| Abd paracentesis w/imaging (49083) |
$1,370 |
$2,740 |
1.4× |
| Abdom Paracentesis Dx/Ther W/O Imaging Guidance (49082) |
$815 |
$1,630 |
0.8× |
| Ablate Pulm Tumor Perq Crybl (32994) |
$6,220 |
$12,440 |
0.5× |
Ablation Bone Tumor Rf Perq W/Img Gdn When Done (20982)
unusually low: confirm this is the full procedure |
$7,050 |
$14,100 |
0.4× |
| Ablatj Bone Tumor Cryo Perq W/Img Gdn When Prfmd (20983) |
$7,050 |
$14,100 |
0.9× |
| Abltj 1/+Thyroid Nodule 1 Lobe/Isthmus Perq Rf (60660) |
$3,550 |
$7,100 |
2.0× |
| Adjt tis trns/reargmt f/c/c/m/n/a/g/h/f 10sqcm/< (14040) |
$1,950 |
$3,900 |
0.9× |
| Allogeneic lymphocyte infusions (38242) |
$2,030 |
$4,060 |
1.2× |
| Amniocentesis diagnostic (59000) |
$500 |
$1,000 |
0.5× |
| Amniocentesis therapeutic (59001) |
$650 |
$1,300 |
2.0× |
| Amp F/Th 1/2 Jt/Phalanx W/Neurect W/Dir Clsr (26951) |
$3,630 |
$7,260 |
1.0× |
| Anal Sp Inf Pmp W/Reprg&Fill (62369) |
$640 |
$1,280 |
1.9× |
| Anal/Urinary Muscle Study (51784) |
$387.50 |
$775 |
2.8× |
| Anoscopy diagnostic (46600) |
$145 |
$290 |
1.0× |
| Anoscopy W/Rmvl Foreign Body (46608) |
$1,185 |
$2,370 |
1.2× |
| Appl Hip Spica Cast One&One-Half Spica/Both Legs (29325) |
$540 |
$1,080 |
1.8× |
Appl Mltlayr Compres Sys Uparm Lwarm Hand&Fing (29584)
range across 2 matching MRF lines |
$302.50–$360 |
$605–$720 |
varies |
| Application cast elbow finger short arm (29075) |
$307.50 |
$615 |
1.0× |
| Application Cast Finger (29086) |
$185 |
$370 |
1.1× |
| Application Finger Splint Dynamic (29131) |
$135 |
$270 |
2.1× |
| Application finger splint static (29130) |
$160 |
$320 |
1.1× |
| Application long arm splint shoulder hand (29105) |
$360 |
$720 |
2.1× |
Application Long Leg Splint (29505)
range across 2 matching MRF lines |
$360–$370 |
$720–$740 |
varies |
| Application of long leg cast (29345) |
$540 |
$1,080 |
1.8× |
| Application of rigid total contact leg cast (29445) |
$535 |
$1,070 |
1.8× |
| Application Short Arm Splint Dynamic (29126) |
$265 |
$530 |
1.9× |
Application short arm splint forearm-hand static (29125)
range across 2 matching MRF lines |
$287.50–$300 |
$575–$600 |
varies |
Application short leg splint calf foot (29515)
range across 2 matching MRF lines |
$305–$370 |
$610–$740 |
varies |
| Apply hand/wrist cast (29085) |
$185 |
$370 |
1.1× |
| Apply long arm cast (29065) |
$362.50 |
$725 |
1.2× |
Apply Multlay Comprs Lwr Leg (29581)
range across 2 matching MRF lines |
$385–$410 |
$770–$820 |
varies |
| Apply Short Leg Cast (29405) |
$420 |
$840 |
1.4× |
| Arterial puncture (36600) |
$125 |
$250 |
0.9× |
| Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) |
$340 |
$680 |
1.0× |
| Arthrocentesis aspir&/inj interm jt/burs w/us (20606) |
$650 |
$1,300 |
0.9× |
Arthrocentesis aspir&/inj major jt/bursa w/o us (20610)
range across 2 matching MRF lines |
$450–$505 |
$900–$1,010 |
varies |
Arthrocentesis aspir&/inj major jt/bursa w/us (20611)
range across 2 matching MRF lines |
$515–$805 |
$1,030–$1,610 |
varies |
| Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) |
$277.50 |
$555 |
0.8× |
| Aspirate pleura w/ imaging (32555) |
$1,090 |
$2,180 |
1.6× |
Aspirate Pleura W/O Imaging (32554)
range across 2 matching MRF lines |
$910–$1,360 |
$1,820–$2,720 |
varies |
| Aspirate/Inj Ganglion Cyst (20612) |
$505 |
$1,010 |
1.5× |
| Avulsion nail plate partial/complete simple 1 (11730) |
$320 |
$640 |
1.5× |
Biliary Endo Prq T-Tube Dx W/Collect Spec Brush (47552)
likely a partial charge, not the full procedure |
$1,980 |
$3,960 |
0.3× |
Biliary ndsc prq t-tube dilat strix w/stent (47556)
likely a partial charge, not the full procedure |
$2,445 |
$4,890 |
0.2× |
Biliary ndsc prq t-tube w/bx single/multiple (47553)
unusually low: confirm this is the full procedure |
$3,290 |
$6,580 |
0.5× |
Biliary ndsc prq t-tube w/dil duct w/o stent (47555)
likely a partial charge, not the full procedure |
$1,680 |
$3,360 |
0.2× |
| Biopsy Abdominal Mass (49180) |
$1,340 |
$2,680 |
0.8× |
| Biopsy bone trocar/needle deep (20225) |
$1,535 |
$3,070 |
0.9× |
| Biopsy Bone Trocar/Needle Superficial (20220) |
$1,000 |
$2,000 |
0.6× |
| Biopsy muscle percutaneous needle (20206) |
$1,190 |
$2,380 |
0.7× |
| Biopsy of liver, needle; percutaneous (47000) |
$1,770 |
$3,540 |
1.0× |
| Biopsy of rectum (45100) |
$3,190 |
$6,380 |
1.1× |
| Biopsy ovary uni/bi separate procedure (58900) |
$3,555 |
$7,110 |
1.0× |
| Biopsy Pleura Percutaneous Needle (32400) |
$910 |
$1,820 |
0.5× |
| Biopsy Salivary Gland Needle (42400) |
$960 |
$1,920 |
1.3× |
| Biopsy soft tissue neck/thorax (21550) |
$1,190 |
$2,380 |
0.7× |
| Biopsy Testis Needle Separate Procedure (54500) |
$3,820 |
$7,640 |
1.2× |
| Biopsy Vaginal Mucosa Simple (57100) |
$1,255 |
$2,510 |
1.3× |
| Biopsy Vulva/Perineum 1 Lesion Spx (56605) |
$1,255 |
$2,510 |
1.3× |
| Bladder instillation anticarcinogenic agent (51720) |
$425 |
$850 |
0.6× |
| Bladder Irrigation (51700) |
$275 |
$550 |
1.0× |
| Bladder Scan (51798) |
$135 |
$270 |
2.1× |
| Bld-Drv Hematop Progen Cell Hrvg Trnsplj Autol (38206) |
$2,155 |
$4,310 |
1.3× |
| Blood Transfusion Service (36430) |
$1,005 |
$2,010 |
2.1× |
| Blood/Lymph System Procedure (38999) |
$1,645 |
$3,290 |
3.5× |
| Bone Marrow Biopsy (38221) |
$530 |
$1,060 |
0.3× |
| Bone marrow harvest allogen (38230) |
$3,340 |
$6,680 |
2.0× |
| Bone Marrow; Aspiration Only (38220) |
$442.50 |
$885 |
0.3× |
| Bronchoscopy Dilate W/Stent (31631) |
$4,340 |
$8,680 |
0.6× |
| Bx breast 1st lesion mr imag (19085) |
$2,420 |
$4,840 |
1.4× |
| Bx breast 1st lesion strtctc (19081) |
$2,420 |
$4,840 |
1.4× |
| Bx breast 1st lesion us imag (19083) |
$2,415 |
$4,830 |
1.4× |
| Bx breast needle core w/o imaging guidance spx (19100) |
$1,895 |
$3,790 |
1.1× |
| Bx Cervix (57500) |
$915 |
$1,830 |
0.9× |
| Canthotomy Separate Procedure (67715) |
$2,280 |
$4,560 |
0.9× |
| Car-t admn autologous (38228) |
$1,855 |
$3,710 |
5.2× |
| Cessj Therapy Cath Removal (37214) |
$1,845 |
$3,690 |
0.5× |
| Change Cystostomy Tube Complicated (51710) |
$885 |
$1,770 |
1.2× |
| Change Cystostomy Tube Simple (51705) |
$345 |
$690 |
1.3× |
| Change of Windpipe Airway (31502) |
$387.50 |
$775 |
1.5× |
Change ureter stent percut (50382)
range across 2 matching MRF lines |
$2,630–$2,980 |
$5,260–$5,960 |
varies |
| Chemical Cautery Tissue (17250) |
$147.50 |
$295 |
0.7× |
| Chemical Pleurodesis (32560) |
