphate injK$101.84.$20.37

0842J9185Fludarabine phosphate inj

0843Pegaspargase injectionK"$2,675.40".$535.08

0843J9266Pegaspargase injection

0844Pentostatin injectionK"$1,084.10".$216.82

0844J9268Pentostatin injection

0849Rituximab injectionK$615.22.$123.05

0849J9310Rituximab injection

0850Streptozocin injectionK$265.69.$53.14

0850J9320Streptozocin injection

0851Thiotepa injectionK$131.18.$26.24

0851J9340Thiotepa injection

0856Porfimer sodium injectionK"$19,348.11"."$3,869.63"

0856J9600Porfimer sodium injection

0858Inj cladribineK$23.94.$4.79

0858J9065Inj cladribine per 1 MG

0861Leuprolide acetate injecitonK$4.42.$0.89

0861J9218Leuprolide acetate injeciton

0864Mitoxantrone hydrochlK$37.36.$7.48

0864J9293Mitoxantrone hydrochl / 5 MG

0865Interferon alfa-n3 injK$31.20.$6.24

0865J9215Interferon alfa-n3 inj

0868Oral aprepitantK$6.06.$1.22

0868J8501Oral aprepitant

0873Hyalgan/supartz inj per doseK$88.00.$17.60

0873J7321Hyalgan/supartz inj per dose

0874Synvisc or synvisc-oneK$11.93.$2.39

0874J7325Synvisc or Synvisc-One

0875Euflexxa inj per doseK$146.10.$29.22
0875J7323Euflexxa inj per dose

0877Orthovisc inj per doseK$166.14.$33.23

0877J7324Orthovisc inj per dose

0884Rho d immune globulin injK$82.14.$16.43

0884J2790Rho d immune globulin inj

0887Azathioprine parenteralK$122.53.$24.51

0887J7501Azathioprine parenteral

0890Lymphocyte immune globulinK$556.51.$111.31

0890J7504Lymphocyte immune globulin

0900Alglucerase injectionK$41.24.$8.25

0900J0205Alglucerase injection

0901Alpha 1 proteinase inhibitorK$3.83.$0.77

0901J0256Alpha 1 proteinase inhibitor

0902"Injection,onabotulinumtoxinA"K$5.38.$1.08

0902J0585"Injection,onabotulinumtoxinA"

0903Cytomegalovirus imm IV /vialK$947.86.$189.58

0903J0850Cytomegalovirus imm IV /vial

0910Interferon beta-1b / .25 MGK$211.59.$42.32

0910J1830Interferon beta-1b / .25 MG

0913Ganciclovir long act implantK"$16,640.00"."$3,328.00"

0913J7310Ganciclovir long act implant

0917Adenosine injectionK$94.42.$18.89

0917J0152Adenosine injection

0925Factor viiiK$0.85.$0.17

0925J7190Factor viii

0927Factor viii recombinantK$1.09.$0.22

0927J7192Factor viii recombinant NOS

0928Factor ix complexK$0.91.$0.19

0928J7194Factor ix complex

0929Anti-inhibitorK$1.60.$0.32

0929J7198Anti-inhibitor

0931Factor IX non-recombinantK$0.89.$0.18

0931J7193Factor IX non-recombinant

0932Factor IX recombinantK$1.14.$0.23

0932J7195Factor IX recombinant

0933Gamma globulin > 10 CC injK$206.16.$41.24

0933J1560Gamma globulin > 10 CC inj

0934"Capecitabine, oral"K$24.63.$4.93

0934J8521"Capecitabine, oral, 500 mg"

0943Octagam injectionK$55.80.$11.16

0943J1568Octagam injection

0944Gammagard liquid injectionK$37.08.$7.42

0944J1569Gammagard liquid injection

0945Rhophylac injectionK$5.09.$1.02

0945J2791Rhophylac injection

0946Hepagam b im injectionK$52.11.$10.43

0946J1571Hepagam b im injection

0947Flebogamma injectionG$35.15.$6.90

0947J1572Flebogamma injection

0948Gamunex/gamunex cK$36.78.$7.36

0948J1561Gamunex/gamunex c

0949"Frozen plasma, pooled, sd"R0.9547$66.84.$13.37

0949P9023"Frozen plasma, pooled, sd"

0950Whole blood for transfusionR2.7245$190.76.$38.16

0950P9010Whole blood for transfusion

0951Reclast injectionK$218.44.$43.69

0951J3488Reclast injection

0952Cryoprecipitate each unitR1.1823$82.78.$16.56

0952P9012Cryoprecipitate each unit

0954RBC leukocytes reducedR2.8408$198.90.$39.78

0954P9016RBC leukocytes reduced

0955"Plasma, frz between 8-24hour"R1.0400$72.82.$14.57

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

0956"Plasma protein fract,5%,50ml"R0.2574$18.02.$3.61

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

0957"Platelets, each unit"R1.2822$89.77.$17.96
0957P9019"Platelets, each unit"

