BCBS Midlands Choice UHC Medical Associates Health Plan Tricare/Champ VA Self Pay Procedure Record Name Procedure Modifier CPT Code Gross Charge Payer 1 Negotiated Fee Payer 2 Negotiated Fee Payer 3 Negotiated Fee Payer 4 Negotiated Fee Payer 5 Negotiated Fee Payer 6 Negotiated Fee PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION 10021 180.00 174.82 167.93 137.30 102.40 95.70 171.00 PR ACNE SURGERY OF SKIN ABSCESS 10040 200.00 193.90 187.39 152.28 116.80 109.16 190.00 PR DRAIN SKIN ABSCESS SIMPLE 10060 220.00 213.35 207.28 167.55 123.65 115.55 209.00 PR DRAIN SKIN ABSCESS SIMPLE 52 10060 220.00 213.35 207.28 167.55 123.65 115.55 209.00 PR DRAIN SKIN ABSCESS COMPLIC 10061 382.00 370.65 357.81 291.09 211.15 197.34 362.90 PR DRAIN SKIN ABSCESS COMPLIC 52 10061 382.00 370.65 357.81 291.09 211.15 197.34 362.90 PR DRAIN PILONIDAL CYST SIMPL 10080 338.00 328.23 357.05 257.78 244.86 228.84 321.10 PR REMOVE FOREIGN BODY SIMPLE 10120 281.00 272.46 259.22 213.98 153.22 143.20 266.95 PR REMOVE FOREIGN BODY SIMPLE 52 10120 281.00 272.46 259.22 213.98 153.22 143.20 266.95 PR REMOVE FOREIGN BODY COMPLIC 10121 502.00 487.37 462.68 382.76 270.14 252.47 476.90 PR DRAINAGE OF HEMATOMA/FLUID 10140 309.00 300.42 289.89 235.94 171.35 160.14 293.55 PR PUNCTURE DRAINAGE OF LESION 10160 240.00 233.40 222.75 183.30 130.37 121.84 228.00 PR PUNCTURE DRAINAGE OF LESION 52 10160 240.00 233.40 222.75 183.30 130.37 121.84 228.00 "PR COMPLEX DRAINAGE, WOUND" 10180 453.00 440.27 429.27 345.77 259.25 242.29 430.35 "PR DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA" 11000 103.00 100.03 97.22 78.56 58.10 54.30 97.85 "PR DEBRIDEMENT, INFECTED SKIN, EA ADD 10% BSA" 11001 41.00 39.48 40.55 31.01 25.11 23.47 38.95 PR REMOVE MESH FROM ABD WALL FOR INFECTION 11008 498.00 483.13 458.79 379.43 260.25 243.22 473.10 PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ 11010 888.00 861.89 804.77 676.88 467.77 437.17 843.60 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM" 11042 225.00 218.10 214.21 171.29 129.71 121.22 213.75 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM" 11043 425.00 412.37 395.16 323.85 232.64 217.41 403.75 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM" 52 11043 425.00 412.37 395.16 323.85 232.64 217.41 403.75 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM" 11044 576.00 559.10 532.90 439.08 308.53 288.35 547.20 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM" 11045 76.00 73.75 70.31 57.92 40.48 37.83 72.20 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM" 11046 134.00 129.96 124.85 102.06 72.08 67.36 127.30 "PR TRIM HYPERKERATOTIC SKIN LESION, ONE" 11055 104.00 100.94 107.13 79.28 69.69 65.13 98.80 "PR TRIM HYPERKERATOTIC SKIN LESION, ONE" GY 11055 104.00 100.94 107.13 79.28 69.69 65.13 98.80 "PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4" 11056 125.00 120.88 126.29 94.94 80.38 75.12 118.75 "PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4" GY 11056 125.00 120.88 126.29 94.94 80.38 75.12 118.75 "PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4" 11057 139.00 134.56 139.72 105.68 88.44 82.65 132.05 "PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4" GY 11057 139.00 134.56 139.72 105.68 88.44 82.65 132.05 PR BIOPSY OF SKIN LESION 11100 184.00 N/A N/A N/A N/A N/A 174.80 PR BIOPSY OF SKIN LESION 52 11100 184.00 N/A N/A N/A N/A N/A 174.80 "PR BIOPSY, EACH ADDED LESION" 11101 59.00 N/A N/A N/A N/A N/A 56.05 "PR BIOPSY, EACH ADDED LESION" 52 11101 59.00 N/A N/A N/A N/A N/A 56.05 PR TANGENTIAL BIOPSY SKIN SINGLE LESION 11102 181.00 175.82 170.19 138.08 104.41 97.57 171.95 PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION 11103 98.00 94.91 90.34 74.54 52.85 49.39 93.10 PR PUNCH BIOPSY SKIN SINGLE LESION 11104 228.00 221.16 214.38 173.69 130.09 121.58 216.60 PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION 11105 112.00 108.72 103.30 85.38 60.97 56.98 106.40 PR INCISIONAL BIOPSY SKIN SINGLE LESION 11106 275.00 267.40 260.22 210.00 159.02 148.62 261.25 PR INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION 11107 132.00 128.28 122.96 100.74 73.15 68.36 125.40 "PR REMOVAL OF SKIN TAGS, UP TO 15" 11200 163.00 158.22 151.62 124.26 89.71 83.85 154.85 "PR REMOVAL OF SKIN TAGS, UP TO 15" 52 11200 163.00 158.22 151.62 124.26 89.71 83.85 154.85 "PR REMOVAL OF SKIN TAGS, EACH ADD 10" 11201 35.00 34.00 32.14 26.70 18.30 17.10 33.25 "PR REMOVAL OF SKIN TAGS, EACH ADD 10" 52 11201 35.00 34.00 32.14 26.70 18.30 17.10 33.25 "PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG" 11300 179.00 173.96 170.66 136.62 103.52 96.75 170.05 "PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG" 52 11300 179.00 173.96 170.66 136.62 103.52 96.75 170.05 "PR SHAV SKIN LES 0.6-1.0 CM TRUNK,ARM,LEG" 11301 220.00 213.65 207.63 167.79 124.91 116.74 209.00 "PR SHAV SKIN LES 1.1-2.0 CM TRUNK,ARM,LEG" 11302 257.00 249.69 239.93 196.10 142.55 133.22 244.15 "PR SHAV SKIN LES >2.1 CM TRUNK,ARM,LEG" 11303 284.00 275.40 264.59 216.29 156.97 146.70 269.80 PR SHAV SKIN LES <0.5 CM REMAINDER BODY 11305 189.00 183.76 179.98 144.32 109.04 101.91 179.55 PR SHAV SKIN LES <0.5 CM REMAINDER BODY 52 11305 189.00 183.76 179.98 144.32 109.04 101.91 179.55 PR SHAV SKIN LES 0.6-1.0 CM REMAINDER BODY 11306 224.00 217.57 210.97 170.87 125.79 117.56 212.80 PR SHAV SKIN LES 1.1-2.0 CM REMAINDER BODY 11307 265.00 257.53 246.81 202.25 145.78 136.23 251.75 PR SHAV SKIN LES >2.1 CM REMAINDER BODY 11308 283.00 274.79 264.66 215.81 154.98 144.84 268.85 "PR SHAV SKIN LES <0.5 CM FACE,FACIAL" 11310 209.00 202.80 197.47 159.27 118.80 111.03 198.55 "PR SHAV SKIN LES <0.5 CM FACE,FACIAL" 52 11310 209.00 202.80 197.47 159.27 118.80 111.03 198.55 "PR SHAV SKIN LES 0.6-1.0 CM FACE,FACIAL" 11311 250.00 242.49 234.85 190.44 140.18 131.01 237.50 "PR SHAV SKIN LES 0.6-1.0 CM FACE,FACIAL" 52 11311 250.00 242.49 234.85 190.44 140.18 131.01 237.50 "PR SHAV SKIN LES 1.1-2.0 CM FACE,FACIAL" 11312 292.00 283.44 271.65 222.60 160.29 149.80 277.40 "PR SHAV SKIN LES 1.1-2.0 CM FACE,FACIAL" 52 11312 292.00 283.44 271.65 222.60 160.29 149.80 277.40 "PR SHAV SKIN LES >2.1 CM FACE,FACIAL" 11313 342.00 332.21 317.23 260.90 186.25 174.08 324.90 "PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG" 11400 228.00 221.39 213.96 173.87 128.81 120.38 216.60 "PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG" 52 11400 228.00 221.39 213.96 173.87 128.81 120.38 216.60 "PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG" 11401 278.00 269.54 261.15 211.68 156.90 146.65 264.10 "PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG" 52 11401 278.00 269.54 261.15 211.68 156.90 146.65 264.10 "PR EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG" 11402 308.00 299.03 289.16 234.84 172.76 161.46 292.60 "PR EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG" 52 11402 308.00 299.03 289.16 234.84 172.76 161.46 292.60 "PR EXC SKIN BENIG 2.1-3 CM TRUNK,ARM,LEG" 11403 355.00 344.75 332.53 270.75 198.11 185.14 337.25 "PR EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG" 11404 402.00 389.93 376.61 306.23 224.49 209.80 381.90 "PR EXC SKIN BENIG >4 CM TRUNK,ARM,LEG" 11406 575.00 558.29 536.01 438.45 315.78 295.12 546.25 PR EXC SKIN BENIG <0.5 CM REMAINDER BODY 11420 230.00 223.01 216.53 175.14 129.60 121.12 218.50 PR EXC SKIN BENIG <0.5 CM REMAINDER BODY 52 11420 230.00 223.01 216.53 175.14 129.60 121.12 218.50 PR EXC SKIN BENIG 0.6-1 CM REMAINDR BODY 11421 291.00 282.20 272.38 221.63 161.38 150.82 276.45 PR EXC SKIN BENIG 1.1-2 CM REMAINDR BODY 11422 327.00 317.17 305.60 249.09 181.18 169.33 310.65 PR EXC SKIN BENIG 2.1-3 CM REMAINDR BODY 11423 372.00 361.14 347.58 283.62 205.73 192.27 353.40 PR EXC SKIN BENIG 2.1-3 CM REMAINDR BODY 52 11423 372.00 361.14 347.58 283.62 205.73 192.27 353.40 PR EXC SKIN BENIG 3.1-4 CM REMAINDR BODY 11424 430.00 417.72 400.09 328.05 235.08 219.71 408.50 PR EXC SKIN BENIG >4 CM REMAINDR BODY 11426 614.00 595.90 571.19 467.99 334.44 312.56 583.30 "PR EXC SKIN BENIG <0.5 CM FACE,FACIAL" 11440 254.00 246.12 238.75 193.29 144.58 135.13 241.30 "PR EXC SKIN BENIG <0.5 CM FACE,FACIAL" 52 11440 254.00 246.12 238.75 193.29 144.58 135.13 241.30 "PR EXC SKIN BENIG 0.6-1 CM FACE,FACIAL" 11441 312.00 303.06 292.62 238.01 174.73 163.30 296.40 "PR EXC SKIN BENIG 1.1-2 CM FACE,FACIAL" 11442 348.00 337.59 324.82 265.13 193.53 180.87 330.60 "PR EXC SKIN BENIG 2.1-3 CM FACE,FACIAL" 11443 414.00 401.56 385.80 315.36 228.83 213.86 393.30 "PR EXC SKIN BENIG 3.1- 4 CM FACE,FACIAL" 11444 519.00 503.63 482.99 395.52 284.76 266.13 493.05 "PR EXC SKIN BENIG >4 CM FACE,FACIAL" 11446 718.00 697.42 665.59 547.71 388.41 362.99 682.10 "PR EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG" 11601 421.00 408.61 391.28 320.90 231.70 216.53 399.95 "PR EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG" 52 11601 421.00 408.61 391.28 320.90 231.70 216.53 399.95 "PR EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG" 11602 456.00 442.45 422.33 347.48 247.97 231.75 433.20 "PR EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG" 52 11602 456.00 442.45 422.33 347.48 247.97 231.75 433.20 "PR EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG" 11603 521.00 505.44 481.23 396.95 281.67 263.24 494.95 "PR EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG" 52 11603 521.00 505.44 481.23 396.95 281.67 263.24 494.95 "PR EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG" 11604 577.00 559.88 535.10 439.70 312.90 292.43 548.15 "PR EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG" 52 11604 577.00 559.88 535.10 439.70 312.90 292.43 548.15 "PR EXC SKIN MALIG >4 CM TRUNK,ARM,LEG" 11606 823.00 799.33 762.05 627.75 444.80 415.70 781.85 "PR EXC SKIN MALIG >4 CM TRUNK,ARM,LEG" 52 11606 823.00 799.33 762.05 627.75 444.80 415.70 781.85 PR EXC SKIN MALIG <0.5 CM REMAINDER BODY 11620 359.00 348.88 337.41 273.99 201.73 188.53 341.05 PR EXC SKIN MALIG <0.5 CM REMAINDER BODY 52 11620 359.00 348.88 337.41 273.99 201.73 188.53 341.05 PR EXC SKIN MALIG 0.6-1 CM REMAINDR BODY 11621 422.00 410.13 392.72 322.10 232.40 217.20 400.90 PR EXC SKIN MALIG 0.6-1 CM REMAINDR BODY 52 11621 422.00 410.13 392.72 322.10 232.40 217.20 400.90 PR EXC SKIN MALIG 1.1-2 CM REMAINDR BODY 11622 471.00 457.12 436.07 359.00 256.00 239.25 447.45 PR EXC SKIN MALIG 2.1-3 CM REMAINDR BODY 11623 551.00 535.28 511.09 420.38 298.44 278.92 523.45 PR EXC SKIN MALIG 2.1-3 CM REMAINDR BODY 52 11623 551.00 535.28 511.09 420.38 298.44 278.92 523.45 PR EXC SKIN MALIG 3.1-4 CM REMAINDR BODY 11624 622.00 604.11 577.45 474.44 338.02 315.92 590.90 PR EXC SKIN MALIG >4 CM REMAINDR BODY 11626 747.00 725.09 693.00 569.45 405.40 378.88 709.65 "PR EXC SKIN MALIG <0.5 CM FACE,FACIAL" 11640 371.00 359.71 345.76 282.50 206.23 192.74 352.45 "PR EXC SKIN MALIG <0.5 CM FACE,FACIAL" 52 11640 371.00 359.71 345.76 282.50 206.23 192.74 352.45 "PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL" 11641 437.00 424.69 406.57 333.53 239.93 224.23 415.15 "PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL" 52 11641 437.00 424.69 406.57 333.53 239.93 224.23 415.15 "PR EXC SKIN MALIG 1.1-2 CM FACE,FACIAL" 11642 498.00 483.73 461.52 379.89 270.72 253.01 473.10 "PR EXC SKIN MALIG 1.1-2 CM FACE,FACIAL" 52 11642 498.00 483.73 461.52 379.89 270.72 253.01 473.10 "PR EXC SKIN MALIG 2.1-3 CM FACE,FACIAL" 11643 586.00 568.99 543.11 446.85 317.32 296.56 556.70 "PR EXC SKIN MALIG 2.1-3 CM FACE,FACIAL" 52 11643 586.00 568.99 543.11 446.85 317.32 296.56 556.70 "PR EXC SKIN MALIG 3.1-4 CM FACE,FACIAL" 11644 723.00 701.58 668.54 550.98 389.78 364.28 686.85 "PR EXC SKIN MALIG 3.1-4 CM FACE,FACIAL" 52 11644 723.00 701.58 668.54 550.98 389.78 364.28 686.85 "PR EXC SKIN MALIG >4 CM FACE,FACIAL" 11646 941.00 913.44 869.56 717.36 504.95 471.91 893.95 PR TRIM NAIL(S) 11719 27.00 26.32 24.48 20.67 14.23 13.30 25.65 PR TRIM NAIL(S) GY 11719 27.00 26.32 24.48 20.67 14.23 13.30 25.65 "PR DEBRIDEMENT OF NAIL(S), 1-5" 11720 62.00 60.05 56.20 47.16 32.98 30.82 58.90 "PR DEBRIDEMENT OF NAIL(S), 1-5" GY 11720 62.00 60.05 56.20 47.16 32.98 30.82 58.90 "PR DEBRIDEMENT OF NAILS, 6 OR MORE" 11721 85.00 82.51 78.17 64.80 44.92 41.98 80.75 "PR DEBRIDEMENT OF NAILS, 6 OR MORE" GY 11721 85.00 82.51 78.17 64.80 44.92 41.98 80.75 PR REMOVAL OF NAIL PLATE 11730 203.00 196.81 190.01 154.56 117.63 109.93 192.85 PR REMOVAL OF NAIL PLATE 52 11730 203.00 196.81 190.01 154.56 117.63 109.93 192.85 PR REMOVE ADDITIONAL NAIL PLATE 11732 61.00 59.38 57.75 46.64 34.20 31.96 57.95 PR DRAIN BLOOD FROM UNDER NAIL 11740 95.00 92.52 91.73 72.66 56.21 52.52 90.25 PR REMOVAL OF NAIL BED 11750 290.00 281.13 270.16 220.79 163.87 153.15 275.50 PR REMOVAL OF NAIL BED 52 11750 290.00 281.13 270.16 220.79 163.87 153.15 275.50 PR REMOVE NAIL BED/FINGER TIP 11752 723.00 N/A N/A N/A N/A N/A 686.85 "PR BIOPSY, NAIL UNIT (SEP PROC)" 11755 228.00 221.43 210.92 173.90 128.23 119.84 216.60 PR RECONSTRUC OF NAIL BED 11760 355.00 344.77 332.39 270.77 194.91 182.16 337.25 "PR EXCISION OF NAIL FOLD, TOE" 11765 314.00 304.57 290.14 239.19 170.85 159.67 298.30 PR REMV PILONIDAL LESION SIMPLE 11770 516.00 501.03 525.23 393.48 345.18 322.60 490.20 "PR INJECTION INTO SKIN LESIONS, UP TO 7" 11900 100.00 96.84 94.17 76.05 56.46 52.77 95.00 "PR INJECTION INTO SKIN LESIONS, 8 OR MORE" 11901 126.00 122.62 118.66 96.30 70.32 65.72 119.70 PR REMOVAL OF CONTRACEPTIVE CAPSUL 11976 269.00 260.77 246.79 204.45 144.09 134.66 255.55 PR INSERTION DRUG IMPLANT DEVICE 11981 260.00 252.27 174.41 198.12 102.04 