SILVER CROSS PRICE LIST CHARGE CODE CHARGE NAME CPT CODE CHARGE 00019 KIT ARTHROSCOPE 457.80 00023 KIT BREAST BIOPSY 340.20 00027 KIT CYSTOSCOPE 257.80 00028 KIT GYN LAPAROSCOPE 546.30 00029 KIT HIP FRACTURE 555.20 00037 KIT LAP CHOLE 806.80 00038 KIT LITHOTOMY 365.90 00039 KIT LOWER EXTREMITY 502.00 00040 KIT MAJOR GENERAL 622.60 00043 KIT MAJOR VASCULAR 1240.00 00044 PACK, MINOR EYE 235.50 00045 KIT, MINOR GENERAL 288.80 00047 KIT MINOR VASCULAR 586.50 00048 PACK D&C 129.30 00049 KIT SHOULDER 646.30 00053 KIT TONSIL 306.70 00059 KIT UPPER EXTREMITY 469.00 00060 KIT VASCULAR ACCESS 392.40 00061 KIT LOCAL 176.10 00062 SHOULDER IMMOBILIZER MED 61.70 00064 KIT TOTAL JOINT 471.90 00065 PORT POWERPORT 8FR MRI COMPAT C1788 2191.30 00203 DARCO SHOE 76.20 00207 YAG/ARGON LASER PROCEDURE 3071.20 00211 CATH DIALYSIS SHORT TERM C1752 629.50 00300 DRESSING WOUND VAC 1193.60 00307 MIDLINE 8CM CATH FULL KIT 283.80 00308 MIDLINE 10CM CATH FULL KIT 283.80 00309 MIDLINE 8CM CATHETER 173.10 00310 MIDLINE 10CM CATHETER 173.10 00312 INJ IVP ADDL SEQ SAME DRUG 96376 74.00 01301 DIAB IP ASMT BRIEF S0316 66.00 01302 DIAB IP ASMT EXT G0108 137.00 01303 DIAB EDUC IND RN INTL/30 MIN 98960 132.00 01304 DIB EDUC IND RD INTL/30 MIN 98960 132.00 01333 INSULIN PUMP TRAINING/30 MIN G0108 132.00 01337 DIAB EDUC IND RD/RN SUB/30 MIN 98960 132.00 01346 DIAB EDUC GRP 2-4 PT RN/30 MIN 98961 76.00 01347 DIAB EDUC GRP 2-4 PT RD/30 MIN 98961 76.00 03316 PLATE,BONE C1713 5056.00 03317 BONE SCREW C1713 864.90 03318 PLATE,BONE C1713 4635.70 03421 KIT MARS MIN ACC RETRACTOR SYS 4392.10 03604 RESUSITATOR,AMBU ADULT 204.40 03740 MATTRESS,WAFFLE W/PUMP 351.00 03745 CUSHION,WAFFLE 117.80 03769 INJ TRIGGER PTS 573.00 03830 PAK,CESAREAN SECTION 609.90 03835 DURAPREP SURGICAL PREP SOL 64.80 03837 SPLINT,SCOTCHCAST 3 X 12 65.10 03838 SPLINT,SCOTCHCAST 4 X 15 76.60 03839 SPLINT,SCOTCHCAST 4 X 30 140.10 03840 SPLINT,SCOTCHCAST 5 X 30 181.40 03842 SPLINT,SCOTCHCAST 5 X 45 257.40 03856 SHEETING SILASTIC 236.70 03861 PAD INSTRA-MAGNETIC 110.40 03864 TRAY EYE PREPS 120.00 03865 TUBING STERILE IV 84.40 03868 BANDAGE MARTIN 4" X 3 YD 167.00 03871 TRAY VAS CATH 8 SUBCLAV 745.10 03872 TRAY VAS CATH 6 FT SUBCLAV 544.40 03874 FORCED AIR WARMNG UPPER BODY 226.60 03878 KALTOSTAT 7.5 X 12 CM 49.20 03879 KALTOSTAT 10 X 20 CM 101.50 03880 MITRAFLEX 4 X 4 25.30 03886 BAG DISP PRESSURE INFUSION 167.10 03935 TUBING SUCTION/IRRIGATOR 750.90 03948 HOLDER ENDOTRACHAEL TUBE 41.20 03977 VAGINAL DELIVERY PACK 305.10 03995 SPLINT SCOTCHCAST 2 X 10 78.40 03997 DRESSING NU-GEL 3 3/4 25.40 04022 KIT COLOSTOMY DRAINABLE 2 1/2" 42.10 04023 KIT UROSTOMY 2 1/2" 63.50 04033 RADIAL ARTERY CATH 74.20 04206 IV D5W 500ML 71.90 04224 IV LR IL 103.70 04227 IV NS 1 L 65.50 04228 IV NS 500ML 97.50 04232 IRRIG/POUR BTL WATER 1 LITER 15.20 04233 IRRIG/POUR BTL WATER 4 LITER 60.70 04236 IRRIG/POUR BTL SALINE 4 LITER 79.60 04237 IRRIG/POUR BTL GYCINE 4 LITER 98.00 04253 TUR CYSTO SET LARGE BORE 44.30 04254 IRRIG SET 2 BOTTLE LRG BORE 73.10 04369 THORACENTESIS TRAY/BAXTER 279.30 04376 SHOULDER IMMOBILIZER LG 108.50 04377 IMMOBILIZER SHOULDER X-L 24.90 04381 SHOULDER IMMOBILIZER XXL 38.70 04385 SKIN BARRIER WITH FLANGE A4373 48.70 04394 SACRAL FOAM 18X18 22.90 04398 TEGASORB SACRAL DRESSING 62.80 04401 DRESSING ALLEVYN 4X4 46.10 04426 BELT, OSTOMY MEDIUM A4367 18.20 04428 FLANGE, 2 PIECE 4" 34.20 04429 FLANGE, 2 PIECE 2 3/4" (EA) 5.50 04430 FLANGE, 2 PIECE 2 1/4" 24.50 04431 FLANGE, 2 PIECE 2 3/4" 42.30 04432 OSTOMY POUCH 2PC 2.25 IN A4413 5.60 04433 OSTOMY POUCH 2 PC 2.75 IN A4413 5.60 04434 OSTOMY POUCH 2PC 4 IN A4413 5.60 04435 OSTOMY POWDER 18.20 04436 POUCH W/FLANGE A5063 19.60 04437 POUCH, UROSTOMY A4428 45.60 04484 POWER PICC KIT SHERLOCK 6FR 776.80 05000 FEMSTOP DISPOSABLE DEVICE 358.00 05500 INJECTION SPINE CERV/THORACIC 1926.00 05501 INJ SPINE L/S CD/INTERLAM 1751.00 05502 FLUOR GUIDANCE FOR SPINE INJ 77003 1135.00 05503 INJ FORAMEN EPIDURAL CERV/THOR 1576.00 05507 INJ FORAMEN EPIDURAL L/S 1926.00 05508 INJ FORAMEN EPIDURAL L/S BILAT 2364.00 05509 INJ FORAMEN EPI L/S ADDL 385.00 05510 INJ FORAMEN EPI L/S ADDL BILAT 525.00 05511 INJ SI JOINT ANESTH/STEROID 1926.00 05514 DRAIN/INJ JOINT/BURSA 469.00 05516 INJ PARAVERT JOINT 1 LEVEL 1576.00 05517 INJ PARAVERT JOINT 1 LEVEL BIL 2364.00 05518 INJ PARAVERT JOINT 2 LEVELS 876.00 05519 INJ PARAVERT JOINT 2 LEVEL BIL 1182.00 05520 INJ PARAVERT JOINT 3 LEVELS 876.00 05521 INJ PARAVERT JOINT 3 LEVEL BIL 1182.00 05524 DESTROY LUMB/SAC FACET JOINT 3582.00 05525 DESTROY LUMB/SAC FACET JT ADDL 1791.00 05527 INJ ANESTH GR OCCIPITAL NERVE 810.00 05528 GANGLION IMPAR BLOCK 482.00 05529 INJ SACROILIAC JOINT BILATERAL G026050 1970.00 05533 DESTROY LUM/SAC FACET JNT BIL 5373.00 06371 TUBE ENDOTRACH RAE 148.00 06376 TUBE ENDOTRACH REINF 538.20 07000 SHILEY,TRACH FENESTRATED,#4 338.50 07001 SHILEY,TRACH FENESTRATED,#6 339.90 07002 SHILEY,TRACH FENESTRATED,#8 414.60 07010 SHILEY,TRACH NON-FEN,#6 302.40 07011 SHILEY,TRACH NON-FEN,#8 326.70 07059 TUBING,CONNECT,(MALE),6 FT 17.50 07068 TUBE,ENDOTRACH UNCUFFED 2.5 MM 22.20 07069 TUBE,ENDOTRACH UNCUFFED 3.0 MM 25.30 07094 SALEM SUMP,W/VALVE,18 FR 58.00 07095 SUCTION,POOLE 26.60 07096 SALEM SUMP,W/VALVE,14 FR 58.10 07099 T-TUBE CATHETER DRAIN 10FR 101.90 07101 T-TUBE,CATHETER DRAIN,14 FR 101.90 08025 CATH URI STER P-K90 #309 7.00 08075 CATH,FOLEY,30CC 14FR 56.60 08076 CATH,FOLEY,30CC 16FR 64.80 08077 CATH,FOLEY,30CC 18FR 55.50 08091 CATH,FOLEY,STRAIGHT-RR,14FR 10.20 08100 TUBE,YANKAUER SUCTION,LARGE 18.90 08106 CHEST TUBE,TROCAR 36 FR 64.80 08111 CUSTOM EYE PACK 284.00 08113 CHEST TUBE,TROCAR 20 FR 168.70 08115 CHEST TUBE,TROCAR 28FR 148.20 08116 CHEST TUBE,TROCAR 32FR 155.10 08121 CVC,TRIPLE LUMEN KIT,30 CM 256.70 08123 CVC,TRIPLE LUMEN, 20 CM C1751 334.00 08500 DRESSING FOAM 6X6 25.35 08531 AQUACEL/MAXORB 4X4 45.40 08532 DRSG CALCICARE SILVER ROPE 74.10 08544 SPONGE,TRIPAGUE,8 X 4,12 PLY 14.30 08582 DRESSING,HEAVY DRAINAGE 20.60 08607 GAUZE,IODOFORM, 1/4" 41.10 08608 GAUZE,IODOFORM, 1/2" 41.30 08609 GAUZE,IODOFORM,1" 53.20 08610 GAUZE,IODOFORM, 2" 74.80 08612 PACKING STRIP,PLAIN, 1/2" 38.70 08613 PACKING STRIP,PLAIN, 1" 41.20 08623 GAUZE,VASELINE 1/2" X 72" 16.20 08624 GAUZE,VASELINE 1" X 36" 10.20 08627 GAUZE,VASELINE 3" X 36" 13.10 08628 GAUZE,VASELINE 6" X 36" 18.30 08631 TEGADERM,6" X 8" 24.00 08637 OCCULAR OCCLUDERS 22.60 08640 TEGADERM,2 3/8" X 2 3/4" 15.10 08641 DRESSING ULCER,4X4, EA 24.00 08642 HYDROCOLLD DRSG >16=<48 WO BRD A6238 33.50 08674 EYE SHIELD,METAL 9.80 08675 SPONGE,CYLINDRICAL,1 1/2 X 3/8 19.40 08679 GAUZE,PRECUT DRAIN, 4 X 4 3.80 08687 OCULAR IMPLANT SILICONE SLING L8610 172.25 08690 MOMETASONE SINUS IMPLANT S1090 2357.00 08703 STOCKINETTE, 6" X 48" 57.30 08704 SPONGE, LAP, 4 X 18 38.60 08708 HEMOSTAT, SURGICEL, 4 X 8 224.10 08709 HEMOSTAT, SURGICEL, 2 X 3 137.90 09101 MRI BRAIN W/O CONTRAST 70551 3244.00 09102 MRI BRAIN WITH CONTRAST 70552 3633.00 09103 MRI BRAIN W/O & W CONTRAST 70553 5148.00 09104 MRI TEMPOROMANDIBULAR JOINT 70336 3525.00 09105 MRI FACE W/O CONTRAST 70540 3103.00 09106 MRI ORBIT W/O CONTRAST 70540 3103.00 09108 MRI CHEST W/O CONTRAST 71550 3463.00 09110 MRI ABDOMEN W/O CONTRAST 74181 2892.00 09111 MRI PELVIS W/O CONTRAST 72195 3182.00 09112 MRI CERVICL SPINE W/O CONTRAST 72141 2975.00 09113 MRI CERVICAL SPINE W/CONTRAST 72142 3670.00 09114 MRI CERV SPINE W/&W/O CONT 72156 4924.00 09115 MRI THORACIC SPINE W/O CONTRST 72146 3062.00 09116 MRI THORACIC SPINE W/CONTRAST 72147 3580.00 09117 MRI THORACIC SPINE W/O&W/CONT 72157 4692.00 09118 MRI LUMBAR SPINE W/O CONTRAST 72148 3166.00 09119 MRI LUMBAR SPINE W/CONTRAST 72149 3629.00 09120 MRI LUMBAR SPINE W/O & W/CONT 72158 4862.00 09121 MRI SHOULDER LEFT W/O CONT 73221LT 3004.00 09122 MRI ELBOW LEFT W/O CONTRAST 73221LT 3004.00 09123 MRI WRIST LEFT W/O CONTRAST 73221LT 3004.00 09124 MRI ARM LEFT W/O CONTRAST 73218LT 3170.00 09125 MRI HIP LEFT W/O CONTRAST 73721LT 3194.00 09126 MRI KNEE LEFT W/O CONTRAST 73721LT 3194.00 09127 MRI ANKLE LEFT W/O CONTRAST 73721LT 3194.00 09128 MRI LEG LEFT W/O CONTRAST 73718LT 3116.00 09132 MRA HEAD W/O CONTRAST 70544 3385.00 09133 MRA NECK W/O CONTRAST 70547 3377.00 09134 MRA CHEST 71555 3439.00 09135 MRA,ABDOMEN W/O CONTRAST 74185 3410.00 09138 MRA PELVIS 72198 2436.00 09141 MRI SHOULDER RIGHT W/O CONT 73221RT 3004.00 09142 MRI ELBOW RIGHT W/O CONTRAST 73221RT 3004.00 09143 MRI WRIST RIGHT W/O CONTRAST 73221RT 3004.00 09144 MRI ARM RIGHT W/O CONTRAST 73218RT 3170.00 09145 MRI HIP RIGHT W/O CONTRAST 73721RT 3194.00 09146 MRI KNEE RIGHT W/O CONTRAST 73721RT 3194.00 09147 MRI ANKLE RIGHT W/O CONTRAST 73721RT 3194.00 09148 MRI LEG RIGHT W/O CONTRAST 73718RT 3116.00 09152 MRI IAC W/WO CONTRAST 70553 5148.00 09154 MRI FOOT LEFT W/O CONTRAST 73718LT 3116.00 09155 MRI FOOT RIGHT W/O CONTRAST 73718RT 3116.00 09156 MRI SPINAL SURVEY 72146 3062.00 09157 MRI HAND LEFT W/O CONTRAST 73218LT 3170.00 09158 MRI HAND RIGHT W/O CONTRAST 73218RT 3170.00 09161 MRI BREAST BIL W & W/O CONTRST 77059 5201.00 09163 MRI FACE W/ & W/O CONTRAST 70543 4804.00 09165 MRI ORBIT W/ & W/O CONTRAST 70543 4804.00 09167 MRI NECK W/ & W/O CONTRAST 70543 4804.00 09169 MRI CHEST W/ & W/O CONTRAST 71552 5330.00 09170 MRI ABDOMEN W/CONTRAST 74182 3823.00 09171 MRI ABDOMEN W/ & W/O CONTRAST 74183 4891.00 09173 MRI PELVIS W/ & W/O CONTRAST 72197 4887.00 09174 MRI SHOULDER LEFT W/CONTRAST 73222LT 3323.00 09175 MRI SHOULDER LEFT W/&W/O CONT 73223LT 4643.00 09177 MRI ELBOW LEFT W&W/O CONTRAST 73223LT 4643.00 09178 MRI WRIST LEFT W/CONTRAST 73222LT 3323.00 09179 MRI WRIST LEFT W/&W/O CONT 73223LT 4643.00 09181 MRI ARM LEFT W/&W/O CONTRAST 73220LT 4846.00 09182 MRI HIP LEFT W/CONTRAST 73722LT 3364.00 09183 MRI HIP LEFT W/&W/O CONTRAST 73723LT 4630.00 09185 MRI KNEE LEFT W/&W/O CONTRAST 73723LT 4630.00 09187 MRI ANKLE LEFT W/&W/O CONT 73723LT 4630.00 09188 MRI LEG LEFT W/CONTRAST 73719LT 3455.00 09189 MRI LEG LEFT W/&W/O CONTRAST 73720LT 4841.00 09190 MRI SHOULDER RIGHT W/CONTRAST 73222RT 3323.00 09191 MRI SHOULDER RIGHT W/&W/O CON 73223RT 4643.00 09192 MRI WRIST RIGHT W/CONTRAST 73222RT 3323.00 09193 MRI WRIST RIGHT W&W/O CONT 73223RT 4643.00 09195 MRI ARM RIGHT W/&W/O CONTRAST 73220RT 4846.00 09196 MRI HIP RIGHT W/CONTRAST 73722RT 3364.00 09197 MRI HIP RIGHT W/&W/O CONTRAST 73723RT 4630.00 09199 MRI KNEE RIGHT W/&W/O CONT 73723RT 4630.00 09300 MRA HEAD W/CONTRAST 70545 3368.00 09301 MRA HEAD W/&W/O CONTRAST 70546 5288.00 09303 MRA NECK W/&W/O CONTRAST 70549 5292.00 09305 MRI ANKLE RIGHT W/&W/O CONT 73723RT 4630.00 09306 MRI LEG RIGHT W/CONTRAST 73719RT 3455.00 09307 MRI LEG RIGHT W/&W/O CONTRAST 73720RT 4841.00 09309 MRI FOOT LEFT W/&W/O CONTRAST 73720LT 4841.00 09311 MRI FOOT RIGHT W/&W/O CONT 73720RT 4841.00 09313 MRI HAND LEFT W/&W/O CONTRAST 73220LT 4846.00 09315 MRI HAND RIGHT W/&W/O CONT 73220RT 4846.00 09317 MRI ELBOW RIGHT W/&W/O CONT 73223RT 4643.00 09320 MRI BRAIN & IAC W/O CONTRAST 70551 3244.00 09322 MRI BRAIN & IAC W/WO CONTRAST 70553 5148.00 09325 MRI BRAIN & PITUITARY W/O CON 70551 3244.00 09327 MRI BRAIN/PITUITARY W/WO CONT 70553 5148.00 09331 MRI INJ GAD-BASE CONT 1 ML 14.70 09332 NM IN111 PENTETREOTID =<6 MCI A9572 6179.00 09335 MRI BREAST BIL W/O CONTRAST 77047 5201.00 09343 MRI INJ GADOXETATE DISOD 1ML A9581 33.80 09344 MRA QMRA HEAD W/O CONTRAST 70544 3385.00 09345 MRA QMRA NECK W/O CONTRAST 70547 3377.00 09346 MRA QMRA NECK W & W/O CONT 70549 5292.00 09348 MRI BREAST BX RT W/CLIP 1982.00 09349 MRI BREAST BX RT ADDL W/CLIP 573.00 09350 MRI BREAST BX LT W/CLIP 1982.00 09354 MRI BREAST LOCALIZATION LEFT 19287LT 573.00 09356 MRI BREAST BX W/CLIP BILAT 773.00 09358 MRI LE JOINT W/O CONTR BILAT 7372150 3516.00 09359 MRI LE JOINT W&W/O CONT BILAT 7372350 5467.00 09360 MRI GADOBUTROL INJ 0.1ML CONTR A9585 3.00 09361 INJ GADOXETATE DISODIUM 1ML A9581 73.55 09501 INTRACATH INTRO AORTA 36200 2207.00 09513 INSERT CANNULA HEMODIALYSIS 4265.00 09533 CINERADIOGRAPHY 75825 2493.00 09545 CHANGE TUBE/DRNG CATH 544.00 09557 CARDIAC OUTPUT MEASUREMENT 93561 2633.00 09562 INTRAVENTRICULAR PACING 93612 5314.00 09578 SCP VENOUS 2ND ORDER 36012 2207.00 09580 SCP PULMONARY ARTERY RT 36014RT 1714.00 09584 INTRO NDLE/IC UPR/LWR EXT ART 36140 2207.00 09618 CARDIOVERSION EXTERNAL 92960 1998.00 09637 PERICARDIOCENTESIS 5325.00 09638 VENO EXT RT 75820RT 1269.00 09639 VENO EXT BIL 75822 2115.00 09640 XR WRIST NAVICULAR VIEW RIGHT 73100RT 233.00 09641 XR ZYGOMA 70150 484.00 09645 XR CHILD SURVEY 77076 914.00 09653 SP LOCM 300-349MG IODINE 1ML Q9967 2.20 09659 LOCM 300-399 MG/ML, 1 ML Q9967 2.20 09660 XR HAND MIN 3 VIEW LEFT 73130LT 293.00 09661 XR HIP UNI 2-3 VIEWS 73502 352.00 09662 XR HUMERUS LEFT 73060LT 260.00 09663 XR KNEE MIN 4 VIEWS LEFT 73564LT 382.00 09664 XR LOWER LEG LEFT 73590LT 267.00 09665 XR DETECTION EYE FB 70030 346.00 09666 XR KNEE AP & LAT (LEFT) 73560LT 279.00 09667 XR RIBS LEFT 71101LT 463.00 09668 XR SCAPULA LEFT 73010LT 298.00 09669 XR SHOULDER MIN 2 VIEW LEFT 73030LT 347.00 09671 XR TOE 1ST LEFT 73660 206.00 09672 XR TOE 2ND LEFT 73660 206.00 09673 XR TOE 3RD LEFT 73660 206.00 09674 XR TOE 4TH LEFT 73660 206.00 09675 XR TOE 5TH LEFT 73660 206.00 09676 XR TOE 2ND RIGHT 73660 206.00 09677 XR TOE 3RD RIGHT 73660 206.00 09678 XR TOE 4TH RIGHT 73660 206.00 09679 XR TOE 5TH RIGHT 73660 206.00 09682 XR WRIST MIN 3 VIEW LEFT 73110LT 293.00 09683 XR WRIST NAVICULAR VIEW LEFT 73100LT 233.00 09684 XR ABDOMEN PORTABLE 74018 342.00 09685 XR ANKLE MIN 3 VIEWS LEFT 73610LT 293.00 09687 XR ARTHROGRAM HIP LEFT 73525LT 801.00 09688 XR ARTHROGRAM KNEE LEFT 73580LT 827.00 09689 XR ARTHROGRAM SHOULDER LEFT 73040LT 816.00 09690 XR CLAVICLE LEFT 73000LT 290.00 09691 XR CHEST EXPIRATION (1 VIEW) 71045 311.00 09692 XR CHEST PORTABLE 71045 311.00 09693 XR ELBOW MIN 3 VIEW LEFT 73080LT 285.00 09694 XR FINGER 1ST LEFT 73140 208.00 09695 XR FINGER 2ND LEFT 73140 208.00 09696 XR FINGER 3RD LEFT 73140 208.00 09697 XR FINGER 4TH LEFT 73140 208.00 09698 XR FINGER 5TH LEFT 73140 208.00 09699 XR FINGER 2ND RIGHT 73140 208.00 09700 XR FINGER 3RD RIGHT 73140 208.00 09701 XR FINGER 4TH RIGHT 73140 208.00 09702 XR FINGER 5TH RIGHT 73140 208.00 09703 XR FEMUR LEFT 73552 427.00 09704 XR FOREARM LEFT 73090LT 260.00 09705 XR FOOT MIN 3 VIEWS LEFT 73630LT 275.00 09706 XR HEEL (OSCALSIS) LEFT 73650LT 276.00 09715 XR ARTHROGRAM WRIST RIGHT 73115RT 852.00 09716 XR ARTHROGRAM WRIST INJECT PR 515.00 09724 US BREAST LTD LEFT 76642LT 576.00 09726 US DUP LOWER EXTREM ARTERY LT 93926LT 1318.00 09731 US DOPPLER MISCELLANEOUS 93975 2036.00 09734 US DUP UPPER EXTREM ARTERY LT 93931LT 886.00 09737 US VENOUS DOPPLER/DUPLX LMTD 93971 1239.00 09738 US VENOUS DUPPLER/DUPLX LMTD 93971 1239.00 09739 US VENOUS DOPPLER/DUPLX LMTD 93971 1239.00 09755 US BREAST LTD RIGHT 76642RT 576.00 09855 US VENOUS DUPLEX LOWER BIL 93970 1521.00 09860 PLCMT CATH VEIN 1ST ORDER 36011 2207.00 09874 CATH ART 2ND ABD/PEL/LE 36246 2207.00 09882 SCP PULMONARY ARTERY LT 36014LT 1714.00 09888 CATH ART 1ST ABD/PEL/LE 36245 2207.00 09901 SCP THOR/BRACH ARTERY 1ST ORD 36215 2207.00 09902 SCP THOR/BRACH ARTERY 2ND ORD 36216 2207.00 09903 SCP THOR/BRACH ARTERY 3RD ORD 36217 2207.00 09906 XR ARTHROGRAM WRIST LEFT 73115LT 852.00 09917 TEMP PACER/TRANSVENOUS ELECT C1779 667.60 09949 LESION ABLATION 7822.00 09950 CHG NEPHRO/PYELO TUBE LEFT 1591.00 09951 CHG NEPHRO/PYELO TUBE RIGHT 1591.00 09952 CHG NEPHRO/PYELO TUBE BILAT 2387.00 09953 INJ PROC NFROSGRM&/UTRGRM 50430 1375.00 09955 CATH EP 20 OR MORE ELECTRODES C1731 2925.30 09956 CATH EP, <20 ELECTRODES C1730 2459.20 09957 CATH EP, OTHER THAN COOL TIP C1733 3459.70 09958 INTRO SHEATH FIXED PEEL AWAY C1892 1006.10 09959 CATH INTRACARDIAC ECHO C1759 5014.90 09960 INTRO SHEATH EPS FIXED CURVE C1893 894.30 09961 PERCUTANEOUS CHOLECYSTOSTOMY 3564.00 09963 REMOVAL OF TUNNELED CVC W/PORT 3534.00 09966 REMOVE TNLD CVAD WO P/P 36589 997.00 09968 CPR-CARDIOLOGY 92950 1701.00 09969 PORT INDWELLING C1788 1614.10 09974 STENT NONCORONRY TEMP W/O DEL C2617 4643.30 09976 