| Acne Surgery (10040) |
— |
$161 |
— |
| Amputate metacarpal bone (26910) |
— |
$1,100 |
— |
| Amputation Finger/Thumb (26951) |
— |
$1,300 |
— |
| Anoscopy diagnostic (46600) |
— |
$200 |
— |
| Application finger splint static (29130) |
— |
$262.35 |
— |
| Application long arm splint shoulder hand (29105) |
— |
$350 |
— |
| Application short arm splint forearm-hand static (29125) |
— |
$225 |
— |
| Application short leg splint calf foot (29515) |
— |
$295 |
— |
| Arterial puncture (36600) |
— |
$75 |
— |
| Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) |
— |
$657.50 |
— |
| Arthrocentesis aspir&/inj major jt/bursa w/o us (20610) |
— |
$552.50 |
— |
| Arthrocentesis aspir&/inj major jt/bursa w/us (20611) |
— |
$722.50 |
— |
| Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) |
— |
$455 |
— |
| Avulsion nail plate partial/complete simple 1 (11730) |
— |
$185 |
— |
| Biopsy external auditory canal (69105) |
— |
$150 |
— |
| Biopsy external ear (69100) |
— |
$143 |
— |
| Biopsy of nail unit (11755) |
— |
$190 |
— |
| Bladder Scan (51798) |
— |
$105 |
— |
| Blood patch (62273) |
— |
$1,753 |
— |
| Blood transfusion service (36430) |
— |
$895 |
— |
| Bx vulva/perineum 1 lesion (56605) |
— |
$180 |
— |
| Chemodenerv 1 extrem 5/> mus (64644) |
— |
$845 |
— |
| Chemodenerv 1 extremity 1-4 (64642) |
— |
$735 |
— |
| Chemodnrvtj Musc Musc Innervated Facial Nrv Unil (64612) |
— |
$383 |
— |
| Chg Collect Blood From Catheter Venous Nos (36592) |
— |
$65 |
— |
| Clsd tx shoulder dislc w/manipulation req anes (23655) |
— |
$600 |
— |
| Cltx dstl rdl fx/epiphysl sep w/manj when perf (25605) |
— |
$305 |
— |
| Cltx iphal jt dislc w/manj w/o anes (26770) |
— |
$657.62 |
— |
| Cltx Post Hip Arthrp Dislc Req Anes (27266) |
— |
$750 |
— |
| Colonoscopy flex w/rem forcep (45384) |
— |
$1,000 |
— |
| Control Nasal Hemorrhage Anterior Complex (30903) |
— |
$690 |
— |
| Control Nasal Hemorrhage Anterior Simple (30901) |
— |
$485 |
— |
| Dbrdmt extensv eczema/infect skn up 10% bdy surf (11000) |
— |
$130 |
— |
| Debridement subcutaneous tissue 20 sq cm/< (11042) |
— |
$250 |
— |
| Destroy cerv/thor facet jnt (64633) |
— |
$4,590 |
— |
| Destroy lumb/sac facet jnt (64635) |
— |
$1,950 |
— |
| Destruc Benign/Premal,15+ Lesions (17004) |
— |
$275 |
— |
| Destruction benign lesions 15 or more (17111) |
— |
$250 |
— |
| Destruction Benign Lesions Up To 14 (17110) |
— |
$204.50 |
— |
| Destruction by neurolytic agent; other peripheral nerve or branch (64640) |
— |
$852 |
— |
| Destruction mal lesion trunk/arm/leg 0.6-1.0 cm (17261) |
— |
$336 |
— |
| Destruction mal lesion trunk/arm/leg 1.1-2.0cm (17262) |
— |
$418 |
— |
| Destruction malignant lesion f/e/e/n/l/m 0.5cm/< (17280) |
— |
$265 |
— |
| Destruction neurolytic agt genicular nerve w/img (64624) |
— |
$3,950 |
— |
| Destruction of face nerve branch under X-ray monitoring (64610) |
— |
$675 |
— |
| Destruction premalignant lesion 1st (17000) |
— |
$168 |
— |
| Diagnostic lumbar spinal puncture w/fluor or CT (62328) |
— |
$1,028.50 |
— |
| Diagnostic sigmoidoscopy (45330) |
— |
$925 |
— |
| Drain/inj small joint/bursa w/us (20604) |
— |
$610 |
— |
| Drainage Finger Abscess Simple (26010) |
— |
$225 |