95.36 247.00 PR REMOVAL DRUG IMPLANT DEVICE 11982 288.00 280.06 198.23 219.95 114.94 107.42 273.60 PR REMOVAL W/ REINSERT DRUG IMPLANT DEVICE 11983 425.00 412.22 246.32 323.73 142.94 133.58 403.75 PR RESUPERF WND BODY <2.5CM 12001 164.00 159.20 152.84 125.03 92.68 86.61 155.80 PR RESUPERF WND BODY <2.5CM 52 12001 164.00 159.20 152.84 125.03 92.68 86.61 155.80 PR RESUP NPTERF WND BODY 2.6-7.5 CM 12002 200.00 193.88 186.35 152.27 111.87 104.55 190.00 PR RESUP NPTERF WND BODY 2.6-7.5 CM 52 12002 200.00 193.88 186.35 152.27 111.87 104.55 190.00 PR RESUPERF WND BODY 7.6-12.5 CM 12004 234.00 227.31 217.71 178.52 129.95 121.45 222.30 PR RESUPERF WND BODY 7.6-12.5 CM 52 12004 234.00 227.31 217.71 178.52 129.95 121.45 222.30 PR RESUPERF WND BODY 12.6-20 CM 12005 304.00 294.98 287.36 231.66 173.16 161.84 288.80 PR RESUPERF WND BODY 20.1-30 CM 12006 358.00 347.98 339.10 273.29 202.34 189.10 340.10 PR RESUPERF WND BODY >30 CM 12007 411.00 399.06 387.79 313.40 229.30 214.30 390.45 PR RESUPERF WND FACE <2.5 CM 12011 200.00 194.48 185.75 152.73 111.62 104.32 190.00 PR RESUPERF WND FACE <2.5 CM 52 12011 200.00 194.48 185.75 152.73 111.62 104.32 190.00 PR RESUPERF WND FACE 2.6-5 CM 12013 209.00 202.96 193.76 159.39 116.05 108.46 198.55 PR RESUPERF WND FACE 2.6-5 CM 52 12013 209.00 202.96 193.76 159.39 116.05 108.46 198.55 PR RESUPERF WND FACE 5.1-7.5 CM 12014 251.00 243.81 235.76 191.48 141.59 132.33 238.45 PR RESUPERF WND FACE 5.1-7.5 CM 52 12014 251.00 243.81 235.76 191.48 141.59 132.33 238.45 PR RESUPERF WND FACE 7.6-12.5 CM 12015 304.00 295.04 285.03 231.71 170.15 159.01 288.80 PR RESUPERF WND FACE 12.6-20 CM 12016 383.00 371.95 362.22 292.11 216.41 202.25 363.85 PR RESUPERF WND FACE 12.6-20 CM 52 12016 383.00 371.95 362.22 292.11 216.41 202.25 363.85 PR CLOSURE SUPERF WND DEHIS SIMPLE 12020 527.00 511.59 500.23 401.78 300.77 281.09 500.65 PR CLOSURE SUPERF WND DEHIS SIMPLE 52 12020 527.00 511.59 500.23 401.78 300.77 281.09 500.65 PR CLOSURE SUPERF WND DEHIS W PACKING 12021 306.00 297.23 290.56 233.43 173.89 162.51 290.70 "PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM" 12031 450.00 436.99 429.25 343.19 264.68 247.36 427.50 "PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM" 52 12031 450.00 436.99 429.25 343.19 264.68 247.36 427.50 "PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM" 12032 558.00 541.96 516.73 425.63 309.26 289.03 530.10 "PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM" 52 12032 558.00 541.96 516.73 425.63 309.26 289.03 530.10 "PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM" 12034 585.00 567.80 552.41 445.92 335.85 313.88 555.75 "PR LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM" 12035 703.00 682.29 653.74 535.83 393.26 367.53 667.85 "PR LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM" 12036 775.00 752.77 727.18 591.18 431.76 403.52 736.25 PR LAYR CLOS WND REST BODY <2.5 CM 12041 451.00 437.39 430.63 343.50 265.79 248.39 428.45 PR LAYR CLOS WND REST BODY <2.5 CM 52 12041 451.00 437.39 430.63 343.50 265.79 248.39 428.45 PR LAYR CLOS WND REST BODY 2.6-7.5 CM 12042 543.00 527.37 513.70 414.17 311.99 291.57 515.85 PR LAYR CLOS WND REST BODY 2.6-7.5 CM 52 12042 543.00 527.37 513.70 414.17 311.99 291.57 515.85 "PR LAYR CLOS WND FACE,FACIAL <2.5 CM" 12051 487.00 473.11 463.83 371.55 284.72 266.09 462.65 "PR LAYR CLOS WND FACE,FACIAL <2.5 CM" 52 12051 487.00 473.11 463.83 371.55 284.72 266.09 462.65 "PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM" 12052 552.00 536.23 521.52 421.13 316.93 296.19 524.40 "PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM" 52 12052 552.00 536.23 521.52 421.13 316.93 296.19 524.40 "PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM" 12053 646.00 626.88 608.54 492.32 368.93 344.79 613.70 "PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM" 52 12053 646.00 626.88 608.54 492.32 368.93 344.79 613.70 "PR LAYR CLOS WND FACE,FACIAL 12.6-20 CM" 12055 875.00 849.38 825.21 667.05 504.45 471.46 831.25 "PR RECMPL WND SCALP,EXTR 1.1-2.5 CM" 13120 651.00 632.48 608.95 496.71 362.51 338.78 618.45 "PR RECMPL WND SCALP,EXTR 1.1-2.5 CM" 52 13120 651.00 632.48 608.95 496.71 362.51 338.78 618.45 "PR RECMPL WND SCALP,EXTR 2.6-7.5 CM" 13121 792.00 768.70 736.86 603.69 435.84 407.33 752.40 "PR RECMPL WND SCALP,EXTR 2.6-7.5 CM" 52 13121 792.00 768.70 736.86 603.69 435.84 407.33 752.40 "PR REP,SKIN,SCALP/EXTREM+5 CM/<" 13122 243.00 235.92 224.02 185.28 129.42 120.95 230.85 "PR REP,SKIN,SCALP/EXTREM+5 CM/<" 52 13122 243.00 235.92 224.02 185.28 129.42 120.95 230.85 "PR RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM" 13131 716.00 695.37 667.78 546.11 395.93 370.03 680.20 "PR RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM" 13132 882.00 856.33 818.80 672.51 481.43 449.93 837.90 "PR REPR,FACE,GENITAL,HAND,FT+5 CMCM/<" 13133 326.00 316.66 299.23 248.69 171.51 160.29 309.70 "PR RECMPL WND LID,NOS,EAR 1.1-2.5 CM" 13151 783.00 760.22 729.00 597.03 430.60 402.43 743.85 "PR RECMPL WND LID,NOS,EAR 2.5-7.5 CM" 13152 935.00 907.50 865.21 712.70 507.46 474.26 888.25 "PR ADJ TISS XFER HEAD,FAC,HAND <10 SQCM" 14040 " 1,402.00 " " 1,360.80 " " 1,296.73 " " 1,068.69 " 754.22 704.88 " 1,331.90 " "PR EXCISE EXCESS SKIN TISSUE,ABDOMEN" 15831 " 1,311.00 " N/A N/A N/A N/A N/A " 1,245.45 " PR INITIAL RX BURN(S) 1ST DEGREE 16000 130.00 126.31 125.13 99.20 73.69 68.88 123.50 PR DRESS/DEBRID SMALL BURN NO ANES 16020 150.00 145.66 139.99 114.39 83.92 78.43 142.50 PR DRESS/DEBRID MED BURN NO ANESTH 16025 275.00 267.04 260.88 209.72 154.71 144.59 261.25 PR DRESS/DEBRID LARGE BURN NO ANESTH 16030 347.00 337.29 327.84 264.89 192.10 179.53 329.65 "PR DESTRUC BENIGN/PREMAL,FIRST LESION" 17000 120.00 116.40 111.60 91.41 66.27 61.93 114.00 "PR DESTRUC BENIGN/PREMAL,FIRST LESION" 52 17000 120.00 116.40 111.60 91.41 66.27 61.93 114.00 "PR DESTRUC BENIGN/PREMAL,2-14 LESIONS" 17003 10.00 9.86 10.39 7.74 6.58 6.15 9.50 "PR DESTRUC BENIGN/PREMAL,2-14 LESIONS" 52 17003 10.00 9.86 10.39 7.74 6.58 6.15 9.50 "PR DESTRUC BENIGN/PREMAL,15+ LESIONS" 17004 279.00 270.72 270.69 212.61 165.86 155.01 265.05 "PR DESTRUC BENIGN/PREMAL,15+ LESIONS" 52 17004 279.00 270.72 270.69 212.61 165.86 155.01 265.05 PR DESTRUC CUT/VASC <10 SQCM 17106 633.00 614.70 585.79 482.75 341.89 319.52 601.35 PR DESTRUCTION BENIGN LESIONS UP TO 14 17110 203.00 196.73 190.14 154.50 113.78 106.34 192.85 PR DESTRUCTION BENIGN LESIONS UP TO 14 52 17110 203.00 196.73 190.14 154.50 113.78 106.34 192.85 PR DESTRUCTION BENIGN LESIONS 15 OR MORE 17111 240.00 233.10 224.17 183.06 133.28 124.56 228.00 PR DESTRUCTION BENIGN LESIONS 15 OR MORE 52 17111 240.00 233.10 224.17 183.06 133.28 124.56 228.00 PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE 17250 149.00 144.95 143.74 113.84 89.37 83.52 141.55 "PR DESTR MALIG TRUNK,EXTREM <0.6 CM" 17260 175.00 169.99 165.60 133.50 99.35 92.85 166.25 "PR DESTR MALIG TRUNK,EXTREM 0.6-1 CM" 17261 266.00 258.08 249.30 202.68 148.39 138.68 252.70 "PR DESTR MALIG TRUNK,EXTREM 1.1-2 CM" 17262 324.00 314.56 302.65 247.04 179.13 167.41 307.80 "PR DESTR MALIG SCAL,NCK,HAND <0.6 CM" 17270 274.00 265.93 254.75 208.85 150.01 140.20 260.30 "PR DESTR MALIG SCAL,NCK,HAND 0.6-1 CM" 17271 302.00 293.11 281.44 230.19 166.62 155.72 286.90 "PR DESTR MALIG FACE,NOSE,LIP <0.6 CM" 17280 256.00 248.91 237.97 195.48 140.93 131.72 243.20 "PR DESTR MALIG FACE,NOSE,LIP 0.6-1 CM" 17281 329.00 319.20 306.05 250.68 180.38 168.58 312.55 "PR DESTR MALIG FACE,NOSE,LIP 1.1-2 CM" 17282 378.00 366.53 351.26 287.85 206.66 193.14 359.10 "PR MOHS, 1 STAGE, HEAD/NECK/HAND/FEET/GENTIAL" 17311 " 1,225.00 " " 1,189.41 " " 1,138.26 " 934.10 677.03 632.74 " 1,163.75 " PR PUNC/ASPIR BREAST CYST 19000 202.00 196.16 186.13 154.05 107.59 100.55 191.90 PR EXPLO/DRAIN BREAST ABSCESS 19020 860.00 835.13 795.61 655.86 474.97 443.90 817.00 PR EXPLO/DRAIN BREAST ABSCESS 52 19020 860.00 835.13 795.61 655.86 474.97 443.90 817.00 PR BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE 19085 " 1,777.00 " " 1,725.21 " " 1,572.41 " " 1,354.88 " 884.69 826.82 " 1,688.15 " PR BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE 19086 " 1,422.00 " " 1,380.95 " " 1,247.96 " " 1,084.52 " 699.48 653.72 " 1,350.90 " "PR BIOPSY OF BREAST, NEEDLE CORE" 19100 274.00 266.25 257.84 209.10 155.48 145.31 260.30 "PR BIOPSY OF BREAST, INCISIONAL" 19101 612.00 594.11 562.96 466.58 336.93 314.89 581.40 PR I&D SOFT TISSUE ABSCESS SUBFASCIAL 20005 554.00 N/A N/A N/A N/A N/A 526.30 "PR EXPLORE WOUND,EXTREMITY" 20103 " 1,066.00 " " 1,035.22 " 981.40 813.00 575.62 537.96 " 1,012.70 " PR INJECT CARPAL TUNNEL 20526 141.00 137.12 133.32 107.69 79.55 74.35 133.95 PR INJECT TENDON SHEATH/LIGAMENT 20550 98.00 95.56 93.89 75.05 55.91 52.25 93.10 PR INJECT TENDON ORIGIN/INSERT 20551 100.00 97.22 96.28 76.35 57.27 53.52 95.00 "PR INJECT TRIGGER POINT, 1 OR 2" 20552 103.00 99.59 95.15 78.21 53.91 50.38 97.85 "PR INJECT TRIGGER POINTS, > 3" 20553 118.00 114.77 109.42 90.14 62.02 57.96 112.10 PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US 20600 90.00 87.27 86.18 68.54 51.53 48.17 85.50 PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT 20604 137.00 132.97 131.15 104.43 80.89 75.60 130.15 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 20605 94.00 91.15 89.29 71.58 53.64 50.13 89.30 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US 20606 151.00 146.63 144.71 115.16 88.31 82.53 143.45 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 20610 110.00 107.11 105.41 84.12 63.18 59.05 104.50 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 50 20610 110.00 107.11 105.41 84.12 63.18 59.05 104.50 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 52 20610 110.00 107.11 105.41 84.12 63.18 59.05 104.50 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US 20611 169.00 164.18 161.20 128.94 98.32 91.89 160.55 PR ASPIRAT/INJECTION GANGLION CYST(S) 20612 111.00 107.78 105.52 84.65 62.95 58.83 105.45 PR ASPIR/INJEC BONE CYST 20615 450.00 437.14 426.21 343.31 256.49 239.72 427.50 PR REMOVAL SUPERFICIAL IMPLANT 20670 688.00 668.44 627.77 524.96 379.39 354.57 653.60 "PR EXCISION,BENIGN TUMOR,MAXILLA/ZYGOMA" 21030 941.00 913.82 850.32 717.66 482.21 450.66 893.95 "PR CLOSED RX NOSE FRACTURE, W/O STABILIZATION" 21315 506.00 491.42 465.03 385.94 285.63 266.94 480.70 PR CLOSED RX MANDIBLE FX+MANIPULATN 21451 " 1,399.00 " " 1,358.30 " " 1,300.50 " " 1,066.73 " 789.09 737.47 " 1,329.05 " PR REDUCE TEMPOROMANDIBL DISLOC 21480 198.00 192.41 198.49 151.11 136.13 127.22 188.10 PR I&D DEEP ABSC/HEMATOMA NECK/CHEST 21501 843.00 818.45 793.27 642.77 481.39 449.89 800.85 PR CLOSED RX RIB FRACTURE 21800 204.00 N/A N/A N/A N/A N/A 193.80 PR REMOVE SUBCUT SHOULDER FOREIGN BODY 23330 514.00 498.87 490.54 391.28 301.75 282.01 488.30 PR CLOSED RX CLAVICLE FRACTURE 23500 401.00 389.09 372.70 305.57 220.53 210.22 380.95 PR CLOSED RX CLAVICLE FRACTURE 52 23500 401.00 389.09 372.70 305.57 220.53 210.22 380.95 PR CLOSED RX SCAPULA FX 23570 424.00 411.78 394.45 323.39 233.09 224.49 402.80 "PR CLOSED RX SCAPULA FX,MANIPULATN" 23575 738.00 716.75 686.58 562.04 405.32 378.80 701.10 PR CLOSED RX PROX HUMERUS FRACTURE 23600 601.00 583.50 558.49 458.25 331.43 309.75 570.95 PR CLOSED RX PROX HUMERUS FRACTURE 52 23600 601.00 583.50 558.49 458.25 331.43 309.75 570.95 PR CLOSED RX GR TUBEROSITY HUM FX 23620 491.00 476.24 455.24 374.01 268.58 251.01 466.45 PR CLOSED RX SHLDR DISLOCATION 23650 587.00 570.29 541.40 447.87 319.98 299.05 557.65 "PR CLOSED RX SHLDR DISLOC,ANESTHESIA" 23655 739.00 717.15 685.65 563.21 403.18 376.81 702.05 "PR CLOSED RX SHLDR DISLOC,ANESTHESIA" 52 23655 739.00 717.15 685.65 563.21 403.18 376.81 702.05 "PR CLOSED RX SHLDR DISLOC,GR TUB FX" 23665 784.00 760.75 726.67 597.45 427.50 399.53 744.80 PR INCIS/DRAIN ARM/ELBOW INFECT BURSA 23931 527.00 511.38 492.67 401.61 308.31 288.14 500.65 PR CLOSED RX MID HUMERUS FRACTURE 24500 655.00 635.82 607.59 499.34 359.13 335.64 622.25 PR CLOSED RX HUMERAL SUPRACONDYLAR FX 24530 695.00 674.78 643.79 529.94 379.95 355.09 660.25 PR CLOSED RX HUMERAL SUPRACONDYLAR FX 52 24530 695.00 674.78 643.79 529.94 379.95 355.09 660.25 "PR CLOSED RX HUM SUPRACONDYLR FX,MANIPU" 24535 " 1,129.00 " " 1,096.49 " " 1,044.39 " 861.12 614.80 574.58 " 1,072.55 " PR CLOSED RX HUMER EPICONDYLR FX 24560 597.00 580.01 557.17 455.51 331.37 309.69 567.15 PR CLOSED RX ELBOW DISLOCATION 24600 681.00 660.84 627.30 518.99 368.01 343.93 646.95 "PR CLOSED RX ELBOW DISLOCATN,ANESTHESIA" 24605 866.00 840.97 802.86 660.45 472.11 441.23 822.70 "PR CLOSED RX RADIAL HEAD DISLOC,CHILD" 24640 189.00 183.63 176.29 144.21 105.10 98.22 179.55 "PR CLOSED RX RADIAL HEAD DISLOC,CHILD" 52 24640 189.00 183.63 176.29 144.21 105.10 98.22 179.55 PR CLOSED RX RADIAL HEAD/NECK FX 24650 479.00 464.68 443.93 364.94 263.34 246.11 455.05 "PR CLOSED RX RADIAL HEAD/NECK FX,MANIP" 24655 812.00 788.64 747.75 619.35 440.16 411.36 771.40 PR CLOSED RX RADIAL SHAFT FX 25500 507.00 491.96 472.07 386.36 282.31 263.84 481.65 PR CLOSED RX ULNA SHAFT FX 25530 479.00 464.87 444.54 365.09 263.69 246.44 455.05 PR CLOSED RX RAD/ULNA SHAFT FX 25560 517.00 501.93 482.15 394.19 287.70 268.88 491.15 "PR CLOSED RX RAD/ULNA SHAFT FX,MANIP" 25565 945.00 917.54 874.69 720.59 512.59 479.06 897.75 PR CLOSED RX DIST RAD/ULNA FX 25600 604.00 586.47 562.84 460.58 335.83 313.86 573.80 PR CLOSED RX DIST RAD/ULNA FX 52 25600 604.00 586.47 562.84 460.58 335.83 313.86 573.80 "PR CLOSED RX DIST RAD/ULNA FX,MANIPUL" 25605 991.00 962.49 916.10 755.88 