| Abd paracentesis w/imaging (49083) |
— |
$1,927.45 |
— |
| Application of Risser jacket, localizer, body; only Age Under 21 (29010) |
— |
$3,122.50 |
— |
| Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) |
— |
$574.20 |
— |
| Arthrocentesis aspir&/inj interm jt/burs w/us (20606) |
— |
$1,684.85 |
— |
| Arthrocentesis aspir&/inj major jt/bursa w/o us (20610) |
— |
$1,736.42 |
— |
| Arthrocentesis aspir&/inj major jt/bursa w/us (20611) |
— |
$1,869.55 |
— |
| Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) |
— |
$1,275.70 |
— |
| Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of… (22551) |
— |
$13,312.70 |
— |
| Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when… (22612) |
— |
$29,519.45 |
— |
| Arthroplasty glenohumeral joint total shoulder (23472) |
— |
$29,519.45 |
— |
| Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) Age Under 21 (29877) |
— |
$8,942.65 |
— |
| Arthroscopy, knee, surgical; with meniscectomy (medial and lateral, including any meniscal shaving) including… (29880) |
— |
$8,942.65 |
— |
| Avulsion of nail plate, partial or complete, simple; single (11730) |
— |
$1,056.95 |
— |
| Biopsy liver needle percutaneous (47000) |
— |
$2,373.10 |
— |
| Biopsy lymph node (38505) |
— |
$2,373.10 |
— |
| Biopsy muscle percutaneous needle (20206) |
— |
$2,373.10 |
— |
| Biopsy soft tissue neck/thorax (21550) |
— |
$2,930.95 |
— |
| Biopsy, abdominal or retroperitoneal mass, percutaneous needle Age Under 21 (49180) |
— |
$2,011 |
— |
| Bx breast 1st lesion us imag (19083) |
— |
$3,215.30 |
— |
| Collect blood from catheter venous nos (36592) |
— |
$231.50 |
— |
| Colonoscopy w/control bleed (45382) |
— |
$2,373.10 |
— |
| Colonoscopy w/fb removal (45379) |
— |
$2,373.10 |
— |
| Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps Age Under 21 (45384) |
— |
$2,373.10 |
— |
| Colonoscopy, flexible; with transendoscopic balloon dilation Age Under 21 (45386) |
— |
$2,373.10 |
— |
| Colonoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle… (45392) |
— |
$2,373.10 |
— |
| Colsc flx with directed submucosal njx any sbst (45381) |
— |
$2,373.10 |
— |
| Control throat bleeding (42960) |
— |
$708.50 |
— |
| Debridement of nail(s) by any method(s); 1 to 5 (11720) |
— |
$840 |
— |
| Diagnostic lumbar spinal puncture w/fluor or CT (62328) |
— |
$1,734.60 |
— |
| Dry needling (20999) |
— |
$2,193.60 |
— |
| Dstr nrolytc agnt parverteb fct sngl crvcl/thora (64633) |
— |
$6,361.40 |
— |
| Dstr nrolytc agnt parverteb fct sngl lmbr/sacral (64635) |
— |
$5,239.08 |
— |
| Ed prof insert foley cath simple (51702) |
— |
$422.50 |
— |
| Egd endo mucosal resection (43254) |
— |
$2,373.10 |
— |
| Egd injection varices (43243) |
— |
$2,373.10 |
— |
| Egd percutaneous placement gastrostomy tube (43246) |
— |
$4,341.05 |
— |
| Egd removal tumor polyp/other lesion snare tech (43251) |
— |
$4,341.05 |
— |
| Egd transoral control bleeding any method (43255) |
— |
$4,341.05 |
— |
| Egd tube/cath insertion (43241) |
— |
$2,373.10 |
— |
| Egd us fine needle bx/aspir (43242) |
— |
$4,341.05 |
— |
| Egd us transmural injxn/mark (43253) |
— |
$4,341.05 |
— |
| Egd w/transmural drain cyst (43240) |
— |
$4,341.05 |
— |
| Endoscopic us exam esoph (43237) |
— |
$4,341.05 |
— |
| Er inj anesthetic agent, peripheral nerve or branch (64450) |
— |
$1,210.10 |
— |
| Esoph egd dilation <30 mm (43249) |
— |
$4,341.05 |
— |
| Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices Age Under 21 (43244) |
— |
$4,341.05 |
— |
| Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal… (43257) |
— |
$8,942.65 |
— |
| Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger)… (43233) |
— |
$4,341.05 |
— |
| Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie)… (43245) |
— |
$4,341.05 |
— |
| Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through… (43248) |
— |
$2,373.10 |
— |
| Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body (43247) |
— |
$2,373.10 |
— |
| Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy… (43250) |
— |
$4,341.05 |
— |
| Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine… (43238) |