$1,215 |
$2,430 |
1.8× |
| Chemodenerv Musc Migraine (64615) |
$505 |
$1,010 |
1.5× |
Chemodenerv musc neck dyston (64616)
range across 2 matching MRF lines |
$495–$740 |
$990–$1,480 |
varies |
| Chemodnrvtj Musc Musc Innervated Facial Nrv Unil (64612) |
$452.50 |
$905 |
1.4× |
Chest tube placement (32551)
range across 2 matching MRF lines |
$1,790–$3,580 |
$3,580–$7,160 |
varies |
| Chng Urtrost Tube/Xtrnlly Accessible Stent Ileal (50688) |
$990 |
$1,980 |
0.4× |
| Cholecystostomy Prq W/Imaging & Catheter Plmt (47490) |
$2,640 |
$5,280 |
0.7× |
| Cl Tx Tib Shft Fx W Manip (27752) |
$1,790 |
$3,580 |
1.0× |
| Clear outer ear canal (69200) |
$190 |
$380 |
1.3× |
| Closed Treatment Of Distal Radioulnar Dislocation With Manipulation (25675) |
$270 |
$540 |
1.0× |
| Closed treatment of posterior malleolus fracture; with manipulation (27768) |
$1,790 |
$3,580 |
1.0× |
| Closed treatment of ulnar shaft fracture; with manipulation (25535) |
$270 |
$540 |
1.0× |
| Closed tx ankle dislocation w/o anesthesia (27840) |
$270 |
$540 |
1.0× |
| Closed Tx Bimalleolar Ankle Fracture W Manip (27810) |
$1,790 |
$3,580 |
1.0× |
| Closed Tx Bimalleolar Ankle Fracture W/O Manip (27808) |
$270 |
$540 |
1.0× |
| Closed tx carpal scaphoid fracture w/manj (25624) |
$1,790 |
$3,580 |
1.0× |
| Closed tx knee dislocation w/o anesthesia (27550) |
$270 |
$540 |
1.0× |
| Closed Tx Lunate Dislocation W/Manipulation (25690) |
$1,790 |
$3,580 |
1.0× |
Closed Tx Mandibular Fx W/Interdental Fixation (21453)
unusually low: confirm this is the full procedure |
$2,895 |
$5,790 |
0.5× |
| Closed Tx Monteggia Fx Dislocation Elbow W/Manj (24620) |
$1,790 |
$3,580 |
1.0× |
| Closed Tx Nasal Bone Fx W/Mnpj W/O Stabilization (21315) |
$1,735 |
$3,470 |
1.0× |
| Closed tx patellar dislocation w/o anesthesia (27560) |
$270 |
$540 |
1.0× |
| Closed tx radial head/neck fx w/manipulation (24655) |
$1,790 |
$3,580 |
1.0× |
| Closed tx radial shaft fracture w/manipulation (25505) |
$1,790 |
$3,580 |
1.0× |
| Closed Tx Radial&Ulnar Shaft Fractures W/Manj (25565) |
$1,790 |
$3,580 |
1.0× |
| Closed tx talotarsal joint dislc w/o anes (28570) |
$270 |
$540 |
1.0× |
| Closed Tx Talus Fracture W/Manipulation (28435) |
$1,790 |
$3,580 |
1.0× |
| Closed tx tarsometatarsal dislocation w/o anes (28600) |
$270 |
$540 |
1.0× |
Closed tx temporomandibular dislocation 1st/sbsq (21480)
range across 2 matching MRF lines |
$265–$530 |
$530–$1,060 |
varies |
| Closed Tx Ulnar Fracture Prox End W Manipulation (24675) |
$1,790 |
$3,580 |
1.0× |
| Closure Laceration Vestibule Mouth 2.5 Cm/< (40830) |
$275 |
$550 |
1.1× |
| Closure Laceration Vestibule Mouth > 2.5 Cm/Cpl (40831) |
$580 |
$1,160 |
1.0× |
| Clsd tx clavicular fracture w/o manipulation (23500) |
$265 |
$530 |
1.0× |
Clsd tx shoulder dislc w/manipulation w/o anes (23650)
range across 2 matching MRF lines |
$270–$540 |
$540–$1,080 |
varies |
| Cltx artclr fx invg mtcarphlngl/iphal jt w/manj (26742) |
$1,790 |
$3,580 |
1.0× |
| Cltx carpo/metacarpl dislc thmb manj ea w/o anes (26670) |
$270 |
$540 |
1.0× |
| Cltx dstl fibular fx lat malls w/manj (27788) |
$270 |
$540 |
1.0× |
| Cltx dstl phlngl fx fngr/thmb w/manj ea (26755) |
$270 |
$540 |
1.0× |
Cltx dstl rdl fx/epiphysl sep w/manj when perf (25605)
range across 2 matching MRF lines |
$1,790–$3,580 |
$3,580–$7,160 |
varies |
| Cltx Fem Fx Dstl End Medial/Lat Condyle W/Manj (27510) |
$1,790 |
$3,580 |
1.0× |
| Cltx fem shft fx w/manj w/wo skin/skeletal tracj (27502) |
$1,790 |
$3,580 |
1.0× |
| Cltx fx grt toe phlx/phlg w/manj (28495) |
$270 |
$540 |
1.0× |
| Cltx fx phlx/phlg oth/thn grt toe w/manj (28515) |
$270 |
$540 |
1.0× |
| Cltx fx w8 brg artclr prtn dstl tib w/skel tracj (27825) |
$1,790 |
$3,580 |
1.0× |
| Cltx hip dislocation traumatic req anesthesia (27252) |
$1,790 |
$3,580 |
1.0× |
| Cltx hip dislocation traumatic w/o anesthesia (27250) |
$270 |
$540 |
1.0× |
| Cltx Humeral Epicondylar Fx Medial/Lat W/Manj (24565) |
$1,790 |
$3,580 |
1.0× |
| Cltx Interphalangeal Joint Dislocation W/O Anes (28660) |
$270 |
$540 |
1.0× |
| Cltx iphal jt dislc w/manj w/o anes (26770) |
$270 |
$540 |
1.0× |
| Cltx metacarpal fx w/manipulation each bone (26605) |
$270 |
$540 |
1.0× |
| Cltx phlngl fx prox/middle px/f/t w/manj ea (26725) |
$270 |
$540 |
1.0× |
| Cltx phlngl fx prox/middle px/f/t w/o manj ea (26720) |
$270 |
$540 |
1.0× |
| Cltx post hip arthrp dislc w/o anes (27265) |
$270 |
$540 |
1.0× |
| Cltx prox fibula/shft fx w/manj (27781) |
$1,790 |
$3,580 |
1.0× |
| Cltx rdl head sublxtj chld nursemaid elbw w/manj (24640) |
$270 |
$540 |
1.0× |
| Cltx Rdl Shft Fx&Cltx Dislc Dstl Rad/Uln Jt (25520) |
$1,790 |
$3,580 |
1.0× |
| Cltx shoulder dislc w/fx humeral tubrst w/manj (23665) |
$1,790 |
$3,580 |
1.0× |
| Cltx Shoulder Dislc W/Surg/Antmcl Neck Fx W/Manj (23675) |
$1,790 |
$3,580 |
1.0× |
| Cltx trimalleolar ankle fx w/manipulation (27818) |
$1,790 |
$3,580 |
1.0× |
| Collect Blood From Catheter Venous Nos (36592) |
$192.50 |
$385 |
1.4× |
| Collection of venous blood by venipuncture (36415) |
$22.50 |
$45 |
2.4× |
| Colporrhaphy (57200) |
$3,105 |
$6,210 |
0.9× |
| Colposc,Cervix W/Adj Vag,W/Bx & Curretag (57454) |
$462.50 |
$925 |
1.4× |
| Complex drainage wound (10180) |
$3,035 |
$6,070 |
1.0× |
| Composite Skin Graft (15760) |
$2,195 |
$4,390 |
1.0× |
Control Nasal Hemorrhage Anterior Complex (30903)
range across 2 matching MRF lines |
$150–$300 |
$300–$600 |
varies |
Control Nasal Hemorrhage Anterior Simple (30901)
range across 2 matching MRF lines |
$150–$300 |
$300–$600 |
varies |
| Control oropharyngeal hemorrhage simple (42960) |
$322.50 |
$645 |
0.6× |
| Conversion ext bil drg cath (47535) |
$2,430 |
$4,860 |
0.6× |
| Convert gastrostomy-gastro-jejunostomy tube percutaneous (49446) |
$2,610 |
$5,220 |
1.3× |
| Convert Nephrostomy Catheter (50434) |
$1,080 |
$2,160 |
0.5× |
Core Needle Bx Lung/Mediastinum Perq W/Img (32408)
range across 3 matching MRF lines |
$2,160–$2,165 |
$4,320–$4,330 |
varies |
Csf shunt reprogram (62252)
range across 2 matching MRF lines |
$337.50–$340 |
$675–$680 |
varies |
| Ctrl Nasopharyngeal Hemrrg Smpl W/Pst Nsl Packs (42970) |
$392.50 |
$785 |
1.5× |
Ctrl nsl hemrrg pst nasal packs&/cautery 1st (30905)
range across 2 matching MRF lines |
$150–$300 |
$300–$600 |
varies |
| Ctrl Nsl Hemrrg Pst Nasal Packs&/Cautery Subsq (30906) |
$275 |
$550 |
