Northwest Hills Surgical Hospital

Shoppable Services

Prices Posted are Effective January 1st, 2025
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Shoppable Service	CPT/HCPCS Code	Cash Price	Aetna Commercial	Arcadian Medicare Advantage	BCBS Commercial HMO Blue	BCBS Commercial PPO	BCBS Commercial Blue Premier	Cigna Commercial	Connected Senior Care Medicare Advantage	Elder Health TX Medicare Advantage	Fair Price Commercial	Healthcare Highways Commercial	Humana Commercial HMO	Humana Commercial PPO	Humana Military	Occunet UT Athletes	Oscar Exchange	Prime Health Commercial	Prime Health Workers Compensation	Prime Health Medicare Advantage	Sendero Exchange	Sendero CHAP	Seton CHIP & STAR	Seton Commercial	Superior Exchange	Superior Medicare Advantage & Dual	United Healthcare Commercial	Wellmed Medicare Advantage	De-identified Minimum Negotiated Charge	De-identified Maximum Negotiated Charge
Removal of Breast Growth	19120	2206.85	2069	510	2700.5616	3000.624	2700.5616	1273	2856.32	507.08	4284.48	1500	2394	9060	892.8	3427.58	1301	4532.5	3527.56	2856.32	4998.56	2799.19	408.42	4548.76	3093.15	2856.32	1919	2856.32	408.42	8796
Endoscopic Removal of Single Knee Cartilage	29881	2618.55	2549	630	2618.7777	2909.753	2618.7777	4725	2580.92	1400	3871.38	4500	2955	11188	1203.42	3097.1	1606	5292	3187.44	2580.92	4516.61	2529.3	503.08	4077.22	2772.51	2580.92	2277	2580.92	503.08	10862
Endoscopic diagnostic examination of esophagus, stomach, and/or upper small bowel	43235	1380	1296	333	736.0551	817.839	736.0551	950	740.98	331.1	1111.47	1100	2177	11188	357.12	889.18	854	1501.5	915.11	740.98	1296.72	726.16	265.97	1166.24	793.04	740.98	1200	740.98	265.97	5741
Endoscopic biopsy of the esophagus, stomach, and/or upper small bowel	43239	1380	1695	446	736.0551	817.839	736.0551	1125	740.98	443.45	1111.47	1100	2093	7924	491.04	889.18	1139	1589	915.11	740.98	1296.72	726.16	356.12	1166.24	793.04	740.98	1200	740.98	356.12	7693
Endoscopic diagnostic examination of large bowel	45378	1380	1695	446	702.8802	780.978	702.8802	1125	720.2	443.45	1080.3	1100	2177	11188	491.04	864.24	1139	1666	889.45	720.2	1260.35	705.8	356.12	1143.26	793.04	720.2	1200	740.98	356.12	1666
Endoscopic biopsy of Large Bowel	45380	1380	1695	446	927.0261	1030.029	927.0261	1125	946.8	443.45	1420.2	1100	2093	7924	541.26	1136.16	1139	1753.5	1169.3	946.8	1656.9	927.86	356.12	1493.75	1015.75	946.8	1200	946.8	356.12	7693
Endoscopic removal of polyps or growths of large bowel	45385	1380	1695	446	927.0261	1030.029	927.0261	1125	946.8	443.45	1420.2	1100	2093	7924	541.26	1136.16	1139	1879.5	1169.3	946.8	1656.9	927.86	356.12	1493.75	1015.75	946.8	1200	946.8	356.12	1879.5
Removal of cataract with insertion of lens	66984	2206.85	3889	973	1901.8791	2113.199	1901.8791	2975	1906.25	968.29	2859.38	750	4623	17504	1203.42	2287.5	2532	4245.5	2354.22	1906.25	3335.94	1868.13	844.15	2995.05	2036.63	1906.25	959.5	1906.25	750	16995
Shaving of shoulder bone using an endoscope	29826	365.7	517.25	Included in Primary Procedure	Not Applicable	Not Applicable	Not Applicable	4725	Included in Primary Procedure	1400	Included in Primary Procedure	4500	2394	9060	1530.78	Included in Primary Procedure	Included in Primary Procedure	7444.5	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	0	0	Included in Primary Procedure	79.5	Included in Primary Procedure	0	7444.5
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance	64483	906.2	1296	333	665.4582	739.398	665.4582	950	765.62	331.1	1148.43	750	1563	5912	357.12	918.74	854	3724	945.54	765.62	1339.84	750.31	265.97	1184.76	805.64	765.62	788	765.62	265.97	5741
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).	470	Call Us	17734	11725.14	Not Applicable	Not Applicable	Not Applicable	17000	Not Applicable	Not Applicable	17587.71	16268	8517	0	Not Applicable	11725.14	15293.88	0	16740.9	11725.14	20519	11725.14	8234.21	18049.05	11941.06	11725.14	15373.99	11725.14	0	20519
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC).	473	Call Us	19196	15015.36	Not Applicable	Not Applicable	Not Applicable	16000	Not Applicable	Not Applicable	22523.04	20833	8517	0	Not Applicable	15015.36	19585.53	0	22382.87	15015.36	26276.88	15015.36	8164.54	24131.9	15965.41	15015.36	20555.3	15015.36	0	26276.88
Spinal fusion except cervical without major comorbid conditions or complications (MCC)	460	Call Us	33233	23689.57	Not Applicable	Not Applicable	Not Applicable	29000	Not Applicable	Not Applicable	35534.36	32868	8517	0	Not Applicable	23689.57	30899.88	0	34652.84	23689.57	41456.75	23689.57	12469.28	37360.65	24717.41	23689.57	31823.41	23689.57	0	41456.75
X-Ray, lower back, minimum four views	72110	Not Applica	77.72	104.65	Not Applicable	Not Applicable	Not Applicable	228.67	105.67	104.65	158.51	51	Not Applicable	Not Applicable	Not Applicable	126.8	Not Applicable	119	130.5	105.67	184.92	103.56	68	156.97	106.74	104.65	99.77	105.67	51	228.67
Basic metabolic panel	80048	Not Applica	0	8.46	Not Applicable	Not Applicable	Not Applicable	18.7	8.46	8.46	12.69	9.9	15.51	22.44	8.46	8.46	Not Applicable	23.1	11.49	8.46	14.81	8.29	13.2	12.69	8.63	8.46	11.51	8.46	0	23.1
Blood test, comprehensive group of blood chemicals	80053	Not Applica	0	10.56	Not Applicable	Not Applicable	Not Applicable	23.35	10.56	10.56	15.84	12.3	19.37	27.88	10.56	10.56	Not Applicable	28.7	14.35	10.56	18.48	10.35	16.4	15.84	10.77	10.56	14.37	10.56	0	28.7
Kidney function panel test	80069	Not Applica	0	8.68	Not Applicable	Not Applicable	Not Applicable	19.21	8.68	8.68	13.02	10.2	15.92	23.12	8.68	8.68	Not Applicable	23.8	11.79	8.68	15.19	8.51	13.6	13.02	8.85	8.68	11.82	8.68	0	23.8
Liver function blood test panel	80076	Not Applica	0	8.17	Not Applicable	Not Applicable	Not Applicable	18.05	8.17	8.17	12.26	9.6	14.98	21.76	8.17	8.17	Not Applicable	22.4	11.1	8.17	14.3	8.01	12.8	12.26	8.33	8.17	11.11	8.17	0	22.4
Blood test, thyroid stimulating hormone (TSH)	84443	Not Applica	0	16.8	Not Applicable	Not Applicable	Not Applicable	37.16	16.8	16.8	25.2	19.5	30.81	44.2	16.8	16.8	Not Applicable	45.5	22.82	16.8	29.4	16.46	26	25.2	17.14	16.8	22.87	16.8	0	45.5
Complete blood cell count, with differential white blood cells, automated	85025	Not Applica	0	7.77	Not Applicable	Not Applicable	Not Applicable	17.19	7.77	7.77	11.66	11.7	14.24	26.52	7.77	7.77	Not Applicable	27.3	10.56	7.77	13.6	7.61	15.6	11.66	7.93	7.77	10.58	7.77	0	27.3
Complete blood count, automated	85027	Not Applica	0	6.47	Not Applicable	Not Applicable	Not Applicable	14.32	6.47	6.47	9.71	7.5	11.85	17	6.47	6.47	Not Applicable	17.5	8.79	6.47	11.32	6.34	10	9.71	6.6	6.47	8.81	6.47	0	17.5
Blood test, clotting time	85610	Not Applica	0	4.29	Not Applicable	Not Applicable	Not Applicable	8.69	4.29	4.29	6.44	4.5	7.21	10.2	4.29	4.29	Not Applicable	10.5	5.83	4.29	7.51	4.2	6	6.44	4.38	4.29	5.35	4.29	0	10.5
Coagulation assessment blood test	85730	Not Applica	0	6.01	Not Applicable	Not Applicable	Not Applicable	13.28	6.01	6.01	9.02	5.4	11.01	12.24	6.01	6.01	Not Applicable	12.6	8.16	6.01	10.52	5.89	7.2	9.02	6.13	6.01	8.17	6.01	0	13.28
Physical therapy, therapeutic exercise	97110	Not Applica	44.41	30.86	Not Applicable	Not Applicable	Not Applicable	120	30.86	30.86	46.29	90	71.25	64.6	30.86	30.86	Not Applicable	66.5	41.92	30.86	54.01	30.24	38	46.29	31.48	30.86	108	30.86	27.52	120
Electrocardiogram, routine, with interpretation and report	93000	Not Applica	374	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	114.6	286.5	259.76	0	0	Not Applicable	267.4	0	0	0	0	152.8	0	0	0	568	0	0	568
Repair Biceps Tendon	23430	5117.5	2549	630	5550.3558	6167.062	5550.3558	1560	5639.9	626.4	8459.85	2000	4669	17677	806.31	6767.88	1606	8438.5	6965.28	5639.9	9869.83	5527.1	503.08	9024.72	6136.81	6016.48	4450	5639.9	503.08	10862
Shoulder Arthroscopy/Surgery	29822	3415.5	3667	510	2618.7777	2909.753	2618.7777	4725	2580.92	1400	3871.38	4500	2394	9060	674.25	3097.1	1301	6195	3187.44	2580.92	4516.61	2529.3	408.42	4077.22	2772.51	2718.15	2970	2580.92	408.42	8796
Knee Arthroscopy/Surgery	29876	2618.55	2549	630	2618.7777	2909.753	2618.7777	4725	2580.92	1400	3871.38	4500	2955	11188	1203.42	3097.1	1606	5848.5	3187.44	2580.92	4516.61	2529.3	503.08	4077.22	2772.51	2718.15	2277	2580.92	503.08	10862
Knee Arthroscopy/Surgery	29879	2618.55	2069	510	2618.7777	2909.753	2618.7777	4725	2580.92	1400	3871.38	4500	2955	11188	1203.42	3097.1	1301	5439	3187.44	2580.92	4516.61	2529.3	408.42	4077.22	2772.51	2718.15	2277	2580.92	408.42	8796
Removal Of Inner Eye Fluid	67036	3148.7	2549	630	3574.6425	3971.825	3574.6425	1560	3600	626.4	5400	2000	1466	5549	806.31	4320	1606	7287	4446	3600	6300	3528	503.08	5643.54	3837.61	3762.36	2738	3600	503.08	10862
Routine Venipuncture	36415	Not Applica	0	3	Not Applicable	Not Applicable	Not Applicable	4.88	3	3	4.5	2.48	6.19	5.61	3	3	Not Applicable	5.78	4.08	3	5.25	2.94	3.3	4.5	3.06	3	3	3	0	6.19
Unlisted Eye Surgery Procedure	66999	1380	1296	1996.7	1901.8791	2113.199	1901.8791	Not Applicable	1906.25	1996.7	2859.38	1100	Not Applicable	Not Applicable	1203.42	1203.42	Not Applicable	70	2354.22	1906.25	3335.94	1868.13	40	2995.05	2036.63	1996.7	1200	1906.25	40	3335.94
Treatment Of Fibula Fracture	27780	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	6280	23779	357.12	243.97	854	163.1	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
