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Prices Posted are Effective January 1, 2022
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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 Growth191202206.8520695102700.56163000.6242700.561612732856.32507.084284.48150023949060892.83427.5813014532.53527.562856.324998.562799.19408.424548.763093.152856.3219192856.32408.428796
Endoscopic Removal of Single Knee Cartilage298812618.5525496302618.77772909.7532618.777747252580.9214003871.3845002955111881203.423097.1160652923187.442580.924516.612529.3503.084077.222772.512580.9222772580.92503.0810862
Endoscopic diagnostic examination of esophagus, stomach, and/or upper small bowel4323513801296333736.0551817.839736.0551950740.98331.11111.471100217711188357.12889.188541501.5915.11740.981296.72726.16265.971166.24793.04740.981200740.98265.975741
Endoscopic biopsy of the esophagus, stomach, and/or upper small bowel4323913801695446736.0551817.839736.05511125740.98443.451111.47110020937924491.04889.1811391589915.11740.981296.72726.16356.121166.24793.04740.981200740.98356.127693
Endoscopic diagnostic examination of large bowel4537813801695446702.8802780.978702.88021125720.2443.451080.31100217711188491.04864.2411391666889.45720.21260.35705.8356.121143.26793.04720.21200740.98356.121666
Endoscopic biopsy of Large Bowel4538013801695446927.02611030.029927.02611125946.8443.451420.2110020937924541.261136.1611391753.51169.3946.81656.9927.86356.121493.751015.75946.81200946.8356.127693
Endoscopic removal of polyps or growths of large bowel4538513801695446927.02611030.029927.02611125946.8443.451420.2110020937924541.261136.1611391879.51169.3946.81656.9927.86356.121493.751015.75946.81200946.8356.121879.5
Removal of cataract with insertion of lens669842206.8538899731901.87912113.1991901.879129751906.25968.292859.387504623175041203.422287.525324245.52354.221906.253335.941868.13844.152995.052036.631906.25959.51906.2575016995
Shaving of shoulder bone using an endoscope29826365.7517.25Included in Primary ProcedureNot ApplicableNot ApplicableNot Applicable4725Included in Primary Procedure1400Included in Primary Procedure4500239490601530.78Included in Primary ProcedureIncluded in Primary Procedure7444.5Included in Primary ProcedureIncluded in Primary ProcedureIncluded in Primary ProcedureIncluded in Primary ProcedureIncluded in Primary Procedure00Included in Primary Procedure79.5Included in Primary Procedure07444.5
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance64483906.21296333665.4582739.398665.4582950765.62331.11148.4375015635912357.12918.748543724945.54765.621339.84750.31265.971184.76805.64765.62788765.62265.975741
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).470Call Us1773411725.14Not ApplicableNot ApplicableNot Applicable17000Not ApplicableNot Applicable17587.711626885170Not Applicable11725.1415293.88016740.911725.142051911725.148234.2118049.0511941.0611725.1415373.9911725.14020519
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC).473Call Us1919615015.36Not ApplicableNot ApplicableNot Applicable16000Not ApplicableNot Applicable22523.042083385170Not Applicable15015.3619585.53022382.8715015.3626276.8815015.368164.5424131.915965.4115015.3620555.315015.36026276.88
Spinal fusion except cervical without major comorbid conditions or complications (MCC)460Call Us3323323689.57Not ApplicableNot ApplicableNot Applicable29000Not ApplicableNot Applicable35534.363286885170Not Applicable23689.5730899.88034652.8423689.5741456.7523689.5712469.2837360.6524717.4123689.5731823.4123689.57041456.75
X-Ray, lower back, minimum four views72110Not Applica77.72104.65Not ApplicableNot ApplicableNot Applicable228.67105.67104.65158.5151Not ApplicableNot ApplicableNot Applicable126.8Not Applicable119130.5105.67184.92103.5668156.97106.74104.6599.77105.6751228.67
Basic metabolic panel80048Not Applica08.46Not ApplicableNot ApplicableNot Applicable18.78.468.4612.699.915.5122.448.468.46Not Applicable23.111.498.4614.818.2913.212.698.638.4611.518.46023.1
Blood test, comprehensive group of blood chemicals80053Not Applica010.56Not ApplicableNot ApplicableNot Applicable23.3510.5610.5615.8412.319.3727.8810.5610.56Not Applicable28.714.3510.5618.4810.3516.415.8410.7710.5614.3710.56028.7
Kidney function panel test80069Not Applica08.68Not ApplicableNot ApplicableNot Applicable19.218.688.6813.0210.215.9223.128.688.68Not Applicable23.811.798.6815.198.5113.613.028.858.6811.828.68023.8
Liver function blood test panel80076Not Applica08.17Not ApplicableNot ApplicableNot Applicable18.058.178.1712.269.614.9821.768.178.17Not Applicable22.411.18.1714.38.0112.812.268.338.1711.118.17022.4
Blood test, thyroid stimulating hormone (TSH)84443Not Applica016.8Not ApplicableNot ApplicableNot Applicable37.1616.816.825.219.530.8144.216.816.8Not Applicable45.522.8216.829.416.462625.217.1416.822.8716.8045.5
Complete blood cell count, with differential white blood cells, automated85025Not Applica07.77Not ApplicableNot ApplicableNot Applicable17.197.777.7711.6611.714.2426.527.777.77Not Applicable27.310.567.7713.67.6115.611.667.937.7710.587.77027.3
Complete blood count, automated85027Not Applica06.47Not ApplicableNot ApplicableNot Applicable14.326.476.479.717.511.85176.476.47Not Applicable17.58.796.4711.326.34109.716.66.478.816.47017.5
Blood test, clotting time85610Not Applica04.29Not ApplicableNot ApplicableNot Applicable8.694.294.296.444.57.2110.24.294.29Not Applicable10.55.834.297.514.266.444.384.295.354.29010.5
Coagulation assessment blood test85730Not Applica06.01Not ApplicableNot ApplicableNot Applicable13.286.016.019.025.411.0112.246.016.01Not Applicable12.68.166.0110.525.897.29.026.136.018.176.01013.28
Physical therapy, therapeutic exercise97110Not Applica44.4130.86Not ApplicableNot ApplicableNot Applicable12030.8630.8646.299071.2564.630.8630.86Not Applicable66.541.9230.8654.0130.243846.2931.4830.8610830.8627.52120
Electrocardiogram, routine, with interpretation and report93000Not Applica3740Not ApplicableNot ApplicableNot ApplicableNot Applicable000114.6286.5259.7600Not Applicable267.40000152.800056800568
Repair Biceps Tendon234305117.525496305550.35586167.0625550.355815605639.9626.48459.852000466917677806.316767.8816068438.56965.285639.99869.835527.1503.089024.726136.816016.4844505639.9503.0810862
Shoulder Arthroscopy/Surgery298223415.536675102618.77772909.7532618.777747252580.9214003871.38450023949060674.253097.1130161953187.442580.924516.612529.3408.424077.222772.512718.1529702580.92408.428796
Knee Arthroscopy/Surgery298762618.5525496302618.77772909.7532618.777747252580.9214003871.3845002955111881203.423097.116065848.53187.442580.924516.612529.3503.084077.222772.512718.1522772580.92503.0810862
Knee Arthroscopy/Surgery298792618.5520695102618.77772909.7532618.777747252580.9214003871.3845002955111881203.423097.1130154393187.442580.924516.612529.3408.424077.222772.512718.1522772580.92408.428796
Removal Of Inner Eye Fluid670363148.725496303574.64253971.8253574.642515603600626.45400200014665549806.314320160672874446360063003528503.085643.543837.613762.3627383600503.0810862
Routine Venipuncture36415Not Applica03Not ApplicableNot ApplicableNot Applicable4.88334.52.486.195.6133Not Applicable5.784.0835.252.943.34.53.0633306.19
Unlisted Eye Surgery Procedure66999138012961996.71901.87912113.1991901.8791Not Applicable1906.251996.72859.381100Not ApplicableNot Applicable1203.421203.42Not Applicable702354.221906.253335.941868.13402995.052036.631996.712001906.25403335.94
Treatment Of Fibula Fracture27780365.71296333212.751236.39212.751950203.31331.1304.972050628023779357.12243.97854163.1251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
Insj Temp Ndwellg Bladder Catheter Simple51702365.71296182.09103.9896115.544103.98961825102.8151.74154.22050176665203.33123.3691.04212.44126.96102.8179.9100.74121.39161.27109.66107.51318102.833.482050
Treat Big Toe Fracture28490365.71296190.68102.9996114.444102.99961825203.31158.9304.972050295511188212.93243.9795.34222.46251.09203.31355.79199.24265.97297.02201.97198.01318203.3153.782050
Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Genitalia, Trunk And/Or Extremities (Including Hands And Feet); 2.5 Cm Or Less12001365.71296225.23167.2605185.845167.26051825164.74187.69247.112050176665251.5197.69112.61262.77203.45164.74288.3161.45150.15258.64175.88172.43318164.7436.552050