1.1× |
| Cysto Bladder W/Ureteral Catheterization (52005) |
$2,295 |
$4,590 |
1.0× |
| Cysto calibration dilat urtl strix/stenosis (52281) |
$2,295 |
$4,590 |
1.0× |
| Cysto w/insert ureteral stent (52332) |
$3,390 |
$6,780 |
0.9× |
| Cysto W/Simple Removal Stone & Stent (52310) |
$2,125 |
$4,250 |
0.9× |
| Cystourethroscopy (52000) |
$1,080 |
$2,160 |
1.4× |
| Deb Musc/Fascia 20 Sq Cm/< (11043) |
$1,160 |
$2,320 |
1.5× |
| Debride nail 1-5 (11720) |
$107.50 |
$215 |
1.7× |
| Debride nail 6 or more (11721) |
$117.50 |
$235 |
1.9× |
| Debridement Bone Muscle &/Fascia 20 Sq Cm/< (11044) |
$2,030 |
$4,060 |
1.1× |
| Debridement subcutaneous tissue 20 sq cm/< (11042) |
$665 |
$1,330 |
1.5× |
| Declot vascular device (36593) |
$472.50 |
$945 |
1.3× |
| Destr W Neurolytic; Celiac Plexus (64680) |
$1,135 |
$2,270 |
1.2× |
Destroy cerv/thor facet jnt (64633)
range across 2 matching MRF lines |
$2,190–$2,720 |
$4,380–$5,440 |
varies |
Destroy lumb/sac facet jnt (64635)
range across 2 matching MRF lines |
$2,300–$2,840 |
$4,600–$5,680 |
varies |
| Destruct B9 Lesion 1-14 (17110) |
$232.50 |
$465 |
1.1× |
| Destruction by neurolytic agent, intercostal nerve (64620) |
$1,180 |
$2,360 |
1.2× |
| Destruction by neurolytic agent; pudendal nerve (64630) |
$1,025 |
$2,050 |
1.1× |
| Destruction neurolytic agt genicular nerve w/img (64624) |
$1,135 |
$2,270 |
0.5× |
| Dilat Female Urethra W/Suppository&/Instlj Ini (53660) |
$180 |
$360 |
1.3× |
| Dilat Xst Trc New Access Rcs (50437) |
$2,630 |
$5,260 |
0.7× |
| Dilate Urethra Stricture (53620) |
$740 |
$1,480 |
1.0× |
| Dilate Urethra Stricture (53600) |
$380 |
$760 |
1.4× |
| Dilation and catheterization of salivary duct, with or without injection (42660) |
$1,505 |
$3,010 |
2.6× |
| Dilation Cervical Canal (57800) |
$3,105 |
$6,210 |
0.9× |
| Drain Cerebro Spinal Fluid (62272) |
$995 |
$1,990 |
1.3× |
| Drain Hand Tendon Sheath (26020) |
$3,630 |
$7,260 |
1.0× |
| Drain/inj small joint/bursa w/us (20604) |
$387.50 |
$775 |
1.2× |
| Drainage Abscess/Hematoma Nasal Septum (30020) |
$580 |
$1,160 |
1.0× |
| Drainage External Ear Abscess/Hematoma Simple (69000) |
$800 |
$1,600 |
1.1× |
| Drainage Finger Abscess Complicated (26011) |
$1,790 |
$3,580 |
1.0× |
| Drainage Mouth Roof Lesion (42000) |
$275 |
$550 |
1.1× |
| Drainage of eye (65800) |
$2,360 |
$4,720 |
1.0× |
| Drainage of finger abscess simple (26010) |
$240 |
$480 |
1.1× |
| Drainage of gum lesion (41800) |
$150 |
$300 |
1.1× |
| Drainage of hematoma/fluid (10140) |
$1,780 |
$3,560 |
1.0× |
| Drainage of nose lesion (30000) |
$465 |
$930 |
1.8× |
| Drainage of palmar bursa single bursa (26025) |
$3,630 |
$7,260 |
1.0× |
| Drainage of scrotal wall abscess (55100) |
$1,800 |
$3,600 |
1.0× |
| Drainage of scrotum (54700) |
$1,295 |
$2,590 |
0.6× |
| Draw Blood Off Venous Device (36591) |
$205 |
$410 |
1.4× |
| Drg Absc Cst Hmtma Vestibule Mouth Smpl (40800) |
$800 |
$1,600 |
1.1× |
| Drs&/dbrdmt prtl-thkns burns 1st/sbsq large (16030) |
$515 |
$1,030 |
1.2× |
| Drs&/dbrdmt prtl-thkns burns 1st/sbsq medium (16025) |
$442.50 |
$885 |
2.1× |
| Drs&/dbrdmt prtl-thkns burns 1st/sbsq small (16020) |
$337.50 |
$675 |
1.6× |
| Dstrj Neurlytic Trigem Nrv 2/3 Div Radio Monitor (64610) |
$2,785 |
$5,570 |
1.3× |
| Dstrj Neurolytic Agent Other Peripheral Nerve (64640) |
$1,250 |
$2,500 |
1.3× |
| Dstrj nulyt w/worad mntr suprior hypogstr plexus (64681) |
$1,135 |
$2,270 |
1.2× |
| Dstrj Trigeminal Nrv Supraorb Infraorb Branch (64600) |
$1,200 |
$2,400 |
1.3× |
| Dx Bone Marrow Bx & Aspir (38222) |
$730 |
$1,460 |
0.2× |
| Dx Bronchoscope/Lavage (31624) |
$2,095 |
$4,190 |
1.1× |
| Dx Bronchoscope/Wash (31622) |
$2,095 |
$4,190 |
1.1× |
| Dx Laryngoscopy Excl Nb (31525) |
$1,920 |
$3,840 |
1.0× |
| Dx lmbr spi pnxr w/fluor/CT (62328) |
$1,245 |
$2,490 |
1.6× |
| Egd Flexible Foreign Body Removal (43247) |
$1,040 |
$2,080 |
1.1× |
| Elec Anlys Implt Ithcl/Edrl Pmp W/Repr Phys/Qhp (62370) |
$835 |
$1,670 |
2.5× |
| Elect Analys Implt Ithcl/Edrl Pump W/Reprgrmg (62368) |
$550 |
$1,100 |
1.7× |
| Elect anlys implt ithcl/edrl pmp w/o reprg/refil (62367) |
$815 |
$1,630 |
2.5× |
| Endometrial Biopsy (58100) |
$432.50 |
$865 |
2.0× |
Endovasc Temp Balloon Occlus,Head/Nck (61623)
likely a partial charge, not the full procedure |
$3,325 |
$6,650 |
0.3× |
| Endoven abltj incmptnt vein xtr rf 1st vein (36475) |
$4,625 |
$9,250 |
1.4× |
| Epidural Blood Patch (62273) |
$995 |
$1,990 |
1.3× |
| Episiotomy or vaginal repair (59300) |
$3,105 |
$6,210 |
0.9× |
| Evacuation of subungual hematoma (11740) |
$145 |
$290 |
1.0× |
| Exc H-F-Nk-Sp B9+Marg 0.5/< (11420) |
$1,790 |
$3,580 |
1.0× |
| Exchange Biliary Drg Catheter Prq W/Img Gid Rs&I (47536) |
$3,125 |
$6,250 |
0.8× |
Exchange Nephrostomy Catheter Prq W/Img Gid Rs&I (50435)
range across 2 matching MRF lines |
$1,300–$1,930 |
$2,600–$3,860 |
varies |
| Exchng Absc/Cst Drg Cath Rad Gid Spx (49423) |
$1,430 |
$2,860 |
0.7× |
| External cephalic version (59412) |
$1,725 |
$3,450 |
0.5× |
| Fetal Contraction Stress Test (59020) |
$452.50 |
$905 |
2.1× |
| Fetal non-stress test (59025) |
$450 |
$900 |
2.1× |
| Fine needle aspiration bx w/CT gdn 1st lesion (10009) |
$1,705 |
$3,410 |
2.2× |
| Fine needle aspiration without imaging guidance (10021) |
$372.50 |
$745 |
0.9× |
| Fluoro exam of g/colon tube (49465) |
$430 |
$860 |
1.7× |
| Fna Bx W/Fluor Gdn 1St Les (10007) |
$1,160 |
$2,320 |
1.5× |
| Fna bx w/us gdn 1st les (10005) |
$1,065 |
$2,130 |
1.4× |
| Foreskin manipulation (54450) |
$340 |
$680 |
1.3× |
| Guide Cathet Fluid Drainage (10030) |
$435 |
$870 |
0.6× |
| Hem heprn nduc trmbctpna srm (0275U) |
$310 |
$620 |
16.9× |
| Hemorrhoidectomy, internal, by rubber band ligation(s) (46221) |
$770 |
$1,540 |
0.8× |
| I&d abscess peritonsillar (42700) |
$275 |
$550 |
1.1× |
| I&d abscess simple (10060) |
$480 |
$960 |
2.2× |
| I&d perianal abscess superficial (46050) |
$1,020 |
$2,040 |
1.0× |
| I&d pilonidal cyst complicated (10081) |
$800 |
$1,600 |
1.1× |
| I&d pilonidal cyst simple (10080) |
$570 |
$1,140 |
0.8× |
| I&d upper arm/elbow deep abscess/hematoma (23930) |
$3,035 |
$6,070 |
1.0× |
| Icd Pocket Revision (33223) |
$2,310 |
$4,620 |
1.0× |
| Image Cath Fluid Colxn Visc (49405) |
$1,855 |
$3,710 |
1.0× |
| Image Cath Fluid Peri/Retro (49406) |
$1,830 |
$3,660 |
1.0× |
| Image Cath Fluid Trns/Vgnl (49407) |