Insj Temp Ndwellg Bladder Catheter Simple	51702	365.7	1296	182.09	103.9896	115.544	103.9896	1825	102.8	151.74	154.2	2050	176	665	203.33	123.36	91.04	212.44	126.96	102.8	179.9	100.74	121.39	161.27	109.66	107.51	318	102.8	33.48	2050
Treat Big Toe Fracture	28490	365.7	1296	190.68	102.9996	114.444	102.9996	1825	203.31	158.9	304.97	2050	2955	11188	212.93	243.97	95.34	222.46	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	53.78	2050
Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 2.5 Cm Or Less	12001	365.7	1296	225.23	167.2605	185.845	167.2605	1825	164.74	187.69	247.11	2050	176	665	251.5	197.69	112.61	262.77	203.45	164.74	288.3	161.45	150.15	258.64	175.88	172.43	318	164.74	36.55	2050
Repair Of Nail Bed - Minor Surgery - Nail Charges	11760	365.7	1296	225.23	483.318	537.02	483.318	1825	468.6	187.69	702.9	2050	315	1189	674.25	562.32	112.61	262.77	578.72	468.6	820.05	459.23	182	755.07	513.45	503.38	318	468.6	112.61	2050
Skin Sub Graft T/A/L Add-On	15272	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	126.75	316.88	287.3	0	0	Not Applicable	295.75	0	0	0	0	169	0	0	0	318	0	0	1296
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 12.6 Cm To 20.0 Cm	12035	365.7	1695	446	307.692	341.88	307.692	1125	301.24	443.45	451.86	2050	430	1624	541.26	361.49	1139	309.9	372.03	301.24	527.17	295.22	356.12	498.19	338.77	332.12	318	301.24	205.25	2050
Incisional Biopsy Of Skin	11106	906.2	1296	503.38	110.9493	123.277	110.9493	950	301.24	503.38	451.86	134.98	Not Applicable	Not Applicable	541.26	361.49	Not Applicable	314.94	372.03	301.24	527.17	295.22	83.38	755.07	513.45	503.38	318	301.24	83.38	1296
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.5 Cm Or Less	12011	365.7	Not Applicable	298.46	167.2605	185.845	167.2605	1825	164.74	248.72	247.11	2050	430	1624	333.28	197.69	149.23	348.2	203.45	164.74	288.3	161.45	198.97	258.64	175.88	172.43	318	164.74	41.63	2050
Punch Biopsy Skin Single Lesion	11104	365.7	Not Applicable	332.12	89.9415	99.935	89.9415	1825	164.74	332.12	247.11	149.23	Not Applicable	Not Applicable	541.26	197.69	Not Applicable	348.2	203.45	164.74	288.3	161.45	67.59	498.19	338.77	332.12	318	164.74	67.59	1825
Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or Ext	12041	365.7	1296	315.95	155.7468	173.052	155.7468	1825	301.24	263.3	451.86	2050	1517	5742	357.12	361.49	157.98	368.61	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	59.96	2050
Unlisted Procedure, Musculoskeletal System, General - Other Procedures - Orthopedic Charges	20999	365.7	1296	198.01	212.751	236.39	212.751	Not Applicable	203.31	198.01	304.97	180.05	6280	23779	541.26	243.97	Not Applicable	420.13	251.09	203.31	355.79	199.24	240.07	297.02	201.97	198.01	318	203.31	180.05	1639.07
Shoulder Surgery Procedure	23929	365.7	1296	360.11	212.751	236.39	212.751	Not Applicable	203.31	300.09	304.97	2050	1517	5742	541.26	243.97	180.05	420.13	251.09	203.31	355.79	199.24	240.07	297.02	201.97	198.01	318	203.31	97.35	10862
Closed Treatment Of Calcaneal Fracture; With Manipulation - Closed Treatement - Foot/Toes Charges	28405	365.7	1695	446	212.751	236.39	212.751	1125	203.31	443.45	304.97	2050	485	1840	541.26	243.97	1139	443.57	251.09	203.31	355.79	199.24	356.12	297.02	201.97	198.01	318	203.31	198.01	2050
Graft Repair Of Spine Defect	63710	1514.55	Not Applicable	0	1116.7002	1240.778	1116.7002	Not Applicable	0	0	0	190.2	475.5	431.12	0	0	Not Applicable	443.8	0	0	0	0	253.6	0	0	0	1317	0	0	1317
Unlisted Procedure, Humerus Or Elbow - Other Procedures - Orthopedic Charges	24999	365.7	1296	198.01	212.751	236.39	212.751	Not Applicable	203.31	198.01	304.97	190.37	Not Applicable	Not Applicable	541.26	243.97	Not Applicable	444.19	251.09	203.31	355.79	199.24	253.82	297.02	201.97	198.01	318	203.31	97.35	1296
Closed Treatment Of Calcaneal Fracture; Without Manipulation - Closed Treatement - Foot/Toes Charges	28400	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	Not Applicable	Not Applicable	357.12	243.97	854	451.42	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 20.1 Cm To 30.0 Cm	12036	365.7	1695	446	483.318	537.02	483.318	1125	468.6	443.45	702.9	2050	430	1624	541.26	562.32	1139	476.47	578.72	468.6	820.05	459.23	356.12	755.07	513.45	503.38	318	468.6	318	2050
Chemodervate Facial/Trigem/Cerv Musc Migraine	64615	365.7	1296	250.81	62.0136	68.904	62.0136	1825	246.8	250.81	370.2	218.57	2177	11188	357.12	296.16	Not Applicable	509.99	304.8	246.8	431.9	241.86	33.11	376.22	255.83	250.81	318	246.8	33.11	1825
Debrid Extensive Eczemati	11001	365.7	1296	453	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	377.5	377.5	2050	176	665	505.85	0	226.5	528.5	0	0	0	0	302	0	0	0	318	Not Applicable	0	2050
Destruct Premalg Lesion	17000	365.7	1296	453	167.2605	185.845	167.2605	1825	164.74	377.5	247.11	2050	503	1898	505.85	197.69	226.5	528.5	203.45	164.74	288.3	161.45	302	258.64	175.88	172.43	318	164.74	33.25	2050
Injection Intraesional Up	11900	365.7	1296	453	167.2605	185.845	167.2605	1825	164.74	377.5	247.11	2050	2394	9060	505.85	197.69	226.5	528.5	203.45	164.74	288.3	161.45	302	258.64	175.88	172.43	318	164.74	22.4	2050
Destruct B9 Lesion 1-14	17110	365.7	1296	453	167.2605	185.845	167.2605	1825	164.74	377.5	247.11	2050	503	1898	505.85	197.69	226.5	528.5	203.45	164.74	288.3	161.45	302	258.64	175.88	172.43	318	164.74	41.63	2050
Biopsy Skin Subcutaneous	11100	1514.55	Not Applicable	453	Not Applicable	Not Applicable	Not Applicable	Not Applicable	226.5	377.5	377.5	2050	176	665	505.85	Not Applicable	226.5	528.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	302	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	171	2050
Destruction Of Skin Lesions	17264	365.7	1296	453	127.2348	141.372	127.2348	1825	301.24	377.5	451.86	2050	221	836	505.85	361.49	226.5	528.5	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	73.28	2050
Removal Skin Tags M	11200	365.7	1296	453	167.2605	185.845	167.2605	1825	164.74	377.5	247.11	2050	Not Applicable	Not Applicable	505.85	197.69	226.5	528.5	203.45	164.74	288.3	161.45	302	258.64	175.88	172.43	318	164.74	36.08	2050
Removal Of Fixation Device	20665	365.7	1296	453	326.7099	363.011	326.7099	1825	342.8	377.5	514.2	2050	3932	14891	505.85	411.36	226.5	528.5	423.36	342.8	599.9	335.94	265.97	389.25	264.69	259.5	318	342.8	82.97	2050
Incision And Drainage Of Abscess; Simple Or Single - Incision And Drainage Charges	10060	365.7	1296	453	72.3492	80.388	72.3492	1825	164.74	377.5	247.11	2050	176	665	674.25	197.69	226.5	528.5	203.45	164.74	288.3	161.45	52.87	258.64	175.88	172.43	318	164.74	45.28	2050
Closed Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger Or Thumb; Without Manipulation, Each	26720	365.7	1296	453	110.8305	123.145	110.8305	1825	203.31	377.5	304.97	2050	2955	11188	541.26	243.97	226.5	528.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	53.78	2050
Closed Treatment Of Radial And Ulnar Shaft Fractures; Withou - Closed Treatment - Upper Extremity Charges	25560	365.7	1296	453	110.8305	123.145	110.8305	1825	203.31	377.5	304.97	2050	2394	9060	541.26	243.97	226.5	528.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	53.78	2050
Injection For Hip X-Ray	27095	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	226.5	566.25	513.4	0	0	Not Applicable	528.5	0	0	0	0	302	0	0	0	318	0	0	1296
Closed Treatment Of Fracture Great Toe, Phalanx Or Phalanges; With Manipulation	28495	365.7	1296	349.36	110.8305	123.145	110.8305	1825	203.31	291.14	304.97	2050	339	1292	390.12	243.97	174.68	528.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	74.75	2050
Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery - Nasal Hemorrhage Charges	30901	365.7	1296	453	103.9896	115.544	103.9896	1825	102.8	377.5	154.2	2050	1563	5913	505.85	123.36	226.5	528.5	126.96	102.8	179.9	100.74	302	161.27	109.66	107.51	318	102.8	34.66	2050
Biopsy Of Uterus Lining	58100	365.7	1296	453	48.4704	53.856	48.4704	1825	156.56	377.5	234.84	2050	176	665	357.12	187.87	226.5	528.5	193.35	156.56	273.98	153.43	265.97	245.35	166.84	163.57	318	156.56	32.07	2050
N Block Inj Plantar Digit	64455	365.7	1296	465	19.602	21.78	19.602	Not Applicable	246.8	387.5	370.2	2050	Not Applicable	Not Applicable	357.12	296.16	232.5	542.5	304.8	246.8	431.9	241.86	265.97	376.22	255.83	250.81	Not Applicable	246.8	12.74	2050
Place Needle Wire Breast	19290	1514.55	Not Applicable	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	235.5	331.1	392.5	2050	Not Applicable	Not Applicable	525.95	Not Applicable	854	549.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	314	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	235.5	10862
Wound Prep F/N/Hf/G	15004	365.7	1695	446	483.318	537.02	483.318	1125	468.6	396.55	702.9	2050	1517	5742	541.26	562.32	1139	555.17	578.72	468.6	820.05	459.23	356.12	755.07	513.45	503.38	318	468.6	318	5575
Repair, Complex, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands And/Or Feet; 1.1 Cm To 2.5 Cm	13131	365.7	1695	446	307.692	341.88	307.692	1125	301.24	443.45	451.86	2050	430	1624	541.26	361.49	1139	555.17	372.03	301.24	527.17	295.22	356.12	498.19	338.77	332.12	318	301.24	179.13	2050
Debridement, Muscle And/Or Fascia (Includes Epidermis, Dermi - Debridement Charges	11043	365.7	1695	446	483.318	537.02	483.318	1125	468.6	443.45	702.9	2050	771	2921	541.26	562.32	1139	555.17	578.72	468.6	820.05	459.23	356.12	755.07	513.45	503.38	318	468.6	247.33	2836