— |
| Drainage of hematoma/fluid (10140) |
— |
$250 |
— |
| Draw blood off venous device (36591) |
— |
$35 |
— |
| Egd balloon dilation esophagus <30 mm diam (43249) |
— |
$1,750 |
— |
| Egd flexible foreign body removal (43247) |
— |
$600 |
— |
| Egd rem tumr/polyp forcep (43250) |
— |
$1,100 |
— |
| Egd remove lesion snare (43251) |
— |
$1,100 |
— |
| Egd Transoral Control Bleeding Any Method - Egd (43255) |
— |
$1,100 |
— |
| Exc Skin Benig 0.6-1 Cm Remaindr Body (11421) |
— |
$336 |
— |
| Exc Skin Benig 0.6-1 Cm Trunk,Arm,Leg (11401) |
— |
$321 |
— |
| Exc Skin Benig 1.1-2 Cm Trunk,Arm,Leg (11402) |
— |
$354 |
— |
| Exc Skin Benig 2.1-3 Cm Trunk,Arm,Leg (11403) |
— |
$453 |
— |
| Exc Skin Benig >4 Cm Trunk,Arm,Leg (11406) |
— |
$650 |
— |
| Exc Skin Malig >4 Cm Remaindr Body (11626) |
— |
$650 |
— |
| Exc tr-ext b9+marg 0.5 cm or less (11400) |
— |
$228 |
— |
| Excision mal lesion trunk/arm/leg 1.1-2.0 cm (11602) |
— |
$300 |
— |
| Excision Mal Lesion Trunk/Arm/Leg 2.1-3.0 Cm (11603) |
— |
$591 |
— |
| Excision Mal Lesion Trunk/Arm/Leg 3.1-4.0 Cm (11604) |
— |
$518 |
— |
| Excision malignant lesion s/n/h/f/g 1.1-2.0 cm (11622) |
— |
$519 |
— |
| Excision Malignant Lesion S/N/H/F/G 2.1-3.0 Cm (11623) |
— |
$500 |
— |
| Excision of benign lesion other than skin tag 0.6-1.0 cm (11441) |
— |
$405 |
— |
| Excision of benign lesion other than skin tag 1.1-2.0 cm (11442) |
— |
$447 |
— |
| Excision of lesion other than skin tag 1.1-2.0 cm (11422) |
— |
$414 |
— |
| Fetal non-stress test (59025) |
— |
$231 |
— |
| I&d abscess simple (10060) |
— |
$321 |
— |
| Incision & drainage abscess complicated/multiple (10061) |
— |
$250 |
— |
| Incision & removal foreign body subq tiss simple (10120) |
— |
$175 |
— |
| Incisional biopsy eyelid skin & lid margin (67810) |
— |
$210 |
— |
| Incisional biopsy skin single lesion (11106) |
— |
$200 |
— |
| Inj paravert f jnt c/t 1 lev (64490) |
— |
$4,258.50 |
— |
| Inj tendon sheath/ligament (20550) |
— |
$486.50 |
— |
| Inj,Anes Agent,Brachial Plexus,Single (64415) |
— |
$818 |
— |
| Inject Nerv Blck,Axillary Nerv (64417) |
— |
$818 |
— |
| Inject Nerv Blck,Intercost,Multpl (64421) |
— |
$1,578.50 |
— |
| Inject Nerv Blck,Intercostal,One (64420) |
— |
$1,111 |
— |
| Inject Nerv Blck,Pudendal (64430) |
— |
$1,779 |
— |
| Inject Tendon Origin/Insert (20551) |
— |
$507.50 |
— |
| Injection aa&/strd genicular nrv branches w/img (64454) |
— |
$2,163 |
— |
| Injection aa&/strd sciatic nerve w/img gdn (64445) |
— |
$1,111 |
— |
| Injection aa&/strd suprascapular nerve (64418) |
— |
$818 |
— |
| Injection aa&/strd trigeminal nerve each branch (64400) |
— |
$2,125 |
— |
| Injection anes other peripheral nerve/branch (64450) |
— |
$505 |
— |
| Injection single/mlt trigger point 1/2 muscles (20552) |
— |
$507.50 |
— |
| Injection single/mlt trigger point 3/> muscles (20553) |
— |
$592.50 |
— |
| Injection therapeutic carpal tunnel (20526) |
— |
$505 |
— |
| Injection, anesthetic agent; greater occipital nerve (64405) |
— |
$818 |
— |
| Injection, Intralesional; More Than 7 Lesions (11901) |
— |
$435 |
— |
| Injection, intralesional; up to and including 7 lesions (11900) |
— |
$198 |
— |
| Insert Bladder Cath Complex (51703) |