— |
$4,341.05 |
— |
| Excision ganglion wrist dorsal/volar primary (25111) |
— |
$5,964 |
— |
| Fine needle aspiration bx w/us gdn 1st lesion (10005) |
— |
$2,011.95 |
— |
| Ganglion impar nerve block (64999) |
— |
$6,366.95 |
— |
| Guide cathet fluid drainage (10030) |
— |
$1,736.45 |
— |
| Hemorrhoidectomy internal rubber band ligations (46221) |
— |
$2,373.10 |
— |
| I&d abscess simple/single (10060) |
— |
$607.75 |
— |
| Incise finger tendon sheath (26055) |
— |
$3,270.75 |
— |
| Inj epidural blood or clot patch (62273) |
— |
$1,852.20 |
— |
| Inj paravert f jnt c/t 1 lev (64490) |
— |
$3,149.90 |
— |
| Inj paravert f jnt l/s 1 lev (64493) |
— |
$3,265.08 |
— |
| Injection aa&/strd ilioinguinal ih nerves (64425) |
— |
$2,373.10 |
— |
| Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or… (62325) |
— |
$1,202.75 |
— |
| Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) (20552) |
— |
$629.75 |
— |
| Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar fascia) (20550) |
— |
$911.75 |
— |
| Insertion picc w/o img gdn 5 yr/> (36569) |
— |
$2,351.65 |
— |
| Insertion picc w/rs&i 5 yr/> (36573) |
— |
$3,057.35 |
— |
| Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina… (63047) |
— |
$13,312.70 |
— |
| Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or… (63030) |
— |
$13,312.70 |
— |
| Lumbar puncture (62270) |
— |
$1,376.40 |
— |
| Microscopic exam of esophagus, stomach, and/or upper small bowel using a flexible endoscope (43252) |
— |
$4,341.05 |
— |
| Myelography via lumbar inject rs&i lumbosacral (62304) |
— |
$2,865.15 |
— |
| Myelography via lumbar injection rs&i 2+ regions (62305) |
— |
$2,865.15 |
— |
| Myelography via lumbar injection rs&i cervical (62302) |
— |
$2,865.15 |
— |
| Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy Age Under 21 (31257) |
— |
$13,312.70 |
— |
| Nasal/sinus endoscopy, surgical, with maxillary antrostomy; Age Under 21 (31256) |
— |
$8,942.65 |
— |
| Neuroplasty &/transpos median nrv carpal tunne (64721) |
— |
$9,550.40 |
— |
| Njx aa&/strd tfrm epi c/t 1 (64479) |
— |
$2,306.55 |
— |
| Njx dx/ther sbst intrlmnr crv/thrc w/img gdn (62321) |
— |
$2,324.58 |
— |
| Njx dx/ther sbst intrlmnr crv/thrc w/o img gdn (62320) |
— |
$1,328.60 |
— |
| Njx dx/ther sbst intrlmnr crv/thrc w/o img gdn (62324) |
— |
$1,416.15 |
— |
| Njx dx/ther sbst intrlmnr lmbr/sac w/img gdn (62323) |
— |
$1,529.20 |
— |
| Njx dx/ther sbst intrlmnr lmbr/sac w/img gdn (62327) |
— |
$1,579.30 |
— |
| Njx dx/ther sbst intrlmnr lmbr/sac w/o img gdn (62326) |
— |
$2,135.20 |
— |
| Perq dev breast 1st strtctc (19283) |
— |
$4,746.25 |
— |
| Perq dev breast 1st us imag (19285) |
— |
$2,406.70 |
— |
| Perq device breast 1st imag (19281) |
— |
$2,373.10 |
— |
| Punch biopsy skin single lesion (11104) |
— |
$2,373.10 |
— |
| Puncture aspiration of abscess, hematoma, bulla, or cyst (10160) |
— |
$747.80 |
— |
| Puncture aspiration of cyst of breast (19000) |
— |
$7,140.50 |
— |
| Removal of appendix using an endoscope (44970) |
— |
$13,312.70 |
— |
| Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions (11200) |
— |
$1,590.60 |
— |
| Removal tunneled cv cath (36590) |
— |
$2,022.35 |
— |
| Rmvl of access device (36589) |
— |
$1,978.15 |
— |
| SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee (12001) |
— |
$568.35 |
— |
| Tangential biopsy skin single lesion (11102) |
— |
$1,438.90 |
— |
| Tenotomy elbow lateral/medial percutaneous (24357) |
— |
$9,550.40 |
— |
| Thermal dstrj intraosseous bvn 1st 2 lmbr/sac (64628) |
— |
$11,500 |
— |
| Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance (32555) |
— |
$1,873.35 |
— |
| Tonsillectomy and adenoidectomy; age 12 or over Age Under 21 (42821) |
— |
$8,942.65 |
— |
| Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes… (22856) |
— |
$17,943.20 |
— |
| Total knee arthroplasty (27447) |
— |
$41,095.70 |
— |
| Transfusion, blood or blood components (36430) |
— |
$1,212 |
— |
| Upper arm/elbow surgery unlisted (24999) |
— |
$6,366.95 |
— |
| Venipuncture (36415) |
— |
$40.88 |
— |