Debridement, Subcutaneous Tissue (Includes Epidermis And Dermis, If Performed); First 20 Sq Cm Or Less	11042	365.7	1695	446	307.692	341.88	307.692	1125	301.24	443.45	451.86	2050	1180	4468	204.6	361.49	1139	555.17	372.03	301.24	527.17	295.22	356.12	498.19	338.77	332.12	318	301.24	204.6	2836
Closed Treatment Of Distal Radial Fracture (Eg, Colles Or Smith Type) Or Epiphyseal Separation, Includes Closed Treatment Of Fracture Of Ulnar Styloid, When Performed; Without Manipulation	25600	365.7	1296	480	110.8305	123.145	110.8305	1825	203.31	400	304.97	2050	2394	9060	541.26	243.97	240	560	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	86.24	2050
Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.6 Cm To 5.0 Cm	12052	365.7	1296	495	160.281	178.09	160.281	1825	301.24	412.5	451.86	2050	405	1545	541.26	361.49	247.5	577.5	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	98.96	2050
Chemodenerv 1 Extremity 1-4	64642	906.2	1296	609.42	74.4876	82.764	74.4876	1825	589.31	609.42	883.97	750	503	1898	674.25	707.17	Not Applicable	577.6	727.8	589.31	1031.29	577.52	38.79	914.13	621.61	609.42	788	589.31	38.79	1825
Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.5 Cm Or Less	12051	365.7	1296	513	160.281	178.09	160.281	1825	301.24	427.5	451.86	2050	1517	5742	357.12	361.49	256.5	598.5	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	98.96	2050
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 2.6 Cm To 7.5 Cm	12032	365.7	1296	519	160.281	178.09	160.281	1825	301.24	432.5	451.86	2050	405	1545	357.12	361.49	259.5	605.5	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	98.96	2050
Debridement Including Removal Of Foreign Material At The Site Of An Open Fracture And/Or An Open Dislocation (Eg, Excisional Debridement); Skin, Subcutaneous Tissue, Muscle Fascia, Muscle, And Bone	11012	906.2	1695	446	2301.6213	2557.357	2301.6213	1125	2186.3	443.45	3279.45	750	1180	4468	541.26	2623.56	1139	606.38	2700.08	2186.3	3826.03	2142.57	356.12	3414.02	2321.54	2276.02	788	2186.3	356.12	4338
Excision Of Nail And Nail Matrix, Partial Or Complete, For P - Minor Surgery - Nail Charges	11750	365.7	1296	519.75	95.1588	105.732	95.1588	950	301.24	433.13	451.86	2050	176	655	892.8	361.49	259.88	606.38	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	84.65	2050
Excise Benign Lesion	11422	906.2	1296	519.75	110.484	122.76	110.484	950	1294.11	433.13	1941.17	750	415	1572	491.04	1552.93	259.88	606.38	1598.23	1294.11	2264.69	1268.23	265.97	2026.8	1378.22	1351.2	788	1294.11	70.04	2264.69
Debridement, Bone (Includes Epidermis, Dermis, Subcutaneous - Debridement Charges	11044	906.2	1695	446	1334.5497	1482.833	1334.5497	1125	1294.11	443.45	1941.17	750	771	2921	541.26	1552.93	1139	606.38	1598.23	1294.11	2264.69	1268.23	356.12	2026.8	1378.22	1351.2	788	1294.11	356.12	7294
Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm To 7.5 Cm	12042	365.7	1296	537	160.281	178.09	160.281	1825	301.24	447.5	451.86	2050	405	1545	491.04	361.49	268.5	626.5	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	98.96	2050
Bone Marrow Aspiration Bone Grfg	20939	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	274.5	686.25	622.2	0	0	Not Applicable	640.5	0	0	0	0	366	0	0	0	318	0	0	1296
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 2.5 Cm Or Less	12031	365.7	1296	511.58	159.6672	177.408	159.6672	1825	301.24	426.32	451.86	2050	405	1624	357.12	361.49	255.79	644	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	98.96	2050
Repair Complex Trunk	13102	365.7	1296	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	477.5	477.5	2050	1517	5742	357.12	0	854	668.5	0	0	0	0	382	0	0	0	318	Not Applicable	0	2050
Destruction Of Skin Lesions	17263	365.7	1296	573	167.2605	185.845	167.2605	1825	164.74	477.5	247.11	2050	221	836	639.85	197.69	286.5	668.5	203.45	164.74	288.3	161.45	382	258.64	175.88	172.43	318	164.74	73.28	2050
Repair Complex Trunk	13101	365.7	2069	510	483.318	537.02	483.318	1273	468.6	507.08	702.9	2050	1517	5742	674.25	562.32	1301	668.5	578.72	468.6	820.05	459.23	408.42	755.07	513.45	503.38	318	468.6	318	5575
Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separa - Endoscopic Procedures Charges	31231	365.7	1695	573	81.0117	90.013	81.0117	1825	147.6	477.5	221.4	2050	2394	9060	892.8	177.12	286.5	668.5	182.29	147.6	258.3	144.65	265.97	236.81	161.03	157.87	318	147.6	71.91	2050
Injection Intraesional Mo	11901	365.7	1296	582.6	167.2605	185.845	167.2605	1825	164.74	485.5	247.11	2050	176	665	650.57	197.69	291.3	679.7	203.45	164.74	288.3	161.45	388.4	258.64	175.88	172.43	318	164.74	24.53	2050
Correction Hallux Bunion	28291	3783.5	2069	6016.48	5550.3558	6167.062	5550.3558	Not Applicable	5639.9	6016.48	8459.85	2400	2177	11188	674.25	6767.88	Not Applicable	688.8	6965.28	5639.9	9869.83	5527.1	1036.82	9024.72	6136.81	6016.48	3290	5639.9	674.25	23086
Repair, Complex, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands And/Or Feet; Each Additional 5 Cm Or Less	13133	365.7	1296	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	430	1624	357.12	0	854	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	2050
Repair, Complex, Scalp, Arms, And/Or Legs; Each Additional 5 - Complex Wound Closures Charges	13122	365.7	1296	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	430	1624	357.12	0	854	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	2050
Dressings And/Or Debridement Of Partial-Thickness Burns Initial Or Subsequent; Small	16020	365.7	1296	597	167.2605	185.845	167.2605	950	164.74	497.5	247.11	2050	176	665	666.65	197.69	298.5	696.5	203.45	164.74	288.3	161.45	398	258.64	175.88	172.43	318	164.74	35.14	2050
Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint Or Bursa; Without Ultrasound Guidance	20605	365.7	1296	597	24.2352	26.928	24.2352	950	246.8	497.5	370.2	2050	176	665	491.04	296.16	298.5	696.5	304.8	246.8	431.9	241.86	17.89	376.22	255.83	250.81	318	246.8	15.33	2050
15819 Plastic Surgery Neck	15819	1380	1695	597	1552.7457	1725.273	1552.7457	950	1529.95	497.5	2294.93	1100	176	665	666.65	1835.94	298.5	696.5	1889.49	1529.95	2677.41	1499.35	408.42	2470.99	1680.28	1647.33	1200	1529.95	298.5	2677.41
Arthrocentesis, Aspiration And/Or Injection, Major Joint Or - Arthocentesis/Aspiration/Injection-Joint Or Bursa	20610	365.7	1296	597	28.8684	32.076	28.8684	950	246.8	497.5	370.2	2050	176	665	491.04	296.16	298.5	696.5	304.8	246.8	431.9	241.86	21.63	376.22	255.83	250.81	318	246.8	18.86	2050
15157 Cult Epiderm Grft F/N/Hfg +%	15157	365.7	1296	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	1563	5913	357.12	0	854	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	5741
15152 Cult Skin Graft T/A/L +%	15152	365.7	1296	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	1563	5913	357.12	0	854	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	5741
Closed Treatment Of Scapular Fracture; Without Manipulation - Closed Treatment - Shoulder Charges	23570	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2955	11188	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	97.35	2050
Closed Treatment Of Shoulder Dislocation, With Manipulation; Without Anesthesia	23650	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	3361	12739	204.6	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
21820 Treat Sternum Fracture	21820	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	Not Applicable	Not Applicable	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	97.35	2050
Closed Treatment Of Ulnar Fracture, Proximal End; Without Ma - Closed Treatment - Upper Extremity Charges	24670	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2955	11188	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	97.35	2050
Closed Treatment Of Clavicular Fracture; Without Manipulatio - Closed Treatment - Shoulder Charges	23500	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2394	9060	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	97.35	2050
Closed Treatment Of Acromioclavicular Dislocation; Without M - Closed Treatment - Shoulder Charges	23540	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2955	11188	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
Closed Treatment Of Temporomandibular Dislocation; Initial O - Closed Treatment - Skull/Face Charges	21480	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2177	11188	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	75.71	2597
Closed Treatment Of Supracondylar Or Transcondylar Humeral F	24530	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2955	11188	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
21800 Treatment Of Rib Fracture	21800	1514.55	Not Applicable	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	298.5	331.1	497.5	2050	2177	11188	357.12	Not Applicable	854	696.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	398	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	298.5	10862
Closed Treatment Of Humeral Condylar Fracture, Medial Or Lateral; Without Manipulation	24576	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2394	9060	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation	24560	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	3361	12739	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	97.35	2050
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each	26725	365.7	1695	597	110.8305	123.145	110.8305	1825	203.31	497.5	304.97	2050	339	1292	541.26	243.97	298.5	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	86.24	2050