CATHETER DRAINAGE C1729 508.00 09977 CATH, HEMODIALYSIS,LONG-TERM C1750 2235.60 09978 MILINE INFUSION CATH C1751 1057.30 09979 EVENT RECORDR,CARDIAC(IMPLANT) C1764 9550.70 10559 CHOLANGIOCATH, TAVT 130.80 10622 NEEDLE, SPINAL, 22 X 1 1/2 15.00 10626 NEEDLE, SPINAL, 18 X 3 1/3 16.90 10631 DOUBLE NEEDLE COUNTER 1200 NP 15.40 10894 SALT SOLUTION, 15 CC 48.80 11010 BAG BILE 101.50 11011 TUBE VENT REUTER BOBBIN 60.30 11014 BAG, FOLEY, 2000CC 36.10 11015 BAG, URINE LEG 83.80 11021 BAG,FOLEY, 4000CC 64.80 11025 TUBING CVAC EVAC 171.50 11027 GUIDEWIRE/SPADE POINT WIRE C1769 141.40 11030 PROBE XOMED NERVE STIM 514.70 11036 BALLOON ENDO STRUCTURE 1082.50 11045 THORA-DRAIN 394.70 11053 PUTTY GRAFTON C9359 4176.80 11061 CEMENT MIXING DEVICE 473.90 11067 ENDOTRAC BLADE 444.50 11068 BONE SCREW C1713 907.80 11069 BONE SCREW C1713 1193.40 11073 CANN TIBIA TUNNEL ARTHREX 332.90 11074 CATH, FOLEY KIT W/BAG, 16FR 99.90 11075 CATH, FOLEY KIT W/BAG, 18FR 99.90 11076 BLADE DERMATOME ZIMM 224.70 11078 ANCHOR ORTHO C1713 1194.10 11089 GRAFT HARVEST KIT ARTHREX 1568.60 11091 CABLE/SLEEVE SET DALL MILES C1713 1966.30 11106 PAIN PUMP 882.40 11109 REAMER CORE/HEAD 1568.60 11110 SCREW INTERFERENCE C1713 1030.80 11112 DRESSING XEROFOAM 14.90 11118 FORCEP CAUTERY BIOPSY 365.50 11119 FORCEP RADIAL JAW BIOPSY 226.90 11124 CEMENT SPATULAS 274.00 11126 IMAGE GUIDED SYSTEM 3605.00 11127 IMAGE GUIDED SYST EA ADDL HOUR 1093.00 11128 AMPLATZ DIL TRACT MASTER 1800.00 11133 MESH COMPOSIX 6X8 & 7X9 C1781 4972.00 11134 MESH COMPOSIX/V C-QUR/PROGRIP 1912.70 11140 GRASPER INSERTS 5MM 271.50 11141 CANNULA ARTHROSCOPY 152.00 11142 MESH COMPOSIX ALYTE/CQUR C1781 2677.60 11143 ARTHOCARE ELECTRODE/COBLATOR 1033.10 11159 PILLOW, LEG ELEVATOR 244.60 11163 PILLOW ABDUCTION 218.00 11172 SUCTION, SIGMOIDOSCOPE 35.60 11173 MARKER, SKIN STERILE 12.90 11175 RING, FALOPE TUBAL BAND 267.00 11180 SPLINT NASAL 228.20 11185 MESH MARLEX PLUG/KUGEL 4" C1781 1292.10 11186 DRAIN JACKSON-PRATT 7 MM 240.40 11187 DRAIN 10 MM JACKSON-PRATT 237.80 11193 PLATE NEURO BURR HOLE C1713 1299.80 11196 PIN GUIDE X-LONG ARTHREX 538.40 11198 JACKSON-PRATT, RRESERVOIR 161.30 11215 SCROTUM SUPPORT, LARGE 71.90 11217 SCROTUM SUPPORT, EX-LARGE 52.20 11227 BANDAGE ORTHO MARTIN 6" 29.50 11240 REVOLVE LIPOASPIRATE PROC SYS 1308.15 11252 FOLEY BAG, W/URI METER 132.30 11253 TRAY UROLOGY 1137.30 11258 CATH, FOLEY TRAY, 15 FR 24.80 11267 TRACH, CARE KIT 35.50 11273 TRAY, MYELOGRAM W/NEEDLE 20GA 153.60 11275 TRAY, PARACERVICAL #P4540A 108.50 11278 DRESSING, CHANGE KIT, CVC 36.70 11279 PREP E-Z BETADINE 50.10 11284 TRAY, BONE MARROW, NO NEEDLE 182.90 11287 TRAY LUMBAR PUNCTURE 135.00 11295 KIT, SUTURE REMOVAL 18.80 11306 HYDROCOLLD DRSG >16 1 HR 76001 966.00 11465 XR EXAM ENTIRE SPINE 1 AP VIEW 72081 452.00 11466 XR KNEE BILATERAL AP STANDING 73565 353.00 11467 ARTHROGRAM HIP INJECT PROC 755.00 11468 XR ARTHROGRAM HIP BILATERAL 7352550 1202.00 11471 XR ENTIRE SPINE 2-3 VIEWS 72082 515.00 11481 US BIOPSY LIVER 1896.00 11483 US BX ABD/RETROPERITONEAL MASS 49180 1896.00 11484 US RENAL BIOPSY PERQ 1896.00 11486 US BIOPSY THYROID CORE 1516.00 11488 US DUP LOWER EXT ARTERY BIL 93925 1655.00 11489 US DUP LOWER EXT ARTERY RT 93926RT 1318.00 11490 US DUP UPPER EXT ARTERY BIL 93930 1328.00 11491 US DUP UPPER EXT ARTERY RT 93931RT 886.00 11492 US VENOUS DUPLEX UPPER BIL 93970 1521.00 11493 US VASCULAR FLOW-ORGANS COMPLT 93975 2036.00 11495 US VASCULAR FLOW-MAJ VES CMPLT 93978 1299.00 11497 US TRANSPLANTED KIDNEY 76776 834.00 11498 US FOLLOW UP PELVIS NON-OB 76857 853.00 11499 US INTRAOPERATIVE 76998 1244.00 11501 US DUPLEX HD ACCESS 93990 1039.00 11502 US DUPLEX ARTERIAL FLOW LMTD 93976 1175.00 11527 KIT SHOULDER ARTHROSCOPY 267.70 11576 BARD PROTECTIVE SPRAY 90.50 11605 CT FNA 1ST LESION 1146.00 11705 TEMP PACER ELECT INSERT SNGL 7371.00 11706 CARDIOLYTE STRESS TEST 93017 819.00 11708 SWAN GANZ INSERTION 93503 2037.00 11713 RIGHT HEART CATH 93451 9123.00 11778 NM TC99M TETROFSMN 14 WKS 76805 857.00 11902 OB EVAL= OR > 14 WK, EA ADDL 76810 596.00 11903 US INFANT CRANIAL 76506 712.00 11904 US OB LIMITED (QUICKLOOK) 76815 603.00 11912 US NON-OB PELVIS 76856 853.00 11913 US INFANT HIPS 76886 563.00 11914 US VENOUS DOPPL/DUPLX LMTD 93971 1239.00 11917 US ABDOMINAL COMPLETE 76700 1076.00 11920 US ABDOMINAL AORTA 76775 798.00 11923 US EXAM, CHEST 76604 804.00 11924 OB BIOPHYS W NST,SNGL 76818 757.00 11926 US THYROID 76536 786.00 11927 US CAROTID DUPLEX 93880 1345.00 11928 US PELVIS NON-OB TRANSVAGINAL 76830 708.00 11930 US ABD BACK WALL,LIM,KIDNEY(S 76775 798.00 11939 US GUIDE NDL PLCMT 76942 1080.00 11941 US SCROTUM AND CONTENTS 76870 674.00 11948 US PELVIC NON-OB LIMITED 76857 853.00 11949 US TRANSCRANIAL DOPPLER 93886 1610.00 11951 ANGIO PULMONARY LT 75741LT 2536.00 11959 FLUORO <1 HR PHYS/QHP 76000 766.00 11967 ANGIO VISCERAL SEL 75726 4265.00 11968 ABD AORTO/BIL RUNOFF,IF LOW EX 75630 7950.00 11969 AORTO THOR W/SERIALOGRAPHY 75605 4265.00 11970 AORTO ABD W/SERIALOGRAPHY 75625 4964.00 11974 ANGIO EXT RT 75710RT 3721.00 11975 ANGIO EXT BIL 75716 3721.00 11978 XR ERCP 74330 1242.00 11985 INSERT LV ELECTRODE W/NEW GEN 7641.00 12001 XR ABDOMEN 1 VIEW 74018 342.00 12003 XR ABDOMEN 2 VIEWS 74019 557.00 12005 XR ABDOMEN 3 VIEWS 74021 572.00 12009 XR AC JOINTS 73050 384.00 12011 XR COLON AIR CONTRAST 74280 1117.00 12012 XR CYSTOGRAM VOIDING 74455 883.00 12013 XR MYELOGRAM CERVICAL 72240 1539.00 12014 XR MYELOGRAM THORACIC 72255 1450.00 12015 XR MYELOGRAM LUMBOSACRAL 72265 1450.00 12017 XR ANKLE MIN 3 VIEWS RIGHT 73610RT 293.00 12022 ANGIO EXT LEFT 75710LT 3721.00 12024 VENO RENAL UNIL SELCTV 75831 3012.00 12025 XR ARTHROGRAM KNEE RIGHT 73580RT 827.00 12029 XR BONE AGE 77072 236.00 12031 XR BONE SURVEY 77075 914.00 12035 XR SPINE CERVICAL MIN 4 VIEWS 72050 478.00 12036 XR SPEECH SWALLOW STUDY 74230 699.00 12039 XR CHEST 1 VIEW 71045 311.00 12041 XR CHEST 2 VIEWS 71046 342.00 12045 XR FLUORO < 1 HR PHYS/QHP 76000 766.00 12049 XR CHOLANGIOGRAM OPERATIVE 74300 861.00 12053 XR CLAVICLE RIGHT 73000RT 290.00 12055 XR ARTHROGRAM SHOULDER RIGHT 73040RT 816.00 12056 ARTHROGRAM HIP RIGHT 73525RT 801.00 12057 XR COLON SINGLE CONTRAST 74270 811.00 12060 XR CHEST DECUBITUS 71045 311.00 12061 XR CHEST LORDOTIC 71045 311.00 12062 XR KNEE; AP & LAT, RIGHT 73560RT 279.00 12065 XR CYSTOGRAM MIN 3 VIEWS 74430 824.00 12068 XR SPINE THORACIC 3 VIEWS 72072 448.00 12069 XR ELBOW MIN 3 VIEW RIGHT 73080RT 285.00 12071 XR ESOPHAGUS 74220 494.00 12072 XR RIBS BILATERAL 71111 745.00 12077 XR FACIAL BONES 70150 484.00 12079 XR FEMUR RIGHT 73552 427.00 12080 XR SPINE CERVICAL 1 VIEW 72020 224.00 12081 XR FINGER 1ST RIGHT 73140 208.00 12082 XR CERV SPINE 2-3 VIEWS 72040 337.00 12083 XR FOOT MIN 3 VIEWS RIGHT 73630RT 275.00 12085 XR FOREARM RIGHT 73090RT 260.00 12086 XR SPINE LUMBAR 1 VIEW 72020 224.00 12091 ECG TRACING ONLY SUBSEQUENT 9300576 185.00 12099 XR HAND MIN 3 VIEW RIGHT 73130RT 293.00 12100 ECG TRACING ONLY 93005 185.00 12102 ECG TRACING ONLY PEDS 93005 185.00 12103 XR HIP MIN 2 VIEWS RIGHT 73502 352.00 12104 RYTHYM ECG TRACING 93041 144.00 12105 ECHO 2D F-UP/LMTD 93308 809.00 12107 XR HUMERUS RIGHT 73060RT 260.00 12109 XR PYELOGRAM INTRAVENOUS 74410 721.00 12111 XR KIDNEYS URETER BLADDER 74018 342.00 12113 XR KNEE MIN 4 VIEWS RIGHT 73564RT 382.00 12115 XR LOWER LEG RIGHT 73590RT 267.00 12117 XR SPINE LUMBAR MIN 4 VIEWS 72110 493.00 12121 XR MANDIBLE 70110 484.00 12129 XR NASO PHARYNX 1 VIEW 70360 248.00 12131 XR NASAL BONES 70160 267.00 12137 XR ORBIT 70200 422.00 12139 XR HEEL (OSCALSIS) RIGHT 73650RT 276.00 12143 XR PELVIS 72170 310.00 12151 XR PYELOGRAM RETROGRADE 74420 716.00 12153 XR RIBS RIGHT 71101RT 463.00 12155 XR SACROILIAC JOINTS 72202 343.00 12157 XR SACRUM AND COCCYX 72220 340.00 12161 XR HYSTEROSALPINGOGRAM 74740 880.00 12163 XR SCAPULA RIGHT 73010RT 298.00 12165 XR SHOULDER MIN 2 VIEW RIGHT 73030RT 347.00 12167 XR SINUSES MIN 3 VIEWS 70220 508.00 12169 XR SKULL 70260 444.00 12171 XR SMALL BOWEL 74250 668.00 12177 XR STERNUM - MIN 2 VIEWS 71120 284.00 12179 XR UPPER GI 74241 637.00 12183 XR TOE 1ST RIGHT 73660 206.00 12187 XR WRIST MIN 3 VIEW RIGHT 73110RT 293.00 12190 XR FLUORO <1 HR; PHYS/QHP 76000 766.00 12191 XR FLUOROSCOPY MOBILE > 1 HR 76001 966.00 12193 CT TEMPORAL BONE/IAC W/O 70480 1870.00 12194 CT TEMPORAL BONE/IAC/W/CONTR 70481 2177.00 12195 CT TEMPRL BONE/IAC W/&W/O CON 70482 2499.00 12213 LAB T3, TOTAL 84480 143.00 12216 ABSCESS/FISTULA/SINUS 76080 795.00 12218 NM THYROID THERAPY 79005 869.00 12228 NM BRAIN => 4 VIEW W/FLOW 78606 1672.00 12229 NM LUNG PERFUSION SCAN 78580 1267.00 12230 NM LIVER GAMMA CAMERA IMAGING 78215 1215.00 12231 NM BONE SCAN GAMMA CAMERA IMG 78306 1855.00 12232 NM LIMITED BONE 78300 1114.00 12233 NM TRIPHASIC,BONE/JNT; 3 PHASE 78315 1837.00 12234 NM TRI-PHASIC LMTD BONE 78315 1837.00 12239 LAB FREE T4 84439 153.00 12243 LAB ESTRADIAL 82670 444.00 12244 LAB CEA 82378 462.00 12245 LAB CORTISOL URINE 82533 400.00 12246 LAB DIGOXIN 80162 363.00 12248 LAB FOLIC ACID 82746 289.00 12249 LAB FSH 83001 312.00 12254 LAB LH 83002 339.00 12259 LAB TSH 84443 326.00 12260 LAB VITAMIN B 12 82607 356.00 12262 LAB FERRITIN 82728 234.00 12266 LAB PROLACTIN 84146 339.00 12275 NM GB/HEPTOBILIARY IMAGING 78226 2263.00 12279 NM MECKELS IMAGE 78290 1626.00 12283 NM LUNG VENTILATION SCAN 78579 1267.00 12284 NM GATED CARDIAC IMAGE 78472 1599.00 12286 NM G.I. BLEEDING STUDY 78278 1484.00 12294 LAB MYOGLOBIN SERUM 83874 86.00 12295 LAB PSA,TOTAL 84153 217.00 12300 LAB MICROALBUMIN URINE 82043 61.00 12305 NM SPECT BONE 78320 1929.00 12306 NM CARDIAC SPECT REDIST STUDY 78451 2297.00 12308 ARTERIAL PUNCTURE 36600 106.00 12310 LAB ROUTINE VENIPUNCTURE 36415 17.00 12316 LAB PSA SCREENING G0103 217.00 12328 SP/TRAY SP PRCEDURE SET-UP 647.50 12339 PULSE OXIMETRY CONT 94762 219.00 12340 TRACKING INCENT SPIROMETRY 153.00 12342 CPAP/BIPAP INITIATION & MGMT 94660 377.00 12346 CBT W/AERO 1ST HR 94644 253.00 12350 CHEST PT SUBSEQUENT 94668 134.00 12352 PULSE OXIMETRY,SINGLE 94760 48.00 12354 TRACKING RT ATTENDANCE 73.00 12362 TRACKING RT O2 INITIAL 148.20 12366 RESP. 02 SVC DAILY 346.80 12375 RESP O2 SVC PRN-DAILY 80.60 12376 AERO/NEB/MDI/IPPB TX INITIAL 94640 187.00 12378 VENTILATOR MGMT 1ST DAY 94002 1343.00 12380 VENTILATOR MGMT SUBS DAY 94003 1073.00 12381 RESP METERED DOSE INHAL INST 94664 108.00 12383 PULM STRESS TEST SIMPLE LMTD 9461852 209.00 12384 CHEST PT INITIAL 94667 149.00 12385 RESP FLUTTER DEVICE S8185 107.30 12388 TRACKING RT TRAUMA ASSIST 718.80 12390 CARDIOPULMONARY RESUSITATION 92950 1701.00 12391 VITAL CAPACITY TOTAL 94150 153.00 12398 TRACKING RT AEROSOL SETUP 138.80 12399 TRACKING RT HTD AEROSOL SETUP 146.30 12406 ISOLATION SUPPLIES 107.30 12441 CIRCUMCISION INFANT 1757.00 12490 LAB ACTH STIMULATION 80400 168.00 12491 LAB CORTISOL (DEXAMETH SUP) 82533 79.00 12494 LABs ACYLCARNITINES QUANT 82017 83.00 12495 LAB POC UA REFLEX TO CULTURE 81003 55.00 12501 EEG AWAKE/ASLEEP 95819 1328.00 12508 ECHO DOPPLER COMPLETE 93320 509.00 12509 ECHO 2D W/DOPLR COMP COMBO 93306 2026.00 12511 EXT ECG UP TO 48 HRS W/REC 93225 244.00 12515 TILT TABLE EVAL 93660 1187.00 12517 STRESS TEST TRACING ONLY 93017 819.00 12525 BRONCHOSPASM EVAL 94070 1062.00 12526 SPIROMETRY PRE/POST BD 94060 493.00 12528 SPIROMETRY W/GRAPHIC REC 94010 228.00 12529 DIFFUSING CAPACITY 94729 476.00 12532 THERAPEUTIC PHLEBOTOMY 99195 360.00 12533 PLETHYSMOGRAPHY LUNG VOL 94726 486.00 12534 PEAK FLOW METER 107.90 12538 US LOWER EXTR ARTERIAL 93923 1001.00 12540 US UPPER EXTR ARTERIAL (TOS) 93923 1001.00 12541 EXT ECG UP TO 48 HRS W/ANA 93226 1069.00 12542 W-ECG 10-30 DAY CER RECORD 93270 149.00 12578 TEE 2D W/WO COMP 93312 2086.00 12579 STRESS ECHO 2D 93351 1943.00 12580 STRESS TTE W DOBUTAMINE 93350 2109.00 12589 BIOPSY NEEDLE 173.20 12590 COLL BLD SPEC IMP CVAD 36591 134.00 12609 EMERG/OBV HEMODIALYSIS 90999 1631.00 12617 I/P CHRONIC CAPD REGIMEN 90945 981.00 12625 INPATIENT HEMODIALYSIS 90935 1631.00 12626 I/P INTERMITTENT PERITONEAL DL 90999 1362.00 12627 O/P INTERMITTENT CYCLER PERITO G0257 1076.00 12633 THERAPEUTIC APHORESIS TX 36514 3343.00 12640 INPATIENT HEMODIALYSIS BEDSIDE 90935 1783.00 12645 DIALYSIS INPATIENT CCPD 981.00 12646 DIALYSIS OUTPATIENT CAPD 90945 981.00 12800 RECOVERY ROOM 15 MIN 511.00 12802 RECOVERY ROOM COMPLEX 15 MIN 521.00 12828 EPIDURAL NRV BLOCK, EA ADD REG 652.00 12829 EPIDURAL NRV BLOCK,SNGL REGION 1433.00 12855 PERIPHERAL NERVE BLOCK 1224.00 12891 XR FLUORO NDL/SPINE > 1 HR 77003 1135.00 12892 XR FLOURO NDL/SPINE/SI > 1 HR 77003 1135.00 12893 XR FLOURO NDL/NON-SPINE < 1HR 77002 1135.00 12895 XR URETHROGRAM RETROGRADE 74450 824.00 12898 XR CHEMO CNS INTRATHECAL W/LP 96450 1258.00 12906 FIXATION DEVICE EXTERNAL 6586.30 12946 IUPC-INTRAUTERINE PRESS CATH 178.80 12950 VACUUM DELIVERY SYS 158.20 12959 FERN TEST 89060 33.00 12969 STAPLE REMOVER 24.30 12978 FORCEP BIOPSY 513.00 12979 ENDO HEMOCLIPS 1115.30 12993 NON-STRESS TEST 59025 604.00 12999 INJECTION IM/SUBQ 96372 166.00 13000 ELASTIC RETRACTOR DISPOSABLE 462.80 13002 RUPTURED MEMBRANES IA 84112 190.00 13006 COLD THERAPY UNIT 1412.00 13009 KNIFE OPHTHALMIC 89.80 13011 TURBO ENVIR SUITS 310.20 13013 NAIL FEMORAL/TIBIAL/HUMERAL C1713 4629.00 13014 NAIL CAP END 469.90 13015 NEEDLE INSUFFLATION/INCISING 156.00 13018 SLEEVE TROCAR 449.70 13019 INTEG/INFLATION SYSTEM 226.40 13035 HCG URINE 81025 114.00 13043 CT GUIDANCE TISSUE ABLATION 77013 3228.00 13044 CT CHEST W/CONTRAST FOR PE 71260 2226.00 13045 CT BONE LENGTH SCANOGRAM 77073 393.00 13047 PERC CRYOABLATION RENAL TUMOR 8013.00 13048 CT ABD & PELVIS W/O CONTRAST 74176 3527.00 13049 CT ABD & PELVIS W/CONTRAST 74177 4387.00 13050 CT ABD/PELVIS W&W/O CONTRAST 74178 5177.00 13051 CTA ABD/PELVIS W&W/O CONTRAST 74174 5810.00 13052 RF PROBE TALON 5273.30 13053 RF PROBE STARBURST 6488.40 13054 INJ CELIAC PLEXUS W/WO 64530 1386.00 13055 CT BRAIN PERFUSION 0042T 1601.00 13059 CT MOD SED SAME 5+YR 1ST 15 MN 99152 414.00 13060 CT MOD SED SAME ADDL 15 MIN 99153 109.00 13102 XR CHEST 3 VIEWS 71047 311.00 13103 XR CHEST 4 OR MORE VIEWS 71048 483.00 13109 DECLOT BY THROMBO AGENT 36593 388.00 13110 VACCINE ADMIN SNGL 90471 166.00 13113 VISIT NEW PT LEVEL 3 99203 480.00 13116 VISIT EST PT LEVEL 1 99211 177.00 13117 VISIT EST PT LEVEL 2 99212 199.00 13118 VISIT EST PT LEVEL 3 99213 294.00 13119 VISIT EST PT LEVEL 4 99214 443.00 13124 INJ IVP SNGL/INTL 96374 302.00 13125 INJECTION IM/SUBQ 96372 166.00 13137 CHEMO ANTI-NEOPL SUBQ/IM 96401 422.00 13161 EP ABLATION CATH, COOL TIP C2630 4348.90 13163 PUTTY DBM/BONE CHIPS C9359 798.00 13185 FIBRINOGEN PATCH 327.20 13300 PULM STRESS TEST SIMPLE 94618 246.00 13305 US HYSTOSONOGRAPHY 76831 880.00 13306 US HYSTO INJECTION PROCEDURE 557.00 13313 THER PROC RESP OTH GROUP G0239 80.00 13315 AERO/NEB/MDI/IPPB TX INTL 94640 187.00 13318 CHEST PT INTL 94667 149.00 13325 OB EVAL < 14 WKS, EA ADDL 76802 430.00 13326 OB FOLLOW-UP/RE-EVAL, SNGL 76816 695.00 13327 OB FOLLOW-UP/RE-EVAL, EA ADDL 7681659 621.00 13328 US OB TRANSVAGINAL 76817 613.00 13329 OB BIOPHYS W/O NST, ADDL 7681959 571.00 13330 US THORACENTESIS W/IMAGING 1685.00 13331 US ABD PARACENTESIS W IMAGING 1668.00 13332 US BREAST-ASPIRATE CYST 1031.00 13338 US GUIDE VASC ACCESS 76937 431.00 13339 US SACRAL DIMPLE/SPINAL CANAL 76800 695.00 13340 US PSEUDOANEURYSM REPAIR-GUID 76936 1796.00 13341 US VENOUS DUPLEX LMTD 93971 1239.00 13343 FNA W GUIDANCE 1146.00 13344 US VENOUS DUP UPPER/LWR BIL 9397059 2281.00 13350 US SOFT TISSUE HEAD &/OR NECK 76536 786.00 13351 US ABDOMINAL LIMITED 76705 876.00 13352 US ABD BACK WALL, LIM, KID/BL 76775 798.00 13353 US BIOPHYS W/O NST, SNGL 76819 757.00 13354 US BIOPHYS W NST EA ADDL 7681859 679.00 13356 ASP/INJ MAJ JNT/BURSA 397.00 13357 INJ PERC EXT PSEUDOANEURYSM 36002 613.00 13358 US BIOPSY LYMPH NODE 1669.00 13360 US VASC MAP PRE DIAL ACC RT G0365RT 1239.00 13361 US VASC MAP PRE DIAL ACC LT G0365LT 1239.00 13362 US EXAM AAA SCREENING 76706 687.00 13363 US VENOUS DUPLEX LMTD 93971 1239.00 13364 US