535.44 500.40 941.45 "PR CLOSED RX DIST RAD/ULNA FX,MANIPUL" 52 25605 991.00 962.49 916.10 755.88 535.44 500.40 941.45 PR CLOSED RX NAVICULAR FX 25622 559.00 543.09 518.12 426.51 305.95 285.93 531.05 PR CLOSED RX CARPAL FX 25630 559.00 542.33 518.48 425.91 304.83 284.89 531.05 PR CLOSED RX ULNA STYLOID FX 25650 592.00 575.10 552.64 451.65 327.74 306.30 562.40 "PR DRAIN FINGER ABSCESS,SIMPLE" 26010 500.00 485.71 512.97 381.45 337.25 315.19 475.00 "PR DRAIN FINGER ABSCESS,SIMPLE" 52 26010 500.00 485.71 512.97 381.45 337.25 315.19 475.00 PR EXPLORE & TREAT METACARPO-PHAL JT 26075 614.00 596.00 570.72 468.06 334.26 312.39 583.30 "PR EXCIS TENDON SHEATH LESION, HAND/FINGER" 26160 " 1,070.00 " " 1,039.21 " 970.79 816.14 612.50 572.43 " 1,016.50 " "PR EXCIS TENDON SHEATH LESION, HAND/FINGER" 52 26160 " 1,070.00 " " 1,039.21 " 970.79 816.14 612.50 572.43 " 1,016.50 " "PR REPAIR EXTEN TENDON,DORSUM HAND,EA" 26410 " 1,018.00 " 988.41 981.54 776.24 603.30 563.82 967.10 PR ARTHROPLASTY I-P JT 26535 792.00 769.41 739.68 604.25 433.64 405.27 752.40 PR CLOSED RX METACARPAL FX 26600 540.00 524.12 503.12 411.62 298.93 279.37 513.00 PR CLOSED RX METACARPAL FX 52 26600 540.00 524.12 503.12 411.62 298.93 279.37 513.00 "PR CLOSED RX METACARPAL FX,MANIP" 26605 593.00 575.96 551.92 452.33 327.72 306.28 563.35 "PR TREAT THUMB DISLOC,MANIPULATN" 26641 694.00 673.49 648.65 528.92 415.56 388.37 659.30 "PR CLOSED RX, CARPOMETACAR DISLOC,NON-THUMB" 26670 636.00 617.71 582.53 485.12 345.44 322.83 604.20 PR CLOSED RX MC-P DISLOC 26700 606.00 588.05 562.78 461.82 331.87 310.17 575.70 "PR CLOSED RX MC-P DISLOC,ANESTH" 26705 769.00 746.18 715.82 586.01 422.34 394.71 730.55 PR CLOSE RX PROX/MID FING SHFT FX 26720 362.00 351.94 335.17 276.39 198.44 185.47 343.90 "PR CLOSE RX PROX/MID FING SHFT FX,MANIP" 26725 621.00 603.03 576.36 473.58 339.63 317.41 589.95 PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA 26735 " 1,094.00 " " 1,061.69 " " 1,010.30 " 833.79 587.72 549.27 " 1,039.30 " PR CLOSE RX FINGR ARTICULAR FX 26740 421.00 409.06 390.66 321.26 231.39 216.25 399.95 "PR CLOSE RX FINGR ARTICULAR FX,MANIP" 26742 682.00 661.83 631.79 519.77 373.44 349.02 647.90 PR CLOSE RX DIST FINGR FX 26750 339.00 329.00 314.28 258.38 185.45 174.26 322.05 "PR CLOSE RX DIST FINGR FX,MANIPULATN" 26755 579.00 562.36 538.92 441.65 318.34 297.51 550.05 PR OPEN TX DISTAL PHALANGEAL FRACTURE EACH 26765 920.00 893.46 852.40 701.67 497.08 464.56 874.00 PR CLOSED RX IP JT DISLOCATION 26770 514.00 499.35 476.35 392.16 281.61 263.19 488.30 PR CLOSED RX IP JT DISLOCATION 52 26770 514.00 499.35 476.35 392.16 281.61 263.19 488.30 "PR CLOSED RX IP JT DISLOCATION,ANESTH" 26775 706.00 685.67 654.65 538.49 390.50 364.95 670.70 PR AMPUTATION FINGER/THUMB+FLAPS 26952 " 1,165.00 " " 1,130.85 " " 1,119.21 " 888.11 680.03 635.54 " 1,106.75 " "PR INCIS/DRAIN PELVIS/HIP,DEEP ABSCESS" 26990 " 1,164.00 " " 1,130.20 " " 1,107.34 " 887.60 663.60 620.19 " 1,105.80 " "PR INJECTION,SACROILIAC JOINT" 27096 299.00 289.92 278.70 227.69 167.01 156.08 284.05 PR CLOSED RX TRAUMATIC HIP DISLOCATN 27250 334.00 323.88 309.11 254.36 173.95 162.57 317.30 "PR CLOSED RX TRAUMA HIP DISLOC,ANESTH" 27252 " 1,387.00 " " 1,346.66 " " 1,278.62 " " 1,057.59 " 740.03 691.62 " 1,317.65 " PR CLOSED RX SPONTANEOUS HIP DISLOC 27256 562.00 545.65 513.09 428.01 297.27 277.82 533.90 PR CLOSED RX SPONTANEOUS HIP DISLOC 52 27256 562.00 545.65 513.09 428.01 297.27 277.82 533.90 "PR CLOSED RX SPONT HIP DISLOC,ANESTH" 27257 664.00 644.97 611.90 506.18 352.81 329.73 630.80 PR CLOSED RX POST HIP ARTHRPLAS DISLOC 27265 742.00 720.66 684.32 565.97 399.60 373.47 704.90 "PR CLOSED RX POST HIP FIX DISLOC,ANESTH" 27266 " 1,065.00 " " 1,033.84 " 986.88 811.92 574.42 536.84 " 1,011.75 " "PR CLOSED RX POST HIP FIX DISLOC,ANESTH" 52 27266 " 1,065.00 " " 1,033.84 " 986.88 811.92 574.42 536.84 " 1,011.75 " "PR INCIS THIGH TENDON,ADDUC/HAMST,SINGL" 27306 644.00 625.24 596.45 491.03 339.58 317.35 611.80 "PR REMV FOREIGN BODY,KNEE/THIGH,DEEP" 27372 " 1,092.00 " " 1,060.37 " " 1,018.31 " 832.76 597.57 558.48 " 1,037.40 " "PR CLOSED RX FEMUR,DISTAL+MANIP" 27510 " 1,253.00 " " 1,216.38 " " 1,151.91 " 955.28 667.84 624.15 " 1,190.35 " "PR CLOSED RX FEMUR,DISTAL+MANIP" 52 27510 " 1,253.00 " " 1,216.38 " " 1,151.91 " 955.28 667.84 624.15 " 1,190.35 " PR CLOSED RX PATELLA FX 27520 591.00 573.32 546.78 450.26 323.44 302.28 561.45 PR CLOSED RX TIBIAL PLATEAU FX 27530 553.00 537.03 514.11 421.76 305.46 285.48 525.35 PR CLOSED RX KNEE DISLOCATN 27550 952.00 924.75 885.34 726.24 520.51 486.46 904.40 PR CLOSED RX KNEE DISLOC+ANESTH 27552 " 1,150.00 " " 1,116.13 " " 1,065.12 " 876.54 623.03 582.28 " 1,092.50 " PR CLOSED RX KNEE DISLOC+ANESTH 52 27552 " 1,150.00 " " 1,116.13 " " 1,065.12 " 876.54 623.03 582.28 " 1,092.50 " PR CLOSED RX KNEECAP DISLOCATN 27560 674.00 654.73 632.30 514.19 372.78 348.39 640.30 PR CLOSED RX KNEECAP DISLOC+ANESTH 27562 887.00 861.37 823.24 675.27 481.86 450.34 842.65 PR CLOSED RX TIBIA SHAFT FX 27750 633.00 614.28 585.68 482.42 345.68 323.08 601.35 "PR CLOSED RX TIBIA SHAFT FX,MANIPULATN" 27752 981.00 952.08 906.67 747.71 530.51 495.80 931.95 "PR CLOSED RX TIBIA SHAFT FX,MANIPULATN" 52 27752 981.00 952.08 906.67 747.71 530.51 495.80 931.95 PR CLOSED RX MED MALLEOLUS FX 27760 612.00 593.78 566.73 466.32 332.24 310.50 581.40 "PR CLOSED RX MED MALLEOLUS FX,MANIP" 27762 876.00 850.58 811.08 668.00 473.96 442.95 832.20 "PR CLOSED RX MED MALLEOLUS FX,MANIP" 52 27762 876.00 850.58 811.08 668.00 473.96 442.95 832.20 PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP 52 27767 850.00 504.14 487.83 395.93 290.59 271.57 807.50 PR CLOSED RX PROX/SHAFT FIBULA FX 27780 560.00 543.57 520.32 426.89 307.61 287.49 532.00 PR CLOSED RX PROX/SHAFT FIBULA FX 52 27780 560.00 543.57 520.32 426.89 307.61 287.49 532.00 PR CLOSED RX DIST FIBULA FX 27786 577.00 560.20 533.59 439.95 314.02 293.48 548.15 PR CLOSED RX DIST FIBULA FX 52 27786 577.00 560.20 533.59 439.95 314.02 293.48 548.15 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP 27808 612.00 594.12 566.26 466.59 334.66 312.77 581.40 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP 52 27808 612.00 594.12 566.26 466.59 334.66 312.77 581.40 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP 27810 860.00 834.61 793.88 655.46 466.66 436.13 817.00 PR CLOSED RX TRIMALLEOLAR FX 27816 596.00 578.90 553.95 454.64 328.20 306.73 566.20 "PR CLOSED RX TRIMALLEOLAR FX,MANIP" 27818 894.00 867.85 824.04 681.56 483.47 451.84 849.30 PR CLOSED RX PROX TIB/FIB DISLOC+ANESTH 27831 737.00 715.14 684.05 561.63 402.23 375.92 700.15 PR CLOSED RX ANKLE DISLOCATN 27840 691.00 671.08 637.95 527.03 373.72 349.27 656.45 "PR CLOSED RX ANKLE DISLOCATN,ANESTH" 27842 900.00 874.09 836.20 686.46 488.77 456.79 855.00 "PR CLOSED RX ANKLE DISLOCATN,ANESTH" 52 27842 900.00 874.09 836.20 686.46 488.77 456.79 855.00 "PR EXCIS TENDN/CAPSULE LESN,TOES" 28092 803.00 780.06 735.83 612.62 427.70 399.71 762.85 "PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS" 28190 479.00 465.52 437.36 365.60 254.10 237.47 455.05 PR CLOSED RX HEEL FX 28400 457.00 444.17 421.77 348.83 246.53 230.40 434.15 PR CLOSED RX TALUS FX 28430 440.00 426.88 407.73 335.25 239.78 224.09 418.00 "PR CLOSED RX TALUS FX,MANIPULATN" 28435 666.00 646.55 617.45 507.59 330.92 309.27 632.70 "PR CLOSED RX TARSAL FX,EACH" 28450 395.00 383.05 362.93 300.83 211.65 197.79 375.25 PR CLOSED RX METATARSAL FX 28470 405.00 393.29 373.45 308.87 218.60 204.30 384.75 PR CLOSED RX METATARSAL FX 52 28470 405.00 393.29 373.45 308.87 218.60 204.30 384.75 PR CLOSED RX BIG TOE FRACTURE 28490 267.00 259.21 243.35 203.57 140.94 131.72 253.65 PR CLOSED RX BIG TOE FRACTURE 52 28490 267.00 259.21 243.35 203.57 140.94 131.72 253.65 PR CLOSED RX TOE FX 28510 228.00 221.81 208.77 174.20 121.19 113.26 216.60 PR CLOSED RX TOE FX 52 28510 228.00 221.81 208.77 174.20 121.19 113.26 216.60 PR CLOSED RX SESAMOID BONE FX 28530 218.00 211.61 199.09 166.19 114.62 107.12 207.10 "PR CLOSED RX I-P JT,TOE DISLOCATION" 28660 220.00 213.14 202.29 167.39 119.89 112.05 209.00 "PR AMPUTATION METATARSAL+TOE,SINGLE" 28810 795.00 771.75 733.42 606.09 419.33 391.90 755.25 PR APPLY LONG ARM CAST 29065 175.00 169.67 159.76 133.25 93.21 87.11 166.25 PR APPLY FOREARM CAST 29075 158.00 153.56 144.29 120.60 84.98 79.43 150.10 PR APPLY HAND/WRIST CAST 29085 174.00 168.81 158.98 132.57 93.12 87.03 165.30 PR APPLY LONG ARM SPLINT 29105 151.00 146.42 137.30 114.99 80.34 75.08 143.45 "PR APPLY FOREARM SPLINT,STATIC" 29125 118.00 114.87 107.93 90.21 63.53 59.37 112.10 "PR APPLY FINGER SPLINT,STATIC" 29130 76.00 73.53 69.71 57.75 40.14 37.51 72.20 PR STRAPPING OF SHOULDER 29240 58.00 56.10 54.04 44.06 31.35 29.29 55.10 PR STRAPPING OF ELBOW OR WRIST 29260 56.00 54.43 52.43 42.75 30.16 28.20 53.20 PR STRAPPING OF HAND OR FINGER 29280 57.00 55.70 52.80 43.74 29.49 27.56 54.15 PR APPLY LONG LEG CAST 29345 247.00 239.65 227.03 188.21 131.50 122.90 234.65 PR APPLY SHORT LEG CAST 29405 148.00 144.13 134.73 113.19 78.47 73.34 140.60 "PR APPLY SHORT LEG CAST,WALKER" 29425 143.00 138.69 129.78 108.92 74.81 69.92 135.85 PR ADDITION OF WALKER TO CAST 29440 82.00 79.57 74.77 62.49 42.74 39.94 77.90 PR APPLY LONG LEG SPLINT 29505 157.00 152.82 143.45 120.02 85.21 79.64 149.15 PR APPLY LOWER LEG SPLINT 29515 132.00 128.01 119.81 100.53 69.58 65.03 125.40 PR STRAPPING OF HIP 29520 64.00 62.36 61.21 48.98 36.43 34.05 60.80 PR STRAPPING OF KNEE 29530 57.00 55.47 53.45 43.56 31.01 28.98 54.15 PR STRAPPING; ANKLE &/OR FOOT 29540 54.00 52.56 49.45 41.28 28.13 26.29 51.30 PR STRAPPING UNNA BOOT 29580 115.00 112.06 107.43 88.01 63.77 59.60 109.25 PR APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE 29581 162.00 157.61 154.41 123.78 91.40 85.42 153.90 PR REMV/REVISN BOOT/BODY CAST 29700 118.00 114.28 105.94 89.75 60.47 56.51 112.10 PR REMV/REVISN FULL ARM/LEG CAST 29705 119.00 115.71 108.64 90.87 62.73 58.63 113.05 "PR KNEE SCOPE, W/LATERAL RELEASE" 29873 964.00 936.09 896.57 735.15 527.02 492.54 915.80 PR REMOVE NASAL FOREIGN BODY 30300 340.00 330.53 323.52 259.58 205.42 191.97 323.00 PR REMOVE NASAL FOREIGN BODY 52 30300 340.00 330.53 323.52 259.58 205.42 191.97 323.00 "PR REMV NASAL FOR BODY,GEN ANESTH" 30310 373.00 362.48 346.69 284.67 207.93 194.32 354.35 "PR CTRL NOSEBLEED,ANTER,SIMPLE" 30901 253.00 245.63 243.30 192.90 156.47 146.24 240.35 "PR CTRL NOSEBLEED,ANTER,COMPLEX" 30903 398.00 386.43 385.49 303.48 245.90 229.81 378.10 "PR CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT" 30905 605.00 587.52 573.23 461.40 357.57 334.18 574.75 PR IRRIGATION MAXILLARY SINUS 31000 334.00 324.36 309.22 254.73 184.52 172.45 317.30 PR INSERT EMERGENCY ENDOTRACH AIRWAY 31500 267.00 258.86 247.27 203.30 140.19 131.02 253.65 PR TRACH TUBE CHANGE 31502 66.00 64.04 60.46 50.30 34.55 32.29 62.70 "PR LARYNGOSCOPY,INDIRECT,DX" 31505 155.00 150.85 147.98 118.47 90.68 84.75 147.25 PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC 31575 214.00 207.87 209.01 163.25 127.43 119.09 203.30 PR THORACENTESIS PUNCTURE PLEURAL CAVITY ASPIRATION 32421 335.00 N/A N/A N/A N/A N/A 318.25 PR THORACENTESIS WITH INSERTION TUBE WATER SEAL 32422 408.00 N/A N/A N/A N/A N/A 387.60 PR TUBE THORACOSTOMY INCLUDES WATER SEAL 32551 291.00 282.22 268.43 221.64 152.30 142.34 276.45 PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING 32554 391.00 379.99 380.93 298.43 241.50 225.69 371.45 "PR REBL VES DIRECT,HAND/FINGR" 35207 " 1,393.00 " " 1,352.57 " " 1,283.23 " " 1,062.23 " 739.98 691.57 " 1,323.35 " "PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,1ST ACCESS W/ RAD EVAL" 36147 " 1,502.00 " N/A N/A N/A N/A N/A " 1,426.90 " "CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE" 36415 6.00 5.73 4.00 1.80 N/A 3.00 5.70 PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK 36468 280.00 272.19 259.37 N/A N/A N/A 266.00 PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN 36470 194.00 188.12 184.17 147.74 113.06 105.66 184.30 PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS 36471 352.00 341.34 331.09 268.07 199.06 186.04 334.40 "PR CATH, VEIN UMBILICAL NEWBORN" 36510 155.00 150.47 144.11 118.17 85.29 79.72 147.25 PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y 36555 350.00 339.71 324.74 266.79 198.81 185.80 332.50 PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/> 36558 " 1,405.00 " " 1,363.66 " " 1,385.91 " " 1,070.94 " 866.26 809.59 " 1,334.75 " PR INSERTION PICC W/O IMG GDN 5 YR/> 36569 180.00 175.22 166.88 137.61 93.46 87.35 171.00 PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT 36576 597.00 579.28 574.97 454.94 354.02 330.85 567.15 PR REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP 36589 305.00 296.13 284.54 232.56 167.01 156.08 289.75 PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 36590 407.00 394.74 378.23 310.01 223.79 209.15 386.65 "PR INSERT NEEDLE,INTRAOSSEOUS INFUSN" 36680 109.00 105.97 101.52 83.22 57.25 53.50 103.55 PR TEMPORAL ARTERY LIGATN OR BX 37609 566.00 549.66 526.27 431.67 314.33 293.76 537.70 PR PHLEB VEINS - EXTREM 20+ 37766 " 1,400.00 " " 1,359.08 " 868.81 " 1,067.34 " 503.48 470.54 " 1,330.00 " "PR REPAIR LIP,FULL THICK,VERMILION" 40650 841.00 816.16 786.66 640.97 476.88 445.67 798.95 "PR DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL" 40800 392.00 380.32 358.21 298.68 212.16 198.28 372.40 PR INCISION OF LIP FOLD 40806 187.00 181.35 169.35 142.43 102.44 95.74 177.65 PR INCISION OF TONGUE FOLD 41010 381.00 369.93 356.85 