Treat wrist dislocation	25660	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	6280	23779	357.12	243.97	854	696.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
Fine Needle Aspiration W	10022	1514.55	Not Applicable	912	Not Applicable	Not Applicable	Not Applicable	Not Applicable	456	760	760	750	176	665	1018.4	Not Applicable	456	1064	Not Applicable	Not Applicable	Not Applicable	Not Applicable	608	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	456	3093
Acne surgery	10040	365.7	Not Applicable	912	167.2605	185.845	167.2605	1825	164.74	760	247.11	2050	171	Not Applicable	Not Applicable	197.69	456	1064	203.45	164.74	288.3	161.45	608	258.64	175.88	172.43	318	164.74	34.43	2050
Deb musc/fascia add-on	11046	365.7	1296	780	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	650	650	2050	485	1840	871	0	390	910	0	0	0	0	520	0	0	0	318	Not Applicable	0	2050
Trim skin lesion	11055	365.7	1296	912	167.2605	185.845	167.2605	1825	164.74	760	247.11	2050	1517	5742	1018.4	197.69	456	1064	203.45	164.74	288.3	161.45	608	258.64	175.88	172.43	318	164.74	22.64	2050
Shave skin lesion >2.0 cm	11303	365.7	Not Applicable	912	307.692	341.88	307.692	1825	301.24	760	451.86	2050	176	665	1018.4	361.49	456	1064	372.03	301.24	527.17	295.22	608	498.19	338.77	332.12	318	301.24	68.38	2050
Shave skin lesion 0.5 cm/<	11305	365.7	Not Applicable	912	167.2605	185.845	167.2605	1825	164.74	760	247.11	2050	221	836	1018.4	197.69	456	1064	203.45	164.74	288.3	161.45	608	258.64	175.88	172.43	318	164.74	41.63	2050
Shave skin lesion >2.0 cm	11308	365.7	Not Applicable	912	307.692	341.88	307.692	1825	301.24	760	451.86	2050	176	665	1018.4	361.49	456	1064	372.03	301.24	527.17	295.22	608	498.19	338.77	332.12	318	301.24	61.31	2050
Shave skin lesion 1.1-2.0 cm	11312	365.7	Not Applicable	912	110.1276	122.364	110.1276	1825	301.24	760	451.86	2050	176	66	541.26	361.49	456	1064	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	69.8	2050
Shave skin lesion >2.0 cm	11313	365.7	Not Applicable	912	120.4632	133.848	120.4632	1825	301.24	760	451.86	2050	176	665	1018.4	361.49	456	1064	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	73.28	2050
Exc tr-ext b9+marg 0.6-1 cm	11401	365.7	1296	870	99.792	110.88	99.792	950	301.24	725	451.86	2050	329	1292	491.04	361.49	435	1015	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	62.96	2050
Exc tr-ext mal+marg 1.1-2 cm	11602	365.7	1296	846	159.6672	177.408	159.6672	950	301.24	705	451.86	2050	503	1898	357.12	361.49	423	987	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	101.39	2192
Biopsy nail unit	11755	906.2	1296	753	83.3976	92.664	83.3976	950	575.13	627.5	862.7	750	2177	11188	541.26	690.16	376.5	878.5	710.29	575.13	1006.48	563.63	265.97	895.95	609.25	597.3	788	575.13	55.18	1296
Correct skin color ea 20.0cm	11922	365.7	1296	879	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	732.5	732.5	2050	405	1545	981.55	0	439.5	1025.5	0	0	0	0	586	0	0	0	318	Not Applicable	0	2050
Remove contraceptive capsule	11976	906.2	1296	912	75.2004	83.556	75.2004	950	575.13	760	862.7	750	1563	5913	541.26	690.16	456	1064	710.29	575.13	1006.48	563.63	139.5	895.95	609.25	597.3	788	575.13	47.87	1296
Implant hormone pellet(s)	11980	365.7	1296	813	326.7099	363.011	326.7099	1825	342.8	677.5	514.2	2050	221	836	907.85	411.36	406.5	948.5	423.36	342.8	599.9	335.94	542	389.25	264.69	259.5	318	342.8	28.76	2050
Wnd prep f/n/hf/g addl cm	15005	365.7	1296	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	627.5	627.5	2050	1517	5742	357.12	0	854	878.5	0	0	0	0	356.12	0	0	0	318	Not Applicable	0	5575
Skin pinch graft	15050	365.7	1695	446	483.318	537.02	483.318	1125	468.6	443.45	702.9	2050	430	1624	541.26	562.32	1139	871.5	578.72	468.6	820.05	459.23	356.12	755.07	513.45	503.38	318	468.6	318	5575
Epidrm autogrft t/a/l add-on	15111	365.7	1296	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	627.5	627.5	2050	2093	7924	357.12	0	854	878.5	0	0	0	0	502	0	0	0	318	Not Applicable	0	5741
Cult skin grft t/arm/leg	15150	1380	1695	446	1552.7457	1725.273	1552.7457	1125	1529.95	565	2294.93	1800	1563	5913	541.26	1835.94	1139	791	1889.49	1529.95	2677.41	1499.35	356.12	2470.99	1680.28	1647.33	1919	1529.95	356.12	7693
Cult skin graft f/n/hf/g	15155	2618.55	1695	446	2683.3752	2981.528	2683.3752	1125	2807.05	565	4210.58	1800	1563	5913	541.26	3368.46	1139	791	3466.71	2807.05	4912.34	2750.91	356.12	5073.69	3450.11	3382.46	2277	2807.05	356.12	7693
Acell Graft T/Arm/Leg Add-On	15171	1514.55	2549	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	2177	11188	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	10862
Acell Graft F/N/Hf/G Add-On	15176	1514.55	2549	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	2177	11188	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	10862
Aply Acell Grft T/A/L Add-On	15331	1514.55	2549	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	301.5	502.5	502.5	2050	2177	11188	357.12	Not Applicable	854	703.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	402	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	301.5	10862
Apply Cult Skin Substitute	15340	1514.55	2549	831	Not Applicable	Not Applicable	Not Applicable	Not Applicable	415.5	692.5	692.5	2050	2177	11188	927.95	Not Applicable	415.5	969.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	554	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	415.5	10862
Apply Cult Skin Sub Add-On	15341	1514.55	2549	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	2177	11188	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	10862
Apply Cult Derm Sub T/A/L	15360	1514.55	2549	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	2177	11188	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	10862
Aply Cult Derm Sub T/A/L Add	15361	1514.55	2549	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	2177	11188	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	10862
Apply Cult Derm Sub F/N/Hf/G	15365	1514.55	2549	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	2177	11188	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	10862
Apply Cult Derm F/Hf/G Add	15366	1514.55	2549	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	2177	11188	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	10862
Apply Skn Xenogrft T/A/L Add	15401	1514.55	2549	446	Not Applicable	Not Applicable	Not Applicable	Not Applicable	339	443.45	565	2050	2177	11188	541.26	Not Applicable	1139	791	Not Applicable	Not Applicable	Not Applicable	Not Applicable	452	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	339	10862
Apply Acellular Xenograft	15430	1514.55	2549	446	Not Applicable	Not Applicable	Not Applicable	Not Applicable	400.5	667.5	667.5	2050	2177	11188	894.45	Not Applicable	1139	934.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	534	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	400.5	10862
Chemical peel face dermal	15789	365.7	Not Applicable	912	251.7669	279.741	251.7669	1825	468.6	760	702.9	2050	176	665	1018.4	562.32	456	1064	578.72	468.6	820.05	459.23	608	755.07	513.45	503.38	318	468.6	73.28	2050
Dress/debrid p-thick burn l	16030	365.7	1695	446	307.692	341.88	307.692	1125	301.24	565	451.86	2050	315	1189	541.26	361.49	1139	791	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	132.65	2050
Incision of burn scab initi	16035	365.7	1695	780	307.692	341.88	307.692	Not Applicable	301.24	650	451.86	2050	465	1771	871	361.49	390	910	372.03	301.24	527.17	295.22	356.12	498.19	338.77	332.12	318	301.24	132.65	2050
Destruct premalg les 2-14	17003	365.7	1296	912	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	760	760	2050	176	665	1018.4	0	456	1064	0	0	0	0	608	0	0	0	318	Not Applicable	0	2050
Destruction of skin lesions	17106	365.7	1296	729	160.281	178.09	160.281	950	301.24	607.5	451.86	2050	415	1572	541.26	361.49	364.5	850.5	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	124.04	2050
Destruction of skin lesions	17273	365.7	1296	798	125.4528	139.392	125.4528	1825	301.24	665	451.86	2050	221	836	891.1	361.49	399	931	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	79.94	2050
Drainage of breast lesion	19000	906.2	1296	699	80.19	89.1	80.19	950	575.13	582.5	862.7	750	Not Applicable	Not Applicable	541.26	690.16	349.5	815.5	710.29	575.13	1006.48	563.63	65.23	895.95	609.25	597.3	788	575.13	52.11	1296
Bx breast 1st lesion us imag	19083	1380	1695	1351.2	1334.5497	1482.833	1334.5497	1273	1294.11	1351.2	1941.17	1100	1749	6624	541.26	1552.93	Not Applicable	965.09	1598.23	1294.11	2264.69	1268.23	265.97	2026.8	1378.22	1351.2	1200	1294.11	265.97	6431
Us bone stimulation	20979	365.7	Not Applicable	912	17.2953	19.217	17.2953	1825	21.68	760	32.52	2050	176	665	1018.4	26.02	456	1064	26.77	21.68	37.94	21.25	608	35.54	24.17	23.69	318	21.68	18.86	2050
Neck/chest surgery procedure	21899	365.7	Not Applicable	203.21	176.715	196.35	176.715	Not Applicable	192	203.21	288	345.93	485	1840	541.26	230.4	Not Applicable	807.17	237.12	192	336	188.16	461.24	304.81	207.27	203.21	318	192	75.71	864.83
Closed tx vert fx w/o manj	22310	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2177	11188	357.12	243.97	854	899.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
Injection for hip x-ray	27093	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	301.37	753.41	683.09	0	0	Not Applicable	703.19	0	0	0	0	401.82	0	0	0	318	0	0	1296
Fixation of ankle joint	27860	1380	1296	333	1336.4406	1484.934	1336.4406	950	2580.92	331.1	3871.38	1100	2394	9060	357.12	3097.1	854	802.24	3187.44	2580.92	4516.61	2529.3	265.97	4077.22	2772.51	2718.15	1200	2580.92	265.97	5741
