05-16699. Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction  

  • Start Preamble Start Printed Page 50680

    AGENCY:

    Centers for Medicare & Medicaid Services (CMS), HHS.

    ACTION:

    Proposed rule; correction.

    SUMMARY:

    This document corrects technical errors that appeared in the proposed rule published in the Federal Register on July 25, 2005 entitled “Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Proposed Rule.”

    Start Further Info

    FOR FURTHER INFORMATION CONTACT:

    Rebecca Kane, (410) 786-0378.

    End Further Info End Preamble Start Supplemental Information

    SUPPLEMENTARY INFORMATION:

    I. Background

    FR Doc. 05-14448 contains our proposed rule to update the Medicare Outpatient Prospective Payment System for calendar year (CY) 2006. We have identified a number of technical errors in the “Summary of Errors” section and are correcting them in the “Correction of Errors” section below.

    II. Summary of Errors

    A. Corrections Related to the Rural Adjustment Calculation

    The calendar year (CY) 2006 Outpatient Prospective Payment System (OPPS) proposed rule that we published in the Federal Register on July 25, 2005 included a proposed 6.6 percent adjustment for rural sole community hospitals. The calculations used to develop the conversion factor and budget neutrality scalar inadvertently incorporated this adjustment as 6.4 percent. The rural adjustment is used in calculations that determine the scalar and conversion factor, and therefore affects the payment rates and copayment amounts published in the proposed rule. The corrected scalar is 1.003753831, and the corrected conversion factor is $59.343. The various changes to the preamble are specified under section III. of this correction notice. In addition to preamble text changes, we are correcting specific tables and addenda which also reflected the inadvertent use of a 6.4 percent rural adjustment factor, which we have described below.

    On page 42709, we published Table 11. We are correcting the last column of this table to present the corrected proposed CY 2006 payment amounts. In section III. of this notice, we republish Table 11 as corrected.

    On pages 42761-42762, we published Table 33. In section III. of this notice, we republish Table 33 as corrected.

    On pages 42764-42775, we published Addendum A, which provides the payment rates and copayment amounts for Ambulatory Payment Classification (APC) groups used for payment purposes under the OPPS. A corrected Addendum A is posted on the OPPS Web site at http://www.cms.hhs.gov/​providers/​hopps/​2006p/​1501p.asp.

    On pages 42776-42965, we published Addendum B, which provides the payment rates and copayment amounts for services payable under OPPS. A corrected Addendum B, including additional technical errors affecting HCPCS codes 78814, 78815, 78816, 91035, and 95950 is posted on the OPPS Web site at http://www.cms.hhs.gov/​providers/​hopps/​2006p/​1501p.asp.

    We are posting the corrected Addendum A and Addendum B on our Web site rather than publishing them in this notice because of the large volume of data included in these addenda. Hard copies of these tables are available by contacting the CMS staff member identified above.

    We note that as soon as we discovered these inadvertent errors that affected the payment rates noted in the proposed rule, we posted the corrections on the CMS Web site at: http://www.cms.hhs.gov/​providers/​hopps/​2006p/​1501p.asp.

    B. Other Corrections

    We also noted other typographical, formatting, and other technical errors in the proposed rule.

    On page 42714, we published Table 15. The proposed “unadjusted” and “adjusted” CY 2006 APC median cost for APC 0085 Level II Electrophysiologic Evaluation contained a typographical error and should read $2,123.38. We are correcting this under section III. of this notice.

    On page 42761, column 2 includes a comparison that discusses the differences in copayments from CY 2005 to CY 2006. While the analysis of this example is correct, the example incorrectly identifies the comparison as being the “minimum unadjusted copayment” rather than the “national unadjusted copayment”. We are making this correction under section III. of this notice to refer to the “national unadjusted copayment”.

    On page 42737, we published Table 26, which inadvertently excluded C2636 (Brachytherapy linear source, Palladium -103, per 1 mm) which was accurately described in the text of page 42736 as a proposed separately payable brachytherapy source. In section III. of the notice we append the excluded row to correct table 26 as published.

    The other technical, typographical, formatting, and other errors that appeared on various other pages of the Federal Register are corrected as noted in section III. of this notice.

    III. Correction of Errors

    In FR Doc. 05-14448 of July 25, 2005 (70 FR 42674), make the following corrections:

    1. On page 42690, in column 3, in the last paragraph, in line 20, the figure “0.999207669” is corrected to read “1.003753831”.

    2. On page 42691, in column 1, in the second full paragraph, line 8, the year “2006” is corrected to read “2007”.

    3. On page 42694,

    a. In column 1, in the second full paragraph, in line 8, the figure “$240.51” is corrected to read “$241.57”.

    b. In column 1, in the second full paragraph, in line 8, the figure “$48.10” is corrected to read “$48.31”.

    c. In column 3, in the third full paragraph, in line 8, the figure “1.002015212” is corrected to read “1.002023412”.

    d. In column 3, in the third full paragraph, in line 18, the figure “0.99652023” is corrected to read “0.99639633”.

    e. In column 3, in the last partial paragraph, in line 5, the figure “1.002015212” is corrected to read “1.002023412”.

    4. On page 42695,

    a. In column 1, in the first partial paragraph, in line 5, the figure “0.99652023” is corrected to read “0.99639633”.

    b. In column 1, in the first partial paragraph, in line 7, the figure “$59.350” is corrected to read “$59.343”.

    5. On page 42703,

    a. In column 1, in the second full paragraph, in line 5, the figure “$9.95” is corrected to read “$7.00”.

    b. In column 1, in the second full paragraph, in line 5, the figure “40” is corrected to read “28”.

    c. In column 1, in the second full paragraph, in line 6, the figure “$24.89” is corrected to read “$25.00”.

    6. On page 42709,Start Printed Page 50681

    a. In column 1, in the first full paragraph, in line 22, the figure “$1,297” is corrected to read “$1,274”.

    b. In column 1, in the first full paragraph, in line 23, the figure “$1,366” is corrected to read “$1,244”.

    c. In column 1, in the first full paragraph, in line 25, the figure “$1,100” is corrected to read “$1,025”.

    d. Table 11 is corrected to read as follows:

    Table 11.—Proposed APC Reassignment of New Technology Procedures Into Clinical APCs for CY 2006

    HCPCSDescriptorCY 2005 APCCY 2005 status indicatorProposed CY 2006 APCProposed CY 2006 status indicatorCY 2005 payment amountProposed CY 2006 payment amount
    0027TEndoscopic epidural lysis1547T0220T$850$1,030.11
    33225L ventric pacing lead add-on1525S0418T3,7506,486.45
    61623Endovasc tempory vessel occl1555T0081T1,6502,044.21
    92974Cath place, cardio brachytx1559T0103T2,250873.18
    93580Transcath closure of asd1559T0434T2,2505,387.61
    93581Transcath closure of vsd1559T0434T2,2505,387.61
    95965Meg, spontaneous1528S0430T5,250676.75
    95966Meg, evoked, single1516S0430T1,450676.75
    95967Meg, evoked, each add'l1511S0430T950676.75
    C9713Non-contact laser vap prosta1525S0429T3,7502,511.08

    7. On page 42710, in column 2, in the first full paragraph, in line 19, the figure “$93.71” is corrected to read “$93.37”.

    8. On page 42714, Table 15, APC 0085, in columns 5 and 7, in row 7, both occurrences of the figure “$2,123.46” are corrected to read “$2,123.38”.

    9. On page 42737, Table 26, “Proposed Separately payable Brachytherapy Sources for CY 2006” is appended with the following row:

    HCPCSLong descriptorAPCAPC titleNew status indicator
    C2636Brachytherapy linear source, Palladium-103, per 1mm2636Brachytx linear source, P-103H

    10. On page 42756, in column 1, in the first partial paragraph, in line 5, the figure “1.8” is corrected to read “1.7”.

    11. On page 42758, in column 2, in the third full paragraph, in line 13, the figure “$59.35” is corrected to read “$59.34”.

    12. On page 42759,

    a. In column 1, in the first partial paragraph, in line 21, the figure “5.8” is corrected to read “5.6”.

    b. In column 1, in the first partial paragraph, in line 31, the figure “1.2” is corrected to read “1.3”.

    c. In column 1, in the first partial paragraph, in line 31, the figure “1.8” is corrected to read “1.7”.

    d. In column 1, in the first partial paragraph, in line 36, the figure “2.6” is corrected to read “2.5”.

    e. In column 1, in the second partial paragraph, in line 22, the figure “2.9” is corrected to read “2.7”.

    f. In column 1, in the second partial paragraph, in line 25, the figure “0.7” is corrected to read “0.6”.

    g. In column 1, in the second partial paragraph, in line 30, the text “West South Central” is corrected to read “New England”.

    h. In column 2, in the first partial paragraph, in line 2, the figure “1.9” is corrected to read “1.7”.

    i. In column 2, in the first partial paragraph, in line 2, the figure “1.8” is corrected to read “1.6”.

    j. In column 2, in the first full paragraph, in line 4, the figure “0.4” is corrected to read “0.3”.

    k. In column 2, in the first full paragraph, in line 5, the figure “0.5” is corrected to read “0.3”.

    l. In column 2, in the first full paragraph, in line 9, the figure “0.9” is corrected to read “1.6”.

    m. In column 2, in the first full paragraph, in line 10, the figure “1.4” is corrected to read “2.2”.

    n. In column 2, in the first full paragraph, in line 21, the sentence portion “1.3 percent and voluntary and government hospitals will gain at least 0.1 percent.” is corrected to read “1.1 percent, voluntary hospitals would gain 0.2 percent, and government hospitals will see no changes as a result of changes to APC structure.”

    o. In column 3, in the second full paragraph, in line 7, the figure “0.997” is corrected to read “0.996”.

    p. In column 3, in the second full paragraph, in line 10, the figure “0.3” is corrected to read “0.4”.

    q. In column 3, in the second full paragraph, in line 13, the figure “5.2” is corrected to read “5.4”.

    13. On page 42760,

    a. In column 1, in the first partial paragraph, in line 6, the figure “0.3” is corrected to read “0.4”.

    b. In column 1, in the first full paragraph, in line 19, the figure “5.8” is corrected to read “5.6”.

    c. In column 1, in the first full paragraph, in line 24, the figure “-2.8” is corrected to read “-2.4”.

    d. In column 1, in the first full paragraph, in line 32, the figure “1.2” is corrected to read “1.3”.

    e. In column 1, in the first full paragraph, in line 35, the figure “0.3” is corrected to read “0.4”.

    f. In column 1, in the first full paragraph, in line 37, the figure “1.5” is corrected to read “1.4”.

    g. In column 1, in the last paragraph, in line 7, the figure “8.6” is corrected to read “8.7”.

    h. In column 1, in the third partial paragraph, in line 12, the figure “5.0” is corrected to read “4.7”.

    i. In column 3, in the first partial paragraph, in line 6, the figure “2.6” is corrected to read “2.5”.

    j. In column 3, in the first partial paragraph, in line 12, the figure “2.1” is corrected to read “1.8”.

    k. In column 3, in the first partial paragraph, in line 32, the figure “3.7” is corrected to read “3.6”.Start Printed Page 50682

    l. In column 3, in the first full paragraph, in line 11, the figure “3.4” is corrected to read “3.5”.

    m. In column 3, in the first full paragraph, in line 13, the figure “6.4” is corrected to read “6.5”.

    n. In column 3, in the first full paragraph, in line 30, the text “greater than” is corrected to read “of at least”.

    o. In column 3, in the first full paragraph, in lines 33 and 34, the figure “only 1.0” is corrected to read “1.4” and the text “and 0.8 percent, respectively.” is appended to the end of the sentence.

    14. On page 42761

    a. In column 1, in the first partial paragraph, in line 3, the figure “1.9” is corrected to read “2.6”.

    b. In column 1, in the first partial paragraph, in line 6, the figure “2.6” is corrected to read “3.4”.

    c. In column 1, in the first partial paragraph, in line 11, the figure “0.8” is corrected to read “0.6”.

    d. In column 1, in line 12, the designation for the heading “Estimated Impacts of This Proposed Rule on Beneficiaries” is corrected from “G” to read “F”.

    e. In column 1, in the second partial paragraph, in line 12, the figure “$11.86” is corrected to read “$11.91”.

    f. In column 2, in the first partial paragraph, in lines 4 and 6, the term “minimum” is corrected to read “national”.

    g. In column 2, in the first partial paragraph, in line 8, the figure “$223.91” is corrected to read “$224.91”.

    h. Table 33 is corrected to read as follows:

    Table 33.—Impact of Proposed Changes for CY 2006 Hospital Outpatient Prospective Payment System

    Hospital categoryNumber of hospitalsAPC changesNew wage indexNew adj for rural sole community hospitalsCumulative (Cols 2,3,4) with market basket updateAll changes
    (1)(2)(3)(4)(5)(6)
    ALL HOSPITALS42120.00.00.03.21.9
    URBAN HOSPITALS29490.00.0−0.42.81.6
    LARGE URBAN1624−0.80.0−0.42.00.8
    OTHER URBAN13251.00.0−0.43.82.5
    RURAL HOSPITALS1263−0.10.11.85.03.5
    SOLE COMMUNITY478−0.10.05.48.76.5
    OTHER RURAL785−0.10.1−0.42.81.6
    BEDS (URBAN):
    0-99 BEDS9170.00.2−0.43.02.1
    100-199 BEDS964−0.40.0−0.42.51.5
    200-299 BEDS5030.20.1−0.43.22.4
    300-499 BEDS402−0.1−0.1−0.42.61.5
    500 + BEDS1630.30.0−0.43.11.0
    BEDS (RURAL):
    0-49 BEDS551−0.90.22.14.63.1
    50-100 BEDS419−0.80.22.34.83.0
    101-149 BEDS1801.40.01.15.84.7
    150-199 BEDS62−0.2−0.21.84.73.7
    200 + BEDS510.10.01.75.13.1
    VOLUME (URBAN):
    LT 5,000 claim lines600−5.60.5−0.4−2.4−1.8
    5,000-10,999180−2.40.2−0.40.50.6
    11,000-20,999299−0.60.2−0.42.42.5
    21,000-42,999575−0.60.1−0.42.31.9
    GT 42,99912950.20.0−0.43.01.6
    VOLUME (RURAL):
    LT 5,000 claim lines119−2.70.01.41.71.4
    5,000-10,999195−1.90.02.13.42.4
    11,000-20,999325−0.9−0.12.04.33.4
    21,000-42,999364−0.90.21.94.53.0
    GT 42,9992600.60.01.75.73.8
    REGION (URBAN):
    NEW ENGLAND166−1.3−0.1−0.41.4−0.2
    MIDDLE ATLANTIC3930.6−0.1−0.43.42.1
    SOUTH ATLANTIC453−0.4−0.4−0.42.01.0
    EAST NORTH CENT4660.4−0.1−0.43.21.7
    EAST SOUTH CENT1971.50.0−0.44.43.4
    WEST NORTH CENT1842.5−0.3−0.45.13.6
    WEST SOUTH CENT445−0.3−0.1−0.42.51.3
    MOUNTAIN163−0.1−0.2−0.42.51.3
    PACIFIC431−1.71.1−0.42.21.4
    PUERTO RICO510.4−0.3−0.42.92.2
    REGION (RURAL):
    NEW ENGLAND37−1.10.91.24.20.8
    MIDDLE ATLANTIC781.7−0.41.46.04.1
    SOUTH ATLANTIC189−0.4−0.21.74.43.3
    EAST NORTH CENT171−0.60.11.44.12.2
    EAST SOUTH CENT202−0.70.50.53.53.0
    WEST NORTH CENT1881.6−0.32.67.24.7
    Start Printed Page 50683
    WEST SOUTH CENT242−0.9−0.22.24.43.7
    MOUNTAIN95−1.00.14.67.05.2
    PACIFIC61−0.71.82.77.25.3
    TEACHING STATUS:
    NON-TEACHING3115−0.30.10.33.22.3
    MINOR7690.30.0−0.23.32.3
    MAJOR3280.3−0.2−0.33.00.6
    DSH PATIENT PERCENT:
    0160.30.0−0.43.13.1
    GT 0-0.103860.1−0.2−0.32.81.7
    0.10-0.165550.00.10.23.52.4
    0.16-0.238020.10.00.13.52.3
    0.23-0.359770.1−0.10.03.21.9
    GE 0.35792−0.30.1−0.13.01.8
    TEFRA: DSH NOT AVAIL 1684−1.60.0−0.41.2−2.6
    URBAN TEACHING/DSH:
    TEACHING & DSH9440.4−0.1−0.43.11.7
    NO TEACHING/DSH1401−0.30.1−0.42.51.8
    NO TEACHING/NO DSH160.30.0−0.43.13.1
    TEFRA: DSH NOT AVAIL 1588−2.20.1−0.40.7−3.4
    TYPE OF OWNERSHIP:
    VOLUNTARY23970.20.00.03.32.0
    PROPRIETARY1091−1.10.00.02.11.6
    GOVERNMENT7240.00.10.23.61.7
    Col (1) Total Hospitals in 2006.
    Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and from the addition of multiple procedure discounting for radiology procedures (budget neutral overall).
    Col (3) This column shows the adjustment for updating the wage index (budget neutral overall).
    Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall).
    Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket update.
    Col (6) The column shows the impact of the change in MMA dollars in 2006 (drugs and 508) and outlier changes.
    1 Complete DSH numbers are not available for hospitals that are not paid under IPPS.

    15. On pages 42764-42775, Addendum A is corrected to read as follows:

    Start Printed Page 50684

    Addendum A.—List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2006

    APCGroup titleSIRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
    0001Level I PhotochemotherapyS0.4213$25.00$7.00$5.00
    0002Level I Fine Needle Biopsy/AspirationT0.9559$56.73$11.35
    0003Bone Marrow Biopsy/AspirationT2.6530$157.44$31.49
    0004Level I Needle Biopsy/ Aspiration Except Bone MarrowT1.7646$104.72$22.36$20.94
    0005Level II Needle Biopsy/Aspiration Except Bone MarrowT3.5994$213.60$71.59$42.72
    0006Level I Incision & DrainageT1.5500$91.98$22.28$18.40
    0007Level II Incision & DrainageT11.4501$679.48$135.90
    0008Level III Incision and DrainageT16.4989$979.09$195.82
    0009Nail ProceduresT0.6680$39.64$8.34$7.93
    0010Level I Destruction of LesionT0.5719$33.94$9.65$6.79
    0011Level II Destruction of LesionT2.0839$123.66$25.17$24.73
    0012Level I Debridement & DestructionT0.8497$50.42$11.18$10.08
    0013Level II Debridement & DestructionT1.1078$65.74$14.20$13.15
    0015Level III Debridement & DestructionT1.6514$98.00$20.29$19.60
    0016Level IV Debridement & DestructionT2.5834$153.31$33.57$30.66
    0017Level VI Debridement & DestructionT18.4211$1,093.16$227.84$218.63
    0018Biopsy of Skin/Puncture of LesionT1.1726$69.59$16.04$13.92
    0019Level I Excision/ BiopsyT4.0547$240.62$71.87$48.12
    0020Level II Excision/ BiopsyT6.9433$412.04$107.40$82.41
    0021Level III Excision/ BiopsyT14.9776$888.82$219.48$177.76
    0022Level IV Excision/ BiopsyT19.6472$1,165.92$354.45$233.18
    0023Exploration Penetrating WoundT4.7775$283.51$56.70
    0024Level I Skin RepairT1.6084$95.45$31.25$19.09
    0025Level II Skin RepairT5.4938$326.02$101.85$65.20
    0027Level IV Skin RepairT18.4182$1,092.99$329.72$218.60
    0028Level I Breast SurgeryT19.5801$1,161.94$303.74$232.39
    0029Level II Breast SurgeryT32.0476$1,901.80$632.64$380.36
    0030Level III Breast SurgeryT40.0825$2,378.62$763.55$475.72
    0033Partial HospitalizationP4.0708$241.57$48.31
    0035Venous CutdownT0.7158$42.48$8.50
    0036Level II Fine Needle Biopsy/AspirationT2.1773$129.21$25.84
    0037Level IV Needle Biopsy/Aspiration Except Bone MarrowT9.4751$562.28$224.91$112.46
    0039Level I Implantation of NeurostimulatorS181.4000$10,764.82$2,152.96
    0040Level I Implantation of Neurostimulator ElectrodesS55.3297$3,283.43$656.69
    0041Level I ArthroscopyT28.1318$1,669.43$333.89
    0042Level II ArthroscopyT43.9753$2,609.63$804.74$521.93
    0043Closed Treatment Fracture Finger/Toe/TrunkT1.7694$105.00$21.00
    0045Bone/Joint Manipulation Under AnesthesiaT14.4945$860.15$268.47$172.03
    0046Open/Percutaneous Treatment Fracture or DislocationT37.7023$2,237.37$535.76$447.47
    0047Arthroplasty without ProsthesisT31.6107$1,875.87$537.03$375.17
    0048Level I Arthroplasty with ProsthesisT43.1288$2,559.39$570.30$511.88
    0049Level I Musculoskeletal Procedures Except Hand and FootT20.3707$1,208.86$241.77
    0050Level II Musculoskeletal Procedures Except Hand and FootT23.9081$1,418.78$283.76
    0051Level III Musculoskeletal Procedures Except Hand and FootT36.5271$2,167.63$433.53
    0052Level IV Musculoskeletal Procedures Except Hand and FootT43.9378$2,607.40$521.48
    0053Level I Hand Musculoskeletal ProceduresT15.6795$930.47$253.49$186.09
    0054Level II Hand Musculoskeletal ProceduresT25.3711$1,505.60$301.12
    0055Level I Foot Musculoskeletal ProceduresT20.0692$1,190.97$355.34$238.19
    0056Level II Foot Musculoskeletal ProceduresT40.2957$2,391.27$478.25
    0057Bunion ProceduresT27.5493$1,634.86$475.91$326.97
    0058Level I Strapping and Cast ApplicationS1.0934$64.89$12.98
    0060Manipulation TherapyS0.4935$29.29$5.86
    0068CPAP InitiationS1.2293$72.95$29.18$14.59
    0069ThoracoscopyT30.6775$1,820.49$591.64$364.10
    0070Thoracentesis/Lavage ProceduresT3.2101$190.50$38.10
    0071Level I Endoscopy Upper AirwayT0.7915$46.97$11.31$9.39
    0072Level II Endoscopy Upper AirwayT1.4361$85.22$21.27$17.04
    0074Level IV Endoscopy Upper AirwayT15.7757$936.18$295.70$187.24
    0075Level V Endoscopy Upper AirwayT21.3426$1,266.53$445.92$253.31
    0076Level I Endoscopy Lower AirwayT9.4592$561.34$189.82$112.27
    0077Level I Pulmonary TreatmentS0.3444$20.44$7.74$4.09
    0078Level II Pulmonary TreatmentS1.0236$60.74$14.55$12.15
    0079Ventilation Initiation and ManagementS2.3482$139.35$27.87
    0080Diagnostic Cardiac CatheterizationT37.1361$2,203.77$838.92$440.75
    0081Non-Coronary Angioplasty or AtherectomyT34.4473$2,044.21$408.84
    0082Coronary AtherectomyT85.0126$5,044.90$1,085.20$1,008.98
    0083Coronary Angioplasty and Percutaneous ValvuloplastyT50.8925$3,020.11$604.02
    0084Level I Electrophysiologic EvaluationS10.0205$594.65$118.93
    0085Level II Electrophysiologic EvaluationT35.1882$2,088.17$426.25$417.63
    Start Printed Page 50685
    0086Ablate Heart Dysrhythm FocusT44.2596$2,626.50$833.33$525.30
    0087Cardiac Electrophysiologic Recording/MappingT30.7101$1,822.43$364.49
    0088ThrombectomyT36.5617$2,169.68$655.22$433.94
    0089Insertion/Replacement of Permanent Pacemaker and ElectrodesT105.6143$6,267.47$1,682.28$1,253.49
    0090Insertion/Replacement of Pacemaker Pulse GeneratorT89.1574$5,290.87$1,612.80$1,058.17
    0091Level II Vascular LigationT28.9999$1,720.94$348.23$344.19
    0092Level I Vascular LigationT23.4516$1,391.69$278.34
    0093Vascular Reconstruction/Fistula Repair without Device
    0094Level I Resuscitation and CardioversionS2.5363$150.51$47.62$30.10
    0095Cardiac RehabilitationS0.5885$34.92$13.96$6.98
    0096Non-Invasive Vascular StudiesS1.6307$96.77$38.70$19.35
    0097Cardiac and Ambulatory Blood Pressure MonitoringX1.0223$60.67$23.79$12.13
    0098Injection of Sclerosing SolutionT1.1346$67.33$13.47
    0099ElectrocardiogramsS0.3821$22.67$4.53
    0100Cardiac Stress TestsX2.4968$148.17$41.44$29.63
    0101Tilt Table EvaluationS4.2787$253.91$101.56$50.78
    0103Miscellaneous Vascular ProceduresT14.7142$873.18$223.63$174.64
    0104Transcatheter Placement of Intracoronary StentsT79.0094$4,688.65$937.73
    0105Revision/Removal of Pacemakers, AICD, or VascularT22.3685$1,327.41$370.40$265.48
    0106Insertion/Replacement/Repair of Pacemaker and/or ElectrodesT45.4851$2,699.22$539.84
    0107Insertion of Cardioverter-DefibrillatorT260.0295$15,430.93$3,103.22$3,086.19
    0108Insertion/Replacement/Repair of Cardioverter-Defibrillator LeadsT349.1681$20,720.68$4,144.14
    0109Removal of Implanted DevicesT11.0433$655.34$131.49$131.07
    0110TransfusionS3.6594$217.16$43.43
    0111Blood Product ExchangeS12.3956$735.59$200.18$147.12
    0112Apheresis, Photopheresis, and PlasmapheresisS26.7948$1,590.08$438.94$318.02
    0113Excision Lymphatic SystemT21.4653$1,273.82$254.76
    0114Thyroid/Lymphadenectomy ProceduresT40.7652$2,419.13$485.91$483.83
    0115Cannula/Access Device ProceduresT31.4727$1,867.68$459.35$373.54
    0116Chemotherapy Administration by Other Technique Except InfusionS1.1453$67.97$13.59
    0117Chemotherapy Administration by Infusion OnlyS3.2378$192.14$42.54$38.43
    0120Infusion Therapy Except ChemotherapyS2.0193$119.83$28.21$23.97
    0121Level I Tube changes and RepositioningT2.2766$135.10$43.80$27.02
    0122Level II Tube changes and RepositioningT6.9721$413.75$84.85$82.75
    0123Bone Marrow Harvesting and Bone Marrow/Stem Cell TransplantS22.9902$1,364.31$272.86
    0125Refilling of Infusion PumpT1.9331$114.72$22.94
    0130Level I LaparoscopyT31.9271$1,894.65$659.53$378.93
    0131Level II LaparoscopyT43.3389$2,571.86$1,001.89$514.37
    0132Level III LaparoscopyT62.9914$3,738.10$1,239.22$747.62
    0140Esophageal Dilation without EndoscopyT5.4737$324.83$94.18$64.97
    0141Level I Upper GI ProceduresT8.1835$485.63$143.38$97.13
    0142Small Intestine EndoscopyT9.3487$554.78$152.78$110.96
    0143Lower GI EndoscopyT8.6869$515.51$186.06$103.10
    0146Level I Sigmoidoscopy and AnoscopyT4.6374$275.20$64.40$55.04
    0147Level II Sigmoidoscopy and AnoscopyT7.9679$472.84$94.57
    0148Level I Anal/Rectal ProceduresT3.7383$221.84$57.21$44.37
    0149Level III Anal/Rectal ProceduresT18.0726$1,072.48$293.06$214.50
    0150Level IV Anal/Rectal ProceduresT23.8654$1,416.24$437.12$283.25
    0151Endoscopic Retrograde Cholangio-Pancreatography (ERCP)T18.7338$1,111.72$245.46$222.34
    0152Level I Percutaneous Abdominal and Biliary ProceduresT12.2833$728.93$145.79
    0153Peritoneal and Abdominal ProceduresT21.6961$1,287.51$382.75$257.50
    0154Hernia/Hydrocele ProceduresT28.7847$1,708.17$464.85$341.63
    0155Level II Anal/Rectal ProceduresT16.2546$964.60$192.92
    0156Level II Urinary and Anal ProceduresT2.5751$152.81$40.52$30.56
    0157Colorectal Cancer Screening: Barium EnemaS2.2904$135.92$27.18
    0158Colorectal Cancer Screening: ColonoscopyT7.6588$454.50$113.63
    0159Colorectal Cancer Screening: Flexible SigmoidoscopyS3.1455$186.66$46.67
    0160Level I Cystourethroscopy and other Genitourinary ProceduresT6.6753$396.13$105.06$79.23
    0161Level II Cystourethroscopy and other Genitourinary ProceduresT18.5576$1,101.26$249.36$220.25
    0162Level III Cystourethroscopy and other Genitourinary ProceduresT23.3918$1,388.14$277.63
    0163Level IV Cystourethroscopy and other Genitourinary ProceduresT33.7354$2,001.96$400.39
    0164Level I Urinary and Anal ProceduresT1.1855$70.35$17.29$14.07
    Start Printed Page 50686
    0165Level III Urinary and Anal ProceduresT16.6689$989.18$197.84
    0166Level I Urethral ProceduresT17.6743$1,048.85$218.73$209.77
    0168Level II Urethral ProceduresT28.2685$1,677.54$388.03$335.51
    0169LithotripsyT43.0133$2,552.54$1,021.01$510.51
    0170DialysisS5.8994$350.09$70.02
    0180CircumcisionT19.8827$1,179.90$304.87$235.98
    0181Penile ProceduresT30.8663$1,831.70$621.82$366.34
    0183Testes/Epididymis ProceduresT23.6415$1,402.96$280.59
    0184Prostate BiopsyT4.3566$258.53$96.27$51.71
    0188Level II Female Reproductive ProcT1.1400$67.65$13.53
    0189Level III Female Reproductive ProcT2.3710$140.70$28.14
    0190Level I HysteroscopyT21.0653$1,250.08$424.28$250.02
    0191Level I Female Reproductive ProcT0.1670$9.91$2.78$1.98
    0192Level IV Female Reproductive ProcT4.3082$255.66$51.13
    0193Level V Female Reproductive ProcT14.5843$865.48$173.10
    0194Level VIII Female Reproductive ProcT20.7525$1,231.52$397.84$246.30
    0195Level IX Female Reproductive ProcT26.6791$1,583.22$483.80$316.64
    0196Dilation and CurettageT17.0974$1,014.61$338.23$202.92
    0197Infertility ProceduresT2.3572$139.88$27.98
    0198Pregnancy and Neonatal Care ProceduresT1.3683$81.20$32.19$16.24
    0200Level VII Female Reproductive ProcT17.8728$1,060.63$263.69$212.13
    0201Level VI Female Reproductive ProcT17.6047$1,044.72$329.65$208.94
    0202Level X Female Reproductive ProcT40.3866$2,396.66$958.66$479.33
    0203Level IV Nerve InjectionsT10.4015$617.26$246.90$123.45
    0204Level I Nerve InjectionsT2.1910$130.02$40.13$26.00
    0206Level II Nerve InjectionsT5.4920$325.91$75.55$65.18
    0207Level III Nerve InjectionsT6.0109$356.70$86.92$71.34
    0208Laminotomies and LaminectomiesT42.3409$2,512.64$502.53
    0209Extended EEG Studies and Sleep Studies, Level IIS11.5713$686.68$274.67$137.34
    0212Nervous System InjectionsT2.9740$176.49$70.59$35.30
    0213Extended EEG Studies and Sleep Studies, Level IS2.2932$136.09$54.43$27.22
    0214ElectroencephalogramS1.1353$67.37$26.94$13.47
    0215Level I Nerve and Muscle TestsS0.6115$36.29$14.51$7.26
    0216Level III Nerve and Muscle TestsS2.6720$158.56$31.71
    0218Level II Nerve and Muscle TestsS1.1408$67.70$13.54
    0220Level I Nerve ProceduresT17.3586$1,030.11$206.02
    0221Level II Nerve ProceduresT29.9209$1,775.60$463.62$355.12
    0222Implantation of Neurological DeviceT179.0982$10,628.22$2,125.64
    0223Implantation or Revision of Pain Management CatheterT28.1230$1,668.90$333.78
    0224Implantation of Reservoir/Pump/ShuntT40.6455$2,412.03$482.41
    0225Level II Implantation of Neurostimulator ElectrodesS234.6925$13,927.36$2,785.47
    0226Implantation of Drug Infusion ReservoirT138.8695$8,240.93$1,648.19
    0227Implantation of Drug Infusion DeviceT136.4922$8,099.86$1,619.97
    0228Creation of Lumbar Subarachnoid ShuntT51.7258$3,069.56$613.91
    0229Transcatherter Placement of Intravascular ShuntsT64.4545$3,824.92$771.23$764.98
    0230Level I Eye Tests & TreatmentsS0.7858$46.63$14.97$9.33
    0231Level III Eye Tests & TreatmentsS1.9278$114.40$44.61$22.88
    0232Level I Anterior Segment Eye ProceduresT6.6732$396.01$103.17$79.20
    0233Level II Anterior Segment Eye ProceduresT14.9673$888.20$266.33$177.64
    0234Level III Anterior Segment Eye ProceduresT21.9741$1,304.01$511.31$260.80
    0235Level I Posterior Segment Eye ProceduresT4.6593$276.50$67.40$55.30
    0236Level II Posterior Segment Eye ProceduresT17.0229$1,010.19$202.04
    0237Level III Posterior Segment Eye ProceduresT28.9401$1,717.39$343.48
    0238Level I Repair and Plastic Eye ProceduresT2.5933$153.89$30.78
    0239Level II Repair and Plastic Eye ProceduresT6.9097$410.04$82.01
    0240Level III Repair and Plastic Eye ProceduresT18.1508$1,077.12$315.31$215.42
    0241Level IV Repair and Plastic Eye ProceduresT23.3036$1,382.91$384.47$276.58
    0242Level V Repair and Plastic Eye ProceduresT30.5464$1,812.72$597.36$362.54
    0243Strabismus/Muscle ProceduresT22.1671$1,315.46$431.39$263.09
    0244Corneal TransplantT38.3723$2,277.13$803.26$455.43
    0245Level I Cataract Procedures without IOL InsertT13.3625$792.97$221.89$158.59
    0246Cataract Procedures with IOL InsertT23.4597$1,392.17$495.96$278.43
    0247Laser Eye Procedures Except RetinalT5.0330$298.67$104.31$59.73
    0248Laser Retinal ProceduresT4.6769$277.54$93.98$55.51
    0249Level II Cataract Procedures without IOL InsertT27.9369$1,657.86$524.67$331.57
    0250Nasal Cauterization/PackingT1.2896$76.53$26.79$15.31
    0251Level I ENT ProceduresT2.0101$119.29$23.86
    0252Level II ENT ProceduresT7.8673$466.87$113.41$93.37
    0253Level III ENT ProceduresT16.1357$957.54$282.29$191.51
    Start Printed Page 50687
    0254Level IV ENT ProceduresT23.4040$1,388.86$321.35$277.77
    0256Level V ENT ProceduresT37.3204$2,214.70$442.94
    0258Tonsil and Adenoid ProceduresT22.2466$1,320.18$437.25$264.04
    0259Level VI ENT ProceduresT366.3317$21,739.22$8,070.21$4,347.84
    0260Level I Plain Film Except TeethX0.7555$44.83$17.93$8.97
    0261Level II Plain Film Except Teeth Including Bone Density MeasurementX1.2901$76.56$15.31
    0262Plain Film of TeethX0.9228$54.76$10.95
    0263Level I Miscellaneous Radiology ProceduresX1.7476$103.71$24.40$20.74
    0264Level II Miscellaneous Radiology ProceduresX3.5240$209.12$79.41$41.82
    0265Level I Diagnostic UltrasoundS1.0213$60.61$24.24$12.12
    0266Level II Diagnostic UltrasoundS1.6393$97.28$38.91$19.46
    0267Level III Diagnostic UltrasoundS2.6327$156.23$62.18$31.25
    0268Ultrasound Guidance ProceduresS1.0610$62.96$12.59
    0269Level III Echocardiogram Except TransesophagealS3.2437$192.49$76.99$38.50
    0270Transesophageal EchocardiogramS6.0192$357.20$142.88$71.44
    0272Level I FluoroscopyX1.3801$81.90$32.76$16.38
    0274MyelographyS3.0413$180.48$72.19$36.10
    0275ArthrographyS3.5779$212.32$69.09$42.46
    0276Level I Digestive RadiologyS1.5319$90.91$36.36$18.18
    0277Level II Digestive RadiologyS2.3852$141.54$56.61$28.31
    0278Diagnostic UrographyS2.6434$156.87$62.74$31.37
    0279Level II Angiography and Venography except ExtremityS8.9319$530.05$150.03$106.01
    0280Level III Angiography and Venography except ExtremityS20.7902$1,233.75$353.85$246.75
    0282Miscellaneous Computerized Axial TomographyS1.6542$98.17$39.26$19.63
    0283Computerized Axial Tomography with Contrast MaterialS4.4253$262.61$105.04$52.52
    0284Magnetic Resonance Imaging and Magnetic Resonance Angiography with ContrasS6.4201$380.99$152.39$76.20
    0285Myocardial Positron Emission Tomography (PET)S17.1798$1,019.50$318.72$203.90
    0288Bone Density: Axial SkeletonS1.2568$74.58$14.92
    0296Level I Therapeutic Radiologic ProceduresS2.2452$133.24$53.29$26.65
    0297Level II Therapeutic Radiologic ProceduresS5.2530$311.73$122.13$62.35
    0299Miscellaneous Radiation TreatmentS5.8482$347.05$69.41
    0300Level I Radiation TherapyS1.5198$90.19$18.04
    0301Level II Radiation TherapyS2.2195$131.71$26.34
    0302Level III Radiation TherapyS4.6145$273.84$103.74$54.77
    0303Treatment Device ConstructionX2.8356$168.27$66.95$33.65
    0304Level I Therapeutic Radiation Treatment PreparationX1.7738$105.26$41.52$21.05
    0305Level II Therapeutic Radiation Treatment PreparationX4.0036$237.59$91.38$47.52
    0310Level III Therapeutic Radiation Treatment PreparationX13.9490$827.78$325.27$165.56
    0312Radioelement ApplicationsS5.0032$296.90$59.38
    0313BrachytherapyS12.8655$763.48$152.70
    0314Hyperthermic TherapiesS5.9945$355.73$98.36$71.15
    0315Level II Implantation of NeurostimulatorT290.6470$17,247.86$3,449.57
    0320Electroconvulsive TherapyS5.3765$319.06$80.06$63.81
    0321Biofeedback and Other TrainingS1.3579$80.58$21.71$16.12
    0322Brief Individual PsychotherapyS1.2319$73.10$14.62
    0323Extended Individual PsychotherapyS1.6227$96.30$20.08$19.26
    0324Family PsychotherapyS2.0997$124.60$24.92
    0325Group PsychotherapyS1.3189$78.27$17.10$15.65
    0330Dental ProceduresS7.1756$425.82$85.16
    0332Computerized Axial Tomography and Computerized Angiography without ContrasS3.2694$194.02$77.60$38.80
    0333Computerized Axial Tomography and Computerized Angio w/o Contrast MaterialS5.2836$313.54$125.41$62.71
    0335Magnetic Resonance Imaging, MiscellaneousS5.1581$306.10$122.43$61.22
    0336Magnetic Resonance Imaging and Magnetic Resonance Angiography without ContS6.0742$360.46$144.18$72.09
    0337MRI and Magnetic Resonance Angiography without Contrast Material followedS8.7945$521.89$208.75$104.38
    0339ObservationS7.1403$423.73$84.75
    0340Minor Ancillary ProceduresX0.6384$37.88$7.58
    0341Skin TestsX0.1112$6.60$2.62$1.32
    0342Level I PathologyX0.1560$9.26$3.70$1.85
    0343Level III PathologyX0.4786$28.40$11.10$5.68
    0344Level IV PathologyX0.7996$47.45$15.66$9.49
    0345Level I Transfusion Laboratory ProceduresX0.2277$13.51$3.01$2.70
    0346Level II Transfusion Laboratory ProceduresX0.3434$20.38$4.54$4.08
    0347Level III Transfusion Laboratory ProceduresX0.8434$50.05$12.35$10.01
    Start Printed Page 50688
    0348Fertility Laboratory ProceduresX0.7927$47.04$9.41
    0350Administration of flu and PPV vaccinesX0.3954$23.46$0.00$0.00
    0352Level I InjectionsX0.1413$8.39$1.68
    0353Level II InjectionsX0.3954$23.46$4.69
    0359Level III InjectionsX0.8312$49.33$9.87
    0360Level I Alimentary TestsX1.4739$87.47$34.98$17.49
    0361Level II Alimentary TestsX3.6216$214.92$83.23$42.98
    0362Contact Lens and Spectacle ServicesX2.6607$157.89$31.58
    0363Level I Otorhinolaryngologic Function TestsX0.9128$54.17$17.44$10.83
    0364Level I AudiometryX0.4708$27.94$9.06$5.59
    0365Level II AudiometryX1.2356$73.32$18.95$14.66
    0366Level III AudiometryX1.7743$105.29$30.04$21.06
    0367Level I Pulmonary TestX0.6659$39.52$14.80$7.90
    0368Level II Pulmonary TestsX0.9761$57.92$23.16$11.58
    0369Level III Pulmonary TestsX2.7519$163.31$44.18$32.66
    0370Allergy TestsX1.1232$66.65$13.33
    0372Therapeutic PhlebotomyX0.5700$33.83$10.09$6.77
    0373Neuropsychological TestingX2.1926$130.12$26.02
    0374Monitoring Psychiatric DrugsX1.0414$61.80$12.36
    0375Ancillary Outpatient Services When Patient ExpiresT42.5900$2,527.42$505.48
    0376Level II Cardiac ImagingS5.1975$308.44$121.42$61.69
    0377Level III Cardiac ImagingS6.8344$405.57$162.22$81.11
    0378Level II Pulmonary ImagingS5.4997$326.37$130.54$65.27
    0379Injection adenosineK$33.45$6.69
    0381Single Allergy TestsX0.1884$11.18$2.35$2.24
    0384GI Procedures with StentsT22.3392$1,325.68$287.93$265.14
    0385Level I Prosthetic Urological ProceduresS75.6446$4,488.98$897.80
    0386Level II Prosthetic Urological ProceduresS120.1694$7,131.21$1,426.24
    0387Level II HysteroscopyT32.5445$1,931.29$655.55$386.26
    0388DiscographyS12.3294$731.66$292.66$146.33
    0389Non-imaging Nuclear MedicineS1.4976$88.87$35.54$17.77
    0390Level I Endocrine ImagingS2.5562$151.69$60.67$30.34
    0391Level II Endocrine ImagingS2.8774$170.75$68.30$34.15
    0393Red Cell/Plasma StudiesS3.4438$204.37$81.74$40.87
    0394Hepatobiliary ImagingS4.4630$264.85$105.93$52.97
    0395GI Tract ImagingS3.8699$229.65$91.86$45.93
    0396Bone ImagingS4.1426$245.83$98.33$49.17
    0397Vascular ImagingS2.2646$134.39$53.75$26.88
    0398Level I Cardiac ImagingS4.3093$255.73$102.29$51.15
    0399Nuclear Medicine Add-on ImagingS1.5192$90.15$36.06$18.03
    0400Hematopoietic ImagingS4.1335$245.29$98.11$49.06
    0401Level I Pulmonary ImagingS3.4150$202.66$81.06$40.53
    0402Brain ImagingS5.1847$307.68$123.07$61.54
    0403CSF ImagingS3.6138$214.45$85.78$42.89
    0404Renal and Genitourinary Studies Level IS3.8559$228.82$91.52$45.76
    0405Renal and Genitourinary Studies Level IIS4.2674$253.24$101.29$50.65
    0406Tumor/Infection ImagingS4.3035$255.38$102.15$51.08
    0407Radionuclide TherapyS3.9839$236.42$94.56$47.28
    0409Red Blood Cell TestsX0.1258$7.47$2.22$1.49
    0411Respiratory ProceduresS0.3869$22.96$4.59
    0412IMRT Treatment DeliveryS5.3643$318.33$63.67
    0415Level II Endoscopy Lower AirwayT22.0955$1,311.21$459.92$262.24
    0416Level I Intravascular and Intracardiac Ultrasound and Flow ReserveS19.5542$1,160.40$232.08
    0417Computerized ReconstructionS4.0750$241.82$48.36
    0418Insertion of Left Ventricular Pacing ElectT109.3043$6,486.45$1,297.29
    0421Prolonged Physiologic MonitoringX1.6600$98.51$19.70
    0422Level II Upper GI ProceduresT22.9647$1,362.79$448.81$272.56
    0423Level II Percutaneous Abdominal and Biliary ProceduresT40.2866$2,390.73$478.15
    0425Level II Arthroplasty with ProsthesisT100.2058$5,946.51$1,378.01$1,189.30
    0426Level II Strapping and Cast ApplicationS2.1243$126.06$25.21
    0427Level III Tube Changes and RepositioningT10.1977$605.16$124.11$121.03
    0428Level III Sigmoidoscopy and AnoscopyT19.9022$1,181.06$236.21
    0429Level V Cystourethroscopy and other Genitourinary ProceduresT42.3147$2,511.08$502.22
    0430Level IV Nerve and Muscle TestsT11.4040$676.75$135.35
    0432Health and Behavior ServicesS0.6949$41.24$8.25
    0433Level II PathologyX0.2581$15.32$6.12$3.06
    0434Cardiac Defect RepairT90.7877$5,387.61$1,077.52
    Start Printed Page 50689
    0600Low Level Clinic VisitsV0.8688$51.56$10.31
    0601Mid Level Clinic VisitsV1.0038$59.57$11.91
    0602High Level Clinic VisitsV1.4284$84.77$16.95
    0610Low Level Emergency VisitsV1.2947$76.83$19.48$15.37
    0611Mid Level Emergency VisitsV2.2718$134.82$35.76$26.96
    0612High Level Emergency VisitsV3.9853$236.50$54.12$47.30
    0620Critical CareS8.2996$492.52$135.68$98.50
    0621Level I Vascular Access ProceduresT8.2986$492.46$98.49
    0622Level II Vascular Access ProceduresT21.2671$1,262.05$252.41
    0623Level III Vascular Access ProceduresT27.1105$1,608.82$321.76
    0648Breast Reconstruction with ProsthesisT50.4459$2,993.61$598.72
    0651Complex Interstitial Radiation Source ApplicationS12.1448$720.71$144.14
    0652Insertion of Intraperitoneal CathetersT28.8948$1,714.70$342.94
    0653Vascular Reconstruction/Fistula Repair with DeviceT30.5339$1,811.97$362.39
    0654Insertion/Replacement of a permanent dual chamber pacemakerT100.9294$5,989.45$1,197.89
    0655Insertion/Replacement/Conversion of a permanent dual chamber pacemakerT133.7768$7,938.72$1,587.74
    0656Transcatheter Placement of Intracoronary Drug-Eluting StentsT109.9237$6,523.20$1,304.64
    0657Placement of Tissue ClipsS1.7092$101.43$20.29
    0658Percutaneous Breast BiopsiesT6.1049$362.28$72.46
    0659Hyperbaric OxygenS1.5473$91.82$18.36
    0660Level II Otorhinolaryngologic Function TestsX1.6419$97.44$30.66$19.49
    0661Level V PathologyX3.3775$200.43$80.17$40.09
    0662CT AngiographyS5.1621$306.33$122.53$61.27
    0664Level I Proton Beam Radiation TherapyS12.9439$768.13$153.63
    0665Bone Density: AppendicularSkeletonS0.6464$38.36$7.67
    0667Level II Proton Beam Radiation TherapyS15.4857$918.97$183.79
    0668Level I Angiography and Venography except ExtremityS6.5024$385.87$114.67$77.17
    0670Level II Intravascular and Intracardiac Ultrasound and Flow ReserveS25.4131$1,508.09$472.46$301.62
    0671Level II Echocardiogram Except TransesophagealS1.7028$101.05$40.42$20.21
    0672Level IV Posterior Segment Eye ProceduresT36.9284$2,191.44$438.29
    0673Level IV Anterior Segment Eye ProceduresT29.2582$1,736.27$649.56$347.25
    0674Prostate CryoablationT95.7856$5,684.20$1,136.84
    0675Prostatic ThermotherapyT43.7329$2,595.24$519.05
    0676Thrombolysis and ThrombectomyT2.4105$143.05$28.61
    0678External CounterpulsationT1.7276$102.52$20.50
    0679Level II Resuscitation and CardioversionS5.5774$330.98$95.30$66.20
    0680Insertion of Patient Activated Event RecordersS62.9082$3,733.16$746.63
    0681Knee ArthroplastyT137.1630$8,139.66$2,081.48$1,627.93
    0682Level V Debridement & DestructionT6.9107$410.10$162.42$82.02
    0683Level II PhotochemotherapyS1.9006$112.79$25.34$22.56
    0685Level III Needle Biopsy/Aspiration Except Bone MarrowT6.0174$357.09$115.47$71.42
    0686Level III Skin RepairT13.8287$820.64$164.13
    0687Revision/Removal of Neurostimulator ElectrodesT19.2347$1,141.44$456.57$228.29
    0688Revision/Removal of Neurostimulator Pulse Generator ReceiverT43.0444$2,554.38$1,021.75$510.88
    0689Electronic Analysis of Cardioverter-defibrillatorsS0.5735$34.03$6.81
    0690Electronic Analysis of Pacemakers and other Cardiac DevicesS0.3755$22.28$8.91$4.46
    0691Electronic Analysis of Programmable Shunts/PumpsS2.5252$149.85$59.94$29.97
    0692Electronic Analysis of Neurostimulator Pulse GeneratorsS2.0111$119.34$30.16$23.87
    0693Level II Breast ReconstructionT42.2254$2,505.78$798.17$501.16
    0694Mohs SurgeryT3.8452$228.19$61.86$45.64
    0695Level VII Debridement & DestructionT20.3164$1,205.64$266.59$241.13
    0697Level I Echocardiogram Except TransesophagealS1.5357$91.13$36.45$18.23
    0698Level II Eye Tests & TreatmentsS1.2438$73.81$16.55$14.76
    0699Level IV Eye Tests & TreatmentsT10.0177$594.48$118.90
    0700Antepartum ManipulationT5.3614$318.16$63.63
    0701SR 89 chloride, per mCiH
    0702SM 153 lexidronamH
    0704IN 111 Satumomab pendetide per doseH
    0705Technetium TC99M tetrofosminH
    0726Dexrazoxane hcl injectionK$216.39$43.28
    0728Filgrastim injectionK$178.39$35.68
    0730Pamidronate disodiumK$58.42$11.68
    0731Sargramostim injectionK$21.11$4.22
    0732Mesna injectionK$13.68$2.74
    0733Non esrd epoetin alpha injK$9.99$2.00
    Start Printed Page 50690
    0734Injection, darbepoetin alfa (for non-ESRD)K$3.28$0.66
    0735Ampho b cholesteryl sulfateK$12.24$2.45
    0736Amphotericin b liposome injK$21.91$4.38
    0737Ammonia N-13, per doseH
    0738RasburicaseG$109.18$21.84
    0750Dolasetron mesylateK$6.55$1.31
    0763Dolasetron mesylate oralK$48.54$9.71
    0764Granisetron HCl injectionK$7.24$1.45
    0765Granisetron HCl oralK$33.51$6.70
    0768Ondansetron hcl injectionK$3.80$0.76
    0769Ondansetron hcl oralK$32.02$6.40
    0800Leuprolide acetateK$441.78$88.36
    0802Etoposide oralK$41.12$8.22
    0807Aldesleukin/single use vialK$701.76$140.35
    0809Bcg live intravesical vacK$121.74$24.35
    0810Goserelin acetate implantK$196.25$39.25
    0811Carboplatin injectionK$77.16$15.43
    0812Carmus bischl nitro injK$141.29$28.26
    0814Asparaginase injectionK$55.42$11.08
    0819Dacarbazine injK$6.20$1.24
    0820DaunorubicinK$35.28$7.06
    0821Daunorubicin citrate liposomK$57.56$11.51
    0823DocetaxelK$301.17$60.23
    0827Floxuridine injectionK$60.17$12.03
    0828Gemcitabine HCLK$117.45$23.49
    0830Irinotecan injectionK$129.08$25.82
    0831Ifosfomide injectionK$53.54$10.71
    0832Idarubicin hcl injectionK$314.00$62.80
    0834Interferon alfa-2a injK$31.75$6.35
    0835Inj cosyntropinK$69.27$13.85
    0836Interferon alfa-2b inj recombinant, 1 millionK$13.22$2.64
    0838Interferon gamma 1-b injK$277.79$55.56
    0840Melphalan hydrochlK$523.22$104.64
    0842Fludarabine phosphate injK$262.41$52.48
    0843PegaspargaseK$1,528.80$305.76
    0844Pentostatin injectionK$1,868.91$373.78
    0849RituximabK$447.97$89.59
    0850Streptozocin injectionK$153.33$30.67
    0851Thiotepa injectionK$44.55$8.91
    0852TopotecanK$755.51$151.10
    0855Vinorelbine tartrateK$62.85$12.57
    0856Porfimer sodiumK$2,457.97$491.59
    0857Bleomycin sulfate injectionK$54.18$10.84
    0858CladribineK$39.37$7.87
    0860Plicamycin (mithramycin) injK$80.54$16.11
    0861Leuprolide acetate injectionK$10.96$2.19
    0862MitomycinK$26.36$5.27
    0863Paclitaxel injectionK$19.11$3.82
    0864Mitoxantrone hclK$329.69$65.94
    0865Interferon alfa-n3 inj, human leukocyte derived, 2K$8.77$1.75
    0868Oral aprepitantG$4.75$0.95
    0869IVIG lyophil 1gK$39.46$7.89
    0870IVIG lyophil 10 mgK$0.40$0.08
    0871IVIG non-lyophil 1gK$57.26$11.45
    0872IVIG non-lyophil 10 mgK$0.57$0.11
    0876Caffeine citrate injectionK$3.34$0.67
    0880Penicillin g benzathine injK$72.26$14.45
    0884Rho d immune globulin injK$113.91$22.78
    0887Azathioprine parenteralK$47.40$9.48
    0888Cyclosporine oralK$3.94$0.79
    0890Lymphocyte immune globulinK$290.30$58.06
    0891Tacrolimus oralK$3.37$0.67
    0892Edetate calcium disodium injK$40.34$8.07
    0893Calcitonin salmon injectionK$35.68$7.14
    0895Deferoxamine mesylate injK$14.91$2.98
    0900Alglucerase injectionK$39.94$7.99
    0901Alpha 1 proteinase inhibitorK$3.30$0.66
    0902Botulinum toxin a, per unitK$4.80$0.96
    0903Cytomegalovirus imm IV/vialK$683.07$136.61
    Start Printed Page 50691
    0906RSV-ivigK$15.56$3.11
    0910Interferon beta-1bK$81.95$16.39
    0911StreptokinaseK$83.36$16.67
    0912Interferon alfacon-1K$3.91$0.78
    0913Ganciclovir long act implantK$4,318.68$863.74
    0916Injection imiglucerase /unitK$3.98$0.80
    0917Adenosine injectionK$71.53$14.31
    0925Factor viiiK$0.51$0.10
    0926Factor VIII (porcine)K$1.75$0.35
    0927Factor viii recombinantK$0.94$0.19
    0928Factor ix complexK$0.52$0.10
    0929Anti-inhibitor per iuK$1.12$0.22
    0931Factor IX non-recombinantK$0.75$0.15
    0932Factor IX recombinantK$0.86$0.17
    0935Clonidine hydrochlorideK$57.47$11.49
    0949Plasma, Pooled Multiple Donor, Solvent/Detergent TK1.1956$70.95$14.19
    0950Blood (Whole) For TransfusionK2.0123$119.42$23.88
    0952CryoprecipitateK0.7395$43.88$8.78
    0954RBC leukocytes reducedK2.7370$162.42$32.48
    0955Plasma, Fresh FrozenK1.2934$76.75$15.35
    0956Plasma Protein FractionK1.1226$66.62$13.32
    0957Platelet ConcentrateK0.8317$49.36$9.87
    0958Platelet Rich PlasmaK5.1815$307.49$61.50
    0959Red Blood CellsK2.0301$120.47$24.09
    0960Washed Red Blood CellsK2.9707$176.29$35.26
    0961Infusion, Albumin (Human) 5%, 50 mlK0.5119$30.38$6.08
    0963Albumin (human), 5%K1.3869$82.30$16.46
    0964Albumin (human), 25%K0.4878$28.95$5.79
    0965Albumin (human), 25%K1.1117$65.97$13.19
    0966Plasmaprotein fract, 5%K4.9564$294.13$58.83
    0967Split unit of bloodK1.2698$75.35$15.07
    0968Platelets leukocyte reduced irradiatedK2.3639$140.28$28.06
    0969Red blood cell leukocyte reduced irradiatedK3.6451$216.31$43.26
    1009Cryoprecip reduced plasmaK1.3062$77.51$15.50
    1010Blood, L/R, CMV-negK2.9692$176.20$35.24
    1011Platelets, HLA-m, L/R, unitK10.9690$650.93$130.19
    1013Platelet concentrate, L/R, unitK1.6023$95.09$19.02
    1016Blood, L/R, froz/deglycerol/washedK5.2631$312.33$62.47
    1017Platelets, aph/pher, L/R, CMV-neg, unitK8.5998$510.34$102.07
    1018Blood, L/R, irradiatedK2.8004$166.18$33.24
    1019Platelets, aph/pher, L/R, irradiated, unitK9.5131$564.54$112.91
    1020Pit, pher, L/R, CMV, irradK10.1551$602.63$120.53
    1021RBC, frz/deg/wsh, L/R, irradK4.8787$289.52$57.90
    1022RBC, L/R, CMV neg, irradK4.2901$254.59$50.92
    1045Iobenguane sulfate I-131H
    1052Injection, VoriconazoleK$4.63$0.93
    1064I-131 sodium iodide capsuleH
    1065I-131 sodium iodide solutionH
    1080I-131 tositumomab, dxH
    1081I-131 tositumomab, txH
    1082TreprostinilK$55.02$11.00
    1083Injection, AdalimumabK$300.10$60.02
    1084Denileukin diftitoxK$1,235.33$247.07
    1085Injection, Gallium NitrateK$1.30$0.26
    1086Temozolomide,oralK$7.28$1.46
    1088Dx I131 so iodide cap millicH
    1091IN 111 OxyquinolineH
    1092IN 111 PentetateH
    1093TC99M fanolesomabH
    1096TC 99M Exametazime, per doseH
    1150Th I131 so iodide sol millicH
    1166Cytarabine liposomeK$366.43$73.29
    1167Epirubicin hclK$25.15$5.03
    1178Busulfan IVK0.2851$16.92$3.38
    1201TC 99M SUCCIMER, PER VialH
    1203Verteporfin for injectionK$9.16$1.83
    1207Octreotide injection, depotK$87.40$17.48
    1210Inj dihydroergotamine mesyltK$27.82$5.56
    1280Corticotropin injectionK$95.44$19.09
    Start Printed Page 50692
    1305ApligrafK12.9222$766.84$153.37
    1330Ergonovine maleate injectionK0.5263$31.23$6.25
    1409Factor viia recombinantK$1,080.11$216.02
    1436Etidronate disodium injK$68.69$13.74
    1491New Technology—Level I ($0-$10)S$5.00$1.00
    1492New Technology—Level I ($10-$20)S$15.00$3.00
    1493New Technology—Level I ($20-$30)S$25.00$5.00
    1494New Technology—Level I ($30-$40)S$35.00$7.00
    1495New Technology—Level I ($40-$50)S$45.00$9.00
    1496New Technology—Level I ($0-$10)T$5.00$1.00
    1497New Technology—Level I ($10-$20)T$15.00$3.00
    1498New Technology—Level I ($20-$30)T$25.00$5.00
    1499New Technology—Level I ($30-$40)T$35.00$7.00
    1500New Technology—Level I ($40-$50)T$45.00$9.00
    1502New Technology—Level II ($50-$100)S$75.00$15.00
    1503New Technology—Level III ($100-$200)S$150.00$30.00
    1504New Technology—Level IV ($200-$300)S$250.00$50.00
    1505New Technology—Level V ($300-$400)S$350.00$70.00
    1506New Technology—Level VI ($400-$500)S$450.00$90.00
    1507New Technology—Level VII ($500-$600)S$550.00$110.00
    1508New Technology—Level VIII ($600-$700)S$650.00$130.00
    1509New Technology—Level IX ($700-$800)S$750.00$150.00
    1510New Technology—Level X ($800-$900)S$850.00$170.00
    1511New Technology—Level XI ($900-$1000)S$950.00$190.00
    1512New Technology—Level XII ($1000-$1100)S$1,050.00$210.00
    1513New Technology—Level XIII ($1100-$1200)S$1,150.00$230.00
    1514New Technology—Level XIV ($1200-$1300)S$1,250.00$250.00
    1515New Technology—Level XV ($1300-$1400)S$1,350.00$270.00
    1516New Technology—Level XVI ($1400-$1500)S$1,450.00$290.00
    1517New Technology—Level XVII ($1500-$1600)S$1,550.00$310.00
    1518New Technology—Level XVIII ($1600-$1700)S$1,650.00$330.00
    1519New Technology—Level IXX ($1700-$1800)S$1,750.00$350.00
    1520New Technology—Level XX ($1800-$1900)S$1,850.00$370.00
    1521New Technology—Level XXI ($1900-$2000)S$1,950.00$390.00
    1522New Technology—Level XXII ($2000-$2500)S$2,250.00$450.00
    1523New Technology—Level XXIII ($2500-$3000)S$2,750.00$550.00
    1524New Technology—Level XIV ($3000-$3500)S$3,250.00$650.00
    1525New Technology—Level XXV ($3500-$4000)S$3,750.00$750.00
    1526New Technology—Level XXVI ($4000-$4500)S$4,250.00$850.00
    1527New Technology—Level XXVII ($4500-$5000)S$4,750.00$950.00
    1528New Technology—Level XXVIII ($5000-$5500)S$5,250.00$1,050.00
    1529New Technology—Level XXIX ($5500-$6000)S$5,750.00$1,150.00
    1530New Technology—Level XXX ($6000-$6500)S$6,250.00$1,250.00
    1531New Technology—Level XXXI ($6500-$7000)S$6,750.00$1,350.00
    1532New Technology—Level XXXII ($7000-$7500)S$7,250.00$1,450.00
    1533New Technology—Level XXXIII ($7500-$8000)S$7,750.00$1,550.00
    1534New Technology—Level XXXIV ($8000-$8500)S$8,250.00$1,650.00
    1535New Technology—Level XXXV ($8500-$9000)S$8,750.00$1,750.00
    1536New Technology—Level XXXVI ($9000-$9500)S$9,250.00$1,850.00
    1537New Technology—Level XXXVII ($9500-$10000)S$9,750.00$1,950.00
    1539New Technology—Level II ($50-$100)T$75.00$15.00
    1540New Technology—Level III ($100-$200)T$150.00$30.00
    1541New Technology—Level IV ($200-$300)T$250.00$50.00
    1542New Technology—Level V ($300-$400)T$350.00$70.00
    1543New Technology—Level VI ($400-$500)T$450.00$90.00
    1544New Technology—Level VII ($500-$600)T$550.00$110.00
    1545New Technology—Level VIII ($600-$700)T$650.00$130.00
    1546New Technology—Level IX ($700-$800)T$750.00$150.00
    1547New Technology—Level X ($800-$900)T$850.00$170.00
    1548New Technology—Level XI ($900-$1000)T$950.00$190.00
    1549New Technology—Level XII ($1000-$1100)T$1,050.00$210.00
    1550New Technology—Level XIII ($1100-$1200)T$1,150.00$230.00
    1551New Technology—Level XIV ($1200- $1300)T$1,250.00$250.00
    1552New Technology—Level XV ($1300-$1400)T$1,350.00$270.00
    1553New Technology—Level XVI ($1400-$1500)T$1,450.00$290.00
    1554New Technology—Level XVII ($1500-$1600)T$1,550.00$310.00
    1555New Technology—Level XVIII ($1600-$1700)T$1,650.00$330.00
    1556New Technology—Level XIX ($1700-$1800)T$1,750.00$350.00
    1557New Technology—Level XX ($1800-$1900)T$1,850.00$370.00
    Start Printed Page 50693
    1558New Technology—Level XXI ($1900-$2000)T$1,950.00$390.00
    1559New Technology—Level XXII ($2000-$2500)T$2,250.00$450.00
    1560New Technology—Level XXIII ($2500-$3000)T$2,750.00$550.00
    1561New Technology—Level XXIV ($3000-$3500)T$3,250.00$650.00
    1562New Technology—Level XXV ($3500-$4000)T$3,750.00$750.00
    1563New Technology—Level XXVI ($4000-$4500)T$4,250.00$850.00
    1564New Technology—Level XXVII ($4500-$5000)T$4,750.00$950.00
    1565New Technology—Level XXVIII ($5000-$5500)T$5,250.00$1,050.00
    1566New Technology—Level XXIX ($5500-$6000)T$5,750.00$1,150.00
    1567New Technology—Level XXX ($6000-$6500)T$6,250.00$1,250.00
    1568New Technology—Level XXXI ($6500-$7000)T$6,750.00$1,350.00
    1569New Technology—Level XXXII ($7000-$7500)T$7,250.00$1,450.00
    1570New Technology—Level XXXIII ($7500-$8000)T$7,750.00$1,550.00
    1571New Technology—Level XXXIV ($8000-$8500)T$8,250.00$1,650.00
    1572New Technology—Level XXXV ($8500-$9000)T$8,750.00$1,750.00
    1573New Technology—Level XXXVI ($9000-$9500)T$9,250.00$1,850.00
    1574New Technology—Level XXXVII ($9500-$10000)T$9,750.00$1,950.00
    1600Technetium TC 99m sestamibiH
    1603Thallous chloride TL 201H
    1604IN 111 capromab pendetide, per doseH
    1605Abciximab injectionK$450.60$90.12
    1607Eptifibatide injectionK$12.73$2.55
    1608Etanercept injectionK$152.11$30.42
    1609Rho(D) immune globulin h, sdK$12.04$2.41
    1611Hylan G-F 20 injectionK$203.15$40.63
    1612Daclizumab, parenteralK$381.48$76.30
    1613TrastuzumabK$53.98$10.80
    1615BasiliximabK$1,473.57$294.71
    1618Vonwillebrandfactrcmplx, per iuK$0.74$0.15
    1619Gallium ga 67H
    1620Technetium tc99m bicisateH
    1622Technetium tc99m mertiatideH
    1624Sodium phosphate p32H
    1625Indium 111-in pentetreotideH
    1628Chromic phosphate p32H
    1655Tinzaparin sodium injectionK$2.53$0.51
    1670Tetanus immune globulin injK$76.90$15.38
    1716Brachytx source, Gold 198H
    1717Brachytx source, HDR Ir-192H
    1718Brachytx source, Iodine 125H
    1719Brachytx sour, Non-HDR Ir-192H
    1720Brachytx sour, Palladium 103H
    1740Diazoxide injectionK$113.86$22.77
    1775FDG, per dose (4-40 mCi/ml)H
    2210Methyldopate hcl injectionK$9.58$1.92
    2616Brachytx source, Yttrium-90H
    2632Brachytx sol, I-125, per mCiH
    2633Brachytx source, Cesium-131H
    2634Brachytx source, HA, I-125H
    2635Brachytx source, HA, P-103H
    2636Brachytx linear source, P-103H
    2730Pralidoxime chloride injK$76.68$15.34
    2770Quinupristin/dalfopristinK$105.48$21.10
    2940Somatrem injectionK$43.14$8.63
    3030Sumatriptan succinateK$51.03$10.21
    7000AmifostineK$436.01$87.20
    7005Gonadorelin hydrochK$173.44$34.69
    7011Oprelvekin injectionK$249.06$49.81
    7015Busulfan, oralK$1.98$0.40
    7019AprotininK$2.20$0.44
    7024Corticorelin ovine triflutatK$386.53$77.31
    7025Digoxin immune FAB (ovine)K$552.18$110.44
    7026Ethanolamine oleateK$64.53$12.91
    7027FomepizoleK$12.31$2.46
    7028FosphenytoinK$5.19$1.04
    7030HeminK$6.51$1.30
    7034Somatropin injectionK$42.93$8.59
    7035TeniposideK$266.23$53.25
    7036Urokinase injK$415.69$83.14
    Start Printed Page 50694
    7037UrofollitropinK$44.74$8.95
    7038Monoclonal antibodiesK$885.36$177.07
    7040Pentastarch 10% solutionK$12.45$2.49
    7041Tirofiban hclK$7.89$1.58
    7042Capecitabine, oralK$3.30$0.66
    7043Infliximab injectionK$54.20$10.84
    7045Trimetrexate glucoronateK$139.85$27.97
    7046Doxorubicin hcl liposome injK$365.64$73.13
    7048Alteplase recombinantK$30.65$6.13
    7049Filgrastim injectionK$282.29$56.46
    7051Leuprolide acetate implantK$2,262.19$452.44
    7308Aminolevulinic acid hcl topK$96.79$19.36
    7316Sodium hyaluronate injectionK$110.65$22.13
    7515Cyclosporine oralK$1.00$0.20
    9001Linezolid injectionK$24.15$4.83
    9002TenecteplaseK$2,052.77$410.55
    9003PalivizumabK4.1491$246.22$49.24
    9004Gemtuzumab ozogamicinK$2,245.04$449.01
    9005Reteplase injectionK$898.81$179.76
    9006Tacrolimus injectionK$126.61$25.32
    9008Baclofen Refill Kit-500mcgK0.2447$14.52$2.90
    9009Baclofen refill kit—per 2000 mcgK0.7209$42.78$8.56
    9012Arsenic TrioxideK$33.76$6.75
    9015Mycophenolate mofetil oralK$2.50$0.50
    9018Botulinum toxin BK$7.89$1.58
    9019Caspofungin acetateK$32.35$6.47
    9020Sirolimus tabletK$6.85$1.37
    9022IM inj interferon beta 1-aK$89.10$17.82
    9023Rho d immune globulinK$25.08$5.02
    9024Amphotericin b lipid complexK$11.95$2.39
    9025Rubidium-Rb-82H
    9030Amphotericin BK$30.70$6.14
    9031Arbutamine HCl injectionK$163.15$32.63
    9032Baclofen 10 MG injectionK$188.01$37.60
    9033Cidofovir injectionK$782.98$156.60
    9038Inj estrogen conjugateK$57.77$11.55
    9040Intraocular Fomivirsen naK$203.93$40.79
    9042Glucagon hydrochlorideK$62.16$12.43
    9044Ibutilide fumarate injectionK$243.34$48.67
    9045Iron dextranK$11.43$2.29
    9046Iron sucrose injectionK$0.38$0.08
    9047Itraconazole injectionK$36.93$7.39
    9051Urea injectionK1.0454$62.04$12.41
    9054Metabolically active tissueK$15.69$3.14
    9055Injectable human tissueK$3.54$0.71
    9057LepirudinK$128.17$25.63
    9100Iodinated I-131 serumalbumin, per 5uciH
    9104Anti-thymocycte globulin rabbitK$299.47$59.89
    9105Hep B imm globK1.8813$111.64$22.33
    9108Thyrotropin alfaK$712.58$142.52
    9110Alemtuzumab injectionK$516.87$103.37
    9112Inj Perflutren lipid micros, mlK$63.51$12.70
    9114NesiritideK$75.19$15.04
    9115Inj, zoledronic acidK$202.41$40.48
    9117Yttrium 90 ibritumomab tiuxetanH
    9118In-111 ibritumomab tiuxetanH
    9119PegfilgrastimK$2,178.28$435.66
    9120Inj, FulvestrantK$82.90$16.58
    9121Inj, ArgatrobanK0.1897$11.26$2.25
    9122Triptorelin pamoateK$369.98$74.00
    9123TranscyteK$719.41$143.88
    9124Injection, daptomycinG$0.30$0.06
    9125Risperidone, long actingG$4.71$0.94
    9126Injection, natalizumabG$6.51$1.30
    9127Paclitaxel protein prK$8.59$1.72
    9128Inj pegaptanib sodiumK$1,074.27$214.85
    9130Na chromateCr51, per 0.25mCiH
    913251 Na Chromate, 50mCiH
    9133Rabies ig, im/scK$64.56$12.91
    Start Printed Page 50695
    9134Rabies ig, heat treatedK$69.79$13.96
    9135Varicella-zoster ig, imK$96.58$19.32
    9136Adenovirus vaccine, type 4K0.9499$56.37$11.27
    9137Bcg vaccine, percutK$124.54$24.91
    9138Hep a/hep b vacc, adult imK0.9674$57.41$11.48
    9139Rabies vaccine, imK$128.04$25.61
    9140Rabies vaccine, idK1.4959$88.77$17.75
    9141Measles-rubella vaccine, scK0.9467$56.18$11.24
    9142Chicken pox vaccine, scK$64.29$12.86
    9143Meningococcal vaccine, scK$56.75$11.35
    9144Encephalitis vaccine, scK$67.73$13.55
    9145Meningococcal vaccine, imK0.8948$53.10$10.62
    9146Technetium TC99m DisofeninH
    9147Technetium TC 99M DepreotideH
    9148I-123 sodium iodide capsuleH
    9149Dx I131 so iodide microcurieH
    9150I-125 serum albumin microH
    9151Tc 99M ARCITUMOMAB PER VIALH
    9152Baclofen Intrathecal kit-1amK0.8562$50.81$10.16
    9153Na Iothalamate I-125, 10 uCiH
    9154Technetium tc99m glucepatateH
    9155Technetium tc99mlabeledrbcsH
    9156Nonmetabolic active tissueK$53.76$10.75
    9157LOCM <=149 mg/ml iodineK$0.51$0.10
    9158LOCM 150-199mg/ml iodineK$2.00$0.40
    9159LOCM 200-249mg/ml iodineK$0.78$0.16
    9160LOCM 250-299mg/ml iodineK$0.66$0.13
    9161LOCM 300-349mg/ml iodineK$0.41$0.08
    9162LOCM 350-399mg/ml iodineK$0.27$0.05
    9163LOCM >= 400 mg/ml iodineK$0.20$0.04
    9164Inj Gad-base MR contrastK$3.01$0.60
    9165Oral MR contrastK$9.01$1.80
    9166Dyphylline injectionK$7.74$1.55
    9167ValrubicinK$376.87$75.37
    9168Pegademase bovineK$161.16$32.23
    9169Anthrax vaccine, scK$128.95$25.79
    9200OrcelK2.6893$159.59$31.92
    9201DermagraftK6.2066$368.32$73.66
    9202Inj Octafluoropropane mic,mlK$41.42$8.28
    9203Inj Perflexane lipid micros, mlK$13.49$2.70
    9205OxaliplatinK$84.06$16.81
    9206IntegraK$9.23$1.85
    9207Injection, bortezomibK$28.90$5.78
    9208Injection, agalsidase betaK$123.35$24.67
    9209Injection, laronidaseK$23.16$4.63
    9210Injection, palonosetron HCLK18.42$3.68
    9211Inj, alefacept, IVK$571.01$114.20
    9212Inj, alefacept, IMK$402.00$80.40
    9213Injection, PemetrexedG$41.29$8.26
    9214Injection, BevacizumabG$58.17$11.63
    9215Injection, CetuximabG$50.59$10.12
    9216Abarelix InjectionG$66.96$13.39
    9217Leuprolide acetate suspnsionK$230.87$46.17
    9218Injection, AzacitidineK$4.03$0.81
    9219Mycophenolic AcidG$2.47$0.49
    9220Sodium hyaluronateG$203.84$40.77
    9221Graftjacket Reg MatrixG$1,234.36$246.87
    9222Graftjacket SftTisG$890.74$178.15
    9300Injection, OmalizumabG$15.98$3.20
    9500Platelets, irradiatedK1.3589$80.64$16.13
    9501Platelets, pheresis, leukocytes reducedK8.1495$483.62$96.72
    9502Platelet pheresis irradiatedK5.1895$307.96$61.59
    9503Fresh frozen plasma, ea unitK1.6241$96.38$19.28
    9504RBC deglycerolizedK6.4314$381.66$76.33
    9505RBC irradiatedK2.3876$141.69$28.34
    9506Granulocytes, pheresisK15.6155$926.67$185.33
    9507Platelets, pheresisK6.8988$409.40$81.88
    9508Plasma, frozen w/in 8 hoursK1.2038$71.44$14.29
    Start Printed Page 50696

    6. On pages 42776-42965, Addendum B is corrected to read as follows:

    —————————— * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved.

    Addendum B.—Payment Status by HCPCS Code and Related Information Calendar Year 2006