0958Plaelet rich plasma unitR2.0257$141.83.$28.37

0958P9020Plaelet rich plasma unit

0959Red blood cells unitR2.1303$149.16.$29.84

0959P9021Red blood cells unit

0960Washed red blood cells unitR4.1045$287.38.$57.48

0960P9022Washed red blood cells unit

0961"Albumin (human),5%, 50ml"K$21.32.$4.27

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

0963"Albumin (human), 5%, 250 ml"K$61.94.$12.39

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

0964"Albumin (human), 25%, 20 ml"K$26.84.$5.37

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

0965"Albumin (human), 25%, 50ml"K$68.03.$13.61

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

0966"Plasmaprotein fract,5%,250ml"R1.0362$72.55.$14.51

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

0967Blood split unitR1.6761$117.35.$23.47

0967P9011Blood split unit

0968Platelets leukoreduced irradR1.9996$140.00.$28.00

0968P9033Platelets leukoreduced irrad

0969RBC leukoreduced irradiatedR3.7309$261.22.$52.25

0969P9040RBC leukoreduced irradiated

1009CryoprecipitatereducedplasmaR1.0622$74.37.$14.88

1009P9044Cryoprecipitatereducedplasma

1010"Blood, l/r, cmv-neg"R2.6930$188.55.$37.71

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

1011"Platelets, hla-m, l/r, unit"R11.4695$803.05.$160.61

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

1013Platelets leukocytes reducedR1.8720$131.07.$26.22

1013P9031Platelets leukocytes reduced

1015Injection glatiramer acetateK$109.30.$21.86

1015J1595Injection glatiramer acetate

1016"Blood, l/r, froz/degly/wash"R1.4989$104.95.$20.99

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

1017"Plt, aph/pher, l/r, cmv-neg"R5.4802$383.70.$76.74

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

1018"Blood, l/r, irradiated"R2.0966$146.80.$29.36

1018P9056"Blood, l/r, irradiated"

1019Plate pheres leukoredu irradR9.8804$691.79.$138.36

1019P9037Plate pheres leukoredu irrad

1020"Plt, pher, l/r cmv-neg, irr"R8.7936$615.69.$123.14

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

1021"RBC, frz/deg/wsh, l/r, irrad"R6.4103$448.82.$89.77

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

1022"RBC, l/r, cmv-neg, irrad"R4.3700$305.97.$61.20

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

1023Pralidoxime chloride injK$88.51.$17.71

1023J2730Pralidoxime chloride inj

1052"Injection, voriconazole"K$6.07.$1.22

1052J3465"Injection, voriconazole"

1064"I131 iodide cap, rx"K$17.26.$3.46

1064A9517"I131 iodide cap, rx"

1083Adalimumab injectionK$410.95.$82.19

1083J0135Adalimumab injection

1084Denileukin diftitox injK"$1,603.01".$320.61

1084J9160Denileukin diftitox inj

1086TemozolomideK$9.48.$1.90

1086J8700Temozolomide

1138"Hepagam b intravenous, inj"K$52.11.$10.43

1138J1573"Hepagam b intravenous, inj"

1139Protein c concentrateK$12.90.$2.58

1139J2724Protein c concentrate

1142Supprelin LA implantK"$15,418.48"."$3,083.70"

1142J9226Supprelin LA implant

1150"I131 iodide sol, rx"K$10.49.$2.10
1150A9530"I131 iodide sol, rx"

1166Cytarabine liposome injK$503.48.$100.70

1166J9098Cytarabine liposome inj

1167"Inj, epirubicin hcl"K$1.87.$0.38

1167J9178"Inj, epirubicin hcl, 2 mg"

1168"Inj, temsirolimus"K$50.57.$10.12

1168J9330Temsirolimus injection

1178Busulfan injectionK$18.72.$3.75

1178J0594Busulfan injection

1203Verteporfin injectionK$9.76.$1.96

1203J3396Verteporfin injection

1207"Octreotide injection, depot"K$117.11.$23.43

1207J2353"Octreotide injection, depot"