Repair Of Nail Bed - Minor Surgery - Nail Charges11760365.71296225.23483.318537.02483.3181825468.6187.69702.920503151189674.25562.32112.61262.77578.72468.6820.05459.23182755.07513.45503.38318468.6112.612050
Skin Sub Graft T/A/L Add-On15272365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000126.75316.88287.300Not Applicable295.750000169000318001296
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 12.6 Cm To 20.0 Cm12035365.71695446307.692341.88307.6921125301.24443.45451.8620504301624541.26361.491139309.9372.03301.24527.17295.22356.12498.19338.77332.12318301.24205.252050
Incisional Biopsy Of Skin11106906.21296503.38110.9493123.277110.9493950301.24503.38451.86134.98Not ApplicableNot Applicable541.26361.49Not Applicable314.94372.03301.24527.17295.2283.38755.07513.45503.38318301.2483.381296
Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.5 Cm Or Less12011365.7Not Applicable298.46167.2605185.845167.26051825164.74248.72247.1120504301624333.28197.69149.23348.2203.45164.74288.3161.45198.97258.64175.88172.43318164.7441.632050
Punch Biopsy Skin Single Lesion11104365.7Not Applicable332.1289.941599.93589.94151825164.74332.12247.11149.23Not ApplicableNot Applicable541.26197.69Not Applicable348.2203.45164.74288.3161.4567.59498.19338.77332.12318164.7467.591825
Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or Ext12041365.71296315.95155.7468173.052155.74681825301.24263.3451.86205015175742357.12361.49157.98368.61372.03301.24527.17295.22265.97498.19338.77332.12318301.2459.962050
Unlisted Procedure, Musculoskeletal System, General - Other Procedures - Orthopedic Charges20999365.71296198.01212.751236.39212.751Not Applicable203.31198.01304.97180.05628023779541.26243.97Not Applicable420.13251.09203.31355.79199.24240.07297.02201.97198.01318203.31180.051639.07
Shoulder Surgery Procedure23929365.71296360.11212.751236.39212.751Not Applicable203.31300.09304.97205015175742541.26243.97180.05420.13251.09203.31355.79199.24240.07297.02201.97198.01318203.3197.3510862
Closed Treatment Of Calcaneal Fracture; With Manipulation - Closed Treatement - Foot/Toes Charges28405365.71695446212.751236.39212.7511125203.31443.45304.9720504851840541.26243.971139443.57251.09203.31355.79199.24356.12297.02201.97198.01318203.31198.012050
Graft Repair Of Spine Defect637101514.55Not Applicable01116.70021240.7781116.7002Not Applicable000190.2475.5431.1200Not Applicable443.80000253.60001317001317
Unlisted Procedure, Humerus Or Elbow - Other Procedures - Orthopedic Charges24999365.71296198.01212.751236.39212.751Not Applicable203.31198.01304.97190.37Not ApplicableNot Applicable541.26243.97Not Applicable444.19251.09203.31355.79199.24253.82297.02201.97198.01318203.3197.351296
Closed Treatment Of Calcaneal Fracture; Without Manipulation - Closed Treatement - Foot/Toes Charges28400365.71296333212.751236.39212.751950203.31331.1304.972050Not ApplicableNot Applicable357.12243.97854451.42251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 20.1 Cm To 30.0 Cm12036365.71695446483.318537.02483.3181125468.6443.45702.920504301624541.26562.321139476.47578.72468.6820.05459.23356.12755.07513.45503.38318468.63182050
Chemodervate Facial/Trigem/Cerv Musc Migraine64615365.71296250.8162.013668.90462.01361825246.8250.81370.2218.57217711188357.12296.16Not Applicable509.99304.8246.8431.9241.8633.11376.22255.83250.81318246.833.111825
Debrid Extensive Eczemati11001365.71296453Not ApplicableNot ApplicableNot ApplicableNot Applicable0377.5377.52050176665505.850226.5528.50000302000318Not Applicable02050
Destruct Premalg Lesion17000365.71296453167.2605185.845167.26051825164.74377.5247.1120505031898505.85197.69226.5528.5203.45164.74288.3161.45302258.64175.88172.43318164.7433.252050
Injection Intraesional Up11900365.71296453167.2605185.845167.26051825164.74377.5247.11205023949060505.85197.69226.5528.5203.45164.74288.3161.45302258.64175.88172.43318164.7422.42050
Destruct B9 Lesion 1-1417110365.71296453167.2605185.845167.26051825164.74377.5247.1120505031898505.85197.69226.5528.5203.45164.74288.3161.45302258.64175.88172.43318164.7441.632050
Biopsy Skin Subcutaneous111001514.55Not Applicable453Not ApplicableNot ApplicableNot ApplicableNot Applicable226.5377.5377.52050176665505.85Not Applicable226.5528.5Not ApplicableNot ApplicableNot ApplicableNot Applicable302Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable1712050
Destruction Of Skin Lesions17264365.71296453127.2348141.372127.23481825301.24377.5451.862050221836505.85361.49226.5528.5372.03301.24527.17295.22265.97498.19338.77332.12318301.2473.282050
Removal Skin Tags M11200365.71296453167.2605185.845167.26051825164.74377.5247.112050Not ApplicableNot Applicable505.85197.69226.5528.5203.45164.74288.3161.45302258.64175.88172.43318164.7436.082050
Removal Of Fixation Device20665365.71296453326.7099363.011326.70991825342.8377.5514.22050393214891505.85411.36226.5528.5423.36342.8599.9335.94265.97389.25264.69259.5318342.882.972050
Incision And Drainage Of Abscess; Simple Or Single - Incision And Drainage Charges10060365.7129645372.349280.38872.34921825164.74377.5247.112050176665674.25197.69226.5528.5203.45164.74288.3161.4552.87258.64175.88172.43318164.7445.282050
Closed Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger Or Thumb; Without Manipulation, Each26720365.71296453110.8305123.145110.83051825203.31377.5304.972050295511188541.26243.97226.5528.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3153.782050
Closed Treatment Of Radial And Ulnar Shaft Fractures; Withou - Closed Treatment - Upper Extremity Charges25560365.71296453110.8305123.145110.83051825203.31377.5304.97205023949060541.26243.97226.5528.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3153.782050
Injection For Hip X-Ray27095365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000226.5566.25513.400Not Applicable528.50000302000318001296
Closed Treatment Of Fracture Great Toe, Phalanx Or Phalanges; With Manipulation28495365.71296349.36110.8305123.145110.83051825203.31291.14304.9720503391292390.12243.97174.68528.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3174.752050
Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery - Nasal Hemorrhage Charges30901365.71296453103.9896115.544103.98961825102.8377.5154.2205015635913505.85123.36226.5528.5126.96102.8179.9100.74302161.27109.66107.51318102.834.662050
Biopsy Of Uterus Lining58100365.7129645348.470453.85648.47041825156.56377.5234.842050176665357.12187.87226.5528.5193.35156.56273.98153.43265.97245.35166.84163.57318156.5632.072050
N Block Inj Plantar Digit64455365.7129646519.60221.7819.602Not Applicable246.8387.5370.22050Not ApplicableNot Applicable357.12296.16232.5542.5304.8246.8431.9241.86265.97376.22255.83250.81Not Applicable246.812.742050
Place Needle Wire Breast192901514.55Not Applicable333Not ApplicableNot ApplicableNot ApplicableNot Applicable235.5331.1392.52050Not ApplicableNot Applicable525.95Not Applicable854549.5Not ApplicableNot ApplicableNot ApplicableNot Applicable314Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable235.510862
Wound Prep F/N/Hf/G15004365.71695446483.318537.02483.3181125468.6396.55702.9205015175742541.26562.321139555.17578.72468.6820.05459.23356.12755.07513.45503.38318468.63185575
Repair, Complex, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands And/Or Feet; 1.1 Cm To 2.5 Cm13131365.71695446307.692341.88307.6921125301.24443.45451.8620504301624541.26361.491139555.17372.03301.24527.17295.22356.12498.19338.77332.12318301.24179.132050
Debridement, Muscle And/Or Fascia (Includes Epidermis, Dermi - Debridement Charges11043365.71695446483.318537.02483.3181125468.6443.45702.920507712921541.26562.321139555.17578.72468.6820.05459.23356.12755.07513.45503.38318468.6247.332836
Debridement, Subcutaneous Tissue (Includes Epidermis And Dermis, If Performed); First 20 Sq Cm Or Less11042365.71695446307.692341.88307.6921125301.24443.45451.86205011804468204.6361.491139555.17372.03301.24527.17295.22356.12498.19338.77332.12318301.24204.62836
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 Manipulation25600365.71296480110.8305123.145110.83051825203.31400304.97205023949060541.26243.97240560251.09203.31355.79199.24265.97297.02201.97198.01318203.3186.242050
Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.6 Cm To 5.0 Cm12052365.71296495160.281178.09160.2811825301.24412.5451.8620504051545541.26361.49247.5577.5372.03301.24527.17295.22265.97498.19338.77332.12318301.2498.962050