    CPT/HCPCSSICIDescriptionAPCRelative weightPayment rateNational unadjusted copaymentMinimum unadjusted copayment
    0003TSCervicography1492$15.00$3.00
    0008TTUpper gi endoscopy w/suture042222.9647$1,362.79$448.81$272.56
    00100NAnesth, salivary gland
    00102NAnesth, repair of cleft lip
    00103NAnesth, blepharoplasty
    00104NAnesth, electroshock
    0010TATb test, gamma interferon
    00120NAnesth, ear surgery
    00124NAnesth, ear exam
    00126NAnesth, tympanotomy
    00140NAnesth, procedures on eye
    00142NAnesth, lens surgery
    00144NAnesth, corneal transplant
    00145NAnesth, vitreoretinal surg
    00147NAnesth, iridectomy
    00148NAnesth, eye exam
    00160NAnesth, nose/sinus surgery
    00162NAnesth, nose/sinus surgery
    00164NAnesth, biopsy of nose
    0016TTThermotx choroid vasc lesion02354.6593$276.50$67.40$55.30
    00170NAnesth, procedure on mouth
    00172NAnesth, cleft palate repair
    00174NAnesth, pharyngeal surgery
    00176CAnesth, pharyngeal surgery
    0017TEPhotocoagulat macular drusen
    0018TSTranscranial magnetic stimul02150.6115$36.29$14.51$7.26
    00190NAnesth, face/skull bone surg
    00192CAnesth, facial bone surgery
    0019TEExtracorp shock wave tx, ms
    0020TBExtracorp shock wave tx, ft
    00210NAnesth, open head surgery
    00212NAnesth, skull drainage
    00214CAnesth, skull drainage
    00215CAnesth, skull repair/fract
    00216NAnesth, head vessel surgery
    00218NAnesth, special head surgery
    0021TCFetal oximetry, trnsvag/cerv
    00220NAnesth, intrcrn nerve
    00222NAnesth, head nerve surgery
    0023TAPhenotype drug test, hiv 1
    0024TCTranscath cardiac reduction
    0026TAMeasure remnant lipoproteins
    0027TTEndoscopic epidural lysis022017.3586$1,030.11$206.02
    0028TNDexa body composition study
    0029TAMagnetic tx for incontinence
    00300NAnesth, head/neck/ptrunk
    0030TAAntiprothrombin antibody
    0031TNSpeculoscopy
    00320NAnesth, neck organ, 1 & over
    00322NAnesth, biopsy of thyroid
    00326NAnesth, larynx/trach, < 1 yr
    0032TNSpeculoscopy w/direct sample
    0033TCEndovasc taa repr incl subcl
    0034TCEndovasc taa repr w/o subcl
    00350NAnesth, neck vessel surgery
    00352NAnesth, neck vessel surgery
    0035TCInsert endovasc prosth, taa
    0036TCEndovasc prosth, taa, add-on
    0037TCArtery transpose/endovas taa
    0038TCRad endovasc taa rpr w/cover
    0039TCRad s/i, endovasc taa repair
    00400NAnesth, skin, ext/per/atrunk
    Start Printed Page 50697
    00402NAnesth, surgery of breast
    00404CAnesth, surgery of breast
    00406CAnesth, surgery of breast
    0040TCRad s/i, endovasc taa prosth
    00410NAnesth, correct heart rhythm
    0041TADetect ur infect agnt w/cpas
    0042TNCt perfusion w/contrast, cbf
    0043TACo expired gas analysis
    0044TNWhole body photography
    00450NAnesth, surgery of shoulder
    00452CAnesth, surgery of shoulder
    00454NAnesth, collar bone biopsy
    0045TNWhole body photography
    0046TTCath lavage, mammary duct(s)002114.9776$888.82$219.48$177.76
    00470NAnesth, removal of rib
    00472NAnesth, chest wall repair
    00474CAnesth, surgery of rib(s)
    0047TTCath lavage, mammary duct(s)002114.9776$888.82$219.48$177.76
    0048TCImplant ventricular device
    0049TCExternal circulation assist
    00500NAnesth, esophageal surgery
    0050TCRemoval circulation assist
    0051TCImplant total heart system
    00520NAnesth, chest procedure
    00522NAnesth, chest lining biopsy
    00524CAnesth, chest drainage
    00528NAnesth, chest partition view
    00529NAnesth, chest partition view
    0052TCReplace component heart syst
    00530NAnesth, pacemaker insertion
    00532NAnesth, vascular access
    00534NAnesth, cardioverter/defib
    00537NAnesth, cardiac electrophys
    00539NAnesth, trach-bronch reconst
    0053TCReplace component heart syst
    00540CAnesth, chest surgery
    00541NAnesth, one lung ventilation
    00542CAnesth, release of lung
    00546CAnesth, lung,chest wall surg
    00548NAnesth, trachea,bronchi surg
    0054TBBone surgery using computer
    00550NAnesth, sternal debridement
    0055TBBone surgery using computer
    00560CAnesth, open heart surgery
    00561CAnesth, heart surg < age 1
    00562CAnesth, open heart surgery
    00563NAnesth, heart proc w/pump
    00566NAnesth, cabg w/o pump
    0056TBBone surgery using computer
    00580CAnesth, heart/lung transplnt
    0058TXCryopreservation, ovary tiss03480.7927$47.04$9.41
    0059TXCryopreservation, oocyte03480.7927$47.04$9.41
    00600NAnesth, spine, cord surgery
    00604CAnesth, sitting procedure
    0060TBElectrical impedance scan
    0061TBDestruction of tumor, breast
    00620NAnesth, spine, cord surgery
    00622CAnesth, removal of nerves
    0062TTRep intradisc annulus1 lev020310.4015$617.26$246.90$123.45
    00630NAnesth, spine, cord surgery
    00632CAnesth, removal of nerves
    00634NAnesth for chemonucleolysis
    00635NAnesth, lumbar puncture
    0063TTRep intradisc annulus>1lev020310.4015$617.26$246.90$123.45
    00640NAnesth, spine manipulation
    0064TASpectroscop eval expired gas
    Start Printed Page 50698
    0065TAOcular photoscreen bilat
    0066TECt colonography screen
    00670CAnesth, spine, cord surgery
    0067T*SCt colonography dx03335.2836$313.54$125.41$62.71
    0068TBInterp/rept heart sound
    0069TNAnalysis only heart sound
    00700NAnesth, abdominal wall surg
    00702NAnesth, for liver biopsy
    0070TNInterp only heart sound
    0071TTU/s leiomyomata ablate <200019314.5843$865.48$173.10
    0072TTU/s leiomyomata ablate >200019314.5843$865.48$173.10
    00730NAnesth, abdominal wall surg
    0073TSDelivery, comp imrt04125.3643$318.33$63.67
    00740NAnesth, upper gi visualize
    0074TEOnline physician e/m
    00750NAnesth, repair of hernia
    00752NAnesth, repair of hernia
    00754NAnesth, repair of hernia
    00756NAnesth, repair of hernia
    0075TCPerq stent/chest vert art
    0076TCS&i stent/chest vert art
    00770NAnesth, blood vessel repair
    0077TCCereb therm perfusion probe
    0078TCEndovasc aort repr w/device
    00790NAnesth, surg upper abdomen
    00792CAnesth, hemorr/excise liver
    00794CAnesth, pancreas removal
    00796CAnesth, for liver transplant
    00797NAnesth, surgery for obesity
    0079TCEndovasc visc extnsn repr
    00800NAnesth, abdominal wall surg
    00802CAnesth, fat layer removal
    0080TCEndovasc aort repr rad s&i
    00810NAnesth, low intestine scope
    0081TCEndovasc visc extnsn s&i
    00820NAnesth, abdominal wall surg
    0082TBStereotactic rad delivery
    00830NAnesth, repair of hernia
    00832NAnesth, repair of hernia
    00834NAnesth, hernia repair< 1 yr
    00836NAnesth hernia repair preemie
    0083TNStereotactic rad tx mngmt
    00840NAnesth, surg lower abdomen
    00842NAnesth, amniocentesis
    00844CAnesth, pelvis surgery
    00846CAnesth, hysterectomy
    00848CAnesth, pelvic organ surg
    0084TTTemp prostate urethral stent01641.1855$70.35$17.29$14.07
    00851NAnesth, tubal ligation
    0085TXBreath test heart reject03400.6384$37.88$7.58
    00860NAnesth, surgery of abdomen
    00862NAnesth, kidney/ureter surg
    00864CAnesth, removal of bladder
    00865CAnesth, removal of prostate
    00866CAnesth, removal of adrenal
    00868CAnesth, kidney transplant
    0086TNL ventricle fill pressure
    00870NAnesth, bladder stone surg
    00872NAnesth kidney stone destruct
    00873NAnesth kidney stone destruct
    0087TXSperm eval hyaluronan03480.7927$47.04$9.41
    00880NAnesth, abdomen vessel surg
    00882CAnesth, major vein ligation
    0088TTRf tongue base vol reduxn025316.1357$957.54$282.29$191.51
    00902NAnesth, anorectal surgery
    00904CAnesth, perineal surgery
    Start Printed Page 50699
    00906NAnesth, removal of vulva
    00908CAnesth, removal of prostate
    00910NAnesth, bladder surgery
    00912NAnesth, bladder tumor surg
    00914NAnesth, removal of prostate
    00916NAnesth, bleeding control
    00918NAnesth, stone removal
    00920NAnesth, genitalia surgery
    00921NAnesth, vasectomy
    00922NAnesth, sperm duct surgery
    00924NAnesth, testis exploration
    00926NAnesth, removal of testis
    00928NAnesth, removal of testis
    00930NAnesth, testis suspension
    00932CAnesth, amputation of penis
    00934CAnesth, penis, nodes removal
    00936CAnesth, penis, nodes removal
    00938NAnesth, insert penis device
    00940NAnesth, vaginal procedures
    00942NAnesth, surg on vag/urethral
    00944CAnesth, vaginal hysterectomy
    00948NAnesth, repair of cervix
    00950NAnesth, vaginal endoscopy
    00952NAnesth, hysteroscope/graph
    01112NAnesth, bone aspirate/bx
    01120NAnesth, pelvis surgery
    01130NAnesth, body cast procedure
    01140CAnesth, amputation at pelvis
    01150CAnesth, pelvic tumor surgery
    01160NAnesth, pelvis procedure
    01170NAnesth, pelvis surgery
    01173NAnesth, fx repair, pelvis
    01180NAnesth, pelvis nerve removal
    01190NAnesth, pelvis nerve removal
    01200NAnesth, hip joint procedure
    01202NAnesth, arthroscopy of hip
    01210NAnesth, hip joint surgery
    01212CAnesth, hip disarticulation
    01214CAnesth, hip arthroplasty
    01215NAnesth, revise hip repair
    01220NAnesth, procedure on femur
    01230NAnesth, surgery of femur
    01232CAnesth, amputation of femur
    01234CAnesth, radical femur surg
    01250NAnesth, upper leg surgery
    01260NAnesth, upper leg veins surg
    01270NAnesth, thigh arteries surg
    01272CAnesth, femoral artery surg
    01274CAnesth, femoral embolectomy
    01320NAnesth, knee area surgery
    01340NAnesth, knee area procedure
    01360NAnesth, knee area surgery
    01380NAnesth, knee joint procedure
    01382NAnesth, dx knee arthroscopy
    01390NAnesth, knee area procedure
    01392NAnesth, knee area surgery
    01400NAnesth, knee joint surgery
    01402CAnesth, knee arthroplasty
    01404CAnesth, amputation at knee
    01420NAnesth, knee joint casting
    01430NAnesth, knee veins surgery
    01432NAnesth, knee vessel surg
    01440NAnesth, knee arteries surg
    01442CAnesth, knee artery surg
    01444CAnesth, knee artery repair
    01462NAnesth, lower leg procedure
    Start Printed Page 50700
    01464NAnesth, ankle/ft arthroscopy
    01470NAnesth, lower leg surgery
    01472NAnesth, achilles tendon surg
    01474NAnesth, lower leg surgery
    01480NAnesth, lower leg bone surg
    01482NAnesth, radical leg surgery
    01484NAnesth, lower leg revision
    01486CAnesth, ankle replacement
    01490NAnesth, lower leg casting
    01500NAnesth, leg arteries surg
    01502CAnesth, lwr leg embolectomy
    01520NAnesth, lower leg vein surg
    01522NAnesth, lower leg vein surg
    01610NAnesth, surgery of shoulder
    01620NAnesth, shoulder procedure
    01622NAnes dx shoulder arthroscopy
    01630NAnesth, surgery of shoulder
    01632CAnesth, surgery of shoulder
    01634CAnesth, shoulder joint amput
    01636CAnesth, forequarter amput
    01638CAnesth, shoulder replacement
    01650NAnesth, shoulder artery surg
    01652CAnesth, shoulder vessel surg
    01654CAnesth, shoulder vessel surg
    01656CAnesth, arm-leg vessel surg
    01670NAnesth, shoulder vein surg
    01680NAnesth, shoulder casting
    01682NAnesth, airplane cast
    01710NAnesth, elbow area surgery
    01712NAnesth, uppr arm tendon surg
    01714NAnesth, uppr arm tendon surg
    01716NAnesth, biceps tendon repair
    01730NAnesth, uppr arm procedure
    01732NAnesth, dx elbow arthroscopy
    01740NAnesth, upper arm surgery
    01742NAnesth, humerus surgery
    01744NAnesth, humerus repair
    01756CAnesth, radical humerus surg
    01758NAnesth, humeral lesion surg
    01760NAnesth, elbow replacement
    01770NAnesth, uppr arm artery surg
    01772NAnesth, uppr arm embolectomy
    01780NAnesth, upper arm vein surg
    01782NAnesth, uppr arm vein repair
    01810NAnesth, lower arm surgery
    01820NAnesth, lower arm procedure
    01829NAnesth, dx wrist arthroscopy
    01830NAnesth, lower arm surgery
    01832NAnesth, wrist replacement
    01840NAnesth, lwr arm artery surg
    01842NAnesth, lwr arm embolectomy
    01844NAnesth, vascular shunt surg
    01850NAnesth, lower arm vein surg
    01852NAnesth, lwr arm vein repair
    01860NAnesth, lower arm casting
    01905NAnes, spine inject, x-ray/re
    01916NAnesth, dx arteriography
    01920NAnesth, catheterize heart
    01922NAnesth, cat or MRI scan
    01924NAnes, ther interven rad, art
    01925NAnes, ther interven rad, car
    01926NAnes, tx interv rad hrt/cran
    01930NAnes, ther interven rad, vei
    01931NAnes, ther interven rad, tip
    01932NAnes, tx interv rad, th vein
    01933NAnes, tx interv rad, cran v
    Start Printed Page 50701
    01951NAnesth, burn, less 4 percent
    01952NAnesth, burn, 4-9 percent
    01953NAnesth, burn, each 9 percent
    01958NAnesth, antepartum manipul
    01960NAnesth, vaginal delivery
    01961NAnesth, cs delivery
    01962NAnesth, emer hysterectomy
    01963NAnesth, cs hysterectomy
    01964NAnesth, abortion procedures
    01967NAnesth/analg, vag delivery
    01968NAnes/analg cs deliver add-on
    01969NAnesth/analg cs hyst add-on
    01990CSupport for organ donor
    01991NAnesth, nerve block/inj
    01992NAnesth, n block/inj, prone
    01995NRegional anesthesia limb
    01996NHosp manage cont drug admin
    01999NUnlisted anesth procedure
    0500FEInitial prenatal care visit
    0501FEPrenatal flow sheet
    0502FESubsequent prenatal care
    0503FEPostpartum care visit
    1000FETobacco use, smoking, assess
    1001FETobacco use, non-smoking
    10021TFna w/o image00020.9559$56.73$11.35
    10022TFna w/image00362.1773$129.21$25.84
    1002FEAssess anginal symptom/level
    10040TAcne surgery00100.5719$33.94$9.65$6.79
    10060TDrainage of skin abscess00061.55$91.98$22.28$18.40
    10061TDrainage of skin abscess00061.55$91.98$22.28$18.40
    10080TDrainage of pilonidal cyst00061.55$91.98$22.28$18.40
    10081TDrainage of pilonidal cyst000711.4501$679.48$135.90
    10120TRemove foreign body00061.55$91.98$22.28$18.40
    10121TRemove foreign body002114.9776$888.82$219.48$177.76
    10140TDrainage of hematoma/fluid000711.4501$679.48$135.90
    10160TPuncture drainage of lesion00181.1726$69.59$16.04$13.92
    10180TComplex drainage, wound000816.4989$979.09$195.82
    11000TDebride infected skin00151.6514$98.00$20.29$19.60
    11001TDebride infected skin add-on00120.8497$50.42$11.18$10.08
    11004CDebride genitalia & perineum
    11005CDebride abdom wall
    11006CDebride genit/per/abdom wall
    11008CRemove mesh from abd wall
    11010TDebride skin, fx00194.0547$240.62$71.87$48.12
    11011TDebride skin/muscle, fx00194.0547$240.62$71.87$48.12
    11012TDebride skin/muscle/bone, fx00194.0547$240.62$71.87$48.12
    11040TDebride skin, partial00151.6514$98.00$20.29$19.60
    11041TDebride skin, full00151.6514$98.00$20.29$19.60
    11042TDebride skin/tissue00162.5834$153.31$33.57$30.66
    11043TDebride tissue/muscle00162.5834$153.31$33.57$30.66
    11044TDebride tissue/muscle/bone06826.9107$410.10$162.42$82.02
    11055TTrim skin lesion00120.8497$50.42$11.18$10.08
    11056TTrim skin lesions, 2 to 400120.8497$50.42$11.18$10.08
    11057TTrim skin lesions, over 400131.1078$65.74$14.20$13.15
    11100TBiopsy, skin lesion00181.1726$69.59$16.04$13.92
    11101TBiopsy, skin add-on00181.1726$69.59$16.04$13.92
    11200TRemoval of skin tags00131.1078$65.74$14.20$13.15
    11201TRemove skin tags add-on00151.6514$98.00$20.29$19.60
    11300TShave skin lesion00120.8497$50.42$11.18$10.08
    11301TShave skin lesion00120.8497$50.42$11.18$10.08
    11302TShave skin lesion00131.1078$65.74$14.20$13.15
    11303TShave skin lesion00151.6514$98.00$20.29$19.60
    11305TShave skin lesion00131.1078$65.74$14.20$13.15
    11306TShave skin lesion00131.1078$65.74$14.20$13.15
    11307TShave skin lesion00131.1078$65.74$14.20$13.15
    11308TShave skin lesion00131.1078$65.74$14.20$13.15
    Start Printed Page 50702
    11310TShave skin lesion00131.1078$65.74$14.20$13.15
    11311TShave skin lesion00131.1078$65.74$14.20$13.15
    11312TShave skin lesion00131.1078$65.74$14.20$13.15
    11313TShave skin lesion00162.5834$153.31$33.57$30.66
    11400TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11401TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11402TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11403TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11404TRemoval of skin lesion002114.9776$888.82$219.48$177.76
    11406TRemoval of skin lesion002114.9776$888.82$219.48$177.76
    11420TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11421TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11422TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11423TRemoval of skin lesion002114.9776$888.82$219.48$177.76
    11424TRemoval of skin lesion002114.9776$888.82$219.48$177.76
    11426TRemoval of skin lesion002219.6472$1,165.92$354.45$233.18
    11440TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11441TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11442TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11443TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11444TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11446TRemoval of skin lesion002219.6472$1,165.92$354.45$233.18
    11450TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
    11451TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
    11462TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
    11463TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
    11470TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
    11471TRemoval, sweat gland lesion002219.6472$1,165.92$354.45$233.18
    11600TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11601TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11602TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11603TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11604TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11606TRemoval of skin lesion002114.9776$888.82$219.48$177.76
    11620TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11621TRemoval of skin lesion00194.0547$240.62$71.87$48.12
    11622TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11623TRemoval of skin lesion002114.9776$888.82$219.48$177.76
    11624TRemoval of skin lesion002114.9776$888.82$219.48$177.76
    11626TRemoval of skin lesion002219.6472$1,165.92$354.45$233.18
    11640TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11641TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11642TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11643TRemoval of skin lesion00206.9433$412.04$107.40$82.41
    11644TRemoval of skin lesion002114.9776$888.82$219.48$177.76
    11646TRemoval of skin lesion002219.6472$1,165.92$354.45$233.18
    11719TTrim nail(s)00090.668$39.64$8.34$7.93
    11720TDebride nail, 1-500090.668$39.64$8.34$7.93
    11721TDebride nail, 6 or more00090.668$39.64$8.34$7.93
    11730TRemoval of nail plate00131.1078$65.74$14.20$13.15
    11732TRemove nail plate, add-on00120.8497$50.42$11.18$10.08
    11740TDrain blood from under nail00090.668$39.64$8.34$7.93
    11750TRemoval of nail bed00194.0547$240.62$71.87$48.12
    11752TRemove nail bed/finger tip002219.6472$1,165.92$354.45$233.18
    11755TBiopsy, nail unit00194.0547$240.62$71.87$48.12
    11760TRepair of nail bed00241.6084$95.45$31.25$19.09
    11762TReconstruction of nail bed00241.6084$95.45$31.25$19.09
    11765TExcision of nail fold, toe00151.6514$98.00$20.29$19.60
    11770TRemoval of pilonidal lesion002219.6472$1,165.92$354.45$233.18
    11771TRemoval of pilonidal lesion002219.6472$1,165.92$354.45$233.18
    11772TRemoval of pilonidal lesion002219.6472$1,165.92$354.45$233.18
    11900TInjection into skin lesions00120.8497$50.42$11.18$10.08
    11901TAdded skin lesions injection00120.8497$50.42$11.18$10.08
    11920TCorrect skin color defects00241.6084$95.45$31.25$19.09
    11921TCorrect skin color defects00241.6084$95.45$31.25$19.09
    11922TCorrect skin color defects00241.6084$95.45$31.25$19.09
    Start Printed Page 50703
    11950TTherapy for contour defects00241.6084$95.45$31.25$19.09
    11951TTherapy for contour defects00241.6084$95.45$31.25$19.09
    11952TTherapy for contour defects00241.6084$95.45$31.25$19.09
    11954TTherapy for contour defects00241.6084$95.45$31.25$19.09
    11960TInsert tissue expander(s)002718.4182$1,092.99$329.72$218.60
    11970TReplace tissue expander002718.4182$1,092.99$329.72$218.60
    11971TRemove tissue expander(s)002219.6472$1,165.92$354.45$233.18
    11975EInsert contraceptive cap
    11976TRemoval of contraceptive cap00194.0547$240.62$71.87$48.12
    11977ERemoval/reinsert contra cap
    11980XImplant hormone pellet(s)03400.6384$37.88$7.58
    11981XInsert drug implant device03400.6384$37.88$7.58
    11982XRemove drug implant device03400.6384$37.88$7.58
    11983XRemove/insert drug implant03400.6384$37.88$7.58
    12001TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12002TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12004TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12005TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12006TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12007TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12011TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12013TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12014TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12015TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12016TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12017TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12018TRepair superficial wound(s)00241.6084$95.45$31.25$19.09
    12020TClosure of split wound00241.6084$95.45$31.25$19.09
    12021TClosure of split wound00241.6084$95.45$31.25$19.09
    12031TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12032TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12034TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12035TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12036TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12037TLayer closure of wound(s)00255.4938$326.02$101.85$65.20
    12041TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12042TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12044TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12045TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12046TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12047TLayer closure of wound(s)00255.4938$326.02$101.85$65.20
    12051TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12052TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12053TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12054TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12055TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12056TLayer closure of wound(s)00241.6084$95.45$31.25$19.09
    12057TLayer closure of wound(s)00255.4938$326.02$101.85$65.20
    13100TRepair of wound or lesion00255.4938$326.02$101.85$65.20
    13101TRepair of wound or lesion00255.4938$326.02$101.85$65.20
    13102TRepair wound/lesion add-on00241.6084$95.45$31.25$19.09
    13120TRepair of wound or lesion00241.6084$95.45$31.25$19.09
    13121TRepair of wound or lesion00241.6084$95.45$31.25$19.09
    13122TRepair wound/lesion add-on00241.6084$95.45$31.25$19.09
    13131TRepair of wound or lesion00241.6084$95.45$31.25$19.09
    13132TRepair of wound or lesion00241.6084$95.45$31.25$19.09
    13133TRepair wound/lesion add-on00241.6084$95.45$31.25$19.09
    13150TRepair of wound or lesion00255.4938$326.02$101.85$65.20
    13151TRepair of wound or lesion00241.6084$95.45$31.25$19.09
    13152TRepair of wound or lesion00255.4938$326.02$101.85$65.20
    13153TRepair wound/lesion add-on00241.6084$95.45$31.25$19.09
    13160TLate closure of wound002718.4182$1,092.99$329.72$218.60
    14000TSkin tissue rearrangement068613.8287$820.64$164.13
    14001TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
    14020TSkin tissue rearrangement068613.8287$820.64$164.13
    14021TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
    Start Printed Page 50704
    14040TSkin tissue rearrangement068613.8287$820.64$164.13
    14041TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
    14060TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
    14061TSkin tissue rearrangement068613.8287$820.64$164.13
    14300TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
    14350TSkin tissue rearrangement002718.4182$1,092.99$329.72$218.60
    15000TSkin graft00255.4938$326.02$101.85$65.20
    15001TSkin graft add-on00255.4938$326.02$101.85$65.20
    15050TSkin pinch graft00255.4938$326.02$101.85$65.20
    15100TSkin split graft002718.4182$1,092.99$329.72$218.60
    15101TSkin split graft add-on002718.4182$1,092.99$329.72$218.60
    15120TSkin split graft002718.4182$1,092.99$329.72$218.60
    15121TSkin split graft add-on002718.4182$1,092.99$329.72$218.60
    15200TSkin full graft002718.4182$1,092.99$329.72$218.60
    15201TSkin full graft add-on00255.4938$326.02$101.85$65.20
    15220TSkin full graft002718.4182$1,092.99$329.72$218.60
    15221TSkin full graft add-on00255.4938$326.02$101.85$65.20
    15240TSkin full graft068613.8287$820.64$164.13
    15241TSkin full graft add-on00255.4938$326.02$101.85$65.20
    15260TSkin full graft068613.8287$820.64$164.13
    15261TSkin full graft add-on00255.4938$326.02$101.85$65.20
    15342TCultured skin graft, 25 cm00241.6084$95.45$31.25$19.09
    15343TCulture skn graft addl 25 cm00241.6084$95.45$31.25$19.09
    15350TSkin homograft068613.8287$820.64$164.13
    15351TSkin homograft add-on068613.8287$820.64$164.13
    15400TSkin heterograft00255.4938$326.02$101.85$65.20
    15401TSkin heterograft add-on00255.4938$326.02$101.85$65.20
    15570TForm skin pedicle flap002718.4182$1,092.99$329.72$218.60
    15572TForm skin pedicle flap002718.4182$1,092.99$329.72$218.60
    15574TForm skin pedicle flap002718.4182$1,092.99$329.72$218.60
    15576TForm skin pedicle flap068613.8287$820.64$164.13
    15600TSkin graft002718.4182$1,092.99$329.72$218.60
    15610TSkin graft002718.4182$1,092.99$329.72$218.60
    15620TSkin graft002718.4182$1,092.99$329.72$218.60
    15630TSkin graft002718.4182$1,092.99$329.72$218.60
    15650TTransfer skin pedicle flap002718.4182$1,092.99$329.72$218.60
    15732TMuscle-skin graft, head/neck002718.4182$1,092.99$329.72$218.60
    15734TMuscle-skin graft, trunk002718.4182$1,092.99$329.72$218.60
    15736TMuscle-skin graft, arm002718.4182$1,092.99$329.72$218.60
    15738TMuscle-skin graft, leg002718.4182$1,092.99$329.72$218.60
    15740TIsland pedicle flap graft068613.8287$820.64$164.13
    15750TNeurovascular pedicle graft002718.4182$1,092.99$329.72$218.60
    15756CFree muscle flap, microvasc
    15757CFree skin flap, microvasc
    15758CFree fascial flap, microvasc
    15760TComposite skin graft002718.4182$1,092.99$329.72$218.60
    15770TDerma-fat-fascia graft002718.4182$1,092.99$329.72$218.60
    15775THair transplant punch grafts00255.4938$326.02$101.85$65.20
    15776THair transplant punch grafts00255.4938$326.02$101.85$65.20
    15780TAbrasion treatment of skin002219.6472$1,165.92$354.45$233.18
    15781TAbrasion treatment of skin00194.0547$240.62$71.87$48.12
    15782TDressing change not for burn00194.0547$240.62$71.87$48.12
    15783TAbrasion treatment of skin00162.5834$153.31$33.57$30.66
    15786TAbrasion, lesion, single00131.1078$65.74$14.20$13.15
    15787TAbrasion, lesions, add-on00131.1078$65.74$14.20$13.15
    15788TChemical peel, face, epiderm00120.8497$50.42$11.18$10.08
    15789TChemical peel, face, dermal00151.6514$98.00$20.29$19.60
    15792TChemical peel, nonfacial00131.1078$65.74$14.20$13.15
    15793TChemical peel, nonfacial00120.8497$50.42$11.18$10.08
    15810TSalabrasion00162.5834$153.31$33.57$30.66
    15811TSalabrasion00162.5834$153.31$33.57$30.66
    15819TPlastic surgery, neck00255.4938$326.02$101.85$65.20
    15820TRevision of lower eyelid002718.4182$1,092.99$329.72$218.60
    15821TRevision of lower eyelid002718.4182$1,092.99$329.72$218.60
    15822TRevision of upper eyelid002718.4182$1,092.99$329.72$218.60
    15823TRevision of upper eyelid002718.4182$1,092.99$329.72$218.60
    Start Printed Page 50705
    15824TRemoval of forehead wrinkles002718.4182$1,092.99$329.72$218.60
    15825TRemoval of neck wrinkles002718.4182$1,092.99$329.72$218.60
    15826TRemoval of brow wrinkles002718.4182$1,092.99$329.72$218.60
    15828TRemoval of face wrinkles002718.4182$1,092.99$329.72$218.60
    15829TRemoval of skin wrinkles002718.4182$1,092.99$329.72$218.60
    15831TExcise excessive skin tissue002219.6472$1,165.92$354.45$233.18
    15832TExcise excessive skin tissue002219.6472$1,165.92$354.45$233.18
    15833TExcise excessive skin tissue002219.6472$1,165.92$354.45$233.18
    15834TExcise excessive skin tissue002219.6472$1,165.92$354.45$233.18
    15835TExcise excessive skin tissue00255.4938$326.02$101.85$65.20
    15836TExcise excessive skin tissue002114.9776$888.82$219.48$177.76
    15837TExcise excessive skin tissue002114.9776$888.82$219.48$177.76
    15838TExcise excessive skin tissue002114.9776$888.82$219.48$177.76
    15839TExcise excessive skin tissue002114.9776$888.82$219.48$177.76
    15840TGraft for face nerve palsy002718.4182$1,092.99$329.72$218.60
    15841TGraft for face nerve palsy002718.4182$1,092.99$329.72$218.60
    15842TFlap for face nerve palsy002718.4182$1,092.99$329.72$218.60
    15845TSkin and muscle repair, face002718.4182$1,092.99$329.72$218.60
    15850TRemoval of sutures00162.5834$153.31$33.57$30.66
    15851TRemoval of sutures00162.5834$153.31$33.57$30.66
    15852XDressing change not for burn03400.6384$37.88$7.58
    15860XTest for blood flow in graft03590.8312$49.33$9.87
    15876TSuction assisted lipectomy002718.4182$1,092.99$329.72$218.60
    15877TSuction assisted lipectomy002718.4182$1,092.99$329.72$218.60
    15878TSuction assisted lipectomy068613.8287$820.64$164.13
    15879TSuction assisted lipectomy002718.4182$1,092.99$329.72$218.60
    15920TRemoval of tail bone ulcer00194.0547$240.62$71.87$48.12
    15922TRemoval of tail bone ulcer002718.4182$1,092.99$329.72$218.60
    15931TRemove sacrum pressure sore002219.6472$1,165.92$354.45$233.18
    15933TRemove sacrum pressure sore002219.6472$1,165.92$354.45$233.18
    15934TRemove sacrum pressure sore002718.4182$1,092.99$329.72$218.60
    15935TRemove sacrum pressure sore002718.4182$1,092.99$329.72$218.60
    15936TRemove sacrum pressure sore002718.4182$1,092.99$329.72$218.60
    15937TRemove sacrum pressure sore002718.4182$1,092.99$329.72$218.60
    15940TRemove hip pressure sore002219.6472$1,165.92$354.45$233.18
    15941TRemove hip pressure sore002219.6472$1,165.92$354.45$233.18
    15944TRemove hip pressure sore002718.4182$1,092.99$329.72$218.60
    15945TRemove hip pressure sore002718.4182$1,092.99$329.72$218.60
    15946TRemove hip pressure sore002718.4182$1,092.99$329.72$218.60
    15950TRemove thigh pressure sore002219.6472$1,165.92$354.45$233.18
    15951TRemove thigh pressure sore002219.6472$1,165.92$354.45$233.18
    15952TRemove thigh pressure sore002718.4182$1,092.99$329.72$218.60
    15953TRemove thigh pressure sore002718.4182$1,092.99$329.72$218.60
    15956TRemove thigh pressure sore002718.4182$1,092.99$329.72$218.60
    15958TRemove thigh pressure sore002718.4182$1,092.99$329.72$218.60
    15999TRemoval of pressure sore00194.0547$240.62$71.87$48.12
    16000TInitial treatment of burn(s)00120.8497$50.42$11.18$10.08
    16010TTreatment of burn(s)00162.5834$153.31$33.57$30.66
    16015TTreatment of burn(s)001718.4211$1,093.16$227.84$218.63
    16020TTreatment of burn(s)00131.1078$65.74$14.20$13.15
    16025TTreatment of burn(s)00131.1078$65.74$14.20$13.15
    16030TTreatment of burn(s)00151.6514$98.00$20.29$19.60
    16035CIncision of burn scab, initi
    16036CEscharotomy addl incision
    17000TDestroy benign/premlg lesion00100.5719$33.94$9.65$6.79
    17003TDestroy lesions, 2-1400100.5719$33.94$9.65$6.79
    17004TDestroy lesions, 15 or more00112.0839$123.66$25.17$24.73
    17106TDestruction of skin lesions00112.0839$123.66$25.17$24.73
    17107TDestruction of skin lesions00112.0839$123.66$25.17$24.73
    17108TDestruction of skin lesions00112.0839$123.66$25.17$24.73
    17110TDestruct lesion, 1-1400100.5719$33.94$9.65$6.79
    17111TDestruct lesion, 15 or more00100.5719$33.94$9.65$6.79
    17250TChemical cautery, tissue00131.1078$65.74$14.20$13.15
    17260TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17261TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17262TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    Start Printed Page 50706
    17263TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17264TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17266TDestruction of skin lesions00162.5834$153.31$33.57$30.66
    17270TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17271TDestruction of skin lesions00131.1078$65.74$14.20$13.15
    17272TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17273TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17274TDestruction of skin lesions00162.5834$153.31$33.57$30.66
    17276TDestruction of skin lesions00162.5834$153.31$33.57$30.66
    17280TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17281TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17282TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17283TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17284TDestruction of skin lesions00162.5834$153.31$33.57$30.66
    17286TDestruction of skin lesions00151.6514$98.00$20.29$19.60
    17304TChemosurgery of skin lesion06943.8452$228.19$61.86$45.64
    17305T2 stage mohs, up to 5 spec06943.8452$228.19$61.86$45.64
    17306T3 stage mohs, up to 5 spec06943.8452$228.19$61.86$45.64
    17307TMohs addl stage up to 5 spec06943.8452$228.19$61.86$45.64
    17310TExtensive skin chemosurgery06943.8452$228.19$61.86$45.64
    17340TCryotherapy of skin00120.8497$50.42$11.18$10.08
    17360TSkin peel therapy00131.1078$65.74$14.20$13.15
    17380THair removal by electrolysis00131.1078$65.74$14.20$13.15
    17999TSkin tissue procedure00061.55$91.98$22.28$18.40
    19000TDrainage of breast lesion00041.7646$104.72$22.36$20.94
    19001TDrain breast lesion add-on00041.7646$104.72$22.36$20.94
    19020TIncision of breast lesion000816.4989$979.09$195.82
    19030NInjection for breast x-ray
    19100TBx breast percut w/o image00053.5994$213.60$71.59$42.72
    19101TBiopsy of breast, open002819.5801$1,161.94$303.74$232.39
    19102TBx breast percut w/image00053.5994$213.60$71.59$42.72
    19103TBx breast percut w/device06586.1049$362.28$72.46
    19110Tnipple exploration002819.5801$1,161.94$303.74$232.39
    19112TExcise breast duct fistula002819.5801$1,161.94$303.74$232.39
    19120TRemoval of breast lesion002819.5801$1,161.94$303.74$232.39
    19125TExcision, breast lesion002819.5801$1,161.94$303.74$232.39
    19126TExcision, addl breast lesion002819.5801$1,161.94$303.74$232.39
    19140TRemoval of breast tissue002819.5801$1,161.94$303.74$232.39
    19160TRemoval of breast tissue002819.5801$1,161.94$303.74$232.39
    19162TRemove breast tissue, nodes069342.2254$2,505.78$798.17$501.16
    19180TRemoval of breast002932.0476$1,901.80$632.64$380.36
    19182TRemoval of breast002932.0476$1,901.80$632.64$380.36
    19200CRemoval of breast
    19220CRemoval of breast
    19240TRemoval of breast003040.0825$2,378.62$763.55$475.72
    19260TRemoval of chest wall lesion002114.9776$888.82$219.48$177.76
    19271CRevision of chest wall
    19272CExtensive chest wall surgery
    19290NPlace needle wire, breast
    19291NPlace needle wire, breast
    19295SPlace breast clip, percut06571.7092$101.43$20.29
    19296SPlace po breast cath for rad1524$3,250.00$650.00
    19297SPlace breast cath for rad1523$2,750.00$550.00
    19298SPlace breast rad tube/caths1524$3,250.00$650.00
    19316TSuspension of breast002932.0476$1,901.80$632.64$380.36
    19318TReduction of large breast069342.2254$2,505.78$798.17$501.16
    19324TEnlarge breast069342.2254$2,505.78$798.17$501.16
    19325TEnlarge breast with implant064850.4459$2,993.61$598.72
    19328TRemoval of breast implant002932.0476$1,901.80$632.64$380.36
    19330TRemoval of implant material002932.0476$1,901.80$632.64$380.36
    19340TImmediate breast prosthesis003040.0825$2,378.62$763.55$475.72
    19342TDelayed breast prosthesis064850.4459$2,993.61$598.72
    19350TBreast reconstruction002819.5801$1,161.94$303.74$232.39
    19355TCorrect inverted nipple(s)002932.0476$1,901.80$632.64$380.36
    19357TBreast reconstruction064850.4459$2,993.61$598.72
    19361CBreast reconstruction
    Start Printed Page 50707
    19364CBreast reconstruction
    19366TBreast reconstruction002932.0476$1,901.80$632.64$380.36
    19367CBreast reconstruction
    19368CBreast reconstruction
    19369CBreast reconstruction
    19370TSurgery of breast capsule002932.0476$1,901.80$632.64$380.36
    19371TRemoval of breast capsule002932.0476$1,901.80$632.64$380.36
    19380TRevise breast reconstruction003040.0825$2,378.62$763.55$475.72
    19396TDesign custom breast implant002932.0476$1,901.80$632.64$380.36
    19499TBreast surgery procedure002819.5801$1,161.94$303.74$232.39
    20000TIncision of abscess00061.55$91.98$22.28$18.40
    20005TIncision of deep abscess004920.3707$1,208.86$241.77
    2000FEBlood pressure, measured
    20100TExplore wound, neck00234.7775$283.51$56.70
    20101TExplore wound, chest002718.4182$1,092.99$329.72$218.60
    20102TExplore wound, abdomen002718.4182$1,092.99$329.72$218.60
    20103TExplore wound, extremity00234.7775$283.51$56.70
    20150TExcise epiphyseal bar005136.5271$2,167.63$433.53
    20200TMuscle biopsy002114.9776$888.82$219.48$177.76
    20205TDeep muscle biopsy002114.9776$888.82$219.48$177.76
    20206TNeedle biopsy, muscle00053.5994$213.60$71.59$42.72
    20220TBone biopsy, trocar/needle00194.0547$240.62$71.87$48.12
    20225TBone biopsy, trocar/needle00206.9433$412.04$107.40$82.41
    20240TBone biopsy, excisional002219.6472$1,165.92$354.45$233.18
    20245TBone biopsy, excisional002219.6472$1,165.92$354.45$233.18
    20250TOpen bone biopsy004920.3707$1,208.86$241.77
    20251TOpen bone biopsy004920.3707$1,208.86$241.77
    20500TInjection of sinus tract02512.0101$119.29$23.86
    20501NInject sinus tract for x-ray
    20520TRemoval of foreign body00194.0547$240.62$71.87$48.12
    20525TRemoval of foreign body002219.6472$1,165.92$354.45$233.18
    20526TTher injection, carp tunnel02042.191$130.02$40.13$26.00
    20550TInject tendon/ligament/cyst02042.191$130.02$40.13$26.00
    20551TInj tendon origin/insertion02042.191$130.02$40.13$26.00
    20552TInj trigger point, 1/2 muscl02042.191$130.02$40.13$26.00
    20553TInject trigger points, > 302042.191$130.02$40.13$26.00
    20600TDrain/inject, joint/bursa02042.191$130.02$40.13$26.00
    20605TDrain/inject, joint/bursa02042.191$130.02$40.13$26.00
    20610TDrain/inject, joint/bursa02042.191$130.02$40.13$26.00
    20612TAspirate/inj ganglion cyst02042.191$130.02$40.13$26.00
    20615TTreatment of bone cyst00041.7646$104.72$22.36$20.94
    20650TInsert and remove bone pin004920.3707$1,208.86$241.77
    20660CApply, rem fixation device
    20661CApplication of head brace
    20662TApplication of pelvis brace004920.3707$1,208.86$241.77
    20663TApplication of thigh brace004920.3707$1,208.86$241.77
    20664CHalo brace application
    20665XRemoval of fixation device03400.6384$37.88$7.58
    20670TRemoval of support implant002114.9776$888.82$219.48$177.76
    20680TRemoval of support implant002219.6472$1,165.92$354.45$233.18
    20690TApply bone fixation device005023.9081$1,418.78$283.76
    20692TApply bone fixation device005023.9081$1,418.78$283.76
    20693TAdjust bone fixation device004920.3707$1,208.86$241.77
    20694TRemove bone fixation device004920.3707$1,208.86$241.77
    20802CReplantation, arm, complete
    20805CReplant forearm, complete
    20808CReplantation hand, complete
    20816CReplantation digit, complete
    20822TReplantation digit, complete005425.3711$1,505.60$301.12
    20824CReplantation thumb, complete
    20827CReplantation thumb, complete
    20838CReplantation foot, complete
    20900TRemoval of bone for graft005023.9081$1,418.78$283.76
    20902TRemoval of bone for graft005023.9081$1,418.78$283.76
    20910TRemove cartilage for graft002718.4182$1,092.99$329.72$218.60
    20912TRemove cartilage for graft002718.4182$1,092.99$329.72$218.60
    Start Printed Page 50708
    20920TRemoval of fascia for graft068613.8287$820.64$164.13
    20922TRemoval of fascia for graft002718.4182$1,092.99$329.72$218.60
    20924TRemoval of tendon for graft005023.9081$1,418.78$283.76
    20926TRemoval of tissue for graft068613.8287$820.64$164.13
    20930CSpinal bone allograft
    20931CSpinal bone allograft
    20936CSpinal bone autograft
    20937CSpinal bone autograft
    20938CSpinal bone autograft
    20950TFluid pressure, muscle00061.55$91.98$22.28$18.40
    20955CFibula bone graft, microvasc
    20956CIliac bone graft, microvasc
    20957CMt bone graft, microvasc
    20962COther bone graft, microvasc
    20969CBone/skin graft, microvasc
    20970CBone/skin graft, iliac crest
    20972TBone/skin graft, metatarsal005640.2957$2,391.27$478.25
    20973TBone/skin graft, great toe005640.2957$2,391.27$478.25
    20974AElectrical bone stimulation
    20975XElectrical bone stimulation03400.6384$37.88$7.58
    20979AUs bone stimulation
    20982TAblate, bone tumor(s) perq1557$1,850.00$370.00
    20999TMusculoskeletal surgery004920.3707$1,208.86$241.77
    21010TIncision of jaw joint025423.404$1,388.86$321.35$277.77
    21015TResection of facial tumor025316.1357$957.54$282.29$191.51
    21025TExcision of bone, lower jaw025637.3204$2,214.70$442.94
    21026TExcision of facial bone(s)025637.3204$2,214.70$442.94
    21029TContour of face bone lesion025637.3204$2,214.70$442.94
    21030TRemoval of face bone lesion025423.404$1,388.86$321.35$277.77
    21031TRemove exostosis, mandible025423.404$1,388.86$321.35$277.77
    21032TRemove exostosis, maxilla025423.404$1,388.86$321.35$277.77
    21034TRemoval of face bone lesion025637.3204$2,214.70$442.94
    21040TRemoval of jaw bone lesion025423.404$1,388.86$321.35$277.77
    21044TRemoval of jaw bone lesion025637.3204$2,214.70$442.94
    21045CExtensive jaw surgery
    21046TRemove mandible cyst complex025637.3204$2,214.70$442.94
    21047TExcise lwr jaw cyst w/repair025637.3204$2,214.70$442.94
    21048TRemove maxilla cyst complex025637.3204$2,214.70$442.94
    21049TExcis uppr jaw cyst w/repair025637.3204$2,214.70$442.94
    21050TRemoval of jaw joint025637.3204$2,214.70$442.94
    21060TRemove jaw joint cartilage025637.3204$2,214.70$442.94
    21070TRemove coronoid process025637.3204$2,214.70$442.94
    21076TPrepare face/oral prosthesis025423.404$1,388.86$321.35$277.77
    21077TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21079TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21080TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21081TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21082TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21083TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21084TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21085TPrepare face/oral prosthesis025316.1357$957.54$282.29$191.51
    21086TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21087TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21088TPrepare face/oral prosthesis025637.3204$2,214.70$442.94
    21089TPrepare face/oral prosthesis02512.0101$119.29$23.86
    21100TMaxillofacial fixation025637.3204$2,214.70$442.94
    21110TInterdental fixation02527.8673$466.87$113.41$93.37
    21116NInjection, jaw joint x-ray
    21120TReconstruction of chin025423.404$1,388.86$321.35$277.77
    21121TReconstruction of chin025423.404$1,388.86$321.35$277.77
    21122TReconstruction of chin025423.404$1,388.86$321.35$277.77
    21123TReconstruction of chin025423.404$1,388.86$321.35$277.77
    21125TAugmentation, lower jaw bone025423.404$1,388.86$321.35$277.77
    21127TAugmentation, lower jaw bone025637.3204$2,214.70$442.94
    21137TReduction of forehead025423.404$1,388.86$321.35$277.77
    21138TReduction of forehead025637.3204$2,214.70$442.94
    Start Printed Page 50709
    21139TReduction of forehead025637.3204$2,214.70$442.94
    21141CReconstruct midface, lefort
    21142CReconstruct midface, lefort
    21143CReconstruct midface, lefort
    21145CReconstruct midface, lefort
    21146CReconstruct midface, lefort
    21147CReconstruct midface, lefort
    21150TReconstruct midface, lefort025637.3204$2,214.70$442.94
    21151CReconstruct midface, lefort
    21154CReconstruct midface, lefort
    21155CReconstruct midface, lefort
    21159CReconstruct midface, lefort
    21160CReconstruct midface, lefort
    21172CReconstruct orbit/forehead
    21175TReconstruct orbit/forehead025637.3204$2,214.70$442.94
    21179CReconstruct entire forehead
    21180CReconstruct entire forehead
    21181TContour cranial bone lesion025423.404$1,388.86$321.35$277.77
    21182CReconstruct cranial bone
    21183CReconstruct cranial bone
    21184CReconstruct cranial bone
    21188CReconstruction of midface
    21193CReconst lwr jaw w/o graft
    21194CReconst lwr jaw w/graft
    21195TReconst lwr jaw w/o fixation025637.3204$2,214.70$442.94
    21196CReconst lwr jaw w/fixation
    21198TReconstr lwr jaw segment025637.3204$2,214.70$442.94
    21199TReconstr lwr jaw w/advance025637.3204$2,214.70$442.94
    21206TReconstruct upper jaw bone025637.3204$2,214.70$442.94
    21208TAugmentation of facial bones025637.3204$2,214.70$442.94
    21209TReduction of facial bones025637.3204$2,214.70$442.94
    21210TFace bone graft025637.3204$2,214.70$442.94
    21215TLower jaw bone graft025637.3204$2,214.70$442.94
    21230TRib cartilage graft025637.3204$2,214.70$442.94
    21235TEar cartilage graft025423.404$1,388.86$321.35$277.77
    21240TReconstruction of jaw joint025637.3204$2,214.70$442.94
    21242TReconstruction of jaw joint025637.3204$2,214.70$442.94
    21243TReconstruction of jaw joint025637.3204$2,214.70$442.94
    21244TReconstruction of lower jaw025637.3204$2,214.70$442.94
    21245TReconstruction of jaw025637.3204$2,214.70$442.94
    21246TReconstruction of jaw025637.3204$2,214.70$442.94
    21247CReconstruct lower jaw bone
    21248TReconstruction of jaw025637.3204$2,214.70$442.94
    21249TReconstruction of jaw025637.3204$2,214.70$442.94
    21255CReconstruct lower jaw bone
    21256CReconstruction of orbit
    21260TRevise eye sockets025637.3204$2,214.70$442.94
    21261TRevise eye sockets025637.3204$2,214.70$442.94
    21263TRevise eye sockets025637.3204$2,214.70$442.94
    21267TRevise eye sockets025637.3204$2,214.70$442.94
    21268CRevise eye sockets
    21270TAugmentation, cheek bone025637.3204$2,214.70$442.94
    21275TRevision, orbitofacial bones025637.3204$2,214.70$442.94
    21280TRevision of eyelid025637.3204$2,214.70$442.94
    21282TRevision of eyelid025316.1357$957.54$282.29$191.51
    21295TRevision of jaw muscle/bone02527.8673$466.87$113.41$93.37
    21296TRevision of jaw muscle/bone025423.404$1,388.86$321.35$277.77
    21299TCranio/maxillofacial surgery02512.0101$119.29$23.86
    21300TTreatment of skull fracture025316.1357$957.54$282.29$191.51
    21310TTreatment of nose fracture02512.0101$119.29$23.86
    21315TTreatment of nose fracture02512.0101$119.29$23.86
    21320TTreatment of nose fracture02527.8673$466.87$113.41$93.37
    21325TTreatment of nose fracture025423.404$1,388.86$321.35$277.77
    21330TTreatment of nose fracture025423.404$1,388.86$321.35$277.77
    21335TTreatment of nose fracture025423.404$1,388.86$321.35$277.77
    21336TTreat nasal septal fracture004637.7023$2,237.37$535.76$447.47
    Start Printed Page 50710
    21337TTreat nasal septal fracture025316.1357$957.54$282.29$191.51
    21338TTreat nasoethmoid fracture025423.404$1,388.86$321.35$277.77
    21339TTreat nasoethmoid fracture025423.404$1,388.86$321.35$277.77
    21340TTreatment of nose fracture025637.3204$2,214.70$442.94
    21343CTreatment of sinus fracture
    21344CTreatment of sinus fracture
    21345TTreat nose/jaw fracture025423.404$1,388.86$321.35$277.77
    21346CTreat nose/jaw fracture
    21347CTreat nose/jaw fracture
    21348CTreat nose/jaw fracture
    21355TTreat cheek bone fracture025637.3204$2,214.70$442.94
    21356TTreat cheek bone fracture025423.404$1,388.86$321.35$277.77
    21360CTreat cheek bone fracture
    21365CTreat cheek bone fracture
    21366CTreat cheek bone fracture
    21385CTreat eye socket fracture
    21386CTreat eye socket fracture
    21387CTreat eye socket fracture
    21390TTreat eye socket fracture025637.3204$2,214.70$442.94
    21395CTreat eye socket fracture
    21400TTreat eye socket fracture02527.8673$466.87$113.41$93.37
    21401TTreat eye socket fracture025316.1357$957.54$282.29$191.51
    21406TTreat eye socket fracture025637.3204$2,214.70$442.94
    21407TTreat eye socket fracture025637.3204$2,214.70$442.94
    21408TTreat eye socket fracture025637.3204$2,214.70$442.94
    21421TTreat mouth roof fracture025423.404$1,388.86$321.35$277.77
    21422CTreat mouth roof fracture
    21423CTreat mouth roof fracture
    21431CTreat craniofacial fracture
    21432CTreat craniofacial fracture
    21433CTreat craniofacial fracture
    21435CTreat craniofacial fracture
    21436CTreat craniofacial fracture
    21440TTreat dental ridge fracture025423.404$1,388.86$321.35$277.77
    21445TTreat dental ridge fracture025423.404$1,388.86$321.35$277.77
    21450TTreat lower jaw fracture02512.0101$119.29$23.86
    21451TTreat lower jaw fracture02527.8673$466.87$113.41$93.37
    21452TTreat lower jaw fracture025316.1357$957.54$282.29$191.51
    21453TTreat lower jaw fracture025637.3204$2,214.70$442.94
    21454TTreat lower jaw fracture025423.404$1,388.86$321.35$277.77
    21461TTreat lower jaw fracture025637.3204$2,214.70$442.94
    21462TTreat lower jaw fracture025637.3204$2,214.70$442.94
    21465TTreat lower jaw fracture025637.3204$2,214.70$442.94
    21470TTreat lower jaw fracture025637.3204$2,214.70$442.94
    21480TReset dislocated jaw02512.0101$119.29$23.86
    21485TReset dislocated jaw025316.1357$957.54$282.29$191.51
    21490TRepair dislocated jaw025637.3204$2,214.70$442.94
    21493TTreat hyoid bone fracture02527.8673$466.87$113.41$93.37
    21494TTreat hyoid bone fracture02527.8673$466.87$113.41$93.37
    21495TTreat hyoid bone fracture025316.1357$957.54$282.29$191.51
    21497TInterdental wiring025316.1357$957.54$282.29$191.51
    21499THead surgery procedure02512.0101$119.29$23.86
    21501TDrain neck/chest lesion000816.4989$979.09$195.82
    21502TDrain chest lesion004920.3707$1,208.86$241.77
    21510CDrainage of bone lesion
    21550TBiopsy of neck/chest002114.9776$888.82$219.48$177.76
    21555TRemove lesion, neck/chest002219.6472$1,165.92$354.45$233.18
    21556TRemove lesion, neck/chest002219.6472$1,165.92$354.45$233.18
    21557TRemove tumor, neck/chest002219.6472$1,165.92$354.45$233.18
    21600TPartial removal of rib005023.9081$1,418.78$283.76
    21610TPartial removal of rib005023.9081$1,418.78$283.76
    21615CRemoval of rib
    21616CRemoval of rib and nerves
    21620CPartial removal of sternum
    21627CSternal debridement
    21630CExtensive sternum surgery
    Start Printed Page 50711
    21632CExtensive sternum surgery
    21685THyoid myotomy & suspension02527.8673$466.87$113.41$93.37
    21700TRevision of neck muscle004920.3707$1,208.86$241.77
    21705CRevision of neck muscle/rib
    21720TRevision of neck muscle004920.3707$1,208.86$241.77
    21725TRevision of neck muscle00061.55$91.98$22.28$18.40
    21740CReconstruction of sternum
    21742TRepair stern/nuss w/o scope005136.5271$2,167.63$433.53
    21743TRepair sternum/nuss w/scope005136.5271$2,167.63$433.53
    21750CRepair of sternum separation
    21800TTreatment of rib fracture00431.7694$105.00$21.00
    21805TTreatment of rib fracture004637.7023$2,237.37$535.76$447.47
    21810CTreatment of rib fracture(s)
    21820TTreat sternum fracture00431.7694$105.00$21.00
    21825CTreat sternum fracture
    21899TNeck/chest surgery procedure02512.0101$119.29$23.86
    21920TBiopsy soft tissue of back00206.9433$412.04$107.40$82.41
    21925TBiopsy soft tissue of back002219.6472$1,165.92$354.45$233.18
    21930TRemove lesion, back or flank002219.6472$1,165.92$354.45$233.18
    21935TRemove tumor, back002219.6472$1,165.92$354.45$233.18
    22100TRemove part of neck vertebra020842.3409$2,512.64$502.53
    22101TRemove part, thorax vertebra020842.3409$2,512.64$502.53
    22102TRemove part, lumbar vertebra020842.3409$2,512.64$502.53
    22103TRemove extra spine segment020842.3409$2,512.64$502.53
    22110CRemove part of neck vertebra
    22112CRemove part, thorax vertebra
    22114CRemove part, lumbar vertebra
    22116CRemove extra spine segment
    22210CRevision of neck spine
    22212CRevision of thorax spine
    22214CRevision of lumbar spine
    22216CRevise, extra spine segment
    22220CRevision of neck spine
    22222TRevision of thorax spine020842.3409$2,512.64$502.53
    22224CRevision of lumbar spine
    22226CRevise, extra spine segment
    22305TTreat spine process fracture00431.7694$105.00$21.00
    22310TTreat spine fracture00431.7694$105.00$21.00
    22315TTreat spine fracture00431.7694$105.00$21.00
    22318CTreat odontoid fx w/o graft
    22319CTreat odontoid fx w/graft
    22325CTreat spine fracture
    22326CTreat neck spine fracture
    22327CTreat thorax spine fracture
    22328CTreat each add spine fx
    22505TManipulation of spine004514.4945$860.15$268.47$172.03
    22520TPercut vertebroplasty thor005023.9081$1,418.78$283.76
    22521TPercut vertebroplasty lumb005023.9081$1,418.78$283.76
    22522TPercut vertebroplasty add'l005023.9081$1,418.78$283.76
    22532CLat thorax spine fusion
    22533CLat lumbar spine fusion
    22534CLat thor/lumb, add'l seg
    22548CNeck spine fusion
    22554CNeck spine fusion
    22556CThorax spine fusion
    22558CLumbar spine fusion
    22585CAdditional spinal fusion
    22590CSpine & skull spinal fusion
    22595CNeck spinal fusion
    22600CNeck spine fusion
    22610CThorax spine fusion
    22612TLumbar spine fusion020842.3409$2,512.64$502.53
    22614TSpine fusion, extra segment020842.3409$2,512.64$502.53
    22630CLumbar spine fusion
    22632CSpine fusion, extra segment
    22800CFusion of spine
    Start Printed Page 50712
    22802CFusion of spine
    22804CFusion of spine
    22808CFusion of spine
    22810CFusion of spine
    22812CFusion of spine
    22818CKyphectomy, 1-2 segments
    22819CKyphectomy, 3 or more
    22830CExploration of spinal fusion
    22840CInsert spine fixation device
    22841CInsert spine fixation device
    22842CInsert spine fixation device
    22843CInsert spine fixation device
    22844CInsert spine fixation device
    22845CInsert spine fixation device
    22846CInsert spine fixation device
    22847CInsert spine fixation device
    22848CInsert pelv fixation device
    22849CReinsert spinal fixation
    22850CRemove spine fixation device
    22851CApply spine prosth device
    22852CRemove spine fixation device
    22855CRemove spine fixation device
    22899TSpine surgery procedure00431.7694$105.00$21.00
    22900TRemove abdominal wall lesion002219.6472$1,165.92$354.45$233.18
    22999TAbdomen surgery procedure00194.0547$240.62$71.87$48.12
    23000TRemoval of calcium deposits002114.9776$888.82$219.48$177.76
    23020TRelease shoulder joint005136.5271$2,167.63$433.53
    23030TDrain shoulder lesion000816.4989$979.09$195.82
    23031TDrain shoulder bursa000816.4989$979.09$195.82
    23035TDrain shoulder bone lesion004920.3707$1,208.86$241.77
    23040TExploratory shoulder surgery005023.9081$1,418.78$283.76
    23044TExploratory shoulder surgery005023.9081$1,418.78$283.76
    23065TBiopsy shoulder tissues002114.9776$888.82$219.48$177.76
    23066TBiopsy shoulder tissues002219.6472$1,165.92$354.45$233.18
    23075TRemoval of shoulder lesion002114.9776$888.82$219.48$177.76
    23076TRemoval of shoulder lesion002219.6472$1,165.92$354.45$233.18
    23077TRemove tumor of shoulder002219.6472$1,165.92$354.45$233.18
    23100TBiopsy of shoulder joint004920.3707$1,208.86$241.77
    23101TShoulder joint surgery005023.9081$1,418.78$283.76
    23105TRemove shoulder joint lining005023.9081$1,418.78$283.76
    23106TIncision of collarbone joint005023.9081$1,418.78$283.76
    23107TExplore treat shoulder joint005023.9081$1,418.78$283.76
    23120TPartial removal, collar bone005136.5271$2,167.63$433.53
    23125TRemoval of collar bone005136.5271$2,167.63$433.53
    23130TRemove shoulder bone, part005136.5271$2,167.63$433.53
    23140TRemoval of bone lesion004920.3707$1,208.86$241.77
    23145TRemoval of bone lesion005023.9081$1,418.78$283.76
    23146TRemoval of bone lesion005023.9081$1,418.78$283.76
    23150TRemoval of humerus lesion005023.9081$1,418.78$283.76
    23155TRemoval of humerus lesion005023.9081$1,418.78$283.76
    23156TRemoval of humerus lesion005023.9081$1,418.78$283.76
    23170TRemove collar bone lesion005023.9081$1,418.78$283.76
    23172TRemove shoulder blade lesion005023.9081$1,418.78$283.76
    23174TRemove humerus lesion005023.9081$1,418.78$283.76
    23180TRemove collar bone lesion005023.9081$1,418.78$283.76
    23182TRemove shoulder blade lesion005023.9081$1,418.78$283.76
    23184TRemove humerus lesion005023.9081$1,418.78$283.76
    23190TPartial removal of scapula005023.9081$1,418.78$283.76
    23195TRemoval of head of humerus005023.9081$1,418.78$283.76
    23200CRemoval of collar bone
    23210CRemoval of shoulder blade
    23220CPartial removal of humerus
    23221CPartial removal of humerus
    23222CPartial removal of humerus
    23330TRemove shoulder foreign body00206.9433$412.04$107.40$82.41
    23331TRemove shoulder foreign body002219.6472$1,165.92$354.45$233.18
    Start Printed Page 50713
    23332CRemove shoulder foreign body
    23350NInjection for shoulder x-ray
    23395TMuscle transfer,shoulder/arm005136.5271$2,167.63$433.53
    23397TMuscle transfers005243.9378$2,607.40$521.48
    23400TFixation of shoulder blade005023.9081$1,418.78$283.76
    23405TIncision of tendon & muscle005023.9081$1,418.78$283.76
    23406TIncise tendon(s) & muscle(s)005023.9081$1,418.78$283.76
    23410TRepair of tendon(s)005243.9378$2,607.40$521.48
    23412TRepair rotator cuff, chronic005243.9378$2,607.40$521.48
    23415TRelease of shoulder ligament005136.5271$2,167.63$433.53
    23420TRepair of shoulder005243.9378$2,607.40$521.48
    23430TRepair biceps tendon005243.9378$2,607.40$521.48
    23440TRemove/transplant tendon005243.9378$2,607.40$521.48
    23450TRepair shoulder capsule005243.9378$2,607.40$521.48
    23455TRepair shoulder capsule005243.9378$2,607.40$521.48
    23460TRepair shoulder capsule005243.9378$2,607.40$521.48
    23462TRepair shoulder capsule005243.9378$2,607.40$521.48
    23465TRepair shoulder capsule005243.9378$2,607.40$521.48
    23466TRepair shoulder capsule005243.9378$2,607.40$521.48
    23470TReconstruct shoulder joint0425100.2058$5,946.51$1,378.01$1,189.30
    23472CReconstruct shoulder joint
    23480TRevision of collar bone005136.5271$2,167.63$433.53
    23485TRevision of collar bone005136.5271$2,167.63$433.53
    23490TReinforce clavicle005136.5271$2,167.63$433.53
    23491TReinforce shoulder bones005136.5271$2,167.63$433.53
    23500TTreat clavicle fracture00431.7694$105.00$21.00
    23505TTreat clavicle fracture00431.7694$105.00$21.00
    23515TTreat clavicle fracture004637.7023$2,237.37$535.76$447.47
    23520TTreat clavicle dislocation00431.7694$105.00$21.00
    23525TTreat clavicle dislocation00431.7694$105.00$21.00
    23530TTreat clavicle dislocation004637.7023$2,237.37$535.76$447.47
    23532TTreat clavicle dislocation004637.7023$2,237.37$535.76$447.47
    23540TTreat clavicle dislocation00431.7694$105.00$21.00
    23545TTreat clavicle dislocation00431.7694$105.00$21.00
    23550TTreat clavicle dislocation004637.7023$2,237.37$535.76$447.47
    23552TTreat clavicle dislocation004637.7023$2,237.37$535.76$447.47
    23570TTreat shoulder blade fx00431.7694$105.00$21.00
    23575TTreat shoulder blade fx00431.7694$105.00$21.00
    23585TTreat scapula fracture004637.7023$2,237.37$535.76$447.47
    23600TTreat humerus fracture00431.7694$105.00$21.00
    23605TTreat humerus fracture00431.7694$105.00$21.00
    23615TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    23616TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    23620TTreat humerus fracture00431.7694$105.00$21.00
    23625TTreat humerus fracture00431.7694$105.00$21.00
    23630TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    23650TTreat shoulder dislocation00431.7694$105.00$21.00
    23655TTreat shoulder dislocation004514.4945$860.15$268.47$172.03
    23660TTreat shoulder dislocation004637.7023$2,237.37$535.76$447.47
    23665TTreat dislocation/fracture00431.7694$105.00$21.00
    23670TTreat dislocation/fracture004637.7023$2,237.37$535.76$447.47
    23675TTreat dislocation/fracture00431.7694$105.00$21.00
    23680TTreat dislocation/fracture004637.7023$2,237.37$535.76$447.47
    23700TFixation of shoulder004514.4945$860.15$268.47$172.03
    23800TFusion of shoulder joint005136.5271$2,167.63$433.53
    23802TFusion of shoulder joint005136.5271$2,167.63$433.53
    23900CAmputation of arm & girdle
    23920CAmputation at shoulder joint
    23921TAmputation follow-up surgery00255.4938$326.02$101.85$65.20
    23929TShoulder surgery procedure00431.7694$105.00$21.00
    23930TDrainage of arm lesion000816.4989$979.09$195.82
    23931TDrainage of arm bursa000816.4989$979.09$195.82
    23935TDrain arm/elbow bone lesion004920.3707$1,208.86$241.77
    24000TExploratory elbow surgery005023.9081$1,418.78$283.76
    24006TRelease elbow joint005023.9081$1,418.78$283.76
    24065TBiopsy arm/elbow soft tissue002114.9776$888.82$219.48$177.76
    Start Printed Page 50714
    24066TBiopsy arm/elbow soft tissue002114.9776$888.82$219.48$177.76
    24075TRemove arm/elbow lesion002114.9776$888.82$219.48$177.76
    24076TRemove arm/elbow lesion002219.6472$1,165.92$354.45$233.18
    24077TRemove tumor of arm/elbow002219.6472$1,165.92$354.45$233.18
    24100TBiopsy elbow joint lining004920.3707$1,208.86$241.77
    24101TExplore/treat elbow joint005023.9081$1,418.78$283.76
    24102TRemove elbow joint lining005023.9081$1,418.78$283.76
    24105TRemoval of elbow bursa004920.3707$1,208.86$241.77
    24110TRemove humerus lesion004920.3707$1,208.86$241.77
    24115TRemove/graft bone lesion005023.9081$1,418.78$283.76
    24116TRemove/graft bone lesion005023.9081$1,418.78$283.76
    24120TRemove elbow lesion004920.3707$1,208.86$241.77
    24125TRemove/graft bone lesion005023.9081$1,418.78$283.76
    24126TRemove/graft bone lesion005023.9081$1,418.78$283.76
    24130TRemoval of head of radius005023.9081$1,418.78$283.76
    24134TRemoval of arm bone lesion005023.9081$1,418.78$283.76
    24136TRemove radius bone lesion005023.9081$1,418.78$283.76
    24138TRemove elbow bone lesion005023.9081$1,418.78$283.76
    24140TPartial removal of arm bone005023.9081$1,418.78$283.76
    24145TPartial removal of radius005023.9081$1,418.78$283.76
    24147TPartial removal of elbow005023.9081$1,418.78$283.76
    24149TRadical resection of elbow005023.9081$1,418.78$283.76
    24150TExtensive humerus surgery005243.9378$2,607.40$521.48
    24151TExtensive humerus surgery005243.9378$2,607.40$521.48
    24152TExtensive radius surgery005243.9378$2,607.40$521.48
    24153TExtensive radius surgery005243.9378$2,607.40$521.48
    24155TRemoval of elbow joint005136.5271$2,167.63$433.53
    24160TRemove elbow joint implant005023.9081$1,418.78$283.76
    24164TRemove radius head implant005023.9081$1,418.78$283.76
    24200TRemoval of arm foreign body00194.0547$240.62$71.87$48.12
    24201TRemoval of arm foreign body002114.9776$888.82$219.48$177.76
    24220NInjection for elbow x-ray
    24300TManipulate elbow w/anesth004514.4945$860.15$268.47$172.03
    24301TMuscle/tendon transfer005023.9081$1,418.78$283.76
    24305TArm tendon lengthening005023.9081$1,418.78$283.76
    24310TRevision of arm tendon004920.3707$1,208.86$241.77
    24320TRepair of arm tendon005136.5271$2,167.63$433.53
    24330TRevision of arm muscles005136.5271$2,167.63$433.53
    24331TRevision of arm muscles005136.5271$2,167.63$433.53
    24332TTenolysis, triceps004920.3707$1,208.86$241.77
    24340TRepair of biceps tendon005136.5271$2,167.63$433.53
    24341TRepair arm tendon/muscle005136.5271$2,167.63$433.53
    24342TRepair of ruptured tendon005136.5271$2,167.63$433.53
    24343TRepr elbow lat ligmnt w/tiss005023.9081$1,418.78$283.76
    24344TReconstruct elbow lat ligmnt005136.5271$2,167.63$433.53
    24345TRepr elbw med ligmnt w/tissu005023.9081$1,418.78$283.76
    24346TReconstruct elbow med ligmnt005136.5271$2,167.63$433.53
    24350TRepair of tennis elbow005023.9081$1,418.78$283.76
    24351TRepair of tennis elbow005023.9081$1,418.78$283.76
    24352TRepair of tennis elbow005023.9081$1,418.78$283.76
    24354TRepair of tennis elbow005023.9081$1,418.78$283.76
    24356TRevision of tennis elbow005023.9081$1,418.78$283.76
    24360TReconstruct elbow joint004731.6107$1,875.87$537.03$375.17
    24361TReconstruct elbow joint0425100.2058$5,946.51$1,378.01$1,189.30
    24362TReconstruct elbow joint004843.1288$2,559.39$570.30$511.88
    24363TReplace elbow joint0425100.2058$5,946.51$1,378.01$1,189.30
    24365TReconstruct head of radius004731.6107$1,875.87$537.03$375.17
    24366TReconstruct head of radius0425100.2058$5,946.51$1,378.01$1,189.30
    24400TRevision of humerus005023.9081$1,418.78$283.76
    24410TRevision of humerus005023.9081$1,418.78$283.76
    24420TRevision of humerus005136.5271$2,167.63$433.53
    24430TRepair of humerus005136.5271$2,167.63$433.53
    24435TRepair humerus with graft005136.5271$2,167.63$433.53
    24470TRevision of elbow joint005136.5271$2,167.63$433.53
    24495TDecompression of forearm005023.9081$1,418.78$283.76
    24498TReinforce humerus005136.5271$2,167.63$433.53
    Start Printed Page 50715
    24500TTreat humerus fracture00431.7694$105.00$21.00
    24505TTreat humerus fracture00431.7694$105.00$21.00
    24515TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24516TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24530TTreat humerus fracture00431.7694$105.00$21.00
    24535TTreat humerus fracture00431.7694$105.00$21.00
    24538TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24545TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24546TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24560TTreat humerus fracture00431.7694$105.00$21.00
    24565TTreat humerus fracture00431.7694$105.00$21.00
    24566TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24575TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24576TTreat humerus fracture00431.7694$105.00$21.00
    24577TTreat humerus fracture00431.7694$105.00$21.00
    24579TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24582TTreat humerus fracture004637.7023$2,237.37$535.76$447.47
    24586TTreat elbow fracture004637.7023$2,237.37$535.76$447.47
    24587TTreat elbow fracture004637.7023$2,237.37$535.76$447.47
    24600TTreat elbow dislocation00431.7694$105.00$21.00
    24605TTreat elbow dislocation004514.4945$860.15$268.47$172.03
    24615TTreat elbow dislocation004637.7023$2,237.37$535.76$447.47
    24620TTreat elbow fracture00431.7694$105.00$21.00
    24635TTreat elbow fracture004637.7023$2,237.37$535.76$447.47
    24640TTreat elbow dislocation00431.7694$105.00$21.00
    24650TTreat radius fracture00431.7694$105.00$21.00
    24655TTreat radius fracture00431.7694$105.00$21.00
    24665TTreat radius fracture004637.7023$2,237.37$535.76$447.47
    24666TTreat radius fracture004637.7023$2,237.37$535.76$447.47
    24670TTreat ulnar fracture00431.7694$105.00$21.00
    24675TTreat ulnar fracture00431.7694$105.00$21.00
    24685TTreat ulnar fracture004637.7023$2,237.37$535.76$447.47
    24800TFusion of elbow joint005136.5271$2,167.63$433.53
    24802TFusion/graft of elbow joint005136.5271$2,167.63$433.53
    24900CAmputation of upper arm
    24920CAmputation of upper arm
    24925TAmputation follow-up surgery004920.3707$1,208.86$241.77
    24930CAmputation follow-up surgery
    24931CAmputate upper arm & implant
    24935TRevision of amputation005243.9378$2,607.40$521.48
    24940CRevision of upper arm
    24999TUpper arm/elbow surgery00431.7694$105.00$21.00
    25000TIncision of tendon sheath004920.3707$1,208.86$241.77
    25001TIncise flexor carpi radialis004920.3707$1,208.86$241.77
    25020TDecompress forearm 1 space004920.3707$1,208.86$241.77
    25023TDecompress forearm 1 space005023.9081$1,418.78$283.76
    25024TDecompress forearm 2 spaces005023.9081$1,418.78$283.76
    25025TDecompress forearm 2 spaces005023.9081$1,418.78$283.76
    25028TDrainage of forearm lesion004920.3707$1,208.86$241.77
    25031TDrainage of forearm bursa004920.3707$1,208.86$241.77
    25035TTreat forearm bone lesion004920.3707$1,208.86$241.77
    25040TExplore/treat wrist joint005023.9081$1,418.78$283.76
    25065TBiopsy forearm soft tissues002114.9776$888.82$219.48$177.76
    25066TBiopsy forearm soft tissues002219.6472$1,165.92$354.45$233.18
    25075TRemovel forearm lesion subcu002114.9776$888.82$219.48$177.76
    25076TRemovel forearm lesion deep002219.6472$1,165.92$354.45$233.18
    25077TRemove tumor, forearm/wrist002219.6472$1,165.92$354.45$233.18
    25085TIncision of wrist capsule004920.3707$1,208.86$241.77
    25100TBiopsy of wrist joint004920.3707$1,208.86$241.77
    25101TExplore/treat wrist joint005023.9081$1,418.78$283.76
    25105TRemove wrist joint lining005023.9081$1,418.78$283.76
    25107TRemove wrist joint cartilage005023.9081$1,418.78$283.76
    25110TRemove wrist tendon lesion004920.3707$1,208.86$241.77
    25111TRemove wrist tendon lesion005315.6795$930.47$253.49$186.09
    25112TReremove wrist tendon lesion005315.6795$930.47$253.49$186.09
    25115TRemove wrist/forearm lesion004920.3707$1,208.86$241.77
    Start Printed Page 50716
    25116TRemove wrist/forearm lesion004920.3707$1,208.86$241.77
    25118TExcise wrist tendon sheath005023.9081$1,418.78$283.76
    25119TPartial removal of ulna005023.9081$1,418.78$283.76
    25120TRemoval of forearm lesion005023.9081$1,418.78$283.76
    25125TRemove/graft forearm lesion005023.9081$1,418.78$283.76
    25126TRemove/graft forearm lesion005023.9081$1,418.78$283.76
    25130TRemoval of wrist lesion005023.9081$1,418.78$283.76
    25135TRemove & graft wrist lesion005023.9081$1,418.78$283.76
    25136TRemove & graft wrist lesion005023.9081$1,418.78$283.76
    25145TRemove forearm bone lesion005023.9081$1,418.78$283.76
    25150TPartial removal of ulna005023.9081$1,418.78$283.76
    25151TPartial removal of radius005023.9081$1,418.78$283.76
    25170TExtensive forearm surgery005243.9378$2,607.40$521.48
    25210TRemoval of wrist bone005425.3711$1,505.60$301.12
    25215TRemoval of wrist bones005425.3711$1,505.60$301.12
    25230TPartial removal of radius005023.9081$1,418.78$283.76
    25240TPartial removal of ulna005023.9081$1,418.78$283.76
    25246NInjection for wrist x-ray
    25248TRemove forearm foreign body004920.3707$1,208.86$241.77
    25250TRemoval of wrist prosthesis005023.9081$1,418.78$283.76
    25251TRemoval of wrist prosthesis005023.9081$1,418.78$283.76
    25259TManipulate wrist w/anesthes00431.7694$105.00$21.00
    25260TRepair forearm tendon/muscle005023.9081$1,418.78$283.76
    25263TRepair forearm tendon/muscle005023.9081$1,418.78$283.76
    25265TRepair forearm tendon/muscle005023.9081$1,418.78$283.76
    25270TRepair forearm tendon/muscle005023.9081$1,418.78$283.76
    25272TRepair forearm tendon/muscle005023.9081$1,418.78$283.76
    25274TRepair forearm tendon/muscle005023.9081$1,418.78$283.76
    25275TRepair forearm tendon sheath005023.9081$1,418.78$283.76
    25280TRevise wrist/forearm tendon005023.9081$1,418.78$283.76
    25290TIncise wrist/forearm tendon005023.9081$1,418.78$283.76
    25295TRelease wrist/forearm tendon004920.3707$1,208.86$241.77
    25300TFusion of tendons at wrist005023.9081$1,418.78$283.76
    25301TFusion of tendons at wrist005023.9081$1,418.78$283.76
    25310TTransplant forearm tendon005136.5271$2,167.63$433.53
    25312TTransplant forearm tendon005136.5271$2,167.63$433.53
    25315TRevise palsy hand tendon(s)005136.5271$2,167.63$433.53
    25316TRevise palsy hand tendon(s)005136.5271$2,167.63$433.53
    25320TRepair/revise wrist joint005136.5271$2,167.63$433.53
    25332TRevise wrist joint004731.6107$1,875.87$537.03$375.17
    25335TRealignment of hand005136.5271$2,167.63$433.53
    25337TReconstruct ulna/radioulnar005136.5271$2,167.63$433.53
    25350TRevision of radius005136.5271$2,167.63$433.53
    25355TRevision of radius005136.5271$2,167.63$433.53
    25360TRevision of ulna005023.9081$1,418.78$283.76
    25365TRevise radius & ulna005023.9081$1,418.78$283.76
    25370TRevise radius or ulna005136.5271$2,167.63$433.53
    25375TRevise radius & ulna005136.5271$2,167.63$433.53
    25390TShorten radius or ulna005023.9081$1,418.78$283.76
    25391TLengthen radius or ulna005136.5271$2,167.63$433.53
    25392TShorten radius & ulna005023.9081$1,418.78$283.76
    25393TLengthen radius & ulna005136.5271$2,167.63$433.53
    25394TRepair carpal bone, shorten005315.6795$930.47$253.49$186.09
    25400TRepair radius or ulna005023.9081$1,418.78$283.76
    25405TRepair/graft radius or ulna005023.9081$1,418.78$283.76
    25415TRepair radius & ulna005023.9081$1,418.78$283.76
    25420TRepair/graft radius & ulna005136.5271$2,167.63$433.53
    25425TRepair/graft radius or ulna005136.5271$2,167.63$433.53
    25426TRepair/graft radius & ulna005136.5271$2,167.63$433.53
    25430TVasc graft into carpal bone005425.3711$1,505.60$301.12
    25431TRepair nonunion carpal bone005425.3711$1,505.60$301.12
    25440TRepair/graft wrist bone005136.5271$2,167.63$433.53
    25441TReconstruct wrist joint0425100.2058$5,946.51$1,378.01$1,189.30
    25442TReconstruct wrist joint0425100.2058$5,946.51$1,378.01$1,189.30
    25443TReconstruct wrist joint004843.1288$2,559.39$570.30$511.88
    25444TReconstruct wrist joint004843.1288$2,559.39$570.30$511.88
    Start Printed Page 50717
    25445TReconstruct wrist joint004843.1288$2,559.39$570.30$511.88
    25446TWrist replacement0425100.2058$5,946.51$1,378.01$1,189.30
    25447TRepair wrist joint(s)004731.6107$1,875.87$537.03$375.17
    25449TRemove wrist joint implant004731.6107$1,875.87$537.03$375.17
    25450TRevision of wrist joint005136.5271$2,167.63$433.53
    25455TRevision of wrist joint005136.5271$2,167.63$433.53
    25490TReinforce radius005136.5271$2,167.63$433.53
    25491TReinforce ulna005136.5271$2,167.63$433.53
    25492TReinforce radius and ulna005136.5271$2,167.63$433.53
    25500TTreat fracture of radius00431.7694$105.00$21.00
    25505TTreat fracture of radius00431.7694$105.00$21.00
    25515TTreat fracture of radius004637.7023$2,237.37$535.76$447.47
    25520TTreat fracture of radius00431.7694$105.00$21.00
    25525TTreat fracture of radius004637.7023$2,237.37$535.76$447.47
    25526TTreat fracture of radius004637.7023$2,237.37$535.76$447.47
    25530TTreat fracture of ulna00431.7694$105.00$21.00
    25535TTreat fracture of ulna00431.7694$105.00$21.00
    25545TTreat fracture of ulna004637.7023$2,237.37$535.76$447.47
    25560TTreat fracture radius & ulna00431.7694$105.00$21.00
    25565TTreat fracture radius & ulna00431.7694$105.00$21.00
    25574TTreat fracture radius & ulna004637.7023$2,237.37$535.76$447.47
    25575TTreat fracture radius/ulna004637.7023$2,237.37$535.76$447.47
    25600TTreat fracture radius/ulna00431.7694$105.00$21.00
    25605TTreat fracture radius/ulna00431.7694$105.00$21.00
    25611TTreat fracture radius/ulna004637.7023$2,237.37$535.76$447.47
    25620TTreat fracture radius/ulna004637.7023$2,237.37$535.76$447.47
    25622TTreat wrist bone fracture00431.7694$105.00$21.00
    25624TTreat wrist bone fracture00431.7694$105.00$21.00
    25628TTreat wrist bone fracture004637.7023$2,237.37$535.76$447.47
    25630TTreat wrist bone fracture00431.7694$105.00$21.00
    25635TTreat wrist bone fracture00431.7694$105.00$21.00
    25645TTreat wrist bone fracture004637.7023$2,237.37$535.76$447.47
    25650TTreat wrist bone fracture00431.7694$105.00$21.00
    25651TPin ulnar styloid fracture004637.7023$2,237.37$535.76$447.47
    25652TTreat fracture ulnar styloid004637.7023$2,237.37$535.76$447.47
    25660TTreat wrist dislocation00431.7694$105.00$21.00
    25670TTreat wrist dislocation004637.7023$2,237.37$535.76$447.47
    25671TPin radioulnar dislocation004637.7023$2,237.37$535.76$447.47
    25675TTreat wrist dislocation00431.7694$105.00$21.00
    25676TTreat wrist dislocation004637.7023$2,237.37$535.76$447.47
    25680TTreat wrist fracture00431.7694$105.00$21.00
    25685TTreat wrist fracture004637.7023$2,237.37$535.76$447.47
    25690TTreat wrist dislocation00431.7694$105.00$21.00
    25695TTreat wrist dislocation004637.7023$2,237.37$535.76$447.47
    25800TFusion of wrist joint005136.5271$2,167.63$433.53
    25805TFusion/graft of wrist joint005136.5271$2,167.63$433.53
    25810TFusion/graft of wrist joint005136.5271$2,167.63$433.53
    25820TFusion of hand bones005315.6795$930.47$253.49$186.09
    25825TFuse hand bones with graft005425.3711$1,505.60$301.12
    25830TFusion, radioulnar jnt/ulna005136.5271$2,167.63$433.53
    25900CAmputation of forearm
    25905CAmputation of forearm
    25907TAmputation follow-up surgery004920.3707$1,208.86$241.77
    25909CAmputation follow-up surgery
    25915CAmputation of forearm
    25920CAmputate hand at wrist
    25922TAmputate hand at wrist004920.3707$1,208.86$241.77
    25924CAmputation follow-up surgery
    25927CAmputation of hand
    25929TAmputation follow-up surgery068613.8287$820.64$164.13
    25931CAmputation follow-up surgery
    25999TForearm or wrist surgery00431.7694$105.00$21.00
    26010TDrainage of finger abscess00061.55$91.98$22.28$18.40
    26011TDrainage of finger abscess000711.4501$679.48$135.90
    26020TDrain hand tendon sheath005315.6795$930.47$253.49$186.09
    26025TDrainage of palm bursa005315.6795$930.47$253.49$186.09
    Start Printed Page 50718
    26030TDrainage of palm bursa(s)005315.6795$930.47$253.49$186.09
    26034TTreat hand bone lesion005315.6795$930.47$253.49$186.09
    26035TDecompress fingers/hand005315.6795$930.47$253.49$186.09
    26037TDecompress fingers/hand005315.6795$930.47$253.49$186.09
    26040TRelease palm contracture005425.3711$1,505.60$301.12
    26045TRelease palm contracture005425.3711$1,505.60$301.12
    26055TIncise finger tendon sheath005315.6795$930.47$253.49$186.09
    26060TIncision of finger tendon005315.6795$930.47$253.49$186.09
    26070TExplore/treat hand joint005315.6795$930.47$253.49$186.09
    26075TExplore/treat finger joint005315.6795$930.47$253.49$186.09
    26080TExplore/treat finger joint005315.6795$930.47$253.49$186.09
    26100TBiopsy hand joint lining005315.6795$930.47$253.49$186.09
    26105TBiopsy finger joint lining005315.6795$930.47$253.49$186.09
    26110TBiopsy finger joint lining005315.6795$930.47$253.49$186.09
    26115TRemovel hand lesion subcut002219.6472$1,165.92$354.45$233.18
    26116TRemovel hand lesion, deep002219.6472$1,165.92$354.45$233.18
    26117TRemove tumor, hand/finger002219.6472$1,165.92$354.45$233.18
    26121TRelease palm contracture005425.3711$1,505.60$301.12
    26123TRelease palm contracture005425.3711$1,505.60$301.12
    26125TRelease palm contracture005315.6795$930.47$253.49$186.09
    26130TRemove wrist joint lining005315.6795$930.47$253.49$186.09
    26135TRevise finger joint, each005425.3711$1,505.60$301.12
    26140TRevise finger joint, each005315.6795$930.47$253.49$186.09
    26145TTendon excision, palm/finger005315.6795$930.47$253.49$186.09
    26160TRemove tendon sheath lesion005315.6795$930.47$253.49$186.09
    26170TRemoval of palm tendon, each005315.6795$930.47$253.49$186.09
    26180TRemoval of finger tendon005315.6795$930.47$253.49$186.09
    26185TRemove finger bone005315.6795$930.47$253.49$186.09
    26200TRemove hand bone lesion005315.6795$930.47$253.49$186.09
    26205TRemove/graft bone lesion005425.3711$1,505.60$301.12
    26210TRemoval of finger lesion005315.6795$930.47$253.49$186.09
    26215TRemove/graft finger lesion005315.6795$930.47$253.49$186.09
    26230TPartial removal of hand bone005315.6795$930.47$253.49$186.09
    26235TPartial removal, finger bone005315.6795$930.47$253.49$186.09
    26236TPartial removal, finger bone005315.6795$930.47$253.49$186.09
    26250TExtensive hand surgery005315.6795$930.47$253.49$186.09
    26255TExtensive hand surgery005425.3711$1,505.60$301.12
    26260TExtensive finger surgery005315.6795$930.47$253.49$186.09
    26261TExtensive finger surgery005315.6795$930.47$253.49$186.09
    26262TPartial removal of finger005315.6795$930.47$253.49$186.09
    26320TRemoval of implant from hand002114.9776$888.82$219.48$177.76
    26340TManipulate finger w/anesth00431.7694$105.00$21.00
    26350TRepair finger/hand tendon005425.3711$1,505.60$301.12
    26352TRepair/graft hand tendon005425.3711$1,505.60$301.12
    26356TRepair finger/hand tendon005425.3711$1,505.60$301.12
    26357TRepair finger/hand tendon005425.3711$1,505.60$301.12
    26358TRepair/graft hand tendon005425.3711$1,505.60$301.12
    26370TRepair finger/hand tendon005425.3711$1,505.60$301.12
    26372TRepair/graft hand tendon005425.3711$1,505.60$301.12
    26373TRepair finger/hand tendon005425.3711$1,505.60$301.12
    26390TRevise hand/finger tendon005425.3711$1,505.60$301.12
    26392TRepair/graft hand tendon005425.3711$1,505.60$301.12
    26410TRepair hand tendon005315.6795$930.47$253.49$186.09
    26412TRepair/graft hand tendon005425.3711$1,505.60$301.12
    26415TExcision, hand/finger tendon005425.3711$1,505.60$301.12
    26416TGraft hand or finger tendon005425.3711$1,505.60$301.12
    26418TRepair finger tendon005315.6795$930.47$253.49$186.09
    26420TRepair/graft finger tendon005425.3711$1,505.60$301.12
    26426TRepair finger/hand tendon005425.3711$1,505.60$301.12
    26428TRepair/graft finger tendon005425.3711$1,505.60$301.12
    26432TRepair finger tendon005315.6795$930.47$253.49$186.09
    26433TRepair finger tendon005315.6795$930.47$253.49$186.09
    26434TRepair/graft finger tendon005425.3711$1,505.60$301.12
    26437TRealignment of tendons005315.6795$930.47$253.49$186.09
    26440TRelease palm/finger tendon005315.6795$930.47$253.49$186.09
    26442TRelease palm & finger tendon005425.3711$1,505.60$301.12
    Start Printed Page 50719
    26445TRelease hand/finger tendon005315.6795$930.47$253.49$186.09
    26449TRelease forearm/hand tendon005425.3711$1,505.60$301.12
    26450TIncision of palm tendon005315.6795$930.47$253.49$186.09
    26455TIncision of finger tendon005315.6795$930.47$253.49$186.09
    26460TIncise hand/finger tendon005315.6795$930.47$253.49$186.09
    26471TFusion of finger tendons005315.6795$930.47$253.49$186.09
    26474TFusion of finger tendons005315.6795$930.47$253.49$186.09
    26476TTendon lengthening005315.6795$930.47$253.49$186.09
    26477TTendon shortening005315.6795$930.47$253.49$186.09
    26478TLengthening of hand tendon005315.6795$930.47$253.49$186.09
    26479TShortening of hand tendon005315.6795$930.47$253.49$186.09
    26480TTransplant hand tendon005425.3711$1,505.60$301.12
    26483TTransplant/graft hand tendon005425.3711$1,505.60$301.12
    26485TTransplant palm tendon005425.3711$1,505.60$301.12
    26489TTransplant/graft palm tendon005425.3711$1,505.60$301.12
    26490TRevise thumb tendon005425.3711$1,505.60$301.12
    26492TTendon transfer with graft005425.3711$1,505.60$301.12
    26494THand tendon/muscle transfer005425.3711$1,505.60$301.12
    26496TRevise thumb tendon005425.3711$1,505.60$301.12
    26497TFinger tendon transfer005425.3711$1,505.60$301.12
    26498TFinger tendon transfer005425.3711$1,505.60$301.12
    26499TRevision of finger005425.3711$1,505.60$301.12
    26500THand tendon reconstruction005315.6795$930.47$253.49$186.09
    26502THand tendon reconstruction005425.3711$1,505.60$301.12
    26504THand tendon reconstruction005425.3711$1,505.60$301.12
    26508TRelease thumb contracture005315.6795$930.47$253.49$186.09
    26510TThumb tendon transfer005425.3711$1,505.60$301.12
    26516TFusion of knuckle joint005425.3711$1,505.60$301.12
    26517TFusion of knuckle joints005425.3711$1,505.60$301.12
    26518TFusion of knuckle joints005425.3711$1,505.60$301.12
    26520TRelease knuckle contracture005315.6795$930.47$253.49$186.09
    26525TRelease finger contracture005315.6795$930.47$253.49$186.09
    26530TRevise knuckle joint004731.6107$1,875.87$537.03$375.17
    26531TRevise knuckle with implant004843.1288$2,559.39$570.30$511.88
    26535TRevise finger joint004731.6107$1,875.87$537.03$375.17
    26536TRevise/implant finger joint004843.1288$2,559.39$570.30$511.88