290.52 221.42 206.93 361.95 "PR REPAIR TONGUE LACER,<2.6 CM" 41250 507.00 492.23 473.64 386.57 286.52 267.78 481.65 PR DRAINAGE OF GUM LESION 41800 536.00 520.23 498.79 408.56 306.14 286.11 509.20 PR REMOVE PHARYNX FOREIGN BODY 42809 372.00 360.70 343.40 283.28 201.99 188.78 353.40 "PR CNTRL NASOPHAR BLEED,SIMPLE,W/POST PACKS" 42970 764.00 741.79 702.34 582.39 407.63 380.96 725.80 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY 43202 591.00 574.24 576.30 450.98 369.22 345.07 561.45 PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY 43215 681.00 661.55 653.84 519.54 409.36 382.58 646.95 PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER 43233 431.00 418.79 395.92 328.89 225.95 211.16 409.45 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC 43235 493.00 478.23 478.15 375.57 303.63 283.77 468.35 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE 43239 659.00 640.06 637.33 502.67 391.19 365.60 626.05 PR EGD DILATION GASTRIC/DUODENAL STRICTURE 43245 " 1,047.00 " " 1,016.75 " " 1,003.86 " 798.50 628.55 587.43 994.65 PR EGD FLEXIBLE FOREIGN BODY REMOVAL 43247 662.00 643.17 633.91 505.11 394.64 368.82 628.90 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS 43248 681.00 661.51 665.05 519.51 422.66 395.01 646.95 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM 43249 " 1,937.00 " " 1,880.43 " " 1,856.96 " " 1,476.78 " " 1,169.26 " " 1,092.77 " " 1,840.15 " "PR UPPER GI ENDOSCOPY,TUMOR ABLATN" 43258 489.00 N/A N/A N/A N/A N/A 464.55 "PR DILATE ESOPHAGUS,BALLOON RETROGRADE" 43456 " 1,236.00 " N/A N/A N/A N/A N/A " 1,174.20 " PR PLACEMENT NG/OG TUBE BY PHYSICIAN 43752 77.00 75.04 71.56 58.94 40.52 37.87 73.15 "PR GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC" 43753 41.00 39.80 37.77 31.26 21.33 19.92 38.95 PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE 43760 868.00 N/A N/A N/A N/A N/A 824.60 PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 43762 407.00 395.43 384.60 310.55 240.34 224.62 386.65 "PR LAP, PLACE ADJUST GAST RESTRICT DEVICE" 43770 " 2,036.00 " " 1,977.08 " " 1,884.72 " " 1,552.68 " " 1,082.70 " " 1,011.87 " " 1,934.20 " "PR FREEING BOWEL ADHESION,ENTEROLYSIS" 44005 " 1,988.00 " " 1,929.79 " " 1,835.54 " " 1,515.54 " " 1,049.41 " 980.76 " 1,888.60 " "PR FREEING BOWEL ADHESION,ENTEROLYSIS" 55 44005 " 1,988.00 " " 1,929.79 " " 1,835.54 " " 1,515.54 " " 1,049.41 " 980.76 " 1,888.60 " PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY 44160 " 2,261.00 " " 2,195.58 " " 2,090.43 " " 1,724.28 " " 1,195.49 " " 1,117.28 " " 2,147.95 " PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY 55 44160 " 2,261.00 " " 2,195.58 " " 2,090.43 " " 1,724.28 " " 1,195.49 " " 1,117.28 " " 2,147.95 " "PR LAP, SURG ENTEROLYSIS" 44180 " 1,672.00 " " 1,622.98 " " 1,544.67 " " 1,274.60 " 884.33 826.48 " 1,588.40 " "PR LAP, SURG ENTEROLYSIS" 55 44180 " 1,672.00 " " 1,622.98 " " 1,544.67 " " 1,274.60 " 884.33 826.48 " 1,588.40 " PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX 44388 543.00 526.76 304.56 413.69 321.60 300.56 515.85 PR COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE 44389 716.00 695.24 684.90 546.00 425.60 397.76 680.20 PR DRAINAGE OF DEEP RECTAL ABSCESS 45020 " 1,048.00 " " 1,017.84 " 968.86 799.35 559.79 523.18 995.60 PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ 45309 324.00 314.90 318.46 247.31 211.54 197.70 307.80 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD 45330 315.00 306.00 297.79 240.32 189.97 177.54 299.25 "PR SIGMOIDOSCOPY,BIOPSY" 45331 491.00 477.00 468.92 374.61 298.05 278.55 466.45 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD 45378 594.00 576.48 323.07 452.73 347.70 324.96 564.30 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE 45380 764.00 741.42 728.49 582.27 450.18 420.73 725.80 "PR COLONOSCOPY,ABLATE LESION" 45383 " 1,066.00 " N/A N/A N/A N/A N/A " 1,012.70 " PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS 45384 847.00 822.41 808.90 645.87 503.67 470.72 804.65 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 45385 802.00 778.94 762.20 611.73 467.32 436.75 761.90 PR REPAIR OF RECTOCELE 45560 " 1,288.00 " " 1,250.13 " " 1,193.48 " 981.78 685.91 641.03 " 1,223.60 " PR REPAIR OF RECTOCELE 52 45560 " 1,288.00 " " 1,250.13 " " 1,193.48 " 981.78 685.91 641.03 " 1,223.60 " PR I&D PERIRECTAL ABSCESS 46040 987.00 958.53 924.36 752.78 555.43 519.09 937.65 "PR I&D PERIANAL ABSCESS,SUPERFICIAL" 46050 384.00 372.89 371.39 292.85 236.64 221.16 364.80 PR INCISE EXTERNAL HEMORRHOID 46083 337.00 327.43 327.04 257.15 209.31 195.62 320.15 PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS 46230 520.00 505.08 499.88 396.66 310.50 290.19 494.00 PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS 55 46230 520.00 505.08 499.88 396.66 310.50 290.19 494.00 "PR EXCISION THROMBOSED HEMORRHOID, EXTERNAL" 46320 348.00 338.07 335.52 265.50 212.51 198.61 330.60 "PR EXCISION THROMBOSED HEMORRHOID, EXTERNAL" 52 46320 348.00 338.07 335.52 265.50 212.51 198.61 330.60 PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD 46600 175.00 170.12 175.08 133.61 120.65 112.76 166.25 "PR DESTRUCT,ANAL LESN(S),SIMPLE,CHEM" 46900 437.00 424.27 404.42 333.20 242.67 226.80 415.15 "PR CAUTERY ANAL FISSURE,INITIAL" 46940 438.00 425.20 421.69 333.93 264.97 247.63 416.10 "PR LAP,CHOLECYSTECTOMY" 47562 " 1,194.00 " " 1,159.16 " " 1,104.56 " 910.34 634.81 593.28 " 1,134.30 " "PR LAP,CHOLECYSTECTOMY/GRAPH" 47563 " 1,297.00 " " 1,259.59 " " 1,202.07 " 989.21 691.03 645.82 " 1,232.15 " PR ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE 49083 550.00 533.73 515.57 419.16 310.08 289.79 522.50 PR REMOVAL OF OMENTUM 49255 " 1,445.00 " " 1,402.89 " " 1,332.86 " " 1,101.75 " 767.61 717.39 " 1,372.75 " PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS 49451 " 1,324.00 " " 1,285.05 " " 1,217.34 " " 1,009.20 " 713.97 667.26 " 1,257.80 " "PR REPAIR INCISIONAL HERNIA,REDUCIBLE" 49560 " 1,339.00 " " 1,299.79 " " 1,238.69 " " 1,020.78 " 710.55 664.07 " 1,272.05 " "PR REPAIR INCISIONAL HERNIA,REDUCIBLE" 55 49560 " 1,339.00 " " 1,299.79 " " 1,238.69 " " 1,020.78 " 710.55 664.07 " 1,272.05 " "PR REPAIR EPIGASTRIC HERNIA,REDUC" 49570 758.00 736.08 700.43 578.07 405.82 379.27 720.10 "PR REPAIR UMBILICAL HERN,5+Y/O,REDUC" 49585 808.00 784.65 748.84 616.22 432.62 404.32 767.60 PR FRAGMENT KIDNEY STONE/ ESWL 50590 " 1,372.00 " " 1,331.94 " " 1,275.46 " " 1,046.03 " 748.70 699.71 " 1,303.40 " "PR INSERT,NON-INDWELLING BLADDER CATHETER" 51701 83.00 80.62 76.09 63.32 45.64 42.65 78.85 "PR INSERT,TEMP INDWELLING BLAD CATH,SIMPLE" 51702 115.00 111.31 104.40 87.42 63.86 59.68 109.25 "PR INSERT,TEMP INDWELLING BLAD CATH,COMP" 51703 247.00 239.36 238.95 187.98 148.92 139.18 234.65 "PR CHANGE OF BLADDER TUBE,SIMPLE" 51705 174.00 168.75 162.62 132.53 97.28 90.92 165.30 "PR CHANGE OF BLADDER TUBE,COMPLICATED" 51710 240.00 233.38 226.94 183.29 136.47 127.54 228.00 "PR MEAS,POST-VOID RES,US,NON-IMAGING" 51798 23.00 22.14 16.91 17.39 9.92 9.27 21.85 "PR ANTER VESICOURETHROPEXY,SIMPLE" 51840 " 1,261.00 " " 1,224.31 " " 1,183.09 " 961.50 689.51 644.39 " 1,197.95 " "PR ANTER VESICOURETHROPEXY,SIMPLE" 55 51840 " 1,261.00 " " 1,224.31 " " 1,183.09 " 961.50 689.51 644.39 " 1,197.95 " "PR LAP,SLING OPERATION" 51992 " 1,571.00 " " 1,525.00 " " 1,451.72 " " 1,197.65 " 829.22 774.97 " 1,492.45 " "PR LAP,SLING OPERATION" 55 51992 " 1,571.00 " " 1,525.00 " " 1,451.72 " " 1,197.65 " 829.22 774.97 " 1,492.45 " PR CYSTOURETHROSCOPY 52000 350.00 340.17 359.30 267.15 235.24 219.85 332.50 PR CYSTOURETHROSCOPY W/IRRIG & EVAC CLOTS 52001 740.00 718.33 716.68 564.14 437.21 408.61 703.00 "PR CYSTOURETHROSCOPY,BIOPSY" 52204 702.00 681.77 658.00 535.43 397.65 371.64 666.90 "PR CYSTOURETHROSCOPY,FULGUR <0.5 CM LESN" 52224 " 1,356.00 " " 1,316.33 " " 1,302.70 " " 1,033.77 " 813.25 760.05 " 1,288.20 " "PR CYSTOURETHROSCOPY,FULGUR 0.5-2 CM LESN" 52234 467.00 453.84 428.34 356.42 243.59 227.65 443.65 "PR CYSTOURETHROSCOPY,FULGUR 2-5 CM LESN" 52235 548.00 531.67 502.94 417.54 285.68 266.99 520.60 "PR CYSTOURETHROSCOPY,FULGUR >5 CM LESN" 52240 745.00 723.37 684.41 568.10 388.59 363.17 707.75 "PR CYSTOSCOPY,DIR VIS INT URETHROTOMY" 52276 502.00 487.70 461.12 383.01 262.00 244.85 476.90 "PR CYSTOSCOPY,DIL URETHRAL STRICTURE" 52281 555.00 538.72 550.06 423.08 335.67 313.71 527.25 PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER 52287 628.00 609.63 616.12 478.77 388.00 362.62 596.60 "PR CYSTOSCOPY,REMV CALCULUS,SIMPLE" 52310 500.00 485.45 496.68 381.24 312.91 292.44 475.00 "PR CYSTOSCOPY,INSERT URETERAL STENT" 52332 877.00 851.94 776.76 669.06 445.15 416.03 833.15 "PR CYSTO/URETERO/PYELOSCOPY, DX" 52351 575.00 558.04 527.84 438.26 299.80 280.18 546.25 PR CYSTO/URETERO/PYELOSCOPY W/LITHOTRIPSY 52353 745.00 723.37 684.41 568.10 388.59 363.17 707.75 PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT 52356 791.00 768.11 725.73 603.23 412.27 385.30 751.45 "PR DESTR PENIS LESN,SIMPL,CHEMICAL" 54050 246.00 239.09 230.99 187.77 140.59 131.39 233.70 "PR DESTR PENIS LESN,SIMPL,CRYOSURG" 54056 261.00 253.09 240.95 198.77 143.21 133.84 247.95 "PR DESTR PENIS LESN,SIMPL,SURG EXCIS" 54060 344.00 334.25 322.49 262.50 194.93 182.18 326.80 "PR BX,PENIS (SEPARATE PROCEDURE)" 54100 366.00 354.88 342.00 278.70 205.16 191.74 347.70 PR REMV FOR.BODY DEEP PENILE TISS 54115 857.00 831.63 789.70 653.12 455.92 426.10 814.15 "PR CIRCUMCISION,CLAMP" 54150 288.00 279.26 263.68 219.32 152.45 142.48 273.60 "PR CIRCUMCISION,OTHR" 54161 373.00 362.14 342.78 284.40 196.54 183.68 354.35 "PR LYSIS/EXCIS,PENILE POSTCIRCUM ADHESIONS" 54162 484.00 469.86 444.88 369.00 261.63 244.51 459.80 "PR DRAINAGE OF HYDROCELE,TUNICA" 55000 217.00 211.15 203.48 165.83 120.31 112.44 206.15 "PR REMOVAL OF HYDROCELE,TUNICA,UNILAT" 55040 638.00 619.68 586.35 486.66 337.76 315.66 606.10 PR REMOVAL OF SPERM DUCT(S) 55250 693.00 673.12 620.11 528.63 355.03 331.80 658.35 "PR BIOPSY OF PROSTATE,NEEDLE/PUNCH" 55700 464.00 450.47 426.63 353.78 250.72 234.32 440.80 "PR BIOPSY OF PROSTATE,INCISIONAL" 55705 504.00 489.27 463.50 384.24 264.91 247.58 478.80 "PR PLACE RADIOTHER DEVICE/MARKER, PROSTATE" 55876 265.00 257.07 251.25 201.89 150.15 140.33 251.75 PR I&D OF VULVA/PERINEUM ABSCESS 56405 211.00 205.06 218.44 161.04 140.54 131.34 200.45 PR I&D BARTHOLIN GLAND ABSCESS 56420 251.00 243.37 265.12 191.13 174.95 163.50 238.45 PR MARSUP BARTHOLIN GLAND CYST 56440 336.00 325.83 311.22 255.89 179.31 167.58 319.20 "PR DESTRUCTION,LESION(S),VULVA,SIMPLE" 56501 266.00 258.46 279.50 202.98 182.71 170.76 252.70 "PR DESTRUCTION,LESION(S),VULVA;EXTENSIVE" 56515 436.00 422.91 431.36 332.13 268.62 251.05 414.20 "PR BIOPSY VULVA/PERINEUM,ONE LESN" 56605 158.00 153.32 154.34 120.41 94.34 88.17 150.10 "PR BX,VULVA/PERINEUM,ADDL LESION" 56606 70.00 68.42 65.83 53.73 38.27 35.77 66.50 PR EXCIS BARTHOLIN GLAND/CYST 56740 560.00 544.16 528.95 427.35 310.41 290.10 532.00 "PR REPAIR OF PERINEUM,NON OBSTETRICAL" 56810 488.00 474.16 460.01 372.38 267.57 250.07 463.60 PR EXPLOR VAGINA/DRAIN PELVIC ABSCESS 57010 813.00 789.00 769.66 619.47 451.48 421.94 772.35 "PR I&D VAGINAL HEMATOMA,OBSTET/POSTPART" 57022 318.00 308.29 302.56 242.12 178.67 166.98 302.10 "PR DESTRUCT,VAGINAL LESION(S),SIMPLE" 57061 228.00 221.62 240.86 174.05 158.52 148.15 216.60 "PR BIOPSY OF VAGINA,SIMPLE" 57100 170.00 165.06 164.49 129.63 100.71 94.12 161.50 PR FIT/INSERT INTRAVAG SUPPORT DEVICE 57160 117.00 113.57 116.95 89.19 72.09 67.37 111.15 PR TREAT VAGINAL BLEEDING 57180 284.00 276.09 295.70 216.83 192.55 179.95 269.80 PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO 57240 " 1,112.00 " " 1,079.23 " " 1,044.32 " 847.56 607.47 567.73 " 1,056.40 " PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO 55 57240 " 1,112.00 " " 1,079.23 " " 1,044.32 " 847.56 607.47 567.73 " 1,056.40 " "PR POST COLPORRHAPHY,RECTUM/VAGINA" 57250 " 1,114.00 " " 1,081.33 " " 1,047.97 " 849.21 609.35 569.49 " 1,058.30 " "PR POST COLPORRHAPHY,RECTUM/VAGINA" 55 57250 " 1,114.00 " " 1,081.33 " " 1,047.97 " 849.21 609.35 569.49 " 1,058.30 " PR CMBND ANTERPOST COLPORRAPHY W/CYSTO 57260 " 1,423.00 " " 1,381.96 " " 1,335.37 " " 1,085.31 " 772.26 721.74 " 1,351.85 " PR CMBND ANTERPOST COLPORRAPHY W/CYSTO 55 57260 " 1,423.00 " " 1,381.96 " " 1,335.37 " " 1,085.31 " 772.26 721.74 " 1,351.85 " PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR 57265 " 1,597.00 " " 1,550.67 " " 1,496.75 " " 1,217.81 " 864.47 807.92 " 1,517.15 " PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR 55 57265 " 1,597.00 " " 1,550.67 " " 1,496.75 " " 1,217.81 " 864.47 807.92 " 1,517.15 " PR PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPROACH 57284 " 1,527.00 " " 1,482.33 " " 1,428.83 " " 1,164.14 " 827.27 773.15 " 1,450.65 " PR PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPROACH 55 57284 " 1,527.00 " " 1,482.33 " " 1,428.83 " " 1,164.14 " 827.27 773.15 " 1,450.65 " PR SLING OPER STRES INCONTINENCE 57288 " 1,350.00 " " 1,311.16 " " 1,267.52 " " 1,029.71 " 736.89 688.68 " 1,282.50 " PR SLING OPER STRES INCONTINENCE 55 57288 " 1,350.00 " " 1,311.16 " " 1,267.52 " " 1,029.71 " 736.89 688.68 " 1,282.50 " PR PELVIC EXAMINATION W ANESTH 57410 197.00 191.71 182.55 150.56 104.23 97.41 187.15 "PR COLPOSCOPY,ENTIRE VAGINA" 57420 222.00 215.43 214.31 169.19 128.71 120.29 210.90 "PR COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S)" 57421 298.00 289.58 288.80 227.42 173.61 162.25 283.10 "PR COLPOSCOPY,CERVIX W/ADJ VAGINA" 57452 210.00 204.31 204.99 160.46 