Chemodenerv 1 Extremity 1-464642906.21296609.4274.487682.76474.48761825589.31609.42883.977505031898674.25707.17Not Applicable577.6727.8589.311031.29577.5238.79914.13621.61609.42788589.3138.791825
Repair, Intermediate, Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Membranes; 2.5 Cm Or Less12051365.71296513160.281178.09160.2811825301.24427.5451.86205015175742357.12361.49256.5598.5372.03301.24527.17295.22265.97498.19338.77332.12318301.2498.962050
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 2.6 Cm To 7.5 Cm12032365.71296519160.281178.09160.2811825301.24432.5451.8620504051545357.12361.49259.5605.5372.03301.24527.17295.22265.97498.19338.77332.12318301.2498.962050
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 Bone11012906.216954462301.62132557.3572301.621311252186.3443.453279.4575011804468541.262623.561139606.382700.082186.33826.032142.57356.123414.022321.542276.027882186.3356.124338
Excision Of Nail And Nail Matrix, Partial Or Complete, For P - Minor Surgery - Nail Charges11750365.71296519.7595.1588105.73295.1588950301.24433.13451.862050176655892.8361.49259.88606.38372.03301.24527.17295.22265.97498.19338.77332.12318301.2484.652050
Excise Benign Lesion11422906.21296519.75110.484122.76110.4849501294.11433.131941.177504151572491.041552.93259.88606.381598.231294.112264.691268.23265.972026.81378.221351.27881294.1170.042264.69
Debridement, Bone (Includes Epidermis, Dermis, Subcutaneous - Debridement Charges11044906.216954461334.54971482.8331334.549711251294.11443.451941.177507712921541.261552.931139606.381598.231294.112264.691268.23356.122026.81378.221351.27881294.11356.127294
Repair, Intermediate, Wounds Of Neck, Hands, Feet And/Or External Genitalia; 2.6 Cm To 7.5 Cm12042365.71296537160.281178.09160.2811825301.24447.5451.8620504051545491.04361.49268.5626.5372.03301.24527.17295.22265.97498.19338.77332.12318301.2498.962050
Bone Marrow Aspiration Bone Grfg20939365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000274.5686.25622.200Not Applicable640.50000366000318001296
Repair, Intermediate, Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Excluding Hands And Feet); 2.5 Cm Or Less12031365.71296511.58159.6672177.408159.66721825301.24426.32451.8620504051624357.12361.49255.79644372.03301.24527.17295.22265.97498.19338.77332.12318301.2498.962050
Repair Complex Trunk13102365.71296333Not ApplicableNot ApplicableNot ApplicableNot Applicable0477.5477.5205015175742357.120854668.50000382000318Not Applicable02050
Destruction Of Skin Lesions17263365.71296573167.2605185.845167.26051825164.74477.5247.112050221836639.85197.69286.5668.5203.45164.74288.3161.45382258.64175.88172.43318164.7473.282050
Repair Complex Trunk13101365.72069510483.318537.02483.3181273468.6507.08702.9205015175742674.25562.321301668.5578.72468.6820.05459.23408.42755.07513.45503.38318468.63185575
Nasal Endoscopy, Diagnostic, Unilateral Or Bilateral (Separa - Endoscopic Procedures Charges31231365.7169557381.011790.01381.01171825147.6477.5221.4205023949060892.8177.12286.5668.5182.29147.6258.3144.65265.97236.81161.03157.87318147.671.912050
Injection Intraesional Mo11901365.71296582.6167.2605185.845167.26051825164.74485.5247.112050176665650.57197.69291.3679.7203.45164.74288.3161.45388.4258.64175.88172.43318164.7424.532050
Correction Hallux Bunion282913783.520696016.485550.35586167.0625550.3558Not Applicable5639.96016.488459.852400217711188674.256767.88Not Applicable688.86965.285639.99869.835527.11036.829024.726136.816016.4832905639.9674.2523086
Repair, Complex, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands And/Or Feet; Each Additional 5 Cm Or Less13133365.71296333Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.520504301624357.120854696.50000398000318Not Applicable02050
Repair, Complex, Scalp, Arms, And/Or Legs; Each Additional 5 - Complex Wound Closures Charges13122365.71296333Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.520504301624357.120854696.50000398000318Not Applicable02050
Dressings And/Or Debridement Of Partial-Thickness Burns Initial Or Subsequent; Small16020365.71296597167.2605185.845167.2605950164.74497.5247.112050176665666.65197.69298.5696.5203.45164.74288.3161.45398258.64175.88172.43318164.7435.142050
Arthrocentesis, Aspiration And/Or Injection, Intermediate Joint Or Bursa; Without Ultrasound Guidance20605365.7129659724.235226.92824.2352950246.8497.5370.22050176665491.04296.16298.5696.5304.8246.8431.9241.8617.89376.22255.83250.81318246.815.332050
15819 Plastic Surgery Neck15819138016955971552.74571725.2731552.74579501529.95497.52294.931100176665666.651835.94298.5696.51889.491529.952677.411499.35408.422470.991680.281647.3312001529.95298.52677.41
Arthrocentesis, Aspiration And/Or Injection, Major Joint Or - Arthocentesis/Aspiration/Injection-Joint Or Bursa20610365.7129659728.868432.07628.8684950246.8497.5370.22050176665491.04296.16298.5696.5304.8246.8431.9241.8621.63376.22255.83250.81318246.818.862050
15157 Cult Epiderm Grft F/N/Hfg +%15157365.71296333Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.5205015635913357.120854696.50000398000318Not Applicable05741
15152 Cult Skin Graft T/A/L +%15152365.71296333Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.5205015635913357.120854696.50000398000318Not Applicable05741
Closed Treatment Of Scapular Fracture; Without Manipulation - Closed Treatment - Shoulder Charges23570365.71296333212.751236.39212.751950203.31331.1304.972050295511188357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3197.352050
Closed Treatment Of Shoulder Dislocation, With Manipulation; Without Anesthesia23650365.71296333212.751236.39212.751950203.31331.1304.972050336112739204.6243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
21820 Treat Sternum Fracture21820365.71296333212.751236.39212.751950203.31331.1304.972050Not ApplicableNot Applicable357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3197.352050
Closed Treatment Of Ulnar Fracture, Proximal End; Without Ma - Closed Treatment - Upper Extremity Charges24670365.71296333212.751236.39212.751950203.31331.1304.972050295511188357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3197.352050
Closed Treatment Of Clavicular Fracture; Without Manipulatio - Closed Treatment - Shoulder Charges23500365.71296333212.751236.39212.751950203.31331.1304.97205023949060357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3197.352050
Closed Treatment Of Acromioclavicular Dislocation; Without M - Closed Treatment - Shoulder Charges23540365.71296333212.751236.39212.751950203.31331.1304.972050295511188357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
Closed Treatment Of Temporomandibular Dislocation; Initial O - Closed Treatment - Skull/Face Charges21480365.71296333212.751236.39212.751950203.31331.1304.972050217711188357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3175.712597
Closed Treatment Of Supracondylar Or Transcondylar Humeral F24530365.71296333212.751236.39212.751950203.31331.1304.972050295511188357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
21800 Treatment Of Rib Fracture218001514.55Not Applicable333Not ApplicableNot ApplicableNot ApplicableNot Applicable298.5331.1497.52050217711188357.12Not Applicable854696.5Not ApplicableNot ApplicableNot ApplicableNot Applicable398Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable298.510862
Closed Treatment Of Humeral Condylar Fracture, Medial Or Lateral; Without Manipulation24576365.71296333212.751236.39212.751950203.31331.1304.97205023949060357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation24560365.71296333212.751236.39212.751950203.31331.1304.972050336112739357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3197.352050
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each26725365.71695597110.8305123.145110.83051825203.31497.5304.9720503391292541.26243.97298.5696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.3186.242050
Treat wrist dislocation25660365.71296333212.751236.39212.751950203.31331.1304.972050628023779357.12243.97854696.5251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
Fine Needle Aspiration W100221514.55Not Applicable912Not ApplicableNot ApplicableNot ApplicableNot Applicable4567607607501766651018.4Not Applicable4561064Not ApplicableNot ApplicableNot ApplicableNot Applicable608Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable4563093