    26540TRepair hand joint005315.6795$930.47$253.49$186.09
    26541TRepair hand joint with graft005425.3711$1,505.60$301.12
    26542TRepair hand joint with graft005315.6795$930.47$253.49$186.09
    26545TReconstruct finger joint005425.3711$1,505.60$301.12
    26546TRepair nonunion hand005425.3711$1,505.60$301.12
    26548TReconstruct finger joint005425.3711$1,505.60$301.12
    26550TConstruct thumb replacement005425.3711$1,505.60$301.12
    26551CGreat toe-hand transfer
    26553CSingle transfer, toe-hand
    26554CDouble transfer, toe-hand
    26555TPositional change of finger005425.3711$1,505.60$301.12
    26556CToe joint transfer
    26560TRepair of web finger005315.6795$930.47$253.49$186.09
    26561TRepair of web finger005425.3711$1,505.60$301.12
    26562TRepair of web finger005425.3711$1,505.60$301.12
    26565TCorrect metacarpal flaw005425.3711$1,505.60$301.12
    26567TCorrect finger deformity005425.3711$1,505.60$301.12
    26568TLengthen metacarpal/finger005425.3711$1,505.60$301.12
    26580TRepair hand deformity005315.6795$930.47$253.49$186.09
    26587TReconstruct extra finger005315.6795$930.47$253.49$186.09
    26590TRepair finger deformity005315.6795$930.47$253.49$186.09
    26591TRepair muscles of hand005425.3711$1,505.60$301.12
    26593TRelease muscles of hand005315.6795$930.47$253.49$186.09
    26596TExcision constricting tissue005315.6795$930.47$253.49$186.09
    26600TTreat metacarpal fracture00431.7694$105.00$21.00
    26605TTreat metacarpal fracture00431.7694$105.00$21.00
    26607TTreat metacarpal fracture00431.7694$105.00$21.00
    26608TTreat metacarpal fracture004637.7023$2,237.37$535.76$447.47
    26615TTreat metacarpal fracture004637.7023$2,237.37$535.76$447.47
    26641TTreat thumb dislocation00431.7694$105.00$21.00
    Start Printed Page 50720
    26645TTreat thumb fracture00431.7694$105.00$21.00
    26650TTreat thumb fracture004637.7023$2,237.37$535.76$447.47
    26665TTreat thumb fracture004637.7023$2,237.37$535.76$447.47
    26670TTreat hand dislocation00431.7694$105.00$21.00
    26675TTreat hand dislocation00431.7694$105.00$21.00
    26676TPin hand dislocation004637.7023$2,237.37$535.76$447.47
    26685TTreat hand dislocation004637.7023$2,237.37$535.76$447.47
    26686TTreat hand dislocation004637.7023$2,237.37$535.76$447.47
    26700TTreat knuckle dislocation00431.7694$105.00$21.00
    26705TTreat knuckle dislocation00431.7694$105.00$21.00
    26706TPin knuckle dislocation00431.7694$105.00$21.00
    26715TTreat knuckle dislocation004637.7023$2,237.37$535.76$447.47
    26720TTreat finger fracture, each00431.7694$105.00$21.00
    26725TTreat finger fracture, each00431.7694$105.00$21.00
    26727TTreat finger fracture, each004637.7023$2,237.37$535.76$447.47
    26735TTreat finger fracture, each004637.7023$2,237.37$535.76$447.47
    26740TTreat finger fracture, each00431.7694$105.00$21.00
    26742TTreat finger fracture, each00431.7694$105.00$21.00
    26746TTreat finger fracture, each004637.7023$2,237.37$535.76$447.47
    26750TTreat finger fracture, each00431.7694$105.00$21.00
    26755TTreat finger fracture, each00431.7694$105.00$21.00
    26756TPin finger fracture, each004637.7023$2,237.37$535.76$447.47
    26765TTreat finger fracture, each004637.7023$2,237.37$535.76$447.47
    26770TTreat finger dislocation00431.7694$105.00$21.00
    26775TTreat finger dislocation004514.4945$860.15$268.47$172.03
    26776TPin finger dislocation004637.7023$2,237.37$535.76$447.47
    26785TTreat finger dislocation004637.7023$2,237.37$535.76$447.47
    26820TThumb fusion with graft005425.3711$1,505.60$301.12
    26841TFusion of thumb005425.3711$1,505.60$301.12
    26842TThumb fusion with graft005425.3711$1,505.60$301.12
    26843TFusion of hand joint005425.3711$1,505.60$301.12
    26844TFusion/graft of hand joint005425.3711$1,505.60$301.12
    26850TFusion of knuckle005425.3711$1,505.60$301.12
    26852TFusion of knuckle with graft005425.3711$1,505.60$301.12
    26860TFusion of finger joint005425.3711$1,505.60$301.12
    26861TFusion of finger jnt, add-on005425.3711$1,505.60$301.12
    26862TFusion/graft of finger joint005425.3711$1,505.60$301.12
    26863TFuse/graft added joint005425.3711$1,505.60$301.12
    26910TAmputate metacarpal bone005425.3711$1,505.60$301.12
    26951TAmputation of finger/thumb005315.6795$930.47$253.49$186.09
    26952TAmputation of finger/thumb005315.6795$930.47$253.49$186.09
    26989THand/finger surgery00431.7694$105.00$21.00
    26990TDrainage of pelvis lesion004920.3707$1,208.86$241.77
    26991TDrainage of pelvis bursa004920.3707$1,208.86$241.77
    26992CDrainage of bone lesion
    27000TIncision of hip tendon004920.3707$1,208.86$241.77
    27001TIncision of hip tendon005023.9081$1,418.78$283.76
    27003TIncision of hip tendon005023.9081$1,418.78$283.76
    27005CIncision of hip tendon
    27006CIncision of hip tendons
    27025CIncision of hip/thigh fascia
    27030CDrainage of hip joint
    27033TExploration of hip joint005136.5271$2,167.63$433.53
    27035TDenervation of hip joint005243.9378$2,607.40$521.48
    27036CExcision of hip joint/muscle
    27040TBiopsy of soft tissues00206.9433$412.04$107.40$82.41
    27041TBiopsy of soft tissues00206.9433$412.04$107.40$82.41
    27047TRemove hip/pelvis lesion002219.6472$1,165.92$354.45$233.18
    27048TRemove hip/pelvis lesion002219.6472$1,165.92$354.45$233.18
    27049TRemove tumor, hip/pelvis002219.6472$1,165.92$354.45$233.18
    27050TBiopsy of sacroiliac joint004920.3707$1,208.86$241.77
    27052TBiopsy of hip joint004920.3707$1,208.86$241.77
    27054CRemoval of hip joint lining
    27060TRemoval of ischial bursa004920.3707$1,208.86$241.77
    27062TRemove femur lesion/bursa004920.3707$1,208.86$241.77
    27065TRemoval of hip bone lesion004920.3707$1,208.86$241.77
    Start Printed Page 50721
    27066TRemoval of hip bone lesion005023.9081$1,418.78$283.76
    27067TRemove/graft hip bone lesion005023.9081$1,418.78$283.76
    27070CPartial removal of hip bone
    27071CPartial removal of hip bone
    27075CExtensive hip surgery
    27076CExtensive hip surgery
    27077CExtensive hip surgery
    27078CExtensive hip surgery
    27079CExtensive hip surgery
    27080TRemoval of tail bone005023.9081$1,418.78$283.76
    27086TRemove hip foreign body00206.9433$412.04$107.40$82.41
    27087TRemove hip foreign body004920.3707$1,208.86$241.77
    27090CRemoval of hip prosthesis
    27091CRemoval of hip prosthesis
    27093NInjection for hip x-ray
    27095NInjection for hip x-ray
    27096BInject sacroiliac joint
    27097TRevision of hip tendon005023.9081$1,418.78$283.76
    27098TTransfer tendon to pelvis005023.9081$1,418.78$283.76
    27100TTransfer of abdominal muscle005136.5271$2,167.63$433.53
    27105TTransfer of spinal muscle005136.5271$2,167.63$433.53
    27110TTransfer of iliopsoas muscle005136.5271$2,167.63$433.53
    27111TTransfer of iliopsoas muscle005136.5271$2,167.63$433.53
    27120CReconstruction of hip socket
    27122CReconstruction of hip socket
    27125CPartial hip replacement
    27130CTotal hip arthroplasty
    27132CTotal hip arthroplasty
    27134CRevise hip joint replacement
    27137CRevise hip joint replacement
    27138CRevise hip joint replacement
    27140CTransplant femur ridge
    27146CIncision of hip bone
    27147CRevision of hip bone
    27151CIncision of hip bones
    27156CRevision of hip bones
    27158CRevision of pelvis
    27161CIncision of neck of femur
    27165CIncision/fixation of femur
    27170CRepair/graft femur head/neck
    27175CTreat slipped epiphysis
    27176CTreat slipped epiphysis
    27177CTreat slipped epiphysis
    27178CTreat slipped epiphysis
    27179CRevise head/neck of femur
    27181CTreat slipped epiphysis
    27185CRevision of femur epiphysis
    27187CReinforce hip bones
    27193TTreat pelvic ring fracture00431.7694$105.00$21.00
    27194TTreat pelvic ring fracture004514.4945$860.15$268.47$172.03
    27200TTreat tail bone fracture00431.7694$105.00$21.00
    27202TTreat tail bone fracture004637.7023$2,237.37$535.76$447.47
    27215CTreat pelvic fracture(s)
    27216TTreat pelvic ring fracture005023.9081$1,418.78$283.76
    27217CTreat pelvic ring fracture
    27218CTreat pelvic ring fracture
    27220TTreat hip socket fracture00431.7694$105.00$21.00
    27222CTreat hip socket fracture
    27226CTreat hip wall fracture
    27227CTreat hip fracture(s)
    27228CTreat hip fracture(s)
    27230TTreat thigh fracture00431.7694$105.00$21.00
    27232CTreat thigh fracture
    27235TTreat thigh fracture005023.9081$1,418.78$283.76
    27236CTreat thigh fracture
    27238TTreat thigh fracture00431.7694$105.00$21.00
    Start Printed Page 50722
    27240CTreat thigh fracture
    27244CTreat thigh fracture
    27245CTreat thigh fracture
    27246TTreat thigh fracture00431.7694$105.00$21.00
    27248CTreat thigh fracture
    27250TTreat hip dislocation00431.7694$105.00$21.00
    27252TTreat hip dislocation004514.4945$860.15$268.47$172.03
    27253CTreat hip dislocation
    27254CTreat hip dislocation
    27256TTreat hip dislocation00431.7694$105.00$21.00
    27257TTreat hip dislocation004514.4945$860.15$268.47$172.03
    27258CTreat hip dislocation
    27259CTreat hip dislocation
    27265TTreat hip dislocation00431.7694$105.00$21.00
    27266TTreat hip dislocation004514.4945$860.15$268.47$172.03
    27275TManipulation of hip joint004514.4945$860.15$268.47$172.03
    27280CFusion of sacroiliac joint
    27282CFusion of pubic bones
    27284CFusion of hip joint
    27286CFusion of hip joint
    27290CAmputation of leg at hip
    27295CAmputation of leg at hip
    27299TPelvis/hip joint surgery00431.7694$105.00$21.00
    27301TDrain thigh/knee lesion000816.4989$979.09$195.82
    27303CDrainage of bone lesion
    27305TIncise thigh tendon & fascia004920.3707$1,208.86$241.77
    27306TIncision of thigh tendon004920.3707$1,208.86$241.77
    27307TIncision of thigh tendons004920.3707$1,208.86$241.77
    27310TExploration of knee joint005023.9081$1,418.78$283.76
    27315TPartial removal, thigh nerve022017.3586$1,030.11$206.02
    27320TPartial removal, thigh nerve022017.3586$1,030.11$206.02
    27323TBiopsy, thigh soft tissues002114.9776$888.82$219.48$177.76
    27324TBiopsy, thigh soft tissues002219.6472$1,165.92$354.45$233.18
    27327TRemoval of thigh lesion002219.6472$1,165.92$354.45$233.18
    27328TRemoval of thigh lesion002219.6472$1,165.92$354.45$233.18
    27329TRemove tumor, thigh/knee002219.6472$1,165.92$354.45$233.18
    27330TBiopsy, knee joint lining005023.9081$1,418.78$283.76
    27331TExplore/treat knee joint005023.9081$1,418.78$283.76
    27332TRemoval of knee cartilage005023.9081$1,418.78$283.76
    27333TRemoval of knee cartilage005023.9081$1,418.78$283.76
    27334TRemove knee joint lining005023.9081$1,418.78$283.76
    27335TRemove knee joint lining005023.9081$1,418.78$283.76
    27340TRemoval of kneecap bursa004920.3707$1,208.86$241.77
    27345TRemoval of knee cyst004920.3707$1,208.86$241.77
    27347TRemove knee cyst004920.3707$1,208.86$241.77
    27350TRemoval of kneecap005023.9081$1,418.78$283.76
    27355TRemove femur lesion005023.9081$1,418.78$283.76
    27356TRemove femur lesion/graft005023.9081$1,418.78$283.76
    27357TRemove femur lesion/graft005023.9081$1,418.78$283.76
    27358TRemove femur lesion/fixation005023.9081$1,418.78$283.76
    27360TPartial removal, leg bone(s)005023.9081$1,418.78$283.76
    27365CExtensive leg surgery
    27370NInjection for knee x-ray
    27372TRemoval of foreign body002219.6472$1,165.92$354.45$233.18
    27380TRepair of kneecap tendon004920.3707$1,208.86$241.77
    27381TRepair/graft kneecap tendon004920.3707$1,208.86$241.77
    27385TRepair of thigh muscle004920.3707$1,208.86$241.77
    27386TRepair/graft of thigh muscle004920.3707$1,208.86$241.77
    27390TIncision of thigh tendon004920.3707$1,208.86$241.77
    27391TIncision of thigh tendons004920.3707$1,208.86$241.77
    27392TIncision of thigh tendons004920.3707$1,208.86$241.77
    27393TLengthening of thigh tendon005023.9081$1,418.78$283.76
    27394TLengthening of thigh tendons005023.9081$1,418.78$283.76
    27395TLengthening of thigh tendons005136.5271$2,167.63$433.53
    27396TTransplant of thigh tendon005023.9081$1,418.78$283.76
    27397TTransplants of thigh tendons005136.5271$2,167.63$433.53
    Start Printed Page 50723
    27400TRevise thigh muscles/tendons005136.5271$2,167.63$433.53
    27403TRepair of knee cartilage005023.9081$1,418.78$283.76
    27405TRepair of knee ligament005136.5271$2,167.63$433.53
    27407TRepair of knee ligament005136.5271$2,167.63$433.53
    27409TRepair of knee ligaments005136.5271$2,167.63$433.53
    27412TAutochondrocyte implant knee004243.9753$2,609.63$804.74$521.93
    27415TOsteochondral knee allograft004243.9753$2,609.63$804.74$521.93
    27418TRepair degenerated kneecap005136.5271$2,167.63$433.53
    27420TRevision of unstable kneecap005136.5271$2,167.63$433.53
    27422TRevision of unstable kneecap005136.5271$2,167.63$433.53
    27424TRevision/removal of kneecap005136.5271$2,167.63$433.53
    27425TLateral retinacular release005023.9081$1,418.78$283.76
    27427TReconstruction, knee005243.9378$2,607.40$521.48
    27428TReconstruction, knee005243.9378$2,607.40$521.48
    27429TReconstruction, knee005243.9378$2,607.40$521.48
    27430TRevision of thigh muscles005136.5271$2,167.63$433.53
    27435TIncision of knee joint005136.5271$2,167.63$433.53
    27437TRevise kneecap004731.6107$1,875.87$537.03$375.17
    27438TRevise kneecap with implant004843.1288$2,559.39$570.30$511.88
    27440TRevision of knee joint004731.6107$1,875.87$537.03$375.17
    27441TRevision of knee joint004731.6107$1,875.87$537.03$375.17
    27442TRevision of knee joint004731.6107$1,875.87$537.03$375.17
    27443TRevision of knee joint004731.6107$1,875.87$537.03$375.17
    27445CRevision of knee joint
    27446TRevision of knee joint0681137.163$8,139.66$2,081.48$1,627.93
    27447CTotal knee arthroplasty
    27448CIncision of thigh
    27450CIncision of thigh
    27454CRealignment of thigh bone
    27455CRealignment of knee
    27457CRealignment of knee
    27465CShortening of thigh bone
    27466CLengthening of thigh bone
    27468CShorten/lengthen thighs
    27470CRepair of thigh
    27472CRepair/graft of thigh
    27475TSurgery to stop leg growth005023.9081$1,418.78$283.76
    27477CSurgery to stop leg growth
    27479CSurgery to stop leg growth
    27485CSurgery to stop leg growth
    27486CRevise/replace knee joint
    27487CRevise/replace knee joint
    27488CRemoval of knee prosthesis
    27495CReinforce thigh
    27496TDecompression of thigh/knee004920.3707$1,208.86$241.77
    27497TDecompression of thigh/knee004920.3707$1,208.86$241.77
    27498TDecompression of thigh/knee004920.3707$1,208.86$241.77
    27499TDecompression of thigh/knee004920.3707$1,208.86$241.77
    27500TTreatment of thigh fracture00431.7694$105.00$21.00
    27501TTreatment of thigh fracture00431.7694$105.00$21.00
    27502TTreatment of thigh fracture00431.7694$105.00$21.00
    27503TTreatment of thigh fracture00431.7694$105.00$21.00
    27506CTreatment of thigh fracture
    27507CTreatment of thigh fracture
    27508TTreatment of thigh fracture00431.7694$105.00$21.00
    27509TTreatment of thigh fracture004637.7023$2,237.37$535.76$447.47
    27510TTreatment of thigh fracture00431.7694$105.00$21.00
    27511CTreatment of thigh fracture
    27513CTreatment of thigh fracture
    27514CTreatment of thigh fracture
    27516TTreat thigh fx growth plate00431.7694$105.00$21.00
    27517TTreat thigh fx growth plate00431.7694$105.00$21.00
    27519CTreat thigh fx growth plate
    27520TTreat kneecap fracture00431.7694$105.00$21.00
    27524TTreat kneecap fracture004637.7023$2,237.37$535.76$447.47
    27530TTreat knee fracture00431.7694$105.00$21.00
    Start Printed Page 50724
    27532TTreat knee fracture00431.7694$105.00$21.00
    27535CTreat knee fracture
    27536CTreat knee fracture
    27538TTreat knee fracture(s)00431.7694$105.00$21.00
    27540CTreat knee fracture
    27550TTreat knee dislocation00431.7694$105.00$21.00
    27552TTreat knee dislocation004514.4945$860.15$268.47$172.03
    27556CTreat knee dislocation
    27557CTreat knee dislocation
    27558CTreat knee dislocation
    27560TTreat kneecap dislocation00431.7694$105.00$21.00
    27562TTreat kneecap dislocation004514.4945$860.15$268.47$172.03
    27566TTreat kneecap dislocation004637.7023$2,237.37$535.76$447.47
    27570TFixation of knee joint004514.4945$860.15$268.47$172.03
    27580CFusion of knee
    27590CAmputate leg at thigh
    27591CAmputate leg at thigh
    27592CAmputate leg at thigh
    27594TAmputation follow-up surgery004920.3707$1,208.86$241.77
    27596CAmputation follow-up surgery
    27598CAmputate lower leg at knee
    27599TLeg surgery procedure00431.7694$105.00$21.00
    27600TDecompression of lower leg004920.3707$1,208.86$241.77
    27601TDecompression of lower leg004920.3707$1,208.86$241.77
    27602TDecompression of lower leg004920.3707$1,208.86$241.77
    27603TDrain lower leg lesion000816.4989$979.09$195.82
    27604TDrain lower leg bursa004920.3707$1,208.86$241.77
    27605TIncision of achilles tendon005520.0692$1,190.97$355.34$238.19
    27606TIncision of achilles tendon004920.3707$1,208.86$241.77
    27607TTreat lower leg bone lesion004920.3707$1,208.86$241.77
    27610TExplore/treat ankle joint005023.9081$1,418.78$283.76
    27612TExploration of ankle joint005023.9081$1,418.78$283.76
    27613TBiopsy lower leg soft tissue00206.9433$412.04$107.40$82.41
    27614TBiopsy lower leg soft tissue002219.6472$1,165.92$354.45$233.18
    27615TRemove tumor, lower leg004637.7023$2,237.37$535.76$447.47
    27618TRemove lower leg lesion002114.9776$888.82$219.48$177.76
    27619TRemove lower leg lesion002219.6472$1,165.92$354.45$233.18
    27620TExplore/treat ankle joint005023.9081$1,418.78$283.76
    27625TRemove ankle joint lining005023.9081$1,418.78$283.76
    27626TRemove ankle joint lining005023.9081$1,418.78$283.76
    27630TRemoval of tendon lesion004920.3707$1,208.86$241.77
    27635TRemove lower leg bone lesion005023.9081$1,418.78$283.76
    27637TRemove/graft leg bone lesion005023.9081$1,418.78$283.76
    27638TRemove/graft leg bone lesion005023.9081$1,418.78$283.76
    27640TPartial removal of tibia005136.5271$2,167.63$433.53
    27641TPartial removal of fibula005023.9081$1,418.78$283.76
    27645CExtensive lower leg surgery
    27646CExtensive lower leg surgery
    27647TExtensive ankle/heel surgery005136.5271$2,167.63$433.53
    27648NInjection for ankle x-ray
    27650TRepair achilles tendon005136.5271$2,167.63$433.53
    27652TRepair/graft achilles tendon005136.5271$2,167.63$433.53
    27654TRepair of achilles tendon005136.5271$2,167.63$433.53
    27656TRepair leg fascia defect004920.3707$1,208.86$241.77
    27658TRepair of leg tendon, each004920.3707$1,208.86$241.77
    27659TRepair of leg tendon, each004920.3707$1,208.86$241.77
    27664TRepair of leg tendon, each004920.3707$1,208.86$241.77
    27665TRepair of leg tendon, each005023.9081$1,418.78$283.76
    27675TRepair lower leg tendons004920.3707$1,208.86$241.77
    27676TRepair lower leg tendons005023.9081$1,418.78$283.76
    27680TRelease of lower leg tendon005023.9081$1,418.78$283.76
    27681TRelease of lower leg tendons005023.9081$1,418.78$283.76
    27685TRevision of lower leg tendon005023.9081$1,418.78$283.76
    27686TRevise lower leg tendons005023.9081$1,418.78$283.76
    27687TRevision of calf tendon005023.9081$1,418.78$283.76
    27690TRevise lower leg tendon005136.5271$2,167.63$433.53
    Start Printed Page 50725
    27691TRevise lower leg tendon005136.5271$2,167.63$433.53
    27692TRevise additional leg tendon005136.5271$2,167.63$433.53
    27695TRepair of ankle ligament005023.9081$1,418.78$283.76
    27696TRepair of ankle ligaments005023.9081$1,418.78$283.76
    27698TRepair of ankle ligament005023.9081$1,418.78$283.76
    27700TRevision of ankle joint004731.6107$1,875.87$537.03$375.17
    27702CReconstruct ankle joint
    27703CReconstruction, ankle joint
    27704TRemoval of ankle implant004920.3707$1,208.86$241.77
    27705TIncision of tibia005136.5271$2,167.63$433.53
    27707TIncision of fibula004920.3707$1,208.86$241.77
    27709TIncision of tibia & fibula005023.9081$1,418.78$283.76
    27712CRealignment of lower leg
    27715CRevision of lower leg
    27720CRepair of tibia
    27722CRepair/graft of tibia
    27724CRepair/graft of tibia
    27725CRepair of lower leg
    27727CRepair of lower leg
    27730TRepair of tibia epiphysis005023.9081$1,418.78$283.76
    27732TRepair of fibula epiphysis005023.9081$1,418.78$283.76
    27734TRepair lower leg epiphyses005023.9081$1,418.78$283.76
    27740TRepair of leg epiphyses005023.9081$1,418.78$283.76
    27742TRepair of leg epiphyses005136.5271$2,167.63$433.53
    27745TReinforce tibia005136.5271$2,167.63$433.53
    27750TTreatment of tibia fracture00431.7694$105.00$21.00
    27752TTreatment of tibia fracture00431.7694$105.00$21.00
    27756TTreatment of tibia fracture004637.7023$2,237.37$535.76$447.47
    27758TTreatment of tibia fracture004637.7023$2,237.37$535.76$447.47
    27759TTreatment of tibia fracture004637.7023$2,237.37$535.76$447.47
    27760TTreatment of ankle fracture00431.7694$105.00$21.00
    27762TTreatment of ankle fracture00431.7694$105.00$21.00
    27766TTreatment of ankle fracture004637.7023$2,237.37$535.76$447.47
    27780TTreatment of fibula fracture00431.7694$105.00$21.00
    27781TTreatment of fibula fracture00431.7694$105.00$21.00
    27784TTreatment of fibula fracture004637.7023$2,237.37$535.76$447.47
    27786TTreatment of ankle fracture00431.7694$105.00$21.00
    27788TTreatment of ankle fracture00431.7694$105.00$21.00
    27792TTreatment of ankle fracture004637.7023$2,237.37$535.76$447.47
    27808TTreatment of ankle fracture00431.7694$105.00$21.00
    27810TTreatment of ankle fracture00431.7694$105.00$21.00
    27814TTreatment of ankle fracture004637.7023$2,237.37$535.76$447.47
    27816TTreatment of ankle fracture00431.7694$105.00$21.00
    27818TTreatment of ankle fracture00431.7694$105.00$21.00
    27822TTreatment of ankle fracture004637.7023$2,237.37$535.76$447.47
    27823TTreatment of ankle fracture004637.7023$2,237.37$535.76$447.47
    27824TTreat lower leg fracture00431.7694$105.00$21.00
    27825TTreat lower leg fracture00431.7694$105.00$21.00
    27826TTreat lower leg fracture004637.7023$2,237.37$535.76$447.47
    27827TTreat lower leg fracture004637.7023$2,237.37$535.76$447.47
    27828TTreat lower leg fracture004637.7023$2,237.37$535.76$447.47
    27829TTreat lower leg joint004637.7023$2,237.37$535.76$447.47
    27830TTreat lower leg dislocation00431.7694$105.00$21.00
    27831TTreat lower leg dislocation00431.7694$105.00$21.00
    27832TTreat lower leg dislocation004637.7023$2,237.37$535.76$447.47
    27840TTreat ankle dislocation00431.7694$105.00$21.00
    27842TTreat ankle dislocation004514.4945$860.15$268.47$172.03
    27846TTreat ankle dislocation004637.7023$2,237.37$535.76$447.47
    27848TTreat ankle dislocation004637.7023$2,237.37$535.76$447.47
    27860TFixation of ankle joint004514.4945$860.15$268.47$172.03
    27870TFusion of ankle joint005136.5271$2,167.63$433.53
    27871TFusion of tibiofibular joint005136.5271$2,167.63$433.53
    27880CAmputation of lower leg
    27881CAmputation of lower leg
    27882CAmputation of lower leg
    27884TAmputation follow-up surgery004920.3707$1,208.86$241.77
    Start Printed Page 50726
    27886CAmputation follow-up surgery
    27888CAmputation of foot at ankle
    27889TAmputation of foot at ankle005023.9081$1,418.78$283.76
    27892TDecompression of leg004920.3707$1,208.86$241.77
    27893TDecompression of leg004920.3707$1,208.86$241.77
    27894TDecompression of leg004920.3707$1,208.86$241.77
    27899TLeg/ankle surgery procedure00431.7694$105.00$21.00
    28001TDrainage of bursa of foot000711.4501$679.48$135.90
    28002TTreatment of foot infection004920.3707$1,208.86$241.77
    28003TTreatment of foot infection004920.3707$1,208.86$241.77
    28005TTreat foot bone lesion005520.0692$1,190.97$355.34$238.19
    28008TIncision of foot fascia005520.0692$1,190.97$355.34$238.19
    28010TIncision of toe tendon005520.0692$1,190.97$355.34$238.19
    28011TIncision of toe tendons005520.0692$1,190.97$355.34$238.19
    28020TExploration of foot joint005520.0692$1,190.97$355.34$238.19
    28022TExploration of foot joint005520.0692$1,190.97$355.34$238.19
    28024TExploration of toe joint005520.0692$1,190.97$355.34$238.19
    28030TRemoval of foot nerve022017.3586$1,030.11$206.02
    28035TDecompression of tibia nerve022017.3586$1,030.11$206.02
    28043TExcision of foot lesion002114.9776$888.82$219.48$177.76
    28045TExcision of foot lesion005520.0692$1,190.97$355.34$238.19
    28046TResection of tumor, foot005520.0692$1,190.97$355.34$238.19
    28050TBiopsy of foot joint lining005520.0692$1,190.97$355.34$238.19
    28052TBiopsy of foot joint lining005520.0692$1,190.97$355.34$238.19
    28054TBiopsy of toe joint lining005520.0692$1,190.97$355.34$238.19
    28060TPartial removal, foot fascia005520.0692$1,190.97$355.34$238.19
    28062TRemoval of foot fascia005520.0692$1,190.97$355.34$238.19
    28070TRemoval of foot joint lining005520.0692$1,190.97$355.34$238.19
    28072TRemoval of foot joint lining005520.0692$1,190.97$355.34$238.19
    28080TRemoval of foot lesion005520.0692$1,190.97$355.34$238.19
    28086TExcise foot tendon sheath005520.0692$1,190.97$355.34$238.19
    28088TExcise foot tendon sheath005520.0692$1,190.97$355.34$238.19
    28090TRemoval of foot lesion005520.0692$1,190.97$355.34$238.19
    28092TRemoval of toe lesions005520.0692$1,190.97$355.34$238.19
    28100TRemoval of ankle/heel lesion005520.0692$1,190.97$355.34$238.19
    28102TRemove/graft foot lesion005640.2957$2,391.27$478.25
    28103TRemove/graft foot lesion005640.2957$2,391.27$478.25
    28104TRemoval of foot lesion005520.0692$1,190.97$355.34$238.19
    28106TRemove/graft foot lesion005640.2957$2,391.27$478.25
    28107TRemove/graft foot lesion005640.2957$2,391.27$478.25
    28108TRemoval of toe lesions005520.0692$1,190.97$355.34$238.19
    28110TPart removal of metatarsal005520.0692$1,190.97$355.34$238.19
    28111TPart removal of metatarsal005520.0692$1,190.97$355.34$238.19
    28112TPart removal of metatarsal005520.0692$1,190.97$355.34$238.19
    28113TPart removal of metatarsal005520.0692$1,190.97$355.34$238.19
    28114TRemoval of metatarsal heads005520.0692$1,190.97$355.34$238.19
    28116TRevision of foot005520.0692$1,190.97$355.34$238.19
    28118TRemoval of heel bone005520.0692$1,190.97$355.34$238.19
    28119TRemoval of heel spur005520.0692$1,190.97$355.34$238.19
    28120TPart removal of ankle/heel005520.0692$1,190.97$355.34$238.19
    28122TPartial removal of foot bone005520.0692$1,190.97$355.34$238.19
    28124TPartial removal of toe005520.0692$1,190.97$355.34$238.19
    28126TPartial removal of toe005520.0692$1,190.97$355.34$238.19
    28130TRemoval of ankle bone005520.0692$1,190.97$355.34$238.19
    28140TRemoval of metatarsal005520.0692$1,190.97$355.34$238.19
    28150TRemoval of toe005520.0692$1,190.97$355.34$238.19
    28153TPartial removal of toe005520.0692$1,190.97$355.34$238.19
    28160TPartial removal of toe005520.0692$1,190.97$355.34$238.19
    28171TExtensive foot surgery005520.0692$1,190.97$355.34$238.19
    28173TExtensive foot surgery005520.0692$1,190.97$355.34$238.19
    28175TExtensive foot surgery005520.0692$1,190.97$355.34$238.19
    28190TRemoval of foot foreign body00194.0547$240.62$71.87$48.12
    28192TRemoval of foot foreign body002114.9776$888.82$219.48$177.76
    28193TRemoval of foot foreign body00206.9433$412.04$107.40$82.41
    28200TRepair of foot tendon005520.0692$1,190.97$355.34$238.19
    28202TRepair/graft of foot tendon005520.0692$1,190.97$355.34$238.19
    Start Printed Page 50727
    28208TRepair of foot tendon005520.0692$1,190.97$355.34$238.19
    28210TRepair/graft of foot tendon005640.2957$2,391.27$478.25
    28220TRelease of foot tendon005520.0692$1,190.97$355.34$238.19
    28222TRelease of foot tendons005520.0692$1,190.97$355.34$238.19
    28225TRelease of foot tendon005520.0692$1,190.97$355.34$238.19
    28226TRelease of foot tendons005520.0692$1,190.97$355.34$238.19
    28230TIncision of foot tendon(s)005520.0692$1,190.97$355.34$238.19
    28232TIncision of toe tendon005520.0692$1,190.97$355.34$238.19
    28234TIncision of foot tendon005520.0692$1,190.97$355.34$238.19
    28238TRevision of foot tendon005640.2957$2,391.27$478.25
    28240TRelease of big toe005520.0692$1,190.97$355.34$238.19
    28250TRevision of foot fascia005520.0692$1,190.97$355.34$238.19
    28260TRelease of midfoot joint005520.0692$1,190.97$355.34$238.19
    28261TRevision of foot tendon005520.0692$1,190.97$355.34$238.19
    28262TRevision of foot and ankle005520.0692$1,190.97$355.34$238.19
    28264TRelease of midfoot joint005640.2957$2,391.27$478.25
    28270TRelease of foot contracture005520.0692$1,190.97$355.34$238.19
    28272TRelease of toe joint, each005520.0692$1,190.97$355.34$238.19
    28280TFusion of toes005520.0692$1,190.97$355.34$238.19
    28285TRepair of hammertoe005520.0692$1,190.97$355.34$238.19
    28286TRepair of hammertoe005520.0692$1,190.97$355.34$238.19
    28288TPartial removal of foot bone005520.0692$1,190.97$355.34$238.19
    28289TRepair hallux rigidus005520.0692$1,190.97$355.34$238.19
    28290TCorrection of bunion005727.5493$1,634.86$475.91$326.97
    28292TCorrection of bunion005727.5493$1,634.86$475.91$326.97
    28293TCorrection of bunion005727.5493$1,634.86$475.91$326.97
    28294TCorrection of bunion005727.5493$1,634.86$475.91$326.97
    28296TCorrection of bunion005727.5493$1,634.86$475.91$326.97
    28297TCorrection of bunion005727.5493$1,634.86$475.91$326.97
    28298TCorrection of bunion005727.5493$1,634.86$475.91$326.97
    28299TCorrection of bunion005727.5493$1,634.86$475.91$326.97
    28300TIncision of heel bone005640.2957$2,391.27$478.25
    28302TIncision of ankle bone005520.0692$1,190.97$355.34$238.19
    28304TIncision of midfoot bones005640.2957$2,391.27$478.25
    28305TIncise/graft midfoot bones005640.2957$2,391.27$478.25
    28306TIncision of metatarsal005520.0692$1,190.97$355.34$238.19
    28307TIncision of metatarsal005520.0692$1,190.97$355.34$238.19
    28308TIncision of metatarsal005520.0692$1,190.97$355.34$238.19
    28309TIncision of metatarsals005640.2957$2,391.27$478.25
    28310TRevision of big toe005520.0692$1,190.97$355.34$238.19
    28312TRevision of toe005520.0692$1,190.97$355.34$238.19
    28313TRepair deformity of toe005520.0692$1,190.97$355.34$238.19
    28315TRemoval of sesamoid bone005520.0692$1,190.97$355.34$238.19
    28320TRepair of foot bones005640.2957$2,391.27$478.25
    28322TRepair of metatarsals005640.2957$2,391.27$478.25
    28340TResect enlarged toe tissue005520.0692$1,190.97$355.34$238.19
    28341TResect enlarged toe005520.0692$1,190.97$355.34$238.19
    28344TRepair extra toe(s)005520.0692$1,190.97$355.34$238.19
    28345TRepair webbed toe(s)005520.0692$1,190.97$355.34$238.19
    28360TReconstruct cleft foot005640.2957$2,391.27$478.25
    28400TTreatment of heel fracture00431.7694$105.00$21.00
    28405TTreatment of heel fracture00431.7694$105.00$21.00
    28406TTreatment of heel fracture004637.7023$2,237.37$535.76$447.47
    28415TTreat heel fracture004637.7023$2,237.37$535.76$447.47
    28420TTreat/graft heel fracture004637.7023$2,237.37$535.76$447.47
    28430TTreatment of ankle fracture00431.7694$105.00$21.00
    28435TTreatment of ankle fracture00431.7694$105.00$21.00
    28436TTreatment of ankle fracture004637.7023$2,237.37$535.76$447.47
    28445TTreat ankle fracture004637.7023$2,237.37$535.76$447.47
    28450TTreat midfoot fracture, each00431.7694$105.00$21.00
    28455TTreat midfoot fracture, each00431.7694$105.00$21.00
    28456TTreat midfoot fracture004637.7023$2,237.37$535.76$447.47
    28465TTreat midfoot fracture, each004637.7023$2,237.37$535.76$447.47
    28470TTreat metatarsal fracture00431.7694$105.00$21.00
    28475TTreat metatarsal fracture00431.7694$105.00$21.00
    28476TTreat metatarsal fracture004637.7023$2,237.37$535.76$447.47
    Start Printed Page 50728
    28485TTreat metatarsal fracture004637.7023$2,237.37$535.76$447.47
    28490TTreat big toe fracture00431.7694$105.00$21.00
    28495TTreat big toe fracture00431.7694$105.00$21.00
    28496TTreat big toe fracture004637.7023$2,237.37$535.76$447.47
    28505TTreat big toe fracture004637.7023$2,237.37$535.76$447.47
    28510TTreatment of toe fracture00431.7694$105.00$21.00
    28515TTreatment of toe fracture00431.7694$105.00$21.00
    28525TTreat toe fracture004637.7023$2,237.37$535.76$447.47
    28530TTreat sesamoid bone fracture00431.7694$105.00$21.00
    28531TTreat sesamoid bone fracture004637.7023$2,237.37$535.76$447.47
    28540TTreat foot dislocation00431.7694$105.00$21.00
    28545TTreat foot dislocation004514.4945$860.15$268.47$172.03
    28546TTreat foot dislocation004637.7023$2,237.37$535.76$447.47
    28555TRepair foot dislocation004637.7023$2,237.37$535.76$447.47
    28570TTreat foot dislocation00431.7694$105.00$21.00
    28575TTreat foot dislocation00431.7694$105.00$21.00
    28576TTreat foot dislocation004637.7023$2,237.37$535.76$447.47
    28585TRepair foot dislocation004637.7023$2,237.37$535.76$447.47
    28600TTreat foot dislocation00431.7694$105.00$21.00
    28605TTreat foot dislocation00431.7694$105.00$21.00
    28606TTreat foot dislocation004637.7023$2,237.37$535.76$447.47
    28615TRepair foot dislocation004637.7023$2,237.37$535.76$447.47
    28630TTreat toe dislocation00431.7694$105.00$21.00
    28635TTreat toe dislocation004514.4945$860.15$268.47$172.03
    28636TTreat toe dislocation004637.7023$2,237.37$535.76$447.47
    28645TRepair toe dislocation004637.7023$2,237.37$535.76$447.47
    28660TTreat toe dislocation00431.7694$105.00$21.00
    28665TTreat toe dislocation004514.4945$860.15$268.47$172.03
    28666TTreat toe dislocation004637.7023$2,237.37$535.76$447.47
    28675TRepair of toe dislocation004637.7023$2,237.37$535.76$447.47
    28705TFusion of foot bones005640.2957$2,391.27$478.25
    28715TFusion of foot bones005640.2957$2,391.27$478.25
    28725TFusion of foot bones005640.2957$2,391.27$478.25
    28730TFusion of foot bones005640.2957$2,391.27$478.25
    28735TFusion of foot bones005640.2957$2,391.27$478.25
    28737TRevision of foot bones005640.2957$2,391.27$478.25
    28740TFusion of foot bones005640.2957$2,391.27$478.25
    28750TFusion of big toe joint005640.2957$2,391.27$478.25
    28755TFusion of big toe joint005520.0692$1,190.97$355.34$238.19
    28760TFusion of big toe joint005640.2957$2,391.27$478.25
    28800CAmputation of midfoot
    28805CAmputation thru metatarsal
    28810TAmputation toe & metatarsal005520.0692$1,190.97$355.34$238.19
    28820TAmputation of toe005520.0692$1,190.97$355.34$238.19
    28825TPartial amputation of toe005520.0692$1,190.97$355.34$238.19
    28899TFoot/toes surgery procedure00431.7694$105.00$21.00
    29000SApplication of body cast00581.0934$64.89$12.98
    29010SApplication of body cast04262.1243$126.06$25.21
    29015SApplication of body cast04262.1243$126.06$25.21
    29020SApplication of body cast00581.0934$64.89$12.98
    29025SApplication of body cast00581.0934$64.89$12.98
    29035SApplication of body cast04262.1243$126.06$25.21
    29040SApplication of body cast00581.0934$64.89$12.98
    29044SApplication of body cast04262.1243$126.06$25.21
    29046SApplication of body cast04262.1243$126.06$25.21
    29049SApplication of figure eight00581.0934$64.89$12.98
    29055SApplication of shoulder cast04262.1243$126.06$25.21
    29058SApplication of shoulder cast00581.0934$64.89$12.98
    29065SApplication of long arm cast04262.1243$126.06$25.21
    29075SApplication of forearm cast04262.1243$126.06$25.21
    29085SApply hand/wrist cast00581.0934$64.89$12.98
    29086SApply finger cast00581.0934$64.89$12.98
    29105SApply long arm splint00581.0934$64.89$12.98
    29125SApply forearm splint00581.0934$64.89$12.98
    29126SApply forearm splint00581.0934$64.89$12.98
    29130SApplication of finger splint00581.0934$64.89$12.98
    Start Printed Page 50729
    29131SApplication of finger splint00581.0934$64.89$12.98
    29200SStrapping of chest00581.0934$64.89$12.98
    29220SStrapping of low back00581.0934$64.89$12.98
    29240SStrapping of shoulder00581.0934$64.89$12.98
    29260SStrapping of elbow or wrist00581.0934$64.89$12.98
    29280SStrapping of hand or finger00581.0934$64.89$12.98
    29305SApplication of hip cast04262.1243$126.06$25.21
    29325SApplication of hip casts04262.1243$126.06$25.21
    29345SApplication of long leg cast04262.1243$126.06$25.21
    29355SApplication of long leg cast04262.1243$126.06$25.21
    29358SApply long leg cast brace04262.1243$126.06$25.21
    29365SApplication of long leg cast04262.1243$126.06$25.21
    29405SApply short leg cast04262.1243$126.06$25.21
    29425SApply short leg cast04262.1243$126.06$25.21
    29435SApply short leg cast04262.1243$126.06$25.21
    29440SAddition of walker to cast00581.0934$64.89$12.98
    29445SApply rigid leg cast04262.1243$126.06$25.21
    29450SApplication of leg cast00581.0934$64.89$12.98
    29505SApplication, long leg splint00581.0934$64.89$12.98
    29515SApplication lower leg splint00581.0934$64.89$12.98
    29520SStrapping of hip00581.0934$64.89$12.98
    29530SStrapping of knee00581.0934$64.89$12.98
    29540SStrapping of ankle00581.0934$64.89$12.98
    29550SStrapping of toes00581.0934$64.89$12.98
    29580SApplication of paste boot00581.0934$64.89$12.98
    29590SApplication of foot splint00581.0934$64.89$12.98
    29700SRemoval/revision of cast00581.0934$64.89$12.98
    29705SRemoval/revision of cast00581.0934$64.89$12.98
    29710SRemoval/revision of cast04262.1243$126.06$25.21
    29715SRemoval/revision of cast00581.0934$64.89$12.98
    29720SRepair of body cast00581.0934$64.89$12.98
    29730SWindowing of cast00581.0934$64.89$12.98
    29740SWedging of cast00581.0934$64.89$12.98
    29750SWedging of clubfoot cast00581.0934$64.89$12.98
    29799SCasting/strapping procedure00581.0934$64.89$12.98
    29800TJaw arthroscopy/surgery004128.1318$1,669.43$333.89
    29804TJaw arthroscopy/surgery004128.1318$1,669.43$333.89
    29805TShoulder arthroscopy, dx004128.1318$1,669.43$333.89
    29806TShoulder arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29807TShoulder arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29819TShoulder arthroscopy/surgery004128.1318$1,669.43$333.89
    29820TShoulder arthroscopy/surgery004128.1318$1,669.43$333.89
    29821TShoulder arthroscopy/surgery004128.1318$1,669.43$333.89
    29822TShoulder arthroscopy/surgery004128.1318$1,669.43$333.89
    29823TShoulder arthroscopy/surgery004128.1318$1,669.43$333.89
    29824TShoulder arthroscopy/surgery004128.1318$1,669.43$333.89
    29825TShoulder arthroscopy/surgery004128.1318$1,669.43$333.89
    29826TShoulder arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29827TArthroscop rotator cuff repr004243.9753$2,609.63$804.74$521.93
    29830TElbow arthroscopy004128.1318$1,669.43$333.89
    29834TElbow arthroscopy/surgery004128.1318$1,669.43$333.89
    29835TElbow arthroscopy/surgery004128.1318$1,669.43$333.89
    29836TElbow arthroscopy/surgery004128.1318$1,669.43$333.89
    29837TElbow arthroscopy/surgery004128.1318$1,669.43$333.89
    29838TElbow arthroscopy/surgery004128.1318$1,669.43$333.89
    29840TWrist arthroscopy004128.1318$1,669.43$333.89
    29843TWrist arthroscopy/surgery004128.1318$1,669.43$333.89
    29844TWrist arthroscopy/surgery004128.1318$1,669.43$333.89
    29845TWrist arthroscopy/surgery004128.1318$1,669.43$333.89
    29846TWrist arthroscopy/surgery004128.1318$1,669.43$333.89
    29847TWrist arthroscopy/surgery004128.1318$1,669.43$333.89
    29848TWrist endoscopy/surgery004128.1318$1,669.43$333.89
    29850TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29851TKnee arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29855TTibial arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29856TTibial arthroscopy/surgery004128.1318$1,669.43$333.89
    Start Printed Page 50730
    29860THip arthroscopy, dx004128.1318$1,669.43$333.89
    29861THip arthroscopy/surgery004128.1318$1,669.43$333.89
    29862THip arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29863THip arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29866TAutgrft implnt, knee w/scope004243.9753$2,609.63$804.74$521.93
    29867TAllgrft implnt, knee w/scope004243.9753$2,609.63$804.74$521.93
    29868TMeniscal trnspl, knee w/scpe004243.9753$2,609.63$804.74$521.93
    29870TKnee arthroscopy, dx004128.1318$1,669.43$333.89
    29871TKnee arthroscopy/drainage004128.1318$1,669.43$333.89
    29873TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29874TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29875TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29876TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29877TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29879TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29880TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29881TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29882TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29883TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29884TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29885TKnee arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29886TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29887TKnee arthroscopy/surgery004128.1318$1,669.43$333.89
    29888TKnee arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29889TKnee arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29891TAnkle arthroscopy/surgery004128.1318$1,669.43$333.89
    29892TAnkle arthroscopy/surgery004128.1318$1,669.43$333.89
    29893TScope, plantar fasciotomy005520.0692$1,190.97$355.34$238.19
    29894TAnkle arthroscopy/surgery004128.1318$1,669.43$333.89
    29895TAnkle arthroscopy/surgery004128.1318$1,669.43$333.89
    29897TAnkle arthroscopy/surgery004128.1318$1,669.43$333.89
    29898TAnkle arthroscopy/surgery004128.1318$1,669.43$333.89
    29899TAnkle arthroscopy/surgery004243.9753$2,609.63$804.74$521.93
    29900TMcp joint arthroscopy, dx005315.6795$930.47$253.49$186.09
    29901TMcp joint arthroscopy, surg005315.6795$930.47$253.49$186.09
    29902TMcp joint arthroscopy, surg005315.6795$930.47$253.49$186.09
    29999TArthroscopy of joint004128.1318$1,669.43$333.89
    30000TDrainage of nose lesion02512.0101$119.29$23.86
    30020TDrainage of nose lesion02512.0101$119.29$23.86
    30100TIntranasal biopsy02527.8673$466.87$113.41$93.37
    30110TRemoval of nose polyp(s)025316.1357$957.54$282.29$191.51
    30115TRemoval of nose polyp(s)025316.1357$957.54$282.29$191.51
    30117TRemoval of intranasal lesion025316.1357$957.54$282.29$191.51
    30118TRemoval of intranasal lesion025423.404$1,388.86$321.35$277.77
    30120TRevision of nose025316.1357$957.54$282.29$191.51
    30124TRemoval of nose lesion02527.8673$466.87$113.41$93.37
    30125TRemoval of nose lesion025637.3204$2,214.70$442.94
    30130TRemoval of turbinate bones025316.1357$957.54$282.29$191.51
    30140TRemoval of turbinate bones025423.404$1,388.86$321.35$277.77
    30150TPartial removal of nose025637.3204$2,214.70$442.94
    30160TRemoval of nose025637.3204$2,214.70$442.94
    30200TInjection treatment of nose02527.8673$466.87$113.41$93.37
    30210TNasal sinus therapy02527.8673$466.87$113.41$93.37
    30220TInsert nasal septal button02527.8673$466.87$113.41$93.37
    30300XRemove nasal foreign body03400.6384$37.88$7.58
    30310TRemove nasal foreign body025316.1357$957.54$282.29$191.51
    30320TRemove nasal foreign body025316.1357$957.54$282.29$191.51
    30400TReconstruction of nose025637.3204$2,214.70$442.94
    30410TReconstruction of nose025637.3204$2,214.70$442.94
    30420TReconstruction of nose025637.3204$2,214.70$442.94
    30430TRevision of nose025423.404$1,388.86$321.35$277.77
    30435TRevision of nose025637.3204$2,214.70$442.94
    30450TRevision of nose025637.3204$2,214.70$442.94
    30460TRevision of nose025637.3204$2,214.70$442.94
    30462TRevision of nose025637.3204$2,214.70$442.94
    30465TRepair nasal stenosis025637.3204$2,214.70$442.94
    Start Printed Page 50731
    30520TRepair of nasal septum025423.404$1,388.86$321.35$277.77
    30540TRepair nasal defect025637.3204$2,214.70$442.94
    30545TRepair nasal defect025637.3204$2,214.70$442.94
    30560TRelease of nasal adhesions02512.0101$119.29$23.86
    30580TRepair upper jaw fistula025637.3204$2,214.70$442.94
    30600TRepair mouth/nose fistula025637.3204$2,214.70$442.94
    30620TIntranasal reconstruction025637.3204$2,214.70$442.94
    30630TRepair nasal septum defect025423.404$1,388.86$321.35$277.77
    30801TCauterization, inner nose02527.8673$466.87$113.41$93.37
    30802TCauterization, inner nose02527.8673$466.87$113.41$93.37
    30901TControl of nosebleed02501.2896$76.53$26.79$15.31
    30903TControl of nosebleed02501.2896$76.53$26.79$15.31
    30905TControl of nosebleed02501.2896$76.53$26.79$15.31
    30906TRepeat control of nosebleed02501.2896$76.53$26.79$15.31
    30915TLigation, nasal sinus artery009128.9999$1,720.94$348.23$344.19
    30920TLigation, upper jaw artery009226.482$1,571.52$505.37$314.30
    30930TTherapy, fracture of nose025316.1357$957.54$282.29$191.51
    30999TNasal surgery procedure02512.0101$119.29$23.86
    31000TIrrigation, maxillary sinus02512.0101$119.29$23.86
    31002TIrrigation, sphenoid sinus02527.8673$466.87$113.41$93.37
    31020TExploration, maxillary sinus025423.404$1,388.86$321.35$277.77
    31030TExploration, maxillary sinus025637.3204$2,214.70$442.94
    31032TExplore sinus, remove polyps025637.3204$2,214.70$442.94
    31040TExploration behind upper jaw025423.404$1,388.86$321.35$277.77
    31050TExploration, sphenoid sinus025637.3204$2,214.70$442.94
    31051TSphenoid sinus surgery025637.3204$2,214.70$442.94
    31070TExploration of frontal sinus025423.404$1,388.86$321.35$277.77
    31075TExploration of frontal sinus025637.3204$2,214.70$442.94
    31080TRemoval of frontal sinus025637.3204$2,214.70$442.94
    31081TRemoval of frontal sinus025637.3204$2,214.70$442.94
    31084TRemoval of frontal sinus025637.3204$2,214.70$442.94
    31085TRemoval of frontal sinus025637.3204$2,214.70$442.94
    31086TRemoval of frontal sinus025637.3204$2,214.70$442.94
    31087TRemoval of frontal sinus025637.3204$2,214.70$442.94
    31090TExploration of sinuses025637.3204$2,214.70$442.94
    31200TRemoval of ethmoid sinus025637.3204$2,214.70$442.94
    31201TRemoval of ethmoid sinus025637.3204$2,214.70$442.94
    31205TRemoval of ethmoid sinus025637.3204$2,214.70$442.94
    31225CRemoval of upper jaw
    31230CRemoval of upper jaw
    31231TNasal endoscopy, dx00721.4361$85.22$21.27$17.04
    31233TNasal/sinus endoscopy, dx00721.4361$85.22$21.27$17.04
    31235TNasal/sinus endoscopy, dx007415.7757$936.18$295.70$187.24
    31237TNasal/sinus endoscopy, surg007521.3426$1,266.53$445.92$253.31
    31238TNasal/sinus endoscopy, surg007415.7757$936.18$295.70$187.24
    31239TNasal/sinus endoscopy, surg007521.3426$1,266.53$445.92$253.31
    31240TNasal/sinus endoscopy, surg007415.7757$936.18$295.70$187.24
    31254TRevision of ethmoid sinus007521.3426$1,266.53$445.92$253.31
    31255TRemoval of ethmoid sinus007521.3426$1,266.53$445.92$253.31
    31256TExploration maxillary sinus007521.3426$1,266.53$445.92$253.31
    31267TEndoscopy, maxillary sinus007521.3426$1,266.53$445.92$253.31
    31276TSinus endoscopy, surgical007521.3426$1,266.53$445.92$253.31
    31287TNasal/sinus endoscopy, surg007521.3426$1,266.53$445.92$253.31
    31288TNasal/sinus endoscopy, surg007521.3426$1,266.53$445.92$253.31
    31290CNasal/sinus endoscopy, surg
    31291CNasal/sinus endoscopy, surg
    31292TNasal/sinus endoscopy, surg007521.3426$1,266.53$445.92$253.31
    31293TNasal/sinus endoscopy, surg007521.3426$1,266.53$445.92$253.31
    31294TNasal/sinus endoscopy, surg007521.3426$1,266.53$445.92$253.31
    31299TSinus surgery procedure02512.0101$119.29$23.86
    31300TRemoval of larynx lesion025423.404$1,388.86$321.35$277.77
    31320TDiagnostic incision, larynx025637.3204$2,214.70$442.94
    31360CRemoval of larynx
    31365CRemoval of larynx
    31367CPartial removal of larynx
    31368CPartial removal of larynx
    Start Printed Page 50732
    31370CPartial removal of larynx
    31375CPartial removal of larynx
    31380CPartial removal of larynx
    31382CPartial removal of larynx
    31390CRemoval of larynx & pharynx
    31395CReconstruct larynx & pharynx
    31400TRevision of larynx025637.3204$2,214.70$442.94
    31420TRemoval of epiglottis025637.3204$2,214.70$442.94
    31500SInsert emergency airway00942.5363$150.51$47.62$30.10
    31502TChange of windpipe airway01212.2766$135.10$43.80$27.02
    31505TDiagnostic laryngoscopy00710.7915$46.97$11.31$9.39
    31510TLaryngoscopy with biopsy007415.7757$936.18$295.70$187.24
    31511TRemove foreign body, larynx00721.4361$85.22$21.27$17.04
    31512TRemoval of larynx lesion007415.7757$936.18$295.70$187.24
    31513TInjection into vocal cord00721.4361$85.22$21.27$17.04
    31515TLaryngoscopy for aspiration007415.7757$936.18$295.70$187.24
    31520TDiagnostic laryngoscopy00721.4361$85.22$21.27$17.04
    31525TDiagnostic laryngoscopy007415.7757$936.18$295.70$187.24
    31526TDiagnostic laryngoscopy007521.3426$1,266.53$445.92$253.31
    31527TLaryngoscopy for treatment007521.3426$1,266.53$445.92$253.31
    31528TLaryngoscopy and dilation007415.7757$936.18$295.70$187.24
    31529TLaryngoscopy and dilation007415.7757$936.18$295.70$187.24
    31530TOperative laryngoscopy007521.3426$1,266.53$445.92$253.31
    31531TOperative laryngoscopy007521.3426$1,266.53$445.92$253.31
    31535TOperative laryngoscopy007521.3426$1,266.53$445.92$253.31
    31536TOperative laryngoscopy007521.3426$1,266.53$445.92$253.31
    31540TOperative laryngoscopy007521.3426$1,266.53$445.92$253.31
    31541TOperative laryngoscopy007521.3426$1,266.53$445.92$253.31
    31545TRemove vc lesion w/scope007521.3426$1,266.53$445.92$253.31
    31546TRemove vc lesion scope/graft007521.3426$1,266.53$445.92$253.31
    31560TOperative laryngoscopy007521.3426$1,266.53$445.92$253.31
    31561TOperative laryngoscopy007521.3426$1,266.53$445.92$253.31
    31570TLaryngoscopy with injection007415.7757$936.18$295.70$187.24
    31571TLaryngoscopy with injection007521.3426$1,266.53$445.92$253.31
    31575TDiagnostic laryngoscopy00721.4361$85.22$21.27$17.04
    31576TLaryngoscopy with biopsy007521.3426$1,266.53$445.92$253.31
    31577TRemove foreign body, larynx00734.1609$246.92$73.38$49.38
    31578TRemoval of larynx lesion007521.3426$1,266.53$445.92$253.31
    31579TDiagnostic laryngoscopy00734.1609$246.92$73.38$49.38
    31580TRevision of larynx025637.3204$2,214.70$442.94
    31582TRevision of larynx025637.3204$2,214.70$442.94
    31584CTreat larynx fracture
    31585TTreat larynx fracture025316.1357$957.54$282.29$191.51
    31586TTreat larynx fracture025637.3204$2,214.70$442.94
    31587CRevision of larynx
    31588TRevision of larynx025637.3204$2,214.70$442.94
    31590TReinnervate larynx025637.3204$2,214.70$442.94
    31595TLarynx nerve surgery025637.3204$2,214.70$442.94
    31599TLarynx surgery procedure02512.0101$119.29$23.86
    31600TIncision of windpipe025423.404$1,388.86$321.35$277.77
    31601TIncision of windpipe025423.404$1,388.86$321.35$277.77
    31603TIncision of windpipe02527.8673$466.87$113.41$93.37
    31605TIncision of windpipe02527.8673$466.87$113.41$93.37
    31610TIncision of windpipe025423.404$1,388.86$321.35$277.77
    31611TSurgery/speech prosthesis025423.404$1,388.86$321.35$277.77
    31612TPuncture/clear windpipe025423.404$1,388.86$321.35$277.77
    31613TRepair windpipe opening025423.404$1,388.86$321.35$277.77
    31614TRepair windpipe opening025637.3204$2,214.70$442.94
    31615TVisualization of windpipe00769.4592$561.34$189.82$112.27
    31620SEndobronchial us add-on067025.4131$1,508.09$472.46$301.62
    31622TDx bronchoscope/wash00769.4592$561.34$189.82$112.27
    31623TDx bronchoscope/brush00769.4592$561.34$189.82$112.27
    31624TDx bronchoscope/lavage00769.4592$561.34$189.82$112.27
    31625TBronchoscopy w/biopsy(s)00769.4592$561.34$189.82$112.27
    31628TBronchoscopy/lung bx, each00769.4592$561.34$189.82$112.27
    31629TBronchoscopy/needle bx, each00769.4592$561.34$189.82$112.27
    Start Printed Page 50733
    31630TBronchoscopy dilate/fx repr041522.0955$1,311.21$459.92$262.24
    31631TBronchoscopy, dilate w/stent041522.0955$1,311.21$459.92$262.24
    31632TBronchoscopy/lung bx, add'l00769.4592$561.34$189.82$112.27
    31633TBronchoscopy/needle bx add'l00769.4592$561.34$189.82$112.27
    31635TBronchoscopy w/fb removal00769.4592$561.34$189.82$112.27
    31636TBronchoscopy, bronch stents041522.0955$1,311.21$459.92$262.24
    31637TBronchoscopy, stent add-on00769.4592$561.34$189.82$112.27
    31638TBronchoscopy, revise stent041522.0955$1,311.21$459.92$262.24
    31640TBronchoscopy w/tumor excise041522.0955$1,311.21$459.92$262.24
    31641TBronchoscopy, treat blockage041522.0955$1,311.21$459.92$262.24
    31643TDiag bronchoscope/catheter00769.4592$561.34$189.82$112.27
    31645TBronchoscopy, clear airways00769.4592$561.34$189.82$112.27
    31646TBronchoscopy, reclear airway00769.4592$561.34$189.82$112.27
    31656TBronchoscopy, inj for x-ray00769.4592$561.34$189.82$112.27
    31700TInsertion of airway catheter00721.4361$85.22$21.27$17.04
    31708NInstill airway contrast dye
    31710NInsertion of airway catheter
    31715NInjection for bronchus x-ray
    31717TBronchial brush biopsy00734.1609$246.92$73.38$49.38
    31720TClearance of airways00710.7915$46.97$11.31$9.39
    31725CClearance of airways
    31730TIntro, windpipe wire/tube00734.1609$246.92$73.38$49.38
    31750TRepair of windpipe025637.3204$2,214.70$442.94
    31755TRepair of windpipe025637.3204$2,214.70$442.94
    31760CRepair of windpipe
    31766CReconstruction of windpipe
    31770CRepair/graft of bronchus
    31775CReconstruct bronchus
    31780CReconstruct windpipe
    31781CReconstruct windpipe
    31785TRemove windpipe lesion025423.404$1,388.86$321.35$277.77
    31786CRemove windpipe lesion
    31800CRepair of windpipe injury
    31805CRepair of windpipe injury
    31820TClosure of windpipe lesion025316.1357$957.54$282.29$191.51
    31825TRepair of windpipe defect025423.404$1,388.86$321.35$277.77
    31830TRevise windpipe scar025423.404$1,388.86$321.35$277.77
    31899TAirways surgical procedure00769.4592$561.34$189.82$112.27
    32000TDrainage of chest00703.2101$190.50$38.10
    32002TTreatment of collapsed lung00703.2101$190.50$38.10
    32005TTreat lung lining chemically00703.2101$190.50$38.10
    32019TInsert pleural catheter00703.2101$190.50$38.10
    32020TInsertion of chest tube00703.2101$190.50$38.10
    32035CExploration of chest
    32036CExploration of chest
    32095CBiopsy through chest wall
    32100CExploration/biopsy of chest
    32110CExplore/repair chest
    32120CRe-exploration of chest
    32124CExplore chest free adhesions
    32140CRemoval of lung lesion(s)
    32141CRemove/treat lung lesions
    32150CRemoval of lung lesion(s)
    32151CRemove lung foreign body
    32160COpen chest heart massage
    32200CDrain, open, lung lesion
    32201TDrain, percut, lung lesion00703.2101$190.50$38.10
    32215CTreat chest lining
    32220CRelease of lung
    32225CPartial release of lung
    32310CRemoval of chest lining
    32320CFree/remove chest lining
    32400TNeedle biopsy chest lining06856.0174$357.09$115.47$71.42
    32402COpen biopsy chest lining
    32405TBiopsy, lung or mediastinum06856.0174$357.09$115.47$71.42
    32420TPuncture/clear lung00703.2101$190.50$38.10
    Start Printed Page 50734
    32440CRemoval of lung
    32442CSleeve pneumonectomy
    32445CRemoval of lung
    32480CPartial removal of lung
    32482CBilobectomy
    32484CSegmentectomy
    32486CSleeve lobectomy
    32488CCompletion pneumonectomy
    32491CLung volume reduction
    32500CPartial removal of lung
    32501CRepair bronchus add-on
    32520CRemove lung & revise chest
    32522CRemove lung & revise chest
    32525CRemove lung & revise chest
    32540CRemoval of lung lesion
    32601TThoracoscopy, diagnostic006930.6775$1,820.49$591.64$364.10
    32602TThoracoscopy, diagnostic006930.6775$1,820.49$591.64$364.10
    32603TThoracoscopy, diagnostic006930.6775$1,820.49$591.64$364.10
    32604TThoracoscopy, diagnostic006930.6775$1,820.49$591.64$364.10
    32605TThoracoscopy, diagnostic006930.6775$1,820.49$591.64$364.10
    32606TThoracoscopy, diagnostic006930.6775$1,820.49$591.64$364.10
    32650CThoracoscopy, surgical
    32651CThoracoscopy, surgical
    32652CThoracoscopy, surgical
    32653CThoracoscopy, surgical
    32654CThoracoscopy, surgical
    32655CThoracoscopy, surgical
    32656CThoracoscopy, surgical
    32657CThoracoscopy, surgical
    32658CThoracoscopy, surgical
    32659CThoracoscopy, surgical
    32660CThoracoscopy, surgical
    32661CThoracoscopy, surgical
    32662CThoracoscopy, surgical
    32663CThoracoscopy, surgical
    32664CThoracoscopy, surgical
    32665CThoracoscopy, surgical
    32800CRepair lung hernia
    32810CClose chest after drainage
    32815CClose bronchial fistula
    32820CReconstruct injured chest
    32850CDonor pneumonectomy
    32851CLung transplant, single
    32852CLung transplant with bypass
    32853CLung transplant, double
    32854CLung transplant with bypass
    32855CPrepare donor lung, single
    32856CPrepare donor lung, double
    32900CRemoval of rib(s)
    32905CRevise & repair chest wall
    32906CRevise & repair chest wall
    32940CRevision of lung
    32960TTherapeutic pneumothorax00703.2101$190.50$38.10
    32997CTotal lung lavage
    32999TChest surgery procedure00703.2101$190.50$38.10
    33010TDrainage of heart sac00703.2101$190.50$38.10
    33011TRepeat drainage of heart sac00703.2101$190.50$38.10
    33015CIncision of heart sac
    33020CIncision of heart sac
    33025CIncision of heart sac
    33030CPartial removal of heart sac
    33031CPartial removal of heart sac
    33050CRemoval of heart sac lesion
    33120CRemoval of heart lesion
    33130CRemoval of heart lesion
    33140CHeart revascularize (tmr)
    Start Printed Page 50735
    33141CHeart tmr w/other procedure
    33200CInsertion of heart pacemaker
    33201CInsertion of heart pacemaker
    33206TInsertion of heart pacemaker0089105.6143$6,267.47$1,682.28$1,253.49
    33207TInsertion of heart pacemaker0089105.6143$6,267.47$1,682.28$1,253.49
    33208TInsertion of heart pacemaker0655133.7768$7,938.72$1,587.74
    33210TInsertion of heart electrode010645.4851$2,699.22$539.84
    33211TInsertion of heart electrode010645.4851$2,699.22$539.84
    33212TInsertion of pulse generator009089.1574$5,290.87$1,612.80$1,058.17
    33213TInsertion of pulse generator0654100.9294$5,989.45$1,197.89
    33214TUpgrade of pacemaker system0655133.7768$7,938.72$1,587.74
    33215TReposition pacing-defib lead010522.3685$1,327.41$370.40$265.48
    33216TRevise eltrd pacing-defib010645.4851$2,699.22$539.84
    33217TInsert lead pace-defib, dual010645.4851$2,699.22$539.84
    33218TRepair lead pace-defib, one010645.4851$2,699.22$539.84
    33220TRepair lead pace-defib, dual010645.4851$2,699.22$539.84
    33222TRevise pocket, acemaker002718.4182$1,092.99$329.72$218.60
    33223TRevise pocket, pacing-defib002718.4182$1,092.99$329.72$218.60
    33224TInsert pacing lead & connect0418109.3043$6,486.45$1,297.29
    33225TL ventric pacing lead add-on0418109.3043$6,486.45$1,297.29
    33226TReposition l ventric lead010522.3685$1,327.41$370.40$265.48
    33233TRemoval of pacemaker system010522.3685$1,327.41$370.40$265.48
    33234TRemoval of pacemaker system010522.3685$1,327.41$370.40$265.48
    33235TRemoval pacemaker electrode010522.3685$1,327.41$370.40$265.48
    33236CRemove electrode/thoracotomy
    33237CRemove electrode/thoracotomy
    33238CRemove electrode/thoracotomy
    33240BInsert pulse generator
    33241TRemove pulse generator010522.3685$1,327.41$370.40$265.48
    33243CRemove eltrd/thoracotomy
    33244TRemove eltrd, transven010522.3685$1,327.41$370.40$265.48
    33245CInsert epic eltrd pace-defib
    33246CInsert epic eltrd/generator
    33249BEltrd/insert pace-defib
    33250CAblate heart dysrhythm focus
    33251CAblate heart dysrhythm focus
    33253CReconstruct atria
    33261CAblate heart dysrhythm focus
    33282SImplant pat-active ht record068062.9082$3,733.16$746.63
    33284TRemove pat-active ht record010911.0433$655.34$131.49$131.07
    33300CRepair of heart wound
    33305CRepair of heart wound
    33310CExploratory heart surgery
    33315CExploratory heart surgery
    33320CRepair major blood vessel(s)
    33321CRepair major vessel
    33322CRepair major blood vessel(s)
    33330CInsert major vessel graft
    33332CInsert major vessel graft
    33335CInsert major vessel graft
    33400CRepair of aortic valve
    33401CValvuloplasty, open
    33403CValvuloplasty, w/cp bypass
    33404CPrepare heart-aorta conduit
    33405CReplacement of aortic valve
    33406CReplacement of aortic valve
    33410CReplacement of aortic valve
    33411CReplacement of aortic valve
    33412CReplacement of aortic valve
    33413CReplacement of aortic valve
    33414CRepair of aortic valve
    33415CRevision, subvalvular tissue
    33416CRevise ventricle muscle
    33417CRepair of aortic valve
    33420CRevision of mitral valve
    33422CRevision of mitral valve
    Start Printed Page 50736
    33425CRepair of mitral valve
    33426CRepair of mitral valve
    33427CRepair of mitral valve
    33430CReplacement of mitral valve
    33460CRevision of tricuspid valve
    33463CValvuloplasty, tricuspid
    33464CValvuloplasty, tricuspid
    33465CReplace tricuspid valve
    33468CRevision of tricuspid valve
    33470CRevision of pulmonary valve
    33471CValvotomy, pulmonary valve
    33472CRevision of pulmonary valve
    33474CRevision of pulmonary valve
    33475CReplacement, pulmonary valve
    33476CRevision of heart chamber
    33478CRevision of heart chamber
    33496CRepair, prosth valve clot
    33500CRepair heart vessel fistula
    33501CRepair heart vessel fistula
    33502CCoronary artery correction
    33503CCoronary artery graft
    33504CCoronary artery graft
    33505CRepair artery w/tunnel
    33506CRepair artery, translocation
    33508NEndoscopic vein harvest
    33510CCABG, vein, single
    33511CCABG, vein, two
    33512CCABG, vein, three
    33513CCABG, vein, four
    33514CCABG, vein, five
    33516CCabg, vein, six or more
    33517CCABG, artery-vein, single
    33518CCABG, artery-vein, two
    33519CCABG, artery-vein, three
    33521CCABG, artery-vein, four
    33522CCABG, artery-vein, five
    33523CCabg, art-vein, six or more
    33530CCoronary artery, bypass/reop
    33533CCABG, arterial, single
    33534CCABG, arterial, two
    33535CCABG, arterial, three
    33536CCabg, arterial, four or more
    33542CRemoval of heart lesion
    33545CRepair of heart damage
    33572COpen coronary endarterectomy
    33600CClosure of valve
    33602CClosure of valve
    33606CAnastomosis/artery-aorta
    33608CRepair anomaly w/conduit
    33610CRepair by enlargement
    33611CRepair double ventricle
    33612CRepair double ventricle
    33615CRepair, modified fontan
    33617CRepair single ventricle
    33619CRepair single ventricle
    33641CRepair heart septum defect
    33645CRevision of heart veins
    33647CRepair heart septum defects
    33660CRepair of heart defects
    33665CRepair of heart defects
    33670CRepair of heart chambers
    33681CRepair heart septum defect
    33684CRepair heart septum defect
    33688CRepair heart septum defect
    33690CReinforce pulmonary artery
    33692CRepair of heart defects
    Start Printed Page 50737
    33694CRepair of heart defects
    33697CRepair of heart defects
    33702CRepair of heart defects
    33710CRepair of heart defects
    33720CRepair of heart defect
    33722CRepair of heart defect
    33730CRepair heart-vein defect(s)
    33732CRepair heart-vein defect
    33735CRevision of heart chamber
    33736CRevision of heart chamber
    33737CRevision of heart chamber
    33750CMajor vessel shunt
    33755CMajor vessel shunt
    33762CMajor vessel shunt
    33764CMajor vessel shunt & graft
    33766CMajor vessel shunt
    33767CMajor vessel shunt
    33770CRepair great vessels defect
    33771CRepair great vessels defect
    33774CRepair great vessels defect
    33775CRepair great vessels defect
    33776CRepair great vessels defect
    33777CRepair great vessels defect
    33778CRepair great vessels defect
    33779CRepair great vessels defect
    33780CRepair great vessels defect
    33781CRepair great vessels defect
    33786CRepair arterial trunk
    33788CRevision of pulmonary artery
    33800CAortic suspension
    33802CRepair vessel defect
    33803CRepair vessel defect
    33813CRepair septal defect
    33814CRepair septal defect
    33820CRevise major vessel
    33822CRevise major vessel
    33824CRevise major vessel
    33840CRemove aorta constriction
    33845CRemove aorta constriction
    33851CRemove aorta constriction
    33852CRepair septal defect
    33853CRepair septal defect
    33860CAscending aortic graft
    33861CAscending aortic graft
    33863CAscending aortic graft
    33870CTransverse aortic arch graft
    33875CThoracic aortic graft
    33877CThoracoabdominal graft
    33910CRemove lung artery emboli
    33915CRemove lung artery emboli
    33916CSurgery of great vessel
    33917CRepair pulmonary artery
    33918CRepair pulmonary atresia
    33919CRepair pulmonary atresia
    33920CRepair pulmonary atresia
    33922CTransect pulmonary artery
    33924CRemove pulmonary shunt
    33930CRemoval of donor heart/lung
    33933CPrepare donor heart/lung
    33935CTransplantation, heart/lung
    33940CRemoval of donor heart
    33944CPrepare donor heart
    33945CTransplantation of heart
    33960CExternal circulation assist
    33961CExternal circulation assist
    33967CInsert ia percut device
    Start Printed Page 50738
    33968CRemove aortic assist device
    33970CAortic circulation assist
    33971CAortic circulation assist
    33973CInsert balloon device
    33974CRemove intra-aortic balloon
    33975CImplant ventricular device
    33976CImplant ventricular device
    33977CRemove ventricular device
    33978CRemove ventricular device
    33979CInsert intracorporeal device
    33980CRemove intracorporeal device
    33999TCardiac surgery procedure00703.2101$190.50$38.10
    34001CRemoval of artery clot
    34051CRemoval of artery clot
    34101TRemoval of artery clot008836.5617$2,169.68$655.22$433.94
    34111TRemoval of arm artery clot008836.5617$2,169.68$655.22$433.94
    34151CRemoval of artery clot
    34201TRemoval of artery clot008836.5617$2,169.68$655.22$433.94
    34203TRemoval of leg artery clot008836.5617$2,169.68$655.22$433.94
    34401CRemoval of vein clot
    34421TRemoval of vein clot008836.5617$2,169.68$655.22$433.94
    34451CRemoval of vein clot
    34471TRemoval of vein clot008836.5617$2,169.68$655.22$433.94
    34490TRemoval of vein clot008836.5617$2,169.68$655.22$433.94
    34501TRepair valve, femoral vein008836.5617$2,169.68$655.22$433.94
    34502CReconstruct vena cava
    34510TTransposition of vein valve008836.5617$2,169.68$655.22$433.94
    34520TCross-over vein graft008836.5617$2,169.68$655.22$433.94
    34530TLeg vein fusion008836.5617$2,169.68$655.22$433.94
    34800CEndovasc abdo repair w/tube
    34802CEndovasc abdo repr w/device
    34803CEndovas aaa repr w/3-p part
    34804CEndovasc abdo repr w/device
    34805CEndovasc abdo repair w/pros
    34808CEndovasc abdo occlud device
    34812CXpose for endoprosth, aortic
    34813CFemoral endovas graft add-on
    34820CXpose for endoprosth, iliac
    34825CEndovasc extend prosth, init
    34826CEndovasc exten prosth, add'l
    34830COpen aortic tube prosth repr
    34831COpen aortoiliac prosth repr
    34832COpen aortofemor prosth repr
    34833CXpose for endoprosth, iliac
    34834CXpose, endoprosth, brachial
    34900CEndovasc iliac repr w/graft
    35001CRepair defect of artery
    35002CRepair artery rupture, neck
    35005CRepair defect of artery
    35011TRepair defect of artery065330.5339$1,811.97$362.39
    35013CRepair artery rupture, arm
    35021CRepair defect of artery
    35022CRepair artery rupture, chest
    35045CRepair defect of arm artery
    35081CRepair defect of artery
    35082CRepair artery rupture, aorta
    35091CRepair defect of artery
    35092CRepair artery rupture, aorta
    35102CRepair defect of artery
    35103CRepair artery rupture, groin
    35111CRepair defect of artery
    35112CRepair artery rupture,spleen
    35121CRepair defect of artery
    35122CRepair artery rupture, belly
    35131CRepair defect of artery
    35132CRepair artery rupture, groin
    Start Printed Page 50739
    35141CRepair defect of artery
    35142CRepair artery rupture, thigh
    35151CRepair defect of artery
    35152CRepair artery rupture, knee
    35180TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35182CRepair blood vessel lesion
    35184TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35188TRepair blood vessel lesion008836.5617$2,169.68$655.22$433.94
    35189CRepair blood vessel lesion
    35190TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35201TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35206TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35207TRepair blood vessel lesion008836.5617$2,169.68$655.22$433.94
    35211CRepair blood vessel lesion
    35216CRepair blood vessel lesion
    35221CRepair blood vessel lesion
    35226TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35231TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35236TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35241CRepair blood vessel lesion
    35246CRepair blood vessel lesion
    35251CRepair blood vessel lesion
    35256TRepair blood vessel lesion009323.4516$1,391.69$278.34
    35261TRepair blood vessel lesion065330.5339$1,811.97$362.39
    35266TRepair blood vessel lesion065330.5339$1,811.97$362.39
    35271CRepair blood vessel lesion
    35276CRepair blood vessel lesion
    35281CRepair blood vessel lesion
    35286TRepair blood vessel lesion065330.5339$1,811.97$362.39
    35301CRechanneling of artery
    35311CRechanneling of artery
    35321TRechanneling of artery009323.4516$1,391.69$278.34
    35331CRechanneling of artery
    35341CRechanneling of artery
    35351CRechanneling of artery
    35355CRechanneling of artery
    35361CRechanneling of artery
    35363CRechanneling of artery
    35371CRechanneling of artery
    35372CRechanneling of artery
    35381CRechanneling of artery
    35390CReoperation, carotid add-on
    35400CAngioscopy
    35450CRepair arterial blockage
    35452CRepair arterial blockage
    35454CRepair arterial blockage
    35456CRepair arterial blockage
    35458TRepair arterial blockage008134.4473$2,044.21$408.84
    35459TRepair arterial blockage008134.4473$2,044.21$408.84
    35460TRepair venous blockage008134.4473$2,044.21$408.84
    35470TRepair arterial blockage008134.4473$2,044.21$408.84
    35471TRepair arterial blockage008134.4473$2,044.21$408.84
    35472TRepair arterial blockage008134.4473$2,044.21$408.84
    35473TRepair arterial blockage008134.4473$2,044.21$408.84
    35474TRepair arterial blockage008134.4473$2,044.21$408.84
    35475TRepair arterial blockage008134.4473$2,044.21$408.84
    35476TRepair venous blockage008134.4473$2,044.21$408.84
    35480CAtherectomy, open
    35481CAtherectomy, open
    35482CAtherectomy, open
    35483CAtherectomy, open
    35484TAtherectomy, open008134.4473$2,044.21$408.84
    35485TAtherectomy, open008134.4473$2,044.21$408.84
    35490TAtherectomy, percutaneous008134.4473$2,044.21$408.84
    35491TAtherectomy, percutaneous008134.4473$2,044.21$408.84
    35492TAtherectomy, percutaneous008134.4473$2,044.21$408.84
    Start Printed Page 50740
    35493TAtherectomy, percutaneous008134.4473$2,044.21$408.84
    35494TAtherectomy, percutaneous008134.4473$2,044.21$408.84
    35495TAtherectomy, percutaneous008134.4473$2,044.21$408.84
    35500THarvest vein for bypass008134.4473$2,044.21$408.84
    35501CArtery bypass graft
    35506CArtery bypass graft
    35507CArtery bypass graft
    35508CArtery bypass graft
    35509CArtery bypass graft
    35510CArtery bypass graft
    35511CArtery bypass graft
    35512CArtery bypass graft
    35515CArtery bypass graft
    35516CArtery bypass graft
    35518CArtery bypass graft
    35521CArtery bypass graft
    35522CArtery bypass graft
    35525CArtery bypass graft
    35526CArtery bypass graft
    35531CArtery bypass graft
    35533CArtery bypass graft
    35536CArtery bypass graft
    35541CArtery bypass graft
    35546CArtery bypass graft
    35548CArtery bypass graft
    35549CArtery bypass graft
    35551CArtery bypass graft
    35556CArtery bypass graft
    35558CArtery bypass graft
    35560CArtery bypass graft
    35563CArtery bypass graft
    35565CArtery bypass graft
    35566CArtery bypass graft
    35571CArtery bypass graft
    35572NHarvest femoropopliteal vein
    35583CVein bypass graft
    35585CVein bypass graft
    35587CVein bypass graft
    35600CHarvest artery for cabg
    35601CArtery bypass graft
    35606CArtery bypass graft
    35612CArtery bypass graft
    35616CArtery bypass graft
    35621CArtery bypass graft
    35623CBypass graft, not vein
    35626CArtery bypass graft
    35631CArtery bypass graft
    35636CArtery bypass graft
    35641CArtery bypass graft
    35642CArtery bypass graft
    35645CArtery bypass graft
    35646CArtery bypass graft
    35647CArtery bypass graft
    35650CArtery bypass graft
    35651CArtery bypass graft
    35654CArtery bypass graft
    35656CArtery bypass graft
    35661CArtery bypass graft
    35663CArtery bypass graft
    35665CArtery bypass graft
    35666CArtery bypass graft
    35671CArtery bypass graft
    35681CComposite bypass graft
    35682CComposite bypass graft
    35683CComposite bypass graft
    35685TBypass graft patency/patch009323.4516$1,391.69$278.34
    Start Printed Page 50741
    35686TBypass graft/av fist patency009323.4516$1,391.69$278.34
    35691CArterial transposition
    35693CArterial transposition
    35694CArterial transposition
    35695CArterial transposition
    35697CReimplant artery each
    35700CReoperation, bypass graft
    35701CExploration, carotid artery
    35721CExploration, femoral artery
    35741CExploration popliteal artery
    35761TExploration of artery/vein011531.4727$1,867.68$459.35$373.54
    35800CExplore neck vessels
    35820CExplore chest vessels
    35840CExplore abdominal vessels
    35860TExplore limb vessels009323.4516$1,391.69$278.34
    35870CRepair vessel graft defect
    35875TRemoval of clot in graft008836.5617$2,169.68$655.22$433.94
    35876TRemoval of clot in graft008836.5617$2,169.68$655.22$433.94
    35879TRevise graft w/vein008836.5617$2,169.68$655.22$433.94
    35881TRevise graft w/vein008836.5617$2,169.68$655.22$433.94
    35901CExcision, graft, neck
    35903TExcision, graft, extremity011531.4727$1,867.68$459.35$373.54
    35905CExcision, graft, thorax
    35907CExcision, graft, abdomen
    36000NPlace needle in vein
    36002SPseudoaneurysm injection trt02672.6327$156.23$62.18$31.25
    36005NInjection ext venography
    36010NPlace catheter in vein
    36011NPlace catheter in vein
    36012NPlace catheter in vein
    36013NPlace catheter in artery
    36014NPlace catheter in artery
    36015NPlace catheter in artery
    36100NEstablish access to artery
    36120NEstablish access to artery
    36140NEstablish access to artery
    36145NArtery to vein shunt
    36160NEstablish access to aorta
    36200NPlace catheter in aorta
    36215NPlace catheter in artery
    36216NPlace catheter in artery
    36217NPlace catheter in artery
    36218NPlace catheter in artery
    36245NPlace catheter in artery
    36246NPlace catheter in artery
    36247NPlace catheter in artery
    36248NPlace catheter in artery
    36260TInsertion of infusion pump062327.1105$1,608.82$321.76
    36261TRevision of infusion pump062327.1105$1,608.82$321.76
    36262TRemoval of infusion pump062221.2671$1,262.05$252.41
    36299NVessel injection procedure
    36400NBl draw < 3 yrs fem/jugular
    36405NBl draw < 3 yrs scalp vein
    36406NBl draw < 3 yrs other vein
    36410NNon-routine bl draw > 3 yrs
    36415ADrawing blood
    36416NCapillary blood draw
    36420TVein access cutdown < 1 yr00350.7158$42.48$8.50
    36425TVein access cutdown > 1 yr00350.7158$42.48$8.50
    36430SBlood transfusion service01103.6594$217.16$43.43
    36440SBl push transfuse, 2 yr or <01103.6594$217.16$43.43
    36450SBl exchange/transfuse, nb01103.6594$217.16$43.43
    36455SBl exchange/transfuse non-nb01103.6594$217.16$43.43
    36460STransfusion service, fetal01103.6594$217.16$43.43
    36468TInjection(s), spider veins00981.1346$67.33$13.47
    36469TInjection(s), spider veins00981.1346$67.33$13.47
    Start Printed Page 50742
    36470TInjection therapy of vein00981.1346$67.33$13.47
    36471TInjection therapy of veins00981.1346$67.33$13.47
    36475TEndovenous rf, 1st vein009226.482$1,571.52$505.37$314.30
    36476TEndovenous rf, vein add-on009226.482$1,571.52$505.37$314.30
    36478TEndovenous laser, 1st vein009226.482$1,571.52$505.37$314.30
    36479TEndovenous laser vein addon009226.482$1,571.52$505.37$314.30
    36481NInsertion of catheter, vein
    36500NInsertion of catheter, vein
    36510NInsertion of catheter, vein
    36511SApheresis wbc011112.3956$735.59$200.18$147.12
    36512SApheresis rbc011112.3956$735.59$200.18$147.12
    36513SApheresis platelets011112.3956$735.59$200.18$147.12
    36514SApheresis plasma011112.3956$735.59$200.18$147.12
    36515SApheresis, adsorp/reinfuse011226.7948$1,590.08$438.94$318.02
    36516SApheresis, selective011226.7948$1,590.08$438.94$318.02
    36522SPhotopheresis011226.7948$1,590.08$438.94$318.02
    36540NCollect blood venous device
    36550TDeclot vascular device06762.4105$143.05$28.61
    36555TInsert non-tunnel cv cath06218.2986$492.46$98.49
    36556TInsert non-tunnel cv cath06218.2986$492.46$98.49
    36557TInsert tunneled cv cath062221.2671$1,262.05$252.41
    36558TInsert tunneled cv cath062221.2671$1,262.05$252.41
    36560TInsert tunneled cv cath062327.1105$1,608.82$321.76
    36561TInsert tunneled cv cath062327.1105$1,608.82$321.76
    36563TInsert tunneled cv cath062327.1105$1,608.82$321.76
    36565TInsert tunneled cv cath062327.1105$1,608.82$321.76
    36566TInsert tunneled cv cath1564$4,750.00$950.00
    36568TInsert tunneled cv cath06218.2986$492.46$98.49
    36569TInsert tunneled cv cath06218.2986$492.46$98.49
    36570TInsert tunneled cv cath062221.2671$1,262.05$252.41
    36571TInsert tunneled cv cath062221.2671$1,262.05$252.41
    36575TRepair tunneled cv cath06218.2986$492.46$98.49
    36576TRepair tunneled cv cath06218.2986$492.46$98.49
    36578TReplace tunneled cv cath062221.2671$1,262.05$252.41
    36580TReplace tunneled cv cath06218.2986$492.46$98.49
    36581TReplace tunneled cv cath062221.2671$1,262.05$252.41
    36582TReplace tunneled cv cath062327.1105$1,608.82$321.76
    36583TReplace tunneled cv cath062327.1105$1,608.82$321.76
    36584TReplace tunneled cv cath06218.2986$492.46$98.49
    36585TReplace tunneled cv cath062221.2671$1,262.05$252.41
    36589TRemoval tunneled cv cath06218.2986$492.46$98.49
    36590TRemoval tunneled cv cath06218.2986$492.46$98.49
    36595TMech remov tunneled cv cath062221.2671$1,262.05$252.41
    36596TMech remov tunneled cv cath06218.2986$492.46$98.49
    36597TReposition venous catheter06218.2986$492.46$98.49
    36600NWithdrawal of arterial blood
    36620NInsertion catheter, artery
    36625NInsertion catheter, artery
    36640TInsertion catheter, artery062327.1105$1,608.82$321.76
    36660CInsertion catheter, artery
    36680TInsert needle, bone cavity00020.9559$56.73$11.35
    36800TInsertion of cannula011531.4727$1,867.68$459.35$373.54
    36810TInsertion of cannula011531.4727$1,867.68$459.35$373.54
    36815TInsertion of cannula011531.4727$1,867.68$459.35$373.54
    36818TAv fuse, uppr arm, cephalic008836.5617$2,169.68$655.22$433.94
    36819TAv fusion/uppr arm vein008836.5617$2,169.68$655.22$433.94
    36820TAv fusion/forearm vein008836.5617$2,169.68$655.22$433.94
    36821TAv fusion direct any site008836.5617$2,169.68$655.22$433.94
    36822CInsertion of cannula(s)
    36823CInsertion of cannula(s)
    36825TArtery-vein autograft008836.5617$2,169.68$655.22$433.94
    36830TArtery-vein graft008836.5617$2,169.68$655.22$433.94
    36831TOpen thrombect av fistula008836.5617$2,169.68$655.22$433.94
    36832TAv fistula revision, open008836.5617$2,169.68$655.22$433.94
    36833TAv fistula revision008836.5617$2,169.68$655.22$433.94
    36834TRepair A-V aneurysm008836.5617$2,169.68$655.22$433.94
    Start Printed Page 50743
    36835TArtery to vein shunt011531.4727$1,867.68$459.35$373.54
    36838TDist revas ligation, hemo008836.5617$2,169.68$655.22$433.94
    36860TExternal cannula declotting06762.4105$143.05$28.61
    36861TCannula declotting011531.4727$1,867.68$459.35$373.54
    36870TPercut thrombect av fistula065330.5339$1,811.97$362.39
    37140CRevision of circulation
    37145CRevision of circulation
    37160CRevision of circulation
    37180CRevision of circulation
    37181CSplice spleen/kidney veins
    37182CInsert hepatic shunt (tips)
    37183TRemove hepatic shunt (tips)022964.4545$3,824.92$771.23$764.98
    37195TThrombolytic therapy, stroke06762.4105$143.05$28.61
    37200TTranscatheter biopsy06856.0174$357.09$115.47$71.42
    37201TTranscatheter therapy infuse06762.4105$143.05$28.61
    37202TTranscatheter therapy infuse06762.4105$143.05$28.61
    37203TTranscatheter retrieval010314.7142$873.18$223.63$174.64
    37204TTranscatheter occlusion011531.4727$1,867.68$459.35$373.54
    37205TTranscatheter stent022964.4545$3,824.92$771.23$764.98
    37206TTranscatheter stent add-on022964.4545$3,824.92$771.23$764.98
    37207TTranscatheter stent022964.4545$3,824.92$771.23$764.98
    37208TTranscatheter stent add-on022964.4545$3,824.92$771.23$764.98
    37209TExchange arterial catheter010314.7142$873.18$223.63$174.64
    37215CTranscath stent, cca w/eps
    37216CTranscath stent, cca w/o eps
    37250SIv us first vessel add-on041619.5542$1,160.40$232.08
    37251SIv us each add vessel add-on041619.5542$1,160.40$232.08
    37500TEndoscopy ligate perf veins009226.482$1,571.52$505.37$314.30
    37501TVascular endoscopy procedure009226.482$1,571.52$505.37$314.30
    37565TLigation of neck vein009323.4516$1,391.69$278.34
    37600TLigation of neck artery009323.4516$1,391.69$278.34
    37605TLigation of neck artery009128.9999$1,720.94$348.23$344.19
    37606TLigation of neck artery009128.9999$1,720.94$348.23$344.19
    37607TLigation of a-v fistula009226.482$1,571.52$505.37$314.30
    37609TTemporal artery procedure002114.9776$888.82$219.48$177.76
    37615TLigation of neck artery009128.9999$1,720.94$348.23$344.19
    37616CLigation of chest artery
    37617CLigation of abdomen artery
    37618CLigation of extremity artery
    37620TRevision of major vein009128.9999$1,720.94$348.23$344.19
    37650TRevision of major vein009128.9999$1,720.94$348.23$344.19
    37660CRevision of major vein
    37700TRevise leg vein009128.9999$1,720.94$348.23$344.19
    37720TRemoval of leg vein009226.482$1,571.52$505.37$314.30
    37730TRemoval of leg veins009226.482$1,571.52$505.37$314.30
    37735TRemoval of leg veins/lesion009226.482$1,571.52$505.37$314.30
    37760TRevision of leg veins009128.9999$1,720.94$348.23$344.19
    37765TPhleb veins - extrem - to 20009128.9999$1,720.94$348.23$344.19
    37766TPhleb veins - extrem 20+009128.9999$1,720.94$348.23$344.19
    37780TRevision of leg vein009128.9999$1,720.94$348.23$344.19
    37785TLigate/divide/excise vein009128.9999$1,720.94$348.23$344.19
    37788CRevascularization, penis
    37790TPenile venous occlusion018130.8663$1,831.70$621.82$366.34
    37799TVascular surgery procedure010314.7142$873.18$223.63$174.64
    38100CRemoval of spleen, total
    38101CRemoval of spleen, partial
    38102CRemoval of spleen, total
    38115CRepair of ruptured spleen
    38120TLaparoscopy, splenectomy013143.3389$2,571.86$1,001.89$514.37
    38129TLaparoscope proc, spleen013031.9271$1,894.65$659.53$378.93
    38200NInjection for spleen x-ray
    38204EBl donor search management
    38205SHarvest allogenic stem cells011112.3956$735.59$200.18$147.12
    38206SHarvest auto stem cells011112.3956$735.59$200.18$147.12
    38207ECryopreserve stem cells
    38208EThaw preserved stem cells
    Start Printed Page 50744
    38209EWash harvest stem cells
    38210ET-cell depletion of harvest
    38211ETumor cell deplete of harvst
