2015 National Physician Fee Schedule Relative Value File ... · 2015 National Physician Fee Schedule Relative Value File January Release CPT codes and descriptions only are copyright

2015 National Physician Fee Schedule Relative Value File January Release

CPT codes and descriptions only are copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.

Dental codes (D codes) are copyright 2014/15 American Dental Association. All Rights Reserved.

RELEASED 12/23/2014

NON-FACILITY

HCPCS MOD DESCRIPTION TOTAL MULTIPLIER TOTAL

10021 Fna w/o image 4.23 70.00 $296.10

10022 Fna w/image 4.02 70.00 $281.40

1003F Level of activity assess 0.00 70.00 $0.00

10030 Guide cathet fluid drainage 22.06 70.00 $1,544.20

1004F Clin symp vol ovrld assess 0.00 70.00 $0.00

10040 Acne surgery 2.86 70.00 $200.20

1005F Asthma symptoms evaluate 0.00 70.00 $0.00

1006F Osteoarthritis assess 0.00 70.00 $0.00

10060 Drainage of skin abscess 3.31 70.00 $231.70

10061 Drainage of skin abscess 5.85 70.00 $409.50

1007F Anti-inflm/anlgsc otc assess 0.00 70.00 $0.00

1008F Gi/renal risk assess 0.00 70.00 $0.00

10080 Drainage of pilonidal cyst 5.08 70.00 $355.60

10081 Drainage of pilonidal cyst 7.61 70.00 $532.70

1010F Severity angina by actvty 0.00 70.00 $0.00

1011F Angina present 0.00 70.00 $0.00

1012F Angina absent 0.00 70.00 $0.00

10120 Remove foreign body 4.32 70.00 $302.40

10121 Remove foreign body 7.75 70.00 $542.50

10140 Drainage of hematoma/fluid 4.62 70.00 $323.40

1015F Copd symptoms assess 0.00 70.00 $0.00

10160 Puncture drainage of lesion 3.69 70.00 $258.30

1018F Assess dyspnea not present 0.00 70.00 $0.00

10180 Complex drainage wound 6.99 70.00 $489.30

1019F Assess dyspnea present 0.00 70.00 $0.00

1022F Pneumo imm status assess 0.00 70.00 $0.00

1026F Co-morbid condition assess 0.00 70.00 $0.00

1030F Influenza imm status assess 0.00 70.00 $0.00

1031F Smoking & 2nd hand assessed 0.00 70.00 $0.00

1032F Smoker/exposed 2nd hnd smoke 0.00 70.00 $0.00

1033F Tobacco nonsmoker nor 2ndhnd 0.00 70.00 $0.00

1034F Current tobacco smoker 0.00 70.00 $0.00

1035F Smokeless tobacco user 0.00 70.00 $0.00

1036F Tobacco non-user 0.00 70.00 $0.00

1038F Persistent asthma 0.00 70.00 $0.00

1039F Intermittent asthma 0.00 70.00 $0.00

1040F Dsm-5 info mdd docd 0.00 70.00 $0.00

1050F History of mole changes 0.00 70.00 $0.00

1052F Type location activityassess 0.00 70.00 $0.00

1055F Visual funct status assess 0.00 70.00 $0.00

1060F Doc perm/cont/parox atr fib 0.00 70.00 $0.00

1061F Doc lack perm+cont+parox fib 0.00 70.00 $0.00

1065F Ischm stroke symp lt3 hrsb/4 0.00 70.00 $0.00

1066F Ischm stroke symp ge3 hrsb/4 0.00 70.00 $0.00

1070F Alarm symp assessed-absent 0.00 70.00 $0.00

1071F Alarm symp assessed-1+ prsnt 0.00 70.00 $0.00

1090F Pres/absn urine incon assess 0.00 70.00 $0.00

1091F Urine incon characterized 0.00 70.00 $0.00

1100F Ptfalls assess-docd ge2>/yr 0.00 70.00 $0.00

11000 Debride infected skin 1.54 70.00 $107.80

11001 Debride infected skin add-on 0.59 70.00 $41.30

11004 Debride genitalia & perineum 16.74 70.00 $1,171.80

11005 Debride abdom wall 22.62 70.00 $1,583.40

11006 Debride genit/per/abdom wall 20.27 70.00 $1,418.90

11008 Remove mesh from abd wall 7.96 70.00 $557.20

1101F Pt falls assess-docd le1/yr 0.00 70.00 $0.00

11010 Debride skin at fx site 13.94 70.00 $975.80

11011 Debride skin musc at fx site 14.98 70.00 $1,048.60

11012 Deb skin bone at fx site 20.15 70.00 $1,410.50

11042 Deb subq tissue 20 sq cm/< 3.31 70.00 $231.70

11043 Deb musc/fascia 20 sq cm/< 6.48 70.00 $453.60

11044 Deb bone 20 sq cm/< 8.96 70.00 $627.20

11045 Deb subq tissue add-on 1.17 70.00 $81.90

11046 Deb musc/fascia add-on 2.07 70.00 $144.90

11047 Deb bone add-on 3.53 70.00 $247.10

11055 Trim skin lesion 1.35 70.00 $94.50

11056 Trim skin lesions 2 to 4 1.65 70.00 $115.50

11057 Trim skin lesions over 4 1.85 70.00 $129.50

1110F Pt lft inpt fac w/in 60 days 0.00 70.00 $0.00

11100 Biopsy skin lesion 2.92 70.00 $204.40

11101 Biopsy skin add-on 0.92 70.00 $64.40

1111F Dschrg med/current med merge 0.00 70.00 $0.00

1116F Auric/peri pain assessed 0.00 70.00 $0.00

1118F Gerd symps assessed 12 month 0.00 70.00 $0.00

1119F Init eval for condition 0.00 70.00 $0.00

11200 Removal of skin tags <w/15 2.49 70.00 $174.30

11201 Remove skin tags add-on 0.53 70.00 $37.10

1121F Subs eval for condition 0.00 70.00 $0.00

1123F Acp discuss/dscn mkr docd 0.00 70.00 $0.00

1124F Acp discuss-no dscnmkr docd 0.00 70.00 $0.00

1125F Amnt pain noted pain prsnt 0.00 70.00 $0.00

1126F Amnt pain noted none prsnt 0.00 70.00 $0.00

1127F New episode for condition 0.00 70.00 $0.00

1128F Subs episode for condition 0.00 70.00 $0.00

1130F Bk pain & fxn assessed 0.00 70.00 $0.00

11300 Shave skin lesion 0.5 cm/< 2.74 70.00 $191.80

11301 Shave skin lesion 0.6-1.0 cm 3.38 70.00 $236.60


11303 Shave skin lesion >2.0 cm 4.39 70.00 $307.30









1134F Epsd bk pain for 6 wks/< 0.00 70.00 $0.00

1135F Epsd bk pain for >6 wks 0.00 70.00 $0.00

1136F Epsd bk pain for 12 wks/< 0.00 70.00 $0.00

1137F Epsd bk pain for >12 wks 0.00 70.00 $0.00

11400 Exc tr-ext b9+marg 0.5 cm< 3.51 70.00 $245.70

11401 Exc tr-ext b9+marg 0.6-1 cm 4.21 70.00 $294.70


11403 Exc tr-ext b9+marg 2.1-3cm/< 5.42 70.00 $379.40


11406 Exc tr-ext b9+marg >4.0 cm 8.88 70.00 $621.60

11420 Exc h-f-nk-sp b9+marg 0.5/< 3.46 70.00 $242.20

11421 Exc h-f-nk-sp b9+marg 0.6-1 4.44 70.00 $310.80

11422 Exc h-f-nk-sp b9+marg 1.1-2 4.96 70.00 $347.20

11423 Exc h-f-nk-sp b9+marg 2.1-3 5.72 70.00 $400.40

11424 Exc h-f-nk-sp b9+marg 3.1-4 6.61 70.00 $462.70

11426 Exc h-f-nk-sp b9+marg >4 cm 9.45 70.00 $661.50

11440 Exc face-mm b9+marg 0.5 cm/< 3.80 70.00 $266.00

11441 Exc face-mm b9+marg 0.6-1 cm 4.76 70.00 $333.20




11446 Exc face-mm b9+marg >4 cm 11.08 70.00 $775.60

11450 Removal sweat gland lesion 10.87 70.00 $760.90





11471 Removal sweat gland lesion 14.38 70.00 $1,006.60

1150F Doc pt rsk death w/in 1yr 0.00 70.00 $0.00

1151F Doc no pt rsk death w/in 1yr 0.00 70.00 $0.00

1152F Doc advncd dis comfort 1st 0.00 70.00 $0.00

1153F Doc advncd dis cmfrt not 1st 0.00 70.00 $0.00

1157F Advnc care plan in rcrd 0.00 70.00 $0.00

1158F Advnc care plan tlk docd 0.00 70.00 $0.00

1159F Med list docd in rcrd 0.00 70.00 $0.00

1160F Rvw meds by rx/dr in rcrd 0.00 70.00 $0.00

11600 Exc tr-ext mal+marg 0.5 cm/< 5.43 70.00 $380.10

11601 Exc tr-ext mal+marg 0.6-1 cm 6.45 70.00 $451.50




11606 Exc tr-ext mal+marg >4 cm 12.75 70.00 $892.50

11620 Exc h-f-nk-sp mal+marg 0.5/< 5.49 70.00 $384.30

11621 Exc s/n/h/f/g mal+mrg 0.6-1 6.49 70.00 $454.30

11622 Exc s/n/h/f/g mal+mrg 1.1-2 7.23 70.00 $506.10

11623 Exc s/n/h/f/g mal+mrg 2.1-3 8.49 70.00 $594.30

11624 Exc s/n/h/f/g mal+mrg 3.1-4 9.57 70.00 $669.90

11626 Exc s/n/h/f/g mal+mrg >4 cm 11.57 70.00 $809.90

11640 Exc f/e/e/n/l mal+mrg 0.5cm< 5.65 70.00 $395.50

11641 Exc f/e/e/n/l mal+mrg 0.6-1 6.71 70.00 $469.70

11642 Exc f/e/e/n/l mal+mrg 1.1-2 7.65 70.00 $535.50

11643 Exc f/e/e/n/l mal+mrg 2.1-3 9.04 70.00 $632.80

11644 Exc f/e/e/n/l mal+mrg 3.1-4 11.17 70.00 $781.90

11646 Exc f/e/e/n/l mal+mrg >4 cm 14.63 70.00 $1,024.10

1170F Fxnl status assessed 0.00 70.00 $0.00

11719 Trim nail(s) any number 0.39 70.00 $27.30

11720 Debride nail 1-5 0.91 70.00 $63.70

11721 Debride nail 6 or more 1.26 70.00 $88.20

11730 Removal of nail plate 2.79 70.00 $195.30

11732 Remove nail plate add-on 1.01 70.00 $70.70

11740 Drain blood from under nail 1.40 70.00 $98.00

1175F Function stat assessed rvwd 0.00 70.00 $0.00

11750 Removal of nail bed 6.31 70.00 $441.70

11752 Remove nail bed/tip 9.21 70.00 $644.70

11755 Biopsy nail unit 3.77 70.00 $263.90

11760 Repair of nail bed 6.47 70.00 $452.90

11762 Reconstruction of nail bed 8.00 70.00 $560.00

11765 Excision of nail fold toe 4.73 70.00 $331.10

11770 Remove pilonidal cyst simple 7.84 70.00 $548.80

11771 Remove pilonidal cyst exten 16.29 70.00 $1,140.30

11772 Remove pilonidal cyst compl 19.81 70.00 $1,386.70

1180F Thromboemb risk assessed 0.00 70.00 $0.00

1181F Neuropsychia sympts assessed 0.00 70.00 $0.00

1182F Neuropsychi sympt 1+present 0.00 70.00 $0.00

1183F Neuropsychiatric symp absent 0.00 70.00 $0.00

11900 Inject skin lesions </w 7 1.56 70.00 $109.20

11901 Inject skin lesions >7 1.96 70.00 $137.20

11920 Correct skin color 6.0 cm/< 4.84 70.00 $338.80

11921 Corect skin color 6.1-20.0cm 5.60 70.00 $392.00

11922 Correct skin color ea 20.0cm 1.73 70.00 $121.10

11950 Tx contour defects 1 cc/< 2.21 70.00 $154.70

11951 Tx contour defects 1.1-5.0cc 3.01 70.00 $210.70

11952 Tx contour defects 5.1-10cc 3.66 70.00 $256.20

11954 Tx contour defects >10.0 cc 4.50 70.00 $315.00

11960 Insert tissue expander(s) 26.95 70.00 $1,886.50

11970 Replace tissue expander 17.40 70.00 $1,218.00

11971 Remove tissue expander(s) 13.33 70.00 $933.10

11976 Remove contraceptive capsule 4.05 70.00 $283.50

11980 Implant hormone pellet(s) 2.66 70.00 $186.20

11981 Insert drug implant device 4.01 70.00 $280.70

11982 Remove drug implant device 4.54 70.00 $317.80

11983 Remove/insert drug implant 6.32 70.00 $442.40

1200F Seizure type& frequ docd 0.00 70.00 $0.00

12001 Rpr s/n/ax/gen/trnk 2.5cm/< 2.53 70.00 $177.10

12002 Rpr s/n/ax/gen/trnk2.6-7.5cm 3.09 70.00 $216.30

12004 Rpr s/n/ax/gen/trk7.6-12.5cm 3.64 70.00 $254.80

12005 Rpr s/n/a/gen/trk12.6-20.0cm 4.72 70.00 $330.40

12006 Rpr s/n/a/gen/trk20.1-30.0cm 5.64 70.00 $394.80

12007 Rpr s/n/ax/gen/trnk >30.0 cm 6.56 70.00 $459.20

12011 Rpr f/e/e/n/l/m 2.5 cm/< 3.10 70.00 $217.00

12013 Rpr f/e/e/n/l/m 2.6-5.0 cm 3.40 70.00 $238.00

12014 Rpr f/e/e/n/l/m 5.1-7.5 cm 4.02 70.00 $281.40

12015 Rpr f/e/e/n/l/m 7.6-12.5 cm 4.86 70.00 $340.20

12016 Rpr fe/e/en/l/m 12.6-20.0 cm 6.04 70.00 $422.80

12017 Rpr fe/e/en/l/m 20.1-30.0 cm 4.42 70.00 $309.40

12018 Rpr f/e/e/n/l/m >30.0 cm 5.02 70.00 $351.40

12020 Closure of split wound 7.95 70.00 $556.50

12021 Closure of split wound 4.65 70.00 $325.50

12031 Intmd rpr s/a/t/ext 2.5 cm/< 6.68 70.00 $467.60

12032 Intmd rpr s/a/t/ext 2.6-7.5 8.54 70.00 $597.80

12034 Intmd rpr s/tr/ext 7.6-12.5 8.80 70.00 $616.00

12035 Intmd rpr s/a/t/ext 12.6-20 10.80 70.00 $756.00

12036 Intmd rpr s/a/t/ext 20.1-30 11.87 70.00 $830.90

12037 Intmd rpr s/tr/ext >30.0 cm 13.64 70.00 $954.80

12041 Intmd rpr n-hf/genit 2.5cm/< 6.82 70.00 $477.40

12042 Intmd rpr n-hf/genit2.6-7.5 8.14 70.00 $569.80

12044 Intmd rpr n-hf/genit7.6-12.5 10.15 70.00 $710.50

12045 Intmd rpr n-hf/genit12.6-20 11.44 70.00 $800.80

12046 Intmd rpr n-hf/genit20.1-30 13.67 70.00 $956.90

12047 Intmd rpr n-hf/genit >30.0cm 15.84 70.00 $1,108.80

1205F Epi etiol synd rvwd and docd 0.00 70.00 $0.00

12051 Intmd rpr face/mm 2.5 cm/< 7.27 70.00 $508.90

12052 Intmd rpr face/mm 2.6-5.0 cm 8.29 70.00 $580.30

12053 Intmd rpr face/mm 5.1-7.5 cm 9.75 70.00 $682.50

12054 Intmd rpr face/mm 7.6-12.5cm 10.38 70.00 $726.60

12055 Intmd rpr face/mm 12.6-20 cm 13.46 70.00 $942.20

12056 Intmd rpr face/mm 20.1-30.0 14.11 70.00 $987.70

12057 Intmd rpr face/mm >30.0 cm 16.48 70.00 $1,153.60

1220F Pt screened for depression 0.00 70.00 $0.00

13100 Cmplx rpr trunk 1.1-2.5 cm 9.44 70.00 $660.80

13101 Cmplx rpr trunk 2.6-7.5 cm 11.16 70.00 $781.20

13102 Cmplx rpr trunk addl 5cm/< 3.45 70.00 $241.50

13120 Cmplx rpr s/a/l 1.1-2.5 cm 9.87 70.00 $690.90

13121 Cmplx rpr s/a/l 2.6-7.5 cm 12.03 70.00 $842.10

13122 Cmplx rpr s/a/l addl 5 cm/> 3.78 70.00 $264.60

13131 Cmplx rpr f/c/c/m/n/ax/g/h/f 10.87 70.00 $760.90



13151 Cmplx rpr e/n/e/l 1.1-2.5 cm 11.93 70.00 $835.10

13152 Cmplx rpr e/n/e/l 2.6-7.5 cm 14.31 70.00 $1,001.70

13153 Cmplx rpr e/n/e/l addl 5cm/< 5.50 70.00 $385.00

13160 Late closure of wound 23.18 70.00 $1,622.60

1400F Prkns diag rviewed 0.00 70.00 $0.00

14000 Tis trnfr trunk 10 sq cm/< 17.63 70.00 $1,234.10

14001 Tis trnfr trunk 10.1-30sqcm 22.67 70.00 $1,586.90

14020 Tis trnfr s/a/l 10 sq cm/< 19.72 70.00 $1,380.40

14021 Tis trnfr s/a/l 10.1-30 sqcm 24.67 70.00 $1,726.90

14040 Tis trnfr f/c/c/m/n/a/g/h/f 21.57 70.00 $1,509.90

14041 Tis trnfr f/c/c/m/n/a/g/h/f 26.69 70.00 $1,868.30

14060 Tis trnfr e/n/e/l 10 sq cm/< 22.00 70.00 $1,540.00

14061 Tis trnfr e/n/e/l10.1-30sqcm 28.72 70.00 $2,010.40

14301 Tis trnfr any 30.1-60 sq cm 30.57 70.00 $2,139.90

14302 Tis trnfr addl 30 sq cm/< 6.38 70.00 $446.60

14350 Filleted finger/toe flap 19.85 70.00 $1,389.50

1450F Symptoms improved/consist 0.00 70.00 $0.00

1451F Sympt show clin import drop 0.00 70.00 $0.00

1460F Qual card diag prior 12 mons 0.00 70.00 $0.00

1461F No qual card diag prior12mon 0.00 70.00 $0.00

1490F Dem severity classified mild 0.00 70.00 $0.00

1491F Dem severity classified mod 0.00 70.00 $0.00

1493F Dem severity class severe 0.00 70.00 $0.00

1494F Cognit assessed and reviewed 0.00 70.00 $0.00

1500F Symptom+sign symm polyneuro 0.00 70.00 $0.00

15002 Wound prep trk/arm/leg 9.85 70.00 $689.50

15003 Wound prep addl 100 cm 2.16 70.00 $151.20

15004 Wound prep f/n/hf/g 11.42 70.00 $799.40

15005 Wnd prep f/n/hf/g addl cm 3.55 70.00 $248.50

1501F Not initial eval for cond 0.00 70.00 $0.00

1502F Pt queried pain fxn w/ instr 0.00 70.00 $0.00

1503F Pt queried symp resp insuff 0.00 70.00 $0.00

1504F Pt has resp insufficiency 0.00 70.00 $0.00

15040 Harvest cultured skin graft 7.21 70.00 $504.70

1505F Pt has no resp insufficiency 0.00 70.00 $0.00

15050 Skin pinch graft 16.14 70.00 $1,129.80

15100 Skin splt grft trnk/arm/leg 24.44 70.00 $1,710.80

15101 Skin splt grft t/a/l add-on 5.29 70.00 $370.30

15110 Epidrm autogrft trnk/arm/leg 23.26 70.00 $1,628.20

15111 Epidrm autogrft t/a/l add-on 3.32 70.00 $232.40

15115 Epidrm a-grft face/nck/hf/g 23.58 70.00 $1,650.60

15116 Epidrm a-grft f/n/hf/g addl 4.81 70.00 $336.70

15120 Skn splt a-grft fac/nck/hf/g 24.19 70.00 $1,693.30

15121 Skn splt a-grft f/n/hf/g add 5.92 70.00 $414.40

15130 Derm autograft trnk/arm/leg 19.34 70.00 $1,353.80

15131 Derm autograft t/a/l add-on 2.62 70.00 $183.40

15135 Derm autograft face/nck/hf/g 23.97 70.00 $1,677.90

15136 Derm autograft f/n/hf/g add 2.72 70.00 $190.40

15150 Cult skin grft t/arm/leg 19.91 70.00 $1,393.70

15151 Cult skin grft t/a/l addl 3.46 70.00 $242.20

15152 Cult skin graft t/a/l +% 4.27 70.00 $298.90

15155 Cult skin graft f/n/hf/g 19.69 70.00 $1,378.30

15156 Cult skin grft f/n/hfg add 4.67 70.00 $326.90

15157 Cult epiderm grft f/n/hfg +% 4.47 70.00 $312.90

15200 Skin full graft trunk 23.55 70.00 $1,648.50

15201 Skin full graft trunk add-on 4.20 70.00 $294.00

15220 Skin full graft sclp/arm/leg 21.85 70.00 $1,529.50

15221 Skin full graft add-on 3.89 70.00 $272.30

15240 Skin full grft face/genit/hf 26.47 70.00 $1,852.90


15260 Skin full graft een & lips 28.68 70.00 $2,007.60


15271 Skin sub graft trnk/arm/leg 4.00 70.00 $280.00

15272 Skin sub graft t/a/l add-on 0.77 70.00 $53.90

15273 Skin sub grft t/arm/lg child 8.45 70.00 $591.50

15274 Skn sub grft t/a/l child add 2.02 70.00 $141.40

15275 Skin sub graft face/nk/hf/g 4.24 70.00 $296.80

15276 Skin sub graft f/n/hf/g addl 0.97 70.00 $67.90

15277 Skn sub grft f/n/hf/g child 9.20 70.00 $644.00

15278 Skn sub grft f/n/hf/g ch add 2.42 70.00 $169.40

15570 Skin pedicle flap trunk 25.93 70.00 $1,815.10

15572 Skin pedicle flap arms/legs 25.19 70.00 $1,763.30

15574 Pedcle fh/ch/ch/m/n/ax/g/h/f 25.97 70.00 $1,817.90

15576 Pedicle e/n/e/l/ntroral 22.87 70.00 $1,600.90

15600 Delay flap trunk 9.17 70.00 $641.90

15610 Delay flap arms/legs 10.10 70.00 $707.00

15620 Delay flap f/c/c/n/ax/g/h/f 12.45 70.00 $871.50

15630 Delay flap eye/nos/ear/lip 13.04 70.00 $912.80

15650 Transfer skin pedicle flap 14.40 70.00 $1,008.00

15731 Forehead flap w/vasc pedicle 32.16 70.00 $2,251.20

15732 Muscle-skin graft head/neck 36.53 70.00 $2,557.10

15734 Muscle-skin graft trunk 42.84 70.00 $2,998.80

15736 Muscle-skin graft arm 37.56 70.00 $2,629.20

15738 Muscle-skin graft leg 39.96 70.00 $2,797.20

15740 Island pedicle flap graft 28.94 70.00 $2,025.80

15750 Neurovascular pedicle flap 26.46 70.00 $1,852.20

15756 Free myo/skin flap microvasc 66.88 70.00 $4,681.60

15757 Free skin flap microvasc 66.29 70.00 $4,640.30

15758 Free fascial flap microvasc 66.14 70.00 $4,629.80

15760 Composite skin graft 24.24 70.00 $1,696.80

15770 Derma-fat-fascia graft 19.22 70.00 $1,345.40

15775 Hair trnspl 1-15 punch grfts 8.29 70.00 $580.30

15776 Hair trnspl >15 punch grafts 13.56 70.00 $949.20

15777 Acellular derm matrix implt 6.16 70.00 $431.20

15780 Dermabrasion total face 24.12 70.00 $1,688.40

15781 Dermabrasion segmental face 15.68 70.00 $1,097.60

15782 Dermabrasion other than face 18.16 70.00 $1,271.20

15783 Dermabrasion suprfl any site 13.71 70.00 $959.70

15786 Abrasion lesion single 6.86 70.00 $480.20

15787 Abrasion lesions add-on 1.38 70.00 $96.60

15788 Chemical peel face epiderm 13.02 70.00 $911.40

15789 Chemical peel face dermal 15.76 70.00 $1,103.20

15792 Chemical peel nonfacial 12.25 70.00 $857.50

15793 Chemical peel nonfacial 13.93 70.00 $975.10

15819 Plastic surgery neck 22.65 70.00 $1,585.50

15820 Revision of lower eyelid 16.19 70.00 $1,133.30

15821 Revision of lower eyelid 17.15 70.00 $1,200.50

15822 Revision of upper eyelid 12.62 70.00 $883.40

15823 Revision of upper eyelid 17.17 70.00 $1,201.90

15824 Removal of forehead wrinkles 0.00 70.00 $0.00

15825 Removal of neck wrinkles 0.00 70.00 $0.00

15826 Removal of brow wrinkles 0.00 70.00 $0.00

15828 Removal of face wrinkles 0.00 70.00 $0.00

15829 Removal of skin wrinkles 0.00 70.00 $0.00

15830 Exc skin abd 33.64 70.00 $2,354.80

15832 Excise excessive skin thigh 26.17 70.00 $1,831.90

15833 Excise excessive skin leg 24.94 70.00 $1,745.80

15834 Excise excessive skin hip 25.40 70.00 $1,778.00

15835 Excise excessive skin buttck 26.81 70.00 $1,876.70

15836 Excise excessive skin arm 22.57 70.00 $1,579.90

15837 Excise excess skin arm/hand 25.28 70.00 $1,769.60

15838 Excise excess skin fat pad 16.35 70.00 $1,144.50

15839 Excise excess skin & tissue 25.10 70.00 $1,757.00

15840 Nerve palsy fascial graft 28.80 70.00 $2,016.00

15841 Nerve palsy muscle graft 46.01 70.00 $3,220.70

15842 Nerve palsy microsurg graft 70.28 70.00 $4,919.60

15845 Skin and muscle repair face 28.63 70.00 $2,004.10

15847 Exc skin abd add-on 0.00 70.00 $0.00

15850 Remove sutures same surgeon 2.46 70.00 $172.20

15851 Remove sutures diff surgeon 2.80 70.00 $196.00

15852 Dressing change not for burn 1.36 70.00 $95.20

15860 Test for blood flow in graft 3.20 70.00 $224.00

15876 Suction lipectomy head&neck 0.00 70.00 $0.00

15877 Suction lipectomy trunk 0.00 70.00 $0.00

15878 Suction lipectomy upr extrem 0.00 70.00 $0.00

15879 Suction lipectomy lwr extrem 0.00 70.00 $0.00

15920 Removal of tail bone ulcer 17.21 70.00 $1,204.70

15922 Removal of tail bone ulcer 22.34 70.00 $1,563.80

15931 Remove sacrum pressure sore 19.70 70.00 $1,379.00






15940 Remove hip pressure sore 20.04 70.00 $1,402.80





15950 Remove thigh pressure sore 16.91 70.00 $1,183.70






15999 Removal of pressure sore 0.00 70.00 $0.00

16000 Initial treatment of burn(s) 1.95 70.00 $136.50

16020 Dress/debrid p-thick burn s 2.32 70.00 $162.40

16025 Dress/debrid p-thick burn m 4.21 70.00 $294.70

16030 Dress/debrid p-thick burn l 5.19 70.00 $363.30

16035 Incision of burn scab initi 5.59 70.00 $391.30

16036 Escharotomy addl incision 2.34 70.00 $163.80

17000 Destruct premalg lesion 1.87 70.00 $130.90

17003 Destruct premalg les 2-14 0.16 70.00 $11.20

17004 Destroy premal lesions 15/> 4.23 70.00 $296.10

17106 Destruction of skin lesions 9.67 70.00 $676.90


17108 Destruction of skin lesions 18.17 70.00 $1,271.90

17110 Destruct b9 lesion 1-14 3.12 70.00 $218.40

17111 Destruct lesion 15 or more 3.70 70.00 $259.00

17250 Chemical cautery tissue 2.24 70.00 $156.80



















17311 Mohs 1 stage h/n/hf/g 18.63 70.00 $1,304.10

17312 Mohs addl stage 10.95 70.00 $766.50

17313 Mohs 1 stage t/a/l 17.43 70.00 $1,220.10

17314 Mohs addl stage t/a/l 10.50 70.00 $735.00

17315 Mohs surg addl block 2.25 70.00 $157.50

17340 Cryotherapy of skin 1.47 70.00 $102.90

17360 Skin peel therapy 3.63 70.00 $254.10

17380 Hair removal by electrolysis 0.00 70.00 $0.00

17999 Skin tissue procedure 0.00 70.00 $0.00

19000 Drainage of breast lesion 3.21 70.00 $224.70

19001 Drain breast lesion add-on 0.77 70.00 $53.90

19020 Incision of breast lesion 13.41 70.00 $938.70

19030 Injection for breast x-ray 4.71 70.00 $329.70

19081 Bx breast 1st lesion strtctc 18.86 70.00 $1,320.20

19082 Bx breast add lesion strtctc 15.46 70.00 $1,082.20

19083 Bx breast 1st lesion us imag 18.43 70.00 $1,290.10

19084 Bx breast add lesion us imag 14.88 70.00 $1,041.60

19085 Bx breast 1st lesion mr imag 29.12 70.00 $2,038.40

19086 Bx breast add lesion mr imag 23.26 70.00 $1,628.20

19100 Bx breast percut w/o image 4.31 70.00 $301.70

19101 Biopsy of breast open 9.70 70.00 $679.00

19105 Cryosurg ablate fa each 70.83 70.00 $4,958.10

19110 Nipple exploration 13.79 70.00 $965.30

19112 Excise breast duct fistula 13.14 70.00 $919.80

19120 Removal of breast lesion 14.06 70.00 $984.20

19125 Excision breast lesion 15.63 70.00 $1,094.10

19126 Excision addl breast lesion 4.68 70.00 $327.60

19260 Removal of chest wall lesion 34.63 70.00 $2,424.10

19271 Revision of chest wall 46.86 70.00 $3,280.20

19272 Extensive chest wall surgery 51.44 70.00 $3,600.80

19281 Perq device breast 1st imag 6.80 70.00 $476.00

19282 Perq device breast ea imag 4.76 70.00 $333.20

19283 Perq dev breast 1st strtctc 7.75 70.00 $542.50

19284 Perq dev breast add strtctc 5.73 70.00 $401.10

19285 Perq dev breast 1st us imag 12.64 70.00 $884.80

19286 Perq dev breast add us imag 10.74 70.00 $751.80

19287 Perq dev breast 1st mr guide 24.70 70.00 $1,729.00

19288 Perq dev breast add mr guide 19.84 70.00 $1,388.80

19296 Place po breast cath for rad 110.94 70.00 $7,765.80

19297 Place breast cath for rad 2.74 70.00 $191.80

19298 Place breast rad tube/caths 29.67 70.00 $2,076.90

19300 Removal of breast tissue 14.93 70.00 $1,045.10

19301 Partial mastectomy 18.74 70.00 $1,311.80

19302 P-mastectomy w/ln removal 25.86 70.00 $1,810.20

19303 Mast simple complete 29.03 70.00 $2,032.10

19304 Mast subq 16.48 70.00 $1,153.60

19305 Mast radical 32.38 70.00 $2,266.60

19306 Mast rad urban type 34.43 70.00 $2,410.10

19307 Mast mod rad 34.39 70.00 $2,407.30

19316 Suspension of breast 22.08 70.00 $1,545.60

19318 Reduction of large breast 31.59 70.00 $2,211.30

19324 Enlarge breast 14.07 70.00 $984.90

19325 Enlarge breast with implant 18.39 70.00 $1,287.30

19328 Removal of breast implant 14.17 70.00 $991.90

19330 Removal of implant material 18.15 70.00 $1,270.50

19340 Immediate breast prosthesis 28.74 70.00 $2,011.80

19342 Delayed breast prosthesis 26.42 70.00 $1,849.40

19350 Breast reconstruction 23.45 70.00 $1,641.50

19355 Correct inverted nipple(s) 20.06 70.00 $1,404.20


19361 Breast reconstr w/lat flap 45.16 70.00 $3,161.20






19370 Surgery of breast capsule 19.63 70.00 $1,374.10

19371 Removal of breast capsule 22.46 70.00 $1,572.20

19380 Revise breast reconstruction 22.13 70.00 $1,549.10

19396 Design custom breast implant 8.29 70.00 $580.30

19499 Breast surgery procedure 0.00 70.00 $0.00

2000F Blood pressure measure 0.00 70.00 $0.00

20005 I&d abscess subfascial 8.76 70.00 $613.20

2001F Weight record 0.00 70.00 $0.00

2002F Clin sign vol ovrld assess 0.00 70.00 $0.00

2004F Initial exam involved joints 0.00 70.00 $0.00

2010F Vital signs recorded 0.00 70.00 $0.00

20100 Explore wound neck 17.56 70.00 $1,229.20

20101 Explore wound chest 12.87 70.00 $900.90

20102 Explore wound abdomen 13.97 70.00 $977.90

20103 Explore wound extremity 16.57 70.00 $1,159.90

2014F Mental status assess 0.00 70.00 $0.00

2015F Asthma impairment assessed 0.00 70.00 $0.00

20150 Excise epiphyseal bar 26.08 70.00 $1,825.60

2016F Asthma risk assessed 0.00 70.00 $0.00

2018F Hydration status assess 0.00 70.00 $0.00

2019F Dilated macul exam done 0.00 70.00 $0.00

2020F Dilated fundus eval done 0.00 70.00 $0.00

20200 Muscle biopsy 5.91 70.00 $413.70

20205 Deep muscle biopsy 8.24 70.00 $576.80

20206 Needle biopsy muscle 6.71 70.00 $469.70

2021F Dilat maculor exam done 0.00 70.00 $0.00

2022F Dil retina exam interp rev 0.00 70.00 $0.00

20220 Bone biopsy trocar/needle 4.79 70.00 $335.30

20225 Bone biopsy trocar/needle 14.94 70.00 $1,045.80

2024F 7 field photo interp doc rev 0.00 70.00 $0.00

20240 Bone biopsy excisional 6.23 70.00 $436.10

20245 Bone biopsy excisional 17.70 70.00 $1,239.00

20250 Open bone biopsy 11.35 70.00 $794.50

20251 Open bone biopsy 12.14 70.00 $849.80

2026F Eye image valid to dx rev 0.00 70.00 $0.00

2027F Optic nerve head eval done 0.00 70.00 $0.00

2028F Foot exam performed 0.00 70.00 $0.00

2029F Complete phys skin exam done 0.00 70.00 $0.00

2030F H2o stat docd normal 0.00 70.00 $0.00

2031F H2o stat docd dehydrated 0.00 70.00 $0.00

2035F Tymp memb motion examd 0.00 70.00 $0.00

2040F Bk pn xm on init visit date 0.00 70.00 $0.00

2044F Doc mntl tst b/4 bk trxmnt 0.00 70.00 $0.00

2050F Wound char size etc docd 0.00 70.00 $0.00

20500 Injection of sinus tract 2.98 70.00 $208.60

20501 Inject sinus tract for x-ray 3.36 70.00 $235.20

20520 Removal of foreign body 5.79 70.00 $405.30

20525 Removal of foreign body 13.70 70.00 $959.00

20526 Ther injection carp tunnel 2.20 70.00 $154.00

20527 Inj dupuytren cord w/enzyme 2.40 70.00 $168.00

20550 Inj tendon sheath/ligament 1.68 70.00 $117.60

20551 Inj tendon origin/insertion 1.72 70.00 $120.40

20552 Inj trigger point 1/2 muscl 1.56 70.00 $109.20

20553 Inject trigger points 3/> 1.81 70.00 $126.70

20555 Place ndl musc/tis for rt 9.56 70.00 $669.20

2060F Pt talk eval hlthwkr re mdd 0.00 70.00 $0.00

20600 Drain/inj joint/bursa w/o us 1.35 70.00 $94.50

20604 Drain/inj joint/bursa w/us 2.05 70.00 $143.50





20612 Aspirate/inj ganglion cyst 1.73 70.00 $121.10

20615 Treatment of bone cyst 7.03 70.00 $492.10

20650 Insert and remove bone pin 5.87 70.00 $410.90

20660 Apply rem fixation device 7.19 70.00 $503.30

20661 Application of head brace 14.64 70.00 $1,024.80

20662 Application of pelvis brace 13.34 70.00 $933.80

20663 Application of thigh brace 11.30 70.00 $791.00

20664 Application of halo 25.55 70.00 $1,788.50

20665 Removal of fixation device 2.98 70.00 $208.60

20670 Removal of support implant 10.82 70.00 $757.40

20680 Removal of support implant 17.66 70.00 $1,236.20

20690 Apply bone fixation device 17.14 70.00 $1,199.80

20692 Apply bone fixation device 32.19 70.00 $2,253.30

20693 Adjust bone fixation device 12.87 70.00 $900.90

20694 Remove bone fixation device 12.15 70.00 $850.50

20696 Comp multiplane ext fixation 34.86 70.00 $2,440.20

20697 Comp ext fixate strut change 59.98 70.00 $4,198.60

20802 Replantation arm complete 79.80 70.00 $5,586.00

20805 Replant forearm complete 94.60 70.00 $6,622.00

20808 Replantation hand complete 114.53 70.00 $8,017.10

20816 Replantation digit complete 60.50 70.00 $4,235.00

20822 Replantation digit complete 51.72 70.00 $3,620.40

20824 Replantation thumb complete 58.59 70.00 $4,101.30

20827 Replantation thumb complete 53.16 70.00 $3,721.20

20838 Replantation foot complete 62.20 70.00 $4,354.00

20900 Removal of bone for graft 11.98 70.00 $838.60

20902 Removal of bone for graft 8.28 70.00 $579.60

20910 Remove cartilage for graft 13.11 70.00 $917.70

20912 Remove cartilage for graft 13.75 70.00 $962.50

20920 Removal of fascia for graft 11.31 70.00 $791.70

20922 Removal of fascia for graft 17.31 70.00 $1,211.70

20924 Removal of tendon for graft 14.60 70.00 $1,022.00

20926 Removal of tissue for graft 12.35 70.00 $864.50

20930 Sp bone algrft morsel add-on 0.00 70.00 $0.00

20931 Sp bone algrft struct add-on 3.31 70.00 $231.70

20936 Sp bone agrft local add-on 0.00 70.00 $0.00

20937 Sp bone agrft morsel add-on 4.91 70.00 $343.70

20938 Sp bone agrft struct add-on 5.44 70.00 $380.80

20950 Fluid pressure muscle 7.02 70.00 $491.40

20955 Fibula bone graft microvasc 72.71 70.00 $5,089.70

20956 Iliac bone graft microvasc 76.74 70.00 $5,371.80

20957 Mt bone graft microvasc 60.69 70.00 $4,248.30

20962 Other bone graft microvasc 58.38 70.00 $4,086.60

20969 Bone/skin graft microvasc 79.50 70.00 $5,565.00

20970 Bone/skin graft iliac crest 83.02 70.00 $5,811.40

20972 Bone/skin graft metatarsal 66.11 70.00 $4,627.70

20973 Bone/skin graft great toe 72.90 70.00 $5,103.00

20974 Electrical bone stimulation 2.19 70.00 $153.30

20975 Electrical bone stimulation 5.19 70.00 $363.30

20979 Us bone stimulation 1.47 70.00 $102.90

20982 Ablate bone tumor(s) perq 106.17 70.00 $7,431.90

20983 Ablate bone tumor(s) perq 196.22 70.00 $13,735.40

20985 Cptr-asst dir ms px 4.27 70.00 $298.90

20999 Musculoskeletal surgery 0.00 70.00 $0.00

21010 Incision of jaw joint 21.93 70.00 $1,535.10

21011 Exc face les sc <2 cm 9.93 70.00 $695.10

21012 Exc face les sbq 2 cm/> 9.70 70.00 $679.00

21013 Exc face tum deep < 2 cm 14.81 70.00 $1,036.70

21014 Exc face tum deep 2 cm/> 14.94 70.00 $1,045.80

21015 Resect face/scalp tum < 2 cm 20.30 70.00 $1,421.00

21016 Resect face/scalp tum 2 cm/> 29.39 70.00 $2,057.30

21025 Excision of bone lower jaw 25.76 70.00 $1,803.20

21026 Excision of facial bone(s) 17.83 70.00 $1,248.10

21029 Contour of face bone lesion 21.96 70.00 $1,537.20

21030 Excise max/zygoma b9 tumor 14.97 70.00 $1,047.90

21031 Remove exostosis mandible 11.40 70.00 $798.00

21032 Remove exostosis maxilla 11.56 70.00 $809.20

21034 Excise max/zygoma mal tumor 38.09 70.00 $2,666.30

21040 Excise mandible lesion 15.11 70.00 $1,057.70

21044 Removal of jaw bone lesion 25.41 70.00 $1,778.70

21045 Extensive jaw surgery 35.41 70.00 $2,478.70

21046 Remove mandible cyst complex 32.44 70.00 $2,270.80

21047 Excise lwr jaw cyst w/repair 38.26 70.00 $2,678.20

21048 Remove maxilla cyst complex 33.31 70.00 $2,331.70

21049 Excis uppr jaw cyst w/repair 35.00 70.00 $2,450.00

21050 Removal of jaw joint 24.29 70.00 $1,700.30

21060 Remove jaw joint cartilage 23.45 70.00 $1,641.50

21070 Remove coronoid process 17.81 70.00 $1,246.70

21073 Mnpj of tmj w/anesth 11.38 70.00 $796.60

21076 Prepare face/oral prosthesis 29.09 70.00 $2,036.30











21088 Prepare face/oral prosthesis 0.00 70.00 $0.00

21089 Prepare face/oral prosthesis 0.00 70.00 $0.00

21100 Maxillofacial fixation 33.16 70.00 $2,321.20

21110 Interdental fixation 23.35 70.00 $1,634.50

21116 Injection jaw joint x-ray 4.23 70.00 $296.10

21120 Reconstruction of chin 17.24 70.00 $1,206.80




21125 Augmentation lower jaw bone 89.96 70.00 $6,297.20

21127 Augmentation lower jaw bone 124.47 70.00 $8,712.90

21137 Reduction of forehead 19.94 70.00 $1,395.80



21141 Lefort i-1 piece w/o graft 38.98 70.00 $2,728.60

21142 Lefort i-2 piece w/o graft 41.69 70.00 $2,918.30

21143 Lefort i-3/> piece w/o graft 42.06 70.00 $2,944.20

21145 Lefort i-1 piece w/ graft 47.24 70.00 $3,306.80

21146 Lefort i-2 piece w/ graft 49.20 70.00 $3,444.00

21147 Lefort i-3/> piece w/ graft 52.00 70.00 $3,640.00

21150 Lefort ii anterior intrusion 48.48 70.00 $3,393.60

21151 Lefort ii w/bone grafts 59.29 70.00 $4,150.30

21154 Lefort iii w/o lefort i 63.78 70.00 $4,464.60

21155 Lefort iii w/ lefort i 67.82 70.00 $4,747.40

21159 Lefort iii w/fhdw/o lefort i 69.37 70.00 $4,855.90

21160 Lefort iii w/fhd w/ lefort i 75.27 70.00 $5,268.90

21172 Reconstruct orbit/forehead 50.90 70.00 $3,563.00

21175 Reconstruct orbit/forehead 66.81 70.00 $4,676.70

21179 Reconstruct entire forehead 37.67 70.00 $2,636.90

21180 Reconstruct entire forehead 44.10 70.00 $3,087.00

21181 Contour cranial bone lesion 21.25 70.00 $1,487.50

21182 Reconstruct cranial bone 55.19 70.00 $3,863.30



21188 Reconstruction of midface 45.09 70.00 $3,156.30

21193 Reconst lwr jaw w/o graft 34.26 70.00 $2,398.20

21194 Reconst lwr jaw w/graft 43.24 70.00 $3,026.80

21195 Reconst lwr jaw w/o fixation 38.70 70.00 $2,709.00

21196 Reconst lwr jaw w/fixation 42.66 70.00 $2,986.20

21198 Reconstr lwr jaw segment 33.60 70.00 $2,352.00

21199 Reconstr lwr jaw w/advance 28.97 70.00 $2,027.90

21206 Reconstruct upper jaw bone 35.73 70.00 $2,501.10

21208 Augmentation of facial bones 54.87 70.00 $3,840.90

21209 Reduction of facial bones 23.24 70.00 $1,626.80

21210 Face bone graft 66.10 70.00 $4,627.00

21215 Lower jaw bone graft 118.03 70.00 $8,262.10

21230 Rib cartilage graft 21.93 70.00 $1,535.10

21235 Ear cartilage graft 20.79 70.00 $1,455.30

21240 Reconstruction of jaw joint 32.44 70.00 $2,270.80



21244 Reconstruction of lower jaw 30.80 70.00 $2,156.00

21245 Reconstruction of jaw 31.77 70.00 $2,223.90


21247 Reconstruct lower jaw bone 43.97 70.00 $3,077.90



21255 Reconstruct lower jaw bone 37.96 70.00 $2,657.20

21256 Reconstruction of orbit 34.32 70.00 $2,402.40

21260 Revise eye sockets 32.95 70.00 $2,306.50





21270 Augmentation cheek bone 27.61 70.00 $1,932.70

21275 Revision orbitofacial bones 24.04 70.00 $1,682.80

21280 Revision of eyelid 16.24 70.00 $1,136.80

21282 Revision of eyelid 10.84 70.00 $758.80

21295 Revision of jaw muscle/bone 5.41 70.00 $378.70

21296 Revision of jaw muscle/bone 12.06 70.00 $844.20

21299 Cranio/maxillofacial surgery 0.00 70.00 $0.00

21310 Closed tx nose fx w/o manj 3.75 70.00 $262.50

21315 Closed tx nose fx w/o stablj 7.97 70.00 $557.90

21320 Closed tx nose fx w/ stablj 7.34 70.00 $513.80

21325 Open tx nose fx uncomplicatd 13.70 70.00 $959.00

21330 Open tx nose fx w/skele fixj 16.46 70.00 $1,152.20

21335 Open tx nose & septal fx 20.85 70.00 $1,459.50

21336 Open tx septal fx w/wo stabj 18.51 70.00 $1,295.70

21337 Closed tx septal&nose fx 11.63 70.00 $814.10

21338 Open nasoethmoid fx w/o fixj 21.60 70.00 $1,512.00

21339 Open nasoethmoid fx w/ fixj 24.48 70.00 $1,713.60

21340 Perq tx nasoethmoid fx 22.95 70.00 $1,606.50

21343 Open tx dprsd front sinus fx 34.94 70.00 $2,445.80

21344 Open tx compl front sinus fx 40.06 70.00 $2,804.20

21345 Closed tx nose/jaw fx 22.40 70.00 $1,568.00

21346 Opn tx nasomax fx w/fixj 26.00 70.00 $1,820.00

21347 Opn tx nasomax fx multple 32.72 70.00 $2,290.40

21348 Opn tx nasomax fx w/graft 34.73 70.00 $2,431.10

21355 Perq tx malar fracture 13.87 70.00 $970.90

21356 Opn tx dprsd zygomatic arch 14.41 70.00 $1,008.70

21360 Opn tx dprsd malar fracture 15.47 70.00 $1,082.90

21365 Opn tx complx malar fx 32.02 70.00 $2,241.40

21366 Opn tx complx malar w/grft 33.39 70.00 $2,337.30

21385 Opn tx orbit fx transantral 19.61 70.00 $1,372.70

21386 Opn tx orbit fx periorbital 20.00 70.00 $1,400.00

21387 Opn tx orbit fx combined 20.47 70.00 $1,432.90

21390 Opn tx orbit periorbtl implt 22.77 70.00 $1,593.90

21395 Opn tx orbit periorbt w/grft 28.98 70.00 $2,028.60

21400 Closed tx orbit w/o manipulj 5.55 70.00 $388.50

21401 Closed tx orbit w/manipulj 14.11 70.00 $987.70

21406 Opn tx orbit fx w/o implant 16.44 70.00 $1,150.80

21407 Opn tx orbit fx w/implant 18.51 70.00 $1,295.70

21408 Opn tx orbit fx w/bone grft 25.84 70.00 $1,808.80

21421 Treat mouth roof fracture 24.22 70.00 $1,695.40



21431 Treat craniofacial fracture 22.68 70.00 $1,587.60





21440 Treat dental ridge fracture 16.66 70.00 $1,166.20

21445 Treat dental ridge fracture 22.34 70.00 $1,563.80

21450 Treat lower jaw fracture 18.03 70.00 $1,262.10









21480 Reset dislocated jaw 2.82 70.00 $197.40

21485 Reset dislocated jaw 20.36 70.00 $1,425.20

21490 Repair dislocated jaw 26.61 70.00 $1,862.70

21495 Treat hyoid bone fracture 18.37 70.00 $1,285.90

21497 Interdental wiring 21.27 70.00 $1,488.90

21499 Head surgery procedure 0.00 70.00 $0.00

21501 Drain neck/chest lesion 12.95 70.00 $906.50

21502 Drain chest lesion 14.65 70.00 $1,025.50

21510 Drainage of bone lesion 12.69 70.00 $888.30

21550 Biopsy of neck/chest 7.49 70.00 $524.30

21552 Exc neck les sc 3 cm/> 12.85 70.00 $899.50

21554 Exc neck tum deep 5 cm/> 21.08 70.00 $1,475.60

21555 Exc neck les sc < 3 cm 11.88 70.00 $831.60

21556 Exc neck tum deep < 5 cm 15.25 70.00 $1,067.50

21557 Resect neck thorax tumor<5cm 27.62 70.00 $1,933.40

21558 Resect neck tumor 5 cm/> 38.77 70.00 $2,713.90

21600 Partial removal of rib 16.06 70.00 $1,124.20

21610 Partial removal of rib 35.47 70.00 $2,482.90

21615 Removal of rib 18.06 70.00 $1,264.20

21616 Removal of rib and nerves 21.14 70.00 $1,479.80

21620 Partial removal of sternum 14.55 70.00 $1,018.50

21627 Sternal debridement 15.64 70.00 $1,094.80

21630 Extensive sternum surgery 34.66 70.00 $2,426.20

21632 Extensive sternum surgery 34.80 70.00 $2,436.00

21685 Hyoid myotomy & suspension 28.65 70.00 $2,005.50

21700 Revision of neck muscle 10.63 70.00 $744.10

21705 Revision of neck muscle/rib 15.85 70.00 $1,109.50

21720 Revision of neck muscle 13.83 70.00 $968.10

21725 Revision of neck muscle 15.57 70.00 $1,089.90

21740 Reconstruction of sternum 29.85 70.00 $2,089.50

21742 Repair stern/nuss w/o scope 0.00 70.00 $0.00

21743 Repair sternum/nuss w/scope 0.00 70.00 $0.00

21750 Repair of sternum separation 19.79 70.00 $1,385.30

21805 Treatment of rib fracture 7.81 70.00 $546.70

21811 Optx of rib fx w/fixj scope 17.49 70.00 $1,224.30

21812 Treatment of rib fracture 20.97 70.00 $1,467.90

21813 Treatment of rib fracture 28.54 70.00 $1,997.80

21820 Treat sternum fracture 4.07 70.00 $284.90

21825 Treat sternum fracture 15.60 70.00 $1,092.00

21899 Neck/chest surgery procedure 0.00 70.00 $0.00

21920 Biopsy soft tissue of back 7.30 70.00 $511.00

21925 Biopsy soft tissue of back 12.79 70.00 $895.30

21930 Exc back les sc < 3 cm 13.50 70.00 $945.00

21931 Exc back les sc 3 cm/> 13.52 70.00 $946.40

21932 Exc back tum deep < 5 cm 19.04 70.00 $1,332.80

21933 Exc back tum deep 5 cm/> 21.29 70.00 $1,490.30

21935 Resect back tum < 5 cm 29.54 70.00 $2,067.80

21936 Resect back tum 5 cm/> 40.72 70.00 $2,850.40

22010 I&d p-spine c/t/cerv-thor 27.59 70.00 $1,931.30

22015 I&d abscess p-spine l/s/ls 26.20 70.00 $1,834.00

22100 Remove part of neck vertebra 27.20 70.00 $1,904.00

22101 Remove part thorax vertebra 23.79 70.00 $1,665.30

22102 Remove part lumbar vertebra 23.04 70.00 $1,612.80

22103 Remove extra spine segment 4.10 70.00 $287.00

22110 Remove part of neck vertebra 30.42 70.00 $2,129.40

22112 Remove part thorax vertebra 33.02 70.00 $2,311.40

22114 Remove part lumbar vertebra 28.75 70.00 $2,012.50

22116 Remove extra spine segment 4.14 70.00 $289.80

22206 Incis spine 3 column thorac 71.30 70.00 $4,991.00

22207 Incis spine 3 column lumbar 69.78 70.00 $4,884.60

22208 Incis spine 3 column adl seg 16.75 70.00 $1,172.50

22210 Incis 1 vertebral seg cerv 52.17 70.00 $3,651.90

22212 Incis 1 vertebral seg thorac 43.20 70.00 $3,024.00

22214 Incis 1 vertebral seg lumbar 43.15 70.00 $3,020.50

22216 Incis addl spine segment 10.65 70.00 $745.50

22220 Incis w/discectomy cervical 46.43 70.00 $3,250.10

22222 Incis w/discectomy thoracic 45.26 70.00 $3,168.20

22224 Incis w/discectomy lumbar 45.89 70.00 $3,212.30

22226 Revise extra spine segment 10.59 70.00 $741.30

22305 Closed tx spine process fx 5.47 70.00 $382.90

22310 Closed tx vert fx w/o manj 8.82 70.00 $617.40

22315 Closed tx vert fx w/manj 25.56 70.00 $1,789.20

22318 Treat odontoid fx w/o graft 48.08 70.00 $3,365.60

22319 Treat odontoid fx w/graft 54.13 70.00 $3,789.10

22325 Treat spine fracture 41.71 70.00 $2,919.70

22326 Treat neck spine fracture 43.74 70.00 $3,061.80

22327 Treat thorax spine fracture 43.88 70.00 $3,071.60

22328 Treat each add spine fx 8.33 70.00 $583.10

22505 Manipulation of spine 3.83 70.00 $268.10

22510 Perq cervicothoracic inject 50.11 70.00 $3,507.70

22511 Perq lumbosacral injection 49.65 70.00 $3,475.50

22512 Vertebroplasty addl inject 27.87 70.00 $1,950.90

22513 Perq vertebral augmentation 208.61 70.00 $14,602.70



22526 Idet single level 67.37 70.00 $4,715.90

22527 Idet 1 or more levels 56.07 70.00 $3,924.90

22532 Lat thorax spine fusion 51.88 70.00 $3,631.60

22533 Lat lumbar spine fusion 47.94 70.00 $3,355.80

22534 Lat thor/lumb addl seg 10.55 70.00 $738.50

22548 Neck spine fusion 58.16 70.00 $4,071.20

22551 Neck spine fuse&remov bel c2 50.22 70.00 $3,515.40

22552 Addl neck spine fusion 11.77 70.00 $823.90


22556 Thorax spine fusion 48.86 70.00 $3,420.20

22558 Lumbar spine fusion 44.86 70.00 $3,140.20

22585 Additional spinal fusion 9.67 70.00 $676.90

22586 Prescrl fuse w/ instr l5-s1 59.10 70.00 $4,137.00

22590 Spine & skull spinal fusion 46.26 70.00 $3,238.20

22595 Neck spinal fusion 44.23 70.00 $3,096.10


22610 Thorax spine fusion 36.88 70.00 $2,581.60


22614 Spine fusion extra segment 11.54 70.00 $807.80


22632 Spine fusion extra segment 9.46 70.00 $662.20

22633 Lumbar spine fusion combined 54.19 70.00 $3,793.30

22634 Spine fusion extra segment 14.60 70.00 $1,022.00

22800 Post fusion </6 vert seg 39.35 70.00 $2,754.50

22802 Post fusion 7-12 vert seg 61.10 70.00 $4,277.00

22804 Post fusion 13/> vert seg 70.83 70.00 $4,958.10

22808 Ant fusion 2-3 vert seg 53.89 70.00 $3,772.30

22810 Ant fusion 4-7 vert seg 58.91 70.00 $4,123.70

22812 Ant fusion 8/> vert seg 64.19 70.00 $4,493.30

22818 Kyphectomy 1-2 segments 63.07 70.00 $4,414.90

22819 Kyphectomy 3 or more 81.52 70.00 $5,706.40

22830 Exploration of spinal fusion 23.65 70.00 $1,655.50

22840 Insert spine fixation device 22.37 70.00 $1,565.90

22841 Insert spine fixation device 0.00 70.00 $0.00







22848 Insert pelv fixation device 10.56 70.00 $739.20

22849 Reinsert spinal fixation 37.99 70.00 $2,659.30

22850 Remove spine fixation device 21.07 70.00 $1,474.90

22851 Apply spine prosth device 11.98 70.00 $838.60



22856 Cerv artific diskectomy 46.46 70.00 $3,252.20

22857 Lumbar artif diskectomy 51.55 70.00 $3,608.50

22858 Second level cer diskectomy 14.52 70.00 $1,016.40

22861 Revise cerv artific disc 55.93 70.00 $3,915.10

22862 Revise lumbar artif disc 50.71 70.00 $3,549.70

22864 Remove cerv artif disc 61.60 70.00 $4,312.00

22865 Remove lumb artif disc 59.49 70.00 $4,164.30

22899 Spine surgery procedure 0.00 70.00 $0.00

22900 Exc abdl tum deep < 5 cm 16.23 70.00 $1,136.10

22901 Exc abdl tum deep 5 cm/> 19.15 70.00 $1,340.50

22902 Exc abd les sc < 3 cm 12.54 70.00 $877.80

22903 Exc abd les sc 3 cm/> 12.64 70.00 $884.80

22904 Radical resect abd tumor<5cm 30.34 70.00 $2,123.80

22905 Rad resect abd tumor 5 cm/> 38.31 70.00 $2,681.70

22999 Abdomen surgery procedure 0.00 70.00 $0.00

23000 Removal of calcium deposits 16.80 70.00 $1,176.00

23020 Release shoulder joint 19.83 70.00 $1,388.10

23030 Drain shoulder lesion 12.62 70.00 $883.40

23031 Drain shoulder bursa 12.21 70.00 $854.70

23035 Drain shoulder bone lesion 19.59 70.00 $1,371.30

23040 Exploratory shoulder surgery 20.70 70.00 $1,449.00

23044 Exploratory shoulder surgery 16.46 70.00 $1,152.20

23065 Biopsy shoulder tissues 6.16 70.00 $431.20

23066 Biopsy shoulder tissues 15.91 70.00 $1,113.70

23071 Exc shoulder les sc 3 cm/> 12.05 70.00 $843.50

23073 Exc shoulder tum deep 5 cm/> 19.96 70.00 $1,397.20

23075 Exc shoulder les sc < 3 cm 13.38 70.00 $936.60

23076 Exc shoulder tum deep < 5 cm 15.50 70.00 $1,085.00

23077 Resect shoulder tumor < 5 cm 32.85 70.00 $2,299.50

23078 Resect shoulder tumor 5 cm/> 41.22 70.00 $2,885.40

23100 Biopsy of shoulder joint 14.39 70.00 $1,007.30

23101 Shoulder joint surgery 12.91 70.00 $903.70

23105 Remove shoulder joint lining 18.32 70.00 $1,282.40

23106 Incision of collarbone joint 14.28 70.00 $999.60

23107 Explore treat shoulder joint 18.97 70.00 $1,327.90

23120 Partial removal collar bone 16.80 70.00 $1,176.00

23125 Removal of collar bone 20.44 70.00 $1,430.80

23130 Remove shoulder bone part 17.55 70.00 $1,228.50

23140 Removal of bone lesion 15.18 70.00 $1,062.60



23150 Removal of humerus lesion 19.07 70.00 $1,334.90



23170 Remove collar bone lesion 16.13 70.00 $1,129.10

23172 Remove shoulder blade lesion 16.29 70.00 $1,140.30

23174 Remove humerus lesion 21.84 70.00 $1,528.80

23180 Remove collar bone lesion 19.22 70.00 $1,345.40

23182 Remove shoulder blade lesion 18.97 70.00 $1,327.90


23190 Partial removal of scapula 16.45 70.00 $1,151.50

23195 Removal of head of humerus 21.78 70.00 $1,524.60

23200 Resect clavicle tumor 43.87 70.00 $3,070.90

23210 Resect scapula tumor 51.57 70.00 $3,609.90

23220 Resect prox humerus tumor 56.53 70.00 $3,957.10

23330 Remove shoulder foreign body 6.88 70.00 $481.60

23333 Remove shoulder fb deep 13.08 70.00 $915.60

23334 Shoulder prosthesis removal 30.88 70.00 $2,161.60

23335 Shoulder prosthesis removal 36.78 70.00 $2,574.60

23350 Injection for shoulder x-ray 3.73 70.00 $261.10

23395 Muscle transfer shoulder/arm 37.00 70.00 $2,590.00

23397 Muscle transfers 32.98 70.00 $2,308.60

23400 Fixation of shoulder blade 28.01 70.00 $1,960.70

23405 Incision of tendon & muscle 17.97 70.00 $1,257.90

23406 Incise tendon(s) & muscle(s) 22.18 70.00 $1,552.60

23410 Repair rotator cuff acute 23.67 70.00 $1,656.90

23412 Repair rotator cuff chronic 24.53 70.00 $1,717.10

23415 Release of shoulder ligament 20.09 70.00 $1,406.30

23420 Repair of shoulder 27.89 70.00 $1,952.30

23430 Repair biceps tendon 21.49 70.00 $1,504.30

23440 Remove/transplant tendon 21.76 70.00 $1,523.20

23450 Repair shoulder capsule 27.38 70.00 $1,916.60






23470 Reconstruct shoulder joint 34.70 70.00 $2,429.00

23472 Reconstruct shoulder joint 42.05 70.00 $2,943.50

23473 Revis reconst shoulder joint 46.97 70.00 $3,287.90

23474 Revis reconst shoulder joint 50.80 70.00 $3,556.00

23480 Revision of collar bone 23.68 70.00 $1,657.60

23485 Revision of collar bone 27.49 70.00 $1,924.30

23490 Reinforce clavicle 24.87 70.00 $1,740.90

23491 Reinforce shoulder bones 29.21 70.00 $2,044.70

23500 Treat clavicle fracture 6.20 70.00 $434.00

23505 Treat clavicle fracture 10.07 70.00 $704.90

23515 Treat clavicle fracture 20.71 70.00 $1,449.70

23520 Treat clavicle dislocation 6.61 70.00 $462.70


23530 Treat clavicle dislocation 16.49 70.00 $1,154.30






23570 Treat shoulder blade fx 6.61 70.00 $462.70

23575 Treat shoulder blade fx 11.47 70.00 $802.90

23585 Treat scapula fracture 28.23 70.00 $1,976.10

23600 Treat humerus fracture 9.28 70.00 $649.60


23615 Treat humerus fracture 25.46 70.00 $1,782.20





23650 Treat shoulder dislocation 8.92 70.00 $624.40

23655 Treat shoulder dislocation 11.49 70.00 $804.30

23660 Treat shoulder dislocation 16.66 70.00 $1,166.20

23665 Treat dislocation/fracture 12.12 70.00 $848.40

23670 Treat dislocation/fracture 25.28 70.00 $1,769.60



23700 Fixation of shoulder 5.66 70.00 $396.20

23800 Fusion of shoulder joint 29.61 70.00 $2,072.70

23802 Fusion of shoulder joint 37.11 70.00 $2,597.70

23900 Amputation of arm & girdle 40.15 70.00 $2,810.50

23920 Amputation at shoulder joint 32.56 70.00 $2,279.20

23921 Amputation follow-up surgery 13.19 70.00 $923.30

23929 Shoulder surgery procedure 0.00 70.00 $0.00

23930 Drainage of arm lesion 10.02 70.00 $701.40

23931 Drainage of arm bursa 8.17 70.00 $571.90

23935 Drain arm/elbow bone lesion 14.52 70.00 $1,016.40

24000 Exploratory elbow surgery 13.71 70.00 $959.70

24006 Release elbow joint 20.45 70.00 $1,431.50

24065 Biopsy arm/elbow soft tissue 7.28 70.00 $509.60

24066 Biopsy arm/elbow soft tissue 17.87 70.00 $1,250.90

24071 Exc arm/elbow les sc 3 cm/> 11.65 70.00 $815.50

24073 Ex arm/elbow tum deep 5 cm/> 19.99 70.00 $1,399.30

24075 Exc arm/elbow les sc < 3 cm 13.99 70.00 $979.30

24076 Ex arm/elbow tum deep < 5 cm 15.56 70.00 $1,089.20

24077 Resect arm/elbow tum < 5 cm 29.76 70.00 $2,083.20

24079 Resect arm/elbow tum 5 cm/> 38.21 70.00 $2,674.70

24100 Biopsy elbow joint lining 12.00 70.00 $840.00

24101 Explore/treat elbow joint 14.35 70.00 $1,004.50

24102 Remove elbow joint lining 17.66 70.00 $1,236.20

24105 Removal of elbow bursa 10.04 70.00 $702.80


24115 Remove/graft bone lesion 21.26 70.00 $1,488.20


24120 Remove elbow lesion 15.13 70.00 $1,059.10



24130 Removal of head of radius 14.55 70.00 $1,018.50

24134 Removal of arm bone lesion 21.55 70.00 $1,508.50

24136 Remove radius bone lesion 16.65 70.00 $1,165.50

24138 Remove elbow bone lesion 19.43 70.00 $1,360.10

24140 Partial removal of arm bone 20.24 70.00 $1,416.80

24145 Partial removal of radius 17.04 70.00 $1,192.80

24147 Partial removal of elbow 17.91 70.00 $1,253.70

24149 Radical resection of elbow 33.74 70.00 $2,361.80

24150 Resect distal humerus tumor 45.04 70.00 $3,152.80

24152 Resect radius tumor 39.10 70.00 $2,737.00

24155 Removal of elbow joint 24.61 70.00 $1,722.70

24160 Remove elbow joint implant 36.31 70.00 $2,541.70

24164 Remove radius head implant 20.94 70.00 $1,465.80

24200 Removal of arm foreign body 5.91 70.00 $413.70

24201 Removal of arm foreign body 15.95 70.00 $1,116.50

24220 Injection for elbow x-ray 4.57 70.00 $319.90

24300 Manipulate elbow w/anesth 11.95 70.00 $836.50

24301 Muscle/tendon transfer 21.42 70.00 $1,499.40

24305 Arm tendon lengthening 16.49 70.00 $1,154.30

24310 Revision of arm tendon 13.55 70.00 $948.50

24320 Repair of arm tendon 22.52 70.00 $1,576.40

24330 Revision of arm muscles 20.69 70.00 $1,448.30

24331 Revision of arm muscles 22.67 70.00 $1,586.90

24332 Tenolysis triceps 17.63 70.00 $1,234.10

24340 Repair of biceps tendon 17.58 70.00 $1,230.60

24341 Repair arm tendon/muscle 21.43 70.00 $1,500.10

24342 Repair of ruptured tendon 22.31 70.00 $1,561.70

24343 Repr elbow lat ligmnt w/tiss 20.28 70.00 $1,419.60

24344 Reconstruct elbow lat ligmnt 31.69 70.00 $2,218.30

24345 Repr elbw med ligmnt w/tissu 20.39 70.00 $1,427.30

24346 Reconstruct elbow med ligmnt 31.69 70.00 $2,218.30

24357 Repair elbow perc 12.38 70.00 $866.60

24358 Repair elbow w/deb open 14.99 70.00 $1,049.30

24359 Repair elbow deb/attch open 18.90 70.00 $1,323.00

24360 Reconstruct elbow joint 25.95 70.00 $1,816.50



24363 Replace elbow joint 41.98 70.00 $2,938.60

24365 Reconstruct head of radius 18.41 70.00 $1,288.70

24366 Reconstruct head of radius 19.57 70.00 $1,369.90

24370 Revise reconst elbow joint 44.78 70.00 $3,134.60

24371 Revise reconst elbow joint 51.89 70.00 $3,632.30

24400 Revision of humerus 23.55 70.00 $1,648.50



24430 Repair of humerus 30.45 70.00 $2,131.50

24435 Repair humerus with graft 31.03 70.00 $2,172.10

24470 Revision of elbow joint 19.33 70.00 $1,353.10

24495 Decompression of forearm 15.45 70.00 $1,081.50

24498 Reinforce humerus 25.03 70.00 $1,752.10


















24586 Treat elbow fracture 31.22 70.00 $2,185.40


24600 Treat elbow dislocation 10.37 70.00 $725.90


24615 Treat elbow dislocation 20.41 70.00 $1,428.70




24650 Treat radius fracture 7.43 70.00 $520.10

24655 Treat radius fracture 12.39 70.00 $867.30

24665 Treat radius fracture 18.72 70.00 $1,310.40

24666 Treat radius fracture 21.08 70.00 $1,475.60

24670 Treat ulnar fracture 8.29 70.00 $580.30

24675 Treat ulnar fracture 13.01 70.00 $910.70

24685 Treat ulnar fracture 18.79 70.00 $1,315.30

24800 Fusion of elbow joint 23.90 70.00 $1,673.00

24802 Fusion/graft of elbow joint 28.89 70.00 $2,022.30

24900 Amputation of upper arm 20.83 70.00 $1,458.10

24920 Amputation of upper arm 21.12 70.00 $1,478.40

24925 Amputation follow-up surgery 14.67 70.00 $1,026.90


24931 Amputate upper arm & implant 22.12 70.00 $1,548.40

24935 Revision of amputation 26.07 70.00 $1,824.90

24940 Revision of upper arm 0.00 70.00 $0.00

24999 Upper arm/elbow surgery 0.00 70.00 $0.00

25000 Incision of tendon sheath 9.61 70.00 $672.70

25001 Incise flexor carpi radialis 9.83 70.00 $688.10

25020 Decompress forearm 1 space 16.40 70.00 $1,148.00

25023 Decompress forearm 1 space 31.57 70.00 $2,209.90

25024 Decompress forearm 2 spaces 22.35 70.00 $1,564.50

25025 Decompress forearm 2 spaces 35.43 70.00 $2,480.10

25028 Drainage of forearm lesion 14.98 70.00 $1,048.60

25031 Drainage of forearm bursa 10.45 70.00 $731.50

25035 Treat forearm bone lesion 16.70 70.00 $1,169.00

25040 Explore/treat wrist joint 16.12 70.00 $1,128.40

25065 Biopsy forearm soft tissues 7.24 70.00 $506.80

25066 Biopsy forearm soft tissues 10.30 70.00 $721.00

25071 Exc forearm les sc 3 cm/> 12.21 70.00 $854.70

25073 Exc forearm tum deep 3 cm/> 15.28 70.00 $1,069.60

25075 Exc forearm les sc < 3 cm 13.61 70.00 $952.70

25076 Exc forearm tum deep < 3 cm 14.80 70.00 $1,036.00

25077 Resect forearm/wrist tum<3cm 25.47 70.00 $1,782.90

25078 Resect forarm/wrist tum 3cm> 33.52 70.00 $2,346.40

25085 Incision of wrist capsule 12.95 70.00 $906.50

25100 Biopsy of wrist joint 9.92 70.00 $694.40

25101 Explore/treat wrist joint 11.55 70.00 $808.50

25105 Remove wrist joint lining 13.76 70.00 $963.20

25107 Remove wrist joint cartilage 17.68 70.00 $1,237.60

25109 Excise tendon forearm/wrist 15.38 70.00 $1,076.60

25110 Remove wrist tendon lesion 9.75 70.00 $682.50

25111 Remove wrist tendon lesion 9.15 70.00 $640.50

25112 Reremove wrist tendon lesion 11.01 70.00 $770.70

25115 Remove wrist/forearm lesion 21.72 70.00 $1,520.40

25116 Remove wrist/forearm lesion 17.14 70.00 $1,199.80

25118 Excise wrist tendon sheath 10.88 70.00 $761.60

25119 Partial removal of ulna 14.30 70.00 $1,001.00

25120 Removal of forearm lesion 14.23 70.00 $996.10

25125 Remove/graft forearm lesion 17.21 70.00 $1,204.70

25126 Remove/graft forearm lesion 17.18 70.00 $1,202.60

25130 Removal of wrist lesion 12.74 70.00 $891.80

25135 Remove & graft wrist lesion 16.05 70.00 $1,123.50

25136 Remove & graft wrist lesion 14.17 70.00 $991.90

25145 Remove forearm bone lesion 14.85 70.00 $1,039.50

25150 Partial removal of ulna 16.31 70.00 $1,141.70

25151 Partial removal of radius 16.88 70.00 $1,181.60

25170 Resect radius/ulnar tumor 42.78 70.00 $2,994.60

25210 Removal of wrist bone 13.92 70.00 $974.40

25215 Removal of wrist bones 17.69 70.00 $1,238.30

25230 Partial removal of radius 12.38 70.00 $866.60

25240 Partial removal of ulna 12.21 70.00 $854.70

25246 Injection for wrist x-ray 4.62 70.00 $323.40

25248 Remove forearm foreign body 11.87 70.00 $830.90

25250 Removal of wrist prosthesis 15.24 70.00 $1,066.80

25251 Removal of wrist prosthesis 20.32 70.00 $1,422.40

25259 Manipulate wrist w/anesthes 11.90 70.00 $833.00

25260 Repair forearm tendon/muscle 18.05 70.00 $1,263.50



25270 Repair forearm tendon/muscle 14.00 70.00 $980.00



25275 Repair forearm tendon sheath 19.21 70.00 $1,344.70

25280 Revise wrist/forearm tendon 16.09 70.00 $1,126.30

25290 Incise wrist/forearm tendon 12.47 70.00 $872.90

25295 Release wrist/forearm tendon 14.95 70.00 $1,046.50

25300 Fusion of tendons at wrist 19.71 70.00 $1,379.70

25301 Fusion of tendons at wrist 18.42 70.00 $1,289.40

25310 Transplant forearm tendon 17.73 70.00 $1,241.10

25312 Transplant forearm tendon 20.59 70.00 $1,441.30

25315 Revise palsy hand tendon(s) 22.23 70.00 $1,556.10

25316 Revise palsy hand tendon(s) 26.33 70.00 $1,843.10

25320 Repair/revise wrist joint 28.27 70.00 $1,978.90

25332 Revise wrist joint 24.08 70.00 $1,685.60

25335 Realignment of hand 27.18 70.00 $1,902.60

25337 Reconstruct ulna/radioulnar 25.45 70.00 $1,781.50

25350 Revision of radius 19.32 70.00 $1,352.40

25355 Revision of radius 22.08 70.00 $1,545.60

25360 Revision of ulna 18.77 70.00 $1,313.90

25365 Revise radius & ulna 26.36 70.00 $1,845.20

25370 Revise radius or ulna 29.00 70.00 $2,030.00

25375 Revise radius & ulna 27.46 70.00 $1,922.20

25390 Shorten radius or ulna 22.06 70.00 $1,544.20

25391 Lengthen radius or ulna 28.72 70.00 $2,010.40

25392 Shorten radius & ulna 28.95 70.00 $2,026.50

25393 Lengthen radius & ulna 32.34 70.00 $2,263.80

25394 Repair carpal bone shorten 22.90 70.00 $1,603.00

25400 Repair radius or ulna 23.05 70.00 $1,613.50

25405 Repair/graft radius or ulna 29.73 70.00 $2,081.10

25415 Repair radius & ulna 27.90 70.00 $1,953.00

25420 Repair/graft radius & ulna 33.72 70.00 $2,360.40

25425 Repair/graft radius or ulna 27.75 70.00 $1,942.50

25426 Repair/graft radius & ulna 32.44 70.00 $2,270.80

25430 Vasc graft into carpal bone 21.07 70.00 $1,474.90

25431 Repair nonunion carpal bone 22.44 70.00 $1,570.80

25440 Repair/graft wrist bone 22.03 70.00 $1,542.10

25441 Reconstruct wrist joint 26.70 70.00 $1,869.00





25446 Wrist replacement 33.60 70.00 $2,352.00

25447 Repair wrist joints 23.71 70.00 $1,659.70

25449 Remove wrist joint implant 29.56 70.00 $2,069.20

25450 Revision of wrist joint 14.29 70.00 $1,000.30

25455 Revision of wrist joint 16.93 70.00 $1,185.10

25490 Reinforce radius 19.09 70.00 $1,336.30

25491 Reinforce ulna 21.32 70.00 $1,492.40

25492 Reinforce radius and ulna 26.05 70.00 $1,823.50

25500 Treat fracture of radius 7.75 70.00 $542.50

25505 Treat fracture of radius 14.32 70.00 $1,002.40





25530 Treat fracture of ulna 7.46 70.00 $522.20

25535 Treat fracture of ulna 13.99 70.00 $979.30

25545 Treat fracture of ulna 17.89 70.00 $1,252.30

25560 Treat fracture radius & ulna 7.89 70.00 $552.30

25565 Treat fracture radius & ulna 14.83 70.00 $1,038.10

25574 Treat fracture radius & ulna 19.37 70.00 $1,355.90

25575 Treat fracture radius/ulna 25.88 70.00 $1,811.60

25600 Treat fracture radius/ulna 9.33 70.00 $653.10

25605 Treat fracture radius/ulna 15.58 70.00 $1,090.60

25606 Treat fx distal radial 19.05 70.00 $1,333.50

25607 Treat fx rad extra-articul 21.08 70.00 $1,475.60

25608 Treat fx rad intra-articul 23.66 70.00 $1,656.20

25609 Treat fx radial 3+ frag 30.07 70.00 $2,104.90

25622 Treat wrist bone fracture 8.63 70.00 $604.10


25628 Treat wrist bone fracture 20.66 70.00 $1,446.20



25645 Treat wrist bone fracture 16.39 70.00 $1,147.30


25651 Pin ulnar styloid fracture 13.85 70.00 $969.50

25652 Treat fracture ulnar styloid 17.90 70.00 $1,253.00

25660 Treat wrist dislocation 11.69 70.00 $818.30

25670 Treat wrist dislocation 17.34 70.00 $1,213.80

25671 Pin radioulnar dislocation 15.22 70.00 $1,065.40



25680 Treat wrist fracture 13.37 70.00 $935.90

25685 Treat wrist fracture 21.21 70.00 $1,484.70



25800 Fusion of wrist joint 20.98 70.00 $1,468.60

25805 Fusion/graft of wrist joint 24.34 70.00 $1,703.80

25810 Fusion/graft of wrist joint 24.86 70.00 $1,740.20

25820 Fusion of hand bones 17.60 70.00 $1,232.00

25825 Fuse hand bones with graft 21.66 70.00 $1,516.20

25830 Fusion radioulnar jnt/ulna 27.35 70.00 $1,914.50

25900 Amputation of forearm 20.25 70.00 $1,417.50





25920 Amputate hand at wrist 20.05 70.00 $1,403.50

25922 Amputate hand at wrist 17.58 70.00 $1,230.60


25927 Amputation of hand 23.28 70.00 $1,629.60



25999 Forearm or wrist surgery 0.00 70.00 $0.00

26010 Drainage of finger abscess 7.49 70.00 $524.30

26011 Drainage of finger abscess 11.07 70.00 $774.90

26020 Drain hand tendon sheath 12.40 70.00 $868.00

26025 Drainage of palm bursa 12.09 70.00 $846.30

26030 Drainage of palm bursas 14.07 70.00 $984.90

26034 Treat hand bone lesion 15.42 70.00 $1,079.40

26035 Decompress fingers/hand 24.68 70.00 $1,727.60

26037 Decompress fingers/hand 16.17 70.00 $1,131.90

26040 Release palm contracture 8.88 70.00 $621.60


26055 Incise finger tendon sheath 15.86 70.00 $1,110.20

26060 Incision of finger tendon 7.49 70.00 $524.30

26070 Explore/treat hand joint 9.03 70.00 $632.10

26075 Explore/treat finger joint 9.53 70.00 $667.10

26080 Explore/treat finger joint 11.13 70.00 $779.10

26100 Biopsy hand joint lining 9.61 70.00 $672.70

26105 Biopsy finger joint lining 9.67 70.00 $676.90

26110 Biopsy finger joint lining 9.17 70.00 $641.90

26111 Exc hand les sc 1.5 cm/> 11.98 70.00 $838.60

26113 Exc hand tum deep 1.5 cm/> 15.68 70.00 $1,097.60

26115 Exc hand les sc < 1.5 cm 14.35 70.00 $1,004.50

26116 Exc hand tum deep < 1.5 cm 15.08 70.00 $1,055.60

26117 Rad resect hand tumor < 3 cm 21.37 70.00 $1,495.90

26118 Rad resect hand tumor 3 cm/> 30.35 70.00 $2,124.50

26121 Release palm contracture 17.10 70.00 $1,197.00

26123 Release palm contracture 23.86 70.00 $1,670.20


26130 Remove wrist joint lining 13.28 70.00 $929.60

26135 Revise finger joint each 15.69 70.00 $1,098.30

26140 Revise finger joint each 14.40 70.00 $1,008.00

26145 Tendon excision palm/finger 14.65 70.00 $1,025.50

26160 Remove tendon sheath lesion 16.31 70.00 $1,141.70

26170 Removal of palm tendon each 11.60 70.00 $812.00

26180 Removal of finger tendon 12.66 70.00 $886.20

26185 Remove finger bone 15.49 70.00 $1,084.30

26200 Remove hand bone lesion 12.82 70.00 $897.40


26210 Removal of finger lesion 12.62 70.00 $883.40

26215 Remove/graft finger lesion 16.19 70.00 $1,133.30

26230 Partial removal of hand bone 14.27 70.00 $998.90

26235 Partial removal finger bone 14.10 70.00 $987.00

26236 Partial removal finger bone 12.58 70.00 $880.60

26250 Extensive hand surgery 30.89 70.00 $2,162.30

26260 Resect prox finger tumor 23.17 70.00 $1,621.90

26262 Resect distal finger tumor 18.25 70.00 $1,277.50

26320 Removal of implant from hand 9.89 70.00 $692.30

26340 Manipulate finger w/anesth 9.49 70.00 $664.30

26341 Manipulat palm cord post inj 2.82 70.00 $197.40

26350 Repair finger/hand tendon 20.02 70.00 $1,401.40

26352 Repair/graft hand tendon 22.89 70.00 $1,602.30







26390 Revise hand/finger tendon 23.75 70.00 $1,662.50


26410 Repair hand tendon 15.86 70.00 $1,110.20


26415 Excision hand/finger tendon 19.25 70.00 $1,347.50

26416 Graft hand or finger tendon 25.15 70.00 $1,760.50

26418 Repair finger tendon 16.22 70.00 $1,135.40

26420 Repair/graft finger tendon 19.91 70.00 $1,393.70



26432 Repair finger tendon 14.06 70.00 $984.20

26433 Repair finger tendon 14.93 70.00 $1,045.10


26437 Realignment of tendons 17.53 70.00 $1,227.10

26440 Release palm/finger tendon 17.39 70.00 $1,217.30

26442 Release palm & finger tendon 27.19 70.00 $1,903.30

26445 Release hand/finger tendon 16.15 70.00 $1,130.50

26449 Release forearm/hand tendon 19.88 70.00 $1,391.60

26450 Incision of palm tendon 11.44 70.00 $800.80

26455 Incision of finger tendon 11.37 70.00 $795.90

26460 Incise hand/finger tendon 11.03 70.00 $772.10

26471 Fusion of finger tendons 17.24 70.00 $1,206.80

26474 Fusion of finger tendons 17.00 70.00 $1,190.00

26476 Tendon lengthening 16.51 70.00 $1,155.70

26477 Tendon shortening 16.19 70.00 $1,133.30

26478 Lengthening of hand tendon 17.36 70.00 $1,215.20

26479 Shortening of hand tendon 17.19 70.00 $1,203.30

26480 Transplant hand tendon 21.10 70.00 $1,477.00

26483 Transplant/graft hand tendon 23.70 70.00 $1,659.00

26485 Transplant palm tendon 22.70 70.00 $1,589.00

26489 Transplant/graft palm tendon 26.55 70.00 $1,858.50

26490 Revise thumb tendon 22.58 70.00 $1,580.60

26492 Tendon transfer with graft 25.05 70.00 $1,753.50

26494 Hand tendon/muscle transfer 21.99 70.00 $1,539.30

26496 Revise thumb tendon 24.06 70.00 $1,684.20

26497 Finger tendon transfer 24.57 70.00 $1,719.90

26498 Finger tendon transfer 32.75 70.00 $2,292.50

26499 Revision of finger 23.01 70.00 $1,610.70

26500 Hand tendon reconstruction 17.52 70.00 $1,226.40

26502 Hand tendon reconstruction 20.11 70.00 $1,407.70

26508 Release thumb contracture 17.78 70.00 $1,244.60

26510 Thumb tendon transfer 16.69 70.00 $1,168.30

26516 Fusion of knuckle joint 19.66 70.00 $1,376.20

26517 Fusion of knuckle joints 23.42 70.00 $1,639.40

26518 Fusion of knuckle joints 23.20 70.00 $1,624.00

26520 Release knuckle contracture 18.28 70.00 $1,279.60

26525 Release finger contracture 18.29 70.00 $1,280.30

26530 Revise knuckle joint 15.37 70.00 $1,075.90

26531 Revise knuckle with implant 17.84 70.00 $1,248.80

26535 Revise finger joint 12.03 70.00 $842.10

26536 Revise/implant finger joint 19.99 70.00 $1,399.30

26540 Repair hand joint 18.46 70.00 $1,292.20

26541 Repair hand joint with graft 22.58 70.00 $1,580.60

26542 Repair hand joint with graft 19.11 70.00 $1,337.70

26545 Reconstruct finger joint 20.04 70.00 $1,402.80

26546 Repair nonunion hand 28.10 70.00 $1,967.00

26548 Reconstruct finger joint 21.38 70.00 $1,496.60

26550 Construct thumb replacement 47.01 70.00 $3,290.70

26551 Great toe-hand transfer 94.85 70.00 $6,639.50

26553 Single transfer toe-hand 77.67 70.00 $5,436.90

26554 Double transfer toe-hand 90.88 70.00 $6,361.60

26555 Positional change of finger 39.11 70.00 $2,737.70

26556 Toe joint transfer 81.14 70.00 $5,679.80

26560 Repair of web finger 16.70 70.00 $1,169.00



26565 Correct metacarpal flaw 19.20 70.00 $1,344.00

26567 Correct finger deformity 19.10 70.00 $1,337.00

26568 Lengthen metacarpal/finger 25.54 70.00 $1,787.80

26580 Repair hand deformity 43.19 70.00 $3,023.30

26587 Reconstruct extra finger 27.52 70.00 $1,926.40

26590 Repair finger deformity 40.21 70.00 $2,814.70

26591 Repair muscles of hand 12.18 70.00 $852.60

26593 Release muscles of hand 16.86 70.00 $1,180.20

26596 Excision constricting tissue 21.28 70.00 $1,489.60

26600 Treat metacarpal fracture 8.35 70.00 $584.50




26615 Treat metacarpal fracture 16.50 70.00 $1,155.00

26641 Treat thumb dislocation 10.74 70.00 $751.80

26645 Treat thumb fracture 12.24 70.00 $856.80

26650 Treat thumb fracture 13.69 70.00 $958.30

26665 Treat thumb fracture 18.03 70.00 $1,262.10

26670 Treat hand dislocation 9.58 70.00 $670.60

26675 Treat hand dislocation 13.01 70.00 $910.70

26676 Pin hand dislocation 14.30 70.00 $1,001.00

26685 Treat hand dislocation 16.51 70.00 $1,155.70

26686 Treat hand dislocation 17.94 70.00 $1,255.80