1213Antihemophilic viii/vwf compK$0.90.$0.18

1213J7186Antihemophilic viii/vwf comp

1214Inj IVIG privigen 500 mgK$34.42.$6.89

1214J1459Inj IVIG privigen 500 mg

1221Dimethyl sulfoxide 50%K$94.38.$18.88

1221J1212Dimethyl sulfoxide 50% 50 ML

1222Pentastarch 10% solutionK$13.23.$2.65

1222J2513Pentastarch 10% solution

1226Inj streptokinase /250000 IUK$19.78.$3.96

1226J2995Inj streptokinase /250000 IU

1232Mitomycin 5 MG injK$19.55.$3.91

1232J9280Mitomycin 5 MG inj

1235Valrubicin injectionK$959.07.$191.82

1235J9357Valrubicin injection

1236Levoleucovorin injectionK$1.58.$0.32

1236J0641Levoleucovorin injection

1237Inj iron dextranK$11.53.$2.31

1237J1750Inj iron dextran

1238Topotecan oralK$77.92.$15.59

1238J8705Topotecan oral

1239Rotavirus vacc 2 dose oralK$106.60.$21.32

123990681Rotavirus vacc 2 dose oral

1240Apligraf skin subK$35.88.$7.18

1240Q4101Apligraf

1241Oasis wound matrix skin subK$5.74.$1.15

1241Q4102Oasis wound matrix

1242Oasis burn matrix skin subK$5.74.$1.15

1242Q4103Oasis burn matrix

1243Integra BMWD skin subK$16.26.$3.26

1243Q4104Integra BMWD

1244Integra DRT skin subK$9.62.$1.93

1244Q4105Integra DRT

1245Dermagraft skin subK$40.51.$8.11

1245Q4106Dermagraft

1246Graftjacket skin subK$94.95.$18.99

1246Q4107Graftjacket

1247Integra matrix skin subK$21.73.$4.35

1247Q4108Integra matrix

1248Primatrix skin subK$31.42.$6.29

1248Q4110Primatrix

1249Cymetra allograftK$332.25.$66.45

1249Q4112Cymetra injectable

1250Graftjacket express allografK$332.25.$66.45

1250Q4113Graftjacket xpress

1251Integra flowable wound matriK"$1,019.89".$203.98

1251Q4114Integra flowable wound matri

1252Gammagraft skin subK$6.78.$1.36

1252Q4111Gammagraft

1253Triamcinolone A inj PRS-freeK$3.41.$0.69

1253J3300Triamcinolone A inj PRS-free

1263Antithrombin iii injectionK$2.71.$0.55

1263J7197Antithrombin iii injection

1268Xyntha injK$1.07.$0.22
1268J7185Xyntha inj

1270Alloderm skin subK$31.72.$6.35

1270Q4116Alloderm

1272Acetylcysteine injectionK$2.74.$0.55

1272J0132Acetylcysteine injection

1274Edetate calcium disodium injK$189.47.$37.90

1274J0600Edetate calcium disodium inj

1275"Vivaglobin, inj"K$12.48.$2.50

1275J1562"Vivaglobin, inj"

1279Factor VIII (porcine)K$9.12.$1.83

1279J7191Factor VIII (porcine)

1280Corticotropin injectionK"$2,516.22".$503.25

1280J0800Corticotropin injection

1281Bevacizumab injectionK$1.50.$0.30

1281C9257Bevacizumab injection

1287Alloskin skin subK$8.26.$1.66

1287Q4115Alloskin

1289AbobotulinumtoxinAK$7.29.$1.46

1289J0586AbobotulinumtoxinA

1290Human fibrinogen conc injK$71.57.$14.32

1290J1680Human fibrinogen conc inj

1291Rilonacept injectionK$23.64.$4.73

1291J2793Rilonacept injection

1295Sm 153 lexidronamK"$7,592.00"."$1,518.40"

1295A9604Sm 153 lexidronam

1296Degarelix injectionK$2.71.$0.55

1296J9155Degarelix injection

1297"Ferumoxytol, non-esrd"K$0.65.$0.13

1297Q0138"Ferumoxytol, non-esrd"

1304Perphenazine injecitonK$19.54.$3.91

1304J3310Perphenazine injeciton

1306Urea injectionK$72.00.$14.40

1306J3350Urea injection

1307Oral busulfanK$3.77.$0.76

1307J8510Oral busulfan

1308Mecasermin injectionK$25.65.$5.13

1308J2170Mecasermin injection

1311Canakinumab injectionG$88.97.$17.46

1311J0638Canakinumab injection

1312Hizentra injectionK$7.15.$1.43

1312J1559Hizentra injection

1327Imiglucerase injectionK$41.20.$8.24

1327J1786Imuglucerase injection

1331Olanzapine long-acting injK$2.70.$0.54

1331J2358Olanzapine long-acting inj

1332Antithrombin recombinantK$101.40.$20.28

1332J7196Antithrombin recombinant

1338"Methyl aminolevulinate, top"K$74.52.$14.91

1338J7309"Methyl aminolevulinate, top"

