Procedure Master # Procedure Record Name Procedure Modifier CPT Code Gross Charge BCBS Negotiated Fee Midlands Choice Negotiated Fee UHC Negotiated Fee 10021 PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION 10021 180.00 174.82 167.93 137.30 10040 PR ACNE SURGERY OF SKIN ABSCESS 10040 200.00 193.90 187.39 152.28 10060 PR DRAIN SKIN ABSCESS SIMPLE 52 10060 220.00 213.35 207.28 167.55 10060 PR DRAIN SKIN ABSCESS SIMPLE 10060 220.00 213.35 207.28 167.55 10061 PR DRAIN SKIN ABSCESS COMPLIC 52 10061 382.00 370.65 357.81 291.09 10061 PR DRAIN SKIN ABSCESS COMPLIC 10061 382.00 370.65 357.81 291.09 10080 PR DRAIN PILONIDAL CYST SIMPL 10080 338.00 328.23 357.05 257.78 10120 PR REMOVE FOREIGN BODY SIMPLE 52 10120 281.00 272.46 259.22 213.98 10120 PR REMOVE FOREIGN BODY SIMPLE 10120 281.00 272.46 259.22 213.98 10121 PR REMOVE FOREIGN BODY COMPLIC 10121 502.00 487.37 462.68 382.76 10140 PR DRAINAGE OF HEMATOMA/FLUID 10140 309.00 300.42 289.89 235.94 10160 PR PUNCTURE DRAINAGE OF LESION 52 10160 240.00 233.40 222.75 183.30 10160 PR PUNCTURE DRAINAGE OF LESION 10160 240.00 233.40 222.75 183.30 10180 "PR COMPLEX DRAINAGE, WOUND" 10180 453.00 440.27 429.27 345.77 11000 "PR DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA" 11000 103.00 100.03 97.22 78.56 11001 "PR DEBRIDEMENT, INFECTED SKIN, EA ADD 10% BSA" 11001 41.00 39.48 40.55 31.01 11008 PR REMOVE MESH FROM ABD WALL FOR INFECTION 11008 498.00 483.13 458.79 379.43 11010 PR DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ 11010 888.00 861.89 804.77 676.88 11042 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM" 11042 225.00 218.10 214.21 171.29 11043 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM" 52 11043 425.00 412.37 395.16 323.85 11043 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,=<20 SQ CM" 11043 425.00 412.37 395.16 323.85 11044 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,BONE,=<20 SQ CM" 11044 576.00 559.10 532.90 439.08 11045 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM" 11045 76.00 73.75 70.31 57.92 11046 "PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,MUSCLE,EACH ADD 20 SQ CM" 11046 134.00 129.96 124.85 102.06 11055 "PR TRIM HYPERKERATOTIC SKIN LESION, ONE" GY 11055 104.00 100.94 107.13 79.28 11055 "PR TRIM HYPERKERATOTIC SKIN LESION, ONE" 11055 104.00 100.94 107.13 79.28 11056 "PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4" GY 11056 125.00 120.88 126.29 94.94 11056 "PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,2-4" 11056 125.00 120.88 126.29 94.94 11057 "PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4" GY 11057 139.00 134.56 139.72 105.68 11057 "PR TRIM BENIGN HYPERKERATOTIC SKIN LESION,>4" 11057 139.00 134.56 139.72 105.68 11100 PR BIOPSY OF SKIN LESION 52 11100 184.00 N/A N/A N/A 11100 PR BIOPSY OF SKIN LESION 11100 184.00 N/A N/A N/A 11101 "PR BIOPSY, EACH ADDED LESION" 52 11101 59.00 N/A N/A N/A 11101 "PR BIOPSY, EACH ADDED LESION" 11101 59.00 N/A N/A N/A 11102 PR TANGENTIAL BIOPSY SKIN SINGLE LESION 11102 181.00 175.82 170.19 138.08 11103 PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION 11103 98.00 94.91 90.34 74.54 11104 PR PUNCH BIOPSY SKIN SINGLE LESION 11104 228.00 221.16 214.38 173.69 11105 PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION 11105 112.00 108.72 103.30 85.38 11106 PR INCISIONAL BIOPSY SKIN SINGLE LESION 11106 275.00 267.40 260.22 210.00 11107 PR INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION 11107 132.00 128.28 122.96 100.74 11200 "PR REMOVAL OF SKIN TAGS, UP TO 15" 52 11200 163.00 158.22 151.62 124.26 11200 "PR REMOVAL OF SKIN TAGS, UP TO 15" 11200 163.00 158.22 151.62 124.26 11201 "PR REMOVAL OF SKIN TAGS, EACH ADD 10" 52 11201 35.00 34.00 32.14 26.70 11201 "PR REMOVAL OF SKIN TAGS, EACH ADD 10" 11201 35.00 34.00 32.14 26.70 11300 "PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG" 52 11300 179.00 173.96 170.66 136.62 11300 "PR SHAV SKIN LES < 0.5 CM TRUNK,ARM,LEG" 11300 179.00 173.96 170.66 136.62 11301 "PR SHAV SKIN LES 0.6-1.0 CM TRUNK,ARM,LEG" 11301 220.00 213.65 207.63 167.79 11302 "PR SHAV SKIN LES 1.1-2.0 CM TRUNK,ARM,LEG" 11302 257.00 249.69 239.93 196.10 11303 "PR SHAV SKIN LES >2.1 CM TRUNK,ARM,LEG" 11303 284.00 275.40 264.59 216.29 11305 PR SHAV SKIN LES <0.5 CM REMAINDER BODY 52 11305 189.00 183.76 179.98 144.32 11305 PR SHAV SKIN LES <0.5 CM REMAINDER BODY 11305 189.00 183.76 179.98 144.32 11306 PR SHAV SKIN LES 0.6-1.0 CM REMAINDER BODY 11306 224.00 217.57 210.97 170.87 11307 PR SHAV SKIN LES 1.1-2.0 CM REMAINDER BODY 11307 265.00 257.53 246.81 202.25 11308 PR SHAV SKIN LES >2.1 CM REMAINDER BODY 11308 283.00 274.79 264.66 215.81 11310 "PR SHAV SKIN LES <0.5 CM FACE,FACIAL" 52 11310 209.00 202.80 197.47 159.27 11310 "PR SHAV SKIN LES <0.5 CM FACE,FACIAL" 11310 209.00 202.80 197.47 159.27 11311 "PR SHAV SKIN LES 0.6-1.0 CM FACE,FACIAL" 52 11311 250.00 242.49 234.85 190.44 11311 "PR SHAV SKIN LES 0.6-1.0 CM FACE,FACIAL" 11311 250.00 242.49 234.85 190.44 11312 "PR SHAV SKIN LES 1.1-2.0 CM FACE,FACIAL" 52 11312 292.00 283.44 271.65 222.60 11312 "PR SHAV SKIN LES 1.1-2.0 CM FACE,FACIAL" 11312 292.00 283.44 271.65 222.60 11313 "PR SHAV SKIN LES >2.1 CM FACE,FACIAL" 11313 342.00 332.21 317.23 260.90 11400 "PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG" 52 11400 228.00 221.39 213.96 173.87 11400 "PR EXC SKIN BENIG <0.5 CM TRUNK,ARM,LEG" 11400 228.00 221.39 213.96 173.87 11401 "PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG" 52 11401 278.00 269.54 261.15 211.68 11401 "PR EXC SKIN BENIG 0.6-1 CM TRUNK,ARM,LEG" 11401 278.00 269.54 261.15 211.68 11402 "PR EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG" 52 11402 308.00 299.03 289.16 234.84 11402 "PR EXC SKIN BENIG 1.1-2 CM TRUNK,ARM,LEG" 11402 308.00 299.03 289.16 234.84 11403 "PR EXC SKIN BENIG 2.1-3 CM TRUNK,ARM,LEG" 11403 355.00 344.75 332.53 270.75 11404 "PR EXC SKIN BENIG 3.1-4 CM TRUNK,ARM,LEG" 11404 402.00 389.93 376.61 306.23 11406 "PR EXC SKIN BENIG >4 CM TRUNK,ARM,LEG" 11406 575.00 558.29 536.01 438.45 11420 PR EXC SKIN BENIG <0.5 CM REMAINDER BODY 52 11420 230.00 223.01 216.53 175.14 11420 PR EXC SKIN BENIG <0.5 CM REMAINDER BODY 11420 230.00 223.01 216.53 175.14 11421 PR EXC SKIN BENIG 0.6-1 CM REMAINDR BODY 11421 291.00 282.20 272.38 221.63 11422 PR EXC SKIN BENIG 1.1-2 CM REMAINDR BODY 11422 327.00 317.17 305.60 249.09 11423 PR EXC SKIN BENIG 2.1-3 CM REMAINDR BODY 52 11423 372.00 361.14 347.58 283.62 11423 PR EXC SKIN BENIG 2.1-3 CM REMAINDR BODY 11423 372.00 361.14 347.58 283.62 11424 PR EXC SKIN BENIG 3.1-4 CM REMAINDR BODY 11424 430.00 417.72 400.09 328.05 11426 PR EXC SKIN BENIG >4 CM REMAINDR BODY 11426 614.00 595.90 571.19 467.99 11440 "PR EXC SKIN BENIG <0.5 CM FACE,FACIAL" 52 11440 254.00 246.12 238.75 193.29 11440 "PR EXC SKIN BENIG <0.5 CM FACE,FACIAL" 11440 254.00 246.12 238.75 193.29 11441 "PR EXC SKIN BENIG 0.6-1 CM FACE,FACIAL" 11441 312.00 303.06 292.62 238.01 11442 "PR EXC SKIN BENIG 1.1-2 CM FACE,FACIAL" 11442 348.00 337.59 324.82 265.13 11443 "PR EXC SKIN BENIG 2.1-3 CM FACE,FACIAL" 11443 414.00 401.56 385.80 315.36 11444 "PR EXC SKIN BENIG 3.1- 4 CM FACE,FACIAL" 11444 519.00 503.63 482.99 395.52 11446 "PR EXC SKIN BENIG >4 CM FACE,FACIAL" 11446 718.00 697.42 665.59 547.71 11601 "PR EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG" 52 11601 421.00 408.61 391.28 320.90 11601 "PR EXC SKIN MALIG 0.6-1 CM TRUNK,ARM,LEG" 11601 421.00 408.61 391.28 320.90 11602 "PR EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG" 52 11602 456.00 442.45 422.33 347.48 11602 "PR EXC SKIN MALIG 1.1-2 CM TRUNK,ARM,LEG" 11602 456.00 442.45 422.33 347.48 11603 "PR EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG" 52 11603 521.00 505.44 481.23 396.95 11603 "PR EXC SKIN MALIG 2.1-3 CM TRUNK,ARM,LEG" 11603 521.00 505.44 481.23 396.95 11604 "PR EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG" 52 11604 577.00 559.88 535.10 439.70 11604 "PR EXC SKIN MALIG 3.1-4 CM TRUNK,ARM,LEG" 11604 577.00 559.88 535.10 439.70 11606 "PR EXC SKIN MALIG >4 CM TRUNK,ARM,LEG" 52 11606 823.00 799.33 762.05 627.75 11606 "PR EXC SKIN MALIG >4 CM TRUNK,ARM,LEG" 11606 823.00 799.33 762.05 627.75 11620 PR EXC SKIN MALIG <0.5 CM REMAINDER BODY 52 11620 359.00 348.88 337.41 273.99 11620 PR EXC SKIN MALIG <0.5 CM REMAINDER BODY 11620 359.00 348.88 337.41 273.99 11621 PR EXC SKIN MALIG 0.6-1 CM REMAINDR BODY 52 11621 422.00 410.13 392.72 322.10 11621 PR EXC SKIN MALIG 0.6-1 CM REMAINDR BODY 11621 422.00 410.13 392.72 322.10 11622 PR EXC SKIN MALIG 1.1-2 CM REMAINDR BODY 11622 471.00 457.12 436.07 359.00 11623 PR EXC SKIN MALIG 2.1-3 CM REMAINDR BODY 52 11623 551.00 535.28 511.09 420.38 11623 PR EXC SKIN MALIG 2.1-3 CM REMAINDR BODY 11623 551.00 535.28 511.09 420.38 11624 PR EXC SKIN MALIG 3.1-4 CM REMAINDR BODY 11624 622.00 604.11 577.45 474.44 11626 PR EXC SKIN MALIG >4 CM REMAINDR BODY 11626 747.00 725.09 693.00 569.45 11640 "PR EXC SKIN MALIG <0.5 CM FACE,FACIAL" 52 11640 371.00 359.71 345.76 282.50 11640 "PR EXC SKIN MALIG <0.5 CM FACE,FACIAL" 11640 371.00 359.71 345.76 282.50 11641 "PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL" 52 11641 437.00 424.69 406.57 333.53 11641 "PR EXC SKIN MALIG 0.6-1CM FACE,FACIAL" 11641 437.00 424.69 406.57 333.53 11642 "PR EXC SKIN MALIG 1.1-2 CM FACE,FACIAL" 52 11642 498.00 483.73 461.52 379.89 11642 "PR EXC SKIN MALIG 1.1-2 CM FACE,FACIAL" 11642 498.00 483.73 461.52 379.89 11643 "PR EXC SKIN MALIG 2.1-3 CM FACE,FACIAL" 52 11643 586.00 568.99 543.11 446.85 11643 "PR EXC SKIN MALIG 2.1-3 CM FACE,FACIAL" 11643 586.00 568.99 543.11 446.85 11644 "PR EXC SKIN MALIG 3.1-4 CM FACE,FACIAL" 52 11644 723.00 701.58 668.54 550.98 11644 "PR EXC SKIN MALIG 3.1-4 CM FACE,FACIAL" 11644 723.00 701.58 668.54 550.98 11646 "PR EXC SKIN MALIG >4 CM FACE,FACIAL" 11646 941.00 913.44 869.56 717.36 11719 PR TRIM NAIL(S) GY 11719 27.00 26.32 24.48 20.67 11719 PR TRIM NAIL(S) 11719 27.00 26.32 24.48 20.67 11720 "PR DEBRIDEMENT OF NAIL(S), 1-5" GY 11720 62.00 60.05 56.20 47.16 11720 "PR DEBRIDEMENT OF NAIL(S), 1-5" 11720 62.00 60.05 56.20 47.16 11721 "PR DEBRIDEMENT OF NAILS, 6 OR MORE" GY 11721 85.00 82.51 78.17 64.80 11721 "PR DEBRIDEMENT OF NAILS, 6 OR MORE" 11721 85.00 82.51 78.17 64.80 11730 PR REMOVAL OF NAIL PLATE 52 11730 203.00 196.81 190.01 154.56 11730 PR REMOVAL OF NAIL PLATE 11730 203.00 196.81 190.01 154.56 11732 PR REMOVE ADDITIONAL NAIL PLATE 11732 61.00 59.38 57.75 46.64 11740 PR DRAIN BLOOD FROM UNDER NAIL 11740 95.00 92.52 91.73 72.66 11750 PR REMOVAL OF NAIL BED 52 11750 290.00 281.13 270.16 220.79 11750 PR REMOVAL OF NAIL BED 11750 290.00 281.13 270.16 220.79 11752 PR REMOVE NAIL BED/FINGER TIP 11752 723.00 N/A N/A N/A 11755 "PR BIOPSY, NAIL UNIT (SEP PROC)" 11755 228.00 221.43 210.92 173.90 11760 PR RECONSTRUC OF NAIL BED 11760 355.00 344.77 332.39 270.77 11765 "PR EXCISION OF NAIL FOLD, TOE" 11765 314.00 304.57 290.14 239.19 11770 PR REMV PILONIDAL LESION SIMPLE 11770 516.00 501.03 525.23 393.48 11900 "PR INJECTION INTO SKIN LESIONS, UP TO 7" 11900 100.00 96.84 94.17 76.05 11901 "PR INJECTION INTO SKIN LESIONS, 8 OR MORE" 11901 126.00 122.62 118.66 96.30 11976 PR REMOVAL