26700 Treat knuckle dislocation 9.14 70.00 $639.80

26705 Treat knuckle dislocation 11.89 70.00 $832.30

26706 Pin knuckle dislocation 12.44 70.00 $870.80

26715 Treat knuckle dislocation 16.36 70.00 $1,145.20

26720 Treat finger fracture each 5.62 70.00 $393.40



26735 Treat finger fracture each 17.08 70.00 $1,195.60






26756 Pin finger fracture each 11.89 70.00 $832.30


26770 Treat finger dislocation 7.81 70.00 $546.70

26775 Treat finger dislocation 10.90 70.00 $763.00

26776 Pin finger dislocation 12.64 70.00 $884.80

26785 Treat finger dislocation 15.63 70.00 $1,094.10

26820 Thumb fusion with graft 22.33 70.00 $1,563.10

26841 Fusion of thumb 20.44 70.00 $1,430.80

26842 Thumb fusion with graft 22.13 70.00 $1,549.10

26843 Fusion of hand joint 20.92 70.00 $1,464.40

26844 Fusion/graft of hand joint 22.74 70.00 $1,591.80

26850 Fusion of knuckle 19.44 70.00 $1,360.80

26852 Fusion of knuckle with graft 22.38 70.00 $1,566.60

26860 Fusion of finger joint 15.86 70.00 $1,110.20

26861 Fusion of finger jnt add-on 2.99 70.00 $209.30

26862 Fusion/graft of finger joint 20.42 70.00 $1,429.40

26863 Fuse/graft added joint 6.61 70.00 $462.70

26910 Amputate metacarpal bone 20.20 70.00 $1,414.00

26951 Amputation of finger/thumb 18.38 70.00 $1,286.60

26952 Amputation of finger/thumb 18.14 70.00 $1,269.80

26989 Hand/finger surgery 0.00 70.00 $0.00

26990 Drainage of pelvis lesion 17.99 70.00 $1,259.30

26991 Drainage of pelvis bursa 20.09 70.00 $1,406.30

26992 Drainage of bone lesion 27.51 70.00 $1,925.70

27000 Incision of hip tendon 11.94 70.00 $835.80

27001 Incision of hip tendon 15.52 70.00 $1,086.40



27006 Incision of hip tendons 21.17 70.00 $1,481.90

27025 Incision of hip/thigh fascia 26.21 70.00 $1,834.70

27027 Buttock fasciotomy 25.56 70.00 $1,789.20

27030 Drainage of hip joint 27.02 70.00 $1,891.40

27033 Exploration of hip joint 28.00 70.00 $1,960.00

27035 Denervation of hip joint 30.83 70.00 $2,158.10

27036 Excision of hip joint/muscle 29.15 70.00 $2,040.50

27040 Biopsy of soft tissues 9.83 70.00 $688.10

27041 Biopsy of soft tissues 19.76 70.00 $1,383.20

27043 Exc hip pelvis les sc 3 cm/> 13.51 70.00 $945.70

27045 Exc hip/pelv tum deep 5 cm/> 21.58 70.00 $1,510.60

27047 Exc hip/pelvis les sc < 3 cm 13.44 70.00 $940.80

27048 Exc hip/pelv tum deep < 5 cm 17.54 70.00 $1,227.80

27049 Resect hip/pelv tum < 5 cm 38.58 70.00 $2,700.60

27050 Biopsy of sacroiliac joint 11.54 70.00 $807.80

27052 Biopsy of hip joint 16.68 70.00 $1,167.60

27054 Removal of hip joint lining 19.68 70.00 $1,377.60

27057 Buttock fasciotomy w/dbrdmt 29.29 70.00 $2,050.30

27059 Resect hip/pelv tum 5 cm/> 52.56 70.00 $3,679.20

27060 Removal of ischial bursa 13.37 70.00 $935.90

27062 Remove femur lesion/bursa 13.13 70.00 $919.10

27065 Remove hip bone les super 14.89 70.00 $1,042.30

27066 Remove hip bone les deep 23.41 70.00 $1,638.70

27067 Remove/graft hip bone lesion 29.86 70.00 $2,090.20

27070 Part remove hip bone super 24.41 70.00 $1,708.70

27071 Part removal hip bone deep 26.31 70.00 $1,841.70

27075 Resect hip tumor 60.89 70.00 $4,262.30

27076 Resect hip tum incl acetabul 73.74 70.00 $5,161.80

27077 Resect hip tum w/innom bone 82.32 70.00 $5,762.40

27078 Rsect hip tum incl femur 60.05 70.00 $4,203.50

27080 Removal of tail bone 14.78 70.00 $1,034.60

27086 Remove hip foreign body 8.43 70.00 $590.10

27087 Remove hip foreign body 17.98 70.00 $1,258.60

27090 Removal of hip prosthesis 23.80 70.00 $1,666.00

27091 Removal of hip prosthesis 46.14 70.00 $3,229.80

27093 Injection for hip x-ray 5.33 70.00 $373.10

27095 Injection for hip x-ray 6.87 70.00 $480.90

27096 Inject sacroiliac joint 4.56 70.00 $319.20

27097 Revision of hip tendon 19.65 70.00 $1,375.50

27098 Transfer tendon to pelvis 20.01 70.00 $1,400.70

27100 Transfer of abdominal muscle 23.80 70.00 $1,666.00

27105 Transfer of spinal muscle 24.98 70.00 $1,748.60

27110 Transfer of iliopsoas muscle 27.94 70.00 $1,955.80

27111 Transfer of iliopsoas muscle 25.95 70.00 $1,816.50

27120 Reconstruction of hip socket 37.60 70.00 $2,632.00

27122 Reconstruction of hip socket 31.67 70.00 $2,216.90

27125 Partial hip replacement 32.72 70.00 $2,290.40

27130 Total hip arthroplasty 39.18 70.00 $2,742.60

27132 Total hip arthroplasty 48.40 70.00 $3,388.00

27134 Revise hip joint replacement 55.39 70.00 $3,877.30



27140 Transplant femur ridge 25.88 70.00 $1,811.60

27146 Incision of hip bone 37.05 70.00 $2,593.50

27147 Revision of hip bone 42.56 70.00 $2,979.20

27151 Incision of hip bones 46.07 70.00 $3,224.90

27156 Revision of hip bones 49.68 70.00 $3,477.60

27158 Revision of pelvis 40.58 70.00 $2,840.60

27161 Incision of neck of femur 35.10 70.00 $2,457.00

27165 Incision/fixation of femur 39.59 70.00 $2,771.30

27170 Repair/graft femur head/neck 34.01 70.00 $2,380.70

27175 Treat slipped epiphysis 19.25 70.00 $1,347.50




27179 Revise head/neck of femur 28.18 70.00 $1,972.60


27185 Revision of femur epiphysis 16.81 70.00 $1,176.70

27187 Reinforce hip bones 28.60 70.00 $2,002.00

27193 Treat pelvic ring fracture 13.51 70.00 $945.70

27194 Treat pelvic ring fracture 20.52 70.00 $1,436.40

27200 Treat tail bone fracture 5.16 70.00 $361.20

27202 Treat tail bone fracture 15.35 70.00 $1,074.50

27215 Treat pelvic fracture(s) 17.22 70.00 $1,205.40




27220 Treat hip socket fracture 15.23 70.00 $1,066.10

27222 Treat hip socket fracture 28.20 70.00 $1,974.00

27226 Treat hip wall fracture 30.55 70.00 $2,138.50

27227 Treat hip fracture(s) 47.99 70.00 $3,359.30

27228 Treat hip fracture(s) 54.72 70.00 $3,830.40

27230 Treat thigh fracture 13.61 70.00 $952.70

27232 Treat thigh fracture 21.74 70.00 $1,521.80









27250 Treat hip dislocation 5.23 70.00 $366.10

27252 Treat hip dislocation 21.91 70.00 $1,533.70









27267 Cltx thigh fx 12.43 70.00 $870.10

27268 Cltx thigh fx w/mnpj 15.51 70.00 $1,085.70

27269 Optx thigh fx 35.95 70.00 $2,516.50

27275 Manipulation of hip joint 5.25 70.00 $367.50

27279 Arthrodesis sacroiliac joint 16.05 70.00 $1,123.50

27280 Fusion of sacroiliac joint 31.15 70.00 $2,180.50

27282 Fusion of pubic bones 21.50 70.00 $1,505.00

27284 Fusion of hip joint 44.18 70.00 $3,092.60

27286 Fusion of hip joint 47.87 70.00 $3,350.90

27290 Amputation of leg at hip 47.03 70.00 $3,292.10

27295 Amputation of leg at hip 36.34 70.00 $2,543.80

27299 Pelvis/hip joint surgery 0.00 70.00 $0.00

27301 Drain thigh/knee lesion 18.93 70.00 $1,325.10

27303 Drainage of bone lesion 18.32 70.00 $1,282.40

27305 Incise thigh tendon & fascia 13.83 70.00 $968.10

27306 Incision of thigh tendon 10.31 70.00 $721.70

27307 Incision of thigh tendons 13.80 70.00 $966.00

27310 Exploration of knee joint 21.04 70.00 $1,472.80

27323 Biopsy thigh soft tissues 7.68 70.00 $537.60

27324 Biopsy thigh soft tissues 11.39 70.00 $797.30

27325 Neurectomy hamstring 14.66 70.00 $1,026.20

27326 Neurectomy popliteal 14.77 70.00 $1,033.90

27327 Exc thigh/knee les sc < 3 cm 13.12 70.00 $918.40

27328 Exc thigh/knee tum deep <5cm 17.88 70.00 $1,251.60

27329 Resect thigh/knee tum < 5 cm 29.83 70.00 $2,088.10

27330 Biopsy knee joint lining 11.93 70.00 $835.10

27331 Explore/treat knee joint 13.67 70.00 $956.90

27332 Removal of knee cartilage 18.51 70.00 $1,295.70

27333 Removal of knee cartilage 16.86 70.00 $1,180.20

27334 Remove knee joint lining 19.68 70.00 $1,377.60

27335 Remove knee joint lining 21.98 70.00 $1,538.60

27337 Exc thigh/knee les sc 3 cm/> 12.01 70.00 $840.70

27339 Exc thigh/knee tum dep 5cm/> 21.70 70.00 $1,519.00

27340 Removal of kneecap bursa 10.66 70.00 $746.20

27345 Removal of knee cyst 13.82 70.00 $967.40

27347 Remove knee cyst 15.20 70.00 $1,064.00

27350 Removal of kneecap 18.73 70.00 $1,311.10

27355 Remove femur lesion 17.36 70.00 $1,215.20

27356 Remove femur lesion/graft 21.28 70.00 $1,489.60

27357 Remove femur lesion/graft 23.42 70.00 $1,639.40

27358 Remove femur lesion/fixation 8.11 70.00 $567.70

27360 Partial removal leg bone(s) 24.50 70.00 $1,715.00

27364 Resect thigh/knee tum 5 cm/> 45.19 70.00 $3,163.30

27365 Resect femur/knee tumor 59.76 70.00 $4,183.20

27370 Injection for knee x-ray 4.40 70.00 $308.00

27372 Removal of foreign body 17.38 70.00 $1,216.60

27380 Repair of kneecap tendon 17.06 70.00 $1,194.20

27381 Repair/graft kneecap tendon 22.89 70.00 $1,602.30

27385 Repair of thigh muscle 16.50 70.00 $1,155.00

27386 Repair/graft of thigh muscle 23.83 70.00 $1,668.10

27390 Incision of thigh tendon 12.89 70.00 $902.30

27391 Incision of thigh tendons 16.61 70.00 $1,162.70

27392 Incision of thigh tendons 20.53 70.00 $1,437.10

27393 Lengthening of thigh tendon 14.67 70.00 $1,026.90

27394 Lengthening of thigh tendons 18.72 70.00 $1,310.40

27395 Lengthening of thigh tendons 25.33 70.00 $1,773.10

27396 Transplant of thigh tendon 17.73 70.00 $1,241.10

27397 Transplants of thigh tendons 26.43 70.00 $1,850.10

27400 Revise thigh muscles/tendons 20.03 70.00 $1,402.10

27403 Repair of knee cartilage 18.44 70.00 $1,290.80

27405 Repair of knee ligament 19.47 70.00 $1,362.90

27407 Repair of knee ligament 22.84 70.00 $1,598.80

27409 Repair of knee ligaments 27.84 70.00 $1,948.80

27412 Autochondrocyte implant knee 47.85 70.00 $3,349.50

27415 Osteochondral knee allograft 39.76 70.00 $2,783.20

27416 Osteochondral knee autograft 28.30 70.00 $1,981.00

27418 Repair degenerated kneecap 23.81 70.00 $1,666.70

27420 Revision of unstable kneecap 21.29 70.00 $1,490.30

27422 Revision of unstable kneecap 21.38 70.00 $1,496.60

27424 Revision/removal of kneecap 21.57 70.00 $1,509.90

27425 Lat retinacular release open 12.88 70.00 $901.60

27427 Reconstruction knee 20.55 70.00 $1,438.50



27430 Revision of thigh muscles 21.20 70.00 $1,484.00

27435 Incision of knee joint 23.19 70.00 $1,623.30

27437 Revise kneecap 19.05 70.00 $1,333.50

27438 Revise kneecap with implant 24.21 70.00 $1,694.70

27440 Revision of knee joint 23.01 70.00 $1,610.70






27447 Total knee arthroplasty 39.17 70.00 $2,741.90

27448 Incision of thigh 22.03 70.00 $1,542.10

27450 Incision of thigh 29.09 70.00 $2,036.30

27454 Realignment of thigh bone 37.59 70.00 $2,631.30

27455 Realignment of knee 27.20 70.00 $1,904.00

27457 Realignment of knee 27.72 70.00 $1,940.40

27465 Shortening of thigh bone 36.09 70.00 $2,526.30

27466 Lengthening of thigh bone 34.23 70.00 $2,396.10

27468 Shorten/lengthen thighs 38.84 70.00 $2,718.80

27470 Repair of thigh 33.92 70.00 $2,374.40

27472 Repair/graft of thigh 36.51 70.00 $2,555.70

27475 Surgery to stop leg growth 19.07 70.00 $1,334.90




27486 Revise/replace knee joint 40.61 70.00 $2,842.70

27487 Revise/replace knee joint 50.78 70.00 $3,554.60

27488 Removal of knee prosthesis 34.66 70.00 $2,426.20

27495 Reinforce thigh 32.54 70.00 $2,277.80

27496 Decompression of thigh/knee 15.66 70.00 $1,096.20




27500 Treatment of thigh fracture 14.92 70.00 $1,044.40












27516 Treat thigh fx growth plate 14.60 70.00 $1,022.00



27520 Treat kneecap fracture 9.22 70.00 $645.40

27524 Treat kneecap fracture 21.70 70.00 $1,519.00

27530 Treat knee fracture 8.62 70.00 $603.40

27532 Treat knee fracture 17.73 70.00 $1,241.10



27538 Treat knee fracture(s) 13.58 70.00 $950.60


27550 Treat knee dislocation 14.41 70.00 $1,008.70





27560 Treat kneecap dislocation 10.27 70.00 $718.90

27562 Treat kneecap dislocation 13.91 70.00 $973.70

27566 Treat kneecap dislocation 25.78 70.00 $1,804.60

27570 Fixation of knee joint 4.35 70.00 $304.50

27580 Fusion of knee 41.41 70.00 $2,898.70

27590 Amputate leg at thigh 23.42 70.00 $1,639.40





27598 Amputate lower leg at knee 20.88 70.00 $1,461.60

27599 Leg surgery procedure 0.00 70.00 $0.00

27600 Decompression of lower leg 11.96 70.00 $837.20



27603 Drain lower leg lesion 15.16 70.00 $1,061.20

27604 Drain lower leg bursa 14.03 70.00 $982.10

27605 Incision of achilles tendon 9.72 70.00 $680.40

27606 Incision of achilles tendon 8.22 70.00 $575.40

27607 Treat lower leg bone lesion 17.59 70.00 $1,231.30

27610 Explore/treat ankle joint 18.77 70.00 $1,313.90

27612 Exploration of ankle joint 16.25 70.00 $1,137.50

27613 Biopsy lower leg soft tissue 7.14 70.00 $499.80

27614 Biopsy lower leg soft tissue 16.39 70.00 $1,147.30

27615 Resect leg/ankle tum < 5 cm 29.40 70.00 $2,058.00

27616 Resect leg/ankle tum 5 cm/> 36.58 70.00 $2,560.60

27618 Exc leg/ankle tum < 3 cm 12.88 70.00 $901.60

27619 Exc leg/ankle tum deep <5 cm 13.59 70.00 $951.30

27620 Explore/treat ankle joint 13.19 70.00 $923.30

27625 Remove ankle joint lining 16.80 70.00 $1,176.00

27626 Remove ankle joint lining 17.75 70.00 $1,242.50

27630 Removal of tendon lesion 16.06 70.00 $1,124.20

27632 Exc leg/ankle les sc 3 cm/> 11.92 70.00 $834.40

27634 Exc leg/ankle tum dep 5 cm/> 19.74 70.00 $1,381.80

27635 Remove lower leg bone lesion 16.92 70.00 $1,184.40

27637 Remove/graft leg bone lesion 22.03 70.00 $1,542.10

27638 Remove/graft leg bone lesion 22.40 70.00 $1,568.00

27640 Partial removal of tibia 24.12 70.00 $1,688.40

27641 Partial removal of fibula 19.26 70.00 $1,348.20

27645 Resect tibia tumor 51.57 70.00 $3,609.90

27646 Resect fibula tumor 44.73 70.00 $3,131.10

27647 Resect talus/calcaneus tum 29.51 70.00 $2,065.70

27648 Injection for ankle x-ray 4.62 70.00 $323.40

27650 Repair achilles tendon 18.96 70.00 $1,327.20

27652 Repair/graft achilles tendon 19.76 70.00 $1,383.20

27654 Repair of achilles tendon 20.36 70.00 $1,425.20

27656 Repair leg fascia defect 18.22 70.00 $1,275.40

27658 Repair of leg tendon each 10.75 70.00 $752.50




27675 Repair lower leg tendons 13.86 70.00 $970.20

27676 Repair lower leg tendons 17.04 70.00 $1,192.80

27680 Release of lower leg tendon 12.39 70.00 $867.30

27681 Release of lower leg tendons 15.75 70.00 $1,102.50

27685 Revision of lower leg tendon 19.01 70.00 $1,330.70

27686 Revise lower leg tendons 16.22 70.00 $1,135.40

27687 Revision of calf tendon 13.10 70.00 $917.00

27690 Revise lower leg tendon 18.09 70.00 $1,266.30

27691 Revise lower leg tendon 21.61 70.00 $1,512.70

27692 Revise additional leg tendon 3.01 70.00 $210.70

27695 Repair of ankle ligament 13.70 70.00 $959.00

27696 Repair of ankle ligaments 15.84 70.00 $1,108.80

27698 Repair of ankle ligament 18.39 70.00 $1,287.30

27700 Revision of ankle joint 16.76 70.00 $1,173.20

27702 Reconstruct ankle joint 27.98 70.00 $1,958.60

27703 Reconstruction ankle joint 32.08 70.00 $2,245.60

27704 Removal of ankle implant 16.59 70.00 $1,161.30

27705 Incision of tibia 21.65 70.00 $1,515.50

27707 Incision of fibula 11.58 70.00 $810.60

27709 Incision of tibia & fibula 33.87 70.00 $2,370.90

27712 Realignment of lower leg 31.94 70.00 $2,235.80

27715 Revision of lower leg 30.33 70.00 $2,123.10

27720 Repair of tibia 25.23 70.00 $1,766.10

27722 Repair/graft of tibia 25.70 70.00 $1,799.00

27724 Repair/graft of tibia 36.59 70.00 $2,561.30

27725 Repair of lower leg 35.27 70.00 $2,468.90

27726 Repair fibula nonunion 27.88 70.00 $1,951.60

27727 Repair of lower leg 24.55 70.00 $1,718.50

27730 Repair of tibia epiphysis 16.88 70.00 $1,181.60

27732 Repair of fibula epiphysis 12.86 70.00 $900.20

27734 Repair lower leg epiphyses 18.90 70.00 $1,323.00

27740 Repair of leg epiphyses 20.43 70.00 $1,430.10

27742 Repair of leg epiphyses 22.44 70.00 $1,570.80

27745 Reinforce tibia 21.87 70.00 $1,530.90

27750 Treatment of tibia fracture 9.90 70.00 $693.00

27752 Treatment of tibia fracture 15.39 70.00 $1,077.30




27760 Cltx medial ankle fx 9.51 70.00 $665.70

27762 Cltx med ankle fx w/mnpj 13.55 70.00 $948.50

27766 Optx medial ankle fx 17.63 70.00 $1,234.10

27767 Cltx post ankle fx 8.04 70.00 $562.80

27768 Cltx post ankle fx w/mnpj 12.66 70.00 $886.20

27769 Optx post ankle fx 20.91 70.00 $1,463.70

27780 Treatment of fibula fracture 8.72 70.00 $610.40

27781 Treatment of fibula fracture 12.11 70.00 $847.70

27784 Treatment of fibula fracture 20.66 70.00 $1,446.20

27786 Treatment of ankle fracture 9.03 70.00 $632.10


27792 Treatment of ankle fracture 18.83 70.00 $1,318.10








27824 Treat lower leg fracture 8.92 70.00 $624.40

27825 Treat lower leg fracture 15.64 70.00 $1,094.80




27829 Treat lower leg joint 19.70 70.00 $1,379.00

27830 Treat lower leg dislocation 10.77 70.00 $753.90

27831 Treat lower leg dislocation 11.49 70.00 $804.30

27832 Treat lower leg dislocation 21.81 70.00 $1,526.70

27840 Treat ankle dislocation 10.51 70.00 $735.70

27842 Treat ankle dislocation 14.28 70.00 $999.60

27846 Treat ankle dislocation 21.12 70.00 $1,478.40

27848 Treat ankle dislocation 23.47 70.00 $1,642.90

27860 Fixation of ankle joint 4.99 70.00 $349.30

27870 Fusion of ankle joint open 29.76 70.00 $2,083.20

27871 Fusion of tibiofibular joint 19.73 70.00 $1,381.10

27880 Amputation of lower leg 26.82 70.00 $1,877.40





27888 Amputation of foot at ankle 19.92 70.00 $1,394.40

27889 Amputation of foot at ankle 18.87 70.00 $1,320.90

27892 Decompression of leg 15.78 70.00 $1,104.60



27899 Leg/ankle surgery procedure 0.00 70.00 $0.00

28001 Drainage of bursa of foot 8.07 70.00 $564.90

28002 Treatment of foot infection 12.72 70.00 $890.40

28003 Treatment of foot infection 20.37 70.00 $1,425.90

28005 Treat foot bone lesion 16.68 70.00 $1,167.60

28008 Incision of foot fascia 12.49 70.00 $874.30

28010 Incision of toe tendon 6.67 70.00 $466.90

28011 Incision of toe tendons 9.28 70.00 $649.60

28020 Exploration of foot joint 15.76 70.00 $1,103.20

28022 Exploration of foot joint 14.15 70.00 $990.50

28024 Exploration of toe joint 13.37 70.00 $935.90

28035 Decompression of tibia nerve 15.24 70.00 $1,066.80

28039 Exc foot/toe tum sc 1.5 cm/> 14.68 70.00 $1,027.60

28041 Exc foot/toe tum dep 1.5cm/> 13.19 70.00 $923.30

28043 Exc foot/toe tum sc < 1.5 cm 11.53 70.00 $807.10

28045 Exc foot/toe tum deep <1.5cm 14.27 70.00 $998.90

28046 Resect foot/toe tumor < 3 cm 21.04 70.00 $1,472.80

28047 Resect foot/toe tumor 3 cm/> 31.03 70.00 $2,172.10

28050 Biopsy of foot joint lining 13.88 70.00 $971.60

28052 Biopsy of foot joint lining 12.69 70.00 $888.30

28054 Biopsy of toe joint lining 10.84 70.00 $758.80

28055 Neurectomy foot 10.89 70.00 $762.30

28060 Partial removal foot fascia 14.94 70.00 $1,045.80

28062 Removal of foot fascia 16.82 70.00 $1,177.40

28070 Removal of foot joint lining 15.27 70.00 $1,068.90

28072 Removal of foot joint lining 14.90 70.00 $1,043.00

28080 Removal of foot lesion 15.21 70.00 $1,064.70

28086 Excise foot tendon sheath 15.94 70.00 $1,115.80

28088 Excise foot tendon sheath 12.66 70.00 $886.20

28090 Removal of foot lesion 13.62 70.00 $953.40

28092 Removal of toe lesions 12.22 70.00 $855.40

28100 Removal of ankle/heel lesion 17.65 70.00 $1,235.50

28102 Remove/graft foot lesion 17.48 70.00 $1,223.60

28103 Remove/graft foot lesion 11.25 70.00 $787.50

28104 Removal of foot lesion 15.39 70.00 $1,077.30

28106 Remove/graft foot lesion 12.32 70.00 $862.40

28107 Remove/graft foot lesion 14.91 70.00 $1,043.70

28108 Removal of toe lesions 12.81 70.00 $896.70

28110 Part removal of metatarsal 13.41 70.00 $938.70

28111 Part removal of metatarsal 14.32 70.00 $1,002.40

28112 Part removal of metatarsal 14.20 70.00 $994.00

28113 Part removal of metatarsal 17.18 70.00 $1,202.60

28114 Removal of metatarsal heads 31.21 70.00 $2,184.70

28116 Revision of foot 21.80 70.00 $1,526.00

28118 Removal of heel bone 17.15 70.00 $1,200.50

28119 Removal of heel spur 15.18 70.00 $1,062.60

28120 Part removal of ankle/heel 19.55 70.00 $1,368.50

28122 Partial removal of foot bone 17.30 70.00 $1,211.00

28124 Partial removal of toe 13.77 70.00 $963.90


28130 Removal of ankle bone 17.56 70.00 $1,229.20

28140 Removal of metatarsal 17.20 70.00 $1,204.00

28150 Removal of toe 12.36 70.00 $865.20



28171 Resect tarsal tumor 24.43 70.00 $1,710.10

28173 Resect metatarsal tumor 21.94 70.00 $1,535.80

28175 Resect phalanx of toe tumor 14.09 70.00 $986.30

28190 Removal of foot foreign body 7.40 70.00 $518.00

28192 Removal of foot foreign body 13.57 70.00 $949.90

28193 Removal of foot foreign body 15.41 70.00 $1,078.70

28200 Repair of foot tendon 14.13 70.00 $989.10

28202 Repair/graft of foot tendon 17.12 70.00 $1,198.40

28208 Repair of foot tendon 13.73 70.00 $961.10

28210 Repair/graft of foot tendon 16.83 70.00 $1,178.10

28220 Release of foot tendon 13.04 70.00 $912.80

28222 Release of foot tendons 14.53 70.00 $1,017.10

28225 Release of foot tendon 11.78 70.00 $824.60

28226 Release of foot tendons 12.73 70.00 $891.10

28230 Incision of foot tendon(s) 12.64 70.00 $884.80

28232 Incision of toe tendon 11.20 70.00 $784.00

28234 Incision of foot tendon 11.85 70.00 $829.50

28238 Revision of foot tendon 19.56 70.00 $1,369.20

28240 Release of big toe 12.75 70.00 $892.50

28250 Revision of foot fascia 16.79 70.00 $1,175.30

28260 Release of midfoot joint 19.85 70.00 $1,389.50

28261 Revision of foot tendon 28.83 70.00 $2,018.10

28262 Revision of foot and ankle 42.54 70.00 $2,977.80

28264 Release of midfoot joint 24.38 70.00 $1,706.60

28270 Release of foot contracture 14.23 70.00 $996.10

28272 Release of toe joint each 11.42 70.00 $799.40

28280 Fusion of toes 14.86 70.00 $1,040.20

28285 Repair of hammertoe 15.45 70.00 $1,081.50

28286 Repair of hammertoe 12.99 70.00 $909.30

28288 Partial removal of foot bone 17.42 70.00 $1,219.40

28289 Repair hallux rigidus 21.19 70.00 $1,483.30

28290 Correction of bunion 17.11 70.00 $1,197.70








28300 Incision of heel bone 18.83 70.00 $1,318.10

28302 Incision of ankle bone 20.64 70.00 $1,444.80

28304 Incision of midfoot bones 23.96 70.00 $1,677.20

28305 Incise/graft midfoot bones 18.78 70.00 $1,314.60

28306 Incision of metatarsal 17.75 70.00 $1,242.50



28309 Incision of metatarsals 26.28 70.00 $1,839.60

28310 Revision of big toe 15.84 70.00 $1,108.80

28312 Revision of toe 14.98 70.00 $1,048.60

28313 Repair deformity of toe 15.31 70.00 $1,071.70

28315 Removal of sesamoid bone 13.96 70.00 $977.20

28320 Repair of foot bones 17.50 70.00 $1,225.00

28322 Repair of metatarsals 22.82 70.00 $1,597.40

28340 Resect enlarged toe tissue 16.72 70.00 $1,170.40

28341 Resect enlarged toe 19.39 70.00 $1,357.30

28344 Repair extra toe(s) 16.01 70.00 $1,120.70

28345 Repair webbed toe(s) 15.10 70.00 $1,057.00

28360 Reconstruct cleft foot 23.56 70.00 $1,649.20

28400 Treatment of heel fracture 7.12 70.00 $498.40

28405 Treatment of heel fracture 11.41 70.00 $798.70

28406 Treatment of heel fracture 15.16 70.00 $1,061.20

28415 Treat heel fracture 31.91 70.00 $2,233.70

28420 Treat/graft heel fracture 36.25 70.00 $2,537.50




28445 Treat ankle fracture 30.81 70.00 $2,156.70

28446 Osteochondral talus autogrft 35.40 70.00 $2,478.00

28450 Treat midfoot fracture each 6.18 70.00 $432.60

28455 Treat midfoot fracture each 8.27 70.00 $578.90

28456 Treat midfoot fracture 9.18 70.00 $642.60

28465 Treat midfoot fracture each 17.77 70.00 $1,243.90

28470 Treat metatarsal fracture 6.28 70.00 $439.60



28485 Treat metatarsal fracture 15.15 70.00 $1,060.50

28490 Treat big toe fracture 4.18 70.00 $292.60



28505 Treat big toe fracture 19.50 70.00 $1,365.00

28510 Treatment of toe fracture 3.56 70.00 $249.20

28515 Treatment of toe fracture 4.67 70.00 $326.90

28525 Treat toe fracture 16.13 70.00 $1,129.10

28530 Treat sesamoid bone fracture 3.31 70.00 $231.70

28531 Treat sesamoid bone fracture 9.88 70.00 $691.60

28540 Treat foot dislocation 5.52 70.00 $386.40


28546 Treat foot dislocation 16.67 70.00 $1,166.90

28555 Repair foot dislocation 25.48 70.00 $1,783.60









28630 Treat toe dislocation 4.49 70.00 $314.30



28645 Repair toe dislocation 18.91 70.00 $1,323.70




28675 Repair of toe dislocation 17.07 70.00 $1,194.90

28705 Fusion of foot bones 36.28 70.00 $2,539.60





28737 Revision of foot bones 19.95 70.00 $1,396.50


28750 Fusion of big toe joint 23.57 70.00 $1,649.90



28800 Amputation of midfoot 15.73 70.00 $1,101.10

28805 Amputation thru metatarsal 21.19 70.00 $1,483.30

28810 Amputation toe & metatarsal 12.49 70.00 $874.30

28820 Amputation of toe 16.37 70.00 $1,145.90

28825 Partial amputation of toe 15.63 70.00 $1,094.10

28890 Hi enrgy eswt plantar fascia 9.33 70.00 $653.10

28899 Foot/toes surgery procedure 0.00 70.00 $0.00

29000 Application of body cast 8.72 70.00 $610.40







29049 Application of figure eight 2.10 70.00 $147.00

29055 Application of shoulder cast 6.38 70.00 $446.60

29058 Application of shoulder cast 3.58 70.00 $250.60

29065 Application of long arm cast 2.76 70.00 $193.20

29075 Application of forearm cast 2.49 70.00 $174.30

29085 Apply hand/wrist cast 2.74 70.00 $191.80

29086 Apply finger cast 2.21 70.00 $154.70

29105 Apply long arm splint 2.53 70.00 $177.10

29125 Apply forearm splint 1.83 70.00 $128.10

29126 Apply forearm splint 2.21 70.00 $154.70

29130 Application of finger splint 1.16 70.00 $81.20

29131 Application of finger splint 1.46 70.00 $102.20

29200 Strapping of chest 0.85 70.00 $59.50

29240 Strapping of shoulder 0.82 70.00 $57.40

29260 Strapping of elbow or wrist 0.82 70.00 $57.40

29280 Strapping of hand or finger 0.83 70.00 $58.10

29305 Application of hip cast 7.10 70.00 $497.00

29325 Application of hip casts 7.86 70.00 $550.20

29345 Application of long leg cast 3.92 70.00 $274.40


29358 Apply long leg cast brace 4.62 70.00 $323.40


29405 Apply short leg cast 2.34 70.00 $163.80



29440 Addition of walker to cast 1.25 70.00 $87.50

29445 Apply rigid leg cast 3.89 70.00 $272.30

29450 Application of leg cast 4.12 70.00 $288.40

29505 Application long leg splint 2.38 70.00 $166.60

29515 Application lower leg splint 2.05 70.00 $143.50

29520 Strapping of hip 0.88 70.00 $61.60

29530 Strapping of knee 0.80 70.00 $56.00

29540 Strapping of ankle and/or ft 0.73 70.00 $51.10

29550 Strapping of toes 0.54 70.00 $37.80

29580 Application of paste boot 1.49 70.00 $104.30

29581 Apply multlay comprs lwr leg 1.77 70.00 $123.90

29582 Apply multlay comprs upr leg 2.01 70.00 $140.70

29583 Apply multlay comprs upr arm 1.26 70.00 $88.20

29584 Appl multlay comprs arm/hand 2.01 70.00 $140.70

29700 Removal/revision of cast 1.75 70.00 $122.50



29720 Repair of body cast 2.45 70.00 $171.50

29730 Windowing of cast 1.83 70.00 $128.10

29740 Wedging of cast 2.86 70.00 $200.20

29750 Wedging of clubfoot cast 2.74 70.00 $191.80

29799 Casting/strapping procedure 0.00 70.00 $0.00

29800 Jaw arthroscopy/surgery 14.92 70.00 $1,044.40

29804 Jaw arthroscopy/surgery 18.49 70.00 $1,294.30

29805 Shoulder arthroscopy dx 13.60 70.00 $952.00

29806 Shoulder arthroscopy/surgery 30.63 70.00 $2,144.10









29826 Shoulder arthroscopy/surgery 5.10 70.00 $357.00

29827 Arthroscop rotator cuff repr 30.33 70.00 $2,123.10

29828 Arthroscopy biceps tenodesis 26.14 70.00 $1,829.80

29830 Elbow arthroscopy 13.16 70.00 $921.20

29834 Elbow arthroscopy/surgery 13.94 70.00 $975.80

29835 Elbow arthroscopy/surgery 14.50 70.00 $1,015.00




29840 Wrist arthroscopy 13.03 70.00 $912.10

29843 Wrist arthroscopy/surgery 13.95 70.00 $976.50

29844 Wrist arthroscopy/surgery 14.17 70.00 $991.90

29845 Wrist arthroscopy/surgery 16.52 70.00 $1,156.40



29848 Wrist endoscopy/surgery 14.65 70.00 $1,025.50

29850 Knee arthroscopy/surgery 18.01 70.00 $1,260.70


29855 Tibial arthroscopy/surgery 22.64 70.00 $1,584.80

29856 Tibial arthroscopy/surgery 28.81 70.00 $2,016.70

29860 Hip arthroscopy dx 19.26 70.00 $1,348.20

29861 Hip arthro w/fb removal 20.60 70.00 $1,442.00

29862 Hip arthr0 w/debridement 23.19 70.00 $1,623.30

29863 Hip arthr0 w/synovectomy 23.13 70.00 $1,619.10

29866 Autgrft implnt knee w/scope 30.34 70.00 $2,123.80

29867 Allgrft implnt knee w/scope 37.01 70.00 $2,590.70

29868 Meniscal trnspl knee w/scpe 48.49 70.00 $3,394.30

29870 Knee arthroscopy dx 16.78 70.00 $1,174.60

29871 Knee arthroscopy/drainage 14.82 70.00 $1,037.40



29875 Knee arthroscopy/surgery 14.27 70.00 $998.90














29891 Ankle arthroscopy/surgery 19.59 70.00 $1,371.30


29893 Scope plantar fasciotomy 17.64 70.00 $1,234.80


29895 Ankle arthroscopy/surgery 13.93 70.00 $975.10




29900 Mcp joint arthroscopy dx 12.01 70.00 $840.70

29901 Mcp joint arthroscopy surg 15.08 70.00 $1,055.60

29902 Mcp joint arthroscopy surg 13.94 70.00 $975.80

29904 Subtalar arthro w/fb rmvl 18.44 70.00 $1,290.80

29905 Subtalar arthro w/exc 18.70 70.00 $1,309.00

29906 Subtalar arthro w/deb 20.40 70.00 $1,428.00

29907 Subtalar arthro w/fusion 25.32 70.00 $1,772.40

29914 Hip arthro w/femoroplasty 28.55 70.00 $1,998.50

29915 Hip arthro acetabuloplasty 29.08 70.00 $2,035.60

29916 Hip arthro w/labral repair 29.16 70.00 $2,041.20

29999 Arthroscopy of joint 0.00 70.00 $0.00

30000 Drainage of nose lesion 6.56 70.00 $459.20

30020 Drainage of nose lesion 6.64 70.00 $464.80

3006F Cxr doc rev 0.00 70.00 $0.00

3008F Body mass index docd 0.00 70.00 $0.00

30100 Intranasal biopsy 4.04 70.00 $282.80

3011F Lipid panel doc rev 0.00 70.00 $0.00

30110 Removal of nose polyp(s) 6.58 70.00 $460.60

30115 Removal of nose polyp(s) 12.33 70.00 $863.10

30117 Removal of intranasal lesion 24.99 70.00 $1,749.30

30118 Removal of intranasal lesion 21.88 70.00 $1,531.60

30120 Revision of nose 14.79 70.00 $1,035.30

30124 Removal of nose lesion 8.13 70.00 $569.10

30125 Removal of nose lesion 17.34 70.00 $1,213.80

30130 Excise inferior turbinate 10.86 70.00 $760.20

3014F Screen mammo doc rev 0.00 70.00 $0.00

30140 Resect inferior turbinate 12.56 70.00 $879.20

3015F Cerv cancer screen docd 0.00 70.00 $0.00

30150 Partial removal of nose 21.94 70.00 $1,535.80

3016F Pt scrnd unhlthy oh use 0.00 70.00 $0.00

30160 Removal of nose 22.07 70.00 $1,544.90

3017F Colorectal ca screen doc rev 0.00 70.00 $0.00

3018F Pre-prxd rsk et al docd 0.00 70.00 $0.00

3019F Lvef assess planpost dschrge 0.00 70.00 $0.00

3020F Lvf assess 0.00 70.00 $0.00

30200 Injection treatment of nose 3.24 70.00 $226.80

3021F Lvef mod/sever deprs syst 0.00 70.00 $0.00

30210 Nasal sinus therapy 4.29 70.00 $300.30

3022F Lvef >/=40% systolic 0.00 70.00 $0.00

30220 Insert nasal septal button 8.62 70.00 $603.40

3023F Spirom doc rev 0.00 70.00 $0.00

3025F Spirom fev/fvc <70% w/copd 0.00 70.00 $0.00

3027F Spirom fev/fvc>/=70%/w/ocopd 0.00 70.00 $0.00

3028F O2 saturation doc rev 0.00 70.00 $0.00

30300 Remove nasal foreign body 6.57 70.00 $459.90



3035F O2 saturation</=88%/pao</=55 0.00 70.00 $0.00

3037F O2 saturation >88%/pao>55 hg 0.00 70.00 $0.00

3038F Pulm fx w/in 12 mon b/4 surg 0.00 70.00 $0.00

3040F Fev <40% predicted value 0.00 70.00 $0.00

30400 Reconstruction of nose 28.68 70.00 $2,007.60


3042F Fev >/=40% predicted value 0.00 70.00 $0.00


30430 Revision of nose 24.68 70.00 $1,727.60

30435 Revision of nose 35.56 70.00 $2,489.20

3044F Hg a1c level lt 7.0% 0.00 70.00 $0.00

3045F Hg a1c level 7.0-9.0% 0.00 70.00 $0.00

30450 Revision of nose 42.67 70.00 $2,986.90

3046F Hemoglobin a1c level >9.0% 0.00 70.00 $0.00

30460 Revision of nose 23.22 70.00 $1,625.40

30462 Revision of nose 40.40 70.00 $2,828.00

30465 Repair nasal stenosis 27.99 70.00 $1,959.30

3048F Ldl-c <100 mg/dl 0.00 70.00 $0.00

3049F Ldl-c 100-129 mg/dl 0.00 70.00 $0.00

3050F Ldl-c >/= 130 mg/dl 0.00 70.00 $0.00

30520 Repair of nasal septum 17.78 70.00 $1,244.60

30540 Repair nasal defect 19.61 70.00 $1,372.70

30545 Repair nasal defect 24.38 70.00 $1,706.60

3055F Lvef less than/equal to 35% 0.00 70.00 $0.00

3056F Lvef greater than 35% 0.00 70.00 $0.00

30560 Release of nasal adhesions 7.66 70.00 $536.20

30580 Repair upper jaw fistula 18.71 70.00 $1,309.70

3060F Pos microalbuminuria rev 0.00 70.00 $0.00

30600 Repair mouth/nose fistula 16.29 70.00 $1,140.30

3061F Neg microalbuminuria rev 0.00 70.00 $0.00

3062F Pos macroalbuminuria rev 0.00 70.00 $0.00

30620 Intranasal reconstruction 17.80 70.00 $1,246.00

30630 Repair nasal septum defect 17.86 70.00 $1,250.20

3066F Nephropathy doc tx 0.00 70.00 $0.00

3072F Low risk for retinopathy 0.00 70.00 $0.00

3073F Pre-surg eye measures docd 0.00 70.00 $0.00

3074F Syst bp lt 130 mm hg 0.00 70.00 $0.00

3075F Syst bp ge 130 - 139mm hg 0.00 70.00 $0.00

3077F Syst bp >/= 140 mm hg 0.00 70.00 $0.00

3078F Diast bp <80 mm hg 0.00 70.00 $0.00

3079F Diast bp 80-89 mm hg 0.00 70.00 $0.00

3080F Diast bp >/= 90 mm hg 0.00 70.00 $0.00

30801 Ablate inf turbinate superf 6.52 70.00 $456.40

30802 Ablate inf turbinate submuc 8.29 70.00 $580.30

3082F Kt/v <1.2 0.00 70.00 $0.00

3083F Kt/v =/> 1.2 & <1.7 0.00 70.00 $0.00

3084F Kt/v ge 1.7 0.00 70.00 $0.00

3085F Suicide risk assessed 0.00 70.00 $0.00

3088F Mdd mild 0.00 70.00 $0.00

3089F Mdd moderate 0.00 70.00 $0.00

3090F Mdd severe w/o psych 0.00 70.00 $0.00

30901 Control of nosebleed 2.72 70.00 $190.40



30906 Repeat control of nosebleed 8.00 70.00 $560.00

3091F Mdd severe w/psych 0.00 70.00 $0.00

30915 Ligation nasal sinus artery 16.44 70.00 $1,150.80

3092F Mdd in remission 0.00 70.00 $0.00

30920 Ligation upper jaw artery 23.83 70.00 $1,668.10

3093F Doc new diag 1st/addl mdd 0.00 70.00 $0.00

30930 Ther fx nasal inf turbinate 3.52 70.00 $246.40

3095F Central dexa results docd 0.00 70.00 $0.00

3096F Central dexa ordered 0.00 70.00 $0.00

30999 Nasal surgery procedure 0.00 70.00 $0.00

3100F Image test ref carot diam 0.00 70.00 $0.00

31000 Irrigation maxillary sinus 5.24 70.00 $366.80

31002 Irrigation sphenoid sinus 5.51 70.00 $385.70

31020 Exploration maxillary sinus 13.89 70.00 $972.30

31030 Exploration maxillary sinus 19.79 70.00 $1,385.30

31032 Explore sinus remove polyps 16.40 70.00 $1,148.00

31040 Exploration behind upper jaw 21.93 70.00 $1,535.10

31050 Exploration sphenoid sinus 13.82 70.00 $967.40

31051 Sphenoid sinus surgery 18.39 70.00 $1,287.30

31070 Exploration of frontal sinus 12.51 70.00 $875.70

31075 Exploration of frontal sinus 22.26 70.00 $1,558.20

31080 Removal of frontal sinus 29.38 70.00 $2,056.60






31090 Exploration of sinuses 29.17 70.00 $2,041.90

3110F Pres/absn hmrhg/lesion docd 0.00 70.00 $0.00

3111F Ct/mri brain done w/in 24hrs 0.00 70.00 $0.00

3112F Ct/mri brain done 24 hrs 0.00 70.00 $0.00

3115F Quant results activity &symp 0.00 70.00 $0.00

3117F Hf assessment tool completed 0.00 70.00 $0.00

3118F Ny heart assoc class docd 0.00 70.00 $0.00

3119F No eval activity clin symp 0.00 70.00 $0.00

3120F 12-lead ecg performed 0.00 70.00 $0.00

31200 Removal of ethmoid sinus 16.18 70.00 $1,132.60



31225 Removal of upper jaw 53.65 70.00 $3,755.50

31230 Removal of upper jaw 59.37 70.00 $4,155.90

31231 Nasal endoscopy dx 5.97 70.00 $417.90

31233 Nasal/sinus endoscopy dx 7.49 70.00 $524.30

31235 Nasal/sinus endoscopy dx 8.53 70.00 $597.10

31237 Nasal/sinus endoscopy surg 7.37 70.00 $515.90


31239 Nasal/sinus endoscopy surg 17.56 70.00 $1,229.20


31254 Revision of ethmoid sinus 7.87 70.00 $550.90

31255 Removal of ethmoid sinus 11.53 70.00 $807.10

31256 Exploration maxillary sinus 5.71 70.00 $399.70

3126F Esoph bx rprt w/dyspl info 0.00 70.00 $0.00

31267 Endoscopy maxillary sinus 9.16 70.00 $641.20

31276 Sinus endoscopy surgical 14.53 70.00 $1,017.10








31295 Sinus endo w/balloon dil 58.37 70.00 $4,085.90



31299 Sinus surgery procedure 0.00 70.00 $0.00

3130F Upper gi endoscopy performed 0.00 70.00 $0.00

31300 Removal of larynx lesion 36.16 70.00 $2,531.20

3132F Doc ref upper gi endoscopy 0.00 70.00 $0.00

31320 Diagnostic incision larynx 18.73 70.00 $1,311.10

31360 Removal of larynx 59.60 70.00 $4,172.00

31365 Removal of larynx 73.77 70.00 $5,163.90

31367 Partial removal of larynx 63.14 70.00 $4,419.80






31390 Removal of larynx & pharynx 81.78 70.00 $5,724.60

31395 Reconstruct larynx & pharynx 86.07 70.00 $6,024.90

3140F Upper gi endo shows barrtts 0.00 70.00 $0.00

31400 Revision of larynx 28.57 70.00 $1,999.90

3141F Upper gi endo not barrtts 0.00 70.00 $0.00

3142F Barium swallow test ordered 0.00 70.00 $0.00

31420 Removal of epiglottis 23.88 70.00 $1,671.60

3150F Forceps esoph biopsy done 0.00 70.00 $0.00

31500 Insert emergency airway 3.17 70.00 $221.90

31502 Change of windpipe airway 1.00 70.00 $70.00

31505 Diagnostic laryngoscopy 2.36 70.00 $165.20

31510 Laryngoscopy with biopsy 6.06 70.00 $424.20

31511 Remove foreign body larynx 6.04 70.00 $422.80

31512 Removal of larynx lesion 5.92 70.00 $414.40

31513 Injection into vocal cord 3.83 70.00 $268.10

31515 Laryngoscopy for aspiration 5.92 70.00 $414.40

31520 Dx laryngoscopy newborn 4.54 70.00 $317.80

31525 Dx laryngoscopy excl nb 7.23 70.00 $506.10

31526 Dx laryngoscopy w/oper scope 4.55 70.00 $318.50

31527 Laryngoscopy for treatment 5.68 70.00 $397.60

31528 Laryngoscopy and dilation 4.19 70.00 $293.30

31529 Laryngoscopy and dilation 4.70 70.00 $329.00

31530 Laryngoscopy w/fb removal 5.70 70.00 $399.00

31531 Laryngoscopy w/fb & op scope 6.17 70.00 $431.90

31535 Laryngoscopy w/biopsy 5.51 70.00 $385.70

31536 Laryngoscopy w/bx & op scope 6.12 70.00 $428.40

31540 Laryngoscopy w/exc of tumor 7.03 70.00 $492.10

31541 Larynscop w/tumr exc + scope 7.68 70.00 $537.60

31545 Remove vc lesion w/scope 10.51 70.00 $735.70

31546 Remove vc lesion scope/graft 15.99 70.00 $1,119.30

3155F Cytogen test marrow b/4 tx 0.00 70.00 $0.00

31560 Laryngoscop w/arytenoidectom 9.11 70.00 $637.70

31561 Larynscop remve cart + scop 9.96 70.00 $697.20

31570 Laryngoscope w/vc inj 9.73 70.00 $681.10

31571 Laryngoscop w/vc inj + scope 7.26 70.00 $508.20


31576 Laryngoscopy with biopsy 6.39 70.00 $447.30

31577 Remove foreign body larynx 6.92 70.00 $484.40

31578 Removal of larynx lesion 7.95 70.00 $556.50




31584 Treat larynx fracture 43.29 70.00 $3,030.30



31590 Reinnervate larynx 25.45 70.00 $1,781.50

31595 Larynx nerve surgery 21.88 70.00 $1,531.60

31599 Larynx surgery procedure 0.00 70.00 $0.00

3160F Doc fe+ stores b/4 epo thx 0.00 70.00 $0.00

31600 Incision of windpipe 11.49 70.00 $804.30




31610 Incision of windpipe 20.53 70.00 $1,437.10

31611 Surgery/speech prosthesis 15.47 70.00 $1,082.90

31612 Puncture/clear windpipe 2.47 70.00 $172.90

31613 Repair windpipe opening 13.01 70.00 $910.70

31614 Repair windpipe opening 21.69 70.00 $1,518.30

31615 Visualization of windpipe 5.20 70.00 $364.00

31620 Endobronchial us add-on 8.20 70.00 $574.00

31622 Dx bronchoscope/wash 8.92 70.00 $624.40

31623 Dx bronchoscope/brush 9.43 70.00 $660.10

31624 Dx bronchoscope/lavage 8.93 70.00 $625.10

31625 Bronchoscopy w/biopsy(s) 9.49 70.00 $664.30

31626 Bronchoscopy w/markers 12.76 70.00 $893.20

31627 Navigational bronchoscopy 40.13 70.00 $2,809.10

31628 Bronchoscopy/lung bx each 10.60 70.00 $742.00

31629 Bronchoscopy/needle bx each 16.78 70.00 $1,174.60

31630 Bronchoscopy dilate/fx repr 5.79 70.00 $405.30

31631 Bronchoscopy dilate w/stent 6.70 70.00 $469.00

31632 Bronchoscopy/lung bx addl 2.03 70.00 $142.10

31633 Bronchoscopy/needle bx addl 2.51 70.00 $175.70

31634 Bronch w/balloon occlusion 53.50 70.00 $3,745.00

31635 Bronchoscopy w/fb removal 9.97 70.00 $697.90

31636 Bronchoscopy bronch stents 6.41 70.00 $448.70

31637 Bronchoscopy stent add-on 2.14 70.00 $149.80

31638 Bronchoscopy revise stent 7.34 70.00 $513.80

31640 Bronchoscopy w/tumor excise 7.36 70.00 $515.20

31641 Bronchoscopy treat blockage 7.44 70.00 $520.80

31643 Diag bronchoscope/catheter 5.10 70.00 $357.00

31645 Bronchoscopy clear airways 9.22 70.00 $645.40

31646 Bronchoscopy reclear airway 8.29 70.00 $580.30

31647 Bronchial valve init insert 6.44 70.00 $450.80

31648 Bronchial valve remov init 5.86 70.00 $410.20

31649 Bronchial valve remov addl 1.96 70.00 $137.20

31651 Bronchial valve addl insert 2.14 70.00 $149.80

31660 Bronch thermoplsty 1 lobe 6.02 70.00 $421.40

31661 Bronch thermoplsty 2/> lobes 6.30 70.00 $441.00

3170F Flow cyto done b/4 tx 0.00 70.00 $0.00

31717 Bronchial brush biopsy 7.44 70.00 $520.80

31720 Clearance of airways 1.47 70.00 $102.90

31725 Clearance of airways 2.57 70.00 $179.90

31730 Intro windpipe wire/tube 34.89 70.00 $2,442.30

31750 Repair of windpipe 39.47 70.00 $2,762.90



31766 Reconstruction of windpipe 48.91 70.00 $3,423.70

31770 Repair/graft of bronchus 38.88 70.00 $2,721.60

31775 Reconstruct bronchus 35.60 70.00 $2,492.00

31780 Reconstruct windpipe 34.22 70.00 $2,395.40

31781 Reconstruct windpipe 40.42 70.00 $2,829.40

31785 Remove windpipe lesion 30.95 70.00 $2,166.50

31786 Remove windpipe lesion 45.84 70.00 $3,208.80

31800 Repair of windpipe injury 20.41 70.00 $1,428.70

31805 Repair of windpipe injury 23.75 70.00 $1,662.50

31820 Closure of windpipe lesion 12.41 70.00 $868.70

31825 Repair of windpipe defect 17.26 70.00 $1,208.20

31830 Revise windpipe scar 12.68 70.00 $887.60

31899 Airways surgical procedure 0.00 70.00 $0.00

3200F Barium swallow test not req 0.00 70.00 $0.00

32035 Thoracostomy w/rib resection 21.02 70.00 $1,471.40

32036 Thoracostomy w/flap drainage 22.56 70.00 $1,579.20

32096 Open wedge/bx lung infiltr 23.37 70.00 $1,635.90

32097 Open wedge/bx lung nodule 23.37 70.00 $1,635.90

32098 Open biopsy of lung pleura 22.15 70.00 $1,550.50

3210F Grp a strep test performed 0.00 70.00 $0.00

32100 Exploration of chest 23.49 70.00 $1,644.30

32110 Explore/repair chest 42.45 70.00 $2,971.50

32120 Re-exploration of chest 25.23 70.00 $1,766.10

32124 Explore chest free adhesions 26.93 70.00 $1,885.10

32140 Removal of lung lesion(s) 28.96 70.00 $2,027.20

32141 Remove/treat lung lesions 44.27 70.00 $3,098.90

3215F Pt immunity to hep a docd 0.00 70.00 $0.00

32150 Removal of lung lesion(s) 29.22 70.00 $2,045.40

32151 Remove lung foreign body 29.38 70.00 $2,056.60

3216F Pt immunity to hep b docd 0.00 70.00 $0.00

32160 Open chest heart massage 22.86 70.00 $1,600.20

3218F Rna tstng hep c docd done 0.00 70.00 $0.00

3220F Hep c quant rna tstng docd 0.00 70.00 $0.00

32200 Drain open lung lesion 33.26 70.00 $2,328.20

32215 Treat chest lining 23.25 70.00 $1,627.50

32220 Release of lung 45.96 70.00 $3,217.20

32225 Partial release of lung 28.82 70.00 $2,017.40

3230F Note hring tst w/in 6 mon 0.00 70.00 $0.00

32310 Removal of chest lining 26.20 70.00 $1,834.00

32320 Free/remove chest lining 46.40 70.00 $3,248.00

32400 Needle biopsy chest lining 4.34 70.00 $303.80

32405 Percut bx lung/mediastinum 12.80 70.00 $896.00

32440 Remove lung pneumonectomy 45.43 70.00 $3,180.10

32442 Sleeve pneumonectomy 89.58 70.00 $6,270.60

32445 Removal of lung extrapleural 103.29 70.00 $7,230.30

32480 Partial removal of lung 42.92 70.00 $3,004.40

32482 Bilobectomy 46.03 70.00 $3,222.10

32484 Segmentectomy 41.78 70.00 $2,924.60

32486 Sleeve lobectomy 68.44 70.00 $4,790.80

32488 Completion pneumonectomy 70.26 70.00 $4,918.20

32491 Lung volume reduction 42.96 70.00 $3,007.20

3250F Nonprim loc anat bx site tum 0.00 70.00 $0.00

32501 Repair bronchus add-on 7.14 70.00 $499.80

32503 Resect apical lung tumor 52.66 70.00 $3,686.20

32504 Resect apical lung tum/chest 60.42 70.00 $4,229.40

32505 Wedge resect of lung initial 27.07 70.00 $1,894.90

32506 Wedge resect of lung add-on 4.58 70.00 $320.60

32507 Wedge resect of lung diag 4.57 70.00 $319.90

32540 Removal of lung lesion 50.35 70.00 $3,524.50

32550 Insert pleural cath 22.30 70.00 $1,561.00

32551 Insertion of chest tube 4.93 70.00 $345.10

32552 Remove lung catheter 5.34 70.00 $373.80

32553 Ins mark thor for rt perq 16.84 70.00 $1,178.80

32554 Aspirate pleura w/o imaging 5.71 70.00 $399.70

32555 Aspirate pleura w/ imaging 8.21 70.00 $574.70

32556 Insert cath pleura w/o image 15.76 70.00 $1,103.20

32557 Insert cath pleura w/ image 14.52 70.00 $1,016.40

32560 Treat pleurodesis w/agent 6.94 70.00 $485.80

32561 Lyse chest fibrin init day 2.66 70.00 $186.20

32562 Lyse chest fibrin subq day 2.41 70.00 $168.70

3260F Pt cat/pn cat/hist grd docd 0.00 70.00 $0.00

32601 Thoracoscopy diagnostic 8.96 70.00 $627.20

32604 Thoracoscopy wbx sac 14.08 70.00 $985.60

32606 Thoracoscopy w/bx med space 13.42 70.00 $939.40

32607 Thoracoscopy w/bx infiltrate 8.98 70.00 $628.60

32608 Thoracoscopy w/bx nodule 11.02 70.00 $771.40

32609 Thoracoscopy w/bx pleura 7.54 70.00 $527.80

3265F Rna tstng hepc vir ord/docd 0.00 70.00 $0.00

32650 Thoracoscopy w/pleurodesis 19.30 70.00 $1,351.00

32651 Thoracoscopy remove cortex 31.86 70.00 $2,230.20

32652 Thoracoscopy rem totl cortex 48.27 70.00 $3,378.90

32653 Thoracoscopy remov fb/fibrin 30.75 70.00 $2,152.50

32654 Thoracoscopy contrl bleeding 33.21 70.00 $2,324.70

32655 Thoracoscopy resect bullae 27.74 70.00 $1,941.80

32656 Thoracoscopy w/pleurectomy 23.31 70.00 $1,631.70

32658 Thoracoscopy w/sac fb remove 20.82 70.00 $1,457.40

32659 Thoracoscopy w/sac drainage 21.27 70.00 $1,488.90

3266F Hepc gn tstng docd b/4txmnt 0.00 70.00 $0.00

32661 Thoracoscopy w/pericard exc 23.29 70.00 $1,630.30

32662 Thoracoscopy w/mediast exc 25.97 70.00 $1,817.90

32663 Thoracoscopy w/lobectomy 40.72 70.00 $2,850.40

32664 Thoracoscopy w/ th nrv exc 24.74 70.00 $1,731.80

32665 Thoracoscop w/esoph musc exc 36.02 70.00 $2,521.40

32666 Thoracoscopy w/wedge resect 25.30 70.00 $1,771.00

32667 Thoracoscopy w/w resect addl 4.59 70.00 $321.30

32668 Thoracoscopy w/w resect diag 4.58 70.00 $320.60

32669 Thoracoscopy remove segment 39.10 70.00 $2,737.00

3267F Path rprt w/ pt pn cat et al 0.00 70.00 $0.00

32670 Thoracoscopy bilobectomy 46.66 70.00 $3,266.20

32671 Thoracoscopy pneumonectomy 51.97 70.00 $3,637.90

32672 Thoracoscopy for lvrs 44.21 70.00 $3,094.70

32673 Thoracoscopy w/thymus resect 35.41 70.00 $2,478.70

32674 Thoracoscopy lymph node exc 6.30 70.00 $441.00

3268F Psa/t/glsc docd b/4 txmnt 0.00 70.00 $0.00

3269F Bone scn b/4 txmnt/aftr dx 0.00 70.00 $0.00

3270F No bone scn b/4 txmnt/aftrdx 0.00 70.00 $0.00

32701 Thorax stereo rad targetw/tx 6.23 70.00 $436.10

3271F Low risk prostate cancer 0.00 70.00 $0.00

3272F Med risk prostate cancer 0.00 70.00 $0.00

3273F High risk prostate cancer 0.00 70.00 $0.00

3274F Prost cncr rsk not lw/md/hgh 0.00 70.00 $0.00

3278F Serum lvls ca/ipth/lpd ord 0.00 70.00 $0.00

3279F Hgb lvl >/= 13 g/dl 0.00 70.00 $0.00

3280F Hgb lvl 11-12.9 g/dl 0.00 70.00 $0.00

32800 Repair lung hernia 27.73 70.00 $1,941.10

3281F Hgb lvl <11 g/dl 0.00 70.00 $0.00

32810 Close chest after drainage 26.31 70.00 $1,841.70

32815 Close bronchial fistula 81.53 70.00 $5,707.10

32820 Reconstruct injured chest 40.77 70.00 $2,853.90

3284F Iop down >15% of pre-svc lvl 0.00 70.00 $0.00

3285F Iop down <15% of pre-svc lvl 0.00 70.00 $0.00

32850 Donor pneumonectomy 0.00 70.00 $0.00

32851 Lung transplant single 95.83 70.00 $6,708.10

32852 Lung transplant with bypass 105.04 70.00 $7,352.80

32853 Lung transplant double 133.96 70.00 $9,377.20

32854 Lung transplant with bypass 142.19 70.00 $9,953.30

32855 Prepare donor lung single 0.00 70.00 $0.00

32856 Prepare donor lung double 0.00 70.00 $0.00

3288F Fall risk assessment docd 0.00 70.00 $0.00

3290F Pt=d(rh)- and unsensitized 0.00 70.00 $0.00

32900 Removal of rib(s) 41.46 70.00 $2,902.20

32905 Revise & repair chest wall 39.03 70.00 $2,732.10

32906 Revise & repair chest wall 48.21 70.00 $3,374.70

3291F Pt=d(rh)+ or sensitized 0.00 70.00 $0.00

3292F Hiv tstng asked/docd/revwd 0.00 70.00 $0.00

3293F Abo rh blood typing docd 0.00 70.00 $0.00

3294F Grp b strep screening docd 0.00 70.00 $0.00

32940 Revision of lung 36.07 70.00 $2,524.90

32960 Therapeutic pneumothorax 3.61 70.00 $252.70

32997 Total lung lavage 9.87 70.00 $690.90

32998 Perq rf ablate tx pul tumor 84.03 70.00 $5,882.10

32999 Chest surgery procedure 0.00 70.00 $0.00

3300F Ajcc stage docd b/4 thxpy 0.00 70.00 $0.00

3301F Cancer stage docd metast 0.00 70.00 $0.00

33010 Drainage of heart sac 3.49 70.00 $244.30

33011 Repeat drainage of heart sac 3.52 70.00 $246.40

33015 Incision of heart sac 14.74 70.00 $1,031.80



33030 Partial removal of heart sac 58.26 70.00 $4,078.20

33031 Partial removal of heart sac 71.72 70.00 $5,020.40

33050 Resect heart sac lesion 29.25 70.00 $2,047.50

33120 Removal of heart lesion 61.06 70.00 $4,274.20


33140 Heart revascularize (tmr) 46.14 70.00 $3,229.80

33141 Heart tmr w/other procedure 3.82 70.00 $267.40

3315F Er+ or pr+ breast cancer 0.00 70.00 $0.00

3316F Er- or pr- breast cancer 0.00 70.00 $0.00

3317F Path rpt malig cancer docd 0.00 70.00 $0.00

3318F Path rpt malig cancer docd 0.00 70.00 $0.00

3319F X-ray/ct/ultrsnd et al ord 0.00 70.00 $0.00

3320F No xray/ct/ et al ordd 0.00 70.00 $0.00

33202 Insert epicard eltrd open 22.55 70.00 $1,578.50

33203 Insert epicard eltrd endo 23.42 70.00 $1,639.40

33206 Insert heart pm atrial 13.38 70.00 $936.60

33207 Insert heart pm ventricular 14.25 70.00 $997.50

33208 Insrt heart pm atrial & vent 15.42 70.00 $1,079.40

3321F Ajcc cncr 0/ia melan docd 0.00 70.00 $0.00

33210 Insert electrd/pm cath sngl 5.19 70.00 $363.30

33211 Insert card electrodes dual 5.29 70.00 $370.30

33212 Insert pulse gen sngl lead 9.64 70.00 $674.80

33213 Insert pulse gen dual leads 10.07 70.00 $704.90

33214 Upgrade of pacemaker system 14.13 70.00 $989.10

33215 Reposition pacing-defib lead 8.97 70.00 $627.90

33216 Insert 1 electrode pm-defib 11.06 70.00 $774.20

33217 Insert 2 electrode pm-defib 10.85 70.00 $759.50

33218 Repair lead pace-defib one 11.59 70.00 $811.30

3322F Melanomaajcc stage 0 or ia 0.00 70.00 $0.00

33220 Repair lead pace-defib dual 11.60 70.00 $812.00

33221 Insert pulse gen mult leads 10.77 70.00 $753.90

33222 Relocation pocket pacemaker 10.07 70.00 $704.90

33223 Relocate pocket for defib 12.15 70.00 $850.50

33224 Insert pacing lead & connect 14.93 70.00 $1,045.10

33225 L ventric pacing lead add-on 13.56 70.00 $949.20

33226 Reposition l ventric lead 14.34 70.00 $1,003.80

33227 Remove&replace pm gen singl 10.15 70.00 $710.50

33228 Remv&replc pm gen dual lead 10.57 70.00 $739.90

33229 Remv&replc pm gen mult leads 11.09 70.00 $776.30

3323F Clin node stgng docdb/4 surg 0.00 70.00 $0.00

33230 Insrt pulse gen w/dual leads 11.41 70.00 $798.70

33231 Insrt pulse gen w/mult leads 12.03 70.00 $842.10

33233 Removal of pm generator 7.02 70.00 $491.40

33234 Removal of pacemaker system 14.39 70.00 $1,007.30

33235 Removal pacemaker electrode 18.72 70.00 $1,310.40

33236 Remove electrode/thoracotomy 22.74 70.00 $1,591.80



3324F Mri ct scan ord rvwd rqstd 0.00 70.00 $0.00

33240 Insrt pulse gen w/singl lead 10.92 70.00 $764.40

33241 Remove pulse generator 6.61 70.00 $462.70

33243 Remove eltrd/thoracotomy 39.82 70.00 $2,787.40

33244 Remove elctrd transvenously 25.18 70.00 $1,762.60

33249 Insj/rplcmt defib w/lead(s) 26.84 70.00 $1,878.80

3325F Preop asses 4 cataract surg 0.00 70.00 $0.00

33250 Ablate heart dysrhythm focus 43.01 70.00 $3,010.70


33254 Ablate atria lmtd 39.61 70.00 $2,772.70

33255 Ablate atria w/o bypass ext 47.70 70.00 $3,339.00

33256 Ablate atria w/bypass exten 56.75 70.00 $3,972.50

33257 Ablate atria lmtd add-on 16.91 70.00 $1,183.70

33258 Ablate atria x10sv add-on 19.12 70.00 $1,338.40

33259 Ablate atria w/bypass add-on 24.51 70.00 $1,715.70


33262 Rmvl& replc pulse gen 1 lead 11.12 70.00 $778.40

33263 Rmvl & rplcmt dfb gen 2 lead 11.58 70.00 $810.60

33264 Rmvl & rplcmt dfb gen mlt ld 12.06 70.00 $844.20

33265 Ablate atria lmtd endo 39.49 70.00 $2,764.30

33266 Ablate atria x10sv endo 53.83 70.00 $3,768.10

33270 Ins/rep subq defibrillator 17.06 70.00 $1,194.20

33271 Insj subq impltbl dfb elctrd 14.35 70.00 $1,004.50

33272 Rmvl of subq defibrillator 10.56 70.00 $739.20

33273 Repos prev impltbl subq dfb 11.62 70.00 $813.40

3328F Prfrmnc docd 2 wks b/4 surg 0.00 70.00 $0.00

33282 Implant pat-active ht record 6.90 70.00 $483.00

33284 Remove pat-active ht record 6.12 70.00 $428.40

3330F Imaging study ordered (bkp) 0.00 70.00 $0.00

33300 Repair of heart wound 71.22 70.00 $4,985.40

33305 Repair of heart wound 119.45 70.00 $8,361.50

3331F Bk imaging tst not ordered 0.00 70.00 $0.00

33310 Exploratory heart surgery 34.86 70.00 $2,440.20

33315 Exploratory heart surgery 55.78 70.00 $3,904.60

33320 Repair major blood vessel(s) 30.99 70.00 $2,169.30

33321 Repair major vessel 35.05 70.00 $2,453.50

33322 Repair major blood vessel(s) 40.32 70.00 $2,822.40

33330 Insert major vessel graft 41.72 70.00 $2,920.40

33335 Insert major vessel graft 55.05 70.00 $3,853.50

33361 Replace aortic valve perq 39.54 70.00 $2,767.80

33362 Replace aortic valve open 43.23 70.00 $3,026.10




33366 Trcath replace aortic valve 56.08 70.00 $3,925.60

33367 Replace aortic valve w/byp 18.17 70.00 $1,271.90



3340F Mammo assess inc xray docd 0.00 70.00 $0.00

33400 Repair of aortic valve 66.30 70.00 $4,641.00

33401 Valvuloplasty open 42.07 70.00 $2,944.90

33403 Valvuloplasty w/cp bypass 43.15 70.00 $3,020.50

33404 Prepare heart-aorta conduit 51.67 70.00 $3,616.90

33405 Replacement of aortic valve 66.00 70.00 $4,620.00


3341F Mammo assess negative docd 0.00 70.00 $0.00






33415 Revision subvalvular tissue 59.14 70.00 $4,139.80

33416 Revise ventricle muscle 59.10 70.00 $4,137.00


33418 Repair tcat mitral valve 54.00 70.00 $3,780.00

33419 Repair tcat mitral valve 12.69 70.00 $888.30

3342F Mammo assess bengn docd 0.00 70.00 $0.00

33420 Revision of mitral valve 41.91 70.00 $2,933.70


33425 Repair of mitral valve 79.44 70.00 $5,560.80



3343F Mammo probably bengn docd 0.00 70.00 $0.00

33430 Replacement of mitral valve 81.36 70.00 $5,695.20

3344F Mammo assess susp docd 0.00 70.00 $0.00

3345F Mammo assess hghlymalig doc 0.00 70.00 $0.00

33460 Revision of tricuspid valve 71.12 70.00 $4,978.40

33463 Valvuloplasty tricuspid 90.02 70.00 $6,301.40

33464 Valvuloplasty tricuspid 71.01 70.00 $4,970.70

33465 Replace tricuspid valve 80.22 70.00 $5,615.40

33468 Revision of tricuspid valve 71.30 70.00 $4,991.00

33470 Revision of pulmonary valve 35.94 70.00 $2,515.80

33471 Valvotomy pulmonary valve 36.41 70.00 $2,548.70


33475 Replacement pulmonary valve 68.32 70.00 $4,782.40

33476 Revision of heart chamber 44.41 70.00 $3,108.70


33496 Repair prosth valve clot 48.80 70.00 $3,416.00

3350F Mammo bx proven malig docd 0.00 70.00 $0.00

33500 Repair heart vessel fistula 45.72 70.00 $3,200.40

33501 Repair heart vessel fistula 32.68 70.00 $2,287.60

33502 Coronary artery correction 37.09 70.00 $2,596.30

33503 Coronary artery graft 38.48 70.00 $2,693.60

33504 Coronary artery graft 42.54 70.00 $2,977.80

33505 Repair artery w/tunnel 60.01 70.00 $4,200.70

33506 Repair artery translocation 63.02 70.00 $4,411.40

33507 Repair art intramural 50.11 70.00 $3,507.70

33508 Endoscopic vein harvest 0.46 70.00 $32.20

3351F Neg scrn dep symp by deptool 0.00 70.00 $0.00

33510 Cabg vein single 56.17 70.00 $3,931.90

33511 Cabg vein two 61.73 70.00 $4,321.10

33512 Cabg vein three 70.21 70.00 $4,914.70

33513 Cabg vein four 72.27 70.00 $5,058.90

33514 Cabg vein five 76.39 70.00 $5,347.30

33516 Cabg vein six or more 80.01 70.00 $5,600.70

33517 Cabg artery-vein single 5.46 70.00 $382.20

33518 Cabg artery-vein two 12.00 70.00 $840.00

33519 Cabg artery-vein three 15.86 70.00 $1,110.20

3352F No sig dep symp by dep tool 0.00 70.00 $0.00

33521 Cabg artery-vein four 19.01 70.00 $1,330.70

33522 Cabg artery-vein five 21.36 70.00 $1,495.20

33523 Cabg art-vein six or more 24.42 70.00 $1,709.40

3353F Mild-mod dep symp by deptool 0.00 70.00 $0.00

33530 Coronary artery bypass/reop 15.35 70.00 $1,074.50

33533 Cabg arterial single 54.34 70.00 $3,803.80

33534 Cabg arterial two 63.94 70.00 $4,475.80

33535 Cabg arterial three 71.34 70.00 $4,993.80

33536 Cabg arterial four or more 76.98 70.00 $5,388.60

3354F Clin sig dep sym by dep tool 0.00 70.00 $0.00


33545 Repair of heart damage 90.16 70.00 $6,311.20

33548 Restore/remodel ventricle 86.20 70.00 $6,034.00

33572 Open coronary endarterectomy 6.72 70.00 $470.40

33600 Closure of valve 50.35 70.00 $3,524.50

33602 Closure of valve 48.83 70.00 $3,418.10

33606 Anastomosis/artery-aorta 49.05 70.00 $3,433.50

33608 Repair anomaly w/conduit 52.29 70.00 $3,660.30

33610 Repair by enlargement 52.02 70.00 $3,641.40

33611 Repair double ventricle 54.02 70.00 $3,781.40

33612 Repair double ventricle 58.28 70.00 $4,079.60

33615 Repair modified fontan 58.53 70.00 $4,097.10

33617 Repair single ventricle 62.88 70.00 $4,401.60

33619 Repair single ventricle 75.27 70.00 $5,268.90

33620 Apply r&l pulm art bands 44.00 70.00 $3,080.00

33621 Transthor cath for stent 27.22 70.00 $1,905.40

33622 Redo compl cardiac anomaly 98.91 70.00 $6,923.70

33641 Repair heart septum defect 47.55 70.00 $3,328.50

33645 Revision of heart veins 50.31 70.00 $3,521.70

33647 Repair heart septum defects 52.84 70.00 $3,698.80

33660 Repair of heart defects 51.55 70.00 $3,608.50


33670 Repair of heart chambers 57.86 70.00 $4,050.20

33675 Close mult vsd 57.85 70.00 $4,049.50

33676 Close mult vsd w/resection 56.05 70.00 $3,923.50

33677 Cl mult vsd w/rem pul band 58.24 70.00 $4,076.80




33690 Reinforce pulmonary artery 35.12 70.00 $2,458.40




3370F Ajcc brst cncr stage 0 docd 0.00 70.00 $0.00




33720 Repair of heart defect 45.32 70.00 $3,172.40

33722 Repair of heart defect 47.59 70.00 $3,331.30

33724 Repair venous anomaly 44.75 70.00 $3,132.50

33726 Repair pul venous stenosis 59.65 70.00 $4,175.50

33730 Repair heart-vein defect(s) 58.77 70.00 $4,113.90

33732 Repair heart-vein defect 48.29 70.00 $3,380.30





33750 Major vessel shunt 38.72 70.00 $2,710.40


3376F Ajcc brstcncr stage 2 docd 0.00 70.00 $0.00


33764 Major vessel shunt & graft 36.19 70.00 $2,533.30



33768 Cavopulmonary shunting 11.61 70.00 $812.70

33770 Repair great vessels defect 58.69 70.00 $4,108.30











33782 Nikaidoh proc 94.66 70.00 $6,626.20

33783 Nikaidoh proc w/ostia implt 96.85 70.00 $6,779.50

33786 Repair arterial trunk 63.06 70.00 $4,414.20

33788 Revision of pulmonary artery 44.92 70.00 $3,144.40


33800 Aortic suspension 30.32 70.00 $2,122.40

33802 Repair vessel defect 33.30 70.00 $2,331.00

33803 Repair vessel defect 31.70 70.00 $2,219.00

33813 Repair septal defect 34.10 70.00 $2,387.00


3382F Ajcc cln cncr stage 0 docd 0.00 70.00 $0.00

33820 Revise major vessel 28.14 70.00 $1,969.80




33840 Remove aorta constriction 34.07 70.00 $2,384.90






33860 Ascending aortic graft 93.46 70.00 $6,542.20



33870 Transverse aortic arch graft 73.38 70.00 $5,136.60

33875 Thoracic aortic graft 80.05 70.00 $5,603.50

33877 Thoracoabdominal graft 106.43 70.00 $7,450.10


33880 Endovasc taa repr incl subcl 52.97 70.00 $3,707.90

33881 Endovasc taa repr w/o subcl 45.52 70.00 $3,186.40

33883 Insert endovasc prosth taa 32.97 70.00 $2,307.90

33884 Endovasc prosth taa add-on 12.19 70.00 $853.30

33886 Endovasc prosth delayed 28.46 70.00 $1,992.20

33889 Artery transpose/endovas taa 23.34 70.00 $1,633.80

33891 Car-car bp grft/endovas taa 28.64 70.00 $2,004.80


33910 Remove lung artery emboli 76.70 70.00 $5,369.00

33915 Remove lung artery emboli 37.37 70.00 $2,615.90

33916 Surgery of great vessel 122.86 70.00 $8,600.20

33917 Repair pulmonary artery 42.67 70.00 $2,986.90

33920 Repair pulmonary atresia 53.01 70.00 $3,710.70

33922 Transect pulmonary artery 40.32 70.00 $2,822.40

33924 Remove pulmonary shunt 8.33 70.00 $583.10

33925 Rpr pul art unifocal w/o cpb 50.38 70.00 $3,526.60

33926 Repr pul art unifocal w/cpb 74.06 70.00 $5,184.20

33930 Removal of donor heart/lung 0.00 70.00 $0.00

33933 Prepare donor heart/lung 0.00 70.00 $0.00

33935 Transplantation heart/lung 144.79 70.00 $10,135.30

3394F Quant her2 ihc eval brst cx 0.00 70.00 $0.00

33940 Removal of donor heart 0.00 70.00 $0.00

33944 Prepare donor heart 0.00 70.00 $0.00

33945 Transplantation of heart 141.57 70.00 $9,909.90

33946 Ecmo/ecls initiation venous 8.99 70.00 $629.30

33947 Ecmo/ecls initiation artery 9.93 70.00 $695.10

33948 Ecmo/ecls daily mgmt-venous 7.10 70.00 $497.00

33949 Ecmo/ecls daily mgmt artery 6.91 70.00 $483.70

3395F Quant nonher2 ihc brst cx 0.00 70.00 $0.00

33951 Ecmo/ecls insj prph cannula 12.90 70.00 $903.00


33953 Ecmo/ecls insj prph cannula 14.39 70.00 $1,007.30


33955 Ecmo/ecls insj ctr cannula 25.98 70.00 $1,818.60

33956 Ecmo/ecls insj ctr cannula 24.58 70.00 $1,720.60

33957 Ecmo/ecls repos perph cnula 5.77 70.00 $403.90




33963 Ecmo/ecls repos perph cnula 14.64 70.00 $1,024.80

33964 Ecmo/ecls repos perph cnula 14.99 70.00 $1,049.30

33965 Ecmo/ecls rmvl perph cannula 5.77 70.00 $403.90

33966 Ecmo/ecls rmvl prph cannula 6.93 70.00 $485.10

33967 Insert i-aort percut device 7.55 70.00 $528.50

33968 Remove aortic assist device 0.97 70.00 $67.90

33969 Ecmo/ecls rmvl perph cannula 8.50 70.00 $595.00

33970 Aortic circulation assist 10.35 70.00 $724.50

33971 Aortic circulation assist 20.68 70.00 $1,447.60

33973 Insert balloon device 15.03 70.00 $1,052.10

33974 Remove intra-aortic balloon 26.01 70.00 $1,820.70

33975 Implant ventricular device 38.27 70.00 $2,678.90

33976 Implant ventricular device 46.64 70.00 $3,264.80

33977 Remove ventricular device 32.99 70.00 $2,309.30

33978 Remove ventricular device 39.14 70.00 $2,739.80

33979 Insert intracorporeal device 57.06 70.00 $3,994.20

33980 Remove intracorporeal device 52.01 70.00 $3,640.70

33981 Replace vad pump ext 24.43 70.00 $1,710.10

33982 Replace vad intra w/o bp 57.41 70.00 $4,018.70

33983 Replace vad intra w/bp 67.79 70.00 $4,745.30

33984 Ecmo/ecls rmvl prph cannula 8.34 70.00 $583.80

33985 Ecmo/ecls rmvl ctr cannula 16.01 70.00 $1,120.70

33986 Ecmo/ecls rmvl ctr cannula 15.21 70.00 $1,064.70

33987 Artery expos/graft artery 6.10 70.00 $427.00

33988 Insertion of left heart vent 22.68 70.00 $1,587.60

33989 Removal of left heart vent 14.42 70.00 $1,009.40

33990 Insert vad artery access 12.79 70.00 $895.30

33991 Insert vad art&vein access 18.52 70.00 $1,296.40

33992 Remove vad different session 6.23 70.00 $436.10

33993 Reposition vad diff session 5.49 70.00 $384.30

33999 Cardiac surgery procedure 0.00 70.00 $0.00

34001 Removal of artery clot 29.13 70.00 $2,039.10



34111 Removal of arm artery clot 17.69 70.00 $1,238.30



34203 Removal of leg artery clot 28.19 70.00 $1,973.30

34401 Removal of vein clot 43.05 70.00 $3,013.50





3450F Dyspnea scrnd no-mild dysp 0.00 70.00 $0.00

34501 Repair valve femoral vein 26.46 70.00 $1,852.20

34502 Reconstruct vena cava 44.99 70.00 $3,149.30

3451F Dyspnea scrnd mod-high dysp 0.00 70.00 $0.00

34510 Transposition of vein valve 34.82 70.00 $2,437.40

3452F Dyspnea not screened 0.00 70.00 $0.00

34520 Cross-over vein graft 29.30 70.00 $2,051.00

34530 Leg vein fusion 32.34 70.00 $2,263.80

3455F Tb scrng done-interpd 6mon 0.00 70.00 $0.00

3470F Ra disease activity low 0.00 70.00 $0.00

3471F Ra disease activity mod 0.00 70.00 $0.00

3472F Ra disease activity high 0.00 70.00 $0.00

3475F Disease progn ra poor docd 0.00 70.00 $0.00

3476F Disease progn ra good docd 0.00 70.00 $0.00

34800 Endovas aaa repr w/sm tube 33.33 70.00 $2,333.10

34802 Endovas aaa repr w/2-p part 36.86 70.00 $2,580.20



34805 Endovas aaa repr w/long tube 35.48 70.00 $2,483.60

34806 Aneurysm press sensor add-on 2.96 70.00 $207.20

34808 Endovas iliac a device addon 6.17 70.00 $431.90

34812 Xpose for endoprosth femorl 9.98 70.00 $698.60

34813 Femoral endovas graft add-on 7.01 70.00 $490.70

34820 Xpose for endoprosth iliac 14.51 70.00 $1,015.70

34825 Endovasc extend prosth init 20.53 70.00 $1,437.10

34826 Endovasc exten prosth addl 6.08 70.00 $425.60

34830 Open aortic tube prosth repr 52.31 70.00 $3,661.70

34831 Open aortoiliac prosth repr 56.25 70.00 $3,937.50

34832 Open aortofemor prosth repr 56.25 70.00 $3,937.50

34833 Xpose for endoprosth iliac 18.08 70.00 $1,265.60

34834 Xpose endoprosth brachial 8.05 70.00 $563.50

34839 Plnning pt spec fenest graft 0.00 70.00 $0.00

34841 Endovasc visc aorta 1 graft 0.00 70.00 $0.00




34845 Visc & infraren abd 1 prosth 0.00 70.00 $0.00



34848 Visc & infraren abd 4+ prost 0.00 70.00 $0.00

3490F History aids-defining cond 0.00 70.00 $0.00

34900 Endovasc iliac repr w/graft 26.42 70.00 $1,849.40

3491F Hiv unsure baby of hiv+moms 0.00 70.00 $0.00

3492F History cd4+ cell count <350 0.00 70.00 $0.00

3493F No hist cd4+ cell count <350 0.00 70.00 $0.00

3494F Cd4+cell count <200cells/mm3 0.00 70.00 $0.00

3495F Cd4+cell cnt 200-499 cells 0.00 70.00 $0.00

3496F Cd4+ cell count + 500 cells 0.00 70.00 $0.00

3497F Cd4+ cell percentage <15% 0.00 70.00 $0.00

3498F Cd4+ cell =15% (hiv) 0.00 70.00 $0.00

3500F Cd4+cell cnt/% docd as done 0.00 70.00 $0.00

35001 Repair defect of artery 33.42 70.00 $2,339.40

35002 Repair artery rupture neck 33.66 70.00 $2,356.20



35013 Repair artery rupture arm 36.82 70.00 $2,577.40

3502F Hiv rna vrl ld <lmts quantif 0.00 70.00 $0.00


35022 Repair artery rupture chest 42.50 70.00 $2,975.00

3503F Hiv rna vrl ldnot<lmts quntf 0.00 70.00 $0.00

35045 Repair defect of arm artery 29.33 70.00 $2,053.10


35082 Repair artery rupture aorta 64.93 70.00 $4,545.10



3510F Doc tb scrng-rslts interpd 0.00 70.00 $0.00



3511F Chlmyd/gonrh tsts docd done 0.00 70.00 $0.00


35112 Repair artery rupture spleen 55.16 70.00 $3,861.20

3512F Syph scrng docd as done 0.00 70.00 $0.00


35122 Repair artery rupture belly 63.65 70.00 $4,455.50

3513F Hep b scrng docd as done 0.00 70.00 $0.00


35132 Repair artery rupture groin 48.50 70.00 $3,395.00

3514F Hep c scrng docd as done 0.00 70.00 $0.00