123.79 115.69 199.50 "PR COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG" 57454 291.00 282.18 279.79 221.61 166.51 155.62 276.45 "PR COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX" 57455 273.00 265.22 264.12 208.29 158.72 148.34 259.35 "PR COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG" 57456 257.00 249.52 248.41 195.96 149.16 139.40 244.15 "PR BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION" 57500 247.00 239.36 244.68 187.98 153.34 143.31 234.65 PR ENDOCERVICAL CURETTAGE 57505 207.00 200.66 219.95 157.59 146.11 136.55 196.65 PR CRYOCAUTERY OF CERVIX 57511 289.00 280.20 297.32 220.05 190.79 178.30 274.55 PR BIOPSY OF UTERUS LINING 58100 172.00 166.74 166.53 130.95 101.17 94.55 163.40 PR ENDOMET BIOPSY DONE W/COLPOSCOPY 58110 94.00 90.90 86.80 71.39 49.89 46.63 89.30 "PR DILATION/CURETTAGE,DIAGNOSTIC" 58120 497.00 482.08 480.64 378.60 292.01 272.91 472.15 PR TOTAL ABDOM HYSTERECTOMY 58150 " 1,872.00 " " 1,817.58 " " 1,736.12 " " 1,427.42 " 999.58 934.19 " 1,778.40 " PR TOTAL ABDOM HYSTERECTOMY 55 58150 " 1,872.00 " " 1,817.58 " " 1,736.12 " " 1,427.42 " 999.58 934.19 " 1,778.40 " PR TOTAL ABD HYSTERECTOMY+BLAD REPR 58152 " 2,312.00 " " 2,244.96 " " 2,154.66 " " 1,763.06 " " 1,228.57 " " 1,148.20 " " 2,196.40 " PR TOTAL ABD HYSTERECTOMY+BLAD REPR 55 58152 " 2,312.00 " " 2,244.96 " " 2,154.66 " " 1,763.06 " " 1,228.57 " " 1,148.20 " " 2,196.40 " PR SUPRACERV ABD HYSTERECTOMY 58180 " 1,777.00 " " 1,725.63 " " 1,653.09 " " 1,355.21 " 949.22 887.12 " 1,688.15 " PR SUPRACERV ABD HYSTERECTOMY 55 58180 " 1,777.00 " " 1,725.63 " " 1,653.09 " " 1,355.21 " 949.22 887.12 " 1,688.15 " PR RADICAL ABD HYSTEREC+PELV NODES 58210 " 3,375.00 " " 3,276.49 " " 3,107.32 " " 2,573.16 " " 1,794.12 " " 1,676.76 " " 3,206.25 " PR RADICAL ABD HYSTEREC+PELV NODES 55 58210 " 3,375.00 " " 3,276.49 " " 3,107.32 " " 2,573.16 " " 1,794.12 " " 1,676.76 " " 3,206.25 " "PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/<" 58260 " 1,534.00 " " 1,489.57 " " 1,438.13 " " 1,169.82 " 831.53 777.13 " 1,457.30 " "PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/<" 55 58260 " 1,534.00 " " 1,489.57 " " 1,438.13 " " 1,169.82 " 831.53 777.13 " 1,457.30 " "PR VAG HYST,RMV TUBE/OVARY" 58262 " 1,706.00 " " 1,656.22 " " 1,596.63 " " 1,300.70 " 919.28 859.15 " 1,620.70 " "PR VAG HYST,RMV TUBE/OVARY" 55 58262 " 1,706.00 " " 1,656.22 " " 1,596.63 " " 1,300.70 " 919.28 859.15 " 1,620.70 " "PR VAG HYST,UTERUS >250 GMS" 58290 " 2,129.00 " " 2,066.94 " " 1,986.91 " " 1,623.26 " " 1,142.35 " " 1,067.62 " " 2,022.55 " PR INSERT INTRAUTERINE DEVICE 58300 148.00 143.21 157.54 112.59 N/A 97.76 140.60 PR REMOVE INTRAUTERINE DEVICE 58301 176.00 170.89 173.45 134.21 107.48 100.45 167.20 "PR LAP, SUPRACERVIAL HYSTERECTOMY, <250G" 58541 " 1,333.00 " " 1,294.22 " " 1,253.65 " " 1,016.40 " 725.52 678.06 " 1,266.35 " "PR LAP, SUPRACERVIAL HYSTERECTOMY, <250G" 55 58541 " 1,333.00 " " 1,294.22 " " 1,253.65 " " 1,016.40 " 725.52 678.06 " 1,266.35 " "PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G" 58542 " 1,522.00 " " 1,477.33 " " 1,425.72 " " 1,160.21 " 824.26 770.34 " 1,445.90 " "PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G" 55 58542 " 1,522.00 " " 1,477.33 " " 1,425.72 " " 1,160.21 " 824.26 770.34 " 1,445.90 " "PR LAP,VAG HYST,UTERUS 250GMS/<" 58550 " 1,628.00 " " 1,580.77 " " 1,519.75 " " 1,241.45 " 874.07 816.89 " 1,546.60 " "PR LAP,VAG HYST,UTERUS 250GMS/<" 55 58550 " 1,628.00 " " 1,580.77 " " 1,519.75 " " 1,241.45 " 874.07 816.89 " 1,546.60 " "PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH" 58552 " 1,820.00 " " 1,767.27 " " 1,693.06 " " 1,387.91 " 972.00 908.41 " 1,729.00 " "PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH" 55 58552 " 1,820.00 " " 1,767.27 " " 1,693.06 " " 1,387.91 " 972.00 908.41 " 1,729.00 " "PR HYSTEROSCOPY,W/ENDO BX" 58558 " 2,513.00 " " 2,439.85 " " 2,363.31 " " 1,916.12 " " 1,451.32 " " 1,356.37 " " 2,387.35 " "PR HYSTEROSCOPY,RMV FB" 58562 676.00 656.45 673.44 515.54 428.54 400.50 642.20 PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY 58571 " 1,654.00 " " 1,606.18 " " 1,540.28 " " 1,261.40 " 893.99 835.50 " 1,571.30 " "PR LIGATE FALLOPIAN TUBE,POSTPARTUM" 58605 611.00 593.53 573.68 466.13 333.49 311.67 580.45 "PR LIGATION,FALLOPIAN TUBE W/C-SECTION" 58611 142.00 137.98 132.44 108.36 75.14 70.22 134.90 "PR LAP,LYSIS OF ADHESIONS" 58660 " 1,245.00 " " 1,208.29 " " 1,160.30 " 948.92 668.51 624.78 " 1,182.75 " "PR LAP,LYSIS OF ADHESIONS" 55 58660 " 1,245.00 " " 1,208.29 " " 1,160.30 " 948.92 668.51 624.78 " 1,182.75 " "PR LAP,RMV ADNEXAL STRUCTURE" 58661 " 1,201.00 " " 1,165.86 " " 1,119.17 " 915.60 644.49 602.33 " 1,140.95 " "PR LAP,RMV ADNEXAL STRUCTURE" 55 58661 " 1,201.00 " " 1,165.86 " " 1,119.17 " 915.60 644.49 602.33 " 1,140.95 " "PR LAP,FULGURATE/EXCISE LESIONS" 58662 " 1,311.00 " " 1,272.98 " " 1,222.99 " 999.72 703.72 657.69 " 1,245.45 " "PR LAP,FULGURATE/EXCISE LESIONS" 55 58662 " 1,311.00 " " 1,272.98 " " 1,222.99 " 999.72 703.72 657.69 " 1,245.45 " "PR LAP,TUBAL CAUTERY" 58670 676.00 655.97 634.98 515.16 368.23 344.14 642.20 PR REMOVAL OF OVARY/TUBE(S) 58720 " 1,366.00 " " 1,326.06 " " 1,277.51 " " 1,041.41 " 743.77 695.12 " 1,297.70 " PR REMOVAL OF OVARY/TUBE(S) 55 58720 " 1,366.00 " " 1,326.06 " " 1,277.51 " " 1,041.41 " 743.77 695.12 " 1,297.70 " PR LYSIS ADNEXAL ADHESIONS 58740 " 1,642.00 " " 1,593.91 " " 1,531.93 " " 1,251.77 " 885.66 827.72 " 1,559.90 " PR LYSIS ADNEXAL ADHESIONS 55 58740 " 1,642.00 " " 1,593.91 " " 1,531.93 " " 1,251.77 " 885.66 827.72 " 1,559.90 " PR REMOVAL OF OVARIAN CYST(S) 58925 " 1,383.00 " " 1,343.02 " " 1,296.55 " " 1,054.73 " 753.04 703.78 " 1,313.85 " PR REMOVAL OF OVARIAN CYST(S) 55 58925 " 1,383.00 " " 1,343.02 " " 1,296.55 " " 1,054.73 " 753.04 703.78 " 1,313.85 " PR REMOVAL OF OVARY(S) 58940 979.00 950.86 922.50 746.75 543.21 507.67 930.05 PR REMOVAL OF OVARY(S) 55 58940 979.00 950.86 922.50 746.75 543.21 507.67 930.05 PR FETAL NON-STRESS TEST 59025 86.00 83.81 31.23 65.82 47.12 N/A 81.70 PR FETAL MONITOR/INTERPRET ONLY 59051 75.00 72.64 69.14 57.05 38.96 47.05 71.25 PR D&C AFTER DELIVERY 59160 389.00 377.57 398.94 296.52 255.31 238.61 369.55 PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING 59300 362.00 351.10 355.03 275.73 218.83 204.51 343.90 "PR FULL ROUT OBSTE CARE,VAGINAL DELIV" 59400 " 3,782.00 " " 3,671.99 " " 3,528.43 " " 2,883.77 " " 2,274.34 " " 2,125.55 " " 3,592.90 " "PR OBSTETRICAL CARE,VAG DELIV ONLY" 59409 " 1,457.00 " " 1,414.36 " " 1,341.74 " " 1,110.75 " 760.32 907.93 " 1,384.15 " "PR OBSTE CARE,VAG DELIV+POSTPARTUM" 59410 " 1,867.00 " " 1,812.99 " " 1,728.93 " " 1,423.82 " " 1,004.34 " " 1,080.87 " " 1,773.65 " PR ANTEPARTUM HEAD MANIPULATION 59412 183.00 177.86 169.41 139.68 96.11 107.82 173.85 PR DELIVER PLACENTA 59414 164.00 158.85 150.17 124.76 85.08 100.87 155.80 "PR ANTEPARTUM CARE ONLY, 4-6 VISITS" 59425 829.00 805.18 778.94 632.34 533.18 498.30 787.55 "PR ANTEPARTUM CARE ONLY, >7 VISITS" 59426 " 1,483.00 " " 1,440.14 " " 1,389.48 " " 1,131.00 " 976.60 912.71 " 1,408.85 " PR CARE AFTER DELIVERY ONLY 59430 352.00 341.79 344.87 268.43 249.03 232.74 334.40 "PR FULL ROUT OBSTE CARE,CESAREAN DELIV" 59510 " 4,168.00 " " 4,046.81 " " 3,883.02 " " 3,178.13 " " 2,490.02 " " 2,327.12 " " 3,959.60 " PR CESAREAN DELIVERY ONLY 59514 " 1,634.00 " " 1,586.64 " " 1,505.49 " " 1,246.05 " 852.45 " 1,253.81 " " 1,552.30 " PR CESAREAN DELIVERY+POSTPARTUM CARE 59515 " 2,257.00 " " 2,191.00 " " 2,088.45 " " 1,720.68 " " 1,225.12 " " 1,513.22 " " 2,144.15 " "PR ROUT OB CARE,VAG DELIV,PREV C-SEC" 59610 " 3,953.00 " " 3,837.46 " " 3,679.26 " " 3,013.71 " " 2,354.43 " " 2,200.40 " " 3,755.35 " PR SURG RX INCOMPLETE ABORTN 59812 585.00 568.40 566.38 446.39 342.51 393.14 555.75 "PR SURG RX MISSED ABORTN,1ST TRI" 59820 704.00 683.93 682.25 537.12 414.26 442.22 668.80 "PR SURG RX MISSED ABORTN,2ND TRI" 59821 704.00 683.25 677.62 536.58 408.37 491.41 668.80 PR SURG RX SEPTIC ABORTN 59830 794.00 771.24 747.60 605.69 437.79 409.16 754.30 PR REMOVE CERCLAGE SUTURE 59871 238.00 231.09 218.53 181.32 124.37 116.23 226.10 PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE 62270 273.00 265.49 237.67 208.50 131.71 123.09 259.35 PR THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF 62272 355.00 345.04 307.82 270.98 174.19 162.79 337.25 PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH 64400 247.00 239.72 179.11 188.27 111.03 103.76 234.65 "PR INJECT NERV BLCK,FACIAL NERV" 64402 270.00 261.80 N/A 205.61 N/A N/A 256.50 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE 64405 151.00 146.13 120.48 114.77 72.19 67.48 143.45 PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH 64450 143.00 138.97 130.91 109.14 77.95 72.85 135.85 PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES 64455 90.00 87.38 84.39 68.63 49.46 46.22 85.50 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE 64615 262.00 254.07 244.92 199.53 144.76 135.29 248.90 "PR REMV F.B.,EYE,SUPERF CONJUNC" 65205 86.00 83.87 65.39 65.87 29.83 27.88 81.70 "PR REMV F.B.,EYE,EMBED CONJUNC" 65210 105.00 102.38 80.03 80.40 39.74 37.14 99.75 "PR REMV F.B.,EYE,CORNEA,NO SLIT" 65220 110.00 106.79 102.01 83.87 60.18 56.24 104.50 "PR REMV F.B.,EYE,CORNEA,SLIT LAMP" 65222 128.00 124.05 118.17 97.43 68.75 64.26 121.60 PR REPAIR CONJUNC LACERATN 65270 509.00 494.35 480.32 388.23 290.75 271.72 483.55 PR CURETTE/TREAT CORNEA 65435 153.00 148.58 141.29 116.69 82.68 77.26 145.35 PR DRAINAGE OF EYELID ABSCESS 67700 509.00 494.04 476.68 387.99 295.63 276.28 483.55 "PR EXCIS CHALAZION,MULT,SAME LID" 67801 306.00 296.78 281.26 233.07 163.82 153.10 290.70 "PR REMOVE EYELID FOREIGN BODY,EMBEDDED" 67938 469.00 455.27 443.95 357.54 280.47 262.11 445.55 PR INCISE/DRAIN CONJUNCTIVA 68020 227.00 220.20 208.35 172.94 122.03 114.05 215.65 PR EXPRESS CONJUNC FOLLICLES 68040 118.00 114.73 109.27 90.11 62.94 58.82 112.10 PR BIOPSY OF TEAR GLAND 68510 843.00 818.11 781.69 642.50 467.74 437.14 800.85 "PR DRAIN EXT EAR ABSC/BLOOD,SIMPLE" 69000 343.00 332.91 318.25 261.45 188.79 176.44 325.85 "PR DRAIN EXT EAR ABSC/BLOOD,COMPLIC" 69005 396.00 384.33 369.02 301.83 219.65 205.28 376.20 PR BIOPSY OF EXTERNAL EAR 69100 181.00 175.30 167.68 137.67 99.17 92.69 171.95 PR REMV EXT CANAL FOREIGN BODY 69200 150.00 146.02 137.96 114.68 80.90 75.61 142.50 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT 69209 25.00 24.64 23.46 19.35 14.67 13.70 23.75 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 69210 87.00 84.86 81.12 66.65 46.95 43.88 82.65 "PR CREATE EARDRUM OPENING,LOCAL ANESTH" 69433 366.00 355.53 335.79 279.21 201.15 187.99 347.70 CHG US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG 76882 104.00 101.26 49.01 80.79 56.87 N/A 98.80 CHG SONO GUIDE NEEDLE BIOPSY 76942 105.00 101.75 48.18 81.18 58.34 N/A 99.75 "CHG METABOLIC PANEL,COMPREHENSIVE" 80053 18.00 17.84 19.22 7.04 N/A 8.73 17.10 CHG LIPID PANEL 80061 23.00 22.62 24.37 8.93 N/A 11.07 21.85 "CHG URINALYSIS, AUTO, W/SCOPE" 81001 6.00 5.35 5.77 3.52 N/A 2.62 5.70 "CHG URINALYSIS, AUTO, W/O SCOPE" 81003 4.00 3.78 4.10 2.49 N/A 1.86 3.80 CHG URINE PREGNANCY TEST 81025 13.00 13.09 15.67 8.61 N/A 7.12 12.35 CHG URINE ALBUMIN SEMIQUANTITATIVE 82044 10.00 9.47 11.34 6.23 N/A 5.15 9.50 "CHG BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN" 82270 7.00 6.66 7.97 4.38 N/A 3.62 6.65 CHG GLUCOSE BLOOD TEST WITH DEVICE 82962 5.00 4.99 5.97 3.28 N/A 2.71 4.75 "CHG PROSTATE SPECIFIC ANTIGEN,TOTAL" 84153 32.00 31.07 33.47 12.26 N/A 15.20 30.40 CHG ASSAY THYROID STIM HORMONE 84443 29.00 28.38 30.58 11.20 N/A 13.89 27.55 "CHG MICROHEMATOCRIT,SPUN" 85013 11.00 10.64 12.74 7.00 N/A 5.79 10.45 CHG HEMOGLOBIN 85018 4.00 4.00 4.31 2.63 N/A 1.96 3.80 CHG COMPLETE CBC & AUTO DIFF WBC 85025 14.00 13.12 14.14 5.18 N/A 6.42 13.30 CHG PROTHROMBIN TIME 85610 7.00 6.64 7.81 4.37 N/A 3.55 6.65 CHG TB INTRADERMAL TEST 86580 12.00 11.64 15.11 7.66 9.58 8.95 11.40 "CHG SMEAR,STAIN,WET MNT,INTERP" 87210 9.00 8.85 10.59 5.82 N/A 4.81 8.55 CHG TISSUE EXAM BY KOH 87220 7.00 7.22 7.77 4.75 N/A 3.53 6.65 "CHG DETECT AGENT,IMMUN,DIR OBS,INFLUENZA" 87804 26.00 25.16 30.12 16.55 N/A 13.68 24.70 CHG STREP A ASSAY W/OPTIC 87880 26.00 25.13 30.08 16.53 N/A 13.67 24.70 "PR RH IG, FULL-DOSE, IM" 90384 158.00 N/A 142.11 75.52 N/A N/A 150.10 "PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID" 90460 31.00 30.08 24.48 15.75 16.95 15.84 29.45 "PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID" 90461 24.00 23.07 21.97 12.08 12.81 11.97 22.80 "PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID" 90471 15.00 30.08 24.48 15.75 16.95 15.84 14.25 "PR IMMUNIZ,ADMIN,EACH ADDL" 90472 10.00 23.07 21.97 12.08 12.81 11.97 9.50 "PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX" 90473 31.00 30.08 24.48 15.75 16.95 15.84 29.45 "PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ADDL" 90474 24.00 23.07 21.97 12.08 12.81 11.97 22.80 PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM 90620 179.00 N/A - 170.75 N/A N/A 170.05 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE 90632 85.00 N/A N/A 68.00 N/A N/A 80.75 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE 90633 61.00 N/A 40.60 32.78 N/A N/A 57.95 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE SL 90633 19.82 N/A 40.60 32.78 N/A N/A 18.83 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE 90647 42.00 N/A 34.63 26.23 N/A N/A 39.90 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE 90648 32.00 N/A 32.23 13.68 N/A