cmh physician practice pricing 2018 - United Health Services

CMH PHYSICIAN PRACTICE PRICING

EFFECTIVE FEBRUARY 1, 2018

SERVICE DESCRIPTION PRICE

1 lung with ventilation; PRO $1,600.00

12 LEAD EKG $0.01

1ST HOSP CARE PR D 30 MIN $201.13



1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB $258.16

1ST HOSP/BIRTHING CENTER NB ADMIT&DSCHG SM DATE $294.25

1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/< $2,592.55

1ST INPT CONSLTJ 110 MIN $475.01





1ST NF CARE PR D E/M HI SEVERITY $320.35

1ST NF CARE PR D E/M LW SEVERITY $237.44

1ST NF CARE PR D E/M MOD SEVERITY $251.01

1ST OBS CARE PR D HIGH SEVERITY $369.28

1ST OBS CARE PR D LOW SEVERITY $198.80

1ST OBS CARE PR D MODERATE SEVERITY $269.53

1ST PREVENTIVE MEDICINE NEW PATIENT < 1YR $274.17

1ST PREVENTIVE MEDICINE NEW PATIENT AGE 12-17 YR $294.88

1ST PREVENTIVE MEDICINE NEW PATIENT AGE 1-4 YRS $271.93

1ST PREVENTIVE MEDICINE NEW PATIENT AGE 18-39YRS $338.17

1ST PREVENTIVE MEDICINE NEW PATIENT AGE 40-64YRS $379.14

1ST PREVENTIVE MEDICINE NEW PATIENT AGE 5-11 YRS $290.27

1ST PREVENTIVE MEDICINE NEW PATIENT AGE 65YRS&> $76.69

2 OR MORE FALLS WITH INJURY $0.01

7 FIELD PHOTO INTERP DOC REV $0.01

76856 U/S PELVIC COMPL/OFC; PRO $319.25

ABD PARACENTESIS WO IMAGING $219.25

ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC $740.82

ABDOM PARACENTESE WO/IMAGING GUIDANCE $465.49

ABDOMEN ULTRASOUND LTD $215.32

Abdominoperineal resection; PRO $800.00

ABLATION & RCNSTJ ATRIA LMTD $3,868.03

ABLTJ SOF TISS INF TURBS UNI/BI SUPFC $539.42

ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL $800.04

Access to CVC; PRO $500.00

ACETABULOPLASTY $3,708.81

ACETABULOPLASTY RESECTION FEMORAL HEAD $3,130.04

ACNE SURGERY $270.19

ACUP 1/> NDLS W/ELEC STIMJ 1ST 15 MIN $40.10

ACUP 1/> NDLS W/ELEC STIMJ EA 15 MIN W/RE-INSJ $37.88

ACUP 1/> NDLS W/O ELEC STIMJ 1ST 15 MIN $40.10

ACUP 1/> NDLS W/O ELEC STIMJ EA 15 MIN $27.85

ADENOIDECTOMY PRIM AGE 12/> $663.20

ADENOIDECTOMY PRIM UNDER AGE 12 $613.63

ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 CM/< $1,464.90

ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES $1,305.01

ADMN&INTERPJ HLTH RISK ASSMT INSTRUMENT $35.65

Adrenalectomy; PRO $1,100.00

ADRENALIN 1 ML $8.00

ADRENALIN, EPINEPHRINE $5.00

ADVNC CARE PLAN IN RCRD $0.01

ADVNC CARE PLAN TLK DOCD $0.01

ADVNCD CARE PLAN 30 MINS $206.10

ADVNCD CARE PLAN ADDTL 30 MINS $204.65

AFO; PREFAB W/FITTING+AD $133.02

AIR CAST $315.59

ALBUTEROL UNIT 1MG $5.00

ALGINATE OR OTHER FIBER GELLING DRESSING $22.32

All procedures nerve, muscle, tendon, knee; PRO $500.00

All procedures nerve, muscle, tendon, upper leg; PRO $500.00

All procedures veins includes exploration; PRO $400.00

ALLERGEN IMMUN OTHER SERUM $23.97

ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED $535.60

ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL $306.95

ALUMINUM CRUTCHES $74.28

Amniocentesis Anes; PRO $500.00

AMNIOCNTS DX $362.67

AMNISURE/ROM POINT OF CARETEST $40.00

AMNT PAIN NOTED NONE PRSNT $0.01

AMNT PAIN NOTED PAIN PRSNT $0.01

AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV $1,955.09

AMP F/TH 1/2 JT/PHALANX 1 W/NEURECT LOCAL FLAP $1,864.29

AMP F/TH 1/2 JT/PHALANX 1 W/NEURECT W/DIR CLSR $1,860.26

AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST $2,496.84

AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION $1,946.49

AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REVJ $1,653.98

AMP MTCRPL W/FNGR/THMB 1 +-INTEROSS TR $2,018.04

AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION $1,408.07

AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE $1,997.76

AMPUTATION FOOT MIDTARSAL $1,560.01

AMPUTATION FOOT TRANSMETARSAL $2,172.56

AMPUTATION FOREARM THROUGH RADIUS & ULNA $2,015.45

AMPUTATION LEG THROUGH TIBIA&FIBULA $2,714.26

AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR $1,778.00

AMPUTATION METATARSAL W/TOE SINGLE $1,277.87

AMPUTATION THIGH THROUGH FEMUR ANY LEVEL $2,372.98

AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION $2,132.81

AMPUTATION TOE INTERPHALANGEAL JOINT $1,124.55

AMPUTATION TOE METATARSOPHALANGEAL JOINT $1,199.88

Amputation; PRO $600.00

ANALYZE PACEMAKER SYSTEM; PRO $645.02

ANES Gastrocnemius recession $600.00

ANGIOGRAPHY EXT BIL $191.36

ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I $52.53

ANGRPH XTR UNI RS&I $167.32

ANKLE DISARTICULATION $1,868.31

ANKLE FOOT ORTHOSIS AFO $689.67

ANKLE FOOT ORTHOTIC $146.32

ANNUAL DEPRESSION SCR 15 MIN; PRO $52.18

ANNUAL WELLNESS VISIT INITIAL $499.65

ANNUAL WELLNESS VISIT SUBSEQ $335.27

Anorectal procedure; PRO $600.00

ANOSC DX +-COLLJ SPEC BR/WA SPX $243.29

ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX $318.00

ANT COLPORRHAPHY RPR CSTOCELE +-RPR URETHROCELE $1,953.82

ANTB HIV-1 $20.00

ANTEPARTUM C DLVR&POSTPARTUM FA V AP C DLVER $5,558.86

ANTEPARTUM CARE ONLY 4-6 VSTS $1,274.26

ANTEPARTUM CARE ONLY 7+ VSTS $2,288.04

ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS $2,119.82

ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS $3,605.00

ANTERIOR TIBIAL TUBERCLEPLASTY $2,240.63

ANTI RHEUM DRUGTHXPYRXD GVN $0.01

ANTIGEN,RAPID GROUP A STREP $39.00

AORTOGRAPY ABDL SRLOGRAPY RS&I $165.83

APLIGRAF,PER SQUARE CM $81.69

APPENDEC INDICATED PURPOSE OTH MAJOR PX X SPX $246.51

APPENDEC RPTD APPENDIX ABSC/PRITONITIS $2,493.56

APPENDECTOMY INCIDENTAL TO PROCEDURE $1,885.51

APPL CLUBFOOT CAST MOLDING/MNPJ LONG/SHORT LEG $352.65

APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS $768.36

APPL SURF TC NSTIM $46.80

APPLICATION CAST ELBOW FINGER SHORT ARM $251.32

APPLICATION CAST HAND&LOWER FOREARM GAUNTLET $227.23

APPLICATION CAST SHOULDER HAND LONG ARM $279.72

APPLICATION CYLINDER CAST THIGH ANKLE $290.15

APPLICATION FINGER SPLINT STATIC $97.72

APPLICATION FINGER SPLINT STATIC ER PHY $65.05

APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE $1,116.68

APPLICATION LONG ARM SPLINT SHOULDER HAND $248.17

APPLICATION LONG LEG CAST THIGH-TOE $386.18

APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE $373.11

APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES $226.92

APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM $2,656.14

Application of lower leg cast removal or repair; PRO $400.00

APPLICATION SHORT ARM SPLINT DYNAMIC $223.51

APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC $182.53

APPLICATION SHORT LEG CAST BELOW KNEE-TOE $231.41

APPLICATION SHORT LEG SPLINT CALF FOOT $203.27

APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM $1,417.63

APPLY FEET, DIG, TO 100 SQCM; 1ST 25 SQ CM $419.99

APPLY SHORT LEG CAST $222.02

APPROPRIATE EMPIRIC ANTIBIOTIC PRESCRIBED $0.01

ARANESP/MCG NON ESRD $14.40

Arteries of knee and popliteal area; PRO $900.00

ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT $1,985.00

Arteriovenous fistula; PRO $700.00

ARTHO KNEE OSTEOCHOND ALLOGRAFT $3,695.30

Arthoscopic ankle and/or foot; PRO $400.00

Arthoscopic elbow procedures; PRO $400.00

ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 $4,998.89

ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC $1,545.00

ARTHRD ANT MIN DISCECT INTERBODY CERV BELW C2 $3,672.98

ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT $2,269.18

ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH $2,036.13

ARTHRD CARP/MTCRPL JT THMB +-INT FIXJ $2,067.08

ARTHRD IPHAL JT +-INT FIXJ $1,626.63

ARTHRD IPHAL JT +-INT FIXJ EA IPHAL JT $297.27

ARTHRD IPHAL JT +-INT FIXJ W/AGRFT $2,010.24

ARTHRD IPHAL JT +-INT FIXJ W/AGRFT EA JT $624.59

ARTHRD MIDTARSL/TARS MLT/TRANSVRS $2,157.08

ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT $2,303.44

ARTHRD MTCARPHLNGL JT +-INT FIXJ $1,938.96

ARTHRD MTCARPHLNGL JT +-INT FIXJ W/AGRFT $2,202.09

ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFORM $1,957.99

ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK $1,892.39

ARTHRD WRST COMPL W/O B1 GRF $2,084.54

ARTHRD WRST W/ILIAC/OTH AGRFT $2,427.61

ARTHRD WRST W/SLIDING GRF $2,274.97

ARTHRO ANKLE EXCISION OF OSTEOCHON DEFECT $1,960.29

ARTHRO KNEE MEN REPAIR MED AND LATERAL $2,436.13

ARTHROCENTESIS ASPIR&/INJECTION INTERM JT/BURSA $141.78

ARTHROCENTESIS ASPIR&/INJECTION MAJOR JT/BURSA $174.07

ARTHROCENTESIS ASPIR&/INJECTION SMALL JT/BURSA $135.01

ARTHRODESIS ANKLE OPEN $2,937.80

ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC $968.43

ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT $1,389.54

ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT $2,395.75

ARTHRODESIS KNEE ANY TECHNIQUE $4,087.53

ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR $1,029.11

ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR $4,774.51

ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT $2,076.24

ARTHRODESIS PANTALAR $3,469.18

ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL $1,142.02

ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR $4,498.47

ARTHRODESIS SACROILIAC JOINT $1,821.22

ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT $3,253.88

ARTHRODESIS SUBTALAR $2,283.15

ARTHRODESIS TRIPLE $2,236.78

ARTHRODESIS WRIST LIMITED W/AUTOGRAFT $2,122.42

ARTHRODESIS WRIST LIMITED W/O BONE GRAFT $1,665.58

ARTHROPLASTY ANKLE $1,725.24

ARTHROPLASTY ELBOW W/MEMBRANE $2,507.62

ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE $2,362.69

ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER $4,269.22

ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY $3,525.83

ARTHROPLASTY INTERPHALANGEAL JOINT EACH $1,201.36

ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA $2,056.58

ARTHROPLASTY KNEE HINGE PROSTHESIS $3,428.25

ARTHROPLASTY PATELLA W/O PROSTHESIS $1,835.17

ARTHROPLASTY PATELLA W/PROSTHESIS $2,340.35

ARTHROPLASTY RADIAL HEAD $1,781.57

ARTHROPLASTY RADIAL HEAD W/IMPLANT $1,897.69

Arthroscopic procedure hip joint; PRO $500.00

Arthroscopic shoulder procedure; PRO $500.00

ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE $1,661.51

ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL $1,417.28

ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB $1,160.10

ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY $1,927.08

ARTHROSCOPY KNEE DIAGNOSTIC +-SYNOVIAL BX SPX $1,388.44

ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE $1,464.31

ARTHROSCOPY KNEE LATERAL RELEASE $1,252.35

ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY $1,574.65

ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS $1,927.95

ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX $1,452.18

ARTHROSCOPY KNEE W/LYSIS ADHESIONS+-MNPJ SPX $1,720.56

ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL $2,103.76

ARTHROSCOPY SHOULDER BICEPS TENODESIS $2,649.27

ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY $1,947.85

ARTHROSCOPY SHOULDER DX +-SYNOVIAL BIOPSY SPX $1,127.90

ARTHROSCOPY SHOULDER LYSIS&RESCJ ADHESION +-MNPJ $1,378.21

ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR $3,092.17

ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE $1,815.70

ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED $1,662.97

ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE $1,662.25

ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL $1,568.48

ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY $3,098.20

ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB $1,716.44

ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION $3,114.80

ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE $1,617.15

ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL $1,395.70

ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB $1,908.91

ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH $762.28

ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH $944.09

ARTHROTOMY ELBOW W/SYNOVECTOMY $1,721.86

ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY $1,126.37

ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB $2,012.97

ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY $2,845.61

ARTHROTOMY HIP W/DRAINAGE $2,744.06

ARTHROTOMY W/MENISCUS REPAIR KNEE $1,864.74

ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY $1,626.98

ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR $1,934.41

ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT $4,086.59

ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCMT $3,928.86

ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS $2,429.99

ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT CMPRTS $3,966.53

ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT $3,237.67

ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT $1,634.36

ARTHRP W/PROSTC RPLCMT DSTL RDS&PRTL/CARPUS $3,279.80

ARTHRP WRST +-INTERPOS +-XTRNL/INT FIXJ $2,400.13

ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR $1,916.11

ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ $2,962.03

ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ $3,418.65

ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG $1,925.85

ARTHRS KNE DRLG OSTEO DISS GRFG $1,803.43

ARTHRS KNE DRLG OSTEO DISS LES $1,525.32

ARTHRS KNE DRLG OSTEO DISS LES INT FIXJ $1,787.18

ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG $1,578.51

ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX $1,942.49

ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG $1,823.72

ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING $1,687.89

ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JT DBRDMT $1,513.97

ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB $1,607.79

ARTHRT ANKLE W/JT EXPL +-BX +-RMVL LOOSE/FB $1,226.96

ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX $1,982.62

ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB $3,556.13

ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT $892.54

ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA $1,141.50

ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA $968.06

ARTHRT KNE W/EXPL DRG/RMVL FB $2,139.10

ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB $3,549.32

ARTHRT PST CAPSULAR RLS ANKLE +-ACHLL TDN LNGTH $1,552.13

ARTHRT W/EXC SEMILUNAR CRTLG KNE MEDIAL&LAT $1,566.16

ARTHRT W/EXC SEMILUNAR CRTLG KNE MEDIAL/LAT $1,787.22

ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT $969.36

ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT $1,067.08

ARTHRT W/SYNVCT KNE ANT&PST W/POP AREA $2,162.02

ARTHRT WRST JT W/JT EXPL +-BX +-RMVL LOOSE/FB $1,142.50

ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN $295.37

ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ $154.40

ARTL PNXR W/DRAWAL BLD DX $86.55

ARVEN ANAST OPN F/ARM VEIN TRPOS $2,185.20

ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS $2,189.71

ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS $2,071.89

AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT $9,300.55

ASCENDING AORTA GRF W/CARD BYP & VALVE SSP $9,480.68

ASPIRATION&/INJECTION GANGLION CYST ANY LOCATION $170.96

ASPIRATION&INJECTION TREATMENT BONE CYST $595.86

ATRIA ABLATE & RCNSTJ W OTHER PROCEDURE LIMITED $1,720.21

ATRIA ABLATE &RCNSTJ W OTHER PX EXTENSIVE W BYP $2,490.42

ATT/R ANY AREA DEFECT 30.1-60SQCM $3,019.54

ATT/R ANY AREA DEFECT EA ADDL 30SQCM OR PART $645.00

ATT/REARGMT E/N/E/L DFCT 10 CM/< $2,179.79

ATT/REARGMT EYELID/NOSE/EAR/LIP 10.1-30.0 CM $2,847.83

ATT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0CM $2,657.46

ATT/REARRANGEMENT F/C/C/M/N/AX/G/H/F 10 CM/< $2,135.52

ATT/REARRANGEMENT SCALP/ARM/LEG 10 CM/< $1,867.92

ATT/REARRANGEMENT SCALP/ARM/LEG 10.1-30.0 CM $2,453.18

ATT/REARRANGEMENT TRUNK 10.1-30.0CM $2,134.62

ATTN AT DELIVERY& 1ST STABILIZATION OF NEWBORN $207.49

AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC $509.24

AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION $255.11

AVULSION NAIL PLATE PARTIAL/COMPLETE SMPL EA $100.40

AVULSION NAIL PLATE-ONE $233.74

AX LMPHADEC COMPL $2,567.42

AX LMPHADEC SUPFC $1,925.08

Axillary femoral bypass graft; PRO $1,100.00

Axillary-brachial aneurysm; PRO $1,100.00

BENADRYL,25-50MG $5.00

BETAMETHACETATE ACETATE $65.18

BINOC MIC $84.00

BIOPSY BONE OPEN SUPERFICIAL $633.45

BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL $471.14

BIOPSY BREAST NEEDLE CORE W/IMAGING GUIDANCE $592.00

BIOPSY BREAST OPEN INCISIONAL $952.79

BIOPSY CERVIX 1/MLT OR EXCISION OF LESION $357.00

BIOPSY INTRANASAL $385.92

BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE $272.95

BIOPSY MUSCLE DEEP $776.65

BIOPSY MUSCLE PERCUTANEOUS NEEDLE $660.04

BIOPSY MUSCLE SUPERFICIAL $483.30

BIOPSY NAIL UNIT SPX $363.76

Biopsy of clavicle; PRO $400.00

BIOPSY SKIN-EACH ADL ONE LESION $93.73

BIOPSY SKIN-ONE LESION $294.54

BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP $1,011.20

BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL $596.36

BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP $1,361.59

BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL $472.77