35142 Repair artery rupture thigh 39.07 70.00 $2,734.90

3515F Pt has docd immun to hep c 0.00 70.00 $0.00


35152 Repair ruptd popliteal art 41.45 70.00 $2,901.50

3517F Hbv assess&results intrp 1yr 0.00 70.00 $0.00

35180 Repair blood vessel lesion 26.42 70.00 $1,849.40






3520F Cdifficile testing performed 0.00 70.00 $0.00




















35301 Rechanneling of artery 33.49 70.00 $2,344.30





35306 Rechanneling of artery 13.25 70.00 $927.50











35390 Reoperation carotid add-on 4.73 70.00 $331.10

35400 Angioscopy 4.42 70.00 $309.40

35450 Repair arterial blockage 14.85 70.00 $1,039.50

35452 Repair arterial blockage 10.11 70.00 $707.70


35460 Repair venous blockage 9.26 70.00 $648.20




35476 Repair venous blockage 40.60 70.00 $2,842.00

3550F Low rsk thromboembolism 0.00 70.00 $0.00

35500 Harvest vein for bypass 9.46 70.00 $662.20

35501 Art byp grft ipsilat carotid 44.55 70.00 $3,118.50

35506 Art byp grft subclav-carotid 37.83 70.00 $2,648.10

35508 Art byp grft carotid-vertbrl 39.42 70.00 $2,759.40

35509 Art byp grft contral carotid 41.98 70.00 $2,938.60

3551F Intrmed rsk thromboembolism 0.00 70.00 $0.00

35510 Art byp grft carotid-brchial 36.51 70.00 $2,555.70

35511 Art byp grft subclav-subclav 33.26 70.00 $2,328.20

35512 Art byp grft subclav-brchial 40.79 70.00 $2,855.30

35515 Art byp grft subclav-vertbrl 45.12 70.00 $3,158.40

35516 Art byp grft subclav-axilary 36.22 70.00 $2,535.40

35518 Art byp grft axillary-axilry 33.90 70.00 $2,373.00

3552F Hgh risk for thromboembolism 0.00 70.00 $0.00

35521 Art byp grft axill-femoral 36.39 70.00 $2,547.30

35522 Art byp grft axill-brachial 36.00 70.00 $2,520.00

35523 Art byp grft brchl-ulnr-rdl 38.28 70.00 $2,679.60

35525 Art byp grft brachial-brchl 34.04 70.00 $2,382.80

35526 Art byp grft aor/carot/innom 51.17 70.00 $3,581.90

35531 Art byp grft aorcel/aormesen 59.91 70.00 $4,193.70

35533 Art byp grft axill/fem/fem 44.70 70.00 $3,129.00

35535 Art byp grft hepatorenal 56.49 70.00 $3,954.30

35536 Art byp grft splenorenal 50.16 70.00 $3,511.20

35537 Art byp grft aortoiliac 70.14 70.00 $4,909.80

35538 Art byp grft aortobi-iliac 69.29 70.00 $4,850.30

35539 Art byp grft aortofemoral 65.09 70.00 $4,556.30

35540 Art byp grft aortbifemoral 76.05 70.00 $5,323.50

3555F Pt inr measurement performed 0.00 70.00 $0.00

35556 Art byp grft fem-popliteal 41.51 70.00 $2,905.70

35558 Art byp grft fem-femoral 36.37 70.00 $2,545.90

35560 Art byp grft aortorenal 50.59 70.00 $3,541.30

35563 Art byp grft ilioiliac 44.87 70.00 $3,140.90

35565 Art byp grft iliofemoral 39.36 70.00 $2,755.20

35566 Art byp fem-ant-post tib/prl 49.55 70.00 $3,468.50

35570 Art byp tibial-tib/peroneal 45.02 70.00 $3,151.40

35571 Art byp pop-tibl-prl-other 39.43 70.00 $2,760.10

35572 Harvest femoropopliteal vein 10.22 70.00 $715.40

35583 Vein byp grft fem-popliteal 43.06 70.00 $3,014.20

35585 Vein byp fem-tibial peroneal 49.82 70.00 $3,487.40

35587 Vein byp pop-tibl peroneal 40.68 70.00 $2,847.60

35600 Harvest art for cabg add-on 7.47 70.00 $522.90

35601 Art byp common ipsi carotid 41.59 70.00 $2,911.30

35606 Art byp carotid-subclavian 34.91 70.00 $2,443.70

35612 Art byp subclav-subclavian 30.98 70.00 $2,168.60

35616 Art byp subclav-axillary 32.71 70.00 $2,289.70

35621 Art byp axillary-femoral 32.65 70.00 $2,285.50

35623 Art byp axillary-pop-tibial 38.97 70.00 $2,727.90

35626 Art byp aorsubcl/carot/innom 46.44 70.00 $3,250.80

35631 Art byp aor-celiac-msn-renal 54.90 70.00 $3,843.00

35632 Art byp ilio-celiac 53.64 70.00 $3,754.80

35633 Art byp ilio-mesenteric 59.73 70.00 $4,181.10

35634 Art byp iliorenal 54.32 70.00 $3,802.40

35636 Art byp spenorenal 47.32 70.00 $3,312.40

35637 Art byp aortoiliac 51.61 70.00 $3,612.70

35638 Art byp aortobi-iliac 52.30 70.00 $3,661.00

35642 Art byp carotid-vertebral 33.91 70.00 $2,373.70

35645 Art byp subclav-vertebrl 28.05 70.00 $1,963.50

35646 Art byp aortobifemoral 50.92 70.00 $3,564.40

35647 Art byp aortofemoral 45.95 70.00 $3,216.50

35650 Art byp axillary-axillary 32.29 70.00 $2,260.30

35654 Art byp axill-fem-femoral 40.71 70.00 $2,849.70

35656 Art byp femoral-popliteal 32.15 70.00 $2,250.50

35661 Art byp femoral-femoral 32.18 70.00 $2,252.60

35663 Art byp ilioiliac 37.45 70.00 $2,621.50

35665 Art byp iliofemoral 34.76 70.00 $2,433.20

35666 Art byp fem-ant-post tib/prl 37.49 70.00 $2,624.30

35671 Art byp pop-tibl-prl-other 33.13 70.00 $2,319.10

35681 Composite byp grft pros&vein 2.37 70.00 $165.90

35682 Composite byp grft 2 veins 10.48 70.00 $733.60

35683 Composite byp grft 3/> segmt 12.17 70.00 $851.90

35685 Bypass graft patency/patch 5.90 70.00 $413.00

35686 Bypass graft/av fist patency 4.79 70.00 $335.30

35691 Art trnsposj vertbrl carotid 28.02 70.00 $1,961.40

35693 Art trnsposj subclavian 24.72 70.00 $1,730.40

35694 Art trnsposj subclav carotid 29.27 70.00 $2,048.90

35695 Art trnsposj carotid subclav 30.40 70.00 $2,128.00

35697 Reimplant artery each 4.38 70.00 $306.60

3570F Rprt bone scint xref w xray 0.00 70.00 $0.00

35700 Reoperation bypass graft 4.53 70.00 $317.10

35701 Exploration carotid artery 16.58 70.00 $1,160.60

3572F Pt consid poss risk fx 0.00 70.00 $0.00

35721 Exploration femoral artery 13.46 70.00 $942.20

3573F Pt not consid poss risk fx 0.00 70.00 $0.00

35741 Exploration popliteal artery 15.07 70.00 $1,054.90

35761 Exploration of artery/vein 11.48 70.00 $803.60

35800 Explore neck vessels 20.90 70.00 $1,463.00

35820 Explore chest vessels 58.55 70.00 $4,098.50

35840 Explore abdominal vessels 34.61 70.00 $2,422.70

35860 Explore limb vessels 24.76 70.00 $1,733.20

35870 Repair vessel graft defect 36.91 70.00 $2,583.70

35875 Removal of clot in graft 17.58 70.00 $1,230.60

35876 Removal of clot in graft 27.97 70.00 $1,957.90

35879 Revise graft w/vein 27.32 70.00 $1,912.40


35883 Revise graft w/nonauto graft 35.84 70.00 $2,508.80


35901 Excision graft neck 14.57 70.00 $1,019.90

35903 Excision graft extremity 16.69 70.00 $1,168.30

35905 Excision graft thorax 52.08 70.00 $3,645.60

35907 Excision graft abdomen 56.64 70.00 $3,964.80

36000 Place needle in vein 0.72 70.00 $50.40

36002 Pseudoaneurysm injection trt 4.67 70.00 $326.90

36005 Injection ext venography 9.18 70.00 $642.60

36010 Place catheter in vein 14.27 70.00 $998.90

36011 Place catheter in vein 23.76 70.00 $1,663.20

36012 Place catheter in vein 24.55 70.00 $1,718.50

36013 Place catheter in artery 22.21 70.00 $1,554.70



36100 Establish access to artery 13.99 70.00 $979.30



36147 Access av dial grft for eval 23.77 70.00 $1,663.90

36148 Access av dial grft for proc 7.45 70.00 $521.50

36160 Establish access to aorta 14.10 70.00 $987.00

36200 Place catheter in aorta 17.80 70.00 $1,246.00




36218 Place catheter in artery 5.25 70.00 $367.50

36221 Place cath thoracic aorta 31.14 70.00 $2,179.80

36222 Place cath carotid/inom art 36.07 70.00 $2,524.90

36223 Place cath carotid/inom art 43.29 70.00 $3,030.30

36224 Place cath carotd art 54.00 70.00 $3,780.00

36225 Place cath subclavian art 41.78 70.00 $2,924.60

36226 Place cath vertebral art 52.74 70.00 $3,691.80

36227 Place cath xtrnl carotid 7.47 70.00 $522.90

36228 Place cath intracranial art 35.90 70.00 $2,513.00

36245 Ins cath abd/l-ext art 1st 38.95 70.00 $2,726.50

36246 Ins cath abd/l-ext art 2nd 25.42 70.00 $1,779.40

36247 Ins cath abd/l-ext art 3rd 44.90 70.00 $3,143.00

36248 Ins cath abd/l-ext art addl 4.35 70.00 $304.50

36251 Ins cath ren art 1st unilat 40.50 70.00 $2,835.00

36252 Ins cath ren art 1st bilat 43.99 70.00 $3,079.30

36253 Ins cath ren art 2nd+ unilat 64.50 70.00 $4,515.00

36254 Ins cath ren art 2nd+ bilat 62.75 70.00 $4,392.50

36260 Insertion of infusion pump 18.71 70.00 $1,309.70

36261 Revision of infusion pump 10.49 70.00 $734.30

36262 Removal of infusion pump 8.84 70.00 $618.80

36299 Vessel injection procedure 0.00 70.00 $0.00

36400 Bl draw < 3 yrs fem/jugular 0.80 70.00 $56.00

36405 Bl draw <3 yrs scalp vein 0.75 70.00 $52.50

36406 Bl draw <3 yrs other vein 0.58 70.00 $40.60

36410 Non-routine bl draw 3/> yrs 0.48 70.00 $33.60

36415 Routine venipuncture 0.00 70.00 $0.00

36416 Capillary blood draw 0.00 70.00 $0.00

36420 Vein access cutdown < 1 yr 1.46 70.00 $102.20

36425 Vein access cutdown > 1 yr 1.15 70.00 $80.50

36430 Blood transfusion service 0.98 70.00 $68.60

36440 Bl push transfuse 2 yr/< 1.62 70.00 $113.40

36450 Bl exchange/transfuse nb 3.42 70.00 $239.40

36455 Bl exchange/transfuse non-nb 3.72 70.00 $260.40

36460 Transfusion service fetal 9.99 70.00 $699.30

36468 Injection(s) spider veins 0.00 70.00 $0.00

36470 Injection therapy of vein 4.27 70.00 $298.90

36471 Injection therapy of veins 4.99 70.00 $349.30

36475 Endovenous rf 1st vein 43.66 70.00 $3,056.20

36476 Endovenous rf vein add-on 8.45 70.00 $591.50

36478 Endovenous laser 1st vein 34.17 70.00 $2,391.90

36479 Endovenous laser vein addon 8.78 70.00 $614.60

36481 Insertion of catheter vein 58.66 70.00 $4,106.20

3650F Eeg ordered rvwd reqstd 0.00 70.00 $0.00

36500 Insertion of catheter vein 5.27 70.00 $368.90

36510 Insertion of catheter vein 2.64 70.00 $184.80

36511 Apheresis wbc 2.65 70.00 $185.50

36512 Apheresis rbc 2.72 70.00 $190.40

36513 Apheresis platelets 2.79 70.00 $195.30

36514 Apheresis plasma 15.16 70.00 $1,061.20

36515 Apheresis adsorp/reinfuse 58.24 70.00 $4,076.80

36516 Apheresis selective 58.80 70.00 $4,116.00

36522 Photopheresis 39.45 70.00 $2,761.50

36555 Insert non-tunnel cv cath 7.23 70.00 $506.10

36556 Insert non-tunnel cv cath 6.65 70.00 $465.50

36557 Insert tunneled cv cath 29.14 70.00 $2,039.80







36568 Insert picc cath 8.64 70.00 $604.80

36569 Insert picc cath 7.12 70.00 $498.40

36570 Insert picvad cath 33.86 70.00 $2,370.20

36571 Insert picvad cath 37.26 70.00 $2,608.20

36575 Repair tunneled cv cath 4.73 70.00 $331.10

36576 Repair tunneled cv cath 11.10 70.00 $777.00

36578 Replace tunneled cv cath 14.88 70.00 $1,041.60

36580 Replace cvad cath 6.13 70.00 $429.10




36584 Replace picc cath 5.82 70.00 $407.40

36585 Replace picvad cath 33.01 70.00 $2,310.70

36589 Removal tunneled cv cath 4.74 70.00 $331.80

36590 Removal tunneled cv cath 8.40 70.00 $588.00

36591 Draw blood off venous device 0.66 70.00 $46.20

36592 Collect blood from picc 0.74 70.00 $51.80

36593 Declot vascular device 0.87 70.00 $60.90

36595 Mech remov tunneled cv cath 16.67 70.00 $1,166.90

36596 Mech remov tunneled cv cath 3.80 70.00 $266.00

36597 Reposition venous catheter 3.66 70.00 $256.20

36598 Inj w/fluor eval cv device 3.13 70.00 $219.10

36600 Withdrawal of arterial blood 0.90 70.00 $63.00

36620 Insertion catheter artery 1.47 70.00 $102.90




36680 Insert needle bone cavity 1.70 70.00 $119.00

36800 Insertion of cannula 3.58 70.00 $250.60



36818 Av fuse uppr arm cephalic 20.44 70.00 $1,430.80

36819 Av fuse uppr arm basilic 21.67 70.00 $1,516.90

36820 Av fusion/forearm vein 21.52 70.00 $1,506.40

36821 Av fusion direct any site 19.62 70.00 $1,373.40

36823 Insertion of cannula(s) 40.34 70.00 $2,823.80

36825 Artery-vein autograft 23.66 70.00 $1,656.20

36830 Artery-vein nonautograft 19.73 70.00 $1,381.10

36831 Open thrombect av fistula 18.25 70.00 $1,277.50

36832 Av fistula revision open 22.37 70.00 $1,565.90

36833 Av fistula revision 23.93 70.00 $1,675.10

36835 Artery to vein shunt 14.67 70.00 $1,026.90

36838 Dist revas ligation hemo 33.84 70.00 $2,368.80

36860 External cannula declotting 5.92 70.00 $414.40

36861 Cannula declotting 3.85 70.00 $269.50

36870 Percut thrombect av fistula 52.17 70.00 $3,651.90

3700F Psych disorders assessed 0.00 70.00 $0.00

37140 Revision of circulation 67.20 70.00 $4,704.00




37181 Splice spleen/kidney veins 67.20 70.00 $4,704.00

37182 Insert hepatic shunt (tips) 24.42 70.00 $1,709.40

37183 Remove hepatic shunt (tips) 168.10 70.00 $11,767.00

37184 Prim art mech thrombectomy 64.79 70.00 $4,535.30

37185 Prim art m-thrombect add-on 20.50 70.00 $1,435.00

37186 Sec art m-thrombect add-on 39.27 70.00 $2,748.90

37187 Venous mech thrombectomy 58.82 70.00 $4,117.40

37188 Venous m-thrombectomy add-on 50.20 70.00 $3,514.00

37191 Ins endovas vena cava filtr 74.98 70.00 $5,248.60

37192 Redo endovas vena cava filtr 47.84 70.00 $3,348.80

37193 Rem endovas vena cava filter 45.67 70.00 $3,196.90

37195 Thrombolytic therapy stroke 0.00 70.00 $0.00

37197 Remove intrvas foreign body 43.34 70.00 $3,033.80

3720F Cognit impairment assessed 0.00 70.00 $0.00

37200 Transcatheter biopsy 6.45 70.00 $451.50

37202 Transcatheter therapy infuse 8.78 70.00 $614.60

37211 Thrombolytic art therapy 11.73 70.00 $821.10

37212 Thrombolytic venous therapy 10.28 70.00 $719.60

37213 Thromblytic art/ven therapy 7.25 70.00 $507.50

37214 Cessj therapy cath removal 3.99 70.00 $279.30

37215 Transcath stent cca w/eps 31.90 70.00 $2,233.00

37216 Transcath stent cca w/o eps 0.00 70.00 $0.00

37217 Stent placemt retro carotid 32.94 70.00 $2,305.80

37218 Stent placemt ante carotid 24.06 70.00 $1,684.20

37220 Iliac revasc 89.92 70.00 $6,294.40

37221 Iliac revasc w/stent 132.59 70.00 $9,281.30

37222 Iliac revasc add-on 25.23 70.00 $1,766.10

37223 Iliac revasc w/stent add-on 73.88 70.00 $5,171.60

37224 Fem/popl revas w/tla 109.10 70.00 $7,637.00

37225 Fem/popl revas w/ather 313.80 70.00 $21,966.00

37226 Fem/popl revasc w/stent 258.06 70.00 $18,064.20

37227 Fem/popl revasc stnt & ather 423.76 70.00 $29,663.20

37228 Tib/per revasc w/tla 155.15 70.00 $10,860.50

37229 Tib/per revasc w/ather 309.59 70.00 $21,671.30

37230 Tib/per revasc w/stent 236.72 70.00 $16,570.40

37231 Tib/per revasc stent & ather 380.32 70.00 $26,622.40

37232 Tib/per revasc add-on 34.62 70.00 $2,423.40

37233 Tibper revasc w/ather add-on 41.88 70.00 $2,931.60

37234 Revsc opn/prq tib/pero stent 110.40 70.00 $7,728.00

37235 Tib/per revasc stnt & ather 118.57 70.00 $8,299.90

37236 Open/perq place stent 1st 118.06 70.00 $8,264.20

37237 Open/perq place stent ea add 70.77 70.00 $4,953.90

37238 Open/perq place stent same 117.02 70.00 $8,191.40

37239 Open/perq place stent ea add 57.75 70.00 $4,042.50

37241 Vasc embolize/occlude venous 130.70 70.00 $9,149.00

37242 Vasc embolize/occlude artery 220.30 70.00 $15,421.00

37243 Vasc embolize/occlude organ 278.10 70.00 $19,467.00

37244 Vasc embolize/occlude bleed 194.62 70.00 $13,623.40

3725F Screen depression performed 0.00 70.00 $0.00

37250 Iv us first vessel add-on 3.14 70.00 $219.80

37251 Iv us each add vessel add-on 2.36 70.00 $165.20

3750F Ptnotrcvngsteroid>/=10mg/day 0.00 70.00 $0.00

37500 Endoscopy ligate perf veins 18.88 70.00 $1,321.60

37501 Vascular endoscopy procedure 0.00 70.00 $0.00

3751F Electrodiag polyneuro 6 mn 0.00 70.00 $0.00

3752F No electrodiag polyneuro 6mn 0.00 70.00 $0.00

3753F Pt has symp&signs neuropathy 0.00 70.00 $0.00

3754F Screening tests dm done 0.00 70.00 $0.00

3755F Cog&behav imprmnt scrng done 0.00 70.00 $0.00

3756F Pt w/pseudobulb affect/als 0.00 70.00 $0.00

37565 Ligation of neck vein 21.37 70.00 $1,495.90

3757F Pt w/o pseudobulbaffect/als 0.00 70.00 $0.00

3758F Pt ref pulm fx test/peakflow 0.00 70.00 $0.00

3759F Pt scrn dysphag/wt loss/nutr 0.00 70.00 $0.00

3760F Pt w/ dysphag/wt loss/nutr 0.00 70.00 $0.00

37600 Ligation of neck artery 21.16 70.00 $1,481.20


37606 Ligation of neck artery 14.21 70.00 $994.70

37607 Ligation of a-v fistula 11.07 70.00 $774.90

37609 Temporal artery procedure 8.91 70.00 $623.70

3761F Pt w/o dysphag/wt loss/nutr 0.00 70.00 $0.00


37616 Ligation of chest artery 32.29 70.00 $2,260.30

37617 Ligation of abdomen artery 39.21 70.00 $2,744.70

37618 Ligation of extremity artery 11.17 70.00 $781.90

37619 Ligation of inf vena cava 47.70 70.00 $3,339.00

3762F Patient is dysarthric 0.00 70.00 $0.00

3763F Patient is not dysarthric 0.00 70.00 $0.00

37650 Revision of major vein 13.62 70.00 $953.40

37660 Revision of major vein 38.09 70.00 $2,666.30

37700 Revise leg vein 7.32 70.00 $512.40

37718 Ligate/strip short leg vein 12.83 70.00 $898.10

37722 Ligate/strip long leg vein 14.04 70.00 $982.80

37735 Removal of leg veins/lesion 17.24 70.00 $1,206.80

3775F Adenoma detected screening 0.00 70.00 $0.00

3776F Adenoma not detect screening 0.00 70.00 $0.00

37760 Ligate leg veins radical 18.02 70.00 $1,261.40

37761 Ligate leg veins open 16.31 70.00 $1,141.70

37765 Stab phleb veins xtr 10-20 18.90 70.00 $1,323.00

37766 Phleb veins - extrem 20+ 22.44 70.00 $1,570.80

37780 Revision of leg vein 7.57 70.00 $529.90

37785 Ligate/divide/excise vein 10.37 70.00 $725.90

37788 Revascularization penis 36.26 70.00 $2,538.20

37790 Penile venous occlusion 13.97 70.00 $977.90

37799 Vascular surgery procedure 0.00 70.00 $0.00

38100 Removal of spleen total 33.37 70.00 $2,335.90

38101 Removal of spleen partial 33.74 70.00 $2,361.80

38102 Removal of spleen total 7.60 70.00 $532.00

38115 Repair of ruptured spleen 36.94 70.00 $2,585.80

38120 Laparoscopy splenectomy 30.45 70.00 $2,131.50

38129 Laparoscope proc spleen 0.00 70.00 $0.00

38200 Injection for spleen x-ray 3.90 70.00 $273.00

38204 Bl donor search management 2.91 70.00 $203.70

38205 Harvest allogeneic stem cell 2.36 70.00 $165.20

38206 Harvest auto stem cells 2.38 70.00 $166.60

38207 Cryopreserve stem cells 1.28 70.00 $89.60

38208 Thaw preserved stem cells 0.80 70.00 $56.00

38209 Wash harvest stem cells 0.34 70.00 $23.80

38210 T-cell depletion of harvest 2.28 70.00 $159.60

38211 Tumor cell deplete of harvst 2.06 70.00 $144.20

38212 Rbc depletion of harvest 1.36 70.00 $95.20

38213 Platelet deplete of harvest 0.34 70.00 $23.80

38214 Volume deplete of harvest 1.17 70.00 $81.90

38215 Harvest stem cell concentrte 1.36 70.00 $95.20

38220 Bone marrow aspiration 4.67 70.00 $326.90

38221 Bone marrow biopsy 4.76 70.00 $333.20

38230 Bone marrow harvest allogen 5.70 70.00 $399.00

38232 Bone marrow harvest autolog 5.86 70.00 $410.20

38240 Transplt allo hct/donor 6.42 70.00 $449.40

38241 Transplt autol hct/donor 4.83 70.00 $338.10

38242 Transplt allo lymphocytes 3.42 70.00 $239.40

38243 Transplj hematopoietic boost 3.42 70.00 $239.40

38300 Drainage lymph node lesion 7.85 70.00 $549.50

38305 Drainage lymph node lesion 13.34 70.00 $933.80

38308 Incision of lymph channels 12.80 70.00 $896.00

38380 Thoracic duct procedure 16.14 70.00 $1,129.80



38500 Biopsy/removal lymph nodes 9.49 70.00 $664.30

38505 Needle biopsy lymph nodes 3.63 70.00 $254.10

38510 Biopsy/removal lymph nodes 14.92 70.00 $1,044.40



38530 Biopsy/removal lymph nodes 15.77 70.00 $1,103.90

38542 Explore deep node(s) neck 14.93 70.00 $1,045.10

38550 Removal neck/armpit lesion 14.65 70.00 $1,025.50

38555 Removal neck/armpit lesion 29.07 70.00 $2,034.90

38562 Removal pelvic lymph nodes 20.32 70.00 $1,422.40

38564 Removal abdomen lymph nodes 20.34 70.00 $1,423.80

38570 Laparoscopy lymph node biop 15.51 70.00 $1,085.70

38571 Laparoscopy lymphadenectomy 23.00 70.00 $1,610.00

38572 Laparoscopy lymphadenectomy 28.45 70.00 $1,991.50

38589 Laparoscope proc lymphatic 0.00 70.00 $0.00

38700 Removal of lymph nodes neck 23.28 70.00 $1,629.60



38740 Remove armpit lymph nodes 20.03 70.00 $1,402.10

38745 Remove armpit lymph nodes 25.27 70.00 $1,768.90

38746 Remove thoracic lymph nodes 6.28 70.00 $439.60

38747 Remove abdominal lymph nodes 7.75 70.00 $542.50

38760 Remove groin lymph nodes 24.30 70.00 $1,701.00

38765 Remove groin lymph nodes 37.33 70.00 $2,613.10

38770 Remove pelvis lymph nodes 23.26 70.00 $1,628.20

38780 Remove abdomen lymph nodes 29.60 70.00 $2,072.00

38790 Inject for lymphatic x-ray 2.42 70.00 $169.40

38792 Ra tracer id of sentinl node 1.14 70.00 $79.80

38794 Access thoracic lymph duct 8.70 70.00 $609.00

38900 Io map of sent lymph node 3.99 70.00 $279.30

38999 Blood/lymph system procedure 0.00 70.00 $0.00



39200 Resect mediastinal cyst 25.57 70.00 $1,789.90

39220 Resect mediastinal tumor 33.11 70.00 $2,317.70

39400 Mediastinoscopy incl biopsy 14.78 70.00 $1,034.60

39499 Chest procedure 0.00 70.00 $0.00

39501 Repair diaphragm laceration 24.60 70.00 $1,722.00

39503 Repair of diaphragm hernia 178.42 70.00 $12,489.40



39545 Revision of diaphragm 25.91 70.00 $1,813.70

39560 Resect diaphragm simple 23.09 70.00 $1,616.30

39561 Resect diaphragm complex 35.88 70.00 $2,511.60

39599 Diaphragm surgery procedure 0.00 70.00 $0.00

4000F Tobacco use txmnt counseling 0.00 70.00 $0.00

4001F Tobacco use txmnt pharmacol 0.00 70.00 $0.00

4003F Pt ed write/oral pts w/ hf 0.00 70.00 $0.00

4004F Pt tobacco screen rcvd tlk 0.00 70.00 $0.00

4005F Pharm thx for op rxd 0.00 70.00 $0.00

4008F Beta-blocker therapy rxd/tkn 0.00 70.00 $0.00

4010F Ace/arb therapy rxd/taken 0.00 70.00 $0.00

4011F Oral antiplatelet therapy rx 0.00 70.00 $0.00

4012F Warfarin therapy rx 0.00 70.00 $0.00

4013F Statin therapy/currently tkn 0.00 70.00 $0.00

4014F Written discharge instr prvd 0.00 70.00 $0.00

4015F Persist asthma medicine ctrl 0.00 70.00 $0.00

4016F Anti-inflm/anlgsc agent rx 0.00 70.00 $0.00

4017F Gi prophylaxis for nsaid rx 0.00 70.00 $0.00

4018F Therapy exercise joint rx 0.00 70.00 $0.00

4019F Doc recpt counsl vit d/calc+ 0.00 70.00 $0.00

4025F Inhaled bronchodilator rx 0.00 70.00 $0.00

4030F Oxygen therapy rx 0.00 70.00 $0.00

4033F Pulmonary rehab rec 0.00 70.00 $0.00

4035F Influenza imm rec 0.00 70.00 $0.00

4037F Influenza imm order/admin 0.00 70.00 $0.00

4040F Pneumoc vac/admin/rcvd 0.00 70.00 $0.00

4041F Doc order cefazolin/cefurox 0.00 70.00 $0.00

4042F Doc antibio not given 0.00 70.00 $0.00

4043F Doc order given stop antibio 0.00 70.00 $0.00

4044F Doc order given vte prophylx 0.00 70.00 $0.00

4045F Empiric antibiotic rx 0.00 70.00 $0.00

4046F Doc antibio given b/4 surg 0.00 70.00 $0.00



4049F Doc order given stop antibio 0.00 70.00 $0.00

40490 Biopsy of lip 3.68 70.00 $257.60

4050F Ht care plan doc 0.00 70.00 $0.00

40500 Partial excision of lip 14.56 70.00 $1,019.20

4051F Referred for an av fistula 0.00 70.00 $0.00

40510 Partial excision of lip 13.97 70.00 $977.90

4052F Hemodialysis via av fistula 0.00 70.00 $0.00

40520 Partial excision of lip 14.12 70.00 $988.40

40525 Reconstruct lip with flap 15.93 70.00 $1,115.10

40527 Reconstruct lip with flap 17.87 70.00 $1,250.90

4053F Hemodialysis via av graft 0.00 70.00 $0.00

40530 Partial removal of lip 15.55 70.00 $1,088.50

4054F Hemodialysis via catheter 0.00 70.00 $0.00

4055F Pt rcvng periton dialysis 0.00 70.00 $0.00

4056F Approp oral rehyd recommd 0.00 70.00 $0.00

4058F Ped gastro ed given caregvr 0.00 70.00 $0.00

4060F Psych svcs provided 0.00 70.00 $0.00

4062F Pt referral psych docd 0.00 70.00 $0.00

4063F Antidepres rxthxpy not rxd 0.00 70.00 $0.00

4064F Antidepressant rx 0.00 70.00 $0.00

4065F Antipsychotic rx 0.00 70.00 $0.00

40650 Repair lip 12.59 70.00 $881.30

40652 Repair lip 14.18 70.00 $992.60

40654 Repair lip 16.37 70.00 $1,145.90

4066F Ect provided 0.00 70.00 $0.00

4067F Pt referral for ect docd 0.00 70.00 $0.00

4069F Vte prophylaxis rcvd 0.00 70.00 $0.00

4070F Dvt prophylx recvd day 2 0.00 70.00 $0.00

40700 Repair cleft lip/nasal 29.07 70.00 $2,034.90




4073F Oral antiplat thx rx dischrg 0.00 70.00 $0.00

4075F Anticoag thx rx at dischrg 0.00 70.00 $0.00


4077F Doc t-pa admin considered 0.00 70.00 $0.00

4079F Doc rehab svcs considered 0.00 70.00 $0.00

40799 Lip surgery procedure 0.00 70.00 $0.00

40800 Drainage of mouth lesion 6.17 70.00 $431.90


40804 Removal foreign body mouth 6.17 70.00 $431.90

40805 Removal foreign body mouth 9.43 70.00 $660.10

40806 Incision of lip fold 3.13 70.00 $219.10

40808 Biopsy of mouth lesion 5.44 70.00 $380.80

40810 Excision of mouth lesion 6.01 70.00 $420.70

40812 Excise/repair mouth lesion 8.42 70.00 $589.40

40814 Excise/repair mouth lesion 11.27 70.00 $788.90


40818 Excise oral mucosa for graft 10.48 70.00 $733.60

40819 Excise lip or cheek fold 9.17 70.00 $641.90

40820 Treatment of mouth lesion 7.74 70.00 $541.80

40830 Repair mouth laceration 7.74 70.00 $541.80

40831 Repair mouth laceration 9.81 70.00 $686.70

4084F Aspirin recvd w/in 24 hrs 0.00 70.00 $0.00

40840 Reconstruction of mouth 23.60 70.00 $1,652.00





4086F Aspirin/clopidogrel rxd 0.00 70.00 $0.00

40899 Mouth surgery procedure 0.00 70.00 $0.00

4090F Pt rcvng epo thxpy 0.00 70.00 $0.00

4095F Pt not rcvng epo thxpy 0.00 70.00 $0.00

4100F Biphos thxpy vein ord/recvd 0.00 70.00 $0.00







41010 Incision of tongue fold 5.87 70.00 $410.90




41018 Drainage of mouth lesion 14.75 70.00 $1,032.50

41019 Place needles h&n for rt 13.37 70.00 $935.90

4110F Int mam art used for cabg 0.00 70.00 $0.00

41100 Biopsy of tongue 4.89 70.00 $342.30

41105 Biopsy of tongue 4.97 70.00 $347.90

41108 Biopsy of floor of mouth 4.31 70.00 $301.70

41110 Excision of tongue lesion 6.16 70.00 $431.20



41114 Excision of tongue lesion 18.56 70.00 $1,299.20

41115 Excision of tongue fold 7.17 70.00 $501.90


41120 Partial removal of tongue 30.45 70.00 $2,131.50

41130 Partial removal of tongue 37.69 70.00 $2,638.30

41135 Tongue and neck surgery 62.57 70.00 $4,379.90

41140 Removal of tongue 62.87 70.00 $4,400.90

41145 Tongue removal neck surgery 79.56 70.00 $5,569.20

4115F Beta blckr admin w/in 24 hrs 0.00 70.00 $0.00

41150 Tongue mouth jaw surgery 63.17 70.00 $4,421.90

41153 Tongue mouth neck surgery 68.97 70.00 $4,827.90

41155 Tongue jaw & neck surgery 86.81 70.00 $6,076.70

4120F Antibiot rxd/given 0.00 70.00 $0.00

4124F Antibiot not rxd/given 0.00 70.00 $0.00

41250 Repair tongue laceration 7.81 70.00 $546.70



4130F Topical prep rx aoe 0.00 70.00 $0.00

4131F Syst antimicrobial thx rx 0.00 70.00 $0.00

4132F No syst antimicrobial thx rx 0.00 70.00 $0.00

4133F Antihist/decong rx/recom 0.00 70.00 $0.00

4134F No antihist/decong rx/recom 0.00 70.00 $0.00

4135F Systemic corticosteroids rx 0.00 70.00 $0.00

4136F Syst corticosteroids not rx 0.00 70.00 $0.00

4140F Inhaled corticosteroids rxd 0.00 70.00 $0.00

4142F Corticoster sparng thrpy rxd 0.00 70.00 $0.00

4144F Alt long-term cntrl med rxd 0.00 70.00 $0.00

4145F 2+ anti-hyprtnsv agents tkn 0.00 70.00 $0.00

4148F Hep a vac injxn admin/recvd 0.00 70.00 $0.00

4149F Hep b vac injxn admin/recvd 0.00 70.00 $0.00

4150F Pt recvng antivir txmnt hepc 0.00 70.00 $0.00

41500 Fixation of tongue 13.27 70.00 $928.90

4151F Pt not recvng antiv hep c 0.00 70.00 $0.00

41510 Tongue to lip surgery 11.59 70.00 $811.30

41512 Tongue suspension 18.47 70.00 $1,292.90

41520 Reconstruction tongue fold 10.35 70.00 $724.50

4153F Combo pegintf/rib rx 0.00 70.00 $0.00

41530 Tongue base vol reduction 92.44 70.00 $6,470.80

4155F Hep a vac series prev recvd 0.00 70.00 $0.00

4157F Hep b vac series prev recvd 0.00 70.00 $0.00

4158F Pt edu re alcoh drnkng done 0.00 70.00 $0.00

4159F Contrcp talk b/4 antiv txmnt 0.00 70.00 $0.00

41599 Tongue and mouth surgery 0.00 70.00 $0.00

4163F Pt couns 4 txmnt opt prost 0.00 70.00 $0.00

4164F Adjv hrmnl thxpy rxd 0.00 70.00 $0.00

4165F 3d-crt/imrt received 0.00 70.00 $0.00

4167F Hd bed tilted 1st day vent 0.00 70.00 $0.00

4168F Pt care icu&vent w/in 24hrs 0.00 70.00 $0.00

4169F No pt care icu/vent in 24hrs 0.00 70.00 $0.00

4171F Pt rcvng esa thxpy 0.00 70.00 $0.00

4172F Pt not rcvng esa thxpy 0.00 70.00 $0.00

4174F Couns potent glauc impct 0.00 70.00 $0.00

4175F Vis 20/40/> w/in 90 days 0.00 70.00 $0.00

4176F Talk re uv light pt/crgvr 0.00 70.00 $0.00

4177F Talk pt/crgvr re areds prev 0.00 70.00 $0.00

4178F Antid glbln rcvd w/in 26wks 0.00 70.00 $0.00

4179F Tamoxifen/ai prescribed 0.00 70.00 $0.00

4180F Adjv thxpyrxd/rcvd colon ca 0.00 70.00 $0.00

41800 Drainage of gum lesion 7.81 70.00 $546.70

41805 Removal foreign body gum 7.25 70.00 $507.50

41806 Removal foreign body jawbone 10.39 70.00 $727.30

4181F Conformal radn thxpy rcvd 0.00 70.00 $0.00

4182F No conformal radn thxpy 0.00 70.00 $0.00

41820 Excision gum each quadrant 0.00 70.00 $0.00

41821 Excision of gum flap 0.00 70.00 $0.00

41822 Excision of gum lesion 9.06 70.00 $634.20






41830 Removal of gum tissue 11.54 70.00 $807.80

4185F Continuous ppi or h2ra rcvd 0.00 70.00 $0.00

41850 Treatment of gum lesion 0.00 70.00 $0.00

4186F No cont ppi or h2ra rcvd 0.00 70.00 $0.00

4187F Anti rheum drugthxpyrxd/gvn 0.00 70.00 $0.00

41870 Gum graft 0.00 70.00 $0.00

41872 Repair gum 10.92 70.00 $764.40

41874 Repair tooth socket 11.05 70.00 $773.50

4188F Approp ace/arb tstng done 0.00 70.00 $0.00

4189F Approp digoxin tstng done 0.00 70.00 $0.00

41899 Dental surgery procedure 0.00 70.00 $0.00

4190F Approp diuretic tstng done 0.00 70.00 $0.00

4191F Approp anticonvuls tstng 0.00 70.00 $0.00

4192F Pt not rcvng glucoco thxpy 0.00 70.00 $0.00

4193F Pt rcvng<10mg daily predniso 0.00 70.00 $0.00

4194F Pt rcvng10mg daily predniso 0.00 70.00 $0.00

4195F Pt rcvng anti-rheum thxpy ra 0.00 70.00 $0.00

4196F Ptnot rcvng anti-rhm thxpyra 0.00 70.00 $0.00

4200F External beam to prost only 0.00 70.00 $0.00

42000 Drainage mouth roof lesion 4.58 70.00 $320.60

4201F Extrnl beam other than prost 0.00 70.00 $0.00

4210F Ace/arb thxpy for mos/> 0.00 70.00 $0.00

42100 Biopsy roof of mouth 4.38 70.00 $306.60

42104 Excision lesion mouth roof 6.27 70.00 $438.90



42120 Remove palate/lesion 28.89 70.00 $2,022.30

42140 Excision of uvula 7.33 70.00 $513.10

42145 Repair palate pharynx/uvula 20.47 70.00 $1,432.90

42160 Treatment mouth roof lesion 6.75 70.00 $472.50

42180 Repair palate 7.05 70.00 $493.50

42182 Repair palate 9.26 70.00 $648.20

4220F Digoxin thxpy for 6 mos/> 0.00 70.00 $0.00

42200 Reconstruct cleft palate 24.64 70.00 $1,724.80


4221F Diuretic thxpy for 6 mos/> 0.00 70.00 $0.00





42226 Lengthening of palate 25.94 70.00 $1,815.80

42227 Lengthening of palate 24.32 70.00 $1,702.40

42235 Repair palate 21.31 70.00 $1,491.70

42260 Repair nose to lip fistula 25.03 70.00 $1,752.10

42280 Preparation palate mold 4.80 70.00 $336.00

42281 Insertion palate prosthesis 5.93 70.00 $415.10

42299 Palate/uvula surgery 0.00 70.00 $0.00

4230F Anticonv thxpy for 6 mos/> 0.00 70.00 $0.00

42300 Drainage of salivary gland 6.06 70.00 $424.20




42330 Removal of salivary stone 6.73 70.00 $471.10



4240F Instr xrcz back pain 12 wks 0.00 70.00 $0.00

42400 Biopsy of salivary gland 3.07 70.00 $214.90

42405 Biopsy of salivary gland 8.63 70.00 $604.10

42408 Excision of salivary cyst 13.10 70.00 $917.00

42409 Drainage of salivary cyst 9.65 70.00 $675.50

42410 Excise parotid gland/lesion 18.00 70.00 $1,260.00


4242F Sprvsd xrcz back pn >12 wks 0.00 70.00 $0.00




42440 Excise submaxillary gland 11.95 70.00 $836.50

4245F Pt instr nrml lifest 0.00 70.00 $0.00

42450 Excise sublingual gland 13.14 70.00 $919.80

4248F Pt instr no bd rest 4 days/> 0.00 70.00 $0.00

4250F Wrmng 4 surg normothermia 0.00 70.00 $0.00

42500 Repair salivary duct 12.58 70.00 $880.60

42505 Repair salivary duct 16.11 70.00 $1,127.70

42507 Parotid duct diversion 14.87 70.00 $1,040.90



4255F Anesth 60 min/> as docd 0.00 70.00 $0.00

42550 Injection for salivary x-ray 3.88 70.00 $271.60

4256F Anesthe <60 min as docd 0.00 70.00 $0.00

4260F Wound srfc culturetech used 0.00 70.00 $0.00

42600 Closure of salivary fistula 13.87 70.00 $970.90

4261F Tech other than surfc cultr 0.00 70.00 $0.00

4265F Wet-dry dressings rx recmd 0.00 70.00 $0.00

42650 Dilation of salivary duct 2.42 70.00 $169.40

4266F No wet-dry drssings rx recmd 0.00 70.00 $0.00

42660 Dilation of salivary duct 3.68 70.00 $257.60

42665 Ligation of salivary duct 9.01 70.00 $630.70

4267F Comprssion thxpy prescribed 0.00 70.00 $0.00

4268F Pt ed re comp thxpy rcvd 0.00 70.00 $0.00

4269F Appropos mthd offloading rxd 0.00 70.00 $0.00

42699 Salivary surgery procedure 0.00 70.00 $0.00

4270F Pt rcvng anti r-viral thxpy 0.00 70.00 $0.00

42700 Drainage of tonsil abscess 5.50 70.00 $385.00

4271F Pt rcvng anti r-viral thxpy 0.00 70.00 $0.00

42720 Drainage of throat abscess 13.14 70.00 $919.80

42725 Drainage of throat abscess 23.74 70.00 $1,661.80

4274F Flu immuno admind rcvd 0.00 70.00 $0.00

4276F Potent antivir thxpy rxd 0.00 70.00 $0.00

4279F Pcp prophylaxis rxd 0.00 70.00 $0.00

4280F Pcp prophylax rxd 3mon low % 0.00 70.00 $0.00

42800 Biopsy of throat 4.60 70.00 $322.00

42804 Biopsy of upper nose/throat 5.64 70.00 $394.80

42806 Biopsy of upper nose/throat 6.33 70.00 $443.10

42808 Excise pharynx lesion 6.55 70.00 $458.50

42809 Remove pharynx foreign body 5.02 70.00 $351.40

42810 Excision of neck cyst 11.24 70.00 $786.80

42815 Excision of neck cyst 16.25 70.00 $1,137.50

42820 Remove tonsils and adenoids 8.40 70.00 $588.00

42821 Remove tonsils and adenoids 8.72 70.00 $610.40

42825 Removal of tonsils 7.58 70.00 $530.60

42826 Removal of tonsils 7.28 70.00 $509.60

42830 Removal of adenoids 6.02 70.00 $421.40




42842 Extensive surgery of throat 28.86 70.00 $2,020.20



42860 Excision of tonsil tags 5.47 70.00 $382.90

42870 Excision of lingual tonsil 16.77 70.00 $1,173.90

42890 Partial removal of pharynx 40.85 70.00 $2,859.50

42892 Revision of pharyngeal walls 54.33 70.00 $3,803.10

42894 Revision of pharyngeal walls 68.10 70.00 $4,767.00

4290F Pt scrned for inj drug use 0.00 70.00 $0.00

42900 Repair throat wound 9.82 70.00 $687.40

4293F Pt scrnd hgh-risk sex behav 0.00 70.00 $0.00

42950 Reconstruction of throat 22.98 70.00 $1,608.60

42953 Repair throat esophagus 27.66 70.00 $1,936.20

42955 Surgical opening of throat 21.78 70.00 $1,524.60

42960 Control throat bleeding 4.95 70.00 $346.50

42961 Control throat bleeding 12.27 70.00 $858.90

42962 Control throat bleeding 15.05 70.00 $1,053.50

42970 Control nose/throat bleeding 12.01 70.00 $840.70

42971 Control nose/throat bleeding 13.26 70.00 $928.20

42972 Control nose/throat bleeding 14.84 70.00 $1,038.80

42999 Throat surgery procedure 0.00 70.00 $0.00

4300F Pt rcvng warf thxpy 0.00 70.00 $0.00

4301F Pt not rcvng warf thxpy 0.00 70.00 $0.00

43020 Incision of esophagus 16.38 70.00 $1,146.60

43030 Throat muscle surgery 15.04 70.00 $1,052.80

43045 Incision of esophagus 37.99 70.00 $2,659.30

4305F Pt ed re ft care inspct rcvd 0.00 70.00 $0.00

4306F Pt tlk psych & rx opd addic 0.00 70.00 $0.00

43100 Excision of esophagus lesion 18.17 70.00 $1,271.90

43101 Excision of esophagus lesion 30.85 70.00 $2,159.50

43107 Removal of esophagus 74.43 70.00 $5,210.10




43116 Partial removal of esophagus 151.59 70.00 $10,611.30







43130 Removal of esophagus pouch 22.81 70.00 $1,596.70

43135 Removal of esophagus pouch 43.42 70.00 $3,039.40

43180 Esophagoscopy rigid trnso 16.18 70.00 $1,132.60

43191 Esophagoscopy rigid trnso dx 4.45 70.00 $311.50

43192 Esophagoscp rig trnso inject 4.94 70.00 $345.80

43193 Esophagoscp rig trnso biopsy 4.93 70.00 $345.10

43194 Esophagoscp rig trnso rem fb 5.56 70.00 $389.20

43195 Esophagoscopy rigid balloon 5.39 70.00 $377.30

43196 Esophagoscp guide wire dilat 5.71 70.00 $399.70

43197 Esophagoscopy flex dx brush 5.39 70.00 $377.30

43198 Esophagosc flex trnsn biopsy 6.06 70.00 $424.20

4320F Pt talk psychsoc&rx oh dpnd 0.00 70.00 $0.00

43200 Esophagoscopy flexible brush 7.75 70.00 $542.50

43201 Esoph scope w/submucous inj 7.92 70.00 $554.40

43202 Esophagoscopy flex biopsy 10.40 70.00 $728.00

43204 Esoph scope w/sclerosis inj 4.22 70.00 $295.40

43205 Esophagus endoscopy/ligation 4.35 70.00 $304.50

43206 Esoph optical endomicroscopy 9.46 70.00 $662.20

43211 Esophagoscop mucosal resect 7.27 70.00 $508.90

43212 Esophagoscop stent placement 5.79 70.00 $405.30

43213 Esophagoscopy retro balloon 35.34 70.00 $2,473.80

43214 Esophagosc dilate balloon 30 5.86 70.00 $410.20

43215 Esophagoscopy flex remove fb 11.73 70.00 $821.10

43216 Esophagoscopy lesion removal 12.04 70.00 $842.80

43217 Esophagoscopy snare les remv 12.83 70.00 $898.10

4322F Crgvr prov w/ ed addl rsrcs 0.00 70.00 $0.00

43220 Esophagoscopy balloon <30mm 32.49 70.00 $2,274.30

43226 Esoph endoscopy dilation 10.91 70.00 $763.70

43227 Esophagoscopy control bleed 11.33 70.00 $793.10

43229 Esophagoscopy lesion ablate 20.88 70.00 $1,461.60

43231 Esophagoscop ultrasound exam 11.58 70.00 $810.60

43232 Esophagoscopy w/us needle bx 13.76 70.00 $963.20

43233 Egd balloon dil esoph30 mm/> 6.91 70.00 $483.70

43235 Egd diagnostic brush wash 8.99 70.00 $629.30

43236 Uppr gi scope w/submuc inj 11.20 70.00 $784.00

43237 Endoscopic us exam esoph 6.00 70.00 $420.00

43238 Egd us fine needle bx/aspir 7.14 70.00 $499.80

43239 Egd biopsy single/multiple 11.48 70.00 $803.60

4324F Pt queried prkns complic 0.00 70.00 $0.00

43240 Egd w/transmural drain cyst 11.89 70.00 $832.30

43241 Egd tube/cath insertion 4.40 70.00 $308.00

43242 Egd us fine needle bx/aspir 8.05 70.00 $563.50

43243 Egd injection varices 7.25 70.00 $507.50

43244 Egd varices ligation 7.52 70.00 $526.40

43245 Egd dilate stricture 17.69 70.00 $1,238.30

43246 Egd place gastrostomy tube 6.11 70.00 $427.70

43247 Egd remove foreign body 11.71 70.00 $819.70

43248 Egd guide wire insertion 11.83 70.00 $828.10

43249 Esoph egd dilation <30 mm 31.03 70.00 $2,172.10

4325F Med txmnt options rvwd w/pt 0.00 70.00 $0.00

43250 Egd cautery tumor polyp 13.13 70.00 $919.10

43251 Egd remove lesion snare 14.42 70.00 $1,009.40

43252 Egd optical endomicroscopy 10.59 70.00 $741.30

43253 Egd us transmural injxn/mark 8.05 70.00 $563.50

43254 Egd endo mucosal resection 8.25 70.00 $577.50

43255 Egd control bleeding any 12.40 70.00 $868.00

43257 Egd w/thrml txmnt gerd 7.11 70.00 $497.70

43259 Egd us exam duodenum/jejunum 6.93 70.00 $485.10

4326F Pt asked re symp auto dysfxn 0.00 70.00 $0.00

43260 Ercp w/specimen collection 9.82 70.00 $687.40

43261 Endo cholangiopancreatograph 10.28 70.00 $719.60

43262 Endo cholangiopancreatograph 10.85 70.00 $759.50

43263 Ercp sphincter pressure meas 10.88 70.00 $761.60

43264 Ercp remove duct calculi 11.06 70.00 $774.20

43265 Ercp lithotripsy calculi 13.12 70.00 $918.40

43266 Egd endoscopic stent place 6.92 70.00 $484.40

43270 Egd lesion ablation 21.75 70.00 $1,522.50

43273 Endoscopic pancreatoscopy 3.58 70.00 $250.60

43274 Ercp duct stent placement 14.00 70.00 $980.00

43275 Ercp remove forgn body duct 11.42 70.00 $799.40

43276 Ercp stent exchange w/dilate 14.57 70.00 $1,019.90

43277 Ercp ea duct/ampulla dilate 11.48 70.00 $803.60

43278 Ercp lesion ablate w/dilate 13.11 70.00 $917.70

43279 Lap myotomy heller 37.48 70.00 $2,623.60

4328F Pt asked re sleep disturb 0.00 70.00 $0.00

43280 Laparoscopy fundoplasty 31.31 70.00 $2,191.70

43281 Lap paraesophag hern repair 44.74 70.00 $3,131.80

43282 Lap paraesoph her rpr w/mesh 50.31 70.00 $3,521.70

43283 Lap esoph lengthening 4.62 70.00 $323.40

43289 Laparoscope proc esoph 0.00 70.00 $0.00

4330F Cnslng epi spec sfty issues 0.00 70.00 $0.00

43300 Repair of esophagus 17.82 70.00 $1,247.40

43305 Repair esophagus and fistula 31.63 70.00 $2,214.10

43310 Repair of esophagus 43.00 70.00 $3,010.00

43312 Repair esophagus and fistula 46.72 70.00 $3,270.40

43313 Esophagoplasty congenital 75.26 70.00 $5,268.20

43314 Tracheo-esophagoplasty cong 81.22 70.00 $5,685.40

43320 Fuse esophagus & stomach 40.46 70.00 $2,832.20

43325 Revise esophagus & stomach 38.98 70.00 $2,728.60

43327 Esoph fundoplasty lap 23.65 70.00 $1,655.50

43328 Esoph fundoplasty thor 33.01 70.00 $2,310.70

43330 Esophagomyotomy abdominal 38.65 70.00 $2,705.50

43331 Esophagomyotomy thoracic 39.19 70.00 $2,743.30

43332 Transab esoph hiat hern rpr 33.66 70.00 $2,356.20

43333 Transab esoph hiat hern rpr 36.64 70.00 $2,564.80

43334 Transthor diaphrag hern rpr 36.48 70.00 $2,553.60

43335 Transthor diaphrag hern rpr 39.20 70.00 $2,744.00

43336 Thorabd diaphr hern repair 44.15 70.00 $3,090.50

43337 Thorabd diaphr hern repair 47.45 70.00 $3,321.50

43338 Esoph lengthening 3.38 70.00 $236.60

43340 Fuse esophagus & intestine 39.93 70.00 $2,795.10

43341 Fuse esophagus & intestine 42.95 70.00 $3,006.50

43351 Surgical opening esophagus 40.37 70.00 $2,825.90

43352 Surgical opening esophagus 31.19 70.00 $2,183.30

43360 Gastrointestinal repair 69.10 70.00 $4,837.00

43361 Gastrointestinal repair 74.55 70.00 $5,218.50

4340F Cnslng chldbrng women epi 0.00 70.00 $0.00

43400 Ligate esophagus veins 44.10 70.00 $3,087.00

43401 Esophagus surgery for veins 45.52 70.00 $3,186.40

43405 Ligate/staple esophagus 44.67 70.00 $3,126.90

43410 Repair esophagus wound 30.51 70.00 $2,135.70

43415 Repair esophagus wound 74.61 70.00 $5,222.70

43420 Repair esophagus opening 29.50 70.00 $2,065.00

43425 Repair esophagus opening 42.21 70.00 $2,954.70

43450 Dilate esophagus 1/mult pass 6.12 70.00 $428.40

43453 Dilate esophagus 27.92 70.00 $1,954.40

43460 Pressure treatment esophagus 6.38 70.00 $446.60

43496 Free jejunum flap microvasc 0.00 70.00 $0.00

43499 Esophagus surgery procedure 0.00 70.00 $0.00

4350F Cnslng provided symp mngmnt 0.00 70.00 $0.00

43500 Surgical opening of stomach 22.68 70.00 $1,587.60

43501 Surgical repair of stomach 39.00 70.00 $2,730.00

43502 Surgical repair of stomach 44.19 70.00 $3,093.30

43510 Surgical opening of stomach 27.37 70.00 $1,915.90

43520 Incision of pyloric muscle 19.86 70.00 $1,390.20

43605 Biopsy of stomach 24.16 70.00 $1,691.20

43610 Excision of stomach lesion 28.40 70.00 $1,988.00

43611 Excision of stomach lesion 35.33 70.00 $2,473.10

43620 Removal of stomach 57.03 70.00 $3,992.10



43631 Removal of stomach partial 41.99 70.00 $2,939.30




43635 Removal of stomach partial 3.27 70.00 $228.90

43640 Vagotomy & pylorus repair 34.07 70.00 $2,384.90

43641 Vagotomy & pylorus repair 34.81 70.00 $2,436.70

43644 Lap gastric bypass/roux-en-y 50.14 70.00 $3,509.80

43645 Lap gastr bypass incl smll i 53.58 70.00 $3,750.60

43647 Lap impl electrode antrum 0.00 70.00 $0.00

43648 Lap revise/remv eltrd antrum 0.00 70.00 $0.00

43651 Laparoscopy vagus nerve 18.94 70.00 $1,325.80

43652 Laparoscopy vagus nerve 22.13 70.00 $1,549.10

43653 Laparoscopy gastrostomy 16.54 70.00 $1,157.80

43659 Laparoscope proc stom 0.00 70.00 $0.00

43752 Nasal/orogastric w/tube plmt 1.19 70.00 $83.30

43753 Tx gastro intub w/asp 0.62 70.00 $43.40

43754 Dx gastr intub w/asp spec 3.73 70.00 $261.10

43755 Dx gastr intub w/asp specs 3.98 70.00 $278.60

43756 Dx duod intub w/asp spec 5.89 70.00 $412.30

43757 Dx duod intub w/asp specs 8.42 70.00 $589.40

43760 Change gastrostomy tube 13.98 70.00 $978.60

43761 Reposition gastrostomy tube 3.36 70.00 $235.20

43770 Lap place gastr adj device 32.35 70.00 $2,264.50

43771 Lap revise gastr adj device 36.75 70.00 $2,572.50

43772 Lap rmvl gastr adj device 27.52 70.00 $1,926.40

43773 Lap replace gastr adj device 37.04 70.00 $2,592.80

43774 Lap rmvl gastr adj all parts 27.75 70.00 $1,942.50

43775 Lap sleeve gastrectomy 0.00 70.00 $0.00

43800 Reconstruction of pylorus 26.89 70.00 $1,882.30

43810 Fusion of stomach and bowel 29.50 70.00 $2,065.00



43830 Place gastrostomy tube 20.20 70.00 $1,414.00



43840 Repair of stomach lesion 39.30 70.00 $2,751.00

43842 V-band gastroplasty 33.03 70.00 $2,312.10

43843 Gastroplasty w/o v-band 37.10 70.00 $2,597.00

43845 Gastroplasty duodenal switch 56.85 70.00 $3,979.50

43846 Gastric bypass for obesity 46.68 70.00 $3,267.60

43847 Gastric bypass incl small i 52.24 70.00 $3,656.80

43848 Revision gastroplasty 55.72 70.00 $3,900.40

43850 Revise stomach-bowel fusion 47.20 70.00 $3,304.00




43870 Repair stomach opening 20.62 70.00 $1,443.40

43880 Repair stomach-bowel fistula 46.15 70.00 $3,230.50

43881 Impl/redo electrd antrum 0.00 70.00 $0.00

43882 Revise/remove electrd antrum 0.00 70.00 $0.00

43886 Revise gastric port open 10.45 70.00 $731.50

43887 Remove gastric port open 9.43 70.00 $660.10

43888 Change gastric port open 13.27 70.00 $928.90

43999 Stomach surgery procedure 0.00 70.00 $0.00

4400F Rehab thxpy options w/pt 0.00 70.00 $0.00

44005 Freeing of bowel adhesion 31.64 70.00 $2,214.80

44010 Incision of small bowel 25.09 70.00 $1,756.30

44015 Insert needle cath bowel 4.14 70.00 $289.80

44020 Explore small intestine 28.20 70.00 $1,974.00

44021 Decompress small bowel 28.23 70.00 $1,976.10

44025 Incision of large bowel 28.55 70.00 $1,998.50

44050 Reduce bowel obstruction 27.05 70.00 $1,893.50

44055 Correct malrotation of bowel 43.08 70.00 $3,015.60

44100 Biopsy of bowel 3.23 70.00 $226.10

44110 Excise intestine lesion(s) 24.65 70.00 $1,725.50

44111 Excision of bowel lesion(s) 28.45 70.00 $1,991.50

44120 Removal of small intestine 35.39 70.00 $2,477.30

44121 Removal of small intestine 7.03 70.00 $492.10

44125 Removal of small intestine 34.16 70.00 $2,391.20

44126 Enterectomy w/o taper cong 71.52 70.00 $5,006.40

44127 Enterectomy w/taper cong 82.71 70.00 $5,789.70

44128 Enterectomy cong add-on 7.09 70.00 $496.30

44130 Bowel to bowel fusion 37.98 70.00 $2,658.60

44132 Enterectomy cadaver donor 0.00 70.00 $0.00

44133 Enterectomy live donor 0.00 70.00 $0.00

44135 Intestine transplnt cadaver 0.00 70.00 $0.00

44136 Intestine transplant live 0.00 70.00 $0.00

44137 Remove intestinal allograft 0.00 70.00 $0.00

44139 Mobilization of colon 3.52 70.00 $246.40

44140 Partial removal of colon 38.83 70.00 $2,718.10







44150 Removal of colon 54.17 70.00 $3,791.90

44151 Removal of colon/ileostomy 62.33 70.00 $4,363.10



44157 Colectomy w/ileoanal anast 63.23 70.00 $4,426.10

44158 Colectomy w/neo-rectum pouch 61.28 70.00 $4,289.60

44160 Removal of colon 35.93 70.00 $2,515.10

44180 Lap enterolysis 26.58 70.00 $1,860.60

44186 Lap jejunostomy 18.87 70.00 $1,320.90

44187 Lap ileo/jejuno-stomy 32.06 70.00 $2,244.20

44188 Lap colostomy 35.45 70.00 $2,481.50

44202 Lap enterectomy 40.10 70.00 $2,807.00

44203 Lap resect s/intestine addl 7.09 70.00 $496.30

44204 Laparo partial colectomy 44.54 70.00 $3,117.80

44205 Lap colectomy part w/ileum 38.75 70.00 $2,712.50

44206 Lap part colectomy w/stoma 50.79 70.00 $3,555.30

44207 L colectomy/coloproctostomy 52.78 70.00 $3,694.60

44208 L colectomy/coloproctostomy 57.66 70.00 $4,036.20

44210 Laparo total proctocolectomy 51.59 70.00 $3,611.30

44211 Lap colectomy w/proctectomy 62.99 70.00 $4,409.30

44212 Laparo total proctocolectomy 59.42 70.00 $4,159.40

44213 Lap mobil splenic fl add-on 5.48 70.00 $383.60

44227 Lap close enterostomy 48.34 70.00 $3,383.80

44238 Laparoscope proc intestine 0.00 70.00 $0.00

44300 Open bowel to skin 24.32 70.00 $1,702.40

44310 Ileostomy/jejunostomy 30.21 70.00 $2,114.70

44312 Revision of ileostomy 17.06 70.00 $1,194.20

44314 Revision of ileostomy 29.04 70.00 $2,032.80

44316 Devise bowel pouch 40.97 70.00 $2,867.90

44320 Colostomy 34.76 70.00 $2,433.20

44322 Colostomy with biopsies 28.92 70.00 $2,024.40

44340 Revision of colostomy 18.05 70.00 $1,263.50



44360 Small bowel endoscopy 4.45 70.00 $311.50

44361 Small bowel endoscopy/biopsy 4.91 70.00 $343.70






44370 Small bowel endoscopy/stent 8.14 70.00 $569.80




44377 Small bowel endoscopy/biopsy 9.13 70.00 $639.10


44379 S bowel endoscope w/stent 12.44 70.00 $870.80

44380 Small bowel endoscopy br/wa 1.96 70.00 $137.20

44381 Small bowel endoscopy br/wa 0.00 70.00 $0.00



44385 Endoscopy of bowel pouch 7.58 70.00 $530.60

44386 Endoscopy bowel pouch/biop 10.10 70.00 $707.00

44388 Colonoscopy thru stoma spx 10.06 70.00 $704.20

44389 Colonoscopy with biopsy 11.27 70.00 $788.90

44390 Colonoscopy for foreign body 13.21 70.00 $924.70

44391 Colonoscopy for bleeding 14.20 70.00 $994.00

44392 Colonoscopy & polypectomy 12.52 70.00 $876.40

44394 Colonoscopy w/snare 14.15 70.00 $990.50

44401 Colonoscopy with ablation 0.00 70.00 $0.00

44402 Colonoscopy w/stent plcmt 0.00 70.00 $0.00

44403 Colonoscopy w/resection 0.00 70.00 $0.00

44404 Colonoscopy w/injection 0.00 70.00 $0.00

44405 Colonoscopy w/dilation 0.00 70.00 $0.00

44406 Colonoscopy w/ultrasound 0.00 70.00 $0.00

44407 Colonoscopy w/ndl aspir/bx 0.00 70.00 $0.00

44408 Colonoscopy w/decompression 0.00 70.00 $0.00

4450F Self-care ed provided to pt 0.00 70.00 $0.00

44500 Intro gastrointestinal tube 0.71 70.00 $49.70

44602 Suture small intestine 40.84 70.00 $2,858.80

44603 Suture small intestine 46.93 70.00 $3,285.10

44604 Suture large intestine 30.65 70.00 $2,145.50

44605 Repair of bowel lesion 37.80 70.00 $2,646.00

44615 Intestinal stricturoplasty 31.02 70.00 $2,171.40

44620 Repair bowel opening 25.14 70.00 $1,759.80



44640 Repair bowel-skin fistula 40.58 70.00 $2,840.60

44650 Repair bowel fistula 42.06 70.00 $2,944.20

44660 Repair bowel-bladder fistula 38.64 70.00 $2,704.80

44661 Repair bowel-bladder fistula 44.91 70.00 $3,143.70

44680 Surgical revision intestine 30.87 70.00 $2,160.90

4470F Icd counseling provided 0.00 70.00 $0.00

44700 Suspend bowel w/prosthesis 29.53 70.00 $2,067.10

44701 Intraop colon lavage add-on 4.88 70.00 $341.60

44705 Prepare fecal microbiota 0.00 70.00 $0.00

44715 Prepare donor intestine 0.00 70.00 $0.00

44720 Prep donor intestine/venous 7.99 70.00 $559.30

44721 Prep donor intestine/artery 11.17 70.00 $781.90

44799 Unlisted px small intestine 0.00 70.00 $0.00

4480F Pt rcvng ace/arb b-blockertx 0.00 70.00 $0.00

44800 Excision of bowel pouch 22.14 70.00 $1,549.80

4481F Pt rcvng ace/arb blker >3mos 0.00 70.00 $0.00

44820 Excision of mesentery lesion 24.55 70.00 $1,718.50

44850 Repair of mesentery 21.74 70.00 $1,521.80

44899 Bowel surgery procedure 0.00 70.00 $0.00

44900 Drain appendix abscess open 22.42 70.00 $1,569.40

44950 Appendectomy 18.56 70.00 $1,299.20

44955 Appendectomy add-on 2.43 70.00 $170.10

44960 Appendectomy 25.26 70.00 $1,768.20

44970 Laparoscopy appendectomy 17.35 70.00 $1,214.50

44979 Laparoscope proc app 0.00 70.00 $0.00

4500F Ref to outpt card rehab prog 0.00 70.00 $0.00

45000 Drainage of pelvic abscess 12.15 70.00 $850.50

45005 Drainage of rectal abscess 7.77 70.00 $543.90

45020 Drainage of rectal abscess 16.44 70.00 $1,150.80

4510F Prev cardrehab qualcardevent 0.00 70.00 $0.00

45100 Biopsy of rectum 8.65 70.00 $605.50

45108 Removal of anorectal lesion 10.65 70.00 $745.50

45110 Removal of rectum 53.51 70.00 $3,745.70

45111 Partial removal of rectum 31.47 70.00 $2,202.90


45113 Partial proctectomy 54.65 70.00 $3,825.50



45119 Remove rectum w/reservoir 56.49 70.00 $3,954.30


45121 Removal of rectum and colon 47.62 70.00 $3,333.40

45123 Partial proctectomy 32.45 70.00 $2,271.50

45126 Pelvic exenteration 78.56 70.00 $5,499.20

45130 Excision of rectal prolapse 31.49 70.00 $2,204.30

45135 Excision of rectal prolapse 39.88 70.00 $2,791.60

45136 Excise ileoanal reservior 52.17 70.00 $3,651.90

45150 Excision of rectal stricture 10.34 70.00 $723.80

45160 Excision of rectal lesion 29.61 70.00 $2,072.70

45171 Exc rect tum transanal part 17.34 70.00 $1,213.80

45172 Exc rect tum transanal full 23.40 70.00 $1,638.00

45190 Destruction rectal tumor 20.04 70.00 $1,402.80

4525F Neuropsychia interven order 0.00 70.00 $0.00

4526F Neuropsychia interven rcvd 0.00 70.00 $0.00

45300 Proctosigmoidoscopy dx 3.53 70.00 $247.10

45303 Proctosigmoidoscopy dilate 27.58 70.00 $1,930.60

45305 Proctosigmoidoscopy w/bx 5.58 70.00 $390.60

45307 Proctosigmoidoscopy fb 6.39 70.00 $447.30

45308 Proctosigmoidoscopy removal 6.28 70.00 $439.60



45317 Proctosigmoidoscopy bleed 6.93 70.00 $485.10

45320 Proctosigmoidoscopy ablate 7.01 70.00 $490.70

45321 Proctosigmoidoscopy volvul 3.10 70.00 $217.00

45327 Proctosigmoidoscopy w/stent 3.54 70.00 $247.80

45330 Diagnostic sigmoidoscopy 3.91 70.00 $273.70

45331 Sigmoidoscopy and biopsy 4.64 70.00 $324.80

45332 Sigmoidoscopy w/fb removal 8.32 70.00 $582.40

45333 Sigmoidoscopy & polypectomy 8.46 70.00 $592.20

45334 Sigmoidoscopy for bleeding 4.68 70.00 $327.60

45335 Sigmoidoscopy w/submuc inj 7.83 70.00 $548.10

45337 Sigmoidoscopy & decompress 4.09 70.00 $286.30

45338 Sigmoidoscopy w/tumr remove 9.08 70.00 $635.60

45340 Sig w/tndsc balloon dilation 13.86 70.00 $970.20

45341 Sigmoidoscopy w/ultrasound 4.46 70.00 $312.20

45342 Sigmoidoscopy w/us guide bx 6.77 70.00 $473.90

45346 Sigmoidoscopy w/ablation 0.00 70.00 $0.00

45347 Sigmoidoscopy w/plcmt stent 0.00 70.00 $0.00

45349 Sigmoidoscopy w/resection 0.00 70.00 $0.00

45350 Sgmdsc w/band ligation 0.00 70.00 $0.00

45378 Diagnostic colonoscopy 11.06 70.00 $774.20

45378 53 Diagnostic colonoscopy 3.91 70.00 $273.70

45379 Colonoscopy w/fb removal 14.25 70.00 $997.50

45380 Colonoscopy and biopsy 13.18 70.00 $922.60

45381 Colonoscopy submucous njx 13.24 70.00 $926.80

45382 Colonoscopy w/control bleed 17.12 70.00 $1,198.40

45384 Colonoscopy w/lesion removal 13.21 70.00 $924.70

45385 Colonoscopy w/lesion removal 14.88 70.00 $1,041.60

45386 Colonoscopy w/balloon dilat 18.96 70.00 $1,327.20

45388 Colonoscopy w/ablation 0.00 70.00 $0.00

45389 Colonoscopy w/stent plcmt 0.00 70.00 $0.00

45390 Colonoscopy w/resection 0.00 70.00 $0.00

45391 Colonoscopy w/endoscope us 8.43 70.00 $590.10

45392 Colonoscopy w/endoscopic fnb 10.73 70.00 $751.10

45393 Colonoscopy w/decompression 0.00 70.00 $0.00

45395 Lap removal of rectum 57.35 70.00 $4,014.50

45397 Lap remove rectum w/pouch 62.45 70.00 $4,371.50

45398 Colonoscopy w/band ligation 0.00 70.00 $0.00

45399 Unlisted procedure colon 0.00 70.00 $0.00

4540F Disease modif pharmacothxpy 0.00 70.00 $0.00

45400 Laparoscopic proc 32.95 70.00 $2,306.50

45402 Lap proctopexy w/sig resect 44.02 70.00 $3,081.40

4541F Pt offered tx for pseudobulb 0.00 70.00 $0.00

45499 Laparoscope proc rectum 0.00 70.00 $0.00

4550F Noninvas resp support talk 0.00 70.00 $0.00

45500 Repair of rectum 15.14 70.00 $1,059.80

45505 Repair of rectum 17.16 70.00 $1,201.20

4551F Nutritional support offered 0.00 70.00 $0.00

4552F Pt ref for speech lang path 0.00 70.00 $0.00

45520 Treatment of rectal prolapse 4.53 70.00 $317.10

4553F Pt asst re end life issues 0.00 70.00 $0.00

4554F Pt recvd inhal anesthetic 0.00 70.00 $0.00

45540 Correct rectal prolapse 30.68 70.00 $2,147.60

45541 Correct rectal prolapse 27.14 70.00 $1,899.80

4555F Pt recvd no inhal anesthic 0.00 70.00 $0.00

45550 Repair rectum/remove sigmoid 42.25 70.00 $2,957.50

4556F Pt w/ 3+ post-op nausea&vom 0.00 70.00 $0.00

45560 Repair of rectocele 19.87 70.00 $1,390.90

45562 Exploration/repair of rectum 33.12 70.00 $2,318.40

45563 Exploration/repair of rectum 47.74 70.00 $3,341.80

4557F Pt w/o 3+ post-opnausea&vom 0.00 70.00 $0.00

4558F Pt recvd 2 rx anti-emet agt 0.00 70.00 $0.00

4559F 1 bodytemp >=35.5cw/in 30min 0.00 70.00 $0.00

4560F Anesth w/o gen/neurax anesth 0.00 70.00 $0.00

4561F Pt w/ coronary artery stent 0.00 70.00 $0.00

4562F Pt w/o coronary artery stent 0.00 70.00 $0.00

4563F Pt recvd aspirin w/in 24 hrs 0.00 70.00 $0.00

45800 Repair rect/bladder fistula 35.83 70.00 $2,508.10

45805 Repair fistula w/colostomy 39.90 70.00 $2,793.00

45820 Repair rectourethral fistula 32.41 70.00 $2,268.70

45825 Repair fistula w/colostomy 41.80 70.00 $2,926.00

45900 Reduction of rectal prolapse 5.90 70.00 $413.00

45905 Dilation of anal sphincter 4.89 70.00 $342.30

45910 Dilation of rectal narrowing 5.62 70.00 $393.40

45915 Remove rectal obstruction 9.49 70.00 $664.30

45990 Surg dx exam anorectal 3.12 70.00 $218.40

45999 Rectum surgery procedure 0.00 70.00 $0.00

46020 Placement of seton 7.92 70.00 $554.40

46030 Removal of rectal marker 3.99 70.00 $279.30

46040 Incision of rectal abscess 15.35 70.00 $1,074.50

46045 Incision of rectal abscess 12.52 70.00 $876.40

46050 Incision of anal abscess 5.76 70.00 $403.20

46060 Incision of rectal abscess 13.72 70.00 $960.40

46070 Incision of anal septum 6.33 70.00 $443.10

46080 Incision of anal sphincter 7.08 70.00 $495.60

46083 Incise external hemorrhoid 5.02 70.00 $351.40

46200 Removal of anal fissure 12.79 70.00 $895.30

46220 Excise anal ext tag/papilla 5.90 70.00 $413.00

46221 Ligation of hemorrhoid(s) 7.73 70.00 $541.10

46230 Removal of anal tags 7.81 70.00 $546.70

46250 Remove ext hem groups 2+ 13.27 70.00 $928.90

46255 Remove int/ext hem 1 group 14.54 70.00 $1,017.80

46257 Remove in/ex hem grp & fiss 12.12 70.00 $848.40

46258 Remove in/ex hem grp w/fistu 13.43 70.00 $940.10

46260 Remove in/ex hem groups 2+ 13.71 70.00 $959.70

46261 Remove in/ex hem grps & fiss 15.01 70.00 $1,050.70

46262 Remove in/ex hem grps w/fist 15.96 70.00 $1,117.20

46270 Remove anal fist subq 14.57 70.00 $1,019.90

46275 Remove anal fist inter 15.45 70.00 $1,081.50

46280 Remove anal fist complex 13.53 70.00 $947.10

46285 Remove anal fist 2 stage 15.30 70.00 $1,071.00

46288 Repair anal fistula 15.86 70.00 $1,110.20

46320 Removal of hemorrhoid clot 5.25 70.00 $367.50

46500 Injection into hemorrhoid(s) 6.85 70.00 $479.50

46505 Chemodenervation anal musc 8.15 70.00 $570.50

46600 Diagnostic anoscopy spx 2.52 70.00 $176.40

46601 Diagnostic anoscopy 0.00 70.00 $0.00

46604 Anoscopy and dilation 17.86 70.00 $1,250.20

46606 Anoscopy and biopsy 6.43 70.00 $450.10

46607 Diagnostic anoscopy & biopsy 0.00 70.00 $0.00

46608 Anoscopy remove for body 6.79 70.00 $475.30

46610 Anoscopy remove lesion 6.46 70.00 $452.20

46611 Anoscopy 4.99 70.00 $349.30

46612 Anoscopy remove lesions 7.85 70.00 $549.50

46614 Anoscopy control bleeding 3.68 70.00 $257.60

46615 Anoscopy 4.13 70.00 $289.10

46700 Repair of anal stricture 18.86 70.00 $1,320.20

46705 Repair of anal stricture 13.91 70.00 $973.70

46706 Repr of anal fistula w/glue 5.07 70.00 $354.90

46707 Repair anorectal fist w/plug 13.65 70.00 $955.50

46710 Repr per/vag pouch sngl proc 30.23 70.00 $2,116.10

46712 Repr per/vag pouch dbl proc 57.82 70.00 $4,047.40

46715 Rep perf anoper fistu 15.61 70.00 $1,092.70

46716 Rep perf anoper/vestib fistu 30.78 70.00 $2,154.60

46730 Construction of absent anus 56.71 70.00 $3,969.70



46742 Repair of imperforated anus 64.29 70.00 $4,500.30

46744 Repair of cloacal anomaly 101.94 70.00 $7,135.80



46750 Repair of anal sphincter 21.74 70.00 $1,521.80


46753 Reconstruction of anus 16.65 70.00 $1,165.50

46754 Removal of suture from anus 8.48 70.00 $593.60



46762 Implant artificial sphincter 26.64 70.00 $1,864.80

46900 Destruction anal lesion(s) 6.95 70.00 $486.50

46910 Destruction anal lesion(s) 7.31 70.00 $511.70

46916 Cryosurgery anal lesion(s) 6.52 70.00 $456.40

46917 Laser surgery anal lesions 12.86 70.00 $900.20

46922 Excision of anal lesion(s) 7.63 70.00 $534.10

46924 Destruction anal lesion(s) 15.32 70.00 $1,072.40

46930 Destroy internal hemorrhoids 5.91 70.00 $413.70

46940 Treatment of anal fissure 6.57 70.00 $459.90

46942 Treatment of anal fissure 6.22 70.00 $435.40

46945 Remove by ligat int hem grp 8.84 70.00 $618.80

46946 Remove by ligat int hem grps 9.03 70.00 $632.10

46947 Hemorrhoidopexy by stapling 10.99 70.00 $769.30

46999 Anus surgery procedure 0.00 70.00 $0.00

47000 Needle biopsy of liver 10.35 70.00 $724.50

47001 Needle biopsy liver add-on 3.02 70.00 $211.40

47010 Open drainage liver lesion 34.82 70.00 $2,437.40

47015 Inject/aspirate liver cyst 33.64 70.00 $2,354.80

47100 Wedge biopsy of liver 24.44 70.00 $1,710.80

47120 Partial removal of liver 67.42 70.00 $4,719.40

47122 Extensive removal of liver 99.38 70.00 $6,956.60



47133 Removal of donor liver 0.00 70.00 $0.00

47135 Transplantation of liver 141.47 70.00 $9,902.90

47136 Transplantation of liver 121.57 70.00 $8,509.90

47140 Partial removal donor liver 92.80 70.00 $6,496.00



47143 Prep donor liver whole 0.00 70.00 $0.00

47144 Prep donor liver 3-segment 0.00 70.00 $0.00

47145 Prep donor liver lobe split 0.00 70.00 $0.00

47146 Prep donor liver/venous 9.59 70.00 $671.30

47147 Prep donor liver/arterial 11.12 70.00 $778.40

47300 Surgery for liver lesion 32.82 70.00 $2,297.40

47350 Repair liver wound 39.64 70.00 $2,774.80




47370 Laparo ablate liver tumor rf 36.07 70.00 $2,524.90

47371 Laparo ablate liver cryosurg 36.37 70.00 $2,545.90

47379 Laparoscope procedure liver 0.00 70.00 $0.00

47380 Open ablate liver tumor rf 41.67 70.00 $2,916.90

47381 Open ablate liver tumor cryo 38.92 70.00 $2,724.40

47382 Percut ablate liver rf 142.43 70.00 $9,970.10

47383 Perq abltj lvr cryoablation 215.51 70.00 $15,085.70

47399 Liver surgery procedure 0.00 70.00 $0.00

47400 Incision of liver duct 62.45 70.00 $4,371.50

47420 Incision of bile duct 38.82 70.00 $2,717.40

47425 Incision of bile duct 39.57 70.00 $2,769.90

47460 Incise bile duct sphincter 36.71 70.00 $2,569.70

47480 Incision of gallbladder 25.32 70.00 $1,772.40

47490 Incision of gallbladder 9.62 70.00 $673.40

47500 Injection for liver x-rays 2.80 70.00 $196.00

47505 Injection for liver x-rays 1.08 70.00 $75.60

47510 Insert catheter bile duct 13.64 70.00 $954.80

47511 Insert bile duct drain 16.70 70.00 $1,169.00

47525 Change bile duct catheter 14.80 70.00 $1,036.00

47530 Revise/reinsert bile tube 39.22 70.00 $2,745.40

47550 Bile duct endoscopy add-on 4.81 70.00 $336.70

47552 Biliary endo perq dx w/speci 9.13 70.00 $639.10

47553 Biliary endoscopy thru skin 9.06 70.00 $634.20




47560 Laparoscopy w/cholangio 7.80 70.00 $546.00

47561 Laparo w/cholangio/biopsy 8.56 70.00 $599.20

47562 Laparoscopic cholecystectomy 19.00 70.00 $1,330.00

47563 Laparo cholecystectomy/graph 20.63 70.00 $1,444.10

47564 Laparo cholecystectomy/explr 32.14 70.00 $2,249.80

47570 Laparo cholecystoenterostomy 22.44 70.00 $1,570.80

47579 Laparoscope proc biliary 0.00 70.00 $0.00

47600 Removal of gallbladder 30.86 70.00 $2,160.20





47630 Remove bile duct stone 15.46 70.00 $1,082.20

47700 Exploration of bile ducts 30.44 70.00 $2,130.80

47701 Bile duct revision 50.26 70.00 $3,518.20

47711 Excision of bile duct tumor 44.91 70.00 $3,143.70

47712 Excision of bile duct tumor 57.92 70.00 $4,054.40

47715 Excision of bile duct cyst 38.51 70.00 $2,695.70

47720 Fuse gallbladder & bowel 33.40 70.00 $2,338.00

47721 Fuse upper gi structures 39.21 70.00 $2,744.70



47760 Fuse bile ducts and bowel 65.34 70.00 $4,573.80

47765 Fuse liver ducts & bowel 88.12 70.00 $6,168.40



47800 Reconstruction of bile ducts 45.75 70.00 $3,202.50

47801 Placement bile duct support 29.01 70.00 $2,030.70

47802 Fuse liver duct & intestine 44.20 70.00 $3,094.00

47900 Suture bile duct injury 39.76 70.00 $2,783.20

47999 Bile tract surgery procedure 0.00 70.00 $0.00

48000 Drainage of abdomen 54.47 70.00 $3,812.90

48001 Placement of drain pancreas 66.96 70.00 $4,687.20

48020 Removal of pancreatic stone 34.09 70.00 $2,386.30

48100 Biopsy of pancreas open 25.49 70.00 $1,784.30

48102 Needle biopsy pancreas 15.25 70.00 $1,067.50

48105 Resect/debride pancreas 82.47 70.00 $5,772.90

48120 Removal of pancreas lesion 32.02 70.00 $2,241.40

48140 Partial removal of pancreas 45.23 70.00 $3,166.10


48146 Pancreatectomy 54.42 70.00 $3,809.40

48148 Removal of pancreatic duct 36.15 70.00 $2,530.50


48152 Pancreatectomy 83.65 70.00 $5,855.50

48153 Pancreatectomy 89.60 70.00 $6,272.00

48154 Pancreatectomy 84.03 70.00 $5,882.10

48155 Removal of pancreas 52.50 70.00 $3,675.00

48160 Pancreas removal/transplant 0.00 70.00 $0.00

48400 Injection intraop add-on 3.12 70.00 $218.40

48500 Surgery of pancreatic cyst 33.31 70.00 $2,331.70

48510 Drain pancreatic pseudocyst 31.76 70.00 $2,223.20

48520 Fuse pancreas cyst and bowel 31.65 70.00 $2,215.50

48540 Fuse pancreas cyst and bowel 37.97 70.00 $2,657.90

48545 Pancreatorrhaphy 38.95 70.00 $2,726.50

48547 Duodenal exclusion 51.98 70.00 $3,638.60

48548 Fuse pancreas and bowel 48.30 70.00 $3,381.00

48550 Donor pancreatectomy 0.00 70.00 $0.00

48551 Prep donor pancreas 0.00 70.00 $0.00

48552 Prep donor pancreas/venous 6.87 70.00 $480.90

48554 Transpl allograft pancreas 73.95 70.00 $5,176.50

48556 Removal allograft pancreas 36.86 70.00 $2,580.20

48999 Pancreas surgery procedure 0.00 70.00 $0.00

49000 Exploration of abdomen 22.27 70.00 $1,558.90

49002 Reopening of abdomen 30.27 70.00 $2,118.90

49010 Exploration behind abdomen 26.96 70.00 $1,887.20

49020 Drainage abdom abscess open 46.09 70.00 $3,226.30

49040 Drain open abdom abscess 28.94 70.00 $2,025.80

49060 Drain open retroperi abscess 31.79 70.00 $2,225.30

49062 Drain to peritoneal cavity 21.41 70.00 $1,498.70

49082 Abd paracentesis 5.51 70.00 $385.70

49083 Abd paracentesis w/imaging 8.34 70.00 $583.80

49084 Peritoneal lavage 3.16 70.00 $221.20

49180 Biopsy abdominal mass 4.68 70.00 $327.60

49203 Exc abd tum 5 cm or less 34.65 70.00 $2,425.50

49204 Exc abd tum over 5 cm 44.30 70.00 $3,101.00

49205 Exc abd tum over 10 cm 50.82 70.00 $3,557.40

49215 Excise sacral spine tumor 63.61 70.00 $4,452.70

49220 Multiple surgery abdomen 28.11 70.00 $1,967.70

49250 Excision of umbilicus 16.88 70.00 $1,181.60

49255 Removal of omentum 22.81 70.00 $1,596.70

49320 Diag laparo separate proc 9.38 70.00 $656.60

49321 Laparoscopy biopsy 9.94 70.00 $695.80

49322 Laparoscopy aspiration 10.61 70.00 $742.70

49323 Laparo drain lymphocele 18.45 70.00 $1,291.50

49324 Lap insert tunnel ip cath 11.28 70.00 $789.60

49325 Lap revision perm ip cath 12.03 70.00 $842.10

49326 Lap w/omentopexy add-on 5.50 70.00 $385.00

49327 Lap ins device for rt 3.79 70.00 $265.30

49329 Laparo proc abdm/per/oment 0.00 70.00 $0.00

49400 Air injection into abdomen 3.92 70.00 $274.40

49402 Remove foreign body adbomen 24.73 70.00 $1,731.10

49405 Image cath fluid colxn visc 24.88 70.00 $1,741.60

49406 Image cath fluid peri/retro 24.91 70.00 $1,743.70