$1,980 |
$3,960 |
1.1× |
| Incise external hemorrhoid (46083) |
$470 |
$940 |
1.8× |
| Incision & drainage abscess complicated/multiple (10061) |
$605 |
$1,210 |
1.4× |
| Incision & removal foreign body subq tiss compl (10121) |
$1,735 |
$3,470 |
1.0× |
| Incision & removal foreign body subq tiss simple (10120) |
$465 |
$930 |
1.1× |
| Incision and drainage of bartholin's gland abscess (56420) |
$472.50 |
$945 |
2.2× |
| Incision and drainage of vulva or perineal abscess (56405) |
$362.50 |
$725 |
1.1× |
| Incision of lingual frenum (frenotomy) (41010) |
$1,515 |
$3,030 |
0.9× |
| Incision of rectal abscess (46040) |
$1,330 |
$2,660 |
1.0× |
| Incisional biopsy skin single lesion (11106) |
$230 |
$460 |
0.3× |
| Initial Tx 1st Degree Burn Local Tx (16000) |
$295 |
$590 |
1.4× |
Inj Dx/Ther Agnt Paravert Facet Joint,Img Guide,Cerv/Thorac, 1st Level (64490)
range across 4 matching MRF lines |
$1,245–$1,540 |
$2,490–$3,080 |
varies |
| Inj W/Fluor Eval Cv Device (36598) |
$540 |
$1,080 |
2.4× |
| Inj,Anes Agent,Femoral Nerve,Cont Inf (64448) |
$1,595 |
$3,190 |
1.7× |
| Inject Anes/Steroid Foramen Cerv/Thoracic W Img Guide ,1 Level (64479) |
$1,250 |
$2,500 |
1.3× |
| Inject Intravitreal Pharmcologic (67028) |
$450 |
$900 |
1.3× |
| Injection 1 tendon sheath/ligament aponeurosis (20550) |
$412.50 |
$825 |
1.3× |
| Injection aa&/strd axillary nerve w/img gdn (64417) |
$1,540 |
$3,080 |
1.6× |
| Injection Aa&/Strd Brach Plex Cont Nfs Cath Img (64416) |
$1,535 |
$3,070 |
1.6× |
Injection aa&/strd genicular nrv branches w/img (64454)
range across 2 matching MRF lines |
$1,135–$1,700 |
$2,270–$3,400 |
varies |
| Injection aa&/strd intercostal nrv ea addl lvl (64421) |
$855 |
$1,710 |
0.9× |
| Injection Aa&/Strd Lumbar Plexus Cont Nfs Cath (64449) |
$1,130 |
$2,260 |
1.2× |
| Injection aa&/strd nerves nrvtg si joint w/img (64451) |
$1,135 |
$2,270 |
1.5× |
| Injection Aa&/Strd Sciatic Nerve W/Img Gdn (64445) |
$1,310 |
$2,620 |
1.7× |
| Injection Aa&/Strd Sciatic Nrv Cont Nfs Cath Img (64446) |
$1,535 |
$3,070 |
1.6× |
| Injection Anes Agent Sphenopalatine Ganglion (64505) |
$1,190 |
$2,380 |
3.6× |
| Injection Anes Superior Hypogastric Plexus (64517) |
$1,135 |
$2,270 |
1.2× |
Injection anesthetic agent suprascapular nerve (64418)
range across 2 matching MRF lines |
$770–$940 |
$1,540–$1,880 |
varies |
| Injection for identification of sentinel node (38792) |
$650 |
$1,300 |
1.5× |
| Injection Into Brain Canal (61055) |
$650 |
$1,300 |
2.0× |
| Injection into disk lesion (62292) |
$2,775 |
$5,550 |
1.3× |
| Injection into spinal artery (62294) |
$1,135 |
$2,270 |
1.2× |
| Injection single tendon origin/insertion (20551) |
$412.50 |
$825 |
1.3× |
| Injection single/mlt trigger point 1/2 muscles (20552) |
$500 |
$1,000 |
1.5× |
| Injection single/mlt trigger point 3/> muscles (20553) |
$625 |
$1,250 |
1.9× |
| Injection Sinus Tract Therapeutic Separate Proc (20500) |
$625 |
$1,250 |
0.4× |
Injection therapeutic carpal tunnel (20526)
range across 3 matching MRF lines |
$345–$670 |
$690–$1,340 |
varies |
| Injection, anesthetic agent; brachial plexus, single (64415) |
$1,095 |
$2,190 |
1.2× |
| Injection, anesthetic agent; femoral nerve, single (64447) |
$1,565 |
$3,130 |
2.1× |
Injection, anesthetic agent; other peripheral nerve or branch (64450)
range across 2 matching MRF lines |
$482.50–$775 |
$965–$1,550 |
varies |
| Injection, intralesional; up to and including 7 lesions (11900) |
$332.50 |
$665 |
1.5× |
| Injx/Infus Neurolyt Sbst Epidural Lumbar/Sacral (62282) |
$1,135 |
$2,270 |
1.2× |
| Injx/Infus Neurolyt Subst Epidural Cerv/Thoracic (62281) |
$1,170 |
$2,340 |
1.2× |
| Injx/Infusion Neurolytic Substance Subarachnoid (62280) |
$1,135 |
$2,270 |
1.2× |
| Ins cath ren art 1st bilat (36252) |
$3,780 |
$7,560 |
1.1× |
| Ins cath ren art 1st unilat (36251) |
$3,970 |
$7,940 |
1.2× |
| Ins cath ren art 2nd+ bilat (36254) |
$6,850 |
$13,700 |
2.0× |
| Ins cath ren art 2nd+ unilat (36253) |
$3,205 |
$6,410 |
0.5× |
| Ins endovas vena cava filtr (37191) |
$4,960 |
$9,920 |
0.8× |
| Ins Vag Brachytx Device (57156) |
$615 |
$1,230 |
1.9× |
| Ins/Rep Subq Defibrillator (33270) |
$32,280 |
$64,560 |
1.0× |
| Insert 1 Electrode Pm-Defib (33216) |
$6,020 |
$12,040 |
0.7× |
| Insert and remove bone pin (20650) |
$3,630 |
$7,260 |
1.0× |
| Insert Bladder Cath Complex (51703) |
$320 |
$640 |
2.3× |
| Insert cath pleura w/ image (32557) |
$1,090 |
$2,180 |
0.6× |
| Insert cath pleura w/o image (32556) |
$660 |
$1,320 |
0.3× |
| Insert Cecostomy/Other Colonic Tube Percutaneous (49442) |
$1,665 |
$3,330 |
1.3× |
| Insert cervical dilator (59200) |
$382.50 |
$765 |
1.2× |
| Insert Gastrostomy Tube Percutaneous (49440) |
$2,610 |
$5,220 |
1.3× |
| Insert Heart Pm Atrial (33206) |
$6,140 |
$12,280 |
0.5× |
| Insert Heart Pm Ventricular (33207) |
$9,955 |
$19,910 |
0.9× |
Insert hepatic shunt (tips) (37182)
likely a partial charge, not the full procedure |
$3,015 |
$6,030 |
0.2× |
| Insert non-tunnel cv cath (36556) |
$2,330 |
$4,660 |
0.7× |
Insert Pacing Lead & Connect (33224)
unusually low: confirm this is the full procedure |
$3,790 |
$7,580 |
0.3× |
| Insert pessary/other device (57160) |
$295 |
$590 |
1.4× |
| Insert Picc W/O Sub-Q Port <5 Y/O (36568) |
$1,430 |
$2,860 |
0.8× |
| Insert pulse gen dual leads (33213) |
$6,840 |
$13,680 |
0.6× |
Insert pulse gen mult leads (33221)
likely a partial charge, not the full procedure |
$4,315 |
$8,630 |
0.2× |
Insert Pulse Gen Sngl Lead (33212)
unusually low: confirm this is the full procedure |
$4,315 |
$8,630 |
0.5× |
| Insert Temp Bladder Cath (51702) |
$245 |
$490 |
1.7× |
| Insert tun ip cath perc (49418) |
$3,275 |
$6,550 |
0.9× |
| Insert tunneled cv cath (36561) |
$4,280 |
$8,560 |
1.3× |
| Insert tunneled cvc w/o subq port/pmp age <5 yr (36557) |
$3,260 |
$6,520 |
0.5× |
| Insert,Non-Indwelling Bladder Catheter (51701) |
$220 |
$440 |
1.5× |
| Insertion indwelling tunneled pleural catheter (32550) |
$4,585 |
$9,170 |
1.2× |
| Insertion Picc W/Rs&I 5 Yr/> (36573) |
$1,520 |
$3,040 |
0.9× |
| Insertion subq cardiac rhythm monitor w/prgrmg (33285) |
$7,780 |
$15,560 |
0.9× |
| Insertion Tunnel Intraperitoneal Cath Dial Open (49421) |
$4,445 |
$8,890 |
1.2× |
| Insertion Uterine Tandem&/Vaginal Ovoids (57155) |
$3,370 |
$6,740 |
0.6× |
| Insj 2 Transvns Eltrd Perm Pacemaker/Impltbl Dfb (33217) |