OF CONTRACEPTIVE CAPSUL 11976 269.00 260.77 246.79 204.45 11981 PR INSERTION DRUG IMPLANT DEVICE 11981 260.00 252.27 174.41 198.12 11982 PR REMOVAL DRUG IMPLANT DEVICE 11982 288.00 280.06 198.23 219.95 11983 PR REMOVAL W/ REINSERT DRUG IMPLANT DEVICE 11983 425.00 412.22 246.32 323.73 12001 PR RESUPERF WND BODY <2.5CM 52 12001 164.00 159.20 152.84 125.03 12001 PR RESUPERF WND BODY <2.5CM 12001 164.00 159.20 152.84 125.03 12002 PR RESUP NPTERF WND BODY 2.6-7.5 CM 52 12002 200.00 193.88 186.35 152.27 12002 PR RESUP NPTERF WND BODY 2.6-7.5 CM 12002 200.00 193.88 186.35 152.27 12004 PR RESUPERF WND BODY 7.6-12.5 CM 52 12004 234.00 227.31 217.71 178.52 12004 PR RESUPERF WND BODY 7.6-12.5 CM 12004 234.00 227.31 217.71 178.52 12005 PR RESUPERF WND BODY 12.6-20 CM 12005 304.00 294.98 287.36 231.66 12006 PR RESUPERF WND BODY 20.1-30 CM 12006 358.00 347.98 339.10 273.29 12007 PR RESUPERF WND BODY >30 CM 12007 411.00 399.06 387.79 313.40 12011 PR RESUPERF WND FACE <2.5 CM 52 12011 200.00 194.48 185.75 152.73 12011 PR RESUPERF WND FACE <2.5 CM 12011 200.00 194.48 185.75 152.73 12013 PR RESUPERF WND FACE 2.6-5 CM 52 12013 209.00 202.96 193.76 159.39 12013 PR RESUPERF WND FACE 2.6-5 CM 12013 209.00 202.96 193.76 159.39 12014 PR RESUPERF WND FACE 5.1-7.5 CM 52 12014 251.00 243.81 235.76 191.48 12014 PR RESUPERF WND FACE 5.1-7.5 CM 12014 251.00 243.81 235.76 191.48 12015 PR RESUPERF WND FACE 7.6-12.5 CM 12015 304.00 295.04 285.03 231.71 12016 PR RESUPERF WND FACE 12.6-20 CM 52 12016 383.00 371.95 362.22 292.11 12016 PR RESUPERF WND FACE 12.6-20 CM 12016 383.00 371.95 362.22 292.11 12020 PR CLOSURE SUPERF WND DEHIS SIMPLE 52 12020 527.00 511.59 500.23 401.78 12020 PR CLOSURE SUPERF WND DEHIS SIMPLE 12020 527.00 511.59 500.23 401.78 12021 PR CLOSURE SUPERF WND DEHIS W PACKING 12021 306.00 297.23 290.56 233.43 12031 "PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM" 52 12031 450.00 436.99 429.25 343.19 12031 "PR LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM" 12031 450.00 436.99 429.25 343.19 12032 "PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM" 52 12032 558.00 541.96 516.73 425.63 12032 "PR LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM" 12032 558.00 541.96 516.73 425.63 12034 "PR LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM" 12034 585.00 567.80 552.41 445.92 12035 "PR LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM" 12035 703.00 682.29 653.74 535.83 12036 "PR LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM" 12036 775.00 752.77 727.18 591.18 12041 PR LAYR CLOS WND REST BODY <2.5 CM 52 12041 451.00 437.39 430.63 343.50 12041 PR LAYR CLOS WND REST BODY <2.5 CM 12041 451.00 437.39 430.63 343.50 12042 PR LAYR CLOS WND REST BODY 2.6-7.5 CM 52 12042 543.00 527.37 513.70 414.17 12042 PR LAYR CLOS WND REST BODY 2.6-7.5 CM 12042 543.00 527.37 513.70 414.17 12051 "PR LAYR CLOS WND FACE,FACIAL <2.5 CM" 52 12051 487.00 473.11 463.83 371.55 12051 "PR LAYR CLOS WND FACE,FACIAL <2.5 CM" 12051 487.00 473.11 463.83 371.55 12052 "PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM" 52 12052 552.00 536.23 521.52 421.13 12052 "PR LAYR CLOS WND FACE,FACIAL 2.5-5 CM" 12052 552.00 536.23 521.52 421.13 12053 "PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM" 52 12053 646.00 626.88 608.54 492.32 12053 "PR LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM" 12053 646.00 626.88 608.54 492.32 12055 "PR LAYR CLOS WND FACE,FACIAL 12.6-20 CM" 12055 875.00 849.38 825.21 667.05 13120 "PR RECMPL WND SCALP,EXTR 1.1-2.5 CM" 52 13120 651.00 632.48 608.95 496.71 13120 "PR RECMPL WND SCALP,EXTR 1.1-2.5 CM" 13120 651.00 632.48 608.95 496.71 13121 "PR RECMPL WND SCALP,EXTR 2.6-7.5 CM" 52 13121 792.00 768.70 736.86 603.69 13121 "PR RECMPL WND SCALP,EXTR 2.6-7.5 CM" 13121 792.00 768.70 736.86 603.69 13122 "PR REP,SKIN,SCALP/EXTREM+5 CM/<" 52 13122 243.00 235.92 224.02 185.28 13122 "PR REP,SKIN,SCALP/EXTREM+5 CM/<" 13122 243.00 235.92 224.02 185.28 13131 "PR RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM" 13131 716.00 695.37 667.78 546.11 13132 "PR RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM" 13132 882.00 856.33 818.80 672.51 13133 "PR REPR,FACE,GENITAL,HAND,FT+5 CMCM/<" 13133 326.00 316.66 299.23 248.69 13151 "PR RECMPL WND LID,NOS,EAR 1.1-2.5 CM" 13151 783.00 760.22 729.00 597.03 13152 "PR RECMPL WND LID,NOS,EAR 2.5-7.5 CM" 13152 935.00 907.50 865.21 712.70 14040 "PR ADJ TISS XFER HEAD,FAC,HAND <10 SQCM" 14040 " 1,402.00 " " 1,360.80 " " 1,296.73 " " 1,068.69 " 15831 "PR EXCISE EXCESS SKIN TISSUE,ABDOMEN" 15831 " 1,311.00 " N/A N/A N/A 16000 PR INITIAL RX BURN(S) 1ST DEGREE 16000 130.00 126.31 125.13 99.20 16020 PR DRESS/DEBRID SMALL BURN NO ANES 16020 150.00 145.66 139.99 114.39 16025 PR DRESS/DEBRID MED BURN NO ANESTH 16025 275.00 267.04 260.88 209.72 16030 PR DRESS/DEBRID LARGE BURN NO ANESTH 16030 347.00 337.29 327.84 264.89 17000 "PR DESTRUC BENIGN/PREMAL,FIRST LESION" 52 17000 120.00 116.40 111.60 91.41 17000 "PR DESTRUC BENIGN/PREMAL,FIRST LESION" 17000 120.00 116.40 111.60 91.41 17003 "PR DESTRUC BENIGN/PREMAL,2-14 LESIONS" 52 17003 10.00 9.86 10.39 7.74 17003 "PR DESTRUC BENIGN/PREMAL,2-14 LESIONS" 17003 10.00 9.86 10.39 7.74 17004 "PR DESTRUC BENIGN/PREMAL,15+ LESIONS" 52 17004 279.00 270.72 270.69 212.61 17004 "PR DESTRUC BENIGN/PREMAL,15+ LESIONS" 17004 279.00 270.72 270.69 212.61 17106 PR DESTRUC CUT/VASC <10 SQCM 17106 633.00 614.70 585.79 482.75 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14 52 17110 203.00 196.73 190.14 154.50 17110 PR DESTRUCTION BENIGN LESIONS UP TO 14 17110 203.00 196.73 190.14 154.50 17111 PR DESTRUCTION BENIGN LESIONS 15 OR MORE 52 17111 240.00 233.10 224.17 183.06 17111 PR DESTRUCTION BENIGN LESIONS 15 OR MORE 17111 240.00 233.10 224.17 183.06 17250 PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE 17250 149.00 144.95 143.74 113.84 17260 "PR DESTR MALIG TRUNK,EXTREM <0.6 CM" 17260 175.00 169.99 165.60 133.50 17261 "PR DESTR MALIG TRUNK,EXTREM 0.6-1 CM" 17261 266.00 258.08 249.30 202.68 17262 "PR DESTR MALIG TRUNK,EXTREM 1.1-2 CM" 17262 324.00 314.56 302.65 247.04 17270 "PR DESTR MALIG SCAL,NCK,HAND <0.6 CM" 17270 274.00 265.93 254.75 208.85 17271 "PR DESTR MALIG SCAL,NCK,HAND 0.6-1 CM" 17271 302.00 293.11 281.44 230.19 17280 "PR DESTR MALIG FACE,NOSE,LIP <0.6 CM" 17280 256.00 248.91 237.97 195.48 17281 "PR DESTR MALIG FACE,NOSE,LIP 0.6-1 CM" 17281 329.00 319.20 306.05 250.68 17282 "PR DESTR MALIG FACE,NOSE,LIP 1.1-2 CM" 17282 378.00 366.53 351.26 287.85 17311 "PR MOHS, 1 STAGE, HEAD/NECK/HAND/FEET/GENTIAL" 17311 " 1,225.00 " " 1,189.41 " " 1,138.26 " 934.10 19000 PR PUNC/ASPIR BREAST CYST 19000 202.00 196.16 186.13 154.05 19020 PR EXPLO/DRAIN BREAST ABSCESS 52 19020 860.00 835.13 795.61 655.86 19020 PR EXPLO/DRAIN BREAST ABSCESS 19020 860.00 835.13 795.61 655.86 19085 PR BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE 19085 " 1,777.00 " " 1,725.21 " " 1,572.41 " " 1,354.88 " 19086 PR BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE 19086 " 1,422.00 " " 1,380.95 " " 1,247.96 " " 1,084.52 " 19100 "PR BIOPSY OF BREAST, NEEDLE CORE" 19100 274.00 266.25 257.84 209.10 19101 "PR BIOPSY OF BREAST, INCISIONAL" 19101 612.00 594.11 562.96 466.58 20005 PR I&D SOFT TISSUE ABSCESS SUBFASCIAL 20005 554.00 N/A N/A N/A 20103 "PR EXPLORE WOUND,EXTREMITY" 20103 " 1,066.00 " " 1,035.22 " 981.40 813.00 20526 PR INJECT CARPAL TUNNEL 20526 141.00 137.12 133.32 107.69 20550 PR INJECT TENDON SHEATH/LIGAMENT 20550 98.00 95.56 93.89 75.05 20551 PR INJECT TENDON ORIGIN/INSERT 20551 100.00 97.22 96.28 76.35 20552 "PR INJECT TRIGGER POINT, 1 OR 2" 20552 103.00 99.59 95.15 78.21 20553 "PR INJECT TRIGGER POINTS, > 3" 20553 118.00 114.77 109.42 90.14 20600 PR ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US 20600 90.00 87.27 86.18 68.54 20604 PR ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT 20604 137.00 132.97 131.15 104.43 20605 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US 20605 94.00 91.15 89.29 71.58 20606 PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US 20606 151.00 146.63 144.71 115.16 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 50 20610 110.00 107.11 105.41 84.12 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 52 20610 110.00 107.11 105.41 84.12 20610 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US 20610 110.00 107.11 105.41 84.12 20611 PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US 20611 169.00 164.18 161.20 128.94 20612 PR ASPIRAT/INJECTION GANGLION CYST(S) 20612 111.00 107.78 105.52 84.65 20615 PR ASPIR/INJEC BONE CYST 20615 450.00 437.14 426.21 343.31 20670 PR REMOVAL SUPERFICIAL IMPLANT 20670 688.00 668.44 627.77 524.96 21030 "PR EXCISION,BENIGN TUMOR,MAXILLA/ZYGOMA" 21030 941.00 913.82 850.32 717.66 21315 "PR CLOSED RX NOSE FRACTURE, W/O STABILIZATION" 21315 506.00 491.42 465.03 385.94 21451 PR CLOSED RX MANDIBLE FX+MANIPULATN 21451 " 1,399.00 " " 1,358.30 " " 1,300.50 " " 1,066.73 " 21480 PR REDUCE TEMPOROMANDIBL DISLOC 21480 198.00 192.41 198.49 151.11 21501 PR I&D DEEP ABSC/HEMATOMA NECK/CHEST 21501 843.00 818.45 793.27 642.77 21800 PR CLOSED RX RIB FRACTURE 21800 204.00 N/A N/A N/A 23330 PR REMOVE SUBCUT SHOULDER FOREIGN BODY 23330 514.00 498.87 490.54 391.28 23500 PR CLOSED RX CLAVICLE FRACTURE 52 23500 401.00 389.09 372.70 305.57 23500 PR CLOSED RX CLAVICLE FRACTURE 23500 401.00 389.09 372.70 305.57 23570 PR CLOSED RX SCAPULA FX 23570 424.00 411.78 394.45 323.39 23575 "PR CLOSED RX SCAPULA FX,MANIPULATN" 23575 738.00 716.75 686.58 562.04 23600 PR CLOSED RX PROX HUMERUS FRACTURE 52 23600 601.00 583.50 558.49 458.25 23600 PR CLOSED RX PROX HUMERUS FRACTURE 23600 601.00 583.50 558.49 458.25 23620 PR CLOSED RX GR TUBEROSITY HUM FX 23620 491.00 476.24 455.24 374.01 23650 PR CLOSED RX SHLDR DISLOCATION 23650 587.00 570.29 541.40 447.87 23655 "PR CLOSED RX SHLDR DISLOC,ANESTHESIA" 52 23655 739.00 717.15 685.65 563.21 23655 "PR CLOSED RX SHLDR DISLOC,ANESTHESIA" 23655 739.00 717.15 685.65 563.21 23665 "PR CLOSED RX SHLDR DISLOC,GR TUB FX" 23665 784.00 760.75 726.67 597.45 23931 PR INCIS/DRAIN ARM/ELBOW INFECT BURSA 23931 527.00 511.38 492.67 401.61 24500 PR CLOSED RX MID HUMERUS FRACTURE 24500 655.00 635.82 607.59 499.34 24530 PR CLOSED RX HUMERAL SUPRACONDYLAR FX 52 24530 695.00 674.78 643.79 529.94 24530 PR CLOSED RX HUMERAL SUPRACONDYLAR FX 24530 695.00 674.78 643.79 529.94 24535 "PR CLOSED RX HUM SUPRACONDYLR FX,MANIPU" 24535 " 1,129.00 " " 1,096.49 " " 1,044.39 " 861.12 24560 PR CLOSED RX HUMER EPICONDYLR FX 24560 597.00 580.01 557.17 455.51 24600 PR CLOSED RX ELBOW DISLOCATION 24600 681.00 660.84 627.30 518.99 24605 "PR CLOSED RX ELBOW DISLOCATN,ANESTHESIA" 24605 866.00 840.97 802.86 660.45 24640 "PR CLOSED RX RADIAL HEAD DISLOC,CHILD" 52 24640 189.00 183.63 176.29 144.21 24640 "PR CLOSED RX RADIAL HEAD DISLOC,CHILD" 24640 189.00 183.63 176.29 144.21 24650 PR CLOSED RX RADIAL HEAD/NECK FX 24650 479.00 464.68 443.93 364.94 24655 "PR CLOSED RX RADIAL HEAD/NECK FX,MANIP" 24655 812.00 788.64 747.75 619.35 25500 PR CLOSED RX RADIAL SHAFT FX 25500 507.00 491.96 472.07 386.36 25530 PR CLOSED RX ULNA SHAFT FX 25530 479.00 464.87 444.54 