49407 Image cath fluid trns/vgnl 20.84 70.00 $1,458.80

49411 Ins mark abd/pel for rt perq 15.62 70.00 $1,093.40

49412 Ins device for rt guide open 2.39 70.00 $167.30

49418 Insert tun ip cath perc 40.74 70.00 $2,851.80

49419 Insert tun ip cath w/port 12.87 70.00 $900.90

49421 Ins tun ip cath for dial opn 6.69 70.00 $468.30

49422 Remove tunneled ip cath 10.98 70.00 $768.60

49423 Exchange drainage catheter 15.62 70.00 $1,093.40

49424 Assess cyst contrast inject 4.16 70.00 $291.20

49425 Insert abdomen-venous drain 21.07 70.00 $1,474.90

49426 Revise abdomen-venous shunt 17.66 70.00 $1,236.20

49427 Injection abdominal shunt 1.31 70.00 $91.70

49428 Ligation of shunt 15.45 70.00 $1,081.50

49429 Removal of shunt 13.27 70.00 $928.90

49435 Insert subq exten to ip cath 3.47 70.00 $242.90

49436 Embedded ip cath exit-site 5.40 70.00 $378.00

49440 Place gastrostomy tube perc 29.60 70.00 $2,072.00

49441 Place duod/jej tube perc 33.14 70.00 $2,319.80

49442 Place cecostomy tube perc 27.54 70.00 $1,927.80

49446 Change g-tube to g-j perc 28.45 70.00 $1,991.50

49450 Replace g/c tube perc 18.97 70.00 $1,327.90

49451 Replace duod/jej tube perc 20.69 70.00 $1,448.30

49452 Replace g-j tube perc 25.60 70.00 $1,792.00

49460 Fix g/colon tube w/device 20.85 70.00 $1,459.50

49465 Fluoro exam of g/colon tube 4.62 70.00 $323.40

49491 Rpr hern preemie reduc 21.58 70.00 $1,510.60

49492 Rpr ing hern premie blocked 24.75 70.00 $1,732.50

49495 Rpr ing hernia baby reduc 10.72 70.00 $750.40

49496 Rpr ing hernia baby blocked 15.76 70.00 $1,103.20

49500 Rpr ing hernia init reduce 11.85 70.00 $829.50

49501 Rpr ing hernia init blocked 17.50 70.00 $1,225.00

49505 Prp i/hern init reduc >5 yr 15.01 70.00 $1,050.70

49507 Prp i/hern init block >5 yr 16.89 70.00 $1,182.30

49520 Rerepair ing hernia reduce 18.24 70.00 $1,276.80

49521 Rerepair ing hernia blocked 20.67 70.00 $1,446.90

49525 Repair ing hernia sliding 16.52 70.00 $1,156.40

49540 Repair lumbar hernia 19.43 70.00 $1,360.10

49550 Rpr rem hernia init reduce 16.61 70.00 $1,162.70

49553 Rpr fem hernia init blocked 18.22 70.00 $1,275.40

49555 Rerepair fem hernia reduce 17.20 70.00 $1,204.00

49557 Rerepair fem hernia blocked 20.89 70.00 $1,462.30

49560 Rpr ventral hern init reduc 21.28 70.00 $1,489.60

49561 Rpr ventral hern init block 26.89 70.00 $1,882.30

49565 Rerepair ventrl hern reduce 22.18 70.00 $1,552.60

49566 Rerepair ventrl hern block 27.12 70.00 $1,898.40

49568 Hernia repair w/mesh 7.76 70.00 $543.20

49570 Rpr epigastric hern reduce 11.96 70.00 $837.20

49572 Rpr epigastric hern blocked 14.88 70.00 $1,041.60

49580 Rpr umbil hern reduc < 5 yr 9.58 70.00 $670.60

49582 Rpr umbil hern block < 5 yr 13.92 70.00 $974.40

49585 Rpr umbil hern reduc > 5 yr 12.82 70.00 $897.40

49587 Rpr umbil hern block > 5 yr 13.70 70.00 $959.00

49590 Repair spigelian hernia 16.52 70.00 $1,156.40

49600 Repair umbilical lesion 20.07 70.00 $1,404.90





49650 Lap ing hernia repair init 12.34 70.00 $863.80

49651 Lap ing hernia repair recur 16.05 70.00 $1,123.50

49652 Lap vent/abd hernia repair 21.49 70.00 $1,504.30

49653 Lap vent/abd hern proc comp 26.82 70.00 $1,877.40

49654 Lap inc hernia repair 24.43 70.00 $1,710.10

49655 Lap inc hern repair comp 29.85 70.00 $2,089.50

49656 Lap inc hernia repair recur 26.55 70.00 $1,858.50

49657 Lap inc hern recur comp 38.17 70.00 $2,671.90

49659 Laparo proc hernia repair 0.00 70.00 $0.00

49900 Repair of abdominal wall 23.54 70.00 $1,647.80

49904 Omental flap extra-abdom 41.11 70.00 $2,877.70

49905 Omental flap intra-abdom 10.23 70.00 $716.10

49906 Free omental flap microvasc 0.00 70.00 $0.00

49999 Abdomen surgery procedure 0.00 70.00 $0.00

50010 Exploration of kidney 21.42 70.00 $1,499.40

50020 Renal abscess open drain 29.04 70.00 $2,032.80

50040 Drainage of kidney 26.60 70.00 $1,862.00


5005F Pt counsld on exam for moles 0.00 70.00 $0.00

50060 Removal of kidney stone 32.72 70.00 $2,290.40

50065 Incision of kidney 34.71 70.00 $2,429.70

50070 Incision of kidney 34.02 70.00 $2,381.40




5010F Macul result phy/qhp mng dm 0.00 70.00 $0.00

50100 Revise kidney blood vessels 31.19 70.00 $2,183.30


50125 Explore and drain kidney 28.21 70.00 $1,974.70



5015F Doc fx & test/txmnt for op 0.00 70.00 $0.00

5020F Txmnts 2 phys/qhp by 1 mon 0.00 70.00 $0.00

50200 Renal biopsy perq 17.49 70.00 $1,224.30

50205 Renal biopsy open 21.71 70.00 $1,519.70

50220 Remove kidney open 30.05 70.00 $2,103.50

50225 Removal kidney open complex 34.47 70.00 $2,412.90

50230 Removal kidney open radical 36.81 70.00 $2,576.70

50234 Removal of kidney & ureter 37.33 70.00 $2,613.10

50236 Removal of kidney & ureter 42.11 70.00 $2,947.70

50240 Partial removal of kidney 37.99 70.00 $2,659.30

50250 Cryoablate renal mass open 34.91 70.00 $2,443.70

50280 Removal of kidney lesion 27.42 70.00 $1,919.40

50290 Removal of kidney lesion 25.77 70.00 $1,803.90

50300 Remove cadaver donor kidney 0.00 70.00 $0.00

50320 Remove kidney living donor 43.40 70.00 $3,038.00

50323 Prep cadaver renal allograft 0.00 70.00 $0.00

50325 Prep donor renal graft 0.00 70.00 $0.00

50327 Prep renal graft/venous 6.29 70.00 $440.30

50328 Prep renal graft/arterial 5.51 70.00 $385.70

50329 Prep renal graft/ureteral 5.31 70.00 $371.70

50340 Removal of kidney 27.36 70.00 $1,915.20

50360 Transplantation of kidney 69.91 70.00 $4,893.70

50365 Transplantation of kidney 81.94 70.00 $5,735.80

50370 Remove transplanted kidney 34.61 70.00 $2,422.70

50380 Reimplantation of kidney 57.85 70.00 $4,049.50

50382 Change ureter stent percut 33.76 70.00 $2,363.20

50384 Remove ureter stent percut 26.87 70.00 $1,880.90

50385 Change stent via transureth 32.46 70.00 $2,272.20

50386 Remove stent via transureth 21.11 70.00 $1,477.70

50387 Change ext/int ureter stent 15.46 70.00 $1,082.20

50389 Remove renal tube w/fluoro 8.44 70.00 $590.80

50390 Drainage of kidney lesion 2.81 70.00 $196.70

50391 Instll rx agnt into rnal tub 3.50 70.00 $245.00

50392 Insert kidney drain 5.19 70.00 $363.30

50393 Insert ureteral tube 6.31 70.00 $441.70

50394 Injection for kidney x-ray 2.96 70.00 $207.20

50395 Create passage to kidney 5.19 70.00 $363.30

50396 Measure kidney pressure 3.44 70.00 $240.80

50398 Change kidney tube 14.20 70.00 $994.00

50400 Revision of kidney/ureter 33.19 70.00 $2,323.30

50405 Revision of kidney/ureter 40.11 70.00 $2,807.70

5050F Plan 2 main dr by 1 month 0.00 70.00 $0.00

50500 Repair of kidney wound 33.11 70.00 $2,317.70

50520 Close kidney-skin fistula 29.74 70.00 $2,081.80

50525 Repair renal-abdomen fistula 43.78 70.00 $3,064.60

50526 Repair renal-abdomen fistula 40.94 70.00 $2,865.80

50540 Revision of horseshoe kidney 32.94 70.00 $2,305.80

50541 Laparo ablate renal cyst 26.37 70.00 $1,845.90

50542 Laparo ablate renal mass 33.46 70.00 $2,342.20

50543 Laparo partial nephrectomy 42.69 70.00 $2,988.30

50544 Laparoscopy pyeloplasty 35.75 70.00 $2,502.50

50545 Laparo radical nephrectomy 38.47 70.00 $2,692.90

50546 Laparoscopic nephrectomy 34.53 70.00 $2,417.10

50547 Laparo removal donor kidney 46.35 70.00 $3,244.50

50548 Laparo remove w/ureter 38.69 70.00 $2,708.30

50549 Laparoscope proc renal 0.00 70.00 $0.00

50551 Kidney endoscopy 10.28 70.00 $719.60


50555 Kidney endoscopy & biopsy 11.79 70.00 $825.30

50557 Kidney endoscopy & treatment 11.99 70.00 $839.30

50561 Kidney endoscopy & treatment 13.57 70.00 $949.90

50562 Renal scope w/tumor resect 16.70 70.00 $1,169.00


50572 Kidney endoscopy 15.30 70.00 $1,071.00

50574 Kidney endoscopy & biopsy 16.26 70.00 $1,138.20

50575 Kidney endoscopy 20.55 70.00 $1,438.50

50576 Kidney endoscopy & treatment 16.22 70.00 $1,135.40

50580 Kidney endoscopy & treatment 17.48 70.00 $1,223.60

50590 Fragmenting of kidney stone 20.51 70.00 $1,435.70

50592 Perc rf ablate renal tumor 89.35 70.00 $6,254.50

50593 Perc cryo ablate renal tum 131.67 70.00 $9,216.90

5060F Fndngs mammo 2pt w/in 3 days 0.00 70.00 $0.00

50600 Exploration of ureter 26.96 70.00 $1,887.20

50605 Insert ureteral support 28.34 70.00 $1,983.80

50610 Removal of ureter stone 27.14 70.00 $1,899.80

5062F Mammo result com to pt 5 day 0.00 70.00 $0.00



50650 Removal of ureter 29.71 70.00 $2,079.70

50660 Removal of ureter 32.82 70.00 $2,297.40

50684 Injection for ureter x-ray 3.01 70.00 $210.70

50686 Measure ureter pressure 4.50 70.00 $315.00

50688 Change of ureter tube/stent 2.30 70.00 $161.00

50690 Injection for ureter x-ray 2.81 70.00 $196.70

50700 Revision of ureter 26.57 70.00 $1,859.90

50715 Release of ureter 35.17 70.00 $2,461.90


50725 Release/revise ureter 31.92 70.00 $2,234.40

50727 Revise ureter 14.57 70.00 $1,019.90

50728 Revise ureter 20.02 70.00 $1,401.40

50740 Fusion of ureter & kidney 35.39 70.00 $2,477.30

50750 Fusion of ureter & kidney 33.11 70.00 $2,317.70

50760 Fusion of ureters 32.47 70.00 $2,272.90

50770 Splicing of ureters 33.11 70.00 $2,317.70

50780 Reimplant ureter in bladder 31.88 70.00 $2,231.60




50800 Implant ureter in bowel 26.60 70.00 $1,862.00

50810 Fusion of ureter & bowel 40.41 70.00 $2,828.70

50815 Urine shunt to intestine 35.09 70.00 $2,456.30

50820 Construct bowel bladder 37.83 70.00 $2,648.10

50825 Construct bowel bladder 47.52 70.00 $3,326.40

50830 Revise urine flow 51.75 70.00 $3,622.50

50840 Replace ureter by bowel 35.27 70.00 $2,468.90

50845 Appendico-vesicostomy 35.83 70.00 $2,508.10

50860 Transplant ureter to skin 27.14 70.00 $1,899.80

50900 Repair of ureter 24.38 70.00 $1,706.60

50920 Closure ureter/skin fistula 25.29 70.00 $1,770.30

50930 Closure ureter/bowel fistula 31.65 70.00 $2,215.50


50945 Laparoscopy ureterolithotomy 27.95 70.00 $1,956.50

50947 Laparo new ureter/bladder 39.88 70.00 $2,791.60

50948 Laparo new ureter/bladder 36.62 70.00 $2,563.40

50949 Laparoscope proc ureter 0.00 70.00 $0.00

50951 Endoscopy of ureter 10.74 70.00 $751.80

50953 Endoscopy of ureter 11.38 70.00 $796.60

50955 Ureter endoscopy & biopsy 12.16 70.00 $851.20

50957 Ureter endoscopy & treatment 12.28 70.00 $859.60


50970 Ureter endoscopy 10.69 70.00 $748.30

50972 Ureter endoscopy & catheter 10.33 70.00 $723.10

50974 Ureter endoscopy & biopsy 13.61 70.00 $952.70



5100F Rsk fx ref w/n 24 hrs xray 0.00 70.00 $0.00

51020 Incise & treat bladder 13.40 70.00 $938.00

51030 Incise & treat bladder 13.47 70.00 $942.90

51040 Incise & drain bladder 8.27 70.00 $578.90

51045 Incise bladder/drain ureter 14.07 70.00 $984.90

51050 Removal of bladder stone 13.52 70.00 $946.40


51065 Remove ureter calculus 16.58 70.00 $1,160.60

51080 Drainage of bladder abscess 11.69 70.00 $818.30

51100 Drain bladder by needle 1.77 70.00 $123.90

51101 Drain bladder by trocar/cath 3.55 70.00 $248.50

51102 Drain bl w/cath insertion 6.46 70.00 $452.20

51500 Removal of bladder cyst 18.24 70.00 $1,276.80

51520 Removal of bladder lesion 17.03 70.00 $1,192.10



51535 Repair of ureter lesion 22.36 70.00 $1,565.20

51550 Partial removal of bladder 27.69 70.00 $1,938.30

51555 Partial removal of bladder 36.44 70.00 $2,550.80

51565 Revise bladder & ureter(s) 37.36 70.00 $2,615.20

51570 Removal of bladder 42.49 70.00 $2,974.30

51575 Removal of bladder & nodes 52.31 70.00 $3,661.70

51580 Remove bladder/revise tract 54.44 70.00 $3,810.80

51585 Removal of bladder & nodes 60.62 70.00 $4,243.40



51596 Remove bladder/create pouch 67.49 70.00 $4,724.30

51597 Removal of pelvic structures 65.91 70.00 $4,613.70

51600 Injection for bladder x-ray 5.20 70.00 $364.00

51605 Preparation for bladder xray 1.09 70.00 $76.30

51610 Injection for bladder x-ray 3.04 70.00 $212.80

51700 Irrigation of bladder 2.36 70.00 $165.20

51701 Insert bladder catheter 1.54 70.00 $107.80

51702 Insert temp bladder cath 1.98 70.00 $138.60

51703 Insert bladder cath complex 3.68 70.00 $257.60

51705 Change of bladder tube 2.58 70.00 $180.60

51710 Change of bladder tube 3.65 70.00 $255.50

51715 Endoscopic injection/implant 8.27 70.00 $578.90

51720 Treatment of bladder lesion 3.10 70.00 $217.00

51725 Simple cystometrogram 5.31 70.00 $371.70

51725 TC Simple cystometrogram 3.11 70.00 $217.70

51725 26 Simple cystometrogram 2.20 70.00 $154.00

51726 Complex cystometrogram 7.43 70.00 $520.10

51726 TC Complex cystometrogram 4.97 70.00 $347.90

51726 26 Complex cystometrogram 2.46 70.00 $172.20

51727 Cystometrogram w/up 8.80 70.00 $616.00

51727 TC Cystometrogram w/up 5.72 70.00 $400.40

51727 26 Cystometrogram w/up 3.08 70.00 $215.60

51728 Cystometrogram w/vp 8.87 70.00 $620.90

51728 TC Cystometrogram w/vp 5.87 70.00 $410.90

51728 26 Cystometrogram w/vp 3.00 70.00 $210.00

51729 Cystometrogram w/vp&up 9.61 70.00 $672.70

51729 TC Cystometrogram w/vp&up 5.97 70.00 $417.90

51729 26 Cystometrogram w/vp&up 3.64 70.00 $254.80

51736 Urine flow measurement 0.44 70.00 $30.80

51736 TC Urine flow measurement 0.20 70.00 $14.00

51736 26 Urine flow measurement 0.24 70.00 $16.80

51741 Electro-uroflowmetry first 0.45 70.00 $31.50

51741 TC Electro-uroflowmetry first 0.21 70.00 $14.70

51741 26 Electro-uroflowmetry first 0.24 70.00 $16.80

51784 Anal/urinary muscle study 5.44 70.00 $380.80

51784 TC Anal/urinary muscle study 3.23 70.00 $226.10

51784 26 Anal/urinary muscle study 2.21 70.00 $154.70

51785 Anal/urinary muscle study 7.14 70.00 $499.80

51785 TC Anal/urinary muscle study 4.73 70.00 $331.10

51785 26 Anal/urinary muscle study 2.41 70.00 $168.70

51792 Urinary reflex study 5.96 70.00 $417.20

51792 TC Urinary reflex study 4.38 70.00 $306.60

51792 26 Urinary reflex study 1.58 70.00 $110.60

51797 Intraabdominal pressure test 3.16 70.00 $221.20

51797 TC Intraabdominal pressure test 2.02 70.00 $141.40

51797 26 Intraabdominal pressure test 1.14 70.00 $79.80

51798 Us urine capacity measure 0.53 70.00 $37.10

51800 Revision of bladder/urethra 29.96 70.00 $2,097.20

51820 Revision of urinary tract 35.06 70.00 $2,454.20

51840 Attach bladder/urethra 18.81 70.00 $1,316.70

51841 Attach bladder/urethra 22.21 70.00 $1,554.70

51845 Repair bladder neck 16.80 70.00 $1,176.00

51860 Repair of bladder wound 21.41 70.00 $1,498.70

51865 Repair of bladder wound 25.77 70.00 $1,803.90

51880 Repair of bladder opening 13.44 70.00 $940.80

51900 Repair bladder/vagina lesion 23.90 70.00 $1,673.00

51920 Close bladder-uterus fistula 21.89 70.00 $1,532.30

51925 Hysterectomy/bladder repair 32.31 70.00 $2,261.70

51940 Correction of bladder defect 47.13 70.00 $3,299.10

51960 Revision of bladder & bowel 39.86 70.00 $2,790.20

51980 Construct bladder opening 20.44 70.00 $1,430.80

51990 Laparo urethral suspension 21.56 70.00 $1,509.20

51992 Laparo sling operation 24.18 70.00 $1,692.60

51999 Laparoscope proc bla 0.00 70.00 $0.00

5200F Eval appros surg thxpy epi 0.00 70.00 $0.00

52000 Cystoscopy 5.80 70.00 $406.00

52001 Cystoscopy removal of clots 10.57 70.00 $739.90

52005 Cystoscopy & ureter catheter 7.51 70.00 $525.70

52007 Cystoscopy and biopsy 12.53 70.00 $877.10

52010 Cystoscopy & duct catheter 10.36 70.00 $725.20

52204 Cystoscopy w/biopsy(s) 10.43 70.00 $730.10

52214 Cystoscopy and treatment 18.60 70.00 $1,302.00

52224 Cystoscopy and treatment 19.49 70.00 $1,364.30

52234 Cystoscopy and treatment 7.08 70.00 $495.60



52250 Cystoscopy and radiotracer 6.90 70.00 $483.00



52270 Cystoscopy & revise urethra 10.06 70.00 $704.20

52275 Cystoscopy & revise urethra 13.57 70.00 $949.90




52282 Cystoscopy implant stent 9.71 70.00 $679.70



52287 Cystoscopy chemodenervation 8.81 70.00 $616.70







52317 Remove bladder stone 22.73 70.00 $1,591.10

52318 Remove bladder stone 13.64 70.00 $954.80


52325 Cystoscopy stone removal 9.24 70.00 $646.80

52327 Cystoscopy inject material 7.55 70.00 $528.50



52334 Create passage to kidney 7.37 70.00 $515.90

52341 Cysto w/ureter stricture tx 8.17 70.00 $571.90

52342 Cysto w/up stricture tx 8.91 70.00 $623.70

52343 Cysto w/renal stricture tx 9.92 70.00 $694.40

52344 Cysto/uretero stricture tx 10.65 70.00 $745.50

52345 Cysto/uretero w/up stricture 11.36 70.00 $795.20

52346 Cystouretero w/renal strict 12.88 70.00 $901.60

52351 Cystouretero & or pyeloscope 8.72 70.00 $610.40

52352 Cystouretero w/stone remove 10.22 70.00 $715.40

52353 Cystouretero w/lithotripsy 11.29 70.00 $790.30

52354 Cystouretero w/biopsy 12.00 70.00 $840.00

52355 Cystouretero w/excise tumor 13.44 70.00 $940.80

52356 Cysto/uretero w/lithotripsy 11.97 70.00 $837.90

52400 Cystouretero w/congen repr 13.72 70.00 $960.40

52402 Cystourethro cut ejacul duct 7.68 70.00 $537.60

52441 Cystourethro w/implant 34.90 70.00 $2,443.00

52442 Cystourethro w/addl implant 26.69 70.00 $1,868.30

52450 Incision of prostate 13.45 70.00 $941.50

5250F Asthma discharge plan presnt 0.00 70.00 $0.00

52500 Revision of bladder neck 13.99 70.00 $979.30

52601 Prostatectomy (turp) 24.26 70.00 $1,698.20

52630 Remove prostate regrowth 11.45 70.00 $801.50

52640 Relieve bladder contracture 9.01 70.00 $630.70

52647 Laser surgery of prostate 50.24 70.00 $3,516.80

52648 Laser surgery of prostate 51.71 70.00 $3,619.70

52649 Prostate laser enucleation 23.61 70.00 $1,652.70

52700 Drainage of prostate abscess 12.62 70.00 $883.40

53000 Incision of urethra 4.26 70.00 $298.20




53040 Drainage of urethra abscess 11.24 70.00 $786.80

53060 Drainage of urethra abscess 5.26 70.00 $368.20

53080 Drainage of urinary leakage 12.23 70.00 $856.10

53085 Drainage of urinary leakage 18.61 70.00 $1,302.70

53200 Biopsy of urethra 4.48 70.00 $313.60

53210 Removal of urethra 22.16 70.00 $1,551.20

53215 Removal of urethra 26.64 70.00 $1,864.80

53220 Treatment of urethra lesion 13.06 70.00 $914.20

53230 Removal of urethra lesion 17.39 70.00 $1,217.30

53235 Removal of urethra lesion 18.13 70.00 $1,269.10

53240 Surgery for urethra pouch 12.16 70.00 $851.20

53250 Removal of urethra gland 11.33 70.00 $793.10



53270 Removal of urethra gland 5.87 70.00 $410.90

53275 Repair of urethra defect 7.54 70.00 $527.80

53400 Revise urethra stage 1 22.98 70.00 $1,608.60

53405 Revise urethra stage 2 25.07 70.00 $1,754.90

53410 Reconstruction of urethra 28.11 70.00 $1,967.70


53420 Reconstruct urethra stage 1 24.12 70.00 $1,688.40

53425 Reconstruct urethra stage 2 26.87 70.00 $1,880.90


53431 Reconstruct urethra/bladder 33.13 70.00 $2,319.10

53440 Male sling procedure 21.60 70.00 $1,512.00

53442 Remove/revise male sling 22.45 70.00 $1,571.50

53444 Insert tandem cuff 22.75 70.00 $1,592.50

53445 Insert uro/ves nck sphincter 21.60 70.00 $1,512.00

53446 Remove uro sphincter 18.40 70.00 $1,288.00

53447 Remove/replace ur sphincter 23.19 70.00 $1,623.30

53448 Remov/replc ur sphinctr comp 36.74 70.00 $2,571.80

53449 Repair uro sphincter 17.53 70.00 $1,227.10

53450 Revision of urethra 11.72 70.00 $820.40


53500 Urethrlys transvag w/ scope 21.48 70.00 $1,503.60

53502 Repair of urethra injury 13.95 70.00 $976.50

53505 Repair of urethra injury 13.93 70.00 $975.10

53510 Repair of urethra injury 18.09 70.00 $1,266.30

53515 Repair of urethra injury 22.83 70.00 $1,598.10

53520 Repair of urethra defect 15.94 70.00 $1,115.80

53600 Dilate urethra stricture 2.37 70.00 $165.90





53660 Dilation of urethra 1.99 70.00 $139.30



53850 Prostatic microwave thermotx 58.45 70.00 $4,091.50

53852 Prostatic rf thermotx 53.89 70.00 $3,772.30

53855 Insert prost urethral stent 21.85 70.00 $1,529.50

53860 Transurethral rf treatment 44.14 70.00 $3,089.80

53899 Urology surgery procedure 0.00 70.00 $0.00

54000 Slitting of prepuce 4.21 70.00 $294.70

54001 Slitting of prepuce 5.25 70.00 $367.50

54015 Drain penis lesion 8.78 70.00 $614.60

54050 Destruction penis lesion(s) 3.76 70.00 $263.20


54056 Cryosurgery penis lesion(s) 4.03 70.00 $282.10

54057 Laser surg penis lesion(s) 3.84 70.00 $268.80

54060 Excision of penis lesion(s) 5.09 70.00 $356.30


54100 Biopsy of penis 5.63 70.00 $394.10

54105 Biopsy of penis 7.52 70.00 $526.40

54110 Treatment of penis lesion 17.89 70.00 $1,252.30

54111 Treat penis lesion graft 22.98 70.00 $1,608.60

54112 Treat penis lesion graft 26.91 70.00 $1,883.70

54115 Treatment of penis lesion 12.91 70.00 $903.70

54120 Partial removal of penis 18.13 70.00 $1,269.10

54125 Removal of penis 23.30 70.00 $1,631.00

54130 Remove penis & nodes 34.24 70.00 $2,396.80

54135 Remove penis & nodes 43.41 70.00 $3,038.70

54150 Circumcision w/regionl block 4.39 70.00 $307.30

54160 Circumcision neonate 6.24 70.00 $436.80

54161 Circum 28 days or older 5.64 70.00 $394.80

54162 Lysis penil circumic lesion 7.29 70.00 $510.30

54163 Repair of circumcision 6.26 70.00 $438.20

54164 Frenulotomy of penis 5.54 70.00 $387.80


54205 Treatment of penis lesion 15.25 70.00 $1,067.50


54230 Prepare penis study 2.76 70.00 $193.20

54231 Dynamic cavernosometry 4.00 70.00 $280.00

54235 Penile injection 2.58 70.00 $180.60

54240 Penis study 2.83 70.00 $198.10

54240 TC Penis study 0.99 70.00 $69.30

54240 26 Penis study 1.84 70.00 $128.80

54250 Penis study 3.46 70.00 $242.20

54250 TC Penis study 0.31 70.00 $21.70

54250 26 Penis study 3.15 70.00 $220.50

54300 Revision of penis 18.40 70.00 $1,288.00









54328 Revise penis/urethra 26.97 70.00 $1,887.90



54340 Secondary urethral surgery 16.34 70.00 $1,143.80



54352 Reconstruct urethra/penis 40.67 70.00 $2,846.90

54360 Penis plastic surgery 20.68 70.00 $1,447.60

54380 Repair penis 22.93 70.00 $1,605.10

54385 Repair penis 29.86 70.00 $2,090.20

54390 Repair penis and bladder 35.90 70.00 $2,513.00

54400 Insert semi-rigid prosthesis 15.18 70.00 $1,062.60

54401 Insert self-contd prosthesis 18.77 70.00 $1,313.90

54405 Insert multi-comp penis pros 23.19 70.00 $1,623.30

54406 Remove muti-comp penis pros 20.96 70.00 $1,467.20

54408 Repair multi-comp penis pros 22.67 70.00 $1,586.90

54410 Remove/replace penis prosth 24.65 70.00 $1,725.50

54411 Remov/replc penis pros comp 29.45 70.00 $2,061.50

54415 Remove self-contd penis pros 15.17 70.00 $1,061.90

54416 Remv/repl penis contain pros 20.34 70.00 $1,423.80

54417 Remv/replc penis pros compl 25.79 70.00 $1,805.30



54435 Revision of penis 11.93 70.00 $835.10

54440 Repair of penis 0.00 70.00 $0.00

54450 Preputial stretching 1.99 70.00 $139.30

54500 Biopsy of testis 2.15 70.00 $150.50

54505 Biopsy of testis 6.01 70.00 $420.70

54512 Excise lesion testis 15.53 70.00 $1,087.10

54520 Removal of testis 9.36 70.00 $655.20

54522 Orchiectomy partial 16.92 70.00 $1,184.40

54530 Removal of testis 14.47 70.00 $1,012.90

54535 Extensive testis surgery 21.36 70.00 $1,495.20

54550 Exploration for testis 14.11 70.00 $987.70

54560 Exploration for testis 19.48 70.00 $1,363.60

54600 Reduce testis torsion 12.97 70.00 $907.90

54620 Suspension of testis 8.61 70.00 $602.70

54640 Suspension of testis 13.75 70.00 $962.50

54650 Orchiopexy (fowler-stephens) 20.40 70.00 $1,428.00

54660 Revision of testis 10.23 70.00 $716.10

54670 Repair testis injury 11.60 70.00 $812.00

54680 Relocation of testis(es) 22.58 70.00 $1,580.60

54690 Laparoscopy orchiectomy 18.86 70.00 $1,320.20

54692 Laparoscopy orchiopexy 21.79 70.00 $1,525.30

54699 Laparoscope proc testis 0.00 70.00 $0.00

54700 Drainage of scrotum 6.17 70.00 $431.90

54800 Biopsy of epididymis 3.63 70.00 $254.10

54830 Remove epididymis lesion 10.67 70.00 $746.90

54840 Remove epididymis lesion 9.19 70.00 $643.30

54860 Removal of epididymis 12.00 70.00 $840.00

54861 Removal of epididymis 16.23 70.00 $1,136.10

54865 Explore epididymis 10.27 70.00 $718.90

54900 Fusion of spermatic ducts 23.21 70.00 $1,624.70

54901 Fusion of spermatic ducts 30.58 70.00 $2,140.60

55000 Drainage of hydrocele 3.34 70.00 $233.80

55040 Removal of hydrocele 9.70 70.00 $679.00

55041 Removal of hydroceles 14.63 70.00 $1,024.10

55060 Repair of hydrocele 10.91 70.00 $763.70

55100 Drainage of scrotum abscess 6.13 70.00 $429.10

55110 Explore scrotum 11.10 70.00 $777.00

55120 Removal of scrotum lesion 10.25 70.00 $717.50

55150 Removal of scrotum 14.14 70.00 $989.80

55175 Revision of scrotum 10.39 70.00 $727.30

55180 Revision of scrotum 19.77 70.00 $1,383.90

55200 Incision of sperm duct 12.36 70.00 $865.20

55250 Removal of sperm duct(s) 10.88 70.00 $761.60

55300 Prepare sperm duct x-ray 5.38 70.00 $376.60

55400 Repair of sperm duct 14.29 70.00 $1,000.30

55450 Ligation of sperm duct 10.19 70.00 $713.30

55500 Removal of hydrocele 11.36 70.00 $795.20

55520 Removal of sperm cord lesion 13.05 70.00 $913.50

55530 Revise spermatic cord veins 10.11 70.00 $707.70

55535 Revise spermatic cord veins 12.33 70.00 $863.10

55540 Revise hernia & sperm veins 15.95 70.00 $1,116.50

55550 Laparo ligate spermatic vein 12.27 70.00 $858.90

55559 Laparo proc spermatic cord 0.00 70.00 $0.00

55600 Incise sperm duct pouch 12.07 70.00 $844.90

55605 Incise sperm duct pouch 15.16 70.00 $1,061.20

55650 Remove sperm duct pouch 20.55 70.00 $1,438.50

55680 Remove sperm pouch lesion 10.06 70.00 $704.20

55700 Biopsy of prostate 6.18 70.00 $432.60

55705 Biopsy of prostate 7.65 70.00 $535.50

55706 Prostate saturation sampling 10.68 70.00 $747.60

55720 Drainage of prostate abscess 12.94 70.00 $905.80

55725 Drainage of prostate abscess 18.20 70.00 $1,274.00

55801 Removal of prostate 31.36 70.00 $2,195.20

55810 Extensive prostate surgery 37.83 70.00 $2,648.10








55860 Surgical exposure prostate 25.11 70.00 $1,757.70



55866 Laparo radical prostatectomy 49.77 70.00 $3,483.90

55870 Electroejaculation 5.01 70.00 $350.70

55873 Cryoablate prostate 200.47 70.00 $14,032.90

55875 Transperi needle place pros 21.87 70.00 $1,530.90

55876 Place rt device/marker pros 3.85 70.00 $269.50

55899 Genital surgery procedure 0.00 70.00 $0.00

55920 Place needles pelvic for rt 12.78 70.00 $894.60

55970 Sex transformation m to f 0.00 70.00 $0.00

55980 Sex transformation f to m 0.00 70.00 $0.00

56405 I & d of vulva/perineum 3.12 70.00 $218.40

56420 Drainage of gland abscess 3.46 70.00 $242.20

56440 Surgery for vulva lesion 5.19 70.00 $363.30

56441 Lysis of labial lesion(s) 4.13 70.00 $289.10

56442 Hymenotomy 1.35 70.00 $94.50

56501 Destroy vulva lesions sim 3.72 70.00 $260.40

56515 Destroy vulva lesion/s compl 6.45 70.00 $451.50

56605 Biopsy of vulva/perineum 2.34 70.00 $163.80

56606 Biopsy of vulva/perineum 1.07 70.00 $74.90

56620 Partial removal of vulva 14.86 70.00 $1,040.20

56625 Complete removal of vulva 18.05 70.00 $1,263.50

56630 Extensive vulva surgery 26.60 70.00 $1,862.00







56700 Partial removal of hymen 5.31 70.00 $371.70

56740 Remove vagina gland lesion 8.58 70.00 $600.60

56800 Repair of vagina 6.87 70.00 $480.90

56805 Repair clitoris 32.49 70.00 $2,274.30

56810 Repair of perineum 7.40 70.00 $518.00

56820 Exam of vulva w/scope 3.19 70.00 $223.30

56821 Exam/biopsy of vulva w/scope 4.21 70.00 $294.70

57000 Exploration of vagina 5.25 70.00 $367.50

57010 Drainage of pelvic abscess 12.30 70.00 $861.00

57020 Drainage of pelvic fluid 2.63 70.00 $184.10

57022 I & d vaginal hematoma pp 4.78 70.00 $334.60

57023 I & d vag hematoma non-ob 8.84 70.00 $618.80

57061 Destroy vag lesions simple 3.24 70.00 $226.80

57065 Destroy vag lesions complex 5.58 70.00 $390.60

57100 Biopsy of vagina 2.54 70.00 $177.80

57105 Biopsy of vagina 3.88 70.00 $271.60

57106 Remove vagina wall partial 14.10 70.00 $987.00

57107 Remove vagina tissue part 41.73 70.00 $2,921.10

57109 Vaginectomy partial w/nodes 50.31 70.00 $3,521.70

57110 Remove vagina wall complete 25.43 70.00 $1,780.10

57111 Remove vagina tissue compl 45.53 70.00 $3,187.10

57112 Vaginectomy w/nodes compl 53.85 70.00 $3,769.50

57120 Closure of vagina 14.47 70.00 $1,012.90

57130 Remove vagina lesion 5.03 70.00 $352.10

57135 Remove vagina lesion 5.45 70.00 $381.50

57150 Treat vagina infection 1.28 70.00 $89.60

57155 Insert uteri tandem/ovoids 12.13 70.00 $849.10

57156 Ins vag brachytx device 5.58 70.00 $390.60

57160 Insert pessary/other device 2.17 70.00 $151.90

57170 Fitting of diaphragm/cap 1.72 70.00 $120.40

57180 Treat vaginal bleeding 4.00 70.00 $280.00

57200 Repair of vagina 8.61 70.00 $602.70

57210 Repair vagina/perineum 10.46 70.00 $732.20


57230 Repair of urethral lesion 11.20 70.00 $784.00

57240 Repair bladder & vagina 19.10 70.00 $1,337.00

57250 Repair rectum & vagina 19.24 70.00 $1,346.80

57260 Repair of vagina 23.71 70.00 $1,659.70

57265 Extensive repair of vagina 25.96 70.00 $1,817.20

57267 Insert mesh/pelvic flr addon 7.31 70.00 $511.70

57268 Repair of bowel bulge 13.74 70.00 $961.80

57270 Repair of bowel pouch 22.69 70.00 $1,588.30

57280 Suspension of vagina 27.16 70.00 $1,901.20

57282 Colpopexy extraperitoneal 14.22 70.00 $995.40

57283 Colpopexy intraperitoneal 19.61 70.00 $1,372.70

57284 Repair paravag defect open 23.22 70.00 $1,625.40

57285 Repair paravag defect vag 19.13 70.00 $1,339.10

57287 Revise/remove sling repair 19.37 70.00 $1,355.90

57288 Repair bladder defect 20.38 70.00 $1,426.60

57289 Repair bladder & vagina 20.91 70.00 $1,463.70

57291 Construction of vagina 15.04 70.00 $1,052.80

57292 Construct vagina with graft 23.19 70.00 $1,623.30

57295 Revise vag graft via vagina 13.57 70.00 $949.90

57296 Revise vag graft open abd 26.59 70.00 $1,861.30

57300 Repair rectum-vagina fistula 16.21 70.00 $1,134.70

57305 Repair rectum-vagina fistula 26.89 70.00 $1,882.30

57307 Fistula repair & colostomy 30.96 70.00 $2,167.20

57308 Fistula repair transperine 18.15 70.00 $1,270.50

57310 Repair urethrovaginal lesion 13.18 70.00 $922.60

57311 Repair urethrovaginal lesion 15.01 70.00 $1,050.70

57320 Repair bladder-vagina lesion 15.11 70.00 $1,057.70

57330 Repair bladder-vagina lesion 21.21 70.00 $1,484.70

57335 Repair vagina 31.86 70.00 $2,230.20

57400 Dilation of vagina 3.79 70.00 $265.30

57410 Pelvic examination 3.09 70.00 $216.30

57415 Remove vaginal foreign body 4.56 70.00 $319.20

57420 Exam of vagina w/scope 3.37 70.00 $235.90

57421 Exam/biopsy of vag w/scope 4.49 70.00 $314.30

57423 Repair paravag defect lap 26.01 70.00 $1,820.70

57425 Laparoscopy surg colpopexy 27.58 70.00 $1,930.60

57426 Revise prosth vag graft lap 24.01 70.00 $1,680.70

57452 Exam of cervix w/scope 3.10 70.00 $217.00

57454 Bx/curett of cervix w/scope 4.35 70.00 $304.50

57455 Biopsy of cervix w/scope 4.07 70.00 $284.90

57456 Endocerv curettage w/scope 3.83 70.00 $268.10

57460 Bx of cervix w/scope leep 8.00 70.00 $560.00

57461 Conz of cervix w/scope leep 9.06 70.00 $634.20

57500 Biopsy of cervix 3.63 70.00 $254.10

57505 Endocervical curettage 2.89 70.00 $202.30

57510 Cauterization of cervix 3.72 70.00 $260.40

57511 Cryocautery of cervix 4.13 70.00 $289.10

57513 Laser surgery of cervix 4.13 70.00 $289.10

57520 Conization of cervix 8.71 70.00 $609.70

57522 Conization of cervix 7.47 70.00 $522.90

57530 Removal of cervix 9.92 70.00 $694.40

57531 Removal of cervix radical 53.10 70.00 $3,717.00

57540 Removal of residual cervix 22.85 70.00 $1,599.50

57545 Remove cervix/repair pelvis 23.33 70.00 $1,633.10

57550 Removal of residual cervix 11.54 70.00 $807.80

57555 Remove cervix/repair vagina 17.06 70.00 $1,194.20

57556 Remove cervix repair bowel 16.13 70.00 $1,129.10

57558 D&c of cervical stump 3.55 70.00 $248.50

57700 Revision of cervix 8.80 70.00 $616.00


57800 Dilation of cervical canal 1.73 70.00 $121.10

58100 Biopsy of uterus lining 3.09 70.00 $216.30

58110 Bx done w/colposcopy add-on 1.37 70.00 $95.90

58120 Dilation and curettage 7.34 70.00 $513.80

58140 Myomectomy abdom method 26.27 70.00 $1,838.90

58145 Myomectomy vag method 15.59 70.00 $1,091.30

58146 Myomectomy abdom complex 32.72 70.00 $2,290.40

58150 Total hysterectomy 28.94 70.00 $2,025.80

58152 Total hysterectomy 35.69 70.00 $2,498.30

58180 Partial hysterectomy 27.47 70.00 $1,922.90

58200 Extensive hysterectomy 39.24 70.00 $2,746.80


58240 Removal of pelvis contents 83.64 70.00 $5,854.80

58260 Vaginal hysterectomy 23.49 70.00 $1,644.30

58262 Vag hyst including t/o 26.23 70.00 $1,836.10

58263 Vag hyst w/t/o & vag repair 28.11 70.00 $1,967.70

58267 Vag hyst w/urinary repair 30.01 70.00 $2,100.70

58270 Vag hyst w/enterocele repair 25.07 70.00 $1,754.90

58275 Hysterectomy/revise vagina 28.08 70.00 $1,965.60

58280 Hysterectomy/revise vagina 29.86 70.00 $2,090.20


58290 Vag hyst complex 32.63 70.00 $2,284.10

58291 Vag hyst incl t/o complex 35.34 70.00 $2,473.80

58292 Vag hyst t/o & repair compl 37.28 70.00 $2,609.60

58293 Vag hyst w/uro repair compl 38.76 70.00 $2,713.20

58294 Vag hyst w/enterocele compl 34.55 70.00 $2,418.50

58300 Insert intrauterine device 1.98 70.00 $138.60

58301 Remove intrauterine device 2.69 70.00 $188.30

58321 Artificial insemination 2.16 70.00 $151.20

58322 Artificial insemination 2.43 70.00 $170.10

58323 Sperm washing 0.44 70.00 $30.80

58340 Catheter for hysterography 3.36 70.00 $235.20

58345 Reopen fallopian tube 7.92 70.00 $554.40

58346 Insert heyman uteri capsule 12.59 70.00 $881.30

58350 Reopen fallopian tube 2.74 70.00 $191.80

58353 Endometr ablate thermal 28.34 70.00 $1,983.80

58356 Endometrial cryoablation 52.94 70.00 $3,705.80

58400 Suspension of uterus 12.47 70.00 $872.90

58410 Suspension of uterus 22.81 70.00 $1,596.70

58520 Repair of ruptured uterus 22.77 70.00 $1,593.90

58540 Revision of uterus 25.79 70.00 $1,805.30

58541 Lsh uterus 250 g or less 20.38 70.00 $1,426.60

58542 Lsh w/t/o ut 250 g or less 23.29 70.00 $1,630.30

58543 Lsh uterus above 250 g 23.56 70.00 $1,649.20

58544 Lsh w/t/o uterus above 250 g 25.73 70.00 $1,801.10

58545 Laparoscopic myomectomy 25.80 70.00 $1,806.00

58546 Laparo-myomectomy complex 31.92 70.00 $2,234.40

58548 Lap radical hyst 54.50 70.00 $3,815.00

58550 Laparo-asst vag hysterectomy 25.08 70.00 $1,755.60

58552 Laparo-vag hyst incl t/o 28.16 70.00 $1,971.20

58553 Laparo-vag hyst complex 32.21 70.00 $2,254.70

58554 Laparo-vag hyst w/t/o compl 37.76 70.00 $2,643.20

58555 Hysteroscopy dx sep proc 8.59 70.00 $601.30

58558 Hysteroscopy biopsy 11.24 70.00 $786.80

58559 Hysteroscopy lysis 9.71 70.00 $679.70

58560 Hysteroscopy resect septum 10.98 70.00 $768.60

58561 Hysteroscopy remove myoma 15.55 70.00 $1,088.50

58562 Hysteroscopy remove fb 11.66 70.00 $816.20

58563 Hysteroscopy ablation 46.85 70.00 $3,279.50

58565 Hysteroscopy sterilization 52.67 70.00 $3,686.90

58570 Tlh uterus 250 g or less 22.17 70.00 $1,551.90

58571 Tlh w/t/o 250 g or less 25.64 70.00 $1,794.80

58572 Tlh uterus over 250 g 28.98 70.00 $2,028.60

58573 Tlh w/t/o uterus over 250 g 34.63 70.00 $2,424.10

58578 Laparo proc uterus 0.00 70.00 $0.00

58579 Hysteroscope procedure 0.00 70.00 $0.00

58600 Division of fallopian tube 10.32 70.00 $722.40

58605 Division of fallopian tube 9.35 70.00 $654.50

58611 Ligate oviduct(s) add-on 2.20 70.00 $154.00

58615 Occlude fallopian tube(s) 6.92 70.00 $484.40

58660 Laparoscopy lysis 19.19 70.00 $1,343.30

58661 Laparoscopy remove adnexa 18.50 70.00 $1,295.00

58662 Laparoscopy excise lesions 20.21 70.00 $1,414.70

58670 Laparoscopy tubal cautery 10.35 70.00 $724.50

58671 Laparoscopy tubal block 10.33 70.00 $723.10

58672 Laparoscopy fimbrioplasty 20.86 70.00 $1,460.20

58673 Laparoscopy salpingostomy 22.69 70.00 $1,588.30

58679 Laparo proc oviduct-ovary 0.00 70.00 $0.00

58700 Removal of fallopian tube 22.31 70.00 $1,561.70

58720 Removal of ovary/tube(s) 21.00 70.00 $1,470.00

58740 Adhesiolysis tube ovary 25.21 70.00 $1,764.70

58750 Repair oviduct 25.92 70.00 $1,814.40

58752 Revise ovarian tube(s) 24.75 70.00 $1,732.50

58760 Fimbrioplasty 22.98 70.00 $1,608.60

58770 Create new tubal opening 24.19 70.00 $1,693.30

58800 Drainage of ovarian cyst(s) 9.01 70.00 $630.70

58805 Drainage of ovarian cyst(s) 11.46 70.00 $802.20

58820 Drain ovary abscess open 8.84 70.00 $618.80

58822 Drain ovary abscess percut 19.86 70.00 $1,390.20

58825 Transposition ovary(s) 21.73 70.00 $1,521.10

58900 Biopsy of ovary(s) 11.71 70.00 $819.70

58920 Partial removal of ovary(s) 20.29 70.00 $1,420.30

58925 Removal of ovarian cyst(s) 21.32 70.00 $1,492.40

58940 Removal of ovary(s) 15.02 70.00 $1,051.40

58943 Removal of ovary(s) 33.64 70.00 $2,354.80

58950 Resect ovarian malignancy 32.41 70.00 $2,268.70



58953 Tah rad dissect for debulk 58.30 70.00 $4,081.00

58954 Tah rad debulk/lymph remove 63.22 70.00 $4,425.40

58956 Bso omentectomy w/tah 39.67 70.00 $2,776.90

58957 Resect recurrent gyn mal 45.62 70.00 $3,193.40

58958 Resect recur gyn mal w/lym 50.09 70.00 $3,506.30

58960 Exploration of abdomen 28.00 70.00 $1,960.00

58970 Retrieval of oocyte 6.32 70.00 $442.40

58974 Transfer of embryo 0.00 70.00 $0.00

58976 Transfer of embryo 6.94 70.00 $485.80

58999 Genital surgery procedure 0.00 70.00 $0.00

59000 Amniocentesis diagnostic 3.61 70.00 $252.70

59001 Amniocentesis therapeutic 5.24 70.00 $366.80

59012 Fetal cord puncture prenatal 5.91 70.00 $413.70

59015 Chorion biopsy 4.50 70.00 $315.00

59020 Fetal contract stress test 2.04 70.00 $142.80

59020 TC Fetal contract stress test 0.96 70.00 $67.20

59020 26 Fetal contract stress test 1.08 70.00 $75.60

59025 Fetal non-stress test 1.38 70.00 $96.60

59025 TC Fetal non-stress test 0.52 70.00 $36.40

59025 26 Fetal non-stress test 0.86 70.00 $60.20

59030 Fetal scalp blood sample 2.89 70.00 $202.30

59050 Fetal monitor w/report 1.48 70.00 $103.60

59051 Fetal monitor/interpret only 1.22 70.00 $85.40

59070 Transabdom amnioinfus w/us 11.81 70.00 $826.70

59072 Umbilical cord occlud w/us 13.45 70.00 $941.50

59074 Fetal fluid drainage w/us 11.33 70.00 $793.10

59076 Fetal shunt placement w/us 13.45 70.00 $941.50

59100 Remove uterus lesion 24.19 70.00 $1,693.30

59120 Treat ectopic pregnancy 23.02 70.00 $1,611.40





59140 Treat ectopic pregnancy 11.60 70.00 $812.00



59160 D & c after delivery 5.88 70.00 $411.60

59200 Insert cervical dilator 2.07 70.00 $144.90

59300 Episiotomy or vaginal repair 5.58 70.00 $390.60



59350 Repair of uterus 8.20 70.00 $574.00

59400 Obstetrical care 60.62 70.00 $4,243.40



59412 Antepartum manipulation 3.02 70.00 $211.40

59414 Deliver placenta 2.67 70.00 $186.90

59425 Antepartum care only 13.15 70.00 $920.50

59426 Antepartum care only 23.55 70.00 $1,648.50

59430 Care after delivery 5.35 70.00 $374.50

59510 Cesarean delivery 66.97 70.00 $4,687.90

59514 Cesarean delivery only 26.68 70.00 $1,867.60

59515 Cesarean delivery 36.65 70.00 $2,565.50

59525 Remove uterus after cesarean 14.14 70.00 $989.80

59610 Vbac delivery 63.51 70.00 $4,445.70

59612 Vbac delivery only 26.66 70.00 $1,866.20

59614 Vbac care after delivery 33.17 70.00 $2,321.90

59618 Attempted vbac delivery 67.90 70.00 $4,753.00

59620 Attempted vbac delivery only 27.61 70.00 $1,932.70

59622 Attempted vbac after care 37.63 70.00 $2,634.10

59812 Treatment of miscarriage 9.17 70.00 $641.90

59820 Care of miscarriage 10.93 70.00 $765.10

59821 Treatment of miscarriage 11.01 70.00 $770.70

59830 Treat uterus infection 12.63 70.00 $884.10

59840 Abortion 6.28 70.00 $439.60

59841 Abortion 11.05 70.00 $773.50

59850 Abortion 9.97 70.00 $697.90

59851 Abortion 11.51 70.00 $805.70

59852 Abortion 14.42 70.00 $1,009.40

59855 Abortion 12.01 70.00 $840.70

59856 Abortion 14.12 70.00 $988.40

59857 Abortion 14.84 70.00 $1,038.80

59866 Abortion (mpr) 6.22 70.00 $435.40

59870 Evacuate mole of uterus 13.61 70.00 $952.70

59871 Remove cerclage suture 3.88 70.00 $271.60

59897 Fetal invas px w/us 0.00 70.00 $0.00

59898 Laparo proc ob care/deliver 0.00 70.00 $0.00

59899 Maternity care procedure 0.00 70.00 $0.00

60000 Drain thyroid/tongue cyst 4.56 70.00 $319.20

6005F Care level rationale doc 0.00 70.00 $0.00

6010F Dysphag test done b/4 eating 0.00 70.00 $0.00

60100 Biopsy of thyroid 3.24 70.00 $226.80

6015F Dysphag test done b/4 eating 0.00 70.00 $0.00

6020F Npo (nothing-mouth) ordered 0.00 70.00 $0.00

60200 Remove thyroid lesion 19.02 70.00 $1,331.40

60210 Partial thyroid excision 20.39 70.00 $1,427.30

60212 Partial thyroid excision 29.12 70.00 $2,038.40

60220 Partial removal of thyroid 20.39 70.00 $1,427.30

60225 Partial removal of thyroid 26.91 70.00 $1,883.70

60240 Removal of thyroid 26.53 70.00 $1,857.10


60254 Extensive thyroid surgery 48.41 70.00 $3,388.70

60260 Repeat thyroid surgery 31.55 70.00 $2,208.50



60280 Remove thyroid duct lesion 12.77 70.00 $893.90

60281 Remove thyroid duct lesion 16.95 70.00 $1,186.50

6030F Max sterile barriers follwd 0.00 70.00 $0.00

60300 Aspir/inj thyroid cyst 3.39 70.00 $237.30

6040F Appro rad ds dvcs techs docd 0.00 70.00 $0.00

6045F Radxps in end rprt4fluro pxd 0.00 70.00 $0.00

60500 Explore parathyroid glands 27.85 70.00 $1,949.50

60502 Re-explore parathyroids 37.19 70.00 $2,603.30

60505 Explore parathyroid glands 40.10 70.00 $2,807.00

60512 Autotransplant parathyroid 7.07 70.00 $494.90

60520 Removal of thymus gland 30.25 70.00 $2,117.50



60540 Explore adrenal gland 30.50 70.00 $2,135.00

60545 Explore adrenal gland 35.13 70.00 $2,459.10

60600 Remove carotid body lesion 40.63 70.00 $2,844.10

60605 Remove carotid body lesion 57.91 70.00 $4,053.70

60650 Laparoscopy adrenalectomy 34.39 70.00 $2,407.30

60659 Laparo proc endocrine 0.00 70.00 $0.00

60699 Endocrine surgery procedure 0.00 70.00 $0.00

6070F Pt asked/cnsld aed effects 0.00 70.00 $0.00

6080F Pt/caregiver queried falls 0.00 70.00 $0.00

6090F Pt/caregiver counsel safety 0.00 70.00 $0.00

6100F Verify pt site pxd docd 0.00 70.00 $0.00

61000 Remove cranial cavity fluid 3.15 70.00 $220.50

61001 Remove cranial cavity fluid 2.35 70.00 $164.50

6101F Safety counseling dementia 0.00 70.00 $0.00

6102F Safety counseling dem order 0.00 70.00 $0.00

61020 Remove brain cavity fluid 3.07 70.00 $214.90

61026 Injection into brain canal 2.99 70.00 $209.30

61050 Remove brain canal fluid 2.47 70.00 $172.90

61055 Injection into brain canal 3.52 70.00 $246.40

61070 Brain canal shunt procedure 1.67 70.00 $116.90

6110F Counsel prov driving risks 0.00 70.00 $0.00

61105 Twist drill hole 13.70 70.00 $959.00

61107 Drill skull for implantation 9.35 70.00 $654.50

61108 Drill skull for drainage 26.92 70.00 $1,884.40

61120 Burr hole for puncture 22.14 70.00 $1,549.80

61140 Pierce skull for biopsy 37.27 70.00 $2,608.90

61150 Pierce skull for drainage 40.26 70.00 $2,818.20


61154 Pierce skull & remove clot 37.50 70.00 $2,625.00


61210 Pierce skull implant device 11.00 70.00 $770.00

61215 Insert brain-fluid device 14.84 70.00 $1,038.80

61250 Pierce skull & explore 25.73 70.00 $1,801.10

61253 Pierce skull & explore 27.41 70.00 $1,918.70

61304 Open skull for exploration 48.43 70.00 $3,390.10

61305 Open skull for exploration 59.75 70.00 $4,182.50

61312 Open skull for drainage 61.57 70.00 $4,309.90




61316 Implt cran bone flap to abdo 2.62 70.00 $183.40



61322 Decompressive craniotomy 70.36 70.00 $4,925.20

61323 Decompressive lobectomy 71.04 70.00 $4,972.80

61330 Decompress eye socket 44.37 70.00 $3,105.90

61332 Explore/biopsy eye socket 51.31 70.00 $3,591.70

61333 Explore orbit/remove lesion 52.44 70.00 $3,670.80

61340 Subtemporal decompression 42.95 70.00 $3,006.50

61343 Incise skull (press relief) 64.98 70.00 $4,548.60

61345 Relieve cranial pressure 60.69 70.00 $4,248.30

61450 Incise skull for surgery 57.22 70.00 $4,005.40

61458 Incise skull for brain wound 59.40 70.00 $4,158.00



6150F Pt notrcvng1st antitnf txmnt 0.00 70.00 $0.00

61500 Removal of skull lesion 38.71 70.00 $2,709.70

61501 Remove infected skull bone 33.99 70.00 $2,379.30

61510 Removal of brain lesion 64.61 70.00 $4,522.70

61512 Remove brain lining lesion 75.40 70.00 $5,278.00

61514 Removal of brain abscess 56.50 70.00 $3,955.00


61517 Implt brain chemotx add-on 2.62 70.00 $183.40


61519 Remove brain lining lesion 87.26 70.00 $6,108.20



61522 Removal of brain abscess 65.07 70.00 $4,554.90




61531 Implant brain electrodes 36.25 70.00 $2,537.50



61535 Remove brain electrodes 29.63 70.00 $2,074.10


61537 Removal of brain tissue 72.77 70.00 $5,093.90




61541 Incision of brain tissue 63.93 70.00 $4,475.10


61544 Remove & treat brain lesion 56.58 70.00 $3,960.60

61545 Excision of brain tumor 94.77 70.00 $6,633.90

61546 Removal of pituitary gland 68.68 70.00 $4,807.60

61548 Removal of pituitary gland 46.28 70.00 $3,239.60

61550 Release of skull seams 28.17 70.00 $1,971.90

61552 Release of skull seams 32.16 70.00 $2,251.20

61556 Incise skull/sutures 50.65 70.00 $3,545.50

61557 Incise skull/sutures 49.92 70.00 $3,494.40

61558 Excision of skull/sutures 49.47 70.00 $3,462.90

61559 Excision of skull/sutures 71.09 70.00 $4,976.30

61563 Excision of skull tumor 58.89 70.00 $4,122.30

61564 Excision of skull tumor 71.59 70.00 $5,011.30


61567 Incision of brain tissue 69.85 70.00 $4,889.50

61570 Remove foreign body brain 55.53 70.00 $3,887.10

61571 Incise skull for brain wound 59.14 70.00 $4,139.80

61575 Skull base/brainstem surgery 74.58 70.00 $5,220.60

61576 Skull base/brainstem surgery 98.88 70.00 $6,921.60

61580 Craniofacial approach skull 72.67 70.00 $5,086.90




61584 Orbitocranial approach/skull 84.10 70.00 $5,887.00


61586 Resect nasopharynx skull 71.19 70.00 $4,983.30

61590 Infratemporal approach/skull 88.19 70.00 $6,173.30

61591 Infratemporal approach/skull 90.57 70.00 $6,339.90


61595 Transtemporal approach/skull 68.77 70.00 $4,813.90

61596 Transcochlear approach/skull 70.75 70.00 $4,952.50

61597 Transcondylar approach/skull 85.45 70.00 $5,981.50

61598 Transpetrosal approach/skull 84.03 70.00 $5,882.10

61600 Resect/excise cranial lesion 61.87 70.00 $4,330.90






61610 Transect artery sinus 55.50 70.00 $3,885.00

61611 Transect artery sinus 10.76 70.00 $753.20

61612 Transect artery sinus 40.37 70.00 $2,825.90

61613 Remove aneurysm sinus 97.50 70.00 $6,825.00

61615 Resect/excise lesion skull 79.71 70.00 $5,579.70

61616 Resect/excise lesion skull 97.65 70.00 $6,835.50

61618 Repair dura 38.08 70.00 $2,665.60

61619 Repair dura 42.14 70.00 $2,949.80

61623 Endovasc tempory vessel occl 16.44 70.00 $1,150.80

61624 Transcath occlusion cns 33.31 70.00 $2,331.70

61626 Transcath occlusion non-cns 25.06 70.00 $1,754.20

61630 Intracranial angioplasty 38.52 70.00 $2,696.40

61635 Intracran angioplsty w/stent 40.68 70.00 $2,847.60

61640 Dilate ic vasospasm init 17.85 70.00 $1,249.50

61641 Dilate ic vasospasm add-on 6.29 70.00 $440.30

61642 Dilate ic vasospasm add-on 12.56 70.00 $879.20

61680 Intracranial vessel surgery 66.57 70.00 $4,659.90






61697 Brain aneurysm repr complx 125.31 70.00 $8,771.70

61698 Brain aneurysm repr complx 138.22 70.00 $9,675.40

61700 Brain aneurysm repr simple 101.08 70.00 $7,075.60

61702 Inner skull vessel surgery 120.04 70.00 $8,402.80

61703 Clamp neck artery 40.36 70.00 $2,825.20

61705 Revise circulation to head 77.51 70.00 $5,425.70



61711 Fusion of skull arteries 76.83 70.00 $5,378.10

61720 Incise skull/brain surgery 37.73 70.00 $2,641.10

61735 Incise skull/brain surgery 47.26 70.00 $3,308.20

61750 Incise skull/brain biopsy 41.58 70.00 $2,910.60

61751 Brain biopsy w/ct/mr guide 40.82 70.00 $2,857.40


61770 Incise skull for treatment 48.30 70.00 $3,381.00

61781 Scan proc cranial intra 7.01 70.00 $490.70

61782 Scan proc cranial extra 5.10 70.00 $357.00

61783 Scan proc spinal 6.91 70.00 $483.70

61790 Treat trigeminal nerve 25.97 70.00 $1,817.90

61791 Treat trigeminal tract 33.37 70.00 $2,335.90

61796 Srs cranial lesion simple 30.05 70.00 $2,103.50

61797 Srs cran les simple addl 6.60 70.00 $462.00

61798 Srs cranial lesion complex 41.03 70.00 $2,872.10

61799 Srs cran les complex addl 9.09 70.00 $636.30

61800 Apply srs headframe add-on 4.60 70.00 $322.00

61850 Implant neuroelectrodes 29.14 70.00 $2,039.80


61863 Implant neuroelectrode 44.57 70.00 $3,119.90

61864 Implant neuroelectrde addl 8.52 70.00 $596.40

61867 Implant neuroelectrode 67.51 70.00 $4,725.70

61868 Implant neuroelectrde addl 14.89 70.00 $1,042.30


61880 Revise/remove neuroelectrode 16.74 70.00 $1,171.80

61885 Insrt/redo neurostim 1 array 15.10 70.00 $1,057.00

61886 Implant neurostim arrays 24.84 70.00 $1,738.80

61888 Revise/remove neuroreceiver 11.62 70.00 $813.40

62000 Treat skull fracture 30.56 70.00 $2,139.20

62005 Treat skull fracture 37.75 70.00 $2,642.50

62010 Treatment of head injury 45.51 70.00 $3,185.70

62100 Repair brain fluid leakage 47.29 70.00 $3,310.30

62115 Reduction of skull defect 39.82 70.00 $2,787.40

62117 Reduction of skull defect 58.38 70.00 $4,086.60

62120 Repair skull cavity lesion 48.03 70.00 $3,362.10

62121 Incise skull repair 47.01 70.00 $3,290.70

62140 Repair of skull defect 30.46 70.00 $2,132.20

62141 Repair of skull defect 33.70 70.00 $2,359.00

62142 Remove skull plate/flap 26.09 70.00 $1,826.30

62143 Replace skull plate/flap 30.81 70.00 $2,156.70

62145 Repair of skull & brain 41.71 70.00 $2,919.70

62146 Repair of skull with graft 36.41 70.00 $2,548.70

62147 Repair of skull with graft 43.33 70.00 $3,033.10

62148 Retr bone flap to fix skull 3.79 70.00 $265.30

62160 Neuroendoscopy add-on 5.69 70.00 $398.30

62161 Dissect brain w/scope 45.14 70.00 $3,159.80

62162 Remove colloid cyst w/scope 56.17 70.00 $3,931.90

62163 Zneuroendoscopy w/fb removal 36.34 70.00 $2,543.80

62164 Remove brain tumor w/scope 62.09 70.00 $4,346.30

62165 Remove pituit tumor w/scope 45.31 70.00 $3,171.70

62180 Establish brain cavity shunt 47.58 70.00 $3,330.60



62194 Replace/irrigate catheter 14.38 70.00 $1,006.60


62201 Brain cavity shunt w/scope 35.63 70.00 $2,494.10



62225 Replace/irrigate catheter 15.48 70.00 $1,083.60

62230 Replace/revise brain shunt 24.88 70.00 $1,741.60

62252 Csf shunt reprogram 2.46 70.00 $172.20

62252 TC Csf shunt reprogram 1.11 70.00 $77.70

62252 26 Csf shunt reprogram 1.35 70.00 $94.50

62256 Remove brain cavity shunt 17.71 70.00 $1,239.70

62258 Replace brain cavity shunt 33.16 70.00 $2,321.20

62263 Epidural lysis mult sessions 18.01 70.00 $1,260.70

62264 Epidural lysis on single day 11.93 70.00 $835.10

62267 Interdiscal perq aspir dx 7.14 70.00 $499.80

62268 Drain spinal cord cyst 7.60 70.00 $532.00

62269 Needle biopsy spinal cord 7.80 70.00 $546.00

62270 Spinal fluid tap diagnostic 4.56 70.00 $319.20

62272 Drain cerebro spinal fluid 5.75 70.00 $402.50

62273 Inject epidural patch 4.94 70.00 $345.80

62280 Treat spinal cord lesion 8.54 70.00 $597.80

62281 Treat spinal cord lesion 6.66 70.00 $466.20

62282 Treat spinal canal lesion 8.39 70.00 $587.30

62284 Injection for myelogram 5.21 70.00 $364.70

62287 Percutaneous diskectomy 16.50 70.00 $1,155.00

62290 Inject for spine disk x-ray 9.52 70.00 $666.40

62291 Inject for spine disk x-ray 9.61 70.00 $672.70

62292 Injection into disk lesion 16.79 70.00 $1,175.30

62294 Injection into spinal artery 22.83 70.00 $1,598.10

62302 Myelography lumbar injection 6.95 70.00 $486.50




62310 Inject spine cerv/thoracic 6.83 70.00 $478.10

62311 Inject spine lumbar/sacral 6.29 70.00 $440.30

62318 Inject spine w/cath crv/thrc 6.52 70.00 $456.40

62319 Inject spine w/cath lmb/scrl 4.77 70.00 $333.90

62350 Implant spinal canal cath 11.61 70.00 $812.70

62351 Implant spinal canal cath 25.16 70.00 $1,761.20

62355 Remove spinal canal catheter 7.83 70.00 $548.10

62360 Insert spine infusion device 8.82 70.00 $617.40

62361 Implant spine infusion pump 12.61 70.00 $882.70

62362 Implant spine infusion pump 11.22 70.00 $785.40

62365 Remove spine infusion device 8.65 70.00 $605.50

62367 Analyze spine infus pump 1.16 70.00 $81.20

62368 Analyze sp inf pump w/reprog 1.61 70.00 $112.70

62369 Anal sp inf pmp w/reprg&fill 3.43 70.00 $240.10

62370 Anl sp inf pmp w/mdreprg&fil 3.62 70.00 $253.40

63001 Remove spine lamina 1/2 crvl 36.53 70.00 $2,557.10

63003 Remove spine lamina 1/2 thrc 36.37 70.00 $2,545.90

63005 Remove spine lamina 1/2 lmbr 34.65 70.00 $2,425.50

63011 Remove spine lamina 1/2 scrl 32.17 70.00 $2,251.90

63012 Remove lamina/facets lumbar 34.82 70.00 $2,437.40

63015 Remove spine lamina >2 crvcl 43.67 70.00 $3,056.90

63016 Remove spine lamina >2 thrc 44.64 70.00 $3,124.80

63017 Remove spine lamina >2 lmbr 36.80 70.00 $2,576.00

63020 Neck spine disk surgery 34.14 70.00 $2,389.80

63030 Low back disk surgery 28.29 70.00 $1,980.30

63035 Spinal disk surgery add-on 5.64 70.00 $394.80

63040 Laminotomy single cervical 40.80 70.00 $2,856.00

63042 Laminotomy single lumbar 37.83 70.00 $2,648.10

63043 Laminotomy addl cervical 0.00 70.00 $0.00

63044 Laminotomy addl lumbar 0.00 70.00 $0.00

63045 Remove spine lamina 1 crvl 37.40 70.00 $2,618.00

63046 Remove spine lamina 1 thrc 35.34 70.00 $2,473.80

63047 Remove spine lamina 1 lmbr 32.25 70.00 $2,257.50

63048 Remove spinal lamina add-on 6.24 70.00 $436.80

63050 Cervical laminoplsty 2/> seg 43.48 70.00 $3,043.60

63051 C-laminoplasty w/graft/plate 50.10 70.00 $3,507.00

63055 Decompress spinal cord thrc 47.98 70.00 $3,358.60

63056 Decompress spinal cord lmbr 43.42 70.00 $3,039.40

63057 Decompress spine cord add-on 9.41 70.00 $658.70

63064 Decompress spinal cord thrc 51.99 70.00 $3,639.30

63066 Decompress spine cord add-on 6.17 70.00 $431.90

63075 Neck spine disk surgery 39.64 70.00 $2,774.80

63076 Neck spine disk surgery 7.27 70.00 $508.90

63077 Spine disk surgery thorax 43.93 70.00 $3,075.10

63078 Spine disk surgery thorax 5.56 70.00 $389.20

63081 Remove vert body dcmprn crvl 51.45 70.00 $3,601.50

63082 Remove vertebral body add-on 7.85 70.00 $549.50

63085 Remove vert body dcmprn thrc 56.05 70.00 $3,923.50


63087 Remov vertbr dcmprn thrclmbr 70.57 70.00 $4,939.90


63090 Remove vert body dcmprn lmbr 56.81 70.00 $3,976.70


63101 Remove vert body dcmprn thrc 68.20 70.00 $4,774.00

63102 Remove vert body dcmprn lmbr 66.62 70.00 $4,663.40


63170 Incise spinal cord tract(s) 47.33 70.00 $3,313.10

63172 Drainage of spinal cyst 42.13 70.00 $2,949.10

63173 Drainage of spinal cyst 51.30 70.00 $3,591.00

63180 Revise spinal cord ligaments 44.15 70.00 $3,090.50

63182 Revise spinal cord ligaments 48.47 70.00 $3,392.90

63185 Incise spine nrv half segmnt 33.36 70.00 $2,335.20

63190 Incise spine nrv >2 segmnts 36.70 70.00 $2,569.00

63191 Incise spine accessory nerve 40.92 70.00 $2,864.40

63194 Incise spine & cord cervical 47.45 70.00 $3,321.50

63195 Incise spine & cord thoracic 33.66 70.00 $2,356.20

63196 Incise spine&cord 2 trx crvl 39.12 70.00 $2,738.40

63197 Incise spine&cord 2 trx thrc 50.86 70.00 $3,560.20

63198 Incise spin&cord 2 stgs crvl 46.08 70.00 $3,225.60

63199 Incise spin&cord 2 stgs thrc 48.34 70.00 $3,383.80

63200 Release spinal cord lumbar 45.21 70.00 $3,164.70

63250 Revise spinal cord vsls crvl 88.43 70.00 $6,190.10

63251 Revise spinal cord vsls thrc 90.38 70.00 $6,326.60

63252 Revise spine cord vsl thrlmb 90.37 70.00 $6,325.90

63265 Excise intraspinl lesion crv 49.13 70.00 $3,439.10

63266 Excise intrspinl lesion thrc 50.66 70.00 $3,546.20

63267 Excise intrspinl lesion lmbr 40.22 70.00 $2,815.40

63268 Excise intrspinl lesion scrl 42.74 70.00 $2,991.80

63270 Excise intrspinl lesion crvl 61.76 70.00 $4,323.20

63271 Excise intrspinl lesion thrc 61.33 70.00 $4,293.10

63272 Excise intrspinl lesion lmbr 55.67 70.00 $3,896.90

63273 Excise intrspinl lesion scrl 55.46 70.00 $3,882.20

63275 Bx/exc xdrl spine lesn crvl 53.22 70.00 $3,725.40

63276 Bx/exc xdrl spine lesn thrc 52.72 70.00 $3,690.40

63277 Bx/exc xdrl spine lesn lmbr 45.63 70.00 $3,194.10

63278 Bx/exc xdrl spine lesn scrl 47.20 70.00 $3,304.00

63280 Bx/exc idrl spine lesn crvl 62.79 70.00 $4,395.30

63281 Bx/exc idrl spine lesn thrc 61.86 70.00 $4,330.20

63282 Bx/exc idrl spine lesn lmbr 58.19 70.00 $4,073.30

63283 Bx/exc idrl spine lesn scrl 56.46 70.00 $3,952.20

63285 Bx/exc idrl imed lesn cervl 77.88 70.00 $5,451.60

63286 Bx/exc idrl imed lesn thrc 77.01 70.00 $5,390.70

63287 Bx/exc idrl imed lesn thrlmb 81.74 70.00 $5,721.80

63290 Bx/exc xdrl/idrl lsn any lvl 83.14 70.00 $5,819.80

63295 Repair laminectomy defect 9.98 70.00 $698.60

63300 Remove vert xdrl body crvcl 54.16 70.00 $3,791.20

63301 Remove vert xdrl body thrc 64.05 70.00 $4,483.50

63302 Remove vert xdrl body thrlmb 64.80 70.00 $4,536.00

63303 Remov vert xdrl bdy lmbr/sac 68.89 70.00 $4,822.30

63304 Remove vert idrl body crvcl 69.93 70.00 $4,895.10

63305 Remove vert idrl body thrc 74.45 70.00 $5,211.50

63306 Remov vert idrl bdy thrclmbr 58.09 70.00 $4,066.30

63307 Remov vert idrl bdy lmbr/sac 63.82 70.00 $4,467.40


63600 Remove spinal cord lesion 26.20 70.00 $1,834.00

63610 Stimulation of spinal cord 11.25 70.00 $787.50

63615 Remove lesion of spinal cord 31.04 70.00 $2,172.80

63620 Srs spinal lesion 32.99 70.00 $2,309.30

63621 Srs spinal lesion addl 7.54 70.00 $527.80



63661 Remove spine eltrd perq aray 16.53 70.00 $1,157.10

63662 Remove spine eltrd plate 24.51 70.00 $1,715.70

63663 Revise spine eltrd perq aray 22.47 70.00 $1,572.90

63664 Revise spine eltrd plate 25.07 70.00 $1,754.90

63685 Insrt/redo spine n generator 10.64 70.00 $744.80

63688 Revise/remove neuroreceiver 10.74 70.00 $751.80

63700 Repair of spinal herniation 33.88 70.00 $2,371.60




63707 Repair spinal fluid leakage 26.82 70.00 $1,877.40

63709 Repair spinal fluid leakage 32.17 70.00 $2,251.90

63710 Graft repair of spine defect 31.59 70.00 $2,211.30

63740 Install spinal shunt 28.27 70.00 $1,978.90

63741 Install spinal shunt 19.92 70.00 $1,394.40

63744 Revision of spinal shunt 19.94 70.00 $1,395.80

63746 Removal of spinal shunt 17.74 70.00 $1,241.80

64400 N block inj trigeminal 3.63 70.00 $254.10

64402 N block inj facial 3.71 70.00 $259.70

64405 N block inj occipital 2.88 70.00 $201.60

64408 N block inj vagus 3.32 70.00 $232.40

64410 N block inj phrenic 3.42 70.00 $239.40

64412 N block inj spinal accessor 4.05 70.00 $283.50

64413 N block inj cervical plexus 3.68 70.00 $257.60

64415 N block inj brachial plexus 3.34 70.00 $233.80

64416 N block cont infuse b plex 2.27 70.00 $158.90

64417 N block inj axillary 3.67 70.00 $256.90

64418 N block inj suprascapular 4.17 70.00 $291.90

64420 N block inj intercost sng 3.20 70.00 $224.00

64421 N block inj intercost mlt 4.26 70.00 $298.20

64425 N block inj ilio-ing/hypogi 3.74 70.00 $261.80

64430 N block inj pudendal 3.98 70.00 $278.60

64435 N block inj paracervical 3.85 70.00 $269.50

64445 N block inj sciatic sng 3.84 70.00 $268.80

64446 N blk inj sciatic cont inf 2.28 70.00 $159.60

64447 N block inj fem single 3.39 70.00 $237.30

64448 N block inj fem cont inf 2.03 70.00 $142.10

64449 N block inj lumbar plexus 2.40 70.00 $168.00

64450 N block other peripheral 2.28 70.00 $159.60

64455 N block inj plantar digit 1.35 70.00 $94.50

64479 Inj foramen epidural c/t 6.70 70.00 $469.00

64480 Inj foramen epidural add-on 3.21 70.00 $224.70

64483 Inj foramen epidural l/s 6.22 70.00 $435.40

64484 Inj foramen epidural add-on 2.48 70.00 $173.60

64486 Tap block unil by injection 3.53 70.00 $247.10

64487 Tap block uni by infusion 4.31 70.00 $301.70

64488 Tap block bi injection 4.34 70.00 $303.80

64489 Tap block bi by infusion 6.03 70.00 $422.10

64490 Inj paravert f jnt c/t 1 lev 5.41 70.00 $378.70



64493 Inj paravert f jnt l/s 1 lev 4.90 70.00 $343.00



64505 N block spenopalatine gangl 2.98 70.00 $208.60

64508 N block carotid sinus s/p 1.80 70.00 $126.00

64510 N block stellate ganglion 3.62 70.00 $253.40

64517 N block inj hypogas plxs 5.14 70.00 $359.80

64520 N block lumbar/thoracic 5.28 70.00 $369.60

64530 N block inj celiac pelus 5.42 70.00 $379.40

64550 Apply neurostimulator 0.45 70.00 $31.50

64553 Implant neuroelectrodes 6.09 70.00 $426.30




64566 Neuroeltrd stim post tibial 3.44 70.00 $240.80

64568 Inc for vagus n elect impl 19.30 70.00 $1,351.00

64569 Revise/repl vagus n eltrd 22.98 70.00 $1,608.60

64570 Remove vagus n eltrd 19.50 70.00 $1,365.00




64585 Revise/remove neuroelectrode 6.98 70.00 $488.60

64590 Insrt/redo pn/gastr stimul 7.54 70.00 $527.80

64595 Revise/rmv pn/gastr stimul 6.99 70.00 $489.30

64600 Injection treatment of nerve 10.91 70.00 $763.70

64605 Injection treatment of nerve 16.71 70.00 $1,169.70

64610 Injection treatment of nerve 20.88 70.00 $1,461.60

64611 Chemodenerv saliv glands 3.35 70.00 $234.50

64612 Destroy nerve face muscle 3.74 70.00 $261.80

64615 Chemodenerv musc migraine 4.21 70.00 $294.70

64616 Chemodenerv musc neck dyston 3.57 70.00 $249.90

64617 Chemodener muscle larynx emg 5.42 70.00 $379.40



64632 N block inj common digit 2.44 70.00 $170.80

64633 Destroy cerv/thor facet jnt 11.85 70.00 $829.50

64634 Destroy c/th facet jnt addl 5.29 70.00 $370.30

64635 Destroy lumb/sac facet jnt 11.75 70.00 $822.50

64636 Destroy l/s facet jnt addl 4.84 70.00 $338.80


64642 Chemodenerv 1 extremity 1-4 4.04 70.00 $282.80

64643 Chemodenerv 1 extrem 1-4 ea 2.68 70.00 $187.60

64644 Chemodenerv 1 extrem 5/> mus 4.65 70.00 $325.50

64645 Chemodenerv 1 extrem 5/> ea 3.26 70.00 $228.20

64646 Chemodenerv trunk musc 1-5 4.39 70.00 $307.30

64647 Chemodenerv trunk musc 6/> 5.07 70.00 $354.90

64650 Chemodenerv eccrine glands 2.22 70.00 $155.40

64653 Chemodenerv eccrine glands 2.71 70.00 $189.70



64702 Revise finger/toe nerve 14.33 70.00 $1,003.10

64704 Revise hand/foot nerve 9.07 70.00 $634.90

64708 Revise arm/leg nerve 14.34 70.00 $1,003.80

64712 Revision of sciatic nerve 16.45 70.00 $1,151.50

64713 Revision of arm nerve(s) 20.78 70.00 $1,454.60

64714 Revise low back nerve(s) 18.63 70.00 $1,304.10

64716 Revision of cranial nerve 15.35 70.00 $1,074.50

64718 Revise ulnar nerve at elbow 17.00 70.00 $1,190.00

64719 Revise ulnar nerve at wrist 11.47 70.00 $802.90

64721 Carpal tunnel surgery 12.33 70.00 $863.10

64722 Relieve pressure on nerve(s) 10.68 70.00 $747.60

64726 Release foot/toe nerve 7.91 70.00 $553.70

64727 Internal nerve revision 5.35 70.00 $374.50

64732 Incision of brow nerve 10.91 70.00 $763.70

64734 Incision of cheek nerve 14.67 70.00 $1,026.90

64736 Incision of chin nerve 11.45 70.00 $801.50

64738 Incision of jaw nerve 13.25 70.00 $927.50

64740 Incision of tongue nerve 13.12 70.00 $918.40

64742 Incision of facial nerve 13.15 70.00 $920.50

64744 Incise nerve back of head 14.53 70.00 $1,017.10

64746 Incise diaphragm nerve 12.50 70.00 $875.00

64755 Incision of stomach nerves 26.59 70.00 $1,861.30

64760 Incision of vagus nerve 14.83 70.00 $1,038.10

64763 Incise hip/thigh nerve 14.69 70.00 $1,028.30

64766 Incise hip/thigh nerve 16.35 70.00 $1,144.50

64771 Sever cranial nerve 17.14 70.00 $1,199.80

64772 Incision of spinal nerve 16.40 70.00 $1,148.00

64774 Remove skin nerve lesion 11.98 70.00 $838.60

64776 Remove digit nerve lesion 11.16 70.00 $781.20

64778 Digit nerve surgery add-on 4.10 70.00 $287.00

64782 Remove limb nerve lesion 12.94 70.00 $905.80

64783 Limb nerve surgery add-on 6.35 70.00 $444.50

64784 Remove nerve lesion 20.96 70.00 $1,467.20

64786 Remove sciatic nerve lesion 31.29 70.00 $2,190.30

64787 Implant nerve end 7.08 70.00 $495.60

64788 Remove skin nerve lesion 11.77 70.00 $823.90

64790 Removal of nerve lesion 24.35 70.00 $1,704.50

64792 Removal of nerve lesion 31.14 70.00 $2,179.80

64795 Biopsy of nerve 5.57 70.00 $389.90

64802 Sympathectomy cervical 19.15 70.00 $1,340.50

64804 Remove sympathetic nerves 27.12 70.00 $1,898.40



64820 Sympathectomy digital artery 20.92 70.00 $1,464.40



64823 Sympathectomy supfc palmar 22.74 70.00 $1,591.80

64831 Repair of digit nerve 19.68 70.00 $1,377.60

64832 Repair nerve add-on 9.76 70.00 $683.20

64834 Repair of hand or foot nerve 21.21 70.00 $1,484.70



64837 Repair nerve add-on 10.97 70.00 $767.90

64840 Repair of leg nerve 27.89 70.00 $1,952.30

64856 Repair/transpose nerve 29.20 70.00 $2,044.00

64857 Repair arm/leg nerve 30.27 70.00 $2,118.90

64858 Repair sciatic nerve 34.10 70.00 $2,387.00

64859 Nerve surgery 7.31 70.00 $511.70

64861 Repair of arm nerves 36.59 70.00 $2,561.30

64862 Repair of low back nerves 33.13 70.00 $2,319.10

64864 Repair of facial nerve 25.10 70.00 $1,757.00

64865 Repair of facial nerve 31.98 70.00 $2,238.60

64866 Fusion of facial/other nerve 33.17 70.00 $2,321.90

64868 Fusion of facial/other nerve 29.28 70.00 $2,049.60

64872 Subsequent repair of nerve 3.43 70.00 $240.10

64874 Repair & revise nerve add-on 4.77 70.00 $333.90

64876 Repair nerve/shorten bone 4.89 70.00 $342.30

64885 Nerve graft head/neck </4 cm 32.27 70.00 $2,258.90

64886 Nerve graft head/neck >4 cm 37.42 70.00 $2,619.40

64890 Nerve graft hand/foot </4 cm 31.50 70.00 $2,205.00

64891 Nerve graft hand/foot >4 cm 33.56 70.00 $2,349.20

64892 Nerve graft arm/leg <4 cm 30.41 70.00 $2,128.70

64893 Nerve graft arm/leg >4 cm 32.71 70.00 $2,289.70

64895 Nerve graft hand/foot </4 cm 38.92 70.00 $2,724.40

64896 Nerve graft hand/foot >4 cm 46.97 70.00 $3,287.90

64897 Nerve graft arm/leg </4 cm 36.53 70.00 $2,557.10

64898 Nerve graft arm/leg >4 cm 39.66 70.00 $2,776.20

64901 Nerve graft add-on 16.22 70.00 $1,135.40

64902 Nerve graft add-on 18.78 70.00 $1,314.60

64905 Nerve pedicle transfer 29.52 70.00 $2,066.40

64907 Nerve pedicle transfer 42.69 70.00 $2,988.30

64910 Nerve repair w/allograft 23.74 70.00 $1,661.80

64911 Neurorraphy w/vein autograft 29.22 70.00 $2,045.40

64999 Nervous system surgery 0.00 70.00 $0.00

65091 Revise eye 17.91 70.00 $1,253.70

65093 Revise eye with implant 17.71 70.00 $1,239.70

65101 Removal of eye 20.83 70.00 $1,458.10