Drainage of nose lesion	30000	365.7	1296	798	92.0502	102.278	92.0502	1825	192	665	288	2050	Not Applicable	Not Applicable	891.1	230.4	399	931	237.12	192	336	188.16	71.14	304.81	207.27	203.21	318	192	41.82	2050
Largsc w/ther injection	31573	1380	1695	1437.04	1310.463	1456.07	1310.463	2575	1348.81	1437.04	2023.22	1100	6280	23779	Not Applicable	1618.57	Not Applicable	902.41	1665.78	1348.81	2360.42	1321.83	574.31	2155.56	1465.78	1437.04	1200	1348.81	574.31	12368
Diagnostic laryngoscopy	31575	365.7	1695	597	75.9132	84.348	75.9132	1825	147.6	497.5	221.4	2050	3361	12739	541.26	177.12	298.5	696.5	182.29	147.6	258.3	144.65	265.97	236.81	161.03	157.87	318	147.6	47.87	2050
Laryngoscopy telescopic	31579	365.7	1695	819	105.138	116.82	105.138	950	356.28	682.5	534.42	2050	2093	7924	914.55	427.54	409.5	955.5	440.01	356.28	623.49	349.15	77.43	542.37	368.81	361.58	318	356.28	77.43	2050
Bronchial brush biopsy	31717	365.7	1296	333	371.7153	413.017	371.7153	950	356.28	331.1	534.42	2050	Not Applicable	Not Applicable	357.12	427.54	854	784	440.01	356.28	623.49	349.15	265.97	542.37	368.81	361.58	318	356.28	265.97	4073
Clearance of airways	31720	365.7	1296	333	184.5162	205.018	184.5162	950	173.44	331.1	260.16	2050	1108	4195	357.12	208.13	854	696.5	214.2	173.44	303.52	169.97	398	270.64	184.04	180.43	318	173.44	70.37	2050
Thoracentesis For Aspiration	32421	1514.55	2549	861	Not Applicable	Not Applicable	Not Applicable	Not Applicable	430.5	717.5	717.5	2050	2177	11188	961.45	Not Applicable	430.5	1004.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	574	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	430.5	10862
Lyse chest fibrin subq day	32562	906.2	1296	840	606.4443	673.827	606.4443	950	594.46	700	891.69	750	2177	11188	938	713.35	420	980	734.16	594.46	1040.31	582.57	560	780.21	530.54	520.14	788	594.46	420	10862
Pseudoaneurysm injection trt	36002	906.2	1296	897	606.4443	673.827	606.4443	950	594.46	747.5	891.69	750	Not Applicable	Not Applicable	1001.65	713.35	448.5	1046.5	734.16	594.46	1040.31	582.57	265.97	780.21	530.54	520.14	788	594.46	171.76	1577
Vein access cutdown > 1 yr	36425	365.7	1296	798	326.7099	363.011	326.7099	1825	342.8	665	514.2	2050	176	665	891.1	411.36	399	931	423.36	342.8	599.9	335.94	532	389.25	264.69	259.5	318	342.8	10.99	2050
Inj w/fluor eval cv device	36598	365.7	1695	798	84.4668	93.852	84.4668	950	173.23	665	259.85	2050	2093	7924	891.1	207.88	399	931	213.94	173.23	303.15	169.77	265.97	293.14	199.34	195.43	318	173.23	54.71	2050
Insert needle bone cavity	36680	365.7	1296	798	326.7099	363.011	326.7099	1825	342.8	665	514.2	2050	1563	5913	891.1	411.36	399	931	423.36	342.8	599.9	335.94	532	389.25	264.69	259.5	318	342.8	48.1	2050
Dx bone marrow aspirations	38220	906.2	1296	798	123.3144	137.016	123.3144	950	1294.11	665	1941.17	750	2177	11188	806.31	1552.93	399	931	1598.23	1294.11	2264.69	1268.23	265.97	2026.8	1378.22	1351.2	788	1294.11	78.53	2264.69
Dx bone marrow biopsies	38221	906.2	1296	798	106.5636	118.404	106.5636	950	1294.11	665	1941.17	750	503	1898	806.31	1552.93	399	931	1598.23	1294.11	2264.69	1268.23	265.97	2026.8	1378.22	1351.2	788	1294.11	76.17	2264.69
Io map of sent lymph node	38900	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	390	975	884	0	0	Not Applicable	910	0	0	0	0	520	0	0	0	318	0	0	1296
Biopsy of mouth lesion	40808	365.7	1296	798	148.9752	165.528	148.9752	1825	416.46	665	624.69	2050	339	1292	674.25	499.75	399	931	514.33	416.46	728.81	408.13	112.68	651.63	443.11	434.42	318	416.46	100.69	2050
Drainage of mouth lesion	41005	365.7	1296	333	176.715	196.35	176.715	950	192	331.1	288	2050	430	1624	357.12	230.4	854	696.5	237.12	192	336	188.16	265.97	304.81	207.27	203.21	318	192	188.16	2597
Drainage of mouth lesion	41015	365.7	1296	333	455.2713	505.857	455.2713	950	416.46	331.1	624.69	2050	1563	5913	357.12	499.75	854	696.5	514.33	416.46	728.81	408.13	265.97	651.63	443.11	434.42	318	416.46	234.98	2597
Repair tongue laceration	41251	365.7	1695	446	176.715	196.35	176.715	1125	192	443.45	288	2050	709	2675	541.26	230.4	1139	791	237.12	192	336	188.16	356.12	304.81	207.27	203.21	318	192	188.16	2597
Drainage of gum lesion	41800	365.7	1296	333	103.9896	115.544	103.9896	950	102.8	331.1	154.2	2050	Not Applicable	Not Applicable	357.12	123.36	854	696.5	126.96	102.8	179.9	100.74	398	161.27	109.66	107.51	318	102.8	82.97	2050
Repair palate	42180	365.7	1296	333	455.2713	505.857	455.2713	950	416.46	331.1	624.69	2050	709	2675	357.12	499.75	854	696.5	514.33	416.46	728.81	408.13	265.97	651.63	443.11	434.42	318	416.46	234.98	2597
Preparation palate mold	42280	365.7	1296	798	112.9788	125.532	112.9788	1825	416.46	665	624.69	2050	2955	11188	891.1	499.75	399	931	514.33	416.46	728.81	408.13	532	651.63	443.11	434.42	318	416.46	69.8	2050
Control nose/throat bleeding	42970	365.7	1296	798	92.0502	102.278	92.0502	1825	192	665	288	2050	2093	7924	541.26	230.4	399	931	237.12	192	336	188.16	71.14	304.81	207.27	203.21	318	192	41.82	2050
Dx gastr intub w/asp spec	43754	365.7	1296	780	246.3417	273.713	246.3417	950	238.63	650	357.95	2050	176	665	871	286.36	390	910	294.71	238.63	417.6	233.86	520	380.94	259.04	253.96	318	238.63	88.43	2050
Dx gastr intub w/asp specs	43755	365.7	1296	780	134.9568	149.952	134.9568	950	130.44	650	195.66	2050	176	665	871	156.53	390	910	161.09	130.44	228.27	127.83	520	201.02	136.7	134.02	318	130.44	117.95	2050
Dx duod intub w/asp spec	43756	1380	1296	780	736.0551	817.839	736.0551	950	740.98	650	1111.47	1100	176	665	871	889.18	390	910	915.11	740.98	1296.72	726.16	520	1166.24	793.04	777.49	1200	740.98	91.63	1296.72
Dx duod intub w/asp specs	43757	1380	1296	780	736.0551	817.839	736.0551	950	740.98	650	1111.47	1100	176	665	871	889.18	390	910	915.11	740.98	1296.72	726.16	265.97	1166.24	793.04	777.49	1200	740.98	141	1296.72
Reduction of rectal prolapse	45900	906.2	1296	333	702.8802	780.978	702.8802	950	720.2	331.1	1080.3	750	2093	7924	357.12	864.24	854	980	889.45	720.2	1260.35	705.8	265.97	1143.26	777.42	762.17	788	720.2	265.97	5380
Destruction anal lesion(s)	46900	365.7	1296	798	160.281	178.09	160.281	950	301.24	665	451.86	2050	2177	11188	541.26	361.49	399	931	372.03	301.24	527.17	295.22	117.53	498.19	338.77	332.12	318	301.24	109.18	2050
Cryosurgery anal lesion(s)	46916	365.7	1695	798	87.1299	96.811	87.1299	1825	164.74	665	247.11	2050	597	2266	891.1	197.69	399	931	203.45	164.74	288.3	161.45	61.51	258.64	175.88	172.43	318	164.74	61.51	2050
Drain bladder by needle	51100	365.7	1296	804	32.076	35.64	32.076	1825	221.47	670	332.21	750	1563	5913	897.8	265.76	402	938	273.52	221.47	387.57	217.04	265.97	383.38	260.7	255.58	788	221.47	20.28	1825
Cystometrogram w/vp&up	51729	906.2	1296	711	217.7604	241.956	217.7604	1825	524.71	592.5	787.07	750	503	1898	357.12	629.65	355.5	829.5	648.02	524.71	918.24	514.22	160.2	827.96	563.01	551.97	788	524.71	138.42	1843
Anal/urinary muscle study	51785	365.7	1296	333	227.2347	252.483	227.2347	950	221.47	331.1	332.21	2050	176	665	357.12	265.76	854	696.5	273.52	221.47	387.57	217.04	265.97	383.38	260.7	255.58	318	221.47	188.02	2050
Dilate urethra stricture	53601	365.7	1296	798	103.9896	115.544	103.9896	950	102.8	665	154.2	2050	176	665	891.1	123.36	399	931	126.96	102.8	179.9	100.74	265.97	161.27	109.66	107.51	318	102.8	28.3	2050
Dilation of urethra	53660	365.7	1296	798	44.1936	49.104	44.1936	1825	130.44	665	195.66	2050	339	1292	891.1	156.53	399	931	161.09	130.44	228.27	127.83	265.97	201.02	136.7	134.02	318	130.44	28.06	2050
Treatment of penis lesion	54220	365.7	1296	333	227.2347	252.483	227.2347	950	221.47	331.1	332.21	2050	2955	11188	357.12	265.76	854	696.5	273.52	221.47	387.57	217.04	265.97	383.38	260.7	255.58	318	221.47	188.02	2267
Penis study	54240	365.7	1296	798	36.7092	40.788	36.7092	1825	130.44	665	195.66	2050	176	665	891.1	156.53	399	931	161.09	130.44	228.27	127.83	532	380.94	259.04	253.96	318	130.44	22.64	2050
Penis study	54250	365.7	1296	840	11.0484	12.276	11.0484	1825	221.47	700	332.21	2050	176	665	938	265.76	420	980	273.52	221.47	387.57	217.04	560	383.38	260.7	255.58	318	221.47	6.84	2050
Drainage of gland abscess	56420	365.7	1296	690	65.934	73.26	65.934	950	156.56	575	234.84	2050	221	836	770.5	187.87	345	805	193.35	156.56	273.98	153.43	265.97	245.35	166.84	163.57	318	156.56	42.44	2050
Biopsy of vulva/perineum	56605	906.2	1296	909	38.8476	43.164	38.8476	950	601.95	757.5	902.93	2050	2394	9060	1015.05	722.34	454.5	1060.5	743.41	601.95	1053.41	589.91	265.97	912.43	620.45	608.29	788	601.95	25.7	2050
Biopsy of vulva/perineum	56606	365.7	1296	597	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	176	665	666.65	0	298.5	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	2050
Exam of vulva w/scope	56820	365.7	1296	798	52.0344	57.816	52.0344	1825	156.56	665	234.84	2050	3361	12739	357.12	187.87	399	931	193.35	156.56	273.98	153.43	265.97	245.35	166.84	163.57	318	156.56	34.19	2050
Exam/biopsy of vulva w/scope	56821	365.7	1296	828	66.2904	73.656	66.2904	950	255.24	690	382.86	2050	221	836	924.6	306.29	414	966	315.22	255.24	446.67	250.14	265.97	405.47	275.72	270.32	318	255.24	43.39	2050
Ins vag brachytx device	57156	365.7	1695	780	265.6665	295.185	265.6665	950	255.24	650	382.86	2050	1921	7275	871	306.29	390	910	315.22	255.24	446.67	250.14	110.76	405.47	275.72	270.32	318	255.24	110.76	2399