365.09 25560 PR CLOSED RX RAD/ULNA SHAFT FX 25560 517.00 501.93 482.15 394.19 25565 "PR CLOSED RX RAD/ULNA SHAFT FX,MANIP" 25565 945.00 917.54 874.69 720.59 25600 PR CLOSED RX DIST RAD/ULNA FX 52 25600 604.00 586.47 562.84 460.58 25600 PR CLOSED RX DIST RAD/ULNA FX 25600 604.00 586.47 562.84 460.58 25605 "PR CLOSED RX DIST RAD/ULNA FX,MANIPUL" 52 25605 991.00 962.49 916.10 755.88 25605 "PR CLOSED RX DIST RAD/ULNA FX,MANIPUL" 25605 991.00 962.49 916.10 755.88 25622 PR CLOSED RX NAVICULAR FX 25622 559.00 543.09 518.12 426.51 25630 PR CLOSED RX CARPAL FX 25630 559.00 542.33 518.48 425.91 25650 PR CLOSED RX ULNA STYLOID FX 25650 592.00 575.10 552.64 451.65 26010 "PR DRAIN FINGER ABSCESS,SIMPLE" 52 26010 500.00 485.71 512.97 381.45 26010 "PR DRAIN FINGER ABSCESS,SIMPLE" 26010 500.00 485.71 512.97 381.45 26075 PR EXPLORE & TREAT METACARPO-PHAL JT 26075 614.00 596.00 570.72 468.06 26160 "PR EXCIS TENDON SHEATH LESION, HAND/FINGER" 52 26160 " 1,070.00 " " 1,039.21 " 970.79 816.14 26160 "PR EXCIS TENDON SHEATH LESION, HAND/FINGER" 26160 " 1,070.00 " " 1,039.21 " 970.79 816.14 26410 "PR REPAIR EXTEN TENDON,DORSUM HAND,EA" 26410 " 1,018.00 " 988.41 981.54 776.24 26535 PR ARTHROPLASTY I-P JT 26535 792.00 769.41 739.68 604.25 26600 PR CLOSED RX METACARPAL FX 52 26600 540.00 524.12 503.12 411.62 26600 PR CLOSED RX METACARPAL FX 26600 540.00 524.12 503.12 411.62 26605 "PR CLOSED RX METACARPAL FX,MANIP" 26605 593.00 575.96 551.92 452.33 26641 "PR TREAT THUMB DISLOC,MANIPULATN" 26641 694.00 673.49 648.65 528.92 26670 "PR CLOSED RX, CARPOMETACAR DISLOC,NON-THUMB" 26670 636.00 617.71 582.53 485.12 26700 PR CLOSED RX MC-P DISLOC 26700 606.00 588.05 562.78 461.82 26705 "PR CLOSED RX MC-P DISLOC,ANESTH" 26705 769.00 746.18 715.82 586.01 26720 PR CLOSE RX PROX/MID FING SHFT FX 26720 362.00 351.94 335.17 276.39 26725 "PR CLOSE RX PROX/MID FING SHFT FX,MANIP" 26725 621.00 603.03 576.36 473.58 26735 PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA 26735 " 1,094.00 " " 1,061.69 " " 1,010.30 " 833.79 26740 PR CLOSE RX FINGR ARTICULAR FX 26740 421.00 409.06 390.66 321.26 26742 "PR CLOSE RX FINGR ARTICULAR FX,MANIP" 26742 682.00 661.83 631.79 519.77 26750 PR CLOSE RX DIST FINGR FX 26750 339.00 329.00 314.28 258.38 26755 "PR CLOSE RX DIST FINGR FX,MANIPULATN" 26755 579.00 562.36 538.92 441.65 26765 PR OPEN TX DISTAL PHALANGEAL FRACTURE EACH 26765 920.00 893.46 852.40 701.67 26770 PR CLOSED RX IP JT DISLOCATION 52 26770 514.00 499.35 476.35 392.16 26770 PR CLOSED RX IP JT DISLOCATION 26770 514.00 499.35 476.35 392.16 26775 "PR CLOSED RX IP JT DISLOCATION,ANESTH" 26775 706.00 685.67 654.65 538.49 26952 PR AMPUTATION FINGER/THUMB+FLAPS 26952 " 1,165.00 " " 1,130.85 " " 1,119.21 " 888.11 26990 "PR INCIS/DRAIN PELVIS/HIP,DEEP ABSCESS" 26990 " 1,164.00 " " 1,130.20 " " 1,107.34 " 887.60 27096 "PR INJECTION,SACROILIAC JOINT" 27096 299.00 289.92 278.70 227.69 27250 PR CLOSED RX TRAUMATIC HIP DISLOCATN 27250 334.00 323.88 309.11 254.36 27252 "PR CLOSED RX TRAUMA HIP DISLOC,ANESTH" 27252 " 1,387.00 " " 1,346.66 " " 1,278.62 " " 1,057.59 " 27256 PR CLOSED RX SPONTANEOUS HIP DISLOC 52 27256 562.00 545.65 513.09 428.01 27256 PR CLOSED RX SPONTANEOUS HIP DISLOC 27256 562.00 545.65 513.09 428.01 27257 "PR CLOSED RX SPONT HIP DISLOC,ANESTH" 27257 664.00 644.97 611.90 506.18 27265 PR CLOSED RX POST HIP ARTHRPLAS DISLOC 27265 742.00 720.66 684.32 565.97 27266 "PR CLOSED RX POST HIP FIX DISLOC,ANESTH" 52 27266 " 1,065.00 " " 1,033.84 " 986.88 811.92 27266 "PR CLOSED RX POST HIP FIX DISLOC,ANESTH" 27266 " 1,065.00 " " 1,033.84 " 986.88 811.92 27306 "PR INCIS THIGH TENDON,ADDUC/HAMST,SINGL" 27306 644.00 625.24 596.45 491.03 27372 "PR REMV FOREIGN BODY,KNEE/THIGH,DEEP" 27372 " 1,092.00 " " 1,060.37 " " 1,018.31 " 832.76 27510 "PR CLOSED RX FEMUR,DISTAL+MANIP" 52 27510 " 1,253.00 " " 1,216.38 " " 1,151.91 " 955.28 27510 "PR CLOSED RX FEMUR,DISTAL+MANIP" 27510 " 1,253.00 " " 1,216.38 " " 1,151.91 " 955.28 27520 PR CLOSED RX PATELLA FX 27520 591.00 573.32 546.78 450.26 27530 PR CLOSED RX TIBIAL PLATEAU FX 27530 553.00 537.03 514.11 421.76 27550 PR CLOSED RX KNEE DISLOCATN 27550 952.00 924.75 885.34 726.24 27552 PR CLOSED RX KNEE DISLOC+ANESTH 52 27552 " 1,150.00 " " 1,116.13 " " 1,065.12 " 876.54 27552 PR CLOSED RX KNEE DISLOC+ANESTH 27552 " 1,150.00 " " 1,116.13 " " 1,065.12 " 876.54 27560 PR CLOSED RX KNEECAP DISLOCATN 27560 674.00 654.73 632.30 514.19 27562 PR CLOSED RX KNEECAP DISLOC+ANESTH 27562 887.00 861.37 823.24 675.27 27750 PR CLOSED RX TIBIA SHAFT FX 27750 633.00 614.28 585.68 482.42 27752 "PR CLOSED RX TIBIA SHAFT FX,MANIPULATN" 52 27752 981.00 952.08 906.67 747.71 27752 "PR CLOSED RX TIBIA SHAFT FX,MANIPULATN" 27752 981.00 952.08 906.67 747.71 27760 PR CLOSED RX MED MALLEOLUS FX 27760 612.00 593.78 566.73 466.32 27762 "PR CLOSED RX MED MALLEOLUS FX,MANIP" 52 27762 876.00 850.58 811.08 668.00 27762 "PR CLOSED RX MED MALLEOLUS FX,MANIP" 27762 876.00 850.58 811.08 668.00 27767 PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANIP 52 27767 850.00 504.14 487.83 395.93 27780 PR CLOSED RX PROX/SHAFT FIBULA FX 52 27780 560.00 543.57 520.32 426.89 27780 PR CLOSED RX PROX/SHAFT FIBULA FX 27780 560.00 543.57 520.32 426.89 27786 PR CLOSED RX DIST FIBULA FX 52 27786 577.00 560.20 533.59 439.95 27786 PR CLOSED RX DIST FIBULA FX 27786 577.00 560.20 533.59 439.95 27808 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP 52 27808 612.00 594.12 566.26 466.59 27808 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANIP 27808 612.00 594.12 566.26 466.59 27810 PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP 27810 860.00 834.61 793.88 655.46 27816 PR CLOSED RX TRIMALLEOLAR FX 27816 596.00 578.90 553.95 454.64 27818 "PR CLOSED RX TRIMALLEOLAR FX,MANIP" 27818 894.00 867.85 824.04 681.56 27831 PR CLOSED RX PROX TIB/FIB DISLOC+ANESTH 27831 737.00 715.14 684.05 561.63 27840 PR CLOSED RX ANKLE DISLOCATN 27840 691.00 671.08 637.95 527.03 27842 "PR CLOSED RX ANKLE DISLOCATN,ANESTH" 52 27842 900.00 874.09 836.20 686.46 27842 "PR CLOSED RX ANKLE DISLOCATN,ANESTH" 27842 900.00 874.09 836.20 686.46 28092 "PR EXCIS TENDN/CAPSULE LESN,TOES" 28092 803.00 780.06 735.83 612.62 28190 "PR REMV FOOT FOREIGN BODY,SUBCUTANEOUS" 28190 479.00 465.52 437.36 365.60 28400 PR CLOSED RX HEEL FX 28400 457.00 444.17 421.77 348.83 28430 PR CLOSED RX TALUS FX 28430 440.00 426.88 407.73 335.25 28435 "PR CLOSED RX TALUS FX,MANIPULATN" 28435 666.00 646.55 617.45 507.59 28450 "PR CLOSED RX TARSAL FX,EACH" 28450 395.00 383.05 362.93 300.83 28470 PR CLOSED RX METATARSAL FX 52 28470 405.00 393.29 373.45 308.87 28470 PR CLOSED RX METATARSAL FX 28470 405.00 393.29 373.45 308.87 28490 PR CLOSED RX BIG TOE FRACTURE 52 28490 267.00 259.21 243.35 203.57 28490 PR CLOSED RX BIG TOE FRACTURE 28490 267.00 259.21 243.35 203.57 28510 PR CLOSED RX TOE FX 52 28510 228.00 221.81 208.77 174.20 28510 PR CLOSED RX TOE FX 28510 228.00 221.81 208.77 174.20 28530 PR CLOSED RX SESAMOID BONE FX 28530 218.00 211.61 199.09 166.19 28660 "PR CLOSED RX I-P JT,TOE DISLOCATION" 28660 220.00 213.14 202.29 167.39 28810 "PR AMPUTATION METATARSAL+TOE,SINGLE" 28810 795.00 771.75 733.42 606.09 29065 PR APPLY LONG ARM CAST 29065 175.00 169.67 159.76 133.25 29075 PR APPLY FOREARM CAST 29075 158.00 153.56 144.29 120.60 29085 PR APPLY HAND/WRIST CAST 29085 174.00 168.81 158.98 132.57 29105 PR APPLY LONG ARM SPLINT 29105 151.00 146.42 137.30 114.99 29125 "PR APPLY FOREARM SPLINT,STATIC" 29125 118.00 114.87 107.93 90.21 29130 "PR APPLY FINGER SPLINT,STATIC" 29130 76.00 73.53 69.71 57.75 29240 PR STRAPPING OF SHOULDER 29240 58.00 56.10 54.04 44.06 29260 PR STRAPPING OF ELBOW OR WRIST 29260 56.00 54.43 52.43 42.75 29280 PR STRAPPING OF HAND OR FINGER 29280 57.00 55.70 52.80 43.74 29345 PR APPLY LONG LEG CAST 29345 247.00 239.65 227.03 188.21 29405 PR APPLY SHORT LEG CAST 29405 148.00 144.13 134.73 113.19 29425 "PR APPLY SHORT LEG CAST,WALKER" 29425 143.00 138.69 129.78 108.92 29440 PR ADDITION OF WALKER TO CAST 29440 82.00 79.57 74.77 62.49 29505 PR APPLY LONG LEG SPLINT 29505 157.00 152.82 143.45 120.02 29515 PR APPLY LOWER LEG SPLINT 29515 132.00 128.01 119.81 100.53 29520 PR STRAPPING OF HIP 29520 64.00 62.36 61.21 48.98 29530 PR STRAPPING OF KNEE 29530 57.00 55.47 53.45 43.56 29540 PR STRAPPING; ANKLE &/OR FOOT 29540 54.00 52.56 49.45 41.28 29580 PR STRAPPING UNNA BOOT 29580 115.00 112.06 107.43 88.01 29581 PR APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE 29581 162.00 157.61 154.41 123.78 29700 PR REMV/REVISN BOOT/BODY CAST 29700 118.00 114.28 105.94 89.75 29705 PR REMV/REVISN FULL ARM/LEG CAST 29705 119.00 115.71 108.64 90.87 29873 "PR KNEE SCOPE, W/LATERAL RELEASE" 29873 964.00 936.09 896.57 735.15 30300 PR REMOVE NASAL FOREIGN BODY 52 30300 340.00 330.53 323.52 259.58 30300 PR REMOVE NASAL FOREIGN BODY 30300 340.00 330.53 323.52 259.58 30310 "PR REMV NASAL FOR BODY,GEN ANESTH" 30310 373.00 362.48 346.69 284.67 30901 "PR CTRL NOSEBLEED,ANTER,SIMPLE" 30901 253.00 245.63 243.30 192.90 30903 "PR CTRL NOSEBLEED,ANTER,COMPLEX" 30903 398.00 386.43 385.49 303.48 30905 "PR CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT" 30905 605.00 587.52 573.23 461.40 31000 PR IRRIGATION MAXILLARY SINUS 31000 334.00 324.36 309.22 254.73 31500 PR INSERT EMERGENCY ENDOTRACH AIRWAY 31500 267.00 258.86 247.27 203.30 31502 PR TRACH TUBE CHANGE 31502 66.00 64.04 60.46 50.30 31505 "PR LARYNGOSCOPY,INDIRECT,DX" 31505 155.00 150.85 147.98 118.47 31575 PR LARYNGOSCOPY FLEXIBLE DIAGNOSTIC 31575 214.00 207.87 209.01 163.25 32421 PR THORACENTESIS PUNCTURE PLEURAL CAVITY ASPIRATION 32421 335.00 N/A N/A N/A 32422 PR THORACENTESIS WITH INSERTION TUBE WATER SEAL 32422 408.00 N/A N/A N/A 32551 PR TUBE THORACOSTOMY INCLUDES WATER SEAL 32551 291.00 282.22 268.43 221.64 32554 PR THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING 32554 391.00 379.99 380.93 298.43 35207 "PR REBL VES DIRECT,HAND/FINGR" 35207 " 1,393.00 " " 1,352.57 " " 1,283.23 " " 1,062.23 " 36147 "PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,1ST ACCESS W/ RAD EVAL" 36147 " 1,502.00 " N/A N/A N/A 36415 "CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE" 36415 6.00 5.73 4.00 1.80 36468 PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK 36468 280.00 272.19 259.37 N/A 36470 PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN 36470 194.00 188.12 184.17 147.74 36471 PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS 36471 352.00 341.34 331.09 268.07 36510 "PR CATH, VEIN UMBILICAL NEWBORN" 36510 155.00 150.47 144.11 118.17 36555 PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y 36555 350.00 339.71 324.74 266.79 36558 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 " 36569 PR INSERTION PICC W/O IMG GDN 5 YR/> 36569 180.00 175.22 166.88 137.61 36576 PR RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT 36576 597.00 579.28 574.97 454.94 36589 PR REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP 36589 305.00 296.13 284.54 232.56 36590 PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ 36590 407.00 394.74 378.23 310.01 36680 "PR INSERT NEEDLE,INTRAOSSEOUS INFUSN" 36680 109.00 105.97 101.52 83.22 37609 PR TEMPORAL