Acne surgery10040365.7Not Applicable912167.2605185.845167.26051825164.74760247.112050171Not ApplicableNot Applicable197.694561064203.45164.74288.3161.45608258.64175.88172.43318164.7434.432050
Deb musc/fascia add-on11046365.71296780Not ApplicableNot ApplicableNot ApplicableNot Applicable06506502050485184087103909100000520000318Not Applicable02050
Trim skin lesion11055365.71296912167.2605185.845167.26051825164.74760247.112050151757421018.4197.694561064203.45164.74288.3161.45608258.64175.88172.43318164.7422.642050
Shave skin lesion >2.0 cm11303365.7Not Applicable912307.692341.88307.6921825301.24760451.8620501766651018.4361.494561064372.03301.24527.17295.22608498.19338.77332.12318301.2468.382050
Shave skin lesion 0.5 cm/<11305365.7Not Applicable912167.2605185.845167.26051825164.74760247.1120502218361018.4197.694561064203.45164.74288.3161.45608258.64175.88172.43318164.7441.632050
Shave skin lesion >2.0 cm11308365.7Not Applicable912307.692341.88307.6921825301.24760451.8620501766651018.4361.494561064372.03301.24527.17295.22608498.19338.77332.12318301.2461.312050
Shave skin lesion 1.1-2.0 cm11312365.7Not Applicable912110.1276122.364110.12761825301.24760451.86205017666541.26361.494561064372.03301.24527.17295.22265.97498.19338.77332.12318301.2469.82050
Shave skin lesion >2.0 cm11313365.7Not Applicable912120.4632133.848120.46321825301.24760451.8620501766651018.4361.494561064372.03301.24527.17295.22265.97498.19338.77332.12318301.2473.282050
Exc tr-ext b9+marg 0.6-1 cm11401365.7129687099.792110.8899.792950301.24725451.8620503291292491.04361.494351015372.03301.24527.17295.22265.97498.19338.77332.12318301.2462.962050
Exc tr-ext mal+marg 1.1-2 cm11602365.71296846159.6672177.408159.6672950301.24705451.8620505031898357.12361.49423987372.03301.24527.17295.22265.97498.19338.77332.12318301.24101.392192
Biopsy nail unit11755906.2129675383.397692.66483.3976950575.13627.5862.7750217711188541.26690.16376.5878.5710.29575.131006.48563.63265.97895.95609.25597.3788575.1355.181296
Correct skin color ea 20.0cm11922365.71296879Not ApplicableNot ApplicableNot ApplicableNot Applicable0732.5732.520504051545981.550439.51025.50000586000318Not Applicable02050
Remove contraceptive capsule11976906.2129691275.200483.55675.2004950575.13760862.775015635913541.26690.164561064710.29575.131006.48563.63139.5895.95609.25597.3788575.1347.871296
Implant hormone pellet(s)11980365.71296813326.7099363.011326.70991825342.8677.5514.22050221836907.85411.36406.5948.5423.36342.8599.9335.94542389.25264.69259.5318342.828.762050
Wnd prep f/n/hf/g addl cm15005365.71296333Not ApplicableNot ApplicableNot ApplicableNot Applicable0627.5627.5205015175742357.120854878.50000356.12000318Not Applicable05575
Skin pinch graft15050365.71695446483.318537.02483.3181125468.6443.45702.920504301624541.26562.321139871.5578.72468.6820.05459.23356.12755.07513.45503.38318468.63185575
Epidrm autogrft t/a/l add-on15111365.71296333Not ApplicableNot ApplicableNot ApplicableNot Applicable0627.5627.5205020937924357.120854878.50000502000318Not Applicable05741
Cult skin grft t/arm/leg15150138016954461552.74571725.2731552.745711251529.955652294.93180015635913541.261835.9411397911889.491529.952677.411499.35356.122470.991680.281647.3319191529.95356.127693
Cult skin graft f/n/hf/g151552618.5516954462683.37522981.5282683.375211252807.055654210.58180015635913541.263368.4611397913466.712807.054912.342750.91356.125073.693450.113382.4622772807.05356.127693
Acell Graft T/Arm/Leg Add-On151711514.552549798Not ApplicableNot ApplicableNot ApplicableNot Applicable3996656652050217711188891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable39910862
Acell Graft F/N/Hf/G Add-On151761514.552549798Not ApplicableNot ApplicableNot ApplicableNot Applicable3996656652050217711188891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable39910862
Aply Acell Grft T/A/L Add-On153311514.552549333Not ApplicableNot ApplicableNot ApplicableNot Applicable301.5502.5502.52050217711188357.12Not Applicable854703.5Not ApplicableNot ApplicableNot ApplicableNot Applicable402Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable301.510862
Apply Cult Skin Substitute153401514.552549831Not ApplicableNot ApplicableNot ApplicableNot Applicable415.5692.5692.52050217711188927.95Not Applicable415.5969.5Not ApplicableNot ApplicableNot ApplicableNot Applicable554Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable415.510862
Apply Cult Skin Sub Add-On153411514.552549798Not ApplicableNot ApplicableNot ApplicableNot Applicable3996656652050217711188891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable39910862
Apply Cult Derm Sub T/A/L153601514.552549798Not ApplicableNot ApplicableNot ApplicableNot Applicable3996656652050217711188891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable39910862
Aply Cult Derm Sub T/A/L Add153611514.552549798Not ApplicableNot ApplicableNot ApplicableNot Applicable3996656652050217711188891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable39910862
Apply Cult Derm Sub F/N/Hf/G153651514.552549798Not ApplicableNot ApplicableNot ApplicableNot Applicable3996656652050217711188891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable39910862
Apply Cult Derm F/Hf/G Add153661514.552549798Not ApplicableNot ApplicableNot ApplicableNot Applicable3996656652050217711188891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable39910862
Apply Skn Xenogrft T/A/L Add154011514.552549446Not ApplicableNot ApplicableNot ApplicableNot Applicable339443.455652050217711188541.26Not Applicable1139791Not ApplicableNot ApplicableNot ApplicableNot Applicable452Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable33910862
Apply Acellular Xenograft154301514.552549446Not ApplicableNot ApplicableNot ApplicableNot Applicable400.5667.5667.52050217711188894.45Not Applicable1139934.5Not ApplicableNot ApplicableNot ApplicableNot Applicable534Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable400.510862
Chemical peel face dermal15789365.7Not Applicable912251.7669279.741251.76691825468.6760702.920501766651018.4562.324561064578.72468.6820.05459.23608755.07513.45503.38318468.673.282050
Dress/debrid p-thick burn l16030365.71695446307.692341.88307.6921125301.24565451.8620503151189541.26361.491139791372.03301.24527.17295.22265.97498.19338.77332.12318301.24132.652050
Incision of burn scab initi16035365.71695780307.692341.88307.692Not Applicable301.24650451.8620504651771871361.49390910372.03301.24527.17295.22356.12498.19338.77332.12318301.24132.652050
Destruct premalg les 2-1417003365.71296912Not ApplicableNot ApplicableNot ApplicableNot Applicable076076020501766651018.4045610640000608000318Not Applicable02050
Destruction of skin lesions17106365.71296729160.281178.09160.281950301.24607.5451.8620504151572541.26361.49364.5850.5372.03301.24527.17295.22265.97498.19338.77332.12318301.24124.042050
Destruction of skin lesions17273365.71296798125.4528139.392125.45281825301.24665451.862050221836891.1361.49399931372.03301.24527.17295.22265.97498.19338.77332.12318301.2479.942050
Drainage of breast lesion19000906.2129669980.1989.180.19950575.13582.5862.7750Not ApplicableNot Applicable541.26690.16349.5815.5710.29575.131006.48563.6365.23895.95609.25597.3788575.1352.111296
Bx breast 1st lesion us imag19083138016951351.21334.54971482.8331334.549712731294.111351.21941.17110017496624541.261552.93Not Applicable965.091598.231294.112264.691268.23265.972026.81378.221351.212001294.11265.976431
Us bone stimulation20979365.7Not Applicable91217.295319.21717.2953182521.6876032.5220501766651018.426.02456106426.7721.6837.9421.2560835.5424.1723.6931821.6818.862050
Neck/chest surgery procedure21899365.7Not Applicable203.21176.715196.35176.715Not Applicable192203.21288345.934851840541.26230.4Not Applicable807.17237.12192336188.16461.24304.81207.27203.2131819275.71864.83
Closed tx vert fx w/o manj22310365.71296333212.751236.39212.751950203.31331.1304.972050217711188357.12243.97854899.5251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
Injection for hip x-ray27093365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000301.37753.41683.0900Not Applicable703.190000401.82000318001296
Fixation of ankle joint27860138012963331336.44061484.9341336.44069502580.92331.13871.38110023949060357.123097.1854802.243187.442580.924516.612529.3265.974077.222772.512718.1512002580.92265.975741