$6,020 |
$12,040 |
0.7× |
| Insj Non-Tunneled Central Venous Cath Age < 5 Y (36555) |
$2,415 |
$4,830 |
0.7× |
| Insj Picc Rs&I <5 Yr (36572) |
$1,850 |
$3,700 |
2.8× |
| Insj prph ctr vad w/subq port age 5 yr/> (36571) |
$3,520 |
$7,040 |
1.0× |
| Insj Prph Ctr Vad W/Subq Port Under 5 Yr (36570) |
$3,770 |
$7,540 |
1.1× |
| Insj prph cvc w/o subq port/pmp age 5 yr/> (36569) |
$1,090 |
$2,180 |
0.6× |
| Insj Subq Impltbl Dfb Elctrd (33271) |
$18,295 |
$36,590 |
2.1× |
| Insj Tunneled Ctr Vad W/Subq Port Under 5 Yr (36560) |
$3,770 |
$7,540 |
1.1× |
| Insj tunneled cvc w/o subq port/pmp age 5 yr/> (36558) |
$3,665 |
$7,330 |
1.1× |
| Insj/Rplcmt Defib W/Lead(S) (33249) |
$29,805 |
$59,610 |
0.9× |
| Insj/rplcmt temp transvns 1chmbr eltrd/pm cath (33210) |
$4,505 |
$9,010 |
0.5× |
| Insrt heart pm atrial & vent (33208) |
$10,380 |
$20,760 |
0.9× |
| Insrt Pulse Gen W/Dual Leads (33230) |
$12,130 |
$24,260 |
0.5× |
Insrt Pulse Gen W/Mult Leads (33231)
unusually low: confirm this is the full procedure |
$14,560 |
$29,120 |
0.4× |
| Insrt Pulse Gen W/Singl Lead (33240) |
$12,515 |
$25,030 |
0.5× |
| Instlj ther agent renal pelvis&/ureter via tub (50391) |
$387.50 |
$775 |
1.4× |
| Interstitial Dev Plmt Radiation Therapy 1/Mlt (49411) |
$1,920 |
$3,840 |
1.3× |
| Intmd Rpr Face/Mm 12.6-20 Cm (12055) |
$800 |
$1,600 |
1.8× |
| Intmd Rpr Face/Mm 20.1-30.0 (12056) |
$865 |
$1,730 |
2.0× |
| Intro cath dialysis circuit (36901) |
$1,110 |
$2,220 |
0.7× |
| Intro cath dialysis circuit w/tcat plmt IV stent (36903) |
$15,255 |
$30,510 |
1.2× |
| Intro Cath Dialysis Circuit W/Trluml Balo Angiop (36902) |
$7,725 |
$15,450 |
1.3× |
| Intro Gastrointestinal Tube (44500) |
$1,120 |
$2,240 |
1.2× |
| Intubation endotracheal emergency procedure (31500) |
$565 |
$1,130 |
2.2× |
| Irrigation of corpora cavernosa for priapism (54220) |
$670 |
$1,340 |
2.5× |
Kidney endoscopy (50553)
unusually low: confirm this is the full procedure |
$2,280 |
$4,560 |
0.4× |
| Klhl11 antb serum/csf cell binding assay qual (0432U) |
$62.50 |
$125 |
1.7× |
| Laryngoscopy and dilation (31528) |
$3,970 |
$7,940 |
1.0× |
| Laryngoscopy diagnostic (31505) |
$215 |
$430 |
1.0× |
| Laryngoscopy flexible diagnostic (31575) |
$215 |
$430 |
1.0× |
| Laryngoscopy Flx Rmvl Foreign Body(S) (31577) |
$485 |
$970 |
1.2× |
| Laryngoscopy Flx/Rgd Telescopic W/Stroboscopy (31579) |
$705 |
$1,410 |
1.7× |
| Laryngoscopy Indirect W/Removal Foreign Body (31511) |
$215 |
$430 |
1.0× |
| Lyse chest fibrin init day (32561) |
$1,215 |
$2,430 |
1.8× |
| Manometric stds thru tube/ndwellg urtrl cath (50396) |
$980 |
$1,960 |
1.3× |
| Maternity Care Procedure (59899) |
$380 |
$760 |
1.8× |
| Mech Remov Intralum Obstr Cv Dev Thru Lumen (36596) |
$1,215 |
$2,430 |
0.7× |
| Mech remov tunneled cv cath (36595) |
$1,560 |
$3,120 |
0.5× |
| Musc myocutaneous/fasciocutaneous flap uxtr (15736) |
$2,195 |
$4,390 |
1.0× |
| Myelography Lumbar Injection (62305) |
$1,035 |
$2,070 |
1.2× |
| Myelography Lumbar Injection (62304) |
$1,070 |
$2,140 |
1.3× |
| Myelography via lumbar injection rs&i cervical (62302) |
$890 |
$1,780 |
1.1× |
| Myelography Via Lumbar Injection Rs&I Thoracic (62303) |
$925 |
$1,850 |
1.1× |
| Myomectomy 1-4 Myomas 250 Gm/< Vaginal Appr (58145) |
$2,505 |
$5,010 |
0.7× |
| N Block Inj Celiac Pelus (64530) |
$1,025 |
$2,050 |
1.1× |
N Block Inj Ilio-Ing/Hypogi (64425)
range across 2 matching MRF lines |
$387.50–$615 |
$775–$1,230 |
varies |
| N block inj intercost sng (64420) |
$935 |
$1,870 |
1.2× |
| N Block Inj Pudendal (64430) |
$1,025 |
$2,050 |
1.1× |
| N Block Lumbar/Thoracic (64520) |
$1,025 |
$2,050 |
1.1× |
| Nasal Endoscopy Dx (31231) |
$215 |
$430 |
1.0× |
| Nasal/Orogastric W/Tube Plmt (43752) |
$515 |
$1,030 |
1.1× |
| Nasal/Sinus Ndsc Surg W/Control Nasal Hemrrg (31238) |
$1,920 |
$3,840 |
1.0× |
| Ndl Emg Stds Emg Anal/Urtl Sphnctr Any Tq (51785) |
$700 |
$1,400 |
2.6× |
| Needle Biopsy Lymph Nodes (38505) |
$1,265 |
$2,530 |
0.7× |
| Needle Biopsy Pancreas (48102) |
$1,330 |
$2,660 |
0.8× |
| Needle insertion w/o injection 1 or 2 muscles (20560) |
$35 |
$70 |
1.1× |
| Needle insertion w/o injection 3 or more muscles (20561) |
$35 |
$70 |
1.1× |
| Nfct ds bct/vir respir DNA/RNA 22 trgt sarscov2 (0202U) |
$785 |
$1,570 |
1.9× |
| Nfct ds mcrb cll fr DNA untrgt next genrj seq (0152U) |
$2,460 |
$4,920 |
1.2× |
| Njx anes stellate ganglion crv sympathetic (64510) |
$1,025 |
$2,050 |
1.1× |
Njx Anes Trigeminal Nrv Any Div/Branch (64400)
range across 2 matching MRF lines |
$492.50–$825 |
$985–$1,650 |
varies |
| Njx Cholangio Prq W/Img Gid Rs&I Existing Access (47531) |
$1,430 |
$2,860 |
0.4× |
| Njx Cholangio Prq W/Img Gid Rs&I New Access (47532) |
$2,185 |
$4,370 |
0.6× |
Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 1 Level (64493)
range across 4 matching MRF lines |
$1,245–$1,820 |
$2,490–$3,640 |
varies |
| Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn (62321) |
$1,145 |
$2,290 |
1.5× |
| Njx dx/ther sbst intrlmnr lmbr/sac w/img gdn (62323) |
$1,145 |
$2,290 |
1.5× |
| Njx Px Antegrde Nfrosgrm &/Urtrgrm Exstng Acess (50431) |
$875 |
$1,750 |
1.2× |
| Njx Px Antegrde Nfrosgrm &/Urtrgrm New Access (50430) |
$885 |
$1,770 |
1.2× |
| Njx Sclrsnt 1 Incmptnt Vein (36470) |
$620 |
$1,240 |
1.4× |
| Obstructive material removal from gi tube (49460) |
$1,120 |
$2,240 |
1.2× |
Occipital Nerve Block (64405)
range across 2 matching MRF lines |
$445–$452.50 |
$890–$905 |
varies |
| Onc Hl Neo Gen Seq Alys Alg (0364U) |
$3,055 |
$6,110 |
1.5× |
| Open/Perq Place Stent 1St (37236) |
$6,865 |
$13,730 |
0.6× |
| Open/Perq Place Stent Same (37238) |
$9,285 |
$18,570 |
0.8× |
| Penile Injection (54235) |
$415 |
$830 |
1.6× |
Perc Cryo Ablate Renal Tum (50593)
unusually low: confirm this is the full procedure |
$3,825 |
$7,650 |
0.3× |
| Perc Place Intra-Thoracic Interstit Rad Therapy Guide, 1/Mult (32553) |
$1,415 |
$2,830 |
1.0× |
Perc Rf Ablate Renal Tumor (50592)
range across 2 matching MRF lines |
$3,555–$6,380 |
$7,110–$12,760 |
varies |
| Percut Ablate Liver Rf (47382) |
$4,055 |
$8,110 |
0.6× |
| Percut Cath Occlusn Non Cns Lesn (61626) |
$7,045 |
$14,090 |
0.6× |
Percut Drain/Inject Renal Cyst (50390)
range across 2 matching MRF lines |
$750–$1,120 |
$1,500–$2,240 |
varies |
| Percut Mech Thrombectomy, Venous, Repeat (37188) |
$4,025 |
$8,050 |
