| Procedure |
Short Descriptor |
2020 Physician Fee
Schedule |
| 0509T |
PATTERN ERG W/I&R
|
$XXX.XX
|
| 0509T-26 |
PATTERN ERG W/I&R
|
$XXX.XX
|
| 0509T-TC |
PATTERN ERG W/I&R
|
$XXX.XX
|
| 10004 |
FNA BX W/O IMG GDN EA ADDL
|
$XXX.XX
|
| 10005 |
FNA BX W/US GDN 1ST LES
|
$XXX.XX
|
| 10006 |
FNA BX W/US GDN EA ADDL
|
$XXX.XX
|
| 10007 |
FNA BX W/FLUOR GDN 1ST LES
|
$XXX.XX
|
| 10008 |
FNA BX W/FLUOR GDN EA ADDL
|
$XXX.XX
|
| 10009 |
FNA BX W/CT GDN 1ST LES
|
$XXX.XX
|
| 10010 |
FNA BX W/CT GDN EA ADDL
|
$XXX.XX
|
| 10021 |
FNA BX W/O IMG GDN 1ST LES
|
$XXX.XX
|
| 10030 |
GUIDE CATHET FLUID DRAINAGE
|
$XXX.XX
|
| 10035 |
PERQ DEV SOFT TISS 1ST IMAG
|
$XXX.XX
|
| 10036 |
PERQ DEV SOFT TISS ADD IMAG
|
$XXX.XX
|
| 10040 |
ACNE SURGERY
|
$XXX.XX
|
| 10060 |
DRAINAGE OF SKIN ABSCESS
|
$XXX.XX
|
| 10061 |
DRAINAGE OF SKIN ABSCESS
|
$XXX.XX
|
| 10080 |
DRAINAGE OF PILONIDAL CYST
|
$XXX.XX
|
| 10081 |
DRAINAGE OF PILONIDAL CYST
|
$XXX.XX
|
| 10120 |
REMOVE FOREIGN BODY
|
$XXX.XX
|
| 10121 |
REMOVE FOREIGN BODY
|
$XXX.XX
|
| 10140 |
DRAINAGE OF HEMATOMA/FLUID
|
$XXX.XX
|
| 10160 |
PUNCTURE DRAINAGE OF LESION
|
$XXX.XX
|
| 10180 |
COMPLEX DRAINAGE WOUND
|
$XXX.XX
|
| 11000 |
DEBRIDE INFECTED SKIN
|
$XXX.XX
|
| 11001 |
DEBRIDE INFECTED SKIN ADD-ON
|
$XXX.XX
|
| 11004 |
DEBRIDE GENITALIA & PERINEUM
|
$XXX.XX
|
| 11005 |
DEBRIDE ABDOM WALL
|
$XXX.XX
|
| 11006 |
DEBRIDE GENIT/PER/ABDOM WALL
|
$XXX.XX
|
| 11008 |
REMOVE MESH FROM ABD WALL
|
$XXX.XX
|
| 11010 |
DEBRIDE SKIN AT FX SITE
|
$XXX.XX
|
| 11011 |
DEBRIDE SKIN MUSC AT FX SITE
|
$XXX.XX
|
| 11012 |
DEB SKIN BONE AT FX SITE
|
$XXX.XX
|
| 11042 |
DEB SUBQ TISSUE 20 SQ CM/<
|
$XXX.XX
|
| 11043 |
DEB MUSC/FASCIA 20 SQ CM/<
|
$XXX.XX
|
| 11044 |
DEB BONE 20 SQ CM/<
|
$XXX.XX
|
| 11045 |
DEB SUBQ TISSUE ADD-ON
|
$XXX.XX
|
| 11046 |
DEB MUSC/FASCIA ADD-ON
|
$XXX.XX
|
| 11047 |
DEB BONE ADD-ON
|
$XXX.XX
|
| 11055 |
TRIM SKIN LESION
|
$XXX.XX
|
| 11056 |
TRIM SKIN LESIONS 2 TO 4
|
$XXX.XX
|
| 11057 |
TRIM SKIN LESIONS OVER 4
|
$XXX.XX
|
| 11102 |
TANGNTL BX SKIN SINGLE LES
|
$XXX.XX
|
| 11103 |
TANGNTL BX SKIN EA SEP/ADDL
|
$XXX.XX
|
| 11104 |
PUNCH BX SKIN SINGLE LESION
|
$XXX.XX
|
| 11105 |
PUNCH BX SKIN EA SEP/ADDL
|
$XXX.XX
|
| 11106 |
INCAL BX SKN SINGLE LES
|
$XXX.XX
|
| 11107 |
INCAL BX SKN EA SEP/ADDL
|
$XXX.XX
|
| 11200 |
REMOVAL OF SKIN TAGS
|
$XXX.XX
|
|
| 11201 |
REMOVE SKIN TAGS ADD-ON
|
$XXX.XX
|
| 11300 |
SHAVE SKIN LESION 0.5 CM/<
|
$XXX.XX
|
| 11301 |
SHAVE SKIN LESION 0.6-1.0 CM
|
$XXX.XX
|
| 11302 |
SHAVE SKIN LESION 1.1-2.0 CM
|
$XXX.XX
|
| 11303 |
SHAVE SKIN LESION >2.0 CM
|
$XXX.XX
|
| 11305 |
SHAVE SKIN LESION 0.5 CM/<
|
$XXX.XX
|
| 11306 |
SHAVE SKIN LESION 0.6-1.0 CM
|
$XXX.XX
|
| 11307 |
SHAVE SKIN LESION 1.1-2.0 CM
|
$XXX.XX
|
| 11308 |
SHAVE SKIN LESION >2.0 CM
|
$XXX.XX
|
| 11310 |
SHAVE SKIN LESION 0.5 CM/<
|
$XXX.XX
|
| 11311 |
SHAVE SKIN LESION 0.6-1.0 CM
|
$XXX.XX
|
| 11312 |
SHAVE SKIN LESION 1.1-2.0 CM
|
$XXX.XX
|
| 11313 |
SHAVE SKIN LESION >2.0 CM
|
$XXX.XX
|
| 11400 |
EXC TR-EXT B9+MARG 0.5 CM<
|
$XXX.XX
|
| 11401 |
EXC TR-EXT B9+MARG 0.6-1 CM
|
$XXX.XX
|
| 11402 |
EXC TR-EXT B9+MARG 1.1-2 CM
|
$XXX.XX
|
| 11403 |
EXC TR-EXT B9+MARG 2.1-3CM
|
$XXX.XX
|
| 11404 |
EXC TR-EXT B9+MARG 3.1-4 CM
|
$XXX.XX
|
| 11406 |
EXC TR-EXT B9+MARG >4.0 CM
|
$XXX.XX
|
| 11420 |
EXC H-F-NK-SP B9+MARG 0.5/<
|
$XXX.XX
|
| 11421 |
EXC H-F-NK-SP B9+MARG 0.6-1
|
$XXX.XX
|
| 11422 |
EXC H-F-NK-SP B9+MARG 1.1-2
|
$XXX.XX
|
| 11423 |
EXC H-F-NK-SP B9+MARG 2.1-3
|
$XXX.XX
|
| 11424 |
EXC H-F-NK-SP B9+MARG 3.1-4
|
$XXX.XX
|
| 11426 |
EXC H-F-NK-SP B9+MARG >4 CM
|
$XXX.XX
|
| 11440 |
EXC FACE-MM B9+MARG 0.5 CM/<
|
$XXX.XX
|
| 11441 |
EXC FACE-MM B9+MARG 0.6-1 CM
|
$XXX.XX
|
| 11442 |
EXC FACE-MM B9+MARG 1.1-2 CM
|
$XXX.XX
|
| 11443 |
EXC FACE-MM B9+MARG 2.1-3 CM
|
$XXX.XX
|
| 11444 |
EXC FACE-MM B9+MARG 3.1-4 CM
|
$XXX.XX
|
| 11446 |
EXC FACE-MM B9+MARG >4 CM
|
$XXX.XX
|
| 11450 |
REMOVAL SWEAT GLAND LESION
|
$XXX.XX
|
| 11451 |
REMOVAL SWEAT GLAND LESION
|
$XXX.XX
|
| 11462 |
REMOVAL SWEAT GLAND LESION
|
$XXX.XX
|
| 11463 |
REMOVAL SWEAT GLAND LESION
|
$XXX.XX
|
| 11470 |
REMOVAL SWEAT GLAND LESION
|
$XXX.XX
|
| 11471 |
REMOVAL SWEAT GLAND LESION
|
$XXX.XX
|
| 11600 |
EXC TR-EXT MAL+MARG 0.5 CM/<
|
$XXX.XX
|
| 11601 |
EXC TR-EXT MAL+MARG 0.6-1 CM
|
$XXX.XX
|
| 11602 |
EXC TR-EXT MAL+MARG 1.1-2 CM
|
$XXX.XX
|
| 11603 |
EXC TR-EXT MAL+MARG 2.1-3 CM
|
$XXX.XX
|
| 11604 |
EXC TR-EXT MAL+MARG 3.1-4 CM
|
$XXX.XX
|
| 11606 |
EXC TR-EXT MAL+MARG >4 CM
|
$XXX.XX
|
| 11620 |
EXC H-F-NK-SP MAL+MARG 0.5/<
|
$XXX.XX
|
| 11621 |
EXC S/N/H/F/G MAL+MRG 0.6-1
|
$XXX.XX
|
| 11622 |
EXC S/N/H/F/G MAL+MRG 1.1-2
|
$XXX.XX
|
| 11623 |
EXC S/N/H/F/G MAL+MRG 2.1-3
|
$XXX.XX
|
| 11624 |
EXC S/N/H/F/G MAL+MRG 3.1-4
|
$XXX.XX
|
| 11626 |
EXC S/N/H/F/G MAL+MRG >4 CM
|
$XXX.XX
|
| 11640 |
EXC F/E/E/N/L MAL+MRG 0.5CM<
|
$XXX.XX
|
| 11641 |
EXC F/E/E/N/L MAL+MRG 0.6-1
|
$XXX.XX
|
| 11642 |
EXC F/E/E/N/L MAL+MRG 1.1-2
|
$XXX.XX
|
| 11643 |
EXC F/E/E/N/L MAL+MRG 2.1-3
|
$XXX.XX
|
| 11644 |
EXC F/E/E/N/L MAL+MRG 3.1-4
|
$XXX.XX
|
| 11646 |
EXC F/E/E/N/L MAL+MRG >4 CM
|
$XXX.XX
|
| 11719 |
TRIM NAIL(S) ANY NUMBER
|
$XXX.XX
|
| 11720 |
DEBRIDE NAIL 1-5
|
$XXX.XX
|
| 11721 |
DEBRIDE NAIL 6 OR MORE
|
$XXX.XX
|
| 11730 |
REMOVAL OF NAIL PLATE
|
$XXX.XX
|
| 11732 |
REMOVE NAIL PLATE ADD-ON
|
$XXX.XX
|
| 11740 |
DRAIN BLOOD FROM UNDER NAIL
|
$XXX.XX
|
| 11750 |
REMOVAL OF NAIL BED
|
$XXX.XX
|
| 11755 |
BIOPSY NAIL UNIT
|
$XXX.XX
|
| 11760 |
REPAIR OF NAIL BED
|
$XXX.XX
|
| 11762 |
RECONSTRUCTION OF NAIL BED
|
$XXX.XX
|
| 11765 |
EXCISION OF NAIL FOLD TOE
|
$XXX.XX
|
| 11770 |
REMOVE PILONIDAL CYST SIMPLE
|
$XXX.XX
|
| 11771 |
REMOVE PILONIDAL CYST EXTEN
|
$XXX.XX
|
| 11772 |
REMOVE PILONIDAL CYST COMPL
|
$XXX.XX
|
| 11900 |
INJECT SKIN LESIONS
|
$XXX.XX
|
| 11901 |
INJECT SKIN LESIONS >7
|
$XXX.XX
|
| 11920 |
CORRECT SKIN COLOR 6.0 CM/<
|
$XXX.XX
|
| 11921 |
CORRECT SKN COLOR 6.1-20.0CM
|
$XXX.XX
|
| 11922 |
CORRECT SKIN COLOR EA 20.0CM
|
$XXX.XX
|
| 11950 |
TX CONTOUR DEFECTS 1 CC/<
|
$XXX.XX
|
| 11951 |
TX CONTOUR DEFECTS 1.1-5.0CC
|
$XXX.XX
|
| 11952 |
TX CONTOUR DEFECTS 5.1-10CC
|
$XXX.XX
|
| 11954 |
TX CONTOUR DEFECTS >10.0 CC
|
$XXX.XX
|
| 11960 |
INSERT TISSUE EXPANDER(S)
|
$XXX.XX
|
| 11970 |
REPLACE TISSUE EXPANDER
|
$XXX.XX
|
| 11971 |
REMOVE TISSUE EXPANDER(S)
|
$XXX.XX
|
| 11976 |
REMOVE CONTRACEPTIVE CAPSULE
|
$XXX.XX
|
| 11980 |
IMPLANT HORMONE PELLET(S)
|
$XXX.XX
|
| 11981 |
INSERT DRUG IMPLANT DEVICE
|
$XXX.XX
|
| 11982 |
REMOVE DRUG IMPLANT DEVICE
|
$XXX.XX
|
| 11983 |
REMOVE/INSERT DRUG IMPLANT
|
$XXX.XX
|
| 12001 |
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
$XXX.XX
|
| 12002 |
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
$XXX.XX
|
| 12004 |
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
$XXX.XX
|
| 12005 |
RPR S/N/A/GEN/TRK12.6-20.0CM
|
$XXX.XX
|
| 12006 |
RPR S/N/A/GEN/TRK20.1-30.0CM
|
$XXX.XX
|
| 12007 |
RPR S/N/AX/GEN/TRNK >30.0 CM
|
$XXX.XX
|
| 12011 |
RPR F/E/E/N/L/M 2.5 CM/<
|
$XXX.XX
|
| 12013 |
RPR F/E/E/N/L/M 2.6-5.0 CM
|
$XXX.XX
|
| 12014 |
RPR F/E/E/N/L/M 5.1-7.5 CM
|
$XXX.XX
|
| 12015 |
RPR F/E/E/N/L/M 7.6-12.5 CM
|
$XXX.XX
|
| 12016 |
RPR FE/E/EN/L/M 12.6-20.0 CM
|
$XXX.XX
|
| 12017 |
RPR FE/E/EN/L/M 20.1-30.0 CM
|
$XXX.XX
|
| 12018 |
RPR F/E/E/N/L/M >30.0 CM
|
$XXX.XX
|
| 12020 |
CLOSURE OF SPLIT WOUND
|
$XXX.XX
|
| 12021 |
CLOSURE OF SPLIT WOUND
|
$XXX.XX
|
| 12031 |
INTMD RPR S/A/T/EXT 2.5 CM/<
|
$XXX.XX
|
| 12032 |
INTMD RPR S/A/T/EXT 2.6-7.5
|
$XXX.XX
|
| 12034 |
INTMD RPR S/TR/EXT 7.6-12.5
|
$XXX.XX
|
| 12035 |
INTMD RPR S/A/T/EXT 12.6-20
|
$XXX.XX
|
| 12036 |
INTMD RPR S/A/T/EXT 20.1-30
|
$XXX.XX
|
| 12037 |
INTMD RPR S/TR/EXT >30.0 CM
|
$XXX.XX
|
| 12041 |
INTMD RPR N-HF/GENIT 2.5CM/<
|
$XXX.XX
|
| 12042 |
INTMD RPR N-HF/GENIT2.6-7.5
|
$XXX.XX
|
| 12044 |
INTMD RPR N-HF/GENIT7.6-12.5
|
$XXX.XX
|
| 12045 |
INTMD RPR N-HF/GENIT12.6-20
|
$XXX.XX
|
| 12046 |
INTMD RPR N-HF/GENIT20.1-30
|
$XXX.XX
|
| 12047 |
INTMD RPR N-HF/GENIT >30.0CM
|
$XXX.XX
|
| 12051 |
INTMD RPR FACE/MM 2.5 CM/<
|
$XXX.XX
|
| 12052 |
INTMD RPR FACE/MM 2.6-5.0 CM
|
$XXX.XX
|
| 12053 |
INTMD RPR FACE/MM 5.1-7.5 CM
|
$XXX.XX
|
| 12054 |
INTMD RPR FACE/MM 7.6-12.5CM
|
$XXX.XX
|
| 12055 |
INTMD RPR FACE/MM 12.6-20 CM
|
$XXX.XX
|
| 12056 |
INTMD RPR FACE/MM 20.1-30.0
|
$XXX.XX
|
| 12057 |
INTMD RPR FACE/MM >30.0 CM
|
$XXX.XX
|
| 13100 |
CMPLX RPR TRUNK 1.1-2.5 CM
|
$XXX.XX
|
| 13101 |
CMPLX RPR TRUNK 2.6-7.5 CM
|
$XXX.XX
|
| 13102 |
CMPLX RPR TRUNK ADDL 5CM/<
|
$XXX.XX
|
| 13120 |
CMPLX RPR S/A/L 1.1-2.5 CM
|
$XXX.XX
|
| 13121 |
CMPLX RPR S/A/L 2.6-7.5 CM
|
$XXX.XX
|
| 13122 |
CMPLX RPR S/A/L ADDL 5 CM/>
|
$XXX.XX
|
| 13131 |
CMPLX RPR F/C/C/M/N/AX/G/H/F
|
$XXX.XX
|
| 13132 |
CMPLX RPR F/C/C/M/N/AX/G/H/F
|
$XXX.XX
|
| 13133 |
CMPLX RPR F/C/C/M/N/AX/G/H/F
|
$XXX.XX
|
| 13151 |
CMPLX RPR E/N/E/L 1.1-2.5 CM
|
$XXX.XX
|
| 13152 |
CMPLX RPR E/N/E/L 2.6-7.5 CM
|
$XXX.XX
|
| 13153 |
CMPLX RPR E/N/E/L ADDL 5CM/<
|
$XXX.XX
|
| 13160 |
LATE CLOSURE OF WOUND
|
$XXX.XX
|
| 14000 |
TIS TRNFR TRUNK 10 SQ CM/<
|
$XXX.XX
|
| 14001 |
TIS TRNFR TRUNK 10.1-30SQCM
|
$XXX.XX
|
| 14020 |
TIS TRNFR S/A/L 10 SQ CM/<
|
$XXX.XX
|
| 14021 |
TIS TRNFR S/A/L 10.1-30 SQCM
|
$XXX.XX
|
| 14040 |
TIS TRNFR F/C/C/M/N/A/G/H/F
|
$XXX.XX
|
| 14041 |
TIS TRNFR F/C/C/M/N/A/G/H/F
|
$XXX.XX
|
| 14060 |
TIS TRNFR E/N/E/L 10 SQ CM/<
|
$XXX.XX
|
| 14061 |
TIS TRNFR E/N/E/L10.1-30SQCM
|
$XXX.XX
|
| 14301 |
TIS TRNFR ANY 30.1-60 SQ CM
|
$XXX.XX
|
| 14302 |
TIS TRNFR ADDL 30 SQ CM
|
$XXX.XX
|
| 14350 |
FILLETED FINGER/TOE FLAP
|
$XXX.XX
|
| 15002 |
WOUND PREP TRK/ARM/LEG
|
$XXX.XX
|
| 15003 |
WOUND PREP ADDL 100 CM
|
$XXX.XX
|
| 15004 |
WOUND PREP F/N/HF/G
|
$XXX.XX
|
| 15005 |
WND PREP F/N/HF/G ADDL CM
|
$XXX.XX
|
| 15040 |
HARVEST CULTURED SKIN GRAFT
|
$XXX.XX
|
| 15050 |
SKIN PINCH GRAFT
|
$XXX.XX
|
| 15100 |
SKIN SPLT GRFT TRNK/ARM/LEG
|
$XXX.XX
|
| 15101 |
SKIN SPLT GRFT T/A/L ADD-ON
|
$XXX.XX
|
| 15110 |
EPIDRM AUTOGRFT TRNK/ARM/LEG
|
$XXX.XX
|
| 15111 |
EPIDRM AUTOGRFT T/A/L ADD-ON
|
$XXX.XX
|
| 15115 |
EPIDRM A-GRFT FACE/NCK/HF/G
|
$XXX.XX
|
| 15116 |
EPIDRM A-GRFT F/N/HF/G ADDL
|
$XXX.XX
|
| 15120 |
SKN SPLT A-GRFT FAC/NCK/HF/G
|
$XXX.XX
|
| 15121 |
SKN SPLT A-GRFT F/N/HF/G ADD
|
$XXX.XX
|
| 15130 |
DERM AUTOGRAFT TRNK/ARM/LEG
|
$XXX.XX
|
| 15131 |
DERM AUTOGRAFT T/A/L ADD-ON
|
$XXX.XX
|
| 15135 |
DERM AUTOGRAFT FACE/NCK/HF/G
|
$XXX.XX
|
| 15136 |
DERM AUTOGRAFT F/N/HF/G ADD
|
$XXX.XX
|
| 15150 |
CULT SKIN GRFT T/ARM/LEG
|
$XXX.XX
|
| 15151 |
CULT SKIN GRFT T/A/L ADDL
|
$XXX.XX
|
| 15152 |
CULT SKIN GRAFT T/A/L +%
|
$XXX.XX
|
| 15155 |
CULT SKIN GRAFT F/N/HF/G
|
$XXX.XX
|
| 15156 |
CULT SKIN GRFT F/N/HFG ADD
|
$XXX.XX
|
| 15157 |
CULT EPIDERM GRFT F/N/HFG +%
|
$XXX.XX
|
| 15200 |
SKIN FULL GRAFT TRUNK
|
$XXX.XX
|
| 15201 |
SKIN FULL GRAFT TRUNK ADD-ON
|
$XXX.XX
|
| 15220 |
SKIN FULL GRAFT SCLP/ARM/LEG
|
$XXX.XX
|
| 15221 |
SKIN FULL GRAFT ADD-ON
|
$XXX.XX
|
| 15240 |
SKIN FULL GRFT FACE/GENIT/HF
|
$XXX.XX
|
| 15241 |
SKIN FULL GRAFT ADD-ON
|
$XXX.XX
|
| 15260 |
SKIN FULL GRAFT EEN & LIPS
|
$XXX.XX
|
| 15261 |
SKIN FULL GRAFT ADD-ON
|
$XXX.XX
|
| 15271 |
SKIN SUB GRAFT TRNK/ARM/LEG
|
$XXX.XX
|
| 15272 |
SKIN SUB GRAFT T/A/L ADD-ON
|
$XXX.XX
|
| 15273 |
SKIN SUB GRFT T/ARM/LG CHILD
|
$XXX.XX
|
| 15274 |
SKN SUB GRFT T/A/L CHILD ADD
|
$XXX.XX
|
| 15275 |
SKIN SUB GRAFT FACE/NK/HF/G
|
$XXX.XX
|
| 15276 |
SKIN SUB GRAFT F/N/HF/G ADDL
|
$XXX.XX
|
| 15277 |
SKN SUB GRFT F/N/HF/G CHILD
|
$XXX.XX
|
| 15278 |
SKN SUB GRFT F/N/HF/G CH ADD
|
$XXX.XX
|
| 15570 |
SKIN PEDICLE FLAP TRUNK
|
$XXX.XX
|
| 15572 |
SKIN PEDICLE FLAP ARMS/LEGS
|
$XXX.XX
|
| 15574 |
PEDCLE FH/CH/CH/M/N/AX/G/H/F
|
$XXX.XX
|
| 15576 |
PEDICLE E/N/E/L/NTRORAL
|
$XXX.XX
|
| 15600 |
DELAY FLAP TRUNK
|
$XXX.XX
|
| 15610 |
DELAY FLAP ARMS/LEGS
|
$XXX.XX
|
| 15620 |
DELAY FLAP F/C/C/N/AX/G/H/F
|
$XXX.XX
|
| 15630 |
DELAY FLAP EYE/NOS/EAR/LIP
|
$XXX.XX
|
| 15650 |
TRANSFER SKIN PEDICLE FLAP
|
$XXX.XX
|
| 15730 |
MDFC FLAP W/PRSRV VASC PEDCL
|
$XXX.XX
|
| 15731 |
FOREHEAD FLAP W/VASC PEDICLE
|
$XXX.XX
|
| 15733 |
MUSC MYOQ/FSCQ FLP H&N PEDCL
|
$XXX.XX
|
| 15734 |
MUSCLE-SKIN GRAFT TRUNK
|
$XXX.XX
|
| 15736 |
MUSCLE-SKIN GRAFT ARM
|
$XXX.XX
|
| 15738 |
MUSCLE-SKIN GRAFT LEG
|
$XXX.XX
|
| 15740 |
ISLAND PEDICLE FLAP GRAFT
|
$XXX.XX
|
| 15750 |
NEUROVASCULAR PEDICLE FLAP
|
$XXX.XX
|
| 15756 |
FREE MYO/SKIN FLAP MICROVASC
|
$XXX.XX
|
| 15757 |
FREE SKIN FLAP MICROVASC
|
$XXX.XX
|
| 15758 |
FREE FASCIAL FLAP MICROVASC
|
$XXX.XX
|
| 15760 |
COMPOSITE SKIN GRAFT
|
$XXX.XX
|
| 15769 |
GRFG AUTOL SOFT TISS DIR EXC
|
$XXX.XX
|
| 15770 |
DERMA-FAT-FASCIA GRAFT
|
$XXX.XX
|
| 15771 |
GRFG AUTOL FAT LIPO 50 CC/<
|
$XXX.XX
|
| 15772 |
GRFG AUTOL FAT LIPO EA ADDL
|
$XXX.XX
|
| 15773 |
GRFG AUTOL FAT LIPO 25 CC/<
|
$XXX.XX
|
| 15774 |
GFRG AUTOL FAT LIPO EA ADDL
|
$XXX.XX
|
| 15775 |
HAIR TRNSPL 1-15 PUNCH GRFTS
|
$XXX.XX
|
| 15776 |
HAIR TRNSPL >15 PUNCH GRAFTS
|
$XXX.XX
|
| 15777 |
ACELLULAR DERM MATRIX IMPLT
|
$XXX.XX
|
| 15780 |
DERMABRASION TOTAL FACE
|
$XXX.XX
|
| 15781 |
DERMABRASION SEGMENTAL FACE
|
$XXX.XX
|
| 15782 |
DERMABRASION OTHER THAN FACE
|
$XXX.XX
|
| 15783 |
DERMABRASION SUPRFL ANY SITE
|
$XXX.XX
|
| 15786 |
ABRASION LESION SINGLE
|
$XXX.XX
|
| 15787 |
ABRASION LESIONS ADD-ON
|
$XXX.XX
|
| 15788 |
CHEMICAL PEEL FACE EPIDERM
|
$XXX.XX
|
| 15789 |
CHEMICAL PEEL FACE DERMAL
|
$XXX.XX
|
| 15792 |
CHEMICAL PEEL NONFACIAL
|
$XXX.XX
|
| 15793 |
CHEMICAL PEEL NONFACIAL
|
$XXX.XX
|
| 15819 |
PLASTIC SURGERY NECK
|
$XXX.XX
|
| 15820 |
REVISION OF LOWER EYELID
|
$XXX.XX
|
| 15821 |
REVISION OF LOWER EYELID
|
$XXX.XX
|
| 15822 |
REVISION OF UPPER EYELID
|
$XXX.XX
|
| 15823 |
REVISION OF UPPER EYELID
|
$XXX.XX
|
| 15830 |
EXC SKIN ABD
|
$XXX.XX
|
| 15832 |
EXCISE EXCESSIVE SKIN THIGH
|
$XXX.XX
|
| 15833 |
EXCISE EXCESSIVE SKIN LEG
|
$XXX.XX
|
| 15834 |
EXCISE EXCESSIVE SKIN HIP
|
$XXX.XX
|
| 15835 |
EXCISE EXCESSIVE SKIN BUTTCK
|
$XXX.XX
|
| 15836 |
EXCISE EXCESSIVE SKIN ARM
|
$XXX.XX
|
| 15837 |
EXCISE EXCESS SKIN ARM/HAND
|
$XXX.XX
|
| 15838 |
EXCISE EXCESS SKIN FAT PAD
|
$XXX.XX
|
| 15839 |
EXCISE EXCESS SKIN & TISSUE
|
$XXX.XX
|
| 15840 |
NERVE PALSY FASCIAL GRAFT
|
$XXX.XX
|
| 15841 |
NERVE PALSY MUSCLE GRAFT
|
$XXX.XX
|
| 15842 |
NERVE PALSY MICROSURG GRAFT
|
$XXX.XX
|
| 15845 |
SKIN AND MUSCLE REPAIR FACE
|
$XXX.XX
|
| 15851 |
REMOVE SUTURES DIFF SURGEON
|
$XXX.XX
|
| 15852 |
DRESSING CHANGE NOT FOR BURN
|
$XXX.XX
|
| 15860 |
TEST FOR BLOOD FLOW IN GRAFT
|
$XXX.XX
|
| 15920 |
REMOVAL OF TAIL BONE ULCER
|
$XXX.XX
|
| 15922 |
REMOVAL OF TAIL BONE ULCER
|
$XXX.XX
|
| 15931 |
REMOVE SACRUM PRESSURE SORE
|
$XXX.XX
|
| 15933 |
REMOVE SACRUM PRESSURE SORE
|
$XXX.XX
|
| 15934 |
REMOVE SACRUM PRESSURE SORE
|
$XXX.XX
|
| 15935 |
REMOVE SACRUM PRESSURE SORE
|
$XXX.XX
|
| 15936 |
REMOVE SACRUM PRESSURE SORE
|
$XXX.XX
|
| 15937 |
REMOVE SACRUM PRESSURE SORE
|
$XXX.XX
|
| 15940 |
REMOVE HIP PRESSURE SORE
|
$XXX.XX
|
| 15941 |
REMOVE HIP PRESSURE SORE
|
$XXX.XX
|
| 15944 |
REMOVE HIP PRESSURE SORE
|
$XXX.XX
|
| 15945 |
REMOVE HIP PRESSURE SORE
|
$XXX.XX
|
| 15946 |
REMOVE HIP PRESSURE SORE
|
$XXX.XX
|
| 15950 |
REMOVE THIGH PRESSURE SORE
|
$XXX.XX
|
| 15951 |
REMOVE THIGH PRESSURE SORE
|
$XXX.XX
|
| 15952 |
REMOVE THIGH PRESSURE SORE
|
$XXX.XX
|
| 15953 |
REMOVE THIGH PRESSURE SORE
|
$XXX.XX
|
| 15956 |
REMOVE THIGH PRESSURE SORE
|
$XXX.XX
|
| 15958 |
REMOVE THIGH PRESSURE SORE
|
$XXX.XX
|
| 16000 |
INITIAL TREATMENT OF BURN(S)
|
$XXX.XX
|
| 16020 |
DRESS/DEBRID P-THICK BURN S
|
$XXX.XX
|
| 16025 |
DRESS/DEBRID P-THICK BURN M
|
$XXX.XX
|
| 16030 |
DRESS/DEBRID P-THICK BURN L
|
$XXX.XX
|
| 16035 |
INCISION OF BURN SCAB INITI
|
$XXX.XX
|
| 16036 |
ESCHAROTOMY ADDL INCISION
|
$XXX.XX
|
| 17000 |
DESTRUCT PREMALG LESION
|
$XXX.XX
|
| 17003 |
DESTRUCT PREMALG LES 2-14
|
$XXX.XX
|
| 17004 |
DESTROY PREMAL LESIONS 15/>
|
$XXX.XX
|
| 17106 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17107 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17108 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17110 |
DESTRUCT B9 LESION 1-14
|
$XXX.XX
|
| 17111 |
DESTRUCT LESION 15 OR MORE
|
$XXX.XX
|
| 17250 |
CHEM CAUT OF GRANLTJ TISSUE
|
$XXX.XX
|
| 17260 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17261 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17262 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17263 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17264 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17266 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17270 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17271 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17272 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17273 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17274 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17276 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17280 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17281 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17282 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17283 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17284 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17286 |
DESTRUCTION OF SKIN LESIONS
|
$XXX.XX
|
| 17311 |
MOHS 1 STAGE H/N/HF/G
|
$XXX.XX
|
| 17312 |
MOHS ADDL STAGE
|
$XXX.XX
|
| 17313 |
MOHS 1 STAGE T/A/L
|
$XXX.XX
|
| 17314 |
MOHS ADDL STAGE T/A/L
|
$XXX.XX
|
| 17315 |
MOHS SURG ADDL BLOCK
|
$XXX.XX
|
| 17340 |
CRYOTHERAPY OF SKIN
|
$XXX.XX
|
| 17360 |
SKIN PEEL THERAPY
|
$XXX.XX
|
| 19000 |
DRAINAGE OF BREAST LESION
|
$XXX.XX
|
| 19001 |
DRAIN BREAST LESION ADD-ON
|
$XXX.XX
|
| 19020 |
INCISION OF BREAST LESION
|
$XXX.XX
|
| 19030 |
INJECTION FOR BREAST X-RAY
|
$XXX.XX
|
| 19081 |
BX BREAST 1ST LESION STRTCTC
|
$XXX.XX
|
| 19082 |
BX BREAST ADD LESION STRTCTC
|
$XXX.XX
|
| 19083 |
BX BREAST 1ST LESION US IMAG
|
$XXX.XX
|
| 19084 |
BX BREAST ADD LESION US IMAG
|
$XXX.XX
|
| 19085 |
BX BREAST 1ST LESION MR IMAG
|
$XXX.XX
|
| 19086 |
BX BREAST ADD LESION MR IMAG
|
$XXX.XX
|
| 19100 |
BX BREAST PERCUT W/O IMAGE
|
$XXX.XX
|
| 19101 |
BIOPSY OF BREAST OPEN
|
$XXX.XX
|
| 19105 |
CRYOSURG ABLATE FA EACH
|
$XXX.XX
|
| 19110 |
NIPPLE EXPLORATION
|
$XXX.XX
|
| 19112 |
EXCISE BREAST DUCT FISTULA
|
$XXX.XX
|
| 19120 |
REMOVAL OF BREAST LESION
|
$XXX.XX
|
| 19125 |
EXCISION BREAST LESION
|
$XXX.XX
|
| 19126 |
EXCISION ADDL BREAST LESION
|
$XXX.XX
|
| 19281 |
PERQ DEVICE BREAST 1ST IMAG
|
$XXX.XX
|
| 19282 |
PERQ DEVICE BREAST EA IMAG
|
$XXX.XX
|
| 19283 |
PERQ DEV BREAST 1ST STRTCTC
|
$XXX.XX
|
| 19284 |
PERQ DEV BREAST ADD STRTCTC
|
$XXX.XX
|
| 19285 |
PERQ DEV BREAST 1ST US IMAG
|
$XXX.XX
|
| 19286 |
PERQ DEV BREAST ADD US IMAG
|
$XXX.XX
|
| 19287 |
PERQ DEV BREAST 1ST MR GUIDE
|
$XXX.XX
|
| 19288 |
PERQ DEV BREAST ADD MR GUIDE
|
$XXX.XX
|
| 19294 |
PREP TUM CAV IORT PRTL MAST
|
$XXX.XX
|
| 19296 |
PLACE PO BREAST CATH FOR RAD
|
$XXX.XX
|
| 19297 |
PLACE BREAST CATH FOR RAD
|
$XXX.XX
|
| 19298 |
PLACE BREAST RAD TUBE/CATHS
|
$XXX.XX
|
| 19300 |
REMOVAL OF BREAST TISSUE
|
$XXX.XX
|
| 19301 |
PARTIAL MASTECTOMY
|
$XXX.XX
|
| 19302 |
P-MASTECTOMY W/LN REMOVAL
|
$XXX.XX
|
| 19303 |
MAST SIMPLE COMPLETE
|
$XXX.XX
|
| 19305 |
MAST RADICAL
|
$XXX.XX
|
| 19306 |
MAST RAD URBAN TYPE
|
$XXX.XX
|
| 19307 |
MAST MOD RAD
|
$XXX.XX
|
| 19316 |
SUSPENSION OF BREAST
|
$XXX.XX
|
| 19318 |
REDUCTION OF LARGE BREAST
|
$XXX.XX
|
| 19324 |
ENLARGE BREAST
|
$XXX.XX
|
| 19325 |
ENLARGE BREAST WITH IMPLANT
|
$XXX.XX
|
| 19328 |
REMOVAL OF BREAST IMPLANT
|
$XXX.XX
|
| 19330 |
REMOVAL OF IMPLANT MATERIAL
|
$XXX.XX
|
| 19340 |
IMMEDIATE BREAST PROSTHESIS
|
$XXX.XX
|
| 19342 |
DELAYED BREAST PROSTHESIS
|
$XXX.XX
|
| 19350 |
BREAST RECONSTRUCTION
|
$XXX.XX
|
| 19355 |
CORRECT INVERTED NIPPLE(S)
|
$XXX.XX
|
| 19357 |
BREAST RECONSTRUCTION
|
$XXX.XX
|
| 19361 |
BREAST RECONSTR W/LAT FLAP
|
$XXX.XX
|
| 19364 |
BREAST RECONSTRUCTION
|
$XXX.XX
|
| 19366 |
BREAST RECONSTRUCTION
|
$XXX.XX
|
| 19367 |
BREAST RECONSTRUCTION
|
$XXX.XX
|
| 19368 |
BREAST RECONSTRUCTION
|
$XXX.XX
|
| 19369 |
BREAST RECONSTRUCTION
|
$XXX.XX
|
| 19370 |
SURGERY OF BREAST CAPSULE
|
$XXX.XX
|
| 19371 |
REMOVAL OF BREAST CAPSULE
|
$XXX.XX
|
| 19380 |
REVISE BREAST RECONSTRUCTION
|
$XXX.XX
|
| 19396 |
DESIGN CUSTOM BREAST IMPLANT
|
$XXX.XX
|
| 20100 |
EXPLORE WOUND NECK
|
$XXX.XX
|
| 20101 |
EXPLORE WOUND CHEST
|
$XXX.XX
|
| 20102 |
EXPLORE WOUND ABDOMEN
|
$XXX.XX
|
| 20103 |
EXPLORE WOUND EXTREMITY
|
$XXX.XX
|
| 20150 |
EXCISE EPIPHYSEAL BAR
|
$XXX.XX
|
| 20200 |
MUSCLE BIOPSY
|
$XXX.XX
|
| 20205 |
DEEP MUSCLE BIOPSY
|
$XXX.XX
|
| 20206 |
NEEDLE BIOPSY MUSCLE
|
$XXX.XX
|
| 20220 |
BONE BIOPSY TROCAR/NEEDLE
|
$XXX.XX
|
| 20225 |
BONE BIOPSY TROCAR/NEEDLE
|
$XXX.XX
|
| 20240 |
BONE BIOPSY OPEN SUPERFICIAL
|
$XXX.XX
|
| 20245 |
BONE BIOPSY OPEN DEEP
|
$XXX.XX
|
| 20250 |
OPEN BONE BIOPSY
|
$XXX.XX
|
| 20251 |
OPEN BONE BIOPSY
|
$XXX.XX
|
| 20500 |
INJECTION OF SINUS TRACT
|
$XXX.XX
|
| 20501 |
INJECT SINUS TRACT FOR X-RAY
|
$XXX.XX
|
| 20520 |
REMOVAL OF FOREIGN BODY
|
$XXX.XX
|
| 20525 |
REMOVAL OF FOREIGN BODY
|
$XXX.XX
|
| 20526 |
THER INJECTION CARP TUNNEL
|
$XXX.XX
|
| 20527 |
INJ DUPUYTREN CORD W/ENZYME
|
$XXX.XX
|
| 20550 |
INJ TENDON SHEATH/LIGAMENT
|
$XXX.XX
|
| 20551 |
INJ TENDON ORIGIN/INSERTION
|
$XXX.XX
|
| 20552 |
INJ TRIGGER POINT 1/2 MUSCL
|
$XXX.XX
|
| 20553 |
INJECT TRIGGER POINTS 3/>
|
$XXX.XX
|
| 20555 |
PLACE NDL MUSC/TIS FOR RT
|
$XXX.XX
|
| 20560 |
NDL INSJ W/O NJX 1 OR 2 MUSC
|
$XXX.XX
|
| 20561 |
NDL INSJ W/O NJX 3+ MUSC
|
$XXX.XX
|
| 20600 |
DRAIN/INJ JOINT/BURSA W/O US
|
$XXX.XX
|
| 20604 |
DRAIN/INJ JOINT/BURSA W/US
|
$XXX.XX
|
| 20605 |
DRAIN/INJ JOINT/BURSA W/O US
|
$XXX.XX
|
| 20606 |
DRAIN/INJ JOINT/BURSA W/US
|
$XXX.XX
|
| 20610 |
DRAIN/INJ JOINT/BURSA W/O US
|
$XXX.XX
|
| 20611 |
DRAIN/INJ JOINT/BURSA W/US
|
$XXX.XX
|
| 20612 |
ASPIRATE/INJ GANGLION CYST
|
$XXX.XX
|
| 20615 |
TREATMENT OF BONE CYST
|
$XXX.XX
|
| 20650 |
INSERT AND REMOVE BONE PIN
|
$XXX.XX
|
| 20660 |
APPLY REM FIXATION DEVICE
|
$XXX.XX
|
| 20661 |
APPLICATION OF HEAD BRACE
|
$XXX.XX
|
| 20662 |
APPLICATION OF PELVIS BRACE
|
$XXX.XX
|
| 20663 |
APPLICATION OF THIGH BRACE
|
$XXX.XX
|
| 20664 |
APPLICATION OF HALO
|
$XXX.XX
|
| 20665 |
REMOVAL OF FIXATION DEVICE
|
$XXX.XX
|
| 20670 |
REMOVAL OF SUPPORT IMPLANT
|
$XXX.XX
|
| 20680 |
REMOVAL OF SUPPORT IMPLANT
|
$XXX.XX
|
| 20690 |
APPLY BONE FIXATION DEVICE
|
$XXX.XX
|
| 20692 |
APPLY BONE FIXATION DEVICE
|
$XXX.XX
|
| 20693 |
ADJUST BONE FIXATION DEVICE
|
$XXX.XX
|
| 20694 |
REMOVE BONE FIXATION DEVICE
|
$XXX.XX
|
| 20696 |
COMP MULTIPLANE EXT FIXATION
|
$XXX.XX
|
| 20697 |
COMP EXT FIXATE STRUT CHANGE
|
$XXX.XX
|
| 20700 |
MNL PREP&INSJ DP RX DLVR DEV
|
$XXX.XX
|
| 20701 |
RMVL DEEP RX DELIVERY DEVICE
|
$XXX.XX
|
| 20702 |
MNL PREP&INSJ IMED RX DEV
|
$XXX.XX
|
| 20703 |
RMVL IMED RX DELIVERY DEVICE
|
$XXX.XX
|
| 20704 |
MNL PREP&INSJ I-ARTIC RX DEV
|
$XXX.XX
|
| 20705 |
RMVL I-ARTIC RX DELIVERY DEV
|
$XXX.XX
|
| 20802 |
REPLANTATION ARM COMPLETE
|
$XXX.XX
|
| 20805 |
REPLANT FOREARM COMPLETE
|
$XXX.XX
|
| 20808 |
REPLANTATION HAND COMPLETE
|
$XXX.XX
|
| 20816 |
REPLANTATION DIGIT COMPLETE
|
$XXX.XX
|
| 20822 |
REPLANTATION DIGIT COMPLETE
|
$XXX.XX
|
| 20824 |
REPLANTATION THUMB COMPLETE
|
$XXX.XX
|
| 20827 |
REPLANTATION THUMB COMPLETE
|
$XXX.XX
|
| 20838 |
REPLANTATION FOOT COMPLETE
|
$XXX.XX
|
| 20900 |
REMOVAL OF BONE FOR GRAFT
|
$XXX.XX
|
| 20902 |
REMOVAL OF BONE FOR GRAFT
|
$XXX.XX
|
| 20910 |
REMOVE CARTILAGE FOR GRAFT
|
$XXX.XX
|
| 20912 |
REMOVE CARTILAGE FOR GRAFT
|
$XXX.XX
|
| 20920 |
REMOVAL OF FASCIA FOR GRAFT
|
$XXX.XX
|
| 20922 |
REMOVAL OF FASCIA FOR GRAFT
|
$XXX.XX
|
| 20924 |
REMOVAL OF TENDON FOR GRAFT
|
$XXX.XX
|
| 20931 |
SP BONE ALGRFT STRUCT ADD-ON
|
$XXX.XX
|
| 20932 |
OSTEOART ALGRFT W/SURF & B1
|
$XXX.XX
|
| 20933 |
HEMICRT INTRCLRY ALGRFT PRTL
|
$XXX.XX
|
| 20934 |
INTERCALARY ALGRFT COMPL
|
$XXX.XX
|
| 20937 |
SP BONE AGRFT MORSEL ADD-ON
|
$XXX.XX
|
| 20938 |
SP BONE AGRFT STRUCT ADD-ON
|
$XXX.XX
|
| 20939 |
BONE MARROW ASPIR BONE GRFG
|
$XXX.XX
|
| 20950 |
FLUID PRESSURE MUSCLE
|
$XXX.XX
|
| 20955 |
FIBULA BONE GRAFT MICROVASC
|
$XXX.XX
|
| 20956 |
ILIAC BONE GRAFT MICROVASC
|
$XXX.XX
|
| 20957 |
MT BONE GRAFT MICROVASC
|
$XXX.XX
|
| 20962 |
OTHER BONE GRAFT MICROVASC
|
$XXX.XX
|
| 20969 |
BONE/SKIN GRAFT MICROVASC
|
$XXX.XX
|
| 20970 |
BONE/SKIN GRAFT ILIAC CREST
|
$XXX.XX
|
| 20972 |
BONE/SKIN GRAFT METATARSAL
|
$XXX.XX
|
| 20973 |
BONE/SKIN GRAFT GREAT TOE
|
$XXX.XX
|
| 20974 |
ELECTRICAL BONE STIMULATION
|
$XXX.XX
|
| 20975 |
ELECTRICAL BONE STIMULATION
|
$XXX.XX
|
| 20979 |
US BONE STIMULATION
|
$XXX.XX
|
| 20982 |
ABLATE BONE TUMOR(S) PERQ
|
$XXX.XX
|
| 20983 |
ABLATE BONE TUMOR(S) PERQ
|
$XXX.XX
|
| 20985 |
CPTR-ASST DIR MS PX
|
$XXX.XX
|
| 21010 |
INCISION OF JAW JOINT
|
$XXX.XX
|
| 21011 |
EXC FACE LES SC <2 CM
|
$XXX.XX
|
| 21012 |
EXC FACE LES SBQ 2 CM/>
|
$XXX.XX
|
| 21013 |
EXC FACE TUM DEEP < 2 CM
|
$XXX.XX
|
| 21014 |
EXC FACE TUM DEEP 2 CM/>
|
$XXX.XX
|
| 21015 |
RESECT FACE/SCALP TUM < 2 CM
|
$XXX.XX
|
| 21016 |
RESECT FACE/SCALP TUM 2 CM/>
|
$XXX.XX
|
| 21025 |
EXCISION OF BONE LOWER JAW
|
$XXX.XX
|
| 21026 |
EXCISION OF FACIAL BONE(S)
|
$XXX.XX
|
| 21029 |
CONTOUR OF FACE BONE LESION
|
$XXX.XX
|
| 21030 |
EXCISE MAX/ZYGOMA B9 TUMOR
|
$XXX.XX
|
| 21031 |
REMOVE EXOSTOSIS MANDIBLE
|
$XXX.XX
|
| 21032 |
REMOVE EXOSTOSIS MAXILLA
|
$XXX.XX
|
| 21034 |
EXCISE MAX/ZYGOMA MAL TUMOR
|
$XXX.XX
|
| 21040 |
EXCISE MANDIBLE LESION
|
$XXX.XX
|
| 21044 |
REMOVAL OF JAW BONE LESION
|
$XXX.XX
|
| 21045 |
EXTENSIVE JAW SURGERY
|
$XXX.XX
|
| 21046 |
REMOVE MANDIBLE CYST COMPLEX
|
$XXX.XX
|
| 21047 |
EXCISE LWR JAW CYST W/REPAIR
|
$XXX.XX
|
| 21048 |
REMOVE MAXILLA CYST COMPLEX
|
$XXX.XX
|
| 21049 |
EXCIS UPPR JAW CYST W/REPAIR
|
$XXX.XX
|
| 21050 |
REMOVAL OF JAW JOINT
|
$XXX.XX
|
| 21060 |
REMOVE JAW JOINT CARTILAGE
|
$XXX.XX
|
| 21070 |
REMOVE CORONOID PROCESS
|
$XXX.XX
|
| 21073 |
MNPJ OF TMJ W/ANESTH
|
$XXX.XX
|
| 21076 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21077 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21079 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21080 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21081 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21082 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21083 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21084 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21085 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21086 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21087 |
PREPARE FACE/ORAL PROSTHESIS
|
$XXX.XX
|
| 21100 |
MAXILLOFACIAL FIXATION
|
$XXX.XX
|
| 21110 |
INTERDENTAL FIXATION
|
$XXX.XX
|
| 21116 |
INJECTION JAW JOINT X-RAY
|
$XXX.XX
|
| 21120 |
RECONSTRUCTION OF CHIN
|
$XXX.XX
|
| 21121 |
RECONSTRUCTION OF CHIN
|
$XXX.XX
|
| 21122 |
RECONSTRUCTION OF CHIN
|
$XXX.XX
|
| 21123 |
RECONSTRUCTION OF CHIN
|
$XXX.XX
|
| 21125 |
AUGMENTATION LOWER JAW BONE
|
$XXX.XX
|
| 21127 |
AUGMENTATION LOWER JAW BONE
|
$XXX.XX
|
| 21137 |
REDUCTION OF FOREHEAD
|
$XXX.XX
|
| 21138 |
REDUCTION OF FOREHEAD
|
$XXX.XX
|
| 21139 |
REDUCTION OF FOREHEAD
|
$XXX.XX
|
| 21141 |
LEFORT I-1 PIECE W/O GRAFT
|
$XXX.XX
|
| 21142 |
LEFORT I-2 PIECE W/O GRAFT
|
$XXX.XX
|
| 21143 |
LEFORT I-3/> PIECE W/O GRAFT
|
$XXX.XX
|
| 21145 |
LEFORT I-1 PIECE W/ GRAFT
|
$XXX.XX
|
| 21146 |
LEFORT I-2 PIECE W/ GRAFT
|
$XXX.XX
|
| 21147 |
LEFORT I-3/> PIECE W/ GRAFT
|
$XXX.XX
|
| 21150 |
LEFORT II ANTERIOR INTRUSION
|
$XXX.XX
|
| 21151 |
LEFORT II W/BONE GRAFTS
|
$XXX.XX
|
| 21154 |
LEFORT III W/O LEFORT I
|
$XXX.XX
|
| 21155 |
LEFORT III W/ LEFORT I
|
$XXX.XX
|
| 21159 |
LEFORT III W/FHDW/O LEFORT I
|
$XXX.XX
|
| 21160 |
LEFORT III W/FHD W/ LEFORT I
|
$XXX.XX
|
| 21172 |
RECONSTRUCT ORBIT/FOREHEAD
|
$XXX.XX
|
| 21175 |
RECONSTRUCT ORBIT/FOREHEAD
|
$XXX.XX
|
| 21179 |
RECONSTRUCT ENTIRE FOREHEAD
|
$XXX.XX
|
| 21180 |
RECONSTRUCT ENTIRE FOREHEAD
|
$XXX.XX
|
| 21181 |
CONTOUR CRANIAL BONE LESION
|
$XXX.XX
|
| 21182 |
RECONSTRUCT CRANIAL BONE
|
$XXX.XX
|
| 21183 |
RECONSTRUCT CRANIAL BONE
|
$XXX.XX
|
| 21184 |
RECONSTRUCT CRANIAL BONE
|
$XXX.XX
|
| 21188 |
RECONSTRUCTION OF MIDFACE
|
$XXX.XX
|
| 21193 |
RECONST LWR JAW W/O GRAFT
|
$XXX.XX
|
| 21194 |
RECONST LWR JAW W/GRAFT
|
$XXX.XX
|
| 21195 |
RECONST LWR JAW W/O FIXATION
|
$XXX.XX
|
| 21196 |
RECONST LWR JAW W/FIXATION
|
$XXX.XX
|
| 21198 |
RECONSTR LWR JAW SEGMENT
|
$XXX.XX
|
| 21199 |
RECONSTR LWR JAW W/ADVANCE
|
$XXX.XX
|
| 21206 |
RECONSTRUCT UPPER JAW BONE
|
$XXX.XX
|
| 21208 |
AUGMENTATION OF FACIAL BONES
|
$XXX.XX
|
| 21209 |
REDUCTION OF FACIAL BONES
|
$XXX.XX
|
| 21210 |
FACE BONE GRAFT
|
$XXX.XX
|
| 21215 |
LOWER JAW BONE GRAFT
|
$XXX.XX
|
| 21230 |
RIB CARTILAGE GRAFT
|
$XXX.XX
|
| 21235 |
EAR CARTILAGE GRAFT
|
$XXX.XX
|
| 21240 |
RECONSTRUCTION OF JAW JOINT
|
$XXX.XX
|
| 21242 |
RECONSTRUCTION OF JAW JOINT
|
$XXX.XX
|
| 21243 |
RECONSTRUCTION OF JAW JOINT
|
$XXX.XX
|
| 21244 |
RECONSTRUCTION OF LOWER JAW
|
$XXX.XX
|
| 21245 |
RECONSTRUCTION OF JAW
|
$XXX.XX
|
| 21246 |
RECONSTRUCTION OF JAW
|
$XXX.XX
|
| 21247 |
RECONSTRUCT LOWER JAW BONE
|
$XXX.XX
|
| 21248 |
RECONSTRUCTION OF JAW
|
$XXX.XX
|
| 21249 |
RECONSTRUCTION OF JAW
|
$XXX.XX
|
| 21255 |
RECONSTRUCT LOWER JAW BONE
|
$XXX.XX
|
| 21256 |
RECONSTRUCTION OF ORBIT
|
$XXX.XX
|
| 21260 |
REVISE EYE SOCKETS
|
$XXX.XX
|
| 21261 |
REVISE EYE SOCKETS
|
$XXX.XX
|
| 21263 |
REVISE EYE SOCKETS
|
$XXX.XX
|
| 21267 |
REVISE EYE SOCKETS
|
$XXX.XX
|
| 21268 |
REVISE EYE SOCKETS
|
$XXX.XX
|
| 21270 |
AUGMENTATION CHEEK BONE
|
$XXX.XX
|
| 21275 |
REVISION ORBITOFACIAL BONES
|
$XXX.XX
|
| 21280 |
REVISION OF EYELID
|
$XXX.XX
|
| 21282 |
REVISION OF EYELID
|
$XXX.XX
|
| 21295 |
REVISION OF JAW MUSCLE/BONE
|
$XXX.XX
|
| 21296 |
REVISION OF JAW MUSCLE/BONE
|
$XXX.XX
|
| 21310 |
CLOSED TX NOSE FX W/O MANJ
|
$XXX.XX
|
| 21315 |
CLOSED TX NOSE FX W/O STABLJ
|
$XXX.XX
|
| 21320 |
CLOSED TX NOSE FX W/ STABLJ
|
$XXX.XX
|
| 21325 |
OPEN TX NOSE FX UNCOMPLICATD
|
$XXX.XX
|
| 21330 |
OPEN TX NOSE FX W/SKELE FIXJ
|
$XXX.XX
|
| 21335 |
OPEN TX NOSE & SEPTAL FX
|
$XXX.XX
|
| 21336 |
OPEN TX SEPTAL FX W/WO STABJ
|
$XXX.XX
|
| 21337 |
CLOSED TX SEPTAL&NOSE FX
|
$XXX.XX
|
| 21338 |
OPEN NASOETHMOID FX W/O FIXJ
|
$XXX.XX
|
| 21339 |
OPEN NASOETHMOID FX W/ FIXJ
|
$XXX.XX
|
| 21340 |
PERQ TX NASOETHMOID FX
|
$XXX.XX
|
| 21343 |
OPEN TX DPRSD FRONT SINUS FX
|
$XXX.XX
|
| 21344 |
OPEN TX COMPL FRONT SINUS FX
|
$XXX.XX
|
| 21345 |
CLOSED TX NOSE/JAW FX
|
$XXX.XX
|
| 21346 |
OPN TX NASOMAX FX W/FIXJ
|
$XXX.XX
|
| 21347 |
OPN TX NASOMAX FX MULTPLE
|
$XXX.XX
|
| 21348 |
OPN TX NASOMAX FX W/GRAFT
|
$XXX.XX
|
| 21355 |
PERQ TX MALAR FRACTURE
|
$XXX.XX
|
| 21356 |
OPN TX DPRSD ZYGOMATIC ARCH
|
$XXX.XX
|
| 21360 |
OPN TX DPRSD MALAR FRACTURE
|
$XXX.XX
|
| 21365 |
OPN TX COMPLX MALAR FX
|
$XXX.XX
|
| 21366 |
OPN TX COMPLX MALAR W/GRFT
|
$XXX.XX
|
| 21385 |
OPN TX ORBIT FX TRANSANTRAL
|
$XXX.XX
|
| 21386 |
OPN TX ORBIT FX PERIORBITAL
|
$XXX.XX
|
| 21387 |
OPN TX ORBIT FX COMBINED
|
$XXX.XX
|
| 21390 |
OPN TX ORBIT PERIORBTL IMPLT
|
$XXX.XX
|
| 21395 |
OPN TX ORBIT PERIORBT W/GRFT
|
$XXX.XX
|
| 21400 |
CLOSED TX ORBIT W/O MANIPULJ
|
$XXX.XX
|
| 21401 |
CLOSED TX ORBIT W/MANIPULJ
|
$XXX.XX
|
| 21406 |
OPN TX ORBIT FX W/O IMPLANT
|
$XXX.XX
|
| 21407 |
OPN TX ORBIT FX W/IMPLANT
|
$XXX.XX
|
| 21408 |
OPN TX ORBIT FX W/BONE GRFT
|
$XXX.XX
|
| 21421 |
TREAT MOUTH ROOF FRACTURE
|
$XXX.XX
|
| 21422 |
TREAT MOUTH ROOF FRACTURE
|
$XXX.XX
|
| 21423 |
TREAT MOUTH ROOF FRACTURE
|
$XXX.XX
|
| 21431 |
TREAT CRANIOFACIAL FRACTURE
|
$XXX.XX
|
| 21432 |
TREAT CRANIOFACIAL FRACTURE
|
$XXX.XX
|
| 21433 |
TREAT CRANIOFACIAL FRACTURE
|
$XXX.XX
|
| 21435 |
TREAT CRANIOFACIAL FRACTURE
|
$XXX.XX
|
| 21436 |
TREAT CRANIOFACIAL FRACTURE
|
$XXX.XX
|
| 21440 |
TREAT DENTAL RIDGE FRACTURE
|
$XXX.XX
|
| 21445 |
TREAT DENTAL RIDGE FRACTURE
|
$XXX.XX
|
| 21450 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21451 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21452 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21453 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21454 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21461 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21462 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21465 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21470 |
TREAT LOWER JAW FRACTURE
|
$XXX.XX
|
| 21480 |
RESET DISLOCATED JAW
|
$XXX.XX
|
| 21485 |
RESET DISLOCATED JAW
|
$XXX.XX
|
| 21490 |
REPAIR DISLOCATED JAW
|
$XXX.XX
|
| 21497 |
INTERDENTAL WIRING
|
$XXX.XX
|
| 21501 |
DRAIN NECK/CHEST LESION
|
$XXX.XX
|
| 21502 |
DRAIN CHEST LESION
|
$XXX.XX
|
| 21510 |
DRAINAGE OF BONE LESION
|
$XXX.XX
|
| 21550 |
BIOPSY OF NECK/CHEST
|
$XXX.XX
|
| 21552 |
EXC NECK LES SC 3 CM/>
|
$XXX.XX
|
| 21554 |
EXC NECK TUM DEEP 5 CM/>
|
$XXX.XX
|
| 21555 |
EXC NECK LES SC < 3 CM
|
$XXX.XX
|
| 21556 |
EXC NECK TUM DEEP < 5 CM
|
$XXX.XX
|
| 21557 |
RESECT NECK THORAX TUMOR<5CM
|
$XXX.XX
|
| 21558 |
RESECT NECK TUMOR 5 CM/>
|
$XXX.XX
|
| 21600 |
PARTIAL REMOVAL OF RIB
|
$XXX.XX
|
| 21601 |
EXC CHEST WALL TUMOR W/RIBS
|
$XXX.XX
|
| 21602 |
EXC CH WAL TUM W/O LYMPHADEC
|
$XXX.XX
|
| 21603 |
EXC CH WAL TUM W/LYMPHADEC
|
$XXX.XX
|
| 21610 |
PARTIAL REMOVAL OF RIB
|
$XXX.XX
|
| 21615 |
REMOVAL OF RIB
|
$XXX.XX
|
| 21616 |
REMOVAL OF RIB AND NERVES
|
$XXX.XX
|
| 21620 |
PARTIAL REMOVAL OF STERNUM
|
$XXX.XX
|
| 21627 |
STERNAL DEBRIDEMENT
|
$XXX.XX
|
| 21630 |
EXTENSIVE STERNUM SURGERY
|
$XXX.XX
|
| 21632 |
EXTENSIVE STERNUM SURGERY
|
$XXX.XX
|
| 21685 |
HYOID MYOTOMY & SUSPENSION
|
$XXX.XX
|
| 21700 |
REVISION OF NECK MUSCLE
|
$XXX.XX
|
| 21705 |
REVISION OF NECK MUSCLE/RIB
|
$XXX.XX
|
| 21720 |
REVISION OF NECK MUSCLE
|
$XXX.XX
|
| 21725 |
REVISION OF NECK MUSCLE
|
$XXX.XX
|
| 21740 |
RECONSTRUCTION OF STERNUM
|
$XXX.XX
|
| 21750 |
REPAIR OF STERNUM SEPARATION
|
$XXX.XX
|
| 21811 |
OPTX OF RIB FX W/FIXJ SCOPE
|
$XXX.XX
|
| 21812 |
TREATMENT OF RIB FRACTURE
|
$XXX.XX
|
| 21813 |
TREATMENT OF RIB FRACTURE
|
$XXX.XX
|
| 21820 |
TREAT STERNUM FRACTURE
|
$XXX.XX
|
| 21825 |
TREAT STERNUM FRACTURE
|
$XXX.XX
|
| 21920 |
BIOPSY SOFT TISSUE OF BACK
|
$XXX.XX
|
| 21925 |
BIOPSY SOFT TISSUE OF BACK
|
$XXX.XX
|
| 21930 |
EXC BACK LES SC < 3 CM
|
$XXX.XX
|
| 21931 |
EXC BACK LES SC 3 CM/>
|
$XXX.XX
|
| 21932 |
EXC BACK TUM DEEP < 5 CM
|
$XXX.XX
|
| 21933 |
EXC BACK TUM DEEP 5 CM/>
|
$XXX.XX
|
| 21935 |
RESECT BACK TUM < 5 CM
|
$XXX.XX
|
| 21936 |
RESECT BACK TUM 5 CM/>
|
$XXX.XX
|
| 22010 |
I&D P-SPINE C/T/CERV-THOR
|
$XXX.XX
|
| 22015 |
I&D ABSCESS P-SPINE L/S/LS
|
$XXX.XX
|
| 22100 |
REMOVE PART OF NECK VERTEBRA
|
$XXX.XX
|
| 22101 |
REMOVE PART THORAX VERTEBRA
|
$XXX.XX
|
| 22102 |
REMOVE PART LUMBAR VERTEBRA
|
$XXX.XX
|
| 22103 |
REMOVE EXTRA SPINE SEGMENT
|
$XXX.XX
|
| 22110 |
REMOVE PART OF NECK VERTEBRA
|
$XXX.XX
|
| 22112 |
REMOVE PART THORAX VERTEBRA
|
$XXX.XX
|
| 22114 |
REMOVE PART LUMBAR VERTEBRA
|
$XXX.XX
|
| 22116 |
REMOVE EXTRA SPINE SEGMENT
|
$XXX.XX
|
| 22206 |
INCIS SPINE 3 COLUMN THORAC
|
$XXX.XX
|
| 22207 |
INCIS SPINE 3 COLUMN LUMBAR
|
$XXX.XX
|
| 22208 |
INCIS SPINE 3 COLUMN ADL SEG
|
$XXX.XX
|
| 22210 |
INCIS 1 VERTEBRAL SEG CERV
|
$XXX.XX
|
| 22212 |
INCIS 1 VERTEBRAL SEG THORAC
|
$XXX.XX
|
| 22214 |
INCIS 1 VERTEBRAL SEG LUMBAR
|
$XXX.XX
|
| 22216 |
INCIS ADDL SPINE SEGMENT
|
$XXX.XX
|
| 22220 |
INCIS W/DISCECTOMY CERVICAL
|
$XXX.XX
|
| 22222 |
INCIS W/DISCECTOMY THORACIC
|
$XXX.XX
|
| 22224 |
INCIS W/DISCECTOMY LUMBAR
|
$XXX.XX
|
| 22226 |
REVISE EXTRA SPINE SEGMENT
|
$XXX.XX
|
| 22310 |
CLOSED TX VERT FX W/O MANJ
|
$XXX.XX
|
| 22315 |
CLOSED TX VERT FX W/MANJ
|
$XXX.XX
|
| 22318 |
TREAT ODONTOID FX W/O GRAFT
|
$XXX.XX
|
| 22319 |
TREAT ODONTOID FX W/GRAFT
|
$XXX.XX
|
| 22325 |
TREAT SPINE FRACTURE
|
$XXX.XX
|
| 22326 |
TREAT NECK SPINE FRACTURE
|
$XXX.XX
|
| 22327 |
TREAT THORAX SPINE FRACTURE
|
$XXX.XX
|
| 22328 |
TREAT EACH ADD SPINE FX
|
$XXX.XX
|
| 22505 |
MANIPULATION OF SPINE
|
$XXX.XX
|
| 22510 |
PERQ CERVICOTHORACIC INJECT
|
$XXX.XX
|
| 22511 |
PERQ LUMBOSACRAL INJECTION
|
$XXX.XX
|
| 22512 |
VERTEBROPLASTY ADDL INJECT
|
$XXX.XX
|
| 22513 |
PERQ VERTEBRAL AUGMENTATION
|
$XXX.XX
|
| 22514 |
PERQ VERTEBRAL AUGMENTATION
|
$XXX.XX
|
| 22515 |
PERQ VERTEBRAL AUGMENTATION
|
$XXX.XX
|
| 22532 |
LAT THORAX SPINE FUSION
|
$XXX.XX
|
| 22533 |
LAT LUMBAR SPINE FUSION
|
$XXX.XX
|
| 22534 |
LAT THOR/LUMB ADDL SEG
|
$XXX.XX
|
| 22548 |
NECK SPINE FUSION
|
$XXX.XX
|
| 22551 |
NECK SPINE FUSE&REMOV BEL C2
|
$XXX.XX
|
| 22552 |
ADDL NECK SPINE FUSION
|
$XXX.XX
|
| 22554 |
NECK SPINE FUSION
|
$XXX.XX
|
| 22556 |
THORAX SPINE FUSION
|
$XXX.XX
|
| 22558 |
LUMBAR SPINE FUSION
|
$XXX.XX
|
| 22585 |
ADDITIONAL SPINAL FUSION
|
$XXX.XX
|
| 22586 |
PRESCRL FUSE W/ INSTR L5-S1
|
$XXX.XX
|
| 22590 |
SPINE & SKULL SPINAL FUSION
|
$XXX.XX
|
| 22595 |
NECK SPINAL FUSION
|
$XXX.XX
|
| 22600 |
NECK SPINE FUSION
|
$XXX.XX
|
| 22610 |
THORAX SPINE FUSION
|
$XXX.XX
|
| 22612 |
LUMBAR SPINE FUSION
|
$XXX.XX
|
| 22614 |
SPINE FUSION EXTRA SEGMENT
|
$XXX.XX
|
| 22630 |
LUMBAR SPINE FUSION
|
$XXX.XX
|
| 22632 |
SPINE FUSION EXTRA SEGMENT
|
$XXX.XX
|
| 22633 |
LUMBAR SPINE FUSION COMBINED
|
$XXX.XX
|
| 22634 |
SPINE FUSION EXTRA SEGMENT
|
$XXX.XX
|
| 22800 |
POST FUSION
|
$XXX.XX
|
| 22802 |
POST FUSION 7-12 VERT SEG
|
$XXX.XX
|
| 22804 |
POST FUSION 13/> VERT SEG
|
$XXX.XX
|
| 22808 |
ANT FUSION 2-3 VERT SEG
|
$XXX.XX
|
| 22810 |
ANT FUSION 4-7 VERT SEG
|
$XXX.XX
|
| 22812 |
ANT FUSION 8/> VERT SEG
|
$XXX.XX
|
| 22818 |
KYPHECTOMY 1-2 SEGMENTS
|
$XXX.XX
|
| 22819 |
KYPHECTOMY 3 OR MORE
|
$XXX.XX
|
| 22830 |
EXPLORATION OF SPINAL FUSION
|
$XXX.XX
|
| 22840 |
INSERT SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22842 |
INSERT SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22843 |
INSERT SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22844 |
INSERT SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22845 |
INSERT SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22846 |
INSERT SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22847 |
INSERT SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22848 |
INSERT PELV FIXATION DEVICE
|
$XXX.XX
|
| 22849 |
REINSERT SPINAL FIXATION
|
$XXX.XX
|
| 22850 |
REMOVE SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22852 |
REMOVE SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22853 |
INSJ BIOMECHANICAL DEVICE
|
$XXX.XX
|
| 22854 |
INSJ BIOMECHANICAL DEVICE
|
$XXX.XX
|
| 22855 |
REMOVE SPINE FIXATION DEVICE
|
$XXX.XX
|
| 22856 |
CERV ARTIFIC DISKECTOMY
|
$XXX.XX
|
| 22857 |
LUMBAR ARTIF DISKECTOMY
|
$XXX.XX
|
| 22858 |
SECOND LEVEL CER DISKECTOMY
|
$XXX.XX
|
| 22859 |
INSJ BIOMECHANICAL DEVICE
|
$XXX.XX
|
| 22861 |
REVISE CERV ARTIFIC DISC
|
$XXX.XX
|
| 22862 |
REVISE LUMBAR ARTIF DISC
|
$XXX.XX
|
| 22864 |
REMOVE CERV ARTIF DISC
|
$XXX.XX
|
| 22865 |
REMOVE LUMB ARTIF DISC
|
$XXX.XX
|
| 22867 |
INSJ STABLJ DEV W/DCMPRN
|
$XXX.XX
|
| 22868 |
INSJ STABLJ DEV W/DCMPRN
|
$XXX.XX
|
| 22869 |
INSJ STABLJ DEV W/O DCMPRN
|
$XXX.XX
|
| 22870 |
INSJ STABLJ DEV W/O DCMPRN
|
$XXX.XX
|
| 22900 |
EXC ABDL TUM DEEP < 5 CM
|
$XXX.XX
|
| 22901 |
EXC ABDL TUM DEEP 5 CM/>
|
$XXX.XX
|
| 22902 |
EXC ABD LES SC < 3 CM
|
$XXX.XX
|
| 22903 |
EXC ABD LES SC 3 CM/>
|
$XXX.XX
|
| 22904 |
RADICAL RESECT ABD TUMOR<5CM
|
$XXX.XX
|
| 22905 |
RAD RESECT ABD TUMOR 5 CM/>
|
$XXX.XX
|
| 23000 |
REMOVAL OF CALCIUM DEPOSITS
|
$XXX.XX
|
| 23020 |
RELEASE SHOULDER JOINT
|
$XXX.XX
|
| 23030 |
DRAIN SHOULDER LESION
|
$XXX.XX
|
| 23031 |
DRAIN SHOULDER BURSA
|
$XXX.XX
|
| 23035 |
DRAIN SHOULDER BONE LESION
|
$XXX.XX
|
| 23040 |
EXPLORATORY SHOULDER SURGERY
|
$XXX.XX
|
| 23044 |
EXPLORATORY SHOULDER SURGERY
|
$XXX.XX
|
| 23065 |
BIOPSY SHOULDER TISSUES
|
$XXX.XX
|
| 23066 |
BIOPSY SHOULDER TISSUES
|
$XXX.XX
|
| 23071 |
EXC SHOULDER LES SC 3 CM/>
|
$XXX.XX
|
| 23073 |
EXC SHOULDER TUM DEEP 5 CM/>
|
$XXX.XX
|
| 23075 |
EXC SHOULDER LES SC < 3 CM
|
$XXX.XX
|
| 23076 |
EXC SHOULDER TUM DEEP < 5 CM
|
$XXX.XX
|
| 23077 |
RESECT SHOULDER TUMOR < 5 CM
|
$XXX.XX
|
| 23078 |
RESECT SHOULDER TUMOR 5 CM/>
|
$XXX.XX
|
| 23100 |
BIOPSY OF SHOULDER JOINT
|
$XXX.XX
|
| 23101 |
SHOULDER JOINT SURGERY
|
$XXX.XX
|
| 23105 |
REMOVE SHOULDER JOINT LINING
|
$XXX.XX
|
| 23106 |
INCISION OF COLLARBONE JOINT
|
$XXX.XX
|
| 23107 |
EXPLORE TREAT SHOULDER JOINT
|
$XXX.XX
|
| 23120 |
PARTIAL REMOVAL COLLAR BONE
|
$XXX.XX
|
| 23125 |
REMOVAL OF COLLAR BONE
|
$XXX.XX
|
| 23130 |
REMOVE SHOULDER BONE PART
|
$XXX.XX
|
| 23140 |
REMOVAL OF BONE LESION
|
$XXX.XX
|
| 23145 |
REMOVAL OF BONE LESION
|
$XXX.XX
|
| 23146 |
REMOVAL OF BONE LESION
|
$XXX.XX
|
| 23150 |
REMOVAL OF HUMERUS LESION
|
$XXX.XX
|
| 23155 |
REMOVAL OF HUMERUS LESION
|
$XXX.XX
|
| 23156 |
REMOVAL OF HUMERUS LESION
|
$XXX.XX
|
| 23170 |
REMOVE COLLAR BONE LESION
|
$XXX.XX
|
| 23172 |
REMOVE SHOULDER BLADE LESION
|
$XXX.XX
|
| 23174 |
REMOVE HUMERUS LESION
|
$XXX.XX
|
| 23180 |
REMOVE COLLAR BONE LESION
|
$XXX.XX
|
| 23182 |
REMOVE SHOULDER BLADE LESION
|
$XXX.XX
|
| 23184 |
REMOVE HUMERUS LESION
|
$XXX.XX
|
| 23190 |
PARTIAL REMOVAL OF SCAPULA
|
$XXX.XX
|
| 23195 |
REMOVAL OF HEAD OF HUMERUS
|
$XXX.XX
|
| 23200 |
RESECT CLAVICLE TUMOR
|
$XXX.XX
|
| 23210 |
RESECT SCAPULA TUMOR
|
$XXX.XX
|
| 23220 |
RESECT PROX HUMERUS TUMOR
|
$XXX.XX
|
| 23330 |
REMOVE SHOULDER FOREIGN BODY
|
$XXX.XX
|
| 23333 |
REMOVE SHOULDER FB DEEP
|
$XXX.XX
|
| 23334 |
SHOULDER PROSTHESIS REMOVAL
|
$XXX.XX
|
| 23335 |
SHOULDER PROSTHESIS REMOVAL
|
$XXX.XX
|
| 23350 |
INJECTION FOR SHOULDER X-RAY
|
$XXX.XX
|
| 23395 |
MUSCLE TRANSFER SHOULDER/ARM
|
$XXX.XX
|
| 23397 |
MUSCLE TRANSFERS
|
$XXX.XX
|
| 23400 |
FIXATION OF SHOULDER BLADE
|
$XXX.XX
|
| 23405 |
INCISION OF TENDON & MUSCLE
|
$XXX.XX
|
| 23406 |
INCISE TENDON(S) & MUSCLE(S)
|
$XXX.XX
|
| 23410 |
REPAIR ROTATOR CUFF ACUTE
|
$XXX.XX
|
| 23412 |
REPAIR ROTATOR CUFF CHRONIC
|
$XXX.XX
|
| 23415 |
RELEASE OF SHOULDER LIGAMENT
|
$XXX.XX
|
| 23420 |
REPAIR OF SHOULDER
|
$XXX.XX
|
| 23430 |
REPAIR BICEPS TENDON
|
$XXX.XX
|
| 23440 |
REMOVE/TRANSPLANT TENDON
|
$XXX.XX
|
| 23450 |
REPAIR SHOULDER CAPSULE
|
$XXX.XX
|
| 23455 |
REPAIR SHOULDER CAPSULE
|
$XXX.XX
|
| 23460 |
REPAIR SHOULDER CAPSULE
|
$XXX.XX
|
| 23462 |
REPAIR SHOULDER CAPSULE
|
$XXX.XX
|
| 23465 |
REPAIR SHOULDER CAPSULE
|
$XXX.XX
|
| 23466 |
REPAIR SHOULDER CAPSULE
|
$XXX.XX
|
| 23470 |
RECONSTRUCT SHOULDER JOINT
|
$XXX.XX
|
| 23472 |
RECONSTRUCT SHOULDER JOINT
|
$XXX.XX
|
| 23473 |
REVIS RECONST SHOULDER JOINT
|
$XXX.XX
|
| 23474 |
REVIS RECONST SHOULDER JOINT
|
$XXX.XX
|
| 23480 |
REVISION OF COLLAR BONE
|
$XXX.XX
|
| 23485 |
REVISION OF COLLAR BONE
|
$XXX.XX
|
| 23490 |
REINFORCE CLAVICLE
|
$XXX.XX
|
| 23491 |
REINFORCE SHOULDER BONES
|
$XXX.XX
|
| 23500 |
TREAT CLAVICLE FRACTURE
|
$XXX.XX
|
| 23505 |
TREAT CLAVICLE FRACTURE
|
$XXX.XX
|
| 23515 |
TREAT CLAVICLE FRACTURE
|
$XXX.XX
|
| 23520 |
TREAT CLAVICLE DISLOCATION
|
$XXX.XX
|
| 23525 |
TREAT CLAVICLE DISLOCATION
|
$XXX.XX
|
| 23530 |
TREAT CLAVICLE DISLOCATION
|
$XXX.XX
|
| 23532 |
TREAT CLAVICLE DISLOCATION
|
$XXX.XX
|
| 23540 |
TREAT CLAVICLE DISLOCATION
|
$XXX.XX
|
| 23545 |
TREAT CLAVICLE DISLOCATION
|
$XXX.XX
|
| 23550 |
TREAT CLAVICLE DISLOCATION
|
$XXX.XX
|
| 23552 |
TREAT CLAVICLE DISLOCATION
|
$XXX.XX
|
| 23570 |
TREAT SHOULDER BLADE FX
|
$XXX.XX
|
| 23575 |
TREAT SHOULDER BLADE FX
|
$XXX.XX
|
| 23585 |
TREAT SCAPULA FRACTURE
|
$XXX.XX
|
| 23600 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 23605 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 23615 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 23616 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 23620 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 23625 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 23630 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 23650 |
TREAT SHOULDER DISLOCATION
|
$XXX.XX
|
| 23655 |
TREAT SHOULDER DISLOCATION
|
$XXX.XX
|
| 23660 |
TREAT SHOULDER DISLOCATION
|
$XXX.XX
|
| 23665 |
TREAT DISLOCATION/FRACTURE
|
$XXX.XX
|
| 23670 |
TREAT DISLOCATION/FRACTURE
|
$XXX.XX
|
| 23675 |
TREAT DISLOCATION/FRACTURE
|
$XXX.XX
|
| 23680 |
TREAT DISLOCATION/FRACTURE
|
$XXX.XX
|
| 23700 |
FIXATION OF SHOULDER
|
$XXX.XX
|
| 23800 |
FUSION OF SHOULDER JOINT
|
$XXX.XX
|
| 23802 |
FUSION OF SHOULDER JOINT
|
$XXX.XX
|
| 23900 |
AMPUTATION OF ARM & GIRDLE
|
$XXX.XX
|
| 23920 |
AMPUTATION AT SHOULDER JOINT
|
$XXX.XX
|
| 23921 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 23930 |
DRAINAGE OF ARM LESION
|
$XXX.XX
|
| 23931 |
DRAINAGE OF ARM BURSA
|
$XXX.XX
|
| 23935 |
DRAIN ARM/ELBOW BONE LESION
|
$XXX.XX
|
| 24000 |
EXPLORATORY ELBOW SURGERY
|
$XXX.XX
|
| 24006 |
RELEASE ELBOW JOINT
|
$XXX.XX
|
| 24065 |
BIOPSY ARM/ELBOW SOFT TISSUE
|
$XXX.XX
|
| 24066 |
BIOPSY ARM/ELBOW SOFT TISSUE
|
$XXX.XX
|
| 24071 |
EXC ARM/ELBOW LES SC 3 CM/>
|
$XXX.XX
|
| 24073 |
EX ARM/ELBOW TUM DEEP 5 CM/>
|
$XXX.XX
|
| 24075 |
EXC ARM/ELBOW LES SC < 3 CM
|
$XXX.XX
|
| 24076 |
EX ARM/ELBOW TUM DEEP < 5 CM
|
$XXX.XX
|
| 24077 |
RESECT ARM/ELBOW TUM < 5 CM
|
$XXX.XX
|
| 24079 |
RESECT ARM/ELBOW TUM 5 CM/>
|
$XXX.XX
|
| 24100 |
BIOPSY ELBOW JOINT LINING
|
$XXX.XX
|
| 24101 |
EXPLORE/TREAT ELBOW JOINT
|
$XXX.XX
|
| 24102 |
REMOVE ELBOW JOINT LINING
|
$XXX.XX
|
| 24105 |
REMOVAL OF ELBOW BURSA
|
$XXX.XX
|
| 24110 |
REMOVE HUMERUS LESION
|
$XXX.XX
|
| 24115 |
REMOVE/GRAFT BONE LESION
|
$XXX.XX
|
| 24116 |
REMOVE/GRAFT BONE LESION
|
$XXX.XX
|
| 24120 |
REMOVE ELBOW LESION
|
$XXX.XX
|
| 24125 |
REMOVE/GRAFT BONE LESION
|
$XXX.XX
|
| 24126 |
REMOVE/GRAFT BONE LESION
|
$XXX.XX
|
| 24130 |
REMOVAL OF HEAD OF RADIUS
|
$XXX.XX
|
| 24134 |
REMOVAL OF ARM BONE LESION
|
$XXX.XX
|
| 24136 |
REMOVE RADIUS BONE LESION
|
$XXX.XX
|
| 24138 |
REMOVE ELBOW BONE LESION
|
$XXX.XX
|
| 24140 |
PARTIAL REMOVAL OF ARM BONE
|
$XXX.XX
|
| 24145 |
PARTIAL REMOVAL OF RADIUS
|
$XXX.XX
|
| 24147 |
PARTIAL REMOVAL OF ELBOW
|
$XXX.XX
|
| 24149 |
RADICAL RESECTION OF ELBOW
|
$XXX.XX
|
| 24150 |
RESECT DISTAL HUMERUS TUMOR
|
$XXX.XX
|
| 24152 |
RESECT RADIUS TUMOR
|
$XXX.XX
|
| 24155 |
REMOVAL OF ELBOW JOINT
|
$XXX.XX
|
| 24160 |
REMOVE ELBOW JOINT IMPLANT
|
$XXX.XX
|
| 24164 |
REMOVE RADIUS HEAD IMPLANT
|
$XXX.XX
|
| 24200 |
REMOVAL OF ARM FOREIGN BODY
|
$XXX.XX
|
| 24201 |
REMOVAL OF ARM FOREIGN BODY
|
$XXX.XX
|
| 24220 |
INJECTION FOR ELBOW X-RAY
|
$XXX.XX
|
| 24300 |
MANIPULATE ELBOW W/ANESTH
|
$XXX.XX
|
| 24301 |
MUSCLE/TENDON TRANSFER
|
$XXX.XX
|
| 24305 |
ARM TENDON LENGTHENING
|
$XXX.XX
|
| 24310 |
REVISION OF ARM TENDON
|
$XXX.XX
|
| 24320 |
REPAIR OF ARM TENDON
|
$XXX.XX
|
| 24330 |
REVISION OF ARM MUSCLES
|
$XXX.XX
|
| 24331 |
REVISION OF ARM MUSCLES
|
$XXX.XX
|
| 24332 |
TENOLYSIS TRICEPS
|
$XXX.XX
|
| 24340 |
REPAIR OF BICEPS TENDON
|
$XXX.XX
|
| 24341 |
REPAIR ARM TENDON/MUSCLE
|
$XXX.XX
|
| 24342 |
REPAIR OF RUPTURED TENDON
|
$XXX.XX
|
| 24343 |
REPR ELBOW LAT LIGMNT W/TISS
|
$XXX.XX
|
| 24344 |
RECONSTRUCT ELBOW LAT LIGMNT
|
$XXX.XX
|
| 24345 |
REPR ELBW MED LIGMNT W/TISSU
|
$XXX.XX
|
| 24346 |
RECONSTRUCT ELBOW MED LIGMNT
|
$XXX.XX
|
| 24357 |
REPAIR ELBOW PERC
|
$XXX.XX
|
| 24358 |
REPAIR ELBOW W/DEB OPEN
|
$XXX.XX
|
| 24359 |
REPAIR ELBOW DEB/ATTCH OPEN
|
$XXX.XX
|
| 24360 |
RECONSTRUCT ELBOW JOINT
|
$XXX.XX
|
| 24361 |
RECONSTRUCT ELBOW JOINT
|
$XXX.XX
|
| 24362 |
RECONSTRUCT ELBOW JOINT
|
$XXX.XX
|
| 24363 |
REPLACE ELBOW JOINT
|
$XXX.XX
|
| 24365 |
RECONSTRUCT HEAD OF RADIUS
|
$XXX.XX
|
| 24366 |
RECONSTRUCT HEAD OF RADIUS
|
$XXX.XX
|
| 24370 |
REVISE RECONST ELBOW JOINT
|
$XXX.XX
|
| 24371 |
REVISE RECONST ELBOW JOINT
|
$XXX.XX
|
| 24400 |
REVISION OF HUMERUS
|
$XXX.XX
|
| 24410 |
REVISION OF HUMERUS
|
$XXX.XX
|
| 24420 |
REVISION OF HUMERUS
|
$XXX.XX
|
| 24430 |
REPAIR OF HUMERUS
|
$XXX.XX
|
| 24435 |
REPAIR HUMERUS WITH GRAFT
|
$XXX.XX
|
| 24470 |
REVISION OF ELBOW JOINT
|
$XXX.XX
|
| 24495 |
DECOMPRESSION OF FOREARM
|
$XXX.XX
|
| 24498 |
REINFORCE HUMERUS
|
$XXX.XX
|
| 24500 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24505 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24515 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24516 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24530 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24535 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24538 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24545 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24546 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24560 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24565 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24566 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24575 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24576 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24577 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24579 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24582 |
TREAT HUMERUS FRACTURE
|
$XXX.XX
|
| 24586 |
TREAT ELBOW FRACTURE
|
$XXX.XX
|
| 24587 |
TREAT ELBOW FRACTURE
|
$XXX.XX
|
| 24600 |
TREAT ELBOW DISLOCATION
|
$XXX.XX
|
| 24605 |
TREAT ELBOW DISLOCATION
|
$XXX.XX
|
| 24615 |
TREAT ELBOW DISLOCATION
|
$XXX.XX
|
| 24620 |
TREAT ELBOW FRACTURE
|
$XXX.XX
|
| 24635 |
TREAT ELBOW FRACTURE
|
$XXX.XX
|
| 24640 |
TREAT ELBOW DISLOCATION
|
$XXX.XX
|
| 24650 |
TREAT RADIUS FRACTURE
|
$XXX.XX
|
| 24655 |
TREAT RADIUS FRACTURE
|
$XXX.XX
|
| 24665 |
TREAT RADIUS FRACTURE
|
$XXX.XX
|
| 24666 |
TREAT RADIUS FRACTURE
|
$XXX.XX
|
| 24670 |
TREAT ULNAR FRACTURE
|
$XXX.XX
|
| 24675 |
TREAT ULNAR FRACTURE
|
$XXX.XX
|
| 24685 |
TREAT ULNAR FRACTURE
|
$XXX.XX
|
| 24800 |
FUSION OF ELBOW JOINT
|
$XXX.XX
|
| 24802 |
FUSION/GRAFT OF ELBOW JOINT
|
$XXX.XX
|
| 24900 |
AMPUTATION OF UPPER ARM
|
$XXX.XX
|
| 24920 |
AMPUTATION OF UPPER ARM
|
$XXX.XX
|
| 24925 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 24930 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 24931 |
AMPUTATE UPPER ARM & IMPLANT
|
$XXX.XX
|
| 24935 |
REVISION OF AMPUTATION
|
$XXX.XX
|
| 25000 |
INCISION OF TENDON SHEATH
|
$XXX.XX
|
| 25001 |
INCISE FLEXOR CARPI RADIALIS
|
$XXX.XX
|
| 25020 |
DECOMPRESS FOREARM 1 SPACE
|
$XXX.XX
|
| 25023 |
DECOMPRESS FOREARM 1 SPACE
|
$XXX.XX
|
| 25024 |
DECOMPRESS FOREARM 2 SPACES
|
$XXX.XX
|
| 25025 |
DECOMPRESS FOREARM 2 SPACES
|
$XXX.XX
|
| 25028 |
DRAINAGE OF FOREARM LESION
|
$XXX.XX
|
| 25031 |
DRAINAGE OF FOREARM BURSA
|
$XXX.XX
|
| 25035 |
TREAT FOREARM BONE LESION
|
$XXX.XX
|
| 25040 |
EXPLORE/TREAT WRIST JOINT
|
$XXX.XX
|
| 25065 |
BIOPSY FOREARM SOFT TISSUES
|
$XXX.XX
|
| 25066 |
BIOPSY FOREARM SOFT TISSUES
|
$XXX.XX
|
| 25071 |
EXC FOREARM LES SC 3 CM/>
|
$XXX.XX
|
| 25073 |
EXC FOREARM TUM DEEP 3 CM/>
|
$XXX.XX
|
| 25075 |
EXC FOREARM LES SC < 3 CM
|
$XXX.XX
|
| 25076 |
EXC FOREARM TUM DEEP < 3 CM
|
$XXX.XX
|
| 25077 |
RESECT FOREARM/WRIST TUM<3CM
|
$XXX.XX
|
| 25078 |
RESECT FORARM/WRIST TUM 3CM>
|
$XXX.XX
|
| 25085 |
INCISION OF WRIST CAPSULE
|
$XXX.XX
|
| 25100 |
BIOPSY OF WRIST JOINT
|
$XXX.XX
|
| 25101 |
EXPLORE/TREAT WRIST JOINT
|
$XXX.XX
|
| 25105 |
REMOVE WRIST JOINT LINING
|
$XXX.XX
|
| 25107 |
REMOVE WRIST JOINT CARTILAGE
|
$XXX.XX
|
| 25109 |
EXCISE TENDON FOREARM/WRIST
|
$XXX.XX
|
| 25110 |
REMOVE WRIST TENDON LESION
|
$XXX.XX
|
| 25111 |
REMOVE WRIST TENDON LESION
|
$XXX.XX
|
| 25112 |
REREMOVE WRIST TENDON LESION
|
$XXX.XX
|
| 25115 |
REMOVE WRIST/FOREARM LESION
|
$XXX.XX
|
| 25116 |
REMOVE WRIST/FOREARM LESION
|
$XXX.XX
|
| 25118 |
EXCISE WRIST TENDON SHEATH
|
$XXX.XX
|
| 25119 |
PARTIAL REMOVAL OF ULNA
|
$XXX.XX
|
| 25120 |
REMOVAL OF FOREARM LESION
|
$XXX.XX
|
| 25125 |
REMOVE/GRAFT FOREARM LESION
|
$XXX.XX
|
| 25126 |
REMOVE/GRAFT FOREARM LESION
|
$XXX.XX
|
| 25130 |
REMOVAL OF WRIST LESION
|
$XXX.XX
|
| 25135 |
REMOVE & GRAFT WRIST LESION
|
$XXX.XX
|
| 25136 |
REMOVE & GRAFT WRIST LESION
|
$XXX.XX
|
| 25145 |
REMOVE FOREARM BONE LESION
|
$XXX.XX
|
| 25150 |
PARTIAL REMOVAL OF ULNA
|
$XXX.XX
|
| 25151 |
PARTIAL REMOVAL OF RADIUS
|
$XXX.XX
|
| 25170 |
RESECT RADIUS/ULNAR TUMOR
|
$XXX.XX
|
| 25210 |
REMOVAL OF WRIST BONE
|
$XXX.XX
|
| 25215 |
REMOVAL OF WRIST BONES
|
$XXX.XX
|
| 25230 |
PARTIAL REMOVAL OF RADIUS
|
$XXX.XX
|
| 25240 |
PARTIAL REMOVAL OF ULNA
|
$XXX.XX
|
| 25246 |
INJECTION FOR WRIST X-RAY
|
$XXX.XX
|
| 25248 |
REMOVE FOREARM FOREIGN BODY
|
$XXX.XX
|
| 25250 |
REMOVAL OF WRIST PROSTHESIS
|
$XXX.XX
|
| 25251 |
REMOVAL OF WRIST PROSTHESIS
|
$XXX.XX
|
| 25259 |
MANIPULATE WRIST W/ANESTHES
|
$XXX.XX
|
| 25260 |
REPAIR FOREARM TENDON/MUSCLE
|
$XXX.XX
|
| 25263 |
REPAIR FOREARM TENDON/MUSCLE
|
$XXX.XX
|
| 25265 |
REPAIR FOREARM TENDON/MUSCLE
|
$XXX.XX
|
| 25270 |
REPAIR FOREARM TENDON/MUSCLE
|
$XXX.XX
|
| 25272 |
REPAIR FOREARM TENDON/MUSCLE
|
$XXX.XX
|
| 25274 |
REPAIR FOREARM TENDON/MUSCLE
|
$XXX.XX
|
| 25275 |
REPAIR FOREARM TENDON SHEATH
|
$XXX.XX
|
| 25280 |
REVISE WRIST/FOREARM TENDON
|
$XXX.XX
|
| 25290 |
INCISE WRIST/FOREARM TENDON
|
$XXX.XX
|
| 25295 |
RELEASE WRIST/FOREARM TENDON
|
$XXX.XX
|
| 25300 |
FUSION OF TENDONS AT WRIST
|
$XXX.XX
|
| 25301 |
FUSION OF TENDONS AT WRIST
|
$XXX.XX
|
| 25310 |
TRANSPLANT FOREARM TENDON
|
$XXX.XX
|
| 25312 |
TRANSPLANT FOREARM TENDON
|
$XXX.XX
|
| 25315 |
REVISE PALSY HAND TENDON(S)
|
$XXX.XX
|
| 25316 |
REVISE PALSY HAND TENDON(S)
|
$XXX.XX
|
| 25320 |
REPAIR/REVISE WRIST JOINT
|
$XXX.XX
|
| 25332 |
REVISE WRIST JOINT
|
$XXX.XX
|
| 25335 |
REALIGNMENT OF HAND
|
$XXX.XX
|
| 25337 |
RECONSTRUCT ULNA/RADIOULNAR
|
$XXX.XX
|
| 25350 |
REVISION OF RADIUS
|
$XXX.XX
|
| 25355 |
REVISION OF RADIUS
|
$XXX.XX
|
| 25360 |
REVISION OF ULNA
|
$XXX.XX
|
| 25365 |
REVISE RADIUS & ULNA
|
$XXX.XX
|
| 25370 |
REVISE RADIUS OR ULNA
|
$XXX.XX
|
| 25375 |
REVISE RADIUS & ULNA
|
$XXX.XX
|
| 25390 |
SHORTEN RADIUS OR ULNA
|
$XXX.XX
|
| 25391 |
LENGTHEN RADIUS OR ULNA
|
$XXX.XX
|
| 25392 |
SHORTEN RADIUS & ULNA
|
$XXX.XX
|
| 25393 |
LENGTHEN RADIUS & ULNA
|
$XXX.XX
|
| 25394 |
REPAIR CARPAL BONE SHORTEN
|
$XXX.XX
|
| 25400 |
REPAIR RADIUS OR ULNA
|
$XXX.XX
|
| 25405 |
REPAIR/GRAFT RADIUS OR ULNA
|
$XXX.XX
|
| 25415 |
REPAIR RADIUS & ULNA
|
$XXX.XX
|
| 25420 |
REPAIR/GRAFT RADIUS & ULNA
|
$XXX.XX
|
| 25425 |
REPAIR/GRAFT RADIUS OR ULNA
|
$XXX.XX
|
| 25426 |
REPAIR/GRAFT RADIUS & ULNA
|
$XXX.XX
|
| 25430 |
VASC GRAFT INTO CARPAL BONE
|
$XXX.XX
|
| 25431 |
REPAIR NONUNION CARPAL BONE
|
$XXX.XX
|
| 25440 |
REPAIR/GRAFT WRIST BONE
|
$XXX.XX
|
| 25441 |
RECONSTRUCT WRIST JOINT
|
$XXX.XX
|
| 25442 |
RECONSTRUCT WRIST JOINT
|
$XXX.XX
|
| 25443 |
RECONSTRUCT WRIST JOINT
|
$XXX.XX
|
| 25444 |
RECONSTRUCT WRIST JOINT
|
$XXX.XX
|
| 25445 |
RECONSTRUCT WRIST JOINT
|
$XXX.XX
|
| 25446 |
WRIST REPLACEMENT
|
$XXX.XX
|
| 25447 |
REPAIR WRIST JOINTS
|
$XXX.XX
|
| 25449 |
REMOVE WRIST JOINT IMPLANT
|
$XXX.XX
|
| 25450 |
REVISION OF WRIST JOINT
|
$XXX.XX
|
| 25455 |
REVISION OF WRIST JOINT
|
$XXX.XX
|
| 25490 |
REINFORCE RADIUS
|
$XXX.XX
|
| 25491 |
REINFORCE ULNA
|
$XXX.XX
|
| 25492 |
REINFORCE RADIUS AND ULNA
|
$XXX.XX
