| Application cast elbow finger short arm (29075) |
$112.50 |
$150 |
0.5× |
| Application cast shoulder hand long arm (29065) |
$300 |
$400 |
1.2× |
| Application Finger Splint Dynamic (29131) |
$62.25 |
$83 |
1.2× |
| Application finger splint static (29130) |
$73.50 |
$98 |
0.6× |
| Application long arm splint shoulder hand (29105) |
$100.12 |
$133.50 |
0.7× |
| Application long leg splint thigh ankle/toes (29505) |
$187.50 |
$250 |
1.3× |
| Application Short Arm Splint Dynamic (29126) |
$124.50 |
$166 |
1.1× |
| Application short arm splint forearm-hand static (29125) |
$87 |
$116 |
0.8× |
| Application short leg splint calf foot (29515) |
$93 |
$124 |
0.7× |
| Arterial puncture (36600) |
$112.50 |
$150 |
1.0× |
| Arthrocentesis aspir&/inj interm jt/burs w/o us (20605) |
$337.50 |
$450 |
1.3× |
| Arthrocentesis aspir&/inj major jt/bursa w/o us (20610) |
$337.50 |
$450 |
1.3× |
| Arthrocentesis aspir&/inj small jt/bursa w/o us (20600) |
$337.50 |
$450 |
1.3× |
| Biopsy muscle percutaneous needle (20206) |
$1,500 |
$2,000 |
1.1× |
| Bladder Irrigation Simple (51700) |
$375 |
$500 |
1.7× |
| Bladder Scan (51798) |
$150 |
$200 |
3.0× |
| Blood transfusion service (36430) |
$750 |
$1,000 |
2.0× |
| Bone marrow aspiration only (38220) |
$1,500 |
$2,000 |
1.1× |
| Change Cystostomy Tube Complicated (51710) |
$750 |
$1,000 |
1.2× |
| Change Cystostomy Tube Simple (51705) |
$262.50 |
$350 |
1.2× |
| Chest tube placement (32551) |
$1,125 |
$1,500 |
0.8× |
| Clsd tx shoulder dislc w/manipulation w/o anes (23650) |
$151.50 |
$202 |
0.7× |
| Cltx metacarpophalangeal dislc w/manj w/o anes (26700) |
$84 |
$112 |
0.4× |
| Complete replacement picc rs&i (36584) |
$225 |
$300 |
0.2× |
| Contrast Inj Cent Ven Cath, Inc Flouro (36598) |
$375 |
$500 |
2.0× |
| Debridement subcutaneous tissue 20 sq cm/< (11042) |
$33 |
$44 |
0.1× |
| Debridement, Skin, Sub-Q Tissue,Muscle,=<20 Sq Cm (11043) |
$48 |
$64 |
0.1× |
| Debridement, Skin, Sub-Q Tissue,Muscle,Bone,=<20 Sq Cm (11044) |
$64.50 |
$86 |
0.0× |
| Delivery placenta separate procedure (59414) |
$3,750 |
$5,000 |
1.3× |
| Drs&/dbrdmt prtl-thkns burns 1st/sbsq large (16030) |
$450 |
$600 |
1.3× |
| Drs&/dbrdmt prtl-thkns burns 1st/sbsq medium (16025) |
$225 |
$300 |
1.3× |
| Drs&/dbrdmt prtl-thkns burns 1st/sbsq small (16020) |
$33 |
$44 |
0.2× |
| Evacuation of subungual hematoma (11740) |
$150 |
$200 |
1.3× |
| Fluid pressure muscle (20950) |
$753.30 |
$1,004.40 |
1.2× |
| Fluoro exam of g/colon tube (49465) |
$450 |
$600 |
2.2× |
| Gastric Intubation/Aspiration, Therapeutic (43753) |
$375 |
$500 |
2.0× |
| I&d abscess simple (10060) |
$337.50 |
$450 |
2.0× |
| I&d pilonidal cyst simple (10080) |
$825 |
$1,100 |
1.4× |
| Incision & drainage abscess complicated/multiple (10061) |
$450 |
$600 |
1.3× |