Exam of vagina w/scope	57420	365.7	1296	807	53.46	59.4	53.46	950	255.24	672.5	382.86	2050	2093	7924	901.15	306.29	403.5	941.5	315.22	255.24	446.67	250.14	265.97	405.47	275.72	270.32	318	255.24	35.14	2050
Exam of cervix w/scope	57452	365.7	1695	597	49.5396	55.044	49.5396	950	156.56	497.5	234.84	2050	3361	12739	357.12	187.87	298.5	696.5	193.35	156.56	273.98	153.43	265.97	245.35	166.84	163.57	318	156.56	32.78	2050
Bx/curett of cervix w/scope	57454	365.7	1695	666	60.9444	67.716	60.9444	950	255.24	555	382.86	2050	175	665	743.7	306.29	333	777	315.22	255.24	446.67	250.14	265.97	405.47	275.72	270.32	318	255.24	40.56	2050
Biopsy of cervix w/scope	57455	365.7	1296	816	64.152	71.28	64.152	950	255.24	680	382.86	2050	221	836	911.2	306.29	408	952	315.22	255.24	446.67	250.14	265.97	405.47	275.72	270.32	318	255.24	42.21	2050
Endocerv curettage w/scope	57456	365.7	1296	798	61.6572	68.508	61.6572	950	255.24	665	382.86	2050	221	836	891.1	306.29	399	931	315.22	255.24	446.67	250.14	265.97	405.47	275.72	270.32	318	255.24	40.8	2050
Cryocautery of cervix	57511	365.7	1296	798	69.1416	76.824	69.1416	950	255.24	665	382.86	2050	221	836	891.1	306.29	399	931	315.22	255.24	446.67	250.14	265.97	405.47	275.72	270.32	318	255.24	44.8	2050
Insert intrauterine device	58300	365.7	1296	597	54.7173	60.797	54.7173	1825	0	497.5	497.5	2050	Not Applicable	Not Applicable	674.25	0	298.5	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	10862
Remove intrauterine device	58301	365.7	1296	597	45.6192	50.688	45.6192	950	255.24	497.5	382.86	2050	2177	11188	674.25	306.29	298.5	696.5	315.22	255.24	446.67	250.14	33.91	405.47	275.72	270.32	318	255.24	29.71	2050
Transfer of embryo	58974	906.2	1296	333	569.844	633.16	569.844	950	601.95	331.1	902.93	2050	1156	4368	710.2	722.34	854	742	743.41	601.95	1053.41	589.91	424	912.43	620.45	608.29	788	601.95	228.32	4241
Transfer of embryo	58976	365.7	1296	333	265.6665	295.185	265.6665	950	255.24	331.1	382.86	2050	1156	4368	666.65	306.29	854	696.5	315.22	255.24	446.67	250.14	398	405.47	275.72	270.32	318	255.24	170.49	4241
Amniocentesis diagnostic	59000	906.2	1296	798	70.9236	78.804	70.9236	Not Applicable	601.95	665	902.93	750	Not Applicable	Not Applicable	891.1	722.34	399	931	743.41	601.95	1053.41	589.91	52.6	912.43	620.45	608.29	788	601.95	45.98	1296
Transabdom amnioinfus w/us	59070	365.7	1296	798	265.6665	295.185	265.6665	950	255.24	665	382.86	2050	2177	11188	891.1	306.29	399	931	315.22	255.24	446.67	250.14	532	405.47	275.72	270.32	318	255.24	228.32	2050
Umbilical cord occlud w/us	59072	365.7	1296	798	265.6665	295.185	265.6665	950	255.24	665	382.86	2050	503	1898	891.1	306.29	399	931	315.22	255.24	446.67	250.14	532	405.47	275.72	270.32	318	255.24	170.49	2050
Fetal fluid drainage w/us	59074	365.7	1296	798	265.6665	295.185	265.6665	950	255.24	665	382.86	2050	503	1898	891.1	306.29	399	931	315.22	255.24	446.67	250.14	110.76	405.47	275.72	270.32	318	255.24	110.76	2399
Fetal shunt placement w/us	59076	365.7	1296	798	265.6665	295.185	265.6665	950	255.24	665	382.86	2050	653	2471	891.1	306.29	399	931	315.22	255.24	446.67	250.14	532	405.47	275.72	270.32	318	255.24	170.49	2050
Biopsy of thyroid	60100	906.2	1296	825	53.46	59.4	53.46	950	575.13	687.5	862.7	750	1563	5913	541.26	690.16	412.5	962.5	710.29	575.13	1006.48	563.63	40.32	895.95	609.25	597.3	788	575.13	35.37	1296
Aspir/inj thyroid cyst	60300	906.2	1296	750	81.2592	90.288	81.2592	1825	575.13	625	862.7	750	2955	11188	837.5	690.16	375	875	710.29	575.13	1006.48	563.63	265.97	895.95	609.25	597.3	788	575.13	53.06	1825
Dx lmbr spi pnxr	62270	906.2	1296	333	537.9462	597.718	537.9462	950	589.31	331.1	883.97	750	1563	5913	204.6	707.17	854	896	727.8	589.31	1031.29	577.52	265.97	914.13	621.61	609.42	788	589.31	204.6	2399
Ther spi pnxr drg csf	62272	906.2	1296	333	537.9462	597.718	537.9462	950	589.31	331.1	883.97	750	653	2471	357.12	707.17	854	959	727.8	589.31	1031.29	577.52	265.97	914.13	621.61	609.42	788	589.31	265.97	2399
Njx px discography lumbar	62290	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	399	997.5	904.4	0	0	Not Applicable	931	0	0	0	0	532	0	0	0	318	0	0	1296
Njx px discography crv/thrc	62291	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	399	997.5	904.4	0	0	Not Applicable	931	0	0	0	0	532	0	0	0	318	0	0	1296
Analyze spine infus pump	62367	365.7	1695	678	Not Applicable	Not Applicable	Not Applicable	1125	255.42	565	383.13	2050	2093	7924	757.1	306.5	339	791	315.44	255.42	446.99	250.31	452	392.5	266.9	261.66	318	255.42	22.32	2050
Analyze sp inf pump w/reprog	62368	365.7	1695	678	Not Applicable	Not Applicable	Not Applicable	1125	255.42	565	383.13	2050	176	665	757.1	306.5	339	791	315.44	255.42	446.99	250.31	452	392.5	266.9	261.66	318	255.42	30.28	2050
Njx aa&/strd trigeminal nrv	64400	365.7	1296	597	85.1796	94.644	85.1796	Not Applicable	246.8	497.5	370.2	2050	2093	7924	357.12	296.16	298.5	696.5	304.8	246.8	431.9	241.86	61.15	376.22	255.83	250.81	Not Applicable	246.8	52.82	2050
N Block Inj Facial	64402	1514.55	1296	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	221	836	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	82.97	2050
Njx aa&/strd gr ocpl nrv	64405	365.7	1296	903	63.7956	70.884	63.7956	950	246.8	752.5	370.2	2050	221	836	491.04	296.16	451.5	1053.5	304.8	246.8	431.9	241.86	46.19	376.22	255.83	250.81	318	246.8	40.8	2050
N Block Inj Phrenic	64410	1514.55	1296	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	441	331.1	735	750	221	836	984.9	Not Applicable	854	1029	Not Applicable	Not Applicable	Not Applicable	Not Applicable	588	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	331.1	5741
Njx aa&/strd axillary nrv	64417	906.2	1296	333	665.4582	739.398	665.4582	Not Applicable	765.62	331.1	1148.43	750	1180	4468	357.12	918.74	854	696.5	945.54	765.62	1339.84	750.31	265.97	1184.76	805.64	789.84	Not Applicable	765.62	265.97	2399
Njx aa&/strd sprscap nrv	64418	906.2	1296	855	75.5568	83.952	75.5568	Not Applicable	589.31	712.5	883.97	750	653	2471	491.04	707.17	427.5	997.5	727.8	589.31	1031.29	577.52	71.02	914.13	621.61	609.42	Not Applicable	589.31	61.31	1296
Njx aa&/strd ntrcost nrv 1	64420	906.2	1296	333	537.9462	597.718	537.9462	Not Applicable	589.31	331.1	883.97	750	339	1292	357.12	707.17	854	1008	727.8	589.31	1031.29	577.52	265.97	914.13	621.61	609.42	Not Applicable	589.31	265.97	2399
Njx aa&/strd ii ih nerves	64425	906.2	1296	831	67.716	75.24	67.716	Not Applicable	589.31	692.5	883.97	750	1563	5913	674.25	707.17	415.5	969.5	727.8	589.31	1031.29	577.52	48.6	914.13	621.61	609.42	Not Applicable	589.31	43.62	1296
Njx aa&/strd paracrv nrv	64435	906.2	1296	597	80.9028	89.892	80.9028	Not Applicable	589.31	497.5	883.97	750	653	2471	674.25	707.17	298.5	696.5	727.8	589.31	1031.29	577.52	59.28	914.13	621.61	609.42	Not Applicable	589.31	51.17	1296
Njx aa&/strd other pn/branch	64450	906.2	1296	741	52.0344	57.816	52.0344	950	589.31	617.5	883.97	750	1180	4468	892.8	707.17	370.5	864.5	727.8	589.31	1031.29	577.52	38.72	914.13	621.61	609.42	788	589.31	34.19	1296
Inj paravert f jnt c/t 2 lev	64491	365.7	1296	597	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	1180	4468	357.12	0	298.5	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	2050
Inj paravert f jnt c/t 3 lev	64492	365.7	1296	597	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	465	1771	357.12	0	298.5	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	2050
Inj paravert f jnt l/s 2 lev	64494	365.7	1296	597	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	1180	4468	357.12	0	298.5	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	2050
Inj paravert f jnt l/s 3 lev	64495	365.7	1296	597	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	497.5	497.5	2050	465	1771	357.12	0	298.5	696.5	0	0	0	0	398	0	0	0	318	Not Applicable	0	2050
N block spenopalatine gangl	64505	365.7	1296	732	54.8856	60.984	54.8856	950	246.8	610	370.2	2050	465	1771	817.4	296.16	366	854	304.8	246.8	431.9	241.86	39.53	376.22	255.83	250.81	318	246.8	34.9	2050
N Block Carotid Sinus S/P	64508	1514.55	Not Applicable	597	Not Applicable	Not Applicable	Not Applicable	Not Applicable	298.5	497.5	497.5	2050	176	665	666.65	Not Applicable	298.5	696.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	398	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	298.5	10862
Neuroeltrd stim post tibial	64566	365.7	1296	780	107.6328	119.592	107.6328	950	246.8	650	370.2	2050	2177	11188	871	296.16	390	910	304.8	246.8	431.9	241.86	520	376.22	255.83	250.81	318	246.8	64.14	2050
Destroy nerve face muscle	64612	365.7	1296	798	75.2004	83.556	75.2004	950	246.8	665	370.2	2050	221	836	891.1	296.16	399	931	304.8	246.8	431.9	241.86	265.97	376.22	255.83	250.81	318	246.8	48.34	2050
Destroy Nerve Neck Muscle	64613	1514.55	Not Applicable	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	665	665	2050	339	1292	891.1	Not Applicable	399	931	Not Applicable	Not Applicable	Not Applicable	Not Applicable	532	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	399	10862
Destr Paravertebral N Add-On	64623	1514.55	2549	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	441	331.1	735	2050	2177	11188	984.9	Not Applicable	854	1029	Not Applicable	Not Applicable	Not Applicable	Not Applicable	588	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	331.1	10862