    38212ERbc depletion of harvest
    38213EPlatelet deplete of harvest
    38214EVolume deplete of harvest
    38215EHarvest stem cell concentrte
    38220TBone marrow aspiration00032.653$157.44$31.49
    38221TBone marrow biopsy00032.653$157.44$31.49
    38230SBone marrow collection011112.3956$735.59$200.18$147.12
    38240SBone marrow/stem transplant012322.9902$1,364.31$272.86
    38241SBone marrow/stem transplant012322.9902$1,364.31$272.86
    38242SLymphocyte infuse transplant011112.3956$735.59$200.18$147.12
    38300TDrainage, lymph node lesion000711.4501$679.48$135.90
    38305TDrainage, lymph node lesion000816.4989$979.09$195.82
    38308TIncision of lymph channels011321.4653$1,273.82$254.76
    38380CThoracic duct procedure
    38381CThoracic duct procedure
    38382CThoracic duct procedure
    38500TBiopsy/removal, lymph nodes011321.4653$1,273.82$254.76
    38505TNeedle biopsy, lymph nodes00053.5994$213.60$71.59$42.72
    38510TBiopsy/removal, lymph nodes011321.4653$1,273.82$254.76
    38520TBiopsy/removal, lymph nodes011321.4653$1,273.82$254.76
    38525TBiopsy/removal, lymph nodes011321.4653$1,273.82$254.76
    38530TBiopsy/removal, lymph nodes011321.4653$1,273.82$254.76
    38542TExplore deep node(s), neck011440.7652$2,419.13$485.91$483.83
    38550TRemoval, neck/armpit lesion011321.4653$1,273.82$254.76
    38555TRemoval, neck/armpit lesion011321.4653$1,273.82$254.76
    38562CRemoval, pelvic lymph nodes
    38564CRemoval, abdomen lymph nodes
    38570TLaparoscopy, lymph node biop013143.3389$2,571.86$1,001.89$514.37
    38571TLaparoscopy, lymphadenectomy013262.9914$3,738.10$1,239.22$747.62
    38572TLaparoscopy, lymphadenectomy013143.3389$2,571.86$1,001.89$514.37
    38589TLaparoscope proc, lymphatic013031.9271$1,894.65$659.53$378.93
    38700TRemoval of lymph nodes, neck011321.4653$1,273.82$254.76
    38720TRemoval of lymph nodes, neck011321.4653$1,273.82$254.76
    38724CRemoval of lymph nodes, neck
    38740TRemove armpit lymph nodes011440.7652$2,419.13$485.91$483.83
    38745TRemove armpit lymph nodes011440.7652$2,419.13$485.91$483.83
    38746CRemove thoracic lymph nodes
    38747CRemove abdominal lymph nodes
    38760TRemove groin lymph nodes011321.4653$1,273.82$254.76
    38765CRemove groin lymph nodes
    38770CRemove pelvis lymph nodes
    38780CRemove abdomen lymph nodes
    38790NInject for lymphatic x-ray
    38792NIdentify sentinel node
    38794NAccess thoracic lymph duct
    38999SBlood/lymph system procedure01103.6594$217.16$43.43
    39000CExploration of chest
    39010CExploration of chest
    39200CRemoval chest lesion
    39220CRemoval chest lesion
    39400TVisualization of chest006930.6775$1,820.49$591.64$364.10
    39499CChest procedure
    39501CRepair diaphragm laceration
    39502CRepair paraesophageal hernia
    39503CRepair of diaphragm hernia
    39520CRepair of diaphragm hernia
    39530CRepair of diaphragm hernia
    39531CRepair of diaphragm hernia
    39540CRepair of diaphragm hernia
    39541CRepair of diaphragm hernia
    39545CRevision of diaphragm
    39560CResect diaphragm, simple
    39561CResect diaphragm, complex
    Start Printed Page 50745
    39599CDiaphragm surgery procedure
    4000FETobacco use txmnt counseling
    4001FETobacco use txmnt, pharmacol
    4002FEStatin therapy, rx
    4006FEBeta-blocker therapy, rx
    4009FEAce inhibitor therapy, rx
    4011FEOral antiplatelet tx, rx
    40490TBiopsy of lip02512.0101$119.29$23.86
    40500TPartial excision of lip025316.1357$957.54$282.29$191.51
    40510TPartial excision of lip025423.404$1,388.86$321.35$277.77
    40520TPartial excision of lip025316.1357$957.54$282.29$191.51
    40525TReconstruct lip with flap025423.404$1,388.86$321.35$277.77
    40527TReconstruct lip with flap025423.404$1,388.86$321.35$277.77
    40530TPartial removal of lip025423.404$1,388.86$321.35$277.77
    40650TRepair lip02527.8673$466.87$113.41$93.37
    40652TRepair lip02527.8673$466.87$113.41$93.37
    40654TRepair lip02527.8673$466.87$113.41$93.37
    40700TRepair cleft lip/nasal025637.3204$2,214.70$442.94
    40701TRepair cleft lip/nasal025637.3204$2,214.70$442.94
    40702TRepair cleft lip/nasal025637.3204$2,214.70$442.94
    40720TRepair cleft lip/nasal025637.3204$2,214.70$442.94
    40761TRepair cleft lip/nasal025637.3204$2,214.70$442.94
    40799TLip surgery procedure02512.0101$119.29$23.86
    40800TDrainage of mouth lesion02512.0101$119.29$23.86
    40801TDrainage of mouth lesion02527.8673$466.87$113.41$93.37
    40804XRemoval, foreign body, mouth03400.6384$37.88$7.58
    40805TRemoval, foreign body, mouth02527.8673$466.87$113.41$93.37
    40806TIncision of lip fold02512.0101$119.29$23.86
    40808TBiopsy of mouth lesion02512.0101$119.29$23.86
    40810TExcision of mouth lesion025316.1357$957.54$282.29$191.51
    40812TExcise/repair mouth lesion025316.1357$957.54$282.29$191.51
    40814TExcise/repair mouth lesion025316.1357$957.54$282.29$191.51
    40816TExcision of mouth lesion025423.404$1,388.86$321.35$277.77
    40818TExcise oral mucosa for graft02512.0101$119.29$23.86
    40819TExcise lip or cheek fold02527.8673$466.87$113.41$93.37
    40820TTreatment of mouth lesion025316.1357$957.54$282.29$191.51
    40830TRepair mouth laceration02512.0101$119.29$23.86
    40831TRepair mouth laceration02527.8673$466.87$113.41$93.37
    40840TReconstruction of mouth025423.404$1,388.86$321.35$277.77
    40842TReconstruction of mouth025423.404$1,388.86$321.35$277.77
    40843TReconstruction of mouth025423.404$1,388.86$321.35$277.77
    40844TReconstruction of mouth025637.3204$2,214.70$442.94
    40845TReconstruction of mouth025637.3204$2,214.70$442.94
    40899TMouth surgery procedure02512.0101$119.29$23.86
    41000TDrainage of mouth lesion025316.1357$957.54$282.29$191.51
    41005TDrainage of mouth lesion02512.0101$119.29$23.86
    41006TDrainage of mouth lesion025423.404$1,388.86$321.35$277.77
    41007TDrainage of mouth lesion025316.1357$957.54$282.29$191.51
    41008TDrainage of mouth lesion025316.1357$957.54$282.29$191.51
    41009TDrainage of mouth lesion02512.0101$119.29$23.86
    41010TIncision of tongue fold02527.8673$466.87$113.41$93.37
    41015TDrainage of mouth lesion02512.0101$119.29$23.86
    41016TDrainage of mouth lesion02527.8673$466.87$113.41$93.37
    41017TDrainage of mouth lesion02527.8673$466.87$113.41$93.37
    41018TDrainage of mouth lesion02527.8673$466.87$113.41$93.37
    41100TBiopsy of tongue02527.8673$466.87$113.41$93.37
    41105TBiopsy of tongue025316.1357$957.54$282.29$191.51
    41108TBiopsy of floor of mouth02527.8673$466.87$113.41$93.37
    41110TExcision of tongue lesion025316.1357$957.54$282.29$191.51
    41112TExcision of tongue lesion025316.1357$957.54$282.29$191.51
    41113TExcision of tongue lesion025316.1357$957.54$282.29$191.51
    41114TExcision of tongue lesion025423.404$1,388.86$321.35$277.77
    41115TExcision of tongue fold02527.8673$466.87$113.41$93.37
    41116TExcision of mouth lesion025316.1357$957.54$282.29$191.51
    41120TPartial removal of tongue025423.404$1,388.86$321.35$277.77
    41130CPartial removal of tongue
    Start Printed Page 50746
    41135CTongue and neck surgery
    41140CRemoval of tongue
    41145CTongue removal, neck surgery
    41150CTongue, mouth, jaw surgery
    41153CTongue, mouth, neck surgery
    41155CTongue, jaw, & neck surgery
    41250TRepair tongue laceration02512.0101$119.29$23.86
    41251TRepair tongue laceration02512.0101$119.29$23.86
    41252TRepair tongue laceration02527.8673$466.87$113.41$93.37
    41500TFixation of tongue025423.404$1,388.86$321.35$277.77
    41510TTongue to lip surgery025316.1357$957.54$282.29$191.51
    41520TReconstruction, tongue fold02527.8673$466.87$113.41$93.37
    41599TTongue and mouth surgery02512.0101$119.29$23.86
    41800TDrainage of gum lesion02512.0101$119.29$23.86
    41805TRemoval foreign body, gum025423.404$1,388.86$321.35$277.77
    41806TRemoval foreign body,jawbone025316.1357$957.54$282.29$191.51
    41820TExcision, gum, each quadrant02527.8673$466.87$113.41$93.37
    41821TExcision of gum flap02527.8673$466.87$113.41$93.37
    41822TExcision of gum lesion025316.1357$957.54$282.29$191.51
    41823TExcision of gum lesion025423.404$1,388.86$321.35$277.77
    41825TExcision of gum lesion025316.1357$957.54$282.29$191.51
    41826TExcision of gum lesion025316.1357$957.54$282.29$191.51
    41827TExcision of gum lesion025423.404$1,388.86$321.35$277.77
    41828TExcision of gum lesion025316.1357$957.54$282.29$191.51
    41830TRemoval of gum tissue025316.1357$957.54$282.29$191.51
    41850TTreatment of gum lesion025316.1357$957.54$282.29$191.51
    41870TGum graft025423.404$1,388.86$321.35$277.77
    41872TRepair gum025316.1357$957.54$282.29$191.51
    41874TRepair tooth socket025423.404$1,388.86$321.35$277.77
    41899TDental surgery procedure02512.0101$119.29$23.86
    42000TDrainage mouth roof lesion02512.0101$119.29$23.86
    42100TBiopsy roof of mouth02527.8673$466.87$113.41$93.37
    42104TExcision lesion, mouth roof025316.1357$957.54$282.29$191.51
    42106TExcision lesion, mouth roof025316.1357$957.54$282.29$191.51
    42107TExcision lesion, mouth roof025423.404$1,388.86$321.35$277.77
    42120TRemove palate/lesion025637.3204$2,214.70$442.94
    42140TExcision of uvula02527.8673$466.87$113.41$93.37
    42145TRepair palate, pharynx/uvula025423.404$1,388.86$321.35$277.77
    42160TTreatment mouth roof lesion025316.1357$957.54$282.29$191.51
    42180TRepair palate02512.0101$119.29$23.86
    42182TRepair palate025637.3204$2,214.70$442.94
    42200TReconstruct cleft palate025637.3204$2,214.70$442.94
    42205TReconstruct cleft palate025637.3204$2,214.70$442.94
    42210TReconstruct cleft palate025637.3204$2,214.70$442.94
    42215TReconstruct cleft palate025637.3204$2,214.70$442.94
    42220TReconstruct cleft palate025637.3204$2,214.70$442.94
    42225TReconstruct cleft palate025637.3204$2,214.70$442.94
    42226TLengthening of palate025637.3204$2,214.70$442.94
    42227TLengthening of palate025637.3204$2,214.70$442.94
    42235TRepair palate025316.1357$957.54$282.29$191.51
    42260TRepair nose to lip fistula025423.404$1,388.86$321.35$277.77
    42280TPreparation, palate mold02512.0101$119.29$23.86
    42281TInsertion, palate prosthesis025316.1357$957.54$282.29$191.51
    42299TPalate/uvula surgery02512.0101$119.29$23.86
    42300TDrainage of salivary gland025316.1357$957.54$282.29$191.51
    42305TDrainage of salivary gland025316.1357$957.54$282.29$191.51
    42310TDrainage of salivary gland02512.0101$119.29$23.86
    42320TDrainage of salivary gland02512.0101$119.29$23.86
    42325TCreate salivary cyst drain02512.0101$119.29$23.86
    42326TCreate salivary cyst drain02527.8673$466.87$113.41$93.37
    42330TRemoval of salivary stone025316.1357$957.54$282.29$191.51
    42335TRemoval of salivary stone025316.1357$957.54$282.29$191.51
    42340TRemoval of salivary stone025316.1357$957.54$282.29$191.51
    42400TBiopsy of salivary gland00053.5994$213.60$71.59$42.72
    42405TBiopsy of salivary gland025316.1357$957.54$282.29$191.51
    42408TExcision of salivary cyst025316.1357$957.54$282.29$191.51
    Start Printed Page 50747
    42409TDrainage of salivary cyst025316.1357$957.54$282.29$191.51
    42410TExcise parotid gland/lesion025637.3204$2,214.70$442.94
    42415TExcise parotid gland/lesion025637.3204$2,214.70$442.94
    42420TExcise parotid gland/lesion025637.3204$2,214.70$442.94
    42425TExcise parotid gland/lesion025637.3204$2,214.70$442.94
    42426CExcise parotid gland/lesion
    42440TExcise submaxillary gland025637.3204$2,214.70$442.94
    42450TExcise sublingual gland025423.404$1,388.86$321.35$277.77
    42500TRepair salivary duct025423.404$1,388.86$321.35$277.77
    42505TRepair salivary duct025637.3204$2,214.70$442.94
    42507TParotid duct diversion025637.3204$2,214.70$442.94
    42508TParotid duct diversion025637.3204$2,214.70$442.94
    42509TParotid duct diversion025637.3204$2,214.70$442.94
    42510TParotid duct diversion025637.3204$2,214.70$442.94
    42550NInjection for salivary x-ray
    42600TClosure of salivary fistula025316.1357$957.54$282.29$191.51
    42650TDilation of salivary duct02527.8673$466.87$113.41$93.37
    42660TDilation of salivary duct02512.0101$119.29$23.86
    42665TLigation of salivary duct025423.404$1,388.86$321.35$277.77
    42699TSalivary surgery procedure02512.0101$119.29$23.86
    42700TDrainage of tonsil abscess02512.0101$119.29$23.86
    42720TDrainage of throat abscess025316.1357$957.54$282.29$191.51
    42725TDrainage of throat abscess025637.3204$2,214.70$442.94
    42800TBiopsy of throat025316.1357$957.54$282.29$191.51
    42802TBiopsy of throat025316.1357$957.54$282.29$191.51
    42804TBiopsy of upper nose/throat025316.1357$957.54$282.29$191.51
    42806TBiopsy of upper nose/throat025423.404$1,388.86$321.35$277.77
    42808TExcise pharynx lesion025316.1357$957.54$282.29$191.51
    42809XRemove pharynx foreign body03400.6384$37.88$7.58
    42810TExcision of neck cyst025423.404$1,388.86$321.35$277.77
    42815TExcision of neck cyst025637.3204$2,214.70$442.94
    42820TRemove tonsils and adenoids025822.2466$1,320.18$437.25$264.04
    42821TRemove tonsils and adenoids025822.2466$1,320.18$437.25$264.04
    42825TRemoval of tonsils025822.2466$1,320.18$437.25$264.04
    42826TRemoval of tonsils025822.2466$1,320.18$437.25$264.04
    42830TRemoval of adenoids025822.2466$1,320.18$437.25$264.04
    42831TRemoval of adenoids025822.2466$1,320.18$437.25$264.04
    42835TRemoval of adenoids025822.2466$1,320.18$437.25$264.04
    42836TRemoval of adenoids025822.2466$1,320.18$437.25$264.04
    42842TExtensive surgery of throat025423.404$1,388.86$321.35$277.77
    42844TExtensive surgery of throat025637.3204$2,214.70$442.94
    42845CExtensive surgery of throat
    42860TExcision of tonsil tags025822.2466$1,320.18$437.25$264.04
    42870TExcision of lingual tonsil025822.2466$1,320.18$437.25$264.04
    42890TPartial removal of pharynx025637.3204$2,214.70$442.94
    42892TRevision of pharyngeal walls025637.3204$2,214.70$442.94
    42894CRevision of pharyngeal walls
    42900TRepair throat wound02527.8673$466.87$113.41$93.37
    42950TReconstruction of throat025423.404$1,388.86$321.35$277.77
    42953CRepair throat, esophagus
    42955TSurgical opening of throat025423.404$1,388.86$321.35$277.77
    42960TControl throat bleeding02501.2896$76.53$26.79$15.31
    42961CControl throat bleeding
    42962TControl throat bleeding025637.3204$2,214.70$442.94
    42970TControl nose/throat bleeding02501.2896$76.53$26.79$15.31
    42971CControl nose/throat bleeding
    42972TControl nose/throat bleeding025316.1357$957.54$282.29$191.51
    42999TThroat surgery procedure02512.0101$119.29$23.86
    43020TIncision of esophagus02527.8673$466.87$113.41$93.37
    43030TThroat muscle surgery025316.1357$957.54$282.29$191.51
    43045CIncision of esophagus
    43100CExcision of esophagus lesion
    43101CExcision of esophagus lesion
    43107CRemoval of esophagus
    43108CRemoval of esophagus
    43112CRemoval of esophagus
    Start Printed Page 50748
    43113CRemoval of esophagus
    43116CPartial removal of esophagus
    43117CPartial removal of esophagus
    43118CPartial removal of esophagus
    43121CPartial removal of esophagus
    43122CPartial removal of esophagus
    43123CPartial removal of esophagus
    43124CRemoval of esophagus
    43130TRemoval of esophagus pouch025423.404$1,388.86$321.35$277.77
    43135CRemoval of esophagus pouch
    43200TEsophagus endoscopy01418.1835$485.63$143.38$97.13
    43201TEsoph scope w/submucous inj01418.1835$485.63$143.38$97.13
    43202TEsophagus endoscopy, biopsy01418.1835$485.63$143.38$97.13
    43204TEsoph scope w/sclerosis inj01418.1835$485.63$143.38$97.13
    43205TEsophagus endoscopy/ligation01418.1835$485.63$143.38$97.13
    43215TEsophagus endoscopy01418.1835$485.63$143.38$97.13
    43216TEsophagus endoscopy/lesion01418.1835$485.63$143.38$97.13
    43217TEsophagus endoscopy01418.1835$485.63$143.38$97.13
    43219TEsophagus endoscopy038422.3392$1,325.68$287.93$265.14
    43220TEsoph endoscopy, dilation01418.1835$485.63$143.38$97.13
    43226TEsoph endoscopy, dilation01418.1835$485.63$143.38$97.13
    43227TEsoph endoscopy, repair01418.1835$485.63$143.38$97.13
    43228TEsoph endoscopy, ablation042222.9647$1,362.79$448.81$272.56
    43231TEsoph endoscopy w/us exam01418.1835$485.63$143.38$97.13
    43232TEsoph endoscopy w/us fn bx01418.1835$485.63$143.38$97.13
    43234TUpper GI endoscopy, exam01418.1835$485.63$143.38$97.13
    43235TUppr gi endoscopy, diagnosis01418.1835$485.63$143.38$97.13
    43236TUppr gi scope w/submuc inj01418.1835$485.63$143.38$97.13
    43237TEndoscopic us exam, esoph01418.1835$485.63$143.38$97.13
    43238TUppr gi endoscopy w/us fn bx01418.1835$485.63$143.38$97.13
    43239TUpper GI endoscopy, biopsy01418.1835$485.63$143.38$97.13
    43240TEsoph endoscope w/drain cyst01418.1835$485.63$143.38$97.13
    43241TUpper GI endoscopy with tube01418.1835$485.63$143.38$97.13
    43242TUppr gi endoscopy w/us fn bx01418.1835$485.63$143.38$97.13
    43243TUpper gi endoscopy & inject01418.1835$485.63$143.38$97.13
    43244TUpper GI endoscopy/ligation01418.1835$485.63$143.38$97.13
    43245TUppr gi scope dilate strictr01418.1835$485.63$143.38$97.13
    43246TPlace gastrostomy tube01418.1835$485.63$143.38$97.13
    43247TOperative upper GI endoscopy01418.1835$485.63$143.38$97.13
    43248TUppr gi endoscopy/guide wire01418.1835$485.63$143.38$97.13
    43249TEsoph endoscopy, dilation01418.1835$485.63$143.38$97.13
    43250TUpper GI endoscopy/tumor01418.1835$485.63$143.38$97.13
    43251TOperative upper GI endoscopy01418.1835$485.63$143.38$97.13
    43255TOperative upper GI endoscopy01418.1835$485.63$143.38$97.13
    43256TUppr gi endoscopy w stent038422.3392$1,325.68$287.93$265.14
    43257TUppr gi scope w/thrml txmnt042222.9647$1,362.79$448.81$272.56
    43258TOperative upper GI endoscopy01418.1835$485.63$143.38$97.13
    43259TEndoscopic ultrasound exam01418.1835$485.63$143.38$97.13
    43260TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43261TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43262TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43263TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43264TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43265TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43267TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43268TEndo cholangiopancreatograph038422.3392$1,325.68$287.93$265.14
    43269TEndo cholangiopancreatograph038422.3392$1,325.68$287.93$265.14
    43271TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43272TEndo cholangiopancreatograph015118.7338$1,111.72$245.46$222.34
    43280TLaparoscopy, fundoplasty013262.9914$3,738.10$1,239.22$747.62
    43289TLaparoscope proc, esoph013031.9271$1,894.65$659.53$378.93
    43300CRepair of esophagus
    43305CRepair esophagus and fistula
    43310CRepair of esophagus
    43312CRepair esophagus and fistula
    43313CEsophagoplasty congenital
    Start Printed Page 50749
    43314CTracheo-esophagoplasty cong
    43320CFuse esophagus & stomach
    43324CRevise esophagus & stomach
    43325CRevise esophagus & stomach
    43326CRevise esophagus & stomach
    43330CRepair of esophagus
    43331CRepair of esophagus
    43340CFuse esophagus & intestine
    43341CFuse esophagus & intestine
    43350CSurgical opening, esophagus
    43351CSurgical opening, esophagus
    43352CSurgical opening, esophagus
    43360CGastrointestinal repair
    43361CGastrointestinal repair
    43400CLigate esophagus veins
    43401CEsophagus surgery for veins
    43405CLigate/staple esophagus
    43410CRepair esophagus wound
    43415CRepair esophagus wound
    43420CRepair esophagus opening
    43425CRepair esophagus opening
    43450TDilate esophagus01405.4737$324.83$94.18$64.97
    43453TDilate esophagus01405.4737$324.83$94.18$64.97
    43456TDilate esophagus01405.4737$324.83$94.18$64.97
    43458TDilate esophagus01405.4737$324.83$94.18$64.97
    43460CPressure treatment esophagus
    43496CFree jejunum flap, microvasc
    43499TEsophagus surgery procedure01418.1835$485.63$143.38$97.13
    43500CSurgical opening of stomach
    43501CSurgical repair of stomach
    43502CSurgical repair of stomach
    43510TSurgical opening of stomach01418.1835$485.63$143.38$97.13
    43520CIncision of pyloric muscle
    43600TBiopsy of stomach01418.1835$485.63$143.38$97.13
    43605CBiopsy of stomach
    43610CExcision of stomach lesion
    43611CExcision of stomach lesion
    43620CRemoval of stomach
    43621CRemoval of stomach
    43622CRemoval of stomach
    43631CRemoval of stomach, partial
    43632CRemoval of stomach, partial
    43633CRemoval of stomach, partial
    43634CRemoval of stomach, partial
    43635CRemoval of stomach, partial
    43638CRemoval of stomach, partial
    43639CRemoval of stomach, partial
    43640CVagotomy & pylorus repair
    43641CVagotomy & pylorus repair
    43644CLap gastric bypass/roux-en-y
    43645CLap gastr bypass incl smll i
    43651TLaparoscopy, vagus nerve013262.9914$3,738.10$1,239.22$747.62
    43652TLaparoscopy, vagus nerve013262.9914$3,738.10$1,239.22$747.62
    43653TLaparoscopy, gastrostomy013143.3389$2,571.86$1,001.89$514.37
    43659TLaparoscope proc, stom013031.9271$1,894.65$659.53$378.93
    43750TPlace gastrostomy tube01418.1835$485.63$143.38$97.13
    43752XNasal/orogastric w/stent02721.3801$81.90$32.76$16.38
    43760TChange gastrostomy tube01212.2766$135.10$43.80$27.02
    43761TReposition gastrostomy tube01226.9721$413.75$84.85$82.75
    43800CReconstruction of pylorus
    43810CFusion of stomach and bowel
    43820CFusion of stomach and bowel
    43825CFusion of stomach and bowel
    43830TPlace gastrostomy tube042222.9647$1,362.79$448.81$272.56
    43831TPlace gastrostomy tube01418.1835$485.63$143.38$97.13
    43832CPlace gastrostomy tube
    Start Printed Page 50750
    43840CRepair of stomach lesion
    43842CGastroplasty for obesity
    43843CGastroplasty for obesity
    43845CGastroplasty duodenal switch
    43846CGastric bypass for obesity
    43847CGastric bypass for obesity
    43848CRevision gastroplasty
    43850CRevise stomach-bowel fusion
    43855CRevise stomach-bowel fusion
    43860CRevise stomach-bowel fusion
    43865CRevise stomach-bowel fusion
    43870TRepair stomach opening01418.1835$485.63$143.38$97.13
    43880CRepair stomach-bowel fistula
    43999TStomach surgery procedure01418.1835$485.63$143.38$97.13
    44005CFreeing of bowel adhesion
    44010CIncision of small bowel
    44015CInsert needle cath bowel
    44020CExplore small intestine
    44021CDecompress small bowel
    44025CIncision of large bowel
    44050CReduce bowel obstruction
    44055CCorrect malrotation of bowel
    44100TBiopsy of bowel01418.1835$485.63$143.38$97.13
    44110CExcise intestine lesion(s)
    44111CExcision of bowel lesion(s)
    44120CRemoval of small intestine
    44121CRemoval of small intestine
    44125CRemoval of small intestine
    44126CEnterectomy w/o taper, cong
    44127CEnterectomy w/taper, cong
    44128CEnterectomy cong, add-on
    44130CBowel to bowel fusion
    44132CEnterectomy, cadaver donor
    44133CEnterectomy, live donor
    44135CIntestine transplnt, cadaver
    44136CIntestine transplant, live
    44137CRemove intestinal allograft
    44139CMobilization of colon
    44140CPartial removal of colon
    44141CPartial removal of colon
    44143CPartial removal of colon
    44144CPartial removal of colon
    44145CPartial removal of colon
    44146CPartial removal of colon
    44147CPartial removal of colon
    44150CRemoval of colon
    44151CRemoval of colon/ileostomy
    44152CRemoval of colon/ileostomy
    44153CRemoval of colon/ileostomy
    44155CRemoval of colon/ileostomy
    44156CRemoval of colon/ileostomy
    44160CRemoval of colon
    44200TLaparoscopy, enterolysis013143.3389$2,571.86$1,001.89$514.37
    44201TLaparoscopy, jejunostomy013143.3389$2,571.86$1,001.89$514.37
    44202CLap resect s/intestine singl
    44203CLap resect s/intestine, addl
    44204CLaparo partial colectomy
    44205CLap colectomy part w/ileum
    44206TLap part colectomy w/stoma013262.9914$3,738.10$1,239.22$747.62
    44207TL colectomy/coloproctostomy013262.9914$3,738.10$1,239.22$747.62
    44208TL colectomy/coloproctostomy013262.9914$3,738.10$1,239.22$747.62
    44210CLaparo total proctocolectomy
    44211CLaparo total proctocolectomy
    44212CLaparo total proctocolectomy
    44238TLaparoscope proc, intestine013031.9271$1,894.65$659.53$378.93
    44239TLaparoscope proc, rectum013031.9271$1,894.65$659.53$378.93
    Start Printed Page 50751
    44300COpen bowel to skin
    44310CIleostomy/jejunostomy
    44312TRevision of ileostomy002718.4182$1,092.99$329.72$218.60
    44314CRevision of ileostomy
    44316CDevise bowel pouch
    44320CColostomy
    44322CColostomy with biopsies
    44340TRevision of colostomy002718.4182$1,092.99$329.72$218.60
    44345CRevision of colostomy
    44346CRevision of colostomy
    44360TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44361TSmall bowel endoscopy/biopsy01429.3487$554.78$152.78$110.96
    44363TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44364TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44365TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44366TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44369TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44370TSmall bowel endoscopy/stent038422.3392$1,325.68$287.93$265.14
    44372TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44373TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44376TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44377TSmall bowel endoscopy/biopsy01429.3487$554.78$152.78$110.96
    44378TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44379TS bowel endoscope w/stent038422.3392$1,325.68$287.93$265.14
    44380TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44382TSmall bowel endoscopy01429.3487$554.78$152.78$110.96
    44383TIleoscopy w/stent038422.3392$1,325.68$287.93$265.14
    44385TEndoscopy of bowel pouch01438.6869$515.51$186.06$103.10
    44386TEndoscopy, bowel pouch/biop01438.6869$515.51$186.06$103.10
    44388TColonoscopy01438.6869$515.51$186.06$103.10
    44389TColonoscopy with biopsy01438.6869$515.51$186.06$103.10
    44390TColonoscopy for foreign body01438.6869$515.51$186.06$103.10
    44391TColonoscopy for bleeding01438.6869$515.51$186.06$103.10
    44392TColonoscopy & polypectomy01438.6869$515.51$186.06$103.10
    44393TColonoscopy, lesion removal01438.6869$515.51$186.06$103.10
    44394TColonoscopy w/snare01438.6869$515.51$186.06$103.10
    44397TColonoscopy w/stent038422.3392$1,325.68$287.93$265.14
    44500TIntro, gastrointestinal tube01212.2766$135.10$43.80$27.02
    44602CSuture, small intestine
    44603CSuture, small intestine
    44604CSuture, large intestine
    44605CRepair of bowel lesion
    44615CIntestinal stricturoplasty
    44620CRepair bowel opening
    44625CRepair bowel opening
    44626CRepair bowel opening
    44640CRepair bowel-skin fistula
    44650CRepair bowel fistula
    44660CRepair bowel-bladder fistula
    44661CRepair bowel-bladder fistula
    44680CSurgical revision, intestine
    44700CSuspend bowel w/prosthesis
    44701NIntraop colon lavage add-on
    44715CPrepare donor intestine
    44720CPrep donor intestine/venous
    44721CPrep donor intestine/artery
    44799TUnlisted procedure intestine01429.3487$554.78$152.78$110.96
    44800CExcision of bowel pouch
    44820CExcision of mesentery lesion
    44850CRepair of mesentery
    44899CBowel surgery procedure
    44900CDrain app abscess, open
    44901TDrain app abscess, percut00379.4751$562.28$224.91$112.46
    44950CAppendectomy
    44955CAppendectomy add-on
    44960CAppendectomy
    Start Printed Page 50752
    44970TLaparoscopy, appendectomy013143.3389$2,571.86$1,001.89$514.37
    44979TLaparoscope proc, app013031.9271$1,894.65$659.53$378.93
    45000TDrainage of pelvic abscess01483.7383$221.84$57.21$44.37
    45005TDrainage of rectal abscess015516.2546$964.60$192.92
    45020TDrainage of rectal abscess015516.2546$964.60$192.92
    45100TBiopsy of rectum014918.0726$1,072.48$293.06$214.50
    45108TRemoval of anorectal lesion015023.8654$1,416.24$437.12$283.25
    45110CRemoval of rectum
    45111CPartial removal of rectum
    45112CRemoval of rectum
    45113CPartial proctectomy
    45114CPartial removal of rectum
    45116CPartial removal of rectum
    45119CRemove rectum w/reservoir
    45120CRemoval of rectum
    45121CRemoval of rectum and colon
    45123CPartial proctectomy
    45126CPelvic exenteration
    45130CExcision of rectal prolapse
    45135CExcision of rectal prolapse
    45136CExcise ileoanal reservior
    45150TExcision of rectal stricture014918.0726$1,072.48$293.06$214.50
    45160TExcision of rectal lesion015023.8654$1,416.24$437.12$283.25
    45170TExcision of rectal lesion015023.8654$1,416.24$437.12$283.25
    45190TDestruction, rectal tumor015023.8654$1,416.24$437.12$283.25
    45300TProctosigmoidoscopy dx01464.6374$275.20$64.40$55.04
    45303TProctosigmoidoscopy dilate01477.9679$472.84$94.57
    45305TProctosigmoidoscopy w/bx01477.9679$472.84$94.57
    45307TProctosigmoidoscopy fb042819.9022$1,181.06$236.21
    45308TProctosigmoidoscopy removal01477.9679$472.84$94.57
    45309TProctosigmoidoscopy removal01477.9679$472.84$94.57
    45315TProctosigmoidoscopy removal01477.9679$472.84$94.57
    45317TProctosigmoidoscopy bleed01477.9679$472.84$94.57
    45320TProctosigmoidoscopy ablate042819.9022$1,181.06$236.21
    45321TProctosigmoidoscopy volvul042819.9022$1,181.06$236.21
    45327TProctosigmoidoscopy w/stent038422.3392$1,325.68$287.93$265.14
    45330TDiagnostic sigmoidoscopy01464.6374$275.20$64.40$55.04
    45331TSigmoidoscopy and biopsy01464.6374$275.20$64.40$55.04
    45332TSigmoidoscopy w/fb removal01464.6374$275.20$64.40$55.04
    45333TSigmoidoscopy & polypectomy01477.9679$472.84$94.57
    45334TSigmoidoscopy for bleeding01477.9679$472.84$94.57
    45335TSigmoidoscopy w/submuc inj01464.6374$275.20$64.40$55.04
    45337TSigmoidoscopy & decompress01464.6374$275.20$64.40$55.04
    45338TSigmoidoscopy w/tumr remove01477.9679$472.84$94.57
    45339TSigmoidoscopy w/ablate tumr01477.9679$472.84$94.57
    45340TSig w/balloon dilation01477.9679$472.84$94.57
    45341TSigmoidoscopy w/ultrasound01477.9679$472.84$94.57
    45342TSigmoidoscopy w/us guide bx01477.9679$472.84$94.57
    45345TSigmoidoscopy w/stent038422.3392$1,325.68$287.93$265.14
    45355TSurgical colonoscopy01438.6869$515.51$186.06$103.10
    45378TDiagnostic colonoscopy01438.6869$515.51$186.06$103.10
    45379TColonoscopy w/fb removal01438.6869$515.51$186.06$103.10
    45380TColonoscopy and biopsy01438.6869$515.51$186.06$103.10
    45381TColonoscopy, submucous inj01438.6869$515.51$186.06$103.10
    45382TColonoscopy/control bleeding01438.6869$515.51$186.06$103.10
    45383TLesion removal colonoscopy01438.6869$515.51$186.06$103.10
    45384TLesion remove colonoscopy01438.6869$515.51$186.06$103.10
    45385TLesion removal colonoscopy01438.6869$515.51$186.06$103.10
    45386TColonoscopy dilate stricture01438.6869$515.51$186.06$103.10
    45387TColonoscopy w/stent038422.3392$1,325.68$287.93$265.14
    45391TColonoscopy w/endoscope us01438.6869$515.51$186.06$103.10
    45392TColonoscopy w/endoscopic fnb01438.6869$515.51$186.06$103.10
    45500TRepair of rectum014918.0726$1,072.48$293.06$214.50
    45505TRepair of rectum015023.8654$1,416.24$437.12$283.25
    45520TTreatment of rectal prolapse00981.1346$67.33$13.47
    45540CCorrect rectal prolapse
    Start Printed Page 50753
    45541TCorrect rectal prolapse015023.8654$1,416.24$437.12$283.25
    45550CRepair rectum/remove sigmoid
    45560TRepair of rectocele015023.8654$1,416.24$437.12$283.25
    45562CExploration/repair of rectum
    45563CExploration/repair of rectum
    45800CRepair rect/bladder fistula
    45805CRepair fistula w/colostomy
    45820CRepair rectourethral fistula
    45825CRepair fistula w/colostomy
    45900TReduction of rectal prolapse01483.7383$221.84$57.21$44.37
    45905TDilation of anal sphincter014918.0726$1,072.48$293.06$214.50
    45910TDilation of rectal narrowing014918.0726$1,072.48$293.06$214.50
    45915TRemove rectal obstruction01483.7383$221.84$57.21$44.37
    45999TRectum surgery procedure01483.7383$221.84$57.21$44.37
    46020TPlacement of seton015023.8654$1,416.24$437.12$283.25
    46030TRemoval of rectal marker01483.7383$221.84$57.21$44.37
    46040TIncision of rectal abscess014918.0726$1,072.48$293.06$214.50
    46045TIncision of rectal abscess015023.8654$1,416.24$437.12$283.25
    46050TIncision of anal abscess01483.7383$221.84$57.21$44.37
    46060TIncision of rectal abscess015023.8654$1,416.24$437.12$283.25
    46070TIncision of anal septum015516.2546$964.60$192.92
    46080TIncision of anal sphincter014918.0726$1,072.48$293.06$214.50
    46083TIncise external hemorrhoid01483.7383$221.84$57.21$44.37
    46200TRemoval of anal fissure015023.8654$1,416.24$437.12$283.25
    46210TRemoval of anal crypt014918.0726$1,072.48$293.06$214.50
    46211TRemoval of anal crypts015023.8654$1,416.24$437.12$283.25
    46220TRemoval of anal tag014918.0726$1,072.48$293.06$214.50
    46221TLigation of hemorrhoid(s)01483.7383$221.84$57.21$44.37
    46230TRemoval of anal tags014918.0726$1,072.48$293.06$214.50
    46250THemorrhoidectomy015023.8654$1,416.24$437.12$283.25
    46255THemorrhoidectomy015023.8654$1,416.24$437.12$283.25
    46257TRemove hemorrhoids & fissure015023.8654$1,416.24$437.12$283.25
    46258TRemove hemorrhoids & fistula015023.8654$1,416.24$437.12$283.25
    46260THemorrhoidectomy015023.8654$1,416.24$437.12$283.25
    46261TRemove hemorrhoids & fissure015023.8654$1,416.24$437.12$283.25
    46262TRemove hemorrhoids & fistula015023.8654$1,416.24$437.12$283.25
    46270TRemoval of anal fistula015023.8654$1,416.24$437.12$283.25
    46275TRemoval of anal fistula015023.8654$1,416.24$437.12$283.25
    46280TRemoval of anal fistula015023.8654$1,416.24$437.12$283.25
    46285TRemoval of anal fistula015023.8654$1,416.24$437.12$283.25
    46288TRepair anal fistula015023.8654$1,416.24$437.12$283.25
    46320TRemoval of hemorrhoid clot01483.7383$221.84$57.21$44.37
    46500TInjection into hemorrhoid(s)015516.2546$964.60$192.92
    46600XDiagnostic anoscopy03400.6384$37.88$7.58
    46604TAnoscopy and dilation01477.9679$472.84$94.57
    46606TAnoscopy and biopsy01464.6374$275.20$64.40$55.04
    46608TAnoscopy, remove for body01477.9679$472.84$94.57
    46610TAnoscopy, remove lesion042819.9022$1,181.06$236.21
    46611TAnoscopy01477.9679$472.84$94.57
    46612TAnoscopy, remove lesions042819.9022$1,181.06$236.21
    46614TAnoscopy, control bleeding01464.6374$275.20$64.40$55.04
    46615TAnoscopy042819.9022$1,181.06$236.21
    46700TRepair of anal stricture015023.8654$1,416.24$437.12$283.25
    46705CRepair of anal stricture
    46706TRepr of anal fistula w/glue015023.8654$1,416.24$437.12$283.25
    46715CRepair of anovaginal fistula
    46716CRepair of anovaginal fistula
    46730CConstruction of absent anus
    46735CConstruction of absent anus
    46740CConstruction of absent anus
    46742CRepair of imperforated anus
    46744CRepair of cloacal anomaly
    46746CRepair of cloacal anomaly
    46748CRepair of cloacal anomaly
    46750TRepair of anal sphincter015023.8654$1,416.24$437.12$283.25
    46751CRepair of anal sphincter
    Start Printed Page 50754
    46753TReconstruction of anus015023.8654$1,416.24$437.12$283.25
    46754TRemoval of suture from anus014918.0726$1,072.48$293.06$214.50
    46760TRepair of anal sphincter015023.8654$1,416.24$437.12$283.25
    46761TRepair of anal sphincter015023.8654$1,416.24$437.12$283.25
    46762TImplant artificial sphincter015023.8654$1,416.24$437.12$283.25
    46900TDestruction, anal lesion(s)00162.5834$153.31$33.57$30.66
    46910TDestruction, anal lesion(s)001718.4211$1,093.16$227.84$218.63
    46916TCryosurgery, anal lesion(s)00131.1078$65.74$14.20$13.15
    46917TLaser surgery, anal lesions069520.3164$1,205.64$266.59$241.13
    46922TExcision of anal lesion(s)069520.3164$1,205.64$266.59$241.13
    46924TDestruction, anal lesion(s)069520.3164$1,205.64$266.59$241.13
    46934TDestruction of hemorrhoids015516.2546$964.60$192.92
    46935TDestruction of hemorrhoids015516.2546$964.60$192.92
    46936TDestruction of hemorrhoids014918.0726$1,072.48$293.06$214.50
    46937TCryotherapy of rectal lesion014918.0726$1,072.48$293.06$214.50
    46938TCryotherapy of rectal lesion015023.8654$1,416.24$437.12$283.25
    46940TTreatment of anal fissure014918.0726$1,072.48$293.06$214.50
    46942TTreatment of anal fissure01483.7383$221.84$57.21$44.37
    46945TLigation of hemorrhoids015516.2546$964.60$192.92
    46946TLigation of hemorrhoids015516.2546$964.60$192.92
    46947THemorrhoidopexy by stapling015023.8654$1,416.24$437.12$283.25
    46999TAnus surgery procedure01483.7383$221.84$57.21$44.37
    47000TNeedle biopsy of liver06856.0174$357.09$115.47$71.42
    47001NNeedle biopsy, liver add-on
    47010COpen drainage, liver lesion
    47011TPercut drain, liver lesion00379.4751$562.28$224.91$112.46
    47015CInject/aspirate liver cyst
    47100CWedge biopsy of liver
    47120CPartial removal of liver
    47122CExtensive removal of liver
    47125CPartial removal of liver
    47130CPartial removal of liver
    47133CRemoval of donor liver
    47135CTransplantation of liver
    47136CTransplantation of liver
    47140CPartial removal, donor liver
    47141CPartial removal, donor liver
    47142CPartial removal, donor liver
    47143CPrep donor liver, whole
    47144CPrep donor liver, 3-segment
    47145CPrep donor liver, lobe split
    47146CPrep donor liver/venous
    47147CPrep donor liver/arterial
    47300CSurgery for liver lesion
    47350CRepair liver wound
    47360CRepair liver wound
    47361CRepair liver wound
    47362CRepair liver wound
    47370TLaparo ablate liver tumor rf013143.3389$2,571.86$1,001.89$514.37
    47371TLaparo ablate liver cryosurg013143.3389$2,571.86$1,001.89$514.37
    47379TLaparoscope procedure, liver013031.9271$1,894.65$659.53$378.93
    47380COpen ablate liver tumor rf
    47381COpen ablate liver tumor cryo
    47382TPercut ablate liver rf042340.2866$2,390.73$478.15
    47399TLiver surgery procedure00020.9559$56.73$11.35
    47400CIncision of liver duct
    47420CIncision of bile duct
    47425CIncision of bile duct
    47460CIncise bile duct sphincter
    47480CIncision of gallbladder
    47490TIncision of gallbladder015212.2833$728.93$145.79
    47500NInjection for liver x-rays
    47505NInjection for liver x-rays
    47510TInsert catheter, bile duct015212.2833$728.93$145.79
    47511TInsert bile duct drain015212.2833$728.93$145.79
    47525TChange bile duct catheter042710.1977$605.16$124.11$121.03
    Start Printed Page 50755
    47530TRevise/reinsert bile tube042710.1977$605.16$124.11$121.03
    47550CBile duct endoscopy add-on
    47552TBiliary endoscopy thru skin015212.2833$728.93$145.79
    47553TBiliary endoscopy thru skin015212.2833$728.93$145.79
    47554TBiliary endoscopy thru skin015212.2833$728.93$145.79
    47555TBiliary endoscopy thru skin015212.2833$728.93$145.79
    47556TBiliary endoscopy thru skin015212.2833$728.93$145.79
    47560TLaparoscopy w/cholangio013031.9271$1,894.65$659.53$378.93
    47561TLaparo w/cholangio/biopsy013031.9271$1,894.65$659.53$378.93
    47562TLaparoscopic cholecystectomy013143.3389$2,571.86$1,001.89$514.37
    47563TLaparo cholecystectomy/graph013143.3389$2,571.86$1,001.89$514.37
    47564TLaparo cholecystectomy/explr013143.3389$2,571.86$1,001.89$514.37
    47570CLaparo cholecystoenterostomy
    47579TLaparoscope proc, biliary013031.9271$1,894.65$659.53$378.93
    47600CRemoval of gallbladder
    47605CRemoval of gallbladder
    47610CRemoval of gallbladder
    47612CRemoval of gallbladder
    47620CRemoval of gallbladder
    47630TRemove bile duct stone015212.2833$728.93$145.79
    47700CExploration of bile ducts
    47701CBile duct revision
    47711CExcision of bile duct tumor
    47712CExcision of bile duct tumor
    47715CExcision of bile duct cyst
    47716CFusion of bile duct cyst
    47720CFuse gallbladder & bowel
    47721CFuse upper gi structures
    47740CFuse gallbladder & bowel
    47741CFuse gallbladder & bowel
    47760CFuse bile ducts and bowel
    47765CFuse liver ducts & bowel
    47780CFuse bile ducts and bowel
    47785CFuse bile ducts and bowel
    47800CReconstruction of bile ducts
    47801CPlacement, bile duct support
    47802CFuse liver duct & intestine
    47900CSuture bile duct injury
    47999TBile tract surgery procedure015212.2833$728.93$145.79
    48000CDrainage of abdomen
    48001CPlacement of drain, pancreas
    48005CResect/debride pancreas
    48020CRemoval of pancreatic stone
    48100CBiopsy of pancreas, open
    48102TNeedle biopsy, pancreas06856.0174$357.09$115.47$71.42
    48120CRemoval of pancreas lesion
    48140CPartial removal of pancreas
    48145CPartial removal of pancreas
    48146CPancreatectomy
    48148CRemoval of pancreatic duct
    48150CPartial removal of pancreas
    48152CPancreatectomy
    48153CPancreatectomy
    48154CPancreatectomy
    48155CRemoval of pancreas
    48160EPancreas removal/transplant
    48180CFuse pancreas and bowel
    48400CInjection, intraop add-on
    48500CSurgery of pancreatic cyst
    48510CDrain pancreatic pseudocyst
    48511TDrain pancreatic pseudocyst00379.4751$562.28$224.91$112.46
    48520CFuse pancreas cyst and bowel
    48540CFuse pancreas cyst and bowel
    48545CPancreatorrhaphy
    48547CDuodenal exclusion
    48550EDonor pancreatectomy
    Start Printed Page 50756
    48551CPrep donor pancreas
    48552CPrep donor pancreas/venous
    48554ETranspl allograft pancreas
    48556CRemoval, allograft pancreas
    48999TPancreas surgery procedure00041.7646$104.72$22.36$20.94
    49000CExploration of abdomen
    49002CReopening of abdomen
    49010CExploration behind abdomen
    49020CDrain abdominal abscess
    49021TDrain abdominal abscess00379.4751$562.28$224.91$112.46
    49040CDrain, open, abdom abscess
    49041TDrain, percut, abdom abscess00379.4751$562.28$224.91$112.46
    49060CDrain, open, retrop abscess
    49061TDrain, percut, retroper absc00379.4751$562.28$224.91$112.46
    49062CDrain to peritoneal cavity
    49080TPuncture, peritoneal cavity00703.2101$190.50$38.10
    49081TRemoval of abdominal fluid00703.2101$190.50$38.10
    49085TRemove abdomen foreign body015321.6961$1,287.51$382.75$257.50
    49180TBiopsy, abdominal mass06856.0174$357.09$115.47$71.42
    49200TRemoval of abdominal lesion013031.9271$1,894.65$659.53$378.93
    49201CRemove abdom lesion, complex
    49215CExcise sacral spine tumor
    49220CMultiple surgery, abdomen
    49250TExcision of umbilicus015321.6961$1,287.51$382.75$257.50
    49255CRemoval of omentum
    49320TDiag laparo separate proc013031.9271$1,894.65$659.53$378.93
    49321TLaparoscopy, biopsy013031.9271$1,894.65$659.53$378.93
    49322TLaparoscopy, aspiration013031.9271$1,894.65$659.53$378.93
    49323TLaparo drain lymphocele013031.9271$1,894.65$659.53$378.93
    49329TLaparo proc, abdm/per/oment013031.9271$1,894.65$659.53$378.93
    49400NAir injection into abdomen
    49419TInsrt abdom cath for chemotx011531.4727$1,867.68$459.35$373.54
    49420TInsert abdom drain, temp065228.8948$1,714.70$342.94
    49421TInsert abdom drain, perm065228.8948$1,714.70$342.94
    49422TRemove perm cannula/catheter010522.3685$1,327.41$370.40$265.48
    49423TExchange drainage catheter015212.2833$728.93$145.79
    49424NAssess cyst, contrast inject
    49425CInsert abdomen-venous drain
    49426TRevise abdomen-venous shunt015321.6961$1,287.51$382.75$257.50
    49427NInjection, abdominal shunt
    49428CLigation of shunt
    49429TRemoval of shunt010522.3685$1,327.41$370.40$265.48
    49491TRpr hern preemie reduc015428.7847$1,708.17$464.85$341.63
    49492TRpr ing hern premie, blocked015428.7847$1,708.17$464.85$341.63
    49495TRpr ing hernia baby, reduc015428.7847$1,708.17$464.85$341.63
    49496TRpr ing hernia baby, blocked015428.7847$1,708.17$464.85$341.63
    49500TRpr ing hernia, init, reduce015428.7847$1,708.17$464.85$341.63
    49501TRpr ing hernia, init blocked015428.7847$1,708.17$464.85$341.63
    49505TPrp i/hern init reduc>5 yr015428.7847$1,708.17$464.85$341.63
    49507TPrp i/hern init block>5 yr015428.7847$1,708.17$464.85$341.63
    49520TRerepair ing hernia, reduce015428.7847$1,708.17$464.85$341.63
    49521TRerepair ing hernia, blocked015428.7847$1,708.17$464.85$341.63
    49525TRepair ing hernia, sliding015428.7847$1,708.17$464.85$341.63
    49540TRepair lumbar hernia015428.7847$1,708.17$464.85$341.63
    49550TRpr rem hernia, init, reduce015428.7847$1,708.17$464.85$341.63
    49553TRpr fem hernia, init blocked015428.7847$1,708.17$464.85$341.63
    49555TRerepair fem hernia, reduce015428.7847$1,708.17$464.85$341.63
    49557TRerepair fem hernia, blocked015428.7847$1,708.17$464.85$341.63
    49560TRpr ventral hern init, reduc015428.7847$1,708.17$464.85$341.63
    49561TRpr ventral hern init, block015428.7847$1,708.17$464.85$341.63
    49565TRerepair ventrl hern, reduce015428.7847$1,708.17$464.85$341.63
    49566TRerepair ventrl hern, block015428.7847$1,708.17$464.85$341.63
    49568THernia repair w/mesh015428.7847$1,708.17$464.85$341.63
    49570TRpr epigastric hern, reduce015428.7847$1,708.17$464.85$341.63
    49572TRpr epigastric hern, blocked015428.7847$1,708.17$464.85$341.63
    49580TRpr umbil hern, reduc < 5 yr015428.7847$1,708.17$464.85$341.63
    Start Printed Page 50757
    49582TRpr umbil hern, block < 5 yr015428.7847$1,708.17$464.85$341.63
    49585TRpr umbil hern, reduc > 5 yr015428.7847$1,708.17$464.85$341.63
    49587TRpr umbil hern, block > 5 yr015428.7847$1,708.17$464.85$341.63
    49590TRepair spigilian hernia015428.7847$1,708.17$464.85$341.63
    49600TRepair umbilical lesion015428.7847$1,708.17$464.85$341.63
    49605CRepair umbilical lesion
    49606CRepair umbilical lesion
    49610CRepair umbilical lesion
    49611CRepair umbilical lesion
    49650TLaparo hernia repair initial013143.3389$2,571.86$1,001.89$514.37
    49651TLaparo hernia repair recur013143.3389$2,571.86$1,001.89$514.37
    49659TLaparo proc, hernia repair013031.9271$1,894.65$659.53$378.93
    49900CRepair of abdominal wall
    49904COmental flap, extra-abdom
    49905COmental flap
    49906CFree omental flap, microvasc
    49999TAbdomen surgery procedure015321.6961$1,287.51$382.75$257.50
    50010CExploration of kidney
    50020TRenal abscess, open drain016223.3918$1,388.14$277.63
    50021TRenal abscess, percut drain00379.4751$562.28$224.91$112.46
    50040CDrainage of kidney
    50045CExploration of kidney
    50060CRemoval of kidney stone
    50065CIncision of kidney
    50070CIncision of kidney
    50075CRemoval of kidney stone
    50080TRemoval of kidney stone042942.3147$2,511.08$502.22
    50081TRemoval of kidney stone042942.3147$2,511.08$502.22
    50100CRevise kidney blood vessels
    50120CExploration of kidney
    50125CExplore and drain kidney
    50130CRemoval of kidney stone
    50135CExploration of kidney
    50200TBiopsy of kidney06856.0174$357.09$115.47$71.42
    50205CBiopsy of kidney
    50220CRemove kidney, open
    50225CRemoval kidney open, complex
    50230CRemoval kidney open, radical
    50234CRemoval of kidney & ureter
    50236CRemoval of kidney & ureter
    50240CPartial removal of kidney
    50280CRemoval of kidney lesion
    50290CRemoval of kidney lesion
    50300CRemoval of donor kidney
    50320CRemoval of donor kidney
    50323CPrep cadaver renal allograft
    50325CPrep donor renal graft
    50327CPrep renal graft/venous
    50328CPrep renal graft/arterial
    50329CPrep renal graft/ureteral
    50340CRemoval of kidney
    50360CTransplantation of kidney
    50365CTransplantation of kidney
    50370CRemove transplanted kidney
    50380CReimplantation of kidney
    50390TDrainage of kidney lesion06856.0174$357.09$115.47$71.42
    50391TInstll rx agnt into rnal tub01562.5751$152.81$40.52$30.56
    50392TInsert kidney drain016118.5576$1,101.26$249.36$220.25
    50393TInsert ureteral tube016118.5576$1,101.26$249.36$220.25
    50394NInjection for kidney x-ray
    50395TCreate passage to kidney016118.5576$1,101.26$249.36$220.25
    50396TMeasure kidney pressure01641.1855$70.35$17.29$14.07
    50398TChange kidney tube01226.9721$413.75$84.85$82.75
    50400CRevision of kidney/ureter
    50405CRevision of kidney/ureter
    50500CRepair of kidney wound
    Start Printed Page 50758
    50520CClose kidney-skin fistula
    50525CRepair renal-abdomen fistula
    50526CRepair renal-abdomen fistula
    50540CRevision of horseshoe kidney
    50541TLaparo ablate renal cyst013031.9271$1,894.65$659.53$378.93
    50542TLaparo ablate renal mass013143.3389$2,571.86$1,001.89$514.37
    50543TLaparo partial nephrectomy013143.3389$2,571.86$1,001.89$514.37
    50544TLaparoscopy, pyeloplasty013031.9271$1,894.65$659.53$378.93
    50545CLaparo radical nephrectomy
    50546CLaparoscopic nephrectomy
    50547CLaparo removal donor kidney
    50548CLaparo remove w/ ureter
    50549TLaparoscope proc, renal013031.9271$1,894.65$659.53$378.93
    50551TKidney endoscopy01606.6753$396.13$105.06$79.23
    50553TKidney endoscopy016118.5576$1,101.26$249.36$220.25
    50555TKidney endoscopy & biopsy01606.6753$396.13$105.06$79.23
    50557TKidney endoscopy & treatment016223.3918$1,388.14$277.63
    50561TKidney endoscopy & treatment016118.5576$1,101.26$249.36$220.25
    50562TRenal scope w/tumor resect01606.6753$396.13$105.06$79.23
    50570TKidney endoscopy01606.6753$396.13$105.06$79.23
    50572TKidney endoscopy01606.6753$396.13$105.06$79.23
    50574TKidney endoscopy & biopsy01606.6753$396.13$105.06$79.23
    50575TKidney endoscopy016333.7354$2,001.96$400.39
    50576TKidney endoscopy & treatment016118.5576$1,101.26$249.36$220.25
    50580CKidney endoscopy & treatment
    50590TFragmenting of kidney stone016943.0133$2,552.54$1,021.01$510.51
    50600CExploration of ureter
    50605CInsert ureteral support
    50610CRemoval of ureter stone
    50620CRemoval of ureter stone
    50630CRemoval of ureter stone
    50650CRemoval of ureter
    50660CRemoval of ureter
    50684NInjection for ureter x-ray
    50686TMeasure ureter pressure01641.1855$70.35$17.29$14.07
    50688TChange of ureter tube01226.9721$413.75$84.85$82.75
    50690NInjection for ureter x-ray
    50700CRevision of ureter
    50715CRelease of ureter
    50722CRelease of ureter
    50725CRelease/revise ureter
    50727CRevise ureter
    50728CRevise ureter
    50740CFusion of ureter & kidney
    50750CFusion of ureter & kidney
    50760CFusion of ureters
    50770CSplicing of ureters
    50780CReimplant ureter in bladder
    50782CReimplant ureter in bladder
    50783CReimplant ureter in bladder
    50785CReimplant ureter in bladder
    50800CImplant ureter in bowel
    50810CFusion of ureter & bowel
    50815CUrine shunt to intestine
    50820CConstruct bowel bladder
    50825CConstruct bowel bladder
    50830CRevise urine flow
    50840CReplace ureter by bowel
    50845CAppendico-vesicostomy
    50860CTransplant ureter to skin
    50900CRepair of ureter
    50920CClosure ureter/skin fistula
    50930CClosure ureter/bowel fistula
    50940CRelease of ureter
    50945TLaparoscopy ureterolithotomy013143.3389$2,571.86$1,001.89$514.37
    50947TLaparo new ureter/bladder013143.3389$2,571.86$1,001.89$514.37
    Start Printed Page 50759
    50948TLaparo new ureter/bladder013143.3389$2,571.86$1,001.89$514.37
    50949TLaparoscope proc, ureter013031.9271$1,894.65$659.53$378.93
    50951TEndoscopy of ureter01606.6753$396.13$105.06$79.23
    50953TEndoscopy of ureter01606.6753$396.13$105.06$79.23
    50955TUreter endoscopy & biopsy016118.5576$1,101.26$249.36$220.25
    50957TUreter endoscopy & treatment016118.5576$1,101.26$249.36$220.25
    50961TUreter endoscopy & treatment016118.5576$1,101.26$249.36$220.25
    50970TUreter endoscopy01606.6753$396.13$105.06$79.23
    50972TUreter endoscopy & catheter01606.6753$396.13$105.06$79.23
    50974TUreter endoscopy & biopsy016118.5576$1,101.26$249.36$220.25
    50976TUreter endoscopy & treatment016118.5576$1,101.26$249.36$220.25
    50980TUreter endoscopy & treatment016118.5576$1,101.26$249.36$220.25
    51000TDrainage of bladder01641.1855$70.35$17.29$14.07
    51005TDrainage of bladder01641.1855$70.35$17.29$14.07
    51010TDrainage of bladder016516.6689$989.18$197.84
    51020TIncise & treat bladder016223.3918$1,388.14$277.63
    51030TIncise & treat bladder016223.3918$1,388.14$277.63
    51040TIncise & drain bladder016223.3918$1,388.14$277.63
    51045TIncise bladder/drain ureter01606.6753$396.13$105.06$79.23
    51050TRemoval of bladder stone016223.3918$1,388.14$277.63
    51060CRemoval of ureter stone
    51065TRemove ureter calculus016223.3918$1,388.14$277.63
    51080TDrainage of bladder abscess000816.4989$979.09$195.82
    51500TRemoval of bladder cyst015428.7847$1,708.17$464.85$341.63
    51520TRemoval of bladder lesion016223.3918$1,388.14$277.63
    51525CRemoval of bladder lesion
    51530CRemoval of bladder lesion
    51535CRepair of ureter lesion
    51550CPartial removal of bladder
    51555CPartial removal of bladder
    51565CRevise bladder & ureter(s)
    51570CRemoval of bladder
    51575CRemoval of bladder & nodes
    51580CRemove bladder/revise tract
    51585CRemoval of bladder & nodes
    51590CRemove bladder/revise tract
    51595CRemove bladder/revise tract
    51596CRemove bladder/create pouch
    51597CRemoval of pelvic structures
    51600NInjection for bladder x-ray
    51605NPreparation for bladder xray
    51610NInjection for bladder x-ray
    51700TIrrigation of bladder01641.1855$70.35$17.29$14.07
    51701XInsert bladder catheter03400.6384$37.88$7.58
    51702XInsert temp bladder cath03400.6384$37.88$7.58
    51703TInsert bladder cath, complex01641.1855$70.35$17.29$14.07
    51705TChange of bladder tube01212.2766$135.10$43.80$27.02
    51710TChange of bladder tube01226.9721$413.75$84.85$82.75
    51715TEndoscopic injection/implant016828.2685$1,677.54$388.03$335.51
    51720TTreatment of bladder lesion01562.5751$152.81$40.52$30.56
    51725TSimple cystometrogram01562.5751$152.81$40.52$30.56
    51726TComplex cystometrogram01562.5751$152.81$40.52$30.56
    51736TUrine flow measurement01641.1855$70.35$17.29$14.07
    51741TElectro-uroflowmetry, first01641.1855$70.35$17.29$14.07
    51772TUrethra pressure profile01562.5751$152.81$40.52$30.56
    51784TAnal/urinary muscle study01641.1855$70.35$17.29$14.07
    51785TAnal/urinary muscle study01641.1855$70.35$17.29$14.07
    51792TUrinary reflex study01641.1855$70.35$17.29$14.07
    51795TUrine voiding pressure study01641.1855$70.35$17.29$14.07
    51797TIntraabdominal pressure test01641.1855$70.35$17.29$14.07
    51798XUs urine capacity measure03400.6384$37.88$7.58
    51800CRevision of bladder/urethra
    51820CRevision of urinary tract
    51840CAttach bladder/urethra
    51841CAttach bladder/urethra
    51845CRepair bladder neck
    Start Printed Page 50760
    51860CRepair of bladder wound
    51865CRepair of bladder wound
    51880TRepair of bladder opening016223.3918$1,388.14$277.63
    51900CRepair bladder/vagina lesion
    51920CClose bladder-uterus fistula
    51925CHysterectomy/bladder repair
    51940CCorrection of bladder defect
    51960CRevision of bladder & bowel
    51980CConstruct bladder opening
    51990TLaparo urethral suspension013143.3389$2,571.86$1,001.89$514.37
    51992TLaparo sling operation013262.9914$3,738.10$1,239.22$747.62
    52000TCystoscopy01606.6753$396.13$105.06$79.23
    52001TCystoscopy, removal of clots01606.6753$396.13$105.06$79.23
    52005TCystoscopy & ureter catheter016118.5576$1,101.26$249.36$220.25
    52007TCystoscopy and biopsy016118.5576$1,101.26$249.36$220.25
    52010TCystoscopy & duct catheter01606.6753$396.13$105.06$79.23
    52204TCystoscopy016118.5576$1,101.26$249.36$220.25
    52214TCystoscopy and treatment016223.3918$1,388.14$277.63
    52224TCystoscopy and treatment016223.3918$1,388.14$277.63
    52234TCystoscopy and treatment016223.3918$1,388.14$277.63
    52235TCystoscopy and treatment016223.3918$1,388.14$277.63
    52240TCystoscopy and treatment016223.3918$1,388.14$277.63
    52250TCystoscopy and radiotracer016223.3918$1,388.14$277.63
    52260TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52265TCystoscopy and treatment01606.6753$396.13$105.06$79.23
    52270TCystoscopy & revise urethra016118.5576$1,101.26$249.36$220.25
    52275TCystoscopy & revise urethra016118.5576$1,101.26$249.36$220.25
    52276TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52277TCystoscopy and treatment016223.3918$1,388.14$277.63
    52281TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52282TCystoscopy, implant stent016333.7354$2,001.96$400.39
    52283TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52285TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52290TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52300TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52301TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52305TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52310TCystoscopy and treatment01606.6753$396.13$105.06$79.23
    52315TCystoscopy and treatment016118.5576$1,101.26$249.36$220.25
    52317TRemove bladder stone016223.3918$1,388.14$277.63
    52318TRemove bladder stone016223.3918$1,388.14$277.63
    52320TCystoscopy and treatment016223.3918$1,388.14$277.63
    52325TCystoscopy, stone removal016223.3918$1,388.14$277.63
    52327TCystoscopy, inject material016223.3918$1,388.14$277.63
    52330TCystoscopy and treatment016223.3918$1,388.14$277.63
    52332TCystoscopy and treatment016223.3918$1,388.14$277.63
    52334TCreate passage to kidney016223.3918$1,388.14$277.63
    52341TCysto w/ureter stricture tx016223.3918$1,388.14$277.63
    52342TCysto w/up stricture tx016223.3918$1,388.14$277.63
    52343TCysto w/renal stricture tx016223.3918$1,388.14$277.63
    52344TCysto/uretero, stone remove016223.3918$1,388.14$277.63
    52345TCysto/uretero w/up stricture016223.3918$1,388.14$277.63
    52346TCystouretero w/renal strict016223.3918$1,388.14$277.63
    52351TCystouretero & or pyeloscope016118.5576$1,101.26$249.36$220.25
    52352TCystouretero w/stone remove016223.3918$1,388.14$277.63
    52353TCystouretero w/lithotripsy016333.7354$2,001.96$400.39
    52354TCystouretero w/biopsy016223.3918$1,388.14$277.63
    52355TCystouretero w/excise tumor016223.3918$1,388.14$277.63
    52400TCystouretero w/congen repr016223.3918$1,388.14$277.63
    52402TCystourethro cut ejacul duct016223.3918$1,388.14$277.63
    52450TIncision of prostate016223.3918$1,388.14$277.63
    52500TRevision of bladder neck016223.3918$1,388.14$277.63
    52510TDilation prostatic urethra016118.5576$1,101.26$249.36$220.25
    52601TProstatectomy (TURP)016333.7354$2,001.96$400.39
    52606TControl postop bleeding016223.3918$1,388.14$277.63
    52612TProstatectomy, first stage016333.7354$2,001.96$400.39
    Start Printed Page 50761
    52614TProstatectomy, second stage016333.7354$2,001.96$400.39
    52620TRemove residual prostate016333.7354$2,001.96$400.39
    52630TRemove prostate regrowth016333.7354$2,001.96$400.39
    52640TRelieve bladder contracture016223.3918$1,388.14$277.63
    52647TLaser surgery of prostate042942.3147$2,511.08$502.22
    52648TLaser surgery of prostate042942.3147$2,511.08$502.22
    52700TDrainage of prostate abscess016223.3918$1,388.14$277.63
    53000TIncision of urethra016617.6743$1,048.85$218.73$209.77
    53010TIncision of urethra016617.6743$1,048.85$218.73$209.77
    53020TIncision of urethra016617.6743$1,048.85$218.73$209.77
    53025TIncision of urethra016617.6743$1,048.85$218.73$209.77
    53040TDrainage of urethra abscess016617.6743$1,048.85$218.73$209.77
    53060TDrainage of urethra abscess016617.6743$1,048.85$218.73$209.77
    53080TDrainage of urinary leakage016617.6743$1,048.85$218.73$209.77
    53085TDrainage of urinary leakage016617.6743$1,048.85$218.73$209.77
    53200TBiopsy of urethra016617.6743$1,048.85$218.73$209.77
    53210TRemoval of urethra016828.2685$1,677.54$388.03$335.51
    53215TRemoval of urethra016617.6743$1,048.85$218.73$209.77
    53220TTreatment of urethra lesion016828.2685$1,677.54$388.03$335.51
    53230TRemoval of urethra lesion016828.2685$1,677.54$388.03$335.51
    53235TRemoval of urethra lesion016617.6743$1,048.85$218.73$209.77
    53240TSurgery for urethra pouch016828.2685$1,677.54$388.03$335.51
    53250TRemoval of urethra gland016617.6743$1,048.85$218.73$209.77
    53260TTreatment of urethra lesion016617.6743$1,048.85$218.73$209.77
    53265TTreatment of urethra lesion016617.6743$1,048.85$218.73$209.77
    53270TRemoval of urethra gland016617.6743$1,048.85$218.73$209.77
    53275TRepair of urethra defect016617.6743$1,048.85$218.73$209.77
    53400TRevise urethra, stage 1016828.2685$1,677.54$388.03$335.51
    53405TRevise urethra, stage 20168128.2685$1,677.54$388.03$335.51
    53410TReconstruction of urethra016828.2685$1,677.54$388.03$335.51
    53415CReconstruction of urethra
    53420TReconstruct urethra, stage 1016828.2685$1,677.54$388.03$335.51
    53425TReconstruct urethra, stage 2016828.2685$1,677.54$388.03$335.51
    53430TReconstruction of urethra016828.2685$1,677.54$388.03$335.51
    53431TReconstruct urethra/bladder016828.2685$1,677.54$388.03$335.51
    53440SCorrect bladder function038575.6446$4,488.98$897.80
    53442TRemove perineal prosthesis016828.2685$1,677.54$388.03$335.51
    53444SInsert tandem cuff038575.6446$4,488.98$897.80
    53445SInsert uro/ves nck sphincter0386120.1694$7,131.21$1,426.24
    53446TRemove uro sphincter016828.2685$1,677.54$388.03$335.51
    53447SRemove/replace ur sphincter0386120.1694$7,131.21$1,426.24
    53448CRemov/replc ur sphinctr comp
    53449TRepair uro sphincter016828.2685$1,677.54$388.03$335.51
    53450TRevision of urethra016828.2685$1,677.54$388.03$335.51
    53460TRevision of urethra016617.6743$1,048.85$218.73$209.77
    53500TUrethrlys, transvag w/ scope016828.2685$1,677.54$388.03$335.51
    53502TRepair of urethra injury016617.6743$1,048.85$218.73$209.77
    53505TRepair of urethra injury016828.2685$1,677.54$388.03$335.51
    53510TRepair of urethra injury016617.6743$1,048.85$218.73$209.77
    53515TRepair of urethra injury016828.2685$1,677.54$388.03$335.51
    53520TRepair of urethra defect016828.2685$1,677.54$388.03$335.51
    53600TDilate urethra stricture01562.5751$152.81$40.52$30.56
    53601TDilate urethra stricture01641.1855$70.35$17.29$14.07
    53605TDilate urethra stricture016118.5576$1,101.26$249.36$220.25
    53620TDilate urethra stricture016516.6689$989.18$197.84
    53621TDilate urethra stricture01641.1855$70.35$17.29$14.07
    53660TDilation of urethra01641.1855$70.35$17.29$14.07
    53661TDilation of urethra01641.1855$70.35$17.29$14.07
    53665TDilation of urethra016617.6743$1,048.85$218.73$209.77
    53850TProstatic microwave thermotx067543.7329$2,595.24$519.05
    53852TProstatic rf thermotx067543.7329$2,595.24$519.05
    53853TProstatic water thermother016223.3918$1,388.14$277.63
    53899TUrology surgery procedure01641.1855$70.35$17.29$14.07
    54000TSlitting of prepuce016617.6743$1,048.85$218.73$209.77
    54001TSlitting of prepuce016617.6743$1,048.85$218.73$209.77
    54015TDrain penis lesion000816.4989$979.09$195.82
    Start Printed Page 50762
    54050TDestruction, penis lesion(s)00131.1078$65.74$14.20$13.15
    54055TDestruction, penis lesion(s)001718.4211$1,093.16$227.84$218.63
    54056TCryosurgery, penis lesion(s)00120.8497$50.42$11.18$10.08
    54057TLaser surg, penis lesion(s)001718.4211$1,093.16$227.84$218.63
    54060TExcision of penis lesion(s)001718.4211$1,093.16$227.84$218.63
    54065TDestruction, penis lesion(s)069520.3164$1,205.64$266.59$241.13
    54100TBiopsy of penis002114.9776$888.82$219.48$177.76
    54105TBiopsy of penis002219.6472$1,165.92$354.45$233.18
    54110TTreatment of penis lesion018130.8663$1,831.70$621.82$366.34
    54111TTreat penis lesion, graft018130.8663$1,831.70$621.82$366.34
    54112TTreat penis lesion, graft018130.8663$1,831.70$621.82$366.34
    54115TTreatment of penis lesion000816.4989$979.09$195.82
    54120TPartial removal of penis018130.8663$1,831.70$621.82$366.34
    54125CRemoval of penis
    54130CRemove penis & nodes
    54135CRemove penis & nodes
    54150TCircumcision018019.8827$1,179.90$304.87$235.98
    54152TCircumcision018019.8827$1,179.90$304.87$235.98
    54160TCircumcision018019.8827$1,179.90$304.87$235.98
    54161TCircumcision018019.8827$1,179.90$304.87$235.98
    54162TLysis penil circumic lesion018019.8827$1,179.90$304.87$235.98
    54163TRepair of circumcision018019.8827$1,179.90$304.87$235.98
    54164TFrenulotomy of penis018019.8827$1,179.90$304.87$235.98
    54200TTreatment of penis lesion01562.5751$152.81$40.52$30.56
    54205TTreatment of penis lesion018130.8663$1,831.70$621.82$366.34
    54220TTreatment of penis lesion01562.5751$152.81$40.52$30.56
    54230NPrepare penis study
    54231TDynamic cavernosometry016516.6689$989.18$197.84
    54235TPenile injection01641.1855$70.35$17.29$14.07
    54240TPenis study01641.1855$70.35$17.29$14.07
    54250TPenis study01641.1855$70.35$17.29$14.07
    54300TRevision of penis018130.8663$1,831.70$621.82$366.34
    54304TRevision of penis018130.8663$1,831.70$621.82$366.34
    54308TReconstruction of urethra018130.8663$1,831.70$621.82$366.34
    54312TReconstruction of urethra018130.8663$1,831.70$621.82$366.34
    54316TReconstruction of urethra018130.8663$1,831.70$621.82$366.34
    54318TReconstruction of urethra018130.8663$1,831.70$621.82$366.34
    54322TReconstruction of urethra018130.8663$1,831.70$621.82$366.34
    54324TReconstruction of urethra018130.8663$1,831.70$621.82$366.34
    54326TReconstruction of urethra018130.8663$1,831.70$621.82$366.34
    54328TRevise penis/urethra018130.8663$1,831.70$621.82$366.34
    54332CRevise penis/urethra
    54336CRevise penis/urethra
    54340TSecondary urethral surgery018130.8663$1,831.70$621.82$366.34
    54344TSecondary urethral surgery018130.8663$1,831.70$621.82$366.34
    54348TSecondary urethral surgery018130.8663$1,831.70$621.82$366.34
    54352TReconstruct urethra/penis018130.8663$1,831.70$621.82$366.34
    54360TPenis plastic surgery018130.8663$1,831.70$621.82$366.34
    54380TRepair penis018130.8663$1,831.70$621.82$366.34
    54385TRepair penis018130.8663$1,831.70$621.82$366.34
    54390CRepair penis and bladder
    54400SInsert semi-rigid prosthesis038575.6446$4,488.98$897.80
    54401SInsert self-contd prosthesis0386120.1694$7,131.21$1,426.24
    54405SInsert multi-comp penis pros0386120.1694$7,131.21$1,426.24
    54406TRemove muti-comp penis pros018130.8663$1,831.70$621.82$366.34
    54408TRepair multi-comp penis pros018130.8663$1,831.70$621.82$366.34
    54410SRemove/replace penis prosth0386120.1694$7,131.21$1,426.24
    54411CRemov/replc penis pros, comp
    54415TRemove self-contd penis pros018130.8663$1,831.70$621.82$366.34
    54416SRemv/repl penis contain pros0386120.1694$7,131.21$1,426.24
    54417CRemv/replc penis pros, compl
    54420TRevision of penis018130.8663$1,831.70$621.82$366.34
    54430CRevision of penis
    54435TRevision of penis018130.8663$1,831.70$621.82$366.34
    54440TRepair of penis018130.8663$1,831.70$621.82$366.34
    54450TPreputial stretching01562.5751$152.81$40.52$30.56
    Start Printed Page 50763
    54500TBiopsy of testis00379.4751$562.28$224.91$112.46
    54505TBiopsy of testis018323.6415$1,402.96$280.59
    54512TExcise lesion testis018323.6415$1,402.96$280.59
    54520TRemoval of testis018323.6415$1,402.96$280.59
    54522TOrchiectomy, partial018323.6415$1,402.96$280.59
    54530TRemoval of testis015428.7847$1,708.17$464.85$341.63
    54535CExtensive testis surgery
    54550TExploration for testis015428.7847$1,708.17$464.85$341.63
    54560TExploration for testis018323.6415$1,402.96$280.59
    54600TReduce testis torsion018323.6415$1,402.96$280.59
    54620TSuspension of testis018323.6415$1,402.96$280.59
    54640TSuspension of testis015428.7847$1,708.17$464.85$341.63
    54650COrchiopexy (Fowler-Stephens)
    54660TRevision of testis018323.6415$1,402.96$280.59
    54670TRepair testis injury018323.6415$1,402.96$280.59
    54680TRelocation of testis(es)018323.6415$1,402.96$280.59
    54690TLaparoscopy, orchiectomy013143.3389$2,571.86$1,001.89$514.37
    54692TLaparoscopy, orchiopexy013262.9914$3,738.10$1,239.22$747.62
    54699TLaparoscope proc, testis013031.9271$1,894.65$659.53$378.93
    54700TDrainage of scrotum018323.6415$1,402.96$280.59
    54800TBiopsy of epididymis00041.7646$104.72$22.36$20.94
    54820TExploration of epididymis018323.6415$1,402.96$280.59
    54830TRemove epididymis lesion018323.6415$1,402.96$280.59
    54840TRemove epididymis lesion018323.6415$1,402.96$280.59
    54860TRemoval of epididymis018323.6415$1,402.96$280.59
    54861TRemoval of epididymis018323.6415$1,402.96$280.59
    54900TFusion of spermatic ducts018323.6415$1,402.96$280.59
    54901TFusion of spermatic ducts018323.6415$1,402.96$280.59
    55000TDrainage of hydrocele00041.7646$104.72$22.36$20.94
    55040TRemoval of hydrocele015428.7847$1,708.17$464.85$341.63
    55041TRemoval of hydroceles015428.7847$1,708.17$464.85$341.63
    55060TRepair of hydrocele018323.6415$1,402.96$280.59
    55100TDrainage of scrotum abscess000816.4989$979.09$195.82
    55110TExplore scrotum018323.6415$1,402.96$280.59
    55120TRemoval of scrotum lesion018323.6415$1,402.96$280.59
    55150TRemoval of scrotum018323.6415$1,402.96$280.59
    55175TRevision of scrotum018323.6415$1,402.96$280.59
    55180TRevision of scrotum018323.6415$1,402.96$280.59
    55200TIncision of sperm duct018323.6415$1,402.96$280.59
    55250TRemoval of sperm duct(s)018323.6415$1,402.96$280.59
    55300NPrepare, sperm duct x-ray
    55400TRepair of sperm duct018323.6415$1,402.96$280.59
    55450TLigation of sperm duct018323.6415$1,402.96$280.59
    55500TRemoval of hydrocele018323.6415$1,402.96$280.59
    55520TRemoval of sperm cord lesion018323.6415$1,402.96$280.59
    55530TRevise spermatic cord veins018323.6415$1,402.96$280.59
    55535TRevise spermatic cord veins015428.7847$1,708.17$464.85$341.63
    55540TRevise hernia & sperm veins015428.7847$1,708.17$464.85$341.63
    55550TLaparo ligate spermatic vein013143.3389$2,571.86$1,001.89$514.37
    55559TLaparo proc, spermatic cord013031.9271$1,894.65$659.53$378.93
    55600TIncise sperm duct pouch018323.6415$1,402.96$280.59
    55605CIncise sperm duct pouch
    55650CRemove sperm duct pouch
    55680TRemove sperm pouch lesion018323.6415$1,402.96$280.59
    55700TBiopsy of prostate01844.3566$258.53$96.27$51.71
    55705TBiopsy of prostate01844.3566$258.53$96.27$51.71
    55720TDrainage of prostate abscess016223.3918$1,388.14$277.63
    55725TDrainage of prostate abscess016223.3918$1,388.14$277.63
    55801CRemoval of prostate
    55810CExtensive prostate surgery
    55812CExtensive prostate surgery
    55815CExtensive prostate surgery
    55821CRemoval of prostate
    55831CRemoval of prostate
    55840CExtensive prostate surgery
    55842CExtensive prostate surgery
    Start Printed Page 50764
    55845CExtensive prostate surgery
    55859TPercut/needle insert, pros016333.7354$2,001.96$400.39
    55860TSurgical exposure, prostate016516.6689$989.18$197.84
    55862CExtensive prostate surgery
    55865CExtensive prostate surgery
    55866CLaparo radical prostatectomy
    55870TElectroejaculation01972.3572$139.88$27.98
    55873TCryoablate prostate067495.7856$5,684.20$1,136.84
    55899TGenital surgery procedure01641.1855$70.35$17.29$14.07
    55970ESex transformation, M to F
    55980ESex transformation, F to M
    56405TI & D of vulva/perineum01892.371$140.70$28.14
    56420TDrainage of gland abscess01892.371$140.70$28.14
    56440TSurgery for vulva lesion019420.7525$1,231.52$397.84$246.30
    56441TLysis of labial lesion(s)019314.5843$865.48$173.10
    56501TDestroy, vulva lesions, sim001718.4211$1,093.16$227.84$218.63
    56515TDestroy vulva lesion/s compl069520.3164$1,205.64$266.59$241.13
    56605TBiopsy of vulva/perineum00194.0547$240.62$71.87$48.12
    56606TBiopsy of vulva/perineum00194.0547$240.62$71.87$48.12
    56620TPartial removal of vulva019526.6791$1,583.22$483.80$316.64
    56625TComplete removal of vulva019526.6791$1,583.22$483.80$316.64
    56630CExtensive vulva surgery
    56631CExtensive vulva surgery
    56632CExtensive vulva surgery
    56633CExtensive vulva surgery
    56634CExtensive vulva surgery
    56637CExtensive vulva surgery
    56640CExtensive vulva surgery
    56700TPartial removal of hymen019420.7525$1,231.52$397.84$246.30
    56720TIncision of hymen019314.5843$865.48$173.10
    56740TRemove vagina gland lesion019420.7525$1,231.52$397.84$246.30
    56800TRepair of vagina019420.7525$1,231.52$397.84$246.30
    56805TRepair clitoris019314.5843$865.48$173.10
    56810TRepair of perineum019420.7525$1,231.52$397.84$246.30
    56820TExam of vulva w/scope01881.14$67.65$13.53
    56821TExam/biopsy of vulva w/scope01892.371$140.70$28.14
    57000TExploration of vagina019314.5843$865.48$173.10
    57010TDrainage of pelvic abscess019314.5843$865.48$173.10
    57020TDrainage of pelvic fluid01924.3082$255.66$51.13
    57022TI & d vaginal hematoma, pp000711.4501$679.48$135.90
    57023TI & d vag hematoma, non-ob000816.4989$979.09$195.82
    57061TDestroy vag lesions, simple019420.7525$1,231.52$397.84$246.30
    57065TDestroy vag lesions, complex019420.7525$1,231.52$397.84$246.30
    57100TBiopsy of vagina01924.3082$255.66$51.13
    57105TBiopsy of vagina019420.7525$1,231.52$397.84$246.30
    57106TRemove vagina wall, partial019420.7525$1,231.52$397.84$246.30
    57107TRemove vagina tissue, part019526.6791$1,583.22$483.80$316.64
    57109TVaginectomy partial w/nodes019526.6791$1,583.22$483.80$316.64
    57110CRemove vagina wall, complete
    57111CRemove vagina tissue, compl
    57112CVaginectomy w/nodes, compl
    57120TClosure of vagina019526.6791$1,583.22$483.80$316.64
    57130TRemove vagina lesion019420.7525$1,231.52$397.84$246.30
    57135TRemove vagina lesion019420.7525$1,231.52$397.84$246.30
    57150TTreat vagina infection01910.167$9.91$2.78$1.98
    57155TInsert uteri tandems/ovoids01924.3082$255.66$51.13
    57160TInsert pessary/other device01881.14$67.65$13.53
    57170TFitting of diaphragm/cap01910.167$9.91$2.78$1.98
    57180TTreat vaginal bleeding01892.371$140.70$28.14
    57200TRepair of vagina019420.7525$1,231.52$397.84$246.30
    57210TRepair vagina/perineum019420.7525$1,231.52$397.84$246.30
    57220TRevision of urethra020240.3866$2,396.66$958.66$479.33
    57230TRepair of urethral lesion019526.6791$1,583.22$483.80$316.64
    57240TRepair bladder & vagina019526.6791$1,583.22$483.80$316.64
    57250TRepair rectum & vagina019526.6791$1,583.22$483.80$316.64
    57260TRepair of vagina019526.6791$1,583.22$483.80$316.64
    Start Printed Page 50765
    57265TExtensive repair of vagina020240.3866$2,396.66$958.66$479.33
    57267TInsert mesh/pelvic flr addon015428.7847$1,708.17$464.85$341.63
    57268TRepair of bowel bulge019526.6791$1,583.22$483.80$316.64
    57270CRepair of bowel pouch
    57280CSuspension of vagina
    57282CRepair of vaginal prolapse
    57283CColpopexy, intraperitoneal
    57284TRepair paravaginal defect020240.3866$2,396.66$958.66$479.33
    57287TRevise/remove sling repair020240.3866$2,396.66$958.66$479.33
    57288TRepair bladder defect020240.3866$2,396.66$958.66$479.33
    57289TRepair bladder & vagina019526.6791$1,583.22$483.80$316.64
    57291TConstruction of vagina019526.6791$1,583.22$483.80$316.64
    57292CConstruct vagina with graft
    57300TRepair rectum-vagina fistula019526.6791$1,583.22$483.80$316.64
    57305CRepair rectum-vagina fistula
    57307CFistula repair & colostomy
    57308CFistula repair, transperine
    57310TRepair urethrovaginal lesion020240.3866$2,396.66$958.66$479.33
    57311CRepair urethrovaginal lesion
    57320TRepair bladder-vagina lesion019526.6791$1,583.22$483.80$316.64
    57330TRepair bladder-vagina lesion019526.6791$1,583.22$483.80$316.64
    57335CRepair vagina
    57400TDilation of vagina019420.7525$1,231.52$397.84$246.30
    57410TPelvic examination019314.5843$865.48$173.10
    57415TRemove vaginal foreign body019420.7525$1,231.52$397.84$246.30
    57420TExam of vagina w/scope01892.371$140.70$28.14
    57421TExam/biopsy of vag w/scope01892.371$140.70$28.14
    57425TLaparoscopy, surg, colpopexy013031.9271$1,894.65$659.53$378.93
    57452TExamination of vagina01892.371$140.70$28.14
    57454TVagina examination & biopsy01892.371$140.70$28.14
    57455TBiopsy of cervix w/scope01892.371$140.70$28.14
    57456TEndocerv curettage w/scope01892.371$140.70$28.14
    57460TCervix excision019314.5843$865.48$173.10
    57461TConz of cervix w/scope, leep019420.7525$1,231.52$397.84$246.30
    57500TBiopsy of cervix01924.3082$255.66$51.13
    57505TEndocervical curettage01892.371$140.70$28.14
    57510TCauterization of cervix019314.5843$865.48$173.10
    57511TCryocautery of cervix01892.371$140.70$28.14
    57513TLaser surgery of cervix019314.5843$865.48$173.10
    57520TConization of cervix019420.7525$1,231.52$397.84$246.30
    57522TConization of cervix019526.6791$1,583.22$483.80$316.64
    57530TRemoval of cervix019526.6791$1,583.22$483.80$316.64
    57531CRemoval of cervix, radical
    57540CRemoval of residual cervix
    57545CRemove cervix/repair pelvis
    57550TRemoval of residual cervix019526.6791$1,583.22$483.80$316.64
    57555TRemove cervix/repair vagina019526.6791$1,583.22$483.80$316.64
    57556TRemove cervix, repair bowel020240.3866$2,396.66$958.66$479.33
    57700TRevision of cervix019420.7525$1,231.52$397.84$246.30
    57720TRevision of cervix019420.7525$1,231.52$397.84$246.30
    57800TDilation of cervical canal019314.5843$865.48$173.10
    57820TD & c of residual cervix019617.0974$1,014.61$338.23$202.92
    58100TBiopsy of uterus lining01881.14$67.65$13.53
    58120TDilation and curettage019617.0974$1,014.61$338.23$202.92
    58140CRemoval of uterus lesion
    58145TMyomectomy vag method019526.6791$1,583.22$483.80$316.64
    58146CMyomectomy abdom complex
    58150CTotal hysterectomy
    58152CTotal hysterectomy
    58180CPartial hysterectomy
    58200CExtensive hysterectomy
    58210CExtensive hysterectomy
    58240CRemoval of pelvis contents
    58260CVaginal hysterectomy
    58262CVag hyst including t/o
    58263CVag hyst w/t/o & vag repair
    Start Printed Page 50766
    58267CVag hyst w/urinary repair
    58270CVag hyst w/enterocele repair
    58275CHysterectomy/revise vagina
    58280CHysterectomy/revise vagina
    58285CExtensive hysterectomy
    58290CVag hyst complex
    58291CVag hyst incl t/o, complex
    58292CVag hyst t/o & repair, compl
    58293CVag hyst w/uro repair, compl
    58294CVag hyst w/enterocele, compl
    58300EInsert intrauterine device
    58301TRemove intrauterine device01892.371$140.70$28.14
    58321TArtificial insemination01972.3572$139.88$27.98
    58322TArtificial insemination01972.3572$139.88$27.98
    58323TSperm washing01972.3572$139.88$27.98
    58340NCatheter for hysterography
    58345TReopen fallopian tube019314.5843$865.48$173.10
    58346TInsert heyman uteri capsule019314.5843$865.48$173.10
    58350TReopen fallopian tube019526.6791$1,583.22$483.80$316.64
    58353TEndometr ablate, thermal019526.6791$1,583.22$483.80$316.64
    58356TEndometrial cryoablation020240.3866$2,396.66$958.66$479.33
    58400CSuspension of uterus
    58410CSuspension of uterus
    58520CRepair of ruptured uterus
    58540CRevision of uterus
    58545TLaparoscopic myomectomy013031.9271$1,894.65$659.53$378.93
    58546TLaparo-myomectomy, complex013143.3389$2,571.86$1,001.89$514.37
    58550TLaparo-asst vag hysterectomy013262.9914$3,738.10$1,239.22$747.62
    58552TLaparo-vag hyst incl t/o013143.3389$2,571.86$1,001.89$514.37
    58553TLaparo-vag hyst, complex013143.3389$2,571.86$1,001.89$514.37
    58554TLaparo-vag hyst w/t/o, compl013143.3389$2,571.86$1,001.89$514.37
    58555THysteroscopy, dx, sep proc019021.0653$1,250.08$424.28$250.02
    58558THysteroscopy, biopsy019021.0653$1,250.08$424.28$250.02
    58559THysteroscopy, lysis019021.0653$1,250.08$424.28$250.02
    58560THysteroscopy, resect septum038732.5445$1,931.29$655.55$386.26
    58561THysteroscopy, remove myoma038732.5445$1,931.29$655.55$386.26
    58562THysteroscopy, remove fb019021.0653$1,250.08$424.28$250.02
    58563THysteroscopy, ablation038732.5445$1,931.29$655.55$386.26
    58565THysteroscopy, sterilization020240.3866$2,396.66$958.66$479.33
    58578TLaparo proc, uterus013031.9271$1,894.65$659.53$378.93
    58579THysteroscope procedure019021.0653$1,250.08$424.28$250.02
    58600TDivision of fallopian tube019526.6791$1,583.22$483.80$316.64
    58605CDivision of fallopian tube
    58611CLigate oviduct(s) add-on
    58615TOcclude fallopian tube(s)019420.7525$1,231.52$397.84$246.30
    58660TLaparoscopy, lysis013143.3389$2,571.86$1,001.89$514.37
    58661TLaparoscopy, remove adnexa013143.3389$2,571.86$1,001.89$514.37
    58662TLaparoscopy, excise lesions013143.3389$2,571.86$1,001.89$514.37
    58670TLaparoscopy, tubal cautery013143.3389$2,571.86$1,001.89$514.37
    58671TLaparoscopy, tubal block013143.3389$2,571.86$1,001.89$514.37
    58672TLaparoscopy, fimbrioplasty013143.3389$2,571.86$1,001.89$514.37
    58673TLaparoscopy, salpingostomy013143.3389$2,571.86$1,001.89$514.37
    58679TLaparo proc, oviduct-ovary013031.9271$1,894.65$659.53$378.93
    58700CRemoval of fallopian tube
    58720CRemoval of ovary/tube(s)
    58740CRevise fallopian tube(s)
    58750CRepair oviduct
    58752CRevise ovarian tube(s)
    58760CRemove tubal obstruction
    58770TCreate new tubal opening019526.6791$1,583.22$483.80$316.64
    58800TDrainage of ovarian cyst(s)019314.5843$865.48$173.10
    58805CDrainage of ovarian cyst(s)
    58820TDrain ovary abscess, open019526.6791$1,583.22$483.80$316.64
    58822CDrain ovary abscess, percut
    58823TDrain pelvic abscess, percut019314.5843$865.48$173.10
    58825CTransposition, ovary(s)
    Start Printed Page 50767
    58900TBiopsy of ovary(s)019314.5843$865.48$173.10
    58920TPartial removal of ovary(s)019526.6791$1,583.22$483.80$316.64
    58925TRemoval of ovarian cyst(s)019526.6791$1,583.22$483.80$316.64
    58940CRemoval of ovary(s)
    58943CRemoval of ovary(s)
    58950CResect ovarian malignancy
    58951CResect ovarian malignancy
    58952CResect ovarian malignancy
    58953CTah, rad dissect for debulk
    58954CTah rad debulk/lymph remove
    58956CBso, omentectomy w/tah
    58960CExploration of abdomen
    58970TRetrieval of oocyte01972.3572$139.88$27.98
    58974TTransfer of embryo01972.3572$139.88$27.98
    58976TTransfer of embryo01972.3572$139.88$27.98
    58999TGenital surgery procedure01910.167$9.91$2.78$1.98
    59000TAmniocentesis, diagnostic01981.3683$81.20$32.19$16.24
    59001TAmniocentesis, therapeutic01924.3082$255.66$51.13
    59012TFetal cord puncture,prenatal01981.3683$81.20$32.19$16.24
    59015TChorion biopsy01981.3683$81.20$32.19$16.24
    59020TFetal contract stress test01924.3082$255.66$51.13
    59025TFetal non-stress test01981.3683$81.20$32.19$16.24
    59030TFetal scalp blood sample01981.3683$81.20$32.19$16.24
    59050EFetal monitor w/report
    59051BFetal monitor/interpret only
    59070TTransabdom amnioinfus w/ us01981.3683$81.20$32.19$16.24
    59072TUmbilical cord occlud w/ us01981.3683$81.20$32.19$16.24
    59074TFetal fluid drainage w/ us01981.3683$81.20$32.19$16.24
    59076TFetal shunt placement, w/ us01981.3683$81.20$32.19$16.24
    59100TRemove uterus lesion019526.6791$1,583.22$483.80$316.64
    59120CTreat ectopic pregnancy
    59121CTreat ectopic pregnancy
    59130CTreat ectopic pregnancy
    59135CTreat ectopic pregnancy
    59136CTreat ectopic pregnancy
    59140CTreat ectopic pregnancy
    59150TTreat ectopic pregnancy013143.3389$2,571.86$1,001.89$514.37
    59151TTreat ectopic pregnancy013143.3389$2,571.86$1,001.89$514.37
    59160TD & c after delivery019617.0974$1,014.61$338.23$202.92
    59200TInsert cervical dilator01892.371$140.70$28.14
    59300TEpisiotomy or vaginal repair019314.5843$865.48$173.10
    59320TRevision of cervix019420.7525$1,231.52$397.84$246.30
    59325CRevision of cervix
    59350CRepair of uterus
    59400BObstetrical care
    59409TObstetrical care019420.7525$1,231.52$397.84$246.30
    59410BObstetrical care
    59412TAntepartum manipulation07005.3614$318.16$63.63
    59414TDeliver placenta019314.5843$865.48$173.10
    59425BAntepartum care only
    59426BAntepartum care only
    59430BCare after delivery
    59510ECesarean delivery
    59514CCesarean delivery only
    59515ECesarean delivery
    59525CRemove uterus after cesarean
    59610EVbac delivery
    59612TVbac delivery only019420.7525$1,231.52$397.84$246.30
    59614EVbac care after delivery
    59618EAttempted vbac delivery
    59620CAttempted vbac delivery only
    59622EAttempted vbac after care