1339Oral fludarabine phosphateG$77.93.$15.30

1339J8562Oral fludarabine phosphate

1340"Collagenase, clost hist inj"G$37.51.$7.36

1340J0775"Collagenase, clost hist inj"

1341Amobarbital 125 MG injK$113.08.$22.62

1341J0300Amobarbital 125 MG inj

1342Matristem micromatrixK$2.94.$0.59

1342Q4118Matristem micromatrix

1343Ganciclovir sodium injectionK$66.58.$13.32

1343J1570Ganciclovir sodium injection

1344Gonadorelin hydroch/ 100 mcgK$167.25.$33.45

1344J1620Gonadorelin hydroch/ 100 mcg

1345TheraskinK$32.84.$6.57

1345Q4121Theraskin

1347Oxacillin sodium injecitonK$2.51.$0.51

1347J2700Oxacillin sodium injeciton

1349Anidulafungin injectionK$1.20.$0.24
1349J0348Anidulafungin injection

1350Topotecan injectionK$9.85.$1.97

1350J9351Topotecan injection

1351Matristem wound matrixK$4.52.$0.91

1351Q4119Matristem wound matrix

1352Wilate injectionG$0.87.$0.17

1352J7183Wilate injection

1353Belimumab injectionG$38.61.$7.58

1353J0490Belimumab injection

1354Hydroxyprogesterone caproateK$2.52.$0.51

1354J1725Hydroxyprogesterone caproate

1355Itraconazole injectionK$372.55.$74.51

1355J1835Itraconazole injection

1357Inj protirelin per 250 mcgK$27.03.$5.41

1357J2725Inj protirelin per 250 mcg

1358Phentolaine mesylate injK$53.76.$10.76

1358J2760Phentolaine mesylate inj

1359Foscarnet sodium injectionK$14.37.$2.88

1359J1455Foscarnet sodium injection

1360Apomorphine hydrochlorideK$5.12.$1.03

1360J0364Apomorphine hydrochloride

1361Enfuvirtide injectionK$0.51.$0.11

1361J1324Enfuvirtide injection

1362Inj heparin sodium per 10 uK$0.18.$0.04

1362J1642Inj heparin sodium per 10 u

1373Inj heparin sodium per 1000uK$0.27.$0.06

1373J1644Inj heparin sodium per 1000u

1374Sumatriptan succinate / 6 MGK$76.71.$15.35

1374J3030Sumatriptan succinate / 6 MG

1408Cyclophosphamide 100 MG injK$13.43.$2.69

1408J9070Cyclophosphamide 100 MG inj

1412Vinorelbine tartrate injK$17.45.$3.49

1412J9390Vinorelbine tartrate inj

1413Lumizyme injectionG$148.30.$29.10

1413J0221Lumizyme injection

1415Glassia injectionK$3.81.$0.77

1415J0257Glassia injection

1416Factor XIII anti-hem factorG$8.44.$1.66

1416J7180Factor XIII anti-hem factor

1417Gel-oneK"$1,014.00".$202.80

1417J7326Gel-one

1418Oral everolimusK$5.68.$1.14

1418J8561Oral everolimus

1419DermacellK$31.52.$6.31

1419Q4122Dermacell

1426Eribulin mesylate injectionG$90.06.$17.68

1426J9179Eribulin mesylate injection

1505New Technology - Level V ($300 - $400)S$350.00.$70.00

1505G0417Sat biopsy prostate 21-40

1506New Technology - Level VI ($400 - $500)S$450.00.$90.00

1506G0418Sat biopsy prostate 41-60

1508New Technology - Level VIII ($600 - $700)S$650.00.$130.00

1508G0419Sat biopsy prostate: >60

1605Abciximab injectionK$548.95.$109.79

1605J0130Abciximab injection

1607Eptifibatide injectionK$22.02.$4.41

1607J1327Eptifibatide injection

1608Etanercept injectionK$204.31.$40.87

1608J1438Etanercept injection

1609"Rho(D) immune globulin h, sd"K$17.21.$3.45

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

1612"Daclizumab, parenteral"K$516.41.$103.29

1612J7513"Daclizumab, parenteral"

1613Trastuzumab injectionK$71.08.$14.22

1613J9355Trastuzumab injection

1630"Hep b ig, im"K$113.50.$22.70
163090371Hep b ig im

1631Baclofen intrathecal trialK$76.39.$15.28

1631J0476Baclofen intrathecal trial

1633AlefaceptK$38.72.$7.75

1633J0215Alefacept

1643"Y90 ibritumomab, rx"K"$36,100.41"."$7,220.09"

1643A9543"Y90 ibritumomab, rx"

1645"I131 tositumomab, rx"K"$29,618.96"."$5,923.80"

1645A9545"I131 tositumomab, rx"

