Px Code colonoscopy CPT(R)/HCPCS Code Gross Charge Blue Cross Blue Shield Sanford Health Plan Avera Health Plans Western Providers Network Monument Health Employee Benefit Plan Midlands Choice Network United Healthcare Self Pay Minimum Contracted Payment Maximum Contracted Payment Subject to multiple procedure discounting Subject to multiple procedure discounting Subject to multiple procedure discounting Subject to multiple procedure discounting Subject to multiple procedure discounting Subject to multiple procedure discounting Subject to multiple procedure discounting Subject to multiple procedure discounting 3601002100 FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION 10021 2020 821.38 " 1,717.00 " 133.91 " 1,717.00 " " 1,232.20 " " 1,818.00 " 821.00 " 1,818.00 " 133.91 " 1,818.00 " 3601006000 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE 10060 2720 737.55 " 2,312.00 " 160.15 " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 160.15 " 2,448.00 " 3601006100 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE 10061 2720 737.55 " 2,312.00 " 241.61 " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 241.61 " 2,448.00 " 3601012000 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE 10120 3869.25 737.55 " 3,288.86 " 222.97 " 3,288.86 " " 2,360.24 " " 3,482.33 " 821.00 " 3,482.33 " 222.97 " 3,482.33 " 3601012100 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL 10121 3869.25 737.55 " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " 737.55 " 3,482.33 " 3601014000 I&D HEMATOMA SEROMA/FLUID COLLECTION 10140 3869.25 737.55 " 3,288.86 " 228.49 " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " 228.49 " 3,482.33 " 3601016000 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST 10160 951.06 737.55 808.40 171.19 808.40 580.15 855.95 821.00 855.95 171.19 855.95 3601018000 INCISION & DRAINAGE COMPLEX PO WOUND INFECTION 10180 6517.53 " 3,128.41 " " 5,539.90 " " 2,131.02 " " 5,539.90 " " 3,975.69 " " 5,865.78 " " 2,714.00 " " 5,865.78 " " 2,131.02 " " 5,865.78 " 3601104200 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< 11042 "2,720.00" " 1,305.60 " " 2,312.00 " 374.16 " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 374.16 " 2,448.00 " 3601104300 DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< 11043 "3,240.00" " 1,555.20 " " 2,754.00 " 567.09 " 2,754.00 " " 1,976.40 " " 2,916.00 " 821.00 " 2,916.00 " 567.09 " 2,916.00 " 3601104400 DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/< 11044 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 1,643.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3601104500 DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM 11045 1441.46 691.90 " 1,225.24 " 763.97 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 691.90 " 1,297.31 " 3601104600 DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM 11046 1441.46 691.90 " 1,225.24 " 763.97 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 691.90 " 1,297.31 " 3601120000 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 11200 493.76 737.55 419.70 261.69 419.70 301.19 444.38 821.00 444.38 261.69 821.00 3601120100 REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10 11201 231.52 737.55 196.79 122.71 196.79 141.23 208.37 821.00 208.37 122.71 821.00 3601131100 SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM 11311 493.76 737.55 419.70 194.26 419.70 301.19 444.38 821.00 444.38 194.26 821.00 3601140000 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< 11400 1710.41 " 1,055.49 " " 1,453.85 " 196.73 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 196.73 " 1,643.00 " 3601140100 EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM 11401 951.06 " 1,055.49 " 808.40 222.97 808.40 580.15 855.95 821.00 855.95 222.97 " 1,055.49 " 3601140200 EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM 11402 1710.42 " 1,055.49 " " 1,453.86 " 240.92 " 1,453.86 " " 1,043.36 " " 1,539.38 " " 1,643.00 " " 1,539.38 " 240.92 " 1,643.00 " 3601140300 EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM/< 11403 1710.41 " 1,055.49 " " 1,453.85 " 262.31 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 262.31 " 1,643.00 " 3601140400 EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM 11404 3869.25 " 2,798.43 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3601140600 EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM 11406 3869.25 " 4,338.02 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 4,338.02 " 3601142000 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< 11420 3869.25 " 2,798.43 " " 3,288.86 " 187.08 " 3,288.86 " " 2,360.24 " " 3,482.33 " " 1,643.00 " " 3,482.33 " 187.08 " 3,482.33 " 3601142100 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM 11421 1710.41 " 1,055.49 " " 1,453.85 " 217.45 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 217.45 " 1,643.00 " 3601142200 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM 11422 3869.25 " 2,798.43 " " 3,288.86 " 240.92 " 3,288.86 " " 2,360.24 " " 3,482.33 " " 1,643.00 " " 3,482.33 " 240.92 " 3,482.33 " 3601142300 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM 11423 3869.25 " 2,798.43 " " 3,288.86 " 261.63 " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " 261.63 " 3,482.33 " 3601142400 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM 11424 2123 " 2,798.43 " " 1,804.55 " " 1,272.10 " " 1,804.55 " " 1,295.03 " " 1,910.70 " " 2,000.00 " " 1,910.70 " " 1,272.10 " " 2,798.43 " 3601142600 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM 11426 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601144000 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< 11440 1710.42 " 1,055.49 " " 1,453.86 " 216.07 " 1,453.86 " " 1,043.36 " " 1,539.38 " " 1,643.00 " " 1,539.38 " 216.07 " 1,643.00 " 3601144100 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM 11441 1710.41 " 1,055.49 " " 1,453.85 " 240.22 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 240.22 " 1,643.00 " 3601144200 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM 11442 1710.41 " 1,055.49 " " 1,453.85 " 258.86 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 258.86 " 1,643.00 " 3601144300 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM 11443 1630 " 2,798.43 " " 1,385.50 " 286.49 " 1,385.50 " 994.30 " 1,467.00 " " 1,643.00 " " 1,467.00 " 286.49 " 2,798.43 " 3601144400 EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM 11444 "3,017.02" " 2,798.43 " " 2,564.47 " " 1,272.10 " " 2,564.47 " " 1,840.38 " " 2,715.32 " " 1,643.00 " " 2,715.32 " " 1,272.10 " " 2,798.43 " 3601144600 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM 11446 6517.53 " 4,338.02 " " 5,539.90 " " 2,131.02 " " 5,539.90 " " 3,975.69 " " 5,865.78 " " 2,714.00 " " 5,865.78 " " 2,131.02 " " 5,865.78 " 3601145000 EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR 11450 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601145100 EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR 11451 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601146200 EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR 11462 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601146300 EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR 11463 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601147000 EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR 11470 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601147100 EXCISION H/P/P/U COMPLEX REPAIR 11471 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601160000 EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< 11600 1710.41 " 1,055.49 " " 1,453.85 " 287.85 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 287.85 " 1,643.00 " 3601160200 EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM 11602 951.06 " 1,055.49 " 808.40 330.66 808.40 580.15 855.95 821.00 855.95 330.66 " 1,055.49 " 3601160300 EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/< 11603 1710.41 " 1,055.49 " " 1,453.85 " 355.50 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 355.50 " 1,643.00 " 3601160400 EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM 11604 1710.41 " 1,055.49 " " 1,453.85 " 672.91 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 672.91 " 1,643.00 " 3601160600 EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM 11606 "3,125.52" " 2,798.43 " " 2,656.69 " " 1,272.10 " " 2,656.69 " " 1,906.57 " " 2,812.97 " " 2,000.00 " " 2,812.97 " " 1,272.10 " " 2,812.97 " 3601162000 EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/< 11620 "3,572.28" " 2,798.43 " " 3,036.44 " 287.85 " 3,036.44 " " 2,179.09 " " 3,215.05 " " 1,643.00 " " 3,215.05 " 287.85 " 3,215.05 " 3601162100 EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM 11621 1710.41 " 1,055.49 " " 1,453.85 " 314.77 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 314.77 " 1,643.00 " 3601162200 EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM 11622 1710.41 " 1,055.49 " " 1,453.85 " 336.18 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 336.18 " 1,643.00 " 3601162300 EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/< 11623 "3,572.28" " 2,798.43 " " 3,036.44 " 367.94 " 3,036.44 " " 2,179.09 " " 3,215.05 " " 1,643.00 " " 3,215.05 " 367.94 " 3,215.05 " 3601162400 EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM 11624 "3,572.28" " 2,798.43 " " 3,036.44 " " 1,272.10 " " 3,036.44 " " 2,179.09 " " 3,215.05 " " 2,000.00 " " 3,215.05 " " 1,272.10 " " 3,215.05 " 3601162600 EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM 11626 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601164200 EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM 11642 1710.41 " 2,553.41 " " 1,453.85 " 349.98 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 349.98 " 2,553.41 " 3601164300 EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM 11643 "1,630.00" " 2,798.43 " " 1,385.50 " 383.12 " 1,385.50 " 994.30 " 1,467.00 " " 1,643.00 " " 1,467.00 " 383.12 " 2,798.43 " 3601164400 EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM 11644 "1,780.00" " 2,798.43 " " 1,513.00 " " 1,272.10 " " 1,513.00 " " 1,085.80 " " 1,602.00 " " 2,000.00 " " 1,602.00 " " 1,085.80 " " 2,798.43 " 3601164600 EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM 11646 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601173200 AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL 11732 387.27 156.24 329.18 205.25 329.18 236.23 348.54 821.00 348.54 156.24 821.00 3601175000 EXCISION NAIL MATRIX PERMANENT REMOVAL 11750 951.06 " 1,055.49 " 808.40 214.00 808.40 580.15 855.95 821.00 855.95 214.00 " 1,055.49 " 3601175500 BIOPSY NAIL UNIT SEPARATE PROCEDURE 11755 1710.42 " 1,055.49 " " 1,453.86 " 166.35 " 1,453.86 " " 1,043.36 " " 1,539.38 " " 1,643.00 " " 1,539.38 " 166.35 " 1,643.00 " 3601177000 EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE 11770 6517.52 " 2,798.43 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601177100 EXCISION PILONIDAL CYST/SINUS EXTENSIVE 11771 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601177200 EXCISION PILONIDAL CYST/SINUS COMPLICATED 11772 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601190000 INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS 11900 493.76 737.55 419.70 261.69 419.70 301.19 444.38 821.00 444.38 261.69 821.00 3601190100 INJECTION INTRALESIONAL >7 LESIONS 11901 493.76 737.55 419.70 261.69 419.70 301.19 444.38 821.00 444.38 261.69 821.00 3601197000 REPLACEMENT TISSUE EXPANDER W/PERMANENT IMPLANT 11970 "9,971.95" " 4,786.54 " " 8,476.16 " " 8,119.41 " " 8,476.16 " " 6,082.89 " " 8,974.76 " " 4,500.00 " " 8,974.76 " " 4,500.00 " " 8,974.76 " 3601197100 REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT 11971 6517.52 " 2,798.43 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601198200 REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT 11982 743.1 737.55 631.64 393.84 631.64 453.29 668.79 821.00 668.79 393.84 821.00 3601200100 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< 12001 493.76 237.00 419.70 261.69 419.70 301.19 444.38 821.00 444.38 237.00 821.00 3601202000 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE 12020 "2,525.00" " 1,212.00 " " 2,146.25 " 567.09 " 2,146.25 " " 1,540.25 " " 2,272.50 " 821.00 " 2,272.50 " 567.09 " 2,272.50 " 3601203100 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< 12031 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601203200 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM 12032 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601203400 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM 12034 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601203500 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM 12035 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601203600 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM 12036 1441.46 691.90 " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601203700 REPAIR INTERMEDIATE S/A/T/E >30.0 CM 12037 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 3,143.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601204100 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< 12041 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601204200 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM 12042 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601204400 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM 12044 1441.46 691.90 " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601204500 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM 12045 1441.46 691.90 " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601204600 RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM 12046 1441.46 691.90 " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601204700 REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM 12047 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601205100 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< 12051 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601205200 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM 12052 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601205300 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM 12053 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601205400 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM 12054 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601205500 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM 12055 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601205700 REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM 12057 951.06 456.51 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 855.95 3601310000 REPAIR COMPLEX TRUNK 1.1-2.5 CM 13100 1441.46 " 1,055.49 " " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601310100 REPAIR COMPLEX TRUNK 2.6-7.5 CM 13101 1441.46 " 1,055.49 " " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601310200 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< 13102 1441.46 " 1,055.49 " " 1,225.24 " 763.97 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 763.97 " 1,297.31 " 3601312000 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM 13120 1441.46 " 1,055.49 " " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601312100 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM 13121 1441.46 " 1,055.49 " " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601312200 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< 13122 846.70 " 1,055.49 " 719.70 448.75 719.70 516.49 762.03 821.00 762.03 448.75 " 1,055.49 " 3601313100 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM 13131 951.06 " 1,055.49 " 808.40 374.16 808.40 580.15 855.95 821.00 855.95 374.16 " 1,055.49 " 3601313200 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM 13132 1441.46 " 1,055.49 " " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601313300 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< 13133 846.7 " 1,055.49 " 719.70 448.75 719.70 516.49 762.03 821.00 762.03 448.75 " 1,055.49 " 3601315100 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM 13151 1441.46 " 1,055.49 " " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601315200 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM 13152 1441.46 " 1,055.49 " " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601315300 REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/< 13153 951.06 " 2,798.43 " 808.40 504.06 808.40 580.15 855.95 821.00 855.95 504.06 " 2,798.43 " 3601316000 SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC 13160 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601400000 ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/< 14000 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601400100 ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM 14001 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601402000 ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/< 14020 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601404000 ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/< 14040 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601404100 ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM 14041 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601406000 ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< 14060 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601406100 ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM 14061 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601430100 ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM 14301 9685.91 " 4,649.24 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601430200 ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/< 14302 "2,796.52" " 1,342.33 " " 2,377.04 " " 1,482.16 " " 2,377.04 " " 1,705.88 " " 2,516.87 " 821.00 " 2,516.87 " 821.00 " 2,516.87 " 3601500200 PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT 15002 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601500300 PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT 15003 488.20 234.34 414.97 258.75 414.97 297.80 439.38 821.00 439.38 234.34 821.00 3601500400 PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT 15004 1441.46 691.90 " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 1,297.31 " 3601500500 PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT 15005 488.20 234.34 414.97 258.75 414.97 297.80 439.38 821.00 439.38 234.34 821.00 3601510000 SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD 15100 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601510100 SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD 15101 1427.77 685.33 " 1,213.60 " 756.72 " 1,213.60 " 870.94 " 1,284.99 " 821.00 " 1,284.99 " 685.33 " 1,284.99 " 3601512000 SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/100SCM ADL 100SCM 15274 "1,252.36" 601.13 " 1,064.51 " 663.75 " 1,064.51 " 763.94 " 1,127.12 " 821.00 " 1,127.12 " 601.13 " 1,127.12 " 3601557600 FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL 15576 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601562000 DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F 15620 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601563000 DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS 15630 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601573100 FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE 15731 9685.91 " 4,649.24 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601573200 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NC 15732 9066.96 " 4,352.14 " " 7,706.92 " " 3,810.55 " " 7,706.92 " " 5,530.85 " " 8,160.26 " " 3,143.00 " " 8,160.26 " " 3,143.00 " " 8,160.26 " 3601573400 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK 15734 9685.91 " 4,649.24 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601573600 MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR 15736 4717.24 " 2,264.28 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 3,143.