EXT NON-VASC LMT LWR RT 76882RT 699.00 13365 US EXT NON-VASC LMT UPPR LT 76882LT 699.00 13366 US EXT NON-VASC LMT LWR LT 76882LT 699.00 13367 US EXT NON-VASC LMT UPPR RT 76882RT 699.00 13369 US PUNCT/ASP ABSCESS HEMA CYST 468.00 13370 US OB ER LIMITED >14 WKS 76815 603.00 13371 US BILATERAL ASP THORACENTESIS 2209.00 13376 US BREAST BX RT W/CLIP 2202.00 13378 US BREAST BX LT W/CLIP 2202.00 13382 CWUS BREAST BILAT W/CLIP 2973.00 13384 CWUS BREASTS LIMITED BILATERAL 7664250 534.00 13386 US VASC FLOW MAJOR VESS LTD 93979 1077.00 13389 US BREAST COMPLETE BILATERAL 7664150 635.00 13402 LAB HOMOCYSTINE, SERUM 83090 188.00 13408 LAB TRANSFERRIN 84466 67.00 13413 LAB PREALBUMIN 84134 129.00 13417 LAB PTH INTACT 83970 199.00 13424 LAB HCG AFP MARKER 84702 83.00 13437 LAB BASIC METABLC PANL TOT CA 80048 195.00 13438 LAB COMP METABOLIC PANEL 80053 458.00 13439 LAB HEPATIC FUNCTION PANEL 80076 256.00 13451 LAB RENAL FUNCTION PANEL 80069 198.00 13452 LAB POC CREATININE 82565 25.00 13463 LAB PROCALCITONIN PCT 84145 82.00 13582 TUBE ENDOTRACH DBL LUMEN 880.30 13584 EPIDURAL CONTINUOUS TRAY 380.10 13603 LEVEL 1 I.V. TUBING 334.50 13613 DESFLURANE 77.00 13629 FLUID WARMING SET 148.80 13630 IOP HALF DAY PGM 90853 261.60 13631 IOP HALF DAY PROGRAM (MCD) S9480 261.60 13632 IOP HALF DAY PROGRAM (FHP) S9480 261.60 13638 SALEM SUMP NASOGAST TUB 18 FR 84.70 13703 SEVOFLURANE 1 UNIT/10 MIN 84.00 13721 IV HYDRAT THRPY 31-90 MIN 96360 552.00 13722 IV HYDRAT ADD HR 96361 116.00 13723 IV DX/TX THRPY 1ST HR 96365 552.00 13724 IV DX/TX THRPY ADD HR 96366 124.00 13726 IV DX/TX NEW ADD SEQ MAX 1 96367 194.00 13727 INJ IVP SNGL/INITIAL 96374 302.00 13728 INJ IVP ADD SEQ NEW DRUG 96375 137.00 13800 INJECTION IM/SUBQ 96372 166.00 13802 CORON/PERIPH DIAG WIRE C1769 570.60 13804 TORQUE DEVICE 75.10 13903 SKIN STAPLER L&D 63.50 13911 ADHESIVE TISSUE CLOSURE 147.00 13912 BARRIER INTERCEED C1765 811.30 13914 VISIT NEW PT LEVEL 1 99201 190.00 13915 VISIT EST PT LEVEL 1 99211 177.00 13916 VISIT NEW PT LEVEL 2 99202 327.00 13917 VISIT EST PT LEVEL 2 99212 199.00 13918 VIST NEW PT LEVEL 3 99203 480.00 13919 VISIT EST PT LEVEL 3 99213 294.00 13920 VISIT NEW PT LEVEL 4 99204 728.00 13921 VISIT EST PT LEVEL 4 99214 443.00 13922 VISIT NEW PT LEVEL 5 99205 919.00 13923 VISIT EST PT LEVEL 5 99215 637.00 13928 INJ IVP SNGL/INITIAL 96374 302.00 13929 INJ IVP ADD SEQ NEW DRUG 96375 137.00 13930 OB LAB VENIPUNCTURE 36415 17.00 13932 VACCINE ADMIN PNEUMONIA G0009 166.00 13933 VACCINE ADMIN INFLUENZA G0008 166.00 14001 NERVE COND STUDIES 1-2 95907 241.00 14002 NERVE COND STUDIES 3-4 95908 723.00 14003 NERVE COND STUDIES 5-6 95909 1205.00 14004 NERVE COND STUDIES 7-8 95910 1617.00 14005 NERVE COND STUDIES 9-10 95911 2169.00 14006 NERVE COND STUDIES 11-12 95912 2651.00 14007 NERVE COND STUDIES 13+ 95913 2889.00 14502 PLCMT CATH VEIN 2ND ORDER 36012 2207.00 14505 PLCMT CATH ART 2ND THOR 36216 2207.00 14508 CATH ART 1ST ABD/PEL/LE 36245 2207.00 14518 TRANSCATH STENT W/DIS EP 37215 8966.00 14529 PLACE CATH XTRNL CAROTID 36227 4544.00 14534 ANGIO EXT RT 75710 3721.00 14535 ANGIO EXT LEFT 75710 3721.00 14537 ANGIO SEL EA ADDL VESSEL 75774 2579.00 14540 TRANSCATH EMBOLIZATION 75894 5561.00 14552 COAG TIME ACTIVATED 85347 134.00 14556 SEL CATH CAR/INNO ART EC 36222 5517.00 14557 SEL CATH CAR/INNO ART IC 36223 5517.00 14558 SEL CATH INT CAR ART 36224 5517.00 14559 SEL CATH SUB/INNO ART 36225 5517.00 14560 SEL CATH VERT ART BIL 3622650 8275.00 14561 SEL CATH CAR/VERT ART 36228 4544.00 14562 NEURO RAD CT RECONSTRUCTIONS 76377 849.00 14563 US GUIDE VASC ACCESS 76937 431.00 14564 TRANSCATH-P EMBOL CNS 61624 10151.00 14569 COILS NEURO INTERVENTIONAL 2356.70 14573 PLC CATH CAROTID/INOM ART BIL 3622250 8034.00 14574 PLC CATH CAROTID/INOM ART BIL 3622350 8275.00 14575 SEL CATH INT CAR ART BIL 3622450 8275.00 14576 SEL CATH SUB/INNO ART BIL 3622550 8275.00 14577 SEL CATH VERT ART BIL 3622650 8275.00 14581 INR BALLOON CATHETER C1725 1005.80 14582 INR BALLOON OCCLUSION CATH C2628 3213.60 14583 INR DIAGNOSTIC CATHETER 194.80 14584 INR GUIDING CATHETER C1887 1177.30 14585 INR MICRO CATHETER C1887 3213.60 14586 INR PENUMBRA CATHETER C1757 4713.30 14588 INR SOLITARE CATHETER C1757 17473.50 14590 INR EXTERNAL CLOSURE DEVICE 280.70 14592 INR INTERNAL CLOSURE DEVICE C1760 1391.70 14593 INR DETACHMENT DEVICE 535.60 14597 INR INFLATION DEVICE 275.60 14598 INR SHEATH C1894 257.10 14601 INR STENT NON COAT W/DEL C1876 5757.70 14602 INR DIAGNOSTIC WIRE C1769 570.60 14603 INR EMBOLIC PROTECTION WIRE C1884 4954.30 14604 INR INTERVENTIONAL WIRE C1769 973.80 14608 PLACE CATH XTRNL CAROTID BILAT 3622750 6816.00 14613 GUIDED CATH FLUID DRAINAGE 1421.00 14614 SCLERODERMA FLUID COLLECTION 49185 1421.00 14616 DIALYSIS CIRCUIT EMBOLIZATION 36909 2121.00 14618 PTA CENTRAL DIALYSIS CIRCUIT 36907 25642.00 14619 STENT PLACEMENT CENT DIAL CIRC 36908 25642.00 14620 CHANGE G TUBE TO G-J PERC 49446 3511.00 14621 PLACEMENT URETERAL STENT PERC 6689.00 14622 PM DEVICE PROGR EVAL DUAL 93280 414.00 14625 IR NEEDLE BIOPSY-MUSCLE 20206 2696.00 14629 IR PERQ CERVICOTHORACIC INJ 22510 6279.00 14632 IR PERQ VERTEBRAL AUGMENTN 22513 13446.00 14658 IR REVASC ILIAC W/STENT BILAT 3722150 24381.07 14661 IR REVASC FEM/POP W/STNT/ATH 3722750 32041.00 14671 IR OPEN/PERQ STENT SAME-BILAT 3723850 25113.00 14676 IR INJ PROC/PERQ W/GUID EXIST 47531 5822.00 14677 IR INJ PROC/PERQ W/GUID NEW 47532 5822.00 14678 IR PLC BIL CATH W/CHOLAN EXT 47533 5822.00 14679 IR PLC BIL CATH W/CHOL EXT/INT 47534 5822.00 14680 IR CONV EXT BIL CATH TO INT/EX 47535 5822.00 14681 IR EXCH BIL CATH PERC W/GUID 47536 7372.00 14690 IR REP GAST/CEC TUBE PERC W/G 49450 1802.00 14691 IR REP DUOD/JTUBE PERC 49451 1802.00 14692 IR REP GASTRO/JTUBE PERC W/GUI 49452 1802.00 14693 IR MECH REM TUBE OBS/ANY METH 49460 1802.00 14699 IR INS NEPHRO TUBE-BILATERAL 5043250 3391.00 14701 IR CONV NEPHROSTOMY CATH-NEW 50434 1696.00 14705 IR PLMT URETERAL STENT PERQ 50694 6547.00 14708 IR PERQ ART M-THROMBEC & NFS 61645 3605.00 14712 IR INJ DX/TX SUBS W/GUIDANCE 1268.00 14715 IR IND LONG GI TUBE W/MULTI 350.00 14717 IR ANGGRAPHY PUL NON SEL CATH 75746 1762.00 14730 IR REVASC FEM/POP W/ATH BILAT 3722550 25113.00 14731 IR REVASC FEM/POP W/STENT BIL 3722650 21021.00 14744 NEEDLE BIOPSY LIVER PERC 1562.00 14745 FNA W/IMAGING GUIDANCE 1562.00 15001 REMOVE TNLD CVAD W/O P/P 968.00 15002 CHEMO IV SNGLE/INTL 1ST HR 96413 923.00 15003 CHEMO IV INFUS ADD HR 96415 219.00 15010 IV DX/TX THRPY 1ST HR 96365 552.00 15011 IV DX/TX THRPY ADD HR 96366 124.00 15012 VENIPUNCTIRE ROUTINE 36415 17.00 15016 CHEMO IVP SNGL/INTL 96409 683.00 15021 IRRIG IVAD RX DELIVERY 96523 153.00 15025 IV HYDRAT THRPY 31-90 MIN 96360 552.00 15026 IV HYDRAT THRPY ADD HR 96361 116.00 15027 INJ IVP ADD SEQ NEW DRUG 96375 137.00 15029 IV DX/TX NEW ADD SEQ MAX 1 96367 194.00 15033 REPAIR CVA CATH 36575 1225.00 16201 ED LEVEL 1 99281 293.00 16202 ED LEVEL 2 99282 474.00 16203 ED LEVEL 3 99283 867.00 16204 ED LEVEL 4 99284 1436.00 16205 ED LEVEL 5 99285 2287.00 16206 CRITICAL CARE 1ST 30-74 MIN 99291 3221.00 16215 ER GASTRIC LAVAGE 609.00 16216 ER SKIN REPAIR SIMPLE LEVEL I 519.00 16217 ER SKIN REP INTERMED LEVEL II 849.00 16218 ER SKIN REP COMPLEX LEVEL III 821.00 16219 VACCINE ADMIN SNGL 90471 166.00 16220 ER FB/CERUMEN REMOVAL EAR 198.00 16221 TUBE THOROCOSTOMY OPEN 32551 2170.00 16222 ER TUBE CHANGE/REPOSITIONING 286.00 16223 INTUB ENDOTRACH EMERGENT 31500 1101.00 16224 ER THORACENTESIS 1517.00 16225 ER LUMBAR PUNCTURE 492.00 16226 ER CATHETERIZATION URETHRA 348.00 16228 ER FB REMOVAL EYE 651.00 16229 CARDIOVERSION EXTERNAL 92960 1998.00 16230 DRESS/DEBRIDE P-THICK BURN L 497.00 16235 ER LARYNGOSCOPY 198.00 16236 ED CRITI CARE EA ADDL 30 MIN 99292 588.00 16237 IV DX/TX THRPY 1ST HR 96365 552.00 16238 ER STRAPPING ONLY 138.00 16241 ER APP SPLINT FINGER 118.00 16242 ER INCISION & DRAINAGE 309.00 16244 ER CLOSED TX JOINT DISLOCATION 241.00 16245 ER INSERTION PERCUT CVC 36556 1562.00 16246 ER FB REMOVAL EAR/NOSE/THROAT 454.00 16247 INJECTION IM/SUBQ 96372 166.00 16249 ED WEDGE EXC NAIL FOLD 197.00 16302 HGED LEVEL 1 99281 293.00 16303 HGED LEVEL 2 99282 474.00 16304 HGED LEVEL 3 99283 867.00 16305 HGED LEVEL 4 99284 1436.00 16306 HGED LEVEL 5 99285 2287.00 16307 HGED CRITI CARE 1ST 30-74 MIN 99291 3221.00 16310 HGED GASTRIC LAVAGE 548.00 16311 HGED SKIN REP SIMPLE LEVEL I 519.00 16312 HGED SKIN REP INTERMED LEV II 849.00 16314 VACCINE ADMIN SNGL 90471 166.00 16315 HGED FB/CERUMEN REMOVAL EAR 198.00 16316 TUBE THORACOSTOMY OPEN 32551 2170.00 16318 INTUB ENDOTRACH EMERGENT 31500 1101.00 16320 HGED LUMBAR PUNCTURE 492.00 16321 HGED CATHETERIZATION URETHRA 348.00 16323 HGED FB REMOVAL EYE 651.00 16324 CARDIOVERSION EXTERNAL 92960 1998.00 16325 HGED DRESS/DEBR P-THICK BURN L 608.00 16327 HGED CRITI CARE ADDL 30 MIN 99292 588.00 16328 IV DX/TX THRPY 1ST HR 96365 552.00 16329 HGED STRAPPING ONLY 138.00 16330 HGED APP SPLINT FINGER 118.00 16331 HGED INCISION &/OR DRAINAGE 309.00 16332 HGED CLOSED TX JOINT DISLOC 241.00 16334 HGED FB REM EAR/NOSE/THROAT 454.00 16335 INJECTION IM/SUBQ 96372 166.00 16338 HGED APP SPLINT/IMMOB SMALL 252.00 16339 HGED APP SPLINT/IMMOB LARGE 408.00 16340 HGED AVULSION OF NAIL PLATE 751.00 16341 HGED BLADDER IRRIGATION SIMPLE 592.00 16343 HGED DEBRIDEMENT SKIN 548.00 16344 HGED DRAIN BLOOD UNDER NAIL 223.00 16346 HGED FB REMOVAL OTHER 651.00 16347 INJ IVP SNGL/INITIAL 96374 302.00 16353 HGED CANE 51.40 16354 HGED COLLAR 84.30 16355 HGED CRUTCH 82.80 16356 HGED POST OP SHOE 35.00 16357 HGED SLING ENVELOPE 16.70 16359 HGED WALKER 171.70 16361 HGED ACCUCHEK W/REAGENT STRIP 82948 30.00 16362 IV DX/TX THRPY ADD HR 96366 124.00 16363 IV DX/TX NEW ADD SEQ MAX 1 96367 194.00 16364 INJ IVP ADD SEQ NEW DRUG 96375 137.00 16366 HGED JOINT ASPIRATION/INJCTION 405.00 16368 MOD SED SAME ADDL 15 MIN 99153 109.00 16370 HGED CLSD TX METACARP/TARSL FX 312.00 16373 VACCINE ADMIN ADD 90472 58.00 16374 IV HYDRAT THRPY 31-90 MIN 96360 552.00 16375 IV HYDRAT THRPY ADD HR 96361 116.00 16383 HGED CNTRL NASAL HEMM ANT SMPL 212.00 16384 HGED CNTRL NASAL HEMM ANT COMP 423.00 16386 HGED INIT RX 1ST DEGREE BURN 203.00 16387 HGED PERIPHERAL NERVE BLOCK 1102.00 16392 CTRL NASAL HEMM ANT COMPLX BIL 519.00 16393 HGED ROUTINE VENIPUNCTURE DUI 36415 17.00 16394 HGED STRAPPING BILATERAL 207.00 16395 HGED WEDGE EXC NAIL FOLD 219.00 16398 INSERT CATH PLEURA W/O IMAGING 1427.00 16901 MOD SED SAME 5+ YR 1ST 15 MIN 99152 414.00 16903 MOD SED SAME 5+ YR 1ST 15 MIN 99152 414.00 16904 MOD SED SAME 5+ YR 1ST 15 MIN 99152 414.00 16905 MOD SED SAME <5YR 1ST 15 MIN 99151 414.00 16906 MOD SED SAME 5+ YR 1ST 15 MIN 99152 414.00 17001 EPIDURAL INSERTION 511.00 18056 TRANSLUMIN ANGIO NONLASER CATH C1725 1662.20 18057 CORON/PERIPH STENT NON-COAT C1877 5324.60 20000 ENDO PROCEDURE FIRST 15 MIN 2179.00 20001 ENDO PROCEDURE EA ADDL 15 MIN 767.00 20004 ENDO TUBE CHANGE/REPOSITION 257.00 20016 STENT ESOPHAGEAL FLEX C1874 5189.30 20061 STENT NON-COR TEM W/DEL SYSTEM C2625 2776.90 21000 HGMRI BRAIN W/O CONTRAST 70551 3244.00 21002 HGMRI BRAIN W/&W/O CONTRAST 70553 5148.00 21003 HGMRI TEMPEROMANDIBULAR JOINT 70336 3525.00 21006 HGMRI NECK W/O CONTRAST 70540 3103.00 21007 HGMRI CHEST W/O CONTRAST 71550 3463.00 21008 HGMRI ABDOMEN W/O CONTRAST 74181 2892.00 21009 HGMRI PELVIS W/O CONTRAST 72195 3182.00 21010 HGMRI CERV SPINE W/O CONTRAST 72141 2975.00 21011 HGMRI CERV SPINE W/ CONTRAST 72142 3670.00 21012 HGMRI CERV SPINE W/&W/O CONT 72156 4924.00 21013 HGMRI THOR SPINE W/O CONTRAST 72146 3062.00 21014 HGMRI THOR SPINE W/ CONTRAST 72147 3580.00 21015 HGMRI THOR SPINE W & WO CONT 72157 4692.00 21016 HGMRI LUMBAR SPINE W/O CONT 72148 3166.00 21017 HGMRI LUMBAR SPINE W/ CONT 72149 3629.00 21018 HGMRI LUMB SPINE W/&W/O CONT 72158 4862.00 21019 HGMRI SHOULDER LT W/O CONT 73221LT 3004.00 21020 HGMRI ELBOW LT W/O CONTRAST 73221LT 3004.00 21021 HGMRI WRIST LT W/O CONTRAST 73221LT 3004.00 21023 HGMRI HIP LT W/O CONTRAST 73721LT 3194.00 21024 HGMRI KNEE LT W/O CONTRAST 73721LT 3194.00 21025 HGMRI ANKLE LT W/O CONTRAST 73721LT 3194.00 21026 HGMRI LEG LT W/O CONTRAST 73718LT 3116.00 21027 HGMRA HEAD W/O CONTRAST 70544 3385.00 21028 HGMRA NECK W/O CONTRAST 70547 3377.00 21034 HGMRI SHOULDER RT W/O CONT 73221RT 3004.00 21035 HGMRI ELBOW RT W/O CONTRAST 73221RT 3004.00 21036 HGMRI WRIST RT W/O CONTRAST 73221RT 3004.00 21037 HGMRI ARM RT W/O CONTRAST 73218RT 3170.00 21038 HGMRI HIP RT W/O CONTRAST 73721RT 3194.00 21039 HGMRI KNEE RT W/O CONTRAST 73721RT 3194.00 21040 HGMRI ANKLE RT W/O CONTRAST 73721RT 3194.00 21041 HGMRI LEG RT W/O CONTRAST 73718RT 3116.00 21045 HGMRI PITUITARY W/ & W/O CONT 70553 5148.00 21046 HGMRI FOOT LT W/O CONTRAST 73718LT 3116.00 21047 HGMRI FOOT RT W/O CONTRAST 73718RT 3116.00 21049 HGMRI HAND LT W/O CONTRAST 73218LT 3170.00 21050 HGMRI HAND RT W/O CONTRAST 73218RT 3170.00 21054 HGMRI ORBIT W/ & W/O CONTRAST 70543 4804.00 21056 HGMRI NECK W/ & W/O CONTRAST 70543 4804.00 21058 HGMRI CHEST W/ & W/O CONTRAST 71552 5330.00 21059 HGMRI ABDOMEN W/ CONTRAST 74182 3823.00 21060 HGMRI ABDOMEN W/ & W/O CONT 74183 4891.00 21062 HGMRI PELVIS W/ & W/O CONT 72197 4887.00 21064 HGMRI SHOULDER LT W/&W/O CONT 73223LT 4643.00 21070 HGMRI ARM LT W/ & W/O CONT 73220LT 4846.00 21072 HGMRI HIP LT W/ & W/O CONT 73723LT 4630.00 21074 HGMRI KNEE LT W/ & W/O CONT 73723LT 4630.00 21076 HGMRI ANKLE LT W/ & W/O CONT 73723LT 4630.00 21078 HGMRI LEG LT W/ & W/O CONT 73720LT 4841.00 21080 HGMRI SHOULDER RT W/&W/O CONT 73223RT 4643.00 21082 HGMRI WRIST RT W/ & W/O CONT 73223RT 4643.00 21084 HGMRI ARM RT W/ & W/O CONT 73220RT 4846.00 21088 HGMRI KNEE RT W/ & W/O CONT 73723RT 4630.00 21091 HGMRA NECK W/ CONTRAST 70548 3505.00 21093 HGMRI ANKLE RT W/ CONTRAST 73722RT 3364.00 21094 HGMRI ANKLE RT W/ & W/O CONT 73723RT 4630.00 21098 HGMRI FOOT LT W/ & W/O CONT 73720LT 4841.00 21100 HGMRI FOOT RT W/ & W/O CONT 73720RT 4841.00 21102 HGMRI HAND LT W/ & W/O CONT 73220LT 4846.00 21104 HGMRI HAND RT W/ & W/O CONT 73220RT 4846.00 21107 HGMRI BRAIN & IAC W/O CONT 70551 3244.00 21108 HGMRI BRAIN & IAC W/ CONTRAST 70552 3633.00 21109 HGMRI BRAIN & IAC W/&W/O CONT 70553 5148.00 21114 HGMRI BRAIN/PITUITRY W&W/O CO 70553 5148.00 21117 HGMRI INJ GAD-BASE CONT 1ML A9579 14.70 21119 HGCT SINUS STEREOTACT W/O CONT 70486 1663.00 21121 HGCT SINUS W/O CONTRAST 70486 1663.00 21122 HGCT ABDOMEN PLAIN W/O CONT 74150 1746.00 21123 HGCT ABDOMEN W/ CONTRAST 74160 2184.00 21124 HGCT ABDOMEN W/ & W/O CONT 74170 2822.00 21125 HGCT CERVICAL SPINE W/O CONT 72125 1929.00 21127 HGCT CERV SPINE W/&W/O CONT 72127 2646.00 21128 HGCT BRAIN W/O CONTRAST 70450 1751.00 21130 HGCT BRAIN W/ & W/O CONTRAST 70470 2389.00 21131 HGCT LOWER EXT RT W/O CONT 73700RT 1838.00 21132 HGCT LOWER EXT RT W/ CONTRAST 73701RT 2297.00 21134 HGCT LUMBAR SPINE W/O CONT 72131 1954.00 21136 HGCT LUMBAR SPINE W/&W/O CONT 72133 2375.00 21137 HGCT MAXILLOFACIAL W/O CONTRST 70486 1663.00 21138 HGCT MAXILLOFACIAL W/CONTRAST 70487 2175.00 21139 HGCT MAXILLOFACIAL W/&W/O CONT 70488 2611.00 21140 HGCT NECK W/O CONTRAST 70490 1629.00 21141 HGCT NECK W/ CONTRAST 70491 2037.00 21142 HGCT NECK W/ & W/O CONTRAST 70492 2601.00 21143 HGCT ORB/SELLA/EAR W/O CONT 70480 1870.00 21144 HGCT ORB/SELLA/EAR W/ CONT 70481 2177.00 21146 HGCT PELVIS W/O CONTRAST 72192 1781.00 21147 HGCT PELVIS W/CONTRAST 72193 2203.00 21150 HGCT THORACIC SPINE W/O CONT 72128 1858.00 21151 HGCT THORACIC SPINE W/O CONT 72129 2226.00 21153 HGCT CHEST W/O CONTRAST 71250 1746.00 21154 HGCT CHEST W/ CONTRAST 71260 2226.00 21155 HGCT CHEST W/&W/O CONTRAST 71270 2559.00 21156 HGCT UPPER EXT RT W/O CONT 73200RT 1942.00 21159 HGCT URINARY TRACT FOR STONES 72192 1781.00 21160 HGCTA HEAD 70496 3662.00 21161 HGCTA NECK 70498 3679.00 21162 HGCTA CHEST 71275 2930.00 21163 HGCTA ABDOMEN W/&W/O CONTRAST 74175 2983.00 21165 HGCTA UPPER EXT RT W/&W/O CNT 73206RT 2710.00 21168 HGCTA LOWER EXT LT W/&W/O CNT 73706LT 2938.00 21169 HGCTA RUNOFF ABD AORTA/ILIACS 75635 3385.00 21170 HGCT LOWER EXT