BIOPSY SOFT TISSUE NECK/THORAX $618.55

BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL $510.15

BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP $1,122.94

BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL $636.95

BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP $1,464.65

BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL $720.32

Biopsy soft tissue; PRO $500.00

BLADDER PRESSURE MEASUREMENT DURING FILLING $951.64

BLDR INSTLJ ANTICARCINOGENIC AGT $307.00

BLDR IRRIGATION SMPL LVG&/INSTLJ $239.99

BLEPHAROPLASTY UPPER EYELID $1,254.15

BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN $1,716.36

BLEPHAROTOMY DRG ABSC EYELID $757.76

BLOOD COUNT OTHER THAN SPL $32.00

Body cast application; PRO $400.00

BODY MASS INDEX DOCD $0.01

BONE GRAFT ANY DONOR AREA MAJOR/LARGE $839.45

BONE GRAFT ANY DONOR AREA MINOR/SMALL $1,172.00

Bone marrow aspiration; PRO $600.00

BONIVA 1MG $221.73

Bony pelvis procedures; PRO $700.00

BOTULINUM TOXIN TYPE A PER UNIT $12.38

BP < 80 DIASTOLIC $0.01

BP 80-89 DIASTOLIC $0.01

BP GREATER-EQUAL 90 DIASTOLIC $0.01

BREAST BIOPSY VACUUM ASSISTED/ROTATING DEVICE $1,485.00

BREATHING CAPACITY TEST (PFT) $100.37

BRIEF EMOTIONAL/BEHAV ASSESSMENT $13.80

BRNCHSC BRNCL/ENDOBRNCL BX 1+ SITS $941.13

BRNCHSC BRUSHING/PROTECTED BRUSHINGS $765.33

BRNCHSC INCL FLUOR GID DX W/CELL WASHG SPX $431.57

BRNCHSC NDL BX TRACHEA MAIN STEM&/BRONCHUSI $567.74

BRNCHSC W/BRNCL ALVEOLAR LAVAGE $436.72

BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC $622.85

BRNCHSC W/EXCISION TUMOR $733.22

BRNCHSC W/PLACEMENT TRACHEAL STENT $664.00

BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL $512.06

BRNCHSC W/REMOVAL FOREIGN BODY $788.57

BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE 1ST $728.38

BRNCHSC W/THER ASPIR TRACHEOBRNCL TREE SBSQ $646.96

BRNCHSC W/TRACHEAL/BRNCL DILAT/CLSD RDCTJ FX $576.26

BRNCHSC W/TRANSBRNCL LUNG BX 1 LOBE $981.17

BRNCHSC W/TRANSBRNCL LUNG BX EA LOBE $177.47

BRNCHSC W/TRANSBRNCL NDL ASPIR BX EA LOBE $219.16

BURN DEB PRTL THICKNESS-5-10% $414.63

BURN DEBRIDE PRTL THICKNESS < 5% $230.52

Burn excision 4%; PRO $400.00

Burr holes; PRO $1,000.00

BX ABDL/RPR MASS PRQ NDL $461.98

BX ANRCT WALL ANAL APPR $877.85

BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX $405.86

BX HYPOPHARYNX $488.00

BX LVR NDL DONE PURPOSE TM OTH MAJOR PX $305.57

BX LVR WEDGE $2,345.10

BX NASOPHARYNX SURV UNKNOWN PRIM LES $584.82

BX NASOPHARYNX VISIBLE LES SMPL $541.64

BX OROPHARYNX $442.12

BX PALATE UVULA $363.56

BX THYR PRQ CORE NDL $321.00

BX TONGUE PST ONE-3RD $445.64

BX VAG MUCOSA SMPL SPX $251.02

BX VESTIBULE MOUTH $493.59

BX VULVA/PR SPX 1 LES $231.29

BX VULVA/PR SPX EA SEP ADDL LES $106.91

BX XTRNL EAR $281.75

BX/EXC LYMPH NODE NDL SUPFC $357.00

BX/EXC LYMPH NODE OPN DP AX NODE $1,035.74

BX/EXC LYMPH NODE OPN DP CRV NODE $1,474.53

BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD $1,111.04

BX/EXC LYMPH NODE OPN INT MAM NODE $1,561.08

BX/EXC LYMPH NODE OPN SUPFC $885.42

BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL $5,011.08

BYP OTH/THN VEIN AORTOBIFEM $5,153.65

BYP OTH/THN VEIN AX-FEM-FEM $4,113.82

BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL $3,804.47

BYP OTH/THN VEIN FEM-FEM $3,256.90

BYP OTH/THN VEIN FEMPOP $3,253.78

BYP OTH/THN VEIN ILIOFEM $3,521.48

BYP OTH/THN VEIN ILIOILIAC $3,165.48

BYP W/VEIN FEMPOP $4,197.99

BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL $3,987.05

BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL $5,147.22

Bypass graft; PRO $900.00

C DLVR ONLY $2,687.27

C DLVR ONLY FA V AP C DLVER $2,777.91

C DLVR ONLY FA V AP C DLVER W/POSTPARTUM CARE $3,414.23

C DLVR ONLY W/POSTPARTUM CARE $3,693.88

C ENDARTERCOMY OPN ANY METH $679.80

C.DIPHTHERIAE CULTURE $62.00

CAB W/ARTL GRF 1 ARTL GRF $5,504.66

CAB W/ARTL GRF 2 C ARTL GRFS $6,485.70

CAB W/ARTL GRF 3 C ARTL GRFS $7,224.84

CAB W/ARTL GRF 4/> C ARTL GRFS $7,292.45

CAM-WALKER NONPNEUMATIC $181.83

CANALITH REPOSITIONING PROCEDURE $122.54

CAPILLARY STICK $12.00

CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC $2,617.68

CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS $2,328.40

CAPSUL MTTARPHLNGL JT +-TENORRHAPHY EA JT SPX $1,348.61

CAPSULAR CONTRACTURE RELEASE $1,927.59

CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON $2,645.05

CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR $2,841.78

CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK $3,039.84

CAPSULORRHAPHY GLENOHUMERAL JT PST +-BONE BLK $3,053.96

CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS $3,062.14

Cardiac catherization; PRO $800.00

Cardiac elecrophysiologic; PRO $800.00

CARDIO STRESS TEST; TRACING ONLY $111.74

CARDIOPULM RESUSCITATION $880.75

CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP $4,718.41

CARDIOVASCULAR STRESS TEST, INTERP AND REPORT (H) $43.88

CARDIOVASCULAR STRESS TEST; SUPERVISON W/O INTERP $65.82

CARDIOVERSION ELECTIVE ARRHYT XTRNL $595.34

Carotid and coronary; PRO $800.00

CARPECTOMY 1 BONE $1,388.38

CARPECTOMY ALL BONES PROXIMAL ROW $1,726.76

CARTILAGE GRAFT COSTOCHONDRAL $1,310.46

CASING SUPPLY SHORT ARM FIBERGLASS $20.26

Cast application for forearm, wrist and hand; PRO $400.00

Cast application removal or repair involving knee; PRO $400.00

CAST SUP LNG LEG PED PLASTER $17.59

CAST SUPPLIES $80.34

CASTING SUPPLY FIBERGLASS LONG LEG $93.82

CASTING SYNTHETIC $50.65

CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I; PRO $917.30

CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I; PRO $1,034.17

CATHETER PLACEMENT MAIN RENAL ARTERY BILATERAL $1,084.08

CATHJ&INTRO SALINE NFS SHG/HSG $334.57

CBC WITH DIFFERENTIAL $132.00

CC E/M CRITICALLY ILL/INJURED 1ST 30-74 MIN $528.59

CC E/M CRITICALLY ILL/INJURED EA 30 MIN $236.15

CEFAZOLIN SODIUM 500 MG $5.00

CEFTRIAXONE 250MG $5.00

CERCLAGE CERVIX PREGNANCY VAG $447.02

Cerebrospinal fluid shunting procedures; PRO $1,100.00

CERV/VAG CANCER SCREEN $113.52

Cervical cerclage; PRO $500.00

Cervical spine; PRO $1,100.00

Cesarean delivery following neuraxial analgesia; PRO $300.00

Cesarean delivery only; PRO $800.00

Cesarean hysterectomy following neuraxial analgesia; PRO $600.00

Cesarean hysterectomy; PRO $900.00

CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE $138.50

CHECKOUT ORTHOTIC/PROSTHETIC USE $106.09

CHEMICAL CAUTERIZATION $224.90

CHEMODNRVTJ ECCRINE GLNDS BTH AX $224.54

CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO $183.34

CHNG CSTOST TUBE SMPL $261.62

CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL $225.74

CHOLECSTC $2,557.96

CHOLECSTC CHOLANGRPH $3,211.10

CHRONIC CARE MANAGEMENT SERVICES $114.75

CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK $439.72

CLAVICULECTOMY PARTIAL $1,699.57

Closed chest procedures; PRO $700.00

Closed procedure lower femur; PRO $500.00

Closed procedure pubis or si joint; PRO $500.00

Closed procedures hip joint; PRO $500.00

Closed procedures knee; PRO $400.00

Closed procedures on humeral head, shoulder joints; PRO $500.00

Closed procedures on humerus and wlbow; PRO $400.00

Closed procedures on lower leg, ankle and/or foot; PRO $400.00

Closed procedures on radius, ulna, wrist and hand; PRO $400.00

Closed procedures upper ends of tibia, fibula and patella; P $400.00

Closed procedures upper femur; PRO $500.00

CLOSED TREATMENT COCCYGEAL FRACTURE $509.99

CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION $366.10

CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION $706.47

CLOSED TREATMENT OF LUNATE DISLOCATION $1,384.16

CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MNPJ $756.76

CLOSED TREATMENT SESAMOID FRACTURE $330.16

CLOSED TREATMENT ULNAR STYLOID FRACTURE $902.76

CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA $869.79

CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MNPJ $1,324.14

CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MNPJ $941.82

CLOSED TX CALCANEAL FRACTURE W/MANIPULATION $1,105.32

CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION $703.44

CLOSED TX CARPAL SCAPHOID FRACTURE W/MNPJ $1,155.29

CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ $855.85

CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MNPJ $1,034.88

CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION $1,471.42

CLOSED TX KNEE DISLOCATION W/ANESTHESIA $1,485.43

CLOSED TX KNEE DISLOCATION W/O ANESTHESIA $1,430.70

CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION $1,666.94

CLOSED TX METATARSAL FRACTURE W/O MANIPULATION $620.09

CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MNPJ $1,538.78

CLOSED TX NASAL FRACTURE W/O STABILIZATION $763.75

CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA $1,348.10

CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA $1,056.10

CLOSED TX PATELLAR FRACTURE W/O MANIPULATION $909.30

CLOSED TX PELVIC RIGHT FX $298.48

CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION $1,197.72

CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION $735.44

CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION $1,418.72

CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION $728.69

CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MNPJ $1,455.00

CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ $780.51

CLOSED TX RIB FRACTURE UNCOMPLICATED EACH $283.00

CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION $653.24

CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION $928.97

CLOSED TX TALUS FRACTURE W/ MANIPULATION $899.45

CLOSED TX TALUS FRACTURE W/O MANIPULATION $669.95

CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES $771.36

CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES $515.30

CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ $287.03

CLOSED TX ULNAR FRACTURE PROXIMAL END W MNPJ $1,208.25

CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MNPJ $819.94

CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION $1,378.63

CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION $737.19

CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION $638.21

CLSD TX CLAVICULAR FRACTURE W/MANIPULATION $835.08

CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION $612.43

CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION $528.67

CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION $1,002.79

CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES $1,171.16

CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES $882.46

CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION $626.92

CLSR ENTEROENTERIC/ENTEROCOLIC FSTL $3,492.67

CLSR ENTEROVES FSTL W/O INTSTINAL/BLDR RESCJ $3,289.16

CLSR LAC VESTIBULE MOUTH > 2.5 CM/CPLX $813.76

CLSR LAC VESTIBULE MOUTH 2.5 CM/< $637.74

CLSR NTRSTM LG/SM RESCJ&ANAST OTH/THN CLRCT $2,998.26

CLSR NTRSTM LG/SM RESCJ&CLRCT ANAST $4,721.06

CLSR RECTOVAG FSTL ABDL APPR $2,542.81

CLSR VESICOVAG FSTL VAG APPR $1,520.12

CLST/SKN LVL CECOSTOMY $3,378.49

CLTX ACETABULUM HIP/SOCKT FX MNPJ +-SKEL TRACJ $2,870.56

CLTX ACETABULUM HIP/SOCKT FX W/O MNPJ $1,504.31

CLTX ANKLE DISLC REQ ANES +-PRQ SKEL FIXJ $1,185.59

CLTX ARTICULAR FX INVG MTCARPHLNGL/IPHAL JT W/ $1,010.58

CLTX ARTICULAR FX INVG MTCARPHLNGL/IPHAL JT W/O $612.89

CLTX CARP/MTCRPL DISLC THMB MNPJ EA JT REQ ANES $1,175.50

CLTX CARP/MTCRPL DISLC THMB MNPJ EA W/O ANES $957.25

CLTX CARP/MTCRPL DISLC THMB W/MNPJ $1,016.42

CLTX CARP/MTCRPL FX DISLC THMB W/MNPJ $1,128.71

CLTX CARPL B1 FX W/MNPJ EA B1 $1,353.42

CLTX CARPL B1 FX W/O MNPJ EA B1 $862.04

CLTX DSTL FEM EPIPHYSL SEP W/MNPJ +-SKN/SKEL $1,671.46

CLTX DSTL FEM EPIPHYSL SEP W/O MNPJ $1,416.53

CLTX DSTL FIBULAR FX LAT MALLS W/MNPJ $1,191.14

CLTX DSTL FIBULAR FX LAT MALLS W/O MNPJ $886.00

CLTX DSTL PHLNGL FX FNGR/THMB W/MNPJ EA $887.56

CLTX DSTL PHLNGL FX FNGR/THMB W/O MNPJ EA $517.39

CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ $881.92

CLTX DSTL RDL FX/EPIPHYSL SEP +-W/MNPJ $1,530.00

CLTX DSTL XTNSR TDN INSJ +-PRQ PINNING $2,237.05

CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MNPJ $1,490.14

CLTX FEM FX PROX END NCK W/MNPJ +-SKEL TRACJ $2,112.88

CLTX FEM FX PROX END NCK W/O MNPJ $1,346.72

CLTX FEM SHFT FX W/MNPJ +-SKN/SKEL TRACJ $2,234.07

CLTX FX GRT TOE PHLX/PHLG W/MNPJ $504.12

CLTX FX GRT TOE PHLX/PHLG W/O MNPJ $397.68

CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MNPJ $438.62

CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MNPJ $351.33

CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ $1,535.44

CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MNPJ $885.69

CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ $757.09

CLTX GRTER TRCHNTRIC FX W/O MNPJ $1,124.80

CLTX HIP DISLC TRAUMTC REQ ANES $2,165.62

CLTX HIP DISLC TRAUMTC W/O ANES $534.57

CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MNPJ $913.50

CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MNPJ $1,289.32

CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MNPJ $903.08

CLTX HUMERAL SHFT FX W/MANIPULATION +-SKEL TRACJ $1,452.70

CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MNPJ $1,343.78

CLTX INTERCONDYLAR SPI&/TUBRST FX KNE +-MNPJ $1,321.70

CLTX IPHAL JT DISLC 1 W/MNPJ REQ ANES $1,099.38

CLTX IPHAL JT DISLC 1 W/MNPJ W/O ANES $774.00

CLTX IPHAL JT DISLC REQ ANES $376.10

CLTX IPHAL JT DISLC W/O ANES $340.30

CLTX MEDIAL MALLS FX W/MNPJ +-SKN/SKEL TRACJ $1,344.50

CLTX MEDIAL MALLS FX W/O MNPJ $940.87

CLTX METAR FX W/MNPJ $684.28

CLTX METATARSOPHLNGL JT DISLC REQ ANES $472.54

CLTX METATARSOPHLNGL JT DISLC W/O ANES $371.20

CLTX MTCARPHLNGL DISLC 1 W/MNPJ REQ ANES $1,124.03

CLTX MTCARPHLNGL DISLC 1 W/MNPJ W/O ANES $906.77

CLTX MTCRPL FX 1 W/MNPJ EA B1 $906.51

CLTX MTCRPL FX 1 W/O MNPJ EA B1 $789.52

CLTX MTCRPL FX W/MNPJ W/XTRNL FIXJ EA B1 $3,269.38

CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/O MNPJ $1,326.18

CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MNPJ EA $951.81

CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MNPJ EA $556.27

CLTX POST HIP ARTHRP DISLC REQ ANES $1,700.31

CLTX POST HIP ARTHRP DISLC W/O ANES $1,167.52

CLTX PROX FIBULA/SHFT FX W/MNPJ $1,024.00

CLTX PROX FIBULA/SHFT FX W/O MNPJ $862.44

CLTX PROX HUMRL FX W/MANIPULATION +-SKEL TRACJ $1,311.38

CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION $913.19

CLTX RDCRPL/INTERCARPL DISLC 1+ B1S W/MNPJ $1,125.50

CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MNPJ $379.67

CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT $1,503.00

CLTX SCAPULAR FX W/MANIPULATION +-SKEL TRACTION $949.96

CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ $1,201.62

CLTX SHOULDER DISLC W/SURG/ANTMCL NCK FX W/MNPJ $1,557.62

CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MNPJ $1,719.85

CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX+-MNPJ $1,072.97

CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MNPJ $2,353.96

CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MNPJ $1,428.22

CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES $580.31

CLTX TIBL FX PROX +-MNPJ W/SKEL TRACJ $1,455.65

CLTX TIBL FX PROX W/O MNPJ $849.74

CLTX TIBL SHFT FX W/MNPJ +-SKEL TRACJ $1,523.89

CLTX TIBL SHFT FX W/O MNPJ $976.15

CLTX TRIMAL ANKLE FX W/MNPJ $1,371.51

CLTX TRIMAL ANKLE FX W/O MNPJ $903.43

CLTX VRT BDY FX W/O MNPJ REQ&W/CSTING/BRACING $897.27

CMBN ANTEROPOST COLPORRHAPHY $2,119.31

CMBN ANTEROPOST COLPORRHAPHY W/NTRCL RPR $2,637.69

COLCT PRTL W/ANAST $3,943.74

COLCT PRTL W/END CLST&CLSR DSTL SGM $4,895.43

COLCT PRTL W/RESCJ W/CLST/ILEOST&MUCOFSTL $4,252.37

COLCT PRTL W/RMVL TERMINAL ILE W/ILEOCLST $3,653.00

COLCT PRTL W/SKN LVL CECOSTOMY/CLST $4,361.69

COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS $5,500.51

COLLECT OF PAP SMEAR $60.56

COLONOSCOPY W/ABLATION $1,213.83

COLONOSCOPY W/BAND LIGATION $792.92

COLONOSCOPY W/RESECTION $849.46

COLORECTAL CANCER SCREENING $552.13

COLORECTAL SCREENING NOT HIGH RISK $553.56

COLOTOMY EXPL BX/FB RMVL $2,369.50

COLPOCLEISIS LE FORT TYP $1,481.84

COLPOPEXY ABDL APPR $2,777.91

COLPOPEXY VAG INTRA-PRTL APPR $2,004.72

COLPOPEXY VAG XTR-PRTL APPR $1,456.88

COLPORRHAPHY SUTR INJ VAG $876.04

COLPOSCOPY CERVIX BX CERVIX&ENDOCRV CURTG $443.71

COLPOSCOPY CERVIX UPR/ADJ VAG $306.98

COLPOSCOPY CERVIX VAG BX CERVIX $402.00

COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX $894.18

COLPOSCOPY CERVIX VAG ENDOCRV CURTG $378.60

COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX $789.61

COLPOSCOPY ENTIRE VAG W/CERVIX BX $443.81

COLPOSCOPY ENTIRE VAG W/CERVIX IF PRESENT $332.00

COLPOSCOPY VULVA $307.61

COLPOSCOPY VULVA W/BX $382.48

COLPOTOMY W/DRG PEL ABSC $1,262.00

Colpotomy, vaginectomy,; PRO $500.00

COLSC FLX PROX SPLENIC FLXR ABLTJ LES $1,191.00

COLSC FLX PROX SPLENIC FLXR RMVL LES CAUT $662.05

COLSC FLX PROX SPLENIC FLXR RMVL LES SNARE TQ $740.48

COLSC FLX PROX SPLENIC FLXR SBMCSL NJX $584.12