| Incision & drainage pilonidal cyst complicated (10081) |
$825 |
$1,100 |
1.4× |
| Incision & removal foreign body subq tiss compl (10121) |
$1,875 |
$2,500 |
1.3× |
| Incision & removal foreign body subq tiss simple (10120) |
$450 |
$600 |
1.3× |
| Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or… (62325) |
$1,650 |
$2,200 |
2.2× |
| Insert Bladder Cath Complex (51703) |
$187.50 |
$250 |
1.7× |
| Insert picc cath (36569) |
$1,931.25 |
$2,575 |
1.4× |
| Insert Temp Bladder Cath (51702) |
$150 |
$200 |
1.3× |
| Insert,Non-Indwelling Bladder Catheter (51701) |
$147.80 |
$197.06 |
1.3× |
| Insertion Picc W/Rs&I 5 Yr/> (36573) |
$787.50 |
$1,050 |
0.6× |
| Intubation endotracheal emergency procedure (31500) |
$228.75 |
$305 |
1.1× |
| Lithotripsy (50590) |
$246.75 |
$329 |
0.1× |
| Njx Cholangio Prq W/Img Gid Rs&I Existing Access (47531) |
$172.47 |
$229.96 |
0.1× |
| Njx Cholangio Prq W/Img Gid Rs&I New Access (47532) |
$187.50 |
$250 |
0.1× |
| Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn (62323) |
$1,200 |
$1,600 |
2.0× |
| Peritoneal Lavage (49084) |
$900 |
$1,200 |
1.2× |
| Perq dev breast 1st us imag (19285) |
$712.50 |
$950 |
1.2× |
| Perq device breast 1st imag (19281) |
$1,050 |
$1,400 |
0.7× |
| Perq replacement gtube not req revj gstrst trc (43762) |
$300 |
$400 |
1.4× |
| Removal Impacted Cerumen Requiring Instrumentation, Unilateral (69210) |
$56.25 |
$75 |
1.1× |
| Removal of nail bed (11750) |
$246 |
$328 |
0.7× |
| Removal of pressure sore (15999) |
$33 |
$44 |
0.1× |
| Removal/bivalving full arm/full leg cast (29705) |
$300 |
$400 |
1.2× |
| Renal biopsy (50200) |
$1,875 |
$2,500 |
1.3× |
| Repair intermediate f/e/e/n/l&/muc 12.6-20.0cm (12055) |
$450 |
$600 |
1.3× |
| Repair intermediate f/e/e/n/l&/muc 2.5 cm/< (12051) |
$450 |
$600 |
1.3× |
| Repair intermediate f/e/e/n/l&/muc 2.6-5.0 cm (12052) |
$450 |
$600 |
1.3× |
| Repair intermediate f/e/e/n/l&/muc 20.1-30.0cm (12056) |
$450 |
$600 |
1.3× |
| Repair intermediate f/e/e/n/l&/muc 5.1-7.5 cm (12053) |
$450 |
$600 |
1.3× |
| Repair intermediate f/e/e/n/l&/muc 7.6-12.5 cm (12054) |
$450 |
$600 |
1.3× |
| Repair intermediate f/e/e/n/l&/muc >30.0 cm (12057) |
$450 |
$600 |
1.3× |
| Repair intermediate n/h/f/xtrnl gent 12.6-20 cm (12045) |
$750 |
$1,000 |
1.2× |
| Repair intermediate n/h/f/xtrnl gent 2.5cm/< (12041) |
$450 |
$600 |
1.3× |
| Repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm (12042) |
$450 |
$600 |
1.3× |
| Repair intermediate n/h/f/xtrnl gent 7.6-12.5cm (12044) |
$750 |
$1,000 |
1.2× |
| Repair intermediate n/h/f/xtrnl gent >30.0 cm (12047) |
$2,250 |
$3,000 |
1.3× |
| Repair intermediate s/a/t/e 12.6-20.0cm (12035) |
$450 |
$600 |
1.3× |
| Repair intermediate s/a/t/e 2.5 cm/< (12031) |
$450 |
$600 |
1.3× |
| Repair intermediate s/a/t/e 2.6-7.5 cm (12032) |
$450 |
$600 |