LT W/O CONT 73700LT 1838.00 21171 HGCT LOWER EXT LT W/ CONTRAST 73701LT 2297.00 21173 HGCT LOWER EXT BILAT W/O CONT 7370050 2374.00 21174 HGCT UPPER EXT LT W/O CONT 73200LT 1942.00 21179 HGCT HEART W/O DYE W/CALC QUA 75571 250.00 21180 HGCT TEMPORL BONE/IAC W/O DYE 70480 1870.00 21181 HGCT TEMPORAL BONE/IAC W/CONT 70481 2177.00 21182 HGCT TEMP BONE/IAC W/&W/O CON 70482 2499.00 21185 HGCT CHEST W/ CONTRAST FOR PE 71260 2226.00 21186 HGXR WRIST NAVICULAR VIEW RT 73100RT 233.00 21189 HGXR CHILD SURVEY 77076 914.00 21191 HGXR HAND MINIMUM 3 VIEWS LT 73130LT 293.00 21192 HGXR HIP MINIMUM 2 VIEW LT 73502 352.00 21193 HGXR HUMERUS LEFT 73060LT 260.00 21194 HGXR KNEE MINIMUM 4 VIEWS LT 73564LT 382.00 21195 HGXR LOWER LEG LEFT 73590LT 267.00 21196 XR DETECTION EYE FB 70030 346.00 21197 HGXR KNEE AP & LAT LEFT 73560LT 279.00 21198 HGXR RIBS LEFT 71101LT 463.00 21199 HGXR SCAPULA LEFT 73010LT 298.00 21200 HGXR SHOULDER MIN 2 VIEW LT 73030LT 347.00 21201 HGXR TOE 1ST LEFT 73660 206.00 21202 HGXR ROW 2ND LEFT 73660 206.00 21204 HGXR TOE 4TH LEFT 73660 206.00 21205 HGXR TOE 5TH LEFT 73660 206.00 21206 HGXR TOE 2ND RIGHT 73660 206.00 21207 HGXR TOE 3RD RIGHT 73660 206.00 21208 HGXR TOE 4TH RIGHT 73660 206.00 21209 HGXR TOE 5TH RIGHT 73660 206.00 21210 HGXR WRIST MINIMUM 3 VIEWS LT 73110LT 293.00 21211 HGXR WRIST NAVICULAR VIEW LEFT 73100LT 233.00 21212 HGXR ANKLE MINIMUM 3 VIEWS LT 73610LT 293.00 21213 HGXR CLAVICLE LEFT 73000LT 290.00 21215 HGXR ELBOW MINIMUM 3 VIEWS LT 73080LT 285.00 21216 HGXR FINGER MIN 2 VWS 1ST LFT 73140 208.00 21217 HGXR FINGER MIN 2 VWS 2ND LFT 73140 208.00 21218 HGXR FINGER MIN 2 VWS 3RD LFT 73140 208.00 21219 HGXR FINGER MIN 2 VWS 4TH LFT 73140 208.00 21220 HGXR FINGER MIN 2 VWS 5TH LFT 73140 208.00 21221 HGXR FINGER MIN 2 VWS 2ND RT 73140 208.00 21222 HGXR FINGER 3RD RIGHT 73140 208.00 21223 GXR FINGER MIN 2 VWS 4TH RT 73140 208.00 21224 HGXR FINGER MIN 2 VWS 5TH RT 73140 208.00 21225 HGXR FEMUR LEFT 73551 427.00 21226 HGXR FOREARM LEFT 73090LT 260.00 21227 HGXR FOOT MINIMUM 3 VIEWS LT 73630LT 275.00 21228 HGXR HEEL (OSCALSIS) LEFT 73650LT 276.00 21229 HGXR CHILD FB NOSE TO RECTUM 73010 249.00 21231 HGXR FOOT 2 VIEWS LEFT 73620LT 220.00 21232 HGXR FOOT 2 VIEWS RIGHT 73620RT 220.00 21233 HGXR ANKLE 2 VIEWS LEFT 73600LT 224.00 21234 HGXR ANKLE 2 VIEWS RIGHT 73600RT 224.00 21235 HGXR LOWER EXT INFANT LEFT 73592LT 310.00 21236 HGXR LOWER EXT INFANT RIGHT 73592RT 310.00 21237 HGXR HIPS & PELVIS INFANT 73522 670.00 21238 HGXR HIP 1 VIEW, LEFT 73501LT 325.00 21240 HGXR HAND 2 VIEW LEFT 73120LT 267.00 21241 HGXR HAND 2 VIEW RIGHT 73120RT 267.00 21242 HGXR WRIST 2 VIEW LEFT 73100LT 257.00 21243 HGXR WRIST 2 VIEW RIGHT 73100RT 257.00 21244 HGXR UPPER EXT INFANT LEFT 73092LT 263.00 21245 HGXR UPPER EXT INFANT RIGHT 73092RT 263.00 21246 HGXR ELBOW 2 VIEW LEFT 73070LT 257.00 21247 HGXR ELBOW 2 VIEW RIGHT 73070RT 257.00 21248 HGXR SHOULDER 1 VIEW LEFT 73020LT 232.00 21249 HGXR SHOULDER 1 VIEW RIGHT 73020RT 232.00 21250 HGXR SPINE LUMBAR W/ FLEX/EXT 72114 884.00 21251 HGXR SPINE LUMB FLEX/EXT ONLY 72120 328.00 21252 HGXR SPINE CERV FLEX/EXT/OBL 72052 672.00 21253 HGXR SPINE THORACIC 1 VIEW 72020 249.20 21254 HGXR SCOLIOSIS SURVEY 72082 515.00 21255 HGXR KNEE BILAT AP STANDING 73565 353.00 21256 HGXR ABDOMEN 1 VIEW 74018 342.00 21257 HGXR ABDOMEN 2 VIEWS 74019 557.00 21258 HGXR ABDOMEN 3 VIEWS 74021 572.00 21259 HGXR AC JOINTS 73050 384.00 21260 HGXR ANKLE MINIMUM 3 VIEWS RT 73610RT 293.00 21261 HGXR BONE AGE 77072 236.00 21262 HGXR BONE SURVEY 77075 914.00 21263 HGXR SPINE CERV MIN 4 VIEWS 72050 478.00 21265 HGXR CHEST FRONTAL SINGL VIEW 71045 311.00 21266 HGXR CHEST 2 VIEWS PA & LAT 71046 342.00 21267 HGXR CLAVICLE RIGHT 73000RT 290.00 21270 HGXR CHEST LORDOTIC 71045 311.00 21271 HGXR KNEE AP & LAT RIGHT 73560RT 279.00 21273 HGXR SPINE THORACIC 3 VIEWS 72072 448.00 21274 HGXR ELBOW MINIMUM 3 VIEWS RT 73080RT 285.00 21275 HGXR RIBS BILATERAL 71111 745.00 21276 HGXR FACIAL BONES 70150 484.00 21277 HGXR FEMUR RIGHT 73551 427.00 21279 HGXR FINGER MIN 2 VWS 1ST RT 73140 208.00 21280 HGXR CERV SPINE 2-3 VIEWS 72040 337.00 21281 HGXR FOOT MINIMUM 3 VIEWS RT 73630RT 275.00 21282 HGXR FOREARM RIGHT 73090RT 260.00 21284 HGXR HAND MINIMUM 3 VIEW RT 73130RT 293.00 21285 HGXR HIP MINIMUM 2 VIEWS RT 73502 352.00 21286 HGXR HUMERUS RIGHT 73060RT 260.00 21287 HGXR KIDNEYS URETER BLADDER 74018 342.00 21288 HGXR KNEE MINIMUM 4 VIEW RT 73564RT 382.00 21289 HGXR LOWER LEG RIGHT 73590RT 267.00 21290 HGXR SPINE LUMBAR MIN 4 VIEWS 72110 493.00 21292 HGXR MANDIBLE 70110 484.00 21294 HGXR NASOPHARYNX 2 VIEWS 70360 248.00 21295 HGXR NASAL BONES 70160 267.00 21296 HGXR ORBIT 70200 422.00 21297 HGXR HEEL (OSCALSIS) RIGHT 73650RT 276.00 21298 HGXR PELVIS 72170 310.00 21299 HGXR RIBS RIGHT 71101RT 463.00 21300 HGXR SACROILIAC JOINTS 72202 343.00 21301 HGXR SACRUM AND COCCYX 72220 340.00 21302 HGXR SCAPULA RIGHT 73010RT 298.00 21303 HGXR SHOULDER MIN 2 VIEWS RT 73030RT 347.00 21304 HGXR SINUSES MINIMUM 3 VIEWS 70220 508.00 21305 HGXR SKULL 70260 444.00 21307 HGXR STERNUM MINIMUM 2 VIEWS 71120 284.00 21309 HGXR TOE 1ST RIGHT 73660 206.00 21310 HGXR WRIST MINIMUM 3 VIEWS RT 73110RT 293.00 21311 HGXR FEMUR BILATERAL 73552 642.00 21312 HGXR KNEE BILATERAL 7356450 573.00 21313 HGXR LOWER LEG BILATERAL 7359050 468.00 21314 HGXR LOWER EXT INFANT BILAT 7359250 468.00 21315 HGXR ANKLE BILATERAL 7361050 445.00 21316 HGXR FOOT BILATERAL 7363050 482.00 21317 HGXR HEEL (OSCALSIS) BILAT 7365050 414.00 21319 HGXR SHOULDER BILATERAL 7303050 625.00 21321 HGXR ELBOW BILATERAL 7308050 445.00 21322 HGXR FOREARM BILATERAL 7309050 439.00 21323 HGXR WRIST BILATERAL 7311050 447.00 21324 HGXR HAND BILATERAL 7313050 514.00 21325 HGXR HIP BIL 3-4 VIEWS 73522 670.00 21326 HGXR SPINE LUMBNAR AP/LAT 72100 328.00 21328 HGXR CHEST LATERAL 71046 342.00 21329 ECG TRACING ONLY 93005 185.00 21330 HGUS NON-OB PELVIS 76856 853.00 21331 HGUS VENOUS DOPP/DUPLX UP RT 93971RT 1239.00 21333 HGUS ABDOMINAL COMPLETE 76700 1076.00 21334 HGUS ABD BCK WALL LTD ABD AOR 76775 798.00 21335 HGUS EXAM CHEST 76604 804.00 21337 HGUS THYROID 76536 786.00 21338 HGUS CAROTID DUPLEX 93880 1345.00 21339 HGUS PELVIS NON-OB TRANSVAG 76830 708.00 21340 HGUS ABD BACK WALL LTD KIDNEY 76775 798.00 21343 HGUS SCROTUM AND CONTENTS 76870 674.00 21345 HGUS EXAM PELVIC LTD BLADDER 76857 853.00 21346 HGUS OB EVAL < 14WKS EA ADDL 76802 430.00 21347 HGUS OB F/U RE-EVAL SINGLE 76816 695.00 21349 HGUS OB TRANSVAGINAL 76817 613.00 21354 HGUS VENOUS DOPP/DUPLX LWR LT 93971LT 1239.00 21355 HGUS VENOUS DUPP/DUPLX LWR RT 93971RT 1239.00 21356 HGUS VENOUS DOPP/DUPLX UP LT 93971LT 1239.00 21357 HGUS VENOUS DUPLEX LWR BILAT 93970 1521.00 21358 HGUS VENOUS DUPLEX UP BILAT 93970 1521.00 21359 HGUS TRANSPLANTED KIDNEY 76776 834.00 21361 HGUS OB EVAL <14 WK SNG FETUS 76801 774.00 21362 HGUS OB EVAL =OR>14 WKS SINGL 76805 857.00 21365 HGUS OB LIMITED QUICKLOOK 76815 603.00 21367 HGUS VENOUS DUPL UPR/LWR BIL 9397059 2281.00 21368 HGUS SOFT TISS HEAD &/OR NECK 76536 786.00 21369 HGUS ABDOMINAL LIMITED 76705 876.00 21370 HGUS ABD BCK WALL LTD KID/BLD 76770 912.00 21373 HGUS EXAM AAA SCREENING 76706 687.00 21375 HGUS EXT NON-VASC LMT LWR RT 76882RT 699.00 21376 HGUS EXT NON-VASC LMT UPPR LT 76882LT 699.00 21377 HGUS EXT NON-VASC LMT LWR LT 76882LT 699.00 21378 HGUS EXT NON-VASC LMT UPPR RT 76882RT 699.00 21379 HGCT ABD & PELVIS W/O CONTRST 74176 3527.00 21380 HGCT ABD & PELVIS W/CONTRAST 74177 4387.00 21381 HGCT ABD/PELVIS W&W/O CONTRST 74178 5177.00 21382 HGCTA ABD/PELVIS W&W/O CNTRST 74174 5810.00 21383 HGMRI LE JOINT W/O CONT BILAT 7372150 3516.00 21386 HGUS VASC FLOW ORGANS COMPLETE 93975 2036.00 21387 HGUS BREAST LTD LEFT 76642LT 576.00 21388 HGUS BREAST LTD RIGHT 76642RT 576.00 21392 HGUS DUP LOWER EXT ART BILAT 93925 1655.00 21393 HGUS DUP LOWER EXT ART RIGHT 93926RT 1318.00 21394 HGUS LOWER EXT ART LEFT 93926LT 1318.00 22000 HGLAB BASIC METABOLIC PANEL 80048 195.00 22001 HGLAB ELECTROLYTE PROFILE 80051 259.00 22002 HGLAB COMP METABOLIC PANEL 80053 458.00 22003 HGLAB URINALYSIS W/MICRO 81001 75.00 22004 HG LAB HCG URINE 81025 114.00 22005 HGLAB KETONE 82009 82.00 22007 HGLAB ETOH LEVEL 80320 83.00 22008 HGLAB AMYLASE 82150 147.00 22009 HGLAB TOTAL BILIRUBIN 82247 123.00 22012 HGLAB CALCIUM 82310 129.00 22013 HGLAB CALCIUM IONIZED 82330 226.00 22014 HGLAB CARBON MONOXIDE 82375 234.00 22017 HGLAB CREATINE PHOSPHOKINASE 82550 86.00 22019 HGLAB CREATININE SERUM 82565 109.00 22022 HGLAB GLUCOSE BLOOD 82947 79.00 22023 HGLAB SPINAL FLUID SUGAR 82945 79.00 22024 HGLAB LIPASE 83690 105.00 22025 HGLAB MYOGLOBIN SERUM 83874 86.00 22026 HGLAB PHOSPHATASE ALKALINE 84075 173.00 22027 HGLAB POTASSIUM 84132 98.00 22031 HGLAB QUANTITATIVE TROPONIN 84484 86.00 22032 HGLAB UREA NITROGEN 84520 104.00 22033 HGLAB HCG SERUM QUALITATIVE 84703 54.00 22035 HGLAB CBC WITH DIFFERENTIAL 85025 83.00 22037 HGLAB MONO SPOT TEST 86308 101.00 22039 HGLAB HIV RAPID SCREEN OB 86703 170.00 22041 HGLAB WET MOUNT 87210 39.00 22042 HGLAB RSV 87420 306.00 22043 HGLAB DIRECT STREP TESTING 87880 166.00 22048 HGLAB PROTHROMBIN TIME 85610 77.00 22049 HGLAB URINALYSIS ROUTINE 81003 55.00 22050 HGLAB PRIORITY LAB SERVICES S3600 72.00 22051 HGLAB CBC WITHOUT DIFF 85027 83.00 22052 HGLAB HGB 85018 38.00 22053 HGLAB HCT 85014 38.00 22054 HBLAB CSF CELL COUNT 89051 88.00 22055 HGLAB HCG, BETA, SERUM 84702 236.00 22056 HGLAB BNP TRIAGE 83880 242.00 22057 HGLAB HEPATIC FUNCTION PANEL 80076 256.00 22058 HGLAB MAGNESIUM 83735 111.00 22059 HGLAB D-DIMER 85379 251.00 22061 HGLAB PHLEBOTOMY COLLECTION 36415 17.00 22062 HGLAB SED RATE WESTERGREN 85651 138.00 22063 HGLAB BILIRUBIN DIRECT 82248 91.00 22064 HGUS VASC FLOW MAJOR VES CMPLT 93978 1299.00 22068 HGCT BONE LENGTH SCANOGRAM 77073 393.00 22070 HGUS OB ER LIMITED >14WKS 76815 603.00 22071 LAB FLU A & B AMP PROBE 87502 261.00 22072 HGMRI GADOBUTROL INJ 0.1ML CON A9585 3.00 22075 HGXR ENTIRE SPINE 2-3 VIEWS 72082 515.00 22082 HGLAB KETONE BODY B-HB QUANT 82010 46.00 22083 HGLAB GROUP A STREP DNA AMPLIF 87651 170.00 22084 HGLAB LACTIC ACID 83605 187.00 22085 HGLAB CRP INFLAMMATORY 86140 101.00 22086 HGLAB PHOSPHOROUS 84100 120.00 23013 CONT IO NEURO OR EA 15 MIN 95940 229.00 26022 WIRE COIL C1713 95.00 26023 PIN KNOWLES/SECURING NEURO C1713 369.20 26051 TUBE VENT COHON 164.10 26052 CATH ADHERENT CLOT C1757 1739.30 26058 TUBE ENDOTRACH EMG 1415.50 26059 ELECTRODE EMG NEEDLE 467.30 26062 PACK NEURO MAJOR 3573.20 26063 PACK NEURO MINOR 1961.20 26065 STAPLER REFILL CONTOUR 1029.60 26074 BLADE KARLIN SPINAL 257.40 26078 TUBE MIC GASTROTROSTOMY FEED 354.20 26079 CATH DUO FLOW VAS C1751 1057.30 26083 BLADE BONESCALPEL 1812.10 26084 STOCKINETTE LGE 79.80 26089 DRAIN ROUND 7MM 85.20 26090 HALTER HEAD 54.80 26093 DISSECTION TOOL MIDAS REX 769.10 26099 BLADE STRYKER 483.40 26100 BALLOON/PROBE ENDO 1441.60 26102 CATCH POUCH ENDO 556.50 26103 CLOSE ENDO 325.10 26105 LENS ALCON V2632 1729.90 26119 VAPORTRODE 1350.50 26124 ASPIRATOR TUBING 121.70 26134 STAPLES ENDO TACKER 2508.20 26141 BLANKET BAIR HUGGER 187.30 26142 DEBRIDER XPS CUTTER 683.20 26143 SCOPE CONN ENDO 298.70 26144 TUBING XPS XOMED 137.20 26146 PLATE,BONE C1713 686.30 26149 BONE SCREW 381.50 26153 CELL SAVER AUTO TRANSFUSION 86891 3999.30 26154 FRAME KIT POSITIONING 323.90 26167 MESH COMPOSIX/SURGISIS/FLEXHD C1781 6480.50 26168 SEPRAFILM C1765 850.90 26169 MESH V C-QUR C1781 1479.50 26170 MESH SEPRA/VENTRIO/XENFORM C1781 4065.50 26171 RETRACTOR/PROTRACTOR 369.30 26173 SUTURE ASSIST 789.00 26175 LAP DISC HAND ACCESS 4301.70 26176 SUTURE FOR SUTURE ASSIST 149.40 26177 ARM STRAPS FOR WRIST TOWER 224.20 26178 FINGER TRAP FOR WRIST TOWER 179.00 26181 MICROVASC ANASTOMOTIC COUPLER 901.10 26182 OTOLOGIC GRAFT 2.5X2.5 C1763 726.75 27999RONC RESPIRATORY MOTION MGMT SIMUL 77293 3074.10 28003RONC CONE BEAM CT 77014 1436.00 28004RONC SIMULATION SIMPLE 77280 1106.90 28006RONC SIMULATION COMPLEX 77290 2777.00 28007RONC 3D TREATMENT PLAN 77295 7722.70 28008RONC BASIC DOSIMETRY CALC PER FIELD 77300 552.30 28010RONC TELETHERAPY ISODOSE PLAN SIMPL 77305 583.00 28012RONC TELETHERAPY ISODOSE PLAN COMPL 77307 2525.00 28017RONC SPEC DOSIMETRY RX BY PHYSICIAN 77331 737.90 28018RONC TREATMENT DEVICES SIMPLE3 77332 1053.90 28020RONC IMMOBILIZATION DEVICE COMPLEX 77334 1019.10 28021RONC TREATMENT DEVICE COMPLEX 77334 1019.10 28022RONC CONTINUING PHYSICS CONSULT 77336 552.30 28024RONC SPEC RAD PHYSICS CONSULT 77370 932.50 28025RONC RAD TX DELIVERY SINGLE 6-10MeV 77403 706.00 28031RONC RAD TX DEL 3 OR> AREAS 6-10MeV 77412 1756.00 28034RONC THERAPEUTIC RAD PRT FILMS 77417 175.60 28036RONC STEREOSCOPIC XRAY GUIDANCE 77387 1436.00 28037RONC SPECIAL TREATMENT PROCEDURE 77470 3074.10 28051RONC SRS FRACTIONATED TX DELIVERY 77373 5969.20 28053RONC LOW OSMOLAR CONT 300-349 MG/ML 2.30 28078RONC IMRT TX DELIVERY SIMPLE 77385 4539.00 28079RONC IMRT TX DELIVERY COMPLEX 77386 5572.00 29005 NM MUGA 1ST PASS ADD-ON 78496 1543.00 29012 NM CARDIAC SPECT STRESS STUDY 78451 2297.00 29023 NM PARATHYROID SCAN RVU 180 78070 1739.00 29024 NM GASTRIC EMPTYING RVU 75 78264 1996.00 29031 NM WHOL BODY SCAN I131 RVU204 78802 1796.00 29034 NM GALLIUM 67 PER MCI A9556 70.00 29035 NM I-123 SOD IODIDE/100 UCI A9516 323.00 29036 NM INDIUM IN 111 WBC DOSE A9570 2945.00 29040 NM CHOLECTEC 3 82952 105.00 43227 LAB LACTIC ACID 83605 187.00 43230 LAB IRON SERUM TOTAL 83540 154.00 43231 LAB IRON BINDING CAPACITY 83550 186.00 43235 LAB LIPASE 83690 105.00 43236 LAB MAGNESIUM 83735 111.00 43238 LAB OSMOLALITY 83930 145.00 43240 LAB PHOSPHATASE ALKALINE 84075 173.00 43241 LAB PHOSPHORUS 84100 120.00 43242 LAB SERUM POTASSIUM 84132 98.00 43246 LAB ARTERIAL BLOOD GASES 82805 273.00 43247 LAB SALICYLATE 80329 248.00 43249 LAB SODIUM, SERUM 84295 103.00 43250 LAB CARBON MONOXIDE 82375 234.00 43251 LAB GLUCOSE BLOOD 82947 79.00 43254 LAB SPINAL FLUID SUGAR 82947 79.00 43256 LAB SPINAL FLUID PROTEIN 84157 104.00 43261 LAB TRANSAMINASE SGO 84450 127.00 43262 LAB GAMMA-GLUTAMYL TRANSPETID 82977 141.00 43263 LAB TRANSAMINASE SGP 84460 145.00 43264 LAB CREATININE CLEARANCE 82575 203.00 43265 LAB UREA NITROGEN 84520 104.00 43266 LAB URIC ACID 84550 108.00 43267 LAB TRIGLYCERIDES 84478 163.00 43268 LAB BILIRUBIN DIRECT 82248 91.00 43269 LAB LACTIC DEHYDROGENASE 83615 152.00 43271 LAB ACETAMINOPHEN 80329 207.00 43274 LAB CKMB CREATININE KINASE 82553 86.00 43275 LAB GLUCOSE PC SUGAR 82950 127.00 43276 LAB URINE URIC ACID 84560 129.00 43277 LAB URINE UREA NITROGEN-24 HR 84540 123.00 43280 LAB QUANTITATIVE TROPONIN 84484 86.00 43281 LAB SODIUM (URINE) 84300 138.00 43282 LAB POTASSIUM (URINE) 84133 122.00 43284 LAB CREATINE PHOSPHOKINASE 82550 86.00 43291 LAB ELECTROLYTE PROFILE 80051 259.00 43303 LAB ASO TITRE 86060 166.00 43304 LAB ASO SCREENING 86063 115.00 43307 LAB CRP INFLAMMATORY 86140 101.00 43309 LAB RAPID FLU TEST 87804 66.00 43315 LAB RPR TITER 86593 113.00 43319 LAB RPR 86592 64.00 43321 LAB URINE ORGANSM IDENTIFICATN 87077 97.00 43324 LAB MONO SPOT TEST 86308 101.00 43329 LAB RHEUMATOID ARTHRITIS 86430 104.00 43332 LAB ROTAVIRUS 86759 151.00 43346 LAB H. INFUL, URINE 86403 106.00 43350 LAB DRUG SCREEN, SERUM 80307 332.00 43351 LAB DRUG SCREEN, URINE 80307 397.00 43356 LAB CARBAMAZEPINE 80156 207.00 43358 LAB GENTAMICIN 80170 343.00 43360 LAB PHENOBARBITAL 80184 159.00 43361 LAB PHENYTOIN (DILANTIN) 80185 159.00 43366 LAB THEOPHYLLINE 80198 172.00 43370 LAB TOBRAMYCIN 80200 391.00 43401 LAB BLOOD CULTURE 87040 154.00 43403 LAB NOSE/THROAT CULTURE 87070 165.00 43404 LAB CULTURE FUNGUS 87102 210.00 43405 LAB SPUTUM ROUTINE CULTURE 87070 165.00 43406 BACTERIAL CULTURE-OTHR SOURCE 87070 165.00 43407 LAB FECES ROUTINE CULTURE 87045 194.00 43408 LAB CULTURE MISCELLANEOUS 87070 165.00 43409 LAB URINE CULTURE 87088 105.00 43411 LAB ANAEROBIC CULTURE 87075 167.00 43412 LAB BRONCH CULTURE 87070 165.00 43420 LAB SMEAR GRAM STAIN 87205 78.00 43422 LAB KOH PREP 87220 84.00 43426 LAB WET MOUNT 87210 39.00 43441 LAB AGGLUTINATION TESTING 87077 97.00 43442 LAB ORGANISM IDENTIFICATION 87077 97.00 43443 LAB GC SCREEN 87081 104.00 43445 LAB DIRECT STREP TESTING 87880 166.00 43452 soALLERGEN SPECIFIC IgE 86003 25.00 43480 LAB GI PANEL MOLECULAR 87507 1276.00 43501 LAB URINALYSIS ROUTINE 81003 55.00 43508 LAB PH, URINE/STOOL 83986 39.00 43603 BLOOD P.C./W.B. PROCESSING P9021 185.00 43604 BLOOD TYPING ABO CORD 86900 106.00 43607 BLOOD COMPATIBILITY I.S. 86920 186.00 43609 BLOOD TRANSFUSION ADMIN 36430 938.00 43610 BLOOD COOMBS DIRECT 86880 40.00 43611 BLOOD ANTIGEN TYPING 86905 216.00 43612 BLOOD ANTIBODY TITER 86886 259.00 43615 BLOOD FETAL SCREEN 85461 84.00 43616 BLOOD KLEIHAUER BETKE 85460 338.00 43617 BLOOD FRESH FROZEN PLASMA PROC P9017 55.00 43618 BLOOD ANTI.SCREEN.