|
| 25500 |
TREAT FRACTURE OF RADIUS
|
$XXX.XX
|
| 25505 |
TREAT FRACTURE OF RADIUS
|
$XXX.XX
|
| 25515 |
TREAT FRACTURE OF RADIUS
|
$XXX.XX
|
| 25520 |
TREAT FRACTURE OF RADIUS
|
$XXX.XX
|
| 25525 |
TREAT FRACTURE OF RADIUS
|
$XXX.XX
|
| 25526 |
TREAT FRACTURE OF RADIUS
|
$XXX.XX
|
| 25530 |
TREAT FRACTURE OF ULNA
|
$XXX.XX
|
| 25535 |
TREAT FRACTURE OF ULNA
|
$XXX.XX
|
| 25545 |
TREAT FRACTURE OF ULNA
|
$XXX.XX
|
| 25560 |
TREAT FRACTURE RADIUS & ULNA
|
$XXX.XX
|
| 25565 |
TREAT FRACTURE RADIUS & ULNA
|
$XXX.XX
|
| 25574 |
TREAT FRACTURE RADIUS & ULNA
|
$XXX.XX
|
| 25575 |
TREAT FRACTURE RADIUS/ULNA
|
$XXX.XX
|
| 25600 |
TREAT FRACTURE RADIUS/ULNA
|
$XXX.XX
|
| 25605 |
TREAT FRACTURE RADIUS/ULNA
|
$XXX.XX
|
| 25606 |
TREAT FX DISTAL RADIAL
|
$XXX.XX
|
| 25607 |
TREAT FX RAD EXTRA-ARTICUL
|
$XXX.XX
|
| 25608 |
TREAT FX RAD INTRA-ARTICUL
|
$XXX.XX
|
| 25609 |
TREAT FX RADIAL 3+ FRAG
|
$XXX.XX
|
| 25622 |
TREAT WRIST BONE FRACTURE
|
$XXX.XX
|
| 25624 |
TREAT WRIST BONE FRACTURE
|
$XXX.XX
|
| 25628 |
TREAT WRIST BONE FRACTURE
|
$XXX.XX
|
| 25630 |
TREAT WRIST BONE FRACTURE
|
$XXX.XX
|
| 25635 |
TREAT WRIST BONE FRACTURE
|
$XXX.XX
|
| 25645 |
TREAT WRIST BONE FRACTURE
|
$XXX.XX
|
| 25650 |
TREAT WRIST BONE FRACTURE
|
$XXX.XX
|
| 25651 |
PIN ULNAR STYLOID FRACTURE
|
$XXX.XX
|
| 25652 |
TREAT FRACTURE ULNAR STYLOID
|
$XXX.XX
|
| 25660 |
TREAT WRIST DISLOCATION
|
$XXX.XX
|
| 25670 |
TREAT WRIST DISLOCATION
|
$XXX.XX
|
| 25671 |
PIN RADIOULNAR DISLOCATION
|
$XXX.XX
|
| 25675 |
TREAT WRIST DISLOCATION
|
$XXX.XX
|
| 25676 |
TREAT WRIST DISLOCATION
|
$XXX.XX
|
| 25680 |
TREAT WRIST FRACTURE
|
$XXX.XX
|
| 25685 |
TREAT WRIST FRACTURE
|
$XXX.XX
|
| 25690 |
TREAT WRIST DISLOCATION
|
$XXX.XX
|
| 25695 |
TREAT WRIST DISLOCATION
|
$XXX.XX
|
| 25800 |
FUSION OF WRIST JOINT
|
$XXX.XX
|
| 25805 |
FUSION/GRAFT OF WRIST JOINT
|
$XXX.XX
|
| 25810 |
FUSION/GRAFT OF WRIST JOINT
|
$XXX.XX
|
| 25820 |
FUSION OF HAND BONES
|
$XXX.XX
|
| 25825 |
FUSE HAND BONES WITH GRAFT
|
$XXX.XX
|
| 25830 |
FUSION RADIOULNAR JNT/ULNA
|
$XXX.XX
|
| 25900 |
AMPUTATION OF FOREARM
|
$XXX.XX
|
| 25905 |
AMPUTATION OF FOREARM
|
$XXX.XX
|
| 25907 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 25909 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 25915 |
AMPUTATION OF FOREARM
|
$XXX.XX
|
| 25920 |
AMPUTATE HAND AT WRIST
|
$XXX.XX
|
| 25922 |
AMPUTATE HAND AT WRIST
|
$XXX.XX
|
| 25924 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 25927 |
AMPUTATION OF HAND
|
$XXX.XX
|
| 25929 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 25931 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 26010 |
DRAINAGE OF FINGER ABSCESS
|
$XXX.XX
|
| 26011 |
DRAINAGE OF FINGER ABSCESS
|
$XXX.XX
|
| 26020 |
DRAIN HAND TENDON SHEATH
|
$XXX.XX
|
| 26025 |
DRAINAGE OF PALM BURSA
|
$XXX.XX
|
| 26030 |
DRAINAGE OF PALM BURSAS
|
$XXX.XX
|
| 26034 |
TREAT HAND BONE LESION
|
$XXX.XX
|
| 26035 |
DECOMPRESS FINGERS/HAND
|
$XXX.XX
|
| 26037 |
DECOMPRESS FINGERS/HAND
|
$XXX.XX
|
| 26040 |
RELEASE PALM CONTRACTURE
|
$XXX.XX
|
| 26045 |
RELEASE PALM CONTRACTURE
|
$XXX.XX
|
| 26055 |
INCISE FINGER TENDON SHEATH
|
$XXX.XX
|
| 26060 |
INCISION OF FINGER TENDON
|
$XXX.XX
|
| 26070 |
EXPLORE/TREAT HAND JOINT
|
$XXX.XX
|
| 26075 |
EXPLORE/TREAT FINGER JOINT
|
$XXX.XX
|
| 26080 |
EXPLORE/TREAT FINGER JOINT
|
$XXX.XX
|
| 26100 |
BIOPSY HAND JOINT LINING
|
$XXX.XX
|
| 26105 |
BIOPSY FINGER JOINT LINING
|
$XXX.XX
|
| 26110 |
BIOPSY FINGER JOINT LINING
|
$XXX.XX
|
| 26111 |
EXC HAND LES SC 1.5 CM/>
|
$XXX.XX
|
| 26113 |
EXC HAND TUM DEEP 1.5 CM/>
|
$XXX.XX
|
| 26115 |
EXC HAND LES SC < 1.5 CM
|
$XXX.XX
|
| 26116 |
EXC HAND TUM DEEP < 1.5 CM
|
$XXX.XX
|
| 26117 |
RAD RESECT HAND TUMOR < 3 CM
|
$XXX.XX
|
| 26118 |
RAD RESECT HAND TUMOR 3 CM/>
|
$XXX.XX
|
| 26121 |
RELEASE PALM CONTRACTURE
|
$XXX.XX
|
| 26123 |
RELEASE PALM CONTRACTURE
|
$XXX.XX
|
| 26125 |
RELEASE PALM CONTRACTURE
|
$XXX.XX
|
| 26130 |
REMOVE WRIST JOINT LINING
|
$XXX.XX
|
| 26135 |
REVISE FINGER JOINT EACH
|
$XXX.XX
|
| 26140 |
REVISE FINGER JOINT EACH
|
$XXX.XX
|
| 26145 |
TENDON EXCISION PALM/FINGER
|
$XXX.XX
|
| 26160 |
REMOVE TENDON SHEATH LESION
|
$XXX.XX
|
| 26170 |
REMOVAL OF PALM TENDON EACH
|
$XXX.XX
|
| 26180 |
REMOVAL OF FINGER TENDON
|
$XXX.XX
|
| 26185 |
REMOVE FINGER BONE
|
$XXX.XX
|
| 26200 |
REMOVE HAND BONE LESION
|
$XXX.XX
|
| 26205 |
REMOVE/GRAFT BONE LESION
|
$XXX.XX
|
| 26210 |
REMOVAL OF FINGER LESION
|
$XXX.XX
|
| 26215 |
REMOVE/GRAFT FINGER LESION
|
$XXX.XX
|
| 26230 |
PARTIAL REMOVAL OF HAND BONE
|
$XXX.XX
|
| 26235 |
PARTIAL REMOVAL FINGER BONE
|
$XXX.XX
|
| 26236 |
PARTIAL REMOVAL FINGER BONE
|
$XXX.XX
|
| 26250 |
EXTENSIVE HAND SURGERY
|
$XXX.XX
|
| 26260 |
RESECT PROX FINGER TUMOR
|
$XXX.XX
|
| 26262 |
RESECT DISTAL FINGER TUMOR
|
$XXX.XX
|
| 26320 |
REMOVAL OF IMPLANT FROM HAND
|
$XXX.XX
|
| 26340 |
MANIPULATE FINGER W/ANESTH
|
$XXX.XX
|
| 26341 |
MANIPULAT PALM CORD POST INJ
|
$XXX.XX
|
| 26350 |
REPAIR FINGER/HAND TENDON
|
$XXX.XX
|
| 26352 |
REPAIR/GRAFT HAND TENDON
|
$XXX.XX
|
| 26356 |
REPAIR FINGER/HAND TENDON
|
$XXX.XX
|
| 26357 |
REPAIR FINGER/HAND TENDON
|
$XXX.XX
|
| 26358 |
REPAIR/GRAFT HAND TENDON
|
$XXX.XX
|
| 26370 |
REPAIR FINGER/HAND TENDON
|
$XXX.XX
|
| 26372 |
REPAIR/GRAFT HAND TENDON
|
$XXX.XX
|
| 26373 |
REPAIR FINGER/HAND TENDON
|
$XXX.XX
|
| 26390 |
REVISE HAND/FINGER TENDON
|
$XXX.XX
|
| 26392 |
REPAIR/GRAFT HAND TENDON
|
$XXX.XX
|
| 26410 |
REPAIR HAND TENDON
|
$XXX.XX
|
| 26412 |
REPAIR/GRAFT HAND TENDON
|
$XXX.XX
|
| 26415 |
EXCISION HAND/FINGER TENDON
|
$XXX.XX
|
| 26416 |
GRAFT HAND OR FINGER TENDON
|
$XXX.XX
|
| 26418 |
REPAIR FINGER TENDON
|
$XXX.XX
|
| 26420 |
REPAIR/GRAFT FINGER TENDON
|
$XXX.XX
|
| 26426 |
REPAIR FINGER/HAND TENDON
|
$XXX.XX
|
| 26428 |
REPAIR/GRAFT FINGER TENDON
|
$XXX.XX
|
| 26432 |
REPAIR FINGER TENDON
|
$XXX.XX
|
| 26433 |
REPAIR FINGER TENDON
|
$XXX.XX
|
| 26434 |
REPAIR/GRAFT FINGER TENDON
|
$XXX.XX
|
| 26437 |
REALIGNMENT OF TENDONS
|
$XXX.XX
|
| 26440 |
RELEASE PALM/FINGER TENDON
|
$XXX.XX
|
| 26442 |
RELEASE PALM & FINGER TENDON
|
$XXX.XX
|
| 26445 |
RELEASE HAND/FINGER TENDON
|
$XXX.XX
|
| 26449 |
RELEASE FOREARM/HAND TENDON
|
$XXX.XX
|
| 26450 |
INCISION OF PALM TENDON
|
$XXX.XX
|
| 26455 |
INCISION OF FINGER TENDON
|
$XXX.XX
|
| 26460 |
INCISE HAND/FINGER TENDON
|
$XXX.XX
|
| 26471 |
FUSION OF FINGER TENDONS
|
$XXX.XX
|
| 26474 |
FUSION OF FINGER TENDONS
|
$XXX.XX
|
| 26476 |
TENDON LENGTHENING
|
$XXX.XX
|
| 26477 |
TENDON SHORTENING
|
$XXX.XX
|
| 26478 |
LENGTHENING OF HAND TENDON
|
$XXX.XX
|
| 26479 |
SHORTENING OF HAND TENDON
|
$XXX.XX
|
| 26480 |
TRANSPLANT HAND TENDON
|
$XXX.XX
|
| 26483 |
TRANSPLANT/GRAFT HAND TENDON
|
$XXX.XX
|
| 26485 |
TRANSPLANT PALM TENDON
|
$XXX.XX
|
| 26489 |
TRANSPLANT/GRAFT PALM TENDON
|
$XXX.XX
|
| 26490 |
REVISE THUMB TENDON
|
$XXX.XX
|
| 26492 |
TENDON TRANSFER WITH GRAFT
|
$XXX.XX
|
| 26494 |
HAND TENDON/MUSCLE TRANSFER
|
$XXX.XX
|
| 26496 |
REVISE THUMB TENDON
|
$XXX.XX
|
| 26497 |
FINGER TENDON TRANSFER
|
$XXX.XX
|
| 26498 |
FINGER TENDON TRANSFER
|
$XXX.XX
|
| 26499 |
REVISION OF FINGER
|
$XXX.XX
|
| 26500 |
HAND TENDON RECONSTRUCTION
|
$XXX.XX
|
| 26502 |
HAND TENDON RECONSTRUCTION
|
$XXX.XX
|
| 26508 |
RELEASE THUMB CONTRACTURE
|
$XXX.XX
|
| 26510 |
THUMB TENDON TRANSFER
|
$XXX.XX
|
| 26516 |
FUSION OF KNUCKLE JOINT
|
$XXX.XX
|
| 26517 |
FUSION OF KNUCKLE JOINTS
|
$XXX.XX
|
| 26518 |
FUSION OF KNUCKLE JOINTS
|
$XXX.XX
|
| 26520 |
RELEASE KNUCKLE CONTRACTURE
|
$XXX.XX
|
| 26525 |
RELEASE FINGER CONTRACTURE
|
$XXX.XX
|
| 26530 |
REVISE KNUCKLE JOINT
|
$XXX.XX
|
| 26531 |
REVISE KNUCKLE WITH IMPLANT
|
$XXX.XX
|
| 26535 |
REVISE FINGER JOINT
|
$XXX.XX
|
| 26536 |
REVISE/IMPLANT FINGER JOINT
|
$XXX.XX
|
| 26540 |
REPAIR HAND JOINT
|
$XXX.XX
|
| 26541 |
REPAIR HAND JOINT WITH GRAFT
|
$XXX.XX
|
| 26542 |
REPAIR HAND JOINT WITH GRAFT
|
$XXX.XX
|
| 26545 |
RECONSTRUCT FINGER JOINT
|
$XXX.XX
|
| 26546 |
REPAIR NONUNION HAND
|
$XXX.XX
|
| 26548 |
RECONSTRUCT FINGER JOINT
|
$XXX.XX
|
| 26550 |
CONSTRUCT THUMB REPLACEMENT
|
$XXX.XX
|
| 26551 |
GREAT TOE-HAND TRANSFER
|
$XXX.XX
|
| 26553 |
SINGLE TRANSFER TOE-HAND
|
$XXX.XX
|
| 26554 |
DOUBLE TRANSFER TOE-HAND
|
$XXX.XX
|
| 26555 |
POSITIONAL CHANGE OF FINGER
|
$XXX.XX
|
| 26556 |
TOE JOINT TRANSFER
|
$XXX.XX
|
| 26560 |
REPAIR OF WEB FINGER
|
$XXX.XX
|
| 26561 |
REPAIR OF WEB FINGER
|
$XXX.XX
|
| 26562 |
REPAIR OF WEB FINGER
|
$XXX.XX
|
| 26565 |
CORRECT METACARPAL FLAW
|
$XXX.XX
|
| 26567 |
CORRECT FINGER DEFORMITY
|
$XXX.XX
|
| 26568 |
LENGTHEN METACARPAL/FINGER
|
$XXX.XX
|
| 26580 |
REPAIR HAND DEFORMITY
|
$XXX.XX
|
| 26587 |
RECONSTRUCT EXTRA FINGER
|
$XXX.XX
|
| 26590 |
REPAIR FINGER DEFORMITY
|
$XXX.XX
|
| 26591 |
REPAIR MUSCLES OF HAND
|
$XXX.XX
|
| 26593 |
RELEASE MUSCLES OF HAND
|
$XXX.XX
|
| 26596 |
EXCISION CONSTRICTING TISSUE
|
$XXX.XX
|
| 26600 |
TREAT METACARPAL FRACTURE
|
$XXX.XX
|
| 26605 |
TREAT METACARPAL FRACTURE
|
$XXX.XX
|
| 26607 |
TREAT METACARPAL FRACTURE
|
$XXX.XX
|
| 26608 |
TREAT METACARPAL FRACTURE
|
$XXX.XX
|
| 26615 |
TREAT METACARPAL FRACTURE
|
$XXX.XX
|
| 26641 |
TREAT THUMB DISLOCATION
|
$XXX.XX
|
| 26645 |
TREAT THUMB FRACTURE
|
$XXX.XX
|
| 26650 |
TREAT THUMB FRACTURE
|
$XXX.XX
|
| 26665 |
TREAT THUMB FRACTURE
|
$XXX.XX
|
| 26670 |
TREAT HAND DISLOCATION
|
$XXX.XX
|
| 26675 |
TREAT HAND DISLOCATION
|
$XXX.XX
|
| 26676 |
PIN HAND DISLOCATION
|
$XXX.XX
|
| 26685 |
TREAT HAND DISLOCATION
|
$XXX.XX
|
| 26686 |
TREAT HAND DISLOCATION
|
$XXX.XX
|
| 26700 |
TREAT KNUCKLE DISLOCATION
|
$XXX.XX
|
| 26705 |
TREAT KNUCKLE DISLOCATION
|
$XXX.XX
|
| 26706 |
PIN KNUCKLE DISLOCATION
|
$XXX.XX
|
| 26715 |
TREAT KNUCKLE DISLOCATION
|
$XXX.XX
|
| 26720 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26725 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26727 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26735 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26740 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26742 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26746 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26750 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26755 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26756 |
PIN FINGER FRACTURE EACH
|
$XXX.XX
|
| 26765 |
TREAT FINGER FRACTURE EACH
|
$XXX.XX
|
| 26770 |
TREAT FINGER DISLOCATION
|
$XXX.XX
|
| 26775 |
TREAT FINGER DISLOCATION
|
$XXX.XX
|
| 26776 |
PIN FINGER DISLOCATION
|
$XXX.XX
|
| 26785 |
TREAT FINGER DISLOCATION
|
$XXX.XX
|
| 26820 |
THUMB FUSION WITH GRAFT
|
$XXX.XX
|
| 26841 |
FUSION OF THUMB
|
$XXX.XX
|
| 26842 |
THUMB FUSION WITH GRAFT
|
$XXX.XX
|
| 26843 |
FUSION OF HAND JOINT
|
$XXX.XX
|
| 26844 |
FUSION/GRAFT OF HAND JOINT
|
$XXX.XX
|
| 26850 |
FUSION OF KNUCKLE
|
$XXX.XX
|
| 26852 |
FUSION OF KNUCKLE WITH GRAFT
|
$XXX.XX
|
| 26860 |
FUSION OF FINGER JOINT
|
$XXX.XX
|
| 26861 |
FUSION OF FINGER JNT ADD-ON
|
$XXX.XX
|
| 26862 |
FUSION/GRAFT OF FINGER JOINT
|
$XXX.XX
|
| 26863 |
FUSE/GRAFT ADDED JOINT
|
$XXX.XX
|
| 26910 |
AMPUTATE METACARPAL BONE
|
$XXX.XX
|
| 26951 |
AMPUTATION OF FINGER/THUMB
|
$XXX.XX
|
| 26952 |
AMPUTATION OF FINGER/THUMB
|
$XXX.XX
|
| 26990 |
DRAINAGE OF PELVIS LESION
|
$XXX.XX
|
| 26991 |
DRAINAGE OF PELVIS BURSA
|
$XXX.XX
|
| 26992 |
DRAINAGE OF BONE LESION
|
$XXX.XX
|
| 27000 |
INCISION OF HIP TENDON
|
$XXX.XX
|
| 27001 |
INCISION OF HIP TENDON
|
$XXX.XX
|
| 27003 |
INCISION OF HIP TENDON
|
$XXX.XX
|
| 27005 |
INCISION OF HIP TENDON
|
$XXX.XX
|
| 27006 |
INCISION OF HIP TENDONS
|
$XXX.XX
|
| 27025 |
INCISION OF HIP/THIGH FASCIA
|
$XXX.XX
|
| 27027 |
BUTTOCK FASCIOTOMY
|
$XXX.XX
|
| 27030 |
DRAINAGE OF HIP JOINT
|
$XXX.XX
|
| 27033 |
EXPLORATION OF HIP JOINT
|
$XXX.XX
|
| 27035 |
DENERVATION OF HIP JOINT
|
$XXX.XX
|
| 27036 |
EXCISION OF HIP JOINT/MUSCLE
|
$XXX.XX
|
| 27040 |
BIOPSY OF SOFT TISSUES
|
$XXX.XX
|
| 27041 |
BIOPSY OF SOFT TISSUES
|
$XXX.XX
|
| 27043 |
EXC HIP PELVIS LES SC 3 CM/>
|
$XXX.XX
|
| 27045 |
EXC HIP/PELV TUM DEEP 5 CM/>
|
$XXX.XX
|
| 27047 |
EXC HIP/PELVIS LES SC < 3 CM
|
$XXX.XX
|
| 27048 |
EXC HIP/PELV TUM DEEP < 5 CM
|
$XXX.XX
|
| 27049 |
RESECT HIP/PELV TUM < 5 CM
|
$XXX.XX
|
| 27050 |
BIOPSY OF SACROILIAC JOINT
|
$XXX.XX
|
| 27052 |
BIOPSY OF HIP JOINT
|
$XXX.XX
|
| 27054 |
REMOVAL OF HIP JOINT LINING
|
$XXX.XX
|
| 27057 |
BUTTOCK FASCIOTOMY W/DBRDMT
|
$XXX.XX
|
| 27059 |
RESECT HIP/PELV TUM 5 CM/>
|
$XXX.XX
|
| 27060 |
REMOVAL OF ISCHIAL BURSA
|
$XXX.XX
|
| 27062 |
REMOVE FEMUR LESION/BURSA
|
$XXX.XX
|
| 27065 |
REMOVE HIP BONE LES SUPER
|
$XXX.XX
|
| 27066 |
REMOVE HIP BONE LES DEEP
|
$XXX.XX
|
| 27067 |
REMOVE/GRAFT HIP BONE LESION
|
$XXX.XX
|
| 27070 |
PART REMOVE HIP BONE SUPER
|
$XXX.XX
|
| 27071 |
PART REMOVAL HIP BONE DEEP
|
$XXX.XX
|
| 27075 |
RESECT HIP TUMOR
|
$XXX.XX
|
| 27076 |
RESECT HIP TUM INCL ACETABUL
|
$XXX.XX
|
| 27077 |
RESECT HIP TUM W/INNOM BONE
|
$XXX.XX
|
| 27078 |
RSECT HIP TUM INCL FEMUR
|
$XXX.XX
|
| 27080 |
REMOVAL OF TAIL BONE
|
$XXX.XX
|
| 27086 |
REMOVE HIP FOREIGN BODY
|
$XXX.XX
|
| 27087 |
REMOVE HIP FOREIGN BODY
|
$XXX.XX
|
| 27090 |
REMOVAL OF HIP PROSTHESIS
|
$XXX.XX
|
| 27091 |
REMOVAL OF HIP PROSTHESIS
|
$XXX.XX
|
| 27093 |
INJECTION FOR HIP X-RAY
|
$XXX.XX
|
| 27095 |
INJECTION FOR HIP X-RAY
|
$XXX.XX
|
| 27096 |
INJECT SACROILIAC JOINT
|
$XXX.XX
|
| 27097 |
REVISION OF HIP TENDON
|
$XXX.XX
|
| 27098 |
TRANSFER TENDON TO PELVIS
|
$XXX.XX
|
| 27100 |
TRANSFER OF ABDOMINAL MUSCLE
|
$XXX.XX
|
| 27105 |
TRANSFER OF SPINAL MUSCLE
|
$XXX.XX
|
| 27110 |
TRANSFER OF ILIOPSOAS MUSCLE
|
$XXX.XX
|
| 27111 |
TRANSFER OF ILIOPSOAS MUSCLE
|
$XXX.XX
|
| 27120 |
RECONSTRUCTION OF HIP SOCKET
|
$XXX.XX
|
| 27122 |
RECONSTRUCTION OF HIP SOCKET
|
$XXX.XX
|
| 27125 |
PARTIAL HIP REPLACEMENT
|
$XXX.XX
|
| 27130 |
TOTAL HIP ARTHROPLASTY
|
$XXX.XX
|
| 27132 |
TOTAL HIP ARTHROPLASTY
|
$XXX.XX
|
| 27134 |
REVISE HIP JOINT REPLACEMENT
|
$XXX.XX
|
| 27137 |
REVISE HIP JOINT REPLACEMENT
|
$XXX.XX
|
| 27138 |
REVISE HIP JOINT REPLACEMENT
|
$XXX.XX
|
| 27140 |
TRANSPLANT FEMUR RIDGE
|
$XXX.XX
|
| 27146 |
INCISION OF HIP BONE
|
$XXX.XX
|
| 27147 |
REVISION OF HIP BONE
|
$XXX.XX
|
| 27151 |
INCISION OF HIP BONES
|
$XXX.XX
|
| 27156 |
REVISION OF HIP BONES
|
$XXX.XX
|
| 27158 |
REVISION OF PELVIS
|
$XXX.XX
|
| 27161 |
INCISION OF NECK OF FEMUR
|
$XXX.XX
|
| 27165 |
INCISION/FIXATION OF FEMUR
|
$XXX.XX
|
| 27170 |
REPAIR/GRAFT FEMUR HEAD/NECK
|
$XXX.XX
|
| 27175 |
TREAT SLIPPED EPIPHYSIS
|
$XXX.XX
|
| 27176 |
TREAT SLIPPED EPIPHYSIS
|
$XXX.XX
|
| 27177 |
TREAT SLIPPED EPIPHYSIS
|
$XXX.XX
|
| 27178 |
TREAT SLIPPED EPIPHYSIS
|
$XXX.XX
|
| 27179 |
REVISE HEAD/NECK OF FEMUR
|
$XXX.XX
|
| 27181 |
TREAT SLIPPED EPIPHYSIS
|
$XXX.XX
|
| 27185 |
REVISION OF FEMUR EPIPHYSIS
|
$XXX.XX
|
| 27187 |
REINFORCE HIP BONES
|
$XXX.XX
|
| 27197 |
CLSD TX PELVIC RING FX
|
$XXX.XX
|
| 27198 |
CLSD TX PELVIC RING FX
|
$XXX.XX
|
| 27200 |
TREAT TAIL BONE FRACTURE
|
$XXX.XX
|
| 27202 |
TREAT TAIL BONE FRACTURE
|
$XXX.XX
|
| 27220 |
TREAT HIP SOCKET FRACTURE
|
$XXX.XX
|
| 27222 |
TREAT HIP SOCKET FRACTURE
|
$XXX.XX
|
| 27226 |
TREAT HIP WALL FRACTURE
|
$XXX.XX
|
| 27227 |
TREAT HIP FRACTURE(S)
|
$XXX.XX
|
| 27228 |
TREAT HIP FRACTURE(S)
|
$XXX.XX
|
| 27230 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27232 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27235 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27236 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27238 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27240 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27244 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27245 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27246 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27248 |
TREAT THIGH FRACTURE
|
$XXX.XX
|
| 27250 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27252 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27253 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27254 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27256 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27257 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27258 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27259 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27265 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27266 |
TREAT HIP DISLOCATION
|
$XXX.XX
|
| 27267 |
CLTX THIGH FX
|
$XXX.XX
|
| 27268 |
CLTX THIGH FX W/MNPJ
|
$XXX.XX
|
| 27269 |
OPTX THIGH FX
|
$XXX.XX
|
| 27275 |
MANIPULATION OF HIP JOINT
|
$XXX.XX
|
| 27279 |
ARTHRODESIS SACROILIAC JOINT
|
$XXX.XX
|
| 27280 |
FUSION OF SACROILIAC JOINT
|
$XXX.XX
|
| 27282 |
FUSION OF PUBIC BONES
|
$XXX.XX
|
| 27284 |
FUSION OF HIP JOINT
|
$XXX.XX
|
| 27286 |
FUSION OF HIP JOINT
|
$XXX.XX
|
| 27290 |
AMPUTATION OF LEG AT HIP
|
$XXX.XX
|
| 27295 |
AMPUTATION OF LEG AT HIP
|
$XXX.XX
|
| 27301 |
DRAIN THIGH/KNEE LESION
|
$XXX.XX
|
| 27303 |
DRAINAGE OF BONE LESION
|
$XXX.XX
|
| 27305 |
INCISE THIGH TENDON & FASCIA
|
$XXX.XX
|
| 27306 |
INCISION OF THIGH TENDON
|
$XXX.XX
|
| 27307 |
INCISION OF THIGH TENDONS
|
$XXX.XX
|
| 27310 |
EXPLORATION OF KNEE JOINT
|
$XXX.XX
|
| 27323 |
BIOPSY THIGH SOFT TISSUES
|
$XXX.XX
|
| 27324 |
BIOPSY THIGH SOFT TISSUES
|
$XXX.XX
|
| 27325 |
NEURECTOMY HAMSTRING
|
$XXX.XX
|
| 27326 |
NEURECTOMY POPLITEAL
|
$XXX.XX
|
| 27327 |
EXC THIGH/KNEE LES SC < 3 CM
|
$XXX.XX
|
| 27328 |
EXC THIGH/KNEE TUM DEEP <5CM
|
$XXX.XX
|
| 27329 |
RESECT THIGH/KNEE TUM < 5 CM
|
$XXX.XX
|
| 27330 |
BIOPSY KNEE JOINT LINING
|
$XXX.XX
|
| 27331 |
EXPLORE/TREAT KNEE JOINT
|
$XXX.XX
|
| 27332 |
REMOVAL OF KNEE CARTILAGE
|
$XXX.XX
|
| 27333 |
REMOVAL OF KNEE CARTILAGE
|
$XXX.XX
|
| 27334 |
REMOVE KNEE JOINT LINING
|
$XXX.XX
|
| 27335 |
REMOVE KNEE JOINT LINING
|
$XXX.XX
|
| 27337 |
EXC THIGH/KNEE LES SC 3 CM/>
|
$XXX.XX
|
| 27339 |
EXC THIGH/KNEE TUM DEP 5CM/>
|
$XXX.XX
|
| 27340 |
REMOVAL OF KNEECAP BURSA
|
$XXX.XX
|
| 27345 |
REMOVAL OF KNEE CYST
|
$XXX.XX
|
| 27347 |
REMOVE KNEE CYST
|
$XXX.XX
|
| 27350 |
REMOVAL OF KNEECAP
|
$XXX.XX
|
| 27355 |
REMOVE FEMUR LESION
|
$XXX.XX
|
| 27356 |
REMOVE FEMUR LESION/GRAFT
|
$XXX.XX
|
| 27357 |
REMOVE FEMUR LESION/GRAFT
|
$XXX.XX
|
| 27358 |
REMOVE FEMUR LESION/FIXATION
|
$XXX.XX
|
| 27360 |
PARTIAL REMOVAL LEG BONE(S)
|
$XXX.XX
|
| 27364 |
RESECT THIGH/KNEE TUM 5 CM/>
|
$XXX.XX
|
| 27365 |
RESECT FEMUR/KNEE TUMOR
|
$XXX.XX
|
| 27369 |
NJX CNTRST KNE ARTHG/CT/MRI
|
$XXX.XX
|
| 27372 |
REMOVAL OF FOREIGN BODY
|
$XXX.XX
|
| 27380 |
REPAIR OF KNEECAP TENDON
|
$XXX.XX
|
| 27381 |
REPAIR/GRAFT KNEECAP TENDON
|
$XXX.XX
|
| 27385 |
REPAIR OF THIGH MUSCLE
|
$XXX.XX
|
| 27386 |
REPAIR/GRAFT OF THIGH MUSCLE
|
$XXX.XX
|
| 27390 |
INCISION OF THIGH TENDON
|
$XXX.XX
|
| 27391 |
INCISION OF THIGH TENDONS
|
$XXX.XX
|
| 27392 |
INCISION OF THIGH TENDONS
|
$XXX.XX
|
| 27393 |
LENGTHENING OF THIGH TENDON
|
$XXX.XX
|
| 27394 |
LENGTHENING OF THIGH TENDONS
|
$XXX.XX
|
| 27395 |
LENGTHENING OF THIGH TENDONS
|
$XXX.XX
|
| 27396 |
TRANSPLANT OF THIGH TENDON
|
$XXX.XX
|
| 27397 |
TRANSPLANTS OF THIGH TENDONS
|
$XXX.XX
|
| 27400 |
REVISE THIGH MUSCLES/TENDONS
|
$XXX.XX
|
| 27403 |
REPAIR OF KNEE CARTILAGE
|
$XXX.XX
|
| 27405 |
REPAIR OF KNEE LIGAMENT
|
$XXX.XX
|
| 27407 |
REPAIR OF KNEE LIGAMENT
|
$XXX.XX
|
| 27409 |
REPAIR OF KNEE LIGAMENTS
|
$XXX.XX
|
| 27412 |
AUTOCHONDROCYTE IMPLANT KNEE
|
$XXX.XX
|
| 27415 |
OSTEOCHONDRAL KNEE ALLOGRAFT
|
$XXX.XX
|
| 27416 |
OSTEOCHONDRAL KNEE AUTOGRAFT
|
$XXX.XX
|
| 27418 |
REPAIR DEGENERATED KNEECAP
|
$XXX.XX
|
| 27420 |
REVISION OF UNSTABLE KNEECAP
|
$XXX.XX
|
| 27422 |
REVISION OF UNSTABLE KNEECAP
|
$XXX.XX
|
| 27424 |
REVISION/REMOVAL OF KNEECAP
|
$XXX.XX
|
| 27425 |
LAT RETINACULAR RELEASE OPEN
|
$XXX.XX
|
| 27427 |
RECONSTRUCTION KNEE
|
$XXX.XX
|
| 27428 |
RECONSTRUCTION KNEE
|
$XXX.XX
|
| 27429 |
RECONSTRUCTION KNEE
|
$XXX.XX
|
| 27430 |
REVISION OF THIGH MUSCLES
|
$XXX.XX
|
| 27435 |
INCISION OF KNEE JOINT
|
$XXX.XX
|
| 27437 |
REVISE KNEECAP
|
$XXX.XX
|
| 27438 |
REVISE KNEECAP WITH IMPLANT
|
$XXX.XX
|
| 27440 |
REVISION OF KNEE JOINT
|
$XXX.XX
|
| 27441 |
REVISION OF KNEE JOINT
|
$XXX.XX
|
| 27442 |
REVISION OF KNEE JOINT
|
$XXX.XX
|
| 27443 |
REVISION OF KNEE JOINT
|
$XXX.XX
|
| 27445 |
REVISION OF KNEE JOINT
|
$XXX.XX
|
| 27446 |
REVISION OF KNEE JOINT
|
$XXX.XX
|
| 27447 |
TOTAL KNEE ARTHROPLASTY
|
$XXX.XX
|
| 27448 |
INCISION OF THIGH
|
$XXX.XX
|
| 27450 |
INCISION OF THIGH
|
$XXX.XX
|
| 27454 |
REALIGNMENT OF THIGH BONE
|
$XXX.XX
|
| 27455 |
REALIGNMENT OF KNEE
|
$XXX.XX
|
| 27457 |
REALIGNMENT OF KNEE
|
$XXX.XX
|
| 27465 |
SHORTENING OF THIGH BONE
|
$XXX.XX
|
| 27466 |
LENGTHENING OF THIGH BONE
|
$XXX.XX
|
| 27468 |
SHORTEN/LENGTHEN THIGHS
|
$XXX.XX
|
| 27470 |
REPAIR OF THIGH
|
$XXX.XX
|
| 27472 |
REPAIR/GRAFT OF THIGH
|
$XXX.XX
|
| 27475 |
SURGERY TO STOP LEG GROWTH
|
$XXX.XX
|
| 27477 |
SURGERY TO STOP LEG GROWTH
|
$XXX.XX
|
| 27479 |
SURGERY TO STOP LEG GROWTH
|
$XXX.XX
|
| 27485 |
SURGERY TO STOP LEG GROWTH
|
$XXX.XX
|
| 27486 |
REVISE/REPLACE KNEE JOINT
|
$XXX.XX
|
| 27487 |
REVISE/REPLACE KNEE JOINT
|
$XXX.XX
|
| 27488 |
REMOVAL OF KNEE PROSTHESIS
|
$XXX.XX
|
| 27495 |
REINFORCE THIGH
|
$XXX.XX
|
| 27496 |
DECOMPRESSION OF THIGH/KNEE
|
$XXX.XX
|
| 27497 |
DECOMPRESSION OF THIGH/KNEE
|
$XXX.XX
|
| 27498 |
DECOMPRESSION OF THIGH/KNEE
|
$XXX.XX
|
| 27499 |
DECOMPRESSION OF THIGH/KNEE
|
$XXX.XX
|
| 27500 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27501 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27502 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27503 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27506 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27507 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27508 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27509 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27510 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27511 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27513 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27514 |
TREATMENT OF THIGH FRACTURE
|
$XXX.XX
|
| 27516 |
TREAT THIGH FX GROWTH PLATE
|
$XXX.XX
|
| 27517 |
TREAT THIGH FX GROWTH PLATE
|
$XXX.XX
|
| 27519 |
TREAT THIGH FX GROWTH PLATE
|
$XXX.XX
|
| 27520 |
TREAT KNEECAP FRACTURE
|
$XXX.XX
|
| 27524 |
TREAT KNEECAP FRACTURE
|
$XXX.XX
|
| 27530 |
TREAT KNEE FRACTURE
|
$XXX.XX
|
| 27532 |
TREAT KNEE FRACTURE
|
$XXX.XX
|
| 27535 |
TREAT KNEE FRACTURE
|
$XXX.XX
|
| 27536 |
TREAT KNEE FRACTURE
|
$XXX.XX
|
| 27538 |
TREAT KNEE FRACTURE(S)
|
$XXX.XX
|
| 27540 |
TREAT KNEE FRACTURE
|
$XXX.XX
|
| 27550 |
TREAT KNEE DISLOCATION
|
$XXX.XX
|
| 27552 |
TREAT KNEE DISLOCATION
|
$XXX.XX
|
| 27556 |
TREAT KNEE DISLOCATION
|
$XXX.XX
|
| 27557 |
TREAT KNEE DISLOCATION
|
$XXX.XX
|
| 27558 |
TREAT KNEE DISLOCATION
|
$XXX.XX
|
| 27560 |
TREAT KNEECAP DISLOCATION
|
$XXX.XX
|
| 27562 |
TREAT KNEECAP DISLOCATION
|
$XXX.XX
|
| 27566 |
TREAT KNEECAP DISLOCATION
|
$XXX.XX
|
| 27570 |
FIXATION OF KNEE JOINT
|
$XXX.XX
|
| 27580 |
FUSION OF KNEE
|
$XXX.XX
|
| 27590 |
AMPUTATE LEG AT THIGH
|
$XXX.XX
|
| 27591 |
AMPUTATE LEG AT THIGH
|
$XXX.XX
|
| 27592 |
AMPUTATE LEG AT THIGH
|
$XXX.XX
|
| 27594 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 27596 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 27598 |
AMPUTATE LOWER LEG AT KNEE
|
$XXX.XX
|
| 27600 |
DECOMPRESSION OF LOWER LEG
|
$XXX.XX
|
| 27601 |
DECOMPRESSION OF LOWER LEG
|
$XXX.XX
|
| 27602 |
DECOMPRESSION OF LOWER LEG
|
$XXX.XX
|
| 27603 |
DRAIN LOWER LEG LESION
|
$XXX.XX
|
| 27604 |
DRAIN LOWER LEG BURSA
|
$XXX.XX
|
| 27605 |
INCISION OF ACHILLES TENDON
|
$XXX.XX
|
| 27606 |
INCISION OF ACHILLES TENDON
|
$XXX.XX
|
| 27607 |
TREAT LOWER LEG BONE LESION
|
$XXX.XX
|
| 27610 |
EXPLORE/TREAT ANKLE JOINT
|
$XXX.XX
|
| 27612 |
EXPLORATION OF ANKLE JOINT
|
$XXX.XX
|
| 27613 |
BIOPSY LOWER LEG SOFT TISSUE
|
$XXX.XX
|
| 27614 |
BIOPSY LOWER LEG SOFT TISSUE
|
$XXX.XX
|
| 27615 |
RESECT LEG/ANKLE TUM < 5 CM
|
$XXX.XX
|
| 27616 |
RESECT LEG/ANKLE TUM 5 CM/>
|
$XXX.XX
|
| 27618 |
EXC LEG/ANKLE TUM < 3 CM
|
$XXX.XX
|
| 27619 |
EXC LEG/ANKLE TUM DEEP <5 CM
|
$XXX.XX
|
| 27620 |
EXPLORE/TREAT ANKLE JOINT
|
$XXX.XX
|
| 27625 |
REMOVE ANKLE JOINT LINING
|
$XXX.XX
|
| 27626 |
REMOVE ANKLE JOINT LINING
|
$XXX.XX
|
| 27630 |
REMOVAL OF TENDON LESION
|
$XXX.XX
|
| 27632 |
EXC LEG/ANKLE LES SC 3 CM/>
|
$XXX.XX
|
| 27634 |
EXC LEG/ANKLE TUM DEP 5 CM/>
|
$XXX.XX
|
| 27635 |
REMOVE LOWER LEG BONE LESION
|
$XXX.XX
|
| 27637 |
REMOVE/GRAFT LEG BONE LESION
|
$XXX.XX
|
| 27638 |
REMOVE/GRAFT LEG BONE LESION
|
$XXX.XX
|
| 27640 |
PARTIAL REMOVAL OF TIBIA
|
$XXX.XX
|
| 27641 |
PARTIAL REMOVAL OF FIBULA
|
$XXX.XX
|
| 27645 |
RESECT TIBIA TUMOR
|
$XXX.XX
|
| 27646 |
RESECT FIBULA TUMOR
|
$XXX.XX
|
| 27647 |
RESECT TALUS/CALCANEUS TUM
|
$XXX.XX
|
| 27648 |
INJECTION FOR ANKLE X-RAY
|
$XXX.XX
|
| 27650 |
REPAIR ACHILLES TENDON
|
$XXX.XX
|
| 27652 |
REPAIR/GRAFT ACHILLES TENDON
|
$XXX.XX
|
| 27654 |
REPAIR OF ACHILLES TENDON
|
$XXX.XX
|
| 27656 |
REPAIR LEG FASCIA DEFECT
|
$XXX.XX
|
| 27658 |
REPAIR OF LEG TENDON EACH
|
$XXX.XX
|
| 27659 |
REPAIR OF LEG TENDON EACH
|
$XXX.XX
|
| 27664 |
REPAIR OF LEG TENDON EACH
|
$XXX.XX
|
| 27665 |
REPAIR OF LEG TENDON EACH
|
$XXX.XX
|
| 27675 |
REPAIR LOWER LEG TENDONS
|
$XXX.XX
|
| 27676 |
REPAIR LOWER LEG TENDONS
|
$XXX.XX
|
| 27680 |
RELEASE OF LOWER LEG TENDON
|
$XXX.XX
|
| 27681 |
RELEASE OF LOWER LEG TENDONS
|
$XXX.XX
|
| 27685 |
REVISION OF LOWER LEG TENDON
|
$XXX.XX
|
| 27686 |
REVISE LOWER LEG TENDONS
|
$XXX.XX
|
| 27687 |
REVISION OF CALF TENDON
|
$XXX.XX
|
| 27690 |
REVISE LOWER LEG TENDON
|
$XXX.XX
|
| 27691 |
REVISE LOWER LEG TENDON
|
$XXX.XX
|
| 27692 |
REVISE ADDITIONAL LEG TENDON
|
$XXX.XX
|
| 27695 |
REPAIR OF ANKLE LIGAMENT
|
$XXX.XX
|
| 27696 |
REPAIR OF ANKLE LIGAMENTS
|
$XXX.XX
|
| 27698 |
REPAIR OF ANKLE LIGAMENT
|
$XXX.XX
|
| 27700 |
REVISION OF ANKLE JOINT
|
$XXX.XX
|
| 27702 |
RECONSTRUCT ANKLE JOINT
|
$XXX.XX
|
| 27703 |
RECONSTRUCTION ANKLE JOINT
|
$XXX.XX
|
| 27704 |
REMOVAL OF ANKLE IMPLANT
|
$XXX.XX
|
| 27705 |
INCISION OF TIBIA
|
$XXX.XX
|
| 27707 |
INCISION OF FIBULA
|
$XXX.XX
|
| 27709 |
INCISION OF TIBIA & FIBULA
|
$XXX.XX
|
| 27712 |
REALIGNMENT OF LOWER LEG
|
$XXX.XX
|
| 27715 |
REVISION OF LOWER LEG
|
$XXX.XX
|
| 27720 |
REPAIR OF TIBIA
|
$XXX.XX
|
| 27722 |
REPAIR/GRAFT OF TIBIA
|
$XXX.XX
|
| 27724 |
REPAIR/GRAFT OF TIBIA
|
$XXX.XX
|
| 27725 |
REPAIR OF LOWER LEG
|
$XXX.XX
|
| 27726 |
REPAIR FIBULA NONUNION
|
$XXX.XX
|
| 27727 |
REPAIR OF LOWER LEG
|
$XXX.XX
|
| 27730 |
REPAIR OF TIBIA EPIPHYSIS
|
$XXX.XX
|
| 27732 |
REPAIR OF FIBULA EPIPHYSIS
|
$XXX.XX
|
| 27734 |
REPAIR LOWER LEG EPIPHYSES
|
$XXX.XX
|
| 27740 |
REPAIR OF LEG EPIPHYSES
|
$XXX.XX
|
| 27742 |
REPAIR OF LEG EPIPHYSES
|
$XXX.XX
|
| 27745 |
REINFORCE TIBIA
|
$XXX.XX
|
| 27750 |
TREATMENT OF TIBIA FRACTURE
|
$XXX.XX
|
| 27752 |
TREATMENT OF TIBIA FRACTURE
|
$XXX.XX
|
| 27756 |
TREATMENT OF TIBIA FRACTURE
|
$XXX.XX
|
| 27758 |
TREATMENT OF TIBIA FRACTURE
|
$XXX.XX
|
| 27759 |
TREATMENT OF TIBIA FRACTURE
|
$XXX.XX
|
| 27760 |
CLTX MEDIAL ANKLE FX
|
$XXX.XX
|
| 27762 |
CLTX MED ANKLE FX W/MNPJ
|
$XXX.XX
|
| 27766 |
OPTX MEDIAL ANKLE FX
|
$XXX.XX
|
| 27767 |
CLTX POST ANKLE FX
|
$XXX.XX
|
| 27768 |
CLTX POST ANKLE FX W/MNPJ
|
$XXX.XX
|
| 27769 |
OPTX POST ANKLE FX
|
$XXX.XX
|
| 27780 |
TREATMENT OF FIBULA FRACTURE
|
$XXX.XX
|
| 27781 |
TREATMENT OF FIBULA FRACTURE
|
$XXX.XX
|
| 27784 |
TREATMENT OF FIBULA FRACTURE
|
$XXX.XX
|
| 27786 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27788 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27792 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27808 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27810 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27814 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27816 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27818 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27822 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27823 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 27824 |
TREAT LOWER LEG FRACTURE
|
$XXX.XX
|
| 27825 |
TREAT LOWER LEG FRACTURE
|
$XXX.XX
|
| 27826 |
TREAT LOWER LEG FRACTURE
|
$XXX.XX
|
| 27827 |
TREAT LOWER LEG FRACTURE
|
$XXX.XX
|
| 27828 |
TREAT LOWER LEG FRACTURE
|
$XXX.XX
|
| 27829 |
TREAT LOWER LEG JOINT
|
$XXX.XX
|
| 27830 |
TREAT LOWER LEG DISLOCATION
|
$XXX.XX
|
| 27831 |
TREAT LOWER LEG DISLOCATION
|
$XXX.XX
|
| 27832 |
TREAT LOWER LEG DISLOCATION
|
$XXX.XX
|
| 27840 |
TREAT ANKLE DISLOCATION
|
$XXX.XX
|
| 27842 |
TREAT ANKLE DISLOCATION
|
$XXX.XX
|
| 27846 |
TREAT ANKLE DISLOCATION
|
$XXX.XX
|
| 27848 |
TREAT ANKLE DISLOCATION
|
$XXX.XX
|
| 27860 |
FIXATION OF ANKLE JOINT
|
$XXX.XX
|
| 27870 |
FUSION OF ANKLE JOINT OPEN
|
$XXX.XX
|
| 27871 |
FUSION OF TIBIOFIBULAR JOINT
|
$XXX.XX
|
| 27880 |
AMPUTATION OF LOWER LEG
|
$XXX.XX
|
| 27881 |
AMPUTATION OF LOWER LEG
|
$XXX.XX
|
| 27882 |
AMPUTATION OF LOWER LEG
|
$XXX.XX
|
| 27884 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 27886 |
AMPUTATION FOLLOW-UP SURGERY
|
$XXX.XX
|
| 27888 |
AMPUTATION OF FOOT AT ANKLE
|
$XXX.XX
|
| 27889 |
AMPUTATION OF FOOT AT ANKLE
|
$XXX.XX
|
| 27892 |
DECOMPRESSION OF LEG
|
$XXX.XX
|
| 27893 |
DECOMPRESSION OF LEG
|
$XXX.XX
|
| 27894 |
DECOMPRESSION OF LEG
|
$XXX.XX
|
| 28001 |
DRAINAGE OF BURSA OF FOOT
|
$XXX.XX
|
| 28002 |
TREATMENT OF FOOT INFECTION
|
$XXX.XX
|
| 28003 |
TREATMENT OF FOOT INFECTION
|
$XXX.XX
|
| 28005 |
TREAT FOOT BONE LESION
|
$XXX.XX
|
| 28008 |
INCISION OF FOOT FASCIA
|
$XXX.XX
|
| 28010 |
INCISION OF TOE TENDON
|
$XXX.XX
|
| 28011 |
INCISION OF TOE TENDONS
|
$XXX.XX
|
| 28020 |
EXPLORATION OF FOOT JOINT
|
$XXX.XX
|
| 28022 |
EXPLORATION OF FOOT JOINT
|
$XXX.XX
|
| 28024 |
EXPLORATION OF TOE JOINT
|
$XXX.XX
|
| 28035 |
DECOMPRESSION OF TIBIA NERVE
|
$XXX.XX
|
| 28039 |
EXC FOOT/TOE TUM SC 1.5 CM/>
|
$XXX.XX
|
| 28041 |
EXC FOOT/TOE TUM DEP 1.5CM/>
|
$XXX.XX
|
| 28043 |
EXC FOOT/TOE TUM SC < 1.5 CM
|
$XXX.XX
|
| 28045 |
EXC FOOT/TOE TUM DEEP <1.5CM
|
$XXX.XX
|
| 28046 |
RESECT FOOT/TOE TUMOR < 3 CM
|
$XXX.XX
|
| 28047 |
RESECT FOOT/TOE TUMOR 3 CM/>
|
$XXX.XX
|
| 28050 |
BIOPSY OF FOOT JOINT LINING
|
$XXX.XX
|
| 28052 |
BIOPSY OF FOOT JOINT LINING
|
$XXX.XX
|
| 28054 |
BIOPSY OF TOE JOINT LINING
|
$XXX.XX
|
| 28055 |
NEURECTOMY FOOT
|
$XXX.XX
|
| 28060 |
PARTIAL REMOVAL FOOT FASCIA
|
$XXX.XX
|
| 28062 |
REMOVAL OF FOOT FASCIA
|
$XXX.XX
|
| 28070 |
REMOVAL OF FOOT JOINT LINING
|
$XXX.XX
|
| 28072 |
REMOVAL OF FOOT JOINT LINING
|
$XXX.XX
|
| 28080 |
REMOVAL OF FOOT LESION
|
$XXX.XX
|
| 28086 |
EXCISE FOOT TENDON SHEATH
|
$XXX.XX
|
| 28088 |
EXCISE FOOT TENDON SHEATH
|
$XXX.XX
|
| 28090 |
REMOVAL OF FOOT LESION
|
$XXX.XX
|
| 28092 |
REMOVAL OF TOE LESIONS
|
$XXX.XX
|
| 28100 |
REMOVAL OF ANKLE/HEEL LESION
|
$XXX.XX
|
| 28102 |
REMOVE/GRAFT FOOT LESION
|
$XXX.XX
|
| 28103 |
REMOVE/GRAFT FOOT LESION
|
$XXX.XX
|
| 28104 |
REMOVAL OF FOOT LESION
|
$XXX.XX
|
| 28106 |
REMOVE/GRAFT FOOT LESION
|
$XXX.XX
|
| 28107 |
REMOVE/GRAFT FOOT LESION
|
$XXX.XX
|
| 28108 |
REMOVAL OF TOE LESIONS
|
$XXX.XX
|
| 28110 |
PART REMOVAL OF METATARSAL
|
$XXX.XX
|
| 28111 |
PART REMOVAL OF METATARSAL
|
$XXX.XX
|
| 28112 |
PART REMOVAL OF METATARSAL
|
$XXX.XX
|
| 28113 |
PART REMOVAL OF METATARSAL
|
$XXX.XX
|
| 28114 |
REMOVAL OF METATARSAL HEADS
|
$XXX.XX
|
| 28116 |
REVISION OF FOOT
|
$XXX.XX
|
| 28118 |
REMOVAL OF HEEL BONE
|
$XXX.XX
|
| 28119 |
REMOVAL OF HEEL SPUR
|
$XXX.XX
|
| 28120 |
PART REMOVAL OF ANKLE/HEEL
|
$XXX.XX
|
| 28122 |
PARTIAL REMOVAL OF FOOT BONE
|
$XXX.XX
|
| 28124 |
PARTIAL REMOVAL OF TOE
|
$XXX.XX
|
| 28126 |
PARTIAL REMOVAL OF TOE
|
$XXX.XX
|
| 28130 |
REMOVAL OF ANKLE BONE
|
$XXX.XX
|
| 28140 |
REMOVAL OF METATARSAL
|
$XXX.XX
|
| 28150 |
REMOVAL OF TOE
|
$XXX.XX
|
| 28153 |
PARTIAL REMOVAL OF TOE
|
$XXX.XX
|
| 28160 |
PARTIAL REMOVAL OF TOE
|
$XXX.XX
|
| 28171 |
RESECT TARSAL TUMOR
|
$XXX.XX
|
| 28173 |
RESECT METATARSAL TUMOR
|
$XXX.XX
|
| 28175 |
RESECT PHALANX OF TOE TUMOR
|
$XXX.XX
|
| 28190 |
REMOVAL OF FOOT FOREIGN BODY
|
$XXX.XX
|
| 28192 |
REMOVAL OF FOOT FOREIGN BODY
|
$XXX.XX
|
| 28193 |
REMOVAL OF FOOT FOREIGN BODY
|
$XXX.XX
|
| 28200 |
REPAIR OF FOOT TENDON
|
$XXX.XX
|
| 28202 |
REPAIR/GRAFT OF FOOT TENDON
|
$XXX.XX
|
| 28208 |
REPAIR OF FOOT TENDON
|
$XXX.XX
|
| 28210 |
REPAIR/GRAFT OF FOOT TENDON
|
$XXX.XX
|
| 28220 |
RELEASE OF FOOT TENDON
|
$XXX.XX
|
| 28222 |
RELEASE OF FOOT TENDONS
|
$XXX.XX
|
| 28225 |
RELEASE OF FOOT TENDON
|
$XXX.XX
|
| 28226 |
RELEASE OF FOOT TENDONS
|
$XXX.XX
|
| 28230 |
INCISION OF FOOT TENDON(S)
|
$XXX.XX
|
| 28232 |
INCISION OF TOE TENDON
|
$XXX.XX
|
| 28234 |
INCISION OF FOOT TENDON
|
$XXX.XX
|
| 28238 |
REVISION OF FOOT TENDON
|
$XXX.XX
|
| 28240 |
RELEASE OF BIG TOE
|
$XXX.XX
|
| 28250 |
REVISION OF FOOT FASCIA
|
$XXX.XX
|
| 28260 |
RELEASE OF MIDFOOT JOINT
|
$XXX.XX
|
| 28261 |
REVISION OF FOOT TENDON
|
$XXX.XX
|
| 28262 |
REVISION OF FOOT AND ANKLE
|
$XXX.XX
|
| 28264 |
RELEASE OF MIDFOOT JOINT
|
$XXX.XX
|
| 28270 |
RELEASE OF FOOT CONTRACTURE
|
$XXX.XX
|
| 28272 |
RELEASE OF TOE JOINT EACH
|
$XXX.XX
|
| 28280 |
FUSION OF TOES
|
$XXX.XX
|
| 28285 |
REPAIR OF HAMMERTOE
|
$XXX.XX
|
| 28286 |
REPAIR OF HAMMERTOE
|
$XXX.XX
|
| 28288 |
PARTIAL REMOVAL OF FOOT BONE
|
$XXX.XX
|
| 28289 |
CORRJ HALUX RIGDUS W/O IMPLT
|
$XXX.XX
|
| 28291 |
CORRJ HALUX RIGDUS W/IMPLT
|
$XXX.XX
|
| 28292 |
CORRECTION HALLUX VALGUS
|
$XXX.XX
|
| 28295 |
CORRECTION HALLUX VALGUS
|
$XXX.XX
|
| 28296 |
CORRECTION HALLUX VALGUS
|
$XXX.XX
|
| 28297 |
CORRECTION HALLUX VALGUS
|
$XXX.XX
|
| 28298 |
CORRECTION HALLUX VALGUS
|
$XXX.XX
|
| 28299 |
CORRECTION HALLUX VALGUS
|
$XXX.XX
|
| 28300 |
INCISION OF HEEL BONE
|
$XXX.XX
|
| 28302 |
INCISION OF ANKLE BONE
|
$XXX.XX
|
| 28304 |
INCISION OF MIDFOOT BONES
|
$XXX.XX
|
| 28305 |
INCISE/GRAFT MIDFOOT BONES
|
$XXX.XX
|
| 28306 |
INCISION OF METATARSAL
|
$XXX.XX
|
| 28307 |
INCISION OF METATARSAL
|
$XXX.XX
|
| 28308 |
INCISION OF METATARSAL
|
$XXX.XX
|
| 28309 |
INCISION OF METATARSALS
|
$XXX.XX
|
| 28310 |
REVISION OF BIG TOE
|
$XXX.XX
|
| 28312 |
REVISION OF TOE
|
$XXX.XX
|
| 28313 |
REPAIR DEFORMITY OF TOE
|
$XXX.XX
|
| 28315 |
REMOVAL OF SESAMOID BONE
|
$XXX.XX
|
| 28320 |
REPAIR OF FOOT BONES
|
$XXX.XX
|
| 28322 |
REPAIR OF METATARSALS
|
$XXX.XX
|
| 28340 |
RESECT ENLARGED TOE TISSUE
|
$XXX.XX
|
| 28341 |
RESECT ENLARGED TOE
|
$XXX.XX
|
| 28344 |
REPAIR EXTRA TOE(S)
|
$XXX.XX
|
| 28345 |
REPAIR WEBBED TOE(S)
|
$XXX.XX
|
| 28360 |
RECONSTRUCT CLEFT FOOT
|
$XXX.XX
|
| 28400 |
TREATMENT OF HEEL FRACTURE
|
$XXX.XX
|
| 28405 |
TREATMENT OF HEEL FRACTURE
|
$XXX.XX
|
| 28406 |
TREATMENT OF HEEL FRACTURE
|
$XXX.XX
|
| 28415 |
TREAT HEEL FRACTURE
|
$XXX.XX
|
| 28420 |
TREAT/GRAFT HEEL FRACTURE
|
$XXX.XX
|
| 28430 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 28435 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 28436 |
TREATMENT OF ANKLE FRACTURE
|
$XXX.XX
|
| 28445 |
TREAT ANKLE FRACTURE
|
$XXX.XX
|
| 28446 |
OSTEOCHONDRAL TALUS AUTOGRFT
|
$XXX.XX
|
| 28450 |
TREAT MIDFOOT FRACTURE EACH
|
$XXX.XX
|
| 28455 |
TREAT MIDFOOT FRACTURE EACH
|
$XXX.XX
|
| 28456 |
TREAT MIDFOOT FRACTURE
|
$XXX.XX
|
| 28465 |
TREAT MIDFOOT FRACTURE EACH
|
$XXX.XX
|
| 28470 |
TREAT METATARSAL FRACTURE
|
$XXX.XX
|
| 28475 |
TREAT METATARSAL FRACTURE
|
$XXX.XX
|
| 28476 |
TREAT METATARSAL FRACTURE
|
$XXX.XX
|
| 28485 |
TREAT METATARSAL FRACTURE
|
$XXX.XX
|
| 28490 |
TREAT BIG TOE FRACTURE
|
$XXX.XX
|
| 28495 |
TREAT BIG TOE FRACTURE
|
$XXX.XX
|
| 28496 |
TREAT BIG TOE FRACTURE
|
$XXX.XX
|
| 28505 |
TREAT BIG TOE FRACTURE
|
$XXX.XX
|
| 28510 |
TREATMENT OF TOE FRACTURE
|
$XXX.XX
|
| 28515 |
TREATMENT OF TOE FRACTURE
|
$XXX.XX
|
| 28525 |
TREAT TOE FRACTURE
|
$XXX.XX
|
| 28530 |
TREAT SESAMOID BONE FRACTURE
|
$XXX.XX
|
| 28531 |
TREAT SESAMOID BONE FRACTURE
|
$XXX.XX
|
| 28540 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28545 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28546 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28555 |
REPAIR FOOT DISLOCATION
|
$XXX.XX
|
| 28570 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28575 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28576 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28585 |
REPAIR FOOT DISLOCATION
|
$XXX.XX
|
| 28600 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28605 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28606 |
TREAT FOOT DISLOCATION
|
$XXX.XX
|
| 28615 |
REPAIR FOOT DISLOCATION
|
$XXX.XX
|
| 28630 |
TREAT TOE DISLOCATION
|
$XXX.XX
|
| 28635 |
TREAT TOE DISLOCATION
|
$XXX.XX
|
| 28636 |
TREAT TOE DISLOCATION
|
$XXX.XX
|
| 28645 |
REPAIR TOE DISLOCATION
|
$XXX.XX
|
| 28660 |
TREAT TOE DISLOCATION
|
$XXX.XX
|
| 28665 |
TREAT TOE DISLOCATION
|
$XXX.XX
|
| 28666 |
TREAT TOE DISLOCATION
|
$XXX.XX
|
| 28675 |
REPAIR OF TOE DISLOCATION
|
$XXX.XX
|
| 28705 |
FUSION OF FOOT BONES
|
$XXX.XX
|
| 28715 |
FUSION OF FOOT BONES
|
$XXX.XX
|
| 28725 |
FUSION OF FOOT BONES
|
$XXX.XX
|
| 28730 |
FUSION OF FOOT BONES
|
$XXX.XX
|
| 28735 |
FUSION OF FOOT BONES
|
$XXX.XX
|
| 28737 |
REVISION OF FOOT BONES
|
$XXX.XX
|
| 28740 |
FUSION OF FOOT BONES
|
$XXX.XX
|
| 28750 |
FUSION OF BIG TOE JOINT
|
$XXX.XX
|
| 28755 |
FUSION OF BIG TOE JOINT
|
$XXX.XX
|
| 28760 |
FUSION OF BIG TOE JOINT
|
$XXX.XX
|
| 28800 |
AMPUTATION OF MIDFOOT
|
$XXX.XX
|
| 28805 |
AMPUTATION THRU METATARSAL
|
$XXX.XX
|
| 28810 |
AMPUTATION TOE & METATARSAL
|
$XXX.XX
|
| 28820 |
AMPUTATION OF TOE
|
$XXX.XX
|
| 28825 |
PARTIAL AMPUTATION OF TOE
|
$XXX.XX
|
| 28890 |
HI ENRGY ESWT PLANTAR FASCIA
|
$XXX.XX
|
| 29000 |
APPLICATION OF BODY CAST
|
$XXX.XX
|
| 29010 |
APPLICATION OF BODY CAST
|
$XXX.XX
|
| 29015 |
APPLICATION OF BODY CAST
|
$XXX.XX
|
| 29035 |
APPLICATION OF BODY CAST
|
$XXX.XX
|
| 29040 |
APPLICATION OF BODY CAST
|
$XXX.XX
|
| 29044 |
APPLICATION OF BODY CAST
|
$XXX.XX
|
| 29046 |
APPLICATION OF BODY CAST
|
$XXX.XX
|
| 29049 |
APPLICATION OF FIGURE EIGHT
|
$XXX.XX
|
| 29055 |
APPLICATION OF SHOULDER CAST
|
$XXX.XX
|
| 29058 |
APPLICATION OF SHOULDER CAST
|
$XXX.XX
|
| 29065 |
APPLICATION OF LONG ARM CAST
|
$XXX.XX
|
| 29075 |
APPLICATION OF FOREARM CAST
|
$XXX.XX
|
| 29085 |
APPLY HAND/WRIST CAST
|
$XXX.XX
|
| 29086 |
APPLY FINGER CAST
|
$XXX.XX
|
| 29105 |
APPLY LONG ARM SPLINT
|
$XXX.XX
|
| 29125 |
APPLY FOREARM SPLINT
|
$XXX.XX
|
| 29126 |
APPLY FOREARM SPLINT
|
$XXX.XX
|
| 29130 |
APPLICATION OF FINGER SPLINT
|
$XXX.XX
|
| 29131 |
APPLICATION OF FINGER SPLINT
|
$XXX.XX
|
| 29200 |
STRAPPING OF CHEST
|
$XXX.XX
|
| 29240 |
STRAPPING OF SHOULDER
|
$XXX.XX
|
| 29260 |
STRAPPING OF ELBOW OR WRIST
|
$XXX.XX
|
| 29280 |
STRAPPING OF HAND OR FINGER
|
$XXX.XX
|
| 29305 |
APPLICATION OF HIP CAST
|
$XXX.XX
|
| 29325 |
APPLICATION OF HIP CASTS
|
$XXX.XX
|
| 29345 |
APPLICATION OF LONG LEG CAST
|
$XXX.XX
|
| 29355 |
APPLICATION OF LONG LEG CAST
|
$XXX.XX
|
| 29358 |
APPLY LONG LEG CAST BRACE
|
$XXX.XX
|
| 29365 |
APPLICATION OF LONG LEG CAST
|
$XXX.XX
|
| 29405 |
APPLY SHORT LEG CAST
|
$XXX.XX
|
| 29425 |
APPLY SHORT LEG CAST
|
$XXX.XX
|
| 29435 |
APPLY SHORT LEG CAST
|
$XXX.XX
|
| 29440 |
ADDITION OF WALKER TO CAST
|
$XXX.XX
|
| 29445 |
APPLY RIGID LEG CAST
|
$XXX.XX
|
| 29450 |
APPLICATION OF LEG CAST
|
$XXX.XX
|
| 29505 |
APPLICATION LONG LEG SPLINT
|
$XXX.XX
|
| 29515 |
APPLICATION LOWER LEG SPLINT
|
$XXX.XX
|
| 29520 |
STRAPPING OF HIP
|
$XXX.XX
|
| 29530 |
STRAPPING OF KNEE
|
$XXX.XX
|
| 29540 |
STRAPPING OF ANKLE AND/OR FT
|
$XXX.XX
|
| 29550 |
STRAPPING OF TOES
|
$XXX.XX
|
| 29580 |
APPLICATION OF PASTE BOOT
|
$XXX.XX
|
| 29581 |
APPLY MULTLAY COMPRS LWR LEG
|
$XXX.XX
|
| 29584 |
APPL MULTLAY COMPRS ARM/HAND
|
$XXX.XX
|
| 29700 |
REMOVAL/REVISION OF CAST
|
$XXX.XX
|
| 29705 |
REMOVAL/REVISION OF CAST
|
$XXX.XX
|
| 29710 |
REMOVAL/REVISION OF CAST
|
$XXX.XX
|
| 29720 |
REPAIR OF BODY CAST
|
$XXX.XX
|
| 29730 |
WINDOWING OF CAST
|
$XXX.XX
|
| 29740 |
WEDGING OF CAST
|
$XXX.XX
|
| 29750 |
WEDGING OF CLUBFOOT CAST
|
$XXX.XX
|
| 29800 |
JAW ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29804 |
JAW ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29805 |
SHOULDER ARTHROSCOPY DX
|
$XXX.XX
|
| 29806 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29807 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29819 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29820 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29821 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29822 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29823 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29824 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29825 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29826 |
SHOULDER ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29827 |
ARTHROSCOP ROTATOR CUFF REPR
|
$XXX.XX
|
| 29828 |
ARTHROSCOPY BICEPS TENODESIS
|
$XXX.XX
|
| 29830 |
ELBOW ARTHROSCOPY
|
$XXX.XX
|
| 29834 |
ELBOW ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29835 |
ELBOW ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29836 |
ELBOW ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29837 |
ELBOW ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29838 |
ELBOW ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29840 |
WRIST ARTHROSCOPY
|
$XXX.XX
|
| 29843 |
WRIST ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29844 |
WRIST ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29845 |
WRIST ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29846 |
WRIST ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29847 |
WRIST ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29848 |
WRIST ENDOSCOPY/SURGERY
|
$XXX.XX
|
| 29850 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29851 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29855 |
TIBIAL ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29856 |
TIBIAL ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29860 |
HIP ARTHROSCOPY DX
|
$XXX.XX
|
| 29861 |
HIP ARTHRO W/FB REMOVAL
|
$XXX.XX
|
| 29862 |
HIP ARTHR0 W/DEBRIDEMENT
|
$XXX.XX
|
| 29863 |
HIP ARTHR0 W/SYNOVECTOMY
|
$XXX.XX
|
| 29866 |
AUTGRFT IMPLNT KNEE W/SCOPE
|
$XXX.XX
|
| 29867 |
ALLGRFT IMPLNT KNEE W/SCOPE
|
$XXX.XX
|
| 29868 |
MENISCAL TRNSPL KNEE W/SCPE
|
$XXX.XX
|
| 29870 |
KNEE ARTHROSCOPY DX
|
$XXX.XX
|
| 29871 |
KNEE ARTHROSCOPY/DRAINAGE
|
$XXX.XX
|
| 29873 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29874 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29875 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29876 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29877 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29879 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29880 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29881 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29882 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29883 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29884 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29885 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29886 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29887 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29888 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29889 |
KNEE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29891 |
ANKLE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29892 |
ANKLE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29893 |
SCOPE PLANTAR FASCIOTOMY
|
$XXX.XX
|
| 29894 |
ANKLE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29895 |
ANKLE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29897 |
ANKLE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29898 |
ANKLE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29899 |
ANKLE ARTHROSCOPY/SURGERY
|
$XXX.XX
|
| 29900 |
MCP JOINT ARTHROSCOPY DX
|
$XXX.XX
|
| 29901 |
MCP JOINT ARTHROSCOPY SURG
|
$XXX.XX
|
| 29902 |
MCP JOINT ARTHROSCOPY SURG
|
$XXX.XX
|
| 29904 |
SUBTALAR ARTHRO W/FB RMVL
|
$XXX.XX
|
| 29905 |
SUBTALAR ARTHRO W/EXC
|
$XXX.XX
|
| 29906 |
SUBTALAR ARTHRO W/DEB
|
$XXX.XX
|
| 29907 |
SUBTALAR ARTHRO W/FUSION
|
$XXX.XX
|
| 29914 |
HIP ARTHRO W/FEMOROPLASTY
|
$XXX.XX
|
| 29915 |
HIP ARTHRO ACETABULOPLASTY
|
$XXX.XX
|
| 29916 |
HIP ARTHRO W/LABRAL REPAIR
|
$XXX.XX
|
| 30000 |
DRAINAGE OF NOSE LESION
|
$XXX.XX
|
| 30020 |
DRAINAGE OF NOSE LESION
|
$XXX.XX
|
| 30100 |
INTRANASAL BIOPSY
|
$XXX.XX
|
| 30110 |
REMOVAL OF NOSE POLYP(S)
|
$XXX.XX
|
| 30115 |
REMOVAL OF NOSE POLYP(S)
|
$XXX.XX
|
| 30117 |
REMOVAL OF INTRANASAL LESION
|
$XXX.XX
|
| 30118 |
REMOVAL OF INTRANASAL LESION
|
$XXX.XX
|
| 30120 |
REVISION OF NOSE
|
$XXX.XX
|
| 30124 |
REMOVAL OF NOSE LESION
|
$XXX.XX
|
| 30125 |
REMOVAL OF NOSE LESION
|
$XXX.XX
|
| 30130 |
EXCISE INFERIOR TURBINATE
|
$XXX.XX
|
| 30140 |
RESECT INFERIOR TURBINATE
|
$XXX.XX
|
| 30150 |
PARTIAL REMOVAL OF NOSE
|
$XXX.XX
|
| 30160 |
REMOVAL OF NOSE
|
$XXX.XX
|
| 30200 |
INJECTION TREATMENT OF NOSE
|
$XXX.XX
|
| 30210 |
NASAL SINUS THERAPY
|
$XXX.XX
|
| 30220 |
INSERT NASAL SEPTAL BUTTON
|
$XXX.XX
|
| 30300 |
REMOVE NASAL FOREIGN BODY
|
$XXX.XX
|
| 30310 |
REMOVE NASAL FOREIGN BODY
|
$XXX.XX
|
| 30320 |
REMOVE NASAL FOREIGN BODY
|
$XXX.XX
|
| 30400 |
RECONSTRUCTION OF NOSE
|
$XXX.XX
|
| 30410 |
RECONSTRUCTION OF NOSE
|
$XXX.XX
|
| 30420 |
RECONSTRUCTION OF NOSE
|
$XXX.XX
|
| 30430 |
REVISION OF NOSE
|
$XXX.XX
|
| 30435 |
REVISION OF NOSE
|
$XXX.XX
|
| 30450 |
REVISION OF NOSE
|
$XXX.XX
|
| 30460 |
REVISION OF NOSE
|
$XXX.XX
|
| 30462 |
REVISION OF NOSE
|
$XXX.XX
|
| 30465 |
REPAIR NASAL STENOSIS
|
$XXX.XX
|
| 30520 |
REPAIR OF NASAL SEPTUM
|
$XXX.XX
|
| 30540 |
REPAIR NASAL DEFECT
|
$XXX.XX
|
| 30545 |
REPAIR NASAL DEFECT
|
$XXX.XX
|
| 30560 |
RELEASE OF NASAL ADHESIONS
|
$XXX.XX
|
| 30580 |
REPAIR UPPER JAW FISTULA
|
$XXX.XX
|
| 30600 |
REPAIR MOUTH/NOSE FISTULA
|
$XXX.XX
|
| 30620 |
INTRANASAL RECONSTRUCTION
|
$XXX.XX
|
| 30630 |
REPAIR NASAL SEPTUM DEFECT
|
$XXX.XX
|
| 30801 |
ABLATE INF TURBINATE SUPERF
|
$XXX.XX
|
| 30802 |
ABLATE INF TURBINATE SUBMUC
|
$XXX.XX
|
| 30901 |
CONTROL OF NOSEBLEED
|
$XXX.XX
|
| 30903 |
CONTROL OF NOSEBLEED
|
$XXX.XX
|
| 30905 |
CONTROL OF NOSEBLEED
|
$XXX.XX
|
| 30906 |
REPEAT CONTROL OF NOSEBLEED
|
$XXX.XX
|
| 30915 |
LIGATION NASAL SINUS ARTERY
|
$XXX.XX
|
| 30920 |
LIGATION UPPER JAW ARTERY
|
$XXX.XX
|
| 30930 |
THER FX NASAL INF TURBINATE
|
$XXX.XX
|
| 31000 |
IRRIGATION MAXILLARY SINUS
|
$XXX.XX
|
| 31002 |
IRRIGATION SPHENOID SINUS
|
$XXX.XX
|
| 31020 |
EXPLORATION MAXILLARY SINUS
|
$XXX.XX
|
| 31030 |
EXPLORATION MAXILLARY SINUS
|
$XXX.XX
|
| 31032 |
EXPLORE SINUS REMOVE POLYPS
|
$XXX.XX
|
| 31040 |
EXPLORATION BEHIND UPPER JAW
|
$XXX.XX
|
| 31050 |
EXPLORATION SPHENOID SINUS
|
$XXX.XX
|
| 31051 |
SPHENOID SINUS SURGERY
|
$XXX.XX
|
| 31070 |
EXPLORATION OF FRONTAL SINUS
|
$XXX.XX
|
| 31075 |
EXPLORATION OF FRONTAL SINUS
|
$XXX.XX
|
| 31080 |
REMOVAL OF FRONTAL SINUS
|
$XXX.XX
|
| 31081 |
REMOVAL OF FRONTAL SINUS
|
$XXX.XX
|
| 31084 |
REMOVAL OF FRONTAL SINUS
|
$XXX.XX
|
| 31085 |
REMOVAL OF FRONTAL SINUS
|
$XXX.XX
|
| 31086 |
REMOVAL OF FRONTAL SINUS
|
$XXX.XX
|
| 31087 |
REMOVAL OF FRONTAL SINUS
|
$XXX.XX
|
| 31090 |
EXPLORATION OF SINUSES
|
$XXX.XX
|
| 31200 |
REMOVAL OF ETHMOID SINUS
|
$XXX.XX
|
| 31201 |
REMOVAL OF ETHMOID SINUS
|
$XXX.XX
|
| 31205 |
REMOVAL OF ETHMOID SINUS
|
$XXX.XX
|
| 31225 |
REMOVAL OF UPPER JAW
|
$XXX.XX
|
| 31230 |
REMOVAL OF UPPER JAW
|
$XXX.XX
|
| 31231 |
NASAL ENDOSCOPY DX
|
$XXX.XX
|
| 31233 |
NSL/SINS NDSC DX MAX SINUSC
|
$XXX.XX
|
| 31235 |
NSL/SINS NDSC DX SPHN SINUSC
|
$XXX.XX
|
| 31237 |
NASAL/SINUS ENDOSCOPY SURG
|
$XXX.XX
|
| 31238 |
NASAL/SINUS ENDOSCOPY SURG
|
$XXX.XX
|
| 31239 |
NASAL/SINUS ENDOSCOPY SURG
|
$XXX.XX
|
| 31240 |
NASAL/SINUS ENDOSCOPY SURG
|
$XXX.XX
|
| 31241 |
NSL/SINS NDSC W/ARTERY LIG
|
$XXX.XX
|
| 31253 |
NSL/SINS NDSC TOTAL
|
$XXX.XX
|
| 31254 |
NSL/SINS NDSC W/PRTL ETHMDCT
|
$XXX.XX
|
| 31255 |
NSL/SINS NDSC W/TOT ETHMDCT
|
$XXX.XX
|
| 31256 |
EXPLORATION MAXILLARY SINUS
|
$XXX.XX
|
| 31257 |
NSL/SINS NDSC TOT W/SPHENDT
|
$XXX.XX
|
| 31259 |
NSL/SINS NDSC SPHN TISS RMVL
|
$XXX.XX
|
| 31267 |
ENDOSCOPY MAXILLARY SINUS
|
$XXX.XX
|
| 31276 |
NSL/SINS NDSC FRNT TISS RMVL
|
$XXX.XX
|
| 31287 |
NASAL/SINUS ENDOSCOPY SURG
|
$XXX.XX
|
| 31288 |
NASAL/SINUS ENDOSCOPY SURG
|
$XXX.XX
|
| 31290 |
NASAL/SINUS ENDOSCOPY SURG
|
$XXX.XX
|
| 31291 |
NASAL/SINUS ENDOSCOPY SURG
|
$XXX.XX
|
| 31292 |
NSL/SINS NDSC MED/INF DCMPRN
|
$XXX.XX
|
| 31293 |
NSL/SINS NDSC MED&INF DCMPRN
|
$XXX.XX
|
| 31294 |
NSL/SINS NDSC SURG ON DCMPRN
|
$XXX.XX
|
| 31295 |
NSL/SINS NDSC SURG MAX SINS
|
$XXX.XX
|
| 31296 |
NSL/SINS NDSC SURG FRNT SINS
|
$XXX.XX
|
| 31297 |
NSL/SINS NDSC SURG SPHN SINS
|
$XXX.XX
|
| 31298 |
NSL/SINS NDSC SURG FRNT&SPHN
|
$XXX.XX
|
| 31300 |
REMOVAL OF LARYNX LESION
|
$XXX.XX
|
| 31360 |
REMOVAL OF LARYNX
|
$XXX.XX
|
| 31365 |
REMOVAL OF LARYNX
|
$XXX.XX
|
| 31367 |
PARTIAL REMOVAL OF LARYNX
|
$XXX.XX
|
| 31368 |
PARTIAL REMOVAL OF LARYNX
|
$XXX.XX
|
| 31370 |
PARTIAL REMOVAL OF LARYNX
|
$XXX.XX
|
| 31375 |
PARTIAL REMOVAL OF LARYNX
|
$XXX.XX
|
| 31380 |
PARTIAL REMOVAL OF LARYNX
|
$XXX.XX
|
| 31382 |
PARTIAL REMOVAL OF LARYNX
|
$XXX.XX
|
| 31390 |
REMOVAL OF LARYNX & PHARYNX
|
$XXX.XX
|
| 31395 |
RECONSTRUCT LARYNX & PHARYNX
|
$XXX.XX
|
| 31400 |
REVISION OF LARYNX
|
$XXX.XX
|
| 31420 |
REMOVAL OF EPIGLOTTIS
|
$XXX.XX
|
| 31500 |
INSERT EMERGENCY AIRWAY
|
$XXX.XX
|
| 31502 |
CHANGE OF WINDPIPE AIRWAY
|
$XXX.XX
|
| 31505 |
DIAGNOSTIC LARYNGOSCOPY
|
$XXX.XX
|
| 31510 |
LARYNGOSCOPY WITH BIOPSY
|
$XXX.XX
|
| 31511 |
REMOVE FOREIGN BODY LARYNX
|
$XXX.XX
|
| 31512 |
REMOVAL OF LARYNX LESION
|
$XXX.XX
|
| 31513 |
INJECTION INTO VOCAL CORD
|
$XXX.XX
|
| 31515 |
LARYNGOSCOPY FOR ASPIRATION
|
$XXX.XX
|
| 31520 |
DX LARYNGOSCOPY NEWBORN
|
$XXX.XX
|
| 31525 |
DX LARYNGOSCOPY EXCL NB
|
$XXX.XX
|
| 31526 |
DX LARYNGOSCOPY W/OPER SCOPE
|
$XXX.XX
|
| 31527 |
LARYNGOSCOPY FOR TREATMENT
|
$XXX.XX
|
| 31528 |
LARYNGOSCOPY AND DILATION
|
$XXX.XX
|
| 31529 |
LARYNGOSCOPY AND DILATION
|
$XXX.XX
|
| 31530 |
LARYNGOSCOPY W/FB REMOVAL
|
$XXX.XX
|
| 31531 |
LARYNGOSCOPY W/FB & OP SCOPE
|
$XXX.XX
|
| 31535 |
LARYNGOSCOPY W/BIOPSY
|
$XXX.XX
|
| 31536 |
LARYNGOSCOPY W/BX & OP SCOPE
|
$XXX.XX
|
| 31540 |
LARYNGOSCOPY W/EXC OF TUMOR
|
$XXX.XX
|
| 31541 |
LARYNSCOP W/TUMR EXC + SCOPE
|
$XXX.XX
|
| 31545 |
REMOVE VC LESION W/SCOPE
|
$XXX.XX
|
| 31546 |
REMOVE VC LESION SCOPE/GRAFT
|
$XXX.XX
|
| 31551 |
LARYNGOPLASTY LARYNGEAL STEN
|
$XXX.XX
|
| 31552 |
LARYNGOPLASTY LARYNGEAL STEN
|
$XXX.XX
|
| 31553 |
LARYNGOPLASTY LARYNGEAL STEN
|
$XXX.XX
|
| 31554 |
LARYNGOPLASTY LARYNGEAL STEN
|
$XXX.XX
|
| 31560 |
LARYNGOSCOP W/ARYTENOIDECTOM
|
$XXX.XX
|
| 31561 |
LARYNSCOP REMVE CART + SCOP
|
$XXX.XX
|
| 31570 |
LARYNGOSCOPE W/VC INJ
|
$XXX.XX
|
| 31571 |
LARYNGOSCOP W/VC INJ + SCOPE
|
$XXX.XX
|
| 31572 |
LARGSC W/LASER DSTRJ LES
|
$XXX.XX
|
| 31573 |
LARGSC W/THER INJECTION
|
$XXX.XX
|
| 31574 |
LARGSC W/NJX AUGMENTATION
|
$XXX.XX
|
| 31575 |
DIAGNOSTIC LARYNGOSCOPY
|
$XXX.XX
|
| 31576 |
LARYNGOSCOPY WITH BIOPSY
|
$XXX.XX
|
| 31577 |
LARGSC W/RMVL FOREIGN BDY(S)
|
$XXX.XX
|
| 31578 |
LARGSC W/REMOVAL LESION
|
$XXX.XX
|
| 31579 |
LARYNGOSCOPY TELESCOPIC
|
$XXX.XX
|
| 31580 |
LARYNGOPLASTY LARYNGEAL WEB
|
$XXX.XX
|
| 31584 |
LARYNGOPLASTY FX RDCTJ FIXJ
|
$XXX.XX
|
| 31587 |
LARYNGOPLASTY CRICOID SPLIT
|
$XXX.XX
|
| 31590 |
REINNERVATE LARYNX
|
$XXX.XX
|
| 31591 |
LARYNGOPLASTY MEDIALIZATION
|
$XXX.XX
|
| 31592 |
CRICOTRACHEAL RESECTION
|
$XXX.XX
|
| 31600 |
INCISION OF WINDPIPE
|
$XXX.XX
|
| 31601 |
INCISION OF WINDPIPE
|
$XXX.XX
|
| 31603 |
INCISION OF WINDPIPE
|
$XXX.XX
|
| 31605 |
INCISION OF WINDPIPE
|
$XXX.XX
|
| 31610 |
INCISION OF WINDPIPE
|
$XXX.XX
|
| 31611 |
SURGERY/SPEECH PROSTHESIS
|
$XXX.XX
|
| 31612 |
PUNCTURE/CLEAR WINDPIPE
|
$XXX.XX
|
| 31613 |
REPAIR WINDPIPE OPENING
|
$XXX.XX
|
| 31614 |
REPAIR WINDPIPE OPENING
|
$XXX.XX
|
| 31615 |
VISUALIZATION OF WINDPIPE
|
$XXX.XX
|
| 31622 |
DX BRONCHOSCOPE/WASH
|
$XXX.XX
|
| 31623 |
DX BRONCHOSCOPE/BRUSH
|
$XXX.XX
|
| 31624 |
DX BRONCHOSCOPE/LAVAGE
|
$XXX.XX
|
| 31625 |
BRONCHOSCOPY W/BIOPSY(S)
|
$XXX.XX
|
| 31626 |
BRONCHOSCOPY W/MARKERS
|
$XXX.XX
|
| 31627 |
NAVIGATIONAL BRONCHOSCOPY
|
$XXX.XX
|
| 31628 |
BRONCHOSCOPY/LUNG BX EACH
|
$XXX.XX
|
| 31629 |
BRONCHOSCOPY/NEEDLE BX EACH
|
$XXX.XX
|
| 31630 |
BRONCHOSCOPY DILATE/FX REPR
|
$XXX.XX
|
| 31631 |
BRONCHOSCOPY DILATE W/STENT
|
$XXX.XX
|
| 31632 |
BRONCHOSCOPY/LUNG BX ADDL
|
$XXX.XX
|
| 31633 |
BRONCHOSCOPY/NEEDLE BX ADDL
|
$XXX.XX
|
| 31634 |
BRONCH W/BALLOON OCCLUSION
|
$XXX.XX
|
| 31635 |
BRONCHOSCOPY W/FB REMOVAL
|
$XXX.XX
|
| 31636 |
BRONCHOSCOPY BRONCH STENTS
|
$XXX.XX
|
| 31637 |
BRONCHOSCOPY STENT ADD-ON
|
$XXX.XX
|
| 31638 |
BRONCHOSCOPY REVISE STENT
|
$XXX.XX
|
| 31640 |
BRONCHOSCOPY W/TUMOR EXCISE
|
$XXX.XX
|
| 31641 |
BRONCHOSCOPY TREAT BLOCKAGE
|
$XXX.XX
|
| 31643 |
DIAG BRONCHOSCOPE/CATHETER
|
$XXX.XX
|
| 31645 |
BRNCHSC W/THER ASPIR 1ST
|
$XXX.XX
|
| 31646 |
BRNCHSC W/THER ASPIR SBSQ
|
$XXX.XX
|
| 31647 |
BRONCHIAL VALVE INIT INSERT
|
$XXX.XX
|
| 31648 |
BRONCHIAL VALVE REMOV INIT
|
$XXX.XX
|
| 31649 |
BRONCHIAL VALVE REMOV ADDL
|
$XXX.XX
|
| 31651 |
BRONCHIAL VALVE ADDL INSERT
|
$XXX.XX
|
| 31652 |
BRONCH EBUS SAMPLNG 1/2 NODE
|
$XXX.XX
|
| 31653 |
BRONCH EBUS SAMPLNG 3/> NODE
|
$XXX.XX
|
| 31654 |
BRONCH EBUS IVNTJ PERPH LES
|
$XXX.XX
|
| 31660 |
BRONCH THERMOPLSTY 1 LOBE
|
$XXX.XX
|
| 31661 |
BRONCH THERMOPLSTY 2/> LOBES
|
$XXX.XX
|
| 31717 |
BRONCHIAL BRUSH BIOPSY
|
$XXX.XX
|
| 31720 |
CLEARANCE OF AIRWAYS
|
$XXX.XX
|
| 31725 |
CLEARANCE OF AIRWAYS
|
$XXX.XX
|
| 31730 |
INTRO WINDPIPE WIRE/TUBE
|
$XXX.XX
|
| 31750 |
REPAIR OF WINDPIPE
|
$XXX.XX
|
| 31755 |
REPAIR OF WINDPIPE
|
$XXX.XX
|
| 31760 |
REPAIR OF WINDPIPE
|
$XXX.XX
|
| 31766 |
RECONSTRUCTION OF WINDPIPE
|
$XXX.XX
|
| 31770 |
REPAIR/GRAFT OF BRONCHUS
|
$XXX.XX
|
| 31775 |
RECONSTRUCT BRONCHUS
|
$XXX.XX
|
| 31780 |
RECONSTRUCT WINDPIPE
|
$XXX.XX
|
| 31781 |
RECONSTRUCT WINDPIPE
|
$XXX.XX
|
| 31785 |
REMOVE WINDPIPE LESION
|
$XXX.XX
|
| 31786 |
REMOVE WINDPIPE LESION
|
$XXX.XX
|
| 31800 |
REPAIR OF WINDPIPE INJURY
|
$XXX.XX
|
| 31805 |
REPAIR OF WINDPIPE INJURY
|
$XXX.XX
|
| 31820 |
CLOSURE OF WINDPIPE LESION
|
$XXX.XX
|
| 31825 |
REPAIR OF WINDPIPE DEFECT
|
$XXX.XX
|
| 31830 |
REVISE WINDPIPE SCAR
|
$XXX.XX
|
| 32035 |
THORACOSTOMY W/RIB RESECTION
|
$XXX.XX
|
| 32036 |
THORACOSTOMY W/FLAP DRAINAGE
|
$XXX.XX
|
| 32096 |
OPEN WEDGE/BX LUNG INFILTR
|
$XXX.XX
|
| 32097 |
OPEN WEDGE/BX LUNG NODULE
|
$XXX.XX
|
| 32098 |
OPEN BIOPSY OF LUNG PLEURA
|
$XXX.XX
|
| 32100 |
EXPLORATION OF CHEST
|
$XXX.XX
|
| 32110 |
EXPLORE/REPAIR CHEST
|
$XXX.XX
|
| 32120 |
RE-EXPLORATION OF CHEST
|
$XXX.XX
|
| 32124 |
EXPLORE CHEST FREE ADHESIONS
|
$XXX.XX
|
| 32140 |
REMOVAL OF LUNG LESION(S)
|
$XXX.XX
|
| 32141 |
REMOVE/TREAT LUNG LESIONS
|
$XXX.XX
|
| 32150 |
REMOVAL OF LUNG LESION(S)
|
$XXX.XX
|
| 32151 |
REMOVE LUNG FOREIGN BODY
|
$XXX.XX
|
| 32160 |
OPEN CHEST HEART MASSAGE