1.2× |
| Pericardiocentesis W/Imaging (33016) |
$2,375 |
$4,750 |
1.4× |
Perm Occlusion/Embolization,Percut,Cns (61624)
likely a partial charge, not the full procedure |
$2,250 |
$4,500 |
0.1× |
| Perq av fistula creation uxtr sep access sites (36837) |
$16,360 |
$32,720 |
0.8× |
| Perq av fistula creation uxtr single access (36836) |
$14,025 |
$28,050 |
0.7× |
| Perq Cervicothoracic Inject (22510) |
$8,245 |
$16,490 |
2.4× |
| Perq dev breast 1st mr guide (19287) |
$1,220 |
$2,440 |
1.6× |
| Perq dev breast 1st strtctc (19283) |
$1,340 |
$2,680 |
1.8× |
| Perq dev breast 1st us imag (19285) |
$1,180 |
$2,360 |
1.6× |
| Perq device breast 1st imag (19281) |
$1,070 |
$2,140 |
0.6× |
| Perq dilation xst trc endourologic px w/img (50436) |
$2,630 |
$5,260 |
0.7× |
| Perq Lumbosacral Injection (22511) |
$3,115 |
$6,230 |
0.9× |
Perq nl/pl lithotrp simple up to 2 cm 1 location (50080)
unusually low: confirm this is the full procedure |
$3,490 |
$6,980 |
0.3× |
| Perq p-art revsc 1 nm nt uni (33900) |
$9,635 |
$19,270 |
0.8× |
| Perq p-art revsc st 1st abnor connj unilateral (33902) |
$15,580 |
$31,160 |
0.8× |
| Perq p-art revsc st 1st abnormal connj bilateral (33903) |
$19,475 |
$38,950 |
1.6× |
| Perq p-art revsc st 1st nml native connj bi (33901) |
$12,050 |
$24,100 |
1.0× |
| Perq sft tiss loc device plmt 1st les w/gdnce (10035) |
$995 |
$1,990 |
1.3× |
| Perq thrmbc/nfs dial circuit trluml balo angiop (36905) |
$15,255 |
$30,510 |
1.2× |
| Perq thrmbc/nfs dialysis circuit img dx angrph (36904) |
$6,185 |
$12,370 |
1.0× |
| Perq vert agmntj cavity crtj uni/bi cannulj lmbr (22514) |
$7,030 |
$14,060 |
0.9× |
| Perq Vertebral Augmentation (22513) |
$7,030 |
$14,060 |
0.9× |
| Phleb Veins - Extrem 20+ (37766) |
$4,355 |
$8,710 |
1.3× |
Place Cath Subclavian Art (36225)
range across 3 matching MRF lines |
$3,780–$4,720 |
$7,560–$9,440 |
varies |
| Place Cath Thoracic Aorta (36221) |
$4,200 |
$8,400 |
1.2× |
Place Cath Vertebral Art (36226)
range across 2 matching MRF lines |
$5,030–$7,680 |
$10,060–$15,360 |
varies |
| Place Duod/Jej Tube Perc (49441) |
$2,135 |
$4,270 |
1.0× |
| Place Rt Device/Marker Pros (55876) |
$1,585 |
$3,170 |
1.1× |
| Placement of needle for intraosseous infusion (36680) |
$350 |
$700 |
0.7× |
| Plmt Bile Duct Stent Prq Existing Access (47538) |
$6,295 |
$12,590 |
1.0× |
| Plmt Bile Duct Stent Prq New Access W/O Sep Cath (47539) |
$7,075 |
$14,150 |
1.1× |
| Plmt Bile Duct Stent Prq New Access W/Sep Cath (47540) |
$4,545 |
$9,090 |
0.7× |
Plmt Nephrostomy Cath Prq New Access Rs&I (50432)
range across 2 matching MRF lines |
$2,515–$3,780 |
$5,030–$7,560 |
varies |
| Plmt Nephroureteral Catheter (50433) |
$2,615 |
$5,230 |
0.7× |
| Plmt Urtrl Stent Prq New Access W/Sep Nfros Cath (50695) |
$3,520 |
$7,040 |
0.9× |
| Plmt Urtrl Stent Prq Pre-Existing Nfros Tract (50693) |
$2,960 |
$5,920 |
0.8× |
| Plmt Urtrl Stnt Prq New Acess W/O Sep Nfros Cath (50694) |
$4,510 |
$9,020 |
1.2× |
Prim art mech thrombectomy (37184)
unusually low: confirm this is the full procedure |
$6,105 |
$12,210 |
0.3× |
| Prq Aspir Pulposus/Intervertebral Disc/Pvrt Tiss (62267) |
$865 |
$1,730 |
1.1× |
| Prq Plmt Biliary Drg Cath W/Img Gid Rs&I Externl (47533) |
$3,275 |
$6,550 |
0.9× |
| Prq Plmt Biliary Drg Cath W/Img Gid Rs&I Int-Ext (47534) |
$3,275 |
$6,550 |
0.9× |
| Pseudoaneurysm Injection Trt (36002) |
$690 |
$1,380 |
1.0× |
| Punch biopsy skin single lesion (11104) |
$230 |
$460 |
0.5× |
| Puncture aspiration abscess hematoma bulla/cyst (10160) |
$402.50 |
$805 |
0.9× |
| Puncture Aspiration Cyst Breast (19000) |
$675 |
$1,350 |
0.9× |
| Puncture shunt tube/reservoir aspiration/inj px (61070) |
$1,445 |
$2,890 |
1.9× |
| Radiofrequency abltj nrv nrvtg si jt w/img gdn (64625) |
$1,135 |
$2,270 |
0.5× |
| Rbc DNA gntyp 12 bld grp gen (0282U) |
$575 |
$1,150 |
0.8× |
| Redo Endovas Vena Cava Filtr (37192) |
$4,190 |
$8,380 |
1.2× |
| Relocation Pocket Pacemaker (33222) |
$1,830 |
$3,660 |
0.8× |
| Rem Endovas Vena Cava Filter (37193) |
$4,405 |
$8,810 |
1.3× |
| Removal Biliary Drg Catheter Req Fluor Gid Rs&I (47537) |
$1,370 |
$2,740 |
1.4× |
| Removal Foreign Body Foot Subcutaneous (28190) |
$800 |
$1,600 |
1.1× |
| Removal Foreign Body Muscle/Tendon Sheath Simple (20520) |
$940 |
$1,880 |
0.5× |
| Removal Foreign Body Scrotum (55120) |
$3,150 |
$6,300 |
1.4× |
Removal impacted cerumen irrigation/lvg unilat (69209)
range across 2 matching MRF lines |
$125–$150 |
$250–$300 |
varies |
Removal Impacted Cerumen Requiring Instrumentation, Unilateral (69210)
range across 2 matching MRF lines |
$125–$150 |
$250–$300 |
varies |
| Removal of foreign body from pharynx (42809) |
$347.50 |
$695 |
0.7× |
| Removal of nail bed (11750) |
$700 |
$1,400 |
1.6× |
| Removal of tunneled intraperitoneal catheter (49422) |
$4,200 |
$8,400 |
1.2× |
| Removal or bivalving full arm or full leg cast (29705) |
$390 |
$780 |
1.3× |
| Removal Pacemaker Electrode (33235) |
$3,790 |
$7,580 |
0.9× |
Removal ppm generator only (33233)
unusually low: confirm this is the full procedure |
$3,690 |
$7,380 |
0.4× |
| Removal subcutaneous cardiac rhythm monitor (33286) |
$1,100 |
$2,200 |
1.4× |
| Removal Sutures/Staples Requiring Anesthesia (15851) |
$125 |
$250 |
0.1× |
| Removal tong/halo applied by another individual (20665) |
$397.50 |
$795 |
0.8× |
| Removal/bivalving gauntlet boot/body cast (29700) |
$225 |
$450 |
0.8× |
| Remove & Replace Indwell Ureteral Stent Trurthrl (50385) |
$2,930 |
$5,860 |
1.3× |
| Remove brain canal fluid (61050) |
$835 |
$1,670 |
2.5× |
| Remove cerclage suture (59871) |
$2,995 |
$5,990 |
0.9× |
| Remove Elctrd Transvenously (33244) |
$4,705 |
$9,410 |
1.2× |
| Remove foreign body from eye (65205) |
$187.50 |
$375 |
1.3× |
| Remove Int Dwell Ureteral Stent Transurethral (50386) |
$2,930 |
$5,860 |
1.3× |
| Remove Intrauterine Device (58301) |
$337.50 |
$675 |
1.0× |
| Remove intrvas foreign body (37197) |
$3,780 |
$7,560 |
1.1× |
| Remove lung catheter (32552) |
$800 |
$1,600 |
1.2× |
| Remove Nasal Foreign Body (30300) |
$267.50 |
$535 |
1.9× |
| Remove Pulse Generator (33241) |
$3,685 |
$7,370 |
0.9× |
Remove renal tube w/fluoro (50389)
range across 2 matching MRF lines |
$600–$885 |
$1,200–$1,770 |
varies |
| Remove ureter stent percut (50384) |
$3,220 |
$6,440 |
1.4× |
| Remove&replace pm gen singl (33227) |
$9,105 |