1.3× |
| Repair intermediate s/a/t/e 20.1-30.0 cm (12036) |
$750 |
$1,000 |
1.2× |
| Repair intermediate s/a/t/e 7.6-12.5 cm (12034) |
$450 |
$600 |
1.3× |
| Repair intermediate s/a/t/e >30.0 cm (12037) |
$1,650 |
$2,200 |
0.9× |
| Repair of nail bed (11760) |
$750 |
$1,000 |
1.2× |
| Rmvl Tun Cvc W/O Subq Port/Pmp (36589) |
$225 |
$300 |
0.4× |
| Rplc gtube revj gstrst trc (43763) |
$300 |
$400 |
1.4× |
| Rpr intermediate n/h/f/xtrnl gent 20.1-30.0 cm (12046) |
$750 |
$1,000 |
1.2× |
| Rpr tun/non-tun ctr vad cath w/o subq port/pmp (36575) |
$787.50 |
$1,050 |
1.5× |
| Simple repair f/e/e/n/l/m 12.6cm-20.0 cm (12016) |
$525 |
$700 |
1.5× |
| Simple repair f/e/e/n/l/m 2.5cm/< (12011) |
$225 |
$300 |
1.3× |
| Simple repair f/e/e/n/l/m 2.6cm-5.0 cm (12013) |
$300 |
$400 |
1.7× |
| Simple repair f/e/e/n/l/m 20.1cm-30.0 cm (12017) |
$600 |
$800 |
1.7× |
| Simple repair f/e/e/n/l/m 5.1cm-7.5 cm (12014) |
$375 |
$500 |
2.2× |
| Simple repair f/e/e/n/l/m 7.6cm-12.5 cm (12015) |
$450 |
$600 |
2.6× |
| Simple repair f/e/e/n/l/m >30.0 cm (12018) |
$225 |
$300 |
1.3× |
| Simple repair scalp/neck/ax/genit/trunk 2.5cm/< (12001) |
$225 |
$300 |
1.3× |
| Simple repair scalp/neck/ax/genit/trunk >30.0cm (12007) |
$600 |
$800 |
3.5× |
| Simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm (12004) |
$375 |
$500 |
2.2× |
| Smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm (12002) |
$300 |
$400 |
1.7× |
| Smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm (12005) |
$450 |
$600 |
1.3× |
| Smpl rpr scalp/neck/ax/genit/trunk 20.1-30.0cm (12006) |
$525 |
$700 |
1.5× |
| Spinal puncture lumbar diagnostic (62270) |
$712.50 |
$950 |
1.2× |
| Strapping ankle (29540) |
$56.25 |
$75 |
0.4× |
| Strapping elbow/wrist (29260) |
$74.25 |
$99 |
1.5× |
| Strapping hand/finger (29280) |
$66 |
$88 |
1.3× |
| Strapping Hip (29520) |
$66 |
$88 |
0.6× |
| Strapping knee (29530) |
$69 |
$92 |
0.6× |
| Strapping shoulder (29240) |
$78 |
$104 |
0.7× |
| Strapping thorax (29200) |
$71.25 |
$95 |
0.5× |
| Strapping toes (29550) |
$54.75 |
$73 |
1.1× |
| Strapping unna boot (29580) |
$112.50 |
$150 |
0.8× |
| Thoracentesis Needle/Cath Pleura W/Imaging (32555) |
$750 |
$1,000 |
1.4× |
| Thoracentesis needle/cath pleura w/o imaging (32554) |
$750 |
$1,000 |
1.4× |
| Thyroid biopsy (60100) |
$450 |
$600 |
0.7× |
| Trach Tube Change (31502) |
$262.50 |
$350 |
1.3× |
| Tracheostomy emergency cricothyroid membrane (31605) |
$262.50 |
$350 |
1.3× |
| Tracheostomy Emergency Procedure Transtracheal (31603) |
$1,800 |
$2,400 |
1.3× |
| Tx Superficial Wound Dehiscence Simple Closure (12020) |
$675 |
$900 |
1.1× |
| Tx superficial wound dehiscence w/packing (12021) |
$450 |
$600 |
1.3× |
| Vaginal delivery only (59409) |
$3,750 |
$5,000 |
1.3× |
| Venipuncture (36415) |
$5.25 |
$7 |
0.6× |