65103 Remove eye/insert implant 21.70 70.00 $1,519.00

65105 Remove eye/attach implant 23.97 70.00 $1,677.90

65110 Removal of eye 34.49 70.00 $2,414.30

65112 Remove eye/revise socket 40.00 70.00 $2,800.00

65114 Remove eye/revise socket 41.95 70.00 $2,936.50

65125 Revise ocular implant 12.89 70.00 $902.30

65130 Insert ocular implant 20.65 70.00 $1,445.50

65135 Insert ocular implant 20.95 70.00 $1,466.50

65140 Attach ocular implant 22.79 70.00 $1,595.30

65150 Revise ocular implant 16.29 70.00 $1,140.30

65155 Reinsert ocular implant 23.87 70.00 $1,670.90

65175 Removal of ocular implant 18.54 70.00 $1,297.80

65205 Remove foreign body from eye 1.58 70.00 $110.60




65235 Remove foreign body from eye 20.13 70.00 $1,409.10



65270 Repair of eye wound 7.53 70.00 $527.10



65275 Repair of eye wound 16.33 70.00 $1,143.10




65290 Repair of eye socket wound 13.87 70.00 $970.90

65400 Removal of eye lesion 19.19 70.00 $1,343.30

65410 Biopsy of cornea 4.04 70.00 $282.80



65430 Corneal smear 3.24 70.00 $226.80

65435 Curette/treat cornea 2.24 70.00 $156.80

65436 Curette/treat cornea 10.95 70.00 $766.50

65450 Treatment of corneal lesion 9.19 70.00 $643.30

65600 Revision of cornea 11.14 70.00 $779.80

65710 Corneal transplant 31.28 70.00 $2,189.60




65756 Corneal trnspl endothelial 33.52 70.00 $2,346.40

65757 Prep corneal endo allograft 0.00 70.00 $0.00



65767 Corneal tissue transplant 0.00 70.00 $0.00

65770 Revise cornea with implant 39.79 70.00 $2,785.30

65771 Radial keratotomy 0.00 70.00 $0.00

65772 Correction of astigmatism 12.74 70.00 $891.80

65775 Correction of astigmatism 15.60 70.00 $1,092.00

65778 Cover eye w/membrane 38.92 70.00 $2,724.40

65779 Cover eye w/membrane suture 34.58 70.00 $2,420.60

65780 Ocular reconst transplant 25.14 70.00 $1,759.80



65800 Drainage of eye 3.37 70.00 $235.90

65810 Drainage of eye 13.17 70.00 $921.90

65815 Drainage of eye 18.01 70.00 $1,260.70

65820 Relieve inner eye pressure 21.14 70.00 $1,479.80

65850 Incision of eye 23.73 70.00 $1,661.10

65855 Laser surgery of eye 9.55 70.00 $668.50

65860 Incise inner eye adhesions 8.73 70.00 $611.10

65865 Incise inner eye adhesions 13.38 70.00 $936.60

65870 Incise inner eye adhesions 16.71 70.00 $1,169.70



65900 Remove eye lesion 27.25 70.00 $1,907.50

65920 Remove implant of eye 22.29 70.00 $1,560.30

65930 Remove blood clot from eye 18.04 70.00 $1,262.80

66020 Injection treatment of eye 5.25 70.00 $367.50

66030 Injection treatment of eye 4.68 70.00 $327.60

66130 Remove eye lesion 19.65 70.00 $1,375.50

66150 Glaucoma surgery 24.64 70.00 $1,724.80




66172 Incision of eye 42.80 70.00 $2,996.00

66174 Translum dil eye canal 26.80 70.00 $1,876.00

66175 Trnslum dil eye canal w/stnt 28.07 70.00 $1,964.90

66179 Aqueous shunt eye w/o graft 30.48 70.00 $2,133.60

66180 Aqueous shunt eye w/graft 32.17 70.00 $2,251.90

66183 Insert ant drainage device 29.13 70.00 $2,039.10

66184 Revision of aqueous shunt 22.19 70.00 $1,553.30

66185 Revise aqueous shunt eye 23.89 70.00 $1,672.30

66220 Repair eye lesion 21.02 70.00 $1,471.40

66225 Repair/graft eye lesion 26.35 70.00 $1,844.50

66250 Follow-up surgery of eye 21.14 70.00 $1,479.80

66500 Incision of iris 10.00 70.00 $700.00

66505 Incision of iris 10.96 70.00 $767.20

66600 Remove iris and lesion 23.52 70.00 $1,646.40

66605 Removal of iris 29.88 70.00 $2,091.60

66625 Removal of iris 12.13 70.00 $849.10

66630 Removal of iris 16.10 70.00 $1,127.00

66635 Removal of iris 16.26 70.00 $1,138.20

66680 Repair iris & ciliary body 14.64 70.00 $1,024.80

66682 Repair iris & ciliary body 18.01 70.00 $1,260.70

66700 Destruction ciliary body 12.72 70.00 $890.40

66710 Ciliary transsleral therapy 12.43 70.00 $870.10

66711 Ciliary endoscopic ablation 18.14 70.00 $1,269.80



66761 Revision of iris 8.36 70.00 $585.20

66762 Revision of iris 13.41 70.00 $938.70

66770 Removal of inner eye lesion 14.93 70.00 $1,045.10

66820 Incision secondary cataract 11.11 70.00 $777.70

66821 After cataract laser surgery 9.32 70.00 $652.40

66825 Reposition intraocular lens 21.47 70.00 $1,502.90

66830 Removal of lens lesion 20.14 70.00 $1,409.80

66840 Removal of lens material 19.71 70.00 $1,379.70



66920 Extraction of lens 21.33 70.00 $1,493.10



66982 Cataract surgery complex 22.49 70.00 $1,574.30

66983 Cataract surg w/iol 1 stage 20.75 70.00 $1,452.50

66984 Cataract surg w/iol 1 stage 18.10 70.00 $1,267.00

66985 Insert lens prosthesis 21.77 70.00 $1,523.90

66986 Exchange lens prosthesis 25.68 70.00 $1,797.60

66990 Ophthalmic endoscope add-on 2.57 70.00 $179.90

66999 Eye surgery procedure 0.00 70.00 $0.00

67005 Partial removal of eye fluid 13.36 70.00 $935.20

67010 Partial removal of eye fluid 15.35 70.00 $1,074.50

67015 Release of eye fluid 16.41 70.00 $1,148.70

67025 Replace eye fluid 20.52 70.00 $1,436.40

67027 Implant eye drug system 24.09 70.00 $1,686.30

67028 Injection eye drug 2.88 70.00 $201.60

67030 Incise inner eye strands 15.05 70.00 $1,053.50

67031 Laser surgery eye strands 10.97 70.00 $767.90

67036 Removal of inner eye fluid 25.48 70.00 $1,783.60

67039 Laser treatment of retina 27.31 70.00 $1,911.70

67040 Laser treatment of retina 29.51 70.00 $2,065.70

67041 Vit for macular pucker 32.63 70.00 $2,284.10

67042 Vit for macular hole 32.63 70.00 $2,284.10

67043 Vit for membrane dissect 34.43 70.00 $2,410.10

67101 Repair detached retina 22.14 70.00 $1,549.80





67112 Rerepair detached retina 37.51 70.00 $2,625.70

67113 Repair retinal detach cplx 49.34 70.00 $3,453.80

67115 Release encircling material 14.13 70.00 $989.10

67120 Remove eye implant material 18.56 70.00 $1,299.20

67121 Remove eye implant material 25.69 70.00 $1,798.30

67141 Treatment of retina 14.81 70.00 $1,036.70

67145 Treatment of retina 14.90 70.00 $1,043.00

67208 Treatment of retinal lesion 16.93 70.00 $1,185.10



67220 Treatment of choroid lesion 15.12 70.00 $1,058.40

67221 Ocular photodynamic ther 8.11 70.00 $567.70

67225 Eye photodynamic ther add-on 0.84 70.00 $58.80



67229 Tr retinal les preterm inf 32.99 70.00 $2,309.30

67250 Reinforce eye wall 22.06 70.00 $1,544.20

67255 Reinforce/graft eye wall 19.32 70.00 $1,352.40

67299 Eye surgery procedure 0.00 70.00 $0.00

67311 Revise eye muscle 16.92 70.00 $1,184.40

67312 Revise two eye muscles 20.13 70.00 $1,409.10

67314 Revise eye muscle 19.04 70.00 $1,332.80

67316 Revise two eye muscles 22.68 70.00 $1,587.60

67318 Revise eye muscle(s) 19.93 70.00 $1,395.10

67320 Revise eye muscle(s) add-on 9.14 70.00 $639.80

67331 Eye surgery follow-up add-on 8.67 70.00 $606.90

67332 Rerevise eye muscles add-on 9.41 70.00 $658.70

67334 Revise eye muscle w/suture 8.55 70.00 $598.50

67335 Eye suture during surgery 4.23 70.00 $296.10

67340 Revise eye muscle add-on 10.17 70.00 $711.90

67343 Release eye tissue 18.48 70.00 $1,293.60

67345 Destroy nerve of eye muscle 6.88 70.00 $481.60

67346 Biopsy eye muscle 5.51 70.00 $385.70

67399 Unlisted px extraocular musc 0.00 70.00 $0.00


67405 Explore/drain eye socket 22.41 70.00 $1,568.70

67412 Explore/treat eye socket 24.05 70.00 $1,683.50


67414 Explr/decompress eye socket 37.46 70.00 $2,622.20

67415 Aspiration orbital contents 2.97 70.00 $207.90



67440 Explore/drain eye socket 34.07 70.00 $2,384.90

67445 Explr/decompress eye socket 39.64 70.00 $2,774.80


67500 Inject/treat eye socket 2.22 70.00 $155.40



67550 Insert eye socket implant 27.24 70.00 $1,906.80

67560 Revise eye socket implant 27.93 70.00 $1,955.10

67570 Decompress optic nerve 32.67 70.00 $2,286.90

67599 Orbit surgery procedure 0.00 70.00 $0.00

67700 Drainage of eyelid abscess 7.54 70.00 $527.80

67710 Incision of eyelid 6.28 70.00 $439.60

67715 Incision of eyelid fold 6.70 70.00 $469.00

67800 Remove eyelid lesion 3.59 70.00 $251.30

67801 Remove eyelid lesions 4.58 70.00 $320.60

67805 Remove eyelid lesions 5.69 70.00 $398.30

67808 Remove eyelid lesion(s) 10.42 70.00 $729.40

67810 Biopsy eyelid & lid margin 4.84 70.00 $338.80

67820 Revise eyelashes 1.41 70.00 $98.70




67840 Remove eyelid lesion 7.75 70.00 $542.50

67850 Treat eyelid lesion 6.04 70.00 $422.80

67875 Closure of eyelid by suture 4.82 70.00 $337.40



67900 Repair brow defect 18.07 70.00 $1,264.90

67901 Repair eyelid defect 21.34 70.00 $1,493.80





67908 Repair eyelid defect 13.92 70.00 $974.40

67909 Revise eyelid defect 15.15 70.00 $1,060.50

67911 Revise eyelid defect 15.90 70.00 $1,113.00

67912 Correction eyelid w/implant 24.87 70.00 $1,740.90









67930 Repair eyelid wound 10.28 70.00 $719.60

67935 Repair eyelid wound 16.78 70.00 $1,174.60

67938 Remove eyelid foreign body 6.78 70.00 $474.60




67971 Reconstruction of eyelid 20.48 70.00 $1,433.60





68020 Incise/drain eyelid lining 3.38 70.00 $236.60

68040 Treatment of eyelid lesions 1.76 70.00 $123.20

68100 Biopsy of eyelid lining 4.78 70.00 $334.60

68110 Remove eyelid lining lesion 6.35 70.00 $444.50


68130 Remove eyelid lining lesion 15.18 70.00 $1,062.60


68200 Treat eyelid by injection 1.16 70.00 $81.20

68320 Revise/graft eyelid lining 20.43 70.00 $1,430.10




68330 Revise eyelid lining 17.04 70.00 $1,192.80


68340 Separate eyelid adhesions 15.36 70.00 $1,075.20



68371 Harvest eye tissue alograft 11.67 70.00 $816.90

68399 Eyelid lining surgery 0.00 70.00 $0.00

68400 Incise/drain tear gland 8.01 70.00 $560.70

68420 Incise/drain tear sac 9.04 70.00 $632.80

68440 Incise tear duct opening 2.88 70.00 $201.60

68500 Removal of tear gland 27.58 70.00 $1,930.60

68505 Partial removal tear gland 27.45 70.00 $1,921.50

68510 Biopsy of tear gland 12.59 70.00 $881.30

68520 Removal of tear sac 19.42 70.00 $1,359.40

68525 Biopsy of tear sac 7.49 70.00 $524.30

68530 Clearance of tear duct 12.06 70.00 $844.20

68540 Remove tear gland lesion 26.27 70.00 $1,838.90

68550 Remove tear gland lesion 30.48 70.00 $2,133.60

68700 Repair tear ducts 17.09 70.00 $1,196.30

68705 Revise tear duct opening 6.66 70.00 $466.20

68720 Create tear sac drain 21.38 70.00 $1,496.60

68745 Create tear duct drain 21.48 70.00 $1,503.60

68750 Create tear duct drain 22.23 70.00 $1,556.10

68760 Close tear duct opening 5.66 70.00 $396.20

68761 Close tear duct opening 4.17 70.00 $291.90

68770 Close tear system fistula 17.81 70.00 $1,246.70

68801 Dilate tear duct opening 3.51 70.00 $245.70

68810 Probe nasolacrimal duct 6.81 70.00 $476.70



68816 Probe nl duct w/balloon 20.90 70.00 $1,463.00

68840 Explore/irrigate tear ducts 3.61 70.00 $252.70

68850 Injection for tear sac x-ray 1.73 70.00 $121.10

68899 Tear duct system surgery 0.00 70.00 $0.00

69000 Drain external ear lesion 5.32 70.00 $372.40

69005 Drain external ear lesion 6.13 70.00 $429.10

69020 Drain outer ear canal lesion 6.63 70.00 $464.10

69090 Pierce earlobes 0.00 70.00 $0.00

69100 Biopsy of external ear 2.85 70.00 $199.50

69105 Biopsy of external ear canal 4.01 70.00 $280.70

69110 Remove external ear partial 13.08 70.00 $915.60

69120 Removal of external ear 11.55 70.00 $808.50

69140 Remove ear canal lesion(s) 25.21 70.00 $1,764.70

69145 Remove ear canal lesion(s) 11.36 70.00 $795.20

69150 Extensive ear canal surgery 30.16 70.00 $2,111.20

69155 Extensive ear/neck surgery 47.96 70.00 $3,357.20

69200 Clear outer ear canal 3.50 70.00 $245.00

69205 Clear outer ear canal 2.92 70.00 $204.40

69210 Remove impacted ear wax uni 1.40 70.00 $98.00

69220 Clean out mastoid cavity 3.91 70.00 $273.70

69222 Clean out mastoid cavity 6.27 70.00 $438.90

69300 Revise external ear 20.93 70.00 $1,465.10

69310 Rebuild outer ear canal 31.34 70.00 $2,193.80

69320 Rebuild outer ear canal 43.97 70.00 $3,077.90

69399 Outer ear surgery procedure 0.00 70.00 $0.00

69420 Incision of eardrum 5.47 70.00 $382.90

69421 Incision of eardrum 4.30 70.00 $301.00

69424 Remove ventilating tube 3.65 70.00 $255.50

69433 Create eardrum opening 5.78 70.00 $404.60

69436 Create eardrum opening 4.63 70.00 $324.10

69440 Exploration of middle ear 19.81 70.00 $1,386.70

69450 Eardrum revision 15.66 70.00 $1,096.20

69501 Mastoidectomy 21.06 70.00 $1,474.20

69502 Mastoidectomy 28.03 70.00 $1,962.10

69505 Remove mastoid structures 34.64 70.00 $2,424.80

69511 Extensive mastoid surgery 35.48 70.00 $2,483.60

69530 Extensive mastoid surgery 47.59 70.00 $3,331.30

69535 Remove part of temporal bone 77.21 70.00 $5,404.70

69540 Remove ear lesion 5.95 70.00 $416.50

69550 Remove ear lesion 29.96 70.00 $2,097.20



69601 Mastoid surgery revision 30.14 70.00 $2,109.80





69610 Repair of eardrum 11.01 70.00 $770.70

69620 Repair of eardrum 19.88 70.00 $1,391.60

69631 Repair eardrum structures 25.46 70.00 $1,782.20

69632 Rebuild eardrum structures 31.02 70.00 $2,171.40


69635 Repair eardrum structures 35.47 70.00 $2,482.90



69641 Revise middle ear & mastoid 29.98 70.00 $2,098.60






69650 Release middle ear bone 23.14 70.00 $1,619.80

69660 Revise middle ear bone 26.76 70.00 $1,873.20



69666 Repair middle ear structures 23.34 70.00 $1,633.80

69667 Repair middle ear structures 23.32 70.00 $1,632.40

69670 Remove mastoid air cells 27.16 70.00 $1,901.20

69676 Remove middle ear nerve 23.93 70.00 $1,675.10

69700 Close mastoid fistula 19.72 70.00 $1,380.40

69710 Implant/replace hearing aid 0.00 70.00 $0.00

69711 Remove/repair hearing aid 24.82 70.00 $1,737.40

69714 Implant temple bone w/stimul 31.08 70.00 $2,175.60

69715 Temple bne implnt w/stimulat 38.30 70.00 $2,681.00

69717 Temple bone implant revision 32.56 70.00 $2,279.20

69718 Revise temple bone implant 38.69 70.00 $2,708.30

69720 Release facial nerve 34.53 70.00 $2,417.10


69740 Repair facial nerve 33.65 70.00 $2,355.50

69745 Repair facial nerve 35.78 70.00 $2,504.60

69799 Middle ear surgery procedure 0.00 70.00 $0.00

69801 Incise inner ear 5.61 70.00 $392.70

69805 Explore inner ear 30.37 70.00 $2,125.90

69806 Explore inner ear 27.24 70.00 $1,906.80

69820 Establish inner ear window 24.66 70.00 $1,726.20

69840 Revise inner ear window 26.22 70.00 $1,835.40

69905 Remove inner ear 26.41 70.00 $1,848.70

69910 Remove inner ear & mastoid 29.30 70.00 $2,051.00

69915 Incise inner ear nerve 44.35 70.00 $3,104.50

69930 Implant cochlear device 35.32 70.00 $2,472.40

69949 Inner ear surgery procedure 0.00 70.00 $0.00

69950 Incise inner ear nerve 51.44 70.00 $3,600.80


69960 Release inner ear canal 55.55 70.00 $3,888.50

69970 Remove inner ear lesion 61.81 70.00 $4,326.70

69979 Temporal bone surgery 0.00 70.00 $0.00

69990 Microsurgery add-on 6.51 70.00 $455.70

70010 Contrast x-ray of brain 2.05 70.00 $143.50

70015 Contrast x-ray of brain 4.34 70.00 $303.80

70015 TC Contrast x-ray of brain 2.63 70.00 $184.10

70015 26 Contrast x-ray of brain 1.71 70.00 $119.70

70030 X-ray eye for foreign body 0.77 70.00 $53.90

70030 TC X-ray eye for foreign body 0.53 70.00 $37.10

70030 26 X-ray eye for foreign body 0.24 70.00 $16.80

7010F Pt info into recall system 0.00 70.00 $0.00

70100 X-ray exam of jaw <4views 0.92 70.00 $64.40

70100 TC X-ray exam of jaw <4views 0.66 70.00 $46.20

70100 26 X-ray exam of jaw <4views 0.26 70.00 $18.20

70110 X-ray exam of jaw 4/> views 1.06 70.00 $74.20

70110 TC X-ray exam of jaw 4/> views 0.70 70.00 $49.00

70110 26 X-ray exam of jaw 4/> views 0.36 70.00 $25.20

70120 X-ray exam of mastoids 0.95 70.00 $66.50

70120 TC X-ray exam of mastoids 0.69 70.00 $48.30

70120 26 X-ray exam of mastoids 0.26 70.00 $18.20

70130 X-ray exam of mastoids 1.53 70.00 $107.10

70130 TC X-ray exam of mastoids 1.04 70.00 $72.80

70130 26 X-ray exam of mastoids 0.49 70.00 $34.30

70134 X-ray exam of middle ear 1.44 70.00 $100.80

70134 TC X-ray exam of middle ear 0.94 70.00 $65.80

70134 26 X-ray exam of middle ear 0.50 70.00 $35.00

70140 X-ray exam of facial bones 0.83 70.00 $58.10

70140 TC X-ray exam of facial bones 0.53 70.00 $37.10

70140 26 X-ray exam of facial bones 0.30 70.00 $21.00

70150 X-ray exam of facial bones 1.16 70.00 $81.20

70150 TC X-ray exam of facial bones 0.78 70.00 $54.60

70150 26 X-ray exam of facial bones 0.38 70.00 $26.60

70160 X-ray exam of nasal bones 0.91 70.00 $63.70

70160 TC X-ray exam of nasal bones 0.66 70.00 $46.20

70160 26 X-ray exam of nasal bones 0.25 70.00 $17.50

70170 X-ray exam of tear duct 0.00 70.00 $0.00

70170 TC X-ray exam of tear duct 0.00 70.00 $0.00

70170 26 X-ray exam of tear duct 0.44 70.00 $30.80

70190 X-ray exam of eye sockets 0.98 70.00 $68.60

70190 TC X-ray exam of eye sockets 0.66 70.00 $46.20

70190 26 X-ray exam of eye sockets 0.32 70.00 $22.40

7020F Mammo assess cat in dbase 0.00 70.00 $0.00

70200 X-ray exam of eye sockets 1.18 70.00 $82.60

70200 TC X-ray exam of eye sockets 0.78 70.00 $54.60

70200 26 X-ray exam of eye sockets 0.40 70.00 $28.00

70210 X-ray exam of sinuses 0.83 70.00 $58.10

70210 TC X-ray exam of sinuses 0.58 70.00 $40.60

70210 26 X-ray exam of sinuses 0.25 70.00 $17.50

70220 X-ray exam of sinuses 1.04 70.00 $72.80

70220 TC X-ray exam of sinuses 0.68 70.00 $47.60

70220 26 X-ray exam of sinuses 0.36 70.00 $25.20

70240 X-ray exam pituitary saddle 0.84 70.00 $58.80

70240 TC X-ray exam pituitary saddle 0.55 70.00 $38.50

70240 26 X-ray exam pituitary saddle 0.29 70.00 $20.30

7025F Pt infosys alarm 4 nxt mammo 0.00 70.00 $0.00

70250 X-ray exam of skull 1.00 70.00 $70.00

70250 TC X-ray exam of skull 0.64 70.00 $44.80

70250 26 X-ray exam of skull 0.36 70.00 $25.20

70260 X-ray exam of skull 1.26 70.00 $88.20

70260 TC X-ray exam of skull 0.77 70.00 $53.90

70260 26 X-ray exam of skull 0.49 70.00 $34.30

70300 X-ray exam of teeth 0.42 70.00 $29.40

70300 TC X-ray exam of teeth 0.25 70.00 $17.50

70300 26 X-ray exam of teeth 0.17 70.00 $11.90

70310 X-ray exam of teeth 1.08 70.00 $75.60

70310 TC X-ray exam of teeth 0.84 70.00 $58.80

70310 26 X-ray exam of teeth 0.24 70.00 $16.80

70320 Full mouth x-ray of teeth 1.50 70.00 $105.00

70320 TC Full mouth x-ray of teeth 1.14 70.00 $79.80

70320 26 Full mouth x-ray of teeth 0.36 70.00 $25.20

70328 X-ray exam of jaw joint 0.87 70.00 $60.90

70328 TC X-ray exam of jaw joint 0.60 70.00 $42.00

70328 26 X-ray exam of jaw joint 0.27 70.00 $18.90

70330 X-ray exam of jaw joints 1.32 70.00 $92.40

70330 TC X-ray exam of jaw joints 0.95 70.00 $66.50

70330 26 X-ray exam of jaw joints 0.37 70.00 $25.90

70332 X-ray exam of jaw joint 2.30 70.00 $161.00

70332 TC X-ray exam of jaw joint 1.39 70.00 $97.30

70332 26 X-ray exam of jaw joint 0.91 70.00 $63.70

70336 Magnetic image jaw joint 8.97 70.00 $627.90

70336 TC Magnetic image jaw joint 6.88 70.00 $481.60

70336 26 Magnetic image jaw joint 2.09 70.00 $146.30

70350 X-ray head for orthodontia 0.55 70.00 $38.50

70350 TC X-ray head for orthodontia 0.26 70.00 $18.20

70350 26 X-ray head for orthodontia 0.29 70.00 $20.30

70355 Panoramic x-ray of jaws 0.57 70.00 $39.90

70355 TC Panoramic x-ray of jaws 0.25 70.00 $17.50

70355 26 Panoramic x-ray of jaws 0.32 70.00 $22.40

70360 X-ray exam of neck 0.78 70.00 $54.60

70360 TC X-ray exam of neck 0.54 70.00 $37.80

70360 26 X-ray exam of neck 0.24 70.00 $16.80

70370 Throat x-ray & fluoroscopy 2.26 70.00 $158.20

70370 TC Throat x-ray & fluoroscopy 1.80 70.00 $126.00

70370 26 Throat x-ray & fluoroscopy 0.46 70.00 $32.20

70371 Speech evaluation complex 2.53 70.00 $177.10

70371 TC Speech evaluation complex 1.33 70.00 $93.10

70371 26 Speech evaluation complex 1.20 70.00 $84.00

70373 Contrast x-ray of larynx 2.14 70.00 $149.80

70373 TC Contrast x-ray of larynx 1.51 70.00 $105.70

70373 26 Contrast x-ray of larynx 0.63 70.00 $44.10

70380 X-ray exam of salivary gland 1.01 70.00 $70.70

70380 TC X-ray exam of salivary gland 0.74 70.00 $51.80

70380 26 X-ray exam of salivary gland 0.27 70.00 $18.90

70390 X-ray exam of salivary duct 2.63 70.00 $184.10

70390 TC X-ray exam of salivary duct 2.09 70.00 $146.30

70390 26 X-ray exam of salivary duct 0.54 70.00 $37.80

70450 Ct head/brain w/o dye 3.25 70.00 $227.50

70450 TC Ct head/brain w/o dye 2.04 70.00 $142.80

70450 26 Ct head/brain w/o dye 1.21 70.00 $84.70

70460 Ct head/brain w/dye 4.54 70.00 $317.80

70460 TC Ct head/brain w/dye 2.93 70.00 $205.10

70460 26 Ct head/brain w/dye 1.61 70.00 $112.70

70470 Ct head/brain w/o & w/dye 5.37 70.00 $375.90

70470 TC Ct head/brain w/o & w/dye 3.56 70.00 $249.20

70470 26 Ct head/brain w/o & w/dye 1.81 70.00 $126.70

70480 Ct orbit/ear/fossa w/o dye 6.53 70.00 $457.10

70480 TC Ct orbit/ear/fossa w/o dye 4.71 70.00 $329.70

70480 26 Ct orbit/ear/fossa w/o dye 1.82 70.00 $127.40

70481 Ct orbit/ear/fossa w/dye 7.72 70.00 $540.40

70481 TC Ct orbit/ear/fossa w/dye 5.76 70.00 $403.20

70481 26 Ct orbit/ear/fossa w/dye 1.96 70.00 $137.20

70482 Ct orbit/ear/fossa w/o&w/dye 8.45 70.00 $591.50

70482 TC Ct orbit/ear/fossa w/o&w/dye 6.39 70.00 $447.30

70482 26 Ct orbit/ear/fossa w/o&w/dye 2.06 70.00 $144.20

70486 Ct maxillofacial w/o dye 3.92 70.00 $274.40

70486 TC Ct maxillofacial w/o dye 2.71 70.00 $189.70

70486 26 Ct maxillofacial w/o dye 1.21 70.00 $84.70

70487 Ct maxillofacial w/dye 4.72 70.00 $330.40

70487 TC Ct maxillofacial w/dye 3.11 70.00 $217.70

70487 26 Ct maxillofacial w/dye 1.61 70.00 $112.70

70488 Ct maxillofacial w/o & w/dye 5.74 70.00 $401.80

70488 TC Ct maxillofacial w/o & w/dye 3.94 70.00 $275.80

70488 26 Ct maxillofacial w/o & w/dye 1.80 70.00 $126.00

70490 Ct soft tissue neck w/o dye 5.40 70.00 $378.00

70490 TC Ct soft tissue neck w/o dye 3.58 70.00 $250.60

70490 26 Ct soft tissue neck w/o dye 1.82 70.00 $127.40

70491 Ct soft tissue neck w/dye 6.60 70.00 $462.00

70491 TC Ct soft tissue neck w/dye 4.63 70.00 $324.10

70491 26 Ct soft tissue neck w/dye 1.97 70.00 $137.90

70492 Ct sft tsue nck w/o & w/dye 7.78 70.00 $544.60

70492 TC Ct sft tsue nck w/o & w/dye 5.72 70.00 $400.40

70492 26 Ct sft tsue nck w/o & w/dye 2.06 70.00 $144.20

70496 Ct angiography head 8.28 70.00 $579.60

70496 TC Ct angiography head 5.78 70.00 $404.60

70496 26 Ct angiography head 2.50 70.00 $175.00

70498 Ct angiography neck 8.23 70.00 $576.10

70498 TC Ct angiography neck 5.74 70.00 $401.80

70498 26 Ct angiography neck 2.49 70.00 $174.30

70540 Mri orbit/face/neck w/o dye 10.03 70.00 $702.10

70540 TC Mri orbit/face/neck w/o dye 8.13 70.00 $569.10

70540 26 Mri orbit/face/neck w/o dye 1.90 70.00 $133.00

70542 Mri orbit/face/neck w/dye 11.29 70.00 $790.30

70542 TC Mri orbit/face/neck w/dye 8.98 70.00 $628.60

70542 26 Mri orbit/face/neck w/dye 2.31 70.00 $161.70

70543 Mri orbt/fac/nck w/o &w/dye 13.79 70.00 $965.30

70543 TC Mri orbt/fac/nck w/o &w/dye 10.74 70.00 $751.80

70543 26 Mri orbt/fac/nck w/o &w/dye 3.05 70.00 $213.50

70544 Mr angiography head w/o dye 11.00 70.00 $770.00

70544 TC Mr angiography head w/o dye 9.29 70.00 $650.30

70544 26 Mr angiography head w/o dye 1.71 70.00 $119.70

70545 Mr angiography head w/dye 10.82 70.00 $757.40

70545 TC Mr angiography head w/dye 9.12 70.00 $638.40

70545 26 Mr angiography head w/dye 1.70 70.00 $119.00

70546 Mr angiograph head w/o&w/dye 16.82 70.00 $1,177.40

70546 TC Mr angiograph head w/o&w/dye 14.25 70.00 $997.50

70546 26 Mr angiograph head w/o&w/dye 2.57 70.00 $179.90

70547 Mr angiography neck w/o dye 11.04 70.00 $772.80

70547 TC Mr angiography neck w/o dye 9.34 70.00 $653.80

70547 26 Mr angiography neck w/o dye 1.70 70.00 $119.00

70548 Mr angiography neck w/dye 11.59 70.00 $811.30

70548 TC Mr angiography neck w/dye 9.88 70.00 $691.60

70548 26 Mr angiography neck w/dye 1.71 70.00 $119.70

70549 Mr angiograph neck w/o&w/dye 16.89 70.00 $1,182.30

70549 TC Mr angiograph neck w/o&w/dye 14.32 70.00 $1,002.40

70549 26 Mr angiograph neck w/o&w/dye 2.57 70.00 $179.90

70551 Mri brain stem w/o dye 6.44 70.00 $450.80

70551 TC Mri brain stem w/o dye 4.34 70.00 $303.80

70551 26 Mri brain stem w/o dye 2.10 70.00 $147.00

70552 Mri brain stem w/dye 8.97 70.00 $627.90

70552 TC Mri brain stem w/dye 6.42 70.00 $449.40

70552 26 Mri brain stem w/dye 2.55 70.00 $178.50

70553 Mri brain stem w/o & w/dye 10.58 70.00 $740.60

70553 TC Mri brain stem w/o & w/dye 7.32 70.00 $512.40

70553 26 Mri brain stem w/o & w/dye 3.26 70.00 $228.20

70554 Fmri brain by tech 12.65 70.00 $885.50

70554 TC Fmri brain by tech 9.59 70.00 $671.30

70554 26 Fmri brain by tech 3.06 70.00 $214.20

70555 Fmri brain by phys/psych 0.00 70.00 $0.00

70555 TC Fmri brain by phys/psych 0.00 70.00 $0.00

70555 26 Fmri brain by phys/psych 3.72 70.00 $260.40

70557 Mri brain w/o dye 0.00 70.00 $0.00

70557 TC Mri brain w/o dye 0.00 70.00 $0.00

70557 26 Mri brain w/o dye 4.28 70.00 $299.60

70558 Mri brain w/dye 0.00 70.00 $0.00

70558 TC Mri brain w/dye 0.00 70.00 $0.00

70558 26 Mri brain w/dye 4.73 70.00 $331.10

70559 Mri brain w/o & w/dye 0.00 70.00 $0.00

70559 TC Mri brain w/o & w/dye 0.00 70.00 $0.00

70559 26 Mri brain w/o & w/dye 4.74 70.00 $331.80

71010 Chest x-ray 1 view frontal 0.63 70.00 $44.10

71010 TC Chest x-ray 1 view frontal 0.37 70.00 $25.90

71010 26 Chest x-ray 1 view frontal 0.26 70.00 $18.20

71015 Chest x-ray stereo frontal 0.77 70.00 $53.90

71015 TC Chest x-ray stereo frontal 0.46 70.00 $32.20

71015 26 Chest x-ray stereo frontal 0.31 70.00 $21.70

71020 Chest x-ray 2vw frontal&latl 0.78 70.00 $54.60

71020 TC Chest x-ray 2vw frontal&latl 0.47 70.00 $32.90

71020 26 Chest x-ray 2vw frontal&latl 0.31 70.00 $21.70

71021 Chest x-ray frnt lat lordotc 0.95 70.00 $66.50

71021 TC Chest x-ray frnt lat lordotc 0.56 70.00 $39.20

71021 26 Chest x-ray frnt lat lordotc 0.39 70.00 $27.30

71022 Chest x-ray frnt lat oblique 1.17 70.00 $81.90

71022 TC Chest x-ray frnt lat oblique 0.70 70.00 $49.00

71022 26 Chest x-ray frnt lat oblique 0.47 70.00 $32.90

71023 Chest x-ray and fluoroscopy 1.78 70.00 $124.60

71023 TC Chest x-ray and fluoroscopy 1.23 70.00 $86.10

71023 26 Chest x-ray and fluoroscopy 0.55 70.00 $38.50

71030 Chest x-ray 4/> views 1.16 70.00 $81.20

71030 TC Chest x-ray 4/> views 0.72 70.00 $50.40

71030 26 Chest x-ray 4/> views 0.44 70.00 $30.80

71034 Chest x-ray&fluoro 4/> views 2.36 70.00 $165.20

71034 TC Chest x-ray&fluoro 4/> views 1.70 70.00 $119.00

71034 26 Chest x-ray&fluoro 4/> views 0.66 70.00 $46.20

71035 Chest x-ray special views 0.91 70.00 $63.70

71035 TC Chest x-ray special views 0.65 70.00 $45.50

71035 26 Chest x-ray special views 0.26 70.00 $18.20

71100 X-ray exam ribs uni 2 views 0.85 70.00 $59.50

71100 TC X-ray exam ribs uni 2 views 0.53 70.00 $37.10

71100 26 X-ray exam ribs uni 2 views 0.32 70.00 $22.40

71101 X-ray exam unilat ribs/chest 1.01 70.00 $70.70

71101 TC X-ray exam unilat ribs/chest 0.63 70.00 $44.10

71101 26 X-ray exam unilat ribs/chest 0.38 70.00 $26.60

71110 X-ray exam ribs bil 3 views 1.04 70.00 $72.80

71110 TC X-ray exam ribs bil 3 views 0.65 70.00 $45.50

71110 26 X-ray exam ribs bil 3 views 0.39 70.00 $27.30

71111 X-ray exam ribs/chest4/> vws 1.32 70.00 $92.40

71111 TC X-ray exam ribs/chest4/> vws 0.86 70.00 $60.20

71111 26 X-ray exam ribs/chest4/> vws 0.46 70.00 $32.20

71120 X-ray exam breastbone 2/>vws 0.82 70.00 $57.40

71120 TC X-ray exam breastbone 2/>vws 0.53 70.00 $37.10

71120 26 X-ray exam breastbone 2/>vws 0.29 70.00 $20.30

71130 X-ray strenoclavic jt 3/>vws 1.01 70.00 $70.70

71130 TC X-ray strenoclavic jt 3/>vws 0.68 70.00 $47.60

71130 26 X-ray strenoclavic jt 3/>vws 0.33 70.00 $23.10

71250 Ct thorax w/o dye 5.04 70.00 $352.80

71250 TC Ct thorax w/o dye 3.59 70.00 $251.30

71250 26 Ct thorax w/o dye 1.45 70.00 $101.50

71260 Ct thorax w/dye 6.42 70.00 $449.40

71260 TC Ct thorax w/dye 4.65 70.00 $325.50

71260 26 Ct thorax w/dye 1.77 70.00 $123.90

71270 Ct thorax w/o & w/dye 7.70 70.00 $539.00

71270 TC Ct thorax w/o & w/dye 5.74 70.00 $401.80

71270 26 Ct thorax w/o & w/dye 1.96 70.00 $137.20

71275 Ct angiography chest 8.41 70.00 $588.70

71275 TC Ct angiography chest 5.81 70.00 $406.70

71275 26 Ct angiography chest 2.60 70.00 $182.00

71550 Mri chest w/o dye 11.61 70.00 $812.70

71550 TC Mri chest w/o dye 9.54 70.00 $667.80

71550 26 Mri chest w/o dye 2.07 70.00 $144.90

71551 Mri chest w/dye 12.83 70.00 $898.10

71551 TC Mri chest w/dye 10.36 70.00 $725.20

71551 26 Mri chest w/dye 2.47 70.00 $172.90

71552 Mri chest w/o & w/dye 16.26 70.00 $1,138.20

71552 TC Mri chest w/o & w/dye 13.02 70.00 $911.40

71552 26 Mri chest w/o & w/dye 3.24 70.00 $226.80

71555 Mri angio chest w or w/o dye 11.16 70.00 $781.20

71555 TC Mri angio chest w or w/o dye 8.60 70.00 $602.00

71555 26 Mri angio chest w or w/o dye 2.56 70.00 $179.20

72010 X-ray exam spine ap&lat 1.97 70.00 $137.90

72010 TC X-ray exam spine ap&lat 1.30 70.00 $91.00

72010 26 X-ray exam spine ap&lat 0.67 70.00 $46.90

72020 X-ray exam of spine 1 view 0.61 70.00 $42.70

72020 TC X-ray exam of spine 1 view 0.39 70.00 $27.30

72020 26 X-ray exam of spine 1 view 0.22 70.00 $15.40

72040 X-ray exam neck spine 2-3 vw 0.93 70.00 $65.10

72040 TC X-ray exam neck spine 2-3 vw 0.60 70.00 $42.00

72040 26 X-ray exam neck spine 2-3 vw 0.33 70.00 $23.10

72050 X-ray exam neck spine 4/5vws 1.25 70.00 $87.50

72050 TC X-ray exam neck spine 4/5vws 0.80 70.00 $56.00

72050 26 X-ray exam neck spine 4/5vws 0.45 70.00 $31.50

72052 X-ray exam neck spine 6/>vws 1.57 70.00 $109.90

72052 TC X-ray exam neck spine 6/>vws 1.04 70.00 $72.80

72052 26 X-ray exam neck spine 6/>vws 0.53 70.00 $37.10

72069 X-ray exam trunk spine stand 0.90 70.00 $63.00

72069 TC X-ray exam trunk spine stand 0.57 70.00 $39.90

72069 26 X-ray exam trunk spine stand 0.33 70.00 $23.10

72070 X-ray exam thorac spine 2vws 0.88 70.00 $61.60

72070 TC X-ray exam thorac spine 2vws 0.55 70.00 $38.50

72070 26 X-ray exam thorac spine 2vws 0.33 70.00 $23.10

72072 X-ray exam thorac spine 3vws 0.96 70.00 $67.20

72072 TC X-ray exam thorac spine 3vws 0.65 70.00 $45.50

72072 26 X-ray exam thorac spine 3vws 0.31 70.00 $21.70

72074 X-ray exam thorac spine4/>vw 1.09 70.00 $76.30

72074 TC X-ray exam thorac spine4/>vw 0.78 70.00 $54.60

72074 26 X-ray exam thorac spine4/>vw 0.31 70.00 $21.70

72080 X-ray exam trunk spine 2 vws 0.94 70.00 $65.80

72080 TC X-ray exam trunk spine 2 vws 0.60 70.00 $42.00

72080 26 X-ray exam trunk spine 2 vws 0.34 70.00 $23.80

72090 X-ray exam scloiosis erect 1.20 70.00 $84.00

72090 TC X-ray exam scloiosis erect 0.76 70.00 $53.20

72090 26 X-ray exam scloiosis erect 0.44 70.00 $30.80

72100 X-ray exam l-s spine 2/3 vws 0.98 70.00 $68.60

72100 TC X-ray exam l-s spine 2/3 vws 0.65 70.00 $45.50

72100 26 X-ray exam l-s spine 2/3 vws 0.33 70.00 $23.10

72110 X-ray exam l-2 spine 4/>vws 1.37 70.00 $95.90

72110 TC X-ray exam l-2 spine 4/>vws 0.91 70.00 $63.70

72110 26 X-ray exam l-2 spine 4/>vws 0.46 70.00 $32.20

72114 X-ray exam l-s spine bending 1.75 70.00 $122.50

72114 TC X-ray exam l-s spine bending 1.27 70.00 $88.90

72114 26 X-ray exam l-s spine bending 0.48 70.00 $33.60

72120 X-ray bend only l-s spine 1.13 70.00 $79.10

72120 TC X-ray bend only l-s spine 0.79 70.00 $55.30

72120 26 X-ray bend only l-s spine 0.34 70.00 $23.80

72125 Ct neck spine w/o dye 5.16 70.00 $361.20

72125 TC Ct neck spine w/o dye 3.64 70.00 $254.80

72125 26 Ct neck spine w/o dye 1.52 70.00 $106.40

72126 Ct neck spine w/dye 6.42 70.00 $449.40

72126 TC Ct neck spine w/dye 4.68 70.00 $327.60

72126 26 Ct neck spine w/dye 1.74 70.00 $121.80

72127 Ct neck spine w/o & w/dye 7.57 70.00 $529.90

72127 TC Ct neck spine w/o & w/dye 5.77 70.00 $403.90

72127 26 Ct neck spine w/o & w/dye 1.80 70.00 $126.00

72128 Ct chest spine w/o dye 5.04 70.00 $352.80

72128 TC Ct chest spine w/o dye 3.62 70.00 $253.40

72128 26 Ct chest spine w/o dye 1.42 70.00 $99.40

72129 Ct chest spine w/dye 6.42 70.00 $449.40

72129 TC Ct chest spine w/dye 4.69 70.00 $328.30

72129 26 Ct chest spine w/dye 1.73 70.00 $121.10

72130 Ct chest spine w/o & w/dye 7.58 70.00 $530.60

72130 TC Ct chest spine w/o & w/dye 5.78 70.00 $404.60

72130 26 Ct chest spine w/o & w/dye 1.80 70.00 $126.00

72131 Ct lumbar spine w/o dye 5.01 70.00 $350.70

72131 TC Ct lumbar spine w/o dye 3.59 70.00 $251.30

72131 26 Ct lumbar spine w/o dye 1.42 70.00 $99.40

72132 Ct lumbar spine w/dye 6.40 70.00 $448.00

72132 TC Ct lumbar spine w/dye 4.66 70.00 $326.20

72132 26 Ct lumbar spine w/dye 1.74 70.00 $121.80

72133 Ct lumbar spine w/o & w/dye 7.58 70.00 $530.60

72133 TC Ct lumbar spine w/o & w/dye 5.77 70.00 $403.90

72133 26 Ct lumbar spine w/o & w/dye 1.81 70.00 $126.70

72141 Mri neck spine w/o dye 6.25 70.00 $437.50

72141 TC Mri neck spine w/o dye 4.15 70.00 $290.50

72141 26 Mri neck spine w/o dye 2.10 70.00 $147.00

72142 Mri neck spine w/dye 9.07 70.00 $634.90

72142 TC Mri neck spine w/dye 6.52 70.00 $456.40

72142 26 Mri neck spine w/dye 2.55 70.00 $178.50

72146 Mri chest spine w/o dye 6.25 70.00 $437.50

72146 TC Mri chest spine w/o dye 4.15 70.00 $290.50

72146 26 Mri chest spine w/o dye 2.10 70.00 $147.00

72147 Mri chest spine w/dye 9.01 70.00 $630.70

72147 TC Mri chest spine w/dye 6.46 70.00 $452.20

72147 26 Mri chest spine w/dye 2.55 70.00 $178.50

72148 Mri lumbar spine w/o dye 6.22 70.00 $435.40

72148 TC Mri lumbar spine w/o dye 4.11 70.00 $287.70

72148 26 Mri lumbar spine w/o dye 2.11 70.00 $147.70

72149 Mri lumbar spine w/dye 8.96 70.00 $627.20

72149 TC Mri lumbar spine w/dye 6.41 70.00 $448.70

72149 26 Mri lumbar spine w/dye 2.55 70.00 $178.50

72156 Mri neck spine w/o & w/dye 10.64 70.00 $744.80

72156 TC Mri neck spine w/o & w/dye 7.38 70.00 $516.60

72156 26 Mri neck spine w/o & w/dye 3.26 70.00 $228.20

72157 Mri chest spine w/o & w/dye 10.67 70.00 $746.90

72157 TC Mri chest spine w/o & w/dye 7.39 70.00 $517.30

72157 26 Mri chest spine w/o & w/dye 3.28 70.00 $229.60

72158 Mri lumbar spine w/o & w/dye 10.61 70.00 $742.70

72158 TC Mri lumbar spine w/o & w/dye 7.33 70.00 $513.10

72158 26 Mri lumbar spine w/o & w/dye 3.28 70.00 $229.60

72159 Mr angio spine w/o&w/dye 11.71 70.00 $819.70

72159 TC Mr angio spine w/o&w/dye 9.11 70.00 $637.70

72159 26 Mr angio spine w/o&w/dye 2.60 70.00 $182.00

72170 X-ray exam of pelvis 0.77 70.00 $53.90

72170 TC X-ray exam of pelvis 0.51 70.00 $35.70

72170 26 X-ray exam of pelvis 0.26 70.00 $18.20

72190 X-ray exam of pelvis 1.07 70.00 $74.90

72190 TC X-ray exam of pelvis 0.75 70.00 $52.50

72190 26 X-ray exam of pelvis 0.32 70.00 $22.40

72191 Ct angiograph pelv w/o&w/dye 8.53 70.00 $597.10

72191 TC Ct angiograph pelv w/o&w/dye 5.96 70.00 $417.20

72191 26 Ct angiograph pelv w/o&w/dye 2.57 70.00 $179.90

72192 Ct pelvis w/o dye 4.10 70.00 $287.00

72192 TC Ct pelvis w/o dye 2.55 70.00 $178.50

72192 26 Ct pelvis w/o dye 1.55 70.00 $108.50

72193 Ct pelvis w/dye 6.32 70.00 $442.40

72193 TC Ct pelvis w/dye 4.67 70.00 $326.90

72193 26 Ct pelvis w/dye 1.65 70.00 $115.50

72194 Ct pelvis w/o & w/dye 7.29 70.00 $510.30

72194 TC Ct pelvis w/o & w/dye 5.56 70.00 $389.20

72194 26 Ct pelvis w/o & w/dye 1.73 70.00 $121.10

72195 Mri pelvis w/o dye 10.53 70.00 $737.10

72195 TC Mri pelvis w/o dye 8.45 70.00 $591.50

72195 26 Mri pelvis w/o dye 2.08 70.00 $145.60

72196 Mri pelvis w/dye 11.53 70.00 $807.10

72196 TC Mri pelvis w/dye 9.05 70.00 $633.50

72196 26 Mri pelvis w/dye 2.48 70.00 $173.60

72197 Mri pelvis w/o & w/dye 14.19 70.00 $993.30

72197 TC Mri pelvis w/o & w/dye 10.95 70.00 $766.50

72197 26 Mri pelvis w/o & w/dye 3.24 70.00 $226.80

72198 Mr angio pelvis w/o & w/dye 11.27 70.00 $788.90

72198 TC Mr angio pelvis w/o & w/dye 8.72 70.00 $610.40

72198 26 Mr angio pelvis w/o & w/dye 2.55 70.00 $178.50

72200 X-ray exam si joints 0.79 70.00 $55.30

72200 TC X-ray exam si joints 0.54 70.00 $37.80

72200 26 X-ray exam si joints 0.25 70.00 $17.50

72202 X-ray exam si joints 3/> vws 0.92 70.00 $64.40

72202 TC X-ray exam si joints 3/> vws 0.65 70.00 $45.50

72202 26 X-ray exam si joints 3/> vws 0.27 70.00 $18.90

72220 X-ray exam sacrum tailbone 0.78 70.00 $54.60

72220 TC X-ray exam sacrum tailbone 0.53 70.00 $37.10

72220 26 X-ray exam sacrum tailbone 0.25 70.00 $17.50

72240 Myelography neck spine 2.76 70.00 $193.20

72240 TC Myelography neck spine 1.45 70.00 $101.50

72240 26 Myelography neck spine 1.31 70.00 $91.70

72255 Myelography thoracic spine 2.74 70.00 $191.80

72255 TC Myelography thoracic spine 1.43 70.00 $100.10

72255 26 Myelography thoracic spine 1.31 70.00 $91.70

72265 Myelography l-s spine 2.58 70.00 $180.60

72265 TC Myelography l-s spine 1.39 70.00 $97.30

72265 26 Myelography l-s spine 1.19 70.00 $83.30

72270 Myelogphy 2/> spine regions 3.57 70.00 $249.90

72270 TC Myelogphy 2/> spine regions 1.67 70.00 $116.90

72270 26 Myelogphy 2/> spine regions 1.90 70.00 $133.00

72275 Epidurography 3.24 70.00 $226.80

72275 TC Epidurography 2.12 70.00 $148.40

72275 26 Epidurography 1.12 70.00 $78.40

72285 Discography cerv/thor spine 3.21 70.00 $224.70

72285 TC Discography cerv/thor spine 1.47 70.00 $102.90

72285 26 Discography cerv/thor spine 1.74 70.00 $121.80

72295 X-ray of lower spine disk 2.75 70.00 $192.50

72295 TC X-ray of lower spine disk 1.53 70.00 $107.10

72295 26 X-ray of lower spine disk 1.22 70.00 $85.40

73000 X-ray exam of collar bone 0.78 70.00 $54.60

73000 TC X-ray exam of collar bone 0.53 70.00 $37.10

73000 26 X-ray exam of collar bone 0.25 70.00 $17.50

73010 X-ray exam of shoulder blade 0.84 70.00 $58.80

73010 TC X-ray exam of shoulder blade 0.57 70.00 $39.90

73010 26 X-ray exam of shoulder blade 0.27 70.00 $18.90

73020 X-ray exam of shoulder 0.65 70.00 $45.50

73020 TC X-ray exam of shoulder 0.42 70.00 $29.40

73020 26 X-ray exam of shoulder 0.23 70.00 $16.10

73030 X-ray exam of shoulder 0.81 70.00 $56.70

73030 TC X-ray exam of shoulder 0.53 70.00 $37.10

73030 26 X-ray exam of shoulder 0.28 70.00 $19.60

73040 Contrast x-ray of shoulder 2.82 70.00 $197.40

73040 TC Contrast x-ray of shoulder 2.03 70.00 $142.10

73040 26 Contrast x-ray of shoulder 0.79 70.00 $55.30

73050 X-ray exam of shoulders 1.00 70.00 $70.00

73050 TC X-ray exam of shoulders 0.69 70.00 $48.30

73050 26 X-ray exam of shoulders 0.31 70.00 $21.70

73060 X-ray exam of humerus 0.75 70.00 $52.50

73060 TC X-ray exam of humerus 0.49 70.00 $34.30

73060 26 X-ray exam of humerus 0.26 70.00 $18.20

73070 X-ray exam of elbow 0.77 70.00 $53.90

73070 TC X-ray exam of elbow 0.53 70.00 $37.10

73070 26 X-ray exam of elbow 0.24 70.00 $16.80

73080 X-ray exam of elbow 0.88 70.00 $61.60

73080 TC X-ray exam of elbow 0.62 70.00 $43.40

73080 26 X-ray exam of elbow 0.26 70.00 $18.20

73085 Contrast x-ray of elbow 2.76 70.00 $193.20

73085 TC Contrast x-ray of elbow 1.95 70.00 $136.50

73085 26 Contrast x-ray of elbow 0.81 70.00 $56.70

73090 X-ray exam of forearm 0.72 70.00 $50.40

73090 TC X-ray exam of forearm 0.48 70.00 $33.60

73090 26 X-ray exam of forearm 0.24 70.00 $16.80

73092 X-ray exam of arm infant 0.76 70.00 $53.20

73092 TC X-ray exam of arm infant 0.53 70.00 $37.10

73092 26 X-ray exam of arm infant 0.23 70.00 $16.10

73100 X-ray exam of wrist 0.82 70.00 $57.40

73100 TC X-ray exam of wrist 0.57 70.00 $39.90

73100 26 X-ray exam of wrist 0.25 70.00 $17.50

73110 X-ray exam of wrist 0.99 70.00 $69.30

73110 TC X-ray exam of wrist 0.73 70.00 $51.10

73110 26 X-ray exam of wrist 0.26 70.00 $18.20

73115 Contrast x-ray of wrist 3.00 70.00 $210.00

73115 TC Contrast x-ray of wrist 2.19 70.00 $153.30

73115 26 Contrast x-ray of wrist 0.81 70.00 $56.70

73120 X-ray exam of hand 0.73 70.00 $51.10

73120 TC X-ray exam of hand 0.49 70.00 $34.30

73120 26 X-ray exam of hand 0.24 70.00 $16.80

73130 X-ray exam of hand 0.85 70.00 $59.50

73130 TC X-ray exam of hand 0.60 70.00 $42.00

73130 26 X-ray exam of hand 0.25 70.00 $17.50

73140 X-ray exam of finger(s) 0.87 70.00 $60.90

73140 TC X-ray exam of finger(s) 0.67 70.00 $46.90

73140 26 X-ray exam of finger(s) 0.20 70.00 $14.00

73200 Ct upper extremity w/o dye 5.01 70.00 $350.70

73200 TC Ct upper extremity w/o dye 3.59 70.00 $251.30

73200 26 Ct upper extremity w/o dye 1.42 70.00 $99.40

73201 Ct upper extremity w/dye 6.23 70.00 $436.10

73201 TC Ct upper extremity w/dye 4.58 70.00 $320.60

73201 26 Ct upper extremity w/dye 1.65 70.00 $115.50

73202 Ct uppr extremity w/o&w/dye 7.78 70.00 $544.60

73202 TC Ct uppr extremity w/o&w/dye 6.05 70.00 $423.50

73202 26 Ct uppr extremity w/o&w/dye 1.73 70.00 $121.10

73206 Ct angio upr extrm w/o&w/dye 9.15 70.00 $640.50

73206 TC Ct angio upr extrm w/o&w/dye 6.59 70.00 $461.30

73206 26 Ct angio upr extrm w/o&w/dye 2.56 70.00 $179.20

73218 Mri upper extremity w/o dye 10.20 70.00 $714.00

73218 TC Mri upper extremity w/o dye 8.29 70.00 $580.30

73218 26 Mri upper extremity w/o dye 1.91 70.00 $133.70

73219 Mri upper extremity w/dye 11.32 70.00 $792.40

73219 TC Mri upper extremity w/dye 8.99 70.00 $629.30

73219 26 Mri upper extremity w/dye 2.33 70.00 $163.10

73220 Mri uppr extremity w/o&w/dye 14.00 70.00 $980.00

73220 TC Mri uppr extremity w/o&w/dye 10.93 70.00 $765.10

73220 26 Mri uppr extremity w/o&w/dye 3.07 70.00 $214.90

73221 Mri joint upr extrem w/o dye 6.60 70.00 $462.00

73221 TC Mri joint upr extrem w/o dye 4.66 70.00 $326.20

73221 26 Mri joint upr extrem w/o dye 1.94 70.00 $135.80

73222 Mri joint upr extrem w/dye 10.61 70.00 $742.70

73222 TC Mri joint upr extrem w/dye 8.29 70.00 $580.30

73222 26 Mri joint upr extrem w/dye 2.32 70.00 $162.40

73223 Mri joint upr extr w/o&w/dye 13.15 70.00 $920.50

73223 TC Mri joint upr extr w/o&w/dye 10.08 70.00 $705.60

73223 26 Mri joint upr extr w/o&w/dye 3.07 70.00 $214.90

73225 Mr angio upr extr w/o&w/dye 11.32 70.00 $792.40

73225 TC Mr angio upr extr w/o&w/dye 8.89 70.00 $622.30

73225 26 Mr angio upr extr w/o&w/dye 2.43 70.00 $170.10

73500 X-ray exam of hip 0.74 70.00 $51.80

73500 TC X-ray exam of hip 0.48 70.00 $33.60

73500 26 X-ray exam of hip 0.26 70.00 $18.20

73510 X-ray exam of hip 1.04 70.00 $72.80


73510 26 X-ray exam of hip 0.32 70.00 $22.40

73520 X-ray exam of hips 1.11 70.00 $77.70

73520 TC X-ray exam of hips 0.71 70.00 $49.70

73520 26 X-ray exam of hips 0.40 70.00 $28.00

73525 Contrast x-ray of hip 2.85 70.00 $199.50

73525 TC Contrast x-ray of hip 2.03 70.00 $142.10

73525 26 Contrast x-ray of hip 0.82 70.00 $57.40

73530 X-ray exam of hip 0.00 70.00 $0.00


73530 26 X-ray exam of hip 0.42 70.00 $29.40

73540 X-ray exam of pelvis & hips 1.10 70.00 $77.00

73540 TC X-ray exam of pelvis & hips 0.81 70.00 $56.70

73540 26 X-ray exam of pelvis & hips 0.29 70.00 $20.30

73550 X-ray exam of thigh 0.76 70.00 $53.20

73550 TC X-ray exam of thigh 0.50 70.00 $35.00

73550 26 X-ray exam of thigh 0.26 70.00 $18.20

73560 X-ray exam of knee 1 or 2 0.82 70.00 $57.40

73560 TC X-ray exam of knee 1 or 2 0.55 70.00 $38.50

73560 26 X-ray exam of knee 1 or 2 0.27 70.00 $18.90

73562 X-ray exam of knee 3 0.96 70.00 $67.20

73562 TC X-ray exam of knee 3 0.68 70.00 $47.60

73562 26 X-ray exam of knee 3 0.28 70.00 $19.60

73564 X-ray exam knee 4 or more 1.12 70.00 $78.40

73564 TC X-ray exam knee 4 or more 0.78 70.00 $54.60

73564 26 X-ray exam knee 4 or more 0.34 70.00 $23.80

73565 X-ray exam of knees 0.92 70.00 $64.40

73565 TC X-ray exam of knees 0.65 70.00 $45.50

73565 26 X-ray exam of knees 0.27 70.00 $18.90

73580 Contrast x-ray of knee joint 3.22 70.00 $225.40

73580 TC Contrast x-ray of knee joint 2.42 70.00 $169.40

73580 26 Contrast x-ray of knee joint 0.80 70.00 $56.00

73590 X-ray exam of lower leg 0.74 70.00 $51.80

73590 TC X-ray exam of lower leg 0.49 70.00 $34.30

73590 26 X-ray exam of lower leg 0.25 70.00 $17.50

73592 X-ray exam of leg infant 0.76 70.00 $53.20

73592 TC X-ray exam of leg infant 0.53 70.00 $37.10

73592 26 X-ray exam of leg infant 0.23 70.00 $16.10

73600 X-ray exam of ankle 0.76 70.00 $53.20

73600 TC X-ray exam of ankle 0.52 70.00 $36.40

73600 26 X-ray exam of ankle 0.24 70.00 $16.80

73610 X-ray exam of ankle 0.88 70.00 $61.60

73610 TC X-ray exam of ankle 0.62 70.00 $43.40

73610 26 X-ray exam of ankle 0.26 70.00 $18.20

73615 Contrast x-ray of ankle 2.77 70.00 $193.90

73615 TC Contrast x-ray of ankle 1.94 70.00 $135.80

73615 26 Contrast x-ray of ankle 0.83 70.00 $58.10

73620 X-ray exam of foot 0.72 70.00 $50.40

73620 TC X-ray exam of foot 0.50 70.00 $35.00

73620 26 X-ray exam of foot 0.22 70.00 $15.40

73630 X-ray exam of foot 0.81 70.00 $56.70

73630 TC X-ray exam of foot 0.57 70.00 $39.90

73630 26 X-ray exam of foot 0.24 70.00 $16.80

73650 X-ray exam of heel 0.75 70.00 $52.50

73650 TC X-ray exam of heel 0.52 70.00 $36.40

73650 26 X-ray exam of heel 0.23 70.00 $16.10

73660 X-ray exam of toe(s) 0.78 70.00 $54.60

73660 TC X-ray exam of toe(s) 0.59 70.00 $41.30

73660 26 X-ray exam of toe(s) 0.19 70.00 $13.30

73700 Ct lower extremity w/o dye 5.01 70.00 $350.70

73700 TC Ct lower extremity w/o dye 3.59 70.00 $251.30

73700 26 Ct lower extremity w/o dye 1.42 70.00 $99.40

73701 Ct lower extremity w/dye 6.32 70.00 $442.40

73701 TC Ct lower extremity w/dye 4.67 70.00 $326.90

73701 26 Ct lower extremity w/dye 1.65 70.00 $115.50

73702 Ct lwr extremity w/o&w/dye 7.65 70.00 $535.50

73702 TC Ct lwr extremity w/o&w/dye 5.94 70.00 $415.80

73702 26 Ct lwr extremity w/o&w/dye 1.71 70.00 $119.70

73706 Ct angio lwr extr w/o&w/dye 9.84 70.00 $688.80

73706 TC Ct angio lwr extr w/o&w/dye 7.16 70.00 $501.20

73706 26 Ct angio lwr extr w/o&w/dye 2.68 70.00 $187.60

73718 Mri lower extremity w/o dye 10.22 70.00 $715.40

73718 TC Mri lower extremity w/o dye 8.31 70.00 $581.70

73718 26 Mri lower extremity w/o dye 1.91 70.00 $133.70

73719 Mri lower extremity w/dye 11.34 70.00 $793.80

73719 TC Mri lower extremity w/dye 9.03 70.00 $632.10

73719 26 Mri lower extremity w/dye 2.31 70.00 $161.70

73720 Mri lwr extremity w/o&w/dye 14.09 70.00 $986.30

73720 TC Mri lwr extremity w/o&w/dye 11.02 70.00 $771.40

73720 26 Mri lwr extremity w/o&w/dye 3.07 70.00 $214.90

73721 Mri jnt of lwr extre w/o dye 6.59 70.00 $461.30

73721 TC Mri jnt of lwr extre w/o dye 4.66 70.00 $326.20

73721 26 Mri jnt of lwr extre w/o dye 1.93 70.00 $135.10

73722 Mri joint of lwr extr w/dye 10.70 70.00 $749.00

73722 TC Mri joint of lwr extr w/dye 8.37 70.00 $585.90

73722 26 Mri joint of lwr extr w/dye 2.33 70.00 $163.10

73723 Mri joint lwr extr w/o&w/dye 13.21 70.00 $924.70

73723 TC Mri joint lwr extr w/o&w/dye 10.14 70.00 $709.80

73723 26 Mri joint lwr extr w/o&w/dye 3.07 70.00 $214.90

73725 Mr ang lwr ext w or w/o dye 11.30 70.00 $791.00

73725 TC Mr ang lwr ext w or w/o dye 8.73 70.00 $611.10

73725 26 Mr ang lwr ext w or w/o dye 2.57 70.00 $179.90

74000 X-ray exam of abdomen 0.66 70.00 $46.20

74000 TC X-ray exam of abdomen 0.40 70.00 $28.00

74000 26 X-ray exam of abdomen 0.26 70.00 $18.20







74022 X-ray exam series abdomen 1.23 70.00 $86.10

74022 TC X-ray exam series abdomen 0.78 70.00 $54.60

74022 26 X-ray exam series abdomen 0.45 70.00 $31.50

74150 Ct abdomen w/o dye 4.20 70.00 $294.00

74150 TC Ct abdomen w/o dye 2.51 70.00 $175.70

74150 26 Ct abdomen w/o dye 1.69 70.00 $118.30

74160 Ct abdomen w/dye 6.46 70.00 $452.20

74160 TC Ct abdomen w/dye 4.65 70.00 $325.50

74160 26 Ct abdomen w/dye 1.81 70.00 $126.70

74170 Ct abdomen w/o & w/dye 7.35 70.00 $514.50

74170 TC Ct abdomen w/o & w/dye 5.36 70.00 $375.20

74170 26 Ct abdomen w/o & w/dye 1.99 70.00 $139.30

74174 Ct angio abd&pelv w/o&w/dye 10.91 70.00 $763.70

74174 TC Ct angio abd&pelv w/o&w/dye 7.77 70.00 $543.90

74174 26 Ct angio abd&pelv w/o&w/dye 3.14 70.00 $219.80

74175 Ct angio abdom w/o & w/dye 8.60 70.00 $602.00

74175 TC Ct angio abdom w/o & w/dye 6.02 70.00 $421.40

74175 26 Ct angio abdom w/o & w/dye 2.58 70.00 $180.60

74176 Ct abd & pelvis w/o contrast 5.62 70.00 $393.40

74176 TC Ct abd & pelvis w/o contrast 3.13 70.00 $219.10

74176 26 Ct abd & pelvis w/o contrast 2.49 70.00 $174.30

74177 Ct abd & pelv w/contrast 8.74 70.00 $611.80

74177 TC Ct abd & pelv w/contrast 6.13 70.00 $429.10

74177 26 Ct abd & pelv w/contrast 2.61 70.00 $182.70

74178 Ct abd & pelv 1/> regns 9.89 70.00 $692.30

74178 TC Ct abd & pelv 1/> regns 7.02 70.00 $491.40

74178 26 Ct abd & pelv 1/> regns 2.87 70.00 $200.90

74181 Mri abdomen w/o dye 9.32 70.00 $652.40

74181 TC Mri abdomen w/o dye 7.25 70.00 $507.50

74181 26 Mri abdomen w/o dye 2.07 70.00 $144.90

74182 Mri abdomen w/dye 12.75 70.00 $892.50

74182 TC Mri abdomen w/dye 10.28 70.00 $719.60

74182 26 Mri abdomen w/dye 2.47 70.00 $172.90

74183 Mri abdomen w/o & w/dye 14.22 70.00 $995.40

74183 TC Mri abdomen w/o & w/dye 10.98 70.00 $768.60

74183 26 Mri abdomen w/o & w/dye 3.24 70.00 $226.80

74185 Mri angio abdom w orw/o dye 11.30 70.00 $791.00

74185 TC Mri angio abdom w orw/o dye 8.75 70.00 $612.50

74185 26 Mri angio abdom w orw/o dye 2.55 70.00 $178.50

74190 X-ray exam of peritoneum 0.00 70.00 $0.00

74190 TC X-ray exam of peritoneum 0.00 70.00 $0.00

74190 26 X-ray exam of peritoneum 0.68 70.00 $47.60

74210 Contrst x-ray exam of throat 2.17 70.00 $151.90

74210 TC Contrst x-ray exam of throat 1.66 70.00 $116.20

74210 26 Contrst x-ray exam of throat 0.51 70.00 $35.70

74220 Contrast x-ray esophagus 2.48 70.00 $173.60

74220 TC Contrast x-ray esophagus 1.82 70.00 $127.40

74220 26 Contrast x-ray esophagus 0.66 70.00 $46.20

74230 Cine/vid x-ray throat/esoph 3.60 70.00 $252.00

74230 TC Cine/vid x-ray throat/esoph 2.84 70.00 $198.80

74230 26 Cine/vid x-ray throat/esoph 0.76 70.00 $53.20

74235 Remove esophagus obstruction 0.00 70.00 $0.00

74235 TC Remove esophagus obstruction 0.00 70.00 $0.00

74235 26 Remove esophagus obstruction 1.80 70.00 $126.00

74240 X-ray upper gi delay w/o kub 3.19 70.00 $223.30

74240 TC X-ray upper gi delay w/o kub 2.19 70.00 $153.30

74240 26 X-ray upper gi delay w/o kub 1.00 70.00 $70.00

74241 X-rayupper gi delay w/kub 3.29 70.00 $230.30

74241 TC X-rayupper gi delay w/kub 2.31 70.00 $161.70

74241 26 X-rayupper gi delay w/kub 0.98 70.00 $68.60

74245 X-ray upper gi&small intest 4.80 70.00 $336.00

74245 TC X-ray upper gi&small intest 3.50 70.00 $245.00

74245 26 X-ray upper gi&small intest 1.30 70.00 $91.00

74246 Contrst x-ray uppr gi tract 3.59 70.00 $251.30

74246 TC Contrst x-ray uppr gi tract 2.58 70.00 $180.60

74246 26 Contrst x-ray uppr gi tract 1.01 70.00 $70.70







74250 X-ray exam of small bowel 2.92 70.00 $204.40

74250 TC X-ray exam of small bowel 2.24 70.00 $156.80

74250 26 X-ray exam of small bowel 0.68 70.00 $47.60







74261 Ct colonography dx 13.64 70.00 $954.80

74261 TC Ct colonography dx 10.19 70.00 $713.30

74261 26 Ct colonography dx 3.45 70.00 $241.50

74262 Ct colonography dx w/dye 15.25 70.00 $1,067.50

74262 TC Ct colonography dx w/dye 11.66 70.00 $816.20

74262 26 Ct colonography dx w/dye 3.59 70.00 $251.30

74263 Ct colonography screening 21.17 70.00 $1,481.90

74263 TC Ct colonography screening 17.93 70.00 $1,255.10

74263 26 Ct colonography screening 3.24 70.00 $226.80

74270 Contrast x-ray exam of colon 4.20 70.00 $294.00

74270 TC Contrast x-ray exam of colon 3.21 70.00 $224.70

74270 26 Contrast x-ray exam of colon 0.99 70.00 $69.30







74290 Contrast x-ray gallbladder 1.96 70.00 $137.20

74290 TC Contrast x-ray gallbladder 1.50 70.00 $105.00

74290 26 Contrast x-ray gallbladder 0.46 70.00 $32.20

74300 X-ray bile ducts/pancreas 0.00 70.00 $0.00

74300 TC X-ray bile ducts/pancreas 0.00 70.00 $0.00

74300 26 X-ray bile ducts/pancreas 0.53 70.00 $37.10

74301 X-rays at surgery add-on 0.00 70.00 $0.00

74301 TC X-rays at surgery add-on 0.00 70.00 $0.00

74301 26 X-rays at surgery add-on 0.31 70.00 $21.70

74305 X-ray bile ducts/pancreas 0.00 70.00 $0.00

74305 TC X-ray bile ducts/pancreas 0.00 70.00 $0.00

74305 26 X-ray bile ducts/pancreas 0.60 70.00 $42.00

74320 Contrast x-ray of bile ducts 2.61 70.00 $182.70

74320 TC Contrast x-ray of bile ducts 1.86 70.00 $130.20

74320 26 Contrast x-ray of bile ducts 0.75 70.00 $52.50

74327 X-ray bile stone removal 3.77 70.00 $263.90

74327 TC X-ray bile stone removal 2.79 70.00 $195.30

74327 26 X-ray bile stone removal 0.98 70.00 $68.60

74328 X-ray bile duct endoscopy 0.00 70.00 $0.00

74328 TC X-ray bile duct endoscopy 0.00 70.00 $0.00

74328 26 X-ray bile duct endoscopy 1.04 70.00 $72.80

74329 X-ray for pancreas endoscopy 0.00 70.00 $0.00

74329 TC X-ray for pancreas endoscopy 0.00 70.00 $0.00

74329 26 X-ray for pancreas endoscopy 1.03 70.00 $72.10

74330 X-ray bile/panc endoscopy 0.00 70.00 $0.00

74330 TC X-ray bile/panc endoscopy 0.00 70.00 $0.00

74330 26 X-ray bile/panc endoscopy 1.32 70.00 $92.40

74340 X-ray guide for gi tube 0.00 70.00 $0.00

74340 TC X-ray guide for gi tube 0.00 70.00 $0.00

74340 26 X-ray guide for gi tube 0.78 70.00 $54.60

74355 X-ray guide intestinal tube 0.00 70.00 $0.00

74355 TC X-ray guide intestinal tube 0.00 70.00 $0.00

74355 26 X-ray guide intestinal tube 1.12 70.00 $78.40

74360 X-ray guide gi dilation 0.00 70.00 $0.00

74360 TC X-ray guide gi dilation 0.00 70.00 $0.00

74360 26 X-ray guide gi dilation 0.81 70.00 $56.70

74363 X-ray bile duct dilation 0.00 70.00 $0.00

74363 TC X-ray bile duct dilation 0.00 70.00 $0.00

74363 26 X-ray bile duct dilation 1.26 70.00 $88.20

74400 Contrst x-ray urinary tract 3.06 70.00 $214.20

74400 TC Contrst x-ray urinary tract 2.37 70.00 $165.90

74400 26 Contrst x-ray urinary tract 0.69 70.00 $48.30













74430 Contrast x-ray bladder 1.04 70.00 $72.80

74430 TC Contrast x-ray bladder 0.59 70.00 $41.30

74430 26 Contrast x-ray bladder 0.45 70.00 $31.50

74440 X-ray male genital tract 2.23 70.00 $156.10

74440 TC X-ray male genital tract 1.71 70.00 $119.70

74440 26 X-ray male genital tract 0.52 70.00 $36.40

74445 X-ray exam of penis 0.00 70.00 $0.00

74445 TC X-ray exam of penis 0.00 70.00 $0.00

74445 26 X-ray exam of penis 1.65 70.00 $115.50

74450 X-ray urethra/bladder 0.00 70.00 $0.00

74450 TC X-ray urethra/bladder 0.00 70.00 $0.00

74450 26 X-ray urethra/bladder 0.47 70.00 $32.90

74455 X-ray urethra/bladder 2.28 70.00 $159.60

74455 TC X-ray urethra/bladder 1.82 70.00 $127.40

74455 26 X-ray urethra/bladder 0.46 70.00 $32.20

74470 X-ray exam of kidney lesion 0.00 70.00 $0.00

74470 TC X-ray exam of kidney lesion 0.00 70.00 $0.00

74470 26 X-ray exam of kidney lesion 0.75 70.00 $52.50

74475 X-ray control cath insert 2.59 70.00 $181.30

74475 TC X-ray control cath insert 1.84 70.00 $128.80

74475 26 X-ray control cath insert 0.75 70.00 $52.50

74480 X-ray control cath insert 2.59 70.00 $181.30

74480 TC X-ray control cath insert 1.84 70.00 $128.80

74480 26 X-ray control cath insert 0.75 70.00 $52.50

74485 X-ray guide gu dilation 2.57 70.00 $179.90

74485 TC X-ray guide gu dilation 1.84 70.00 $128.80

74485 26 X-ray guide gu dilation 0.73 70.00 $51.10

74710 X-ray measurement of pelvis 1.12 70.00 $78.40

74710 TC X-ray measurement of pelvis 0.62 70.00 $43.40

74710 26 X-ray measurement of pelvis 0.50 70.00 $35.00

74740 X-ray female genital tract 2.11 70.00 $147.70

74740 TC X-ray female genital tract 1.56 70.00 $109.20

74740 26 X-ray female genital tract 0.55 70.00 $38.50

74742 X-ray fallopian tube 0.00 70.00 $0.00

74742 TC X-ray fallopian tube 0.00 70.00 $0.00

74742 26 X-ray fallopian tube 0.89 70.00 $62.30

74775 X-ray exam of perineum 0.00 70.00 $0.00

74775 TC X-ray exam of perineum 0.00 70.00 $0.00

74775 26 X-ray exam of perineum 0.90 70.00 $63.00

75557 Cardiac mri for morph 8.92 70.00 $624.40

75557 TC Cardiac mri for morph 5.61 70.00 $392.70

75557 26 Cardiac mri for morph 3.31 70.00 $231.70

75559 Cardiac mri w/stress img 12.15 70.00 $850.50

75559 TC Cardiac mri w/stress img 8.09 70.00 $566.30

75559 26 Cardiac mri w/stress img 4.06 70.00 $284.20

75561 Cardiac mri for morph w/dye 11.90 70.00 $833.00

75561 TC Cardiac mri for morph w/dye 8.24 70.00 $576.80

75561 26 Cardiac mri for morph w/dye 3.66 70.00 $256.20

75563 Card mri w/stress img & dye 14.12 70.00 $988.40

75563 TC Card mri w/stress img & dye 9.92 70.00 $694.40

75563 26 Card mri w/stress img & dye 4.20 70.00 $294.00

75565 Card mri veloc flow mapping 1.55 70.00 $108.50

75565 TC Card mri veloc flow mapping 1.20 70.00 $84.00

75565 26 Card mri veloc flow mapping 0.35 70.00 $24.50

75571 Ct hrt w/o dye w/ca test 2.82 70.00 $197.40

75571 TC Ct hrt w/o dye w/ca test 2.00 70.00 $140.00

75571 26 Ct hrt w/o dye w/ca test 0.82 70.00 $57.40

75572 Ct hrt w/3d image 7.98 70.00 $558.60

75572 TC Ct hrt w/3d image 5.51 70.00 $385.70

75572 26 Ct hrt w/3d image 2.47 70.00 $172.90

75573 Ct hrt w/3d image congen 10.91 70.00 $763.70

75573 TC Ct hrt w/3d image congen 7.36 70.00 $515.20

75573 26 Ct hrt w/3d image congen 3.55 70.00 $248.50

75574 Ct angio hrt w/3d image 11.74 70.00 $821.80

75574 TC Ct angio hrt w/3d image 8.38 70.00 $586.60

75574 26 Ct angio hrt w/3d image 3.36 70.00 $235.20

75600 Contrast exam thoracic aorta 5.62 70.00 $393.40

75600 TC Contrast exam thoracic aorta 4.88 70.00 $341.60

75600 26 Contrast exam thoracic aorta 0.74 70.00 $51.80

75605 Contrast exam thoracic aorta 3.92 70.00 $274.40

75605 TC Contrast exam thoracic aorta 2.31 70.00 $161.70

75605 26 Contrast exam thoracic aorta 1.61 70.00 $112.70

75625 Contrast exam abdominl aorta 3.92 70.00 $274.40

75625 TC Contrast exam abdominl aorta 2.30 70.00 $161.00

75625 26 Contrast exam abdominl aorta 1.62 70.00 $113.40

75630 X-ray aorta leg arteries 4.85 70.00 $339.50

75630 TC X-ray aorta leg arteries 2.30 70.00 $161.00

75630 26 X-ray aorta leg arteries 2.55 70.00 $178.50

75635 Ct angio abdominal arteries 10.65 70.00 $745.50

75635 TC Ct angio abdominal arteries 7.25 70.00 $507.50

75635 26 Ct angio abdominal arteries 3.40 70.00 $238.00

75658 Artery x-rays arm 4.70 70.00 $329.00

75658 TC Artery x-rays arm 2.83 70.00 $198.10

75658 26 Artery x-rays arm 1.87 70.00 $130.90

75705 Artery x-rays spine 6.64 70.00 $464.80

75705 TC Artery x-rays spine 3.60 70.00 $252.00

75705 26 Artery x-rays spine 3.04 70.00 $212.80

75710 Artery x-rays arm/leg 4.53 70.00 $317.10

75710 TC Artery x-rays arm/leg 2.99 70.00 $209.30

75710 26 Artery x-rays arm/leg 1.54 70.00 $107.80

75716 Artery x-rays arms/legs 5.25 70.00 $367.50

75716 TC Artery x-rays arms/legs 3.41 70.00 $238.70

75716 26 Artery x-rays arms/legs 1.84 70.00 $128.80

75726 Artery x-rays abdomen 4.23 70.00 $296.10

75726 TC Artery x-rays abdomen 2.62 70.00 $183.40

75726 26 Artery x-rays abdomen 1.61 70.00 $112.70

75731 Artery x-rays adrenal gland 4.80 70.00 $336.00

75731 TC Artery x-rays adrenal gland 3.19 70.00 $223.30

75731 26 Artery x-rays adrenal gland 1.61 70.00 $112.70

75733 Artery x-rays adrenals 5.14 70.00 $359.80

75733 TC Artery x-rays adrenals 3.33 70.00 $233.10

75733 26 Artery x-rays adrenals 1.81 70.00 $126.70

75736 Artery x-rays pelvis 4.59 70.00 $321.30

75736 TC Artery x-rays pelvis 2.93 70.00 $205.10

75736 26 Artery x-rays pelvis 1.66 70.00 $116.20

75741 Artery x-rays lung 4.28 70.00 $299.60

75741 TC Artery x-rays lung 2.46 70.00 $172.20

75741 26 Artery x-rays lung 1.82 70.00 $127.40

75743 Artery x-rays lungs 4.79 70.00 $335.30

75743 TC Artery x-rays lungs 2.49 70.00 $174.30

75743 26 Artery x-rays lungs 2.30 70.00 $161.00

75746 Artery x-rays lung 4.31 70.00 $301.70

75746 TC Artery x-rays lung 2.73 70.00 $191.10

75746 26 Artery x-rays lung 1.58 70.00 $110.60

75756 Artery x-rays chest 4.78 70.00 $334.60

75756 TC Artery x-rays chest 3.11 70.00 $217.70

75756 26 Artery x-rays chest 1.67 70.00 $116.90

75774 Artery x-ray each vessel 2.47 70.00 $172.90

75774 TC Artery x-ray each vessel 1.96 70.00 $137.20

75774 26 Artery x-ray each vessel 0.51 70.00 $35.70

75791 Av dialysis shunt imaging 9.00 70.00 $630.00

75791 TC Av dialysis shunt imaging 6.66 70.00 $466.20

75791 26 Av dialysis shunt imaging 2.34 70.00 $163.80

75801 Lymph vessel x-ray arm/leg 0.00 70.00 $0.00

75801 TC Lymph vessel x-ray arm/leg 0.00 70.00 $0.00

75801 26 Lymph vessel x-ray arm/leg 1.29 70.00 $90.30

75803 Lymph vessel x-ray arms/legs 0.00 70.00 $0.00

75803 TC Lymph vessel x-ray arms/legs 0.00 70.00 $0.00

75803 26 Lymph vessel x-ray arms/legs 1.72 70.00 $120.40

75805 Lymph vessel x-ray trunk 0.00 70.00 $0.00

75805 TC Lymph vessel x-ray trunk 0.00 70.00 $0.00

75805 26 Lymph vessel x-ray trunk 1.18 70.00 $82.60

75807 Lymph vessel x-ray trunk 0.00 70.00 $0.00

75807 TC Lymph vessel x-ray trunk 0.00 70.00 $0.00

75807 26 Lymph vessel x-ray trunk 1.72 70.00 $120.40

75809 Nonvascular shunt x-ray 2.78 70.00 $194.60

75809 TC Nonvascular shunt x-ray 2.11 70.00 $147.70

75809 26 Nonvascular shunt x-ray 0.67 70.00 $46.90

75810 Vein x-ray spleen/liver 0.00 70.00 $0.00

75810 TC Vein x-ray spleen/liver 0.00 70.00 $0.00

75810 26 Vein x-ray spleen/liver 1.68 70.00 $117.60

75820 Vein x-ray arm/leg 3.25 70.00 $227.50

75820 TC Vein x-ray arm/leg 2.25 70.00 $157.50

75820 26 Vein x-ray arm/leg 1.00 70.00 $70.00

75822 Vein x-ray arms/legs 3.87 70.00 $270.90

75822 TC Vein x-ray arms/legs 2.38 70.00 $166.60

75822 26 Vein x-ray arms/legs 1.49 70.00 $104.30

75825 Vein x-ray trunk 3.86 70.00 $270.20

75825 TC Vein x-ray trunk 2.24 70.00 $156.80

75825 26 Vein x-ray trunk 1.62 70.00 $113.40

75827 Vein x-ray chest 3.89 70.00 $272.30

75827 TC Vein x-ray chest 2.30 70.00 $161.00

75827 26 Vein x-ray chest 1.59 70.00 $111.30

75831 Vein x-ray kidney 3.96 70.00 $277.20

75831 TC Vein x-ray kidney 2.41 70.00 $168.70

75831 26 Vein x-ray kidney 1.55 70.00 $108.50

75833 Vein x-ray kidneys 4.75 70.00 $332.50

75833 TC Vein x-ray kidneys 2.56 70.00 $179.20

75833 26 Vein x-ray kidneys 2.19 70.00 $153.30

75840 Vein x-ray adrenal gland 4.19 70.00 $293.30

75840 TC Vein x-ray adrenal gland 2.55 70.00 $178.50

75840 26 Vein x-ray adrenal gland 1.64 70.00 $114.80

75842 Vein x-ray adrenal glands 5.09 70.00 $356.30

75842 TC Vein x-ray adrenal glands 2.94 70.00 $205.80

75842 26 Vein x-ray adrenal glands 2.15 70.00 $150.50

75860 Vein x-ray neck 4.06 70.00 $284.20

75860 TC Vein x-ray neck 2.45 70.00 $171.50

75860 26 Vein x-ray neck 1.61 70.00 $112.70

75870 Vein x-ray skull 4.18 70.00 $292.60

75870 TC Vein x-ray skull 2.54 70.00 $177.80

75870 26 Vein x-ray skull 1.64 70.00 $114.80

75872 Vein x-ray skull epidural 4.20 70.00 $294.00

75872 TC Vein x-ray skull epidural 2.56 70.00 $179.20

75872 26 Vein x-ray skull epidural 1.64 70.00 $114.80

75880 Vein x-ray eye socket 4.10 70.00 $287.00

75880 TC Vein x-ray eye socket 3.08 70.00 $215.60

75880 26 Vein x-ray eye socket 1.02 70.00 $71.40

75885 Vein x-ray liver w/hemodynam 4.45 70.00 $311.50

75885 TC Vein x-ray liver w/hemodynam 2.47 70.00 $172.90

75885 26 Vein x-ray liver w/hemodynam 1.98 70.00 $138.60

75887 Vein x-ray liver w/o hemodyn 4.51 70.00 $315.70

75887 TC Vein x-ray liver w/o hemodyn 2.50 70.00 $175.00

75887 26 Vein x-ray liver w/o hemodyn 2.01 70.00 $140.70

75889 Vein x-ray liver w/hemodynam 4.06 70.00 $284.20

75889 TC Vein x-ray liver w/hemodynam 2.49 70.00 $174.30

75889 26 Vein x-ray liver w/hemodynam 1.57 70.00 $109.90

75891 Vein x-ray liver 4.11 70.00 $287.70

75891 TC Vein x-ray liver 2.51 70.00 $175.70

75891 26 Vein x-ray liver 1.60 70.00 $112.00

75893 Venous sampling by catheter 3.34 70.00 $233.80

75893 TC Venous sampling by catheter 2.57 70.00 $179.90

75893 26 Venous sampling by catheter 0.77 70.00 $53.90

75894 X-rays transcath therapy 0.00 70.00 $0.00

75894 TC X-rays transcath therapy 0.00 70.00 $0.00

75894 26 X-rays transcath therapy 1.90 70.00 $133.00

75896 X-rays transcath therapy 0.00 70.00 $0.00

75896 TC X-rays transcath therapy 0.00 70.00 $0.00

75896 26 X-rays transcath therapy 1.97 70.00 $137.90

75898 Follow-up angiography 0.00 70.00 $0.00

75898 TC Follow-up angiography 0.00 70.00 $0.00

75898 26 Follow-up angiography 2.44 70.00 $170.80

75901 Remove cva device obstruct 4.91 70.00 $343.70

75901 TC Remove cva device obstruct 4.25 70.00 $297.50

75901 26 Remove cva device obstruct 0.66 70.00 $46.20

75902 Remove cva lumen obstruct 2.01 70.00 $140.70

75902 TC Remove cva lumen obstruct 1.47 70.00 $102.90

75902 26 Remove cva lumen obstruct 0.54 70.00 $37.80

75945 Intravascular us 0.00 70.00 $0.00

75945 TC Intravascular us 0.00 70.00 $0.00

75945 26 Intravascular us 0.57 70.00 $39.90

75946 Intravascular us add-on 0.00 70.00 $0.00

75946 TC Intravascular us add-on 0.00 70.00 $0.00

75946 26 Intravascular us add-on 0.57 70.00 $39.90

75952 Endovasc repair abdom aorta 0.00 70.00 $0.00

75952 TC Endovasc repair abdom aorta 0.00 70.00 $0.00

75952 26 Endovasc repair abdom aorta 6.56 70.00 $459.20

75953 Abdom aneurysm endovas rpr 0.00 70.00 $0.00

75953 TC Abdom aneurysm endovas rpr 0.00 70.00 $0.00

75953 26 Abdom aneurysm endovas rpr 1.99 70.00 $139.30

75954 Iliac aneurysm endovas rpr 0.00 70.00 $0.00

75954 TC Iliac aneurysm endovas rpr 0.00 70.00 $0.00

75954 26 Iliac aneurysm endovas rpr 3.32 70.00 $232.40

75956 Xray endovasc thor ao repr 0.00 70.00 $0.00

75956 TC Xray endovasc thor ao repr 0.00 70.00 $0.00

75956 26 Xray endovasc thor ao repr 10.22 70.00 $715.40

75957 Xray endovasc thor ao repr 0.00 70.00 $0.00

75957 TC Xray endovasc thor ao repr 0.00 70.00 $0.00

75957 26 Xray endovasc thor ao repr 8.76 70.00 $613.20

75958 Xray place prox ext thor ao 0.00 70.00 $0.00

75958 TC Xray place prox ext thor ao 0.00 70.00 $0.00

75958 26 Xray place prox ext thor ao 5.83 70.00 $408.10

75959 Xray place dist ext thor ao 0.00 70.00 $0.00

75959 TC Xray place dist ext thor ao 0.00 70.00 $0.00

75959 26 Xray place dist ext thor ao 5.02 70.00 $351.40


75962 TC Repair arterial blockage 3.16 70.00 $221.20

75962 26 Repair arterial blockage 0.73 70.00 $51.10