|
$XXX.XX
|
| 32200 |
DRAIN OPEN LUNG LESION
|
$XXX.XX
|
| 32215 |
TREAT CHEST LINING
|
$XXX.XX
|
| 32220 |
RELEASE OF LUNG
|
$XXX.XX
|
| 32225 |
PARTIAL RELEASE OF LUNG
|
$XXX.XX
|
| 32310 |
REMOVAL OF CHEST LINING
|
$XXX.XX
|
| 32320 |
FREE/REMOVE CHEST LINING
|
$XXX.XX
|
| 32400 |
NEEDLE BIOPSY CHEST LINING
|
$XXX.XX
|
| 32405 |
PERCUT BX LUNG/MEDIASTINUM
|
$XXX.XX
|
| 32440 |
REMOVE LUNG PNEUMONECTOMY
|
$XXX.XX
|
| 32442 |
SLEEVE PNEUMONECTOMY
|
$XXX.XX
|
| 32445 |
REMOVAL OF LUNG EXTRAPLEURAL
|
$XXX.XX
|
| 32480 |
PARTIAL REMOVAL OF LUNG
|
$XXX.XX
|
| 32482 |
BILOBECTOMY
|
$XXX.XX
|
| 32484 |
SEGMENTECTOMY
|
$XXX.XX
|
| 32486 |
SLEEVE LOBECTOMY
|
$XXX.XX
|
| 32488 |
COMPLETION PNEUMONECTOMY
|
$XXX.XX
|
| 32491 |
LUNG VOLUME REDUCTION
|
$XXX.XX
|
| 32501 |
REPAIR BRONCHUS ADD-ON
|
$XXX.XX
|
| 32503 |
RESECT APICAL LUNG TUMOR
|
$XXX.XX
|
| 32504 |
RESECT APICAL LUNG TUM/CHEST
|
$XXX.XX
|
| 32505 |
WEDGE RESECT OF LUNG INITIAL
|
$XXX.XX
|
| 32506 |
WEDGE RESECT OF LUNG ADD-ON
|
$XXX.XX
|
| 32507 |
WEDGE RESECT OF LUNG DIAG
|
$XXX.XX
|
| 32540 |
REMOVAL OF LUNG LESION
|
$XXX.XX
|
| 32550 |
INSERT PLEURAL CATH
|
$XXX.XX
|
| 32551 |
INSERTION OF CHEST TUBE
|
$XXX.XX
|
| 32552 |
REMOVE LUNG CATHETER
|
$XXX.XX
|
| 32553 |
INS MARK THOR FOR RT PERQ
|
$XXX.XX
|
| 32554 |
ASPIRATE PLEURA W/O IMAGING
|
$XXX.XX
|
| 32555 |
ASPIRATE PLEURA W/ IMAGING
|
$XXX.XX
|
| 32556 |
INSERT CATH PLEURA W/O IMAGE
|
$XXX.XX
|
| 32557 |
INSERT CATH PLEURA W/ IMAGE
|
$XXX.XX
|
| 32560 |
TREAT PLEURODESIS W/AGENT
|
$XXX.XX
|
| 32561 |
LYSE CHEST FIBRIN INIT DAY
|
$XXX.XX
|
| 32562 |
LYSE CHEST FIBRIN SUBQ DAY
|
$XXX.XX
|
| 32601 |
THORACOSCOPY DIAGNOSTIC
|
$XXX.XX
|
| 32604 |
THORACOSCOPY WBX SAC
|
$XXX.XX
|
| 32606 |
THORACOSCOPY W/BX MED SPACE
|
$XXX.XX
|
| 32607 |
THORACOSCOPY W/BX INFILTRATE
|
$XXX.XX
|
| 32608 |
THORACOSCOPY W/BX NODULE
|
$XXX.XX
|
| 32609 |
THORACOSCOPY W/BX PLEURA
|
$XXX.XX
|
| 32650 |
THORACOSCOPY W/PLEURODESIS
|
$XXX.XX
|
| 32651 |
THORACOSCOPY REMOVE CORTEX
|
$XXX.XX
|
| 32652 |
THORACOSCOPY REM TOTL CORTEX
|
$XXX.XX
|
| 32653 |
THORACOSCOPY REMOV FB/FIBRIN
|
$XXX.XX
|
| 32654 |
THORACOSCOPY CONTRL BLEEDING
|
$XXX.XX
|
| 32655 |
THORACOSCOPY RESECT BULLAE
|
$XXX.XX
|
| 32656 |
THORACOSCOPY W/PLEURECTOMY
|
$XXX.XX
|
| 32658 |
THORACOSCOPY W/SAC FB REMOVE
|
$XXX.XX
|
| 32659 |
THORACOSCOPY W/SAC DRAINAGE
|
$XXX.XX
|
| 32661 |
THORACOSCOPY W/PERICARD EXC
|
$XXX.XX
|
| 32662 |
THORACOSCOPY W/MEDIAST EXC
|
$XXX.XX
|
| 32663 |
THORACOSCOPY W/LOBECTOMY
|
$XXX.XX
|
| 32664 |
THORACOSCOPY W/ TH NRV EXC
|
$XXX.XX
|
| 32665 |
THORACOSCOP W/ESOPH MUSC EXC
|
$XXX.XX
|
| 32666 |
THORACOSCOPY W/WEDGE RESECT
|
$XXX.XX
|
| 32667 |
THORACOSCOPY W/W RESECT ADDL
|
$XXX.XX
|
| 32668 |
THORACOSCOPY W/W RESECT DIAG
|
$XXX.XX
|
| 32669 |
THORACOSCOPY REMOVE SEGMENT
|
$XXX.XX
|
| 32670 |
THORACOSCOPY BILOBECTOMY
|
$XXX.XX
|
| 32671 |
THORACOSCOPY PNEUMONECTOMY
|
$XXX.XX
|
| 32672 |
THORACOSCOPY FOR LVRS
|
$XXX.XX
|
| 32673 |
THORACOSCOPY W/THYMUS RESECT
|
$XXX.XX
|
| 32674 |
THORACOSCOPY LYMPH NODE EXC
|
$XXX.XX
|
| 32701 |
THORAX STEREO RAD TARGETW/TX
|
$XXX.XX
|
| 32800 |
REPAIR LUNG HERNIA
|
$XXX.XX
|
| 32810 |
CLOSE CHEST AFTER DRAINAGE
|
$XXX.XX
|
| 32815 |
CLOSE BRONCHIAL FISTULA
|
$XXX.XX
|
| 32820 |
RECONSTRUCT INJURED CHEST
|
$XXX.XX
|
| 32851 |
LUNG TRANSPLANT SINGLE
|
$XXX.XX
|
| 32852 |
LUNG TRANSPLANT WITH BYPASS
|
$XXX.XX
|
| 32853 |
LUNG TRANSPLANT DOUBLE
|
$XXX.XX
|
| 32854 |
LUNG TRANSPLANT WITH BYPASS
|
$XXX.XX
|
| 32900 |
REMOVAL OF RIB(S)
|
$XXX.XX
|
| 32905 |
REVISE & REPAIR CHEST WALL
|
$XXX.XX
|
| 32906 |
REVISE & REPAIR CHEST WALL
|
$XXX.XX
|
| 32940 |
REVISION OF LUNG
|
$XXX.XX
|
| 32960 |
THERAPEUTIC PNEUMOTHORAX
|
$XXX.XX
|
| 32994 |
ABLATE PULM TUMOR PERQ CRYBL
|
$XXX.XX
|
| 32997 |
TOTAL LUNG LAVAGE
|
$XXX.XX
|
| 32998 |
ABLATE PULM TUMOR PERQ RF
|
$XXX.XX
|
| 33016 |
PERICARDIOCENTESIS W/IMAGING
|
$XXX.XX
|
| 33017 |
PRCRD DRG 6YR+ W/O CGEN CAR
|
$XXX.XX
|
| 33018 |
PRCRD DRG 0-5YR OR W/ANOMLY
|
$XXX.XX
|
| 33019 |
PERQ PRCRD DRG INSJ CATH CT
|
$XXX.XX
|
| 33020 |
INCISION OF HEART SAC
|
$XXX.XX
|
| 33025 |
INCISION OF HEART SAC
|
$XXX.XX
|
| 33030 |
PARTIAL REMOVAL OF HEART SAC
|
$XXX.XX
|
| 33031 |
PARTIAL REMOVAL OF HEART SAC
|
$XXX.XX
|
| 33050 |
RESECT HEART SAC LESION
|
$XXX.XX
|
| 33120 |
REMOVAL OF HEART LESION
|
$XXX.XX
|
| 33130 |
REMOVAL OF HEART LESION
|
$XXX.XX
|
| 33140 |
HEART REVASCULARIZE (TMR)
|
$XXX.XX
|
| 33141 |
HEART TMR W/OTHER PROCEDURE
|
$XXX.XX
|
| 33202 |
INSERT EPICARD ELTRD OPEN
|
$XXX.XX
|
| 33203 |
INSERT EPICARD ELTRD ENDO
|
$XXX.XX
|
| 33206 |
INSERT HEART PM ATRIAL
|
$XXX.XX
|
| 33207 |
INSERT HEART PM VENTRICULAR
|
$XXX.XX
|
| 33208 |
INSRT HEART PM ATRIAL & VENT
|
$XXX.XX
|
| 33210 |
INSERT ELECTRD/PM CATH SNGL
|
$XXX.XX
|
| 33211 |
INSERT CARD ELECTRODES DUAL
|
$XXX.XX
|
| 33212 |
INSERT PULSE GEN SNGL LEAD
|
$XXX.XX
|
| 33213 |
INSERT PULSE GEN DUAL LEADS
|
$XXX.XX
|
| 33214 |
UPGRADE OF PACEMAKER SYSTEM
|
$XXX.XX
|
| 33215 |
REPOSITION PACING-DEFIB LEAD
|
$XXX.XX
|
| 33216 |
INSERT 1 ELECTRODE PM-DEFIB
|
$XXX.XX
|
| 33217 |
INSERT 2 ELECTRODE PM-DEFIB
|
$XXX.XX
|
| 33218 |
REPAIR LEAD PACE-DEFIB ONE
|
$XXX.XX
|
| 33220 |
REPAIR LEAD PACE-DEFIB DUAL
|
$XXX.XX
|
| 33221 |
INSERT PULSE GEN MULT LEADS
|
$XXX.XX
|
| 33222 |
RELOCATION POCKET PACEMAKER
|
$XXX.XX
|
| 33223 |
RELOCATE POCKET FOR DEFIB
|
$XXX.XX
|
| 33224 |
INSERT PACING LEAD & CONNECT
|
$XXX.XX
|
| 33225 |
L VENTRIC PACING LEAD ADD-ON
|
$XXX.XX
|
| 33226 |
REPOSITION L VENTRIC LEAD
|
$XXX.XX
|
| 33227 |
REMOVE&REPLACE PM GEN SINGL
|
$XXX.XX
|
| 33228 |
REMV&REPLC PM GEN DUAL LEAD
|
$XXX.XX
|
| 33229 |
REMV&REPLC PM GEN MULT LEADS
|
$XXX.XX
|
| 33230 |
INSRT PULSE GEN W/DUAL LEADS
|
$XXX.XX
|
| 33231 |
INSRT PULSE GEN W/MULT LEADS
|
$XXX.XX
|
| 33233 |
REMOVAL OF PM GENERATOR
|
$XXX.XX
|
| 33234 |
REMOVAL OF PACEMAKER SYSTEM
|
$XXX.XX
|
| 33235 |
REMOVAL PACEMAKER ELECTRODE
|
$XXX.XX
|
| 33236 |
REMOVE ELECTRODE/THORACOTOMY
|
$XXX.XX
|
| 33237 |
REMOVE ELECTRODE/THORACOTOMY
|
$XXX.XX
|
| 33238 |
REMOVE ELECTRODE/THORACOTOMY
|
$XXX.XX
|
| 33240 |
INSRT PULSE GEN W/SINGL LEAD
|
$XXX.XX
|
| 33241 |
REMOVE PULSE GENERATOR
|
$XXX.XX
|
| 33243 |
REMOVE ELTRD/THORACOTOMY
|
$XXX.XX
|
| 33244 |
REMOVE ELCTRD TRANSVENOUSLY
|
$XXX.XX
|
| 33249 |
INSJ/RPLCMT DEFIB W/LEAD(S)
|
$XXX.XX
|
| 33250 |
ABLATE HEART DYSRHYTHM FOCUS
|
$XXX.XX
|
| 33251 |
ABLATE HEART DYSRHYTHM FOCUS
|
$XXX.XX
|
| 33254 |
ABLATE ATRIA LMTD
|
$XXX.XX
|
| 33255 |
ABLATE ATRIA W/O BYPASS EXT
|
$XXX.XX
|
| 33256 |
ABLATE ATRIA W/BYPASS EXTEN
|
$XXX.XX
|
| 33257 |
ABLATE ATRIA LMTD ADD-ON
|
$XXX.XX
|
| 33258 |
ABLATE ATRIA X10SV ADD-ON
|
$XXX.XX
|
| 33259 |
ABLATE ATRIA W/BYPASS ADD-ON
|
$XXX.XX
|
| 33261 |
ABLATE HEART DYSRHYTHM FOCUS
|
$XXX.XX
|
| 33262 |
RMVL& REPLC PULSE GEN 1 LEAD
|
$XXX.XX
|
| 33263 |
RMVL & RPLCMT DFB GEN 2 LEAD
|
$XXX.XX
|
| 33264 |
RMVL & RPLCMT DFB GEN MLT LD
|
$XXX.XX
|
| 33265 |
ABLATE ATRIA LMTD ENDO
|
$XXX.XX
|
| 33266 |
ABLATE ATRIA X10SV ENDO
|
$XXX.XX
|
| 33270 |
INS/REP SUBQ DEFIBRILLATOR
|
$XXX.XX
|
| 33271 |
INSJ SUBQ IMPLTBL DFB ELCTRD
|
$XXX.XX
|
| 33272 |
RMVL OF SUBQ DEFIBRILLATOR
|
$XXX.XX
|
| 33273 |
REPOS PREV IMPLTBL SUBQ DFB
|
$XXX.XX
|
| 33274 |
TCAT INSJ/RPL PERM LDLS PM
|
$XXX.XX
|
| 33275 |
TCAT RMVL PERM LDLS PM W/IMG
|
$XXX.XX
|
| 33285 |
INSJ SUBQ CAR RHYTHM MNTR
|
$XXX.XX
|
| 33286 |
RMVL SUBQ CAR RHYTHM MNTR
|
$XXX.XX
|
| 33289 |
TCAT IMPL WRLS P-ART PRS SNR
|
$XXX.XX
|
| 33300 |
REPAIR OF HEART WOUND
|
$XXX.XX
|
| 33305 |
REPAIR OF HEART WOUND
|
$XXX.XX
|
| 33310 |
EXPLORATORY HEART SURGERY
|
$XXX.XX
|
| 33315 |
EXPLORATORY HEART SURGERY
|
$XXX.XX
|
| 33320 |
REPAIR MAJOR BLOOD VESSEL(S)
|
$XXX.XX
|
| 33321 |
REPAIR MAJOR VESSEL
|
$XXX.XX
|
| 33322 |
REPAIR MAJOR BLOOD VESSEL(S)
|
$XXX.XX
|
| 33330 |
INSERT MAJOR VESSEL GRAFT
|
$XXX.XX
|
| 33335 |
INSERT MAJOR VESSEL GRAFT
|
$XXX.XX
|
| 33340 |
PERQ CLSR TCAT L ATR APNDGE
|
$XXX.XX
|
| 33361 |
REPLACE AORTIC VALVE PERQ
|
$XXX.XX
|
| 33362 |
REPLACE AORTIC VALVE OPEN
|
$XXX.XX
|
| 33363 |
REPLACE AORTIC VALVE OPEN
|
$XXX.XX
|
| 33364 |
REPLACE AORTIC VALVE OPEN
|
$XXX.XX
|
| 33365 |
REPLACE AORTIC VALVE OPEN
|
$XXX.XX
|
| 33366 |
TRCATH REPLACE AORTIC VALVE
|
$XXX.XX
|
| 33367 |
REPLACE AORTIC VALVE W/BYP
|
$XXX.XX
|
| 33368 |
REPLACE AORTIC VALVE W/BYP
|
$XXX.XX
|
| 33369 |
REPLACE AORTIC VALVE W/BYP
|
$XXX.XX
|
| 33390 |
VALVULOPLASTY AORTIC VALVE
|
$XXX.XX
|
| 33391 |
VALVULOPLASTY AORTIC VALVE
|
$XXX.XX
|
| 33404 |
PREPARE HEART-AORTA CONDUIT
|
$XXX.XX
|
| 33405 |
REPLACEMENT AORTIC VALVE OPN
|
$XXX.XX
|
| 33406 |
REPLACEMENT AORTIC VALVE OPN
|
$XXX.XX
|
| 33410 |
REPLACEMENT AORTIC VALVE OPN
|
$XXX.XX
|
| 33411 |
REPLACEMENT OF AORTIC VALVE
|
$XXX.XX
|
| 33412 |
REPLACEMENT OF AORTIC VALVE
|
$XXX.XX
|
| 33413 |
REPLACEMENT OF AORTIC VALVE
|
$XXX.XX
|
| 33414 |
REPAIR OF AORTIC VALVE
|
$XXX.XX
|
| 33415 |
REVISION SUBVALVULAR TISSUE
|
$XXX.XX
|
| 33416 |
REVISE VENTRICLE MUSCLE
|
$XXX.XX
|
| 33417 |
REPAIR OF AORTIC VALVE
|
$XXX.XX
|
| 33418 |
REPAIR TCAT MITRAL VALVE
|
$XXX.XX
|
| 33419 |
REPAIR TCAT MITRAL VALVE
|
$XXX.XX
|
| 33420 |
REVISION OF MITRAL VALVE
|
$XXX.XX
|
| 33422 |
REVISION OF MITRAL VALVE
|
$XXX.XX
|
| 33425 |
REPAIR OF MITRAL VALVE
|
$XXX.XX
|
| 33426 |
REPAIR OF MITRAL VALVE
|
$XXX.XX
|
| 33427 |
REPAIR OF MITRAL VALVE
|
$XXX.XX
|
| 33430 |
REPLACEMENT OF MITRAL VALVE
|
$XXX.XX
|
| 33440 |
RPLCMT A-VALVE TLCJ AUTOL PV
|
$XXX.XX
|
| 33460 |
REVISION OF TRICUSPID VALVE
|
$XXX.XX
|
| 33463 |
VALVULOPLASTY TRICUSPID
|
$XXX.XX
|
| 33464 |
VALVULOPLASTY TRICUSPID
|
$XXX.XX
|
| 33465 |
REPLACE TRICUSPID VALVE
|
$XXX.XX
|
| 33468 |
REVISION OF TRICUSPID VALVE
|
$XXX.XX
|
| 33470 |
REVISION OF PULMONARY VALVE
|
$XXX.XX
|
| 33471 |
VALVOTOMY PULMONARY VALVE
|
$XXX.XX
|
| 33474 |
REVISION OF PULMONARY VALVE
|
$XXX.XX
|
| 33475 |
REPLACEMENT PULMONARY VALVE
|
$XXX.XX
|
| 33476 |
REVISION OF HEART CHAMBER
|
$XXX.XX
|
| 33477 |
IMPLANT TCAT PULM VLV PERQ
|
$XXX.XX
|
| 33478 |
REVISION OF HEART CHAMBER
|
$XXX.XX
|
| 33496 |
REPAIR PROSTH VALVE CLOT
|
$XXX.XX
|
| 33500 |
REPAIR HEART VESSEL FISTULA
|
$XXX.XX
|
| 33501 |
REPAIR HEART VESSEL FISTULA
|
$XXX.XX
|
| 33502 |
CORONARY ARTERY CORRECTION
|
$XXX.XX
|
| 33503 |
CORONARY ARTERY GRAFT
|
$XXX.XX
|
| 33504 |
CORONARY ARTERY GRAFT
|
$XXX.XX
|
| 33505 |
REPAIR ARTERY W/TUNNEL
|
$XXX.XX
|
| 33506 |
REPAIR ARTERY TRANSLOCATION
|
$XXX.XX
|
| 33507 |
REPAIR ART INTRAMURAL
|
$XXX.XX
|
| 33508 |
ENDOSCOPIC VEIN HARVEST
|
$XXX.XX
|
| 33510 |
CABG VEIN SINGLE
|
$XXX.XX
|
| 33511 |
CABG VEIN TWO
|
$XXX.XX
|
| 33512 |
CABG VEIN THREE
|
$XXX.XX
|
| 33513 |
CABG VEIN FOUR
|
$XXX.XX
|
| 33514 |
CABG VEIN FIVE
|
$XXX.XX
|
| 33516 |
CABG VEIN SIX OR MORE
|
$XXX.XX
|
| 33517 |
CABG ARTERY-VEIN SINGLE
|
$XXX.XX
|
| 33518 |
CABG ARTERY-VEIN TWO
|
$XXX.XX
|
| 33519 |
CABG ARTERY-VEIN THREE
|
$XXX.XX
|
| 33521 |
CABG ARTERY-VEIN FOUR
|
$XXX.XX
|
| 33522 |
CABG ARTERY-VEIN FIVE
|
$XXX.XX
|
| 33523 |
CABG ART-VEIN SIX OR MORE
|
$XXX.XX
|
| 33530 |
CORONARY ARTERY BYPASS/REOP
|
$XXX.XX
|
| 33533 |
CABG ARTERIAL SINGLE
|
$XXX.XX
|
| 33534 |
CABG ARTERIAL TWO
|
$XXX.XX
|
| 33535 |
CABG ARTERIAL THREE
|
$XXX.XX
|
| 33536 |
CABG ARTERIAL FOUR OR MORE
|
$XXX.XX
|
| 33542 |
REMOVAL OF HEART LESION
|
$XXX.XX
|
| 33545 |
REPAIR OF HEART DAMAGE
|
$XXX.XX
|
| 33548 |
RESTORE/REMODEL VENTRICLE
|
$XXX.XX
|
| 33572 |
OPEN CORONARY ENDARTERECTOMY
|
$XXX.XX
|
| 33600 |
CLOSURE OF VALVE
|
$XXX.XX
|
| 33602 |
CLOSURE OF VALVE
|
$XXX.XX
|
| 33606 |
ANASTOMOSIS/ARTERY-AORTA
|
$XXX.XX
|
| 33608 |
REPAIR ANOMALY W/CONDUIT
|
$XXX.XX
|
| 33610 |
REPAIR BY ENLARGEMENT
|
$XXX.XX
|
| 33611 |
REPAIR DOUBLE VENTRICLE
|
$XXX.XX
|
| 33612 |
REPAIR DOUBLE VENTRICLE
|
$XXX.XX
|
| 33615 |
REPAIR MODIFIED FONTAN
|
$XXX.XX
|
| 33617 |
REPAIR SINGLE VENTRICLE
|
$XXX.XX
|
| 33619 |
REPAIR SINGLE VENTRICLE
|
$XXX.XX
|
| 33620 |
APPLY R&L PULM ART BANDS
|
$XXX.XX
|
| 33621 |
TRANSTHOR CATH FOR STENT
|
$XXX.XX
|
| 33622 |
REDO COMPL CARDIAC ANOMALY
|
$XXX.XX
|
| 33641 |
REPAIR HEART SEPTUM DEFECT
|
$XXX.XX
|
| 33645 |
REVISION OF HEART VEINS
|
$XXX.XX
|
| 33647 |
REPAIR HEART SEPTUM DEFECTS
|
$XXX.XX
|
| 33660 |
REPAIR OF HEART DEFECTS
|
$XXX.XX
|
| 33665 |
REPAIR OF HEART DEFECTS
|
$XXX.XX
|
| 33670 |
REPAIR OF HEART CHAMBERS
|
$XXX.XX
|
| 33675 |
CLOSE MULT VSD
|
$XXX.XX
|
| 33676 |
CLOSE MULT VSD W/RESECTION
|
$XXX.XX
|
| 33677 |
CL MULT VSD W/REM PUL BAND
|
$XXX.XX
|
| 33681 |
REPAIR HEART SEPTUM DEFECT
|
$XXX.XX
|
| 33684 |
REPAIR HEART SEPTUM DEFECT
|
$XXX.XX
|
| 33688 |
REPAIR HEART SEPTUM DEFECT
|
$XXX.XX
|
| 33690 |
REINFORCE PULMONARY ARTERY
|
$XXX.XX
|
| 33692 |
REPAIR OF HEART DEFECTS
|
$XXX.XX
|
| 33694 |
REPAIR OF HEART DEFECTS
|
$XXX.XX
|
| 33697 |
REPAIR OF HEART DEFECTS
|
$XXX.XX
|
| 33702 |
REPAIR OF HEART DEFECTS
|
$XXX.XX
|
| 33710 |
REPAIR OF HEART DEFECTS
|
$XXX.XX
|
| 33720 |
REPAIR OF HEART DEFECT
|
$XXX.XX
|
| 33722 |
REPAIR OF HEART DEFECT
|
$XXX.XX
|
| 33724 |
REPAIR VENOUS ANOMALY
|
$XXX.XX
|
| 33726 |
REPAIR PUL VENOUS STENOSIS
|
$XXX.XX
|
| 33730 |
REPAIR HEART-VEIN DEFECT(S)
|
$XXX.XX
|
| 33732 |
REPAIR HEART-VEIN DEFECT
|
$XXX.XX
|
| 33735 |
REVISION OF HEART CHAMBER
|
$XXX.XX
|
| 33736 |
REVISION OF HEART CHAMBER
|
$XXX.XX
|
| 33737 |
REVISION OF HEART CHAMBER
|
$XXX.XX
|
| 33750 |
MAJOR VESSEL SHUNT
|
$XXX.XX
|
| 33755 |
MAJOR VESSEL SHUNT
|
$XXX.XX
|
| 33762 |
MAJOR VESSEL SHUNT
|
$XXX.XX
|
| 33764 |
MAJOR VESSEL SHUNT & GRAFT
|
$XXX.XX
|
| 33766 |
MAJOR VESSEL SHUNT
|
$XXX.XX
|
| 33767 |
MAJOR VESSEL SHUNT
|
$XXX.XX
|
| 33768 |
CAVOPULMONARY SHUNTING
|
$XXX.XX
|
| 33770 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33771 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33774 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33775 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33776 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33777 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33778 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33779 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33780 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33781 |
REPAIR GREAT VESSELS DEFECT
|
$XXX.XX
|
| 33782 |
NIKAIDOH PROC
|
$XXX.XX
|
| 33783 |
NIKAIDOH PROC W/OSTIA IMPLT
|
$XXX.XX
|
| 33786 |
REPAIR ARTERIAL TRUNK
|
$XXX.XX
|
| 33788 |
REVISION OF PULMONARY ARTERY
|
$XXX.XX
|
| 33800 |
AORTIC SUSPENSION
|
$XXX.XX
|
| 33802 |
REPAIR VESSEL DEFECT
|
$XXX.XX
|
| 33803 |
REPAIR VESSEL DEFECT
|
$XXX.XX
|
| 33813 |
REPAIR SEPTAL DEFECT
|
$XXX.XX
|
| 33814 |
REPAIR SEPTAL DEFECT
|
$XXX.XX
|
| 33820 |
REVISE MAJOR VESSEL
|
$XXX.XX
|
| 33822 |
REVISE MAJOR VESSEL
|
$XXX.XX
|
| 33824 |
REVISE MAJOR VESSEL
|
$XXX.XX
|
| 33840 |
REMOVE AORTA CONSTRICTION
|
$XXX.XX
|
| 33845 |
REMOVE AORTA CONSTRICTION
|
$XXX.XX
|
| 33851 |
REMOVE AORTA CONSTRICTION
|
$XXX.XX
|
| 33852 |
REPAIR SEPTAL DEFECT
|
$XXX.XX
|
| 33853 |
REPAIR SEPTAL DEFECT
|
$XXX.XX
|
| 33858 |
AS-AORT GRF F/AORTIC DSJ
|
$XXX.XX
|
| 33859 |
AS-AORT GRF F/DS OTH/THN DSJ
|
$XXX.XX
|
| 33863 |
ASCENDING AORTIC GRAFT
|
$XXX.XX
|
| 33864 |
ASCENDING AORTIC GRAFT
|
$XXX.XX
|
| 33866 |
AORTIC HEMIARCH GRAFT
|
$XXX.XX
|
| 33871 |
TRANSVRS A-ARCH GRF HYPTHRM
|
$XXX.XX
|
| 33875 |
THORACIC AORTIC GRAFT
|
$XXX.XX
|
| 33877 |
THORACOABDOMINAL GRAFT
|
$XXX.XX
|
| 33880 |
ENDOVASC TAA REPR INCL SUBCL
|
$XXX.XX
|
| 33881 |
ENDOVASC TAA REPR W/O SUBCL
|
$XXX.XX
|
| 33883 |
INSERT ENDOVASC PROSTH TAA
|
$XXX.XX
|
| 33884 |
ENDOVASC PROSTH TAA ADD-ON
|
$XXX.XX
|
| 33886 |
ENDOVASC PROSTH DELAYED
|
$XXX.XX
|
| 33889 |
ARTERY TRANSPOSE/ENDOVAS TAA
|
$XXX.XX
|
| 33891 |
CAR-CAR BP GRFT/ENDOVAS TAA
|
$XXX.XX
|
| 33910 |
REMOVE LUNG ARTERY EMBOLI
|
$XXX.XX
|
| 33915 |
REMOVE LUNG ARTERY EMBOLI
|
$XXX.XX
|
| 33916 |
SURGERY OF GREAT VESSEL
|
$XXX.XX
|
| 33917 |
REPAIR PULMONARY ARTERY
|
$XXX.XX
|
| 33920 |
REPAIR PULMONARY ATRESIA
|
$XXX.XX
|
| 33922 |
TRANSECT PULMONARY ARTERY
|
$XXX.XX
|
| 33924 |
REMOVE PULMONARY SHUNT
|
$XXX.XX
|
| 33925 |
RPR PUL ART UNIFOCAL W/O CPB
|
$XXX.XX
|
| 33926 |
REPR PUL ART UNIFOCAL W/CPB
|
$XXX.XX
|
| 33927 |
IMPLTJ TOT RPLCMT HRT SYS
|
$XXX.XX
|
| 33935 |
TRANSPLANTATION HEART/LUNG
|
$XXX.XX
|
| 33945 |
TRANSPLANTATION OF HEART
|
$XXX.XX
|
| 33946 |
ECMO/ECLS INITIATION VENOUS
|
$XXX.XX
|
| 33947 |
ECMO/ECLS INITIATION ARTERY
|
$XXX.XX
|
| 33948 |
ECMO/ECLS DAILY MGMT-VENOUS
|
$XXX.XX
|
| 33949 |
ECMO/ECLS DAILY MGMT ARTERY
|
$XXX.XX
|
| 33951 |
ECMO/ECLS INSJ PRPH CANNULA
|
$XXX.XX
|
| 33952 |
ECMO/ECLS INSJ PRPH CANNULA
|
$XXX.XX
|
| 33953 |
ECMO/ECLS INSJ PRPH CANNULA
|
$XXX.XX
|
| 33954 |
ECMO/ECLS INSJ PRPH CANNULA
|
$XXX.XX
|
| 33955 |
ECMO/ECLS INSJ CTR CANNULA
|
$XXX.XX
|
| 33956 |
ECMO/ECLS INSJ CTR CANNULA
|
$XXX.XX
|
| 33957 |
ECMO/ECLS REPOS PERPH CNULA
|
$XXX.XX
|
| 33958 |
ECMO/ECLS REPOS PERPH CNULA
|
$XXX.XX
|
| 33959 |
ECMO/ECLS REPOS PERPH CNULA
|
$XXX.XX
|
| 33962 |
ECMO/ECLS REPOS PERPH CNULA
|
$XXX.XX
|
| 33963 |
ECMO/ECLS REPOS PERPH CNULA
|
$XXX.XX
|
| 33964 |
ECMO/ECLS REPOS PERPH CNULA
|
$XXX.XX
|
| 33965 |
ECMO/ECLS RMVL PERPH CANNULA
|
$XXX.XX
|
| 33966 |
ECMO/ECLS RMVL PRPH CANNULA
|
$XXX.XX
|
| 33967 |
INSERT I-AORT PERCUT DEVICE
|
$XXX.XX
|
| 33968 |
REMOVE AORTIC ASSIST DEVICE
|
$XXX.XX
|
| 33969 |
ECMO/ECLS RMVL PERPH CANNULA
|
$XXX.XX
|
| 33970 |
AORTIC CIRCULATION ASSIST
|
$XXX.XX
|
| 33971 |
AORTIC CIRCULATION ASSIST
|
$XXX.XX
|
| 33973 |
INSERT BALLOON DEVICE
|
$XXX.XX
|
| 33974 |
REMOVE INTRA-AORTIC BALLOON
|
$XXX.XX
|
| 33975 |
IMPLANT VENTRICULAR DEVICE
|
$XXX.XX
|
| 33976 |
IMPLANT VENTRICULAR DEVICE
|
$XXX.XX
|
| 33977 |
REMOVE VENTRICULAR DEVICE
|
$XXX.XX
|
| 33978 |
REMOVE VENTRICULAR DEVICE
|
$XXX.XX
|
| 33979 |
INSERT INTRACORPOREAL DEVICE
|
$XXX.XX
|
| 33980 |
REMOVE INTRACORPOREAL DEVICE
|
$XXX.XX
|
| 33981 |
REPLACE VAD PUMP EXT
|
$XXX.XX
|
| 33982 |
REPLACE VAD INTRA W/O BP
|
$XXX.XX
|
| 33983 |
REPLACE VAD INTRA W/BP
|
$XXX.XX
|
| 33984 |
ECMO/ECLS RMVL PRPH CANNULA
|
$XXX.XX
|
| 33985 |
ECMO/ECLS RMVL CTR CANNULA
|
$XXX.XX
|
| 33986 |
ECMO/ECLS RMVL CTR CANNULA
|
$XXX.XX
|
| 33987 |
ARTERY EXPOS/GRAFT ARTERY
|
$XXX.XX
|
| 33988 |
INSERTION OF LEFT HEART VENT
|
$XXX.XX
|
| 33989 |
REMOVAL OF LEFT HEART VENT
|
$XXX.XX
|
| 33990 |
INSERT VAD ARTERY ACCESS
|
$XXX.XX
|
| 33991 |
INSERT VAD ART&VEIN ACCESS
|
$XXX.XX
|
| 33992 |
REMOVE VAD DIFFERENT SESSION
|
$XXX.XX
|
| 33993 |
REPOSITION VAD DIFF SESSION
|
$XXX.XX
|
| 34001 |
REMOVAL OF ARTERY CLOT
|
$XXX.XX
|
| 34051 |
REMOVAL OF ARTERY CLOT
|
$XXX.XX
|
| 34101 |
REMOVAL OF ARTERY CLOT
|
$XXX.XX
|
| 34111 |
REMOVAL OF ARM ARTERY CLOT
|
$XXX.XX
|
| 34151 |
REMOVAL OF ARTERY CLOT
|
$XXX.XX
|
| 34201 |
REMOVAL OF ARTERY CLOT
|
$XXX.XX
|
| 34203 |
REMOVAL OF LEG ARTERY CLOT
|
$XXX.XX
|
| 34401 |
REMOVAL OF VEIN CLOT
|
$XXX.XX
|
| 34421 |
REMOVAL OF VEIN CLOT
|
$XXX.XX
|
| 34451 |
REMOVAL OF VEIN CLOT
|
$XXX.XX
|
| 34471 |
REMOVAL OF VEIN CLOT
|
$XXX.XX
|
| 34490 |
REMOVAL OF VEIN CLOT
|
$XXX.XX
|
| 34501 |
REPAIR VALVE FEMORAL VEIN
|
$XXX.XX
|
| 34502 |
RECONSTRUCT VENA CAVA
|
$XXX.XX
|
| 34510 |
TRANSPOSITION OF VEIN VALVE
|
$XXX.XX
|
| 34520 |
CROSS-OVER VEIN GRAFT
|
$XXX.XX
|
| 34530 |
LEG VEIN FUSION
|
$XXX.XX
|
| 34701 |
EVASC RPR A-AO NDGFT
|
$XXX.XX
|
| 34702 |
EVASC RPR A-AO NDGFT RPT
|
$XXX.XX
|
| 34703 |
EVASC RPR A-UNILAC NDGFT
|
$XXX.XX
|
| 34704 |
EVASC RPR A-UNILAC NDGFT RPT
|
$XXX.XX
|
| 34705 |
EVAC RPR A-BIILIAC NDGFT
|
$XXX.XX
|
| 34706 |
EVASC RPR A-BIILIAC RPT
|
$XXX.XX
|
| 34707 |
EVASC RPR ILIO-ILIAC NDGFT
|
$XXX.XX
|
| 34708 |
EVASC RPR ILIO-ILIAC RPT
|
$XXX.XX
|
| 34709 |
PLMT XTN PROSTH EVASC RPR
|
$XXX.XX
|
| 34710 |
DLYD PLMT XTN PROSTH 1ST VSL
|
$XXX.XX
|
| 34711 |
DLYD PLMT XTN PROSTH EA ADDL
|
$XXX.XX
|
| 34712 |
TCAT DLVR ENHNCD FIXJ DEV
|
$XXX.XX
|
| 34713 |
PERQ ACCESS & CLSR FEM ART
|
$XXX.XX
|
| 34714 |
OPN FEM ART EXPOS CNDT CRTJ
|
$XXX.XX
|
| 34715 |
OPN AX/SUBCLA ART EXPOS
|
$XXX.XX
|
| 34716 |
OPN AX/SUBCLA ART EXPOS CNDT
|
$XXX.XX
|
| 34717 |
EVASC RPR A-ILIAC NDGFT
|
$XXX.XX
|
| 34718 |
EVASC RPR N/A A-ILIAC NDGFT
|
$XXX.XX
|
| 34808 |
ENDOVAS ILIAC A DEVICE ADDON
|
$XXX.XX
|
| 34812 |
OPN FEM ART EXPOS
|
$XXX.XX
|
| 34813 |
FEMORAL ENDOVAS GRAFT ADD-ON
|
$XXX.XX
|
| 34820 |
OPN ILIAC ART EXPOS
|
$XXX.XX
|
| 34830 |
OPEN AORTIC TUBE PROSTH REPR
|
$XXX.XX
|
| 34831 |
OPEN AORTOILIAC PROSTH REPR
|
$XXX.XX
|
| 34832 |
OPEN AORTOFEMOR PROSTH REPR
|
$XXX.XX
|
| 34833 |
OPN ILAC ART EXPOS CNDT CRTJ
|
$XXX.XX
|
| 34834 |
OPN BRACH ART EXPOS
|
$XXX.XX
|
| 35001 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35002 |
REPAIR ARTERY RUPTURE NECK
|
$XXX.XX
|
| 35005 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35011 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35013 |
REPAIR ARTERY RUPTURE ARM
|
$XXX.XX
|
| 35021 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35022 |
REPAIR ARTERY RUPTURE CHEST
|
$XXX.XX
|
| 35045 |
REPAIR DEFECT OF ARM ARTERY
|
$XXX.XX
|
| 35081 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35082 |
REPAIR ARTERY RUPTURE AORTA
|
$XXX.XX
|
| 35091 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35092 |
REPAIR ARTERY RUPTURE AORTA
|
$XXX.XX
|
| 35102 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35103 |
REPAIR ARTERY RUPTURE AORTA
|
$XXX.XX
|
| 35111 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35112 |
REPAIR ARTERY RUPTURE SPLEEN
|
$XXX.XX
|
| 35121 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35122 |
REPAIR ARTERY RUPTURE BELLY
|
$XXX.XX
|
| 35131 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35132 |
REPAIR ARTERY RUPTURE GROIN
|
$XXX.XX
|
| 35141 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35142 |
REPAIR ARTERY RUPTURE THIGH
|
$XXX.XX
|
| 35151 |
REPAIR DEFECT OF ARTERY
|
$XXX.XX
|
| 35152 |
REPAIR RUPTD POPLITEAL ART
|
$XXX.XX
|
| 35180 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35182 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35184 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35188 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35189 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35190 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35201 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35206 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35207 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35211 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35216 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35221 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35226 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35231 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35236 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35241 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35246 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35251 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35256 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35261 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35266 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35271 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35276 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35281 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35286 |
REPAIR BLOOD VESSEL LESION
|
$XXX.XX
|
| 35301 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35302 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35303 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35304 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35305 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35306 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35311 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35321 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35331 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35341 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35351 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35355 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35361 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35363 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35371 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35372 |
RECHANNELING OF ARTERY
|
$XXX.XX
|
| 35390 |
REOPERATION CAROTID ADD-ON
|
$XXX.XX
|
| 35400 |
ANGIOSCOPY
|
$XXX.XX
|
| 35500 |
HARVEST VEIN FOR BYPASS
|
$XXX.XX
|
| 35501 |
ART BYP GRFT IPSILAT CAROTID
|
$XXX.XX
|
| 35506 |
ART BYP GRFT SUBCLAV-CAROTID
|
$XXX.XX
|
| 35508 |
ART BYP GRFT CAROTID-VERTBRL
|
$XXX.XX
|
| 35509 |
ART BYP GRFT CONTRAL CAROTID
|
$XXX.XX
|
| 35510 |
ART BYP GRFT CAROTID-BRCHIAL
|
$XXX.XX
|
| 35511 |
ART BYP GRFT SUBCLAV-SUBCLAV
|
$XXX.XX
|
| 35512 |
ART BYP GRFT SUBCLAV-BRCHIAL
|
$XXX.XX
|
| 35515 |
ART BYP GRFT SUBCLAV-VERTBRL
|
$XXX.XX
|
| 35516 |
ART BYP GRFT SUBCLAV-AXILARY
|
$XXX.XX
|
| 35518 |
ART BYP GRFT AXILLARY-AXILRY
|
$XXX.XX
|
| 35521 |
ART BYP GRFT AXILL-FEMORAL
|
$XXX.XX
|
| 35522 |
ART BYP GRFT AXILL-BRACHIAL
|
$XXX.XX
|
| 35523 |
ART BYP GRFT BRCHL-ULNR-RDL
|
$XXX.XX
|
| 35525 |
ART BYP GRFT BRACHIAL-BRCHL
|
$XXX.XX
|
| 35526 |
ART BYP GRFT AOR/CAROT/INNOM
|
$XXX.XX
|
| 35531 |
ART BYP GRFT AORCEL/AORMESEN
|
$XXX.XX
|
| 35533 |
ART BYP GRFT AXILL/FEM/FEM
|
$XXX.XX
|
| 35535 |
ART BYP GRFT HEPATORENAL
|
$XXX.XX
|
| 35536 |
ART BYP GRFT SPLENORENAL
|
$XXX.XX
|
| 35537 |
ART BYP GRFT AORTOILIAC
|
$XXX.XX
|
| 35538 |
ART BYP GRFT AORTOBI-ILIAC
|
$XXX.XX
|
| 35539 |
ART BYP GRFT AORTOFEMORAL
|
$XXX.XX
|
| 35540 |
ART BYP GRFT AORTBIFEMORAL
|
$XXX.XX
|
| 35556 |
ART BYP GRFT FEM-POPLITEAL
|
$XXX.XX
|
| 35558 |
ART BYP GRFT FEM-FEMORAL
|
$XXX.XX
|
| 35560 |
ART BYP GRFT AORTORENAL
|
$XXX.XX
|
| 35563 |
ART BYP GRFT ILIOILIAC
|
$XXX.XX
|
| 35565 |
ART BYP GRFT ILIOFEMORAL
|
$XXX.XX
|
| 35566 |
ART BYP FEM-ANT-POST TIB/PRL
|
$XXX.XX
|
| 35570 |
ART BYP TIBIAL-TIB/PERONEAL
|
$XXX.XX
|
| 35571 |
ART BYP POP-TIBL-PRL-OTHER
|
$XXX.XX
|
| 35572 |
HARVEST FEMOROPOPLITEAL VEIN
|
$XXX.XX
|
| 35583 |
VEIN BYP GRFT FEM-POPLITEAL
|
$XXX.XX
|
| 35585 |
VEIN BYP FEM-TIBIAL PERONEAL
|
$XXX.XX
|
| 35587 |
VEIN BYP POP-TIBL PERONEAL
|
$XXX.XX
|
| 35600 |
HARVEST ART FOR CABG ADD-ON
|
$XXX.XX
|
| 35601 |
ART BYP COMMON IPSI CAROTID
|
$XXX.XX
|
| 35606 |
ART BYP CAROTID-SUBCLAVIAN
|
$XXX.XX
|
| 35612 |
ART BYP SUBCLAV-SUBCLAVIAN
|
$XXX.XX
|
| 35616 |
ART BYP SUBCLAV-AXILLARY
|
$XXX.XX
|
| 35621 |
ART BYP AXILLARY-FEMORAL
|
$XXX.XX
|
| 35623 |
ART BYP AXILLARY-POP-TIBIAL
|
$XXX.XX
|
| 35626 |
ART BYP AORSUBCL/CAROT/INNOM
|
$XXX.XX
|
| 35631 |
ART BYP AOR-CELIAC-MSN-RENAL
|
$XXX.XX
|
| 35632 |
ART BYP ILIO-CELIAC
|
$XXX.XX
|
| 35633 |
ART BYP ILIO-MESENTERIC
|
$XXX.XX
|
| 35634 |
ART BYP ILIORENAL
|
$XXX.XX
|
| 35636 |
ART BYP SPENORENAL
|
$XXX.XX
|
| 35637 |
ART BYP AORTOILIAC
|
$XXX.XX
|
| 35638 |
ART BYP AORTOBI-ILIAC
|
$XXX.XX
|
| 35642 |
ART BYP CAROTID-VERTEBRAL
|
$XXX.XX
|
| 35645 |
ART BYP SUBCLAV-VERTEBRL
|
$XXX.XX
|
| 35646 |
ART BYP AORTOBIFEMORAL
|
$XXX.XX
|
| 35647 |
ART BYP AORTOFEMORAL
|
$XXX.XX
|
| 35650 |
ART BYP AXILLARY-AXILLARY
|
$XXX.XX
|
| 35654 |
ART BYP AXILL-FEM-FEMORAL
|
$XXX.XX
|
| 35656 |
ART BYP FEMORAL-POPLITEAL
|
$XXX.XX
|
| 35661 |
ART BYP FEMORAL-FEMORAL
|
$XXX.XX
|
| 35663 |
ART BYP ILIOILIAC
|
$XXX.XX
|
| 35665 |
ART BYP ILIOFEMORAL
|
$XXX.XX
|
| 35666 |
ART BYP FEM-ANT-POST TIB/PRL
|
$XXX.XX
|
| 35671 |
ART BYP POP-TIBL-PRL-OTHER
|
$XXX.XX
|
| 35681 |
COMPOSITE BYP GRFT PROS&VEIN
|
$XXX.XX
|
| 35682 |
COMPOSITE BYP GRFT 2 VEINS
|
$XXX.XX
|
| 35683 |
COMPOSITE BYP GRFT 3/> SEGMT
|
$XXX.XX
|
| 35685 |
BYPASS GRAFT PATENCY/PATCH
|
$XXX.XX
|
| 35686 |
BYPASS GRAFT/AV FIST PATENCY
|
$XXX.XX
|
| 35691 |
ART TRNSPOSJ VERTBRL CAROTID
|
$XXX.XX
|
| 35693 |
ART TRNSPOSJ SUBCLAVIAN
|
$XXX.XX
|
| 35694 |
ART TRNSPOSJ SUBCLAV CAROTID
|
$XXX.XX
|
| 35695 |
ART TRNSPOSJ CAROTID SUBCLAV
|
$XXX.XX
|
| 35697 |
REIMPLANT ARTERY EACH
|
$XXX.XX
|
| 35700 |
REOPERATION BYPASS GRAFT
|
$XXX.XX
|
| 35701 |
EXPL N/FLWD SURG NECK ART
|
$XXX.XX
|
| 35702 |
EXPL N/FLWD SURG UXTR ART
|
$XXX.XX
|
| 35703 |
EXPL N/FLWD SURG LXTR ART
|
$XXX.XX
|
| 35800 |
EXPLORE NECK VESSELS
|
$XXX.XX
|
| 35820 |
EXPLORE CHEST VESSELS
|
$XXX.XX
|
| 35840 |
EXPLORE ABDOMINAL VESSELS
|
$XXX.XX
|
| 35860 |
EXPLORE LIMB VESSELS
|
$XXX.XX
|
| 35870 |
REPAIR VESSEL GRAFT DEFECT
|
$XXX.XX
|
| 35875 |
REMOVAL OF CLOT IN GRAFT
|
$XXX.XX
|
| 35876 |
REMOVAL OF CLOT IN GRAFT
|
$XXX.XX
|
| 35879 |
REVISE GRAFT W/VEIN
|
$XXX.XX
|
| 35881 |
REVISE GRAFT W/VEIN
|
$XXX.XX
|
| 35883 |
REVISE GRAFT W/NONAUTO GRAFT
|
$XXX.XX
|
| 35884 |
REVISE GRAFT W/VEIN
|
$XXX.XX
|
| 35901 |
EXCISION GRAFT NECK
|
$XXX.XX
|
| 35903 |
EXCISION GRAFT EXTREMITY
|
$XXX.XX
|
| 35905 |
EXCISION GRAFT THORAX
|
$XXX.XX
|
| 35907 |
EXCISION GRAFT ABDOMEN
|
$XXX.XX
|
| 36002 |
PSEUDOANEURYSM INJECTION TRT
|
$XXX.XX
|
| 36005 |
INJECTION EXT VENOGRAPHY
|
$XXX.XX
|
| 36010 |
PLACE CATHETER IN VEIN
|
$XXX.XX
|
| 36011 |
PLACE CATHETER IN VEIN
|
$XXX.XX
|
| 36012 |
PLACE CATHETER IN VEIN
|
$XXX.XX
|
| 36013 |
PLACE CATHETER IN ARTERY
|
$XXX.XX
|
| 36014 |
PLACE CATHETER IN ARTERY
|
$XXX.XX
|
| 36015 |
PLACE CATHETER IN ARTERY
|
$XXX.XX
|
| 36100 |
ESTABLISH ACCESS TO ARTERY
|
$XXX.XX
|
| 36140 |
INTRO NDL ICATH UPR/LXTR ART
|
$XXX.XX
|
| 36160 |
ESTABLISH ACCESS TO AORTA
|
$XXX.XX
|
| 36200 |
PLACE CATHETER IN AORTA
|
$XXX.XX
|
| 36215 |
PLACE CATHETER IN ARTERY
|
$XXX.XX
|
| 36216 |
PLACE CATHETER IN ARTERY
|
$XXX.XX
|
| 36217 |
PLACE CATHETER IN ARTERY
|
$XXX.XX
|
| 36218 |
PLACE CATHETER IN ARTERY
|
$XXX.XX
|
| 36221 |
PLACE CATH THORACIC AORTA
|
$XXX.XX
|
| 36222 |
PLACE CATH CAROTID/INOM ART
|
$XXX.XX
|
| 36223 |
PLACE CATH CAROTID/INOM ART
|
$XXX.XX
|
| 36224 |
PLACE CATH CAROTD ART
|
$XXX.XX
|
| 36225 |
PLACE CATH SUBCLAVIAN ART
|
$XXX.XX
|
| 36226 |
PLACE CATH VERTEBRAL ART
|
$XXX.XX
|
| 36227 |
PLACE CATH XTRNL CAROTID
|
$XXX.XX
|
| 36228 |
PLACE CATH INTRACRANIAL ART
|
$XXX.XX
|
| 36245 |
INS CATH ABD/L-EXT ART 1ST
|
$XXX.XX
|
| 36246 |
INS CATH ABD/L-EXT ART 2ND
|
$XXX.XX
|
| 36247 |
INS CATH ABD/L-EXT ART 3RD
|
$XXX.XX
|
| 36248 |
INS CATH ABD/L-EXT ART ADDL
|
$XXX.XX
|
| 36251 |
INS CATH REN ART 1ST UNILAT
|
$XXX.XX
|
| 36252 |
INS CATH REN ART 1ST BILAT
|
$XXX.XX
|
| 36253 |
INS CATH REN ART 2ND+ UNILAT
|
$XXX.XX
|
| 36254 |
INS CATH REN ART 2ND+ BILAT
|
$XXX.XX
|
| 36260 |
INSERTION OF INFUSION PUMP
|
$XXX.XX
|
| 36261 |
REVISION OF INFUSION PUMP
|
$XXX.XX
|
| 36262 |
REMOVAL OF INFUSION PUMP
|
$XXX.XX
|
| 36400 |
BL DRAW < 3 YRS FEM/JUGULAR
|
$XXX.XX
|
| 36405 |
BL DRAW <3 YRS SCALP VEIN
|
$XXX.XX
|
| 36406 |
BL DRAW <3 YRS OTHER VEIN
|
$XXX.XX
|
| 36410 |
NON-ROUTINE BL DRAW 3/> YRS
|
$XXX.XX
|
| 36420 |
VEIN ACCESS CUTDOWN < 1 YR
|
$XXX.XX
|
| 36425 |
VEIN ACCESS CUTDOWN > 1 YR
|
$XXX.XX
|
| 36430 |
BLOOD TRANSFUSION SERVICE
|
$XXX.XX
|
| 36440 |
BL PUSH TRANSFUSE 2 YR/<
|
$XXX.XX
|
| 36450 |
BL EXCHANGE/TRANSFUSE NB
|
$XXX.XX
|
| 36455 |
BL EXCHANGE/TRANSFUSE NON-NB
|
$XXX.XX
|
| 36456 |
PRTL EXCHANGE TRANSFUSE NB
|
$XXX.XX
|
| 36460 |
TRANSFUSION SERVICE FETAL
|
$XXX.XX
|
| 36465 |
NJX NONCMPND SCLRSNT 1 VEIN
|
$XXX.XX
|
| 36466 |
NJX NONCMPND SCLRSNT MLT VN
|
$XXX.XX
|
| 36470 |
NJX SCLRSNT 1 INCMPTNT VEIN
|
$XXX.XX
|
| 36471 |
NJX SCLRSNT MLT INCMPTNT VN
|
$XXX.XX
|
| 36473 |
ENDOVENOUS MCHNCHEM 1ST VEIN
|
$XXX.XX
|
| 36474 |
ENDOVENOUS MCHNCHEM ADD-ON
|
$XXX.XX
|
| 36475 |
ENDOVENOUS RF 1ST VEIN
|
$XXX.XX
|
| 36476 |
ENDOVENOUS RF VEIN ADD-ON
|
$XXX.XX
|
| 36478 |
ENDOVENOUS LASER 1ST VEIN
|
$XXX.XX
|
| 36479 |
ENDOVENOUS LASER VEIN ADDON
|
$XXX.XX
|
| 36481 |
INSERTION OF CATHETER VEIN
|
$XXX.XX
|
| 36482 |
ENDOVEN THER CHEM ADHES 1ST
|
$XXX.XX
|
| 36483 |
ENDOVEN THER CHEM ADHES SBSQ
|
$XXX.XX
|
| 36500 |
INSERTION OF CATHETER VEIN
|
$XXX.XX
|
| 36510 |
INSERTION OF CATHETER VEIN
|
$XXX.XX
|
| 36511 |
APHERESIS WBC
|
$XXX.XX
|
| 36512 |
APHERESIS RBC
|
$XXX.XX
|
| 36513 |
APHERESIS PLATELETS
|
$XXX.XX
|
| 36514 |
APHERESIS PLASMA
|
$XXX.XX
|
| 36516 |
APHERESIS IMMUNOADS SLCTV
|
$XXX.XX
|
| 36522 |
PHOTOPHERESIS
|
$XXX.XX
|
| 36555 |
INSERT NON-TUNNEL CV CATH
|
$XXX.XX
|
| 36556 |
INSERT NON-TUNNEL CV CATH
|
$XXX.XX
|
| 36557 |
INSERT TUNNELED CV CATH
|
$XXX.XX
|
| 36558 |
INSERT TUNNELED CV CATH
|
$XXX.XX
|
| 36560 |
INSERT TUNNELED CV CATH
|
$XXX.XX
|
| 36561 |
INSERT TUNNELED CV CATH
|
$XXX.XX
|
| 36563 |
INSERT TUNNELED CV CATH
|
$XXX.XX
|
| 36565 |
INSERT TUNNELED CV CATH
|
$XXX.XX
|
| 36566 |
INSERT TUNNELED CV CATH
|
$XXX.XX
|
| 36568 |
INSJ PICC <5 YR W/O IMAGING
|
$XXX.XX
|
| 36569 |
INSJ PICC 5 YR+ W/O IMAGING
|
$XXX.XX
|
| 36570 |
INSERT PICVAD CATH
|
$XXX.XX
|
| 36571 |
INSERT PICVAD CATH
|
$XXX.XX
|
| 36572 |
INSJ PICC RS&I <5 YR
|
$XXX.XX
|
| 36573 |
INSJ PICC RS&I 5 YR+
|
$XXX.XX
|
| 36575 |
REPAIR TUNNELED CV CATH
|
$XXX.XX
|
| 36576 |
REPAIR TUNNELED CV CATH
|
$XXX.XX
|
| 36578 |
REPLACE TUNNELED CV CATH
|
$XXX.XX
|
| 36580 |
REPLACE CVAD CATH
|
$XXX.XX
|
| 36581 |
REPLACE TUNNELED CV CATH
|
$XXX.XX
|
| 36582 |
REPLACE TUNNELED CV CATH
|
$XXX.XX
|
| 36583 |
REPLACE TUNNELED CV CATH
|
$XXX.XX
|
| 36584 |
COMPL RPLCMT PICC RS&I
|
$XXX.XX
|
| 36585 |
REPLACE PICVAD CATH
|
$XXX.XX
|
| 36589 |
REMOVAL TUNNELED CV CATH
|
$XXX.XX
|
| 36590 |
REMOVAL TUNNELED CV CATH
|
$XXX.XX
|
| 36591 |
DRAW BLOOD OFF VENOUS DEVICE
|
$XXX.XX
|
| 36592 |
COLLECT BLOOD FROM PICC
|
$XXX.XX
|
| 36593 |
DECLOT VASCULAR DEVICE
|
$XXX.XX
|
| 36595 |
MECH REMOV TUNNELED CV CATH
|
$XXX.XX
|
| 36596 |
MECH REMOV TUNNELED CV CATH
|
$XXX.XX
|
| 36597 |
REPOSITION VENOUS CATHETER
|
$XXX.XX
|
| 36598 |
INJ W/FLUOR EVAL CV DEVICE
|
$XXX.XX
|
| 36600 |
WITHDRAWAL OF ARTERIAL BLOOD
|
$XXX.XX
|
| 36620 |
INSERTION CATHETER ARTERY
|
$XXX.XX
|
| 36625 |
INSERTION CATHETER ARTERY
|
$XXX.XX
|
| 36640 |
INSERTION CATHETER ARTERY
|
$XXX.XX
|
| 36660 |
INSERTION CATHETER ARTERY
|
$XXX.XX
|
| 36680 |
INSERT NEEDLE BONE CAVITY
|
$XXX.XX
|
| 36800 |
INSERTION OF CANNULA
|
$XXX.XX
|
| 36810 |
INSERTION OF CANNULA
|
$XXX.XX
|
| 36815 |
INSERTION OF CANNULA
|
$XXX.XX
|
| 36818 |
AV FUSE UPPR ARM CEPHALIC
|
$XXX.XX
|
| 36819 |
AV FUSE UPPR ARM BASILIC
|
$XXX.XX
|
| 36820 |
AV FUSION/FOREARM VEIN
|
$XXX.XX
|
| 36821 |
AV FUSION DIRECT ANY SITE
|
$XXX.XX
|
| 36823 |
INSERTION OF CANNULA(S)
|
$XXX.XX
|
| 36825 |
ARTERY-VEIN AUTOGRAFT
|
$XXX.XX
|
| 36830 |
ARTERY-VEIN NONAUTOGRAFT
|
$XXX.XX
|
| 36831 |
OPEN THROMBECT AV FISTULA
|
$XXX.XX
|
| 36832 |
AV FISTULA REVISION OPEN
|
$XXX.XX
|
| 36833 |
AV FISTULA REVISION
|
$XXX.XX
|
| 36835 |
ARTERY TO VEIN SHUNT
|
$XXX.XX
|
| 36838 |
DIST REVAS LIGATION HEMO
|
$XXX.XX
|
| 36860 |
EXTERNAL CANNULA DECLOTTING
|
$XXX.XX
|
| 36861 |
CANNULA DECLOTTING
|
$XXX.XX
|
| 36901 |
INTRO CATH DIALYSIS CIRCUIT
|
$XXX.XX
|
| 36902 |
INTRO CATH DIALYSIS CIRCUIT
|
$XXX.XX
|
| 36903 |
INTRO CATH DIALYSIS CIRCUIT
|
$XXX.XX
|
| 36904 |
THRMBC/NFS DIALYSIS CIRCUIT
|
$XXX.XX
|
| 36905 |
THRMBC/NFS DIALYSIS CIRCUIT
|
$XXX.XX
|
| 36906 |
THRMBC/NFS DIALYSIS CIRCUIT
|
$XXX.XX
|
| 36907 |
BALO ANGIOP CTR DIALYSIS SEG
|
$XXX.XX
|
| 36908 |
STENT PLMT CTR DIALYSIS SEG
|
$XXX.XX
|
| 36909 |
DIALYSIS CIRCUIT EMBOLJ
|
$XXX.XX
|
| 37140 |
REVISION OF CIRCULATION
|
$XXX.XX
|
| 37145 |
REVISION OF CIRCULATION
|
$XXX.XX
|
| 37160 |
REVISION OF CIRCULATION
|
$XXX.XX
|
| 37180 |
REVISION OF CIRCULATION
|
$XXX.XX
|
| 37181 |
SPLICE SPLEEN/KIDNEY VEINS
|
$XXX.XX
|
| 37182 |
INSERT HEPATIC SHUNT (TIPS)
|
$XXX.XX
|
| 37183 |
REMOVE HEPATIC SHUNT (TIPS)
|
$XXX.XX
|
| 37184 |
PRIM ART M-THRMBC 1ST VSL
|
$XXX.XX
|
| 37185 |
PRIM ART M-THRMBC SBSQ VSL
|
$XXX.XX
|
| 37186 |
SEC ART THROMBECTOMY ADD-ON
|
$XXX.XX
|
| 37187 |
VENOUS MECH THROMBECTOMY
|
$XXX.XX
|
| 37188 |
VEN MECHNL THRMBC REPEAT TX
|
$XXX.XX
|
| 37191 |
INS ENDOVAS VENA CAVA FILTR
|
$XXX.XX
|
| 37192 |
REDO ENDOVAS VENA CAVA FILTR
|
$XXX.XX
|
| 37193 |
REM ENDOVAS VENA CAVA FILTER
|
$XXX.XX
|
| 37197 |
REMOVE INTRVAS FOREIGN BODY
|
$XXX.XX
|
| 37200 |
TRANSCATHETER BIOPSY
|
$XXX.XX
|
| 37211 |
THROMBOLYTIC ART THERAPY
|
$XXX.XX
|
| 37212 |
THROMBOLYTIC VENOUS THERAPY
|
$XXX.XX
|
| 37213 |
THROMBLYTIC ART/VEN THERAPY
|
$XXX.XX
|
| 37214 |
CESSJ THERAPY CATH REMOVAL
|
$XXX.XX
|
| 37215 |
TRANSCATH STENT CCA W/EPS
|
$XXX.XX
|
| 37217 |
STENT PLACEMT RETRO CAROTID
|
$XXX.XX
|
| 37218 |
STENT PLACEMT ANTE CAROTID
|
$XXX.XX
|
| 37220 |
ILIAC REVASC
|
$XXX.XX
|
| 37221 |
ILIAC REVASC W/STENT
|
$XXX.XX
|
| 37222 |
ILIAC REVASC ADD-ON
|
$XXX.XX
|
| 37223 |
ILIAC REVASC W/STENT ADD-ON
|
$XXX.XX
|
| 37224 |
FEM/POPL REVAS W/TLA
|
$XXX.XX
|
| 37225 |
FEM/POPL REVAS W/ATHER
|
$XXX.XX
|
| 37226 |
FEM/POPL REVASC W/STENT
|
$XXX.XX
|
| 37227 |
FEM/POPL REVASC STNT & ATHER
|
$XXX.XX
|
| 37228 |
TIB/PER REVASC W/TLA
|
$XXX.XX
|
| 37229 |
TIB/PER REVASC W/ATHER
|
$XXX.XX
|
| 37230 |
TIB/PER REVASC W/STENT
|
$XXX.XX
|
| 37231 |
TIB/PER REVASC STENT & ATHER
|
$XXX.XX
|
| 37232 |
TIB/PER REVASC ADD-ON
|
$XXX.XX
|
| 37233 |
TIBPER REVASC W/ATHER ADD-ON
|
$XXX.XX
|
| 37234 |
REVSC OPN/PRQ TIB/PERO STENT
|
$XXX.XX
|
| 37235 |
TIB/PER REVASC STNT & ATHER
|
$XXX.XX
|
| 37236 |
OPEN/PERQ PLACE STENT 1ST
|
$XXX.XX
|
| 37237 |
OPEN/PERQ PLACE STENT EA ADD
|
$XXX.XX
|
| 37238 |
OPEN/PERQ PLACE STENT SAME
|
$XXX.XX
|
| 37239 |
OPEN/PERQ PLACE STENT EA ADD
|
$XXX.XX
|
| 37241 |
VASC EMBOLIZE/OCCLUDE VENOUS
|
$XXX.XX
|
| 37242 |
VASC EMBOLIZE/OCCLUDE ARTERY
|
$XXX.XX
|
| 37243 |
VASC EMBOLIZE/OCCLUDE ORGAN
|
$XXX.XX
|
| 37244 |
VASC EMBOLIZE/OCCLUDE BLEED
|
$XXX.XX
|
| 37246 |
TRLUML BALO ANGIOP 1ST ART
|
$XXX.XX
|
| 37247 |
TRLUML BALO ANGIOP ADDL ART
|
$XXX.XX
|
| 37248 |
TRLUML BALO ANGIOP 1ST VEIN
|
$XXX.XX
|
| 37249 |
TRLUML BALO ANGIOP ADDL VEIN
|
$XXX.XX
|
| 37252 |
INTRVASC US NONCORONARY 1ST
|
$XXX.XX
|
| 37253 |
INTRVASC US NONCORONARY ADDL
|
$XXX.XX
|
| 37500 |
ENDOSCOPY LIGATE PERF VEINS
|
$XXX.XX
|
| 37565 |
LIGATION OF NECK VEIN
|
$XXX.XX
|
| 37600 |
LIGATION OF NECK ARTERY
|
$XXX.XX
|
| 37605 |
LIGATION OF NECK ARTERY
|
$XXX.XX
|
| 37606 |
LIGATION OF NECK ARTERY
|
$XXX.XX
|
| 37607 |
LIGATION OF A-V FISTULA
|
$XXX.XX
|
| 37609 |
TEMPORAL ARTERY PROCEDURE
|
$XXX.XX
|
| 37615 |
LIGATION OF NECK ARTERY
|
$XXX.XX
|
| 37616 |
LIGATION OF CHEST ARTERY
|
$XXX.XX
|
| 37617 |
LIGATION OF ABDOMEN ARTERY
|
$XXX.XX
|
| 37618 |
LIGATION OF EXTREMITY ARTERY
|
$XXX.XX
|
| 37619 |
LIGATION OF INF VENA CAVA
|
$XXX.XX
|
| 37650 |
REVISION OF MAJOR VEIN
|
$XXX.XX
|
| 37660 |
REVISION OF MAJOR VEIN
|
$XXX.XX
|
| 37700 |
REVISE LEG VEIN
|
$XXX.XX
|
| 37718 |
LIGATE/STRIP SHORT LEG VEIN
|
$XXX.XX
|
| 37722 |
LIGATE/STRIP LONG LEG VEIN
|
$XXX.XX
|
| 37735 |
REMOVAL OF LEG VEINS/LESION
|
$XXX.XX
|
| 37760 |
LIGATE LEG VEINS RADICAL
|
$XXX.XX
|
| 37761 |
LIGATE LEG VEINS OPEN
|
$XXX.XX
|
| 37765 |
STAB PHLEB VEINS XTR 10-20
|
$XXX.XX
|
| 37766 |
PHLEB VEINS - EXTREM 20+
|
$XXX.XX
|
| 37780 |
REVISION OF LEG VEIN
|
$XXX.XX
|
| 37785 |
LIGATE/DIVIDE/EXCISE VEIN
|
$XXX.XX
|
| 37788 |
REVASCULARIZATION PENIS
|
$XXX.XX
|
| 37790 |
PENILE VENOUS OCCLUSION
|
$XXX.XX
|
| 38100 |
REMOVAL OF SPLEEN TOTAL
|
$XXX.XX
|
| 38101 |
REMOVAL OF SPLEEN PARTIAL
|
$XXX.XX
|
| 38102 |
REMOVAL OF SPLEEN TOTAL
|
$XXX.XX
|
| 38115 |
REPAIR OF RUPTURED SPLEEN
|
$XXX.XX
|
| 38120 |
LAPAROSCOPY SPLENECTOMY
|
$XXX.XX
|
| 38200 |
INJECTION FOR SPLEEN X-RAY
|
$XXX.XX
|
| 38205 |
HARVEST ALLOGENEIC STEM CELL
|
$XXX.XX
|
| 38206 |
HARVEST AUTO STEM CELLS
|
$XXX.XX
|
| 38220 |
DX BONE MARROW ASPIRATIONS
|
$XXX.XX
|
| 38221 |
DX BONE MARROW BIOPSIES
|
$XXX.XX
|
| 38222 |
DX BONE MARROW BX & ASPIR
|
$XXX.XX
|
| 38230 |
BONE MARROW HARVEST ALLOGEN
|
$XXX.XX
|
| 38232 |
BONE MARROW HARVEST AUTOLOG
|
$XXX.XX
|
| 38240 |
TRANSPLT ALLO HCT/DONOR
|
$XXX.XX
|
| 38241 |
TRANSPLT AUTOL HCT/DONOR
|
$XXX.XX
|
| 38242 |
TRANSPLT ALLO LYMPHOCYTES
|
$XXX.XX
|
| 38243 |
TRANSPLJ HEMATOPOIETIC BOOST
|
$XXX.XX
|
| 38300 |
DRAINAGE LYMPH NODE LESION
|
$XXX.XX
|
| 38305 |
DRAINAGE LYMPH NODE LESION
|
$XXX.XX
|
| 38308 |
INCISION OF LYMPH CHANNELS
|
$XXX.XX
|
| 38380 |
THORACIC DUCT PROCEDURE
|
$XXX.XX
|
| 38381 |
THORACIC DUCT PROCEDURE
|
$XXX.XX
|
| 38382 |
THORACIC DUCT PROCEDURE
|
$XXX.XX
|
| 38500 |
BIOPSY/REMOVAL LYMPH NODES
|
$XXX.XX
|
| 38505 |
NEEDLE BIOPSY LYMPH NODES
|
$XXX.XX
|
| 38510 |
BIOPSY/REMOVAL LYMPH NODES
|
$XXX.XX
|
| 38520 |
BIOPSY/REMOVAL LYMPH NODES
|
$XXX.XX
|
| 38525 |
BIOPSY/REMOVAL LYMPH NODES
|
$XXX.XX
|
| 38530 |
BIOPSY/REMOVAL LYMPH NODES
|
$XXX.XX
|
| 38531 |
OPEN BX/EXC INGUINOFEM NODES
|
$XXX.XX
|
| 38542 |
EXPLORE DEEP NODE(S) NECK
|
$XXX.XX
|
| 38550 |
REMOVAL NECK/ARMPIT LESION
|
$XXX.XX
|
| 38555 |
REMOVAL NECK/ARMPIT LESION
|
$XXX.XX
|
| 38562 |
REMOVAL PELVIC LYMPH NODES
|
$XXX.XX
|
| 38564 |
REMOVAL ABDOMEN LYMPH NODES
|
$XXX.XX
|
| 38570 |
LAPAROSCOPY LYMPH NODE BIOP
|
$XXX.XX
|
| 38571 |
LAPAROSCOPY LYMPHADENECTOMY
|
$XXX.XX
|
| 38572 |
LAPAROSCOPY LYMPHADENECTOMY
|
$XXX.XX
|
| 38573 |
LAPS PELVIC LYMPHADEC
|
$XXX.XX
|
| 38700 |
REMOVAL OF LYMPH NODES NECK
|
$XXX.XX
|
| 38720 |
REMOVAL OF LYMPH NODES NECK
|
$XXX.XX
|
| 38724 |
REMOVAL OF LYMPH NODES NECK
|
$XXX.XX
|
| 38740 |
REMOVE ARMPIT LYMPH NODES
|
$XXX.XX
|
| 38745 |
REMOVE ARMPIT LYMPH NODES
|
$XXX.XX
|
| 38746 |
REMOVE THORACIC LYMPH NODES
|
$XXX.XX
|
| 38747 |
REMOVE ABDOMINAL LYMPH NODES
|
$XXX.XX
|
| 38760 |
REMOVE GROIN LYMPH NODES
|
$XXX.XX
|
| 38765 |
REMOVE GROIN LYMPH NODES
|
$XXX.XX
|
| 38770 |
REMOVE PELVIS LYMPH NODES
|
$XXX.XX
|
| 38780 |
REMOVE ABDOMEN LYMPH NODES
|
$XXX.XX
|
| 38790 |
INJECT FOR LYMPHATIC X-RAY
|
$XXX.XX
|
| 38792 |
RA TRACER ID OF SENTINL NODE
|
$XXX.XX
|
| 38794 |
ACCESS THORACIC LYMPH DUCT
|
$XXX.XX
|
| 38900 |
IO MAP OF SENT LYMPH NODE
|
$XXX.XX
|
| 39000 |
EXPLORATION OF CHEST
|
$XXX.XX
|
| 39010 |
EXPLORATION OF CHEST
|
$XXX.XX
|
| 39200 |
RESECT MEDIASTINAL CYST
|
$XXX.XX
|
| 39220 |
RESECT MEDIASTINAL TUMOR
|
$XXX.XX
|
| 39401 |
MEDIASTINOSCPY W/MEDSTNL BX
|
$XXX.XX
|
| 39402 |
MEDIASTINOSCPY W/LMPH NOD BX
|
$XXX.XX
|
| 39501 |
REPAIR DIAPHRAGM LACERATION
|
$XXX.XX
|
| 39503 |
REPAIR OF DIAPHRAGM HERNIA
|
$XXX.XX
|
| 39540 |
REPAIR OF DIAPHRAGM HERNIA
|
$XXX.XX
|
| 39541 |
REPAIR OF DIAPHRAGM HERNIA
|
$XXX.XX
|
| 39545 |
REVISION OF DIAPHRAGM
|
$XXX.XX
|
| 39560 |
RESECT DIAPHRAGM SIMPLE
|
$XXX.XX
|
| 39561 |
RESECT DIAPHRAGM COMPLEX
|
$XXX.XX
|
| 40490 |
BIOPSY OF LIP
|
$XXX.XX
|
| 40500 |
PARTIAL EXCISION OF LIP
|
$XXX.XX
|
| 40510 |
PARTIAL EXCISION OF LIP
|
$XXX.XX
|
| 40520 |
PARTIAL EXCISION OF LIP
|
$XXX.XX
|
| 40525 |
RECONSTRUCT LIP WITH FLAP
|
$XXX.XX
|
| 40527 |
RECONSTRUCT LIP WITH FLAP
|
$XXX.XX
|
| 40530 |
PARTIAL REMOVAL OF LIP
|
$XXX.XX
|
| 40650 |
REPAIR LIP
|
$XXX.XX
|
| 40652 |
REPAIR LIP
|
$XXX.XX
|
| 40654 |
REPAIR LIP
|
$XXX.XX
|
| 40700 |
REPAIR CLEFT LIP/NASAL
|
$XXX.XX
|
| 40701 |
REPAIR CLEFT LIP/NASAL
|
$XXX.XX
|
| 40702 |
REPAIR CLEFT LIP/NASAL
|
$XXX.XX
|
| 40720 |
REPAIR CLEFT LIP/NASAL
|
$XXX.XX
|
| 40761 |
REPAIR CLEFT LIP/NASAL
|
$XXX.XX
|
| 40800 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 40801 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 40804 |
REMOVAL FOREIGN BODY MOUTH
|
$XXX.XX
|
| 40805 |
REMOVAL FOREIGN BODY MOUTH
|
$XXX.XX
|
| 40806 |
INCISION OF LIP FOLD
|
$XXX.XX
|
| 40808 |
BIOPSY OF MOUTH LESION
|
$XXX.XX
|
| 40810 |
EXCISION OF MOUTH LESION
|
$XXX.XX
|
| 40812 |
EXCISE/REPAIR MOUTH LESION
|
$XXX.XX
|
| 40814 |
EXCISE/REPAIR MOUTH LESION
|
$XXX.XX
|
| 40816 |
EXCISION OF MOUTH LESION
|
$XXX.XX
|
| 40818 |
EXCISE ORAL MUCOSA FOR GRAFT
|
$XXX.XX
|
| 40819 |
EXCISE LIP OR CHEEK FOLD
|
$XXX.XX
|
| 40820 |
TREATMENT OF MOUTH LESION
|
$XXX.XX
|
| 40830 |
REPAIR MOUTH LACERATION
|
$XXX.XX
|
| 40831 |
REPAIR MOUTH LACERATION
|
$XXX.XX
|
| 40840 |
RECONSTRUCTION OF MOUTH
|
$XXX.XX
|
| 40842 |
RECONSTRUCTION OF MOUTH
|
$XXX.XX
|
| 40843 |
RECONSTRUCTION OF MOUTH
|
$XXX.XX
|
| 40844 |
RECONSTRUCTION OF MOUTH
|
$XXX.XX
|
| 40845 |
RECONSTRUCTION OF MOUTH
|
$XXX.XX
|
| 41000 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41005 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41006 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41007 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41008 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41009 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41010 |
INCISION OF TONGUE FOLD
|
$XXX.XX
|
| 41015 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41016 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41017 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41018 |
DRAINAGE OF MOUTH LESION
|
$XXX.XX
|
| 41019 |
PLACE NEEDLES H&N FOR RT
|
$XXX.XX
|
| 41100 |
BIOPSY OF TONGUE
|
$XXX.XX
|
| 41105 |
BIOPSY OF TONGUE
|
$XXX.XX
|
| 41108 |
BIOPSY OF FLOOR OF MOUTH
|
$XXX.XX
|
| 41110 |
EXCISION OF TONGUE LESION
|
$XXX.XX
|
| 41112 |
EXCISION OF TONGUE LESION
|
$XXX.XX
|
| 41113 |
EXCISION OF TONGUE LESION
|
$XXX.XX
|
| 41114 |
EXCISION OF TONGUE LESION
|
$XXX.XX
|
| 41115 |
EXCISION OF TONGUE FOLD
|
$XXX.XX
|
| 41116 |
EXCISION OF MOUTH LESION
|
$XXX.XX
|
| 41120 |
PARTIAL REMOVAL OF TONGUE
|
$XXX.XX
|
| 41130 |
PARTIAL REMOVAL OF TONGUE
|
$XXX.XX
|
| 41135 |
TONGUE AND NECK SURGERY
|
$XXX.XX
|
| 41140 |
REMOVAL OF TONGUE
|
$XXX.XX
|
| 41145 |
TONGUE REMOVAL NECK SURGERY
|
$XXX.XX
|
| 41150 |
TONGUE MOUTH JAW SURGERY
|
$XXX.XX
|
| 41153 |
TONGUE MOUTH NECK SURGERY
|
$XXX.XX
|
| 41155 |
TONGUE JAW & NECK SURGERY
|
$XXX.XX
|
| 41250 |
REPAIR TONGUE LACERATION
|
$XXX.XX
|
| 41251 |
REPAIR TONGUE LACERATION
|
$XXX.XX
|
| 41252 |
REPAIR TONGUE LACERATION
|
$XXX.XX
|
| 41510 |
TONGUE TO LIP SURGERY
|
$XXX.XX
|
| 41512 |
TONGUE SUSPENSION
|
$XXX.XX
|
| 41520 |
RECONSTRUCTION TONGUE FOLD
|
$XXX.XX
|
| 41530 |
TONGUE BASE VOL REDUCTION
|
$XXX.XX
|
| 41800 |
DRAINAGE OF GUM LESION
|
$XXX.XX
|
| 41805 |
REMOVAL FOREIGN BODY GUM
|
$XXX.XX
|
| 41806 |
REMOVAL FOREIGN BODY JAWBONE
|
$XXX.XX
|
| 41822 |
EXCISION OF GUM LESION
|
$XXX.XX
|
| 41823 |
EXCISION OF GUM LESION
|
$XXX.XX
|
| 41825 |
EXCISION OF GUM LESION
|
$XXX.XX
|
| 41826 |
EXCISION OF GUM LESION
|
$XXX.XX
|
| 41827 |
EXCISION OF GUM LESION
|
$XXX.XX
|
| 41828 |
EXCISION OF GUM LESION
|
$XXX.XX
|
| 41830 |
REMOVAL OF GUM TISSUE
|
$XXX.XX
|
| 41872 |
REPAIR GUM
|
$XXX.XX
|
| 41874 |
REPAIR TOOTH SOCKET
|
$XXX.XX
|
| 42000 |
DRAINAGE MOUTH ROOF LESION
|
$XXX.XX
|
| 42100 |
BIOPSY ROOF OF MOUTH
|
$XXX.XX
|
| 42104 |
EXCISION LESION MOUTH ROOF
|
$XXX.XX
|
| 42106 |
EXCISION LESION MOUTH ROOF
|
$XXX.XX
|
| 42107 |
EXCISION LESION MOUTH ROOF
|
$XXX.XX
|
| 42120 |
REMOVE PALATE/LESION
|
$XXX.XX
|
| 42140 |
EXCISION OF UVULA
|
$XXX.XX
|
| 42145 |
REPAIR PALATE PHARYNX/UVULA
|
$XXX.XX
|
| 42160 |
TREATMENT MOUTH ROOF LESION
|
$XXX.XX
|
| 42180 |
REPAIR PALATE
|
$XXX.XX
|
| 42182 |
REPAIR PALATE
|
$XXX.XX
|
| 42200 |
RECONSTRUCT CLEFT PALATE
|
$XXX.XX
|
| 42205 |
RECONSTRUCT CLEFT PALATE
|
$XXX.XX
|
| 42210 |
RECONSTRUCT CLEFT PALATE
|
$XXX.XX
|
| 42215 |
RECONSTRUCT CLEFT PALATE
|
$XXX.XX
|
| 42220 |
RECONSTRUCT CLEFT PALATE
|
$XXX.XX
|
| 42225 |
RECONSTRUCT CLEFT PALATE
|
$XXX.XX
|
| 42226 |
LENGTHENING OF PALATE
|
$XXX.XX
|
| 42227 |
LENGTHENING OF PALATE
|
$XXX.XX
|
| 42235 |
REPAIR PALATE
|
$XXX.XX
|
| 42260 |
REPAIR NOSE TO LIP FISTULA
|
$XXX.XX
|
| 42280 |
PREPARATION PALATE MOLD
|
$XXX.XX
|
| 42281 |
INSERTION PALATE PROSTHESIS
|
$XXX.XX
|
| 42300 |
DRAINAGE OF SALIVARY GLAND
|
$XXX.XX
|
| 42305 |
DRAINAGE OF SALIVARY GLAND
|
$XXX.XX
|
| 42310 |
DRAINAGE OF SALIVARY GLAND
|
$XXX.XX
|
| 42320 |
DRAINAGE OF SALIVARY GLAND
|
$XXX.XX
|
| 42330 |
REMOVAL OF SALIVARY STONE
|
$XXX.XX
|
| 42335 |
REMOVAL OF SALIVARY STONE
|
$XXX.XX
|
| 42340 |
REMOVAL OF SALIVARY STONE
|
$XXX.XX
|
| 42400 |
BIOPSY OF SALIVARY GLAND
|
$XXX.XX
|
| 42405 |
BIOPSY OF SALIVARY GLAND
|
$XXX.XX
|
| 42408 |
EXCISION OF SALIVARY CYST
|
$XXX.XX
|
| 42409 |
DRAINAGE OF SALIVARY CYST
|
$XXX.XX
|
| 42410 |
EXCISE PAROTID GLAND/LESION
|
$XXX.XX
|
| 42415 |
EXCISE PAROTID GLAND/LESION
|
$XXX.XX
|
| 42420 |
EXCISE PAROTID GLAND/LESION
|
$XXX.XX
|
| 42425 |
EXCISE PAROTID GLAND/LESION
|
$XXX.XX
|
| 42426 |
EXCISE PAROTID GLAND/LESION
|
$XXX.XX
|
| 42440 |
EXCISE SUBMAXILLARY GLAND
|
$XXX.XX
|
| 42450 |
EXCISE SUBLINGUAL GLAND
|
$XXX.XX
|
| 42500 |
REPAIR SALIVARY DUCT
|
$XXX.XX
|
| 42505 |
REPAIR SALIVARY DUCT
|
$XXX.XX
|
| 42507 |
PAROTID DUCT DIVERSION
|
$XXX.XX
|
| 42509 |
PAROTID DUCT DIVERSION
|
$XXX.XX
|
| 42510 |
PAROTID DUCT DIVERSION
|
$XXX.XX
|
| 42550 |
INJECTION FOR SALIVARY X-RAY
|
$XXX.XX
|
| 42600 |
CLOSURE OF SALIVARY FISTULA
|
$XXX.XX
|
| 42650 |
DILATION OF SALIVARY DUCT
|
$XXX.XX
|
| 42660 |
DILATION OF SALIVARY DUCT
|
$XXX.XX
|
| 42665 |
LIGATION OF SALIVARY DUCT
|
$XXX.XX
|
| 42700 |
DRAINAGE OF TONSIL ABSCESS
|
$XXX.XX
|
| 42720 |
DRAINAGE OF THROAT ABSCESS
|
$XXX.XX
|
| 42725 |
DRAINAGE OF THROAT ABSCESS
|
$XXX.XX
|
| 42800 |
BIOPSY OF THROAT
|
$XXX.XX
|
| 42804 |
BIOPSY OF UPPER NOSE/THROAT
|
$XXX.XX
|
| 42806 |
BIOPSY OF UPPER NOSE/THROAT
|
$XXX.XX
|
| 42808 |
EXCISE PHARYNX LESION
|
$XXX.XX
|
| 42809 |
REMOVE PHARYNX FOREIGN BODY
|
$XXX.XX
|
| 42810 |
EXCISION OF NECK CYST
|
$XXX.XX
|
| 42815 |
EXCISION OF NECK CYST
|
$XXX.XX
|
| 42820 |
REMOVE TONSILS AND ADENOIDS
|
$XXX.XX
|
| 42821 |
REMOVE TONSILS AND ADENOIDS
|
$XXX.XX
|
| 42825 |
REMOVAL OF TONSILS
|
$XXX.XX
|
| 42826 |
REMOVAL OF TONSILS
|
$XXX.XX
|
| 42830 |
REMOVAL OF ADENOIDS
|
$XXX.XX
|
| 42831 |
REMOVAL OF ADENOIDS
|
$XXX.XX
|
| 42835 |
REMOVAL OF ADENOIDS
|
$XXX.XX
|
| 42836 |
REMOVAL OF ADENOIDS
|
$XXX.XX
|
| 42842 |
EXTENSIVE SURGERY OF THROAT
|
$XXX.XX
|
| 42844 |
EXTENSIVE SURGERY OF THROAT
|
$XXX.XX
|
| 42845 |
EXTENSIVE SURGERY OF THROAT
|
$XXX.XX
|
| 42860 |
EXCISION OF TONSIL TAGS
|
$XXX.XX
|
| 42870 |
EXCISION OF LINGUAL TONSIL
|
$XXX.XX
|
| 42890 |
PARTIAL REMOVAL OF PHARYNX
|
$XXX.XX
|
| 42892 |
REVISION OF PHARYNGEAL WALLS
|
$XXX.XX
|
| 42894 |
REVISION OF PHARYNGEAL WALLS
|
$XXX.XX
|
| 42900 |
REPAIR THROAT WOUND
|
$XXX.XX
|
| 42950 |
RECONSTRUCTION OF THROAT
|
$XXX.XX
|
| 42953 |
REPAIR THROAT ESOPHAGUS
|
$XXX.XX
|
| 42955 |
SURGICAL OPENING OF THROAT
|
$XXX.XX
|
| 42960 |
CONTROL THROAT BLEEDING
|
$XXX.XX
|
| 42961 |
CONTROL THROAT BLEEDING
|
$XXX.XX
|
| 42962 |
CONTROL THROAT BLEEDING
|
$XXX.XX
|
| 42970 |
CONTROL NOSE/THROAT BLEEDING
|
$XXX.XX
|
| 42971 |
CONTROL NOSE/THROAT BLEEDING
|
$XXX.XX
|
| 42972 |
CONTROL NOSE/THROAT BLEEDING
|
$XXX.XX
|
| 43020 |
INCISION OF ESOPHAGUS
|
$XXX.XX
|
| 43030 |
THROAT MUSCLE SURGERY
|
$XXX.XX
|
| 43045 |
INCISION OF ESOPHAGUS
|
$XXX.XX
|
| 43100 |
EXCISION OF ESOPHAGUS LESION
|
$XXX.XX
|
| 43101 |
EXCISION OF ESOPHAGUS LESION
|
$XXX.XX
|
| 43107 |
REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43108 |
REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43112 |
ESPHG TOT W/THRCM
|
$XXX.XX
|
| 43113 |
REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43116 |
PARTIAL REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43117 |
PARTIAL REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43118 |
PARTIAL REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43121 |
PARTIAL REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43122 |
PARTIAL REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43123 |
PARTIAL REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43124 |
REMOVAL OF ESOPHAGUS
|
$XXX.XX
|
| 43130 |
REMOVAL OF ESOPHAGUS POUCH
|
$XXX.XX
|
| 43135 |
REMOVAL OF ESOPHAGUS POUCH
|
$XXX.XX
|
| 43180 |
ESOPHAGOSCOPY RIGID TRNSO
|
$XXX.XX
|
| 43191 |
ESOPHAGOSCOPY RIGID TRNSO DX
|
$XXX.XX
|
| 43192 |
ESOPHAGOSCP RIG TRNSO INJECT
|
$XXX.XX
|
| 43193 |
ESOPHAGOSCP RIG TRNSO BIOPSY
|
$XXX.XX
|
| 43194 |
ESOPHAGOSCP RIG TRNSO REM FB
|
$XXX.XX
|
| 43195 |
ESOPHAGOSCOPY RIGID BALLOON
|
$XXX.XX
|
| 43196 |
ESOPHAGOSCP GUIDE WIRE DILAT
|
$XXX.XX
|
| 43197 |
ESOPHAGOSCOPY FLEX DX BRUSH
|
$XXX.XX
|
| 43198 |
ESOPHAGOSC FLEX TRNSN BIOPSY
|
$XXX.XX
|
| 43200 |
ESOPHAGOSCOPY FLEXIBLE BRUSH
|
$XXX.XX
|
| 43201 |
ESOPH SCOPE W/SUBMUCOUS INJ
|
$XXX.XX
|
| 43202 |
ESOPHAGOSCOPY FLEX BIOPSY
|
$XXX.XX
|
| 43204 |
ESOPH SCOPE W/SCLEROSIS INJ
|
$XXX.XX
|
| 43205 |
ESOPHAGUS ENDOSCOPY/LIGATION
|
$XXX.XX
|
| 43206 |
ESOPH OPTICAL ENDOMICROSCOPY
|
$XXX.XX
|
| 43210 |
EGD ESOPHAGOGASTRC FNDOPLSTY
|
$XXX.XX
|
| 43211 |
ESOPHAGOSCOP MUCOSAL RESECT
|
$XXX.XX
|
| 43212 |
ESOPHAGOSCOP STENT PLACEMENT
|
$XXX.XX
|
| 43213 |
ESOPHAGOSCOPY RETRO BALLOON
|
$XXX.XX
|
| 43214 |
ESOPHAGOSC DILATE BALLOON 30
|
$XXX.XX
|
| 43215 |
ESOPHAGOSCOPY FLEX REMOVE FB
|
$XXX.XX
|
| 43216 |
ESOPHAGOSCOPY LESION REMOVAL
|
$XXX.XX
|
| 43217 |
ESOPHAGOSCOPY SNARE LES REMV
|
$XXX.XX
|
| 43220 |
ESOPHAGOSCOPY BALLOON <30MM
|
$XXX.XX
|
| 43226 |
ESOPH ENDOSCOPY DILATION
|
$XXX.XX
|
| 43227 |
ESOPHAGOSCOPY CONTROL BLEED
|
$XXX.XX
|
| 43229 |
ESOPHAGOSCOPY LESION ABLATE
|
$XXX.XX
|
| 43231 |
ESOPHAGOSCOP ULTRASOUND EXAM
|
$XXX.XX
|
| 43232 |
ESOPHAGOSCOPY W/US NEEDLE BX
|
$XXX.XX
|
| 43233 |
EGD BALLOON DIL ESOPH30 MM/>
|
$XXX.XX
|
| 43235 |
EGD DIAGNOSTIC BRUSH WASH
|
$XXX.XX
|
| 43236 |
UPPR GI SCOPE W/SUBMUC INJ
|
$XXX.XX
|
| 43237 |
ENDOSCOPIC US EXAM ESOPH
|
$XXX.XX
|
| 43238 |
EGD US FINE NEEDLE BX/ASPIR
|
$XXX.XX
|
| 43239 |
EGD BIOPSY SINGLE/MULTIPLE
|
$XXX.XX
|
| 43240 |
EGD W/TRANSMURAL DRAIN CYST
|
$XXX.XX
|
| 43241 |
EGD TUBE/CATH INSERTION
|
$XXX.XX
|
| 43242 |
EGD US FINE NEEDLE BX/ASPIR
|
$XXX.XX
|
| 43243 |
EGD INJECTION VARICES
|
$XXX.XX
|
| 43244 |
EGD VARICES LIGATION
|
$XXX.XX
|
| 43245 |
EGD DILATE STRICTURE
|
$XXX.XX
|
| 43246 |
EGD PLACE GASTROSTOMY TUBE
|
$XXX.XX
|
| 43247 |
EGD REMOVE FOREIGN BODY
|
$XXX.XX
|
| 43248 |
EGD GUIDE WIRE INSERTION
|
$XXX.XX
|
| 43249 |
ESOPH EGD DILATION <30 MM
|
$XXX.XX
|
| 43250 |
EGD CAUTERY TUMOR POLYP
|
$XXX.XX
|
| 43251 |
EGD REMOVE LESION SNARE
|
$XXX.XX
|
| 43252 |
EGD OPTICAL ENDOMICROSCOPY
|
$XXX.XX
|
| 43253 |
EGD US TRANSMURAL INJXN/MARK
|
$XXX.XX
|
| 43254 |
EGD ENDO MUCOSAL RESECTION
|
$XXX.XX
|
| 43255 |
EGD CONTROL BLEEDING ANY
|
$XXX.XX
|
| 43257 |
EGD W/THRML TXMNT GERD
|
$XXX.XX
|
| 43259 |
EGD US EXAM DUODENUM/JEJUNUM
|
$XXX.XX
|
| 43260 |
ERCP W/SPECIMEN COLLECTION
|
$XXX.XX
|
| 43261 |
ENDO CHOLANGIOPANCREATOGRAPH
|
$XXX.XX
|
| 43262 |
ENDO CHOLANGIOPANCREATOGRAPH
|
$XXX.XX
|
| 43263 |
ERCP SPHINCTER PRESSURE MEAS
|
$XXX.XX
|
| 43264 |
ERCP REMOVE DUCT CALCULI
|
$XXX.XX
|
| 43265 |
ERCP LITHOTRIPSY CALCULI
|
$XXX.XX
|
| 43266 |
EGD ENDOSCOPIC STENT PLACE
|
$XXX.XX
|
| 43270 |
EGD LESION ABLATION
|
$XXX.XX
|
| 43273 |
ENDOSCOPIC PANCREATOSCOPY
|
$XXX.XX
|
| 43274 |
ERCP DUCT STENT PLACEMENT
|
$XXX.XX
|
| 43275 |
ERCP REMOVE FORGN BODY DUCT
|
$XXX.XX
|
| 43276 |
ERCP STENT EXCHANGE W/DILATE
|
$XXX.XX
|
| 43277 |
ERCP EA DUCT/AMPULLA DILATE
|
$XXX.XX
|
| 43278 |
ERCP LESION ABLATE W/DILATE
|
$XXX.XX
|
| 43279 |
LAP MYOTOMY HELLER
|
$XXX.XX
|
| 43280 |
LAPAROSCOPY FUNDOPLASTY
|
$XXX.XX
|
| 43281 |
LAP PARAESOPHAG HERN REPAIR
|
$XXX.XX
|
| 43282 |
LAP PARAESOPH HER RPR W/MESH
|
$XXX.XX
|
| 43283 |
LAP ESOPH LENGTHENING
|
$XXX.XX
|
| 43284 |
LAPS ESOPHGL SPHNCTR AGMNTJ
|
$XXX.XX
|
| 43285 |
RMVL ESOPHGL SPHNCTR DEV
|
$XXX.XX
|
| 43286 |
ESPHG TOT W/LAPS MOBLJ
|
$XXX.XX
|
| 43287 |
ESPHG DSTL 2/3 W/LAPS MOBLJ
|
$XXX.XX
|
| 43288 |