-IND COOMBS 86850 133.00 43619 BLOOD ANTIBODY IDENTIFICATION 86870 284.00 43626 BLOOD RHO IG J2790 354.30 43628 COOMBS TEST INDIRECT QUAL 86885 141.00 43629 BLOOD DEGLYC RED CELLS PROCESS P9039 665.00 43635 BLOOD PLT PHER LEUK RED IRAD P9037 565.00 43637 THERAPEUTIC APHERESIS FILTER 467.30 43640 BLOOD PACKED CELLS IRAD P9038 235.00 43642 BLOOD PLAT PHER LEUK RED P9035 515.00 43643 BLOOD PC LEUKO RED PROC P9016 206.00 43646 BLOOD TYPING; ABO 86900 106.00 43647 BLOOD TYPING; RH D 86901 44.00 43650 COOMBS DIRECT 86880 40.00 43651 BLOOD, COOMBS DIRECT C3 86880 40.00 43656 RBC, LR, IRRADIATED, EA UNIT P9040 256.00 43670 BLOOD CMV ANTIGEN TESTING 86644 70.00 43674 BLOOD CRYOPRECIP POOLED PROC P9012 420.00 43812 LAB HCG, URINE 81025 114.00 43905 LAB C.DIFFICILE STOOL 87324 301.00 43906 LAB STOOL FOR FAT 82705 81.00 43909 LAB OCCULT BLOOD 82274 87.00 43931 LAB OCCULT BLOOD GAST FLUID 82271 92.00 43942 LAB IGG TOTAL 82784 540.00 43944 LAB BLOOD GAS CORD VENOUS 82805 273.00 43958 LAB OSMOLALITY URINE 83935 146.00 43962 LAB WHITE BLOOD CELL 85048 34.00 43986 LAB BORDETLLA PERTUS ABS IGA 86615 154.00 43987 LAB BORDETLLA PERTUS ABS IGG 86615 154.00 45000 PERM PACER SYS INSERT A & V 9748.00 45001 PERM PACER SYS INSERT VENTRIC 9748.00 45002 PERM PACER SYS INSERT ATRIAL 9748.00 45003 REPOSITION PACER/AICD ELECT 3958.00 45006 REMOVAL EVENT RECORDER 3530.00 45007 IMPLANT EVENT RECORDER 7371.00 45010 AICD SYSTEM INSERT 6045.00 45011 ECHO DOPPLER COLOR FLOW 93325 456.00 45021 ANGIO PULMONARY RT 75741RT 2536.00 45028 REMOVL AICD LEAD TRNSVNS 33244 3534.00 45029 REMOVAL AICD GENERATOR SUBQ 3534.00 45032 COAG TIME ACTIVATED 85347 134.00 45033 S&I US GUIDE/PERICARDIOCENTES 76930 620.00 45036 CATH INTRO MAIN PULM ARTERY 36013 2207.00 45055 US GUIDE VASC ACCESS 76937 431.00 45056 ECHO 2D WO DPLR COMP 93307 1146.00 45059 MOD SED SAME ADDL 15 MIN 99153 109.00 45064 SINUS OR JUGLAR CATH VENOGRAM 75860 6912.00 45065 RADIOPHARM THERPY INTRA-ARTERY 79445 612.50 45066 PERCUTANEOUS PORTAL VEIN CATH 36481 2143.20 47000 NUC STRESS TEST TRACING ONLY 93017 819.00 47001 NMCV MYOCARD PERF IMG-MULTI\ 78452 5657.00 47008 NMCV CARD SPECT REST STUDY 78451 2297.00 48002 ECG TRACING ONLY 93005 185.00 48004 ECHO 2D F/U/LMTD 93308 809.00 48006 ECHO 2D W/DPLR COMP COMBO 93306 2026.00 48007 EXT ECG UP TO 48 HR W/REC 93225 244.00 48008 EXT ECG UP TO 48HRS W/ANALYSIS 93226 1069.00 48009 REMOTE PT 30 DAY ECG REV/REPRT 93270 149.00 48024 TILT TABLE EVAL 93660 1187.00 48025 STRESS TEST TRACNG ONLY 93017 819.00 48028 STRESS ECHO 2D 93351 1943.00 48029 DOBUTAMINE STRESS ECHO 2D 93351 1943.00 48042 PROTHROMBIN TIME 85610 77.00 48044 EXT VENOGRAM INJ 36005 351.00 48045 IC ECHO DURING TX/DX INIT 93662 3189.00 48046 IC EP 3D MAPPING 93613 4357.00 48048 MAPPING CATHETER C1732 2499.90 48049 TRANSCATHETER BIOPSY 75970 2735.00 48050 EMBOLIZATION PROTECTIVE SYS C1884 4372.90 48051 EP STEERABLE GUIDING INTRODCR C1766 580.80 48053 GUIDE DRNG PERC DRNG W/CATH 75989 1781.00 48055 IV DOPPLER FLOW INITIAL 93571 3992.00 48056 IV DOPPLER FLOW EA ADDL 93572 2492.00 48059 ART CATH SMPL/MONITOR/TRNSFUS 36620 888.00 48065 REPLACE TUNNELLED CV CATH 3556.00 48066 REPLACE NON-TUNNELED CV CATH 2391.00 48067 ECG TRACING ONLY PEDS 93005 185.00 48069 PULM REHAB W/EXERCISE/HR G0424 160.00 48070 REPLACE DUOD/JEJUN TUBE PERC 1404.00 48072 INJ FOR LYMPHANGIOGRAPHY 38790 1119.00 48076 I&D HEMATOMA 2238.00 48078 REMOVE LUNG CATH W CUFF 32552 613.00 48079 INSERT LUNG CATH W CUFF 32550 6684.00 48082 ABD PARACENTESIS W/IMAGING 1736.00 48083 THORACENTESIS W/IMAGING 1736.00 48084 INSERT SUBQ DEFIB W/ELTRD 33270 40827.00 48087 EXT ECG RECORDING 72 HR 0296T 106.00 48088 EXT ECG SCAN W/ANALYSIS 72-HR 0297T 891.00 49000 PLACE CATH THORACIC AORTA 36221 4985.00 49001 PLACE CATH CAROTID/INOM ART 36222 5517.00 49003 SEL CATH INT CAROTID ART 36224 5356.00 49006 LD PERC CARDIAC ANGIOPL 1 ART 92920LD 12137.00 49008 LD PERC CARD STNT W/ANG 1 VSL 92928LD 14729.00 49009 LD PERC CARD STENT/ATH/ANGIO 92933LD 16021.00 49010 REVASC BP GRAFT SNGL 92937 12137.00 49011 LD PERC CARD REVASC MI 1 VSL 92941LD 8837.00 49012 LD PERC CARD REVASC CHR 1 VSL 92943LD 14729.00 49013 EP & ABLATE VENTRIC TACHY 93654 18517.00 49014 IC CATH ABLATE ARRTHY ADD-ON 93655 16550.00 49015 TX ATRIAL FIB PULM VEIN ISOL 93656 18517.00 49016 ABLATE LT/RT ATRIAL FIB ADDL 93657 8827.00 49017 PTCA ADDL 92921 12137.00 49019 PLCMT STENT IC ADDL 92929 12137.00 49022 REVASC CHRONIC OCCL ADDL 92944 11783.00 49023 EP & ABLATE SUPRAVENT ARRHYTH 93653 18517.00 49024 LD PERC DRUG-EL COR STENT SNG C9600LD 12137.00 49025 PLCMT RX STENT IC ADDL C9601 12137.00 49026 LD PERC DRUG-EL COR STENT ATH C9602LD 16021.00 49028 REVASC GRFT W/RX STENT SNGL C9604 12137.00 49030 LD PERC D-E COR REVASC AMI S C9606LD 16021.00 49031 LD PERC D-E COR REVSC CHR SNG C9607LD 16021.00 49106 LC PERC CARD ANGIOPLAST 1 ART 92920LC 12137.00 49108 LC PERC CARD STENT W/ANG 1 VS 92928LC 14729.00 49109 LC PERC CARD STENT/ATH/ANGIO 92933LC 16021.00 49111 LC PERC CARD REVASC MI 1 VSL 92941LC 8837.00 49112 LC PERC CARD REVASC CHR 1 VSL 92943LC 14729.00 49124 LC PERC D-E COR STENT SINGLE C9600LC 12137.00 49130 LC PERC D-E COR REVASC AMI S C9606LC 16021.00 49133 PLC CATH CAROTID/INOM ART BIL 3622250 8275.00 49134 PLC CATH CAROTID/INOM ART BIL 3622350 8034.00 49135 SEL CATH INT CAR ART BIL 3622450 8275.00 49140 ANGIOGRAPHY ADRENAL UNILATERAL 75731 10943.00 49206 RC PERC CARD ANGIOPLAST 1 ART 92920RC 12137.00 49208 RC PERC CARD STENT W/ANG 1 VS 92928RC 14729.00 49211 RC PERC CARD REVASC MI 1 VSL 92941RC 8837.00 49212 RC PERC CARD REVASC CHR 1 VSL 92943RC 14729.00 49224 RC PERC D-E COR STENT SINGLE C9600RC 12137.00 49226 RC PERC D-E COR STENT ATHER S C9602RC 16021.00 49230 RC PERC D-E COR REVASC AMI S C9606RC 16021.00 49231 RC PERC D-E COR REVASC CHR S C9607RC 16021.00 49306 LM PERC CARD ANGIOPLAST 1 ART 92920LM 12137.00 49309 LM PERC CARD STENT/ATH/ANGIO 92933LM 16021.00 49311 LM PERC CARD REVASC MI 1 VSL 92941LM 8837.00 49324 LM PERC D-E COR STENT SINGLE C9600LM 12137.00 49330 LM PERC D-E COR REVASC AMI S C9606LM 16021.00 49408 RI PERC CARD STENT W/ANG 1 VS 92928RI 14729.00 49424 RI PERC D-E COR STENT SINGLE C9600RI 12137.00 49433 TRANSCATH VEIN INF INITIAL 37212 2493.00 49434 TRANSCATH ART/VEN INF CESSJ 37214 3972.00 49439 INS PERC DIALYSIS CATH W/IMAG 49418 6153.00 49440 THROMBOLYSIS CONT TX SUBSEQ 37213 3770.00 49442 INSERT PICC CATH 5 YRS/> 2142.00 49443 UNLISTED PROC ABD PERITONEUM 3955.00 49448 ABLATE BONE TUMOR(S) PERQ 9833.00 49450 A/V FISTULAGRAM 36901 1849.00 49451 A/V FISTULAGRAM & ANGIOPLASTY 36902 12688.00 49452 A/V FISTULAGRAM & STENT 36903 25642.00 49453 A/V FISTULAGRAM & THROMBECTOMY 36904 12688.00 49454 A/V FISTULAGRAM THROMBEC & PTA 36905 25642.00 49455 A/V FISTULAGRAM THROMB & STENT 36906 38870.00 49456 PTA RENAL OR VISCERAL ARTERY 37246 10170.00 49457 PTA RENAL OR VISCERAL ART ADDL 37247 5255.00 49458 PTA VENOUS 37248 5085.00 49459 PTA VENOUS ADDL VEIN 37249 4240.00 50001 OPM PT GAIT TRAINING 15 MIN 97110GP 124.00 50003 OPM PT EXERCISE EA 15 MIN 97110GP 145.00 50014 OPM PT ELECT STIM UNATTENDED 97014GP 76.00 50028 OPM PT IONTOPHORESIS 15 MIN 97110GP 124.00 50030 OPM PT ULTRASOUND EA 15 MIN 97110GP 64.00 50031 OPM PT EMS ATTENDED EA 15 MIN 97110GP 83.00 50038 OPM PT THERAP MASSAGE 15 MIN 97110GP 116.00 50055 OPM PT TRACTION MECHANICAL 97110GP 74.00 50056 OPM OT MANUAL THERAPY 15 MIN 97110GO 132.00 50057 OPM OT MASSAGE EA 15 MIN 97110GO 116.00 50061 OPM OT NEUROMUSC RE-ED EA 15MN 97110GO 149.00 50066 OPM OT THERAP ACTIVTY 15 MIN 97530GO 149.00 50070 OPM PT VASOPNEUMATIC DEVICE 97110GP 87.00 50075 OPM SPCH APHASIA ASSESS 1 HR 96105GN 455.00 50079 OPM PT MANUAL THERAPY 15 MIN 97140GP 132.00 50084 OPM PT NEUROMUSC RE-ED 15 MIN 97110GP 149.00 50086 OPM PT PHY PERF TEST 15 MIN 97750GP 149.00 50103 CARDIAC REHAB W/CONT ECG 93798 161.00 50109 OPM OT WHIRLPOOL/FLUIDOTHER 97110GO 91.00 50112 OPM OT EXERCISE EA 15 MIN 97110GO 145.00 50158 OPM OT ULTRASOUND EA 15 MIN 97110GO 64.00 50162 IPM OT COG SKILLS DEV NON MC 97127GO 354.00 50164 RHB OT COG SKILLS DEV NON MC 97127GO 354.00 50177 IPM PT ORTHOTIC TRAIN 15 MIN 97763GP 155.00 50179 OPM PT ORTHOTIC TRAIN 15 MIN 97763GP 155.00 50187 RHB PT ORTHOTIC TRAIN 15 MIN 97763GP 155.00 50192 IPM OT COG SKILLS DEV 15 MIN G0515GO 98.00 50194 RHB OT COG SKILLS DEV 15 MIN G0515GO 98.00 50201 OPM PT THERAP ACTIVITY 15 MN 97530GP 149.00 50245 OPM OT IONTOPHORESIS 15 MIN 97110GO 124.00 50259 OPM PT RE-EVALUATION 97164GP 265.00 50271 OPM OT RE-EVAL EST POC 97168GO 103.00 50273 OPM OT PARAFFIN BATH 97110GO 64.00 50300 RHB PT GAIT TRAINING EA 15 MN 97116GP 124.00 50301 RHB PT THER EXRS/ROM EA 15 MIN 97110GP 145.00 50311 RHB PT EMS ATTENDED EA 15 MIN 97032GP 83.00 50324 RHB PT MANUAL THER EA 15 MIN 97140GP 132.00 50325 RHB PT NEURO RE-ED EA 15 MIN 97112GP 149.00 50330 RHB PT THER ACTIVITY EA 15 MI 97530GP 149.00 50342 RHB OT MANUAL THER EA 15 MIN 97140GO 132.00 50343 RHB OT MASSAGE EA 15 MIN 97124GO 116.00 50345 RHB OT ORTHO TRAIN 15 MN INIT 97760GO 166.00 50346 RHB OT SENSORY INTGR EA 15 MN 97533GO 132.00 50347 RHB OT NEURO RE-ED EA 15 MIN 97112GO 149.00 50348 RHB OT ADL.SLFCARE, EA 15 MIN 97535GO 149.00 50349 RHB OT THER ACTIVITY EA 15 MN 97530GO 149.00 50352 RHB OT EXERCISE EA 15 MIN 97110GO 145.00 50385 RHB OT GROUP THERAPY 97150GO 91.00 50410 OPM PT AQUATIC THERAPY 15 MIN 97110GP 174.00 50431 OPM SPEECH/LANG TREATMENT 92507GN 385.00 50439 OPM DYSPHAGIA EVAL 92610GN 459.00 50447 VFSE EVAL 92611GN 501.00 50455 OPM DYSPHAGIA TREATMENT 92526GN 492.00 50483 RHB PT THERAPY PROC GRP 97150GP 91.00 50487 RHB PT WHLCHR MANG EA 15 MIN 97542GP 137.00 50509 RHB SPEECH/HEARING THERAPY 92507GN 385.00 50517 RHB DYSPHAGIA EVAL 92610GN 459.00 50525 RHB VFSE EVAL 92611GN 501.00 50526 RHB SLP INP COMUNICTN EVAL 96125GN 554.00 50533 RHB TREAT SWALLOW DYSFUNCTION 92526GN 492.00 50541 RHB EVAL AUGMENT VOICE 92607GN 873.00 50549 RHB THERAPEUTIC SP DV SRVS 92609GN 468.00 50550 RHB APHASIA ASSESS, PER HR 96105GN 455.00 50588 PT GAIT TRAINING EA 15 MIN 97110GP 124.00 50589 PT EXERCISE EA 15 MIN 97110GP 145.00 50590 PT ES UNATTNDED EA 15 MINB 97014GP 76.00 50591 PT WHIRLPOOL 97110GP 91.00 50593 PT ULTRASOUND EA 15 MIN 97110GP 64.00 50595 PT THERAPTC MASSAGE EA 15 MIN 97110GP 116.00 50598 PT TRACTION (MECHANICAL) 97110GP 74.00 50600 PT MANUAL THERAPY EA 15 MIN 97140GP 132.00 50601 PT NEUROMUSCULAR RE-ED EA 15 97110GP 149.00 50602 PT PHY PERF TEST EA 15 MIN 97750GP 149.00 50603 PT THERAPEUTC ACTVTY EA 15 MN 97530GP 149.00 50604 PT RE-EVALUATION 97164GP 265.00 50606 PT CONTRAST BATH EA 15 MIN 97110GP 74.00 50659 OPM PT WOUND DEBRIDE > 20 CM 97589GP 119.00 50670 OPM ST CNT NERVOUS SYS ASSESS 96125GN 554.00 50681 OPM SPEECH DYSARTHRIA/APR EVAL 92522GN 931.00 50682 OPM SPEECH LANGUAGE EVAL 92523GN 931.00 50683 BEHAVRAL QUALITY ANALYS VOICE 92524GN 931.00 50688 PT GAIT TRAINING EA 15 MIN 97110GP 124.00 50689 PT EXERCISE EA 15 MIN 97110GP 145.00 50690 PT ELECT STIM UNATTENDED 97014GP 76.00 50692 PT IONTOPHORESIS EA 15 MIN 97110GP 124.00 50693 PT ULTRASOUND EA 15 MIN 97110GP 64.00 50695 PT THERAPTC MASSAGE EA 15 MIN 97110GP 116.00 50698 PT TRACTION (MECHANICAL) 97110GP 74.00 50700 PT MANUAL THERAPY EA 15 MIN 97140GP 132.00 50701 PT NEUROMUSCLE RE-ED EA 15 MIN 97110GP 149.00 50703 PT THERAPEUTC ACTVTY EA 15 MN 97530GP 149.00 50704 PT RE-EVAL 97164GP 265.00 50788 PT GAIT TRAINING EA 15 MIN 97110GP 124.00 50789 PT EXERCISE EA 15 MIN 97110GP 145.00 50790 PT ELECT STIM UNATTENDED 97014GP 76.00 50793 PT ULTRASOUND EA 15 MIN 97110GP 64.00 50795 PT THERAPTC MASSAGE EA 15 MIN 97110GP 116.00 50798 PT TRACTION 97110GP 74.00 50800 PT MANUAL THERAPY EA 15 MIN 97140GP 132.00 50801 PT NEUROMUSCULAR RE-ED EA 15 97110GP 149.00 50802 PT PHY PERF TEST EA 15 MIN 97750GP 149.00 50803 PT THERAPEUTC ACTVTY EA 15 MN 97530GP 149.00 51015 OPM OT INFRARED APPLICATION 97026GO 59.00 51016 PT INFRARED APPLICATION 97026GP 59.00 51018 OPM ORTHOTIC TRAIN 15 MIN INIT 97760GP 166.00 51019 OPM ORTHOTIC TRAIN 15 MIN INIT 97760GO 166.00 51022 OPM PT PROST TRAIN 15 MIN INIT 97761GP 145.00 51039 OPM PT CANALITH REPOSITION 97110GP 184.00 54724 IPM PT EVAL LOW COMPLEX 20 MIN 97161GP 255.00 54725 IPM PT EVAL MOD COMPLEX 30 MIN 97162GP 382.00 54726 IPM PT EVAL HIGH COMPLX 45 MIN 97163GP 572.00 54727 IPM OT EVAL LOW COMPLEX 30 MIN 97165GO 254.00 54728 IPM OT EVAL MOD COMPLEX 45 MIN 97166GO 382.00 54729 IPM OT EVAL HIGH COMPLX 60 MIN 97167GO 572.00 54730 OPM PT EVAL LOW COMPLEX 20 MIN 97161GP 255.00 54731 OPM PT EVAL MOD COMPLEX 30 MIN 97162GP 382.00 54732 OPM PT EVAL HIGH COMPLX 45 MIN 97163GP 572.00 54733 OPM OT EVAL LOW COMPLEX 30 MIN 97165GO 254.00 54734 OPM OT EVAL MOD COMPLEX 45 MIN 97166GO 382.00 54735 OPM OT EVAL HIGH COMPLX 60 MIN 97167GO 572.00 54736 PT EVAL LOW COMPLEX 20 MIN 97161GP 255.00 54737 PT EVAL MOD COMPLEX 30 MIN 97162GP 382.00 54738 PT EVAL HIGH COMPLEX 45 MIN 97163GP 572.00 54742 PT EVAL LOW COMPLEX 20 MIN 97161GP 255.00 54743 PT EVAL MOD COMPLEX 30 MIN 97162GP 382.00 54744 PT EVAL HIGH COMPLEX 45 MIN 97163GP 572.00 54748 PT EVAL LOW COMPLEX 20 MIN 97161GP 255.00 54749 PT EVAL MOD COMPLEX 30 MIN 97162GP 382.00 54750 PT EVAL HIGH COMPLEX 45 MIN 97163GP 572.00 54754 PT EVAL LOW COMPLEX 20 MIN 97161GP 255.00 54755 PT EVAL MOD COMPLEX 30 MIN 97162GP 382.00 54756 PT EVAL HIGH COMPLEX 45 MIN 97163GP 572.00 54757 OT EVAL LOW COMPLEX 30 MIN 97165GO 254.00 54758 OT EVAL MOD COMPLEX 45 MIN 97166GO 382.00 54759 OT EVAL HIGH COMPLEX 60 MIN 97167GO 572.00 55001 IPM PT GAIT TRAINING 15 MIN 97110GP 124.00 55003 IPM PT EXERCISE 15 MIN 97110GP 145.00 55056 IPM OT MANUAL THERAPY 15 MIN 97110GO 132.00 55057 IPM OT MASSAGE 15 MIN 97110GO 116.00 55060 OT SENSORY INTEGRA 15 MIN 97110GO 132.00 55061 IPM OT NEUROMUSC RE-ED 15 MIN 97110GO 149.00 55062 IPM OT SELF-CARE HOME 15 MIN 97535GO 149.00 55066 IPM OT THERAP ACTIVITY 15 MIN 97530GO 149.00 55084 IPM PT NEUROMUSC RE-ED 15 MIN 97110GP 149.00 55086 IPM PT PHYS PERF TEST 15 MIN 97750GP 149.00 55112 IPM OT EXERCISE 15 MIN 97110GO 145.00 55201 IPM PT THERAP ACTIVITY 15 MIN 97530GP 149.00 55243 IPM OT COMM REENTRY TRN 15 MN 97537GO 137.00 55271 IPM OT RE-EVAL EST POC 97168GO 103.00 55408 IPM PT WHLCHR MANG 15 MIN 97542GP 137.00 55410 IPM PT AQUATIC THERAPY 15 MIN 97110GP 174.00 55431 IPM SPEECH/LANG TREATMENT 92507GN 385.00 55439 IPM EVALUATE SWALLOWING FCN 92610GN 459.00 55447 IPM VFSE EVAL 92611GN 501.00 55455 IPM SPEECH DYSPHAGIA TREATMNT 92526GN 492.00 55463 IPM EVAL AUGMENT VOICE 60 MIN 92607GN 873.00 55482 SPEECH SOUND LANG COMPREHEN 92523GN 931.00 55483 BEHAVRAL QUALITY ANALYS VOICE 92524GN 931.00 55561 IPM SLCT WND DEBRD 20 CM OR < 97597GO 306.00 55582 RHB SPEECH LANGUAGE EVAL 92523GN 931.00 55670 IPM ST CNT NERVOUS SYS ASSESS 96125GN 554.00 56000 SPEECH GROUP TREATMENT 92508GN 186.00 56018 IPM PT ORTHOTIC TRAIN 15 MIN 97760GP 166.00 56019 IPM OT ORTHO TRAIN 15 MIN INIT 97760GO 166.00 58004 SWGI FORCEP BIOPSY 513.00 58005 SWGI ENDO HEMOCLIPS 1115.30 58007 SWGI ENDO PROCEDURE 1ST 15 MIN 2179.30 58008 SWGI ENDO PROC EA ADDL 15 MIN 767.10 58017 SWGI SNARE DISPOSABLE 232.60 58029 SWGI BALLOON ESOPHAGEAL C1727 617.10 58031 SWGI LIGATOR MULTI-BND 6 SHOOT 932.60 58033 SWGI KIT PEG DIR ACCESS SYSTEM 1129.10 58040 SWGI NET RETRIEVAL