| Abd paracentesis w/imaging (49083) |
— |
$1,600 |
— |
| Abdom Paracentesis Dx/Ther W/O Imaging Guidance (49082) |
— |
$1,512 |
— |
| Ablate inf turbinate submuc (30802) |
— |
$542 |
— |
| Application cast shoulder hand long arm (29065) |
— |
$263 |
— |
| Application finger splint static (29130) |
— |
$214.50 |
— |
| Application long arm splint shoulder hand (29105) |
— |
$337 |
— |
| Application long leg splint thigh ankle/toes (29505) |
— |
$228 |
— |
| Application Short Arm Splint Dynamic (29126) |
— |
$323 |
— |
| Application short arm splint forearm-hand static (29125) |
— |
$242 |
— |
| Application short leg splint calf foot (29515) |
— |
$236.50 |
— |
| Arterial puncture (36600) |
— |
$392.66 |
— |
| Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) |
— |
$162 |
— |
| Arthrocentesis aspir&/inj major jt/bursa w/o us (20610) |
— |
$390 |
— |
| Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) |
— |
$144 |
— |
| Avulsion nail plate partial/complete simple 1 (11730) |
— |
$323.50 |
— |
| Biopsy Cervix Single/Mult/Excision Of Lesion Spx (57500) |
— |
$318 |
— |
| Biopsy of tongue (41100) |
— |
$374 |
— |
| Biopsy of uterus lining (58100) |
— |
$318 |
— |
| Bladder Scan (51798) |
— |
$95 |
— |
| Blood patch (62273) |
— |
$869 |
— |
| Blood transfusion service (36430) |
— |
$768.35 |
— |
| Bx vulva/perineum 1 lesion (56605) |
— |
$291 |
— |
| Catheter Aspiration Nasotracheal Spx (31720) |
— |
$2,064.66 |
— |
| Circumcision (54150) |
— |
$338.98 |
— |
| Closed treatment nasal fracture w/stabilization (21320) |
— |
$2,596 |
— |
| Clsd tx shoulder dislc w/manipulation w/o anes (23650) |
— |
$450 |
— |
| Cltx ankle dislc req anes w/wo prq skel fixj (27842) |
— |
$1,748 |
— |
| Cltx dstl rdl fx/epiphysl sep w/manj when perf (25605) |
— |
$1,799 |
— |
| Colonoscopy thru stoma (44388) |
— |
$2,142 |
— |
| Colposc,Cervix W/Adj Vag,W/Bx & Curretag (57454) |
— |
$491 |
— |
| Colposcopy cervix upper/adjacent vagina (57452) |
— |
$341 |
— |
| Colposcopy cervix vag loop eltrd bx cervix (57460) |
— |
$400 |
— |
| Colposcopy,Cervix W/Adj Vagina, Curettag (57456) |
— |
$250 |
— |
| Conization of cervix (57520) |
— |
$6,707.50 |
— |
| Control Nasal Hemorrhage Anterior Simple (30901) |
— |
$671.68 |
— |
| Control oropharyngeal hemorrhage, primary or secondary; with secondary surgical intervention (42962) |
— |
$11,900 |
— |
| Create eardrum opening (69436) |
— |
$2,596 |
— |
| Curettage postpartum (59160) |
— |
$951 |
— |
| Debridement Mastoidectomy Cavity Simple (69220) |
— |
$156 |
— |
| Debridement subcutaneous tissue 20 sq cm/< (11042) |
— |
$304 |
— |
| Destruction benign lesions 15 or more (17111) |
— |
$2,596 |
— |
| Destruction Benign Lesions Up To 14 (17110) |
— |
$205 |
— |
| Destruction premalignant lesion 1st (17000) |
— |
$143 |
— |
| Division of fallopian tube (58600) |
— |
$12,010 |
— |
| Drain Ext Ear Absc/Blood,Complic (69005) |
— |
$300 |
— |
| Drainage External Ear Abscess/Hematoma Simple (69000) |
— |
$160 |
— |
| Drainage of hematoma/fluid (10140) |
— |
$263 |
— |
| Exc Face-Mm B9+Marg 0.5 Cm/< (11440) |
— |
$218.63 |
— |
| Exc Face-Mm B9+Marg 2.1-3 Cm (11443) |
— |
$519 |
— |
| Exc Skin Benig 0.6-1 Cm Remaindr Body (11421) |
— |
$319 |
— |
| Exc Skin Benig 0.6-1 Cm Trunk,Arm,Leg (11401) |
— |
$285 |
— |
| Exc Skin Benig 1.1-2 Cm Trunk,Arm,Leg (11402) |
— |
$351 |
— |
| Exc Skin Benig 2.1-3 Cm Trunk,Arm,Leg (11403) |
— |
$437 |
— |
| Exc Skin Benig 3.1-4 Cm Trunk,Arm,Leg (11404) |
— |
$388 |
— |
| Exc Skin Benig >4 Cm Trunk,Arm,Leg (11406) |
— |
$528.30 |
— |