1670Tetanus immune globulin injK$245.02.$49.01

1670J1670Tetanus immune globulin inj

1675P32 Na phosphateK$126.14.$25.23

1675A9563P32 Na phosphate

1676P32 chromic phosphateK$579.98.$116.00

1676A9564P32 chromic phosphate

1683BasiliximabK"$2,190.58".$438.12

1683J0480Basiliximab

1684Corticorelin ovine triflutalK$5.58.$1.12

1684J0795Corticorelin ovine triflutal

1685"Darbepoetin alfa, non-esrd"K$3.14.$0.63

1685J0881"Darbepoetin alfa, non-esrd"

1686"Epoetin alfa, non-esrd"K$9.70.$1.94

1686J0885"Epoetin alfa, non-esrd"

1687Digoxin immune fab (ovine)K$626.71.$125.35

1687J1162Digoxin immune fab (ovine)

1688Ethanolamine oleateK$294.28.$58.86

1688J1430Ethanolamine oleate 100 mg

1689FomepizoleK$6.91.$1.39

1689J1451"Fomepizole, 15 mg"

1690HeminK$10.41.$2.09

1690J1640"Hemin, 1 mg"

1693LepirudinK$346.19.$69.24

1693J1945Lepirudin

1694Ziconotide injectionK$6.48.$1.30

1694J2278Ziconotide injection

1695Nesiritide injectionK$46.36.$9.28

1695J2325Nesiritide injection

1696Palifermin injectionK$11.45.$2.29

1696J2425Palifermin injection

1697Pegaptanib sodium injectionK"$1,001.34".$200.27

1697J2503Pegaptanib sodium injection

1700Inj secretin synthetic humanK$26.98.$5.40

1700J2850Inj secretin synthetic human

1701Treprostinil injectionK$60.08.$12.02

1701J3285Treprostinil injection

1704"Humate-P, inj"K$0.88.$0.18

1704J7187"Humate-P, inj"

1705Factor viiaK$1.52.$0.31

1705J7189Factor viia

1709Azacitidine injectionK$5.15.$1.03

1709J9025Azacitidine injection

1710Clofarabine injectionK$119.68.$23.94

1710J9027Clofarabine injection

1711Vantas implantK"$3,816.98".$763.40

1711J9225Vantas implant

1712Paclitaxel protein boundK$9.33.$1.87

1712J9264Paclitaxel protein bound

1716"Brachytx, non-str, Gold-198"U0.5004$35.04.$7.01

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

1717"Brachytx, non-str, HDR Ir-192"U3.3224$232.62.$46.53

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

1719"Brachytx, NS, Non-HDRIr-192"U0.4544$31.82.$6.37

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

1738OxaliplatinK$9.96.$2.00

1738J9263Oxaliplatin

1739"Pegademase bovine, 25 iu"K$248.56.$49.72
1739J2504"Pegademase bovine, 25 iu"

1741"Urofollitropin, 75 iu"K$65.66.$13.14

1741J3355"Urofollitropin, 75 iu"

1749"Endo, colon, retro imaging"H

1749C1749"Endo, colon, retro imaging"

1830Power bone marrow bx needleH

1830C1830Power bone marrow bx needle

1840Telescopic intraocular lensH

1840C1840Telescopic intraocular lens

1886"Catheter, ablation"H

1886C1886"Catheter, ablation"

2210Methyldopate hcl injectionK$39.16.$7.84

2210J0210Methyldopate hcl injection

2616"Brachytx, non-str,Yttrium-90"U224.7054"$15,732.97"."$3,146.60"

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

2632Iodine I-125 sodium iodideU0.2404$16.83.$3.37

2632A9527Iodine I-125 sodium iodide

2634"Brachytx, non-str, HA, I-125"U0.8944$62.62.$12.53

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

2635"Brachytx, non-str, HA, P-103"U0.3855$26.99.$5.40

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

2636"Brachy linear, non-str,P-103"U0.5294$37.07.$7.42

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

2638"Brachytx, stranded, I-125"U0.6498$45.50.$9.10

2638C2638"Brachytx, stranded, I-125"

2639"Brachytx, non-stranded,I-125"U0.5078$35.55.$7.11

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

2640"Brachytx, stranded, P-103"U1.1433$80.05.$16.01

2640C2640"Brachytx, stranded, P-103"

2641"Brachytx, non-stranded,P-103"U0.9180$64.27.$12.86

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

2642"Brachytx, stranded, C-131"U1.7379$121.68.$24.34

2642C2642"Brachytx, stranded, C-131"

2643"Brachytx, non-stranded,C-131"U1.1044$77.33.$15.47

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

2698"Brachytx, stranded, NOS"U0.6498$45.50.$9.10

2698C2698"Brachytx, stranded, NOS"