ROTH 248.40 61036 LAB CALCIUM, IONIZED 82330 226.00 61050 LAB COMPLEMENT C3 86160 145.00 61051 LAB COMPLEMENT C4 86160 196.00 61076 LAB T3 FREE 84481 326.00 61080 LAB HEMOGLOBIN A1C 83036 112.00 61112 LAB LITHIUM 80178 122.00 61143 LAB VANCOMYCIN, PEAK 80202 324.00 61144 LAB VANCOMYCIN, TROUGH 80202 324.00 61150 LAB VITAMIN D (25-OH) 82306 632.00 61156 LAB HEP B SURFACE AB 86706 123.00 61157 LAB HEP B SURFACE AG 87340 95.00 61158 LAB HEP B CORE AB IGM 86705 161.00 61161 LAB HEP B E ANTIBODY 86707 141.00 61169 LAB HIV SCREEN 86701 170.00 61171 LAB RSV 87420 306.00 61194 LAB HEP C ANTIBODY 86803 166.00 61195 LAB OB DRUG SCREEN 80307 327.00 61200 LAB GLUCOSE, FLUID 82945 79.00 61213 LAB D-DIMER 85378 251.00 61227 LAB THIN PREP LIQUID PAP 88142 99.00 61233 LAB BNP TRIAGE 83880 242.00 61335 LAB INFLUENZA VIRUS AMP PROBE 87502 261.00 62030 OSTOMY PASTE A4406 87.70 62052 BINDER, COMBO, 3-PANEL,30-45" 117.10 62058 BINDER, COMBO, 4-PANEL, 46-62" 146.50 62134 SHOE, REESE WOMENS MEDIUM 121.90 62135 SHOE, REESE LARGE, WOMENS 86.60 62141 SHOE, REESE SMALL, MENS 121.90 62143 SHOE, REESE LARGE, MENS 121.90 62241 SPLINT, BUCKS TRACTION SMALL 227.80 62442 CAST LEG SHORT PEDS WALKING 138.50 62520 CAST LONG ARM SCOTCH CHILD 306.60 62521 CAST LONG ARM FIBERGLSS CHILD 294.50 62522 CAST SHORT ARM SCOTCH ADLULT 330.10 62524 CAST SHORT ARM SCOTCH CHILD 189.20 62527 CAST LONG LEG N/W SCOTCH CHILD 389.70 62532 CAST SHORT LEG ADULT FIBERGLS 591.30 62533 CAST SHORT LEG N/W SCOTCH CHL 226.40 62534 CAST SHORT LEG WLK SCOTCH ADL 615.10 62537 CAST HIP SPICA SCOTCH CHILD 1318.30 62542 CAST SHORT LEG PLASTER 93.70 62543 CAST LON ARM PLASTER POST SPT 95.20 62544 CAST LONG ARM PLASTER CHILD 92.70 62546 CAST SHORT ARM PLASTER CHILD 56.90 62549 CAST LONG LEG N/W PLTER CHILD 135.10 62556 LASER/FIBER FEE HOLMIUM 5098.90 62558 CAST LOG LEG POST SPT.PLASTER 118.60 62563 ER APP SPLINT/IMMOB SMALL 252.00 62564 ER APP SPLINT/IMMOB LARGE 408.00 62566 ER AVULSION OF NAIL PLATE 751.00 62567 ER BLADDER IRRIGATION SIMPLE 521.00 62569 ER TRACHEOSTOMY,EMERG CRICO 3267.00 62570 ER DEBRIDEMENT SKIN 548.00 62571 ER DRAIN BLOOD FROM UNDER NAIL 183.00 62572 ER EXPLORE PENETRATING WOUND 759.00 62573 ER FB REMOVAL OTHER 651.00 62574 INJ IVP SNGL/INITIAL 96374 302.00 62577 ER PERICARDIOCENTESIS INITIAL 996.00 62582 ER TREATMENT OF MISCARRIAGE 164.00 62584 BRACE/CLAVICLE STRAP 35.00 62585 ER CANE 51.40 62586 ER COLLAR 84.30 62587 ER CRUTCH 82.80 62589 ER POST OP SHOE 35.00 62591 SLING ENVELOPE 16.70 62593 ER WALKER 171.70 62595 ER ACCUCHECK W/REAGENT STRIP 82948 30.00 62596 IV DX/TX THRPY ADD HR 96366 124.00 62597 IV DX/TX NEW ADD SEQ MAX 1 96367 194.00 62600 INJ IVP ADD SEQ NEW DRUG 96375 137.00 62602 ER ASPIRATION/INJECTION 405.00 62604 MOD SED SAME ADDL 15 MIN 99153 109.00 62606 ER CLSD TX METACARPL/TARSAL FX 312.00 62608 IV DX/TX CONCURRENT MAX 1 96368 116.00 62609 VACCINE ADMIN ADD 90472 58.00 62610 IV HYDRAT THRPY 31-90 MIN 96360 552.00 62611 IV HYDRAT THRPY ADD HR 96361 116.00 62612 ER CLOSED TX ACETABULUM FX 284.00 62615 NDL PLACE INTRAOSSEOUS INFUS 36680 474.00 62618 REM FB EYE CORNEAL W/SLIT LAMP 355.00 62619 CNTRL NASAL HEMMOR ANT SIMPLE 212.00 62620 CNTRL NASAL HEMMOR ANT COMPLEX 423.00 62622 INIT RX 1ST DEGREE BURN 203.00 62623 ED PERIPHERAL NERVE BLOCK 1346.00 62624 ER IRRIGATION FOR PRIAPISM 433.00 62625 INS PACK NON-OB VAG HEMORRHAGE 320.00 62626 CTRL NASAL HEMM ANT SIMPLE BIL 259.00 62627 CTRL NASAL HEMM ANT COMPLX BIL 635.00 62628 INSERT PICC CATH 5 YRS/> 1871.00 62629 VENIPUNCTURE ROUTINE (DUI) 36415 17.00 62630 ED STRAPPING BILATERAL 207.00 62632 ASPIRATE PLEURA W/O IMAGING 32554 1585.00 62635 INS NON-TUN CV CATH >= 5 YRS 36556 2776.00 62637 TRAUMA RESPONSE CRITICAL CARE G0390 2585.00 62645 THOROCOTOMY W CARD MSG SI-C 2001.00 62650 ED DENTAL UNSPEC REST PROC 1441.00 62652 ED REMOVAL/BI-VALVING OF CAST 509.00 62655 ED ABD PARACENTESIS W/O IMAGE 1111.90 63446 LAB LYME DISEASE IgG Abs 86618 131.00 63447 LAB LYME DISEASE IgM Abs 86618 131.00 63518 LAB CRP HIGHLY SENSITIVE 86141 99.00 63589 LAB CREATININE (URINE) 2 82570 109.00 63632 LAB HIV RAPID SCREEN 86703 170.00 63639 LAB CHOLESTEROL BODY FLUID 82465 146.00 63655 LAB FETAL FIBRONECTIN 82731 278.00 63664 LAB CULTURE MRSA 87081 102.00 63667 LAB SICKLE CELL SCREEN BLOOD 86970 103.00 63693 LAB UA WITH MICROSCOPIC 81001 75.00 63702 LAB C DIFF AMPLIFIED PROBE 87493 286.00 63703 GROUP B STREP DNA AMPLIFICAT 87653 260.00 66256 HGED AIRWAY INHALATION TX 94640 101.90 66440 LAB GROUP A STREP DNA AMPLIFIC 87651 170.00 66454 LABs PLT AGG ASPIRIN RESPONSE 85576 103.00 66455 LABs KETONE BODY B-HB, QUANT 82010 46.00 69403 NEWBORN METABOLIC SCR PANEL 84999 80.00 69405 US PREG UTERUS LTD 1+ 76815 603.00 69406 CAR SEAT/BED TEST 60 MIN 94780 181.00 69532 DRESSING OWEN NON-ADH 3" X 8" 24.00 69533 DRSG CONTACT LYR <= 16SQ IN 45.60 69614 WOUND CLEANSER 6 OZ 13.50 69624 DRSG FOAM WO BRDR <=16 SQ IN 39.10 69626 DRSG TUBULAR/LINEAR YD 52.70 69627 STOCKING TUBIGRIP SUPPORT LG 52.70 69629 DRSG HYDROGEL WO BRD<=16 SQ IN 18.60 69632 ALGINATE DRSG WND FILLER/6 IN 58.10 69637 DRSG CONTACT LYR >16<=48 SQ IN 34.70 69638 GAUZE IO WO BRDR <=16 SQ IN 34.70 69641 VISIT EST PT LEVEL 1 99211 177.00 69642 VISIT NEW PT LEVEL 2 99202 327.00 69643 VISIT EST PT LEVEL 2 99212 199.00 69644 VISIT NEW PT LEVEL 3 99203 480.00 69645 VISIT EST PT LEVEL 3 99213 294.00 69647 VISIT EST PT LEVEL 4 99214 443.00 69648 VISIT NEW PT LEVEL 5 99205 919.00 69649 VISIT EST PT LEVEL 5 99215 637.00 69651 DRSG FIBER GEL SILVER >16SQ IN 76.30 69654 DRSG HYDROCOLL WO <16 SQ IN 16.10 69655 DRSG FOAM SILVER WO < 16 SQ IN 77.00 69666 DRSG HYDROGEL SILVR FILLER GEL 117.70 69667 NEG PRESSURE WOUND TX >50CM 97606 311.00 69668 NEG PRESSURE WOUND TX <50CM 97605 216.00 69671 3M TEGADERM AG MESH 4X5 38.60 69677 APP MULT LYR COMP SYS BIL 2958150 390.00 69681 SLCTV WND DEBRIDE 20CM OR < 97597 324.00 69683 DEB SUBQ TISSUE 20 SQ CM/< 11042 839.00 69685 DEB MUSC/FASCIA 20 SQ CM/< 11043 1585.00 69686 DEB MUSC/FASCIA ADDON =<20CM 11046 834.00 69688 DEB BONE ADDON =<20 SQ CM 1669.00 69689 APPLY MULTI LAYER COMP SYS RT 29581RT 312.00 69690 APPLY MULTI LAYER COMP SYS LT 29581LT 312.00 69691 WOUND CARE NON-SELECTIVE 97602 353.00 69692 SEL WOUND DEBRIDE ADDL 20 CM 97598 372.00 69693 DRSG COLLAGN W/O AG <=16 SQ IN A6021 55.70 69694 DRSG COLLAGN AG >16<=48 SQ IN A6022 96.55 69695 HYDROPHERA BLU FOAM <=16 SQ IN A6209 32.00 69696 HYDROCOLLD DRSG FILLER PASTE A6240 37.95 69697 WOUND FILLER GEL/PASTE A6261 48.60 70036 WOUND VAC & SUPPLIES DAILY 696.90 70040 SPECIALTY OVERLAY/MATT DAILY 152.40 70041 SPECIALTY BED BARIATRIC DAILY 408.40 70042 SPECIALTY BED DAILY 274.20 70240 OR PROC LEVEL 1 1ST 15 MIN 2612.00 70241 OR PROC LEVEL 1 ADDL 15 MIN 874.00 70248 PROBE GOLD/LITHOCLAST 1890.80 70301 PULSE OXIMETRY MULT 94761 151.00 70302 AERO/NEB/MDI/IPPB TX SUBSQUNT 9464076 95.00 70307 SURFACTANT ADMIN VIA ENDOTRACH 94610 476.00 70312 INSERT PICC AGE > 5 YRS 2287.00 70313 REPLACE PICC CATH 1871.00 70500 OR PROC LEVEL 2 1ST 15 MIN 2975.00 70501 OR PROC LEVEL 2 ADDL 15 MIN 1005.00 72101 VAGINAL DELIVERY LEVEL 1 2217.40 72142 OB OR SURG 1ST 15 MIN 727.40 72143 OB OR SURGERY ADDL 15 MIN 375.00 72152 OB RECOVERY RM COMPLEX 15 MIN 252.90 72153 OB RECOVERY RM SIMPLE 15 MIN 146.80 72154 CATH OCCLUSION BALLOON UTERINE C2628 805.00 76001 CWXR DX MAMMO DIR DIG UNI-LT 77065LT 558.00 76002 CWXR MAMMO SURGICAL SPEC LT 76098LT 487.00 76003 CWXR MAMMO SPOT COMPRESS LT 77065LT 558.00 76005 CWXR MAMMO SURGICAL SPEC RT 76098RT 487.00 76006 CWXR DX MAMMO DIR DIG UNI-RT 77065RT 558.00 76009 CWXR MAMMO SPOT COMPRESS RT 77065RT 558.00 76023 CWXR BONE DENSITY/DEXASCAN 77080 583.00 76025 CWUS ABDOMINAL LIMITED 76705 876.00 76026 CW US ABDOMINAL COMPLETE 76700 1076.00 76028 CWUS ABDOMINAL AORTA 76775 798.00 76029 CWUS, NON-OB PELVIS, COMPLETE 76856 853.00 76032 CWUS BREAST BILATERAL 7664150 635.00 76033 CWUS BREAST COMPLETE, LFT 76641LT 534.00 76034 CWUS BREAST COMPLETE RIGHT 76641RT 534.00 76035 US GUIDED NDL PLACEMENT 76942 1080.00 76036 CWUS ABD BCK WALL LTD KIDNEYS 76775 798.00 76054 CWUS SOFT TISSUE HEAD/NECK 76536 786.00 76055 CWUS THYROID/NECK 76536 786.00 76056 CWUS NON-OB TRANSVAGINAL 76830 708.00 76057 CWUS BREAST-ASPIRATE CYST 1021.00 76058 CWUS BREAST-ASPIRATE CYST ADDL 488.00 76067 CWXR MAMMO SPOT COMPRESS BIL 77065 558.00 76068 CWLAB ROUTINE VENIPUNCTURE 36415 17.00 76071 CWUS BREAST LOCAL RT 398.00 76072 CWUS BREAST LOCAL ADDL RT 133.00 76073 CWUS BREAST LOCAL LT 398.00 76075 CWUS BREAST BX RT W/CLIP 2202.10 76076 CWUS BREAST BX RT ADDL CLIP 515.00 76077 CWUS BREAST BX LT W/CLIP 2202.10 76078 CWUS BREAST BX LT ADDL CLIP 515.00 76083 CWXR BREAST BX RT STEREO W/CL 2202.10 76084 CWXR BREAST BX RT STEREO ADDL 573.00 76085 CWXR BREAST BX LT STEREO W/CL 2202.10 76087 CWXR BREAST BX STEREO BILAT 2909.00 76088 CWXR MAMMO BREAST LOCAL RT 442.00 76089 CWXR MAMMO BREAST LOC ADDL RT 120.00 76090 CWXR MAMMO BREAST LOCAL LT 442.00 76091 CWXR MAMMO BREAST LOC ADDL LT 120.00 76093 US UMBILICAL ARTERY ECHO 76820 323.00 76095 MAMMO W/TOMO RIGHT BREAST G0279 522.00 76096 MAMMO W/TOMO BILATERAL DIAG G0279 549.00 76098 CWXR MAMMO SCREEN TOMO ADD-ON 77063 112.00 76099 CWXR DX MAMMO TOMO ADD-ON G0279 112.00 76100 US BREAST LEFT LIMITED 76642LT 576.00 76101 US BREAST RIGHT LIMITED 76642RT 576.00 77000 CWXR DX MAMMO BILATERAL W/CAD 77066 705.00 77001 CWXR DX MAMMO CHG FM SCR W/CAD 77066 705.00 77002 CWXR MAMMO SCRN BILAT W/CAD 77067 568.00 77004 CWUS AXILLA RIGHT 76882RT 699.00 77005 CWUS AXILLA LEFT 76882LT 699.00 77006 CWUS AXILLA BILATERAL 7688250 699.00 78020 FETAL NON STRESS TEST 59025 604.00 78022 OB CLINIC VISIT NEW PT 99202 327.00 78023 OB CLINIC VISIT EST PT 99213 294.00 78024 BREASTFEEDING CLINIC 99211 222.00 79000 POLYSOM >6 YRS 4+ W/CPAP 95811 4854.00 79001 POLYSOM >6YRS 4+ 95810 4415.00 79002 MSLT MULT 95805 3062.00 79003 SLEEP STUDY UNATTENDED EFFT 95806 1233.00 80009 CAUTERY, OPTHALMIC 99.00 80010 PICO DRESSING 4X12 A4649 765.30 80013 OR NERVE COND STUDIES 1-2 95907 241.00 80014 OR NERVE COND STUDIES 3-4 95908 723.00 80015 OR NERVE COND STUDIES 5-6 95909 1205.00 80017 OR NERVE COND STUDIES 7-8 95910 1617.00 80018 OR NERVE COND STUDIES 9-10 95911 2169.00 80020 OR NERVE COND STUDIES 13+ 95913 2889.00 80021 GUIDING CATHETERS C1887 107.75 80053 SWAN GANZ COIL 177.80 83012 TIB/PER REVASC ADD-ON 12773.00 83013 INJ RT VENT/RT ATRIAL ANGIO 93566 3893.00 83014 INJ SUPRVALVULAR AORTO 93567 2311.00 83016 L HRT CATH TRNSPLT PUNCTURE 93462 9123.00 83017 DEEP BONE BIOPSY TRCR NDL 3899.00 83019 INJ PROC SACROILIAC JNT 1079.00 85000 PET F18 FDG =< 45 MCI A9552 1655.00 85001 PET BRAIN IMAGING METABOLIC 78608 7825.00 85002 PET CT LIMITED AREA 78814 8036.00 85003 PET CT SKULL BASE TO MID-THIGH 78815 8081.00 85004 PET CT WHOLE BODY 78816 8098.00 85005 GLUCOSE BLOOD REAGENT STRIP 82948 30.00 85097 LAB BM SMEAR INTERP ONLY 85097 541.00 88104 LAB CYTOPATH FL NONGYN SMEARS 88104 216.00 88112 LAB CYTOPATH ENHANCE TECH 88112 252.00 88161 LAB INTRAOP CP CONSULT INIT 88333 541.00 88163 LAB INTRAOP CP CONSULT EA ADD 88334 108.00 88172 LAB CP FNA IMMED INTITIAL 88172 213.00 88173 LAB EVAL FNA FNL;INTER & RPRT 88173 356.00 88300 LAB SURG PATH LVL 1 GROSS ONLY 88300 114.00 88302 LAB SURG PATH LEVEL 2 EXAM 88302 236.00 88304 LAB TISSUE EXAM/PATH LVL 3 88304 289.00 88305 LAB TISSUE EXAM/PATH LEVL 4 88305 461.00 88307 LAB TISS EXAM/PATH LVL 5 88307 728.00 88309 LAB TISSUE EXAM/PATH; LEVL 6 88309 989.00 88311 LAB PATH DECALCIFICATION 88311 129.00 88312 LAB PATH SPECIAL STAIN I 88312 397.00 88313 LAB PATH SPECIAL STAIN 2 88313 335.00 88321 LAB PATH CONSULT REFER IN MET 88321 476.00 88329 LAB PATH CONSULT DURING SURG 88329 269.00 88331 LAB PATH OR CONSULT & FROZEN 88331 327.00 88332 LAB PATH CONSULT INTRAOP ADDL 88332 218.00 88342 LAB PATH I-PEROXIDASE INITIAL 88342 381.00 88343 LAB PATH I PERIOXIDASE EA ADDL 88341 381.00 88355 LAB PATH CYTO IMMED EVAL ADD 88177 213.00 88360 LAB IHC SINGLE AB STAIN MANUAL 88360 381.00 88361 COMPUTR MORPHOMETRC ANA EA AB 88361 526.00 88363 LAB XM ARCHIVE TISS MOL ANAL 88363 27.00 88543 EMG EA EXTM W NERVE COND LTD 95885 454.00 88544 EMG EA EXTM W/NERVE COND COMP 95886 700.00 88545 EEG EXT MON 41-60 MIN 95812 1349.00 88546 EEG EXT MON >1HR 95813 1651.00 88547 EEG AWAKE/DROWSY 95816 1237.00 93001 SUTURE AUTO EEA-25 3955.60 93008 STAPLER TA 30-3.8 612.70 93014 KIT, SKIN STAPLER REMOVER 62.50 93016 SUTURE PLDS-15W DISP AUTO 1463.10 93030 SUTURE PACK 45.60 93035 STAPLER,SKIN SURGICAL 35W 176.10 93037 CATH MICROVAS BALLOON DILATOR C1726 2615.00 93038 NEEDLE, BIOPSY 401.80 93043 CANNULA SHILEY SINGL IPC TRAC 367.70 93062 SUTURE GORETEX 226.40 93090 STAPLER TA 90-4.8 602.00 93091 STAPLER TA 60-4.8 633.70 93092 STAPLER TA 90-3.5 602.00 93093 STAPLER TA 60-3.8 581.50 93094 STAPLER GIA 55-3.8 1205.40 93095 BONE CHIP CORTICAL STRUT/SPCR C1713 3251.00 93096 STAPLER GIA 75-3.8 892.60 93105 EYE GARTER GOFFMAN 13.10 93113 SUTURE GORETEX 198.90 93118 DISSECTOR KITTNER/ROTICULAR 318.80 93124 HEMOCLIP 169.70 93159 O.R. TIME CATARACT 4749.00 93210 PERFORATOR 14MM NEURO 982.30 93240 BLADE BEAVER 64/67 30.30 93243 BLADE MYRYGOTOMY 71 92.80 93244 BLADE BEAVER 68.40 93247 MESH C-QUR C1781 2082.80 93248 BLADE TREPHINE TURBINATE 528.40 93250 CANNULA/SLEEVE 49.40 93273 NEEDLE RETROBULBAR #1638 74.30 93282 ARTERIAL RADIAL CATH 226.10 93300 HEMOVAC SMALL 3/32" DRAIN 288.50 93301 HEMOVAC MEDIUM 1/8" DRAIN 288.50 93302 HEMOVAC LG SOFT 3/16" DRAIN 229.70 93303 HEMOVAC LARGE 1/4" DRAIN 221.50 93308 VASECTOMY 2222.00 93310 BLADE/FIBERWIRE ARTHROSCOPY 532.90 93311 DILATOR URETERAL NOTTINGHAM 862.30 93312 GUIDEWIRE URO C1769 248.50 93320 EYE WET FIELD HEMASTATIC ERAS 129.40 93336 NEEDLE ENDO SURGINEEDLE 134.60 93343 BLADE ORTHO RECIPROCATING 287.60 93375 STAPLE W/SPIKES ORTH FIXATION C1713 831.90 93376 SUTURE RETRIEVER ORTHO HEWSON 318.20 93386 CORNEAL TISSUE PROCESSING V2785 8619.70 93388 VACUUM TREPHINE HESSBURG EYE 620.60 93391 EUSTACHIAN TUBE BALLOON C1726 3236.10 93402 STAPLER PREMIUM 35W SKIN 486.50 93404 STAPLER FASCIA DFS-20W 599.70 93405 STAPLER ROTICUL 55-3.5 1312.30 93407 SURGICLIP AUTO APPLIER PREM 723.70 93412 SNARE DISPOSABLE 232.60 93419 NEEDLE BRONCHIAL BIOPSY 633.00 93420 CANNULA PLAIN TIP ECRP 490.60 93424 BALLOON/SNARE STONE REMOVER 1141.90 93429 CATH GROSHONG CV 1180 C1751 2975.00 93435 STONETOME REMOVAL DEVICE 2788.40 93436 PORT VAS SYS SINGLE C1788 1598.10 93442 RESECTOSCOPE ELECTRODE 404.20 93444 DILATOR SET URO AMPLATZ RENAL 1171.60 93447 GUIDEWIRE URO TSCM C1769 171.30 93454 CATH URETERAL/ACCESS 119.50 93465 CATH VAN ANDLE URETERAL 261.30 93479 CATH STAMEY PERCUT SUPRAPUBIC C2627 339.90 93482 NEEDLE BIOPSY 1074.00 93483 NEEDLE TEFLON SHEATH URO 414.40 93500 BLADE SUPER/TREPHINE 126.90 93509 LENS COOPERVISION INTRAOCULAR 1367.20 93510 SURE CLOSURE SKIN 2894.10 93532 MESH KUGEL 3" C1781 987.30 93535 EYE SPHERE WHEELER 475.10 93544 LIGACLIPS 97.80 93545 PLATE,BONE C1713 2263.40 93546 BONE SCREW C1713 1116.10 93547 BONE SCREW C1713 246.40 93554 LASER FLEX TRACH.TUBE (BAXTER 764.70 93555 SAW BLADE GIGLI ORTHO 182.90 93576 BI-LAYER MATRIX WOUND DRSG 2X2 Q4104 3311.80 93577 BI-LAYER MATRIX WOUND DRSG 4X5 Q4104 5775.75 93605 BRUSH DISP CYTOLOGY 183.30 93608 CATH CONE TIP/RUTNER 177.60 93611 CATH FOLEY 88.20 93612 CATH 24 FR 3-WAY 30CC BAG 155.00 93628 STONE BASKET RETRIEVERS 890.30 93636 VESSEL LOOPS ALL SIZES/COLOR 31.40 93658 CEMENT BONE PALACOS/SIMPLEX C1713 722.40 93664 RANEY CLIPS (DISP. WECK) 102.60 93694 SHUNT JAVID CAROTID BYPASS 582.50 93696 CATH ARTERIAL EMBOLECTOM 3 FR C1757 576.70 93698 CATH ARTERIAL EMBOLECTOM 4 FR C1757 576.70 93700 CATH ARTERIAL EMBOLECTOM 5 FR C1757 576.70 93727 TROCAR ENDO 310.30 93735 BONE CEMENT ZIMMER C1713 1162.70 93738 ESOPH SPHINCTER AUGMENT DEVICE L8699 8855.00 93800 BALLOON MICRO V NEPHROSTOMY 1984.50 93815 SLEEVE KNEE ARTHRO 394.10 93820 BONE SCREW C1713 455.30 93823 O.R. CO2 LASER SET-UP 268.00 93824 O.R.CO2 LASER SURG.TIME0-10MIN 1108.00 93825 SHUNT CAROTID 297.80 93839 