75964 Repair artery blockage each 2.42 70.00 $169.40

75964 TC Repair artery blockage each 1.93 70.00 $135.10

75964 26 Repair artery blockage each 0.49 70.00 $34.30


75966 TC Repair arterial blockage 3.00 70.00 $210.00

75966 26 Repair arterial blockage 1.82 70.00 $127.40

75968 Repair artery blockage each 2.49 70.00 $174.30

75968 TC Repair artery blockage each 1.99 70.00 $139.30

75968 26 Repair artery blockage each 0.50 70.00 $35.00

75970 Vascular biopsy 0.00 70.00 $0.00

75970 TC Vascular biopsy 0.00 70.00 $0.00

75970 26 Vascular biopsy 1.16 70.00 $81.20

75978 Repair venous blockage 3.85 70.00 $269.50

75978 TC Repair venous blockage 3.12 70.00 $218.40

75978 26 Repair venous blockage 0.73 70.00 $51.10

75980 Contrast xray exam bile duct 0.00 70.00 $0.00

75980 TC Contrast xray exam bile duct 0.00 70.00 $0.00

75980 26 Contrast xray exam bile duct 2.07 70.00 $144.90

75982 Contrast xray exam bile duct 0.00 70.00 $0.00

75982 TC Contrast xray exam bile duct 0.00 70.00 $0.00

75982 26 Contrast xray exam bile duct 2.05 70.00 $143.50

75984 Xray control catheter change 2.99 70.00 $209.30

75984 TC Xray control catheter change 1.99 70.00 $139.30

75984 26 Xray control catheter change 1.00 70.00 $70.00

75989 Abscess drainage under x-ray 3.41 70.00 $238.70

75989 TC Abscess drainage under x-ray 1.73 70.00 $121.10

75989 26 Abscess drainage under x-ray 1.68 70.00 $117.60

76000 Fluoroscope examination 1.32 70.00 $92.40

76000 TC Fluoroscope examination 1.07 70.00 $74.90

76000 26 Fluoroscope examination 0.25 70.00 $17.50

76001 Fluoroscope exam extensive 0.00 70.00 $0.00

76001 TC Fluoroscope exam extensive 0.00 70.00 $0.00

76001 26 Fluoroscope exam extensive 1.04 70.00 $72.80

76010 X-ray nose to rectum 0.73 70.00 $51.10

76010 TC X-ray nose to rectum 0.47 70.00 $32.90

76010 26 X-ray nose to rectum 0.26 70.00 $18.20

76080 X-ray exam of fistula 1.55 70.00 $108.50

76080 TC X-ray exam of fistula 0.80 70.00 $56.00

76080 26 X-ray exam of fistula 0.75 70.00 $52.50

76098 X-ray exam breast specimen 0.46 70.00 $32.20

76098 TC X-ray exam breast specimen 0.23 70.00 $16.10

76098 26 X-ray exam breast specimen 0.23 70.00 $16.10

76100 X-ray exam of body section 2.60 70.00 $182.00

76100 TC X-ray exam of body section 1.69 70.00 $118.30

76100 26 X-ray exam of body section 0.91 70.00 $63.70

76101 Complex body section x-ray 3.72 70.00 $260.40

76101 TC Complex body section x-ray 2.72 70.00 $190.40

76101 26 Complex body section x-ray 1.00 70.00 $70.00

76102 Complex body section x-rays 4.89 70.00 $342.30

76102 TC Complex body section x-rays 3.89 70.00 $272.30

76102 26 Complex body section x-rays 1.00 70.00 $70.00

76120 Cine/video x-rays 2.55 70.00 $178.50

76120 TC Cine/video x-rays 1.98 70.00 $138.60

76120 26 Cine/video x-rays 0.57 70.00 $39.90

76125 Cine/video x-rays add-on 0.00 70.00 $0.00

76125 TC Cine/video x-rays add-on 0.00 70.00 $0.00

76125 26 Cine/video x-rays add-on 0.42 70.00 $29.40

76140 X-ray consultation 0.00 70.00 $0.00

76376 3d render w/intrp postproces 0.64 70.00 $44.80

76376 TC 3d render w/intrp postproces 0.36 70.00 $25.20

76376 26 3d render w/intrp postproces 0.28 70.00 $19.60

76377 3d render w/intrp postproces 1.80 70.00 $126.00

76377 TC 3d render w/intrp postproces 0.68 70.00 $47.60

76377 26 3d render w/intrp postproces 1.12 70.00 $78.40

76380 Cat scan follow-up study 4.11 70.00 $287.70

76380 TC Cat scan follow-up study 2.72 70.00 $190.40

76380 26 Cat scan follow-up study 1.39 70.00 $97.30

76390 Mr spectroscopy 12.49 70.00 $874.30

76390 TC Mr spectroscopy 10.50 70.00 $735.00

76390 26 Mr spectroscopy 1.99 70.00 $139.30

76496 Fluoroscopic procedure 0.00 70.00 $0.00

76496 TC Fluoroscopic procedure 0.00 70.00 $0.00

76496 26 Fluoroscopic procedure 0.00 70.00 $0.00

76497 Ct procedure 0.00 70.00 $0.00

76497 TC Ct procedure 0.00 70.00 $0.00

76497 26 Ct procedure 0.00 70.00 $0.00

76498 Mri procedure 0.00 70.00 $0.00

76498 TC Mri procedure 0.00 70.00 $0.00

76498 26 Mri procedure 0.00 70.00 $0.00

76499 Radiographic procedure 0.00 70.00 $0.00

76499 TC Radiographic procedure 0.00 70.00 $0.00

76499 26 Radiographic procedure 0.00 70.00 $0.00

76506 Echo exam of head 3.35 70.00 $234.50

76506 TC Echo exam of head 2.44 70.00 $170.80

76506 26 Echo exam of head 0.91 70.00 $63.70

76510 Ophth us b & quant a 4.80 70.00 $336.00

76510 TC Ophth us b & quant a 2.29 70.00 $160.30

76510 26 Ophth us b & quant a 2.51 70.00 $175.70

76511 Ophth us quant a only 2.90 70.00 $203.00

76511 TC Ophth us quant a only 1.39 70.00 $97.30

76511 26 Ophth us quant a only 1.51 70.00 $105.70

76512 Ophth us b w/non-quant a 2.62 70.00 $183.40

76512 TC Ophth us b w/non-quant a 1.12 70.00 $78.40

76512 26 Ophth us b w/non-quant a 1.50 70.00 $105.00

76513 Echo exam of eye water bath 2.71 70.00 $189.70

76513 TC Echo exam of eye water bath 1.69 70.00 $118.30

76513 26 Echo exam of eye water bath 1.02 70.00 $71.40

76514 Echo exam of eye thickness 0.43 70.00 $30.10

76514 TC Echo exam of eye thickness 0.15 70.00 $10.50

76514 26 Echo exam of eye thickness 0.28 70.00 $19.60

76516 Echo exam of eye 2.22 70.00 $155.40

76516 TC Echo exam of eye 1.34 70.00 $93.80

76516 26 Echo exam of eye 0.88 70.00 $61.60

76519 Echo exam of eye 2.38 70.00 $166.60


76519 26 Echo exam of eye 0.88 70.00 $61.60

76529 Echo exam of eye 2.25 70.00 $157.50


76529 26 Echo exam of eye 0.92 70.00 $64.40

76536 Us exam of head and neck 3.28 70.00 $229.60

76536 TC Us exam of head and neck 2.49 70.00 $174.30

76536 26 Us exam of head and neck 0.79 70.00 $55.30

76604 Us exam chest 2.49 70.00 $174.30

76604 TC Us exam chest 1.71 70.00 $119.70

76604 26 Us exam chest 0.78 70.00 $54.60

76641 Ultrasound breast complete 3.06 70.00 $214.20

76641 TC Ultrasound breast complete 2.01 70.00 $140.70

76641 26 Ultrasound breast complete 1.05 70.00 $73.50

76642 Ultrasound breast limited 2.52 70.00 $176.40

76642 TC Ultrasound breast limited 1.54 70.00 $107.80

76642 26 Ultrasound breast limited 0.98 70.00 $68.60

76700 Us exam abdom complete 3.47 70.00 $242.90

76700 TC Us exam abdom complete 2.32 70.00 $162.40

76700 26 Us exam abdom complete 1.15 70.00 $80.50

76705 Echo exam of abdomen 2.59 70.00 $181.30

76705 TC Echo exam of abdomen 1.75 70.00 $122.50

76705 26 Echo exam of abdomen 0.84 70.00 $58.80

76770 Us exam abdo back wall comp 3.19 70.00 $223.30

76770 TC Us exam abdo back wall comp 2.15 70.00 $150.50

76770 26 Us exam abdo back wall comp 1.04 70.00 $72.80

76775 Us exam abdo back wall lim 1.62 70.00 $113.40

76775 TC Us exam abdo back wall lim 0.81 70.00 $56.70

76775 26 Us exam abdo back wall lim 0.81 70.00 $56.70

76776 Us exam k transpl w/doppler 4.42 70.00 $309.40

76776 TC Us exam k transpl w/doppler 3.34 70.00 $233.80

76776 26 Us exam k transpl w/doppler 1.08 70.00 $75.60

76800 Us exam spinal canal 3.89 70.00 $272.30

76800 TC Us exam spinal canal 2.28 70.00 $159.60

76800 26 Us exam spinal canal 1.61 70.00 $112.70

76801 Ob us < 14 wks single fetus 3.52 70.00 $246.40

76801 TC Ob us < 14 wks single fetus 2.06 70.00 $144.20

76801 26 Ob us < 14 wks single fetus 1.46 70.00 $102.20

76802 Ob us < 14 wks addl fetus 1.86 70.00 $130.20

76802 TC Ob us < 14 wks addl fetus 0.64 70.00 $44.80

76802 26 Ob us < 14 wks addl fetus 1.22 70.00 $85.40

76805 Ob us >/= 14 wks sngl fetus 4.04 70.00 $282.80

76805 TC Ob us >/= 14 wks sngl fetus 2.58 70.00 $180.60

76805 26 Ob us >/= 14 wks sngl fetus 1.46 70.00 $102.20

76810 Ob us >/= 14 wks addl fetus 2.69 70.00 $188.30

76810 TC Ob us >/= 14 wks addl fetus 1.24 70.00 $86.80

76810 26 Ob us >/= 14 wks addl fetus 1.45 70.00 $101.50

76811 Ob us detailed sngl fetus 5.16 70.00 $361.20

76811 TC Ob us detailed sngl fetus 2.35 70.00 $164.50

76811 26 Ob us detailed sngl fetus 2.81 70.00 $196.70

76812 Ob us detailed addl fetus 5.85 70.00 $409.50

76812 TC Ob us detailed addl fetus 3.20 70.00 $224.00

76812 26 Ob us detailed addl fetus 2.65 70.00 $185.50

76813 Ob us nuchal meas 1 gest 3.45 70.00 $241.50

76813 TC Ob us nuchal meas 1 gest 1.70 70.00 $119.00

76813 26 Ob us nuchal meas 1 gest 1.75 70.00 $122.50

76814 Ob us nuchal meas add-on 2.32 70.00 $162.40

76814 TC Ob us nuchal meas add-on 0.85 70.00 $59.50

76814 26 Ob us nuchal meas add-on 1.47 70.00 $102.90

76815 Ob us limited fetus(s) 2.40 70.00 $168.00

76815 TC Ob us limited fetus(s) 1.45 70.00 $101.50

76815 26 Ob us limited fetus(s) 0.95 70.00 $66.50

76816 Ob us follow-up per fetus 3.26 70.00 $228.20

76816 TC Ob us follow-up per fetus 2.01 70.00 $140.70

76816 26 Ob us follow-up per fetus 1.25 70.00 $87.50

76817 Transvaginal us obstetric 2.76 70.00 $193.20

76817 TC Transvaginal us obstetric 1.66 70.00 $116.20

76817 26 Transvaginal us obstetric 1.10 70.00 $77.00

76818 Fetal biophys profile w/nst 3.45 70.00 $241.50

76818 TC Fetal biophys profile w/nst 1.89 70.00 $132.30

76818 26 Fetal biophys profile w/nst 1.56 70.00 $109.20

76819 Fetal biophys profil w/o nst 2.52 70.00 $176.40

76819 TC Fetal biophys profil w/o nst 1.39 70.00 $97.30

76819 26 Fetal biophys profil w/o nst 1.13 70.00 $79.10

76820 Umbilical artery echo 1.34 70.00 $93.80

76820 TC Umbilical artery echo 0.61 70.00 $42.70

76820 26 Umbilical artery echo 0.73 70.00 $51.10

76821 Middle cerebral artery echo 2.63 70.00 $184.10

76821 TC Middle cerebral artery echo 1.60 70.00 $112.00

76821 26 Middle cerebral artery echo 1.03 70.00 $72.10

76825 Echo exam of fetal heart 7.85 70.00 $549.50

76825 TC Echo exam of fetal heart 5.42 70.00 $379.40

76825 26 Echo exam of fetal heart 2.43 70.00 $170.10










76830 Transvaginal us non-ob 3.46 70.00 $242.20

76830 TC Transvaginal us non-ob 2.46 70.00 $172.20

76830 26 Transvaginal us non-ob 1.00 70.00 $70.00

76831 Echo exam uterus 3.36 70.00 $235.20

76831 TC Echo exam uterus 2.30 70.00 $161.00

76831 26 Echo exam uterus 1.06 70.00 $74.20

76856 Us exam pelvic complete 3.10 70.00 $217.00

76856 TC Us exam pelvic complete 2.13 70.00 $149.10

76856 26 Us exam pelvic complete 0.97 70.00 $67.90

76857 Us exam pelvic limited 1.33 70.00 $93.10

76857 TC Us exam pelvic limited 0.64 70.00 $44.80

76857 26 Us exam pelvic limited 0.69 70.00 $48.30

76870 Us exam scrotum 1.88 70.00 $131.60

76870 TC Us exam scrotum 0.99 70.00 $69.30

76870 26 Us exam scrotum 0.89 70.00 $62.30

76872 Us transrectal 2.64 70.00 $184.80

76872 TC Us transrectal 1.69 70.00 $118.30

76872 26 Us transrectal 0.95 70.00 $66.50

76873 Echograp trans r pros study 4.69 70.00 $328.30

76873 TC Echograp trans r pros study 2.50 70.00 $175.00

76873 26 Echograp trans r pros study 2.19 70.00 $153.30

76881 Us xtr non-vasc complete 3.29 70.00 $230.30

76881 TC Us xtr non-vasc complete 2.39 70.00 $167.30

76881 26 Us xtr non-vasc complete 0.90 70.00 $63.00

76882 Us xtr non-vasc lmtd 1.02 70.00 $71.40

76882 TC Us xtr non-vasc lmtd 0.32 70.00 $22.40

76882 26 Us xtr non-vasc lmtd 0.70 70.00 $49.00

76885 Us exam infant hips dynamic 4.08 70.00 $285.60

76885 TC Us exam infant hips dynamic 3.05 70.00 $213.50

76885 26 Us exam infant hips dynamic 1.03 70.00 $72.10

76886 Us exam infant hips static 3.01 70.00 $210.70

76886 TC Us exam infant hips static 2.12 70.00 $148.40

76886 26 Us exam infant hips static 0.89 70.00 $62.30

76930 Echo guide cardiocentesis 0.00 70.00 $0.00

76930 TC Echo guide cardiocentesis 0.00 70.00 $0.00

76930 26 Echo guide cardiocentesis 0.95 70.00 $66.50

76932 Echo guide for heart biopsy 0.00 70.00 $0.00

76932 TC Echo guide for heart biopsy 0.00 70.00 $0.00

76932 26 Echo guide for heart biopsy 0.94 70.00 $65.80

76936 Echo guide for artery repair 7.74 70.00 $541.80

76936 TC Echo guide for artery repair 4.87 70.00 $340.90

76936 26 Echo guide for artery repair 2.87 70.00 $200.90

76937 Us guide vascular access 0.91 70.00 $63.70

76937 TC Us guide vascular access 0.49 70.00 $34.30

76937 26 Us guide vascular access 0.42 70.00 $29.40

76940 Us guide tissue ablation 0.00 70.00 $0.00

76940 TC Us guide tissue ablation 0.00 70.00 $0.00

76940 26 Us guide tissue ablation 3.01 70.00 $210.70

76941 Echo guide for transfusion 0.00 70.00 $0.00

76941 TC Echo guide for transfusion 0.00 70.00 $0.00

76941 26 Echo guide for transfusion 1.96 70.00 $137.20

76942 Echo guide for biopsy 1.70 70.00 $119.00

76942 TC Echo guide for biopsy 0.76 70.00 $53.20

76942 26 Echo guide for biopsy 0.94 70.00 $65.80

76945 Echo guide villus sampling 0.00 70.00 $0.00

76945 TC Echo guide villus sampling 0.00 70.00 $0.00

76945 26 Echo guide villus sampling 1.00 70.00 $70.00

76946 Echo guide for amniocentesis 0.93 70.00 $65.10

76946 TC Echo guide for amniocentesis 0.37 70.00 $25.90

76946 26 Echo guide for amniocentesis 0.56 70.00 $39.20

76948 Echo guide ova aspiration 0.93 70.00 $65.10

76948 TC Echo guide ova aspiration 0.37 70.00 $25.90

76948 26 Echo guide ova aspiration 0.56 70.00 $39.20

76965 Echo guidance radiotherapy 2.54 70.00 $177.80

76965 TC Echo guidance radiotherapy 0.66 70.00 $46.20

76965 26 Echo guidance radiotherapy 1.88 70.00 $131.60

76970 Ultrasound exam follow-up 2.63 70.00 $184.10

76970 TC Ultrasound exam follow-up 2.05 70.00 $143.50

76970 26 Ultrasound exam follow-up 0.58 70.00 $40.60

76975 Gi endoscopic ultrasound 0.00 70.00 $0.00

76975 TC Gi endoscopic ultrasound 0.00 70.00 $0.00

76975 26 Gi endoscopic ultrasound 1.25 70.00 $87.50

76977 Us bone density measure 0.20 70.00 $14.00

76977 TC Us bone density measure 0.12 70.00 $8.40

76977 26 Us bone density measure 0.08 70.00 $5.60

76998 Us guide intraop 0.00 70.00 $0.00

76998 TC Us guide intraop 0.00 70.00 $0.00

76998 26 Us guide intraop 1.85 70.00 $129.50

76999 Echo examination procedure 0.00 70.00 $0.00

76999 TC Echo examination procedure 0.00 70.00 $0.00

76999 26 Echo examination procedure 0.00 70.00 $0.00

77001 Fluoroguide for vein device 1.97 70.00 $137.90

77001 TC Fluoroguide for vein device 1.44 70.00 $100.80

77001 26 Fluoroguide for vein device 0.53 70.00 $37.10

77002 Needle localization by xray 2.59 70.00 $181.30

77002 TC Needle localization by xray 1.80 70.00 $126.00

77002 26 Needle localization by xray 0.79 70.00 $55.30

77003 Fluoroguide for spine inject 2.40 70.00 $168.00

77003 TC Fluoroguide for spine inject 1.54 70.00 $107.80

77003 26 Fluoroguide for spine inject 0.86 70.00 $60.20

77011 Ct scan for localization 6.17 70.00 $431.90

77011 TC Ct scan for localization 4.42 70.00 $309.40

77011 26 Ct scan for localization 1.75 70.00 $122.50

77012 Ct scan for needle biopsy 3.50 70.00 $245.00

77012 TC Ct scan for needle biopsy 1.87 70.00 $130.90

77012 26 Ct scan for needle biopsy 1.63 70.00 $114.10

77013 Ct guide for tissue ablation 0.00 70.00 $0.00

77013 TC Ct guide for tissue ablation 0.00 70.00 $0.00

77013 26 Ct guide for tissue ablation 5.72 70.00 $400.40

77014 Ct scan for therapy guide 3.28 70.00 $229.60

77014 TC Ct scan for therapy guide 2.05 70.00 $143.50

77014 26 Ct scan for therapy guide 1.23 70.00 $86.10

77021 Mr guidance for needle place 11.55 70.00 $808.50

77021 TC Mr guidance for needle place 9.40 70.00 $658.00

77021 26 Mr guidance for needle place 2.15 70.00 $150.50

77022 Mri for tissue ablation 0.00 70.00 $0.00

77022 TC Mri for tissue ablation 0.00 70.00 $0.00

77022 26 Mri for tissue ablation 6.23 70.00 $436.10

77051 Computer dx mammogram add-on 0.25 70.00 $17.50

77051 TC Computer dx mammogram add-on 0.16 70.00 $11.20

77051 26 Computer dx mammogram add-on 0.09 70.00 $6.30

77052 Comp screen mammogram add-on 0.25 70.00 $17.50

77052 TC Comp screen mammogram add-on 0.16 70.00 $11.20

77052 26 Comp screen mammogram add-on 0.09 70.00 $6.30

77053 X-ray of mammary duct 1.63 70.00 $114.10

77053 TC X-ray of mammary duct 1.12 70.00 $78.40

77053 26 X-ray of mammary duct 0.51 70.00 $35.70

77054 X-ray of mammary ducts 2.14 70.00 $149.80

77054 TC X-ray of mammary ducts 1.49 70.00 $104.30

77054 26 X-ray of mammary ducts 0.65 70.00 $45.50

77055 Mammogram one breast 2.52 70.00 $176.40

77055 TC Mammogram one breast 1.52 70.00 $106.40

77055 26 Mammogram one breast 1.00 70.00 $70.00

77056 Mammogram both breasts 3.24 70.00 $226.80

77056 TC Mammogram both breasts 2.00 70.00 $140.00

77056 26 Mammogram both breasts 1.24 70.00 $86.80

77057 Mammogram screening 2.31 70.00 $161.70

77057 TC Mammogram screening 1.31 70.00 $91.70

77057 26 Mammogram screening 1.00 70.00 $70.00

77058 Mri one breast 15.18 70.00 $1,062.60

77058 TC Mri one breast 12.85 70.00 $899.50

77058 26 Mri one breast 2.33 70.00 $163.10

77059 Mri both breasts 15.02 70.00 $1,051.40

77059 TC Mri both breasts 12.69 70.00 $888.30

77059 26 Mri both breasts 2.33 70.00 $163.10

77061 Breast tomosynthesis uni 0.00 70.00 $0.00

77061 TC Breast tomosynthesis uni 0.00 70.00 $0.00

77061 26 Breast tomosynthesis uni 0.00 70.00 $0.00

77062 Breast tomosynthesis bi 0.00 70.00 $0.00

77062 TC Breast tomosynthesis bi 0.00 70.00 $0.00

77062 26 Breast tomosynthesis bi 0.00 70.00 $0.00

77063 Breast tomosynthesis bi 1.57 70.00 $109.90

77063 TC Breast tomosynthesis bi 0.72 70.00 $50.40

77063 26 Breast tomosynthesis bi 0.85 70.00 $59.50

77071 X-ray stress view 1.36 70.00 $95.20

77072 X-rays for bone age 0.65 70.00 $45.50

77072 TC X-rays for bone age 0.38 70.00 $26.60

77072 26 X-rays for bone age 0.27 70.00 $18.90

77073 X-rays bone length studies 1.02 70.00 $71.40

77073 TC X-rays bone length studies 0.60 70.00 $42.00

77073 26 X-rays bone length studies 0.42 70.00 $29.40

77074 X-rays bone survey limited 1.79 70.00 $125.30

77074 TC X-rays bone survey limited 1.15 70.00 $80.50

77074 26 X-rays bone survey limited 0.64 70.00 $44.80

77075 X-rays bone survey complete 2.44 70.00 $170.80

77075 TC X-rays bone survey complete 1.67 70.00 $116.90

77075 26 X-rays bone survey complete 0.77 70.00 $53.90

77076 X-rays bone survey infant 2.67 70.00 $186.90

77076 TC X-rays bone survey infant 1.67 70.00 $116.90

77076 26 X-rays bone survey infant 1.00 70.00 $70.00

77077 Joint survey single view 1.06 70.00 $74.20

77077 TC Joint survey single view 0.58 70.00 $40.60

77077 26 Joint survey single view 0.48 70.00 $33.60

77078 Ct bone density axial 3.19 70.00 $223.30

77078 TC Ct bone density axial 2.84 70.00 $198.80

77078 26 Ct bone density axial 0.35 70.00 $24.50

77080 Dxa bone density axial 1.16 70.00 $81.20

77080 TC Dxa bone density axial 0.87 70.00 $60.90

77080 26 Dxa bone density axial 0.29 70.00 $20.30

77081 Dxa bone density/peripheral 0.79 70.00 $55.30

77081 TC Dxa bone density/peripheral 0.48 70.00 $33.60

77081 26 Dxa bone density/peripheral 0.31 70.00 $21.70

77084 Magnetic image bone marrow 10.97 70.00 $767.90

77084 TC Magnetic image bone marrow 8.66 70.00 $606.20

77084 26 Magnetic image bone marrow 2.31 70.00 $161.70

77085 Dxa bone density study 1.58 70.00 $110.60

77085 TC Dxa bone density study 1.15 70.00 $80.50

77085 26 Dxa bone density study 0.43 70.00 $30.10

77086 Fracture assessment via dxa 1.00 70.00 $70.00

77086 TC Fracture assessment via dxa 0.75 70.00 $52.50

77086 26 Fracture assessment via dxa 0.25 70.00 $17.50

77261 Radiation therapy planning 2.13 70.00 $149.10



77280 Set radiation therapy field 7.59 70.00 $531.30

77280 TC Set radiation therapy field 6.58 70.00 $460.60

77280 26 Set radiation therapy field 1.01 70.00 $70.70

77285 Set radiation therapy field 11.96 70.00 $837.20



77290 Set radiation therapy field 14.29 70.00 $1,000.30



77293 Respirator motion mgmt simul 12.99 70.00 $909.30

77293 TC Respirator motion mgmt simul 10.09 70.00 $706.30

77293 26 Respirator motion mgmt simul 2.90 70.00 $203.00

77295 3-d radiotherapy plan 13.68 70.00 $957.60

77295 TC 3-d radiotherapy plan 7.46 70.00 $522.20

77295 26 3-d radiotherapy plan 6.22 70.00 $435.40


77299 TC Radiation therapy planning 0.00 70.00 $0.00

77299 26 Radiation therapy planning 0.00 70.00 $0.00

77300 Radiation therapy dose plan 1.77 70.00 $123.90

77300 TC Radiation therapy dose plan 0.87 70.00 $60.90

77300 26 Radiation therapy dose plan 0.90 70.00 $63.00

77301 Radiotherapy dose plan imrt 54.29 70.00 $3,800.30

77301 TC Radiotherapy dose plan imrt 42.72 70.00 $2,990.40

77301 26 Radiotherapy dose plan imrt 11.57 70.00 $809.90

77306 Telethx isodose plan simple 4.07 70.00 $284.90

77306 TC Telethx isodose plan simple 2.05 70.00 $143.50

77306 26 Telethx isodose plan simple 2.02 70.00 $141.40

77307 Telethx isodose plan cplx 7.97 70.00 $557.90

77307 TC Telethx isodose plan cplx 3.76 70.00 $263.20

77307 26 Telethx isodose plan cplx 4.21 70.00 $294.70

77316 Brachytx isodose plan simple 5.22 70.00 $365.40

77316 TC Brachytx isodose plan simple 3.20 70.00 $224.00

77316 26 Brachytx isodose plan simple 2.02 70.00 $141.40

77317 Brachytx isodose intermed 6.83 70.00 $478.10

77317 TC Brachytx isodose intermed 4.17 70.00 $291.90

77317 26 Brachytx isodose intermed 2.66 70.00 $186.20

77318 Brachytx isodose complex 9.87 70.00 $690.90

77318 TC Brachytx isodose complex 5.66 70.00 $396.20

77318 26 Brachytx isodose complex 4.21 70.00 $294.70

77321 Special teletx port plan 2.58 70.00 $180.60

77321 TC Special teletx port plan 1.21 70.00 $84.70

77321 26 Special teletx port plan 1.37 70.00 $95.90

77331 Special radiation dosimetry 1.79 70.00 $125.30

77331 TC Special radiation dosimetry 0.53 70.00 $37.10

77331 26 Special radiation dosimetry 1.26 70.00 $88.20

77332 Radiation treatment aid(s) 2.31 70.00 $161.70

77332 TC Radiation treatment aid(s) 1.52 70.00 $106.40

77332 26 Radiation treatment aid(s) 0.79 70.00 $55.30







77336 Radiation physics consult 2.15 70.00 $150.50

77338 Design mlc device for imrt 14.15 70.00 $990.50

77338 TC Design mlc device for imrt 7.93 70.00 $555.10

77338 26 Design mlc device for imrt 6.22 70.00 $435.40

77370 Radiation physics consult 3.27 70.00 $228.90

77371 Srs multisource 0.00 70.00 $0.00

77372 Srs linear based 29.73 70.00 $2,081.10

77373 Sbrt delivery 37.75 70.00 $2,642.50

77385 Ntsty modul rad tx dlvr smpl 0.00 70.00 $0.00

77386 Ntsty modul rad tx dlvr cplx 0.00 70.00 $0.00

77387 Guidance for radiaj tx dlvr 0.00 70.00 $0.00

77399 External radiation dosimetry 0.00 70.00 $0.00

77399 TC External radiation dosimetry 0.00 70.00 $0.00

77399 26 External radiation dosimetry 0.00 70.00 $0.00

77401 Radiation treatment delivery 0.58 70.00 $40.60




77417 Radiology port film(s) 0.30 70.00 $21.00

77422 Neutron beam tx simple 0.94 70.00 $65.80

77423 Neutron beam tx complex 1.83 70.00 $128.10

77424 Io rad tx delivery by x-ray 0.00 70.00 $0.00

77425 Io rad tx deliver by elctrns 0.00 70.00 $0.00

77427 Radiation tx management x5 5.22 70.00 $365.40

77431 Radiation therapy management 2.86 70.00 $200.20

77432 Stereotactic radiation trmt 11.71 70.00 $819.70

77435 Sbrt management 17.67 70.00 $1,236.90

77469 Io radiation tx management 9.01 70.00 $630.70

77470 Special radiation treatment 4.36 70.00 $305.20

77470 TC Special radiation treatment 1.33 70.00 $93.10

77470 26 Special radiation treatment 3.03 70.00 $212.10

77499 Radiation therapy management 0.00 70.00 $0.00

77499 TC Radiation therapy management 0.00 70.00 $0.00

77499 26 Radiation therapy management 0.00 70.00 $0.00

77520 Proton trmt simple w/o comp 0.00 70.00 $0.00

77522 Proton trmt simple w/comp 0.00 70.00 $0.00

77523 Proton trmt intermediate 0.00 70.00 $0.00

77525 Proton treatment complex 0.00 70.00 $0.00

77600 Hyperthermia treatment 11.30 70.00 $791.00

77600 TC Hyperthermia treatment 9.04 70.00 $632.80

77600 26 Hyperthermia treatment 2.26 70.00 $158.20

77605 Hyperthermia treatment 21.39 70.00 $1,497.30

77605 TC Hyperthermia treatment 18.38 70.00 $1,286.60








77620 Hyperthermia treatment 13.04 70.00 $912.80

77620 TC Hyperthermia treatment 10.57 70.00 $739.90


77750 Infuse radioactive materials 10.39 70.00 $727.30

77750 TC Infuse radioactive materials 3.14 70.00 $219.80

77750 26 Infuse radioactive materials 7.25 70.00 $507.50

77761 Apply intrcav radiat simple 10.87 70.00 $760.90

77761 TC Apply intrcav radiat simple 5.35 70.00 $374.50

77761 26 Apply intrcav radiat simple 5.52 70.00 $386.40

77762 Apply intrcav radiat interm 15.36 70.00 $1,075.20

77762 TC Apply intrcav radiat interm 6.16 70.00 $431.20

77762 26 Apply intrcav radiat interm 9.20 70.00 $644.00

77763 Apply intrcav radiat compl 20.49 70.00 $1,434.30

77763 TC Apply intrcav radiat compl 7.96 70.00 $557.20

77763 26 Apply intrcav radiat compl 12.53 70.00 $877.10

77776 Apply interstit radiat simpl 13.13 70.00 $919.10

77776 TC Apply interstit radiat simpl 6.43 70.00 $450.10

77776 26 Apply interstit radiat simpl 6.70 70.00 $469.00

77777 Apply interstit radiat inter 16.44 70.00 $1,150.80

77777 TC Apply interstit radiat inter 5.49 70.00 $384.30

77777 26 Apply interstit radiat inter 10.95 70.00 $766.50

77778 Apply interstit radiat compl 24.43 70.00 $1,710.10

77778 TC Apply interstit radiat compl 8.09 70.00 $566.30

77778 26 Apply interstit radiat compl 16.34 70.00 $1,143.80

77785 Hdr brachytx 1 channel 6.70 70.00 $469.00

77785 TC Hdr brachytx 1 channel 4.65 70.00 $325.50

77785 26 Hdr brachytx 1 channel 2.05 70.00 $143.50

77786 Hdr brachytx 2-12 channel 13.73 70.00 $961.10

77786 TC Hdr brachytx 2-12 channel 9.01 70.00 $630.70

77786 26 Hdr brachytx 2-12 channel 4.72 70.00 $330.40

77787 Hdr brachytx over 12 chan 21.89 70.00 $1,532.30

77787 TC Hdr brachytx over 12 chan 14.80 70.00 $1,036.00

77787 26 Hdr brachytx over 12 chan 7.09 70.00 $496.30

77789 Apply surface radiation 3.33 70.00 $233.10

77789 TC Apply surface radiation 1.68 70.00 $117.60

77789 26 Apply surface radiation 1.65 70.00 $115.50

77790 Radiation handling 2.71 70.00 $189.70

77790 TC Radiation handling 1.21 70.00 $84.70

77790 26 Radiation handling 1.50 70.00 $105.00

77799 Radium/radioisotope therapy 0.00 70.00 $0.00

77799 TC Radium/radioisotope therapy 0.00 70.00 $0.00

77799 26 Radium/radioisotope therapy 0.00 70.00 $0.00

78012 Thyroid uptake measurement 2.31 70.00 $161.70

78012 TC Thyroid uptake measurement 2.04 70.00 $142.80

78012 26 Thyroid uptake measurement 0.27 70.00 $18.90

78013 Thyroid imaging w/blood flow 5.51 70.00 $385.70

78013 TC Thyroid imaging w/blood flow 5.00 70.00 $350.00

78013 26 Thyroid imaging w/blood flow 0.51 70.00 $35.70

78014 Thyroid imaging w/blood flow 6.99 70.00 $489.30

78014 TC Thyroid imaging w/blood flow 6.30 70.00 $441.00

78014 26 Thyroid imaging w/blood flow 0.69 70.00 $48.30

78015 Thyroid met imaging 6.39 70.00 $447.30

78015 TC Thyroid met imaging 5.47 70.00 $382.90

78015 26 Thyroid met imaging 0.92 70.00 $64.40

78016 Thyroid met imaging/studies 8.21 70.00 $574.70

78016 TC Thyroid met imaging/studies 7.23 70.00 $506.10

78016 26 Thyroid met imaging/studies 0.98 70.00 $68.60

78018 Thyroid met imaging body 9.04 70.00 $632.80

78018 TC Thyroid met imaging body 7.87 70.00 $550.90

78018 26 Thyroid met imaging body 1.17 70.00 $81.90

78020 Thyroid met uptake 2.42 70.00 $169.40

78020 TC Thyroid met uptake 1.63 70.00 $114.10

78020 26 Thyroid met uptake 0.79 70.00 $55.30

78070 Parathyroid planar imaging 8.72 70.00 $610.40

78070 TC Parathyroid planar imaging 7.60 70.00 $532.00

78070 26 Parathyroid planar imaging 1.12 70.00 $78.40

78071 Parathyrd planar w/wo subtrj 10.39 70.00 $727.30

78071 TC Parathyrd planar w/wo subtrj 8.72 70.00 $610.40

78071 26 Parathyrd planar w/wo subtrj 1.67 70.00 $116.90

78072 Parathyrd planar w/spect&ct 11.89 70.00 $832.30

78072 TC Parathyrd planar w/spect&ct 9.72 70.00 $680.40

78072 26 Parathyrd planar w/spect&ct 2.17 70.00 $151.90

78075 Adrenal cortex & medulla img 13.13 70.00 $919.10

78075 TC Adrenal cortex & medulla img 12.07 70.00 $844.90

78075 26 Adrenal cortex & medulla img 1.06 70.00 $74.20

78099 Endocrine nuclear procedure 0.00 70.00 $0.00

78099 TC Endocrine nuclear procedure 0.00 70.00 $0.00

78099 26 Endocrine nuclear procedure 0.00 70.00 $0.00

78102 Bone marrow imaging ltd 4.92 70.00 $344.40

78102 TC Bone marrow imaging ltd 4.16 70.00 $291.20

78102 26 Bone marrow imaging ltd 0.76 70.00 $53.20

78103 Bone marrow imaging mult 6.40 70.00 $448.00

78103 TC Bone marrow imaging mult 5.40 70.00 $378.00

78103 26 Bone marrow imaging mult 1.00 70.00 $70.00

78104 Bone marrow imaging body 7.10 70.00 $497.00

78104 TC Bone marrow imaging body 6.03 70.00 $422.10

78104 26 Bone marrow imaging body 1.07 70.00 $74.90

78110 Plasma volume single 2.98 70.00 $208.60

78110 TC Plasma volume single 2.70 70.00 $189.00

78110 26 Plasma volume single 0.28 70.00 $19.60

78111 Plasma volume multiple 2.79 70.00 $195.30

78111 TC Plasma volume multiple 2.48 70.00 $173.60

78111 26 Plasma volume multiple 0.31 70.00 $21.70

78120 Red cell mass single 2.72 70.00 $190.40

78120 TC Red cell mass single 2.39 70.00 $167.30

78120 26 Red cell mass single 0.33 70.00 $23.10

78121 Red cell mass multiple 3.05 70.00 $213.50

78121 TC Red cell mass multiple 2.60 70.00 $182.00

78121 26 Red cell mass multiple 0.45 70.00 $31.50

78122 Blood volume 2.78 70.00 $194.60

78122 TC Blood volume 2.19 70.00 $153.30

78122 26 Blood volume 0.59 70.00 $41.30

78130 Red cell survival study 4.56 70.00 $319.20

78130 TC Red cell survival study 3.74 70.00 $261.80

78130 26 Red cell survival study 0.82 70.00 $57.40

78135 Red cell survival kinetics 10.18 70.00 $712.60

78135 TC Red cell survival kinetics 9.26 70.00 $648.20

78135 26 Red cell survival kinetics 0.92 70.00 $64.40

78140 Red cell sequestration 3.93 70.00 $275.10

78140 TC Red cell sequestration 3.08 70.00 $215.60

78140 26 Red cell sequestration 0.85 70.00 $59.50

78185 Spleen imaging 6.15 70.00 $430.50

78185 TC Spleen imaging 5.58 70.00 $390.60

78185 26 Spleen imaging 0.57 70.00 $39.90

78190 Platelet survival kinetics 11.40 70.00 $798.00

78190 TC Platelet survival kinetics 9.85 70.00 $689.50

78190 26 Platelet survival kinetics 1.55 70.00 $108.50

78191 Platelet survival 4.83 70.00 $338.10

78191 TC Platelet survival 3.95 70.00 $276.50

78191 26 Platelet survival 0.88 70.00 $61.60

78195 Lymph system imaging 10.33 70.00 $723.10

78195 TC Lymph system imaging 8.66 70.00 $606.20

78195 26 Lymph system imaging 1.67 70.00 $116.90

78199 Blood/lymph nuclear exam 0.00 70.00 $0.00

78199 TC Blood/lymph nuclear exam 0.00 70.00 $0.00

78199 26 Blood/lymph nuclear exam 0.00 70.00 $0.00

78201 Liver imaging 5.46 70.00 $382.20

78201 TC Liver imaging 4.85 70.00 $339.50

78201 26 Liver imaging 0.61 70.00 $42.70

78202 Liver imaging with flow 5.82 70.00 $407.40

78202 TC Liver imaging with flow 5.15 70.00 $360.50

78202 26 Liver imaging with flow 0.67 70.00 $46.90

78205 Liver imaging (3d) 6.10 70.00 $427.00

78205 TC Liver imaging (3d) 5.14 70.00 $359.80

78205 26 Liver imaging (3d) 0.96 70.00 $67.20

78206 Liver image (3d) with flow 9.97 70.00 $697.90

78206 TC Liver image (3d) with flow 8.63 70.00 $604.10

78206 26 Liver image (3d) with flow 1.34 70.00 $93.80

78215 Liver and spleen imaging 5.63 70.00 $394.10

78215 TC Liver and spleen imaging 4.95 70.00 $346.50

78215 26 Liver and spleen imaging 0.68 70.00 $47.60

78216 Liver & spleen image/flow 3.64 70.00 $254.80

78216 TC Liver & spleen image/flow 2.85 70.00 $199.50

78216 26 Liver & spleen image/flow 0.79 70.00 $55.30

78226 Hepatobiliary system imaging 9.62 70.00 $673.40

78226 TC Hepatobiliary system imaging 8.58 70.00 $600.60

78226 26 Hepatobiliary system imaging 1.04 70.00 $72.80

78227 Hepatobil syst image w/drug 13.04 70.00 $912.80

78227 TC Hepatobil syst image w/drug 11.78 70.00 $824.60

78227 26 Hepatobil syst image w/drug 1.26 70.00 $88.20

78230 Salivary gland imaging 5.01 70.00 $350.70

78230 TC Salivary gland imaging 4.38 70.00 $306.60

78230 26 Salivary gland imaging 0.63 70.00 $44.10

78231 Serial salivary imaging 3.75 70.00 $262.50

78231 TC Serial salivary imaging 3.02 70.00 $211.40

78231 26 Serial salivary imaging 0.73 70.00 $51.10

78232 Salivary gland function exam 2.86 70.00 $200.20

78232 TC Salivary gland function exam 2.28 70.00 $159.60

78232 26 Salivary gland function exam 0.58 70.00 $40.60

78258 Esophageal motility study 6.38 70.00 $446.60

78258 TC Esophageal motility study 5.36 70.00 $375.20

78258 26 Esophageal motility study 1.02 70.00 $71.40

78261 Gastric mucosa imaging 7.34 70.00 $513.80

78261 TC Gastric mucosa imaging 6.35 70.00 $444.50

78261 26 Gastric mucosa imaging 0.99 70.00 $69.30

78262 Gastroesophageal reflux exam 7.07 70.00 $494.90

78262 TC Gastroesophageal reflux exam 6.13 70.00 $429.10

78262 26 Gastroesophageal reflux exam 0.94 70.00 $65.80

78264 Gastric emptying study 8.40 70.00 $588.00

78264 TC Gastric emptying study 7.28 70.00 $509.60

78264 26 Gastric emptying study 1.12 70.00 $78.40

78267 Breath tst attain/anal c-14 0.00 70.00 $0.00

78268 Breath test analysis c-14 0.00 70.00 $0.00

78270 Vit b-12 absorption exam 2.94 70.00 $205.80

78270 TC Vit b-12 absorption exam 2.64 70.00 $184.80

78270 26 Vit b-12 absorption exam 0.30 70.00 $21.00

78271 Vit b-12 absrp exam int fac 2.62 70.00 $183.40

78271 TC Vit b-12 absrp exam int fac 2.33 70.00 $163.10

78271 26 Vit b-12 absrp exam int fac 0.29 70.00 $20.30

78272 Vit b-12 absorp combined 2.81 70.00 $196.70

78272 TC Vit b-12 absorp combined 2.43 70.00 $170.10

78272 26 Vit b-12 absorp combined 0.38 70.00 $26.60

78278 Acute gi blood loss imaging 10.14 70.00 $709.80

78278 TC Acute gi blood loss imaging 8.74 70.00 $611.80

78278 26 Acute gi blood loss imaging 1.40 70.00 $98.00

78282 Gi protein loss exam 0.00 70.00 $0.00

78282 TC Gi protein loss exam 0.00 70.00 $0.00

78282 26 Gi protein loss exam 0.55 70.00 $38.50

78290 Meckels divert exam 9.66 70.00 $676.20

78290 TC Meckels divert exam 8.70 70.00 $609.00

78290 26 Meckels divert exam 0.96 70.00 $67.20

78291 Leveen/shunt patency exam 7.22 70.00 $505.40

78291 TC Leveen/shunt patency exam 6.02 70.00 $421.40

78291 26 Leveen/shunt patency exam 1.20 70.00 $84.00

78299 Gi nuclear procedure 0.00 70.00 $0.00

78299 TC Gi nuclear procedure 0.00 70.00 $0.00

78299 26 Gi nuclear procedure 0.00 70.00 $0.00

78300 Bone imaging limited area 5.23 70.00 $366.10

78300 TC Bone imaging limited area 4.34 70.00 $303.80

78300 26 Bone imaging limited area 0.89 70.00 $62.30

78305 Bone imaging multiple areas 6.69 70.00 $468.30

78305 TC Bone imaging multiple areas 5.53 70.00 $387.10

78305 26 Bone imaging multiple areas 1.16 70.00 $81.20

78306 Bone imaging whole body 7.31 70.00 $511.70

78306 TC Bone imaging whole body 6.11 70.00 $427.70

78306 26 Bone imaging whole body 1.20 70.00 $84.00

78315 Bone imaging 3 phase 10.08 70.00 $705.60

78315 TC Bone imaging 3 phase 8.65 70.00 $605.50

78315 26 Bone imaging 3 phase 1.43 70.00 $100.10

78320 Bone imaging (3d) 6.61 70.00 $462.70

78320 TC Bone imaging (3d) 5.18 70.00 $362.60

78320 26 Bone imaging (3d) 1.43 70.00 $100.10

78350 Bone mineral single photon 0.93 70.00 $65.10

78350 TC Bone mineral single photon 0.62 70.00 $43.40

78350 26 Bone mineral single photon 0.31 70.00 $21.70

78351 Bone mineral dual photon 0.43 70.00 $30.10

78399 Musculoskeletal nuclear exam 0.00 70.00 $0.00

78399 TC Musculoskeletal nuclear exam 0.00 70.00 $0.00

78399 26 Musculoskeletal nuclear exam 0.00 70.00 $0.00

78414 Non-imaging heart function 0.00 70.00 $0.00

78414 TC Non-imaging heart function 0.00 70.00 $0.00

78414 26 Non-imaging heart function 0.64 70.00 $44.80

78428 Cardiac shunt imaging 5.24 70.00 $366.80

78428 TC Cardiac shunt imaging 4.17 70.00 $291.90

78428 26 Cardiac shunt imaging 1.07 70.00 $74.90

78445 Vascular flow imaging 5.21 70.00 $364.70

78445 TC Vascular flow imaging 4.54 70.00 $317.80

78445 26 Vascular flow imaging 0.67 70.00 $46.90

78451 Ht muscle image spect sing 9.90 70.00 $693.00

78451 TC Ht muscle image spect sing 8.00 70.00 $560.00

78451 26 Ht muscle image spect sing 1.90 70.00 $133.00

78452 Ht muscle image spect mult 13.71 70.00 $959.70

78452 TC Ht muscle image spect mult 11.47 70.00 $802.90

78452 26 Ht muscle image spect mult 2.24 70.00 $156.80

78453 Ht muscle image planar sing 8.83 70.00 $618.10

78453 TC Ht muscle image planar sing 7.44 70.00 $520.80

78453 26 Ht muscle image planar sing 1.39 70.00 $97.30

78454 Ht musc image planar mult 12.64 70.00 $884.80

78454 TC Ht musc image planar mult 10.76 70.00 $753.20

78454 26 Ht musc image planar mult 1.88 70.00 $131.60

78456 Acute venous thrombus image 9.30 70.00 $651.00

78456 TC Acute venous thrombus image 7.92 70.00 $554.40

78456 26 Acute venous thrombus image 1.38 70.00 $96.60

78457 Venous thrombosis imaging 5.08 70.00 $355.60

78457 TC Venous thrombosis imaging 4.02 70.00 $281.40

78457 26 Venous thrombosis imaging 1.06 70.00 $74.20

78458 Ven thrombosis images bilat 5.95 70.00 $416.50

78458 TC Ven thrombosis images bilat 4.68 70.00 $327.60

78458 26 Ven thrombosis images bilat 1.27 70.00 $88.90

78459 Heart muscle imaging (pet) 0.00 70.00 $0.00

78459 TC Heart muscle imaging (pet) 0.00 70.00 $0.00

78459 26 Heart muscle imaging (pet) 2.06 70.00 $144.20

78466 Heart infarct image 5.65 70.00 $395.50

78466 TC Heart infarct image 4.66 70.00 $326.20

78466 26 Heart infarct image 0.99 70.00 $69.30

78468 Heart infarct image (ef) 5.60 70.00 $392.00

78468 TC Heart infarct image (ef) 4.50 70.00 $315.00

78468 26 Heart infarct image (ef) 1.10 70.00 $77.00

78469 Heart infarct image (3d) 6.60 70.00 $462.00

78469 TC Heart infarct image (3d) 5.31 70.00 $371.70

78469 26 Heart infarct image (3d) 1.29 70.00 $90.30

78472 Gated heart planar single 6.67 70.00 $466.90

78472 TC Gated heart planar single 5.31 70.00 $371.70

78472 26 Gated heart planar single 1.36 70.00 $95.20

78473 Gated heart multiple 8.37 70.00 $585.90

78473 TC Gated heart multiple 6.36 70.00 $445.20

78473 26 Gated heart multiple 2.01 70.00 $140.70

78481 Heart first pass single 5.06 70.00 $354.20

78481 TC Heart first pass single 3.71 70.00 $259.70

78481 26 Heart first pass single 1.35 70.00 $94.50

78483 Heart first pass multiple 6.89 70.00 $482.30

78483 TC Heart first pass multiple 4.87 70.00 $340.90

78483 26 Heart first pass multiple 2.02 70.00 $141.40

78491 Heart image (pet) single 0.00 70.00 $0.00

78491 TC Heart image (pet) single 0.00 70.00 $0.00

78491 26 Heart image (pet) single 2.07 70.00 $144.90

78492 Heart image (pet) multiple 0.00 70.00 $0.00

78492 TC Heart image (pet) multiple 0.00 70.00 $0.00

78492 26 Heart image (pet) multiple 2.60 70.00 $182.00

78494 Heart image spect 6.49 70.00 $454.30

78494 TC Heart image spect 4.85 70.00 $339.50

78494 26 Heart image spect 1.64 70.00 $114.80

78496 Heart first pass add-on 1.28 70.00 $89.60

78496 TC Heart first pass add-on 0.59 70.00 $41.30

78496 26 Heart first pass add-on 0.69 70.00 $48.30

78499 Cardiovascular nuclear exam 0.00 70.00 $0.00

78499 TC Cardiovascular nuclear exam 0.00 70.00 $0.00

78499 26 Cardiovascular nuclear exam 0.00 70.00 $0.00

78579 Lung ventilation imaging 5.35 70.00 $374.50

78579 TC Lung ventilation imaging 4.69 70.00 $328.30

78579 26 Lung ventilation imaging 0.66 70.00 $46.20

78580 Lung perfusion imaging 6.92 70.00 $484.40

78580 TC Lung perfusion imaging 5.89 70.00 $412.30

78580 26 Lung perfusion imaging 1.03 70.00 $72.10

78582 Lung ventilat&perfus imaging 9.72 70.00 $680.40

78582 TC Lung ventilat&perfus imaging 8.22 70.00 $575.40

78582 26 Lung ventilat&perfus imaging 1.50 70.00 $105.00

78597 Lung perfusion differential 5.86 70.00 $410.20

78597 TC Lung perfusion differential 4.84 70.00 $338.80

78597 26 Lung perfusion differential 1.02 70.00 $71.40

78598 Lung perf&ventilat diferentl 8.89 70.00 $622.30

78598 TC Lung perf&ventilat diferentl 7.71 70.00 $539.70

78598 26 Lung perf&ventilat diferentl 1.18 70.00 $82.60

78599 Respiratory nuclear exam 0.00 70.00 $0.00

78599 TC Respiratory nuclear exam 0.00 70.00 $0.00

78599 26 Respiratory nuclear exam 0.00 70.00 $0.00

78600 Brain image < 4 views 5.34 70.00 $373.80

78600 TC Brain image < 4 views 4.72 70.00 $330.40

78600 26 Brain image < 4 views 0.62 70.00 $43.40

78601 Brain image w/flow < 4 views 6.23 70.00 $436.10

78601 TC Brain image w/flow < 4 views 5.52 70.00 $386.40

78601 26 Brain image w/flow < 4 views 0.71 70.00 $49.70

78605 Brain image 4+ views 5.76 70.00 $403.20

78605 TC Brain image 4+ views 5.01 70.00 $350.70

78605 26 Brain image 4+ views 0.75 70.00 $52.50

78606 Brain image w/flow 4 + views 9.66 70.00 $676.20

78606 TC Brain image w/flow 4 + views 8.77 70.00 $613.90

78606 26 Brain image w/flow 4 + views 0.89 70.00 $62.30

78607 Brain imaging (3d) 10.23 70.00 $716.10

78607 TC Brain imaging (3d) 8.55 70.00 $598.50

78607 26 Brain imaging (3d) 1.68 70.00 $117.60

78608 Brain imaging (pet) 0.00 70.00 $0.00

78608 TC Brain imaging (pet) 0.00 70.00 $0.00

78608 26 Brain imaging (pet) 2.09 70.00 $146.30

78609 Brain imaging (pet) 2.17 70.00 $151.90

78609 TC Brain imaging (pet) 0.00 70.00 $0.00

78609 26 Brain imaging (pet) 2.17 70.00 $151.90

78610 Brain flow imaging only 5.05 70.00 $353.50

78610 TC Brain flow imaging only 4.63 70.00 $324.10

78610 26 Brain flow imaging only 0.42 70.00 $29.40

78630 Cerebrospinal fluid scan 9.86 70.00 $690.20

78630 TC Cerebrospinal fluid scan 8.90 70.00 $623.00

78630 26 Cerebrospinal fluid scan 0.96 70.00 $67.20

78635 Csf ventriculography 9.89 70.00 $692.30

78635 TC Csf ventriculography 9.01 70.00 $630.70

78635 26 Csf ventriculography 0.88 70.00 $61.60

78645 Csf shunt evaluation 9.40 70.00 $658.00

78645 TC Csf shunt evaluation 8.61 70.00 $602.70

78645 26 Csf shunt evaluation 0.79 70.00 $55.30

78647 Cerebrospinal fluid scan 10.19 70.00 $713.30

78647 TC Cerebrospinal fluid scan 8.94 70.00 $625.80

78647 26 Cerebrospinal fluid scan 1.25 70.00 $87.50

78650 Csf leakage imaging 9.70 70.00 $679.00

78650 TC Csf leakage imaging 8.84 70.00 $618.80

78650 26 Csf leakage imaging 0.86 70.00 $60.20

78660 Nuclear exam of tear flow 5.11 70.00 $357.70

78660 TC Nuclear exam of tear flow 4.38 70.00 $306.60

78660 26 Nuclear exam of tear flow 0.73 70.00 $51.10

78699 Nervous system nuclear exam 0.00 70.00 $0.00

78699 TC Nervous system nuclear exam 0.00 70.00 $0.00

78699 26 Nervous system nuclear exam 0.00 70.00 $0.00

78700 Kidney imaging morphol 4.97 70.00 $347.90

78700 TC Kidney imaging morphol 4.35 70.00 $304.50

78700 26 Kidney imaging morphol 0.62 70.00 $43.40

78701 Kidney imaging with flow 6.10 70.00 $427.00

78701 TC Kidney imaging with flow 5.43 70.00 $380.10

78701 26 Kidney imaging with flow 0.67 70.00 $46.90

78707 K flow/funct image w/o drug 6.73 70.00 $471.10

78707 TC K flow/funct image w/o drug 5.41 70.00 $378.70

78707 26 K flow/funct image w/o drug 1.32 70.00 $92.40

78708 K flow/funct image w/drug 5.03 70.00 $352.10

78708 TC K flow/funct image w/drug 3.34 70.00 $233.80

78708 26 K flow/funct image w/drug 1.69 70.00 $118.30

78709 K flow/funct image multiple 10.48 70.00 $733.60

78709 TC K flow/funct image multiple 8.56 70.00 $599.20

78709 26 K flow/funct image multiple 1.92 70.00 $134.40

78710 Kidney imaging (3d) 5.73 70.00 $401.10

78710 TC Kidney imaging (3d) 4.89 70.00 $342.30

78710 26 Kidney imaging (3d) 0.84 70.00 $58.80

78725 Kidney function study 3.13 70.00 $219.10

78725 TC Kidney function study 2.62 70.00 $183.40

78725 26 Kidney function study 0.51 70.00 $35.70

78730 Urinary bladder retention 2.22 70.00 $155.40

78730 TC Urinary bladder retention 2.00 70.00 $140.00

78730 26 Urinary bladder retention 0.22 70.00 $15.40

78740 Ureteral reflux study 6.34 70.00 $443.80

78740 TC Ureteral reflux study 5.55 70.00 $388.50

78740 26 Ureteral reflux study 0.79 70.00 $55.30

78761 Testicular imaging w/flow 6.11 70.00 $427.70

78761 TC Testicular imaging w/flow 5.09 70.00 $356.30

78761 26 Testicular imaging w/flow 1.02 70.00 $71.40

78799 Genitourinary nuclear exam 0.00 70.00 $0.00

78799 TC Genitourinary nuclear exam 0.00 70.00 $0.00

78799 26 Genitourinary nuclear exam 0.00 70.00 $0.00

78800 Tumor imaging limited area 5.52 70.00 $386.40

78800 TC Tumor imaging limited area 4.58 70.00 $320.60

78800 26 Tumor imaging limited area 0.94 70.00 $65.80

78801 Tumor imaging mult areas 7.55 70.00 $528.50

78801 TC Tumor imaging mult areas 6.42 70.00 $449.40

78801 26 Tumor imaging mult areas 1.13 70.00 $79.10

78802 Tumor imaging whole body 9.42 70.00 $659.40

78802 TC Tumor imaging whole body 8.22 70.00 $575.40

78802 26 Tumor imaging whole body 1.20 70.00 $84.00

78803 Tumor imaging (3d) 9.89 70.00 $692.30

78803 TC Tumor imaging (3d) 8.41 70.00 $588.70

78803 26 Tumor imaging (3d) 1.48 70.00 $103.60

78804 Tumor imaging whole body 16.55 70.00 $1,158.50

78804 TC Tumor imaging whole body 15.07 70.00 $1,054.90

78804 26 Tumor imaging whole body 1.48 70.00 $103.60

78805 Abscess imaging ltd area 5.27 70.00 $368.90

78805 TC Abscess imaging ltd area 4.25 70.00 $297.50

78805 26 Abscess imaging ltd area 1.02 70.00 $71.40

78806 Abscess imaging whole body 9.68 70.00 $677.60

78806 TC Abscess imaging whole body 8.49 70.00 $594.30

78806 26 Abscess imaging whole body 1.19 70.00 $83.30

78807 Nuclear localization/abscess 9.90 70.00 $693.00

78807 TC Nuclear localization/abscess 8.44 70.00 $590.80

78807 26 Nuclear localization/abscess 1.46 70.00 $102.20

78808 Iv inj ra drug dx study 1.27 70.00 $88.90

78811 Pet image ltd area 0.00 70.00 $0.00

78811 TC Pet image ltd area 0.00 70.00 $0.00

78811 26 Pet image ltd area 2.24 70.00 $156.80

78812 Pet image skull-thigh 0.00 70.00 $0.00

78812 TC Pet image skull-thigh 0.00 70.00 $0.00

78812 26 Pet image skull-thigh 2.75 70.00 $192.50

78813 Pet image full body 0.00 70.00 $0.00

78813 TC Pet image full body 0.00 70.00 $0.00

78813 26 Pet image full body 2.87 70.00 $200.90

78814 Pet image w/ct lmtd 0.00 70.00 $0.00

78814 TC Pet image w/ct lmtd 0.00 70.00 $0.00

78814 26 Pet image w/ct lmtd 3.19 70.00 $223.30

78815 Pet image w/ct skull-thigh 0.00 70.00 $0.00

78815 TC Pet image w/ct skull-thigh 0.00 70.00 $0.00

78815 26 Pet image w/ct skull-thigh 3.50 70.00 $245.00

78816 Pet image w/ct full body 0.00 70.00 $0.00

78816 TC Pet image w/ct full body 0.00 70.00 $0.00

78816 26 Pet image w/ct full body 3.52 70.00 $246.40

78999 Nuclear diagnostic exam 0.00 70.00 $0.00

78999 TC Nuclear diagnostic exam 0.00 70.00 $0.00

78999 26 Nuclear diagnostic exam 0.00 70.00 $0.00

79005 Nuclear rx oral admin 3.86 70.00 $270.20

79005 TC Nuclear rx oral admin 1.38 70.00 $96.60

79005 26 Nuclear rx oral admin 2.48 70.00 $173.60

79101 Nuclear rx iv admin 4.03 70.00 $282.10

79101 TC Nuclear rx iv admin 1.35 70.00 $94.50

79101 26 Nuclear rx iv admin 2.68 70.00 $187.60

79200 Nuclear rx intracav admin 3.84 70.00 $268.80

79200 TC Nuclear rx intracav admin 1.46 70.00 $102.20

79200 26 Nuclear rx intracav admin 2.38 70.00 $166.60

79300 Nuclr rx interstit colloid 0.00 70.00 $0.00

79300 TC Nuclr rx interstit colloid 0.00 70.00 $0.00

79300 26 Nuclr rx interstit colloid 2.05 70.00 $143.50

79403 Hematopoietic nuclear tx 5.38 70.00 $376.60

79403 TC Hematopoietic nuclear tx 2.27 70.00 $158.90

79403 26 Hematopoietic nuclear tx 3.11 70.00 $217.70

79440 Nuclear rx intra-articular 3.64 70.00 $254.80

79440 TC Nuclear rx intra-articular 1.13 70.00 $79.10

79440 26 Nuclear rx intra-articular 2.51 70.00 $175.70

79445 Nuclear rx intra-arterial 0.00 70.00 $0.00

79445 TC Nuclear rx intra-arterial 0.00 70.00 $0.00

79445 26 Nuclear rx intra-arterial 3.37 70.00 $235.90

79999 Nuclear medicine therapy 0.00 70.00 $0.00

79999 TC Nuclear medicine therapy 0.00 70.00 $0.00

79999 26 Nuclear medicine therapy 0.00 70.00 $0.00

80047 Metabolic panel ionized ca 0.00 58.28 $0.00

80048 Metabolic panel total ca 0.00 58.28 $0.00

80050 General health panel 0.00 58.28 $0.00

80051 Electrolyte panel 0.00 58.28 $0.00

80053 Comprehen metabolic panel 0.00 58.28 $0.00

80055 Obstetric panel 0.00 58.28 $0.00

80061 Lipid panel 0.00 58.28 $0.00

80069 Renal function panel 0.00 58.28 $0.00

80074 Acute hepatitis panel 0.00 58.28 $0.00

80076 Hepatic function panel 0.00 58.28 $0.00

80150 Assay of amikacin 0.00 58.28 $0.00

80155 Drug screen quant caffeine 0.00 58.28 $0.00

80156 Assay carbamazepine total 0.00 58.28 $0.00

80157 Assay carbamazepine free 0.00 58.28 $0.00

80158 Assay of cyclosporine 0.00 58.28 $0.00

80159 Drug screen quant clozapine 0.00 58.28 $0.00

80162 Assay of digoxin total 0.00 58.28 $0.00

80163 Assay of digoxin free 0.00 58.28 $0.00

80164 Assay dipropylacetic acd tot 0.00 58.28 $0.00

80165 Dipropylacetic acid free 0.00 58.28 $0.00

80168 Assay of ethosuximide 0.00 58.28 $0.00

80169 Drug screen quant everolimus 0.00 58.28 $0.00

80170 Assay of gentamicin 0.00 58.28 $0.00

80171 Drug screen quant gabapentin 0.00 58.28 $0.00

80173 Assay of haloperidol 0.00 58.28 $0.00

80175 Drug screen quan lamotrigine 0.00 58.28 $0.00

80176 Assay of lidocaine 0.00 58.28 $0.00

80177 Drug scrn quan levetiracetam 0.00 58.28 $0.00

80178 Assay of lithium 0.00 58.28 $0.00

80180 Drug scrn quan mycophenolate 0.00 58.28 $0.00

80183 Drug scrn quant oxcarbazepin 0.00 58.28 $0.00

80184 Assay of phenobarbital 0.00 58.28 $0.00

80185 Assay of phenytoin total 0.00 58.28 $0.00

80186 Assay of phenytoin free 0.00 58.28 $0.00

80188 Assay of primidone 0.00 58.28 $0.00

80190 Assay of procainamide 0.00 58.28 $0.00

80192 Assay of procainamide 0.00 58.28 $0.00

80194 Assay of quinidine 0.00 58.28 $0.00

80195 Assay of sirolimus 0.00 58.28 $0.00

80197 Assay of tacrolimus 0.00 58.28 $0.00

80198 Assay of theophylline 0.00 58.28 $0.00

80199 Drug screen quant tiagabine 0.00 58.28 $0.00

80200 Assay of tobramycin 0.00 58.28 $0.00

80201 Assay of topiramate 0.00 58.28 $0.00

80202 Assay of vancomycin 0.00 58.28 $0.00

80203 Drug screen quant zonisamide 0.00 58.28 $0.00

80299 Quantitative assay drug 0.00 58.28 $0.00

80300 Drug screen non tlc devices 0.00 58.28 $0.00

80301 Drug screen class list a 0.00 58.28 $0.00

80302 Drug screen prsmptv 1 class 0.00 58.28 $0.00

80303 Drug screen one/mult class 0.00 58.28 $0.00

80304 Drug screen one/mult class 0.00 58.28 $0.00

80320 Drug screen quantalcohols 0.00 58.28 $0.00

80321 Alcohols biomarkers 1or 2 0.00 58.28 $0.00

80322 Alcohols biomarkers 3/more 0.00 58.28 $0.00

80323 Alkaloids nos 0.00 58.28 $0.00

80324 Drug screen amphetamines 1/2 0.00 58.28 $0.00

80325 Amphetamines 3or 4 0.00 58.28 $0.00

80326 Amphetamines 5 or more 0.00 58.28 $0.00

80327 Anabolic steroid 1 or 2 0.00 58.28 $0.00

80328 Anabolic steroid 3 or more 0.00 58.28 $0.00

80329 Analgesics non-opioid 1 or 2 0.00 58.28 $0.00

80330 Analgesics non-opioid 3-5 0.00 58.28 $0.00

80331 Analgesics non-opioid 6/more 0.00 58.28 $0.00

80332 Antidepressants class 1 or 2 0.00 58.28 $0.00

80333 Antidepressants class 3-5 0.00 58.28 $0.00

80334 Antidepressants class 6/more 0.00 58.28 $0.00

80335 Antidepressant tricyclic 1/2 0.00 58.28 $0.00

80336 Antidepressant tricyclic 3-5 0.00 58.28 $0.00

80337 Tricyclic & cyclicals 6/more 0.00 58.28 $0.00

80338 Antidepressant not specified 0.00 58.28 $0.00

80339 Antiepileptics nos 1-3 0.00 58.28 $0.00

80340 Antiepileptics nos 4-6 0.00 58.28 $0.00

80341 Antiepileptics nos 7/more 0.00 58.28 $0.00

80342 Antipsychotics nos 1-3 0.00 58.28 $0.00

80343 Antipsychotics nos 4-6 0.00 58.28 $0.00

80344 Antipsychotics nos 7/more 0.00 58.28 $0.00

80345 Drug screening barbiturates 0.00 58.28 $0.00

80346 Benzodiazepines1-12 0.00 58.28 $0.00

80347 Benzodiazepines 13 or more 0.00 58.28 $0.00

80348 Drug screening buprenorphine 0.00 58.28 $0.00

80349 Cannabinoids natural 0.00 58.28 $0.00

80350 Cannabinoids synthetic 1-3 0.00 58.28 $0.00

80351 Cannabinoids synthetic 4-6 0.00 58.28 $0.00

80352 Cannabinoid synthetic 7/more 0.00 58.28 $0.00

80353 Drug screening cocaine 0.00 58.28 $0.00

80354 Drug screening fentanyl 0.00 58.28 $0.00

80355 Gabapentin non-blood 0.00 58.28 $0.00

80356 Heroin metabolite 0.00 58.28 $0.00

80357 Ketamine and norketamine 0.00 58.28 $0.00

80358 Drug screening methadone 0.00 58.28 $0.00

80359 Methylenedioxyamphetamines 0.00 58.28 $0.00

80360 Methylphenidate 0.00 58.28 $0.00

80361 Opiates 1 or more 0.00 58.28 $0.00

80362 Opioids & opiate analogs 1/2 0.00 58.28 $0.00

80363 Opioids & opiate analogs 3/4 0.00 58.28 $0.00

80364 Opioid &opiate analog 5/more 0.00 58.28 $0.00

80365 Drug screening oxycodone 0.00 58.28 $0.00

80366 Drug screening pregabalin 0.00 58.28 $0.00

80367 Drug screening propoxyphene 0.00 58.28 $0.00

80368 Sedative hypnotics 0.00 58.28 $0.00

80369 Skeletal muscle relaxant 1/2 0.00 58.28 $0.00

80370 Skel musc relaxant 3 or more 0.00 58.28 $0.00

80371 Stimulants synthetic 0.00 58.28 $0.00

80372 Drug screening tapentadol 0.00 58.28 $0.00

80373 Drug screening tramadol 0.00 58.28 $0.00

80374 Stereoisomer analysis 0.00 58.28 $0.00

80375 Drug/substance nos 1-3 0.00 58.28 $0.00

80376 Drug/substance nos 4-6 0.00 58.28 $0.00

80377 Drug/substance nos 7/more 0.00 58.28 $0.00

80400 Acth stimulation panel 0.00 58.28 $0.00



80408 Aldosterone suppression eval 0.00 58.28 $0.00

80410 Calcitonin stimul panel 0.00 58.28 $0.00

80412 Crh stimulation panel 0.00 58.28 $0.00

80414 Testosterone response 0.00 58.28 $0.00

80415 Estradiol response panel 0.00 58.28 $0.00

80416 Renin stimulation panel 0.00 58.28 $0.00

80417 Renin stimulation panel 0.00 58.28 $0.00

80418 Pituitary evaluation panel 0.00 58.28 $0.00

80420 Dexamethasone panel 0.00 58.28 $0.00

80422 Glucagon tolerance panel 0.00 58.28 $0.00

80424 Glucagon tolerance panel 0.00 58.28 $0.00

80426 Gonadotropin hormone panel 0.00 58.28 $0.00

80428 Growth hormone panel 0.00 58.28 $0.00

80430 Growth hormone panel 0.00 58.28 $0.00

80432 Insulin suppression panel 0.00 58.28 $0.00

80434 Insulin tolerance panel 0.00 58.28 $0.00

80435 Insulin tolerance panel 0.00 58.28 $0.00

80436 Metyrapone panel 0.00 58.28 $0.00

80438 Trh stimulation panel 0.00 58.28 $0.00

80439 Trh stimulation panel 0.00 58.28 $0.00

80500 Lab pathology consultation 0.65 58.28 $37.88

80502 Lab pathology consultation 2.05 58.28 $119.47

81000 Urinalysis nonauto w/scope 0.00 58.28 $0.00

81001 Urinalysis auto w/scope 0.00 58.28 $0.00

81002 Urinalysis nonauto w/o scope 0.00 58.28 $0.00

81003 Urinalysis auto w/o scope 0.00 58.28 $0.00

81005 Urinalysis 0.00 58.28 $0.00

81007 Urine screen for bacteria 0.00 58.28 $0.00

81015 Microscopic exam of urine 0.00 58.28 $0.00

81020 Urinalysis glass test 0.00 58.28 $0.00

81025 Urine pregnancy test 0.00 58.28 $0.00

81050 Urinalysis volume measure 0.00 58.28 $0.00

81099 Urinalysis test procedure 0.00 58.28 $0.00

81161 Dmd dup/delet analysis 0.00 58.28 $0.00

81200 Aspa gene 0.00 58.28 $0.00

81201 Apc gene full sequence 0.00 58.28 $0.00

81202 Apc gene known fam variants 0.00 58.28 $0.00

81203 Apc gene dup/delet variants 0.00 58.28 $0.00

81205 Bckdhb gene 0.00 58.28 $0.00

81206 Bcr/abl1 gene major bp 0.00 58.28 $0.00

81207 Bcr/abl1 gene minor bp 0.00 58.28 $0.00

81208 Bcr/abl1 gene other bp 0.00 58.28 $0.00

81209 Blm gene 0.00 58.28 $0.00

81210 Braf gene 0.00 58.28 $0.00

81211 Brca1&2 seq & com dup/del 0.00 58.28 $0.00

81212 Brca1&2 185&5385&6174 var 0.00 58.28 $0.00

81213 Brca1&2 uncom dup/del var 0.00 58.28 $0.00

81214 Brca1 full seq & com dup/del 0.00 58.28 $0.00

81215 Brca1 gene known fam variant 0.00 58.28 $0.00

81216 Brca2 gene full sequence 0.00 58.28 $0.00

81217 Brca2 gene known fam variant 0.00 58.28 $0.00

81220 Cftr gene com variants 0.00 58.28 $0.00

81221 Cftr gene known fam variants 0.00 58.28 $0.00

81222 Cftr gene dup/delet variants 0.00 58.28 $0.00

81223 Cftr gene full sequence 0.00 58.28 $0.00

81224 Cftr gene intron poly t 0.00 58.28 $0.00

81225 Cyp2c19 gene com variants 0.00 58.28 $0.00

81226 Cyp2d6 gene com variants 0.00 58.28 $0.00

81227 Cyp2c9 gene com variants 0.00 58.28 $0.00

81228 Cytogen micrarray copy nmbr 0.00 58.28 $0.00

81229 Cytogen m array copy no&snp 0.00 58.28 $0.00

81235 Egfr gene com variants 0.00 58.28 $0.00

81240 F2 gene 0.00 58.28 $0.00

81241 F5 gene 0.00 58.28 $0.00

81242 Fancc gene 0.00 58.28 $0.00

81243 Fmr1 gene detection 0.00 58.28 $0.00

81244 Fmr1 gene characterization 0.00 58.28 $0.00

81245 Flt3 gene 0.00 58.28 $0.00

81246 Flt3 gene analysis 0.00 58.28 $0.00

81250 G6pc gene 0.00 58.28 $0.00

81251 Gba gene 0.00 58.28 $0.00

81252 Gjb2 gene full sequence 0.00 58.28 $0.00

81253 Gjb2 gene known fam variants 0.00 58.28 $0.00

81254 Gjb6 gene com variants 0.00 58.28 $0.00

81255 Hexa gene 0.00 58.28 $0.00

81256 Hfe gene 0.00 58.28 $0.00

81257 Hba1/hba2 gene 0.00 58.28 $0.00

81260 Ikbkap gene 0.00 58.28 $0.00

81261 Igh gene rearrange amp meth 0.00 58.28 $0.00

81262 Igh gene rearrang dir probe 0.00 58.28 $0.00

81263 Igh vari regional mutation 0.00 58.28 $0.00

81264 Igk rearrangeabn clonal pop 0.00 58.28 $0.00

81265 Str markers specimen anal 0.00 58.28 $0.00

81266 Str markers spec anal addl 0.00 58.28 $0.00

81267 Chimerism anal no cell selec 0.00 58.28 $0.00

81268 Chimerism anal w/cell select 0.00 58.28 $0.00

81270 Jak2 gene 0.00 58.28 $0.00

81275 Kras gene 0.00 58.28 $0.00

81280 Long qt synd gene full seq 0.00 58.28 $0.00

81281 Long qt synd known fam var 0.00 58.28 $0.00

81282 Long qt syn gene dup/dlt var 0.00 58.28 $0.00

81287 Mgmt gene methylation anal 0.00 58.28 $0.00

81288 Mlh1 gene 0.00 58.28 $0.00

81290 Mcoln1 gene 0.00 58.28 $0.00

81291 Mthfr gene 0.00 58.28 $0.00

81292 Mlh1 gene full seq 0.00 58.28 $0.00

81293 Mlh1 gene known variants 0.00 58.28 $0.00

81294 Mlh1 gene dup/delete variant 0.00 58.28 $0.00

81295 Msh2 gene full seq 0.00 58.28 $0.00

81296 Msh2 gene known variants 0.00 58.28 $0.00

81297 Msh2 gene dup/delete variant 0.00 58.28 $0.00

81298 Msh6 gene full seq 0.00 58.28 $0.00

81299 Msh6 gene known variants 0.00 58.28 $0.00

81300 Msh6 gene dup/delete variant 0.00 58.28 $0.00

81301 Microsatellite instability 0.00 58.28 $0.00

81302 Mecp2 gene full seq 0.00 58.28 $0.00

81303 Mecp2 gene known variant 0.00 58.28 $0.00

81304 Mecp2 gene dup/delet variant 0.00 58.28 $0.00

81310 Npm1 gene 0.00 58.28 $0.00

81313 Pca3/klk3 antigen 0.00 58.28 $0.00

81315 Pml/raralpha com breakpoints 0.00 58.28 $0.00

81316 Pml/raralpha 1 breakpoint 0.00 58.28 $0.00

81317 Pms2 gene full seq analysis 0.00 58.28 $0.00

81318 Pms2 known familial variants 0.00 58.28 $0.00

81319 Pms2 gene dup/delet variants 0.00 58.28 $0.00

81321 Pten gene full sequence 0.00 58.28 $0.00

81322 Pten gene known fam variant 0.00 58.28 $0.00

81323 Pten gene dup/delet variant 0.00 58.28 $0.00

81324 Pmp22 gene dup/delet 0.00 58.28 $0.00

81325 Pmp22 gene full sequence 0.00 58.28 $0.00

81326 Pmp22 gene known fam variant 0.00 58.28 $0.00

81330 Smpd1 gene common variants 0.00 58.28 $0.00

81331 Snrpn/ube3a gene 0.00 58.28 $0.00

81332 Serpina1 gene 0.00 58.28 $0.00

81340 Trb@ gene rearrange amplify 0.00 58.28 $0.00

81341 Trb@ gene rearrange dirprobe 0.00 58.28 $0.00

81342 Trg gene rearrangement anal 0.00 58.28 $0.00

81350 Ugt1a1 gene 0.00 58.28 $0.00

81355 Vkorc1 gene 0.00 58.28 $0.00

81370 Hla i & ii typing lr 0.00 58.28 $0.00

81371 Hla i & ii type verify lr 0.00 58.28 $0.00

81372 Hla i typing complete lr 0.00 58.28 $0.00

81373 Hla i typing 1 locus lr 0.00 58.28 $0.00

81374 Hla i typing 1 antigen lr 0.00 58.28 $0.00

81375 Hla ii typing ag equiv lr 0.00 58.28 $0.00

81376 Hla ii typing 1 locus lr 0.00 58.28 $0.00

81377 Hla ii type 1 ag equiv lr 0.00 58.28 $0.00

81378 Hla i & ii typing hr 0.00 58.28 $0.00

81379 Hla i typing complete hr 0.00 58.28 $0.00

81380 Hla i typing 1 locus hr 0.00 58.28 $0.00

81381 Hla i typing 1 allele hr 0.00 58.28 $0.00

81382 Hla ii typing 1 loc hr 0.00 58.28 $0.00

81383 Hla ii typing 1 allele hr 0.00 58.28 $0.00

81400 Mopath procedure level 1 0.00 58.28 $0.00









81410 Aortic dysfunction/dilation 0.00 58.28 $0.00

81411 Aortic dysfunction/dilation 0.00 58.28 $0.00

81415 Exome sequence analysis 0.00 58.28 $0.00

81416 Exome sequence analysis 0.00 58.28 $0.00

81417 Exome re-evaluation 0.00 58.28 $0.00

81420 Fetal chrmoml aneuploidy 0.00 58.28 $0.00

81425 Genome sequence analysis 0.00 58.28 $0.00

81426 Genome sequence analysis 0.00 58.28 $0.00

81427 Genome re-evaluation 0.00 58.28 $0.00

81430 Hearing loss sequence analys 0.00 58.28 $0.00

81431 Hearing loss dup/del analys 0.00 58.28 $0.00

81435 Hereditary colon cancer 0.00 58.28 $0.00

81436 Hereditary colon ca synd 0.00 58.28 $0.00

81440 Mitochondrial gene 0.00 58.28 $0.00

81445 Targeted genomic seq analys 0.00 58.28 $0.00



81460 Whole mitochondrial genome 0.00 58.28 $0.00

81465 Whole mitochondrial genome 0.00 58.28 $0.00

81470 X-linked intellectual dblt 0.00 58.28 $0.00

81471 X-linked intellectual dblt 0.00 58.28 $0.00

81479 Unlisted molecular pathology 0.00 58.28 $0.00

81500 Onco (ovar) two proteins 0.00 58.28 $0.00

81503 Onco (ovar) five proteins 0.00 58.28 $0.00

81504 Oncology tissue of origin 0.00 58.28 $0.00

81506 Endo assay seven anal 0.00 58.28 $0.00

81507 Fetal aneuploidy trisom risk 0.00 58.28 $0.00

81508 Ftl cgen abnor two proteins 0.00 58.28 $0.00

81509 Ftl cgen abnor 3 proteins 0.00 58.28 $0.00

81510 Ftl cgen abnor three anal 0.00 58.28 $0.00

81511 Ftl cgen abnor four anal 0.00 58.28 $0.00

81512 Ftl cgen abnor five anal 0.00 58.28 $0.00

81519 Oncology breast mrna 0.00 58.28 $0.00

81599 Unlisted maaa 0.00 58.28 $0.00

82009 Test for acetone/ketones 0.00 58.28 $0.00

82010 Acetone assay 0.00 58.28 $0.00

82013 Acetylcholinesterase assay 0.00 58.28 $0.00

82016 Acylcarnitines qual 0.00 58.28 $0.00

82017 Acylcarnitines quant 0.00 58.28 $0.00

82024 Assay of acth 0.00 58.28 $0.00

82030 Assay of adp & amp 0.00 58.28 $0.00

82040 Assay of serum albumin 0.00 58.28 $0.00

82042 Assay of urine albumin 0.00 58.28 $0.00

82043 Microalbumin quantitative 0.00 58.28 $0.00

82044 Microalbumin semiquant 0.00 58.28 $0.00

82045 Albumin ischemia modified 0.00 58.28 $0.00

82075 Assay of breath ethanol 0.00 58.28 $0.00

82085 Assay of aldolase 0.00 58.28 $0.00

82088 Assay of aldosterone 0.00 58.28 $0.00

82103 Alpha-1-antitrypsin total 0.00 58.28 $0.00

82104 Alpha-1-antitrypsin pheno 0.00 58.28 $0.00

82105 Alpha-fetoprotein serum 0.00 58.28 $0.00

82106 Alpha-fetoprotein amniotic 0.00 58.28 $0.00

82107 Alpha-fetoprotein l3 0.00 58.28 $0.00

82108 Assay of aluminum 0.00 58.28 $0.00

82120 Amines vaginal fluid qual 0.00 58.28 $0.00

82127 Amino acid single qual 0.00 58.28 $0.00

82128 Amino acids mult qual 0.00 58.28 $0.00

82131 Amino acids single quant 0.00 58.28 $0.00

82135 Assay aminolevulinic acid 0.00 58.28 $0.00

82136 Amino acids quant 2-5 0.00 58.28 $0.00

82139 Amino acids quan 6 or more 0.00 58.28 $0.00

82140 Assay of ammonia 0.00 58.28 $0.00

82143 Amniotic fluid scan 0.00 58.28 $0.00

82150 Assay of amylase 0.00 58.28 $0.00

82154 Androstanediol glucuronide 0.00 58.28 $0.00

82157 Assay of androstenedione 0.00 58.28 $0.00

82160 Assay of androsterone 0.00 58.28 $0.00

82163 Assay of angiotensin ii 0.00 58.28 $0.00

82164 Angiotensin i enzyme test 0.00 58.28 $0.00

82172 Assay of apolipoprotein 0.00 58.28 $0.00

82175 Assay of arsenic 0.00 58.28 $0.00

82180 Assay of ascorbic acid 0.00 58.28 $0.00

82190 Atomic absorption 0.00 58.28 $0.00

82232 Assay of beta-2 protein 0.00 58.28 $0.00

82239 Bile acids total 0.00 58.28 $0.00

82240 Bile acids cholylglycine 0.00 58.28 $0.00

82247 Bilirubin total 0.00 58.28 $0.00

82248 Bilirubin direct 0.00 58.28 $0.00

82252 Fecal bilirubin test 0.00 58.28 $0.00

82261 Assay of biotinidase 0.00 58.28 $0.00

82270 Occult blood feces 0.00 58.28 $0.00

82271 Occult blood other sources 0.00 58.28 $0.00

82272 Occult bld feces 1-3 tests 0.00 58.28 $0.00

82274 Assay test for blood fecal 0.00 58.28 $0.00

82286 Assay of bradykinin 0.00 58.28 $0.00

82300 Assay of cadmium 0.00 58.28 $0.00

82306 Vitamin d 25 hydroxy 0.00 58.28 $0.00

82308 Assay of calcitonin 0.00 58.28 $0.00

82310 Assay of calcium 0.00 58.28 $0.00

82330 Assay of calcium 0.00 58.28 $0.00

82331 Calcium infusion test 0.00 58.28 $0.00

82340 Assay of calcium in urine 0.00 58.28 $0.00

82355 Calculus analysis qual 0.00 58.28 $0.00

82360 Calculus assay quant 0.00 58.28 $0.00

82365 Calculus spectroscopy 0.00 58.28 $0.00

82370 X-ray assay calculus 0.00 58.28 $0.00

82373 Assay c-d transfer measure 0.00 58.28 $0.00

82374 Assay blood carbon dioxide 0.00 58.28 $0.00

82375 Assay carboxyhb quant 0.00 58.28 $0.00

82376 Assay carboxyhb qual 0.00 58.28 $0.00

82378 Carcinoembryonic antigen 0.00 58.28 $0.00

82379 Assay of carnitine 0.00 58.28 $0.00

82380 Assay of carotene 0.00 58.28 $0.00

82382 Assay urine catecholamines 0.00 58.28 $0.00

82383 Assay blood catecholamines 0.00 58.28 $0.00

82384 Assay three catecholamines 0.00 58.28 $0.00

82387 Assay of cathepsin-d 0.00 58.28 $0.00

82390 Assay of ceruloplasmin 0.00 58.28 $0.00

82397 Chemiluminescent assay 0.00 58.28 $0.00

82415 Assay of chloramphenicol 0.00 58.28 $0.00

82435 Assay of blood chloride 0.00 58.28 $0.00

82436 Assay of urine chloride 0.00 58.28 $0.00

82438 Assay other fluid chlorides 0.00 58.28 $0.00

82441 Test for chlorohydrocarbons 0.00 58.28 $0.00

82465 Assay bld/serum cholesterol 0.00 58.28 $0.00

82480 Assay serum cholinesterase 0.00 58.28 $0.00

82482 Assay rbc cholinesterase 0.00 58.28 $0.00

82485 Assay chondroitin sulfate 0.00 58.28 $0.00

82486 Gas/liquid chromatography 0.00 58.28 $0.00

82487 Paper chromatography 0.00 58.28 $0.00

82488 Paper chromatography 0.00 58.28 $0.00

82489 Thin layer chromatography 0.00 58.28 $0.00

82491 Chromotography quant sing 0.00 58.28 $0.00

82492 Chromotography quant mult 0.00 58.28 $0.00