Drainage of nose lesion30000365.7129679892.0502102.27892.050218251926652882050Not ApplicableNot Applicable891.1230.4399931237.12192336188.1671.14304.81207.27203.2131819241.822050
Largsc w/ther injection31573138016951437.041310.4631456.071310.46325751348.811437.042023.221100628023779Not Applicable1618.57Not Applicable902.411665.781348.812360.421321.83574.312155.561465.781437.0412001348.81574.3112368
Diagnostic laryngoscopy31575365.7169559775.913284.34875.91321825147.6497.5221.42050336112739541.26177.12298.5696.5182.29147.6258.3144.65265.97236.81161.03157.87318147.647.872050
Laryngoscopy telescopic31579365.71695819105.138116.82105.138950356.28682.5534.42205020937924914.55427.54409.5955.5440.01356.28623.49349.1577.43542.37368.81361.58318356.2877.432050
Bronchial brush biopsy31717365.71296333371.7153413.017371.7153950356.28331.1534.422050Not ApplicableNot Applicable357.12427.54854784440.01356.28623.49349.15265.97542.37368.81361.58318356.28265.974073
Clearance of airways31720365.71296333184.5162205.018184.5162950173.44331.1260.16205011084195357.12208.13854696.5214.2173.44303.52169.97398270.64184.04180.43318173.4470.372050
Thoracentesis For Aspiration324211514.552549861Not ApplicableNot ApplicableNot ApplicableNot Applicable430.5717.5717.52050217711188961.45Not Applicable430.51004.5Not ApplicableNot ApplicableNot ApplicableNot Applicable574Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable430.510862
Lyse chest fibrin subq day32562906.21296840606.4443673.827606.4443950594.46700891.69750217711188938713.35420980734.16594.461040.31582.57560780.21530.54520.14788594.4642010862
Pseudoaneurysm injection trt36002906.21296897606.4443673.827606.4443950594.46747.5891.69750Not ApplicableNot Applicable1001.65713.35448.51046.5734.16594.461040.31582.57265.97780.21530.54520.14788594.46171.761577
Vein access cutdown > 1 yr36425365.71296798326.7099363.011326.70991825342.8665514.22050176665891.1411.36399931423.36342.8599.9335.94532389.25264.69259.5318342.810.992050
Inj w/fluor eval cv device36598365.7169579884.466893.85284.4668950173.23665259.85205020937924891.1207.88399931213.94173.23303.15169.77265.97293.14199.34195.43318173.2354.712050
Insert needle bone cavity36680365.71296798326.7099363.011326.70991825342.8665514.2205015635913891.1411.36399931423.36342.8599.9335.94532389.25264.69259.5318342.848.12050
Dx bone marrow aspirations38220906.21296798123.3144137.016123.31449501294.116651941.17750217711188806.311552.933999311598.231294.112264.691268.23265.972026.81378.221351.27881294.1178.532264.69
Dx bone marrow biopsies38221906.21296798106.5636118.404106.56369501294.116651941.177505031898806.311552.933999311598.231294.112264.691268.23265.972026.81378.221351.27881294.1176.172264.69
Io map of sent lymph node38900365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable00039097588400Not Applicable9100000520000318001296
Biopsy of mouth lesion40808365.71296798148.9752165.528148.97521825416.46665624.6920503391292674.25499.75399931514.33416.46728.81408.13112.68651.63443.11434.42318416.46100.692050
Drainage of mouth lesion41005365.71296333176.715196.35176.715950192331.128820504301624357.12230.4854696.5237.12192336188.16265.97304.81207.27203.21318192188.162597
Drainage of mouth lesion41015365.71296333455.2713505.857455.2713950416.46331.1624.69205015635913357.12499.75854696.5514.33416.46728.81408.13265.97651.63443.11434.42318416.46234.982597
Repair tongue laceration41251365.71695446176.715196.35176.7151125192443.4528820507092675541.26230.41139791237.12192336188.16356.12304.81207.27203.21318192188.162597
Drainage of gum lesion41800365.71296333103.9896115.544103.9896950102.8331.1154.22050Not ApplicableNot Applicable357.12123.36854696.5126.96102.8179.9100.74398161.27109.66107.51318102.882.972050
Repair palate42180365.71296333455.2713505.857455.2713950416.46331.1624.6920507092675357.12499.75854696.5514.33416.46728.81408.13265.97651.63443.11434.42318416.46234.982597
Preparation palate mold42280365.71296798112.9788125.532112.97881825416.46665624.692050295511188891.1499.75399931514.33416.46728.81408.13532651.63443.11434.42318416.4669.82050
Control nose/throat bleeding42970365.7129679892.0502102.27892.05021825192665288205020937924541.26230.4399931237.12192336188.1671.14304.81207.27203.2131819241.822050
Dx gastr intub w/asp spec43754365.71296780246.3417273.713246.3417950238.63650357.952050176665871286.36390910294.71238.63417.6233.86520380.94259.04253.96318238.6388.432050
Dx gastr intub w/asp specs43755365.71296780134.9568149.952134.9568950130.44650195.662050176665871156.53390910161.09130.44228.27127.83520201.02136.7134.02318130.44117.952050
Dx duod intub w/asp spec4375613801296780736.0551817.839736.0551950740.986501111.471100176665871889.18390910915.11740.981296.72726.165201166.24793.04777.491200740.9891.631296.72
Dx duod intub w/asp specs4375713801296780736.0551817.839736.0551950740.986501111.471100176665871889.18390910915.11740.981296.72726.16265.971166.24793.04777.491200740.981411296.72
Reduction of rectal prolapse45900906.21296333702.8802780.978702.8802950720.2331.11080.375020937924357.12864.24854980889.45720.21260.35705.8265.971143.26777.42762.17788720.2265.975380
Destruction anal lesion(s)46900365.71296798160.281178.09160.281950301.24665451.862050217711188541.26361.49399931372.03301.24527.17295.22117.53498.19338.77332.12318301.24109.182050
Cryosurgery anal lesion(s)46916365.7169579887.129996.81187.12991825164.74665247.1120505972266891.1197.69399931203.45164.74288.3161.4561.51258.64175.88172.43318164.7461.512050
Drain bladder by needle51100365.7129680432.07635.6432.0761825221.47670332.2175015635913897.8265.76402938273.52221.47387.57217.04265.97383.38260.7255.58788221.4720.281825
Cystometrogram w/vp&up51729906.21296711217.7604241.956217.76041825524.71592.5787.077505031898357.12629.65355.5829.5648.02524.71918.24514.22160.2827.96563.01551.97788524.71138.421843
Anal/urinary muscle study51785365.71296333227.2347252.483227.2347950221.47331.1332.212050176665357.12265.76854696.5273.52221.47387.57217.04265.97383.38260.7255.58318221.47188.022050
Dilate urethra stricture53601365.71296798103.9896115.544103.9896950102.8665154.22050176665891.1123.36399931126.96102.8179.9100.74265.97161.27109.66107.51318102.828.32050
Dilation of urethra53660365.7129679844.193649.10444.19361825130.44665195.6620503391292891.1156.53399931161.09130.44228.27127.83265.97201.02136.7134.02318130.4428.062050
Treatment of penis lesion54220365.71296333227.2347252.483227.2347950221.47331.1332.212050295511188357.12265.76854696.5273.52221.47387.57217.04265.97383.38260.7255.58318221.47188.022267
Penis study54240365.7129679836.709240.78836.70921825130.44665195.662050176665891.1156.53399931161.09130.44228.27127.83532380.94259.04253.96318130.4422.642050
Penis study54250365.7129684011.048412.27611.04841825221.47700332.212050176665938265.76420980273.52221.47387.57217.04560383.38260.7255.58318221.476.842050
Drainage of gland abscess56420365.7129669065.93473.2665.934950156.56575234.842050221836770.5187.87345805193.35156.56273.98153.43265.97245.35166.84163.57318156.5642.442050
Biopsy of vulva/perineum56605906.2129690938.847643.16438.8476950601.95757.5902.932050239490601015.05722.34454.51060.5743.41601.951053.41589.91265.97912.43620.45608.29788601.9525.72050
Biopsy of vulva/perineum56606365.71296597Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.52050176665666.650298.5696.50000398000318Not Applicable02050
Exam of vulva w/scope56820365.7129679852.034457.81652.03441825156.56665234.842050336112739357.12187.87399931193.35156.56273.98153.43265.97245.35166.84163.57318156.5634.192050
Exam/biopsy of vulva w/scope56821365.7129682866.290473.65666.2904950255.24690382.862050221836924.6306.29414966315.22255.24446.67250.14265.97405.47275.72270.32318255.2443.392050
Ins vag brachytx device57156365.71695780265.6665295.185265.6665950255.24650382.86205019217275871306.29390910315.22255.24446.67250.14110.76405.47275.72270.32318255.24110.762399
Exam of vagina w/scope57420365.7129680753.4659.453.46950255.24672.5382.86205020937924901.15306.29403.5941.5315.22255.24446.67250.14265.97405.47275.72270.32318255.2435.142050
Exam of cervix w/scope57452365.7169559749.539655.04449.5396950156.56497.5234.842050336112739357.12187.87298.5696.5193.35156.56273.98153.43265.97245.35166.84163.57318156.5632.782050