$18,210 |
1.0× |
| Remv&replc cvd gen dual lead (33263) |
$31,070 |
$62,140 |
1.3× |
| Remv&replc cvd gen mult lead (33264) |
$25,525 |
$51,050 |
0.8× |
| Remv&replc cvd gen sing lead (33262) |
$27,155 |
$54,310 |
1.1× |
| Remv&replc pm gen dual lead (33228) |
$9,105 |
$18,210 |
0.8× |
Remv&replc pm gen mult leads (33229)
unusually low: confirm this is the full procedure |
$10,285 |
$20,570 |
0.5× |
| Renal Biopsy Perq (50200) |
$1,505 |
$3,010 |
0.9× |
Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or… (50555)
likely a partial charge, not the full procedure |
$2,420 |
$4,840 |
0.2× |
| Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography,… (50574) |
$1,805 |
$3,610 |
0.5× |
| Renal ndsc nephros/pyelostomy rmvl fb/calculus (50561) |
$3,645 |
$7,290 |
0.6× |
| Repair Blood Vessel Direct Hand Finger (35207) |
$3,670 |
$7,340 |
1.1× |
| Repair Blood Vessel Direct Upper Extremity (35206) |
$3,670 |
$7,340 |
1.1× |
| Repair complex eyelid/nose/ear/lip 1.1-2.5 cm (13151) |
$820 |
$1,640 |
1.0× |
| Repair complex eyelid/nose/ear/lip 2.6-7.5 cm (13152) |
$945 |
$1,890 |
1.2× |
| Repair complex f/c/c/m/n/ax/g/h/f 1.1-2.5 cm (13131) |
$820 |
$1,640 |
1.9× |
| Repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm (13132) |
$945 |
$1,890 |
2.2× |
| Repair complex scalp/arm/leg 2.6-7.5 cm (13121) |
$945 |
$1,890 |
2.2× |
| Repair complex trunk 2.6-7.5 cm (13101) |
$820 |
$1,640 |
1.0× |
| Repair Hand Tendon (26410) |
$1,790 |
$3,580 |
1.0× |
| Repair intermediate f/e/e/n/l&/muc 2.5 cm/< (12051) |
$620 |
$1,240 |
1.4× |
| Repair intermediate f/e/e/n/l&/muc 2.6-5.0 cm (12052) |
$675 |
$1,350 |
1.5× |
| Repair intermediate f/e/e/n/l&/muc 5.1-7.5 cm (12053) |
$705 |
$1,410 |
1.6× |
| Repair intermediate f/e/e/n/l&/muc 7.6-12.5 cm (12054) |
$740 |
$1,480 |
1.7× |
| Repair intermediate n/h/f/xtrnl gent 2.5cm/< (12041) |
$620 |
$1,240 |
1.4× |
| Repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm (12042) |
$675 |
$1,350 |
1.5× |
| Repair intermediate n/h/f/xtrnl gent 7.6-12.5cm (12044) |
$740 |
$1,480 |
0.9× |
| Repair intermediate s/a/t/e 12.6-20.0cm (12035) |
$800 |
$1,600 |
1.8× |
| Repair intermediate s/a/t/e 2.5 cm/< (12031) |
$620 |
$1,240 |
1.4× |
| Repair intermediate s/a/t/e 2.6-7.5 cm (12032) |
$675 |
$1,350 |
1.5× |
| Repair intermediate s/a/t/e 20.1-30.0 cm (12036) |
$865 |
$1,730 |
1.1× |
| Repair intermediate s/a/t/e 7.6-12.5 cm (12034) |
$740 |
$1,480 |
1.7× |
| Repair intermediate s/a/t/e >30.0 cm (12037) |
$925 |
$1,850 |
0.4× |
| Repair Laceration Palate >2 Cm/Complex (42182) |
$4,195 |
$8,390 |
0.7× |
| Repair of nail bed (11760) |
$625 |
$1,250 |
0.8× |
| Repair tongue laceration (41252) |
$275 |
$550 |
1.1× |
| Repair tongue laceration (41250) |
$350 |
$700 |
0.7× |
| Replace duodenostomy/jejunostomy tube perq (49451) |
$1,230 |
$2,460 |
1.3× |
| Replace G-J Tube Perc (49452) |
$1,370 |
$2,740 |
1.4× |
| Replace g/c tube perc (49450) |
$1,120 |
$2,240 |
1.2× |
| Repos Previously Implanted Subq Implantable Dfb (33273) |
$7,915 |
$15,830 |
2.0× |
| Reposition Gastrostomy Tube (43761) |
$670 |
$1,340 |
2.5× |
| Reposition L Ventric Lead (33226) |
$4,205 |
$8,410 |
1.2× |
| Reposition Pacing-Defib Lead (33215) |
$3,750 |
$7,500 |
1.1× |
| Reposition Venous Catheter (36597) |
$1,305 |
$2,610 |
0.8× |
| Revj Transvns Intrahepatic Portosystemic Shunt (37183) |
$6,980 |
$13,960 |
1.1× |
Rmvl & rplcmt xtrnl accessible nephrourtrl cath (50387)
range across 2 matching MRF lines |
$1,720–$2,640 |
$3,440–$5,280 |
varies |
| Rmvl embedded fb vestibule mouth comp (40805) |
$800 |
$1,600 |
1.4× |
| Rmvl fb xtrnl eye corneal w/o slit lamp (65220) |
$417.50 |
$835 |
0.9× |
| Rmvl fb xtrnl eye corneal w/slit lamp (65222) |
$265 |
$530 |
1.9× |
| Rmvl of subq implantable defibrillator electrode (33272) |
$5,875 |
$11,750 |
1.5× |
| Rmvl transvns pm eltrd 1 lead sys atr/ventr (33234) |
$3,790 |
$7,580 |
0.9× |
| Rmvl tun ctr vad w/subq port/pmp ctr/prph insj (36590) |
$1,335 |
$2,670 |
0.8× |
| Rmvl Tun Cvc W/O Subq Port/Pmp (36589) |
$1,335 |
$2,670 |
2.0× |
| Rplc Gtube No Revj Trc (43762) |
$555 |
$1,110 |
2.1× |
| Rplcmt cath ctr vad subq port/pmp (36578) |
$4,190 |
$8,380 |
1.2× |
| Rplcmt compl non-tun cvc w/o subq port/pmp (36580) |
$1,260 |
$2,520 |
0.7× |
| Rplcmt Compl Prph Ctr Vad W/Subq Port (36585) |
$3,505 |
$7,010 |
1.0× |
| Rplcmt Compl Prph Cvc W/O Subq Port/Pmp (36584) |
$1,560 |
$3,120 |
0.9× |
| Rplcmt compl tun ctr vad w/subq port (36582) |
$3,505 |
$7,010 |
1.0× |
| Rplcmt compl tun cvc w/o subq port/pmp (36581) |
$3,155 |
$6,310 |
0.9× |
| Rpr blood vessel direct lower extremity (35226) |
$800 |
$1,600 |
1.1× |
| Rpr blvsl w/grf other/than vein lower extremity (35286) |
$4,160 |
$8,320 |
0.7× |
| Rpr ctr vad w/subq port/pmp ctr/prph insj sit (36576) |
$1,635 |
$3,270 |
1.0× |
| Rpr F/E/E/N/L/M 7.6-12.5 Cm (12015) |
$495 |
$990 |
2.3× |
| Rpr Lip Full Thickness Half/< Vertical Height (40652) |
$580 |
$1,160 |
1.0× |
| Rpr Lip Full Thickness Vermilion Only (40650) |
$580 |
$1,160 |
1.0× |
| Rpr Lip Full Thkns >One-Half Vert Height/Comple (40654) |
$1,735 |
$3,470 |
1.0× |
| Rpr/advmnt flxr tdn zone 2 w/o fr grft ea tendon (26356) |
$3,630 |
$7,260 |
1.0× |
| Sclerotx Fluid Collection (49185) |
$1,095 |
$2,190 |
0.6× |
| Simple repair f/e/e/n/l/m 12.6cm-20.0 cm (12016) |
$535 |
$1,070 |
1.2× |
| Simple repair f/e/e/n/l/m 2.5cm/< (12011) |
$410 |
$820 |
1.9× |
| Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) |
$452.50 |
$905 |
2.1× |
| Simple Repair F/E/E/N/L/M 20.1cm-30.0 Cm (12017) |
$575 |
$1,150 |
1.3× |
| Simple repair f/e/e/n/l/m 5.1cm-7.5 cm (12014) |
$472.50 |
$945 |
2.2× |
| Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001) |
$410 |
$820 |
1.9× |
| Simple repair scalp/neck/ax/genit/trunk >30.0cm (12007) |
$620 |
$1,240 |
2.9× |
| Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004) |
$495 |
$990 |
2.3× |
| Skin sub graft face/nk/hf/g (15275) |
$1,800 |
$3,600 |
2.3× |
| Skin sub graft trnk/arm/leg (15271) |
$1,800 |
$3,600 |
2.3× |
| Skin sub grft t/arm/lg child (15273) |
$3,150 |
$6,300 |
1.4× |
| Skn sub grft f/n/hf/g child (15277) |
$2,700 |
$5,400 |
1.2× |
Slctv Cath Carotid/Innom Art Angio Intrcranl Art (36223)
range across 2 matching MRF lines |
$5,540–$7,030 |
$11,080–$14,060 |
varies |
Slctv cath carotid/innom art angio xtrcranl art (36222)
range across 2 matching MRF lines |