Destr Paravertebral N Add-On	64627	1514.55	2549	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	375	331.1	625	2050	2177	11188	837.5	Not Applicable	854	875	Not Applicable	Not Applicable	Not Applicable	Not Applicable	500	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	331.1	10862
Destroy c/th facet jnt addl	64634	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	375	937.5	850	0	0	Not Applicable	875	0	0	0	0	500	0	0	0	318	0	0	1296
Remove skin nerve lesion	64788	2206.85	2069	510	1594.395	1771.55	1594.395	1273	1621.04	507.08	2431.56	1500	2093	7924	674.25	1945.25	1301	1030.3	2001.98	1621.04	2836.82	1588.62	408.42	2527.22	1718.51	1684.81	1919	1621.04	408.42	8796
Ophthalmic endoscope add-on	66990	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	356.7	891.75	808.52	0	0	Not Applicable	832.3	0	0	0	0	475.6	0	0	0	318	0	0	1296
Injection eye drug	67028	365.7	1296	798	48.114	53.46	48.114	950	291.9	665	437.85	2050	2955	11188	891.1	350.28	399	931	360.5	291.9	510.83	286.06	265.97	447.64	304.39	298.43	318	291.9	31.6	2050
Treatment of retina	67141	365.7	1695	446	264.9834	294.426	264.9834	1125	255.02	443.45	382.53	2050	2093	7924	541.26	306.02	1139	948.5	314.95	255.02	446.29	249.92	356.12	376.38	255.94	250.92	318	255.02	237.54	4167
Ocular photodynamic ther	67221	906.2	1296	798	159.3108	177.012	159.3108	950	477.94	665	716.91	750	771	2921	891.1	573.53	399	931	590.26	477.94	836.4	468.38	408.42	725.82	493.55	483.88	788	477.94	103.99	2274
Eye photodynamic ther add-on	67225	365.7	1296	798	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	665	665	2050	618	2342	891.1	0	399	931	0	0	0	0	532	0	0	0	318	Not Applicable	0	2050
Tr retinal les preterm inf	67229	906.2	1695	825	251.6481	279.609	251.6481	1825	477.94	687.5	716.91	750	981	3718	921.25	573.53	412.5	962.5	590.26	477.94	836.4	468.38	265.97	725.82	493.55	483.88	788	477.94	212.91	3610
Destroy nerve of eye muscle	67345	365.7	1296	798	126.1656	140.184	126.1656	950	255.02	665	382.53	2050	4669	17677	541.26	306.02	399	931	314.95	255.02	446.29	249.92	92.65	376.38	255.94	250.92	318	255.02	81.59	2050
Inject/treat eye socket	67515	365.7	1296	759	44.9064	49.896	44.9064	950	255.02	632.5	382.53	2050	503	1898	541.26	306.02	379.5	885.5	314.95	255.02	446.29	249.92	33.38	376.38	255.94	250.92	318	255.02	29.48	2050
Drainage of eyelid abscess	67700	365.7	1296	798	138.0357	153.373	138.0357	950	255.02	665	382.53	2050	Not Applicable	Not Applicable	541.26	306.02	399	931	314.95	255.02	446.29	249.92	107.85	376.38	255.94	250.92	318	255.02	107.85	2050
Remove eyelid lesion	67800	365.7	1296	852	75.9132	84.348	75.9132	950	255.02	710	382.53	2050	1563	5913	541.26	306.02	426	994	314.95	255.02	446.29	249.92	265.97	376.38	255.94	250.92	318	255.02	48.82	2050
Biopsy eyelid & lid margin	67810	365.7	1296	828	126.8784	140.976	126.8784	950	255.02	690	382.53	2050	2093	7924	541.26	306.02	414	966	314.95	255.02	446.29	249.92	265.97	376.38	255.94	250.92	318	255.02	81.12	2050
Close tear duct opening	68760	365.7	1296	723	137.214	152.46	137.214	1825	255.02	602.5	382.53	2050	2955	11188	541.26	306.02	361.5	843.5	314.95	255.02	446.29	249.92	356.12	376.38	255.94	250.92	318	255.02	88.43	2050
Close tear duct opening	68761	365.7	1296	798	97.2972	108.108	97.2972	1825	255.02	665	382.53	2050	415	1572	541.26	306.02	399	931	314.95	255.02	446.29	249.92	265.97	376.38	255.94	250.92	318	255.02	62.49	2050
Probe nasolacrimal duct	68810	365.7	1296	333	264.9834	294.426	264.9834	950	255.02	331.1	382.53	2050	176	665	357.12	306.02	854	980	314.95	255.02	446.29	249.92	265.97	376.38	255.94	250.92	318	255.02	229.82	2274
Explore/irrigate tear ducts	68840	365.7	1296	798	80.9028	89.892	80.9028	1825	255.02	665	382.53	2050	3361	12739	541.26	306.02	399	931	314.95	255.02	446.29	249.92	265.97	376.38	255.94	250.92	318	255.02	52.35	2050
Drain external ear lesion	69000	906.2	1296	852	128.6604	142.956	128.6604	1825	575.13	710	862.7	750	Not Applicable	Not Applicable	541.26	690.16	426	994	710.29	575.13	1006.48	563.63	96.92	895.95	609.25	597.3	788	575.13	79.38	1825
Remove impacted ear wax uni	69210	365.7	1296	798	55.4004	61.556	55.4004	1825	51.86	665	77.79	2050	Not Applicable	Not Applicable	891.1	62.23	399	931	64.05	51.86	90.76	50.82	532	80.18	54.52	53.45	318	51.86	16.97	2050
Incision of eardrum	69420	365.7	2069	834	92.0502	102.278	92.0502	950	192	695	288	2050	2177	11188	541.26	230.4	417	973	237.12	192	336	188.16	265.97	304.81	207.27	203.21	318	192	92.91	2069
Application of finger splint; dynamic - Cast/Splint Application-Upper Body/Ext	29131	365.7	Not Applicable	603.9	55.4004	61.556	55.4004	1825	51.86	503.25	77.79	2050	176	665	674.36	62.23	301.95	704.55	64.05	51.86	90.76	50.82	402.6	80.18	54.52	53.45	318	51.86	19.58	2050
Arterial puncture, withdrawal of blood for diagnosis - Diagnostic Procedures Charges	36600	365.7	Not Applicable	798	103.9896	115.544	103.9896	1825	102.8	665	154.2	2050	430	1624	891.1	123.36	399	931	126.96	102.8	179.9	100.74	532	161.27	109.66	107.51	318	102.8	82.97	10862
Change of gastrostomy tube, percutaneous, without imaging or - GI Tube Placement/Change Charges	43760	1514.55	Not Applicable	333	Not Applicable	Not Applicable	Not Applicable	Not Applicable	298.5	331.1	497.5	2050	176	665	666.65	Not Applicable	854	696.5	Not Applicable	Not Applicable	Not Applicable	Not Applicable	398	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	298.5	2500
Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each	26740	365.7	1296	840	110.8305	123.145	110.8305	1825	203.31	700	304.97	2050	2955	11188	938	243.97	420	980	251.09	203.31	355.79	199.24	80.27	297.02	201.97	198.01	318	203.31	80.27	2050
Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone	25630	365.7	1296	798	110.8305	123.145	110.8305	1825	203.31	665	304.97	2050	2394	9060	541.26	243.97	399	931	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	86.24	2050
Closed treatment of carpometacarpal fracture dislocation, th - Closed Treatment - Hand/Fingers Charges	26645	365.7	1296	333	1336.4406	1484.934	1336.4406	950	1277.89	331.1	1916.84	2050	339	1292	357.12	1533.47	854	899.5	1578.19	1277.89	2236.31	1252.33	265.97	2005.69	1363.87	1337.13	318	1277.89	156.11	2236.31
Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each	28515	365.7	1296	798	104.7816	116.424	104.7816	1825	203.31	665	304.97	2050	221	836	541.26	243.97	399	931	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	66.97	2050
Closed treatment of greater humeral tuberosity fracture; wit - Closed Treatment - Shoulder Charges	23620	365.7	1296	798	110.8305	123.145	110.8305	950	203.31	665	304.97	2050	2955	11188	891.1	243.97	399	931	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	53.78	2050
Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation	24565	365.7	1695	446	1336.4406	1484.934	1336.4406	1125	1277.89	443.45	1916.84	2050	485	1840	541.26	1533.47	1139	892.5	1578.19	1277.89	2236.31	1252.33	356.12	2005.69	1363.87	1337.13	318	1277.89	156.11	2236.31
Closed treatment of humeral shaft fracture; without manipula - Closed Treatment - Upper Extremity Charges	24500	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	2394	9060	357.12	243.97	854	745.5	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
Closed treatment of metacarpal fracture, single; with manipu - Closed Treatment - Hand/Fingers Charges	26605	365.7	1695	446	212.751	236.39	212.751	1125	203.31	443.45	304.97	2050	339	1292	541.26	243.97	1139	791	251.09	203.31	355.79	199.24	356.12	297.02	201.97	198.01	318	203.31	156.11	2050
Closed treatment of nasal bone fracture without manipulation - Closed Treatment - Skull/Face Charges	21310	1514.55	1695	446	212.751	236.39	212.751	1125	203.31	443.45	304.97	2050	Not Applicable	Not Applicable	541.26	243.97	1139	791	251.09	203.31	355.79	199.24	356.12	297.02	201.97	198.01	318	203.31	75.71	2597
Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation	23600	365.7	1296	798	110.8305	123.145	110.8305	950	203.31	665	304.97	2050	2394	9060	891.1	243.97	399	931	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	86.24	2050
Closed treatment of radial head or neck fracture; without ma - Closed Treatment - Upper Extremity Charges	24650	365.7	1296	798	110.8305	123.145	110.8305	1825	203.31	665	304.97	2050	221	836	891.1	243.97	399	931	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	86.24	2050
Closed treatment of radial shaft fracture; without manipulat - Closed Treatment - Upper Extremity Charges	25500	365.7	1296	798	110.8305	123.145	110.8305	1825	203.31	665	304.97	2050	2394	9060	891.1	243.97	399	931	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	53.78	2050
Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation	25680	365.7	1695	446	212.751	236.39	212.751	1125	203.31	443.45	304.97	2050	2093	7924	541.26	243.97	1139	791	251.09	203.31	355.79	199.24	356.12	297.02	201.97	198.01	318	203.31	97.35	2050
Closed treatment of ulnar shaft fracture; without manipulati - Closed Treatment - Upper Extremity Charges	25530	365.7	1296	798	110.8305	123.145	110.8305	1825	203.31	665	304.97	2050	3361	12739	891.1	243.97	399	931	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	53.78	2050
Control nasal hemorrhage, anterior, complex (extensive caute - Other Minor Surgery - ENT Charges	30903	365.7	1296	333	103.9896	115.544	103.9896	950	102.8	331.1	154.2	2050	176	665	357.12	123.36	854	696.5	126.96	102.8	179.9	100.74	265.97	161.27	109.66	107.51	318	102.8	75.71	2050
Control nasal hemorrhage, posterior, with posterior nasal pa - Nasal Hemorrhage Charges	30906	365.7	1296	333	176.715	196.35	176.715	950	192	331.1	288	2050	339	1292	357.12	230.4	854	696.5	237.12	192	336	188.16	265.97	304.81	207.27	203.21	318	192	75.71	2050