ESPHG THRSC MOBLJ
|
$XXX.XX
|
| 43300 |
REPAIR OF ESOPHAGUS
|
$XXX.XX
|
| 43305 |
REPAIR ESOPHAGUS AND FISTULA
|
$XXX.XX
|
| 43310 |
REPAIR OF ESOPHAGUS
|
$XXX.XX
|
| 43312 |
REPAIR ESOPHAGUS AND FISTULA
|
$XXX.XX
|
| 43313 |
ESOPHAGOPLASTY CONGENITAL
|
$XXX.XX
|
| 43314 |
TRACHEO-ESOPHAGOPLASTY CONG
|
$XXX.XX
|
| 43320 |
FUSE ESOPHAGUS & STOMACH
|
$XXX.XX
|
| 43325 |
REVISE ESOPHAGUS & STOMACH
|
$XXX.XX
|
| 43327 |
ESOPH FUNDOPLASTY LAP
|
$XXX.XX
|
| 43328 |
ESOPH FUNDOPLASTY THOR
|
$XXX.XX
|
| 43330 |
ESOPHAGOMYOTOMY ABDOMINAL
|
$XXX.XX
|
| 43331 |
ESOPHAGOMYOTOMY THORACIC
|
$XXX.XX
|
| 43332 |
TRANSAB ESOPH HIAT HERN RPR
|
$XXX.XX
|
| 43333 |
TRANSAB ESOPH HIAT HERN RPR
|
$XXX.XX
|
| 43334 |
TRANSTHOR DIAPHRAG HERN RPR
|
$XXX.XX
|
| 43335 |
TRANSTHOR DIAPHRAG HERN RPR
|
$XXX.XX
|
| 43336 |
THORABD DIAPHR HERN REPAIR
|
$XXX.XX
|
| 43337 |
THORABD DIAPHR HERN REPAIR
|
$XXX.XX
|
| 43338 |
ESOPH LENGTHENING
|
$XXX.XX
|
| 43340 |
FUSE ESOPHAGUS & INTESTINE
|
$XXX.XX
|
| 43341 |
FUSE ESOPHAGUS & INTESTINE
|
$XXX.XX
|
| 43351 |
SURGICAL OPENING ESOPHAGUS
|
$XXX.XX
|
| 43352 |
SURGICAL OPENING ESOPHAGUS
|
$XXX.XX
|
| 43360 |
GASTROINTESTINAL REPAIR
|
$XXX.XX
|
| 43361 |
GASTROINTESTINAL REPAIR
|
$XXX.XX
|
| 43400 |
LIGATE ESOPHAGUS VEINS
|
$XXX.XX
|
| 43405 |
LIGATE/STAPLE ESOPHAGUS
|
$XXX.XX
|
| 43410 |
REPAIR ESOPHAGUS WOUND
|
$XXX.XX
|
| 43415 |
REPAIR ESOPHAGUS WOUND
|
$XXX.XX
|
| 43420 |
REPAIR ESOPHAGUS OPENING
|
$XXX.XX
|
| 43425 |
REPAIR ESOPHAGUS OPENING
|
$XXX.XX
|
| 43450 |
DILATE ESOPHAGUS 1/MULT PASS
|
$XXX.XX
|
| 43453 |
DILATE ESOPHAGUS
|
$XXX.XX
|
| 43460 |
PRESSURE TREATMENT ESOPHAGUS
|
$XXX.XX
|
| 43500 |
SURGICAL OPENING OF STOMACH
|
$XXX.XX
|
| 43501 |
SURGICAL REPAIR OF STOMACH
|
$XXX.XX
|
| 43502 |
SURGICAL REPAIR OF STOMACH
|
$XXX.XX
|
| 43510 |
SURGICAL OPENING OF STOMACH
|
$XXX.XX
|
| 43520 |
INCISION OF PYLORIC MUSCLE
|
$XXX.XX
|
| 43605 |
BIOPSY OF STOMACH
|
$XXX.XX
|
| 43610 |
EXCISION OF STOMACH LESION
|
$XXX.XX
|
| 43611 |
EXCISION OF STOMACH LESION
|
$XXX.XX
|
| 43620 |
REMOVAL OF STOMACH
|
$XXX.XX
|
| 43621 |
REMOVAL OF STOMACH
|
$XXX.XX
|
| 43622 |
REMOVAL OF STOMACH
|
$XXX.XX
|
| 43631 |
REMOVAL OF STOMACH PARTIAL
|
$XXX.XX
|
| 43632 |
REMOVAL OF STOMACH PARTIAL
|
$XXX.XX
|
| 43633 |
REMOVAL OF STOMACH PARTIAL
|
$XXX.XX
|
| 43634 |
REMOVAL OF STOMACH PARTIAL
|
$XXX.XX
|
| 43635 |
REMOVAL OF STOMACH PARTIAL
|
$XXX.XX
|
| 43640 |
VAGOTOMY & PYLORUS REPAIR
|
$XXX.XX
|
| 43641 |
VAGOTOMY & PYLORUS REPAIR
|
$XXX.XX
|
| 43644 |
LAP GASTRIC BYPASS/ROUX-EN-Y
|
$XXX.XX
|
| 43645 |
LAP GASTR BYPASS INCL SMLL I
|
$XXX.XX
|
| 43651 |
LAPAROSCOPY VAGUS NERVE
|
$XXX.XX
|
| 43652 |
LAPAROSCOPY VAGUS NERVE
|
$XXX.XX
|
| 43653 |
LAPAROSCOPY GASTROSTOMY
|
$XXX.XX
|
| 43752 |
NASAL/OROGASTRIC W/TUBE PLMT
|
$XXX.XX
|
| 43753 |
TX GASTRO INTUB W/ASP
|
$XXX.XX
|
| 43754 |
DX GASTR INTUB W/ASP SPEC
|
$XXX.XX
|
| 43755 |
DX GASTR INTUB W/ASP SPECS
|
$XXX.XX
|
| 43756 |
DX DUOD INTUB W/ASP SPEC
|
$XXX.XX
|
| 43757 |
DX DUOD INTUB W/ASP SPECS
|
$XXX.XX
|
| 43761 |
REPOSITION GASTROSTOMY TUBE
|
$XXX.XX
|
| 43762 |
RPLC GTUBE NO REVJ TRC
|
$XXX.XX
|
| 43763 |
RPLC GTUBE REVJ GSTRST TRC
|
$XXX.XX
|
| 43770 |
LAP PLACE GASTR ADJ DEVICE
|
$XXX.XX
|
| 43771 |
LAP REVISE GASTR ADJ DEVICE
|
$XXX.XX
|
| 43772 |
LAP RMVL GASTR ADJ DEVICE
|
$XXX.XX
|
| 43773 |
LAP REPLACE GASTR ADJ DEVICE
|
$XXX.XX
|
| 43774 |
LAP RMVL GASTR ADJ ALL PARTS
|
$XXX.XX
|
| 43775 |
LAP SLEEVE GASTRECTOMY
|
$XXX.XX
|
| 43800 |
RECONSTRUCTION OF PYLORUS
|
$XXX.XX
|
| 43810 |
FUSION OF STOMACH AND BOWEL
|
$XXX.XX
|
| 43820 |
FUSION OF STOMACH AND BOWEL
|
$XXX.XX
|
| 43825 |
FUSION OF STOMACH AND BOWEL
|
$XXX.XX
|
| 43830 |
PLACE GASTROSTOMY TUBE
|
$XXX.XX
|
| 43831 |
PLACE GASTROSTOMY TUBE
|
$XXX.XX
|
| 43832 |
PLACE GASTROSTOMY TUBE
|
$XXX.XX
|
| 43840 |
REPAIR OF STOMACH LESION
|
$XXX.XX
|
| 43843 |
GASTROPLASTY W/O V-BAND
|
$XXX.XX
|
| 43845 |
GASTROPLASTY DUODENAL SWITCH
|
$XXX.XX
|
| 43846 |
GASTRIC BYPASS FOR OBESITY
|
$XXX.XX
|
| 43847 |
GASTRIC BYPASS INCL SMALL I
|
$XXX.XX
|
| 43848 |
REVISION GASTROPLASTY
|
$XXX.XX
|
| 43850 |
REVISE STOMACH-BOWEL FUSION
|
$XXX.XX
|
| 43855 |
REVISE STOMACH-BOWEL FUSION
|
$XXX.XX
|
| 43860 |
REVISE STOMACH-BOWEL FUSION
|
$XXX.XX
|
| 43865 |
REVISE STOMACH-BOWEL FUSION
|
$XXX.XX
|
| 43870 |
REPAIR STOMACH OPENING
|
$XXX.XX
|
| 43880 |
REPAIR STOMACH-BOWEL FISTULA
|
$XXX.XX
|
| 43886 |
REVISE GASTRIC PORT OPEN
|
$XXX.XX
|
| 43887 |
REMOVE GASTRIC PORT OPEN
|
$XXX.XX
|
| 43888 |
CHANGE GASTRIC PORT OPEN
|
$XXX.XX
|
| 44005 |
FREEING OF BOWEL ADHESION
|
$XXX.XX
|
| 44010 |
INCISION OF SMALL BOWEL
|
$XXX.XX
|
| 44015 |
INSERT NEEDLE CATH BOWEL
|
$XXX.XX
|
| 44020 |
EXPLORE SMALL INTESTINE
|
$XXX.XX
|
| 44021 |
DECOMPRESS SMALL BOWEL
|
$XXX.XX
|
| 44025 |
INCISION OF LARGE BOWEL
|
$XXX.XX
|
| 44050 |
REDUCE BOWEL OBSTRUCTION
|
$XXX.XX
|
| 44055 |
CORRECT MALROTATION OF BOWEL
|
$XXX.XX
|
| 44100 |
BIOPSY OF BOWEL
|
$XXX.XX
|
| 44110 |
EXCISE INTESTINE LESION(S)
|
$XXX.XX
|
| 44111 |
EXCISION OF BOWEL LESION(S)
|
$XXX.XX
|
| 44120 |
REMOVAL OF SMALL INTESTINE
|
$XXX.XX
|
| 44121 |
REMOVAL OF SMALL INTESTINE
|
$XXX.XX
|
| 44125 |
REMOVAL OF SMALL INTESTINE
|
$XXX.XX
|
| 44126 |
ENTERECTOMY W/O TAPER CONG
|
$XXX.XX
|
| 44127 |
ENTERECTOMY W/TAPER CONG
|
$XXX.XX
|
| 44128 |
ENTERECTOMY CONG ADD-ON
|
$XXX.XX
|
| 44130 |
BOWEL TO BOWEL FUSION
|
$XXX.XX
|
| 44139 |
MOBILIZATION OF COLON
|
$XXX.XX
|
| 44140 |
PARTIAL REMOVAL OF COLON
|
$XXX.XX
|
| 44141 |
PARTIAL REMOVAL OF COLON
|
$XXX.XX
|
| 44143 |
PARTIAL REMOVAL OF COLON
|
$XXX.XX
|
| 44144 |
PARTIAL REMOVAL OF COLON
|
$XXX.XX
|
| 44145 |
PARTIAL REMOVAL OF COLON
|
$XXX.XX
|
| 44146 |
PARTIAL REMOVAL OF COLON
|
$XXX.XX
|
| 44147 |
PARTIAL REMOVAL OF COLON
|
$XXX.XX
|
| 44150 |
REMOVAL OF COLON
|
$XXX.XX
|
| 44151 |
REMOVAL OF COLON/ILEOSTOMY
|
$XXX.XX
|
| 44155 |
REMOVAL OF COLON/ILEOSTOMY
|
$XXX.XX
|
| 44156 |
REMOVAL OF COLON/ILEOSTOMY
|
$XXX.XX
|
| 44157 |
COLECTOMY W/ILEOANAL ANAST
|
$XXX.XX
|
| 44158 |
COLECTOMY W/NEO-RECTUM POUCH
|
$XXX.XX
|
| 44160 |
REMOVAL OF COLON
|
$XXX.XX
|
| 44180 |
LAP ENTEROLYSIS
|
$XXX.XX
|
| 44186 |
LAP JEJUNOSTOMY
|
$XXX.XX
|
| 44187 |
LAP ILEO/JEJUNO-STOMY
|
$XXX.XX
|
| 44188 |
LAP COLOSTOMY
|
$XXX.XX
|
| 44202 |
LAP ENTERECTOMY
|
$XXX.XX
|
| 44203 |
LAP RESECT S/INTESTINE ADDL
|
$XXX.XX
|
| 44204 |
LAPARO PARTIAL COLECTOMY
|
$XXX.XX
|
| 44205 |
LAP COLECTOMY PART W/ILEUM
|
$XXX.XX
|
| 44206 |
LAP PART COLECTOMY W/STOMA
|
$XXX.XX
|
| 44207 |
L COLECTOMY/COLOPROCTOSTOMY
|
$XXX.XX
|
| 44208 |
L COLECTOMY/COLOPROCTOSTOMY
|
$XXX.XX
|
| 44210 |
LAPARO TOTAL PROCTOCOLECTOMY
|
$XXX.XX
|
| 44211 |
LAP COLECTOMY W/PROCTECTOMY
|
$XXX.XX
|
| 44212 |
LAPARO TOTAL PROCTOCOLECTOMY
|
$XXX.XX
|
| 44213 |
LAP MOBIL SPLENIC FL ADD-ON
|
$XXX.XX
|
| 44227 |
LAP CLOSE ENTEROSTOMY
|
$XXX.XX
|
| 44300 |
OPEN BOWEL TO SKIN
|
$XXX.XX
|
| 44310 |
ILEOSTOMY/JEJUNOSTOMY
|
$XXX.XX
|
| 44312 |
REVISION OF ILEOSTOMY
|
$XXX.XX
|
| 44314 |
REVISION OF ILEOSTOMY
|
$XXX.XX
|
| 44316 |
DEVISE BOWEL POUCH
|
$XXX.XX
|
| 44320 |
COLOSTOMY
|
$XXX.XX
|
| 44322 |
COLOSTOMY WITH BIOPSIES
|
$XXX.XX
|
| 44340 |
REVISION OF COLOSTOMY
|
$XXX.XX
|
| 44345 |
REVISION OF COLOSTOMY
|
$XXX.XX
|
| 44346 |
REVISION OF COLOSTOMY
|
$XXX.XX
|
| 44360 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44361 |
SMALL BOWEL ENDOSCOPY/BIOPSY
|
$XXX.XX
|
| 44363 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44364 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44365 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44366 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44369 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44370 |
SMALL BOWEL ENDOSCOPY/STENT
|
$XXX.XX
|
| 44372 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44373 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44376 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44377 |
SMALL BOWEL ENDOSCOPY/BIOPSY
|
$XXX.XX
|
| 44378 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44379 |
S BOWEL ENDOSCOPE W/STENT
|
$XXX.XX
|
| 44380 |
SMALL BOWEL ENDOSCOPY BR/WA
|
$XXX.XX
|
| 44381 |
SMALL BOWEL ENDOSCOPY BR/WA
|
$XXX.XX
|
| 44382 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44384 |
SMALL BOWEL ENDOSCOPY
|
$XXX.XX
|
| 44385 |
ENDOSCOPY OF BOWEL POUCH
|
$XXX.XX
|
| 44386 |
ENDOSCOPY BOWEL POUCH/BIOP
|
$XXX.XX
|
| 44388-53 |
COLONOSCOPY THRU STOMA SPX
|
$XXX.XX
|
| 44389 |
COLONOSCOPY WITH BIOPSY
|
$XXX.XX
|
| 44390 |
COLONOSCOPY FOR FOREIGN BODY
|
$XXX.XX
|
| 44391 |
COLONOSCOPY FOR BLEEDING
|
$XXX.XX
|
| 44392 |
COLONOSCOPY & POLYPECTOMY
|
$XXX.XX
|
| 44394 |
COLONOSCOPY W/SNARE
|
$XXX.XX
|
| 44401 |
COLONOSCOPY WITH ABLATION
|
$XXX.XX
|
| 44402 |
COLONOSCOPY W/STENT PLCMT
|
$XXX.XX
|
| 44403 |
COLONOSCOPY W/RESECTION
|
$XXX.XX
|
| 44404 |
COLONOSCOPY W/INJECTION
|
$XXX.XX
|
| 44405 |
COLONOSCOPY W/DILATION
|
$XXX.XX
|
| 44406 |
COLONOSCOPY W/ULTRASOUND
|
$XXX.XX
|
| 44407 |
COLONOSCOPY W/NDL ASPIR/BX
|
$XXX.XX
|
| 44408 |
COLONOSCOPY W/DECOMPRESSION
|
$XXX.XX
|
| 44500 |
INTRO GASTROINTESTINAL TUBE
|
$XXX.XX
|
| 44602 |
SUTURE SMALL INTESTINE
|
$XXX.XX
|
| 44603 |
SUTURE SMALL INTESTINE
|
$XXX.XX
|
| 44604 |
SUTURE LARGE INTESTINE
|
$XXX.XX
|
| 44605 |
REPAIR OF BOWEL LESION
|
$XXX.XX
|
| 44615 |
INTESTINAL STRICTUROPLASTY
|
$XXX.XX
|
| 44620 |
REPAIR BOWEL OPENING
|
$XXX.XX
|
| 44625 |
REPAIR BOWEL OPENING
|
$XXX.XX
|
| 44626 |
REPAIR BOWEL OPENING
|
$XXX.XX
|
| 44640 |
REPAIR BOWEL-SKIN FISTULA
|
$XXX.XX
|
| 44650 |
REPAIR BOWEL FISTULA
|
$XXX.XX
|
| 44660 |
REPAIR BOWEL-BLADDER FISTULA
|
$XXX.XX
|
| 44661 |
REPAIR BOWEL-BLADDER FISTULA
|
$XXX.XX
|
| 44680 |
SURGICAL REVISION INTESTINE
|
$XXX.XX
|
| 44700 |
SUSPEND BOWEL W/PROSTHESIS
|
$XXX.XX
|
| 44701 |
INTRAOP COLON LAVAGE ADD-ON
|
$XXX.XX
|
| 44720 |
PREP DONOR INTESTINE/VENOUS
|
$XXX.XX
|
| 44721 |
PREP DONOR INTESTINE/ARTERY
|
$XXX.XX
|
| 44800 |
EXCISION OF BOWEL POUCH
|
$XXX.XX
|
| 44820 |
EXCISION OF MESENTERY LESION
|
$XXX.XX
|
| 44850 |
REPAIR OF MESENTERY
|
$XXX.XX
|
| 44900 |
DRAIN APPENDIX ABSCESS OPEN
|
$XXX.XX
|
| 44950 |
APPENDECTOMY
|
$XXX.XX
|
| 44955 |
APPENDECTOMY ADD-ON
|
$XXX.XX
|
| 44960 |
APPENDECTOMY
|
$XXX.XX
|
| 44970 |
LAPAROSCOPY APPENDECTOMY
|
$XXX.XX
|
| 45000 |
DRAINAGE OF PELVIC ABSCESS
|
$XXX.XX
|
| 45005 |
DRAINAGE OF RECTAL ABSCESS
|
$XXX.XX
|
| 45020 |
DRAINAGE OF RECTAL ABSCESS
|
$XXX.XX
|
| 45100 |
BIOPSY OF RECTUM
|
$XXX.XX
|
| 45108 |
REMOVAL OF ANORECTAL LESION
|
$XXX.XX
|
| 45110 |
REMOVAL OF RECTUM
|
$XXX.XX
|
| 45111 |
PARTIAL REMOVAL OF RECTUM
|
$XXX.XX
|
| 45112 |
REMOVAL OF RECTUM
|
$XXX.XX
|
| 45113 |
PARTIAL PROCTECTOMY
|
$XXX.XX
|
| 45114 |
PARTIAL REMOVAL OF RECTUM
|
$XXX.XX
|
| 45116 |
PARTIAL REMOVAL OF RECTUM
|
$XXX.XX
|
| 45119 |
REMOVE RECTUM W/RESERVOIR
|
$XXX.XX
|
| 45120 |
REMOVAL OF RECTUM
|
$XXX.XX
|
| 45121 |
REMOVAL OF RECTUM AND COLON
|
$XXX.XX
|
| 45123 |
PARTIAL PROCTECTOMY
|
$XXX.XX
|
| 45126 |
PELVIC EXENTERATION
|
$XXX.XX
|
| 45130 |
EXCISION OF RECTAL PROLAPSE
|
$XXX.XX
|
| 45135 |
EXCISION OF RECTAL PROLAPSE
|
$XXX.XX
|
| 45136 |
EXCISE ILEOANAL RESERVIOR
|
$XXX.XX
|
| 45150 |
EXCISION OF RECTAL STRICTURE
|
$XXX.XX
|
| 45160 |
EXCISION OF RECTAL LESION
|
$XXX.XX
|
| 45171 |
EXC RECT TUM TRANSANAL PART
|
$XXX.XX
|
| 45172 |
EXC RECT TUM TRANSANAL FULL
|
$XXX.XX
|
| 45190 |
DESTRUCTION RECTAL TUMOR
|
$XXX.XX
|
| 45300 |
PROCTOSIGMOIDOSCOPY DX
|
$XXX.XX
|
| 45303 |
PROCTOSIGMOIDOSCOPY DILATE
|
$XXX.XX
|
| 45305 |
PROCTOSIGMOIDOSCOPY W/BX
|
$XXX.XX
|
| 45307 |
PROCTOSIGMOIDOSCOPY FB
|
$XXX.XX
|
| 45308 |
PROCTOSIGMOIDOSCOPY REMOVAL
|
$XXX.XX
|
| 45309 |
PROCTOSIGMOIDOSCOPY REMOVAL
|
$XXX.XX
|
| 45315 |
PROCTOSIGMOIDOSCOPY REMOVAL
|
$XXX.XX
|
| 45317 |
PROCTOSIGMOIDOSCOPY BLEED
|
$XXX.XX
|
| 45320 |
PROCTOSIGMOIDOSCOPY ABLATE
|
$XXX.XX
|
| 45321 |
PROCTOSIGMOIDOSCOPY VOLVUL
|
$XXX.XX
|
| 45327 |
PROCTOSIGMOIDOSCOPY W/STENT
|
$XXX.XX
|
| 45330 |
DIAGNOSTIC SIGMOIDOSCOPY
|
$XXX.XX
|
| 45331 |
SIGMOIDOSCOPY AND BIOPSY
|
$XXX.XX
|
| 45332 |
SIGMOIDOSCOPY W/FB REMOVAL
|
$XXX.XX
|
| 45333 |
SIGMOIDOSCOPY & POLYPECTOMY
|
$XXX.XX
|
| 45334 |
SIGMOIDOSCOPY FOR BLEEDING
|
$XXX.XX
|
| 45335 |
SIGMOIDOSCOPY W/SUBMUC INJ
|
$XXX.XX
|
| 45337 |
SIGMOIDOSCOPY & DECOMPRESS
|
$XXX.XX
|
| 45338 |
SIGMOIDOSCOPY W/TUMR REMOVE
|
$XXX.XX
|
| 45340 |
SIG W/TNDSC BALLOON DILATION
|
$XXX.XX
|
| 45341 |
SIGMOIDOSCOPY W/ULTRASOUND
|
$XXX.XX
|
| 45342 |
SIGMOIDOSCOPY W/US GUIDE BX
|
$XXX.XX
|
| 45346 |
SIGMOIDOSCOPY W/ABLATION
|
$XXX.XX
|
| 45347 |
SIGMOIDOSCOPY W/PLCMT STENT
|
$XXX.XX
|
| 45349 |
SIGMOIDOSCOPY W/RESECTION
|
$XXX.XX
|
| 45350 |
SGMDSC W/BAND LIGATION
|
$XXX.XX
|
| 45378-53 |
DIAGNOSTIC COLONOSCOPY
|
$XXX.XX
|
| 45379 |
COLONOSCOPY W/FB REMOVAL
|
$XXX.XX
|
| 45380 |
COLONOSCOPY AND BIOPSY
|
$XXX.XX
|
| 45381 |
COLONOSCOPY SUBMUCOUS NJX
|
$XXX.XX
|
| 45382 |
COLONOSCOPY W/CONTROL BLEED
|
$XXX.XX
|
| 45384 |
COLONOSCOPY W/LESION REMOVAL
|
$XXX.XX
|
| 45385 |
COLONOSCOPY W/LESION REMOVAL
|
$XXX.XX
|
| 45386 |
COLONOSCOPY W/BALLOON DILAT
|
$XXX.XX
|
| 45388 |
COLONOSCOPY W/ABLATION
|
$XXX.XX
|
| 45389 |
COLONOSCOPY W/STENT PLCMT
|
$XXX.XX
|
| 45390 |
COLONOSCOPY W/RESECTION
|
$XXX.XX
|
| 45391 |
COLONOSCOPY W/ENDOSCOPE US
|
$XXX.XX
|
| 45392 |
COLONOSCOPY W/ENDOSCOPIC FNB
|
$XXX.XX
|
| 45393 |
COLONOSCOPY W/DECOMPRESSION
|
$XXX.XX
|
| 45395 |
LAP REMOVAL OF RECTUM
|
$XXX.XX
|
| 45397 |
LAP REMOVE RECTUM W/POUCH
|
$XXX.XX
|
| 45398 |
COLONOSCOPY W/BAND LIGATION
|
$XXX.XX
|
| 45400 |
LAPAROSCOPIC PROC
|
$XXX.XX
|
| 45402 |
LAP PROCTOPEXY W/SIG RESECT
|
$XXX.XX
|
| 45500 |
REPAIR OF RECTUM
|
$XXX.XX
|
| 45505 |
REPAIR OF RECTUM
|
$XXX.XX
|
| 45520 |
TREATMENT OF RECTAL PROLAPSE
|
$XXX.XX
|
| 45540 |
CORRECT RECTAL PROLAPSE
|
$XXX.XX
|
| 45541 |
CORRECT RECTAL PROLAPSE
|
$XXX.XX
|
| 45550 |
REPAIR RECTUM/REMOVE SIGMOID
|
$XXX.XX
|
| 45560 |
REPAIR OF RECTOCELE
|
$XXX.XX
|
| 45562 |
EXPLORATION/REPAIR OF RECTUM
|
$XXX.XX
|
| 45563 |
EXPLORATION/REPAIR OF RECTUM
|
$XXX.XX
|
| 45800 |
REPAIR RECT/BLADDER FISTULA
|
$XXX.XX
|
| 45805 |
REPAIR FISTULA W/COLOSTOMY
|
$XXX.XX
|
| 45820 |
REPAIR RECTOURETHRAL FISTULA
|
$XXX.XX
|
| 45825 |
REPAIR FISTULA W/COLOSTOMY
|
$XXX.XX
|
| 45900 |
REDUCTION OF RECTAL PROLAPSE
|
$XXX.XX
|
| 45905 |
DILATION OF ANAL SPHINCTER
|
$XXX.XX
|
| 45910 |
DILATION OF RECTAL NARROWING
|
$XXX.XX
|
| 45915 |
REMOVE RECTAL OBSTRUCTION
|
$XXX.XX
|
| 45990 |
SURG DX EXAM ANORECTAL
|
$XXX.XX
|
| 46020 |
PLACEMENT OF SETON
|
$XXX.XX
|
| 46030 |
REMOVAL OF RECTAL MARKER
|
$XXX.XX
|
| 46040 |
INCISION OF RECTAL ABSCESS
|
$XXX.XX
|
| 46045 |
INCISION OF RECTAL ABSCESS
|
$XXX.XX
|
| 46050 |
INCISION OF ANAL ABSCESS
|
$XXX.XX
|
| 46060 |
INCISION OF RECTAL ABSCESS
|
$XXX.XX
|
| 46070 |
INCISION OF ANAL SEPTUM
|
$XXX.XX
|
| 46080 |
INCISION OF ANAL SPHINCTER
|
$XXX.XX
|
| 46083 |
INCISE EXTERNAL HEMORRHOID
|
$XXX.XX
|
| 46200 |
REMOVAL OF ANAL FISSURE
|
$XXX.XX
|
| 46220 |
EXCISE ANAL EXT TAG/PAPILLA
|
$XXX.XX
|
| 46221 |
LIGATION OF HEMORRHOID(S)
|
$XXX.XX
|
| 46230 |
REMOVAL OF ANAL TAGS
|
$XXX.XX
|
| 46250 |
REMOVE EXT HEM GROUPS 2+
|
$XXX.XX
|
| 46255 |
REMOVE INT/EXT HEM 1 GROUP
|
$XXX.XX
|
| 46257 |
REMOVE IN/EX HEM GRP & FISS
|
$XXX.XX
|
| 46258 |
REMOVE IN/EX HEM GRP W/FISTU
|
$XXX.XX
|
| 46260 |
REMOVE IN/EX HEM GROUPS 2+
|
$XXX.XX
|
| 46261 |
REMOVE IN/EX HEM GRPS & FISS
|
$XXX.XX
|
| 46262 |
REMOVE IN/EX HEM GRPS W/FIST
|
$XXX.XX
|
| 46270 |
REMOVE ANAL FIST SUBQ
|
$XXX.XX
|
| 46275 |
REMOVE ANAL FIST INTER
|
$XXX.XX
|
| 46280 |
REMOVE ANAL FIST COMPLEX
|
$XXX.XX
|
| 46285 |
REMOVE ANAL FIST 2 STAGE
|
$XXX.XX
|
| 46288 |
REPAIR ANAL FISTULA
|
$XXX.XX
|
| 46320 |
REMOVAL OF HEMORRHOID CLOT
|
$XXX.XX
|
| 46500 |
INJECTION INTO HEMORRHOID(S)
|
$XXX.XX
|
| 46505 |
CHEMODENERVATION ANAL MUSC
|
$XXX.XX
|
| 46600 |
DIAGNOSTIC ANOSCOPY SPX
|
$XXX.XX
|
| 46601 |
DIAGNOSTIC ANOSCOPY
|
$XXX.XX
|
| 46604 |
ANOSCOPY AND DILATION
|
$XXX.XX
|
| 46606 |
ANOSCOPY AND BIOPSY
|
$XXX.XX
|
| 46607 |
DIAGNOSTIC ANOSCOPY & BIOPSY
|
$XXX.XX
|
| 46608 |
ANOSCOPY REMOVE FOR BODY
|
$XXX.XX
|
| 46610 |
ANOSCOPY REMOVE LESION
|
$XXX.XX
|
| 46611 |
ANOSCOPY
|
$XXX.XX
|
| 46612 |
ANOSCOPY REMOVE LESIONS
|
$XXX.XX
|
| 46614 |
ANOSCOPY CONTROL BLEEDING
|
$XXX.XX
|
| 46615 |
ANOSCOPY
|
$XXX.XX
|
| 46700 |
REPAIR OF ANAL STRICTURE
|
$XXX.XX
|
| 46705 |
REPAIR OF ANAL STRICTURE
|
$XXX.XX
|
| 46706 |
REPR OF ANAL FISTULA W/GLUE
|
$XXX.XX
|
| 46707 |
REPAIR ANORECTAL FIST W/PLUG
|
$XXX.XX
|
| 46710 |
REPR PER/VAG POUCH SNGL PROC
|
$XXX.XX
|
| 46712 |
REPR PER/VAG POUCH DBL PROC
|
$XXX.XX
|
| 46715 |
REP PERF ANOPER FISTU
|
$XXX.XX
|
| 46716 |
REP PERF ANOPER/VESTIB FISTU
|
$XXX.XX
|
| 46730 |
CONSTRUCTION OF ABSENT ANUS
|
$XXX.XX
|
| 46735 |
CONSTRUCTION OF ABSENT ANUS
|
$XXX.XX
|
| 46740 |
CONSTRUCTION OF ABSENT ANUS
|
$XXX.XX
|
| 46742 |
REPAIR OF IMPERFORATED ANUS
|
$XXX.XX
|
| 46744 |
REPAIR OF CLOACAL ANOMALY
|
$XXX.XX
|
| 46746 |
REPAIR OF CLOACAL ANOMALY
|
$XXX.XX
|
| 46748 |
REPAIR OF CLOACAL ANOMALY
|
$XXX.XX
|
| 46750 |
REPAIR OF ANAL SPHINCTER
|
$XXX.XX
|
| 46751 |
REPAIR OF ANAL SPHINCTER
|
$XXX.XX
|
| 46753 |
RECONSTRUCTION OF ANUS
|
$XXX.XX
|
| 46754 |
REMOVAL OF SUTURE FROM ANUS
|
$XXX.XX
|
| 46760 |
REPAIR OF ANAL SPHINCTER
|
$XXX.XX
|
| 46761 |
REPAIR OF ANAL SPHINCTER
|
$XXX.XX
|
| 46900 |
DESTRUCTION ANAL LESION(S)
|
$XXX.XX
|
| 46910 |
DESTRUCTION ANAL LESION(S)
|
$XXX.XX
|
| 46916 |
CRYOSURGERY ANAL LESION(S)
|
$XXX.XX
|
| 46917 |
LASER SURGERY ANAL LESIONS
|
$XXX.XX
|
| 46922 |
EXCISION OF ANAL LESION(S)
|
$XXX.XX
|
| 46924 |
DESTRUCTION ANAL LESION(S)
|
$XXX.XX
|
| 46930 |
DESTROY INTERNAL HEMORRHOIDS
|
$XXX.XX
|
| 46940 |
TREATMENT OF ANAL FISSURE
|
$XXX.XX
|
| 46942 |
TREATMENT OF ANAL FISSURE
|
$XXX.XX
|
| 46945 |
INT HRHC LIG 1 HROID W/O IMG
|
$XXX.XX
|
| 46946 |
INT HRHC LIG 2+HROID W/O IMG
|
$XXX.XX
|
| 46947 |
HEMORRHOIDOPEXY BY STAPLING
|
$XXX.XX
|
| 46948 |
INT HRHC TRANAL DARTLZJ 2+
|
$XXX.XX
|
| 47000 |
NEEDLE BIOPSY OF LIVER
|
$XXX.XX
|
| 47001 |
NEEDLE BIOPSY LIVER ADD-ON
|
$XXX.XX
|
| 47010 |
OPEN DRAINAGE LIVER LESION
|
$XXX.XX
|
| 47015 |
INJECT/ASPIRATE LIVER CYST
|
$XXX.XX
|
| 47100 |
WEDGE BIOPSY OF LIVER
|
$XXX.XX
|
| 47120 |
PARTIAL REMOVAL OF LIVER
|
$XXX.XX
|
| 47122 |
EXTENSIVE REMOVAL OF LIVER
|
$XXX.XX
|
| 47125 |
PARTIAL REMOVAL OF LIVER
|
$XXX.XX
|
| 47130 |
PARTIAL REMOVAL OF LIVER
|
$XXX.XX
|
| 47135 |
TRANSPLANTATION OF LIVER
|
$XXX.XX
|
| 47140 |
PARTIAL REMOVAL DONOR LIVER
|
$XXX.XX
|
| 47141 |
PARTIAL REMOVAL DONOR LIVER
|
$XXX.XX
|
| 47142 |
PARTIAL REMOVAL DONOR LIVER
|
$XXX.XX
|
| 47146 |
PREP DONOR LIVER/VENOUS
|
$XXX.XX
|
| 47147 |
PREP DONOR LIVER/ARTERIAL
|
$XXX.XX
|
| 47300 |
SURGERY FOR LIVER LESION
|
$XXX.XX
|
| 47350 |
REPAIR LIVER WOUND
|
$XXX.XX
|
| 47360 |
REPAIR LIVER WOUND
|
$XXX.XX
|
| 47361 |
REPAIR LIVER WOUND
|
$XXX.XX
|
| 47362 |
REPAIR LIVER WOUND
|
$XXX.XX
|
| 47370 |
LAPARO ABLATE LIVER TUMOR RF
|
$XXX.XX
|
| 47371 |
LAPARO ABLATE LIVER CRYOSURG
|
$XXX.XX
|
| 47380 |
OPEN ABLATE LIVER TUMOR RF
|
$XXX.XX
|
| 47381 |
OPEN ABLATE LIVER TUMOR CRYO
|
$XXX.XX
|
| 47382 |
PERCUT ABLATE LIVER RF
|
$XXX.XX
|
| 47383 |
PERQ ABLTJ LVR CRYOABLATION
|
$XXX.XX
|
| 47400 |
INCISION OF LIVER DUCT
|
$XXX.XX
|
| 47420 |
INCISION OF BILE DUCT
|
$XXX.XX
|
| 47425 |
INCISION OF BILE DUCT
|
$XXX.XX
|
| 47460 |
INCISE BILE DUCT SPHINCTER
|
$XXX.XX
|
| 47480 |
INCISION OF GALLBLADDER
|
$XXX.XX
|
| 47490 |
INCISION OF GALLBLADDER
|
$XXX.XX
|
| 47531 |
INJECTION FOR CHOLANGIOGRAM
|
$XXX.XX
|
| 47532 |
INJECTION FOR CHOLANGIOGRAM
|
$XXX.XX
|
| 47533 |
PLMT BILIARY DRAINAGE CATH
|
$XXX.XX
|
| 47534 |
PLMT BILIARY DRAINAGE CATH
|
$XXX.XX
|
| 47535 |
CONVERSION EXT BIL DRG CATH
|
$XXX.XX
|
| 47536 |
EXCHANGE BILIARY DRG CATH
|
$XXX.XX
|
| 47537 |
REMOVAL BILIARY DRG CATH
|
$XXX.XX
|
| 47538 |
PERQ PLMT BILE DUCT STENT
|
$XXX.XX
|
| 47539 |
PERQ PLMT BILE DUCT STENT
|
$XXX.XX
|
| 47540 |
PERQ PLMT BILE DUCT STENT
|
$XXX.XX
|
| 47541 |
PLMT ACCESS BIL TREE SM BWL
|
$XXX.XX
|
| 47542 |
DILATE BILIARY DUCT/AMPULLA
|
$XXX.XX
|
| 47543 |
ENDOLUMINAL BX BILIARY TREE
|
$XXX.XX
|
| 47544 |
REMOVAL DUCT GLBLDR CALCULI
|
$XXX.XX
|
| 47550 |
BILE DUCT ENDOSCOPY ADD-ON
|
$XXX.XX
|
| 47552 |
BILIARY ENDO PERQ DX W/SPECI
|
$XXX.XX
|
| 47553 |
BILIARY ENDOSCOPY THRU SKIN
|
$XXX.XX
|
| 47554 |
BILIARY ENDOSCOPY THRU SKIN
|
$XXX.XX
|
| 47555 |
BILIARY ENDOSCOPY THRU SKIN
|
$XXX.XX
|
| 47556 |
BILIARY ENDOSCOPY THRU SKIN
|
$XXX.XX
|
| 47562 |
LAPAROSCOPIC CHOLECYSTECTOMY
|
$XXX.XX
|
| 47563 |
LAPARO CHOLECYSTECTOMY/GRAPH
|
$XXX.XX
|
| 47564 |
LAPARO CHOLECYSTECTOMY/EXPLR
|
$XXX.XX
|
| 47570 |
LAPARO CHOLECYSTOENTEROSTOMY
|
$XXX.XX
|
| 47600 |
REMOVAL OF GALLBLADDER
|
$XXX.XX
|
| 47605 |
REMOVAL OF GALLBLADDER
|
$XXX.XX
|
| 47610 |
REMOVAL OF GALLBLADDER
|
$XXX.XX
|
| 47612 |
REMOVAL OF GALLBLADDER
|
$XXX.XX
|
| 47620 |
REMOVAL OF GALLBLADDER
|
$XXX.XX
|
| 47700 |
EXPLORATION OF BILE DUCTS
|
$XXX.XX
|
| 47701 |
BILE DUCT REVISION
|
$XXX.XX
|
| 47711 |
EXCISION OF BILE DUCT TUMOR
|
$XXX.XX
|
| 47712 |
EXCISION OF BILE DUCT TUMOR
|
$XXX.XX
|
| 47715 |
EXCISION OF BILE DUCT CYST
|
$XXX.XX
|
| 47720 |
FUSE GALLBLADDER & BOWEL
|
$XXX.XX
|
| 47721 |
FUSE UPPER GI STRUCTURES
|
$XXX.XX
|
| 47740 |
FUSE GALLBLADDER & BOWEL
|
$XXX.XX
|
| 47741 |
FUSE GALLBLADDER & BOWEL
|
$XXX.XX
|
| 47760 |
FUSE BILE DUCTS AND BOWEL
|
$XXX.XX
|
| 47765 |
FUSE LIVER DUCTS & BOWEL
|
$XXX.XX
|
| 47780 |
FUSE BILE DUCTS AND BOWEL
|
$XXX.XX
|
| 47785 |
FUSE BILE DUCTS AND BOWEL
|
$XXX.XX
|
| 47800 |
RECONSTRUCTION OF BILE DUCTS
|
$XXX.XX
|
| 47801 |
PLACEMENT BILE DUCT SUPPORT
|
$XXX.XX
|
| 47802 |
FUSE LIVER DUCT & INTESTINE
|
$XXX.XX
|
| 47900 |
SUTURE BILE DUCT INJURY
|
$XXX.XX
|
| 48000 |
DRAINAGE OF ABDOMEN
|
$XXX.XX
|
| 48001 |
PLACEMENT OF DRAIN PANCREAS
|
$XXX.XX
|
| 48020 |
REMOVAL OF PANCREATIC STONE
|
$XXX.XX
|
| 48100 |
BIOPSY OF PANCREAS OPEN
|
$XXX.XX
|
| 48102 |
NEEDLE BIOPSY PANCREAS
|
$XXX.XX
|
| 48105 |
RESECT/DEBRIDE PANCREAS
|
$XXX.XX
|
| 48120 |
REMOVAL OF PANCREAS LESION
|
$XXX.XX
|
| 48140 |
PARTIAL REMOVAL OF PANCREAS
|
$XXX.XX
|
| 48145 |
PARTIAL REMOVAL OF PANCREAS
|
$XXX.XX
|
| 48146 |
PANCREATECTOMY
|
$XXX.XX
|
| 48148 |
REMOVAL OF PANCREATIC DUCT
|
$XXX.XX
|
| 48150 |
PARTIAL REMOVAL OF PANCREAS
|
$XXX.XX
|
| 48152 |
PANCREATECTOMY
|
$XXX.XX
|
| 48153 |
PANCREATECTOMY
|
$XXX.XX
|
| 48154 |
PANCREATECTOMY
|
$XXX.XX
|
| 48155 |
REMOVAL OF PANCREAS
|
$XXX.XX
|
| 48400 |
INJECTION INTRAOP ADD-ON
|
$XXX.XX
|
| 48500 |
SURGERY OF PANCREATIC CYST
|
$XXX.XX
|
| 48510 |
DRAIN PANCREATIC PSEUDOCYST
|
$XXX.XX
|
| 48520 |
FUSE PANCREAS CYST AND BOWEL
|
$XXX.XX
|
| 48540 |
FUSE PANCREAS CYST AND BOWEL
|
$XXX.XX
|
| 48545 |
PANCREATORRHAPHY
|
$XXX.XX
|
| 48547 |
DUODENAL EXCLUSION
|
$XXX.XX
|
| 48548 |
FUSE PANCREAS AND BOWEL
|
$XXX.XX
|
| 48552 |
PREP DONOR PANCREAS/VENOUS
|
$XXX.XX
|
| 48554 |
TRANSPL ALLOGRAFT PANCREAS
|
$XXX.XX
|
| 48556 |
REMOVAL ALLOGRAFT PANCREAS
|
$XXX.XX
|
| 49000 |
EXPLORATION OF ABDOMEN
|
$XXX.XX
|
| 49002 |
REOPENING OF ABDOMEN
|
$XXX.XX
|
| 49010 |
EXPLORATION BEHIND ABDOMEN
|
$XXX.XX
|
| 49013 |
PRPERTL PEL PACK HEMRRG TRMA
|
$XXX.XX
|
| 49014 |
REEXPLORATION PELVIC WOUND
|
$XXX.XX
|
| 49020 |
DRAINAGE ABDOM ABSCESS OPEN
|
$XXX.XX
|
| 49040 |
DRAIN OPEN ABDOM ABSCESS
|
$XXX.XX
|
| 49060 |
DRAIN OPEN RETROPERI ABSCESS
|
$XXX.XX
|
| 49062 |
DRAIN TO PERITONEAL CAVITY
|
$XXX.XX
|
| 49082 |
ABD PARACENTESIS
|
$XXX.XX
|
| 49083 |
ABD PARACENTESIS W/IMAGING
|
$XXX.XX
|
| 49084 |
PERITONEAL LAVAGE
|
$XXX.XX
|
| 49180 |
BIOPSY ABDOMINAL MASS
|
$XXX.XX
|
| 49185 |
SCLEROTX FLUID COLLECTION
|
$XXX.XX
|
| 49203 |
EXC ABD TUM 5 CM OR LESS
|
$XXX.XX
|
| 49204 |
EXC ABD TUM OVER 5 CM
|
$XXX.XX
|
| 49205 |
EXC ABD TUM OVER 10 CM
|
$XXX.XX
|
| 49215 |
EXCISE SACRAL SPINE TUMOR
|
$XXX.XX
|
| 49220 |
MULTIPLE SURGERY ABDOMEN
|
$XXX.XX
|
| 49250 |
EXCISION OF UMBILICUS
|
$XXX.XX
|
| 49255 |
REMOVAL OF OMENTUM
|
$XXX.XX
|
| 49320 |
DIAG LAPARO SEPARATE PROC
|
$XXX.XX
|
| 49321 |
LAPAROSCOPY BIOPSY
|
$XXX.XX
|
| 49322 |
LAPAROSCOPY ASPIRATION
|
$XXX.XX
|
| 49323 |
LAPARO DRAIN LYMPHOCELE
|
$XXX.XX
|
| 49324 |
LAP INSERT TUNNEL IP CATH
|
$XXX.XX
|
| 49325 |
LAP REVISION PERM IP CATH
|
$XXX.XX
|
| 49326 |
LAP W/OMENTOPEXY ADD-ON
|
$XXX.XX
|
| 49327 |
LAP INS DEVICE FOR RT
|
$XXX.XX
|
| 49400 |
AIR INJECTION INTO ABDOMEN
|
$XXX.XX
|
| 49402 |
REMOVE FOREIGN BODY ADBOMEN
|
$XXX.XX
|
| 49405 |
IMAGE CATH FLUID COLXN VISC
|
$XXX.XX
|
| 49406 |
IMAGE CATH FLUID PERI/RETRO
|
$XXX.XX
|
| 49407 |
IMAGE CATH FLUID TRNS/VGNL
|
$XXX.XX
|
| 49411 |
INS MARK ABD/PEL FOR RT PERQ
|
$XXX.XX
|
| 49412 |
INS DEVICE FOR RT GUIDE OPEN
|
$XXX.XX
|
| 49418 |
INSERT TUN IP CATH PERC
|
$XXX.XX
|
| 49419 |
INSERT TUN IP CATH W/PORT
|
$XXX.XX
|
| 49421 |
INS TUN IP CATH FOR DIAL OPN
|
$XXX.XX
|
| 49422 |
REMOVE TUNNELED IP CATH
|
$XXX.XX
|
| 49423 |
EXCHANGE DRAINAGE CATHETER
|
$XXX.XX
|
| 49424 |
ASSESS CYST CONTRAST INJECT
|
$XXX.XX
|
| 49425 |
INSERT ABDOMEN-VENOUS DRAIN
|
$XXX.XX
|
| 49426 |
REVISE ABDOMEN-VENOUS SHUNT
|
$XXX.XX
|
| 49427 |
INJECTION ABDOMINAL SHUNT
|
$XXX.XX
|
| 49428 |
LIGATION OF SHUNT
|
$XXX.XX
|
| 49429 |
REMOVAL OF SHUNT
|
$XXX.XX
|
| 49435 |
INSERT SUBQ EXTEN TO IP CATH
|
$XXX.XX
|
| 49436 |
EMBEDDED IP CATH EXIT-SITE
|
$XXX.XX
|
| 49440 |
PLACE GASTROSTOMY TUBE PERC
|
$XXX.XX
|
| 49441 |
PLACE DUOD/JEJ TUBE PERC
|
$XXX.XX
|
| 49442 |
PLACE CECOSTOMY TUBE PERC
|
$XXX.XX
|
| 49446 |
CHANGE G-TUBE TO G-J PERC
|
$XXX.XX
|
| 49450 |
REPLACE G/C TUBE PERC
|
$XXX.XX
|
| 49451 |
REPLACE DUOD/JEJ TUBE PERC
|
$XXX.XX
|
| 49452 |
REPLACE G-J TUBE PERC
|
$XXX.XX
|
| 49460 |
FIX G/COLON TUBE W/DEVICE
|
$XXX.XX
|
| 49465 |
FLUORO EXAM OF G/COLON TUBE
|
$XXX.XX
|
| 49491 |
RPR HERN PREEMIE REDUC
|
$XXX.XX
|
| 49492 |
RPR ING HERN PREMIE BLOCKED
|
$XXX.XX
|
| 49495 |
RPR ING HERNIA BABY REDUC
|
$XXX.XX
|
| 49496 |
RPR ING HERNIA BABY BLOCKED
|
$XXX.XX
|
| 49500 |
RPR ING HERNIA INIT REDUCE
|
$XXX.XX
|
| 49501 |
RPR ING HERNIA INIT BLOCKED
|
$XXX.XX
|
| 49505 |
PRP I/HERN INIT REDUC >5 YR
|
$XXX.XX
|
| 49507 |
PRP I/HERN INIT BLOCK >5 YR
|
$XXX.XX
|
| 49520 |
REREPAIR ING HERNIA REDUCE
|
$XXX.XX
|
| 49521 |
REREPAIR ING HERNIA BLOCKED
|
$XXX.XX
|
| 49525 |
REPAIR ING HERNIA SLIDING
|
$XXX.XX
|
| 49540 |
REPAIR LUMBAR HERNIA
|
$XXX.XX
|
| 49550 |
RPR REM HERNIA INIT REDUCE
|
$XXX.XX
|
| 49553 |
RPR FEM HERNIA INIT BLOCKED
|
$XXX.XX
|
| 49555 |
REREPAIR FEM HERNIA REDUCE
|
$XXX.XX
|
| 49557 |
REREPAIR FEM HERNIA BLOCKED
|
$XXX.XX
|
| 49560 |
RPR VENTRAL HERN INIT REDUC
|
$XXX.XX
|
| 49561 |
RPR VENTRAL HERN INIT BLOCK
|
$XXX.XX
|
| 49565 |
REREPAIR VENTRL HERN REDUCE
|
$XXX.XX
|
| 49566 |
REREPAIR VENTRL HERN BLOCK
|
$XXX.XX
|
| 49568 |
HERNIA REPAIR W/MESH
|
$XXX.XX
|
| 49570 |
RPR EPIGASTRIC HERN REDUCE
|
$XXX.XX
|
| 49572 |
RPR EPIGASTRIC HERN BLOCKED
|
$XXX.XX
|
| 49580 |
RPR UMBIL HERN REDUC < 5 YR
|
$XXX.XX
|
| 49582 |
RPR UMBIL HERN BLOCK < 5 YR
|
$XXX.XX
|
| 49585 |
RPR UMBIL HERN REDUC > 5 YR
|
$XXX.XX
|
| 49587 |
RPR UMBIL HERN BLOCK > 5 YR
|
$XXX.XX
|
| 49590 |
REPAIR SPIGELIAN HERNIA
|
$XXX.XX
|
| 49600 |
REPAIR UMBILICAL LESION
|
$XXX.XX
|
| 49605 |
REPAIR UMBILICAL LESION
|
$XXX.XX
|
| 49606 |
REPAIR UMBILICAL LESION
|
$XXX.XX
|
| 49610 |
REPAIR UMBILICAL LESION
|
$XXX.XX
|
| 49611 |
REPAIR UMBILICAL LESION
|
$XXX.XX
|
| 49650 |
LAP ING HERNIA REPAIR INIT
|
$XXX.XX
|
| 49651 |
LAP ING HERNIA REPAIR RECUR
|
$XXX.XX
|
| 49652 |
LAP VENT/ABD HERNIA REPAIR
|
$XXX.XX
|
| 49653 |
LAP VENT/ABD HERN PROC COMP
|
$XXX.XX
|
| 49654 |
LAP INC HERNIA REPAIR
|
$XXX.XX
|
| 49655 |
LAP INC HERN REPAIR COMP
|
$XXX.XX
|
| 49656 |
LAP INC HERNIA REPAIR RECUR
|
$XXX.XX
|
| 49657 |
LAP INC HERN RECUR COMP
|
$XXX.XX
|
| 49900 |
REPAIR OF ABDOMINAL WALL
|
$XXX.XX
|
| 49904 |
OMENTAL FLAP EXTRA-ABDOM
|
$XXX.XX
|
| 49905 |
OMENTAL FLAP INTRA-ABDOM
|
$XXX.XX
|
| 50010 |
EXPLORATION OF KIDNEY
|
$XXX.XX
|
| 50020 |
RENAL ABSCESS OPEN DRAIN
|
$XXX.XX
|
| 50040 |
DRAINAGE OF KIDNEY
|
$XXX.XX
|
| 50045 |
EXPLORATION OF KIDNEY
|
$XXX.XX
|
| 50060 |
REMOVAL OF KIDNEY STONE
|
$XXX.XX
|
| 50065 |
INCISION OF KIDNEY
|
$XXX.XX
|
| 50070 |
INCISION OF KIDNEY
|
$XXX.XX
|
| 50075 |
REMOVAL OF KIDNEY STONE
|
$XXX.XX
|
| 50080 |
REMOVAL OF KIDNEY STONE
|
$XXX.XX
|
| 50081 |
REMOVAL OF KIDNEY STONE
|
$XXX.XX
|
| 50100 |
REVISE KIDNEY BLOOD VESSELS
|
$XXX.XX
|
| 50120 |
EXPLORATION OF KIDNEY
|
$XXX.XX
|
| 50125 |
EXPLORE AND DRAIN KIDNEY
|
$XXX.XX
|
| 50130 |
REMOVAL OF KIDNEY STONE
|
$XXX.XX
|
| 50135 |
EXPLORATION OF KIDNEY
|
$XXX.XX
|
| 50200 |
RENAL BIOPSY PERQ
|
$XXX.XX
|
| 50205 |
RENAL BIOPSY OPEN
|
$XXX.XX
|
| 50220 |
REMOVE KIDNEY OPEN
|
$XXX.XX
|
| 50225 |
REMOVAL KIDNEY OPEN COMPLEX
|
$XXX.XX
|
| 50230 |
REMOVAL KIDNEY OPEN RADICAL
|
$XXX.XX
|
| 50234 |
REMOVAL OF KIDNEY & URETER
|
$XXX.XX
|
| 50236 |
REMOVAL OF KIDNEY & URETER
|
$XXX.XX
|
| 50240 |
PARTIAL REMOVAL OF KIDNEY
|
$XXX.XX
|
| 50250 |
CRYOABLATE RENAL MASS OPEN
|
$XXX.XX
|
| 50280 |
REMOVAL OF KIDNEY LESION
|
$XXX.XX
|
| 50290 |
REMOVAL OF KIDNEY LESION
|
$XXX.XX
|
| 50320 |
REMOVE KIDNEY LIVING DONOR
|
$XXX.XX
|
| 50327 |
PREP RENAL GRAFT/VENOUS
|
$XXX.XX
|
| 50328 |
PREP RENAL GRAFT/ARTERIAL
|
$XXX.XX
|
| 50329 |
PREP RENAL GRAFT/URETERAL
|
$XXX.XX
|
| 50340 |
REMOVAL OF KIDNEY
|
$XXX.XX
|
| 50360 |
TRANSPLANTATION OF KIDNEY
|
$XXX.XX
|
| 50365 |
TRANSPLANTATION OF KIDNEY
|
$XXX.XX
|
| 50370 |
REMOVE TRANSPLANTED KIDNEY
|
$XXX.XX
|
| 50380 |
REIMPLANTATION OF KIDNEY
|
$XXX.XX
|
| 50382 |
CHANGE URETER STENT PERCUT
|
$XXX.XX
|
| 50384 |
REMOVE URETER STENT PERCUT
|
$XXX.XX
|
| 50385 |
CHANGE STENT VIA TRANSURETH
|
$XXX.XX
|
| 50386 |
REMOVE STENT VIA TRANSURETH
|
$XXX.XX
|
| 50387 |
CHANGE NEPHROURETERAL CATH
|
$XXX.XX
|
| 50389 |
REMOVE RENAL TUBE W/FLUORO
|
$XXX.XX
|
| 50390 |
DRAINAGE OF KIDNEY LESION
|
$XXX.XX
|
| 50391 |
INSTLL RX AGNT INTO RNAL TUB
|
$XXX.XX
|
| 50396 |
MEASURE KIDNEY PRESSURE
|
$XXX.XX
|
| 50400 |
REVISION OF KIDNEY/URETER
|
$XXX.XX
|
| 50405 |
REVISION OF KIDNEY/URETER
|
$XXX.XX
|
| 50430 |
NJX PX NFROSGRM &/URTRGRM
|
$XXX.XX
|
| 50431 |
NJX PX NFROSGRM &/URTRGRM
|
$XXX.XX
|
| 50432 |
PLMT NEPHROSTOMY CATHETER
|
$XXX.XX
|
| 50433 |
PLMT NEPHROURETERAL CATHETER
|
$XXX.XX
|
| 50434 |
CONVERT NEPHROSTOMY CATHETER
|
$XXX.XX
|
| 50435 |
EXCHANGE NEPHROSTOMY CATH
|
$XXX.XX
|
| 50436 |
DILAT XST TRC NDURLGC PX
|
$XXX.XX
|
| 50437 |
DILAT XST TRC NEW ACCESS RCS
|
$XXX.XX
|
| 50500 |
REPAIR OF KIDNEY WOUND
|
$XXX.XX
|
| 50520 |
CLOSE KIDNEY-SKIN FISTULA
|
$XXX.XX
|
| 50525 |
CLOSE NEPHROVISCERAL FISTULA
|
$XXX.XX
|
| 50526 |
CLOSE NEPHROVISCERAL FISTULA
|
$XXX.XX
|
| 50540 |
REVISION OF HORSESHOE KIDNEY
|
$XXX.XX
|
| 50541 |
LAPARO ABLATE RENAL CYST
|
$XXX.XX
|
| 50542 |
LAPARO ABLATE RENAL MASS
|
$XXX.XX
|
| 50543 |
LAPARO PARTIAL NEPHRECTOMY
|
$XXX.XX
|
| 50544 |
LAPAROSCOPY PYELOPLASTY
|
$XXX.XX
|
| 50545 |
LAPARO RADICAL NEPHRECTOMY
|
$XXX.XX
|
| 50546 |
LAPAROSCOPIC NEPHRECTOMY
|
$XXX.XX
|
| 50547 |
LAPARO REMOVAL DONOR KIDNEY
|
$XXX.XX
|
| 50548 |
LAPARO REMOVE W/URETER
|
$XXX.XX
|
| 50551 |
KIDNEY ENDOSCOPY
|
$XXX.XX
|
| 50553 |
KIDNEY ENDOSCOPY
|
$XXX.XX
|
| 50555 |
KIDNEY ENDOSCOPY & BIOPSY
|
$XXX.XX
|
| 50557 |
KIDNEY ENDOSCOPY & TREATMENT
|
$XXX.XX
|
| 50561 |
KIDNEY ENDOSCOPY & TREATMENT
|
$XXX.XX
|
| 50562 |
RENAL SCOPE W/TUMOR RESECT
|
$XXX.XX
|
| 50570 |
KIDNEY ENDOSCOPY
|
$XXX.XX
|
| 50572 |
KIDNEY ENDOSCOPY
|
$XXX.XX
|
| 50574 |
KIDNEY ENDOSCOPY & BIOPSY
|
$XXX.XX
|
| 50575 |
KIDNEY ENDOSCOPY
|
$XXX.XX
|
| 50576 |
KIDNEY ENDOSCOPY & TREATMENT
|
$XXX.XX
|
| 50580 |
KIDNEY ENDOSCOPY & TREATMENT
|
$XXX.XX
|
| 50590 |
FRAGMENTING OF KIDNEY STONE
|
$XXX.XX
|
| 50592 |
PERC RF ABLATE RENAL TUMOR
|
$XXX.XX
|
| 50593 |
PERC CRYO ABLATE RENAL TUM
|
$XXX.XX
|
| 50600 |
EXPLORATION OF URETER
|
$XXX.XX
|
| 50605 |
INSERT URETERAL SUPPORT
|
$XXX.XX
|
| 50606 |
ENDOLUMINAL BX URTR RNL PLVS
|
$XXX.XX
|
| 50610 |
REMOVAL OF URETER STONE
|
$XXX.XX
|
| 50620 |
REMOVAL OF URETER STONE
|
$XXX.XX
|
| 50630 |
REMOVAL OF URETER STONE
|
$XXX.XX
|
| 50650 |
REMOVAL OF URETER
|
$XXX.XX
|
| 50660 |
REMOVAL OF URETER
|
$XXX.XX
|
| 50684 |
INJECTION FOR URETER X-RAY
|
$XXX.XX
|
| 50686 |
MEASURE URETER PRESSURE
|
$XXX.XX
|
| 50688 |
CHANGE OF URETER TUBE/STENT
|
$XXX.XX
|
| 50690 |
INJECTION FOR URETER X-RAY
|
$XXX.XX
|
| 50693 |
PLMT URETERAL STENT PRQ
|
$XXX.XX
|
| 50694 |
PLMT URETERAL STENT PRQ
|
$XXX.XX
|
| 50695 |
PLMT URETERAL STENT PRQ
|
$XXX.XX
|
| 50700 |
REVISION OF URETER
|
$XXX.XX
|
| 50705 |
URETERAL EMBOLIZATION/OCCL
|
$XXX.XX
|
| 50706 |
BALLOON DILATE URTRL STRIX
|
$XXX.XX
|
| 50715 |
RELEASE OF URETER
|
$XXX.XX
|
| 50722 |
RELEASE OF URETER
|
$XXX.XX
|
| 50725 |
RELEASE/REVISE URETER
|
$XXX.XX
|
| 50727 |
REVISE URETER
|
$XXX.XX
|
| 50728 |
REVISE URETER
|
$XXX.XX
|
| 50740 |
FUSION OF URETER & KIDNEY
|
$XXX.XX
|
| 50750 |
FUSION OF URETER & KIDNEY
|
$XXX.XX
|
| 50760 |
FUSION OF URETERS
|
$XXX.XX
|
| 50770 |
SPLICING OF URETERS
|
$XXX.XX
|
| 50780 |
REIMPLANT URETER IN BLADDER
|
$XXX.XX
|
| 50782 |
REIMPLANT URETER IN BLADDER
|
$XXX.XX
|
| 50783 |
REIMPLANT URETER IN BLADDER
|
$XXX.XX
|
| 50785 |
REIMPLANT URETER IN BLADDER
|
$XXX.XX
|
| 50800 |
IMPLANT URETER IN BOWEL
|
$XXX.XX
|
| 50810 |
FUSION OF URETER & BOWEL
|
$XXX.XX
|
| 50815 |
URINE SHUNT TO INTESTINE
|
$XXX.XX
|
| 50820 |
CONSTRUCT BOWEL BLADDER
|
$XXX.XX
|
| 50825 |
CONSTRUCT BOWEL BLADDER
|
$XXX.XX
|
| 50830 |
REVISE URINE FLOW
|
$XXX.XX
|
| 50840 |
REPLACE URETER BY BOWEL
|
$XXX.XX
|
| 50845 |
APPENDICO-VESICOSTOMY
|
$XXX.XX
|
| 50860 |
TRANSPLANT URETER TO SKIN
|
$XXX.XX
|
| 50900 |
REPAIR OF URETER
|
$XXX.XX
|
| 50920 |
CLOSURE URETER/SKIN FISTULA
|
$XXX.XX
|
| 50930 |
CLOSURE URETER/BOWEL FISTULA
|
$XXX.XX
|
| 50940 |
RELEASE OF URETER
|
$XXX.XX
|
| 50945 |
LAPAROSCOPY URETEROLITHOTOMY
|
$XXX.XX
|
| 50947 |
LAPARO NEW URETER/BLADDER
|
$XXX.XX
|
| 50948 |
LAPARO NEW URETER/BLADDER
|
$XXX.XX
|
| 50951 |
ENDOSCOPY OF URETER
|
$XXX.XX
|
| 50953 |
ENDOSCOPY OF URETER
|
$XXX.XX
|
| 50955 |
URETER ENDOSCOPY & BIOPSY
|
$XXX.XX
|
| 50957 |
URETER ENDOSCOPY & TREATMENT
|
$XXX.XX
|
| 50961 |
URETER ENDOSCOPY & TREATMENT
|
$XXX.XX
|
| 50970 |
URETER ENDOSCOPY
|
$XXX.XX
|
| 50972 |
URETER ENDOSCOPY & CATHETER
|
$XXX.XX
|
| 50974 |
URETER ENDOSCOPY & BIOPSY
|
$XXX.XX
|
| 50976 |
URETER ENDOSCOPY & TREATMENT
|
$XXX.XX
|
| 50980 |
URETER ENDOSCOPY & TREATMENT
|
$XXX.XX
|
| 51020 |
INCISE & TREAT BLADDER
|
$XXX.XX
|
| 51030 |
INCISE & TREAT BLADDER
|
$XXX.XX
|
| 51040 |
INCISE & DRAIN BLADDER
|
$XXX.XX
|
| 51045 |
INCISE BLADDER/DRAIN URETER
|
$XXX.XX
|
| 51050 |
REMOVAL OF BLADDER STONE
|
$XXX.XX
|
| 51060 |
REMOVAL OF URETER STONE
|
$XXX.XX
|
| 51065 |
REMOVE URETER CALCULUS
|
$XXX.XX
|
| 51080 |
DRAINAGE OF BLADDER ABSCESS
|
$XXX.XX
|
| 51100 |
DRAIN BLADDER BY NEEDLE
|
$XXX.XX
|
| 51101 |
DRAIN BLADDER BY TROCAR/CATH
|
$XXX.XX
|
| 51102 |
DRAIN BL W/CATH INSERTION
|
$XXX.XX
|
| 51500 |
REMOVAL OF BLADDER CYST
|
$XXX.XX
|
| 51520 |
REMOVAL OF BLADDER LESION
|
$XXX.XX
|
| 51525 |
REMOVAL OF BLADDER LESION
|
$XXX.XX
|
| 51530 |
REMOVAL OF BLADDER LESION
|
$XXX.XX
|
| 51535 |
REPAIR OF URETER LESION
|
$XXX.XX
|
| 51550 |
PARTIAL REMOVAL OF BLADDER
|
$XXX.XX
|
| 51555 |
PARTIAL REMOVAL OF BLADDER
|
$XXX.XX
|
| 51565 |
REVISE BLADDER & URETER(S)
|
$XXX.XX
|
| 51570 |
REMOVAL OF BLADDER
|
$XXX.XX
|
| 51575 |
REMOVAL OF BLADDER & NODES
|
$XXX.XX
|
| 51580 |
REMOVE BLADDER/REVISE TRACT
|
$XXX.XX
|
| 51585 |
REMOVAL OF BLADDER & NODES
|
$XXX.XX
|
| 51590 |
REMOVE BLADDER/REVISE TRACT
|
$XXX.XX
|
| 51595 |
REMOVE BLADDER/REVISE TRACT
|
$XXX.XX
|
| 51596 |
REMOVE BLADDER/CREATE POUCH
|
$XXX.XX
|
| 51597 |
REMOVAL OF PELVIC STRUCTURES
|
$XXX.XX
|
| 51600 |
INJECTION FOR BLADDER X-RAY
|
$XXX.XX
|
| 51605 |
PREPARATION FOR BLADDER XRAY
|
$XXX.XX
|
| 51610 |
INJECTION FOR BLADDER X-RAY
|
$XXX.XX
|
| 51700 |
IRRIGATION OF BLADDER
|
$XXX.XX
|
| 51701 |
INSERT BLADDER CATHETER
|
$XXX.XX
|
| 51702 |
INSERT TEMP BLADDER CATH
|
$XXX.XX
|
| 51703 |
INSERT BLADDER CATH COMPLEX
|
$XXX.XX
|
| 51705 |
CHANGE OF BLADDER TUBE
|
$XXX.XX
|
| 51710 |
CHANGE OF BLADDER TUBE
|
$XXX.XX
|
| 51715 |
ENDOSCOPIC INJECTION/IMPLANT
|
$XXX.XX
|
| 51720 |
TREATMENT OF BLADDER LESION
|
$XXX.XX
|
| 51725 |
SIMPLE CYSTOMETROGRAM
|
$XXX.XX
|
| 51725-26 |
SIMPLE CYSTOMETROGRAM
|
$XXX.XX
|
| 51725-TC |
SIMPLE CYSTOMETROGRAM
|
$XXX.XX
|
| 51726 |
COMPLEX CYSTOMETROGRAM
|
$XXX.XX
|
| 51726-26 |
COMPLEX CYSTOMETROGRAM
|
$XXX.XX
|
| 51726-TC |
COMPLEX CYSTOMETROGRAM
|
$XXX.XX
|
| 51727 |
CYSTOMETROGRAM W/UP
|
$XXX.XX
|
| 51727-26 |
CYSTOMETROGRAM W/UP
|
$XXX.XX
|
| 51727-TC |
CYSTOMETROGRAM W/UP
|
$XXX.XX
|
| 51728 |
CYSTOMETROGRAM W/VP
|
$XXX.XX
|
| 51728-26 |
CYSTOMETROGRAM W/VP
|
$XXX.XX
|
| 51728-TC |
CYSTOMETROGRAM W/VP
|
$XXX.XX
|
| 51729 |
CYSTOMETROGRAM W/VP&UP
|
$XXX.XX
|
| 51729-26 |
CYSTOMETROGRAM W/VP&UP
|
$XXX.XX
|
| 51729-TC |
CYSTOMETROGRAM W/VP&UP
|
$XXX.XX
|
| 51736 |
URINE FLOW MEASUREMENT
|
$XXX.XX
|
| 51736-26 |
URINE FLOW MEASUREMENT
|
$XXX.XX
|
| 51736-TC |
URINE FLOW MEASUREMENT
|
$XXX.XX
|
| 51741 |
ELECTRO-UROFLOWMETRY FIRST
|
$XXX.XX
|
| 51741-26 |
ELECTRO-UROFLOWMETRY FIRST
|
$XXX.XX
|
| 51741-TC |
ELECTRO-UROFLOWMETRY FIRST
|
$XXX.XX
|
| 51784 |
ANAL/URINARY MUSCLE STUDY
|
$XXX.XX
|
| 51784-26 |
ANAL/URINARY MUSCLE STUDY
|
$XXX.XX
|
| 51784-TC |
ANAL/URINARY MUSCLE STUDY
|
$XXX.XX
|
| 51785 |
ANAL/URINARY MUSCLE STUDY
|
$XXX.XX
|
| 51785-26 |
ANAL/URINARY MUSCLE STUDY
|
$XXX.XX
|
| 51785-TC |
ANAL/URINARY MUSCLE STUDY
|
$XXX.XX
|
| 51792 |
URINARY REFLEX STUDY
|
$XXX.XX
|
| 51792-26 |
URINARY REFLEX STUDY
|
$XXX.XX
|
| 51792-TC |
URINARY REFLEX STUDY
|
$XXX.XX
|
| 51797 |
INTRAABDOMINAL PRESSURE TEST
|
$XXX.XX
|
| 51797-26 |
INTRAABDOMINAL PRESSURE TEST
|
$XXX.XX
|
| 51797-TC |
INTRAABDOMINAL PRESSURE TEST
|
$XXX.XX
|
| 51798 |
US URINE CAPACITY MEASURE
|
$XXX.XX
|
| 51800 |
REVISION OF BLADDER/URETHRA
|
$XXX.XX
|
| 51820 |
REVISION OF URINARY TRACT
|
$XXX.XX
|
| 51840 |
ATTACH BLADDER/URETHRA
|
$XXX.XX
|
| 51841 |
ATTACH BLADDER/URETHRA
|
$XXX.XX
|
| 51845 |
REPAIR BLADDER NECK
|
$XXX.XX
|
| 51860 |
REPAIR OF BLADDER WOUND
|
$XXX.XX
|
| 51865 |
REPAIR OF BLADDER WOUND
|
$XXX.XX
|
| 51880 |
REPAIR OF BLADDER OPENING
|
$XXX.XX
|
| 51900 |
REPAIR BLADDER/VAGINA LESION
|
$XXX.XX
|
| 51920 |
CLOSE BLADDER-UTERUS FISTULA
|
$XXX.XX
|
| 51925 |
HYSTERECTOMY/BLADDER REPAIR
|
$XXX.XX
|
| 51940 |
CORRECTION OF BLADDER DEFECT
|
$XXX.XX
|
| 51960 |
REVISION OF BLADDER & BOWEL
|
$XXX.XX
|
| 51980 |
CONSTRUCT BLADDER OPENING
|
$XXX.XX
|
| 51990 |
LAPARO URETHRAL SUSPENSION
|
$XXX.XX
|
| 51992 |
LAPARO SLING OPERATION
|
$XXX.XX
|
| 52000 |
CYSTOSCOPY
|
$XXX.XX
|
| 52001 |
CYSTOSCOPY REMOVAL OF CLOTS
|
$XXX.XX
|
| 52005 |
CYSTOSCOPY & URETER CATHETER
|
$XXX.XX
|
| 52007 |
CYSTOSCOPY AND BIOPSY
|
$XXX.XX
|
| 52010 |
CYSTOSCOPY & DUCT CATHETER
|
$XXX.XX
|
| 52204 |
CYSTOSCOPY W/BIOPSY(S)
|
$XXX.XX
|
| 52214 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52224 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52234 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52235 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52240 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52250 |
CYSTOSCOPY AND RADIOTRACER
|
$XXX.XX
|
| 52260 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52265 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52270 |
CYSTOSCOPY & REVISE URETHRA
|
$XXX.XX
|
| 52275 |
CYSTOSCOPY & REVISE URETHRA
|
$XXX.XX
|
| 52276 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52277 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52281 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52282 |
CYSTOSCOPY IMPLANT STENT
|
$XXX.XX
|
| 52283 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52285 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52287 |
CYSTOSCOPY CHEMODENERVATION
|
$XXX.XX
|
| 52290 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52300 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52301 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52305 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52310 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52315 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52317 |
REMOVE BLADDER STONE
|
$XXX.XX
|
| 52318 |
REMOVE BLADDER STONE
|
$XXX.XX
|
| 52320 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52325 |
CYSTOSCOPY STONE REMOVAL
|
$XXX.XX
|
| 52327 |
CYSTOSCOPY INJECT MATERIAL
|
$XXX.XX
|
| 52330 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52332 |
CYSTOSCOPY AND TREATMENT
|
$XXX.XX
|
| 52334 |
CREATE PASSAGE TO KIDNEY
|
$XXX.XX
|
| 52341 |
CYSTO W/URETER STRICTURE TX
|
$XXX.XX
|
| 52342 |
CYSTO W/UP STRICTURE TX
|
$XXX.XX
|
| 52343 |
CYSTO W/RENAL STRICTURE TX
|
$XXX.XX
|
| 52344 |
CYSTO/URETERO STRICTURE TX
|
$XXX.XX
|
| 52345 |
CYSTO/URETERO W/UP STRICTURE
|
$XXX.XX
|
| 52346 |
CYSTOURETERO W/RENAL STRICT
|
$XXX.XX
|
| 52351 |
CYSTOURETERO & OR PYELOSCOPE
|
$XXX.XX
|
| 52352 |
CYSTOURETERO W/STONE REMOVE
|
$XXX.XX
|
| 52353 |
CYSTOURETERO W/LITHOTRIPSY
|
$XXX.XX
|
| 52354 |
CYSTOURETERO W/BIOPSY
|
$XXX.XX
|
| 52355 |
CYSTOURETERO W/EXCISE TUMOR
|
$XXX.XX
|
| 52356 |
CYSTO/URETERO W/LITHOTRIPSY
|
$XXX.XX
|
| 52400 |
CYSTOURETERO W/CONGEN REPR
|
$XXX.XX
|
| 52402 |
CYSTOURETHRO CUT EJACUL DUCT
|
$XXX.XX
|
| 52441 |
CYSTOURETHRO W/IMPLANT
|
$XXX.XX
|
| 52442 |
CYSTOURETHRO W/ADDL IMPLANT
|
$XXX.XX
|
| 52450 |
INCISION OF PROSTATE
|
$XXX.XX
|
| 52500 |
REVISION OF BLADDER NECK
|
$XXX.XX
|
| 52601 |
PROSTATECTOMY (TURP)
|
$XXX.XX
|
| 52630 |
REMOVE PROSTATE REGROWTH
|
$XXX.XX
|
| 52640 |
RELIEVE BLADDER CONTRACTURE
|
$XXX.XX
|
| 52647 |
LASER SURGERY OF PROSTATE
|
$XXX.XX
|
| 52648 |
LASER SURGERY OF PROSTATE
|
$XXX.XX
|
| 52649 |
PROSTATE LASER ENUCLEATION
|
$XXX.XX
|
| 52700 |
DRAINAGE OF PROSTATE ABSCESS
|
$XXX.XX
|
| 53000 |
INCISION OF URETHRA
|
$XXX.XX
|
| 53010 |
INCISION OF URETHRA
|
$XXX.XX
|
| 53020 |
INCISION OF URETHRA
|
$XXX.XX
|
| 53025 |
INCISION OF URETHRA
|
$XXX.XX
|
| 53040 |
DRAINAGE OF URETHRA ABSCESS
|
$XXX.XX
|
| 53060 |
DRAINAGE OF URETHRA ABSCESS
|
$XXX.XX
|
| 53080 |
DRAINAGE OF URINARY LEAKAGE
|
$XXX.XX
|
| 53085 |
DRAINAGE OF URINARY LEAKAGE
|
$XXX.XX
|
| 53200 |
BIOPSY OF URETHRA
|
$XXX.XX
|
| 53210 |
REMOVAL OF URETHRA
|
$XXX.XX
|
| 53215 |
REMOVAL OF URETHRA
|
$XXX.XX
|
| 53220 |
TREATMENT OF URETHRA LESION
|
$XXX.XX
|
| 53230 |
REMOVAL OF URETHRA LESION
|
$XXX.XX
|
| 53235 |
REMOVAL OF URETHRA LESION
|
$XXX.XX
|
| 53240 |
SURGERY FOR URETHRA POUCH
|
$XXX.XX
|
| 53250 |
REMOVAL OF URETHRA GLAND
|
$XXX.XX
|
| 53260 |
TREATMENT OF URETHRA LESION
|
$XXX.XX
|
| 53265 |
TREATMENT OF URETHRA LESION
|
$XXX.XX
|
| 53270 |
REMOVAL OF URETHRA GLAND
|
$XXX.XX
|
| 53275 |
REPAIR OF URETHRA DEFECT
|
$XXX.XX
|
| 53400 |
REVISE URETHRA STAGE 1
|
$XXX.XX
|
| 53405 |
REVISE URETHRA STAGE 2
|
$XXX.XX
|
| 53410 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 53415 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 53420 |
RECONSTRUCT URETHRA STAGE 1
|
$XXX.XX
|
| 53425 |
RECONSTRUCT URETHRA STAGE 2
|
$XXX.XX
|
| 53430 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 53431 |
RECONSTRUCT URETHRA/BLADDER
|
$XXX.XX
|
| 53440 |
MALE SLING PROCEDURE
|
$XXX.XX
|
| 53442 |
REMOVE/REVISE MALE SLING
|
$XXX.XX
|
| 53444 |
INSERT TANDEM CUFF
|
$XXX.XX
|
| 53445 |
INSERT URO/VES NCK SPHINCTER
|
$XXX.XX
|
| 53446 |
REMOVE URO SPHINCTER
|
$XXX.XX
|
| 53447 |
REMOVE/REPLACE UR SPHINCTER
|
$XXX.XX
|
| 53448 |
REMOV/REPLC UR SPHINCTR COMP
|
$XXX.XX
|
| 53449 |
REPAIR URO SPHINCTER
|
$XXX.XX
|
| 53450 |
REVISION OF URETHRA
|
$XXX.XX
|
| 53460 |
REVISION OF URETHRA
|
$XXX.XX
|
| 53500 |
URETHRLYS TRANSVAG W/ SCOPE
|
$XXX.XX
|
| 53502 |
REPAIR OF URETHRA INJURY
|
$XXX.XX
|
| 53505 |
REPAIR OF URETHRA INJURY
|
$XXX.XX
|
| 53510 |
REPAIR OF URETHRA INJURY
|
$XXX.XX
|
| 53515 |
REPAIR OF URETHRA INJURY
|
$XXX.XX
|
| 53520 |
REPAIR OF URETHRA DEFECT
|
$XXX.XX
|
| 53600 |
DILATE URETHRA STRICTURE
|
$XXX.XX
|
| 53601 |
DILATE URETHRA STRICTURE
|
$XXX.XX
|
| 53605 |
DILATE URETHRA STRICTURE
|
$XXX.XX
|
| 53620 |
DILATE URETHRA STRICTURE
|
$XXX.XX
|
| 53621 |
DILATE URETHRA STRICTURE
|
$XXX.XX
|
| 53660 |
DILATION OF URETHRA
|
$XXX.XX
|
| 53661 |
DILATION OF URETHRA
|
$XXX.XX
|
| 53665 |
DILATION OF URETHRA
|
$XXX.XX
|
| 53850 |
PROSTATIC MICROWAVE THERMOTX
|
$XXX.XX
|
| 53852 |
PROSTATIC RF THERMOTX
|
$XXX.XX
|
| 53854 |
TRURL DSTRJ PRST8 TISS RF WV
|
$XXX.XX
|
| 53855 |
INSERT PROST URETHRAL STENT
|
$XXX.XX
|
| 53860 |
TRANSURETHRAL RF TREATMENT
|
$XXX.XX
|
| 54000 |
SLITTING OF PREPUCE
|
$XXX.XX
|
| 54001 |
SLITTING OF PREPUCE
|
$XXX.XX
|
| 54015 |
DRAIN PENIS LESION
|
$XXX.XX
|
| 54050 |
DESTRUCTION PENIS LESION(S)
|
$XXX.XX
|
| 54055 |
DESTRUCTION PENIS LESION(S)
|
$XXX.XX
|
| 54056 |
CRYOSURGERY PENIS LESION(S)
|
$XXX.XX
|
| 54057 |
LASER SURG PENIS LESION(S)
|
$XXX.XX
|
| 54060 |
EXCISION OF PENIS LESION(S)
|
$XXX.XX
|
| 54065 |
DESTRUCTION PENIS LESION(S)
|
$XXX.XX
|
| 54100 |
BIOPSY OF PENIS
|
$XXX.XX
|
| 54105 |
BIOPSY OF PENIS
|
$XXX.XX
|
| 54110 |
TREATMENT OF PENIS LESION
|
$XXX.XX
|
| 54111 |
TREAT PENIS LESION GRAFT
|
$XXX.XX
|
| 54112 |
TREAT PENIS LESION GRAFT
|
$XXX.XX
|
| 54115 |
TREATMENT OF PENIS LESION
|
$XXX.XX
|
| 54120 |
PARTIAL REMOVAL OF PENIS
|
$XXX.XX
|
| 54125 |
REMOVAL OF PENIS
|
$XXX.XX
|
| 54130 |
REMOVE PENIS & NODES
|
$XXX.XX
|
| 54135 |
REMOVE PENIS & NODES
|
$XXX.XX
|
| 54150 |
CIRCUMCISION W/REGIONL BLOCK
|
$XXX.XX
|
| 54160 |
CIRCUMCISION NEONATE
|
$XXX.XX
|
| 54161 |
CIRCUM 28 DAYS OR OLDER
|
$XXX.XX
|
| 54162 |
LYSIS PENIL CIRCUMIC LESION
|
$XXX.XX
|
| 54163 |
REPAIR OF CIRCUMCISION
|
$XXX.XX
|
| 54164 |
FRENULOTOMY OF PENIS
|
$XXX.XX
|
| 54200 |
TREATMENT OF PENIS LESION
|
$XXX.XX
|
| 54205 |
TREATMENT OF PENIS LESION
|
$XXX.XX
|
| 54220 |
TREATMENT OF PENIS LESION
|
$XXX.XX
|
| 54230 |
PREPARE PENIS STUDY
|
$XXX.XX
|
| 54231 |
DYNAMIC CAVERNOSOMETRY
|
$XXX.XX
|
| 54235 |
PENILE INJECTION
|
$XXX.XX
|
| 54240 |
PENIS STUDY
|
$XXX.XX
|
| 54240-26 |
PENIS STUDY
|
$XXX.XX
|
| 54240-TC |
PENIS STUDY
|
$XXX.XX
|
| 54250 |
PENIS STUDY
|
$XXX.XX
|
| 54250-26 |
PENIS STUDY
|
$XXX.XX
|
| 54250-TC |
PENIS STUDY
|
$XXX.XX
|
| 54300 |
REVISION OF PENIS
|
$XXX.XX
|
| 54304 |
REVISION OF PENIS
|
$XXX.XX
|
| 54308 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 54312 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 54316 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 54318 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 54322 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 54324 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 54326 |
RECONSTRUCTION OF URETHRA
|
$XXX.XX
|
| 54328 |
REVISE PENIS/URETHRA
|
$XXX.XX
|
| 54332 |
REVISE PENIS/URETHRA
|
$XXX.XX
|
| 54336 |
REVISE PENIS/URETHRA
|
$XXX.XX
|
| 54340 |
SECONDARY URETHRAL SURGERY
|
$XXX.XX
|
| 54344 |
SECONDARY URETHRAL SURGERY
|
$XXX.XX
|
| 54348 |
SECONDARY URETHRAL SURGERY
|
$XXX.XX
|
| 54352 |
RECONSTRUCT URETHRA/PENIS
|
$XXX.XX
|
| 54360 |
PENIS PLASTIC SURGERY
|
$XXX.XX
|
| 54380 |
REPAIR PENIS
|
$XXX.XX
|
| 54385 |
REPAIR PENIS
|
$XXX.XX
|
| 54390 |
REPAIR PENIS AND BLADDER
|
$XXX.XX
|
| 54400 |
INSERT SEMI-RIGID PROSTHESIS
|
$XXX.XX
|
| 54401 |
INSERT SELF-CONTD PROSTHESIS
|
$XXX.XX
|
| 54405 |
INSERT MULTI-COMP PENIS PROS
|
$XXX.XX
|
| 54406 |
REMOVE MUTI-COMP PENIS PROS
|
$XXX.XX
|
| 54408 |
REPAIR MULTI-COMP PENIS PROS
|
$XXX.XX
|
| 54410 |
REMOVE/REPLACE PENIS PROSTH
|
$XXX.XX
|
| 54411 |
REMOV/REPLC PENIS PROS COMP
|
$XXX.XX
|
| 54415 |
REMOVE SELF-CONTD PENIS PROS
|
$XXX.XX
|
| 54416 |
REMV/REPL PENIS CONTAIN PROS
|
$XXX.XX
|
| 54417 |
REMV/REPLC PENIS PROS COMPL
|
$XXX.XX
|
| 54420 |
REVISION OF PENIS
|
$XXX.XX
|
| 54430 |
REVISION OF PENIS
|
$XXX.XX
|
| 54435 |
REVISION OF PENIS
|
$XXX.XX
|
| 54437 |
REPAIR CORPOREAL TEAR
|
$XXX.XX
|
| 54438 |
REPLANTATION OF PENIS
|
$XXX.XX
|
| 54450 |
PREPUTIAL STRETCHING
|
$XXX.XX
|
| 54500 |
BIOPSY OF TESTIS
|
$XXX.XX
|
| 54505 |
BIOPSY OF TESTIS
|
$XXX.XX
|
| 54512 |
EXCISE LESION TESTIS
|
$XXX.XX
|
| 54520 |
REMOVAL OF TESTIS
|
$XXX.XX
|
| 54522 |
ORCHIECTOMY PARTIAL
|
$XXX.XX
|
| 54530 |
REMOVAL OF TESTIS
|
$XXX.XX
|
| 54535 |
EXTENSIVE TESTIS SURGERY
|
$XXX.XX
|
| 54550 |
EXPLORATION FOR TESTIS
|
$XXX.XX
|
| 54560 |
EXPLORATION FOR TESTIS
|
$XXX.XX
|
| 54600 |
REDUCE TESTIS TORSION
|
$XXX.XX
|
| 54620 |
SUSPENSION OF TESTIS
|
$XXX.XX
|
| 54640 |
ORCHIOPEXY INGUN/SCROT APPR
|
$XXX.XX
|
| 54650 |
ORCHIOPEXY (FOWLER-STEPHENS)
|
$XXX.XX
|
| 54660 |
REVISION OF TESTIS
|
$XXX.XX
|
| 54670 |
REPAIR TESTIS INJURY
|
$XXX.XX
|
| 54680 |
RELOCATION OF TESTIS(ES)
|
$XXX.XX
|
| 54690 |
LAPAROSCOPY ORCHIECTOMY
|
$XXX.XX
|
| 54692 |
LAPAROSCOPY ORCHIOPEXY
|
$XXX.XX
|
| 54700 |
DRAINAGE OF SCROTUM
|
$XXX.XX
|
| 54800 |
BIOPSY OF EPIDIDYMIS
|
$XXX.XX
|
| 54830 |
REMOVE EPIDIDYMIS LESION
|
$XXX.XX
|
| 54840 |
REMOVE EPIDIDYMIS LESION
|
$XXX.XX
|
| 54860 |
REMOVAL OF EPIDIDYMIS
|
$XXX.XX
|
| 54861 |
REMOVAL OF EPIDIDYMIS
|
$XXX.XX
|
| 54865 |
EXPLORE EPIDIDYMIS
|
$XXX.XX
|
| 54900 |
FUSION OF SPERMATIC DUCTS
|
$XXX.XX
|
| 54901 |
FUSION OF SPERMATIC DUCTS
|
$XXX.XX
|
| 55000 |
DRAINAGE OF HYDROCELE
|
$XXX.XX
|
| 55040 |
REMOVAL OF HYDROCELE
|
$XXX.XX
|
| 55041 |
REMOVAL OF HYDROCELES
|
$XXX.XX
|
| 55060 |
REPAIR OF HYDROCELE
|
$XXX.XX
|
| 55100 |
DRAINAGE OF SCROTUM ABSCESS
|
$XXX.XX
|
| 55110 |
EXPLORE SCROTUM
|
$XXX.XX
|
| 55120 |
REMOVAL OF SCROTUM LESION
|
$XXX.XX
|
| 55150 |
REMOVAL OF SCROTUM
|
$XXX.XX
|
| 55175 |
REVISION OF SCROTUM
|
$XXX.XX
|
| 55180 |
REVISION OF SCROTUM
|
$XXX.XX
|
| 55200 |
INCISION OF SPERM DUCT
|
$XXX.XX
|
| 55250 |
REMOVAL OF SPERM DUCT(S)
|
$XXX.XX
|
| 55300 |
PREPARE SPERM DUCT X-RAY
|
$XXX.XX
|
| 55400 |
REPAIR OF SPERM DUCT
|
$XXX.XX
|
| 55500 |
REMOVAL OF HYDROCELE
|
$XXX.XX
|
| 55520 |
REMOVAL OF SPERM CORD LESION
|
$XXX.XX
|
| 55530 |
REVISE SPERMATIC CORD VEINS
|
$XXX.XX
|
| 55535 |
REVISE SPERMATIC CORD VEINS
|
$XXX.XX
|
| 55540 |
REVISE HERNIA & SPERM VEINS
|
$XXX.XX
|
| 55550 |
LAPARO LIGATE SPERMATIC VEIN
|
$XXX.XX
|
| 55600 |
INCISE SPERM DUCT POUCH
|
$XXX.XX
|
| 55605 |
INCISE SPERM DUCT POUCH
|
$XXX.XX
|
| 55650 |
REMOVE SPERM DUCT POUCH
|
$XXX.XX
|
| 55680 |
REMOVE SPERM POUCH LESION
|
$XXX.XX
|
| 55700 |
BIOPSY OF PROSTATE
|
$XXX.XX
|
| 55705 |
BIOPSY OF PROSTATE
|
$XXX.XX
|
| 55706 |
PROSTATE SATURATION SAMPLING
|
$XXX.XX
|
| 55720 |
DRAINAGE OF PROSTATE ABSCESS
|
$XXX.XX
|
| 55725 |
DRAINAGE OF PROSTATE ABSCESS
|
$XXX.XX
|
| 55801 |
REMOVAL OF PROSTATE
|
$XXX.XX
|
| 55810 |
EXTENSIVE PROSTATE SURGERY
|
$XXX.XX
|
| 55812 |
EXTENSIVE PROSTATE SURGERY
|
$XXX.XX
|
| 55815 |
EXTENSIVE PROSTATE SURGERY
|
$XXX.XX
|
| 55821 |
REMOVAL OF PROSTATE
|
$XXX.XX
|
| 55831 |
REMOVAL OF PROSTATE
|
$XXX.XX
|
| 55840 |
EXTENSIVE PROSTATE SURGERY
|
$XXX.XX
|
| 55842 |
EXTENSIVE PROSTATE SURGERY
|
$XXX.XX
|
| 55845 |
EXTENSIVE PROSTATE SURGERY
|
$XXX.XX
|
| 55860 |
SURGICAL EXPOSURE PROSTATE
|
$XXX.XX
|
| 55862 |
EXTENSIVE PROSTATE SURGERY
|
$XXX.XX
|
| 55865 |
EXTENSIVE PROSTATE SURGERY
|
$XXX.XX
|
| 55866 |
LAPARO RADICAL PROSTATECTOMY
|
$XXX.XX
|
| 55870 |
ELECTROEJACULATION
|
$XXX.XX
|
| 55873 |
CRYOABLATE PROSTATE
|
$XXX.XX
|
| 55874 |
TPRNL PLMT BIODEGRDABL MATRL
|
$XXX.XX
|
| 55875 |
TRANSPERI NEEDLE PLACE PROS
|
$XXX.XX
|
| 55876 |
PLACE RT DEVICE/MARKER PROS
|
$XXX.XX
|
| 55920 |
PLACE NEEDLES PELVIC FOR RT
|
$XXX.XX
|
| 56405 |
I & D OF VULVA/PERINEUM
|
$XXX.XX
|
| 56420 |
DRAINAGE OF GLAND ABSCESS
|
$XXX.XX
|
| 56440 |
SURGERY FOR VULVA LESION
|
$XXX.XX
|
| 56441 |
LYSIS OF LABIAL LESION(S)
|
$XXX.XX
|
| 56442 |
HYMENOTOMY
|
$XXX.XX
|
| 56501 |
DESTROY VULVA LESIONS SIM
|
$XXX.XX
|
| 56515 |
DESTROY VULVA LESION/S COMPL
|
$XXX.XX
|
| 56605 |
BIOPSY OF VULVA/PERINEUM
|
$XXX.XX
|
| 56606 |
BIOPSY OF VULVA/PERINEUM
|
$XXX.XX
|
| 56620 |
PARTIAL REMOVAL OF VULVA
|
$XXX.XX
|
| 56625 |
COMPLETE REMOVAL OF VULVA
|
$XXX.XX
|
| 56630 |
EXTENSIVE VULVA SURGERY
|
$XXX.XX
|
| 56631 |
EXTENSIVE VULVA SURGERY
|
$XXX.XX
|
| 56632 |
EXTENSIVE VULVA SURGERY
|
$XXX.XX
|
| 56633 |
EXTENSIVE VULVA SURGERY
|
$XXX.XX
|
| 56634 |
EXTENSIVE VULVA SURGERY
|
$XXX.XX
|
| 56637 |
EXTENSIVE VULVA SURGERY
|
$XXX.XX
|
| 56640 |
EXTENSIVE VULVA SURGERY
|
$XXX.XX
|
| 56700 |
PARTIAL REMOVAL OF HYMEN
|
$XXX.XX
|
| 56740 |
REMOVE VAGINA GLAND LESION
|
$XXX.XX
|
| 56800 |
REPAIR OF VAGINA
|
$XXX.XX
|
| 56805 |
REPAIR CLITORIS
|
$XXX.XX
|
| 56810 |
REPAIR OF PERINEUM
|
$XXX.XX
|
| 56820 |
EXAM OF VULVA W/SCOPE
|
$XXX.XX
|
| 56821 |
EXAM/BIOPSY OF VULVA W/SCOPE
|
$XXX.XX
|
| 57000 |
EXPLORATION OF VAGINA
|
$XXX.XX
|
| 57010 |
DRAINAGE OF PELVIC ABSCESS
|
$XXX.XX
|
| 57020 |
DRAINAGE OF PELVIC FLUID
|
$XXX.XX
|
| 57022 |
I & D VAGINAL HEMATOMA PP
|
$XXX.XX
|
| 57023 |
I & D VAG HEMATOMA NON-OB
|
$XXX.XX
|
| 57061 |
DESTROY VAG LESIONS SIMPLE
|
$XXX.XX
|
| 57065 |
DESTROY VAG LESIONS COMPLEX
|
$XXX.XX
|
| 57100 |
BIOPSY OF VAGINA
|
$XXX.XX
|
| 57105 |
BIOPSY OF VAGINA
|
$XXX.XX
|
| 57106 |
REMOVE VAGINA WALL PARTIAL
|
$XXX.XX
|
| 57107 |
REMOVE VAGINA TISSUE PART
|
$XXX.XX
|
| 57109 |
VAGINECTOMY PARTIAL W/NODES
|
$XXX.XX
|
| 57110 |
REMOVE VAGINA WALL COMPLETE
|
$XXX.XX
|
| 57111 |
REMOVE VAGINA TISSUE COMPL
|
$XXX.XX
|
| 57112 |
VAGINECTOMY W/NODES COMPL
|
$XXX.XX
|
| 57120 |
CLOSURE OF VAGINA
|
$XXX.XX
|
| 57130 |
REMOVE VAGINA LESION
|
$XXX.XX
|
| 57135 |
REMOVE VAGINA LESION
|
$XXX.XX
|
| 57150 |
TREAT VAGINA INFECTION
|
$XXX.XX
|
| 57155 |
INSERT UTERI TANDEM/OVOIDS
|
$XXX.XX
|
| 57156 |
INS VAG BRACHYTX DEVICE
|
$XXX.XX
|
| 57160 |
INSERT PESSARY/OTHER DEVICE
|
$XXX.XX
|
| 57170 |
FITTING OF DIAPHRAGM/CAP
|
$XXX.XX
|
| 57180 |
TREAT VAGINAL BLEEDING
|
$XXX.XX
|
| 57200 |
REPAIR OF VAGINA
|
$XXX.XX
|
| 57210 |
REPAIR VAGINA/PERINEUM
|
$XXX.XX
|
| 57220 |
REVISION OF URETHRA
|
$XXX.XX
|
| 57230 |
REPAIR OF URETHRAL LESION
|
$XXX.XX
|
| 57240 |
ANTERIOR COLPORRHAPHY
|
$XXX.XX
|
| 57250 |
REPAIR RECTUM & VAGINA
|
$XXX.XX
|
| 57260 |
CMBN ANT PST COLPRHY
|
$XXX.XX
|
| 57265 |
CMBN AP COLPRHY W/NTRCL RPR
|
$XXX.XX
|
| 57267 |
INSERT MESH/PELVIC FLR ADDON
|
$XXX.XX
|
| 57268 |
REPAIR OF BOWEL BULGE
|
$XXX.XX
|
| 57270 |
REPAIR OF BOWEL POUCH
|
$XXX.XX
|
| 57280 |
SUSPENSION OF VAGINA
|
$XXX.XX
|
| 57282 |
COLPOPEXY EXTRAPERITONEAL
|
$XXX.XX
|
| 57283 |
COLPOPEXY INTRAPERITONEAL
|
$XXX.XX
|
| 57284 |
REPAIR PARAVAG DEFECT OPEN
|
$XXX.XX
|
| 57285 |
REPAIR PARAVAG DEFECT VAG
|
$XXX.XX
|
| 57287 |
REVISE/REMOVE SLING REPAIR
|
$XXX.XX
|
| 57288 |
REPAIR BLADDER DEFECT
|
$XXX.XX
|
| 57289 |
REPAIR BLADDER & VAGINA
|
$XXX.XX
|
| 57291 |
CONSTRUCTION OF VAGINA
|
$XXX.XX
|
| 57292 |
CONSTRUCT VAGINA WITH GRAFT
|
$XXX.XX
|
| 57295 |
REVISE VAG GRAFT VIA VAGINA
|
$XXX.XX
|
| 57296 |
REVISE VAG GRAFT OPEN ABD
|
$XXX.XX
|
| 57300 |
REPAIR RECTUM-VAGINA FISTULA
|
$XXX.XX
|
| 57305 |
REPAIR RECTUM-VAGINA FISTULA
|
$XXX.XX
|
| 57307 |
FISTULA REPAIR & COLOSTOMY
|
$XXX.XX
|
| 57308 |
FISTULA REPAIR TRANSPERINE
|
$XXX.XX
|
| 57310 |
REPAIR URETHROVAGINAL LESION
|
$XXX.XX
|
| 57311 |
REPAIR URETHROVAGINAL LESION
|
$XXX.XX
|
| 57320 |
REPAIR BLADDER-VAGINA LESION