    59812TTreatment of miscarriage020117.6047$1,044.72$329.65$208.94
    59820TCare of miscarriage020117.6047$1,044.72$329.65$208.94
    59821TTreatment of miscarriage020117.6047$1,044.72$329.65$208.94
    59830CTreat uterus infection
    Start Printed Page 50768
    59840TAbortion020017.8728$1,060.63$263.69$212.13
    59841TAbortion020017.8728$1,060.63$263.69$212.13
    59850CAbortion
    59851CAbortion
    59852CAbortion
    59855CAbortion
    59856CAbortion
    59857CAbortion
    59866TAbortion (mpr)01981.3683$81.20$32.19$16.24
    59870TEvacuate mole of uterus020117.6047$1,044.72$329.65$208.94
    59871TRemove cerclage suture019420.7525$1,231.52$397.84$246.30
    59897TFetal invas px w/ us01981.3683$81.20$32.19$16.24
    59898TLaparo proc, ob care/deliver013031.9271$1,894.65$659.53$378.93
    59899TMaternity care procedure01981.3683$81.20$32.19$16.24
    60000TDrain thyroid/tongue cyst02527.8673$466.87$113.41$93.37
    60001TAspirate/inject thyriod cyst00041.7646$104.72$22.36$20.94
    60100TBiopsy of thyroid00041.7646$104.72$22.36$20.94
    60200TRemove thyroid lesion011440.7652$2,419.13$485.91$483.83
    60210TPartial thyroid excision011440.7652$2,419.13$485.91$483.83
    60212TPartial thyroid excision011440.7652$2,419.13$485.91$483.83
    60220TPartial removal of thyroid011440.7652$2,419.13$485.91$483.83
    60225TPartial removal of thyroid011440.7652$2,419.13$485.91$483.83
    60240TRemoval of thyroid011440.7652$2,419.13$485.91$483.83
    60252TRemoval of thyroid025637.3204$2,214.70$442.94
    60254CExtensive thyroid surgery
    60260TRepeat thyroid surgery025637.3204$2,214.70$442.94
    60270CRemoval of thyroid
    60271CRemoval of thyroid
    60280TRemove thyroid duct lesion011440.7652$2,419.13$485.91$483.83
    60281TRemove thyroid duct lesion011440.7652$2,419.13$485.91$483.83
    60500TExplore parathyroid glands025637.3204$2,214.70$442.94
    60502CRe-explore parathyroids
    60505CExplore parathyroid glands
    60512TAutotransplant parathyroid002219.6472$1,165.92$354.45$233.18
    60520CRemoval of thymus gland
    60521CRemoval of thymus gland
    60522CRemoval of thymus gland
    60540CExplore adrenal gland
    60545CExplore adrenal gland
    60600CRemove carotid body lesion
    60605CRemove carotid body lesion
    60650CLaparoscopy adrenalectomy
    60659TLaparo proc, endocrine013031.9271$1,894.65$659.53$378.93
    60699TEndocrine surgery procedure011440.7652$2,419.13$485.91$483.83
    61000TRemove cranial cavity fluid02122.974$176.49$70.59$35.30
    61001TRemove cranial cavity fluid02122.974$176.49$70.59$35.30
    61020TRemove brain cavity fluid02122.974$176.49$70.59$35.30
    61026TInjection into brain canal02122.974$176.49$70.59$35.30
    61050TRemove brain canal fluid02122.974$176.49$70.59$35.30
    61055TInjection into brain canal02122.974$176.49$70.59$35.30
    61070TBrain canal shunt procedure02122.974$176.49$70.59$35.30
    61105CTwist drill hole
    61107CDrill skull for implantation
    61108CDrill skull for drainage
    61120CBurr hole for puncture
    61140CPierce skull for biopsy
    61150CPierce skull for drainage
    61151CPierce skull for drainage
    61154CPierce skull & remove clot
    61156CPierce skull for drainage
    61210CPierce skull, implant device
    61215TInsert brain-fluid device022440.6455$2,412.03$482.41
    61250CPierce skull & explore
    61253CPierce skull & explore
    61304COpen skull for exploration
    61305COpen skull for exploration
    Start Printed Page 50769
    61312COpen skull for drainage
    61313COpen skull for drainage
    61314COpen skull for drainage
    61315COpen skull for drainage
    61316CImplt cran bone flap to abdo
    61320COpen skull for drainage
    61321COpen skull for drainage
    61322CDecompressive craniotomy
    61323CDecompressive lobectomy
    61330TDecompress eye socket025637.3204$2,214.70$442.94
    61332CExplore/biopsy eye socket
    61333CExplore orbit/remove lesion
    61334TExplore orbit/remove object025637.3204$2,214.70$442.94
    61340CRelieve cranial pressure
    61343CIncise skull (press relief)
    61345CRelieve cranial pressure
    61440CIncise skull for surgery
    61450CIncise skull for surgery
    61458CIncise skull for brain wound
    61460CIncise skull for surgery
    61470CIncise skull for surgery
    61480CIncise skull for surgery
    61490CIncise skull for surgery
    61500CRemoval of skull lesion
    61501CRemove infected skull bone
    61510CRemoval of brain lesion
    61512CRemove brain lining lesion
    61514CRemoval of brain abscess
    61516CRemoval of brain lesion
    61517CImplt brain chemotx add-on
    61518CRemoval of brain lesion
    61519CRemove brain lining lesion
    61520CRemoval of brain lesion
    61521CRemoval of brain lesion
    61522CRemoval of brain abscess
    61524CRemoval of brain lesion
    61526CRemoval of brain lesion
    61530CRemoval of brain lesion
    61531CImplant brain electrodes
    61533CImplant brain electrodes
    61534CRemoval of brain lesion
    61535CRemove brain electrodes
    61536CRemoval of brain lesion
    61537CRemoval of brain tissue
    61538CRemoval of brain tissue
    61539CRemoval of brain tissue
    61540CRemoval of brain tissue
    61541CIncision of brain tissue
    61542CRemoval of brain tissue
    61543CRemoval of brain tissue
    61544CRemove & treat brain lesion
    61545CExcision of brain tumor
    61546CRemoval of pituitary gland
    61548CRemoval of pituitary gland
    61550CRelease of skull seams
    61552CRelease of skull seams
    61556CIncise skull/sutures
    61557CIncise skull/sutures
    61558CExcision of skull/sutures
    61559CExcision of skull/sutures
    61563CExcision of skull tumor
    61564CExcision of skull tumor
    61566CRemoval of brain tissue
    61567CIncision of brain tissue
    61570CRemove foreign body, brain
    61571CIncise skull for brain wound
    Start Printed Page 50770
    61575CSkull base/brainstem surgery
    61576CSkull base/brainstem surgery
    61580CCraniofacial approach, skull
    61581CCraniofacial approach, skull
    61582CCraniofacial approach, skull
    61583CCraniofacial approach, skull
    61584COrbitocranial approach/skull
    61585COrbitocranial approach/skull
    61586CResect nasopharynx, skull
    61590CInfratemporal approach/skull
    61591CInfratemporal approach/skull
    61592COrbitocranial approach/skull
    61595CTranstemporal approach/skull
    61596CTranscochlear approach/skull
    61597CTranscondylar approach/skull
    61598CTranspetrosal approach/skull
    61600CResect/excise cranial lesion
    61601CResect/excise cranial lesion
    61605CResect/excise cranial lesion
    61606CResect/excise cranial lesion
    61607CResect/excise cranial lesion
    61608CResect/excise cranial lesion
    61609CTransect artery, sinus
    61610CTransect artery, sinus
    61611CTransect artery, sinus
    61612CTransect artery, sinus
    61613CRemove aneurysm, sinus
    61615CResect/excise lesion, skull
    61616CResect/excise lesion, skull
    61618CRepair dura
    61619CRepair dura
    61623TEndovasc tempory vessel occl008134.4473$2,044.21$408.84
    61624COcclusion/embolization cath
    61626TTranscath occlusion, non-cns008134.4473$2,044.21$408.84
    61680CIntracranial vessel surgery
    61682CIntracranial vessel surgery
    61684CIntracranial vessel surgery
    61686CIntracranial vessel surgery
    61690CIntracranial vessel surgery
    61692CIntracranial vessel surgery
    61697CBrain aneurysm repr, complx
    61698CBrain aneurysm repr, complx
    61700CBrain aneurysm repr, simple
    61702CInner skull vessel surgery
    61703CClamp neck artery
    61705CRevise circulation to head
    61708CRevise circulation to head
    61710CRevise circulation to head
    61711CFusion of skull arteries
    61720CIncise skull/brain surgery
    61735CIncise skull/brain surgery
    61750CIncise skull/brain biopsy
    61751CBrain biopsy w/ ct/mr guide
    61760CImplant brain electrodes
    61770CIncise skull for treatment
    61790TTreat trigeminal nerve022017.3586$1,030.11$206.02
    61791TTreat trigeminal tract02065.492$325.91$75.55$65.18
    61793EFocus radiation beam
    61795SBrain surgery using computer03024.6145$273.84$103.74$54.77
    61850CImplant neuroelectrodes
    61860CImplant neuroelectrodes
    61863CImplant neuroelectrode
    61864CImplant neuroelectrde, add'l
    61867CImplant neuroelectrode
    61868CImplant neuroelectrde, add'l
    61870CImplant neuroelectrodes
    Start Printed Page 50771
    61875CImplant neuroelectrodes
    61880TRevise/remove neuroelectrode068719.2347$1,141.44$456.57$228.29
    61885SImplant neurostim one array0039181.4$10,764.82$2,152.96
    61886TImplant neurostim arrays0315290.647$17,247.86$3,449.57
    61888TRevise/remove neuroreceiver068843.0444$2,554.38$1,021.75$510.88
    62000CTreat skull fracture
    62005CTreat skull fracture
    62010CTreatment of head injury
    62100CRepair brain fluid leakage
    62115CReduction of skull defect
    62116CReduction of skull defect
    62117CReduction of skull defect
    62120CRepair skull cavity lesion
    62121CIncise skull repair
    62140CRepair of skull defect
    62141CRepair of skull defect
    62142CRemove skull plate/flap
    62143CReplace skull plate/flap
    62145CRepair of skull & brain
    62146CRepair of skull with graft
    62147CRepair of skull with graft
    62148CRetr bone flap to fix skull
    62160TNeuroendoscopy add-on01226.9721$413.75$84.85$82.75
    62161CDissect brain w/scope
    62162CRemove colloid cyst w/scope
    62163CNeuroendoscopy w/fb removal
    62164CRemove brain tumor w/scope
    62165CRemove pituit tumor w/scope
    62180CEstablish brain cavity shunt
    62190CEstablish brain cavity shunt
    62192CEstablish brain cavity shunt
    62194TReplace/irrigate catheter042710.1977$605.16$124.11$121.03
    62200CEstablish brain cavity shunt
    62201CEstablish brain cavity shunt
    62220CEstablish brain cavity shunt
    62223CEstablish brain cavity shunt
    62225TReplace/irrigate catheter042710.1977$605.16$124.11$121.03
    62230TReplace/revise brain shunt022440.6455$2,412.03$482.41
    62252SCsf shunt reprogram06912.5252$149.85$59.94$29.97
    62256CRemove brain cavity shunt
    62258CReplace brain cavity shunt
    62263TLysis epidural adhesions020310.4015$617.26$246.90$123.45
    62264TEpidural lysis on single day020310.4015$617.26$246.90$123.45
    62268TDrain spinal cord cyst02122.974$176.49$70.59$35.30
    62269TNeedle biopsy, spinal cord06856.0174$357.09$115.47$71.42
    62270TSpinal fluid tap, diagnostic02042.191$130.02$40.13$26.00
    62272TDrain cerebro spinal fluid02042.191$130.02$40.13$26.00
    62273TTreat epidural spine lesion02065.492$325.91$75.55$65.18
    62280TTreat spinal cord lesion02076.0109$356.70$86.92$71.34
    62281TTreat spinal cord lesion02076.0109$356.70$86.92$71.34
    62282TTreat spinal canal lesion02076.0109$356.70$86.92$71.34
    62284NInjection for myelogram
    62287TPercutaneous diskectomy022129.9209$1,775.60$463.62$355.12
    62290NInject for spine disk x-ray
    62291NInject for spine disk x-ray
    62292TInjection into disk lesion02122.974$176.49$70.59$35.30
    62294TInjection into spinal artery02122.974$176.49$70.59$35.30
    62310TInject spine c/t02076.0109$356.70$86.92$71.34
    62311TInject spine l/s (cd)02076.0109$356.70$86.92$71.34
    62318TInject spine w/cath, c/t02076.0109$356.70$86.92$71.34
    62319TInject spine w/cath l/s (cd)02076.0109$356.70$86.92$71.34
    62350TImplant spinal canal cath022328.123$1,668.90$333.78
    62351TImplant spinal canal cath020842.3409$2,512.64$502.53
    62355TRemove spinal canal catheter020310.4015$617.26$246.90$123.45
    62360TInsert spine infusion device0226138.8695$8,240.93$1,648.19
    62361TImplant spine infusion pump0227136.4922$8,099.86$1,619.97
    Start Printed Page 50772
    62362TImplant spine infusion pump0227136.4922$8,099.86$1,619.97
    62365TRemove spine infusion device022129.9209$1,775.60$463.62$355.12
    62367SAnalyze spine infusion pump06912.5252$149.85$59.94$29.97
    62368SAnalyze spine infusion pump06912.5252$149.85$59.94$29.97
    63001TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63003TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63005TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63011TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63012TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63015TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63016TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63017TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63020TNeck spine disk surgery020842.3409$2,512.64$502.53
    63030TLow back disk surgery020842.3409$2,512.64$502.53
    63035TSpinal disk surgery add-on020842.3409$2,512.64$502.53
    63040TLaminotomy, single cervical020842.3409$2,512.64$502.53
    63042TLaminotomy, single lumbar020842.3409$2,512.64$502.53
    63043CLaminotomy, add'l cervical
    63044CLaminotomy, add'l lumbar
    63045TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63046TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63047TRemoval of spinal lamina020842.3409$2,512.64$502.53
    63048TRemove spinal lamina add-on020842.3409$2,512.64$502.53
    63050CCervical laminoplasty
    63051CC-laminoplasty w/graft/plate
    63055TDecompress spinal cord020842.3409$2,512.64$502.53
    63056TDecompress spinal cord020842.3409$2,512.64$502.53
    63057TDecompress spine cord add-on020842.3409$2,512.64$502.53
    63064TDecompress spinal cord020842.3409$2,512.64$502.53
    63066TDecompress spine cord add-on020842.3409$2,512.64$502.53
    63075CNeck spine disk surgery
    63076CNeck spine disk surgery
    63077CSpine disk surgery, thorax
    63078CSpine disk surgery, thorax
    63081CRemoval of vertebral body
    63082CRemove vertebral body add-on
    63085CRemoval of vertebral body
    63086CRemove vertebral body add-on
    63087CRemoval of vertebral body
    63088CRemove vertebral body add-on
    63090CRemoval of vertebral body
    63091CRemove vertebral body add-on
    63101CRemoval of vertebral body
    63102CRemoval of vertebral body
    63103CRemove vertebral body add-on
    63170CIncise spinal cord tract(s)
    63172CDrainage of spinal cyst
    63173CDrainage of spinal cyst
    63180CRevise spinal cord ligaments
    63182CRevise spinal cord ligaments
    63185CIncise spinal column/nerves
    63190CIncise spinal column/nerves
    63191CIncise spinal column/nerves
    63194CIncise spinal column & cord
    63195CIncise spinal column & cord
    63196CIncise spinal column & cord
    63197CIncise spinal column & cord
    63198CIncise spinal column & cord
    63199CIncise spinal column & cord
    63200CRelease of spinal cord
    63250CRevise spinal cord vessels
    63251CRevise spinal cord vessels
    63252CRevise spinal cord vessels
    63265CExcise intraspinal lesion
    63266CExcise intraspinal lesion
    63267CExcise intraspinal lesion
    Start Printed Page 50773
    63268CExcise intraspinal lesion
    63270CExcise intraspinal lesion
    63271CExcise intraspinal lesion
    63272CExcise intraspinal lesion
    63273CExcise intraspinal lesion
    63275CBiopsy/excise spinal tumor
    63276CBiopsy/excise spinal tumor
    63277CBiopsy/excise spinal tumor
    63278CBiopsy/excise spinal tumor
    63280CBiopsy/excise spinal tumor
    63281CBiopsy/excise spinal tumor
    63282CBiopsy/excise spinal tumor
    63283CBiopsy/excise spinal tumor
    63285CBiopsy/excise spinal tumor
    63286CBiopsy/excise spinal tumor
    63287CBiopsy/excise spinal tumor
    63290CBiopsy/excise spinal tumor
    63295CRepair of laminectomy defect
    63300CRemoval of vertebral body
    63301CRemoval of vertebral body
    63302CRemoval of vertebral body
    63303CRemoval of vertebral body
    63304CRemoval of vertebral body
    63305CRemoval of vertebral body
    63306CRemoval of vertebral body
    63307CRemoval of vertebral body
    63308CRemove vertebral body add-on
    63600TRemove spinal cord lesion022017.3586$1,030.11$206.02
    63610TStimulation of spinal cord022017.3586$1,030.11$206.02
    63615TRemove lesion of spinal cord022017.3586$1,030.11$206.02
    63650SImplant neuroelectrodes004055.3297$3,283.43$656.69
    63655SImplant neuroelectrodes004055.3297$3,283.43$656.69
    63660TRevise/remove neuroelectrode068719.2347$1,141.44$456.57$228.29
    63685TImplant neuroreceiver0222179.0982$10,628.22$2,125.64
    63688TRevise/remove neuroreceiver068843.0444$2,554.38$1,021.75$510.88
    63700CRepair of spinal herniation
    63702CRepair of spinal herniation
    63704CRepair of spinal herniation
    63706CRepair of spinal herniation
    63707CRepair spinal fluid leakage
    63709CRepair spinal fluid leakage
    63710CGraft repair of spine defect
    63740CInstall spinal shunt
    63741TInstall spinal shunt022851.7258$3,069.56$613.91
    63744TRevision of spinal shunt022851.7258$3,069.56$613.91
    63746TRemoval of spinal shunt010911.0433$655.34$131.49$131.07
    64400TN block inj, trigeminal02042.191$130.02$40.13$26.00
    64402TN block inj, facial02042.191$130.02$40.13$26.00
    64405TN block inj, occipital02042.191$130.02$40.13$26.00
    64408TN block inj, vagus02042.191$130.02$40.13$26.00
    64410TN block inj, phrenic02065.492$325.91$75.55$65.18
    64412TN block inj, spinal accessor02065.492$325.91$75.55$65.18
    64413TN block inj, cervical plexus02042.191$130.02$40.13$26.00
    64415TInjection for nerve block02042.191$130.02$40.13$26.00
    64416TN block cont infuse, b plex02042.191$130.02$40.13$26.00
    64417TN block inj, axillary02042.191$130.02$40.13$26.00
    64418TN block inj, suprascapular02042.191$130.02$40.13$26.00
    64420TN block inj, intercost, sng02042.191$130.02$40.13$26.00
    64421TN block inj, intercost, mlt02065.492$325.91$75.55$65.18
    64425TN block inj ilio-ing/hypogi02042.191$130.02$40.13$26.00
    64430TN block inj, pudendal02042.191$130.02$40.13$26.00
    64435TN block inj, paracervical02042.191$130.02$40.13$26.00
    64445TInjection for nerve block02042.191$130.02$40.13$26.00
    64446TN blk inj, sciatic, cont inf02065.492$325.91$75.55$65.18
    64447TN block inj fem, single02042.191$130.02$40.13$26.00
    64448TN block inj fem, cont inf02042.191$130.02$40.13$26.00
    Start Printed Page 50774
    64449TN block inj, lumbar plexus02042.191$130.02$40.13$26.00
    64450TN block, other peripheral02042.191$130.02$40.13$26.00
    64470TInj paravertebral c/t02076.0109$356.70$86.92$71.34
    64472TInj paravertebral c/t add-on02065.492$325.91$75.55$65.18
    64475TInj paravertebral l/s02076.0109$356.70$86.92$71.34
    64476TInj paravertebral l/s add-on02065.492$325.91$75.55$65.18
    64479TInj foramen epidural c/t02076.0109$356.70$86.92$71.34
    64480TInj foramen epidural add-on02076.0109$356.70$86.92$71.34
    64483TInj foramen epidural l/s02076.0109$356.70$86.92$71.34
    64484TInj foramen epidural add-on02076.0109$356.70$86.92$71.34
    64505TN block, spenopalatine gangl02042.191$130.02$40.13$26.00
    64508TN block, carotid sinus s/p02042.191$130.02$40.13$26.00
    64510TN block, stellate ganglion02076.0109$356.70$86.92$71.34
    64517TN block inj, hypogas plxs02042.191$130.02$40.13$26.00
    64520TN block, lumbar/thoracic02076.0109$356.70$86.92$71.34
    64530TN block inj, celiac pelus02076.0109$356.70$86.92$71.34
    64550AApply neurostimulator
    64553SImplant neuroelectrodes0225234.6925$13,927.36$2,785.47
    64555SImplant neuroelectrodes004055.3297$3,283.43$656.69
    64560SImplant neuroelectrodes004055.3297$3,283.43$656.69
    64561SImplant neuroelectrodes004055.3297$3,283.43$656.69
    64565SImplant neuroelectrodes004055.3297$3,283.43$656.69
    64573SImplant neuroelectrodes0225234.6925$13,927.36$2,785.47
    64575SImplant neuroelectrodes004055.3297$3,283.43$656.69
    64577SImplant neuroelectrodes0225234.6925$13,927.36$2,785.47
    64580SImplant neuroelectrodes004055.3297$3,283.43$656.69
    64581SImplant neuroelectrodes004055.3297$3,283.43$656.69
    64585TRevise/remove neuroelectrode068719.2347$1,141.44$456.57$228.29
    64590TImplant neuroreceiver0222179.0982$10,628.22$2,125.64
    64595TRevise/remove neuroreceiver068843.0444$2,554.38$1,021.75$510.88
    64600TInjection treatment of nerve020310.4015$617.26$246.90$123.45
    64605TInjection treatment of nerve020310.4015$617.26$246.90$123.45
    64610TInjection treatment of nerve020310.4015$617.26$246.90$123.45
    64612TDestroy nerve, face muscle02042.191$130.02$40.13$26.00
    64613TDestroy nerve, spine muscle02042.191$130.02$40.13$26.00
    64614TDestroy nerve, extrem musc02042.191$130.02$40.13$26.00
    64620TInjection treatment of nerve020310.4015$617.26$246.90$123.45
    64622TDestr paravertebrl nerve l/s020310.4015$617.26$246.90$123.45
    64623TDestr paravertebral n add-on02076.0109$356.70$86.92$71.34
    64626TDestr paravertebrl nerve c/t020310.4015$617.26$246.90$123.45
    64627TDestr paravertebral n add-on02076.0109$356.70$86.92$71.34
    64630TInjection treatment of nerve02065.492$325.91$75.55$65.18
    64640TInjection treatment of nerve02065.492$325.91$75.55$65.18
    64680TInjection treatment of nerve02076.0109$356.70$86.92$71.34
    64681TInjection treatment of nerve020310.4015$617.26$246.90$123.45
    64702TRevise finger/toe nerve022017.3586$1,030.11$206.02
    64704TRevise hand/foot nerve022017.3586$1,030.11$206.02
    64708TRevise arm/leg nerve022017.3586$1,030.11$206.02
    64712TRevision of sciatic nerve022017.3586$1,030.11$206.02
    64713TRevision of arm nerve(s)022017.3586$1,030.11$206.02
    64714TRevise low back nerve(s)022017.3586$1,030.11$206.02
    64716TRevision of cranial nerve022017.3586$1,030.11$206.02
    64718TRevise ulnar nerve at elbow022017.3586$1,030.11$206.02
    64719TRevise ulnar nerve at wrist022017.3586$1,030.11$206.02
    64721TCarpal tunnel surgery022017.3586$1,030.11$206.02
    64722TRelieve pressure on nerve(s)022017.3586$1,030.11$206.02
    64726TRelease foot/toe nerve022017.3586$1,030.11$206.02
    64727TInternal nerve revision022017.3586$1,030.11$206.02
    64732TIncision of brow nerve022017.3586$1,030.11$206.02
    64734TIncision of cheek nerve022017.3586$1,030.11$206.02
    64736TIncision of chin nerve022017.3586$1,030.11$206.02
    64738TIncision of jaw nerve022017.3586$1,030.11$206.02
    64740TIncision of tongue nerve022017.3586$1,030.11$206.02
    64742TIncision of facial nerve022017.3586$1,030.11$206.02
    64744TIncise nerve, back of head022017.3586$1,030.11$206.02
    64746TIncise diaphragm nerve022017.3586$1,030.11$206.02
    Start Printed Page 50775
    64752CIncision of vagus nerve
    64755CIncision of stomach nerves
    64760CIncision of vagus nerve
    64761TIncision of pelvis nerve022017.3586$1,030.11$206.02
    64763TIncise hip/thigh nerve022017.3586$1,030.11$206.02
    64766TIncise hip/thigh nerve022129.9209$1,775.60$463.62$355.12
    64771TSever cranial nerve022017.3586$1,030.11$206.02
    64772TIncision of spinal nerve022017.3586$1,030.11$206.02
    64774TRemove skin nerve lesion022017.3586$1,030.11$206.02
    64776TRemove digit nerve lesion022017.3586$1,030.11$206.02
    64778TDigit nerve surgery add-on022017.3586$1,030.11$206.02
    64782TRemove limb nerve lesion022017.3586$1,030.11$206.02
    64783TLimb nerve surgery add-on022017.3586$1,030.11$206.02
    64784TRemove nerve lesion022017.3586$1,030.11$206.02
    64786TRemove sciatic nerve lesion022129.9209$1,775.60$463.62$355.12
    64787TImplant nerve end022017.3586$1,030.11$206.02
    64788TRemove skin nerve lesion022017.3586$1,030.11$206.02
    64790TRemoval of nerve lesion022017.3586$1,030.11$206.02
    64792TRemoval of nerve lesion022129.9209$1,775.60$463.62$355.12
    64795TBiopsy of nerve022017.3586$1,030.11$206.02
    64802TRemove sympathetic nerves022017.3586$1,030.11$206.02
    64804CRemove sympathetic nerves
    64809CRemove sympathetic nerves
    64818CRemove sympathetic nerves
    64820TRemove sympathetic nerves022017.3586$1,030.11$206.02
    64821TRemove sympathetic nerves005425.3711$1,505.60$301.12
    64822TRemove sympathetic nerves005425.3711$1,505.60$301.12
    64823TRemove sympathetic nerves005425.3711$1,505.60$301.12
    64831TRepair of digit nerve022129.9209$1,775.60$463.62$355.12
    64832TRepair nerve add-on022129.9209$1,775.60$463.62$355.12
    64834TRepair of hand or foot nerve022129.9209$1,775.60$463.62$355.12
    64835TRepair of hand or foot nerve022129.9209$1,775.60$463.62$355.12
    64836TRepair of hand or foot nerve022129.9209$1,775.60$463.62$355.12
    64837TRepair nerve add-on022129.9209$1,775.60$463.62$355.12
    64840TRepair of leg nerve022129.9209$1,775.60$463.62$355.12
    64856TRepair/transpose nerve022129.9209$1,775.60$463.62$355.12
    64857TRepair arm/leg nerve022129.9209$1,775.60$463.62$355.12
    64858TRepair sciatic nerve022129.9209$1,775.60$463.62$355.12
    64859TNerve surgery022129.9209$1,775.60$463.62$355.12
    64861TRepair of arm nerves022129.9209$1,775.60$463.62$355.12
    64862TRepair of low back nerves022129.9209$1,775.60$463.62$355.12
    64864TRepair of facial nerve022129.9209$1,775.60$463.62$355.12
    64865TRepair of facial nerve022129.9209$1,775.60$463.62$355.12
    64866CFusion of facial/other nerve
    64868CFusion of facial/other nerve
    64870TFusion of facial/other nerve022129.9209$1,775.60$463.62$355.12
    64872TSubsequent repair of nerve022129.9209$1,775.60$463.62$355.12
    64874TRepair & revise nerve add-on022129.9209$1,775.60$463.62$355.12
    64876TRepair nerve/shorten bone022129.9209$1,775.60$463.62$355.12
    64885TNerve graft, head or neck022129.9209$1,775.60$463.62$355.12
    64886TNerve graft, head or neck022129.9209$1,775.60$463.62$355.12
    64890TNerve graft, hand or foot022129.9209$1,775.60$463.62$355.12
    64891TNerve graft, hand or foot022129.9209$1,775.60$463.62$355.12
    64892TNerve graft, arm or leg022129.9209$1,775.60$463.62$355.12
    64893TNerve graft, arm or leg022129.9209$1,775.60$463.62$355.12
    64895TNerve graft, hand or foot022129.9209$1,775.60$463.62$355.12
    64896TNerve graft, hand or foot022129.9209$1,775.60$463.62$355.12
    64897TNerve graft, arm or leg022129.9209$1,775.60$463.62$355.12
    64898TNerve graft, arm or leg022129.9209$1,775.60$463.62$355.12
    64901TNerve graft add-on022129.9209$1,775.60$463.62$355.12
    64902TNerve graft add-on022129.9209$1,775.60$463.62$355.12
    64905TNerve pedicle transfer022129.9209$1,775.60$463.62$355.12
    64907TNerve pedicle transfer022129.9209$1,775.60$463.62$355.12
    64999TNervous system surgery02042.191$130.02$40.13$26.00
    65091TRevise eye024230.5464$1,812.72$597.36$362.54
    65093TRevise eye with implant024123.3036$1,382.91$384.47$276.58
    Start Printed Page 50776
    65101TRemoval of eye024230.5464$1,812.72$597.36$362.54
    65103TRemove eye/insert implant024230.5464$1,812.72$597.36$362.54
    65105TRemove eye/attach implant024230.5464$1,812.72$597.36$362.54
    65110TRemoval of eye024230.5464$1,812.72$597.36$362.54
    65112TRemove eye/revise socket024230.5464$1,812.72$597.36$362.54
    65114TRemove eye/revise socket024230.5464$1,812.72$597.36$362.54
    65125TRevise ocular implant024018.1508$1,077.12$315.31$215.42
    65130TInsert ocular implant024123.3036$1,382.91$384.47$276.58
    65135TInsert ocular implant024123.3036$1,382.91$384.47$276.58
    65140TAttach ocular implant024230.5464$1,812.72$597.36$362.54
    65150TRevise ocular implant024123.3036$1,382.91$384.47$276.58
    65155TReinsert ocular implant024230.5464$1,812.72$597.36$362.54
    65175TRemoval of ocular implant024018.1508$1,077.12$315.31$215.42
    65205SRemove foreign body from eye06981.2438$73.81$16.55$14.76
    65210SRemove foreign body from eye06981.2438$73.81$16.55$14.76
    65220SRemove foreign body from eye06981.2438$73.81$16.55$14.76
    65222SRemove foreign body from eye06981.2438$73.81$16.55$14.76
    65235TRemove foreign body from eye023314.9673$888.20$266.33$177.64
    65260TRemove foreign body from eye023617.0229$1,010.19$202.04
    65265TRemove foreign body from eye023728.9401$1,717.39$343.48
    65270TRepair of eye wound024018.1508$1,077.12$315.31$215.42
    65272TRepair of eye wound023421.9741$1,304.01$511.31$260.80
    65273CRepair of eye wound
    65275TRepair of eye wound023421.9741$1,304.01$511.31$260.80
    65280TRepair of eye wound023617.0229$1,010.19$202.04
    65285TRepair of eye wound067236.9284$2,191.44$438.29
    65286TRepair of eye wound02326.6732$396.01$103.17$79.20
    65290TRepair of eye socket wound024322.1671$1,315.46$431.39$263.09
    65400TRemoval of eye lesion023314.9673$888.20$266.33$177.64
    65410TBiopsy of cornea023314.9673$888.20$266.33$177.64
    65420TRemoval of eye lesion023314.9673$888.20$266.33$177.64
    65426TRemoval of eye lesion023421.9741$1,304.01$511.31$260.80
    65430SCorneal smear06981.2438$73.81$16.55$14.76
    65435TCurette/treat cornea02396.9097$410.04$82.01
    65436TCurette/treat cornea023314.9673$888.20$266.33$177.64
    65450STreatment of corneal lesion02311.9278$114.40$44.61$22.88
    65600TRevision of cornea024018.1508$1,077.12$315.31$215.42
    65710TCorneal transplant024438.3723$2,277.13$803.26$455.43
    65730TCorneal transplant024438.3723$2,277.13$803.26$455.43
    65750TCorneal transplant024438.3723$2,277.13$803.26$455.43
    65755TCorneal transplant024438.3723$2,277.13$803.26$455.43
    65760ERevision of cornea
    65765ERevision of cornea
    65767ECorneal tissue transplant
    65770TRevise cornea with implant024438.3723$2,277.13$803.26$455.43
    65771ERadial keratotomy
    65772TCorrection of astigmatism023314.9673$888.20$266.33$177.64
    65775TCorrection of astigmatism023314.9673$888.20$266.33$177.64
    65780TOcular reconst, transplant024438.3723$2,277.13$803.26$455.43
    65781TOcular reconst, transplant024438.3723$2,277.13$803.26$455.43
    65782TOcular reconst, transplant024438.3723$2,277.13$803.26$455.43
    65800TDrainage of eye023314.9673$888.20$266.33$177.64
    65805TDrainage of eye023314.9673$888.20$266.33$177.64
    65810TDrainage of eye023421.9741$1,304.01$511.31$260.80
    65815TDrainage of eye023421.9741$1,304.01$511.31$260.80
    65820TRelieve inner eye pressure02326.6732$396.01$103.17$79.20
    65850TIncision of eye023421.9741$1,304.01$511.31$260.80
    65855TLaser surgery of eye02475.033$298.67$104.31$59.73
    65860TIncise inner eye adhesions02475.033$298.67$104.31$59.73
    65865TIncise inner eye adhesions023314.9673$888.20$266.33$177.64
    65870TIncise inner eye adhesions023421.9741$1,304.01$511.31$260.80
    65875TIncise inner eye adhesions023421.9741$1,304.01$511.31$260.80
    65880TIncise inner eye adhesions023314.9673$888.20$266.33$177.64
    65900TRemove eye lesion023314.9673$888.20$266.33$177.64
    65920TRemove implant of eye023421.9741$1,304.01$511.31$260.80
    65930TRemove blood clot from eye023421.9741$1,304.01$511.31$260.80
    Start Printed Page 50777
    66020TInjection treatment of eye023314.9673$888.20$266.33$177.64
    66030TInjection treatment of eye02326.6732$396.01$103.17$79.20
    66130TRemove eye lesion023421.9741$1,304.01$511.31$260.80
    66150TGlaucoma surgery023421.9741$1,304.01$511.31$260.80
    66155TGlaucoma surgery023421.9741$1,304.01$511.31$260.80
    66160TGlaucoma surgery023421.9741$1,304.01$511.31$260.80
    66165TGlaucoma surgery023421.9741$1,304.01$511.31$260.80
    66170TGlaucoma surgery023421.9741$1,304.01$511.31$260.80
    66172TIncision of eye067329.2582$1,736.27$649.56$347.25
    66180TImplant eye shunt067329.2582$1,736.27$649.56$347.25
    66185TRevise eye shunt067329.2582$1,736.27$649.56$347.25
    66220TRepair eye lesion067236.9284$2,191.44$438.29
    66225TRepair/graft eye lesion067329.2582$1,736.27$649.56$347.25
    66250TFollow-up surgery of eye023314.9673$888.20$266.33$177.64
    66500TIncision of iris02326.6732$396.01$103.17$79.20
    66505TIncision of iris02326.6732$396.01$103.17$79.20
    66600TRemove iris and lesion023421.9741$1,304.01$511.31$260.80
    66605TRemoval of iris023421.9741$1,304.01$511.31$260.80
    66625TRemoval of iris02326.6732$396.01$103.17$79.20
    66630TRemoval of iris023421.9741$1,304.01$511.31$260.80
    66635TRemoval of iris023421.9741$1,304.01$511.31$260.80
    66680TRepair iris & ciliary body023421.9741$1,304.01$511.31$260.80
    66682TRepair iris & ciliary body023421.9741$1,304.01$511.31$260.80
    66700TDestruction, ciliary body023314.9673$888.20$266.33$177.64
    66710TDestruction, ciliary body023314.9673$888.20$266.33$177.64
    66711TCiliary endoscopic ablation023314.9673$888.20$266.33$177.64
    66720TDestruction, ciliary body023314.9673$888.20$266.33$177.64
    66740TDestruction, ciliary body023421.9741$1,304.01$511.31$260.80
    66761TRevision of iris02475.033$298.67$104.31$59.73
    66762TRevision of iris02475.033$298.67$104.31$59.73
    66770TRemoval of inner eye lesion02475.033$298.67$104.31$59.73
    66820TIncision, secondary cataract02326.6732$396.01$103.17$79.20
    66821TAfter cataract laser surgery02475.033$298.67$104.31$59.73
    66825TReposition intraocular lens023421.9741$1,304.01$511.31$260.80
    66830TRemoval of lens lesion02326.6732$396.01$103.17$79.20
    66840TRemoval of lens material024513.3625$792.97$221.89$158.59
    66850TRemoval of lens material024927.9369$1,657.86$524.67$331.57
    66852TRemoval of lens material024927.9369$1,657.86$524.67$331.57
    66920TExtraction of lens024927.9369$1,657.86$524.67$331.57
    66930TExtraction of lens024927.9369$1,657.86$524.67$331.57
    66940TExtraction of lens024513.3625$792.97$221.89$158.59
    66982TCataract surgery, complex024623.4597$1,392.17$495.96$278.43
    66983TCataract surg w/iol, 1 stage024623.4597$1,392.17$495.96$278.43
    66984TCataract surg w/iol, 1 stage024623.4597$1,392.17$495.96$278.43
    66985TInsert lens prosthesis024623.4597$1,392.17$495.96$278.43
    66986TExchange lens prosthesis024623.4597$1,392.17$495.96$278.43
    66990NOphthalmic endoscope add-on
    66999TEye surgery procedure02326.6732$396.01$103.17$79.20
    67005TPartial removal of eye fluid023728.9401$1,717.39$343.48
    67010TPartial removal of eye fluid023728.9401$1,717.39$343.48
    67015TRelease of eye fluid023728.9401$1,717.39$343.48
    67025TReplace eye fluid023728.9401$1,717.39$343.48
    67027TImplant eye drug system067236.9284$2,191.44$438.29
    67028TInjection eye drug02354.6593$276.50$67.40$55.30
    67030TIncise inner eye strands023617.0229$1,010.19$202.04
    67031TLaser surgery, eye strands02475.033$298.67$104.31$59.73
    67036TRemoval of inner eye fluid067236.9284$2,191.44$438.29
    67038TStrip retinal membrane067236.9284$2,191.44$438.29
    67039TLaser treatment of retina067236.9284$2,191.44$438.29
    67040TLaser treatment of retina067236.9284$2,191.44$438.29
    67101TRepair detached retina023617.0229$1,010.19$202.04
    67105TRepair detached retina02484.6769$277.54$93.98$55.51
    67107TRepair detached retina067236.9284$2,191.44$438.29
    67108TRepair detached retina067236.9284$2,191.44$438.29
    67110TRepair detached retina023617.0229$1,010.19$202.04
    67112TRerepair detached retina067236.9284$2,191.44$438.29
    Start Printed Page 50778
    67115TRelease encircling material023617.0229$1,010.19$202.04
    67120TRemove eye implant material023617.0229$1,010.19$202.04
    67121TRemove eye implant material023728.9401$1,717.39$343.48
    67141TTreatment of retina02354.6593$276.50$67.40$55.30
    67145TTreatment of retina02484.6769$277.54$93.98$55.51
    67208TTreatment of retinal lesion023617.0229$1,010.19$202.04
    67210TTreatment of retinal lesion02484.6769$277.54$93.98$55.51
    67218TTreatment of retinal lesion023617.0229$1,010.19$202.04
    67220TTreatment of choroid lesion02354.6593$276.50$67.40$55.30
    67221TOcular photodynamic ther02354.6593$276.50$67.40$55.30
    67225TEye photodynamic ther add-on02354.6593$276.50$67.40$55.30
    67227TTreatment of retinal lesion023617.0229$1,010.19$202.04
    67228TTreatment of retinal lesion02484.6769$277.54$93.98$55.51
    67250TReinforce eye wall024018.1508$1,077.12$315.31$215.42
    67255TReinforce/graft eye wall023728.9401$1,717.39$343.48
    67299TEye surgery procedure02354.6593$276.50$67.40$55.30
    67311TRevise eye muscle024322.1671$1,315.46$431.39$263.09
    67312TRevise two eye muscles024322.1671$1,315.46$431.39$263.09
    67314TRevise eye muscle024322.1671$1,315.46$431.39$263.09
    67316TRevise two eye muscles024322.1671$1,315.46$431.39$263.09
    67318TRevise eye muscle(s)024322.1671$1,315.46$431.39$263.09
    67320TRevise eye muscle(s) add-on024322.1671$1,315.46$431.39$263.09
    67331TEye surgery follow-up add-on024322.1671$1,315.46$431.39$263.09
    67332TRerevise eye muscles add-on024322.1671$1,315.46$431.39$263.09
    67334TRevise eye muscle w/suture024322.1671$1,315.46$431.39$263.09
    67335TEye suture during surgery024322.1671$1,315.46$431.39$263.09
    67340TRevise eye muscle add-on024322.1671$1,315.46$431.39$263.09
    67343TRelease eye tissue024322.1671$1,315.46$431.39$263.09
    67345TDestroy nerve of eye muscle02382.5933$153.89$30.78
    67350TBiopsy eye muscle069910.0177$594.48$118.90
    67399TEye muscle surgery procedure024322.1671$1,315.46$431.39$263.09
    67400TExplore/biopsy eye socket024123.3036$1,382.91$384.47$276.58
    67405TExplore/drain eye socket024123.3036$1,382.91$384.47$276.58
    67412TExplore/treat eye socket024123.3036$1,382.91$384.47$276.58
    67413TExplore/treat eye socket024123.3036$1,382.91$384.47$276.58
    67414TExplr/decompress eye socket024230.5464$1,812.72$597.36$362.54
    67415TAspiration, orbital contents024018.1508$1,077.12$315.31$215.42
    67420TExplore/treat eye socket024230.5464$1,812.72$597.36$362.54
    67430TExplore/treat eye socket024230.5464$1,812.72$597.36$362.54
    67440TExplore/drain eye socket024230.5464$1,812.72$597.36$362.54
    67445TExplr/decompress eye socket024230.5464$1,812.72$597.36$362.54
    67450TExplore/biopsy eye socket024230.5464$1,812.72$597.36$362.54
    67500SInject/treat eye socket02311.9278$114.40$44.61$22.88
    67505TInject/treat eye socket02382.5933$153.89$30.78
    67515TInject/treat eye socket02382.5933$153.89$30.78
    67550TInsert eye socket implant024230.5464$1,812.72$597.36$362.54
    67560TRevise eye socket implant024123.3036$1,382.91$384.47$276.58
    67570TDecompress optic nerve024230.5464$1,812.72$597.36$362.54
    67599TOrbit surgery procedure02382.5933$153.89$30.78
    67700TDrainage of eyelid abscess02382.5933$153.89$30.78
    67710TIncision of eyelid02396.9097$410.04$82.01
    67715TIncision of eyelid fold024018.1508$1,077.12$315.31$215.42
    67800TRemove eyelid lesion02382.5933$153.89$30.78
    67801TRemove eyelid lesions02396.9097$410.04$82.01
    67805TRemove eyelid lesions02382.5933$153.89$30.78
    67808TRemove eyelid lesion(s)024018.1508$1,077.12$315.31$215.42
    67810TBiopsy of eyelid02382.5933$153.89$30.78
    67820SRevise eyelashes06981.2438$73.81$16.55$14.76
    67825TRevise eyelashes02382.5933$153.89$30.78
    67830TRevise eyelashes02396.9097$410.04$82.01
    67835TRevise eyelashes024018.1508$1,077.12$315.31$215.42
    67840TRemove eyelid lesion02396.9097$410.04$82.01
    67850TTreat eyelid lesion02396.9097$410.04$82.01
    67875TClosure of eyelid by suture02396.9097$410.04$82.01
    67880TRevision of eyelid023314.9673$888.20$266.33$177.64
    67882TRevision of eyelid024018.1508$1,077.12$315.31$215.42
    Start Printed Page 50779
    67900TRepair brow defect024018.1508$1,077.12$315.31$215.42
    67901TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67902TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67903TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67904TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67906TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67908TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67909TRevise eyelid defect024018.1508$1,077.12$315.31$215.42
    67911TRevise eyelid defect024018.1508$1,077.12$315.31$215.42
    67912TCorrection eyelid w/ implant024018.1508$1,077.12$315.31$215.42
    67914TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67915TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67916TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67917TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67921TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67922TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67923TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67924TRepair eyelid defect024018.1508$1,077.12$315.31$215.42
    67930TRepair eyelid wound024018.1508$1,077.12$315.31$215.42
    67935TRepair eyelid wound024018.1508$1,077.12$315.31$215.42
    67938SRemove eyelid foreign body06981.2438$73.81$16.55$14.76
    67950TRevision of eyelid024018.1508$1,077.12$315.31$215.42
    67961TRevision of eyelid024018.1508$1,077.12$315.31$215.42
    67966TRevision of eyelid024018.1508$1,077.12$315.31$215.42
    67971TReconstruction of eyelid024123.3036$1,382.91$384.47$276.58
    67973TReconstruction of eyelid024123.3036$1,382.91$384.47$276.58
    67974TReconstruction of eyelid024123.3036$1,382.91$384.47$276.58
    67975TReconstruction of eyelid024018.1508$1,077.12$315.31$215.42
    67999TRevision of eyelid02382.5933$153.89$30.78
    68020TIncise/drain eyelid lining024018.1508$1,077.12$315.31$215.42
    68040STreatment of eyelid lesions06981.2438$73.81$16.55$14.76
    68100TBiopsy of eyelid lining02326.6732$396.01$103.17$79.20
    68110TRemove eyelid lining lesion069910.0177$594.48$118.90
    68115TRemove eyelid lining lesion024018.1508$1,077.12$315.31$215.42
    68130TRemove eyelid lining lesion023314.9673$888.20$266.33$177.64
    68135TRemove eyelid lining lesion02396.9097$410.04$82.01
    68200STreat eyelid by injection02300.7858$46.63$14.97$9.33
    68320TRevise/graft eyelid lining024018.1508$1,077.12$315.31$215.42
    68325TRevise/graft eyelid lining024230.5464$1,812.72$597.36$362.54
    68326TRevise/graft eyelid lining024123.3036$1,382.91$384.47$276.58
    68328TRevise/graft eyelid lining024123.3036$1,382.91$384.47$276.58
    68330TRevise eyelid lining023421.9741$1,304.01$511.31$260.80
    68335TRevise/graft eyelid lining024123.3036$1,382.91$384.47$276.58
    68340TSeparate eyelid adhesions024018.1508$1,077.12$315.31$215.42
    68360TRevise eyelid lining023421.9741$1,304.01$511.31$260.80
    68362TRevise eyelid lining023421.9741$1,304.01$511.31$260.80
    68371THarvest eye tissue, alograft023314.9673$888.20$266.33$177.64
    68399TEyelid lining surgery02382.5933$153.89$30.78
    68400TIncise/drain tear gland02382.5933$153.89$30.78
    68420TIncise/drain tear sac024018.1508$1,077.12$315.31$215.42
    68440TIncise tear duct opening02382.5933$153.89$30.78
    68500TRemoval of tear gland024123.3036$1,382.91$384.47$276.58
    68505TPartial removal, tear gland024123.3036$1,382.91$384.47$276.58
    68510TBiopsy of tear gland024018.1508$1,077.12$315.31$215.42
    68520TRemoval of tear sac024123.3036$1,382.91$384.47$276.58
    68525TBiopsy of tear sac024018.1508$1,077.12$315.31$215.42
    68530TClearance of tear duct024018.1508$1,077.12$315.31$215.42
    68540TRemove tear gland lesion024123.3036$1,382.91$384.47$276.58
    68550TRemove tear gland lesion024230.5464$1,812.72$597.36$362.54
    68700TRepair tear ducts024123.3036$1,382.91$384.47$276.58
    68705TRevise tear duct opening02382.5933$153.89$30.78
    68720TCreate tear sac drain024230.5464$1,812.72$597.36$362.54
    68745TCreate tear duct drain024123.3036$1,382.91$384.47$276.58
    68750TCreate tear duct drain024230.5464$1,812.72$597.36$362.54
    68760SClose tear duct opening06981.2438$73.81$16.55$14.76
    68761SClose tear duct opening02311.9278$114.40$44.61$22.88
    Start Printed Page 50780
    68770TClose tear system fistula024018.1508$1,077.12$315.31$215.42
    68801SDilate tear duct opening06981.2438$73.81$16.55$14.76
    68810SProbe nasolacrimal duct02311.9278$114.40$44.61$22.88
    68811TProbe nasolacrimal duct024018.1508$1,077.12$315.31$215.42
    68815TProbe nasolacrimal duct024018.1508$1,077.12$315.31$215.42
    68840SExplore/irrigate tear ducts02311.9278$114.40$44.61$22.88
    68850NInjection for tear sac x-ray
    68899STear duct system surgery02300.7858$46.63$14.97$9.33
    69000TDrain external ear lesion00061.55$91.98$22.28$18.40
    69005TDrain external ear lesion000816.4989$979.09$195.82
    69020TDrain outer ear canal lesion00061.55$91.98$22.28$18.40
    69090EPierce earlobes
    69100TBiopsy of external ear00194.0547$240.62$71.87$48.12
    69105TBiopsy of external ear canal025316.1357$957.54$282.29$191.51
    69110TRemove external ear, partial002114.9776$888.82$219.48$177.76
    69120TRemoval of external ear025423.404$1,388.86$321.35$277.77
    69140TRemove ear canal lesion(s)025423.404$1,388.86$321.35$277.77
    69145TRemove ear canal lesion(s)002114.9776$888.82$219.48$177.76
    69150TExtensive ear canal surgery02527.8673$466.87$113.41$93.37
    69155CExtensive ear/neck surgery
    69200XClear outer ear canal03400.6384$37.88$7.58
    69205TClear outer ear canal002219.6472$1,165.92$354.45$233.18
    69210XRemove impacted ear wax03400.6384$37.88$7.58
    69220TClean out mastoid cavity00120.8497$50.42$11.18$10.08
    69222TClean out mastoid cavity025316.1357$957.54$282.29$191.51
    69300TRevise external ear025423.404$1,388.86$321.35$277.77
    69310TRebuild outer ear canal025637.3204$2,214.70$442.94
    69320TRebuild outer ear canal025637.3204$2,214.70$442.94
    69399TOuter ear surgery procedure02512.0101$119.29$23.86
    69400TInflate middle ear canal02512.0101$119.29$23.86
    69401TInflate middle ear canal02512.0101$119.29$23.86
    69405TCatheterize middle ear canal02527.8673$466.87$113.41$93.37
    69410TInset middle ear (baffle)02512.0101$119.29$23.86
    69420TIncision of eardrum02512.0101$119.29$23.86
    69421TIncision of eardrum025316.1357$957.54$282.29$191.51
    69424TRemove ventilating tube02527.8673$466.87$113.41$93.37
    69433TCreate eardrum opening02527.8673$466.87$113.41$93.37
    69436TCreate eardrum opening025316.1357$957.54$282.29$191.51
    69440TExploration of middle ear025423.404$1,388.86$321.35$277.77
    69450TEardrum revision025637.3204$2,214.70$442.94
    69501TMastoidectomy025637.3204$2,214.70$442.94
    69502TMastoidectomy025423.404$1,388.86$321.35$277.77
    69505TRemove mastoid structures025637.3204$2,214.70$442.94
    69511TExtensive mastoid surgery025637.3204$2,214.70$442.94
    69530TExtensive mastoid surgery025637.3204$2,214.70$442.94
    69535CRemove part of temporal bone
    69540TRemove ear lesion025316.1357$957.54$282.29$191.51
    69550TRemove ear lesion025637.3204$2,214.70$442.94
    69552TRemove ear lesion025637.3204$2,214.70$442.94
    69554CRemove ear lesion
    69601TMastoid surgery revision025637.3204$2,214.70$442.94
    69602TMastoid surgery revision025637.3204$2,214.70$442.94
    69603TMastoid surgery revision025637.3204$2,214.70$442.94
    69604TMastoid surgery revision025637.3204$2,214.70$442.94
    69605TMastoid surgery revision025637.3204$2,214.70$442.94
    69610TRepair of eardrum025423.404$1,388.86$321.35$277.77
    69620TRepair of eardrum025423.404$1,388.86$321.35$277.77
    69631TRepair eardrum structures025637.3204$2,214.70$442.94
    69632TRebuild eardrum structures025637.3204$2,214.70$442.94
    69633TRebuild eardrum structures025637.3204$2,214.70$442.94
    69635TRepair eardrum structures025637.3204$2,214.70$442.94
    69636TRebuild eardrum structures025637.3204$2,214.70$442.94
    69637TRebuild eardrum structures025637.3204$2,214.70$442.94
    69641TRevise middle ear & mastoid025637.3204$2,214.70$442.94
    69642TRevise middle ear & mastoid025637.3204$2,214.70$442.94
    69643TRevise middle ear & mastoid025637.3204$2,214.70$442.94
    Start Printed Page 50781
    69644TRevise middle ear & mastoid025637.3204$2,214.70$442.94
    69645TRevise middle ear & mastoid025637.3204$2,214.70$442.94
    69646TRevise middle ear & mastoid025637.3204$2,214.70$442.94
    69650TRelease middle ear bone025423.404$1,388.86$321.35$277.77
    69660TRevise middle ear bone025637.3204$2,214.70$442.94
    69661TRevise middle ear bone025637.3204$2,214.70$442.94
    69662TRevise middle ear bone025637.3204$2,214.70$442.94
    69666TRepair middle ear structures025637.3204$2,214.70$442.94
    69667TRepair middle ear structures025637.3204$2,214.70$442.94
    69670TRemove mastoid air cells025637.3204$2,214.70$442.94
    69676TRemove middle ear nerve025637.3204$2,214.70$442.94
    69700TClose mastoid fistula025637.3204$2,214.70$442.94
    69710EImplant/replace hearing aid
    69711TRemove/repair hearing aid025637.3204$2,214.70$442.94
    69714TImplant temple bone w/stimul025637.3204$2,214.70$442.94
    69715TTemple bne implnt w/stimulat025637.3204$2,214.70$442.94
    69717TTemple bone implant revision025637.3204$2,214.70$442.94
    69718TRevise temple bone implant025637.3204$2,214.70$442.94
    69720TRelease facial nerve025637.3204$2,214.70$442.94
    69725TRelease facial nerve025637.3204$2,214.70$442.94
    69740TRepair facial nerve025637.3204$2,214.70$442.94
    69745TRepair facial nerve025637.3204$2,214.70$442.94
    69799TMiddle ear surgery procedure02512.0101$119.29$23.86
    69801TIncise inner ear025637.3204$2,214.70$442.94
    69802TIncise inner ear025637.3204$2,214.70$442.94
    69805TExplore inner ear025637.3204$2,214.70$442.94
    69806TExplore inner ear025637.3204$2,214.70$442.94
    69820TEstablish inner ear window025637.3204$2,214.70$442.94
    69840TRevise inner ear window025637.3204$2,214.70$442.94
    69905TRemove inner ear025637.3204$2,214.70$442.94
    69910TRemove inner ear & mastoid025637.3204$2,214.70$442.94
    69915TIncise inner ear nerve025637.3204$2,214.70$442.94
    69930TImplant cochlear device0259366.3317$21,739.22$8,070.21$4,347.84
    69949TInner ear surgery procedure02512.0101$119.29$23.86
    69950CIncise inner ear nerve
    69955TRelease facial nerve025637.3204$2,214.70$442.94
    69960TRelease inner ear canal025637.3204$2,214.70$442.94
    69970CRemove inner ear lesion
    69979TTemporal bone surgery02512.0101$119.29$23.86
    69990NMicrosurgery add-on
    70010SContrast x-ray of brain02743.0413$180.48$72.19$36.10
    70015SContrast x-ray of brain02743.0413$180.48$72.19$36.10
    70030XX-ray eye for foreign body02600.7555$44.83$17.93$8.97
    70100XX-ray exam of jaw02600.7555$44.83$17.93$8.97
    70110XX-ray exam of jaw02600.7555$44.83$17.93$8.97
    70120XX-ray exam of mastoids02600.7555$44.83$17.93$8.97
    70130XX-ray exam of mastoids02600.7555$44.83$17.93$8.97
    70134XX-ray exam of middle ear02611.2901$76.56$15.31
    70140XX-ray exam of facial bones02600.7555$44.83$17.93$8.97
    70150XX-ray exam of facial bones02600.7555$44.83$17.93$8.97
    70160XX-ray exam of nasal bones02600.7555$44.83$17.93$8.97
    70170XX-ray exam of tear duct02643.524$209.12$79.41$41.82
    70190XX-ray exam of eye sockets02600.7555$44.83$17.93$8.97
    70200XX-ray exam of eye sockets02600.7555$44.83$17.93$8.97
    70210XX-ray exam of sinuses02600.7555$44.83$17.93$8.97
    70220XX-ray exam of sinuses02600.7555$44.83$17.93$8.97
    70240XX-ray exam, pituitary saddle02600.7555$44.83$17.93$8.97
    70250XX-ray exam of skull02600.7555$44.83$17.93$8.97
    70260XX-ray exam of skull02611.2901$76.56$15.31
    70300XX-ray exam of teeth02620.9228$54.76$10.95
    70310XX-ray exam of teeth02620.9228$54.76$10.95
    70320XFull mouth x-ray of teeth02620.9228$54.76$10.95
    70328XX-ray exam of jaw joint02600.7555$44.83$17.93$8.97
    70330XX-ray exam of jaw joints02600.7555$44.83$17.93$8.97
    70332SX-ray exam of jaw joint02753.5779$212.32$69.09$42.46
    70336SMagnetic image, jaw joint03355.1581$306.10$122.43$61.22
    Start Printed Page 50782
    70350XX-ray head for orthodontia02600.7555$44.83$17.93$8.97
    70355XPanoramic x-ray of jaws02600.7555$44.83$17.93$8.97
    70360XX-ray exam of neck02600.7555$44.83$17.93$8.97
    70370XThroat x-ray & fluoroscopy02721.3801$81.90$32.76$16.38
    70371XSpeech evaluation, complex02721.3801$81.90$32.76$16.38
    70373XContrast x-ray of larynx02631.7476$103.71$24.40$20.74
    70380XX-ray exam of salivary gland02600.7555$44.83$17.93$8.97
    70390XX-ray exam of salivary duct02631.7476$103.71$24.40$20.74
    70450*SCt head/brain w/o dye03323.2694$194.02$77.60$38.80
    70460*SCt head/brain w/dye02834.4253$262.61$105.04$52.52
    70470*SCt head/brain w/o & w/ dye03335.2836$313.54$125.41$62.71
    70480*SCt orbit/ear/fossa w/o dye03323.2694$194.02$77.60$38.80
    70481*SCt orbit/ear/fossa w/dye02834.4253$262.61$105.04$52.52
    70482*SCt orbit/ear/fossa w/o&w dye03335.2836$313.54$125.41$62.71
    70486*SCt maxillofacial w/o dye03323.2694$194.02$77.60$38.80
    70487*SCt maxillofacial w/dye02834.4253$262.61$105.04$52.52
    70488*SCt maxillofacial w/o & w dye03335.2836$313.54$125.41$62.71
    70490*SCt soft tissue neck w/o dye03323.2694$194.02$77.60$38.80
    70491*SCt soft tissue neck w/dye02834.4253$262.61$105.04$52.52
    70492*SCt sft tsue nck w/o & w/dye03335.2836$313.54$125.41$62.71
    70496*SCt angiography, head06625.1621$306.33$122.53$61.27
    70498*SCt angiography, neck06625.1621$306.33$122.53$61.27
    70540*SMri orbit/face/neck w/o dye03366.0742$360.46$144.18$72.09
    70542*SMri orbit/face/neck w/dye02846.4201$380.99$152.39$76.20
    70543*SMri orbt/fac/nck w/o & w dye03378.7945$521.89$208.75$104.38
    70544*SMr angiography head w/o dye03366.0742$360.46$144.18$72.09
    70545*SMr angiography head w/dye02846.4201$380.99$152.39$76.20
    70546*SMr angiograph head w/o&w dye03378.7945$521.89$208.75$104.38
    70547*SMr angiography neck w/o dye03366.0742$360.46$144.18$72.09
    70548*SMr angiography neck w/dye02846.4201$380.99$152.39$76.20
    70549*SMr angiograph neck w/o&w dye03378.7945$521.89$208.75$104.38
    70551*SMri brain w/o dye03366.0742$360.46$144.18$72.09
    70552*SMri brain w/ dye02846.4201$380.99$152.39$76.20
    70553*SMri brain w/o & w/ dye03378.7945$521.89$208.75$104.38
    70557SMri brain w/o dye03366.0742$360.46$144.18$72.09
    70558SMri brain w/ dye02846.4201$380.99$152.39$76.20
    70559SMri brain w/o & w/ dye03378.7945$521.89$208.75$104.38
    71010XChest x-ray02600.7555$44.83$17.93$8.97
    71015XChest x-ray02600.7555$44.83$17.93$8.97
    71020XChest x-ray02600.7555$44.83$17.93$8.97
    71021XChest x-ray02600.7555$44.83$17.93$8.97
    71022XChest x-ray02600.7555$44.83$17.93$8.97
    71023XChest x-ray and fluoroscopy02721.3801$81.90$32.76$16.38
    71030XChest x-ray02600.7555$44.83$17.93$8.97
    71034XChest x-ray and fluoroscopy02721.3801$81.90$32.76$16.38
    71035XChest x-ray02600.7555$44.83$17.93$8.97
    71040XContrast x-ray of bronchi02631.7476$103.71$24.40$20.74
    71060XContrast x-ray of bronchi02631.7476$103.71$24.40$20.74
    71090XX-ray & pacemaker insertion02721.3801$81.90$32.76$16.38
    71100XX-ray exam of ribs02600.7555$44.83$17.93$8.97
    71101XX-ray exam of ribs/chest02600.7555$44.83$17.93$8.97
    71110XX-ray exam of ribs02600.7555$44.83$17.93$8.97
    71111XX-ray exam of ribs/ chest02611.2901$76.56$15.31
    71120XX-ray exam of breastbone02600.7555$44.83$17.93$8.97
    71130XX-ray exam of breastbone02600.7555$44.83$17.93$8.97
    71250*SCt thorax w/o dye03323.2694$194.02$77.60$38.80
    71260*SCt thorax w/dye02834.4253$262.61$105.04$52.52
    71270*SCt thorax w/o & w/ dye03335.2836$313.54$125.41$62.71
    71275*SCt angiography, chest06625.1621$306.33$122.53$61.27
    71550*SMri chest w/o dye03366.0742$360.46$144.18$72.09
    71551*SMri chest w/dye02846.4201$380.99$152.39$76.20
    71552*SMri chest w/o & w/dye03378.7945$521.89$208.75$104.38
    71555BMri angio chest w or w/o dye
    72010XX-ray exam of spine02600.7555$44.83$17.93$8.97
    72020XX-ray exam of spine02600.7555$44.83$17.93$8.97
    72040XX-ray exam of neck spine02600.7555$44.83$17.93$8.97
    Start Printed Page 50783
    72050XX-ray exam of neck spine02611.2901$76.56$15.31
    72052XX-ray exam of neck spine02611.2901$76.56$15.31
    72069XX-ray exam of trunk spine02600.7555$44.83$17.93$8.97
    72070XX-ray exam of thoracic spine02600.7555$44.83$17.93$8.97
    72072XX-ray exam of thoracic spine02600.7555$44.83$17.93$8.97
    72074XX-ray exam of thoracic spine02600.7555$44.83$17.93$8.97
    72080XX-ray exam of trunk spine02600.7555$44.83$17.93$8.97
    72090XX-ray exam of trunk spine02611.2901$76.56$15.31
    72100XX-ray exam of lower spine02600.7555$44.83$17.93$8.97
    72110XX-ray exam of lower spine02611.2901$76.56$15.31
    72114XX-ray exam of lower spine02611.2901$76.56$15.31
    72120XX-ray exam of lower spine02611.2901$76.56$15.31
    72125*SCt neck spine w/o dye03323.2694$194.02$77.60$38.80
    72126*SCt neck spine w/dye02834.4253$262.61$105.04$52.52
    72127*SCt neck spine w/o & w/dye03335.2836$313.54$125.41$62.71
    72128*SCt chest spine w/o dye03323.2694$194.02$77.60$38.80
    72129*SCt chest spine w/dye02834.4253$262.61$105.04$52.52
    72130*SCt chest spine w/o & w/dye03335.2836$313.54$125.41$62.71
    72131*SCt lumbar spine w/o dye03323.2694$194.02$77.60$38.80
    72132*SCt lumbar spine w/dye02834.4253$262.61$105.04$52.52
    72133*SCt lumbar spine w/o & w/dye03335.2836$313.54$125.41$62.71
    72141*SMri neck spine w/o dye03366.0742$360.46$144.18$72.09
    72142*SMri neck spine w/dye02846.4201$380.99$152.39$76.20
    72146*SMri chest spine w/o dye03366.0742$360.46$144.18$72.09
    72147*SMri chest spine w/dye02846.4201$380.99$152.39$76.20
    72148*SMri lumbar spine w/o dye03366.0742$360.46$144.18$72.09
    72149*SMri lumbar spine w/dye02846.4201$380.99$152.39$76.20
    72156*SMri neck spine w/o & w/dye03378.7945$521.89$208.75$104.38
    72157*SMri chest spine w/o & w/dye03378.7945$521.89$208.75$104.38
    72158*SMri lumbar spine w/o & w/dye03378.7945$521.89$208.75$104.38
    72159EMr angio spine w/o&w/dye
    72170XX-ray exam of pelvis02600.7555$44.83$17.93$8.97
    72190XX-ray exam of pelvis02600.7555$44.83$17.93$8.97
    72191*SCt angiograph pelv w/o&w/dye06625.1621$306.33$122.53$61.27
    72192*SCt pelvis w/o dye03323.2694$194.02$77.60$38.80
    72193*SCt pelvis w/dye02834.4253$262.61$105.04$52.52
    72194*SCt pelvis w/o & w/dye03335.2836$313.54$125.41$62.71
    72195*SMri pelvis w/o dye03366.0742$360.46$144.18$72.09
    72196*SMri pelvis w/dye02846.4201$380.99$152.39$76.20
    72197*SMri pelvis w/o & w/dye03378.7945$521.89$208.75$104.38
    72198BMr angio pelvis w/o & w/dye
    72200XX-ray exam sacroiliac joints02600.7555$44.83$17.93$8.97
    72202XX-ray exam sacroiliac joints02600.7555$44.83$17.93$8.97
    72220XX-ray exam of tailbone02600.7555$44.83$17.93$8.97
    72240SContrast x-ray of neck spine02743.0413$180.48$72.19$36.10
    72255SContrast x-ray, thorax spine02743.0413$180.48$72.19$36.10
    72265SContrast x-ray, lower spine02743.0413$180.48$72.19$36.10
    72270SContrast x-ray, spine02743.0413$180.48$72.19$36.10
    72275SEpidurography02743.0413$180.48$72.19$36.10
    72285SX-ray c/t spine disk038812.3294$731.66$292.66$146.33
    72295SX-ray of lower spine disk038812.3294$731.66$292.66$146.33
    73000XX-ray exam of collar bone02600.7555$44.83$17.93$8.97
    73010XX-ray exam of shoulder blade02600.7555$44.83$17.93$8.97
    73020XX-ray exam of shoulder02600.7555$44.83$17.93$8.97
    73030XX-ray exam of shoulder02600.7555$44.83$17.93$8.97
    73040SContrast x-ray of shoulder02753.5779$212.32$69.09$42.46
    73050XX-ray exam of shoulders02600.7555$44.83$17.93$8.97
    73060XX-ray exam of humerus02600.7555$44.83$17.93$8.97
    73070XX-ray exam of elbow02600.7555$44.83$17.93$8.97
    73080XX-ray exam of elbow02600.7555$44.83$17.93$8.97
    73085SContrast x-ray of elbow02753.5779$212.32$69.09$42.46
    73090XX-ray exam of forearm02600.7555$44.83$17.93$8.97
    73092XX-ray exam of arm, infant02600.7555$44.83$17.93$8.97
    73100XX-ray exam of wrist02600.7555$44.83$17.93$8.97
    73110XX-ray exam of wrist02600.7555$44.83$17.93$8.97
    73115SContrast x-ray of wrist02753.5779$212.32$69.09$42.46
    Start Printed Page 50784
    73120XX-ray exam of hand02600.7555$44.83$17.93$8.97
    73130XX-ray exam of hand02600.7555$44.83$17.93$8.97
    73140XX-ray exam of finger(s)02600.7555$44.83$17.93$8.97
    73200*SCt upper extremity w/o dye03323.2694$194.02$77.60$38.80
    73201*SCt upper extremity w/dye02834.4253$262.61$105.04$52.52
    73202*SCt uppr extremity w/o&w/dye03335.2836$313.54$125.41$62.71
    73206*SCt angio upr extrm w/o&w/dye06625.1621$306.33$122.53$61.27
    73218*SMri upper extremity w/o dye03366.0742$360.46$144.18$72.09
    73219*SMri upper extremity w/dye02846.4201$380.99$152.39$76.20
    73220*SMri uppr extremity w/o&w/dye03378.7945$521.89$208.75$104.38
    73221*SMri joint upr extrem w/o dye03366.0742$360.46$144.18$72.09
    73222*SMri joint upr extrem w/dye02846.4201$380.99$152.39$76.20
    73223*SMri joint upr extr w/o&w/dye03378.7945$521.89$208.75$104.38
    73225EMr angio upr extr w/o&w/dye
    73500XX-ray exam of hip02600.7555$44.83$17.93$8.97
    73510XX-ray exam of hip02600.7555$44.83$17.93$8.97
    73520XX-ray exam of hips02611.2901$76.56$15.31
    73525SContrast x-ray of hip02753.5779$212.32$69.09$42.46
    73530XX-ray exam of hip02611.2901$76.56$15.31
    73540XX-ray exam of pelvis & hips02600.7555$44.83$17.93$8.97
    73542SX-ray exam, sacroiliac joint02753.5779$212.32$69.09$42.46
    73550XX-ray exam of thigh02600.7555$44.83$17.93$8.97
    73560XX-ray exam of knee, 1 or 202600.7555$44.83$17.93$8.97
    73562XX-ray exam of knee, 302600.7555$44.83$17.93$8.97
    73564XX-ray exam, knee, 4 or more02600.7555$44.83$17.93$8.97
    73565XX-ray exam of knees02600.7555$44.83$17.93$8.97
    73580SContrast x-ray of knee joint02753.5779$212.32$69.09$42.46
    73590XX-ray exam of lower leg02600.7555$44.83$17.93$8.97
    73592XX-ray exam of leg, infant02600.7555$44.83$17.93$8.97
    73600XX-ray exam of ankle02600.7555$44.83$17.93$8.97
    73610XX-ray exam of ankle02600.7555$44.83$17.93$8.97
    73615SContrast x-ray of ankle02753.5779$212.32$69.09$42.46
    73620XX-ray exam of foot02600.7555$44.83$17.93$8.97
    73630XX-ray exam of foot02600.7555$44.83$17.93$8.97
    73650XX-ray exam of heel02600.7555$44.83$17.93$8.97
    73660XX-ray exam of toe(s)02600.7555$44.83$17.93$8.97
    73700*SCt lower extremity w/o dye03323.2694$194.02$77.60$38.80
    73701*SCt lower extremity w/dye02834.4253$262.61$105.04$52.52
    73702*SCt lwr extremity w/o&w/dye03335.2836$313.54$125.41$62.71
    73706*SCt angio lwr extr w/o&w/dye06625.1621$306.33$122.53$61.27
    73718*SMri lower extremity w/o dye03366.0742$360.46$144.18$72.09
    73719*SMri lower extremity w/dye02846.4201$380.99$152.39$76.20
    73720*SMri lwr extremity w/o&w/dye03378.7945$521.89$208.75$104.38
    73721*SMri jnt of lwr extre w/o dye03366.0742$360.46$144.18$72.09
    73722*SMri joint of lwr extr w/dye02846.4201$380.99$152.39$76.20
    73723*SMri joint lwr extr w/o&w/dye03378.7945$521.89$208.75$104.38
    73725BMr ang lwr ext w or w/o dye
    74000XX-ray exam of abdomen02600.7555$44.83$17.93$8.97
    74010XX-ray exam of abdomen02600.7555$44.83$17.93$8.97
    74020XX-ray exam of abdomen02600.7555$44.83$17.93$8.97
    74022XX-ray exam series, abdomen02611.2901$76.56$15.31
    74150*SCt abdomen w/o dye03323.2694$194.02$77.60$38.80
    74160*SCt abdomen w/dye02834.4253$262.61$105.04$52.52
    74170*SCt abdomen w/o &w /dye03335.2836$313.54$125.41$62.71
    74175*SCt angio abdom w/o & w/dye06625.1621$306.33$122.53$61.27
    74181*SMri abdomen w/o dye03366.0742$360.46$144.18$72.09
    74182*SMri abdomen w/dye02846.4201$380.99$152.39$76.20
    74183*SMri abdomen w/o & w/dye03378.7945$521.89$208.75$104.38
    74185BMri angio, abdom w orw/o dye
    74190XX-ray exam of peritoneum02643.524$209.12$79.41$41.82
    74210SContrst x-ray exam of throat02761.5319$90.91$36.36$18.18
    74220SContrast x-ray, esophagus02761.5319$90.91$36.36$18.18
    74230SCine/vid x-ray, throat/esoph02761.5319$90.91$36.36$18.18
    74235SRemove esophagus obstruction02962.2452$133.24$53.29$26.65
    74240SX-ray exam, upper gi tract02761.5319$90.91$36.36$18.18
    74241SX-ray exam, upper gi tract02761.5319$90.91$36.36$18.18
    Start Printed Page 50785
    74245SX-ray exam, upper gi tract02772.3852$141.54$56.61$28.31
    74246SContrst x-ray uppr gi tract02761.5319$90.91$36.36$18.18
    74247SContrst x-ray uppr gi tract02761.5319$90.91$36.36$18.18
    74249SContrst x-ray uppr gi tract02772.3852$141.54$56.61$28.31
    74250SX-ray exam of small bowel02761.5319$90.91$36.36$18.18
    74251SX-ray exam of small bowel02772.3852$141.54$56.61$28.31
    74260SX-ray exam of small bowel02772.3852$141.54$56.61$28.31
    74270SContrast x-ray exam of colon02761.5319$90.91$36.36$18.18
    74280SContrast x-ray exam of colon02772.3852$141.54$56.61$28.31
    74283SContrast x-ray exam of colon02761.5319$90.91$36.36$18.18
    74290SContrast x-ray, gallbladder02761.5319$90.91$36.36$18.18
    74291SContrast x-rays, gallbladder02761.5319$90.91$36.36$18.18
    74300XX-ray bile ducts/pancreas02631.7476$103.71$24.40$20.74
    74301XX-rays at surgery add-on02631.7476$103.71$24.40$20.74
    74305XX-ray bile ducts/pancreas02631.7476$103.71$24.40$20.74
    74320XContrast x-ray of bile ducts02643.524$209.12$79.41$41.82
    74327SX-ray bile stone removal02962.2452$133.24$53.29$26.65
    74328NX-ray bile duct endoscopy
    74329NX-ray for pancreas endoscopy
    74330NX-ray bile/panc endoscopy
    74340XX-ray guide for GI tube02721.3801$81.90$32.76$16.38
    74350XX-ray guide, stomach tube02631.7476$103.71$24.40$20.74
    74355XX-ray guide, intestinal tube02631.7476$103.71$24.40$20.74
    74360SX-ray guide, GI dilation02962.2452$133.24$53.29$26.65
    74363SX-ray, bile duct dilation02975.253$311.73$122.13$62.35
    74400SContrst x-ray, urinary tract02782.6434$156.87$62.74$31.37
    74410SContrst x-ray, urinary tract02782.6434$156.87$62.74$31.37
    74415SContrst x-ray, urinary tract02782.6434$156.87$62.74$31.37
    74420SContrst x-ray, urinary tract02782.6434$156.87$62.74$31.37
    74425SContrst x-ray, urinary tract02782.6434$156.87$62.74$31.37
    74430SContrast x-ray, bladder02782.6434$156.87$62.74$31.37
    74440SX-ray, male genital tract02782.6434$156.87$62.74$31.37
    74445SX-ray exam of penis02782.6434$156.87$62.74$31.37
    74450SX-ray, urethra/bladder02782.6434$156.87$62.74$31.37
    74455SX-ray, urethra/bladder02782.6434$156.87$62.74$31.37
    74470XX-ray exam of kidney lesion02631.7476$103.71$24.40$20.74
    74475SX-ray control, cath insert02975.253$311.73$122.13$62.35
    74480SX-ray control, cath insert02962.2452$133.24$53.29$26.65
    74485SX-ray guide, GU dilation02962.2452$133.24$53.29$26.65
    74710XX-ray measurement of pelvis02611.2901$76.56$15.31
    74740XX-ray, female genital tract02643.524$209.12$79.41$41.82
    74742XX-ray, fallopian tube02643.524$209.12$79.41$41.82
    74775SX-ray exam of perineum02782.6434$156.87$62.74$31.37
    75552SHeart mri for morph w/o dye03366.0742$360.46$144.18$72.09
    75553SHeart mri for morph w/dye02846.4201$380.99$152.39$76.20
    75554SCardiac MRI/function03366.0742$360.46$144.18$72.09
    75555SCardiac MRI/limited study03366.0742$360.46$144.18$72.09
    75556ECardiac MRI/flow mapping
    75600SContrast x-ray exam of aorta028020.7902$1,233.75$353.85$246.75
    75605SContrast x-ray exam of aorta028020.7902$1,233.75$353.85$246.75
    75625SContrast x-ray exam of aorta028020.7902$1,233.75$353.85$246.75
    75630SX-ray aorta, leg arteries028020.7902$1,233.75$353.85$246.75
    75635*SCt angio abdominal arteries06625.1621$306.33$122.53$61.27
    75650SArtery x-rays, head & neck028020.7902$1,233.75$353.85$246.75
    75658SArtery x-rays, arm02798.9319$530.05$150.03$106.01
    75660SArtery x-rays, head & neck06686.5024$385.87$114.67$77.17
    75662SArtery x-rays, head & neck028020.7902$1,233.75$353.85$246.75
    75665SArtery x-rays, head & neck028020.7902$1,233.75$353.85$246.75
    75671SArtery x-rays, head & neck028020.7902$1,233.75$353.85$246.75
    75676SArtery x-rays, neck028020.7902$1,233.75$353.85$246.75
    75680SArtery x-rays, neck028020.7902$1,233.75$353.85$246.75
    75685SArtery x-rays, spine028020.7902$1,233.75$353.85$246.75
    75705SArtery x-rays, spine06686.5024$385.87$114.67$77.17
    75710SArtery x-rays, arm/leg028020.7902$1,233.75$353.85$246.75
    75716SArtery x-rays, arms/legs028020.7902$1,233.75$353.85$246.75
    75722SArtery x-rays, kidney028020.7902$1,233.75$353.85$246.75
    Start Printed Page 50786
    75724SArtery x-rays, kidneys028020.7902$1,233.75$353.85$246.75
    75726SArtery x-rays, abdomen028020.7902$1,233.75$353.85$246.75
    75731SArtery x-rays, adrenal gland028020.7902$1,233.75$353.85$246.75
    75733SArtery x-rays, adrenals06686.5024$385.87$114.67$77.17
    75736SArtery x-rays, pelvis028020.7902$1,233.75$353.85$246.75
    75741SArtery x-rays, lung02798.9319$530.05$150.03$106.01
    75743SArtery x-rays, lungs028020.7902$1,233.75$353.85$246.75
    75746SArtery x-rays, lung02798.9319$530.05$150.03$106.01
    75756SArtery x-rays, chest02798.9319$530.05$150.03$106.01
    75774SArtery x-ray, each vessel02798.9319$530.05$150.03$106.01
    75790SVisualize A-V shunt02798.9319$530.05$150.03$106.01
    75801XLymph vessel x-ray, arm/leg02643.524$209.12$79.41$41.82
    75803XLymph vessel x-ray,arms/legs02643.524$209.12$79.41$41.82
    75805XLymph vessel x-ray, trunk02643.524$209.12$79.41$41.82
    75807XLymph vessel x-ray, trunk02643.524$209.12$79.41$41.82
    75809XNonvascular shunt, x-ray02631.7476$103.71$24.40$20.74
    75810SVein x-ray, spleen/liver02798.9319$530.05$150.03$106.01
    75820SVein x-ray, arm/leg06686.5024$385.87$114.67$77.17
    75822SVein x-ray, arms/legs06686.5024$385.87$114.67$77.17
    75825SVein x-ray, trunk02798.9319$530.05$150.03$106.01
    75827SVein x-ray, chest02798.9319$530.05$150.03$106.01
    75831SVein x-ray, kidney02798.9319$530.05$150.03$106.01
    75833SVein x-ray, kidneys02798.9319$530.05$150.03$106.01
    75840SVein x-ray, adrenal gland028020.7902$1,233.75$353.85$246.75
    75842SVein x-ray, adrenal glands028020.7902$1,233.75$353.85$246.75
    75860SVein x-ray, neck06686.5024$385.87$114.67$77.17
    75870SVein x-ray, skull06686.5024$385.87$114.67$77.17
    75872SVein x-ray, skull02798.9319$530.05$150.03$106.01
    75880SVein x-ray, eye socket06686.5024$385.87$114.67$77.17
    75885SVein x-ray, liver028020.7902$1,233.75$353.85$246.75
    75887SVein x-ray, liver02798.9319$530.05$150.03$106.01
    75889SVein x-ray, liver028020.7902$1,233.75$353.85$246.75
    75891SVein x-ray, liver02798.9319$530.05$150.03$106.01
    75893NVenous sampling by catheter
    75894SX-rays, transcath therapy02975.253$311.73$122.13$62.35
    75896SX-rays, transcath therapy02975.253$311.73$122.13$62.35
    75898XFollow-up angiography02631.7476$103.71$24.40$20.74
    75900CArterial catheter exchange
    75901XRemove cva device obstruct02631.7476$103.71$24.40$20.74
    75902XRemove cva lumen obstruct02631.7476$103.71$24.40$20.74
    75940SX-ray placement, vein filter02975.253$311.73$122.13$62.35
    75945SIntravascular us02672.6327$156.23$62.18$31.25
    75946SIntravascular us add-on02661.6393$97.28$38.91$19.46
    75952CEndovasc repair abdom aorta
    75953CAbdom aneurysm endovas rpr
    75954CIliac aneurysm endovas rpr
    75960STranscatheter intro, stent06686.5024$385.87$114.67$77.17
    75961SRetrieval, broken catheter06686.5024$385.87$114.67$77.17
    75962SRepair arterial blockage06686.5024$385.87$114.67$77.17
    75964SRepair artery blockage, each06686.5024$385.87$114.67$77.17
    75966SRepair arterial blockage06686.5024$385.87$114.67$77.17
    75968SRepair artery blockage, each06686.5024$385.87$114.67$77.17
    75970SVascular biopsy06686.5024$385.87$114.67$77.17
    75978SRepair venous blockage06686.5024$385.87$114.67$77.17
    75980SContrast xray exam bile duct02975.253$311.73$122.13$62.35
    75982SContrast xray exam bile duct02975.253$311.73$122.13$62.35
    75984XXray control catheter change02631.7476$103.71$24.40$20.74
    75989NAbscess drainage under x-ray
    75992SAtherectomy, x-ray exam02798.9319$530.05$150.03$106.01
    75993SAtherectomy, x-ray exam02798.9319$530.05$150.03$106.01
    75994SAtherectomy, x-ray exam02798.9319$530.05$150.03$106.01
    75995SAtherectomy, x-ray exam02798.9319$530.05$150.03$106.01
    75996SAtherectomy, x-ray exam02798.9319$530.05$150.03$106.01
    75998NFluoroguide for vein device
    76000XFluoroscope examination02721.3801$81.90$32.76$16.38
    76001NFluoroscope exam, extensive
    Start Printed Page 50787
    76003NNeedle localization by x-ray
    76005NFluoroguide for spine inject
    76006XX-ray stress view02600.7555$44.83$17.93$8.97
    76010XX-ray, nose to rectum02600.7555$44.83$17.93$8.97
    76012SPercut vertebroplasty fluor02743.0413$180.48$72.19$36.10
    76013SPercut vertebroplasty, ct02743.0413$180.48$72.19$36.10
    76020XX-rays for bone age02600.7555$44.83$17.93$8.97
    76040XX-rays, bone evaluation02611.2901$76.56$15.31
    76061XX-rays, bone survey02611.2901$76.56$15.31
    76062XX-rays, bone survey02611.2901$76.56$15.31
    76065XX-rays, bone evaluation02611.2901$76.56$15.31
    76066XJoint survey, single view02600.7555$44.83$17.93$8.97
    76070SCT scan, bone density study02881.2568$74.58$14.92
    76071SCt bone density, peripheral02821.6542$98.17$39.26$19.63
    76075SDexa, axial skeleton study02881.2568$74.58$14.92
    76076SDexa, peripheral study06650.6464$38.36$7.67
    76077XDxa bone density/v-fracture02600.7555$44.83$17.93$8.97
    76078XRadiographic absorptiometry02600.7555$44.83$17.93$8.97
    76080XX-ray exam of fistula02631.7476$103.71$24.40$20.74
    76082AComputer mammogram add-on
    76083AComputer mammogram add-on
    76086XX-ray of mammary duct02631.7476$103.71$24.40$20.74
    76088XX-ray of mammary ducts02631.7476$103.71$24.40$20.74
    76090AMammogram, one breast
    76091AMammogram, both breasts
    76092AMammogram, screening
    76093EMagnetic image, breast
    76094EMagnetic image, both breasts
    76095XStereotactic breast biopsy02643.524$209.12$79.41$41.82
    76096XX-ray of needle wire, breast02631.7476$103.71$24.40$20.74
    76098XX-ray exam, breast specimen02600.7555$44.83$17.93$8.97
    76100XX-ray exam of body section02611.2901$76.56$15.31
    76101XComplex body section x-ray02631.7476$103.71$24.40$20.74
    76102XComplex body section x-rays02643.524$209.12$79.41$41.82
    76120XCine/video x-rays02721.3801$81.90$32.76$16.38
    76125XCine/video x-rays add-on02600.7555$44.83$17.93$8.97
    76140EX-ray consultation
    76150XX-ray exam, dry process02600.7555$44.83$17.93$8.97
    76350NSpecial x-ray contrast study
    76355SCt scan for localization02834.4253$262.61$105.04$52.52
    76360SCt scan for needle biopsy02834.4253$262.61$105.04$52.52
    76362SCt guide for tissue ablation03323.2694$194.02$77.60$38.80
    76370SCt scan for therapy guide02821.6542$98.17$39.26$19.63
    76375S3d/holograph reconstr add-on02821.6542$98.17$39.26$19.63
    76380SCAT scan follow-up study02821.6542$98.17$39.26$19.63
    76390EMr spectroscopy
    76393SMr guidance for needle place03355.1581$306.10$122.43$61.22
    76394SMri for tissue ablation03355.1581$306.10$122.43$61.22
    76400SMagnetic image, bone marrow03355.1581$306.10$122.43$61.22
    76496XFluoroscopic procedure02721.3801$81.90$32.76$16.38
    76497SCt procedure02821.6542$98.17$39.26$19.63
    76498SMri procedure03355.1581$306.10$122.43$61.22
    76499XRadiographic procedure02600.7555$44.83$17.93$8.97
    76506SEcho exam of head02651.0213$60.61$24.24$12.12
    76510SOphth us, b & quant a02661.6393$97.28$38.91$19.46
    76511SEcho exam of eye02661.6393$97.28$38.91$19.46
    76512SEcho exam of eye02661.6393$97.28$38.91$19.46
    76513SEcho exam of eye, water bath02661.6393$97.28$38.91$19.46
    76514XEcho exam of eye, thickness03400.6384$37.88$7.58
    76516SEcho exam of eye02651.0213$60.61$24.24$12.12
    76519SEcho exam of eye02661.6393$97.28$38.91$19.46
    76529SEcho exam of eye02651.0213$60.61$24.24$12.12
    76536SUs exam of head and neck02661.6393$97.28$38.91$19.46
    76604*SUs exam, chest, b-scan02661.6393$97.28$38.91$19.46
    76645*SUs exam, breast(s)02651.0213$60.61$24.24$12.12
    76700*SUs exam, abdom, complete02661.6393$97.28$38.91$19.46
    Start Printed Page 50788
    76705*SEcho exam of abdomen02661.6393$97.28$38.91$19.46
    76770*SUs exam abdo back wall, comp02661.6393$97.28$38.91$19.46
    76775*SUs exam abdo back wall, lim02661.6393$97.28$38.91$19.46
    76778*SUs exam kidney transplant02661.6393$97.28$38.91$19.46
    76800SUs exam, spinal canal02661.6393$97.28$38.91$19.46
    76801SOb us < 14 wks, single fetus02661.6393$97.28$38.91$19.46
    76802SOb us < 14 wks, add'l fetus02651.0213$60.61$24.24$12.12
    76805SUs exam, pg uterus, compl02661.6393$97.28$38.91$19.46
    76810SUs exam, pg uterus, mult02661.6393$97.28$38.91$19.46
    76811SOb us, detailed, sngl fetus02672.6327$156.23$62.18$31.25
    76812SOb us, detailed, addl fetus02661.6393$97.28$38.91$19.46
    76815SUs exam, pg uterus limit02651.0213$60.61$24.24$12.12
    76816SUs exam pg uterus repeat02651.0213$60.61$24.24$12.12
    76817STransvaginal us, obstetric02661.6393$97.28$38.91$19.46
    76818SFetal biophys profile w/nst02661.6393$97.28$38.91$19.46
    76819SFetal biophys profil w/o nst02661.6393$97.28$38.91$19.46
    76820SUmbilical artery echo00961.6307$96.77$38.70$19.35
    76821SMiddle cerebral artery echo00961.6307$96.77$38.70$19.35
    76825SEcho exam of fetal heart06711.7028$101.05$40.42$20.21
    76826SEcho exam of fetal heart06971.5357$91.13$36.45$18.23
    76827SEcho exam of fetal heart06711.7028$101.05$40.42$20.21
    76828SEcho exam of fetal heart06971.5357$91.13$36.45$18.23
    76830*STransvaginal us, non-ob02661.6393$97.28$38.91$19.46
    76831*SEcho exam, uterus02672.6327$156.23$62.18$31.25
    76856*SUs exam, pelvic, complete02661.6393$97.28$38.91$19.46
    76857*SUs exam, pelvic, limited02651.0213$60.61$24.24$12.12
    76870SUs exam, scrotum02661.6393$97.28$38.91$19.46
    76872SUs, transrectal02661.6393$97.28$38.91$19.46
    76873SEchograp trans r, pros study02661.6393$97.28$38.91$19.46
    76880SUs exam, extremity02661.6393$97.28$38.91$19.46
    76885SUs exam infant hips, dynamic02651.0213$60.61$24.24$12.12
    76886SUs exam infant hips, static02661.6393$97.28$38.91$19.46
    76930SEcho guide, cardiocentesis02681.061$62.96$12.59
    76932SEcho guide for heart biopsy02681.061$62.96$12.59
    76936SEcho guide for artery repair02681.061$62.96$12.59
    76937NUs guide, vascular access
    76940SUs guide, tissue ablation02681.061$62.96$12.59
    76941SEcho guide for transfusion02681.061$62.96$12.59
    76942SEcho guide for biopsy02681.061$62.96$12.59
    76945SEcho guide, villus sampling02681.061$62.96$12.59
    76946SEcho guide for amniocentesis02681.061$62.96$12.59
    76948SEcho guide, ova aspiration02681.061$62.96$12.59
    76950SEcho guidance radiotherapy02681.061$62.96$12.59
    76965SEcho guidance radiotherapy02681.061$62.96$12.59
    76970SUltrasound exam follow-up02651.0213$60.61$24.24$12.12
    76975SGI endoscopic ultrasound02661.6393$97.28$38.91$19.46
    76977XUs bone density measure03400.6384$37.88$7.58
    76986SUltrasound guide intraoper02661.6393$97.28$38.91$19.46
    76999SEcho examination procedure02651.0213$60.61$24.24$12.12
    77261ERadiation therapy planning
    77262ERadiation therapy planning
    77263ERadiation therapy planning
    77280XSet radiation therapy field03041.7738$105.26$41.52$21.05
    77285XSet radiation therapy field03054.0036$237.59$91.38$47.52
    77290XSet radiation therapy field03054.0036$237.59$91.38$47.52
    77295XSet radiation therapy field031013.949$827.78$325.27$165.56
    77299ERadiation therapy planning
    77300XRadiation therapy dose plan03041.7738$105.26$41.52$21.05
    77301XRadiotherapy dose plan, imrt031013.949$827.78$325.27$165.56
    77305XTeletx isodose plan simple03041.7738$105.26$41.52$21.05
    77310XTeletx isodose plan intermed03054.0036$237.59$91.38$47.52
    77315XTeletx isodose plan complex03054.0036$237.59$91.38$47.52
    77321XSpecial teletx port plan03054.0036$237.59$91.38$47.52
    77326XRadiation therapy dose plan03041.7738$105.26$41.52$21.05
    77327XBrachytx isodose calc interm03054.0036$237.59$91.38$47.52
    77328XBrachytx isodose plan compl03054.0036$237.59$91.38$47.52
    Start Printed Page 50789
    77331XSpecial radiation dosimetry03041.7738$105.26$41.52$21.05
    77332XRadiation treatment aid(s)03032.8356$168.27$66.95$33.65
    77333XRadiation treatment aid(s)03032.8356$168.27$66.95$33.65
    77334XRadiation treatment aid(s)03032.8356$168.27$66.95$33.65
    77336XRadiation physics consult03041.7738$105.26$41.52$21.05
    77370XRadiation physics consult03041.7738$105.26$41.52$21.05
    77399XExternal radiation dosimetry03041.7738$105.26$41.52$21.05
    77401SRadiation treatment delivery03001.5198$90.19$18.04
    77402SRadiation treatment delivery03001.5198$90.19$18.04
    77403SRadiation treatment delivery03001.5198$90.19$18.04
    77404SRadiation treatment delivery03001.5198$90.19$18.04
    77406SRadiation treatment delivery03001.5198$90.19$18.04
    77407SRadiation treatment delivery03001.5198$90.19$18.04
    77408SRadiation treatment delivery03001.5198$90.19$18.04
    77409SRadiation treatment delivery03001.5198$90.19$18.04
    77411SRadiation treatment delivery03012.2195$131.71$26.34
    77412SRadiation treatment delivery03012.2195$131.71$26.34
    77413SRadiation treatment delivery03012.2195$131.71$26.34
    77414SRadiation treatment delivery03012.2195$131.71$26.34
    77416SRadiation treatment delivery03012.2195$131.71$26.34
    77417XRadiology port film(s)02600.7555$44.83$17.93$8.97
    77418SRadiation tx delivery, imrt04125.3643$318.33$63.67
    77427ERadiation tx management, x5
    77431ERadiation therapy management
    77432EStereotactic radiation trmt
    77470SSpecial radiation treatment02995.8482$347.05$69.41
    77499ERadiation therapy management
    77520SProton trmt, simple w/o comp066412.9439$768.13$153.63
    77522SProton trmt, simple w/comp066412.9439$768.13$153.63
    77523SProton trmt, intermediate066715.4857$918.97$183.79
    77525SProton treatment, complex066715.4857$918.97$183.79
    77600SHyperthermia treatment03145.9945$355.73$98.36$71.15
    77605SHyperthermia treatment03145.9945$355.73$98.36$71.15
    77610SHyperthermia treatment03145.9945$355.73$98.36$71.15
    77615SHyperthermia treatment03145.9945$355.73$98.36$71.15
    77620SHyperthermia treatment03145.9945$355.73$98.36$71.15
    77750SInfuse radioactive materials03012.2195$131.71$26.34
    77761SApply intrcav radiat simple03125.0032$296.90$59.38
    77762SApply intrcav radiat interm03125.0032$296.90$59.38
    77763SApply intrcav radiat compl03125.0032$296.90$59.38
    77776SApply interstit radiat simpl03125.0032$296.90$59.38
    77777SApply interstit radiat inter03125.0032$296.90$59.38
    77778SApply interstit radiat compl065112.1448$720.71$144.14
    77781SHigh intensity brachytherapy031312.8655$763.48$152.70
    77782SHigh intensity brachytherapy031312.8655$763.48$152.70
    77783SHigh intensity brachytherapy031312.8655$763.48$152.70
    77784SHigh intensity brachytherapy031312.8655$763.48$152.70
    77789SApply surface radiation03001.5198$90.19$18.04
    77790NRadiation handling
    77799SRadium/radioisotope therapy031312.8655$763.48$152.70
    78000SThyroid, single uptake03891.4976$88.87$35.54$17.77
    78001SThyroid, multiple uptakes03891.4976$88.87$35.54$17.77
    78003SThyroid suppress/stimul03891.4976$88.87$35.54$17.77
    78006SThyroid imaging with uptake03902.5562$151.69$60.67$30.34
    78007SThyroid image, mult uptakes03912.8774$170.75$68.30$34.15
    78010SThyroid imaging03902.5562$151.69$60.67$30.34
    78011SThyroid imaging with flow03902.5562$151.69$60.67$30.34
    78015SThyroid met imaging04064.3035$255.38$102.15$51.08
    78016SThyroid met imaging/studies04064.3035$255.38$102.15$51.08
    78018SThyroid met imaging, body04064.3035$255.38$102.15$51.08
    78020SThyroid met uptake03991.5192$90.15$36.06$18.03
    78070SParathyroid nuclear imaging03912.8774$170.75$68.30$34.15
    78075SAdrenal nuclear imaging03912.8774$170.75$68.30$34.15
    78099SEndocrine nuclear procedure03902.5562$151.69$60.67$30.34
    78102SBone marrow imaging, ltd04004.1335$245.29$98.11$49.06
    78103SBone marrow imaging, mult04004.1335$245.29$98.11$49.06
    Start Printed Page 50790
    78104SBone marrow imaging, body04004.1335$245.29$98.11$49.06
    78110SPlasma volume, single03933.4438$204.37$81.74$40.87
    78111SPlasma volume, multiple03933.4438$204.37$81.74$40.87
    78120SRed cell mass, single03933.4438$204.37$81.74$40.87
    78121SRed cell mass, multiple03933.4438$204.37$81.74$40.87
    78122SBlood volume03933.4438$204.37$81.74$40.87
    78130SRed cell survival study03933.4438$204.37$81.74$40.87
    78135SRed cell survival kinetics03933.4438$204.37$81.74$40.87
    78140SRed cell sequestration03933.4438$204.37$81.74$40.87
    78160SPlasma iron turnover03933.4438$204.37$81.74$40.87
    78162SRadioiron absorption exam03933.4438$204.37$81.74$40.87
    78170SRed cell iron utilization03933.4438$204.37$81.74$40.87
    78172STotal body iron estimation03933.4438$204.37$81.74$40.87
    78185SSpleen imaging04004.1335$245.29$98.11$49.06
    78190SPlatelet survival, kinetics03891.4976$88.87$35.54$17.77
    78191SPlatelet survival03891.4976$88.87$35.54$17.77
    78195SLymph system imaging04004.1335$245.29$98.11$49.06
    78199SBlood/lymph nuclear exam04004.1335$245.29$98.11$49.06
    78201SLiver imaging03944.463$264.85$105.93$52.97
    78202SLiver imaging with flow03944.463$264.85$105.93$52.97