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3601576900 GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC 15769 9685.91 " 4,649.24 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 2,000.00 " " 8,717.32 " " 2,000.00 " " 8,717.32 " 3601577000 GRAFT DERMA-FAT-FASCIA 15770 9685.91 " 4,649.24 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601577100 GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS 15771 9685.91 " 4,649.24 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601577200 GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC 15772 "4,300.26" " 2,064.12 " " 3,655.22 " " 3,810.55 " " 3,655.22 " " 2,623.16 " " 3,870.23 " " 3,143.00 " " 3,870.23 " " 2,064.12 " " 3,870.23 " 3601577300 GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS 15773 2150.13 " 1,032.06 " " 1,827.61 " " 1,855.83 " " 1,827.61 " " 1,311.58 " " 1,935.12 " " 3,143.00 " " 1,935.12 " " 1,032.06 " " 3,143.00 " 3601577400 GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC 15774 "2,150.13" " 1,032.06 " " 1,827.61 " " 1,855.83 " " 1,827.61 " " 1,311.58 " " 1,935.12 " " 3,143.00 " " 1,935.12 " " 1,032.06 " " 3,143.00 " 3601577700 IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT 15777 "3,104.26" " 1,490.04 " " 2,638.62 " " 1,645.26 " " 2,638.62 " " 1,893.60 " " 2,793.83 " 821.00 " 2,793.83 " 821.00 " 2,793.83 " 3601578100 "DERMABRASION; SEGMENTAL, FACE" 15781 1710.41 " 2,015.74 " " 1,453.85 " 672.91 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 672.91 " 2,015.74 " 3601578200 "DERMABRASION; REGIONAL, OTHER THAN FACE" 15782 6517.53 " 2,015.74 " " 5,539.90 " 707.56 " 5,539.90 " " 3,975.69 " " 5,865.78 " " 1,643.00 " " 5,865.78 " 707.56 " 5,865.78 " 3601582000 BLEPHAROPLASTY LOWER EYELID 15820 4717.24 " 4,338.02 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,338.02 " 3601582100 BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD 15821 4717.24 " 4,338.02 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 3,143.00 " " 4,245.52 " " 1,855.83 " " 4,338.02 " 3601582200 BLEPHAROPLASTY UPPER EYELID 15822 4717.24 " 4,338.02 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,338.02 " 3601582300 BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN 15823 4717.24 " 4,338.02 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,338.02 " 3601582400 RHYTIDECTOMY FOREHEAD 15824 4717.24 " 4,338.02 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,338.02 " 3601582500 RHYTIDECTOMY; NECK WITH PLATYSMAL TIGHTENING 15825 9685.92 " 4,338.02 " " 8,233.03 " " 3,810.55 " " 8,233.03 " " 5,908.41 " " 8,717.33 " " 3,143.00 " " 8,717.33 " " 3,143.00 " " 8,717.33 " 3601582800 "RHYTIDECTOMY; CHEEK, CHIN, AND NECK" 15828 9685.91 " 4,338.02 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601582900 RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC SYSTEM (SMAS) FLAP 15829 9685.91 " 4,338.02 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601583000 EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY 15830 15218.33 " 4,338.02 " " 12,935.58 " " 4,818.68 " " 12,935.58 " " 9,283.18 " " 13,696.50 " " 4,500.00 " " 13,696.50 " " 4,338.02 " " 13,696.50 " 3601583200 "EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); THIGH" 15832 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3601583600 "EXCISION, EXCESSIVE SKIN AND SUBQ TISSUE (INCLUDES LIPECTOMY); ARM" 15836 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3601583900 EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA 15839 6517.52 " 4,338.02 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3601584700 "EXCISION, EXCESSIVE SKIN & SUBQ TISSUE, ABDOMEN INCL UMBILICAL TRANSPOSITION & FASCIAL PLICATION" 15847 15218.33 " 4,338.02 " " 12,935.58 " " 8,065.71 " " 12,935.58 " " 9,283.18 " " 13,696.50 " 821.00 " 13,696.50 " 821.00 " 13,696.50 " 3601585000 REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON 15850 1441.46 " 2,798.43 " " 1,225.24 " 567.09 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 567.09 " 2,798.43 " 3601585200 DRESSING CHANGE UNDER ANESTHESIA 15852 1441.46 691.90 " 1,225.24 " 763.97 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 691.90 " 1,297.31 " 3601586000 IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT 15860 743.1 " 1,194.86 " 631.64 393.84 631.64 453.29 668.79 821.00 668.79 393.84 " 1,194.86 " 3601587600 SUCTION ASSISTED LIPECTOMY; HEAD AND NECK 15876 9685.91 " 4,338.02 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601587700 SUCTION ASSISTED LIPECTOMY TRUNK 15877 9685.91 " 4,338.02 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601587800 SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY 15878 4717.24 " 4,338.02 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " " 1,855.83 " " 4,338.02 " 3601587900 SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY 15879 9685.91 " 4,338.02 " " 8,233.02 " " 3,810.55 " " 8,233.02 " " 5,908.41 " " 8,717.32 " " 3,143.00 " " 8,717.32 " " 3,143.00 " " 8,717.32 " 3601700000 DESTRUCTION PREMALIGNANT LESION 1ST 17000 493.76 737.55 419.70 261.69 419.70 301.19 444.38 821.00 444.38 261.69 821.00 3601700400 DESTRUCTION PREMALIGNANT LESION 15/> 17004 951.06 737.55 808.40 233.32 808.40 580.15 855.95 821.00 855.95 233.32 855.95 3601710700 DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM 17107 1441.46 737.55 " 1,225.24 " 538.44 " 1,225.24 " 879.29 " 1,297.31 " 821.00 " 1,297.31 " 538.44 " 1,297.31 " 3601711000 DESTRUCTION BENIGN LESIONS UP TO 14 17110 493.76 737.55 419.70 261.69 419.70 301.19 444.38 821.00 444.38 261.69 821.00 3601711100 DESTRUCTION BENIGN LESIONS 15/> 17111 493.76 737.55 419.70 261.69 419.70 301.19 444.38 821.00 444.38 261.69 821.00 3601799900 Hc Unlisted Px Skin Muc Membrane & Subq Tissue 17999 493.76 737.55 419.70 567.09 419.70 301.19 444.38 821.00 444.38 301.19 821.00 3601902000 MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP 19020 3869.25 " 1,918.53 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,714.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3601908100 BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID 19081 3869.25 " 1,918.53 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3601908200 BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID 19082 1053.12 " 1,918.53 " 895.15 558.15 895.15 642.40 947.81 821.00 947.81 558.15 " 1,918.53 " 3601908300 BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID 19083 3869.25 " 1,918.53 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3601910100 BIOPSY BREAST OPEN INCISIONAL 19101 8683.78 " 1,918.53 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 1,918.53 " " 7,815.40 " 3601911000 "NIPPLE EXPLORATION, W/WO EXCISION OF A SOLITARY OR A PAPILLOMA LACTIFEROUS DUCT" 19110 8683.78 " 1,918.53 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 1,918.53 " " 7,815.40 " 3601911200 EXCISION OF LACTIFEROUS DUCT FISTULA 19112 8683.78 " 1,918.53 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 1,918.53 " " 7,815.40 " 3601912000 EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION 19120 8683.78 " 1,918.53 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 1,918.53 " " 7,815.40 " 3601912500 EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES 19125 8683.78 " 1,918.53 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 1,918.53 " " 7,815.40 " 3601912600 EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL 19126 924.00 " 1,918.53 " 785.40 489.72 785.40 563.64 831.60 821.00 831.60 489.72 " 1,918.53 " 3601928100 PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE 19281 1710.41 821.00 " 1,453.85 " 906.52 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 821.00 " 1,643.00 " 3601928200 PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE 19282 574.76 275.88 488.55 304.62 488.55 350.60 517.28 821.00 517.28 275.88 821.00 3601928300 PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE 19283 1710.41 821.00 " 1,453.85 " 906.52 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 821.00 " 1,643.00 " 3601928400 PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC 19284 572.85 274.97 486.92 303.61 486.92 349.44 515.57 821.00 515.57 274.97 821.00 3601928500 PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG 19285 1710.41 821.00 " 1,453.85 " 906.52 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 821.00 " 1,643.00 " 3601929600 PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST 19296 11549.65 " 5,543.83 " " 9,817.20 " " 9,167.46 " " 9,817.20 " " 7,045.29 " " 10,394.69 " " 5,357.00 " " 10,394.69 " " 5,357.00 " " 10,394.69 " 3601930000 MASTECTOMY GYNECOMASTIA 19300 8683.78 " 5,232.30 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3601930100 MASTECTOMY PARTIAL 19301 8683.78 " 5,232.30 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3601930200 MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY 19302 15218.33 " 5,232.30 " " 12,935.58 " " 4,818.68 " " 12,935.58 " " 9,283.18 " " 13,696.50 " " 4,500.00 " " 13,696.50 " " 4,500.00 " " 13,696.50 " 3601930300 MASTECTOMY SIMPLE COMPLETE 19303 15218.33 " 5,232.30 " " 12,935.58 " " 4,818.68 " " 12,935.58 " " 9,283.18 " " 13,696.50 " " 3,143.00 " " 13,696.50 " " 3,143.00 " " 13,696.50 " 3601930500 MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES 19305 24767.2 " 10,734.93 " " 21,052.12 " " 4,818.68 " " 21,052.12 " " 15,107.99 " " 22,290.48 " " 2,000.00 " " 22,290.48 " " 2,000.00 " " 22,290.48 " 3601930700 MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN 19307 15218.33 " 10,734.93 " " 12,935.58 " " 4,818.68 " " 12,935.58 " " 9,283.18 " " 13,696.50 " " 4,500.00 " " 13,696.50 " " 4,500.00 " " 13,696.50 " 3601931600 MASTOPEXY 19316 24767.2 " 5,232.30 " " 21,052.12 " " 4,818.68 " " 21,052.12 " " 15,107.99 " " 22,290.48 " " 3,143.00 " " 22,290.48 " " 3,143.00 " " 22,290.48 " 3601931800 BREAST REDUCTION 19318 15218.33 " 10,734.93 " " 12,935.58 " " 4,818.68 " " 12,935.58 " " 9,283.18 " " 13,696.50 " " 4,500.00 " " 13,696.50 " " 4,500.00 " " 13,696.50 " 3601932500 BREAST AUGMENTATION WITH IMPLANT 19325 11666.94 " 5,232.30 " " 9,916.90 " " 5,969.77 " " 9,916.90 " " 7,116.83 " " 10,500.25 " " 5,357.00 " " 10,500.25 " " 5,232.30 " " 10,500.25 " 3601932800 REMOVAL INTACT BREAST IMPLANT 19328 8683.78 " 5,232.30 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 3,143.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3601933000 RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS 19330 8683.78 " 5,232.30 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 3,143.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3601934000 INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY 19340 10998.69 " 5,232.30 " " 9,348.89 " " 4,818.68 " " 9,348.89 " " 6,709.20 " " 9,898.82 " " 4,500.00 " " 9,898.82 " " 4,500.00 " " 9,898.82 " 3601934200 INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY 19342 10998.69 " 5,232.30 " " 9,348.89 " " 5,969.77 " " 9,348.89 " " 6,709.20 " " 9,898.82 " " 5,357.00 " " 9,898.82 " " 5,232.30 " " 9,898.82 " 3601935000 NIPPLE/AREOLA RECONSTRUCTION 19350 8683.78 " 5,232.30 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3601935700 TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION 19357 15928.7 " 10,734.93 " " 13,539.40 " " 12,001.78 " " 13,539.40 " " 9,716.51 " " 14,335.83 " " 5,357.00 " " 14,335.83 " " 5,357.00 " " 14,335.83 " 3601936100 BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP 19361 24767.2 " 10,734.93 " " 21,052.12 " " 12,001.78 " " 21,052.12 " " 15,107.99 " " 22,290.48 " " 2,000.00 " " 22,290.48 " " 2,000.00 " " 22,290.48 " 3601936600 BREAST RECONSTRUCTION OTHER TECHNIQUE 19366 11666.94 " 10,734.93 " " 9,916.90 " " 12,001.78 " " 9,916.90 " " 7,116.83 " " 10,500.25 " " 3,143.00 " " 10,500.25 " " 3,143.00 " " 12,001.78 " 3601936700 BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP 19367 11666.94 " 5,232.30 " " 9,916.90 " " 12,001.78 " " 9,916.90 " " 7,116.83 " " 10,500.25 " " 4,500.00 " " 10,500.25 " " 4,500.00 " " 12,001.78 " 3601937000 REVISION PERI-IMPLANT CAPSULE BREAST 19370 8683.78 " 5,232.30 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 3,143.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3601937100 PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE 19371 8386.78 " 5,232.30 " " 7,128.76 " " 2,518.32 " " 7,128.76 " " 5,115.94 " " 7,548.10 " " 3,143.00 " " 7,548.10 " " 2,518.32 " " 7,548.10 " 3601938000 REVISION OF RECONSTRUCTED BREAST 19380 11666.94 " 5,232.30 " " 9,916.90 " " 4,818.68 " " 9,916.90 " " 7,116.83 " " 10,500.25 " " 4,500.00 " " 10,500.25 " " 4,500.00 " " 10,500.25 " 3601949900 Hc Unlisted Procedure Breast 19499 8683.78 " 1,918.53 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 1,918.53 " " 7,815.40 " 3602020500 BIOPSY MUSCLE DEEP 20205 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3602024000 BIOPSY BONE OPEN SUPERFICIAL 20240 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602052600 INJECTION THERAPEUTIC CARPAL TUNNEL 20526 718.22 513.36 610.49 88.35 610.49 438.11 646.40 821.00 646.40 88.35 821.00 3602055000 INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS 20550 718.22 513.36 610.49 55.91 610.49 438.11 646.40 821.00 646.40 55.91 821.00 3602060000 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US 20600 718.21 513.36 610.48 53.85 610.48 438.11 646.39 821.00 646.39 53.85 821.00 3602067000 REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE 20670 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602068000 REMOVAL IMPLANT DEEP 20680 6517.53 " 3,128.41 " " 5,539.90 " " 2,131.02 " " 5,539.90 " " 3,975.69 " " 5,865.78 " " 2,714.00 " " 5,865.78 " " 2,131.02 " " 5,865.78 " 3602090000 BONE GRAFT ANY DONOR AREA MINOR/SMALL 20900 9064.07 " 4,350.75 " " 7,704.46 " " 6,271.23 " " 7,704.46 " " 5,529.08 " " 8,157.66 " " 3,143.00 " " 8,157.66 " " 3,143.00 " " 8,157.66 " 3602090200 BONE GRAFT ANY DONOR AREA MAJOR/LARGE 20902 11064.95 " 5,311.18 " " 9,405.21 " " 6,271.23 " " 9,405.21 " " 6,749.62 " " 9,958.46 " " 3,143.00 " " 9,958.46 " " 3,143.00 " " 9,958.46 " 3602091200 CARTILAGE GRAFT NASAL SEPTUM 20912 3859.15 " 1,852.39 " " 3,280.28 " " 3,810.55 " " 3,280.28 " " 2,354.08 " " 3,473.24 " " 3,143.00 " " 3,473.24 " " 1,852.39 " " 3,810.55 " 3602101100 EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM 21011 3869.25 " 1,857.24 " " 3,288.86 " 526.00 " 3,288.86 " " 2,360.24 " " 3,482.33 " " 1,643.00 " " 3,482.33 " 526.00 " 3,482.33 " 3602101200 EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/> 21012 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 1,643.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602101400 EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/> 21014 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 1,643.00 " " 5,865.77 " " 1,643.00 " " 5,865.77 " 3602102500 EXCISION BONE MANDIBLE 21025 8086.05 " 5,265.04 " " 6,873.14 " " 5,110.15 " " 6,873.14 " " 4,932.49 " " 7,277.45 " " 4,500.00 " " 7,277.45 " " 4,500.00 " " 7,277.45 " 3602102600 EXCISION OF FACIAL BONE(S) 21026 11986.63 " 5,753.58 " " 10,188.64 " " 5,110.15 " " 10,188.64 " " 7,311.84 " " 10,787.97 " " 2,714.00 " " 10,787.97 " " 2,714.00 " " 10,787.97 " 3602102900 REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE 21029 7525.07 " 3,612.03 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3602103000 EXCISION OF BENIGN TUMOR OR CYST OF MAXILLA OR ZYGOMA BY ENUCLEATION AND CURETTAGE 21030 13986.63 " 1,866.94 " " 11,888.64 " 605.39 " 11,888.64 " " 8,531.84 " " 12,587.97 " " 2,714.00 " " 12,587.97 " 605.39 " 12,587.97 " 3602103100 EXCISION TORUS MANDIBULARIS 21031 7525.07 " 1,866.94 " " 6,396.31 " 550.86 " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " 550.86 " 6,772.56 " 3602103200 REMOVE EXOSTOSIS MAXILLA 21032 7525.07 " 4,609.82 " " 6,396.31 " 542.57 " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " 542.57 " 6,772.56 " 3602104000 EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT 21040 7525.07 " 2,077.25 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,077.25 " " 6,772.56 " 3602104400 REMV MALIG JAW BONE LESION 21044 13986.63 " 2,077.25 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 2,077.25 " " 12,587.97 " 3602104600 REMOVE MANDIBLE CYST COMPLEX 21046 13986.63 " 1,866.94 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 1,866.94 " " 12,587.97 " 3602104700 EXCISE LWR JAW CYST W/REPAIR 21047 13986.63 " 2,077.25 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 2,077.25 " " 12,587.97 " 3602114200 "RECONSTRUCTION MIDFACE, LEFORT I; 2 PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WO BONE GRAFT" 21142 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 2,000.00 " " 12,587.97 " " 2,000.00 " " 12,587.97 " 3602123000 GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR 21230 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3602123500 GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR 21235 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 2,000.00 " " 12,587.97 " " 2,000.00 " " 12,587.97 " 3602131500 CLOSED TX NASAL FRACTURE W/O STABILIZATION 21315 3720.17 " 2,800.91 " " 3,162.14 " " 1,100.38 " " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " " 1,100.38 " " 3,348.15 " 3602132000 "CLOSED TREATMENT NASAL FRACTURE, W STABILIZATION" 21320 7525.07 " 2,800.91 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3602132500 OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED 21325 7525.07 " 3,612.03 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3602133500 OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM 21335 7525.07 " 3,612.03 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3602133600 OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION 21336 7783.6 " 7,033.28 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,033.28 " 3602133700 CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION 21337 7525.07 " 2,800.91 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3602134600 OPEN RX NOSE/JAW FRACT+WIRES 21346 "12,853.91" " 7,371.55 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 2,714.00 " " 11,568.52 " " 2,714.00 " " 11,568.52 " 3602135600 OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE 21356 12853.91 " 6,169.88 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 2,714.00 " " 11,568.52 " " 2,714.00 " " 11,568.52 " 3602136500 OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG 21365 12853.91 " 6,169.88 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 4,500.00 " " 11,568.52 " " 4,500.00 " " 11,568.52 " 3602138500 OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; TRANSANTRAL APPROACH 21385 12853.91 " 6,169.88 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 4,500.00 " " 11,568.52 " " 4,500.00 " " 11,568.52 " 3602138700 OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR 21387 12853.91 " 6,169.88 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 4,500.00 " " 11,568.52 " " 4,500.00 " " 11,568.52 " 3602139000 OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC 21390 12853.91 " 6,169.88 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 4,500.00 " " 11,568.52 " " 4,500.00 " " 11,568.52 " 3602140600 OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT 21406 12853.91 " 6,169.88 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 4,500.00 " " 11,568.52 " " 4,500.00 " " 11,568.52 " 3602140700 OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT 21407 12853.91 " 6,169.88 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 4,500.00 " " 11,568.52 " " 4,500.00 " " 11,568.52 " 3602146200 Hc Open Tx Mandibular Fx W/interdental Fixation 21462 12853.91 " 6,169.88 " " 10,925.82 " " 7,286.94 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 4,500.00 " " 11,568.52 " " 4,500.00 " " 11,568.52 " 3602149900 Hc Unlisted Musculoskeletal Procedure Head 21499 9747.84 " 4,678.96 " " 8,285.66 " " 1,100.38 " " 8,285.66 " " 5,946.18 " " 8,773.06 " 821.00 " 8,773.06 " 821.00 " 8,773.06 " 3602150100 I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX 21501 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602155000 BIOPSY SOFT TISSUE NECK/THORAX 21550 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602155200 EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/> 21552 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602155400 EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/> 21554 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602155500 EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM 21555 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602155600 EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM 21556 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602168500 HYOID MYOTOMY & SUSPENSION 21685 12853.91 " 6,169.88 " " 10,925.82 " " 5,110.15 " " 10,925.82 " " 7,840.89 " " 11,568.52 " " 2,714.00 " " 11,568.52 " " 2,714.00 " " 11,568.52 " 3602189900 Hc Unlisted Procedure Neck/thorax 21899 9400 " 4,512.00 " " 7,990.00 " 223.07 " 7,990.00 " " 5,734.00 " " 8,460.00 " 821.00 " 8,460.00 " 223.07 " 8,460.00 " 3602193000 EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM 21930 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602193100 "EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS" 21931 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,714.