|
$XXX.XX
|
| 57330 |
REPAIR BLADDER-VAGINA LESION
|
$XXX.XX
|
| 57335 |
REPAIR VAGINA
|
$XXX.XX
|
| 57400 |
DILATION OF VAGINA
|
$XXX.XX
|
| 57410 |
PELVIC EXAMINATION
|
$XXX.XX
|
| 57415 |
REMOVE VAGINAL FOREIGN BODY
|
$XXX.XX
|
| 57420 |
EXAM OF VAGINA W/SCOPE
|
$XXX.XX
|
| 57421 |
EXAM/BIOPSY OF VAG W/SCOPE
|
$XXX.XX
|
| 57423 |
REPAIR PARAVAG DEFECT LAP
|
$XXX.XX
|
| 57425 |
LAPAROSCOPY SURG COLPOPEXY
|
$XXX.XX
|
| 57426 |
REVISE PROSTH VAG GRAFT LAP
|
$XXX.XX
|
| 57452 |
EXAM OF CERVIX W/SCOPE
|
$XXX.XX
|
| 57454 |
BX/CURETT OF CERVIX W/SCOPE
|
$XXX.XX
|
| 57455 |
BIOPSY OF CERVIX W/SCOPE
|
$XXX.XX
|
| 57456 |
ENDOCERV CURETTAGE W/SCOPE
|
$XXX.XX
|
| 57460 |
BX OF CERVIX W/SCOPE LEEP
|
$XXX.XX
|
| 57461 |
CONZ OF CERVIX W/SCOPE LEEP
|
$XXX.XX
|
| 57500 |
BIOPSY OF CERVIX
|
$XXX.XX
|
| 57505 |
ENDOCERVICAL CURETTAGE
|
$XXX.XX
|
| 57510 |
CAUTERIZATION OF CERVIX
|
$XXX.XX
|
| 57511 |
CRYOCAUTERY OF CERVIX
|
$XXX.XX
|
| 57513 |
LASER SURGERY OF CERVIX
|
$XXX.XX
|
| 57520 |
CONIZATION OF CERVIX
|
$XXX.XX
|
| 57522 |
CONIZATION OF CERVIX
|
$XXX.XX
|
| 57530 |
REMOVAL OF CERVIX
|
$XXX.XX
|
| 57531 |
REMOVAL OF CERVIX RADICAL
|
$XXX.XX
|
| 57540 |
REMOVAL OF RESIDUAL CERVIX
|
$XXX.XX
|
| 57545 |
REMOVE CERVIX/REPAIR PELVIS
|
$XXX.XX
|
| 57550 |
REMOVAL OF RESIDUAL CERVIX
|
$XXX.XX
|
| 57555 |
REMOVE CERVIX/REPAIR VAGINA
|
$XXX.XX
|
| 57556 |
REMOVE CERVIX REPAIR BOWEL
|
$XXX.XX
|
| 57558 |
D&C OF CERVICAL STUMP
|
$XXX.XX
|
| 57700 |
REVISION OF CERVIX
|
$XXX.XX
|
| 57720 |
REVISION OF CERVIX
|
$XXX.XX
|
| 57800 |
DILATION OF CERVICAL CANAL
|
$XXX.XX
|
| 58100 |
BIOPSY OF UTERUS LINING
|
$XXX.XX
|
| 58110 |
BX DONE W/COLPOSCOPY ADD-ON
|
$XXX.XX
|
| 58120 |
DILATION AND CURETTAGE
|
$XXX.XX
|
| 58140 |
MYOMECTOMY ABDOM METHOD
|
$XXX.XX
|
| 58145 |
MYOMECTOMY VAG METHOD
|
$XXX.XX
|
| 58146 |
MYOMECTOMY ABDOM COMPLEX
|
$XXX.XX
|
| 58150 |
TOTAL HYSTERECTOMY
|
$XXX.XX
|
| 58152 |
TOTAL HYSTERECTOMY
|
$XXX.XX
|
| 58180 |
PARTIAL HYSTERECTOMY
|
$XXX.XX
|
| 58200 |
EXTENSIVE HYSTERECTOMY
|
$XXX.XX
|
| 58210 |
EXTENSIVE HYSTERECTOMY
|
$XXX.XX
|
| 58240 |
REMOVAL OF PELVIS CONTENTS
|
$XXX.XX
|
| 58260 |
VAGINAL HYSTERECTOMY
|
$XXX.XX
|
| 58262 |
VAG HYST INCLUDING T/O
|
$XXX.XX
|
| 58263 |
VAG HYST W/T/O & VAG REPAIR
|
$XXX.XX
|
| 58267 |
VAG HYST W/URINARY REPAIR
|
$XXX.XX
|
| 58270 |
VAG HYST W/ENTEROCELE REPAIR
|
$XXX.XX
|
| 58275 |
HYSTERECTOMY/REVISE VAGINA
|
$XXX.XX
|
| 58280 |
HYSTERECTOMY/REVISE VAGINA
|
$XXX.XX
|
| 58285 |
EXTENSIVE HYSTERECTOMY
|
$XXX.XX
|
| 58290 |
VAG HYST COMPLEX
|
$XXX.XX
|
| 58291 |
VAG HYST INCL T/O COMPLEX
|
$XXX.XX
|
| 58292 |
VAG HYST T/O & REPAIR COMPL
|
$XXX.XX
|
| 58293 |
VAG HYST W/URO REPAIR COMPL
|
$XXX.XX
|
| 58294 |
VAG HYST W/ENTEROCELE COMPL
|
$XXX.XX
|
| 58301 |
REMOVE INTRAUTERINE DEVICE
|
$XXX.XX
|
| 58321 |
ARTIFICIAL INSEMINATION
|
$XXX.XX
|
| 58322 |
ARTIFICIAL INSEMINATION
|
$XXX.XX
|
| 58323 |
SPERM WASHING
|
$XXX.XX
|
| 58340 |
CATHETER FOR HYSTEROGRAPHY
|
$XXX.XX
|
| 58345 |
REOPEN FALLOPIAN TUBE
|
$XXX.XX
|
| 58346 |
INSERT HEYMAN UTERI CAPSULE
|
$XXX.XX
|
| 58350 |
REOPEN FALLOPIAN TUBE
|
$XXX.XX
|
| 58353 |
ENDOMETR ABLATE THERMAL
|
$XXX.XX
|
| 58356 |
ENDOMETRIAL CRYOABLATION
|
$XXX.XX
|
| 58400 |
SUSPENSION OF UTERUS
|
$XXX.XX
|
| 58410 |
SUSPENSION OF UTERUS
|
$XXX.XX
|
| 58520 |
REPAIR OF RUPTURED UTERUS
|
$XXX.XX
|
| 58540 |
REVISION OF UTERUS
|
$XXX.XX
|
| 58541 |
LSH UTERUS 250 G OR LESS
|
$XXX.XX
|
| 58542 |
LSH W/T/O UT 250 G OR LESS
|
$XXX.XX
|
| 58543 |
LSH UTERUS ABOVE 250 G
|
$XXX.XX
|
| 58544 |
LSH W/T/O UTERUS ABOVE 250 G
|
$XXX.XX
|
| 58545 |
LAPAROSCOPIC MYOMECTOMY
|
$XXX.XX
|
| 58546 |
LAPARO-MYOMECTOMY COMPLEX
|
$XXX.XX
|
| 58548 |
LAP RADICAL HYST
|
$XXX.XX
|
| 58550 |
LAPARO-ASST VAG HYSTERECTOMY
|
$XXX.XX
|
| 58552 |
LAPARO-VAG HYST INCL T/O
|
$XXX.XX
|
| 58553 |
LAPARO-VAG HYST COMPLEX
|
$XXX.XX
|
| 58554 |
LAPARO-VAG HYST W/T/O COMPL
|
$XXX.XX
|
| 58555 |
HYSTEROSCOPY DX SEP PROC
|
$XXX.XX
|
| 58558 |
HYSTEROSCOPY BIOPSY
|
$XXX.XX
|
| 58559 |
HYSTEROSCOPY LYSIS
|
$XXX.XX
|
| 58560 |
HYSTEROSCOPY RESECT SEPTUM
|
$XXX.XX
|
| 58561 |
HYSTEROSCOPY REMOVE MYOMA
|
$XXX.XX
|
| 58562 |
HYSTEROSCOPY REMOVE FB
|
$XXX.XX
|
| 58563 |
HYSTEROSCOPY ABLATION
|
$XXX.XX
|
| 58565 |
HYSTEROSCOPY STERILIZATION
|
$XXX.XX
|
| 58570 |
TLH UTERUS 250 G OR LESS
|
$XXX.XX
|
| 58571 |
TLH W/T/O 250 G OR LESS
|
$XXX.XX
|
| 58572 |
TLH UTERUS OVER 250 G
|
$XXX.XX
|
| 58573 |
TLH W/T/O UTERUS OVER 250 G
|
$XXX.XX
|
| 58575 |
LAPS TOT HYST RESJ MAL
|
$XXX.XX
|
| 58600 |
DIVISION OF FALLOPIAN TUBE
|
$XXX.XX
|
| 58605 |
DIVISION OF FALLOPIAN TUBE
|
$XXX.XX
|
| 58611 |
LIGATE OVIDUCT(S) ADD-ON
|
$XXX.XX
|
| 58615 |
OCCLUDE FALLOPIAN TUBE(S)
|
$XXX.XX
|
| 58660 |
LAPAROSCOPY LYSIS
|
$XXX.XX
|
| 58661 |
LAPAROSCOPY REMOVE ADNEXA
|
$XXX.XX
|
| 58662 |
LAPAROSCOPY EXCISE LESIONS
|
$XXX.XX
|
| 58670 |
LAPAROSCOPY TUBAL CAUTERY
|
$XXX.XX
|
| 58671 |
LAPAROSCOPY TUBAL BLOCK
|
$XXX.XX
|
| 58672 |
LAPAROSCOPY FIMBRIOPLASTY
|
$XXX.XX
|
| 58673 |
LAPAROSCOPY SALPINGOSTOMY
|
$XXX.XX
|
| 58674 |
LAPS ABLTJ UTERINE FIBROIDS
|
$XXX.XX
|
| 58700 |
REMOVAL OF FALLOPIAN TUBE
|
$XXX.XX
|
| 58720 |
REMOVAL OF OVARY/TUBE(S)
|
$XXX.XX
|
| 58740 |
ADHESIOLYSIS TUBE OVARY
|
$XXX.XX
|
| 58750 |
REPAIR OVIDUCT
|
$XXX.XX
|
| 58752 |
REVISE OVARIAN TUBE(S)
|
$XXX.XX
|
| 58760 |
FIMBRIOPLASTY
|
$XXX.XX
|
| 58770 |
CREATE NEW TUBAL OPENING
|
$XXX.XX
|
| 58800 |
DRAINAGE OF OVARIAN CYST(S)
|
$XXX.XX
|
| 58805 |
DRAINAGE OF OVARIAN CYST(S)
|
$XXX.XX
|
| 58820 |
DRAIN OVARY ABSCESS OPEN
|
$XXX.XX
|
| 58822 |
DRAIN OVARY ABSCESS PERCUT
|
$XXX.XX
|
| 58825 |
TRANSPOSITION OVARY(S)
|
$XXX.XX
|
| 58900 |
BIOPSY OF OVARY(S)
|
$XXX.XX
|
| 58920 |
PARTIAL REMOVAL OF OVARY(S)
|
$XXX.XX
|
| 58925 |
REMOVAL OF OVARIAN CYST(S)
|
$XXX.XX
|
| 58940 |
REMOVAL OF OVARY(S)
|
$XXX.XX
|
| 58943 |
REMOVAL OF OVARY(S)
|
$XXX.XX
|
| 58950 |
RESECT OVARIAN MALIGNANCY
|
$XXX.XX
|
| 58951 |
RESECT OVARIAN MALIGNANCY
|
$XXX.XX
|
| 58952 |
RESECT OVARIAN MALIGNANCY
|
$XXX.XX
|
| 58953 |
TAH RAD DISSECT FOR DEBULK
|
$XXX.XX
|
| 58954 |
TAH RAD DEBULK/LYMPH REMOVE
|
$XXX.XX
|
| 58956 |
BSO OMENTECTOMY W/TAH
|
$XXX.XX
|
| 58957 |
RESECT RECURRENT GYN MAL
|
$XXX.XX
|
| 58958 |
RESECT RECUR GYN MAL W/LYM
|
$XXX.XX
|
| 58960 |
EXPLORATION OF ABDOMEN
|
$XXX.XX
|
| 58970 |
RETRIEVAL OF OOCYTE
|
$XXX.XX
|
| 58976 |
TRANSFER OF EMBRYO
|
$XXX.XX
|
| 59000 |
AMNIOCENTESIS DIAGNOSTIC
|
$XXX.XX
|
| 59001 |
AMNIOCENTESIS THERAPEUTIC
|
$XXX.XX
|
| 59012 |
FETAL CORD PUNCTURE PRENATAL
|
$XXX.XX
|
| 59015 |
CHORION BIOPSY
|
$XXX.XX
|
| 59020 |
FETAL CONTRACT STRESS TEST
|
$XXX.XX
|
| 59020-26 |
FETAL CONTRACT STRESS TEST
|
$XXX.XX
|
| 59020-TC |
FETAL CONTRACT STRESS TEST
|
$XXX.XX
|
| 59025 |
FETAL NON-STRESS TEST
|
$XXX.XX
|
| 59025-26 |
FETAL NON-STRESS TEST
|
$XXX.XX
|
| 59025-TC |
FETAL NON-STRESS TEST
|
$XXX.XX
|
| 59030 |
FETAL SCALP BLOOD SAMPLE
|
$XXX.XX
|
| 59050 |
FETAL MONITOR W/REPORT
|
$XXX.XX
|
| 59051 |
FETAL MONITOR/INTERPRET ONLY
|
$XXX.XX
|
| 59070 |
TRANSABDOM AMNIOINFUS W/US
|
$XXX.XX
|
| 59072 |
UMBILICAL CORD OCCLUD W/US
|
$XXX.XX
|
| 59074 |
FETAL FLUID DRAINAGE W/US
|
$XXX.XX
|
| 59076 |
FETAL SHUNT PLACEMENT W/US
|
$XXX.XX
|
| 59100 |
REMOVE UTERUS LESION
|
$XXX.XX
|
| 59120 |
TREAT ECTOPIC PREGNANCY
|
$XXX.XX
|
| 59121 |
TREAT ECTOPIC PREGNANCY
|
$XXX.XX
|
| 59130 |
TREAT ECTOPIC PREGNANCY
|
$XXX.XX
|
| 59135 |
TREAT ECTOPIC PREGNANCY
|
$XXX.XX
|
| 59136 |
TREAT ECTOPIC PREGNANCY
|
$XXX.XX
|
| 59140 |
TREAT ECTOPIC PREGNANCY
|
$XXX.XX
|
| 59150 |
TREAT ECTOPIC PREGNANCY
|
$XXX.XX
|
| 59151 |
TREAT ECTOPIC PREGNANCY
|
$XXX.XX
|
| 59160 |
D & C AFTER DELIVERY
|
$XXX.XX
|
| 59200 |
INSERT CERVICAL DILATOR
|
$XXX.XX
|
| 59300 |
EPISIOTOMY OR VAGINAL REPAIR
|
$XXX.XX
|
| 59320 |
REVISION OF CERVIX
|
$XXX.XX
|
| 59325 |
REVISION OF CERVIX
|
$XXX.XX
|
| 59350 |
REPAIR OF UTERUS
|
$XXX.XX
|
| 59400 |
OBSTETRICAL CARE
|
$XXX.XX
|
| 59409 |
OBSTETRICAL CARE
|
$XXX.XX
|
| 59410 |
OBSTETRICAL CARE
|
$XXX.XX
|
| 59412 |
ANTEPARTUM MANIPULATION
|
$XXX.XX
|
| 59414 |
DELIVER PLACENTA
|
$XXX.XX
|
| 59425 |
ANTEPARTUM CARE ONLY
|
$XXX.XX
|
| 59426 |
ANTEPARTUM CARE ONLY
|
$XXX.XX
|
| 59430 |
CARE AFTER DELIVERY
|
$XXX.XX
|
| 59510 |
CESAREAN DELIVERY
|
$XXX.XX
|
| 59514 |
CESAREAN DELIVERY ONLY
|
$XXX.XX
|
| 59515 |
CESAREAN DELIVERY
|
$XXX.XX
|
| 59525 |
REMOVE UTERUS AFTER CESAREAN
|
$XXX.XX
|
| 59610 |
VBAC DELIVERY
|
$XXX.XX
|
| 59612 |
VBAC DELIVERY ONLY
|
$XXX.XX
|
| 59614 |
VBAC CARE AFTER DELIVERY
|
$XXX.XX
|
| 59618 |
ATTEMPTED VBAC DELIVERY
|
$XXX.XX
|
| 59620 |
ATTEMPTED VBAC DELIVERY ONLY
|
$XXX.XX
|
| 59622 |
ATTEMPTED VBAC AFTER CARE
|
$XXX.XX
|
| 59812 |
TREATMENT OF MISCARRIAGE
|
$XXX.XX
|
| 59820 |
CARE OF MISCARRIAGE
|
$XXX.XX
|
| 59821 |
TREATMENT OF MISCARRIAGE
|
$XXX.XX
|
| 59830 |
TREAT UTERUS INFECTION
|
$XXX.XX
|
| 59840 |
ABORTION
|
$XXX.XX
|
| 59841 |
ABORTION
|
$XXX.XX
|
| 59850 |
ABORTION
|
$XXX.XX
|
| 59851 |
ABORTION
|
$XXX.XX
|
| 59852 |
ABORTION
|
$XXX.XX
|
| 59855 |
ABORTION
|
$XXX.XX
|
| 59856 |
ABORTION
|
$XXX.XX
|
| 59857 |
ABORTION
|
$XXX.XX
|
| 59866 |
ABORTION (MPR)
|
$XXX.XX
|
| 59870 |
EVACUATE MOLE OF UTERUS
|
$XXX.XX
|
| 59871 |
REMOVE CERCLAGE SUTURE
|
$XXX.XX
|
| 60000 |
DRAIN THYROID/TONGUE CYST
|
$XXX.XX
|
| 60100 |
BIOPSY OF THYROID
|
$XXX.XX
|
| 60200 |
REMOVE THYROID LESION
|
$XXX.XX
|
| 60210 |
PARTIAL THYROID EXCISION
|
$XXX.XX
|
| 60212 |
PARTIAL THYROID EXCISION
|
$XXX.XX
|
| 60220 |
PARTIAL REMOVAL OF THYROID
|
$XXX.XX
|
| 60225 |
PARTIAL REMOVAL OF THYROID
|
$XXX.XX
|
| 60240 |
REMOVAL OF THYROID
|
$XXX.XX
|
| 60252 |
REMOVAL OF THYROID
|
$XXX.XX
|
| 60254 |
EXTENSIVE THYROID SURGERY
|
$XXX.XX
|
| 60260 |
REPEAT THYROID SURGERY
|
$XXX.XX
|
| 60270 |
REMOVAL OF THYROID
|
$XXX.XX
|
| 60271 |
REMOVAL OF THYROID
|
$XXX.XX
|
| 60280 |
REMOVE THYROID DUCT LESION
|
$XXX.XX
|
| 60281 |
REMOVE THYROID DUCT LESION
|
$XXX.XX
|
| 60300 |
ASPIR/INJ THYROID CYST
|
$XXX.XX
|
| 60500 |
EXPLORE PARATHYROID GLANDS
|
$XXX.XX
|
| 60502 |
RE-EXPLORE PARATHYROIDS
|
$XXX.XX
|
| 60505 |
EXPLORE PARATHYROID GLANDS
|
$XXX.XX
|
| 60512 |
AUTOTRANSPLANT PARATHYROID
|
$XXX.XX
|
| 60520 |
REMOVAL OF THYMUS GLAND
|
$XXX.XX
|
| 60521 |
REMOVAL OF THYMUS GLAND
|
$XXX.XX
|
| 60522 |
REMOVAL OF THYMUS GLAND
|
$XXX.XX
|
| 60540 |
EXPLORE ADRENAL GLAND
|
$XXX.XX
|
| 60545 |
EXPLORE ADRENAL GLAND
|
$XXX.XX
|
| 60600 |
REMOVE CAROTID BODY LESION
|
$XXX.XX
|
| 60605 |
REMOVE CAROTID BODY LESION
|
$XXX.XX
|
| 60650 |
LAPAROSCOPY ADRENALECTOMY
|
$XXX.XX
|
| 61000 |
REMOVE CRANIAL CAVITY FLUID
|
$XXX.XX
|
| 61001 |
REMOVE CRANIAL CAVITY FLUID
|
$XXX.XX
|
| 61020 |
REMOVE BRAIN CAVITY FLUID
|
$XXX.XX
|
| 61026 |
INJECTION INTO BRAIN CANAL
|
$XXX.XX
|
| 61050 |
REMOVE BRAIN CANAL FLUID
|
$XXX.XX
|
| 61055 |
INJECTION INTO BRAIN CANAL
|
$XXX.XX
|
| 61070 |
BRAIN CANAL SHUNT PROCEDURE
|
$XXX.XX
|
| 61105 |
TWIST DRILL HOLE
|
$XXX.XX
|
| 61107 |
DRILL SKULL FOR IMPLANTATION
|
$XXX.XX
|
| 61108 |
DRILL SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61120 |
BURR HOLE FOR PUNCTURE
|
$XXX.XX
|
| 61140 |
PIERCE SKULL FOR BIOPSY
|
$XXX.XX
|
| 61150 |
PIERCE SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61151 |
PIERCE SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61154 |
PIERCE SKULL & REMOVE CLOT
|
$XXX.XX
|
| 61156 |
PIERCE SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61210 |
PIERCE SKULL IMPLANT DEVICE
|
$XXX.XX
|
| 61215 |
INSERT BRAIN-FLUID DEVICE
|
$XXX.XX
|
| 61250 |
PIERCE SKULL & EXPLORE
|
$XXX.XX
|
| 61253 |
PIERCE SKULL & EXPLORE
|
$XXX.XX
|
| 61304 |
OPEN SKULL FOR EXPLORATION
|
$XXX.XX
|
| 61305 |
OPEN SKULL FOR EXPLORATION
|
$XXX.XX
|
| 61312 |
OPEN SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61313 |
OPEN SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61314 |
OPEN SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61315 |
OPEN SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61316 |
IMPLT CRAN BONE FLAP TO ABDO
|
$XXX.XX
|
| 61320 |
OPEN SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61321 |
OPEN SKULL FOR DRAINAGE
|
$XXX.XX
|
| 61322 |
DECOMPRESSIVE CRANIOTOMY
|
$XXX.XX
|
| 61323 |
DECOMPRESSIVE LOBECTOMY
|
$XXX.XX
|
| 61330 |
DECOMPRESS EYE SOCKET
|
$XXX.XX
|
| 61333 |
EXPLORE ORBIT/REMOVE LESION
|
$XXX.XX
|
| 61340 |
SUBTEMPORAL DECOMPRESSION
|
$XXX.XX
|
| 61343 |
INCISE SKULL (PRESS RELIEF)
|
$XXX.XX
|
| 61345 |
RELIEVE CRANIAL PRESSURE
|
$XXX.XX
|
| 61450 |
INCISE SKULL FOR SURGERY
|
$XXX.XX
|
| 61458 |
INCISE SKULL FOR BRAIN WOUND
|
$XXX.XX
|
| 61460 |
INCISE SKULL FOR SURGERY
|
$XXX.XX
|
| 61500 |
REMOVAL OF SKULL LESION
|
$XXX.XX
|
| 61501 |
REMOVE INFECTED SKULL BONE
|
$XXX.XX
|
| 61510 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61512 |
REMOVE BRAIN LINING LESION
|
$XXX.XX
|
| 61514 |
REMOVAL OF BRAIN ABSCESS
|
$XXX.XX
|
| 61516 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61517 |
IMPLT BRAIN CHEMOTX ADD-ON
|
$XXX.XX
|
| 61518 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61519 |
REMOVE BRAIN LINING LESION
|
$XXX.XX
|
| 61520 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61521 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61522 |
REMOVAL OF BRAIN ABSCESS
|
$XXX.XX
|
| 61524 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61526 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61530 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61531 |
IMPLANT BRAIN ELECTRODES
|
$XXX.XX
|
| 61533 |
IMPLANT BRAIN ELECTRODES
|
$XXX.XX
|
| 61534 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61535 |
REMOVE BRAIN ELECTRODES
|
$XXX.XX
|
| 61536 |
REMOVAL OF BRAIN LESION
|
$XXX.XX
|
| 61537 |
REMOVAL OF BRAIN TISSUE
|
$XXX.XX
|
| 61538 |
REMOVAL OF BRAIN TISSUE
|
$XXX.XX
|
| 61539 |
REMOVAL OF BRAIN TISSUE
|
$XXX.XX
|
| 61540 |
REMOVAL OF BRAIN TISSUE
|
$XXX.XX
|
| 61541 |
INCISION OF BRAIN TISSUE
|
$XXX.XX
|
| 61543 |
REMOVAL OF BRAIN TISSUE
|
$XXX.XX
|
| 61544 |
REMOVE & TREAT BRAIN LESION
|
$XXX.XX
|
| 61545 |
EXCISION OF BRAIN TUMOR
|
$XXX.XX
|
| 61546 |
REMOVAL OF PITUITARY GLAND
|
$XXX.XX
|
| 61548 |
REMOVAL OF PITUITARY GLAND
|
$XXX.XX
|
| 61550 |
RELEASE OF SKULL SEAMS
|
$XXX.XX
|
| 61552 |
RELEASE OF SKULL SEAMS
|
$XXX.XX
|
| 61556 |
INCISE SKULL/SUTURES
|
$XXX.XX
|
| 61557 |
INCISE SKULL/SUTURES
|
$XXX.XX
|
| 61558 |
EXCISION OF SKULL/SUTURES
|
$XXX.XX
|
| 61559 |
EXCISION OF SKULL/SUTURES
|
$XXX.XX
|
| 61563 |
EXCISION OF SKULL TUMOR
|
$XXX.XX
|
| 61564 |
EXCISION OF SKULL TUMOR
|
$XXX.XX
|
| 61566 |
REMOVAL OF BRAIN TISSUE
|
$XXX.XX
|
| 61567 |
INCISION OF BRAIN TISSUE
|
$XXX.XX
|
| 61570 |
REMOVE FOREIGN BODY BRAIN
|
$XXX.XX
|
| 61571 |
INCISE SKULL FOR BRAIN WOUND
|
$XXX.XX
|
| 61575 |
SKULL BASE/BRAINSTEM SURGERY
|
$XXX.XX
|
| 61576 |
SKULL BASE/BRAINSTEM SURGERY
|
$XXX.XX
|
| 61580 |
CRANIOFACIAL APPROACH SKULL
|
$XXX.XX
|
| 61581 |
CRANIOFACIAL APPROACH SKULL
|
$XXX.XX
|
| 61582 |
CRANIOFACIAL APPROACH SKULL
|
$XXX.XX
|
| 61583 |
CRANIOFACIAL APPROACH SKULL
|
$XXX.XX
|
| 61584 |
ORBITOCRANIAL APPROACH/SKULL
|
$XXX.XX
|
| 61585 |
ORBITOCRANIAL APPROACH/SKULL
|
$XXX.XX
|
| 61586 |
RESECT NASOPHARYNX SKULL
|
$XXX.XX
|
| 61590 |
INFRATEMPORAL APPROACH/SKULL
|
$XXX.XX
|
| 61591 |
INFRATEMPORAL APPROACH/SKULL
|
$XXX.XX
|
| 61592 |
ORBITOCRANIAL APPROACH/SKULL
|
$XXX.XX
|
| 61595 |
TRANSTEMPORAL APPROACH/SKULL
|
$XXX.XX
|
| 61596 |
TRANSCOCHLEAR APPROACH/SKULL
|
$XXX.XX
|
| 61597 |
TRANSCONDYLAR APPROACH/SKULL
|
$XXX.XX
|
| 61598 |
TRANSPETROSAL APPROACH/SKULL
|
$XXX.XX
|
| 61600 |
RESECT/EXCISE CRANIAL LESION
|
$XXX.XX
|
| 61601 |
RESECT/EXCISE CRANIAL LESION
|
$XXX.XX
|
| 61605 |
RESECT/EXCISE CRANIAL LESION
|
$XXX.XX
|
| 61606 |
RESECT/EXCISE CRANIAL LESION
|
$XXX.XX
|
| 61607 |
RESECT/EXCISE CRANIAL LESION
|
$XXX.XX
|
| 61608 |
RESECT/EXCISE CRANIAL LESION
|
$XXX.XX
|
| 61611 |
TRANSECT ARTERY SINUS
|
$XXX.XX
|
| 61613 |
REMOVE ANEURYSM SINUS
|
$XXX.XX
|
| 61615 |
RESECT/EXCISE LESION SKULL
|
$XXX.XX
|
| 61616 |
RESECT/EXCISE LESION SKULL
|
$XXX.XX
|
| 61618 |
REPAIR DURA
|
$XXX.XX
|
| 61619 |
REPAIR DURA
|
$XXX.XX
|
| 61623 |
ENDOVASC TEMPORY VESSEL OCCL
|
$XXX.XX
|
| 61624 |
TRANSCATH OCCLUSION CNS
|
$XXX.XX
|
| 61626 |
TRANSCATH OCCLUSION NON-CNS
|
$XXX.XX
|
| 61630 |
INTRACRANIAL ANGIOPLASTY
|
$XXX.XX
|
| 61635 |
INTRACRAN ANGIOPLSTY W/STENT
|
$XXX.XX
|
| 61645 |
PERQ ART M-THROMBECT &/NFS
|
$XXX.XX
|
| 61650 |
EVASC PRLNG ADMN RX AGNT 1ST
|
$XXX.XX
|
| 61651 |
EVASC PRLNG ADMN RX AGNT ADD
|
$XXX.XX
|
| 61680 |
INTRACRANIAL VESSEL SURGERY
|
$XXX.XX
|
| 61682 |
INTRACRANIAL VESSEL SURGERY
|
$XXX.XX
|
| 61684 |
INTRACRANIAL VESSEL SURGERY
|
$XXX.XX
|
| 61686 |
INTRACRANIAL VESSEL SURGERY
|
$XXX.XX
|
| 61690 |
INTRACRANIAL VESSEL SURGERY
|
$XXX.XX
|
| 61692 |
INTRACRANIAL VESSEL SURGERY
|
$XXX.XX
|
| 61697 |
BRAIN ANEURYSM REPR COMPLX
|
$XXX.XX
|
| 61698 |
BRAIN ANEURYSM REPR COMPLX
|
$XXX.XX
|
| 61700 |
BRAIN ANEURYSM REPR SIMPLE
|
$XXX.XX
|
| 61702 |
INNER SKULL VESSEL SURGERY
|
$XXX.XX
|
| 61703 |
CLAMP NECK ARTERY
|
$XXX.XX
|
| 61705 |
REVISE CIRCULATION TO HEAD
|
$XXX.XX
|
| 61708 |
REVISE CIRCULATION TO HEAD
|
$XXX.XX
|
| 61710 |
REVISE CIRCULATION TO HEAD
|
$XXX.XX
|
| 61711 |
FUSION OF SKULL ARTERIES
|
$XXX.XX
|
| 61720 |
INCISE SKULL/BRAIN SURGERY
|
$XXX.XX
|
| 61735 |
INCISE SKULL/BRAIN SURGERY
|
$XXX.XX
|
| 61750 |
INCISE SKULL/BRAIN BIOPSY
|
$XXX.XX
|
| 61751 |
BRAIN BIOPSY W/CT/MR GUIDE
|
$XXX.XX
|
| 61760 |
IMPLANT BRAIN ELECTRODES
|
$XXX.XX
|
| 61770 |
INCISE SKULL FOR TREATMENT
|
$XXX.XX
|
| 61781 |
SCAN PROC CRANIAL INTRA
|
$XXX.XX
|
| 61782 |
SCAN PROC CRANIAL EXTRA
|
$XXX.XX
|
| 61783 |
SCAN PROC SPINAL
|
$XXX.XX
|
| 61790 |
TREAT TRIGEMINAL NERVE
|
$XXX.XX
|
| 61791 |
TREAT TRIGEMINAL TRACT
|
$XXX.XX
|
| 61796 |
SRS CRANIAL LESION SIMPLE
|
$XXX.XX
|
| 61797 |
SRS CRAN LES SIMPLE ADDL
|
$XXX.XX
|
| 61798 |
SRS CRANIAL LESION COMPLEX
|
$XXX.XX
|
| 61799 |
SRS CRAN LES COMPLEX ADDL
|
$XXX.XX
|
| 61800 |
APPLY SRS HEADFRAME ADD-ON
|
$XXX.XX
|
| 61850 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 61860 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 61863 |
IMPLANT NEUROELECTRODE
|
$XXX.XX
|
| 61864 |
IMPLANT NEUROELECTRDE ADDL
|
$XXX.XX
|
| 61867 |
IMPLANT NEUROELECTRODE
|
$XXX.XX
|
| 61868 |
IMPLANT NEUROELECTRDE ADDL
|
$XXX.XX
|
| 61870 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 61880 |
REVISE/REMOVE NEUROELECTRODE
|
$XXX.XX
|
| 61885 |
INSRT/REDO NEUROSTIM 1 ARRAY
|
$XXX.XX
|
| 61886 |
IMPLANT NEUROSTIM ARRAYS
|
$XXX.XX
|
| 61888 |
REVISE/REMOVE NEURORECEIVER
|
$XXX.XX
|
| 62000 |
TREAT SKULL FRACTURE
|
$XXX.XX
|
| 62005 |
TREAT SKULL FRACTURE
|
$XXX.XX
|
| 62010 |
TREATMENT OF HEAD INJURY
|
$XXX.XX
|
| 62100 |
REPAIR BRAIN FLUID LEAKAGE
|
$XXX.XX
|
| 62115 |
REDUCTION OF SKULL DEFECT
|
$XXX.XX
|
| 62117 |
REDUCTION OF SKULL DEFECT
|
$XXX.XX
|
| 62120 |
REPAIR SKULL CAVITY LESION
|
$XXX.XX
|
| 62121 |
INCISE SKULL REPAIR
|
$XXX.XX
|
| 62140 |
REPAIR OF SKULL DEFECT
|
$XXX.XX
|
| 62141 |
REPAIR OF SKULL DEFECT
|
$XXX.XX
|
| 62142 |
REMOVE SKULL PLATE/FLAP
|
$XXX.XX
|
| 62143 |
REPLACE SKULL PLATE/FLAP
|
$XXX.XX
|
| 62145 |
REPAIR OF SKULL & BRAIN
|
$XXX.XX
|
| 62146 |
REPAIR OF SKULL WITH GRAFT
|
$XXX.XX
|
| 62147 |
REPAIR OF SKULL WITH GRAFT
|
$XXX.XX
|
| 62148 |
RETR BONE FLAP TO FIX SKULL
|
$XXX.XX
|
| 62160 |
NEUROENDOSCOPY ADD-ON
|
$XXX.XX
|
| 62161 |
DISSECT BRAIN W/SCOPE
|
$XXX.XX
|
| 62162 |
REMOVE COLLOID CYST W/SCOPE
|
$XXX.XX
|
| 62163 |
ZNEUROENDOSCOPY W/FB REMOVAL
|
$XXX.XX
|
| 62164 |
REMOVE BRAIN TUMOR W/SCOPE
|
$XXX.XX
|
| 62165 |
REMOVE PITUIT TUMOR W/SCOPE
|
$XXX.XX
|
| 62180 |
ESTABLISH BRAIN CAVITY SHUNT
|
$XXX.XX
|
| 62190 |
ESTABLISH BRAIN CAVITY SHUNT
|
$XXX.XX
|
| 62192 |
ESTABLISH BRAIN CAVITY SHUNT
|
$XXX.XX
|
| 62194 |
REPLACE/IRRIGATE CATHETER
|
$XXX.XX
|
| 62200 |
ESTABLISH BRAIN CAVITY SHUNT
|
$XXX.XX
|
| 62201 |
BRAIN CAVITY SHUNT W/SCOPE
|
$XXX.XX
|
| 62220 |
ESTABLISH BRAIN CAVITY SHUNT
|
$XXX.XX
|
| 62223 |
ESTABLISH BRAIN CAVITY SHUNT
|
$XXX.XX
|
| 62225 |
REPLACE/IRRIGATE CATHETER
|
$XXX.XX
|
| 62230 |
REPLACE/REVISE BRAIN SHUNT
|
$XXX.XX
|
| 62252 |
CSF SHUNT REPROGRAM
|
$XXX.XX
|
| 62252-26 |
CSF SHUNT REPROGRAM
|
$XXX.XX
|
| 62252-TC |
CSF SHUNT REPROGRAM
|
$XXX.XX
|
| 62256 |
REMOVE BRAIN CAVITY SHUNT
|
$XXX.XX
|
| 62258 |
REPLACE BRAIN CAVITY SHUNT
|
$XXX.XX
|
| 62263 |
EPIDURAL LYSIS MULT SESSIONS
|
$XXX.XX
|
| 62264 |
EPIDURAL LYSIS ON SINGLE DAY
|
$XXX.XX
|
| 62267 |
INTERDISCAL PERQ ASPIR DX
|
$XXX.XX
|
| 62268 |
DRAIN SPINAL CORD CYST
|
$XXX.XX
|
| 62269 |
NEEDLE BIOPSY SPINAL CORD
|
$XXX.XX
|
| 62270 |
DX LMBR SPI PNXR
|
$XXX.XX
|
| 62272 |
THER SPI PNXR DRG CSF
|
$XXX.XX
|
| 62273 |
INJECT EPIDURAL PATCH
|
$XXX.XX
|
| 62280 |
TREAT SPINAL CORD LESION
|
$XXX.XX
|
| 62281 |
TREAT SPINAL CORD LESION
|
$XXX.XX
|
| 62282 |
TREAT SPINAL CANAL LESION
|
$XXX.XX
|
| 62284 |
INJECTION FOR MYELOGRAM
|
$XXX.XX
|
| 62287 |
PERCUTANEOUS DISKECTOMY
|
$XXX.XX
|
| 62290 |
NJX PX DISCOGRAPHY LUMBAR
|
$XXX.XX
|
| 62291 |
NJX PX DISCOGRAPHY CRV/THRC
|
$XXX.XX
|
| 62292 |
NJX CHEMONUCLEOLYSIS LMBR
|
$XXX.XX
|
| 62294 |
INJECTION INTO SPINAL ARTERY
|
$XXX.XX
|
| 62302 |
MYELOGRAPHY LUMBAR INJECTION
|
$XXX.XX
|
| 62303 |
MYELOGRAPHY LUMBAR INJECTION
|
$XXX.XX
|
| 62304 |
MYELOGRAPHY LUMBAR INJECTION
|
$XXX.XX
|
| 62305 |
MYELOGRAPHY LUMBAR INJECTION
|
$XXX.XX
|
| 62320 |
NJX INTERLAMINAR CRV/THRC
|
$XXX.XX
|
| 62321 |
NJX INTERLAMINAR CRV/THRC
|
$XXX.XX
|
| 62322 |
NJX INTERLAMINAR LMBR/SAC
|
$XXX.XX
|
| 62323 |
NJX INTERLAMINAR LMBR/SAC
|
$XXX.XX
|
| 62324 |
NJX INTERLAMINAR CRV/THRC
|
$XXX.XX
|
| 62325 |
NJX INTERLAMINAR CRV/THRC
|
$XXX.XX
|
| 62326 |
NJX INTERLAMINAR LMBR/SAC
|
$XXX.XX
|
| 62327 |
NJX INTERLAMINAR LMBR/SAC
|
$XXX.XX
|
| 62328 |
DX LMBR SPI PNXR W/FLUOR/CT
|
$XXX.XX
|
| 62329 |
THER SPI PNXR CSF FLUOR/CT
|
$XXX.XX
|
| 62350 |
IMPLANT SPINAL CANAL CATH
|
$XXX.XX
|
| 62351 |
IMPLANT SPINAL CANAL CATH
|
$XXX.XX
|
| 62355 |
REMOVE SPINAL CANAL CATHETER
|
$XXX.XX
|
| 62360 |
INSERT SPINE INFUSION DEVICE
|
$XXX.XX
|
| 62361 |
IMPLANT SPINE INFUSION PUMP
|
$XXX.XX
|
| 62362 |
IMPLANT SPINE INFUSION PUMP
|
$XXX.XX
|
| 62365 |
REMOVE SPINE INFUSION DEVICE
|
$XXX.XX
|
| 62367 |
ANALYZE SPINE INFUS PUMP
|
$XXX.XX
|
| 62368 |
ANALYZE SP INF PUMP W/REPROG
|
$XXX.XX
|
| 62369 |
ANAL SP INF PMP W/REPRG&FILL
|
$XXX.XX
|
| 62370 |
ANL SP INF PMP W/MDREPRG&FIL
|
$XXX.XX
|
| 63001 |
REMOVE SPINE LAMINA 1/2 CRVL
|
$XXX.XX
|
| 63003 |
REMOVE SPINE LAMINA 1/2 THRC
|
$XXX.XX
|
| 63005 |
REMOVE SPINE LAMINA 1/2 LMBR
|
$XXX.XX
|
| 63011 |
REMOVE SPINE LAMINA 1/2 SCRL
|
$XXX.XX
|
| 63012 |
REMOVE LAMINA/FACETS LUMBAR
|
$XXX.XX
|
| 63015 |
REMOVE SPINE LAMINA >2 CRVCL
|
$XXX.XX
|
| 63016 |
REMOVE SPINE LAMINA >2 THRC
|
$XXX.XX
|
| 63017 |
REMOVE SPINE LAMINA >2 LMBR
|
$XXX.XX
|
| 63020 |
NECK SPINE DISK SURGERY
|
$XXX.XX
|
| 63030 |
LOW BACK DISK SURGERY
|
$XXX.XX
|
| 63035 |
SPINAL DISK SURGERY ADD-ON
|
$XXX.XX
|
| 63040 |
LAMINOTOMY SINGLE CERVICAL
|
$XXX.XX
|
| 63042 |
LAMINOTOMY SINGLE LUMBAR
|
$XXX.XX
|
| 63045 |
REMOVE SPINE LAMINA 1 CRVL
|
$XXX.XX
|
| 63046 |
REMOVE SPINE LAMINA 1 THRC
|
$XXX.XX
|
| 63047 |
REMOVE SPINE LAMINA 1 LMBR
|
$XXX.XX
|
| 63048 |
REMOVE SPINAL LAMINA ADD-ON
|
$XXX.XX
|
| 63050 |
CERVICAL LAMINOPLSTY 2/> SEG
|
$XXX.XX
|
| 63051 |
C-LAMINOPLASTY W/GRAFT/PLATE
|
$XXX.XX
|
| 63055 |
DECOMPRESS SPINAL CORD THRC
|
$XXX.XX
|
| 63056 |
DECOMPRESS SPINAL CORD LMBR
|
$XXX.XX
|
| 63057 |
DECOMPRESS SPINE CORD ADD-ON
|
$XXX.XX
|
| 63064 |
DECOMPRESS SPINAL CORD THRC
|
$XXX.XX
|
| 63066 |
DECOMPRESS SPINE CORD ADD-ON
|
$XXX.XX
|
| 63075 |
NECK SPINE DISK SURGERY
|
$XXX.XX
|
| 63076 |
NECK SPINE DISK SURGERY
|
$XXX.XX
|
| 63077 |
SPINE DISK SURGERY THORAX
|
$XXX.XX
|
| 63078 |
SPINE DISK SURGERY THORAX
|
$XXX.XX
|
| 63081 |
REMOVE VERT BODY DCMPRN CRVL
|
$XXX.XX
|
| 63082 |
REMOVE VERTEBRAL BODY ADD-ON
|
$XXX.XX
|
| 63085 |
REMOVE VERT BODY DCMPRN THRC
|
$XXX.XX
|
| 63086 |
REMOVE VERTEBRAL BODY ADD-ON
|
$XXX.XX
|
| 63087 |
REMOV VERTBR DCMPRN THRCLMBR
|
$XXX.XX
|
| 63088 |
REMOVE VERTEBRAL BODY ADD-ON
|
$XXX.XX
|
| 63090 |
REMOVE VERT BODY DCMPRN LMBR
|
$XXX.XX
|
| 63091 |
REMOVE VERTEBRAL BODY ADD-ON
|
$XXX.XX
|
| 63101 |
REMOVE VERT BODY DCMPRN THRC
|
$XXX.XX
|
| 63102 |
REMOVE VERT BODY DCMPRN LMBR
|
$XXX.XX
|
| 63103 |
REMOVE VERTEBRAL BODY ADD-ON
|
$XXX.XX
|
| 63170 |
INCISE SPINAL CORD TRACT(S)
|
$XXX.XX
|
| 63172 |
DRAINAGE OF SPINAL CYST
|
$XXX.XX
|
| 63173 |
DRAINAGE OF SPINAL CYST
|
$XXX.XX
|
| 63180 |
REVISE SPINAL CORD LIGAMENTS
|
$XXX.XX
|
| 63182 |
REVISE SPINAL CORD LIGAMENTS
|
$XXX.XX
|
| 63185 |
INCISE SPINE NRV HALF SEGMNT
|
$XXX.XX
|
| 63190 |
INCISE SPINE NRV >2 SEGMNTS
|
$XXX.XX
|
| 63191 |
INCISE SPINE ACCESSORY NERVE
|
$XXX.XX
|
| 63194 |
INCISE SPINE & CORD CERVICAL
|
$XXX.XX
|
| 63195 |
INCISE SPINE & CORD THORACIC
|
$XXX.XX
|
| 63196 |
INCISE SPINE&CORD 2 TRX CRVL
|
$XXX.XX
|
| 63197 |
INCISE SPINE&CORD 2 TRX THRC
|
$XXX.XX
|
| 63198 |
INCISE SPIN&CORD 2 STGS CRVL
|
$XXX.XX
|
| 63199 |
INCISE SPIN&CORD 2 STGS THRC
|
$XXX.XX
|
| 63200 |
RELEASE SPINAL CORD LUMBAR
|
$XXX.XX
|
| 63250 |
REVISE SPINAL CORD VSLS CRVL
|
$XXX.XX
|
| 63251 |
REVISE SPINAL CORD VSLS THRC
|
$XXX.XX
|
| 63252 |
REVISE SPINE CORD VSL THRLMB
|
$XXX.XX
|
| 63265 |
EXCISE INTRASPINL LESION CRV
|
$XXX.XX
|
| 63266 |
EXCISE INTRSPINL LESION THRC
|
$XXX.XX
|
| 63267 |
EXCISE INTRSPINL LESION LMBR
|
$XXX.XX
|
| 63268 |
EXCISE INTRSPINL LESION SCRL
|
$XXX.XX
|
| 63270 |
EXCISE INTRSPINL LESION CRVL
|
$XXX.XX
|
| 63271 |
EXCISE INTRSPINL LESION THRC
|
$XXX.XX
|
| 63272 |
EXCISE INTRSPINL LESION LMBR
|
$XXX.XX
|
| 63273 |
EXCISE INTRSPINL LESION SCRL
|
$XXX.XX
|
| 63275 |
BX/EXC XDRL SPINE LESN CRVL
|
$XXX.XX
|
| 63276 |
BX/EXC XDRL SPINE LESN THRC
|
$XXX.XX
|
| 63277 |
BX/EXC XDRL SPINE LESN LMBR
|
$XXX.XX
|
| 63278 |
BX/EXC XDRL SPINE LESN SCRL
|
$XXX.XX
|
| 63280 |
BX/EXC IDRL SPINE LESN CRVL
|
$XXX.XX
|
| 63281 |
BX/EXC IDRL SPINE LESN THRC
|
$XXX.XX
|
| 63282 |
BX/EXC IDRL SPINE LESN LMBR
|
$XXX.XX
|
| 63283 |
BX/EXC IDRL SPINE LESN SCRL
|
$XXX.XX
|
| 63285 |
BX/EXC IDRL IMED LESN CERVL
|
$XXX.XX
|
| 63286 |
BX/EXC IDRL IMED LESN THRC
|
$XXX.XX
|
| 63287 |
BX/EXC IDRL IMED LESN THRLMB
|
$XXX.XX
|
| 63290 |
BX/EXC XDRL/IDRL LSN ANY LVL
|
$XXX.XX
|
| 63295 |
REPAIR LAMINECTOMY DEFECT
|
$XXX.XX
|
| 63300 |
REMOVE VERT XDRL BODY CRVCL
|
$XXX.XX
|
| 63301 |
REMOVE VERT XDRL BODY THRC
|
$XXX.XX
|
| 63302 |
REMOVE VERT XDRL BODY THRLMB
|
$XXX.XX
|
| 63303 |
REMOV VERT XDRL BDY LMBR/SAC
|
$XXX.XX
|
| 63304 |
REMOVE VERT IDRL BODY CRVCL
|
$XXX.XX
|
| 63305 |
REMOVE VERT IDRL BODY THRC
|
$XXX.XX
|
| 63306 |
REMOV VERT IDRL BDY THRCLMBR
|
$XXX.XX
|
| 63307 |
REMOV VERT IDRL BDY LMBR/SAC
|
$XXX.XX
|
| 63308 |
REMOVE VERTEBRAL BODY ADD-ON
|
$XXX.XX
|
| 63600 |
REMOVE SPINAL CORD LESION
|
$XXX.XX
|
| 63610 |
STIMULATION OF SPINAL CORD
|
$XXX.XX
|
| 63620 |
SRS SPINAL LESION
|
$XXX.XX
|
| 63621 |
SRS SPINAL LESION ADDL
|
$XXX.XX
|
| 63650 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 63655 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 63661 |
REMOVE SPINE ELTRD PERQ ARAY
|
$XXX.XX
|
| 63662 |
REMOVE SPINE ELTRD PLATE
|
$XXX.XX
|
| 63663 |
REVISE SPINE ELTRD PERQ ARAY
|
$XXX.XX
|
| 63664 |
REVISE SPINE ELTRD PLATE
|
$XXX.XX
|
| 63685 |
INSRT/REDO SPINE N GENERATOR
|
$XXX.XX
|
| 63688 |
REVISE/REMOVE NEURORECEIVER
|
$XXX.XX
|
| 63700 |
REPAIR OF SPINAL HERNIATION
|
$XXX.XX
|
| 63702 |
REPAIR OF SPINAL HERNIATION
|
$XXX.XX
|
| 63704 |
REPAIR OF SPINAL HERNIATION
|
$XXX.XX
|
| 63706 |
REPAIR OF SPINAL HERNIATION
|
$XXX.XX
|
| 63707 |
REPAIR SPINAL FLUID LEAKAGE
|
$XXX.XX
|
| 63709 |
REPAIR SPINAL FLUID LEAKAGE
|
$XXX.XX
|
| 63710 |
GRAFT REPAIR OF SPINE DEFECT
|
$XXX.XX
|
| 63740 |
INSTALL SPINAL SHUNT
|
$XXX.XX
|
| 63741 |
INSTALL SPINAL SHUNT
|
$XXX.XX
|
| 63744 |
REVISION OF SPINAL SHUNT
|
$XXX.XX
|
| 63746 |
REMOVAL OF SPINAL SHUNT
|
$XXX.XX
|
| 64400 |
NJX AA&/STRD TRIGEMINAL NRV
|
$XXX.XX
|
| 64405 |
NJX AA&/STRD GR OCPL NRV
|
$XXX.XX
|
| 64408 |
NJX AA&/STRD VAGUS NRV
|
$XXX.XX
|
| 64415 |
NJX AA&/STRD BRACH PLEXUS
|
$XXX.XX
|
| 64416 |
NJX AA&/STRD BRACH PLEX NFS
|
$XXX.XX
|
| 64417 |
NJX AA&/STRD AXILLARY NRV
|
$XXX.XX
|
| 64418 |
NJX AA&/STRD SPRSCAP NRV
|
$XXX.XX
|
| 64420 |
NJX AA&/STRD NTRCOST NRV 1
|
$XXX.XX
|
| 64421 |
NJX AA&/STRD NTRCOST NRV EA
|
$XXX.XX
|
| 64425 |
NJX AA&/STRD II IH NERVES
|
$XXX.XX
|
| 64430 |
NJX AA&/STRD PUDENDAL NERVE
|
$XXX.XX
|
| 64435 |
NJX AA&/STRD PARACRV NRV
|
$XXX.XX
|
| 64445 |
NJX AA&/STRD SCIATIC NERVE
|
$XXX.XX
|
| 64446 |
NJX AA&/STRD SCIATIC NRV NFS
|
$XXX.XX
|
| 64447 |
NJX AA&/STRD FEMORAL NERVE
|
$XXX.XX
|
| 64448 |
NJX AA&/STRD FEM NERVE NFS
|
$XXX.XX
|
| 64449 |
NJX AA&/STRD LMBR PLEX NFS
|
$XXX.XX
|
| 64450 |
NJX AA&/STRD OTHER PN/BRANCH
|
$XXX.XX
|
| 64451 |
NJX AA&/STRD NRV NRVTG SI JT
|
$XXX.XX
|
| 64454 |
NJX AA&/STRD GNCLR NRV BRNCH
|
$XXX.XX
|
| 64455 |
N BLOCK INJ PLANTAR DIGIT
|
$XXX.XX
|
| 64461 |
PVB THORACIC SINGLE INJ SITE
|
$XXX.XX
|
| 64462 |
PVB THORACIC 2ND+ INJ SITE
|
$XXX.XX
|
| 64463 |
PVB THORACIC CONT INFUSION
|
$XXX.XX
|
| 64479 |
INJ FORAMEN EPIDURAL C/T
|
$XXX.XX
|
| 64480 |
INJ FORAMEN EPIDURAL ADD-ON
|
$XXX.XX
|
| 64483 |
INJ FORAMEN EPIDURAL L/S
|
$XXX.XX
|
| 64484 |
INJ FORAMEN EPIDURAL ADD-ON
|
$XXX.XX
|
| 64486 |
TAP BLOCK UNIL BY INJECTION
|
$XXX.XX
|
| 64487 |
TAP BLOCK UNI BY INFUSION
|
$XXX.XX
|
| 64488 |
TAP BLOCK BI INJECTION
|
$XXX.XX
|
| 64489 |
TAP BLOCK BI BY INFUSION
|
$XXX.XX
|
| 64490 |
INJ PARAVERT F JNT C/T 1 LEV
|
$XXX.XX
|
| 64491 |
INJ PARAVERT F JNT C/T 2 LEV
|
$XXX.XX
|
| 64492 |
INJ PARAVERT F JNT C/T 3 LEV
|
$XXX.XX
|
| 64493 |
INJ PARAVERT F JNT L/S 1 LEV
|
$XXX.XX
|
| 64494 |
INJ PARAVERT F JNT L/S 2 LEV
|
$XXX.XX
|
| 64495 |
INJ PARAVERT F JNT L/S 3 LEV
|
$XXX.XX
|
| 64505 |
N BLOCK SPENOPALATINE GANGL
|
$XXX.XX
|
| 64510 |
N BLOCK STELLATE GANGLION
|
$XXX.XX
|
| 64517 |
N BLOCK INJ HYPOGAS PLXS
|
$XXX.XX
|
| 64520 |
N BLOCK LUMBAR/THORACIC
|
$XXX.XX
|
| 64530 |
N BLOCK INJ CELIAC PELUS
|
$XXX.XX
|
| 64553 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 64555 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 64561 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 64566 |
NEUROELTRD STIM POST TIBIAL
|
$XXX.XX
|
| 64568 |
INC FOR VAGUS N ELECT IMPL
|
$XXX.XX
|
| 64569 |
REVISE/REPL VAGUS N ELTRD
|
$XXX.XX
|
| 64570 |
REMOVE VAGUS N ELTRD
|
$XXX.XX
|
| 64575 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 64580 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 64581 |
IMPLANT NEUROELECTRODES
|
$XXX.XX
|
| 64585 |
REVISE/REMOVE NEUROELECTRODE
|
$XXX.XX
|
| 64590 |
INSRT/REDO PN/GASTR STIMUL
|
$XXX.XX
|
| 64595 |
REVISE/RMV PN/GASTR STIMUL
|
$XXX.XX
|
| 64600 |
INJECTION TREATMENT OF NERVE
|
$XXX.XX
|
| 64605 |
INJECTION TREATMENT OF NERVE
|
$XXX.XX
|
| 64610 |
INJECTION TREATMENT OF NERVE
|
$XXX.XX
|
| 64611 |
CHEMODENERV SALIV GLANDS
|
$XXX.XX
|
| 64612 |
DESTROY NERVE FACE MUSCLE
|
$XXX.XX
|
| 64615 |
CHEMODENERV MUSC MIGRAINE
|
$XXX.XX
|
| 64616 |
CHEMODENERV MUSC NECK DYSTON
|
$XXX.XX
|
| 64617 |
CHEMODENER MUSCLE LARYNX EMG
|
$XXX.XX
|
| 64620 |
INJECTION TREATMENT OF NERVE
|
$XXX.XX
|
| 64624 |
DSTRJ NULYT AGT GNCLR NRV
|
$XXX.XX
|
| 64625 |
RF ABLTJ NRV NRVTG SI JT
|
$XXX.XX
|
| 64630 |
INJECTION TREATMENT OF NERVE
|
$XXX.XX
|
| 64632 |
N BLOCK INJ COMMON DIGIT
|
$XXX.XX
|
| 64633 |
DESTROY CERV/THOR FACET JNT
|
$XXX.XX
|
| 64634 |
DESTROY C/TH FACET JNT ADDL
|
$XXX.XX
|
| 64635 |
DESTROY LUMB/SAC FACET JNT
|
$XXX.XX
|
| 64636 |
DESTROY L/S FACET JNT ADDL
|
$XXX.XX
|
| 64640 |
INJECTION TREATMENT OF NERVE
|
$XXX.XX
|
| 64642 |
CHEMODENERV 1 EXTREMITY 1-4
|
$XXX.XX
|
| 64643 |
CHEMODENERV 1 EXTREM 1-4 EA
|
$XXX.XX
|
| 64644 |
CHEMODENERV 1 EXTREM 5/> MUS
|
$XXX.XX
|
| 64645 |
CHEMODENERV 1 EXTREM 5/> EA
|
$XXX.XX
|
| 64646 |
CHEMODENERV TRUNK MUSC 1-5
|
$XXX.XX
|
| 64647 |
CHEMODENERV TRUNK MUSC 6/>
|
$XXX.XX
|
| 64650 |
CHEMODENERV ECCRINE GLANDS
|
$XXX.XX
|
| 64653 |
CHEMODENERV ECCRINE GLANDS
|
$XXX.XX
|
| 64680 |
INJECTION TREATMENT OF NERVE
|
$XXX.XX
|
| 64681 |
INJECTION TREATMENT OF NERVE
|
$XXX.XX
|
| 64702 |
REVISE FINGER/TOE NERVE
|
$XXX.XX
|
| 64704 |
REVISE HAND/FOOT NERVE
|
$XXX.XX
|
| 64708 |
REVISE ARM/LEG NERVE
|
$XXX.XX
|
| 64712 |
REVISION OF SCIATIC NERVE
|
$XXX.XX
|
| 64713 |
REVISION OF ARM NERVE(S)
|
$XXX.XX
|
| 64714 |
REVISE LOW BACK NERVE(S)
|
$XXX.XX
|
| 64716 |
REVISION OF CRANIAL NERVE
|
$XXX.XX
|
| 64718 |
REVISE ULNAR NERVE AT ELBOW
|
$XXX.XX
|
| 64719 |
REVISE ULNAR NERVE AT WRIST
|
$XXX.XX
|
| 64721 |
CARPAL TUNNEL SURGERY
|
$XXX.XX
|
| 64722 |
RELIEVE PRESSURE ON NERVE(S)
|
$XXX.XX
|
| 64726 |
RELEASE FOOT/TOE NERVE
|
$XXX.XX
|
| 64727 |
INTERNAL NERVE REVISION
|
$XXX.XX
|
| 64732 |
INCISION OF BROW NERVE
|
$XXX.XX
|
| 64734 |
INCISION OF CHEEK NERVE
|
$XXX.XX
|
| 64736 |
INCISION OF CHIN NERVE
|
$XXX.XX
|
| 64738 |
INCISION OF JAW NERVE
|
$XXX.XX
|
| 64740 |
INCISION OF TONGUE NERVE
|
$XXX.XX
|
| 64742 |
INCISION OF FACIAL NERVE
|
$XXX.XX
|
| 64744 |
INCISE NERVE BACK OF HEAD
|
$XXX.XX
|
| 64746 |
INCISE DIAPHRAGM NERVE
|
$XXX.XX
|
| 64755 |
INCISION OF STOMACH NERVES
|
$XXX.XX
|
| 64760 |
INCISION OF VAGUS NERVE
|
$XXX.XX
|
| 64763 |
INCISE HIP/THIGH NERVE
|
$XXX.XX
|
| 64766 |
INCISE HIP/THIGH NERVE
|
$XXX.XX
|
| 64771 |
SEVER CRANIAL NERVE
|
$XXX.XX
|
| 64772 |
INCISION OF SPINAL NERVE
|
$XXX.XX
|
| 64774 |
REMOVE SKIN NERVE LESION
|
$XXX.XX
|
| 64776 |
REMOVE DIGIT NERVE LESION
|
$XXX.XX
|
| 64778 |
DIGIT NERVE SURGERY ADD-ON
|
$XXX.XX
|
| 64782 |
REMOVE LIMB NERVE LESION
|
$XXX.XX
|
| 64783 |
LIMB NERVE SURGERY ADD-ON
|
$XXX.XX
|
| 64784 |
REMOVE NERVE LESION
|
$XXX.XX
|
| 64786 |
REMOVE SCIATIC NERVE LESION
|
$XXX.XX
|
| 64787 |
IMPLANT NERVE END
|
$XXX.XX
|
| 64788 |
REMOVE SKIN NERVE LESION
|
$XXX.XX
|
| 64790 |
REMOVAL OF NERVE LESION
|
$XXX.XX
|
| 64792 |
REMOVAL OF NERVE LESION
|
$XXX.XX
|
| 64795 |
BIOPSY OF NERVE
|
$XXX.XX
|
| 64802 |
SYMPATHECTOMY CERVICAL
|
$XXX.XX
|
| 64804 |
REMOVE SYMPATHETIC NERVES
|
$XXX.XX
|
| 64809 |
REMOVE SYMPATHETIC NERVES
|
$XXX.XX
|
| 64818 |
REMOVE SYMPATHETIC NERVES
|
$XXX.XX
|
| 64820 |
SYMPATHECTOMY DIGITAL ARTERY
|
$XXX.XX
|
| 64821 |
REMOVE SYMPATHETIC NERVES
|
$XXX.XX
|
| 64822 |
REMOVE SYMPATHETIC NERVES
|
$XXX.XX
|
| 64823 |
SYMPATHECTOMY SUPFC PALMAR
|
$XXX.XX
|
| 64831 |
REPAIR OF DIGIT NERVE
|
$XXX.XX
|
| 64832 |
REPAIR NERVE ADD-ON
|
$XXX.XX
|
| 64834 |
REPAIR OF HAND OR FOOT NERVE
|
$XXX.XX
|
| 64835 |
REPAIR OF HAND OR FOOT NERVE
|
$XXX.XX
|
| 64836 |
REPAIR OF HAND OR FOOT NERVE
|
$XXX.XX
|
| 64837 |
REPAIR NERVE ADD-ON
|
$XXX.XX
|
| 64840 |
REPAIR OF LEG NERVE
|
$XXX.XX
|
| 64856 |
REPAIR/TRANSPOSE NERVE
|
$XXX.XX
|
| 64857 |
REPAIR ARM/LEG NERVE
|
$XXX.XX
|
| 64858 |
REPAIR SCIATIC NERVE
|
$XXX.XX
|
| 64859 |
NERVE SURGERY
|
$XXX.XX
|
| 64861 |
REPAIR OF ARM NERVES
|
$XXX.XX
|
| 64862 |
REPAIR OF LOW BACK NERVES
|
$XXX.XX
|
| 64864 |
REPAIR OF FACIAL NERVE
|
$XXX.XX
|
| 64865 |
REPAIR OF FACIAL NERVE
|
$XXX.XX
|
| 64866 |
FUSION OF FACIAL/OTHER NERVE
|
$XXX.XX
|
| 64868 |
FUSION OF FACIAL/OTHER NERVE
|
$XXX.XX
|
| 64872 |
SUBSEQUENT REPAIR OF NERVE
|
$XXX.XX
|
| 64874 |
REPAIR & REVISE NERVE ADD-ON
|
$XXX.XX
|
| 64876 |
REPAIR NERVE/SHORTEN BONE
|
$XXX.XX
|
| 64885 |
NERVE GRAFT HEAD/NECK
|
$XXX.XX
|
| 64886 |
NERVE GRAFT HEAD/NECK >4 CM
|
$XXX.XX
|
| 64890 |
NERVE GRAFT HAND/FOOT
|
$XXX.XX
|
| 64891 |
NERVE GRAFT HAND/FOOT >4 CM
|
$XXX.XX
|
| 64892 |
NERVE GRAFT ARM/LEG <4 CM
|
$XXX.XX
|
| 64893 |
NERVE GRAFT ARM/LEG >4 CM
|
$XXX.XX
|
| 64895 |
NERVE GRAFT HAND/FOOT
|
$XXX.XX
|
| 64896 |
NERVE GRAFT HAND/FOOT >4 CM
|
$XXX.XX
|
| 64897 |
NERVE GRAFT ARM/LEG
|
$XXX.XX
|
| 64898 |
NERVE GRAFT ARM/LEG >4 CM
|
$XXX.XX
|
| 64901 |
NERVE GRAFT ADD-ON
|
$XXX.XX
|
| 64902 |
NERVE GRAFT ADD-ON
|
$XXX.XX
|
| 64905 |
NERVE PEDICLE TRANSFER
|
$XXX.XX
|
| 64907 |
NERVE PEDICLE TRANSFER
|
$XXX.XX
|
| 64910 |
NERVE REPAIR W/ALLOGRAFT
|
$XXX.XX
|
| 64911 |
NEURORRAPHY W/VEIN AUTOGRAFT
|
$XXX.XX
|
| 64912 |
NRV RPR W/NRV ALGRFT 1ST
|
$XXX.XX
|
| 64913 |
NRV RPR W/NRV ALGRFT EA ADDL
|
$XXX.XX
|
| 65091 |
REVISE EYE
|
$XXX.XX
|
| 65093 |
REVISE EYE WITH IMPLANT
|
$XXX.XX
|
| 65101 |
REMOVAL OF EYE
|
$XXX.XX
|
| 65103 |
REMOVE EYE/INSERT IMPLANT
|
$XXX.XX
|
| 65105 |
REMOVE EYE/ATTACH IMPLANT
|
$XXX.XX
|
| 65110 |
REMOVAL OF EYE
|
$XXX.XX
|
| 65112 |
REMOVE EYE/REVISE SOCKET
|
$XXX.XX
|
| 65114 |
REMOVE EYE/REVISE SOCKET
|
$XXX.XX
|
| 65125 |
REVISE OCULAR IMPLANT
|
$XXX.XX
|
| 65130 |
INSERT OCULAR IMPLANT
|
$XXX.XX
|
| 65135 |
INSERT OCULAR IMPLANT
|
$XXX.XX
|
| 65140 |
ATTACH OCULAR IMPLANT
|
$XXX.XX
|
| 65150 |
REVISE OCULAR IMPLANT
|
$XXX.XX
|
| 65155 |
REINSERT OCULAR IMPLANT
|
$XXX.XX
|
| 65175 |
REMOVAL OF OCULAR IMPLANT
|
$XXX.XX
|
| 65205 |
REMOVE FOREIGN BODY FROM EYE
|
$XXX.XX
|
| 65210 |
REMOVE FOREIGN BODY FROM EYE
|
$XXX.XX
|
| 65220 |
REMOVE FOREIGN BODY FROM EYE
|
$XXX.XX
|
| 65222 |
REMOVE FOREIGN BODY FROM EYE
|
$XXX.XX
|
| 65235 |
REMOVE FOREIGN BODY FROM EYE
|
$XXX.XX
|
| 65260 |
REMOVE FOREIGN BODY FROM EYE
|
$XXX.XX
|
| 65265 |
REMOVE FOREIGN BODY FROM EYE
|
$XXX.XX
|
| 65270 |
REPAIR OF EYE WOUND
|
$XXX.XX
|
| 65272 |
REPAIR OF EYE WOUND
|
$XXX.XX
|
| 65273 |
REPAIR OF EYE WOUND
|
$XXX.XX
|
| 65275 |
REPAIR OF EYE WOUND
|
$XXX.XX
|
| 65280 |
REPAIR OF EYE WOUND
|
$XXX.XX
|
| 65285 |
REPAIR OF EYE WOUND
|
$XXX.XX
|
| 65286 |
REPAIR OF EYE WOUND
|
$XXX.XX
|
| 65290 |
REPAIR OF EYE SOCKET WOUND
|
$XXX.XX
|
| 65400 |
REMOVAL OF EYE LESION
|
$XXX.XX
|
| 65410 |
BIOPSY OF CORNEA
|
$XXX.XX
|
| 65420 |
REMOVAL OF EYE LESION
|
$XXX.XX
|
| 65426 |
REMOVAL OF EYE LESION
|
$XXX.XX
|
| 65430 |
CORNEAL SMEAR
|
$XXX.XX
|
| 65435 |
CURETTE/TREAT CORNEA
|
$XXX.XX
|
| 65436 |
CURETTE/TREAT CORNEA
|
$XXX.XX
|
| 65450 |
TREATMENT OF CORNEAL LESION
|
$XXX.XX
|
| 65600 |
REVISION OF CORNEA
|
$XXX.XX
|
| 65710 |
CORNEAL TRANSPLANT
|
$XXX.XX
|
| 65730 |
CORNEAL TRANSPLANT
|
$XXX.XX
|
| 65750 |
CORNEAL TRANSPLANT
|
$XXX.XX
|
| 65755 |
CORNEAL TRANSPLANT
|
$XXX.XX
|
| 65756 |
CORNEAL TRNSPL ENDOTHELIAL
|
$XXX.XX
|
| 65770 |
REVISE CORNEA WITH IMPLANT
|
$XXX.XX
|
| 65772 |
CORRECTION OF ASTIGMATISM
|
$XXX.XX
|
| 65775 |
CORRECTION OF ASTIGMATISM
|
$XXX.XX
|
| 65778 |
COVER EYE W/MEMBRANE
|
$XXX.XX
|
| 65779 |
COVER EYE W/MEMBRANE SUTURE
|
$XXX.XX
|
| 65780 |
OCULAR RECONST TRANSPLANT
|
$XXX.XX
|
| 65781 |
OCULAR RECONST TRANSPLANT
|
$XXX.XX
|
| 65782 |
OCULAR RECONST TRANSPLANT
|
$XXX.XX
|
| 65785 |
IMPLTJ NTRSTRML CRNL RNG SEG
|
$XXX.XX
|
| 65800 |
DRAINAGE OF EYE
|
$XXX.XX
|
| 65810 |
DRAINAGE OF EYE
|
$XXX.XX
|
| 65815 |
DRAINAGE OF EYE
|
$XXX.XX
|
| 65820 |
RELIEVE INNER EYE PRESSURE
|
$XXX.XX
|
| 65850 |
INCISION OF EYE
|
$XXX.XX
|
| 65855 |
TRABECULOPLASTY LASER SURG
|
$XXX.XX
|
| 65860 |
INCISE INNER EYE ADHESIONS
|
$XXX.XX
|
| 65865 |
INCISE INNER EYE ADHESIONS
|
$XXX.XX
|
| 65870 |
INCISE INNER EYE ADHESIONS
|
$XXX.XX
|
| 65875 |
INCISE INNER EYE ADHESIONS
|
$XXX.XX
|
| 65880 |
INCISE INNER EYE ADHESIONS
|
$XXX.XX
|
| 65900 |
REMOVE EYE LESION
|
$XXX.XX
|
| 65920 |
REMOVE IMPLANT OF EYE
|
$XXX.XX
|
| 65930 |
REMOVE BLOOD CLOT FROM EYE
|
$XXX.XX
|
| 66020 |
INJECTION TREATMENT OF EYE
|
$XXX.XX
|
| 66030 |
INJECTION TREATMENT OF EYE
|
$XXX.XX
|
| 66130 |
REMOVE EYE LESION
|
$XXX.XX
|
| 66150 |
GLAUCOMA SURGERY
|
$XXX.XX
|
| 66155 |
GLAUCOMA SURGERY
|
$XXX.XX
|
| 66160 |
GLAUCOMA SURGERY
|
$XXX.XX
|
| 66170 |
GLAUCOMA SURGERY
|
$XXX.XX
|
| 66172 |
INCISION OF EYE
|
$XXX.XX
|
| 66174 |
TRANSLUM DIL EYE CANAL
|
$XXX.XX
|
| 66175 |
TRNSLUM DIL EYE CANAL W/STNT
|
$XXX.XX
|
| 66179 |
AQUEOUS SHUNT EYE W/O GRAFT
|
$XXX.XX
|
| 66180 |
AQUEOUS SHUNT EYE W/GRAFT
|
$XXX.XX
|
| 66183 |
INSERT ANT DRAINAGE DEVICE
|
$XXX.XX
|
| 66184 |
REVISION OF AQUEOUS SHUNT
|
$XXX.XX
|
| 66185 |
REVISE AQUEOUS SHUNT EYE
|
$XXX.XX
|
| 66225 |
REPAIR/GRAFT EYE LESION
|
$XXX.XX
|
| 66250 |
FOLLOW-UP SURGERY OF EYE
|
$XXX.XX
|
| 66500 |
INCISION OF IRIS
|
$XXX.XX
|
| 66505 |
INCISION OF IRIS
|
$XXX.XX
|
| 66600 |
REMOVE IRIS AND LESION
|
$XXX.XX
|
| 66605 |
REMOVAL OF IRIS
|
$XXX.XX
|
| 66625 |
REMOVAL OF IRIS
|
$XXX.XX
|
| 66630 |
REMOVAL OF IRIS
|
$XXX.XX
|
| 66635 |
REMOVAL OF IRIS
|
$XXX.XX
|
| 66680 |
REPAIR IRIS & CILIARY BODY
|
$XXX.XX
|
| 66682 |
REPAIR IRIS & CILIARY BODY
|
$XXX.XX
|
| 66700 |
DESTRUCTION CILIARY BODY
|
$XXX.XX
|
| 66710 |
CILIARY TRANSSLERAL THERAPY
|
$XXX.XX
|
| 66711 |
ECP CILIARY BODY DESTRUCTION
|
$XXX.XX
|
| 66720 |
DESTRUCTION CILIARY BODY
|
$XXX.XX
|
| 66740 |
DESTRUCTION CILIARY BODY
|
$XXX.XX
|
| 66761 |
REVISION OF IRIS
|
$XXX.XX
|
| 66762 |
REVISION OF IRIS
|
$XXX.XX
|
| 66770 |
REMOVAL OF INNER EYE LESION
|
$XXX.XX
|
| 66820 |
INCISION SECONDARY CATARACT
|
$XXX.XX
|
| 66821 |
AFTER CATARACT LASER SURGERY
|
$XXX.XX
|
| 66825 |
REPOSITION INTRAOCULAR LENS
|
$XXX.XX
|
| 66830 |
REMOVAL OF LENS LESION
|
$XXX.XX
|
| 66840 |
REMOVAL OF LENS MATERIAL
|
$XXX.XX
|
| 66850 |
REMOVAL OF LENS MATERIAL
|
$XXX.XX
|
| 66852 |
REMOVAL OF LENS MATERIAL
|
$XXX.XX
|
| 66920 |
EXTRACTION OF LENS
|
$XXX.XX
|
| 66930 |
EXTRACTION OF LENS
|
$XXX.XX
|
| 66940 |
EXTRACTION OF LENS
|
$XXX.XX
|
| 66982 |
XCAPSL CTRC RMVL CPLX WO ECP
|
$XXX.XX
|
| 66984 |
XCAPSL CTRC RMVL W/O ECP
|
$XXX.XX
|
| 66985 |
INSERT LENS PROSTHESIS
|
$XXX.XX
|
| 66986 |
EXCHANGE LENS PROSTHESIS
|
$XXX.XX
|
| 66990 |
OPHTHALMIC ENDOSCOPE ADD-ON
|
$XXX.XX
|
| 67005 |
PARTIAL REMOVAL OF EYE FLUID
|
$XXX.XX
|
| 67010 |
PARTIAL REMOVAL OF EYE FLUID
|
$XXX.XX
|
| 67015 |
RELEASE OF EYE FLUID
|
$XXX.XX
|
| 67025 |
REPLACE EYE FLUID
|
$XXX.XX
|
| 67027 |
IMPLANT EYE DRUG SYSTEM
|
$XXX.XX
|
| 67028 |
INJECTION EYE DRUG
|
$XXX.XX
|
| 67030 |
INCISE INNER EYE STRANDS
|
$XXX.XX
|
| 67031 |
LASER SURGERY EYE STRANDS
|
$XXX.XX
|
| 67036 |
REMOVAL OF INNER EYE FLUID
|
$XXX.XX
|
| 67039 |
LASER TREATMENT OF RETINA
|
$XXX.XX
|
| 67040 |
LASER TREATMENT OF RETINA
|
$XXX.XX
|
| 67041 |
VIT FOR MACULAR PUCKER
|
$XXX.XX
|
| 67042 |
VIT FOR MACULAR HOLE
|
$XXX.XX
|
| 67043 |
VIT FOR MEMBRANE DISSECT
|
$XXX.XX
|
| 67101 |
REPAIR DETACHED RETINA CRTX
|
$XXX.XX
|
| 67105 |
REPAIR DETACHED RETINA PC
|
$XXX.XX
|
| 67107 |
REPAIR DETACHED RETINA
|
$XXX.XX
|
| 67108 |
REPAIR DETACHED RETINA
|
$XXX.XX
|
| 67110 |
REPAIR DETACHED RETINA
|
$XXX.XX
|
| 67113 |
REPAIR RETINAL DETACH CPLX
|
$XXX.XX
|
| 67115 |
RELEASE ENCIRCLING MATERIAL
|
$XXX.XX
|
| 67120 |
REMOVE EYE IMPLANT MATERIAL
|
$XXX.XX
|
| 67121 |
REMOVE EYE IMPLANT MATERIAL
|
$XXX.XX
|
| 67141 |
TREATMENT OF RETINA
|
$XXX.XX
|
| 67145 |
TREATMENT OF RETINA
|
$XXX.XX
|
| 67208 |
TREATMENT OF RETINAL LESION
|
$XXX.XX
|
| 67210 |
TREATMENT OF RETINAL LESION
|
$XXX.XX
|
| 67218 |
TREATMENT OF RETINAL LESION
|
$XXX.XX
|
| 67220 |
TREATMENT OF CHOROID LESION
|
$XXX.XX
|
| 67221 |
OCULAR PHOTODYNAMIC THER
|
$XXX.XX
|
| 67225 |
EYE PHOTODYNAMIC THER ADD-ON
|
$XXX.XX
|
| 67227 |
DSTRJ EXTENSIVE RETINOPATHY
|
$XXX.XX
|
| 67228 |
TREATMENT X10SV RETINOPATHY
|
$XXX.XX
|
| 67229 |
TR RETINAL LES PRETERM INF
|
$XXX.XX
|
| 67250 |
REINFORCE EYE WALL
|
$XXX.XX
|
| 67255 |
REINFORCE/GRAFT EYE WALL
|
$XXX.XX
|
| 67311 |
REVISE EYE MUSCLE
|
$XXX.XX
|
| 67312 |
REVISE TWO EYE MUSCLES
|
$XXX.XX
|
| 67314 |
REVISE EYE MUSCLE
|
$XXX.XX
|
| 67316 |
REVISE TWO EYE MUSCLES
|
$XXX.XX
|
| 67318 |
REVISE EYE MUSCLE(S)
|
$XXX.XX
|
| 67320 |
REVISE EYE MUSCLE(S) ADD-ON
|
$XXX.XX
|
| 67331 |
EYE SURGERY FOLLOW-UP ADD-ON
|
$XXX.XX
|
| 67332 |
REREVISE EYE MUSCLES ADD-ON
|
$XXX.XX
|
| 67334 |
REVISE EYE MUSCLE W/SUTURE
|
$XXX.XX
|
| 67335 |
EYE SUTURE DURING SURGERY
|
$XXX.XX
|
| 67340 |
REVISE EYE MUSCLE ADD-ON
|
$XXX.XX
|
| 67343 |
RELEASE EYE TISSUE
|
$XXX.XX
|
| 67345 |
DESTROY NERVE OF EYE MUSCLE
|
$XXX.XX
|
| 67346 |
BIOPSY EYE MUSCLE
|
$XXX.XX
|
| 67400 |
EXPLORE/BIOPSY EYE SOCKET
|
$XXX.XX
|
| 67405 |
EXPLORE/DRAIN EYE SOCKET
|
$XXX.XX
|
| 67412 |
EXPLORE/TREAT EYE SOCKET
|
$XXX.XX
|
| 67413 |
EXPLORE/TREAT EYE SOCKET
|
$XXX.XX
|
| 67414 |
EXPLR/DECOMPRESS EYE SOCKET
|
$XXX.XX
|
| 67415 |
ASPIRATION ORBITAL CONTENTS
|
$XXX.XX
|
| 67420 |
EXPLORE/TREAT EYE SOCKET
|
$XXX.XX
|
| 67430 |
EXPLORE/TREAT EYE SOCKET
|
$XXX.XX
|
| 67440 |
EXPLORE/DRAIN EYE SOCKET
|
$XXX.XX
|
| 67445 |
EXPLR/DECOMPRESS EYE SOCKET
|
$XXX.XX
|
| 67450 |
EXPLORE/BIOPSY EYE SOCKET
|
$XXX.XX
|
| 67500 |
INJECT/TREAT EYE SOCKET
|
$XXX.XX
|
| 67505 |
INJECT/TREAT EYE SOCKET
|
$XXX.XX
|
| 67515 |
INJECT/TREAT EYE SOCKET
|
$XXX.XX
|
| 67550 |
INSERT EYE SOCKET IMPLANT
|
$XXX.XX
|
| 67560 |
REVISE EYE SOCKET IMPLANT
|
$XXX.XX
|
| 67570 |
DECOMPRESS OPTIC NERVE
|
$XXX.XX
|
| 67700 |
DRAINAGE OF EYELID ABSCESS
|
$XXX.XX
|
| 67710 |
INCISION OF EYELID
|
$XXX.XX
|
| 67715 |
INCISION OF EYELID FOLD
|
$XXX.XX
|
| 67800 |
REMOVE EYELID LESION
|
$XXX.XX
|
| 67801 |
REMOVE EYELID LESIONS
|
$XXX.XX
|
| 67805 |
REMOVE EYELID LESIONS
|
$XXX.XX
|
| 67808 |
REMOVE EYELID LESION(S)
|
$XXX.XX
|
| 67810 |
BIOPSY EYELID & LID MARGIN
|
$XXX.XX
|
| 67820 |
REVISE EYELASHES
|
$XXX.XX
|
| 67825 |
REVISE EYELASHES
|
$XXX.XX
|
| 67830 |
REVISE EYELASHES
|
$XXX.XX
|
| 67835 |
REVISE EYELASHES
|
$XXX.XX
|
| 67840 |
REMOVE EYELID LESION
|
$XXX.XX
|
| 67850 |
TREAT EYELID LESION
|
$XXX.XX
|
| 67875 |
CLOSURE OF EYELID BY SUTURE
|
$XXX.XX
|
| 67880 |
REVISION OF EYELID
|
$XXX.XX
|
| 67882 |
REVISION OF EYELID
|
$XXX.XX
|
| 67900 |
REPAIR BROW DEFECT
|
$XXX.XX
|
| 67901 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67902 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67903 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67904 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67906 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67908 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67909 |
REVISE EYELID DEFECT
|
$XXX.XX
|
| 67911 |
REVISE EYELID DEFECT
|
$XXX.XX
|
| 67912 |
CORRECTION EYELID W/IMPLANT
|
$XXX.XX
|
| 67914 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67915 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67916 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67917 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67921 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67922 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67923 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67924 |
REPAIR EYELID DEFECT
|
$XXX.XX
|
| 67930 |
REPAIR EYELID WOUND
|
$XXX.XX
|
| 67935 |
REPAIR EYELID WOUND
|
$XXX.XX
|
| 67938 |
REMOVE EYELID FOREIGN BODY
|
$XXX.XX
|
| 67950 |
REVISION OF EYELID
|
$XXX.XX
|
| 67961 |
REVISION OF EYELID
|
$XXX.XX
|
| 67966 |
REVISION OF EYELID
|
$XXX.XX
|
| 67971 |
RECONSTRUCTION OF EYELID
|
$XXX.XX
|
| 67973 |
RECONSTRUCTION OF EYELID
|
$XXX.XX
|
| 67974 |
RECONSTRUCTION OF EYELID
|
$XXX.XX
|
| 67975 |
RECONSTRUCTION OF EYELID
|
$XXX.XX
|
| 68020 |
INCISE/DRAIN EYELID LINING
|
$XXX.XX
|
| 68040 |
TREATMENT OF EYELID LESIONS
|
$XXX.XX
|
| 68100 |
BIOPSY OF EYELID LINING
|
$XXX.XX
|
| 68110 |
REMOVE EYELID LINING LESION
|
$XXX.XX
|
| 68115 |
REMOVE EYELID LINING LESION
|
$XXX.XX
|
| 68130 |
REMOVE EYELID LINING LESION
|
$XXX.XX
|
| 68135 |
REMOVE EYELID LINING LESION
|
$XXX.XX
|
| 68200 |
TREAT EYELID BY INJECTION
|
$XXX.XX
|
| 68320 |
REVISE/GRAFT EYELID LINING
|
$XXX.XX
|
| 68325 |
REVISE/GRAFT EYELID LINING
|
$XXX.XX
|
| 68326 |
REVISE/GRAFT EYELID LINING
|
$XXX.XX
|
| 68328 |
REVISE/GRAFT EYELID LINING
|
$XXX.XX
|
| 68330 |
REVISE EYELID LINING
|
$XXX.XX
|
| 68335 |
REVISE/GRAFT EYELID LINING
|
$XXX.XX
|
| 68340 |
SEPARATE EYELID ADHESIONS
|
$XXX.XX
|
| 68360 |
REVISE EYELID LINING
|
$XXX.XX
|
| 68362 |
REVISE EYELID LINING
|
$XXX.XX
|
| 68371 |
HARVEST EYE TISSUE ALOGRAFT
|
$XXX.XX
|
| 68400 |
INCISE/DRAIN TEAR GLAND
|
$XXX.XX
|
| 68420 |
INCISE/DRAIN TEAR SAC
|
$XXX.XX
|
| 68440 |
INCISE TEAR DUCT OPENING
|
$XXX.XX
|
| 68500 |
REMOVAL OF TEAR GLAND
|
$XXX.XX
|
| 68505 |
PARTIAL REMOVAL TEAR GLAND
|
$XXX.XX
|
| 68510 |
BIOPSY OF TEAR GLAND
|
$XXX.XX
|
| 68520 |
REMOVAL OF TEAR SAC
|
$XXX.XX
|
| 68525 |
BIOPSY OF TEAR SAC
|
$XXX.XX
|
| 68530 |
CLEARANCE OF TEAR DUCT
|
$XXX.XX
|
| 68540 |
REMOVE TEAR GLAND LESION
|
$XXX.XX
|
| 68550 |
REMOVE TEAR GLAND LESION
|
$XXX.XX
|
| 68700 |
REPAIR TEAR DUCTS
|
$XXX.XX
|
| 68705 |
REVISE TEAR DUCT OPENING
|
$XXX.XX
|
| 68720 |
CREATE TEAR SAC DRAIN
|
$XXX.XX
|
| 68745 |
CREATE TEAR DUCT DRAIN
|
$XXX.XX
|
| 68750 |
CREATE TEAR DUCT DRAIN
|
$XXX.XX
|
| 68760 |
CLOSE TEAR DUCT OPENING
|
$XXX.XX
|
| 68761 |
CLOSE TEAR DUCT OPENING
|
$XXX.XX
|
| 68770 |
CLOSE TEAR SYSTEM FISTULA
|
$XXX.XX
|
| 68801 |
DILATE TEAR DUCT OPENING
|
$XXX.XX
|
| 68810 |
PROBE NASOLACRIMAL DUCT
|
$XXX.XX
|
| 68811 |
PROBE NASOLACRIMAL DUCT
|
$XXX.XX
|
| 68815 |
PROBE NASOLACRIMAL DUCT
|
$XXX.XX
|
| 68816 |
PROBE NL DUCT W/BALLOON
|
$XXX.XX
|
| 68840 |
EXPLORE/IRRIGATE TEAR DUCTS
|
$XXX.XX
|
| 68850 |
INJECTION FOR TEAR SAC X-RAY
|
$XXX.XX
|
| 69000 |
DRAIN EXTERNAL EAR LESION
|
$XXX.XX
|
| 69005 |
DRAIN EXTERNAL EAR LESION
|
$XXX.XX
|
| 69020 |
DRAIN OUTER EAR CANAL LESION
|
$XXX.XX
|
| 69100 |
BIOPSY OF EXTERNAL EAR
|
$XXX.XX
|
| 69105 |
BIOPSY OF EXTERNAL EAR CANAL
|
$XXX.XX
|
| 69110 |
REMOVE EXTERNAL EAR PARTIAL
|
$XXX.XX
|
| 69120 |
REMOVAL OF EXTERNAL EAR
|
$XXX.XX
|
| 69140 |
REMOVE EAR CANAL LESION(S)
|
$XXX.XX
|
| 69145 |
REMOVE EAR CANAL LESION(S)
|
$XXX.XX
|
| 69150 |
EXTENSIVE EAR CANAL SURGERY
|
$XXX.XX
|
| 69155 |
EXTENSIVE EAR/NECK SURGERY
|
$XXX.XX
|
| 69200 |
CLEAR OUTER EAR CANAL
|
$XXX.XX
|
| 69205 |
CLEAR OUTER EAR CANAL
|
$XXX.XX
|
| 69209 |
REMOVE IMPACTED EAR WAX UNI
|
$XXX.XX
|
| 69210 |
REMOVE IMPACTED EAR WAX UNI
|
$XXX.XX
|
| 69220 |
CLEAN OUT MASTOID CAVITY
|
$XXX.XX
|
| 69222 |
CLEAN OUT MASTOID CAVITY
|
$XXX.XX
|
| 69300 |
REVISE EXTERNAL EAR
|
$XXX.XX
|
| 69310 |
REBUILD OUTER EAR CANAL
|
$XXX.XX
|
| 69320 |
REBUILD OUTER EAR CANAL
|
$XXX.XX
|
| 69420 |
INCISION OF EARDRUM
|
$XXX.XX
|
| 69421 |
INCISION OF EARDRUM
|
$XXX.XX
|
| 69424 |
REMOVE VENTILATING TUBE
|
$XXX.XX
|
| 69433 |
CREATE EARDRUM OPENING
|
$XXX.XX
|
| 69436 |
CREATE EARDRUM OPENING
|
$XXX.XX
|
| 69440 |
EXPLORATION OF MIDDLE EAR
|
$XXX.XX
|
| 69450 |
EARDRUM REVISION
|
$XXX.XX
|
| 69501 |
MASTOIDECTOMY
|
$XXX.XX
|
| 69502 |
MASTOIDECTOMY
|
$XXX.XX
|
| 69505 |
REMOVE MASTOID STRUCTURES
|
$XXX.XX
|
| 69511 |
EXTENSIVE MASTOID SURGERY
|
$XXX.XX
|
| 69530 |
EXTENSIVE MASTOID SURGERY
|
$XXX.XX
|
| 69535 |
REMOVE PART OF TEMPORAL BONE
|
$XXX.XX
|
| 69540 |
REMOVE EAR LESION
|
$XXX.XX
|
| 69550 |
REMOVE EAR LESION
|
$XXX.XX
|
| 69552 |
REMOVE EAR LESION
|
$XXX.XX
|
| 69554 |
REMOVE EAR LESION
|
$XXX.XX
|
| 69601 |
MASTOID SURGERY REVISION
|
$XXX.XX
|
| 69602 |
MASTOID SURGERY REVISION
|
$XXX.XX
|
| 69603 |
MASTOID SURGERY REVISION
|
$XXX.XX
|
| 69604 |
MASTOID SURGERY REVISION
|
$XXX.XX
|
| 69605 |
MASTOID SURGERY REVISION
|
$XXX.XX
|
| 69610 |
REPAIR OF EARDRUM
|
$XXX.XX
|
| 69620 |
REPAIR OF EARDRUM
|
$XXX.XX
|
| 69631 |
REPAIR EARDRUM STRUCTURES
|
$XXX.XX
|
| 69632 |
REBUILD EARDRUM STRUCTURES
|
$XXX.XX
|
| 69633 |
REBUILD EARDRUM STRUCTURES
|
$XXX.XX
|
| 69635 |
REPAIR EARDRUM STRUCTURES
|
$XXX.XX
|
| 69636 |
REBUILD EARDRUM STRUCTURES
|
$XXX.XX
|
| 69637 |
REBUILD EARDRUM STRUCTURES
|
$XXX.XX
|
| 69641 |
REVISE MIDDLE EAR & MASTOID
|
$XXX.XX
|
| 69642 |
REVISE MIDDLE EAR & MASTOID
|
$XXX.XX
|
| 69643 |
REVISE MIDDLE EAR & MASTOID
|
$XXX.XX
|
| 69644 |
REVISE MIDDLE EAR & MASTOID
|
$XXX.XX
|
| 69645 |
REVISE MIDDLE EAR & MASTOID
|
$XXX.XX
|
| 69646 |
REVISE MIDDLE EAR & MASTOID
|
$XXX.XX
|
| 69650 |
RELEASE MIDDLE EAR BONE
|
$XXX.XX
|
| 69660 |
REVISE MIDDLE EAR BONE
|
$XXX.XX
|
| 69661 |
REVISE MIDDLE EAR BONE
|
$XXX.XX
|
| 69662 |
REVISE MIDDLE EAR BONE
|
$XXX.XX
|
| 69666 |
REPAIR MIDDLE EAR STRUCTURES
|
$XXX.XX
|
| 69667 |
REPAIR MIDDLE EAR STRUCTURES
|
$XXX.XX
|
| 69670 |
REMOVE MASTOID AIR CELLS
|
$XXX.XX
|
| 69676 |
REMOVE MIDDLE EAR NERVE
|
$XXX.XX
|
| 69700 |
CLOSE MASTOID FISTULA
|
$XXX.XX
|
| 69711 |
REMOVE/REPAIR HEARING AID
|
$XXX.XX
|
| 69714 |
IMPLANT TEMPLE BONE W/STIMUL
|
$XXX.XX
|
| 69715 |
TEMPLE BNE IMPLNT W/STIMULAT
|
$XXX.XX
|
| 69717 |
TEMPLE BONE IMPLANT REVISION
|
$XXX.XX
|
| 69718 |
REVISE TEMPLE BONE IMPLANT
|
$XXX.XX
|
| 69720 |
RELEASE FACIAL NERVE
|
$XXX.XX
|
| 69725 |
RELEASE FACIAL NERVE
|
$XXX.XX
|
| 69740 |
REPAIR FACIAL NERVE
|
$XXX.XX
|
| 69745 |
REPAIR FACIAL NERVE
|
$XXX.XX
|
| 69801 |
INCISE INNER EAR
|
$XXX.XX
|
| 69805 |
EXPLORE INNER EAR
|
$XXX.XX
|
| 69806 |
EXPLORE INNER EAR
|
$XXX.XX
|
| 69905 |
REMOVE INNER EAR
|
$XXX.XX
|
| 69910 |
REMOVE INNER EAR & MASTOID
|
$XXX.XX
|
| 69915 |
INCISE INNER EAR NERVE
|
$XXX.XX
|
| 69930 |
IMPLANT COCHLEAR DEVICE
|
$XXX.XX
|
| 69950 |
INCISE INNER EAR NERVE
|
$XXX.XX
|
| 69955 |
RELEASE FACIAL NERVE
|
$XXX.XX
|
| 69960 |
RELEASE INNER EAR CANAL
|
$XXX.XX
|
| 69970 |
REMOVE INNER EAR LESION
|
$XXX.XX
|
| 69990 |
MICROSURGERY ADD-ON
|
$XXX.XX
|
| 70010 |
CONTRAST X-RAY OF BRAIN
|
$XXX.XX
|
| 70015 |
CONTRAST X-RAY OF BRAIN
|
$XXX.XX
|
| 70015-26 |
CONTRAST X-RAY OF BRAIN
|
$XXX.XX
|
| 70015-TC |
CONTRAST X-RAY OF BRAIN
|
$XXX.XX
|
| 70030 |
X-RAY EYE FOR FOREIGN BODY
|
$XXX.XX
|
| 70030-26 |
X-RAY EYE FOR FOREIGN BODY
|
$XXX.XX
|
| 70030-TC |
X-RAY EYE FOR FOREIGN BODY
|
$XXX.XX
|
| 70100 |
X-RAY EXAM OF JAW <4VIEWS
|
$XXX.XX
|
| 70100-26 |
X-RAY EXAM OF JAW <4VIEWS
|
$XXX.XX
|
| 70100-TC |
X-RAY EXAM OF JAW <4VIEWS
|
$XXX.XX
|
| 70110 |
X-RAY EXAM OF JAW 4/> VIEWS
|
$XXX.XX
|
| 70110-26 |
X-RAY EXAM OF JAW 4/> VIEWS
|
$XXX.XX
|
| 70110-TC |
X-RAY EXAM OF JAW 4/> VIEWS
|
$XXX.XX
|
| 70120 |
X-RAY EXAM OF MASTOIDS
|
$XXX.XX
|
| 70120-26 |
X-RAY EXAM OF MASTOIDS
|
$XXX.XX
|
| 70120-TC |
X-RAY EXAM OF MASTOIDS
|
$XXX.XX
|
| 70130 |
X-RAY EXAM OF MASTOIDS
|
$XXX.XX
|
| 70130-26 |
X-RAY EXAM OF MASTOIDS
|
$XXX.XX
|
| 70130-TC |
X-RAY EXAM OF MASTOIDS
|
$XXX.XX
|
| 70134 |
X-RAY EXAM OF MIDDLE EAR
|
$XXX.XX
|
| 70134-26 |
X-RAY EXAM OF MIDDLE EAR
|
$XXX.XX
|
| 70134-TC |
X-RAY EXAM OF MIDDLE EAR
|
$XXX.XX
|
| 70140 |
X-RAY EXAM OF FACIAL BONES
|
$XXX.XX
|
| 70140-26 |
X-RAY EXAM OF FACIAL BONES
|
$XXX.XX
|
| 70140-TC |
X-RAY EXAM OF FACIAL BONES
|
$XXX.XX
|
| 70150 |
X-RAY EXAM OF FACIAL BONES
|
$XXX.XX
|
| 70150-26 |
X-RAY EXAM OF FACIAL BONES
|
$XXX.XX
|
| 70150-TC |
X-RAY EXAM OF FACIAL BONES
|
$XXX.XX
|
| 70160 |
X-RAY EXAM OF NASAL BONES
|
$XXX.XX
|
| 70160-26 |
X-RAY EXAM OF NASAL BONES
|
$XXX.XX
|
| 70160-TC |
X-RAY EXAM OF NASAL BONES
|
$XXX.XX
|
| 70170-26 |
X-RAY EXAM OF TEAR DUCT
|
$XXX.XX
|
| 70190 |
X-RAY EXAM OF EYE SOCKETS
|
$XXX.XX
|
| 70190-26 |
X-RAY EXAM OF EYE SOCKETS
|
$XXX.XX
|
| 70190-TC |
X-RAY EXAM OF EYE SOCKETS
|
$XXX.XX
|
| 70200 |
X-RAY EXAM OF EYE SOCKETS
|
$XXX.XX
|
| 70200-26 |
X-RAY EXAM OF EYE SOCKETS
|
$XXX.XX
|
| 70200-TC |
X-RAY EXAM OF EYE SOCKETS
|
$XXX.XX
|
| 70210 |
X-RAY EXAM OF SINUSES
|
$XXX.XX
|
| 70210-26 |
X-RAY EXAM OF SINUSES
|
$XXX.XX
|
| 70210-TC |
X-RAY EXAM OF SINUSES
|
$XXX.XX
|
| 70220 |
X-RAY EXAM OF SINUSES
|
$XXX.XX
|
| 70220-26 |
X-RAY EXAM OF SINUSES
|
$XXX.XX
|
| 70220-TC |
X-RAY EXAM OF SINUSES
|
$XXX.XX
|
| 70240 |
X-RAY EXAM PITUITARY SADDLE
|
$XXX.XX
|
| 70240-26 |
X-RAY EXAM PITUITARY SADDLE
|
$XXX.XX
|
| 70240-TC |