82495 Assay of chromium 0.00 58.28 $0.00

82507 Assay of citrate 0.00 58.28 $0.00

82523 Collagen crosslinks 0.00 58.28 $0.00

82525 Assay of copper 0.00 58.28 $0.00

82528 Assay of corticosterone 0.00 58.28 $0.00

82530 Cortisol free 0.00 58.28 $0.00

82533 Total cortisol 0.00 58.28 $0.00

82540 Assay of creatine 0.00 58.28 $0.00

82541 Column chromotography qual 0.00 58.28 $0.00

82542 Column chromotography quant 0.00 58.28 $0.00

82543 Column chromotograph/isotope 0.00 58.28 $0.00

82544 Column chromotograph/isotope 0.00 58.28 $0.00

82550 Assay of ck (cpk) 0.00 58.28 $0.00

82552 Assay of cpk in blood 0.00 58.28 $0.00

82553 Creatine mb fraction 0.00 58.28 $0.00

82554 Creatine isoforms 0.00 58.28 $0.00

82565 Assay of creatinine 0.00 58.28 $0.00

82570 Assay of urine creatinine 0.00 58.28 $0.00

82575 Creatinine clearance test 0.00 58.28 $0.00

82585 Assay of cryofibrinogen 0.00 58.28 $0.00

82595 Assay of cryoglobulin 0.00 58.28 $0.00

82600 Assay of cyanide 0.00 58.28 $0.00

82607 Vitamin b-12 0.00 58.28 $0.00

82608 B-12 binding capacity 0.00 58.28 $0.00

82610 Cystatin c 0.00 58.28 $0.00

82615 Test for urine cystines 0.00 58.28 $0.00

82626 Dehydroepiandrosterone 0.00 58.28 $0.00

82627 Dehydroepiandrosterone 0.00 58.28 $0.00

82633 Desoxycorticosterone 0.00 58.28 $0.00

82634 Deoxycortisol 0.00 58.28 $0.00

82638 Assay of dibucaine number 0.00 58.28 $0.00

82652 Vit d 1 25-dihydroxy 0.00 58.28 $0.00

82656 Pancreatic elastase fecal 0.00 58.28 $0.00

82657 Enzyme cell activity 0.00 58.28 $0.00

82658 Enzyme cell activity ra 0.00 58.28 $0.00

82664 Electrophoretic test 0.00 58.28 $0.00

82668 Assay of erythropoietin 0.00 58.28 $0.00

82670 Assay of estradiol 0.00 58.28 $0.00

82671 Assay of estrogens 0.00 58.28 $0.00

82672 Assay of estrogen 0.00 58.28 $0.00

82677 Assay of estriol 0.00 58.28 $0.00

82679 Assay of estrone 0.00 58.28 $0.00

82693 Assay of ethylene glycol 0.00 58.28 $0.00

82696 Assay of etiocholanolone 0.00 58.28 $0.00

82705 Fats/lipids feces qual 0.00 58.28 $0.00

82710 Fats/lipids feces quant 0.00 58.28 $0.00

82715 Assay of fecal fat 0.00 58.28 $0.00

82725 Assay of blood fatty acids 0.00 58.28 $0.00

82726 Long chain fatty acids 0.00 58.28 $0.00

82728 Assay of ferritin 0.00 58.28 $0.00

82731 Assay of fetal fibronectin 0.00 58.28 $0.00

82735 Assay of fluoride 0.00 58.28 $0.00

82746 Assay of folic acid serum 0.00 58.28 $0.00

82747 Assay of folic acid rbc 0.00 58.28 $0.00

82757 Assay of semen fructose 0.00 58.28 $0.00

82759 Assay of rbc galactokinase 0.00 58.28 $0.00

82760 Assay of galactose 0.00 58.28 $0.00

82775 Assay galactose transferase 0.00 58.28 $0.00

82776 Galactose transferase test 0.00 58.28 $0.00

82777 Galectin-3 0.00 58.28 $0.00

82784 Assay iga/igd/igg/igm each 0.00 58.28 $0.00

82785 Assay of ige 0.00 58.28 $0.00

82787 Igg 1 2 3 or 4 each 0.00 58.28 $0.00

82800 Blood ph 0.00 58.28 $0.00

82803 Blood gases any combination 0.00 58.28 $0.00

82805 Blood gases w/o2 saturation 0.00 58.28 $0.00

82810 Blood gases o2 sat only 0.00 58.28 $0.00

82820 Hemoglobin-oxygen affinity 0.00 58.28 $0.00

82930 Gastric analy w/ph ea spec 0.00 58.28 $0.00

82938 Gastrin test 0.00 58.28 $0.00

82941 Assay of gastrin 0.00 58.28 $0.00

82943 Assay of glucagon 0.00 58.28 $0.00

82945 Glucose other fluid 0.00 58.28 $0.00

82946 Glucagon tolerance test 0.00 58.28 $0.00

82947 Assay glucose blood quant 0.00 58.28 $0.00

82948 Reagent strip/blood glucose 0.00 58.28 $0.00

82950 Glucose test 0.00 58.28 $0.00

82951 Glucose tolerance test (gtt) 0.00 58.28 $0.00

82952 Gtt-added samples 0.00 58.28 $0.00

82955 Assay of g6pd enzyme 0.00 58.28 $0.00

82960 Test for g6pd enzyme 0.00 58.28 $0.00

82962 Glucose blood test 0.00 58.28 $0.00

82963 Assay of glucosidase 0.00 58.28 $0.00

82965 Assay of gdh enzyme 0.00 58.28 $0.00

82977 Assay of ggt 0.00 58.28 $0.00

82978 Assay of glutathione 0.00 58.28 $0.00

82979 Assay rbc glutathione 0.00 58.28 $0.00

82985 Assay of glycated protein 0.00 58.28 $0.00

83001 Assay of gonadotropin (fsh) 0.00 58.28 $0.00

83002 Assay of gonadotropin (lh) 0.00 58.28 $0.00

83003 Assay growth hormone (hgh) 0.00 58.28 $0.00

83006 Growth stimulation gene 2 0.00 58.28 $0.00

83009 H pylori (c-13) blood 0.00 58.28 $0.00

83010 Assay of haptoglobin quant 0.00 58.28 $0.00

83012 Assay of haptoglobins 0.00 58.28 $0.00

83013 H pylori (c-13) breath 0.00 58.28 $0.00

83014 H pylori drug admin 0.00 58.28 $0.00

83015 Heavy metal screen 0.00 58.28 $0.00

83018 Quantitative screen metals 0.00 58.28 $0.00

83020 Hemoglobin electrophoresis 0.00 58.28 $0.00

83020 26 Hemoglobin electrophoresis 0.53 58.28 $30.89

83021 Hemoglobin chromotography 0.00 58.28 $0.00

83026 Hemoglobin copper sulfate 0.00 58.28 $0.00

83030 Fetal hemoglobin chemical 0.00 58.28 $0.00

83033 Fetal hemoglobin assay qual 0.00 58.28 $0.00

83036 Glycosylated hemoglobin test 0.00 58.28 $0.00

83037 Glycosylated hb home device 0.00 58.28 $0.00

83045 Blood methemoglobin test 0.00 58.28 $0.00

83050 Blood methemoglobin assay 0.00 58.28 $0.00

83051 Assay of plasma hemoglobin 0.00 58.28 $0.00

83060 Blood sulfhemoglobin assay 0.00 58.28 $0.00

83065 Assay of hemoglobin heat 0.00 58.28 $0.00

83068 Hemoglobin stability screen 0.00 58.28 $0.00

83069 Assay of urine hemoglobin 0.00 58.28 $0.00

83070 Assay of hemosiderin qual 0.00 58.28 $0.00

83080 Assay of b hexosaminidase 0.00 58.28 $0.00

83088 Assay of histamine 0.00 58.28 $0.00

83090 Assay of homocystine 0.00 58.28 $0.00

83150 Assay of homovanillic acid 0.00 58.28 $0.00

83491 Assay of corticosteroids 17 0.00 58.28 $0.00

83497 Assay of 5-hiaa 0.00 58.28 $0.00

83498 Assay of progesterone 17-d 0.00 58.28 $0.00

83499 Assay of progesterone 20- 0.00 58.28 $0.00

83500 Assay free hydroxyproline 0.00 58.28 $0.00

83505 Assay total hydroxyproline 0.00 58.28 $0.00

83516 Immunoassay nonantibody 0.00 58.28 $0.00

83518 Immunoassay dipstick 0.00 58.28 $0.00

83519 Ria nonantibody 0.00 58.28 $0.00

83520 Immunoassay quant nos nonab 0.00 58.28 $0.00

83525 Assay of insulin 0.00 58.28 $0.00

83527 Assay of insulin 0.00 58.28 $0.00

83528 Assay of intrinsic factor 0.00 58.28 $0.00

83540 Assay of iron 0.00 58.28 $0.00

83550 Iron binding test 0.00 58.28 $0.00

83570 Assay of idh enzyme 0.00 58.28 $0.00

83582 Assay of ketogenic steroids 0.00 58.28 $0.00

83586 Assay 17- ketosteroids 0.00 58.28 $0.00

83593 Fractionation ketosteroids 0.00 58.28 $0.00

83605 Assay of lactic acid 0.00 58.28 $0.00

83615 Lactate (ld) (ldh) enzyme 0.00 58.28 $0.00

83625 Assay of ldh enzymes 0.00 58.28 $0.00

83630 Lactoferrin fecal (qual) 0.00 58.28 $0.00

83631 Lactoferrin fecal (quant) 0.00 58.28 $0.00

83632 Placental lactogen 0.00 58.28 $0.00

83633 Test urine for lactose 0.00 58.28 $0.00

83655 Assay of lead 0.00 58.28 $0.00

83661 L/s ratio fetal lung 0.00 58.28 $0.00

83662 Foam stability fetal lung 0.00 58.28 $0.00

83663 Fluoro polarize fetal lung 0.00 58.28 $0.00

83664 Lamellar bdy fetal lung 0.00 58.28 $0.00

83670 Assay of lap enzyme 0.00 58.28 $0.00

83690 Assay of lipase 0.00 58.28 $0.00

83695 Assay of lipoprotein(a) 0.00 58.28 $0.00

83698 Assay lipoprotein pla2 0.00 58.28 $0.00

83700 Lipopro bld electrophoretic 0.00 58.28 $0.00

83701 Lipoprotein bld hr fraction 0.00 58.28 $0.00

83704 Lipoprotein bld by nmr 0.00 58.28 $0.00

83718 Assay of lipoprotein 0.00 58.28 $0.00

83719 Assay of blood lipoprotein 0.00 58.28 $0.00

83721 Assay of blood lipoprotein 0.00 58.28 $0.00

83727 Assay of lrh hormone 0.00 58.28 $0.00

83735 Assay of magnesium 0.00 58.28 $0.00

83775 Assay malate dehydrogenase 0.00 58.28 $0.00

83785 Assay of manganese 0.00 58.28 $0.00

83788 Mass spectrometry qual 0.00 58.28 $0.00

83789 Mass spectrometry quant 0.00 58.28 $0.00

83825 Assay of mercury 0.00 58.28 $0.00

83835 Assay of metanephrines 0.00 58.28 $0.00

83857 Assay of methemalbumin 0.00 58.28 $0.00

83861 Microfluid analy tears 0.00 58.28 $0.00

83864 Mucopolysaccharides 0.00 58.28 $0.00

83872 Assay synovial fluid mucin 0.00 58.28 $0.00

83873 Assay of csf protein 0.00 58.28 $0.00

83874 Assay of myoglobin 0.00 58.28 $0.00

83876 Assay myeloperoxidase 0.00 58.28 $0.00

83880 Assay of natriuretic peptide 0.00 58.28 $0.00

83883 Assay nephelometry not spec 0.00 58.28 $0.00

83885 Assay of nickel 0.00 58.28 $0.00

83915 Assay of nucleotidase 0.00 58.28 $0.00

83916 Oligoclonal bands 0.00 58.28 $0.00

83918 Organic acids total quant 0.00 58.28 $0.00

83919 Organic acids qual each 0.00 58.28 $0.00

83921 Organic acid single quant 0.00 58.28 $0.00

83930 Assay of blood osmolality 0.00 58.28 $0.00

83935 Assay of urine osmolality 0.00 58.28 $0.00

83937 Assay of osteocalcin 0.00 58.28 $0.00

83945 Assay of oxalate 0.00 58.28 $0.00

83950 Oncoprotein her-2/neu 0.00 58.28 $0.00

83951 Oncoprotein dcp 0.00 58.28 $0.00

83970 Assay of parathormone 0.00 58.28 $0.00

83986 Assay ph body fluid nos 0.00 58.28 $0.00

83987 Exhaled breath condensate 0.00 58.28 $0.00

83992 Assay for phencyclidine 0.00 58.28 $0.00

83993 Assay for calprotectin fecal 0.00 58.28 $0.00

84030 Assay of blood pku 0.00 58.28 $0.00

84035 Assay of phenylketones 0.00 58.28 $0.00

84060 Assay acid phosphatase 0.00 58.28 $0.00

84061 Phosphatase forensic exam 0.00 58.28 $0.00

84066 Assay prostate phosphatase 0.00 58.28 $0.00

84075 Assay alkaline phosphatase 0.00 58.28 $0.00

84078 Assay alkaline phosphatase 0.00 58.28 $0.00

84080 Assay alkaline phosphatases 0.00 58.28 $0.00

84081 Assay phosphatidylglycerol 0.00 58.28 $0.00

84085 Assay of rbc pg6d enzyme 0.00 58.28 $0.00

84087 Assay phosphohexose enzymes 0.00 58.28 $0.00

84100 Assay of phosphorus 0.00 58.28 $0.00

84105 Assay of urine phosphorus 0.00 58.28 $0.00

84106 Test for porphobilinogen 0.00 58.28 $0.00

84110 Assay of porphobilinogen 0.00 58.28 $0.00

84112 Eval amniotic fluid protein 0.00 58.28 $0.00

84119 Test urine for porphyrins 0.00 58.28 $0.00

84120 Assay of urine porphyrins 0.00 58.28 $0.00

84126 Assay of feces porphyrins 0.00 58.28 $0.00

84132 Assay of serum potassium 0.00 58.28 $0.00

84133 Assay of urine potassium 0.00 58.28 $0.00

84134 Assay of prealbumin 0.00 58.28 $0.00

84135 Assay of pregnanediol 0.00 58.28 $0.00

84138 Assay of pregnanetriol 0.00 58.28 $0.00

84140 Assay of pregnenolone 0.00 58.28 $0.00

84143 Assay of 17-hydroxypregneno 0.00 58.28 $0.00

84144 Assay of progesterone 0.00 58.28 $0.00

84145 Procalcitonin (pct) 0.00 58.28 $0.00

84146 Assay of prolactin 0.00 58.28 $0.00

84150 Assay of prostaglandin 0.00 58.28 $0.00

84152 Assay of psa complexed 0.00 58.28 $0.00

84153 Assay of psa total 0.00 58.28 $0.00

84154 Assay of psa free 0.00 58.28 $0.00

84155 Assay of protein serum 0.00 58.28 $0.00

84156 Assay of protein urine 0.00 58.28 $0.00

84157 Assay of protein other 0.00 58.28 $0.00

84160 Assay of protein any source 0.00 58.28 $0.00

84163 Pappa serum 0.00 58.28 $0.00

84165 Protein e-phoresis serum 0.00 58.28 $0.00

84165 26 Protein e-phoresis serum 0.53 58.28 $30.89

84166 Protein e-phoresis/urine/csf 0.00 58.28 $0.00

84166 26 Protein e-phoresis/urine/csf 0.53 58.28 $30.89

84181 Western blot test 0.00 58.28 $0.00

84181 26 Western blot test 0.53 58.28 $30.89

84182 Protein western blot test 0.00 58.28 $0.00

84182 26 Protein western blot test 0.53 58.28 $30.89

84202 Assay rbc protoporphyrin 0.00 58.28 $0.00

84203 Test rbc protoporphyrin 0.00 58.28 $0.00

84206 Assay of proinsulin 0.00 58.28 $0.00

84207 Assay of vitamin b-6 0.00 58.28 $0.00

84210 Assay of pyruvate 0.00 58.28 $0.00

84220 Assay of pyruvate kinase 0.00 58.28 $0.00

84228 Assay of quinine 0.00 58.28 $0.00

84233 Assay of estrogen 0.00 58.28 $0.00

84234 Assay of progesterone 0.00 58.28 $0.00

84235 Assay of endocrine hormone 0.00 58.28 $0.00

84238 Assay nonendocrine receptor 0.00 58.28 $0.00

84244 Assay of renin 0.00 58.28 $0.00


84255 Assay of selenium 0.00 58.28 $0.00

84260 Assay of serotonin 0.00 58.28 $0.00

84270 Assay of sex hormone globul 0.00 58.28 $0.00

84275 Assay of sialic acid 0.00 58.28 $0.00

84285 Assay of silica 0.00 58.28 $0.00

84295 Assay of serum sodium 0.00 58.28 $0.00

84300 Assay of urine sodium 0.00 58.28 $0.00

84302 Assay of sweat sodium 0.00 58.28 $0.00

84305 Assay of somatomedin 0.00 58.28 $0.00

84307 Assay of somatostatin 0.00 58.28 $0.00

84311 Spectrophotometry 0.00 58.28 $0.00

84315 Body fluid specific gravity 0.00 58.28 $0.00

84375 Chromatogram assay sugars 0.00 58.28 $0.00

84376 Sugars single qual 0.00 58.28 $0.00

84377 Sugars multiple qual 0.00 58.28 $0.00

84378 Sugars single quant 0.00 58.28 $0.00

84379 Sugars multiple quant 0.00 58.28 $0.00

84392 Assay of urine sulfate 0.00 58.28 $0.00

84402 Assay of free testosterone 0.00 58.28 $0.00

84403 Assay of total testosterone 0.00 58.28 $0.00


84430 Assay of thiocyanate 0.00 58.28 $0.00

84431 Thromboxane urine 0.00 58.28 $0.00

84432 Assay of thyroglobulin 0.00 58.28 $0.00

84436 Assay of total thyroxine 0.00 58.28 $0.00

84437 Assay of neonatal thyroxine 0.00 58.28 $0.00

84439 Assay of free thyroxine 0.00 58.28 $0.00

84442 Assay of thyroid activity 0.00 58.28 $0.00

84443 Assay thyroid stim hormone 0.00 58.28 $0.00

84445 Assay of tsi globulin 0.00 58.28 $0.00

84446 Assay of vitamin e 0.00 58.28 $0.00

84449 Assay of transcortin 0.00 58.28 $0.00

84450 Transferase (ast) (sgot) 0.00 58.28 $0.00

84460 Alanine amino (alt) (sgpt) 0.00 58.28 $0.00

84466 Assay of transferrin 0.00 58.28 $0.00

84478 Assay of triglycerides 0.00 58.28 $0.00

84479 Assay of thyroid (t3 or t4) 0.00 58.28 $0.00

84480 Assay triiodothyronine (t3) 0.00 58.28 $0.00

84481 Free assay (ft-3) 0.00 58.28 $0.00

84482 T3 reverse 0.00 58.28 $0.00

84484 Assay of troponin quant 0.00 58.28 $0.00

84485 Assay duodenal fluid trypsin 0.00 58.28 $0.00

84488 Test feces for trypsin 0.00 58.28 $0.00

84490 Assay of feces for trypsin 0.00 58.28 $0.00

84510 Assay of tyrosine 0.00 58.28 $0.00

84512 Assay of troponin qual 0.00 58.28 $0.00

84520 Assay of urea nitrogen 0.00 58.28 $0.00

84525 Urea nitrogen semi-quant 0.00 58.28 $0.00

84540 Assay of urine/urea-n 0.00 58.28 $0.00

84545 Urea-n clearance test 0.00 58.28 $0.00

84550 Assay of blood/uric acid 0.00 58.28 $0.00

84560 Assay of urine/uric acid 0.00 58.28 $0.00

84577 Assay of feces/urobilinogen 0.00 58.28 $0.00

84578 Test urine urobilinogen 0.00 58.28 $0.00

84580 Assay of urine urobilinogen 0.00 58.28 $0.00

84583 Assay of urine urobilinogen 0.00 58.28 $0.00

84585 Assay of urine vma 0.00 58.28 $0.00

84586 Assay of vip 0.00 58.28 $0.00

84588 Assay of vasopressin 0.00 58.28 $0.00

84590 Assay of vitamin a 0.00 58.28 $0.00

84591 Assay of nos vitamin 0.00 58.28 $0.00

84597 Assay of vitamin k 0.00 58.28 $0.00

84600 Assay of volatiles 0.00 58.28 $0.00

84620 Xylose tolerance test 0.00 58.28 $0.00

84630 Assay of zinc 0.00 58.28 $0.00

84681 Assay of c-peptide 0.00 58.28 $0.00

84702 Chorionic gonadotropin test 0.00 58.28 $0.00

84703 Chorionic gonadotropin assay 0.00 58.28 $0.00

84704 Hcg free betachain test 0.00 58.28 $0.00

84830 Ovulation tests 0.00 58.28 $0.00

84999 Clinical chemistry test 0.00 58.28 $0.00

85002 Bleeding time test 0.00 58.28 $0.00

85004 Automated diff wbc count 0.00 58.28 $0.00

85007 Bl smear w/diff wbc count 0.00 58.28 $0.00

85008 Bl smear w/o diff wbc count 0.00 58.28 $0.00

85009 Manual diff wbc count b-coat 0.00 58.28 $0.00

85013 Spun microhematocrit 0.00 58.28 $0.00

85014 Hematocrit 0.00 58.28 $0.00

85018 Hemoglobin 0.00 58.28 $0.00

85025 Complete cbc w/auto diff wbc 0.00 58.28 $0.00

85027 Complete cbc automated 0.00 58.28 $0.00

85032 Manual cell count each 0.00 58.28 $0.00

85041 Automated rbc count 0.00 58.28 $0.00

85044 Manual reticulocyte count 0.00 58.28 $0.00

85045 Automated reticulocyte count 0.00 58.28 $0.00

85046 Reticyte/hgb concentrate 0.00 58.28 $0.00

85048 Automated leukocyte count 0.00 58.28 $0.00

85049 Automated platelet count 0.00 58.28 $0.00

85055 Reticulated platelet assay 0.00 58.28 $0.00

85060 Blood smear interpretation 0.70 58.28 $40.80

85097 Bone marrow interpretation 2.50 58.28 $145.70

85130 Chromogenic substrate assay 0.00 58.28 $0.00

85170 Blood clot retraction 0.00 58.28 $0.00

85175 Blood clot lysis time 0.00 58.28 $0.00

85210 Clot factor ii prothrom spec 0.00 58.28 $0.00

85220 Blooc clot factor v test 0.00 58.28 $0.00

85230 Clot factor vii proconvertin 0.00 58.28 $0.00

85240 Clot factor viii ahg 1 stage 0.00 58.28 $0.00

85244 Clot factor viii reltd antgn 0.00 58.28 $0.00

85245 Clot factor viii vw ristoctn 0.00 58.28 $0.00

85246 Clot factor viii vw antigen 0.00 58.28 $0.00

85247 Clot factor viii multimetric 0.00 58.28 $0.00

85250 Clot factor ix ptc/chrstmas 0.00 58.28 $0.00

85260 Clot factor x stuart-power 0.00 58.28 $0.00

85270 Clot factor xi pta 0.00 58.28 $0.00

85280 Clot factor xii hageman 0.00 58.28 $0.00

85290 Clot factor xiii fibrin stab 0.00 58.28 $0.00

85291 Clot factor xiii fibrin scrn 0.00 58.28 $0.00

85292 Clot factor fletcher fact 0.00 58.28 $0.00

85293 Clot factor wght kininogen 0.00 58.28 $0.00

85300 Antithrombin iii activity 0.00 58.28 $0.00

85301 Antithrombin iii antigen 0.00 58.28 $0.00

85302 Clot inhibit prot c antigen 0.00 58.28 $0.00

85303 Clot inhibit prot c activity 0.00 58.28 $0.00

85305 Clot inhibit prot s total 0.00 58.28 $0.00

85306 Clot inhibit prot s free 0.00 58.28 $0.00

85307 Assay activated protein c 0.00 58.28 $0.00

85335 Factor inhibitor test 0.00 58.28 $0.00

85337 Thrombomodulin 0.00 58.28 $0.00

85345 Coagulation time lee & white 0.00 58.28 $0.00

85347 Coagulation time activated 0.00 58.28 $0.00

85348 Coagulation time otr method 0.00 58.28 $0.00

85360 Euglobulin lysis 0.00 58.28 $0.00

85362 Fibrin degradation products 0.00 58.28 $0.00

85366 Fibrinogen test 0.00 58.28 $0.00

85370 Fibrinogen test 0.00 58.28 $0.00

85378 Fibrin degrade semiquant 0.00 58.28 $0.00

85379 Fibrin degradation quant 0.00 58.28 $0.00

85380 Fibrin degradj d-dimer 0.00 58.28 $0.00

85384 Fibrinogen activity 0.00 58.28 $0.00

85385 Fibrinogen antigen 0.00 58.28 $0.00

85390 Fibrinolysins screen i&r 0.00 58.28 $0.00

85390 26 Fibrinolysins screen i&r 0.53 58.28 $30.89

85396 Clotting assay whole blood 0.58 58.28 $33.80

85397 Clotting funct activity 0.00 58.28 $0.00

85400 Fibrinolytic plasmin 0.00 58.28 $0.00

85410 Fibrinolytic antiplasmin 0.00 58.28 $0.00

85415 Fibrinolytic plasminogen 0.00 58.28 $0.00



85441 Heinz bodies direct 0.00 58.28 $0.00

85445 Heinz bodies induced 0.00 58.28 $0.00

85460 Hemoglobin fetal 0.00 58.28 $0.00

85461 Hemoglobin fetal 0.00 58.28 $0.00

85475 Hemolysin acid 0.00 58.28 $0.00

85520 Heparin assay 0.00 58.28 $0.00

85525 Heparin neutralization 0.00 58.28 $0.00

85530 Heparin-protamine tolerance 0.00 58.28 $0.00

85536 Iron stain peripheral blood 0.00 58.28 $0.00

85540 Wbc alkaline phosphatase 0.00 58.28 $0.00

85547 Rbc mechanical fragility 0.00 58.28 $0.00

85549 Muramidase 0.00 58.28 $0.00

85555 Rbc osmotic fragility 0.00 58.28 $0.00

85557 Rbc osmotic fragility 0.00 58.28 $0.00

85576 Blood platelet aggregation 0.00 58.28 $0.00

85576 26 Blood platelet aggregation 0.53 58.28 $30.89

85597 Phospholipid pltlt neutraliz 0.00 58.28 $0.00

85598 Hexagnal phosph pltlt neutrl 0.00 58.28 $0.00

85610 Prothrombin time 0.00 58.28 $0.00

85611 Prothrombin test 0.00 58.28 $0.00

85612 Viper venom prothrombin time 0.00 58.28 $0.00

85613 Russell viper venom diluted 0.00 58.28 $0.00

85635 Reptilase test 0.00 58.28 $0.00

85651 Rbc sed rate nonautomated 0.00 58.28 $0.00

85652 Rbc sed rate automated 0.00 58.28 $0.00

85660 Rbc sickle cell test 0.00 58.28 $0.00

85670 Thrombin time plasma 0.00 58.28 $0.00

85675 Thrombin time titer 0.00 58.28 $0.00

85705 Thromboplastin inhibition 0.00 58.28 $0.00

85730 Thromboplastin time partial 0.00 58.28 $0.00

85732 Thromboplastin time partial 0.00 58.28 $0.00

85810 Blood viscosity examination 0.00 58.28 $0.00

85999 Hematology procedure 0.00 58.28 $0.00

86000 Agglutinins febrile antigen 0.00 58.28 $0.00

86001 Allergen specific igg 0.00 58.28 $0.00

86003 Allergen specific ige 0.00 58.28 $0.00

86005 Allergen specific ige 0.00 58.28 $0.00

86021 Wbc antibody identification 0.00 58.28 $0.00

86022 Platelet antibodies 0.00 58.28 $0.00

86023 Immunoglobulin assay 0.00 58.28 $0.00

86038 Antinuclear antibodies 0.00 58.28 $0.00

86039 Antinuclear antibodies (ana) 0.00 58.28 $0.00

86060 Antistreptolysin o titer 0.00 58.28 $0.00

86063 Antistreptolysin o screen 0.00 58.28 $0.00

86077 Phys blood bank serv xmatch 1.58 58.28 $92.08

86078 Phys blood bank serv reactj 1.57 58.28 $91.50

86079 Phys blood bank serv authrj 1.54 58.28 $89.75

86140 C-reactive protein 0.00 58.28 $0.00

86141 C-reactive protein hs 0.00 58.28 $0.00

86146 Beta-2 glycoprotein antibody 0.00 58.28 $0.00

86147 Cardiolipin antibody ea ig 0.00 58.28 $0.00

86148 Anti-phospholipid antibody 0.00 58.28 $0.00

86152 Cell enumeration & id 0.00 58.28 $0.00

86153 26 Cell enumeration phys interp 0.99 58.28 $57.70

86155 Chemotaxis assay 0.00 58.28 $0.00

86156 Cold agglutinin screen 0.00 58.28 $0.00

86157 Cold agglutinin titer 0.00 58.28 $0.00

86160 Complement antigen 0.00 58.28 $0.00

86161 Complement/function activity 0.00 58.28 $0.00

86162 Complement total (ch50) 0.00 58.28 $0.00

86171 Complement fixation each 0.00 58.28 $0.00

86185 Counterimmunoelectrophoresis 0.00 58.28 $0.00

86200 Ccp antibody 0.00 58.28 $0.00

86215 Deoxyribonuclease antibody 0.00 58.28 $0.00

86225 Dna antibody native 0.00 58.28 $0.00

86226 Dna antibody single strand 0.00 58.28 $0.00

86235 Nuclear antigen antibody 0.00 58.28 $0.00

86243 Fc receptor 0.00 58.28 $0.00

86255 Fluorescent antibody screen 0.00 58.28 $0.00

86255 26 Fluorescent antibody screen 0.53 58.28 $30.89

86256 Fluorescent antibody titer 0.00 58.28 $0.00

86256 26 Fluorescent antibody titer 0.53 58.28 $30.89

86277 Growth hormone antibody 0.00 58.28 $0.00

86280 Hemagglutination inhibition 0.00 58.28 $0.00

86294 Immunoassay tumor qual 0.00 58.28 $0.00

86300 Immunoassay tumor ca 15-3 0.00 58.28 $0.00

86301 Immunoassay tumor ca 19-9 0.00 58.28 $0.00

86304 Immunoassay tumor ca 125 0.00 58.28 $0.00

86305 Human epididymis protein 4 0.00 58.28 $0.00

86308 Heterophile antibody screen 0.00 58.28 $0.00

86309 Heterophile antibody titer 0.00 58.28 $0.00

86310 Heterophile antibody absrbj 0.00 58.28 $0.00

86316 Immunoassay tumor other 0.00 58.28 $0.00

86317 Immunoassay infectious agent 0.00 58.28 $0.00

86318 Immunoassay infectious agent 0.00 58.28 $0.00

86320 Serum immunoelectrophoresis 0.00 58.28 $0.00

86320 26 Serum immunoelectrophoresis 0.53 58.28 $30.89

86325 Other immunoelectrophoresis 0.00 58.28 $0.00

86325 26 Other immunoelectrophoresis 0.53 58.28 $30.89

86327 Immunoelectrophoresis assay 0.00 58.28 $0.00

86327 26 Immunoelectrophoresis assay 0.61 58.28 $35.55

86329 Immunodiffusion nes 0.00 58.28 $0.00

86331 Immunodiffusion ouchterlony 0.00 58.28 $0.00

86332 Immune complex assay 0.00 58.28 $0.00

86334 Immunofix e-phoresis serum 0.00 58.28 $0.00

86334 26 Immunofix e-phoresis serum 0.53 58.28 $30.89

86335 Immunfix e-phorsis/urine/csf 0.00 58.28 $0.00

86335 26 Immunfix e-phorsis/urine/csf 0.53 58.28 $30.89

86336 Inhibin a 0.00 58.28 $0.00

86337 Insulin antibodies 0.00 58.28 $0.00

86340 Intrinsic factor antibody 0.00 58.28 $0.00

86341 Islet cell antibody 0.00 58.28 $0.00

86343 Leukocyte histamine release 0.00 58.28 $0.00

86344 Leukocyte phagocytosis 0.00 58.28 $0.00

86352 Cell function assay w/stim 0.00 58.28 $0.00

86353 Lymphocyte transformation 0.00 58.28 $0.00

86355 B cells total count 0.00 58.28 $0.00

86356 Mononuclear cell antigen 0.00 58.28 $0.00

86357 Nk cells total count 0.00 58.28 $0.00

86359 T cells total count 0.00 58.28 $0.00

86360 T cell absolute count/ratio 0.00 58.28 $0.00

86361 T cell absolute count 0.00 58.28 $0.00

86367 Stem cells total count 0.00 58.28 $0.00

86376 Microsomal antibody each 0.00 58.28 $0.00

86378 Migration inhibitory factor 0.00 58.28 $0.00

86382 Neutralization test viral 0.00 58.28 $0.00

86384 Nitroblue tetrazolium dye 0.00 58.28 $0.00

86386 Nuclear matrix protein 22 0.00 58.28 $0.00

86403 Particle agglut antbdy scrn 0.00 58.28 $0.00

86406 Particle agglut antbdy titr 0.00 58.28 $0.00

86430 Rheumatoid factor test qual 0.00 58.28 $0.00

86431 Rheumatoid factor quant 0.00 58.28 $0.00

86480 Tb test cell immun measure 0.00 58.28 $0.00

86481 Tb ag response t-cell susp 0.00 58.28 $0.00

86485 Skin test candida 0.00 58.28 $0.00

86486 Skin test nos antigen 0.14 58.28 $8.16

86490 Coccidioidomycosis skin test 0.19 58.28 $11.07

86510 Histoplasmosis skin test 0.17 58.28 $9.91

86580 Tb intradermal test 0.22 58.28 $12.82

86590 Streptokinase antibody 0.00 58.28 $0.00

86592 Syphilis test non-trep qual 0.00 58.28 $0.00

86593 Syphilis test non-trep quant 0.00 58.28 $0.00

86602 Antinomyces antibody 0.00 58.28 $0.00

86603 Adenovirus antibody 0.00 58.28 $0.00

86606 Aspergillus antibody 0.00 58.28 $0.00

86609 Bacterium antibody 0.00 58.28 $0.00

86611 Bartonella antibody 0.00 58.28 $0.00

86612 Blastomyces antibody 0.00 58.28 $0.00

86615 Bordetella antibody 0.00 58.28 $0.00

86617 Lyme disease antibody 0.00 58.28 $0.00

86618 Lyme disease antibody 0.00 58.28 $0.00

86619 Borrelia antibody 0.00 58.28 $0.00

86622 Brucella antibody 0.00 58.28 $0.00

86625 Campylobacter antibody 0.00 58.28 $0.00

86628 Candida antibody 0.00 58.28 $0.00

86631 Chlamydia antibody 0.00 58.28 $0.00

86632 Chlamydia igm antibody 0.00 58.28 $0.00

86635 Coccidioides antibody 0.00 58.28 $0.00

86638 Q fever antibody 0.00 58.28 $0.00

86641 Cryptococcus antibody 0.00 58.28 $0.00

86644 Cmv antibody 0.00 58.28 $0.00

86645 Cmv antibody igm 0.00 58.28 $0.00

86648 Diphtheria antibody 0.00 58.28 $0.00

86651 Encephalitis californ antbdy 0.00 58.28 $0.00

86652 Encephaltis east eqne anbdy 0.00 58.28 $0.00

86653 Encephaltis st louis antbody 0.00 58.28 $0.00

86654 Encephaltis west eqne antbdy 0.00 58.28 $0.00

86658 Enterovirus antibody 0.00 58.28 $0.00

86663 Epstein-barr antibody 0.00 58.28 $0.00

86664 Epstein-barr nuclear antigen 0.00 58.28 $0.00

86665 Epstein-barr capsid vca 0.00 58.28 $0.00

86666 Ehrlichia antibody 0.00 58.28 $0.00

86668 Francisella tularensis 0.00 58.28 $0.00

86671 Fungus nes antibody 0.00 58.28 $0.00

86674 Giardia lamblia antibody 0.00 58.28 $0.00

86677 Helicobacter pylori antibody 0.00 58.28 $0.00

86682 Helminth antibody 0.00 58.28 $0.00

86684 Hemophilus influenza antibdy 0.00 58.28 $0.00

86687 Htlv-i antibody 0.00 58.28 $0.00

86688 Htlv-ii antibody 0.00 58.28 $0.00

86689 Htlv/hiv confirmj antibody 0.00 58.28 $0.00

86692 Hepatitis delta agent antbdy 0.00 58.28 $0.00

86694 Herpes simplex nes antbdy 0.00 58.28 $0.00

86695 Herpes simplex type 1 test 0.00 58.28 $0.00

86696 Herpes simplex type 2 test 0.00 58.28 $0.00

86698 Histoplasma antibody 0.00 58.28 $0.00

86701 Hiv-1antibody 0.00 58.28 $0.00

86702 Hiv-2 antibody 0.00 58.28 $0.00

86703 Hiv-1/hiv-2 1 result antbdy 0.00 58.28 $0.00

86704 Hep b core antibody total 0.00 58.28 $0.00

86705 Hep b core antibody igm 0.00 58.28 $0.00

86706 Hep b surface antibody 0.00 58.28 $0.00

86707 Hepatitis be antibody 0.00 58.28 $0.00

86708 Hepatitis a total antibody 0.00 58.28 $0.00

86709 Hepatitis a igm antibody 0.00 58.28 $0.00

86710 Influenza virus antibody 0.00 58.28 $0.00

86711 John cunningham antibody 0.00 58.28 $0.00

86713 Legionella antibody 0.00 58.28 $0.00

86717 Leishmania antibody 0.00 58.28 $0.00

86720 Leptospira antibody 0.00 58.28 $0.00

86723 Listeria monocytogenes 0.00 58.28 $0.00

86727 Lymph choriomeningitis ab 0.00 58.28 $0.00

86729 Lympho venereum antibody 0.00 58.28 $0.00

86732 Mucormycosis antibody 0.00 58.28 $0.00

86735 Mumps antibody 0.00 58.28 $0.00

86738 Mycoplasma antibody 0.00 58.28 $0.00

86741 Neisseria meningitidis 0.00 58.28 $0.00

86744 Nocardia antibody 0.00 58.28 $0.00

86747 Parvovirus antibody 0.00 58.28 $0.00

86750 Malaria antibody 0.00 58.28 $0.00

86753 Protozoa antibody nos 0.00 58.28 $0.00

86756 Respiratory virus antibody 0.00 58.28 $0.00

86757 Rickettsia antibody 0.00 58.28 $0.00

86759 Rotavirus antibody 0.00 58.28 $0.00

86762 Rubella antibody 0.00 58.28 $0.00

86765 Rubeola antibody 0.00 58.28 $0.00

86768 Salmonella antibody 0.00 58.28 $0.00

86771 Shigella antibody 0.00 58.28 $0.00

86774 Tetanus antibody 0.00 58.28 $0.00

86777 Toxoplasma antibody 0.00 58.28 $0.00

86778 Toxoplasma antibody igm 0.00 58.28 $0.00

86780 Treponema pallidum 0.00 58.28 $0.00

86784 Trichinella antibody 0.00 58.28 $0.00

86787 Varicella-zoster antibody 0.00 58.28 $0.00

86788 West nile virus ab igm 0.00 58.28 $0.00

86789 West nile virus antibody 0.00 58.28 $0.00

86790 Virus antibody nos 0.00 58.28 $0.00

86793 Yersinia antibody 0.00 58.28 $0.00

86800 Thyroglobulin antibody 0.00 58.28 $0.00

86803 Hepatitis c ab test 0.00 58.28 $0.00

86804 Hep c ab test confirm 0.00 58.28 $0.00

86805 Lymphocytotoxicity assay 0.00 58.28 $0.00

86806 Lymphocytotoxicity assay 0.00 58.28 $0.00

86807 Cytotoxic antibody screening 0.00 58.28 $0.00

86808 Cytotoxic antibody screening 0.00 58.28 $0.00

86812 Hla typing a b or c 0.00 58.28 $0.00

86813 Hla typing a b or c 0.00 58.28 $0.00

86816 Hla typing dr/dq 0.00 58.28 $0.00

86817 Hla typing dr/dq 0.00 58.28 $0.00

86821 Lymphocyte culture mixed 0.00 58.28 $0.00

86822 Lymphocyte culture primed 0.00 58.28 $0.00

86825 Hla x-math non-cytotoxic 0.00 58.28 $0.00

86826 Hla x-match noncytotoxc addl 0.00 58.28 $0.00

86828 Hla class i&ii antibody qual 0.00 58.28 $0.00

86829 Hla class i/ii antibody qual 0.00 58.28 $0.00

86830 Hla class i phenotype qual 0.00 58.28 $0.00

86831 Hla class ii phenotype qual 0.00 58.28 $0.00

86832 Hla class i high defin qual 0.00 58.28 $0.00

86833 Hla class ii high defin qual 0.00 58.28 $0.00

86834 Hla class i semiquant panel 0.00 58.28 $0.00

86835 Hla class ii semiquant panel 0.00 58.28 $0.00

86849 Immunology procedure 0.00 58.28 $0.00

86850 Rbc antibody screen 0.00 58.28 $0.00

86860 Rbc antibody elution 0.00 58.28 $0.00

86870 Rbc antibody identification 0.00 58.28 $0.00

86880 Coombs test direct 0.00 58.28 $0.00

86885 Coombs test indirect qual 0.00 58.28 $0.00

86886 Coombs test indirect titer 0.00 58.28 $0.00

86890 Autologous blood process 0.00 58.28 $0.00

86891 Autologous blood op salvage 0.00 58.28 $0.00

86900 Blood typing serologic abo 0.00 58.28 $0.00

86901 Blood typing serologic rh(d) 0.00 58.28 $0.00

86902 Blood type antigen donor ea 0.00 58.28 $0.00

86904 Blood typing patient serum 0.00 58.28 $0.00

86905 Blood typing rbc antigens 0.00 58.28 $0.00

86906 Bld typing serologic rh phnt 0.00 58.28 $0.00

86910 Blood typing paternity test 0.00 58.28 $0.00

86911 Blood typing antigen system 0.00 58.28 $0.00

86920 Compatibility test spin 0.00 58.28 $0.00

86921 Compatibility test incubate 0.00 58.28 $0.00

86922 Compatibility test antiglob 0.00 58.28 $0.00

86923 Compatibility test electric 0.00 58.28 $0.00

86927 Plasma fresh frozen 0.00 58.28 $0.00

86930 Frozen blood prep 0.00 58.28 $0.00

86931 Frozen blood thaw 0.00 58.28 $0.00

86932 Frozen blood freeze/thaw 0.00 58.28 $0.00

86940 Hemolysins/agglutinins auto 0.00 58.28 $0.00

86941 Hemolysins/agglutinins 0.00 58.28 $0.00

86945 Blood product/irradiation 0.00 58.28 $0.00

86950 Leukacyte transfusion 0.00 58.28 $0.00

86960 Vol reduction of blood/prod 0.00 58.28 $0.00

86965 Pooling blood platelets 0.00 58.28 $0.00

86970 Rbc pretx incubatj w/chemicl 0.00 58.28 $0.00

86971 Rbc pretx incubatj w/enzymes 0.00 58.28 $0.00

86972 Rbc pretx incubatj w/density 0.00 58.28 $0.00

86975 Rbc serum pretx incubj drugs 0.00 58.28 $0.00

86976 Rbc serum pretx id dilution 0.00 58.28 $0.00

86977 Rbc serum pretx incubj/inhib 0.00 58.28 $0.00

86978 Rbc pretreatment serum 0.00 58.28 $0.00

86985 Split blood or products 0.00 58.28 $0.00

86999 Transfusion procedure 0.00 58.28 $0.00

87003 Small animal inoculation 0.00 58.28 $0.00

87015 Specimen infect agnt concntj 0.00 58.28 $0.00

87040 Blood culture for bacteria 0.00 58.28 $0.00

87045 Feces culture aerobic bact 0.00 58.28 $0.00

87046 Stool cultr aerobic bact ea 0.00 58.28 $0.00

87070 Culture othr specimn aerobic 0.00 58.28 $0.00

87071 Culture aerobic quant other 0.00 58.28 $0.00

87073 Culture bacteria anaerobic 0.00 58.28 $0.00

87075 Cultr bacteria except blood 0.00 58.28 $0.00

87076 Culture anaerobe ident each 0.00 58.28 $0.00

87077 Culture aerobic identify 0.00 58.28 $0.00

87081 Culture screen only 0.00 58.28 $0.00

87084 Culture of specimen by kit 0.00 58.28 $0.00

87086 Urine culture/colony count 0.00 58.28 $0.00

87088 Urine bacteria culture 0.00 58.28 $0.00

87101 Skin fungi culture 0.00 58.28 $0.00

87102 Fungus isolation culture 0.00 58.28 $0.00

87103 Blood fungus culture 0.00 58.28 $0.00

87106 Fungi identification yeast 0.00 58.28 $0.00

87107 Fungi identification mold 0.00 58.28 $0.00

87109 Mycoplasma 0.00 58.28 $0.00

87110 Chlamydia culture 0.00 58.28 $0.00

87116 Mycobacteria culture 0.00 58.28 $0.00

87118 Mycobacteric identification 0.00 58.28 $0.00

87140 Culture type immunofluoresc 0.00 58.28 $0.00

87143 Culture typing glc/hplc 0.00 58.28 $0.00

87147 Culture type immunologic 0.00 58.28 $0.00

87149 Dna/rna direct probe 0.00 58.28 $0.00

87150 Dna/rna amplified probe 0.00 58.28 $0.00

87152 Culture type pulse field gel 0.00 58.28 $0.00

87153 Dna/rna sequencing 0.00 58.28 $0.00

87158 Culture typing added method 0.00 58.28 $0.00

87164 Dark field examination 0.00 58.28 $0.00

87164 26 Dark field examination 0.53 58.28 $30.89

87166 Dark field examination 0.00 58.28 $0.00

87168 Macroscopic exam arthropod 0.00 58.28 $0.00

87169 Macroscopic exam parasite 0.00 58.28 $0.00

87172 Pinworm exam 0.00 58.28 $0.00

87176 Tissue homogenization cultr 0.00 58.28 $0.00

87177 Ova and parasites smears 0.00 58.28 $0.00

87181 Microbe susceptible diffuse 0.00 58.28 $0.00

87184 Microbe susceptible disk 0.00 58.28 $0.00

87185 Microbe susceptible enzyme 0.00 58.28 $0.00

87186 Microbe susceptible mic 0.00 58.28 $0.00

87187 Microbe susceptible mlc 0.00 58.28 $0.00

87188 Microbe suscept macrobroth 0.00 58.28 $0.00

87190 Microbe suscept mycobacteri 0.00 58.28 $0.00

87197 Bactericidal level serum 0.00 58.28 $0.00

87205 Smear gram stain 0.00 58.28 $0.00

87206 Smear fluorescent/acid stai 0.00 58.28 $0.00

87207 Smear special stain 0.00 58.28 $0.00

87207 26 Smear special stain 0.53 58.28 $30.89

87209 Smear complex stain 0.00 58.28 $0.00

87210 Smear wet mount saline/ink 0.00 58.28 $0.00

87220 Tissue exam for fungi 0.00 58.28 $0.00

87230 Assay toxin or antitoxin 0.00 58.28 $0.00

87250 Virus inoculate eggs/animal 0.00 58.28 $0.00

87252 Virus inoculation tissue 0.00 58.28 $0.00

87253 Virus inoculate tissue addl 0.00 58.28 $0.00

87254 Virus inoculation shell via 0.00 58.28 $0.00

87255 Genet virus isolate hsv 0.00 58.28 $0.00

87260 Adenovirus ag if 0.00 58.28 $0.00

87265 Pertussis ag if 0.00 58.28 $0.00

87267 Enterovirus antibody dfa 0.00 58.28 $0.00

87269 Giardia ag if 0.00 58.28 $0.00

87270 Chlamydia trachomatis ag if 0.00 58.28 $0.00

87271 Cytomegalovirus dfa 0.00 58.28 $0.00

87272 Cryptosporidium ag if 0.00 58.28 $0.00

87273 Herpes simplex 2 ag if 0.00 58.28 $0.00

87274 Herpes simplex 1 ag if 0.00 58.28 $0.00

87275 Influenza b ag if 0.00 58.28 $0.00

87276 Influenza a ag if 0.00 58.28 $0.00

87277 Legionella micdadei ag if 0.00 58.28 $0.00

87278 Legion pneumophilia ag if 0.00 58.28 $0.00

87279 Parainfluenza ag if 0.00 58.28 $0.00

87280 Respiratory syncytial ag if 0.00 58.28 $0.00

87281 Pneumocystis carinii ag if 0.00 58.28 $0.00

87283 Rubeola ag if 0.00 58.28 $0.00

87285 Treponema pallidum ag if 0.00 58.28 $0.00

87290 Varicella zoster ag if 0.00 58.28 $0.00

87299 Antibody detection nos if 0.00 58.28 $0.00

87300 Ag detection polyval if 0.00 58.28 $0.00

87301 Adenovirus ag eia 0.00 58.28 $0.00

87305 Aspergillus ag eia 0.00 58.28 $0.00

87320 Chylmd trach ag eia 0.00 58.28 $0.00

87324 Clostridium ag eia 0.00 58.28 $0.00

87327 Cryptococcus neoform ag eia 0.00 58.28 $0.00

87328 Cryptosporidium ag eia 0.00 58.28 $0.00

87329 Giardia ag eia 0.00 58.28 $0.00

87332 Cytomegalovirus ag eia 0.00 58.28 $0.00

87335 E coli 0157 ag eia 0.00 58.28 $0.00

87336 Entamoeb hist dispr ag eia 0.00 58.28 $0.00

87337 Entamoeb hist group ag eia 0.00 58.28 $0.00

87338 Hpylori stool eia 0.00 58.28 $0.00

87339 H pylori ag eia 0.00 58.28 $0.00

87340 Hepatitis b surface ag eia 0.00 58.28 $0.00

87341 Hepatitis b surface ag eia 0.00 58.28 $0.00

87350 Hepatitis be ag eia 0.00 58.28 $0.00

87380 Hepatitis delta ag eia 0.00 58.28 $0.00

87385 Histoplasma capsul ag eia 0.00 58.28 $0.00

87389 Hiv-1 ag w/hiv-1 & hiv-2 ab 0.00 58.28 $0.00

87390 Hiv-1 ag eia 0.00 58.28 $0.00

87391 Hiv-2 ag eia 0.00 58.28 $0.00

87400 Influenza a/b ag eia 0.00 58.28 $0.00

87420 Resp syncytial ag eia 0.00 58.28 $0.00

87425 Rotavirus ag eia 0.00 58.28 $0.00

87427 Shiga-like toxin ag eia 0.00 58.28 $0.00

87430 Strep a ag eia 0.00 58.28 $0.00

87449 Ag detect nos eia mult 0.00 58.28 $0.00

87450 Ag detect nos eia single 0.00 58.28 $0.00

87451 Ag detect polyval eia mult 0.00 58.28 $0.00

87470 Bartonella dna dir probe 0.00 58.28 $0.00

87471 Bartonella dna amp probe 0.00 58.28 $0.00

87472 Bartonella dna quant 0.00 58.28 $0.00

87475 Lyme dis dna dir probe 0.00 58.28 $0.00

87476 Lyme dis dna amp probe 0.00 58.28 $0.00

87477 Lyme dis dna quant 0.00 58.28 $0.00

87480 Candida dna dir probe 0.00 58.28 $0.00

87481 Candida dna amp probe 0.00 58.28 $0.00

87482 Candida dna quant 0.00 58.28 $0.00

87485 Chylmd pneum dna dir probe 0.00 58.28 $0.00

87486 Chylmd pneum dna amp probe 0.00 58.28 $0.00

87487 Chylmd pneum dna quant 0.00 58.28 $0.00

87490 Chylmd trach dna dir probe 0.00 58.28 $0.00

87491 Chylmd trach dna amp probe 0.00 58.28 $0.00

87492 Chylmd trach dna quant 0.00 58.28 $0.00

87493 C diff amplified probe 0.00 58.28 $0.00

87495 Cytomeg dna dir probe 0.00 58.28 $0.00

87496 Cytomeg dna amp probe 0.00 58.28 $0.00

87497 Cytomeg dna quant 0.00 58.28 $0.00

87498 Enterovirus probe&revrs trns 0.00 58.28 $0.00

87500 Vanomycin dna amp probe 0.00 58.28 $0.00

87501 Influenza dna amp prob 1+ 0.00 58.28 $0.00

87502 Influenza dna amp probe 0.00 58.28 $0.00

87503 Influenza dna amp prob addl 0.00 58.28 $0.00

87505 Nfct agent detection gi 0.00 58.28 $0.00

87506 Iadna-dna/rna probe tq 6-11 0.00 58.28 $0.00

87507 Iadna-dna/rna probe tq 12-25 0.00 58.28 $0.00

87510 Gardner vag dna dir probe 0.00 58.28 $0.00

87511 Gardner vag dna amp probe 0.00 58.28 $0.00

87512 Gardner vag dna quant 0.00 58.28 $0.00

87515 Hepatitis b dna dir probe 0.00 58.28 $0.00

87516 Hepatitis b dna amp probe 0.00 58.28 $0.00

87517 Hepatitis b dna quant 0.00 58.28 $0.00

87520 Hepatitis c rna dir probe 0.00 58.28 $0.00

87521 Hepatitis c probe&rvrs trnsc 0.00 58.28 $0.00

87522 Hepatitis c revrs trnscrpj 0.00 58.28 $0.00

87525 Hepatitis g dna dir probe 0.00 58.28 $0.00

87526 Hepatitis g dna amp probe 0.00 58.28 $0.00

87527 Hepatitis g dna quant 0.00 58.28 $0.00

87528 Hsv dna dir probe 0.00 58.28 $0.00

87529 Hsv dna amp probe 0.00 58.28 $0.00

87530 Hsv dna quant 0.00 58.28 $0.00

87531 Hhv-6 dna dir probe 0.00 58.28 $0.00

87532 Hhv-6 dna amp probe 0.00 58.28 $0.00

87533 Hhv-6 dna quant 0.00 58.28 $0.00

87534 Hiv-1 dna dir probe 0.00 58.28 $0.00

87535 Hiv-1 probe&reverse trnscrpj 0.00 58.28 $0.00

87536 Hiv-1 quant&revrse trnscrpj 0.00 58.28 $0.00

87537 Hiv-2 dna dir probe 0.00 58.28 $0.00

87538 Hiv-2 probe&revrse trnscripj 0.00 58.28 $0.00

87539 Hiv-2 quant&revrse trnscripj 0.00 58.28 $0.00

87540 Legion pneumo dna dir prob 0.00 58.28 $0.00

87541 Legion pneumo dna amp prob 0.00 58.28 $0.00

87542 Legion pneumo dna quant 0.00 58.28 $0.00

87550 Mycobacteria dna dir probe 0.00 58.28 $0.00

87551 Mycobacteria dna amp probe 0.00 58.28 $0.00

87552 Mycobacteria dna quant 0.00 58.28 $0.00

87555 M.tuberculo dna dir probe 0.00 58.28 $0.00

87556 M.tuberculo dna amp probe 0.00 58.28 $0.00

87557 M.tuberculo dna quant 0.00 58.28 $0.00

87560 M.avium-intra dna dir prob 0.00 58.28 $0.00

87561 M.avium-intra dna amp prob 0.00 58.28 $0.00

87562 M.avium-intra dna quant 0.00 58.28 $0.00

87580 M.pneumon dna dir probe 0.00 58.28 $0.00

87581 M.pneumon dna amp probe 0.00 58.28 $0.00

87582 M.pneumon dna quant 0.00 58.28 $0.00

87590 N.gonorrhoeae dna dir prob 0.00 58.28 $0.00

87591 N.gonorrhoeae dna amp prob 0.00 58.28 $0.00

87592 N.gonorrhoeae dna quant 0.00 58.28 $0.00

87623 Hpv low-risk types 0.00 58.28 $0.00

87624 Hpv high-risk types 0.00 58.28 $0.00

87625 Hpv types 16 & 18 only 0.00 58.28 $0.00

87631 Resp virus 3-5 targets 0.00 58.28 $0.00



87640 Staph a dna amp probe 0.00 58.28 $0.00

87641 Mr-staph dna amp probe 0.00 58.28 $0.00

87650 Strep a dna dir probe 0.00 58.28 $0.00

87651 Strep a dna amp probe 0.00 58.28 $0.00

87652 Strep a dna quant 0.00 58.28 $0.00

87653 Strep b dna amp probe 0.00 58.28 $0.00

87660 Trichomonas vagin dir probe 0.00 58.28 $0.00

87661 Trichomonas vaginalis amplif 0.00 58.28 $0.00

87797 Detect agent nos dna dir 0.00 58.28 $0.00

87798 Detect agent nos dna amp 0.00 58.28 $0.00

87799 Detect agent nos dna quant 0.00 58.28 $0.00

87800 Detect agnt mult dna direc 0.00 58.28 $0.00

87801 Detect agnt mult dna ampli 0.00 58.28 $0.00

87802 Strep b assay w/optic 0.00 58.28 $0.00

87803 Clostridium toxin a w/optic 0.00 58.28 $0.00

87804 Influenza assay w/optic 0.00 58.28 $0.00

87806 Hiv antigen w/hiv antibodies 0.00 58.28 $0.00

87807 Rsv assay w/optic 0.00 58.28 $0.00

87808 Trichomonas assay w/optic 0.00 58.28 $0.00

87809 Adenovirus assay w/optic 0.00 58.28 $0.00

87810 Chylmd trach assay w/optic 0.00 58.28 $0.00

87850 N. gonorrhoeae assay w/optic 0.00 58.28 $0.00

87880 Strep a assay w/optic 0.00 58.28 $0.00

87899 Agent nos assay w/optic 0.00 58.28 $0.00

87900 Phenotype infect agent drug 0.00 58.28 $0.00

87901 Genotype dna hiv reverse t 0.00 58.28 $0.00

87902 Genotype dna/rna hep c 0.00 58.28 $0.00

87903 Phenotype dna hiv w/culture 0.00 58.28 $0.00

87904 Phenotype dna hiv w/clt add 0.00 58.28 $0.00

87905 Sialidase enzyme assay 0.00 58.28 $0.00

87906 Genotype dna/rna hiv 0.00 58.28 $0.00

87910 Genotype cytomegalovirus 0.00 58.28 $0.00

87912 Genotype dna hepatitis b 0.00 58.28 $0.00

87999 Microbiology procedure 0.00 58.28 $0.00

88000 Autopsy (necropsy) gross 0.00 58.28 $0.00






88020 Autopsy (necropsy) complete 0.00 58.28 $0.00





88036 Limited autopsy 0.00 58.28 $0.00

88037 Limited autopsy 0.00 58.28 $0.00

88040 Forensic autopsy (necropsy) 0.00 58.28 $0.00

88045 Coroners autopsy (necropsy) 0.00 58.28 $0.00

88099 Necropsy (autopsy) procedure 0.00 58.28 $0.00

88104 Cytopath fl nongyn smears 2.10 58.28 $122.39

88104 TC Cytopath fl nongyn smears 1.27 58.28 $74.02

88104 26 Cytopath fl nongyn smears 0.83 58.28 $48.37

88106 Cytopath fl nongyn filter 2.46 58.28 $143.37

88106 TC Cytopath fl nongyn filter 1.90 58.28 $110.73

88106 26 Cytopath fl nongyn filter 0.56 58.28 $32.64

88108 Cytopath concentrate tech 2.37 58.28 $138.12

88108 TC Cytopath concentrate tech 1.71 58.28 $99.66

88108 26 Cytopath concentrate tech 0.66 58.28 $38.46

88112 Cytopath cell enhance tech 1.81 58.28 $105.49

88112 TC Cytopath cell enhance tech 1.01 58.28 $58.86

88112 26 Cytopath cell enhance tech 0.80 58.28 $46.62

88120 Cytp urne 3-5 probes ea spec 17.43 58.28 $1,015.82

88120 TC Cytp urne 3-5 probes ea spec 15.78 58.28 $919.66

88120 26 Cytp urne 3-5 probes ea spec 1.65 58.28 $96.16

88121 Cytp urine 3-5 probes cmptr 15.50 58.28 $903.34

88121 TC Cytp urine 3-5 probes cmptr 14.06 58.28 $819.42

88121 26 Cytp urine 3-5 probes cmptr 1.44 58.28 $83.92

88125 Forensic cytopathology 0.74 58.28 $43.13

88125 TC Forensic cytopathology 0.33 58.28 $19.23

88125 26 Forensic cytopathology 0.41 58.28 $23.89

88130 Sex chromatin identification 0.00 58.28 $0.00

88140 Sex chromatin identification 0.00 58.28 $0.00

88141 Cytopath c/v interpret 0.91 58.28 $53.03

88142 Cytopath c/v thin layer 0.00 58.28 $0.00

88143 Cytopath c/v thin layer redo 0.00 58.28 $0.00

88147 Cytopath c/v automated 0.00 58.28 $0.00

88148 Cytopath c/v auto rescreen 0.00 58.28 $0.00

88150 Cytopath c/v manual 0.00 58.28 $0.00

88152 Cytopath c/v auto redo 0.00 58.28 $0.00

88153 Cytopath c/v redo 0.00 58.28 $0.00

88154 Cytopath c/v select 0.00 58.28 $0.00

88155 Cytopath c/v index add-on 0.00 58.28 $0.00

88160 Cytopath smear other source 1.88 58.28 $109.57

88160 TC Cytopath smear other source 1.13 58.28 $65.86

88160 26 Cytopath smear other source 0.75 58.28 $43.71







88164 Cytopath tbs c/v manual 0.00 58.28 $0.00

88165 Cytopath tbs c/v redo 0.00 58.28 $0.00

88166 Cytopath tbs c/v auto redo 0.00 58.28 $0.00

88167 Cytopath tbs c/v select 0.00 58.28 $0.00

88172 Cytp dx eval fna 1st ea site 1.59 58.28 $92.67

88172 TC Cytp dx eval fna 1st ea site 0.55 58.28 $32.05

88172 26 Cytp dx eval fna 1st ea site 1.04 58.28 $60.61

88173 Cytopath eval fna report 4.24 58.28 $247.11

88173 TC Cytopath eval fna report 2.22 58.28 $129.38

88173 26 Cytopath eval fna report 2.02 58.28 $117.73

88174 Cytopath c/v auto in fluid 0.00 58.28 $0.00

88175 Cytopath c/v auto fluid redo 0.00 58.28 $0.00

88177 Cytp fna eval ea addl 0.86 58.28 $50.12

88177 TC Cytp fna eval ea addl 0.22 58.28 $12.82

88177 26 Cytp fna eval ea addl 0.64 58.28 $37.30

88182 Cell marker study 3.04 58.28 $177.17

88182 TC Cell marker study 2.03 58.28 $118.31

88182 26 Cell marker study 1.01 58.28 $58.86

88184 Flowcytometry/ tc 1 marker 2.63 58.28 $153.28

88185 Flowcytometry/tc add-on 1.60 58.28 $93.25

88187 Flowcytometry/read 2-8 2.02 58.28 $117.73

88188 Flowcytometry/read 9-15 2.57 58.28 $149.78

88189 Flowcytometry/read 16 & > 3.17 58.28 $184.75

88199 Cytopathology procedure 0.00 58.28 $0.00

88199 TC Cytopathology procedure 0.00 58.28 $0.00

88199 26 Cytopathology procedure 0.00 58.28 $0.00

88230 Tissue culture lymphocyte 0.00 58.28 $0.00

88233 Tissue culture skin/biopsy 0.00 58.28 $0.00

88235 Tissue culture placenta 0.00 58.28 $0.00

88237 Tissue culture bone marrow 0.00 58.28 $0.00

88239 Tissue culture tumor 0.00 58.28 $0.00

88240 Cell cryopreserve/storage 0.00 58.28 $0.00

88241 Frozen cell preparation 0.00 58.28 $0.00

88245 Chromosome analysis 20-25 0.00 58.28 $0.00


88249 Chromosome analysis 100 0.00 58.28 $0.00





88267 Chromosome analys placenta 0.00 58.28 $0.00

88269 Chromosome analys amniotic 0.00 58.28 $0.00

88271 Cytogenetics dna probe 0.00 58.28 $0.00

88272 Cytogenetics 3-5 0.00 58.28 $0.00

88273 Cytogenetics 10-30 0.00 58.28 $0.00

88274 Cytogenetics 25-99 0.00 58.28 $0.00

88275 Cytogenetics 100-300 0.00 58.28 $0.00

88280 Chromosome karyotype study 0.00 58.28 $0.00

88283 Chromosome banding study 0.00 58.28 $0.00

88285 Chromosome count additional 0.00 58.28 $0.00

88289 Chromosome study additional 0.00 58.28 $0.00

88291 Cyto/molecular report 0.89 58.28 $51.87

88299 Cytogenetic study 0.00 58.28 $0.00

88300 Surgical path gross 0.43 58.28 $25.06

88300 TC Surgical path gross 0.30 58.28 $17.48

88300 26 Surgical path gross 0.13 58.28 $7.58

88302 Tissue exam by pathologist 0.90 58.28 $52.45

88302 TC Tissue exam by pathologist 0.70 58.28 $40.80

88302 26 Tissue exam by pathologist 0.20 58.28 $11.66













88311 Decalcify tissue 0.59 58.28 $34.39

88311 TC Decalcify tissue 0.23 58.28 $13.40

88311 26 Decalcify tissue 0.36 58.28 $20.98

88312 Special stains group 1 2.73 58.28 $159.10

88312 TC Special stains group 1 1.95 58.28 $113.65

88312 26 Special stains group 1 0.78 58.28 $45.46

88313 Special stains group 2 1.90 58.28 $110.73

88313 TC Special stains group 2 1.55 58.28 $90.33

88313 26 Special stains group 2 0.35 58.28 $20.40

88314 Histochemical stains add-on 2.09 58.28 $121.81

88314 TC Histochemical stains add-on 1.45 58.28 $84.51

88314 26 Histochemical stains add-on 0.64 58.28 $37.30

88319 Enzyme histochemistry 2.48 58.28 $144.53

88319 TC Enzyme histochemistry 1.69 58.28 $98.49

88319 26 Enzyme histochemistry 0.79 58.28 $46.04

88321 Microslide consultation 2.70 58.28 $157.36

88323 Microslide consultation 4.26 58.28 $248.27

88323 TC Microslide consultation 1.76 58.28 $102.57

88323 26 Microslide consultation 2.50 58.28 $145.70

88325 Comprehensive review of data 6.03 58.28 $351.43

88329 Path consult introp 1.65 58.28 $96.16

88331 Path consult intraop 1 bloc 2.89 58.28 $168.43

88331 TC Path consult intraop 1 bloc 1.09 58.28 $63.53

88331 26 Path consult intraop 1 bloc 1.80 58.28 $104.90

88332 Path consult intraop addl 1.27 58.28 $74.02

88332 TC Path consult intraop addl 0.38 58.28 $22.15

88332 26 Path consult intraop addl 0.89 58.28 $51.87

88333 Intraop cyto path consult 1 3.05 58.28 $177.75

88333 TC Intraop cyto path consult 1 1.24 58.28 $72.27

88333 26 Intraop cyto path consult 1 1.81 58.28 $105.49

88334 Intraop cyto path consult 2 1.87 58.28 $108.98

88334 TC Intraop cyto path consult 2 0.76 58.28 $44.29

88334 26 Intraop cyto path consult 2 1.11 58.28 $64.69

88341 Immunohisto antibody slide 1.89 58.28 $110.15

88341 TC Immunohisto antibody slide 1.28 58.28 $74.60

88341 26 Immunohisto antibody slide 0.61 58.28 $35.55

88342 Immunohisto antibody stain 2.53 58.28 $147.45

88342 TC Immunohisto antibody stain 1.51 58.28 $88.00

88342 26 Immunohisto antibody stain 1.02 58.28 $59.45

88344 Immunohisto antibody slide 3.27 58.28 $190.58

88344 TC Immunohisto antibody slide 2.15 58.28 $125.30

88344 26 Immunohisto antibody slide 1.12 58.28 $65.27

88346 Immunofluorescent study 3.09 58.28 $180.09

88346 TC Immunofluorescent study 1.87 58.28 $108.98

88346 26 Immunofluorescent study 1.22 58.28 $71.10

88347 Immunofluorescent study 2.60 58.28 $151.53

88347 TC Immunofluorescent study 1.40 58.28 $81.59

88347 26 Immunofluorescent study 1.20 58.28 $69.94

88348 Electron microscopy 9.70 58.28 $565.32

88348 TC Electron microscopy 7.52 58.28 $438.27

88348 26 Electron microscopy 2.18 58.28 $127.05

88355 Analysis skeletal muscle 4.89 58.28 $284.99

88355 TC Analysis skeletal muscle 2.56 58.28 $149.20

88355 26 Analysis skeletal muscle 2.33 58.28 $135.79

88356 Analysis nerve 5.75 58.28 $335.11

88356 TC Analysis nerve 2.33 58.28 $135.79

88356 26 Analysis nerve 3.42 58.28 $199.32

88358 Analysis tumor 2.36 58.28 $137.54

88358 TC Analysis tumor 1.09 58.28 $63.53

88358 26 Analysis tumor 1.27 58.28 $74.02

88360 Tumor immunohistochem/manual 3.80 58.28 $221.46

88360 TC Tumor immunohistochem/manual 2.25 58.28 $131.13

88360 26 Tumor immunohistochem/manual 1.55 58.28 $90.33

88361 Tumor immunohistochem/comput 4.74 58.28 $276.25

88361 TC Tumor immunohistochem/comput 3.06 58.28 $178.34

88361 26 Tumor immunohistochem/comput 1.68 58.28 $97.91

88362 Nerve teasing preparations 8.28 58.28 $482.56

88362 TC Nerve teasing preparations 5.13 58.28 $298.98

88362 26 Nerve teasing preparations 3.15 58.28 $183.58

88363 Xm archive tissue molec anal 0.64 58.28 $37.30

88364 Insitu hybridization (fish) 2.72 58.28 $158.52

88364 TC Insitu hybridization (fish) 1.96 58.28 $114.23

88364 26 Insitu hybridization (fish) 0.76 58.28 $44.29







88367 Insitu hybridization auto 3.00 58.28 $174.84

88367 TC Insitu hybridization auto 2.01 58.28 $117.14

88367 26 Insitu hybridization auto 0.99 58.28 $57.70

88368 Insitu hybridization manual 3.04 58.28 $177.17

88368 TC Insitu hybridization manual 1.89 58.28 $110.15

88368 26 Insitu hybridization manual 1.15 58.28 $67.02

88369 M/phmtrc alysishquant/semiq 2.06 58.28 $120.06

88369 TC M/phmtrc alysishquant/semiq 1.36 58.28 $79.26

88369 26 M/phmtrc alysishquant/semiq 0.70 58.28 $40.80

88371 Protein western blot tissue 0.00 58.28 $0.00

88371 26 Protein western blot tissue 0.53 58.28 $30.89

88372 Protein analysis w/probe 0.00 58.28 $0.00

88372 26 Protein analysis w/probe 0.53 58.28 $30.89

88373 M/phmtrc alys ishquant/semiq 1.69 58.28 $98.49

88373 TC M/phmtrc alys ishquant/semiq 1.10 58.28 $64.11

88373 26 M/phmtrc alys ishquant/semiq 0.59 58.28 $34.39




88375 Optical endomicroscpy interp 1.34 58.28 $78.10




88380 Microdissection laser 3.71 58.28 $216.22

88380 TC Microdissection laser 2.13 58.28 $124.14

88380 26 Microdissection laser 1.58 58.28 $92.08

88381 Microdissection manual 3.48 58.28 $202.81

88381 TC Microdissection manual 2.75 58.28 $160.27

88381 26 Microdissection manual 0.73 58.28 $42.54

88387 Tiss exam molecular study 1.20 58.28 $69.94

88387 TC Tiss exam molecular study 0.28 58.28 $16.32

88387 26 Tiss exam molecular study 0.92 58.28 $53.62

88388 Tiss ex molecul study add-on 0.96 58.28 $55.95

88388 TC Tiss ex molecul study add-on 0.27 58.28 $15.74

88388 26 Tiss ex molecul study add-on 0.69 58.28 $40.21

88399 Surgical pathology procedure 0.00 58.28 $0.00

88399 TC Surgical pathology procedure 0.00 58.28 $0.00

88399 26 Surgical pathology procedure 0.00 58.28 $0.00

88720 Bilirubin total transcut 0.00 58.28 $0.00

88738 Hgb quant transcutaneous 0.00 58.28 $0.00

88740 Transcutaneous carboxyhb 0.00 58.28 $0.00

88741 Transcutaneous methb 0.00 58.28 $0.00

88749 In vivo lab service 0.00 58.28 $0.00

89049 Chct for mal hyperthermia 6.76 58.28 $393.97

89050 Body fluid cell count 0.00 58.28 $0.00

89051 Body fluid cell count 0.00 58.28 $0.00

89055 Leukocyte assessment fecal 0.00 58.28 $0.00

89060 Exam synovial fluid crystals 0.00 58.28 $0.00

89060 26 Exam synovial fluid crystals 0.53 58.28 $30.89

89125 Specimen fat stain 0.00 58.28 $0.00

89160 Exam feces for meat fibers 0.00 58.28 $0.00

89190 Nasal smear for eosinophils 0.00 58.28 $0.00

89220 Sputum specimen collection 0.44 58.28 $25.64

89230 Collect sweat for test 0.07 58.28 $4.08

89240 Pathology lab procedure 0.00 58.28 $0.00

89250 Cultr oocyte/embryo <4 days 0.00 58.28 $0.00

89251 Cultr oocyte/embryo <4 days 0.00 58.28 $0.00

89253 Embryo hatching 0.00 58.28 $0.00

89254 Oocyte identification 0.00 58.28 $0.00

89255 Prepare embryo for transfer 0.00 58.28 $0.00

89257 Sperm identification 0.00 58.28 $0.00

89258 Cryopreservation embryo(s) 0.00 58.28 $0.00

89259 Cryopreservation sperm 0.00 58.28 $0.00

89260 Sperm isolation simple 0.00 58.28 $0.00

89261 Sperm isolation complex 0.00 58.28 $0.00

89264 Identify sperm tissue 0.00 58.28 $0.00

89268 Insemination of oocytes 0.00 58.28 $0.00

89272 Extended culture of oocytes 0.00 58.28 $0.00

89280 Assist oocyte fertilization 0.00 58.28 $0.00

89281 Assist oocyte fertilization 0.00 58.28 $0.00

89290 Biopsy oocyte polar body 0.00 58.28 $0.00

89291 Biopsy oocyte polar body 0.00 58.28 $0.00

89300 Semen analysis w/huhner 0.00 58.28 $0.00

89310 Semen analysis w/count 0.00 58.28 $0.00

89320 Semen anal vol/count/mot 0.00 58.28 $0.00

89321 Semen anal sperm detection 0.00 58.28 $0.00

89322 Semen anal strict criteria 0.00 58.28 $0.00

89325 Sperm antibody test 0.00 58.28 $0.00

89329 Sperm evaluation test 0.00 58.28 $0.00

89330 Evaluation cervical mucus 0.00 58.28 $0.00

89331 Retrograde ejaculation anal 0.00 58.28 $0.00

89335 Cryopreserve testicular tiss 0.00 58.28 $0.00

89337 Cryopreservation oocyte(s) 0.00 58.28 $0.00

89342 Storage/year embryo(s) 0.00 58.28 $0.00

89343 Storage/year sperm/semen 0.00 58.28 $0.00

89344 Storage/year reprod tissue 0.00 58.28 $0.00

89346 Storage/year oocyte(s) 0.00 58.28 $0.00

89352 Thawing cryopresrved embryo 0.00 58.28 $0.00

89353 Thawing cryopresrved sperm 0.00 58.28 $0.00

89354 Thaw cryoprsvrd reprod tiss 0.00 58.28 $0.00

89356 Thawing cryopresrved oocyte 0.00 58.28 $0.00

89398 Unlisted reprod med lab proc 0.00 58.28 $0.00

9001F Aortic aneurysm<5cm diam ct 0.00 44.28 $0.00

9002F Aortic aneurysm 5-5.4cm diam 0.00 44.28 $0.00

9003F Aortic anrysm5.5-5.9cm diam 0.00 44.28 $0.00

9004F Aortic anrysm 6/> cm diam 0.00 44.28 $0.00

9005F Asympt carot/vrtbrbas sten 0.00 44.28 $0.00

9006F Sympt sten-tia/strk<120days 0.00 44.28 $0.00

9007F Other carot sten 120 days/> 0.00 44.28 $0.00

90281 Human ig im 0.00 44.28 $0.00

90283 Human ig iv 0.00 44.28 $0.00

90284 Human ig sc 0.00 44.28 $0.00

90287 Botulinum antitoxin 0.00 44.28 $0.00

90288 Botulism ig iv 0.00 44.28 $0.00

90291 Cmv ig iv 0.00 44.28 $0.00

90296 Diphtheria antitoxin 0.00 44.28 $0.00

90371 Hep b ig im 0.00 44.28 $0.00

90375 Rabies ig im/sc 0.00 44.28 $0.00

90376 Rabies ig heat treated 0.00 44.28 $0.00

90378 Rsv mab im 50mg 0.00 44.28 $0.00

90384 Rh ig full-dose im 0.00 44.28 $0.00

90385 Rh ig minidose im 0.00 44.28 $0.00

90386 Rh ig iv 0.00 44.28 $0.00

90389 Tetanus ig im 0.00 44.28 $0.00

90393 Vaccina ig im 0.00 44.28 $0.00

90396 Varicella-zoster ig im 0.00 44.28 $0.00

90399 Immune globulin 0.00 44.28 $0.00

90460 Im admin 1st/only component 0.71 44.28 $31.44

90461 Im admin each addl component 0.36 44.28 $15.94

90471 Immunization admin 0.71 44.28 $31.44

90472 Immunization admin each add 0.36 44.28 $15.94

90473 Immune admin oral/nasal 0.71 44.28 $31.44

90474 Immune admin oral/nasal addl 0.36 44.28 $15.94

90476 Adenovirus vaccine type 4 0.00 44.28 $0.00

90477 Adenovirus vaccine type 7 0.00 44.28 $0.00

90581 Anthrax vaccine sc or im 0.00 44.28 $0.00

90585 Bcg vaccine percut 0.00 44.28 $0.00

90586 Bcg vaccine intravesical 0.00 44.28 $0.00

90630 Flu vacc iiv4 no preserv id 0.00 44.28 $0.00

90632 Hep a vaccine adult im 0.00 44.28 $0.00

90633 Hep a vacc ped/adol 2 dose 0.00 44.28 $0.00

90634 Hep a vacc ped/adol 3 dose 0.00 44.28 $0.00

90636 Hep a/hep b vacc adult im 0.00 44.28 $0.00

90644 Meningoccl hib vac 4 dose im 0.00 44.28 $0.00

90645 Hib vaccine hboc im 0.00 44.28 $0.00

90646 Hib vaccine prp-d im 0.00 44.28 $0.00

90647 Hib vaccine prp-omp im 0.00 44.28 $0.00

90648 Hib vaccine prp-t im 0.00 44.28 $0.00

90649 Hpv vaccine 4 valent im 0.00 44.28 $0.00

90650 Hpv vaccine 2 valent im 0.00 44.28 $0.00

90651 Hpv vaccine non valent im 0.00 44.28 $0.00

90653 Flu vaccine adjuvant im 0.00 44.28 $0.00

90654 Flu vacc iiv3 no preserv id 0.00 44.28 $0.00

90655 Flu vac no prsv 3 val 6-35 m 0.00 44.28 $0.00

90656 Flu vaccine no preserv 3 & > 0.00 44.28 $0.00

90657 Flu vaccine 3 yrs im 0.00 44.28 $0.00

90658 Flu vaccine 3 yrs & > im 0.00 44.28 $0.00

90660 Flu vaccine nasal 0.00 44.28 $0.00

90661 Flu vacc cell cult prsv free 0.00 44.28 $0.00

90662 Flu vacc prsv free inc antig 0.00 44.28 $0.00

90664 Flu vacc pandemic intranasal 0.00 44.28 $0.00

90666 Flu vac pandem prsrv free im 0.00 44.28 $0.00

90667 Flu vac pandemic adjuvant im 0.00 44.28 $0.00

90668 Flu vac pandemic splt im 0.00 44.28 $0.00

90669 Pneumococcal vacc 7 val im 0.00 44.28 $0.00


90672 Flu vaccine 4 valent nasal 0.00 44.28 $0.00

90673 Flu vacc riv3 no preserv 0.00 44.28 $0.00

90675 Rabies vaccine im 0.00 44.28 $0.00

90676 Rabies vaccine id 0.00 44.28 $0.00

90680 Rotovirus vacc 3 dose oral 0.00 44.28 $0.00

90681 Rotavirus vacc 2 dose oral 0.00 44.28 $0.00

90685 Flu vac no prsv 4 val 6-35 m 0.00 44.28 $0.00

90686 Flu vac no prsv 4 val 3 yrs+ 0.00 44.28 $0.00

90687 Flu vaccine 4 val 6-35 mo im 0.00 44.28 $0.00

90688 Flu vacc 4 val 3 yrs plus im 0.00 44.28 $0.00

90690 Typhoid vaccine oral 0.00 44.28 $0.00

90691 Typhoid vaccine im 0.00 44.28 $0.00

90692 Typhoid vaccine h-p sc/id 0.00 44.28 $0.00

90693 Typhoid vaccine akd sc 0.00 44.28 $0.00

90696 Dtap-ipv vacc 4-6 yr im 0.00 44.28 $0.00

90698 Dtap-hib-ip vaccine im 0.00 44.28 $0.00

90700 Dtap vaccine < 7 yrs im 0.00 44.28 $0.00

90702 Dt vaccine < 7 yrs im 0.00 44.28 $0.00

90703 Tetanus vaccine im 0.00 44.28 $0.00

90704 Mumps vaccine sc 0.00 44.28 $0.00

90705 Measles vaccine sc 0.00 44.28 $0.00

90706 Rubella vaccine sc 0.00 44.28 $0.00

90707 Mmr vaccine sc 0.00 44.28 $0.00

90708 Measles-rubella vaccine sc 0.00 44.28 $0.00

90710 Mmrv vaccine sc 0.00 44.28 $0.00

90712 Oral poliovirus vaccine 0.00 44.28 $0.00

90713 Poliovirus ipv sc/im 0.00 44.28 $0.00

90714 Td vaccine no prsrv 7/> im 0.00 44.28 $0.00

90715 Tdap vaccine 7 yrs/> im 0.00 44.28 $0.00

90716 Chicken pox vaccine sc 0.00 44.28 $0.00

90717 Yellow fever vaccine sc 0.00 44.28 $0.00

90719 Diphtheria vaccine im 0.00 44.28 $0.00

90720 Dtp/hib vaccine im 0.00 44.28 $0.00

90721 Dtap/hib vaccine im 0.00 44.28 $0.00

90723 Dtap-hep b-ipv vaccine im 0.00 44.28 $0.00

90725 Cholera vaccine injectable 0.00 44.28 $0.00

90727 Plague vaccine im 0.00 44.28 $0.00


90733 Meningococcal vaccine sc 0.00 44.28 $0.00

90734 Meningococcal vaccine im 0.00 44.28 $0.00

90735 Encephalitis vaccine sc 0.00 44.28 $0.00

90736 Zoster vacc sc 0.00 44.28 $0.00

90738 Inactivated je vacc im 0.00 44.28 $0.00

90739 Hep b vacc adult 2 dose im 0.00 44.28 $0.00

90740 Hepb vacc ill pat 3 dose im 0.00 44.28 $0.00

90743 Hep b vacc adol 2 dose im 0.00 44.28 $0.00

90744 Hepb vacc ped/adol 3 dose im 0.00 44.28 $0.00

90746 Hep b vacc adult 3 dose im 0.00 44.28 $0.00

90747 Hepb vacc ill pat 4 dose im 0.00 44.28 $0.00

90748 Hep b/hib vaccine im 0.00 44.28 $0.00

90749 Vaccine toxoid 0.00 44.28 $0.00

90785 Psytx complex interactive 0.40 44.28 $17.71

90791 Psych diagnostic evaluation 3.67 44.28 $162.51

90792 Psych diag eval w/med srvcs 4.12 44.28 $182.43

90832 Psytx pt&/family 30 minutes 1.79 44.28 $79.26

90833 Psytx pt&/fam w/e&m 30 min 1.84 44.28 $81.48





90839 Psytx crisis initial 60 min 3.72 44.28 $164.72

90840 Psytx crisis ea addl 30 min 1.78 44.28 $78.82

90845 Psychoanalysis 2.55 44.28 $112.91

90846 Family psytx w/o patient 2.87 44.28 $127.08

90847 Family psytx w/patient 2.99 44.28 $132.40

90849 Multiple family group psytx 0.99 44.28 $43.84

90853 Group psychotherapy 0.72 44.28 $31.88

90863 Pharmacologic mgmt w/psytx 0.00 44.28 $0.00

90865 Narcosynthesis 4.73 44.28 $209.44

90867 Tcranial magn stim tx plan 0.00 44.28 $0.00

90868 Tcranial magn stim tx deli 0.00 44.28 $0.00

90869 Tcran magn stim redetemine 0.00 44.28 $0.00

90870 Electroconvulsive therapy 4.99 44.28 $220.96

90875 Psychophysiological therapy 1.73 44.28 $76.60

90876 Psychophysiological therapy 3.07 44.28 $135.94

90880 Hypnotherapy 2.84 44.28 $125.76

90882 Environmental manipulation 0.00 44.28 $0.00

90885 Psy evaluation of records 1.40 44.28 $61.99

90887 Consultation with family 2.50 44.28 $110.70

90889 Preparation of report 0.00 44.28 $0.00

90899 Psychiatric service/therapy 0.00 44.28 $0.00

90901 Biofeedback train any meth 1.07 44.28 $47.38

90911 Biofeedback peri/uro/rectal 2.38 44.28 $105.39

90935 Hemodialysis one evaluation 2.05 44.28 $90.77

90937 Hemodialysis repeated eval 2.94 44.28 $130.18

90940 Hemodialysis access study 0.00 44.28 $0.00

90945 Dialysis one evaluation 2.42 44.28 $107.16

90947 Dialysis repeated eval 3.50 44.28 $154.98

90951 Esrd serv 4 visits p mo <2yr 26.52 44.28 $1,174.31

90952 Esrd serv 2-3 vsts p mo <2yr 0.00 44.28 $0.00

90953 Esrd serv 1 visit p mo <2yrs 0.00 44.28 $0.00

90954 Esrd serv 4 vsts p mo 2-11 23.09 44.28 $1,022.43

90955 Esrd srv 2-3 vsts p mo 2-11 12.92 44.28 $572.10

90956 Esrd srv 1 visit p mo 2-11 9.04 44.28 $400.29

90957 Esrd srv 4 vsts p mo 12-19 18.20 44.28 $805.90

90958 Esrd srv 2-3 vsts p mo 12-19 12.28 44.28 $543.76

90959 Esrd serv 1 vst p mo 12-19 8.35 44.28 $369.74

90960 Esrd srv 4 visits p mo 20+ 8.01 44.28 $354.68

90961 Esrd srv 2-3 vsts p mo 20+ 6.74 44.28 $298.45

90962 Esrd serv 1 visit p mo 20+ 5.19 44.28 $229.81

90963 Esrd home pt serv p mo <2yrs 15.39 44.28 $681.47

90964 Esrd home pt serv p mo 2-11 13.41 44.28 $593.79

90965 Esrd home pt serv p mo 12-19 12.79 44.28 $566.34

90966 Esrd home pt serv p mo 20+ 6.71 44.28 $297.12

90967 Esrd home pt serv p day <2 0.51 44.28 $22.58

90968 Esrd home pt srv p day 2-11 0.44 44.28 $19.48

90969 Esrd home pt srv p day 12-19 0.43 44.28 $19.04

90970 Esrd home pt serv p day 20+ 0.22 44.28 $9.74

90989 Dialysis training complete 0.00 44.28 $0.00

90993 Dialysis training incompl 0.00 44.28 $0.00

90997 Hemoperfusion 2.67 44.28 $118.23

90999 Dialysis procedure 0.00 44.28 $0.00

91010 Esophagus motility study 5.03 44.28 $222.73

91010 TC Esophagus motility study 3.09 44.28 $136.83

91010 26 Esophagus motility study 1.94 44.28 $85.90

91013 Esophgl motil w/stim/perfus 0.68 44.28 $30.11

91013 TC Esophgl motil w/stim/perfus 0.41 44.28 $18.15

91013 26 Esophgl motil w/stim/perfus 0.27 44.28 $11.96

91020 Gastric motility studies 6.63 44.28 $293.58

91020 TC Gastric motility studies 4.49 44.28 $198.82

91020 26 Gastric motility studies 2.14 44.28 $94.76

91022 Duodenal motility study 4.82 44.28 $213.43

91022 TC Duodenal motility study 2.67 44.28 $118.23

91022 26 Duodenal motility study 2.15 44.28 $95.20

91030 Acid perfusion of esophagus 3.89 44.28 $172.25

91030 TC Acid perfusion of esophagus 2.54 44.28 $112.47

91030 26 Acid perfusion of esophagus 1.35 44.28 $59.78

91034 Gastroesophageal reflux test 5.32 44.28 $235.57

91034 TC Gastroesophageal reflux test 3.89 44.28 $172.25

91034 26 Gastroesophageal reflux test 1.43 44.28 $63.32

91035 G-esoph reflx tst w/electrod 13.70 44.28 $606.64

91035 TC G-esoph reflx tst w/electrod 11.32 44.28 $501.25

91035 26 G-esoph reflx tst w/electrod 2.38 44.28 $105.39

91037 Esoph imped function test 4.58 44.28 $202.80

91037 TC Esoph imped function test 3.12 44.28 $138.15

91037 26 Esoph imped function test 1.46 44.28 $64.65

91038 Esoph imped funct test > 1hr 12.89 44.28 $570.77

91038 TC Esoph imped funct test > 1hr 11.21 44.28 $496.38

91038 26 Esoph imped funct test > 1hr 1.68 44.28 $74.39