    78205SLiver imaging (3D)03944.463$264.85$105.93$52.97
    78206SLiver image (3d) with flow03944.463$264.85$105.93$52.97
    78215SLiver and spleen imaging03944.463$264.85$105.93$52.97
    78216SLiver & spleen image/flow03944.463$264.85$105.93$52.97
    78220SLiver function study03944.463$264.85$105.93$52.97
    78223SHepatobiliary imaging03944.463$264.85$105.93$52.97
    78230SSalivary gland imaging03953.8699$229.65$91.86$45.93
    78231SSerial salivary imaging03953.8699$229.65$91.86$45.93
    78232SSalivary gland function exam03953.8699$229.65$91.86$45.93
    78258SEsophageal motility study03953.8699$229.65$91.86$45.93
    78261SGastric mucosa imaging03953.8699$229.65$91.86$45.93
    78262SGastroesophageal reflux exam03953.8699$229.65$91.86$45.93
    78264SGastric emptying study03953.8699$229.65$91.86$45.93
    78267ABreath tst attain/anal c-14
    78268ABreath test analysis, c-14
    78270SVit B-12 absorption exam03891.4976$88.87$35.54$17.77
    78271SVit b-12 absrp exam, int fac03891.4976$88.87$35.54$17.77
    78272SVit B-12 absorp, combined03891.4976$88.87$35.54$17.77
    78278SAcute GI blood loss imaging03953.8699$229.65$91.86$45.93
    78282SGI protein loss exam03953.8699$229.65$91.86$45.93
    78290SMeckel's divert exam03953.8699$229.65$91.86$45.93
    78291SLeveen/shunt patency exam03953.8699$229.65$91.86$45.93
    78299SGI nuclear procedure03953.8699$229.65$91.86$45.93
    78300SBone imaging, limited area03964.1426$245.83$98.33$49.17
    78305SBone imaging, multiple areas03964.1426$245.83$98.33$49.17
    78306SBone imaging, whole body03964.1426$245.83$98.33$49.17
    78315SBone imaging, 3 phase03964.1426$245.83$98.33$49.17
    78320SBone imaging (3D)03964.1426$245.83$98.33$49.17
    78350XBone mineral, single photon02600.7555$44.83$17.93$8.97
    78351EBone mineral, dual photon
    78399SMusculoskeletal nuclear exam03964.1426$245.83$98.33$49.17
    78414SNon-imaging heart function03984.3093$255.73$102.29$51.15
    78428SCardiac shunt imaging03984.3093$255.73$102.29$51.15
    78445SVascular flow imaging03972.2646$134.39$53.75$26.88
    78455SVenous thrombosis study03972.2646$134.39$53.75$26.88
    78456SAcute venous thrombus image03972.2646$134.39$53.75$26.88
    78457SVenous thrombosis imaging03972.2646$134.39$53.75$26.88
    78458SVen thrombosis images, bilat03972.2646$134.39$53.75$26.88
    78459SHeart muscle imaging (PET)028517.1798$1,019.50$318.72$203.90
    78460SHeart muscle blood, single03984.3093$255.73$102.29$51.15
    78461SHeart muscle blood, multiple03776.8344$405.57$162.22$81.11
    78464SHeart image (3d), single03984.3093$255.73$102.29$51.15
    78465SHeart image (3d), multiple03776.8344$405.57$162.22$81.11
    78466SHeart infarct image03984.3093$255.73$102.29$51.15
    78468SHeart infarct image (ef)03984.3093$255.73$102.29$51.15
    78469SHeart infarct image (3D)03984.3093$255.73$102.29$51.15
    Start Printed Page 50791
    78472SGated heart, planar, single03984.3093$255.73$102.29$51.15
    78473SGated heart, multiple03765.1975$308.44$121.42$61.69
    78478SHeart wall motion add-on03991.5192$90.15$36.06$18.03
    78480SHeart function add-on03991.5192$90.15$36.06$18.03
    78481SHeart first pass, single03984.3093$255.73$102.29$51.15
    78483SHeart first pass, multiple03765.1975$308.44$121.42$61.69
    78491SHeart image (pet), single028517.1798$1,019.50$318.72$203.90
    78492SHeart image (pet), multiple028517.1798$1,019.50$318.72$203.90
    78494SHeart image, spect03984.3093$255.73$102.29$51.15
    78496SHeart first pass add-on03991.5192$90.15$36.06$18.03
    78499SCardiovascular nuclear exam03984.3093$255.73$102.29$51.15
    78580SLung perfusion imaging04013.415$202.66$81.06$40.53
    78584SLung V/Q image single breath03785.4997$326.37$130.54$65.27
    78585SLung V/Q imaging03785.4997$326.37$130.54$65.27
    78586SAerosol lung image, single04013.415$202.66$81.06$40.53
    78587SAerosol lung image, multiple04013.415$202.66$81.06$40.53
    78588SPerfusion lung image03785.4997$326.37$130.54$65.27
    78591SVent image, 1 breath, 1 proj04013.415$202.66$81.06$40.53
    78593SVent image, 1 proj, gas04013.415$202.66$81.06$40.53
    78594SVent image, mult proj, gas04013.415$202.66$81.06$40.53
    78596SLung differential function03785.4997$326.37$130.54$65.27
    78599SRespiratory nuclear exam04013.415$202.66$81.06$40.53
    78600SBrain imaging, ltd static04025.1847$307.68$123.07$61.54
    78601SBrain imaging, ltd w/flow04025.1847$307.68$123.07$61.54
    78605SBrain imaging, complete04025.1847$307.68$123.07$61.54
    78606SBrain imaging, compl w/flow04025.1847$307.68$123.07$61.54
    78607SBrain imaging (3D)04025.1847$307.68$123.07$61.54
    78608SBrain imaging (PET)1513$1,150.00$230.00
    78609SBrain imaging (PET)1513$1,150.00$230.00
    78610SBrain flow imaging only04025.1847$307.68$123.07$61.54
    78615SCerebral vascular flow image04025.1847$307.68$123.07$61.54
    78630SCerebrospinal fluid scan04033.6138$214.45$85.78$42.89
    78635SCSF ventriculography04033.6138$214.45$85.78$42.89
    78645SCSF shunt evaluation04033.6138$214.45$85.78$42.89
    78647SCerebrospinal fluid scan04033.6138$214.45$85.78$42.89
    78650SCSF leakage imaging04033.6138$214.45$85.78$42.89
    78660SNuclear exam of tear flow04033.6138$214.45$85.78$42.89
    78699SNervous system nuclear exam04025.1847$307.68$123.07$61.54
    78700SKidney imaging, static02672.6327$156.23$62.18$31.25
    78701SKidney imaging with flow04043.8559$228.82$91.52$45.76
    78704SImaging renogram04043.8559$228.82$91.52$45.76
    78707SKidney flow/function image04043.8559$228.82$91.52$45.76
    78708SKidney flow/function image04054.2674$253.24$101.29$50.65
    78709SKidney flow/function image04054.2674$253.24$101.29$50.65
    78710SKidney imaging (3D)04043.8559$228.82$91.52$45.76
    78715SRenal vascular flow exam04043.8559$228.82$91.52$45.76
    78725SKidney function study03891.4976$88.87$35.54$17.77
    78730XUrinary bladder retention03400.6384$37.88$7.58
    78740SUreteral reflux study04043.8559$228.82$91.52$45.76
    78760STesticular imaging04043.8559$228.82$91.52$45.76
    78761STesticular imaging/flow04043.8559$228.82$91.52$45.76
    78799SGenitourinary nuclear exam04043.8559$228.82$91.52$45.76
    78800STumor imaging, limited area04064.3035$255.38$102.15$51.08
    78801STumor imaging, mult areas04064.3035$255.38$102.15$51.08
    78802STumor imaging, whole body04064.3035$255.38$102.15$51.08
    78803STumor imaging (3D)04064.3035$255.38$102.15$51.08
    78804STumor imaging, whole body1508$650.00$130.00
    78805SAbscess imaging, ltd area04064.3035$255.38$102.15$51.08
    78806SAbscess imaging, whole body04064.3035$255.38$102.15$51.08
    78807SNuclear localization/abscess04064.3035$255.38$102.15$51.08
    78811STumor imaging (pet), limited1513$1,150.00$230.00
    78812STumor image (pet)/skul-thigh1513$1,150.00$230.00
    78813STumor image (pet) full body1513$1,150.00$230.00
    78814STumor image pet/ct, limited1514$1,250.00$250.00
    78815STumorimage pet/ct skul-thigh1514$1,250.00$250.00
    78816STumor image pet/ct full body1514$1,250.00$250.00
    Start Printed Page 50792
    78890NNuclear medicine data proc
    78891NNuclear med data proc
    78999SNuclear diagnostic exam03891.4976$88.87$35.54$17.77
    79005SNuclear rx, oral admin04073.9839$236.42$94.56$47.28
    79101SNuclear rx, iv admin04073.9839$236.42$94.56$47.28
    79200SIntracavitary nuclear trmt04073.9839$236.42$94.56$47.28
    79300SInterstitial nuclear therapy04073.9839$236.42$94.56$47.28
    79403SHematopoetic nuclear therapy1507$550.00$110.00
    79440SNuclear joint therapy04073.9839$236.42$94.56$47.28
    79445SNuclear rx, intra-arterial04073.9839$236.42$94.56$47.28
    79999SNuclear medicine therapy04073.9839$236.42$94.56$47.28
    80048ABasic metabolic panel
    80050EGeneral health panel
    80051AElectrolyte panel
    80053AComprehen metabolic panel
    80055EObstetric panel
    80061ALipid panel
    80069ARenal function panel
    80074AAcute hepatitis panel
    80076AHepatic function panel
    80100ADrug screen, qualitate/multi
    80101ADrug screen, single
    80102ADrug confirmation
    80103NDrug analysis, tissue prep
    80150AAssay of amikacin
    80152AAssay of amitriptyline
    80154AAssay of benzodiazepines
    80156AAssay, carbamazepine, total
    80157AAssay, carbamazepine, free
    80158AAssay of cyclosporine
    80160AAssay of desipramine
    80162AAssay of digoxin
    80164AAssay, dipropylacetic acid
    80166AAssay of doxepin
    80168AAssay of ethosuximide
    80170AAssay of gentamicin
    80172AAssay of gold
    80173AAssay of haloperidol
    80174AAssay of imipramine
    80176AAssay of lidocaine
    80178AAssay of lithium
    80182AAssay of nortriptyline
    80184AAssay of phenobarbital
    80185AAssay of phenytoin, total
    80186AAssay of phenytoin, free
    80188AAssay of primidone
    80190AAssay of procainamide
    80192AAssay of procainamide
    80194AAssay of quinidine
    80196AAssay of salicylate
    80197AAssay of tacrolimus
    80198AAssay of theophylline
    80200AAssay of tobramycin
    80201AAssay of topiramate
    80202AAssay of vancomycin
    80299AQuantitative assay, drug
    80400AActh stimulation panel
    80402AActh stimulation panel
    80406AActh stimulation panel
    80408AAldosterone suppression eval
    80410ACalcitonin stimul panel
    80412ACRH stimulation panel
    80414ATestosterone response
    80415AEstradiol response panel
    80416ARenin stimulation panel
    80417ARenin stimulation panel
    Start Printed Page 50793
    80418APituitary evaluation panel
    80420ADexamethasone panel
    80422AGlucagon tolerance panel
    80424AGlucagon tolerance panel
    80426AGonadotropin hormone panel
    80428AGrowth hormone panel
    80430AGrowth hormone panel
    80432AInsulin suppression panel
    80434AInsulin tolerance panel
    80435AInsulin tolerance panel
    80436AMetyrapone panel
    80438ATRH stimulation panel
    80439ATRH stimulation panel
    80440ATRH stimulation panel
    80500XLab pathology consultation04330.2581$15.32$6.12$3.06
    80502XLab pathology consultation03420.156$9.26$3.70$1.85
    81000AUrinalysis, nonauto w/scope
    81001AUrinalysis, auto w/scope
    81002AUrinalysis nonauto w/o scope
    81003AUrinalysis, auto, w/o scope
    81005AUrinalysis
    81007AUrine screen for bacteria
    81015AMicroscopic exam of urine
    81020AUrinalysis, glass test
    81025AUrine pregnancy test
    81050AUrinalysis, volume measure
    81099AUrinalysis test procedure
    82000AAssay of blood acetaldehyde
    82003AAssay of acetaminophen
    82009ATest for acetone/ketones
    82010AAcetone assay
    82013AAcetylcholinesterase assay
    82016AAcylcarnitines, qual
    82017AAcylcarnitines, quant
    82024AAssay of acth
    82030AAssay of adp & amp
    82040AAssay of serum albumin
    82042AAssay of urine albumin
    82043AMicroalbumin, quantitative
    82044AMicroalbumin, semiquant
    82045AAlbumin, ischemia modified
    82055AAssay of ethanol
    82075AAssay of breath ethanol
    82085AAssay of aldolase
    82088AAssay of aldosterone
    82101AAssay of urine alkaloids
    82103AAlpha-1-antitrypsin, total
    82104AAlpha-1-antitrypsin, pheno
    82105AAlpha-fetoprotein, serum
    82106AAlpha-fetoprotein, amniotic
    82108AAssay of aluminum
    82120AAmines, vaginal fluid qual
    82127AAmino acid, single qual
    82128AAmino acids, mult qual
    82131AAmino acids, single quant
    82135AAssay, aminolevulinic acid
    82136AAmino acids, quant, 2-5
    82139AAmino acids, quan, 6 or more
    82140AAssay of ammonia
    82143AAmniotic fluid scan
    82145AAssay of amphetamines
    82150AAssay of amylase
    82154AAndrostanediol glucuronide
    82157AAssay of androstenedione
    82160AAssay of androsterone
    82163AAssay of angiotensin II
    Start Printed Page 50794
    82164AAngiotensin I enzyme test
    82172AAssay of apolipoprotein
    82175AAssay of arsenic
    82180AAssay of ascorbic acid
    82190AAtomic absorption
    82205AAssay of barbiturates
    82232AAssay of beta-2 protein
    82239ABile acids, total
    82240ABile acids, cholylglycine
    82247ABilirubin, total
    82248ABilirubin, direct
    82252AFecal bilirubin test
    82261AAssay of biotinidase
    82270ATest for blood, feces
    82273ATest for blood, other source
    82274AAssay test for blood, fecal
    82286AAssay of bradykinin
    82300AAssay of cadmium
    82306AAssay of vitamin D
    82307AAssay of vitamin D
    82308AAssay of calcitonin
    82310AAssay of calcium
    82330AAssay of calcium
    82331ACalcium infusion test
    82340AAssay of calcium in urine
    82355ACalculus analysis, qual
    82360ACalculus assay, quant
    82365ACalculus spectroscopy
    82370AX-ray assay, calculus
    82373AAssay, c-d transfer measure
    82374AAssay, blood carbon dioxide
    82375AAssay, blood carbon monoxide
    82376ATest for carbon monoxide
    82378ACarcinoembryonic antigen
    82379AAssay of carnitine
    82380AAssay of carotene
    82382AAssay, urine catecholamines
    82383AAssay, blood catecholamines
    82384AAssay, three catecholamines
    82387AAssay of cathepsin-d
    82390AAssay of ceruloplasmin
    82397AChemiluminescent assay
    82415AAssay of chloramphenicol
    82435AAssay of blood chloride
    82436AAssay of urine chloride
    82438AAssay, other fluid chlorides
    82441ATest for chlorohydrocarbons
    82465AAssay, bld/serum cholesterol
    82480AAssay, serum cholinesterase
    82482AAssay, rbc cholinesterase
    82485AAssay, chondroitin sulfate
    82486AGas/liquid chromatography
    82487APaper chromatography
    82488APaper chromatography
    82489AThin layer chromatography
    82491AChromotography, quant, sing
    82492AChromotography, quant, mult
    82495AAssay of chromium
    82507AAssay of citrate
    82520AAssay of cocaine
    82523ACollagen crosslinks
    82525AAssay of copper
    82528AAssay of corticosterone
    82530ACortisol, free
    82533ATotal cortisol
    82540AAssay of creatine
    Start Printed Page 50795
    82541AColumn chromotography, qual
    82542AColumn chromotography, quant
    82543AColumn chromotograph/isotope
    82544AColumn chromotograph/isotope
    82550AAssay of ck (cpk)
    82552AAssay of cpk in blood
    82553ACreatine, MB fraction
    82554ACreatine, isoforms
    82565AAssay of creatinine
    82570AAssay of urine creatinine
    82575ACreatinine clearance test
    82585AAssay of cryofibrinogen
    82595AAssay of cryoglobulin
    82600AAssay of cyanide
    82607AVitamin B-12
    82608AB-12 binding capacity
    82615ATest for urine cystines
    82626ADehydroepiandrosterone
    82627ADehydroepiandrosterone
    82633ADesoxycorticosterone
    82634ADeoxycortisol
    82638AAssay of dibucaine number
    82646AAssay of dihydrocodeinone
    82649AAssay of dihydromorphinone
    82651AAssay of dihydrotestosterone
    82652AAssay of dihydroxyvitamin d
    82654AAssay of dimethadione
    82656APancreatic elastase, fecal
    82657AEnzyme cell activity
    82658AEnzyme cell activity, ra
    82664AElectrophoretic test
    82666AAssay of epiandrosterone
    82668AAssay of erythropoietin
    82670AAssay of estradiol
    82671AAssay of estrogens
    82672AAssay of estrogen
    82677AAssay of estriol
    82679AAssay of estrone
    82690AAssay of ethchlorvynol
    82693AAssay of ethylene glycol
    82696AAssay of etiocholanolone
    82705AFats/lipids, feces, qual
    82710AFats/lipids, feces, quant
    82715AAssay of fecal fat
    82725AAssay of blood fatty acids
    82726ALong chain fatty acids
    82728AAssay of ferritin
    82731AAssay of fetal fibronectin
    82735AAssay of fluoride
    82742AAssay of flurazepam
    82746ABlood folic acid serum
    82747AAssay of folic acid, rbc
    82757AAssay of semen fructose
    82759AAssay of rbc galactokinase
    82760AAssay of galactose
    82775AAssay galactose transferase
    82776AGalactose transferase test
    82784AAssay of gammaglobulin igm
    82785AAssay of gammaglobulin ige
    82787AIgg 1, 2, 3 or 4, each
    82800ABlood pH
    82803ABlood gases pH, pO2 & pCO2
    82805ABlood gases W/02 saturation
    82810ABlood gases, O2 sat only
    82820AHemoglobin-oxygen affinity
    82926AAssay of gastric acid
    Start Printed Page 50796
    82928AAssay of gastric acid
    82938AGastrin test
    82941AAssay of gastrin
    82943AAssay of glucagon
    82945AGlucose other fluid
    82946AGlucagon tolerance test
    82947AAssay, glucose, blood quant
    82948AReagent strip/blood glucose
    82950AGlucose test
    82951AGlucose tolerance test (GTT)
    82952AGTT-added samples
    82953AGlucose-tolbutamide test
    82955AAssay of g6pd enzyme
    82960ATest for G6PD enzyme
    82962AGlucose blood test
    82963AAssay of glucosidase
    82965AAssay of gdh enzyme
    82975AAssay of glutamine
    82977AAssay of GGT
    82978AAssay of glutathione
    82979AAssay, rbc glutathione
    82980AAssay of glutethimide
    82985AGlycated protein
    83001AGonadotropin (FSH)
    83002AGonadotropin (LH)
    83003AAssay, growth hormone (hgh)
    83008AAssay of guanosine
    83009AH pylori (c-13), blood
    83010AAssay of haptoglobin, quant
    83012AAssay of haptoglobins
    83013AH pylori analysis
    83014AH pylori drug admin/collect
    83015AHeavy metal screen
    83018AQuantitative screen, metals
    83020AHemoglobin electrophoresis
    83021AHemoglobin chromotography
    83026AHemoglobin, copper sulfate
    83030AFetal hemoglobin, chemical
    83033AFetal hemoglobin assay, qual
    83036AGlycated hemoglobin test
    83045ABlood methemoglobin test
    83050ABlood methemoglobin assay
    83051AAssay of plasma hemoglobin
    83055ABlood sulfhemoglobin test
    83060ABlood sulfhemoglobin assay
    83065AAssay of hemoglobin heat
    83068AHemoglobin stability screen
    83069AAssay of urine hemoglobin
    83070AAssay of hemosiderin, qual
    83071AAssay of hemosiderin, quant
    83080AAssay of b hexosaminidase
    83088AAssay of histamine
    83090AAssay of homocystine
    83150AAssay of for hva
    83491AAssay of corticosteroids
    83497AAssay of 5-hiaa
    83498AAssay of progesterone
    83499AAssay of progesterone
    83500AAssay, free hydroxyproline
    83505AAssay, total hydroxyproline
    83516AImmunoassay, nonantibody
    83518AImmunoassay, dipstick
    83519AImmunoassay, nonantibody
    83520AImmunoassay, RIA
    83525AAssay of insulin
    83527AAssay of insulin
    Start Printed Page 50797
    83528AAssay of intrinsic factor
    83540AAssay of iron
    83550AIron binding test
    83570AAssay of idh enzyme
    83582AAssay of ketogenic steroids
    83586AAssay 17- ketosteroids
    83593AFractionation, ketosteroids
    83605AAssay of lactic acid
    83615ALactate (LD) (LDH) enzyme
    83625AAssay of ldh enzymes
    83630ALactoferrin, fecal (qual)
    83632APlacental lactogen
    83633ATest urine for lactose
    83634AAssay of urine for lactose
    83655AAssay of lead
    83661AL/s ratio, fetal lung
    83662AFoam stability, fetal lung
    83663AFluoro polarize, fetal lung
    83664ALamellar bdy, fetal lung
    83670AAssay of lap enzyme
    83690AAssay of lipase
    83715AAssay of blood lipoproteins
    83716AAssay of blood lipoproteins
    83718AAssay of lipoprotein
    83719AAssay of blood lipoprotein
    83721AAssay of blood lipoprotein
    83727AAssay of lrh hormone
    83735AAssay of magnesium
    83775AAssay of md enzyme
    83785AAssay of manganese
    83788AMass spectrometry qual
    83789AMass spectrometry quant
    83805AAssay of meprobamate
    83825AAssay of mercury
    83835AAssay of metanephrines
    83840AAssay of methadone
    83857AAssay of methemalbumin
    83858AAssay of methsuximide
    83864AMucopolysaccharides
    83866AMucopolysaccharides screen
    83872AAssay synovial fluid mucin
    83873AAssay of csf protein
    83874AAssay of myoglobin
    83880ANatriuretic peptide
    83883AAssay, nephelometry not spec
    83885AAssay of nickel
    83887AAssay of nicotine
    83890AMolecule isolate
    83891AMolecule isolate nucleic
    83892AMolecular diagnostics
    83893AMolecule dot/slot/blot
    83894AMolecule gel electrophor
    83896AMolecular diagnostics
    83897AMolecule nucleic transfer
    83898AMolecule nucleic ampli
    83901AMolecule nucleic ampli
    83902AMolecular diagnostics
    83903AMolecule mutation scan
    83904AMolecule mutation identify
    83905AMolecule mutation identify
    83906AMolecule mutation identify
    83912AGenetic examination
    83915AAssay of nucleotidase
    83916AOligoclonal bands
    83918AOrganic acids, total, quant
    83919AOrganic acids, qual, each
    Start Printed Page 50798
    83921AOrganic acid, single, quant
    83925AAssay of opiates
    83930AAssay of blood osmolality
    83935AAssay of urine osmolality
    83937AAssay of osteocalcin
    83945AAssay of oxalate
    83950AOncoprotein, her-2/neu
    83970AAssay of parathormone
    83986AAssay of body fluid acidity
    83992AAssay for phencyclidine
    84022AAssay of phenothiazine
    84030AAssay of blood pku
    84035AAssay of phenylketones
    84060AAssay acid phosphatase
    84061APhosphatase, forensic exam
    84066AAssay prostate phosphatase
    84075AAssay alkaline phosphatase
    84078AAssay alkaline phosphatase
    84080AAssay alkaline phosphatases
    84081AAmniotic fluid enzyme test
    84085AAssay of rbc pg6d enzyme
    84087AAssay phosphohexose enzymes
    84100AAssay of phosphorus
    84105AAssay of urine phosphorus
    84106ATest for porphobilinogen
    84110AAssay of porphobilinogen
    84119ATest urine for porphyrins
    84120AAssay of urine porphyrins
    84126AAssay of feces porphyrins
    84127AAssay of feces porphyrins
    84132AAssay of serum potassium
    84133AAssay of urine potassium
    84134AAssay of prealbumin
    84135AAssay of pregnanediol
    84138AAssay of pregnanetriol
    84140AAssay of pregnenolone
    84143AAssay of 17-hydroxypregneno
    84144AAssay of progesterone
    84146AAssay of prolactin
    84150AAssay of prostaglandin
    84152AAssay of psa, complexed
    84153AAssay of psa, total
    84154AAssay of psa, free
    84155AAssay of protein, serum
    84156AAssay of protein, urine
    84157AAssay of protein, other
    84160AAssay of protein, any source
    84163APappa, serum
    84165AElectrophoreisis of proteins
    84166AProtein e-phoresis/urine/csf
    84181AWestern blot test
    84182AProtein, western blot test
    84202AAssay RBC protoporphyrin
    84203ATest RBC protoporphyrin
    84206AAssay of proinsulin
    84207AAssay of vitamin b-6
    84210AAssay of pyruvate
    84220AAssay of pyruvate kinase
    84228AAssay of quinine
    84233AAssay of estrogen
    84234AAssay of progesterone
    84235AAssay of endocrine hormone
    84238AAssay, nonendocrine receptor
    84244AAssay of renin
    84252AAssay of vitamin b-2
    84255AAssay of selenium
    Start Printed Page 50799
    84260AAssay of serotonin
    84270AAssay of sex hormone globul
    84275AAssay of sialic acid
    84285AAssay of silica
    84295AAssay of serum sodium
    84300AAssay of urine sodium
    84302AAssay of sweat sodium
    84305AAssay of somatomedin
    84307AAssay of somatostatin
    84311ASpectrophotometry
    84315ABody fluid specific gravity
    84375AChromatogram assay, sugars
    84376ASugars, single, qual
    84377ASugars, multiple, qual
    84378ASugars, single, quant
    84379ASugars multiple quant
    84392AAssay of urine sulfate
    84402AAssay of testosterone
    84403AAssay of total testosterone
    84425AAssay of vitamin b-1
    84430AAssay of thiocyanate
    84432AAssay of thyroglobulin
    84436AAssay of total thyroxine
    84437AAssay of neonatal thyroxine
    84439AAssay of free thyroxine
    84442AAssay of thyroid activity
    84443AAssay thyroid stim hormone
    84445AAssay of tsi
    84446AAssay of vitamin e
    84449AAssay of transcortin
    84450ATransferase (AST) (SGOT)
    84460AAlanine amino (ALT) (SGPT)
    84466AAssay of transferrin
    84478AAssay of triglycerides
    84479AAssay of thyroid (t3 or t4)
    84480AAssay, triiodothyronine (t3)
    84481AFree assay (FT-3)
    84482AT3 reverse
    84484AAssay of troponin, quant
    84485AAssay duodenal fluid trypsin
    84488ATest feces for trypsin
    84490AAssay of feces for trypsin
    84510AAssay of tyrosine
    84512AAssay of troponin, qual
    84520AAssay of urea nitrogen
    84525AUrea nitrogen semi-quant
    84540AAssay of urine/urea-n
    84545AUrea-N clearance test
    84550AAssay of blood/uric acid
    84560AAssay of urine/uric acid
    84577AAssay of feces/urobilinogen
    84578ATest urine urobilinogen
    84580AAssay of urine urobilinogen
    84583AAssay of urine urobilinogen
    84585AAssay of urine vma
    84586AAssay of vip
    84588AAssay of vasopressin
    84590AAssay of vitamin a
    84591AAssay of nos vitamin
    84597AAssay of vitamin k
    84600AAssay of volatiles
    84620AXylose tolerance test
    84630AAssay of zinc
    84681AAssay of c-peptide
    84702AChorionic gonadotropin test
    84703AChorionic gonadotropin assay
    Start Printed Page 50800
    84830AOvulation tests
    84999AClinical chemistry test
    85002ABleeding time test
    85004AAutomated diff wbc count
    85007ADifferential WBC count
    85008ANondifferential WBC count
    85009ADifferential WBC count
    85013ASpun microhematocrit
    85014AHematocrit
    85018AHemoglobin
    85025AAutomated hemogram
    85027AAutomated hemogram
    85032AManual cell count, each
    85041ARed blood cell (RBC) count
    85044AReticulocyte count
    85045AReticulocyte count
    85046AReticyte/hgb concentrate
    85048AWhite blood cell (WBC) count
    85049AAutomated platelet count
    85055AReticulated platelet assay
    85060BBlood smear interpretation
    85097XBone marrow interpretation03430.4786$28.40$11.10$5.68
    85130AChromogenic substrate assay
    85170ABlood clot retraction
    85175ABlood clot lysis time
    85210ABlood clot factor II test
    85220ABlood clot factor V test
    85230ABlood clot factor VII test
    85240ABlood clot factor VIII test
    85244ABlood clot factor VIII test
    85245ABlood clot factor VIII test
    85246ABlood clot factor VIII test
    85247ABlood clot factor VIII test
    85250ABlood clot factor IX test
    85260ABlood clot factor X test
    85270ABlood clot factor XI test
    85280ABlood clot factor XII test
    85290ABlood clot factor XIII test
    85291ABlood clot factor XIII test
    85292ABlood clot factor assay
    85293ABlood clot factor assay
    85300AAntithrombin III test
    85301AAntithrombin III test
    85302ABlood clot inhibitor antigen
    85303ABlood clot inhibitor test
    85305ABlood clot inhibitor assay
    85306ABlood clot inhibitor test
    85307AAssay activated protein c
    85335AFactor inhibitor test
    85337AThrombomodulin
    85345ACoagulation time
    85347ACoagulation time
    85348ACoagulation time
    85360AEuglobulin lysis
    85362AFibrin degradation products
    85366AFibrinogen test
    85370AFibrinogen test
    85378AFibrin degradation
    85379AFibrin degradation, quant
    85380AFibrin degradation, vte
    85384AFibrinogen
    85385AFibrinogen
    85390AFibrinolysins screen
    85396NClotting assay, whole blood
    85400AFibrinolytic plasmin
    85410AFibrinolytic antiplasmin
    Start Printed Page 50801
    85415AFibrinolytic plasminogen
    85420AFibrinolytic plasminogen
    85421AFibrinolytic plasminogen
    85441AHeinz bodies, direct
    85445AHeinz bodies, induced
    85460AHemoglobin, fetal
    85461AHemoglobin, fetal
    85475AHemolysin
    85520AHeparin assay
    85525AHeparin neutralization
    85530AHeparin-protamine tolerance
    85536AIron stain peripheral blood
    85540AWbc alkaline phosphatase
    85547ARBC mechanical fragility
    85549AMuramidase
    85555ARBC osmotic fragility
    85557ARBC osmotic fragility
    85576ABlood platelet aggregation
    85597APlatelet neutralization
    85610AProthrombin time
    85611AProthrombin test
    85612AViper venom prothrombin time
    85613ARussell viper venom, diluted
    85635AReptilase test
    85651ARbc sed rate, nonautomated
    85652ARbc sed rate, automated
    85660ARBC sickle cell test
    85670AThrombin time, plasma
    85675AThrombin time, titer
    85705AThromboplastin inhibition
    85730AThromboplastin time, partial
    85732AThromboplastin time, partial
    85810ABlood viscosity examination
    85999AHematology procedure
    86000AAgglutinins, febrile
    86001AAllergen specific igg
    86003AAllergen specific IgE
    86005AAllergen specific IgE
    86021AWBC antibody identification
    86022APlatelet antibodies
    86023AImmunoglobulin assay
    86038AAntinuclear antibodies
    86039AAntinuclear antibodies (ANA)
    86060AAntistreptolysin o, titer
    86063AAntistreptolysin o, screen
    86064AB cells, total count
    86077XPhysician blood bank service04330.2581$15.32$6.12$3.06
    86078XPhysician blood bank service03430.4786$28.40$11.10$5.68
    86079XPhysician blood bank service04330.2581$15.32$6.12$3.06
    86140AC-reactive protein
    86141AC-reactive protein, hs
    86146AGlycoprotein antibody
    86147ACardiolipin antibody
    86148APhospholipid antibody
    86155AChemotaxis assay
    86156ACold agglutinin, screen
    86157ACold agglutinin, titer
    86160AComplement, antigen
    86161AComplement/function activity
    86162AComplement, total (CH50)
    86171AComplement fixation, each
    86185ACounterimmunoelectrophoresis
    86215ADeoxyribonuclease, antibody
    86225ADNA antibody
    86226ADNA antibody, single strand
    86235ANuclear antigen antibody
    Start Printed Page 50802
    86243AFc receptor
    86255AFluorescent antibody, screen
    86256AFluorescent antibody, titer
    86277AGrowth hormone antibody
    86280AHemagglutination inhibition
    86294AImmunoassay, tumor, qual
    86300AImmunoassay, tumor, ca 15-3
    86301AImmunoassay, tumor, ca 19-9
    86304AImmunoassay, tumor, ca 125
    86308AHeterophile antibodies
    86309AHeterophile antibodies
    86310AHeterophile antibodies
    86316AImmunoassay, tumor other
    86317AImmunoassay,infectious agent
    86318AImmunoassay,infectious agent
    86320ASerum immunoelectrophoresis
    86325AOther immunoelectrophoresis
    86327AImmunoelectrophoresis assay
    86329AImmunodiffusion
    86331AImmunodiffusion ouchterlony
    86332AImmune complex assay
    86334AImmunofixation procedure
    86335AImmunfix e-phorsis/urine/csf
    86336AInhibin A
    86337AInsulin antibodies
    86340AIntrinsic factor antibody
    86341AIslet cell antibody
    86343ALeukocyte histamine release
    86344ALeukocyte phagocytosis
    86353ALymphocyte transformation
    86359AT cells, total count
    86360AT cell, absolute count/ratio
    86361AT cell, absolute count
    86376AMicrosomal antibody
    86378AMigration inhibitory factor
    86379ANk cells, total count
    86382ANeutralization test, viral
    86384Anitroblue tetrazolium dye
    86403AParticle agglutination test
    86406AParticle agglutination test
    86430ARheumatoid factor test
    86431ARheumatoid factor, quant
    86485XSkin test, candida03410.1112$6.60$2.62$1.32
    86490XCoccidioidomycosis skin test03410.1112$6.60$2.62$1.32
    86510XHistoplasmosis skin test03410.1112$6.60$2.62$1.32
    86580XTB intradermal test03410.1112$6.60$2.62$1.32
    86585XTB tine test03410.1112$6.60$2.62$1.32
    86586XSkin test, unlisted03410.1112$6.60$2.62$1.32
    86587AStem cells, total count
    86590AStreptokinase, antibody
    86592ABlood serology, qualitative
    86593ABlood serology, quantitative
    86602AAntinomyces antibody
    86603AAdenovirus antibody
    86606AAspergillus antibody
    86609ABacterium antibody
    86611ABartonella antibody
    86612ABlastomyces antibody
    86615ABordetella antibody
    86617ALyme disease antibody
    86618ALyme disease antibody
    86619ABorrelia antibody
    86622ABrucella antibody
    86625ACampylobacter antibody
    86628ACandida antibody
    86631AChlamydia antibody
    Start Printed Page 50803
    86632AChlamydia igm antibody
    86635ACoccidioides antibody
    86638AQ fever antibody
    86641ACryptococcus antibody
    86644ACMV antibody
    86645ACMV antibody, IgM
    86648ADiphtheria antibody
    86651AEncephalitis antibody
    86652AEncephalitis antibody
    86653AEncephalitis antibody
    86654AEncephalitis antibody
    86658AEnterovirus antibody
    86663AEpstein-barr antibody
    86664AEpstein-barr antibody
    86665AEpstein-barr antibody
    86666AEhrlichia antibody
    86668AFrancisella tularensis
    86671AFungus antibody
    86674AGiardia lamblia antibody
    86677AHelicobacter pylori
    86682AHelminth antibody
    86684AHemophilus influenza
    86687AHtlv-i antibody
    86688AHtlv-ii antibody
    86689AHTLV/HIV confirmatory test
    86692AHepatitis, delta agent
    86694AHerpes simplex test
    86695AHerpes simplex test
    86696AHerpes simplex type 2
    86698AHistoplasma
    86701AHIV-1
    86702AHIV-2
    86703AHIV-1/HIV-2, single assay
    86704AHep b core antibody, total
    86705AHep b core antibody, igm
    86706AHep b surface antibody
    86707AHep be antibody
    86708AHep a antibody, total
    86709AHep a antibody, igm
    86710AInfluenza virus antibody
    86713ALegionella antibody
    86717ALeishmania antibody
    86720ALeptospira antibody
    86723AListeria monocytogenes ab
    86727ALymph choriomeningitis ab
    86729ALympho venereum antibody
    86732AMucormycosis antibody
    86735AMumps antibody
    86738AMycoplasma antibody
    86741ANeisseria meningitidis
    86744ANocardia antibody
    86747AParvovirus antibody
    86750AMalaria antibody
    86753AProtozoa antibody nos
    86756ARespiratory virus antibody
    86757ARickettsia antibody
    86759ARotavirus antibody
    86762ARubella antibody
    86765ARubeola antibody
    86768ASalmonella antibody
    86771AShigella antibody
    86774ATetanus antibody
    86777AToxoplasma antibody
    86778AToxoplasma antibody, igm
    86781ATreponema pallidum, confirm
    86784ATrichinella antibody
    Start Printed Page 50804
    86787AVaricella-zoster antibody
    86790AVirus antibody nos
    86793AYersinia antibody
    86800AThyroglobulin antibody
    86803AHepatitis c ab test
    86804AHep c ab test, confirm
    86805ALymphocytotoxicity assay
    86806ALymphocytotoxicity assay
    86807ACytotoxic antibody screening
    86808ACytotoxic antibody screening
    86812AHLA typing, A, B, or C
    86813AHLA typing, A, B, or C
    86816AHLA typing, DR/DQ
    86817AHLA typing, DR/DQ
    86821ALymphocyte culture, mixed
    86822ALymphocyte culture, primed
    86849AImmunology procedure
    86850XRBC antibody screen03450.2277$13.51$3.01$2.70
    86860XRBC antibody elution03460.3434$20.38$4.54$4.08
    86870XRBC antibody identification03460.3434$20.38$4.54$4.08
    86880XCoombs test, direct04090.1258$7.47$2.22$1.49
    86885XCoombs test, indirect, qual04090.1258$7.47$2.22$1.49
    86886XCoombs test, indirect, titer04090.1258$7.47$2.22$1.49
    86890XAutologous blood process03470.8434$50.05$12.35$10.01
    86891XAutologous blood, op salvage03460.3434$20.38$4.54$4.08
    86900XBlood typing, ABO04090.1258$7.47$2.22$1.49
    86901XBlood typing, Rh (D)04090.1258$7.47$2.22$1.49
    86903XBlood typing, antigen screen03450.2277$13.51$3.01$2.70
    86904XBlood typing, patient serum03460.3434$20.38$4.54$4.08
    86905XBlood typing, RBC antigens03450.2277$13.51$3.01$2.70
    86906XBlood typing, Rh phenotype03450.2277$13.51$3.01$2.70
    86910EBlood typing, paternity test
    86911EBlood typing, antigen system
    86920XCompatibility test03460.3434$20.38$4.54$4.08
    86921XCompatibility test03450.2277$13.51$3.01$2.70
    86922XCompatibility test03460.3434$20.38$4.54$4.08
    86927XPlasma, fresh frozen03450.2277$13.51$3.01$2.70
    86930XFrozen blood prep03470.8434$50.05$12.35$10.01
    86931XFrozen blood thaw03470.8434$50.05$12.35$10.01
    86932XFrozen blood freeze/thaw03470.8434$50.05$12.35$10.01
    86940AHemolysins/agglutinins, auto
    86941AHemolysins/agglutinins
    86945XBlood product/irradiation03450.2277$13.51$3.01$2.70
    86950XLeukacyte transfusion03450.2277$13.51$3.01$2.70
    86965XPooling blood platelets03450.2277$13.51$3.01$2.70
    86970XRBC pretreatment03450.2277$13.51$3.01$2.70
    86971XRBC pretreatment03450.2277$13.51$3.01$2.70
    86972XRBC pretreatment03460.3434$20.38$4.54$4.08
    86975XRBC pretreatment, serum03450.2277$13.51$3.01$2.70
    86976XRBC pretreatment, serum03450.2277$13.51$3.01$2.70
    86977XRBC pretreatment, serum03450.2277$13.51$3.01$2.70
    86978XRBC pretreatment, serum03450.2277$13.51$3.01$2.70
    86985XSplit blood or products03450.2277$13.51$3.01$2.70
    86999XTransfusion procedure03450.2277$13.51$3.01$2.70
    87001ASmall animal inoculation
    87003ASmall animal inoculation
    87015ASpecimen concentration
    87040ABlood culture for bacteria
    87045AFeces culture, bacteria
    87046AStool cultr, bacteria, each
    87070ACulture, bacteria, other
    87071ACulture bacteri aerobic othr
    87073ACulture bacteria anaerobic
    87075ACultr bacteria, except blood
    87076ACulture anaerobe ident, each
    87077ACulture aerobic identify
    Start Printed Page 50805
    87081ACulture screen only
    87084ACulture of specimen by kit
    87086AUrine culture/colony count
    87088AUrine bacteria culture
    87101ASkin fungi culture
    87102AFungus isolation culture
    87103ABlood fungus culture
    87106AFungi identification, yeast
    87107AFungi identification, mold
    87109AMycoplasma
    87110AChlamydia culture
    87116AMycobacteria culture
    87118AMycobacteric identification
    87140ACulture type immunofluoresc
    87143ACulture typing, glc/hplc
    87147ACulture type, immunologic
    87149ACulture type, nucleic acid
    87152ACulture type pulse field gel
    87158ACulture typing, added method
    87164ADark field examination
    87166ADark field examination
    87168AMacroscopic exam arthropod
    87169AMacroscopic exam parasite
    87172APinworm exam
    87176ATissue homogenization, cultr
    87177AOva and parasites smears
    87181AMicrobe susceptible, diffuse
    87184AMicrobe susceptible, disk
    87185AMicrobe susceptible, enzyme
    87186AMicrobe susceptible, mic
    87187AMicrobe susceptible, mlc
    87188AMicrobe suscept, macrobroth
    87190AMicrobe suscept, mycobacteri
    87197ABactericidal level, serum
    87205ASmear, gram stain
    87206ASmear, fluorescent/acid stai
    87207ASmear, special stain
    87210ASmear, wet mount, saline/ink
    87220ATissue exam for fungi
    87230AAssay, toxin or antitoxin
    87250AVirus inoculate, eggs/animal
    87252AVirus inoculation, tissue
    87253AVirus inoculate tissue, addl
    87254AVirus inoculation, shell via
    87255AGenet virus isolate, hsv
    87260AAdenovirus ag, if
    87265APertussis ag, if
    87267AEnterovirus antibody, dfa
    87269AGiardia ag, if
    87270AChlamydia trachomatis ag, if
    87271ACryptosporidum/gardia ag, if
    87272ACryptosporidium ag, if
    87273AHerpes simplex 2, ag, if
    87274AHerpes simplex 1, ag, if
    87275AInfluenza b, ag, if
    87276AInfluenza a, ag, if
    87277ALegionella micdadei, ag, if
    87278ALegion pneumophilia ag, if
    87279AParainfluenza, ag, if
    87280ARespiratory syncytial ag, if
    87281APneumocystis carinii, ag, if
    87283ARubeola, ag, if
    87285ATreponema pallidum, ag, if
    87290AVaricella zoster, ag, if
    87299AAntibody detection, nos, if
    87300AAg detection, polyval, if
    Start Printed Page 50806
    87301AAdenovirus ag, eia
    87320AChylmd trach ag, eia
    87324AClostridium ag, eia
    87327ACryptococcus neoform ag, eia
    87328ACryptosporidium ag, eia
    87329AGiardia ag, eia
    87332ACytomegalovirus ag, eia
    87335AE coli 0157 ag, eia
    87336AEntamoeb hist dispr, ag, eia
    87337AEntamoeb hist group, ag, eia
    87338AHpylori, stool, eia
    87339AH pylori ag, eia
    87340AHepatitis b surface ag, eia
    87341AHepatitis b surface, ag, eia
    87350AHepatitis be ag, eia
    87380AHepatitis delta ag, eia
    87385AHistoplasma capsul ag, eia
    87390AHiv-1 ag, eia
    87391AHiv-2 ag, eia
    87400AInfluenza a/b, ag, eia
    87420AResp syncytial ag, eia
    87425ARotavirus ag, eia
    87427AShiga-like toxin ag, eia
    87430AStrep a ag, eia
    87449AAg detect nos, eia, mult
    87450AAg detect nos, eia, single
    87451AAg detect polyval, eia, mult
    87470ABartonella, dna, dir probe
    87471ABartonella, dna, amp probe
    87472ABartonella, dna, quant
    87475ALyme dis, dna, dir probe
    87476ALyme dis, dna, amp probe
    87477ALyme dis, dna, quant
    87480ACandida, dna, dir probe
    87481ACandida, dna, amp probe
    87482ACandida, dna, quant
    87485AChylmd pneum, dna, dir probe
    87486AChylmd pneum, dna, amp probe
    87487AChylmd pneum, dna, quant
    87490AChylmd trach, dna, dir probe
    87491AChylmd trach, dna, amp probe
    87492AChylmd trach, dna, quant
    87495ACytomeg, dna, dir probe
    87496ACytomeg, dna, amp probe
    87497ACytomeg, dna, quant
    87510AGardner vag, dna, dir probe
    87511AGardner vag, dna, amp probe
    87512AGardner vag, dna, quant
    87515AHepatitis b, dna, dir probe
    87516AHepatitis b, dna, amp probe
    87517AHepatitis b, dna, quant
    87520AHepatitis c, rna, dir probe
    87521AHepatitis c, rna, amp probe
    87522AHepatitis c, rna, quant
    87525AHepatitis g, dna, dir probe
    87526AHepatitis g, dna, amp probe
    87527AHepatitis g, dna, quant
    87528AHsv, dna, dir probe
    87529AHsv, dna, amp probe
    87530AHsv, dna, quant
    87531AHhv-6, dna, dir probe
    87532AHhv-6, dna, amp probe
    87533AHhv-6, dna, quant
    87534AHiv-1, dna, dir probe
    87535AHiv-1, dna, amp probe
    87536AHiv-1, dna, quant
    Start Printed Page 50807
    87537AHiv-2, dna, dir probe
    87538AHiv-2, dna, amp probe
    87539AHiv-2, dna, quant
    87540ALegion pneumo, dna, dir prob
    87541ALegion pneumo, dna, amp prob
    87542ALegion pneumo, dna, quant
    87550AMycobacteria, dna, dir probe
    87551AMycobacteria, dna, amp probe
    87552AMycobacteria, dna, quant
    87555AM.tuberculo, dna, dir probe
    87556AM.tuberculo, dna, amp probe
    87557AM.tuberculo, dna, quant
    87560AM.avium-intra, dna, dir prob
    87561AM.avium-intra, dna, amp prob
    87562AM.avium-intra, dna, quant
    87580AM.pneumon, dna, dir probe
    87581AM.pneumon, dna, amp probe
    87582AM.pneumon, dna, quant
    87590AN.gonorrhoeae, dna, dir prob
    87591AN.gonorrhoeae, dna, amp prob
    87592AN.gonorrhoeae, dna, quant
    87620AHpv, dna, dir probe
    87621AHpv, dna, amp probe
    87622AHpv, dna, quant
    87650AStrep a, dna, dir probe
    87651AStrep a, dna, amp probe
    87652AStrep a, dna, quant
    87660ATrichomonas vagin, dir probe
    87797ADetect agent nos, dna, dir
    87798ADetect agent nos, dna, amp
    87799ADetect agent nos, dna, quant
    87800ADetect agnt mult, dna, direc
    87801ADetect agnt mult, dna, ampli
    87802AStrep b assay w/optic
    87803AClostridium toxin a w/optic
    87804AInfluenza assay w/optic
    87807ARsv assay w/optic
    87810AChylmd trach assay w/optic
    87850AN. gonorrhoeae assay w/optic
    87880AStrep a assay w/optic
    87899AAgent nos assay w/optic
    87901AGenotype, dna, hiv reverse t
    87902AGenotype, dna, hepatitis C
    87903APhenotype, dna hiv w/culture
    87904APhenotype, dna hiv w/clt add
    87999AMicrobiology procedure
    88000EAutopsy (necropsy), gross
    88005EAutopsy (necropsy), gross
    88007EAutopsy (necropsy), gross
    88012EAutopsy (necropsy), gross
    88014EAutopsy (necropsy), gross
    88016EAutopsy (necropsy), gross
    88020EAutopsy (necropsy), complete
    88025EAutopsy (necropsy), complete
    88027EAutopsy (necropsy), complete
    88028EAutopsy (necropsy), complete
    88029EAutopsy (necropsy), complete
    88036ELimited autopsy
    88037ELimited autopsy
    88040EForensic autopsy (necropsy)
    88045ECoroner's autopsy (necropsy)
    88099ENecropsy (autopsy) procedure
    88104XCytopathology, fluids04330.2581$15.32$6.12$3.06
    88106XCytopathology, fluids04330.2581$15.32$6.12$3.06
    88107XCytopathology, fluids04330.2581$15.32$6.12$3.06
    88108XCytopath, concentrate tech04330.2581$15.32$6.12$3.06
    Start Printed Page 50808
    88112XCytopath, cell enhance tech03430.4786$28.40$11.10$5.68
    88125XForensic cytopathology03420.156$9.26$3.70$1.85
    88130ASex chromatin identification
    88140ASex chromatin identification
    88141NCytopath, c/v, interpret
    88142ACytopath, c/v, thin layer
    88143ACytopath c/v thin layer redo
    88147ACytopath, c/v, automated
    88148ACytopath, c/v, auto rescreen
    88150ACytopath, c/v, manual
    88152ACytopath, c/v, auto redo
    88153ACytopath, c/v, redo
    88154ACytopath, c/v, select
    88155ACytopath, c/v, index add-on
    88160XCytopath smear, other source04330.2581$15.32$6.12$3.06
    88161XCytopath smear, other source04330.2581$15.32$6.12$3.06
    88162XCytopath smear, other source04330.2581$15.32$6.12$3.06
    88164ACytopath tbs, c/v, manual
    88165ACytopath tbs, c/v, redo
    88166ACytopath tbs, c/v, auto redo
    88167ACytopath tbs, c/v, select
    88172XCytopathology eval of fna03430.4786$28.40$11.10$5.68
    88173XCytopath eval, fna, report03430.4786$28.40$11.10$5.68
    88174ACytopath, c/v auto, in fluid
    88175ACytopath c/v auto fluid redo
    88182XCell marker study03440.7996$47.45$15.66$9.49
    88184XFlowcytometry/ tc, 1 marker03440.7996$47.45$15.66$9.49
    88185XFlowcytometry/tc, add-on03430.4786$28.40$11.10$5.68
    88187XFlowcytometry/read, 2-804330.2581$15.32$6.12$3.06
    88188XFlowcytometry/read, 9-1504330.2581$15.32$6.12$3.06
    88189XFlowcytometry/read, 16 & >03430.4786$28.40$11.10$5.68
    88199ACytopathology procedure
    88230ATissue culture, lymphocyte
    88233ATissue culture, skin/biopsy
    88235ATissue culture, placenta
    88237ATissue culture, bone marrow
    88239ATissue culture, tumor
    88240ACell cryopreserve/storage
    88241AFrozen cell preparation
    88245AChromosome analysis, 20-25
    88248AChromosome analysis, 50-100
    88249AChromosome analysis, 100
    88261AChromosome analysis, 5
    88262AChromosome analysis, 15-20
    88263AChromosome analysis, 45
    88264AChromosome analysis, 20-25
    88267AChromosome analys, placenta
    88269AChromosome analys, amniotic
    88271ACytogenetics, dna probe
    88272ACytogenetics, 3-5
    88273ACytogenetics, 10-30
    88274ACytogenetics, 25-99
    88275ACytogenetics, 100-300
    88280AChromosome karyotype study
    88283AChromosome banding study
    88285AChromosome count, additional
    88289AChromosome study, additional
    88291ACyto/molecular report
    88299XCytogenetic study03420.156$9.26$3.70$1.85
    88300XSurgical path, gross04330.2581$15.32$6.12$3.06
    88302XTissue exam by pathologist04330.2581$15.32$6.12$3.06
    88304XTissue exam by pathologist03430.4786$28.40$11.10$5.68
    88305XTissue exam by pathologist03430.4786$28.40$11.10$5.68
    88307XTissue exam by pathologist03440.7996$47.45$15.66$9.49
    88309XTissue exam by pathologist03440.7996$47.45$15.66$9.49
    88311XDecalcify tissue03420.156$9.26$3.70$1.85
    Start Printed Page 50809
    88312XSpecial stains04330.2581$15.32$6.12$3.06
    88313XSpecial stains04330.2581$15.32$6.12$3.06
    88314XHistochemical stain03420.156$9.26$3.70$1.85
    88318XChemical histochemistry04330.2581$15.32$6.12$3.06
    88319XEnzyme histochemistry03430.4786$28.40$11.10$5.68
    88321XMicroslide consultation04330.2581$15.32$6.12$3.06
    88323XMicroslide consultation03430.4786$28.40$11.10$5.68
    88325XComprehensive review of data03440.7996$47.45$15.66$9.49
    88329XPath consult introp04330.2581$15.32$6.12$3.06
    88331XPath consult intraop, 1 bloc03430.4786$28.40$11.10$5.68
    88332XPath consult intraop, add'l04330.2581$15.32$6.12$3.06
    88342XImmunohistochemistry03430.4786$28.40$11.10$5.68
    88346XImmunofluorescent study03430.4786$28.40$11.10$5.68
    88347XImmunofluorescent study03430.4786$28.40$11.10$5.68
    88348XElectron microscopy06613.3775$200.43$80.17$40.09
    88349XScanning electron microscopy06613.3775$200.43$80.17$40.09
    88355XAnalysis, skeletal muscle03430.4786$28.40$11.10$5.68
    88356XAnalysis, nerve03440.7996$47.45$15.66$9.49
    88358XAnalysis, tumor03440.7996$47.45$15.66$9.49
    88360XTumor immunohistochem/manual03440.7996$47.45$15.66$9.49
    88361XImmunohistochemistry, tumor03440.7996$47.45$15.66$9.49
    88362XNerve teasing preparations03440.7996$47.45$15.66$9.49
    88365XTissue hybridization03440.7996$47.45$15.66$9.49
    88367XInsitu hybridization, auto03440.7996$47.45$15.66$9.49
    88368XInsitu hybridization, manual03440.7996$47.45$15.66$9.49
    88371AProtein, western blot tissue
    88372AProtein analysis w/probe
    88380AMicrodissection
    88399ASurgical pathology procedure
    88400ABilirubin total transcut
    89050ABody fluid cell count
    89051ABody fluid cell count
    89055ALeukocyte assessment, fecal
    89060AExam,synovial fluid crystals
    89100XSample intestinal contents03601.4739$87.47$34.98$17.49
    89105XSample intestinal contents03601.4739$87.47$34.98$17.49
    89125ASpecimen fat stain
    89130XSample stomach contents03601.4739$87.47$34.98$17.49
    89132XSample stomach contents03601.4739$87.47$34.98$17.49
    89135XSample stomach contents03601.4739$87.47$34.98$17.49
    89136XSample stomach contents03601.4739$87.47$34.98$17.49
    89140XSample stomach contents03601.4739$87.47$34.98$17.49
    89141XSample stomach contents03601.4739$87.47$34.98$17.49
    89160AExam feces for meat fibers
    89190ANasal smear for eosinophils
    89220XSputum specimen collection03430.4786$28.40$11.10$5.68
    89225AStarch granules, feces
    89230XCollect sweat for test04330.2581$15.32$6.12$3.06
    89235AWater load test
    89240APathology lab procedure
    89250XCultr oocyte/embryo <4 days03480.7927$47.04$9.41
    89251XCultr oocyte/embryo <4 days03480.7927$47.04$9.41
    89253XEmbryo hatching03480.7927$47.04$9.41
    89254XOocyte identification03480.7927$47.04$9.41
    89255XPrepare embryo for transfer03480.7927$47.04$9.41
    89257XSperm identification03480.7927$47.04$9.41
    89258XCryopreservation embryo(s)03480.7927$47.04$9.41
    89259XCryopreservation, sperm03480.7927$47.04$9.41
    89260XSperm isolation, simple03480.7927$47.04$9.41
    89261XSperm isolation, complex03480.7927$47.04$9.41
    89264XIdentify sperm tissue03480.7927$47.04$9.41
    89268XInsemination of oocytes03480.7927$47.04$9.41
    89272XExtended culture of oocytes03480.7927$47.04$9.41
    89280XAssist oocyte fertilization03480.7927$47.04$9.41
    89281XAssist oocyte fertilization03480.7927$47.04$9.41
    89290XBiopsy, oocyte polar body03480.7927$47.04$9.41
    Start Printed Page 50810
    89291XBiopsy, oocyte polar body03480.7927$47.04$9.41
    89300ASemen analysis w/huhner
    89310ASemen analysis
    89320ASemen analysis, complete
    89321ASemen analysis & motility
    89325ASperm antibody test
    89329ASperm evaluation test
    89330AEvaluation, cervical mucus
    89335XCryopreserve testicular tiss03480.7927$47.04$9.41
    89342XStorage/year embryo(s)03480.7927$47.04$9.41
    89343XStorage/year sperm/semen03480.7927$47.04$9.41
    89344XStorage/year reprod tissue03480.7927$47.04$9.41
    89346XStorage/year oocyte03480.7927$47.04$9.41
    89352XThawing cryopresrved embryo03480.7927$47.04$9.41
    89353XThawing cryopresrved sperm03480.7927$47.04$9.41
    89354XThaw cryoprsvrd reprod tiss03480.7927$47.04$9.41
    89356XThawing cryopresrved oocyte03480.7927$47.04$9.41
    90281EHuman ig, im
    90283EHuman ig, iv
    90287EBotulinum antitoxin
    90288EBotulism ig, iv
    90291ECmv ig, iv
    90296NDiphtheria antitoxin
    90371EHep b ig, im
    90375KRabies ig, im/sc9133$64.56$12.91
    90376KRabies ig, heat treated9134$69.79$13.96
    90378ERsv ig, im, 50mg
    90379ERsv ig, iv
    90384ERh ig, full-dose, im
    90385NRh ig, minidose, im
    90386ERh ig, iv
    90389ETetanus ig, im
    90393NVaccina ig, im
    90396KVaricella-zoster ig, im9135$96.58$19.32
    90399EImmune globulin
    90465BImmune admin 1 inj, < 8 yrs
    90466BImmune admin addl inj, < 8 y
    90467BImmune admin o or n, < 8 yrs
    90468BImmune admin o/n, addl < 8 y
    90471XImmunization admin03530.3954$23.46$4.69
    90472XImmunization admin, each add03530.3954$23.46$4.69
    90473SImmune admin oral/nasal1491$5.00$1.00
    90474SImmune admin oral/nasal addl1491$5.00$1.00
    90476KAdenovirus vaccine, type 491360.9499$56.37$11.27
    90477NAdenovirus vaccine, type 7
    90581KAnthrax vaccine, sc9169$128.95$25.79
    90585KBcg vaccine, percut9137$124.54$24.91
    90586BBcg vaccine, intravesical
    90632NHep a vaccine, adult im
    90633NHep a vacc, ped/adol, 2 dose
    90634NHep a vacc, ped/adol, 3 dose
    90636KHep a/hep b vacc, adult im91380.9674$57.41$11.48
    90645NHib vaccine, hboc, im
    90646NHib vaccine, prp-d, im
    90647NHib vaccine, prp-omp, im
    90648NHib vaccine, prp-t, im
    90655LFlu vaccine, 6-35 mo, im
    90656LFlu vaccine no preserv 3 & >
    90657LFlu vaccine, 6-35 mo, im
    90658LFlu vaccine, 3 yrs, im
    90660EFlu vaccine, nasal
    90665NLyme disease vaccine, im
    90669EPneumococcal vacc, ped <5
    90675KRabies vaccine, im9139$128.04$25.61
    90676KRabies vaccine, id91401.4959$88.77$17.75
    90680NRotovirus vaccine, oral
    Start Printed Page 50811
    90690NTyphoid vaccine, oral
    90691NTyphoid vaccine, im
    90692NTyphoid vaccine, h-p, sc/id
    90693NTyphoid vaccine, akd, sc
    90698NDtap-hib-ip vaccine, im
    90700NDtap vaccine, im
    90701NDtp vaccine, im
    90702NDt vaccine < 7, im
    90703NTetanus vaccine, im
    90704NMumps vaccine, sc
    90705NMeasles vaccine, sc
    90706NRubella vaccine, sc
    90707NMmr vaccine, sc
    90708KMeasles-rubella vaccine, sc91410.9467$56.18$11.24
    90710NMmrv vaccine, sc
    90712NOral poliovirus vaccine
    90713NPoliovirus, ipv, sc
    90715NTdap vaccine >7 im
    90716KChicken pox vaccine, sc9142$64.29$12.86
    90717NYellow fever vaccine, sc
    90718NTd vaccine > 7, im
    90719NDiphtheria vaccine, im
    90720NDtp/hib vaccine, im
    90721NDtap/hib vaccine, im
    90723EDtap-hep b-ipv vaccine, im
    90725NCholera vaccine, injectable
    90727NPlague vaccine, im
    90732LPneumococcal vaccine
    90733KMeningococcal vaccine, sc9143$56.75$11.35
    90734KMeningococcal vaccine, im91450.8948$53.10$10.62
    90735KEncephalitis vaccine, sc9144$67.73$13.55
    90740FHepb vacc, ill pat 3 dose im
    90743FHep b vacc, adol, 2 dose, im
    90744FHepb vacc ped/adol 3 dose im
    90746FHep b vaccine, adult, im
    90747FHepb vacc, ill pat 4 dose im
    90748EHep b/hib vaccine, im
    90749NVaccine toxoid
    90780SIV infusion therapy, 1 hour01202.0193$119.83$28.21$23.97
    90781NIV infusion, additional hour
    90782XInjection, sc/im03530.3954$23.46$4.69
    90783XInjection, ia03590.8312$49.33$9.87
    90784XInjection, iv03590.8312$49.33$9.87
    90788XInjection of antibiotic03590.8312$49.33$9.87
    90799XTher/prophylactic/dx inject03520.1413$8.39$1.68
    90801SPsy dx interview03231.6227$96.30$20.08$19.26
    90802SIntac psy dx interview03231.6227$96.30$20.08$19.26
    90804SPsytx, office, 20-30 min03221.2319$73.10$14.62
    90805SPsytx, off, 20-30 min w/e&m03221.2319$73.10$14.62
    90806SPsytx, off, 45-50 min03231.6227$96.30$20.08$19.26
    90807SPsytx, off, 45-50 min w/e&m03231.6227$96.30$20.08$19.26
    90808SPsytx, office, 75-80 min03231.6227$96.30$20.08$19.26
    90809SPsytx, off, 75-80, w/e&m03231.6227$96.30$20.08$19.26
    90810SIntac psytx, off, 20-30 min03221.2319$73.10$14.62
    90811SIntac psytx, 20-30, w/e&m03221.2319$73.10$14.62
    90812SIntac psytx, off, 45-50 min03231.6227$96.30$20.08$19.26
    90813SIntac psytx, 45-50 min w/e&m03231.6227$96.30$20.08$19.26
    90814SIntac psytx, off, 75-80 min03231.6227$96.30$20.08$19.26
    90815SIntac psytx, 75-80 w/e&m03231.6227$96.30$20.08$19.26
    90816SPsytx, hosp, 20-30 min03221.2319$73.10$14.62
    90817SPsytx, hosp, 20-30 min w/e&m03221.2319$73.10$14.62
    90818SPsytx, hosp, 45-50 min03231.6227$96.30$20.08$19.26
    90819SPsytx, hosp, 45-50 min w/e&m03231.6227$96.30$20.08$19.26
    90821SPsytx, hosp, 75-80 min03231.6227$96.30$20.08$19.26
    90822SPsytx, hosp, 75-80 min w/e&m03231.6227$96.30$20.08$19.26
    90823SIntac psytx, hosp, 20-30 min03221.2319$73.10$14.62
    Start Printed Page 50812
    90824SIntac psytx, hsp 20-30 w/e&m03221.2319$73.10$14.62
    90826SIntac psytx, hosp, 45-50 min03231.6227$96.30$20.08$19.26
    90827SIntac psytx, hsp 45-50 w/e&m03231.6227$96.30$20.08$19.26
    90828SIntac psytx, hosp, 75-80 min03231.6227$96.30$20.08$19.26
    90829SIntac psytx, hsp 75-80 w/e&m03231.6227$96.30$20.08$19.26
    90845SPsychoanalysis03231.6227$96.30$20.08$19.26
    90846SFamily psytx w/o patient03242.0997$124.60$24.92
    90847SFamily psytx w/patient03242.0997$124.60$24.92
    90849SMultiple family group psytx03251.3189$78.27$17.10$15.65
    90853SGroup psychotherapy03251.3189$78.27$17.10$15.65
    90857SIntac group psytx03251.3189$78.27$17.10$15.65
    90862XMedication management03741.0414$61.80$12.36
    90865SNarcosynthesis03231.6227$96.30$20.08$19.26
    90870SElectroconvulsive therapy03205.3765$319.06$80.06$63.81
    90871EElectroconvulsive therapy
    90875EPsychophysiological therapy
    90876EPsychophysiological therapy
    90880SHypnotherapy03231.6227$96.30$20.08$19.26
    90882EEnvironmental manipulation
    90885NPsy evaluation of records
    90887NConsultation with family
    90889NPreparation of report
    90899SPsychiatric service/therapy03221.2319$73.10$14.62
    90901ABiofeedback train, any meth
    90911SBiofeedback peri/uro/rectal03211.3579$80.58$21.71$16.12
    90918EESRD related services, month
    90919EESRD related services, month
    90920EESRD related services, month
    90921EESRD related services, month
    90922EESRD related services, day
    90923EEsrd related services, day
    90924EEsrd related services, day
    90925EEsrd related services, day
    90935SHemodialysis, one evaluation01705.8994$350.09$70.02
    90937EHemodialysis, repeated eval
    90939NHemodialysis study, transcut
    90940NHemodialysis access study
    90945SDialysis, one evaluation01705.8994$350.09$70.02
    90947EDialysis, repeated eval
    90989BDialysis training, complete
    90993BDialysis training, incompl
    90997EHemoperfusion
    90999BDialysis procedure
    91000XEsophageal intubation03613.6216$214.92$83.23$42.98
    91010XEsophagus motility study03613.6216$214.92$83.23$42.98
    91011XEsophagus motility study03613.6216$214.92$83.23$42.98
    91012XEsophagus motility study03613.6216$214.92$83.23$42.98
    91020XGastric motility03613.6216$214.92$83.23$42.98
    91030XAcid perfusion of esophagus03613.6216$214.92$83.23$42.98
    91034XGastroesophageal reflux test03613.6216$214.92$83.23$42.98
    91035SG-esoph reflx tst w/electrod1506$450.00$90.00
    91037XEsoph imped function test03613.6216$214.92$83.23$42.98
    91038XEsoph imped funct test > 1h03613.6216$214.92$83.23$42.98
    91040XEsoph balloon distension tst03601.4739$87.47$34.98$17.49
    91052XGastric analysis test03613.6216$214.92$83.23$42.98
    91055XGastric intubation for smear03601.4739$87.47$34.98$17.49
    91060XGastric saline load test03601.4739$87.47$34.98$17.49
    91065XBreath hydrogen test03601.4739$87.47$34.98$17.49
    91100XPass intestine bleeding tube03601.4739$87.47$34.98$17.49
    91105XGastric intubation treatment03601.4739$87.47$34.98$17.49
    91110TGi tract capsule endoscopy01429.3487$554.78$152.78$110.96
    91120TRectal sensation test01562.5751$152.81$40.52$30.56
    91122TAnal pressure record01562.5751$152.81$40.52$30.56
    91123NIrrigate fecal impaction
    91132XElectrogastrography03601.4739$87.47$34.98$17.49
    91133XElectrogastrography w/test03601.4739$87.47$34.98$17.49
    Start Printed Page 50813
    91299XGastroenterology procedure03601.4739$87.47$34.98$17.49
    92002VEye exam, new patient06011.0038$59.57$11.91
    92004VEye exam, new patient06011.0038$59.57$11.91
    92012VEye exam established pat06000.8688$51.56$10.31
    92014VEye exam & treatment06011.0038$59.57$11.91
    92015ERefraction
    92018TNew eye exam & treatment069910.0177$594.48$118.90
    92019TEye exam & treatment069910.0177$594.48$118.90
    92020SSpecial eye evaluation02300.7858$46.63$14.97$9.33
    92060SSpecial eye evaluation02300.7858$46.63$14.97$9.33
    92065SOrthoptic/pleoptic training06981.2438$73.81$16.55$14.76
    92070NFitting of contact lens
    92081SVisual field examination(s)02300.7858$46.63$14.97$9.33
    92082SVisual field examination(s)02300.7858$46.63$14.97$9.33
    92083SVisual field examination(s)02300.7858$46.63$14.97$9.33
    92100NSerial tonometry exam(s)
    92120STonography & eye evaluation02300.7858$46.63$14.97$9.33
    92130SWater provocation tonography02300.7858$46.63$14.97$9.33
    92135SOpthalmic dx imaging02300.7858$46.63$14.97$9.33
    92136SOphthalmic biometry06981.2438$73.81$16.55$14.76
    92140SGlaucoma provocative tests06981.2438$73.81$16.55$14.76
    92225SSpecial eye exam, initial02300.7858$46.63$14.97$9.33
    92226SSpecial eye exam, subsequent02300.7858$46.63$14.97$9.33
    92230TEye exam with photos069910.0177$594.48$118.90
    92235SEye exam with photos02311.9278$114.40$44.61$22.88
    92240SIcg angiography02311.9278$114.40$44.61$22.88
    92250SEye exam with photos02300.7858$46.63$14.97$9.33
    92260SOphthalmoscopy/dynamometry06981.2438$73.81$16.55$14.76
    92265SEye muscle evaluation02300.7858$46.63$14.97$9.33
    92270SElectro-oculography02300.7858$46.63$14.97$9.33
    92275SElectroretinography02311.9278$114.40$44.61$22.88
    92283SColor vision examination02300.7858$46.63$14.97$9.33
    92284SDark adaptation eye exam06981.2438$73.81$16.55$14.76
    92285SEye photography02300.7858$46.63$14.97$9.33
    92286SInternal eye photography06981.2438$73.81$16.55$14.76
    92287SInternal eye photography06981.2438$73.81$16.55$14.76
    92310EContact lens fitting
    92311XContact lens fitting03622.6607$157.89$31.58
    92312XContact lens fitting03622.6607$157.89$31.58
    92313XContact lens fitting03622.6607$157.89$31.58
    92314EPrescription of contact lens
    92315XPrescription of contact lens03622.6607$157.89$31.58
    92316XPrescription of contact lens03622.6607$157.89$31.58
    92317XPrescription of contact lens03622.6607$157.89$31.58
    92325XModification of contact lens03622.6607$157.89$31.58
    92326XReplacement of contact lens03622.6607$157.89$31.58
    92330SFitting of artificial eye02300.7858$46.63$14.97$9.33
    92335NFitting of artificial eye
    92340EFitting of spectacles
    92341EFitting of spectacles
    92342EFitting of spectacles
    92352XSpecial spectacles fitting03622.6607$157.89$31.58
    92353XSpecial spectacles fitting03622.6607$157.89$31.58
    92354XSpecial spectacles fitting03622.6607$157.89$31.58
    92355XSpecial spectacles fitting03622.6607$157.89$31.58
    92358XEye prosthesis service03622.6607$157.89$31.58
    92370ERepair & adjust spectacles
    92371XRepair & adjust spectacles03622.6607$157.89$31.58
    92390ESupply of spectacles
    92391ESupply of contact lenses
    92392ESupply of low vision aids
    92393ESupply of artificial eye
    92395ESupply of spectacles
    92396ESupply of contact lenses
    92499SEye service or procedure02300.7858$46.63$14.97$9.33
    92502TEar and throat examination02512.0101$119.29$23.86
    Start Printed Page 50814
    92504NEar microscopy examination
    92506ASpeech/hearing evaluation
    92507ASpeech/hearing therapy
    92508ASpeech/hearing therapy
    92510ERehab for ear implant
    92511TNasopharyngoscopy00710.7915$46.97$11.31$9.39
    92512XNasal function studies03630.9128$54.17$17.44$10.83
    92516XFacial nerve function test06601.6419$97.44$30.66$19.49
    92520XLaryngeal function studies06601.6419$97.44$30.66$19.49
    92526AOral function therapy
    92531NSpontaneous nystagmus study
    92532NPositional nystagmus test
    92533NCaloric vestibular test
    92534NOptokinetic nystagmus test
    92541XSpontaneous nystagmus test03630.9128$54.17$17.44$10.83
    92542XPositional nystagmus test03630.9128$54.17$17.44$10.83
    92543XCaloric vestibular test06601.6419$97.44$30.66$19.49
    92544XOptokinetic nystagmus test03630.9128$54.17$17.44$10.83
    92545XOscillating tracking test03630.9128$54.17$17.44$10.83
    92546XSinusoidal rotational test06601.6419$97.44$30.66$19.49
    92547XSupplemental electrical test03630.9128$54.17$17.44$10.83
    92548XPosturography06601.6419$97.44$30.66$19.49
    92551EPure tone hearing test, air
    92552XPure tone audiometry, air03640.4708$27.94$9.06$5.59
    92553XAudiometry, air & bone03651.2356$73.32$18.95$14.66
    92555XSpeech threshold audiometry03640.4708$27.94$9.06$5.59
    92556XSpeech audiometry, complete03640.4708$27.94$9.06$5.59
    92557XComprehensive hearing test03651.2356$73.32$18.95$14.66
    92559EGroup audiometric testing
    92560EBekesy audiometry, screen
    92561XBekesy audiometry, diagnosis03640.4708$27.94$9.06$5.59
    92562XLoudness balance test03640.4708$27.94$9.06$5.59
    92563XTone decay hearing test03640.4708$27.94$9.06$5.59
    92564XSisi hearing test03640.4708$27.94$9.06$5.59
    92565XStenger test, pure tone03640.4708$27.94$9.06$5.59
    92567XTympanometry03640.4708$27.94$9.06$5.59
    92568XAcoustic reflex testing03640.4708$27.94$9.06$5.59
    92569XAcoustic reflex decay test03640.4708$27.94$9.06$5.59
    92571XFiltered speech hearing test03640.4708$27.94$9.06$5.59
    92572XStaggered spondaic word test03651.2356$73.32$18.95$14.66
    92573XLombard test03640.4708$27.94$9.06$5.59
    92575XSensorineural acuity test03640.4708$27.94$9.06$5.59
    92576XSynthetic sentence test03640.4708$27.94$9.06$5.59
    92577XStenger test, speech03661.7743$105.29$30.04$21.06
    92579XVisual audiometry (vra)03651.2356$73.32$18.95$14.66
    92582XConditioning play audiometry03651.2356$73.32$18.95$14.66
    92583XSelect picture audiometry03640.4708$27.94$9.06$5.59
    92584XElectrocochleography06601.6419$97.44$30.66$19.49
    92585SAuditor evoke potent, compre02162.672$158.56$31.71
    92586SAuditor evoke potent, limit02181.1408$67.70$13.54
    92587XEvoked auditory test03630.9128$54.17$17.44$10.83
    92588XEvoked auditory test03630.9128$54.17$17.44$10.83
    92590EHearing aid exam, one ear
    92591EHearing aid exam, both ears
    92592EHearing aid check, one ear
    92593EHearing aid check, both ears
    92594EElectro hearng aid test, one
    92595EElectro hearng aid tst, both
    92596XEar protector evaluation03640.4708$27.94$9.06$5.59
    92597AVoice Prosthetic Evaluation
    92601XCochlear implt f/up exam < 703661.7743$105.29$30.04$21.06
    92602XReprogram cochlear implt < 703661.7743$105.29$30.04$21.06
    92603XCochlear implt f/up exam 7 >03661.7743$105.29$30.04$21.06
    92604XReprogram cochlear implt 7 >03661.7743$105.29$30.04$21.06
    92605AEval for nonspeech device rx
    92606ANon-speech device service
    Start Printed Page 50815
    92607AEx for speech device rx, 1hr
    92608AEx for speech device rx addl
    92609AUse of speech device service
    92610AEvaluate swallowing function
    92611AMotion fluoroscopy/swallow
    92612AEndoscopy swallow tst (fees)
    92613EEndoscopy swallow tst (fees)
    92614ALaryngoscopic sensory test
    92615EEval laryngoscopy sense tst
    92616AFees w/laryngeal sense test
    92617EInterprt fees/laryngeal test
    92620XAuditory function, 60 min03640.4708$27.94$9.06$5.59
    92621NAuditory function, + 15 min
    92625XTinnitus assessment03640.4708$27.94$9.06$5.59
    92700XEnt procedure/service03640.4708$27.94$9.06$5.59
    92950SHeart/lung resuscitation cpr00942.5363$150.51$47.62$30.10
    92953STemporary external pacing00942.5363$150.51$47.62$30.10
    92960SCardioversion electric, ext06795.5774$330.98$95.30$66.20
    92961SCardioversion, electric, int06795.5774$330.98$95.30$66.20
    92970CCardioassist, internal
    92971CCardioassist, external
    92973TPercut coronary thrombectomy06762.4105$143.05$28.61
    92974TCath place, cardio brachytx010314.7142$873.18$223.63$174.64
    92975CDissolve clot, heart vessel
    92977TDissolve clot, heart vessel06762.4105$143.05$28.61
    92978SIntravasc us, heart add-on067025.4131$1,508.09$472.46$301.62
    92979SIntravasc us, heart add-on041619.5542$1,160.40$232.08
    92980TInsert intracoronary stent010479.0094$4,688.65$937.73
    92981TInsert intracoronary stent010479.0094$4,688.65$937.73
    92982TCoronary artery dilation008350.8925$3,020.11$604.02
    92984TCoronary artery dilation008350.8925$3,020.11$604.02
    92986TRevision of aortic valve008350.8925$3,020.11$604.02
    92987TRevision of mitral valve008350.8925$3,020.11$604.02
    92990TRevision of pulmonary valve008350.8925$3,020.11$604.02
    92992CRevision of heart chamber
    92993CRevision of heart chamber
    92995TCoronary atherectomy008285.0126$5,044.90$1,085.20$1,008.98
    92996TCoronary atherectomy add-on008285.0126$5,044.90$1,085.20$1,008.98
    92997TPul art balloon repr, percut008134.4473$2,044.21$408.84
    92998TPul art balloon repr, percut008134.4473$2,044.21$408.84
    93000BElectrocardiogram, complete
    93005SElectrocardiogram, tracing00990.3821$22.67$4.53
    93010AElectrocardiogram report
    93012NTransmission of ecg
    93014BReport on transmitted ecg
    93015BCardiovascular stress test
    93016BCardiovascular stress test
    93017XCardiovascular stress test01002.4968$148.17$41.44$29.63
    93018BCardiovascular stress test
    93024XCardiac drug stress test01002.4968$148.17$41.44$29.63
    93025XMicrovolt t-wave assess01002.4968$148.17$41.44$29.63
    93040BRhythm ECG with report
    93041SRhythm ECG, tracing00990.3821$22.67$4.53
    93042BRhythm ECG, report
    93224BECG monitor/report, 24 hrs
    93225XECG monitor/record, 24 hrs00971.0223$60.67$23.79$12.13
    93226XECG monitor/report, 24 hrs00971.0223$60.67$23.79$12.13
    93227BECG monitor/review, 24 hrs
    93230BECG monitor/report, 24 hrs
    93231XEcg monitor/record, 24 hrs00971.0223$60.67$23.79$12.13
    93232XECG monitor/report, 24 hrs00971.0223$60.67$23.79$12.13
    93233BECG monitor/review, 24 hrs
    93235BECG monitor/report, 24 hrs
    93236XECG monitor/report, 24 hrs00971.0223$60.67$23.79$12.13
    93237BECG monitor/review, 24 hrs
    93268BECG record/review
    Start Printed Page 50816
    93270XECG recording00971.0223$60.67$23.79$12.13
    93271XEcg/monitoring and analysis00971.0223$60.67$23.79$12.13
    93272BEcg/review, interpret only
    93278SECG/signal-averaged00990.3821$22.67$4.53
    93303SEcho transthoracic02693.2437$192.49$76.99$38.50
    93304SEcho transthoracic06971.5357$91.13$36.45$18.23
    93307SEcho exam of heart02693.2437$192.49$76.99$38.50
    93308SEcho exam of heart06971.5357$91.13$36.45$18.23
    93312SEcho transesophageal02706.0192$357.20$142.88$71.44
    93313SEcho transesophageal02706.0192$357.20$142.88$71.44
    93314NEcho transesophageal
    93315SEcho transesophageal02706.0192$357.20$142.88$71.44
    93316SEcho transesophageal02706.0192$357.20$142.88$71.44
    93317NEcho transesophageal
    93318SEcho transesophageal intraop02706.0192$357.20$142.88$71.44
    93320SDoppler echo exam, heart06711.7028$101.05$40.42$20.21
    93321SDoppler echo exam, heart06971.5357$91.13$36.45$18.23
    93325SDoppler color flow add-on06971.5357$91.13$36.45$18.23
    93350SEcho transthoracic02693.2437$192.49$76.99$38.50
    93501TRight heart catheterization008037.1361$2,203.77$838.92$440.75
    93503TInsert/place heart catheter010314.7142$873.18$223.63$174.64
    93505TBiopsy of heart lining010314.7142$873.18$223.63$174.64
    93508TCath placement, angiography008037.1361$2,203.77$838.92$440.75
    93510TLeft heart catheterization00037.1361$2,203.77$838.92$440.75
    93511TLeft heart catheterization008037.1361$2,203.77$838.92$440.75
    93514TLeft heart catheterization008037.1361$2,203.77$838.92$440.75
    93524TLeft heart catheterization008037.1361$2,203.77$838.92$440.75
    93526TRt & Lt heart catheters008037.1361$2,203.77$838.92$440.75
    93527TRt & Lt heart catheters008037.1361$2,203.77$838.92$440.75
    93528TRt & Lt heart catheters008037.1361$2,203.77$838.92$440.75
    93529TRt, lt heart catheterization008037.1361$2,203.77$838.92$440.75
    93530TRt heart cath, congenital008037.1361$2,203.77$838.92$440.75
    93531TR & l heart cath, congenital008037.1361$2,203.77$838.92$440.75
    93532TR & l heart cath, congenital008037.1361$2,203.77$838.92$440.75
    93533TR & l heart cath, congenital008037.1361$2,203.77$838.92$440.75
    93539NInjection, cardiac cath
    93540NInjection, cardiac cath
    93541NInjection for lung angiogram
    93542NInjection for heart x-rays
    93543NInjection for heart x-rays
    93544NInjection for aortography
    93545NInject for coronary x-rays
    93555NImaging, cardiac cath
    93556NImaging, cardiac cath
    93561NCardiac output measurement
    93562NCardiac output measurement
    93571SHeart flow reserve measure067025.4131$1,508.09$472.46$301.62
    93572SHeart flow reserve measure041619.5542$1,160.40$232.08
    93580TTranscath closure of asd043490.7877$5,387.61$1,077.52
    93581TTranscath closure of vsd043490.7877$5,387.61$1,077.52
    93600TBundle of His recording008730.7101$1,822.43$364.49
    93602TIntra-atrial recording008730.7101$1,822.43$364.49
    93603TRight ventricular recording008730.7101$1,822.43$364.49
    93609TMap tachycardia, add-on008730.7101$1,822.43$364.49
    93610TIntra-atrial pacing008730.7101$1,822.43$364.49
    93612TIntraventricular pacing008730.7101$1,822.43$364.49
    93613TElectrophys map 3d, add-on008730.7101$1,822.43$364.49
    93615TEsophageal recording008730.7101$1,822.43$364.49
    93616TEsophageal recording008730.7101$1,822.43$364.49
    93618THeart rhythm pacing008730.7101$1,822.43$364.49
    93619TElectrophysiology evaluation008535.1882$2,088.17$426.25$417.63
    93620TElectrophysiology evaluation008535.1882$2,088.17$426.25$417.63
    93621TElectrophysiology evaluation008535.1882$2,088.17$426.25$417.63
    93622TElectrophysiology evaluation008535.1882$2,088.17$426.25$417.63
    93623TStimulation, pacing heart008730.7101$1,822.43$364.49
    93624TElectrophysiologic study008535.1882$2,088.17$426.25$417.63
    Start Printed Page 50817
    93631THeart pacing, mapping008730.7101$1,822.43$364.49
    93640SEvaluation heart device008410.0205$594.65$118.93
    93641SElectrophysiology evaluation008410.0205$594.65$118.93
    93642SElectrophysiology evaluation008410.0205$594.65$118.93
    93650TAblate heart dysrhythm focus008644.2596$2,626.50$833.33$525.30
    93651TAblate heart dysrhythm focus008644.2596$2,626.50$833.33$525.30
    93652TAblate heart dysrhythm focus008644.2596$2,626.50$833.33$525.30
    93660STilt table evaluation01014.2787$253.91$101.56$50.78
    93662SIntracardiac ecg (ice)067025.4131$1,508.09$472.46$301.62
    93668EPeripheral vascular rehab
    93701SBioimpedance, thoracic00990.3821$22.67$4.53
    93720BTotal body plethysmography
    93721XPlethysmography tracing03680.9761$57.92$23.16$11.58
    93722BPlethysmography report
    93724SAnalyze pacemaker system06900.3755$22.28$8.91$4.46
    93727SAnalyze ilr system06900.3755$22.28$8.91$4.46
    93731SAnalyze pacemaker system06900.3755$22.28$8.91$4.46
    93732SAnalyze pacemaker system06900.3755$22.28$8.91$4.46
    93733STelephone analy, pacemaker06900.3755$22.28$8.91$4.46
    93734SAnalyze pacemaker system06900.3755$22.28$8.91$4.46
    93735SAnalyze pacemaker system06900.3755$22.28$8.91$4.46
    93736STelephonic analy, pacemaker06900.3755$22.28$8.91$4.46
    93740XTemperature gradient studies03680.9761$57.92$23.16$11.58
    93741SAnalyze ht pace device sngl06890.5735$34.03$6.81
    93742SAnalyze ht pace device sngl06890.5735$34.03$6.81
    93743SAnalyze ht pace device dual06890.5735$34.03$6.81
    93744SAnalyze ht pace device dual06890.5735$34.03$6.81
    93745SSet-up cardiovert-defibrill06890.5735$34.03$6.81
    93760ECephalic thermogram
    93762EPeripheral thermogram
    93770NMeasure venous pressure
    93784EAmbulatory BP monitoring
    93786XAmbulatory BP recording00971.0223$60.67$23.79$12.13
    93788XAmbulatory BP analysis00971.0223$60.67$23.79$12.13
    93790BReview/report BP recording
    93797SCardiac rehab00950.5885$34.92$13.96$6.98
    93798SCardiac rehab/monitor00950.5885$34.92$13.96$6.98
    93799SCardiovascular procedure00961.6307$96.77$38.70$19.35
    93875SExtracranial study00961.6307$96.77$38.70$19.35
    93880SExtracranial study02672.6327$156.23$62.18$31.25
    93882SExtracranial study02672.6327$156.23$62.18$31.25
    93886SIntracranial study02672.6327$156.23$62.18$31.25
    93888SIntracranial study02661.6393$97.28$38.91$19.46
    93890STcd, vasoreactivity study02661.6393$97.28$38.91$19.46
    93892STcd, emboli detect w/o inj02661.6393$97.28$38.91$19.46
    93893STcd, emboli detect w/inj02661.6393$97.28$38.91$19.46
    93922SExtremity study00961.6307$96.77$38.70$19.35
    93923SExtremity study00961.6307$96.77$38.70$19.35
    93924SExtremity study00961.6307$96.77$38.70$19.35
    93925SLower extremity study02672.6327$156.23$62.18$31.25
    93926SLower extremity study02661.6393$97.28$38.91$19.46
    93930SUpper extremity study02672.6327$156.23$62.18$31.25
    93931SUpper extremity study02661.6393$97.28$38.91$19.46
    93965SExtremity study00961.6307$96.77$38.70$19.35
    93970SExtremity study02672.6327$156.23$62.18$31.25
    93971SExtremity study02661.6393$97.28$38.91$19.46
    93975SVascular study02672.6327$156.23$62.18$31.25
    93976SVascular study02672.6327$156.23$62.18$31.25
    93978SVascular study02661.6393$97.28$38.91$19.46
    93979SVascular study02661.6393$97.28$38.91$19.46
    93980SPenile vascular study02672.6327$156.23$62.18$31.25
    93981SPenile vascular study02661.6393$97.28$38.91$19.46
    93990SDoppler flow testing02661.6393$97.28$38.91$19.46
    94010XBreathing capacity test03680.9761$57.92$23.16$11.58
    94014XPatient recorded spirometry03670.6659$39.52$14.80$7.90
    94015XPatient recorded spirometry03670.6659$39.52$14.80$7.90
    Start Printed Page 50818
    94016AReview patient spirometry
    94060XEvaluation of wheezing03680.9761$57.92$23.16$11.58
    94070XEvaluation of wheezing03692.7519$163.31$44.18$32.66
    94150XVital capacity test03670.6659$39.52$14.80$7.90
    94200XLung function test (MBC/MVV)03670.6659$39.52$14.80$7.90
    94240XResidual lung capacity03680.9761$57.92$23.16$11.58
    94250XExpired gas collection03670.6659$39.52$14.80$7.90
    94260XThoracic gas volume03670.6659$39.52$14.80$7.90
    94350XLung nitrogen washout curve03670.6659$39.52$14.80$7.90
    94360XMeasure airflow resistance03670.6659$39.52$14.80$7.90
    94370XBreath airway closing volume03670.6659$39.52$14.80$7.90
    94375XRespiratory flow volume loop03670.6659$39.52$14.80$7.90
    94400XCO2 breathing response curve03670.6659$39.52$14.80$7.90
    94450XHypoxia response curve03680.9761$57.92$23.16$11.58
    94452XHast w/report03680.9761$57.92$23.16$11.58
    94453XHast w/oxygen titrate03680.9761$57.92$23.16$11.58
    94620XPulmonary stress test/simple03680.9761$57.92$23.16$11.58
    94621XPulm stress test/complex03692.7519$163.31$44.18$32.66
    94640SAirway inhalation treatment00770.3444$20.44$7.74$4.09
    94642SAerosol inhalation treatment00781.0236$60.74$14.55$12.15
    94656SInitial ventilator mgmt00792.3482$139.35$27.87
    94657SContinued ventilator mgmt00792.3482$139.35$27.87
    94660SPos airway pressure, CPAP00681.2293$72.95$29.18$14.59
    94662SNeg press ventilation, cnp00792.3482$139.35$27.87
    94664SAerosol or vapor inhalations00770.3444$20.44$7.74$4.09
    94667SChest wall manipulation00770.3444$20.44$7.74$4.09
    94668SChest wall manipulation00770.3444$20.44$7.74$4.09
    94680XExhaled air analysis, o203670.6659$39.52$14.80$7.90
    94681XExhaled air analysis, o2/co203680.9761$57.92$23.16$11.58
    94690XExhaled air analysis03680.9761$57.92$23.16$11.58
    94720XMonoxide diffusing capacity03680.9761$57.92$23.16$11.58
    94725XMembrane diffusion capacity03680.9761$57.92$23.16$11.58
    94750XPulmonary compliance study03680.9761$57.92$23.16$11.58
    94760NMeasure blood oxygen level
    94761NMeasure blood oxygen level
    94762NMeasure blood oxygen level
    94770XExhaled carbon dioxide test03670.6659$39.52$14.80$7.90
    94772XBreath recording, infant03692.7519$163.31$44.18$32.66
    94799XPulmonary service/procedure03670.6659$39.52$14.80$7.90
    95004XPercut allergy skin tests03810.1884$11.18$2.35$2.24
    95010XPercut allergy titrate test03810.1884$11.18$2.35$2.24
    95015XId allergy titrate-drug/bug03810.1884$11.18$2.35$2.24
    95024XId allergy test, drug/bug03810.1884$11.18$2.35$2.24
    95027XSkin end point titration03810.1884$11.18$2.35$2.24
    95028XId allergy test-delayed type03810.1884$11.18$2.35$2.24
    95044XAllergy patch tests03810.1884$11.18$2.35$2.24
    95052XPhoto patch test03810.1884$11.18$2.35$2.24
    95056XPhotosensitivity tests03701.1232$66.65$13.33
    95060XEye allergy tests03701.1232$66.65$13.33
    95065XNose allergy test03810.1884$11.18$2.35$2.24
    95070XBronchial allergy tests03692.7519$163.31$44.18$32.66
    95071XBronchial allergy tests03692.7519$163.31$44.18$32.66
    95075XIngestion challenge test03613.6216$214.92$83.23$42.98
    95078XProvocative testing03701.1232$66.65$13.33
    95115XImmunotherapy, one injection03520.1413$8.39$1.68
    95117XImmunotherapy injections03530.3954$23.46$4.69
    95120BImmunotherapy, one injection
    95125BImmunotherapy, many antigens
    95130BImmunotherapy, insect venom
    95131BImmunotherapy, insect venoms
    95132BImmunotherapy, insect venoms
    95133BImmunotherapy, insect venoms
    95134BImmunotherapy, insect venoms
    95144XAntigen therapy services03530.3954$23.46$4.69
    95145XAntigen therapy services03530.3954$23.46$4.69
    95146XAntigen therapy services03590.8312$49.33$9.87
    Start Printed Page 50819
    95147XAntigen therapy services03590.8312$49.33$9.87
    95148XAntigen therapy services03530.3954$23.46$4.69
    95149XAntigen therapy services03520.1413$8.39$1.68
    95165XAntigen therapy services03530.3954$23.46$4.69
    95170XAntigen therapy services03520.1413$8.39$1.68
    95180XRapid desensitization03701.1232$66.65$13.33
    95199XAllergy immunology services03701.1232$66.65$13.33
    95250XGlucose monitoring, cont04211.66$98.51$19.70
    95805SMultiple sleep latency test020911.5713$686.68$274.67$137.34
    95806SSleep study, unattended02132.2932$136.09$54.43$27.22
    95807SSleep study, attended020911.5713$686.68$274.67$137.34
    95808SPolysomnography, 1-3020911.5713$686.68$274.67$137.34
    95810SPolysomnography, 4 or more020911.5713$686.68$274.67$137.34
    95811SPolysomnography w/cpap020911.5713$686.68$274.67$137.34
    95812SElectroencephalogram (EEG)02132.2932$136.09$54.43$27.22
    95813SEeg, over 1 hour02132.2932$136.09$54.43$27.22
    95816SElectroencephalogram (EEG)02132.2932$136.09$54.43$27.22
    95819SElectroencephalogram (EEG)02132.2932$136.09$54.43$27.22
    95822SSleep electroencephalogram02132.2932$136.09$54.43$27.22
    95824SEeg, cerebral death only02141.1353$67.37$26.94$13.47
    95827Snight electroencephalogram02132.2932$136.09$54.43$27.22
    95829SSurgery electrocorticogram02141.1353$67.37$26.94$13.47
    95830BInsert electrodes for EEG
    95831ALimb muscle testing, manual
    95832AHand muscle testing, manual
    95833ABody muscle testing, manual
    95834ABody muscle testing, manual
    95851ARange of motion measurements
    95852ARange of motion measurements
    95857STensilon test02181.1408$67.70$13.54
    95858STensilon test & myogram02150.6115$36.29$14.51$7.26
    95860SMuscle test, one limb02181.1408$67.70$13.54
    95861SMuscle test, 2 limbs02181.1408$67.70$13.54
    95863SMuscle test, 3 limbs02181.1408$67.70$13.54
    95864SMuscle test, 4 limbs02181.1408$67.70$13.54
    95867SMuscle test, head or neck02181.1408$67.70$13.54
    95868SMuscle test cran nerve bilat02181.1408$67.70$13.54
    95869SMuscle test, thor paraspinal02150.6115$36.29$14.51$7.26
    95870SMuscle test, nonparaspinal02150.6115$36.29$14.51$7.26
    95872SMuscle test, one fiber02181.1408$67.70$13.54
    95875SLimb exercise test02150.6115$36.29$14.51$7.26
    95900SMotor nerve conduction test02150.6115$36.29$14.51$7.26
    95903SMotor nerve conduction test02150.6115$36.29$14.51$7.26
    95904SSense nerve conduction test02150.6115$36.29$14.51$7.26
    95920SIntraop nerve test add-on02162.672$158.56$31.71
    95921SAutonomic nerv function test02181.1408$67.70$13.54
    95922SAutonomic nerv function test02181.1408$67.70$13.54
    95923SAutonomic nerv function test02181.1408$67.70$13.54
    95925SSomatosensory testing02162.672$158.56$31.71
    95926SSomatosensory testing02162.672$158.56$31.71
    95927SSomatosensory testing02162.672$158.56$31.71
    95928SC motor evoked, uppr limbs02181.1408$67.70$13.54
    95929SC motor evoked, lwr limbs02181.1408$67.70$13.54
    95930SVisual evoked potential test02162.672$158.56$31.71
    95933SBlink reflex test02150.6115$36.29$14.51$7.26
    95934SH-reflex test02150.6115$36.29$14.51$7.26
    95936SH-reflex test02150.6115$36.29$14.51$7.26
    95937SNeuromuscular junction test02181.1408$67.70$13.54
    95950SAmbulatory eeg monitoring020911.5713$686.68$274.67$137.34
    95951SEEG monitoring/videorecord020911.5713$686.68$274.67$137.34