COMFORT NIGHT SPLINT $192.43

COMPAZINE $24.40

COMPL RPR ANOM VEN RETURN $4,938.65

Complete amputation of the penis; PRO $500.00

COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE $880.30

COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES $897.41

COMPLX CYSTOMETRO W/VOID PRESS&URETHRAL PROFILE $961.88

COMPUTER-ASSISTED SURG NAVIGATIONAL PROC $410.77

CONIZATION CERVIX +-D&C RPR ELTRD EXC $739.53

CONIZATION CERVIX +-D&C RPR KNIFE/LASER $888.58

CONSULT BEFORE SCREEN COLONOSCOPY $312.28

CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX $611.14

CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE $287.08

CONV PREVIOUS HIP TOT HIP ARTHRP +-AGRFT/ALGRFT $4,911.44

CORACOACROMIAL LIGAMENT RELEASE +-ACROMIOPLASTY $1,942.50

Corneal Transplant; PRO $700.00

CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 1 VEIN $552.13

CORONARY ARTERY BYP W VEIN &ARTERY GRAFT 2 VEIN $1,250.80




CORONARY ARTERY BYPASS 1 CORONARY VENOUS GRAFT $5,687.60

CORONARY ARTERY BYPASS 2 CORONARY VENOUS GRAFTS $6,260.86



CORRECTION HAMMERTOE $1,457.38

CORRJ HALLUX VALGUS +-SESMDC 2 OSTEOT $2,063.45

CORRJ HALLUX VALGUS +-SESMDC LAPIDUS-TYP PX $2,487.75

CORRJ HALLUX VALGUS +-SESMDC PHALANX OSTEOT $1,735.92

CORRJ HALLUX VALGUS +-SESMDC RESCJ JT W/IMPLT $2,349.05

CORRJ HALLUX VALGUS +-SESMDC W/METAR OSTEOT $2,182.12

CORRJ HALUX RIGDUS W/IMPLT $1,243.74

CORTROSYN, 0.25 MG $107.15

CPLX UROFLOMETRY $45.32

Cranioplasty, elevation of skull fracture; PRO $1,000.00

Craniotomy, craniectomy, evac hematoma; PRO $1,100.00

CRTJ ARVEN FSTL XCP DIR ARVEN ANAST NONAUTOG GRF $1,993.05

CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO $484.10

CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM $1,662.85

CRV LMPHADEC COMPL $3,239.70

CRV LMPHADEC MODF RAD NCK DSJ $3,511.13

CSTORR SUTR BLDR WND INJ/RPT SMPL $2,189.33

CTRL NASPHRYNGL HEMRRG 1/2 COMP REQ HOSPIZATION $1,317.00

CTRL NASPHRYNGL HEMRRG 1/2 SMPL W/PST NSL PACKS $1,156.15

CTRL NASPHRYNGL HEMRRG 1/2 W/SEC SURG IVNTJ $1,475.37

CTRL NSL HEMRRG PST PST NSL PACKS&/CAUT 1ST $705.31

CTRL NSL HEMRRG PST PST NSL PACKS&/CAUT SBSQ $818.90

CTRL OROPHARYNGEAL HEMRRG 1/2 COMP REQ HOSPITJ $1,023.80

CTRL OROPHARYNGEAL HEMRRG 1/2 SMPL $505.17

CTRL OROPHARYNGEAL HEMRRG 1/2 W/SEC SURG IVNTJ $1,479.40

Culdoscopy; PRO $600.00

CURR MED/ROUTE DOC BY ELIG PROF $0.01

CURTG POSTPARTUM $574.30

CUSTOM AFO(PLASTIC) $1,322.48

CYSTO BLADDER DILAT INTRSTL CYSTITIS LOCAL $1,031.73

CYSTO W INJECTION CHEMODENERVATION OF BLAD $856.19

Cystolithotomy; PRO $600.00

CYSTOSCOPY $589.16

CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT $969.32

CYSTOURETHROSCOPY WITH BIOPSY $1,047.25

D&C DX&/THER $725.10

DBRDMT FX&/DISLC SUBQ T/M/F BONE $2,006.73

DBRDMT MSTDC CAVITY CPLX $564.94

DBRDMT MSTDC CAVITY SMPL $347.68

DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL $2,303.03

DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT&PR $1,708.91

DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT/ABDL $2,011.94

DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC $1,528.73

DBRDMT W/RMVL FM FX&/DISLC SKN&SUBQ TISS $1,326.38

DBRDMT X10SV ECZMT/INFCT SKN EA 10% BDY SURF $60.62

DBRDMT X10SV ECZMT/INFCT SKN UP 10% BDY SURF $146.21

DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DBRDMT $1,843.04

DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT $3,097.38

DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT $1,684.24

DCMPRN FASCT LEG ANT&/LAT CMPRTS ONLY $1,220.31

DCMPRN FASCT LEG ANT&/LAT&PST CMPRT $1,464.60

DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUSC&/NRV $2,253.92

DCMPRN FASCT LEG PST CMPRT ONLY $1,294.30

DCMPRN FASCT THI&/KNE 1 CMPRT $1,450.36

DCMPRN FASCT THI&/KNE MLT CMPRTS $1,595.33

DCMPRN FASCT THI&/KNE MLT DBRDMT NV MUSC&/NRV $1,674.71

DEBRIDE NAIL 1-5 $86.55

DEBRIDE NAIL 6 OR MORE $128.75

DEBRIDEMENT OPEN WOUND 20 SQ CM< $205.86

DEBRIDEMENT OPEN WOUND ADDL 20 SQ CM $72.66

DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< $315.81

DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL $1,620.88

DECOMPRESSION FINGERS&/HAND INJECTION INJURY $4,164.21

DECOMPRESSIVE FASCIOTOMY HAND $1,637.93

Decortication; PRO $1,600.00

DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F $1,276.59

DELIVERY/BIRTHING ROOM RESUSCITATION $424.16

DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IPPB $213.81

DENOSUMAB 1 MG $35.00

DEPO MEDROL,5ML,80MG $97.08

DEPO PROVERA 1 MG $1.00

DEPO-MEDROL,5ML,20MG $61.48

DEPO-PROVERA 1MG $1.00

DEPO-TESTOSTERONE 200 MG $20.00

DEPRO-MEDROL,5ML,40MG $64.82

DESTROY C/TH FACET INT ADDL $168.20

DESTROY CERV/THOR FACET JNT $553.95

DESTROY L/S FACET JNT ADDL $147.09

DESTROY LUMB/SAC FACET JNT $543.89

DESTRUCTION BENIGN LESIONS 15/> $369.27

DESTRUCTION BENIGN LESIONS UP TO 14 $300.60

DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM $387.16

DESTRUCTION PREMALIGNANT LESION 1ST $155.70

DESTRUCTION PREMALIGNANT LESION 2-14 EA $16.08

DEVELOPMENTAL TSTG LMTD W/I&R $57.84

DEXAMETHASONE 1 MG $5.00

DEXAMETHASONE 1MG $5.00

DIABETIC SHOE FITTING $111.43

Diagnositic knee arthroscopies; PRO $400.00

Diagnostic arteriography and venography; PRO $600.00

Diagnostic arthroscopic wrist; PRO $400.00

Diagnostic or therapeutic nerve block; PRO $400.00

DIAMOX UP TO 500MG $36.26

DIGITAL RECTAL PROSTATE CANCER SCREENING $45.92

DIL RETINA EXAM INTERP REV $0.01

DILAT CRV CANAL INSTRUMENTAL SPX $147.08

DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ 1ST $199.73

DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ $195.81

DIPH,PERTUS,TET,POLIO/PF 0.5 ML VIAL $99.44

DIPH,PERTUSS(ACELL)TET VAC/PF 0.5 SYR $71.07

DIPHT PERTUSS TETANUS VAC 0.5 ML SYR $65.56

DIPHTHERIA TETANUS TOXOID PERTUSSIS VACCINE IM $71.00

DIR RPR ARYSM&GRF INSJ ABDL AORTA $5,234.27

DIR RPR ARYSM&GRF INSJ AX-BRACH ART $2,998.14

DIR RPR ARYSM&GRF INSJ AX-BRACH ART 3 $3,573.13

DIR RPR ARYSM&GRF INSJ COMMON FEM ART $3,315.87

DIR RPR ARYSM&GRF INSJ POP ART $3,614.05

DIR/PATCH CLSR SINUS VENOSUS +-ANOM PULM VEN DRG $4,170.08

Direct coronary artery bypass grafting; PRO $2,600.00

Disarticulation of knee; PRO $600.00

DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB $1,062.37

DLVR PLACENTA SPX $269.32

DOM/R-HOME E/M EST PT LW MOD SEVERITY $182.64

DOM/R-HOME E/M EST PT MOD HI SEVERITY $259.28

DOM/R-HOME E/M EST PT SELF-LMTD/MINOR $116.19

DOM/R-HOME E/M EST PT SIGNIFICANT NEW PROBLEM $370.36

DOM/R-HOME E/M NEW PT HI SEVERITY $357.41

DOM/R-HOME E/M NEW PT MOD HI SEVERITY $268.45

DOM/R-HOME E/M NEW PT MOD SEVERITY $155.43

DOM/R-HOME E/M NEW PT SIGNIFICANT NEW PROBLEM $508.13

DOM/R-HOME LW SEVERITY $146.41

DPHRM/CRV CAP FITG W/INSTRUCTIONS $171.33

DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM $639.16

DRAINAGE FINGER ABSCESS COMPLICATED $1,095.78

DRAINAGE FINGER ABSCESS SIMPLE $744.22

DRAINAGE OF NOSE LESION $298.22

DRAINAGE OF PALMAR BURSA MULTIPLE BURSA $3,593.79

DRAINAGE OF PALMAR BURSA SINGLE BURSA $1,200.70

DRAINAGE OF SKIN ABS COMPL. $484.21

DRAINAGE OF SKIN ABS-SINGLE $312.29

DRAINAGE TENDON SHEATH DIGIT&/PALM EACH $1,270.87

DRESSING CHANGE UNDER ANESTHESIA $138.02

DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS $766.13

DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL $555.59

DRG PRTL ABSC/LOCLZD PRITONITIS OPN $3,823.85

DRG RPR ABSC OPN $2,639.68

DRG SCROTAL WALL ABSC $611.97

DRG SUBDIPHRG/SUBPHRENIC ABSC OPN $2,400.35

DRG XTRNL AUD CANAL ABSC $597.69

DRG XTRNL EAR ABSC/HMTMA COMP $597.20

DRG XTRNL EAR ABSC/HMTMA SMPL $515.31

DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE $471.37

DSCHRG MED CURRENT MED MERGE $0.01

DSJ DP JUG NODE $1,244.29

DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS $3,420.97

DSTRJ LES ANUS SMPL CHEM $681.93

DSTRJ LES ANUS SMPL ELTRDSICCATION $600.98

DSTRJ LES ANUS SMPL SURG EXC $731.04

DSTRJ LES VULVA SMPL $368.06

DSTRJ LES VULVA X10SV $636.28

DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE $243.39

DSTRJ NULYT OTH PRPH NRV/BRANCH $386.88

DSTRJ VAG LES SMPL $319.00

DTAP-HEPB-IPV VACCINE INTRAMUSCU $104.90

DTAP-HIB-IPV VACCINE IM $130.04

DTP-HIB VACCINE INTRAMUSCULAR $46.35

DUONEB $6.18

DUP-SCAN OF HEMODIALYSIS ACCESS $376.03

DX BONE MARROW BX AND ASPIR $415.43

E/M PT INVG ANNUAL NF ASSMT $184.61

each additional 9%; PRO $200.00

ECHO TRANSESOPHAGEAL $52.87

ECHO TTHRC R-T 2D -+M-MODE COMPLETE REST&STRS (pro) $168.28

ECHOCARDIOGRAM ADULT PROFESSIONAL $150.62

EKG $49.86

EKG - TRACING ONLY $25.11

EKG GLOBAL $356.16

EKG INTERP ONLY $24.88

EKG TRACING FOR IPPE; PRO $23.27

ELBOW ORTHOTIC, W/O JOINTS, SOFT $301.37

Electrical conversion of arrythymias; PRO $500.00

Electrocoagulation of intracranial nerve; PRO $700.00

Electroconvulsive therapy; PRO $500.00

ELIGIBLE PROF ATTESTS THE PT IS NOT ELIG M; PRO $0.01

EMBLC/THRMBC +-CATH RDL/UR ART ARM INC $1,796.45

EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART $1,799.27

EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART $2,761.08

EMBLC/THRMBC FEMPOP A-ILIAC ART $3,085.23

EMBLC/THRMBC POP-TIBIO-PRONEAL ART LEG INC $2,858.27

EMBLC/THRMBC RNL CELIAC MESENTERY A-ILIAC ART $3,772.12

Embolectomy; PRO $700.00

EMER DEPT HI SEVERITY&URGENT EVAL $356.83

EMER DEPT HIGH SEVERITY&THREAT FUNCJ $539.27

EMER DEPT LOW TO MODERATE SEVERITY $127.36

EMER DEPT MODERATE SEVERITY $192.32

EMER DEPT SELF LIMITED/MINOR $64.90

EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL $551.05

EMPLOYER PHYSICAL $100.00

ENDO SHEATH $37.11

ENDOCRV CURTG X DONE AS PART DILAT&CURTG $286.47

ENDOMETRIAL BX +-ENDOCRV BX W/O DILAT SPX $306.66

ENDOSCOPIC PLANTAR FASCIOTOMY $1,463.78

ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN $1,037.21

ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS $832.20

ENTEROLSS FRING INTSTINAL ADHESION SPX $3,214.98

ENTERONTRSTM ANAST INT +-CUTAN NTRSTM SPX $3,861.92

ENTERORRHAPHY 1 PRF8J $3,388.76

ENTERORRHAPHY MLT PRF8J $3,873.39

ENTRC RESCJ SM INT 1 RESCJ&ANAST $3,598.21

ENTRC RESCJ SM INT EA RESCJ&ANAST $713.15

EPIGLOTTIDECTOMY $2,194.26

EPISIOTOMY/VAG RPR OTH/THN ATTENDING PHYS $544.00

EPO 1,000 UNITS NON $65.56

ERCP W/PLACEMENT OF STENT $1,329.65

ERCP W/RMVL ST1/CALCULI BILIARY&/PNCRTC DUXS $1,162.82

ERTAPENEM SODIUM 500 $163.43

ESOPHAGOSCOPY RIG TRNSO BIOPSY $469.68

ESOPHAGOSCOPY RIGID TRNSO DX $424.00

Esophagus procedures; PRO $1,600.00

Esophagus, thyroid, neck age 1 year or older; PRO $700.00

ESPHGSC RGD/FLX DX +-COLLJ SPEC BR/WA SPX $252.35

ETHMOIDECTOMY EXTRANASAL TOTAL $2,127.22

ETONOGESTREL IMPLANT $1,264.28

EUFLEXXA PER DOSE $474.41

EVACUATION SUBUNGUAL HEMATOMA $141.53

EVASC PLMT ILIAC ART OCCLUSION DEV $576.98

EVASC RPR AAA AORTO-UNIILIAC/AORTO-UNIFEM PROSTH $3,564.60

EVASC RPR AAA W/MDLR BFRC PROSTH 1 LIMB $3,729.24

EVASC RPR AAA W/UNIBDY BFRC PROSTH $3,725.44

EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH $5,212.02

EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN $4,608.92

EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5+CM $1,609.63

EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5+CM $1,210.32

EXC AURAL POLYP $574.99

EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M > 4.0CM $919.22

EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< $380.42

EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM $451.48




EXC B9 LES MRGN XCP SK TG S/N/H/F/G > 4.0CM $783.17

EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.5 CM/< $331.01

EXC B9 LES MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM $422.24



EXC B9 LES MRGN XCP SK TG T/A/L > 4.0 CM $876.01

EXC B9 LES MRGN XCP SK TG T/A/L 0.5 CM/< $333.35

EXC B9 LES MRGN XCP SK TG T/A/L 0.6-1.0 CM $400.03




EXC BARTHOLIN'S GLAND OR CYST $875.09

EXC BRANCHIAL CL CST CONFINED SKN&SUBQ TISS $933.08

EXC BRANCHIAL CL CST EXTG BELW SUBQ TISS&/PHRNX $1,657.98

EXC BRST LES PREOP PLMT RAD MARKER OPN 1 LES $1,285.27

EXC CRV STUMP ABDL APPR $2,179.60

EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ $2,390.92

EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ $1,212.21

EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LES $1,159.31

EXC DEBRIDE-BONE 20 SQCM OR LESS $886.29

EXC DEBRIDE-MUSCLE 20 SQCM OR LESS $640.51

EXC DEBRIDE-MUSCLE>20 SQ CM $172.57

EXC DEBRIDE-SUBQ>20 SQ CM $106.43

EXC EXOSTOSIS XTRNL AUD CANAL $2,423.58

EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F $1,957.25

EXC FRENUM LABIAL/BUCCAL $765.67

EXC INFCT GRF XTR $1,689.30

EXC LES FLOOR MOUTH $932.37

EXC LES MUCOSA&SBMCSL VESTIBULE MOUTH W/O RPR $576.64

EXC LES MUCOSA&SBMCSL VESTIBULE SMPL RPR $793.02

EXC LES PALATE UVULA W/LOCAL FLAP CLSR $1,115.99

EXC LES PALATE UVULA W/O CLSR $619.92

EXC LES PALATE UVULA W/SMPL PRIM CLSR $661.60

EXC LES SPRMATIC CORD SPX $1,102.78

EXC LES TDN SHTH/JT CAPSL HAND/FNGR $1,608.65

EXC LES TONGUE W/CLSR ANT 2-3RD $925.18

EXC LES TONGUE W/CLSR PST ONE-3RD $887.88

EXC LES TONGUE W/O CLSR $510.53

EXC LES/TUM XCP LISTED ABOVE DENTALVLR $611.11

EXC LES/TUM XCP LISTED ABOVE DENTALVLR SMPL RPR $763.82

EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT $1,127.50

EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA $1,210.15

EXC MUCOSA VESTIBULE MOUTH AS DON GRF $786.14

EXC NAIL MATRIX PRM RMVL W/AMP TUFT DSTL PHALANX $732.14

EXC NEUROMA HAND/FOOT XCP DGTAL NRV $2,545.54

EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NRV $3,137.14

EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NRV $3,524.35

EXC PRTD TUM/PRTD GLND TOT EN BLOC RMVL $2,201.28

EXC PRTD TUM/PRTD GLND TOT W/UNI RAD NCK DSJ $4,008.26

EXC RCT PROCIDENTIA W/ANAST ABDL&PRNL APPR $3,622.38

EXC RCT TUM NOT INCL MUSCULARIS PROPRIA $1,761.84

EXC SOFT TISS LES XTRNL AUD CANAL $1,090.66

EXC SUBMNDBLR SUBMAX GLND $1,223.82

EXC THROMBOSED HEMORRHOID XTRNL $498.27

EXC THYROGLOSSAL DUX CST/SINUS $1,306.32

EXC THYROGLOSSAL DUX CST/SINUS RECRT $1,683.68

EXC TONSIL TAGS $500.61

EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM $1,547.07

EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM $1,423.01

EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM $3,660.47

EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5+CM $3,830.05

EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3+CM $2,640.90

EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM $3,363.91

EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM $3,391.91

EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM $1,325.21

EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5+CM $2,026.85

EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM $3,403.44

EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM $1,340.77

EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5+CM $1,943.43

EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM $1,233.07

EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM $1,282.16

EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM $1,357.96

EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM $1,294.80

EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5+CM $3,712.47

EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM $3,234.37

EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM $1,300.02

EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM $1,167.96

EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ 3+CM $3,016.86

EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5+CM $2,145.48

EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM $1,315.00

EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5+CM $3,736.28

EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM $3,576.09

EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5+CM $2,104.20

EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM $3,093.80

EXC VAG CST/TUM $555.63

EXC VAG SEPTUM $511.91

EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA $2,045.99

EXC XTRNL EAR COMPL AMP $965.31

EXC XTRNL EAR PRTL SMPL RPR $1,082.55

EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT $1,707.06

EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT $1,643.65

EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN $1,479.74

EXC/CURTG CST/B9 TUM PHALANGES FOOT $1,089.04

EXC/CURTG CST/B9 TUM TARSAL/METAR $1,306.52

EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT $1,349.19

EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT $1,651.33

EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM $4,299.64

EXC/DSTRJ LES PHARYNX ANY METH $650.42

EXC/DSTRJ LNGL TONSIL ANY METH SPX $1,453.07

EXC/FULGURATION URTL CARUNCLE $619.80

EXC/FULGURATION URTL POLYP DSTL URT $477.85

EXCHNG PREV PLACED IV CATH THROMBOLYTIC THER $880.00

EXCISION BENIGN 2.1-3.0 CM $540.37

Excision Burn between 4-9%; PRO $600.00

EXCISION DISTAL ULNA PARTIAL/COMPLETE $1,216.80

EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY $925.42

EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT $1,130.05

EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR $1,017.60

EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE $1,035.13

EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH $1,443.34

EXCISION LESION MENISCUS/CAPSULE KNEE $1,254.84

EXCISION LESION TENDON SHEATH FOREARM&/WRIST $969.09

EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANKLE $1,326.59

EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< $516.99

EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM $614.07




EXCISION MALIGNANT LES F/E/E/N/L/M 0.6-1.0 CM $664.82



EXCISION MALIGNANT LES F/E/E/N/L/M 3.1-4.0 CM $1,108.05

EXCISION MALIGNANT LESION F/E/E/N/L/M > 4.0 CM $1,452.59

EXCISION MALIGNANT LESION F/E/E/N/L/M 0.5 CM/< $540.37

EXCISION MALIGNANT LESION S/N/H/F/G > 4.0 CM $1,086.60

EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/< $524.00

EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM $617.57




EXCISION MALIGNANT LESION TRUNK/ARM/LEG >4.0 CM $1,197.72

EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS $766.54

EXCISION NASAL POLYP EXTENSIVE $1,171.99

EXCISION NASAL POLYP SIMPLE $637.46

Excision of cyst or tumor fo humerus; PRO $600.00

EXCISION OF NAIL-PART OR COMPL $503.97

Excision of retropharyngeal tumor; PRO $700.00

EXCISION OLECRANON BURSA $1,022.16

EXCISION PILONIDAL CYST/SINUS COMPLICATED $1,848.04

EXCISION PILONIDAL CYST/SINUS EXTENSIVE $1,601.34

EXCISION PILONIDAL CYST/SINUS SIMPLE $766.71

EXCISION PREPATELLAR BURSA $1,084.22

EXCISION RADIAL HEAD $1,306.50

EXCISION SYNOVIAL CYST POPLITEAL SPACE $1,398.18

EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH $2,266.46

EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM $938.06

EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2+CM $2,027.37

EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM $1,322.55

EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM $2,739.99

EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM $1,098.30

EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ 1.5+CM $982.68

EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3+ CM $1,213.97

EXCISION TUMOR SOFT TISSUE PELVIS&HIP SUBQ 3+CM $3,232.66

EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM $1,262.05

EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM $2,625.65

EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM $1,281.46

EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA $1,718.19

EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES $1,269.96

EXCISION/CURETTAGE CYST/TUMOR FEMUR $1,755.12

EXCISION/CURETTAGE CYST/TUMOR METACARPAL $1,319.04

EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER $1,295.99

EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA $1,413.48

EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS $1,670.26

EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS $1,429.44

EXCISION/DESTRUCTION INTRANASAL LESION INT APPR $2,408.95

EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5 CM $3,417.49

EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM $3,120.62

EXPL LAPT EXPL CELIOTOMY +-BX SPX $1,847.55

EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK $1,325.21

EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD $3,526.45

EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR $2,053.36

EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST $1,176.34

EXPLORATION PENETRATING WOUND SPX CHEST $1,082.60

EXPLORATION PENETRATING WOUND SPX EXTREMITY $1,567.33

EXPLORATION PENETRATING WOUND SPX NECK $1,784.65

Extensive spine procedures; PRO $1,400.00

External cephalic verson procedure; PRO $600.00

External, middle and inner ear; PRO $600.00

Extraperitonela procedures lower inclds urinary tract; PRO $700.00

EYE IMAGE VALID TO DX REV $0.01

Eye procedure; PRO $600.00

Eyelid reconstructive; PRO $600.00

FACET INJECTION LEVEL 2 $206.61

FACET INJECTION LEVEL 3 $207.43

FACET INJECTIONS LEVEL 1 $408.25

Facial bones and skull; PRO $600.00

FALL CARE PLAN; PRO $0.01

FALL RISK ASSESSMENT $0.01

FAM PSYCTX W/O PT PRESENT $533.88

FAMILY PSYCHOTHERAPY $315.00

FASCIECTOMY PLANTAR FASCIA PARTIAL SPX $1,416.45

FASCIOTOMY HIP/THIGH ANY TYPE $2,583.51

FASCIOTOMY ILIOTIBIAL OPEN $1,361.66

FASCIOTOMY PALMAR OPEN PARTIAL $1,369.77

FASCIOTOMY PALMAR PERCUTANEOUS $1,970.09

FASCIOTOMY PLANTAR FASCIA RADICAL SPX $1,732.25

FASCT PRTL PLMR 1 DGT PROX IPHAL JT +-TISS $2,420.68

FASCT PRTL PLMR 1 DGT PROX IPHAL JT +-Z-PLASTY $811.45

Femoral artery embolectomy; PRO $700.00

Femoral artery ligation; PRO $500.00

FERN TEST $27.32

FIBERGLASS GAUNTLET CAST $32.36

FIMBRIOPLASTY $1,940.67

FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE $365.70

FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE $407.88

FINGER SPLINT $50.47

FITG&INSJ PESSARY/OTH INTRAVAG SUPPORT DEV $214.62

FITTING CUSTOM PREP AND SUPPLY SHOE MOLDED CAST $259.85

FLAP ISLAND PEDICLE $2,879.71

FLEXOR ORIGIN SLIDE FOREARM &/WRIST $2,096.02

FLU IMMUNO ADMIND RCVD $0.01

FLU VAC NO PRSV 4 VAL 6-35 MNTHS $22.00

FLU VAC QUADRIV SPL VIRUS $20.00

FLU VAC QUADRIVALENT LIV $20.00

FLU VAC TV (18 YR+)RCM/PF $41.00

FLU VACCINE ADMINISTRATION $24.00

FLU VACCINE PRESERV FREE 6-35MTHS $20.00

FLU VIRUS VAC $17.82

FLU VIRUS VAC, SPLIT VIRU $25.33

FLU VIRUS, SPLIT VIRUS, 3 $14.63

FLUOR GID & LOCLZJ NDL/CATH SPI DX/THER NJX $82.87

FLUOR GID CTR VAD PLMT RPLCMT/RMVL $208.54

FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT; PRO $242.76

FOOT ARCH SUPPORT $84.57

FOOT HEEL STABILIZER PREFAB $73.69

FOOT INSERT FORMED TO PATIENT FOOT $254.62

FOOT INSERT REMOVABLE PLASTAZOTE OR EQUAL $233.81

FOOT, ARCH SUPPORT, PREMOLDED $87.79

FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC $293.04

FRMJ DIR/TUBED PEDCL +-TR FT/CH/CH/M/N/AX/G/H/F $2,161.89

FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/< $2,497.20

FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 CM/< $2,712.41

FTL NON-STRS TST $258.05

FXNL STATUS ASSESSED $0.01

GARDASIL $239.60

GARDASIL 9 HPV $286.16

Gastric restrictive procedure; PRO $1,200.00

GASTRIC TUBE PLMT W/ASPIR & LAVAGE $64.73

GASTROCNEMIUS RECESSION $1,114.45

GASTROJEJUNOSTOMY W/O VAGOTOMY $3,216.03

GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ $3,258.14

GASTROSTOMY OPN W/CONSTJ GSTR TUBE $2,497.85

GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX $2,052.31

GENTAMICIN,UP TO 80MG $5.00

GLUC MNTR CONT REC FROM NTRSTL TISS FLU I&R $128.42

GLUCOSE 1 HR POST GLUCOLA $67.00

GLUCOSE ACCUCHEK $23.00

GLUCOSE;BLOOD,REAGENT STRIP $23.00

GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR $1,869.11

GRF THIERSCH RCT INCONT&/PROLAPSE $1,507.68

GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY $4,878.00

GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ $5,480.61

GSTRT W/EXPL/FB RMVL $1,870.56

GSTRT W/SUTR RPR PRE-ESOPG/GSTR LAC $4,226.89

HAEMOPHILUS B VAC VIAL $52.72

HAEMPH B-MENIN/PF 7.5 MCG/0.5 ML VIAL $52.72

HALAPERIDOL DEC PER 50 MG $45.90

HALLUS VALGUS NIGHT DYNAMIC SPLINT $49.58

HALLUX RGDUS CORRJ W/CHEILC $2,194.01

HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB $41.00

HANDLING CONVEY/ANY OTH SVC INVG DEV FIT BY PHYS $34.54

Heart procedures without pump oxygenator; PRO $1,600.00

Heart Transplant; PRO $2,100.00

HEEL PAD AND DEPRESSION FOR SPUR $136.32

HEEL PAD, REMOVABLE SPUR $12.02

HEMIARTHROPLASTY HIP PARTIAL $3,326.67

HEMIPHALANGC/IPHAL JT EXC TOE $795.16

HEMOGLOBIN $32.00

HEMOGLOBIN A1C $90.00

HEMOPHILUS INFLUENZA B VACCINE PRP-D BOOSTER IM $51.50

HEMOPHILUS INFLUENZA B VACCINE PRP-OMP 3 DOSE IM $52.72

HEMORRHOIDECTOMY INT & XTRNL 2+ COLUMN/GROUP $1,392.99

HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS $539.31

HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP $1,425.28

HEMORRHOIDECTOMY XTRNL 2+ COLUMN/GROUP $1,248.01

HEP B (PF) VAC VFC 5 MCG INJ $63.65

HEPARIN 1000UNIT/ML 10 ML $5.00

HEPATITIS A & B VACCINE/PF 1 ML VIAL $143.15

HEPATITIS A VACCINE PEDIATRIC 3 DOSE SCHEDULE IM $59.01

HEPATITIS A VIRUS VAC ADULT 1440 UNI S $101.33

HEPATITIS A VIRUS VAC PED 720 UNIT/0.5 Ml SYR $59.01

HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML 5 ML VIAL $168.28

HEPATITIS B VACCINE ADOLESCENT 2 DOSE IM $33.95

HEPATITIS B VACCINE ADULT DOSAGE INTRAMUSCULAR $105.03

HEPATITIS B VACCINE DIALYSIS DOSAGE 4 IM $172.65

HEPB-HIB VACCINE $90.69

Hernia repair upper abdomen; PRO $500.00

Hernia repairs; PRO $600.00

HIB VACCINE $54.59

Hip disarticulation; PRO $1,100.00

HISTRELIN, IMPLANT 50MG $4,455.78

HIV ANTIGEN W/HIV ANTIBODIES $86.99

HIV-1ANTIBODY CONE WESTERNBLOT $60.00

HOLTER MONITOR ECG RECORDING ONLY (93225) $80.79

HOME VST EST PT LOW TO MOD SEVERITY $162.76

HOME VST EST PT MOD TO HI SEVERITY $300.19

HOME VST EST PT SELF LIMITED/MINOR $154.92

HOME VST NEW PT LOW SEVERITY $129.72

HOME VST NEW PT MOD SEVERITY $153.42

HOSP DSCHRG D MGMT > 30 MIN $212.91

HOSP DSCHRG D MGMT 30 MIN/< $144.60

HRHC NTRNL LIG OTH THAN RBBR BAND 1 COL/GRP $724.34

HRHC NTRNL LIG OTH THAN RBBR BAND 2+ COL/GRP $762.46

HTROPHL ANTIBODIES SCR $108.00

HYALGAN PER DOSE $265.40

HYALURONAN OR SYNVISC 1 M $72.13

HYALURONIDASE UP TO 150 UNITS $64.50

HYDROXYPROGESTERONE 10 MG $52.68

HYPPHSEC/EXC PITUITARY TUM TRANSNSL/SEPTAL $4,634.35

Hysteroscopy; PRO $500.00

HYSTSC BX ENDOMETRIUM&/POLYPC +-D&C $777.23

HYSTSC DX SPX $537.00

HYSTSC ENDOMETRIAL ABLTJ $995.85

HYSTSC OCCLUSION PLMT PRM $5,223.69

HYSTSC RMVL IMPACTED FB $945.19

I & D HEMATOMA/SEROMA $437.44

I&D ABSC PRITONSILLAR $528.67

I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL $1,277.27

I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR $1,982.90

I&D APPENDICEAL ABSC OPN $1,856.67

I&D BELW FSCA FOOT 1 BURSAL SPACE $1,264.98

I&D BELW FSCA FOOT MLT AREAS $1,703.69

I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX $1,068.76

I&D DP ABSC BURSA/HMTMA THI/KNE REGION $1,893.51

I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE $629.33

I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA $3,667.57

I&D INTRAMURAL IM/ABSC TRANSANAL ANES $1,030.23

I&D ISCHIORCT&/PRIRCT ABSC SPX $1,433.99

I&D OF BARTHOLIN'S GLAND ABSC $341.14

I&D PELVIS/HIP JT AREA DP ABSC/HMTMA $3,890.58

I&D PRIANAL ABSC SUPFC $556.75

I&D SHOULDER DEEP ABSCESS/HEMATOMA $1,247.90

I&D SOFT TISSUE ABSCESS SUBFASC $877.85

I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA $955.60

I&D VAG HMTMA NON-OBAL $903.31

I&D VULVA/PRNL ABSC $308.00

ICD DEVICE PROG EVAL 1 SNGL; PRO $184.22

ILEOST/JEJUNOSTOMY NON-TUBE $3,075.71

ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI $1,429.72

IM/SUBCUTANEOUS INJECTION $62.28

IMADM INTRANSL/ORAL EA VAC $16.00

IMADM PRQ ID SUBQ/IM NJXS 1 VACC $24.00

IMADM PRQ ID SUBQ/IM NJXS EA VACC $12.00

IMADM THROUGH 18YR ANY ROUTE 1ST VAC $67.75

IMADM THROUGH 18YR ANY ROUTE 1ST VAC/TOXOID $67.75

IMADM THROUGH 18YR ANY ROUTE EA ADDL VAC/TOXOID $34.90

IMAGE GUIDED FLD COLLECTION PERITONEAL $705.00

IMG GID PLMT MTLC LOCLZJ CLIP PRQ BRST BX/ASPIR $254.00

IMITREX,6 MG $239.76

IMMOBILIZER KNEE $200.35

IMMUNE ADMIN ORAL/NASAL $24.00

IMMUNIZATION ADMIN $24.00

IMMUNIZATION ADMIN EACH ADDTL $12.00

IMMUNOTHERAPY 2 OR MORE INJECTIONS $98.96

IMMUNOTHERAPY ONE INJECTION $59.42

IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE $785.89

IMPLANT REMOVAL RADIAL HEAD $1,739.32

IMPLANTABLE LOOP RECORDER SYSTEM $101.22

In sitting position; PRO $1,400.00

INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW $1,201.73

INC DP W/OPNG B1 CORTEX FEMUR/KNE $3,609.34

INC LNGL FRENUM FREXOMY $596.90

INC THROMBOSED HEMORRHOID XTRNL $501.03

INCISION & DRAINAGE PILONIDAL CYST COMPLICATED $753.52

INCISION & DRAINAGE PILONIDAL CYST SIMPLE $502.36

INCISION BONE CORTEX FOOT $3,799.40

INCISION BONE CORTEX HAND/FINGER $1,527.32

INCISION EXTENSOR TENDON SHEATH WRIST $2,281.07

INCISION LEG/ANKLE $3,849.78

INCISION OF TONGUE FOLD $0.00

INCISION&DRAINAGE BURSA FOOT $686.29

INCISION&DRAINAGE COMPLEX PO WOUND INFECTION $659.68

INCISION&DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA $1,495.50

INCISION&DRAINAGE UPPER ARM/ELBOW BURSA $810.81

INCISION&REMOVAL FOREIGN BODY SUBQ TISS COMP $741.56

Incomplete or missed abortion; PRO $500.00

INDIV PSYCTX IA I/P 60 MINUTES $315.53

INDUCED AB 1+ IAM NJXS DLVR FETUS HYSTOT $1,344.92

INDUCED AB 1+ VAG SUPP DLVR FETUS $1,210.77

INDUCED AB DILAT&EVAC $1,080.32

Induced abortion procedure; PRO $500.00

INDWELLING CATHETER $21.82

Inferior vena cava ligation; PRO $1,100.00

INFLUENZA ASSAY W OPTIC $40.46

INFLUENZA HIGH DOSE FLUAD 65 YRS AND OLDER $35.00

INFLUENZA HIGH-DOSE(65YR+)/PF $35.00

INFLUENZA IMM ORDER ADMIN $0.01

INFLUENZA VAC RECOMB/EGG-FREE $41.00

INFLUENZA VACCINE $15.00

INFLUENZA VIRUS VACCINE LIVE INTRAN $15.00

INFLUENZA VIRUS VACCINE SPLIT VIRUS 3 YEARS + IM $15.00

INFLUENZA VIRUS VACCINE SPLIT VIRUS 6-35 MO IM $15.00

INFLUENZA VIRUS VACCINE(PEDS) 1 SYR VIAL $15.00

INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX $2,341.41

INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC $3,089.08

INITIAL OB $0.01

INITIAL PREVENTIVE MEDICARE EXAM $407.33

INITIAL TREATMENT OF BURN(S) $95.01

INITIAL TX 1ST DEGREE BURN LOCAL TX $104.57

INJ BACLOFEN 10 MG $645.00

INJ HYDROMORPHONE UP TO 4 MG $5.25

INJ MORPHINE SULFATE UP TO 10 MG $5.00

INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS $170.98

INJECTION CERVICAL OR THORACIC 2ND LEVEL $254.26

INJECTION CERVICAL OR THORACIC 3RD+LEVELS $255.21

INJECTION FOR IDENTIFICATION OF SENTINEL NODE $112.06

INJECTION HIP ARTHROGRAPHY W/ANESTHESIA $666.70

INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA $541.16

INJECTION INTRALESIONAL UP TO & INCL 7 $157.02

INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG $316.16

INJECTION SI JOINT ARTHROGRAPHY&/ANES/STEROID $382.00

INJECTION SINGLE TENDON ORIGIN/INSERTION $171.22

INJECTION SINGLE, W/MED SPINE $236.58

INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES $155.49

INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES $179.22

INJECTION THERAPEUTIC CARPAL TUNNEL $217.79

INJECTION TREATMENT OF NOSE $283.19

INSERTION FLOW DIRECTED CATHETER FOR MONITORING $1,754.55

Insertion of penile prosthesis; PRO $500.00

INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN $679.45

INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX $575.47

INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR $748.51

INSJ BIOMECHANICAL DEVICE $662.17

INSJ BIOMECHANICAL DEVICE EACH DEFECT $85.52

INSJ I-AORT BALO ASSIST DEV THRU FEM ART OPN $1,051.83

INSJ INTRAUTERINE DEV $653.18

INSJ MESH/PROSTH PEL FLOOR DFCT EA SIT $750.50

INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT $395.02

INSJ NON-NDWELLG BLDR CATH $156.56

INSJ NON-TUN CTR CVC AGE 5 YR/> $370.25

INSJ NON-TUN CTR CVC UNDER 5 YR $679.10

INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/> $981.33

INSJ PRPH CVC W/O SUBQ PORT/PMP AGE 5 YR/> $273.98

INSJ PRTL-VEN SHUNT $2,045.03

INSJ TEMP NDWELLG BLDR CATH COMP $373.89

INSJ TEMP NDWELLG BLDR CATH SMPL $200.85

INSJ TUN CTR CTR VAD W/SUBQ PORT AGE 5 YR/> $1,075.75

INSJ TUN CTR CTR VAD W/SUBQ PORT UNDER 5 YR $1,046.91

INSJ TUN CTR CVC W/O SUBQ PORT/PMP AGE 5 YR/> $824.00

INSJ TUN CTR CVC W/O SUBQ PORT/PMP UNDER 5 YR $2,449.38

INSJ/RPLCMT PM PLS GEN ONLY 2CHMBR $990.43

INSJ/RPLCMT PRM PM W/TRANSVNS ELTRD ATR&VENTR $1,563.29

INSJ/RPLCMT PRM PM W/TRANSVNS ELTRD VENTR $1,443.09

INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING $1,081.50

INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH $527.81

Integumentary system of extremities; PRO $400.00

Integumentary system; PRO $600.00

INTENS BEHAVE THER CARDIO DX $62.95

INTERFERON ALPHA 2B,1 MIL $45.09

Interpelviabdominal amputation; PRO $1,600.00

INTERROGATION EVAL F2F IMPLANTABLE CV MNTR SYS $73.33

INTERROGATION EVAL IN PERSON 1/DUAL/MLT LEAD PM $107.91

Interthorascoscapular amputation; PRO $1,600.00

Intra hepatic or protal circulation; PRO $800.00

Intracranial procedures; PRO $1,200.00

Intracranial, intracardiac and aorta; PRO $900.00

Intracranial; PRO $800.00

Intraoral procedures; PRO $600.00

Intraperitoneal lower abdomen includes laparoscopy; PRO $700.00

Intrathoracic or juglar; PRO $700.00

Intrathoracic procedures; PRO $1,800.00

INTRO ANY HEMOSTATIC AGT/PACK VAG HEMRRG SPX $339.89

INTRO CATH AORTA $455.26

INTRO CATH SUPRIOR/IVC $364.66

INTRO NDL/CATH AV SHUNT IST ACCESS W/ RAD EVAL $2,228.87

INTRO NDL/INTRACATH RTRGR BRACH ART $298.70

INTRO NDL/INTRACATH XTR ART $314.03

Intrperitoneal procedures; PRO $800.00

INTRVASC US NONCORONARY 1ST $247.07

INTRVASC US NONCORONARY ADDL $197.48

INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE $338.50

IPRATROPIUM EACH MIL $5.00

IPRATROPIUM PER MIL $5.00

Iridectomy; PRO $500.00

IRRIGATION IMPLANTED VAD FOR DRUG DLVR $123.93

IUD $1,211.84

IUD MIRENA $1,326.13

IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL $284.52

IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL $230.53

IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR $296.64

IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR $375.56

IV US C VSL DX&/THER 1ST VSL $284.52

JOINT INJ/ASP MAJOR JOINT W/US GUIDANCE $218.12

KELLER/MCBRIDE/MAYO PROCEDURE $1,906.69

KENALOG $20.16

KETOROLAC TROM $5.00

KOH SLIDE $69.00

LAM FACETEC&FORAMOT 1 SGM EA CRV THRC/LMBR $624.18

LAM FACETEC&FORAMOT 1 SGM LMBR $2,700.43

LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL $3,811.00

LAMINOTOMY INCL OPEN & NDSC 1 INTERSPACE LUMBAR $2,324.11

LAMOT INCL OPEN&NDSC EA ADDL INTERSPACE CRV/LMBR $556.88

LAP RPR HRNA XCPT INCAL/INGUN NCRC8/STRANGULATED $2,717.79

LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE $2,474.58

LAPS ABD PRTM&OMENTUM DX +-SPEC BR/WA SPX $955.30

LAPS ABLTJ UTERINE FIBROIDS $2,081.90

LAPS CLSR NTRSTM LG/SM INT W/RESCJ&ANAST $4,909.33

LAPS CLST/SKN LVL CECOSTOMY $3,604.41

LAPS COLCT PRTL W/ANAST $4,527.34

LAPS COLCT PRTL W/COLOPXTSTMY LW ANAST $5,369.36

LAPS COLCT PRTL W/END CLST&CLSR DSTL SGM $5,162.48

LAPS COLCT PRTL W/RMVL TERMINAL ILE $3,940.09

LAPS ENTEROLSS FRING INTSTINAL ADHESION SPX $2,697.02

LAPS FULG OVIDUXS $1,059.68

LAPS FULG/EXC OVARY VISCERA/PRTL SURF $2,063.97

LAPS INSERTION TUNNELED INTRAPERITONEAL CATHETER $1,144.14

LAPS JEJUNOSTOMY $1,779.46

LAPS LSS ADS SPX $1,961.41

LAPS MOBLJ SPLENIC FLXR PFRMD W/PRTL COLCT $556.20

LAPS MYOMECTOMY EXC 1-4 250 GM/< $2,424.69

LAPS OCCLUSION OVIDUXS DEV $1,058.88

LAPS PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST $5,549.88

LAPS PROCTOPEXY FOR PROLAPSE $2,808.43

LAPS PROCTOPEXY FOR PROLAPSE SIGMOID RESCJ $3,567.29

LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE $2,179.00

LAPS RMVL ADNEXAL STRUXS $1,892.15

LAPS RPR INCISIONAL HERNIA NCRC8/STRANGULATED $3,021.96

LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/MESH $4,948.73

LAPS RPR RECURRENT INCAL HRNA NCRC8/STRANGULATED $3,870.62

LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE $2,692.51

LAPS SUPRACRV HYST >250 G RMVL TUBE/OVARY $2,628.26

LAPS SUPRACRV HYST 250 G/< $2,085.76

LAPS SUPRACRV HYST 250 G/< RMVL TUBE/OVARY $2,384.27

LAPS SURG APPENDEC $1,762.37

LAPS SURG CHOLECSTC $1,925.46

LAPS SURG CHOLECSTC W/CHOLANGRPH $2,092.56

LAPS SURG CHOLECSTC W/EXPL COMMON DUX $2,663.37

LAPS SURG RPR 1ST INGUN HRNA $1,251.05

LAPS SURG RPR LYMPH NODE BX 1/MLT $1,526.40

LAPS SURG RPR RECRT INGUN HRNA $1,625.44

LAPS SURG SPLENC $3,090.42

LAPS SURG W/ASPIR CAVITY/CST 1/MLT $1,081.76

LAPS SURG W/BX 1/MLT $1,012.93

LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY $1,778.54

LAPS TOTAL HYSTERECTOMY 250 G/<W TUBE/OVARY $2,606.46

LAPS TX ECTOPIC PREGNANCY W/O SO $2,248.20

LAPS TX ECTOPIC PREGNANCY W/SO $2,183.03

LAPS VAG HYST > 250 GM RMVL TUBE&/OVARY $3,865.63

LAPS W/REVISION INTRAPERITONEAL CATHETER $1,221.03

LAPS W/VAG HYST > 250 GRAMS $3,307.74

LAPS W/VAG HYST 250 GM/< $2,563.77

LAPS W/VAG HYST 250 GM/< RMVL TUBE&/OVARY $2,873.70

LARGSC EXC TUM&/STRIPPING CORDS/EPIGL $719.35

LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP $783.96

LARGTOM STOT SUPRAGLOTTIC W/RAD NCK DSJ $5,980.55

LARGTOM TOT W/O RAD NCK DSJ $5,059.67

LARGTOM TOT W/RAD NCK DSJ $7,312.56

LARYNGOPLASTY CRICOID SPLIT $2,401.74

LARYNGOPLASTY NOT OTHERWISE SPECIFIED $2,943.49

LARYNGOSCOPY +-TRACHEOSCOPY ASPIRATION $501.16

LARYNGOSCOPY +-TRACHEOSCOPY DIAGNOSTIC NEWBORN $449.57

LARYNGOSCOPY +-TRACHEOSCOPY DX EXCEPT NEWBORN $687.75

LARYNGOSCOPY +-TRACHEOSCOPY MICROSCOPE/TELESCOPE $453.14

LARYNGOSCOPY DIRECT OPERATIVE W/BIOPSY $563.82

LARYNGOSCOPY FLEXIBLE FIBEROPTIC DIAGNOSTIC $322.24

LARYNGOSCOPY FLEXIBLE FIBEROPTIC REMOVAL LESION $661.21

LARYNGOSCOPY FLX FIBEROPTIC RMVL FOREIGN BODY $575.48

LARYNGOSCOPY INDIRECT DIAGNOSTIC SPX $196.01

LARYNGOSCOPY INDIRECT W/REMOVAL FOREIGN BODY $500.48

LARYNGOSCOPY W/BIOPSY MICROSCOPE/TELESCOPE $627.39

LARYNGOSCOPY W/FOREIGN BODY REMOVAL $587.62

LARYNGOSCOPY W/REMOVAL OF LESION $492.09

Larynx and trachea in children younger then 1 yr; PRO $800.00

LASIX,UP TO 20 MG $15.45

LATERAL RETINACULAR RELEASE OPEN $1,293.38

LAVAGE CANNULATION MAXILLARY SINUS $500.61

LEAD SCREENING $75.00

LENGTHENING TENDON EXTENSOR HAND/FINGER EACH $1,368.70

LENGTHENING TENDON FLEXOR HAND/FINGER EACH $1,713.05

Lens surgery; PRO $500.00

LEVALBUTEROL 1 MG $10.93

LEVALBUTEROL 1MG $10.93

LEVONORGESTREL CONTRACEPTIVE KYLEENA $1,287.50

LIFT ELEVATION HEEL AND SOLE NEOPRENE $117.02

LIG DIV&/EXC VARICOSE VEIN CLUSTER 1 LEG $974.32

LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG $1,786.75

LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ $741.00

LIG&DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX $763.23

LIG/BANDING ANGIOACCESS ARVEN FSTL $1,119.64

LIG/BX TEMPORAL ART $900.30

LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI $1,006.85

LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX $926.32

LIG/TRNSXJ FLP TUBE DONE TM C DLVR/SURG $225.42

LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR $2,078.56

LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR $3,115.24

LIGATION ARTERIES ETHMOIDAL $1,497.14

LIGATION ARTERIES INT MAXILLARY TRANSANTRAL $1,987.91

LIGHT COMPRESSION BANDAGE, ELASTIC $14.00

Lithotripsy with water bath; PRO $800.00

Liver transplant recipient; PRO $3,100.00

LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC $2,001.37

LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC $2,009.00

LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRST 1 EA TDN $1,603.99

LNGTH/SHRT TDN LEG/ANKLE 1 TDN SPX $1,569.96

LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA $1,493.65

LONG ARM CAST $103.00

LONG ARM CAST,PED $77.25

LONG ARM SPLINT ADLT PLAS $29.87

LONG ARM SPLINT PEDS PLASTER $21.63

LONG LEG CAST PEDS FIBERGLASS $54.64

LOW RISK FOR RETINOPATHY $0.01

Lower abdomen hernia repairs; PRO $500.00

Lower abdominal hernia repair under 37 weeks; PRO $700.00

Lower anterior abdominal wall; PRO $500.00

Lower intestinal endoscopic procedures; PRO $100.00

Lower posterior abdominal wall; PRO $600.00

LRYNGOT W/RMVL TUM/LARYNGOCELE CORDECTOMY $3,112.50

LSS ADS $2,486.51

LSS LABIAL ADS $408.00

LSS/EXC PEN POST-CIRCUMCISION ADS $731.92

Lumbar and ventral hernia; PRO $700.00

Lumbar puncture anes; PRO $500.00

LUMBAR SPINE FUSION COMBINED $5,665.00

Lumbar spine; PRO $900.00

Lumbar sympathectomy; PRO $800.00

LUPRON DEPOT 7.5MG $1,649.70

LUPRON DEPOT PER 3.75 MG $1,505.04

LYSIS INTRANASAL SYNECHIA $708.81

Major abdominal blood vessels; PRO $1,600.00

Major vessels of the neck; PRO $1,100.00

Male genitalia procedures; PRO $400.00

Management daily of continuos drug administration; PRO $400.00

Manipulation and removal of ureteral calculus; PRO $600.00

MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA $441.08

Manipulation of spine; PRO $400.00

MARROW ASPIRATION ONLY $387.21

MARROW BX NDL/TROCAR $392.69

MARSUPIALIZATION BARTHOLIN'S GLAND CYST $530.07

MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN $3,488.46

MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES $3,075.01

MASTECTOMY GYNECOMASTIA $922.89

MASTECTOMY PARTIAL $1,543.55

MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY $2,621.17

MASTECTOMY SIMPLE COMPLETE $2,405.04

MASTECTOMY SUBCUTANEOUS $1,591.90

MASTOPEXY $2,259.78

MAXILLECTOMY W/O ORBITAL EXENTERATION $4,478.66

MD CERTIFICATION $155.67

MD RECERTIFICATION $116.84

MEAS POST-VOIDING RESIDUAL URINE&/BLDR CAP $131.39

MEASLES,MUMPS&RUBELLA VACCINE VIAL $99.06

MED LIST DOCD IN RCRD $0.01

Mediasinoscopy no ventilation; PRO $900.00

Mediasinoscopy with ventilation; PRO $1,200.00

MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR $2,320.88

MEDIASTINOSCOPY W/BX WHEN PERFORMED $1,447.00

MEDICARE ECG, INTERP & REPORT; PRO $24.17

MEDICARE EKG INITIAL EXAM $48.80

MENINGOCOCCAL DIP CON VACC 16 MCG VIAL $228.68

MENINGOCOCCAL RECOMBINANT PROTEIN $219.61

MENINGOCOCCAL VACC A/C/V/W 135 (MENOMUNE) $186.72

METHOTREXATE 5 MG $8.24

METHOTREXATE SODIUM 50 MG $5.90

MGMT LVR HEMRRG CPLX SUTR WND/INJ $5,306.20

MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ $3,286.10

MICROSURG TQS REQ USE OPRATING MCRSCP $644.78

MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC $5,001.78

MIRENA $1,326.13

MMRV $303.62

MNPJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS $556.56

MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME $706.78

MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT $356.38

MOD SED SAME PHYS/QHP ADDL 15 MINS $27.18

MOD SED SAME PHYS/QHP >5 YRS $31.67

MOD SED SUPPORT PHYS/QHP >5 YRS INITIAL 15 MINS $194.41

MOLDED FOOT ORTHO $34.62

MOLDED RIGID ORTHOTIC $359.16

MOST RECENT A1C < 7% $0.01

MOST RECENT A1C BETWEEN 7 AND 9% $0.01

MR GUIANCE FOR NEEDLE PLACEMENT $956.02

MRGT ASPIR&/EUSTACHIAN TUBE NFLTJ $540.32

MRGT ASPIR&/EUSTACHIAN TUBE NFLTJ ANES $438.16

M-SEDAJ BY SM PHYS PERFRMG SVC 5+ YR $260.60

M-SEDAJ BY SM PHYS PERFRMG SVC EA 15 MIN $51.84

M-SEDATION BY PHYS OTH/THN HC PROF PERFRMG 5+ $260.60

M-SEDATJ BY SM PHYS PERFRMG SVC < 5 YR $253.01

MSTDC MODF RAD $2,882.36

MULTIPLE LEAD SYSTEM $259.48

MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP HEAD&NCK $3,731.16

MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR $3,982.00

MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK $4,225.28

MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR $3,697.83

MYOCARDIAL RESECTION $7,364.30

MYOMECTOMY 1-4 250 GM/< VAG $1,595.69

NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX $575.47

NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY PARTIAL $813.20

NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL $1,183.59

NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY $584.47

NASAL/SINUS ENDOSCOPY W/SPHENOIDECTOMY $685.77

NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDN $122.57

NASOPHARYNGOSCOPY $44.69

NASOPHARYNGOSCOPY W/ENDOSCOPE SPX $377.00

NDL EMG 1 XTR +-RELATED PARASPI AREAS $318.15




NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ $763.49

NDSC NJX IMPLT MATRL URT&/BLDR NCK $823.88

NDSC SURG W/VID-ASSTD HARVEST VEIN CAB $47.13

NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM $1,340.72

Needle biopsy of pleura; PRO $500.00

Needle biopsy thyroid; PRO $400.00

NEG MICROALBUMINURIA REV $0.01

NEG PRESS WND THER </EQUAL 50 SQ CM $124.50

NEONATE CRIT CARE SUBSQ; PRO $1,041.43

NEPHROPATHY DOC TX $0.01

Neuraxial labor analgesia/anesthesia; PRO $600.00

NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC $1,438.75

NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS $1,736.07

NEURP NRV HAND/FOOT $936.04

NEURP&/TRPOS MEDIAN NRV CARPL TUNNEL $1,244.53

NEURP&/TRPOS UR NRV ELBW $1,712.21

NEURP&/TRPOS UR NRV WRST $1,175.44

NF DSCHRG D MGMT > 30 MIN $203.68

NF DSCHRG D MGMT 30 MIN/< $140.13

NFRCT W/PRTL URTREC ANY OPN RIB RESCJ RAD $3,791.00

NJX ANES AX NRV $388.51

NJX ANES FACIAL NRV $352.06

NJX ANES FEM NRV 1 $322.83

NJX ANES GRTER OCCIPITAL NRV $284.83

NJX ANES ILIOINGUN ILIOHYPOGSTR NRV $389.34

NJX ANES INTERCOSTAL NRV 1 $319.56

NJX ANES LMBR/THRC PVRT SYMPATHETIC $497.65

NJX ANES OTH PRPH NRV/BRANCH $225.24

NJX ANES SCIATIC NRV 1 $363.76

NJX ANES SPHENOPALATINE GANGLION $463.50

NJX ANES STELLATE GANGLION CRV SYMPATHETIC $463.50

NJX ANES SUPRASCAPULAR NRV $343.72

NJX ANES SUPRIOR HYPOGSTR PLEXUS $430.76

NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH $363.80

NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE $135.73

NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL $364.14

NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LVL $303.70

NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL $519.80

NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LVL $243.02

NJX C+-DX/THER SBST EDRL/SARACH CRV/THRC $287.50

NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY $518.14

NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL $504.12

NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL $409.77

NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL $224.58

NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL $226.92

NJX EDRL BLD/CLOT PATCH $415.23

NJX INTERLAMINAR CRV/THRC $423.36

NJX INTERLAMINAR CRV/THRC WITH IMAGING GUIDANCE $627.93

NJX INTERLAMINAR LMBR/SAC WITH IMAGING QUIDANCE, FLUROSCOPY $616.72

NJX INTERLAMINAR LMBR/SAC WITHOUT IMAGING GUIDANCE $394.87

NJX PX LYMPHANGRPH $238.12

NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH $144.20

NJX SUPRAVALV AORTOG HRT CATH W/S&I; PRO $155.19

NJX/NFS NULYT SBST EDRL LMBR SAC $824.08

NO FALL OR 1 FALL W/O INJURY $0.01

Non invasive imaging and radiation therapy; PRO $800.00

NON PURCHASED SUPPLY/MATERIAL $0.01

NON REMOV FOOT ARCH SUPPORT $36.42

NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL $254.41

NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER $13.78

NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR $183.29

NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER $8.11

NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS $394.94

NORFLEX UP TO 60MG $11.19

Nose and acessory sinus; PRO $600.00

NRV CNDJ TST 11-12 STUDIES $616.78

NRV CNDJ TST 13/> STUDIES $699.78





NSL SINS NDSC TOT WITH SPHENDT $1,084.60

NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS $938.12

NSL/SINUS NDSC RPR CEREBSP FLU LEAK ETHMOID $3,303.19

NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS $793.10

NSL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX $730.22

NSL/SINUS NDSC SURG W/CONCHA BULLOSA RESCJ $474.80

NSL/SINUS NDSC SURG W/CTRL NSL HEMRRG $729.68

NSL/SINUS NDSC W/FRNT SINUS EXPL $1,492.46

NUTRITION THERAPY INIT.EA15MIN $64.84

NVR CNDJ TST 1-2 STUDIES $122.48

OB ANTEPARTUM CARE C DLVR&POSTPARTUM $5,638.89

OB ANTEPARTUM VAG DLVR&POSTPARTUM AFTER C DLVR $5,201.29

OB CARE ANTEPARTUM VAG DLVR&POSTPARTUM $5,106.78

OBS CARE DSCHRG D MGMT $143.91

OBS/I/P HOSP CARE HIGH SEVERITY $432.75

OBS/I/P HOSP CARE LOW SEVERITY $389.34

OBS/I/P HOSP CARE MODERATE SEVERITY $492.34

OCCULT BLD FECES 1-3 TESTS $22.00

OCCULT BLOOD FECES $20.00

Ochiopexy; PRO $500.00

OFFICE CONSLTJ 15 MIN $110.14





OFFICE O/P EST 5 MIN $37.78

OFFICE OUTPT EST 10 MIN $83.08




OFFICE OUTPT NEW 10 MIN $83.61

OFFICE OUTPT NEW 20 MINUTES $142.77




OMENTAL FLAP INTRA-ABDL $1,040.56

OMENTAL FLAP XTR-ABDL $3,437.86

OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX $1,886.39

Omphaloceld; PRO $800.00

OOPHORECTOMY PRTL/TOT UNI/BI $1,524.40

Open arthroscopic procedure knee joint; PRO $500.00

Open arthroscopic procedures elbow; PRO $500.00

Open arthroscopic procedures radius, ulna, wrist; PRO $400.00

Open arthroscopic shoulder procedure; PRO $600.00

Open procedures hip joint; PRO $700.00

Open procedures lower femur; PRO $600.00

Open procedures lower leg, ankle and foot; PRO $400.00

Open procedures upper ends of tibia, fibula and patella; PRO $500.00

Open procedures upper femur; PRO $700.00

Open procedute pubis or si joing; PRO $900.00

OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT $3,639.57

OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE $2,297.00

OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE $2,705.90

Open repair of disruption of pelvis; PRO $1,300.00

OPEN REPAIR OF ROTATOR CUFF ACUTE $2,401.21

OPEN REPAIR OF ROTATOR CUFF CHRONIC $2,488.57

OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE $2,251.58

OPEN TREATMENT CALCANEAL FRACTURE $3,272.30

OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT $3,407.44

OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA $3,814.79

OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA $1,981.09

OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY $3,189.59

OPEN TREATMENT GREATER TROCHANTERIC FRACTURE $2,113.86

OPEN TREATMENT HUMERAL CONDYLAR FRACTURE $2,342.67

OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION $1,446.74

OPEN TREATMENT LUNATE DISLOCATION $1,797.18

OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE $1,785.09

OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION 1 $1,361.66

OPEN TREATMENT METATARSAL FRACTURE EACH $1,585.42

OPEN TREATMENT OF ULNAR SHAFT FRACTURE $1,820.75

OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE $2,039.21

OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE $1,714.88

OPEN TREATMENT PROXIMAL HUMERAL FRACTURE $2,103.23

OPEN TREATMENT RADIAL SHAFT FRACTURE $1,955.81

OPEN TREATMENT TALOTARSAL JOINT DISLOCATION $1,994.70

OPEN TREATMENT TALUS FRACTURE $3,118.96

OPEN TREATMENT TARSAL BONE DISLOCATION $2,158.62

OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION $1,876.08

OPEN TREATMENT ULNAR FRACTURE PROXIMAL END $1,910.87

OPEN TREATMENT ULNAR STYLOID FRACTURE $1,687.81

OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC $1,535.75