2699"Brachytx, non-stranded, NOS"U0.3855$26.99.$5.40

2699C2699"Brachytx, non-stranded, NOS"

2731"Immune globulin, powder"K$30.46.$6.10

2731J1566"Immune globulin, powder"

2770Quinupristin/dalfopristinK$171.48.$34.30

2770J2770Quinupristin/dalfopristin

3041BivalirudinK$2.71.$0.55

3041J0583Bivalirudin

3043Gamma globulin 1 CC injK$20.62.$4.13

3043J1460Gamma globulin 1 CC inj

3050Sermorelin acetate injectionK$1.77.$0.36

3050Q0515Sermorelin acetate injection

7000AmifostineK$315.94.$63.19

7000J0207Amifostine

7011Oprelvekin injectionK$239.90.$47.98

7011J2355Oprelvekin injection

7034Somatropin injectionK$61.81.$12.37

7034J2941Somatropin injection

7035TeniposideK$316.31.$63.27

7035Q2017"Teniposide, 50 mg"

7036"Urokinase 250,000 IU inj"K$449.09.$89.82

7036J3365"Urokinase 250,000 IU inj"

7038Monoclonal antibodiesK"$1,111.59".$222.32

7038J7505Monoclonal antibodies

7041Tirofiban HClK$8.92.$1.79

7041J3246Tirofiban HCl

7042"Capecitabine, oral"K$7.32.$1.47

7042J8520"Capecitabine, oral, 150 mg"

7043Infliximab injectionK$62.01.$12.41
7043J1745Infliximab injection

7046Doxorubicin hcl liposome injK$525.35.$105.07

7046J9001Doxorubicin hcl liposome inj

7048Alteplase recombinantK$42.24.$8.45

7048J2997Alteplase recombinant

7049Filgrastim 480 mcg injectionK$390.07.$78.02

7049J1441Filgrastim 480 mcg injection

7051Leuprolide acetate implantK"$4,728.88".$945.78

7051J9219Leuprolide acetate implant

7308Aminolevulinic acid hcl topK$147.80.$29.56

7308J7308Aminolevulinic acid hcl top

9001Linezolid injectionK$34.48.$6.90

9001J2020Linezolid injection

9002Tenecteplase injectionK$57.15.$11.43

9002J3101Tenecteplase injection

9003PalivizumabK"$1,158.85".$231.77

900390378Rsv mab im 50mg

9004Gemtuzumab ozogamicin injK"$2,690.84".$538.17

9004J9300Gemtuzumab ozogamicin inj

9005Reteplase injectionK"$1,623.59".$324.72

9005J2993Reteplase injection

9006Tacrolimus injectionK$136.86.$27.38

9006J7525Tacrolimus injection

9012Arsenic trioxide injectionK$40.10.$8.02

9012J9017Arsenic trioxide injection

9018"Inj, rimabotulinumtoxinB"K$10.78.$2.16

9018J0587"Inj, rimabotulinumtoxinB"

9019Caspofungin acetateK$13.32.$2.67

9019J0637Caspofungin acetate

9022IM inj interferon beta 1-aK$238.30.$47.66

9022Q3025IM inj interferon beta 1-a

9023Rho d immune globulinK$21.52.$4.31

9023J2788Rho d immune globulin 50 mcg

9024Amphotericin b lipid complexK$8.42.$1.69

9024J0287Amphotericin b lipid complex

9032Baclofen 10 MG injectionK$187.46.$37.50

9032J0475Baclofen 10 MG injection

9033Cidofovir injectionK$742.66.$148.54

9033J0740Cidofovir injection

9038Inj estrogen conjugateK$103.54.$20.71

9038J1410Inj estrogen conjugate 25 MG

9042Glucagon hydrochlorideK$101.30.$20.26

9042J1610Glucagon hydrochloride/1 MG

9044Ibutilide fumarate injectionK$133.80.$26.76

9044J1742Ibutilide fumarate injection

9046Iron sucrose injectionK$0.32.$0.07

9046J1756Iron sucrose injection

9104Antithymocyte globuln rabbitK$432.20.$86.44

9104J7511Antithymocyte globuln rabbit

9108Thyrotropin injectionK"$1,032.25".$206.45

9108J3240Thyrotropin injection

9110Alemtuzumab injectionK$575.18.$115.04

9110J9010Alemtuzumab injection

9115Zoledronic acidK$220.30.$44.06

9115J3487Zoledronic acid

9119"Injection, pegfilgrastim 6mg"K"$2,676.49".$535.30

9119J2505"Injection, pegfilgrastim 6mg"

9120"Injection, Fulvestrant"K$83.63.$16.73

9120J9395"Injection, Fulvestrant"