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602193200 EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM 21932 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3602193300 EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/> 21933 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602290000 EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM 22900 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602290100 EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/> 22901 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602290200 Hc Exc Tumor Soft Tissue Abdominal Wall Subq <3cm 22902 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602290300 EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/> 22903 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602307100 EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> 23071 4177.7 " 2,005.30 " " 3,551.05 " " 1,272.10 " " 3,551.05 " " 2,548.40 " " 3,759.93 " " 2,714.00 " " 3,759.93 " " 1,272.10 " " 3,759.93 " 3602307300 EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/> 23073 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602307600 "EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM" 23076 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3602341200 "REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC" 23412 11371.88 " 6,686.58 " " 9,666.10 " " 6,271.23 " " 9,666.10 " " 6,936.85 " " 10,234.69 " " 4,500.00 " " 10,234.69 " " 4,500.00 " " 10,234.69 " 3602343000 TENODESIS OF LONG TENDON OF BICEPS 23430 12212.84 " 6,686.58 " " 10,380.91 " " 6,271.23 " " 10,380.91 " " 7,449.83 " " 10,991.56 " " 4,500.00 " " 10,991.56 " " 4,500.00 " " 10,991.56 " 3602351500 OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION 23515 14735.73 " 7,033.28 " " 12,525.37 " " 8,601.81 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 5,357.00 " " 13,262.16 " " 5,357.00 " " 13,262.16 " 3602355000 OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC 23550 14735.73 " 7,033.28 " " 12,525.37 " " 6,271.23 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 5,357.00 " " 13,262.16 " " 5,357.00 " " 13,262.16 " 3602400600 "ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR CAPSULAR RELEASE" 24006 7783.6 " 3,378.26 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602407100 EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/> 24071 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602407500 EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM 24075 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602420000 RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS 24200 3869.25 " 1,857.24 " " 3,288.86 " 316.86 " 3,288.86 " " 2,360.24 " " 3,482.33 " " 1,643.00 " " 3,482.33 " 316.86 " 3,482.33 " 3602433200 TENOLYSIS TRICEPS 24332 7783.6 " 6,686.58 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602434100 REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA 24341 14735.73 " 6,686.58 " " 12,525.37 " " 6,271.23 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 4,500.00 " " 13,262.16 " " 4,500.00 " " 13,262.16 " 3602434200 "REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT" 24342 14735.73 " 6,686.58 " " 12,525.37 " " 6,271.23 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 4,500.00 " " 13,262.16 " " 4,500.00 " " 13,262.16 " 3602434300 REELBOW LAT LIGMNT W/TISS 24343 7783.6 " 3,378.26 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602453800 PERC SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FX W/WO INTERCONDYLAR EXTENSION 24538 14796.37 " 7,033.28 " " 12,576.91 " " 6,271.23 " " 12,576.91 " " 9,025.79 " " 13,316.73 " " 2,714.00 " " 13,316.73 " " 2,714.00 " " 13,316.73 " 3602457500 OPEN TX HUMERAL EPICONDYLAR FRACTURE 24575 20727.4 " 7,033.28 " " 17,618.29 " " 17,230.29 " " 17,618.29 " " 12,643.71 " " 18,654.66 " " 5,357.00 " " 18,654.66 " " 5,357.00 " " 18,654.66 " 3602466600 OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC 24666 20727.4 " 7,033.28 " " 17,618.29 " " 19,462.83 " " 17,618.29 " " 12,643.71 " " 18,654.66 " " 5,357.00 " " 18,654.66 " " 5,357.00 " " 19,462.83 " 3602500000 INCISION EXTENSOR TENDON SHEATH WRIST 25000 "4,401.20" " 3,378.26 " " 3,741.02 " " 1,549.04 " " 3,741.02 " " 2,684.73 " " 3,961.08 " " 2,714.00 " " 3,961.08 " " 1,549.04 " " 3,961.08 " 3602507100 Hc Exc Tumor Soft Tiss Forearm And/wrist Subq 3+cm 25071 3869.25 " 3,378.26 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,714.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602507300 Hc Exc Tumor Sft Tiss Forearm&//wrist Subfasc 3+cm 25073 6517.52 " 3,378.26 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602507500 EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM 25075 3869.25 " 3,378.26 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602507600 Hc Exc Tumor Soft Tiss Forearm&/wrist Subfasc <3cm 25076 3869.25 " 3,378.26 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602511100 EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY 25111 3828.96 " 2,564.82 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,714.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602511800 "EXCIS SYNOV WRIST,EXTENS TENDON" 25118 3828.96 " 2,564.82 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 3,143.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602513000 EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES 25130 7783.6 " 2,564.82 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,564.82 " " 7,005.24 " 3602527000 "REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE" 25270 7783.6 " 6,725.26 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602527200 RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU 25272 7783.6 " 3,378.26 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602532000 "REVISE WRIST JOINT,CARPAL INSTABIL" 25320 "14,857.01" " 6,725.26 " " 12,628.46 " " 6,271.23 " " 12,628.46 " " 9,062.78 " " 13,371.31 " " 4,500.00 " " 13,371.31 " " 4,500.00 " " 13,371.31 " 3602544000 REPAIR NONUNION SCAPHOID CARPAL BONE 25440 "14,954.87" " 6,725.26 " " 12,711.64 " " 6,271.23 " " 12,711.64 " " 9,122.47 " " 13,459.38 " " 4,500.00 " " 13,459.38 " " 4,500.00 " " 13,459.38 " 3602544700 REPAIR INTERCARP/CARP-METACARP JT 25447 7783.6 " 5,127.65 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 4,500.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602556000 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN 25560 "3,577.41" " 2,433.87 " " 3,040.80 " 223.07 " 3,040.80 " " 2,182.22 " " 3,219.67 " 821.00 " 3,219.67 " 223.07 " 3,219.67 " 3602556500 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ 25565 3828.96 " 2,433.87 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " 821.00 " 3,446.06 " 821.00 " 3,446.06 " 3602557400 "OPEN TX OF RADIAL AND ULNAR SHAFT FX, W INTERNAL FIXATION" 25574 14735.73 " 7,033.28 " " 12,525.37 " " 8,938.40 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 5,357.00 " " 13,262.16 " " 5,357.00 " " 13,262.16 " 3602557500 OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA 25575 14735.73 " 7,033.28 " " 12,525.37 " " 8,721.50 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 5,357.00 " " 13,262.16 " " 5,357.00 " " 13,262.16 " 3602560500 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF 25605 3828.96 " 2,433.87 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 1,643.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602560600 PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP 25606 7783.6 " 7,033.28 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,033.28 " 3602560700 OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP 25607 14735.73 " 7,033.28 " " 12,525.37 " " 8,991.24 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 5,357.00 " " 13,262.16 " " 5,357.00 " " 13,262.16 " 3602560800 OPEN TX DISTAL RADIAL INTRA-ARTICULAR FX OR EPIPHYSEAL SEPARATION; W FIXATION OF 2 FRAGMENTS 25608 14735.73 " 7,033.28 " " 12,525.37 " " 8,973.63 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 5,357.00 " " 13,262.16 " " 5,357.00 " " 13,262.16 " 3602560900 "OPEN RX DISTAL RADIUS FX, INTRA-ARTICULAR, 3+ FRAG" 25609 14857.01 " 7,033.28 " " 12,628.46 " " 9,012.52 " " 12,628.46 " " 9,062.78 " " 13,371.31 " " 5,357.00 " " 13,371.31 " " 5,357.00 " " 13,371.31 " 3602582000 ARTHRODESIS WRIST LIMITED W/O BONE GRAFT 25820 14857.01 " 3,625.76 " " 12,628.46 " " 8,571.44 " " 12,628.46 " " 9,062.78 " " 13,371.31 " " 4,500.00 " " 13,371.31 " " 3,625.76 " " 13,371.31 " 3602601100 DRAINAGE FINGER ABSCESS COMPLICATED 26011 3869.25 " 2,015.74 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602603400 INCIS DEEP FINGR/HAND BONE LESN 26034 3828.96 " 2,564.82 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,000.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602605500 TENDON SHEATH INCISION 26055 3828.96 " 2,564.82 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,000.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602607000 EXPLORE & TREAT CARPOMETACARP JT 26070 3828.96 " 2,564.82 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,000.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602608000 ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA 26080 3828.96 " 2,564.82 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,000.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602611500 EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM 26115 3869.25 " 2,564.82 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602612100 FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT 26121 7783.6 " 3,625.76 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602612300 FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR 26123 7783.6 " 3,625.76 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602612500 FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR 26125 "6,480.81" " 3,625.76 " " 5,508.69 " " 3,434.83 " " 5,508.69 " " 3,953.29 " " 5,832.73 " 821.00 " 5,832.73 " 821.00 " 5,832.73 " 3602616000 EXC LESION TDN SHTH/JT CAPSL HAND/FNGR 26160 3828.96 " 2,564.82 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,000.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602635600 RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON 26356 7783.6 " 3,625.76 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602637000 RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN 26370 7783.6 " 3,625.76 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602639000 "EXCISION FLEXOR TENDON, W IMPLANT OF SYNTHETIC ROD, DELAYED TENDON GRAFT,HAND OR FINGER, EA ROD" 26390 14735.73 " 3,625.76 " " 12,525.37 " " 8,361.21 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 3,143.00 " " 13,262.16 " " 3,143.00 " " 13,262.16 " 3602639200 "REMOVAL OF SYNTHETIC ROD AND INSERTION OF FLEXOR TENDON GRAFT, HAND OR FINGER, EACH ROD" 26392 14735.73 " 3,625.76 " " 12,525.37 " " 6,271.23 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 3,143.00 " " 13,262.16 " " 3,143.00 " " 13,262.16 " 3602641800 REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH 26418 3828.96 " 2,564.82 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,000.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602643300 REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF 26433 7783.6 " 2,564.82 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,000.00 " " 7,005.24 " " 2,000.00 " " 7,005.24 " 3602644500 TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH 26445 7783.6 " 2,564.82 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,000.00 " " 7,005.24 " " 2,000.00 " " 7,005.24 " 3602648000 TRANSPLANT HAND TENDON 26480 7783.6 " 3,625.76 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602651600 CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT 26516 7783.6 " 2,564.82 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,564.82 " " 7,005.24 " 3602652000 CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH 26520 7783.6 " 2,564.82 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,000.00 " " 7,005.24 " " 2,000.00 " " 7,005.24 " 3602654000 "REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT" 26540 7783.6 " 2,564.82 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,000.00 " " 7,005.24 " " 2,000.00 " " 7,005.24 " 3602660000 CLTX METACARPAL FX W/O MANIPULATION EACH BONE 26600 3828.96 " 2,433.87 " " 3,254.62 " 223.07 " 3,254.62 " " 2,335.67 " " 3,446.06 " 821.00 " 3,446.06 " 223.07 " 3,446.06 " 3602660800 PRQ SKELETAL FIXJ METACARPAL FX EACH BONE 26608 7783.6 " 7,033.28 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,033.28 " 3602661500 OPEN TX METACARPAL FRACTURE SINGLE EA BONE 26615 7783.6 " 7,033.28 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 5,357.00 " " 7,005.24 " " 2,843.74 " " 7,033.28 " 3602665000 "PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB W/ MANIPULATION" 26650 7783.6 " 7,033.28 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,033.28 " 3602672700 PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T 26727 7783.6 " 7,033.28 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,033.28 " 3602673500 OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA 26735 7783.6 " 7,033.28 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,033.28 " 3602685000 Hc Arthrodesis Metacarpophalangeal Jt W/wo Int Fixj 26850 "15,852.18" " 7,033.28 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 3,143.00 " " 14,266.96 " " 3,143.00 " " 14,266.96 " 3602686000 Hc Arthrodesis Interphalangeal Jt W/wo Int Fixj 26860 7783.6 " 2,564.82 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,564.82 " " 7,005.24 " 3602704500 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/> 27045 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602704700 EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM 27047 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3602708600 "REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS TISSUE" 27086 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3602732800 EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM 27328 6517.52 " 2,433.87 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3602733700 EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/> 27337 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602733900 EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+CM 27339 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602741800 ANTERIOR TIBIAL TUBERCLEPLASTY 27418 14735.73 " 7,071.97 " " 12,525.37 " " 6,271.23 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 4,500.00 " " 13,262.16 " " 4,500.00 " " 13,262.16 " 3602742200 RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL 27422 14735.73 " 7,071.97 " " 12,525.37 " " 6,271.23 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 4,500.00 " " 13,262.16 " " 4,500.00 " " 13,262.16 " 3602742700 LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR 27427 14735.73 " 7,071.97 " " 12,525.37 " " 8,280.42 " " 12,525.37 " " 8,988.80 " " 13,262.16 " " 5,357.00 " " 13,262.16 " " 5,357.00 " " 13,262.16 " 3602742800 "LIGMT REVISION,KNEE,INTRA-ARTIC" 27428 20636.17 " 7,071.97 " " 17,540.74 " " 12,558.37 " " 17,540.74 " " 12,588.06 " " 18,572.55 " " 5,357.00 " " 18,572.55 " " 5,357.00 " " 18,572.55 " 3602744600 Hc Arthrp Knee Condyle&plateau Medial/lat Cmprt 27446 25986 " 16,044.11 " " 22,088.10 " " 18,435.98 " " 22,088.10 " " 15,851.46 " " 23,387.40 " " 6,571.00 " " 23,387.40 " " 6,571.00 " " 23,387.40 " 3602744700 Hc Arthrp Kne Condyle&platu Medial&lat Compartments 27447 25986 " 16,044.11 " " 22,088.10 " " 18,689.05 " " 22,088.10 " " 15,851.46 " " 23,387.40 " " 6,571.00 " " 23,387.40 " " 6,571.00 " " 23,387.40 " 3602752400 OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR 27524 15852.18 " 7,033.28 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602757000 MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA 27570 3828.96 " 2,058.90 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,000.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602760200 "DECOMPRESSION FASCIOTOMY, LEG; ANT/LAT, AND POSTERIOR COMPARTMENT" 27602 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602760600 TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES 27606 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602761200 "ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH OR WITHOUT ACHILLES TENDON LENGTHENING" 27612 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602762500 ARTHROTOMY W/SYNOVECTOMY ANKLE 27625 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602763000 EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK 27630 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602763400 EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM 27634 6517.52 " 4,482.85 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602763500 "EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULAC" 27635 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602765000 REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON 27650 15852.18 " 4,482.85 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 4,500.00 " " 14,266.96 " " 4,482.85 " " 14,266.96 " 3602765400 "REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT" 27654 15852.18 " 4,482.85 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 4,500.00 " " 14,266.96 " " 4,482.85 " " 14,266.96 " 3602765800 REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH 27658 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602767600 "REPAIR, DISLOCATING PERONEAL TENDONS; WITH FIBULAR OSTEOTOMY" 27676 15852.18 " 7,071.97 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 3,143.00 " " 14,266.96 " " 3,143.00 " " 14,266.96 " 3602768500 "LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON" 27685 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602768700 GASTROCNEMIUS RECESSION 27687 7783.6 " 4,482.85 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602769100 TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP 27691 15852.18 " 7,071.97 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 4,500.00 " " 14,266.96 " " 4,500.00 " " 14,266.96 " 3602769500 RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL 27695 15852.18 " 7,071.97 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 3,143.00 " " 14,266.96 " " 3,143.00 " " 14,266.96 " 3602772000 REPAIR NONUNION/MALUNION TIBIA W/O GRAFT 27720 15852.18 " 7,033.28 " " 13,474.35 " " 9,048.37 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602775000 CLTX TIBIAL SHAFT FX W/O MANIPULATION 27750 567.02 " 2,433.87 " 481.97 223.07 481.97 345.88 510.32 821.00 510.32 223.07 " 2,433.87 " 3602775800 OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE 27758 25986 " 7,033.28 " " 22,088.10 " " 17,702.34 " " 22,088.10 " " 15,851.46 " " 23,387.40 " " 5,357.00 " " 23,387.40 " " 5,357.00 " " 23,387.40 " 3602776600 OPTX MEDIAL ANKLE FX 27766 15852.18 " 7,033.28 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602778400 OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE 27784 15852.18 " 7,033.28 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602779200 "OPEN TX DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED" 27792 15852.18 " 7,033.28 " " 13,474.35 " " 8,366.09 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602781400 "OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED" 27814 15852.18 " 7,033.28 " " 13,474.35 " " 8,414.67 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602782200 OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP 27822 15852.18 " 7,033.28 " " 13,474.35 " " 8,420.15 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602782300 OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP 27823 15852.18 " 7,033.28 " " 13,474.35 " " 8,332.67 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602782700 OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY 27827 17228.61 " 7,033.28 " " 14,644.32 " " 17,841.05 " " 14,644.32 " " 10,509.45 " " 15,505.75 " " 5,357.00 " " 15,505.75 " " 5,357.00 " " 17,841.05 " 3602782900 OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION 27829 15852.18 " 7,033.28 " " 13,474.35 " " 8,493.06 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602800800 FASCIOTOMY FOOT&/TOE 28008 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602801000 TENOTOMY PERCUTANEOUS TOE SINGLE TENDON 28010 3828.96 " 3,388.18 " " 3,254.62 " 249.19 " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,714.00 " " 3,446.06 " 249.19 " 3,446.06 " 3602802400 ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT 28024 3828.96 " 3,388.18 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,714.