| Exc tr-ext b9+marg 0.5 cm or less (11400) |
— |
$235 |
— |
| Exchange transfusion, blood; other than newborn (36455) |
— |
$277 |
— |
| Excision Mal Lesion Trunk/Arm/Leg 0.6-1.0 Cm (11601) |
— |
$403 |
— |
| Excision mal lesion trunk/arm/leg 1.1-2.0 cm (11602) |
— |
$476 |
— |
| Excision Mal Lesion Trunk/Arm/Leg 2.1-3.0 Cm (11603) |
— |
$779.77 |
— |
| Excision Mal Lesion Trunk/Arm/Leg 3.1-4.0 Cm (11604) |
— |
$570 |
— |
| Excision malignant lesion f/e/e/n/l 0.6-1.0 cm (11641) |
— |
$432 |
— |
| Excision malignant lesion f/e/e/n/l 1.1-2.0 cm (11642) |
— |
$505 |
— |
| Excision malignant lesion s/n/h/f/g 1.1-2.0 cm (11622) |
— |
$343.76 |
— |
| Excision of benign lesion other than skin tag 0.6-1.0 cm (11441) |
— |
$2,596 |
— |
| Excision of benign lesion other than skin tag 1.1-2.0 cm (11442) |
— |
$395 |
— |
| Excision of lesion of tongue without closure (41110) |
— |
$363 |
— |
| Excision of lesion other than skin tag 1.1-2.0 cm (11422) |
— |
$394 |
— |
| Excision of lesion other than skin tag </= 0.5 cm (11420) |
— |
$366 |
— |
| Excision, lesion of palate, uvula; with simple primary closure (42106) |
— |
$3,462 |
— |
| Excision/destruction intranasal lesion int appr (30117) |
— |
$431.72 |
— |
| Fetal non-stress test (59025) |
— |
$455 |
— |
| Fine needle aspiration without imaging guidance (10021) |
— |
$250.22 |
— |
| Hysteroscopy ablation (58563) |
— |
$3,462 |
— |
| Hysteroscopy biopsy (58558) |
— |
$5,950 |
— |
| Hysteroscopy Removal Impacted Foreign Body (58562) |
— |
$4,435 |
— |
| I&D Abscess Peritonsillar (42700) |
— |
$421 |
— |
| I&d abscess simple (10060) |
— |
$680.02 |
— |
| I&d perianal abscess superficial (46050) |
— |
$1,031.32 |
— |
| I&D Upper Arm/Elbow Bursa (23931) |
— |
$614.92 |
— |
| Incision & drainage abscess complicated/multiple (10061) |
— |
$2,064 |
— |
| Incision & removal foreign body subq tiss simple (10120) |
— |
$236 |
— |
| Incision and drainage of vulva or perineal abscess (56405) |
— |
$369 |
— |
| Incision labial frenum frenotomy (40806) |
— |
$315 |
— |
| Incision of lingual frenum (41010) |
— |
$342 |
— |
| Inj tendon sheath/ligament (20550) |
— |
$169.02 |
— |
| Inject Tendon Origin/Insert (20551) |
— |
$150 |
— |
| Injection single/mlt trigger point 1/2 muscles (20552) |
— |
$331.74 |
— |
| Injection therapeutic carpal tunnel (20526) |
— |
$358.40 |
— |
| Injection, anesthetic agent; greater occipital nerve (64405) |
— |
$415 |
— |
| Injection, intralesional; up to and including 7 lesions (11900) |
— |
$116 |
— |
| Insert Drug Implant Device (11981) |
— |
$294 |
— |
| Insert non-tunnel cv cath (36556) |
— |
$3,400 |
— |
| Insert pessary/other device (57160) |
— |
$136 |
— |
| Insert Temp Bladder Cath (51702) |
— |
$356.77 |
— |
| Insert,Non-Indwelling Bladder Catheter (51701) |
— |
$261.77 |
— |
| Intubation endotracheal emergency procedure (31500) |
— |
$200 |
— |
| Laparoscopy Remove Adnexa (58661) |
— |
$7,465 |
— |
| Laparoscopy w/lysis of adhesions (58660) |
— |
$5,950 |
— |
| Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of spec (49320) |
— |
$8,217 |
— |
| Laps fulg/exc ovary viscera/peritoneal surface (58662) |
— |
$5,722.50 |
— |
| Laryngoscopy Flexible Diagnostic (31575) |
— |
$335 |
— |
| Laryngoscopy w/biopsy (31535) |
— |
$2,290.98 |
— |
| Laryngoscopy w/bx op scope (31536) |
— |
$6,060 |
— |
| Nasal Endoscopy Diagnostic Uni/Bi Spx (31231) |
— |
$422 |
— |
| Nasal/sinus endoscopy, surgical with frontal sinus exploration (31276) |
— |
$2,536 |
— |
| Nasal/sinus endoscopy, surgical, w/ maxillary antrostomy; w/ removal of tissue from sinus (31267) |