    95953SEEG monitoring/computer020911.5713$686.68$274.67$137.34
    95954SEEG monitoring/giving drugs02141.1353$67.37$26.94$13.47
    95955SEEG during surgery02132.2932$136.09$54.43$27.22
    95956SEeg monitoring, cable/radio020911.5713$686.68$274.67$137.34
    95957SEEG digital analysis02141.1353$67.37$26.94$13.47
    95958SEEG monitoring/function test02132.2932$136.09$54.43$27.22
    Start Printed Page 50820
    95961SElectrode stimulation, brain02162.672$158.56$31.71
    95962SElectrode stim, brain add-on02162.672$158.56$31.71
    95965TMeg, spontaneous043011.404$676.75$135.35
    95966TMeg, evoked, single043011.404$676.75$135.35
    95967TMeg, evoked, each add'l043011.404$676.75$135.35
    95970SAnalyze neurostim, no prog02181.1408$67.70$13.54
    95971SAnalyze neurostim, simple06922.0111$119.34$30.16$23.87
    95972SAnalyze neurostim, complex06922.0111$119.34$30.16$23.87
    95973SAnalyze neurostim, complex06922.0111$119.34$30.16$23.87
    95974SCranial neurostim, complex06922.0111$119.34$30.16$23.87
    95975SCranial neurostim, complex06922.0111$119.34$30.16$23.87
    95978SAnalyze neurostim brain/1h06922.0111$119.34$30.16$23.87
    95979SAnalyz neurostim brain addon06922.0111$119.34$30.16$23.87
    95990TSpin/brain pump refil & main01251.9331$114.72$22.94
    95991TSpin/brain pump refil & main01251.9331$114.72$22.94
    95999SNeurological procedure02150.6115$36.29$14.51$7.26
    96000SMotion analysis, video/3d02162.672$158.56$31.71
    96001SMotion test w/ft press meas02162.672$158.56$31.71
    96002SDynamic surface emg02181.1408$67.70$13.54
    96003SDynamic fine wire emg02150.6115$36.29$14.51$7.26
    96004EPhys review of motion tests
    96100XPsychological testing03732.1926$130.12$26.02
    96105AAssessment of aphasia
    96110XDevelopmental test, lim03732.1926$130.12$26.02
    96111XDevelopmental test, extend03732.1926$130.12$26.02
    96115XNeurobehavior status exam03732.1926$130.12$26.02
    96117XNeuropsych test battery03732.1926$130.12$26.02
    96150SAssess lth/behave, init04320.6949$41.24$8.25
    96151SAssess hlth/behave, subseq04320.6949$41.24$8.25
    96152SIntervene hlth/behave, indiv04320.6949$41.24$8.25
    96153SIntervene hlth/behave, group04320.6949$41.24$8.25
    96154SInterv hlth/behav, fam w/pt04320.6949$41.24$8.25
    96155EInterv hlth/behav fam no pt
    96400SChemotherapy, sc/im01161.1453$67.97$13.59
    96405SIntralesional chemo admin01161.1453$67.97$13.59
    96406SIntralesional chemo admin01161.1453$67.97$13.59
    96408SChemotherapy, push technique01161.1453$67.97$13.59
    96410SChemotherapy,infusion method01173.2378$192.14$42.54$38.43
    96412NChemo, infuse method add-on
    96414SChemo, infuse method add-on01173.2378$192.14$42.54$38.43
    96420SChemotherapy, push technique01161.1453$67.97$13.59
    96422SChemotherapy,infusion method01173.2378$192.14$42.54$38.43
    96423NChemo, infuse method add-on
    96425SChemotherapy,infusion method01173.2378$192.14$42.54$38.43
    96440SChemotherapy, intracavitary01161.1453$67.97$13.59
    96445SChemotherapy, intracavitary01161.1453$67.97$13.59
    96450SChemotherapy, into CNS01161.1453$67.97$13.59
    96520TPort pump refill & main01251.9331$114.72$22.94
    96530TPump refilling, maintenance01251.9331$114.72$22.94
    96542SChemotherapy injection01161.1453$67.97$13.59
    96545NProvide chemotherapy agent
    96549SChemotherapy, unspecified01161.1453$67.97$13.59
    96567TPhotodynamic tx, skin00162.5834$153.31$33.57$30.66
    96570TPhotodynamic tx, 30 min00151.6514$98.00$20.29$19.60
    96571TPhotodynamic tx, addl 15 min00151.6514$98.00$20.29$19.60
    96900SUltraviolet light therapy00010.4213$25.00$7.00$5.00
    96902NTrichogram
    96910SPhotochemotherapy with UV-B00010.4213$25.00$7.00$5.00
    96912SPhotochemotherapy with UV-A00010.4213$25.00$7.00$5.00
    96913SPhotochemotherapy, UV-A or B06831.9006$112.79$25.34$22.56
    96920TLaser tx, skin < 250 sq cm00131.1078$65.74$14.20$13.15
    96921TLaser tx, skin 250-500 sq cm00131.1078$65.74$14.20$13.15
    96922TLaser tx, skin > 500 sq cm00131.1078$65.74$14.20$13.15
    96999TDermatological procedure00100.5719$33.94$9.65$6.79
    97001APt evaluation
    97002APt re-evaluation
    Start Printed Page 50821
    97003AOt evaluation
    97004AOt re-evaluation
    97005EAthletic train eval
    97006EAthletic train reeval
    97010AHot or cold packs therapy
    97012AMechanical traction therapy
    97014EElectric stimulation therapy
    97016AVasopneumatic device therapy
    97018AParaffin bath therapy
    97020AMicrowave therapy
    97022AWhirlpool therapy
    97024ADiathermy treatment
    97026AInfrared therapy
    97028AUltraviolet therapy
    97032AElectrical stimulation
    97033AElectric current therapy
    97034AContrast bath therapy
    97035AUltrasound therapy
    97036AHydrotherapy
    97039APhysical therapy treatment
    97110ATherapeutic exercises
    97112ANeuromuscular reeducation
    97113AAquatic therapy/exercises
    97116AGait training therapy
    97124AMassage therapy
    97139APhysical medicine procedure
    97140AManual therapy
    97150AGroup therapeutic procedures
    97504AOrthotic training
    97520AProsthetic training
    97530ATherapeutic activities
    97532ACognitive skills development
    97533ASensory integration
    97535ASelf care mngment training
    97537ACommunity/work reintegration
    97542AWheelchair mngment training
    97545AWork hardening
    97546AWork hardening add-on
    97597AActive wound care/20 cm or <
    97598AActive wound care > 20 cm
    97602AWound(s) care non-selective
    97605ANeg press wound tx, < 50 cm
    97606ANeg press wound tx, > 50 cm
    97703AProsthetic checkout
    97750APhysical performance test
    97755AAssistive technology assess
    97799APhysical medicine procedure
    97802AMedical nutrition, indiv, in
    97803AMed nutrition, indiv, subseq
    97804AMedical nutrition, group
    97810EAcupunct w/o stimul 15 min
    97811EAcupunct w/o stimul addl 15m
    97813EAcupunct w/stimul 15 min
    97814EAcupunct w/stimul addl 15m
    98925SOsteopathic manipulation00600.4935$29.29$5.86
    98926SOsteopathic manipulation00600.4935$29.29$5.86
    98927SOsteopathic manipulation00600.4935$29.29$5.86
    98928SOsteopathic manipulation00600.4935$29.29$5.86
    98929SOsteopathic manipulation00600.4935$29.29$5.86
    98940SChiropractic manipulation00600.4935$29.29$5.86
    98941SChiropractic manipulation00600.4935$29.29$5.86
    98942SChiropractic manipulation00600.4935$29.29$5.86
    98943EChiropractic manipulation
    99000BSpecimen handling
    99001BSpecimen handling
    99002BDevice handling
    Start Printed Page 50822
    99024BPostop follow-up visit
    99026EIn-hospital on call service
    99027EOut-of-hosp on call service
    99050BMedical services after hrs
    99052BMedical services at night
    99054BMedical servcs, unusual hrs
    99056BNon-office medical services
    99058BOffice emergency care
    99070BSpecial supplies
    99071BPatient education materials
    99075EMedical testimony
    99078NGroup health education
    99080BSpecial reports or forms
    99082BUnusual physician travel
    99090BComputer data analysis
    99091ECollect/review data from pt
    99100BSpecial anesthesia service
    99116BAnesthesia with hypothermia
    99135BSpecial anesthesia procedure
    99140BEmergency anesthesia
    99141NSedation, iv/im or inhalant
    99142NSedation, oral/rectal/nasal
    99170TAnogenital exam, child01910.167$9.91$2.78$1.98
    99172EOcular function screen
    99173EVisual acuity screen
    99175NInduction of vomiting
    99183BHyperbaric oxygen therapy
    99185NRegional hypothermia
    99186NTotal body hypothermia
    99190CSpecial pump services
    99191CSpecial pump services
    99192CSpecial pump services
    99195XPhlebotomy03720.57$33.83$10.09$6.77
    99199BSpecial service/proc/report
    99201VOffice/outpatient visit, new06000.8688$51.56$10.31
    99202VOffice/outpatient visit, new06000.8688$51.56$10.31
    99203VOffice/outpatient visit, new06011.0038$59.57$11.91
    99204VOffice/outpatient visit, new06021.4284$84.77$16.95
    99205VOffice/outpatient visit, new06021.4284$84.77$16.95
    99211VOffice/outpatient visit, est06000.8688$51.56$10.31
    99212VOffice/outpatient visit, est06000.8688$51.56$10.31
    99213VOffice/outpatient visit, est06011.0038$59.57$11.91
    99214VOffice/outpatient visit, est06021.4284$84.77$16.95
    99215VOffice/outpatient visit, est06021.4284$84.77$16.95
    99217BObservation care discharge
    99218BObservation care
    99219BObservation care
    99220BObservation care
    99221EInitial hospital care
    99222EInitial hospital care
    99223EInitial hospital care
    99231ESubsequent hospital care
    99232ESubsequent hospital care
    99233ESubsequent hospital care
    99234BObserv/hosp same date
    99235BObserv/hosp same date
    99236BObserv/hosp same date
    99238EHospital discharge day
    99239EHospital discharge day
    99241VOffice consultation06000.8688$51.56$10.31
    99242VOffice consultation06000.8688$51.56$10.31
    99243VOffice consultation06011.0038$59.57$11.91
    99244VOffice consultation06021.4284$84.77$16.95
    99245VOffice consultation06021.4284$84.77$16.95
    99251CInitial inpatient consult
    99252CInitial inpatient consult
    Start Printed Page 50823
    99253CInitial inpatient consult
    99254CInitial inpatient consult
    99255CInitial inpatient consult
    99261CFollow-up inpatient consult
    99262CFollow-up inpatient consult
    99263CFollow-up inpatient consult
    99271VConfirmatory consultation06000.8688$51.56$10.31
    99272VConfirmatory consultation06000.8688$51.56$10.31
    99273VConfirmatory consultation06011.0038$59.57$11.91
    99274VConfirmatory consultation06021.4284$84.77$16.95
    99275VConfirmatory consultation06021.4284$84.77$16.95
    99281VEmergency dept visit06101.2947$76.83$19.48$15.37
    99282VEmergency dept visit06101.2947$76.83$19.48$15.37
    99283VEmergency dept visit06112.2718$134.82$35.76$26.96
    99284VEmergency dept visit06123.9853$236.50$54.12$47.30
    99285VEmergency dept visit06123.9853$236.50$54.12$47.30
    99288BDirect advanced life support
    99289NPt transport, 30-74 min
    99290NPt transport, addl 30 min
    99291SCritical care, first hour06208.2996$492.52$135.68$98.50
    99292NCritical care, add=l 30 min
    99293CPed critical care, initial
    99294CPed critical care, subseq
    99295CNeonatal critical care
    99296CNeonatal critical care
    99298CNeonatal critical care
    99299CIc, lbw infant 1500-2500 gm
    99301BNursing facility care
    99302BNursing facility care
    99303BNursing facility care
    99311BNursing fac care, subseq
    99312BNursing fac care, subseq
    99313BNursing fac care, subseq
    99315BNursing fac discharge day
    99316BNursing fac discharge day
    99321BRest home visit, new patient
    99322BRest home visit, new patient
    99323BRest home visit, new patient
    99331BRest home visit, est pat
    99332BRest home visit, est pat
    99333BRest home visit, est pat
    99341BHome visit, new patient
    99342BHome visit, new patient
    99343BHome visit, new patient
    99344BHome visit, new patient
    99345BHome visit, new patient
    99347BHome visit, est patient
    99348BHome visit, est patient
    99349BHome visit, est patient
    99350BHome visit, est patient
    99354NProlonged service, office
    99355NProlonged service, office
    99356CProlonged service, inpatient
    99357CProlonged service, inpatient
    99358NProlonged serv, w/o contact
    99359NProlonged serv, w/o contact
    99360BPhysician standby services
    99361EPhysician/team conference
    99362EPhysician/team conference
    99371BPhysician phone consultation
    99372BPhysician phone consultation
    99373BPhysician phone consultation
    99374BHome health care supervision
    99375EHome health care supervision
    99377BHospice care supervision
    99378EHospice care supervision
    Start Printed Page 50824
    99379BNursing fac care supervision
    99380BNursing fac care supervision
    99381EPrev visit, new, infant
    99382EPrev visit, new, age 1-4
    99383EPrev visit, new, age 5-11
    99384EPrev visit, new, age 12-17
    99385EPrev visit, new, age 18-39
    99386EPrev visit, new, age 40-64
    99387EPrev visit, new, 65 & over
    99391EPrev visit, est, infant
    99392EPrev visit, est, age 1-4
    99393EPrev visit, est, age 5-11
    99394EPrev visit, est, age 12-17
    99395EPrev visit, est, age 18-39
    99396EPrev visit, est, age 40-64
    99397EPrev visit, est, 65 & over
    99401EPreventive counseling, indiv
    99402EPreventive counseling, indiv
    99403EPreventive counseling, indiv
    99404EPreventive counseling, indiv
    99411EPreventive counseling, group
    99412EPreventive counseling, group
    99420EHealth risk assessment test
    99429EUnlisted preventive service
    99431VInitial care, normal newborn06000.8688$51.56$10.31
    99432NNewborn care, not in hosp
    99433CNormal newborn care/hospital
    99435ENewborn discharge day hosp
    99436NAttendance, birth
    99440SNewborn resuscitation00942.5363$150.51$47.62$30.10
    99450ELife/disability evaluation
    99455BDisability examination
    99456BDisability examination
    99499BUnlisted e&m service
    99500EHome visit, prenatal
    99501EHome visit, postnatal
    99502EHome visit, nb care
    99503EHome visit, resp therapy
    99504EHome visit mech ventilator
    99505EHome visit, stoma care
    99506EHome visit, im injection
    99507EHome visit, cath maintain
    99509EHome visit day life activity
    99510EHome visit, sing/m/fam couns
    99511EHome visit, fecal/enema mgmt
    99512EHome visit for hemodialysis
    99600EHome visit nos
    99601EHome infusion/visit, 2 hrs
    99602EHome infusion, each addtl hr
    A0021EOutside state ambulance serv
    A0080ENoninterest escort in non er
    A0090EInterest escort in non er
    A0100ENonemergency transport taxi
    A0110ENonemergency transport bus
    A0120ENoner transport mini-bus
    A0130ENoner transport wheelch van
    A0140ENonemergency transport air
    A0160ENoner transport case worker
    A0170ENoner transport parking fees
    A0180ENoner transport lodgng recip
    A0190ENoner transport meals recip
    A0200ENoner transport lodgng escrt
    A0210ENoner transport meals escort
    A0225ANeonatal emergency transport
    A0380ABasic life support mileage
    A0382ABasic support routine suppls
    Start Printed Page 50825
    A0384ABls defibrillation supplies
    A0390AAdvanced life support mileag
    A0392AAls defibrillation supplies
    A0394AAls IV drug therapy supplies
    A0396AAls esophageal intub suppls
    A0398AAls routine disposble suppls
    A0420AAmbulance waiting 1/2 hr
    A0422AAmbulance 02 life sustaining
    A0424AExtra ambulance attendant
    A0425AGround mileage
    A0426AAls 1
    A0427AALS1-emergency
    A0428Abls
    A0429ABLS-emergency
    A0430AFixed wing air transport
    A0431ARotary wing air transport
    A0432API volunteer ambulance co
    A0433Aals 2
    A0434ASpecialty care transport
    A0435AFixed wing air mileage
    A0436ARotary wing air mileage
    A0800BAmb trans 7pm-7am
    A0888ENoncovered ambulance mileage
    A0999AUnlisted ambulance service
    A4206E1 CC sterile syringe&needle
    A4207E2 CC sterile syringe&needle
    A4208E3 CC sterile syringe&needle
    A4209E5+ CC sterile syringe&needle
    A4210ENonneedle injection device
    A4211BSupp for self-adm injections
    A4212BNon coring needle or stylet
    A4213E20+ CC syringe only
    A4215ESterile needle
    A4216ASterile water/saline, 10 ml
    A4217ASterile water/saline, 500 ml
    A4220NInfusion pump refill kit
    A4221YMaint drug infus cath per wk
    A4222YDrug infusion pump supplies
    A4223EInfusion supplies w/o pump
    A4230YInfus insulin pump non needl
    A4231YInfusion insulin pump needle
    A4232YSyringe w/needle insulin 3cc
    A4244EAlcohol or peroxide per pint
    A4245EAlcohol wipes per box
    A4246EBetadine/phisohex solution
    A4247EBetadine/iodine swabs/wipes
    A4248NChlorhexidine antisept
    A4250EUrine reagent strips/tablets
    A4253YBlood glucose/reagent strips
    A4254YBattery for glucose monitor
    A4255YGlucose monitor platforms
    A4256YCalibrator solution/chips
    A4257YReplace Lensshield Cartridge
    A4258YLancet device each
    A4259YLancets per box
    A4260ELevonorgestrel implant
    A4261ECervical cap contraceptive
    A4262NTemporary tear duct plug
    A4263NPermanent tear duct plug
    A4265YParaffin
    A4266EDiaphragm
    A4267EMale condom
    A4268EFemale condom
    A4269ESpermicide
    A4270ADisposable endoscope sheath
    A4280ABrst prsths adhsv attchmnt
    Start Printed Page 50826
    A4281EReplacement breastpump tube
    A4282EReplacement breastpump adpt
    A4283EReplacement breastpump cap
    A4284EReplcmnt breast pump shield
    A4285EReplcmnt breast pump bottle
    A4286EReplcmnt breastpump lok ring
    A4290BSacral nerve stim test lead
    A4300NCath impl vasc access portal
    A4301NImplantable access syst perc
    A4305ADrug delivery system >=50 ML
    A4306ADrug delivery system <=5 ML
    A4310AInsert tray w/o bag/cath
    A4311ACatheter w/o bag 2-way latex
    A4312ACath w/o bag 2-way silicone
    A4313ACatheter w/bag 3-way
    A4314ACath w/drainage 2-way latex
    A4315ACath w/drainage 2-way silcne
    A4316ACath w/drainage 3-way
    A4320AIrrigation tray
    A4321ACath therapeutic irrig agent
    A4322AIrrigation syringe
    A4326AMale external catheter
    A4327AFem urinary collect dev cup
    A4328AFem urinary collect pouch
    A4330AStool collection pouch
    A4331AExtension drainage tubing
    A4332ALubricant for cath insertion
    A4333AUrinary cath anchor device
    A4334AUrinary cath leg strap
    A4335AIncontinence supply
    A4338AIndwelling catheter latex
    A4340AIndwelling catheter special
    A4344ACath indw foley 2 way silicn
    A4346ACath indw foley 3 way
    A4348AMale ext cath extended wear
    A4349ADisposable male external cat
    A4351AStraight tip urine catheter
    A4352ACoude tip urinary catheter
    A4353AIntermittent urinary cath
    A4354ACath insertion tray w/bag
    A4355ABladder irrigation tubing
    A4356AExt ureth clmp or compr dvc
    A4357ABedside drainage bag
    A4358AUrinary leg or abdomen bag
    A4359AUrinary suspensory w/o leg b
    A4361AOstomy face plate
    A4362ASolid skin barrier
    A4364AAdhesive, liquid or equal
    A4365AAdhesive remover wipes
    A4366AOstomy vent
    A4367AOstomy belt
    A4368AOstomy filter
    A4369ASkin barrier liquid per oz
    A4371ASkin barrier powder per oz
    A4372ASkin barrier solid 4x4 equiv
    A4373ASkin barrier with flange
    A4375ADrainable plastic pch w fcpl
    A4376ADrainable rubber pch w fcplt
    A4377ADrainable plstic pch w/o fp
    A4378ADrainable rubber pch w/o fp
    A4379AUrinary plastic pouch w fcpl
    A4380AUrinary rubber pouch w fcplt
    A4381AUrinary plastic pouch w/o fp
    A4382AUrinary hvy plstc pch w/o fp
    A4383AUrinary rubber pouch w/o fp
    A4384AOstomy faceplt/silicone ring
    Start Printed Page 50827
    A4385AOst skn barrier sld ext wear
    A4387AOst clsd pouch w att st barr
    A4388ADrainable pch w ex wear barr
    A4389ADrainable pch w st wear barr
    A4390ADrainable pch ex wear convex
    A4391AUrinary pouch w ex wear barr
    A4392AUrinary pouch w st wear barr
    A4393AUrine pch w ex wear bar conv
    A4394AOstomy pouch liq deodorant
    A4395AOstomy pouch solid deodorant
    A4396APeristomal hernia supprt blt
    A4397AIrrigation supply sleeve
    A4398AOstomy irrigation bag
    A4399AOstomy irrig cone/cath w brs
    A4400AOstomy irrigation set
    A4402ALubricant per ounce
    A4404AOstomy ring each
    A4405ANonpectin based ostomy paste
    A4406APectin based ostomy paste
    A4407AExt wear ost skn barr <=4sq÷
    A4408AExt wear ost skn barr >4sq÷
    A4409AOst skn barr w flng <=4 sq÷
    A4410AOst skn barr w flng >4sq÷
    A4413A2 pc drainable ost pouch
    A4414AOstomy sknbarr w flng <=4sq÷
    A4415AOstomy skn barr w flng >4sq÷
    A4416AOst pch clsd w barrier/filtr
    A4417AOst pch w bar/bltinconv/fltr
    A4418AOst pch clsd w/o bar w filtr
    A4419AOst pch for bar w flange/flt
    A4420AOst pch clsd for bar w lk fl
    A4421EOstomy supply misc
    A4422AOst pouch absorbent material
    A4423AOst pch for bar w lk fl/fltr
    A4424AOst pch drain w bar & filter
    A4425AOst pch drain for barrier fl
    A4426AOst pch drain 2 piece system
    A4427AOst pch drain/barr lk flng/f
    A4428AUrine ost pouch w faucet/tap
    A4429AUrine ost pch bar w lock fln
    A4430AOst pch urine w lock flng/ft
    A4431AUrine ost pch bar w lock fln
    A4432AOst pch urine w lock flng/ft
    A4433AUrine ost pch bar w lock fln
    A4434AOst pch urine w lock flng/ft
    A4450ANon-waterproof tape
    A4452AWaterproof tape
    A4455AAdhesive remover per ounce
    A4458EReusable enema bag
    A4462AAbdmnl drssng holder/binder
    A4465ANon-elastic extremity binder
    A4470AGravlee jet washer
    A4480AVabra aspirator
    A4481ATracheostoma filter
    A4483AMoisture exchanger
    A4490EAbove knee surgical stocking
    A4495EThigh length surg stocking
    A4500EBelow knee surgical stocking
    A4510EFull length surg stocking
    A4520EIncontinence garment anytype
    A4550BSurgical trays
    A4554EDisposable underpads
    A4555EDisposable underpad small
    A4556YElectrodes, pair
    A4557YLead wires, pair
    A4558YConductive paste or gel
    Start Printed Page 50828
    A4561NPessary rubber, any type
    A4562NPessary, non rubber,any type
    A4565ASlings
    A4570ESplint
    A4575EHyperbaric o2 chamber disps
    A4580ECast supplies (plaster)
    A4590ESpecial casting material
    A4595YTENS suppl 2 lead per month
    A4605YTrach suction cath close sys
    A4606AOxygen probe used w oximeter
    A4608YTranstracheal oxygen cath
    A4611YHeavy duty battery
    A4612YBattery cables
    A4613YBattery charger
    A4614AHand-held PEFR meter
    A4615YCannula nasal
    A4616YTubing (oxygen) per foot
    A4617YMouth piece
    A4618YBreathing circuits
    A4619YFace tent
    A4620YVariable concentration mask
    A4623ATracheostomy inner cannula
    A4624YTracheal suction tube
    A4625ATrach care kit for new trach
    A4626ATracheostomy cleaning brush
    A4627ESpacer bag/reservoir
    A4628YOropharyngeal suction cath
    A4629ATracheostomy care kit
    A4630YRepl bat t.e.n.s. own by pt
    A4632YInfus pump rplcemnt battery
    A4633YUvl replacement bulb
    A4634AReplacement bulb th lightbox
    A4635YUnderarm crutch pad
    A4636YHandgrip for cane etc
    A4637YRepl tip cane/crutch/walker
    A4638YRepl batt pulse gen sys
    A4639YInfrared ht sys replcmnt pad
    A4640YAlternating pressure pad
    A4641NDiagnostic imaging agent
    A4642HSatumomab pendetide per dose0704
    A4643BHigh dose contrast MRI
    A4644BContrast 100-199 MGs iodine
    A4645BContrast 200-299 MGs iodine
    A4646BContrast 300-399 MGs iodine
    A4647BSupp- paramagnetic contr mat
    A4649ASurgical supplies
    A4651ACalibrated microcap tube
    A4652AMicrocapillary tube sealant
    A4653APD catheter anchor belt
    A4656ADialysis needle
    A4657ADialysis syringe w/wo needle
    A4660ASphyg/bp app w cuff and stet
    A4663ADialysis blood pressure cuff
    A4670EAutomatic bp monitor, dial
    A4671BDisposable cycler set
    A4672BDrainage ext line, dialysis
    A4673BExt line w easy lock connect
    A4674BChem/antisept solution, 8oz
    A4680AActivated carbon filter, ea
    A4690ADialyzer, each
    A4706ABicarbonate conc sol per gal
    A4707ABicarbonate conc pow per pac
    A4708AAcetate conc sol per gallon
    A4709AAcid conc sol per gallon
    A4714ATreated water per gallon
    A4719A÷Y set÷ tubing
    Start Printed Page 50829
    A4720ADialysat sol fld vol > 249cc
    A4721ADialysat sol fld vol > 999cc
    A4722ADialys sol fld vol > 1999cc
    A4723ADialys sol fld vol > 2999cc
    A4724ADialys sol fld vol > 3999cc
    A4725ADialys sol fld vol > 4999cc
    A4726ADialys sol fld vol > 5999cc
    A4728BDialysate solution, non-dex
    A4730AFistula cannulation set, ea
    A4736ATopical anesthetic, per gram
    A4737AInj anesthetic per 10 ml
    A4740AShunt accessory
    A4750AArt or venous blood tubing
    A4755AComb art/venous blood tubing
    A4760ADialysate sol test kit, each
    A4765ADialysate conc pow per pack
    A4766ADialysate conc sol add 10 ml
    A4770ABlood collection tube/vacuum
    A4771ASerum clotting time tube
    A4772ABlood glucose test strips
    A4773AOccult blood test strips
    A4774AAmmonia test strips
    A4802AProtamine sulfate per 50 mg
    A4860ADisposable catheter tips
    A4870APlumb/elec wk hm hemo equip
    A4890ARepair/maint cont hemo equip
    A4911ADrain bag/bottle
    A4913AMisc dialysis supplies noc
    A4918AVenous pressure clamp
    A4927ANon-sterile gloves
    A4928ASurgical mask
    A4929ATourniquet for dialysis, ea
    A4930ASterile, gloves per pair
    A4931AReusable oral thermometer
    A4932EReusable rectal thermometer
    A5051APouch clsd w barr attached
    A5052AClsd ostomy pouch w/o barr
    A5053AClsd ostomy pouch faceplate
    A5054AClsd ostomy pouch w/flange
    A5055AStoma cap
    A5061APouch drainable w barrier at
    A5062ADrnble ostomy pouch w/o barr
    A5063ADrain ostomy pouch w/flange
    A5071AUrinary pouch w/barrier
    A5072AUrinary pouch w/o barrier
    A5073AUrinary pouch on barr w/flng
    A5081AContinent stoma plug
    A5082AContinent stoma catheter
    A5093AOstomy accessory convex inse
    A5102ABedside drain btl w/wo tube
    A5105AUrinary suspensory
    A5112AUrinary leg bag
    A5113ALatex leg strap
    A5114AFoam/fabric leg strap
    A5119ASkin barrier wipes box pr 50
    A5121ASolid skin barrier 6x6
    A5122ASolid skin barrier 8x8
    A5126ADisk/foam pad +or- adhesive
    A5131AAppliance cleaner
    A5200APercutaneous catheter anchor
    A5500YDiab shoe for density insert
    A5501YDiabetic custom molded shoe
    A5503YDiabetic shoe w/roller/rockr
    A5504YDiabetic shoe with wedge
    A5505YDiab shoe w/metatarsal bar
    A5506YDiabetic shoe w/off set heel
    Start Printed Page 50830
    A5507YModification diabetic shoe
    A5508YDiabetic deluxe shoe
    A5509EDirect heat form shoe insert
    A5510ECompression form shoe insert
    A5511ECustom fab molded shoe inser
    A6000EWound warming wound cover
    A6010ACollagen based wound filler
    A6011ACollagen gel/paste wound fil
    A6021ACollagen dressing <=16 sq in
    A6022ACollagen drsg>6<=48 sq in
    A6023ACollagen dressing >48 sq in
    A6024ACollagen dsg wound filler
    A6025ESilicone gel sheet, each
    A6154AWound pouch each
    A6196AAlginate dressing <=16 sq in
    A6197AAlginate drsg >16 <=48 sq in
    A6198Aalginate dressing > 48 sq in
    A6199AAlginate drsg wound filler
    A6200ACompos drsg <=16 no border
    A6201ACompos drsg >16<=48 no bdr
    A6202ACompos drsg >48 no border
    A6203AComposite drsg <= 16 sq in
    A6204AComposite drsg >16<=48 sq in
    A6205AComposite drsg > 48 sq in
    A6206AContact layer <= 16 sq in
    A6207AContact layer >16<= 48 sq in
    A6208AContact layer > 48 sq in
    A6209AFoam drsg <=16 sq in w/o bdr
    A6210AFoam drg >16<=48 sq in w/o b
    A6211AFoam drg > 48 sq in w/o brdr
    A6212AFoam drg <=16 sq in w/border
    A6213AFoam drg >16<=48 sq in w/bdr
    A6214AFoam drg > 48 sq in w/border
    A6215AFoam dressing wound filler
    A6216ANon-sterile gauze<=16 sq in
    A6217ANon-sterile gauze>16<=48 sq
    A6218ANon-sterile gauze > 48 sq in
    A6219AGauze <= 16 sq in w/border
    A6220AGauze >16 <=48 sq in w/bordr
    A6221AGauze > 48 sq in w/border
    A6222AGauze <=16 in no w/sal w/o b
    A6223AGauze >16<=48 no w/sal w/o b
    A6224AGauze > 48 in no w/sal w/o b
    A6228AGauze <= 16 sq in water/sal
    A6229AGauze >16<=48 sq in watr/sal
    A6230AGauze > 48 sq in water/salne
    A6231AHydrogel dsg<=16 sq in
    A6232AHydrogel dsg>16<=48 sq in
    A6233AHydrogel dressing >48 sq in
    A6234AHydrocolld drg <=16 w/o bdr
    A6235AHydrocolld drg >16<=48 w/o b
    A6236AHydrocolld drg > 48 in w/o b
    A6237AHydrocolld drg <=16 in w/bdr
    A6238AHydrocolld drg >16<=48 w/bdr
    A6239AHydrocolld drg > 48 in w/bdr
    A6240AHydrocolld drg filler paste
    A6241AHydrocolloid drg filler dry
    A6242AHydrogel drg <=16 in w/o bdr
    A6243AHydrogel drg >16<=48 w/o bdr
    A6244AHydrogel drg >48 in w/o bdr
    A6245AHydrogel drg <= 16 in w/bdr
    A6246AHydrogel drg >16<=48 in w/b
    A6247AHydrogel drg > 48 sq in w/b
    A6248AHydrogel drsg gel filler
    A6250ASkin seal protect moisturizr
    A6251AAbsorpt drg <=16 sq in w/o b
    Start Printed Page 50831
    A6252AAbsorpt drg >16 <=48 w/o bdr
    A6253AAbsorpt drg > 48 sq in w/o b
    A6254AAbsorpt drg <=16 sq in w/bdr
    A6255AAbsorpt drg >16<=48 in w/bdr
    A6256AAbsorpt drg > 48 sq in w/bdr
    A6257ATransparent film <= 16 sq in
    A6258ATransparent film >16<=48 in
    A6259ATransparent film > 48 sq in
    A6260AWound cleanser any type/size
    A6261AWound filler gel/paste /oz
    A6262AWound filler dry form / gram
    A6266AImpreg gauze no h20/sal/yard
    A6402ASterile gauze <= 16 sq in
    A6403ASterile gauze>16 <= 48 sq in
    A6404ASterile gauze > 48 sq in
    A6407APacking strips, non-impreg
    A6410ASterile eye pad
    A6411ANon-sterile eye pad
    A6412EOcclusive eye patch
    A6441APad band w>=3÷ <5÷/yd
    A6442AConform band n/s w<3÷/yd
    A6443AConform band n/s w>=3÷<5÷/yd
    A6444AConform band n/s w>=5÷/yd
    A6445AConform band s w <3÷/yd
    A6446AConform band s w>=3÷ <5÷/yd
    A6447AConform band s w >=5÷/yd
    A6448ALt compres band <3÷/yd
    A6449ALt compres band >=3÷ <5÷/yd
    A6450ALt compres band >=5÷/yd
    A6451AMod compres band w>=3÷<5÷/yd
    A6452AHigh compres band w>=3÷<5÷yd
    A6453ASelf-adher band w <3÷/yd
    A6454ASelf-adher band w>=3÷ <5÷/yd
    A6455ASelf-adher band >=5÷/yd
    A6456AZinc paste band w >=3÷<5÷/yd
    A6501ACompres burngarment bodysuit
    A6502ACompres burngarment chinstrp
    A6503ACompres burngarment facehood
    A6504ACmprsburngarment glove-wrist
    A6505ACmprsburngarment glove-elbow
    A6506ACmprsburngrmnt glove-axilla
    A6507ACmprs burngarment foot-knee
    A6508ACmprs burngarment foot-thigh
    A6509ACompres burn garment jacket
    A6510ACompres burn garment leotard
    A6511ACompres burn garment panty
    A6512ACompres burn garment, noc
    A6550YNeg pres wound ther drsg set
    A6551YNeg press wound ther canistr
    A7000YDisposable canister for pump
    A7001YNondisposable pump canister
    A7002YTubing used w suction pump
    A7003YNebulizer administration set
    A7004YDisposable nebulizer sml vol
    A7005YNondisposable nebulizer set
    A7006YFiltered nebulizer admin set
    A7007YLg vol nebulizer disposable
    A7008YDisposable nebulizer prefill
    A7009YNebulizer reservoir bottle
    A7010YDisposable corrugated tubing
    A7011YNondispos corrugated tubing
    A7012YNebulizer water collec devic
    A7013YDisposable compressor filter
    A7014YCompressor nondispos filter
    A7015YAerosol mask used w nebulize
    A7016YNebulizer dome & mouthpiece
    Start Printed Page 50832
    A7017YNebulizer not used w oxygen
    A7018YWater distilled w/nebulizer
    A7025YReplace chest compress vest
    A7026YReplace chst cmprss sys hose
    A7030YCPAP full face mask
    A7031YReplacement facemask interfa
    A7032YReplacement nasal cushion
    A7033YReplacement nasal pillows
    A7034YNasal application device
    A7035YPos airway press headgear
    A7036YPos airway press chinstrap
    A7037YPos airway pressure tubing
    A7038YPos airway pressure filter
    A7039YFilter, non disposable w pap
    A7040AOne way chest drain valve
    A7041AWater seal drain container
    A7042AImplanted pleural catheter
    A7043AVacuum drainagebottle/tubing
    A7044YPAP oral interface
    A7045YRepl exhalation port for PAP
    A7046YRepl water chamber, PAP dev
    A7501ATracheostoma valve w diaphra
    A7502AReplacement diaphragm/fplate
    A7503AHMES filter holder or cap
    A7504ATracheostoma HMES filter
    A7505AHMES or trach valve housing
    A7506AHMES/trachvalve adhesivedisk
    A7507AIntegrated filter & holder
    A7508AHousing & Integrated Adhesiv
    A7509AHeat & moisture exchange sys
    A7520ATrach/laryn tube non-cuffed
    A7521ATrach/laryn tube cuffed
    A7522ATrach/laryn tube stainless
    A7523ATracheostomy shower protect
    A7524ATracheostoma stent/stud/bttn
    A7525ATracheostomy mask
    A7526ATracheostomy tube collar
    A7527ATrach/laryn tube plug/stop
    A9150BMisc/exper non-prescript dru
    A9152ESingle vitamin nos
    A9153EMulti-vitamin nos
    A9180ELice treatment, topical
    A9270ENon-covered item or service
    A9280EAlert device, noc
    A9300EExercise equipment
    A9500HTechnetium TC 99m sestamibi1600
    A9502HTechnetium TC99M tetrofosmin0705
    A9503NTechnetium TC 99m medronate
    A9504NTechnetium tc 99m apcitide
    A9505HThallous chloride TL 201/mci1603
    A9507HIndium/111 capromab pendetid1604
    A9508HIobenguane sulfate I-131, pe1045
    A9510HTechnetium TC99m Disofenin9146
    A9511HTechnetium TC 99m depreotide9147
    A9512NTechnetium tc99m pertechnetate
    A9513NTechnetium tc-99m mebrofenin
    A9514NTechnetium tc99m pyrophosphate
    A9515NTechnetium tc-99m pentetate
    A9516HI-123 sodium iodide capsule9148
    A9517HTh I131 so iodide cap millic1064
    A9519NTechnetium tc-99m macroag albu
    A9520NTechnetium tc-99m sulfur clld
    A9521HTechnetium tc-99m exametazine1096
    A9522BIndium 111i britumomabtiuxetan
    A9523BYttrium 90i britumomabtiuxetan
    A9524HIodinated I-131 serumalbumin9100
    Start Printed Page 50833
    A9525ELow/iso-osmolar contrast mat
    A9526HAmmonia N-13, per dose0737
    A9528HDx I131 so iodide cap millic1088
    A9529HDx I131 so iodide sol millic1065
    A9530HTh I131 so iodide sol millic1150
    A9531HDx I131 so iodide microcurie9149
    A9532HI-125 serum albumin micro9150
    A9533BI-131 tositumomab diagnostic
    A9534BI-131 tositumomab therapeut
    A9600HStrontium-89 chloride0701
    A9605HSamarium sm153 lexidronamm0702
    A9699NNoc therapeutic radiopharm
    A9700BEchocardiography Contrast
    A9900ASupply/accessory/service
    A9901ADelivery/set up/dispensing
    A9999YDME supply or accessory, nos
    B4034AEnter feed supkit syr by day
    B4035AEnteral feed supp pump per d
    B4036AEnteral feed sup kit grav by
    B4081AEnteral ng tubing w/ stylet
    B4082AEnteral ng tubing w/o stylet
    B4083AEnteral stomach tube levine
    B4086AGastrostomy/jejunostomy tube
    B4100EFood thickener oral
    B4102YEF adult fluids and electro
    B4103YEF ped fluid and electrolyte
    B4104EAdditive for enteral formula
    B4149YEF blenderized foods
    B4150AEnteral formulae category i
    B4152AEnteral formulae category ii
    B4153AEnteral formulae category III
    B4154AEnteral formulae category IV
    B4155AEnteral formulae category v
    B4157YEF special metabolic inherit
    B4158YEF ped complete intact nut
    B4159YEF ped complete soy based
    B4160YEF ped calorie dense > / =0.7kc
    B4161YEF ped hydrolyzed/amino acid
    B4162YEF ped specmetabolic inherit
    B4164AParenteral 50% dextrose solu
    B4168AParenteral sol amino acid 3
    B4172AParenteral sol amino acid 5
    B4176AParenteral sol amino acid 7-
    B4178AParenteral sol amino acid >
    B4180AParenteral sol carb > 50%
    B4184AParenteral sol lipids 10%
    B4186AParenteral sol lipids 20%
    B4189AParenteral sol amino acid &
    B4193AParenteral sol 52-73 gm prot
    B4197AParenteral sol 74-100 gm pro
    B4199AParenteral sol > 100gm prote
    B4216AParenteral nutrition additiv
    B4220AParenteral supply kit premix
    B4222AParenteral supply kit homemi
    B4224AParenteral administration ki
    B5000AParenteral sol renal-amirosy
    B5100AParenteral sol hepatic-fream
    B5200AParenteral sol stres-brnch c
    B9000AEnter infusion pump w/o alrm
    B9002AEnteral infusion pump w/ ala
    B9004AParenteral infus pump portab
    B9006AParenteral infus pump statio
    B9998AEnteral supp not otherwise c
    B9999AParenteral supp not othrws c
    C1079NCO 57/58 per 0.5 uCi
    C1080HI-131 tositumomab, dx1080
    Start Printed Page 50834
    C1081HI-131 tositumomab, tx1081
    C1082HIn-111 ibritumomab tiuxetan9118
    C1083HYttrium 90 ibritumomab tiuxe9117
    C1091HIN111 oxyquinoline,per 0.5 mCi1091
    C1092HIN 111 pentetate per 0.5 mCi1092
    C1093HTC99M fanolesomab1093
    C1122HTc 99M ARCITUMOMAB PER VIAL9151
    C1178KBUSULFAN IV, 6 Mg11780.2851$16.92$3.38
    C1200NTC 99M Sodium Glucoheptonat
    C1201HTC 99M SUCCIMER, PER Vial1201
    C1300SHYPERBARIC Oxygen06591.5473$91.82$18.36
    C1305KApligraf, 44cm2130512.9222$766.84$153.37
    C1713NAnchor/screw bn/bn,tis/bn
    C1714NCath, trans atherectomy, dir
    C1715NBrachytherapy needle
    C1716HBrachytx source, Gold 1981716
    C1717HBrachytx source, HDR Ir-1921717
    C1718HBrachytx source, Iodine 1251718
    C1719HBrachytx sour,Non-HDR Ir-1921719
    C1720HBrachytx sour, Palladium 1031720
    C1721NAICD, dual chamber
    C1722NAICD, single chamber
    C1724NCath, trans atherec,rotation
    C1725NCath, translumin non-laser
    C1726NCath, bal dil, non-vascular
    C1727NCath, bal tis dis, non-vas
    C1728NCath, brachytx seed adm
    C1729NCath, drainage
    C1730NCath, EP, 19 or few elect
    C1731NCath, EP, 20 or more elec
    C1732NCath, EP, diag/abl, 3D/vect
    C1733NCath, EP, othr than cool-tip
    C1750NCath, hemodialysis,long-term
    C1751NCath, inf, per/cent/midline
    C1752NCath,hemodialysis,short-term
    C1753NCath, intravas ultrasound
    C1754NCatheter, intradiscal
    C1755NCatheter, intraspinal
    C1756NCath, pacing, transesoph
    C1757NCath, thrombectomy/embolect
    C1758NCatheter, ureteral
    C1759NCath, intra echocardiography
    C1760NClosure dev, vasc
    C1762NConn tiss, human(inc fascia)
    C1763NConn tiss, non-human
    C1764NEvent recorder, cardiac
    C1765NAdhesion barrier
    C1766NIntro/sheath,strble,non-peel
    C1767NGenerator, neurostim, imp
    C1768NGraft, vascular
    C1769NGuide wire
    C1770NImaging coil, MR, insertable
    C1771NRep dev, urinary, w/sling
    C1772NInfusion pump, programmable
    C1773NRet dev, insertable
    C1775HFDG, per dose (4-40 mCi/ml)1775
    C1776NJoint device (implantable)
    C1777NLead, AICD, endo single coil
    C1778NLead, neurostimulator
    C1779NLead, pmkr, transvenous VDD
    C1780NLens, intraocular (new tech)
    C1781NMesh (implantable)
    C1782NMorcellator
    C1783NOcular imp, aqueous drain de
    C1784NOcular dev, intraop, det ret
    C1785NPmkr, dual, rate-resp
    Start Printed Page 50835
    C1786NPmkr, single, rate-resp
    C1787NPatient progr, neurostim
    C1788NPort, indwelling, imp
    C1789NProsthesis, breast, imp
    C1813NProsthesis, penile, inflatab
    C1814NRetinal tamp, silicone oil
    C1815NPros, urinary sph, imp
    C1816NReceiver/transmitter, neuro
    C1817NSeptal defect imp sys
    C1818NIntegrated keratoprosthesis
    C1819NTissue local excision
    C1874NStent, coated/cov w/del sys
    C1875NStent, coated/cov w/o del sy
    C1876NStent, non-coa/non-cov w/del
    C1877NStent, non-coat/cov w/o del
    C1878NMatrl for vocal cord
    C1879NTissue marker, implantable
    C1880NVena cava filter
    C1881NDialysis access system
    C1882NAICD, other than sing/dual
    C1883NAdapt/ext, pacing/neuro lead
    C1884NEmbolization Protect syst
    C1885NCath, translumin angio laser
    C1887NCatheter, guiding
    C1888NEndovas non-cardiac abl cath
    C1891NInfusion pump,non-prog, perm
    C1892NIntro/sheath,fixed,peel-away
    C1893NIntro/sheath, fixed,non-peel
    C1894NIntro/sheath, non-laser
    C1895NLead, AICD, endo dual coil
    C1896NLead, AICD, non sing/dual
    C1897NLead, neurostim test kit
    C1898NLead, pmkr, other than trans
    C1899NLead, pmkr/AICD combination
    C1900NLead coronary venous
    C2614NProbe, perc lumb disc
    C2615NSealant, pulmonary, liquid
    C2616HBrachytx source, Yttrium-902616
    C2617NStent, non-cor, tem w/o del
    C2618NProbe, cryoablation
    C2619NPmkr, dual, non rate-resp
    C2620NPmkr, single, non rate-resp
    C2621NPmkr, other than sing/dual
    C2622NProsthesis, penile, non-inf
    C2625NStent, non-cor, tem w/del sy
    C2626NInfusion pump, non-prog,temp
    C2627NCath, suprapubic/cystoscopic
    C2628NCatheter, occlusion
    C2629NIntro/sheath, laser
    C2630NCath, EP, cool-tip
    C2631NRep dev, urinary, w/o sling
    C2632HBrachytx sol, I-125, per mCi2632
    C2633HBrachytx source, Cesium-1312633
    C2634HBrachytx source, HA, I-1252634
    C2635HBrachytx source, HA, P-1032635
    C2636HBrachytx linear source, P-102636
    C8900*SMRA w/cont, abd02846.4201$380.99$152.39$76.20
    C8901*SMRA w/o cont, abd03366.0742$360.46$144.18$72.09
    C8902*SMRA w/o fol w/cont, abd03378.7945$521.89$208.75$104.38
    C8903*SMRI w/cont, breast, uni02846.4201$380.99$152.39$76.20
    C8904*SMRI w/o cont, breast, uni03366.0742$360.46$144.18$72.09
    C8905*SMRI w/o fol w/cont, brst, un03378.7945$521.89$208.75$104.38
    C8906*SMRI w/cont, breast, bi02846.4201$380.99$152.39$76.20
    C8907*SMRI w/o cont, breast, bi03366.0742$360.46$144.18$72.09
    C8908*SMRI w/o fol w/cont, breast,03378.7945$521.89$208.75$104.38
    C8909*SMRA w/cont, chest02846.4201$380.99$152.39$76.20
    Start Printed Page 50836
    C8910*SMRA w/o cont, chest03366.0742$360.46$144.18$72.09
    C8911*SMRA w/o fol w/cont, chest03378.7945$521.89$208.75$104.38
    C8912*SMRA w/cont, lwr ext02846.4201$380.99$152.39$76.20
    C8913*SMRA w/o cont, lwr ext03366.0742$360.46$144.18$72.09
    C8914*SMRA w/o fol w/cont, lwr ext03378.7945$521.89$208.75$104.38
    C8918*SMRA w/cont, pelvis02846.4201$380.99$152.39$76.20
    C8919*SMRA w/o cont, pelvis03366.0742$360.46$144.18$72.09
    C8920*SMRA w/o fol w/cont, pelvis03378.7945$521.89$208.75$104.38
    C9000HNa chromateCr51, per 0.25mCi9130
    C9003KPalivizumab, per 50 mg90034.1491$246.22$49.24
    C9007KBaclofen Intrathecal kit-1am91520.8562$50.81$10.16
    C9008KBaclofen Refill Kit-500mcg90080.2447$14.52$2.90
    C9009KBaclofen Refill Kit-2000mcg90090.7209$42.78$8.56
    C9013NCo 57 cobaltous chloride
    C9102H51 Na Chromate, 50mCi9132
    C9103HNa Iothalamate I-125, 10 uCi9153
    C9105KHep B imm glob, per 1 ml91051.8813$111.64$22.33
    C9112DPerflutren lipid micro, 2ml
    C9113NInj pantoprazole sodium, via
    C9121KInjection, argatroban91210.1897$11.26$2.25
    C9123KTranscyte, 247cm29123$719.41$143.88
    C9127KPaclitaxel protein pr9127$8.59$1.72
    C9128KInj pegaptanib sodium9128$1,074.27$214.85
    C9200KOrcel, 36 cm292002.6893$159.59$31.92
    C9201KDermagraft, 37.5cm292016.2066$368.32$73.66
    C9202DOctafluoropropane
    C9203DPerflexane lipid micro
    C9205KOxaliplatin9205$84.06$16.81
    C9206KIntegra, per cm29206$9.23$1.85
    C9211KInj, alefacept, IV9211$571.01$114.20
    C9212KInj, alefacept, IM9212$402.00$80.40
    C9218KInjection, Azacitidine9218$4.03$0.81
    C9220GSodium hyaluronate9220$203.84$40.77
    C9221GGraftjacket Reg Matrix9221$1,234.36$246.87
    C9222GGraftjacket SftTis9222$890.74$178.15
    C9223DInj adenosine, tx dx
    C9399AUnclass drugs/biologicals
    C9400DThallous chloride, brand
    C9401DStrontium-89 chloride, brand
    C9402DTh I131 so iodide cap, brand
    C9403DDx I131 so iodide cap, brand
    C9404DDx I131 so iodide sol, brand
    C9405DTh I131 so iodide sol, brand
    C9410DDexrazoxane HCl inj, brand
    C9411DPamidronate disodium, brand
    C9413DNa hyaluronate bran
    C9414DEtoposide oral, brand
    C9415DDoxorubic hcl chemo, brand
    C9417DBleomycin sulfate inj, brand
    C9418DCisplatin inj, brand
    C9419DInj cladribine, brand
    C9420DCyclophosphamide inj, brand
    C9421DCyclophosphamide lyo, brand
    C9422DCytarabine hcl inj, brand
    C9423DDacarbazine inj, brand
    C9424DDaunorubicin, brand
    C9425DEtoposide inj, brand
    C9426DFloxuridine inj, brand
    C9427DIfosfomide inj, brand
    C9428DMesna injection, brand
    C9429DIdarubicin hcl inj, brand
    C9430DLeuprolide acetate bran
    C9431DPaclitaxel inj, brand
    C9432DMitomycin inj, brand
    C9433DThiotepa inj, brand
    C9435DGonadorelin hydroch, brand
    Start Printed Page 50837
    C9436DAzathioprine parenteral,brnd
    C9437DCarmus bischl nitro inj
    C9438DCyclosporine oral, brand
    C9439DDiethylstilbestrol injection
    C9440DVinorelbine tar,brand
    C9704TInj inert subs upper GI1556$1,750.00$350.00
    C9713TNon-contact laser vap prosta042942.3147$2,511.08$502.22
    C9716SRF Energy to Anus1519$1,750.00$350.00
    C9718TKyphoplasty, first vertebra005136.5271$2,167.63$433.53
    C9719TKyphoplasty, each addl005136.5271$2,167.63$433.53
    C9720THE ESW tx, tennis elbow1547$850.00$170.00
    C9721THE ESW tx, plantar fasciitis1547$850.00$170.00
    C9722SKV imaging w/IR tracking1502$75.00$15.00
    C9723SDyn IR Perf Img1502$75.00$15.00
    C9724TEPS gast cardia plic042222.9647$1,362.79$448.81$272.56
    D0120EPeriodic oral evaluation
    D0140ELimit oral eval problm focus
    D0150SComprehensve oral evaluation03307.1756$425.82$85.16
    D0160EExtensv oral eval prob focus
    D0170ERe-eval,est pt,problem focus
    D0180EComp periodontal evaluation
    D0210EIntraor complete film series
    D0220EIntraoral periapical first f
    D0230EIntraoral periapical ea add
    D0240SIntraoral occlusal film03307.1756$425.82$85.16
    D0250SExtraoral first film03307.1756$425.82$85.16
    D0260SExtraoral ea additional film03307.1756$425.82$85.16
    D0270SDental bitewing single film03307.1756$425.82$85.16
    D0272SDental bitewings two films03307.1756$425.82$85.16
    D0274SDental bitewings four films03307.1756$425.82$85.16
    D0277SVert bitewings-sev to eight03307.1756$425.82$85.16
    D0290EDental film skull/facial bon
    D0310EDental saliography
    D0320EDental tmj arthrogram incl i
    D0321EDental other tmj films
    D0322EDental tomographic survey
    D0330EDental panoramic film
    D0340EDental cephalometric film
    D0350EOral/facial images
    D0415EBacteriologic study
    D0416BViral culture
    D0421BGen tst suscept oral disease
    D0425ECaries susceptibility test
    D0431BDiag tst detect mucos abnorm
    D0460SPulp vitality test03307.1756$425.82$85.16
    D0470EDiagnostic casts
    D0472BGross exam, prep & report
    D0473BMicro exam, prep & report
    D0474BMicro w exam of surg margins
    D0475BDecalcification procedure
    D0476BSpec stains for microorganis
    D0477BSpec stains not for microorg
    D0478BImmunohistochemical stains
    D0479BTissue in-situ hybridization
    D0480BCytopath smear prep & report
    D0481BElectron microscopy diagnost
    D0482BDirect immunofluorescence
    D0483BIndirect immunofluorescence
    D0484BConsult slides prep elsewher
    D0485BConsult inc prep of slides
    D0502BOther oral pathology procedu
    D0999BUnspecified diagnostic proce
    D1110EDental prophylaxis adult
    D1120EDental prophylaxis child
    D1201ETopical fluor w prophy child
    D1203ETopical fluor w/o prophy chi
    Start Printed Page 50838
    D1204ETopical fluor w/o prophy adu
    D1205ETopical fluoride w/ prophy a
    D1310ENutri counsel-control caries
    D1320ETobacco counseling
    D1330EOral hygiene instruction
    D1351EDental sealant per tooth
    D1510SSpace maintainer fxd unilat03307.1756$425.82$85.16
    D1515SFixed bilat space maintainer03307.1756$425.82$85.16
    D1520SRemove unilat space maintain03307.1756$425.82$85.16
    D1525SRemove bilat space maintain03307.1756$425.82$85.16
    D1550SRecement space maintainer03307.1756$425.82$85.16
    D2140EAmalgam one surface permanen
    D2150EAmalgam two surfaces permane
    D2160EAmalgam three surfaces perma
    D2161EAmalgam 4 or > surfaces perm
    D2330EResin one surface-anterior
    D2331EResin two surfaces-anterior
    D2332EResin three surfaces-anterio
    D2335EResin 4/> surf or w incis an
    D2390EAnt resin-based cmpst crown
    D2391EPost 1 srfc resinbased cmpst
    D2392EPost 2 srfc resinbased cmpst
    D2393EPost 3 srfc resinbased cmpst
    D2394EPost >=4srfc resinbase cmpst
    D2410EDental gold foil one surface
    D2420EDental gold foil two surface
    D2430EDental gold foil three surfa
    D2510EDental inlay metalic 1 surf
    D2520EDental inlay metallic 2 surf
    D2530EDental inlay metl 3/more sur
    D2542EDental onlay metallic 2 surf
    D2543EDental onlay metallic 3 surf
    D2544EDental onlay metl 4/more sur
    D2610EInlay porcelain/ceramic 1 su
    D2620EInlay porcelain/ceramic 2 su
    D2630EDental onlay porc 3/more sur
    D2642EDental onlay porcelin 2 surf
    D2643EDental onlay porcelin 3 surf
    D2644EDental onlay porc 4/more sur
    D2650EInlay composite/resin one su
    D2651EInlay composite/resin two su
    D2652EDental inlay resin 3/mre sur
    D2662EDental onlay resin 2 surface
    D2663EDental onlay resin 3 surface
    D2664EDental onlay resin 4/mre sur
    D2710ECrown resin laboratory
    D2712ECrown 3/4 resin-based compos
    D2720ECrown resin w/ high noble me
    D2721ECrown resin w/ base metal
    D2722ECrown resin w/ noble metal
    D2740ECrown porcelain/ceramic subs
    D2750ECrown porcelain w/ h noble m
    D2751ECrown porcelain fused base m
    D2752ECrown porcelain w/ noble met
    D2780ECrown 3/4 cast hi noble met
    D2781ECrown 3/4 cast base metal
    D2782ECrown 3/4 cast noble metal
    D2783ECrown 3/4 porcelain/ceramic
    D2790ECrown full cast high noble m
    D2791ECrown full cast base metal
    D2792ECrown full cast noble metal
    D2794ECrown-titanium
    D2799EProvisional crown
    D2910EDental recement inlay
    D2915ERecement cast or prefab post
    D2920EDental recement crown
    Start Printed Page 50839
    D2930EPrefab stnlss steel crwn pri
    D2931EPrefab stnlss steel crown pe
    D2932EPrefabricated resin crown
    D2933EPrefab stainless steel crown
    D2934EPrefab steel crown primary
    D2940EDental sedative filling
    D2950ECore build-up incl any pins
    D2951ETooth pin retention
    D2952EPost and core cast + crown
    D2953EEach addtnl cast post
    D2954EPrefab post/core + crown
    D2955EPost removal
    D2957EEach addtnl prefab post
    D2960ELaminate labial veneer
    D2961ELab labial veneer resin
    D2962ELab labial veneer porcelain
    D2971EAdd proc construct new crown
    D2975ECoping
    D2980ECrown repair
    D2999SDental unspec restorative pr03307.1756$425.82$85.16
    D3110EPulp cap direct
    D3120EPulp cap indirect
    D3220ETherapeutic pulpotomy
    D3221EGross pulpal debridement
    D3230EPulpal therapy anterior prim
    D3240EPulpal therapy posterior pri
    D3310EAnterior
    D3320ERoot canal therapy 2 canals
    D3330ERoot canal therapy 3 canals
    D3331ENon-surg tx root canal obs
    D3332EIncomplete endodontic tx
    D3333EInternal root repair
    D3346ERetreat root canal anterior
    D3347ERetreat root canal bicuspid
    D3348ERetreat root canal molar
    D3351EApexification/recalc initial
    D3352EApexification/recalc interim
    D3353EApexification/recalc final
    D3410EApicoect/perirad surg anter
    D3421ERoot surgery bicuspid
    D3425ERoot surgery molar
    D3426ERoot surgery ea add root
    D3430ERetrograde filling
    D3450ERoot amputation
    D3460SEndodontic endosseous implan03307.1756$425.82$85.16
    D3470EIntentional replantation
    D3910EIsolation- tooth w rubb dam
    D3920ETooth splitting
    D3950ECanal prep/fitting of dowel
    D3999SEndodontic procedure03307.1756$425.82$85.16
    D4210EGingivectomy/plasty per quad
    D4211EGingivectomy/plasty per toot
    D4240EGingival flap proc w/ planin
    D4241EGngvl flap w rootplan 1-3 th
    D4245EApically positioned flap
    D4249ECrown lengthen hard tissue
    D4260SOsseous surgery per quadrant03307.1756$425.82$85.16
    D4261EOsseous surgl-3teethperquad
    D4263SBone replce graft first site03307.1756$425.82$85.16
    D4264SBone replce graft each add03307.1756$425.82$85.16
    D4265EBio mtrls to aid soft/os reg
    D4266EGuided tiss regen resorble
    D4267EGuided tiss regen nonresorb
    D4268SSurgical revision procedure03307.1756$425.82$85.16
    D4270SPedicle soft tissue graft pr03307.1756$425.82$85.16
    D4271SFree soft tissue graft proc03307.1756$425.82$85.16
    Start Printed Page 50840
    D4273SSubepithelial tissue graft03307.1756$425.82$85.16
    D4274EDistal/proximal wedge proc
    D4275ESoft tissue allograft
    D4276ECon tissue w dble ped graft
    D4320EProvision splnt intracoronal
    D4321EProvisional splint extracoro
    D4341EPeriodontal scaling & root
    D4342EPeriodontal scaling 1-3teeth
    D4355SFull mouth debridement03307.1756$425.82$85.16
    D4381SLocalized chemo delivery03307.1756$425.82$85.16
    D4910EPeriodontal maint procedures
    D4920EUnscheduled dressing change
    D4999EUnspecified periodontal proc
    D5110EDentures complete maxillary
    D5120EDentures complete mandible
    D5130EDentures immediat maxillary
    D5140EDentures immediat mandible
    D5211EDentures maxill part resin
    D5212EDentures mand part resin
    D5213EDentures maxill part metal
    D5214EDentures mandibl part metal
    D5225EMaxillary part denture flex
    D5226EMandibular part denture flex
    D5281ERemovable partial denture
    D5410EDentures adjust cmplt maxil
    D5411EDentures adjust cmplt mand
    D5421EDentures adjust part maxill
    D5422EDentures adjust part mandbl
    D5510EDentur repr broken compl bas
    D5520EReplace denture teeth complt
    D5610EDentures repair resin base
    D5620ERep part denture cast frame
    D5630ERep partial denture clasp
    D5640EReplace part denture teeth
    D5650EAdd tooth to partial denture
    D5660EAdd clasp to partial denture
    D5670EReplc tth&acrlc on mtl frmwk
    D5671EReplc tth&acrlc mandibular
    D5710EDentures rebase cmplt maxil
    D5711EDentures rebase cmplt mand
    D5720EDentures rebase part maxill
    D5721EDentures rebase part mandbl
    D5730EDenture reln cmplt maxil ch
    D5731EDenture reln cmplt mand chr
    D5740EDenture reln part maxil chr
    D5741EDenture reln part mand chr
    D5750EDenture reln cmplt max lab
    D5751EDenture reln cmplt mand lab
    D5760EDenture reln part maxil lab
    D5761EDenture reln part mand lab
    D5810EDenture interm cmplt maxill
    D5811EDenture interm cmplt mandbl
    D5820EDenture interm part maxill
    D5821EDenture interm part mandbl
    D5850EDenture tiss conditn maxill
    D5851EDenture tiss condtin mandbl
    D5860EOverdenture complete
    D5861EOverdenture partial
    D5862EPrecision attachment
    D5867EReplacement of precision att
    D5875EProsthesis modification
    D5899ERemovable prosthodontic proc
    D5911SFacial moulage sectional03307.1756$425.82$85.16
    D5912SFacial moulage complete03307.1756$425.82$85.16
    D5913ENasal prosthesis
    D5914EAuricular prosthesis
    Start Printed Page 50841
    D5915EOrbital prosthesis
    D5916EOcular prosthesis
    D5919EFacial prosthesis
    D5922ENasal septal prosthesis
    D5923EOcular prosthesis interim
    D5924ECranial prosthesis
    D5925EFacial augmentation implant
    D5926EReplacement nasal prosthesis
    D5927EAuricular replacement
    D5928EOrbital replacement
    D5929EFacial replacement
    D5931ESurgical obturator
    D5932EPostsurgical obturator
    D5933ERefitting of obturator
    D5934EMandibular flange prosthesis
    D5935EMandibular denture prosth
    D5936ETemp obturator prosthesis
    D5937ETrismus appliance
    D5951EFeeding aid
    D5952EPediatric speech aid
    D5953EAdult speech aid
    D5954ESuperimposed prosthesis
    D5955EPalatal lift prosthesis
    D5958EIntraoral con def inter plt
    D5959EIntraoral con def mod palat
    D5960EModify speech aid prosthesis
    D5982ESurgical stent
    D5983SRadiation applicator03307.1756$425.82$85.16
    D5984SRadiation shield03307.1756$425.82$85.16
    D5985SRadiation cone locator03307.1756$425.82$85.16
    D5986EFluoride applicator
    D5987SCommissure splint03307.1756$425.82$85.16
    D5988ESurgical splint
    D5999EMaxillofacial prosthesis
    D6010EOdontics endosteal implant
    D6040EOdontics eposteal implant
    D6050EOdontics transosteal implnt
    D6053EImplnt/abtmnt spprt remv dnt
    D6054EImplnt/abtmnt spprt remvprtl
    D6055EImplant connecting bar
    D6056EPrefabricated abutment
    D6057ECustom abutment
    D6058EAbutment supported crown
    D6059EAbutment supported mtl crown
    D6060EAbutment supported mtl crown
    D6061EAbutment supported mtl crown
    D6062EAbutment supported mtl crown
    D6063EAbutment supported mtl crown
    D6064EAbutment supported mtl crown
    D6065EImplant supported crown
    D6066EImplant supported mtl crown
    D6067EImplant supported mtl crown
    D6068EAbutment supported retainer
    D6069EAbutment supported retainer
    D6070EAbutment supported retainer
    D6071EAbutment supported retainer
    D6072EAbutment supported retainer
    D6073EAbutment supported retainer
    D6074EAbutment supported retainer
    D6075EImplant supported retainer
    D6076EImplant supported retainer
    D6077EImplant supported retainer
    D6078EImplnt/abut suprtd fixd dent
    D6079EImplnt/abut suprtd fixd dent
    D6080EImplant maintenance
    D6090ERepair implant
    Start Printed Page 50842
    D6094EAbut support crown titanium
    D6095EOdontics repr abutment
    D6100ERemoval of implant
    D6190ERadio/surgical implant index
    D6194EAbut support retainer titani
    D6199EImplant procedure
    D6205EPontic-indirect resin based
    D6210EProsthodont high noble metal
    D6211EBridge base metal cast
    D6212EBridge noble metal cast
    D6214EPontic titanium
    D6240EBridge porcelain high noble
    D6241EBridge porcelain base metal
    D6242EBridge porcelain nobel metal
    D6245EBridge porcelain/ceramic
    D6250EBridge resin w/high noble
    D6251EBridge resin base metal
    D6252EBridge resin w/noble metal
    D6253EProvisional pontic
    D6545EDental retainr cast metl
    D6548EPorcelain/ceramic retainer
    D6600EPorcelain/ceramic inlay 2srf
    D6601EPorc/ceram inlay >= 3 surfac
    D6602ECst hgh nble mtl inlay 2 srf
    D6603ECst hgh nble mtl inlay >=3sr
    D6604ECst bse mtl inlay 2 surfaces
    D6605ECst bse mtl inlay >= 3 surfa
    D6606ECast noble metal inlay 2 sur
    D6607ECst noble mtl inlay >=3 surf
    D6608EOnlay porc/crmc 2 surfaces
    D6609EOnlay porc/crmc >=3 surfaces
    D6610EOnlay cst hgh nbl mtl 2 srfc
    D6611EOnlay cst hgh nbl mtl >=3srf
    D6612EOnlay cst base mtl 2 surface
    D6613EOnlay cst base mtl >=3 surfa
    D6614EOnlay cst nbl mtl 2 surfaces
    D6615EOnlay cst nbl mtl >=3 surfac
    D6624EInlay titanium
    D6634EOnlay titanium
    D6710ECrown-indirect resin based
    D6720ERetain crown resin w hi nble
    D6721ECrown resin w/base metal
    D6722ECrown resin w/noble metal
    D6740ECrown porcelain/ceramic
    D6750ECrown porcelain high noble
    D6751ECrown porcelain base metal
    D6752ECrown porcelain noble metal
    D6780ECrown 3/4 high noble metal
    D6781ECrown 3/4 cast based metal
    D6782ECrown 3/4 cast noble metal
    D6783ECrown 3/4 porcelain/ceramic
    D6790ECrown full high noble metal
    D6791ECrown full base metal cast
    D6792ECrown full noble metal cast
    D6793EProvisional retainer crown
    D6794ECrown titanium
    D6920SDental connector bar03307.1756$425.82$85.16
    D6930EDental recement bridge
    D6940EStress breaker
    D6950EPrecision attachment
    D6970EPost & core plus retainer
    D6971ECast post bridge retainer
    D6972EPrefab post & core plus reta
    D6973ECore build up for retainer
    D6975ECoping metal
    D6976EEach addtnl cast post
    Start Printed Page 50843
    D6977EEach addtl prefab post
    D6980EBridge repair
    D6985EPediatric partial denture fx
    D6999EFixed prosthodontic proc
    D7111SCoronal remnants deciduous t03307.1756$425.82$85.16
    D7140SExtraction erupted tooth/exr03307.1756$425.82$85.16
    D7210SRem imp tooth w mucoper flp03307.1756$425.82$85.16
    D7220SImpact tooth remov soft tiss03307.1756$425.82$85.16
    D7230SImpact tooth remov part bony03307.1756$425.82$85.16
    D7240SImpact tooth remov comp bony03307.1756$425.82$85.16
    D7241SImpact tooth rem bony w/comp03307.1756$425.82$85.16
    D7250STooth root removal03307.1756$425.82$85.16
    D7260SOral antral fistula closure03307.1756$425.82$85.16
    D7261SPrimary closure sinus perf03307.1756$425.82$85.16
    D7270ETooth reimplantation
    D7272ETooth transplantation
    D7280EExposure impact tooth orthod
    D7282EMobilize erupted/malpos toot
    D7283BPlace device impacted tooth
    D7285EBiopsy of oral tissue hard
    D7286EBiopsy of oral tissue soft
    D7287ECytology sample collection
    D7288BBrush biopsy
    D7290ERepositioning of teeth
    D7291STransseptal fiberotomy03307.1756$425.82$85.16
    D7310EAlveoplasty w/ extraction
    D7311EAlveoloplasty w/extract 1-3
    D7320EAlveoplasty w/o extraction
    D7321BAlveoloplasty not w/extracts
    D7340EVestibuloplasty ridge extens
    D7350EVestibuloplasty exten graft
    D7410ERad exc lesion up to 1.25 cm
    D7411EExcision benign lesion>1.25c
    D7412EExcision benign lesion compl
    D7413EExcision malig lesion < =1.25c
    D7414EExcision malig lesion > 1.25cm
    D7415EExcision malig les complicat
    D7440EMalig tumor exc to 1.25 cm
    D7441EMalig tumor > 1.25 cm
    D7450ERem odontogen cyst to 1.25cm
    D7451ERem odontogen cyst > 1.25 cm
    D7460ERem nonodonto cyst to 1.25cm
    D7461ERem nonodonto cyst > 1.25 cm
    D7465ELesion destruction
    D7471ERem exostosis any site
    D7472ERemoval of torus palatinus
    D7473ERemove torus mandibularis
    D7485ESurg reduct osseoustuberosit
    D7490EMandible resection
    D7510EI&d absc intraoral soft tiss
    D7511BIncision/drain abscess intra
    D7520EI&d abscess extraoral
    D7521BIncision/drain abscess extra
    D7530ERemoval fb skin/areolar tiss
    D7540ERemoval of fb reaction
    D7550ERemoval of sloughed off bone
    D7560EMaxillary sinusotomy
    D7610EMaxilla open reduct simple
    D7620EClsd reduct simpl maxilla fx
    D7630EOpen red simpl mandible fx
    D7640EClsd red simpl mandible fx
    D7650EOpen red simp malar/zygom fx
    D7660EClsd red simp malar/zygom fx
    D7670EClosd rductn splint alveolus
    D7671EAlveolus open reduction
    D7680EReduct simple facial bone fx
    Start Printed Page 50844
    D7710EMaxilla open reduct compound
    D7720EClsd reduct compd maxilla fx
    D7730EOpen reduct compd mandble fx
    D7740EClsd reduct compd mandble fx
    D7750EOpen red comp malar/zygma fx
    D7760EClsd red comp malar/zygma fx
    D7770EOpen reduc compd alveolus fx
    D7771EAlveolus clsd reduc stblz te
    D7780EReduct compnd facial bone fx
    D7810ETmj open reduct-dislocation
    D7820EClosed tmp manipulation
    D7830ETmj manipulation under anest
    D7840ERemoval of tmj condyle
    D7850ETmj meniscectomy
    D7852ETmj repair of joint disc
    D7854ETmj excisn of joint membrane
    D7856ETmj cutting of a muscle
    D7858ETmj reconstruction
    D7860ETmj cutting into joint
    D7865ETmj reshaping components
    D7870ETmj aspiration joint fluid
    D7871ELysis + lavage w catheters
    D7872ETmj diagnostic arthroscopy
    D7873ETmj arthroscopy lysis adhesn
    D7874ETmj arthroscopy disc reposit
    D7875ETmj arthroscopy synovectomy
    D7876ETmj arthroscopy discectomy
    D7877ETmj arthroscopy debridement
    D7880EOcclusal orthotic appliance
    D7899ETmj unspecified therapy
    D7910EDent sutur recent wnd to 5cm
    D7911EDental suture wound to 5 cm
    D7912ESuture complicate wnd > 5 cm
    D7920EDental skin graft
    D7940SReshaping bone orthognathic03307.1756$425.82$85.16
    D7941EBone cutting ramus closed
    D7943ECutting ramus open w/graft
    D7944EBone cutting segmented
    D7945EBone cutting body mandible
    D7946EReconstruction maxilla total
    D7947EReconstruct maxilla segment
    D7948EReconstruct midface no graft
    D7949EReconstruct midface w/graft
    D7950EMandible graft
    D7953EBone replacement graft
    D7955ERepair maxillofacial defects
    D7960EFrenulectomy/frenulotomy
    D7963EFrenuloplasty
    D7970EExcision hyperplastic tissue
    D7971EExcision pericoronal gingiva
    D7972ESurg redct fibrous tuberosit
    D7980ESialolithotomy
    D7981EExcision of salivary gland
    D7982ESialodochoplasty
    D7983EClosure of salivary fistula
    D7990EEmergency tracheotomy
    D7991EDental coronoidectomy
    D7995ESynthetic graft facial bones
    D7996EImplant mandible for augment
    D7997EAppliance removal
    D7999EOral surgery procedure
    D8010ELimited dental tx primary
    D8020ELimited dental tx transition
    D8030ELimited dental tx adolescent
    D8040ELimited dental tx adult
    D8050EIntercep dental tx primary
    Start Printed Page 50845
    D8060EIntercep dental tx transitn
    D8070ECompre dental tx transition
    D8080ECompre dental tx adolescent
    D8090ECompre dental tx adult
    D8210EOrthodontic rem appliance tx
    D8220EFixed appliance therapy habt
    D8660EPreorthodontic tx visit
    D8670EPeriodic orthodontc tx visit
    D8680EOrthodontic retention
    D8690EOrthodontic treatment
    D8691ERepair ortho appliance
    D8692EReplacement retainer
    D8999EOrthodontic procedure
    D9110NTx dental pain minor proc
    D9210EDent anesthesia w/o surgery
    D9211ERegional block anesthesia
    D9212ETrigeminal block anesthesia
    D9215ELocal anesthesia
    D9220EGeneral anesthesia
    D9221EGeneral anesthesia ea ad 15m
    D9230NAnalgesia
    D9241EIntravenous sedation
    D9242EIV sedation ea ad 30 m
    D9248NSedation (non-iv)
    D9310EDental consultation
    D9410EDental house call
    D9420EHospital call
    D9430EOffice visit during hours
    D9440EOffice visit after hours
    D9450ECase presentation tx plan
    D9610EDent therapeutic drug inject
    D9630SOther drugs/medicaments03307.1756$425.82$85.16
    D9910EDent appl desensitizing med
    D9911EAppl desensitizing resin
    D9920EBehavior management
    D9930STreatment of complications03307.1756$425.82$85.16
    D9940SDental occlusal guard03307.1756$425.82$85.16
    D9941EFabrication athletic guard
    D9942ERepair/reline occlusal guard
    D9950SOcclusion analysis03307.1756$425.82$85.16
    D9951SLimited occlusal adjustment03307.1756$425.82$85.16
    D9952SComplete occlusal adjustment03307.1756$425.82$85.16
    D9970EEnamel microabrasion
    D9971EOdontoplasty 1-2 teeth
    D9972EExtrnl bleaching per arch
    D9973EExtrnl bleaching per tooth
    D9974EIntrnl bleaching per tooth
    D9999EAdjunctive procedure
    E0100YCane adjust/fixed with tip
    E0105YCane adjust/fixed quad/3 pro
    E0110YCrutch forearm pair
    E0111YCrutch forearm each
    E0112YCrutch underarm pair wood
    E0113YCrutch underarm each wood
    E0114YCrutch underarm pair no wood
    E0116YCrutch underarm each no wood
    E0117YUnderarm springassist crutch
    E0118ECrutch substitute
    E0130YWalker rigid adjust/fixed ht
    E0135YWalker folding adjust/fixed
    E0140YWalker w trunk support
    E0141YRigid wheeled walker adj/fix
    E0143YWalker folding wheeled w/o s
    E0144YEnclosed walker w rear seat
    E0147YWalker variable wheel resist
    E0148YHeavyduty walker no wheels
    Start Printed Page 50846
    E0149YHeavy duty wheeled walker
    E0153YForearm crutch platform atta
    E0154YWalker platform attachment
    E0155YWalker wheel attachment,pair
    E0156YWalker seat attachment
    E0157YWalker crutch attachment
    E0158YWalker leg extenders set of4
    E0159YBrake for wheeled walker
    E0160YSitz type bath or equipment
    E0161YSitz bath/equipment w/faucet
    E0162YSitz bath chair
    E0163YCommode chair stationry fxd
    E0164YCommode chair mobile fixed a
    E0166YCommode chair mobile detach
    E0167YCommode chair pail or pan
    E0168YHeavyduty/wide commode chair
    E0169YSeatlift incorp commodechair
    E0175YCommode chair foot rest
    E0180YPress pad alternating w pump
    E0181YPress pad alternating w/ pum
    E0182YPressure pad alternating pum
    E0184YDry pressure mattress
    E0185YGel pressure mattress pad
    E0186YAir pressure mattress
    E0187YWater pressure mattress
    E0188YSynthetic sheepskin pad
    E0189YLambswool sheepskin pad
    E0190EPositioning cushion
    E0191YProtector heel or elbow
    E0193YPowered air flotation bed
    E0194YAir fluidized bed
    E0196YGel pressure mattress
    E0197YAir pressure pad for mattres
    E0198YWater pressure pad for mattr
    E0199YDry pressure pad for mattres
    E0200YHeat lamp without stand
    E0202YPhototherapy light w/ photom
    E0203ETherapeutic lightbox tabletp
    E0205YHeat lamp with stand
    E0210YElectric heat pad standard
    E0215YElectric heat pad moist
    E0217YWater circ heat pad w pump
    E0218YWater circ cold pad w pump
    E0220YHot water bottle
    E0221EInfrared heating pad system
    E0225YHydrocollator unit
    E0230YIce cap or collar
    E0231EWound warming device
    E0232EWarming card for NWT
    E0235YParaffin bath unit portable
    E0236YPump for water circulating p
    E0238YHeat pad non-electric moist
    E0239YHydrocollator unit portable
    E0240EBath/shower chair
    E0241EBath tub wall rail
    E0242EBath tub rail floor
    E0243EToilet rail
    E0244EToilet seat raised
    E0245ETub stool or bench
    E0246ETransfer tub rail attachment
    E0247ETrans bench w/wo comm open
    E0248EHDtrans bench w/wo comm open
    E0249YPad water circulating heat u
    E0250YHosp bed fixed ht w/ mattres
    E0251YHosp bed fixd ht w/o mattres
    E0255YHospital bed var ht w/ mattr
    Start Printed Page 50847
    E0256YHospital bed var ht w/o matt
    E0260YHosp bed semi-electr w/ matt
    E0261YHosp bed semi-electr w/o mat
    E0265YHosp bed total electr w/ mat
    E0266YHosp bed total elec w/o matt
    E0270EHospital bed institutional t
    E0271YMattress innerspring
    E0272YMattress foam rubber
    E0273EBed board
    E0274EOver-bed table
    E0275YBed pan standard
    E0276YBed pan fracture
    E0277YPowered pres-redu air mattrs
    E0280YBed cradle
    E0290YHosp bed fx ht w/o rails w/m
    E0291YHosp bed fx ht w/o rail w/o
    E0292YHosp bed var ht w/o rail w/o
    E0293YHosp bed var ht w/o rail w/
    E0294YHosp bed semi-elect w/ mattr
    E0295YHosp bed semi-elect w/o matt
    E0296YHosp bed total elect w/ matt
    E0297YHosp bed total elect w/o mat
    E0300YEnclosed ped crib hosp grade
    E0301YHD hosp bed, 350-600 lbs
    E0302YEx hd hosp bed > 600 lbs
    E0303YHosp bed hvy dty xtra wide
    E0304YHosp bed xtra hvy dty × wide
    E0305YRails bed side half length
    E0310YRails bed side full length
    E0315EBed accessory brd/tbl/supprt
    E0316YBed safety enclosure
    E0325YUrinal male jug-type
    E0326YUrinal female jug-type
    E0350EControl unit bowel system
    E0352EDisposable pack w/bowel syst
    E0370EAir elevator for heel
    E0371YNonpower mattress overlay
    E0372YPowered air mattress overlay
    E0373YNonpowered pressure mattress
    E0424YStationary compressed gas 02
    E0425EGas system stationary compre
    E0430EOxygen system gas portable
    E0431YPortable gaseous 02
    E0434YPortable liquid 02
    E0435EOxygen system liquid portabl
    E0439YStationary liquid 02
    E0440EOxygen system liquid station
    E0441YOxygen contents, gaseous
    E0442YOxygen contents, liquid
    E0443YPortable 02 contents, gas
    E0444YPortable 02 contents, liquid
    E0445AOximeter non-invasive
    E0450YVolume vent stationary/porta
    E0455YOxygen tent excl croup/ped t
    E0457YChest shell
    E0459YChest wrap
    E0460YNeg press vent portabl/statn
    E0461YVol vent noninvasive interfa
    E0462YRocking bed w/ or w/o side r
    E0463YPress supp vent invasive int
    E0464YPress supp vent noninv int
    E0470YRAD w/o backup non-inv intfc
    E0471YRAD w/backup non inv intrfc
    E0472YRAD w backup invasive intrfc
    E0480YPercussor elect/pneum home m
    E0481EIntrpulmnry percuss vent sys
    Start Printed Page 50848
    E0482YCough stimulating device
    E0483YChest compression gen system
    E0484YNon-elec oscillatory pep dvc
    E0500YIppb all types
    E0550YHumidif extens supple w ippb
    E0555YHumidifier for use w/ regula
    E0560YHumidifier supplemental w/ i
    E0561YHumidifier nonheated w PAP
    E0562YHumidifier heated used w PAP
    E0565YCompressor air power source
    E0570YNebulizer with compression
    E0571YAerosol compressor for svneb
    E0572YAerosol compressor adjust pr
    E0574YUltrasonic generator w svneb
    E0575YNebulizer ultrasonic
    E0580YNebulizer for use w/ regulat
    E0585YNebulizer w/ compressor & he
    E0590YDispensing fee dme neb drug
    E0600YSuction pump portab hom modl
    E0601YCont airway pressure device
    E0602YManual breast pump
    E0603AElectric breast pump
    E0604AHosp grade elec breast pump
    E0605YVaporizer room type
    E0606YDrainage board postural
    E0607YBlood glucose monitor home
    E0610YPacemaker monitr audible/vis
    E0615YPacemaker monitr digital/vis
    E0616NCardiac event recorder
    E0617YAutomatic ext defibrillator
    E0618AApnea monitor
    E0619AApnea monitor w recorder
    E0620YCap bld skin piercing laser
    E0621YPatient lift sling or seat
    E0625EPatient lift bathroom or toi
    E0627YSeat lift incorp lift-chair
    E0628YSeat lift for pt furn-electr
    E0629YSeat lift for pt furn-non-el
    E0630YPatient lift hydraulic
    E0635YPatient lift electric
    E0636YPT support & positioning sys
    E0637ESit-stand w seatlift wheeled
    E0638EStanding frame sys wheeled
    E0639EMoveable patient lift system
    E0640EFixed patient lift system
    E0650YPneuma compresor non-segment
    E0651YPneum compressor segmental
    E0652YPneum compres w/cal pressure
    E0655YPneumatic appliance half arm
    E0660YPneumatic appliance full leg
    E0665YPneumatic appliance full arm
    E0666YPneumatic appliance half leg
    E0667YSeg pneumatic appl full leg
    E0668YSeg pneumatic appl full arm
    E0669YSeg pneumatic appli half leg
    E0671YPressure pneum appl full leg
    E0672YPressure pneum appl full arm
    E0673YPressure pneum appl half leg
    E0675YPneumatic compression device
    E0691YUvl pnl 2 sq ft or less
    E0692YUvl sys panel 4 ft
    E0693YUvl sys panel 6 ft
    E0694YUvl md cabinet sys 6 ft
    E0700ESafety equipment
    E0701YHelmet w face guard prefab
    E0710ERestraints any type
    Start Printed Page 50849
    E0720YTens two lead
    E0730YTens four lead
    E0731YConductive garment for tens/
    E0740YIncontinence treatment systm
    E0744YNeuromuscular stim for scoli
    E0745YNeuromuscular stim for shock
    E0746EElectromyograph biofeedback
    E0747YElec osteogen stim not spine
    E0748YElec osteogen stim spinal
    E0749NElec osteogen stim implanted
    E0752BNeurostimulator electrode
    E0754APulsegenerator pt programmer
    E0755EElectronic salivary reflex s
    E0756BImplantable pulse generator
    E0757NImplantable RF receiver
    E0758AExternal RF transmitter
    E0759AReplace rdfrquncy transmittr
    E0760YOsteogen ultrasound stimltor
    E0761ENontherm electromgntc device
    E0765YNerve stimulator for tx n&v
    E0769BElectric wound treatment dev
    E0776YIv pole
    E0779YAmb infusion pump mechanical
    E0780YMech amb infusion pump <8hrs
    E0781YExternal ambulatory infus pu
    E0782NNon-programble infusion pump
    E0783NProgrammable infusion pump
    E0784YExt amb infusn pump insulin
    E0785NReplacement impl pump cathet
    E0786NImplantable pump replacement
    E0791YParenteral infusion pump sta
    E0830NAmbulatory traction device
    E0840YTract frame attach headboard
    E0849YCervical pneum trac equip
    E0850YTraction stand free standing
    E0855YCervical traction equipment
    E0860YTract equip cervical tract
    E0870YTract frame attach footboard
    E0880YTrac stand free stand extrem
    E0890YTraction frame attach pelvic
    E0900YTrac stand free stand pelvic
    E0910YTrapeze bar attached to bed
    E0920YFracture frame attached to b
    E0930YFracture frame free standing
    E0935YExercise device passive moti
    E0940YTrapeze bar free standing
    E0941YGravity assisted traction de
    E0942YCervical head harness/halter
    E0944YPelvic belt/harness/boot
    E0945YBelt/harness extremity
    E0946YFracture frame dual w cross
    E0947YFracture frame attachmnts pe
    E0948YFracture frame attachmnts ce
    E0950ETray
    E0951ELoop heel
    E0952EToe loop/holder, each
    E0953EPneumatic tire
    E0954EWheelchair semi-pneumatic ca
    E0955YCushioned headrest
    E0956YW/c lateral trunk/hip suppor
    E0957YW/c medial thigh support
    E0958AWhlchr att- conv 1 arm drive
    E0959BAmputee adapter
    E0960YW/c shoulder harness/straps
    E0961BWheelchair brake extension
    E0966BWheelchair head rest extensi
    Start Printed Page 50850
    E0967YWheelchair hand rims
    E0968YWheelchair commode seat
    E0969YWheelchair narrowing device
    E0970BWheelchair no. 2 footplates
    E0971BWheelchair anti-tipping devi
    E0972ATransfer board or device
    E0973BW/Ch access det adj armrest
    E0974BW/Ch access anti-rollback
    E0977YWheelchair wedge cushion
    E0978BW/C acc,saf belt pelv strap
    E0980YWheelchair safety vest
    E0981YSeat upholstery, replacement
    E0982YBack upholstery, replacement
    E0983YAdd pwr joystick
    E0984YAdd pwr tiller
    E0985YW/c seat lift mechanism
    E0986YMan w/c push-rim pow assist
    E0990BWhellchair elevating leg res
    E0992BWheelchair solid seat insert
    E0994YWheelchair arm rest
    E0995BWheelchair calf rest
    E0996BWheelchair tire solid
    E0997YWheelchair caster w/ a fork
    E0998YWheelchair caster w/o a fork
    E0999YWheelchr pneumatic tire w/wh
    E1000BWheelchair tire pneumatic ca
    E1001YWheelchair wheel
    E1002YPwr seat tilt
    E1003YPwr seat recline
    E1004YPwr seat recline mech
    E1005YPwr seat recline pwr
    E1006YPwr seat combo w/o shear
    E1007YPwr seat combo w/shear
    E1008YPwr seat combo pwr shear
    E1009YAdd mech leg elevation
    E1010YAdd pwr leg elevation
    E1011YPed wc modify width adjustm
    E1014YReclining back add ped w/c
    E1015YShock absorber for man w/c
    E1016YShock absorber for power w/c
    E1017YHD shck absrbr for hd man wc
    E1018YHD shck absrber for hd powwc
    E1019EHD feature power seat
    E1020YResidual limb support system
    E1021EEx hd feature power seat
    E1025EPedwc lat/thor sup nocontour
    E1026EPedwc contoured lat/thor sup
    E1027EPed wc lat/ant support
    E1028YW/c manual swingaway
    E1029YW/c vent tray fixed
    E1030YW/c vent tray gimbaled
    E1031YRollabout chair with casters
    E1035YPatient transfer system
    E1037YTransport chair, ped size
    E1038YTransport chair, adult size
    E1039YTransport chair pt wt>=250lb
    E1050AWhelchr fxd full length arms
    E1060AWheelchair detachable arms
    E1070AWheelchair detachable foot r
    E1083AHemi-wheelchair fixed arms
    E1084AHemi-wheelchair detachable a
    E1085AHemi-wheelchair fixed arms
    E1086AHemi-wheelchair detachable a
    E1087AWheelchair lightwt fixed arm
    E1088AWheelchair lightweight det a
    E1089AWheelchair lightwt fixed arm
    Start Printed Page 50851
    E1090AWheelchair lightweight det a
    E1092AWheelchair wide w/ leg rests
    E1093AWheelchair wide w/ foot rest
    E1100AWhchr s-recl fxd arm leg res
    E1110AWheelchair semi-recl detach
    E1130AWhlchr stand fxd arm ft rest
    E1140AWheelchair standard detach a
    E1150YWheelchair standard w/ leg r
    E1160AWheelchair fixed arms
    E1161AManual adult wc w tiltinspac
    E1170AWhlchr ampu fxd arm leg rest
    E1171AWheelchair amputee w/o leg r
    E1172AWheelchair amputee detach ar
    E1180AWheelchair amputee w/ foot r
    E1190AWheelchair amputee w/ leg re
    E1195AWheelchair amputee heavy dut
    E1200AWheelchair amputee fixed arm
    E1210YWhlchr moto ful arm leg rest
    E1211YWheelchair motorized w/ det
    E1212AWheelchair motorized w full
    E1213AWheelchair motorized w/ det
    E1220AWhlchr special size/constrc
    E1221AWheelchair spec size w foot
    E1222AWheelchair spec size w/ leg
    E1223AWheelchair spec size w foot
    E1224AWheelchair spec size w/ leg
    E1225YWheelchair spec sz semi-recl
    E1226BW/C access fully reclineback
    E1227YWheelchair spec sz spec ht a
    E1228YWheelchair spec sz spec ht b
    E1229YPediatric wheelchair NOS
    E1230YPower operated vehicle
    E1231YRigid ped w/c tilt-in-space
    E1232YFolding ped wc tilt-in-space
    E1233YRig ped wc tltnspc w/o seat
    E1234YFld ped wc tltnspc w/o seat
    E1235YRigid ped wc adjustable
    E1236YFolding ped wc adjustable
    E1237YRgd ped wc adjstabl w/o seat
    E1238YFld ped wc adjstabl w/o seat
    E1239YPed power wheelchair NOS
    E1240AWhchr litwt det arm leg rest
    E1250AWheelchair lightwt fixed arm
    E1260AWheelchair lightwt foot rest
    E1270AWheelchair lightweight leg r
    E1280AWhchr h-duty det arm leg res
    E1285AWheelchair heavy duty fixed
    E1290AWheelchair hvy duty detach a
    E1295AWheelchair heavy duty fixed
    E1296YWheelchair special seat heig
    E1297YWheelchair special seat dept
    E1298YWheelchair spec seat depth/w
    E1300EWhirlpool portable
    E1310YWhirlpool non-portable
    E1340YRepair for DME, per 15 min
    E1353YOxygen supplies regulator
    E1355YOxygen supplies stand/rack
    E1372YOxy suppl heater for nebuliz
    E1390YOxygen concentrator
    E1391YOxygen concentrator, dual
    E1399NDurable medical equipment mi
    E1405YO2/water vapor enrich w/heat
    E1406YO2/water vapor enrich w/o he
    E1500ACentrifuge
    E1510AKidney dialysate delivry sys
    E1520AHeparin infusion pump
    Start Printed Page 50852
    E1530AReplacement air bubble detec
    E1540AReplacement pressure alarm
    E1550ABath conductivity meter
    E1560AReplace blood leak detector
    E1570AAdjustable chair for esrd pt
    E1575ATransducer protect/fld bar
    E1580AUnipuncture control system
    E1590AHemodialysis machine
    E1592AAuto interm peritoneal dialy
    E1594ACycler dialysis machine
    E1600ADeli/install chrg hemo equip
    E1610AReverse osmosis h2o puri sys
    E1615ADeionizer H2O puri system
    E1620AReplacement blood pump
    E1625AWater softening system
    E1630AReciprocating peritoneal dia
    E1632AWearable artificial kidney
    E1634BPeritoneal dialysis clamp
    E1635ACompact travel hemodialyzer
    E1636ASorbent cartridges per 10
    E1637AHemostats for dialysis, each
    E1639ADialysis scale
    E1699ADialysis equipment noc
    E1700YJaw motion rehab system
    E1701YRepl cushions for jaw motion
    E1702YRepl measr scales jaw motion
    E1800YAdjust elbow ext/flex device
    E1801YSPS elbow device
    E1802YAdjst forearm pro/sup device
    E1805YAdjust wrist ext/flex device
    E1806YSPS wrist device
    E1810YAdjust knee ext/flex device
    E1811YSPS knee device
    E1815YAdjust ankle ext/flex device
    E1816YSPS ankle device
    E1818YSPS forearm device
    E1820YSoft interface material
    E1821YReplacement interface SPSD
    E1825YAdjust finger ext/flex devc
    E1830YAdjust toe ext/flex device
    E1840YAdj shoulder ext/flex device
    E1841YStatic str shldr dev rom adj
    E1902AAAC non-electronic board
    E2000YGastric suction pump hme mdl
    E2100YBld glucose monitor w voice
    E2101YBld glucose monitor w lance
    E2120YPulse gen sys tx endolymp fl
    E2201YMan w/ch acc seat w>=20÷<24÷
    E2202YSeat width 24-27 in
    E2203YFrame depth less than 22 in
    E2204YFrame depth 22 to 25 in
    E2205YManual wc accessory, handrim
    E2206YComplete wheel lock assembly
    E2291EPlanar back for ped size wc
    E2292EPlanar seat for ped size wc
    E2293EContour back for ped size wc
    E2294EContour seat for ped size wc
    E2300YPwr seat elevation sys
    E2301YPwr standing
    E2310YElectro connect btw control
    E2311YElectro connect btw 2 sys
    E2320YHand chin control
    E2321YHand interface joystick
    E2322YMult mech switches
    E2323YSpecial joystick handle
    E2324YChin cup interface
    Start Printed Page 50853
    E2325YSip and puff interface
    E2326YBreath tube kit
    E2327YHead control interface mech
    E2328YHead/extremity control inter
    E2329YHead control nonproportional
    E2330YHead control proximity switc
    E2331YAttendant control
    E2340YW/c wdth 20-23 in seat frame
    E2341YW/c wdth 24-27 in seat frame
    E2342YW/c dpth 20-21 in seat frame
    E2343YW/c dpth 22-25 in seat frame
    E2351YElectronic SGD interface
    E2360Y22nf nonsealed leadacid
    E2361Y22nf sealed leadacid battery
    E2362YGr24 nonsealed leadacid
    E2363YGr24 sealed leadacid battery
    E2364YU1nonsealed leadacid battery
    E2365YU1 sealed leadacid battery
    E2366YBattery charger, single mode
    E2367YBattery charger, dual mode
    E2368YPower wc motor replacement
    E2369YPwr wc gear box replacement
    E2370YPwr wc motor/gear box combo
    E2399YNoc interface
    E2402YNeg press wound therapy pump
    E2500YSGD digitized pre-rec <=8min
    E2502YSGD prerec msg >8min <=20min
    E2504YSGD prerec msg>20min <=40min
    E2506YSGD prerec msg > 40 min
    E2508YSGD spelling phys contact