Control nasal hemorrhage, posterior, with posterior nasal pa - Other Minor Surgery - ENT Charges	30905	365.7	1296	333	103.9896	115.544	103.9896	950	102.8	331.1	154.2	2050	339	1292	357.12	123.36	854	696.5	126.96	102.8	179.9	100.74	265.97	161.27	109.66	107.51	318	102.8	75.71	2050
Debridement of nail(s) by any method(s); 1 to 5 - Debridement Charges	11720	365.7	1296	912	55.4004	61.556	55.4004	1825	51.86	760	77.79	2050	176	665	1018.4	62.23	456	1064	64.05	51.86	90.76	50.82	608	80.18	54.52	53.45	318	51.86	13.2	2050
Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof	11045	365.7	1296	780	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	650	650	2050	1985	7513	871	0	390	910	0	0	0	0	520	0	0	0	318	Not Applicable	0	2050
Declotting by thrombolytic agent of implanted vascular acces - Vascular Access Charges	36593	365.7	1296	603	31.3632	34.848	31.3632	1825	291.9	502.5	437.85	2050	2177	11188	673.35	350.28	301.5	703.5	360.5	291.9	510.83	286.06	23.23	447.64	304.39	298.43	318	291.9	20.04	2050
Drainage of abscess of palate, uvula - Drainage of Abscess Charges	42000	365.7	1695	446	176.715	196.35	176.715	1125	192	443.45	288	2050	2177	11188	541.26	230.4	1139	791	237.12	192	336	188.16	356.12	304.81	207.27	203.21	318	192	188.16	2597
Drainage of finger abscess; complicated - Drainage of Abscess Charges	26011	1380	1296	333	1334.5497	1482.833	1334.5497	950	1294.11	331.1	1941.17	1100	221	836	357.12	1552.93	854	1030.84	1598.23	1294.11	2264.69	1268.23	265.97	2026.8	1378.22	1351.2	1200	1294.11	265.97	5741
Dressings and/or debridement of partial-thickness burns initial or subsequent; medium	16025	365.7	1695	446	167.2605	185.845	167.2605	1125	164.74	565	247.11	2050	176	665	541.26	197.69	1139	791	203.45	164.74	288.3	161.45	61.51	258.64	175.88	172.43	318	164.74	61.51	2050
Gastric intubation and aspiration(s) therapeutic, necessitat - Other Minor Procedures - GI Charges	43753	365.7	1296	780	246.3417	273.713	246.3417	950	238.63	650	357.95	2050	221	836	871	286.36	390	910	294.71	238.63	417.6	233.86	520	380.94	259.04	253.96	318	238.63	88.43	2050
Incision and drainage of abscess; complicated or multiple - Incision and Drainage Charges	10061	365.7	1296	702	111.5532	123.948	111.5532	950	301.24	585	451.86	2050	221	836	541.26	361.49	351	819	372.03	301.24	527.17	295.22	265.97	498.19	338.77	332.12	318	301.24	71.69	2050
Incision and drainage of hematoma, seroma or fluid collectio - Incision and Drainage Charges	10140	1380	1296	883.58	103.7124	115.236	103.7124	1825	1294.11	736.32	1941.17	1100	2093	7924	806.31	1552.93	441.79	1030.84	1598.23	1294.11	2264.69	1268.23	265.97	2026.8	1378.22	1351.2	1200	1294.11	66.02	2264.69
Incision and drainage of pilonidal cyst; simple - Incision and Drainage Charges	10080	906.2	1296	717	132.5808	147.312	132.5808	1825	575.13	597.5	862.7	750	221	836	541.26	690.16	358.5	836.5	710.29	575.13	1006.48	563.63	98.26	895.95	609.25	597.3	788	575.13	79.38	1825
Initial treatment, first degree burn, when no more than loca - Burns Charges	16000	365.7	Not Applicable	912	167.2605	185.845	167.2605	1825	164.74	760	247.11	2050	Not Applicable	Not Applicable	1018.4	197.69	456	1064	203.45	164.74	288.3	161.45	608	258.64	175.88	172.43	318	164.74	22.4	2050
Inject for sacroiliac joint	G0259	365.7	1296	0	Not Applicable	Not Applicable	Not Applicable	Not Applicable	0	0	0	399	997.5	904.4	0	0	Not Applicable	931	0	0	0	0	532	0	0	0	318	0	0	1296
Naso- or oro-gastric tube placement, requiring physician's s - GI Tube Placement/Change Charges	43752	365.7	1695	798	326.7099	363.011	326.7099	1825	342.8	665	514.2	2050	23974	32860	891.1	411.36	399	931	423.36	342.8	599.9	335.94	105.89	389.25	264.69	259.5	318	342.8	105.89	2050
Removal of foreign body from pharynx - Foreign Body Removal - Throat Charges	42809	365.7	1296	798	326.7099	363.011	326.7099	950	342.8	665	514.2	2050	2093	7924	891.1	411.36	399	931	423.36	342.8	599.9	335.94	532	389.25	264.69	259.5	318	342.8	82.97	2050
Repair of laceration 2.5 cm or less; floor of mouth and/or a - Laceration Repair - Mouth/Lip Charges	41250	365.7	1695	446	103.9896	115.544	103.9896	1125	102.8	443.45	154.2	2050	3361	12739	541.26	123.36	1139	791	126.96	102.8	179.9	100.74	452	389.25	264.69	259.5	318	102.8	75.71	2597
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm	12034	365.7	1695	446	307.692	341.88	307.692	1125	301.24	443.45	451.86	2050	405	1545	541.26	361.49	1139	822.5	372.03	301.24	527.17	295.22	356.12	498.19	338.77	332.12	318	301.24	179.13	2050
Treatment of closed elbow dislocation; without anesthesia - Closed Treatment - Upper Extremity Charges	24600	365.7	1296	333	212.751	236.39	212.751	950	203.31	331.1	304.97	2050	3361	12739	357.12	243.97	854	700	251.09	203.31	355.79	199.24	265.97	297.02	201.97	198.01	318	203.31	156.11	2050
Endoscopic Removal of Gallbladder	47562	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	62323	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Biopsy of prostate gland	55700	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC)	743	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Removal of tonsils and adenoid glands patient younger than age 12	42820	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Patient office consultation, typically 40 min	99243	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Patient office consultation, typically 60 min	99244	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Initial new patient preventive medicine evaluation (18-39 years)	99385	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Initial new patient preventive medicine evaluation (40-64 years)	99386	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
CT scan, head or brain, without contrast	70450	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
MRI scan of brain before and after contrast	70553	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
MRI scan of lower spinal canal	72148	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
CT scan, pelvis, with contrast	72193	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
MRI scan of leg joint	73721	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
CT scan of abdomen and pelvis with contrast	74177	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Ultrasound of abdomen	76700	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	76805	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Ultrasound pelvis through vagina	76830	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Mammography of one breast	77065	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Mammography of both breasts	77066	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Mammography, screening, bilateral	77067	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Blood test, lipids (cholesterol and triglycerides)	80061	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Manual urinalysis test with examination using microscope	81001	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Automated urinalysis test	81003	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
PSA (prostate specific antigen)	84154	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Insertion of catheter into left heart for diagnosis	93452	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Sleep Study	95810	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
New patient office or other outpatient visit, typically 30 min	99203	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
New patient office of other outpatient visit, typically 45 min	99204	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
New patient office of other outpatient visit, typically 60 min	99205	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities	216	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care	59610	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Obstetric blood test panel	80055	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Psychotherapy, 30 min	90832	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Psychotherapy, 45 min	90834	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Psychotherapy, 60 min	90837	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Family psychotherapy, not including patient, 50 min	90846	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Family psychotherapy, including patient, 50 min	90847	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Group psychotherapy	90853	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Repair of groin hernia patient age 5 years or older	49505	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Surgical removal of prostate and surrounding lymph nodes using an endoscope	55866	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Removal of recurring cataract in lens capsule using laser	66821	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Ultrasound examination of lower large bowel using an endoscope	45391	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Routine obstetric care for vaginal delivery, including pre-and post- delivery care	59400	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided
Routine obstetric care for cesarean delivery, including pre-and post-delivery care	59510	Service Not	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided	Service Not Provided