91040 Esoph balloon distension tst 12.45 44.28 $551.29

91040 TC Esoph balloon distension tst 11.01 44.28 $487.52

91040 26 Esoph balloon distension tst 1.44 44.28 $63.76

91065 Breath hydrogen/methane test 2.30 44.28 $101.84

91065 TC Breath hydrogen/methane test 2.00 44.28 $88.56

91065 26 Breath hydrogen/methane test 0.30 44.28 $13.28

91110 Gi tract capsule endoscopy 25.31 44.28 $1,120.73

91110 TC Gi tract capsule endoscopy 19.85 44.28 $878.96

91110 26 Gi tract capsule endoscopy 5.46 44.28 $241.77

91111 Esophageal capsule endoscopy 20.76 44.28 $919.25

91111 TC Esophageal capsule endoscopy 19.27 44.28 $853.28

91111 26 Esophageal capsule endoscopy 1.49 44.28 $65.98

91112 Gi wireless capsule measure 30.79 44.28 $1,363.38

91112 TC Gi wireless capsule measure 27.64 44.28 $1,223.90

91112 26 Gi wireless capsule measure 3.15 44.28 $139.48

91117 Colon motility 6 hr study 4.02 44.28 $178.01

91120 Rectal sensation test 12.20 44.28 $540.22

91120 TC Rectal sensation test 10.74 44.28 $475.57

91120 26 Rectal sensation test 1.46 44.28 $64.65

91122 Anal pressure record 6.38 44.28 $282.51

91122 TC Anal pressure record 3.83 44.28 $169.59

91122 26 Anal pressure record 2.55 44.28 $112.91

91132 Electrogastrography 4.22 44.28 $186.86

91132 TC Electrogastrography 3.44 44.28 $152.32

91132 26 Electrogastrography 0.78 44.28 $34.54

91133 Electrogastrography w/test 4.89 44.28 $216.53

91133 TC Electrogastrography w/test 3.91 44.28 $173.13

91133 26 Electrogastrography w/test 0.98 44.28 $43.39

91200 Liver elastography 1.01 44.28 $44.72

91200 TC Liver elastography 0.60 44.28 $26.57

91200 26 Liver elastography 0.41 44.28 $18.15

91299 Gastroenterology procedure 0.00 44.28 $0.00

91299 TC Gastroenterology procedure 0.00 44.28 $0.00

91299 26 Gastroenterology procedure 0.00 44.28 $0.00

92002 Eye exam new patient 2.28 44.28 $100.96

92004 Eye exam new patient 4.17 44.28 $184.65

92012 Eye exam establish patient 2.40 44.28 $106.27

92014 Eye exam&tx estab pt 1/>vst 3.47 44.28 $153.65

92015 Determine refractive state 0.56 44.28 $24.80

92018 New eye exam & treatment 4.10 44.28 $181.55

92019 Eye exam & treatment 2.03 44.28 $89.89

92020 Special eye evaluation 0.75 44.28 $33.21

92025 Corneal topography 1.07 44.28 $47.38

92025 TC Corneal topography 0.50 44.28 $22.14

92025 26 Corneal topography 0.57 44.28 $25.24

92060 Special eye evaluation 1.83 44.28 $81.03

92060 TC Special eye evaluation 0.75 44.28 $33.21

92060 26 Special eye evaluation 1.08 44.28 $47.82

92065 Orthoptic/pleoptic training 1.51 44.28 $66.86

92065 TC Orthoptic/pleoptic training 1.00 44.28 $44.28

92065 26 Orthoptic/pleoptic training 0.51 44.28 $22.58

92071 Contact lens fitting for tx 1.07 44.28 $47.38

92072 Fit contac lens for managmnt 3.79 44.28 $167.82

92081 Visual field examination(s) 0.96 44.28 $42.51

92081 TC Visual field examination(s) 0.50 44.28 $22.14

92081 26 Visual field examination(s) 0.46 44.28 $20.37







92100 Serial tonometry exam(s) 2.26 44.28 $100.07

92132 Cmptr ophth dx img ant segmt 0.98 44.28 $43.39

92132 TC Cmptr ophth dx img ant segmt 0.44 44.28 $19.48

92132 26 Cmptr ophth dx img ant segmt 0.54 44.28 $23.91

92133 Cmptr ophth img optic nerve 1.24 44.28 $54.91

92133 TC Cmptr ophth img optic nerve 0.45 44.28 $19.93

92133 26 Cmptr ophth img optic nerve 0.79 44.28 $34.98

92134 Cptr ophth dx img post segmt 1.27 44.28 $56.24

92134 TC Cptr ophth dx img post segmt 0.46 44.28 $20.37

92134 26 Cptr ophth dx img post segmt 0.81 44.28 $35.87

92136 Ophthalmic biometry 2.54 44.28 $112.47

92136 TC Ophthalmic biometry 1.66 44.28 $73.50

92136 26 Ophthalmic biometry 0.88 44.28 $38.97

92140 Glaucoma provocative tests 1.77 44.28 $78.38

92145 Corneal hysteresis deter 0.44 44.28 $19.48

92145 TC Corneal hysteresis deter 0.19 44.28 $8.41

92145 26 Corneal hysteresis deter 0.25 44.28 $11.07

92225 Special eye exam initial 0.76 44.28 $33.65

92226 Special eye exam subsequent 0.70 44.28 $31.00

92227 Remote dx retinal imaging 0.41 44.28 $18.15

92228 Remote retinal imaging mgmt 1.00 44.28 $44.28

92228 TC Remote retinal imaging mgmt 0.39 44.28 $17.27

92228 26 Remote retinal imaging mgmt 0.61 44.28 $27.01

92230 Eye exam with photos 1.63 44.28 $72.18


92235 TC Eye exam with photos 1.76 44.28 $77.93

92235 26 Eye exam with photos 1.33 44.28 $58.89

92240 Icg angiography 7.17 44.28 $317.49

92240 TC Icg angiography 5.37 44.28 $237.78

92240 26 Icg angiography 1.80 44.28 $79.70


92250 TC Eye exam with photos 1.54 44.28 $68.19

92250 26 Eye exam with photos 0.68 44.28 $30.11

92260 Ophthalmoscopy/dynamometry 0.52 44.28 $23.03

92265 Eye muscle evaluation 2.42 44.28 $107.16

92265 TC Eye muscle evaluation 1.10 44.28 $48.71

92265 26 Eye muscle evaluation 1.32 44.28 $58.45

92270 Electro-oculography 2.59 44.28 $114.69

92270 TC Electro-oculography 1.42 44.28 $62.88

92270 26 Electro-oculography 1.17 44.28 $51.81

92275 Electroretinography 4.13 44.28 $182.88

92275 TC Electroretinography 2.62 44.28 $116.01

92275 26 Electroretinography 1.51 44.28 $66.86

92283 Color vision examination 1.58 44.28 $69.96

92283 TC Color vision examination 1.31 44.28 $58.01

92283 26 Color vision examination 0.27 44.28 $11.96

92284 Dark adaptation eye exam 1.76 44.28 $77.93

92284 TC Dark adaptation eye exam 1.40 44.28 $61.99

92284 26 Dark adaptation eye exam 0.36 44.28 $15.94

92285 Eye photography 0.58 44.28 $25.68

92285 TC Eye photography 0.49 44.28 $21.70

92285 26 Eye photography 0.09 44.28 $3.99

92286 Internal eye photography 1.08 44.28 $47.82

92286 TC Internal eye photography 0.45 44.28 $19.93

92286 26 Internal eye photography 0.63 44.28 $27.90

92287 Internal eye photography 3.88 44.28 $171.81

92287 TC Internal eye photography 2.56 44.28 $113.36

92287 26 Internal eye photography 1.32 44.28 $58.45

92310 Contact lens fitting 2.70 44.28 $119.56




92314 Prescription of contact lens 2.25 44.28 $99.63

92315 Rx cntact lens aphakia 1 eye 2.05 44.28 $90.77

92316 Rx cntact lens aphakia 2 eye 2.58 44.28 $114.24

92317 Rx corneoscleral cntact lens 2.14 44.28 $94.76

92325 Modification of contact lens 1.19 44.28 $52.69

92326 Replacement of contact lens 0.99 44.28 $43.84

92340 Fit spectacles monofocal 1.00 44.28 $44.28

92341 Fit spectacles bifocal 1.14 44.28 $50.48

92342 Fit spectacles multifocal 1.23 44.28 $54.46

92352 Fit aphakia spectcl monofocl 1.14 44.28 $50.48

92353 Fit aphakia spectcl multifoc 1.33 44.28 $58.89

92354 Fit spectacles single system 0.38 44.28 $16.83

92355 Fit spectacles compound lens 0.59 44.28 $26.13

92358 Aphakia prosth service temp 0.32 44.28 $14.17

92370 Repair & adjust spectacles 0.87 44.28 $38.52

92371 Repair & adjust spectacles 0.33 44.28 $14.61

92499 Eye service or procedure 0.00 44.28 $0.00

92499 TC Eye service or procedure 0.00 44.28 $0.00

92499 26 Eye service or procedure 0.00 44.28 $0.00

92502 Ear and throat examination 2.75 44.28 $121.77

92504 Ear microscopy examination 0.85 44.28 $37.64

92507 Speech/hearing therapy 2.23 44.28 $98.74

92508 Speech/hearing therapy 0.66 44.28 $29.22

92511 Nasopharyngoscopy 3.85 44.28 $170.48

92512 Nasal function studies 1.73 44.28 $76.60

92516 Facial nerve function test 1.99 44.28 $88.12

92520 Laryngeal function studies 2.12 44.28 $93.87

92521 Evaluation of speech fluency 3.04 44.28 $134.61

92522 Evaluate speech production 2.60 44.28 $115.13

92523 Speech sound lang comprehen 5.30 44.28 $234.68

92524 Behavral qualit analys voice 2.54 44.28 $112.47

92526 Oral function therapy 2.42 44.28 $107.16

92531 Spontaneous nystagmus study 0.00 44.28 $0.00

92532 Positional nystagmus test 0.00 44.28 $0.00

92533 Caloric vestibular test 0.00 44.28 $0.00

92534 Optokinetic nystagmus test 0.00 44.28 $0.00

92540 Basic vestibular evaluation 2.87 44.28 $127.08

92540 TC Basic vestibular evaluation 0.63 44.28 $27.90

92540 26 Basic vestibular evaluation 2.24 44.28 $99.19

92541 Spontaneous nystagmus test 0.63 44.28 $27.90

92541 TC Spontaneous nystagmus test 0.04 44.28 $1.77

92541 26 Spontaneous nystagmus test 0.59 44.28 $26.13

92542 Positional nystagmus test 0.74 44.28 $32.77

92542 TC Positional nystagmus test 0.04 44.28 $1.77

92542 26 Positional nystagmus test 0.70 44.28 $31.00

92543 Caloric vestibular test 0.45 44.28 $19.93

92543 TC Caloric vestibular test 0.29 44.28 $12.84

92543 26 Caloric vestibular test 0.16 44.28 $7.08

92544 Optokinetic nystagmus test 0.44 44.28 $19.48

92544 TC Optokinetic nystagmus test 0.04 44.28 $1.77

92544 26 Optokinetic nystagmus test 0.40 44.28 $17.71

92545 Oscillating tracking test 0.41 44.28 $18.15

92545 TC Oscillating tracking test 0.04 44.28 $1.77

92545 26 Oscillating tracking test 0.37 44.28 $16.38

92546 Sinusoidal rotational test 2.90 44.28 $128.41

92546 TC Sinusoidal rotational test 2.48 44.28 $109.81

92546 26 Sinusoidal rotational test 0.42 44.28 $18.60

92547 Supplemental electrical test 0.18 44.28 $7.97

92548 Posturography 2.91 44.28 $128.85

92548 TC Posturography 2.17 44.28 $96.09

92548 26 Posturography 0.74 44.28 $32.77

92550 Tympanometry & reflex thresh 0.59 44.28 $26.13

92551 Pure tone hearing test air 0.34 44.28 $15.06

92552 Pure tone audiometry air 0.88 44.28 $38.97

92553 Audiometry air & bone 1.04 44.28 $46.05

92555 Speech threshold audiometry 0.65 44.28 $28.78

92556 Speech audiometry complete 1.05 44.28 $46.49

92557 Comprehensive hearing test 1.05 44.28 $46.49

92558 Evoked auditory test qual 0.00 44.28 $0.00

92559 Group audiometric testing 0.00 44.28 $0.00

92560 Bekesy audiometry screen 0.00 44.28 $0.00

92561 Bekesy audiometry diagnosis 1.06 44.28 $46.94

92562 Loudness balance test 1.30 44.28 $57.56

92563 Tone decay hearing test 0.87 44.28 $38.52

92564 Sisi hearing test 0.80 44.28 $35.42

92565 Stenger test pure tone 0.44 44.28 $19.48

92567 Tympanometry 0.41 44.28 $18.15

92568 Acoustic refl threshold tst 0.44 44.28 $19.48

92570 Acoustic immitance testing 0.90 44.28 $39.85

92571 Filtered speech hearing test 0.77 44.28 $34.10

92572 Staggered spondaic word test 0.88 44.28 $38.97

92575 Sensorineural acuity test 2.00 44.28 $88.56

92576 Synthetic sentence test 0.99 44.28 $43.84

92577 Stenger test speech 0.45 44.28 $19.93

92579 Visual audiometry (vra) 1.27 44.28 $56.24

92582 Conditioning play audiometry 2.01 44.28 $89.00

92583 Select picture audiometry 1.43 44.28 $63.32

92584 Electrocochleography 2.08 44.28 $92.10

92585 Auditor evoke potent compre 3.81 44.28 $168.71

92585 TC Auditor evoke potent compre 3.06 44.28 $135.50

92585 26 Auditor evoke potent compre 0.75 44.28 $33.21

92586 Auditor evoke potent limit 2.35 44.28 $104.06

92587 Evoked auditory test limited 0.61 44.28 $27.01

92587 TC Evoked auditory test limited 0.09 44.28 $3.99

92587 26 Evoked auditory test limited 0.52 44.28 $23.03

92588 Evoked auditory tst complete 0.93 44.28 $41.18

92588 TC Evoked auditory tst complete 0.11 44.28 $4.87

92588 26 Evoked auditory tst complete 0.82 44.28 $36.31

92590 Hearing aid exam one ear 0.00 44.28 $0.00

92591 Hearing aid exam both ears 0.00 44.28 $0.00

92592 Hearing aid check one ear 0.00 44.28 $0.00

92593 Hearing aid check both ears 0.00 44.28 $0.00

92594 Electro hearng aid test one 0.00 44.28 $0.00

92595 Electro hearng aid tst both 0.00 44.28 $0.00

92596 Ear protector evaluation 1.18 44.28 $52.25

92597 Oral speech device eval 2.03 44.28 $89.89

92601 Cochlear implt f/up exam <7 3.88 44.28 $171.81

92602 Reprogram cochlear implt 7/> 2.52 44.28 $111.59

92603 Cochlear implt f/up exam 7/> 4.21 44.28 $186.42

92604 Reprogram cochlear implt 7/> 2.50 44.28 $110.70

92605 Ex for nonspeech device rx 2.65 44.28 $117.34

92606 Non-speech device service 2.37 44.28 $104.94

92607 Ex for speech device rx 1hr 3.50 44.28 $154.98

92608 Ex for speech device rx addl 1.50 44.28 $66.42

92609 Use of speech device service 3.12 44.28 $138.15

92610 Evaluate swallowing function 2.39 44.28 $105.83

92611 Motion fluoroscopy/swallow 2.44 44.28 $108.04

92612 Endoscopy swallow tst (fees) 4.88 44.28 $216.09

92613 Endoscopy swallow tst (fees) 1.09 44.28 $48.27

92614 Laryngoscopic sensory test 4.07 44.28 $180.22

92615 Eval laryngoscopy sense tst 0.95 44.28 $42.07

92616 Fees w/laryngeal sense test 5.80 44.28 $256.82

92617 Interprt fees/laryngeal test 1.18 44.28 $52.25

92618 Ex for nonspeech dev rx add 0.96 44.28 $42.51

92620 Auditory function 60 min 2.65 44.28 $117.34

92621 Auditory function + 15 min 0.63 44.28 $27.90

92625 Tinnitus assessment 1.97 44.28 $87.23

92626 Eval aud rehab status 2.53 44.28 $112.03

92627 Eval aud status rehab add-on 0.62 44.28 $27.45

92630 Aud rehab pre-ling hear loss 0.00 44.28 $0.00

92633 Aud rehab postling hear loss 0.00 44.28 $0.00

92640 Aud brainstem implt programg 3.20 44.28 $141.70

92700 Ent procedure/service 0.00 44.28 $0.00

92920 Prq cardiac angioplast 1 art 15.84 44.28 $701.40

92921 Prq cardiac angio addl art 0.00 44.28 $0.00

92924 Prq card angio/athrect 1 art 18.79 44.28 $832.02

92925 Prq card angio/athrect addl 0.00 44.28 $0.00

92928 Prq card stent w/angio 1 vsl 17.57 44.28 $778.00

92929 Prq card stent w/angio addl 0.00 44.28 $0.00

92933 Prq card stent/ath/angio 19.66 44.28 $870.54

92934 Prq card stent/ath/angio 0.00 44.28 $0.00

92937 Prq revasc byp graft 1 vsl 17.56 44.28 $777.56

92938 Prq revasc byp graft addl 0.00 44.28 $0.00

92941 Prq card revasc mi 1 vsl 19.69 44.28 $871.87

92943 Prq card revasc chronic 1vsl 19.67 44.28 $870.99

92944 Prq card revasc chronic addl 0.00 44.28 $0.00

92950 Heart/lung resuscitation cpr 8.63 44.28 $382.14

92953 Temporary external pacing 0.32 44.28 $14.17

92960 Cardioversion electric ext 5.84 44.28 $258.60

92961 Cardioversion electric int 7.54 44.28 $333.87

92970 Cardioassist internal 5.38 44.28 $238.23

92971 Cardioassist external 2.92 44.28 $129.30

92973 Prq coronary mech thrombect 5.15 44.28 $228.04

92974 Cath place cardio brachytx 4.70 44.28 $208.12

92975 Dissolve clot heart vessel 11.37 44.28 $503.46

92977 Dissolve clot heart vessel 1.62 44.28 $71.73

92978 Intravasc us heart add-on 0.00 44.28 $0.00

92978 TC Intravasc us heart add-on 0.00 44.28 $0.00

92978 26 Intravasc us heart add-on 2.83 44.28 $125.31

92979 Intravasc us heart add-on 0.00 44.28 $0.00

92979 TC Intravasc us heart add-on 0.00 44.28 $0.00

92979 26 Intravasc us heart add-on 2.26 44.28 $100.07

92986 Revision of aortic valve 38.63 44.28 $1,710.54



92992 Revision of heart chamber 0.00 44.28 $0.00

92993 Revision of heart chamber 0.00 44.28 $0.00

92997 Pul art balloon repr percut 19.23 44.28 $851.50

92998 Pul art balloon repr percut 9.41 44.28 $416.67

93000 Electrocardiogram complete 0.48 44.28 $21.25

93005 Electrocardiogram tracing 0.24 44.28 $10.63

93010 Electrocardiogram report 0.24 44.28 $10.63

93015 Cardiovascular stress test 2.15 44.28 $95.20




93024 Cardiac drug stress test 3.17 44.28 $140.37

93024 TC Cardiac drug stress test 1.55 44.28 $68.63

93024 26 Cardiac drug stress test 1.62 44.28 $71.73

93025 Microvolt t-wave assess 4.61 44.28 $204.13

93025 TC Microvolt t-wave assess 3.56 44.28 $157.64

93025 26 Microvolt t-wave assess 1.05 44.28 $46.49

93040 Rhythm ecg with report 0.36 44.28 $15.94

93041 Rhythm ecg tracing 0.16 44.28 $7.08

93042 Rhythm ecg report 0.20 44.28 $8.86

93224 Ecg monit/reprt up to 48 hrs 2.59 44.28 $114.69




93228 Remote 30 day ecg rev/report 0.74 44.28 $32.77

93229 Remote 30 day ecg tech supp 19.02 44.28 $842.21

93260 Prgrmg dev eval impltbl sys 1.89 44.28 $83.69

93260 TC Prgrmg dev eval impltbl sys 0.63 44.28 $27.90

93260 26 Prgrmg dev eval impltbl sys 1.26 44.28 $55.79

93261 Interrogate subq defib 1.73 44.28 $76.60

93261 TC Interrogate subq defib 0.63 44.28 $27.90

93261 26 Interrogate subq defib 1.10 44.28 $48.71

93268 Ecg record/review 5.78 44.28 $255.94

93270 Remote 30 day ecg rev/report 0.26 44.28 $11.51

93271 Ecg/monitoring and analysis 4.80 44.28 $212.54

93272 Ecg/review interpret only 0.72 44.28 $31.88

93278 Ecg/signal-averaged 0.86 44.28 $38.08

93278 TC Ecg/signal-averaged 0.51 44.28 $22.58

93278 26 Ecg/signal-averaged 0.35 44.28 $15.50

93279 Pm device progr eval sngl 1.40 44.28 $61.99

93279 TC Pm device progr eval sngl 0.49 44.28 $21.70

93279 26 Pm device progr eval sngl 0.91 44.28 $40.29

93280 Pm device progr eval dual 1.65 44.28 $73.06

93280 TC Pm device progr eval dual 0.56 44.28 $24.80

93280 26 Pm device progr eval dual 1.09 44.28 $48.27

93281 Pm device progr eval multi 1.92 44.28 $85.02

93281 TC Pm device progr eval multi 0.65 44.28 $28.78

93281 26 Pm device progr eval multi 1.27 44.28 $56.24

93282 Prgrmg eval implantable dfb 1.79 44.28 $79.26

93282 TC Prgrmg eval implantable dfb 0.58 44.28 $25.68

93282 26 Prgrmg eval implantable dfb 1.21 44.28 $53.58







93285 Ilr device eval progr 1.19 44.28 $52.69

93285 TC Ilr device eval progr 0.45 44.28 $19.93

93285 26 Ilr device eval progr 0.74 44.28 $32.77

93286 Peri-px pacemaker device evl 0.77 44.28 $34.10

93286 TC Peri-px pacemaker device evl 0.34 44.28 $15.06

93286 26 Peri-px pacemaker device evl 0.43 44.28 $19.04

93287 Peri-px device eval & prgr 1.02 44.28 $45.17

93287 TC Peri-px device eval & prgr 0.37 44.28 $16.38

93287 26 Peri-px device eval & prgr 0.65 44.28 $28.78

93288 Pm device eval in person 1.06 44.28 $46.94

93288 TC Pm device eval in person 0.45 44.28 $19.93

93288 26 Pm device eval in person 0.61 44.28 $27.01

93289 Interrog device eval heart 1.84 44.28 $81.48

93289 TC Interrog device eval heart 0.55 44.28 $24.35

93289 26 Interrog device eval heart 1.29 44.28 $57.12

93290 Icm device eval 0.87 44.28 $38.52

93290 TC Icm device eval 0.27 44.28 $11.96

93290 26 Icm device eval 0.60 44.28 $26.57

93291 Ilr device interrogate 1.01 44.28 $44.72

93291 TC Ilr device interrogate 0.41 44.28 $18.15

93291 26 Ilr device interrogate 0.60 44.28 $26.57

93292 Wcd device interrogate 0.91 44.28 $40.29

93292 TC Wcd device interrogate 0.31 44.28 $13.73

93292 26 Wcd device interrogate 0.60 44.28 $26.57

93293 Pm phone r-strip device eval 1.51 44.28 $66.86

93293 TC Pm phone r-strip device eval 1.07 44.28 $47.38

93293 26 Pm phone r-strip device eval 0.44 44.28 $19.48

93294 Pm device interrogate remote 0.96 44.28 $42.51

93295 Dev interrog remote 1/2/mlt 1.91 44.28 $84.57

93296 Pm/icd remote tech serv 0.73 44.28 $32.32

93297 Icm device interrogat remote 0.75 44.28 $33.21

93298 Ilr device interrogat remote 0.75 44.28 $33.21

93299 Icm/ilr remote tech serv 0.00 44.28 $0.00

93303 Echo transthoracic 6.69 44.28 $296.23

93303 TC Echo transthoracic 4.89 44.28 $216.53

93303 26 Echo transthoracic 1.80 44.28 $79.70

93304 Echo transthoracic 4.36 44.28 $193.06

93304 TC Echo transthoracic 3.33 44.28 $147.45

93304 26 Echo transthoracic 1.03 44.28 $45.61

93306 Tte w/doppler complete 6.40 44.28 $283.39

93306 TC Tte w/doppler complete 4.61 44.28 $204.13

93306 26 Tte w/doppler complete 1.79 44.28 $79.26

93307 Tte w/o doppler complete 3.67 44.28 $162.51

93307 TC Tte w/o doppler complete 2.39 44.28 $105.83

93307 26 Tte w/o doppler complete 1.28 44.28 $56.68

93308 Tte f-up or lmtd 3.51 44.28 $155.42

93308 TC Tte f-up or lmtd 2.78 44.28 $123.10

93308 26 Tte f-up or lmtd 0.73 44.28 $32.32

93312 Echo transesophageal 8.62 44.28 $381.69

93312 TC Echo transesophageal 5.18 44.28 $229.37

93312 26 Echo transesophageal 3.44 44.28 $152.32












93318 Echo transesophageal intraop 0.00 44.28 $0.00

93318 TC Echo transesophageal intraop 0.00 44.28 $0.00

93318 26 Echo transesophageal intraop 3.41 44.28 $150.99

93320 Doppler echo exam heart 1.54 44.28 $68.19

93320 TC Doppler echo exam heart 1.02 44.28 $45.17

93320 26 Doppler echo exam heart 0.52 44.28 $23.03

93321 Doppler echo exam heart 0.78 44.28 $34.54

93321 TC Doppler echo exam heart 0.57 44.28 $25.24

93321 26 Doppler echo exam heart 0.21 44.28 $9.30

93325 Doppler color flow add-on 0.74 44.28 $32.77

93325 TC Doppler color flow add-on 0.64 44.28 $28.34

93325 26 Doppler color flow add-on 0.10 44.28 $4.43

93350 Stress tte only 6.78 44.28 $300.22

93350 TC Stress tte only 4.76 44.28 $210.77

93350 26 Stress tte only 2.02 44.28 $89.45

93351 Stress tte complete 7.62 44.28 $337.41

93351 TC Stress tte complete 5.20 44.28 $230.26

93351 26 Stress tte complete 2.42 44.28 $107.16

93352 Admin ecg contrast agent 0.96 44.28 $42.51

93355 Echo transesophageal (tee) 6.43 44.28 $284.72

93451 Right heart cath 22.21 44.28 $983.46

93451 TC Right heart cath 18.03 44.28 $798.37

93451 26 Right heart cath 4.18 44.28 $185.09

93452 Left hrt cath w/ventrclgrphy 25.11 44.28 $1,111.87

93452 TC Left hrt cath w/ventrclgrphy 17.76 44.28 $786.41

93452 26 Left hrt cath w/ventrclgrphy 7.35 44.28 $325.46

93453 R&l hrt cath w/ventriclgrphy 32.33 44.28 $1,431.57

93453 TC R&l hrt cath w/ventriclgrphy 22.66 44.28 $1,003.38

93453 26 R&l hrt cath w/ventriclgrphy 9.67 44.28 $428.19

93454 Coronary artery angio s&i 25.41 44.28 $1,125.15

93454 TC Coronary artery angio s&i 18.01 44.28 $797.48

93454 26 Coronary artery angio s&i 7.40 44.28 $327.67

93455 Coronary art/grft angio s&i 29.59 44.28 $1,310.25

93455 TC Coronary art/grft angio s&i 21.02 44.28 $930.77

93455 26 Coronary art/grft angio s&i 8.57 44.28 $379.48

93456 R hrt coronary artery angio 31.81 44.28 $1,408.55

93456 TC R hrt coronary artery angio 22.29 44.28 $987.00

93456 26 R hrt coronary artery angio 9.52 44.28 $421.55

93457 R hrt art/grft angio 35.91 44.28 $1,590.09

93457 TC R hrt art/grft angio 25.27 44.28 $1,118.96

93457 26 R hrt art/grft angio 10.64 44.28 $471.14

93458 L hrt artery/ventricle angio 30.45 44.28 $1,348.33

93458 TC L hrt artery/ventricle angio 21.44 44.28 $949.36

93458 26 L hrt artery/ventricle angio 9.01 44.28 $398.96

93459 L hrt art/grft angio 33.64 44.28 $1,489.58

93459 TC L hrt art/grft angio 23.48 44.28 $1,039.69

93459 26 L hrt art/grft angio 10.16 44.28 $449.88

93460 R&l hrt art/ventricle angio 36.12 44.28 $1,599.39

93460 TC R&l hrt art/ventricle angio 24.78 44.28 $1,097.26

93460 26 R&l hrt art/ventricle angio 11.34 44.28 $502.14

93461 R&l hrt art/ventricle angio 41.30 44.28 $1,828.76

93461 TC R&l hrt art/ventricle angio 28.78 44.28 $1,274.38

93461 26 R&l hrt art/ventricle angio 12.52 44.28 $554.39

93462 L hrt cath trnsptl puncture 6.03 44.28 $267.01

93463 Drug admin & hemodynmic meas 2.82 44.28 $124.87

93464 Exercise w/hemodynamic meas 7.76 44.28 $343.61

93464 TC Exercise w/hemodynamic meas 5.28 44.28 $233.80

93464 26 Exercise w/hemodynamic meas 2.48 44.28 $109.81

93503 Insert/place heart catheter 3.70 44.28 $163.84

93505 Biopsy of heart lining 21.69 44.28 $960.43

93505 TC Biopsy of heart lining 14.94 44.28 $661.54

93505 26 Biopsy of heart lining 6.75 44.28 $298.89

93530 Rt heart cath congenital 0.00 44.28 $0.00

93530 TC Rt heart cath congenital 0.00 44.28 $0.00

93530 26 Rt heart cath congenital 6.50 44.28 $287.82

93531 R & l heart cath congenital 0.00 44.28 $0.00

93531 TC R & l heart cath congenital 0.00 44.28 $0.00

93531 26 R & l heart cath congenital 12.69 44.28 $561.91







93561 Cardiac output measurement 0.00 44.28 $0.00

93561 TC Cardiac output measurement 0.00 44.28 $0.00

93561 26 Cardiac output measurement 0.70 44.28 $31.00

93562 Card output measure subsq 0.00 44.28 $0.00

93562 TC Card output measure subsq 0.00 44.28 $0.00

93562 26 Card output measure subsq 0.23 44.28 $10.18

93563 Inject congenital card cath 1.71 44.28 $75.72

93564 Inject hrt congntl art/grft 1.79 44.28 $79.26

93565 Inject l ventr/atrial angio 1.34 44.28 $59.34

93566 Inject r ventr/atrial angio 4.85 44.28 $214.76

93567 Inject suprvlv aortography 4.02 44.28 $178.01

93568 Inject pulm art hrt cath 4.36 44.28 $193.06

93571 Heart flow reserve measure 0.00 44.28 $0.00

93571 TC Heart flow reserve measure 0.00 44.28 $0.00

93571 26 Heart flow reserve measure 2.83 44.28 $125.31

93572 Heart flow reserve measure 0.00 44.28 $0.00

93572 TC Heart flow reserve measure 0.00 44.28 $0.00

93572 26 Heart flow reserve measure 2.26 44.28 $100.07

93580 Transcath closure of asd 28.30 44.28 $1,253.12

93581 Transcath closure of vsd 38.68 44.28 $1,712.75

93582 Perq transcath closure pda 19.51 44.28 $863.90

93583 Perq transcath septal reduxn 21.75 44.28 $963.09

93600 Bundle of his recording 0.00 44.28 $0.00

93600 TC Bundle of his recording 0.00 44.28 $0.00

93600 26 Bundle of his recording 3.48 44.28 $154.09

93602 Intra-atrial recording 0.00 44.28 $0.00

93602 TC Intra-atrial recording 0.00 44.28 $0.00

93602 26 Intra-atrial recording 3.41 44.28 $150.99

93603 Right ventricular recording 0.00 44.28 $0.00

93603 TC Right ventricular recording 0.00 44.28 $0.00

93603 26 Right ventricular recording 3.41 44.28 $150.99

93609 Map tachycardia add-on 0.00 44.28 $0.00

93609 TC Map tachycardia add-on 0.00 44.28 $0.00

93609 26 Map tachycardia add-on 8.16 44.28 $361.32

93610 Intra-atrial pacing 0.00 44.28 $0.00

93610 TC Intra-atrial pacing 0.00 44.28 $0.00

93610 26 Intra-atrial pacing 4.83 44.28 $213.87

93612 Intraventricular pacing 0.00 44.28 $0.00

93612 TC Intraventricular pacing 0.00 44.28 $0.00

93612 26 Intraventricular pacing 4.80 44.28 $212.54

93613 Electrophys map 3d add-on 11.49 44.28 $508.78

93615 Esophageal recording 0.00 44.28 $0.00

93615 TC Esophageal recording 0.00 44.28 $0.00

93615 26 Esophageal recording 1.48 44.28 $65.53

93616 Esophageal recording 0.00 44.28 $0.00

93616 TC Esophageal recording 0.00 44.28 $0.00

93616 26 Esophageal recording 1.85 44.28 $81.92

93618 Heart rhythm pacing 0.00 44.28 $0.00

93618 TC Heart rhythm pacing 0.00 44.28 $0.00

93618 26 Heart rhythm pacing 6.92 44.28 $306.42

93619 Electrophysiology evaluation 0.00 44.28 $0.00

93619 TC Electrophysiology evaluation 0.00 44.28 $0.00

93619 26 Electrophysiology evaluation 11.88 44.28 $526.05










93623 Stimulation pacing heart 0.00 44.28 $0.00

93623 TC Stimulation pacing heart 0.00 44.28 $0.00

93623 26 Stimulation pacing heart 4.69 44.28 $207.67

93624 Electrophysiologic study 0.00 44.28 $0.00

93624 TC Electrophysiologic study 0.00 44.28 $0.00

93624 26 Electrophysiologic study 7.55 44.28 $334.31

93631 Heart pacing mapping 0.00 44.28 $0.00

93631 TC Heart pacing mapping 0.00 44.28 $0.00

93631 26 Heart pacing mapping 11.74 44.28 $519.85

93640 Evaluation heart device 0.00 44.28 $0.00

93640 TC Evaluation heart device 0.00 44.28 $0.00

93640 26 Evaluation heart device 5.66 44.28 $250.62










93650 Ablate heart dysrhythm focus 17.47 44.28 $773.57

93653 Ep & ablate supravent arrhyt 24.58 44.28 $1,088.40

93654 Ep & ablate ventric tachy 32.70 44.28 $1,447.96

93655 Ablate arrhythmia add on 12.28 44.28 $543.76

93656 Tx atrial fib pulm vein isol 32.84 44.28 $1,454.16

93657 Tx l/r atrial fib addl 12.27 44.28 $543.32

93660 Tilt table evaluation 4.46 44.28 $197.49

93660 TC Tilt table evaluation 1.79 44.28 $79.26

93660 26 Tilt table evaluation 2.67 44.28 $118.23

93662 Intracardiac ecg (ice) 0.00 44.28 $0.00

93662 TC Intracardiac ecg (ice) 0.00 44.28 $0.00

93662 26 Intracardiac ecg (ice) 4.14 44.28 $183.32

93668 Peripheral vascular rehab 0.54 44.28 $23.91

93701 Bioimpedance cv analysis 0.69 44.28 $30.55

93702 Bis xtracell fluid analysis 3.20 44.28 $141.70

93724 Analyze pacemaker system 7.74 44.28 $342.73

93724 TC Analyze pacemaker system 0.80 44.28 $35.42

93724 26 Analyze pacemaker system 6.94 44.28 $307.30

93740 Temperature gradient studies 0.23 44.28 $10.18

93745 Set-up cardiovert-defibrill 0.00 44.28 $0.00

93745 TC Set-up cardiovert-defibrill 0.00 44.28 $0.00

93745 26 Set-up cardiovert-defibrill 0.00 44.28 $0.00

93750 Interrogation vad in person 1.58 44.28 $69.96

93770 Measure venous pressure 0.23 44.28 $10.18

93784 Ambulatory bp monitoring 1.52 44.28 $67.31

93786 Ambulatory bp recording 0.84 44.28 $37.20

93788 Ambulatory bp analysis 0.15 44.28 $6.64

93790 Review/report bp recording 0.53 44.28 $23.47

93797 Cardiac rehab 0.46 44.28 $20.37

93798 Cardiac rehab/monitor 0.71 44.28 $31.44

93799 Cardiovascular procedure 0.00 44.28 $0.00

93799 TC Cardiovascular procedure 0.00 44.28 $0.00

93799 26 Cardiovascular procedure 0.00 44.28 $0.00

93880 Extracranial bilat study 5.71 44.28 $252.84

93880 TC Extracranial bilat study 4.59 44.28 $203.25

93880 26 Extracranial bilat study 1.12 44.28 $49.59

93882 Extracranial uni/ltd study 3.64 44.28 $161.18

93882 TC Extracranial uni/ltd study 2.94 44.28 $130.18

93882 26 Extracranial uni/ltd study 0.70 44.28 $31.00

93886 Intracranial complete study 8.12 44.28 $359.55

93886 TC Intracranial complete study 6.80 44.28 $301.10

93886 26 Intracranial complete study 1.32 44.28 $58.45

93888 Intracranial limited study 4.22 44.28 $186.86

93888 TC Intracranial limited study 3.50 44.28 $154.98

93888 26 Intracranial limited study 0.72 44.28 $31.88

93890 Tcd vasoreactivity study 8.22 44.28 $363.98

93890 TC Tcd vasoreactivity study 6.78 44.28 $300.22

93890 26 Tcd vasoreactivity study 1.44 44.28 $63.76

93892 Tcd emboli detect w/o inj 9.53 44.28 $421.99

93892 TC Tcd emboli detect w/o inj 7.86 44.28 $348.04

93892 26 Tcd emboli detect w/o inj 1.67 44.28 $73.95

93893 Tcd emboli detect w/inj 9.78 44.28 $433.06

93893 TC Tcd emboli detect w/inj 8.11 44.28 $359.11

93893 26 Tcd emboli detect w/inj 1.67 44.28 $73.95

93895 Carotid intima atheroma eval 0.00 44.28 $0.00

93895 TC Carotid intima atheroma eval 0.00 44.28 $0.00

93895 26 Carotid intima atheroma eval 0.00 44.28 $0.00

93922 Upr/l xtremity art 2 levels 2.53 44.28 $112.03

93922 TC Upr/l xtremity art 2 levels 2.18 44.28 $96.53

93922 26 Upr/l xtremity art 2 levels 0.35 44.28 $15.50

93923 Upr/lxtr art stdy 3+ lvls 3.92 44.28 $173.58

93923 TC Upr/lxtr art stdy 3+ lvls 3.29 44.28 $145.68

93923 26 Upr/lxtr art stdy 3+ lvls 0.63 44.28 $27.90

93924 Lwr xtr vasc stdy bilat 4.89 44.28 $216.53

93924 TC Lwr xtr vasc stdy bilat 4.19 44.28 $185.53

93924 26 Lwr xtr vasc stdy bilat 0.70 44.28 $31.00

93925 Lower extremity study 7.37 44.28 $326.34

93925 TC Lower extremity study 6.25 44.28 $276.75

93925 26 Lower extremity study 1.12 44.28 $49.59

93926 Lower extremity study 4.34 44.28 $192.18

93926 TC Lower extremity study 3.63 44.28 $160.74

93926 26 Lower extremity study 0.71 44.28 $31.44

93930 Upper extremity study 5.92 44.28 $262.14

93930 TC Upper extremity study 4.80 44.28 $212.54

93930 26 Upper extremity study 1.12 44.28 $49.59

93931 Upper extremity study 3.68 44.28 $162.95

93931 TC Upper extremity study 2.97 44.28 $131.51

93931 26 Upper extremity study 0.71 44.28 $31.44

93965 Extremity study 3.41 44.28 $150.99

93965 TC Extremity study 2.92 44.28 $129.30

93965 26 Extremity study 0.49 44.28 $21.70

93970 Extremity study 5.58 44.28 $247.08


93970 26 Extremity study 0.99 44.28 $43.84

93971 Extremity study 3.43 44.28 $151.88


93971 26 Extremity study 0.64 44.28 $28.34

93975 Vascular study 7.97 44.28 $352.91

93975 TC Vascular study 6.35 44.28 $281.18

93975 26 Vascular study 1.62 44.28 $71.73

93976 Vascular study 4.62 44.28 $204.57


93976 26 Vascular study 1.14 44.28 $50.48

93978 Vascular study 5.40 44.28 $239.11


93978 26 Vascular study 1.11 44.28 $49.15

93979 Vascular study 3.41 44.28 $150.99


93979 26 Vascular study 0.70 44.28 $31.00

93980 Penile vascular study 3.38 44.28 $149.67

93980 TC Penile vascular study 1.66 44.28 $73.50

93980 26 Penile vascular study 1.72 44.28 $76.16

93981 Penile vascular study 2.03 44.28 $89.89

93981 TC Penile vascular study 1.43 44.28 $63.32

93981 26 Penile vascular study 0.60 44.28 $26.57

93982 Aneurysm pressure sens study 1.23 44.28 $54.46

93990 Doppler flow testing 4.56 44.28 $201.92

93990 TC Doppler flow testing 3.84 44.28 $170.04

93990 26 Doppler flow testing 0.72 44.28 $31.88

93998 Noninvas vasc dx study proc 0.00 44.28 $0.00

94002 Vent mgmt inpat init day 2.63 44.28 $116.46

94003 Vent mgmt inpat subq day 1.90 44.28 $84.13

94004 Vent mgmt nf per day 1.38 44.28 $61.11

94005 Home vent mgmt supervision 2.63 44.28 $116.46

94010 Breathing capacity test 1.02 44.28 $45.17

94010 TC Breathing capacity test 0.78 44.28 $34.54

94010 26 Breathing capacity test 0.24 44.28 $10.63

94011 Spirometry up to 2 yrs old 2.84 44.28 $125.76

94012 Spirmtry w/brnchdil inf-2 yr 4.69 44.28 $207.67

94013 Meas lung vol thru 2 yrs 0.88 44.28 $38.97

94014 Patient recorded spirometry 1.58 44.28 $69.96

94015 Patient recorded spirometry 0.86 44.28 $38.08

94016 Review patient spirometry 0.72 44.28 $31.88

94060 Evaluation of wheezing 1.72 44.28 $76.16

94060 TC Evaluation of wheezing 1.35 44.28 $59.78

94060 26 Evaluation of wheezing 0.37 44.28 $16.38

94070 Evaluation of wheezing 1.68 44.28 $74.39

94070 TC Evaluation of wheezing 0.87 44.28 $38.52

94070 26 Evaluation of wheezing 0.81 44.28 $35.87

94150 Vital capacity test 0.72 44.28 $31.88

94150 TC Vital capacity test 0.61 44.28 $27.01

94150 26 Vital capacity test 0.11 44.28 $4.87

94200 Lung function test (mbc/mvv) 0.72 44.28 $31.88

94200 TC Lung function test (mbc/mvv) 0.56 44.28 $24.80

94200 26 Lung function test (mbc/mvv) 0.16 44.28 $7.08

94250 Expired gas collection 0.74 44.28 $32.77

94250 TC Expired gas collection 0.59 44.28 $26.13

94250 26 Expired gas collection 0.15 44.28 $6.64

94375 Respiratory flow volume loop 1.11 44.28 $49.15

94375 TC Respiratory flow volume loop 0.69 44.28 $30.55

94375 26 Respiratory flow volume loop 0.42 44.28 $18.60

94400 Co2 breathing response curve 1.60 44.28 $70.85

94400 TC Co2 breathing response curve 1.05 44.28 $46.49

94400 26 Co2 breathing response curve 0.55 44.28 $24.35

94450 Hypoxia response curve 1.88 44.28 $83.25

94450 TC Hypoxia response curve 1.33 44.28 $58.89

94450 26 Hypoxia response curve 0.55 44.28 $24.35

94452 Hast w/report 1.63 44.28 $72.18

94452 TC Hast w/report 1.22 44.28 $54.02

94452 26 Hast w/report 0.41 44.28 $18.15

94453 Hast w/oxygen titrate 2.26 44.28 $100.07

94453 TC Hast w/oxygen titrate 1.72 44.28 $76.16

94453 26 Hast w/oxygen titrate 0.54 44.28 $23.91

94610 Surfactant admin thru tube 1.60 44.28 $70.85

94620 Pulmonary stress test/simple 1.58 44.28 $69.96

94620 TC Pulmonary stress test/simple 0.72 44.28 $31.88

94620 26 Pulmonary stress test/simple 0.86 44.28 $38.08

94621 Pulm stress test/complex 4.63 44.28 $205.02

94621 TC Pulm stress test/complex 2.68 44.28 $118.67

94621 26 Pulm stress test/complex 1.95 44.28 $86.35

94640 Airway inhalation treatment 0.52 44.28 $23.03

94642 Aerosol inhalation treatment 0.00 44.28 $0.00

94644 Cbt 1st hour 1.23 44.28 $54.46

94645 Cbt each addl hour 0.39 44.28 $17.27

94660 Pos airway pressure cpap 1.77 44.28 $78.38

94662 Neg press ventilation cnp 0.97 44.28 $42.95

94664 Evaluate pt use of inhaler 0.49 44.28 $21.70

94667 Chest wall manipulation 0.74 44.28 $32.77

94668 Chest wall manipulation 0.81 44.28 $35.87

94669 Mechanical chest wall oscill 1.00 44.28 $44.28

94680 Exhaled air analysis o2 1.62 44.28 $71.73

94680 TC Exhaled air analysis o2 1.26 44.28 $55.79

94680 26 Exhaled air analysis o2 0.36 44.28 $15.94

94681 Exhaled air analysis o2/co2 1.51 44.28 $66.86

94681 TC Exhaled air analysis o2/co2 1.23 44.28 $54.46

94681 26 Exhaled air analysis o2/co2 0.28 44.28 $12.40

94690 Exhaled air analysis 1.40 44.28 $61.99

94690 TC Exhaled air analysis 1.29 44.28 $57.12

94690 26 Exhaled air analysis 0.11 44.28 $4.87

94726 Pulm funct tst plethysmograp 1.49 44.28 $65.98

94726 TC Pulm funct tst plethysmograp 1.14 44.28 $50.48

94726 26 Pulm funct tst plethysmograp 0.35 44.28 $15.50

94727 Pulm function test by gas 1.19 44.28 $52.69

94727 TC Pulm function test by gas 0.84 44.28 $37.20

94727 26 Pulm function test by gas 0.35 44.28 $15.50

94728 Pulm funct test oscillometry 1.11 44.28 $49.15

94728 TC Pulm funct test oscillometry 0.76 44.28 $33.65

94728 26 Pulm funct test oscillometry 0.35 44.28 $15.50

94729 Co/membane diffuse capacity 1.54 44.28 $68.19

94729 TC Co/membane diffuse capacity 1.28 44.28 $56.68

94729 26 Co/membane diffuse capacity 0.26 44.28 $11.51

94750 Pulmonary compliance study 2.29 44.28 $101.40

94750 TC Pulmonary compliance study 1.97 44.28 $87.23

94750 26 Pulmonary compliance study 0.32 44.28 $14.17

94760 Measure blood oxygen level 0.09 44.28 $3.99



94770 Exhaled carbon dioxide test 0.21 44.28 $9.30

94772 Breath recording infant 0.00 44.28 $0.00

94772 TC Breath recording infant 0.00 44.28 $0.00

94772 26 Breath recording infant 0.00 44.28 $0.00

94774 Ped home apnea rec compl 0.00 44.28 $0.00

94775 Ped home apnea rec hk-up 0.00 44.28 $0.00

94776 Ped home apnea rec downld 0.00 44.28 $0.00

94777 Ped home apnea rec report 0.00 44.28 $0.00

94780 Car seat/bed test 60 min 1.77 44.28 $78.38

94781 Car seat/bed test + 30 min 0.65 44.28 $28.78

94799 Pulmonary service/procedure 0.00 44.28 $0.00

94799 TC Pulmonary service/procedure 0.00 44.28 $0.00

94799 26 Pulmonary service/procedure 0.00 44.28 $0.00

95004 Percut allergy skin tests 0.18 44.28 $7.97

95012 Exhaled nitric oxide meas 0.55 44.28 $24.35

95017 Perq & icut allg test venoms 0.22 44.28 $9.74

95018 Perq&ic allg test drugs/biol 0.53 44.28 $23.47

95024 Icut allergy test drug/bug 0.22 44.28 $9.74

95027 Icut allergy titrate-airborn 0.13 44.28 $5.76

95028 Icut allergy test-delayed 0.38 44.28 $16.83

95044 Allergy patch tests 0.16 44.28 $7.08

95052 Photo patch test 0.19 44.28 $8.41

95056 Photosensitivity tests 1.25 44.28 $55.35

95060 Eye allergy tests 0.99 44.28 $43.84

95065 Nose allergy test 0.71 44.28 $31.44

95070 Bronchial allergy tests 0.85 44.28 $37.64

95071 Bronchial allergy tests 0.98 44.28 $43.39

95076 Ingest challenge ini 120 min 3.27 44.28 $144.80

95079 Ingest challenge addl 60 min 2.33 44.28 $103.17

95115 Immunotherapy one injection 0.25 44.28 $11.07

95117 Immunotherapy injections 0.29 44.28 $12.84

95120 Immunotherapy one injection 0.00 44.28 $0.00

95125 Immunotherapy 2/> injections 0.00 44.28 $0.00

95130 Immntx 1 sting insect 0.00 44.28 $0.00

95131 Immntx 2 sting insects 0.00 44.28 $0.00




95144 Antigen therapy services 0.35 44.28 $15.50








95180 Rapid desensitization 3.77 44.28 $166.94

95199 Allergy immunology services 0.00 44.28 $0.00

95250 Glucose monitoring cont 4.44 44.28 $196.60

95251 Gluc monitor cont phys i&r 1.22 44.28 $54.02

95782 Polysom <6 yrs 4/> paramtrs 25.73 44.28 $1,139.32

95782 TC Polysom <6 yrs 4/> paramtrs 22.27 44.28 $986.12

95782 26 Polysom <6 yrs 4/> paramtrs 3.46 44.28 $153.21

95783 Polysom <6 yrs cpap/bilvl 35.10 44.28 $1,554.23

95783 TC Polysom <6 yrs cpap/bilvl 30.91 44.28 $1,368.69

95783 26 Polysom <6 yrs cpap/bilvl 4.19 44.28 $185.53

95800 Slp stdy unattended 5.07 44.28 $224.50

95800 TC Slp stdy unattended 3.60 44.28 $159.41

95800 26 Slp stdy unattended 1.47 44.28 $65.09

95801 Slp stdy unatnd w/anal 2.59 44.28 $114.69

95801 TC Slp stdy unatnd w/anal 1.19 44.28 $52.69

95801 26 Slp stdy unatnd w/anal 1.40 44.28 $61.99

95803 Actigraphy testing 3.99 44.28 $176.68

95803 TC Actigraphy testing 2.77 44.28 $122.66

95803 26 Actigraphy testing 1.22 44.28 $54.02

95805 Multiple sleep latency test 11.82 44.28 $523.39

95805 TC Multiple sleep latency test 10.15 44.28 $449.44

95805 26 Multiple sleep latency test 1.67 44.28 $73.95

95806 Sleep study unatt&resp efft 4.74 44.28 $209.89

95806 TC Sleep study unatt&resp efft 3.02 44.28 $133.73

95806 26 Sleep study unatt&resp efft 1.72 44.28 $76.16

95807 Sleep study attended 13.20 44.28 $584.50

95807 TC Sleep study attended 11.45 44.28 $507.01

95807 26 Sleep study attended 1.75 44.28 $77.49

95808 Polysom any age 1-3> param 16.97 44.28 $751.43

95808 TC Polysom any age 1-3> param 14.52 44.28 $642.95

95808 26 Polysom any age 1-3> param 2.45 44.28 $108.49

95810 Polysom 6/> yrs 4/> param 17.50 44.28 $774.90

95810 TC Polysom 6/> yrs 4/> param 14.06 44.28 $622.58

95810 26 Polysom 6/> yrs 4/> param 3.44 44.28 $152.32

95811 Polysom 6/>yrs cpap 4/> parm 18.38 44.28 $813.87

95811 TC Polysom 6/>yrs cpap 4/> parm 14.81 44.28 $655.79

95811 26 Polysom 6/>yrs cpap 4/> parm 3.57 44.28 $158.08

95812 Eeg 41-60 minutes 11.79 44.28 $522.06

95812 TC Eeg 41-60 minutes 10.16 44.28 $449.88

95812 26 Eeg 41-60 minutes 1.63 44.28 $72.18

95813 Eeg over 1 hour 14.11 44.28 $624.79

95813 TC Eeg over 1 hour 11.49 44.28 $508.78

95813 26 Eeg over 1 hour 2.62 44.28 $116.01

95816 Eeg awake and drowsy 10.11 44.28 $447.67

95816 TC Eeg awake and drowsy 8.48 44.28 $375.49

95816 26 Eeg awake and drowsy 1.63 44.28 $72.18

95819 Eeg awake and asleep 11.53 44.28 $510.55

95819 TC Eeg awake and asleep 9.90 44.28 $438.37

95819 26 Eeg awake and asleep 1.63 44.28 $72.18

95822 Eeg coma or sleep only 10.43 44.28 $461.84

95822 TC Eeg coma or sleep only 8.80 44.28 $389.66

95822 26 Eeg coma or sleep only 1.63 44.28 $72.18

95824 Eeg cerebral death only 0.00 44.28 $0.00

95824 TC Eeg cerebral death only 0.00 44.28 $0.00

95824 26 Eeg cerebral death only 1.14 44.28 $50.48

95827 Eeg all night recording 22.10 44.28 $978.59

95827 TC Eeg all night recording 20.48 44.28 $906.85

95827 26 Eeg all night recording 1.62 44.28 $71.73

95829 Surgery electrocorticogram 53.11 44.28 $2,351.71

95829 TC Surgery electrocorticogram 43.72 44.28 $1,935.92

95829 26 Surgery electrocorticogram 9.39 44.28 $415.79

95830 Insert electrodes for eeg 6.94 44.28 $307.30

95831 Limb muscle testing manual 0.87 44.28 $38.52

95832 Hand muscle testing manual 0.86 44.28 $38.08

95833 Body muscle testing manual 1.06 44.28 $46.94

95834 Body muscle testing manual 1.43 44.28 $63.32

95851 Range of motion measurements 0.52 44.28 $23.03

95852 Range of motion measurements 0.46 44.28 $20.37

95857 Cholinesterase challenge 1.52 44.28 $67.31

95860 Muscle test one limb 3.47 44.28 $153.65

95860 TC Muscle test one limb 2.00 44.28 $88.56

95860 26 Muscle test one limb 1.47 44.28 $65.09

95861 Muscle test 2 limbs 4.87 44.28 $215.64

95861 TC Muscle test 2 limbs 2.54 44.28 $112.47

95861 26 Muscle test 2 limbs 2.33 44.28 $103.17







95865 Muscle test larynx 4.07 44.28 $180.22

95865 TC Muscle test larynx 1.69 44.28 $74.83

95865 26 Muscle test larynx 2.38 44.28 $105.39

95866 Muscle test hemidiaphragm 3.76 44.28 $166.49

95866 TC Muscle test hemidiaphragm 1.84 44.28 $81.48

95866 26 Muscle test hemidiaphragm 1.92 44.28 $85.02

95867 Muscle test cran nerv unilat 2.63 44.28 $116.46

95867 TC Muscle test cran nerv unilat 1.45 44.28 $64.21

95867 26 Muscle test cran nerv unilat 1.18 44.28 $52.25

95868 Muscle test cran nerve bilat 3.73 44.28 $165.16

95868 TC Muscle test cran nerve bilat 1.94 44.28 $85.90

95868 26 Muscle test cran nerve bilat 1.79 44.28 $79.26

95869 Muscle test thor paraspinal 2.30 44.28 $101.84

95869 TC Muscle test thor paraspinal 1.74 44.28 $77.05

95869 26 Muscle test thor paraspinal 0.56 44.28 $24.80

95870 Muscle test nonparaspinal 2.49 44.28 $110.26

95870 TC Muscle test nonparaspinal 1.94 44.28 $85.90

95870 26 Muscle test nonparaspinal 0.55 44.28 $24.35

95872 Muscle test one fiber 5.59 44.28 $247.53

95872 TC Muscle test one fiber 1.22 44.28 $54.02

95872 26 Muscle test one fiber 4.37 44.28 $193.50

95873 Guide nerv destr elec stim 2.11 44.28 $93.43

95873 TC Guide nerv destr elec stim 1.53 44.28 $67.75

95873 26 Guide nerv destr elec stim 0.58 44.28 $25.68

95874 Guide nerv destr needle emg 2.03 44.28 $89.89

95874 TC Guide nerv destr needle emg 1.47 44.28 $65.09

95874 26 Guide nerv destr needle emg 0.56 44.28 $24.80

95875 Limb exercise test 3.41 44.28 $150.99

95875 TC Limb exercise test 1.76 44.28 $77.93

95875 26 Limb exercise test 1.65 44.28 $73.06

95885 Musc tst done w/nerv tst lim 1.65 44.28 $73.06

95885 TC Musc tst done w/nerv tst lim 1.12 44.28 $49.59

95885 26 Musc tst done w/nerv tst lim 0.53 44.28 $23.47

95886 Musc test done w/n test comp 2.57 44.28 $113.80

95886 TC Musc test done w/n test comp 1.27 44.28 $56.24

95886 26 Musc test done w/n test comp 1.30 44.28 $57.56

95887 Musc tst done w/n tst nonext 2.30 44.28 $101.84

95887 TC Musc tst done w/n tst nonext 1.22 44.28 $54.02

95887 26 Musc tst done w/n tst nonext 1.08 44.28 $47.82

95905 Motor &/ sens nrve cndj test 2.02 44.28 $89.45

95905 TC Motor &/ sens nrve cndj test 1.94 44.28 $85.90

95905 26 Motor &/ sens nrve cndj test 0.08 44.28 $3.54

95907 Nvr cndj tst 1-2 studies 2.74 44.28 $121.33

95907 TC Nvr cndj tst 1-2 studies 1.23 44.28 $54.46

95907 26 Nvr cndj tst 1-2 studies 1.51 44.28 $66.86

95908 Nrv cndj tst 3-4 studies 3.52 44.28 $155.87

95908 TC Nrv cndj tst 3-4 studies 1.61 44.28 $71.29

95908 26 Nrv cndj tst 3-4 studies 1.91 44.28 $84.57

95909 Nrv cndj tst 5-6 studies 4.17 44.28 $184.65

95909 TC Nrv cndj tst 5-6 studies 1.89 44.28 $83.69

95909 26 Nrv cndj tst 5-6 studies 2.28 44.28 $100.96

95910 Nrv cndj test 7-8 studies 5.54 44.28 $245.31

95910 TC Nrv cndj test 7-8 studies 2.49 44.28 $110.26

95910 26 Nrv cndj test 7-8 studies 3.05 44.28 $135.05







95913 Nrv cndj test 13/> studies 8.33 44.28 $368.85

95913 TC Nrv cndj test 13/> studies 3.01 44.28 $133.28

95913 26 Nrv cndj test 13/> studies 5.32 44.28 $235.57

95921 Autonomic nrv parasym inervj 2.47 44.28 $109.37

95921 TC Autonomic nrv parasym inervj 1.18 44.28 $52.25

95921 26 Autonomic nrv parasym inervj 1.29 44.28 $57.12

95922 Autonomic nrv adrenrg inervj 2.83 44.28 $125.31

95922 TC Autonomic nrv adrenrg inervj 1.46 44.28 $64.65

95922 26 Autonomic nrv adrenrg inervj 1.37 44.28 $60.66

95923 Autonomic nrv syst funj test 5.40 44.28 $239.11

95923 TC Autonomic nrv syst funj test 4.10 44.28 $181.55

95923 26 Autonomic nrv syst funj test 1.30 44.28 $57.56

95924 Ans parasymp & symp w/tilt 4.32 44.28 $191.29

95924 TC Ans parasymp & symp w/tilt 1.81 44.28 $80.15

95924 26 Ans parasymp & symp w/tilt 2.51 44.28 $111.14

95925 Somatosensory testing 4.43 44.28 $196.16

95925 TC Somatosensory testing 3.63 44.28 $160.74

95925 26 Somatosensory testing 0.80 44.28 $35.42







95928 C motor evoked uppr limbs 7.30 44.28 $323.24

95928 TC C motor evoked uppr limbs 5.03 44.28 $222.73

95928 26 C motor evoked uppr limbs 2.27 44.28 $100.52

95929 C motor evoked lwr limbs 7.29 44.28 $322.80

95929 TC C motor evoked lwr limbs 5.07 44.28 $224.50

95929 26 C motor evoked lwr limbs 2.22 44.28 $98.30

95930 Visual evoked potential test 3.62 44.28 $160.29

95930 TC Visual evoked potential test 3.10 44.28 $137.27

95930 26 Visual evoked potential test 0.52 44.28 $23.03

95933 Blink reflex test 2.37 44.28 $104.94

95933 TC Blink reflex test 1.48 44.28 $65.53

95933 26 Blink reflex test 0.89 44.28 $39.41

95937 Neuromuscular junction test 2.34 44.28 $103.62

95937 TC Neuromuscular junction test 1.36 44.28 $60.22

95937 26 Neuromuscular junction test 0.98 44.28 $43.39




95939 C motor evoked upr&lwr limbs 14.17 44.28 $627.45

95939 TC C motor evoked upr&lwr limbs 10.73 44.28 $475.12

95939 26 C motor evoked upr&lwr limbs 3.44 44.28 $152.32

95940 Ionm in operatng room 15 min 0.93 44.28 $41.18

95941 Ionm remote/>1 pt or per hr 0.00 44.28 $0.00

95943 Parasymp&symp hrt rate test 0.00 44.28 $0.00

95943 TC Parasymp&symp hrt rate test 0.00 44.28 $0.00

95943 26 Parasymp&symp hrt rate test 0.00 44.28 $0.00

95950 Ambulatory eeg monitoring 9.26 44.28 $410.03

95950 TC Ambulatory eeg monitoring 7.00 44.28 $309.96

95950 26 Ambulatory eeg monitoring 2.26 44.28 $100.07

95951 Eeg monitoring/videorecord 0.00 44.28 $0.00

95951 TC Eeg monitoring/videorecord 0.00 44.28 $0.00

95951 26 Eeg monitoring/videorecord 9.27 44.28 $410.48

95953 Eeg monitoring/computer 11.80 44.28 $522.50

95953 TC Eeg monitoring/computer 7.15 44.28 $316.60

95953 26 Eeg monitoring/computer 4.65 44.28 $205.90

95954 Eeg monitoring/giving drugs 12.94 44.28 $572.98

95954 TC Eeg monitoring/giving drugs 9.40 44.28 $416.23

95954 26 Eeg monitoring/giving drugs 3.54 44.28 $156.75

95955 Eeg during surgery 6.02 44.28 $266.57

95955 TC Eeg during surgery 4.50 44.28 $199.26

95955 26 Eeg during surgery 1.52 44.28 $67.31

95956 Eeg monitor technol attended 47.02 44.28 $2,082.05

95956 TC Eeg monitor technol attended 41.59 44.28 $1,841.61

95956 26 Eeg monitor technol attended 5.43 44.28 $240.44

95957 Eeg digital analysis 8.92 44.28 $394.98

95957 TC Eeg digital analysis 5.93 44.28 $262.58

95957 26 Eeg digital analysis 2.99 44.28 $132.40

95958 Eeg monitoring/function test 16.39 44.28 $725.75

95958 TC Eeg monitoring/function test 10.03 44.28 $444.13

95958 26 Eeg monitoring/function test 6.36 44.28 $281.62

95961 Electrode stimulation brain 8.18 44.28 $362.21

95961 TC Electrode stimulation brain 3.71 44.28 $164.28

95961 26 Electrode stimulation brain 4.47 44.28 $197.93

95962 Electrode stim brain add-on 7.23 44.28 $320.14

95962 TC Electrode stim brain add-on 2.46 44.28 $108.93

95962 26 Electrode stim brain add-on 4.77 44.28 $211.22

95965 Meg spontaneous 0.00 44.28 $0.00

95965 TC Meg spontaneous 0.00 44.28 $0.00

95965 26 Meg spontaneous 12.27 44.28 $543.32

95966 Meg evoked single 0.00 44.28 $0.00

95966 TC Meg evoked single 0.00 44.28 $0.00

95966 26 Meg evoked single 6.18 44.28 $273.65

95967 Meg evoked each addl 0.00 44.28 $0.00

95967 TC Meg evoked each addl 0.00 44.28 $0.00

95967 26 Meg evoked each addl 5.41 44.28 $239.55

95970 Analyze neurostim no prog 1.89 44.28 $83.69

95971 Analyze neurostim simple 1.62 44.28 $71.73

95972 Analyze neurostim complex 1.56 44.28 $69.08

95973 Analyze neurostim complex 1.14 44.28 $50.48

95974 Cranial neurostim complex 5.89 44.28 $260.81

95975 Cranial neurostim complex 3.16 44.28 $139.92

95978 Analyze neurostim brain/1h 7.05 44.28 $312.17

95979 Analyz neurostim brain addon 3.07 44.28 $135.94

95980 Io anal gast n-stim init 1.31 44.28 $58.01

95981 Io anal gast n-stim subsq 0.90 44.28 $39.85

95982 Io ga n-stim subsq w/reprog 1.50 44.28 $66.42

95990 Spin/brain pump refil & main 2.54 44.28 $112.47

95991 Spin/brain pump refil & main 3.41 44.28 $150.99

95992 Canalith repositioning proc 1.20 44.28 $53.14

95999 Neurological procedure 0.00 44.28 $0.00

96000 Motion analysis video/3d 2.70 44.28 $119.56

96001 Motion test w/ft press meas 2.87 44.28 $127.08

96002 Dynamic surface emg 0.62 44.28 $27.45

96003 Dynamic fine wire emg 0.54 44.28 $23.91

96004 Phys review of motion tests 3.33 44.28 $147.45

96020 Functional brain mapping 0.00 44.28 $0.00

96020 TC Functional brain mapping 0.00 44.28 $0.00

96020 26 Functional brain mapping 4.78 44.28 $211.66

96040 Genetic counseling 30 min 1.33 44.28 $58.89

96101 Psycho testing by psych/phys 2.24 44.28 $99.19

96102 Psycho testing by technician 1.79 44.28 $79.26

96103 Psycho testing admin by comp 0.77 44.28 $34.10

96105 Assessment of aphasia 2.93 44.28 $129.74

96110 Developmental screen w/score 0.27 44.28 $11.96

96111 Developmental test extend 3.61 44.28 $159.85

96116 Neurobehavioral status exam 2.62 44.28 $116.01

96118 Neuropsych tst by psych/phys 2.74 44.28 $121.33

96119 Neuropsych testing by tec 2.28 44.28 $100.96

96120 Neuropsych tst admin w/comp 1.35 44.28 $59.78

96125 Cognitive test by hc pro 3.30 44.28 $146.12

96127 Brief emotional/behav assmt 0.15 44.28 $6.64

96150 Assess hlth/behave init 0.61 44.28 $27.01

96151 Assess hlth/behave subseq 0.58 44.28 $25.68

96152 Intervene hlth/behave indiv 0.55 44.28 $24.35

96153 Intervene hlth/behave group 0.13 44.28 $5.76

96154 Interv hlth/behav fam w/pt 0.54 44.28 $23.91

96155 Interv hlth/behav fam no pt 0.64 44.28 $28.34

96360 Hydration iv infusion init 1.62 44.28 $71.73

96361 Hydrate iv infusion add-on 0.43 44.28 $19.04

96365 Ther/proph/diag iv inf init 1.96 44.28 $86.79

96366 Ther/proph/diag iv inf addon 0.53 44.28 $23.47

96367 Tx/proph/dg addl seq iv inf 0.85 44.28 $37.64

96368 Ther/diag concurrent inf 0.58 44.28 $25.68

96369 Sc ther infusion up to 1 hr 5.48 44.28 $242.65

96370 Sc ther infusion addl hr 0.43 44.28 $19.04

96371 Sc ther infusion reset pump 2.53 44.28 $112.03

96372 Ther/proph/diag inj sc/im 0.71 44.28 $31.44

96373 Ther/proph/diag inj ia 0.55 44.28 $24.35

96374 Ther/proph/diag inj iv push 1.60 44.28 $70.85

96375 Tx/pro/dx inj new drug addon 0.63 44.28 $27.90

96376 Tx/pro/dx inj same drug adon 0.00 44.28 $0.00

96379 Ther/prop/diag inj/inf proc 0.00 44.28 $0.00

96401 Chemo anti-neopl sq/im 2.10 44.28 $92.99

96402 Chemo hormon antineopl sq/im 0.91 44.28 $40.29

96405 Chemo intralesional up to 7 2.30 44.28 $101.84

96406 Chemo intralesional over 7 3.34 44.28 $147.90

96409 Chemo iv push sngl drug 3.11 44.28 $137.71

96411 Chemo iv push addl drug 1.74 44.28 $77.05

96413 Chemo iv infusion 1 hr 3.80 44.28 $168.26

96415 Chemo iv infusion addl hr 0.79 44.28 $34.98

96416 Chemo prolong infuse w/pump 3.94 44.28 $174.46

96417 Chemo iv infus each addl seq 1.76 44.28 $77.93

96420 Chemo ia push tecnique 2.92 44.28 $129.30

96422 Chemo ia infusion up to 1 hr 4.78 44.28 $211.66

96423 Chemo ia infuse each addl hr 2.22 44.28 $98.30

96425 Chemotherapy infusion method 5.07 44.28 $224.50

96440 Chemotherapy intracavitary 24.22 44.28 $1,072.46

96446 Chemotx admn prtl cavity 5.66 44.28 $250.62

96450 Chemotherapy into cns 5.13 44.28 $227.16

96521 Refill/maint portable pump 3.88 44.28 $171.81

96522 Refill/maint pump/resvr syst 3.20 44.28 $141.70

96523 Irrig drug delivery device 0.70 44.28 $31.00

96542 Chemotherapy injection 3.37 44.28 $149.22

96549 Chemotherapy unspecified 0.00 44.28 $0.00

96567 Photodynamic tx skin 3.79 44.28 $167.82

96570 Photodynmc tx 30 min add-on 1.63 44.28 $72.18

96571 Photodynamic tx addl 15 min 0.75 44.28 $33.21

96900 Ultraviolet light therapy 0.58 44.28 $25.68

96902 Trichogram 0.61 44.28 $27.01

96904 Whole body photography 1.77 44.28 $78.38

96910 Photochemotherapy with uv-b 2.01 44.28 $89.00

96912 Photochemotherapy with uv-a 2.58 44.28 $114.24

96913 Photochemotherapy uv-a or b 3.63 44.28 $160.74

96920 Laser tx skin < 250 sq cm 4.37 44.28 $193.50

96921 Laser tx skin 250-500 sq cm 4.83 44.28 $213.87

96922 Laser tx skin >500 sq cm 6.68 44.28 $295.79

96999 Dermatological procedure 0.00 44.28 $0.00

97001 Pt evaluation 2.11 44.28 $93.43

97002 Pt re-evaluation 1.18 44.28 $52.25

97003 Ot evaluation 2.39 44.28 $105.83

97004 Ot re-evaluation 1.48 44.28 $65.53

97005 Athletic train eval 0.00 44.28 $0.00

97006 Athletic train reeval 0.00 44.28 $0.00

97010 Hot or cold packs therapy 0.17 44.28 $7.53

97012 Mechanical traction therapy 0.45 44.28 $19.93

97014 Electric stimulation therapy 0.45 44.28 $19.93

97016 Vasopneumatic device therapy 0.54 44.28 $23.91

97018 Paraffin bath therapy 0.31 44.28 $13.73

97022 Whirlpool therapy 0.66 44.28 $29.22

97024 Diathermy eg microwave 0.18 44.28 $7.97

97026 Infrared therapy 0.17 44.28 $7.53

97028 Ultraviolet therapy 0.21 44.28 $9.30

97032 Electrical stimulation 0.54 44.28 $23.91

97033 Electric current therapy 0.92 44.28 $40.74

97034 Contrast bath therapy 0.51 44.28 $22.58

97035 Ultrasound therapy 0.36 44.28 $15.94

97036 Hydrotherapy 0.94 44.28 $41.62

97039 Physical therapy treatment 0.00 44.28 $0.00

97110 Therapeutic exercises 0.91 44.28 $40.29

97112 Neuromuscular reeducation 0.94 44.28 $41.62

97113 Aquatic therapy/exercises 1.21 44.28 $53.58

97116 Gait training therapy 0.80 44.28 $35.42

97124 Massage therapy 0.75 44.28 $33.21

97139 Physical medicine procedure 0.00 44.28 $0.00

97140 Manual therapy 1/> regions 0.84 44.28 $37.20

97150 Group therapeutic procedures 0.49 44.28 $21.70

97530 Therapeutic activities 0.98 44.28 $43.39

97532 Cognitive skills development 0.75 44.28 $33.21

97533 Sensory integration 0.82 44.28 $36.31

97535 Self care mngment training 0.98 44.28 $43.39

97537 Community/work reintegration 0.85 44.28 $37.64

97542 Wheelchair mngment training 0.86 44.28 $38.08

97545 Work hardening 0.00 44.28 $0.00

97546 Work hardening add-on 0.00 44.28 $0.00

97597 Rmvl devital tis 20 cm/< 2.15 44.28 $95.20

97598 Rmvl devital tis addl 20cm/< 0.71 44.28 $31.44

97602 Wound(s) care non-selective 0.00 44.28 $0.00

97605 Neg press wound tx </=50 cm 1.23 44.28 $54.46

97606 Neg press wound tx >50 cm 1.46 44.28 $64.65

97607 Neg press wnd tx </=50 sq cm 0.00 44.28 $0.00

97608 Neg press wound tx >50 cm 0.00 44.28 $0.00

97610 Low frequency non-thermal us 3.43 44.28 $151.88

97750 Physical performance test 0.93 44.28 $41.18

97755 Assistive technology assess 1.01 44.28 $44.72

97760 Orthotic mgmt and training 1.07 44.28 $47.38

97761 Prosthetic training 0.93 44.28 $41.18

97762 C/o for orthotic/prosth use 1.35 44.28 $59.78

97799 Physical medicine procedure 0.00 44.28 $0.00

97802 Medical nutrition indiv in 0.98 44.28 $43.39

97803 Med nutrition indiv subseq 0.84 44.28 $37.20

97804 Medical nutrition group 0.45 44.28 $19.93

97810 Acupunct w/o stimul 15 min 1.03 44.28 $45.61

97811 Acupunct w/o stimul addl 15m 0.77 44.28 $34.10

97813 Acupunct w/stimul 15 min 1.10 44.28 $48.71

97814 Acupunct w/stimul addl 15m 0.87 44.28 $38.52

98925 Osteopath manj 1-2 regions 0.88 44.28 $38.97





98940 Chiropract manj 1-2 regions 0.79 44.28 $34.98

98941 Chiropract manj 3-4 regions 1.15 44.28 $50.92

98942 Chiropractic manj 5 regions 1.50 44.28 $66.42

98943 Chiropract manj xtrspinl 1/> 0.77 44.28 $34.10

98960 Self-mgmt educ & train 1 pt 0.79 44.28 $34.98

98961 Self-mgmt educ/train 2-4 pt 0.38 44.28 $16.83

98962 Self-mgmt educ/train 5-8 pt 0.28 44.28 $12.40

98966 Hc pro phone call 5-10 min 0.40 44.28 $17.71



98969 Online service by hc pro 0.00 44.28 $0.00

99000 Specimen handling office-lab 0.00 44.28 $0.00

99001 Specimen handling pt-lab 0.00 44.28 $0.00

99002 Device handling phys/qhp 0.00 44.28 $0.00

99024 Postop follow-up visit 0.00 44.28 $0.00

99026 In-hospital on call service 0.00 44.28 $0.00

99027 Out-of-hosp on call service 0.00 44.28 $0.00

99050 Medical services after hrs 0.00 44.28 $0.00

99051 Med serv eve/wkend/holiday 0.00 44.28 $0.00

99053 Med serv 10pm-8am 24 hr fac 0.00 44.28 $0.00

99056 Med service out of office 0.00 44.28 $0.00

99058 Office emergency care 0.00 44.28 $0.00

99060 Out of office emerg med serv 0.00 44.28 $0.00

99070 Special supplies phys/qhp 0.00 44.28 $0.00

99071 Patient education materials 0.00 44.28 $0.00

99075 Medical testimony 0.00 44.28 $0.00

99078 Group health education 0.00 44.28 $0.00

99080 Special reports or forms 0.00 44.28 $0.00

99082 Unusual physician travel 0.00 44.28 $0.00

99090 Computer data analysis 0.00 44.28 $0.00

99091 Collect/review data from pt 1.59 44.28 $70.41

99100 Special anesthesia service 0.00 44.28 $0.00

99116 Anesthesia with hypothermia 0.00 44.28 $0.00

99135 Special anesthesia procedure 0.00 44.28 $0.00

99140 Emergency anesthesia 0.00 44.28 $0.00

99143 Mod sedat phys/qhp <5 yrs 0.00 44.28 $0.00

99144 Mod sedat phys/qhp 5yrs/> 0.00 44.28 $0.00

99145 Mod sedat phys/qhp ea 15 min 0.00 44.28 $0.00

99148 Mod sed diff phys/qhp<5 yrs 0.00 44.28 $0.00

99149 Mod sed diff phys/qhp 5/>yrs 0.00 44.28 $0.00

99150 Mod sed diff phys/qhp add on 0.00 44.28 $0.00

99170 Anogenital exam child w imag 4.51 44.28 $199.70

99172 Ocular function screen 0.00 44.28 $0.00

99173 Visual acuity screen 0.09 44.28 $3.99

99174 Ocular instrumnt screen bil 0.00 44.28 $0.00

99175 Induction of vomiting 0.48 44.28 $21.25

99183 Hyperbaric oxygen therapy 3.15 44.28 $139.48

99184 Hypothermia ill neonate 6.62 44.28 $293.13

99188 App topical fluoride varnish 0.00 44.28 $0.00

99190 Special pump services 0.00 44.28 $0.00



99195 Phlebotomy 2.83 44.28 $125.31

99199 Special service/proc/report 0.00 44.28 $0.00

99201 Office/outpatient visit new 1.23 44.28 $54.46





99211 Office/outpatient visit est 0.56 44.28 $24.80





99217 Observation care discharge 2.05 44.28 $90.77

99218 Initial observation care 2.83 44.28 $125.31



99221 Initial hospital care 2.87 44.28 $127.08



99224 Subsequent observation care 1.11 44.28 $49.15



99231 Subsequent hospital care 1.10 44.28 $48.71



99234 Observ/hosp same date 3.78 44.28 $167.38



99238 Hospital discharge day 2.06 44.28 $91.22

99239 Hospital discharge day 3.03 44.28 $134.17

99241 Office consultation 1.37 44.28 $60.66





99251 Inpatient consultation 1.39 44.28 $61.55





99281 Emergency dept visit 0.59 44.28 $26.13





99288 Direct advanced life support 0.00 44.28 $0.00

99291 Critical care first hour 7.77 44.28 $344.06

99292 Critical care addl 30 min 3.46 44.28 $153.21

99304 Nursing facility care init 2.58 44.28 $114.24



99307 Nursing fac care subseq 1.25 44.28 $55.35




99315 Nursing fac discharge day 2.05 44.28 $90.77

99316 Nursing fac discharge day 2.96 44.28 $131.07

99318 Annual nursing fac assessmnt 2.70 44.28 $119.56

99324 Domicil/r-home visit new pat 1.55 44.28 $68.63





99334 Domicil/r-home visit est pat 1.69 44.28 $74.83




99339 Domicil/r-home care supervis 2.20 44.28 $97.42

99340 Domicil/r-home care supervis 3.07 44.28 $135.94

99341 Home visit new patient 1.54 44.28 $68.19





99347 Home visit est patient 1.56 44.28 $69.08




99354 Prolonged service office 2.81 44.28 $124.43

99355 Prolonged service office 2.73 44.28 $120.88

99356 Prolonged service inpatient 2.59 44.28 $114.69

99357 Prolonged service inpatient 2.56 44.28 $113.36

99358 Prolong service w/o contact 3.09 44.28 $136.83

99359 Prolong serv w/o contact add 1.48 44.28 $65.53

99360 Physician standby services 1.73 44.28 $76.60

99363 Anticoagulant mgmt initial 3.60 44.28 $159.41

99364 Anticoagulant mgmt subseq 1.22 44.28 $54.02

99366 Team conf w/pat by hc prof 1.21 44.28 $53.58

99367 Team conf w/o pat by phys 1.59 44.28 $70.41

99368 Team conf w/o pat by hc pro 1.04 44.28 $46.05

99374 Home health care supervision 1.97 44.28 $87.23

99375 Home health care supervision 2.97 44.28 $131.51

99377 Hospice care supervision 1.97 44.28 $87.23

99378 Hospice care supervision 2.97 44.28 $131.51

99379 Nursing fac care supervision 1.97 44.28 $87.23

99380 Nursing fac care supervision 2.97 44.28 $131.51

99381 Init pm e/m new pat infant 3.12 44.28 $138.15

99382 Init pm e/m new pat 1-4 yrs 3.26 44.28 $144.35

99383 Prev visit new age 5-11 3.39 44.28 $150.11




99387 Init pm e/m new pat 65+ yrs 4.67 44.28 $206.79

99391 Per pm reeval est pat infant 2.80 44.28 $123.98

99392 Prev visit est age 1-4 2.99 44.28 $132.40





99397 Per pm reeval est pat 65+ yr 3.85 44.28 $170.48

99401 Preventive counseling indiv 1.02 44.28 $45.17




99406 Behav chng smoking 3-10 min 0.40 44.28 $17.71

99407 Behav chng smoking > 10 min 0.77 44.28 $34.10

99408 Audit/dast 15-30 min 0.99 44.28 $43.84

99409 Audit/dast over 30 min 1.94 44.28 $85.90

99411 Preventive counseling group 0.46 44.28 $20.37

99412 Preventive counseling group 0.61 44.28 $27.01

99420 Health risk assessment test 0.31 44.28 $13.73

99429 Unlisted preventive service 0.00 44.28 $0.00

99441 Phone e/m phys/qhp 5-10 min 0.40 44.28 $17.71



99444 Online e/m by phys/qhp 0.00 44.28 $0.00

99446 Interprof phone/online 5-10 0.00 44.28 $0.00



99449 Interprof phone/online 31/> 0.00 44.28 $0.00

99450 Basic life disability exam 0.00 44.28 $0.00

99455 Work related disability exam 0.00 44.28 $0.00

99456 Disability examination 0.00 44.28 $0.00

99460 Init nb em per day hosp 2.80 44.28 $123.98

99461 Init nb em per day non-fac 2.53 44.28 $112.03

99462 Sbsq nb em per day hosp 1.17 44.28 $51.81

99463 Same day nb discharge 3.38 44.28 $149.67

99464 Attendance at delivery 2.10 44.28 $92.99

99465 Nb resuscitation 4.25 44.28 $188.19

99466 Ped crit care transport 6.95 44.28 $307.75

99467 Ped crit care transport addl 3.49 44.28 $154.54

99468 Neonate crit care initial 25.87 44.28 $1,145.52

99469 Neonate crit care subsq 11.21 44.28 $496.38

99471 Ped critical care initial 24.60 44.28 $1,089.29

99472 Ped critical care subsq 11.51 44.28 $509.66

99475 Ped crit care age 2-5 init 16.25 44.28 $719.55

99476 Ped crit care age 2-5 subsq 9.79 44.28 $433.50

99477 Init day hosp neonate care 10.17 44.28 $450.33

99478 Ic lbw inf < 1500 gm subsq 3.99 44.28 $176.68

99479 Ic lbw inf 1500-2500 g subsq 3.51 44.28 $155.42

99480 Ic inf pbw 2501-5000 g subsq 3.37 44.28 $149.22

99485 Suprv interfacilty transport 2.17 44.28 $96.09

99486 Suprv interfac trnsport addl 1.89 44.28 $83.69

99487 Cmplx chron care w/o pt vsit 0.00 44.28 $0.00

99489 Cmplx chron care addl 30 min 0.00 44.28 $0.00

99490 Chron care mgmt srvc 20 min 1.20 44.28 $53.14

99495 Trans care mgmt 14 day disch 4.63 44.28 $205.02

99496 Trans care mgmt 7 day disch 6.50 44.28 $287.82

99497 Advncd care plan 30 min 0.00 44.28 $0.00

99498 Advncd care plan addl 30 min 0.00 44.28 $0.00

99499 Unlisted e&m service 0.00 44.28 $0.00

99500 Home visit prenatal 0.00 44.28 $0.00

99501 Home visit postnatal 0.00 44.28 $0.00

99502 Home visit nb care 0.00 44.28 $0.00

99503 Home visit resp therapy 0.00 44.28 $0.00

99504 Home visit mech ventilator 0.00 44.28 $0.00

99505 Home visit stoma care 0.00 44.28 $0.00

99506 Home visit im injection 0.00 44.28 $0.00

99507 Home visit cath maintain 0.00 44.28 $0.00

99509 Home visit day life activity 0.00 44.28 $0.00

99510 Home visit sing/m/fam couns 0.00 44.28 $0.00

99511 Home visit fecal/enema mgmt 0.00 44.28 $0.00

99512 Home visit for hemodialysis 0.00 44.28 $0.00

99600 Home visit nos 0.00 44.28 $0.00

99601 Home infusion/visit 2 hrs 0.00 44.28 $0.00

99602 Home infusion each addtl hr 0.00 44.28 $0.00

99605 Mtms by pharm np 15 min 0.00 44.28 $0.00

99606 Mtms by pharm est 15 min 0.00 44.28 $0.00

99607 Mtms by pharm addl 15 min 0.00 44.28 $0.00

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Documents

2015 National Physician Fee Schedule Relative Value File ... · 2015 National Physician Fee Schedule Relative Value File January Release CPT codes and descriptions only are copyright