INFLATOR W/DISP GAUGE 504.10 93851 KIT THERMASPLINT 333.30 93902 LEAD INTRODUCER AICD 613.00 93916 TEFLON PLEDGET FABRIC 92.80 93931 CURRETTAGE COLLECTOR SET 60.70 93932 CURETTES CURETTAGE 89.80 93933 GRAFT SKIN DERMACARRIER II 251.20 93935 ELECTRODE EXTENDED 70.50 93936 RETAINER MCNEALLY 298.50 93937 CLIPS HULKA/U 305.90 93939 NERVE LOCATOR/STIMULATOR 147.20 93952 MESH MARLEX/FLAT SHEET C1781 984.80 93957 TUBE SUCTION COAGULATOR 5 1/2 126.00 93960 TUBE YANKAUER LG HIGH CAPACIT 20.50 93962 T-TUBE 16FR-5" T-BAR 133.60 93976 IRRIGATOR SURGILAV 369.60 93978 IRRIGATOR SURGILAV TIP 130.30 93979 CATH MUSHROOM (MALECOT) 472.50 93985 DRAIN JACKSON PRATT RND 15FR 216.40 93986 RESERVOIR JACKSON PRATT 238.00 93996 ABBOTT TRANSDUCER 50"TUBING 195.20 94002 SAW BLADE SAGITTAL ORTHO 247.20 94003 SAW BLADE OSCILLATING ORTHO 181.40 94004 SUTURE ENDO LOOP 192.90 94023 CURRETTAGE DISP CANISTER 89.70 94024 HEMOSTATIC AGENT/SURGICEL-AR 370.90 94026 STENT URO URETERAL C2617 1048.70 94033 GLOVES RADIATION RESISTANT 733.70 94036 AUTO PURSTRING INSTR 675.20 94060 PIN SKULL DISPOSABLE MAYFIELD C1713 257.40 94082 LIGA CLIP ENDO APPLIER 1913.50 94085 EQUIPMENT USE LAP CHOLE 2838.60 94086 LOOP OSTOMY SYSTEM 2 3/4" 234.30 94087 LOOP OSTOMY SYSTEM 4" 265.10 94090 CATH GROSHONG DUAL-LUMEN C1788 3407.40 94119 BONE SCREW C1713 120.00 94132 CATH THORACIC MAR 570523 20F 96.60 94134 CATH THORACIC MAR 570549 28FR 96.60 94135 CATH THORACIC 888-5705-56 32F 96.60 94145 TUBING SET NEURO IRRIGATION 301.90 94149 DRILL BUR MED TAPERED MICRO 298.70 94150 DRILL BUR LNG TAPERED MICRO 371.80 94157 UTERINE MANIPULATOR 314.00 94158 TROCAR ENDO 413.60 94168 CATH LAP CHOLE ARROW 709.50 94171 DEVICE BREAST MASS SPECIMEN 180.50 94173 CATH TRIPLE LUMEN BURRON 7X8" 425.60 94180 BLADE MICRO OSCILLATING 370.10 94183 BASKET CYSTO EXTRACTOR 1039.10 94186 PROBE OCCUTOME/RETINA 1441.70 94189 PACK CATARACT AS9360 1624.30 94191 PACK CATARACT AS88401 2869.70 94193 STICKS ABSORBENT 28.90 94201 TROCAR ENDO 11-12MM 621.90 94209 MESH DEXON C1781 1708.70 94229 DRAINAGE SYSTEM EXT NEURO 1081.40 94230 CATH EDM VENTRICULAR NEURO 781.40 94231 DRAINAGE BAG EDM NEURO 259.50 94235 PROBE LITHOCLAST 1487.00 94237 PORT DOUBLE LUMEN BARD C1788 2163.90 94241 BONE SCREW C1713 423.80 94242 CARDIOVASCULAR PAK II 1177.50 94245 SUTURE BOOTS 54.00 94251 STENT SET PERCUFLEX/BANDER 1383.50 94253 KLEPPINGER BIPOLAR ENDO 1161.40 94258 FLUOROSCAN IMAGING 416.10 94260 GRAFT VASCULAR C1768 7175.50 94265 CANNISTER SUCTION X-L 46.90 94268 AUTO-TRANS POST OP ORTHO 1158.00 94281 TUBING INSUFFLATOR 168.10 94284 STENT BILI NONCOAT TEMP WO DEL C2617 483.30 94286 PAK KENNEDY SINUS ENT 188.80 94290 TROCAR ENDO 902.60 94292 STAPLER CONTOUR 1991.70 94294 MESH PROLENE/VICRYL C1781 636.40 94295 SUPPORT SHOULDER ABDUCTION 782.50 94296 KIT LUMBAR DRAINAGE 1782.30 94297 VALVE BIOPSY 33.90 94298 VALVE SUCTION 84.40 94299 SPLINT NASAL DENVER 468.10 94305 NASAL TAMPON POPE 151.00 94323 VESSEL SEALING FORCEP/SCALPEL 1804.40 94326 ELECTRODE MENISECTOMY 525.20 94327 ARTHROSCOPE BUR 643.10 94334 PLATE, DALL MILES GRIP C1713 934.70 94336 DRAIN J.P. 7FR RND 168.30 94340 DECOMPRESSION TUBE 557.80 94341 STAPLER GIA REFILL 75 320.40 94343 TROCAR GUIDE PIN 191.00 94345 ART EMBO 2 FR FOGARTY C1757 843.50 94350 RETRACTOR IRIS FLEXIBLE 1039.10 94354 STENT SET URINARY DIVERSION 1640.20 94355 NEEDLE BRONCHIAL ASPIRATING 454.70 94358 CLIP APPLIER 713.70 94359 BALLOON PREPERITONEAL ENDO 1242.60 94373 TUBE VENT PAPARELLA 142.10 94392 TUBE VENT O.K. 182.90 94393 TUBE VENT GROMMET 175.50 94461 MESH VENTRALEX OR PLUG C1781 1691.70 94462 MESH PLUG X-LARGE C1781 2008.30 94463 BONE SCREW C1713 196.70 94464 WASHER BONE C1713 137.20 94467 PLATE,BONE C1713 537.30 94485 PLATE,BONE C1713 959.10 94487 PLATE,BONE C1713 249.10 94488 PLATE L 2.7MM 3 HOLE C1713 228.20 94491 WIRE KIRSCHNER C1713 48.00 94492 WIRE KIRSCHNER/STEINMAN PIN C1713 98.30 94496 SCISSOR UNIPOLAR/GRASPER 405.00 94497 TROCAR 5 NON/BLADE 287.80 94498 TROCAR 12 NON/BLADE 316.40 94501 STAPLER GIA 45-2.5 1532.60 94503 STAPLER GIA REFILL 45-2.5 493.60 94504 STAPLER REFILL/SEAMGUARD 735.10 94507 BONE INFUSE GRAFT LG L8699 11592.60 94508 HALO 360 CATHETER SET 3469.50 94509 HALO 90 CATHETER SET 2746.70 94510 GUIDEWIRE ESOPHAGEAL C1769 1532.40 94511 BALLOON ESOPHAGEAL C1727 617.10 94512 REVASC ILIAC W/STENT 37221 14111.00 94514 REVASC ILIAC EA ADD W/STENT 37223 13016.00 94515 REVASC FEM/POP W/TLA 37224 13137.00 94516 REVASC FEM/POP W/STENT 37226 24450.00 94517 REVASC FEM/POP W STENT/ATH 37227 42332.00 94518 REVASC TIB/PER W TLA 37228 13090.00 94519 REVASC TIB/PER W/STENT 37230 30426.00 94526 TRN PERIPH ATH ILIAC ART 0238T 25834.00 94541 FORCEP HET BIPOLAR 916.75 95031 DRESSING NASAL/S-SURGICAL 376.60 95034 LIGATOR MULTI-BAND 6 SHOOTER 932.60 95084 KIT GRATRODOME GASTRO 816.10 95088 TRAY, MAJOR 307.20 95093 TUBING SET HYSTER 529.80 95094 KIT HYSTER COLLECTION 176.30 95095 CANNISTER HYSTER 44.90 95103 TRAY, C-SECTION (L&D) 255.40 95111 DRESSING TELFA (3X8) 6.60 95113 DRESSING, TELFA (3X4) 4.20 95139 TRAY, D&C 285.70 95165 GLASS, NED. 6.60 95199 CHEST TUBE TRAY THAL-QUICK 465.30 95305 TISSUE RESTORE C1776 6642.30 95308 CEMENT PREP KIT HIP 849.00 95309 CEMENT BONE HIP 687.30 95312 BONE SCREW C1713 692.80 95344 SCALPEL HARMONIC/LIGASURE 814.70 95345 PLEURAL AIR LEAK SEALANT KIT 3427.40 95351 GRAFT VASCULAR LEVEL II C1768 3271.30 95352 GRAFT VASCULAR LEVEL III C1768 3998.10 95355 SEALANT KIT DURASEAL C1765 2426.40 95385 KIT CARTILAGE BIOPSY 1598.85 95497 TIES, VELCRO TRACH 8.70 95574 SUTURE DEVICE OPEN ACC CAPIO 1068.70 95576 KIT THD HEMORRHOID SYSTEM 1899.80 95622 BLOOD PATCH 544.00 95629 SCD SLEEVES (1 PAIR) 121.90 95631 SCD PULSOFT FOOTIE AIRCAST 301.90 95636 TUBE, MIC GASTROSTOMY 339.00 95700 SPINAL PUNCTURE, LUMBAR DIAG 418.00 95930 TRAY, PACEMAKER CATH LAB 265.60 95965 TRACH TUBE CUFFLESS SIZE 8 311.90 95966 TRAY, INTUBATION 415.00 96000 NASAL IMPLANT ABSORBABLE A4649 3213.85 96100 LHC W VENTRICULOGRAPHY 93452 9123.00 96101 RHC & LHC W VENTRICULOGRAPHY 93453 8857.50 96102 COR ART ANGIO 93454 10340.00 96103 COR ART ANGIO W/GRAFT 93455 10948.00 96104 COR ART ANGIO W/RHC 93456 15205.00 96105 COR ART ANGIO W/GRAFT & RHC 93457 15353.00 96106 COR ART ANGIO W/LHC 93458 14111.00 96107 COR ART ANGIO WGRAFT & LHC 93459 14719.00 96108 COR ART ANGIO W/RHC & LHC 93460 17030.00 96109 COR ART ANGIO W RHC&LHC/GRAFT 93461 17638.00 96110 OPEN/PERQ PLACE STENT 1ST 37236 24551.00 96112 OPEN/PERQ PLACE STENT SAME 37238 24551.00 96113 OPEN/PERQ PLACE STENT EA ADD 37239 11871.00 96114 VASC EMBOLIZE/OCCLUDE VENOUS 37241 19043.00 96115 VASC EMBOLIZE/OCCLUDE ARTERY 19043.00 96116 VASC EMBOLIZE/OCCLUDE ORGAN 19043.00 96117 VASC EMBOLIZE/OCCLUDE BLEED 37244 19043.00 96118 PLEURAL DRAINAGE W/IMAGING 32557 1306.00 96204 RECTAL TUBE KIT W/BAGS 894.50 97111 IOP/PHP MCR PSYCOTHRPY GROUP 90853 68.30 97118 CDU IOP HALF DAY PGM 90853 322.10 97131 IOP PSYCH TX W PT/FAM 30 MIN 90832 96.50 97132 IOP PSYCH W PT/FAM 45 MIN 90834 150.00 97136 IOP/PHP MCR TRN/EDUC >45 MIN G0177 125.00 98805 THROMBECT/EMBOLECTOMY CATH C1757 5324.60 98807 INTERNAL CLOSURE DEVICE C1760 1391.70 98810 STENT COATED/COVD W DEL SYS C1874 8479.70 98812 DIALYSIS CATH TEMP NON TNLD C1752 1211.80 98813 DILATOR 66.30 98815 IABP 5341.10 98817 INTRODUCER/SHEATH C1894 254.10 98818 IVC FILTER C1880 5324.60 98822 PERIPHERAL DIAGNOSTIC CATH 194.80 98823 CORON/PERIPH DIAG WIRE C1769 570.60 98825 COR/PERIPH STENT W DEL SYS C1876 4564.70 98826 CATH, THROMBECTOMY/EMBOLECT C1757 1757.40 98827 TRANSL ATHERECT ROTATN CATH C1724 3610.30 98828 GUIDEWIRE, ROTATIONAL C1769 963.10 98830 SWAN GANZ CATHETER 362.90 98832 TRNSVN PACE/AICD ELEC INS SNG 7371.00 98833 TRNSVNS PACE/AICD ELEC INS DL 7371.00 98834 IABP INSERTION 4518.00 98846 REVASC TIB/PER W/ATH 37229 25071.00 98848 CATH INTRO, SUP/INF VENA CAVA 36010 1902.00 98850 SCP ABD/PELV/LE ART 3RD ORD 36247 2207.00 98851 SCP ADDL ABD/PELV/LE ARTERY 36248 2207.00 98852 TRANSCATHETER BIOPSY 4265.00 98856 INJ PROC CHOLANGIOGRAM 5701.00 98858 EXCHANGE PERC BILI DRNG CATH 5701.00 98859 INJ PROC ABSC/FIST/CYST CONT 732.00 98863 VENO EXTREMITY L 75820LT 1269.00 98864 VENO SVC W SERIAL 75827 2365.00 98865 PERC PORTO W/HEMODYN EVAL 75885 2493.00 98866 PERC PORTO W/O HEMODYM EVAL 75887 3841.00 98867 HEPATIC HEMO W HEMODYN EVAL 75889 2493.00 98875 ABSCESS/FISTULA/SINUS TRC STDY 76080 795.00 98876 US GUIDE NDL PLCMT 76942 1080.00 98887 INSERT LV ELECT W/EXIST GEN 9748.00 98888 REMOVAL PERM PACE GENERATOR 7371.00 98889 REMVL TRANSVENOUS ELECT DUAL 3534.00 98890 REMVL TRANSVENOUS ELECT SINGL 3534.00 98891 REPAIR PACER/AICD ELECT SINGL 5736.00 98898 COILS/SPHERES TRNS CATH EMBLZN 2356.70 98901 SCP ABD/PELV/LE ART 3RD EA AD 36248 2207.00 98902 ANGIO PELVIC SEL 75736 4265.00 98903 ANGIO PELVIC SEL/SUPRASELECT 75736 4116.50 98906 REM RENAL TUBE W/FLOURO W/S&I 566.00 98908 REMV INTRNL URET STENT PERC 50384 2224.00 98910 THROMBEC VEN W/INTL 37187 5085.00 98912 THROMBEC PRIM ART W INTL 37184 5085.00 98915 TRANSCATH STENT W/DIS EP 37215 8705.20 98917 HEPATIC SHUNT INSERTION (TIPS) 9880.00 98919 FLUORO GUIDE NEEDLE PLACEMENT 77002 1135.00 98921 PERC VERTEBROPLASTY L/S 6273.00 98927 PERC KYPHOPLASTY THORACIC 15722.00 98928 PERC KYPHOPLASTY LUMBAR 15722.00 98929 PERC KYPHOPLASTY ADD-ON 11791.00 98930 PERC SACRAL AUGMNT UNILAT INJ 3904.00 98933 REM&RPLC PM GEN SINGLE LEAD 7862.00 98934 REM&RPLC PM GEN DUAL LEAD 8594.00 98935 REM&REPL PM GEN MULTI LEAD 8594.00 98937 INSERT PULSE GEN W/MULTI LEADS 11585.00 98938 REM&REPL CVD GEN SINGLE LEAD 17153.00 98939 REM&REPL CVD GEN DUAL LEAD 17667.00 98940 REM&REPL CVD GEN MULTI LEAD 17667.00 98941 INS CATH RENAL ART 1ST UNILAT 36251 6202.00 98942 INS CATH RENAL ART 1ST BILAT 36252 7360.00 98943 INS CATH RENAL ART 2ND+UNILAT 36253 7526.00 98945 INS ENDOVASC VENA CAVA FILTER 9194.00 98947 REM ENDOVASC VENA CAVA FILTER 37193 6314.00 98948 PLC GASTRO/DUOD/JEJ TUBE PERC 2633.00 98949 FLUORO EXAM OF G/COLON TUBE 423.00 98953 SEL CATH PLCMT SEGMENTAL ART 36015 1806.00 98954 TRANSCATH ART INF INTL 37211 4265.00 99059 TORQUE DEVICE 75.10 99212 DRAINAGE CATHETER C1729 508.00 99213 ACCUSTICK INTRODUCER SYSTEM 554.20 99214 CATHETER CUFF KIT 132.20 99215 DRAINAGE BAG 105.80 99216 BIOPSY NEEDLE 99.00 99217 THORACIC VENT TRAY 1477.30 99219 OBTURATOR 11.50 99224 DEFIB PAD 284.00 99296 ANGIOPLASTY EQUIP 195.50 99318 INFLATION DEVICE 275.60 99382 SNARE 3369.70 99395 CVC INSERT NON-TUNNELLED >5 YR 467.00 99396 CVC INSERT TUNNELLED > 5 YRS 2038.00 99397 FLOURO GUIDANCE CVAD 77001 669.00 99398 ANGIO SEL EA ADDL VESSEL 75774 2579.00 99400 DEVICE FEM STOP 432.50 99413 REVASC ILLIAC W/TLA 37220 14111.00 99414 REVASC FEM/POP W ATHERECTOMY 37225 24450.00 99416 BUNDLE OF HIS RECORDING 93600 5314.00 99418 RIGHT VENTRICULAR RECORDING 93603 1754.00 99421 INTRA-ATRIAL PACING 93610 5314.00 99427 EP EVAL W/INDUC ARRYTH 93620 7031.00 99428 EP EVAL W/LT ATRIAL REC 93621 2068.00 99429 EP EVAL W/LT VENT REC 93622 2008.00 99430 EP IV DRUG INFUSION 93623 1591.00 99433 EP EVAL LEADS INITIAL 93640 3170.00 99434 EP EVAL LEADS W/GEN TEST 93641 4030.00 99436 IC CATH ABLATE AV NODE 93650 9430.00 99450 INSERT NEPHROSTOMY TUBE 50432 3391.00 99464 PERC TRANS COR THROMBEC MECH 92973 2281.00 99471 CORON/PERIP GUIDING CATH C1887 380.30 99474 CC PS BANDFLEX 2306.25 99478 SLING VAGINAL C1771 4549.00 99479 DIL VASCULAR SET 347.50 99480 SHUNT EXT CAROTID 910.90 99481 NEEDLE PROCEDURE 178.50 99482 KIT PLEUREX DRAINAGE 358.40 99483 CATH PLEUREX C1729 1497.80 99484 TUBE IRRIGATION 225.70 99485 ZONE KIT 225.70 99488 STAPLER BARIATRIC SURG 1651.50 99489 STAPLER REFILL BARIATRIC SURG 632.90 99490 ELECTRODE BARIATRIC SURG 320.20 99491 HANDLE BARIATRIC SURG 400.50 99492 SUTURE CLIP BARIATRIC SURG 218.80 99494 PLATE BONE BRL 8-10 HOLES HIP C1713 2532.20 99497 PLATE BONE 6-10 HOLE HIP C1713 3052.90 99498 PLATE BONE SUPRACONDYLAR/MESH C1713 3566.60 99503 GUIDE PIN THREADED 101.70 99506 IMPLANT TOE C1776 3302.70 99509 FORCEP BIOPSY URETERO 1863.00 99510 CATH CURL PERIPHERAL 550.70 99514 SHEATH URETERAL ACCESS 592.10 99519 NEEDLE CV FAST-FIX 1354.50 99520 MENISCUS KNOT PUSH/CUT FF 554.30 99523 PROBE VULCAN LIGACHISEL 706.10 99530 BLADE MICRO STR 107.00 99532 NAIL NANCY C1713 1410.40 99534 DRILL BIT/BURR 1043.50 99535 DRILL BIT/TAP SOLID ORTHO 594.40 99536 SPOT ENDOMARKER 110.40 99537 BRACE BREG POST-OP 615.40 99538 GUIDE ROD/REDUCTION WIRE 522.80 99539 LACRICATH EYE BILATERAL 2811.70 99543 CANNULA ORTHO 225.70 99545 CANNULA J EYE 54.60 99547 ADHESIVE FLOSEAL BLOOD 903.80 99548 KIT PEG SAFETY/DIR ACCESS SYS 1129.10 99549 PUTTY DBX ORTHO C1713 5486.90 99552 STENT-POLARIS C2625 846.90 99558 BURR OPHTHALMIC 63.00 99559 PUNCH CORNEA DONOR 309.10 99563 PUMP SINGLE ACTION UROLOGY 296.30 99564 ADAPTER URETERAL 98.90 99566 PLATE,BONE C1713 1810.60 99567 DERMABOND HIGH VISCOSITY 164.10 99569 PATCH CAROTID C1768 538.00 99571 CATH ENDO ERCP 207.50 99572 DILATOR ENDO 520.00 99573 GUIDEWIRE ENDO; SINGLE WIRE C1769 798.90 99574 STENT WALL ENDO C1874 4772.40 99575 STENT WALL BILIARY ENDO C1876 4772.40 99576 CATH CYTOLOGY BRUSH ENDO 530.10 99579 SHEATH URO 266.50 99580 DILATOR URO COAXIAL 8 FR 283.20 99582 SPHINCTEROTOME UTS-20M 407.80 99583 ABLATION/RESECTION DEVICE 3461.20 99584 CATH URETERAL DILATION 479.50 99585 CATH TAMPONADE/PRUIT KIT 1022.50 99589 MESH VENTRALEX/VENTRIO/XENFRM C1781 2669.90 99590 MESH VENTRALEX SMALL C1781 2234.70 99592 KNIFE PARALLEL GRAFT 296.30 99593 INTRODUCER SET TRACHEOSTOMY 1127.60 99597 PIN TOE/BONE C1713 399.70 99600 NET RETRIEVAL ROTH 248.40 99602 MESH PHYSIO/SURGISIS/C-QUR C1781 4015.80 99603 MESH PHYSIO C1781 4676.90 99604 BONE SCREW C1713 745.70 99606 MESH PHYSIO/V C-QUR C1781 2219.10 99607 LIGATOR BAND 6 SHOOTER 1150.30 99608 LIGATOR BAND SHORT SHOOTER 272.00 99610 SUTURE LASSO CURVED 1038.60 99612 SUTURE SAVER 268.80 99623 BAND LIGATOR SPEED SUPER 7 1584.30 99628 INFLATION DEVICE 275.60 99630 SUTURE ULTRA BRAID 150.80 99631 LACRICATH EYE UNILATERAL 1629.60 99632 SPONGE COLLAGEN 290.20 99635 KIT ICP MONITOR VENTR ACCESS 4227.80 99636 PROBE DOPPLER NEURO 791.10 99637 GRAFT DURAGEN 3X3 NEURO Q4100 2683.70 99638 GRAFT DURAGEN 2X2 NEURO 1475.10 99639 GLUE FIBRIN TISSEEL/EVICEL 873.50 99641 LAP BAND BARIATRIC 8492.90 99644 LIGHT SOURCE DISPOSABLE 1863.80 99649 LASER FIBER HOLMIUM #270 1925.00 99650 LASER FIBER HOLMIUM #400 1925.00 99651 LASER FIBER HOLMIUM #600 2325.10 99652 LASER FIBER HOLMIUM #1000 4924.70 99655 CAPSULAR TENSION RING EYE 995.40 99657 TUTOPLAST DERMIS 6X8 (HUMAN) C1762 3614.80 99664 IV US NON-COR INITIAL 37252 1477.00 99666 IV US NON-COR VES EA ADDL 37253 692.00 99667 IVUS IC INITIAL 92978 3391.00 99668 IVUS IC EA ADDL 92979 1798.00 99669 CATH FOR INTRAVASCULAR US C1753 5587.20 99670 KIT BARIATRIC ACCESS PORT 3099.80 99675 ROD CARBON FIBER EXT FIXATOR 1063.50 99679 BONE CEMENT W/TOBRAMYCIN 2230.10 99680 PRESBYOPIA-CORRECT FUNCTION V2788 1057.10 99681 CATH HEMODIALYSIS LONG TERM C1750 2235.60 99682 NEURO DRILL BIT ANT CERVICAL 1252.00 99683 ANCHOR SYNDESMOSIS KIT 3107.30 99685 ASTIGMATISM-CORRECT FUNCTION V2787 584.70 99687 CATH, GUIDING-SINUS C1887 1437.20 99688 CATH SINUS BALLOON C1726 3390.60 99692 RETRACTOR RING MALYUGIN 532.50 99693 CATHETER MAMMO CAVITY EVAL C1728 634.60 99694 TVT OBTRYX HALO C1771 2773.40 99696 MESH PERMACOL 10X15 C1781 6029.60 99697 INTEGRA DRT OR OMNIGRAFT Q4105 12058.90 99698 MESH PERMACOL STRATTICE FLEX C1781 26529.30 99702 RETINA DISPOSABLE INSTRUMENT 545.60 99703 MARGIN MARKER BREAST BIOPSY A4648 374.00 99704 STAPLER INSERT COVIDIEN 1442.00 99705 STAPLER HANDLE COVIDIEN 1136.90 99706 BONE INFUSE GRAFT X-SMALL L8699 3934.30 99707 INFUSE BONE GRAFT SMALL C1713 6561.90 99708 INFUSE BONE GRAFT MEDIUM C1713 9303.70 99710 BONE SCREW C1713 3414.20 99711 AMNIOTIC MEMBRANE FOR THE EYE V2790 2193.60 99712 PROCORE ECHO NEEDLE 1220.00 99717 RX ADMIN W/HEMO MEASURE 93463 2266.00 99718 ESOPHAGEAL MOTILITY 91010 1446.00 99725 VITRECTOMY CUSTOM PACK 2187.40 99726 ACL KIT TRANS TIBIAL 778.60 99727 KIT HIP