ARTERY LIGATN OR BX 37609 566.00 549.66 526.27 431.67 37766 PR PHLEB VEINS - EXTREM 20+ 37766 " 1,400.00 " " 1,359.08 " 868.81 " 1,067.34 " 40650 "PR REPAIR LIP,FULL THICK,VERMILION" 40650 841.00 816.16 786.66 640.97 40800 "PR DRAIN MOUTH ABSC/CYST/HEMATOMA,SIMPL" 40800 392.00 380.32 358.21 298.68 40806 PR INCISION OF LIP FOLD 40806 187.00 181.35 169.35 142.43 41010 PR INCISION OF TONGUE FOLD 41010 381.00 369.93 356.85 290.52 41250 "PR REPAIR TONGUE LACER,<2.6 CM" 41250 507.00 492.23 473.64 386.57 41800 PR DRAINAGE OF GUM LESION 41800 536.00 520.23 498.79 408.56 42809 PR REMOVE PHARYNX FOREIGN BODY 42809 372.00 360.70 343.40 283.28 42970 "PR CNTRL NASOPHAR BLEED,SIMPLE,W/POST PACKS" 42970 764.00 741.79 702.34 582.39 43202 PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY 43202 591.00 574.24 576.30 450.98 43215 PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY 43215 681.00 661.55 653.84 519.54 43233 PR EGD ESOPHAGUS BALLOON DILATION 30 MM OR LARGER 43233 431.00 418.79 395.92 328.89 43235 PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC 43235 493.00 478.23 478.15 375.57 43239 PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE 43239 659.00 640.06 637.33 502.67 43245 PR EGD DILATION GASTRIC/DUODENAL STRICTURE 43245 " 1,047.00 " " 1,016.75 " " 1,003.86 " 798.50 43247 PR EGD FLEXIBLE FOREIGN BODY REMOVAL 43247 662.00 643.17 633.91 505.11 43248 PR EGD INSERT GUIDE WIRE DILATOR PASSAGE ESOPHAGUS 43248 681.00 661.51 665.05 519.51 43249 PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM 43249 " 1,937.00 " " 1,880.43 " " 1,856.96 " " 1,476.78 " 43258 "PR UPPER GI ENDOSCOPY,TUMOR ABLATN" 43258 489.00 N/A N/A N/A 43456 "PR DILATE ESOPHAGUS,BALLOON RETROGRADE" 43456 " 1,236.00 " N/A N/A N/A 43752 PR PLACEMENT NG/OG TUBE BY PHYSICIAN 43752 77.00 75.04 71.56 58.94 43753 "PR GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC" 43753 41.00 39.80 37.77 31.26 43760 PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE 43760 868.00 N/A N/A N/A 43762 PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC 43762 407.00 395.43 384.60 310.55 43770 "PR LAP, PLACE ADJUST GAST RESTRICT DEVICE" 43770 " 2,036.00 " " 1,977.08 " " 1,884.72 " " 1,552.68 " 44005 "PR FREEING BOWEL ADHESION,ENTEROLYSIS" 55 44005 " 1,988.00 " " 1,929.79 " " 1,835.54 " " 1,515.54 " 44005 "PR FREEING BOWEL ADHESION,ENTEROLYSIS" 44005 " 1,988.00 " " 1,929.79 " " 1,835.54 " " 1,515.54 " 44160 PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY 55 44160 " 2,261.00 " " 2,195.58 " " 2,090.43 " " 1,724.28 " 44160 PR REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY 44160 " 2,261.00 " " 2,195.58 " " 2,090.43 " " 1,724.28 " 44180 "PR LAP, SURG ENTEROLYSIS" 55 44180 " 1,672.00 " " 1,622.98 " " 1,544.67 " " 1,274.60 " 44180 "PR LAP, SURG ENTEROLYSIS" 44180 " 1,672.00 " " 1,622.98 " " 1,544.67 " " 1,274.60 " 44388 PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX 44388 543.00 526.76 518.50 413.69 44389 PR COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE 44389 716.00 695.24 684.90 546.00 45020 PR DRAINAGE OF DEEP RECTAL ABSCESS 45020 " 1,048.00 " " 1,017.84 " 968.86 799.35 45309 PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ 45309 324.00 314.90 318.46 247.31 45330 PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD 45330 315.00 306.00 297.79 240.32 45331 "PR SIGMOIDOSCOPY,BIOPSY" 45331 491.00 477.00 468.92 374.61 45378 PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD 45378 594.00 576.48 564.89 452.73 45380 PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE 45380 764.00 741.42 728.49 582.27 45383 "PR COLONOSCOPY,ABLATE LESION" 45383 " 1,066.00 " N/A N/A N/A 45384 PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS 45384 847.00 822.41 808.90 645.87 45385 PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ 45385 802.00 778.94 762.20 611.73 45560 PR REPAIR OF RECTOCELE 52 45560 " 1,288.00 " " 1,250.13 " " 1,193.48 " 981.78 45560 PR REPAIR OF RECTOCELE 45560 " 1,288.00 " " 1,250.13 " " 1,193.48 " 981.78 46040 PR I&D PERIRECTAL ABSCESS 46040 987.00 958.53 924.36 752.78 46050 "PR I&D PERIANAL ABSCESS,SUPERFICIAL" 46050 384.00 372.89 371.39 292.85 46083 PR INCISE EXTERNAL HEMORRHOID 46083 337.00 327.43 327.04 257.15 46230 PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS 55 46230 520.00 505.08 499.88 396.66 46230 PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS 46230 520.00 505.08 499.88 396.66 46320 "PR EXCISION THROMBOSED HEMORRHOID, EXTERNAL" 52 46320 348.00 338.07 335.52 265.50 46320 "PR EXCISION THROMBOSED HEMORRHOID, EXTERNAL" 46320 348.00 338.07 335.52 265.50 46600 PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD 46600 175.00 170.12 175.08 133.61 46900 "PR DESTRUCT,ANAL LESN(S),SIMPLE,CHEM" 46900 437.00 424.27 404.42 333.20 46940 "PR CAUTERY ANAL FISSURE,INITIAL" 46940 438.00 425.20 421.69 333.93 47562 "PR LAP,CHOLECYSTECTOMY" 47562 " 1,194.00 " " 1,159.16 " " 1,104.56 " 910.34 47563 "PR LAP,CHOLECYSTECTOMY/GRAPH" 47563 " 1,297.00 " " 1,259.59 " " 1,202.07 " 989.21 49083 PR ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE 49083 550.00 533.73 515.57 419.16 49255 PR REMOVAL OF OMENTUM 49255 " 1,445.00 " " 1,402.89 " " 1,332.86 " " 1,101.75 " 49451 PR REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS 49451 " 1,324.00 " " 1,285.05 " " 1,217.34 " " 1,009.20 " 49560 "PR REPAIR INCISIONAL HERNIA,REDUCIBLE" 55 49560 " 1,339.00 " " 1,299.79 " " 1,238.69 " " 1,020.78 " 49560 "PR REPAIR INCISIONAL HERNIA,REDUCIBLE" 49560 " 1,339.00 " " 1,299.79 " " 1,238.69 " " 1,020.78 " 49570 "PR REPAIR EPIGASTRIC HERNIA,REDUC" 49570 758.00 736.08 700.43 578.07 49585 "PR REPAIR UMBILICAL HERN,5+Y/O,REDUC" 49585 808.00 784.65 748.84 616.22 51701 "PR INSERT,NON-INDWELLING BLADDER CATHETER" 51701 83.00 80.62 76.09 63.32 51702 "PR INSERT,TEMP INDWELLING BLAD CATH,SIMPLE" 51702 115.00 111.31 104.40 87.42 51703 "PR INSERT,TEMP INDWELLING BLAD CATH,COMP" 51703 247.00 239.36 238.95 187.98 51705 "PR CHANGE OF BLADDER TUBE,SIMPLE" 51705 174.00 168.75 162.62 132.53 51798 "PR MEAS,POST-VOID RES,US,NON-IMAGING" 51798 23.00 22.14 16.91 17.39 51840 "PR ANTER VESICOURETHROPEXY,SIMPLE" 55 51840 " 1,261.00 " " 1,224.31 " " 1,183.09 " 961.50 51840 "PR ANTER VESICOURETHROPEXY,SIMPLE" 51840 " 1,261.00 " " 1,224.31 " " 1,183.09 " 961.50 51992 "PR LAP,SLING OPERATION" 55 51992 " 1,571.00 " " 1,525.00 " " 1,451.72 " " 1,197.65 " 51992 "PR LAP,SLING OPERATION" 51992 " 1,571.00 " " 1,525.00 " " 1,451.72 " " 1,197.65 " 54050 "PR DESTR PENIS LESN,SIMPL,CHEMICAL" 54050 246.00 239.09 230.99 187.77 54056 "PR DESTR PENIS LESN,SIMPL,CRYOSURG" 54056 261.00 253.09 240.95 198.77 54060 "PR DESTR PENIS LESN,SIMPL,SURG EXCIS" 54060 344.00 334.25 322.49 262.50 54100 "PR BX,PENIS (SEPARATE PROCEDURE)" 54100 366.00 354.88 342.00 278.70 54115 PR REMV FOR.BODY DEEP PENILE TISS 54115 857.00 831.63 789.70 653.12 54150 "PR CIRCUMCISION,CLAMP" 54150 288.00 279.26 263.68 219.32 54161 "PR CIRCUMCISION,OTHR" 54161 373.00 362.14 342.78 284.40 55250 PR REMOVAL OF SPERM DUCT(S) 55250 693.00 673.12 620.11 528.63 56405 PR I&D OF VULVA/PERINEUM ABSCESS 56405 211.00 205.06 218.44 161.04 56420 PR I&D BARTHOLIN GLAND ABSCESS 56420 251.00 243.37 265.12 191.13 56440 PR MARSUP BARTHOLIN GLAND CYST 56440 336.00 325.83 311.22 255.89 56501 "PR DESTRUCTION,LESION(S),VULVA,SIMPLE" 56501 266.00 258.46 279.50 202.98 56515 "PR DESTRUCTION,LESION(S),VULVA;EXTENSIVE" 56515 436.00 422.91 431.36 332.13 56605 "PR BIOPSY VULVA/PERINEUM,ONE LESN" 56605 158.00 153.32 154.34 120.41 56606 "PR BX,VULVA/PERINEUM,ADDL LESION" 56606 70.00 68.42 65.83 53.73 56740 PR EXCIS BARTHOLIN GLAND/CYST 56740 560.00 544.16 528.95 427.35 56810 "PR REPAIR OF PERINEUM,NON OBSTETRICAL" 56810 488.00 474.16 460.01 372.38 57010 PR EXPLOR VAGINA/DRAIN PELVIC ABSCESS 57010 813.00 789.00 769.66 619.47 57022 "PR I&D VAGINAL HEMATOMA,OBSTET/POSTPART" 57022 318.00 308.29 302.56 242.12 57061 "PR DESTRUCT,VAGINAL LESION(S),SIMPLE" 57061 228.00 221.62 240.86 174.05 57100 "PR BIOPSY OF VAGINA,SIMPLE" 57100 170.00 165.06 164.49 129.63 57160 PR FIT/INSERT INTRAVAG SUPPORT DEVICE 57160 117.00 113.57 116.95 89.19 57180 PR TREAT VAGINAL BLEEDING 57180 284.00 276.09 295.70 216.83 57240 PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO 55 57240 " 1,112.00 " " 1,079.23 " " 1,044.32 " 847.56 57240 PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO 57240 " 1,112.00 " " 1,079.23 " " 1,044.32 " 847.56 57250 "PR POST COLPORRHAPHY,RECTUM/VAGINA" 55 57250 " 1,114.00 " " 1,081.33 " " 1,047.97 " 849.21 57250 "PR POST COLPORRHAPHY,RECTUM/VAGINA" 57250 " 1,114.00 " " 1,081.33 " " 1,047.97 " 849.21 57260 PR CMBND ANTERPOST COLPORRAPHY W/CYSTO 55 57260 " 1,423.00 " " 1,381.96 " " 1,335.37 " " 1,085.31 " 57260 PR CMBND ANTERPOST COLPORRAPHY W/CYSTO 57260 " 1,423.00 " " 1,381.96 " " 1,335.37 " " 1,085.31 " 57265 PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR 55 57265 " 1,597.00 " " 1,550.67 " " 1,496.75 " " 1,217.81 " 57265 PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR 57265 " 1,597.00 " " 1,550.67 " " 1,496.75 " " 1,217.81 " 57284 PR PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPROACH 55 57284 " 1,527.00 " " 1,482.33 " " 1,428.83 " " 1,164.14 " 57284 PR PARAVAGINAL DEFECT REPAIR OPEN ABDOMINAL APPROACH 57284 " 1,527.00 " " 1,482.33 " " 1,428.83 " " 1,164.14 " 57288 PR SLING OPER STRES INCONTINENCE 55 57288 " 1,350.00 " " 1,311.16 " " 1,267.52 " " 1,029.71 " 57288 PR SLING OPER STRES INCONTINENCE 57288 " 1,350.00 " " 1,311.16 " " 1,267.52 " " 1,029.71 " 57410 PR PELVIC EXAMINATION W ANESTH 57410 197.00 191.71 182.55 150.56 57420 "PR COLPOSCOPY,ENTIRE VAGINA" 57420 222.00 215.43 214.31 169.19 57421 "PR COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S)" 57421 298.00 289.58 288.80 227.42 57452 "PR COLPOSCOPY,CERVIX W/ADJ VAGINA" 57452 210.00 204.31 204.99 160.46 57454 "PR COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG" 57454 291.00 282.18 279.79 221.61 57455 "PR COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX" 57455 273.00 265.22 264.12 208.29 57456 "PR COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG" 57456 257.00 249.52 248.41 195.96 57500 "PR BIOPSY CERVIX, 1 OR MORE, OR EXCISION OF LESION" 57500 247.00 239.36 244.68 187.98 57505 PR ENDOCERVICAL CURETTAGE 57505 207.00 200.66 219.95 157.59 57511 PR CRYOCAUTERY OF CERVIX 57511 289.00 280.20 297.32 220.05 58100 PR BIOPSY OF UTERUS LINING 58100 172.00 166.74 166.53 130.95 58110 PR ENDOMET BIOPSY DONE W/COLPOSCOPY 58110 94.00 90.90 86.80 71.39 58120 "PR DILATION/CURETTAGE,DIAGNOSTIC" 58120 497.00 482.08 480.64 378.60 58150 PR TOTAL ABDOM HYSTERECTOMY 55 58150 " 1,872.00 " " 1,817.58 " " 1,736.12 " " 1,427.42 " 58150 PR TOTAL ABDOM HYSTERECTOMY 58150 " 1,872.00 " " 1,817.58 " " 1,736.12 " " 1,427.42 " 58152 PR TOTAL ABD HYSTERECTOMY+BLAD REPR 55 58152 " 2,312.00 " " 2,244.96 " " 2,154.66 " " 1,763.06 " 58152 PR TOTAL ABD HYSTERECTOMY+BLAD REPR 58152 " 2,312.00 " " 2,244.96 " " 2,154.66 " " 1,763.06 " 58180 PR SUPRACERV ABD HYSTERECTOMY 55 58180 " 1,777.00 " " 1,725.63 " " 1,653.09 " " 1,355.21 " 58180 PR SUPRACERV ABD HYSTERECTOMY 58180 " 1,777.00 " " 1,725.63 " " 1,653.09 " " 