Bx/curett of cervix w/scope57454365.7169566660.944467.71660.9444950255.24555382.862050175665743.7306.29333777315.22255.24446.67250.14265.97405.47275.72270.32318255.2440.562050
Biopsy of cervix w/scope57455365.7129681664.15271.2864.152950255.24680382.862050221836911.2306.29408952315.22255.24446.67250.14265.97405.47275.72270.32318255.2442.212050
Endocerv curettage w/scope57456365.7129679861.657268.50861.6572950255.24665382.862050221836891.1306.29399931315.22255.24446.67250.14265.97405.47275.72270.32318255.2440.82050
Cryocautery of cervix57511365.7129679869.141676.82469.1416950255.24665382.862050221836891.1306.29399931315.22255.24446.67250.14265.97405.47275.72270.32318255.2444.82050
Insert intrauterine device58300365.7129659754.717360.79754.717318250497.5497.52050Not ApplicableNot Applicable674.250298.5696.50000398000318Not Applicable010862
Remove intrauterine device58301365.7129659745.619250.68845.6192950255.24497.5382.862050217711188674.25306.29298.5696.5315.22255.24446.67250.1433.91405.47275.72270.32318255.2429.712050
Transfer of embryo58974906.21296333569.844633.16569.844950601.95331.1902.93205011564368710.2722.34854742743.41601.951053.41589.91424912.43620.45608.29788601.95228.324241
Transfer of embryo58976365.71296333265.6665295.185265.6665950255.24331.1382.86205011564368666.65306.29854696.5315.22255.24446.67250.14398405.47275.72270.32318255.24170.494241
Amniocentesis diagnostic59000906.2129679870.923678.80470.9236Not Applicable601.95665902.93750Not ApplicableNot Applicable891.1722.34399931743.41601.951053.41589.9152.6912.43620.45608.29788601.9545.981296
Transabdom amnioinfus w/us59070365.71296798265.6665295.185265.6665950255.24665382.862050217711188891.1306.29399931315.22255.24446.67250.14532405.47275.72270.32318255.24228.322050
Umbilical cord occlud w/us59072365.71296798265.6665295.185265.6665950255.24665382.8620505031898891.1306.29399931315.22255.24446.67250.14532405.47275.72270.32318255.24170.492050
Fetal fluid drainage w/us59074365.71296798265.6665295.185265.6665950255.24665382.8620505031898891.1306.29399931315.22255.24446.67250.14110.76405.47275.72270.32318255.24110.762399
Fetal shunt placement w/us59076365.71296798265.6665295.185265.6665950255.24665382.8620506532471891.1306.29399931315.22255.24446.67250.14532405.47275.72270.32318255.24170.492050
Biopsy of thyroid60100906.2129682553.4659.453.46950575.13687.5862.775015635913541.26690.16412.5962.5710.29575.131006.48563.6340.32895.95609.25597.3788575.1335.371296
Aspir/inj thyroid cyst60300906.2129675081.259290.28881.25921825575.13625862.7750295511188837.5690.16375875710.29575.131006.48563.63265.97895.95609.25597.3788575.1353.061825
Dx lmbr spi pnxr62270906.21296333537.9462597.718537.9462950589.31331.1883.9775015635913204.6707.17854896727.8589.311031.29577.52265.97914.13621.61609.42788589.31204.62399
Ther spi pnxr drg csf62272906.21296333537.9462597.718537.9462950589.31331.1883.977506532471357.12707.17854959727.8589.311031.29577.52265.97914.13621.61609.42788589.31265.972399
Njx px discography lumbar62290365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000399997.5904.400Not Applicable9310000532000318001296
Njx px discography crv/thrc62291365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000399997.5904.400Not Applicable9310000532000318001296
Analyze spine infus pump62367365.71695678Not ApplicableNot ApplicableNot Applicable1125255.42565383.13205020937924757.1306.5339791315.44255.42446.99250.31452392.5266.9261.66318255.4222.322050
Analyze sp inf pump w/reprog62368365.71695678Not ApplicableNot ApplicableNot Applicable1125255.42565383.132050176665757.1306.5339791315.44255.42446.99250.31452392.5266.9261.66318255.4230.282050
Njx aa&/strd trigeminal nrv64400365.7129659785.179694.64485.1796Not Applicable246.8497.5370.2205020937924357.12296.16298.5696.5304.8246.8431.9241.8661.15376.22255.83250.81Not Applicable246.852.822050
N Block Inj Facial644021514.551296798Not ApplicableNot ApplicableNot ApplicableNot Applicable3996656652050221836891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable82.972050
Njx aa&/strd gr ocpl nrv64405365.7129690363.795670.88463.7956950246.8752.5370.22050221836491.04296.16451.51053.5304.8246.8431.9241.8646.19376.22255.83250.81318246.840.82050
N Block Inj Phrenic644101514.551296333Not ApplicableNot ApplicableNot ApplicableNot Applicable441331.1735750221836984.9Not Applicable8541029Not ApplicableNot ApplicableNot ApplicableNot Applicable588Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable331.15741
Njx aa&/strd axillary nrv64417906.21296333665.4582739.398665.4582Not Applicable765.62331.11148.4375011804468357.12918.74854696.5945.54765.621339.84750.31265.971184.76805.64789.84Not Applicable765.62265.972399
Njx aa&/strd sprscap nrv64418906.2129685575.556883.95275.5568Not Applicable589.31712.5883.977506532471491.04707.17427.5997.5727.8589.311031.29577.5271.02914.13621.61609.42Not Applicable589.3161.311296
Njx aa&/strd ntrcost nrv 164420906.21296333537.9462597.718537.9462Not Applicable589.31331.1883.977503391292357.12707.178541008727.8589.311031.29577.52265.97914.13621.61609.42Not Applicable589.31265.972399
Njx aa&/strd ii ih nerves64425906.2129683167.71675.2467.716Not Applicable589.31692.5883.9775015635913674.25707.17415.5969.5727.8589.311031.29577.5248.6914.13621.61609.42Not Applicable589.3143.621296
Njx aa&/strd paracrv nrv64435906.2129659780.902889.89280.9028Not Applicable589.31497.5883.977506532471674.25707.17298.5696.5727.8589.311031.29577.5259.28914.13621.61609.42Not Applicable589.3151.171296
Njx aa&/strd other pn/branch64450906.2129674152.034457.81652.0344950589.31617.5883.9775011804468892.8707.17370.5864.5727.8589.311031.29577.5238.72914.13621.61609.42788589.3134.191296
Inj paravert f jnt c/t 2 lev64491365.71296597Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.5205011804468357.120298.5696.50000398000318Not Applicable02050
Inj paravert f jnt c/t 3 lev64492365.71296597Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.520504651771357.120298.5696.50000398000318Not Applicable02050
Inj paravert f jnt l/s 2 lev64494365.71296597Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.5205011804468357.120298.5696.50000398000318Not Applicable02050
Inj paravert f jnt l/s 3 lev64495365.71296597Not ApplicableNot ApplicableNot ApplicableNot Applicable0497.5497.520504651771357.120298.5696.50000398000318Not Applicable02050
N block spenopalatine gangl64505365.7129673254.885660.98454.8856950246.8610370.220504651771817.4296.16366854304.8246.8431.9241.8639.53376.22255.83250.81318246.834.92050
N Block Carotid Sinus S/P645081514.55Not Applicable597Not ApplicableNot ApplicableNot ApplicableNot Applicable298.5497.5497.52050176665666.65Not Applicable298.5696.5Not ApplicableNot ApplicableNot ApplicableNot Applicable398Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable298.510862
Neuroeltrd stim post tibial64566365.71296780107.6328119.592107.6328950246.8650370.22050217711188871296.16390910304.8246.8431.9241.86520376.22255.83250.81318246.864.142050
Destroy nerve face muscle64612365.7129679875.200483.55675.2004950246.8665370.22050221836891.1296.16399931304.8246.8431.9241.86265.97376.22255.83250.81318246.848.342050
Destroy Nerve Neck Muscle646131514.55Not Applicable798Not ApplicableNot ApplicableNot ApplicableNot Applicable39966566520503391292891.1Not Applicable399931Not ApplicableNot ApplicableNot ApplicableNot Applicable532Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable39910862
Destr Paravertebral N Add-On646231514.552549333Not ApplicableNot ApplicableNot ApplicableNot Applicable441331.17352050217711188984.9Not Applicable8541029Not ApplicableNot ApplicableNot ApplicableNot Applicable588Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable331.110862
Destr Paravertebral N Add-On646271514.552549333Not ApplicableNot ApplicableNot ApplicableNot Applicable375331.16252050217711188837.5Not Applicable854875Not ApplicableNot ApplicableNot ApplicableNot Applicable500Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable331.110862
Destroy c/th facet jnt addl64634365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000375937.585000Not Applicable8750000500000318001296
Remove skin nerve lesion647882206.8520695101594.3951771.551594.39512731621.04507.082431.56150020937924674.251945.2513011030.32001.981621.042836.821588.62408.422527.221718.511684.8119191621.04408.428796