X-RAY EXAM PITUITARY SADDLE
|
$XXX.XX
|
| 70250 |
X-RAY EXAM OF SKULL
|
$XXX.XX
|
| 70250-26 |
X-RAY EXAM OF SKULL
|
$XXX.XX
|
| 70250-TC |
X-RAY EXAM OF SKULL
|
$XXX.XX
|
| 70260 |
X-RAY EXAM OF SKULL
|
$XXX.XX
|
| 70260-26 |
X-RAY EXAM OF SKULL
|
$XXX.XX
|
| 70260-TC |
X-RAY EXAM OF SKULL
|
$XXX.XX
|
| 70300 |
X-RAY EXAM OF TEETH
|
$XXX.XX
|
| 70300-26 |
X-RAY EXAM OF TEETH
|
$XXX.XX
|
| 70300-TC |
X-RAY EXAM OF TEETH
|
$XXX.XX
|
| 70310 |
X-RAY EXAM OF TEETH
|
$XXX.XX
|
| 70310-26 |
X-RAY EXAM OF TEETH
|
$XXX.XX
|
| 70310-TC |
X-RAY EXAM OF TEETH
|
$XXX.XX
|
| 70320 |
FULL MOUTH X-RAY OF TEETH
|
$XXX.XX
|
| 70320-26 |
FULL MOUTH X-RAY OF TEETH
|
$XXX.XX
|
| 70320-TC |
FULL MOUTH X-RAY OF TEETH
|
$XXX.XX
|
| 70328 |
X-RAY EXAM OF JAW JOINT
|
$XXX.XX
|
| 70328-26 |
X-RAY EXAM OF JAW JOINT
|
$XXX.XX
|
| 70328-TC |
X-RAY EXAM OF JAW JOINT
|
$XXX.XX
|
| 70330 |
X-RAY EXAM OF JAW JOINTS
|
$XXX.XX
|
| 70330-26 |
X-RAY EXAM OF JAW JOINTS
|
$XXX.XX
|
| 70330-TC |
X-RAY EXAM OF JAW JOINTS
|
$XXX.XX
|
| 70332 |
X-RAY EXAM OF JAW JOINT
|
$XXX.XX
|
| 70332-26 |
X-RAY EXAM OF JAW JOINT
|
$XXX.XX
|
| 70332-TC |
X-RAY EXAM OF JAW JOINT
|
$XXX.XX
|
| 70336 |
MAGNETIC IMAGE JAW JOINT
|
$XXX.XX
|
| 70336-26 |
MAGNETIC IMAGE JAW JOINT
|
$XXX.XX
|
| 70336-TC |
MAGNETIC IMAGE JAW JOINT
|
$XXX.XX
|
| 70350 |
X-RAY HEAD FOR ORTHODONTIA
|
$XXX.XX
|
| 70350-26 |
X-RAY HEAD FOR ORTHODONTIA
|
$XXX.XX
|
| 70350-TC |
X-RAY HEAD FOR ORTHODONTIA
|
$XXX.XX
|
| 70355 |
PANORAMIC X-RAY OF JAWS
|
$XXX.XX
|
| 70355-26 |
PANORAMIC X-RAY OF JAWS
|
$XXX.XX
|
| 70355-TC |
PANORAMIC X-RAY OF JAWS
|
$XXX.XX
|
| 70360 |
X-RAY EXAM OF NECK
|
$XXX.XX
|
| 70360-26 |
X-RAY EXAM OF NECK
|
$XXX.XX
|
| 70360-TC |
X-RAY EXAM OF NECK
|
$XXX.XX
|
| 70370 |
THROAT X-RAY & FLUOROSCOPY
|
$XXX.XX
|
| 70370-26 |
THROAT X-RAY & FLUOROSCOPY
|
$XXX.XX
|
| 70370-TC |
THROAT X-RAY & FLUOROSCOPY
|
$XXX.XX
|
| 70371 |
SPEECH EVALUATION COMPLEX
|
$XXX.XX
|
| 70371-26 |
SPEECH EVALUATION COMPLEX
|
$XXX.XX
|
| 70371-TC |
SPEECH EVALUATION COMPLEX
|
$XXX.XX
|
| 70380 |
X-RAY EXAM OF SALIVARY GLAND
|
$XXX.XX
|
| 70380-26 |
X-RAY EXAM OF SALIVARY GLAND
|
$XXX.XX
|
| 70380-TC |
X-RAY EXAM OF SALIVARY GLAND
|
$XXX.XX
|
| 70390 |
X-RAY EXAM OF SALIVARY DUCT
|
$XXX.XX
|
| 70390-26 |
X-RAY EXAM OF SALIVARY DUCT
|
$XXX.XX
|
| 70390-TC |
X-RAY EXAM OF SALIVARY DUCT
|
$XXX.XX
|
| 70450 |
CT HEAD/BRAIN W/O DYE
|
$XXX.XX
|
| 70450-26 |
CT HEAD/BRAIN W/O DYE
|
$XXX.XX
|
| 70450-TC |
CT HEAD/BRAIN W/O DYE
|
$XXX.XX
|
| 70460 |
CT HEAD/BRAIN W/DYE
|
$XXX.XX
|
| 70460-26 |
CT HEAD/BRAIN W/DYE
|
$XXX.XX
|
| 70460-TC |
CT HEAD/BRAIN W/DYE
|
$XXX.XX
|
| 70470 |
CT HEAD/BRAIN W/O & W/DYE
|
$XXX.XX
|
| 70470-26 |
CT HEAD/BRAIN W/O & W/DYE
|
$XXX.XX
|
| 70470-TC |
CT HEAD/BRAIN W/O & W/DYE
|
$XXX.XX
|
| 70480 |
CT ORBIT/EAR/FOSSA W/O DYE
|
$XXX.XX
|
| 70480-26 |
CT ORBIT/EAR/FOSSA W/O DYE
|
$XXX.XX
|
| 70480-TC |
CT ORBIT/EAR/FOSSA W/O DYE
|
$XXX.XX
|
| 70481 |
CT ORBIT/EAR/FOSSA W/DYE
|
$XXX.XX
|
| 70481-26 |
CT ORBIT/EAR/FOSSA W/DYE
|
$XXX.XX
|
| 70481-TC |
CT ORBIT/EAR/FOSSA W/DYE
|
$XXX.XX
|
| 70482 |
CT ORBIT/EAR/FOSSA W/O&W/DYE
|
$XXX.XX
|
| 70482-26 |
CT ORBIT/EAR/FOSSA W/O&W/DYE
|
$XXX.XX
|
| 70482-TC |
CT ORBIT/EAR/FOSSA W/O&W/DYE
|
$XXX.XX
|
| 70486 |
CT MAXILLOFACIAL W/O DYE
|
$XXX.XX
|
| 70486-26 |
CT MAXILLOFACIAL W/O DYE
|
$XXX.XX
|
| 70486-TC |
CT MAXILLOFACIAL W/O DYE
|
$XXX.XX
|
| 70487 |
CT MAXILLOFACIAL W/DYE
|
$XXX.XX
|
| 70487-26 |
CT MAXILLOFACIAL W/DYE
|
$XXX.XX
|
| 70487-TC |
CT MAXILLOFACIAL W/DYE
|
$XXX.XX
|
| 70488 |
CT MAXILLOFACIAL W/O & W/DYE
|
$XXX.XX
|
| 70488-26 |
CT MAXILLOFACIAL W/O & W/DYE
|
$XXX.XX
|
| 70488-TC |
CT MAXILLOFACIAL W/O & W/DYE
|
$XXX.XX
|
| 70490 |
CT SOFT TISSUE NECK W/O DYE
|
$XXX.XX
|
| 70490-26 |
CT SOFT TISSUE NECK W/O DYE
|
$XXX.XX
|
| 70490-TC |
CT SOFT TISSUE NECK W/O DYE
|
$XXX.XX
|
| 70491 |
CT SOFT TISSUE NECK W/DYE
|
$XXX.XX
|
| 70491-26 |
CT SOFT TISSUE NECK W/DYE
|
$XXX.XX
|
| 70491-TC |
CT SOFT TISSUE NECK W/DYE
|
$XXX.XX
|
| 70492 |
CT SFT TSUE NCK W/O & W/DYE
|
$XXX.XX
|
| 70492-26 |
CT SFT TSUE NCK W/O & W/DYE
|
$XXX.XX
|
| 70492-TC |
CT SFT TSUE NCK W/O & W/DYE
|
$XXX.XX
|
| 70496 |
CT ANGIOGRAPHY HEAD
|
$XXX.XX
|
| 70496-26 |
CT ANGIOGRAPHY HEAD
|
$XXX.XX
|
| 70496-TC |
CT ANGIOGRAPHY HEAD
|
$XXX.XX
|
| 70498 |
CT ANGIOGRAPHY NECK
|
$XXX.XX
|
| 70498-26 |
CT ANGIOGRAPHY NECK
|
$XXX.XX
|
| 70498-TC |
CT ANGIOGRAPHY NECK
|
$XXX.XX
|
| 70540 |
MRI ORBIT/FACE/NECK W/O DYE
|
$XXX.XX
|
| 70540-26 |
MRI ORBIT/FACE/NECK W/O DYE
|
$XXX.XX
|
| 70540-TC |
MRI ORBIT/FACE/NECK W/O DYE
|
$XXX.XX
|
| 70542 |
MRI ORBIT/FACE/NECK W/DYE
|
$XXX.XX
|
| 70542-26 |
MRI ORBIT/FACE/NECK W/DYE
|
$XXX.XX
|
| 70542-TC |
MRI ORBIT/FACE/NECK W/DYE
|
$XXX.XX
|
| 70543 |
MRI ORBT/FAC/NCK W/O &W/DYE
|
$XXX.XX
|
| 70543-26 |
MRI ORBT/FAC/NCK W/O &W/DYE
|
$XXX.XX
|
| 70543-TC |
MRI ORBT/FAC/NCK W/O &W/DYE
|
$XXX.XX
|
| 70544 |
MR ANGIOGRAPHY HEAD W/O DYE
|
$XXX.XX
|
| 70544-26 |
MR ANGIOGRAPHY HEAD W/O DYE
|
$XXX.XX
|
| 70544-TC |
MR ANGIOGRAPHY HEAD W/O DYE
|
$XXX.XX
|
| 70545 |
MR ANGIOGRAPHY HEAD W/DYE
|
$XXX.XX
|
| 70545-26 |
MR ANGIOGRAPHY HEAD W/DYE
|
$XXX.XX
|
| 70545-TC |
MR ANGIOGRAPHY HEAD W/DYE
|
$XXX.XX
|
| 70546 |
MR ANGIOGRAPH HEAD W/O&W/DYE
|
$XXX.XX
|
| 70546-26 |
MR ANGIOGRAPH HEAD W/O&W/DYE
|
$XXX.XX
|
| 70546-TC |
MR ANGIOGRAPH HEAD W/O&W/DYE
|
$XXX.XX
|
| 70547 |
MR ANGIOGRAPHY NECK W/O DYE
|
$XXX.XX
|
| 70547-26 |
MR ANGIOGRAPHY NECK W/O DYE
|
$XXX.XX
|
| 70547-TC |
MR ANGIOGRAPHY NECK W/O DYE
|
$XXX.XX
|
| 70548 |
MR ANGIOGRAPHY NECK W/DYE
|
$XXX.XX
|
| 70548-26 |
MR ANGIOGRAPHY NECK W/DYE
|
$XXX.XX
|
| 70548-TC |
MR ANGIOGRAPHY NECK W/DYE
|
$XXX.XX
|
| 70549 |
MR ANGIOGRAPH NECK W/O&W/DYE
|
$XXX.XX
|
| 70549-26 |
MR ANGIOGRAPH NECK W/O&W/DYE
|
$XXX.XX
|
| 70549-TC |
MR ANGIOGRAPH NECK W/O&W/DYE
|
$XXX.XX
|
| 70551 |
MRI BRAIN STEM W/O DYE
|
$XXX.XX
|
| 70551-26 |
MRI BRAIN STEM W/O DYE
|
$XXX.XX
|
| 70551-TC |
MRI BRAIN STEM W/O DYE
|
$XXX.XX
|
| 70552 |
MRI BRAIN STEM W/DYE
|
$XXX.XX
|
| 70552-26 |
MRI BRAIN STEM W/DYE
|
$XXX.XX
|
| 70552-TC |
MRI BRAIN STEM W/DYE
|
$XXX.XX
|
| 70553 |
MRI BRAIN STEM W/O & W/DYE
|
$XXX.XX
|
| 70553-26 |
MRI BRAIN STEM W/O & W/DYE
|
$XXX.XX
|
| 70553-TC |
MRI BRAIN STEM W/O & W/DYE
|
$XXX.XX
|
| 70554 |
FMRI BRAIN BY TECH
|
$XXX.XX
|
| 70554-26 |
FMRI BRAIN BY TECH
|
$XXX.XX
|
| 70554-TC |
FMRI BRAIN BY TECH
|
$XXX.XX
|
| 70555-26 |
FMRI BRAIN BY PHYS/PSYCH
|
$XXX.XX
|
| 70557-26 |
MRI BRAIN W/O DYE
|
$XXX.XX
|
| 70558-26 |
MRI BRAIN W/DYE
|
$XXX.XX
|
| 70559-26 |
MRI BRAIN W/O & W/DYE
|
$XXX.XX
|
| 71045 |
X-RAY EXAM CHEST 1 VIEW
|
$XXX.XX
|
| 71045-26 |
X-RAY EXAM CHEST 1 VIEW
|
$XXX.XX
|
| 71045-TC |
X-RAY EXAM CHEST 1 VIEW
|
$XXX.XX
|
| 71046 |
X-RAY EXAM CHEST 2 VIEWS
|
$XXX.XX
|
| 71046-26 |
X-RAY EXAM CHEST 2 VIEWS
|
$XXX.XX
|
| 71046-TC |
X-RAY EXAM CHEST 2 VIEWS
|
$XXX.XX
|
| 71047 |
X-RAY EXAM CHEST 3 VIEWS
|
$XXX.XX
|
| 71047-26 |
X-RAY EXAM CHEST 3 VIEWS
|
$XXX.XX
|
| 71047-TC |
X-RAY EXAM CHEST 3 VIEWS
|
$XXX.XX
|
| 71048 |
X-RAY EXAM CHEST 4+ VIEWS
|
$XXX.XX
|
| 71048-26 |
X-RAY EXAM CHEST 4+ VIEWS
|
$XXX.XX
|
| 71048-TC |
X-RAY EXAM CHEST 4+ VIEWS
|
$XXX.XX
|
| 71100 |
X-RAY EXAM RIBS UNI 2 VIEWS
|
$XXX.XX
|
| 71100-26 |
X-RAY EXAM RIBS UNI 2 VIEWS
|
$XXX.XX
|
| 71100-TC |
X-RAY EXAM RIBS UNI 2 VIEWS
|
$XXX.XX
|
| 71101 |
X-RAY EXAM UNILAT RIBS/CHEST
|
$XXX.XX
|
| 71101-26 |
X-RAY EXAM UNILAT RIBS/CHEST
|
$XXX.XX
|
| 71101-TC |
X-RAY EXAM UNILAT RIBS/CHEST
|
$XXX.XX
|
| 71110 |
X-RAY EXAM RIBS BIL 3 VIEWS
|
$XXX.XX
|
| 71110-26 |
X-RAY EXAM RIBS BIL 3 VIEWS
|
$XXX.XX
|
| 71110-TC |
X-RAY EXAM RIBS BIL 3 VIEWS
|
$XXX.XX
|
| 71111 |
X-RAY EXAM RIBS/CHEST4/> VWS
|
$XXX.XX
|
| 71111-26 |
X-RAY EXAM RIBS/CHEST4/> VWS
|
$XXX.XX
|
| 71111-TC |
X-RAY EXAM RIBS/CHEST4/> VWS
|
$XXX.XX
|
| 71120 |
X-RAY EXAM BREASTBONE 2/>VWS
|
$XXX.XX
|
| 71120-26 |
X-RAY EXAM BREASTBONE 2/>VWS
|
$XXX.XX
|
| 71120-TC |
X-RAY EXAM BREASTBONE 2/>VWS
|
$XXX.XX
|
| 71130 |
X-RAY STRENOCLAVIC JT 3/>VWS
|
$XXX.XX
|
| 71130-26 |
X-RAY STRENOCLAVIC JT 3/>VWS
|
$XXX.XX
|
| 71130-TC |
X-RAY STRENOCLAVIC JT 3/>VWS
|
$XXX.XX
|
| 71250 |
CT THORAX W/O DYE
|
$XXX.XX
|
| 71250-26 |
CT THORAX W/O DYE
|
$XXX.XX
|
| 71250-TC |
CT THORAX W/O DYE
|
$XXX.XX
|
| 71260 |
CT THORAX W/DYE
|
$XXX.XX
|
| 71260-26 |
CT THORAX W/DYE
|
$XXX.XX
|
| 71260-TC |
CT THORAX W/DYE
|
$XXX.XX
|
| 71270 |
CT THORAX W/O & W/DYE
|
$XXX.XX
|
| 71270-26 |
CT THORAX W/O & W/DYE
|
$XXX.XX
|
| 71270-TC |
CT THORAX W/O & W/DYE
|
$XXX.XX
|
| 71275 |
CT ANGIOGRAPHY CHEST
|
$XXX.XX
|
| 71275-26 |
CT ANGIOGRAPHY CHEST
|
$XXX.XX
|
| 71275-TC |
CT ANGIOGRAPHY CHEST
|
$XXX.XX
|
| 71550 |
MRI CHEST W/O DYE
|
$XXX.XX
|
| 71550-26 |
MRI CHEST W/O DYE
|
$XXX.XX
|
| 71550-TC |
MRI CHEST W/O DYE
|
$XXX.XX
|
| 71551 |
MRI CHEST W/DYE
|
$XXX.XX
|
| 71551-26 |
MRI CHEST W/DYE
|
$XXX.XX
|
| 71551-TC |
MRI CHEST W/DYE
|
$XXX.XX
|
| 71552 |
MRI CHEST W/O & W/DYE
|
$XXX.XX
|
| 71552-26 |
MRI CHEST W/O & W/DYE
|
$XXX.XX
|
| 71552-TC |
MRI CHEST W/O & W/DYE
|
$XXX.XX
|
| 71555 |
MRI ANGIO CHEST W OR W/O DYE
|
$XXX.XX
|
| 71555-26 |
MRI ANGIO CHEST W OR W/O DYE
|
$XXX.XX
|
| 71555-TC |
MRI ANGIO CHEST W OR W/O DYE
|
$XXX.XX
|
| 72020 |
X-RAY EXAM OF SPINE 1 VIEW
|
$XXX.XX
|
| 72020-26 |
X-RAY EXAM OF SPINE 1 VIEW
|
$XXX.XX
|
| 72020-TC |
X-RAY EXAM OF SPINE 1 VIEW
|
$XXX.XX
|
| 72040 |
X-RAY EXAM NECK SPINE 2-3 VW
|
$XXX.XX
|
| 72040-26 |
X-RAY EXAM NECK SPINE 2-3 VW
|
$XXX.XX
|
| 72040-TC |
X-RAY EXAM NECK SPINE 2-3 VW
|
$XXX.XX
|
| 72050 |
X-RAY EXAM NECK SPINE 4/5VWS
|
$XXX.XX
|
| 72050-26 |
X-RAY EXAM NECK SPINE 4/5VWS
|
$XXX.XX
|
| 72050-TC |
X-RAY EXAM NECK SPINE 4/5VWS
|
$XXX.XX
|
| 72052 |
X-RAY EXAM NECK SPINE 6/>VWS
|
$XXX.XX
|
| 72052-26 |
X-RAY EXAM NECK SPINE 6/>VWS
|
$XXX.XX
|
| 72052-TC |
X-RAY EXAM NECK SPINE 6/>VWS
|
$XXX.XX
|
| 72070 |
X-RAY EXAM THORAC SPINE 2VWS
|
$XXX.XX
|
| 72070-26 |
X-RAY EXAM THORAC SPINE 2VWS
|
$XXX.XX
|
| 72070-TC |
X-RAY EXAM THORAC SPINE 2VWS
|
$XXX.XX
|
| 72072 |
X-RAY EXAM THORAC SPINE 3VWS
|
$XXX.XX
|
| 72072-26 |
X-RAY EXAM THORAC SPINE 3VWS
|
$XXX.XX
|
| 72072-TC |
X-RAY EXAM THORAC SPINE 3VWS
|
$XXX.XX
|
| 72074 |
X-RAY EXAM THORAC SPINE4/>VW
|
$XXX.XX
|
| 72074-26 |
X-RAY EXAM THORAC SPINE4/>VW
|
$XXX.XX
|
| 72074-TC |
X-RAY EXAM THORAC SPINE4/>VW
|
$XXX.XX
|
| 72080 |
X-RAY EXAM THORACOLMB 2/> VW
|
$XXX.XX
|
| 72080-26 |
X-RAY EXAM THORACOLMB 2/> VW
|
$XXX.XX
|
| 72080-TC |
X-RAY EXAM THORACOLMB 2/> VW
|
$XXX.XX
|
| 72081 |
X-RAY EXAM ENTIRE SPI 1 VW
|
$XXX.XX
|
| 72081-26 |
X-RAY EXAM ENTIRE SPI 1 VW
|
$XXX.XX
|
| 72081-TC |
X-RAY EXAM ENTIRE SPI 1 VW
|
$XXX.XX
|
| 72082 |
X-RAY EXAM ENTIRE SPI 2/3 VW
|
$XXX.XX
|
| 72082-26 |
X-RAY EXAM ENTIRE SPI 2/3 VW
|
$XXX.XX
|
| 72082-TC |
X-RAY EXAM ENTIRE SPI 2/3 VW
|
$XXX.XX
|
| 72083 |
X-RAY EXAM ENTIRE SPI 4/5 VW
|
$XXX.XX
|
| 72083-26 |
X-RAY EXAM ENTIRE SPI 4/5 VW
|
$XXX.XX
|
| 72083-TC |
X-RAY EXAM ENTIRE SPI 4/5 VW
|
$XXX.XX
|
| 72084 |
X-RAY EXAM ENTIRE SPI 6/> VW
|
$XXX.XX
|
| 72084-26 |
X-RAY EXAM ENTIRE SPI 6/> VW
|
$XXX.XX
|
| 72084-TC |
X-RAY EXAM ENTIRE SPI 6/> VW
|
$XXX.XX
|
| 72100 |
X-RAY EXAM L-S SPINE 2/3 VWS
|
$XXX.XX
|
| 72100-26 |
X-RAY EXAM L-S SPINE 2/3 VWS
|
$XXX.XX
|
| 72100-TC |
X-RAY EXAM L-S SPINE 2/3 VWS
|
$XXX.XX
|
| 72110 |
X-RAY EXAM L-2 SPINE 4/>VWS
|
$XXX.XX
|
| 72110-26 |
X-RAY EXAM L-2 SPINE 4/>VWS
|
$XXX.XX
|
| 72110-TC |
X-RAY EXAM L-2 SPINE 4/>VWS
|
$XXX.XX
|
| 72114 |
X-RAY EXAM L-S SPINE BENDING
|
$XXX.XX
|
| 72114-26 |
X-RAY EXAM L-S SPINE BENDING
|
$XXX.XX
|
| 72114-TC |
X-RAY EXAM L-S SPINE BENDING
|
$XXX.XX
|
| 72120 |
X-RAY BEND ONLY L-S SPINE
|
$XXX.XX
|
| 72120-26 |
X-RAY BEND ONLY L-S SPINE
|
$XXX.XX
|
| 72120-TC |
X-RAY BEND ONLY L-S SPINE
|
$XXX.XX
|
| 72125 |
CT NECK SPINE W/O DYE
|
$XXX.XX
|
| 72125-26 |
CT NECK SPINE W/O DYE
|
$XXX.XX
|
| 72125-TC |
CT NECK SPINE W/O DYE
|
$XXX.XX
|
| 72126 |
CT NECK SPINE W/DYE
|
$XXX.XX
|
| 72126-26 |
CT NECK SPINE W/DYE
|
$XXX.XX
|
| 72126-TC |
CT NECK SPINE W/DYE
|
$XXX.XX
|
| 72127 |
CT NECK SPINE W/O & W/DYE
|
$XXX.XX
|
| 72127-26 |
CT NECK SPINE W/O & W/DYE
|
$XXX.XX
|
| 72127-TC |
CT NECK SPINE W/O & W/DYE
|
$XXX.XX
|
| 72128 |
CT CHEST SPINE W/O DYE
|
$XXX.XX
|
| 72128-26 |
CT CHEST SPINE W/O DYE
|
$XXX.XX
|
| 72128-TC |
CT CHEST SPINE W/O DYE
|
$XXX.XX
|
| 72129 |
CT CHEST SPINE W/DYE
|
$XXX.XX
|
| 72129-26 |
CT CHEST SPINE W/DYE
|
$XXX.XX
|
| 72129-TC |
CT CHEST SPINE W/DYE
|
$XXX.XX
|
| 72130 |
CT CHEST SPINE W/O & W/DYE
|
$XXX.XX
|
| 72130-26 |
CT CHEST SPINE W/O & W/DYE
|
$XXX.XX
|
| 72130-TC |
CT CHEST SPINE W/O & W/DYE
|
$XXX.XX
|
| 72131 |
CT LUMBAR SPINE W/O DYE
|
$XXX.XX
|
| 72131-26 |
CT LUMBAR SPINE W/O DYE
|
$XXX.XX
|
| 72131-TC |
CT LUMBAR SPINE W/O DYE
|
$XXX.XX
|
| 72132 |
CT LUMBAR SPINE W/DYE
|
$XXX.XX
|
| 72132-26 |
CT LUMBAR SPINE W/DYE
|
$XXX.XX
|
| 72132-TC |
CT LUMBAR SPINE W/DYE
|
$XXX.XX
|
| 72133 |
CT LUMBAR SPINE W/O & W/DYE
|
$XXX.XX
|
| 72133-26 |
CT LUMBAR SPINE W/O & W/DYE
|
$XXX.XX
|
| 72133-TC |
CT LUMBAR SPINE W/O & W/DYE
|
$XXX.XX
|
| 72141 |
MRI NECK SPINE W/O DYE
|
$XXX.XX
|
| 72141-26 |
MRI NECK SPINE W/O DYE
|
$XXX.XX
|
| 72141-TC |
MRI NECK SPINE W/O DYE
|
$XXX.XX
|
| 72142 |
MRI NECK SPINE W/DYE
|
$XXX.XX
|
| 72142-26 |
MRI NECK SPINE W/DYE
|
$XXX.XX
|
| 72142-TC |
MRI NECK SPINE W/DYE
|
$XXX.XX
|
| 72146 |
MRI CHEST SPINE W/O DYE
|
$XXX.XX
|
| 72146-26 |
MRI CHEST SPINE W/O DYE
|
$XXX.XX
|
| 72146-TC |
MRI CHEST SPINE W/O DYE
|
$XXX.XX
|
| 72147 |
MRI CHEST SPINE W/DYE
|
$XXX.XX
|
| 72147-26 |
MRI CHEST SPINE W/DYE
|
$XXX.XX
|
| 72147-TC |
MRI CHEST SPINE W/DYE
|
$XXX.XX
|
| 72148 |
MRI LUMBAR SPINE W/O DYE
|
$XXX.XX
|
| 72148-26 |
MRI LUMBAR SPINE W/O DYE
|
$XXX.XX
|
| 72148-TC |
MRI LUMBAR SPINE W/O DYE
|
$XXX.XX
|
| 72149 |
MRI LUMBAR SPINE W/DYE
|
$XXX.XX
|
| 72149-26 |
MRI LUMBAR SPINE W/DYE
|
$XXX.XX
|
| 72149-TC |
MRI LUMBAR SPINE W/DYE
|
$XXX.XX
|
| 72156 |
MRI NECK SPINE W/O & W/DYE
|
$XXX.XX
|
| 72156-26 |
MRI NECK SPINE W/O & W/DYE
|
$XXX.XX
|
| 72156-TC |
MRI NECK SPINE W/O & W/DYE
|
$XXX.XX
|
| 72157 |
MRI CHEST SPINE W/O & W/DYE
|
$XXX.XX
|
| 72157-26 |
MRI CHEST SPINE W/O & W/DYE
|
$XXX.XX
|
| 72157-TC |
MRI CHEST SPINE W/O & W/DYE
|
$XXX.XX
|
| 72158 |
MRI LUMBAR SPINE W/O & W/DYE
|
$XXX.XX
|
| 72158-26 |
MRI LUMBAR SPINE W/O & W/DYE
|
$XXX.XX
|
| 72158-TC |
MRI LUMBAR SPINE W/O & W/DYE
|
$XXX.XX
|
| 72159 |
MR ANGIO SPINE W/O&W/DYE
|
$XXX.XX
|
| 72159-26 |
MR ANGIO SPINE W/O&W/DYE
|
$XXX.XX
|
| 72159-TC |
MR ANGIO SPINE W/O&W/DYE
|
$XXX.XX
|
| 72170 |
X-RAY EXAM OF PELVIS
|
$XXX.XX
|
| 72170-26 |
X-RAY EXAM OF PELVIS
|
$XXX.XX
|
| 72170-TC |
X-RAY EXAM OF PELVIS
|
$XXX.XX
|
| 72190 |
X-RAY EXAM OF PELVIS
|
$XXX.XX
|
| 72190-26 |
X-RAY EXAM OF PELVIS
|
$XXX.XX
|
| 72190-TC |
X-RAY EXAM OF PELVIS
|
$XXX.XX
|
| 72191 |
CT ANGIOGRAPH PELV W/O&W/DYE
|
$XXX.XX
|
| 72191-26 |
CT ANGIOGRAPH PELV W/O&W/DYE
|
$XXX.XX
|
| 72191-TC |
CT ANGIOGRAPH PELV W/O&W/DYE
|
$XXX.XX
|
| 72192 |
CT PELVIS W/O DYE
|
$XXX.XX
|
| 72192-26 |
CT PELVIS W/O DYE
|
$XXX.XX
|
| 72192-TC |
CT PELVIS W/O DYE
|
$XXX.XX
|
| 72193 |
CT PELVIS W/DYE
|
$XXX.XX
|
| 72193-26 |
CT PELVIS W/DYE
|
$XXX.XX
|
| 72193-TC |
CT PELVIS W/DYE
|
$XXX.XX
|
| 72194 |
CT PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72194-26 |
CT PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72194-TC |
CT PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72195 |
MRI PELVIS W/O DYE
|
$XXX.XX
|
| 72195-26 |
MRI PELVIS W/O DYE
|
$XXX.XX
|
| 72195-TC |
MRI PELVIS W/O DYE
|
$XXX.XX
|
| 72196 |
MRI PELVIS W/DYE
|
$XXX.XX
|
| 72196-26 |
MRI PELVIS W/DYE
|
$XXX.XX
|
| 72196-TC |
MRI PELVIS W/DYE
|
$XXX.XX
|
| 72197 |
MRI PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72197-26 |
MRI PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72197-TC |
MRI PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72198 |
MR ANGIO PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72198-26 |
MR ANGIO PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72198-TC |
MR ANGIO PELVIS W/O & W/DYE
|
$XXX.XX
|
| 72200 |
X-RAY EXAM SI JOINTS
|
$XXX.XX
|
| 72200-26 |
X-RAY EXAM SI JOINTS
|
$XXX.XX
|
| 72200-TC |
X-RAY EXAM SI JOINTS
|
$XXX.XX
|
| 72202 |
X-RAY EXAM SI JOINTS 3/> VWS
|
$XXX.XX
|
| 72202-26 |
X-RAY EXAM SI JOINTS 3/> VWS
|
$XXX.XX
|
| 72202-TC |
X-RAY EXAM SI JOINTS 3/> VWS
|
$XXX.XX
|
| 72220 |
X-RAY EXAM SACRUM TAILBONE
|
$XXX.XX
|
| 72220-26 |
X-RAY EXAM SACRUM TAILBONE
|
$XXX.XX
|
| 72220-TC |
X-RAY EXAM SACRUM TAILBONE
|
$XXX.XX
|
| 72240 |
MYELOGRAPHY NECK SPINE
|
$XXX.XX
|
| 72240-26 |
MYELOGRAPHY NECK SPINE
|
$XXX.XX
|
| 72240-TC |
MYELOGRAPHY NECK SPINE
|
$XXX.XX
|
| 72255 |
MYELOGRAPHY THORACIC SPINE
|
$XXX.XX
|
| 72255-26 |
MYELOGRAPHY THORACIC SPINE
|
$XXX.XX
|
| 72255-TC |
MYELOGRAPHY THORACIC SPINE
|
$XXX.XX
|
| 72265 |
MYELOGRAPHY L-S SPINE
|
$XXX.XX
|
| 72265-26 |
MYELOGRAPHY L-S SPINE
|
$XXX.XX
|
| 72265-TC |
MYELOGRAPHY L-S SPINE
|
$XXX.XX
|
| 72270 |
MYELOGPHY 2/> SPINE REGIONS
|
$XXX.XX
|
| 72270-26 |
MYELOGPHY 2/> SPINE REGIONS
|
$XXX.XX
|
| 72270-TC |
MYELOGPHY 2/> SPINE REGIONS
|
$XXX.XX
|
| 72275 |
EPIDUROGRAPHY
|
$XXX.XX
|
| 72275-26 |
EPIDUROGRAPHY
|
$XXX.XX
|
| 72275-TC |
EPIDUROGRAPHY
|
$XXX.XX
|
| 72285 |
DISCOGRAPHY CERV/THOR SPINE
|
$XXX.XX
|
| 72285-26 |
DISCOGRAPHY CERV/THOR SPINE
|
$XXX.XX
|
| 72285-TC |
DISCOGRAPHY CERV/THOR SPINE
|
$XXX.XX
|
| 72295 |
X-RAY OF LOWER SPINE DISK
|
$XXX.XX
|
| 72295-26 |
X-RAY OF LOWER SPINE DISK
|
$XXX.XX
|
| 72295-TC |
X-RAY OF LOWER SPINE DISK
|
$XXX.XX
|
| 73000 |
X-RAY EXAM OF COLLAR BONE
|
$XXX.XX
|
| 73000-26 |
X-RAY EXAM OF COLLAR BONE
|
$XXX.XX
|
| 73000-TC |
X-RAY EXAM OF COLLAR BONE
|
$XXX.XX
|
| 73010 |
X-RAY EXAM OF SHOULDER BLADE
|
$XXX.XX
|
| 73010-26 |
X-RAY EXAM OF SHOULDER BLADE
|
$XXX.XX
|
| 73010-TC |
X-RAY EXAM OF SHOULDER BLADE
|
$XXX.XX
|
| 73020 |
X-RAY EXAM OF SHOULDER
|
$XXX.XX
|
| 73020-26 |
X-RAY EXAM OF SHOULDER
|
$XXX.XX
|
| 73020-TC |
X-RAY EXAM OF SHOULDER
|
$XXX.XX
|
| 73030 |
X-RAY EXAM OF SHOULDER
|
$XXX.XX
|
| 73030-26 |
X-RAY EXAM OF SHOULDER
|
$XXX.XX
|
| 73030-TC |
X-RAY EXAM OF SHOULDER
|
$XXX.XX
|
| 73040 |
CONTRAST X-RAY OF SHOULDER
|
$XXX.XX
|
| 73040-26 |
CONTRAST X-RAY OF SHOULDER
|
$XXX.XX
|
| 73040-TC |
CONTRAST X-RAY OF SHOULDER
|
$XXX.XX
|
| 73050 |
X-RAY EXAM OF SHOULDERS
|
$XXX.XX
|
| 73050-26 |
X-RAY EXAM OF SHOULDERS
|
$XXX.XX
|
| 73050-TC |
X-RAY EXAM OF SHOULDERS
|
$XXX.XX
|
| 73060 |
X-RAY EXAM OF HUMERUS
|
$XXX.XX
|
| 73060-26 |
X-RAY EXAM OF HUMERUS
|
$XXX.XX
|
| 73060-TC |
X-RAY EXAM OF HUMERUS
|
$XXX.XX
|
| 73070 |
X-RAY EXAM OF ELBOW
|
$XXX.XX
|
| 73070-26 |
X-RAY EXAM OF ELBOW
|
$XXX.XX
|
| 73070-TC |
X-RAY EXAM OF ELBOW
|
$XXX.XX
|
| 73080 |
X-RAY EXAM OF ELBOW
|
$XXX.XX
|
| 73080-26 |
X-RAY EXAM OF ELBOW
|
$XXX.XX
|
| 73080-TC |
X-RAY EXAM OF ELBOW
|
$XXX.XX
|
| 73085 |
CONTRAST X-RAY OF ELBOW
|
$XXX.XX
|
| 73085-26 |
CONTRAST X-RAY OF ELBOW
|
$XXX.XX
|
| 73085-TC |
CONTRAST X-RAY OF ELBOW
|
$XXX.XX
|
| 73090 |
X-RAY EXAM OF FOREARM
|
$XXX.XX
|
| 73090-26 |
X-RAY EXAM OF FOREARM
|
$XXX.XX
|
| 73090-TC |
X-RAY EXAM OF FOREARM
|
$XXX.XX
|
| 73092 |
X-RAY EXAM OF ARM INFANT
|
$XXX.XX
|
| 73092-26 |
X-RAY EXAM OF ARM INFANT
|
$XXX.XX
|
| 73092-TC |
X-RAY EXAM OF ARM INFANT
|
$XXX.XX
|
| 73100 |
X-RAY EXAM OF WRIST
|
$XXX.XX
|
| 73100-26 |
X-RAY EXAM OF WRIST
|
$XXX.XX
|
| 73100-TC |
X-RAY EXAM OF WRIST
|
$XXX.XX
|
| 73110 |
X-RAY EXAM OF WRIST
|
$XXX.XX
|
| 73110-26 |
X-RAY EXAM OF WRIST
|
$XXX.XX
|
| 73110-TC |
X-RAY EXAM OF WRIST
|
$XXX.XX
|
| 73115 |
CONTRAST X-RAY OF WRIST
|
$XXX.XX
|
| 73115-26 |
CONTRAST X-RAY OF WRIST
|
$XXX.XX
|
| 73115-TC |
CONTRAST X-RAY OF WRIST
|
$XXX.XX
|
| 73120 |
X-RAY EXAM OF HAND
|
$XXX.XX
|
| 73120-26 |
X-RAY EXAM OF HAND
|
$XXX.XX
|
| 73120-TC |
X-RAY EXAM OF HAND
|
$XXX.XX
|
| 73130 |
X-RAY EXAM OF HAND
|
$XXX.XX
|
| 73130-26 |
X-RAY EXAM OF HAND
|
$XXX.XX
|
| 73130-TC |
X-RAY EXAM OF HAND
|
$XXX.XX
|
| 73140 |
X-RAY EXAM OF FINGER(S)
|
$XXX.XX
|
| 73140-26 |
X-RAY EXAM OF FINGER(S)
|
$XXX.XX
|
| 73140-TC |
X-RAY EXAM OF FINGER(S)
|
$XXX.XX
|
| 73200 |
CT UPPER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73200-26 |
CT UPPER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73200-TC |
CT UPPER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73201 |
CT UPPER EXTREMITY W/DYE
|
$XXX.XX
|
| 73201-26 |
CT UPPER EXTREMITY W/DYE
|
$XXX.XX
|
| 73201-TC |
CT UPPER EXTREMITY W/DYE
|
$XXX.XX
|
| 73202 |
CT UPPR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73202-26 |
CT UPPR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73202-TC |
CT UPPR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73206 |
CT ANGIO UPR EXTRM W/O&W/DYE
|
$XXX.XX
|
| 73206-26 |
CT ANGIO UPR EXTRM W/O&W/DYE
|
$XXX.XX
|
| 73206-TC |
CT ANGIO UPR EXTRM W/O&W/DYE
|
$XXX.XX
|
| 73218 |
MRI UPPER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73218-26 |
MRI UPPER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73218-TC |
MRI UPPER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73219 |
MRI UPPER EXTREMITY W/DYE
|
$XXX.XX
|
| 73219-26 |
MRI UPPER EXTREMITY W/DYE
|
$XXX.XX
|
| 73219-TC |
MRI UPPER EXTREMITY W/DYE
|
$XXX.XX
|
| 73220 |
MRI UPPR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73220-26 |
MRI UPPR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73220-TC |
MRI UPPR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73221 |
MRI JOINT UPR EXTREM W/O DYE
|
$XXX.XX
|
| 73221-26 |
MRI JOINT UPR EXTREM W/O DYE
|
$XXX.XX
|
| 73221-TC |
MRI JOINT UPR EXTREM W/O DYE
|
$XXX.XX
|
| 73222 |
MRI JOINT UPR EXTREM W/DYE
|
$XXX.XX
|
| 73222-26 |
MRI JOINT UPR EXTREM W/DYE
|
$XXX.XX
|
| 73222-TC |
MRI JOINT UPR EXTREM W/DYE
|
$XXX.XX
|
| 73223 |
MRI JOINT UPR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73223-26 |
MRI JOINT UPR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73223-TC |
MRI JOINT UPR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73225 |
MR ANGIO UPR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73225-26 |
MR ANGIO UPR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73225-TC |
MR ANGIO UPR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73501 |
X-RAY EXAM HIP UNI 1 VIEW
|
$XXX.XX
|
| 73501-26 |
X-RAY EXAM HIP UNI 1 VIEW
|
$XXX.XX
|
| 73501-TC |
X-RAY EXAM HIP UNI 1 VIEW
|
$XXX.XX
|
| 73502 |
X-RAY EXAM HIP UNI 2-3 VIEWS
|
$XXX.XX
|
| 73502-26 |
X-RAY EXAM HIP UNI 2-3 VIEWS
|
$XXX.XX
|
| 73502-TC |
X-RAY EXAM HIP UNI 2-3 VIEWS
|
$XXX.XX
|
| 73503 |
X-RAY EXAM HIP UNI 4/> VIEWS
|
$XXX.XX
|
| 73503-26 |
X-RAY EXAM HIP UNI 4/> VIEWS
|
$XXX.XX
|
| 73503-TC |
X-RAY EXAM HIP UNI 4/> VIEWS
|
$XXX.XX
|
| 73521 |
X-RAY EXAM HIPS BI 2 VIEWS
|
$XXX.XX
|
| 73521-26 |
X-RAY EXAM HIPS BI 2 VIEWS
|
$XXX.XX
|
| 73521-TC |
X-RAY EXAM HIPS BI 2 VIEWS
|
$XXX.XX
|
| 73522 |
X-RAY EXAM HIPS BI 3-4 VIEWS
|
$XXX.XX
|
| 73522-26 |
X-RAY EXAM HIPS BI 3-4 VIEWS
|
$XXX.XX
|
| 73522-TC |
X-RAY EXAM HIPS BI 3-4 VIEWS
|
$XXX.XX
|
| 73523 |
X-RAY EXAM HIPS BI 5/> VIEWS
|
$XXX.XX
|
| 73523-26 |
X-RAY EXAM HIPS BI 5/> VIEWS
|
$XXX.XX
|
| 73523-TC |
X-RAY EXAM HIPS BI 5/> VIEWS
|
$XXX.XX
|
| 73525 |
CONTRAST X-RAY OF HIP
|
$XXX.XX
|
| 73525-26 |
CONTRAST X-RAY OF HIP
|
$XXX.XX
|
| 73525-TC |
CONTRAST X-RAY OF HIP
|
$XXX.XX
|
| 73551 |
X-RAY EXAM OF FEMUR 1
|
$XXX.XX
|
| 73551-26 |
X-RAY EXAM OF FEMUR 1
|
$XXX.XX
|
| 73551-TC |
X-RAY EXAM OF FEMUR 1
|
$XXX.XX
|
| 73552 |
X-RAY EXAM OF FEMUR 2/>
|
$XXX.XX
|
| 73552-26 |
X-RAY EXAM OF FEMUR 2/>
|
$XXX.XX
|
| 73552-TC |
X-RAY EXAM OF FEMUR 2/>
|
$XXX.XX
|
| 73560 |
X-RAY EXAM OF KNEE 1 OR 2
|
$XXX.XX
|
| 73560-26 |
X-RAY EXAM OF KNEE 1 OR 2
|
$XXX.XX
|
| 73560-TC |
X-RAY EXAM OF KNEE 1 OR 2
|
$XXX.XX
|
| 73562 |
X-RAY EXAM OF KNEE 3
|
$XXX.XX
|
| 73562-26 |
X-RAY EXAM OF KNEE 3
|
$XXX.XX
|
| 73562-TC |
X-RAY EXAM OF KNEE 3
|
$XXX.XX
|
| 73564 |
X-RAY EXAM KNEE 4 OR MORE
|
$XXX.XX
|
| 73564-26 |
X-RAY EXAM KNEE 4 OR MORE
|
$XXX.XX
|
| 73564-TC |
X-RAY EXAM KNEE 4 OR MORE
|
$XXX.XX
|
| 73565 |
X-RAY EXAM OF KNEES
|
$XXX.XX
|
| 73565-26 |
X-RAY EXAM OF KNEES
|
$XXX.XX
|
| 73565-TC |
X-RAY EXAM OF KNEES
|
$XXX.XX
|
| 73580 |
CONTRAST X-RAY OF KNEE JOINT
|
$XXX.XX
|
| 73580-26 |
CONTRAST X-RAY OF KNEE JOINT
|
$XXX.XX
|
| 73580-TC |
CONTRAST X-RAY OF KNEE JOINT
|
$XXX.XX
|
| 73590 |
X-RAY EXAM OF LOWER LEG
|
$XXX.XX
|
| 73590-26 |
X-RAY EXAM OF LOWER LEG
|
$XXX.XX
|
| 73590-TC |
X-RAY EXAM OF LOWER LEG
|
$XXX.XX
|
| 73592 |
X-RAY EXAM OF LEG INFANT
|
$XXX.XX
|
| 73592-26 |
X-RAY EXAM OF LEG INFANT
|
$XXX.XX
|
| 73592-TC |
X-RAY EXAM OF LEG INFANT
|
$XXX.XX
|
| 73600 |
X-RAY EXAM OF ANKLE
|
$XXX.XX
|
| 73600-26 |
X-RAY EXAM OF ANKLE
|
$XXX.XX
|
| 73600-TC |
X-RAY EXAM OF ANKLE
|
$XXX.XX
|
| 73610 |
X-RAY EXAM OF ANKLE
|
$XXX.XX
|
| 73610-26 |
X-RAY EXAM OF ANKLE
|
$XXX.XX
|
| 73610-TC |
X-RAY EXAM OF ANKLE
|
$XXX.XX
|
| 73615 |
CONTRAST X-RAY OF ANKLE
|
$XXX.XX
|
| 73615-26 |
CONTRAST X-RAY OF ANKLE
|
$XXX.XX
|
| 73615-TC |
CONTRAST X-RAY OF ANKLE
|
$XXX.XX
|
| 73620 |
X-RAY EXAM OF FOOT
|
$XXX.XX
|
| 73620-26 |
X-RAY EXAM OF FOOT
|
$XXX.XX
|
| 73620-TC |
X-RAY EXAM OF FOOT
|
$XXX.XX
|
| 73630 |
X-RAY EXAM OF FOOT
|
$XXX.XX
|
| 73630-26 |
X-RAY EXAM OF FOOT
|
$XXX.XX
|
| 73630-TC |
X-RAY EXAM OF FOOT
|
$XXX.XX
|
| 73650 |
X-RAY EXAM OF HEEL
|
$XXX.XX
|
| 73650-26 |
X-RAY EXAM OF HEEL
|
$XXX.XX
|
| 73650-TC |
X-RAY EXAM OF HEEL
|
$XXX.XX
|
| 73660 |
X-RAY EXAM OF TOE(S)
|
$XXX.XX
|
| 73660-26 |
X-RAY EXAM OF TOE(S)
|
$XXX.XX
|
| 73660-TC |
X-RAY EXAM OF TOE(S)
|
$XXX.XX
|
| 73700 |
CT LOWER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73700-26 |
CT LOWER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73700-TC |
CT LOWER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73701 |
CT LOWER EXTREMITY W/DYE
|
$XXX.XX
|
| 73701-26 |
CT LOWER EXTREMITY W/DYE
|
$XXX.XX
|
| 73701-TC |
CT LOWER EXTREMITY W/DYE
|
$XXX.XX
|
| 73702 |
CT LWR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73702-26 |
CT LWR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73702-TC |
CT LWR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73706 |
CT ANGIO LWR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73706-26 |
CT ANGIO LWR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73706-TC |
CT ANGIO LWR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73718 |
MRI LOWER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73718-26 |
MRI LOWER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73718-TC |
MRI LOWER EXTREMITY W/O DYE
|
$XXX.XX
|
| 73719 |
MRI LOWER EXTREMITY W/DYE
|
$XXX.XX
|
| 73719-26 |
MRI LOWER EXTREMITY W/DYE
|
$XXX.XX
|
| 73719-TC |
MRI LOWER EXTREMITY W/DYE
|
$XXX.XX
|
| 73720 |
MRI LWR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73720-26 |
MRI LWR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73720-TC |
MRI LWR EXTREMITY W/O&W/DYE
|
$XXX.XX
|
| 73721 |
MRI JNT OF LWR EXTRE W/O DYE
|
$XXX.XX
|
| 73721-26 |
MRI JNT OF LWR EXTRE W/O DYE
|
$XXX.XX
|
| 73721-TC |
MRI JNT OF LWR EXTRE W/O DYE
|
$XXX.XX
|
| 73722 |
MRI JOINT OF LWR EXTR W/DYE
|
$XXX.XX
|
| 73722-26 |
MRI JOINT OF LWR EXTR W/DYE
|
$XXX.XX
|
| 73722-TC |
MRI JOINT OF LWR EXTR W/DYE
|
$XXX.XX
|
| 73723 |
MRI JOINT LWR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73723-26 |
MRI JOINT LWR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73723-TC |
MRI JOINT LWR EXTR W/O&W/DYE
|
$XXX.XX
|
| 73725 |
MR ANG LWR EXT W OR W/O DYE
|
$XXX.XX
|
| 73725-26 |
MR ANG LWR EXT W OR W/O DYE
|
$XXX.XX
|
| 73725-TC |
MR ANG LWR EXT W OR W/O DYE
|
$XXX.XX
|
| 74018 |
X-RAY EXAM ABDOMEN 1 VIEW
|
$XXX.XX
|
| 74018-26 |
X-RAY EXAM ABDOMEN 1 VIEW
|
$XXX.XX
|
| 74018-TC |
X-RAY EXAM ABDOMEN 1 VIEW
|
$XXX.XX
|
| 74019 |
X-RAY EXAM ABDOMEN 2 VIEWS
|
$XXX.XX
|
| 74019-26 |
X-RAY EXAM ABDOMEN 2 VIEWS
|
$XXX.XX
|
| 74019-TC |
X-RAY EXAM ABDOMEN 2 VIEWS
|
$XXX.XX
|
| 74021 |
X-RAY EXAM ABDOMEN 3+ VIEWS
|
$XXX.XX
|
| 74021-26 |
X-RAY EXAM ABDOMEN 3+ VIEWS
|
$XXX.XX
|
| 74021-TC |
X-RAY EXAM ABDOMEN 3+ VIEWS
|
$XXX.XX
|
| 74022 |
X-RAY EXAM COMPLETE ABDOMEN
|
$XXX.XX
|
| 74022-26 |
X-RAY EXAM COMPLETE ABDOMEN
|
$XXX.XX
|
| 74022-TC |
X-RAY EXAM COMPLETE ABDOMEN
|
$XXX.XX
|
| 74150 |
CT ABDOMEN W/O DYE
|
$XXX.XX
|
| 74150-26 |
CT ABDOMEN W/O DYE
|
$XXX.XX
|
| 74150-TC |
CT ABDOMEN W/O DYE
|
$XXX.XX
|
| 74160 |
CT ABDOMEN W/DYE
|
$XXX.XX
|
| 74160-26 |
CT ABDOMEN W/DYE
|
$XXX.XX
|
| 74160-TC |
CT ABDOMEN W/DYE
|
$XXX.XX
|
| 74170 |
CT ABDOMEN W/O & W/DYE
|
$XXX.XX
|
| 74170-26 |
CT ABDOMEN W/O & W/DYE
|
$XXX.XX
|
| 74170-TC |
CT ABDOMEN W/O & W/DYE
|
$XXX.XX
|
| 74174 |
CT ANGIO ABD&PELV W/O&W/DYE
|
$XXX.XX
|
| 74174-26 |
CT ANGIO ABD&PELV W/O&W/DYE
|
$XXX.XX
|
| 74174-TC |
CT ANGIO ABD&PELV W/O&W/DYE
|
$XXX.XX
|
| 74175 |
CT ANGIO ABDOM W/O & W/DYE
|
$XXX.XX
|
| 74175-26 |
CT ANGIO ABDOM W/O & W/DYE
|
$XXX.XX
|
| 74175-TC |
CT ANGIO ABDOM W/O & W/DYE
|
$XXX.XX
|
| 74176 |
CT ABD & PELVIS W/O CONTRAST
|
$XXX.XX
|
| 74176-26 |
CT ABD & PELVIS W/O CONTRAST
|
$XXX.XX
|
| 74176-TC |
CT ABD & PELVIS W/O CONTRAST
|
$XXX.XX
|
| 74177 |
CT ABD & PELV W/CONTRAST
|
$XXX.XX
|
| 74177-26 |
CT ABD & PELV W/CONTRAST
|
$XXX.XX
|
| 74177-TC |
CT ABD & PELV W/CONTRAST
|
$XXX.XX
|
| 74178 |
CT ABD & PELV 1/> REGNS
|
$XXX.XX
|
| 74178-26 |
CT ABD & PELV 1/> REGNS
|
$XXX.XX
|
| 74178-TC |
CT ABD & PELV 1/> REGNS
|
$XXX.XX
|
| 74181 |
MRI ABDOMEN W/O DYE
|
$XXX.XX
|
| 74181-26 |
MRI ABDOMEN W/O DYE
|
$XXX.XX
|
| 74181-TC |
MRI ABDOMEN W/O DYE
|
$XXX.XX
|
| 74182 |
MRI ABDOMEN W/DYE
|
$XXX.XX
|
| 74182-26 |
MRI ABDOMEN W/DYE
|
$XXX.XX
|
| 74182-TC |
MRI ABDOMEN W/DYE
|
$XXX.XX
|
| 74183 |
MRI ABDOMEN W/O & W/DYE
|
$XXX.XX
|
| 74183-26 |
MRI ABDOMEN W/O & W/DYE
|
$XXX.XX
|
| 74183-TC |
MRI ABDOMEN W/O & W/DYE
|
$XXX.XX
|
| 74185 |
MRI ANGIO ABDOM W ORW/O DYE
|
$XXX.XX
|
| 74185-26 |
MRI ANGIO ABDOM W ORW/O DYE
|
$XXX.XX
|
| 74185-TC |
MRI ANGIO ABDOM W ORW/O DYE
|
$XXX.XX
|
| 74190-26 |
X-RAY EXAM OF PERITONEUM
|
$XXX.XX
|
| 74210 |
X-RAY XM PHRNX&/CRV ESOPH C+
|
$XXX.XX
|
| 74210-26 |
X-RAY XM PHRNX&/CRV ESOPH C+
|
$XXX.XX
|
| 74210-TC |
X-RAY XM PHRNX&/CRV ESOPH C+
|
$XXX.XX
|
| 74220 |
X-RAY XM ESOPHAGUS 1CNTRST
|
$XXX.XX
|
| 74220-26 |
X-RAY XM ESOPHAGUS 1CNTRST
|
$XXX.XX
|
| 74220-TC |
X-RAY XM ESOPHAGUS 1CNTRST
|
$XXX.XX
|
| 74221 |
X-RAY XM ESOPHAGUS 2CNTRST
|
$XXX.XX
|
| 74221-26 |
X-RAY XM ESOPHAGUS 2CNTRST
|
$XXX.XX
|
| 74221-TC |
X-RAY XM ESOPHAGUS 2CNTRST
|
$XXX.XX
|
| 74230 |
X-RAY XM SWLNG FUNCJ C+
|
$XXX.XX
|
| 74230-26 |
X-RAY XM SWLNG FUNCJ C+
|
$XXX.XX
|
| 74230-TC |
X-RAY XM SWLNG FUNCJ C+
|
$XXX.XX
|
| 74235-26 |
REMOVE ESOPHAGUS OBSTRUCTION
|
$XXX.XX
|
| 74240 |
X-RAY XM UPR GI TRC 1CNTRST
|
$XXX.XX
|
| 74240-26 |
X-RAY XM UPR GI TRC 1CNTRST
|
$XXX.XX
|
| 74240-TC |
X-RAY XM UPR GI TRC 1CNTRST
|
$XXX.XX
|
| 74246 |
X-RAY XM UPR GI TRC 2CNTRST
|
$XXX.XX
|
| 74246-26 |
X-RAY XM UPR GI TRC 2CNTRST
|
$XXX.XX
|
| 74246-TC |
X-RAY XM UPR GI TRC 2CNTRST
|
$XXX.XX
|
| 74248 |
X-RAY SM INT F-THRU STD
|
$XXX.XX
|
| 74248-26 |
X-RAY SM INT F-THRU STD
|
$XXX.XX
|
| 74248-TC |
X-RAY SM INT F-THRU STD
|
$XXX.XX
|
| 74250 |
X-RAY XM SM INT 1CNTRST STD
|
$XXX.XX
|
| 74250-26 |
X-RAY XM SM INT 1CNTRST STD
|
$XXX.XX
|
| 74250-TC |
X-RAY XM SM INT 1CNTRST STD
|
$XXX.XX
|
| 74251 |
X-RAY XM SM INT 2CNTRST STD
|
$XXX.XX
|
| 74251-26 |
X-RAY XM SM INT 2CNTRST STD
|
$XXX.XX
|
| 74251-TC |
X-RAY XM SM INT 2CNTRST STD
|
$XXX.XX
|
| 74261 |
CT COLONOGRAPHY DX
|
$XXX.XX
|
| 74261-26 |
CT COLONOGRAPHY DX
|
$XXX.XX
|
| 74261-TC |
CT COLONOGRAPHY DX
|
$XXX.XX
|
| 74262 |
CT COLONOGRAPHY DX W/DYE
|
$XXX.XX
|
| 74262-26 |
CT COLONOGRAPHY DX W/DYE
|
$XXX.XX
|
| 74262-TC |
CT COLONOGRAPHY DX W/DYE
|
$XXX.XX
|
| 74270 |
X-RAY XM COLON 1CNTRST STD
|
$XXX.XX
|
| 74270-26 |
X-RAY XM COLON 1CNTRST STD
|
$XXX.XX
|
| 74270-TC |
X-RAY XM COLON 1CNTRST STD
|
$XXX.XX
|
| 74280 |
X-RAY XM COLON 2CNTRST STD
|
$XXX.XX
|
| 74280-26 |
X-RAY XM COLON 2CNTRST STD
|
$XXX.XX
|
| 74280-TC |
X-RAY XM COLON 2CNTRST STD
|
$XXX.XX
|
| 74283 |
THER NMA RDCTJ INTUS/OBSTRCJ
|
$XXX.XX
|
| 74283-26 |
THER NMA RDCTJ INTUS/OBSTRCJ
|
$XXX.XX
|
| 74283-TC |
THER NMA RDCTJ INTUS/OBSTRCJ
|
$XXX.XX
|
| 74290 |
CONTRAST X-RAY GALLBLADDER
|
$XXX.XX
|
| 74290-26 |
CONTRAST X-RAY GALLBLADDER
|
$XXX.XX
|
| 74290-TC |
CONTRAST X-RAY GALLBLADDER
|
$XXX.XX
|
| 74300-26 |
X-RAY BILE DUCTS/PANCREAS
|
$XXX.XX
|
| 74301-26 |
X-RAYS AT SURGERY ADD-ON
|
$XXX.XX
|
| 74328-26 |
X-RAY BILE DUCT ENDOSCOPY
|
$XXX.XX
|
| 74329-26 |
X-RAY FOR PANCREAS ENDOSCOPY
|
$XXX.XX
|
| 74330-26 |
X-RAY BILE/PANC ENDOSCOPY
|
$XXX.XX
|
| 74340-26 |
X-RAY GUIDE FOR GI TUBE
|
$XXX.XX
|
| 74355-26 |
X-RAY GUIDE INTESTINAL TUBE
|
$XXX.XX
|
| 74360-26 |
X-RAY GUIDE GI DILATION
|
$XXX.XX
|
| 74363-26 |
X-RAY BILE DUCT DILATION
|
$XXX.XX
|
| 74400 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74400-26 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74400-TC |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74410 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74410-26 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74410-TC |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74415 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74415-26 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74415-TC |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74420 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74420-26 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74420-TC |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74425 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74425-26 |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74425-TC |
CONTRST X-RAY URINARY TRACT
|
$XXX.XX
|
| 74430 |
CONTRAST X-RAY BLADDER
|
$XXX.XX
|
| 74430-26 |
CONTRAST X-RAY BLADDER
|
$XXX.XX
|
| 74430-TC |
CONTRAST X-RAY BLADDER
|
$XXX.XX
|
| 74440 |
X-RAY MALE GENITAL TRACT
|
$XXX.XX
|
| 74440-26 |
X-RAY MALE GENITAL TRACT
|
$XXX.XX
|
| 74440-TC |
X-RAY MALE GENITAL TRACT
|
$XXX.XX
|
| 74445-26 |
X-RAY EXAM OF PENIS
|
$XXX.XX
|
| 74450-26 |
X-RAY URETHRA/BLADDER
|
$XXX.XX
|
| 74455 |
X-RAY URETHRA/BLADDER
|
$XXX.XX
|
| 74455-26 |
X-RAY URETHRA/BLADDER
|
$XXX.XX
|
| 74455-TC |
X-RAY URETHRA/BLADDER
|
$XXX.XX
|
| 74470-26 |
X-RAY EXAM OF KIDNEY LESION
|
$XXX.XX
|
| 74485 |
DILATION URTR/URT RS&I
|
$XXX.XX
|
| 74485-26 |
DILATION URTR/URT RS&I
|
$XXX.XX
|
| 74485-TC |
DILATION URTR/URT RS&I
|
$XXX.XX
|
| 74710 |
X-RAY MEASUREMENT OF PELVIS
|
$XXX.XX
|
| 74710-26 |
X-RAY MEASUREMENT OF PELVIS
|
$XXX.XX
|
| 74710-TC |
X-RAY MEASUREMENT OF PELVIS
|
$XXX.XX
|
| 74712 |
MRI FETAL SNGL/1ST GESTATION
|
$XXX.XX
|
| 74712-26 |
MRI FETAL SNGL/1ST GESTATION
|
$XXX.XX
|
| 74712-TC |
MRI FETAL SNGL/1ST GESTATION
|
$XXX.XX
|
| 74713 |
MRI FETAL EA ADDL GESTATION
|
$XXX.XX
|
| 74713-26 |
MRI FETAL EA ADDL GESTATION
|
$XXX.XX
|
| 74713-TC |
MRI FETAL EA ADDL GESTATION
|
$XXX.XX
|
| 74740 |
X-RAY FEMALE GENITAL TRACT
|
$XXX.XX
|
| 74740-26 |
X-RAY FEMALE GENITAL TRACT
|
$XXX.XX
|
| 74740-TC |
X-RAY FEMALE GENITAL TRACT
|
$XXX.XX
|
| 74742-26 |
X-RAY FALLOPIAN TUBE
|
$XXX.XX
|
| 74775-26 |
X-RAY EXAM OF PERINEUM
|
$XXX.XX
|
| 75557 |
CARDIAC MRI FOR MORPH
|
$XXX.XX
|
| 75557-26 |
CARDIAC MRI FOR MORPH
|
$XXX.XX
|
| 75557-TC |
CARDIAC MRI FOR MORPH
|
$XXX.XX
|
| 75559 |
CARDIAC MRI W/STRESS IMG
|
$XXX.XX
|
| 75559-26 |
CARDIAC MRI W/STRESS IMG
|
$XXX.XX
|
| 75559-TC |
CARDIAC MRI W/STRESS IMG
|
$XXX.XX
|
| 75561 |
CARDIAC MRI FOR MORPH W/DYE
|
$XXX.XX
|
| 75561-26 |
CARDIAC MRI FOR MORPH W/DYE
|
$XXX.XX
|
| 75561-TC |
CARDIAC MRI FOR MORPH W/DYE
|
$XXX.XX
|
| 75563 |
CARD MRI W/STRESS IMG & DYE
|
$XXX.XX
|
| 75563-26 |
CARD MRI W/STRESS IMG & DYE
|
$XXX.XX
|
| 75563-TC |
CARD MRI W/STRESS IMG & DYE
|
$XXX.XX
|
| 75565 |
CARD MRI VELOC FLOW MAPPING
|
$XXX.XX
|
| 75565-26 |
CARD MRI VELOC FLOW MAPPING
|
$XXX.XX
|
| 75565-TC |
CARD MRI VELOC FLOW MAPPING
|
$XXX.XX
|
| 75571 |
CT HRT W/O DYE W/CA TEST
|
$XXX.XX
|
| 75571-26 |
CT HRT W/O DYE W/CA TEST
|
$XXX.XX
|
| 75571-TC |
CT HRT W/O DYE W/CA TEST
|
$XXX.XX
|
| 75572 |
CT HRT W/3D IMAGE
|
$XXX.XX
|
| 75572-26 |
CT HRT W/3D IMAGE
|
$XXX.XX
|
| 75572-TC |
CT HRT W/3D IMAGE
|
$XXX.XX
|
| 75573 |
CT HRT W/3D IMAGE CONGEN
|
$XXX.XX
|
| 75573-26 |
CT HRT W/3D IMAGE CONGEN
|
$XXX.XX
|
| 75573-TC |
CT HRT W/3D IMAGE CONGEN
|
$XXX.XX
|
| 75574 |
CT ANGIO HRT W/3D IMAGE
|
$XXX.XX
|
| 75574-26 |
CT ANGIO HRT W/3D IMAGE
|
$XXX.XX
|
| 75574-TC |
CT ANGIO HRT W/3D IMAGE
|
$XXX.XX
|
| 75600 |
CONTRAST EXAM THORACIC AORTA
|
$XXX.XX
|
| 75600-26 |
CONTRAST EXAM THORACIC AORTA
|
$XXX.XX
|
| 75600-TC |
CONTRAST EXAM THORACIC AORTA
|
$XXX.XX
|
| 75605 |
CONTRAST EXAM THORACIC AORTA
|
$XXX.XX
|
| 75605-26 |
CONTRAST EXAM THORACIC AORTA
|
$XXX.XX
|
| 75605-TC |
CONTRAST EXAM THORACIC AORTA
|
$XXX.XX
|
| 75625 |
CONTRAST EXAM ABDOMINL AORTA
|
$XXX.XX
|
| 75625-26 |
CONTRAST EXAM ABDOMINL AORTA
|
$XXX.XX
|
| 75625-TC |
CONTRAST EXAM ABDOMINL AORTA
|
$XXX.XX
|
| 75630 |
X-RAY AORTA LEG ARTERIES
|
$XXX.XX
|
| 75630-26 |
X-RAY AORTA LEG ARTERIES
|
$XXX.XX
|
| 75630-TC |
X-RAY AORTA LEG ARTERIES
|
$XXX.XX
|
| 75635 |
CT ANGIO ABDOMINAL ARTERIES
|
$XXX.XX
|
| 75635-26 |
CT ANGIO ABDOMINAL ARTERIES
|
$XXX.XX
|
| 75635-TC |
CT ANGIO ABDOMINAL ARTERIES
|
$XXX.XX
|
| 75705 |
ARTERY X-RAYS SPINE
|
$XXX.XX
|
| 75705-26 |
ARTERY X-RAYS SPINE
|
$XXX.XX
|
| 75705-TC |
ARTERY X-RAYS SPINE
|
$XXX.XX
|
| 75710 |
ARTERY X-RAYS ARM/LEG
|
$XXX.XX
|
| 75710-26 |
ARTERY X-RAYS ARM/LEG
|
$XXX.XX
|
| 75710-TC |
ARTERY X-RAYS ARM/LEG
|
$XXX.XX
|
| 75716 |
ARTERY X-RAYS ARMS/LEGS
|
$XXX.XX
|
| 75716-26 |
ARTERY X-RAYS ARMS/LEGS
|
$XXX.XX
|
| 75716-TC |
ARTERY X-RAYS ARMS/LEGS
|
$XXX.XX
|
| 75726 |
ARTERY X-RAYS ABDOMEN
|
$XXX.XX
|
| 75726-26 |
ARTERY X-RAYS ABDOMEN
|
$XXX.XX
|
| 75726-TC |
ARTERY X-RAYS ABDOMEN
|
$XXX.XX
|
| 75731 |
ARTERY X-RAYS ADRENAL GLAND
|
$XXX.XX
|
| 75731-26 |
ARTERY X-RAYS ADRENAL GLAND
|
$XXX.XX
|
| 75731-TC |
ARTERY X-RAYS ADRENAL GLAND
|
$XXX.XX
|
| 75733 |
ARTERY X-RAYS ADRENALS
|
$XXX.XX
|
| 75733-26 |
ARTERY X-RAYS ADRENALS
|
$XXX.XX
|
| 75733-TC |
ARTERY X-RAYS ADRENALS
|
$XXX.XX
|
| 75736 |
ARTERY X-RAYS PELVIS
|
$XXX.XX
|
| 75736-26 |
ARTERY X-RAYS PELVIS
|
$XXX.XX
|
| 75736-TC |
ARTERY X-RAYS PELVIS
|
$XXX.XX
|
| 75741 |
ARTERY X-RAYS LUNG
|
$XXX.XX
|
| 75741-26 |
ARTERY X-RAYS LUNG
|
$XXX.XX
|
| 75741-TC |
ARTERY X-RAYS LUNG
|
$XXX.XX
|
| 75743 |
ARTERY X-RAYS LUNGS
|
$XXX.XX
|
| 75743-26 |
ARTERY X-RAYS LUNGS
|
$XXX.XX
|
| 75743-TC |
ARTERY X-RAYS LUNGS
|
$XXX.XX
|
| 75746 |
ARTERY X-RAYS LUNG
|
$XXX.XX
|
| 75746-26 |
ARTERY X-RAYS LUNG
|
$XXX.XX
|
| 75746-TC |
ARTERY X-RAYS LUNG
|
$XXX.XX
|
| 75756 |
ARTERY X-RAYS CHEST
|
$XXX.XX
|
| 75756-26 |
ARTERY X-RAYS CHEST
|
$XXX.XX
|
| 75756-TC |
ARTERY X-RAYS CHEST
|
$XXX.XX
|
| 75774 |
ARTERY X-RAY EACH VESSEL
|
$XXX.XX
|
| 75774-26 |
ARTERY X-RAY EACH VESSEL
|
$XXX.XX
|
| 75774-TC |
ARTERY X-RAY EACH VESSEL
|
$XXX.XX
|
| 75801-26 |
LYMPH VESSEL X-RAY ARM/LEG
|
$XXX.XX
|
| 75803-26 |
LYMPH VESSEL X-RAY ARMS/LEGS
|
$XXX.XX
|
| 75805-26 |
LYMPH VESSEL X-RAY TRUNK
|
$XXX.XX
|
| 75807-26 |
LYMPH VESSEL X-RAY TRUNK
|
$XXX.XX
|
| 75809 |
NONVASCULAR SHUNT X-RAY
|
$XXX.XX
|
| 75809-26 |
NONVASCULAR SHUNT X-RAY
|
$XXX.XX
|
| 75809-TC |
NONVASCULAR SHUNT X-RAY
|
$XXX.XX
|
| 75810-26 |
VEIN X-RAY SPLEEN/LIVER
|
$XXX.XX
|
| 75820 |
VEIN X-RAY ARM/LEG
|
$XXX.XX
|
| 75820-26 |
VEIN X-RAY ARM/LEG
|
$XXX.XX
|
| 75820-TC |
VEIN X-RAY ARM/LEG
|
$XXX.XX
|
| 75822 |
VEIN X-RAY ARMS/LEGS
|
$XXX.XX
|
| 75822-26 |
VEIN X-RAY ARMS/LEGS
|
$XXX.XX
|
| 75822-TC |
VEIN X-RAY ARMS/LEGS
|
$XXX.XX
|
| 75825 |
VEIN X-RAY TRUNK
|
$XXX.XX
|
| 75825-26 |
VEIN X-RAY TRUNK
|
$XXX.XX
|
| 75825-TC |
VEIN X-RAY TRUNK
|
$XXX.XX
|
| 75827 |
VEIN X-RAY CHEST
|
$XXX.XX
|
| 75827-26 |
VEIN X-RAY CHEST
|
$XXX.XX
|
| 75827-TC |
VEIN X-RAY CHEST
|
$XXX.XX
|
| 75831 |
VEIN X-RAY KIDNEY
|
$XXX.XX
|
| 75831-26 |
VEIN X-RAY KIDNEY
|
$XXX.XX
|
| 75831-TC |
VEIN X-RAY KIDNEY
|
$XXX.XX
|
| 75833 |
VEIN X-RAY KIDNEYS
|
$XXX.XX
|
| 75833-26 |
VEIN X-RAY KIDNEYS
|
$XXX.XX
|
| 75833-TC |
VEIN X-RAY KIDNEYS
|
$XXX.XX
|
| 75840 |
VEIN X-RAY ADRENAL GLAND
|
$XXX.XX
|
| 75840-26 |
VEIN X-RAY ADRENAL GLAND
|
$XXX.XX
|
| 75840-TC |
VEIN X-RAY ADRENAL GLAND
|
$XXX.XX
|
| 75842 |
VEIN X-RAY ADRENAL GLANDS
|
$XXX.XX
|
| 75842-26 |
VEIN X-RAY ADRENAL GLANDS
|
$XXX.XX
|
| 75842-TC |
VEIN X-RAY ADRENAL GLANDS
|
$XXX.XX
|
| 75860 |
VEIN X-RAY NECK
|
$XXX.XX
|
| 75860-26 |
VEIN X-RAY NECK
|
$XXX.XX
|
| 75860-TC |
VEIN X-RAY NECK
|
$XXX.XX
|
| 75870 |
VEIN X-RAY SKULL
|
$XXX.XX
|
| 75870-26 |
VEIN X-RAY SKULL
|
$XXX.XX
|
| 75870-TC |
VEIN X-RAY SKULL
|
$XXX.XX
|
| 75872 |
VEIN X-RAY SKULL EPIDURAL
|
$XXX.XX
|
| 75872-26 |
VEIN X-RAY SKULL EPIDURAL
|
$XXX.XX
|
| 75872-TC |
VEIN X-RAY SKULL EPIDURAL
|
$XXX.XX
|
| 75880 |
VEIN X-RAY EYE SOCKET
|
$XXX.XX
|
| 75880-26 |
VEIN X-RAY EYE SOCKET
|
$XXX.XX
|
| 75880-TC |
VEIN X-RAY EYE SOCKET
|
$XXX.XX
|
| 75885 |
VEIN X-RAY LIVER W/HEMODYNAM
|
$XXX.XX
|
| 75885-26 |
VEIN X-RAY LIVER W/HEMODYNAM
|
$XXX.XX
|
| 75885-TC |
VEIN X-RAY LIVER W/HEMODYNAM
|
$XXX.XX
|
| 75887 |
VEIN X-RAY LIVER W/O HEMODYN
|
$XXX.XX
|
| 75887-26 |
VEIN X-RAY LIVER W/O HEMODYN
|
$XXX.XX
|
| 75887-TC |
VEIN X-RAY LIVER W/O HEMODYN
|
$XXX.XX
|
| 75889 |
VEIN X-RAY LIVER W/HEMODYNAM
|
$XXX.XX
|
| 75889-26 |
VEIN X-RAY LIVER W/HEMODYNAM
|
$XXX.XX
|
| 75889-TC |
VEIN X-RAY LIVER W/HEMODYNAM
|
$XXX.XX
|
| 75891 |
VEIN X-RAY LIVER
|
$XXX.XX
|
| 75891-26 |
VEIN X-RAY LIVER
|
$XXX.XX
|
| 75891-TC |
VEIN X-RAY LIVER
|
$XXX.XX
|
| 75893 |
VENOUS SAMPLING BY CATHETER
|
$XXX.XX
|
| 75893-26 |
VENOUS SAMPLING BY CATHETER
|
$XXX.XX
|
| 75893-TC |
VENOUS SAMPLING BY CATHETER
|
$XXX.XX
|
| 75894-26 |
X-RAYS TRANSCATH THERAPY
|
$XXX.XX
|
| 75898-26 |
FOLLOW-UP ANGIOGRAPHY
|
$XXX.XX
|
| 75901 |
REMOVE CVA DEVICE OBSTRUCT
|
$XXX.XX
|
| 75901-26 |
REMOVE CVA DEVICE OBSTRUCT
|
$XXX.XX
|
| 75901-TC |
REMOVE CVA DEVICE OBSTRUCT
|
$XXX.XX
|
| 75902 |
REMOVE CVA LUMEN OBSTRUCT
|
$XXX.XX
|
| 75902-26 |
REMOVE CVA LUMEN OBSTRUCT
|
$XXX.XX
|
| 75902-TC |
REMOVE CVA LUMEN OBSTRUCT
|
$XXX.XX
|
| 75956-26 |
XRAY ENDOVASC THOR AO REPR
|
$XXX.XX
|
| 75957-26 |
XRAY ENDOVASC THOR AO REPR
|
$XXX.XX
|
| 75958-26 |
XRAY PLACE PROX EXT THOR AO
|
$XXX.XX
|
| 75959-26 |
XRAY PLACE DIST EXT THOR AO
|
$XXX.XX
|
| 75970-26 |
VASCULAR BIOPSY
|
$XXX.XX
|
| 75984 |
XRAY CONTROL CATHETER CHANGE
|
$XXX.XX
|
| 75984-26 |
XRAY CONTROL CATHETER CHANGE
|
$XXX.XX
|
| 75984-TC |
XRAY CONTROL CATHETER CHANGE
|
$XXX.XX
|
| 75989 |
ABSCESS DRAINAGE UNDER X-RAY
|
$XXX.XX
|
| 75989-26 |
ABSCESS DRAINAGE UNDER X-RAY
|
$XXX.XX
|
| 75989-TC |
ABSCESS DRAINAGE UNDER X-RAY
|
$XXX.XX
|
| 76000 |
FLUOROSCOPY <1 HR PHYS/QHP
|
$XXX.XX
|
| 76000-26 |
FLUOROSCOPY <1 HR PHYS/QHP
|
$XXX.XX
|
| 76000-TC |
FLUOROSCOPY <1 HR PHYS/QHP
|
$XXX.XX
|
| 76010 |
X-RAY NOSE TO RECTUM
|
$XXX.XX
|
| 76010-26 |
X-RAY NOSE TO RECTUM
|
$XXX.XX
|
| 76010-TC |
X-RAY NOSE TO RECTUM
|
$XXX.XX
|
| 76080 |
X-RAY EXAM OF FISTULA
|
$XXX.XX
|
| 76080-26 |
X-RAY EXAM OF FISTULA
|
$XXX.XX
|
| 76080-TC |
X-RAY EXAM OF FISTULA
|
$XXX.XX
|
| 76098 |
X-RAY EXAM SURGICAL SPECIMEN
|
$XXX.XX
|
| 76098-26 |
X-RAY EXAM SURGICAL SPECIMEN
|
$XXX.XX
|
| 76098-TC |
X-RAY EXAM SURGICAL SPECIMEN
|
$XXX.XX
|
| 76100 |
X-RAY EXAM OF BODY SECTION
|
$XXX.XX
|
| 76100-26 |
X-RAY EXAM OF BODY SECTION
|
$XXX.XX
|
| 76100-TC |
X-RAY EXAM OF BODY SECTION
|
$XXX.XX
|
| 76101 |
COMPLEX BODY SECTION X-RAY
|
$XXX.XX
|
| 76101-26 |
COMPLEX BODY SECTION X-RAY
|
$XXX.XX
|
| 76101-TC |
COMPLEX BODY SECTION X-RAY
|
$XXX.XX
|
| 76102 |
COMPLEX BODY SECTION X-RAYS
|
$XXX.XX
|
| 76102-26 |
COMPLEX BODY SECTION X-RAYS
|
$XXX.XX
|
| 76102-TC |
COMPLEX BODY SECTION X-RAYS
|
$XXX.XX
|
| 76120 |
CINE/VIDEO X-RAYS
|
$XXX.XX
|
| 76120-26 |
CINE/VIDEO X-RAYS
|
$XXX.XX
|
| 76120-TC |
CINE/VIDEO X-RAYS
|
$XXX.XX
|
| 76125-26 |
CINE/VIDEO X-RAYS ADD-ON
|
$XXX.XX
|
| 76376 |
3D RENDER W/INTRP POSTPROCES
|
$XXX.XX
|
| 76376-26 |
3D RENDER W/INTRP POSTPROCES
|
$XXX.XX
|
| 76376-TC |
3D RENDER W/INTRP POSTPROCES
|
$XXX.XX
|
| 76377 |
3D RENDER W/INTRP POSTPROCES
|
$XXX.XX
|
| 76377-26 |
3D RENDER W/INTRP POSTPROCES
|
$XXX.XX
|
| 76377-TC |
3D RENDER W/INTRP POSTPROCES
|
$XXX.XX
|
| 76380 |
CAT SCAN FOLLOW-UP STUDY
|
$XXX.XX
|
| 76380-26 |
CAT SCAN FOLLOW-UP STUDY
|
$XXX.XX
|
| 76380-TC |
CAT SCAN FOLLOW-UP STUDY
|
$XXX.XX
|
| 76391 |
MR ELASTOGRAPHY
|
$XXX.XX
|
| 76391-26 |
MR ELASTOGRAPHY
|
$XXX.XX
|
| 76391-TC |
MR ELASTOGRAPHY
|
$XXX.XX
|
| 76506 |
ECHO EXAM OF HEAD
|
$XXX.XX
|
| 76506-26 |
ECHO EXAM OF HEAD
|
$XXX.XX
|
| 76506-TC |
ECHO EXAM OF HEAD
|
$XXX.XX
|
| 76510 |
OPHTH US B & QUANT A
|
$XXX.XX
|
| 76510-26 |
OPHTH US B & QUANT A
|
$XXX.XX
|
| 76510-TC |
OPHTH US B & QUANT A
|
$XXX.XX
|
| 76511 |
OPHTH US QUANT A ONLY
|
$XXX.XX
|
| 76511-26 |
OPHTH US QUANT A ONLY
|
$XXX.XX
|
| 76511-TC |
OPHTH US QUANT A ONLY
|
$XXX.XX
|
| 76512 |
OPHTH US B W/NON-QUANT A
|
$XXX.XX
|
| 76512-26 |
OPHTH US B W/NON-QUANT A
|
$XXX.XX
|
| 76512-TC |
OPHTH US B W/NON-QUANT A
|
$XXX.XX
|
| 76513 |
ECHO EXAM OF EYE WATER BATH
|
$XXX.XX
|
| 76513-26 |
ECHO EXAM OF EYE WATER BATH
|
$XXX.XX
|
| 76513-TC |
ECHO EXAM OF EYE WATER BATH
|
$XXX.XX
|
| 76514 |
ECHO EXAM OF EYE THICKNESS
|
$XXX.XX
|
| 76514-26 |
ECHO EXAM OF EYE THICKNESS
|
$XXX.XX
|
| 76514-TC |
ECHO EXAM OF EYE THICKNESS
|
$XXX.XX
|
| 76516 |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76516-26 |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76516-TC |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76519 |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76519-26 |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76519-TC |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76529 |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76529-26 |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76529-TC |
ECHO EXAM OF EYE
|
$XXX.XX
|
| 76536 |
US EXAM OF HEAD AND NECK
|
$XXX.XX
|
| 76536-26 |
US EXAM OF HEAD AND NECK
|
$XXX.XX
|
| 76536-TC |
US EXAM OF HEAD AND NECK
|
$XXX.XX
|
| 76604 |
US EXAM CHEST
|
$XXX.XX
|
| 76604-26 |
US EXAM CHEST
|
$XXX.XX
|
| 76604-TC |
US EXAM CHEST
|
$XXX.XX
|
| 76641 |
ULTRASOUND BREAST COMPLETE
|
$XXX.XX
|
| 76641-26 |
ULTRASOUND BREAST COMPLETE
|
$XXX.XX
|
| 76641-TC |
ULTRASOUND BREAST COMPLETE
|
$XXX.XX
|
| 76642 |
ULTRASOUND BREAST LIMITED
|
$XXX.XX
|
| 76642-26 |
ULTRASOUND BREAST LIMITED
|
$XXX.XX
|
| 76642-TC |
ULTRASOUND BREAST LIMITED
|
$XXX.XX
|
| 76700 |
US EXAM ABDOM COMPLETE
|
$XXX.XX
|
| 76700-26 |
US EXAM ABDOM COMPLETE
|
$XXX.XX
|
| 76700-TC |
US EXAM ABDOM COMPLETE
|
$XXX.XX
|
| 76705 |
ECHO EXAM OF ABDOMEN
|
$XXX.XX
|
| 76705-26 |
ECHO EXAM OF ABDOMEN
|
$XXX.XX
|
| 76705-TC |
ECHO EXAM OF ABDOMEN
|
$XXX.XX
|
| 76706 |
US ABDL AORTA SCREEN AAA
|
$XXX.XX
|
| 76706-26 |
US ABDL AORTA SCREEN AAA
|
$XXX.XX
|
| 76706-TC |
US ABDL AORTA SCREEN AAA
|
$XXX.XX
|
| 76770 |
US EXAM ABDO BACK WALL COMP
|
$XXX.XX
|
| 76770-26 |
US EXAM ABDO BACK WALL COMP
|
$XXX.XX
|
| 76770-TC |
US EXAM ABDO BACK WALL COMP
|
$XXX.XX
|
| 76775 |
US EXAM ABDO BACK WALL LIM
|
$XXX.XX
|
| 76775-26 |
US EXAM ABDO BACK WALL LIM
|
$XXX.XX
|
| 76775-TC |
US EXAM ABDO BACK WALL LIM
|
$XXX.XX
|
| 76776 |
US EXAM K TRANSPL W/DOPPLER
|
$XXX.XX
|
| 76776-26 |
US EXAM K TRANSPL W/DOPPLER
|
$XXX.XX
|
| 76776-TC |
US EXAM K TRANSPL W/DOPPLER
|
$XXX.XX
|
| 76800 |
US EXAM SPINAL CANAL
|
$XXX.XX
|
| 76800-26 |
US EXAM SPINAL CANAL
|
$XXX.XX
|
| 76800-TC |
US EXAM SPINAL CANAL
|
$XXX.XX
|
| 76801 |
OB US < 14 WKS SINGLE FETUS
|
$XXX.XX
|
| 76801-26 |
OB US < 14 WKS SINGLE FETUS
|
$XXX.XX
|
| 76801-TC |
OB US < 14 WKS SINGLE FETUS
|
$XXX.XX
|
| 76802 |
OB US < 14 WKS ADDL FETUS
|
$XXX.XX
|
| 76802-26 |
OB US < 14 WKS ADDL FETUS
|
$XXX.XX
|
| 76802-TC |
OB US < 14 WKS ADDL FETUS
|
$XXX.XX
|
| 76805 |
OB US >= 14 WKS SNGL FETUS
|
$XXX.XX
|
| 76805-26 |
OB US >= 14 WKS SNGL FETUS
|
$XXX.XX
|
| 76805-TC |
OB US >= 14 WKS SNGL FETUS
|
$XXX.XX
|
| 76810 |
OB US >= 14 WKS ADDL FETUS
|
$XXX.XX
|
| 76810-26 |
OB US >= 14 WKS ADDL FETUS
|
$XXX.XX
|
| 76810-TC |
OB US >= 14 WKS ADDL FETUS
|
$XXX.XX
|
| 76811 |
OB US DETAILED SNGL FETUS
|
$XXX.XX
|
| 76811-26 |
OB US DETAILED SNGL FETUS
|
$XXX.XX
|
| 76811-TC |
OB US DETAILED SNGL FETUS
|
$XXX.XX
|
| 76812 |
OB US DETAILED ADDL FETUS
|
$XXX.XX
|
| 76812-26 |
OB US DETAILED ADDL FETUS
|
$XXX.XX
|
| 76812-TC |
OB US DETAILED ADDL FETUS
|
$XXX.XX
|
| 76813 |
OB US NUCHAL MEAS 1 GEST
|
$XXX.XX
|
| 76813-26 |
OB US NUCHAL MEAS 1 GEST
|
$XXX.XX
|
| 76813-TC |
OB US NUCHAL MEAS 1 GEST
|
$XXX.XX
|
| 76814 |
OB US NUCHAL MEAS ADD-ON
|
$XXX.XX
|
| 76814-26 |
OB US NUCHAL MEAS ADD-ON
|
$XXX.XX
|
| 76814-TC |
OB US NUCHAL MEAS ADD-ON
|
$XXX.XX
|
| 76815 |
OB US LIMITED FETUS(S)
|
$XXX.XX
|
| 76815-26 |
OB US LIMITED FETUS(S)
|
$XXX.XX
|
| 76815-TC |
OB US LIMITED FETUS(S)
|
$XXX.XX
|
| 76816 |
OB US FOLLOW-UP PER FETUS
|
$XXX.XX
|
| 76816-26 |
OB US FOLLOW-UP PER FETUS
|
$XXX.XX
|
| 76816-TC |
OB US FOLLOW-UP PER FETUS
|
$XXX.XX
|
| 76817 |
TRANSVAGINAL US OBSTETRIC
|
$XXX.XX
|
| 76817-26 |
TRANSVAGINAL US OBSTETRIC
|
$XXX.XX
|
| 76817-TC |
TRANSVAGINAL US OBSTETRIC
|
$XXX.XX
|
| 76818 |
FETAL BIOPHYS PROFILE W/NST
|
$XXX.XX
|
| 76818-26 |
FETAL BIOPHYS PROFILE W/NST
|
$XXX.XX
|
| 76818-TC |
FETAL BIOPHYS PROFILE W/NST
|
$XXX.XX
|
| 76819 |
FETAL BIOPHYS PROFIL W/O NST
|
$XXX.XX
|
| 76819-26 |
FETAL BIOPHYS PROFIL W/O NST
|
$XXX.XX
|
| 76819-TC |
FETAL BIOPHYS PROFIL W/O NST
|
$XXX.XX
|
| 76820 |
UMBILICAL ARTERY ECHO
|
$XXX.XX
|
| 76820-26 |
UMBILICAL ARTERY ECHO
|
$XXX.XX
|
| 76820-TC |
UMBILICAL ARTERY ECHO
|
$XXX.XX
|
| 76821 |
MIDDLE CEREBRAL ARTERY ECHO
|
$XXX.XX
|
| 76821-26 |
MIDDLE CEREBRAL ARTERY ECHO
|
$XXX.XX
|
| 76821-TC |
MIDDLE CEREBRAL ARTERY ECHO
|
$XXX.XX
|
| 76825 |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76825-26 |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76825-TC |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76826 |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76826-26 |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76826-TC |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76827 |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76827-26 |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76827-TC |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76828 |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76828-26 |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76828-TC |
ECHO EXAM OF FETAL HEART
|
$XXX.XX
|
| 76830 |
TRANSVAGINAL US NON-OB
|
$XXX.XX
|
| 76830-26 |
TRANSVAGINAL US NON-OB
|
$XXX.XX
|
| 76830-TC |
TRANSVAGINAL US NON-OB
|
$XXX.XX
|
| 76831 |
ECHO EXAM UTERUS
|
$XXX.XX
|
| 76831-26 |
ECHO EXAM UTERUS
|
$XXX.XX
|
| 76831-TC |
ECHO EXAM UTERUS
|
$XXX.XX
|
| 76856 |
US EXAM PELVIC COMPLETE
|
$XXX.XX
|
| 76856-26 |
US EXAM PELVIC COMPLETE
|
$XXX.XX
|
| 76856-TC |
US EXAM PELVIC COMPLETE
|
$XXX.XX
|
| 76857 |
US EXAM PELVIC LIMITED
|
$XXX.XX
|
| 76857-26 |
US EXAM PELVIC LIMITED
|
$XXX.XX
|
| 76857-TC |
US EXAM PELVIC LIMITED
|
$XXX.XX
|
| 76870 |
US EXAM SCROTUM
|
$XXX.XX
|
| 76870-26 |
US EXAM SCROTUM
|
$XXX.XX
|
| 76870-TC |
US EXAM SCROTUM
|
$XXX.XX
|
| 76872 |
US TRANSRECTAL
|
$XXX.XX
|
| 76872-26 |
US TRANSRECTAL
|
$XXX.XX
|
| 76872-TC |
US TRANSRECTAL
|
$XXX.XX
|
| 76873 |
ECHOGRAP TRANS R PROS STUDY
|
$XXX.XX
|
| 76873-26 |
ECHOGRAP TRANS R PROS STUDY
|
$XXX.XX
|
| 76873-TC |
ECHOGRAP TRANS R PROS STUDY
|
$XXX.XX
|
| 76881 |
US COMPL JOINT R-T W/IMG
|
$XXX.XX
|
| 76881-26 |
US COMPL JOINT R-T W/IMG
|
$XXX.XX
|
| 76881-TC |
US COMPL JOINT R-T W/IMG
|
$XXX.XX
|
| 76882 |
US LMTD JT/NONVASC XTR STRUX
|
$XXX.XX
|
| 76882-26 |
US LMTD JT/NONVASC XTR STRUX
|
$XXX.XX
|
| 76882-TC |
US LMTD JT/NONVASC XTR STRUX
|
$XXX.XX
|
| 76885 |
US EXAM INFANT HIPS DYNAMIC
|
$XXX.XX
|
| 76885-26 |
US EXAM INFANT HIPS DYNAMIC
|
$XXX.XX
|
| 76885-TC |
US EXAM INFANT HIPS DYNAMIC
|
$XXX.XX
|
| 76886 |
US EXAM INFANT HIPS STATIC
|
$XXX.XX
|
| 76886-26 |
US EXAM INFANT HIPS STATIC
|
$XXX.XX
|
| 76886-TC |
US EXAM INFANT HIPS STATIC
|
$XXX.XX
|
| 76932-26 |
ECHO GUIDE FOR HEART BIOPSY
|
$XXX.XX
|
| 76936 |
ECHO GUIDE FOR ARTERY REPAIR
|
$XXX.XX
|
| 76936-26 |
ECHO GUIDE FOR ARTERY REPAIR
|
$XXX.XX
|
| 76936-TC |
ECHO GUIDE FOR ARTERY REPAIR
|
$XXX.XX
|
| 76937 |
US GUIDE VASCULAR ACCESS
|
$XXX.XX
|
| 76937-26 |
US GUIDE VASCULAR ACCESS
|
$XXX.XX
|
| 76937-TC |
US GUIDE VASCULAR ACCESS
|
$XXX.XX
|
| 76940-26 |
US GUIDE TISSUE ABLATION
|
$XXX.XX
|
| 76941-26 |
ECHO GUIDE FOR TRANSFUSION
|
$XXX.XX
|
| 76942 |
ECHO GUIDE FOR BIOPSY
|
$XXX.XX
|
| 76942-26 |
ECHO GUIDE FOR BIOPSY
|
$XXX.XX
|
| 76942-TC |
ECHO GUIDE FOR BIOPSY
|
$XXX.XX
|
| 76945-26 |
ECHO GUIDE VILLUS SAMPLING
|
$XXX.XX
|
| 76946 |
ECHO GUIDE FOR AMNIOCENTESIS
|
$XXX.XX
|
| 76946-26 |
ECHO GUIDE FOR AMNIOCENTESIS
|
$XXX.XX
|
| 76946-TC |
ECHO GUIDE FOR AMNIOCENTESIS
|
$XXX.XX
|
| 76948 |
ECHO GUIDE OVA ASPIRATION
|
$XXX.XX
|
| 76948-26 |
ECHO GUIDE OVA ASPIRATION
|
$XXX.XX
|
| 76948-TC |
ECHO GUIDE OVA ASPIRATION
|
$XXX.XX
|
| 76965 |
ECHO GUIDANCE RADIOTHERAPY
|
$XXX.XX
|
| 76965-26 |
ECHO GUIDANCE RADIOTHERAPY
|
$XXX.XX
|
| 76965-TC |
ECHO GUIDANCE RADIOTHERAPY
|
$XXX.XX
|
| 76970 |
ULTRASOUND EXAM FOLLOW-UP
|
$XXX.XX
|
| 76970-26 |
ULTRASOUND EXAM FOLLOW-UP
|
$XXX.XX
|
| 76970-TC |
ULTRASOUND EXAM FOLLOW-UP
|
$XXX.XX
|
| 76975-26 |
GI ENDOSCOPIC ULTRASOUND
|
$XXX.XX
|
| 76977 |
US BONE DENSITY MEASURE
|
$XXX.XX
|
| 76977-26 |
US BONE DENSITY MEASURE
|
$XXX.XX
|
| 76977-TC |
US BONE DENSITY MEASURE
|
$XXX.XX
|
| 76978 |
US TRGT DYN MBUBB 1ST LES
|
$XXX.XX
|
| 76978-26 |
US TRGT DYN MBUBB 1ST LES
|
$XXX.XX
|
| 76978-TC |
US TRGT DYN MBUBB 1ST LES
|
$XXX.XX
|
| 76979 |
US TRGT DYN MBUBB EA ADDL
|
$XXX.XX
|
| 76979-26 |
US TRGT DYN MBUBB EA ADDL
|
$XXX.XX
|
| 76979-TC |
US TRGT DYN MBUBB EA ADDL
|
$XXX.XX
|
| 76981 |
USE PARENCHYMA
|
$XXX.XX
|
| 76981-26 |
USE PARENCHYMA
|
$XXX.XX
|
| 76981-TC |
USE PARENCHYMA
|
$XXX.XX
|
| 76982 |
USE 1ST TARGET LESION
|
$XXX.XX
|
| 76982-26 |
USE 1ST TARGET LESION
|
$XXX.XX
|
| 76982-TC |
USE 1ST TARGET LESION
|
$XXX.XX
|
| 76983 |
USE EA ADDL TARGET LESION
|
$XXX.XX
|
| 76983-26 |
USE EA ADDL TARGET LESION
|
$XXX.XX
|
| 76983-TC |
USE EA ADDL TARGET LESION
|
$XXX.XX
|
| 76998-26 |
US GUIDE INTRAOP
|
$XXX.XX
|
| 77001 |
FLUOROGUIDE FOR VEIN DEVICE
|
$XXX.XX
|
| 77001-26 |
FLUOROGUIDE FOR VEIN DEVICE
|
$XXX.XX
|
| 77001-TC |
FLUOROGUIDE FOR VEIN DEVICE
|
$XXX.XX
|
| 77002 |
NEEDLE LOCALIZATION BY XRAY
|
$XXX.XX
|
| 77002-26 |
NEEDLE LOCALIZATION BY XRAY
|
$XXX.XX
|
| 77002-TC |
NEEDLE LOCALIZATION BY XRAY
|
$XXX.XX
|
| 77003 |
FLUOROGUIDE FOR SPINE INJECT
|
$XXX.XX
|
| 77003-26 |
FLUOROGUIDE FOR SPINE INJECT
|
$XXX.XX
|
| 77003-TC |
FLUOROGUIDE FOR SPINE INJECT
|
$XXX.XX
|
| 77011 |
CT SCAN FOR LOCALIZATION
|
$XXX.XX
|
| 77011-26 |
CT SCAN FOR LOCALIZATION
|
$XXX.XX
|
| 77011-TC |
CT SCAN FOR LOCALIZATION
|
$XXX.XX
|
| 77012 |
CT SCAN FOR NEEDLE BIOPSY
|
$XXX.XX
|
| 77012-26 |
CT SCAN FOR NEEDLE BIOPSY
|
$XXX.XX
|
| 77012-TC |
CT SCAN FOR NEEDLE BIOPSY
|
$XXX.XX
|
| 77013-26 |