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602803500 RELEASE TARSAL TUNNEL 28035 4824.57 " 4,482.85 " " 4,100.88 " " 1,722.89 " " 4,100.88 " " 2,942.99 " " 4,342.11 " " 2,714.00 " " 4,342.11 " " 1,722.89 " " 4,482.85 " 3602803900 EXC FOOT/TOE TUM SC > 1.5 CM 28039 6517.52 " 3,388.18 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,714.00 " " 5,865.77 " " 2,131.02 " " 5,865.77 " 3602805400 ARTHRTOMY W/BX INTERPHALANGEAL JOINT 28054 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602806000 FASCIECTOMY PLANTAR FASCIA PARTIAL SPX 28060 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602808000 EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH 28080 3828.96 " 3,388.18 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,714.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602809000 EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT 28090 3828.96 " 3,388.18 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,714.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602810400 "EXCISION OR CURETTAGE BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS OR CALCANEUS" 28104 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602810800 EXC/CURTG CST/B9 TUM PHALANGES FOOT 28108 3828.96 " 3,388.18 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,714.00 " " 3,446.06 " " 1,549.04 " " 3,446.06 " 3602811000 OSTECTOMY PRTL 5TH METAR HEAD SPX 28110 7783.6 " 7,082.38 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,082.38 " 3602811300 "OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD" 28113 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602811800 OSTECTOMY CALCANEUS 28118 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602811900 OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS 28119 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602812000 PARTIAL EXCISION BONE TALUS/CALCANEUS 28120 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602812200 PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS 28122 7783.6 " 7,082.38 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,082.38 " 3602812400 PARTICAL EXCISION BONE PHALANX TOE 28124 7783.6 " 3,388.18 " " 6,616.06 " 608.84 " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 608.84 " 7,005.24 " 3602812600 RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH 28126 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602816000 HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE 28160 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602819200 REMOVAL FOREIGN BODY FOOT DEEP 28192 3869.25 " 3,388.18 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3602820000 "REPAIR TENDON FLEXOR FT; PRIM OR SECOND, W/O FREE GRAFT, EA TENDON" 28200 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602820800 "REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON" 28208 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602823200 TX OPEN TENDON FLEXOR TOE 1 TENDON SPX 28232 3828.96 " 3,388.18 " " 3,254.62 " 527.39 " 3,254.62 " " 2,335.67 " " 3,446.06 " " 2,714.00 " " 3,446.06 " 527.39 " 3,446.06 " 3602823800 RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR 28238 15852.18 " 7,082.38 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602827000 "CAPSULOTOMY METATARSOPHALANGEAL JOINT, W/WO TENORRHAPHY, EA JOINT" 28270 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602828500 CORRECTION HAMMERTOE 28285 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602828600 CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE 28286 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602828800 OSTC PRTL EXOSTC/CONDYLC METAR HEAD 28288 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602828900 HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT 28289 7783.6 " 7,082.38 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,082.38 " 3602829100 Hc Hallux Rigidus W/cheilectomy 1st Mp Jt W/implt 28291 15852.18 " 7,082.38 " " 13,474.35 " " 9,460.29 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602829200 KELLER/MCBRIDE/MAYO PROCEDURE 28292 7783.6 " 7,082.38 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,082.38 " 3602829500 CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR OSTEOT 28295 7783.6 " 7,082.38 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,082.38 " 3602829600 CORRJ HALLUX VALGUS W/WO SESMDC W/METAR OSTEOT 28296 7783.6 " 7,082.38 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,082.38 " 3602829700 CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX 28297 15852.18 " 7,082.38 " " 13,474.35 " " 9,158.34 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 3,143.00 " " 14,266.96 " " 3,143.00 " " 14,266.96 " 3602829800 "CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUT SESAMOIDECTOMY; BY PHALANX OSTEOTOMY" 28298 15852.18 " 7,082.38 " " 13,474.35 " " 8,104.22 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 3,143.00 " " 14,266.96 " " 3,143.00 " " 14,266.96 " 3602829900 "CORRECTION, HALLUX VALGUS, WITH SESAMOIDECTOMY, W DOUBLE OSTEOTOMY, ANY METHOD" 28299 15852.18 " 7,082.38 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 3,143.00 " " 14,266.96 " " 3,143.00 " " 14,266.96 " 3602830000 OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION 28300 15852.18 " 7,082.38 " " 13,474.35 " " 8,831.47 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602830400 OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS 28304 15852.18 " 7,082.38 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602830800 OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA 28308 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602831500 "SESAMOIDECTOMY, FIRST TOE" 28315 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602832200 "REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUT BONE GRAFT (INCLUDES OBTAINING GRAFT)" 28322 15852.18 " 7,082.38 " " 13,474.35 " " 8,711.79 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 2,714.00 " " 14,266.96 " " 2,714.00 " " 14,266.96 " 3602841500 OPEN TREATMENT CALCANEAL FRACTURE 28415 15852.18 " 7,033.28 " " 13,474.35 " " 8,829.04 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602844500 OPEN TREATMENT TALUS FRACTURE 28445 15852.18 " 7,033.28 " " 13,474.35 " " 8,776.79 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602847600 Hc Prq Skel Fixj Metar Fx W/manj 28476 7783.6 " 7,033.28 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,033.28 " 3602848500 OPEN TREATMENT METATARSAL FRACTURE EACH 28485 15852.18 " 7,033.28 " " 13,474.35 " " 8,426.83 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602861500 "OPEN TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED" 28615 15852.18 " 7,033.28 " " 13,474.35 " " 8,570.82 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602872500 ARTHRODESIS SUBTALAR 28725 17228.61 " 7,082.38 " " 14,644.32 " " 18,122.10 " " 14,644.32 " " 10,509.45 " " 15,505.75 " " 5,357.00 " " 15,505.75 " " 5,357.00 " " 18,122.10 " 3602873000 ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS 28730 17228.61 " 7,082.38 " " 14,644.32 " " 19,235.33 " " 14,644.32 " " 10,509.45 " " 15,505.75 " " 5,357.00 " " 15,505.75 " " 5,357.00 " " 19,235.33 " 3602874000 ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT 28740 15852.18 " 7,082.38 " " 13,474.35 " " 9,397.11 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602875000 ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT 28750 15852.18 " 7,082.38 " " 13,474.35 " " 9,060.51 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602875500 ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT 28755 15852.18 " 3,388.18 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 2,714.00 " " 14,266.96 " " 2,714.00 " " 14,266.96 " 3602881000 AMPUTATION METATARSAL W/TOE SINGLE 28810 7783.6 " 7,082.38 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,082.38 " 3602882000 AMPUTATION TOE METATARSOPHALANGEAL JOINT 28820 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602882500 AMPUTATION TOE INTERPHALANGEAL JOINT 28825 7783.6 " 3,388.18 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " " 2,714.00 " " 7,005.24 " 3602889900 Hc Unlisted Procedure Foot/toes 28899 7783.6 " 2,433.87 " " 6,616.06 " 383.12 " 6,616.06 " " 4,748.00 " " 7,005.24 " 821.00 " 7,005.24 " 383.12 " 7,005.24 " 3602913100 APPLICATION FINGER SPLINT DYNAMIC 29131 153.06 131.44 130.10 81.12 130.10 93.37 137.75 821.00 137.75 81.12 821.00 3602980600 ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY 29806 15852.18 " 7,862.59 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602980700 "ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION" 29807 15852.18 " 7,862.59 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602982300 SURGICAL ARTHROSCOPY SHOULDER XTNSV DBRDMT 3+ 29823 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 5,357.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602982400 "ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURFACE" 29824 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 5,357.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602982600 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE 29826 7783.6 " 3,897.07 " " 6,616.06 " " 4,125.31 " " 6,616.06 " " 4,748.00 " " 7,005.24 " 821.00 " 7,005.24 " 821.00 " 7,005.24 " 3602982700 ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR 29827 15852.18 " 7,862.59 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602982800 "ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS" 29828 15852.18 " 7,862.59 " " 13,474.35 " " 6,271.23 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602984600 "WRIST ARTHROSCOP,EXCIS TRIANG CART" 29846 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602984800 NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM 29848 3828.96 " 3,897.07 " " 3,254.62 " " 1,549.04 " " 3,254.62 " " 2,335.67 " " 3,446.06 " " 3,143.00 " " 3,446.06 " " 1,549.04 " " 3,897.07 " 3602986700 ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT 29867 17228.61 " 7,862.59 " " 14,644.32 " " 20,355.86 " " 14,644.32 " " 10,509.45 " " 15,505.75 " " 5,357.00 " " 15,505.75 " " 5,357.00 " " 20,355.86 " 3602987000 "ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)" 29870 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602987400 ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY 29874 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602987500 "ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED" 29875 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602987600 "ARTHROSCOPY KNEE SURGICAL; SYNOVECTOMY MAJOR, 2 OR MORE COMPARTMENT" 29876 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602987700 "ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE" 29877 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602987900 ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX 29879 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602988000 ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING 29880 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602988100 ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG 29881 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602988200 ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL 29882 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602988300 "ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL AND LATERAL)" 29883 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602988800 ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ 29888 15852.18 " 7,862.59 " " 13,474.35 " " 8,616.38 " " 13,474.35 " " 9,669.83 " " 14,266.96 " " 5,357.00 " " 14,266.96 " " 5,357.00 " " 14,266.96 " 3602988900 ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION 29889 17228.1 " 7,862.59 " " 14,643.89 " " 17,209.61 " " 14,643.89 " " 10,509.14 " " 15,505.29 " " 5,357.00 " " 15,505.29 " " 5,357.00 " " 17,209.61 " 3602989400 "ARTHROSCOPY, ANKLE, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY" 29894 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602989500 ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL 29895 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602989800 ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE 29898 7783.6 " 3,897.07 " " 6,616.06 " " 2,843.74 " " 6,616.06 " " 4,748.00 " " 7,005.24 " " 3,143.00 " " 7,005.24 " " 2,843.74 " " 7,005.24 " 3602999900 Hc Unlisted Procedure Arthroscopy 29999 7783.6 " 3,897.07 " " 6,616.06 " " 6,271.23 " " 6,616.06 " " 4,748.00 " " 7,005.24 " 821.00 " 7,005.24 " 821.00 " 7,005.24 " 3603000000 "DRAIN ABSCESS/HEMATOMA,NASAL" 30000 581.9 263.87 494.62 228.93 494.62 354.96 523.71 821.00 523.71 228.93 821.00 3603010000 BIOPSY INTRANASAL 30100 3720.17 " 2,800.91 " " 3,162.14 " 234.70 " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " 234.70 " 3,348.15 " 3603011700 EXCISION/DESTRUCTION INTRANASAL LESION INT APPR 30117 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3603012000 EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA 30120 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3603013000 EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE 30130 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3603014000 SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL 30140 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3603015000 PARTIAL EXCISION OF NOSE 30150 13986.64 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.85 " " 12,587.98 " " 4,500.00 " " 12,587.98 " " 4,500.00 " " 12,587.98 " 3603016000 RHINECTOMY TOTAL 30160 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603022000 INSERTION NASAL SEPTAL PROSTHESIS BUTTON 30220 3720.17 " 2,800.91 " " 3,162.14 " " 1,100.38 " " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " " 1,100.38 " " 3,348.15 " 3603040000 RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI 30400 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 2,714.00 " " 12,587.97 " " 2,714.00 " " 12,587.97 " 3603041000 RHINP PRIM COMPLETE XTRNL PARTS 30410 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603042000 RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR 30420 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603043500 "REVIS NOSE,SECONDARY,INTERMEDIATE" 30435 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603045000 "RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES)" 30450 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603046500 REPAIR NASAL VESTIBULAR STENOSIS 30465 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603052000 SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF 30520 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3603058000 REPAIR FISTULA OROMAXILLARY 30580 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603060000 REPAIR FISTULA ORONASAL 30600 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603063000 REPAIR NASAL SEPTAL PERFORATIONS 30630 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3603080200 ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL 30802 3720.17 " 2,800.91 " " 3,162.14 " " 1,100.38 " " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " " 1,100.38 " " 3,348.15 " 3603090100 CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE 30901 2720 263.87 " 2,312.00 " " 1,441.60 " " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 263.87 " 2,448.00 " 3603090300 CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX 30903 "2,720.00" 263.87 " 2,312.00 " 121.11 " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 121.11 " 2,448.00 " 3603093000 FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC 30930 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3603099900 Hc Unlisted Procedure Nose 30999 7525.07 " 2,800.91 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " 821.00 " 6,772.56 " 821.00 " 6,772.56 " 3603103000 SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS 31030 13986.63 " 4,609.82 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603103200 SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS 31032 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603123100 NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX 31231 452.07 263.87 384.26 177.86 384.26 275.76 406.86 821.00 406.86 177.86 821.00 3603123700 NASAL/SINUS NDSC SURG W/BX POLYPECT/DBRDMT SPX 31237 4115.07 " 3,696.19 " " 3,497.81 " " 1,374.19 " " 3,497.81 " " 2,510.19 " " 3,703.56 " " 2,000.00 " " 3,703.56 " " 1,374.19 " " 3,703.56 " 3603123800 NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG 31238 4115.07 " 3,696.19 " " 3,497.81 " " 1,374.19 " " 3,497.81 " " 2,510.19 " " 3,703.56 " " 2,000.00 " " 3,703.56 " " 1,374.19 " " 3,703.56 " 3603123900 NASAL/SINUS NDSC SURG W/DACRYOCSTORHINOSTOMY 31239 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 3603124000 NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION 31240 4115.07 " 3,696.19 " " 3,497.81 " " 1,374.19 " " 3,497.81 " " 2,510.19 " " 3,703.56 " " 2,714.00 " " 3,703.56 " " 1,374.19 " " 3,703.56 " 3603125300 "NASAL/SINUS ENDO,W ETHMOIDECTOMY; TOTAL, INCL FRONTAL SINUS EXPLORE, W REMOVAL TISSUE" 31253 "11,430.80" " 4,609.82 " " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 3603125400 NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY PARTIAL 31254 11430.8 344.72 " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 2,714.00 " " 10,287.72 " 344.72 " 10,287.72 " 3603125500 NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL 31255 11430.8 " 3,696.19 " " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 3603125600 NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY 31256 8519.55 344.72 " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 344.72 " 7,667.60 " 3603125700 "NASAL/SINUS ENDO, W ETHMOIDECTOMY; TOTAL, INCL SPHENOIDOTOMY" 31257 11430.8 " 4,609.82 " " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 3603125900 "NASAL/SINUS ENDO, W ETHMOIDECTOMY; TOTAL, INCL SPHENOIDOTOMY, W REMOVAL OF TISSUE" 31259 "11,430.80" " 4,609.82 " " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 3603126700 NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS 31267 11430.8 344.72 " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 2,714.00 " " 10,287.72 " 344.72 " 10,287.72 " 3603127600 NASAL/SINUS NDSC W/FRONTAL SINUS EXPLORATION 31276 11430.8 344.72 " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 344.72 " 10,287.72 " 3603128700 NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY 31287 11430.8 344.72 " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 344.72 " 10,287.72 " 3603128800 NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS 31288 11430.8 344.72 " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 344.72 " 10,287.72 " 3603129500 NASAL/SINUS NDSC SURG W/DILAT MAXILLARY SINUS 31295 11430.8 " 3,696.19 " " 9,716.18 " " 3,862.24 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 3603129600 NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS 31296 11430.8 344.72 " 9,716.18 " " 3,883.63 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 344.72 " 10,287.72 " 3603129700 "NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF SPHENOID SINUS OSTIUM" 31297 11430.8 344.72 " 9,716.18 " " 3,853.26 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 2,714.00 " " 10,287.72 " 344.72 " 10,287.72 " 3603129800 "NASAL/SINUS ENDO, W DILATION OF FRONTAL AND SPHENOID SINUS OSTIA (EG, BALLOON DILATION)" 31298 11430.8 344.72 " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " " 3,143.00 " " 10,287.72 " 344.72 " 10,287.72 " 3603129900 Hc Unlisted Procedure Accessory Sinuses 31299 11430.8 " 2,800.91 " " 9,716.18 " " 4,262.34 " " 9,716.18 " " 6,972.79 " " 10,287.72 " 821.00 " 10,287.72 " 821.00 " 10,287.72 " 3603152500 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN 31525 4115.07 344.72 " 3,497.81 " " 1,374.19 " " 3,497.81 " " 2,510.19 " " 3,703.56 " " 2,000.00 " " 3,703.56 " 344.72 " 3,703.56 " 3603152600 LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE 31526 4115.07 344.72 " 3,497.81 " " 1,374.19 " " 3,497.81 " " 2,510.19 " " 3,703.56 " " 2,000.00 " " 3,703.56 " 344.72 " 3,703.56 " 3603152800 LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN 31528 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 3603153500 LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY 31535 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 3603153600 LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE 31536 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 3603154000 LARYNGOSCOPY EXC TUM&/STRIPPING CORDS/EPIGLOTT 31540 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 3603154100 LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP 31541 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 