9121"Injection, argatroban"K$20.16.$4.04

9121C9121"Injection, argatroban"

9122Triptorelin pamoateK$176.18.$35.24

9122J3315Triptorelin pamoate

9124Daptomycin injectionK$0.48.$0.10

9124J0878Daptomycin injection

9125"Risperidone, long acting"K$5.07.$1.02
9125J2794"Risperidone, long acting"

9126Natalizumab injectionK$10.32.$2.07

9126J2323Natalizumab injection

9133"Rabies ig, im/sc"K$185.74.$37.15

913390375Rabies ig im/sc

9134"Rabies ig, heat treated"K$177.81.$35.57

913490376Rabies ig heat treated

9135"Varicella-zoster ig, im"K$94.28.$18.86

913590396Varicella-zoster ig im

9137"Bcg vaccine, percut"K$112.23.$22.45

913790585Bcg vaccine percut

9139"Rabies vaccine, im"K$205.48.$41.10

913990675Rabies vaccine im

9140"Rabies vaccine, id"K$139.69.$27.94

914090676Rabies vaccine id

9143"Meningococcal vaccine, sc"K$110.75.$22.15

914390733Meningococcal vaccine sc

9144"Encephalitis vaccine, sc"K$100.15.$20.03

914490735Encephalitis vaccine sc

9145"Meningococcal vaccine, im"K$92.92.$18.59

914590734Meningococcal vaccine im

9207Bortezomib injectionK$40.67.$8.14

9207J9041Bortezomib injection

9208Agalsidase beta injectionK$138.53.$27.71

9208J0180Agalsidase beta injection

9209Laronidase injectionK$26.33.$5.27

9209J1931Laronidase injection

9210Palonosetron hclK$18.83.$3.77

9210J2469Palonosetron hcl

9213Pemetrexed injectionK$52.76.$10.56

9213J9305Pemetrexed injection

9214Bevacizumab injectionK$59.98.$12.00

9214J9035Bevacizumab injection

9215Cetuximab injectionK$49.53.$9.91

9215J9055Cetuximab injection

9217Leuprolide acetate suspnsionK$216.90.$43.38

9217J9217Leuprolide acetate suspnsion

9224Galsulfase injectionK$341.40.$68.28

9224J1458Galsulfase injection

9225Fluocinolone acetonide impltK"$18,980.00"."$3,796.00"

9225J7311Fluocinolone acetonide implt

9227Micafungin sodium injectionK$0.98.$0.20

9227J2248Micafungin sodium injection

9228Tigecycline injectionK$1.30.$0.26

9228J3243Tigecycline injection

9229Ibandronate sodium injectionK$148.02.$29.61

9229J1740Ibandronate sodium injection

9230Abatacept injectionK$20.72.$4.15

9230J0129Abatacept injection

9231Decitabine injectionK$31.94.$6.39

9231J0894Decitabine injection

9232Idursulfase injectionK$446.44.$89.29

9232J1743Idursulfase injection

9233Ranibizumab injectionK$395.53.$79.11

9233J2778Ranibizumab injection

9234Alglucosidase alfa injectionK$155.84.$31.17

9234J0220Alglucosidase alfa injection

9235Panitumumab injectionK$85.59.$17.12

9235J9303Panitumumab injection

9236Eculizumab injectionK$186.37.$37.28

9236J1300Eculizumab injection

9237"Inj, lanreotide acetate"K$30.98.$6.20

9237J1930Lanreotide injection

9240"Injection, ixabepilone"K$63.47.$12.70

9240J9207Ixabepilone injection

9242"Injection, fosaprepitant"K$1.69.$0.34
9242J1453Fosaprepitant injection

9243Bendamustine injectionK$18.47.$3.70

9243J9033Bendamustine injection

9244Regadenoson injectionK$51.22.$10.25

9244J2785Regadenoson injection

9245Romiplostim injectionK$45.87.$9.18

9245J2796Romiplostim injection

9248"Inj, clevidipine butyrate"K$2.66.$0.54

9248C9248"Inj, clevidipine butyrate"

9249Certolizumab pegol injK$4.12.$0.83

9249J0718Certolizumab pegol inj

9250Artiss fibrin sealantK$129.72.$25.95

9250C9250Artiss fibrin sealant

9251C1 esterase inhibitor injK$43.37.$8.68

9251J0598"C-1 esterase, cinryze"

9252Plerixafor injectionK$275.80.$55.16

9252J2562Plerixafor injection

9253Temozolomide injectionK$4.75.$0.95

9253J9328Temozolomide injection

9254"Injection, lacosamide"K$0.15.$0.03

9254C9254"Injection, lacosamide"