OPEN TX ACUTE SHOULDER DISLOCATION $1,616.46

OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION $1,989.01

OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA $1,749.57

OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA $1,536.92

OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE $2,113.38

OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB $1,373.44

OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB $1,815.02

OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION $1,709.24

OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS $1,904.47

OPEN TX DISTAL PHALANGEAL FRACTURE EACH $1,178.21

OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC $1,643.38

OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION $1,667.63

OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE $2,838.28

OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W XTN $3,643.01

OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN $2,925.88

OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES $1,656.19

OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE $1,550.96

OPEN TX HUMERAL EPICONDYLAR FRACTURE $2,138.57

OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN $2,209.50

OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN $3,044.18

OPEN TX HUMERAL TUBEROSITY FRACTURE $2,260.57

OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE $2,368.76

OPEN TX INTERPHALANGEAL JOINT DISLOCATION 1 $1,303.13

OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR $2,489.93

OPEN TX METACARPAL FRACTURE SINGLE EA BONE $1,608.62

OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION $1,423.46

OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW $1,967.85

OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA $1,404.92

OPEN TX RADIAL & ULNAR SHAFT FX FIXJ RADIUS/ULNA $1,596.29

OPEN TX RADIAL HEAD/NECK FRACTURE $1,824.28

OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC $2,144.47

OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1+ BONES $1,713.51

OPEN TX RDL& ULNAR SHAFT FX FIXJ RADIUS &ULNA $2,620.58

OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD $2,734.01

OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE $2,223.72

OPEN TX TARSAL FRACTURE XCP TALUS &CALCANEUS EA $1,778.89

OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR $2,632.98

OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC $1,922.92

OPEN TX TRAUM HIP DIS W/ACET WALL FX/FMR $3,539.43

OPEN TX TRIMALLEOLAR ANKLE FX W FIXJ PST LIP $2,823.98

OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP $2,490.35

OPENING OF ESOPHAGUS $496.77

Ophthalmoscopy; PRO $500.00

OPN FEM ART EXPOS DLVR EVASC PROSTH UNI $1,009.85

OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH $4,297.22

OPN SUBCLA CRTD ART TRPOS NCK INC ULAT $2,242.66

OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF $1,841.79

OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT $4,635.16

OPTX ANKLE DISLC W/O RPR/INT FIXJ $1,789.39

OPTX ANKLE DISLC W/RPR/INT/XTRNL FIXJ $2,376.18

OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFRMD $2,802.95

OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ $1,487.89

OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG $2,412.16

OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG $3,046.05

OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP $2,149.52

OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT $3,495.40

OPTX FEM SHFT FX W/INSJ IMED IMPLT +-SCREW $3,907.76

OPTX FEM SHFT FX W/PLATE/SCREWS +-CERCLAGE $2,849.40

OPTX HIP DISLC TRAUMTC W/O INT FIXJ $2,506.57

OPTX HUMERAL SHFT FX W/PLATE/SCREWS +-CERCLAGE $2,562.43

OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR $2,201.54

OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBOW $2,848.09

OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD $3,371.11

OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ $2,937.40

OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM $2,933.48

OPTX TIBL FX PROX BICONDYLAR +-INT FIXJ $3,488.96

OPTX TIBL SHFT FX W/PLATE/SCREWS +-CERCLAGE $2,530.97

ORCHIECTOMY PRTL $1,762.73

ORCHIOPEXY INGUN APPR +-HRNA RPR $1,367.77

ORTHOTIC MGMT&TRAINJ UXTR LXTR&/TRNK EA 15 MIN $88.05

ORTHOVISC PER DOSE $919.79

OSTC PRTL EXOSTC/CONDYLC METAR HEAD $1,651.54

OSTECTOMY COMPLETE 1ST METATARSAL HEAD $1,399.51

OSTECTOMY COMPLETE 5TH METATARSAL HEAD $1,256.60

OSTECTOMY PRTL 5TH METAR HEAD SPX $1,325.23

OSTEOPATHIC MANIPULATIVE TX 1-2 BDY REGIONS $89.31



OSTEOT +-LNGTH SHRT/CORRJ METAR XCP 1ST EA $1,619.25

OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL $3,273.54

OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE $1,270.83

OSTEOTOMY CLAV +-INT FIXJ W/B1 GRF NON/MAL $2,712.82

OSTEOTOMY CLAVICLE +-INTERNAL FIXATION $7,112.44

OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION $2,869.11

OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION $2,184.11

OSTEOTOMY FIBULA $1,114.68

OSTEOTOMY HUMERUS +-INTERNAL FIXATION $2,317.85

OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE $3,596.14

OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT $4,163.95

OSTEOTOMY METACARPAL EACH $1,589.55

Osteotomy of humerus; PRO $600.00

OSTEOTOMY PHALANX FINGER EACH $1,755.64

OSTEOTOMY RADIUS DISTAL THIRD $1,920.36

OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD $2,166.34

OSTEOTOMY TIBIA $2,152.86

Osteotomy tibia and fibula; PRO $500.00

OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX $2,495.46

OTOPLASTY PROTRUDING EAR +-SIZE RDCTJ $1,826.27

Otoscopy; PRO $500.00

OVARIAN CSTC UNI/BI $2,170.21

PAIN ASSMNT AS POS UTILIZING TOOL AND PLAN; PRO $0.01

PALATOPHARYNGOPLASTY $2,092.97

PALIVIZUMAB 50 MG VIAL $2,092.83

Pancreatectomy; PRO $900.00

Panniculectomy; PRO $600.00

PARATHYR AUTOTRNSPLJ $696.00

PARATRDEC/EXPL PARATHYR $2,833.42

PARAVAGINAL DEF REP VAGINAL APPROACH $1,766.08

PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPR $2,307.00

PARAVERTEBRAL BLOCK PVB THORACIC $207.91

PARING BENIGN LESION 2-4 $165.31

PARING BENIGN LESION-ONE $135.53

PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4 $186.80

PARTIAL EXCISION BONE CLAVICLE $1,884.82

PARTIAL EXCISION BONE HUMERUS $1,990.71

PARTIAL EXCISION BONE METACARPAL $1,463.89

PARTIAL EXCISION BONE OLECRANON PROCESS $1,737.07

PARTIAL EXCISION BONE RADIAL HEAD/NECK $1,649.78

PARTIAL EXCISION BONE RADIUS $1,630.49

PARTIAL EXCISION BONE TIBIA $2,376.49

PARTIAL EXCISION BONE ULNA $1,545.11

PARTIAL EXCISION DISTAL PHALANX FINGER $1,295.21

PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER $2,375.75

Partial hepactectomy; PRO $1,400.00

PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE $1,781.42

Partial rib resection; PRO $700.00

PEGFILGRASTIM 6 MG INJ $8,555.30

PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR $2,312.47

PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL $315.18

Pelvic exenteration; PRO $900.00

PENICILLIN G BENZATHINE 100,000 $172.55

Percutaneous image guided procedures spine; PRO $600.00

Percutaneous liver biopsy; PRO $500.00

PERICARDIOCENTESIS INITIAL $1,164.66

Perineal prostatectomy; PRO $700.00

PERIODIC PREVENTIVE MED EST PATIENT AGE 12-17YRS $240.95





PERIODIC PREVENTIVE MED EST PATIENT AGE 65YRS&> $296.02

PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1YR $195.06

PERI-PX EVAL&PROGRAM CARDIOVERTER/DEFIBRILLATOR $127.53

PERI-PX EVAL&PROGRAM IN PRSN PACEMAKER SYSTEM $73.03

PERITONEAL LAVAGE, INC IMAGING GUIDANCE $301.77

Permanent tranvenous pacemaker; PRO $500.00

PERQ CLSR TCAT LEFT ATR APNDGE $2,044.33

PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP $1,936.26

PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DISLC $6,069.34

PERQ VERTEBRAL AUGMENATION LUMBAR $1,545.00

PERQ VERTEBRAL AUGMENTATION $1,648.00

PERQ VERTEBRAL AUGMENTATION EA ADDL $721.00

PESSARY $89.12

PFT W/BRONCH; XPLD P $169.72

PH FLUID $14.00

PHALANGECTOMY TOE EA TOE $1,022.31

PHARMACOLOGIC MANAGEMENT $86.95

PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX $1,990.54

PHENERGAN HCL UP TO 50 MG $199.45

Phleborrhaphy; PRO $500.00

PHONE E/M BY PHYS 5-10 MIN; PRO $39.25

PHYS SERVICE TO ESTABLISH POWER MOBILITY $25.89

PHYS SUPVJ NF PT MO 15-29 MIN $212.78

PHYS SUPVJ NF PT MO 30 MIN/> $318.61

Physiological support for harvesting organs; PRO $800.00

PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN $2,437.28

PLAN OF CARE 4 PAIN DOCD $0.01

PLASTER SHORT LEG ADULT CAST $19.96

PLMT NDL INTRAOSS NFS $173.66

PLMT SETON $652.10

PLMT XTN PROSTH EVASC RPR ARYSM/DSJ 1ST VSL $2,077.84

PLMT XTN PROSTH EVASC RPR ARYSM/DSJ EA VSL $614.91

PLSTC RPR INTROITUS $701.43

PLSTC URTL SPHNCTR VAG APPR $900.29

PM DEVICE PROGR EVAL DUAL $77.11

PM/ICD REMOTE TECH SERV $68.60

PNEUMATIC ANKLE SPLINT $98.21

PNEUMOCCOCAL VAC 23-VAL 0.5 ML $84.00

Pneumocentesis; PRO $500.00

PNEUMOCOCCAL 13 CON VAC 0.5 ML SYR $235.42

PNEUMOCOCCAL VACC 7 VAL IM $194.14

PNEUMONIA ADMINISTRATION MEDICARE $24.00

POLIOVIRUS VACCINE INACTIVATED SUBQ/IM $58.35

Popliteal repair of occlusion or aneurysom; PRO $900.00

Popliteal thromboendarterectomy; PRO $900.00

POS MACROALBUMINURIA REV $0.01

POS MICROALBUMINURIA REV $0.01

POST COLPORRHAPHY RPR RECTOCELE +-PRINEORRHAPHY $1,738.76

POST OP VISIT $0.01

POST PARTUM VISIT $0.01

Post transuretheral resection bleeding; PRO $600.00

POSTERIOR NON-SEGMENTAL INSTRUMENTATION $2,106.54

POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG $4,120.00

POSTPARTUM CARE ONLY SPX $450.66

POTASSIUM CHLORIDE 2 MEQ $5.00

PRE OP NO CHARGE $0.00

PREDNISONE 5 MG $20.16

PREDNISONE,ORAL 5 MG $21.63

PREFAB SM JOINT SPLINT $50.92

PREOP PLACEMENT LOCALIZATION WIRE BREAST $400.00

PREOP PLMT LOCALIZATION WIRE BREAST EA LESION $2,314.13

PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT $83.04

PREV MED CNSL INDIV SPX 15 MIN $203.52




PRIMATRIX, PER SQ CM $74.30

PRINEOPLASTY RPR PR NONOBAL SPX $756.67

PRITONEOCNTS ABDL PCNTS/PRTL LVG 1ST $412.00

Procedures arteries of upper arm and elbow; PRO $700.00

Procedures for arteries of forearm, wrist, and hand; PRO $700.00

Procedures in sitting positions; PRO $1,400.00

Procedures involving arteries upper leg inclds bypass graft; $900.00

Procedures of clavicle and scapula; PRO $600.00

Procedures of the arteries of lower leg; PRO $900.00

Procedures of veins in lower leg; PRO $400.00

Procedures on arteries of shoulder; PRO $700.00

Procedures on nerves, muscle, tendon; PRO $400.00

Procedures on nreves, muscle, tendons etic; PRO $400.00

Procedures on veins of shoulder; PRO $500.00

Procedures shoulder nerves, muscle tendon; PRO $600.00

Procedures upper arm and elbow nerves, muscle, tendon; PRO $400.00

Procedures veins of forearm, wrist and hand; PRO $400.00

Procedures veins upper arm and elbow; PRO $400.00

PROCTOSGMDSC RGD DX +-COLLJ SPEC BR/WA SPX $339.20

PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX $34.97

PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS $70.04

PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER $164.71

PROGRAM EVAL IMPLANTABLE IN PRSN 1 LD PACEMAKER $146.03

PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER $195.32

PROGRAMMING DEVICE EVAL $165.88

PROGRAMMING DEVICE, IMPLANTABLE LOOP RECORDER $114.75

PROGRAMMING EVAL DUAL-ICD $238.05

PROLIXIN DECANOATE UP TO $102.84

PROLNG PHYS SVC OFFICE O/P DIR CONTACT 1ST HR $302.65

PROLNG PHYS SVC OFFICE O/P DIR CONTACT EA 30 MIN $230.08

PROLONGED SERVICE I/P REQ UNIT/FLOOR TIME 1ST HR $268.70

PROLONGED SVC I/P REQ UNIT/FLOOR TIME EA 30 MIN $260.55

Prone position; PRO $600.00

PROPH TX N/P/PLTWR +-MMA FEMUR $3,207.92

PROPHYLACTIC TX +-METHYLMETHACRYLATE HUMRL SHFT $2,272.63

PROTHOMBIN $75.00

PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS $588.49

PRQ IMPLTJ NSTIM ELTRD RA EDRL $3,129.77

PRQ PORTAL VEIN CATHETERIZATION ANY METHOD $567.10

PRQ SKEL FIXATION CARP/MTCRPL FX DISLOCATE THUMB $3,555.74

PRQ SKEL FIXJ CARP/MTCRPL DISLC THMB MNPJ EA JT $1,398.38

PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA $1,220.29

PRQ SKEL FIXJ FEM FX DSTL END $6,714.80

PRQ SKEL FIXJ FEM FX PROX END NCK $2,653.28

PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MNPJ $1,299.86

PRQ SKEL FIXJ IPHAL JT DISLC 1 W/MNPJ $1,293.86

PRQ SKEL FIXJ METAR FX W/MNPJ $835.14

PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MNPJ $866.00

PRQ SKEL FIXJ MTCRPL FX EA B1 $1,391.57

PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T $1,355.55

PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX $2,173.72

PRQ SKEL FIXJ TARS JT DISLC W/MNPJ $1,125.13

PRQ SKEL FIXJ TIBL SHFT FX $6,572.82

PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION $1,503.36

PRQ TRLUML C THRMBC $492.22

PRST8ECT RETROPUBIC RAD W/BI PEL LMPHADEC $3,919.05

PRTL EXC B1 FEMUR PROX TIBIA&/FIBULA $2,414.59

PRTL EXC B1 PHALANX TOE $1,303.00

PRTL EXC B1 TALUS/CALCANEUS $1,924.33

PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS $1,763.89

PRTL HYMENECTOMY/REVJ HYMENAL RING $544.30

PRTL LARGTOM HEMILARGTOM HRZNTL $5,044.51

PSY, 30MIN W/PT & OR FAMILY $185.87

PSYCHIATRIC DIAGNOSTIC EVALUATION $380.76

PSYCHIATRIC DX EVAL WITH MED SER $406.17

PSYCHOTHERAPY 30 MINS WITH PATIENT AND/OR FAMILY $178.23



PT FOCUSED HLTH RISH ASSMT $11.38

PT TOBACCO SCREEN RCVD TLK $0.01

PTNOT RCVNG ANTI RHM THXPYRA $0.01

PULMICORT .25-.50 $14.85

PULMICORT .25-.50 DOSE $14.85

Pulmonary resection with thoracoplasty; PRO $1,600.00

Pump oxygenator with hypothermic circulatory; PRO $2,600.00

PUNCTURE ASPIRATION CYST BREAST $264.18

PUNCTURE ASPIRATION OF ABSCESS $349.73

PURE TONE AUDIOMTRY AIR ONLY $176.67

QUADRICEPSPLASTY $1,943.02

R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I; PRO $1,152.03

R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I; PRO $1,308.09

RABIES VACCINE (CHICK) EACH $450.65

Rad Amp; PRO $900.00

RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS $2,163.83

RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS $1,757.97

RAD RESCJ TONSIL CLSR W/LOCAL FLAP $3,387.64

RAD RESCJ TONSIL CLSR W/OTH FLAP $5,465.24

RAD RESCJ TUM SOFT TISSUE LEG/ANKLE 5+CM $3,581.94

RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3CM $3,244.69

RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM $2,867.98

RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5+CM $3,695.50

RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM $2,949.96

RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM $2,789.61

RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5+CM $3,724.17

RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM $4,475.39

RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5+CM $4,025.72

RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM $2,836.40

RAD RESECTION TUMOR SOFT TISSUE THIGH/KNEE 5+CM $4,147.57

RADEX FOOT COMPL MINIMUM 3 VIEWS $20.21

RADEX KNEE 3 VIEWS $26.93

Radical amputation of penis with lymphadenectomy; PRO $700.00

Radical facial; PRO $800.00

Radical hysterectomy; PRO $900.00

Radical nose and sinus; PRO $800.00

Radical or modified radical breast; PRO $600.00

Radical or modified with node dissection; PRO $1,400.00

Radical oral surgery; PRO $800.00

Radical orchiectomy abdominal; PRO $700.00

Radical orchiectomy inguinal; PRO $500.00

Radical pelvic tumors; PRO $1,100.00

Radical perineal procedure; PRO $800.00

Radical procedures; PRO $1,400.00

Radical procedures; PRO $700.00

Radical prostatectomy; PRO $800.00

Radical resection below knee amputation; PRO $500.00

RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS $2,481.81

RADICAL RESECTION OF TUMOR TIBIA $4,282.21

RADICAL RESECTION TUMOR FEMOR OR KNEE $4,966.44

Radical resection; PRO $900.00

RAPID HIV-1 SCREENING $88.51

RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY $1,491.31

RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS $1,728.74

RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF $2,245.59

RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RLS $2,165.41

RCNSTJ DISLOCATING PATELLA $1,965.01

RCNSTJ POLYDACTYLOUS DGT SOFT TISS&B1 $2,322.02

RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX $1,956.82

RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX $1,796.33

RCNSTJ XTRNL AUD CANAL SPX $2,604.77

RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT $2,593.15

RECENT A1C DOCUMENTED > 9% $0.01

RECENT SYSTOLIC BP>140MM HG(HTN)1(DM)4 $0.01

RECONSTRUCTION NAIL BED W/GRAFT $661.65

Reconstruction of breast; PRO $600.00

RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC $2,803.64

RECONSTRUCTION TOE POLYDACTYLY $1,372.13

REGLAN,10MG $5.00

RELEASE TARSAL TUNNEL $1,503.36

RELEASE THENAR MUSCLE $1,787.82

REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES $1,228.95

REMOVAL FOREIGN BODY DEEP THIGH/KNEE $1,631.66

REMOVAL FOREIGN BODY FOOT DEEP $1,295.96

REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS $736.85

REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES $599.81

REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE $586.18

REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE $573.93

REMOVAL FOREIGN BODY SHOULDER DEEP $1,258.00

REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS $579.79

REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP $1,032.00

REMOVAL FOREIGN BODY, SIMPLE $410.54

REMOVAL HIP PROSTHESIS SPX $2,428.50

REMOVAL IMPACTED CERUMEN IRRIGATION/LAVAGE, UNILATERAL $32.44

REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL $465.63

REMOVAL IMPLANT DEEP $1,734.25

REMOVAL IMPLANT FROM FINGER/HAND $1,016.59

REMOVAL IMPLANT SUPERFICIAL SPX $1,061.65

REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES $402.94

REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT $446.89

REMOVAL OF AN IMPLANTABLE, PT ACTIVATED CA $617.22

REMOVAL OF BONE LESION $1,564.47

REMOVAL OF LUNG $4,616.60

REMOVAL PERMANENT PACEMAKER PULSE GENERATOR $709.14

REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION $809.70

REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10< $53.80

REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA UP&W/15< $235.10

REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON $104.27

REMOVAL TUNNELED INTRAPERITONEAL CATHETER $1,118.24

REMOVAL/BIVALVING FULL ARM/FULL LEG CAST $194.71

REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST $178.96

REMOVE FEMUR LESION GRAFT $1,984.15

Renal procedures; PRO $800.00

Renal transplant Anes; PRO $1,100.00

REOPNG RECENT LAPT $2,511.57

REPAIR BLOOD VESSEL DIRECT HAND FINGER $2,219.46

REPAIR BLOOD VESSEL DIRECT NECK $2,764.00

REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY $2,311.69

REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL $4,252.33

REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY $3,050.17

REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY $2,776.41

REPAIR CARDIAC WOUND W/O BYPASS $6,520.80

REPAIR CHOANAL ATRESIA INTRANASAL $1,643.65

REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.0 CM/< $873.00

REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM $1,184.08

REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM $1,417.36

REPAIR COMPLEX EYELID/NOSE/EAR/LIP EA 5 CM/< $546.45

REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1 CM-2.5 CM $1,079.19

REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6 CM-7.5 CM $1,331.60

REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA 5 CM/< $502.27

REPAIR COMPLEX SCALP/ARM/LEG 1.1 CM-2.5 CM $939.23

REPAIR COMPLEX SCALP/ARM/LEG 2.6 CM-7.5 CM $1,191.34

REPAIR COMPLEX SCALP/ARM/LEG EA 5 CM/< $355.58

REPAIR COMPLEX TRUNK 1.1 CM-2.5 CM $895.95

REPAIR COMPLEX TRUNK 2.6 CM-7.5 CM $1,106.52

REPAIR COMPLEX TRUNK EA 5 CM/< $325.17

REPAIR ELBOW PERC $1,028.55

REPAIR EXTENSOR TENDON DISTAL INSERTION W/GRAFT $1,506.36

REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF $1,509.87

REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH $2,041.56

REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH $1,596.73

REPAIR EXTENSOR TENDON HAND W/GRAFT EACH $1,916.00

REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH $1,627.99

REPAIR FASCIAL DEFECT LEG $944.73

REPAIR FIRST ABDOMINAL WALL HERNIA $2,159.48

REPAIR FISTULA OROMAXILLARY $1,554.98

REPAIR FISTULA ORONASAL $1,399.86

REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH $1,092.83

REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC > 30.0 CM $1,395.33

REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 12.6-20.0CM $1,139.43

REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 2.5 CM/< $720.98

REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 2.6-5.0 CM $821.61

REPAIR INTERMEDIATE F/E/E/N/L/M&/MUC 20.1-30.0CM $1,446.59



REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM $942.58

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< $690.10

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM $807.72

REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM $966.14

REPAIR INTERMEDIATE S/A/T/E > 30.0 CM $1,121.63

REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM $1,038.65

REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< $662.52

REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM $846.58

REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM $1,131.05

REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM $872.29

REPAIR LATERAL COLLATERAL LIGAMENT ELBOW $1,987.23

REPAIR MANIPULATION FINGER/JOINT UNDER ANE $945.96

REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW $1,940.45

REPAIR NAIL BED $570.28

REPAIR NASAL SEPTAL PERFORATIONS $1,763.25

REPAIR NASAL VESTIBULAR STENOSIS $2,782.45

REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT $3,003.00

REPAIR NON/MALUNION HUMERUS W/O GRAFT $3,095.41

REPAIR NONUNION/MALUNION TARSAL BONES $1,793.25

REPAIR NONUNION/MALUNION TIBIA W/O GRAFT $2,561.42

REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT $2,508.22

Repair of cleft lip; PRO $700.00

Repair of cleft palate; PRO $700.00

Repair of non union of humerus; PRO $600.00

Repair of ruptured achilles tendon; PRO $600.00

REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON $1,934.98

REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIATE $2,083.15

REPAIR SECONDARY ACHILLES TENDON +-GRAFT $2,075.88

REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL $1,876.25

REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA $1,771.79

REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS $398.33

REPLACEMENT MITRAL VALVE W/CARDIOPULMONARY BYP $8,242.76

REPOSITION VAD DIFF SESSION $426.53

RESCJ DPHRM SMPL RPR $2,092.50

RESCJ LAT PHRNGL WALL/PYRIFORM SINUS DIR CLSR $4,615.38

RESCJ PALATE/X10SV RESCJ LES $2,475.40

RESCJ PHRNGL WALL CLSR W/FLP OR FLP W/MVASC ANAS $5,808.02

RESCJ PRIM PRTL MAL W/BSO&OMNTC TAH&LMPHADEC $4,112.84

RESECTION HUMERAL HEAD $1,790.85

Resection of bladder tumor; PRO $600.00

RESECTION/TRANSPLANTATION LONG TENDON BICEPS $2,067.94

REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL $1,239.92

REVIS RECONST SHOULDER JOINT $4,254.78

REVISION OF ULNA $1,594.63

REVISION SHOULDER HUMERAL OR GLENOID $4,538.39

Revision total hip arthroplasy; PRO $1,100.00

REVISION TRACHEOSTOMY SCAR $1,052.69

REVISION/RELOCATION SKIN POCKET PACEMAKER $1,021.60

REVJ CLST COMP RCNSTJ IN-DEPTH SPX $3,095.00

REVJ CLST SMPL RLS SUPFC SCAR SPX $1,497.24

REVJ CLST W/RPR PARACLST HRNA SPX $2,828.25

REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP $2,766.37

REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS $3,057.32

REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF $1,854.74

REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF $2,183.74

REVJ PRTL-VEN SHUNT $1,715.88

REVJ RMVL PROSTC VAG GRF VAG APPR $1,390.32

REVJ SKN POCKET FOR CARDIOVERTER-DEFIBRILLATOR $1,185.05

REVJ TOT HIP ARTHRP ACTBLR ONLY +-AGRFT/ALGRFT $4,314.80

REVJ TOT HIP ARTHRP BTH +-AGRFT/ALGRFT $5,615.52

REVJ TOT HIP ARTHRP FEM ONLY +-ALGRFT $4,485.64

REVJ TOT KNE ARTHRP +-ALGRFT 1 COMP $4,121.04

REVJ TOT KNE ARTHRP FEM&ENTIRE TIBL COMP $5,148.42

REVJ/RMVL IMPLTED SPI NPGR $890.49

REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI $1,366.81

REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL $1,603.71

REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL $2,037.14

REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSI VSL $641.69

REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOP UNI $1,524.49

REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI $1,667.92

RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR $4,005.56

RHINOPLASTY SECONDARY INTERMEDIATE REVISION $3,208.35

RHINOPLASTY SECONDARY MAJOR REVISION $3,559.10

RHINOPLASTY SECONDARY MINOR REVISION $2,502.58

RHINP DFRM COLUM LNGTH TIP SEPTUM OSTEOT $4,264.45

RHINP DFRM W/COLUM LNGTH TIP ONLY $2,212.11

RHINP PRIM COMPLETE XTRNL PARTS $3,321.80

RHO(D) IMMUNE GLOBULIN HUMAN FULL DOSE IM $167.69

RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM $167.69

RHOGAM,ONE DOSE $246.95

RINSJ RPTD BICEPS/TRICEPS TDN DSTL +-TDN GRF $2,268.88

RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS $317.97

RMVL FB FROM PHARYNX $516.99

RMVL FB XTRNL AUD CANAL ANES $298.00

RMVL FB XTRNL AUD CANAL W/O ANES $343.00

RMVL FB XTRNL EYE CJNCL SUPFC $160.82

RMVL FB XTRNL EYE CRNL W/O SLIT LAMP $166.23

RMVL FB XTRNL EYE CRNL W/SLIT LAMP $191.49

RMVL FB XTRNL EYE EMBEDDED SCJNCL/SCLL NONPRF8 $195.41

RMVL FECAL IMPACTION/FB SPX UNDER ANES $803.62

RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP $1,350.58

RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS $709.97

RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS $582.08

RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA $3,807.71

RMVL IMPACTED CERUMEN SPX 1/BTH EARS $138.64

RMVL INTRAUTERINE DEV $266.23

RMVL LNG OTH/THN PNUMEC 1 LOBE LOBEC $4,341.74

RMVL LNG OTH/THN PNUMEC 1 SGM SGMECTOMY $4,238.75

RMVL LNG OTH/THN PNUMEC 2 LOBES BILOBEC $4,660.69

RMVL LNG OTH/THN TOT PNUMEC WEDGE RESCJ 1/MLT $3,466.00

RMVL PROSTH TOT KNE PROSTH MMA +-INSJ SPACER $3,519.30

RMVL PRTL-VEN SHUNT $1,230.47

RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR $2,008.08

RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR $1,606.96

RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR $1,392.40

RMVL TRANSVNS PM ELTRD DUAL LEAD SYS $1,855.07

RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ $851.03

RMVL TUN CVC W/O SUBQ PORT/PMP $482.04

RMVL W/RINSJ IMPLANTABLE CONTRACEPTIVE CAPSULES $900.00

RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT $639.50

RMVL/REVJ SLING STRESS INCONTINENCE $1,987.19

ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ $1,552.21

ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATION $464.00

ROTAVIRUS VACC HUMAN ATTENUATED 2 DS LIVE ORAL $168.83

ROTAVIRUS VACC LIVE ORAL TUBE $115.79

ROUTINE VENIPUNCTURE $17.00

RPIR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT $2,356.33

RPLCMT A-VALVE PROSTC XCP HOMOGRF/STENT< VALVE $6,686.00

RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT $3,224.94

RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP $4,736.86

RPR 1 ELTRD 1CHMBR PRM PM/1CHMBR CVDFB $1,173.21

RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE LIGMS $2,497.20

RPR 1ST FEM HRNA ANY AGE NCRC8 $1,848.34

RPR 1ST FEM HRNA ANY AGE RDC $1,635.64

RPR 1ST INCAL/VNT HRNA NCRC8 $2,726.03

RPR 1ST INGUN HRNA AGE 5 YRS/> NCRC8 $1,713.84

RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE $1,522.12

RPR 1ST INGUN HRNA AGE 6 MO-5 YRS NCRC8 $1,702.94

RPR 1ST INGUN HRNA AGE 6 MO-5 YRS RDC $1,143.22

RPR 1ST INGUN HRNA FULL TERM INFT<6 MO RDC $1,134.53

RPR 2 ELTRDS 2 CHMBR PRM PM/2CHMBR CVDFB $1,100.28

RPR ATR SEPTAL DFCT SECUNDUM W/CARD BYP +-PATCH $4,869.25

RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL $4,058.69

RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS $4,966.29

RPR BLOOD VESSEL DIRECT LOWER EXTREMITY $2,488.72

RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP $4,037.62

RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY $2,118.23

RPR BLVSL W/GRF OTH/THN VEIN LXTR $2,720.65

RPR BROW PTOSIS $1,801.01

RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT $1,873.04

RPR DISLOCATING PERONEAL TENDON W/O FIB OSTEOT $1,433.10

RPR EPIGSTR HRNA NCRC8 $1,227.29

RPR EPIGSTR HRNA RDC SPX $1,095.96

RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH $1,026.23

RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH $1,410.65

RPR LAC DPHRM ANY APPR $2,415.60

RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX $757.74

RPR LIP FULL THKNS UP HALF VER H8 $1,199.82

RPR LIP FULL THKNS VERMILION ONLY $1,051.84

RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG B1 GRF $3,300.75

RPR NON/MAL FEMUR DSTL H/N W/O GRF $2,798.32

RPR NON/MAL METAR +-B1 GRF $1,746.24

RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH $2,983.76

RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT $3,511.29

RPR NONUNION SCAPHOID CARPAL BONE +-RDL STYLODC $2,251.91

RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT $3,322.37

RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAFT $8,004.28

RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT $3,043.11

RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS $1,635.46

RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL $1,392.56

RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT $1,910.97

RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL $1,967.29

RPR RECRT FEM HRNA NCRC8 $1,989.57

RPR RECRT FEM HRNA RDC $1,660.91

RPR RECRT INCAL/VNT HRNA NCRC8 $2,750.83

RPR RECRT INCAL/VNT HRNA RDC $2,250.34

RPR RECRT INGUN HRNA ANY AGE NCRC8 $2,077.10

RPR RECRT INGUN HRNA ANY AGE RDC $1,850.56

RPR SINUS VALSALVA ANEURYSM $4,292.67

RPR SPIGELIAN HRNA $1,626.16

RPR TABDL LMPHADEC X10SV W/PEL AORTIC&RNL $2,926.17

RPR TDN FLXR FOOT 1/2 W/O FR GRF EA TDN $1,406.28

RPR TDN XTNSR FOOT 1/2 EA TDN $1,139.88

RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MUSC $1,847.23

RPR TDN/MUSC FLXR F/ARM&/WRST SEC 1 EA TDN/MUSC $1,823.50

RPR TDN/MUSC FLXR F/ARM&/WRST SEC FR GRF EA $2,099.75

RPR TDN/MUSC XTNSR F/ARM&/WRST PRIM 1 EA TDN $1,418.59

RPR TDN/MUSC XTNSR F/ARM&/WRST SEC 1 EA TDN/MUSC $1,617.13

RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN $1,891.24

RPR THORACOAAA W/GRF +-CARD BYP $8,827.32

RPR TUNICA VAGIS HYDROCELE BOTTLE TYP $1,089.82

RPR UMBILICAL HRNA < 5 YRS RDC $942.22

RPR UMBILICAL HRNA <5 YRS NCRC8 $1,280.77

RPR UMBILICAL HRNA 5 YRS/> RDC $1,301.45

RPR UMBILICAL HRNA AGE 5 YRS/> NCRC8 $1,390.32

RPR XTNSR TDN CTR SLIP 2 TISS W/LAT BAND EA FNGR $1,468.84

RPR&RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL JT $1,784.07

RPR/ADVMNT FLXR TDN N/Z/2 2W/FR GRF EA TDN $1,907.67

RPR/ADVMNT FLXR TDN ZONE 2 1W/O FR GRF EA TDN $3,119.87

RPR/ADVMNT FLXR TDN ZONE 2 2W/FR GRF EA TDN $2,260.34

RPR/ADVMNT FLXR TDN ZONE 2 2W/O FR GRF EA TDN $2,562.59

RPR/ADVMNT TDN W/NTC SUPFCIS TDN 2 W/FR GRF EA $2,451.17

RPR/ADVMNT TDN W/NTC SUPFCIS TDN 2 W/O FR GRF EA $1,970.63

RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN $2,184.58

RPR/TRAUMTC ARVEN FSTL XTR $2,206.08

RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD $1,379.38

RVW MEDS BY RD DR IN RCRD $0.01

SALINE SOLUTION 1000CC $5.00

Salivary glands; PRO $600.00

SALPINGECTOMY COMPL/PRTL UNI/BI SPX $2,155.02

SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX $2,140.67

SBSQ HOSP CARE PR D 15 MIN $77.49



SBSQ NF CARE PR D E/M MINOR COMPLCTJ $132.36

SBSQ NF CARE PR D E/M NEW PROBLEM $174.81

SBSQ NF CARE PR D E/M STABLE $86.03

SBSQ NF CARE PR D E/M UNSTABLE/NEW PROBLEM $260.86

SBSQ OBS CARE PR D HIGH SEVERITY $208.96

SBSQ OBS CARE PR D LOW SEVERITY $78.18

SBSQ OBS CARE PR D MODERATE SEVERITY $144.33

SCOPE BLADDER & URETER INSERT STENT INTO URETER $1,389.17

SCOPE BLADDER DESTRUCTION OF LESIONS $1,882.66

SCOPE BLADDER INSERT TUBE FOR INJECTION $754.99

SCOPE BLADDER OPEN NARROWED FEMALE URETHRA $791.97

SCOPE BLADDER OPENING OF BLADDER $623.62

SCOPE BLADDER REMOVAL OF LESIONS SMALL $1,965.92

SCOPE BLADDER REMOVAL OF TUMORS SMALL $730.21

SCOPE BLADDER W/SIMPLE REMOVAL STONE & STENT $691.78

SCOPE OF COLON FOR DIAGNOSIS $537.44

SCOPE OF COLON THRU OSTOMY FOR DIAGNOSIS $452.36

SCOPE OF COLON WITH BIOPSY $583.86

SCOPE OF COLON WITH BIOPSY THRU OSTOMY $513.75

SCOPE OF SIGMOID COLON ONLY FOR DIAGNOSIS $161.86

SCOPE OF SIGMOID COLON ONLY WITH BIOPSY $214.94

SCR TST PURE TONE AIR ONLY $106.95

SCREEN MAMMO DOC REV $0.01

SCREENING CYTOPATHOLOGY CERVICAL OR VAGINA $92.41

SCREENING FOR CLINICAL DEPRESSION POST PARTUM NEGATIVE $35.65

SCREENING FOR CLINICAL DEPRESSION POST PARTUM POSITIVE $35.65

SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN $1,940.07

SEC CLSR SURG WOUND/DEHSN EXTENSIVE/COMPLICATED $3,265.91

SECOND LEVEL CER DISKECTOMY $1,275.46

SED RATE ESR - BLOOD $56.00

Seminal vesicles; PRO $700.00

SEPTAL/OTHER INTRANASAL DERMATOPLASTY $1,479.95

SEPTOP/SBMCSL RESCJ $1,480.11

SESAMOIDECTOMY FIRST TOE SPX $1,378.83

SGMDSC FLX ABLTJ LES $643.00

SGMDSC FLX DCMPRN VOLVULUS ANY METH $394.32

SGMDSC FLX RMVL FB $314.11

SGMDSC FLX RMVL LES CAUT $812.60

SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ $360.29

SHAVING SKIN LES 1 TRUNK/ARM/LEG DIAM 0.5CM/< $264.35

SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM $498.27

SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/< $306.45

SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM $410.54

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/< $265.51

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM $327.50

SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM $387.16

SHINGRIX, ZOSTER VACCINE $191.49

SHOE INSERT $10.00

SHORT ARM CAST, ADULT (11 YEARS +),PLASTER $30.90