3603155100 "LARYNGOPLASTY; LARYNGEAL STENOSIS, W GRAFT, WO INDWELLING STENT PLACEMENT, >12 YRS OF AGE" 31551 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603155200 "LARYNGOPLASTY; LARYNGEAL STENOSIS, W GRAFT, WO INDWELLING STENT PLACEMENT, AGE 12 YRS OR OLDER" 31552 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603155300 "LARYNGOPLASTY; LARYNGEAL STENOSIS, W GRAFT, W INDWELLING STENT PLACEMENT, > 12 YRS OF AGE" 31553 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603155400 "LARYNGOPLASTY; LARYNGEAL STENOSIS, W GRAFT, W INDWELLING STENT PLACEMENT, AGE 12 YRS OR OLDER" 31554 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603157000 LARYNGOSCOPE INJECTION VOCAL CORD THERAPEUTIC 31570 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,000.00 " " 7,667.60 " " 2,000.00 " " 7,667.60 " 3603157100 LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE 31571 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 3603157200 "LARYNGOSCOPY, FLEXIBLE; W ABLATION OR DESTRUCTION OF LESION(S) W LASER, UNI" 31572 8519.55 " 3,696.19 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,714.00 " " 7,667.60 " " 2,714.00 " " 7,667.60 " 3603157300 "LARYNGOSCOPY, FLEXIBLE; W THERAPEUTIC INJECTIONS UNI" 31573 4115.07 " 3,696.19 " " 3,497.81 " 410.73 " 3,497.81 " " 2,510.19 " " 3,703.56 " " 2,000.00 " " 3,703.56 " 410.73 " 3,703.56 " 3603157400 "LARYNGOSCOPY, FLEXIBLE; W INJECTION(S) FOR AUGMENTATION (EG, PERCUTANEOUS, TRANSORAL), UNI" 31574 4115.07 " 3,696.19 " " 3,497.81 " " 1,374.19 " " 3,497.81 " " 2,510.19 " " 3,703.56 " " 2,000.00 " " 3,703.56 " " 1,374.19 " " 3,703.56 " 3603157700 LARYNGOSCOPY FLX RMVL FOREIGN BODY(S) 31577 1035.4 344.72 880.09 407.34 880.09 631.59 931.86 821.00 931.86 344.72 931.86 3603157800 LARYNGOSCOPY FLEXIBLE RMVL LESION(S) NON-LASER 31578 8519.55 344.72 " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 2,000.00 " " 7,667.60 " 344.72 " 7,667.60 " 3603159100 LARYNGOPLASTY MEDIALIZATION UNLIATERAL 31591 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3603161100 CONSTJ TRACHEOESOPHGL FSTL&INSJ SP PROSTH 31611 7525.0 " 3,612.00 " " 6,396.25 " " 2,317.27 " " 6,396.25 " " 4,590.25 " " 6,772.50 " " 2,714.00 " " 6,772.50 " " 2,317.27 " " 6,772.50 " 3603161300 TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION 31613 7525.07 " 3,612.03 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3603164100 BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC 31641 8519.55 " 4,089.38 " " 7,241.62 " " 2,773.98 " " 7,241.62 " " 5,196.93 " " 7,667.60 " " 3,143.00 " " 7,667.60 " " 2,773.98 " " 7,667.60 " 3603189900 Hc Unlisted Procedure Trachea Bronchi 31899 8519.55 " 2,168.02 " " 7,241.62 " " 2,317.27 " " 7,241.62 " " 5,196.93 " " 7,667.60 " 821.00 " 7,667.60 " 821.00 " 7,667.60 " 3603328600 REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR 33286 1710.42 821.00 " 1,453.86 " 672.91 " 1,453.86 " " 1,043.36 " " 1,539.38 " " 1,643.00 " " 1,539.38 " 672.91 " 1,643.00 " 3603586000 "EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS OR INFECTION; EXTREMITY" 35860 7869.56 " 5,643.98 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3003641500 COLLECTION VENOUS BLOOD VENIPUNCTURE 36415 7.95 3.82 6.76 4.21 6.76 4.85 7.16 6.76 7.16 3.82 7.16 3913643000 "TRANSFUSION, BLOOD OR BLOOD COMPONENTS" 36430 1091.91 " 1,050.53 " 928.12 78.00 928.12 666.07 982.72 821.00 982.72 78.00 " 1,050.53 " 3603655600 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> 36556 7869.56 " 1,651.68 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 1,643.00 " " 7,082.60 " " 1,643.00 " " 7,082.60 " 3603655800 INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> 36558 7869.56 " 3,777.39 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603656100 INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/> 36561 7869.56 " 3,479.44 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603657600 RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT 36576 3866.88 " 1,352.10 " " 3,286.85 " " 1,166.94 " " 3,286.85 " " 2,358.80 " " 3,480.19 " " 1,643.00 " " 3,480.19 " " 1,166.94 " " 3,480.19 " 3603658200 RPLCMT COMPL TUN CTR VAD W/SUBQ PORT 36582 7869.56 " 3,479.44 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603658900 RMVL TUN CVC W/O SUBQ PORT/PMP 36589 1489.45 " 1,352.10 " " 1,266.03 " 585.96 " 1,266.03 " 908.56 " 1,340.51 " " 1,643.00 " " 1,340.51 " 585.96 " 1,643.00 " 3603659000 RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 36590 3866.88 " 1,352.10 " " 3,286.85 " " 1,166.94 " " 3,286.85 " " 2,358.80 " " 3,480.19 " " 1,643.00 " " 3,480.19 " " 1,166.94 " " 3,480.19 " 3603681800 ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS 36818 13118.52 " 6,296.89 " " 11,150.74 " " 5,072.25 " " 11,150.74 " " 8,002.30 " " 11,806.67 " " 5,357.00 " " 11,806.67 " " 5,072.25 " " 11,806.67 " 3603681900 ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS 36819 13118.52 " 6,296.89 " " 11,150.74 " " 5,072.25 " " 11,150.74 " " 8,002.30 " " 11,806.67 " " 5,357.00 " " 11,806.67 " " 5,072.25 " " 11,806.67 " 3603682000 ARVEN ANAST OPN F/ARM VEIN TRPOS 36820 13118.51 " 6,296.88 " " 11,150.73 " " 5,072.25 " " 11,150.73 " " 8,002.29 " " 11,806.66 " " 5,357.00 " " 11,806.66 " " 5,072.25 " " 11,806.66 " 3603682100 ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT 36821 7869.56 " 3,777.39 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603682500 CRTJ ARVEN FSTL XCP DIR ARVEN ANAST AUTOG GRF 36825 13118.51 " 6,296.88 " " 11,150.73 " " 5,072.25 " " 11,150.73 " " 8,002.29 " " 11,806.66 " " 5,357.00 " " 11,806.66 " " 5,072.25 " " 11,806.66 " 3603683000 ARTERIOVENOUS FISTULA CREATION OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS; NONAUTOGENOUS GRAFT 36830 13118.51 " 6,296.88 " " 11,150.73 " " 5,072.25 " " 11,150.73 " " 8,002.29 " " 11,806.66 " " 5,357.00 " " 11,806.66 " " 5,072.25 " " 11,806.66 " 3603683100 "THROMBECTOMY,AV FISTULA DIALYS GRFT" 36831 13118.51 " 6,296.88 " " 11,150.73 " " 5,072.25 " " 11,150.73 " " 8,002.29 " " 11,806.66 " " 5,357.00 " " 11,806.66 " " 5,072.25 " " 11,806.66 " 3603683200 REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF 36832 13118.51 " 6,296.88 " " 11,150.73 " " 5,072.25 " " 11,150.73 " " 8,002.29 " " 11,806.66 " " 5,357.00 " " 11,806.66 " " 5,072.25 " " 11,806.66 " 3603683300 REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF 36833 13118.51 " 6,296.88 " " 11,150.73 " " 5,072.25 " " 11,150.73 " " 8,002.29 " " 11,806.66 " " 5,357.00 " " 11,806.66 " " 5,072.25 " " 11,806.66 " 3603760700 LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA 37607 7869.56 " 3,916.91 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603760900 LIGATION/BIOPSY TEMPORAL ARTERY 37609 3869.25 " 3,916.91 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,916.91 " 3603770000 "LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS" 37700 7869.56 " 3,777.39 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603772200 LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW 37722 7869.56 " 3,777.39 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603773500 LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS 37735 7869.56 " 3,777.39 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603776000 LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG 37760 7869.56 " 3,777.39 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603776500 "STAB PHLEBTMY VRCS VEIN, 1 EXTRM, 10-20 STABS" 37765 7869.56 " 3,777.39 " " 6,689.13 " 508.75 " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " 508.75 " 7,082.60 " 3603776600 "STAB PHLEBTMY VRCS VEIN, 1 EXTRM, 20+ STABS" 37766 7869.56 " 3,777.39 " " 6,689.13 " 557.76 " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " 557.76 " 7,082.60 " 3603778500 LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG 37785 7869.56 " 3,777.39 " " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " " 2,922.57 " " 7,082.60 " 3603779900 Hc Unlisted Procedure Vascular Surgery 37799 13118.51 " 3,916.91 " " 11,150.73 " " 2,986.86 " " 11,150.73 " " 8,002.29 " " 11,806.66 " " 1,643.00 " " 11,806.66 " " 1,643.00 " " 11,806.66 " 3603850000 BX/EXC LYMPH NODE OPEN SUPERFICIAL 38500 8683.78 " 4,676.78 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3603850500 BX/EXC LYMPH NODE NEEDLE SUPERFICIAL 38505 3869.25 " 2,798.43 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3603851000 BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE 38510 8683.78 " 4,676.78 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3603852000 BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD 38520 8683.78 " 4,676.78 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3603852500 BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE 38525 8683.78 " 4,676.78 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3603853100 OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES 38531 8683.78 " 4,676.78 " " 7,381.21 " " 2,518.32 " " 7,381.21 " " 5,297.11 " " 7,815.40 " " 2,714.00 " " 7,815.40 " " 2,518.32 " " 7,815.40 " 3603855500 "EXCISION OF CYSTIC HYGROMA, AXILLARY OR CERVICAL; WITH DEEP NEUROVASCULAR DISSECTION" 38555 15218.33 " 7,696.43 " " 12,935.58 " " 4,818.68 " " 12,935.58 " " 9,283.18 " " 13,696.50 " " 2,714.00 " " 13,696.50 " " 2,714.00 " " 13,696.50 " 3603857000 "LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE" 38570 13916.21 " 4,642.06 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,642.06 " " 12,524.59 " 3603857100 LAPS SURG BILATERAL TOTAL PELVIC LMPHADECTOMY 38571 24496.06 " 9,530.64 " " 20,821.65 " " 8,122.54 " " 20,821.65 " " 14,942.60 " " 22,046.45 " " 5,357.00 " " 22,046.45 " " 5,357.00 " " 22,046.45 " 3603857200 LAPS BI TOT PEL LMPHADEC & PRI-AORTIC LYMPH BX 1 38572 24496.06 " 9,530.64 " " 20,821.65 " " 8,122.54 " " 20,821.65 " " 14,942.60 " " 22,046.45 " " 5,357.00 " " 22,046.45 " " 5,357.00 " " 22,046.45 " 3603857300 "LAPAROSCOPY, W BIL TOTAL PELVIC LYMPHADENECTOMY & SAMPLING, WASHINGS, BIOPSY(IES)" 38573 24496.06 " 9,530.64 " " 20,821.65 " " 8,122.54 " " 20,821.65 " " 14,942.60 " " 22,046.45 " " 5,357.00 " " 22,046.45 " " 5,357.00 " " 22,046.45 " 3603872400 CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ 38724 24496.06 " 4,676.78 " " 20,821.65 " " 5,969.77 " " 20,821.65 " " 14,942.60 " " 22,046.45 " " 2,714.00 " " 22,046.45 " " 2,714.00 " " 22,046.45 " 3603874500 AXILLARY LYMPHADENECTOMY; COMPLETE 38745 13916.21 " 5,232.30 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3403879200 INJ RADIOACTIVE TRACER FOR ID OF SENTINEL NODE 38792 1037.08 703.33 881.52 549.65 881.52 632.62 933.37 821.00 933.37 549.65 933.37 3604051000 EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR 40510 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604052000 EXC LIP V-EXC W/PRIM DIR LINR CLSR 40520 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3604080000 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL 40800 1710.41 263.87 " 1,453.85 " 342.40 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 263.87 " 1,643.00 " 3604080600 INCISION LABIAL FRENUM FRENOTOMY 40806 1243.99 " 2,800.91 " " 1,057.39 " 187.76 " 1,057.39 " 758.83 " 1,119.59 " 821.00 " 1,119.59 " 187.76 " 2,800.91 " 3604080800 BIOPSY VESTIBULE MOUTH 40808 1243.99 " 2,800.91 " " 1,057.39 " 271.98 " 1,057.39 " 758.83 " 1,119.59 " 821.00 " 1,119.59 " 271.98 " 2,800.91 " 3604081000 EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR 40810 7525.07 " 4,609.82 " " 6,396.31 " 355.50 " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 355.50 " 6,772.56 " 3604081200 EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR 40812 3720.17 " 4,609.82 " " 3,162.14 " 422.46 " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " 422.46 " 4,609.82 " 3604081400 EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR 40814 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604081600 EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC 40816 7525.07 " 5,265.04 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604081800 Hc Excise Oral Mucosa For Graft 40818 1243.99 " 4,609.82 " " 1,057.39 " 489.41 " 1,057.39 " 758.83 " 1,119.59 " 821.00 " 1,119.59 " 489.41 " 4,609.82 " 3604081900 EXC FRENUM LABIAL/BUCCAL 40819 3720.17 " 2,800.91 " " 3,162.14 " " 1,100.38 " " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " " 1,100.38 " " 3,348.15 " 3604100800 DRAINAGE OF MOUTH LESION 41008 7525.07 " 2,800.91 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3604101000 INCISION OF LINGUAL FRENUM (FRENOTOMY) 41010 3720.17 " 2,800.91 " " 3,162.14 " " 1,100.38 " " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " " 1,100.38 " " 3,348.15 " 3604110000 BIOPSY TONGUE ANTERIOR TWO-THIRDS 41100 1243.99 " 2,800.91 " " 1,057.39 " 283.72 " 1,057.39 " 758.83 " 1,119.59 " 821.00 " 1,119.59 " 283.72 " 2,800.91 " 3604111000 EXCISION LESION TONGUE W/O CLOSURE 41110 7525.07 " 4,609.82 " " 6,396.31 " 368.62 " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 368.62 " 6,772.56 " 3604111200 EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS 41112 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3604111300 EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD 41113 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3604111500 EXCISION OF LINGUAL FRENUM (FRENECTOMY) 41115 3720.17 " 5,265.04 " " 3,162.14 " 427.30 " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " 427.30 " 5,265.04 " 3604111600 EXCISION LESION FLOOR MOUTH 41116 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604112000 GLOSSECTOMY 2.6 CM/CPLX 41252 581.9 263.87 494.62 228.93 494.62 354.96 523.71 821.00 523.71 228.93 821.00 3604152000 FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY 41520 4525.07 " 4,609.82 " " 3,846.31 " " 2,317.27 " " 3,846.31 " " 2,760.29 " " 4,072.56 " " 4,500.00 " " 4,072.56 " " 2,317.27 " " 4,609.82 " 3604182500 EXCIS DENTOALVEOLAR LESION 41825 4525.07 " 1,866.94 " " 3,846.31 " 358.27 " 3,846.31 " " 2,760.29 " " 4,072.56 " " 2,000.00 " " 4,072.56 " 358.27 " 4,072.56 " 3604182600 "EXCIS DENTOALV LESN,SIMPL REPR" 41826 4525.07 " 1,866.94 " " 3,846.31 " 473.54 " 3,846.31 " " 2,760.29 " " 4,072.56 " " 2,714.00 " " 4,072.56 " 473.54 " 4,072.56 " 3604187400 ALVEOLOPLASTY EACH QUADRANT SPECIFY 41874 4525.07 " 1,723.60 " " 3,846.31 " 569.50 " 3,846.31 " " 2,760.29 " " 4,072.56 " " 2,000.00 " " 4,072.56 " 569.50 " 4,072.56 " 3604189900 DENTAL RESTORATIONS OR EXTRACTIONS 41899 3720 " 1,723.60 " " 3,162.00 " 569.50 " 3,162.00 " " 2,269.20 " " 3,348.00 " 821.00 " 3,348.00 " 569.50 " 3,348.00 " 3604210400 EXC LESION PALATE UVULA W/O CLOSURE 42104 7525.07 " 4,609.82 " " 6,396.31 " 328.57 " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 328.57 " 6,772.56 " 3604210700 "EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAP CLOSURE" 42107 13986.63 " 4,609.82 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 2,714.00 " " 12,587.97 " " 2,714.00 " " 12,587.97 " 3604214000 UVULECTOMY EXCISION UVULA 42140 7525.07 " 2,800.91 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3604214500 PALATOPHARYNGOPLASTY 42145 9141.86 " 4,388.09 " " 7,770.58 " " 5,110.15 " " 7,770.58 " " 5,576.53 " " 8,227.67 " " 2,714.00 " " 8,227.67 " " 2,714.00 " " 8,227.67 " 3604222600 LENGTHENING PALATE & PHARYNGEAL FLAP 42226 "9,884.58" " 4,744.60 " " 8,401.89 " " 5,110.15 " " 8,401.89 " " 6,029.59 " " 8,896.12 " " 4,500.00 " " 8,896.12 " " 4,500.00 " " 8,896.12 " 3604229900 Hc Unlisted Procedure Palate Uvula 42299 9884.58 " 2,800.91 " " 8,401.89 " " 5,110.15 " " 8,401.89 " " 6,029.59 " " 8,896.12 " 821.00 " 8,896.12 " 821.00 " 8,896.12 " 3604230000 Hc Drainage Abscess Parotid Simple 42300 3720.17 " 2,800.91 " " 3,162.14 " " 1,100.38 " " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " " 1,100.38 " " 3,348.15 " 3604232000 DRAINAGE ABSCESS SUBMAXILLARY INTRAORAL 42320 7525.07 " 2,800.91 " " 6,396.31 " 489.41 " 6,396.31 " " 4,590.29 " " 6,772.56 " 821.00 " 6,772.56 " 489.41 " 6,772.56 " 3604233000 SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL 42330 7525.07 " 4,609.82 " " 6,396.31 " 317.54 " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 317.54 " 6,772.56 " 3604240500 BIOPSY SALIVARY GLAND INCISIONAL 42405 3720.17 " 4,609.82 " " 3,162.14 " " 1,100.38 " " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,714.00 " " 3,348.15 " " 1,100.38 " " 4,609.82 " 3604240800 EXC SUBLINGUAL SALIVARY CYST RANULA 42408 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604240900 MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA 42409 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604241000 EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ 42410 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3604241500 EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR 42415 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3604242000 EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR 42420 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3604242500 EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL 42425 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3604242600 EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ 42426 16270.46 " 7,696.43 " " 13,829.89 " " 5,110.15 " " 13,829.89 " " 9,924.98 " " 14,643.41 " " 2,714.00 " " 14,643.41 " " 2,714.00 " " 14,643.41 " 3604244000 EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND 42440 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3604245000 EXCISION OF SUBLINGUAL GLAND 42450 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 2,714.00 " " 12,587.97 " " 2,714.00 " " 12,587.97 " 3604265000 DILATION OF SALIVARY DUCT 42650 3720.17 " 4,609.82 " " 3,162.14 " 102.86 " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " 102.86 " 4,609.82 " 3604280000 BIOPSY OROPHARYNX 42800 3720.17 " 2,800.91 " " 3,162.14 " 224.35 " 3,162.14 " " 2,269.30 " " 3,348.15 " " 1,643.00 " " 3,348.15 " 224.35 " 3,348.15 " 3604280400 BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE 42804 7525.07 " 2,800.91 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,000.00 " " 6,772.56 " " 2,000.00 " " 6,772.56 " 3604280600 BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION 42806 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604280800 EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD 42808 7525.07 " 2,800.91 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604281000 EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS 42810 7525.07 " 5,265.04 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3604281500 "EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR FISTULA, EXTEND BENEATH SUBQ TISSUES AND/OR PHARYNX" 42815 13986.63 " 5,265.04 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3604282000 TONSILLECTOMY & ADENOIDECTOMY 42821 4250 " 2,772.64 " " 3,612.50 " " 2,317.27 " " 3,612.50 " " 2,592.50 " " 3,825.00 " " 2,714.00 " " 3,825.00 " " 2,317.27 " " 3,825.00 " 3604282500 TONSILLECTOMY PRIMARY/SECONDARY 42826 4250 " 2,772.64 " " 3,612.50 " " 2,317.27 " " 3,612.50 " " 2,592.50 " " 3,825.00 " " 2,714.00 " " 3,825.00 " " 2,317.27 " " 3,825.00 " 3604283000 ADENOIDECTOMY PRIMARY 42831 4250 " 2,772.64 " " 3,612.50 " " 2,317.27 " " 3,612.50 " " 2,592.50 " " 3,825.00 " " 2,714.00 " " 3,825.00 " " 2,317.27 " " 3,825.00 " 3604283500 ADENOIDECTOMY SECONDARY COLUMN/GROUP 46250 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604625500 HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP 46255 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 7504625800 "HEMORRHOIDECTOMY, INTERNAL & EXTERNAL, SINGLE COLUMN/GROUP; W FISTULECTOMY, INCL FISSURECTOMY" 46258 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604626000 HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO 46260 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604626100 HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU 46261 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 7504626200 REMOVE INTERNAL/EXTERNAL HEMORRHOIDS GROUPS W/FISTULECTOMY 46262 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604627000 SURG TX ANAL FISTULA SUBQ 46270 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 7504627500 SURG TX ANAL FISTULA INTERSPHINCTERIC 46275 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604628000 TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON 46280 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604628500 SURGICAL TREATMENT OF ANAL FISTULA; SECOND STAGE 46285 6719.32 " 3,053.87 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604650500 CHEMODENERVATION INTERNAL ANAL SPHINCTER 46505 2851.64 " 3,053.87 " " 2,423.89 " " 1,121.87 " " 2,423.89 " " 1,739.50 " " 2,566.48 " " 2,000.00 " " 2,566.48 " " 1,121.87 " " 3,053.87 " 7504660600 "ANOSCOPY, W BIOPSY, SINGLE OR MULTIPLE" 46606 2851.64 " 1,352.59 " " 2,423.89 " 506.68 " 2,423.89 " " 1,739.50 " " 2,566.48 " " 2,000.00 " " 2,566.48 " 506.68 " 2,566.48 " 3604691000 "ELECTRODESSICATN,ANAL LESN(S)" 46910 4717.24 " 3,053.87 " " 4,009.65 " 409.34 " 4,009.65 " " 2,877.52 " " 4,245.52 " " 2,000.00 " " 4,245.52 " 409.34 " 4,245.52 " 3604692200 DSTRJ LESION ANUS SIMPLE SURG EXCISION 46922 6719.32 " 3,053.87 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604693000 DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY 46930 2851.64 " 3,053.87 " " 2,423.89 " 334.79 " 2,423.89 " " 1,739.50 " " 2,566.48 " " 1,643.00 " " 2,566.48 " 334.79 " 3,053.87 " 3604694500 HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP 46945 6719.32 " 3,053.87 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604694600 HRHC NTRNL LIG OTH THAN RBBR BAND 2/> COL/GRP 46946 6719.32 " 3,053.87 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 2,714.