9255Paliperidone palmitate injK$6.56.$1.32

9255J2426Paliperidone palmitate inj

9256Dexamethasone intra implantK$192.26.$38.46

9256J7312Dexamethasone intra implant

9258Telavancin injectionG$2.10.$0.42

9258J3095Telavancin injection

9259Pralatrexate injectionG$165.63.$32.50

9259J9307Pralatrexate injection

9260Ofatumumab injectionG$45.41.$8.91

9260J9302Ofatumumab injection

9261Ustekinumab injectionG$117.56.$23.07

9261J3357Ustekinumab injection

9263Ecallantide injectionG$289.07.$56.73

9263J1290Ecallantide injection

9264Tocilizumab injectionG$3.47.$0.68

9264J3262Tocilizumab injection

9265Romidepsin injectionG$224.79.$44.11

9265J9315Romidepsin injection

9268Capsaicin 8% patchG$25.55.$5.02

9268J7335Capsaicin 8% patch

9269"C-1 esterase, berinert"G$30.23.$5.94

9269J0597"C-1 esterase, berinert"

9270Gammaplex IVIGG$37.29.$7.32

9270J1557Gammaplex injection

9271Velaglucerase alfaG$349.51.$68.59

9271J3385Velaglucerase alfa

9272"Inj, denosumab"G$14.47.$2.84

9272J0897Denosumab injection

9273Sipleucel-T auto CD54+G"$32,860.00"."$6,448.00"

9273Q2043Sipuleucel-T auto CD54+

9274Crotalidae Poly Immune FabG"$2,111.36".$414.31

9274J0840Crotalidae poly immune fab

9275Hexaminolevulinate HClG$623.28$0.00$0.00

9275C9275Hexaminolevulinate HCl$0.00$0.00

9276Cabazitaxel injectionG$135.57.$26.61

9276J9043Cabazitaxel injection

9278Incobotulinumtoxin AG$5.53.$1.08

9278J0588Incobotulinumtoxin a

9279"Injection, ibuprofen"G$1.62.$0.32

9279C9279"Injection, ibuprofen"

9281"Injection, pegloticase "G$301.75.$59.22

9281J2507Pegloticase injection

9282"Injection, ceftaroline fosamil "G$0.74.$0.14

9282J0712Ceftaroline fosamil inj

9283"Injection, acetaminophen"G$0.11.$0.03
9283J0131Acetaminophen injection

9284Ipilimumab injectionG$127.20.$24.96

9284J9228Ipilimumab injection

9285"Patch, lidocaine/tetracaine"G$13.57.$2.67

9285C9285"Patch, lidocaine/tetracaine"

9286"Injection, belatacept"G$3.91.$0.77

9286C9286"Injection, belatacept"

9287"Inj, brentuximab vedotin"G$95.40.$18.72

9287C9287"Inj, brentuximab vedotin"

9300Omalizumab injectionK$21.34.$4.27

9300J2357Omalizumab injection

9358"SurgiMend, fetal"K$10.91.$2.19

9358C9358"SurgiMend, fetal"

9360"SurgiMend, neonatal"K$11.23.$2.25

9360C9360"SurgiMend, neonatal"

9363Integra Meshed Bil Wound MatK$20.60.$4.12

9363C9363Integra Meshed Bil Wound Mat

9365Oasis tri-layer wound matrixG$10.39.$2.04

9365Q4124Oasis tri-layer wound matrix

9366EpiFix wound coverG$177.77.$34.89

9366C9366EpiFix wound cover

9367Endoform Dermal TemplateG$4.35.$0.86

9367C9367Endoform Dermal Template

9406Iodine I-123 ioflupaneG"$1,908.00"$0.00$0.00

9406A9584Iodine i-123 ioflupane$0.00$0.00

9500"Platelets, irradiated"R1.8342$128.42.$25.69

9500P9032"Platelets, irradiated"

9501Platelet pheres leukoreducedR7.6960$538.84.$107.77

9501P9035Platelet pheres leukoreduced

9502Platelet pheresis irradiatedR7.9257$554.93.$110.99

9502P9036Platelet pheresis irradiated

9503Fr frz plasma donor retestedR1.1562$80.95.$16.19

9503P9060Fr frz plasma donor retested

9504RBC deglycerolizedR3.4084$238.64.$47.73

9504P9039RBC deglycerolized

9505RBC irradiatedR2.8419$198.98.$39.80

9505P9038RBC irradiated

9506"Granulocytes, pheresis unit"R19.1478"$1,340.65".$268.13

9506P9050"Granulocytes, pheresis unit"

9507"Platelets, pheresis"R6.3148$442.14.$88.43

9507P9034"Platelets, pheresis"

9508Plasma 1 donor frz w/in 8 hrR1.1408$79.87.$15.98

9508P9017Plasma 1 donor frz w/in 8 hr