    E2510YSGD w multi methods msg/accs
    E2511YSGD sftwre prgrm for PC/PDA
    E2512YSGD accessory, mounting sys
    E2599YSGD accessory noc
    E2601YGen w/c cushion wdth < 22 in
    E2602YGen w/c cushion wdth >=22 in
    E2603YSkin protect wc cus wd <22in
    E2604YSkin protect wc cus wd>=22in
    E2605YPosition wc cush wdth <22 in
    E2606YPosition wc cush wdth>=22 in
    E2607YSkin pro/pos wc cus wd <22in
    E2608YSkin pro/pos wc cus wd>=22in
    E2609YCustom fabricate w/c cushion
    E2610BPowered w/c cushion
    E2611YGen use back cush wdth <22in
    E2612YGen use back cush wdth>=22in
    E2613YPosition back cush wd <22in
    E2614YPosition back cush wd>=22in
    E2615YPos back post/lat wdth <22in
    E2616YPos back post/lat wdth>=22in
    E2617YCustom fab w/c back cushion
    E2618YWc acc solid seat supp base
    E2619YReplace cover w/c seat cush
    E2620YWC planar back cush wd <22in
    E2621YWC planar back cush wd>=22in
    E8000EPosterior gait trainer
    E8001EUpright gait trainer
    E8002EAnterior gait trainer
    G0008XAdmin influenza virus vac03500.3954$23.46$0.00$0.00
    G0009XAdmin pneumococcal vaccine03500.3954$23.46$0.00$0.00
    G0010BAdmin hepatitis b vaccine
    G0027ASemen analysis
    G0101VCA screen pelvic/breast exam06000.8688$51.56$10.31
    G0102NProstate ca screening dre
    G0103APsa, total screening
    G0104SCA screen flexi sigmoidscope01593.1455$186.66$46.67
    Start Printed Page 50854
    G0105TColorectal scrn hi risk ind01587.6588$454.50$113.63
    G0106SColon CA screen barium enema01572.2904$135.92$27.18
    G0107ACA screen fecal blood test
    G0108ADiab manage trn per indiv
    G0109ADiab manage trn ind/group
    G0110ANett pulm-rehab educ ind
    G0111ANett pulm-rehab educ group
    G0112ANett nutrition guid, initial
    G0113ANett nutrition guid,subseqnt
    G0114ANett psychosocial consult
    G0115ANett psychological testing
    G0116ANett psychosocial counsel
    G0117SGlaucoma scrn hgh risk direc02300.7858$46.63$14.97$9.33
    G0118SGlaucoma scrn hgh risk direc02300.7858$46.63$14.97$9.33
    G0120SColon ca scrn barium enema01572.2904$135.92$27.18
    G0121TColon ca scrn not hi rsk ind01587.6588$454.50$113.63
    G0122EColon ca scrn barium enema
    G0123AScreen cerv/vag thin layer
    G0124AScreen c/v thin layer by MD
    G0127TTrim nail(s)00090.668$39.64$8.34$7.93
    G0128BCORF skilled nursing service
    G0129PPartial hosp prog service00334.0708$241.57$48.31
    G0130XSingle energy x-ray study02600.7555$44.83$17.93$8.97
    G0141EScr c/v cyto,autosys and md
    G0143AScr c/v cyto,thinlayer,rescr
    G0144AScr c/v cyto,thinlayer,rescr
    G0145AScr c/v cyto,thinlayer,rescr
    G0147AScr c/v cyto, automated sys
    G0148AScr c/v cyto, autosys, rescr
    G0151BHHCP-serv of pt,ea 15 min
    G0152BHHCP-serv of ot,ea 15 min
    G0153BHHCP-svs of s/l path,ea 15mn
    G0154BHHCP-svs of rn,ea 15 min
    G0155BHHCP-svs of csw,ea 15 min
    G0156BHHCP-svs of aide,ea 15 min
    G0166TExtrnl counterpulse, per tx06781.7276$102.52$20.50
    G0168NWound closure by adhesive
    G0173SLinear acc stereo radsur com1528$5,250.00$1,050.00
    G0175VOPPS Service,sched team conf06021.4284$84.77$16.95
    G0176POPPS/PHP activity therapy00334.0708$241.57$48.31
    G0177POPPS/PHP train & educ serv00334.0708$241.57$48.31
    G0179EMD recertification HHA PT
    G0180EMD certification HHA patient
    G0181EHome health care supervision
    G0182EHospice care supervision
    G0186TDstry eye lesn,fdr vssl tech02354.6593$276.50$67.40$55.30
    G0202AScreeningmammographydigital
    G0204ADiagnosticmammographydigital
    G0206ADiagnosticmammographydigital
    G0219EPET img whbd ring noncov ind
    G0235EPET not otherwise specified
    G0237STherapeutic procd strg endur04110.3869$22.96$4.59
    G0238SOth resp proc, indiv04110.3869$22.96$4.59
    G0239SOth resp proc, group04110.3869$22.96$4.59
    G0243SMultisour photon stero treat1528$5,250.00$1,050.00
    G0244BObserv care by facility topt
    G0245VInitial Foot Exam PTLOPS06000.8688$51.56$10.31
    G0246VFollowup eval of foot pt lop06000.8688$51.56$10.31
    G0247TRoutine footcare pt w lops00090.668$39.64$8.34$7.93
    G0248SDemonstrate use home inr mon1503$150.00$30.00
    G0249SProvide test material,equipm1503$150.00$30.00
    G0250EMD review interpret of test
    G0251SLinear acc based stero radio1513$1,150.00$230.00
    G0252EPET imaging initial dx
    G0255ECurrent percep threshold tst
    G0257SUnsched dialysis ESRD pt hos01705.8994$350.09$70.02
    Start Printed Page 50855
    G0258XIV infusion during obs stay03400.6384$37.88$7.58
    G0259NInject for sacroiliac joint
    G0260TInj for sacroiliac jt anesth02065.492$325.91$75.55$65.18
    G0263BAdm with CHF, CP, asthma
    G0264BAssmt otr CHF, CP, asthma
    G0265ACryopresevation Freeze+stora
    G0266AThawing + expansion froz cel
    G0267SBone marrow or psc harvest01103.6594$217.16$43.43
    G0268XRemoval of impacted wax md03400.6384$37.88$7.58
    G0269NOcclusive device in vein art
    G0270AMNT subs tx for change dx
    G0271AGroup MNT 2 or more 30 mins
    G0275NRenal angio, cardiac cath
    G0278NIliac art angio,cardiac cath
    G0279AExcorp shock tx, elbow epi
    G0280AExcorp shock tx other than
    G0281AElec stim unattend for press
    G0282EElect stim wound care not pd
    G0283AElec stim other than wound
    G0288SRecon, CTA for pre & post su04174.075$241.82$48.36
    G0289NArthro, loose body + chondro
    G0290TDrug-eluting stents, single0656109.9237$6,523.20$1,304.64
    G0291TDrug-eluting stents,each add0656109.9237$6,523.20$1,304.64
    G0293SNon-cov surg proc,clin trial1505$350.00$70.00
    G0294SNon-cov proc, clinical trial1502$75.00$15.00
    G0295EElectromagnetic therapy onc
    G0297TInsert single chamber/cd0107260.0295$15,430.93$3,103.22$3,086.19
    G0298TInsert dual chamber/cd0107260.0295$15,430.93$3,103.22$3,086.19
    G0299TInser/repos single icd+leads0108349.1681$20,720.68$4,144.14
    G0300TInsert reposit lead dual+gen0108349.1681$20,720.68$4,144.14
    G0302SPre-op service LVRS complete1509$750.00$150.00
    G0303SPre-op service LVRS 10-15dos507$550.00$110.00
    G0304SPre-op service LVRS 1-9 dos1504$250.00$50.00
    G0305SPost op service LVRS min 61504$250.00$50.00
    G0306ACBC/diffwbc w/o platelet
    G0307ACBC without platelet
    G0308AESRD related svc 4+mo<2yrs
    G0309AESRD related svc 2-3mo<2yrs
    G0310AESRD related svc 1vst<2yr
    G0311AESRD related svs 4+mo 2-11yr
    G0312AESRD relate svs 2-3 mo 2-11y
    G0313AESRD related svs 1 mon 2-11y
    G0314AESRD relate svs 4+mo 12-19
    G0315AESRD related svs 2-3 mo 12-1
    G0316AESRD related svs 1 vis/12-19
    G0317AESRD related svs 4+mo 20+yrs
    G0318AESRD related svs 2-3 mo 20+y
    G0319AESRD related svs 1visit 20+y
    G0320AESRD related svs home under
    G0321AESRDrelatedsvs home mo 2-11y
    G0322AESRD related svs home mo 12-1
    G0323AESRD related svs home mo 20+
    G0324AESRD related svs home/dy/2y
    G0325AESRD relate home/dy 2-11yr
    G0326AESRD relate home/dy 12-19y
    G0327AESRD relate home/dy 20+yrs
    G0328AFecal blood scrn immunoassay
    G0329AElectromagntic tx for ulcers
    G0337AHospice evaluation preelecti
    G0339SRobot lin-radsurg com, first1528$5,250.00$1,050.00
    G0340SRobt lin-radsurg fractx 2-51525$3,750.00$750.00
    G0341CPercutaneous islet celltrans
    G0342CLaparoscopy Islet cell Trans
    G0343CLaparotomy Islet cell tranp
    G0344VInitial preventive exam06011.0038$59.57$11.91
    G0345MIV infuse hydration initial
    Start Printed Page 50856
    G0346MEach additional infuse hours
    G0347MIV infusion therapy/diagnost
    G0348Meach additional hr up to 8hr
    G0349Madditional sequential infuse
    G0350Mconcurrent infusion
    G0351Mtherapeutic/diagnostic injec
    G0353MIV push,single orinitial dru
    G0354Meach addition sequential IV
    G0355Mchemo administrate subcut/IM
    G0356Mhormonal anti-neoplastic
    G0357MIV push single/initial subst
    G0358MIV push each additional drug
    G0359Mchemotherapy IV one hr initi
    G0360Meach additional hr 1-8 hrs
    G0361Mprolong chemo Infuse>8hrs pu
    G0362Meach add sequential infusion
    G0363Mirrigate implanted venous de
    G0364XBone marrow aspirate & biops03420.156$9.26$3.70$1.85
    G0365SVessel mapping hemo access02672.6327$156.23$62.18$31.25
    G0366BEKG for initial prevent exam
    G0367SEKG tracing for initial prev00990.3821$22.67$4.53
    G0368MEKG interpret & report preve
    G0369MPharm fee 1st month transpla
    G0370MPharmacy fee oral cancer etc
    G0371MPharm dispense inhalation 30
    G0374MPharm dispense inhalation 90
    G0375SSmoke/Tobacco counseling 3-11491$5.00$1.00
    G0376SSmoke/Tobacco counseling >101491$5.00$1.00
    G3001SAdmin + supply, tositumomab1522$2,250.00$450.00
    G9001BMCCD, initial rate
    G9002BMCCD,maintenance rate
    G9003BMCCD, risk adj hi, initial
    G9004BMCCD, risk adj lo, initial
    G9005BMCCD, risk adj, maintenance
    G9006BMCCD, Home monitoring
    G9007BMCCD, sch team conf
    G9008BMccd,phys coor-care ovrsght
    G9009EMCCD, risk adj, level 3
    G9010EMCCD, risk adj, level 4
    G9011EMCCD, risk adj, level 5
    G9012EOther Specified Case Mgmt
    G9013EESRD demo bundle level I
    G9014EESRD demo bundle-level II
    G9016EDemo-smoking cessation coun
    G9017AAmantadine HCL,oral
    G9018AZanamivir, inh pwdr
    G9019AOseltamivir phosp
    G9020ARimantadine HCL
    G9021MChemo assess nausea vomit L1
    G9022MChemo assess nausea vomit L2
    G9023MChemo assess nausea vomit L3
    G9024MChemo assess nausea vomit L4
    G9025MChemo assessment pain level1
    G9026MChemo assessment pain level2
    G9027MChemo assessment pain level3
    G9028MChemo assessment pain level4
    G9029MChemo assess for fatigue L1
    G9030MChemo assess for fatigue L2
    G9031MChemo assess for fatigue L3
    G9032MChemo assess for fatigue L4
    G9033AAmantadine HCL, oral, brand
    G9034AZanamivir, inh pwdr, brand
    G9035AOseltamivir phosp, brand
    G9036ARimantadine HCL, brand
    G9041ALow vision serv occupational
    G9042ALow vision orient/mobility
    Start Printed Page 50857
    G9043ALow vision rehab therapist
    G9044ALow vision rehab teacher
    J0120NTetracyclin injection
    J0128GAbarelix injection9216$66.96$13.39
    J0130KAbciximab injection1605$450.60$90.12
    J0135KAdalimumab injection1083$300.10$60.02
    J0150KInjection adenosine 6 MG0379$33.45$6.69
    J0152KAdenosine injection0917$71.53$14.31
    J0170NAdrenalin epinephrin inject
    J0180KAgalsidase beta injection9208$123.35$24.67
    J0190NInj biperiden lactate/5 mg
    J0200NAlatrofloxacin mesylate
    J0205KAlglucerase injection0900$39.94$7.99
    J0207KAmifostine7000$436.01$87.20
    J0210KMethyldopate hcl injection2210$9.58$1.92
    J0215BAlefacept
    J0256KAlpha 1 proteinase inhibitor0901$3.30$0.66
    J0270BAlprostadil for injection
    J0275BAlprostadil urethral suppos
    J0280NAminophyllin 250 MG inj
    J0282NAmiodarone HCl
    J0285KAmphotericin B9030$30.70$6.14
    J0287KAmphotericin b lipid complex9024$11.95$2.39
    J0288KAmpho b cholesteryl sulfate0735$12.24$2.45
    J0289KAmphotericin b liposome inj0736$21.91$4.38
    J0290NAmpicillin 500 MG inj
    J0295NAmpicillin sodium per 1.5 gm
    J0300NAmobarbital 125 MG inj
    J0330NSuccinycholine chloride inj
    J0350NInjection anistreplase 30 u
    J0360NHydralazine hcl injection
    J0380NInj metaraminol bitartrate
    J0390NChloroquine injection
    J0395KArbutamine HCl injection9031$163.15$32.63
    J0456NAzithromycin
    J0460NAtropine sulfate injection
    J0470NDimecaprol injection
    J0475KBaclofen 10 MG injection9032$188.01$37.60
    J0476BBaclofen intrathecal trial
    J0500NDicyclomine injection
    J0515NInj benztropine mesylate
    J0520NBethanechol chloride inject
    J0530NPenicillin g benzathine inj
    J0540NPenicillin g benzathine inj
    J0550NPenicillin g benzathine inj
    J0560NPenicillin g benzathine inj
    J0570NPenicillin g benzathine inj
    J0580KPenicillin g benzathine inj0880$72.26$14.45
    J0583NBivalirudin
    J0585KBotulinum toxin a per unit0902$4.80$0.96
    J0587KBotulinum toxin type B9018$7.89$1.58
    J0592NBuprenorphine hydrochloride
    J0595NButorphanol tartrate 1 mg
    J0600KEdetate calcium disodium inj0892$40.34$8.07
    J0610NCalcium gluconate injection
    J0620NCalcium glycer & lact/10 ML
    J0630KCalcitonin salmon injection0893$35.68$7.14
    J0636NInj calcitriol per 0.1 mcg
    J0637KCaspofungin acetate9019$32.35$6.47
    J0640NLeucovorin calcium injection
    J0670NInj mepivacaine HCL/10 ml
    J0690NCefazolin sodium injection
    J0692NCefepime HCl for injection
    J0694NCefoxitin sodium injection
    J0696NCeftriaxone sodium injection
    J0697NSterile cefuroxime injection
    Start Printed Page 50858
    J0698NCefotaxime sodium injection
    J0702NBetamethasone acet&sod phosp
    J0704NBetamethasone sod phosp/4 MG
    J0706KCaffeine citrate injection0876$3.34$0.67
    J0710NCephapirin sodium injection
    J0713NInj ceftazidime per 500 mg
    J0715NCeftizoxime sodium / 500 MG
    J0720NChloramphenicol sodium injec
    J0725NChorionic gonadotropin/1000u
    J0735KClonidine hydrochloride0935$57.47$11.49
    J0740KCidofovir injection9033$782.98$156.60
    J0743NCilastatin sodium injection
    J0744NCiprofloxacin iv
    J0745NInj codeine phosphate /30 MG
    J0760NColchicine injection
    J0770NColistimethate sodium inj
    J0780NProchlorperazine injection
    J0800KCorticotropin injection1280$95.44$19.09
    J0835KInj cosyntropin per 0.25 MG0835$69.27$13.85
    J0850KCytomegalovirus imm IV /vial0903$683.07$136.61
    J0878GDaptomycin injection9124$0.30$0.06
    J0880EDarbepoetin alfa injection
    J0895KDeferoxamine mesylate inj0895$14.91$2.98
    J0900NTestosterone enanthate inj
    J0945NBrompheniramine maleate inj
    J0970NEstradiol valerate injection
    J1000NDepo-estradiol cypionate inj
    J1020NMethylprednisolone 20 MG inj
    J1030NMethylprednisolone 40 MG inj
    J1040NMethylprednisolone 80 MG inj
    J1051NMedroxyprogesterone inj
    J1055EMedrxyprogester acetate inj
    J1056EMA/EC contraceptiveinjection
    J1060NTestosterone cypionate 1 ML
    J1070NTestosterone cypionat 100 MG
    J1080NTestosterone cypionat 200 MG
    J1094NInj dexamethasone acetate
    J1100NDexamethasone sodium phos
    J1110KInj dihydroergotamine mesylt1210$27.82$5.56
    J1120NAcetazolamid sodium injectio
    J1160NDigoxin injection
    J1165NPhenytoin sodium injection
    J1170NHydromorphone injection
    J1180KDyphylline injection9166$7.74$1.55
    J1190KDexrazoxane HCl injection0726$216.39$43.28
    J1200NDiphenhydramine hcl injectio
    J1205NChlorothiazide sodium inj
    J1212NDimethyl sulfoxide 50% 50 ML
    J1230NMethadone injection
    J1240NDimenhydrinate injection
    J1245NDipyridamole injection
    J1250NInj dobutamine HCL/250 mg
    J1260KDolasetron mesylate0750$6.55$1.31
    J1270NInjection, doxercalciferol
    J1320NAmitriptyline injection
    J1325NEpoprostenol injection
    J1327KEptifibatide injection1607$12.73$2.55
    J1330KErgonovine maleate injection13300.5263$31.23$6.25
    J1335NErtapenem injection
    J1364NErythro lactobionate /500 MG
    J1380NEstradiol valerate 10 MG inj
    J1390NEstradiol valerate 20 MG inj
    J1410KInj estrogen conjugate 25 MG9038$57.77$11.55
    J1435NInjection estrone per 1 MG
    J1436KEtidronate disodium inj1436$68.69$13.74
    J1438KEtanercept injection1608$152.11$30.42
    Start Printed Page 50859
    J1440KFilgrastim 300 mcg injection0728$178.39$35.68
    J1441KFilgrastim 480 mcg injection7049$282.29$56.46
    J1450NFluconazole
    J1452KIntraocular Fomivirsen na9040$203.93$40.79
    J1455NFoscarnet sodium injection
    J1457KGallium nitrate injection1085$1.30$0.26
    J1460NGamma globulin 1 CC inj
    J1470BGamma globulin 2 CC inj
    J1480BGamma globulin 3 CC inj
    J1490BGamma globulin 4 CC inj
    J1500BGamma globulin 5 CC inj
    J1510BGamma globulin 6 CC inj
    J1520BGamma globulin 7 CC inj
    J1530BGamma globulin 8 CC inj
    J1540BGamma globulin 9 CC inj
    J1550BGamma globulin 10 CC inj
    J1560BGamma globulin > 10 CC inj
    J1563EIV immune globulin
    J1564EImmune globulin 10 mg
    J1565KRSV-ivig0906$15.56$3.11
    J1570NGanciclovir sodium injection
    J1580NGaramycin gentamicin inj
    J1590NGatifloxacin injection
    J1595NInjection glatiramer acetate
    J1600NGold sodium thiomaleate inj
    J1610KGlucagon hydrochloride/1 MG9042$62.16$12.43
    J1620KGonadorelin hydroch/ 100 mcg7005$173.44$34.69
    J1626KGranisetron HCl injection0764$7.24$1.45
    J1630NHaloperidol injection
    J1631NHaloperidol decanoate inj
    J1642NInj heparin sodium per 10 u
    J1644NInj heparin sodium per 1000u
    J1645NDalteparin sodium
    J1650NInj enoxaparin sodium
    J1652NFondaparinux sodium
    J1655KTinzaparin sodium injection1655$2.53$0.51
    J1670KTetanus immune globulin inj1670$76.90$15.38
    J1700NHydrocortisone acetate inj
    J1710NHydrocortisone sodium ph inj
    J1720NHydrocortisone sodium succ i
    J1730KDiazoxide injection1740$113.86$22.77
    J1742KIbutilide fumarate injection9044$243.34$48.67
    J1745KInfliximab injection7043$54.20$10.84
    J1750KIron dextran9045$11.43$2.29
    J1756KIron sucrose injection9046$0.38$0.08
    J1785KInjection imiglucerase /unit0916$3.98$0.80
    J1790NDroperidol injection
    J1800NPropranolol injection
    J1810EDroperidol/fentanyl inj
    J1815NInsulin injection
    J1817NInsulin for insulin pump use
    J1825EInterferon beta-1a
    J1830KInterferon beta-1b / .25 MG0910$81.95$16.39
    J1835KItraconazole injection9047$36.93$7.39
    J1840NKanamycin sulfate 500 MG inj
    J1850NKanamycin sulfate 75 MG inj
    J1885NKetorolac tromethamine inj
    J1890NCephalothin sodium injection
    J1931KLaronidase injection9209$23.16$4.63
    J1940NFurosemide injection
    J1950KLeuprolide acetate /3.75 MG0800$441.78$88.36
    J1955BInj levocarnitine per 1 gm
    J1956NLevofloxacin injection
    J1960NLevorphanol tartrate inj
    J1980NHyoscyamine sulfate inj
    J1990NChlordiazepoxide injection
    Start Printed Page 50860
    J2001NLidocaine injection
    J2010NLincomycin injection
    J2020KLinezolid injection9001$24.15$4.83
    J2060NLorazepam injection
    J2150NMannitol injection
    J2175NMeperidine hydrochl /100 MG
    J2180NMeperidine/promethazine inj
    J2185NMeropenem
    J2210NMethylergonovin maleate inj
    J2250NInj midazolam hydrochloride
    J2260NInj milrinone lactate / 5 MG
    J2270NMorphine sulfate injection
    J2271NMorphine so4 injection 100mg
    J2275NMorphine sulfate injection
    J2280NInj, moxifloxacin 100 mg
    J2300NInj nalbuphine hydrochloride
    J2310NInj naloxone hydrochloride
    J2320NNandrolone decanoate 50 MG
    J2321NNandrolone decanoate 100 MG
    J2322NNandrolone decanoate 200 MG
    J2324KNesiritide9114$75.19$15.04
    J2353KOctreotide injection, depot1207$87.40$17.48
    J2354NOctreotide inj, non-depot
    J2355KOprelvekin injection7011$249.06$49.81
    J2357GOmalizumab injection9300$15.98$3.20
    J2360NOrphenadrine injection
    J2370NPhenylephrine hcl injection
    J2400NChloroprocaine hcl injection
    J2405KOndansetron hcl injection0768$3.80$0.76
    J2410NOxymorphone hcl injection
    J2430KPamidronate disodium /30 MG0730$58.42$11.68
    J2440NPapaverin hcl injection
    J2460NOxytetracycline injection
    J2469KPalonosetron HCl9210$18.42$3.68
    J2501NParicalcitol
    J2505KInjection, pegfilgrastim 6mg9119$2,178.28$435.66
    J2510NPenicillin g procaine inj
    J2515NPentobarbital sodium inj
    J2540NPenicillin g potassium inj
    J2543NPiperacillin/tazobactam
    J2545YPentamidine isethionte/300mg
    J2550NPromethazine hcl injection
    J2560NPhenobarbital sodium inj
    J2590NOxytocin injection
    J2597NInj desmopressin acetate
    J2650NPrednisolone acetate inj
    J2670NTotazoline hcl injection
    J2675NInj progesterone per 50 MG
    J2680NFluphenazine decanoate 25 MG
    J2690NProcainamide hcl injection
    J2700NOxacillin sodium injeciton
    J2710NNeostigmine methylslfte inj
    J2720NInj protamine sulfate/10 MG
    J2725NInj protirelin per 250 mcg
    J2730KPralidoxime chloride inj2730$76.68$15.34
    J2760NPhentolaine mesylate inj
    J2765NMetoclopramide hcl injection
    J2770KQuinupristin/dalfopristin2770$105.48$21.10
    J2780NRanitidine hydrochloride inj
    J2783GRasburicase0738$109.18$21.84
    J2788KRho d immune globulin 50 mcg9023$25.08$5.02
    J2790KRho d immune globulin inj0884$113.91$22.78
    J2792KRho(D) immune globulin h, sd1609$12.04$2.41
    J2794GRisperidone, long acting9125$4.71$0.94
    J2795NRopivacaine HCl injection
    J2800NMethocarbamol injection
    Start Printed Page 50861
    J2810NInj theophylline per 40 MG
    J2820KSargramostim injection0731$21.11$4.22
    J2910NAurothioglucose injeciton
    J2912NSodium chloride injection
    J2916NNa ferric gluconate complex
    J2920NMethylprednisolone injection
    J2930NMethylprednisolone injection
    J2940KSomatrem injection2940$43.14$8.63
    J2941KSomatropin injection7034$42.93$8.59
    J2950NPromazine hcl injection
    J2993KReteplase injection9005$898.81$179.76
    J2995KInj streptokinase /250000 IU0911$83.36$16.67
    J2997KAlteplase recombinant7048$30.65$6.13
    J3000NStreptomycin injection
    J3010NFentanyl citrate injeciton
    J3030KSumatriptan succinate / 6 MG3030$51.03$10.21
    J3070NPentazocine hcl injection
    J3100KTenecteplase injection9002$2,052.77$410.55
    J3105NTerbutaline sulfate inj
    J3110BTeriparatide injection
    J3120NTestosterone enanthate inj
    J3130NTestosterone enanthate inj
    J3140NTestosterone suspension inj
    J3150NTestosteron propionate inj
    J3230NChlorpromazine hcl injection
    J3240KThyrotropin injection9108$712.58$142.52
    J3246KTirofiban HCl7041$7.89$1.58
    J3250NTrimethobenzamide hcl inj
    J3260NTobramycin sulfate injection
    J3265NInjection torsemide 10 mg/ml
    J3280NThiethylperazine maleate inj
    J3301NTriamcinolone acetonide inj
    J3302NTriamcinolone diacetate inj
    J3303NTriamcinolone hexacetonl inj
    J3305KInj trimetrexate glucoronate7045$139.85$27.97
    J3310NPerphenazine injeciton
    J3315KTriptorelin pamoate9122$369.98$74.00
    J3320NSpectinomycn di-hcl inj
    J3350KUrea injection90511.0454$62.04$12.41
    J3360NDiazepam injection
    J3364NUrokinase 5000 IU injection
    J3365KUrokinase 250,000 IU inj7036$415.69$83.14
    J3370NVancomycin hcl injection
    J3396KVerteporfin injection1203$9.16$1.83
    J3400NTriflupromazine hcl inj
    J3410NHydroxyzine hcl injection
    J3411NThiamine hcl 100 mg
    J3415NPyridoxine hcl 100 mg
    J3420NVitamin b12 injection
    J3430NVitamin k phytonadione inj
    J3465KInjection, voriconazole1052$4.63$0.93
    J3470NHyaluronidase injection
    J3475NInj magnesium sulfate
    J3480NInj potassium chloride
    J3485NZidovudine
    J3486NZiprasidone mesylate
    J3487KZoledronic acid9115$202.41$40.48
    J3490NDrugs unclassified injection
    J3520EEdetate disodium per 150 mg
    J3530NNasal vaccine inhalation
    J3535EMetered dose inhaler drug
    J3570ELaetrile amygdalin vit B17
    J3590NUnclassified biologics
    J7030NNormal saline solution infus
    J7040NNormal saline solution infus
    J7042N5% dextrose/normal saline
    Start Printed Page 50862
    J7050NNormal saline solution infus
    J7051NSterile saline/water
    J7060N5% dextrose/water
    J7070ND5w infusion
    J7100NDextran 40 infusion
    J7110NDextran 75 infusion
    J7120NRingers lactate infusion
    J7130NHypertonic saline solution
    J7190KFactor viii0925$0.51$0.10
    J7191KFactor VIII (porcine)0926$1.75$0.35
    J7192KFactor viii recombinant0927$0.94$0.19
    J7193KFactor IX non-recombinant0931$0.75$0.15
    J7194KFactor ix complex0928$0.52$0.10
    J7195KFactor IX recombinant0932$0.86$0.17
    J7197NAntithrombin iii injection
    J7198KAnti-inhibitor0929$1.12$0.22
    J7199BHemophilia clot factor noc
    J7300EIntraut copper contraceptive
    J7302ELevonorgestrel iu contracept
    J7303EContraceptive vaginal ring
    J7304EContraceptive hormone patch
    J7308KAminolevulinic acid hcl top7308$96.79$19.36
    J7310KGanciclovir long act implant0913$4,318.68$863.74
    J7317KSodium hyaluronate injection7316$110.65$22.13
    J7320KHylan G-F 20 injection1611$203.15$40.63
    J7330BCultured chondrocytes implnt
    J7340EMetabolic active D/E tissue
    J7342KMetabolically active tissue9054$15.69$3.14
    J7343BNonmetabolic act d/e tissue
    J7344KNonmetabolic active tissue9156$53.76$10.75
    J7350KInjectable human tissue9055$3.54$0.71
    J7500NAzathioprine oral 50mg
    J7501KAzathioprine parenteral0887$47.40$9.48
    J7502KCyclosporine oral 100 mg0888$3.94$0.79
    J7504KLymphocyte immune globulin0890$290.30$58.06
    J7505KMonoclonal antibodies7038$885.3677.07
    J7506NPrednisone oral
    J7507KTacrolimus oral per 1 MG0891$3.37$0.67
    J7509NMethylprednisolone oral
    J7510NPrednisolone oral per 5 mg
    J7511KAntithymocyte globuln rabbit9104$299.47$59.89
    J7513KDaclizumab, parenteral1612$381.48$76.30
    J7515KCyclosporine oral 25 mg7515$1.00$0.20
    J7516NCyclosporin parenteral 250mg
    J7517KMycophenolate mofetil oral9015$2.50$0.50
    J7518GMycophenolic acid9219$2.47$0.49
    J7520KSirolimus, oral9020$6.85$1.37
    J7525KTacrolimus injection9006$126.61$25.32
    J7599NImmunosuppressive drug noc
    J7608YAcetylcysteine inh sol u d
    J7611YAlbuterol concentrated form
    J7612YLevalbuterol concentrated
    J7613YAlbuterol unit dose
    J7614YLevalbuterol unit dose
    J7616YAlbuterol compound solution
    J7617YLevalbuterol compounded sol
    J7622ABeclomethasone inhalatn sol
    J7624ABetamethasone inhalation sol
    J7626ABudesonide inhalation sol
    J7628YBitolterol mes inhal sol con
    J7629YBitolterol mes inh sol u d
    J7631YCromolyn sodium inh sol u d
    J7633NBudesonide concentrated sol
    J7635YAtropine inhal sol con
    J7636YAtropine inhal sol unit dose
    J7637YDexamethasone inhal sol con
    Start Printed Page 50863
    J7638YDexamethasone inhal sol u d
    J7639YDornase alpha inhal sol u d
    J7641AFlunisolide, inhalation sol
    J7642YGlycopyrrolate inhal sol con
    J7643YGlycopyrrolate inhal sol u d
    J7644YIpratropium brom inh sol u d
    J7648YIsoetharine hcl inh sol con
    J7649YIsoetharine hcl inh sol u d
    J7658YIsoproterenolhcl inh sol con
    J7659YIsoproterenol hcl inh sol ud
    J7668YMetaproterenol inh sol con
    J7669YMetaproterenol inh sol u d
    J7674NMethacholine chloride, neb
    J7680YTerbutaline so4 inh sol con
    J7681YTerbutaline so4 inh sol u d
    J7682YTobramycin inhalation sol
    J7683YTriamcinolone inh sol con
    J7684YTriamcinolone inh sol u d
    J7699YInhalation solution for DME
    J7799YNon-inhalation drug for DME
    J8499EOral prescrip drug non chemo
    J8501GOral aprepitant0868$4.75$0.95
    J8510KOral busulfan7015$1.98$0.40
    J8520KCapecitabine, oral, 150 mg7042$3.30$0.66
    J8521ECapecitabine, oral, 500 mg
    J8530NCyclophosphamide oral 25 MG
    J8560KEtoposide oral 50 MG0802$41.12$8.22
    J8565EGefitinib oral
    J8600NMelphalan oral 2 MG
    J8610NMethotrexate oral 2.5 MG
    J8700KTemozolomide1086$7.28$1.46
    J8999BOral prescription drug chemo
    J9000NDoxorubic hcl 10 MG vl chemo
    J9001KDoxorubicin hcl liposome inj7046$365.64$73.13
    J9010KAlemtuzumab injection9110$516.87$103.37
    J9015KAldesleukin/single use vial0807$701.76$140.35
    J9017KArsenic trioxide9012$33.76$6.75
    J9020KAsparaginase injection0814$55.42$11.08
    J9031KBcg live intravesical vac0809$121.74$24.35
    J9035GBevacizumab injection9214$58.17$11.63
    J9040KBleomycin sulfate injection0857$54.18$10.84
    J9041KBortezomib injection9207$28.90$5.78
    J9045KCarboplatin injection0811$77.16$15.43
    J9050KCarmus bischl nitro inj0812$141.29$28.26
    J9055GCetuximab injection9215$50.59$10.12
    J9060NCisplatin 10 MG injection
    J9062BCisplatin 50 MG injection
    J9065KInj cladribine per 1 MG0858$39.37$7.87
    J9070NCyclophosphamide 100 MG inj
    J9080BCyclophosphamide 200 MG inj
    J9090BCyclophosphamide 500 MG inj
    J9091BCyclophosphamide 1.0 grm inj
    J9092BCyclophosphamide 2.0 grm inj
    J9093NCyclophosphamide lyophilized
    J9094BCyclophosphamide lyophilized
    J9095BCyclophosphamide lyophilized
    J9096BCyclophosphamide lyophilized
    J9097BCyclophosphamide lyophilized
    J9098KCytarabine liposome1166$366.43$73.29
    J9100NCytarabine hcl 100 MG inj
    J9110BCytarabine hcl 500 MG inj
    J9120NDactinomycin actinomycin d
    J9130KDacarbazine 100 mg inj0819$6.20$1.24
    J9140BDacarbazine 200 MG inj
    J9150KDaunorubicin0820$35.28$7.06
    J9151KDaunorubicin citrate liposom0821$57.56$11.51
    Start Printed Page 50864
    J9160KDenileukin diftitox, 300 mcg1084$1,235.33$247.07
    J9165NDiethylstilbestrol injection
    J9170KDocetaxel0823$301.17$60.23
    J9178KInj, epirubicin hcl, 2 mg1167$25.15$5.03
    J9181NEtoposide 10 MG inj
    J9182BEtoposide 100 MG inj
    J9185KFludarabine phosphate inj0842$262.41$52.48
    J9190NFluorouracil injection
    J9200KFloxuridine injection0827$60.17$12.03
    J9201KGemcitabine HCl0828$117.45$23.49
    J9202KGoserelin acetate implant0810$196.25$39.25
    J9206KIrinotecan injection0830$129.08$25.82
    J9208KIfosfomide injection0831$53.54$10.71
    J9209KMesna injection0732$13.68$2.74
    J9211KIdarubicin hcl injection0832$314.00$62.80
    J9212KInterferon alfacon-10912$3.91$0.78
    J9213KInterferon alfa-2a inj0834$31.75$6.35
    J9214KInterferon alfa-2b inj0836$13.22$2.64
    J9215KInterferon alfa-n3 inj0865$8.77$1.75
    J9216KInterferon gamma 1-b inj0838$277.79$55.56
    J9217KLeuprolide acetate suspnsion9217$230.87$46.17
    J9218KLeuprolide acetate injeciton0861$10.96$2.19
    J9219KLeuprolide acetate implant7051$2,262.19$452.44
    J9230NMechlorethamine hcl inj
    J9245KInj melphalan hydrochl 50 MG0840$523.22$104.64
    J9250NMethotrexate sodium inj
    J9260BMethotrexate sodium inj
    J9263BOxaliplatin
    J9265KPaclitaxel injection0863$19.11$3.82
    J9266KPegaspargase/singl dose vial0843$1,528.80$305.76
    J9268KPentostatin injection0844$1,868.91$373.78
    J9270KPlicamycin (mithramycin) inj0860$80.54$16.11
    J9280KMitomycin 5 MG inj0862$26.36$5.27
    J9290BMitomycin 20 MG inj
    J9291BMitomycin 40 MG inj
    J9293KMitoxantrone hydrochl / 5 MG0864$329.69$65.94
    J9300KGemtuzumab ozogamicin9004$2,245.04$449.01
    J9305GPemetrexed injection9213$41.29$8.26
    J9310KRituximab cancer treatment0849$447.97$89.59
    J9320KStreptozocin injection0850$153.33$30.67
    J9340KThiotepa injection0851$44.55$8.91
    J9350KTopotecan0852$755.51$151.10
    J9355KTrastuzumab1613$53.98$10.80
    J9357KValrubicin, 200 mg9167$376.87$75.37
    J9360NVinblastine sulfate inj
    J9370NVincristine sulfate 1 MG inj
    J9375BVincristine sulfate 2 MG inj
    J9380BVincristine sulfate 5 MG inj
    J9390KVinorelbine tartrate/10 mg0855$62.85$12.57
    J9395KInjection, Fulvestrant9120$82.90$16.58
    J9600KPorfimer sodium0856$2,457.97$491.59
    J9999NChemotherapy drug
    K0001YStandard wheelchair
    K0002YStnd hemi (low seat) whlchr
    K0003YLightweight wheelchair
    K0004YHigh strength ltwt whlchr
    K0005YUltralightweight wheelchair
    K0006YHeavy duty wheelchair
    K0007YExtra heavy duty wheelchair
    K0009YOther manual wheelchair/base
    K0010YStnd wt frame power whlchr
    K0011YStnd wt pwr whlchr w control
    K0012YLtwt portbl power whlchr
    K0014YOther power whlchr base
    K0015YDetach non-adjus hght armrst
    K0017YDetach adjust armrest base
    Start Printed Page 50865
    K0018YDetach adjust armrst upper
    K0019YArm pad each
    K0020YFixed adjust armrest pair
    K0037YHigh mount flip-up footrest
    K0038YLeg strap each
    K0039YLeg strap h style each
    K0040YAdjustable angle footplate
    K0041YLarge size footplate each
    K0042YStandard size footplate each
    K0043YFtrst lower extension tube
    K0044YFtrst upper hanger bracket
    K0045YFootrest complete assembly
    K0046YElevat legrst low extension
    K0047YElevat legrst up hangr brack
    K0050YRatchet assembly
    K0051YCam relese assem ftrst/lgrst
    K0052YSwingaway detach footrest
    K0053YElevate footrest articulate
    K0056YSeat ht <17 or >=21 ltwt wc
    K0064YZero pressure tube flat free
    K0065YSpoke protectors
    K0066YSolid tire any size each
    K0067YPneumatic tire any size each
    K0068YPneumatic tire tube each
    K0069YRear whl complete solid tire
    K0070YRear whl compl pneum tire
    K0071YFront castr compl pneum tire
    K0072YFrnt cstr cmpl sem-pneum tir
    K0073YCaster pin lock each
    K0074YPneumatic caster tire each
    K0075YSemi-pneumatic caster tire
    K0076YSolid caster tire each
    K0077YFront caster assem complete
    K0078YPneumatic caster tire tube
    K0090YRear tire power wheelchair
    K0091YRear tire tube power whlchr
    K0092YRear assem cmplt powr whlchr
    K0093YRear zero pressure tire tube
    K0094YWheel tire for power base
    K0095YWheel tire tube each base
    K0096YWheel assem powr base complt
    K0097YWheel zero presure tire tube
    K0098YDrive belt power wheelchair
    K0099YPwr wheelchair front caster
    K0102YCrutch and cane holder
    K0104YCylinder tank carrier
    K0105YIv hanger
    K0106YArm trough each
    K0108YW/c component-accessory NOS
    K0195YElevating whlchair leg rests
    K0415BRX antiemetic drg, oral NOS
    K0416BRx antiemetic drg,rectal NOS
    K0452YWheelchair bearings
    K0455YPump uninterrupted infusion
    K0462YTemporary replacement eqpmnt
    K0552YSupply/Ext inf pump syr type
    K0600YFunctional neuromuscularstim
    K0601YRepl batt silver oxide 1.5 v
    K0602YRepl batt silver oxide 3 v
    K0603YRepl batt alkaline 1.5 v
    K0604YRepl batt lithium 3.6 v
    K0605YRepl batt lithium 4.5 v
    K0606YAED garment w/elec analysis
    K0607YRepl batt for AED
    K0608YRepl garment for AED
    K0609YRepl electrode for AED
    Start Printed Page 50866
    K0618ATLSO 2 piece rigid shell
    K0619ATLSO 3 piece rigid shell
    K0620ATubular elastic dressing
    K0628YMult dens insert direct form
    K0629YMult dens insert custom mold
    K0630YSIO flex pelvisacral prefab
    K0631YSIO flex pelvisacral custom
    K0632YSIO panel prefab
    K0633YSIO panel custom
    K0634YLO flexibl L1 - below L5 pre
    K0635YLO sag stays/panels pre-fab
    K0636YLO sagitt rigid panel prefab
    K0637YLO flex w/o rigid stays pre
    K0638YLSO flex w/rigid stays cust
    K0639YLSO post rigid panel pre
    K0640YLSO sag-coro rigid frame pre
    K0641YLSO sag-cor rigid frame cust
    K0642YLSO flexion control prefab
    K0643YLSO flexion control custom
    K0644YLSO sagit rigid panel prefab
    K0645YLSO sagittal rigid panel cus
    K0646YLSO sag-coronal panel prefab
    K0647YLSO sag-coronal panel custom
    K0648YLSO s/c shell/panel prefab
    K0649YLSO s/c shell/panel custom
    K0669YW/c seat/back no CVR SADMERC
    K0670AStance phase only
    K0671YPortable oxygen concentrator
    L0100ACranial orthosis/helmet mold
    L0110ACranial orthosis/helmet nonm
    L0112ACranial cervical orthosis
    L0120ACerv flexible non-adjustable
    L0130AFlex thermoplastic collar mo
    L0140ACervical semi-rigid adjustab
    L0150ACerv semi-rig adj molded chn
    L0160ACerv semi-rig wire occ/mand
    L0170ACervical collar molded to pt
    L0172ACerv col thermplas foam 2 pi
    L0174ACerv col foam 2 piece w thor
    L0180ACer post col occ/man sup adj
    L0190ACerv collar supp adj cerv ba
    L0200ACerv col supp adj bar & thor
    L0210AThoracic rib belt
    L0220AThor rib belt custom fabrica
    L0430ADewall posture protector
    L0450ATLSO flex prefab thoracic
    L0452Atlso flex custom fab thoraci
    L0454ATLSO flex prefab sacrococ-T9
    L0456ATLSO flex prefab
    L0458ATLSO 2Mod symphis-xipho pre
    L0460ATLSO2Mod symphysis-stern pre
    L0462ATLSO 3Mod sacro-scap pre
    L0464ATLSO 4Mod sacro-scap pre
    L0466ATLSO rigid frame pre soft ap
    L0468ATLSO rigid frame prefab pelv
    L0470ATLSO rigid frame pre subclav
    L0472ATLSO rigid frame hyperex pre
    L0480ATLSO rigid plastic custom fa
    L0482ATLSO rigid lined custom fab
    L0484ATLSO rigid plastic cust fab
    L0486ATLSO rigidlined cust fab two
    L0488ATLSO rigid lined pre one pie
    L0490ATLSO rigid plastic pre one
    L0700ACtlso a-p-l control molded
    L0710ACtlso a-p-l control w/ inter
    L0810AHalo cervical into jckt vest
    Start Printed Page 50867
    L0820AHalo cervical into body jack
    L0830AHalo cerv into milwaukee typ
    L0860AMagnetic resonanc image comp
    L0861AHalo repl liner/interface
    L0960EPost surgical support pads
    L0970ATlso corset front
    L0972ALso corset front
    L0974ATlso full corset
    L0976ALso full corset
    L0978AAxillary crutch extension
    L0980APeroneal straps pair
    L0982AStocking supp grips set of f
    L0984AProtective body sock each
    L0999AAdd to spinal orthosis NOS
    L1000ACtlso milwauke initial model
    L1005ATension based scoliosis orth
    L1010ACtlso axilla sling
    L1020AKyphosis pad
    L1025AKyphosis pad floating
    L1030ALumbar bolster pad
    L1040ALumbar or lumbar rib pad
    L1050ASternal pad
    L1060AThoracic pad
    L1070ATrapezius sling
    L1080AOutrigger
    L1085AOutrigger bil w/ vert extens
    L1090ALumbar sling
    L1100ARing flange plastic/leather
    L1110ARing flange plas/leather mol
    L1120ACovers for upright each
    L1200AFurnsh initial orthosis only
    L1210ALateral thoracic extension
    L1220AAnterior thoracic extension
    L1230AMilwaukee type superstructur
    L1240ALumbar derotation pad
    L1250AAnterior asis pad
    L1260AAnterior thoracic derotation
    L1270AAbdominal pad
    L1280ARib gusset (elastic) each
    L1290ALateral trochanteric pad
    L1300ABody jacket mold to patient
    L1310APost-operative body jacket
    L1499ASpinal orthosis NOS
    L1500AThkao mobility frame
    L1510AThkao standing frame
    L1520AThkao swivel walker
    L1600AAbduct hip flex frejka w cvr
    L1610AAbduct hip flex frejka covr
    L1620AAbduct hip flex pavlik harne
    L1630AAbduct control hip semi-flex
    L1640APelv band/spread bar thigh c
    L1650AHO abduction hip adjustable
    L1652AHO bi thighcuffs w sprdr bar
    L1660AHO abduction static plastic
    L1680APelvic & hip control thigh c
    L1685APost-op hip abduct custom fa
    L1686AHO post-op hip abduction
    L1690ACombination bilateral HO
    L1700ALeg perthes orth toronto typ
    L1710ALegg perthes orth newington
    L1720ALegg perthes orthosis trilat
    L1730ALegg perthes orth scottish r
    L1750ALegg perthes sling
    L1755ALegg perthes patten bottom t
    L1800AKnee orthoses elas w stays
    L1810AKo elastic with joints
    Start Printed Page 50868
    L1815AElastic with condylar pads
    L1820AKo elas w/ condyle pads & jo
    L1825AKo elastic knee cap
    L1830AKo immobilizer canvas longit
    L1831AKnee orth pos locking joint
    L1832AKO adj jnt pos rigid support
    L1834AKo w/0 joint rigid molded to
    L1836ARigid KO wo joints
    L1840AKo derot ant cruciate custom
    L1843AKO single upright custom fit
    L1844AKo w/adj jt rot cntrl molded
    L1845AKo w/ adj flex/ext rotat cus
    L1846AKo w adj flex/ext rotat mold
    L1847AKO adjustable w air chambers
    L1850AKo swedish type
    L1855AKo plas doub upright jnt mol
    L1858AKo polycentric pneumatic pad
    L1860AKo supracondylar socket mold
    L1870AKo doub upright lacers molde
    L1880AKo doub upright cuffs/lacers
    L1900AAfo sprng wir drsflx calf bd
    L1901APrefab ankle orthosis
    L1902AAfo ankle gauntlet
    L1904AAfo molded ankle gauntlet
    L1906AAfo multiligamentus ankle su
    L1907AAFO supramalleolar custom
    L1910AAfo sing bar clasp attach sh
    L1920AAfo sing upright w/ adjust s
    L1930AAfo plastic
    L1932AAfo rig ant tib prefab TCF/=
    L1940AAfo molded to patient plasti
    L1945AAfo molded plas rig ant tib
    L1950AAfo spiral molded to pt plas
    L1951AAFO spiral prefabricated
    L1960AAfo pos solid ank plastic mo
    L1970AAfo plastic molded w/ankle j
    L1971AAFO w/ankle joint, prefab
    L1980AAfo sing solid stirrup calf
    L1990AAfo doub solid stirrup calf
    L2000AKafo sing fre stirr thi/calf
    L2005AKAFO sng/dbl mechanical act
    L2010AKafo sng solid stirrup w/o j
    L2020AKafo dbl solid stirrup band/
    L2030AKafo dbl solid stirrup w/o j
    L2035AKAFO plastic pediatric size
    L2036AKafo plas doub free knee mol
    L2037AKafo plas sing free knee mol
    L2038AKafo w/o joint multi-axis an
    L2039AKAFO,plstic,medlat rotat con
    L2040AHkafo torsion bil rot straps
    L2050AHkafo torsion cable hip pelv
    L2060AHkafo torsion ball bearing j
    L2070AHkafo torsion unilat rot str
    L2080AHkafo unilat torsion cable
    L2090AHkafo unilat torsion ball br
    L2106AAfo tib fx cast plaster mold
    L2108AAfo tib fx cast molded to pt
    L2112AAfo tibial fracture soft
    L2114AAfo tib fx semi-rigid
    L2116AAfo tibial fracture rigid
    L2126AKafo fem fx cast thermoplas
    L2128AKafo fem fx cast molded to p
    L2132AKafo femoral fx cast soft
    L2134AKafo fem fx cast semi-rigid
    L2136AKafo femoral fx cast rigid
    L2180APlas shoe insert w ank joint
    Start Printed Page 50869
    L2182ADrop lock knee
    L2184ALimited motion knee joint
    L2186AAdj motion knee jnt lerman t
    L2188AQuadrilateral brim
    L2190AWaist belt
    L2192APelvic band & belt thigh fla
    L2200ALimited ankle motion ea jnt
    L2210ADorsiflexion assist each joi
    L2220ADorsi & plantar flex ass/res
    L2230ASplit flat caliper stirr & p
    L2232ARocker bottom, contact AFO
    L2240ARound caliper and plate atta
    L2250AFoot plate molded stirrup at
    L2260AReinforced solid stirrup
    L2265ALong tongue stirrup
    L2270AVarus/valgus strap padded/li
    L2275APlastic mod low ext pad/line
    L2280AMolded inner boot
    L2300AAbduction bar jointed adjust
    L2310AAbduction bar-straight
    L2320ANon-molded lacer
    L2330ALacer molded to patient mode
    L2335AAnterior swing band
    L2340APre-tibial shell molded to p
    L2350AProsthetic type socket molde
    L2360AExtended steel shank
    L2370APatten bottom
    L2375ATorsion ank & half solid sti
    L2380ATorsion straight knee joint
    L2385AStraight knee joint heavy du
    L2390AOffset knee joint each
    L2395AOffset knee joint heavy duty
    L2397ASuspension sleeve lower ext
    L2405AKnee joint drop lock ea jnt
    L2415AKnee joint cam lock each joi
    L2425AKnee disc/dial lock/adj flex
    L2430AKnee jnt ratchet lock ea jnt
    L2492AKnee lift loop drop lock rin
    L2500AThi/glut/ischia wgt bearing
    L2510ATh/wght bear quad-lat brim m
    L2520ATh/wght bear quad-lat brim c
    L2525ATh/wght bear nar m-l brim mo
    L2526ATh/wght bear nar m-l brim cu
    L2530AThigh/wght bear lacer non-mo
    L2540AThigh/wght bear lacer molded
    L2550AThigh/wght bear high roll cu
    L2570AHip clevis type 2 posit jnt
    L2580APelvic control pelvic sling
    L2600AHip clevis/thrust bearing fr
    L2610AHip clevis/thrust bearing lo
    L2620APelvic control hip heavy dut
    L2622AHip joint adjustable flexion
    L2624AHip adj flex ext abduct cont
    L2627APlastic mold recipro hip & c
    L2628AMetal frame recipro hip & ca
    L2630APelvic control band & belt u
    L2640APelvic control band & belt b
    L2650APelv & thor control gluteal
    L2660AThoracic control thoracic ba
    L2670AThorac cont paraspinal uprig
    L2680AThorac cont lat support upri
    L2750APlating chrome/nickel pr bar
    L2755ACarbon graphite lamination
    L2760AExtension per extension per
    L2768AOrtho sidebar disconnect
    L2770ALow ext orthosis per bar/jnt
    Start Printed Page 50870
    L2780ANon-corrosive finish
    L2785ADrop lock retainer each
    L2795AKnee control full kneecap
    L2800AKnee cap medial or lateral p
    L2810AKnee control condylar pad
    L2820ASoft interface below knee se
    L2830ASoft interface above knee se
    L2840ATibial length sock fx or equ
    L2850AFemoral lgth sock fx or equa
    L2860ATorsion mechanism knee/ankle
    L2999ALower extremity orthosis NOS
    L3000BFt insert ucb berkeley shell
    L3001BFoot insert remov molded spe
    L3002BFoot insert plastazote or eq
    L3003BFoot insert silicone gel eac
    L3010BFoot longitudinal arch suppo
    L3020BFoot longitud/metatarsal sup
    L3030BFoot arch support remov prem
    L3031EFoot lamin/prepreg composite
    L3040BFt arch suprt premold longit
    L3050BFoot arch supp premold metat
    L3060BFoot arch supp longitud/meta
    L3070BArch suprt att to sho longit
    L3080BArch supp att to shoe metata
    L3090BArch supp att to shoe long/m
    L3100BHallus-valgus nght dynamic s
    L3140BAbduction rotation bar shoe
    L3150BAbduct rotation bar w/o shoe
    L3160BShoe styled positioning dev
    L3170BFoot plastic heel stabilizer
    L3201BOxford w supinat/pronat inf
    L3202BOxford w/ supinat/pronator c
    L3203BOxford w/ supinator/pronator
    L3204BHightop w/ supp/pronator inf
    L3206BHightop w/ supp/pronator chi
    L3207BHightop w/ supp/pronator jun
    L3208BSurgical boot each infant
    L3209BSurgical boot each child
    L3211BSurgical boot each junior
    L3212BBenesch boot pair infant
    L3213BBenesch boot pair child
    L3214BBenesch boot pair junior
    L3215BOrthopedic ftwear ladies oxf
    L3216BOrthoped ladies shoes dpth i
    L3217BLadies shoes hightop depth i
    L3219BOrthopedic mens shoes oxford
    L3221BOrthopedic mens shoes dpth i
    L3222BMens shoes hightop depth inl
    L3224AWomans shoe oxford brace
    L3225AMans shoe oxford brace
    L3230BCustom shoes depth inlay
    L3250BCustom mold shoe remov prost
    L3251BShoe molded to pt silicone s
    L3252BShoe molded plastazote cust
    L3253BShoe molded plastazote cust
    L3254BOrth foot non-stndard size/w
    L3255BOrth foot non-standard size/
    L3257BOrth foot add charge split s
    L3260BAmbulatory surgical boot eac
    L3265BPlastazote sandal each
    L3300BSho lift taper to metatarsal
    L3310BShoe lift elev heel/sole neo
    L3320BShoe lift elev heel/sole cor
    L3330BLifts elevation metal extens
    L3332BShoe lifts tapered to one-ha
    L3334BShoe lifts elevation heel /i
    Start Printed Page 50871
    L3340BShoe wedge sach
    L3350BShoe heel wedge
    L3360BShoe sole wedge outside sole
    L3370BShoe sole wedge between sole
    L3380BShoe clubfoot wedge
    L3390BShoe outflare wedge
    L3400BShoe metatarsal bar wedge ro
    L3410BShoe metatarsal bar between
    L3420BFull sole/heel wedge btween
    L3430BSho heel count plast reinfor
    L3440BHeel leather reinforced
    L3450BShoe heel sach cushion type
    L3455BShoe heel new leather standa
    L3460BShoe heel new rubber standar
    L3465BShoe heel thomas with wedge
    L3470BShoe heel thomas extend to b
    L3480BShoe heel pad & depress for
    L3485BShoe heel pad removable for
    L3500BOrtho shoe add leather insol
    L3510BOrthopedic shoe add rub insl
    L3520BO shoe add felt w leath insl
    L3530BOrtho shoe add half sole
    L3540BOrtho shoe add full sole
    L3550BO shoe add standard toe tap
    L3560BO shoe add horseshoe toe tap
    L3570BO shoe add instep extension
    L3580BO shoe add instep velcro clo
    L3590BO shoe convert to sof counte
    L3595BOrtho shoe add march bar
    L3600BTrans shoe calip plate exist
    L3610BTrans shoe caliper plate new
    L3620BTrans shoe solid stirrup exi
    L3630BTrans shoe solid stirrup new
    L3640BShoe dennis browne splint bo
    L3649BOrthopedic shoe modifica NOS
    L3650AShlder fig 8 abduct restrain
    L3651APrefab shoulder orthosis
    L3652APrefab dbl shoulder orthosis
    L3660AAbduct restrainer canvas&web
    L3670AAcromio/clavicular canvas&we
    L3675ACanvas vest SO
    L3677ESO hard plastic stabilizer
    L3700AElbow orthoses elas w stays
    L3701APrefab elbow orthosis
    L3710AElbow elastic with metal joi
    L3720AForearm/arm cuffs free motio
    L3730AForearm/arm cuffs ext/flex a
    L3740ACuffs adj lock w/ active con
    L3760AEO withjoint, Prefabricated
    L3762ARigid EO wo joints
    L3800AWhfo short opponen no attach
    L3805AWhfo long opponens no attach
    L3807AWHFO,no joint, prefabricated
    L3810AWhfo thumb abduction bar
    L3815AWhfo second m.p. abduction a
    L3820AWhfo ip ext asst w/ mp ext s
    L3825AWhfo m.p. extension stop
    L3830AWhfo m.p. extension assist
    L3835AWhfo m.p. spring extension a
    L3840AWhfo spring swivel thumb
    L3845AWhfo thumb ip ext ass w/ mp
    L3850AAction wrist w/ dorsiflex as
    L3855AWhfo adj m.p. flexion contro
    L3860AWhfo adj m.p. flex ctrl & i
    L3890BTorsion mechanism wrist/elbo
    L3900AHinge extension/flex wrist/f
    Start Printed Page 50872
    L3901AHinge ext/flex wrist finger
    L3902EWhfo ext power compress gas
    L3904AWhfo electric custom fitted
    L3906AWrist gauntlet molded to pt
    L3907AWhfo wrst gauntlt thmb spica
    L3908AWrist cock-up non-molded
    L3909APrefab wrist orthosis
    L3910AWhfo swanson design
    L3911APrefab hand finger orthosis
    L3912AFlex glove w/elastic finger
    L3914AWHO wrist extension cock-up
    L3916AWhfo wrist extens w/ outrigg
    L3917APrefab metacarpl fx orthosis
    L3918AHFO knuckle bender
    L3920AKnuckle bender with outrigge
    L3922AKnuckle bend 2 seg to flex j
    L3923AHFO, no joint, prefabricated
    L3924AOppenheimer
    L3926AThomas suspension
    L3928AFinger extension w/ clock sp
    L3930AFinger extension with wrist
    L3932ASafety pin spring wire
    L3934ASafety pin modified
    L3936APalmer
    L3938ADorsal wrist
    L3940ADorsal wrist w/ outrigger at
    L3942AReverse knuckle bender
    L3944AReverse knuckle bend w/ outr
    L3946AHFO composite elastic
    L3948AFinger knuckle bender
    L3950AOppenheimer w/ knuckle bend
    L3952AOppenheimer w/ rev knuckle 2
    L3954ASpreading hand
    L3956AAdd joint upper ext orthosis
    L3960ASewho airplan desig abdu pos
    L3962ASewho erbs palsey design abd
    L3963AMolded w/ articulating elbow
    L3964YSeo mobile arm sup att to wc
    L3965YArm supp att to wc rancho ty
    L3966YMobile arm supports reclinin
    L3968YFriction dampening arm supp
    L3969YMonosuspension arm/hand supp
    L3970YElevat proximal arm support
    L3972YOffset/lat rocker arm w/ ela
    L3974YMobile arm support supinator
    L3980AUpp ext fx orthosis humeral
    L3982AUpper ext fx orthosis rad/ul
    L3984AUpper ext fx orthosis wrist
    L3985AForearm hand fx orth w/ wr h
    L3986AHumeral rad/ulna wrist fx or
    L3995ASock fracture or equal each
    L3999AUpper limb orthosis NOS
    L4000ARepl girdle milwaukee orth
    L4002AReplace strap, any orthosis
    L4010AReplace trilateral socket br
    L4020AReplace quadlat socket brim
    L4030AReplace socket brim cust fit
    L4040AReplace molded thigh lacer
    L4045AReplace non-molded thigh lac
    L4050AReplace molded calf lacer
    L4055AReplace non-molded calf lace
    L4060AReplace high roll cuff
    L4070AReplace prox & dist upright
    L4080ARepl met band kafo-afo prox
    L4090ARepl met band kafo-afo calf/
    L4100ARepl leath cuff kafo prox th
    Start Printed Page 50873
    L4110ARepl leath cuff kafo-afo cal
    L4130AReplace pretibial shell
    L4205AOrtho dvc repair per 15 min
    L4210AOrth dev repair/repl minor p
    L4350AAnkle control orthosi prefab
    L4360APneumati walking boot prefab
    L4370APneumatic full leg splint
    L4380APneumatic knee splint
    L4386ANon-pneum walk boot prefab
    L4392AReplace AFO soft interface
    L4394AReplace foot drop spint
    L4396AStatic AFO
    L4398AFoot drop splint recumbent
    L5000ASho insert w arch toe filler
    L5010AMold socket ank hgt w/ toe f
    L5020ATibial tubercle hgt w/ toe f
    L5050AAnk symes mold sckt sach ft
    L5060ASymes met fr leath socket ar
    L5100AMolded socket shin sach foot
    L5105APlast socket jts/thgh lacer
    L5150AMold sckt ext knee shin sach
    L5160AMold socket bent knee shin s
    L5200AKne sing axis fric shin sach
    L5210ANo knee/ankle joints w/ ft b
    L5220ANo knee joint with artic ali
    L5230AFem focal defic constant fri
    L5250AHip canad sing axi cons fric
    L5270ATilt table locking hip sing
    L5280AHemipelvect canad sing axis
    L5301ABK mold socket SACH ft endo
    L5311AKnee disart, SACH ft, endo
    L5321AAK open end SACH
    L5331AHip disart canadian SACH ft
    L5341AHemipelvectomy canadian SACH
    L5400APostop dress & 1 cast chg bk
    L5410APostop dsg bk ea add cast ch
    L5420APostop dsg & 1 cast chg ak/d
    L5430APostop dsg ak ea add cast ch
    L5450APostop app non-wgt bear dsg
    L5460APostop app non-wgt bear dsg
    L5500AInit bk ptb plaster direct
    L5505AInit ak ischal plstr direct
    L5510APrep BK ptb plaster molded
    L5520APerp BK ptb thermopls direct
    L5530APrep BK ptb thermopls molded
    L5535APrep BK ptb open end socket
    L5540APrep BK ptb laminated socket
    L5560APrep AK ischial plast molded
    L5570APrep AK ischial direct form
    L5580APrep AK ischial thermo mold
    L5585APrep AK ischial open end
    L5590APrep AK ischial laminated
    L5595AHip disartic sach thermopls
    L5600AHip disart sach laminat mold
    L5610AAbove knee hydracadence
    L5611AAk 4 bar link w/fric swing
    L5613AAk 4 bar ling w/hydraul swig
    L5614A4-bar link above knee w/swng
    L5616AAk univ multiplex sys frict
    L5617AAK/BK self-aligning unit ea
    L5618ATest socket symes
    L5620ATest socket below knee
    L5622ATest socket knee disarticula
    L5624ATest socket above knee
    L5626ATest socket hip disarticulat
    L5628ATest socket hemipelvectomy
    Start Printed Page 50874
    L5629ABelow knee acrylic socket
    L5630ASyme typ expandabl wall sckt
    L5631AAk/knee disartic acrylic soc
    L5632ASymes type ptb brim design s
    L5634ASymes type poster opening so
    L5636ASymes type medial opening so
    L5637ABelow knee total contact
    L5638ABelow knee leather socket
    L5639ABelow knee wood socket
    L5640AKnee disarticulat leather so
    L5642AAbove knee leather socket
    L5643AHip flex inner socket ext fr
    L5644AAbove knee wood socket
    L5645ABk flex inner socket ext fra
    L5646ABelow knee cushion socket
    L5647ABelow knee suction socket
    L5648AAbove knee cushion socket
    L5649AIsch containmt/narrow m-l so
    L5650ATot contact ak/knee disart s
    L5651AAk flex inner socket ext fra
    L5652ASuction susp ak/knee disart
    L5653AKnee disart expand wall sock
    L5654ASocket insert symes
    L5655ASocket insert below knee
    L5656ASocket insert knee articulat
    L5658ASocket insert above knee
    L5661AMulti-durometer symes
    L5665AMulti-durometer below knee
    L5666ABelow knee cuff suspension
    L5668ASocket insert w/o lock lower
    L5670ABk molded supracondylar susp
    L5671ABK/AK locking mechanism
    L5672ABk removable medial brim sus
    L5673ASocket insert w lock mech
    L5676ABk knee joints single axis p
    L5677ABk knee joints polycentric p
    L5678ABk joint covers pair
    L5679ASocket insert w/o lock mech
    L5680ABk thigh lacer non-molded
    L5681AIntl custm cong/latyp insert
    L5682ABk thigh lacer glut/ischia m
    L5683AInitial custom socket insert
    L5684ABk fork strap
    L5685ABelow knee sus/seal sleeve
    L5686ABk back check
    L5688ABk waist belt webbing
    L5690ABk waist belt padded and lin
    L5692AAk pelvic control belt light
    L5694AAk pelvic control belt pad/l
    L5695AAk sleeve susp neoprene/equa
    L5696AAk/knee disartic pelvic join
    L5697AAk/knee disartic pelvic band
    L5698AAk/knee disartic silesian ba
    L5699AShoulder harness
    L5700AReplace socket below knee
    L5701AReplace socket above knee
    L5702AReplace socket hip
    L5704ACustom shape cover BK
    L5705ACustom shape cover AK
    L5706ACustom shape cvr knee disart
    L5707ACustom shape cvr hip disart
    L5710AKne-shin exo sng axi mnl loc
    L5711AKnee-shin exo mnl lock ultra
    L5712AKnee-shin exo frict swg & st
    L5714AKnee-shin exo variable frict
    L5716AKnee-shin exo mech stance ph
    Start Printed Page 50875
    L5718AKnee-shin exo frct swg & sta
    L5722AKnee-shin pneum swg frct exo
    L5724AKnee-shin exo fluid swing ph
    L5726AKnee-shin ext jnts fld swg e
    L5728AKnee-shin fluid swg & stance
    L5780AKnee-shin pneum/hydra pneum
    L5781ALower limb pros vacuum pump
    L5782AHD low limb pros vacuum pump
    L5785AExoskeletal bk ultralt mater
    L5790AExoskeletal ak ultra-light m
    L5795AExoskel hip ultra-light mate
    L5810AEndoskel knee-shin mnl lock
    L5811AEndo knee-shin mnl lck ultra
    L5812AEndo knee-shin frct swg & st
    L5814AEndo knee-shin hydral swg ph
    L5816AEndo knee-shin polyc mch sta
    L5818AEndo knee-shin frct swg & st
    L5822AEndo knee-shin pneum swg frc
    L5824AEndo knee-shin fluid swing p
    L5826AMiniature knee joint
    L5828AEndo knee-shin fluid swg/sta
    L5830AEndo knee-shin pneum/swg pha
    L5840AMulti-axial knee/shin system
    L5845AKnee-shin sys stance flexion
    L5848AKnee-shin sys hydraul stance
    L5850AEndo ak/hip knee extens assi
    L5855AMech hip extension assist
    L5856AElec knee-shin swing/stance
    L5857AElec knee-shin swing only
    L5910AEndo below knee alignable sy
    L5920AEndo ak/hip alignable system
    L5925AAbove knee manual lock
    L5930AHigh activity knee frame
    L5940AEndo bk ultra-light material
    L5950AEndo ak ultra-light material
    L5960AEndo hip ultra-light materia
    L5962ABelow knee flex cover system
    L5964AAbove knee flex cover system
    L5966AHip flexible cover system
    L5968AMultiaxial ankle w dorsiflex
    L5970AFoot external keel sach foot
    L5972AFlexible keel foot
    L5974AFoot single axis ankle/foot
    L5975ACombo ankle/foot prosthesis
    L5976AEnergy storing foot
    L5978AFt prosth multiaxial ankl/ft
    L5979AMulti-axial ankle/ft prosth
    L5980AFlex foot system
    L5981AFlex-walk sys low ext prosth
    L5982AExoskeletal axial rotation u
    L5984AEndoskeletal axial rotation
    L5985ALwr ext dynamic prosth pylon
    L5986AMulti-axial rotation unit
    L5987AShank ft w vert load pylon
    L5988AVertical shock reducing pylo
    L5990AUser adjustable heel height
    L5995ALower ext pros heavyduty fea
    L5999ALowr extremity prosthes NOS
    L6000APar hand robin-aids thum rem
    L6010AHand robin-aids little/ring
    L6020APart hand robin-aids no fing
    L6025APart hand disart myoelectric
    L6050AWrst MLd sck flx hng tri pad
    L6055AWrst mold sock w/exp interfa
    L6100AElb mold sock flex hinge pad
    L6110AElbow mold sock suspension t
    Start Printed Page 50876
    L6120AElbow mold doub splt soc ste
    L6130AElbow stump activated lock h
    L6200AElbow mold outsid lock hinge
    L6205AElbow molded w/ expand inter
    L6250AElbow inter loc elbow forarm
    L6300AShlder disart int lock elbow
    L6310AShoulder passive restor comp
    L6320AShoulder passive restor cap
    L6350AThoracic intern lock elbow
    L6360AThoracic passive restor comp
    L6370AThoracic passive restor cap
    L6380APostop dsg cast chg wrst/elb
    L6382APostop dsg cast chg elb dis/
    L6384APostop dsg cast chg shlder/t
    L6386APostop ea cast chg & realign
    L6388APostop applicat rigid dsg on
    L6400ABelow elbow prosth tiss shap
    L6450AElb disart prosth tiss shap
    L6500AAbove elbow prosth tiss shap
    L6550AShldr disar prosth tiss shap
    L6570AScap thorac prosth tiss shap
    L6580AWrist/elbow bowden cable mol
    L6582AWrist/elbow bowden cbl dir f
    L6584AElbow fair lead cable molded
    L6586AElbow fair lead cable dir fo
    L6588AShdr fair lead cable molded
    L6590AShdr fair lead cable direct
    L6600APolycentric hinge pair
    L6605ASingle pivot hinge pair
    L6610AFlexible metal hinge pair
    L6615ADisconnect locking wrist uni
    L6616ADisconnect insert locking wr
    L6620AFlexion/extension wrist unit
    L6623ASpring-ass rot wrst w/ latch
    L6625ARotation wrst w/ cable lock
    L6628AQuick disconn hook adapter o
    L6629ALamination collar w/ couplin
    L6630AStainless steel any wrist
    L6632ALatex suspension sleeve each
    L6635ALift assist for elbow
    L6637ANudge control elbow lock
    L6638AElec lock on manual pw elbow
    L6640AShoulder abduction joint pai
    L6641AExcursion amplifier pulley t
    L6642AExcursion amplifier lever ty
    L6645AShoulder flexion-abduction j
    L6646AMultipo locking shoulder jnt
    L6647AShoulder lock actuator
    L6648AExt pwrd shlder lock/unlock
    L6650AShoulder universal joint
    L6655AStandard control cable extra
    L6660AHeavy duty control cable
    L6665ATeflon or equal cable lining
    L6670AHook to hand cable adapter
    L6672AHarness chest/shlder saddle
    L6675AHarness figure of 8 sing con
    L6676AHarness figure of 8 dual con
    L6680ATest sock wrist disart/bel e
    L6682ATest sock elbw disart/above
    L6684ATest socket shldr disart/tho
    L6686ASuction socket
    L6687AFrame typ socket bel elbow/w
    L6688AFrame typ sock above elb/dis
    L6689AFrame typ socket shoulder di
    L6690AFrame typ sock interscap-tho
    L6691ARemovable insert each
    Start Printed Page 50877
    L6692ASilicone gel insert or equal
    L6693ALockingelbow forearm cntrbal
    L6694AElbow socket ins use w/lock
    L6695AElbow socket ins use w/o lck
    L6696ACus elbo skt in for con/atyp
    L6697ACus elbo skt in not con/atyp
    L6698ABelow/above elbow lock mech
    L6700ATerminal device model #3
    L6705ATerminal device model #5
    L6710ATerminal device model #5x
    L6715ATerminal device model #5xa
    L6720ATerminal device model #6
    L6725ATerminal device model #7
    L6730ATerminal device model #7lo
    L6735ATerminal device model #8
    L6740ATerminal device model #8x
    L6745ATerminal device model #88x
    L6750ATerminal device model #10p
    L6755ATerminal device model #10x
    L6765ATerminal device model #12p
    L6770ATerminal device model #99x
    L6775ATerminal device model #555
    L6780ATerminal device model #ss555
    L6790AHooks-accu hook or equal
    L6795AHooks-2 load or equal
    L6800AHooks-aprl vc or equal
    L6805AModifier wrist flexion unit
    L6806ATrs grip vc or equal
    L6807ATerm device grip1/2 or equal
    L6808ATerm device infant or child
    L6809ATrs super sport passive
    L6810APincher tool otto bock or eq
    L6825AHands dorrance vo
    L6830AHand aprl vc
    L6835AHand sierra vo
    L6840AHand becker imperial
    L6845AHand becker lock grip
    L6850ATerm dvc-hand becker plylite
    L6855AHand robin-aids vo
    L6860AHand robin-aids vo soft
    L6865AHand passive hand
    L6867AHand detroit infant hand
    L6868APassive inf hand steeper/hos
    L6870AHand child mitt
    L6872AHand nyu child hand
    L6873AHand mech inf steeper or equ
    L6875AHand bock vc
    L6880AHand bock vo
    L6881AAutograsp feature ul term dv
    L6882AMicroprocessor control uplmb
    L6890AProduction glove
    L6895ACustom glove
    L6900AHand restorat thumb/1 finger
    L6905AHand restoration multiple fi
    L6910AHand restoration no fingers
    L6915AHand restoration replacmnt g
    L6920AWrist disarticul switch ctrl
    L6925AWrist disart myoelectronic c
    L6930ABelow elbow switch control
    L6935ABelow elbow myoelectronic ct
    L6940AElbow disarticulation switch
    L6945AElbow disart myoelectronic c
    L6950AAbove elbow switch control
    L6955AAbove elbow myoelectronic ct
    L6960AShldr disartic switch contro
    L6965AShldr disartic myoelectronic
    Start Printed Page 50878
    L6970AInterscapular-thor switch ct
    L6975AInterscap-thor myoelectronic
    L7010AHand otto back steeper/eq sw
    L7015AHand sys teknik village swit
    L7020AElectronic greifer switch ct
    L7025AElectron hand myoelectronic
    L7030AHand sys teknik vill myoelec
    L7035AElectron greifer myoelectro
    L7040APrehensile actuator hosmer s
    L7045AElectron hook child michigan
    L7170AElectronic elbow hosmer swit
    L7180AElectronic elbow utah myoele
    L7181AElectronic elbo simultaneous
    L7185AElectron elbow adolescent sw
    L7186AElectron elbow child switch
    L7190AElbow adolescent myoelectron
    L7191AElbow child myoelectronic ct
    L7260AElectron wrist rotator otto
    L7261AElectron wrist rotator utah
    L7266AServo control steeper or equ
    L7272AAnalogue control unb or equa
    L7274AProportional ctl 12 volt uta
    L7360ASix volt bat otto bock/eq ea
    L7362ABattery chrgr six volt otto
    L7364ATwelve volt battery utah/equ
    L7366ABattery chrgr 12 volt utah/e
    L7367AReplacemnt lithium ionbatter
    L7368ALithium ion battery charger
    L7499AUpper extremity prosthes NOS
    L7500AProsthetic dvc repair hourly
    L7510AProsthetic device repair rep
    L7520ARepair prosthesis per 15 min
    L7900AMale vacuum erection system
    L8000AMastectomy bra
    L8001ABreast prosthesis bra & form
    L8002ABrst prsth bra & bilat form
    L8010AMastectomy sleeve
    L8015AExt breastprosthesis garment
    L8020AMastectomy form
    L8030ABreast prosthesis silicone/e
    L8035ACustom breast prosthesis
    L8039ABreast prosthesis NOS
    L8040ANasal prosthesis
    L8041AMidfacial prosthesis
    L8042AOrbital prosthesis
    L8043AUpper facial prosthesis
    L8044AHemi-facial prosthesis
    L8045AAuricular prosthesis
    L8046APartial facial prosthesis
    L8047ANasal septal prosthesis
    L8048AUnspec maxillofacial prosth
    L8049ARepair maxillofacial prosth
    L8100ECompression stocking BK18-30
    L8110ACompression stocking BK30-40
    L8120ACompression stocking BK40-50
    L8130EGc stocking thighlngth 18-30
    L8140EGc stocking thighlngth 30-40
    L8150EGc stocking thighlngth 40-50
    L8160EGc stocking full lngth 18-30
    L8170EGc stocking full lngth 30-40
    L8180EGc stocking full lngth 40-50
    L8190EGc stocking waistlngth 18-30
    L8195EGc stocking waistlngth 30-40
    L8200EGc stocking waistlngth 40-50
    L8210EGc stocking custom made
    L8220EGc stocking lymphedema
    Start Printed Page 50879
    L8230EGc stocking garter belt
    L8239EG compression stocking NOS
    L8300ATruss single w/ standard pad
    L8310ATruss double w/ standard pad
    L8320ATruss addition to std pad wa
    L8330ATruss add to std pad scrotal
    L8400ASheath below knee
    L8410ASheath above knee
    L8415ASheath upper limb
    L8417APros sheath/sock w gel cushn
    L8420AProsthetic sock multi ply BK
    L8430AProsthetic sock multi ply AK
    L8435APros sock multi ply upper lm
    L8440AShrinker below knee
    L8460AShrinker above knee
    L8465AShrinker upper limb
    L8470APros sock single ply BK
    L8480APros sock single ply AK
    L8485APros sock single ply upper l
    L8499AUnlisted misc prosthetic ser
    L8500AArtificial larynx
    L8501ATracheostomy speaking valve
    L8505AArtificial larynx, accessory
    L8507ATrach-esoph voice pros pt in
    L8509ATrach-esoph voice pros md in
    L8510AVoice amplifier
    L8511AIndwelling trach insert
    L8512AGel cap for trach voice pros
    L8513ATrach pros cleaning device
    L8514ARepl trach puncture dilator
    L8515AGel cap app device for trach
    L8600NImplant breast silicone/eq
    L8603NCollagen imp urinary 2.5 ml
    L8606NSynthetic implnt urinary 1ml
    L8610NOcular implant
    L8612NAqueous shunt prosthesis
    L8613NOssicular implant
    L8614NCochlear device/system
    L8615ACoch implant headset replace
    L8616ACoch implant microphone repl
    L8617ACoch implant trans coil repl
    L8618ACoch implant tran cable repl
    L8619AReplace cochlear processor
    L8620ARepl lithium ion battery
    L8621ARepl zinc air battery
    L8622ARepl alkaline battery
    L8630NMetacarpophalangeal implant
    L8631NMCP joint repl 2 pc or more
    L8641NMetatarsal joint implant
    L8642NHallux implant
    L8658NInterphalangeal joint spacer
    L8659NInterphalangeal joint repl
    L8670NVascular graft, synthetic
    L8699NProsthetic implant NOS
    L9900AO&P supply/accessory/service
    M0064XVisit for drug monitoring03741.0414$61.80$12.36
    M0075ECellular therapy
    M0076EProlotherapy
    M0100EIntragastric hypothermia
    M0300EIV chelationtherapy
    M0301EFabric wrapping of aneurysm
    P2028ACephalin floculation test
    P2029ACongo red blood test
    P2031EHair analysis
    P2033ABlood thymol turbidity
    P2038ABlood mucoprotein
    Start Printed Page 50880
    P3000AScreen pap by tech w md supv
    P3001BScreening pap smear by phys
    P7001ECulture bacterial urine
    P9010KWhole blood for transfusion09502.0123$119.42$23.88
    P9011KBlood split unit09671.2698$75.35$15.07
    P9012KCryoprecipitate each unit09520.7395$43.88$8.78
    P9016KRBC leukocytes reduced09542.7370$162.42$32.48
    P9017KPlasma 1 donor frz w/in 8 hr95081.2038$71.44$14.29
    P9019KPlatelets, each unit09570.8317$49.36$9.87
    P9020KPlaelet rich plasma unit09585.1815$307.49$61.50
    P9021KRed blood cells unit09592.0301$120.47$24.09
    P9022KWashed red blood cells unit09602.9707$176.29$35.26
    P9023KFrozen plasma, pooled, sd09491.1956$70.95$14.19
    P9031KPlatelets leukocytes reduced10131.6023$95.09$19.02
    P9032KPlatelets, irradiated95001.3589$80.64$16.13
    P9033KPlatelets leukoreduced irrad09682.3639$140.28$28.06
    P9034KPlatelets, pheresis95076.8988$409.40$81.88
    P9035KPlatelet pheres leukoreduced95018.1495$483.62$96.72
    P9036KPlatelet pheresis irradiated95025.1895$307.96$61.59
    P9037KPlate pheres leukoredu irrad10199.5131$564.54$112.91
    P9038KRBC irradiated95052.3876$141.69$28.34
    P9039KRBC deglycerolized95046.4314$381.66$76.33
    P9040KRBC leukoreduced irradiated09693.6451$216.31$43.26
    P9041KAlbumin (human),5%, 50ml09610.5119$30.38$6.08
    P9043KPlasma protein fract,5%,50ml09561.1226$66.62$13.32
    P9044KCryoprecipitatereducedplasma10091.3062$77.51$15.50
    P9045KAlbumin (human), 5%, 250 ml09631.3869$82.30$16.46
    P9046KAlbumin (human), 25%, 20 ml09640.4878$28.95$5.79
    P9047KAlbumin (human), 25%, 50ml09651.1117$65.97$13.19
    P9048KPlasmaprotein fract,5%,250ml09664.9564$294.13$58.83
    P9050KGranulocytes, pheresis unit950615.6155$926.67$185.33
    P9051KBlood, l/r, cmv-neg10102.9692$176.20$35.24
    P9052KPlatelets, hla-m, l/r, unit101110.9690$650.93$130.19
    P9053KPlt, pher, l/r cmv-neg, irr102010.1551$602.63$120.53
    P9054KBlood, l/r, froz/degly/wash10165.2631$312.33$62.47
    P9055KPlt, aph/pher, l/r, cmv-neg10178.5998$510.34$102.07
    P9056KBlood, l/r, irradiated10182.8004$166.18$33.24
    P9057KRBC, frz/deg/wsh, l/r, irrad10214.8787$289.52$57.90
    P9058KRBC, l/r, cmv-neg, irrad10224.2901$254.59$50.92
    P9059KPlasma, frz between 8-24hour09551.2934$76.75$15.35
    P9060KFr frz plasma donor retested95031.6241$96.38$19.28
    P9603AOne-way allow prorated miles
    P9604AOne-way allow prorated trip
    P9612NCatheterize for urine spec
    P9615NUrine specimen collect mult
    Q0035XCardiokymography01002.4968$148.17$41.44$29.63
    Q0081BInfusion ther other than che
    Q0083BChemo by other than infusion
    Q0084BChemotherapy by infusion
    Q0085BChemo by both infusion and o
    Q0091TObtaining screen pap smear01910.167$9.91$2.78$1.98
    Q0092NSet up port xray equipment
    Q0111AWet mounts/ w preparations
    Q0112APotassium hydroxide preps
    Q0113APinworm examinations
    Q0114AFern test
    Q0115APost-coital mucous exam
    Q0136KNon esrd epoetin alpha inj0733$9.99$2.00
    Q0137KDarbepoetin alfa, non esrd0734$3.28$0.66
    Q0144EAzithromycin dihydrate, oral
    Q0163NDiphenhydramine HCl 50mg
    Q0164NProchlorperazine maleate 5mg
    Q0165BProchlorperazine maleate10mg
    Q0166KGranisetron HCl 1 mg oral0765$33.51$6.70
    Q0167NDronabinol 2.5mg oral
    Q0168BDronabinol 5mg oral
    Start Printed Page 50881
    Q0169NPromethazine HCl 12.5mg oral
    Q0170BPromethazine HCl 25 mg oral
    Q0171N aChlorpromazine HCl 10mg oral
    Q0172BChlorpromazine HCl 25mg oral
    Q0173NTrimethobenzamide HCl 250mg
    Q0174NThiethylperazine maleate10mg
    Q0175NPerphenazine 4mg oral
    Q0176BPerphenazine 8mg oral
    Q0177NHydroxyzine pamoate 25mg
    Q0178BHydroxyzine pamoate 50mg
    Q0179KOndansetron HCl 8mg oral0769$32.02$6.40
    Q0180KDolasetron mesylate oral0763$48.54$9.71
    Q0181EUnspecified oral anti-emetic
    Q0187KFactor viia recombinant1409$1,080.11$216.02
    Q1001NNtiol category 1
    Q1002NNtiol category 2
    Q1003NNtiol category 3
    Q1004NNtiol category 4
    Q1005NNtiol category 5
    Q2001EOral cabergoline 0.5 mg
    Q2002NElliotts b solution per ml
    Q2003KAprotinin, 10,000 kiu7019$2.20$0.44
    Q2004NBladder calculi irrig sol
    Q2005KCorticorelin ovine triflutat7024$386.53$77.31
    Q2006KDigoxin immune fab (ovine)7025$552.18$110.44
    Q2007KEthanolamine oleate 100 mg7026$64.53$12.91
    Q2008KFomepizole, 15 mg7027$12.31$2.46
    Q2009KFosphenytoin, 50 mg7028$5.19$1.04
    Q2011KHemin, per 1 mg7030$6.51$1.30
    Q2012KPegademase bovine, 25 iu9168$161.16$32.23
    Q2013KPentastarch 10% solution7040$12.45$2.49
    Q2014NSermorelin acetate, 0.5 mg
    Q2017KTeniposide, 50 mg7035$266.23$53.25
    Q2018KUrofollitropin, 75 iu7037$44.74$8.95
    Q2019KBasiliximab1615$1,473.57$294.71
    Q2020EHistrelin acetate
    Q2021KLepirudin9057$128.17$25.63
    Q2022KVonWillebrandFactrCmplxperIU1618$0.74$0.15
    Q3000HRubidium-Rb-829025
    Q3001BBrachytherapy Radioelements
    Q3002HGallium ga 671619
    Q3003HTechnetium tc99m bicisate1620
    Q3004NXenon xe 133
    Q3005HTechnetium tc99m mertiatide1622
    Q3006HTechnetium tc99m glucepatate9154
    Q3007HSodium phosphate p321624
    Q3008HIndium 111-in pentetreotide1625
    Q3009NTechnetium tc99m oxidronate
    Q3010HTechnetium tc99m labeledrbcs9155
    Q3011HChromic phosphate p321628
    Q3012NCyanocobalamin cobalt co57
    Q3014ATelehealth facility fee
    Q3019AALS emer trans no ALS serv
    Q3020AALS nonemer trans no ALS se
    Q3025KIM inj interferon beta 1-a9022$89.10$17.82
    Q3026ESubc inj interferon beta-1a
    Q3031NCollagen skin test
    Q4001BCast sup body cast plaster
    Q4002BCast sup body cast fiberglas
    Q4003BCast sup shoulder cast plstr
    Q4004BCast sup shoulder cast fbrgl
    Q4005BCast sup long arm adult plst
    Q4006BCast sup long arm adult fbrg
    Q4007BCast sup long arm ped plster
    Q4008BCast sup long arm ped fbrgls
    Q4009BCast sup sht arm adult plstr
    Start Printed Page 50882
    Q4010BCast sup sht arm adult fbrgl
    Q4011BCast sup sht arm ped plaster
    012BCast sup sht arm ped fbrglas
    Q4013BCast sup gauntlet plaster
    Q4014BCast sup gauntlet fiberglass
    Q4015BCast sup gauntlet ped plster
    Q4016BCast sup gauntlet ped fbrgls
    Q4017BCast sup lng arm splint plst
    Q4018BCast sup lng arm splint fbrg
    Q4019BCast sup lng arm splnt ped p
    Q4020BCast sup lng arm splnt ped f
    Q4021BCast sup sht arm splint plst
    Q4022BCast sup sht arm splint fbrg
    Q4023BCast sup sht arm splnt ped p
    Q4024BCast sup sht arm splnt ped f
    Q4025BCast sup hip spica plaster
    Q4026BCast sup hip spica fiberglas
    Q4027BCast sup hip spica ped plstr
    Q4028BCast sup hip spica ped fbrgl
    Q4029BCast sup long leg plaster
    Q4030BCast sup long leg fiberglass
    Q4031BCast sup lng leg ped plaster
    Q4032BCast sup lng leg ped fbrgls
    Q4033BCast sup lng leg cylinder pl
    Q4034BCast sup lng leg cylinder fb
    Q4035BCast sup lngleg cylndr ped p
    Q4036BCast sup lngleg cylndr ped f
    Q4037BCast sup shrt leg plaster
    Q4038BCast sup shrt leg fiberglass
    Q4039BCast sup shrt leg ped plster
    Q4040BCast sup shrt leg ped fbrgls
    Q4041BCast sup lng leg splnt plstr
    Q4042BCast sup lng leg splnt fbrgl
    Q4043BCast sup lng leg splnt ped p
    Q4044BCast sup lng leg splnt ped f
    Q4045BCast sup sht leg splnt plstr
    Q4046BCast sup sht leg splnt fbrgl
    Q4047BCast sup sht leg splnt ped p
    Q4048BCast sup sht leg splnt ped f
    Q4049BFinger splint, static
    Q4050BCast supplies unlisted
    Q4051BSplint supplies misc
    Q4054ADarbepoetin alfa, esrd use
    Q4055AEpoetin alfa, esrd use
    Q4075NAcyclovir, 5 mg
    Q4076NDopamine hcl, 40 mg
    Q4077KTreprostinil, 1 mg1082$55.02$11.00
    Q4079GInjection, natalizumab9126$6.51$1.30
    Q9941KIVIG lyophil 1g0869$39.46$7.89
    Q9942KIVIG lyophil 10 mg0870$0.40$0.08
    Q9943KIVIG non-lyophil 1g0871$57.26$11.45
    Q9944KIVIG non-lyophil 10 mg0872$0.57$0.11
    Q9945KLOCM <=149 mg/ml iodine, 1ml9157$0.51$0.10
    Q9946KLOCM 150-199mg/ml iodine,1ml9158$2.00$0.40
    Q9947KLOCM 200-249mg/ml iodine,1ml9159$0.78$0.16
    Q9948KLOCM 250-299mg/ml iodine,1ml9160$0.66$0.13
    Q9949KLOCM 300-349mg/ml iodine,1ml9161$0.41$0.08
    Q9950KLOCM 350-399mg/ml iodine,1ml9162$0.27$0.05
    Q9951KLOCM >= 400 mg/ml iodine,1ml19163$0.20$0.04
    Q9952KInj Gad-base MR contrast, ml9164$3.01$0.60
    Q9953NInj Fe-based MR contrast, ml
    Q9954KOral MR contrast, 100 ml9165$9.01$1.80
    Q9955KInj perflexane lip micros, m9203$13.49$2.70
    Q9956KInj octafluoropropane mic,ml9202$41.42$8.28
    Q9957KInj perflutren lip micros, m9112$63.51$12.70
    R0070NTransport portable x-ray
    Start Printed Page 50883
    R0075NTransport port x-ray multipl
    R0076NTransport portable EKG
    V2020AVision svcs frames purchases
    V2025EEyeglasses delux frames
    V2100ALens spher single plano 4.00
    V2101ASingle visn sphere 4.12-7.00
    V2102ASingl visn sphere 7.12-20.00
    V2103ASpherocylindr 4.00d/12-2.00d
    V2104ASpherocylindr 4.00d/2.12-4d
    V2105ASpherocylinder 4.00d/4.25-6d
    V2106ASpherocylinder 4.00d/>6.00d
    V2107ASpherocylinder 4.25d/12-2d
    V2108ASpherocylinder 4.25d/2.12-4d
    V2109ASpherocylinder 4.25d/4.25-6d
    V2110ASpherocylinder 4.25d/over 6d
    V2111ASpherocylindr 7.25d/.25-2.25
    V2112ASpherocylindr 7.25d/2.25-4d
    V2113ASpherocylindr 7.25d/4.25-6d
    V2114ASpherocylinder over 12.00d
    V2115ALens lenticular bifocal
    V2118ALens aniseikonic single
    V2121ALenticular lens, single
    V2199ALens single vision not oth c
    V2200ALens spher bifoc plano 4.00d
    V2201ALens sphere bifocal 4.12-7.0
    V2202ALens sphere bifocal 7.12-20
    V2203ALens sphcyl bifocal 4.00d/.1
    V2204ALens sphcy bifocal 4.00d/2.1
    V2205ALens sphcy bifocal 4.00d/4.2
    V2206ALens sphcy bifocal 4.00d/ove
    V2207ALens sphcy bifocal 4.25-7d/
    V2208ALens sphcy bifocal 4.25-7/2
    V2209ALens sphcy bifocal 4.25-7/4
    V2210ALens sphcy bifocal 4.25-7/ov
    V2211ALens sphcy bifo 7.25-12/.25-
    V2212ALens sphcyl bifo 7.25-12/2.2
    V2213ALens sphcyl bifo 7.25-12/4.2
    V2214ALens sphcyl bifocal over 12
    V2215ALens lenticular bifocal
    V2218ALens aniseikonic bifocal
    V2219ALens bifocal seg width over
    V2220ALens bifocal add over 3.25d
    V2221ALenticular lens, bifocal
    V2299ALens bifocal speciality
    V2300ALens sphere trifocal 4.00d
    V2301ALens sphere trifocal 4.12-7
    V2302ALens sphere trifocal 7.12-20
    V2303ALens sphcy trifocal 4.0/.12-
    V2304ALens sphcy trifocal 4.0/2.25
    V2305ALens sphcy trifocal 4.0/4.25
    V2306ALens sphcyl trifocal 4.00/>6
    V2307ALens sphcy trifocal 4.25-7/
    V2308ALens sphc trifocal 4.25-7/2
    V2309ALens sphc trifocal 4.25-7/4
    V2310ALens sphc trifocal 4.25-7/>6
    V2311ALens sphc trifo 7.25-12/.25-
    V2312ALens sphc trifo 7.25-12/2.25
    V2313ALens sphc trifo 7.25-12/4.25
    V2314ALens sphcyl trifocal over 12
    V2315ALens lenticular trifocal
    V2318ALens aniseikonic trifocal
    V2319ALens trifocal seg width > 28
    V2320ALens trifocal add over 3.25d
    V2321ALenticular lens, trifocal
    V2399ALens trifocal speciality
    V2410ALens variab asphericity sing
    Start Printed Page 50884
    V2430ALens variable asphericity bi
    V2499AVariable asphericity lens
    V2500AContact lens pmma spherical
    V2501ACntct lens pmma-toric/prism
    V2502AContact lens pmma bifocal
    V2503ACntct lens pmma color vision
    V2510ACntct gas permeable sphericl
    V2511ACntct toric prism ballast
    V2512ACntct lens gas permbl bifocl
    V2513AContact lens extended wear
    V2520AContact lens hydrophilic
    V2521ACntct lens hydrophilic toric
    V2522ACntct lens hydrophil bifocl
    V2523ACntct lens hydrophil extend
    V2530AContact lens gas impermeable
    V2531AContact lens gas permeable
    V2599AContact lens/es other type
    V2600AHand held low vision aids
    V2610ASingle lens spectacle mount
    V2615ATelescop/othr compound lens
    V2623APlastic eye prosth custom
    V2624APolishing artifical eye
    V2625AEnlargemnt of eye prosthesis
    V2626AReduction of eye prosthesis
    V2627AScleral cover shell
    V2628AFabrication & fitting
    V2629AProsthetic eye other type
    V2630NAnter chamber intraocul lens
    V2631NIris support intraoclr lens
    V2632NPost chmbr intraocular lens
    V2700ABalance lens
    V2702EDeluxe lens feature
    V2710AGlass/plastic slab off prism
    V2715APrism lens/es
    V2718AFresnell prism press-on lens
    V2730ASpecial base curve
    V2744ATint photochromatic lens/es
    V2745ATint, any color/solid/grad
    V2750AAnti-reflective coating
    V2755AUV lens/es
    V2756EEye glass case
    V2760AScratch resistant coating
    V2761BMirror coating
    V2762APolarization, any lens
    V2770AOccluder lens/es
    V2780AOversize lens/es
    V2781BProgressive lens per lens
    V2782ALens, 1.54-1.65 p/1.60-1.79g
    V2783ALens, >= 1.66 p/>=1.80 g
    V2784ALens polycarb or equal
    V2785FCorneal tissue processing
    V2786AOccupational multifocal lens
    V2790NAmniotic membrane
    V2797AVis item/svc in other code
    V2799AMiscellaneous vision service
    V5008EHearing screening
    V5010EAssessment for hearing aid
    V5011EHearing aid fitting/checking
    V5014EHearing aid repair/modifying
    V5020EConformity evaluation
    V5030EBody-worn hearing aid air
    V5040EBody-worn hearing aid bone
    V5050EHearing aid monaural in ear
    V5060EBehind ear hearing aid
    V5070EGlasses air conduction
    V5080EGlasses bone conduction
    Start Printed Page 50885
    V5090EHearing aid dispensing fee
    V5095EImplant mid ear hearing pros
    V5100EBody-worn bilat hearing aid
    V5110EHearing aid dispensing fee
    V5120EBody-worn binaur hearing aid
    V5130EIn ear binaural hearing aid
    V5140EBehind ear binaur hearing ai
    V5150EGlasses binaural hearing aid
    V5160EDispensing fee binaural
    V5170EWithin ear cros hearing aid
    V5180EBehind ear cros hearing aid
    V5190EGlasses cros hearing aid
    V5200ECros hearing aid dispens fee
    V5210EIn ear bicros hearing aid
    V5220EBehind ear bicros hearing ai
    V5230EGlasses bicros hearing aid
    V5240EDispensing fee bicros
    V5241EDispensing fee, monaural
    V5242EHearing aid, monaural, cic
    V5243EHearing aid, monaural, itc
    V5244EHearing aid, prog, mon, cic
    V5245EHearing aid, prog, mon, itc
    V5246EHearing aid, prog, mon, ite
    V5247EHearing aid, prog, mon, bte
    V5248EHearing aid, binaural, cic
    V5249EHearing aid, binaural, itc
    V5250EHearing aid, prog, bin, cic
    V5251EHearing aid, prog, bin, itc
    V5252EHearing aid, prog, bin, ite
    V5253EHearing aid, prog, bin, bte
    V5254EHearing id, digit, mon, cic
    V5255EHearing aid, digit, mon, itc
    V5256EHearing aid, digit, mon, ite
    V5257EHearing aid, digit, mon, bte
    V5258EHearing aid, digit, bin, cic
    V5259EHearing aid, digit, bin, itc
    V5260EHearing aid, digit, bin, ite
    V5261EHearing aid, digit, bin, bte
    V5262EHearing aid, disp, monaural
    V5263EHearing aid, disp, binaural
    V5264EEar mold/insert
    V5265EEar mold/insert, disp
    V5266EBattery for hearing device
    V5267EHearing aid supply/accessory
    V5268EALD Telephone Amplifier
    V5269EAlerting device, any type
    V5270EALD, TV amplifier, any type
    V5271EALD, TV caption decoder
    V5272ETdd
    V5273EALD for cochlear implant
    V5274EALD unspecified
    V5275EEar impression
    V5298EHearing aid noc
    V5299BHearing service
    V5336ERepair communication device
    V5362ESpeech screening
    V5363ELanguage screening
    V5364EDysphagia screening
    * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule.
    CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
    Copyright American Dental Association. All Rights Reserved.
            Start Printed Page 50886

    Start Signature

    (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare_Hospital Insurance; and Program No. 93.774, Medicare_Supplementary Medical Insurance Program)

    Dated: August 17, 2005

    Ann C. Agnew,

    Executive Secretary to the Department

    End Signature End Supplemental Information

    [FR Doc. 05-16699 Filed 8-18-05; 2:44 pm]

    BILLING CODE 4120-01-P

Document Information

Published:
08/26/2005
Department:
Centers for Medicare & Medicaid Services
Entry Type:
Proposed Rule
Action:
Proposed rule; correction.
Document Number:
05-16699
Pages:
50679-50886 (208 pages)
Docket Numbers:
CMS-1501-CN
RINs:
0938-AN46: Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates (CMS-1501-P)
RIN Links:
https://www.federalregister.gov/regulations/0938-AN46/changes-to-the-hospital-outpatient-prospective-payment-system-and-calendar-year-2006-payment-rates-c
PDF File:
05-16699.pdf
CFR: (2)
42 CFR 419
42 CFR 485