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 7504694700 "HEMORRHOIDOPEXY (EG, FOR PROLAPSING INTERNAL HEMORRHOIDS) BY STAPLING" 46947 6719.32 " 3,607.41 " " 5,711.42 " " 2,456.06 " " 5,711.42 " " 4,098.79 " " 6,047.39 " " 3,143.00 " " 6,047.39 " " 2,456.06 " " 6,047.39 " 3604700100 BX LVR NDL DONE PURPOSE TM OTH MAJOR PX 47001 2851.64 983.07 " 2,423.89 " " 1,511.37 " " 2,423.89 " " 1,739.50 " " 2,566.48 " 821.00 " 2,566.48 " 821.00 " 2,566.48 " 7504756200 LAPAROSCOPY SURG CHOLECYSTECTOMY 47562 13916.21 " 6,637.47 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 7504756300 LAPS SURG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY 47563 13916.21 " 6,637.47 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 7504756400 LAPS SURG CHOLECSTC W/EXPL COMMON DUCT 47564 13916.21 " 6,637.47 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3604757900 "Hc Unlisted Laparoscopy Procedure, Biliary Tract" 47579 13916.21 " 4,642.06 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 4,500.00 " " 12,524.59 " " 4,500.00 " " 12,524.59 " 3604760500 CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY 47605 13916.21 " 9,022.74 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 2,000.00 " " 12,524.59 " " 2,000.00 " " 12,524.59 " 3604920500 EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM 49205 13916.21 " 4,844.93 " " 11,828.78 " 672.91 " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " 672.91 " 12,524.59 " 3604925000 Hc Umbilectomy Omphalectomy Exc Umbilicus Spx 49250 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604932000 LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX 49320 13916.21 " 4,642.06 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 4,500.00 " " 12,524.59 " " 4,500.00 " " 12,524.59 " 3604932100 LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE 49321 13916.21 " 4,642.06 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 4,500.00 " " 12,524.59 " " 4,500.00 " " 12,524.59 " 3604932200 "LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST" 49322 13916.21 " 4,642.06 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 4,500.00 " " 12,524.59 " " 4,500.00 " " 12,524.59 " 3604932400 LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER 49324 13916.21 " 4,642.06 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 4,500.00 " " 12,524.59 " " 4,500.00 " " 12,524.59 " 3604932900 Hc Unlisted Laparoscopic Px Abd Pertoneum & Omentum 49329 13916.21 " 4,642.06 " " 11,828.78 " " 7,375.59 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 4,500.00 " " 12,524.59 " " 4,500.00 " " 12,524.59 " 3604942100 INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN 49421 8754.37 983.07 " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " 983.07 " 7,878.93 " 3604942200 REMOVAL TUNNELED INTRAPERITONEAL CATHETER 49422 7869.56 983.07 " 6,689.13 " " 2,922.57 " " 6,689.13 " " 4,800.43 " " 7,082.60 " " 3,143.00 " " 7,082.60 " 983.07 " 7,082.60 " 3604942600 REVISION OF PERITONEAL-VENOUS SHUNT 49426 8754.38 " 4,183.26 " " 7,441.22 " " 3,010.07 " " 7,441.22 " " 5,340.17 " " 7,878.94 " " 3,143.00 " " 7,878.94 " " 3,010.07 " " 7,878.94 " 3604950000 RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE 49500 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604950500 RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE 49505 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604950700 RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED 49507 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604952000 RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE 49520 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604952100 RPR RECRT INGUN HERNIA ANY AGE INCARCERATED 49521 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604952500 RPR INGUN HERNIA SLIDING ANY AGE 49525 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604954000 REPAIR LUMBAR HERNIA 49540 13916.21 " 4,503.18 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 3,143.00 " " 12,524.59 " " 3,143.00 " " 12,524.59 " 3604955000 Hc Rpr 1st Fem Hrna Any Age Reducible 49550 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604955300 Hc Rpr 1st Fem Hernia Any Age Incarcerated 49553 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604955500 Hc Rpr Recrt Fem Hernia Reducible 49555 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604955700 Hc Rpr Recrt Fem Hrna Incarcerated 49557 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604956000 REPAIR FIRST ABDOMINAL WALL HERNIA 49560 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604956100 RPR 1ST INCAL/VNT HERNIA INCARCERATED 49561 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604956500 RPR RECRT INCAL/VNT HERNIA REDUCIBLE 49565 13916.21 " 4,503.18 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 3,143.00 " " 12,524.59 " " 3,143.00 " " 12,524.59 " 3604956600 RPR RECRT INCAL/VNT HERNIA INCARCERATED 49566 13916.21 " 4,503.18 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 3,143.00 " " 12,524.59 " " 3,143.00 " " 12,524.59 " 3604956800 IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE 49568 2556.46 " 4,503.18 " " 2,172.99 " " 1,354.92 " " 2,172.99 " " 1,559.44 " " 2,300.81 " 821.00 " 2,300.81 " 821.00 " 4,503.18 " 3604957000 RPR EPIGASTRIC HERNIA REDUCIBLE SPX 49570 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3614958000 RPR UMBIL HERN REDUC < 5 YR 49580 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604958500 RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE 49585 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604958700 RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED 49587 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604959000 RPR SPIGELIAN HERNIA 49590 8754.37 " 4,503.18 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3604965000 LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA 49650 13916.21 " 6,637.47 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3604965100 LAPS SURG RPR RECURRENT INGUINAL HERNIA 49651 13916.21 " 6,637.47 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3604965200 LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE 49652 13916.21 " 6,637.47 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3604965300 "LAP, VENTRAL HERNIA REPAIR,INCARCERATED" 49653 13916.21 " 6,637.47 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3604965400 "LAPAROSCOPY, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION); REDUCIBLE" 49654 17849.24 " 6,637.47 " " 15,171.85 " " 8,122.54 " " 15,171.85 " " 10,888.04 " " 16,064.32 " " 5,357.00 " " 16,064.32 " " 5,357.00 " " 16,064.32 " 3604965500 "LAP, SURGICAL, REPAIR, INCISIONAL HERNIA; REDUCIBLE" 49655 17849.24 " 6,637.47 " " 15,171.85 " " 8,122.54 " " 15,171.85 " " 10,888.04 " " 16,064.32 " " 5,357.00 " " 16,064.32 " " 5,357.00 " " 16,064.32 " 3604965600 LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE 49656 17849.24 " 6,637.47 " " 15,171.85 " " 8,122.54 " " 15,171.85 " " 10,888.04 " " 16,064.32 " " 5,357.00 " " 16,064.32 " " 5,357.00 " " 16,064.32 " 3605078000 URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER 50780 "11,825.40" " 5,676.19 " " 10,051.59 " " 2,986.86 " " 10,051.59 " " 7,213.49 " " 10,642.86 " " 2,000.00 " " 10,642.86 " " 2,000.00 " " 10,642.86 " 3605104500 "CYSTOTOMY, WITH INSERTION OF URETERAL CATHETER OR STENT" 51045 4930.72 " 1,350.61 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 1,643.00 " " 4,437.65 " " 1,350.61 " " 4,437.65 " 3605171500 NDSC NJX IMPLT MATRL URT&/BLDR NCK 51715 8459.93 " 1,270.75 " " 7,190.94 " " 4,075.76 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 3,143.00 " " 7,613.94 " " 1,270.75 " " 7,613.94 " 3605186000 CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE 51860 12138.22 " 3,942.70 " " 10,317.49 " " 4,417.62 " " 10,317.49 " " 7,404.31 " " 10,924.40 " " 2,714.00 " " 10,924.40 " " 2,714.00 " " 10,924.40 " 3605200000 CYSTOURETHROSCOPY 52000 1580.61 " 1,350.61 " " 1,343.52 " 621.83 " 1,343.52 " 964.17 " 1,422.55 " " 1,643.00 " " 1,422.55 " 621.83 " 1,643.00 " 3605200500 CYSTO BLADDER W/URETERAL CATHETERIZATION 52005 4930.72 " 1,350.61 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,714.00 " " 4,437.65 " " 1,350.61 " " 4,437.65 " 3605220400 CYSTOURETHROSCOPY WITH BIOPSY 52204 4930.72 " 1,350.61 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,714.00 " " 4,437.65 " " 1,350.61 " " 4,437.65 " 3605222400 CYSTO W/REMOVAL OF LESIONS SMALL 52224 8459.93 " 1,350.61 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 2,714.00 " " 7,613.94 " " 1,350.61 " " 7,613.94 " 3605223500 CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM 52235 8459.93 " 1,350.61 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 2,714.00 " " 7,613.94 " " 1,350.61 " " 7,613.94 " 3605226000 CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH 52260 4930.72 " 1,350.61 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,000.00 " " 4,437.65 " " 1,350.61 " " 4,437.65 " 3605228100 CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS 52281 4930.72 " 1,350.61 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,000.00 " " 4,437.65 " " 1,350.61 " " 4,437.65 " 3605228700 CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER 52287 4930.72 " 1,350.61 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,000.00 " " 4,437.65 " " 1,350.61 " " 4,437.65 " 3605231000 CYSTO W/SIMPLE REMOVAL STONE & STENT 52310 4930.72 " 1,350.61 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,000.00 " " 4,437.65 " " 1,350.61 " " 4,437.65 " 3605231800 LITHOLAPAXY COMP/LG > 2.5 CM 52318 8459.93 " 1,350.61 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 2,714.00 " " 7,613.94 " " 1,350.61 " " 7,613.94 " 3605233200 CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES 52332 8459.93 " 1,350.61 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 2,714.00 " " 7,613.94 " " 1,350.61 " " 7,613.94 " 3605235200 CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES 52352 8459.93 " 1,350.61 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 2,714.00 " " 7,613.94 " " 1,350.61 " " 7,613.94 " 3605235300 CYSTO W/URETEROSCOPY W/LITHOTRIPSY 52353 12138.22 " 3,942.70 " " 10,317.49 " " 4,417.62 " " 10,317.49 " " 7,404.31 " " 10,924.40 " " 4,500.00 " " 10,924.40 " " 3,942.70 " " 10,924.40 " 3605235600 CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT 52356 12138.22 " 3,942.70 " " 10,317.49 " " 4,417.62 " " 10,317.49 " " 7,404.31 " " 10,924.40 " " 4,500.00 " " 10,924.40 " " 3,942.70 " " 10,924.40 " 3605250000 TRANSURETHRAL RESECTION PROSTATE 52500 8459.93 " 1,350.61 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 2,714.00 " " 7,613.94 " " 1,350.61 " " 7,613.94 " 3605302000 MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT 53020 4930.72 " 1,270.75 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,714.00 " " 4,437.65 " " 1,270.75 " " 4,437.65 " 3605389900 Hc Unlisted Procedure Urinary System 53899 8459.93 " 1,350.61 " " 7,190.94 " " 1,706.26 " " 7,190.94 " " 5,160.56 " " 7,613.94 " 821.00 " 7,613.94 " 821.00 " 7,613.94 " 3605416100 CIRCUMCISION AGE >28 DAYS 54161 4930.72 " 3,767.62 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,714.00 " " 4,437.65 " " 1,706.26 " " 4,437.65 " 3605416200 LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS 54162 4930.72 " 3,767.62 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,714.00 " " 4,437.65 " " 1,706.26 " " 4,437.65 " 3605416300 REPAIR INCOMPLETE CIRCUMCISION 54163 4930.72 " 3,767.62 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,714.00 " " 4,437.65 " " 1,706.26 " " 4,437.65 " 3605430000 REVISION OF PENIS 54300 8459.93 " 3,767.62 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 4,500.00 " " 7,613.94 " " 2,986.86 " " 7,613.94 " 3605451200 EXC XTRPARENCHYMAL LESION TESTIS 54512 8459.93 " 2,463.14 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 2,714.00 " " 7,613.94 " " 2,463.14 " " 7,613.94 " 3605452000 ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH 54520 8459.93 " 2,463.14 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 3,143.00 " " 7,613.94 " " 2,463.14 " " 7,613.94 " 3605453000 ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH 54530 8754.37 " 2,463.14 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 2,463.14 " " 7,878.93 " 3605464000 ORCHIOPEXY INGUINAL APPROACH W/WO HERNIA RPR 54640 8754.37 " 2,463.14 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 2,463.14 " " 7,878.93 " 3605483000 EXCIS EPIDIDYMIS LOCAL LESION 54830 8459.93 " 2,463.14 " " 7,190.94 " " 2,986.86 " " 7,190.94 " " 5,160.56 " " 7,613.94 " " 2,714.00 " " 7,613.94 " " 2,463.14 " " 7,613.94 " 3605484000 EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY 54840 4930.72 " 2,463.14 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,714.00 " " 4,437.65 " " 1,706.26 " " 4,437.65 " 3605500000 PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED 55000 1710.41 419.62 " 1,453.85 " 140.81 " 1,453.85 " " 1,043.35 " " 1,539.37 " " 1,643.00 " " 1,539.37 " 140.81 " 1,643.00 " 3605504000 EXCISION HYDROCELE UNILATERAL 55040 8754.37 " 3,767.62 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3605504100 EXCISION HYDROCELE BIILATERAL 55041 8754.37 " 3,767.62 " " 7,441.21 " " 3,010.07 " " 7,441.21 " " 5,340.17 " " 7,878.93 " " 3,143.00 " " 7,878.93 " " 3,010.07 " " 7,878.93 " 3605506000 Hc Rpr Tunica Vaginalis Hydrocele Bottle Type 55060 8459.93 " 2,463.14 " " 7,613.94 " " 2,986.86 " " 7,613.94 " " 7,190.94 " " 5,160.56 " " 2,714.00 " " 7,613.94 " " 2,463.14 " " 7,613.94 " 3605510000 DRAINAGE SCROTAL WALL ABSCESS 55100 3637.39 " 2,463.14 " " 3,091.78 " " 1,272.10 " " 3,091.78 " " 2,218.81 " " 3,273.65 " " 2,000.00 " " 3,273.65 " " 1,272.10 " " 3,273.65 " 3605525000 VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS 55250 4930.72 " 2,463.14 " " 4,191.11 " " 1,706.26 " " 4,191.11 " " 3,007.74 " " 4,437.65 " " 2,714.00 " " 4,437.65 " " 1,706.26 " " 4,437.65 " 3605640500 I&D VULVA/PERINEAL ABSCESS 56405 "3,762.82" 162.69 " 3,198.40 " 176.02 " 3,198.40 " " 2,295.32 " " 3,386.54 " 821.00 " 3,386.54 " 162.69 " 3,386.54 " 3605644000 MARSUPIALIZATION BARTHOLINS GLAND CYST 56440 7213.82 " 2,511.25 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,511.25 " " 6,492.44 " 3605651500 DESTRUCTION LESIONS VULVA EXTENSIVE 56515 4717.24 " 2,511.25 " " 4,009.65 " " 1,855.83 " " 4,009.65 " " 2,877.52 " " 4,245.52 " " 3,143.00 " " 4,245.52 " " 1,855.83 " " 4,245.52 " 3605660500 "BIOPSY OF VULVA OR PERINEUM, 1 LESION" 56605 "2,720.00" " 2,511.25 " " 2,312.00 " 110.44 " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 110.44 " 2,511.25 " 3605660600 BIOPSY VULVA/PERINEUM EACH ADDL LESION 56606 "2,587.91" " 2,511.25 " " 2,199.72 " " 1,371.59 " " 2,199.72 " " 1,578.63 " " 2,329.12 " 821.00 " 2,329.12 " 821.00 " 2,511.25 " 3605662000 VULVECTOMY SIMPLE PARTIAL 56620 7213.82 " 2,511.25 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,511.25 " " 6,492.44 " 3605663000 VULVECTOMY RADICAL PARTIAL 56630 12126.23 " 4,093.49 " " 10,307.30 " " 2,779.22 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 2,000.00 " " 10,913.61 " " 2,000.00 " " 10,913.61 " 3605663100 VULVECTOMY RAD PRTL UNI INGUINOFEM LMPHADECTOMY 56631 "16,702.82" " 4,093.49 " " 14,197.40 " " 2,779.22 " " 14,197.40 " " 10,188.72 " " 15,032.54 " " 6,571.00 " " 15,032.54 " " 2,779.22 " " 15,032.54 " 3605663200 VULVECTOMY RAD PRTL BI INGUINOFEM LMPHADECTOMY 56632 16702.82 " 4,093.49 " " 14,197.40 " " 2,779.22 " " 14,197.40 " " 10,188.72 " " 15,032.54 " " 6,571.00 " " 15,032.54 " " 2,779.22 " " 15,032.54 " 3605663300 VULVECTOMY RADICAL COMPLETE 56633 16702.82 " 4,093.49 " " 14,197.40 " " 2,779.22 " " 14,197.40 " " 10,188.72 " " 15,032.54 " " 6,571.00 " " 15,032.54 " " 2,779.22 " " 15,032.54 " 3605663400 VULVECTOMY RAD COMPL UNI INGUINOFEM LMPHADECTOMY 56634 "16,702.82" " 8,017.35 " " 14,197.40 " " 2,779.22 " " 14,197.40 " " 10,188.72 " " 15,032.54 " " 6,571.00 " " 15,032.54 " " 2,779.22 " " 15,032.54 " 3605663700 VULVECTOMY RAD COMPL BI INGUINOFEM LMPHADECTOMY 56637 "16,702.82" " 8,017.35 " " 14,197.40 " " 2,779.22 " " 14,197.40 " " 10,188.72 " " 15,032.54 " " 6,571.00 " " 15,032.54 " " 2,779.22 " " 15,032.54 " 3605670000 PRTL HYMENECTOMY/REVJ HYMENAL RING 56700 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605674000 EXC BARTHOLINS GLAND/CYST 56740 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605681000 PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX 56810 7213.82 " 4,093.49 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605706500 DESTRUCTION VAGINAL LESIONS EXTENSIVE 57065 7213.82 " 4,093.49 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605710500 BIOPSY VAGINAL MUCOSA EXTENSIVE 57105 7213.82 " 4,093.49 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605710600 Hc Remove Vagina Wall Partial 57106 7213.82 " 4,093.49 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605710700 Hc Vaginectomy Prtl Rmvl Vag Wall & Paravaginal T 57107 7213.82 " 4,093.49 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605712000 CLOSURE OF VAGINA 57120 12126.23 " 4,093.49 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605713500 EXCISION OF VAGINAL CYST OR TUMOR 57135 7213.82 " 2,511.25 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,511.25 " " 6,492.44 " 3605720000 "COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)" 57200 7213.82 " 2,511.25 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,511.25 " " 6,492.44 " 3605724000 ANT COLPORRHAPHY CYSTOCELE W/WO RPR URETHROCELE 57240 12126.23 " 1,270.75 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 1,270.75 " " 10,913.61 " 3605725000 POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY 57250 12126.23 " 3,053.87 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,053.87 " " 10,913.61 " 3605726000 COMBINED ANTEROPOSTERIOR COLPORRHAPHY 57260 12126.23 " 3,053.87 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,053.87 " " 10,913.61 " 3605726500 CMBND ANTEROPOST COLPORRHAPHY W/ENTEROCELE RPR 57265 12126.23 " 3,053.87 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 4,500.00 " " 10,913.61 " " 3,053.87 " " 10,913.61 " 3605726800 REPAIR ENTEROCELE VAGINAL APPROACH SPX 57268 12126.23 " 3,053.87 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 2,714.00 " " 10,913.61 " " 2,714.00 " " 10,913.61 " 3605728200 COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH 57282 18684.35 " 2,511.25 " " 15,881.70 " " 5,966.30 " " 15,881.70 " " 11,397.45 " " 16,815.92 " " 4,500.00 " " 16,815.92 " " 2,511.25 " " 16,815.92 " 3605728300 COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH 57283 18684.35 " 2,511.25 " " 15,881.70 " " 5,966.30 " " 15,881.70 " " 11,397.45 " " 16,815.92 " " 4,500.00 " " 16,815.92 " " 2,511.25 " " 16,815.92 " 3605728700 "REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)" 57287 7213.82 " 1,270.75 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 1,270.75 " " 6,492.44 " 3605728800 SLING OPERATION FOR STRESS INCONTINENCE 57288 12126.23 " 1,270.75 " " 10,307.30 " " 5,395.63 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 4,500.00 " " 10,913.61 " " 1,270.75 " " 10,913.61 " 3605729500 REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP 57295 7213.82 " 2,511.25 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,511.25 " " 6,492.44 " 3605741000 PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL 57410 7213.82 162.69 " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 162.69 " 6,492.44 " 3605741500 REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL 57415 7213.82 " 2,511.25 