CT GUIDE FOR TISSUE ABLATION
|
$XXX.XX
|
| 77014 |
CT SCAN FOR THERAPY GUIDE
|
$XXX.XX
|
| 77014-26 |
CT SCAN FOR THERAPY GUIDE
|
$XXX.XX
|
| 77014-TC |
CT SCAN FOR THERAPY GUIDE
|
$XXX.XX
|
| 77021 |
MRI GUIDANCE NDL PLMT RS&I
|
$XXX.XX
|
| 77021-26 |
MRI GUIDANCE NDL PLMT RS&I
|
$XXX.XX
|
| 77021-TC |
MRI GUIDANCE NDL PLMT RS&I
|
$XXX.XX
|
| 77022-26 |
MRI GDN PARNCHYMA TISS ABLTJ
|
$XXX.XX
|
| 77046 |
MRI BREAST C- UNILATERAL
|
$XXX.XX
|
| 77046-26 |
MRI BREAST C- UNILATERAL
|
$XXX.XX
|
| 77046-TC |
MRI BREAST C- UNILATERAL
|
$XXX.XX
|
| 77047 |
MRI BREAST C- BILATERAL
|
$XXX.XX
|
| 77047-26 |
MRI BREAST C- BILATERAL
|
$XXX.XX
|
| 77047-TC |
MRI BREAST C- BILATERAL
|
$XXX.XX
|
| 77048 |
MRI BREAST C-+ W/CAD UNI
|
$XXX.XX
|
| 77048-26 |
MRI BREAST C-+ W/CAD UNI
|
$XXX.XX
|
| 77048-TC |
MRI BREAST C-+ W/CAD UNI
|
$XXX.XX
|
| 77049 |
MRI BREAST C-+ W/CAD BI
|
$XXX.XX
|
| 77049-26 |
MRI BREAST C-+ W/CAD BI
|
$XXX.XX
|
| 77049-TC |
MRI BREAST C-+ W/CAD BI
|
$XXX.XX
|
| 77053 |
X-RAY OF MAMMARY DUCT
|
$XXX.XX
|
| 77053-26 |
X-RAY OF MAMMARY DUCT
|
$XXX.XX
|
| 77053-TC |
X-RAY OF MAMMARY DUCT
|
$XXX.XX
|
| 77054 |
X-RAY OF MAMMARY DUCTS
|
$XXX.XX
|
| 77054-26 |
X-RAY OF MAMMARY DUCTS
|
$XXX.XX
|
| 77054-TC |
X-RAY OF MAMMARY DUCTS
|
$XXX.XX
|
| 77063 |
BREAST TOMOSYNTHESIS BI
|
$XXX.XX
|
| 77063-26 |
BREAST TOMOSYNTHESIS BI
|
$XXX.XX
|
| 77063-TC |
BREAST TOMOSYNTHESIS BI
|
$XXX.XX
|
| 77065 |
DX MAMMO INCL CAD UNI
|
$XXX.XX
|
| 77065-26 |
DX MAMMO INCL CAD UNI
|
$XXX.XX
|
| 77065-TC |
DX MAMMO INCL CAD UNI
|
$XXX.XX
|
| 77066 |
DX MAMMO INCL CAD BI
|
$XXX.XX
|
| 77066-26 |
DX MAMMO INCL CAD BI
|
$XXX.XX
|
| 77066-TC |
DX MAMMO INCL CAD BI
|
$XXX.XX
|
| 77067 |
SCR MAMMO BI INCL CAD
|
$XXX.XX
|
| 77067-26 |
SCR MAMMO BI INCL CAD
|
$XXX.XX
|
| 77067-TC |
SCR MAMMO BI INCL CAD
|
$XXX.XX
|
| 77071 |
X-RAY STRESS VIEW
|
$XXX.XX
|
| 77072 |
X-RAYS FOR BONE AGE
|
$XXX.XX
|
| 77072-26 |
X-RAYS FOR BONE AGE
|
$XXX.XX
|
| 77072-TC |
X-RAYS FOR BONE AGE
|
$XXX.XX
|
| 77073 |
X-RAYS BONE LENGTH STUDIES
|
$XXX.XX
|
| 77073-26 |
X-RAYS BONE LENGTH STUDIES
|
$XXX.XX
|
| 77073-TC |
X-RAYS BONE LENGTH STUDIES
|
$XXX.XX
|
| 77074 |
X-RAYS BONE SURVEY LIMITED
|
$XXX.XX
|
| 77074-26 |
X-RAYS BONE SURVEY LIMITED
|
$XXX.XX
|
| 77074-TC |
X-RAYS BONE SURVEY LIMITED
|
$XXX.XX
|
| 77075 |
X-RAYS BONE SURVEY COMPLETE
|
$XXX.XX
|
| 77075-26 |
X-RAYS BONE SURVEY COMPLETE
|
$XXX.XX
|
| 77075-TC |
X-RAYS BONE SURVEY COMPLETE
|
$XXX.XX
|
| 77076 |
X-RAYS BONE SURVEY INFANT
|
$XXX.XX
|
| 77076-26 |
X-RAYS BONE SURVEY INFANT
|
$XXX.XX
|
| 77076-TC |
X-RAYS BONE SURVEY INFANT
|
$XXX.XX
|
| 77077 |
JOINT SURVEY SINGLE VIEW
|
$XXX.XX
|
| 77077-26 |
JOINT SURVEY SINGLE VIEW
|
$XXX.XX
|
| 77077-TC |
JOINT SURVEY SINGLE VIEW
|
$XXX.XX
|
| 77078 |
CT BONE DENSITY AXIAL
|
$XXX.XX
|
| 77078-26 |
CT BONE DENSITY AXIAL
|
$XXX.XX
|
| 77078-TC |
CT BONE DENSITY AXIAL
|
$XXX.XX
|
| 77080 |
DXA BONE DENSITY AXIAL
|
$XXX.XX
|
| 77080-26 |
DXA BONE DENSITY AXIAL
|
$XXX.XX
|
| 77080-TC |
DXA BONE DENSITY AXIAL
|
$XXX.XX
|
| 77081 |
DXA BONE DENSITY/PERIPHERAL
|
$XXX.XX
|
| 77081-26 |
DXA BONE DENSITY/PERIPHERAL
|
$XXX.XX
|
| 77081-TC |
DXA BONE DENSITY/PERIPHERAL
|
$XXX.XX
|
| 77084 |
MAGNETIC IMAGE BONE MARROW
|
$XXX.XX
|
| 77084-26 |
MAGNETIC IMAGE BONE MARROW
|
$XXX.XX
|
| 77084-TC |
MAGNETIC IMAGE BONE MARROW
|
$XXX.XX
|
| 77085 |
DXA BONE DENSITY STUDY
|
$XXX.XX
|
| 77085-26 |
DXA BONE DENSITY STUDY
|
$XXX.XX
|
| 77085-TC |
DXA BONE DENSITY STUDY
|
$XXX.XX
|
| 77086 |
FRACTURE ASSESSMENT VIA DXA
|
$XXX.XX
|
| 77086-26 |
FRACTURE ASSESSMENT VIA DXA
|
$XXX.XX
|
| 77086-TC |
FRACTURE ASSESSMENT VIA DXA
|
$XXX.XX
|
| 77261 |
RADIATION THERAPY PLANNING
|
$XXX.XX
|
| 77262 |
RADIATION THERAPY PLANNING
|
$XXX.XX
|
| 77263 |
RADIATION THERAPY PLANNING
|
$XXX.XX
|
| 77280 |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77280-26 |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77280-TC |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77285 |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77285-26 |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77285-TC |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77290 |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77290-26 |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77290-TC |
SET RADIATION THERAPY FIELD
|
$XXX.XX
|
| 77293 |
RESPIRATOR MOTION MGMT SIMUL
|
$XXX.XX
|
| 77293-26 |
RESPIRATOR MOTION MGMT SIMUL
|
$XXX.XX
|
| 77293-TC |
RESPIRATOR MOTION MGMT SIMUL
|
$XXX.XX
|
| 77295 |
3-D RADIOTHERAPY PLAN
|
$XXX.XX
|
| 77295-26 |
3-D RADIOTHERAPY PLAN
|
$XXX.XX
|
| 77295-TC |
3-D RADIOTHERAPY PLAN
|
$XXX.XX
|
| 77300 |
RADIATION THERAPY DOSE PLAN
|
$XXX.XX
|
| 77300-26 |
RADIATION THERAPY DOSE PLAN
|
$XXX.XX
|
| 77300-TC |
RADIATION THERAPY DOSE PLAN
|
$XXX.XX
|
| 77301 |
RADIOTHERAPY DOSE PLAN IMRT
|
$XXX.XX
|
| 77301-26 |
RADIOTHERAPY DOSE PLAN IMRT
|
$XXX.XX
|
| 77301-TC |
RADIOTHERAPY DOSE PLAN IMRT
|
$XXX.XX
|
| 77306 |
TELETHX ISODOSE PLAN SIMPLE
|
$XXX.XX
|
| 77306-26 |
TELETHX ISODOSE PLAN SIMPLE
|
$XXX.XX
|
| 77306-TC |
TELETHX ISODOSE PLAN SIMPLE
|
$XXX.XX
|
| 77307 |
TELETHX ISODOSE PLAN CPLX
|
$XXX.XX
|
| 77307-26 |
TELETHX ISODOSE PLAN CPLX
|
$XXX.XX
|
| 77307-TC |
TELETHX ISODOSE PLAN CPLX
|
$XXX.XX
|
| 77316 |
BRACHYTX ISODOSE PLAN SIMPLE
|
$XXX.XX
|
| 77316-26 |
BRACHYTX ISODOSE PLAN SIMPLE
|
$XXX.XX
|
| 77316-TC |
BRACHYTX ISODOSE PLAN SIMPLE
|
$XXX.XX
|
| 77317 |
BRACHYTX ISODOSE INTERMED
|
$XXX.XX
|
| 77317-26 |
BRACHYTX ISODOSE INTERMED
|
$XXX.XX
|
| 77317-TC |
BRACHYTX ISODOSE INTERMED
|
$XXX.XX
|
| 77318 |
BRACHYTX ISODOSE COMPLEX
|
$XXX.XX
|
| 77318-26 |
BRACHYTX ISODOSE COMPLEX
|
$XXX.XX
|
| 77318-TC |
BRACHYTX ISODOSE COMPLEX
|
$XXX.XX
|
| 77321 |
SPECIAL TELETX PORT PLAN
|
$XXX.XX
|
| 77321-26 |
SPECIAL TELETX PORT PLAN
|
$XXX.XX
|
| 77321-TC |
SPECIAL TELETX PORT PLAN
|
$XXX.XX
|
| 77331 |
SPECIAL RADIATION DOSIMETRY
|
$XXX.XX
|
| 77331-26 |
SPECIAL RADIATION DOSIMETRY
|
$XXX.XX
|
| 77331-TC |
SPECIAL RADIATION DOSIMETRY
|
$XXX.XX
|
| 77332 |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77332-26 |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77332-TC |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77333 |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77333-26 |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77333-TC |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77334 |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77334-26 |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77334-TC |
RADIATION TREATMENT AID(S)
|
$XXX.XX
|
| 77336 |
RADIATION PHYSICS CONSULT
|
$XXX.XX
|
| 77338 |
DESIGN MLC DEVICE FOR IMRT
|
$XXX.XX
|
| 77338-26 |
DESIGN MLC DEVICE FOR IMRT
|
$XXX.XX
|
| 77338-TC |
DESIGN MLC DEVICE FOR IMRT
|
$XXX.XX
|
| 77370 |
RADIATION PHYSICS CONSULT
|
$XXX.XX
|
| 77372 |
SRS LINEAR BASED
|
$XXX.XX
|
| 77373 |
SBRT DELIVERY
|
$XXX.XX
|
| 77401 |
RADIATION TREATMENT DELIVERY
|
$XXX.XX
|
| 77417 |
RADIOLOGY PORT IMAGES(S)
|
$XXX.XX
|
| 77427 |
RADIATION TX MANAGEMENT X5
|
$XXX.XX
|
| 77431 |
RADIATION THERAPY MANAGEMENT
|
$XXX.XX
|
| 77432 |
STEREOTACTIC RADIATION TRMT
|
$XXX.XX
|
| 77435 |
SBRT MANAGEMENT
|
$XXX.XX
|
| 77469 |
IO RADIATION TX MANAGEMENT
|
$XXX.XX
|
| 77470 |
SPECIAL RADIATION TREATMENT
|
$XXX.XX
|
| 77470-26 |
SPECIAL RADIATION TREATMENT
|
$XXX.XX
|
| 77470-TC |
SPECIAL RADIATION TREATMENT
|
$XXX.XX
|
| 77600 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77600-26 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77600-TC |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77605 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77605-26 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77605-TC |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77610 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77610-26 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77610-TC |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77615 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77615-26 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77615-TC |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77620 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77620-26 |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77620-TC |
HYPERTHERMIA TREATMENT
|
$XXX.XX
|
| 77750 |
INFUSE RADIOACTIVE MATERIALS
|
$XXX.XX
|
| 77750-26 |
INFUSE RADIOACTIVE MATERIALS
|
$XXX.XX
|
| 77750-TC |
INFUSE RADIOACTIVE MATERIALS
|
$XXX.XX
|
| 77761 |
APPLY INTRCAV RADIAT SIMPLE
|
$XXX.XX
|
| 77761-26 |
APPLY INTRCAV RADIAT SIMPLE
|
$XXX.XX
|
| 77761-TC |
APPLY INTRCAV RADIAT SIMPLE
|
$XXX.XX
|
| 77762 |
APPLY INTRCAV RADIAT INTERM
|
$XXX.XX
|
| 77762-26 |
APPLY INTRCAV RADIAT INTERM
|
$XXX.XX
|
| 77762-TC |
APPLY INTRCAV RADIAT INTERM
|
$XXX.XX
|
| 77763 |
APPLY INTRCAV RADIAT COMPL
|
$XXX.XX
|
| 77763-26 |
APPLY INTRCAV RADIAT COMPL
|
$XXX.XX
|
| 77763-TC |
APPLY INTRCAV RADIAT COMPL
|
$XXX.XX
|
| 77767 |
HDR RDNCL SKN SURF BRACHYTX
|
$XXX.XX
|
| 77767-26 |
HDR RDNCL SKN SURF BRACHYTX
|
$XXX.XX
|
| 77767-TC |
HDR RDNCL SKN SURF BRACHYTX
|
$XXX.XX
|
| 77768 |
HDR RDNCL SKN SURF BRACHYTX
|
$XXX.XX
|
| 77768-26 |
HDR RDNCL SKN SURF BRACHYTX
|
$XXX.XX
|
| 77768-TC |
HDR RDNCL SKN SURF BRACHYTX
|
$XXX.XX
|
| 77770 |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77770-26 |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77770-TC |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77771 |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77771-26 |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77771-TC |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77772 |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77772-26 |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77772-TC |
HDR RDNCL NTRSTL/ICAV BRCHTX
|
$XXX.XX
|
| 77778 |
APPLY INTERSTIT RADIAT COMPL
|
$XXX.XX
|
| 77778-26 |
APPLY INTERSTIT RADIAT COMPL
|
$XXX.XX
|
| 77778-TC |
APPLY INTERSTIT RADIAT COMPL
|
$XXX.XX
|
| 77789 |
APPLY SURF LDR RADIONUCLIDE
|
$XXX.XX
|
| 77789-26 |
APPLY SURF LDR RADIONUCLIDE
|
$XXX.XX
|
| 77789-TC |
APPLY SURF LDR RADIONUCLIDE
|
$XXX.XX
|
| 77790 |
RADIATION HANDLING
|
$XXX.XX
|
| 78012 |
THYROID UPTAKE MEASUREMENT
|
$XXX.XX
|
| 78012-26 |
THYROID UPTAKE MEASUREMENT
|
$XXX.XX
|
| 78012-TC |
THYROID UPTAKE MEASUREMENT
|
$XXX.XX
|
| 78013 |
THYROID IMAGING W/BLOOD FLOW
|
$XXX.XX
|
| 78013-26 |
THYROID IMAGING W/BLOOD FLOW
|
$XXX.XX
|
| 78013-TC |
THYROID IMAGING W/BLOOD FLOW
|
$XXX.XX
|
| 78014 |
THYROID IMAGING W/BLOOD FLOW
|
$XXX.XX
|
| 78014-26 |
THYROID IMAGING W/BLOOD FLOW
|
$XXX.XX
|
| 78014-TC |
THYROID IMAGING W/BLOOD FLOW
|
$XXX.XX
|
| 78015 |
THYROID MET IMAGING
|
$XXX.XX
|
| 78015-26 |
THYROID MET IMAGING
|
$XXX.XX
|
| 78015-TC |
THYROID MET IMAGING
|
$XXX.XX
|
| 78016 |
THYROID MET IMAGING/STUDIES
|
$XXX.XX
|
| 78016-26 |
THYROID MET IMAGING/STUDIES
|
$XXX.XX
|
| 78016-TC |
THYROID MET IMAGING/STUDIES
|
$XXX.XX
|
| 78018 |
THYROID MET IMAGING BODY
|
$XXX.XX
|
| 78018-26 |
THYROID MET IMAGING BODY
|
$XXX.XX
|
| 78018-TC |
THYROID MET IMAGING BODY
|
$XXX.XX
|
| 78020 |
THYROID MET UPTAKE
|
$XXX.XX
|
| 78020-26 |
THYROID MET UPTAKE
|
$XXX.XX
|
| 78020-TC |
THYROID MET UPTAKE
|
$XXX.XX
|
| 78070 |
PARATHYROID PLANAR IMAGING
|
$XXX.XX
|
| 78070-26 |
PARATHYROID PLANAR IMAGING
|
$XXX.XX
|
| 78070-TC |
PARATHYROID PLANAR IMAGING
|
$XXX.XX
|
| 78071 |
PARATHYRD PLANAR W/WO SUBTRJ
|
$XXX.XX
|
| 78071-26 |
PARATHYRD PLANAR W/WO SUBTRJ
|
$XXX.XX
|
| 78071-TC |
PARATHYRD PLANAR W/WO SUBTRJ
|
$XXX.XX
|
| 78072 |
PARATHYRD PLANAR W/SPECT&CT
|
$XXX.XX
|
| 78072-26 |
PARATHYRD PLANAR W/SPECT&CT
|
$XXX.XX
|
| 78072-TC |
PARATHYRD PLANAR W/SPECT&CT
|
$XXX.XX
|
| 78075 |
ADRENAL CORTEX & MEDULLA IMG
|
$XXX.XX
|
| 78075-26 |
ADRENAL CORTEX & MEDULLA IMG
|
$XXX.XX
|
| 78075-TC |
ADRENAL CORTEX & MEDULLA IMG
|
$XXX.XX
|
| 78102 |
BONE MARROW IMAGING LTD
|
$XXX.XX
|
| 78102-26 |
BONE MARROW IMAGING LTD
|
$XXX.XX
|
| 78102-TC |
BONE MARROW IMAGING LTD
|
$XXX.XX
|
| 78103 |
BONE MARROW IMAGING MULT
|
$XXX.XX
|
| 78103-26 |
BONE MARROW IMAGING MULT
|
$XXX.XX
|
| 78103-TC |
BONE MARROW IMAGING MULT
|
$XXX.XX
|
| 78104 |
BONE MARROW IMAGING BODY
|
$XXX.XX
|
| 78104-26 |
BONE MARROW IMAGING BODY
|
$XXX.XX
|
| 78104-TC |
BONE MARROW IMAGING BODY
|
$XXX.XX
|
| 78110 |
PLASMA VOLUME SINGLE
|
$XXX.XX
|
| 78110-26 |
PLASMA VOLUME SINGLE
|
$XXX.XX
|
| 78110-TC |
PLASMA VOLUME SINGLE
|
$XXX.XX
|
| 78111 |
PLASMA VOLUME MULTIPLE
|
$XXX.XX
|
| 78111-26 |
PLASMA VOLUME MULTIPLE
|
$XXX.XX
|
| 78111-TC |
PLASMA VOLUME MULTIPLE
|
$XXX.XX
|
| 78120 |
RED CELL MASS SINGLE
|
$XXX.XX
|
| 78120-26 |
RED CELL MASS SINGLE
|
$XXX.XX
|
| 78120-TC |
RED CELL MASS SINGLE
|
$XXX.XX
|
| 78121 |
RED CELL MASS MULTIPLE
|
$XXX.XX
|
| 78121-26 |
RED CELL MASS MULTIPLE
|
$XXX.XX
|
| 78121-TC |
RED CELL MASS MULTIPLE
|
$XXX.XX
|
| 78122 |
BLOOD VOLUME
|
$XXX.XX
|
| 78122-26 |
BLOOD VOLUME
|
$XXX.XX
|
| 78122-TC |
BLOOD VOLUME
|
$XXX.XX
|
| 78130 |
RED CELL SURVIVAL STUDY
|
$XXX.XX
|
| 78130-26 |
RED CELL SURVIVAL STUDY
|
$XXX.XX
|
| 78130-TC |
RED CELL SURVIVAL STUDY
|
$XXX.XX
|
| 78135 |
RED CELL SURVIVAL KINETICS
|
$XXX.XX
|
| 78135-26 |
RED CELL SURVIVAL KINETICS
|
$XXX.XX
|
| 78135-TC |
RED CELL SURVIVAL KINETICS
|
$XXX.XX
|
| 78140 |
RED CELL SEQUESTRATION
|
$XXX.XX
|
| 78140-26 |
RED CELL SEQUESTRATION
|
$XXX.XX
|
| 78140-TC |
RED CELL SEQUESTRATION
|
$XXX.XX
|
| 78185 |
SPLEEN IMAGING
|
$XXX.XX
|
| 78185-26 |
SPLEEN IMAGING
|
$XXX.XX
|
| 78185-TC |
SPLEEN IMAGING
|
$XXX.XX
|
| 78191 |
PLATELET SURVIVAL
|
$XXX.XX
|
| 78191-26 |
PLATELET SURVIVAL
|
$XXX.XX
|
| 78191-TC |
PLATELET SURVIVAL
|
$XXX.XX
|
| 78195 |
LYMPH SYSTEM IMAGING
|
$XXX.XX
|
| 78195-26 |
LYMPH SYSTEM IMAGING
|
$XXX.XX
|
| 78195-TC |
LYMPH SYSTEM IMAGING
|
$XXX.XX
|
| 78201 |
LIVER IMAGING
|
$XXX.XX
|
| 78201-26 |
LIVER IMAGING
|
$XXX.XX
|
| 78201-TC |
LIVER IMAGING
|
$XXX.XX
|
| 78202 |
LIVER IMAGING WITH FLOW
|
$XXX.XX
|
| 78202-26 |
LIVER IMAGING WITH FLOW
|
$XXX.XX
|
| 78202-TC |
LIVER IMAGING WITH FLOW
|
$XXX.XX
|
| 78215 |
LIVER AND SPLEEN IMAGING
|
$XXX.XX
|
| 78215-26 |
LIVER AND SPLEEN IMAGING
|
$XXX.XX
|
| 78215-TC |
LIVER AND SPLEEN IMAGING
|
$XXX.XX
|
| 78216 |
LIVER & SPLEEN IMAGE/FLOW
|
$XXX.XX
|
| 78216-26 |
LIVER & SPLEEN IMAGE/FLOW
|
$XXX.XX
|
| 78216-TC |
LIVER & SPLEEN IMAGE/FLOW
|
$XXX.XX
|
| 78226 |
HEPATOBILIARY SYSTEM IMAGING
|
$XXX.XX
|
| 78226-26 |
HEPATOBILIARY SYSTEM IMAGING
|
$XXX.XX
|
| 78226-TC |
HEPATOBILIARY SYSTEM IMAGING
|
$XXX.XX
|
| 78227 |
HEPATOBIL SYST IMAGE W/DRUG
|
$XXX.XX
|
| 78227-26 |
HEPATOBIL SYST IMAGE W/DRUG
|
$XXX.XX
|
| 78227-TC |
HEPATOBIL SYST IMAGE W/DRUG
|
$XXX.XX
|
| 78230 |
SALIVARY GLAND IMAGING
|
$XXX.XX
|
| 78230-26 |
SALIVARY GLAND IMAGING
|
$XXX.XX
|
| 78230-TC |
SALIVARY GLAND IMAGING
|
$XXX.XX
|
| 78231 |
SERIAL SALIVARY IMAGING
|
$XXX.XX
|
| 78231-26 |
SERIAL SALIVARY IMAGING
|
$XXX.XX
|
| 78231-TC |
SERIAL SALIVARY IMAGING
|
$XXX.XX
|
| 78232 |
SALIVARY GLAND FUNCTION EXAM
|
$XXX.XX
|
| 78232-26 |
SALIVARY GLAND FUNCTION EXAM
|
$XXX.XX
|
| 78232-TC |
SALIVARY GLAND FUNCTION EXAM
|
$XXX.XX
|
| 78258 |
ESOPHAGEAL MOTILITY STUDY
|
$XXX.XX
|
| 78258-26 |
ESOPHAGEAL MOTILITY STUDY
|
$XXX.XX
|
| 78258-TC |
ESOPHAGEAL MOTILITY STUDY
|
$XXX.XX
|
| 78261 |
GASTRIC MUCOSA IMAGING
|
$XXX.XX
|
| 78261-26 |
GASTRIC MUCOSA IMAGING
|
$XXX.XX
|
| 78261-TC |
GASTRIC MUCOSA IMAGING
|
$XXX.XX
|
| 78262 |
GASTROESOPHAGEAL REFLUX EXAM
|
$XXX.XX
|
| 78262-26 |
GASTROESOPHAGEAL REFLUX EXAM
|
$XXX.XX
|
| 78262-TC |
GASTROESOPHAGEAL REFLUX EXAM
|
$XXX.XX
|
| 78264 |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78264-26 |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78264-TC |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78265 |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78265-26 |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78265-TC |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78266 |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78266-26 |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78266-TC |
GASTRIC EMPTYING IMAG STUDY
|
$XXX.XX
|
| 78278 |
ACUTE GI BLOOD LOSS IMAGING
|
$XXX.XX
|
| 78278-26 |
ACUTE GI BLOOD LOSS IMAGING
|
$XXX.XX
|
| 78278-TC |
ACUTE GI BLOOD LOSS IMAGING
|
$XXX.XX
|
| 78282-26 |
GI PROTEIN LOSS EXAM
|
$XXX.XX
|
| 78290 |
MECKELS DIVERT EXAM
|
$XXX.XX
|
| 78290-26 |
MECKELS DIVERT EXAM
|
$XXX.XX
|
| 78290-TC |
MECKELS DIVERT EXAM
|
$XXX.XX
|
| 78291 |
LEVEEN/SHUNT PATENCY EXAM
|
$XXX.XX
|
| 78291-26 |
LEVEEN/SHUNT PATENCY EXAM
|
$XXX.XX
|
| 78291-TC |
LEVEEN/SHUNT PATENCY EXAM
|
$XXX.XX
|
| 78300 |
BONE IMAGING LIMITED AREA
|
$XXX.XX
|
| 78300-26 |
BONE IMAGING LIMITED AREA
|
$XXX.XX
|
| 78300-TC |
BONE IMAGING LIMITED AREA
|
$XXX.XX
|
| 78305 |
BONE IMAGING MULTIPLE AREAS
|
$XXX.XX
|
| 78305-26 |
BONE IMAGING MULTIPLE AREAS
|
$XXX.XX
|
| 78305-TC |
BONE IMAGING MULTIPLE AREAS
|
$XXX.XX
|
| 78306 |
BONE IMAGING WHOLE BODY
|
$XXX.XX
|
| 78306-26 |
BONE IMAGING WHOLE BODY
|
$XXX.XX
|
| 78306-TC |
BONE IMAGING WHOLE BODY
|
$XXX.XX
|
| 78315 |
BONE IMAGING 3 PHASE
|
$XXX.XX
|
| 78315-26 |
BONE IMAGING 3 PHASE
|
$XXX.XX
|
| 78315-TC |
BONE IMAGING 3 PHASE
|
$XXX.XX
|
| 78414-26 |
NON-IMAGING HEART FUNCTION
|
$XXX.XX
|
| 78428 |
CARDIAC SHUNT IMAGING
|
$XXX.XX
|
| 78428-26 |
CARDIAC SHUNT IMAGING
|
$XXX.XX
|
| 78428-TC |
CARDIAC SHUNT IMAGING
|
$XXX.XX
|
| 78429-26 |
MYOCRD IMG PET 1 STD W/CT
|
$XXX.XX
|
| 78430-26 |
MYOCRD IMG PET RST/STRS W/CT
|
$XXX.XX
|
| 78431-26 |
MYOCRD IMG PET RST&STRS CT
|
$XXX.XX
|
| 78432-26 |
MYOCRD IMG PET 2RTRACER
|
$XXX.XX
|
| 78433-26 |
MYOCRD IMG PET 2RTRACER CT
|
$XXX.XX
|
| 78434-26 |
AQMBF PET REST & RX STRESS
|
$XXX.XX
|
| 78445 |
VASCULAR FLOW IMAGING
|
$XXX.XX
|
| 78445-26 |
VASCULAR FLOW IMAGING
|
$XXX.XX
|
| 78445-TC |
VASCULAR FLOW IMAGING
|
$XXX.XX
|
| 78451 |
HT MUSCLE IMAGE SPECT SING
|
$XXX.XX
|
| 78451-26 |
HT MUSCLE IMAGE SPECT SING
|
$XXX.XX
|
| 78451-TC |
HT MUSCLE IMAGE SPECT SING
|
$XXX.XX
|
| 78452 |
HT MUSCLE IMAGE SPECT MULT
|
$XXX.XX
|
| 78452-26 |
HT MUSCLE IMAGE SPECT MULT
|
$XXX.XX
|
| 78452-TC |
HT MUSCLE IMAGE SPECT MULT
|
$XXX.XX
|
| 78453 |
HT MUSCLE IMAGE PLANAR SING
|
$XXX.XX
|
| 78453-26 |
HT MUSCLE IMAGE PLANAR SING
|
$XXX.XX
|
| 78453-TC |
HT MUSCLE IMAGE PLANAR SING
|
$XXX.XX
|
| 78454 |
HT MUSC IMAGE PLANAR MULT
|
$XXX.XX
|
| 78454-26 |
HT MUSC IMAGE PLANAR MULT
|
$XXX.XX
|
| 78454-TC |
HT MUSC IMAGE PLANAR MULT
|
$XXX.XX
|
| 78456 |
ACUTE VENOUS THROMBUS IMAGE
|
$XXX.XX
|
| 78456-26 |
ACUTE VENOUS THROMBUS IMAGE
|
$XXX.XX
|
| 78456-TC |
ACUTE VENOUS THROMBUS IMAGE
|
$XXX.XX
|
| 78457 |
VENOUS THROMBOSIS IMAGING
|
$XXX.XX
|
| 78457-26 |
VENOUS THROMBOSIS IMAGING
|
$XXX.XX
|
| 78457-TC |
VENOUS THROMBOSIS IMAGING
|
$XXX.XX
|
| 78458 |
VEN THROMBOSIS IMAGES BILAT
|
$XXX.XX
|
| 78458-26 |
VEN THROMBOSIS IMAGES BILAT
|
$XXX.XX
|
| 78458-TC |
VEN THROMBOSIS IMAGES BILAT
|
$XXX.XX
|
| 78459-26 |
MYOCRD IMG PET SINGLE STUDY
|
$XXX.XX
|
| 78466 |
HEART INFARCT IMAGE
|
$XXX.XX
|
| 78466-26 |
HEART INFARCT IMAGE
|
$XXX.XX
|
| 78466-TC |
HEART INFARCT IMAGE
|
$XXX.XX
|
| 78468 |
HEART INFARCT IMAGE (EF)
|
$XXX.XX
|
| 78468-26 |
HEART INFARCT IMAGE (EF)
|
$XXX.XX
|
| 78468-TC |
HEART INFARCT IMAGE (EF)
|
$XXX.XX
|
| 78469 |
HEART INFARCT IMAGE (3D)
|
$XXX.XX
|
| 78469-26 |
HEART INFARCT IMAGE (3D)
|
$XXX.XX
|
| 78469-TC |
HEART INFARCT IMAGE (3D)
|
$XXX.XX
|
| 78472 |
GATED HEART PLANAR SINGLE
|
$XXX.XX
|
| 78472-26 |
GATED HEART PLANAR SINGLE
|
$XXX.XX
|
| 78472-TC |
GATED HEART PLANAR SINGLE
|
$XXX.XX
|
| 78473 |
GATED HEART MULTIPLE
|
$XXX.XX
|
| 78473-26 |
GATED HEART MULTIPLE
|
$XXX.XX
|
| 78473-TC |
GATED HEART MULTIPLE
|
$XXX.XX
|
| 78481 |
HEART FIRST PASS SINGLE
|
$XXX.XX
|
| 78481-26 |
HEART FIRST PASS SINGLE
|
$XXX.XX
|
| 78481-TC |
HEART FIRST PASS SINGLE
|
$XXX.XX
|
| 78483 |
HEART FIRST PASS MULTIPLE
|
$XXX.XX
|
| 78483-26 |
HEART FIRST PASS MULTIPLE
|
$XXX.XX
|
| 78483-TC |
HEART FIRST PASS MULTIPLE
|
$XXX.XX
|
| 78491-26 |
MYOCRD IMG PET 1STD RST/STRS
|
$XXX.XX
|
| 78492-26 |
MYOCRD IMG PET MLT RST&STRS
|
$XXX.XX
|
| 78494 |
HEART IMAGE SPECT
|
$XXX.XX
|
| 78494-26 |
HEART IMAGE SPECT
|
$XXX.XX
|
| 78494-TC |
HEART IMAGE SPECT
|
$XXX.XX
|
| 78496 |
HEART FIRST PASS ADD-ON
|
$XXX.XX
|
| 78496-26 |
HEART FIRST PASS ADD-ON
|
$XXX.XX
|
| 78496-TC |
HEART FIRST PASS ADD-ON
|
$XXX.XX
|
| 78579 |
LUNG VENTILATION IMAGING
|
$XXX.XX
|
| 78579-26 |
LUNG VENTILATION IMAGING
|
$XXX.XX
|
| 78579-TC |
LUNG VENTILATION IMAGING
|
$XXX.XX
|
| 78580 |
LUNG PERFUSION IMAGING
|
$XXX.XX
|
| 78580-26 |
LUNG PERFUSION IMAGING
|
$XXX.XX
|
| 78580-TC |
LUNG PERFUSION IMAGING
|
$XXX.XX
|
| 78582 |
LUNG VENTILAT&PERFUS IMAGING
|
$XXX.XX
|
| 78582-26 |
LUNG VENTILAT&PERFUS IMAGING
|
$XXX.XX
|
| 78582-TC |
LUNG VENTILAT&PERFUS IMAGING
|
$XXX.XX
|
| 78597 |
LUNG PERFUSION DIFFERENTIAL
|
$XXX.XX
|
| 78597-26 |
LUNG PERFUSION DIFFERENTIAL
|
$XXX.XX
|
| 78597-TC |
LUNG PERFUSION DIFFERENTIAL
|
$XXX.XX
|
| 78598 |
LUNG PERF&VENTILAT DIFERENTL
|
$XXX.XX
|
| 78598-26 |
LUNG PERF&VENTILAT DIFERENTL
|
$XXX.XX
|
| 78598-TC |
LUNG PERF&VENTILAT DIFERENTL
|
$XXX.XX
|
| 78600 |
BRAIN IMAGE < 4 VIEWS
|
$XXX.XX
|
| 78600-26 |
BRAIN IMAGE < 4 VIEWS
|
$XXX.XX
|
| 78600-TC |
BRAIN IMAGE < 4 VIEWS
|
$XXX.XX
|
| 78601 |
BRAIN IMAGE W/FLOW < 4 VIEWS
|
$XXX.XX
|
| 78601-26 |
BRAIN IMAGE W/FLOW < 4 VIEWS
|
$XXX.XX
|
| 78601-TC |
BRAIN IMAGE W/FLOW < 4 VIEWS
|
$XXX.XX
|
| 78605 |
BRAIN IMAGE 4+ VIEWS
|
$XXX.XX
|
| 78605-26 |
BRAIN IMAGE 4+ VIEWS
|
$XXX.XX
|
| 78605-TC |
BRAIN IMAGE 4+ VIEWS
|
$XXX.XX
|
| 78606 |
BRAIN IMAGE W/FLOW 4 + VIEWS
|
$XXX.XX
|
| 78606-26 |
BRAIN IMAGE W/FLOW 4 + VIEWS
|
$XXX.XX
|
| 78606-TC |
BRAIN IMAGE W/FLOW 4 + VIEWS
|
$XXX.XX
|
| 78608-26 |
BRAIN IMAGING (PET)
|
$XXX.XX
|
| 78610 |
BRAIN FLOW IMAGING ONLY
|
$XXX.XX
|
| 78610-26 |
BRAIN FLOW IMAGING ONLY
|
$XXX.XX
|
| 78610-TC |
BRAIN FLOW IMAGING ONLY
|
$XXX.XX
|
| 78630 |
CEREBROSPINAL FLUID SCAN
|
$XXX.XX
|
| 78630-26 |
CEREBROSPINAL FLUID SCAN
|
$XXX.XX
|
| 78630-TC |
CEREBROSPINAL FLUID SCAN
|
$XXX.XX
|
| 78635 |
CSF VENTRICULOGRAPHY
|
$XXX.XX
|
| 78635-26 |
CSF VENTRICULOGRAPHY
|
$XXX.XX
|
| 78635-TC |
CSF VENTRICULOGRAPHY
|
$XXX.XX
|
| 78645 |
CSF SHUNT EVALUATION
|
$XXX.XX
|
| 78645-26 |
CSF SHUNT EVALUATION
|
$XXX.XX
|
| 78645-TC |
CSF SHUNT EVALUATION
|
$XXX.XX
|
| 78650 |
CSF LEAKAGE IMAGING
|
$XXX.XX
|
| 78650-26 |
CSF LEAKAGE IMAGING
|
$XXX.XX
|
| 78650-TC |
CSF LEAKAGE IMAGING
|
$XXX.XX
|
| 78660 |
NUCLEAR EXAM OF TEAR FLOW
|
$XXX.XX
|
| 78660-26 |
NUCLEAR EXAM OF TEAR FLOW
|
$XXX.XX
|
| 78660-TC |
NUCLEAR EXAM OF TEAR FLOW
|
$XXX.XX
|
| 78700 |
KIDNEY IMAGING MORPHOL
|
$XXX.XX
|
| 78700-26 |
KIDNEY IMAGING MORPHOL
|
$XXX.XX
|
| 78700-TC |
KIDNEY IMAGING MORPHOL
|
$XXX.XX
|
| 78701 |
KIDNEY IMAGING WITH FLOW
|
$XXX.XX
|
| 78701-26 |
KIDNEY IMAGING WITH FLOW
|
$XXX.XX
|
| 78701-TC |
KIDNEY IMAGING WITH FLOW
|
$XXX.XX
|
| 78707 |
K FLOW/FUNCT IMAGE W/O DRUG
|
$XXX.XX
|
| 78707-26 |
K FLOW/FUNCT IMAGE W/O DRUG
|
$XXX.XX
|
| 78707-TC |
K FLOW/FUNCT IMAGE W/O DRUG
|
$XXX.XX
|
| 78708 |
K FLOW/FUNCT IMAGE W/DRUG
|
$XXX.XX
|
| 78708-26 |
K FLOW/FUNCT IMAGE W/DRUG
|
$XXX.XX
|
| 78708-TC |
K FLOW/FUNCT IMAGE W/DRUG
|
$XXX.XX
|
| 78709 |
K FLOW/FUNCT IMAGE MULTIPLE
|
$XXX.XX
|
| 78709-26 |
K FLOW/FUNCT IMAGE MULTIPLE
|
$XXX.XX
|
| 78709-TC |
K FLOW/FUNCT IMAGE MULTIPLE
|
$XXX.XX
|
| 78725 |
KIDNEY FUNCTION STUDY
|
$XXX.XX
|
| 78725-26 |
KIDNEY FUNCTION STUDY
|
$XXX.XX
|
| 78725-TC |
KIDNEY FUNCTION STUDY
|
$XXX.XX
|
| 78730 |
URINARY BLADDER RETENTION
|
$XXX.XX
|
| 78730-26 |
URINARY BLADDER RETENTION
|
$XXX.XX
|
| 78730-TC |
URINARY BLADDER RETENTION
|
$XXX.XX
|
| 78740 |
URETERAL REFLUX STUDY
|
$XXX.XX
|
| 78740-26 |
URETERAL REFLUX STUDY
|
$XXX.XX
|
| 78740-TC |
URETERAL REFLUX STUDY
|
$XXX.XX
|
| 78761 |
TESTICULAR IMAGING W/FLOW
|
$XXX.XX
|
| 78761-26 |
TESTICULAR IMAGING W/FLOW
|
$XXX.XX
|
| 78761-TC |
TESTICULAR IMAGING W/FLOW
|
$XXX.XX
|
| 78800 |
RP LOCLZJ TUM 1 AREA 1 D IMG
|
$XXX.XX
|
| 78800-26 |
RP LOCLZJ TUM 1 AREA 1 D IMG
|
$XXX.XX
|
| 78800-TC |
RP LOCLZJ TUM 1 AREA 1 D IMG
|
$XXX.XX
|
| 78801 |
RP LOCLZJ TUM 2+AREA 1+D IMG
|
$XXX.XX
|
| 78801-26 |
RP LOCLZJ TUM 2+AREA 1+D IMG
|
$XXX.XX
|
| 78801-TC |
RP LOCLZJ TUM 2+AREA 1+D IMG
|
$XXX.XX
|
| 78802 |
RP LOCLZJ TUM WHBDY 1 D IMG
|
$XXX.XX
|
| 78802-26 |
RP LOCLZJ TUM WHBDY 1 D IMG
|
$XXX.XX
|
| 78802-TC |
RP LOCLZJ TUM WHBDY 1 D IMG
|
$XXX.XX
|
| 78803 |
RP LOCLZJ TUM SPECT 1 AREA
|
$XXX.XX
|
| 78803-26 |
RP LOCLZJ TUM SPECT 1 AREA
|
$XXX.XX
|
| 78803-TC |
RP LOCLZJ TUM SPECT 1 AREA
|
$XXX.XX
|
| 78804 |
RP LOCLZJ TUM WHBDY 2+D IMG
|
$XXX.XX
|
| 78804-26 |
RP LOCLZJ TUM WHBDY 2+D IMG
|
$XXX.XX
|
| 78804-TC |
RP LOCLZJ TUM WHBDY 2+D IMG
|
$XXX.XX
|
| 78808 |
IV INJ RA DRUG DX STUDY
|
$XXX.XX
|
| 78811-26 |
PET IMAGE LTD AREA
|
$XXX.XX
|
| 78812-26 |
PET IMAGE SKULL-THIGH
|
$XXX.XX
|
| 78813-26 |
PET IMAGE FULL BODY
|
$XXX.XX
|
| 78814-26 |
PET IMAGE W/CT LMTD
|
$XXX.XX
|
| 78815-26 |
PET IMAGE W/CT SKULL-THIGH
|
$XXX.XX
|
| 78816-26 |
PET IMAGE W/CT FULL BODY
|
$XXX.XX
|
| 78830 |
RP LOCLZJ TUM SPECT W/CT 1
|
$XXX.XX
|
| 78830-26 |
RP LOCLZJ TUM SPECT W/CT 1
|
$XXX.XX
|
| 78830-TC |
RP LOCLZJ TUM SPECT W/CT 1
|
$XXX.XX
|
| 78831 |
RP LOCLZJ TUM SPECT 2 AREAS
|
$XXX.XX
|
| 78831-26 |
RP LOCLZJ TUM SPECT 2 AREAS
|
$XXX.XX
|
| 78831-TC |
RP LOCLZJ TUM SPECT 2 AREAS
|
$XXX.XX
|
| 78832 |
RP LOCLZJ TUM SPECT W/CT 2
|
$XXX.XX
|
| 78832-26 |
RP LOCLZJ TUM SPECT W/CT 2
|
$XXX.XX
|
| 78832-TC |
RP LOCLZJ TUM SPECT W/CT 2
|
$XXX.XX
|
| 78835 |
RP QUAN MEAS SINGLE AREA
|
$XXX.XX
|
| 78835-26 |
RP QUAN MEAS SINGLE AREA
|
$XXX.XX
|
| 78835-TC |
RP QUAN MEAS SINGLE AREA
|
$XXX.XX
|
| 79005 |
NUCLEAR RX ORAL ADMIN
|
$XXX.XX
|
| 79005-26 |
NUCLEAR RX ORAL ADMIN
|
$XXX.XX
|
| 79005-TC |
NUCLEAR RX ORAL ADMIN
|
$XXX.XX
|
| 79101 |
NUCLEAR RX IV ADMIN
|
$XXX.XX
|
| 79101-26 |
NUCLEAR RX IV ADMIN
|
$XXX.XX
|
| 79101-TC |
NUCLEAR RX IV ADMIN
|
$XXX.XX
|
| 79200 |
NUCLEAR RX INTRACAV ADMIN
|
$XXX.XX
|
| 79200-26 |
NUCLEAR RX INTRACAV ADMIN
|
$XXX.XX
|
| 79200-TC |
NUCLEAR RX INTRACAV ADMIN
|
$XXX.XX
|
| 79300-26 |
NUCLR RX INTERSTIT COLLOID
|
$XXX.XX
|
| 79403 |
HEMATOPOIETIC NUCLEAR TX
|
$XXX.XX
|
| 79403-26 |
HEMATOPOIETIC NUCLEAR TX
|
$XXX.XX
|
| 79403-TC |
HEMATOPOIETIC NUCLEAR TX
|
$XXX.XX
|
| 79440 |
NUCLEAR RX INTRA-ARTICULAR
|
$XXX.XX
|
| 79440-26 |
NUCLEAR RX INTRA-ARTICULAR
|
$XXX.XX
|
| 79440-TC |
NUCLEAR RX INTRA-ARTICULAR
|
$XXX.XX
|
| 79445-26 |
NUCLEAR RX INTRA-ARTERIAL
|
$XXX.XX
|
| 80500 |
LAB PATHOLOGY CONSULTATION
|
$XXX.XX
|
| 80502 |
LAB PATHOLOGY CONSULTATION
|
$XXX.XX
|
| 83020-26 |
HEMOGLOBIN ELECTROPHORESIS
|
$XXX.XX
|
| 84165-26 |
PROTEIN E-PHORESIS SERUM
|
$XXX.XX
|
| 84166-26 |
PROTEIN E-PHORESIS/URINE/CSF
|
$XXX.XX
|
| 84181-26 |
WESTERN BLOT TEST
|
$XXX.XX
|
| 84182-26 |
PROTEIN WESTERN BLOT TEST
|
$XXX.XX
|
| 85060 |
BLOOD SMEAR INTERPRETATION
|
$XXX.XX
|
| 85097 |
BONE MARROW INTERPRETATION
|
$XXX.XX
|
| 85390-26 |
FIBRINOLYSINS SCREEN I&R
|
$XXX.XX
|
| 85396 |
CLOTTING ASSAY WHOLE BLOOD
|
$XXX.XX
|
| 85576-26 |
BLOOD PLATELET AGGREGATION
|
$XXX.XX
|
| 86077 |
PHYS BLOOD BANK SERV XMATCH
|
$XXX.XX
|
| 86078 |
PHYS BLOOD BANK SERV REACTJ
|
$XXX.XX
|
| 86079 |
PHYS BLOOD BANK SERV AUTHRJ
|
$XXX.XX
|
| 86153-26 |
CELL ENUMERATION PHYS INTERP
|
$XXX.XX
|
| 86255-26 |
FLUORESCENT ANTIBODY SCREEN
|
$XXX.XX
|
| 86256-26 |
FLUORESCENT ANTIBODY TITER
|
$XXX.XX
|
| 86320-26 |
SERUM IMMUNOELECTROPHORESIS
|
$XXX.XX
|
| 86325-26 |
OTHER IMMUNOELECTROPHORESIS
|
$XXX.XX
|
| 86327-26 |
IMMUNOELECTROPHORESIS ASSAY
|
$XXX.XX
|
| 86334-26 |
IMMUNOFIX E-PHORESIS SERUM
|
$XXX.XX
|
| 86335-26 |
IMMUNFIX E-PHORSIS/URINE/CSF
|
$XXX.XX
|
| 86486 |
SKIN TEST NOS ANTIGEN
|
$XXX.XX
|
| 86490 |
COCCIDIOIDOMYCOSIS SKIN TEST
|
$XXX.XX
|
| 86510 |
HISTOPLASMOSIS SKIN TEST
|
$XXX.XX
|
| 86580 |
TB INTRADERMAL TEST
|
$XXX.XX
|
| 87164-26 |
DARK FIELD EXAMINATION
|
$XXX.XX
|
| 87207-26 |
SMEAR SPECIAL STAIN
|
$XXX.XX
|
| 88104 |
CYTOPATH FL NONGYN SMEARS
|
$XXX.XX
|
| 88104-26 |
CYTOPATH FL NONGYN SMEARS
|
$XXX.XX
|
| 88104-TC |
CYTOPATH FL NONGYN SMEARS
|
$XXX.XX
|
| 88106 |
CYTOPATH FL NONGYN FILTER
|
$XXX.XX
|
| 88106-26 |
CYTOPATH FL NONGYN FILTER
|
$XXX.XX
|
| 88106-TC |
CYTOPATH FL NONGYN FILTER
|
$XXX.XX
|
| 88108 |
CYTOPATH CONCENTRATE TECH
|
$XXX.XX
|
| 88108-26 |
CYTOPATH CONCENTRATE TECH
|
$XXX.XX
|
| 88108-TC |
CYTOPATH CONCENTRATE TECH
|
$XXX.XX
|
| 88112 |
CYTOPATH CELL ENHANCE TECH
|
$XXX.XX
|
| 88112-26 |
CYTOPATH CELL ENHANCE TECH
|
$XXX.XX
|
| 88112-TC |
CYTOPATH CELL ENHANCE TECH
|
$XXX.XX
|
| 88120 |
CYTP URNE 3-5 PROBES EA SPEC
|
$XXX.XX
|
| 88120-26 |
CYTP URNE 3-5 PROBES EA SPEC
|
$XXX.XX
|
| 88120-TC |
CYTP URNE 3-5 PROBES EA SPEC
|
$XXX.XX
|
| 88121 |
CYTP URINE 3-5 PROBES CMPTR
|
$XXX.XX
|
| 88121-26 |
CYTP URINE 3-5 PROBES CMPTR
|
$XXX.XX
|
| 88121-TC |
CYTP URINE 3-5 PROBES CMPTR
|
$XXX.XX
|
| 88125 |
FORENSIC CYTOPATHOLOGY
|
$XXX.XX
|
| 88125-26 |
FORENSIC CYTOPATHOLOGY
|
$XXX.XX
|
| 88125-TC |
FORENSIC CYTOPATHOLOGY
|
$XXX.XX
|
| 88141 |
CYTOPATH C/V INTERPRET
|
$XXX.XX
|
| 88160 |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88160-26 |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88160-TC |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88161 |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88161-26 |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88161-TC |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88162 |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88162-26 |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88162-TC |
CYTOPATH SMEAR OTHER SOURCE
|
$XXX.XX
|
| 88172 |
CYTP DX EVAL FNA 1ST EA SITE
|
$XXX.XX
|
| 88172-26 |
CYTP DX EVAL FNA 1ST EA SITE
|
$XXX.XX
|
| 88172-TC |
CYTP DX EVAL FNA 1ST EA SITE
|
$XXX.XX
|
| 88173 |
CYTOPATH EVAL FNA REPORT
|
$XXX.XX
|
| 88173-26 |
CYTOPATH EVAL FNA REPORT
|
$XXX.XX
|
| 88173-TC |
CYTOPATH EVAL FNA REPORT
|
$XXX.XX
|
| 88177 |
CYTP FNA EVAL EA ADDL
|
$XXX.XX
|
| 88177-26 |
CYTP FNA EVAL EA ADDL
|
$XXX.XX
|
| 88177-TC |
CYTP FNA EVAL EA ADDL
|
$XXX.XX
|
| 88182 |
CELL MARKER STUDY
|
$XXX.XX
|
| 88182-26 |
CELL MARKER STUDY
|
$XXX.XX
|
| 88182-TC |
CELL MARKER STUDY
|
$XXX.XX
|
| 88184 |
FLOWCYTOMETRY/ TC 1 MARKER
|
$XXX.XX
|
| 88185 |
FLOWCYTOMETRY/TC ADD-ON
|
$XXX.XX
|
| 88187 |
FLOWCYTOMETRY/READ 2-8
|
$XXX.XX
|
| 88188 |
FLOWCYTOMETRY/READ 9-15
|
$XXX.XX
|
| 88189 |
FLOWCYTOMETRY/READ 16 & >
|
$XXX.XX
|
| 88291 |
CYTO/MOLECULAR REPORT
|
$XXX.XX
|
| 88300 |
SURGICAL PATH GROSS
|
$XXX.XX
|
| 88300-26 |
SURGICAL PATH GROSS
|
$XXX.XX
|
| 88300-TC |
SURGICAL PATH GROSS
|
$XXX.XX
|
| 88302 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88302-26 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88302-TC |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88304 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88304-26 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88304-TC |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88305 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88305-26 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88305-TC |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88307 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88307-26 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88307-TC |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88309 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88309-26 |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88309-TC |
TISSUE EXAM BY PATHOLOGIST
|
$XXX.XX
|
| 88311 |
DECALCIFY TISSUE
|
$XXX.XX
|
| 88311-26 |
DECALCIFY TISSUE
|
$XXX.XX
|
| 88311-TC |
DECALCIFY TISSUE
|
$XXX.XX
|
| 88312 |
SPECIAL STAINS GROUP 1
|
$XXX.XX
|
| 88312-26 |
SPECIAL STAINS GROUP 1
|
$XXX.XX
|
| 88312-TC |
SPECIAL STAINS GROUP 1
|
$XXX.XX
|
| 88313 |
SPECIAL STAINS GROUP 2
|
$XXX.XX
|
| 88313-26 |
SPECIAL STAINS GROUP 2
|
$XXX.XX
|
| 88313-TC |
SPECIAL STAINS GROUP 2
|
$XXX.XX
|
| 88314 |
HISTOCHEMICAL STAINS ADD-ON
|
$XXX.XX
|
| 88314-26 |
HISTOCHEMICAL STAINS ADD-ON
|
$XXX.XX
|
| 88314-TC |
HISTOCHEMICAL STAINS ADD-ON
|
$XXX.XX
|
| 88319 |
ENZYME HISTOCHEMISTRY
|
$XXX.XX
|
| 88319-26 |
ENZYME HISTOCHEMISTRY
|
$XXX.XX
|
| 88319-TC |
ENZYME HISTOCHEMISTRY
|
$XXX.XX
|
| 88321 |
MICROSLIDE CONSULTATION
|
$XXX.XX
|
| 88323 |
MICROSLIDE CONSULTATION
|
$XXX.XX
|
| 88323-26 |
MICROSLIDE CONSULTATION
|
$XXX.XX
|
| 88323-TC |
MICROSLIDE CONSULTATION
|
$XXX.XX
|
| 88325 |
COMPREHENSIVE REVIEW OF DATA
|
$XXX.XX
|
| 88329 |
PATH CONSULT INTROP
|
$XXX.XX
|
| 88331 |
PATH CONSULT INTRAOP 1 BLOC
|
$XXX.XX
|
| 88331-26 |
PATH CONSULT INTRAOP 1 BLOC
|
$XXX.XX
|
| 88331-TC |
PATH CONSULT INTRAOP 1 BLOC
|
$XXX.XX
|
| 88332 |
PATH CONSULT INTRAOP ADDL
|
$XXX.XX
|
| 88332-26 |
PATH CONSULT INTRAOP ADDL
|
$XXX.XX
|
| 88332-TC |
PATH CONSULT INTRAOP ADDL
|
$XXX.XX
|
| 88333 |
INTRAOP CYTO PATH CONSULT 1
|
$XXX.XX
|
| 88333-26 |
INTRAOP CYTO PATH CONSULT 1
|
$XXX.XX
|
| 88333-TC |
INTRAOP CYTO PATH CONSULT 1
|
$XXX.XX
|
| 88334 |
INTRAOP CYTO PATH CONSULT 2
|
$XXX.XX
|
| 88334-26 |
INTRAOP CYTO PATH CONSULT 2
|
$XXX.XX
|
| 88334-TC |
INTRAOP CYTO PATH CONSULT 2
|
$XXX.XX
|
| 88341 |
IMMUNOHISTO ANTB ADDL SLIDE
|
$XXX.XX
|
| 88341-26 |
IMMUNOHISTO ANTB ADDL SLIDE
|
$XXX.XX
|
| 88341-TC |
IMMUNOHISTO ANTB ADDL SLIDE
|
$XXX.XX
|
| 88342 |
IMMUNOHISTO ANTB 1ST STAIN
|
$XXX.XX
|
| 88342-26 |
IMMUNOHISTO ANTB 1ST STAIN
|
$XXX.XX
|
| 88342-TC |
IMMUNOHISTO ANTB 1ST STAIN
|
$XXX.XX
|
| 88344 |
IMMUNOHISTO ANTIBODY SLIDE
|
$XXX.XX
|
| 88344-26 |
IMMUNOHISTO ANTIBODY SLIDE
|
$XXX.XX
|
| 88344-TC |
IMMUNOHISTO ANTIBODY SLIDE
|
$XXX.XX
|
| 88346 |
IMMUNOFLUOR ANTB 1ST STAIN
|
$XXX.XX
|
| 88346-26 |
IMMUNOFLUOR ANTB 1ST STAIN
|
$XXX.XX
|
| 88346-TC |
IMMUNOFLUOR ANTB 1ST STAIN
|
$XXX.XX
|
| 88348 |
ELECTRON MICROSCOPY
|
$XXX.XX
|
| 88348-26 |
ELECTRON MICROSCOPY
|
$XXX.XX
|
| 88348-TC |
ELECTRON MICROSCOPY
|
$XXX.XX
|
| 88350 |
IMMUNOFLUOR ANTB ADDL STAIN
|
$XXX.XX
|
| 88350-26 |
IMMUNOFLUOR ANTB ADDL STAIN
|
$XXX.XX
|
| 88350-TC |
IMMUNOFLUOR ANTB ADDL STAIN
|
$XXX.XX
|
| 88355 |
ANALYSIS SKELETAL MUSCLE
|
$XXX.XX
|
| 88355-26 |
ANALYSIS SKELETAL MUSCLE
|
$XXX.XX
|
| 88355-TC |
ANALYSIS SKELETAL MUSCLE
|
$XXX.XX
|
| 88356 |
ANALYSIS NERVE
|
$XXX.XX
|
| 88356-26 |
ANALYSIS NERVE
|
$XXX.XX
|
| 88356-TC |
ANALYSIS NERVE
|
$XXX.XX
|
| 88358 |
ANALYSIS TUMOR
|
$XXX.XX
|
| 88358-26 |
ANALYSIS TUMOR
|
$XXX.XX
|
| 88358-TC |
ANALYSIS TUMOR
|
$XXX.XX
|
| 88360 |
TUMOR IMMUNOHISTOCHEM/MANUAL
|
$XXX.XX
|
| 88360-26 |
TUMOR IMMUNOHISTOCHEM/MANUAL
|
$XXX.XX
|
| 88360-TC |
TUMOR IMMUNOHISTOCHEM/MANUAL
|
$XXX.XX
|
| 88361 |
TUMOR IMMUNOHISTOCHEM/COMPUT
|
$XXX.XX
|
| 88361-26 |
TUMOR IMMUNOHISTOCHEM/COMPUT
|
$XXX.XX
|
| 88361-TC |
TUMOR IMMUNOHISTOCHEM/COMPUT
|
$XXX.XX
|
| 88362 |
NERVE TEASING PREPARATIONS
|
$XXX.XX
|
| 88362-26 |
NERVE TEASING PREPARATIONS
|
$XXX.XX
|
| 88362-TC |
NERVE TEASING PREPARATIONS
|
$XXX.XX
|
| 88363 |
XM ARCHIVE TISSUE MOLEC ANAL
|
$XXX.XX
|
| 88364 |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88364-26 |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88364-TC |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88365 |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88365-26 |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88365-TC |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88366 |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88366-26 |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88366-TC |
INSITU HYBRIDIZATION (FISH)
|
$XXX.XX
|
| 88367 |
INSITU HYBRIDIZATION AUTO
|
$XXX.XX
|
| 88367-26 |
INSITU HYBRIDIZATION AUTO
|
$XXX.XX
|
| 88367-TC |
INSITU HYBRIDIZATION AUTO
|
$XXX.XX
|
| 88368 |
INSITU HYBRIDIZATION MANUAL
|
$XXX.XX
|
| 88368-26 |
INSITU HYBRIDIZATION MANUAL
|
$XXX.XX
|
| 88368-TC |
INSITU HYBRIDIZATION MANUAL
|
$XXX.XX
|
| 88369 |
M/PHMTRC ALYSISHQUANT/SEMIQ
|
$XXX.XX
|
| 88369-26 |
M/PHMTRC ALYSISHQUANT/SEMIQ
|
$XXX.XX
|
| 88369-TC |
M/PHMTRC ALYSISHQUANT/SEMIQ
|
$XXX.XX
|
| 88371-26 |
PROTEIN WESTERN BLOT TISSUE
|
$XXX.XX
|
| 88372-26 |
PROTEIN ANALYSIS W/PROBE
|
$XXX.XX
|
| 88373 |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88373-26 |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88373-TC |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88374 |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88374-26 |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88374-TC |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88375 |
OPTICAL ENDOMICROSCPY INTERP
|
$XXX.XX
|
| 88377 |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88377-26 |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88377-TC |
M/PHMTRC ALYS ISHQUANT/SEMIQ
|
$XXX.XX
|
| 88380 |
MICRODISSECTION LASER
|
$XXX.XX
|
| 88380-26 |
MICRODISSECTION LASER
|
$XXX.XX
|
| 88380-TC |
MICRODISSECTION LASER
|
$XXX.XX
|
| 88381 |
MICRODISSECTION MANUAL
|
$XXX.XX
|
| 88381-26 |
MICRODISSECTION MANUAL
|
$XXX.XX
|
| 88381-TC |
MICRODISSECTION MANUAL
|
$XXX.XX
|
| 88387 |
TISS EXAM MOLECULAR STUDY
|
$XXX.XX
|
| 88387-26 |
TISS EXAM MOLECULAR STUDY
|
$XXX.XX
|
| 88387-TC |
TISS EXAM MOLECULAR STUDY
|
$XXX.XX
|
| 88388 |
TISS EX MOLECUL STUDY ADD-ON
|
$XXX.XX
|
| 88388-26 |
TISS EX MOLECUL STUDY ADD-ON
|
$XXX.XX
|
| 88388-TC |
TISS EX MOLECUL STUDY ADD-ON
|
$XXX.XX
|
| 89049 |
CHCT FOR MAL HYPERTHERMIA
|
$XXX.XX
|
| 89060-26 |
EXAM SYNOVIAL FLUID CRYSTALS
|
$XXX.XX
|
| 89220 |
SPUTUM SPECIMEN COLLECTION
|
$XXX.XX
|
| 89230 |
COLLECT SWEAT FOR TEST
|
$XXX.XX
|
| 90460 |
IM ADMIN 1ST/ONLY COMPONENT
|
$XXX.XX
|
| 90461 |
IM ADMIN EACH ADDL COMPONENT
|
$XXX.XX
|
| 90471 |
IMMUNIZATION ADMIN
|
$XXX.XX
|
| 90472 |
IMMUNIZATION ADMIN EACH ADD
|
$XXX.XX
|
| 90473 |
IMMUNE ADMIN ORAL/NASAL
|
$XXX.XX
|
| 90474 |
IMMUNE ADMIN ORAL/NASAL ADDL
|
$XXX.XX
|
| 90785 |
PSYTX COMPLEX INTERACTIVE
|
$XXX.XX
|
| 90791 |
PSYCH DIAGNOSTIC EVALUATION
|
$XXX.XX
|
| 90792 |
PSYCH DIAG EVAL W/MED SRVCS
|
$XXX.XX
|
| 90832 |
PSYTX W PT 30 MINUTES
|
$XXX.XX
|
| 90833 |
PSYTX W PT W E/M 30 MIN
|
$XXX.XX
|
| 90834 |
PSYTX W PT 45 MINUTES
|
$XXX.XX
|
| 90836 |
PSYTX W PT W E/M 45 MIN
|
$XXX.XX
|
| 90837 |
PSYTX W PT 60 MINUTES
|
$XXX.XX
|
| 90838 |
PSYTX W PT W E/M 60 MIN
|
$XXX.XX
|
| 90839 |
PSYTX CRISIS INITIAL 60 MIN
|
$XXX.XX
|
| 90840 |
PSYTX CRISIS EA ADDL 30 MIN
|
$XXX.XX
|
| 90845 |
PSYCHOANALYSIS
|
$XXX.XX
|
| 90846 |
FAMILY PSYTX W/O PT 50 MIN
|
$XXX.XX
|
| 90847 |
FAMILY PSYTX W/PT 50 MIN
|
$XXX.XX
|
| 90849 |
MULTIPLE FAMILY GROUP PSYTX
|
$XXX.XX
|
| 90853 |
GROUP PSYCHOTHERAPY
|
$XXX.XX
|
| 90865 |
NARCOSYNTHESIS
|
$XXX.XX
|
| 90870 |
ELECTROCONVULSIVE THERAPY
|
$XXX.XX
|
| 90880 |
HYPNOTHERAPY
|
$XXX.XX
|
| 90901 |
BIOFEEDBACK TRAIN ANY METH
|
$XXX.XX
|
| 90912 |
BFB TRAINING 1ST 15 MIN
|
$XXX.XX
|
| 90913 |
BFB TRAINING EA ADDL 15 MIN
|
$XXX.XX
|
| 90935 |
HEMODIALYSIS ONE EVALUATION
|
$XXX.XX
|
| 90937 |
HEMODIALYSIS REPEATED EVAL
|
$XXX.XX
|
| 90945 |
DIALYSIS ONE EVALUATION
|
$XXX.XX
|
| 90947 |
DIALYSIS REPEATED EVAL
|
$XXX.XX
|
| 90951 |
ESRD SERV 4 VISITS P MO <2YR
|
$XXX.XX
|
| 90954 |
ESRD SERV 4 VSTS P MO 2-11
|
$XXX.XX
|
| 90955 |
ESRD SRV 2-3 VSTS P MO 2-11
|
$XXX.XX
|
| 90956 |
ESRD SRV 1 VISIT P MO 2-11
|
$XXX.XX
|
| 90957 |
ESRD SRV 4 VSTS P MO 12-19
|
$XXX.XX
|
| 90958 |
ESRD SRV 2-3 VSTS P MO 12-19
|
$XXX.XX
|
| 90959 |
ESRD SERV 1 VST P MO 12-19
|
$XXX.XX
|
| 90960 |
ESRD SRV 4 VISITS P MO 20+
|
$XXX.XX
|
| 90961 |
ESRD SRV 2-3 VSTS P MO 20+
|
$XXX.XX
|
| 90962 |
ESRD SERV 1 VISIT P MO 20+
|
$XXX.XX
|
| 90963 |
ESRD HOME PT SERV P MO <2YRS
|
$XXX.XX
|
| 90964 |
ESRD HOME PT SERV P MO 2-11
|
$XXX.XX
|
| 90965 |
ESRD HOME PT SERV P MO 12-19
|
$XXX.XX
|
| 90966 |
ESRD HOME PT SERV P MO 20+
|
$XXX.XX
|
| 90967 |
ESRD SVC PR DAY PT <2
|
$XXX.XX
|
| 90968 |
ESRD SVC PR DAY PT 2-11
|
$XXX.XX
|
| 90969 |
ESRD SVC PR DAY PT 12-19
|
$XXX.XX
|
| 90970 |
ESRD SVC PR DAY PT 20+
|
$XXX.XX
|
| 90997 |
HEMOPERFUSION
|
$XXX.XX
|
| 91010 |
ESOPHAGUS MOTILITY STUDY
|
$XXX.XX
|
| 91010-26 |
ESOPHAGUS MOTILITY STUDY
|
$XXX.XX
|
| 91010-TC |
ESOPHAGUS MOTILITY STUDY
|
$XXX.XX
|
| 91013 |
ESOPHGL MOTIL W/STIM/PERFUS
|
$XXX.XX
|
| 91013-26 |
ESOPHGL MOTIL W/STIM/PERFUS
|
$XXX.XX
|
| 91013-TC |
ESOPHGL MOTIL W/STIM/PERFUS
|
$XXX.XX
|
| 91020 |
GASTRIC MOTILITY STUDIES
|
$XXX.XX
|
| 91020-26 |
GASTRIC MOTILITY STUDIES
|
$XXX.XX
|
| 91020-TC |
GASTRIC MOTILITY STUDIES
|
$XXX.XX
|
| 91022 |
DUODENAL MOTILITY STUDY
|
$XXX.XX
|
| 91022-26 |
DUODENAL MOTILITY STUDY
|
$XXX.XX
|
| 91022-TC |
DUODENAL MOTILITY STUDY
|
$XXX.XX
|
| 91030 |
ACID PERFUSION OF ESOPHAGUS
|
$XXX.XX
|
| 91030-26 |
ACID PERFUSION OF ESOPHAGUS
|
$XXX.XX
|
| 91030-TC |
ACID PERFUSION OF ESOPHAGUS
|
$XXX.XX
|
| 91034 |
GASTROESOPHAGEAL REFLUX TEST
|
$XXX.XX
|
| 91034-26 |
GASTROESOPHAGEAL REFLUX TEST
|
$XXX.XX
|
| 91034-TC |
GASTROESOPHAGEAL REFLUX TEST
|
$XXX.XX
|
| 91035 |
G-ESOPH REFLX TST W/ELECTROD
|
$XXX.XX
|
| 91035-26 |
G-ESOPH REFLX TST W/ELECTROD
|
$XXX.XX
|
| 91035-TC |
G-ESOPH REFLX TST W/ELECTROD
|
$XXX.XX
|
| 91037 |
ESOPH IMPED FUNCTION TEST
|
$XXX.XX
|
| 91037-26 |
ESOPH IMPED FUNCTION TEST
|
$XXX.XX
|
| 91037-TC |
ESOPH IMPED FUNCTION TEST
|
$XXX.XX
|
| 91038 |
ESOPH IMPED FUNCT TEST > 1HR
|
$XXX.XX
|
| 91038-26 |
ESOPH IMPED FUNCT TEST > 1HR
|
$XXX.XX
|
| 91038-TC |
ESOPH IMPED FUNCT TEST > 1HR
|
$XXX.XX
|
| 91040 |
ESOPH BALLOON DISTENSION TST
|
$XXX.XX
|
| 91040-26 |
ESOPH BALLOON DISTENSION TST
|
$XXX.XX
|
| 91040-TC |
ESOPH BALLOON DISTENSION TST
|
$XXX.XX
|
| 91065 |
BREATH HYDROGEN/METHANE TEST
|
$XXX.XX
|
| 91065-26 |
BREATH HYDROGEN/METHANE TEST
|
$XXX.XX
|
| 91065-TC |
BREATH HYDROGEN/METHANE TEST
|
$XXX.XX
|
| 91110 |
GI TRACT CAPSULE ENDOSCOPY
|
$XXX.XX
|
| 91110-26 |
GI TRACT CAPSULE ENDOSCOPY
|
$XXX.XX
|
| 91110-TC |
GI TRACT CAPSULE ENDOSCOPY
|
$XXX.XX
|
| 91111 |
ESOPHAGEAL CAPSULE ENDOSCOPY
|
$XXX.XX
|
| 91111-26 |
ESOPHAGEAL CAPSULE ENDOSCOPY
|
$XXX.XX
|
| 91111-TC |
ESOPHAGEAL CAPSULE ENDOSCOPY
|
$XXX.XX
|
| 91112 |
GI WIRELESS CAPSULE MEASURE
|
$XXX.XX
|
| 91112-26 |
GI WIRELESS CAPSULE MEASURE
|
$XXX.XX
|
| 91112-TC |
GI WIRELESS CAPSULE MEASURE
|
$XXX.XX
|
| 91117 |
COLON MOTILITY 6 HR STUDY
|
$XXX.XX
|
| 91120 |
RECTAL SENSATION TEST
|
$XXX.XX
|
| 91120-26 |
RECTAL SENSATION TEST
|
$XXX.XX
|
| 91120-TC |
RECTAL SENSATION TEST
|
$XXX.XX
|
| 91122 |
ANAL PRESSURE RECORD
|
$XXX.XX
|
| 91122-26 |
ANAL PRESSURE RECORD
|
$XXX.XX
|
| 91122-TC |
ANAL PRESSURE RECORD
|
$XXX.XX
|
| 91132 |
ELECTROGASTROGRAPHY
|
$XXX.XX
|
| 91132-26 |
ELECTROGASTROGRAPHY
|
$XXX.XX
|
| 91132-TC |
ELECTROGASTROGRAPHY
|
$XXX.XX
|
| 91133 |
ELECTROGASTROGRAPHY W/TEST
|
$XXX.XX
|
| 91133-26 |
ELECTROGASTROGRAPHY W/TEST
|
$XXX.XX
|
| 91133-TC |
ELECTROGASTROGRAPHY W/TEST
|
$XXX.XX
|
| 91200 |
LIVER ELASTOGRAPHY
|
$XXX.XX
|
| 91200-26 |
LIVER ELASTOGRAPHY
|
$XXX.XX
|
| 91200-TC |
LIVER ELASTOGRAPHY
|
$XXX.XX
|
| 92002 |
EYE EXAM NEW PATIENT
|
$XXX.XX
|
| 92004 |
EYE EXAM NEW PATIENT
|
$XXX.XX
|
| 92012 |
EYE EXAM ESTABLISH PATIENT
|
$XXX.XX
|
| 92014 |
EYE EXAM&TX ESTAB PT 1/>VST
|
$XXX.XX
|
| 92018 |
NEW EYE EXAM & TREATMENT
|
$XXX.XX
|
| 92019 |
EYE EXAM & TREATMENT
|
$XXX.XX
|
| 92020 |
SPECIAL EYE EVALUATION
|
$XXX.XX
|
| 92025 |
CORNEAL TOPOGRAPHY
|
$XXX.XX
|
| 92025-26 |
CORNEAL TOPOGRAPHY
|
$XXX.XX
|
| 92025-TC |
CORNEAL TOPOGRAPHY
|
$XXX.XX
|
| 92060 |
SPECIAL EYE EVALUATION
|
$XXX.XX
|
| 92060-26 |
SPECIAL EYE EVALUATION
|
$XXX.XX
|
| 92060-TC |
SPECIAL EYE EVALUATION
|
$XXX.XX
|
| 92065 |
ORTHOPTIC/PLEOPTIC TRAINING
|
$XXX.XX
|
| 92065-26 |
ORTHOPTIC/PLEOPTIC TRAINING
|
$XXX.XX
|
| 92065-TC |
ORTHOPTIC/PLEOPTIC TRAINING
|
$XXX.XX
|
| 92071 |
CONTACT LENS FITTING FOR TX
|
$XXX.XX
|
| 92072 |
FIT CONTAC LENS FOR MANAGMNT
|
$XXX.XX
|
| 92081 |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92081-26 |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92081-TC |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92082 |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92082-26 |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92082-TC |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92083 |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92083-26 |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92083-TC |
VISUAL FIELD EXAMINATION(S)
|
$XXX.XX
|
| 92100 |
SERIAL TONOMETRY EXAM(S)
|
$XXX.XX
|
| 92132 |
CMPTR OPHTH DX IMG ANT SEGMT
|
$XXX.XX
|
| 92132-26 |
CMPTR OPHTH DX IMG ANT SEGMT
|
$XXX.XX
|
| 92132-TC |
CMPTR OPHTH DX IMG ANT SEGMT
|
$XXX.XX
|
| 92133 |
CMPTR OPHTH IMG OPTIC NERVE
|
$XXX.XX
|
| 92133-26 |
CMPTR OPHTH IMG OPTIC NERVE
|
$XXX.XX
|
| 92133-TC |
CMPTR OPHTH IMG OPTIC NERVE
|
$XXX.XX
|
| 92134 |
CPTR OPHTH DX IMG POST SEGMT
|
$XXX.XX
|
| 92134-26 |
CPTR OPHTH DX IMG POST SEGMT
|
$XXX.XX
|
| 92134-TC |
CPTR OPHTH DX IMG POST SEGMT
|
$XXX.XX
|
| 92136 |
OPHTHALMIC BIOMETRY
|
$XXX.XX
|
| 92136-26 |
OPHTHALMIC BIOMETRY
|
$XXX.XX
|
| 92136-TC |
OPHTHALMIC BIOMETRY
|
$XXX.XX
|
| 92145 |
CORNEAL HYSTERESIS DETER
|
$XXX.XX
|
| 92145-26 |
CORNEAL HYSTERESIS DETER
|
$XXX.XX
|
| 92145-TC |
CORNEAL HYSTERESIS DETER
|
$XXX.XX
|
| 92201 |
OPSCPY EXTND RTA DRAW UNI/BI
|
$XXX.XX
|
| 92202 |
OPSCPY EXTND ON/MAC DRAW
|
$XXX.XX
|
| 92227 |
REMOTE DX RETINAL IMAGING
|
$XXX.XX
|
| 92228 |
REMOTE RETINAL IMAGING MGMT
|
$XXX.XX
|
| 92228-26 |
REMOTE RETINAL IMAGING MGMT
|
$XXX.XX
|
| 92228-TC |
REMOTE RETINAL IMAGING MGMT
|
$XXX.XX
|
| 92230 |
EYE EXAM WITH PHOTOS
|
$XXX.XX
|
| 92235 |
FLUORESCEIN ANGRPH UNI/BI
|
$XXX.XX
|
| 92235-26 |
FLUORESCEIN ANGRPH UNI/BI
|
$XXX.XX
|
| 92235-TC |
FLUORESCEIN ANGRPH UNI/BI
|
$XXX.XX
|
| 92240 |
ICG ANGIOGRAPHY UNI/BI
|
$XXX.XX
|
| 92240-26 |
ICG ANGIOGRAPHY UNI/BI
|
$XXX.XX
|
| 92240-TC |
ICG ANGIOGRAPHY UNI/BI
|
$XXX.XX
|
| 92242 |
FLUORESCEIN ICG ANGIOGRAPHY
|
$XXX.XX
|
| 92242-26 |
FLUORESCEIN ICG ANGIOGRAPHY
|
$XXX.XX
|
| 92242-TC |
FLUORESCEIN ICG ANGIOGRAPHY
|
$XXX.XX
|
| 92250 |
EYE EXAM WITH PHOTOS
|
$XXX.XX
|
| 92250-26 |
EYE EXAM WITH PHOTOS
|
$XXX.XX
|
| 92250-TC |
EYE EXAM WITH PHOTOS
|
$XXX.XX
|
| 92260 |
OPHTHALMOSCOPY/DYNAMOMETRY
|
$XXX.XX
|
| 92265 |
EYE MUSCLE EVALUATION
|
$XXX.XX
|
| 92265-26 |
EYE MUSCLE EVALUATION
|
$XXX.XX
|
| 92265-TC |
EYE MUSCLE EVALUATION
|
$XXX.XX
|
| 92270 |
ELECTRO-OCULOGRAPHY
|
$XXX.XX
|
| 92270-26 |
ELECTRO-OCULOGRAPHY
|
$XXX.XX
|
| 92270-TC |
ELECTRO-OCULOGRAPHY
|
$XXX.XX
|
| 92273 |
FULL FIELD ERG W/I&R
|
$XXX.XX
|
| 92273-26 |
FULL FIELD ERG W/I&R
|
$XXX.XX
|
| 92273-TC |
FULL FIELD ERG W/I&R
|
$XXX.XX
|
| 92274 |
MULTIFOCAL ERG W/I&R
|
$XXX.XX
|
| 92274-26 |
MULTIFOCAL ERG W/I&R
|
$XXX.XX
|
| 92274-TC |
MULTIFOCAL ERG W/I&R
|
$XXX.XX
|
| 92283 |
COLOR VISION EXAMINATION
|
$XXX.XX
|
| 92283-26 |
COLOR VISION EXAMINATION
|
$XXX.XX
|
| 92283-TC |
COLOR VISION EXAMINATION
|
$XXX.XX
|
| 92284 |
DARK ADAPTATION EYE EXAM
|
$XXX.XX
|
| 92284-26 |
DARK ADAPTATION EYE EXAM
|
$XXX.XX
|
| 92284-TC |
DARK ADAPTATION EYE EXAM
|
$XXX.XX
|
| 92285 |
EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92285-26 |
EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92285-TC |
EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92286 |
INTERNAL EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92286-26 |
INTERNAL EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92286-TC |
INTERNAL EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92287 |
INTERNAL EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92287-26 |
INTERNAL EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92287-TC |
INTERNAL EYE PHOTOGRAPHY
|
$XXX.XX
|
| 92311 |
CONTACT LENS FITTING
|
$XXX.XX
|
| 92312 |
CONTACT LENS FITTING
|
$XXX.XX
|
| 92313 |
CONTACT LENS FITTING
|
$XXX.XX
|
| 92315 |
RX CNTACT LENS APHAKIA 1 EYE
|
$XXX.XX
|
| 92316 |
RX CNTACT LENS APHAKIA 2 EYE
|
$XXX.XX
|
| 92317 |
RX CORNEOSCLERAL CNTACT LENS
|
$XXX.XX
|
| 92325 |
MODIFICATION OF CONTACT LENS
|
$XXX.XX
|
| 92326 |
REPLACEMENT OF CONTACT LENS
|
$XXX.XX
|
| 92502 |
EAR AND THROAT EXAMINATION
|
$XXX.XX
|
| 92504 |
EAR MICROSCOPY EXAMINATION
|
$XXX.XX
|
| 92507 |
SPEECH/HEARING THERAPY
|
$XXX.XX
|
| 92508 |
SPEECH/HEARING THERAPY
|
$XXX.XX
|
| 92511 |
NASOPHARYNGOSCOPY
|
$XXX.XX
|
| 92512 |
NASAL FUNCTION STUDIES
|
$XXX.XX
|
| 92516 |
FACIAL NERVE FUNCTION TEST
|
$XXX.XX
|
| 92520 |
LARYNGEAL FUNCTION STUDIES
|
$XXX.XX
|
| 92521 |
EVALUATION OF SPEECH FLUENCY
|
$XXX.XX
|
| 92522 |
EVALUATE SPEECH PRODUCTION
|
$XXX.XX
|
| 92523 |
SPEECH SOUND LANG COMPREHEN
|
$XXX.XX
|
| 92524 |
BEHAVRAL QUALIT ANALYS VOICE
|
$XXX.XX
|
| 92526 |
ORAL FUNCTION THERAPY
|
$XXX.XX
|
| 92537 |
CALORIC VSTBLR TEST W/REC
|
$XXX.XX
|
| 92537-26 |
CALORIC VSTBLR TEST W/REC
|
$XXX.XX
|
| 92537-TC |
CALORIC VSTBLR TEST W/REC
|
$XXX.XX
|
| 92538 |
CALORIC VSTBLR TEST W/REC
|
$XXX.XX
|
| 92538-26 |
CALORIC VSTBLR TEST W/REC
|
$XXX.XX
|
| 92538-TC |
CALORIC VSTBLR TEST W/REC
|
$XXX.XX
|
| 92540 |
BASIC VESTIBULAR EVALUATION
|
$XXX.XX
|
| 92540-26 |
BASIC VESTIBULAR EVALUATION
|
$XXX.XX
|
| 92540-TC |
BASIC VESTIBULAR EVALUATION
|
$XXX.XX
|
| 92541 |
SPONTANEOUS NYSTAGMUS TEST
|
$XXX.XX
|
| 92541-26 |
SPONTANEOUS NYSTAGMUS TEST
|
$XXX.XX
|
| 92541-TC |
SPONTANEOUS NYSTAGMUS TEST
|
$XXX.XX
|
| 92542 |
POSITIONAL NYSTAGMUS TEST
|
$XXX.XX
|
| 92542-26 |
POSITIONAL NYSTAGMUS TEST
|
$XXX.XX
|
| 92542-TC |
POSITIONAL NYSTAGMUS TEST
|
$XXX.XX
|
| 92544 |
OPTOKINETIC NYSTAGMUS TEST
|
$XXX.XX
|
| 92544-26 |
OPTOKINETIC NYSTAGMUS TEST
|
$XXX.XX
|
| 92544-TC |
OPTOKINETIC NYSTAGMUS TEST
|
$XXX.XX
|
| 92545 |
OSCILLATING TRACKING TEST
|
$XXX.XX
|
| 92545-26 |
OSCILLATING TRACKING TEST
|
$XXX.XX
|
| 92545-TC |
OSCILLATING TRACKING TEST
|
$XXX.XX
|
| 92546 |
SINUSOIDAL ROTATIONAL TEST
|
$XXX.XX
|
| 92546-26 |
SINUSOIDAL ROTATIONAL TEST
|
$XXX.XX
|
| 92546-TC |
SINUSOIDAL ROTATIONAL TEST
|
$XXX.XX
|
| 92547 |
SUPPLEMENTAL ELECTRICAL TEST
|
$XXX.XX
|
| 92548 |
CDP-SOT 6 COND W/I&R
|
$XXX.XX
|
| 92548-26 |
CDP-SOT 6 COND W/I&R
|
$XXX.XX
|
| 92548-TC |
CDP-SOT 6 COND W/I&R
|
$XXX.XX
|
| 92549 |
CDP-SOT 6 COND W/I&R MCT&ADT
|
$XXX.XX
|
| 92549-26 |
CDP-SOT 6 COND W/I&R MCT&ADT
|
$XXX.XX
|
| 92549-TC |
CDP-SOT 6 COND W/I&R MCT&ADT
|
$XXX.XX
|
| 92550 |
TYMPANOMETRY & REFLEX THRESH
|
$XXX.XX
|
| 92552 |
PURE TONE AUDIOMETRY AIR
|
$XXX.XX
|
| 92553 |
AUDIOMETRY AIR & BONE
|
$XXX.XX
|
| 92555 |
SPEECH THRESHOLD AUDIOMETRY
|
$XXX.XX
|
| 92556 |
SPEECH AUDIOMETRY COMPLETE
|
$XXX.XX
|
| 92557 |
COMPREHENSIVE HEARING TEST
|
$XXX.XX
|
| 92561 |
BEKESY AUDIOMETRY DIAGNOSIS
|
$XXX.XX
|
| 92562 |
LOUDNESS BALANCE TEST
|
$XXX.XX
|
| 92563 |
TONE DECAY HEARING TEST
|
$XXX.XX
|
| 92564 |
SISI HEARING TEST
|
$XXX.XX
|
| 92565 |
STENGER TEST PURE TONE
|
$XXX.XX
|
| 92567 |
TYMPANOMETRY
|
$XXX.XX
|
| 92568 |
ACOUSTIC REFL THRESHOLD TST
|
$XXX.XX
|
| 92570 |
ACOUSTIC IMMITANCE TESTING
|
$XXX.XX
|
| 92571 |
FILTERED SPEECH HEARING TEST
|
$XXX.XX
|
| 92572 |
STAGGERED SPONDAIC WORD TEST
|
$XXX.XX
|
| 92575 |
SENSORINEURAL ACUITY TEST
|
$XXX.XX
|
| 92576 |
SYNTHETIC SENTENCE TEST
|
$XXX.XX
|
| 92577 |
STENGER TEST SPEECH
|
$XXX.XX
|
| 92579 |
VISUAL AUDIOMETRY (VRA)
|
$XXX.XX
|
| 92582 |
CONDITIONING PLAY AUDIOMETRY
|
$XXX.XX
|
| 92583 |
SELECT PICTURE AUDIOMETRY
|
$XXX.XX
|
| 92584 |
ELECTROCOCHLEOGRAPHY
|
$XXX.XX
|
| 92585 |
AUDITOR EVOKE POTENT COMPRE
|
$XXX.XX
|
| 92585-26 |
AUDITOR EVOKE POTENT COMPRE
|
$XXX.XX
|
| 92585-TC |
AUDITOR EVOKE POTENT COMPRE
|
$XXX.XX
|
| 92586 |
AUDITOR EVOKE POTENT LIMIT
|
$XXX.XX
|
| 92587 |
EVOKED AUDITORY TEST LIMITED
|
$XXX.XX
|
| 92587-26 |
EVOKED AUDITORY TEST LIMITED
|
$XXX.XX
|
| 92587-TC |
EVOKED AUDITORY TEST LIMITED
|
$XXX.XX
|
| 92588 |
EVOKED AUDITORY TST COMPLETE
|
$XXX.XX
|
| 92588-26 |
EVOKED AUDITORY TST COMPLETE
|
$XXX.XX
|
| 92588-TC |
EVOKED AUDITORY TST COMPLETE
|
$XXX.XX
|
| 92596 |
EAR PROTECTOR EVALUATION
|
$XXX.XX
|
| 92597 |
ORAL SPEECH DEVICE EVAL
|
$XXX.XX
|
| 92601 |
COCHLEAR IMPLT F/UP EXAM <7
|
$XXX.XX
|
| 92602 |
REPROGRAM COCHLEAR IMPLT <7
|
$XXX.XX
|
| 92603 |
COCHLEAR IMPLT F/UP EXAM 7/>
|
$XXX.XX
|
| 92604 |
REPROGRAM COCHLEAR IMPLT 7/>
|
$XXX.XX
|
| 92607 |
EX FOR SPEECH DEVICE RX 1HR
|
$XXX.XX
|
| 92608 |
EX FOR SPEECH DEVICE RX ADDL
|
$XXX.XX
|
| 92609 |
USE OF SPEECH DEVICE SERVICE
|
$XXX.XX
|
| 92610 |
EVALUATE SWALLOWING FUNCTION
|
$XXX.XX
|
| 92611 |
MOTION FLUOROSCOPY/SWALLOW
|
$XXX.XX
|
| 92612 |
ENDOSCOPY SWALLOW (FEES) VID
|
$XXX.XX
|
| 92613 |
ENDOSCOPY SWALLOW (FEES) I&R
|
$XXX.XX
|
| 92614 |
LARYNGOSCOPIC SENSORY VID
|
$XXX.XX
|
| 92615 |
LARYNGOSCOPIC SENSORY I&R
|
$XXX.XX
|
| 92616 |
FEES W/LARYNGEAL SENSE TEST
|
$XXX.XX
|
| 92617 |
FEES W/LARYNGEAL SENSE I&R
|
$XXX.XX
|
| 92620 |
AUDITORY FUNCTION 60 MIN
|
$XXX.XX
|
| 92621 |
AUDITORY FUNCTION + 15 MIN
|
$XXX.XX
|
| 92625 |
TINNITUS ASSESSMENT
|
$XXX.XX
|
| 92626 |
EVAL AUD FUNCJ 1ST HOUR
|
$XXX.XX
|
| 92627 |
EVAL AUD FUNCJ EA ADDL 15
|
$XXX.XX
|
| 92640 |
AUD BRAINSTEM IMPLT PROGRAMG
|
$XXX.XX
|
| 92920 |
PRQ CARDIAC ANGIOPLAST 1 ART
|
$XXX.XX
|
| 92924 |
PRQ CARD ANGIO/ATHRECT 1 ART
|
$XXX.XX
|
| 92928 |
PRQ CARD STENT W/ANGIO 1 VSL
|
$XXX.XX
|
| 92933 |
PRQ CARD STENT/ATH/ANGIO
|
$XXX.XX
|
| 92937 |
PRQ REVASC BYP GRAFT 1 VSL
|
$XXX.XX
|
| 92941 |
PRQ CARD REVASC MI 1 VSL
|
$XXX.XX
|
| 92943 |
PRQ CARD REVASC CHRONIC 1VSL
|
$XXX.XX
|
| 92950 |
HEART/LUNG RESUSCITATION CPR
|
$XXX.XX
|
| 92953 |
TEMPORARY EXTERNAL PACING
|
$XXX.XX
|
| 92960 |
CARDIOVERSION ELECTRIC EXT
|
$XXX.XX
|
| 92961 |
CARDIOVERSION ELECTRIC INT
|
$XXX.XX
|
| 92970 |
CARDIOASSIST INTERNAL
|
$XXX.XX
|
| 92971 |
CARDIOASSIST EXTERNAL
|
$XXX.XX
|
| 92973 |
PRQ CORONARY MECH THROMBECT
|
$XXX.XX
|
| 92974 |
CATH PLACE CARDIO BRACHYTX
|
$XXX.XX
|
| 92975 |
DISSOLVE CLOT HEART VESSEL
|
$XXX.XX
|
| 92977 |
DISSOLVE CLOT HEART VESSEL
|
$XXX.XX
|
| 92978-26 |
ENDOLUMINL IVUS OCT C 1ST
|
$XXX.XX
|
| 92979-26 |
ENDOLUMINL IVUS OCT C EA
|
$XXX.XX
|
| 92986 |
REVISION OF AORTIC VALVE
|
$XXX.XX
|
| 92987 |
REVISION OF MITRAL VALVE
|
$XXX.XX
|
| 92990 |
REVISION OF PULMONARY VALVE
|
$XXX.XX
|
| 92997 |
PUL ART BALLOON REPR PERCUT
|
$XXX.XX
|
| 92998 |
PUL ART BALLOON REPR PERCUT
|
$XXX.XX
|
| 93000 |
ELECTROCARDIOGRAM COMPLETE
|
$XXX.XX
|
| 93005 |
ELECTROCARDIOGRAM TRACING
|
$XXX.XX
|
| 93010 |
ELECTROCARDIOGRAM REPORT
|
$XXX.XX
|
| 93015 |
CARDIOVASCULAR STRESS TEST
|
$XXX.XX
|
| 93016 |
CARDIOVASCULAR STRESS TEST
|
$XXX.XX
|
| 93017 |
CARDIOVASCULAR STRESS TEST
|
$XXX.XX
|
| 93018 |
CARDIOVASCULAR STRESS TEST
|
$XXX.XX
|
| 93024 |
CARDIAC DRUG STRESS TEST
|
$XXX.XX
|
| 93024-26 |
CARDIAC DRUG STRESS TEST
|
$XXX.XX
|
| 93024-TC |
CARDIAC DRUG STRESS TEST
|
$XXX.XX
|
| 93025 |
MICROVOLT T-WAVE ASSESS
|
$XXX.XX
|
| 93025-26 |
MICROVOLT T-WAVE ASSESS
|
$XXX.XX
|
| 93025-TC |
MICROVOLT T-WAVE ASSESS
|
$XXX.XX
|
| 93040 |
RHYTHM ECG WITH REPORT
|
$XXX.XX
|
| 93041 |
RHYTHM ECG TRACING
|
$XXX.XX
|
| 93042 |
RHYTHM ECG REPORT
|
$XXX.XX
|
| 93050 |
ART PRESSURE WAVEFORM ANALYS
|
$XXX.XX
|
| 93050-26 |
ART PRESSURE WAVEFORM ANALYS
|
$XXX.XX
|
| 93050-TC |
ART PRESSURE WAVEFORM ANALYS
|
$XXX.XX
|
| 93224 |
ECG MONIT/REPRT UP TO 48 HRS
|
$XXX.XX
|
| 93225 |
ECG MONIT/REPRT UP TO 48 HRS
|