$3,780–$5,550 |
$7,560–$11,100 |
varies |
Slctv Cath Intrnl Carotid Art Angio Intrcrnl Art (36224)
range across 2 matching MRF lines |
$5,590–$7,710 |
$11,180–$15,420 |
varies |
| Slitting of prepuce (54001) |
$2,295 |
$4,590 |
1.0× |
| Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002) |
$452.50 |
$905 |
2.1× |
| Smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm (12005) |
$535 |
$1,070 |
1.2× |
| Smpl rpr scalp/neck/ax/genit/trunk 20.1-30.0cm (12006) |
$575 |
$1,150 |
1.3× |
| Spinal puncture lumbar diagnostic (62270) |
$720 |
$1,440 |
1.0× |
| Split Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm/</1 % (15120) |
$4,440 |
$8,880 |
1.2× |
| Split Agrft T/a/L 1st 100 Cm/&/1% Bdy Inft/Chld (15100) |
$2,530 |
$5,060 |
1.1× |
| Stab phlebt varicose veins 1 xtr 10-20 stab incs (37765) |
$3,785 |
$7,570 |
1.1× |
| Strapping ankle (29540) |
$142.50 |
$285 |
0.8× |
| Strapping hand/finger (29280) |
$110 |
$220 |
1.7× |
| Strapping Hip (29520) |
$142.50 |
$285 |
1.0× |
| Strapping knee (29530) |
$142.50 |
$285 |
1.0× |
| Strapping shoulder (29240) |
$142.50 |
$285 |
1.0× |
Strapping Unna Boot (29580)
range across 2 matching MRF lines |
$202.50–$300 |
$405–$600 |
varies |
| Tangential biopsy skin single lesion (11102) |
$230 |
$460 |
0.5× |
| Tcat Impl Wrls P-Art Prs Snr L-T Hemodyn Mntr (33289) |
$26,770 |
$53,540 |
0.9× |
| Tcat Insj/Rpl Perm Ldls Pm (33274) |
$19,610 |
$39,220 |
1.0× |
| Thaw preserved stem cells (38208) |
$790 |
$1,580 |
1.7× |
| Ther Apheresis W/Extracorporeal Immunoadsorption (36516) |
$4,250 |
$8,500 |
0.9× |
| Ther Apheresis,Red Blood Cells (36512) |
$2,195 |
$4,390 |
1.3× |
| Ther Spi Pnxr Csf Fluor/Ct (62329) |
$1,520 |
$3,040 |
2.0× |
| Therapeutic Apheresis White Blood Cells (36511) |
$2,195 |
$4,390 |
1.3× |
| Therapeutic plasma exchange (36514) |
$2,195 |
$4,390 |
1.3× |
| Thrmbc/Nfs Dialysis Circuit (36906) |
$21,600 |
$43,200 |
1.1× |
| Thromblytic art/ven therapy (37213) |
$1,795 |
$3,590 |
0.5× |
| Thrombolytic Art Therapy (37211) |
$3,970 |
$7,940 |
0.7× |
| Thrombolytic Therapy Stroke (37195) |
$410 |
$820 |
1.2× |
| Thrombolytic Venous Therapy (37212) |
$3,780 |
$7,560 |
1.1× |
| Thyroid biopsy (60100) |
$960 |
$1,920 |
1.3× |
| Tis Trnfr E/N/E/L 10 Sq Cm/< (14060) |
$1,950 |
$3,900 |
0.9× |
| Tooth extraction (41899) |
$275 |
$550 |
1.1× |
| Tprnl Plmt Biodegrdabl Matrl (55874) |
$6,800 |
$13,600 |
1.2× |
| Tracheobrnchsc Thru Est Trachs Inc (31615) |
$580 |
$1,160 |
1.0× |
| Tracheostomy Emergency Cricothyroid Membrane (31605) |
$307.50 |
$615 |
1.2× |
| Tracheostomy Emergency Procedure Transtracheal (31603) |
$1,735 |
$3,470 |
1.0× |
Transcatheter biopsy (37200)
unusually low: confirm this is the full procedure |
$2,755 |
$5,510 |
0.5× |
| Transcerv Fallopian Tube Cath W/WO Hystosalping (58345) |
$3,695 |
$7,390 |
1.1× |
| Transperineal Plmt Ndl/Caths Prostate Radj Insj (55875) |
$6,800 |
$13,600 |
1.2× |
| Treat Hip Socket Fracture (27222) |
$1,535 |
$3,070 |
5.8× |
| Treat Humerus Fracture (24505) |
$1,790 |
$3,580 |
1.0× |
| Treat knee fracture (27532) |
$3,630 |
$7,260 |
1.0× |
| Treat Knuckle Dislocation (26700) |
$270 |
$540 |
1.0× |
| Treat Metatarsal Fracture (28475) |
$270 |
$540 |
1.0× |
| Treat Thumb Dislocation (26641) |
$270 |
$540 |
1.0× |
| Treat Thumb Fracture (26645) |
$1,790 |
$3,580 |
1.0× |
| Treat toe dislocation (28630) |
$270 |
$540 |
1.0× |
| Treat Vaginal Bleeding (57180) |
$447.50 |
$895 |
2.1× |
| Treatment closed elbow dislocation w/o anes (24600) |
$270 |
$540 |
1.0× |
| Trim skin lesion (11055) |
$132.50 |
$265 |
0.6× |
| Trim skin lesions 2 to 4 (11056) |
$132.50 |
$265 |
0.6× |
| Trimming Nondystrophic Nails Any Number (11719) |
$77.50 |
$155 |
1.2× |
| Trluml Balo Angiop 1St Art (37246) |
$9,275 |
$18,550 |
1.5× |
| Trluml Balo Angiop 1St Vein (37248) |
$5,015 |
$10,030 |
0.8× |
| Trnspl Prepj Hematop Progen Cells Cryoprsrv Stor (38207) |
$2,650 |
$5,300 |
5.6× |
| Trnspl Prepj Hematop Progen Concentration Plsm (38215) |
$470 |
$940 |
1.0× |
| Trnspl Prepj Hematop Progen Plsm Vol Deplj (38214) |
$470 |
$940 |
1.0× |
Trnsplj allogeneic hematopoietic cells per donor (38240)
likely a partial charge, not the full procedure |
$3,860 |
$7,720 |
0.1× |
| Trnsplj autologous hematopoietic cells per donor (38241) |
$1,760 |
$3,520 |
1.1× |
| Trnsplj Hematopoietic Cell Boost (38243) |
$2,030 |
$4,060 |
1.2× |
| Ttrach Intro Ndl Wire Dil/Stent/Tube O2 Ther (31730) |
$1,630 |
$3,260 |
0.9× |
| Tx Gastro Intub W/Asp (43753) |
$340 |
$680 |
1.5× |
| Tx Incomplete Abortion Any Trimester Surgical (59812) |
$2,765 |
$5,530 |
0.8× |
| Tx Superficial Wound Dehiscence Simple Closure (12020) |
$765 |
$1,530 |
1.0× |
| Tx superficial wound dehiscence w/packing (12021) |
$840 |
$1,680 |
1.9× |
| Tx Tarsal Bone Fx Xcp Talus&Calcn W/Manj (28455) |
$1,790 |
$3,580 |
1.0× |
| Unlisted Cardiac Surgery (33999) |
$14,800 |
$29,600 |
22.0× |
| Unlisted procedure anus (46999) |
$1,020 |
$2,040 |
1.0× |
| Unlisted Procedure Biliary Tract (47999) |
$1,245 |
$2,490 |
1.3× |
| Unlisted Procedure Casting/Strapping (29799) |
$142.50 |
$285 |
0.8× |
| Unlisted procedure colon (45399) |
$1,195 |
$2,390 |
1.2× |
| Unlisted Procedure External Ear (69399) |
$362.50 |
$725 |
1.4× |
| Unlisted Procedure Intestine (44799) |
$1,195 |
$2,390 |
1.2× |
| Unlisted Procedure Muscskeletal System General (20999) |
$905 |
$1,810 |
3.4× |
| Unlisted procedure nervous system (64999) |
$452.50 |
$905 |
1.4× |
| Unlisted procedure pelvis/hip joint (27299) |
$900 |
$1,800 |
3.4× |
Unlisted Procedure Vascular Surgery (37799)
range across 2 matching MRF lines |
$775–$1,215 |
$1,550–$2,430 |
varies |
| Unlisted Procedure, Urinary System (53899) |
$457.50 |
$915 |
1.7× |
| Upgrade of pacemaker system (33214) |
$9,320 |
$18,640 |
0.8× |
| Vaginal delivery only (59409) |
$1,135 |
$2,270 |
0.3× |
Vasc embolize/occlude artery (37242)
unusually low: confirm this is the full procedure |
$8,740 |
$17,480 |
0.4× |
| Vasc Embolize/Occlude Bleed (37244) |
$10,875 |
$21,750 |
0.9× |
| Vasc Embolize/Occlude Organ (37243) |
$8,915 |
$17,830 |
0.7× |
| Vasc embolize/occlude venous (37241) |
$10,490 |
$20,980 |
0.8× |
| Venous Mech Thrombectomy (37187) |
$6,280 |
$12,560 |
0.5× |
| Wash harvest stem cells (38209) |
$1,785 |
$3,570 |
3.8× |
| Wedge excision skin nail fold (11765) |
$485 |
$970 |
1.1× |