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,511.25 " " 6,492.44 " 3605742500 LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX 57425 24496.06 " 5,271.98 " " 20,821.65 " " 8,122.54 " " 20,821.65 " " 14,942.60 " " 22,046.45 " " 5,357.00 " " 22,046.45 " " 5,271.98 " " 22,046.45 " 3605745400 COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE 57454 4431.9 " 2,511.25 " " 3,767.12 " 162.90 " 3,767.12 " " 2,703.46 " " 3,988.71 " 821.00 " 3,988.71 " 162.90 " 3,988.71 " 3605745500 COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX 57455 4431.9 " 2,511.25 " " 3,767.12 " 174.64 " 3,767.12 " " 2,703.46 " " 3,988.71 " 821.00 " 3,988.71 " 174.64 " 3,988.71 " 3605750000 BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX 57500 4431.9 " 2,511.25 " " 3,767.12 " 229.19 " 3,767.12 " " 2,703.46 " " 3,988.71 " " 1,643.00 " " 3,988.71 " 229.19 " 3,988.71 " 3605752000 CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER 57520 7213.82 " 4,093.49 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605752200 CONIZATION CERVIX W/WO D&C RPR ELTRD EXC 57522 7213.82 " 2,511.25 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,511.25 " " 6,492.44 " 3605753000 "TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX (SEPARATE PROCEDURE)" 57530 12126.23 " 2,511.25 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 2,714.00 " " 10,913.61 " " 2,511.25 " " 10,913.61 " 3605755500 EXC CRV STUMP VAG APPR W/ANT &/POST REPAIR 57555 12126.23 " 5,271.98 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605772000 "Hc Plastic Recervix,vag Apprch" 57720 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605810000 ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX 58100 3500 " 1,680.00 " " 2,975.00 " 115.98 " 2,975.00 " " 2,135.00 " " 3,150.00 " 821.00 " 3,150.00 " 115.98 " 3,150.00 " 3605812000 DILATION & CURETTAGE DX&/THER NONOBSTETRIC 58120 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605814000 MYOMECTOMY 1-4 MYOMAS W/250 GM/< ABDOMINAL APPR 58140 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 3,143.00 " " 6,492.44 " " 2,779.22 " " 6,492.44 " 3605814500 MYOMECTOMY 1-4 MYOMAS 250 GM/< VAGINAL APPR 58145 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605814600 MYOMECTOMY 5/> MYOMAS &/>250 GM ABDOMINA 58146 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 3,143.00 " " 6,492.44 " " 2,779.22 " " 6,492.44 " 3605815000 TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY 58150 15021.55 " 7,210.34 " " 12,768.32 " " 2,779.22 " " 12,768.32 " " 9,163.15 " " 13,519.40 " " 2,000.00 " " 13,519.40 " " 2,000.00 " " 13,519.40 " 3605818000 SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY 58180 17124.7 " 8,219.86 " " 14,556.00 " " 2,779.22 " " 14,556.00 " " 10,446.07 " " 15,412.23 " " 2,000.00 " " 15,412.23 " " 2,000.00 " " 15,412.23 " 3605820000 TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM 58200 15521.55 " 7,450.34 " " 13,193.32 " " 2,779.22 " " 13,193.32 " " 9,468.15 " " 13,969.40 " " 2,000.00 " " 13,969.40 " " 2,000.00 " " 13,969.40 " 3605821000 RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY 58210 20127.56 " 9,661.23 " " 17,108.43 " " 2,779.22 " " 17,108.43 " " 12,277.81 " " 18,114.80 " " 2,000.00 " " 18,114.80 " " 2,000.00 " " 18,114.80 " 3605826000 VAGINAL HYSTERECTOMY UTERUS 250 GM/< 58260 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605826200 VAG HYST 250 GM/< W/RMVL TUBE&/OVARY 58262 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605826300 VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL 58263 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605827000 VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE 58270 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605829000 VAGINAL HYSTERECTOMY UTERUS > 250 GM 58290 18684.35 " 8,968.49 " " 15,881.70 " " 5,966.30 " " 15,881.70 " " 11,397.45 " " 16,815.92 " " 4,500.00 " " 16,815.92 " " 4,500.00 " " 16,815.92 " 3605829100 VAG HYST > 250 GM RMVL TUBE&/OVARY 58291 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 4,500.00 " " 10,913.61 " " 3,989.81 " " 10,913.61 " 3605830000 INSERTION INTRAUTERINE DEVICE IUD 58300 774.07 371.55 657.96 " 3,989.81 " 657.96 472.18 696.66 821.00 696.66 371.55 " 3,989.81 " 3605830100 REMOVAL INTRAUTERINE DEVICE IUD 58301 774.07 371.55 657.96 124.95 657.96 472.18 696.66 821.00 696.66 124.95 821.00 3605835000 CHROMOTUBATION OVIDUCT W/MATERIALS 58350 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605835300 ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID 58353 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605854100 LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/< 58541 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605854500 LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM/< 58545 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 4,500.00 " " 12,524.59 " " 4,500.00 " " 12,524.59 " 3605855000 LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/< 58550 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605855200 LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES 58552 20684.35 " 9,928.49 " " 17,581.70 " " 8,122.54 " " 17,581.70 " " 12,617.45 " " 18,615.92 " " 5,357.00 " " 18,615.92 " " 5,357.00 " " 18,615.92 " 3605855400 LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR 58554 20684.35 " 9,928.49 " " 17,581.70 " " 8,122.54 " " 17,581.70 " " 12,617.45 " " 18,615.92 " " 5,357.00 " " 18,615.92 " " 5,357.00 " " 18,615.92 " 3605855500 HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE 58555 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605855800 HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C 58558 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605855900 "HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS" 58559 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 2,714.00 " " 10,913.61 " " 2,714.00 " " 10,913.61 " 3605856000 HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM 58560 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605856100 HYSTEROSCOPY REMOVAL LEIOMYOMATA 58561 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605856200 HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY 58562 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605856300 HYSTEROSCOPY ENDOMETRIAL ABLATION 58563 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605857000 LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/< 58570 20684.35 " 9,928.49 " " 17,581.70 " " 8,122.54 " " 17,581.70 " " 12,617.45 " " 18,615.92 " " 5,357.00 " " 18,615.92 " " 5,357.00 " " 18,615.92 " 3605857100 LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY 58571 20684.35 " 9,928.49 " " 17,581.70 " " 8,122.54 " " 17,581.70 " " 12,617.45 " " 18,615.92 " " 5,357.00 " " 18,615.92 " " 5,357.00 " " 18,615.92 " 3605857200 LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM 58572 20684.35 " 9,928.49 " " 17,581.70 " " 8,122.54 " " 17,581.70 " " 12,617.45 " " 18,615.92 " " 5,357.00 " " 18,615.92 " " 5,357.00 " " 18,615.92 " 3605857300 LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR 58573 20684.35 " 9,928.49 " " 17,581.70 " " 8,122.54 " " 17,581.70 " " 12,617.45 " " 18,615.92 " " 5,357.00 " " 18,615.92 " " 5,357.00 " " 18,615.92 " 3605857500 "LAPAROSCOPY, TOTAL HYSTERECTOMY RESECTION MALIG ,W OMENTECTOMY INCL SALPINGO-OOPHORECTOMY, UNI/BI" 58575 24496.06 " 11,758.11 " " 20,821.65 " " 8,122.54 " " 20,821.65 " " 14,942.60 " " 22,046.45 " " 2,000.00 " " 22,046.45 " " 2,000.00 " " 22,046.45 " 3605866000 LAPAROSCOPY W/LYSIS OF ADHESIONS 58660 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605866100 LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES 58661 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605866200 LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE 58662 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605867000 LAPAROSCOPY FULGURATION OVIDUCTS 58670 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605867100 LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS 58671 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605872000 "SALPINGO-OOPHORECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE)" 58720 11895 " 5,709.60 " " 10,110.75 " " 8,122.54 " " 10,110.75 " " 7,255.95 " " 10,705.50 " " 4,500.00 " " 10,705.50 " " 4,500.00 " " 10,705.50 " 3605875000 TUBOTUBAL ANASTOMOSIS 58750 9000 " 4,320.00 " " 7,650.00 " " 8,122.54 " " 7,650.00 " " 5,490.00 " " 8,100.00 " " 3,143.00 " " 8,100.00 " " 3,143.00 " " 8,122.54 " 3605892500 OVARIAN CYSTECTOMY UNI/BI 58925 12126.23 " 5,820.59 " " 10,307.30 " " 3,989.81 " " 10,307.30 " " 7,397.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " " 3,143.00 " " 10,913.61 " 3605894000 OOPHORECTOMY PARTIAL/TOTAL UNI/BI 58940 "8,845.21" " 4,245.70 " " 7,518.43 " " 3,989.81 " " 7,518.43 " " 5,395.58 " " 7,960.69 " " 3,143.00 " " 7,960.69 " " 3,143.00 " " 7,960.69 " 3605895000 Hc Rescj Ovarian/tubal/peritoneal Malignancy W/bso 58950 "22,294.74" " 10,701.48 " " 18,950.53 " " 3,989.81 " " 18,950.53 " " 13,599.79 " " 20,065.27 " " 3,143.00 " " 20,065.27 " " 3,143.00 " " 20,065.27 " 3605895100 Hc Rescj Prim Prtl Mal W/bso & Omntc Tah & Lmphad 58951 "22,294.74" " 10,701.48 " " 18,950.53 " " 3,989.81 " " 18,950.53 " " 13,599.79 " " 20,065.27 " " 2,000.00 " " 20,065.27 " " 2,000.00 " " 20,065.27 " 3605895200 RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING 58952 "16,131.69" " 7,743.21 " " 13,711.94 " " 3,989.81 " " 13,711.94 " " 9,840.33 " " 14,518.52 " " 2,000.00 " " 14,518.52 " " 2,000.00 " " 14,518.52 " 3605895300 Hc Bso W/omentectomy Tah&rad Debulking Dissection 58953 "22,294.74" " 10,701.48 " " 18,950.53 " " 3,989.81 " " 18,950.53 " " 13,599.79 " " 20,065.27 " " 2,000.00 " " 20,065.27 " " 2,000.00 " " 20,065.27 " 3605895400 Hc Bso W/omentectomy Tah Debulking W/lmphadectomy 58954 "22,294.74" " 10,701.48 " " 18,950.53 " " 3,989.81 " " 18,950.53 " " 13,599.79 " " 20,065.27 " " 2,000.00 " " 20,065.27 " " 2,000.00 " " 20,065.27 " 3605895600 Hc Bso W/tot Omentectomy & Hysterectomy Malignanc 58956 "22,294.74" " 10,701.48 " " 18,950.53 " " 3,989.81 " " 18,950.53 " " 13,599.79 " " 20,065.27 " " 2,000.00 " " 20,065.27 " " 2,000.00 " " 20,065.27 " 3605915000 LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY 59150 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605915100 LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY 59151 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3605916000 CURETTAGE POSTPARTUM 59160 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605932000 CERCLAGE CERVIX PREGNANCY VAGINAL 59320 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605981200 TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL 59812 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605982000 TX MISSED ABORTION FIRST TRIMESTER SURGICAL 59820 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605982100 "TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER" 59821 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3605983000 Hc Tx Septic Abortion Surgical 59830 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,000.00 " " 6,492.44 " " 2,000.00 " " 6,492.44 " 3605987000 UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE 59870 7213.82 " 3,462.63 " " 6,131.75 " " 2,779.22 " " 6,131.75 " " 4,400.43 " " 6,492.44 " " 2,714.00 " " 6,492.44 " " 2,714.00 " " 6,492.44 " 3606020000 EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS 60200 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3606021000 PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY 60210 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3606022000 TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY 60220 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3606022500 TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC 60225 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3606024000 THYROIDECTOMY TOTAL/COMPLETE 60240 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3606025200 THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT 60252 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606025400 THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT 60254 15863.58 " 7,614.52 " " 13,484.04 " " 5,110.15 " " 13,484.04 " " 9,676.78 " " 14,277.22 " " 2,714.00 " " 14,277.22 " " 2,714.00 " " 14,277.22 " 3606026000 THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL 60260 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606028000 EXCISION THYROGLOSSAL DUCT CYST/SINUS 60280 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3606028100 EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT 60281 13916.21 " 6,679.78 " " 11,828.78 " " 4,936.89 " " 11,828.78 " " 8,488.89 " " 12,524.59 " " 5,357.00 " " 12,524.59 " " 4,936.89 " " 12,524.59 " 3606050000 PARATHYROIDECTOMY/EXPLORATION PARATHYROIDS 60500 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606051200 PARATHYROID AUTOTRANSPLANTATION ADD-ON 60512 6595.05 " 3,165.62 " " 5,605.79 " " 3,495.38 " " 5,605.79 " " 4,022.98 " " 5,935.55 " 821.00 " 5,935.55 " 821.00 " 5,935.55 " 3606052000 THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX 60520 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606178200 STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL 61782 "1,563.42" 750.44 " 1,328.91 " 828.61 " 1,328.91 " 953.69 " 1,407.08 " 821.00 " 1,407.08 " 750.44 " 1,407.08 " 3606223000 RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS 62230 15675.79 " 7,524.38 " " 13,324.42 " " 5,216.37 " " 13,324.42 " " 9,562.23 " " 14,108.21 " " 4,500.00 " " 14,108.21 " " 4,500.00 " " 14,108.21 " 3606236200 IMPLANT SPINE INFUSION PUMP 62362 "23,017.12" " 11,048.22 " " 19,564.55 " " 30,186.51 " " 19,564.55 " " 14,040.44 " " 20,715.41 " " 7,865.00 " " 20,715.41 " " 7,865.00 " " 30,186.51 " 3606236500 REMOVE INFUSN DEVICE/PUMP 62365 15675.79 " 7,524.38 " " 13,324.42 " " 5,216.37 " " 13,324.42 " " 9,562.23 " " 14,108.21 " " 5,357.00 " " 14,108.21 " " 5,216.37 " " 14,108.21 " 3606365000 PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL 63650 16941.87 " 8,132.10 " " 14,400.59 " " 9,544.36 " " 14,400.59 " " 10,334.54 " " 15,247.68 " " 5,357.00 " " 15,247.68 " " 5,357.00 " " 15,247.68 " 3606366100 RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR 63661 7824.57 " 3,755.79 " " 6,650.88 " " 1,722.89 " " 6,650.88 " " 4,772.99 " " 7,042.11 " " 2,714.00 " " 7,042.11 " " 1,722.89 " " 7,042.11 " 3606366300 REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR 63663 16941.87 " 8,132.10 " " 14,400.59 " " 9,596.78 " " 14,400.59 " " 10,334.54 " " 15,247.68 " " 5,357.00 " " 15,247.68 " " 5,357.00 " " 15,247.68 " 3606368500 INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING 63685 29444.52 " 14,133.37 " " 25,027.84 " " 50,915.78 " " 25,027.84 " " 17,961.16 " " 26,500.07 " " 7,865.00 " " 26,500.07 " " 7,865.00 " " 50,915.78 " 3606368800 REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR 63688 9007.07 " 4,323.39 " " 7,656.01 " " 3,920.80 " " 7,656.01 " " 5,494.31 " " 8,106.36 " " 3,143.00 " " 8,106.36 " " 3,143.00 " " 8,106.36 " 3606456100 PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING 64561 16941.87 " 8,132.10 " " 14,400.59 " " 9,757.17 " " 14,400.59 " " 10,334.54 " " 15,247.68 " " 5,357.00 " " 15,247.68 " " 5,357.00 " " 15,247.68 " 3606458100 INC IMPLTJ NEUROSTIMULATOR ELTRD SACRAL NERVE 64581 16941.87 " 8,132.10 " " 14,400.59 " " 10,325.73 " " 14,400.59 " " 10,334.54 " " 15,247.68 " " 6,571.00 " " 15,247.68 " " 6,571.00 " " 15,247.68 " 3606458500 REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE 64585 9007.07 " 4,323.39 " " 7,656.01 " " 3,920.80 " " 7,656.01 " " 5,494.31 " " 8,106.36 " " 3,143.00 " " 8,106.36 " " 3,143.00 " " 8,106.36 " 3606459000 INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR 64590 "24,592.10" " 11,804.21 " " 20,903.29 " " 38,419.96 " " 20,903.29 " " 15,001.18 " " 22,132.89 " " 7,865.00 " " 22,132.89 " " 7,865.00 " " 38,419.96 " 3606459500 REVISION/RMVL PERIPHERAL/GASTRIC NPGR 64595 9007.07 " 4,323.39 " " 7,656.01 " " 3,920.80 " " 7,656.01 " " 5,494.31 " " 8,106.36 " " 3,143.00 " " 8,106.36 " " 3,143.00 " " 8,106.36 " 3606461100 CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS 64611 718.21 344.74 610.48 168.44 610.48 438.11 646.39 821.00 646.39 168.44 821.00 3606470200 "NEUROPLASTY; DIGITAL, 1 OR BOTH, SAME DIGIT" 64702 4824.57 " 2,315.79 " " 4,100.88 " " 1,722.89 " " 4,100.88 " " 2,942.99 " " 4,342.11 " " 2,714.00 " " 4,342.11 " " 1,722.89 " " 4,342.11 " 3606471800 NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW 64718 4824.57 " 2,315.79 " " 4,100.88 " " 1,722.89 " " 4,100.88 " " 2,942.99 " " 4,342.11 " " 2,714.00 " " 4,342.11 " " 1,722.89 " " 4,342.11 " 3606472100 NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE 64721 4824.57 " 2,315.79 " " 4,100.88 " " 1,722.89 " " 4,100.88 " " 2,942.99 " " 4,342.11 " " 2,714.00 " " 4,342.11 " " 1,722.89 " " 4,342.11 " 3606472200 NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE 64722 4824.57 " 2,315.79 " " 4,100.88 " " 1,722.89 " " 4,100.88 " " 2,942.99 " " 4,342.11 " " 2,714.00 " " 4,342.11 " " 1,722.89 " " 4,342.11 " 3606491000 NERVE REPAIR W/CONDUIT EACH NERVE 64910 15675.79 " 7,524.38 " " 13,324.42 " " 8,097.45 " " 13,324.42 " " 9,562.23 " " 14,108.21 " " 4,500.00 " " 14,108.21 " " 4,500.00 " " 14,108.21 " 3606510500 ENUCLEATION EYE IMPLT MUSC ATTACHED IMPLT 65105 9089.98 " 4,363.19 " " 7,726.48 " " 2,884.04 " " 7,726.48 " " 5,544.89 " " 8,180.98 " " 3,143.00 " " 8,180.98 " " 2,884.04 " " 8,180.98 " 3606511000 EXENTERATION ORBIT REMVL ORBITAL CONTENTS ONLY 65110 9089.98 " 4,363.19 " " 7,726.48 " " 2,884.04 " " 7,726.48 " " 5,544.89 " " 8,180.98 " " 3,143.00 " " 8,180.98 " " 2,884.04 " " 8,180.98 " 3606542600 EXCISION/TRANSPOSITION PTERYGIUM W/GRAFG 65426 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606618300 "INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, W/O EXTRAOCULAR RESERVOIR, EXTERNAL" 66183 10773.78 " 5,171.41 " " 9,157.71 " " 5,816.35 " " 9,157.71 " " 6,572.01 " " 9,696.40 " " 4,500.00 " " 9,696.40 " " 4,500.00 " " 9,696.40 " 3606682500 REPOSITION INTRAOCULAR LENS W INCIS 66825 5717.69 " 2,744.49 " " 4,860.04 " " 2,225.10 " " 4,860.04 " " 3,487.79 " " 5,145.92 " " 2,714.00 " " 5,145.92 " " 2,225.10 " " 5,145.92 " 3606698200 XCAPSULAR CATARACT RMVL INSJ LENS PROSTH 1 STG 66982 5717.69 " 2,744.49 " " 4,860.04 " " 2,225.10 " " 4,860.04 " " 3,487.79 " " 5,145.92 " " 2,714.00 " " 5,145.92 " " 2,225.10 " " 5,145.92 " 3606698400 CATARACT REMOVAL INSERTION OF LENS 66984 5717.69 " 2,744.49 " " 4,860.04 " " 2,225.10 " " 4,860.04 " " 3,487.79 " " 5,145.92 " " 2,714.00 " " 5,145.92 " " 2,225.10 " " 5,145.92 " 3606741200 ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION 67412 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606741400 ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN 67414 9089.98 " 4,363.19 " " 7,726.48 " " 2,884.04 " " 7,726.48 " " 5,544.89 " " 8,180.98 " " 3,143.00 " " 8,180.98 " " 2,884.04 " " 8,180.98 " 3606770000 BLEPHAROTOMY DRAINAGE ABSCESS EYELID 67700 "2,720.00" " 1,305.60 " " 2,312.00 " 282.67 " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 282.67 " 2,448.00 " 3606780800 "EXCISION OF CHALAZION, SINGLE OR MULTIPLE" 67808 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606784000 EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE 67840 2226.23 " 1,068.59 " " 1,892.30 " 434.20 " 1,892.30 " " 1,358.00 " " 2,003.61 " " 2,000.00 " " 2,003.61 " 434.20 " 2,003.61 " 3606788000 CONSTJ INTERMARGIN ADHES/TARSORRH/CANTHORRHAPY 67880 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606790000 REPAIR BROW PTOSIS 67900 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606790400 RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL 67904 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606790800 RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ 67908 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606791200 CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD 67912 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606791600 REPAIR ECTROPION EXCISION TARSAL WEDGE 67916 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606791700 REPAIR ECTROPION EXTENSIVE 67917 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606792300 REPAIR ENTROPION EXCISION TARSAL WEDGE 67923 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606792400 REPAIR ENTROPION EXTENSIVE 67924 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606795000 CANTHOPLASTY (RECONSTRUCTION OF CANTHUS) 67950 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606796100 EXCISION & REPAIR EYELID > ONE-FOURTH LID MARGIN 67961 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606796600 EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN 67966 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606799900 Hc Unlisted Procedure Eyelids 67999 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " 821.00 " 4,955.81 " 821.00 " 4,955.81 " 3606842000 INCISION DRAINAGE LACRIMAL SAC 68420 5506.46 " 2,643.10 " " 4,680.49 " 522.55 " 4,680.49 " " 3,358.94 " " 4,955.81 " " 1,643.00 " " 4,955.81 " 522.55 " 4,955.81 " 3606850500 "EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR" 68505 9089.98 " 4,363.19 " " 7,726.48 " " 2,884.04 " " 7,726.48 " " 5,544.89 " " 8,180.98 " " 3,143.00 " " 8,180.98 " " 2,884.04 " " 8,180.98 " 3606853000 RMVL FB/DACRYOLITH LACRIMAL PASSAGES 68530 718.52 344.89 610.74 282.67 610.74 438.30 646.67 821.00 646.67 282.67 821.00 3606880100 DILATION LACRIMAL PUNCTUM W/WO IRRGATION 68801 "2,720.00" " 1,305.60 " " 2,312.00 " " 1,441.60 " " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 821.00 " 2,448.00 " 3606881000 PROBE NASOLACRIMAL DUCT W/WO IRRIGATION 68810 2720 " 1,305.60 " " 2,312.00 " 282.67 " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 282.67 " 2,448.00 " 3606881100 "PROBING OF NASOLACRIMAL DUCT, W OR WO IRRIGATION; REQUIRING GEN ANES" 68811 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606881500 PROBE NASOLACRIMAL DUCT W/WO IRRG INSJ TUBE/STNT 68815 5506.46 " 2,643.10 " " 4,680.49 " " 1,827.48 " " 4,680.49 " " 3,358.94 " " 4,955.81 " " 2,714.00 " " 4,955.81 " " 1,827.48 " " 4,955.81 " 3606884000 PROBE LACRIMAL CANALICULI W/WO IRRIGATION 68840 2720 " 1,305.60 " " 2,312.00 " 171.19 " 2,312.00 " " 1,659.20 " " 2,448.00 " 821.00 " 2,448.00 " 171.19 " 2,448.00 " 3606900000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE 69000 2720 " 1,305.60 " " 2,312.00 " 283.01 " 2,312.00 " " 1,659.20 " " 2,448.00 " " 1,643.00 " " 2,448.00 " 283.01 " 2,448.00 " 3606900500 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX 69005 3869.25 " 1,857.24 " " 3,288.86 " 294.07 " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " 294.07 " 3,482.33 " 3606911000 "EXCISION EXTERNAL EAR, PARTIAL, SIMPLE REPAIR" 69110 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3606912000 EXCISION EXTERNAL EAR COMPLETE AMPUTATION 69120 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 2,714.00 " " 12,587.97 " " 2,714.00 " " 12,587.97 " 3606914000 EXCISION EXOSTOSIS EXTERNAL AUDITORY CANAL 69140 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 2,714.00 " " 12,587.97 " " 2,714.00 " " 12,587.97 " 3606914500 EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL 69145 6517.52 " 3,128.41 " " 5,539.89 " " 2,131.02 " " 5,539.89 " " 3,975.69 " " 5,865.77 " " 2,000.00 " " 5,865.77 " " 2,000.00 " " 5,865.77 " 3606920500 RMVL FB XTRNL AUDITORY CANAL ANES 69205 3869.25 " 1,857.24 " " 3,288.86 " " 1,272.10 " " 3,288.86 " " 2,360.24 " " 3,482.33 " " 2,000.00 " " 3,482.33 " " 1,272.10 " " 3,482.33 " 3606921000 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 69210 153 73.44 130.05 81.09 130.05 93.33 137.70 821.00 137.70 73.44 821.00 3606922200 "DEBRIDEMENT, MASTOIDECTOMY CAVITY, COMPLEX" 69222 1243.99 597.12 " 1,057.39 " 349.98 " 1,057.39 " 758.83 " 1,119.59 " 821.00 " 1,119.59 " 349.98 " 1,119.59 " 3606931000 RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX 69310 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606939900 Hc Unlisted External Ear Procedures 69399 13986.63 " 6,713.58 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " 821.00 " 12,587.97 " 821.00 " 12,587.97 " 3606942400 VENTILATING TUBE RMVL REQUIRING GENERAL ANES 69424 3557.18 " 1,707.45 " " 3,023.60 " 213.30 " 3,023.60 " " 2,169.88 " " 3,201.46 " " 2,714.00 " " 3,201.46 " 213.30 " 3,201.46 " 3606943600 TYMPANOSTOMY GENERAL ANESTHESIA 69436 3720.17 " 2,800.91 " " 3,162.14 " " 1,100.38 " " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " " 1,100.38 " " 3,348.15 " 3606945000 TYMPANOLYSIS TRANSCANAL 69450 7525.07 " 7,696.43 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 4,500.00 " " 6,772.56 " " 2,317.27 " " 7,696.43 " 3606953000 PETROUS APICECTOMY RADICAL MASTOIDECTOMY 69530 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606954000 EXCISION AURAL POLYP 69540 3720.17 " 2,800.91 " " 3,162.14 " 355.50 " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,000.00 " " 3,348.15 " 355.50 " 3,348.15 " 3606961000 TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH 69610 3720.17 " 4,609.82 " " 3,162.14 " 449.39 " 3,162.14 " " 2,269.30 " " 3,348.15 " " 2,714.00 " " 3,348.15 " 449.39 " 4,609.82 " 3606962000 MYRINGOPLASTY 69620 7525.07 " 4,609.82 " " 6,396.31 " " 2,317.27 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,317.27 " " 6,772.56 " 3606963100 TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ 69631 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606963200 TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ 69632 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606963300 TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP 69633 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606963500 TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ 69635 13986.63 " 7,696.43 " " 11,888.64 " " 5,110.15 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606964100 TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ 69641 13986.63 " 7,696.43 " " 11,888.64 " " 7,412.91 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606964200 TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ 69642 13986.63 " 7,696.43 " " 11,888.64 " " 7,412.91 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606964300 TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR 69643 13986.63 " 7,696.43 " " 11,888.64 " " 7,412.91 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606965000 STAPES MOBILIZATION 69650 7525.07 " 7,696.43 " " 6,396.31 " " 3,988.29 " " 6,396.31 " " 4,590.29 " " 6,772.56 " " 2,714.00 " " 6,772.56 " " 2,714.00 " " 7,696.43 " 3606966000 STAPEDECTOMY/STAPEDOTOMY 69660 13986.63 " 7,696.43 " " 11,888.64 " " 7,412.91 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606966100 STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT 69661 13986.63 " 7,696.43 " " 11,888.64 " " 7,412.91 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606966200 REVISION STAPEDECTOMY/STAPEDOTOMY 69662 13986.63 " 7,696.43 " " 11,888.64 " " 7,412.91 " " 11,888.64 " " 8,531.84 " " 12,587.97 " " 4,500.00 " " 12,587.97 " " 4,500.00 " " 12,587.97 " 3606971400 IMPLTJ OSSEOINTEGRATED TEMPORAL BONE W/MASTOID 69714 "22,780.04" " 7,696.43 " " 19,363.03 " " 12,073.42 " " 19,363.03 " " 13,895.82 " " 20,502.04 " " 6,571.00 " " 20,502.04 " " 6,571.00 " " 20,502.04 " 3606971700 RPLMCT OSSEOINTEGRATE IMPLNT W/O MASTOIDECTOMY 69717 17228.61 " 7,696.43 " " 14,644.32 " " 9,131.16 " " 14,644.32 " " 10,509.45 " " 15,505.75 " " 4,500.00 " " 15,505.75 " " 4,500.00 " " 15,505.75 " 3606979900 Hc Unlisted Procedure Middle Ear 69799 13986.63 " 2,800.91 " " 11,888.64 " " 7,412.91 " " 11,888.64 " " 8,531.84 " " 12,587.97 " 821.00 " 12,587.97 " 821.00 " 12,587.97 " 3606993000 COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY 69930 "37,908.59" " 40,585.70 " " 32,222.30 " " 20,091.55 " " 32,222.30 " " 23,124.24 " " 34,117.73 " " 8,651.00 " " 34,117.73 " " 8,651.00 " " 40,585.70 " 3606994900 "Hc Unlisted Procedure, Inner Ear" 69949 13986.63 " 2,800.91 " " 11,888.64 " " 7,412.91 " " 11,888.64 " " 8,531.84 " " 12,587.97 " 821.00 " 12,587.97 " 821.00 " 12,587.97 " 3247101000 RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL 71010 150 47.62 127.50 79.50 127.50 91.50 135.00 97.50 135.00 47.62 135.00 3247104500 RADIOLOGIC EXAM CHEST SINGLE VIEW 71045 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207202000 RADEX SPINE 1 VIEW SPECIFY LEVEL 72020 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207208000 RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS 72080 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207300000 RADEX CLAVICLE COMPLETE 73000 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207313000 RADEX HAND MINIMUM 3 VIEWS 73130 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207360000 RADIOLOGIC EXAMINATION ANKLE 2 VIEWS 73600 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207362000 RADIOLOGIC EXAMINATION FOOT 2 VIEWS 73620 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207363000 RADEX FOOT COMPLETE MINIMUM 3 VIEWS 73630 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207365000 RADEX CALCANEUS MINIMUM 2 VIEWS 73650 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207401800 RADIOLOGIC EXAM ABDOMEN 1 VIEW 74018 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207430000 CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I 74300 222.47 47.62 189.10 117.91 189.10 135.71 200.22 144.61 200.22 47.62 200.22 3207442000 X-RAY URINARY TRACT EXAM WITH CONTRAST MATERIAL 74420 1012.33 47.62 860.48 536.53 860.48 617.52 911.10 658.01 911.10 47.62 911.10 3207600000 FLUOROSCOPY SPX UP TO 1 HOUR PHYS/QHP TIME 76000 632.85 47.62 537.92 335.41 537.92 386.04 569.57 411.35 569.57 47.62 569.57 3207609800 RADIOLOGICAL EXAMINATION SURGICAL SPECIMEN 76098 1327.94 47.62 " 1,128.75 " 703.81 " 1,128.75 " 810.04 " 1,195.15 " 863.16 " 1,195.15 " 47.62 " 1,195.15 " 4027651000 OPH US DX B-SCAN&QUAN A-SCAN SM PT ENCTR 76510 307.86 153.26 261.68 163.17 261.68 187.79 277.07 200.11 277.07 153.26 277.07 4027694200 US GUIDANCE NEEDLE PLACEMENT IMG S&I 76942 257 153.26 218.45 136.21 218.45 156.77 231.30 167.05 231.30 136.21 231.30 4027699800 ULTRASONIC GUIDANCE INTRAOPERATIVE 76998 257 153.26 218.45 136.21 218.45 156.77 231.30 167.05 231.30 136.21 231.30 3207700100 FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT 77001 375 524.27 318.75 198.75 318.75 228.75 337.50 243.75 337.50 198.75 524.27 3018004800 BMP W TOTAL CALCIUM PANEL 80048 31.56 41.66 26.83 16.73 26.83 19.25 28.40 20.51 28.40 16.73 41.66 3018005300 CMP COMPREHENSIVE METABOLIC 80053 39.41 41.66 33.50 20.89 33.50 24.04 35.47 25.62 35.47 20.89 41.66 3108050000 REF COAG CONSULT VW CLIN PATCH CON 80500 45.24 49.10 38.45 23.98 38.45 27.60 40.72 29.41 40.72 23.98 49.10 3078100100 URINE AUTO WITH MICRO 81001 11.79 17.86 10.02 6.25 10.02 7.19 10.61 7.66 10.61 6.25 17.86 3078100300 URINE AUTO WO MICRO WAIVED 81003 8.37 17.86 7.11 4.44 7.11 5.11 7.53 5.44 7.53 4.44 17.86 3018204000 ALBUMIN SERUM PLASMA WH BLOOD 82040 18.44 41.66 15.67 9.77 15.67 11.25 16.60 11.99 16.60 9.77 41.66 3018216400 REF ANGIOTENSIN I-CONVERTING ENZYME CSF 82164 54.43 41.66 46.27 28.85 46.27 33.20 48.99 35.38 48.99 28.85 48.99 3018231000 CALCIUM TOTAL SERUM 82310 19.24 41.66 16.35 10.20 16.35 11.74 17.32 12.51 17.32 10.20 41.66 3018236500 REF CALCULUS SPECTROSCOPY 82365 119.25 41.66 101.36 63.20 101.36 72.74 107.33 77.51 107.33 41.66 107.33 3018256500 CREATININE SERUM 82565 19.13 41.66 16.26 10.14 16.26 11.67 17.22 12.43 17.22 10.14 41.66 3018397000 "ASSAY, PARATHORMONE" 83970 164.00 41.66 139.40 86.92 139.40 100.04 147.60 106.60 147.60 41.66 147.60 3018448400 TROPONIN I 84484 93.00 41.66 79.05 49.29 79.05 56.73 83.70 60.45 83.70 41.66 83.70 3018470300 HCG QUAL PREG TEST 84703 139.00 41.66 118.15 73.67 118.15 84.79 125.10 90.35 125.10 41.66 125.10 3058500700 BL COUNT W MANUAL DIFF WBC CT 85007 12.83 26.29 10.91 6.80 10.91 7.83 11.55 8.34 11.55 6.80 26.29 3058501400 HEMATOCRIT 85014 8.82 26.29 7.50 4.67 7.50 5.38 7.94 5.73 7.94 4.67 26.29 3058501800 HEMOGLOBIN 85018 8.82 26.29 7.50 4.67 7.50 5.38 7.94 5.73 7.94 4.67 26.29 3058502500 COMPLETE BL COUNT W DIFF AUTO 85025 28.99 26.29 24.64 15.36 24.64 17.68 26.09 18.84 26.09 15.36 26.29 3058502700 COMPLETE BL COUNT AUTOMATED 85027 24.14 26.29 20.52 12.79 20.52 14.73 21.73 15.69 21.73 12.79 26.29 3058524000 REF CLOTTING: FACTOR VIII (AHG) ONE STAG 85240 66.78 26.29 56.76 35.39 56.76 40.74 60.10 43.41 60.10 26.29 60.10 3058524500 REF COAG CONSULT VW RISTO-WILEBR 85245 85.57 26.29 72.73 45.35 72.73 52.20 77.01 55.62 77.01 26.29 77.01 3058524600 REF VON WILLEBRAND FACTOR AG 85246 85.57 26.29 72.73 45.35 72.73 52.20 77.01 55.62 77.01 26.29 77.01 3058539700 REF ADAMT13 ACTIVITY 85397 191.00 26.29 162.35 101.23 162.35 116.51 171.90 124.15 171.90 26.29 171.90 3058561000 "REF PROTHROMBIN TIME (PT),P (MAYO) PROCT PANEL" 85610 14.65 26.29 12.45 7.76 12.45 8.94 13.19 9.52 13.19 7.76 26.29 3098687000 ANTIBODY ID 86870 278.00 77.87 236.30 147.34 236.30 169.58 250.20 180.70 250.20 77.87 250.20 3098688503 AHG INDIRECT QUAL REAGENT RBC*3 86885 21.36 77.87 18.16 11.32 18.16 13.03 19.22 13.88 19.22 11.32 77.87 3098690001 ABO TYPE SEROLOGIC 86900 70.00 77.87 59.50 37.10 59.50 42.70 63.00 45.50 63.00 37.10 77.87 3098690100 RH BLOOD TYPING-OB GROUP 86901 11.13 24.80 9.46 5.90 9.46 6.79 10.02 7.23 10.02 5.90 24.80 3098690101 RH BLOOD TYPING 86901 53.00 24.80 45.05 28.09 45.05 32.33 47.70 34.45 47.70 24.80 47.70 3098692000 IMMEDIATE SPIN CROSSMATCH 86920 79.00 77.87 67.15 41.87 67.15 48.19 71.10 51.35 71.10 41.87 77.87 3098692200 X MATCH AHG 86922 66.46 24.80 56.49 35.22 56.49 40.54 59.81 43.20 59.81 24.80 59.81 3068707000 CULTURE AEROBIC ANY SOURCE 87070 32.12 24.80 27.30 17.02 27.30 19.59 28.91 20.88 28.91 17.02 28.91 3068707500 CULTURE ANAEROBIC ANY SOURCE 87075 34.72 44.14 29.51 18.40 29.51 21.18 31.25 22.57 31.25 18.40 44.14 3068707600 ANAEROBE ID 87076 30.13 44.14 25.61 15.97 25.61 18.38 27.12 19.58 27.12 15.97 44.14 3068707700 BACTERIAL ID 87077 30.13 44.14 25.61 15.97 25.61 18.38 27.12 19.58 27.12 15.97 44.14 3068708800 URINE CULTURE 87088 23.21 44.14 19.73 12.30 19.73 14.16 20.89 15.09 20.89 12.30 44.14 3068711600 REF ACID FAST CULTURE AFBX 87116 54.00 44.14 45.90 28.62 45.90 32.94 48.60 35.10 48.60 28.62 48.60 3068714700 SEROTYPE 87147 19.29 44.14 16.40 10.22 16.40 11.77 17.36 12.54 17.36 10.22 44.14 3068717600 HOMOG TISS HOMOGENIZE TISSUE 87176 21.94 44.14 18.65 11.63 18.65 13.38 19.75 14.26 19.75 11.63 44.14 3068718600 SUSCEPTABILITY AEROBIC MIC 87186 32.25 44.14 27.41 17.09 27.41 19.67 29.03 20.96 29.03 17.09 44.14 3068720500 DIRECT SMEAR ONLY 87205 15.93 44.14 13.54 8.44 13.54 9.72 14.34 10.35 14.34 8.44 44.14 3118811200 REF CYTOPATH CELL ENHANCE TECH 88112 85.52 90.27 72.69 45.33 72.69 52.17 76.97 55.59 76.97 45.33 90.27 3118817200 REF CYTO EVAL FNA ADEQUACY 88172 32.00 90.27 27.20 16.96 27.20 19.52 28.80 20.80 28.80 16.96 90.27 3118817300 REF CYTO FNA INTERP 88173 171.16 90.27 145.49 90.71 145.49 104.41 154.04 111.25 154.04 90.27 154.04 3128830000 REF SURG PATH LEVEL I GROSS ONLY 88300 43.83 90.27 37.26 23.23 37.26 26.74 39.45 28.49 39.45 23.23 90.27 3128830200 TISSUE EXAM BY PATHOLOGIST 88302 91.19 90.27 77.51 48.33 77.51 55.63 82.07 59.27 82.07 48.33 90.27 3128830400 REF SURG PATH LEV III GROSS &MICRO 88304 105.21 90.27 89.43 55.76 89.43 64.18 94.69 68.39 94.69 55.76 94.69 3128830500 REF SURG PATH LEV IV GROSS & MICRO 88305 129.08 90.27 109.72 68.41 109.72 78.74 116.17 83.90 116.17 68.41 116.17 3108830500 Hc Surg Path Lev Iv Gross & Micro 88305 129.08 90.27 109.72 68.41 109.72 78.74 116.17 83.90 116.17 68.41 116.17 3128830700 REF SURG PATH LEVEL V GROSS &MICRO 88307 288.19 90.27 244.96 152.74 244.96 175.80 259.37 187.32 259.37 90.27 259.37 3128830900 REF SURG PATH LEV VI GROSS & MICRO 88309 400.49 90.27 340.42 212.26 340.42 244.30 360.44 260.32 360.44 90.27 360.44 3128831100 REF DECALCIFICATION PROCEDURE 88311 12.91 90.27 10.97 6.84 10.97 7.88 11.62 8.39 11.62 6.84 90.27 3128831200 REF SPEC STAIN GROUP I MICRO ORGANISM 88312 125.29 90.27 106.50 66.40 106.50 76.43 112.76 81.44 112.76 66.40 112.76 3128831300 REF SPEC STAIN GROUP II ALL OTHER 88313 100.04 90.27 85.03 53.02 85.03 61.02 90.04 65.03 90.04 53.02 90.27 3128832300 MICROSLIDE CONSULTATION 88323 93.94 90.27 79.85 49.79 79.85 57.30 84.55 61.06 84.55 49.79 90.27 3128833100 REF FROZEN SECTION 1ST TISSUE BLOC 88331 62.14 90.27 52.82 32.93 52.82 37.91 55.93 40.39 55.93 32.93 90.27 3128833200 REF FROZEN SECTION EA ADDL BLOCK 88332 20.64 90.27 17.54 10.94 17.54 12.59 18.58 13.42 18.58 10.94 90.27 3128834100 REF HISTO CYTO CHEM ADDL ANTIBODY 88341 119.62 90.27 101.68 63.40 101.68 72.97 107.66 77.75 107.66 63.40 107.66 3128834200 REF IMMUNOHISTOCHEM EA ANTIBODY 88342 119.62 90.27 101.68 63.40 101.68 72.97 107.66 77.75 107.66 63.40 107.66 3128836100 MORPHOMETRIC ANAL COMPUTER 88361 152.80 90.27 129.88 80.98 129.88 93.21 137.52 99.32 137.52 80.98 137.52 3128837400 MPHMTRC ALYS ISH QUANT SEMIQ 88374 "1,052.05" 90.27 894.24 557.59 894.24 641.75 946.85 683.83 946.85 90.27 946.85 7719047101 ADMINISTRATION OF INFLUENZA VIRUS VACCINE 90471 53.17 25.52 45.19 28.18 45.19 32.43 47.85 34.56 47.85 25.52 47.85 3609201800 OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL 92018 "1,980.00" 950.40 " 1,683.00 " " 1,049.40 " " 1,683.00 " " 1,207.80 " " 1,782.00 " " 1,287.00 " " 1,782.00 " 950.40 " 1,782.00 " 4219711000 THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES 97110 74.00 88.78 62.90 39.22 62.90 45.14 66.60 48.10 66.60 39.22 88.78 4219711600 THER PX 1/> AREAS EA 15 MIN GAIT TRAINJ W/STAIR 97116 77.00 88.78 65.45 40.81 65.45 46.97 69.30 50.05 69.30 40.81 88.78 4249716100 PT EVAL VISIT LOW COMPLEXITY 97161 216.00 109.12 183.60 114.48 183.60 131.76 194.40 140.40 194.40 109.12 194.40 4249716200 PT EVAL VISIT MODERATE COMPLEX 97162 217.00 109.12 184.45 115.01 184.45 132.37 195.30 141.05 195.30 109.12 195.30 4349716500 OT EVAL LOW COMPLEXITY 97165 209.00 109.12 177.65 110.77 177.65 127.49 188.10 135.85 188.10 109.12 188.10 4209753000 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN 97530 77.00 109.12 65.45 40.81 65.45 46.97 69.30 50.05 69.30 40.81 109.12 4309753000 THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN 97530 77.00 109.12 65.45 40.81 65.45 46.97 69.30 50.05 69.30 40.81 109.12 5109760500 NEGATIVE PRESSURE WOUND THERAPY DME OR = TO 100 CM2; 1ST 100 CM2" C5273 "4,156.34" " 1,995.04 " " 3,532.89 " " 1,855.83 " " 3,532.89 " " 2,535.37 " " 3,740.71 " " 2,000.00 " " 3,740.71 " " 1,855.83 " " 3,740.71 " 3610527400 "APPL OF LOW COST SKIN SUB TO TRUNK,ARMS,LEGS, WOUND AREA > OR = TO 100 CM2; EA ADDL 100 CM2" C5274 "1,293.74" 621.00 " 1,099.68 " 685.68 " 1,099.68 " 789.18 " 1,164.37 " 821.00 " 1,164.37 " 621.00 " 1,164.37 " 3610527500 "APPL LOWCOST SKINSUB TO HEAD,NECK,GENITALIA,HANDS,FEET,TOTAL WOUND UP TO 100CM2;1ST 25CM2 OR LESS" C5275 "1,293.74" 621.00 " 1,099.68 " 567.09 " 1,099.68 " 789.18 " 1,164.37 " 821.00 " 1,164.37 " 567.09 " 1,164.37 " 3610527600 "APPL OF LOW COST SKIN SUB TO HEAD,NECK,GENITALIA,HANDS,FEET, AND/OR MULTI DIGITS, WOUND AREA UP TO 100 CM2; EA ADDL 25 CM2" C5276 "1,293.74" 621.00 " 1,099.68 " 685.68 " 1,099.68 " 789.18 " 1,164.37 " 821.00 " 1,164.37 " 621.00 " 1,164.37 " 3610527700 "APPL OF LOW COST SKIN SUB TO HEAD,NECK,GENITALIA,HANDS,FEET, AND/OR MULTI DIGITS, WOUND AREA > OR = TO 100 CM2; 1ST 100 CM2" C5277 "1,293.74" 621.00 " 1,099.68 " 567.09 " 1,099.68 " 789.18 " 1,164.37 " 821.00 " 1,164.37 " 567.09 " 1,164.37 " 3610527800 "APPL OF LOW COST SKIN SUB TO HEAD,NECK,GENITALIA,HANDS,FEET AND/OR MULTI DIGITS, WOUND AREA > OR = TO 100 CM2; EA ADDL 100 CM2" C5278 "1,293.74" 621.00 " 1,099.68 " 685.68 " 1,099.68 " 789.18 " 1,164.37 " 821.00 " 1,164.37 " 621.00 " 1,164.37 " 3600010100 CA SCREEN; PELVIC/BREAST EXAM G0101 "3,854.56" " 1,850.19 " " 3,276.38 " " 22,561.47 " " 3,276.38 " " 2,351.28 " " 3,469.10 " " 2,505.46 " " 3,469.10 " " 1,850.19 " " 22,561.47 " 7500010500 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK G0105 "1,881.45" 903.10 " 1,599.23 " 858.62 " 1,599.23 " " 1,147.68 " " 1,693.31 " " 1,643.00 " " 1,693.31 " 858.62 " 1,693.31 " 3200012000 "COLON CA SCREEN; BARIUM ENEMA, ALT TO G0105" G0120 "1,881.45" 903.10 " 1,599.23 " 858.62 " 1,599.23 " " 1,147.68 " " 1,693.31 " " 1,222.94 " " 1,693.31 " 858.62 " 1,693.31 " 3600012100 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK G0121 "1,881.45" 903.10 " 1,599.23 " 858.62 " 1,599.23 " " 1,147.68 " " 1,693.31 " " 1,643.00 " " 1,693.31 " 858.62 " 1,693.31 " 7620000100 SSO PER HOUR G0378 62.5 30.00 53.13 " 6,271.23 " 53.13 38.13 56.25 40.63 56.25 30.00 " 6,271.23 " 3900901600 RBC LEUKO REDUCED P9016 283.00 135.84 240.55 200.00 240.55 172.63 254.70 183.95 254.70 135.84 254.70 3900905100 RBC LEUKO REDUCED CMV NEG P9051 293.00 140.64 249.05 200.00 249.05 178.73 263.70 190.45 263.70 140.64 263.70 1100000200 SDSC-PRIVATE ROOM 1500 720.00 " 1,275.00 " " 1,275.00 " " 1,275.00 " 915.00 " 1,350.00 " 975.00 " 1,350.00 " 720.00 " 1,350.00 " 1500000100 ROOM WARD 5 OR MORE PER ROOM 1500 720.00 " 1,275.00 " " 1,275.00 " " 1,275.00 " 915.00 " 1,350.00 " 975.00 " 1,350.00 " 720.00 " 1,350.00 "