1,355.21 " 58210 PR RADICAL ABD HYSTEREC+PELV NODES 55 58210 " 3,375.00 " " 3,276.49 " " 3,107.32 " " 2,573.16 " 58210 PR RADICAL ABD HYSTEREC+PELV NODES 58210 " 3,375.00 " " 3,276.49 " " 3,107.32 " " 2,573.16 " 58260 "PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/<" 55 58260 " 1,534.00 " " 1,489.57 " " 1,438.13 " " 1,169.82 " 58260 "PR VAGINAL HYSTERECTOMY,UTERUS 250 GMS/<" 58260 " 1,534.00 " " 1,489.57 " " 1,438.13 " " 1,169.82 " 58262 "PR VAG HYST,RMV TUBE/OVARY" 55 58262 " 1,706.00 " " 1,656.22 " " 1,596.63 " " 1,300.70 " 58262 "PR VAG HYST,RMV TUBE/OVARY" 58262 " 1,706.00 " " 1,656.22 " " 1,596.63 " " 1,300.70 " 58290 "PR VAG HYST,UTERUS >250 GMS" 58290 " 2,129.00 " " 2,066.94 " " 1,986.91 " " 1,623.26 " 58300 PR INSERT INTRAUTERINE DEVICE 58300 148.00 143.21 157.54 112.59 58301 PR REMOVE INTRAUTERINE DEVICE 58301 176.00 170.89 173.45 134.21 58541 "PR LAP, SUPRACERVIAL HYSTERECTOMY, <250G" 55 58541 " 1,333.00 " " 1,294.22 " " 1,253.65 " " 1,016.40 " 58541 "PR LAP, SUPRACERVIAL HYSTERECTOMY, <250G" 58541 " 1,333.00 " " 1,294.22 " " 1,253.65 " " 1,016.40 " 58542 "PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G" 55 58542 " 1,522.00 " " 1,477.33 " " 1,425.72 " " 1,160.21 " 58542 "PR LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G" 58542 " 1,522.00 " " 1,477.33 " " 1,425.72 " " 1,160.21 " 58550 "PR LAP,VAG HYST,UTERUS 250GMS/<" 55 58550 " 1,628.00 " " 1,580.77 " " 1,519.75 " " 1,241.45 " 58550 "PR LAP,VAG HYST,UTERUS 250GMS/<" 58550 " 1,628.00 " " 1,580.77 " " 1,519.75 " " 1,241.45 " 58552 "PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH" 55 58552 " 1,820.00 " " 1,767.27 " " 1,693.06 " " 1,387.91 " 58552 "PR LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH" 58552 " 1,820.00 " " 1,767.27 " " 1,693.06 " " 1,387.91 " 58558 "PR HYSTEROSCOPY,W/ENDO BX" 58558 " 2,513.00 " " 2,439.85 " " 2,363.31 " " 1,916.12 " 58562 "PR HYSTEROSCOPY,RMV FB" 58562 676.00 656.45 673.44 515.54 58571 PR LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY 58571 " 1,654.00 " " 1,606.18 " " 1,540.28 " " 1,261.40 " 58605 "PR LIGATE FALLOPIAN TUBE,POSTPARTUM" 58605 611.00 593.53 573.68 466.13 58611 "PR LIGATION,FALLOPIAN TUBE W/C-SECTION" 58611 142.00 137.98 132.44 108.36 58660 "PR LAP,LYSIS OF ADHESIONS" 55 58660 " 1,245.00 " " 1,208.29 " " 1,160.30 " 948.92 58660 "PR LAP,LYSIS OF ADHESIONS" 58660 " 1,245.00 " " 1,208.29 " " 1,160.30 " 948.92 58661 "PR LAP,RMV ADNEXAL STRUCTURE" 55 58661 " 1,201.00 " " 1,165.86 " " 1,119.17 " 915.60 58661 "PR LAP,RMV ADNEXAL STRUCTURE" 58661 " 1,201.00 " " 1,165.86 " " 1,119.17 " 915.60 58662 "PR LAP,FULGURATE/EXCISE LESIONS" 55 58662 " 1,311.00 " " 1,272.98 " " 1,222.99 " 999.72 58662 "PR LAP,FULGURATE/EXCISE LESIONS" 58662 " 1,311.00 " " 1,272.98 " " 1,222.99 " 999.72 58670 "PR LAP,TUBAL CAUTERY" 58670 676.00 655.97 634.98 515.16 58720 PR REMOVAL OF OVARY/TUBE(S) 55 58720 " 1,366.00 " " 1,326.06 " " 1,277.51 " " 1,041.41 " 58720 PR REMOVAL OF OVARY/TUBE(S) 58720 " 1,366.00 " " 1,326.06 " " 1,277.51 " " 1,041.41 " 58740 PR LYSIS ADNEXAL ADHESIONS 55 58740 " 1,642.00 " " 1,593.91 " " 1,531.93 " " 1,251.77 " 58740 PR LYSIS ADNEXAL ADHESIONS 58740 " 1,642.00 " " 1,593.91 " " 1,531.93 " " 1,251.77 " 58925 PR REMOVAL OF OVARIAN CYST(S) 55 58925 " 1,383.00 " " 1,343.02 " " 1,296.55 " " 1,054.73 " 58925 PR REMOVAL OF OVARIAN CYST(S) 58925 " 1,383.00 " " 1,343.02 " " 1,296.55 " " 1,054.73 " 58940 PR REMOVAL OF OVARY(S) 55 58940 979.00 950.86 922.50 746.75 58940 PR REMOVAL OF OVARY(S) 58940 979.00 950.86 922.50 746.75 59025 PR FETAL NON-STRESS TEST 59025 86.00 83.81 79.99 65.82 59051 PR FETAL MONITOR/INTERPRET ONLY 59051 75.00 72.64 69.14 57.05 59160 PR D&C AFTER DELIVERY 59160 389.00 377.57 398.94 296.52 59300 PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING 59300 362.00 351.10 355.03 275.73 59400 "PR FULL ROUT OBSTE CARE,VAGINAL DELIV" 59400 " 3,782.00 " " 3,671.99 " " 3,528.43 " " 2,883.77 " 59409 "PR OBSTETRICAL CARE,VAG DELIV ONLY" 59409 " 1,457.00 " " 1,414.36 " " 1,341.74 " " 1,110.75 " 59410 "PR OBSTE CARE,VAG DELIV+POSTPARTUM" 59410 " 1,867.00 " " 1,812.99 " " 1,728.93 " " 1,423.82 " 59412 PR ANTEPARTUM HEAD MANIPULATION 59412 183.00 177.86 169.41 139.68 59414 PR DELIVER PLACENTA 59414 164.00 158.85 150.17 124.76 59425 "PR ANTEPARTUM CARE ONLY, 4-6 VISITS" 59425 829.00 805.18 778.94 632.34 59426 "PR ANTEPARTUM CARE ONLY, >7 VISITS" 59426 " 1,483.00 " " 1,440.14 " " 1,389.48 " " 1,131.00 " 59430 PR CARE AFTER DELIVERY ONLY 59430 352.00 341.79 344.87 268.43 59510 "PR FULL ROUT OBSTE CARE,CESAREAN DELIV" 59510 " 4,168.00 " " 4,046.81 " " 3,883.02 " " 3,178.13 " 59514 PR CESAREAN DELIVERY ONLY 59514 " 1,634.00 " " 1,586.64 " " 1,505.49 " " 1,246.05 " 59515 PR CESAREAN DELIVERY+POSTPARTUM CARE 59515 " 2,257.00 " " 2,191.00 " " 2,088.45 " " 1,720.68 " 59610 "PR ROUT OB CARE,VAG DELIV,PREV C-SEC" 59610 " 3,953.00 " " 3,837.46 " " 3,679.26 " " 3,013.71 " 59812 PR SURG RX INCOMPLETE ABORTN 59812 585.00 568.40 566.38 446.39 59820 "PR SURG RX MISSED ABORTN,1ST TRI" 59820 704.00 683.93 682.25 537.12 59821 "PR SURG RX MISSED ABORTN,2ND TRI" 59821 704.00 683.25 677.62 536.58 59830 PR SURG RX SEPTIC ABORTN 59830 794.00 771.24 747.60 605.69 59871 PR REMOVE CERCLAGE SUTURE 59871 238.00 231.09 218.53 181.32 62270 PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE 62270 273.00 265.49 237.67 208.50 62272 PR THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF 62272 355.00 345.04 307.82 270.98 64400 PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH 64400 247.00 239.72 179.11 188.27 64402 "PR INJECT NERV BLCK,FACIAL NERV" 64402 270.00 261.80 N/A 205.61 64405 PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE 64405 151.00 146.13 120.48 114.77 64450 PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH 64450 143.00 138.97 130.91 109.14 64455 PR INJECT ANES/STEROID PLANTAR COMMON DIGITAL NERVE 64455 90.00 87.38 84.39 68.63 64615 PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE 64615 262.00 254.07 244.92 199.53 65205 "PR REMV F.B.,EYE,SUPERF CONJUNC" 65205 86.00 83.87 65.39 65.87 65210 "PR REMV F.B.,EYE,EMBED CONJUNC" 65210 105.00 102.38 80.03 80.40 65220 "PR REMV F.B.,EYE,CORNEA,NO SLIT" 65220 110.00 106.79 102.01 83.87 65222 "PR REMV F.B.,EYE,CORNEA,SLIT LAMP" 65222 128.00 124.05 118.17 97.43 65270 PR REPAIR CONJUNC LACERATN 65270 509.00 494.35 480.32 388.23 65435 PR CURETTE/TREAT CORNEA 65435 153.00 148.58 141.29 116.69 67700 PR DRAINAGE OF EYELID ABSCESS 67700 509.00 494.04 476.68 387.99 67801 "PR EXCIS CHALAZION,MULT,SAME LID" 67801 306.00 296.78 281.26 233.07 67938 "PR REMOVE EYELID FOREIGN BODY,EMBEDDED" 67938 469.00 455.27 443.95 357.54 68020 PR INCISE/DRAIN CONJUNCTIVA 68020 227.00 220.20 208.35 172.94 68040 PR EXPRESS CONJUNC FOLLICLES 68040 118.00 114.73 109.27 90.11 68510 PR BIOPSY OF TEAR GLAND 68510 843.00 818.11 781.69 642.50 69000 "PR DRAIN EXT EAR ABSC/BLOOD,SIMPLE" 69000 343.00 332.91 318.25 261.45 69005 "PR DRAIN EXT EAR ABSC/BLOOD,COMPLIC" 69005 396.00 384.33 369.02 301.83 69100 PR BIOPSY OF EXTERNAL EAR 69100 181.00 175.30 167.68 137.67 69200 PR REMV EXT CANAL FOREIGN BODY 69200 150.00 146.02 137.96 114.68 69209 PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT 69209 25.00 24.64 23.46 19.35 69210 PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT 69210 87.00 84.86 81.12 66.65 69433 "PR CREATE EARDRUM OPENING,LOCAL ANESTH" 69433 366.00 355.53 335.79 279.21 76882 CHG US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG 76882 104.00 101.26 110.70 80.79 76942 CHG SONO GUIDE NEEDLE BIOPSY 76942 105.00 101.75 112.13 81.18 80053 "CHG METABOLIC PANEL,COMPREHENSIVE" 80053 18.00 17.84 19.22 7.04 80061 CHG LIPID PANEL 80061 23.00 22.62 24.37 8.93 81001 "CHG URINALYSIS, AUTO, W/SCOPE" 81001 6.00 5.35 5.77 3.52 81003 "CHG URINALYSIS, AUTO, W/O SCOPE" 81003 4.00 3.78 4.10 2.49 81025 CHG URINE PREGNANCY TEST 81025 13.00 13.09 15.67 8.61 82044 CHG URINE ALBUMIN SEMIQUANTITATIVE 82044 10.00 9.47 11.34 6.23 82270 "CHG BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN" 82270 7.00 6.66 7.97 4.38 82962 CHG GLUCOSE BLOOD TEST WITH DEVICE 82962 5.00 4.99 5.97 3.28 84153 "CHG PROSTATE SPECIFIC ANTIGEN,TOTAL" 84153 32.00 31.07 33.47 12.26 84443 CHG ASSAY THYROID STIM HORMONE 84443 29.00 28.38 30.58 11.20 85013 "CHG MICROHEMATOCRIT,SPUN" 85013 11.00 10.64 12.74 7.00 85018 CHG HEMOGLOBIN 85018 4.00 4.00 4.31 2.63 85025 CHG COMPLETE CBC & AUTO DIFF WBC 85025 14.00 13.12 14.14 5.18 85610 CHG PROTHROMBIN TIME 85610 7.00 6.64 7.81 4.37 86580 CHG TB INTRADERMAL TEST 86580 12.00 11.64 15.11 7.66 87210 "CHG SMEAR,STAIN,WET MNT,INTERP" 87210 9.00 8.85 10.59 5.82 87220 CHG TISSUE EXAM BY KOH 87220 7.00 7.22 7.77 4.75 87804 "CHG DETECT AGENT,IMMUN,DIR OBS,INFLUENZA" 87804 26.00 25.16 30.12 16.55 87880 CHG STREP A ASSAY W/OPTIC 87880 26.00 25.13 30.08 16.53 90384 "PR RH IG, FULL-DOSE, IM" 90384 158.00 N/A 142.11 75.52 90460 "PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID" 90460 31.00 30.08 24.48 15.75 90461 "PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, EA ADD VACCINE/TOXOID" 90461 24.00 23.07 21.97 12.08 90471 "PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID" 90471 15.00 30.08 24.48 15.75 90472 "PR IMMUNIZ,ADMIN,EACH ADDL" 90472 10.00 23.07 21.97 12.08 90473 "PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX" 90473 31.00 30.08 24.48 15.75 90474 "PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ADDL" 90474 24.00 23.07 21.97 12.08 90620 PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM 90620 179.00 N/A N/A 170.75 90632 PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE 90632 85.00 N/A N/A 68.00 90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE SL 90633 19.82 N/A 40.60 32.78 90633 PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE 90633 61.00 N/A 40.60 32.78 90647 PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE 90647 42.00 N/A 34.63 26.23 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE SL 90648 19.82 N/A 32.23 13.68 90648 PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE 90648 32.00 N/A 32.23 13.68 90649 PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE SL 90649 19.82 N/A Not Reimbursed 164.98 90649 PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE 90649 203.00 N/A Not Reimbursed 164.98 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE SL 90651 19.82 N/A Not Reimbursed 217.11 90651 PR 9VHPV VACC 2/3 DOSE SCHED IM USE 90651 216.46 N/A Not Reimbursed 217.11 90654 PR INFLUENZA VACC IIV3 SPLIT VIRUS PRSRV FREE ID 90654 35.00 N/A N/A 19.91 90657 PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE 90657 15.00 N/A 18.51 6.34 90658 PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE SL 90658 19.82 N/A 18.51 18.24 90661 PR CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE SL 90661 24.56 N/A N/A 23.46 90661 PR CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE 90661 30.00 N/A N/A 23.46 90662 PR IIV VACCINE PRESERV FREE INCREASED AG COUNT IM 90662 50.86 N/A N/A 56.04 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE SL 90670 19.82 N/A N/A 189.03 90670 PR PCV13 VACCINE FOR INTRAMUSCULAR USE 90670 159.00 N/A N/A 189.03 