— |
$235 |
— |
| Insert picc cath (36569) |
— |
$1,450 |
— |
| Insert Temp Bladder Cath (51702) |
— |
$125 |
— |
| Insert,Non-Indwelling Bladder Catheter (51701) |
— |
$65 |
— |
| Insertion Picc W/Rs&I 5 Yr/> (36573) |
— |
$633 |
— |
| Intubation endotracheal emergency procedure (31500) |
— |
$335 |
— |
| Laparoscopy Remove Adnexa (58661) |
— |
$1,100 |
— |
| Laryngoscopy w/wo tracheoscopy dx newborn (31520) |
— |
$600 |
— |
| Laryngoscopy,Direct,Diagnostic (31525) |
— |
$500 |
— |
| Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 1 Level (64493) |
— |
$2,395 |
— |
| Njx dx/ther sbst intrlmnr crv/thrc w/img gdn (62321) |
— |
$1,753 |
— |
| Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn (62323) |
— |
$1,461.50 |
— |
| Perq Drainage Pleura Insert Cath W/O Imaging (32556) |
— |
$865 |
— |
| Placement of needle for intraosseous infusion (36680) |
— |
$250 |
— |
| Proctosigmoidoscopy (45303) |
— |
$175 |
— |
| Punch biopsy skin single lesion (11104) |
— |
$165 |
— |
| Puncture Aspiration (10160) |
— |
$200 |
— |
| Removal foreign body foot subcutaneous (28190) |
— |
$275 |
— |
| Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions (11200) |
— |
$232 |
— |
| Remv Ext Canal Foreign Body (69200) |
— |
$250 |
— |
| Repair complex eyelid/nose/ear/lip 1.1-2.5 cm (13151) |
— |
$310 |
— |
| Repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm (13132) |
— |
$600 |
— |
| Repair complex scalp/arm/leg 2.6-7.5 cm (13121) |
— |
$700 |
— |
| Repair complex trunk 2.6-7.5 cm (13101) |
— |
$529 |
— |
| Repair intermediate f/e/e/n/l&/muc 5.1-7.5 cm (12053) |
— |
$340 |
— |
| Repair intermediate s/a/t/e 2.5 cm/< (12031) |
— |
$250 |
— |
| Repair intermediate s/a/t/e 2.6-7.5 cm (12032) |
— |
$650 |
— |
| Repair kneecap tendon (27380) |
— |
$600 |
— |
| Rpr lac tongue floor mouth > 2.6 cm/cplx (41252) |
— |
$465.25 |
— |
| Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/< (11305) |
— |
$150 |
— |
| Shvg Skin Lesion 1 Trunk/Arm/Leg Diam >2.0 Cm (11303) |
— |
$175 |
— |
| Simple repair f/e/e/n/l/m 2.5cm/< (12011) |
— |
$225 |
— |
| Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) |
— |
$480 |
— |
| Simple repair f/e/e/n/l/m 5.1cm-7.5 cm (12014) |
— |
$650 |
— |
| Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001) |
— |
$310 |
— |
| Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004) |
— |
$625 |
— |
| Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002) |
— |
$425 |
— |
| Spinal puncture lumbar diagnostic (62270) |
— |
$1,114 |
— |
| Spinal Puncture Therapeutic (62272) |
— |
$1,251.50 |
— |
| Strapping unna boot (29580) |
— |
$83 |
— |
| Tangential biopsy skin single lesion (11102) |
— |
$200 |
— |
| Therapeutic spinal pnxr drainage csf w/fluor/CT (62329) |
— |
$1,169 |
— |
| Treatment closed elbow dislocation req anes (24605) |
— |
$950 |
— |
| Treatment closed elbow dislocation w/o anes (24600) |
— |
$450 |
— |
| Treatment of anal fissure (46940) |
— |
$300 |
— |
| Trim skin lesion (11055) |
— |
$150 |
— |
| Trim skin lesions 2 to 4 (11056) |
— |
$150 |
— |
| Unlisted Procedure Nervous System (64999) |
— |
$537.50 |
— |
| Vaginal delivery only (59409) |
— |
$1,800 |
— |
| Venipuncture (36415) |
— |
$26 |
— |