$XXX.XX
|
| 93226 |
ECG MONIT/REPRT UP TO 48 HRS
|
$XXX.XX
|
| 93227 |
ECG MONIT/REPRT UP TO 48 HRS
|
$XXX.XX
|
| 93228 |
REMOTE 30 DAY ECG REV/REPORT
|
$XXX.XX
|
| 93229 |
REMOTE 30 DAY ECG TECH SUPP
|
$XXX.XX
|
| 93260 |
PRGRMG DEV EVAL IMPLTBL SYS
|
$XXX.XX
|
| 93260-26 |
PRGRMG DEV EVAL IMPLTBL SYS
|
$XXX.XX
|
| 93260-TC |
PRGRMG DEV EVAL IMPLTBL SYS
|
$XXX.XX
|
| 93261 |
INTERROGATE SUBQ DEFIB
|
$XXX.XX
|
| 93261-26 |
INTERROGATE SUBQ DEFIB
|
$XXX.XX
|
| 93261-TC |
INTERROGATE SUBQ DEFIB
|
$XXX.XX
|
| 93264 |
REM MNTR WRLS P-ART PRS SNR
|
$XXX.XX
|
| 93268 |
ECG RECORD/REVIEW
|
$XXX.XX
|
| 93270 |
REMOTE 30 DAY ECG REV/REPORT
|
$XXX.XX
|
| 93271 |
ECG/MONITORING AND ANALYSIS
|
$XXX.XX
|
| 93272 |
ECG/REVIEW INTERPRET ONLY
|
$XXX.XX
|
| 93278 |
ECG/SIGNAL-AVERAGED
|
$XXX.XX
|
| 93278-26 |
ECG/SIGNAL-AVERAGED
|
$XXX.XX
|
| 93278-TC |
ECG/SIGNAL-AVERAGED
|
$XXX.XX
|
| 93279 |
PRGRMG DEV EVAL PM/LDLS PM
|
$XXX.XX
|
| 93279-26 |
PRGRMG DEV EVAL PM/LDLS PM
|
$XXX.XX
|
| 93279-TC |
PRGRMG DEV EVAL PM/LDLS PM
|
$XXX.XX
|
| 93280 |
PM DEVICE PROGR EVAL DUAL
|
$XXX.XX
|
| 93280-26 |
PM DEVICE PROGR EVAL DUAL
|
$XXX.XX
|
| 93280-TC |
PM DEVICE PROGR EVAL DUAL
|
$XXX.XX
|
| 93281 |
PM DEVICE PROGR EVAL MULTI
|
$XXX.XX
|
| 93281-26 |
PM DEVICE PROGR EVAL MULTI
|
$XXX.XX
|
| 93281-TC |
PM DEVICE PROGR EVAL MULTI
|
$XXX.XX
|
| 93282 |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93282-26 |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93282-TC |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93283 |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93283-26 |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93283-TC |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93284 |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93284-26 |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93284-TC |
PRGRMG EVAL IMPLANTABLE DFB
|
$XXX.XX
|
| 93285 |
PRGRMG DEV EVAL SCRMS IP
|
$XXX.XX
|
| 93285-26 |
PRGRMG DEV EVAL SCRMS IP
|
$XXX.XX
|
| 93285-TC |
PRGRMG DEV EVAL SCRMS IP
|
$XXX.XX
|
| 93286 |
PERI-PX EVAL PM/LDLS PM IP
|
$XXX.XX
|
| 93286-26 |
PERI-PX EVAL PM/LDLS PM IP
|
$XXX.XX
|
| 93286-TC |
PERI-PX EVAL PM/LDLS PM IP
|
$XXX.XX
|
| 93287 |
PERI-PX DEVICE EVAL & PRGR
|
$XXX.XX
|
| 93287-26 |
PERI-PX DEVICE EVAL & PRGR
|
$XXX.XX
|
| 93287-TC |
PERI-PX DEVICE EVAL & PRGR
|
$XXX.XX
|
| 93288 |
INTERROG EVL PM/LDLS PM IP
|
$XXX.XX
|
| 93288-26 |
INTERROG EVL PM/LDLS PM IP
|
$XXX.XX
|
| 93288-TC |
INTERROG EVL PM/LDLS PM IP
|
$XXX.XX
|
| 93289 |
INTERROG DEVICE EVAL HEART
|
$XXX.XX
|
| 93289-26 |
INTERROG DEVICE EVAL HEART
|
$XXX.XX
|
| 93289-TC |
INTERROG DEVICE EVAL HEART
|
$XXX.XX
|
| 93290 |
INTERROG DEV EVAL ICPMS IP
|
$XXX.XX
|
| 93290-26 |
INTERROG DEV EVAL ICPMS IP
|
$XXX.XX
|
| 93290-TC |
INTERROG DEV EVAL ICPMS IP
|
$XXX.XX
|
| 93291 |
INTERROG DEV EVAL SCRMS IP
|
$XXX.XX
|
| 93291-26 |
INTERROG DEV EVAL SCRMS IP
|
$XXX.XX
|
| 93291-TC |
INTERROG DEV EVAL SCRMS IP
|
$XXX.XX
|
| 93292 |
WCD DEVICE INTERROGATE
|
$XXX.XX
|
| 93292-26 |
WCD DEVICE INTERROGATE
|
$XXX.XX
|
| 93292-TC |
WCD DEVICE INTERROGATE
|
$XXX.XX
|
| 93293 |
PM PHONE R-STRIP DEVICE EVAL
|
$XXX.XX
|
| 93293-26 |
PM PHONE R-STRIP DEVICE EVAL
|
$XXX.XX
|
| 93293-TC |
PM PHONE R-STRIP DEVICE EVAL
|
$XXX.XX
|
| 93294 |
REM INTERROG EVL PM/LDLS PM
|
$XXX.XX
|
| 93295 |
DEV INTERROG REMOTE 1/2/MLT
|
$XXX.XX
|
| 93296 |
REM INTERROG EVL PM/IDS
|
$XXX.XX
|
| 93297 |
REM INTERROG DEV EVAL ICPMS
|
$XXX.XX
|
| 93298 |
REM INTERROG DEV EVAL SCRMS
|
$XXX.XX
|
| 93303 |
ECHO TRANSTHORACIC
|
$XXX.XX
|
| 93303-26 |
ECHO TRANSTHORACIC
|
$XXX.XX
|
| 93303-TC |
ECHO TRANSTHORACIC
|
$XXX.XX
|
| 93304 |
ECHO TRANSTHORACIC
|
$XXX.XX
|
| 93304-26 |
ECHO TRANSTHORACIC
|
$XXX.XX
|
| 93304-TC |
ECHO TRANSTHORACIC
|
$XXX.XX
|
| 93306 |
TTE W/DOPPLER COMPLETE
|
$XXX.XX
|
| 93306-26 |
TTE W/DOPPLER COMPLETE
|
$XXX.XX
|
| 93306-TC |
TTE W/DOPPLER COMPLETE
|
$XXX.XX
|
| 93307 |
TTE W/O DOPPLER COMPLETE
|
$XXX.XX
|
| 93307-26 |
TTE W/O DOPPLER COMPLETE
|
$XXX.XX
|
| 93307-TC |
TTE W/O DOPPLER COMPLETE
|
$XXX.XX
|
| 93308 |
TTE F-UP OR LMTD
|
$XXX.XX
|
| 93308-26 |
TTE F-UP OR LMTD
|
$XXX.XX
|
| 93308-TC |
TTE F-UP OR LMTD
|
$XXX.XX
|
| 93312 |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93312-26 |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93312-TC |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93313 |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93314 |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93314-26 |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93314-TC |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93315-26 |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93316 |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93317-26 |
ECHO TRANSESOPHAGEAL
|
$XXX.XX
|
| 93318-26 |
ECHO TRANSESOPHAGEAL INTRAOP
|
$XXX.XX
|
| 93320 |
DOPPLER ECHO EXAM HEART
|
$XXX.XX
|
| 93320-26 |
DOPPLER ECHO EXAM HEART
|
$XXX.XX
|
| 93320-TC |
DOPPLER ECHO EXAM HEART
|
$XXX.XX
|
| 93321 |
DOPPLER ECHO EXAM HEART
|
$XXX.XX
|
| 93321-26 |
DOPPLER ECHO EXAM HEART
|
$XXX.XX
|
| 93321-TC |
DOPPLER ECHO EXAM HEART
|
$XXX.XX
|
| 93325 |
DOPPLER COLOR FLOW ADD-ON
|
$XXX.XX
|
| 93325-26 |
DOPPLER COLOR FLOW ADD-ON
|
$XXX.XX
|
| 93325-TC |
DOPPLER COLOR FLOW ADD-ON
|
$XXX.XX
|
| 93350 |
STRESS TTE ONLY
|
$XXX.XX
|
| 93350-26 |
STRESS TTE ONLY
|
$XXX.XX
|
| 93350-TC |
STRESS TTE ONLY
|
$XXX.XX
|
| 93351 |
STRESS TTE COMPLETE
|
$XXX.XX
|
| 93351-26 |
STRESS TTE COMPLETE
|
$XXX.XX
|
| 93351-TC |
STRESS TTE COMPLETE
|
$XXX.XX
|
| 93352 |
ADMIN ECG CONTRAST AGENT
|
$XXX.XX
|
| 93355 |
ECHO TRANSESOPHAGEAL (TEE)
|
$XXX.XX
|
| 93356 |
MYOCRD STRAIN IMG SPCKL TRCK
|
$XXX.XX
|
| 93451 |
RIGHT HEART CATH
|
$XXX.XX
|
| 93451-26 |
RIGHT HEART CATH
|
$XXX.XX
|
| 93451-TC |
RIGHT HEART CATH
|
$XXX.XX
|
| 93452 |
LEFT HRT CATH W/VENTRCLGRPHY
|
$XXX.XX
|
| 93452-26 |
LEFT HRT CATH W/VENTRCLGRPHY
|
$XXX.XX
|
| 93452-TC |
LEFT HRT CATH W/VENTRCLGRPHY
|
$XXX.XX
|
| 93453 |
R&L HRT CATH W/VENTRICLGRPHY
|
$XXX.XX
|
| 93453-26 |
R&L HRT CATH W/VENTRICLGRPHY
|
$XXX.XX
|
| 93453-TC |
R&L HRT CATH W/VENTRICLGRPHY
|
$XXX.XX
|
| 93454 |
CORONARY ARTERY ANGIO S&I
|
$XXX.XX
|
| 93454-26 |
CORONARY ARTERY ANGIO S&I
|
$XXX.XX
|
| 93454-TC |
CORONARY ARTERY ANGIO S&I
|
$XXX.XX
|
| 93455 |
CORONARY ART/GRFT ANGIO S&I
|
$XXX.XX
|
| 93455-26 |
CORONARY ART/GRFT ANGIO S&I
|
$XXX.XX
|
| 93455-TC |
CORONARY ART/GRFT ANGIO S&I
|
$XXX.XX
|
| 93456 |
R HRT CORONARY ARTERY ANGIO
|
$XXX.XX
|
| 93456-26 |
R HRT CORONARY ARTERY ANGIO
|
$XXX.XX
|
| 93456-TC |
R HRT CORONARY ARTERY ANGIO
|
$XXX.XX
|
| 93457 |
R HRT ART/GRFT ANGIO
|
$XXX.XX
|
| 93457-26 |
R HRT ART/GRFT ANGIO
|
$XXX.XX
|
| 93457-TC |
R HRT ART/GRFT ANGIO
|
$XXX.XX
|
| 93458 |
L HRT ARTERY/VENTRICLE ANGIO
|
$XXX.XX
|
| 93458-26 |
L HRT ARTERY/VENTRICLE ANGIO
|
$XXX.XX
|
| 93458-TC |
L HRT ARTERY/VENTRICLE ANGIO
|
$XXX.XX
|
| 93459 |
L HRT ART/GRFT ANGIO
|
$XXX.XX
|
| 93459-26 |
L HRT ART/GRFT ANGIO
|
$XXX.XX
|
| 93459-TC |
L HRT ART/GRFT ANGIO
|
$XXX.XX
|
| 93460 |
R&L HRT ART/VENTRICLE ANGIO
|
$XXX.XX
|
| 93460-26 |
R&L HRT ART/VENTRICLE ANGIO
|
$XXX.XX
|
| 93460-TC |
R&L HRT ART/VENTRICLE ANGIO
|
$XXX.XX
|
| 93461 |
R&L HRT ART/VENTRICLE ANGIO
|
$XXX.XX
|
| 93461-26 |
R&L HRT ART/VENTRICLE ANGIO
|
$XXX.XX
|
| 93461-TC |
R&L HRT ART/VENTRICLE ANGIO
|
$XXX.XX
|
| 93462 |
L HRT CATH TRNSPTL PUNCTURE
|
$XXX.XX
|
| 93463 |
DRUG ADMIN & HEMODYNMIC MEAS
|
$XXX.XX
|
| 93464 |
EXERCISE W/HEMODYNAMIC MEAS
|
$XXX.XX
|
| 93464-26 |
EXERCISE W/HEMODYNAMIC MEAS
|
$XXX.XX
|
| 93464-TC |
EXERCISE W/HEMODYNAMIC MEAS
|
$XXX.XX
|
| 93503 |
INSERT/PLACE HEART CATHETER
|
$XXX.XX
|
| 93505 |
BIOPSY OF HEART LINING
|
$XXX.XX
|
| 93505-26 |
BIOPSY OF HEART LINING
|
$XXX.XX
|
| 93505-TC |
BIOPSY OF HEART LINING
|
$XXX.XX
|
| 93530-26 |
RT HEART CATH CONGENITAL
|
$XXX.XX
|
| 93531-26 |
R & L HEART CATH CONGENITAL
|
$XXX.XX
|
| 93532-26 |
R & L HEART CATH CONGENITAL
|
$XXX.XX
|
| 93533-26 |
R & L HEART CATH CONGENITAL
|
$XXX.XX
|
| 93561-26 |
CARDIAC OUTPUT MEASUREMENT
|
$XXX.XX
|
| 93562-26 |
CARD OUTPUT MEASURE SUBSQ
|
$XXX.XX
|
| 93563 |
INJECT CONGENITAL CARD CATH
|
$XXX.XX
|
| 93564 |
INJECT HRT CONGNTL ART/GRFT
|
$XXX.XX
|
| 93565 |
INJECT L VENTR/ATRIAL ANGIO
|
$XXX.XX
|
| 93566 |
INJECT R VENTR/ATRIAL ANGIO
|
$XXX.XX
|
| 93567 |
INJECT SUPRVLV AORTOGRAPHY
|
$XXX.XX
|
| 93568 |
INJECT PULM ART HRT CATH
|
$XXX.XX
|
| 93571-26 |
HEART FLOW RESERVE MEASURE
|
$XXX.XX
|
| 93572-26 |
HEART FLOW RESERVE MEASURE
|
$XXX.XX
|
| 93580 |
TRANSCATH CLOSURE OF ASD
|
$XXX.XX
|
| 93581 |
TRANSCATH CLOSURE OF VSD
|
$XXX.XX
|
| 93582 |
PERQ TRANSCATH CLOSURE PDA
|
$XXX.XX
|
| 93583 |
PERQ TRANSCATH SEPTAL REDUXN
|
$XXX.XX
|
| 93590 |
PERQ TRANSCATH CLS MITRAL
|
$XXX.XX
|
| 93591 |
PERQ TRANSCATH CLS AORTIC
|
$XXX.XX
|
| 93592 |
PERQ TRANSCATH CLOSURE EACH
|
$XXX.XX
|
| 93600-26 |
BUNDLE OF HIS RECORDING
|
$XXX.XX
|
| 93602-26 |
INTRA-ATRIAL RECORDING
|
$XXX.XX
|
| 93603-26 |
RIGHT VENTRICULAR RECORDING
|
$XXX.XX
|
| 93609-26 |
MAP TACHYCARDIA ADD-ON
|
$XXX.XX
|
| 93610-26 |
INTRA-ATRIAL PACING
|
$XXX.XX
|
| 93612-26 |
INTRAVENTRICULAR PACING
|
$XXX.XX
|
| 93613 |
ELECTROPHYS MAP 3D ADD-ON
|
$XXX.XX
|
| 93615-26 |
ESOPHAGEAL RECORDING
|
$XXX.XX
|
| 93616-26 |
ESOPHAGEAL RECORDING
|
$XXX.XX
|
| 93618-26 |
HEART RHYTHM PACING
|
$XXX.XX
|
| 93619-26 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93620-26 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93621-26 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93622-26 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93623-26 |
STIMULATION PACING HEART
|
$XXX.XX
|
| 93624-26 |
ELECTROPHYSIOLOGIC STUDY
|
$XXX.XX
|
| 93631-26 |
HEART PACING MAPPING
|
$XXX.XX
|
| 93640-26 |
EVALUATION HEART DEVICE
|
$XXX.XX
|
| 93641-26 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93642 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93642-26 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93642-TC |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93644 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93644-26 |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93644-TC |
ELECTROPHYSIOLOGY EVALUATION
|
$XXX.XX
|
| 93650 |
ABLATE HEART DYSRHYTHM FOCUS
|
$XXX.XX
|
| 93653 |
EP & ABLATE SUPRAVENT ARRHYT
|
$XXX.XX
|
| 93654 |
EP & ABLATE VENTRIC TACHY
|
$XXX.XX
|
| 93655 |
ABLATE ARRHYTHMIA ADD ON
|
$XXX.XX
|
| 93656 |
TX ATRIAL FIB PULM VEIN ISOL
|
$XXX.XX
|
| 93657 |
TX L/R ATRIAL FIB ADDL
|
$XXX.XX
|
| 93660 |
TILT TABLE EVALUATION
|
$XXX.XX
|
| 93660-26 |
TILT TABLE EVALUATION
|
$XXX.XX
|
| 93660-TC |
TILT TABLE EVALUATION
|
$XXX.XX
|
| 93662-26 |
INTRACARDIAC ECG (ICE)
|
$XXX.XX
|
| 93668 |
PERIPHERAL VASCULAR REHAB
|
$XXX.XX
|
| 93701 |
BIOIMPEDANCE CV ANALYSIS
|
$XXX.XX
|
| 93702 |
BIS XTRACELL FLUID ANALYSIS
|
$XXX.XX
|
| 93724 |
ANALYZE PACEMAKER SYSTEM
|
$XXX.XX
|
| 93724-26 |
ANALYZE PACEMAKER SYSTEM
|
$XXX.XX
|
| 93724-TC |
ANALYZE PACEMAKER SYSTEM
|
$XXX.XX
|
| 93750 |
INTERROGATION VAD IN PERSON
|
$XXX.XX
|
| 93784 |
AMBL BP MNTR W/SOFTWARE
|
$XXX.XX
|
| 93786 |
AMBL BP MNTR W/SW REC ONLY
|
$XXX.XX
|
| 93788 |
AMBL BP MNTR W/SW A/R
|
$XXX.XX
|
| 93790 |
AMBL BP MNTR W/SW I&R
|
$XXX.XX
|
| 93792 |
PT/CAREGIVER TRAING HOME INR
|
$XXX.XX
|
| 93793 |
ANTICOAG MGMT PT WARFARIN
|
$XXX.XX
|
| 93797 |
CARDIAC REHAB
|
$XXX.XX
|
| 93798 |
CARDIAC REHAB/MONITOR
|
$XXX.XX
|
| 93880 |
EXTRACRANIAL BILAT STUDY
|
$XXX.XX
|
| 93880-26 |
EXTRACRANIAL BILAT STUDY
|
$XXX.XX
|
| 93880-TC |
EXTRACRANIAL BILAT STUDY
|
$XXX.XX
|
| 93882 |
EXTRACRANIAL UNI/LTD STUDY
|
$XXX.XX
|
| 93882-26 |
EXTRACRANIAL UNI/LTD STUDY
|
$XXX.XX
|
| 93882-TC |
EXTRACRANIAL UNI/LTD STUDY
|
$XXX.XX
|
| 93886 |
INTRACRANIAL COMPLETE STUDY
|
$XXX.XX
|
| 93886-26 |
INTRACRANIAL COMPLETE STUDY
|
$XXX.XX
|
| 93886-TC |
INTRACRANIAL COMPLETE STUDY
|
$XXX.XX
|
| 93888 |
INTRACRANIAL LIMITED STUDY
|
$XXX.XX
|
| 93888-26 |
INTRACRANIAL LIMITED STUDY
|
$XXX.XX
|
| 93888-TC |
INTRACRANIAL LIMITED STUDY
|
$XXX.XX
|
| 93890 |
TCD VASOREACTIVITY STUDY
|
$XXX.XX
|
| 93890-26 |
TCD VASOREACTIVITY STUDY
|
$XXX.XX
|
| 93890-TC |
TCD VASOREACTIVITY STUDY
|
$XXX.XX
|
| 93892 |
TCD EMBOLI DETECT W/O INJ
|
$XXX.XX
|
| 93892-26 |
TCD EMBOLI DETECT W/O INJ
|
$XXX.XX
|
| 93892-TC |
TCD EMBOLI DETECT W/O INJ
|
$XXX.XX
|
| 93893 |
TCD EMBOLI DETECT W/INJ
|
$XXX.XX
|
| 93893-26 |
TCD EMBOLI DETECT W/INJ
|
$XXX.XX
|
| 93893-TC |
TCD EMBOLI DETECT W/INJ
|
$XXX.XX
|
| 93922 |
UPR/L XTREMITY ART 2 LEVELS
|
$XXX.XX
|
| 93922-26 |
UPR/L XTREMITY ART 2 LEVELS
|
$XXX.XX
|
| 93922-TC |
UPR/L XTREMITY ART 2 LEVELS
|
$XXX.XX
|
| 93923 |
UPR/LXTR ART STDY 3+ LVLS
|
$XXX.XX
|
| 93923-26 |
UPR/LXTR ART STDY 3+ LVLS
|
$XXX.XX
|
| 93923-TC |
UPR/LXTR ART STDY 3+ LVLS
|
$XXX.XX
|
| 93924 |
LWR XTR VASC STDY BILAT
|
$XXX.XX
|
| 93924-26 |
LWR XTR VASC STDY BILAT
|
$XXX.XX
|
| 93924-TC |
LWR XTR VASC STDY BILAT
|
$XXX.XX
|
| 93925 |
LOWER EXTREMITY STUDY
|
$XXX.XX
|
| 93925-26 |
LOWER EXTREMITY STUDY
|
$XXX.XX
|
| 93925-TC |
LOWER EXTREMITY STUDY
|
$XXX.XX
|
| 93926 |
LOWER EXTREMITY STUDY
|
$XXX.XX
|
| 93926-26 |
LOWER EXTREMITY STUDY
|
$XXX.XX
|
| 93926-TC |
LOWER EXTREMITY STUDY
|
$XXX.XX
|
| 93930 |
UPPER EXTREMITY STUDY
|
$XXX.XX
|
| 93930-26 |
UPPER EXTREMITY STUDY
|
$XXX.XX
|
| 93930-TC |
UPPER EXTREMITY STUDY
|
$XXX.XX
|
| 93931 |
UPPER EXTREMITY STUDY
|
$XXX.XX
|
| 93931-26 |
UPPER EXTREMITY STUDY
|
$XXX.XX
|
| 93931-TC |
UPPER EXTREMITY STUDY
|
$XXX.XX
|
| 93970 |
EXTREMITY STUDY
|
$XXX.XX
|
| 93970-26 |
EXTREMITY STUDY
|
$XXX.XX
|
| 93970-TC |
EXTREMITY STUDY
|
$XXX.XX
|
| 93971 |
EXTREMITY STUDY
|
$XXX.XX
|
| 93971-26 |
EXTREMITY STUDY
|
$XXX.XX
|
| 93971-TC |
EXTREMITY STUDY
|
$XXX.XX
|
| 93975 |
VASCULAR STUDY
|
$XXX.XX
|
| 93975-26 |
VASCULAR STUDY
|
$XXX.XX
|
| 93975-TC |
VASCULAR STUDY
|
$XXX.XX
|
| 93976 |
VASCULAR STUDY
|
$XXX.XX
|
| 93976-26 |
VASCULAR STUDY
|
$XXX.XX
|
| 93976-TC |
VASCULAR STUDY
|
$XXX.XX
|
| 93978 |
VASCULAR STUDY
|
$XXX.XX
|
| 93978-26 |
VASCULAR STUDY
|
$XXX.XX
|
| 93978-TC |
VASCULAR STUDY
|
$XXX.XX
|
| 93979 |
VASCULAR STUDY
|
$XXX.XX
|
| 93979-26 |
VASCULAR STUDY
|
$XXX.XX
|
| 93979-TC |
VASCULAR STUDY
|
$XXX.XX
|
| 93980 |
PENILE VASCULAR STUDY
|
$XXX.XX
|
| 93980-26 |
PENILE VASCULAR STUDY
|
$XXX.XX
|
| 93980-TC |
PENILE VASCULAR STUDY
|
$XXX.XX
|
| 93981 |
PENILE VASCULAR STUDY
|
$XXX.XX
|
| 93981-26 |
PENILE VASCULAR STUDY
|
$XXX.XX
|
| 93981-TC |
PENILE VASCULAR STUDY
|
$XXX.XX
|
| 93985 |
DUP-SCAN HEMO COMPL BI STD
|
$XXX.XX
|
| 93985-26 |
DUP-SCAN HEMO COMPL BI STD
|
$XXX.XX
|
| 93985-TC |
DUP-SCAN HEMO COMPL BI STD
|
$XXX.XX
|
| 93986 |
DUP-SCAN HEMO COMPL UNI STD
|
$XXX.XX
|
| 93986-26 |
DUP-SCAN HEMO COMPL UNI STD
|
$XXX.XX
|
| 93986-TC |
DUP-SCAN HEMO COMPL UNI STD
|
$XXX.XX
|
| 93990 |
DOPPLER FLOW TESTING
|
$XXX.XX
|
| 93990-26 |
DOPPLER FLOW TESTING
|
$XXX.XX
|
| 93990-TC |
DOPPLER FLOW TESTING
|
$XXX.XX
|
| 94002 |
VENT MGMT INPAT INIT DAY
|
$XXX.XX
|
| 94003 |
VENT MGMT INPAT SUBQ DAY
|
$XXX.XX
|
| 94004 |
VENT MGMT NF PER DAY
|
$XXX.XX
|
| 94010 |
BREATHING CAPACITY TEST
|
$XXX.XX
|
| 94010-26 |
BREATHING CAPACITY TEST
|
$XXX.XX
|
| 94010-TC |
BREATHING CAPACITY TEST
|
$XXX.XX
|
| 94011 |
SPIROMETRY UP TO 2 YRS OLD
|
$XXX.XX
|
| 94012 |
SPIRMTRY W/BRNCHDIL INF-2 YR
|
$XXX.XX
|
| 94013 |
MEAS LUNG VOL THRU 2 YRS
|
$XXX.XX
|
| 94014 |
PATIENT RECORDED SPIROMETRY
|
$XXX.XX
|
| 94015 |
PATIENT RECORDED SPIROMETRY
|
$XXX.XX
|
| 94016 |
REVIEW PATIENT SPIROMETRY
|
$XXX.XX
|
| 94060 |
EVALUATION OF WHEEZING
|
$XXX.XX
|
| 94060-26 |
EVALUATION OF WHEEZING
|
$XXX.XX
|
| 94060-TC |
EVALUATION OF WHEEZING
|
$XXX.XX
|
| 94070 |
EVALUATION OF WHEEZING
|
$XXX.XX
|
| 94070-26 |
EVALUATION OF WHEEZING
|
$XXX.XX
|
| 94070-TC |
EVALUATION OF WHEEZING
|
$XXX.XX
|
| 94200 |
LUNG FUNCTION TEST (MBC/MVV)
|
$XXX.XX
|
| 94200-26 |
LUNG FUNCTION TEST (MBC/MVV)
|
$XXX.XX
|
| 94200-TC |
LUNG FUNCTION TEST (MBC/MVV)
|
$XXX.XX
|
| 94250 |
EXPIRED GAS COLLECTION
|
$XXX.XX
|
| 94250-26 |
EXPIRED GAS COLLECTION
|
$XXX.XX
|
| 94250-TC |
EXPIRED GAS COLLECTION
|
$XXX.XX
|
| 94375 |
RESPIRATORY FLOW VOLUME LOOP
|
$XXX.XX
|
| 94375-26 |
RESPIRATORY FLOW VOLUME LOOP
|
$XXX.XX
|
| 94375-TC |
RESPIRATORY FLOW VOLUME LOOP
|
$XXX.XX
|
| 94400 |
CO2 BREATHING RESPONSE CURVE
|
$XXX.XX
|
| 94400-26 |
CO2 BREATHING RESPONSE CURVE
|
$XXX.XX
|
| 94400-TC |
CO2 BREATHING RESPONSE CURVE
|
$XXX.XX
|
| 94450 |
HYPOXIA RESPONSE CURVE
|
$XXX.XX
|
| 94450-26 |
HYPOXIA RESPONSE CURVE
|
$XXX.XX
|
| 94450-TC |
HYPOXIA RESPONSE CURVE
|
$XXX.XX
|
| 94452 |
HAST W/REPORT
|
$XXX.XX
|
| 94452-26 |
HAST W/REPORT
|
$XXX.XX
|
| 94452-TC |
HAST W/REPORT
|
$XXX.XX
|
| 94453 |
HAST W/OXYGEN TITRATE
|
$XXX.XX
|
| 94453-26 |
HAST W/OXYGEN TITRATE
|
$XXX.XX
|
| 94453-TC |
HAST W/OXYGEN TITRATE
|
$XXX.XX
|
| 94610 |
SURFACTANT ADMIN THRU TUBE
|
$XXX.XX
|
| 94617 |
EXERCISE TST BRNCSPSM
|
$XXX.XX
|
| 94617-26 |
EXERCISE TST BRNCSPSM
|
$XXX.XX
|
| 94617-TC |
EXERCISE TST BRNCSPSM
|
$XXX.XX
|
| 94618 |
PULMONARY STRESS TESTING
|
$XXX.XX
|
| 94618-26 |
PULMONARY STRESS TESTING
|
$XXX.XX
|
| 94618-TC |
PULMONARY STRESS TESTING
|
$XXX.XX
|
| 94621 |
CARDIOPULM EXERCISE TESTING
|
$XXX.XX
|
| 94621-26 |
CARDIOPULM EXERCISE TESTING
|
$XXX.XX
|
| 94621-TC |
CARDIOPULM EXERCISE TESTING
|
$XXX.XX
|
| 94640 |
AIRWAY INHALATION TREATMENT
|
$XXX.XX
|
| 94644 |
CBT 1ST HOUR
|
$XXX.XX
|
| 94645 |
CBT EACH ADDL HOUR
|
$XXX.XX
|
| 94660 |
POS AIRWAY PRESSURE CPAP
|
$XXX.XX
|
| 94662 |
NEG PRESS VENTILATION CNP
|
$XXX.XX
|
| 94664 |
EVALUATE PT USE OF INHALER
|
$XXX.XX
|
| 94667 |
CHEST WALL MANIPULATION
|
$XXX.XX
|
| 94668 |
CHEST WALL MANIPULATION
|
$XXX.XX
|
| 94669 |
MECHANICAL CHEST WALL OSCILL
|
$XXX.XX
|
| 94680 |
EXHALED AIR ANALYSIS O2
|
$XXX.XX
|
| 94680-26 |
EXHALED AIR ANALYSIS O2
|
$XXX.XX
|
| 94680-TC |
EXHALED AIR ANALYSIS O2
|
$XXX.XX
|
| 94681 |
EXHALED AIR ANALYSIS O2/CO2
|
$XXX.XX
|
| 94681-26 |
EXHALED AIR ANALYSIS O2/CO2
|
$XXX.XX
|
| 94681-TC |
EXHALED AIR ANALYSIS O2/CO2
|
$XXX.XX
|
| 94690 |
EXHALED AIR ANALYSIS
|
$XXX.XX
|
| 94690-26 |
EXHALED AIR ANALYSIS
|
$XXX.XX
|
| 94690-TC |
EXHALED AIR ANALYSIS
|
$XXX.XX
|
| 94726 |
PULM FUNCT TST PLETHYSMOGRAP
|
$XXX.XX
|
| 94726-26 |
PULM FUNCT TST PLETHYSMOGRAP
|
$XXX.XX
|
| 94726-TC |
PULM FUNCT TST PLETHYSMOGRAP
|
$XXX.XX
|
| 94727 |
PULM FUNCTION TEST BY GAS
|
$XXX.XX
|
| 94727-26 |
PULM FUNCTION TEST BY GAS
|
$XXX.XX
|
| 94727-TC |
PULM FUNCTION TEST BY GAS
|
$XXX.XX
|
| 94728 |
AIRWY RESIST BY OSCILLOMETRY
|
$XXX.XX
|
| 94728-26 |
AIRWY RESIST BY OSCILLOMETRY
|
$XXX.XX
|
| 94728-TC |
AIRWY RESIST BY OSCILLOMETRY
|
$XXX.XX
|
| 94729 |
CO/MEMBANE DIFFUSE CAPACITY
|
$XXX.XX
|
| 94729-26 |
CO/MEMBANE DIFFUSE CAPACITY
|
$XXX.XX
|
| 94729-TC |
CO/MEMBANE DIFFUSE CAPACITY
|
$XXX.XX
|
| 94750 |
PULMONARY COMPLIANCE STUDY
|
$XXX.XX
|
| 94750-26 |
PULMONARY COMPLIANCE STUDY
|
$XXX.XX
|
| 94750-TC |
PULMONARY COMPLIANCE STUDY
|
$XXX.XX
|
| 94760 |
MEASURE BLOOD OXYGEN LEVEL
|
$XXX.XX
|
| 94761 |
MEASURE BLOOD OXYGEN LEVEL
|
$XXX.XX
|
| 94762 |
MEASURE BLOOD OXYGEN LEVEL
|
$XXX.XX
|
| 94770 |
EXHALED CARBON DIOXIDE TEST
|
$XXX.XX
|
| 94780 |
CARS/BD TST INFT-12MO 60 MIN
|
$XXX.XX
|
| 94781 |
CARS/BD TST INFT-12MO +30MIN
|
$XXX.XX
|
| 95004 |
PERCUT ALLERGY SKIN TESTS
|
$XXX.XX
|
| 95012 |
EXHALED NITRIC OXIDE MEAS
|
$XXX.XX
|
| 95017 |
PERQ & ICUT ALLG TEST VENOMS
|
$XXX.XX
|
| 95018 |
PERQ&IC ALLG TEST DRUGS/BIOL
|
$XXX.XX
|
| 95024 |
ICUT ALLERGY TEST DRUG/BUG
|
$XXX.XX
|
| 95027 |
ICUT ALLERGY TITRATE-AIRBORN
|
$XXX.XX
|
| 95028 |
ICUT ALLERGY TEST-DELAYED
|
$XXX.XX
|
| 95044 |
ALLERGY PATCH TESTS
|
$XXX.XX
|
| 95052 |
PHOTO PATCH TEST
|
$XXX.XX
|
| 95056 |
PHOTOSENSITIVITY TESTS
|
$XXX.XX
|
| 95060 |
EYE ALLERGY TESTS
|
$XXX.XX
|
| 95065 |
NOSE ALLERGY TEST
|
$XXX.XX
|
| 95070 |
BRONCHIAL ALLERGY TESTS
|
$XXX.XX
|
| 95071 |
BRONCHIAL ALLERGY TESTS
|
$XXX.XX
|
| 95076 |
INGEST CHALLENGE INI 120 MIN
|
$XXX.XX
|
| 95079 |
INGEST CHALLENGE ADDL 60 MIN
|
$XXX.XX
|
| 95115 |
IMMUNOTHERAPY ONE INJECTION
|
$XXX.XX
|
| 95117 |
IMMUNOTHERAPY INJECTIONS
|
$XXX.XX
|
| 95144 |
ANTIGEN THERAPY SERVICES
|
$XXX.XX
|
| 95145 |
ANTIGEN THERAPY SERVICES
|
$XXX.XX
|
| 95146 |
ANTIGEN THERAPY SERVICES
|
$XXX.XX
|
| 95147 |
ANTIGEN THERAPY SERVICES
|
$XXX.XX
|
| 95148 |
ANTIGEN THERAPY SERVICES
|
$XXX.XX
|
| 95149 |
ANTIGEN THERAPY SERVICES
|
$XXX.XX
|
| 95165 |
ANTIGEN THERAPY SERVICES
|
$XXX.XX
|
| 95170 |
ANTIGEN THERAPY SERVICES
|
$XXX.XX
|
| 95180 |
RAPID DESENSITIZATION
|
$XXX.XX
|
| 95249 |
CONT GLUC MNTR PT PROV EQP
|
$XXX.XX
|
| 95250 |
CONT GLUC MNTR PHYS/QHP EQP
|
$XXX.XX
|
| 95251 |
CONT GLUC MNTR ANALYSIS I&R
|
$XXX.XX
|
| 95717 |
EEG PHYS/QHP 2-12 HR W/O VID
|
$XXX.XX
|
| 95718 |
EEG PHYS/QHP 2-12 HR W/VEEG
|
$XXX.XX
|
| 95719 |
EEG PHYS/QHP EA INCR W/O VID
|
$XXX.XX
|
| 95720 |
EEG PHY/QHP EA INCR W/VEEG
|
$XXX.XX
|
| 95721 |
EEG PHY/QHP>36<60 HR W/O VID
|
$XXX.XX
|
| 95722 |
EEG PHY/QHP>36<60 HR W/VEEG
|
$XXX.XX
|
| 95723 |
EEG PHY/QHP>60<84 HR W/O VID
|
$XXX.XX
|
| 95724 |
EEG PHY/QHP>60<84 HR W/VEEG
|
$XXX.XX
|
| 95725 |
EEG PHY/QHP>84 HR W/O VID
|
$XXX.XX
|
| 95726 |
EEG PHY/QHP>84 HR W/VEEG
|
$XXX.XX
|
| 95782 |
POLYSOM <6 YRS 4/> PARAMTRS
|
$XXX.XX
|
| 95782-26 |
POLYSOM <6 YRS 4/> PARAMTRS
|
$XXX.XX
|
| 95782-TC |
POLYSOM <6 YRS 4/> PARAMTRS
|
$XXX.XX
|
| 95783 |
POLYSOM <6 YRS CPAP/BILVL
|
$XXX.XX
|
| 95783-26 |
POLYSOM <6 YRS CPAP/BILVL
|
$XXX.XX
|
| 95783-TC |
POLYSOM <6 YRS CPAP/BILVL
|
$XXX.XX
|
| 95800 |
SLP STDY UNATTENDED
|
$XXX.XX
|
| 95800-26 |
SLP STDY UNATTENDED
|
$XXX.XX
|
| 95800-TC |
SLP STDY UNATTENDED
|
$XXX.XX
|
| 95801 |
SLP STDY UNATND W/ANAL
|
$XXX.XX
|
| 95801-26 |
SLP STDY UNATND W/ANAL
|
$XXX.XX
|
| 95801-TC |
SLP STDY UNATND W/ANAL
|
$XXX.XX
|
| 95803 |
ACTIGRAPHY TESTING
|
$XXX.XX
|
| 95803-26 |
ACTIGRAPHY TESTING
|
$XXX.XX
|
| 95803-TC |
ACTIGRAPHY TESTING
|
$XXX.XX
|
| 95805 |
MULTIPLE SLEEP LATENCY TEST
|
$XXX.XX
|
| 95805-26 |
MULTIPLE SLEEP LATENCY TEST
|
$XXX.XX
|
| 95805-TC |
MULTIPLE SLEEP LATENCY TEST
|
$XXX.XX
|
| 95806 |
SLEEP STUDY UNATT&RESP EFFT
|
$XXX.XX
|
| 95806-26 |
SLEEP STUDY UNATT&RESP EFFT
|
$XXX.XX
|
| 95806-TC |
SLEEP STUDY UNATT&RESP EFFT
|
$XXX.XX
|
| 95807 |
SLEEP STUDY ATTENDED
|
$XXX.XX
|
| 95807-26 |
SLEEP STUDY ATTENDED
|
$XXX.XX
|
| 95807-TC |
SLEEP STUDY ATTENDED
|
$XXX.XX
|
| 95808 |
POLYSOM ANY AGE 1-3> PARAM
|
$XXX.XX
|
| 95808-26 |
POLYSOM ANY AGE 1-3> PARAM
|
$XXX.XX
|
| 95808-TC |
POLYSOM ANY AGE 1-3> PARAM
|
$XXX.XX
|
| 95810 |
POLYSOM 6/> YRS 4/> PARAM
|
$XXX.XX
|
| 95810-26 |
POLYSOM 6/> YRS 4/> PARAM
|
$XXX.XX
|
| 95810-TC |
POLYSOM 6/> YRS 4/> PARAM
|
$XXX.XX
|
| 95811 |
POLYSOM 6/>YRS CPAP 4/> PARM
|
$XXX.XX
|
| 95811-26 |
POLYSOM 6/>YRS CPAP 4/> PARM
|
$XXX.XX
|
| 95811-TC |
POLYSOM 6/>YRS CPAP 4/> PARM
|
$XXX.XX
|
| 95812 |
EEG 41-60 MINUTES
|
$XXX.XX
|
| 95812-26 |
EEG 41-60 MINUTES
|
$XXX.XX
|
| 95812-TC |
EEG 41-60 MINUTES
|
$XXX.XX
|
| 95813 |
EEG EXTND MNTR 61-119 MIN
|
$XXX.XX
|
| 95813-26 |
EEG EXTND MNTR 61-119 MIN
|
$XXX.XX
|
| 95813-TC |
EEG EXTND MNTR 61-119 MIN
|
$XXX.XX
|
| 95816 |
EEG AWAKE AND DROWSY
|
$XXX.XX
|
| 95816-26 |
EEG AWAKE AND DROWSY
|
$XXX.XX
|
| 95816-TC |
EEG AWAKE AND DROWSY
|
$XXX.XX
|
| 95819 |
EEG AWAKE AND ASLEEP
|
$XXX.XX
|
| 95819-26 |
EEG AWAKE AND ASLEEP
|
$XXX.XX
|
| 95819-TC |
EEG AWAKE AND ASLEEP
|
$XXX.XX
|
| 95822 |
EEG COMA OR SLEEP ONLY
|
$XXX.XX
|
| 95822-26 |
EEG COMA OR SLEEP ONLY
|
$XXX.XX
|
| 95822-TC |
EEG COMA OR SLEEP ONLY
|
$XXX.XX
|
| 95824-26 |
EEG CEREBRAL DEATH ONLY
|
$XXX.XX
|
| 95829 |
SURGERY ELECTROCORTICOGRAM
|
$XXX.XX
|
| 95829-26 |
SURGERY ELECTROCORTICOGRAM
|
$XXX.XX
|
| 95829-TC |
SURGERY ELECTROCORTICOGRAM
|
$XXX.XX
|
| 95830 |
INSERT ELECTRODES FOR EEG
|
$XXX.XX
|
| 95836 |
ECOG IMPLTD BRN NPGT <30 D
|
$XXX.XX
|
| 95851 |
RANGE OF MOTION MEASUREMENTS
|
$XXX.XX
|
| 95852 |
RANGE OF MOTION MEASUREMENTS
|
$XXX.XX
|
| 95857 |
CHOLINESTERASE CHALLENGE
|
$XXX.XX
|
| 95860 |
MUSCLE TEST ONE LIMB
|
$XXX.XX
|
| 95860-26 |
MUSCLE TEST ONE LIMB
|
$XXX.XX
|
| 95860-TC |
MUSCLE TEST ONE LIMB
|
$XXX.XX
|
| 95861 |
MUSCLE TEST 2 LIMBS
|
$XXX.XX
|
| 95861-26 |
MUSCLE TEST 2 LIMBS
|
$XXX.XX
|
| 95861-TC |
MUSCLE TEST 2 LIMBS
|
$XXX.XX
|
| 95863 |
MUSCLE TEST 3 LIMBS
|
$XXX.XX
|
| 95863-26 |
MUSCLE TEST 3 LIMBS
|
$XXX.XX
|
| 95863-TC |
MUSCLE TEST 3 LIMBS
|
$XXX.XX
|
| 95864 |
MUSCLE TEST 4 LIMBS
|
$XXX.XX
|
| 95864-26 |
MUSCLE TEST 4 LIMBS
|
$XXX.XX
|
| 95864-TC |
MUSCLE TEST 4 LIMBS
|
$XXX.XX
|
| 95865 |
MUSCLE TEST LARYNX
|
$XXX.XX
|
| 95865-26 |
MUSCLE TEST LARYNX
|
$XXX.XX
|
| 95865-TC |
MUSCLE TEST LARYNX
|
$XXX.XX
|
| 95866 |
MUSCLE TEST HEMIDIAPHRAGM
|
$XXX.XX
|
| 95866-26 |
MUSCLE TEST HEMIDIAPHRAGM
|
$XXX.XX
|
| 95866-TC |
MUSCLE TEST HEMIDIAPHRAGM
|
$XXX.XX
|
| 95867 |
MUSCLE TEST CRAN NERV UNILAT
|
$XXX.XX
|
| 95867-26 |
MUSCLE TEST CRAN NERV UNILAT
|
$XXX.XX
|
| 95867-TC |
MUSCLE TEST CRAN NERV UNILAT
|
$XXX.XX
|
| 95868 |
MUSCLE TEST CRAN NERVE BILAT
|
$XXX.XX
|
| 95868-26 |
MUSCLE TEST CRAN NERVE BILAT
|
$XXX.XX
|
| 95868-TC |
MUSCLE TEST CRAN NERVE BILAT
|
$XXX.XX
|
| 95869 |
MUSCLE TEST THOR PARASPINAL
|
$XXX.XX
|
| 95869-26 |
MUSCLE TEST THOR PARASPINAL
|
$XXX.XX
|
| 95869-TC |
MUSCLE TEST THOR PARASPINAL
|
$XXX.XX
|
| 95870 |
MUSCLE TEST NONPARASPINAL
|
$XXX.XX
|
| 95870-26 |
MUSCLE TEST NONPARASPINAL
|
$XXX.XX
|
| 95870-TC |
MUSCLE TEST NONPARASPINAL
|
$XXX.XX
|
| 95872 |
MUSCLE TEST ONE FIBER
|
$XXX.XX
|
| 95872-26 |
MUSCLE TEST ONE FIBER
|
$XXX.XX
|
| 95872-TC |
MUSCLE TEST ONE FIBER
|
$XXX.XX
|
| 95873 |
GUIDE NERV DESTR ELEC STIM
|
$XXX.XX
|
| 95873-26 |
GUIDE NERV DESTR ELEC STIM
|
$XXX.XX
|
| 95873-TC |
GUIDE NERV DESTR ELEC STIM
|
$XXX.XX
|
| 95874 |
GUIDE NERV DESTR NEEDLE EMG
|
$XXX.XX
|
| 95874-26 |
GUIDE NERV DESTR NEEDLE EMG
|
$XXX.XX
|
| 95874-TC |
GUIDE NERV DESTR NEEDLE EMG
|
$XXX.XX
|
| 95875 |
LIMB EXERCISE TEST
|
$XXX.XX
|
| 95875-26 |
LIMB EXERCISE TEST
|
$XXX.XX
|
| 95875-TC |
LIMB EXERCISE TEST
|
$XXX.XX
|
| 95885 |
MUSC TST DONE W/NERV TST LIM
|
$XXX.XX
|
| 95885-26 |
MUSC TST DONE W/NERV TST LIM
|
$XXX.XX
|
| 95885-TC |
MUSC TST DONE W/NERV TST LIM
|
$XXX.XX
|
| 95886 |
MUSC TEST DONE W/N TEST COMP
|
$XXX.XX
|
| 95886-26 |
MUSC TEST DONE W/N TEST COMP
|
$XXX.XX
|
| 95886-TC |
MUSC TEST DONE W/N TEST COMP
|
$XXX.XX
|
| 95887 |
MUSC TST DONE W/N TST NONEXT
|
$XXX.XX
|
| 95887-26 |
MUSC TST DONE W/N TST NONEXT
|
$XXX.XX
|
| 95887-TC |
MUSC TST DONE W/N TST NONEXT
|
$XXX.XX
|
| 95905 |
MOTOR &/ SENS NRVE CNDJ TEST
|
$XXX.XX
|
| 95905-26 |
MOTOR &/ SENS NRVE CNDJ TEST
|
$XXX.XX
|
| 95905-TC |
MOTOR &/ SENS NRVE CNDJ TEST
|
$XXX.XX
|
| 95907 |
NVR CNDJ TST 1-2 STUDIES
|
$XXX.XX
|
| 95907-26 |
NVR CNDJ TST 1-2 STUDIES
|
$XXX.XX
|
| 95907-TC |
NVR CNDJ TST 1-2 STUDIES
|
$XXX.XX
|
| 95908 |
NRV CNDJ TST 3-4 STUDIES
|
$XXX.XX
|
| 95908-26 |
NRV CNDJ TST 3-4 STUDIES
|
$XXX.XX
|
| 95908-TC |
NRV CNDJ TST 3-4 STUDIES
|
$XXX.XX
|
| 95909 |
NRV CNDJ TST 5-6 STUDIES
|
$XXX.XX
|
| 95909-26 |
NRV CNDJ TST 5-6 STUDIES
|
$XXX.XX
|
| 95909-TC |
NRV CNDJ TST 5-6 STUDIES
|
$XXX.XX
|
| 95910 |
NRV CNDJ TEST 7-8 STUDIES
|
$XXX.XX
|
| 95910-26 |
NRV CNDJ TEST 7-8 STUDIES
|
$XXX.XX
|
| 95910-TC |
NRV CNDJ TEST 7-8 STUDIES
|
$XXX.XX
|
| 95911 |
NRV CNDJ TEST 9-10 STUDIES
|
$XXX.XX
|
| 95911-26 |
NRV CNDJ TEST 9-10 STUDIES
|
$XXX.XX
|
| 95911-TC |
NRV CNDJ TEST 9-10 STUDIES
|
$XXX.XX
|
| 95912 |
NRV CNDJ TEST 11-12 STUDIES
|
$XXX.XX
|
| 95912-26 |
NRV CNDJ TEST 11-12 STUDIES
|
$XXX.XX
|
| 95912-TC |
NRV CNDJ TEST 11-12 STUDIES
|
$XXX.XX
|
| 95913 |
NRV CNDJ TEST 13/> STUDIES
|
$XXX.XX
|
| 95913-26 |
NRV CNDJ TEST 13/> STUDIES
|
$XXX.XX
|
| 95913-TC |
NRV CNDJ TEST 13/> STUDIES
|
$XXX.XX
|
| 95921 |
AUTONOMIC NRV PARASYM INERVJ
|
$XXX.XX
|
| 95921-26 |
AUTONOMIC NRV PARASYM INERVJ
|
$XXX.XX
|
| 95921-TC |
AUTONOMIC NRV PARASYM INERVJ
|
$XXX.XX
|
| 95922 |
AUTONOMIC NRV ADRENRG INERVJ
|
$XXX.XX
|
| 95922-26 |
AUTONOMIC NRV ADRENRG INERVJ
|
$XXX.XX
|
| 95922-TC |
AUTONOMIC NRV ADRENRG INERVJ
|
$XXX.XX
|
| 95923 |
AUTONOMIC NRV SYST FUNJ TEST
|
$XXX.XX
|
| 95923-26 |
AUTONOMIC NRV SYST FUNJ TEST
|
$XXX.XX
|
| 95923-TC |
AUTONOMIC NRV SYST FUNJ TEST
|
$XXX.XX
|
| 95924 |
ANS PARASYMP & SYMP W/TILT
|
$XXX.XX
|
| 95924-26 |
ANS PARASYMP & SYMP W/TILT
|
$XXX.XX
|
| 95924-TC |
ANS PARASYMP & SYMP W/TILT
|
$XXX.XX
|
| 95925 |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95925-26 |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95925-TC |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95926 |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95926-26 |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95926-TC |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95927 |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95927-26 |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95927-TC |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95928 |
C MOTOR EVOKED UPPR LIMBS
|
$XXX.XX
|
| 95928-26 |
C MOTOR EVOKED UPPR LIMBS
|
$XXX.XX
|
| 95928-TC |
C MOTOR EVOKED UPPR LIMBS
|
$XXX.XX
|
| 95929 |
C MOTOR EVOKED LWR LIMBS
|
$XXX.XX
|
| 95929-26 |
C MOTOR EVOKED LWR LIMBS
|
$XXX.XX
|
| 95929-TC |
C MOTOR EVOKED LWR LIMBS
|
$XXX.XX
|
| 95930 |
VISUAL EP TEST CNS W/I&R
|
$XXX.XX
|
| 95930-26 |
VISUAL EP TEST CNS W/I&R
|
$XXX.XX
|
| 95930-TC |
VISUAL EP TEST CNS W/I&R
|
$XXX.XX
|
| 95933 |
BLINK REFLEX TEST
|
$XXX.XX
|
| 95933-26 |
BLINK REFLEX TEST
|
$XXX.XX
|
| 95933-TC |
BLINK REFLEX TEST
|
$XXX.XX
|
| 95937 |
NEUROMUSCULAR JUNCTION TEST
|
$XXX.XX
|
| 95937-26 |
NEUROMUSCULAR JUNCTION TEST
|
$XXX.XX
|
| 95937-TC |
NEUROMUSCULAR JUNCTION TEST
|
$XXX.XX
|
| 95938 |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95938-26 |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95938-TC |
SOMATOSENSORY TESTING
|
$XXX.XX
|
| 95939 |
C MOTOR EVOKED UPR&LWR LIMBS
|
$XXX.XX
|
| 95939-26 |
C MOTOR EVOKED UPR&LWR LIMBS
|
$XXX.XX
|
| 95939-TC |
C MOTOR EVOKED UPR&LWR LIMBS
|
$XXX.XX
|
| 95940 |
IONM IN OPERATNG ROOM 15 MIN
|
$XXX.XX
|
| 95954 |
EEG MONITORING/GIVING DRUGS
|
$XXX.XX
|
| 95954-26 |
EEG MONITORING/GIVING DRUGS
|
$XXX.XX
|
| 95954-TC |
EEG MONITORING/GIVING DRUGS
|
$XXX.XX
|
| 95955 |
EEG DURING SURGERY
|
$XXX.XX
|
| 95955-26 |
EEG DURING SURGERY
|
$XXX.XX
|
| 95955-TC |
EEG DURING SURGERY
|
$XXX.XX
|
| 95957 |
EEG DIGITAL ANALYSIS
|
$XXX.XX
|
| 95957-26 |
EEG DIGITAL ANALYSIS
|
$XXX.XX
|
| 95957-TC |
EEG DIGITAL ANALYSIS
|
$XXX.XX
|
| 95958 |
EEG MONITORING/FUNCTION TEST
|
$XXX.XX
|
| 95958-26 |
EEG MONITORING/FUNCTION TEST
|
$XXX.XX
|
| 95958-TC |
EEG MONITORING/FUNCTION TEST
|
$XXX.XX
|
| 95961 |
ELECTRODE STIMULATION BRAIN
|
$XXX.XX
|
| 95961-26 |
ELECTRODE STIMULATION BRAIN
|
$XXX.XX
|
| 95961-TC |
ELECTRODE STIMULATION BRAIN
|
$XXX.XX
|
| 95962 |
ELECTRODE STIM BRAIN ADD-ON
|
$XXX.XX
|
| 95962-26 |
ELECTRODE STIM BRAIN ADD-ON
|
$XXX.XX
|
| 95962-TC |
ELECTRODE STIM BRAIN ADD-ON
|
$XXX.XX
|
| 95965-26 |
MEG SPONTANEOUS
|
$XXX.XX
|
| 95966-26 |
MEG EVOKED SINGLE
|
$XXX.XX
|
| 95967-26 |
MEG EVOKED EACH ADDL
|
$XXX.XX
|
| 95970 |
ALYS NPGT W/O PRGRMG
|
$XXX.XX
|
| 95971 |
ALYS SMPL SP/PN NPGT W/PRGRM
|
$XXX.XX
|
| 95972 |
ALYS CPLX SP/PN NPGT W/PRGRM
|
$XXX.XX
|
| 95976 |
ALYS SMPL CN NPGT PRGRMG
|
$XXX.XX
|
| 95977 |
ALYS CPLX CN NPGT PRGRMG
|
$XXX.XX
|
| 95980 |
IO ANAL GAST N-STIM INIT
|
$XXX.XX
|
| 95981 |
IO ANAL GAST N-STIM SUBSQ
|
$XXX.XX
|
| 95982 |
IO GA N-STIM SUBSQ W/REPROG
|
$XXX.XX
|
| 95983 |
ALYS BRN NPGT PRGRMG 15 MIN
|
$XXX.XX
|
| 95984 |
ALYS BRN NPGT PRGRMG ADDL 15
|
$XXX.XX
|
| 95990 |
SPIN/BRAIN PUMP REFIL & MAIN
|
$XXX.XX
|
| 95991 |
SPIN/BRAIN PUMP REFIL & MAIN
|
$XXX.XX
|
| 95992 |
CANALITH REPOSITIONING PROC
|
$XXX.XX
|
| 96000 |
MOTION ANALYSIS VIDEO/3D
|
$XXX.XX
|
| 96001 |
MOTION TEST W/FT PRESS MEAS
|
$XXX.XX
|
| 96002 |
DYNAMIC SURFACE EMG
|
$XXX.XX
|
| 96003 |
DYNAMIC FINE WIRE EMG
|
$XXX.XX
|
| 96004 |
PHYS REVIEW OF MOTION TESTS
|
$XXX.XX
|
| 96020-26 |
FUNCTIONAL BRAIN MAPPING
|
$XXX.XX
|
| 96105 |
ASSESSMENT OF APHASIA
|
$XXX.XX
|
| 96112 |
DEVEL TST PHYS/QHP 1ST HR
|
$XXX.XX
|
| 96113 |
DEVEL TST PHYS/QHP EA ADDL
|
$XXX.XX
|
| 96116 |
NUBHVL XM PHYS/QHP 1ST HR
|
$XXX.XX
|
| 96121 |
NUBHVL XM PHY/QHP EA ADDL HR
|
$XXX.XX
|
| 96125 |
COGNITIVE TEST BY HC PRO
|
$XXX.XX
|
| 96127 |
BRIEF EMOTIONAL/BEHAV ASSMT
|
$XXX.XX
|
| 96130 |
PSYCL TST EVAL PHYS/QHP 1ST
|
$XXX.XX
|
| 96131 |
PSYCL TST EVAL PHYS/QHP EA
|
$XXX.XX
|
| 96132 |
NRPSYC TST EVAL PHYS/QHP 1ST
|
$XXX.XX
|
| 96133 |
NRPSYC TST EVAL PHYS/QHP EA
|
$XXX.XX
|
| 96136 |
PSYCL/NRPSYC TST PHY/QHP 1ST
|
$XXX.XX
|
| 96137 |
PSYCL/NRPSYC TST PHY/QHP EA
|
$XXX.XX
|
| 96138 |
PSYCL/NRPSYC TECH 1ST
|
$XXX.XX
|
| 96139 |
PSYCL/NRPSYC TST TECH EA
|
$XXX.XX
|
| 96146 |
PSYCL/NRPSYC TST AUTO RESULT
|
$XXX.XX
|
| 96156 |
HLTH BHV ASSMT/REASSESSMENT
|
$XXX.XX
|
| 96158 |
HLTH BHV IVNTJ INDIV 1ST 30
|
$XXX.XX
|
| 96159 |
HLTH BHV IVNTJ INDIV EA ADDL
|
$XXX.XX
|
| 96160 |
PT-FOCUSED HLTH RISK ASSMT
|
$XXX.XX
|
| 96161 |
CAREGIVER HEALTH RISK ASSMT
|
$XXX.XX
|
| 96164 |
HLTH BHV IVNTJ GRP 1ST 30
|
$XXX.XX
|
| 96165 |
HLTH BHV IVNTJ GRP EA ADDL
|
$XXX.XX
|
| 96167 |
HLTH BHV IVNTJ FAM 1ST 30
|
$XXX.XX
|
| 96168 |
HLTH BHV IVNTJ FAM EA ADDL
|
$XXX.XX
|
| 96360 |
HYDRATION IV INFUSION INIT
|
$XXX.XX
|
| 96361 |
HYDRATE IV INFUSION ADD-ON
|
$XXX.XX
|
| 96365 |
THER/PROPH/DIAG IV INF INIT
|
$XXX.XX
|
| 96366 |
THER/PROPH/DIAG IV INF ADDON
|
$XXX.XX
|
| 96367 |
TX/PROPH/DG ADDL SEQ IV INF
|
$XXX.XX
|
| 96368 |
THER/DIAG CONCURRENT INF
|
$XXX.XX
|
| 96369 |
SC THER INFUSION UP TO 1 HR
|
$XXX.XX
|
| 96370 |
SC THER INFUSION ADDL HR
|
$XXX.XX
|
| 96371 |
SC THER INFUSION RESET PUMP
|
$XXX.XX
|
| 96372 |
THER/PROPH/DIAG INJ SC/IM
|
$XXX.XX
|
| 96373 |
THER/PROPH/DIAG INJ IA
|
$XXX.XX
|
| 96374 |
THER/PROPH/DIAG INJ IV PUSH
|
$XXX.XX
|
| 96375 |
TX/PRO/DX INJ NEW DRUG ADDON
|
$XXX.XX
|
| 96377 |
APPLICATON ON-BODY INJECTOR
|
$XXX.XX
|
| 96401 |
CHEMO ANTI-NEOPL SQ/IM
|
$XXX.XX
|
| 96402 |
CHEMO HORMON ANTINEOPL SQ/IM
|
$XXX.XX
|
| 96405 |
CHEMO INTRALESIONAL UP TO 7
|
$XXX.XX
|
| 96406 |
CHEMO INTRALESIONAL OVER 7
|
$XXX.XX
|
| 96409 |
CHEMO IV PUSH SNGL DRUG
|
$XXX.XX
|
| 96411 |
CHEMO IV PUSH ADDL DRUG
|
$XXX.XX
|
| 96413 |
CHEMO IV INFUSION 1 HR
|
$XXX.XX
|
| 96415 |
CHEMO IV INFUSION ADDL HR
|
$XXX.XX
|
| 96416 |
CHEMO PROLONG INFUSE W/PUMP
|
$XXX.XX
|
| 96417 |
CHEMO IV INFUS EACH ADDL SEQ
|
$XXX.XX
|
| 96420 |
CHEMO IA PUSH TECNIQUE
|
$XXX.XX
|
| 96422 |
CHEMO IA INFUSION UP TO 1 HR
|
$XXX.XX
|
| 96423 |
CHEMO IA INFUSE EACH ADDL HR
|
$XXX.XX
|
| 96425 |
CHEMOTHERAPY INFUSION METHOD
|
$XXX.XX
|
| 96440 |
CHEMOTHERAPY INTRACAVITARY
|
$XXX.XX
|
| 96446 |
CHEMOTX ADMN PRTL CAVITY
|
$XXX.XX
|
| 96450 |
CHEMOTHERAPY INTO CNS
|
$XXX.XX
|
| 96521 |
REFILL/MAINT PORTABLE PUMP
|
$XXX.XX
|
| 96522 |
REFILL/MAINT PUMP/RESVR SYST
|
$XXX.XX
|
| 96523 |
IRRIG DRUG DELIVERY DEVICE
|
$XXX.XX
|
| 96542 |
CHEMOTHERAPY INJECTION
|
$XXX.XX
|
| 96567 |
PDT DSTR PRMLG LES SKN
|
$XXX.XX
|
| 96570 |
PHOTODYNMC TX 30 MIN ADD-ON
|
$XXX.XX
|
| 96571 |
PHOTODYNAMIC TX ADDL 15 MIN
|
$XXX.XX
|
| 96573 |
PDT DSTR PRMLG LES PHYS/QHP
|
$XXX.XX
|
| 96574 |
DBRDMT PRMLG LES W/PDT
|
$XXX.XX
|
| 96900 |
ULTRAVIOLET LIGHT THERAPY
|
$XXX.XX
|
| 96904 |
WHOLE BODY PHOTOGRAPHY
|
$XXX.XX
|
| 96910 |
PHOTOCHEMOTHERAPY WITH UV-B
|
$XXX.XX
|
| 96912 |
PHOTOCHEMOTHERAPY WITH UV-A
|
$XXX.XX
|
| 96913 |
PHOTOCHEMOTHERAPY UV-A OR B
|
$XXX.XX
|
| 96920 |
LASER TX SKIN < 250 SQ CM
|
$XXX.XX
|
| 96921 |
LASER TX SKIN 250-500 SQ CM
|
$XXX.XX
|
| 96922 |
LASER TX SKIN >500 SQ CM
|
$XXX.XX
|
| 96931 |
RCM CELULR SUBCELULR IMG SKN
|
$XXX.XX
|
| 96932 |
RCM CELULR SUBCELULR IMG SKN
|
$XXX.XX
|
| 96933 |
RCM CELULR SUBCELULR IMG SKN
|
$XXX.XX
|
| 96934 |
RCM CELULR SUBCELULR IMG SKN
|
$XXX.XX
|
| 96935 |
RCM CELULR SUBCELULR IMG SKN
|
$XXX.XX
|
| 96936 |
RCM CELULR SUBCELULR IMG SKN
|
$XXX.XX
|
| 97012 |
MECHANICAL TRACTION THERAPY
|
$XXX.XX
|
| 97016 |
VASOPNEUMATIC DEVICE THERAPY
|
$XXX.XX
|
| 97018 |
PARAFFIN BATH THERAPY
|
$XXX.XX
|
| 97022 |
WHIRLPOOL THERAPY
|
$XXX.XX
|
| 97024 |
DIATHERMY EG MICROWAVE
|
$XXX.XX
|
| 97026 |
INFRARED THERAPY
|
$XXX.XX
|
| 97028 |
ULTRAVIOLET THERAPY
|
$XXX.XX
|
| 97032 |
ELECTRICAL STIMULATION
|
$XXX.XX
|
| 97033 |
ELECTRIC CURRENT THERAPY
|
$XXX.XX
|
| 97034 |
CONTRAST BATH THERAPY
|
$XXX.XX
|
| 97035 |
ULTRASOUND THERAPY
|
$XXX.XX
|
| 97036 |
HYDROTHERAPY
|
$XXX.XX
|
| 97110 |
THERAPEUTIC EXERCISES
|
$XXX.XX
|
| 97112 |
NEUROMUSCULAR REEDUCATION
|
$XXX.XX
|
| 97113 |
AQUATIC THERAPY/EXERCISES
|
$XXX.XX
|
| 97116 |
GAIT TRAINING THERAPY
|
$XXX.XX
|
| 97124 |
MASSAGE THERAPY
|
$XXX.XX
|
| 97129 |
THER IVNTJ 1ST 15 MIN
|
$XXX.XX
|
| 97130 |
THER IVNTJ EA ADDL 15 MIN
|
$XXX.XX
|
| 97140 |
MANUAL THERAPY 1/> REGIONS
|
$XXX.XX
|
| 97150 |
GROUP THERAPEUTIC PROCEDURES
|
$XXX.XX
|
| 97161 |
PT EVAL LOW COMPLEX 20 MIN
|
$XXX.XX
|
| 97162 |
PT EVAL MOD COMPLEX 30 MIN
|
$XXX.XX
|
| 97163 |
PT EVAL HIGH COMPLEX 45 MIN
|
$XXX.XX
|
| 97164 |
PT RE-EVAL EST PLAN CARE
|
$XXX.XX
|
| 97165 |
OT EVAL LOW COMPLEX 30 MIN
|
$XXX.XX
|
| 97166 |
OT EVAL MOD COMPLEX 45 MIN
|
$XXX.XX
|
| 97167 |
OT EVAL HIGH COMPLEX 60 MIN
|
$XXX.XX
|
| 97168 |
OT RE-EVAL EST PLAN CARE
|
$XXX.XX
|
| 97530 |
THERAPEUTIC ACTIVITIES
|
$XXX.XX
|
| 97533 |
SENSORY INTEGRATION
|
$XXX.XX
|
| 97535 |
SELF CARE MNGMENT TRAINING
|
$XXX.XX
|
| 97537 |
COMMUNITY/WORK REINTEGRATION
|
$XXX.XX
|
| 97542 |
WHEELCHAIR MNGMENT TRAINING
|
$XXX.XX
|
| 97597 |
RMVL DEVITAL TIS 20 CM/<
|
$XXX.XX
|
| 97598 |
RMVL DEVITAL TIS ADDL 20CM/<
|
$XXX.XX
|
| 97605 |
NEG PRESS WOUND TX <=50 CM
|
$XXX.XX
|
| 97606 |
NEG PRESS WOUND TX >50 CM
|
$XXX.XX
|
| 97607 |
NEG PRESS WND TX <=50 SQ CM
|
$XXX.XX
|
| 97608 |
NEG PRESS WOUND TX >50 CM
|
$XXX.XX
|
| 97610 |
LOW FREQUENCY NON-THERMAL US
|
$XXX.XX
|
| 97750 |
PHYSICAL PERFORMANCE TEST
|
$XXX.XX
|
| 97755 |
ASSISTIVE TECHNOLOGY ASSESS
|
$XXX.XX
|
| 97760 |
ORTHOTIC MGMT&TRAING 1ST ENC
|
$XXX.XX
|
| 97761 |
PROSTHETIC TRAING 1ST ENC
|
$XXX.XX
|
| 97763 |
ORTHC/PROSTC MGMT SBSQ ENC
|
$XXX.XX
|
| 97802 |
MEDICAL NUTRITION INDIV IN
|
$XXX.XX
|
| 97803 |
MED NUTRITION INDIV SUBSEQ
|
$XXX.XX
|
| 97804 |
MEDICAL NUTRITION GROUP
|
$XXX.XX
|
| 97810 |
ACUPUNCT W/O STIMUL 15 MIN
|
$XXX.XX
|
| 97811 |
ACUPUNCT W/O STIMUL ADDL 15M
|
$XXX.XX
|
| 97813 |
ACUPUNCT W/STIMUL 15 MIN
|
$XXX.XX
|
| 97814 |
ACUPUNCT W/STIMUL ADDL 15M
|
$XXX.XX
|
| 98925 |
OSTEOPATH MANJ 1-2 REGIONS
|
$XXX.XX
|
| 98926 |
OSTEOPATH MANJ 3-4 REGIONS
|
$XXX.XX
|
| 98927 |
OSTEOPATH MANJ 5-6 REGIONS
|
$XXX.XX
|
| 98928 |
OSTEOPATH MANJ 7-8 REGIONS
|
$XXX.XX
|
| 98929 |
OSTEOPATH MANJ 9-10 REGIONS
|
$XXX.XX
|
| 98940 |
CHIROPRACT MANJ 1-2 REGIONS
|
$XXX.XX
|
| 98941 |
CHIROPRACT MANJ 3-4 REGIONS
|
$XXX.XX
|
| 98942 |
CHIROPRACTIC MANJ 5 REGIONS
|
$XXX.XX
|
| 99091 |
COLLJ & INTERPJ DATA EA 30 D
|
$XXX.XX
|
| 99151 |
MOD SED SAME PHYS/QHP <5 YRS
|
$XXX.XX
|
| 99152 |
MOD SED SAME PHYS/QHP 5/>YRS
|
$XXX.XX
|
| 99153 |
MOD SED SAME PHYS/QHP EA
|
$XXX.XX
|
| 99155 |
MOD SED OTH PHYS/QHP <5 YRS
|
$XXX.XX
|
| 99156 |
MOD SED OTH PHYS/QHP 5/>YRS
|
$XXX.XX
|
| 99157 |
MOD SED OTHER PHYS/QHP EA
|
$XXX.XX
|
| 99170 |
ANOGENITAL EXAM CHILD W IMAG
|
$XXX.XX
|
| 99175 |
INDUCTION OF VOMITING
|
$XXX.XX
|
| 99183 |
HYPERBARIC OXYGEN THERAPY
|
$XXX.XX
|
| 99184 |
HYPOTHERMIA ILL NEONATE
|
$XXX.XX
|
| 99195 |
PHLEBOTOMY
|
$XXX.XX
|
| 99201 |
OFFICE/OUTPATIENT VISIT NEW
|
$XXX.XX
|
| 99202 |
OFFICE/OUTPATIENT VISIT NEW
|
$XXX.XX
|
| 99203 |
OFFICE/OUTPATIENT VISIT NEW
|
$XXX.XX
|
| 99204 |
OFFICE/OUTPATIENT VISIT NEW
|
$XXX.XX
|
| 99205 |
OFFICE/OUTPATIENT VISIT NEW
|
$XXX.XX
|
| 99211 |
OFFICE/OUTPATIENT VISIT EST
|
$XXX.XX
|
| 99212 |
OFFICE/OUTPATIENT VISIT EST
|
$XXX.XX
|
| 99213 |
OFFICE/OUTPATIENT VISIT EST
|
$XXX.XX
|
| 99214 |
OFFICE/OUTPATIENT VISIT EST
|
$XXX.XX
|
| 99215 |
OFFICE/OUTPATIENT VISIT EST
|
$XXX.XX
|
| 99217 |
OBSERVATION CARE DISCHARGE
|
$XXX.XX
|
| 99218 |
INITIAL OBSERVATION CARE
|
$XXX.XX
|
| 99219 |
INITIAL OBSERVATION CARE
|
$XXX.XX
|
| 99220 |
INITIAL OBSERVATION CARE
|
$XXX.XX
|
| 99221 |
INITIAL HOSPITAL CARE
|
$XXX.XX
|
| 99222 |
INITIAL HOSPITAL CARE
|
$XXX.XX
|
| 99223 |
INITIAL HOSPITAL CARE
|
$XXX.XX
|
| 99224 |
SUBSEQUENT OBSERVATION CARE
|
$XXX.XX
|
| 99225 |
SUBSEQUENT OBSERVATION CARE
|
$XXX.XX
|
| 99226 |
SUBSEQUENT OBSERVATION CARE
|
$XXX.XX
|
| 99231 |
SUBSEQUENT HOSPITAL CARE
|
$XXX.XX
|
| 99232 |
SUBSEQUENT HOSPITAL CARE
|
$XXX.XX
|
| 99233 |
SUBSEQUENT HOSPITAL CARE
|
$XXX.XX
|
| 99234 |
OBSERV/HOSP SAME DATE
|
$XXX.XX
|
| 99235 |
OBSERV/HOSP SAME DATE
|
$XXX.XX
|
| 99236 |
OBSERV/HOSP SAME DATE
|
$XXX.XX
|
| 99238 |
HOSPITAL DISCHARGE DAY
|
$XXX.XX
|
| 99239 |
HOSPITAL DISCHARGE DAY
|
$XXX.XX
|
| 99281 |
EMERGENCY DEPT VISIT
|
$XXX.XX
|
| 99282 |
EMERGENCY DEPT VISIT
|
$XXX.XX
|
| 99283 |
EMERGENCY DEPT VISIT
|
$XXX.XX
|
| 99284 |
EMERGENCY DEPT VISIT
|
$XXX.XX
|
| 99285 |
EMERGENCY DEPT VISIT
|
$XXX.XX
|
| 99291 |
CRITICAL CARE FIRST HOUR
|
$XXX.XX
|
| 99292 |
CRITICAL CARE ADDL 30 MIN
|
$XXX.XX
|
| 99304 |
NURSING FACILITY CARE INIT
|
$XXX.XX
|
| 99305 |
NURSING FACILITY CARE INIT
|
$XXX.XX
|
| 99306 |
NURSING FACILITY CARE INIT
|
$XXX.XX
|
| 99307 |
NURSING FAC CARE SUBSEQ
|
$XXX.XX
|
| 99308 |
NURSING FAC CARE SUBSEQ
|
$XXX.XX
|
| 99309 |
NURSING FAC CARE SUBSEQ
|
$XXX.XX
|
| 99310 |
NURSING FAC CARE SUBSEQ
|
$XXX.XX
|
| 99315 |
NURSING FAC DISCHARGE DAY
|
$XXX.XX
|
| 99316 |
NURSING FAC DISCHARGE DAY
|
$XXX.XX
|
| 99318 |
ANNUAL NURSING FAC ASSESSMNT
|
$XXX.XX
|
| 99324 |
DOMICIL/R-HOME VISIT NEW PAT
|
$XXX.XX
|
| 99325 |
DOMICIL/R-HOME VISIT NEW PAT
|
$XXX.XX
|
| 99326 |
DOMICIL/R-HOME VISIT NEW PAT
|
$XXX.XX
|
| 99327 |
DOMICIL/R-HOME VISIT NEW PAT
|
$XXX.XX
|
| 99328 |
DOMICIL/R-HOME VISIT NEW PAT
|
$XXX.XX
|
| 99334 |
DOMICIL/R-HOME VISIT EST PAT
|
$XXX.XX
|
| 99335 |
DOMICIL/R-HOME VISIT EST PAT
|
$XXX.XX
|
| 99336 |
DOMICIL/R-HOME VISIT EST PAT
|
$XXX.XX
|
| 99337 |
DOMICIL/R-HOME VISIT EST PAT
|
$XXX.XX
|
| 99341 |
HOME VISIT NEW PATIENT
|
$XXX.XX
|
| 99342 |
HOME VISIT NEW PATIENT
|
$XXX.XX
|
| 99343 |
HOME VISIT NEW PATIENT
|
$XXX.XX
|
| 99344 |
HOME VISIT NEW PATIENT
|
$XXX.XX
|
| 99345 |
HOME VISIT NEW PATIENT
|
$XXX.XX
|
| 99347 |
HOME VISIT EST PATIENT
|
$XXX.XX
|
| 99348 |
HOME VISIT EST PATIENT
|
$XXX.XX
|
| 99349 |
HOME VISIT EST PATIENT
|
$XXX.XX
|
| 99350 |
HOME VISIT EST PATIENT
|
$XXX.XX
|
| 99354 |
PROLONG E&M/PSYCTX SERV O/P
|
$XXX.XX
|
| 99355 |
PROLONG E&M/PSYCTX SERV O/P
|
$XXX.XX
|
| 99356 |
PROLONGED SERVICE INPATIENT
|
$XXX.XX
|
| 99357 |
PROLONGED SERVICE INPATIENT
|
$XXX.XX
|
| 99358 |
PROLONG SERVICE W/O CONTACT
|
$XXX.XX
|
| 99359 |
PROLONG SERV W/O CONTACT ADD
|
$XXX.XX
|
| 99406 |
BEHAV CHNG SMOKING 3-10 MIN
|
$XXX.XX
|
| 99407 |
BEHAV CHNG SMOKING > 10 MIN
|
$XXX.XX
|
| 99415 |
PROLONG CLINCL STAFF SVC
|
$XXX.XX
|
| 99416 |
PROLONG CLINCL STAFF SVC ADD
|
$XXX.XX
|
| 99421 |
OL DIG E/M SVC 5-10 MIN
|
$XXX.XX
|
| 99422 |
OL DIG E/M SVC 11-20 MIN
|
$XXX.XX
|
| 99423 |
OL DIG E/M SVC 21+ MIN
|
$XXX.XX
|
| 99446 |
NTRPROF PH1/NTRNET/EHR 5-10
|
$XXX.XX
|
| 99447 |
NTRPROF PH1/NTRNET/EHR 11-20
|
$XXX.XX
|
| 99448 |
NTRPROF PH1/NTRNET/EHR 21-30
|
$XXX.XX
|
| 99449 |
NTRPROF PH1/NTRNET/EHR 31/>
|
$XXX.XX
|
| 99451 |
NTRPROF PH1/NTRNET/EHR 5/>
|
$XXX.XX
|
| 99452 |
NTRPROF PH1/NTRNET/EHR RFRL
|
$XXX.XX
|
| 99453 |
REM MNTR PHYSIOL PARAM SETUP
|
$XXX.XX
|
| 99454 |
REM MNTR PHYSIOL PARAM DEV
|
$XXX.XX
|
| 99457 |
REM PHYSIOL MNTR 1ST 20 MIN
|
$XXX.XX
|
| 99458 |
REM PHYSIOL MNTR EA ADDL 20
|
$XXX.XX
|
| 99460 |
INIT NB EM PER DAY HOSP
|
$XXX.XX
|
| 99461 |
INIT NB EM PER DAY NON-FAC
|
$XXX.XX
|
| 99462 |
SBSQ NB EM PER DAY HOSP
|
$XXX.XX
|
| 99463 |
SAME DAY NB DISCHARGE
|
$XXX.XX
|
| 99464 |
ATTENDANCE AT DELIVERY
|
$XXX.XX
|
| 99465 |
NB RESUSCITATION
|
$XXX.XX
|
| 99466 |
PED CRIT CARE TRANSPORT
|
$XXX.XX
|
| 99467 |
PED CRIT CARE TRANSPORT ADDL
|
$XXX.XX
|
| 99468 |
NEONATE CRIT CARE INITIAL
|
$XXX.XX
|
| 99469 |
NEONATE CRIT CARE SUBSQ
|
$XXX.XX
|
| 99471 |
PED CRITICAL CARE INITIAL
|
$XXX.XX
|
| 99472 |
PED CRITICAL CARE SUBSQ
|
$XXX.XX
|
| 99473 |
SELF-MEAS BP PT EDUCAJ/TRAIN
|
$XXX.XX
|
| 99474 |
SELF-MEAS BP 2 READG BID 30D
|
$XXX.XX
|
| 99475 |
PED CRIT CARE AGE 2-5 INIT
|
$XXX.XX
|
| 99476 |
PED CRIT CARE AGE 2-5 SUBSQ
|
$XXX.XX
|
| 99477 |
INIT DAY HOSP NEONATE CARE
|
$XXX.XX
|
| 99478 |
IC LBW INF < 1500 GM SUBSQ
|
$XXX.XX
|
| 99479 |
IC LBW INF 1500-2500 G SUBSQ
|
$XXX.XX
|
| 99480 |
IC INF PBW 2501-5000 G SUBSQ
|
$XXX.XX
|
| 99483 |
ASSMT & CARE PLN PT COG IMP
|
$XXX.XX
|
| 99484 |
CARE MGMT SVC BHVL HLTH COND
|
$XXX.XX
|
| 99487 |
CMPLX CHRON CARE W/O PT VSIT
|
$XXX.XX
|
| 99489 |
CMPLX CHRON CARE ADDL 30 MIN
|
$XXX.XX
|
| 99490 |
CHRON CARE MGMT SRVC 20 MIN
|
$XXX.XX
|
| 99491 |
CHRNC CARE MGMT SVC 30 MIN
|
$XXX.XX
|
| 99492 |
1ST PSYC COLLAB CARE MGMT
|
$XXX.XX
|
| 99493 |
SBSQ PSYC COLLAB CARE MGMT
|
$XXX.XX
|
| 99494 |
1ST/SBSQ PSYC COLLAB CARE
|
$XXX.XX
|
| 99495 |
TRANS CARE MGMT 14 DAY DISCH
|
$XXX.XX
|
| 99496 |
TRANS CARE MGMT 7 DAY DISCH
|
$XXX.XX
|
| 99497 |
ADVNCD CARE PLAN 30 MIN
|
$XXX.XX
|
| 99498 |
ADVNCD CARE PLAN ADDL 30 MIN
|
$XXX.XX
|
| G0076 |
Care manag h vst new pt 20 m
|
$XXX.XX
|
| G0077 |
Care manag h vst new pt 30 m
|
$XXX.XX
|
| G0078 |
Care manag h vst new pt 45 m
|
$XXX.XX
|
| G0079 |
Care manag h vst new pt 60 m
|
$XXX.XX
|
| G0080 |
Care manag h vst new pt 75 m
|
$XXX.XX
|
| G0081 |
Care man h v ext pt 20 mi
|
$XXX.XX
|
| G0082 |
Care man h v ext pt 30 m
|
$XXX.XX
|
| G0083 |
Care man h v ext pt 45 m
|
$XXX.XX
|
| G0084 |
Care man h v ext pt 60 m
|
$XXX.XX
|
| G0085 |
Care man h v ext pt 75 m
|
$XXX.XX
|
| G0086 |
Care man home care plan 30 m
|
$XXX.XX
|
| G0087 |
Care man home care plan 60 m
|
$XXX.XX
|
| G0101 |
Ca screen;pelvic/breast exam
|
$XXX.XX
|
| G0102 |
Prostate ca screening; dre
|
$XXX.XX
|
| G0104 |
Ca screen;flexi sigmoidscope
|
$XXX.XX
|
| G0105 |
Colorectal scrn; hi risk ind
|
$XXX.XX
|
| G0105-53 |
Colorectal scrn; hi risk ind
|
$XXX.XX
|
| G0105-53 |
Colorectal scrn; hi risk ind
|
$XXX.XX
|
| G0106 |
Colon ca screen;barium enema
|
$XXX.XX
|
| G0106-26 |
Colon ca screen;barium enema
|
$XXX.XX
|
| G0106-TC |
Colon ca screen;barium enema
|
$XXX.XX
|
| G0108 |
Diab manage trn per indiv
|
$XXX.XX
|
| G0109 |
Diab manage trn ind/group
|
$XXX.XX
|
| G0117 |
Glaucoma scrn hgh risk direc
|
$XXX.XX
|
| G0118 |
Glaucoma scrn hgh risk direc
|
$XXX.XX
|
| G0120 |
Colon ca scrn; barium enema
|
$XXX.XX
|
| G0120-26 |
Colon ca scrn; barium enema
|
$XXX.XX
|
| G0120-TC |
Colon ca scrn; barium enema
|
$XXX.XX
|
| G0121-53 |
Colon ca scrn not hi rsk ind
|
$XXX.XX
|
| G0124 |
Screen c/v thin layer by md
|
$XXX.XX
|
| G0127 |
Trim nail(s)
|
$XXX.XX
|
| G0128 |
Corf skilled nursing service
|
$XXX.XX
|
| G0130 |
Single energy x-ray study
|
$XXX.XX
|
| G0130-26 |
Single energy x-ray study
|
$XXX.XX
|
| G0130-TC |
Single energy x-ray study
|
$XXX.XX
|
| G0141 |
Scr c/v cyto,autosys and md
|
$XXX.XX
|
| G0166 |
Extrnl counterpulse, per tx
|
$XXX.XX
|
| G0168 |
Wound closure by adhesive
|
$XXX.XX
|
| G0179 |
Md recertification hha pt
|
$XXX.XX
|
| G0180 |
Md certification hha patient
|
$XXX.XX
|
| G0181 |
Home health care supervision
|
$XXX.XX
|
| G0182 |
Hospice care supervision
|
$XXX.XX
|
| G0237 |
Therapeutic procd strg endur
|
$XXX.XX
|
| G0238 |
Oth resp proc, indiv
|
$XXX.XX
|
| G0239 |
Oth resp proc, group
|
$XXX.XX
|
| G0245 |
Initial foot exam pt lops
|
$XXX.XX
|
| G0246 |
Followup eval of foot pt lop
|
$XXX.XX
|
| G0247 |
Routine footcare pt w lops
|
$XXX.XX
|
| G0248 |
Demonstrate use home inr mon
|
$XXX.XX
|
| G0249 |
Provide inr test mater/equip
|
$XXX.XX
|
| G0250 |
Md inr test revie inter mgmt
|
$XXX.XX
|
| G0268 |
Removal of impacted wax md
|
$XXX.XX
|
| G0270 |
Mnt subs tx for change dx
|
$XXX.XX
|
| G0271 |
Group mnt 2 or more 30 mins
|
$XXX.XX
|
| G0276 |
Pild/placebo control clin tr
|
$XXX.XX
|
| G0277 |
Hbot, full body chamber, 30m
|
$XXX.XX
|
| G0278 |
Iliac art angio,cardiac cath
|
$XXX.XX
|
| G0279 |
Tomosynthesis, mammo
|
$XXX.XX
|
| G0279-26 |
Tomosynthesis, mammo
|
$XXX.XX
|
| G0279-TC |
Tomosynthesis, mammo
|
$XXX.XX
|
| G0281 |
Elec stim unattend for press
|
$XXX.XX
|
| G0283 |
Elec stim other than wound
|
$XXX.XX
|
| G0288 |
Recon, cta for surg plan
|
$XXX.XX
|
| G0289 |
Arthro, loose body + chondro
|
$XXX.XX
|
| G0296 |
Visit to determ ldct elig
|
$XXX.XX
|
| G0297 |
Ldct for lung ca screen
|
$XXX.XX
|
| G0297-26 |
Ldct for lung ca screen
|
$XXX.XX
|
| G0297-TC |
Ldct for lung ca screen
|
$XXX.XX
|
| G0329 |
Electromagntic tx for ulcers
|
$XXX.XX
|
| G0341 |
Percutaneous islet celltrans
|
$XXX.XX
|
| G0342 |
Laparoscopy islet cell trans
|
$XXX.XX
|
| G0343 |
Laparotomy islet cell transp
|
$XXX.XX
|
| G0372 |
Md service required for pmd
|
$XXX.XX
|
| G0396 |
Alcohol/subs interv 15-30mn
|
$XXX.XX
|
| G0397 |
Alcohol/subs interv >30 min
|
$XXX.XX
|
| G0402 |
Initial preventive exam
|
$XXX.XX
|
| G0403 |
Ekg for initial prevent exam
|
$XXX.XX
|
| G0404 |
Ekg tracing for initial prev
|
$XXX.XX
|
| G0405 |
Ekg interpret & report preve
|
$XXX.XX
|
| G0406 |
Inpt/tele follow up 15
|
$XXX.XX
|
| G0407 |
Inpt/tele follow up 25
|
$XXX.XX
|
| G0408 |
Inpt/tele follow up 35
|
$XXX.XX
|
| G0409 |
Corf related serv 15 mins ea
|
$XXX.XX
|
| G0412 |
Open tx iliac spine uni/bil
|
$XXX.XX
|
| G0413 |
Pelvic ring fracture uni/bil
|
$XXX.XX
|
| G0414 |
Pelvic ring fx treat int fix
|
$XXX.XX
|
| G0415 |
Open tx post pelvic fxcture
|
$XXX.XX
|
| G0416 |
Prostate biopsy, any mthd
|
$XXX.XX
|
| G0416-26 |
Prostate biopsy, any mthd
|
$XXX.XX
|
| G0416-TC |
Prostate biopsy, any mthd
|
$XXX.XX
|
| G0420 |
Ed svc ckd ind per session
|
$XXX.XX
|
| G0421 |
Ed svc ckd grp per session
|
$XXX.XX
|
| G0422 |
Intens cardiac rehab w/exerc
|
$XXX.XX
|
| G0423 |
Intens cardiac rehab no exer
|
$XXX.XX
|
| G0424 |
Pulmonary rehab w exer
|
$XXX.XX
|
| G0425 |
Inpt/ed teleconsult30
|
$XXX.XX
|
| G0426 |
Inpt/ed teleconsult50
|
$XXX.XX
|
| G0427 |
Inpt/ed teleconsult70
|
$XXX.XX
|
| G0429 |
Dermal filler injection(s)
|
$XXX.XX
|
| G0438 |
Ppps, initial visit
|
$XXX.XX
|
| G0439 |
Ppps, subseq visit
|
$XXX.XX
|
| G0442 |
Annual alcohol screen 15 min
|
$XXX.XX
|
| G0443 |
Brief alcohol misuse counsel
|
$XXX.XX
|
| G0444 |
Depression screen annual
|
$XXX.XX
|
| G0445 |
High inten beh couns std 30m
|
$XXX.XX
|
| G0446 |
Intens behave ther cardio dx
|
$XXX.XX
|
| G0447 |
Behavior counsel obesity 15m
|
$XXX.XX
|
| G0451 |
Devlopment test interpt&rep
|
$XXX.XX
|
| G0452-26 |
Molecular pathology interpr
|
$XXX.XX
|
| G0453 |
Cont intraop neuro monitor
|
$XXX.XX
|
| G0454 |
Md document visit by npp
|
$XXX.XX
|
| G0455 |
Fecal microbiota prep instil
|
$XXX.XX
|
| G0459 |
Telehealth inpt pharm mgmt
|
$XXX.XX
|
| G0460 |
Autologous prp for ulcers
|
$XXX.XX
|
| G0473 |
Group behave couns 2-10
|
$XXX.XX
|
| G0500 |
Mod sedat endo service >5yrs
|
$XXX.XX
|
| G0506 |
Comp asses care plan ccm svc
|
$XXX.XX
|
| G0508 |
Crit care telehea consult 60
|
$XXX.XX
|
| G0509 |
Crit care telehea consult 50
|
$XXX.XX
|
| G0513 |
Prolong prev svcs, first 30m
|
$XXX.XX
|
| G0514 |
Prolong prev svcs, addl 30m
|
$XXX.XX
|
| G0516 |
Insert drug del implant, >=4
|
$XXX.XX
|
| G0517 |
Remove drug implant
|
$XXX.XX
|
| G0518 |
Remove w insert drug implant
|
$XXX.XX
|
| G2001 |
Post d/c h vst new pt 20 m
|
$XXX.XX
|
| G2002 |
Post-d/c h vst new pt 30 m
|
$XXX.XX
|
| G2003 |
Post-d/c h vst new pt 45 m
|
$XXX.XX
|
| G2004 |
Post-d/c h vst new pt 60 m
|
$XXX.XX
|
| G2005 |
Post-d/c h vst new pt 75 m
|
$XXX.XX
|
| G2006 |
Post-d/c h vst ext pt 20 m
|
$XXX.XX
|
| G2007 |
Post-d/c h vst ext pt 30 m
|
$XXX.XX
|
| G2008 |
Post-d/c h vst ext pt 45 m
|
$XXX.XX
|
| G2009 |
Post-d/c h vst ext pt 60 m
|
$XXX.XX
|
| G2010 |
Remot image submit by pt
|
$XXX.XX
|
| G2011 |
Alcohol/sub abuse assess
|
$XXX.XX
|
| G2012 |
Brief check in by md/qhp
|
$XXX.XX
|
| G2013 |
Post-d/c h vst ext pt 75 m
|
$XXX.XX
|
| G2014 |
Post-d/c care plan overs 30m
|
$XXX.XX
|
| G2015 |
Post-d/c care plan overs 60m
|
$XXX.XX
|
| G2058 |
Ccm add 20min
|
$XXX.XX
|
| G2061 |
Qual nonmd est pt 5-10m
|
$XXX.XX
|
| G2062 |
Qual nonmd est pt 11-20m
|
$XXX.XX
|
| G2063 |
Qual nonmd est pt 21>min
|
$XXX.XX
|
| G2064 |
Md mang high risk dx 30
|
$XXX.XX
|
| G2065 |
Clin mang h risk dx 30
|
$XXX.XX
|
| G2082 |
Visit esketamine 56m or less
|
$XXX.XX
|
| G2083 |
Visit esketamine, > 56m
|
$XXX.XX
|
| G2086 |
Off base opioid tx 70min
|
$XXX.XX
|
| G2087 |
Off base opioid tx, 60 m
|
$XXX.XX
|
| G2088 |
Off base opioid tx, add30
|
$XXX.XX
|
| G6001 |
Echo guidance radiotherapy
|
$XXX.XX
|
| G6001-26 |
Echo guidance radiotherapy
|
$XXX.XX
|
| G6001-TC |
Echo guidance radiotherapy
|
$XXX.XX
|
| G6002 |
Stereoscopic x-ray guidance
|
$XXX.XX
|
| G6002-26 |
Stereoscopic x-ray guidance
|
$XXX.XX
|
| G6002-TC |
Stereoscopic x-ray guidance
|
$XXX.XX
|
| G6003 |
Radiation treatment delivery
|
$XXX.XX
|
| G6004 |
Radiation treatment delivery
|
$XXX.XX
|
| G6005 |
Radiation treatment delivery
|
$XXX.XX
|
| G6006 |
Radiation treatment delivery
|
$XXX.XX
|
| G6007 |
Radiation treatment delivery
|
$XXX.XX
|
| G6008 |
Radiation treatment delivery
|
$XXX.XX
|
| G6009 |
Radiation treatment delivery
|
$XXX.XX
|
| G6010 |
Radiation treatment delivery
|
$XXX.XX
|
| G6011 |
Radiation treatment delivery
|
$XXX.XX
|
| G6012 |
Radiation treatment delivery
|
$XXX.XX
|
| G6013 |
Radiation treatment delivery
|
$XXX.XX
|
| G6014 |
Radiation treatment delivery
|
$XXX.XX
|
| G6015 |
Radiation tx delivery imrt
|
$XXX.XX
|
| G6016 |
Delivery comp imrt
|
$XXX.XX
|
| G9157 |
Transesoph doppl cardiac mon
|
$XXX.XX
|
| G9187 |
Bpci home visit
|
$XXX.XX
|
| G9481 |
Remote e/m new pt 10mins
|
$XXX.XX
|
| G9482 |
Remote e/m new pt 20mins
|
$XXX.XX
|
| G9483 |
Remote e/m new pt 30mins
|
$XXX.XX
|
| G9484 |
Remote e/m new pt 45mins
|
$XXX.XX
|
| G9485 |
Remote e/m new pt 60mins
|
$XXX.XX
|
| G9486 |
Remote e/m est. pt 10mins
|
$XXX.XX
|
| G9487 |
Remote e/m est. pt 15mins
|
$XXX.XX
|
| G9488 |
Remote e/m est. pt 25mins
|
$XXX.XX
|
| G9489 |
Remote e/m est. pt 40mins
|
$XXX.XX
|
| G9490 |
Cmmi mod home visit
|
$XXX.XX
|
| G9685 |
Acute nursing facility care
|
$XXX.XX
|
| G9868 |
Next gen aco model <10min
|
$XXX.XX
|
| G9869 |
Next gen aco model 10-20min
|
$XXX.XX
|
| G9870 |
Next gen aco model >20min
|
$XXX.XX
|
| G9978 |
Remote e/m new pt 10mins
|
$XXX.XX
|
| G9979 |
Remote e/m new pt 20mins
|
$XXX.XX
|
| G9980 |
Remote e/m new pt 30 mins
|
$XXX.XX
|
| G9981 |
Remote e/m new pt 45mins
|
$XXX.XX
|
| G9982 |
Remote e/m new pt 60mins
|
$XXX.XX
|
| G9983 |
Remote e/m est. pt 10mins
|
$XXX.XX
|
| G9984 |
Remote e/m est. pt 15mins
|
$XXX.XX
|
| G9985 |
Remote e/m est. pt 25mins
|
$XXX.XX
|
| G9986 |
Remote e/m est. pt 40mins
|
$XXX.XX
|
| G9987 |
Bpci advanced in home visit
|
$XXX.XX
|
| P3001 |
Screening pap smear by phys
|
$XXX.XX
|
| Q0035 |
Cardiokymography
|
$XXX.XX
|
| Q0035-26 |
Cardiokymography
|
$XXX.XX
|
| Q0035-TC |
Cardiokymography
|
$XXX.XX
|
| Q0091 |
Obtaining screen pap smear
|
$XXX.XX
|
| Q0092 |
Set up port xray equipment
|
$XXX.XX
|