CANNULAS/TROCARS 1297.50 99728 FALOPE RING KIT W/APPLICATOR 381.70 99729 OTSC IMPLANTED CLIP 1130.50 99730 SUPERDIMENSION PROCEDURE KIT 2219.50 99731 TRABECULAR MIC BYP STENT SYS C1783 3715.25 99732 BONE MARROW BIOPSY 2096.00 99737 STENT GASTROINTESTINAL AXIOS C1876 9860.00 99800 KIT CRANIAL ACCESS INSHITH 1359.90 99803 GRAFT DURAGEN 4X5 NEURO Q4100 3284.40 99804 INSERT TUNNELED CV CATH 6299.00 99807 REMOVE SICD ELECTRODE 33272 5736.00 99811 LUMBAR CAGE 10800.00 99816 LYMPHANGIOGRAPHY UNILATERAL 75805 2525.40 99817 SPECIALTY BED ROTOREST PRONE 1485.00 MS-DRG DRG NAME AVERAGE CHARGE 025 CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES 119068.00 038 EXTRACRANIAL PROCEDURES W CC 41044.00 039 EXTRACRANIAL PROCEDURES W/O CC/MCC 23119.00 054 NERVOUS SYSTEM NEOPLASMS W MCC 26401.00 056 DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC 44906.00 057 DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC 31581.00 059 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC 26355.00 060 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC 18387.00 062 ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIEN 52003.00 064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W M 37340.00 065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W C 27352.00 066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O 22344.00 069 TRANSIENT ISCHEMIA W/O THROMBOLYTIC 18613.00 072 NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC 15107.00 074 CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC 20608.00 085 TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC 51859.00 086 TRAUMATIC STUPOR & COMA, COMA <1 HR W CC 25245.00 087 TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC 15913.00 091 OTHER DISORDERS OF NERVOUS SYSTEM W MCC 25145.00 092 OTHER DISORDERS OF NERVOUS SYSTEM W CC 21241.00 093 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC 20876.00 100 SEIZURES W MCC 39153.00 101 SEIZURES W/O MCC 17280.00 103 HEADACHES W/O MCC 18226.00 134 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/ 17248.00 149 DYSEQUILIBRIUM 19265.00 153 OTITIS MEDIA & URI W/O MCC 13406.00 158 DENTAL & ORAL DISEASES W CC 14452.00 163 MAJOR CHEST PROCEDURES W MCC 96457.00 164 MAJOR CHEST PROCEDURES W CC 54039.00 165 MAJOR CHEST PROCEDURES W/O CC/MCC 44614.00 166 OTHER RESP SYSTEM O.R. PROCEDURES W MCC 61666.00 167 OTHER RESP SYSTEM O.R. PROCEDURES W CC 40502.00 168 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC 34183.00 175 PULMONARY EMBOLISM W MCC 34316.00 176 PULMONARY EMBOLISM W/O MCC 21245.00 177 RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC 35339.00 178 RESPIRATORY INFECTIONS & INFLAMMATIONS W CC 22132.00 179 RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC 18129.00 180 RESPIRATORY NEOPLASMS W MCC 32873.00 181 RESPIRATORY NEOPLASMS W CC 27538.00 186 PLEURAL EFFUSION W MCC 32722.00 189 PULMONARY EDEMA & RESPIRATORY FAILURE 24688.00 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 22897.00 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC 17678.00 192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC 14066.00 193 SIMPLE PNEUMONIA & PLEURISY W MCC 25846.00 194 SIMPLE PNEUMONIA & PLEURISY W CC 17341.00 195 SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC 13441.00 200 PNEUMOTHORAX W CC 24178.00 202 BRONCHITIS & ASTHMA W CC/MCC 16405.00 203 BRONCHITIS & ASTHMA W/O CC/MCC 10987.00 204 RESPIRATORY SIGNS & SYMPTOMS 20589.00 206 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC 14921.00 207 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 89349.00 208 RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 42139.00 226 CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W M 111298.00 227 CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O 81546.00 242 PERMANENT CARDIAC PACEMAKER IMPLANT W MCC 59435.00 243 PERMANENT CARDIAC PACEMAKER IMPLANT W CC 46413.00 244 PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC 37764.00 246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES W DRUG-ELUT 84594.00 247 PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC 65504.00 251 PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O 54511.00 252 OTHER VASCULAR PROCEDURES W MCC 85730.00 253 OTHER VASCULAR PROCEDURES W CC 71934.00 264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 47405.00 270 OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC 93424.00 271 OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC 71414.00 272 OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC 45283.00 274 PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC 65046.00 280 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MC 38146.00 281 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC 29484.00 282 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O 27869.00 283 ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC 32656.00 286 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MC 50409.00 287 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O 34590.00 291 HEART FAILURE & SHOCK W MCC OR PERIPHERAL EXTRACOR 25626.00 292 HEART FAILURE & SHOCK W CC 19084.00 293 HEART FAILURE & SHOCK W/O CC/MCC 15872.00 299 PERIPHERAL VASCULAR DISORDERS W MCC 22418.00 300 PERIPHERAL VASCULAR DISORDERS W CC 20351.00 301 PERIPHERAL VASCULAR DISORDERS W/O CC/MCC 13602.00 303 ATHEROSCLEROSIS W/O MCC 15129.00 304 HYPERTENSION W MCC 29760.00 305 HYPERTENSION W/O MCC 17029.00 308 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC 26367.00 309 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 16940.00 310 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/M 13720.00 312 SYNCOPE & COLLAPSE 19662.00 313 CHEST PAIN 18995.00 314 OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC 36111.00 315 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 19213.00 326 STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC 98140.00 327 STOMACH, ESOPHAGEAL & DUODENAL PROC W CC 42538.00 328 STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC 33692.00 329 MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC 97199.00 330 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC 54060.00 331 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC 40173.00 336 PERITONEAL ADHESIOLYSIS W CC 46575.00 337 PERITONEAL ADHESIOLYSIS W/O CC/MCC 37063.00 339 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC 41684.00 340 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/M 36883.00 343 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC 29692.00 348 ANAL & STOMAL PROCEDURES W CC 23495.00 354 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC 36107.00 371 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFE 32816.00 372 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFE 19911.00 373 MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFE 14954.00 374 DIGESTIVE MALIGNANCY W MCC 41364.00 375 DIGESTIVE MALIGNANCY W CC 29565.00 377 G.I. HEMORRHAGE W MCC 35981.00 378 G.I. HEMORRHAGE W CC 22464.00 379 G.I. HEMORRHAGE W/O CC/MCC 14422.00 381 COMPLICATED PEPTIC ULCER W CC 28648.00 384 UNCOMPLICATED PEPTIC ULCER W/O MCC 18829.00 386 INFLAMMATORY BOWEL DISEASE W CC 20273.00 387 INFLAMMATORY BOWEL DISEASE W/O CC/MCC 14948.00 388 G.I. OBSTRUCTION W MCC 34400.00 389 G.I. OBSTRUCTION W CC 19324.00 390 G.I. OBSTRUCTION W/O CC/MCC 15013.00 391 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W M 26218.00 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O 17244.00 393 OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC 25101.00 394 OTHER DIGESTIVE SYSTEM DIAGNOSES W CC 20238.00 395 OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC 15627.00 417 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC 53161.00 418 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC 41323.00 419 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC 36852.00 432 CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC 33109.00 433 CIRRHOSIS & ALCOHOLIC HEPATITIS W CC 22973.00 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W M 40897.00 436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W C 25807.00 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC 34379.00 439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC 21061.00 440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC 15504.00 441 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MC 30368.00 442 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC 22573.00 444 DISORDERS OF THE BILIARY TRACT W MCC 36462.00 445 DISORDERS OF THE BILIARY TRACT W CC 25798.00 446 DISORDERS OF THE BILIARY TRACT W/O CC/MCC 19145.00 454 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC 99425.00 455 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/M 89786.00 460 SPINAL FUSION EXCEPT CERVICAL W/O MCC 87946.00 467 REVISION OF HIP OR KNEE REPLACEMENT W CC 65280.00 468 REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC 58551.00 469 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHME 68482.00 470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHME 44735.00 472 CERVICAL SPINAL FUSION W CC 80225.00 473 CERVICAL SPINAL FUSION W/O CC/MCC 60133.00 478 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TI 45826.00 480 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC 60071.00 481 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC 46702.00 482 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/M 36905.00 483 MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER E 55167.00 493 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W 45637.00 494 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/ 42209.00 501 SOFT TISSUE PROCEDURES W CC 37947.00 504 FOOT PROCEDURES W CC 37571.00 516 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC 47926.00 517 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O 38803.00 520 BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC 35851.00 536 FRACTURES OF HIP & PELVIS W/O MCC 13801.00 540 OSTEOMYELITIS W CC 21421.00 543 PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS 27652.00 551 MEDICAL BACK PROBLEMS W MCC 30615.00 552 MEDICAL BACK PROBLEMS W/O MCC 18996.00 554 BONE DISEASES & ARTHROPATHIES W/O MCC 15976.00 556 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN 16243.00 558 TENDONITIS, MYOSITIS & BURSITIS W/O MCC 13468.00 559 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TIS 40196.00 560 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TIS 30646.00 561 AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TIS 23256.00 563 FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & 14841.00 566 OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAG 15183.00 571 SKIN DEBRIDEMENT W CC 28875.00 579 OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC 37489.00 580 OTHER SKIN, SUBCUT TISS & BREAST PROC W CC 29501.00 581 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC 33938.00 596 MAJOR SKIN DISORDERS W/O MCC 17029.00 602 CELLULITIS W MCC 24491.00 603 CELLULITIS W/O MCC 14403.00 605 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC 18121.00 607 MINOR SKIN DISORDERS W/O MCC 11698.00 617 AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METAB 33957.00 620 O.R. PROCEDURES FOR OBESITY W CC 35898.00 621 O.R. PROCEDURES FOR OBESITY W/O CC/MCC 32892.00 637 DIABETES W MCC 28328.00 638 DIABETES W CC 17151.00 639 DIABETES W/O CC/MCC 11312.00 640 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELEC 23219.00 641 MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELEC 15573.00 643 ENDOCRINE DISORDERS W MCC 28688.00 644 ENDOCRINE DISORDERS W CC 21766.00 657 KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC 44361.00 658 KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC 43460.00 660 KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC 31597.00 669 TRANSURETHRAL PROCEDURES W CC 30545.00 673 OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC 46573.00 674 OTHER KIDNEY & URINARY TRACT PROCEDURES W CC 49344.00 682 RENAL FAILURE W MCC 30211.00 683 RENAL FAILURE W CC 18131.00 684 RENAL FAILURE W/O CC/MCC 15444.00 689 KIDNEY & URINARY TRACT INFECTIONS W MCC 21846.00 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC 15388.00 694 URINARY STONES W/O ESW LITHOTRIPSY W/O MCC 17225.00 698 OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC 27299.00 699 OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC 17952.00 700 OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC 21251.00 708 MAJOR MALE PELVIC PROCEDURES W/O CC/MCC 39315.00 728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O M 13929.00 742 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC 38859.00 743 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MC 28659.00 765 NO LONGER VALID CESAREAN SECTION W CC/MCC 16656.00 766 NO LONGER VALID CESAREAN SECTION W/O CC/MCC 13405.00 767 NO LONGER VALID VAGINAL DELIVERY W STERILIZATION & 16129.00 774 NO LONGER VALID VAGINAL DELIVERY W COMPLICATING DI 10143.00 775 NO LONGER VALID VAGINAL DELIVERY W/O COMPLICATING 7095.00 776 POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROC 13344.00 781 NO LONGER VALID OTHER ANTEPARTUM DIAGNOSES W MEDIC 10604.00 782 NO LONGER VALID OTHER ANTEPARTUM DIAGNOSES W/O MED 4933.00 789 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CAR 6253.00 790 EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROM 31381.00 791 PREMATURITY W MAJOR PROBLEMS 16128.00 792 PREMATURITY W/O MAJOR PROBLEMS 10695.00 793 FULL TERM NEONATE W MAJOR PROBLEMS 10444.00 794 NEONATE W OTHER SIGNIFICANT PROBLEMS 4485.00 795 NORMAL NEWBORN 2972.00 808 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & 33460.00 809 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & 20801.00 810 MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & 18745.00 811 RED BLOOD CELL DISORDERS W MCC 27999.00 812 RED BLOOD CELL DISORDERS W/O MCC 18577.00 813 COAGULATION DISORDERS 22923.00 840 LYMPHOMA & NON-ACUTE LEUKEMIA W MCC 53508.00 841 LYMPHOMA & NON-ACUTE LEUKEMIA W CC 34311.00 847 CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGN 14520.00 853 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W 106087.00 854 INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W 46780.00 857 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. 37824.00 863 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC 21127.00 864 FEVER AND INFLAMMATORY CONDITIONS 16615.00 866 VIRAL ILLNESS W/O MCC 15170.00 870 SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS OR PERI 111377.00 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC 38399.00 872 SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O M 24319.00 880 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTI 13837.00 881 DEPRESSIVE NEUROSES 9344.00 884 ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY 15471.00 885 PSYCHOSES 10526.00 896 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATIO 53430.00 897 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATIO 15057.00 907 OTHER O.R. PROCEDURES FOR INJURIES W MCC 85730.00 908 OTHER O.R. PROCEDURES FOR INJURIES W CC 51547.00 909 OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC 27985.00 914 TRAUMATIC INJURY W/O MCC 20227.00 916 ALLERGIC REACTIONS W/O MCC 9159.00 917 POISONING & TOXIC EFFECTS OF DRUGS W MCC 35262.00 918 POISONING & TOXIC EFFECTS OF DRUGS W/O MCC 14816.00 919 COMPLICATIONS OF TREATMENT W MCC 30819.00 920 COMPLICATIONS OF TREATMENT W CC 16439.00 921 COMPLICATIONS OF TREATMENT W/O CC/MCC 18562.00 947 SIGNS & SYMPTOMS W MCC 21108.00 948 SIGNS & SYMPTOMS W/O MCC 15571.00 949 AFTERCARE W CC/MCC 34373.00 950 AFTERCARE W/O CC/MCC 30424.00 951 OTHER FACTORS INFLUENCING HEALTH STATUS 6142.00 981 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DI 81854.00 982 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DI 61171.00 987 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIA 70844.00 988 NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIA 36285.00