N/A 30.40 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE SL 90648 19.82 N/A 32.23 13.68 N/A N/A 18.83 PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE 90649 203.00 N/A Not Reimbursed 164.98 N/A N/A 192.85 PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE SL 90649 19.82 N/A Not Reimbursed 164.98 N/A N/A 18.83 PR 9VHPV VACC 2/3 DOSE SCHED IM USE 90651 216.46 N/A Not Reimbursed 217.11 N/A N/A 205.64 PR 9VHPV VACC 2/3 DOSE SCHED IM USE SL 90651 19.82 N/A Not Reimbursed 217.11 N/A N/A 18.83 PR INFLUENZA VACC IIV3 SPLIT VIRUS PRSRV FREE ID 90654 35.00 N/A - 19.91 N/A N/A 33.25 PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE 90657 15.00 N/A 18.51 6.34 N/A N/A 14.25 PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE SL 90658 19.82 N/A 18.51 18.24 N/A N/A 18.83 PR CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE 90661 30.00 N/A - 23.46 N/A N/A 28.50 PR CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE SL 90661 24.56 N/A - 23.46 N/A N/A 23.33 PR IIV VACCINE PRESERV FREE INCREASED AG COUNT IM 90662 50.86 N/A N/A 56.04 N/A N/A 48.32 PR PCV13 VACCINE FOR INTRAMUSCULAR USE 90670 159.00 N/A N/A 189.03 N/A N/A 151.05 PR PCV13 VACCINE FOR INTRAMUSCULAR USE SL 90670 19.82 N/A N/A 189.03 N/A N/A 18.83 PR LAIV4 VACCINE FOR INTRANASAL USE 90672 35.00 N/A N/A 23.70 N/A N/A 33.25 PR LAIV4 VACCINE FOR INTRANASAL USE SL 90672 19.82 N/A N/A 23.70 N/A N/A 18.83 PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE 90674 30.00 N/A N/A 24.80 N/A N/A 28.50 "PR RABIES VACCINE, IM" 90675 290.00 N/A N/A 283.76 N/A N/A 275.50 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE 90680 153.00 N/A 91.35 82.89 N/A N/A 145.35 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE SL 90680 19.82 N/A 91.35 82.89 N/A N/A 18.83 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE 90685 21.56 N/A N/A 18.14 N/A N/A 20.48 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE SL 90685 19.82 N/A N/A 18.14 N/A N/A 18.83 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE 90686 20.66 N/A N/A 17.91 N/A N/A 19.63 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE SL 90686 20.66 N/A N/A 17.91 N/A N/A 19.63 PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE 90687 25.00 N/A N/A 8.47 N/A N/A 23.75 PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE 90688 25.00 N/A N/A 16.44 N/A N/A 23.75 "PR TYPHOID VACCINE, IM" 90691 90.00 N/A N/A 93.05 N/A N/A 85.50 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE 90696 92.00 N/A - 52.46 N/A N/A 87.40 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE SL 90696 19.82 N/A - 52.46 N/A N/A 18.83 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE 90698 102.00 N/A 91.35 96.14 N/A N/A 96.90 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE SL 90698 19.82 N/A 91.35 96.14 N/A N/A 18.83 "PR DTAP IMMUNIZATION, IM, <7 YO" 90700 31.00 N/A 30.45 26.75 N/A N/A 29.45 "PR DTAP IMMUNIZATION, IM, <7 YO" SL 90700 19.82 N/A 30.45 26.75 N/A N/A 18.83 "PR MMR VIRUS IMMUNIZATION, SUBCUT" 90707 86.00 N/A 60.90 75.04 N/A N/A 81.70 "PR MMR VIRUS IMMUNIZATION, SUBCUT" SL 90707 19.82 N/A 60.90 75.04 N/A N/A 18.83 "PR COMBINED VACCINE,MMR+VARICELLA,SUB-Q" 90710 277.00 N/A 162.40 214.37 N/A N/A 263.15 "PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q" 90713 35.00 N/A 34.63 33.53 N/A N/A 33.25 "PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q" SL 90713 19.82 N/A 34.63 33.53 N/A N/A 18.83 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE 90714 35.00 N/A N/A 30.93 N/A N/A 33.25 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE SL 90714 19.82 N/A N/A 30.93 N/A N/A 18.83 "PR TDAP VACCINE >7 YO, IM" 90715 61.00 N/A N/A 43.35 N/A N/A 57.95 "PR TDAP VACCINE >7 YO, IM" SL 90715 19.82 N/A N/A 43.35 N/A N/A 18.83 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE 90716 149.00 N/A 89.56 129.30 N/A N/A 141.55 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE SL 90716 19.82 N/A 89.56 129.30 N/A N/A 18.83 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR 90723 75.00 N/A 89.56 79.15 N/A N/A 71.25 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR SL 90723 19.82 N/A 89.56 79.15 N/A N/A 18.83 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE 90732 82.00 N/A N/A 100.19 N/A N/A 77.90 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE SL 90732 19.82 N/A N/A 100.19 N/A N/A 18.83 PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE 90733 136.00 N/A 121.79 147.65 N/A N/A 129.20 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE 90734 136.00 N/A 115.82 126.53 N/A N/A 129.20 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE SL 90734 19.82 N/A 115.82 126.53 N/A N/A 18.83 PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE 90736 222.00 N/A 194.65 219.05 N/A N/A 210.90 PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT 3 DOSE IM 90740 15.00 N/A N/A 134.12 N/A N/A 14.25 PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM 90743 49.00 N/A 60.90 69.64 N/A N/A 46.55 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM 90744 29.03 N/A N/A 23.87 N/A N/A 27.58 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM SL 90744 19.82 N/A N/A 23.87 N/A N/A 18.83 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE 90746 59.00 N/A N/A 57.25 N/A N/A 56.05 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE SL 90746 19.82 N/A N/A 57.25 N/A N/A 18.83 PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE 90748 107.00 N/A 68.07 50.47 N/A N/A 101.65 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX 90750 173.00 N/A - 140.00 N/A N/A 164.35 PR COVID-19 PFIZER MRNA LNP-S PF 30 MCG/0.3 ML DOSE 91300 - N/A N/A N/A N/A N/A - PR COVID-19 MODERNA MRNA LNP-S PF 100 MCG/0.5 ML DOSE 91301 - N/A N/A N/A N/A N/A - PR NASOPHARYNGOSCOPY 92511 205.00 199.46 191.43 156.65 118.05 110.32 194.75 PR POSITIONAL NYSTAGMUS 92532 34.00 33.41 28.72 26.27 N/A 112.69 32.30 "PR PURE TONE AUDIOMETRY, AIR" 92552 57.00 55.33 52.73 43.46 31.62 29.55 54.15 PR TYMPANOMETRY 92567 29.00 27.77 27.65 21.81 16.71 15.62 27.55 PR HEART/LUNG RESUSCITATION (CPR) 92950 586.00 568.86 554.63 446.75 333.45 311.64 556.70 PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL 92960 298.00 289.19 275.84 227.12 160.40 149.90 283.10 "PR ELECTROCARDIOGRAM, COMPLETE" 93000 31.00 30.31 28.85 23.81 14.66 13.70 29.45 "PR ELECTROCARDIOGRAM, TRACING" 93005 15.00 14.63 13.92 11.49 6.18 5.79 14.25 PR ELECTROCARDIOGRAM REPORT 93010 16.00 15.68 14.92 12.32 8.46 7.91 15.20 PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R 93015 133.00 128.92 122.23 101.25 71.16 66.50 126.35 PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R 93016 43.00 41.43 39.48 32.54 22.41 20.93 40.85 "PR CARDIAC STRESS TST,TRACING ONLY" 93017 62.00 59.73 56.31 46.91 33.74 31.53 58.90 "PR CARDIAC STRESS TST,INTERP/REPT ONLY" 93018 29.00 27.75 26.46 21.80 15.02 14.04 27.55 PR RHYTHM ECG WITH REPORT 93040 23.00 22.67 21.57 17.81 12.55 11.73 21.85 "PR RHYTHM ECG, TRACING" 93041 10.00 9.61 9.14 7.55 5.51 5.15 9.50 "PR RHYTHM ECG, REPORT" 93042 13.00 13.05 12.43 10.25 7.04 6.58 12.35 "PR EXT ECG RECORD CONTIN 48 HR, SCAN ANALYSIS W REPORT" 93226 66.00 64.12 60.48 50.36 40.09 37.47 62.70 "PR ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER" 93307 260.00 252.75 80.68 198.50 144.38 N/A 247.00 PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R 93312 460.00 446.37 196.29 350.55 250.24 N/A 437.00 "PR DUPLEX SCAN EXTRACRANIAL,BILAT" 93880 369.00 358.34 69.76 281.42 199.05 N/A 350.55 PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL 93922 157.00 152.76 21.75 119.97 84.36 N/A 149.15 PR DUPLEX LO EXTREM ART BILAT 93925 469.00 455.02 68.56 357.35 253.04 N/A 445.55 PR DUPLEX LO EXTREM ART UNILAT/LTD 93926 246.00 238.90 42.11 209.76 148.78 N/A 233.70 "PR DUPLEX EXTREM VENOUS,BILAT" 93970 357.00 346.86 60.21 272.40 195.23 N/A 339.15 "PR DUPLEX EXTREM VENOUS,UNI OR LTD" 93971 221.00 214.97 39.06 168.83 122.68 N/A 209.95 "PR DUPLEX ABD/PEL VASC STUDY,COMPLETE" 93975 511.00 495.89 100.52 389.45 276.67 N/A 485.45 "PR DUPLEX LARGE VESSEL(S),COMPLETE" 93978 345.00 334.98 67.92 263.07 187.21 N/A 327.75 PR BREATHING CAPACITY TEST 94010 65.00 62.88 14.95 49.38 29.23 N/A 61.75 PR EVAL OF BRONCHOSPASM 94060 109.00 106.10 23.30 83.33 46.02 N/A 103.55 PR EVAL OF BRONCHOSPASM 26 94060 109.00 106.10 23.30 83.33 46.02 N/A 103.55 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT 94640 32.00 31.53 29.43 24.77 13.65 12.76 30.40 "PR DEMO &/OR EVAL,PT USE,AEROSOL DEVICE" 94664 31.00 29.66 27.65 23.30 16.36 15.29 29.45 PR NONINVASV OXYGEN SATUR;SINGLE 94760 4.00 3.97 3.77 3.12 2.12 1.98 3.80 "PR NONINVASV OXYGEN SATUT,CONTINUOUS" 94762 45.00 44.06 43.77 34.61 26.53 24.80 42.75 "PR IMMUNOTHERAPY, ONE INJECTION" 95115 16.00 15.87 15.11 12.47 8.90 8.32 15.20 "PR IMMUNOTHERAPY, 2+ INJECTIONS" 95117 19.00 18.39 17.49 14.45 10.94 10.22 18.05 PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND 95808 " 1,228.00 " " 1,191.90 " 156.58 936.05 657.85 N/A " 1,166.60 " PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND 95811 " 1,181.00 " " 1,146.95 " 225.55 900.75 641.08 N/A " 1,121.95 " "PR EEG,EXTENDED MONITORING,41-60 MINUTES" 95812 596.00 579.09 102.30 454.79 344.86 N/A 566.20 "PR EEG,W/AWAKE & DROWSY RECORD" 95816 666.00 646.32 102.30 507.59 377.07 N/A 632.70 "PR EMG, NEEDLE, ONE LIMB" 95860 225.00 218.77 92.62 171.81 120.35 N/A 213.75 "PR EMG, NEEDLE, TWO LIMBS" 95861 322.00 312.40 146.80 245.34 174.39 N/A 305.90 "PR SOMATOSENSORY TEST,UPPER LIMBS" 95925 242.00 234.95 49.74 184.52 156.97 N/A 229.90 "PR SOMATOSENSORY TEST,LOWER LIMBS" 95926 234.00 227.44 48.98 178.62 145.26 N/A 222.30 "PR CANALITH REPOSITIONING PROCEDURE, PER DAY" 95992 84.00 81.31 78.24 63.86 44.96 42.02 79.80 "PR GENETIC COUNSELING, EACH 30 MIN" 96040 83.00 80.12 74.95 62.99 N/A 41.52 78.85 PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM 96110 18.00 17.11 16.31 13.46 N/A 8.95 17.10 PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 96116 182.00 176.98 172.17 138.99 98.38 91.93 172.90 PR NEUROPSYCH TESTING BY COMPUTER 96120 87.00 N/A N/A N/A N/A N/A 82.65 PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT 96127 10.00 9.00 7.94 7.07 4.49 4.21 9.50 "PR IV INFUSION, HYDRATION, 31-60 MIN" 96360 69.00 67.27 57.51 52.83 35.34 33.03 65.55 "PR IV INFUSION, HYDRATION, EA ADD HOUR" 96361 25.00 23.95 22.80 18.81 13.62 12.73 23.75 "PR IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR" 96365 130.00 126.19 118.59 99.11 71.25 66.58 123.50 "PR IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR" 96366 40.00 38.93 37.07 30.57 22.06 20.62 38.00 "PR INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT" 96372 31.00 30.08 24.48 23.63 14.23 13.30 29.45 "PR INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG" 96374 71.00 69.20 66.52 54.35 40.80 38.13 67.45 "PR INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG" 96375 31.00 29.64 27.65 23.28 16.70 15.61 29.45 "PR MANUAL THER TECH,1+REGIONS,EA 15 MIN" 97140 53.00 51.74 49.50 27.09 28.10 26.25 50.35 PR DEBRIDEMENT OPEN WOUND 20 SQ CM< 97597 165.00 160.19 165.71 83.87 101.06 94.45 156.75 PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS 97602 74.00 71.53 141.12 37.49 N/A 86.39 70.30 "PR MED NUTR THER, 1ST, INDIV, EA 15 MIN" 97802 70.00 68.24 65.63 53.60 37.93 35.45 66.50 "PR MED NUTR THER, SUBSQ, INDIV, EA 15 MIN" 97803 61.00 58.98 56.78 46.32 32.57 30.44 57.95 "PR OSTEOPATHIC MANIP,1-2 BODY REGN" 98925 59.00 57.38 54.64 45.06 31.77 29.68 56.05 "PR OSTEOPATHIC MANIP,3-4 BODY REGN" 98926 85.00 82.95 79.19 65.15 45.51 42.53 80.75 "PR OSTEOPATHIC MANIP,5-6 BODY REGN" 98927 112.00 109.14 103.98 85.71 59.67 55.77 106.40 "PR OSTEOPATHIC MANIP,7-8 BODY REGN" 98928 137.00 132.84 127.15 104.33 73.07 68.30 130.15 "PR OSTEOPATHIC MANIP,9-10 BODY REGN" 98929 164.00 159.03 151.28 124.89 87.16 81.46 155.80 PR HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB 99000 10.00 9.91 9.43 3.12 N/A N/A 9.50 PR HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB 99001 11.00 10.54 10.03 3.31 N/A N/A 10.45 PR POST-OP FOLLOW-UP VISIT 99024 - N/A - N/A N/A 99.44 - PR MEDICAL SERVICES AFTER HRS 99050 33.00 32.09 30.58 25.23 N/A 81.85 31.35 PR MEDICAL SERVICES AT NIGHT 99052 41.00 N/A N/A N/A N/A N/A 38.95 PR SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP 99070 - N/A - N/A N/A N/A - PR SPECIAL REPORTS OR FORMS 99080 - N/A - N/A N/A 187.00 - PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 99151 138.00 133.85 126.29 105.12 86.57 80.91 131.10 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 99152 94.00 90.94 86.05 71.42 51.54 48.18 89.30 PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS 99153 19.00 18.39 17.49 14.45 10.26 9.59 18.05 PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS 99155 168.00 163.53 147.73 128.43 83.63 78.16 159.60 PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS 99156 149.00 144.42 136.19 113.42 76.91 71.87 141.55 PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS 99157 121.00 117.68 111.80 92.42 63.57 59.41 114.95 PR PHLEBOTOMY 99195 182.00 176.71 167.68 138.78 103.92 97.13 172.90 PR SPECIAL SERVICE/PROC/REPORT 99199 - N/A - N/A N/A N/A - PR OFFICE OUTPATIENT NEW 10 MINUTES 99201 84.00 81.75 77.81 64.20 N/A N/A 79.80 PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES 99202 141.00 137.18 129.60 107.73 72.80 68.04 133.95 PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES 99203 200.00 194.15 184.00 152.48 112.24 104.90 190.00 PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES 99204 