90672 PR LAIV4 VACCINE FOR INTRANASAL USE SL 90672 19.82 N/A N/A 23.70 90672 PR LAIV4 VACCINE FOR INTRANASAL USE 90672 35.00 N/A N/A 23.70 90674 PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE 90674 30.00 N/A N/A 24.80 90675 "PR RABIES VACCINE, IM" 90675 290.00 N/A N/A 283.76 90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE SL 90680 19.82 N/A 91.35 82.89 90680 PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE 90680 153.00 N/A 91.35 82.89 90685 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE SL 90685 19.82 N/A N/A 18.14 90685 PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE 90685 21.56 N/A N/A 18.14 90686 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE SL 90686 20.66 N/A N/A 17.91 90686 PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE 90686 20.66 N/A N/A 17.91 90687 PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE 90687 25.00 N/A N/A 8.47 90688 PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE 90688 25.00 N/A N/A 16.44 90691 "PR TYPHOID VACCINE, IM" 90691 90.00 N/A N/A 93.05 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE SL 90696 19.82 N/A N/A 52.46 90696 PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE 90696 92.00 N/A N/A 52.46 90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE SL 90698 19.82 N/A 91.35 96.14 90698 PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE 90698 102.00 N/A 91.35 96.14 90700 "PR DTAP IMMUNIZATION, IM, <7 YO" SL 90700 19.82 N/A 30.45 26.75 90700 "PR DTAP IMMUNIZATION, IM, <7 YO" 90700 31.00 N/A 30.45 26.75 90707 "PR MMR VIRUS IMMUNIZATION, SUBCUT" SL 90707 19.82 N/A 60.90 75.04 90707 "PR MMR VIRUS IMMUNIZATION, SUBCUT" 90707 86.00 N/A 60.90 75.04 90710 "PR COMBINED VACCINE,MMR+VARICELLA,SUB-Q" 90710 277.00 N/A 162.40 214.37 90713 "PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q" SL 90713 19.82 N/A 34.63 33.53 90713 "PR POLIOMYELITIS IMMUNIZATN,INACTV,SUB-Q" 90713 35.00 N/A 34.63 33.53 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE SL 90714 19.82 N/A N/A 30.93 90714 PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE 90714 35.00 N/A N/A 30.93 90715 "PR TDAP VACCINE >7 YO, IM" SL 90715 19.82 N/A N/A 43.35 90715 "PR TDAP VACCINE >7 YO, IM" 90715 61.00 N/A N/A 43.35 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE SL 90716 19.82 N/A 89.56 129.30 90716 PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE 90716 149.00 N/A 89.56 129.30 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR SL 90723 19.82 N/A 89.56 79.15 90723 PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR 90723 75.00 N/A 89.56 79.15 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE SL 90732 19.82 N/A N/A 100.19 90732 PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE 90732 82.00 N/A N/A 100.19 90733 PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE 90733 136.00 N/A 121.79 147.65 90734 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE SL 90734 19.82 N/A 115.82 126.53 90734 PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE 90734 136.00 N/A 115.82 126.53 90736 PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE 90736 222.00 N/A 194.65 219.05 90740 PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT 3 DOSE IM 90740 15.00 N/A N/A 134.12 90743 PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM 90743 49.00 N/A 60.90 69.64 90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM SL 90744 19.82 N/A N/A 23.87 90744 PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM 90744 29.03 N/A N/A 23.87 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE SL 90746 19.82 N/A N/A 57.25 90746 PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE 90746 59.00 N/A N/A 57.25 90748 PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE 90748 107.00 N/A 68.07 50.47 90750 PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX 90750 173.00 N/A N/A 140.00 92511 PR NASOPHARYNGOSCOPY 92511 205.00 199.46 191.43 156.65 92532 PR POSITIONAL NYSTAGMUS 92532 34.00 33.41 28.72 26.27 92552 "PR PURE TONE AUDIOMETRY, AIR" 92552 57.00 55.33 52.73 43.46 92567 PR TYMPANOMETRY 92567 29.00 27.77 27.65 21.81 92950 PR HEART/LUNG RESUSCITATION (CPR) 92950 586.00 568.86 554.63 446.75 92960 PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL 92960 298.00 289.19 275.84 227.12 93000 "PR ELECTROCARDIOGRAM, COMPLETE" 93000 31.00 30.31 28.85 23.81 93005 "PR ELECTROCARDIOGRAM, TRACING" 93005 15.00 14.63 13.92 11.49 93010 PR ELECTROCARDIOGRAM REPORT 93010 16.00 15.68 14.92 12.32 93015 PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R 93015 133.00 128.92 122.23 101.25 93016 PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R 93016 43.00 41.43 39.48 32.54 93017 "PR CARDIAC STRESS TST,TRACING ONLY" 93017 62.00 59.73 56.31 46.91 93018 "PR CARDIAC STRESS TST,INTERP/REPT ONLY" 93018 29.00 27.75 26.46 21.80 93040 PR RHYTHM ECG WITH REPORT 93040 23.00 22.67 21.57 17.81 93041 "PR RHYTHM ECG, TRACING" 93041 10.00 9.61 9.14 7.55 93042 "PR RHYTHM ECG, REPORT" 93042 13.00 13.05 12.43 10.25 93226 "PR EXT ECG RECORD CONTIN 48 HR, SCAN ANALYSIS W REPORT" 93226 66.00 64.12 60.48 50.36 93307 "PR ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER" 93307 260.00 252.75 241.64 198.50 93312 PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R 93312 460.00 446.37 424.73 350.55 93880 "PR DUPLEX SCAN EXTRACRANIAL,BILAT" 93880 369.00 358.34 338.21 281.42 93922 PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL 93922 157.00 152.76 143.12 119.97 93925 PR DUPLEX LO EXTREM ART BILAT 93925 469.00 455.02 429.14 357.35 93926 PR DUPLEX LO EXTREM ART UNILAT/LTD 93926 246.00 238.90 226.97 209.76 93970 "PR DUPLEX EXTREM VENOUS,BILAT" 93970 357.00 346.86 329.84 272.40 93971 "PR DUPLEX EXTREM VENOUS,UNI OR LTD" 93971 221.00 214.97 206.42 168.83 93975 "PR DUPLEX ABD/PEL VASC STUDY,COMPLETE" 93975 511.00 495.89 469.45 389.45 93978 "PR DUPLEX LARGE VESSEL(S),COMPLETE" 93978 345.00 334.98 317.84 263.07 94010 PR BREATHING CAPACITY TEST 94010 65.00 62.88 59.90 49.38 94060 PR EVAL OF BRONCHOSPASM 26 94060 109.00 106.10 100.08 83.33 94060 PR EVAL OF BRONCHOSPASM 94060 109.00 106.10 100.08 83.33 94640 PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT 94640 32.00 31.53 29.43 24.77 94664 "PR DEMO &/OR EVAL,PT USE,AEROSOL DEVICE" 94664 31.00 29.66 27.65 23.30 94760 PR NONINVASV OXYGEN SATUR;SINGLE 94760 4.00 3.97 3.77 3.12 94762 "PR NONINVASV OXYGEN SATUT,CONTINUOUS" 94762 45.00 44.06 43.77 34.61 95115 "PR IMMUNOTHERAPY, ONE INJECTION" 95115 16.00 15.87 15.11 12.47 95117 "PR IMMUNOTHERAPY, 2+ INJECTIONS" 95117 19.00 18.39 17.49 14.45 95808 PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND 95808 " 1,228.00 " " 1,191.90 " " 1,103.96 " 936.05 95811 PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND 95811 " 1,181.00 " " 1,146.95 " " 1,080.75 " 900.75 95812 "PR EEG,EXTENDED MONITORING,41-60 MINUTES" 95812 596.00 579.09 557.79 454.79 95816 "PR EEG,W/AWAKE & DROWSY RECORD" 95816 666.00 646.32 618.11 507.59 95860 "PR EMG, NEEDLE, ONE LIMB" 95860 225.00 218.77 206.24 171.81 95861 "PR EMG, NEEDLE, TWO LIMBS" 95861 322.00 312.40 296.24 245.34 95925 "PR SOMATOSENSORY TEST,UPPER LIMBS" 95925 242.00 234.95 236.98 184.52 95926 "PR SOMATOSENSORY TEST,LOWER LIMBS" 95926 234.00 227.44 226.06 178.62 95992 "PR CANALITH REPOSITIONING PROCEDURE, PER DAY" 95992 84.00 81.31 78.24 63.86 96040 "PR GENETIC COUNSELING, EACH 30 MIN" 96040 83.00 80.12 74.95 62.99 96110 PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM 96110 18.00 17.11 16.31 13.46 96116 PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR 96116 182.00 176.98 172.17 138.99 96120 PR NEUROPSYCH TESTING BY COMPUTER 96120 87.00 N/A N/A N/A 96360 "PR IV INFUSION, HYDRATION, 31-60 MIN" 96360 69.00 67.27 57.51 52.83 96361 "PR IV INFUSION, HYDRATION, EA ADD HOUR" 96361 25.00 23.95 22.80 18.81 96365 "PR IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR" 96365 130.00 126.19 118.59 99.11 96366 "PR IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR" 96366 40.00 38.93 37.07 30.57 96372 "PR INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT" 96372 31.00 30.08 24.48 23.63 96374 "PR INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG" 96374 71.00 69.20 66.52 54.35 96375 "PR INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG" 96375 31.00 29.64 27.65 23.28 97140 "PR MANUAL THER TECH,1+REGIONS,EA 15 MIN" 97140 53.00 51.74 49.50 27.09 97597 PR DEBRIDEMENT OPEN WOUND 20 SQ CM< 97597 165.00 160.19 165.71 83.87 97602 PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS 97602 74.00 71.53 141.12 37.49 97802 "PR MED NUTR THER, 1ST, INDIV, EA 15 MIN" 97802 70.00 68.24 65.63 53.60 97803 "PR MED NUTR THER, SUBSQ, INDIV, EA 15 MIN" 97803 61.00 58.98 56.78 46.32 98925 "PR OSTEOPATHIC MANIP,1-2 BODY REGN" 98925 59.00 57.38 54.64 45.06 98926 "PR OSTEOPATHIC MANIP,3-4 BODY REGN" 98926 85.00 82.95 79.19 65.15 98927 "PR OSTEOPATHIC MANIP,5-6 BODY REGN" 98927 112.00 109.14 103.98 85.71 98928 "PR OSTEOPATHIC MANIP,7-8 BODY REGN" 98928 137.00 132.84 127.15 104.33 98929 "PR OSTEOPATHIC MANIP,9-10 BODY REGN" 98929 164.00 159.03 151.28 124.89 99000 PR HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB 99000 10.00 9.91 9.43 3.12 99001 PR HANDLG&/OR CONVEY OF SPEC FOR TR FROM PT TO LAB 99001 11.00 10.54 10.03 3.31 99024 PR POST-OP FOLLOW-UP VISIT 99024 - N/A N/A N/A 99050 PR MEDICAL SERVICES AFTER HRS 99050 33.00 32.09 30.58 25.23 99052 PR MEDICAL SERVICES AT NIGHT 99052 41.00 N/A N/A N/A 99070 PR SUPPLIES&MATERIALS ABOVE/BEYOND PROV BY PHYS/QHP 99070 - N/A N/A N/A 99080 PR SPECIAL REPORTS OR FORMS 99080 - N/A N/A N/A 99151 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS 99151 138.00 133.85 126.29 105.12 99152 PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS 99152 94.00 90.94 86.05 71.42 99153 PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS 99153 19.00 18.39 17.49 14.45 99155 PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS 99155 168.00 163.53 147.73 128.43 99156 PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS 99156 149.00 144.42 136.19 113.42 99157 PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS 99157 121.00 117.68 111.80 92.42 99195 PR PHLEBOTOMY 99195 182.00 176.71 167.68 138.78 99199 PR SPECIAL SERVICE/PROC/REPORT 99199 - N/A N/A N/A 99201 PR OFFICE OUTPATIENT NEW 10 MINUTES 99201 84.00 81.75 77.81 64.20 99202 PR OFFICE OUTPATIENT NEW 20 MINUTES 99202 141.00 137.18 129.60 107.73 99203 PR OFFICE OUTPATIENT NEW 30 MINUTES 99203 200.00 194.15 184.00 152.48 99204 PR OFFICE OUTPATIENT NEW 45 MINUTES 99204 305.00 296.51 281.83 232.86 99205 PR OFFICE OUTPATIENT NEW 60 MINUTES 99205 384.00 373.19 356.61 293.09 99211 PR OFFICE OUTPATIENT VISIT 5 MINUTES 99211 42.00 40.80 39.48 32.04 99212 PR OFFICE OUTPATIENT VISIT 10 MINUTES 99212 83.00 80.89 77.22 63.53 99213 PR OFFICE OUTPATIENT VISIT 15 MINUTES 99213 138.00 134.08 128.46 105.30 99214 PR OFFICE OUTPATIENT VISIT 25 MINUTES 99214 203.00 196.90 187.10 154.64 99215 PR OFFICE OUTPATIENT VISIT 40 MINUTES 99215 272.00 263.79 251.78 207.17 99217 PR OBSERVATION CARE DISCHARGE MANAGEMENT 99217 137.00 133.30 126.31 104.69 99218 PR INITIAL OBSERVATION CARE/DAY 30 MINUTES 99218 187.00 