SHORT ARM CAST,PED $72.10

SHORT ARM SPLINT ADULT PLASTER $21.63

SHORT LEG CAST PEDS $34.97

SHORT LEG CAST SUPPLIES $50.17

SHORT LEG CASTING SUPPLIES $50.17

SHORT LEG SPLINT ADLT FIB $30.60

SHORTENING TENDON FLEXOR HAND/FINGER EACH $1,731.37

SHOULDER ABDUCT RESTRT $84.71

Shoulder cast application removal or repair; PRO $400.00

Shoulder disarticulation; PRO $1,000.00

SHOULDER SCOPE BONE SHAVING $532.57

SHRT ARM SPLINT PED PLAST $22.66

SHVG SKIN LES 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM $323.99

SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM $298.26

SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM $433.94

SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM $418.72

SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM $381.31

SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL $1,113.85

SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL $901.79

SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL $643.30

Simple ligation; PRO $600.00

SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0CM $631.24

SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< $314.15




SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM $685.34

SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< $256.47

SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM $368.74

SINGLE NERVE BLOCK INJECTION ARM NERVE $321.39

SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC $3,489.87

SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS $1,480.77

SINUSOTOMY FRONTAL EXTERNAL SIMPLE $1,200.07

SINUSOTOMY FRONTAL TRANSORBITAL UNILATERAL $2,030.51

SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL $1,141.02

SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS $2,014.48

SINUSOTOMY SPHENOID +-BIOPSY $1,153.32

SKYLA IUD $1,104.21

SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH $2,389.60

SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANCH $535.75

SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH $800.31

SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH $948.63

SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH $724.21

SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH $703.30

SLING ARM ALL SIZES $10.00

SLING OPERATION STRESS INCONTINENCE $2,147.26

SMPL CSTOMETROGRAM $758.12

SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM $313.12

SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM $478.95

SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM $589.86

SMPL UROFLOMETRY $43.49

SOLUMEDROL 125 MG $13.36

SOLU-MEDROL UP TO 40MG $8.40

SPEC REPORTS > USUAL MED COMUNICAJ/STAND RPRTG $0.00

SPI PNXR LMBR DX $447.00

SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID $515.81

SPINE FUSION EXTRA SEGMENT $1,545.00

SPLENC PRTL SPX $2,794.56

SPLENC TOT EN BLOC X10SV DS CONJUNCT W/OTH PX $749.58

SPLENC TOT SPX $3,351.20

SPLINT DRESSING $25.13

STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS $2,271.70

STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS $1,790.73

STAPEDECTOMY/STAPEDOTOMY $2,652.60

STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT $3,458.13

Sternal debridement anes; PRO $1,100.00

STOMACH-INTESTINE SCOPE FOR FOREIGN BODY REMOVAL $529.65

STOT/TOT HYST AFTER C DLVR $1,233.73

STRAPPING ANKLE &/FOOT $74.28

STRAPPING ELBOW/WRIST $84.12

STRAPPING HAND/FINGER $85.10

STRAPPING KNEE $84.85

STRAPPING SHOULDER $85.06

STRAPPING TOES $53.68

STRAPPING UNNA BOOT $153.98

STRESS ECHO; PRO (H) $601.64

Subdural taps; PRO $600.00

SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL $1,197.79

SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN $114.69

SUBQ RMVL 1/2CHMBR PACG CVDFB PLS GEN $647.34

SUBSEQUENT OB $0.01

SUCTION ASSISTED LIPECTOMY HEAD&NECK $1,329.06

SUPRACRV ABDL HYST +-RMVL TUBE OVARY $2,805.11

SUPRAHYOID LMPHADEC $2,314.48

SURG CLSR TRACHS/FSTL W/O PLSTC RPR $1,230.48

SURG CLSR TRACHS/FSTL W/PLSTC RPR $1,311.18

SURG TX ANAL FSTL 2ND STG $1,257.47

SURG TX ANAL FSTL SUBQ $1,361.47

SUTR DGTAL NRV HAND/FOOT 1 NRV $1,997.16

SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF $2,224.80

SUTR LG INT 1/MLT PRF8J W/O CLST $2,941.06

SUTR QUADRICEPS/HAMSTRING MUSC RPT 2 RCNSTJ $2,421.18

SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP $3,040.65

SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE $2,072.91

SUTURE INFRAPATELLAR TENDON PRIMARY $1,730.28

SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY $1,674.94

SUTURE TRACHEAL WOUND/INJURY CERVICAL $1,751.97

SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS $60.00

SVCS PRV OFFICE OTH/THN REG SCHEDD HRS; PR $60.00

SYNOVECTOMY CARPOMETACARPAL JOINT $1,281.60

SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT $1,084.90

SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD $1,308.58

SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT $1,321.70

SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN $1,498.98

SYSTOLIC BP < 130 MM HG $0.01

SYSTOLIC BP 130-139 MM HG $0.01

T HEPATITIS B ADMINISTRATION $34.97

TAH +-RMVL TUBE +-RMVL OVARY $2,948.89

TAP BLCOK UNI BY INFUSION $164.75

TAP BLOCK BI BY INFUSION $196.45

TAP BLOCK BI INJECTION $354.28

TAP BLOCK UNIL BY INJECTION $325.35

TB INTRADERMAL TEST $22.00

TC MGMT SERVICES 14 DAYS $561.58

TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ $3,222.87

TCAT OCCLS/EMBOLJ PRQ NON-CNS NON-HEAD/NCK $2,453.00

TCAT PLACEMENT PHYSIOLOGIC SENSOR ANEURYSMAL SAC $282.29

TCAT PLMT AN INTRAC STENT PRQ 1 VSL $2,301.02

TCAT PLMT INTRAC STENT PRQ EA VSL $621.00

TCAT PLMT IV STENT OPEN 1ST VESSEL $1,171.00

TCAT PLMT IV STENT OPEN EACH ADDL VESSEL $553.00

TCAT PLMT IV STENT PERCUTANEOUS 1ST VESSEL $1,154.00

TCAT PLMT IV STENT PERCUTANEOUS EACH ADDL VESSEL $573.00

TCU MGMT SERVICES 7 DAYS $334.40

TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN $1,814.87

TEAEC +-PATCH GRF COMMON FEM $2,452.80

TEAEC +-PATCH GRF DP PROFUNDA FEM $2,884.59

TEAEC +-PATCH GRF ILIAC $3,722.95

TEAEC +-PATCH GRF ILIOFEM $3,104.37

TEAEC W/GRAFT POPLITEAL ART $3,452.75

TEAEC W/GRAFT SUPERFICIAL FEMORAL ART $3,273.00

TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL $3,573.73

TEAEC W/GRAFT TIBIOPERONEAL TRUNK ART $3,728.88

TEAEC W/PATCH GRF CRTD VRT SUBCLA NCK INC $3,388.88

TELEHEALTH FACILITY FEE $66.04

TENDON GRAFT FROM A DISTANCE $1,434.00

TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON $1,577.86

TENDON SHEATH INCISION $1,563.55

TENODESIS BICEPS TENDON ELBOW SPX $1,621.13

TENODESIS LONG TENDON BICEPS $2,175.21

TENODESIS WRIST FLEXORS FINGERS $1,789.56

Tenodesis, rupture of long tendon bicpes; PRO $600.00

TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH $1,612.45

TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDON $2,264.32

TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON $1,786.15

TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH $1,256.60

Tenoplasty elbow to shoulder; PRO $600.00

TENOTOMY ADDUCTOR HIP OPEN $1,446.86

TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX $1,154.07

TENOTOMY ELBOW $1,512.06

Tenotomy elbow to shoulder open; PRO $600.00

TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC $1,284.28

TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON $1,338.11

TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON $1,268.84

TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG $1,608.28

TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT $751.36

TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON $846.66

TENOTOMY PERCUTANEOUS TOE SINGLE TENDON $681.71

TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES $834.30

TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES $977.24

TENOTOMY SHOULDER AREA 1 TENDON $1,795.53

TETANUS AND DIPHTHERIA TOXOID 0.5 ML S $60.16

TETANUS DIPTHERIA TOXOID ADULT 1 SYR $99.08

TETANUS DIPTHERIA TOXOID PED 0.5 ML SY $92.52

TETANUS IG IM $456.96

THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG $290.46

Therapeutic interventional radiology; PRO $600.00

Therapeutic; PRO $600.00

Thereapeutic interventional radiology; PRO $600.00

THORACENTESIS, PLEURAL ASPIRATION $475.53

Thoracic spine via anterior transthoracic approach; PRO $1,400.00

Thoracic spine; PRO $1,100.00

Thoracoplasty; PRO $1,100.00

Thoracotomy procedures; PRO $1,300.00

THORCOM THRC W/MEDSTNL & REGIONAL LMPHADEC $634.48

THRMBC ARTL/VEN GRF OTH/THN HEMO GRF/FSTL $1,784.38

THRMBC ARTL/VEN GRF XCP HEMO GRF/FSTL W/REVJ GRF $2,831.49

THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF $1,513.10

THRMBC PRQ ARVEN FSTL AUTOG/NONAUTOG GRF $869.00

THROMBOLSS C IV NFS $165.04

TICE BCG PER INSTALLATION $238.22

TIGAN INJ UP TO 200MG $43.35

TISS CLTR ALGC DRM F/S/N/H/F/G/M/D 1ST 100 CM $758.00

TISSUE CULTURED ALLOGENEIC SKIN 1ST 25CM/< $814.00

TMPP ANTRT/MASTOIDOTOMY OCR $3,306.58

TMPP ANTRT/MASTOIDOTOMY W/O OCR $2,951.49

TMPP W/O MSTDC 1ST/REVJ OCR $3,036.67

TMPP W/O MSTDC 1ST/REVJ W/O OCR $2,599.75

TMPST ANES $472.07

TMPST LOCAL/TOPICAL ANES $561.42

TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA $1,489.59

TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR $1,932.14

TOBACCO NON USER $0.01

TOBACCO USE CESSATION INTENSIVE >10 MINUTES $162.75

TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES $35.14

TONSILLECTOMY 1/2 AGE 12/> $745.51

TONSILLECTOMY 1/2 UNDER AGE 12 $776.82

TONSILLECTOMY&ADENOIDECTOMY AGE 12/> $893.90

TONSILLECTOMY&ADENOIDECTOMY UNDER AGE 12 $861.36

TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV $4,727.02

TOT THYR LOBEC UNI +-ISTHMUSECTOMY $2,080.01

Total ankle replacement; PRO $800.00

Total cystectomy; PRO $900.00

Total elbow replacment; PRO $800.00

Total hip arthroplasty; PRO $900.00

Total knee arthroplasty; PRO $800.00

Total shoulder replacement; PRO $1,100.00

Total wrist replacment; PRO $700.00

TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP $2,197.09

TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC $1,850.94

TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN $2,165.83

TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX $1,009.40

TRACHEOBRNCHSC THRU EST TRACHS INC $514.54

Tracheobronchial reconstruction; PRO $1,900.00

TRACHEOPLASTY CERVICAL $3,360.29

TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION $1,804.96

TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION $1,080.42

TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE $547.04

TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL $669.09

TRACHEOSTOMY FENESTRATION W/SKIN FLAPS $1,710.34

TRACHEOSTOMY PLANNED SPX $1,172.59

TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT $103.68

TRACKING CODE FOR ESCRIPT $0.01

Transabdominal repair hernia; PRO $800.00

TRANSCATHETER PLACE INTRV $425.64

TRANSCATHETER PLACEMENT OF AN INTRAVASULAR $899.64

TRANSFUSION BLD/BLD COMPONENTS $97.75

Transuretheral procedures; PRO $400.00

Transuretheral resection of prostate; PRO $600.00

Transvenous insertion of cardioverter pacemaker; PRO $800.00

TRDEC RMVL REMAINING TISS FLWG RMVL PRTN $3,221.87

TRDEC TOT/COMPL $2,703.07

TREAT FOOT DISLOCATION $806.13

TREAT FRACTURE OF ULNA $372.74

TREATMENT CLOSED ELBOW DISLOCATION REQ ANES $1,117.94

TREATMENT CLOSED ELBOW DISLOCATION W/O ANES $1,026.32

TRIM DYSTROPHIC NAILS, ANY NUMBER MEDICARE $61.99

TRIM NONDYSTROPHIC NAILS ANY # $39.77

TRLUML BALO ANGIOP 1ST ART $913.98

TRLUML BALO ANGIOP OPN RNL/OTH VISC ART $1,469.55

TRLUML BALO ANGIOP PRQ AORTIC $1,033.00

TRLUML BALO ANGIOP PRQ BRCH/CPHLC TRNK/BRNCH EA $999.06

TRLUML BALO ANGIOP PRQ RNL/VISC ART $1,554.27

TRLUML BALO ANGIOP PRQ VEN $807.52

TRNSXJ/AVLSN OTH SPI NRV XDRL $1,594.57

TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER $450.74

Tubal ligation/transection; PRO $700.00

TUBE THORACOSTOMY INCLUDES WATER SEAL $502.54

TX ECTOPIC PREGNANCY REQ SO $2,315.75

TX HUMERAL SHAFT FX W/INSJ IMED IMPLT +-CERCLAGE $2,517.46

TX INCOMPL AB ANY TRI COMPLD SURGLY $925.34

TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW $3,596.76

TX INTER/PR/SUBTRCHNTRIC FEM FX SCREW IMPLT $3,436.50

TX MISSED AB COMPLD SURGLY 1ST TRI $1,064.08

TX MISSED AB COMPLD SURGLY 2ND TRI $1,067.27

TX OPN TDN FLXR FOOT 1/MLT TDN SPX $1,075.07

TX OPN TDN FLXR TOE 1 TDN SPX $1,010.58

TX SLP FEM EPIPHYSIS 1/MLT PINNING SITU $2,240.75

TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MNPJ ANES $2,083.97

TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/O ANES $848.30

TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE $783.48

TX SUPERFICIAL WOUND DEHISCENCE W/PACKING $430.42

TX TARSAL B1 FX XCP TALUS&CALCN W/O MNPJ $609.75

TX TIBL SHFT FX IMED IMPLT +-SCREWS&/CERCLAGE $2,915.02

TYMPANIC MEMB RPR +-SIT PREPJ PRF8J PATCH $1,124.36

TYMPANOMETRY $40.98

Tympanotomy; PRO $500.00

ULTRASOUND GUIDED NEEDLE BIOPSY $170.44

Undescended testis; PRO $500.00

UNLIS LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY $0.00

UNLIS LAPS PX LYMPHATIC SYS $0.00

UNLIS PX ABD PRTM&OMENTUM $0.00

UNLIS PX ANUS $0.00

UNLIS PX DPHRM $0.00

UNLIS PX HANDS/FNGRS $0.00

UNLIS PX HEMIC/LYMPHATIC SYS $0.00

UNLIS PX INT $0.00

UNLIS PX PHARYNX ADENOIDS/TONSILS $0.00

UNLIS XTRNL EAR $0.00

Unlisted anesthesia procedure; PRO $100.00

UNNA BOOT $15.45

Upper anterior abdominal wall; PRO $500.00

Upper GI endoscopic procedures; PRO $100.00

Upper posterior abdominal wall; PRO $600.00

UPPER STOMACH-INTESTINE SCOPE FOR BIOPSY $415.80

UPPER STOMACH-INTESTINE SCOPE FOR DIAGNOSIS $367.57

UPR GI NDSC BALO DILAT ESOPH < 30 MM DIAM $484.20

UPR GI NDSC BAND LIG ESOPHGL&/GSTR VARC $767.41

UPR GI NDSC CTRL BLD ANY METH $979.68

UPR GI NDSC DILAT GSTR OUTLET FOR OBSTRCJ $545.90

UPR GI NDSC DIRED PLMT PRQ GASTROSTOMY TUBE $622.12

UPR GI NDSC INSJ GD WIRE DILAT ESOPH > GD WIRE $497.71

UPR GI NDSC NDSC US XM LMTD ESOPH $565.06

UPR GI NDSC RMVL LES HOT BX/BIPOLAR CAUT $493.06

UPR GI NDSC RMVL TUM POLYP/OTH LES SNARE TQ $587.32

UPR GI NDSC TNDSC INTRAL TUBE/CATH PLMT $436.00

Urgent hysterectomy following delivery; PRO $900.00

URINALYSIS AUTO W/O SCOPE $53.00

URINALYSIS NONAUTO W/O SCOPE $19.10

URINALYSIS NONAUTO W/O SCOPE $16.00

URINE PREGNANCY TEST $28.00

URTROILEAL CONDUIT W/INT ANAST $3,886.46

US VASC ACCESS SITS VSL PATENCY NDL ENTRY $88.07

Uter Evac and Curettage Hydatiform Mole $1,404.58

UTERINE SSP SPX $1,246.12

utilizing 1 lung ventilation; PRO $1,600.00

UVULECTOMY EXC UVULA $706.49

VAG DLVR AFTER C DLVR $2,686.85

VAG DLVR AFTER C DLVR POSTPARTUM CARE $3,341.08

VAG DLVR ONLY $2,392.69

VAG DLVR ONLY POSTPARTUM CARE $3,051.89

VAG HYST > 250 GM RMVL TUBE&/OVARY $3,616.33

VAG HYST 250 GM/< $2,401.60

VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL $2,794.00

VAG HYST 250 GM/< W/RMVL TUBE&/OVARY $2,681.80

Vaginal delivery only; PRO $600.00

VAGINAL HYSTERECTOMY UTERUS > 250 GM $3,348.12

Vaginal hysterectomy; PRO $700.00

Vaginal procedures; PRO $400.00

VARICELLA VIRUS VACCINE 0.5 ML VIAL $183.03

Vascular procedures; PRO $1,600.00

Vascular shunt; PRO $700.00

VASECT UNI/BI SPX W/PO SEMEN XM $1,094.57

Vasectomy; PRO $400.00

VC TOT SPX $61.28

Veins of knee and popliteal area; PRO $400.00

Venous thombectomy lower leg; PRO $600.00

VENTILATING TUBE RMVL ANES $355.58

Ventral and incisional hernias; PRO $700.00

VIRAL AB SCREEN $139.00

VISTARIL UP TO 25MG $9.57

VISUAL ACUITY SCREEN $38.99

VITAL SIGNS PERFORMED DOCU AND REVIEWED $0.01

VITAMIN B-12 $13.00

VITAMIN K,1 MG $7.05

Vitreoretinal Surgery; PRO $700.00

VLVP AORTIC VALVE OPN W/CARD BYP $5,936.12

VLVP MITRAL VALVE W/CARD BYP $7,709.57

VLVP MITRAL VALVE W/CARD BYP RAD RCNSTJ +-RING $7,210.72

VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING $6,823.09

VNGRPH XTR BI RS&I $320.05

VNGRPH XTR UNI RS&I $103.00

VOID PRESSURE STUDIES INTRAABDOMINAL $320.33

VULVECTOMY SMPL PRTL $1,513.97

Vulvectomy; PRO $500.00

WALKING BOOT PNEUMATIC $398.38

WEDGE EXCISION SKIN NAIL FOLD $450.31

WET MOUNT FOR INFECTIOUS AGENTS $88.00

with pump oxygenator 1 and older; PRO $2,100.00

with pump oxygenator under 1 year of age; PRO $2,600.00

with pump oxygenator; PRO $1,900.00

Without water bath; PRO $600.00

WORK RELATED/MED DBLT XM TREATING PHYS $112.45

WOUND CLOSURE-USING ADHESIVES-MCR ONLY $280.72

WRIST FINGER ORTHOSIS PREFAB $260.98

WRIST/HAND ORTHOSIS PREFAB $85.88

WRIST/HAND ORTHOSIS PREFAB OT $85.88

XRAY BILE PANC ENDOSCOPY $118.09

XTRNL CEPHALIC VERSION +-TOCOLSS $302.67

XTRNL ECG CONTINUOUS RHYTHM PHYS REVIEW&INTERPJ $79.31

XTRNL ECG UP TO 48 HR RECORD SCAN STOR W/PHY R&I $254.65

XTRNL MOBILE CV TELEMETRY W/PHYS R&I W/REPORT $73.79

XTRNL PT ACTIV ECG TRANSMIS PHYS R&I 30 DAYS $574.76

XTRNL PT ACTIVTD ECG DWNLD 30 DAYS PHYS R&I $75.19

ZOFRAN 1MG $13.39

ZOSTER SHINGLES VACCINE LIVE SUBCUTANEOUS $268.83

cmh physician practice pricing 2018 - United Health Services

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