305.00 296.51 281.83 232.86 168.25 157.24 289.75 PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES 99205 384.00 373.19 356.61 293.09 222.22 207.67 364.80 PR OFFICE/OUTPATIENT ESTABLISHED MINIMAL PROBLEM(S) 99211 42.00 40.80 39.48 32.04 22.74 21.25 39.90 PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN 99212 83.00 80.89 77.22 63.53 56.41 52.72 78.85 PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN 99213 138.00 134.08 128.46 105.30 91.78 85.79 131.10 PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN 99214 203.00 196.90 187.10 154.64 130.54 122.01 192.85 PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN 99215 272.00 263.79 251.78 207.17 182.32 170.39 258.40 PR OBSERVATION CARE DISCHARGE MANAGEMENT 99217 137.00 133.30 126.31 104.69 72.31 67.58 130.15 PR INITIAL OBSERVATION CARE/DAY 30 MINUTES 99218 187.00 181.39 173.21 142.46 98.17 91.75 177.65 PR INITIAL OBSERVATION CARE/DAY 50 MINUTES 99219 256.00 248.28 236.75 194.99 134.42 125.63 243.20 PR INITIAL OBSERVATION CARE/DAY 70 MINUTES 99220 350.00 339.46 322.16 266.60 182.57 170.62 332.50 PR INITIAL HOSPITAL CARE/DAY 30 MINUTES 99221 189.00 183.30 175.54 143.96 99.88 93.35 179.55 PR INITIAL HOSPITAL CARE/DAY 50 MINUTES 99222 257.00 249.41 238.73 195.87 135.90 127.01 244.15 PR INITIAL HOSPITAL CARE/DAY 70 MINUTES 99223 381.00 369.55 352.37 290.22 200.82 187.68 361.95 PR SBSQ OBSERVATION CARE/DAY 15 MINUTES 99224 75.00 72.43 68.92 56.88 38.98 36.43 71.25 PR SBSQ OBSERVATION CARE/DAY 25 MINUTES 99225 138.00 133.57 126.96 104.90 72.10 67.38 131.10 PR SBSQ OBSERVATION CARE/DAY 35 MINUTES 99226 198.00 191.88 182.69 150.69 103.69 96.91 188.10 PR SBSQ HOSPITAL CARE/DAY 15 MINUTES 99231 74.00 71.80 68.32 56.39 38.65 36.11 70.30 PR SBSQ HOSPITAL CARE/DAY 25 MINUTES 99232 137.00 132.96 126.38 104.42 72.10 67.38 130.15 PR SBSQ HOSPITAL CARE/DAY 35 MINUTES 99233 196.00 190.22 182.09 149.39 103.69 96.91 186.20 PR OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES 99234 250.00 242.61 231.67 190.53 131.32 122.73 237.50 PR OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES 99235 319.00 309.50 294.62 243.06 167.73 156.76 303.05 PR OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES 99236 411.00 398.60 379.25 313.04 215.38 201.29 390.45 "PR HOSPITAL DISCHARGE DAY,<30 MIN" 99238 137.00 133.30 126.91 104.69 72.31 67.58 130.15 "PR HOSPITAL DISCHARGE DAY,>30 MIN" 99239 202.00 196.06 186.70 153.98 106.66 99.68 191.90 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN 99241 89.00 86.18 Not Reimbursed 67.76 N/A 43.66 84.55 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN 99242 168.00 162.71 Not Reimbursed 127.92 N/A 82.51 159.60 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN 99243 230.00 223.03 Not Reimbursed 175.35 N/A 113.09 218.50 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN 99244 344.00 334.23 Not Reimbursed 262.77 N/A 169.52 326.80 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN 99245 420.00 407.96 Not Reimbursed 320.73 N/A 206.88 399.00 PR INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN 99251 93.00 90.09 Not Reimbursed 70.83 N/A 45.77 88.35 PR INITL INPATIENT CONSULT NEW/ESTAB PT 40 MIN 99252 142.00 137.65 Not Reimbursed 108.21 N/A 69.88 134.90 PR INITL INPATIENT CONSULT NEW/ESTAB PT 55 MIN 99253 218.00 211.70 Not Reimbursed 166.44 N/A 107.38 207.10 PR INITL INPATIENT CONSULT NEW/ESTAB PT 80 MIN 99254 317.00 307.55 Not Reimbursed 241.80 N/A 155.90 301.15 PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN 99255 382.00 370.39 Not Reimbursed 291.20 N/A 187.82 362.90 PR EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB 99281 40.00 38.73 39.00 30.42 22.08 20.64 38.00 PR EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY 99282 78.00 75.48 75.26 59.28 42.71 39.93 74.10 PR EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY 99283 116.00 113.03 112.95 88.77 72.33 67.60 110.20 PR EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY 99284 221.00 214.45 206.13 168.42 122.98 114.93 209.95 PR EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNC 99285 325.00 315.59 299.26 247.85 178.54 166.86 308.75 "PR CRITICAL CARE, E/M 30-74 MINUTES" 99291 517.00 501.83 481.37 394.11 280.09 261.76 491.15 "PR CRITICAL CARE, ADDL 30 MIN" 99292 229.00 222.51 213.10 174.75 122.80 114.77 217.55 "PR NURSING FACILITY CARE,LEVEL I" 99301 114.00 N/A N/A N/A N/A N/A 108.30 PR INITIAL NURSING FACILITY CARE/DAY 25 MINUTES 99304 169.00 164.37 157.48 129.09 90.00 84.11 160.55 PR INITIAL NURSING FACILITY CARE/DAY 35 MINUTES 99305 245.00 237.93 226.57 186.86 130.08 121.56 232.75 PR INITIAL NURSING FACILITY CARE/DAY 45 MINUTES 99306 315.00 305.62 291.62 240.02 167.19 156.25 299.25 PR SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN 99307 83.00 80.33 76.49 63.09 44.07 41.19 78.85 PR SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN 99308 129.00 125.45 120.05 98.52 68.84 64.34 122.55 PR SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN 99309 172.00 166.72 158.98 130.94 91.29 85.32 163.40 PR SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN 99310 255.00 247.33 234.94 194.24 135.49 126.64 242.25 "PR NURSING FAC DISCHRGE DAY,1-30 MIN" 99315 138.00 133.93 127.51 105.18 72.98 68.22 131.10 "PR NURSING FAC DISCHRGE DAY,MORE 30 MIN" 99316 199.00 193.14 184.11 151.68 105.30 98.41 189.05 PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN 99318 180.00 175.24 167.46 137.63 96.00 89.72 171.00 "PR REST HOME VISIT,NEW PATIENT,LEVL I" 99321 74.00 N/A N/A N/A N/A N/A 70.30 "PR REST HOME VISIT,NEW PATIENT,LEVL II" 99322 103.00 N/A N/A N/A N/A N/A 97.85 "PR REST HOME VISIT,NEW PATIENT,LEVL III" 99323 87.00 N/A N/A N/A N/A N/A 82.65 PR DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN 99324 104.00 101.12 95.91 79.41 54.76 51.17 98.80 PR DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN 99325 151.00 146.90 139.50 115.37 79.92 74.69 143.45 PR DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES 99326 263.00 254.91 243.17 200.19 140.11 130.94 249.85 PR DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN 99327 352.00 341.55 325.65 268.23 187.21 174.96 334.40 PR DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES 99328 414.00 402.07 384.24 315.77 219.98 205.59 393.30 "PR REST HOME VISIT,ESTAB PAT,LEVEL I" 99331 67.00 N/A N/A N/A N/A N/A 63.65 "PR REST HOME VISIT,ESTAB PAT,LEVEL II" 99332 84.00 N/A N/A N/A N/A N/A 79.80 PR DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES 99334 114.00 110.26 105.40 86.60 60.73 56.76 108.30 PR DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES 99335 179.00 174.04 167.15 136.68 96.28 89.99 170.05 PR DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES 99336 255.00 247.59 236.18 194.45 136.21 127.31 242.25 PR DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES 99337 366.00 355.03 339.45 278.82 195.17 182.40 347.70 "PR DOMICIL/REST-HOME CARE SUPERVISION, <30 MIN" 99339 145.00 140.67 134.50 110.60 N/A 72.00 137.75 "PR DOMICIL/REST-HOME CARE SUPERVISION, =>30 MIN" 99340 203.00 197.51 187.46 155.28 N/A 100.47 192.85 PR HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES 99341 104.00 101.12 95.91 79.41 55.09 51.49 98.80 PR HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES 99342 150.00 145.87 137.72 114.56 78.29 73.17 142.50 PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES 99343 245.00 238.23 226.46 187.10 128.82 120.39 232.75 PR HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES 99344 344.00 333.54 318.55 261.95 182.27 170.36 326.80 PR HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES 99347 104.00 101.06 95.84 79.37 55.40 51.78 98.80 PR HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES 99348 158.00 153.64 147.09 120.66 84.46 78.93 150.10 PR HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES 99349 243.00 235.92 225.26 185.28 129.66 121.18 230.85 PR HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60 MINS 99350 337.00 327.28 312.59 257.03 179.31 167.58 320.15 PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR 99354 245.00 237.79 226.23 186.75 129.66 121.18 232.75 PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN 99355 187.00 181.47 171.99 142.52 96.88 90.54 177.65 "PR PROLONGED SERV,NO CONTACT,1ST HR" 99358 210.00 204.22 195.23 160.38 111.92 104.61 199.50 PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES 99374 130.00 126.59 121.05 99.53 N/A 64.79 123.50 PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/> 99375 196.00 190.60 181.67 149.85 N/A 97.32 186.20 "PR PREVENTIVE VISIT,NEW,INFANT < 1 YR" 99381 208.00 201.47 191.28 158.40 N/A 103.79 197.60 "PR PREVENTIVE VISIT,NEW,INFANT < 1 YR" EP 99381 208.00 201.47 191.28 158.40 N/A 103.79 197.60 "PR PREVENTIVE VISIT,NEW,INFANT < 1 YR" GY 99381 208.00 201.47 191.28 158.40 N/A 103.79 197.60 "PR PREVENTIVE VISIT,NEW,AGE 1-4" 99382 217.00 211.07 200.42 165.95 N/A 108.54 206.15 "PR PREVENTIVE VISIT,NEW,AGE 1-4" EP 99382 217.00 211.07 200.42 165.95 N/A 108.54 206.15 "PR PREVENTIVE VISIT,NEW,AGE 1-4" GY 99382 217.00 211.07 200.42 165.95 N/A 108.54 206.15 "PR PREVENTIVE VISIT,NEW,AGE5-11" 99383 226.00 219.82 208.95 172.82 N/A 112.75 214.70 "PR PREVENTIVE VISIT,NEW,AGE5-11" EP 99383 226.00 219.82 208.95 172.82 N/A 112.75 214.70 "PR PREVENTIVE VISIT,NEW,AGE5-11" GY 99383 226.00 219.82 208.95 172.82 N/A 112.75 214.70 "PR PREVENTIVE VISIT,NEW,12-17" 99384 256.00 248.40 236.38 195.29 N/A 126.86 243.20 "PR PREVENTIVE VISIT,NEW,12-17" EP 99384 256.00 248.40 236.38 195.29 N/A 126.86 243.20 "PR PREVENTIVE VISIT,NEW,12-17" GY 99384 256.00 248.40 236.38 195.29 N/A 126.86 243.20 "PR PREVENTIVE VISIT,NEW,18-39" 99385 247.00 240.16 229.14 188.82 N/A 123.35 234.65 "PR PREVENTIVE VISIT,NEW,18-39" EP 99385 247.00 240.16 229.14 188.82 N/A 123.35 234.65 "PR PREVENTIVE VISIT,NEW,18-39" GY 99385 247.00 240.16 229.14 188.82 N/A 123.35 234.65 "PR PREVENTIVE VISIT,NEW,40-64" 99386 287.00 279.03 265.57 219.38 N/A 142.74 272.65 "PR PREVENTIVE VISIT,NEW,40-64" EP 99386 287.00 279.03 265.57 219.38 N/A 142.74 272.65 "PR PREVENTIVE VISIT,NEW,40-64" GY 99386 287.00 279.03 265.57 219.38 N/A 142.74 272.65 "PR PREVENTIVE VISIT,NEW,65 & OVER" 99387 311.00 302.20 288.03 237.59 N/A 154.54 295.45 "PR PREVENTIVE VISIT,NEW,65 & OVER" EP 99387 311.00 302.20 288.03 237.59 N/A 154.54 295.45 "PR PREVENTIVE VISIT,NEW,65 & OVER" GY 99387 311.00 302.20 288.03 237.59 N/A 154.54 295.45 "PR PREVENTIVE VISIT,EST, INFANT < 1 YR" 99391 187.00 181.68 172.59 142.83 N/A 93.38 177.65 "PR PREVENTIVE VISIT,EST, INFANT < 1 YR" EP 99391 187.00 181.68 172.59 142.83 N/A 93.38 177.65 "PR PREVENTIVE VISIT,EST, INFANT < 1 YR" GY 99391 187.00 181.68 172.59 142.83 N/A 93.38 177.65 "PR PREVENTIVE VISIT,EST,AGE 1-4" 99392 200.00 193.96 184.11 152.49 N/A 99.66 190.00 "PR PREVENTIVE VISIT,EST,AGE 1-4" EP 99392 200.00 193.96 184.11 152.49 N/A 99.66 190.00 "PR PREVENTIVE VISIT,EST,AGE 1-4" GY 99392 200.00 193.96 184.11 152.49 N/A 99.66 190.00 "PR PREVENTIVE VISIT,EST,AGE5-11" 99393 199.00 193.33 183.51 152.00 N/A 99.35 189.05 "PR PREVENTIVE VISIT,EST,AGE5-11" EP 99393 199.00 193.33 183.51 152.00 N/A 99.35 189.05 "PR PREVENTIVE VISIT,EST,AGE5-11" GY 99393 199.00 193.33 183.51 152.00 N/A 99.35 189.05 "PR PREVENTIVE VISIT,EST,12-17" 99394 219.00 212.32 201.80 166.92 N/A 108.94 208.05 "PR PREVENTIVE VISIT,EST,12-17" EP 99394 219.00 212.32 201.80 166.92 N/A 108.94 208.05 "PR PREVENTIVE VISIT,EST,12-17" GY 99394 219.00 212.32 201.80 166.92 N/A 108.94 208.05 "PR PREVENTIVE VISIT,EST,18-39" 99395 224.00 217.00 206.86 170.61 N/A 111.32 212.80 "PR PREVENTIVE VISIT,EST,18-39" EP 99395 224.00 217.00 206.86 170.61 N/A 111.32 212.80 "PR PREVENTIVE VISIT,EST,18-39" GY 99395 224.00 217.00 206.86 170.61 N/A 111.32 212.80 "PR PREVENTIVE VISIT,EST,40-64" 99396 238.00 231.28 220.07 181.83 N/A 118.54 226.10 "PR PREVENTIVE VISIT,EST,40-64" EP 99396 238.00 231.28 220.07 181.83 N/A 118.54 226.10 "PR PREVENTIVE VISIT,EST,40-64" GY 99396 238.00 231.28 220.07 181.83 N/A 118.54 226.10 "PR PREVENTIVE VISIT,EST,65 & OVER" 99397 256.00 248.40 236.38 195.29 N/A 127.18 243.20 "PR PREVENTIVE VISIT,EST,65 & OVER" EP 99397 256.00 248.40 236.38 195.29 N/A 127.18 243.20 "PR PREVENTIVE VISIT,EST,65 & OVER" GY 99397 256.00 248.40 236.38 195.29 N/A 127.18 243.20 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES 99406 28.00 26.99 26.28 21.20 15.58 14.56 26.60 PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES 99407 53.00 51.57 49.87 40.50 28.85 26.96 50.35 PR PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN 99417 50.00 N/A N/A N/A N/A 30.58 47.50 PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES 99421 35.00 N/A 26.34 N/A 14.94 13.95 33.25 PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN 99441 26.00 25.54 24.55 20.09 56.41 52.72 24.70 PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN 99442 51.00 49.43 47.48 38.87 91.88 85.87 48.45 PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN 99443 75.00 73.10 70.05 57.47 130.64 122.09 71.25 "PR INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIRTH CENTER" 99460 182.00 176.75 167.69 138.81 96.21 89.92 172.90 "PR SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN" 99462 79.00 77.09 73.58 60.71 41.98 39.22 75.05 "PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE" 99463 210.00 203.55 193.61 159.86 110.93 103.67 199.50 PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN 99464 142.00 138.02 131.20 108.39 75.19 70.27 134.90 PR DELIVERY/BIRTHING ROOM RESUSCITATION 99465 277.00 269.12 256.22 211.35 146.74 