181.39 173.21 142.46 99219 PR INITIAL OBSERVATION CARE/DAY 50 MINUTES 99219 256.00 248.28 236.75 194.99 99220 PR INITIAL OBSERVATION CARE/DAY 70 MINUTES 99220 350.00 339.46 322.16 266.60 99221 PR INITIAL HOSPITAL CARE/DAY 30 MINUTES 99221 189.00 183.30 175.54 143.96 99222 PR INITIAL HOSPITAL CARE/DAY 50 MINUTES 99222 257.00 249.41 238.73 195.87 99223 PR INITIAL HOSPITAL CARE/DAY 70 MINUTES 99223 381.00 369.55 352.37 290.22 99224 PR SBSQ OBSERVATION CARE/DAY 15 MINUTES 99224 75.00 72.43 68.92 56.88 99225 PR SBSQ OBSERVATION CARE/DAY 25 MINUTES 99225 138.00 133.57 126.96 104.90 99226 PR SBSQ OBSERVATION CARE/DAY 35 MINUTES 99226 198.00 191.88 182.69 150.69 99231 PR SBSQ HOSPITAL CARE/DAY 15 MINUTES 99231 74.00 71.80 68.32 56.39 99232 PR SBSQ HOSPITAL CARE/DAY 25 MINUTES 99232 137.00 132.96 126.38 104.42 99233 PR SBSQ HOSPITAL CARE/DAY 35 MINUTES 99233 196.00 190.22 182.09 149.39 99234 PR OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES 99234 250.00 242.61 231.67 190.53 99235 PR OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES 99235 319.00 309.50 294.62 243.06 99236 PR OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES 99236 411.00 398.60 379.25 313.04 99238 "PR HOSPITAL DISCHARGE DAY,<30 MIN" 99238 137.00 133.30 126.91 104.69 99239 "PR HOSPITAL DISCHARGE DAY,>30 MIN" 99239 202.00 196.06 186.70 153.98 99241 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN 99241 89.00 86.18 Not Reimbursed 67.76 99242 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN 99242 168.00 162.71 Not Reimbursed 127.92 99243 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN 99243 230.00 223.03 Not Reimbursed 175.35 99244 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN 99244 344.00 334.23 Not Reimbursed 262.77 99245 PR OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN 99245 420.00 407.96 Not Reimbursed 320.73 99251 PR INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN 99251 93.00 90.09 Not Reimbursed 70.83 99252 PR INITL INPATIENT CONSULT NEW/ESTAB PT 40 MIN 99252 142.00 137.65 Not Reimbursed 108.21 99253 PR INITL INPATIENT CONSULT NEW/ESTAB PT 55 MIN 99253 218.00 211.70 Not Reimbursed 166.44 99254 PR INITL INPATIENT CONSULT NEW/ESTAB PT 80 MIN 99254 317.00 307.55 Not Reimbursed 241.80 99255 PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN 99255 382.00 370.39 Not Reimbursed 291.20 99281 PR EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB 99281 40.00 38.73 39.00 30.42 99282 PR EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY 99282 78.00 75.48 75.26 59.28 99283 PR EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY 99283 116.00 113.03 112.95 88.77 99284 PR EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY 99284 221.00 214.45 206.13 168.42 99285 PR EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNC 99285 325.00 315.59 299.26 247.85 99291 "PR CRITICAL CARE, E/M 30-74 MINUTES" 99291 517.00 501.83 481.37 394.11 99292 "PR CRITICAL CARE, ADDL 30 MIN" 99292 229.00 222.51 213.10 174.75 99301 "PR NURSING FACILITY CARE,LEVEL I" 99301 114.00 N/A N/A N/A 99304 PR INITIAL NURSING FACILITY CARE/DAY 25 MINUTES 99304 169.00 164.37 157.48 129.09 99305 PR INITIAL NURSING FACILITY CARE/DAY 35 MINUTES 99305 245.00 237.93 226.57 186.86 99306 PR INITIAL NURSING FACILITY CARE/DAY 45 MINUTES 99306 315.00 305.62 291.62 240.02 99307 PR SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN 99307 83.00 80.33 76.49 63.09 99308 PR SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 15 MIN 99308 129.00 125.45 120.05 98.52 99309 PR SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 MIN 99309 172.00 166.72 158.98 130.94 99310 PR SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 35 MIN 99310 255.00 247.33 234.94 194.24 99315 "PR NURSING FAC DISCHRGE DAY,1-30 MIN" 99315 138.00 133.93 127.51 105.18 99316 "PR NURSING FAC DISCHRGE DAY,MORE 30 MIN" 99316 199.00 193.14 184.11 151.68 99318 PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN 99318 180.00 175.24 167.46 137.63 99321 "PR REST HOME VISIT,NEW PATIENT,LEVL I" 99321 74.00 N/A N/A N/A 99322 "PR REST HOME VISIT,NEW PATIENT,LEVL II" 99322 103.00 N/A N/A N/A 99323 "PR REST HOME VISIT,NEW PATIENT,LEVL III" 99323 87.00 N/A N/A N/A 99324 PR DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN 99324 104.00 101.12 95.91 79.41 99325 PR DOMICIL/REST HOME NEW PT VISIT MOD SEVER 30 MIN 99325 151.00 146.90 139.50 115.37 99326 PR DOMICIL/REST HOME NEW PT HI-MOD SEVER 45 MINUTES 99326 263.00 254.91 243.17 200.19 99327 PR DOMICIL/REST HOME NEW PT VISIT HI SEVER 60 MIN 99327 352.00 341.55 325.65 268.23 99328 PR DOM/R-HOME E/M NEW PT SIGNIF NEW PROB 75 MINUTES 99328 414.00 402.07 384.24 315.77 99331 "PR REST HOME VISIT,ESTAB PAT,LEVEL I" 99331 67.00 N/A N/A N/A 99332 "PR REST HOME VISIT,ESTAB PAT,LEVEL II" 99332 84.00 N/A N/A N/A 99334 PR DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES 99334 114.00 110.26 105.40 86.60 99335 PR DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES 99335 179.00 174.04 167.15 136.68 99336 PR DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES 99336 255.00 247.59 236.18 194.45 99337 PR DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES 99337 366.00 355.03 339.45 278.82 99339 "PR DOMICIL/REST-HOME CARE SUPERVISION, <30 MIN" 99339 145.00 140.67 134.50 110.60 99340 "PR DOMICIL/REST-HOME CARE SUPERVISION, =>30 MIN" 99340 203.00 197.51 187.46 155.28 99341 PR HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES 99341 104.00 101.12 95.91 79.41 99342 PR HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES 99342 150.00 145.87 137.72 114.56 99343 PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES 99343 245.00 238.23 226.46 187.10 99344 PR HOME VISIT NEW PATIENT HI SEVERITY 60 MINUTES 99344 344.00 333.54 318.55 261.95 99347 PR HOME VISIT EST PT SELF LIMITED/MINOR 15 MINUTES 99347 104.00 101.06 95.84 79.37 99348 PR HOME VISIT EST PT LOW-MOD SEVERITY 25 MINUTES 99348 158.00 153.64 147.09 120.66 99349 PR HOME VISIT EST PT MOD-HI SEVERITY 40 MINUTES 99349 243.00 235.92 225.26 185.28 99350 PR HOME VST EST PT UNSTABLE/SIGNIF NEW PROB 60 MINS 99350 337.00 327.28 312.59 257.03 99354 PR PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON 1ST HR 99354 245.00 237.79 226.23 186.75 99355 PR PROLNG E&M/PSYCTX SVC OFFICE O/P DIR CON ADDL 30 99355 187.00 181.47 171.99 142.52 99358 "PR PROLONGED SERV,NO CONTACT,1ST HR" 99358 210.00 204.22 195.23 160.38 99374 PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES 99374 130.00 126.59 121.05 99.53 99375 PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/> 99375 196.00 190.60 181.67 149.85 99381 "PR PREVENTIVE VISIT,NEW,INFANT < 1 YR" EP 99381 208.00 201.47 191.28 158.40 99381 "PR PREVENTIVE VISIT,NEW,INFANT < 1 YR" GY 99381 208.00 201.47 191.28 158.40 99381 "PR PREVENTIVE VISIT,NEW,INFANT < 1 YR" 99381 208.00 201.47 191.28 158.40 99382 "PR PREVENTIVE VISIT,NEW,AGE 1-4" EP 99382 217.00 211.07 200.42 165.95 99382 "PR PREVENTIVE VISIT,NEW,AGE 1-4" GY 99382 217.00 211.07 200.42 165.95 99382 "PR PREVENTIVE VISIT,NEW,AGE 1-4" 99382 217.00 211.07 200.42 165.95 99383 "PR PREVENTIVE VISIT,NEW,AGE5-11" EP 99383 226.00 219.82 208.95 172.82 99383 "PR PREVENTIVE VISIT,NEW,AGE5-11" GY 99383 226.00 219.82 208.95 172.82 99383 "PR PREVENTIVE VISIT,NEW,AGE5-11" 99383 226.00 219.82 208.95 172.82 99384 "PR PREVENTIVE VISIT,NEW,12-17" EP 99384 256.00 248.40 236.38 195.29 99384 "PR PREVENTIVE VISIT,NEW,12-17" GY 99384 256.00 248.40 236.38 195.29 99384 "PR PREVENTIVE VISIT,NEW,12-17" 99384 256.00 248.40 236.38 195.29 99385 "PR PREVENTIVE VISIT,NEW,18-39" EP 99385 247.00 240.16 229.14 188.82 99385 "PR PREVENTIVE VISIT,NEW,18-39" GY 99385 247.00 240.16 229.14 188.82 99385 "PR PREVENTIVE VISIT,NEW,18-39" 99385 247.00 240.16 229.14 188.82 99386 "PR PREVENTIVE VISIT,NEW,40-64" EP 99386 287.00 279.03 265.57 219.38 99386 "PR PREVENTIVE VISIT,NEW,40-64" GY 99386 287.00 279.03 265.57 219.38 99386 "PR PREVENTIVE VISIT,NEW,40-64" 99386 287.00 279.03 265.57 219.38 99387 "PR PREVENTIVE VISIT,NEW,65 & OVER" EP 99387 311.00 302.20 288.03 237.59 99387 "PR PREVENTIVE VISIT,NEW,65 & OVER" GY 99387 311.00 302.20 288.03 237.59 99387 "PR PREVENTIVE VISIT,NEW,65 & OVER" 99387 311.00 302.20 288.03 237.59 99391 "PR PREVENTIVE VISIT,EST, INFANT < 1 YR" EP 99391 187.00 181.68 172.59 142.83 99391 "PR PREVENTIVE VISIT,EST, INFANT < 1 YR" GY 99391 187.00 181.68 172.59 142.83 99391 "PR PREVENTIVE VISIT,EST, INFANT < 1 YR" 99391 187.00 181.68 172.59 142.83 99392 "PR PREVENTIVE VISIT,EST,AGE 1-4" EP 99392 200.00 193.96 184.11 152.49 99392 "PR PREVENTIVE VISIT,EST,AGE 1-4" GY 99392 200.00 193.96 184.11 152.49 99392 "PR PREVENTIVE VISIT,EST,AGE 1-4" 99392 200.00 193.96 184.11 152.49 99393 "PR PREVENTIVE VISIT,EST,AGE5-11" EP 99393 199.00 193.33 183.51 152.00 99393 "PR PREVENTIVE VISIT,EST,AGE5-11" GY 99393 199.00 193.33 183.51 152.00 99393 "PR PREVENTIVE VISIT,EST,AGE5-11" 99393 199.00 193.33 183.51 152.00 99394 "PR PREVENTIVE VISIT,EST,12-17" EP 99394 219.00 212.32 201.80 166.92 99394 "PR PREVENTIVE VISIT,EST,12-17" GY 99394 219.00 212.32 201.80 166.92 99394 "PR PREVENTIVE VISIT,EST,12-17" 99394 219.00 212.32 201.80 166.92 99395 "PR PREVENTIVE VISIT,EST,18-39" EP 99395 224.00 217.00 206.86 170.61 99395 "PR PREVENTIVE VISIT,EST,18-39" GY 99395 224.00 217.00 206.86 170.61 99395 "PR PREVENTIVE VISIT,EST,18-39" 99395 224.00 217.00 206.86 170.61 99396 "PR PREVENTIVE VISIT,EST,40-64" EP 99396 238.00 231.28 220.07 181.83 99396 "PR PREVENTIVE VISIT,EST,40-64" GY 99396 238.00 231.28 220.07 181.83 99396 "PR PREVENTIVE VISIT,EST,40-64" 99396 238.00 231.28 220.07 181.83 99397 "PR PREVENTIVE VISIT,EST,65 & OVER" EP 99397 256.00 248.40 236.38 195.29 99397 "PR PREVENTIVE VISIT,EST,65 & OVER" GY 99397 256.00 248.40 236.38 195.29 99397 "PR PREVENTIVE VISIT,EST,65 & OVER" 99397 256.00 248.40 236.38 195.29 99406 PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES 99406 28.00 26.99 26.28 21.20 99407 PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES 99407 53.00 51.57 49.87 40.50 99421 PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES 99421 35.00 N/A 26.34 N/A 99441 PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN 99441 26.00 25.54 24.55 20.09 99442 PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN 99442 51.00 49.43 47.48 38.87 99443 PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN 99443 75.00 73.10 70.05 57.47 99460 "PR INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIRTH CENTER" 99460 182.00 176.75 167.69 138.81 99462 "PR SUBSEQUENT HOSPITAL CARE, NORMAL NEWBORN" 99462 79.00 77.09 73.58 60.71 99463 "PR INITIAL NORMAL NEWBORN CARE, SAME DAY DISCHARGE" 99463 210.00 203.55 193.61 159.86 99464 PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN 99464 142.00 138.02 131.20 108.39 99465 PR DELIVERY/BIRTHING ROOM RESUSCITATION 99465 277.00 269.12 256.22 211.35 99466 PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN 99466 453.00 439.85 418.18 345.44 99468 "PR INITIAL HOSP NEONATE 28 DAY OR LESS, CRITICALLY ILL" 99468 " 1,746.00 " " 1,694.90 " " 1,612.52 " " 1,331.07 " 99495 PR TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE 99495 306.00 