— |
$9,737.50 |
— |
| Nasal/sinus endoscopy, surgical, with maxillary antrostomy (31256) |
— |
$8,980 |
— |
| Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) (31254) |
— |
$1,562 |
— |
| Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) (31255) |
— |
$1,604 |
— |
| Nasal/Sinus Endoscopy,W/Control Nasal Hem (31238) |
— |
$894 |
— |
| Nasal/Sinus Ndsc Surg W/Bx Polypc/Dbrdmt Spx (31237) |
— |
$4,876.50 |
— |
| Ovarian cystectomy (58925) |
— |
$925 |
— |
| Punch biopsy skin single lesion (11104) |
— |
$200 |
— |
| Puncture Aspiration (10160) |
— |
$205 |
— |
| Removal fb intranasal (30300) |
— |
$393 |
— |
| Removal impacted cerumen irrigation/lvg unilat (69209) |
— |
$78 |
— |
| Removal Impacted Cerumen Requiring Instrumentation, Unilateral (69210) |
— |
$2,274 |
— |
| Removal Implantable Contraceptive Capsules (11976) |
— |
$446 |
— |
| Removal of adenoids (42835) |
— |
$3,948.50 |
— |
| Removal of adenoids (42831) |
— |
$4,706 |
— |
| Removal of adenoids (42830) |
— |
$3,462 |
— |
| Removal of humerus lesion (23155) |
— |
$2.50 |
— |
| Removal of intrauterine device (iud) (58301) |
— |
$200 |
— |
| Removal of nail bed (11750) |
— |
$295.70 |
— |
| Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions (11200) |
— |
$177 |
— |
| Removal of tonsils (42825) |
— |
$5,950 |
— |
| Removal of tonsils (42826) |
— |
$6,707.50 |
— |
| Remove drug implant device (11982) |
— |
$219 |
— |
| Remove wrist tendon lesion (25111) |
— |
$485 |
— |
| Remv Ext Canal F.B.,Gen Anesth (69205) |
— |
$2,596 |
— |
| Remv Ext Canal Foreign Body (69200) |
— |
$143 |
— |
| Repair intermediate s/a/t/e 2.6-7.5 cm (12032) |
— |
$1,675 |
— |
| Repair intermediate s/a/t/e 7.6-12.5 cm (12034) |
— |
$2,411.79 |
— |
| Repair of eardrum structures (69631) |
— |
$12,010 |
— |
| Repair of nasal septum (30520) |
— |
$8,980 |
— |
| Repair tympanic membrane (69610) |
— |
$5,030.50 |
— |
| Resect Inferior Turbinate (30140) |
— |
$961 |
— |
| Revision of nose (30435) |
— |
$12,010 |
— |
| Rmvl w/rinsj non-biodegradable drug dlvr implt (11983) |
— |
$375 |
— |
| Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/< (11305) |
— |
$790 |
— |
| Shaving Skin Lesion 1 S/N/H/F/G Diam 0.6-1.0 Cm (11306) |
— |
$185 |
— |
| Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm (11301) |
— |
$200 |
— |
| Shvg Skn Lesion 1 Trunk/Arm/Leg Diam 1.1-2.0 Cm (11302) |
— |
$238 |
— |
| Simple repair f/e/e/n/l/m 2.5cm/< (12011) |
— |
$597 |
— |
| Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) |
— |
$486.24 |
— |
| Simple repair f/e/e/n/l/m 7.6cm-12.5 cm (12015) |
— |
$1,200 |
— |
| Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001) |
— |
$529.17 |
— |
| Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004) |
— |
$725 |
— |
| Sinus endo w/balloon dil (31296) |
— |
$1,500 |
— |
| Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002) |
— |
$574 |
— |
| Tonsillectomy and adenoidectomy; age 12 or over (42821) |
— |
$7,465 |
— |
| Trim skin lesion (11055) |
— |
$125 |
— |
| Trim skin lesions 2 to 4 (11056) |
— |
$450 |
— |
| Tx Incomplete Abortion Any Trimester Surgical (59812) |
— |
$7,465 |
— |
| Tx Missed Abortion First Trimester Surgical (59820) |
— |
$5,950 |
— |
| Tympanostomy (69433) |
— |
$2,436.50 |
— |
| Vaginal delivery only (59409) |
— |
$1,797 |
— |
| Vasectomy (55250) |
— |
$940 |
— |
| Vbac delivery only (59612) |
— |
$2,937 |
— |
| Venipuncture (36415) |
— |
$144 |
— |
| Ventilating tube removal requiring general anesthesia (69424) |
— |
$1,474.50 |
— |