137.14 263.15 PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN 99466 453.00 439.85 418.18 345.44 239.53 223.86 430.35 "PR INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL" 99468 " 1,746.00 " " 1,694.90 " " 1,612.52 " " 1,331.07 " 922.38 862.04 " 1,658.70 " PR TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE 99495 306.00 297.18 319.17 233.39 207.32 193.76 290.70 PR TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE 99496 432.00 419.15 420.82 329.18 280.82 262.45 410.40 PR ADVANCE CARE PLANNING FIRST 30 MINS 99497 160.00 155.55 149.11 122.16 86.04 80.41 152.00 PR ADVANCE CARE PLANNING EA ADDL 30 MINS 99498 141.00 137.18 130.60 107.73 74.76 69.86 133.95 PR EMERGENCY DEPARTMENT VISIT NO CHARGE 1609928101 - N/A N/A N/A N/A N/A - PR PFIZER-BIONTECH COVID-19 VACCINE ADMINISTRATION – FIRST DOSE 0001A 34.00 N/A N/A N/A N/A 36.85 32.30 PR PFIZER-BIONTECH COVID-19 VACCINE ADMINISTRATION-SECOND DOSE 0002A 57.00 N/A N/A N/A N/A 36.85 54.15 PR MODERNA COVID-19 VACCINE ADMINISTRATION - FIRST DOSE 0011A 34.00 N/A N/A N/A N/A 36.85 32.30 PR MODERNA COVID19 VACCINE ADMINISTRATION - SECOND DOSE 0012A 57.00 N/A N/A N/A N/A 36.85 54.15 PR INITIAL PRENATAL CARE VISIT 0500F - N/A Not Reimbursed N/A N/A N/A - PR INTITIAL PRENATAL CARE VISIT W/FLOW SHEET 0501F - N/A Not Reimbursed N/A N/A N/A - PR SUBSEQUENT PRENATAL CARE 0502F - N/A Not Reimbursed N/A N/A N/A - PR POSTPARTUM CARE VISIT 0503F - N/A Not Reimbursed N/A N/A N/A - PR CATH W/DRAINAGE 2-WAY LATEX A4314 25.00 N/A 39.65 17.47 N/A N/A 23.75 PR CATH W/DRAINAGE 2-WAY SILCNE A4315 104.00 N/A 41.36 18.22 N/A N/A 98.80 PR INDWELLING CATHETER LATEX A4338 16.00 N/A 19.24 8.47 N/A N/A 15.20 PR NON-WATERPROOF TAPE A4450 10.00 N/A 0.45 0.07 N/A N/A 9.50 PR SLINGS A4565 10.00 N/A 12.07 5.32 N/A N/A 9.50 PR SPLINT A4570 21.00 N/A 15.50 6.89 N/A N/A 19.95 PR HYDROCOLLD DRG <=16 W/O BDR A6234 6.00 N/A 10.26 4.52 N/A N/A 5.70 PR LT COMPRES BAND <3/YD A6448 1.00 N/A 1.81 0.80 N/A N/A 0.95 PR LT COMPRES BAND >=3 <5/YD A6449 2.00 N/A 2.75 1.21 N/A N/A 1.90 PR LT COMPRES BAND >=5/YD A6450 10.00 N/A 2.75 1.21 N/A N/A 9.50 PR SELF-ADHER BAND W>=3 <5/YD A6454 3.00 N/A 1.23 0.54 N/A N/A 2.85 PR ZINC PASTE BAND W >=3<5/YD A6456 11.00 N/A 1.98 0.88 N/A N/A 10.45 PR COUMADIN CLINIC LEVEL 1 PROVIDER CC1 36.00 N/A N/A N/A N/A N/A 34.20 PR COUMADIN CLINIC LEVEL 2 PROVIDER CC2 78.00 N/A N/A N/A N/A N/A 74.10 PR COUMADIN CLINIC LEVEL 3 PROVIDER CC3 132.00 N/A N/A N/A N/A N/A 125.40 PR COUMADIN CLINIC NURSE CCN 36.00 N/A N/A N/A N/A N/A 34.20 PR DOT EXAM DOTEXAM 175.00 N/A N/A N/A N/A N/A 166.25 PR ADMIN INFLUENZA VIRUS VAC G0008 15.00 30.04 18.16 15.75 N/A 15.84 14.25 PR ADMIN PNEUMOCOCCAL VACCINE G0009 15.00 30.04 18.16 15.75 N/A 15.84 14.25 PR ADMIN HEPATITIS B VACCINE G0010 15.00 30.04 18.16 15.75 N/A 15.84 14.25 PR COMM SVCS BY RHC/FQHC 5 MIN G0071 25.00 24.73 17.19 19.44 N/A 22.09 23.75 PR CA SCREEN;PELVIC/BREAST EXAM G0101 57.00 55.43 49.57 54.71 38.68 36.16 54.15 "PR PSA, TOTAL SCREENING" G0103 32.00 31.07 26.07 12.26 N/A 15.96 30.40 PR CA SCREEN;FLEXI SIGMOIDSCOPE G0104 315.00 306.00 220.89 240.32 189.97 177.54 299.25 PR COLORECTAL SCRN; HI RISK IND G0105 594.00 576.27 239.50 452.57 347.70 324.96 564.30 PR COLON CA SCRN NOT HI RSK IND G0121 594.00 576.48 382.25 452.73 347.79 325.04 564.30 PR TRIM NAIL(S) G0127 45.00 43.24 30.12 33.96 24.06 22.49 42.75 PR WOUND CLOSURE BY ADHESIVE G0168 144.00 N/A 133.72 133.05 120.49 112.61 136.80 PR MD RECERTIFICATION HHA PT G0179 59.00 N/A 52.00 58.29 40.88 38.21 56.05 PR MD CERTIFICATION HHA PATIENT G0180 77.00 N/A 67.86 75.45 52.91 49.45 73.15 PR LDCT FOR LUNG CA SCREEN G0297 428.00 415.89 67.20 331.83 N/A N/A 406.60 PR INITIAL PREVENTIVE EXAM G0402 308.00 N/A 213.60 237.74 169.92 158.80 292.60 PR EKG FOR INITIAL PREVENT EXAM G0403 31.00 30.31 21.40 23.81 14.66 13.70 29.45 PR EKG TRACING FOR INITIAL PREV G0404 15.00 14.63 10.33 11.49 6.18 5.79 14.25 PR EKG INTERPRET & REPORT PREVE G0405 16.00 15.68 11.07 12.32 8.46 7.91 15.20 "PR PPPS, INITIAL VISIT" G0438 318.00 N/A 218.90 244.80 169.58 158.48 302.10 "PR PPPS, SUBSEQ VISIT" G0439 215.00 N/A 147.81 165.45 133.17 124.46 204.25 PR DEPRESSION SCREEN ANNUAL G0444 10.00 N/A 23.07 25.65 18.67 17.45 9.50 PR DEVLOPMENT TEST INTERPT&REP G0451 18.00 17.13 12.10 13.46 9.58 8.95 17.10 PR CDSM NDSC G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC MA G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC MB G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC MC G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC MD G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC ME G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC MF G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC MG G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC MH G1004 0.01 N/A - N/A N/A N/A 0.01 PR CDSM NDSC QQ G1004 0.01 N/A - N/A N/A N/A 0.01 PR BRIEF CHECK IN BY MD/QHP G2012 28.00 N/A 18.66 20.75 14.59 13.64 26.60 PR DIS SITE TELE SVCS RHC/FQHC G2025 100.00 N/A N/A N/A N/A 51.07 95.00 PR PROLONG OUTPT/OFFICE VIS G2212 50.00 N/A N/A N/A 33.38 31.20 47.50 PR IMMIGRATION PHYSICAL IM 263.00 N/A N/A N/A N/A N/A 249.85 PR ADRENALIN EPINEPHRINE INJECT J0171 72.97 N/A N/A 0.77 N/A N/A 69.32 PR DICYCLOMINE INJECTION J0500 73.00 N/A N/A 82.33 N/A N/A 69.35 PR PENICILLIN G BENZATHINE INJ J0561 10.00 N/A N/A 13.87 N/A N/A 9.50 "PR INJECTION,ONABOTULINUMTOXINA" J0585 6.80 N/A N/A 6.12 N/A N/A 6.46 PR CALCITONIN SALMON INJECTION J0630 35.00 N/A N/A " 2,657.54 " N/A N/A 33.25 PR CEFAZOLIN SODIUM INJECTION J0690 10.00 N/A N/A 0.91 N/A N/A 9.50 PR CEFOXITIN SODIUM INJECTION J0694 6.00 N/A N/A 4.50 N/A N/A 5.70 PR CEFTRIAXONE SODIUM INJECTION J0696 10.00 N/A N/A 0.63 N/A N/A 9.50 PR CLONIDINE HYDROCHLORIDE J0735 4.50 N/A N/A 15.44 N/A N/A 4.28 PR PROCHLORPERAZINE INJECTION J0780 15.00 N/A N/A 9.90 N/A N/A 14.25 PR DEPO-ESTRADIOL CYPIONATE INJ J1000 15.00 N/A N/A 21.96 N/A N/A 14.25 PR METHYLPREDNISOLONE 40 MG INJ J1030 10.00 N/A N/A 6.46 N/A N/A 9.50 PR METHYLPREDNISOLONE 80 MG INJ J1040 12.00 N/A N/A 12.49 N/A N/A 11.40 PR MEDROXYPROGESTERONE ACETATE J1050 0.63 N/A N/A 0.82 N/A N/A 0.60 PR TESTOSTERONE CYPIONAT 100 MG J1070 126.86 N/A N/A N/A N/A N/A 120.52 PR INJ TESTOSTERONE CYPIONATE J1071 0.10 N/A N/A 0.03 N/A N/A 0.10 PR TESTOSTERONE CYPIONAT 200 MG J1080 128.00 N/A N/A N/A N/A N/A 121.60 PR DEXAMETHASONE SODIUM PHOS J1100 1.00 N/A N/A 0.10 N/A N/A 0.95 PR INJ DIHYDROERGOTAMINE MESYLT J1110 128.00 N/A N/A 58.59 N/A N/A 121.60 PR HYDROMORPHONE INJECTION J1170 10.00 N/A N/A 3.23 N/A N/A 9.50 PR DIPHENHYDRAMINE HCL INJECTIO J1200 10.00 N/A N/A 0.66 N/A N/A 9.50 PR ERTAPENEM INJECTION J1335 90.00 N/A N/A 48.49 N/A N/A 85.50 PR GLUCAGON HYDROCHLORIDE/1 MG J1610 194.00 N/A N/A 207.13 N/A N/A 184.30 PR HALOPERIDOL DECANOATE INJ J1631 26.00 N/A N/A 16.58 N/A N/A 24.70 PR INJ ENOXAPARIN SODIUM J1650 13.00 N/A N/A 0.87 N/A N/A 12.35 PR INSULIN INJECTION J1815 10.00 N/A N/A 0.91 N/A N/A 9.50 PR KETOROLAC TROMETHAMINE INJ J1885 10.00 N/A N/A 0.46 N/A N/A 9.50 PR FUROSEMIDE INJECTION J1940 10.00 N/A N/A 0.80 N/A N/A 9.50 PR LORAZEPAM INJECTION J2060 10.00 N/A N/A 0.73 N/A N/A 9.50 PR MEPERIDINE HYDROCHL /100 MG J2175 10.00 N/A N/A 4.78 N/A N/A 9.50 PR MEPERIDINE/PROMETHAZINE INJ J2180 10.00 N/A 10.19 3.79 N/A N/A 9.50 PR METHYLERGONOVIN MALEATE INJ J2210 14.00 N/A N/A 16.90 N/A N/A 13.30 PR MORPHINE SULFATE INJECTION J2270 27.27 N/A N/A 2.57 N/A N/A 25.91 PR MORPHINE SULFATE INJECTION J2275 22.00 N/A N/A N/A N/A N/A 20.90 PR INJ NALBUPHINE HYDROCHLORIDE J2300 10.00 N/A N/A 2.75 N/A N/A 9.50 PR ORPHENADRINE INJECTION J2360 70.25 N/A N/A 5.34 N/A N/A 66.74 PR ONDANSETRON HCL INJECTION J2405 1.00 N/A N/A 0.11 N/A N/A 0.95 PR PROMETHAZINE HCL INJECTION J2550 10.00 N/A N/A 2.11 N/A N/A 9.50 PR INJ PROGESTERONE PER 50 MG J2675 6.50 N/A N/A 1.78 N/A N/A 6.18 PR FLUPHENAZINE DECANOATE 25 MG J2680 156.00 N/A N/A 12.43 N/A N/A 148.20 PR METOCLOPRAMIDE HCL INJECTION J2765 10.00 N/A N/A 1.25 N/A N/A 9.50 PR RHOPHYLAC INJECTION J2791 23.07 N/A N/A 4.80 N/A N/A 21.92 PR METHYLPREDNISOLONE INJECTION J2920 10.00 N/A N/A 4.46 N/A N/A 9.50 PR METHYLPREDNISOLONE INJECTION J2930 10.00 N/A N/A 6.36 N/A N/A 9.50 PR SUMATRIPTAN SUCCINATE / 6 MG J3030 13.00 N/A 70.86 55.16 N/A N/A 12.35 PR PENTAZOCINE INJECTION J3070 133.00 N/A 36.32 108.39 N/A N/A 126.35 PR TRIAMCINOLONE ACETONIDE INJ J3301 15.00 N/A N/A 1.60 N/A N/A 14.25 PR TRIAMCINOLONE HEXACETONL INJ J3303 21.00 N/A 3.11 4.26 N/A N/A 19.95 PR DIAZEPAM INJECTION J3360 17.00 N/A N/A 6.85 N/A N/A 16.15 PR HYDROXYZINE HCL INJECTION J3410 10.00 N/A N/A 7.30 N/A N/A 9.50 PR VITAMIN B12 INJECTION J3420 10.00 N/A N/A 1.83 N/A N/A 9.50 PR VITAMIN K PHYTONADIONE INJ J3430 17.00 N/A N/A 4.20 N/A N/A 16.15 PR DRUGS UNCLASSIFIED INJECTION J3490 - N/A - N/A N/A N/A - PR DRUGS UNCLASSIFIED INJECTION TH J3490 0.63 N/A - N/A N/A N/A 0.60 PR NORMAL SALINE SOLUTION INFUS J7030 2.00 N/A N/A 2.50 N/A N/A 1.90 "PR KYLEENA, 19.5 MG" J7296 " 1,710.00 " N/A - 982.12 N/A N/A " 1,624.50 " "PR MIRENA, 52 MG" J7298 852.00 N/A Not Reimbursed 953.51 N/A N/A 809.40 PR INTRAUT COPPER CONTRACEPTIVE J7300 887.00 N/A Not Reimbursed 832.76 N/A N/A 842.65 "PR SKYLA, 13.5 MG" J7301 780.32 N/A - 817.78 N/A N/A 741.30 PR ETONOGESTREL IMPLANT SYSTEM J7307 981.56 N/A - 917.00 N/A N/A 932.48 "PR INJ, DUROLANE 1 MG" J7318 22.50 N/A - 16.74 N/A N/A 21.38 PR HYALGAN SUPARTZ VISCO-3 DOSE J7321 405.25 N/A N/A 83.64 N/A N/A 384.99 PR EUFLEXXA INJ PER DOSE J7323 168.00 N/A N/A 145.30 N/A N/A 159.60 PR ORTHOVISC INJ PER DOSE J7324 655.00 N/A N/A 492.34 N/A N/A 622.25 PR SYNVISC OR SYNVISC-ONE J7325 628.20 N/A N/A 11.32 N/A N/A 596.79 PR IMMUNOSUPPRESSIVE DRUG NOC J7599 - N/A - N/A N/A N/A - PR BUDESONIDE NON-COMP UNIT J7626 7.00 N/A N/A 2.35 N/A N/A 6.65 PR ORAL DEXAMETHASONE J8540 1.00 N/A N/A 0.06 N/A N/A 0.95 PR LEUPROLIDE ACETATE SUSPNSION J9217 " 1,332.00 " N/A N/A 224.30 N/A N/A " 1,265.40 " PR METHOTREXATE SODIUM INJ J9250 10.00 N/A N/A 0.26 N/A N/A 9.50 PR METHOTREXATE SODIUM INJ J9260 10.00 N/A N/A 2.64 N/A N/A 9.50 PR JAIL VISIT JAIL 50.00 N/A N/A N/A N/A N/A N/A PR JAIL TRIP JAILT 65.00 N/A N/A N/A N/A N/A N/A PR CERV FLEX N/ADJ FOAM PRE OTS L0120 30.00 N/A 44.75 19.71 N/A N/A 28.50 PR THOR RIB BELT CUSTOM FABRICA L0220 39.00 N/A 172.57 76.01 N/A N/A 37.05 PR KO ELASTIC WITH JOINTS L1810 87.00 N/A 126.58 55.75 N/A N/A 82.65 PR KO IMMOB CANVAS LONG PRE OTS L1830 79.00 N/A 115.24 50.76 N/A N/A 75.05 PR KO ADJ JNT POS R SUP PRE CST L1832 55.00 N/A 768.84 338.66 N/A N/A 52.25 PR AFO ANKLE GAUNTLET PRE OTS L1902 73.00 N/A 106.54 46.93 N/A N/A 69.35 PR AFO MULTILIG ANK SUP PRE OTS L1906 104.00 N/A 152.08 66.99 N/A N/A 98.80 PR AMBULATORY SURGICAL BOOT EAC L3260 15.00 N/A 16.39 7.28 N/A N/A 14.25 PR PLASTAZOTE SANDAL EACH L3265 90.00 N/A 17.71 7.87 N/A N/A 85.50 PR SO 8 ABD RESTRAINT PRE OTS L3650 60.00 N/A 87.12 38.37 N/A N/A 57.00 PR WHFO W/O JOINTS PRE CST L3807 - N/A 306.22 134.89 N/A N/A - PR WHO COCK-UP NONMOLDE PRE OTS L3908 40.00 N/A 75.34 33.19 N/A N/A 38.00 PR ANKLE CONTROL ORTHO PRE OTS L4350 77.00 N/A 113.05 49.79 N/A N/A 73.15 PR PNEUMAT WALKING BOOT PRE CST L4360 100.00 N/A 350.15 154.24 N/A N/A 95.00 PR NON-PNEUM WALK BOOT PRE CST L4386 70.00 N/A 213.39 94.00 N/A N/A 66.50 PR ADMIT FROM OFFICE NC003 - N/A N/A N/A N/A N/A - PR SENT TO EMERGENCY ROOM NC098 - N/A N/A N/A N/A N/A - PR NO CHARGE NURSE VISIT NCNURSE - N/A N/A N/A N/A N/A - PR NO CHARGE PROVIDER VISIT NCPROV - N/A N/A N/A N/A N/A - PR OH NON-DOT PHYSICAL OHNONDOT 150.00 N/A N/A N/A N/A N/A 142.50 PR OH NURSE VISIT ONLY OHNURSE 36.00 N/A N/A N/A N/A N/A 34.20 PR OCC HEALTH PHYSICAL LEVEL 5 OHPHYS 175.00 N/A N/A N/A N/A N/A 166.25 PR OH CLINIC OFFICE VISIT OHPHYSLTD 132.00 N/A N/A N/A N/A N/A 125.40 PR OSHA OSHA 21.00 N/A N/A N/A N/A N/A 19.95 OPERATIVE NOTE CHARGE PBSUR - N/A N/A N/A N/A N/A - PR POTASSIUM HYDROXIDE PREPS Q0112 9.00 8.86 7.87 5.83 N/A 4.82 8.55 PR ONDANSETRON ORAL Q0162 4.00 N/A N/A 0.03 N/A N/A 3.80 "PR FLUZONE VACC, 3 YRS & >, IM" Q2038 25.00 N/A 13.73 56.18 N/A N/A 23.75 PR CAST SUP LONG ARM ADULT FBRG Q4006 24.00 N/A 40.95 18.04 N/A N/A 22.80 PR CAST SUP LONG ARM PED FBRGLS Q4008 20.00 N/A 20.47 9.01 N/A N/A 19.00 PR CAST SUP SHT ARM ADULT FBRGL Q4010 16.00 N/A 27.30 12.02 N/A N/A 15.20 PR CAST SUP SHT ARM PED FBRGLAS Q4012 11.00 N/A 13.68 6.02 N/A N/A 10.45 PR CAST SUP LNG ARM SPLINT PLST Q4017 8.00 N/A 12.76 5.62 N/A N/A 7.60 PR CAST SUP LNG ARM SPLINT FBRG Q4018 21.00 N/A 20.34 8.96 N/A N/A 19.95 PR CAST SUP LNG ARM SPLNT PED F Q4020 11.00 N/A 10.21 4.49 N/A N/A 10.45 PR CAST SUP SHT ARM SPLINT PLST Q4021 6.00 N/A 9.45 4.16 N/A N/A 5.70 PR CAST SUP SHT ARM SPLINT FBRG Q4022 16.00 N/A 17.04 7.51 N/A N/A 15.20 PR CAST SUP SHT ARM SPLNT PED F Q4024 7.00 N/A 8.55 3.76 N/A N/A 6.65 PR CAST SUP LONG LEG FIBERGLASS Q4030 63.00 N/A 106.65 46.98 N/A N/A 59.85 PR CAST SUP SHRT LEG FIBERGLASS Q4038 22.00 N/A 57.74 25.43 N/A N/A 20.90 PR CAST SUP LNG LEG SPLNT PLSTR Q4041 16.00 N/A 28.04 12.35 N/A N/A 15.20 PR CAST SUP LNG LEG SPLNT FBRGL Q4042 28.00 N/A 47.86 21.08 N/A N/A 26.60 PR CAST SUP SHT LEG SPLNT FBRGL Q4046 15.00 N/A 26.16 11.53 N/A N/A 14.25 PR ONDANSETRON 4 MG S0119 15.00 N/A 19.48 0.57 N/A N/A 14.25 PR BUMETANIDE 0.5 MG S0171 10.00 N/A 1.32 0.84 N/A N/A 9.50 PR SCHOOL PHYSICAL SCHPX 70.00 N/A N/A N/A N/A N/A 66.50 PR SPORTS PHYSICAL SPTPX 68.00 N/A N/A N/A N/A N/A 64.60 PR NURSING ASSESSMENT/EVALUATN T1001 116.00 N/A - N/A N/A N/A 110.20 PR RHC VISIT COUNT VC - N/A N/A N/A N/A N/A N/A