297.18 319.17 233.39 99496 PR TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE 99496 432.00 419.15 420.82 329.18 99497 PR ADVANCE CARE PLANNING FIRST 30 MINS 99497 160.00 155.55 149.11 122.16 99498 PR ADVANCE CARE PLANNING EA ADDL 30 MINS 99498 141.00 137.18 130.60 107.73 1609928101 PR EMERGENCY DEPARTMENT VISIT NO CHARGE 1609928101 - N/A N/A N/A 0500F PR INITIAL PRENATAL CARE VISIT 0500F - N/A Not Reimbursed N/A 0501F PR INTITIAL PRENATAL CARE VISIT W/FLOW SHEET 0501F - N/A Not Reimbursed N/A 0502F PR SUBSEQUENT PRENATAL CARE 0502F - N/A Not Reimbursed N/A 0503F PR POSTPARTUM CARE VISIT 0503F - N/A Not Reimbursed N/A A4314 PR CATH W/DRAINAGE 2-WAY LATEX A4314 25.00 N/A 39.65 17.47 A4315 PR CATH W/DRAINAGE 2-WAY SILCNE A4315 104.00 N/A 41.36 18.22 A4338 PR INDWELLING CATHETER LATEX A4338 16.00 N/A 19.24 8.47 A4450 PR NON-WATERPROOF TAPE A4450 10.00 N/A 0.45 0.07 A4565 PR SLINGS A4565 10.00 N/A 12.07 5.32 A4570 PR SPLINT A4570 21.00 N/A 15.50 6.89 A6234 PR HYDROCOLLD DRG <=16 W/O BDR A6234 6.00 N/A 10.26 4.52 A6448 PR LT COMPRES BAND <3/YD A6448 1.00 N/A 1.81 0.80 A6449 PR LT COMPRES BAND >=3 <5/YD A6449 2.00 N/A 2.75 1.21 A6450 PR LT COMPRES BAND >=5/YD A6450 10.00 N/A 2.75 1.21 A6454 PR SELF-ADHER BAND W>=3 <5/YD A6454 3.00 N/A 1.23 0.54 A6456 PR ZINC PASTE BAND W >=3<5/YD A6456 11.00 N/A 1.98 0.88 CC1 PR COUMADIN CLINIC LEVEL 1 PROVIDER CC1 36.00 N/A N/A N/A CC2 PR COUMADIN CLINIC LEVEL 2 PROVIDER CC2 78.00 N/A N/A N/A CC3 PR COUMADIN CLINIC LEVEL 3 PROVIDER CC3 132.00 N/A N/A N/A CCN PR COUMADIN CLINIC NURSE CCN 36.00 N/A N/A N/A DOTEXAM PR DOT EXAM 175.00 N/A N/A N/A G0008 PR ADMIN INFLUENZA VIRUS VAC G0008 15.00 30.04 18.16 15.75 G0009 PR ADMIN PNEUMOCOCCAL VACCINE G0009 15.00 30.04 18.16 15.75 G0010 PR ADMIN HEPATITIS B VACCINE G0010 15.00 30.04 18.16 15.75 G0071 PR COMM SVCS BY RHC/FQHC 5 MIN G0071 25.00 24.73 17.19 19.44 G0101 PR CA SCREEN;PELVIC/BREAST EXAM G0101 57.00 55.43 49.57 54.71 G0103 "PR PSA, TOTAL SCREENING" G0103 32.00 31.07 26.07 12.26 G0104 PR CA SCREEN;FLEXI SIGMOIDSCOPE G0104 315.00 306.00 220.89 240.32 G0105 PR COLORECTAL SCRN; HI RISK IND G0105 594.00 576.27 418.88 452.57 G0121 PR COLON CA SCRN NOT HI RSK IND G0121 594.00 576.48 419.15 452.73 G0127 PR TRIM NAIL(S) G0127 45.00 43.24 30.12 33.96 G0168 PR WOUND CLOSURE BY ADHESIVE G0168 144.00 N/A 133.72 133.05 G0179 PR MD RECERTIFICATION HHA PT G0179 59.00 N/A 52.00 58.29 G0180 PR MD CERTIFICATION HHA PATIENT G0180 77.00 N/A 67.86 75.45 G0297 PR LDCT FOR LUNG CA SCREEN G0297 428.00 415.89 299.40 331.83 G0402 PR INITIAL PREVENTIVE EXAM G0402 308.00 N/A 213.60 237.74 G0403 PR EKG FOR INITIAL PREVENT EXAM G0403 31.00 30.31 21.40 23.81 G0404 PR EKG TRACING FOR INITIAL PREV G0404 15.00 14.63 10.33 11.49 G0405 PR EKG INTERPRET & REPORT PREVE G0405 16.00 15.68 11.07 12.32 G0438 "PR PPPS, INITIAL VISIT" G0438 318.00 N/A 218.90 244.80 G0439 "PR PPPS, SUBSEQ VISIT" G0439 215.00 N/A 147.81 165.45 G0451 PR DEVLOPMENT TEST INTERPT&REP G0451 18.00 17.13 12.10 13.46 G1004 PR CDSM NDSC MA G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC MB G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC MC G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC MD G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC ME G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC MF G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC MG G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC MH G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC QQ G1004 0.01 N/A N/A N/A G1004 PR CDSM NDSC G1004 0.01 N/A N/A N/A G2012 PR BRIEF CHECK IN BY MD/QHP G2012 28.00 N/A 18.66 20.75 G2025 PR DIS SITE TELE SVCS RHC/FQHC G2025 100.00 N/A N/A N/A IM PR IMMIGRATION PHYSICAL 263.00 N/A N/A N/A J0171 PR ADRENALIN EPINEPHRINE INJECT J0171 72.97 N/A 1.09 0.77 J0500 PR DICYCLOMINE INJECTION J0500 73.00 N/A 48.78 82.33 J0561 PR PENICILLIN G BENZATHINE INJ J0561 10.00 N/A 18.04 13.87 J0585 "PR INJECTION,ONABOTULINUMTOXINA" J0585 6.80 N/A 7.31 6.12 J0630 PR CALCITONIN SALMON INJECTION J0630 35.00 N/A " 3,397.80 " " 2,657.54 " J0690 PR CEFAZOLIN SODIUM INJECTION J0690 10.00 N/A 0.92 0.91 J0694 PR CEFOXITIN SODIUM INJECTION J0694 6.00 N/A 7.86 4.50 J0696 PR CEFTRIAXONE SODIUM INJECTION J0696 10.00 N/A 0.64 0.63 J0735 PR CLONIDINE HYDROCHLORIDE J0735 4.50 N/A 21.20 15.44 J0780 PR PROCHLORPERAZINE INJECTION J0780 15.00 N/A 7.71 9.90 J1000 PR DEPO-ESTRADIOL CYPIONATE INJ J1000 15.00 N/A 28.42 21.96 J1030 PR METHYLPREDNISOLONE 40 MG INJ J1030 10.00 N/A 7.31 6.46 J1040 PR METHYLPREDNISOLONE 80 MG INJ J1040 12.00 N/A 14.04 12.49 J1050 PR MEDROXYPROGESTERONE ACETATE J1050 0.63 N/A 0.67 0.82 J1070 PR TESTOSTERONE CYPIONAT 100 MG J1070 126.86 N/A N/A N/A J1071 PR INJ TESTOSTERONE CYPIONATE J1071 0.10 N/A 0.03 0.03 J1080 PR TESTOSTERONE CYPIONAT 200 MG J1080 128.00 N/A N/A N/A J1100 PR DEXAMETHASONE SODIUM PHOS J1100 1.00 N/A 0.14 0.10 J1110 PR INJ DIHYDROERGOTAMINE MESYLT J1110 128.00 N/A 82.28 58.59 J1170 PR HYDROMORPHONE INJECTION J1170 10.00 N/A 3.73 3.23 J1200 PR DIPHENHYDRAMINE HCL INJECTIO J1200 10.00 N/A 0.86 0.66 J1335 PR ERTAPENEM INJECTION J1335 50.00 N/A 42.39 48.49 J1610 PR GLUCAGON HYDROCHLORIDE/1 MG J1610 194.00 N/A 238.96 207.13 J1631 PR HALOPERIDOL DECANOATE INJ J1631 26.00 N/A 18.78 16.58 J1650 PR INJ ENOXAPARIN SODIUM J1650 13.00 N/A 0.83 0.87 J1815 PR INSULIN INJECTION J1815 10.00 N/A 0.99 0.91 J1885 PR KETOROLAC TROMETHAMINE INJ J1885 10.00 N/A 0.69 0.46 J1940 PR FUROSEMIDE INJECTION J1940 10.00 N/A 0.72 0.80 J2060 PR LORAZEPAM INJECTION J2060 10.00 N/A 0.83 0.73 J2175 PR MEPERIDINE HYDROCHL /100 MG J2175 10.00 N/A 8.89 4.78 J2180 PR MEPERIDINE/PROMETHAZINE INJ J2180 10.00 N/A 10.19 3.79 J2210 PR METHYLERGONOVIN MALEATE INJ J2210 14.00 N/A 23.30 16.90 J2270 PR MORPHINE SULFATE INJECTION J2270 27.27 N/A 4.47 2.57 J2275 PR MORPHINE SULFATE INJECTION J2275 22.00 N/A N/A N/A J2300 PR INJ NALBUPHINE HYDROCHLORIDE J2300 10.00 N/A 2.84 2.75 J2360 PR ORPHENADRINE INJECTION J2360 70.25 N/A 7.82 5.34 J2405 PR ONDANSETRON HCL INJECTION J2405 1.00 N/A 0.12 0.11 J2550 PR PROMETHAZINE HCL INJECTION J2550 10.00 N/A 2.67 2.11 J2675 PR INJ PROGESTERONE PER 50 MG J2675 6.50 N/A 2.03 1.78 J2680 PR FLUPHENAZINE DECANOATE 25 MG J2680 156.00 N/A 13.74 12.43 J2765 PR METOCLOPRAMIDE HCL INJECTION J2765 10.00 N/A 1.48 1.25 J2791 PR RHOPHYLAC INJECTION J2791 23.07 N/A 5.70 4.80 J2920 PR METHYLPREDNISOLONE INJECTION J2920 10.00 N/A 5.42 4.46 J2930 PR METHYLPREDNISOLONE INJECTION J2930 10.00 N/A 8.06 6.36 J3030 PR SUMATRIPTAN SUCCINATE / 6 MG J3030 13.00 N/A 70.86 55.16 J3070 PR PENTAZOCINE INJECTION J3070 133.00 N/A 36.32 108.39 J3301 PR TRIAMCINOLONE ACETONIDE INJ J3301 15.00 N/A 1.78 1.60 J3303 PR TRIAMCINOLONE HEXACETONL INJ J3303 21.00 N/A 3.11 4.26 J3360 PR DIAZEPAM INJECTION J3360 17.00 N/A 7.61 6.85 J3410 PR HYDROXYZINE HCL INJECTION J3410 10.00 N/A 8.37 7.30 J3420 PR VITAMIN B12 INJECTION J3420 10.00 N/A 2.07 1.83 J3430 PR VITAMIN K PHYTONADIONE INJ J3430 17.00 N/A 4.87 4.20 J3490 PR DRUGS UNCLASSIFIED INJECTION TH J3490 0.63 N/A N/A N/A J3490 PR DRUGS UNCLASSIFIED INJECTION J3490 - N/A N/A N/A J7030 PR NORMAL SALINE SOLUTION INFUS J7030 2.00 N/A 3.06 2.50 J7296 "PR KYLEENA, 19.5 MG" J7296 " 1,710.00 " N/A N/A 982.12 J7298 "PR MIRENA, 52 MG" J7298 852.00 N/A Not Reimbursed 953.51 J7300 PR INTRAUT COPPER CONTRACEPTIVE J7300 887.00 N/A Not Reimbursed 832.76 J7301 "PR SKYLA, 13.5 MG" J7301 780.32 N/A N/A 817.78 J7307 PR ETONOGESTREL IMPLANT SYSTEM J7307 926.00 N/A N/A 917.00 J7318 "PR INJ, DUROLANE 1 MG" J7318 22.50 N/A N/A 16.74 J7321 PR HYALGAN SUPARTZ VISCO-3 DOSE J7321 405.25 N/A 90.88 83.64 J7323 PR EUFLEXXA INJ PER DOSE J7323 168.00 N/A 179.07 145.30 J7324 PR ORTHOVISC INJ PER DOSE J7324 655.00 N/A 160.24 492.34 J7325 PR SYNVISC OR SYNVISC-ONE J7325 628.20 N/A 13.42 11.32 J7599 PR IMMUNOSUPPRESSIVE DRUG NOC J7599 - N/A N/A N/A J7626 PR BUDESONIDE NON-COMP UNIT J7626 7.00 N/A 2.13 2.35 J8540 PR ORAL DEXAMETHASONE J8540 1.00 N/A 0.12 0.06 J9217 PR LEUPROLIDE ACETATE SUSPNSION J9217 " 1,332.00 " N/A 345.11 224.30 J9250 PR METHOTREXATE SODIUM INJ J9250 10.00 N/A 0.37 0.26 J9260 PR METHOTREXATE SODIUM INJ J9260 10.00 N/A 3.74 2.64 JAIL PR JAIL VISIT 50.00 N/A N/A N/A JAILT PR JAIL TRIP JAILT 65.00 N/A N/A N/A L0120 PR CERV FLEX N/ADJ FOAM PRE OTS L0120 30.00 N/A 44.75 19.71 L0220 PR THOR RIB BELT CUSTOM FABRICA L0220 39.00 N/A 172.57 76.01 L1810 PR KO ELASTIC WITH JOINTS L1810 87.00 N/A 126.58 55.75 L1830 PR KO IMMOB CANVAS LONG PRE OTS L1830 79.00 N/A 115.24 50.76 L1832 PR KO ADJ JNT POS R SUP PRE CST L1832 55.00 N/A 768.84 338.66 L1902 PR AFO ANKLE GAUNTLET PRE OTS L1902 73.00 N/A 106.54 46.93 L1906 PR AFO MULTILIG ANK SUP PRE OTS L1906 104.00 N/A 152.08 66.99 L3260 PR AMBULATORY SURGICAL BOOT EAC L3260 15.00 N/A 16.39 7.28 L3265 PR PLASTAZOTE SANDAL EACH L3265 90.00 N/A 17.71 7.87 L3650 PR SO 8 ABD RESTRAINT PRE OTS L3650 60.00 N/A 87.12 38.37 L3807 PR WHFO W/O JOINTS PRE CST L3807 - N/A 306.22 134.89 L3908 PR WHO COCK-UP NONMOLDE PRE OTS L3908 40.00 N/A 75.34 33.19 L4350 PR ANKLE CONTROL ORTHO PRE OTS L4350 77.00 N/A 113.05 49.79 L4360 PR PNEUMAT WALKING BOOT PRE CST L4360 100.00 N/A 350.15 154.24 L4386 PR NON-PNEUM WALK BOOT PRE CST L4386 70.00 N/A 213.39 94.00 NC003 PR ADMIT FROM OFFICE NC003 - N/A N/A N/A NC098 PR SENT TO EMERGENCY ROOM NC098 - N/A N/A N/A NCNURSE PR NO CHARGE NURSE VISIT - N/A N/A N/A NCPROV PR NO CHARGE PROVIDER VISIT - N/A N/A N/A OHNONDOT PR OH NON-DOT PHYSICAL 150.00 N/A N/A N/A OHNURSE PR OH NURSE VISIT ONLY 36.00 N/A N/A N/A OHPHYS PR OCC HEALTH PHYSICAL LEVEL 5 175.00 N/A N/A N/A OHPHYSLTD PR OH CLINIC OFFICE VISIT 132.00 N/A N/A N/A OSHA PR OSHA 21.00 N/A N/A N/A PBSUR OPERATIVE NOTE CHARGE - N/A N/A N/A Q0112 PR POTASSIUM HYDROXIDE PREPS Q0112 9.00 8.86 7.87 5.83 Q0162 PR ONDANSETRON ORAL Q0162 4.00 N/A 0.02 0.03 Q2038 "PR FLUZONE VACC, 3 YRS & >, IM" Q2038 25.00 N/A 13.73 56.18 Q4006 PR CAST SUP LONG ARM ADULT FBRG Q4006 24.00 N/A 40.95 18.04 Q4008 PR CAST SUP LONG ARM PED FBRGLS Q4008 20.00 N/A 20.47 9.01 Q4010 PR CAST SUP SHT ARM ADULT FBRGL Q4010 16.00 N/A 27.30 12.02 Q4012 PR CAST SUP SHT ARM PED FBRGLAS Q4012 11.00 N/A 13.68 6.02 Q4017 PR CAST SUP LNG ARM SPLINT PLST Q4017 8.00 N/A 12.76 5.62 Q4018 PR CAST SUP LNG ARM SPLINT FBRG Q4018 21.00 N/A 20.34 8.96 Q4020 PR CAST SUP LNG ARM SPLNT PED F Q4020 11.00 N/A 10.21 4.49 Q4021 PR CAST SUP SHT ARM SPLINT PLST Q4021 6.00 N/A 9.45 4.16 Q4022 PR CAST SUP SHT ARM SPLINT FBRG Q4022 16.00 N/A 17.04 7.51 Q4024 PR CAST SUP SHT ARM SPLNT PED F Q4024 7.00 N/A 8.55 3.76 Q4030 PR CAST SUP LONG LEG FIBERGLASS Q4030 63.00 N/A 106.65 46.98 Q4038 PR CAST SUP SHRT LEG FIBERGLASS Q4038 22.00 N/A 57.74 25.43 Q4041 PR CAST SUP LNG LEG SPLNT PLSTR Q4041 16.00 N/A 28.04 12.35 Q4042 PR CAST SUP LNG LEG SPLNT FBRGL Q4042 28.00 N/A 47.86 21.08 Q4046 PR CAST SUP SHT LEG SPLNT FBRGL Q4046 15.00 N/A 26.16 11.53 S0119 PR ONDANSETRON 4 MG S0119 15.00 N/A 19.48 0.57 S0171 PR BUMETANIDE 0.5 MG S0171 10.00 N/A 1.32 0.84 SCHPX PR SCHOOL PHYSICAL 70.00 N/A N/A N/A SPTPX PR SPORTS PHYSICAL 68.00 N/A N/A N/A T1001 PR NURSING ASSESSMENT/EVALUATN T1001 116.00 N/A N/A N/A VC PR RHC VISIT COUNT - N/A N/A N/A