Ophthalmic endoscope add-on66990365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000356.7891.75808.5200Not Applicable832.30000475.6000318001296
Injection eye drug67028365.7129679848.11453.4648.114950291.9665437.852050295511188891.1350.28399931360.5291.9510.83286.06265.97447.64304.39298.43318291.931.62050
Treatment of retina67141365.71695446264.9834294.426264.98341125255.02443.45382.53205020937924541.26306.021139948.5314.95255.02446.29249.92356.12376.38255.94250.92318255.02237.544167
Ocular photodynamic ther67221906.21296798159.3108177.012159.3108950477.94665716.917507712921891.1573.53399931590.26477.94836.4468.38408.42725.82493.55483.88788477.94103.992274
Eye photodynamic ther add-on67225365.71296798Not ApplicableNot ApplicableNot ApplicableNot Applicable066566520506182342891.103999310000532000318Not Applicable02050
Tr retinal les preterm inf67229906.21695825251.6481279.609251.64811825477.94687.5716.917509813718921.25573.53412.5962.5590.26477.94836.4468.38265.97725.82493.55483.88788477.94212.913610
Destroy nerve of eye muscle67345365.71296798126.1656140.184126.1656950255.02665382.532050466917677541.26306.02399931314.95255.02446.29249.9292.65376.38255.94250.92318255.0281.592050
Inject/treat eye socket67515365.7129675944.906449.89644.9064950255.02632.5382.5320505031898541.26306.02379.5885.5314.95255.02446.29249.9233.38376.38255.94250.92318255.0229.482050
Drainage of eyelid abscess67700365.71296798138.0357153.373138.0357950255.02665382.532050Not ApplicableNot Applicable541.26306.02399931314.95255.02446.29249.92107.85376.38255.94250.92318255.02107.852050
Remove eyelid lesion67800365.7129685275.913284.34875.9132950255.02710382.53205015635913541.26306.02426994314.95255.02446.29249.92265.97376.38255.94250.92318255.0248.822050
Biopsy eyelid & lid margin67810365.71296828126.8784140.976126.8784950255.02690382.53205020937924541.26306.02414966314.95255.02446.29249.92265.97376.38255.94250.92318255.0281.122050
Close tear duct opening68760365.71296723137.214152.46137.2141825255.02602.5382.532050295511188541.26306.02361.5843.5314.95255.02446.29249.92356.12376.38255.94250.92318255.0288.432050
Close tear duct opening68761365.7129679897.2972108.10897.29721825255.02665382.5320504151572541.26306.02399931314.95255.02446.29249.92265.97376.38255.94250.92318255.0262.492050
Probe nasolacrimal duct68810365.71296333264.9834294.426264.9834950255.02331.1382.532050176665357.12306.02854980314.95255.02446.29249.92265.97376.38255.94250.92318255.02229.822274
Explore/irrigate tear ducts68840365.7129679880.902889.89280.90281825255.02665382.532050336112739541.26306.02399931314.95255.02446.29249.92265.97376.38255.94250.92318255.0252.352050
Drain external ear lesion69000906.21296852128.6604142.956128.66041825575.13710862.7750Not ApplicableNot Applicable541.26690.16426994710.29575.131006.48563.6396.92895.95609.25597.3788575.1379.381825
Remove impacted ear wax uni69210365.7129679855.400461.55655.4004182551.8666577.792050Not ApplicableNot Applicable891.162.2339993164.0551.8690.7650.8253280.1854.5253.4531851.8616.972050
Incision of eardrum69420365.7206983492.0502102.27892.05029501926952882050217711188541.26230.4417973237.12192336188.16265.97304.81207.27203.2131819292.912069
Application of finger splint; dynamic - Cast/Splint Application-Upper Body/Ext29131365.7Not Applicable603.955.400461.55655.4004182551.86503.2577.792050176665674.3662.23301.95704.5564.0551.8690.7650.82402.680.1854.5253.4531851.8619.582050
Arterial puncture, withdrawal of blood for diagnosis - Diagnostic Procedures Charges36600365.7Not Applicable798103.9896115.544103.98961825102.8665154.220504301624891.1123.36399931126.96102.8179.9100.74532161.27109.66107.51318102.882.9710862
Change of gastrostomy tube, percutaneous, without imaging or - GI Tube Placement/Change Charges437601514.55Not Applicable333Not ApplicableNot ApplicableNot ApplicableNot Applicable298.5331.1497.52050176665666.65Not Applicable854696.5Not ApplicableNot ApplicableNot ApplicableNot Applicable398Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot Applicable298.52500
Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each26740365.71296840110.8305123.145110.83051825203.31700304.972050295511188938243.97420980251.09203.31355.79199.2480.27297.02201.97198.01318203.3180.272050
Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone25630365.71296798110.8305123.145110.83051825203.31665304.97205023949060541.26243.97399931251.09203.31355.79199.24265.97297.02201.97198.01318203.3186.242050
Closed treatment of carpometacarpal fracture dislocation, th - Closed Treatment - Hand/Fingers Charges26645365.712963331336.44061484.9341336.44069501277.89331.11916.8420503391292357.121533.47854899.51578.191277.892236.311252.33265.972005.691363.871337.133181277.89156.112236.31
Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each28515365.71296798104.7816116.424104.78161825203.31665304.972050221836541.26243.97399931251.09203.31355.79199.24265.97297.02201.97198.01318203.3166.972050
Closed treatment of greater humeral tuberosity fracture; wit - Closed Treatment - Shoulder Charges23620365.71296798110.8305123.145110.8305950203.31665304.972050295511188891.1243.97399931251.09203.31355.79199.24265.97297.02201.97198.01318203.3153.782050
Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation24565365.716954461336.44061484.9341336.440611251277.89443.451916.8420504851840541.261533.471139892.51578.191277.892236.311252.33356.122005.691363.871337.133181277.89156.112236.31
Closed treatment of humeral shaft fracture; without manipula - Closed Treatment - Upper Extremity Charges24500365.71296333212.751236.39212.751950203.31331.1304.97205023949060357.12243.97854745.5251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
Closed treatment of metacarpal fracture, single; with manipu - Closed Treatment - Hand/Fingers Charges26605365.71695446212.751236.39212.7511125203.31443.45304.9720503391292541.26243.971139791251.09203.31355.79199.24356.12297.02201.97198.01318203.31156.112050
Closed treatment of nasal bone fracture without manipulation - Closed Treatment - Skull/Face Charges213101514.551695446212.751236.39212.7511125203.31443.45304.972050Not ApplicableNot Applicable541.26243.971139791251.09203.31355.79199.24356.12297.02201.97198.01318203.3175.712597
Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation23600365.71296798110.8305123.145110.8305950203.31665304.97205023949060891.1243.97399931251.09203.31355.79199.24265.97297.02201.97198.01318203.3186.242050
Closed treatment of radial head or neck fracture; without ma - Closed Treatment - Upper Extremity Charges24650365.71296798110.8305123.145110.83051825203.31665304.972050221836891.1243.97399931251.09203.31355.79199.24265.97297.02201.97198.01318203.3186.242050
Closed treatment of radial shaft fracture; without manipulat - Closed Treatment - Upper Extremity Charges25500365.71296798110.8305123.145110.83051825203.31665304.97205023949060891.1243.97399931251.09203.31355.79199.24265.97297.02201.97198.01318203.3153.782050
Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulation25680365.71695446212.751236.39212.7511125203.31443.45304.97205020937924541.26243.971139791251.09203.31355.79199.24356.12297.02201.97198.01318203.3197.352050
Closed treatment of ulnar shaft fracture; without manipulati - Closed Treatment - Upper Extremity Charges25530365.71296798110.8305123.145110.83051825203.31665304.972050336112739891.1243.97399931251.09203.31355.79199.24265.97297.02201.97198.01318203.3153.782050
Control nasal hemorrhage, anterior, complex (extensive caute - Other Minor Surgery - ENT Charges30903365.71296333103.9896115.544103.9896950102.8331.1154.22050176665357.12123.36854696.5126.96102.8179.9100.74265.97161.27109.66107.51318102.875.712050
Control nasal hemorrhage, posterior, with posterior nasal pa - Nasal Hemorrhage Charges30906365.71296333176.715196.35176.715950192331.128820503391292357.12230.4854696.5237.12192336188.16265.97304.81207.27203.2131819275.712050
Control nasal hemorrhage, posterior, with posterior nasal pa - Other Minor Surgery - ENT Charges30905365.71296333103.9896115.544103.9896950102.8331.1154.220503391292357.12123.36854696.5126.96102.8179.9100.74265.97161.27109.66107.51318102.875.712050
Debridement of nail(s) by any method(s); 1 to 5 - Debridement Charges11720365.7129691255.400461.55655.4004182551.8676077.7920501766651018.462.23456106464.0551.8690.7650.8260880.1854.5253.4531851.8613.22050
Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof11045365.71296780Not ApplicableNot ApplicableNot ApplicableNot Applicable065065020501985751387103909100000520000318Not Applicable02050
Declotting by thrombolytic agent of implanted vascular acces - Vascular Access Charges36593365.7129660331.363234.84831.36321825291.9502.5437.852050217711188673.35350.28301.5703.5360.5291.9510.83286.0623.23447.64304.39298.43318291.920.042050
Drainage of abscess of palate, uvula - Drainage of Abscess Charges42000365.71695446176.715196.35176.7151125192443.452882050217711188541.26230.41139791237.12192336188.16356.12304.81207.27203.21318192188.162597
Drainage of finger abscess; complicated - Drainage of Abscess Charges26011138012963331334.54971482.8331334.54979501294.11331.11941.171100221836357.121552.938541030.841598.231294.112264.691268.23265.972026.81378.221351.212001294.11265.975741
Dressings and/or debridement of partial-thickness burns initial or subsequent; medium16025365.71695446167.2605185.845167.26051125164.74565247.112050176665541.26197.691139791203.45164.74288.3161.4561.51258.64175.88172.43318164.7461.512050
Gastric intubation and aspiration(s) therapeutic, necessitat - Other Minor Procedures - GI Charges43753365.71296780246.3417273.713246.3417950238.63650357.952050221836871286.36390910294.71238.63417.6233.86520380.94259.04253.96318238.6388.432050
Incision and drainage of abscess; complicated or multiple - Incision and Drainage Charges10061365.71296702111.5532123.948111.5532950301.24585451.862050221836541.26361.49351819372.03301.24527.17295.22265.97498.19338.77332.12318301.2471.692050
Incision and drainage of hematoma, seroma or fluid collectio - Incision and Drainage Charges1014013801296883.58103.7124115.236103.712418251294.11736.321941.17110020937924806.311552.93441.791030.841598.231294.112264.691268.23265.972026.81378.221351.212001294.1166.022264.69
Incision and drainage of pilonidal cyst; simple - Incision and Drainage Charges10080906.21296717132.5808147.312132.58081825575.13597.5862.7750221836541.26690.16358.5836.5710.29575.131006.48563.6398.26895.95609.25597.3788575.1379.381825
Initial treatment, first degree burn, when no more than loca - Burns Charges16000365.7Not Applicable912167.2605185.845167.26051825164.74760247.112050Not ApplicableNot Applicable1018.4197.694561064203.45164.74288.3161.45608258.64175.88172.43318164.7422.42050
Inject for sacroiliac jointG0259365.712960Not ApplicableNot ApplicableNot ApplicableNot Applicable000399997.5904.400Not Applicable9310000532000318001296
Naso- or oro-gastric tube placement, requiring physician's s - GI Tube Placement/Change Charges43752365.71695798326.7099363.011326.70991825342.8665514.220502397432860891.1411.36399931423.36342.8599.9335.94105.89389.25264.69259.5318342.8105.892050
Removal of foreign body from pharynx - Foreign Body Removal - Throat Charges42809365.71296798326.7099363.011326.7099950342.8665514.2205020937924891.1411.36399931423.36342.8599.9335.94532389.25264.69259.5318342.882.972050
Repair of laceration 2.5 cm or less; floor of mouth and/or a - Laceration Repair - Mouth/Lip Charges41250365.71695446103.9896115.544103.98961125102.8443.45154.22050336112739541.26123.361139791126.96102.8179.9100.74452389.25264.69259.5318102.875.712597
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm12034365.71695446307.692341.88307.6921125301.24443.45451.8620504051545541.26361.491139822.5372.03301.24527.17295.22356.12498.19338.77332.12318301.24179.132050
Treatment of closed elbow dislocation; without anesthesia - Closed Treatment - Upper Extremity Charges24600365.71296333212.751236.39212.751950203.31331.1304.972050336112739357.12243.97854700251.09203.31355.79199.24265.97297.02201.97198.01318203.31156.112050
Endoscopic Removal of Gallbladder47562Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Injection of substance into spinal canal of lower back or sacrum using imaging guidance62323Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Biopsy of prostate gland55700Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC)743Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Removal of tonsils and adenoid glands patient younger than age 1242820Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Patient office consultation, typically 40 min99243Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Patient office consultation, typically 60 min99244Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Initial new patient preventive medicine evaluation (18-39 years)99385Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Initial new patient preventive medicine evaluation (40-64 years)99386Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
CT scan, head or brain, without contrast70450Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
MRI scan of brain before and after contrast70553Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
MRI scan of lower spinal canal72148Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
CT scan, pelvis, with contrast72193Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
MRI scan of leg joint73721Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
CT scan of abdomen and pelvis with contrast74177Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Ultrasound of abdomen76700Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus76805Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Ultrasound pelvis through vagina76830Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Mammography of one breast77065Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Mammography of both breasts77066Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Mammography, screening, bilateral77067Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Blood test, lipids (cholesterol and triglycerides)80061Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Manual urinalysis test with examination using microscope81001Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Automated urinalysis test81003Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
PSA (prostate specific antigen)84154Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Insertion of catheter into left heart for diagnosis93452Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Sleep Study95810Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
New patient office or other outpatient visit, typically 30 min99203Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
New patient office of other outpatient visit, typically 45 min99204Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
New patient office of other outpatient visit, typically 60 min99205Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities216Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care59610Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Obstetric blood test panel80055Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Psychotherapy, 30 min90832Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Psychotherapy, 45 min90834Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Psychotherapy, 60 min90837Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Family psychotherapy, not including patient, 50 min90846Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Family psychotherapy, including patient, 50 min90847Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Group psychotherapy90853Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Repair of groin hernia patient age 5 years or older49505Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Surgical removal of prostate and surrounding lymph nodes using an endoscope55866Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Removal of recurring cataract in lens capsule using laser66821Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Ultrasound examination of lower large bowel using an endoscope45391Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Routine obstetric care for vaginal delivery, including pre-and post- delivery care59400Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided
Routine obstetric care for cesarean delivery, including pre-and post-delivery care59510Service NotService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not ProvidedService Not Provided